Oncologic benefit of adjuvant chemotherapy for locally advanced rectal cancer after neoadjuvant chemoradiotherapy and curative surgery with selective lateral pelvic lymph node dissection: An international retrospective cohort study

IntroductionIntensive local treatment comprising total mesorectal excision (TME) with selective lateral pelvic lymph node dissection (LPND) after neoadjuvant chemoradiotherapy (CRT) for locally advanced rectal cancer (LARC) has received attention among clinicians treating rectal cancer. It remains unclear whether adjuvant chemotherapy (ACT) after intensive local treatment is beneficial for these patients. We evaluated the oncologic benefit of ACT for patients with LARC who received intensive local treatment.Materials and methodsThis international multicentre retrospective cohort study included 737 patients treated in Japan and Korea between 2010 and 2017. The effectiveness of ACT on recurrence-free survival (RFS) was evaluated using univariable and multivariable Cox proportional hazards models, with subgroup analyses to identify subpopulations potentially benefiting from ACT.ResultsThe median follow-up was 49 months; the 5-year RFS and local recurrence rates for the entire cohort were 72.1% and 4.9%, respectively; 514 patients (69.7%) received adjuvant chemotherapy, without an oncologic benefit (hazard ratio, 1.14; 95% confidence interval [CI]: 0.79–1.68) demonstrated in the multivariable Cox regression analysis. In subgroup analyses, the distributions of the 95% CI in patients aged ≥70 years and those with ypStage 0 tended to place a disproportionate emphasis that favoured the non-ACT treatment strategy.ConclusionDespite achieving good local control with intensive local treatment strategy, the effectiveness of ACT for the LARC patients with CRT followed by TME with selective LPND was not proved. Elderly patients and those with ypStage0 may not receive benefit from ACT after CRT and TME ± LPND.     

Static and dynamic postural control of postpartum women of different delivery methods

ObjectiveThe aim of this study was to determine whether there is a difference in postural control between nulligravida women and women who have given birth by vaginal or cesarean section.MethodsWomen who had only vaginal delivery in the previous 1–3 years were included in the vaginal delivery group (n = 27), those who had only cesarean delivery in the previous 1–3 years were included in the cesarean section group (n = 28), and those who had never given birth were included in the control group (n = 32). Evaluations were administered 6–8 days after the ovulation phase. Postural control of the participants was evaluated with the computerized dynamic posturography device.ResultsA total of 87 women with a mean age of 29.4 ± 4 years and a mean body mass index of 24.1 ± 3.1 kg/m² were included in the study. Antero-posterior somatosensory organization test values of the vaginal delivery group were lower than the control group (p = 0.0016). The cesarean delivery group had statistically lower antero-posterior somatosensory (p < 0.001 and p = 0.0013) and medio-lateral somatosensory (p = 0.002 and p = 0.017, respectively) test scores compared to the control group and the vaginal delivery group.ConclusionsIt was observed that women who birthed with vaginal or cesarean delivery had impaired somatosensory postural control. There is definitely a need for further studies with a long-term follow-up examining the effects of postural control during pregnancy and the postpartum period.     

Exploring peer tutoring from the peer tutor's perspective

IntroductionChanging working practices, student numbers, workforce demands, and deficits, have created a need to consider new ways of radiography student training. One suggestion could be to implement Peer Assisted Learning (PAL) during clinical placements. PAL utilises social constructivist theories, where peer tutors teach lower or same level tutees, reinforcing and practicing material formally taught. The aim of this study was to trial an intervention of PAL, co-designed between the university and students and evaluated to identify opportunities and challenges.MethodsUsing participatory action research 8 final year student volunteers trialled a 3-week intervention, where they delivered PAL to first years, tutoring on first year radiographic clinical practice. Focus groups were held pre and post intervention to gather qualitative data.ResultsFocus group discussions were transcribed and collectively thematically analysed. Two students and the primary researcher took part in the analysis.ConclusionStudents identified benefits and challenges to PAL. Issue around preparing for and being a peer tutor are also discussed.Further study involving experiences of first year students and clinical colleagues is required.Implications for practicePeer-tutoring has potential benefits to students to facilitate the development of skills related to image analysis and critique as well as radiographic anatomy and patient positioning.     

