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BackgroundThe objective of this study is to describe the use of targeted therapies for the treatment of advanced renal cell carcinoma (RCC) and overall survival (OS) among patients in clinical practice in the Veterans Health Administration (VHA).MethodsA retrospective cohort of 286 patients from 24 VHA Medical Centers diagnosed with advanced clear cell RCC between Fiscal Year (FY) 2010 and FY2014 was followed through September 30, 2016. Among patients who received targeted therapy, we described the medications taken, duration of therapy, and overall survival. We also assessed the effect of the first therapy received on overall survival using Cox Proportional Hazards models.ResultsThere were 66 patients who did not receive therapy for their advanced RCC. Of the 220 treated patients, the mean (sd) number of medications received was 1.9 (1.1). The medications most commonly used first were sunitinib (61.8%), pazopanib (17.3%), and temsirolimus (10.9%). The median duration of first-line therapy was 86 days (interquartile range [IQR] 42, 210). Median total duration of therapy was 159 days (IQR 58, 397). 62.3% of patients had ≥ 1 dose of therapy held or reduced, mainly due to an adverse drug event (ADE). Median survival from the start of treatment to death was 1.08 years (IQR 0.80, 1.31). Finally, receipt of temsirolimus vs sunitinib (HR 1.95 [95%CI 1.09,3.47]) as the first targeted therapy was independently associated with an increased hazard of death.ConclusionOur analysis of targeted therapies for advanced RCC in VHA suggests duration of treatment is shorter in a real-world setting than in clinical trials, and dose reductions and ADEs are more common.

Due to the many challenges that teachers face in today's classrooms to facilitate the academic success of all children and to meet federal and state accountability standards, having both the competence and the ability to adjust to meet these challenges are required. Teacher retention is an ongoing issue in the United States; teachers who lack these traits may have a negative impact on teacher retention. Resiliency is a critical element that teachers need to meet these challenges and remain in the education profession. In this study, the stories of four female African American teachers who taught in the same school district in a rural community in the South before, during, and after desegregation, were examined. Using qualitative methodology and a narrative inquiry technique, the data analyzed from the stories of the four women confirmed eight themes of resilience as identified in Polidore's Theory of Adult Resilience in Education (2004). An additional resilience theme, efficacy, also emerged. The additional theme provided an enhanced conceptualization and construct of Polidore's Theory of Adult Resilience in Education model. With the massive challenges facing educators today, the stories of the four teachers can be used to empower, encourage and retain teachers in the education profession.

This article explores the issues of African American participation in the administrative ranks of the academy. The authors find that African Americans tend to hold positions that are marginal in academic organizations, lacking power and influence, and that not much has changed over recent decades. Forces influencing this condition are explored, and examples are given of innovative institutional strategies for increasing leadership opportunities for African American administrators.

Describes a model used to assess differences between student participants and nonparticipants in a minority retention program geared toward African American students. Provides a theoretical approach to measure the extent to which minority students' needs are being met. Suggests the model can be used by student affairs practitioners to categorize existing programs and design additional programs to increase student persistence. (JDM)

Aim: Nurse leaders influence workplace culture; however, little is known about ethnic cultural influences on nurse leader development. This research aims to identify personal strategies promoting effective leadership by nurse leaders from European small island countries. Design: Descriptive qualitative study. Methods: In 2017, nineteen semi‐structured interviews with nurse leaders from England, Greece, Republic of Ireland and Malta explored leadership journeys, strategies employed to support their growth and development, and how cultural identity played a role. Transcripts were analysed using reflexive thematic analysis. Results: Four main themes and 12 subthemes captured the strategies and approaches of the nurse leaders: (1) Influences, (2) Communication, (3) Process and (4) Relationships. These findings reflect and validate the five transformational leadership practices of the Exemplary Leadership Model. While cultural island identity was discussed, there was a shared cultural identity within the role of "nurse leader" that spanned all islands. Patient or Public Contributions: Nineteen nurse leaders contributed to this study. [ABSTRACT FROM AUTHOR]