An evaluation of the feasibility of implementing the BeWEL lifestyle intervention programme for people at increased risk of colorectal cancer - from research to real life.

BACKGROUND: The BeWEL randomised controlled trial (RCT) of weight loss in people with colorectal adenomas demonstrated that a significant proportion of people are interested in lifestyle interventions (49%) and clinically relevant changes in body weight were achieved at 12-month follow-up. The current work aimed to assess the feasibility of the BeWEL programme invitation and delivery in a nonresearch setting to assess whether the original results could be replicated. METHODS: The original BeWel programme was modified through the provision of verbal introductions (vs. letter), requirement for people to contact BeWEL team (vs. BeWEL team contacting them), community delivery (vs. home), duration (12 weeks vs. 12 months) and two intervention visits (vs. 3) and inclusion of people with predisposition to colorectal cancer. Eligible people were informed about the BeWel programme from National Health Service (NHS) staff after colonoscopy procedures and invited to contact a dedicated Bowel Cancer UK lifestyle team. RESULTS: Findings demonstrated that programme uptake (10.6% vs. 33%) and retention (71% vs. 93%) was significantly lower than that obtained from the BeWEL RCT. For people who participated in the 3-month programme (n = 21), self-reported weight loss (mean: -7% body weight) was successful, and the programme was well received. CONCLUSIONS: The current approach to engaging clients with the BeWEL programme is unsustainable. Reliance on busy NHS staff to deliver invitations and the need for people to contact the delivery team (due to data protection) may have impacted on uptake. Alternative approaches to supporting weight management in this population should be explored further.

Update on obinutuzumab in the treatment of B-cell malignancies.

INTRODUCTION: The anti-CD20 mAb rituximab has revolutionized the treatment of B-cell malignancies, improving outcome for patients. Despite these improvements, the majority of patients still relapse and become refractory to rituximab. Further efforts to improve anti-CD20 mAb efficacy have recently focused on obinutuzumab /GA101, a novel anti-CD20 mAb glycoengineered to display enhanced Fc-mediated effector mechanisms and induce direct cell death. AREAS COVERED: We provide an overview of the current insights into the mechanisms of action of obinutuzumab focusing on how structural modifications and differences to rituximab led to designation of obinutuzumab as a type II antibody. We summarize data from preclinical studies and recent clinical trials including the Phase III trial in chronic lymphocytic leukemia (CLL), which led to FDA approval in November 2013. EXPERT OPINION: Clinical data are now emerging confirming the promise of the initial preclinical data that demonstrated superior efficacy of obinutuzumab over rituximab at similar dosing. The emerging randomized Phase III data from older comorbid patients with previously untreated CLL demonstrated significant improvements in molecular remission rates and median progression-free survival of obinutuzumab plus chlorambucil versus rituximab plus chlorambucil. This emerging data provide reasons to be optimistic that outcomes for patients with B-cell malignancies can be further improved with obinutuzumab.

Facial shape and asymmetry in 5-year-old children with repaired unilateral cleft lip and/or palate: an exploratory study using laser scanning.

To investigate the feasibility of facial laser scanning in pre-school children and to demonstrate landmark-independent three-dimensional (3D) analyses for assessment of facial deformity in 5-year-old children with repaired non-syndromic unilateral cleft lip and/or cleft palate (UCL/P). Faces of twelve 5-year-old children with UCL/P (recruited from university hospitals in Cardiff and Swansea, UK) and 35 age-matched healthy children (recruited from a primary school in Cardiff) were laser scanned. Cleft deformity was assessed by comparing individual faces against the age and gender-matched average face of healthy children. Facial asymmetry was quantified by comparing original faces with their mirror images. All facial scans had good quality. In a group of six children with isolated cleft palate coincidence with the average norm ranged from 18.8 to 26.4 per cent. There was no statistically significant difference in facial asymmetry when compared with healthy children (P > 0.05). In a group of six children with UCL with or without cleft palate coincidence with the average norm ranged from 14.8 to 29.8 per cent. Forehead, midface and mandibular deficiencies were a consistent finding, ranging from 4 to 10mm. The amount of 3D facial asymmetry was higher in this group (P < 0.05). Facial laser scanning can be a suitable method for 3D assessment of facial morphology in pre-school children, provided children are well prepared. Landmark-independent methods of 3D analyses can contribute to understanding and quantification of facial soft tissue cleft deformity and be useful in clinical practice.

A successful academic collaborative to increase nurse faculty in New Jersey.

The purpose of this article was to describe a successful academic collaboration of 4 New Jersey state colleges and universities. The aim of the collaborative is to prepare and graduate students in a dual role as advanced clinical/practice nurses and nurse faculty within an innovative master of nursing educational program. This effort was funded by a 4-year grant from the Robert Wood Johnson Foundation NJ Nursing Initiative and the New Jersey Chamber of Commerce. The New Jersey Nursing Education Collaborative (NJNEC) is discussed using E. O'Neil and P. Krauel's (2004) factors for an effective collaborative. The four factors for an effective partnership include a coherent institutional strategy, partners that bring value and assets to the collaborative, mutually beneficial goals, and accountability to each other. The NJNEC is composed of four independent state colleges and universities with separate governing structures and student characteristics. The four schools are located in different geographical locations in the state. Several challenging issues in preparation of faculty and maintaining a collaborative will be presented for future consideration.

Reproducibility of airway dimensions and tongue and hyoid positions on lateral cephalograms.

INTRODUCTION: The aim of this study was to evaluate the reproducibility of airway dimensions and tongue and hyoid positions on lateral cephalometric radiographs. METHODS: Three lateral cephalograms each of 30 patients were obtained in natural head positions at 30-minute intervals. Twelve measurements, including pharyngeal airway dimensions and tongue and hyoid positions, were taken. The relationships between 3 sets of measurements were evaluated by using repeated analysis of variance, Dahlberg's method error formula, and correlation coefficient. RESULTS: No statistically significant differences were found between the 3 sets of measurements with the repeated analysis of variance (P > .05). Correlation coefficient values ranged between 0.964 (vertical position of the hyoid) and 0.683 (hypopharyngeal airway width). The average method error was 1.22 mm. CONCLUSIONS: The results suggest that airway dimension and tongue- and hyoid-position measurements are highly reproducible on natural-head-position cephalograms.