Effect of multidisciplinary team care on the risk of recurrence in breast cancer patients: A national matched cohort study

BackgroundCancer has been the leading cause of death in the past decade in Taiwan, with breast cancer being the most common type of cancer in females. Very few studies looked at the risk of recurrence in patients who received multidisciplinary team (MDT) care. We analyzed the influence of MDT on the risk of recurrence and death in breast cancer patients.MethodIn this retrospective study, we included newly diagnosed patients from 2004 to 2010. The study included 9,266 breast cancer patients who were enrolled in MDT care and 9,266 patients who were not. The study used log-rank test to analyze patients’ characteristics, hospital characteristics, cancer staging, and treatment methods to compare the recurrence rates in MDT care and non-MDT care participants. We used Cox proportional hazards model to examine the effect of MDT and associated factors on the risk of recurrence and mortality of breast cancer patients.ResultsRelative risk of recurrence was lower for patients who received MDT care than for patients who did not (HR, 0.84; 95%CI: 0.70–0.99) after matching. The mortality risk for breast cancer patients with relapse was 8.48 times (95%CI: 7.53–9.54) than that for patients without relapse.ConclusionsThe relative risk of recurrence and death was significantly lower for breast cancer patients who received MDT care than for those who did not. We suggest that MDT care be implanted in the National Health Policy settings of breast cancer patients.     

Mejora del sistema de urgencias médicas: resultados de un cuestionario multi-profesional

ObjectiveThis study aimed to identify ways to improve the Medical Emergency System (MES) in its different components and infer Medical Emergency Team (MET) activation failure causes.MethodsA questionnaire regarding opinions and attitudes towards the MES was conducted, targeting all professionals at the hospital, which has an implemented MES with Basic Life Support (BLS) since 1998.ResultsThirty two percent (n=585) of hospital professionals answered, from these 37.8% were neither doctors nor nurses. In mean six years passed since the BLS certification, yet 102 professionals (17.4%) had not done it. A relevant percentage admitted to not being familiarized with the different components of the MES (activation criteria 16.4%, telephone number 4.1%, content of the resuscitation trolleys 42.4% and defibrillator-monitor 47.4%), percentages lessened among those had taken the BLS course. The majority highly valued MET, however 83 (23%) could not confirm that debriefingand 17 (4.4%) that allocation of tasks happened after and during activation, respectively. When activating MET 52 (18.1%) admitted fear of criticism and 38 (13.3%) agreed that they needed validation by another professional, factors not influenced by BLS course completion. Excessive workload as a barrier to recognize ill patients was pointed by 127 (45.7%) of the respondents.ConclusionDespite educational and auditing efforts, the MES is not fully integrated into hospital culture. BLS certification for all professionals and non-technical skills of MET were identified has major areas for MES improvement. Unfamiliarity with activation criteria, fear of criticism and excessive workload were identified as failure of activation causes.     

Memory Support System training in mild cognitive impairment: Predictors of learning and adherence

ABSTRACT

This study aimed to identify predictors of learning and adherence to a previously validated compensatory calendar and note-taking system (Memory Support System; MSS) in persons with amnestic mild cognitive impairment (aMCI). Age, education, global cognition, depression, and memory-related self-efficacy were studied as predictors of individuals’ ability to learn the use of the MSS during the two-week training and of their adherence to the MSS 6, 12, and 18 months after training. How well an individual was able to learn the use of the MSS was itself examined as a predictor of adherence. Two-hundred-and-fifteen older adults with aMCI and their study partners (e.g., spouse, adult child) received MSS training one-hour daily for 10 days. Ordinal logistic regression analyses indicated that (1) global cognition predicted MSS learning at end of training, and (2) MSS learning at end of trainng predicted MSS adherence at 6, 12, and 18 months post-training. The current study suggests that offering compensatory strategies as early as possible for those with MCI might be of most benefit, and might have implications for long-term adherence.     

项目教学在组织胚胎学实验教学中的实践与探索

依据学生的认知学习发展过程,开展组织胚胎学实验课程的针对性的项目教学,有效地培养学生的团队协作能力、独立工作能力、学习和创新能力。项目教学真正做到医与学结合,同时对专科学生有针对性,对提高学生实验操作水平有重要意义。     

Interchange rotation factors and player characteristics influence physical and technical performance in professional Australian Rules football

Objectives

To examine the effects of match-related and individual player characteristics on activity profile and technical performance during rotations in professional Australian football.

Daily and weekly training load and wellness status in preparatory,regular and congested weeks: a season-long study in elite volleyball players

The study aimed to assess the changes in the perceived internal load and wellness status of volleyball players in preparatory, regular (i.e. uncongested), and congested weeks during a full season. Thirteen elite volleyball players were studied (237 training sessions and 37 official matches). Session-RPE, muscle soreness, stress, fatigue, sleep quality, and the Hooper Index were measured daily using questionnaires. Training sessions were classified based on the number of matches per week and the days before or after a match: preparatory (no match), regular (one match), and congested weeks (two or more matches). Pairwise comparisons found significantly greater session-RPE scores (p < 0.05) one day before the match (304.74 A.U.), in regular weeks than in congested weeks (204.40 A.U.). Matches during the congested weeks (364.71 A.U.) had significantly higher session-RPE scores (p < 0.05) than regular weeks (252.97 A.U.). Three days before the match involved significantly higher values of muscle soreness, fatigue, stress, and sleep quality than regular weeks. Match accumulation increased the session-RPE training load of the matches. This study provides insights into the training load and well-being status before competition, for training the day of competition, and after the competition.     

