Avaliação do tratamento quimioterápico paliativo com o esquema LDE- paclitaxel em pacientes portadores de metástases ósseas por neoplasia maligna / Evaluation of palliative chemotherapy treatment with the LDEpaclitaxel regimen in patients with bone metastases from malignant neoplas

Introdução: Pacientes com câncer em estádios avançados e metástases ósseas frequentemente não apresentam condições clínicas para a realização de esquemas quimioterápicos convencionais subsequentes, restringindo as opções de tratamento. Anteriormente, demonstramos que nanopartículas artificiais lipídicas (LDE), semelhantes à lipoproteína de baixa densidade (LDL) rica em colesterol, são captadas por tecidos malignos, e quando associadas aos quimioterápicos, após injeção pela via endovenosa, reduz drasticamente a toxicidade do tratamento. Os objetivos deste presente estudo foram avaliar a resposta clínica ao tratamento quimioterápico com paclitaxel (PTX) associado à LDE; avaliar as toxicidades clínicas e laboratorial, e a capacidade da associação LDE-PTX em reduzir a dor oncológica relacionada às metástases ósseas em pacientes com carcinoma de mama, próstata e pulmão, previamente tratados e não elegíveis para tratamento quimioterápico convencional subsequente. Métodos: Dezoito pacientes (8 com câncer de mama, 5 de próstata e 5 de pulmão) com metástases ósseas foram incluídos. O tratamento consistiu no esquema LDE-PTX na dose convencional do PTX (175 mg/m2 de superfície corpórea de 3/3 semanas) e os pacientes foram avaliados por resposta clínica, redução da dor óssea, uso de medicamentos opióides, e ocorrência de fraturas ósseas patológicas. Resultados: No total, 104 ciclos de quimioterapia foram realizados, e nenhum paciente apresentou toxicidade clínica, laboratorial, assim como não houve fraturas patológicas. Dos 18 pacientes incluídos, 9 tiveram sobrevida livre de progressão de doença 6 meses. Houve em todos os pacientes redução da dor óssea, permitindo substituição da medicação opióide por analgésico não opióide. Conclusão: A melhora significativa na dor óssea sem que tenha ocorrido toxicidade do tratamento, e o tempo de não progressão de doença 6 meses na metade dos pacientes sugere que esses pacientes tenham se beneficiado consistentemente do tratamento com a LDE-PTX. Portanto, a LDE-PTX pode tornar- se uma opção terapêutica interessante em pacientes com carcinomas de próstata, mama ou pulmão em estágios avançados e sem condições clínicas de se submeterem a outros esquemas quimioterápicos convencionais

Introduction: Patients with advanced cancer and bone metastases usually do not have clinical conditions to perform additional conventional chemotherapy regimens, restricting treatment options. Previously, we showed that lipid core nanoparticles (LDE), similar to cholesterol-rich low-density lipoprotein (LDL), are taken up by malignant tissues, and when associated to chemotherapy, after endovenous injection, it drastically decreases the toxicity of the treatment. The objectives of this study were to evaluate the clinical response to chemotherapy treatment with paclitaxel (PTX) associated with LDE; to evaluate the clinical and laboratorial toxicities, and the ability of the LDE-PTX to reduce cancer pain related to bone metastases in patients with breast, prostate or lung carcinoma, previously treated and not eligible for subsequent conventional chemotherapy treatment. Methods: Eighteen patients (8 with breast cancer, 5 with prostate and 5 with lung) with bone metastases were included. Treatment consisted of the LDE-PTX regimen at a conventional dose of PTX (175 mg/m2 body surface area, 3/3 weeks) and patients were evaluated for clinical response, reduction in bone pain, use of opioid medications, and the occurrence of pathological bone fractures. Results: In total, 104 chemotherapy cycles were performed, and none of the patients showed clinical or laboratorial toxicities, as well as there were no pathological fractures. Of the 18 patients evaluated, 9 had progression-fee survival 6 months. Patients had decrease in bone pain allowing replacement of opioid medication by another non-opioid analgesic. Conclusion: Significant improvement in bone pain without treatment toxicity, and time to disease progression of 6 months in half of the patients suggest that these patients have consistently benefited with LDE-PTX treatment. Therefore, LDE-PTX may become an interesting therapeutic option in patients with advanced stage of prostate, breast or lung carcinomas and without clinical conditions to undergo other conventional chemotherapy regimens

