Biomarkers predictive of a response to extended endocrine therapy in breast cancer: a systematic review and meta-analysis.

PURPOSE: Extension of adjuvant endocrine therapy beyond five years confers only modest survival benefit in breast cancer patients and carries risk of toxicities. This systematic review investigates the role of biomarker tests in predicting the clinical response to an extension of endocrine therapy. METHODS: We searched Ovid MEDLINE, Ovid Embase, Global Index Medicus, and the Cochrane Central Register of Controlled Trials using an iterative approach to identify full-text articles related to breast cancer, endocrine therapy, and biomarkers. RESULTS: Of the 1,217 unique reports identified, five studies were deemed eligible. Four investigated the Breast Cancer Index (BCI) assay in three distinct study populations. These studies consistently showed that BCI score was predictive of response to extended endocrine therapy among 1,946 combined patients, who were predominately non-Hispanic white and postmenopausal. CONCLUSIONS: Evidence in the setting of predictive tests for extended endocrine therapy is sparse. Most relevant studies investigated the use of BCI, but these study populations were largely restricted to a single age, race, and ethnicity group. Future studies should evaluate a variety of biomarkers in diverse populations. Without sufficient evidence, physicians and patients face a difficult decision in balancing the benefits and risks of endocrine therapy extension.

Telemedicine in Neurology: A Scoping Review of Key Outcomes in Movement Disorders.

Introduction: Telemedicine for neurological care has been researched and practiced in various ways over the past three decades, but the recent COVID-19 pandemic has rapidly expanded its use and highlighted the need for a synthesis of the existing literature. We aimed to review the methodology and outcomes of previous studies that have evaluated the use of telemedicine in movement disorders. Methods: This scoping review was performed by searching PubMed, Ovid MEDLINE, and CINAHL databases from 1946 to November 2020. Studies that assessed the application of telemedicine for delivering care to patients with a movement disorder were included. We reported the aims and employed methodologies and categorized the outcomes from each study. Results: The search retrieved 228 articles, and 41 studies met the criteria for inclusion in the review. The majority of telemedicine studies were case series or randomized controlled pilot trials, investigating feasibility and acceptability in Parkinson's disease. Even with heterogeneity among outcome measures, they can be categorized into themes, such as feasibility, satisfaction, and efficacy. Conclusions: Telemedicine use has grown rapidly, due to the demands of providing care during a global pandemic. This application of telemedicine has been considered a promising way to expand care in Neurology, although research evaluating the dissemination of its use is dilatory. This review highlights the number of studies that have found telemedicine to be an acceptable and feasible way to deliver care for movement disorders. Further research is needed to expand on harmonization of outcomes, reach, adoption, and long-term use of telemedicine.

A Promising Approach in Home Visiting to Support Families Affected by Maternal Substance Use.

INTRODUCTION: Many factors influence women's use of alcohol and other drugs while pregnant and postpartum. Substance use impacts the maternal-child relationship during the critical neonatal period. The first days and months of human development lay the foundation for health and well-being across the lifespan, making this period an important window of opportunity to interrupt the transmission of trauma and stress to the next generation. Pregnant and postpartum women with a history of substance use require specialized support services. METHODS: The Team for Infants Exposed to Substance abuse (TIES) Program provides a holistic, multi-disciplinary, community-based model to address the complex needs of families with young children affected by maternal substance use. RESULTS: A multi-year implementation study of the model yielded results that indicate the effectiveness of this home-based family support intervention. The model focuses on reducing maternal alcohol and other drug use, increasing positive parenting, promoting child and maternal health, and improving family income and family housing. A key component of the model is establishing a mutual, trusting relationship between the home visiting specialists and the family. Foundational to the TIES model is a family-centered, culturally competent, trauma-informed approach that includes formal interagency community partnerships DISCUSSION: This article describes elements of the model that lead to high retention and completion rates and family goal attainment for this unique population.

Intimate Partner Violence Educational Materials in the Acute Care Setting: Acceptability and Impact on Female Caregiver Attitudes Toward Screening.