The profile of sabcomeline (SB-202026), a functionally selective M1 receptor partial agonist,in the marmoset

1. Sabcomeline (SB-202026, 0.03 mg kg⁻¹, p.o.), a potent and functionally selective M₁ receptor partial agonist, caused a statistically significant improvement in the performance of a visual object discrimination task by marmosets. No such improvement was seen after RS86 (0.1 mg kg⁻¹, p.o.).
2. Initial learning, which only required an association of object with reward and an appropriate response to be made, was not significantly affected. Reversal learning, which required both the extinction of the previously learned response and the acquisition of a new response strategy, was significantly improved after administration of sabcomeline (0.03 mg kg⁻¹, p.o.).
3. Sabcomeline (0.03 and 0.1 mg kg⁻¹, p.o.) had no significant effect on mean blood pressure measured for 2 h after administration in the conscious marmoset.
4. Sabcomeline (0.03 mg kg⁻¹, p.o.) caused none of the overt effects such as emesis or behaviours often seen after the administration of muscarinic agonists, e.g. face rubbing and licking.
5. This is the first study to demonstrate cognitive enhancement by a functionally selective M₁ receptor partial agonist in a normal (i.e. non-cognitively impaired) non-human primate and this effect was seen at a dose which did not cause side effects.
6. Perseverative behaviour and deficient acquisition of new information are seen in patients with Alzheimer''s disease (AD). Therefore the data suggest that sabcomeline might be of therapeutic benefit in the treatment of AD.

     

Effects of prior experience on differential learning under amphetamine

Differential learning of operant behavior under non-drug and amphetamine states was explained with a drug-behavior-reinforcement interaction process. When a drug affects the relationship between ongoing behavior and existing reinforcement contingencies, the sets of behavioral patterns subjected to the process of reinforcement or non-reinforcement under a drug may differ from the patterns under non-drug conditions. If, following sufficient training, the drug conditions are then changed, persistence of these behavioral patterns may result in a difference from those patterns produced if acquisition occurs solely under non-drug conditions. To investigate this process, groups of rats were given varying amounts of non-drug acquisition training on a response-duration differentiation task before being given extended training under 0.75 mg/kg d-amphetamine. All groups were then tested under non-drug conditions. Amphetamine significantly enhanced performance, and this enhancement transferred to subsequent non-drug conditions. However, if non-drug training occurred before drug training, this enhancement was greatly attenuated. Furthermore, only those behavioral components under which amphetamine led to an increase in reinforcement rate showed enhancement in the non-drug state. The results, which supported the present position, were discussed in relation to a stimulus generalization decrement explanation of differential learning under amphetamine.These results represent part of the doctoral dissertation submitted to the University of New Mexico.     

Hippocampal stimulation limits performance but does not retard acquisition of food-reinforced learning

Facilitation of the usually very slow acquisition of hippocampal (HPC) self-stimulation (SS) by prior, non-contingent HPC stimulation may be due to the progressive attenuation of a disruptive effect of the stimulation on learning. We attempted to answer two questions: (1) Does HPC stimulation disrupt food-reinforced learning when it follows each lever-press as in SS experiments? (2) Does prior exposure to the stimulation attenuate any such disruptive effect? We observed no significant differences in the rate of acquisition when each food-reinforced response was paired contingently with a 0.5 sec train of dorsal HPC stimulation (CS group), or when 0.5 sec trains were administered randomly throughout the session (RS), compared with an implanted control group (IC). Although acquisition was rapid in all groups, performance on the second day was significantly lower in the CS group than in the IC animals. These same electrode placements later supported SS. The same results were obtained with 3 similarly-treated groups that had previously received a program of daily HPC stimulation (kindling). The results imply that kindling does not produce its facilitating effect on acquisition of HPC SS by removing a disruptive effect of the stimulation.     

Decreased resistance to extinction in ob/ob mice following operant training

Inconsistent results have emerged from past studies in which operant conditioning paradigms were used to assess the hunger motivation of genetically obese mice relative to that of normal mice. Methodological considerations indicated the need to examine operant performance to a criterion, rather than performance during time-based sessions, and then to focus upon response differences in resistance to extinction. Therefore, genetically obese (ob/ob) mice and normal littermates were trained successfully to bar-press for 100 food rewards on either a CRF or a FR-10 schedule of reinforcement. Extinction behavior was then examined over 9 daily 1-hr sessions. While obese and normal mice evidenced similar patterns of learning, or response discrimination for food rewards, they evidenced different levels of hunger motivation during extinction conditions. Obese mice displayed a greater reduction in responding across extinction sessions, or less resistance to extinction, than normal mice following training on both schedules of reinforcement. These findings suggest that ob/ob mice exhibit lower levels of hunger motivation than normal littermates.