Science Cafés, informal venues to promote bidirectional dialog, inquiry and learning about science between community members, scientists, healthcare and service providers, hold promise as an ...innovative tool for healthcare researchers and community members to improve health outcomes, especially among populations with health disparities. However, the process of optimizing science cafés is under-studied. We describe the pilot evaluation of a series of Science Cafés, called Garden Cafés (n = 9), conducted from September 2015 through April 2016 in Olmsted County, MN and Duval County, FL to connect Mayo Clinic researchers and local service providers with the community. Selection of discussion topics was guided by a county health needs assessment, which identified community priorities. Before leaving the events, community participants completed a brief anonymous survey assessing sociodemographics and their knowledge of research benefits, readiness to participate as a partner in health research, and health and science literacy confidence. Of the 112 attendees who responded, 51% were female and 51% were Black. Respondents reported that participating in the event significantly improved (all at p<0.001) their understanding on all three measures. Preliminary findings suggest that Garden Cafés are an effective forum to increase community understanding and disposition to collaborate in health research, especially in members from diverse backgrounds.
Background/Objectives
Skin infection is common in atopic dermatitis (AD), often necessitating treatment with systemic antibiotics. Topical adjunctive therapies such as dilute bleach baths are ...increasingly recommended, and topical dilute acetic acid (AA) has not been widely studied. The objective of this study was to evaluate whether various topical anti‐infective bathing recommendations were associated with decreased systemic antibiotic exposure in pediatric AD, as well as evaluate topical anti‐infective recommendations over time within our institution.
Methods
Clinical data were extracted from charts of pediatric patients from 1/1/2000 to 12/31/2005 and 1/1/2009 to 12/31/2014 who visited outpatient dermatology clinics at Mayo Clinic, Rochester, a tertiary referral center. Recommendations for topical anti‐infectives (dilute AA, dilute bleach, other, or none) at any time after patient had clinically proven or suspected AD superinfection were recorded as exposures to topical anti‐infective. Primary outcome was the number of systemic antibiotic courses in a 1‐year period.
Results
Of 1111 patients with AD, 753 met inclusion criteria (303 in 2000‐2005; 450 in 2009‐2014). Of these, 351 (46.6%) had culture‐proven or clinically suspected superinfection. Topical anti‐infective recommendations increased between the time periods (23.3% to 79.2%; P < 0.001) and number of courses of systemic antibiotics decreased (1.9 per year vs 1.5 per year, P = 0.010). Number of systemic antibiotic courses did not differ between those who received bathing recommendations and those who did not, nor between different anti‐infective groups (P = 0.398).
Conclusions
Practice behaviors have changed, and topical anti‐infectives are now commonly recommended. Neither dilute AA nor bleach baths were associated with fewer subsequent exposures to systemic antibiotics in the treatment of pediatric AD.
Researchers have explored using the internet and social media to recruit participants to specific research projects. Less systematic work has been done to inform the engagement of large populations ...in virtual communities to advance clinical and translational science. We report on our first step to use social media to engage Minnesota residents by studying the willingness of participants to engage in a virtual (Facebook) community about the concepts of health and health-related research.
Data were collected at the 2018 Minnesota State Fair using a cross-sectional, 46-item survey with assessment including sociodemographics and willingness to engage in a Facebook group for health-related research. Quantitative analysis included univariate, bivariate, and multivariate analyses. Content analysis was used to generate themes from open-ended survey responses.
Five hundred people completed the survey; after data cleaning, 418 participant responses informed this report. A majority were younger than age 50 (73%), female (66%), and married/partnered (54%). Overall, 46% of participants agreed/strongly agreed they are willing to join the Facebook group. Multivariate logistic regression identified social media use over the past 6 months as the sole variable independently associated with willingness to join the Facebook group (once a day vs. never or rarely OR = 1.82 (0.86, 3.88), several hours a day vs. never or rarely OR = 2.17 (1.17, 4.02, overall p-value 0.048).
Facebook holds potential for reaching a broader community, democratizing access to and engagement with clinical and translational research. Social media infrastructure and content could be disseminated to other institutions with Clinical and Translational Science Awards.