OBJECTIVES: This study aimed to determine acceptability of intimate partner violence (IPV) materials and effect of the materials on caregiver attitudes toward IPV screening. METHODS: We used an anonymous computerized survey to assess approval of IPV materials and screening, and willingness to disclose IPV in response to screening among mothers bringing a child to an urban pediatric emergency department or 2 suburban pediatric urgent care centers affiliated with a free-standing academic children's hospital. We compared responses between participants recruited before and after display of the IPV materials, as well as between subgroups, using χ2 tests. RESULTS: A total of 522 participated (predisplay, n = 261; postdisplay, n = 261). More subjects in the postdisplay group approved of display of IPV materials in pediatric emergency department/urgent care center restrooms (94% pre vs 98% post, P = 0.04) and examination rooms (94% pre vs 98% post, P = 0.01). We found no differences in acceptability of IPV screening between the pre and post groups (73% pre and post, P = 0.92). Willingness to disclose IPV in response to screening was higher in the postdisplay group for those with a personal IPV history (55% pre, 73% post; P = 0.02), African Americans (60% pre, 78% post; P = 0.02), and those with a high school degree or less education (66% pre, 77% post; P = 0.04). CONCLUSIONS: Intimate partner violence materials in this study were acceptable to most participants and did not negatively impact attitudes toward IPV screening or willingness to disclose IPV. Display of IPV materials should be considered as a component of IPV intervention.

Family Adversity and Resilience Measures in Pediatric Acute Care Settings.

OBJECTIVE: Adverse childhood experiences (ACEs) impact health across the life course. The purpose of this study was to identify caregiver ACEs, current adversity, and resilience in families seeking care in pediatric acute care settings. Study aims included identifying demographic characteristics, current adversities, and resilience measures associated with caregiver ACEs ≥4. DESIGN AND SAMPLE: A cross-sectional survey study design was used and a convenience sample (n = 470) recruited at emergency and urgent care settings of a large Midwest pediatric hospital system. MEASURES: Measures were self-reported. The original 10-item ACEs questionnaire measured caregiver past adversity. Current adversity was measured using the 10-item IHELP. The six-item Brief Resiliency Scale measured resilience, and WHO-5 Well-Being Index was used to measure depressive affect. RESULTS: Compared to participants with ACEs score of 0-3 participants with ACEs ≥4 were more likely to have multiple current adversities, increased risk of depression, and lower resilience. CONCLUSIONS: Caregivers using pediatric acute care settings carry a high burden of ACEs and current adversities. Caregiver ACEs are associated with current child experiences of adversity. Caregivers socioeconomic status and education level may not be an accurate indicator of a family's risks or needs. Pediatric acute care settings offer opportunities to access, intervene, and prevent childhood adversity.

Providing adolescent sexual health care in the pediatric emergency department: views of health care providers.

OBJECTIVES: The purpose of this study was to explore health care providers' (HCPs') attitudes and beliefs about adolescent sexual health care provision in the emergency department (ED) and to identify barriers to a health educator-based intervention. METHODS: We conducted focused, semistructured interviews of HCPs from the ED and adolescent clinic of a children's hospital. The interview guide was based on the theory of planned behavior and its constructs: attitudes, subjective norms, perceived behavioral control, and intention to facilitate care. We used purposive sampling and enrollment continued until themes were saturated. Interviews were recorded and transcribed. Transcripts were analyzed using directed content analysis. RESULTS: Twenty-nine interviews were required for saturation. Participants were 12 physicians, 12 nurses, 3 nurse practitioners, and 2 social workers; the majority (83%) were female. Intention to facilitate care was influenced by HCP perception of (1) their professional role, (2) the role of the ED (focused vs expanded care), and (3) need for patient safety. Health care providers identified 3 practice referents: patients/families, peers and administrators, and professional organizations. Health care providers perceived limited behavioral control over care delivery because of time constraints, confidentiality issues, and comfort level. There was overall support for a health educator, and many felt the educator could help overcome barriers to care. CONCLUSIONS: Despite challenges unique to the ED, HCPs were supportive of the intervention and perceived the health educator as a resource to improve adolescent care and services. Future research should evaluate efficacy and costs of a health educator in this setting.

Operative options for extracranial nasal dermoid cysts: A meta-analysis.

