Canadian guidelines recommend shared decision making for women less than 50 years old who are considering breast cancer screening. Nurses can support women in making these decisions. This single case ...pre-/post-test study measured change in decisional conflict after decision support for a woman less than 50 years old considering whether or not to initiate mammography screening. At baseline, a 44-year-old female at average risk of breast cancer was experiencing decisional conflict. She scored 1 out of 4 on the SURE test indicating feeling uninformed, unclear values, and inadequate support. After receiving decision coaching with a breast cancer screening decision aid by a nurse trained in decision coaching, she scored 4 on the SURE test indicating no decisional conflict. She reached an informed decision consistent with her values about mammography screening. Providing decisional support improved her knowledge, reduced her decisional conflict, and enhanced her confidence in making an informed decision that was consistent with her values.
How to Succeed in Hiring Gen Z Moulton, Kelly; McDonald, Mia
BusinessWest,
07/2022, Letnik:
39, Številka:
6
Trade Publication Article
...with the influx of young workers entering the market, employers need to continue to learn and adapt so they can obtain and retain the best applicants, just as they require their new hires to ...adapt, learn, and grow within their roles. Employers need to allow for independence - showing that they trust and value contributions - while also setting clear expectations and providing consistent feedback to foster growth. Perhaps the most important thing employers can do is set aside preconceived notions about the generation, and instead look at each candidate as an individual.
The National Forensic Laboratory Information System (NFLIS) is a drug surveillance program of the US Drug Enforcement Administration that systematically collects data on drugs that are seized by law ...enforcement and submitted to and analyzed by the Nation's forensic laboratories (NFLIS‐Drug). NFLIS‐Drug data are increasingly used in predictive modeling and drug surveillance to examine drug availability patterns. Given the complexity of the data and data collection, there are some common methodological pitfalls that we highlight with the aim of helping researchers avoid these concerns. The analysis done for this Technical Note is based on a review of the scientific literature that includes 428 unique, refereed article citations in 182 distinct journals published between January 1, 2005, and April 30, 2021. Each article was analyzed according to how NFLIS‐Drug data were mentioned and whether NFLIS‐Drug data were included. A sample of 37 articles was studied in‐depth, and data issues were summarized. Using examples from the literature, this Technical Note highlights eight broad concerns that have important implications for the proper applications, interpretations, and limitations of NFLIS‐Drug data with suggestions for improving research methods and accurate reporting of forensic drug data. NFLIS‐Drug data are timely and provide key information to inform drug use trends across the United States; however, our present analysis shows that NFLIS‐Drug data are misunderstood and represented in the literature. In addition to highlighting these issues, DEA has created several resources to assist NFLIS data users and researchers, which are summarized in the discussion.
Abstract
Background/Aims
Individuals with systemic lupus erythematosus (SLE) have an increased rate of mortality compared to the general population. We aimed to assess the cause of death and ...characteristics of these patients in a large national biologics register.
Methods
Patients receiving biological or standard of care (SoC) treatment recruited to the UK national SLE biologics registry (2010-21) were included. Demographic, clinical and laboratory data were recorded at recruitment. Information relating to date and cause of death were collected from study centres and the UK Office for National Statistics. The relationship between mortality and patient variables was analysed using a Cox proportional hazards model.
Results
There were 54 deaths in 1,477 patients over 6,162 patient years of follow up. The mortality rate was 5.97 (6.92-11.80) per 1000 person years (py). The cause of death was identifiable in 52 (96.2%) patients and included infection (21, 38.9%), active SLE (10, 18.5%), malignancy (6, 11.1%), cardiovascular disease (6, 11%), thrombosis (3, 5.6%), opiate toxicity (1, 1.9%) and cerebral haemorrhage (1, 1.9%). The characteristics of patients who died are described in Table 1. The median time between BILAG-BR registration and death was 679 (251-1,227) days. The mortality rate was 11.34 (8.54-15.04) per 1,000 py in patients on rituximab, 2.52 (0.36-17.90) per 1,000 py in belimumab and 3.32 (1.25-8.86) per 1,000 py in patients on SOC medicines. Factors independently associated with mortality included age at recruitment (HR 1.07 1.05-1.09), previous myocardial infarction (HR 5.35 2.27-12.59), diabetes mellitus (HR 3.87 1.81-8.29), previous cancer (HR 3.30 1.59-6.86) and hypertension (HR 1.81 1.00-3.27). In multivariate models adjusted for age, gender and presence of co-morbidities at baseline, risk of death was not significantly different between rituximab and belimumab (HR 0.36 0.05-2.65) or SOC (HR 0.40 0.12-1.32) groups.
