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BackgroundThe cancer genomics field has embraced the advent of precision oncology, and vast volumes of data have been mined for biomarkers of drug actionability. While some cancers, such as lung cancer, have detailed panels of actionable genomic biomarkers, sequencing panels have been less useful in breast cancer given its large number of cancer driver genes mutated at a relatively low frequency. Furthermore, mutation signatures have potential to assist in identifying homologous recombination deficient tumours for targeting with PARP inhibitor therapy.Patients and MethodsTo investigate whether whole genome sequencing could benefit breast cancer patients we initiated the Q-IMPROvE (Queensland-IMplementation of PRecision Oncology in brEast cancer) prospective pilot study. We report the analysis of matched tumour and normal genomes of 28 high-risk breast cancer patients undergoing treatment in the neo-adjuvant setting.ResultsUsing whole genome sequencing, we detected actionable events that would otherwise not have been identified. A quarter of patients demonstrated a defect in homologous recombination DNA repair using the HRDetect and HRD scores. Germline variants of importance (BRCA1, CHEK2) were identified in two patients that did not meet clinical guidelines for germline genetic testing. Somatically,TP53andPIK3CAwere the most commonly mutated breast cancer driver genes.ConclusionsWe have demonstrated the benefit of whole genome sequencing of both the tumour and germline for breast cancer patients otherwise not meeting clinical criteria for genetic health referrals.

COVID-19 has illustrated the urgency of promoting integrated healthcare as the model of the future, with social workers not only supporting the physical and mental health of providers and patients, but also leading efforts to transform systems, policies, and social work education. Primary care, where the role of social workers is continuing to grow, is a central location for integrating the treatment of medical, social, and behavioral problems. In these settings, social workers can take the lead to meet community needs, assist in public health efforts, and bolster the frontline medical workforce. The following article reflects upon what we as social workers have learned a year into the global pandemic and how we can apply this knowledge to shaping the future of social work in primary care. Authors consider how the multiple medical and psychosocial needs of patients affected by COVID-19 are addressed in primary care through three core functions of social work: providing behavioral healthcare, coordinating care, and undertaking population health-based interventions. Article ends with a discussion about how social work can respond to the urgent task of transforming health within the context of social work practice, policy, and education for the next generation of healthcare social workers.

Providing quality special education services for culturally and linguistically diverse (CLD) students with or at risk of disabilities is a double bind, a larger systemic conundrum beyond individuals’ efforts. To create an inclusive, culturally responsive system of support beyond the fragmented division of roles and nonconcerted assemblage of practices and tools, there is a need to explore the possibility of boundary-crossing collaboration for CLD students with disabilities. The purpose of this systematic review is to synthesize the broader literature investigating K-12 school-based boundary-crossing collaborations among multiple stakeholders to address the unique academic, social-emotional, and behavioral needs of CLD students with or at risk of disabilities. Eight studies met the criteria for inclusion. Features of boundary crossers, problems of practice that boundary crossers collaboratively sought to address, emerging tensions in building partnership, facilitators of boundary-crossing communication and collaboration, learning experiences of boundary crossers, and learning outcomes of CLD students with or at risk of disabilities are reported and further discussed.

Background Acupuncture is a popular treatment for women’s health. Several trials and meta-analysis have been published in recent years on key women’s health conditions but it is unclear if this has led to any changes in clinical practice or referrals from other health professionals. The aim of this survey was to explore if, how, and why, aspects of acupuncture practice have changed since our survey in 2013. Method An online cross-sectional survey of registered acupuncturists and Chinese Medicine practitioners in Australia and New Zealand. Questions covered the practitioner demographics and training, women’s health conditions commonly treated, modalities used, sources of information and continuing education (CE) (e.g. webinars), changes in clinical practice, and referral networks. Results One hundred and seventy registered practitioners responded to this survey, with 93% reporting treating women’s health in the last 12 months. The majority of respondents were from Australia (60%), held a bachelors level qualification (60%), and used a traditional Chinese medicine framework (86%). Most practitioners incorporated other modalities in addition to acupuncture. Most practitioners’ referral networks were predominantly based on word of mouth for menstrual, fertility and pregnancy related conditions, with referrals from medical practitioners being much less common. More than half (57%) reported having changed their women’s health practice in the past 12 months; just over a quarter of those who changed treatment (27%) reported it was due to research findings. The most commonly used sources of information/CE used to inform treatment were webinars and conferences, while peer-reviewed journal articles were the least commonly used source. Conclusion Acupuncture practitioners in Australia and New Zealand commonly treat women’s health conditions, but this is usually the result of women seeking them out, rather than being referred from a medical practitioner. The majority of practitioners did report changing their women’s health practice, but peer reviewed academic articles alone are not an ideal medium to convey this information since practitioners favour knowledge obtained from webinars and conferences. Academics and other clinician researchers should consider alternative means of disseminating knowledge beyond traditional academic publications and conferences, special interest groups may assist in this and also help improve research literacy.