BACKGROUND: Nasal dermoid cysts are surgically treated using external incision, open rhinoplasty, transnasal endoscopy, or combined approaches. It is unclear how these approaches differ with regard to the incidence of adverse events. METHODS: We conducted a systematic review of studies on the surgical management of midline nasal dermoids. Following data abstraction, we carried out a series of single-arm meta-analyses to estimate summary risks of recurrence and combined adverse events (recurrence, revision, infection, or readmission) according to the surgical approach. RESULTS: Forty-three eligible studies published between 1958 and 2020 reported on 439 cases of nasal dermoid cysts. Treatment approaches included external incision (25 studies), rhinoplasty (15 studies), and transnasal endoscopy (5 studies). To our knowledge, no study has compared outcome incidence between the surgical approaches. External incision had the lowest summary incidence of both recurrence (1.78% [95% CI: 0.57%, 3.65%]) and combined adverse events (4.94% [95% CI: 2.72%, 7.77%]). Rhinoplasty had a higher incidence of recurrence (4.81% [95% CI: 0.91%, 11.6%]) and combined adverse events (8.32% [95% CI: 2.77%, 16.5%]), and transnasal endoscopy had the highest incidence of recurrence (the only reported adverse event; 7.89% [95% CI: 0%, 28.9%]). CONCLUSION: Our results suggest that the incidence of adverse events was lowest among patients who were subjected to external incision for nasal dermoid removal. Incidence was higher for patients who underwent rhinoplasty and the highest for patients who underwent transnasal endoscopy. Future work on this topic should include well-designed prospective studies that compare rates of adverse events and cosmetic outcomes between surgical approaches.

Family violence assessment practices of pediatric ED nurses and physicians.

BACKGROUND: Recommendations by the ENA and other professional organizations have not resulted in widespread adoption of routine assessment for family violence such as child abuse and intimate partner violence. The aim of this qualitative study was to use a theory-driven approach to explore the salient beliefs and attitudes of nurses and physicians related to routine assessment of child abuse and intimate partner violence in the pediatric emergency department. METHODS: Nurse and physician participants from a large Midwestern pediatric trauma center responded to a series of open-ended questions designed to identify positive or negative attitudes toward family violence assessment, approving or disapproving beliefs about family violence assessment, and the perception of ease or difficulty in performing family violence assessment. RESULTS: Respondents valued early identification and the associated health benefits of keeping pediatric patients safe, as well as linking at-risk families to community resources. They believe that victims, health care organizations, and some providers approve of routine family violence assessment but also believe that some providers and families who value privacy disapprove. Previously identified barriers and facilitators to family violence assessment were confirmed by participants. A finding unique to this study was that participants expressed the belief that routine family violence assessment offers more complete health care to children. DISCUSSION: Participants viewed child abuse and intimate partner violence as an event in a child's life that affects the child's health. Participants valued the benefits of routine family violence assessment; however, translating these value beliefs into practice remains elusive. A theoretical framework may provide insight into yet unidentified aspects of known barriers and facilitators.

Two generations thrive: Bidirectional collaboration among researchers, practitioners, and parents to promote culturally responsive trauma research, practice, and policy.

OBJECTIVE: Prolonged exposure to adverse childhood experiences (ACEs) in the absence of protective relationships and systems contributes to toxic stress and can lead to numerous psychological and physical health consequences. Disproportionate exposure to ACEs and lack of appropriate responses stemming from systemic racism contributes to racial inequities. Culturally responsive practices and policies focused on early childhood are critical to prevent toxic stress and subsequent health inequities. This paper describes a collaboration among researchers, practitioners, and parents of color with lived experiences of ACEs entitled: Two Generations Thrive, which aims to prevent the intergenerational transmission of ACEs through improving practices and policies within the health care, education, and child welfare systems. METHOD: Community-based Participatory Research (CBPR) and cultural humility provided a framework and key principles for our collaboration, with an emphasis on critical reflection, mitigating power imbalances, and institutional accountability. Qualitative and quantitative methods were used to evaluate outcomes. We describe our process of building an infrastructure for bidirectional collaboration and key lessons learned to offer a roadmap for researchers, clinicians, and advocates who seek to partner in preventing ACEs and subsequent health inequities. RESULTS: Key lessons learned include: the importance of building and maintaining trust, consistently working to mitigate power imbalances, and the power of bidirectional collaboration to maximize the benefit of research and action for communities traditionally marginalized in research and practice. CONCLUSIONS: Cultural humility and CBPR provide a strong foundation to promote bidirectional collaboration among researchers, practitioners, and parents with lived experience of ACEs. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Aligning library instruction with the needs of basic sciences graduate students: a case study.