Educação em saúde bucal em uma pré-escola: planejamento estratégico para o desenvolvimento de atividades lúdicas / Oral health education in pre-school: strategic planning for the development of ludic activities

Trata-se de um relato de experiência, que descreve, sob estratégia narrativo-argumentativa, as significâncias político-pedagógicas atreladas ao planejamento estratégico de ações de educação em saúde bucal vivenciadas em um ambiente escolar e experimentadas por acadêmicos estagiários de um curso de Odontologia. Após análise detalhada, algumas inferências se destacaram: o reconhecimento do ambiente escolar como território fértil para o desenvolvimento de ações promotoras de saúde; a efetividade do instrumento "TPC" (Teorizar-Praticar-Criticar) no direcionamento dos acadêmicos estagiários no planejamento estratégico de atividades de educação em saúde bucal; a importância de se disseminar, em espaços científicos, os aprendizados advindos de experimentações práticas de estágios.

This is a report on an experience that describes, under a narrative-argumentative strategy, the political-pedagogical significance linked to the strategic planning of oral health education actions experienced in a school environment and experienced by university trainees from a Dentistry course. After a detailed analysis, some inferences were observed: the recognition of the school environment as a fertile territory for the development of health-promoting actions; the effectiveness of the "TPC" (Theorize-Practice-Criticize) instrument in directing university trainees in the strategic planning of oral health education activities; the importance of disseminating, in scientific spaces, the learning from practical experimentation during internships.

Difficulty in distinguishing malignant gastric lymphoma from advanced gastric cancer: Focusing on endoscopic findings of the Borrmann type.

ABSTRACT: Malignant gastric lymphoma (MGL) accounts for a small proportion (upto 5%) of gastric malignancies. However, unlike for advanced gastric cancer (AGC) that requires surgical treatment, the standard treatments for MGL are chemotherapy and radiotherapy. Hence, the initial impression of the endoscopist is critical for the differential diagnosis and for planning future treatment. The purpose of this study was to assess the endoscopic diagnostic accuracy and the possibility of distinguishing between AGC and MGL depending on the endoscopist's experience.A total of 48 patients who had MGL, and 48 age and sex-matched patients who had AGC were assessed by endoscopic review at a tertiary referral hospital between June 2008 and February 2017. Two endoscopic specialists reviewed the endoscopic findings and divided these diagnoses into 5 groups: Borrmann type (1, 2, 3, and 4) and early gastric cancer-like type. After this, 7 experts and 8 trainees were asked to complete a quiz that was comprised of 6 images for each of the 96 cases and to provide an endoscopic diagnosis for each case. The test results were analyzed to assess the diagnostic accuracy according to the pathologic results, endoscopic subgroups, and endoscopists' experience. For inter-observer agreement was calculated with Fleiss kappa values.The overall diagnostic accuracy of endoscopic findings by the experts was 0.604 and that by the trainees was 0.493 (P = .050). There was no significant difference in the diagnosis according to the final pathology (lymphoma cases, 0.518 vs 0.440, P = .378; AGC cases, 0.690 vs 0.547, P = .089, respectively). In the subgroup analysis, the experts showed significantly higher diagnostic accuracy for the endoscopic Borrmann type 4 subgroup, including lymphoma or AGC cases, than the trainees (P = .001). Inter-observer agreement of final diagnosis (Fleiss kappa, 0.174) and endoscopic classification groups (Fleiss kappa, 0.123-0.271) was slightly and fair agreement.The experts tended to have a higher endoscopic diagnostic accuracy. Distinguishing MGL from AGC based on endoscopic findings is difficult, especially for the beginners. Even if the endoscopic impression is AGC, it is important to consider MGL in the differential diagnosis.

Core surgical field camps: a new deanery-based model for enhancing advanced skills in core surgical trainees through simulation.