Background Increasingly, many patients believe that a combined approach of complementary and alternative medicine (CAM), including acupuncture, and conventional medicine is better than either on its own, and more patients now have the desire to discuss CAM with well-informed general practitioners (GPs). However, to our knowledge, the interaction and collaboration between GPs and acupuncturists specifically in relation to shared care have not been investigated. This research explored interprofessional communication between GPs and acupuncturists in New Zealand. This article specifically reports the GPs’ viewpoints. Methods This study was part of a larger mixed-methods research project. Semi-structured interviews of 14 purposively sampled GP participants were conducted and analysed using thematic analysis. Results The data analysis identified both facilitators of and barriers to integrative health care . Facilitators included the willingness of GPs to engage in communication and a recognition of the importance of patient choice. Barriers included the limited opportunities for sharing information and the lack of current established pathways for communication or direct referrals. GPs also highlighted the confusion around scopes of practice in terms of the different styles of and approaches to acupuncture. Conclusion This research contributes to the body of knowledge concerning interprofessional communication and collaboration between GPs and acupuncturists and suggests that while there are significant barriers to collaboration, there is also the potential to impact provider satisfaction and patient well-being. It provides context within a New Zealand health care setting and also provides additional insights regarding acupuncture, specifically through the disaggregation of specific CAM modalities.

Background: General practitioners (GPs) play an important role in integrated care management and in most cases act as the primary provider and access point for further services. In recent years mor...

The social validity of intervention research has been emphasized in special education and related fields for decades. There is relatively little focus on social validity that considers culturally and linguistically diverse populations. Eleven articles met the inclusionary criteria for this systematic review and were evaluated to describe social validity in early language intervention research—specifically with young (birth through 5 years) dual language learners (DLLs). We examined how social validity was considered and addressed, how social validity was measured, and the results of social validity assessments. Definitions of social validity were generally vague, and researchers in most studies only considered social validity post intervention rather than prior to starting or during the interventions. Participants generally viewed interventions positively, but incomplete data were often reported.

Background. Next-generation sequencing (NGS) technology enables profiling of individual tumours and to measure the increasing number of biomarkers relevant to the management of breast cancer patients. The Australian Translational Genomics Centre (ATGC) is a collaboration between the healthcare sector (Metro South Hospital and Health Service), higher education sector (Queensland University of Technology) and a government-run pathology service (Pathology Queensland) to provide genomic profiling of breast cancer patients at the Princess Alexandra Hospital. The program was developed to integrate the ordering, processing and interpretation of large-scale NGS into clinical practice. Methods. Patients were consented for somatic testing and ordering was integrated into the hospital’s electronic ordering system. Samples were derived from fresh tissue biopsies after surgeries (47%) or from FFPE histology sections. No selection criteria were applied during the initial phase and the cohort was representative of newly presenting patients at the hospitals breast cancer clinic. Patients were sequenced using a NATA-accredited ISO15189 program using whole-exome sequencing (WES) combined with a high-coverage spike-in panel of known cancer genes. Clinical reports included the calculation of tumour purity, tumour mutational burden (TMB), the assessment of copy number events and somatic mutations down to 3% allele frequency. Standard molecular testing in Australia includes ER, PR and HER2 status, and additional testing included testing of Tier 1-2 somatic variants in the genes ABCC3, AKT1, CCND1, CCNE1, CDKN2A, ERBB2, ESR1, FGF3, FGFR1, FGFR2, MTOR, NCOA3, NF2, PIK3CA, PIK3R1, PTEN, RB1, RSF1, SF3B1, TP53. Results. Seventy-one patients were tested by WES/panel, and an average of 1.5 clinically significant Tier 1- 2 mutations were detected per patient. In 77% of cases, the molecular profiling could stratify patients to those with either PI3K/Akt/mTOR pathway activation (by PIK3CA activating mutations, AKT, MTOR mutations or PTEN loss) or CDK4/6 activation (by CCND1 expansion or CDKN2A loss). The most frequently observed mutations were PIK3CA activation (40%) and CCND1 copy number expansions (24%). A small proportion (n=3) were found to have mTOR or TCS1/2 mutations reported to have association with a durable response to mTOR inhibitors. Additionally, 11 patients (15%) had a high TMB (TMB, >6.8 mutations/megabase) with 6 having >10 mutations/Mb. Within this high-TMB cohort, 3 were found to be ER-PR-HER-, however, the majority (n=7) were ER+PR+HER2- patients. Calculation of the tumour purity indicated that, despite expert resection of the biopsies to isolate the most tumour dense regions, tumour purity was not significantly enriched. In 58% of cases, the tumour purity was less than 50%, and in 13% of samples, it was less than 25%, indicating that in clinical practice the method of sequencing must be robust, as many samples have significant amounts of contaminating stroma. Conclusion. We demonstrate that integration of WES/panel testing into clinical practice is practical and provides multiplexed testing of current and emerging biomarkers in a significant number of tested patients. While a high proportion of patients had mutations that could stratify them to targeted therapies in the event of metastatic disease, the somatic molecular profiles did not modify first line therapy decision-making. Training of clinical staff for patient consent and the dissemination of findings, the development of a dedicated molecular tumour board, and decision protocols to identify patients of metastatic risk were identified as key developments in this clinical program. The program identified previously unidentified subsets of patients including a subset of ER+ patients with high TMB for which for there are no effective treatments option in Australia. Citation Format: Kate Roberts, Paul J Leo, Jeremy Khoo, Alice Febery, Jonathan Ellis, Mhairi Clout, Lawrie Wheeler, Lisa Anderson, Matthew Brown, Ian Bennett. Establishing whole-exome sequencing for breast cancer patient care [abstract]. In: Proceedings of the 2019 San Antonio Breast Cancer Symposium; 2019 Dec 10-14; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2020;80(4 Suppl):Abstract nr P4-07-07.

