Search

BackgroundPrevious studies have independently validated the prognostic relevance of residual cancer burden (RCB) after neoadjuvant chemotherapy. We used results from several independent cohorts in a pooled patient-level analysis to evaluate the relationship of RCB with long-term prognosis across different phenotypic subtypes of breast cancer, to assess generalisability in a broad range of practice settings.MethodsIn this pooled analysis, 12 institutes and trials in Europe and the USA were identified by personal communications with site investigators. We obtained participant-level RCB results, and data on clinical and pathological stage, tumour subtype and grade, and treatment and follow-up in November, 2019, from patients (aged ≥18 years) with primary stage I-III breast cancer treated with neoadjuvant chemotherapy followed by surgery. We assessed the association between the continuous RCB score and the primary study outcome, event-free survival, using mixed-effects Cox models with the incorporation of random RCB and cohort effects to account for between-study heterogeneity, and stratification to account for differences in baseline hazard across cancer subtypes defined by hormone receptor status and HER2 status. The association was further evaluated within each breast cancer subtype in multivariable analyses incorporating random RCB and cohort effects and adjustments for age and pretreatment clinical T category, nodal status, and tumour grade. Kaplan-Meier estimates of event-free survival at 3, 5, and 10 years were computed for each RCB class within each subtype.FindingsWe analysed participant-level data from 5161 patients treated with neoadjuvant chemotherapy between Sept 12, 1994, and Feb 11, 2019. Median age was 49 years (IQR 20-80). 1164 event-free survival events occurred during follow-up (median follow-up 56 months [IQR 0-186]). RCB score was prognostic within each breast cancer subtype, with higher RCB score significantly associated with worse event-free survival. The univariable hazard ratio (HR) associated with one unit increase in RCB ranged from 1·55 (95% CI 1·41-1·71) for hormone receptor-positive, HER2-negative patients to 2·16 (1·79-2·61) for the hormone receptor-negative, HER2-positive group (with or without HER2-targeted therapy; p

n/a

Schools in Abingdon, Oxfordshire, funded by a Royal Society Partnership Grant, engaged in an animal behaviour project with a researcher at the University of Oxford's Wildlife Conservation Research Unit. The pupils used camera traps to conduct wildlife surveys and investigate behavioural responses in European badgers ("Meles meles"). The practicalities of collaboration between scientists and a network of primary and secondary schools are discussed. Some qualitative evaluation of the educational benefits and scientific enquiry skills gained is presented, and benefits to schools and researchers of such collaborations are outlined.

Context: Asthma is a prevalent chronic disease that is difficult to manage and associated with marked disparities in outcomes. Among the most visible disparities is the higher rate of visits to the Emergency Department (ED) for uncontrolled asthma involving the most at-risk patients. One promising approach to addressing disparities is Shared Decision Making (SDM), a process by which the patient and provider jointly make a healthcare choice. SDM is associated with improved outcomes for patients; however, time constraints and availability of staff are noted implementation barriers. The use of health IT solutions may increase the adoption of SDM. Coach McLungsSM is an interactive web-based application that engages pediatric patients and their caregivers in a personally tailored experience and collects patient- reported data. The background logic then incorporates the complex asthma guidelines to determine the level of severity or control and pulls forward tailored guideline-based treatment recommendations for both the patient and provider in two respective summaries, which provides decision support for both audiences in developing a shared decision around the treatment plan. Objective: The goal of this study is to evaluate the implementation of the Coach McLungsSM intervention into primary care. Study Design and Analysis: Stepped wedge randomized control study design with a baseline control period and 5 intervention steps over 3 years. Setting: 21 pediatric and family medicine practices within a large, integrated, nonprofit healthcare system based in Charlotte, NC. Population Studied: Patients between 7-17 years old with an asthma diagnosis. Intervention: Implementation will be guided using the Expert Recommendations for Implementing Change (ERIC), a compilation of implementation strategies, and evaluated using CFIR (the Consolidated Framework for Implementation Research) and RE-AIM (Reach Effectiveness, Adoption, Implementation, Maintenance). Outcome Measures: We will measure changes in emergency department visits, hospitalizations, and oral steroid use, which serve as surrogate measures for patient-centered asthma outcomes. Conclusions: We anticipate that the tailored implementation of Coach McLungsSM across primary care practices will lead to a decrease in emergency department visits, hospitalizations, and oral steroid use for patients in the intervention group as compared to the control arm., Presenters Kelly Reeves, BSN, RN, UXC, Hazel Tapp, PhD, Kasey Boehmer, PhD, MPH, Charity Patterson, PhD, MSPH, Katherine O'Hare, MSW, Lindsay Shade, MHS, PA-C, Rebecca Beesley, MD, MPH, Lyn Nuse, [...]

