Standardizing Research Training: a Pilot Curriculum Within a Hematology/Oncology Fellowship Program.

While scholarly activity is recognized as critical in cancer education, there is an outstanding need for methods to define research learning competencies and tools for formal research productivity and competency assessment. We piloted and studied a novel educational initiative within the University of Wisconsin Hematology/Oncology fellowship program, establishing a professional learning community (PLC) of research mentors and developing a formative evaluation tool, a research portfolio. We developed a PLC engaged in reflective conversations about intended learning outcomes and effective instructional strategies. Subsequently, a research portfolio was piloted with four first-year Hematology/Oncology fellows at the start of the 2020 academic year in which trainees document, critically evaluate, and reflect upon the knowledge, skills, confidence, and productivity acquired during research training. We employed surveys to evaluate the initiative. Seven Hematology/Oncology fellows (7/12, 58%) completed pre-intervention and six-month interim evaluation surveys, with 43% (3/7) identifying an increased confidence in quality of research training strategies following the pilot initiation. All four first-year fellows that piloted the research portfolio (4/4, 100%) completed interim evaluation surveys that demonstrated benefits of the research portfolio including self-reflection and goal setting. Research portfolio scoring correlated with other markers of academic success, suggesting its potential to predict research success. Our data suggest that bringing together a community of research mentors to generate shared learning goals and develop the framework for a formative evaluation portfolio may meet critical needs research training needs in cancer education. Given promising results, we aim to create a new educational tool for research training.

Implementation evaluation of a collective impact initiative to promote adolescent health in Oklahoma County, USA.

BACKGROUND: The teenage birth rate in the USA has considerably decreased in recent decades; however, more innovative, collaborative approaches are needed to promote adolescent health and prevent teenage pregnancy at the community level. Despite literature on the promising results of the collective impact (CI) model for health promotion, there is limited literature on the model's ability to reduce teenage pregnancies in a community. The Central Oklahoma Teen Pregnancy Prevention Collaboration is applying the CI model to foster collaboration among multiple stakeholders with the goal of increasing community and organizational capacity to improve adolescent health outcomes. This paper reports the findings from the initiative's implementation evaluation, which sought to understand whether the CI model improved collaboration among organizations and understand barriers and facilitators that affected program delivery. METHODS: Program implementers and evaluators jointly developed research questions to guide the intervention and evaluation design. The Consolidated Framework for Implementation Research (CFIR) was used to assess program components including the intervention characteristics, organization setting, community setting, facilitator characteristics, and the process of implementation. Primary sources of data included performance measures, meeting observations (n = 11), and semi-structured interviews (n = 10). The data was thematically analyzed using CFIR constructs, community capacity domains, and the five constructs of CI. RESULTS: Key findings include the need for shortened meeting times for meaningful engagement, opportunities for organizations to take on more active roles in the Collaboration, and enhanced community context expertise (i.e., those with lived experience) in all Collaboration initiatives. We identified additional elements to the core constructs of CI that are necessary for successful implementation: distinct role identification for partner organizations and incorporation of equity and inclusivity into collaboration processes and procedures. CONCLUSIONS: Results from this implementation evaluation provide valuable insights into implementation fidelity, participant experience, and implementation reach of an innovative, systems-level program. Findings demonstrate the context and requirements needed to successfully implement this innovative program approach and CI overall. Additional core elements for CI are identified and contribute to the growing body of literature on successful CI initiatives.

Network analysis of a community-wide teenage pregnancy prevention initiative.

Although US teenage birth rates substantially decreased over the past two decades, it still remains the highest in the developed world. More innovative, community-wide initiatives are needed to combat the issue. In Oklahoma County, Oklahoma, the Central Oklahoma Teen Pregnancy Prevention Collaboration is utilizing the collective impact model to convene multiple organizations with the goal of making systems-level changes related to teenage pregnancy within the community. This study used an interorganizational network analysis to evaluate the current strength of relationships between organizations in the Collaboration. An interorganizational network survey assessed collaborative relationships (e.g. information sharing and joint planning) within the network. Using R software, network diagrams were developed to depict partner relationships, and network measures, including node-, group- and network-level measures, were calculated. The network depiction (n = 23) revealed that the network core was composed of organizations from multiple sectors, and the backbone organization served as the most central organization for most centrality measures. This study provides insight into how organizational relationships can be assessed in order to increase community capacity to address teenage pregnancy. Continuous monitoring of the strength of relationships is important to ensure success in achieving goals as well as collective impact.

Total Synthesis of Pentacyclic (-)-Ambiguine P Using Sequential Indole Functionalizations.

The first synthesis of a pentacyclic ambiguine (ambiguine P) is reported. The synthesis takes advantage of sequential alkylations of an indole core to rapidly construct the pentacyclic framework of the natural product. Key to the success of the synthesis was the use of a Nicholas reaction to alkylate at C2, crafting a fused seven-membered ring that is characteristic of the pentacyclic ambiguines, as well as the use of an amide-directed functionalization at C12 to set a requisite quaternary center. A versatile late-stage intermediate was prepared that may be applicable to the synthesis of the other pentacyclic ambiguines.

ePRO symptom follow-up of colorectal cancer patients receiving oxaliplatin-based adjuvant chemotherapy is feasible and enhances the quality of patient care: a prospective multicenter study.