Background: Studies suggest that combining radiotherapy (RT) with programmed cell death protein 1 (PD-1) blockade may elicit a synergistic antitumor response. We aimed to assess whether prior or concurrent RT was associated with improved disease control in patients with metastatic non-small cell lung cancer (NSCLC) treated with nivolumab. Methods: We conducted a retrospective study of patients receiving nivolumab as second or subsequent line therapy for metastatic NSCLC. Patients were categorized into those who received any RT for NSCLC prior to or during nivolumab therapy, and those with no history of RT for NSCLC. Results: A total of 85 patients received nivolumab between July 2015 and December 2016 and were followed up for a median of 15 months. Sixty-five patients (76.4%) received RT prior to or during nivolumab and 20 patients (23.6%) received nivolumab alone. Baseline characteristics of age, performance status, histology, smoking status and previous therapy were similar between the two groups. Prior or concurrent RT was associated with a superior PFS, median 2.8 months with RT versus 1.3 months without RT (Hazard Ratio (HR) = 0.494; 95% Confidence Interval (CI), 0.279-0.873; P = 0.02). The median OS of the group receiving RT was 6.4 months versus 4.2 months for the no RT group (P = 0.20). RT was not associated with an increase in toxicity. Conclusion: RT prior to or concurrent with nivolumab for metastatic NSCLC was associated with a modest improvement in PFS over nivolumab alone with no evidence of increase in adverse effects. RT may potentiate the effect of anti-PD-1 immunotherapy in NSCLC.

Background Navigating the world of qualitative thematic analysis can be challenging. This is compounded by the fact that detailed descriptions of methods are often omitted from qualitative discussions. While qualitative research methodologies are now mature, there often remains a lack of fine detail in their description both at submitted peer reviewed article level and in textbooks. As one of research’s aims is to determine the relationship between knowledge and practice through the demonstration of rigour, more detailed descriptions of methods could prove useful. Rigour in quantitative research is often determined through detailed explanation allowing replication, but the ability to replicate is often not considered appropriate in qualitative research. However, a well described qualitative methodology could demonstrate and ensure the same effect. Methods This article details the codebook development which contributed to thematic analysis of qualitative data. This analysis formed part of a mixed methods multiphase design research project, with both qualitative and quantitative inquiry and involving the convergence of data and analyses. This design consisted of three distinct phases: quantitative, qualitative and implementation phases. Results and conclusions This article is aimed at researchers and doctoral students new to thematic analysis by describing a framework to assist their processes. The detailed description of the methods used supports attempts to utilise the thematic analysis process and to determine rigour to support the establishment of credibility. This process will assist practitioners to be confident that the knowledge and claims contained within research are transferable to their practice. The approach described within this article builds on, and enhances, current accepted models.