QUESTION: How can an existing library instruction program be reconfigured to reach basic sciences graduate students and other patrons missed by curriculum-based instruction? SETTING: The setting is an academic health sciences library that serves both the university and its affiliated teaching hospital. METHODS: The existing program was redesigned to incorporate a series of seven workshops that encompassed the range of information literacy skills that graduate students in the basic sciences need. In developing the new model, the teaching librarians made changes in pedagogy, technology, marketing, and assessment strategies. RESULTS: Total attendance at the sessions increased substantially in the first 2 years of the new model, increasing from an average of 20 per semester to an average of 124. Survey results provided insight about what patrons wanted to learn and how best to teach it. CONCLUSION: Modifying the program's content and structure resulted in a program that appealed to the target audience.

Information-seeking behavior of basic science researchers: implications for library services.

OBJECTIVES: This study examined the information-seeking behaviors of basic science researchers to inform the development of customized library services. METHODS: A qualitative study using semi-structured interviews was conducted on a sample of basic science researchers employed at a university medical school. RESULTS: The basic science researchers used a variety of information resources ranging from popular Internet search engines to highly technical databases. They generally relied on basic keyword searching, using the simplest interface of a database or search engine. They were highly collegial, interacting primarily with coworkers in their laboratories and colleagues employed at other institutions. They made little use of traditional library services and instead performed many traditional library functions internally. CONCLUSIONS: Although the basic science researchers expressed a positive attitude toward the library, they did not view its resources or services as integral to their work. To maximize their use by researchers, library resources must be accessible via departmental websites. Use of library services may be increased by cultivating relationships with key departmental administrative personnel. Despite their self-sufficiency, subjects expressed a desire for centralized information about ongoing research on campus and shared resources, suggesting a role for the library in creating and managing an institutional repository.

A survey of scholarly literature databases for clinical laboratory science.

This article reviews the use of journal literature databases including CINAHL, EMBASE, and Web of Science; summarizing databases including Cochrane Database of Systematic Reviews, online textbooks, and clinical decision-support tools; and the Internet search engines Google and Google Scholar. The series closes with a practical example employing a cross-section of the knowledge and skills gained from all three articles.

Building a Collaboration Between a Children's Hospital and an Early Childhood Education and Social Services Center.

To address toxic stress among children growing up in poverty, an innovative collaboration was developed between a community center, Operation Breakthrough (OB), and a tertiary care children's hospital, Children's Mercy Hospital (CMH). OB started as a day care center but has expanded and developed ways to provide shelter, safety, food, employment, education and health care. CMH is a traditional academic children's hospital that, in recent years, has been looking for ways to better address the social determinants of health. This article describes how the two organizations found ways to work together to capitalize on each other's strengths. Although the two institutions shared some common goals, they had very different organizational structure. We describe how a series of complex negotiations and trust-building exercises eventually led to a robust and unique partnership.

Intimate Partner Violence Programs in a Children's Hospital: Comprehensive Assessment Utilizing a Delphi Instrument.

OBJECTIVE: The purpose of this study was to conduct a baseline assessment of intimate partner violence (IPV) practices in a pediatric hospital system. METHODS: The Delphi Instrument for Hospital-based Domestic Violence Programs was used to assess the structure and components of the hospital system's IPV practices. Through key stakeholder interviews, we also assessed IPV practices in individual patient care areas. Qualitative analysis of interview data used a grounded theory approach. RESULTS: The hospital scored 17 of 100 points on the Delphi instrument assessment. Key areas of weakness identified by the Delphi instrument and interviews included lack of coordinated provider training and evaluation of IPV-related processes and no standards for IPV screening, safety assessment, and documentation. Most interviewees supported addressing IPV; all identified barriers to IPV screening at individual provider and institutional levels. Institutional barriers included lack of a standardized response to IPV disclosure, need for individualized screening protocols for different patient care settings, lack of standardized provider training, concerns about overextending social work resources, and lack of resources for hospital staff experiencing vicarious trauma. Individual barriers included concern that screening may harm physician-patient-family relationships and the perception that physicians are unwilling to address psychosocial issues. CONCLUSIONS: The Delphi Instrument for Hospital-based Domestic Violence Programs identified weaknesses and key areas for improvement in IPV practices. Deficiencies revealed by the Delphi instrument were affirmed by individual interview results. Institutional and individual provider level barriers must be addressed to optimize IPV practices in a pediatric hospital system.