Improved survival in non-Ashkenazi Jewish ovarian cancer patients with BRCA1 and BRCA2 gene mutations

Objectives

Previous studies report a survival advantage in ovarian cancer patients with Ashkenazi Jewish (AJ) breast cancer gene (BRCA) founder mutations. The purpose of this study was to determine if this association exists in patients with non-Ashkenazi Jewish (non-AJ) BRCA mutations. We also sought to account for “survival bias” by minimizing lead time that may exist between diagnosis and genetic testing.

Methods

Patients with stage III/IV ovarian cancer and a non-AJ BRCA mutation, seen between January 1996 and July 2007, were identified from eight institutions. Patients with sporadic ovarian cancer were compared to similar cases, matched by age, stage, year of diagnosis, and vital status at time interval to BRCA testing. Progression-free (PFS) and overall survival (OS) were calculated by the Kaplan-Meier method. Multivariate Cox proportional hazards models were calculated for variables of interest. Fisher's exact test and chi-square were also used for analysis.

Results

Ninety-five advanced stage ovarian cancer patients with non-AJ BRCA mutations and 183 sporadic controls were analyzed. Compared to sporadic ovarian cancer patients, non-AJ BRCA patients had longer PFS (27.9 months vs. 17.9 months, HR 0.61 [95% CI 0.43-0.86]) and OS (101.7 months vs. 54.3 months, HR 0.43 [95% CI 0.27-0.68]). BRCA status was an independent predictor of PFS and OS.

Conclusions

This multicenter study demonstrates a significant survival advantage in advanced stage ovarian cancer patients with non-AJ BRCA mutations, confirming the previous studies in the Jewish population. This improved survival was evident when accounting for the “survival bias” that coincides with genetic testing.     

The generalized self-efficacy scale in people with arthritis

Objective . To examine the comprehensibility, reliability, and validity of a trait measure, the Generalized Self-Efficacy Scale (GSES), among people with arthritis. The scale is designed to measure perceived coping ability across a wide range of demanding situations. Methods . Four studies were conducted. Study 1 tested the comprehensibility of the GSES. Studies 2, 3, and 4 tested the reliability and validity of the modified scale. Data were collected through self-administered questionnaires. Reliability and structure of the GSES were examined using standard item analysis, internal consistency (Cronbach's alpha), test-retest reliability, and factor analyses. Concurrent and predictive validity were examined in relation to demographic, physical, psychological, and social dimensions. Results . The GSES assessed a unitary concept. Higher generalized self-efficacy was associated with greater psychological well-being, both cross-sectionally and longitudinally. The GSES was independent of age and physical health status. Conclusions . The GSES is a reliable and valid measure for use among community-based samples of people with arthritis and may be a useful indicator of general adaptational outcomes.     

The impact of remote consultations on the health and wellbeing of first contact physiotherapists in primary care: A mixed methods study

Background

First Contact Physiotherapists (FCPs) were introduced to reduce demands on GPs by providing improving access to expert musculoskeletal care. FCPs experience similar workplace stressors to GPs and there is an emerging concern that remote consultations are causing further impacts to their wellbeing.

Aim

To explore the impact of remote consultations on FCPs.

Methods

A mixed methods sequential explanatory study with FCPs was conducted. An online survey measured the usage and impact of remote consultations. Semi-structured interviews explored the lived experiences of using remote consultations.

Results

The online survey was completed by 109 FCPs. A key benefit of remote consultations was patient convenience; perceived challenges included IT issues, poor efficacy, FCP anxiety, isolation, and increased workload. FCPs viewed remote consultations as a ‘challenge’ rather than a ‘threat’. Nearly two thirds of the FCPs had not received relevant training, yet over half were interested. Follow-up interviews with 16 FCPs revealed 4 themes: (1) Remote consultations provide logistical benefits to the patient; (2) Compromised efficacy is the key challenge of remote consultations; (3) Challenges for FCPs working in areas of high deprivation; and (4) Remote consultations impact the health, wellbeing and work satisfaction of FCPs.

Conclusions

Remote consultations offer a convenient alternative for patients, but may add to FCP stress particularly in areas of high socioeconomic deprivation. Further research is required to understand how remote consultations can be enhanced when communication barriers and lower levels of digital literacy exist. Continued monitoring of job satisfaction and resilience levels is important to ensure FCPs remain in their role.