Conclusion
Risk of mortality was not different between treatment groups after accounting for differences in baseline demographics and co-morbidities. Co-morbidities were independently associated with high risk of death for patients with moderate-to-severe SLE; these should be actively assessed and managed to improve mortality outcomes.
Disclosure
S. Dyball: Grants/research support; MRC. Other; GSK, UCB. M. Rodziewicz: Grants/research support; MRC. Other; UCB. E. Sutton: None. A. Aksoy: None. S. McDonald: None. B. Parker: Honoraria; Fresenius-Kabi, AbbVie. Grants/research support; Genzyme/Sanofi, GSK. Other; Eli Lilly, Roche. I. Bruce: Consultancies; AstraZeneca, Eli Lilly, UCB, ILTOO, Merck Serono, GSK. Grants/research support; UCB, Roche, GSK, Genzyme/Sanofi. Other; AstraZeneca, GSK, UCB.
Bevacizumab-related imaging abnormality (BRIA), appearing as areas of restricted diffusion on magnetic resonance imaging (MRI) and representing atypical coagulative necrosis pathologically, has been ...observed in patients with brain tumors receiving radiotherapy and bevacizumab. We investigated the role of cumulative radiation dose in BRIA development in a voxel-wise analysis.
Patients (n = 18) with BRIA were identified. All had high-grade gliomas or brain metastases treated with radiotherapy and bevacizumab. Areas of BRIA were segmented semi-automatically on diffusion-weighted MRI with apparent diffusion coefficient (ADC) images. To avoid confounding by possible tumor, hypoperfusion was confirmed with perfusion imaging. ADC images and radiation dose maps were co-registered to a high-resolution T1-weighted MRI and registration accuracy was verified. Voxel-wise normal tissue complication probability analyses were performed using a logistic model analyzing the relationship between cumulative voxel equivalent total dose in 2 Gy fractions (EQD2) and BRIA development at each voxel. Confidence intervals for regression model predictions were estimated with bootstrapping.
Among 18 patients, 39 brain tumors were treated. Patients received a median of 4.5 cycles of bevacizumab and 1-4 radiation courses prior to BRIA appearance. Most (64%) treated tumors overlapped with areas of BRIA. The median proportion of each BRIA region of interest volume overlapping with tumor was 98%. We found a dose-dependent association between cumulative voxel EQD2 and the relative probability of BRIA (β0 = -5.1, β1 = 0.03 Gy-1, γ = 1.3).
BRIA is likely a radiation dose-dependent phenomenon in patients with brain tumors receiving bevacizumab and radiotherapy. The combination of radiation effects and tumor microenvironmental factors in potentiating BRIA in this population should be further investigated.
Home health aides provide care to homebound older adults and those with chronic conditions. Aides were less likely to receive COVID-19 vaccines when they became available. We examined aides’ ...perspectives towards COVID-19 vaccination. Qualitative interviews were conducted with 56 home health aides at a large not-for-profit home care agency in New York City. Results suggested that aides’ vaccination decisions were shaped by (1) information sources, beliefs, their health, and experiences providing care during COVID-19; (2) perceived susceptibility and severity of COVID-19; (3) perceived benefits of vaccination including protection from COVID-19, respect from colleagues and patients, and fulfillment of work-related requirements; (4) perceived barriers to vaccination including concerns about safety, efficacy, and side effects; and (5) cues to action including access to vaccination sites/appointments, vaccination mandates, question and answer sessions from trusted sources, and testimonials. Providing tailored information with support to address vaccination barriers could lead to improved vaccine uptake.
