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2. Clinical, radiological and pathological outcomes following treatment of primary giant cell tumour of bone with Denosumab

Author

Murphy, B, Vodanovich, D, Spelman, T, Gullifer, J, Slavin, J, Powell, G, Pang, G, Choong, P, Murphy, B, Vodanovich, D, Spelman, T, Gullifer, J, Slavin, J, Powell, G, Pang, G, and Choong, P

Abstract

BACKGROUND: Giant cell tumour of bone (GCTOB) is a relatively uncommon, benign, but locally aggressive neoplasm. Denosumab is a fully human monoclonal antibody with inhibitory effects on receptor activator of nuclear factor kappa-B ligand that has shown early promise as a possible treatment adjuvant for GCTB. However, much is still unknown about its current indications, long-term effects, the potential risk for rapid relapse and its involvement in sarcomatous transformation. METHODS: We analysed the outcomes of 154 patients with GCTOB. We assessed clinical outcomes via local recurrence free-survival, metastatic free-survival and sarcomatous transformation between those treated without Denosumab and those with neo-adjuvant Denosumab. Our radiological and pathological outcomes were assessed through independent specialist reviews. RESULTS: Four (19.0%) patients of the neo-adjuvant group had local recurrence of disease versus 16 (12.0%) patients in the surgery alone group; this results in a 3.62 times increased likelihood of developing local recurrence (P = 0.030). The median time to local recurrence was shorter for the neo-adjuvant group (421.5 days versus 788.5 days) (P = 0.01). There was no difference between Denosumab and the surgery groups in terms of metastatic disease (P = 0.45). Two patients in our cohort with GCTOB developed sarcomatous transformation, both were treated with Denosumab. CONCLUSION: Our use of Denosumab tended to be for those patients who had surgically difficult tumours to halt the progression and allow easier resections. Of concern we noted a trend towards increasing recurrence rates with the potential risk for rapid relapse. Furthermore, two cases experienced sarcomatous transformation, which is a growing area of concern within the literature.

Published
2020

5. The quality of a simulation examination using a high-fidelity child manikin

Author

Jennett P, Peter H. Harasym, Powell G, Cheri Nijssen-Jordan, and Tsuen-Chiuan Tsai

Subjects
medicine.medical_specialty, Educational measurement, medicine.diagnostic_test, business.industry, Item analysis, media_common.quotation_subject, Concordance, education, Clinical performance, Fidelity, Construct validity, Physical examination, General Medicine, Education, Medicine, Medical physics, business, Competence (human resources), Social psychology, media_common
Abstract

Purpose Developing quality examinations that measure physicians' clinical performance in simulations is difficult. The goal of this study was to develop a quality simulation examination using a high-fidelity child manikin in evaluating paediatric residents' competence about managing critical cases in a simulated emergency room. Quality was determined by evidence of the reliability, validity and feasibility of the examination. In addition, the participants' responses regarding its realism, effectiveness and value are presented. Method Scenario scripts and rating instruments were carefully developed in this study. Experts were used to validate the case scenarios and provide evidence of construct validity. Eighteen paediatric residents, ‘working’ as pairs, participated in a manikin-based simulation pre-test, a training session and a post-test. Three independent raters rated the participants' performance on task-specific technical skills, medications used and behaviours displayed. At the end of the simulation, the participants completed an evaluation questionnaire. Results The manikin-based simulation examination was found to be a realistic, valid and reliable tool. Validity (i.e. face, content and construct) of the test instrument was evident. The level of inter-rater concordance of participants' clinical performance was good to excellent. The item analysis showed good to excellent internal consistency on all the performance scores except the post-test technical score. Conclusions With a carefully designed rating instrument and simulation operation, the manikin-based simulation examination was shown to be reliable and valid. However, a further refinement of the test instrument will be required for higher stake examinations.

Published
2003
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