Development of a Simulation-Based Mastery Learning Curriculum for Breaking Bad News

Introduction

Physician communication impacts patient outcomes. However, communication skills, especially around difficult conversations, remain suboptimal, and there is no clear way to determine the validity of entrustment decisions. The aims of this study were to 1) describe the development of a simulation-based mastery learning (SBML) curriculum for breaking bad news (BBN) conversation skills and 2) set a defensible minimum passing standard (MPS) to ensure uniform skill acquisition among learners.

Tspan8 is expressed in breast cancer and regulates E-cadherin/catenin signalling and metastasis accompanied by increased circulating extracellular vesicles

Tspan8 exhibits a functional role in many cancer types including pancreatic, colorectal, oesophagus carcinoma, and melanoma. We present a first study on the expression and function of Tspan8 in breast cancer. Tspan8 protein was present in the majority of human primary breast cancer lesions and metastases in the brain, bone, lung, and liver. In a syngeneic rat breast cancer model, Tspan8⁺ tumours formed multiple liver and spleen metastases, while Tspan8⁻ tumours exhibited a significantly diminished ability to metastasise, indicating a role of Tspan8 in metastases. Addressing the underlying molecular mechanisms, we discovered that Tspan8 can mediate up-regulation of E-cadherin and down-regulation of Twist, p120-catenin, and β-catenin target genes accompanied by the change of cell phenotype, resembling the mesenchymal–epithelial transition. Furthermore, Tspan8⁺ cells exhibited enhanced cell–cell adhesion, diminished motility, and decreased sensitivity to irradiation. As a regulator of the content and function of extracellular vesicles (EVs), Tspan8 mediated a several-fold increase in EV number in cell culture and the circulation of tumour-bearing animals. We observed increased protein levels of E-cadherin and p120-catenin in these EVs; furthermore, Tspan8 and p120-catenin were co-immunoprecipitated, indicating that they may interact with each other. Altogether, our findings show the presence of Tspan8 in breast cancer primary lesion and metastases and indicate its role as a regulator of cell behaviour and EV release in breast cancer. © 2019 The Authors. The Journal of Pathology published by John Wiley & Sons Ltd on behalf of Pathological Society of Great Britain and Ireland.     

The impact of descriptive norms on motivation to participate in cancer screening – Evidence from online experiments

ObjectiveThe current study tested in two online experiments whether manipulating normative beliefs about cancer screening uptake increases intention to attend colorectal screening among previously disinclined individuals.Methods2461 men and women from an Internet panel (Experiment 1 N = 1032; Experiment 2, N = 1423) who initially stated that they did not intend to take up screening were asked to guess how many men and women they believe to get screened for colorectal cancer. Across participants, we varied the presence/absence of feedback on the participant’s estimate, as well as the stated proportion of men and women doing the screening test.ResultsAcross the two experiments, we found that receiving one of the experimental messages stating that uptake is higher than estimated significantly increased the proportion of disinclined men and women becoming intenders. While, we found a positive relationship between the communicated uptake and screening intentions, we did not find evidence that providing feedback on the estimate has an added benefit.ConclusionScreening intention can be effectively manipulated through a high uptake message.Practice implicationsCommunication of high screening uptake is an easy and effective way to motivate disinclined individuals to engage in colorectal cancer screening.     

Evaluation of odontogenic maxillary sinusitis using cone-beam computed tomography: three case reports

Introduction

Ten to twelve percent of all cases of maxillary sinusitis derive from odontogenic origin. The purpose of this study was to report the use of cone-beam computed tomography (CBCT) scanning in elucidating dental pathology as an etiology of maxillary sinusitis.

Methods

Intraoral periapical radiographs and CBCT scanning were performed in the evaluation of three patients presenting with pain, sinus congestion, or respiratory complaints. In the first case, extractions of impacted third molar and adjacent nonrestorable tooth were performed. In the second two cases, endodontic therapy was done. Radiologic follow-up with CBCT scanning or medical computed tomography scanning was performed 6 to 12 months after dental procedures were performed.

Results

All three patients presented with severe sinusitis that resolved after appropriate dental treatment. The first patient also showed marked improvement of chronic bronchitis after completion of dental treatment. In all patients, complete or near total resolution of sinusitis, including eradication of mucous retention cyst, was confirmed by post-treatment CBCT or computed tomography scanning.

Conclusions

These cases show the utility of CBCT scanning in evaluating patients presenting with concurrent sinus and dental complaints. In these three patients, maxillary sinusitis of odontogenic origin responded well to the eradication of dental etiology.