Context: Implementing new innovations into healthcare settings is challenging. The Consolidated Framework for Implementation Research (CFIR) can provide guidance on the design, implementation strategies, and evaluation processes. CFIR's versatility offers several advantages: (1) promotes use of a shared language across diverse settings, (2) applicable at various stages of implementation, and (3) ability to map results to the Expert Recommendations for Implementation Change (ERIC) strategies to address barriers. Objective: Here we describe three applications of CFIR for pre and post implementation evaluations. Study Design: Descriptive Setting & Participants: Primary care practices and pediatric emergency departments (ED) within two large healthcare systems based in North Carolina and Georgia. Population studied: Researchers, stakeholders, practice facilitators, administrators, healthcare providers, clinic staff, patients, and caregivers. Intervention/Instrument: First, an early study applied CFIR retrospectively to identify barriers and facilitators to adoption of a shared decision-making intervention. Researchers interviewed practice facilitators to score practices on CFIR constructs. Second, a follow-up study used CFIR to prospectively evaluate readiness for change prior to implementation. Third, as a follow-up study progressed, data from periodic CFIR guided surveys and key informant interviews were used to tailor implementation. Outcome Measure: CFIR Analyses Results: First: Retrospective analysis from the early study distinguished 7 high, 1 medium, and 2 low implementation adopters. Weaknesses, such as little interest in setting performance goals, were consistent among the 2 low adopter practices. Second: Pre-implementation results in the follow-up study revealed comparable high levels of compatibility across ED settings; however, there was less agreement on leadership supporting change efforts. Third: Key facilitators and barriers emerged throughout CFIR survey periods. For example, evaluations at full implementation revealed providers felt initial training waned over time. Mapping identified barriers to ERIC strategies led to the development of re-education resources. Conclusion: CFIR is an effective framework to employ at multiple stages of implementation. While retrospective analysis was useful, the ability to gain insight and provide actionable process improvements during implementation was a key strength to improve outcomes., Presenters Katherine O'Hare, MSW, Hazel Tapp, PhD, Lindsay Shade, MHS, PA-C, Kelly Reeves, BSN, RN, UXC, Melinda Manning, BS, Jeremy Thomas, MSW, Cheryl Courtlandt, MD, Rebecca Beesley, MD, MPH, Diane [...]

Neoadjuvant systemic therapy (NAST) provides the unique opportunity to assess response to treatment after months rather than years of follow-up. However, significant variability exists in methods of pathologic assessment of response to NAST, and thus its interpretation for subsequent clinical decisions. Our international multidisciplinary working group was convened by the Breast International Group-North American Breast Cancer Group (BIG-NABCG) collaboration and tasked to recommend practical methods for standardized evaluation of the post-NAST surgical breast cancer specimen for clinical trials that promote accurate and reliable designation of pathologic complete response (pCR) and meaningful characterization of residual disease. Recommendations include multidisciplinary communication; clinical marking of the tumor site (clips); and radiologic, photographic, or pictorial imaging of the sliced specimen, to map the tissue sections and reconcile macroscopic and microscopic findings. The information required to define pCR (ypT0/is ypN0 or ypT0 yp N0), residual ypT and ypN stage using the current AJCC/UICC system, and the Residual Cancer Burden system were recommended for quantification of residual disease in clinical trials.

Background: Amyloid beta (Ab) plaque density was examined in the amygdala of rhesus macaques, to elucidate the influence of age, diet and hormonal environment. Methods: Luminex technology was used to measure cerebrospinal fluid (CSF) concentrations of Ab40 and Ab42 across three decades, while immunohistochemistry was used to examine Ab plaque density in the amygdala. Results: Ab40 was found to be the predominant isoform of Ab in the CSF, but neither Ab40 or Ab42 concentrations showed an age-related change, and the ratio of Ab42 to Ab40 showed only a marginal increase. Significantly fewer Ab plaques were detected in the amygdala of old ovariectomized animals if they received estradiol HRT (p < 0.001); similar results were obtained regardless of whether they had been maintained on a regular monkey chow for ~48 months or on a high-fat, high-sugar, Western-style diet for ~30 months. Conclusion: The results demonstrate that HRT involving estrogen can reduce Ab plaque load in a cognitive brain region of aged non-human primates. The results from this translational animal model may therefore have clinical relevance to the treatment of AD in post-menopausal women, whether used alone, or as a supplement to current pharmacological and monoclonal antibody-based interventions. [ABSTRACT FROM AUTHOR]