To evaluate characteristics associated with burnout and satisfaction with work-life integration (WLI) among nurses and compare their experience to other American workers.
We used data from 8638 ...nurses and 5198 workers to evaluate factors associated with burnout and satisfaction with WLI, and compare nurses to workers in other fields.
In the multivariable analysis, demographics, work hours, and highest academic degree obtained related to nursing were independent predictors of burnout. Factors independently associated with satisfaction with WLI included work hours. In pooled multivariable analyses including nurses and other workers, nurses were not more likely to have symptoms of burnout but were more likely to have lower satisfaction with WLI.
Work hours and professional development related to the risk of burnout among nurses. Nurses are at similar risk for burnout relative to other US workers but experience greater struggles with WLI.
To evaluate the relationships between immediate supervisors' leadership qualities and the subsequent levels and changes in burnout and satisfaction of supervised physicians 2 years later.
In 2015 and ...2017 physicians were asked to complete surveys that included the 9-item Mayo Clinic Leadership Score (range, 9 to 45) assessing their supervisor, an item about satisfaction with the organization, and two items from the Maslach Burnout Inventory. Individual participants' responses to the surveys were linked.
Among the 3698 physicians invited to complete both the 2015 and 2017 survey, 1795 (48.5%) responded. The mean composite baseline leadership score was 38.1 (SD, 8.4). Lower mean baseline leadership scores were reported by physicians who had burnout (mean SD, 36.0 9.7 vs 39.1 7.3; P<.001) 2 years later in comparison to those who did not have burnout 2 years later. In multivariable analysis, higher baseline leadership score of supervisors was independently associated with lower odds of physicians having burnout 2 years later (for each 1-point increase, odds ratio, 0.98; 95% CI, 0.96 to 0.99; P=.002) after adjusting for burnout at baseline, age, gender, length of service, and specialty. Baseline composite leadership score of supervisors was also independently associated with physicians' satisfaction with the organization 2 years later (odds ratio, 1.05; 95% CI, 1.03 to 1.07; P<.0001).
Physicians' ratings of their immediate supervisors' leadership qualities were associated with their subsequent levels and changes in burnout and satisfaction 2 years later. Additional studies are needed to determine the effect of sharing such scores with immediate supervisors and providing additional leadership training to those with low scores, and if doing so ultimately reduces burnout and improves satisfaction of the supervised physicians.
To explore whether burnout is an independent predictor of career choice regret among nurses.
In November 2017 we invited a random sample of 89,995 members of the American Nurses Association to ...participate in an anonymous online survey. The survey collected demographic and professional information and included the Maslach Burnout Inventory-Human Services Survey for Medical Personnel (known as the MBI-HSS MP), as well as several items exploring career choice regret. Of the 86,858 nurses who received the e-mail invitation, 8,638 (9.9%) responded. Multivariable logistic regression analysis was conducted for the final sample of 6,933 nurses who provided complete responses to the MBI-HSS (MP) and the career choice regret survey items.
Fifteen percent of the 6,933 participating nurses had career choice regret. On multivariable analysis, experiencing burnout, working unplanned or mandatory overtime, being male, and having a higher academic degree related to nursing were independent predictors of career choice regret. Burnout was the strongest such predictor.
Career choice regret among U.S. nurses is relatively common. Of the independent predictors this study identified, burnout had the strongest relationship with career choice regret. Organizational strategies aimed at reducing burnout and supporting nurses' ongoing professional development should be pursued.
Oxaliplatin therapy can be complicated by chemotherapy-induced peripheral neuropathy (CIPN). Other neurotoxic chemotherapies have been linked to single nucleotide variants (SNV) in ...Charcot-Marie-Tooth disease (CMT) genes. Whether oxaliplatin carries increased risks of CIPN due to SNV in CMT-associated genes is unknown.
353 patients receiving oxaliplatin in NCCTG N08CB were serially evaluated for CIPN using a validated patient-reported outcome (PRO) instrument, the CIPN20 questionnaire (sensory scale). 49 canonical CMT-associated genes were analyzed for rare and common SNV by nextgen sequencing.