河南省非订单定向全科住院医师规范化培训结业学员的就业状况及影响因素研究

背景 全科医生数量和质量是人力资源管理的两个重要维度，其中，医生数量的新增、保持和流失，是全科人力动态规划、管理和评价的重要考量，也是全科住院医师规范化培训（简称全科住培）的绩效指标。探讨全科住培学员的就业状况及影响因素，可以为今后住培政策和激励机制的制定提供参考，但目前针对非订单定向全科住培学员的相关研究较为缺乏。 目的 了解河南省非订单定向全科住培学员的就业状况，分析学员结业后未从事全科医学相关工作的原因，从而为完善培训管理和人力资源激励机制提供参考。 方法 于2021年8月，采用分层随机整群抽样法，在河南省选取2014—2017年入培且已结业的非订单定向全科住培学员326例进行问卷调查。问卷由课题组自行设计，主要内容为学员的基本信息、全科住培情况、目前工作情况及结业后从事与未从事全科医学相关工作的原因。问卷通过"问卷星"平台发放，由学员自行填写。 结果 共发放问卷326份，回收有效问卷271份（83.1%）。结业后，从事全科医学相关工作者77例（28.4%），从事非全科医学相关工作者194例（71.6%）。多因素Logistic回归分析结果显示，年龄、文化程度、生源类型、全科住培基地所在区域是学员结业后是否从事全科医学相关工作的影响因素（P<0.05）。与结业后未从事全科医学相关工作的学员相比，结业后从事全科医学相关工作学员注册为全科医学专业的比例更高〔70.1%（54/77）比32.0%（62/194），P<0.05〕，在乡镇卫生院/社区卫生服务中心执业的比例更高〔49.4%（38/77）比6.2%（12/194），P<0.05）〕。194例未从事全科医学相关工作的学员中，从事内科学工作者78例（40.2%），从事急诊及危重症医学工作者33例（17.0%），从事外科学工作者17例（8.8%）。不选择从事全科医学相关工作的前3位原因分别为：单位安排〔34.5%（67/194）〕，所在单位没有全科医学科〔29.9%（58/194）〕，薪酬低〔26.8%（52/194）〕。 结论 非订单定向全科住培学员选择从事全科医学相关工作的比例较低，年龄、文化程度、生源类型及基地所在区域是影响因素。建议加大全科医学理念宣传，加快综合医院全科医学科建设，提高全科医生薪酬待遇，以此增加全科医生的职业吸引力。     

Factors influencing the rating of sonographer students’ clinical performance

IntroductionLittle is known about the factors influencing clinical supervisor-assessors’ ratings of sonographer students’ performance. This study identifies these influential factors and relates them to professional competency standards, with the aim of raising awareness and improving assessment practice.MethodsThis study used archived written comments from 94 clinical assessors describing 174 sonographer students’ performance one month into their initial clinical practice (2015–6). Qualitative mixed method analysis revealed factors influencing assessor ratings of student performance and provided an estimate of the valency, association, and frequency of these factors.ResultsAssessors provided written comments for 93 % (n = 162/174) of students. Comments totaled 7190 words (mean of 44 words/student). One-third of comment paragraphs were wholly positive, two-thirds were equivocal. None were wholly negative. Thematic analysis revealed eleven factors, and eight sub-factors, influencing assessor impressions of five dimensions of performance. Of the factors mentioned, 84.6 % (n = 853/1008) related to professional competencies. While 15.4 % (n = 155/1008) were unrelated to competencies, instead reflecting humanistic factors such as student motivation, disposition, approach to learning, prospects and impact on supervisor and staff. Factors were prioritised and combined independently, although some associated.ConclusionClinical assessors formed impressions based on student performance, humanistic behaviours and personal qualities not necessarily outlined in educational outcomes or professional competency standards. Their presence, and interrelations, impact success in clinical practice, through their contribution to, and indication of, competence.Implications for practiceSonographer student curricula and assessor training should raise awareness of the factors influencing performance ratings and judgement of clinical competence, particularly the importance of humanistic factors. Inclusion of narrative comments, multiple assessors, and broad performance dimensions would enhance clinical assessment of sonographer student performance.     

Learning curve analysis for lateral pelvic lymph node dissection in rectal cancers – Outcomes improve with experience

IntroductionLateral pelvic lymph node dissection (LPLND) is a technically challenging procedure and its learning curve has not been analysed against an oncologically relevant outcome. The purpose of the study was to determine the learning curve for LPLND in rectal cancers using nodal retrieval as performance measure.MethodsConsecutive LPLND for rectal adenocarcinomas from a single institution were retrospectively analysed. Cumulative sum (CUSUM) control charts were used to detect difference in performance with respect to lymph node yield. Negative binomial regression was used to determine factors influencing nodal harvest using Incidence Risk Ratios (IRR). Separate CUSUM curves were generated for open and minimally invasive surgeries (MIS).ResultsOne-hundred and twenty patients were included and all received preoperative radiation. MIS was used in 53.3%. Median lymph node yield was 6 with 20% nodal positivity. Increasing experience (IRR – 1.196) and MIS (IRR – 1.586) were the only factors that influenced nodal harvest. CUSUM charts revealed that learning curve was achieved after the 83rd case overall and after the 19 operations in MIS. There was a 20% increase in nodal yield after every 30 MIS LPLND performed.ConclusionsLearning curve for LPLND is relatively long and only increasing experience and minimally invasive operations increased nodal yield.     

体位对超声评估前盆腔相关参数影响的病例交叉研究

摘 要 目的 探讨传统膀胱截石位与改良膀胱截石位对超声评估前盆腔相关参数的影响。方法 应用交叉设计二阶段法，将100例行盆底超声检查的患者随机分为两组（每组各50例），A组采用先传统体位后改良体位规范盆底超声，B组采用先改良体位后传统体位规范盆底超声检查，对比分析两种体位检查的成功率、静息状态、最大Valsalva动作时各盆腔参数的差异。结果 改良体位获得最大Valsalva动作的成功率大于传统体位（96% vs 90%），差异有统计学意义（χ2=4.348，P=0.037）。两种体位在静息状态时膀胱颈到参考线的距离、膀胱后角、尿道倾斜角比较差异均无统计学意义；改良体位在最大Valsalva动作时的膀胱后角、膀胱颈移动度、尿道旋转角均大于传统体位，差异均有统计学意义（P＜0.05），且上述参数受实验顺序影响不明显，改良体位下尿道漏斗形成率大于传统体位，差异有统计学意义（P＜0.05）。结论 体位因素对评估前盆腔相关参数具有影响，改良体位法获得的前盆腔相关参数与传统体位有一定差异，在临床应用中应注意合理解析。