Background: Surveys of acupuncture practitioners worldwide have shown an increase in the use of acupuncture to treat women&rsquo, s health conditions over the last ten years. Published studies have explored the effectiveness of acupuncture for various conditions such as period pain, fertility, and labor induction. However, it is unclear what role, if any, peer-reviewed research plays in guiding practice. Methods: Acupuncturists with a significant women&rsquo, s health caseload were interviewed online in three small groups to explore factors that contribute to acupuncturists&rsquo, clinical decision made around treatment approaches and research. Results: Eleven practitioners participated in the focus groups. The overarching theme that emerged was one of &lsquo, Not mainstream but a stream.&rsquo, This captured two themes relating to acupuncture as a distinct practice: &lsquo, working with what you&rsquo, ve got&rsquo, as well as &lsquo, finding the right lens&rsquo, illustrating practitioners&rsquo, perception of research needing to be more relevant to clinical practice. Conclusions: Acupuncture practitioners treating women&rsquo, s health conditions reported a disconnect between their clinical practice and the design of clinical trials, predominantly due to what they perceived as a lack of individualization of treatment. Case histories were popular as a learning tool and could be used to support increasing research literacy.

Due to continuing pressures on the UK National Health Service’s mental health services, there has been increased interest in the development of brief psychological interventions (BPIs). These interventions are usually defined as including selected components of established psychological interventions, delivered over fewer sessions, and by staff with less specialised training (paraprofessionals). Cognitive behavioural therapy (CBT)-based BPIs for anxiety and depression have been found to be helpful for clients with mild to moderate mental health problems. This project evaluates the introduction of BPIs for anxiety and depression in a secondary care adult mental health service, with clients experiencing moderate to severe mental health difficulties. The service developed CBT-based manuals for anxiety (anxiety management) and depression (behavioural activation) BPIs. The BPIs were delivered by mental health workers without core therapeutic training, who were offered training and group supervision by psychologists in the team. Measures of anxiety (GAD-7), depression (PHQ-9), wellbeing (SWEMWBS) and functioning (WSAS) were completed at the start and end of treatment. The data reported from a 2-year period suggest that BPIs are associated with reductions in symptoms of anxiety and low mood, and improvements in wellbeing and functioning. Whilst this is a small-scale initial evaluation, the results are promising for the potential benefit of BPIs for clients in secondary care settings. Given that this new way of working has possible additional benefits such as improving access to psychological treatment and cost-effectiveness, further research in the area is warranted and encouraged. Key learning aims (1) To overview the current evidence for BPIs. (2) To outline a possible model for offering BPIs in secondary care. (3) To illustrate the potential positive effects of BPIs within a secondary care population. (4) To consider the need for future research and development of BPIs.