The 157 patients with the highest and lowest susceptibility to CIPN (cases and controls) harbored 270 non-synonymous SNV in CMT-associated genes (coding regions). 143 of these were rare, occurring only once (“singletons”). CIPN cases had 0.84 singletons per patient compared with 0.98 in controls. An imbalance in favor of cases was noted only in few genes including PRX, which was previously highlighted as a candidate CIPN gene in patients receiving paclitaxel. However, the imbalance was only modest (5 singleton SNV in cases and 2 in controls). Therefore, while singleton SNV were common, they did overall not portend an increased risk of CIPN. Furthermore, testing CMT-associated genes using recurrent non-synonymous SNV did not reveal any significant association with CIPN.
Genetic analysis of patients from N08CB provides clinical guidance that oxaliplatin chemotherapy decisions should not be altered by the majority of SNV that may be encountered in CMT-associated genes when common genetic tests are performed, such as exome or genome sequencing. Oxaliplatin's CIPN risk appears unrelated to CMT-associated genes.
•Life-saving oxaliplatin therapy should not be withheld if genetic variants in Charcot-Marie-Tooth disease (CMT) genes are encountered.•Oxaliplatin appears not to be linked to CMT-associated genes as shown in this first exome sequencing study from the NCCTG/Alliance trial N08CB.•The results provide guidance to clinicians prescribing oxaliplatin for different solid tumor types with palliative of curative intent.
To demonstrate feasibility of performing geriatric assessment (GA) in the National Clinical Trials Network (NCTN) and to explore the utility of GA to characterize treatment tolerance.
We conducted a ...multisite companion study (CALGB 361006) to CALGB 11001, a phase 2 trial of adults ≥60 years old with newly diagnosed FLT3- mutated AML, testing the efficacy of adding sorafenib to intensive chemotherapy. On 361006, a GA was administered prior to induction and prior to post-remission therapy. The GA is divided into items requiring administration by a health care professional (HCP) and patient self-administered questionnaires. Feasibility outcomes were recruitment rate, time to GA completion, difficulty with GA administration, percent of patients requiring assistance, and satisfaction. Change in GA measures pre- and post-induction were compared using Wilcoxon signed rank test and McNemar's tests.
The recruitment rate was 80% (N = 43, median age 68 years). Median completion time of the GA was 30 min; (10 and 21 min for HCP and patients, respectively). HCP reported no difficulty completing assessments (100%). Most patients completed questionnaires without assistance (77%), and were satisfied with the length (89%). Self-reported physical function, mental health, social activity and nutritional parameters worsened after induction.
GA is feasible to administer in the setting of intensive induction for older adults with AML in the NCTN and provides evidence of the impact of induction therapy on physical and emotional health.
Geriatric assessment (GA) predicts survival among older adults with acute myeloid leukemia (AML) treated intensively. We evaluated the predictive utility of GA among older adults treated with low ...intensity therapy on a multi-site trial. We conducted a companion study (CALGB 361101) to a randomized phase 2 trial (CALGB 11002) of adults >=60 years considered "unfit" for intensive therapy, testing the efficacy of adding bortezomib to decitabine therapy. On 361101, GA and quality of life (QOL) assessment was administered prior to treatment and every other subsequent cycle. Relationships between baseline GA and QOL measures with survival were evaluated using Kaplan Meier estimation and Cox Proportional Hazards models. One-hundred sixty-five patients enrolled on CALGB 11002 and 96 (52%) of them also enrolled on 361101 (median age, 73.9 years). Among participants, 85.4% completed ≥1 baseline assessment. In multivariate analyses, greater comorbidity (Hematopoietic Cell Transplantation-specific Comorbidity Index >3), worse cognition (Blessed Orientation Memory Concentration score > 4), and lower European Organization for Research and Treatment of Cancer global QOL scores at baseline were significantly associated with shorter overall survival (OS) (p<0.05 each) after adjustment for Karnofsky Performance Status, age and treatment arm. Dependence in Instrumental Activities of Daily Living and cognitive impairment were associated with 6 month mortality (HR 3.5, CI 1.2-10.4, and HR 3.1 CI 1.1-8.6 respectively). GA measures evaluating comorbidity, cognition, and self-reported function were associated with survival and represent candidate measures for screening older adults planned to receive lower intensity AML therapies.
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