PURPOSE: Electronic (e) patient-reported outcomes (PROs) have been shown to improve the quality of life and survival in chemotherapy treated advanced cancer patients. We hypothesized that multidimensional ePRO centered approach could improve symptom management, streamline patient flow, and optimize the use of healthcare resources. METHODS: In this multicenter trial (NCT04081558), colorectal cancer (CRC) patients receiving oxaliplatin-based chemotherapy as adjuvant or in the first- or second-line setting in advanced disease were included in the prospective ePRO cohort, while a comparative retrospective cohort was collected from the same institutes. The investigated tool consisted of a weekly e-symptom questionnaire integrated to an urgency algorithm and laboratory value interface, which generated semi-automated decision support for chemotherapy cycle prescription and individualized symptom management. RESULTS: Recruitment to the ePRO cohort occurred 1/2019-1/2021 (n = 43). The comparator group (n = 194) consisted of patients treated in the same institutes 1-7/2017. The analysis was limited to adjuvant treated (n = 36 and n = 35). The feasibility of the ePRO follow-up was good with 98% reporting easy usage and 86% improved care, while health care personnel valued the easy use and logical workflow. In the ePRO cohort, 42% needed a phone call before planned chemotherapy cycles, while this was 100% in the retrospective cohort (p = 1.4e-8). Peripheral sensory neuropathy was detected significantly earlier with ePRO followed (p = 1e-5) but did not translate to earlier dose reduction, delays, or unplanned therapy termination compared to the retrospective cohort. CONCLUSION: The results suggest that the investigated approach is feasible and streamlines workflow. Earlier symptom detection may improve the quality in cancer care.

Mothers whose children have ADD/ADHD discuss their children's medication use: an investigation of blogs.

This article presents the results of a frame and discourse analysis of Internet blog sites where parents (usually mothers) discuss their concerns about medication use by their children with attention deficit disorder or attention deficit hyperactivity disorder (ADD/ADHD). This is a particularly important topic in an era characterized by powerful circulating discourses around the contentious medicalization of, and prevalent pharmaceutical treatments for, ADD/ADHD, as well as the mother blame associated with having a child diagnosed with ADD/ADHD. The findings document that the mothers see ADD/ADHD as legitimate medical diagnoses and view themselves as caretakers of children with brain and neuro-chemical anomalies affecting the behavior of their children. They favor pharmaceutical use and describe themselves as experts in the difficult and complex issues related to pharmaceuticalized parenting. At the same time their adoption of medicalization is contingent as they express specific critiques of some doctors, some types of doctors, and critically evaluate science.

Becoming a Teenager after Early Surgical Ventricular Septal Defect (VSD) Repair: Longitudinal Biopsychological Data on Mental Health and Maternal Involvement.

Beside somatic strains of congenital heart diseases (CHD), affected children often show developmental impairments in the long term. Ventricular septal defect (VSD) is the most common congenital heart defect and early surgical repair is associated with positive somatic outcomes. However, psychological adjustment is of lifelong relevance. We investigated 24 children with a surgically-corrected isolated VSD and their mothers from primary school (6-9 years) to adolescence (10-14 years) and compared them to controls. Both times, mothers reported child internalizing/externalizing problems, mothers and children rated child quality of life, and children performed neurodevelopmental tests. Adolescents also rated internalizing/externalizing problems themselves, and their hair cortisol levels were analyzed. Maternal anxiety and proactive parenting behavior were considered as moderators. Results revealed no group differences in child neurodevelopment (language, cognition), externalizing problems, and cortisol levels at any time. In reports from mothers, internalizing problems (depression, anxiety) were elevated in children with a VSD at both times-when mothers reported anxiety symptoms themselves. In adolescent reports, VSD patients' quality of life was increased and internalizing problems were decreased-proactive parenting behavior went along with decreased symptoms in VSD-affected adolescents and with increased symptoms in controls. The findings pronounce the crucial role of parenting behavior and the influence of maternal anxieties on child mental health after surgical VSD repair and might highlight the need for parent-centered interventions.

Safety of Deep Sedation Without Intubation for Second-Trimester Dilation and Evacuation.

OBJECTIVE: To estimate the incidence of pulmonary aspiration and other anesthesia-related adverse events in women undergoing dilation and evacuation (D&E) under intravenous deep sedation without tracheal intubation in an outpatient setting. METHODS: We reviewed all D&Es done under anesthesiologist-administered intravenous deep sedation without tracheal intubation between February 2009 and April 2013. The study's primary outcome was pulmonary aspiration; secondary outcomes included other anesthesia-related complications. We calculated the incidence of anesthesia-related adverse events as well as a 95% CI around the point estimate. RESULTS: During the 51-month study period, 4,481 second-trimester abortions were completed. Of these, 2,523 (56%) were done under deep sedation without tracheal intubation, 652 (26%) between 14 and 19 6/7 weeks of gestation, and 1,871 (74%) between 20 and 24 weeks of gestation. Seven cases of anesthesia-related complications were identified: two cases of pulmonary aspiration (0.08%, 95% CI 0.01-0.29%), four cases of upper airway obstruction (0.016%, 95% CI 0.04-0.41%), and one case of lingual nerve injury (0.04%, 95% CI 0.001-0.22%). CONCLUSION: Deep sedation without tracheal intubation for women undergoing D&E has a low incidence of anesthesia-related complications.

An exploration of search patterns and credibility issues among older adults seeking online health information.

The Internet is an important resource for health information, among younger and older people alike. Unfortunately, there are limitations associated with online health information. Research is needed on the quality of information found online and on whether users are being critical consumers of the information they find. Also, there is a need for research investigating online use among adults aged 65 and over - a rapidly growing demographic of Internet users. The current study presents important descriptive data about the search patterns of older adults seeking online health information, the types of health topics they research, and whether they consider credibility issues when retrieving online health information. A comparison is also made between search strategies used in printed text and hypertext environments. The results, which have implications with respect to credibility issues, highlight the need to increase awareness about critical searching skills among older adult Internet users.