BACKGROUND: Survival for stage I to III, hormone receptor-positive, breast cancer has substantially improved over time due to advances in screening, surgery and adjuvant therapy. However many adjuvant therapies have significant treatment-related toxicities, which worsen quality of life for breast cancer survivors. Postmenopausal women with hormone receptor-positive breast cancer are now prescribed aromatase inhibitors (AI) as standard, with longer durations of therapy, up to 10 years, being considered for certain women. AI treatment is associated with a high incidence of AI-induced musculoskeletal symptoms (AIMSS), often described as symmetrical pain and soreness in the joints, musculoskeletal pain and joint stiffness. AIMSS reduces compliance with AI therapy in up to one half of women undergoing adjuvant AI therapy, potentially compromising breast cancer outcomes. Exercise has been investigated for the prevention and treatment of AIMSS but the effect of this intervention remains unclear. OBJECTIVES: To assess the effects of exercise therapies on the prevention or management of aromatase inhibitor-induced musculoskeletal symptoms (AIMSS) in women with stage I to III hormone receptor-positive breast cancer. SEARCH METHODS: We searched Cochrane Breast Cancer's Specialised Register, CENTRAL, MEDLINE, Embase and CINAHL databases up to 13 December 2018. We also searched two conference proceedings portals and two clinical trials registries for ongoing studies or unpublished trials, or both, in August 2019. We also reviewed reference lists of the included studies. SELECTION CRITERIA: We included randomised controlled trials that compared exercise versus a comparator arm. We did not impose any restriction on the comparator arm, which could include an alternative type of exercise, no exercise or a waiting list control. Both published and non-peer-reviewed studies were eligible. DATA COLLECTION AND ANALYSIS: Two review authors independently extracted data, assessed risk of bias and certainty of the evidence using the GRADE approach. The outcomes investigated were pain, joint stiffness, grip strength, health-related quality of life, cancer-specific quality of life, adherence to AI therapy, adverse events, incidence of AIMSS, breast cancer-specific survival and overall survival. For continuous outcomes that were assessed with the same instrument, we used the mean difference (MD); for those outcomes that used different instruments, we used the standardised mean difference (SMD) for the analysis. For dichotomous outcomes, we reported outcomes as an odds ratio (OR). MAIN RESULTS: We included seven studies with 400 randomised participants; one study assessed exercise for preventing AIMSS and six studies assessed treating AIMSS. For preventing AIMSS, the single study reported no difference in pain scores, grip strength or compliance to taking AI medication between groups. Data values were not provided in the study and no other outcomes were reported. For managing AIMSS, we found that the evidence for the effect of exercise therapies on overall change in worst pain scores was very uncertain (SMD -0.23, 95% confidence interval (CI) -0.78 to 0.32; 4 studies, 284 women; very low-certainty evidence). The evidence suggested that exercise therapies result in little to no difference in overall change in stiffness scores (Western Ontario McMasters Universities Osteoarthritis Index (WOMAC) stiffness score MD -0.76, 95% CI -1.67 to 0.15 and Visual Analogues Scale (VAS) stiffness score MD -0.42, 95% CI -2.10 to 1.26; 1 study, 53 women; low-certainty evidence). The evidence was very uncertain for the outcomes of overall change in grip strength (MD 0.30, 95% CI -0.55 to 1.15; 1 study, 83 women; very low-certainty evidence); overall change in health-related quality of life (subscales of SF-36 tool ranged from least benefit of MD 1.88, 95% CI -2.69 to 6.45 to most benefit of MD 9.70, 95% CI 1.67 to 17.73; 2 studies, 123 women, very low-certainty evidence); overall change in cancer-specific quality of life (MD 4.58, 95% CI -0.61 to 9.78; 2 studies, 136 women; very low-certainty evidence); and adherence to aromatase inhibitors (OR 2.43, 95% CI 0.41 to 14.63; 2 studies, 224 women; very low-certainty evidence). There were no adverse events identified across four studies in either arm (0 events reported; 4 studies; 331 participants; low-certainty evidence). There were no data reported on incidence of AIMSS, breast cancer-specific survival or overall survival. AUTHORS' CONCLUSIONS: Given the wide-ranging benefits of exercise for people affected by cancer, it was surprising that this review provided no clear evidence of benefit for exercise therapies in women with early breast cancer with AIMSS. This review only yielded seven eligible studies with 400 participants, which is likely to have underpowered the findings. The meta-analysis was challenging due to the considerable heterogeneity amongst the trials, with a wide range of exercise regimens and follow-up periods. Despite these inconclusive findings, exercise needs to be part of routine care for women with breast cancer due to its wide-ranging benefits. Future research in this area would be enhanced with further understanding of the mechanism of AIMSS, a single clear definition of the condition, and phase III randomised controlled trials that are adequately powered to test targeted exercise interventions on the key clinical outcomes in this condition.

Objectives: Assess computed tomography texture analysis of patients likely to benefit from nivolumab. Materials & methods: Texture analysis was used to quantify heterogeneity within the largest tumor before immunotherapy. Histogram analysis was classified as hyperdense (positive skewness) or hypodense (negative skewness) and subclassified on median standard deviation value or entropy measurement. Results: 47 patients were included. At a median follow-up of 18 months, statistical significant differences in progression-free survival were observed when stratified by positive skewness with low entropy, hazard ratio: 0.43 (0.19–0.95); p = 0.036, and positive skewness with low standard deviation, hazard ratio: 0.42 (0.18–0.96); p = 0.04. Conclusion: Patients who derive a clinical benefit to Nivolumab show a computed tomography texture of a hyperdense yet homogenous tumor.

Objective The purpose of this study was to explore anxiety, worry, and posttraumatic stress symptoms (PTSS) in parents of children with food allergies, and to evaluate whether these three psychological outcomes could be predicted by allergy severity, intolerance of uncertainty, and food allergy self-efficacy. Methods Participants were 105 parents who reported their children to have medically diagnosed food allergies. Participants were recruited to a study on parent wellbeing through an allergy clinic and social media advertisements. Participants completed online questionnaires assessing anxiety, worry, PTSS, intolerance of uncertainty, food allergy self-efficacy, and demographic and allergy information. Results In this sample, 81.0% of parents reported clinically significant worry, 42.3% met the clinical cut-off for PTSS, and 39.1% reported moderate-extremely severe anxiety. Greater intolerance of uncertainty and lower food allergy self-efficacy were associated with poorer psychological outcomes, with mixed results for allergy severity. However, intolerance of uncertainty was the only variable to consistently account for unique variance within regression models. Conclusions This study highlights the need for greater awareness of mental health in parents of children with food allergy. The study also indicates that factors impacting on parents’ perception of threat may be most strongly predictive of psychological outcomes, warranting further research. Finally, the study indicates that intolerance of uncertainty may be a promising target for psychological interventions within this population.