The corpus callosum (CC) and intrahemispheric white matter tracts (IHWM) subserve critical aspects of attention and processing speed. We analyzed imaging biomarkers of microstructural injury within ...these regions and association with attention and processing speed performance before and after radiation therapy in primary brain tumor patients.
In a prospective clinical trial, 44 primary brain tumor patients underwent cognitive testing and magnetic resonance imaging/diffusion-weighted imaging at baseline (pre-radiation therapy) and 3-, 6-, and 12-months post-radiation therapy. CC (subregions, total) and IHWM tracts (left/right without CC, total) were autosegmented; tumor, tumor bed, and edema were censored. Biomarkers included volume changes (cm
), mean diffusivity (MD; higher values indicate white matter injury), fractional anisotropy (FA; lower values indicate white matter injury). Reliable-change indices measured changes in attention (Weschler Adult Intelligence Scale WAIS-IV digits-forward; Delis-Kaplan Executive Function System Trail Making D-KEFS-TM visual-scanning), and processing speed (WAIS-IV coding; D-KEFS-TM number-sequencing, letter-sequencing), accounting for practice effects. Linear mixed-effects models evaluated associations between mean radiation dose and biomarkers (volume, MD, FA) and imaging biomarkers and neurocognitive performance. Statistics were corrected for multiple comparisons.
Processing speed declined at 6 months following radiation therapy (number sequencing, letter sequencing; P < .04). Seizures and antiepileptic drug therapy were associated with lower visual-scanning attention reliable-change indices at 6 months (P = .039). Higher radiation dose correlated with smaller midanterior CC volume (P = .023); lower FA in posterior CC, anterior CC, and total CC (all P < .03); and higher MD in anterior CC (P = .012). Smaller midanterior CC and left IHWM volume correlated with worse processing speed (coding, letter-sequencing, number-sequencing; all P < .03). Higher FA in right, left, and total IHWM correlated with better coding scores (all P < .01). Lower FA in total IHWM (P = .009) was associated with worse visual-scanning attention scores. Higher FA in midposterior CC (P = .029) correlated with better digits-forward attention scores.
The CC demonstrated radiation dose-dependent atrophy and WM injury. Microstructural injury within the CC and IHWM was associated with attention and processing speed decline after radiation therapy. These areas represent possible avoidance regions for preservation of attention and processing speed.
To evaluate the hypothesis that various maternal, socioeconomic, delivery, and infant nutritional characteristics are associated with early childhood development in young Tanzanian children.
We ...performed a prospective cohort study among 206 HIV-exposed, uninfected and 247 HIV-unexposed Tanzanian infants who had been enrolled in 2 separate micronutrient trials (NCT00197730 and NCT00421668). Trained nurses administered culturally modified Bayley Scales of Infant and Toddler Development, 3rd edition (BSID-III), to evaluate cognitive, motor, and language development at 15 months of age. This analysis explored predictors of BSID-III z-scores using multivariable linear regression.
Among maternal determinants, we found that low maternal height predicted all BSID-III domains in HIV-unexposed children; low maternal education predicted lower cognitive (standardized mean difference, -0.41; 95% CI, -0.74 to -0.08) and lower gross motor scores (standardized mean difference, -0.32; 95% CI, -0.61 to -0.04) in HIV-exposed children. Among delivery characteristics, facility delivery predicted higher cognitive scores (standardized mean difference, 1.36; 95% CI, 0.26-2.46); and oxytocin administration predicted lower fine motor scores (standardized mean difference, -0.48; 95% CI, -0.87 to -0.09) in HIV-exposed children. Higher length-for-age z-scores at 6 weeks of age predicted better cognitive (standardized mean difference, 0.15; 95% CI, 0.01-0.29) and expressive language scores (standardized mean difference, 0.16; 95% CI, 0.02-0.29) at 15 months in HIV-exposed infants.
This hypothesis-generating study found significant associations between nutritional status and health of the mother and child, and maternal educational attainment, with direct measures of early childhood development at 15 months of age. In addition, several aspects of delivery (facility birth and oxytocin administration) were associated with early childhood development. Future intervention trials should focus on modifiable maternal, infant, and obstetric factors to strengthen the evidence base concerning early childhood development.
ClinicalTrials.gov: NCT00197730 and NCT00421668.
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