Breast cancer management pathways during the COVID-19 pandemic: outcomes from the UK ‘Alert Level 4’ phase of the B-MaP-C study

Background The B-MaP-C study aimed to determine alterations to breast cancer (BC) management during the peak transmission period of the UK COVID-19 pandemic and the potential impact of these treatment decisions.Methods This was a national cohort study of patients with early BC undergoing multidisciplinary team (MDT)-guided treatment recommendations during the pandemic, designated ‘standard’ or ‘COVID-altered’, in the preoperative, operative and post-operative setting.Findings Of 3776 patients (from 64 UK units) in the study, 2246 (59%) had ‘COVID-altered’ management. ‘Bridging’ endocrine therapy was used (n = 951) where theatre capacity was reduced. There was increasing access to COVID-19 low-risk theatres during the study period (59%). In line with national guidance, immediate breast reconstruction was avoided (n = 299). Where adjuvant chemotherapy was omitted (n = 81), the median benefit was only 3% (IQR 2–9%) using ‘NHS Predict’. There was the rapid adoption of new evidence-based hypofractionated radiotherapy (n = 781, from 46 units). Only 14 patients (1%) tested positive for SARS-CoV-2 during their treatment journey.Conclusions The majority of ‘COVID-altered’ management decisions were largely in line with pre-COVID evidence-based guidelines, implying that breast cancer survival outcomes are unlikely to be negatively impacted by the pandemic. However, in this study, the potential impact of delays to BC presentation or diagnosis remains unknown.Subject terms: Breast cancer, Surgical oncology, Health care economics, Quality of life, Health policy     

Medical student perceptions of research and research-orientated careers: An international questionnaire study

Background: Engaging and inspiring the next generation of physician-scientists at an early stage is recognised as key to ensure the future of medical research. However, little is known about medical student perceptions of research.

Objectives: We attempted to ascertain perceptions of research and research-orientated careers from medical students studying in different countries.

Methods: An online questionnaire was developed, piloted, and promoted to medical students in various countries.

Results: 1625 responses were collected from 38 countries. Analysis was restricted to data collected from countries with >100 responses (n?=?890). Less than half the respondents felt their medical school provided adequate research training. Key perceived barriers to research participation as a student included lack of time and difficulty finding mentors or projects. A significant gender disparity existed in research ambitions of students with females desiring less research involvement. The importance of barriers and satisfaction with research training differed significantly between countries.

Conclusions: Students perceive a number of key barriers to research involvement and pursuit of research-orientated careers. Programmes designed to engage students with research should focus on overcoming identified barriers. Greater effort is needed to engage female students who report more significant barriers and less desire to follow research-orientated careers.     

Overweight and obesity among children who are deaf: Quantitative and qualitative findings

The current study examined rates of overweight and obesity among children attending schools for the deaf, including factors associated with greater prevalence of overweight. Further, interviews were conducted with school staff to assess school perceptions of overweight and weight management. Although prevalence of overweight and obesity was high (approximately 28%), this rate was not greater than that of youth in the general population, and body mass index was higher among females. Several themes regarding factors contributing to overweight among deaf children, barriers for weight management, and possible components for weight management interventions emerged in interviews with school staff.     

Use of high-sensitivity digital ELISA improves the diagnostic performance of circulating brain-specific proteins for detection of traumatic brain injury during triage

ABSTRACT

Background: Historically, limited sensitivity associated with traditional immunoassay methods has prevented the use of brain-specific proteins as blood biomarkers of traumatic brain injury (TBI) during triage, as these proteins exhibit low circulating concentrations. Digital ELISA is a newly-developed technique that is up to 1000 times more sensitive than conventional ELISA methods. The purpose of this study was to determine whether the use of digital ELISA over conventional ELISA improves the performance of brain-specific proteins as blood biomarkers of TBI during triage.

Methods: Blood was sampled from TBI patients (n = 13) at emergency department admission, as well as from neurologically normal controls (n = 72). Serum levels of two brain-specific proteins, neurofilament light chain (NfL) and Tau, were measured via digital ELISA. Estimated conventional ELISA measures were generated by adjusting values according to the lower limits of detection achievable with commercially available conventional ELISA assays, and receiver operating characteristic (ROC) analysis was used to compare the diagnostic performance of digital ELISA measures to estimated conventional ELISA measures in terms of their ability to discriminate between TBI patients and controls.

Results: Used in combination, digital ELISA measures of NfL and Tau could discriminate between groups with 100% sensitivity and 91.7% specificity. Estimated conventional ELISA measures could only discriminate between groups with 7.7% sensitivity and 94.4% specificity. This difference in diagnostic performance was statistically significant when comparing areas under ROC curves.

Conclusions: The use of digital ELISA over conventional ELISA methods improves the diagnostic performance of circulating brain-specific proteins for detection of TBI during triage.     

Does restructuring theory and clinical courses better prepare nursing students to manage residents with challenging behaviors in long-term care settings?

ABSTRACT

Bachelor of Nursing students (BN) placed in long-term care encounter residents who exhibit challenging behaviors. Students are often inadequately prepared to manage these behaviors, and this is a source of distress for students. This study explored whether enhancing and restructuring theoretical and clinical courses resulted in student nurses feeling better prepared to manage residents’ challenging behaviors and improve their levels of distress. This study was conducted in two phases with 116 BN students (first phase) and 99 students (second phase) where the course on older adults was restructured. The findings of this study indicated that students who felt less prepared experienced greater distress by residents’ behaviors than those who felt better prepared. Scheduling a theoretical course on the care of older adults prior to the clinical course placement, as well as offering an online learning module focused on responsive behaviors, significantly increased students’ feelings of preparedness to manage residents’ complex behaviors.