The Permian Basin in west Texas and southeast New Mexico (United States) is one of the most productive oil and gas (O&G) basins in the world, but little methane emissions data have been collected from the region. Environmental Defense Fund (EDF) is leading a year-long science and advocacy campaign to measure O&G methane emissions in the Permian Basin and quickly communicate the data to stakeholders including the public and O&G operators to facilitate emission reductions. EDF and our scientific partners are using three primary approaches to repeatedly quantify emissions at different spatial scales during the campaign. Pennsylvania State University is estimating regional methane emissions on a quarterly basis with atmospheric transport modeling of data collected from a network of five tower-based instruments. University of Wyoming is deploying a mobile laboratory on public roads to measure site-level emissions of methane and volatile organic compounds with EPA Other Test Method 33A and the transect approach. Scientific Aviation is performing aerial mass balance flights to quantify emissions from small clusters of sites, gridded areas, and larger regions. Additionally, EDF is collaborating with several groups using remote sensing approaches to quantify methane emissions including TROPOMI, AVIRIS-NG, GAO, and MethaneAIR. Emissions data including site identities will be published on a custom public website as quickly as possible to educate stakeholders about the magnitude of emissions and facilitate the mitigation of detected emission sources. Following the campaign, data will be analyzed to understand patterns and trends in emissions. Furthermore, we will discuss the potential for implementing similar monitoring approaches in other O&G basins to provide scientifically-rigorous, actionable data that supports effective mitigation of methane emissions.

Background In recent years more health service users are utilising complementary and alternative medicine (CAM), including acupuncture, for the management of their health. Currently general practitioners (GPs), in most cases, act as the primary provider and access point for further services and also play an important role in integrated care management. However, the interaction and collaboration between GPs and acupuncturists in relation to shared care has not been investigated. This research explored interprofessional communication between GPs and acupuncturists in New Zealand. This article reports specifically the acupuncturists’ viewpoints. Methods This study formed part of a larger mixed methods trial investigating barriers and facilitators to communication and collaboration between acupuncturists and general practitioners in New Zealand. Semi structured interviews of 13 purposively sampled acupuncture participants were conducted and analysed using thematic analysis. Results The data analysis identified both facilitators and barriers to integrative care. Facilitators included a willingness to engage, and the desire to support patient choice. Barriers included the limited opportunities for sharing of information and the lack of current established pathways for communication or direct referrals. The role evidence played in integrative practice provided complex and contrasting narratives. Conclusions This research contributes to the body of knowledge concerning communication and collaboration between GPs and acupuncturists, and suggests that by facilitating communication and collaboration, acupuncture can provide a significant component of integrated care packages. This research provides context within a New Zealand health care setting, and also provides insight through the disaggregation of specific provider groups for analysis, rather than a grouping together of CAM as a whole.

In many OECD countries up to half of the population uses complementary and alternative medicines (CAM). CAM refers to the diverse medical and health care systems, practices, and products that are not presently considered to be part of conventional medicine. In those countries nearly all patients will also consult their General Practitioner (GP), and it is therefore important to consider how treatment from these different practitioners might affect the patient-doctor relationship. Despite goodwill on both sides to engage, there may be a mutual reluctance between both patients and GPs to communicate about CAM. To date research has predominately focused upon how GPs perceive CAM with limited studies on the ethical and legal concerns over this necessary dialogue. Drawing upon the data from OECD countries, particularly New Zealand, this paper suggests that, from an ethical standpoint, GPs have a responsibility to discuss CAM with their patients, and potentially refer to, complementary practitioners. Such a responsibility is grounded upon the ethical norms of beneficence (the physician's general duty of care) and the patient's rights of autonomous and informed choices. It encourages effective communication to develop mutual understanding and provide better care to the patient.

Immune checkpoint inhibitors have recently emerged as an exciting new treatment paradigm across a broad spectrum of malignancies. This new class of agents also challenges oncologists with a unique set of immune-based toxicities. Early recognition and precise management of these toxicities can result in better outcomes, with minimization of toxicity and harm to the patient. This article provides a comprehensive review of immune-based toxicities caused by immune checkpoint inhibitors, including recommendations for their investigation and guidelines for specific management.

Aromatase Inhibitors (AI) are widely used for the adjuvant treatment of hormone receptor positive breast cancers in the post-menopausal population. AI are often associated with significant joint and muscular symptoms; symptoms that are commonly referred to as aromatase inhibitor-associated musculoskeletal syndrome (AIMSS). AIMSS adversely impacts health-related quality of life of many patients, and reduces AI compliance. Although there are informal practice recommendations, the limited current level of evidence for management of AIMSS for breast cancer patients on aromatase inhibitors has made development of formal guidelines challenging, and remains an unmet need. This is the first systematic review to consider the evidence for all pharmacological and non-pharmacological interventions in the treatment of AIMSS, including physical therapy, acupuncture and complementary therapies.