Hands-on wet lab simulation training is a vital part of modern surgical training. Since 2010, surgical 'boot camps' have been run by many UK deaneries to teach core surgical trainees basic entry level skills. Training in advanced skills often requires attendance at national fee-paying courses. In the Wessex Deanery, multiple, free of charge, core surgical 'field camps' were developed to provide more advanced level teaching in the particular specialty preference of each core surgical trainee. After the COVID-19 pandemic, national hands-on courses will be challenging to provide and deanery-based advanced skills training may be the way forward for craft-based specialties. The experiences over 2 years of delivering the Wessex core surgical field camps are shared, giving a guide and advice for other trainers on how to run a field camp.

Ambiente escolar como cenário de um estágio em atenção primária: análise político-pedagógica de vivências experimentadas / School environment as a stage of an internship in primary care: political-pedagogical analysis of experiences

Objetivo: analisar as significâncias político-pedagógicas de vivências experimentadas por estagiários de um curso de Odontologia em um ambiente escolar. Metodologia: estudo qualitativo transversalmente estruturado sob estratégia narrativo-descritiva e moldado à técnica argumentativa. Resultados: o "Estágio de Clínica Integrada em Atenção Primária" foi didaticamente sistematizado em dois períodos: "Pré-intervenção" e "Intervenção". Do primeiro, desvendaram-se duas ações: "Contextualização dos acadêmicos estagiários" e "Estruturação, ambientalização e levantamento de necessidades do ambiente de trabalho". Já o segundo foi guiado pelo instrumento "TPC" (Teorizar-Praticar-Criticar), em que todas as ações programadas seguiram a lógica ativa do planejamento estratégico, ou seja, contextualizadas às realidades do cenário de prática (ambiente escolar). Conclusão: das experimentações vivenciadas, algumas inferências se destacaram: a efetividade do instrumento "TPC" no direcionamento dos acadêmicos estagiários no planejamento estratégico de atividades de educação em saúde; o reconhecimento do ambiente escolar como território fértil para o desenvolvimento de ações promotoras de saúde; a importância de se disseminar, em espaços científicos, os aprendizados advindos de experimentações práticas de estágios.(AU)

Objective: to analyze the political-pedagogical significance of experiences experienced by trainees of a dentistry course in a school environment. Methodology: qualitative study transversely structured under narrative-descriptive strategy and molded to the argumentative technique. Results: the "Internship of Integrated Clinic in Primary Care" was didactically systematized in two periods, "Pre-intervention" and "Intervention". From the first, two actions were unveiled: the "Contextualization of the Interns" and the "Structuring, Environmentalization and Survey of Work Environment Needs". The second was guided by the instrument "TPC" (Theorize- Practice-Criticize), where all programmed actions followed the active logic of strategic planning, contextualized to the realities of the practice scenario (school environment). Conclusion: from the experiments experienced some inferences stood out: the effectiveness of the "CPT" instrument in guiding the trainee academics in the strategic planning of health education activities; the recognition of the school environment as a fertile territory for the development of health promoting actions; the importance of disseminating, in scientific spaces, the learning that comes from practical experimentation of internships.(AU)

A Binational Need Assessment to Define the Level of Endovascular Expertise Required by Vascular Surgical Trainees.

BACKGROUND: There has been a shift toward competency-based surgical education programs to improve trainee performance and achieve better patient outcomes. Endovascular procedures comprise a significant volume of vascular surgery, but the current methods for assessing the endovascular competence of vascular trainees in Australia and New Zealand are suboptimal. The objective of this study was to perform a need assessment to define the scope of endovascular expertise required by vascular surgical trainees to later aid in the development of novel surgical training assessment tools. METHODS: A modified Delphi method was used to achieve expert consensus. Fifty-three key stakeholders in vascular surgical education and training (SET) in Australia and New Zealand were invited to take part in the 2-stage survey. Experts were asked which procedures they considered to be requisite for vascular surgery trainees and at which SET level competence should be achieved. The results were reiterated to the expert panel in the second stage, and consensus considered achieved if over 75% of experts were in agreement. RESULTS: In the first stage 25 experts reached consensus that competence in 18 of the 26 procedures should be requisite for SET trainees. Twenty-two experts responded to the second stage and consensus was achieved for 12 out of 14 of the procedural items with mean percentage of experts in agreement being 90%. CONCLUSIONS: A need assessment using a modified Delphi method has achieved consensus among experts in vascular surgery regarding the endovascular procedures considered to be requisite for vascular surgery trainees in Australia and New Zealand.