Leptomeningeal disease (LMD) in breast cancer is a rare complication and often portends a poor prognosis. There is a lack of randomized data guiding treatment decisions and no accepted standard of care in the management of LMD. We retrospectively analyzed the treatment and outcomes of six patients diagnosed with LMD at our institution. All patients were treated with intrathecal methotrexate, resulting in a median overall survival after LMD diagnosis of 18.5 weeks, with two patients surviving over 30 weeks. An Ommaya reservoir was used to deliver chemotherapy and this was well tolerated with minimal toxicity. The use of intrathecal methotrexate is a safe option, however, further studies are required to define its role in the management of LMD and identify populations that may derive a benefit.

Background: The provision of discharge plans that meet the requirements of individual patients' needs is an essential component of rehabilitation. The purpose of this quality improvement activity was to survey patients to: investigate whether discharge plans met their requirements; identify factors that might predict the success of discharge planning; and investigate whether the perceptions of patients and a family member/carer regarding the success of discharge planning were in agreement. Methods: Forty patients discharged home from units within two rehabilitation hospitals were recruited. Patient surveys, undertaken via interviews, were conducted to determine participants' satisfaction with their discharge planning: one pre-discharge and the other 1–2 months' post-discharge. Findings: Overall, discharge plans were successfully developed and implemented. Most items that were listed on participants' discharge plans were provided, required, and met participants' requirements. The success of discharge planning did not appear to be influenced by factors including age, gender, length of stay, primary diagnosis, functional scores, or home address. Participants and a family member/carer had a high level of agreement regarding the success of discharge planning. Conclusions: The discharge plans of participants involved in this quality improvement activity accurately identified patients' needs, and the plans identified were provided and met the requirements of participants.

Objectives This prospective descriptive study aimed to test the validity and feasibility of the Team Emergency Assessment Measure (TEAM™) for assessing real-world medical emergency teams' non-technical skills. Second, the present study aimed to explore the instrument's contribution to practice regarding teamwork and learning outcomes. Methods Registered nurses (RNs) and medical staff (n = 104) in two hospital EDs in rural Victoria, Australia, participated. Over a 10 month period, the (TEAM™) instrument was completed by multiple clinicians at medical emergency episodes. Results In 80 real-world medical emergency team resuscitation episodes (283 clinician assessments), non-technical skills ratings averaged 89% per episode (39 of a possible 44 points). Twenty-one episodes were rated in the lowest quartile (i.e. ≤37 points out of 44). Ratings differed by discipline, with significantly higher scores given by medical raters (mean: 41.1 ± 4.4) than RNs (38.7 ± 5.4) (P = 0.001). This difference occurred in the Leadership domain. The tool was reliable with Cronbach's alpha 0.78, high uni-dimensional validity and mean inter-item correlation of 0.45. Concurrent validity was confirmed by strong correlation between TEAM™ score and the awarded Global Rating (P

Background Mental health presents a significant burden of disease and a large, and increasing, number of patients are self-selecting forms of CAM, including acupuncture, as an adjunct, or standalone treatment for the management of their mental health. General practitioners (GPs) play an important role in integrated care management of primary mental health, and in most cases act as the primary provider and access point for further services. However, the interaction and collaboration between GPs and acupuncturists in relation to shared mental health care has not been investigated. This research explores interprofessional communication between GPs and acupuncturists in New Zealand concerning mental health care. The aim of this research was to understand the barriers to communication, and to facilitate collaboration between the two participant groups. Methods The project utilised a mixed methods multiphase design, with both qualitative and quantitative inquiry, and involving the convergence of data and analyses. A nationwide survey of 400 GPs and 250 acupuncturists was conducted. Univariate data was analysed using descriptive statistics, which included frequencies and percentages for categorical data. This was followed by individual semi-structured interviews of 13 purposively sampled acupuncturists, and 14 GPs which was analysed using thematic analysis. This design consisted of three distinct phases: quantitative, qualitative, implementation and reflection. Results Both provider groups acknowledged the complexities of working within mental health care, and supported the development of specific mental health competencies in light of the recognition of the limitations surrounding current mental health care. The unfamiliarity of acupuncture's evidence-base to both provider groups was an identified barrier, yet both groups acknowledged that while practice is informed by the evidence, there are many other factors that also inform clinical practice. Conclusions This study is the first in New Zealand to seek quantitative data and qualitative views regarding alignment about mental health management approaches and the use of acupuncture. This has the potential of improving healthcare outcomes through better inter professional communication and by contributing to better trans-cultural understandings on healthcare issues. The results of this research, whilst looking at the communication model between acupuncture and primary health care, will have easily generalizable findings for other necessary interprofessional communication strategies. This is the first time that the role and potential of the relatively untapped resource base of acupuncture within the health sector has been investigated within a New Zealand context.

Concerns have been raised by the public, both nationally and internationally, about the safety of recycled tire crumb rubber used in synthetic turf fields and playgrounds. Previous studies have not...

This is a protocol for a Cochrane Review (Intervention). The objectives are as follows: To assess the effects of exercise therapies on the prevention or management of aromatase inhibitor‐induced musculoskeletal symptoms (AIMSS) in women with stage I‐III hormone receptor‐positive breast cancer.

ObjectivesTo explore the phenomenology of self-criticism, and the relationship with constructs such as rumination and perfectionism.DesignThe study followed a three-group (Depression, n = 26; Eating Disorder, n = 26; Non-clinical, n = 26) mixed methods design.MethodParticipants completed a set of questionnaires and were interviewed about the occurrence, impact, and content of self-critical thinking, along with their beliefs about self-criticism.ResultsBoth clinical groups reported more frequent, persistent, and less controllable self-criticism compared to controls, present on average 50–60% of the time. They reported a negative impact on mood, and a moderately severe impact on daily activities. They indicated greater desire to change self-criticism whilst judging it more difficult to reduce. Habitual self-criticism was highly correlated with lower self-esteem, lower self-compassion, greater rumination, and greater negative perfectionism. Compared to those with depression, the eating disorder group reported harsher self-criticism, felt it was more part of their personality, and was more beneficial.ConclusionsThe findings highlight the importance of exploring people's beliefs about their self-criticism, and imply that treatment for self-criticism may be more challenging with people with eating disorders than people with depression.Practitioner points* This study highlights that self-criticism is common in depression and eating disorders and that some people find this a significant problem in its own right.* Careful assessment of self-criticism is recommended when working with these clinical presentations, which should include the perceived positive consequences and desire to change.

Background: Self-critical thinking is common across psychological disorders. This study hypothesized that it may play an important role in ‘overgeneralization’, the process of drawing general implications from an isolated negative experience. Aims: To explore the impact of two experimental tasks designed to elicit self-critical thoughts on the endorsement of general negative self-views of clinical and non-clinical populations. Method: Three groups (depression, eating disorders and non-clinical controls), completed standardized questionnaires and the two tasks. Participants rated their self-critical thinking and general negative self-beliefs before and after each task. Results: Following a failure experience, both clinical groups showed a greater increase in general negative self-views compared with controls, indicating greater overgeneralization. Both habitual and increases in state self-critical thinking were associated with overgeneralization while negative perfectionism was not. Overgeneralization was more strongly associated with post-task reduced mood than self-criticism. Conclusions: Self-critical thinking may be an important factor in the process of overgeneralization, and the increase in general negative self-views may be particularly crucial for lowering of mood.

Objective Human papillomavirus (HPV) vaccine coverage in the United States remains low compared with other adolescent vaccines. As the largest primary care network in the United States, safety net clinics such as federally qualified health centers (FQHCs) serve patients at a disproportionate risk of HPV-related cancers. In this pilot project, the American Cancer Society (ACS) leveraged its primary care workforce to implement quality improvement interventions in the unique context of 30 FQHC systems across the country, including 130 clinic sites reaching >20,000 adolescents in a variety of geographic settings. Methods FQHC systems were randomly selected to receive either a $90,000 2-year grant, a $10,000 3-month grant, or training and technical assistance without funding. All 3 intervention groups conducted provider training and education, completed a capacity assessment tool, and measured HPV vaccination rates. Annual HPV vaccine series initiation and completion rates for active, 11- to 12-year-old patients were measured to evaluate project outcomes. Results HPV vaccine series initiation rates among 11- to 12-year-old patients increased by 14.6 percentage points from a baseline of 41.2% before the intervention (2014) to the intervention year (2015). Changes in HPV second dose and series completion rates were not statistically significant. Meningococcal and tetanus, diphtheria, and acellular pertussis vaccination rates also increased significantly, by 13.9 and 9.9 percentage points from baseline rates of 49.1% and 52.5%, respectively. Conclusions The first year of this pilot project showed early success, particularly with HPV vaccine series initiation. On the basis of these promising results, ACS is expanding clinical quality improvement projects to increase HPV vaccination across the country.