Mentoring, Training, and Scholarly Productivity Experiences of Cancer-Related Health Disparities Research Trainees: Do Outcomes Differ for Underrepresented Scientists?

The study aims to explore variation in scholarly productivity outcomes by underrepresented status among a diverse sample of researchers in a community-engaged training program. We identified 141 trainees from a web-based survey of researchers in the National Cancer Institute-funded, Community Networks Program Centers (CNPCs) (2011-2016). We conducted a series of multiple logistic regression models to estimate the effect of National Institutes of Health (NIH)-defined underrepresented status on four, self-reported, scholarly productivity outcomes in the previous 5 years: number of publications (first-authored and total) and funded grants (NIH and any agency). Sixty-five percent (n = 92) indicated NIH underrepresented status. In final adjusted models, non-NIH underrepresented (vs. underrepresented) trainees reported an increased odds of having more than the median number of total publications (> 9) (OR = 3.14, 95% CI 1.21-8.65) and any grant funding (OR = 5.10, 95% CI 1.77-14.65). Reporting ≥ 1 mentors (vs. none) was also positively associated (p < 0.05) with these outcomes. The CNPC underrepresented trainees had similar success in first-authored publications and NIH funding as non-underrepresented trainees, but not total publications and grants. Examining trainees' mentoring experiences over time in relation to scholarly productivity outcomes is needed.

Twenty-five-Year Follow-up of Short-term Cancer Research Trainees at the University of Alabama at Birmingham: a Brief Report.

Long-term follow-up is needed to evaluate the impact of short-term cancer research programs on the career trajectories of medical and graduate students. Participation in these programs may be crucial in fostering the next generation of cancer research scientists. This report presents the career outcomes and research productivity of 77 medical and public health students with 25 years of tracking data following their participation in a summer cancer research training program at the University of Alabama at Birmingham (UAB) in 1990-1998. Of 64 summer trainees with contact information, complete survey responses were received from 55 (86.0%) individuals. Over half reported clinical care of cancer patients and 18.2% stated that they were engaged in cancer research. Literature searches confirmed that 23.4% (18/77) of trainees have published cancer research papers. Future studies should explore the optimal timing of short-term post-baccalaureate academic cancer training experiences to identify participant characteristics and institutional factors that influence career choices and determine research productivity.

Medical student contact with specialty trainees: Missing out in general practice?

BACKGROUND AND OBJECTIVES: Medical students on clinical placements value positive experiences with specialty trainees. We aimed to document student contact with general practice registrars and other specialty registrars and any relationship between this contact and student career interests. METHOD: Medical students were surveyed following their general practice, general medicine, general surgery, psychiatry and medicine-in-society placements. RESULTS: One hundred and twenty-four students completed the survey (73% response rate). Participants reported substantially less contact with general practice registrars and rural generalist trainees than with other registrars. Compared with students placed in regional areas, metropolitan students were more likely to have no contact at all with general practice registrars. Interest in specialty careers was correlated with interest in knowing more about specialty training, but not with the extent of contact with registrars or personal connections in any specialty studied. DISCUSSION: Student exposure to general practice registrars in at least one Australian medical school is relatively low. Opportunities to increase this should be explored. Students themselves may have little influence over their contact with specialty trainees, despite valuing it highly.

Flipping The Practice Based Pathology Laboratory-Can It Support Development Of Practitioner Capability For Trainee Pathologists in Gynaecological Cytopathology?

This study investigated the role of 'flipping', the practice-based pathology laboratory and classroom to support the development of trainee pathologist practitioners' in the field of gynaecological cytopathology, addressing development of their knowledge and practical application in the clinical setting. Content-rich courses traditionally involve lecture led delivery which restricts tutors from adopting approaches that support greater student engagement in the topic area and application of knowledge to practice. We investigated the role of 'flipping', the practice-based pathology laboratory and classroom where 'virtual lectures' were accessed outside of 'class time' allowing more time for students to engage in active learning under the supervision of a consultant histopathologist. 'Flipping' was used to support two gynaecological cytopathology training courses with cohorts of eight trainee pathologists on the first course and six on the second. Lectures were made available to the trainees to watch before attending the workshops. The workshops consisted of group activities and individual practical exercises allowing trainees to review and report on patient practice cases with the support of their peers and tutors. Focus group sessions were held after each course, allowing trainee pathologists to reflect on their experiences. Discussions were transcribed and thematic analysis was used to capture key themes discussed by the trainees. Trainees' identified that 'flipping' provided them with more time during face-to-face sessions, enabling a greater depth of questioning and engagement with the consultant histopathologists. Having already watched the lectures, trainees were able to attend the sessions having identified areas in which they needed additional support and development. Trainee pathologists reported they had more time to concentrate on developing their skills and practise under the guidance of the consultant histopathologists so developing their capability in gynaecological cytopathology. The role of alternative methods of delivery such as 'flipping' is suggested for short courses designed to support practitioner capability and continued professional development.

Computer Aided Assessment in Microsurgical Training.

BACKGROUND: Acquiring competence in microsurgical suturing is a basic requirement for any trainee aspiring to perform clinical microsurgery. New methods and simulation platform continue to evolve, but the assessment of the quality of microsurgical suturing is largely subjective. We present the concept of computer aided assessment of standardised microsurgical task, using a novel training platform. The platform comprises of a simulator (hardware) that provides the trainee standardised microsurgical tasks, which are then evaluated using a customised software. METHODS: A cohort of trainees attending a five day microsurgery training course was selected. The trainees performed three standardised exercises on the platform, on the first third and the fifth day of the course. All the exercises were subjected to computer aided assessment. RESULTS: Trainees demonstrated a learning curve over the five day period through the evaluation system, with initial increase in performance followed by a plateau. Eighty four percent of the trainees were able to achieve acceptable scores. Sixteen percent of the trainees were unable to perform a suturing of acceptable quality at the end of the training (fifth day). CONCLUSIONS: The mean scores correlated with the level of difficulty of the exercise. We conclude that computer aided assessment can provide an objective view of the quality of suturing as well as skill maintenance in for trainees.

A integralidade como eixo da formação em proposta interdisciplinar: estágios de Nutrição e Psicologia no campo da Saúde Coletiva / The comprehensive care as the axis of interdisciplinary training: Nutrition and Psychology undergraduate in the field of Public Health

Trata-se de relato de experiência de estágio interdisciplinar em Nutrição Social e em Psicologia da Universidade Federal de São Paulo campus Baixada Santista, com foco na integralidade da atenção. O trabalho ocorreu entre 2010 e 2012, na Atenção Básica de Saúde do Sistema Único de Saúde no território Centro/Morro do município de Santos, São Paulo. Utilizaram-se registros de campo contendo memórias de supervisões e de reuniões entre professores e equipe de saúde. Construíram-se narrativas e projetos terapêuticos singulares. Em supervisão conjunta de professores de Nutrição e Psicologia, debateram-se situações destacadas pelos estudantes e planos de trabalho construídos para cada ciclo de formação. Isto fundamentou práticas interdisciplinares, reflexões e ações consoantes ao Sistema Único de Saúde, realizadas pelos estagiários. Os resultados corroboram a importância do trabalho interdisciplinar para a promoção da integralidade, constituindo formas de escuta e atenção diferenciadas aos usuários, em estreita relação com os serviços.

This paper aimed to analyze the experience in interdisciplinary training for Nutrition and Psychology undergraduate courses at the Baixada Santista campus of Universidade Federal de São Paulo, focusing on comprehensive care. It took place between 2010 e 2012, in the Primary Care Health of Unified Health System of Santos municipality, São Paulo, Brazil, in the the territory of Monte Serrat Hill. We used field records from memories of supervisions and meetings between teachers and health team, according to qualitative research. Narratives have been constructed and Singular Therapeutic Projects. In joint-supervision by professors of Nutrition and Psychology courses, we debated situations highlighted by students and constructed work plans for each training cycle. Through interdisciplinary practices reflections and actions to SUS consonants were realized. Our results corroborate the importance of interdisciplinar work towards comprehensive care, promoting ways of listenning which leads to special health care in close relation to the services.