Optimizing the Duration of Trastuzumab: A Fresh Perspective.

Prior to the introduction of trastuzumab, the first targeted anti-HER2 agent, in 1998, patients diagnosed with HER2-positive breast cancer felt like they were being handed a death sentence. Despite treatment with aggressive chemotherapy, their tumors recurred faster, more often spread to brain and liver, and were associated with higher rates of death than HER2-negative tumors. HER2-positive breast cancer was also more prevalent in younger patients, making the diagnosis even more devastating. However, in the 1980s, cancer researcher Axel Ullrich, PhD, and oncologist Dennis Slamon, MD, PhD, recognized that HER2 could be targeted by a small molecule that binds to the receptor on the cell surface and blocks the signal telling the cell to divide. This small molecule was called trastuzumab, and it eventually completely changed how HER2-positive breast cancer was treated.

A meta-analysis of anatomy laboratory pedagogies.

The debate regarding anatomy laboratory teaching approaches is ongoing and controversial. To date, the literature has yielded only speculative conclusions because of general methodological weaknesses and a lack of summative empirical evidence. Through a meta-analysis, this study compared the effectiveness of instructional laboratory approaches used in anatomy education to objectively and more conclusively synthesize the existing literature. Studies published between January 1965 and December 2015 were searched through five databases. Titles and abstracts of the retrieved records were screened using eligibility criteria to determine their appropriateness for study inclusion. Only numerical data were extracted for analysis. A summary effect size was estimated to determine the effects of laboratory pedagogies on learner performance and perceptions data were compiled to provide additional context. Of the 3,035 records screened, 327 underwent full-text review. Twenty-seven studies, comprising a total of 7,731 participants, were included in the analysis. The meta-analysis detected no effect (standardized mean difference = -0.03; 95% CI = -0.16 to 0.10; P = 0.62) on learner performance. Additionally, a moderator analysis detected no effects (P ≥ 0.16) for study design, learner population, intervention length, or specimen type. Across studies, student performance on knowledge examinations was equivalent regardless of being exposed to either dissection or another laboratory instructional strategy. This was true of every comparison investigated (i.e., dissection vs. prosection, dissection vs. digital media, dissection vs. models/modeling, and dissection vs. hybrid). In the context of short-term knowledge gains alone, dissection is no better, and no worse, than alternative instructional modalities. Clin. Anat. 31:122-133, 2018. © 2017 Wiley Periodicals, Inc.

Meta-analysis and review of learner performance and preference: virtual versus optical microscopy.

CONTEXT: Over nearly two decades, a wealth of literature describing the various capabilities, uses and adaptations of virtual microscopy (VM) has been published. Many studies have investigated the effects on and benefits to student learning of VM compared with optical microscopy (OM). OBJECTIVES: This study statistically aggregated the findings of multiple comparative studies through a meta-analysis in order to summarise and substantiate the pedagogical efficacy of teaching with VM. METHODS: Using predefined eligibility criteria, teams of paired researchers screened the titles and abstracts of VM studies retrieved from seven different databases. After two rounds of screening, numerical and thematic data were extracted from the eligible studies for analysis. A summary effect size and estimate of heterogeneity were calculated to determine the effects of VM on learner performance and the amount of variance between studies, respectively. Trends in student perceptions were also analysed and reported. RESULTS: Of the 725 records screened, 72 studies underwent full-text review. In total, 12 studies were viable for meta-analysis and additional studies were reviewed to extract themes relating to learners' perceptions of VM. The meta-analysis detected a small yet significant positive effect on learner performance (standardised mean difference 0.28, 95% confidence interval 0.09-0.47; p = 0.003), indicating that learners experience marked knowledge gains when exposed to VM over OM. Variation among studies was evident as high heterogeneity was reported. An analysis of trends in learner perceptions noted that respondents favoured VM over OM by a large margin. CONCLUSIONS: Although many individual studies have reported non-significant findings in comparisons of VM and OM, the enhanced power afforded by meta-analysis revealed that the pedagogical approach of VM is modestly superior to that of OM and is preferred by learners.

How do practicing physical therapists perceive anatomy education?

The purpose of this investigation was to explore the perceptions of the sufficiency and relevancy of physical therapy anatomy education among early, mid, and late career physical therapists. A survey was distributed via email through clinical networks in the greater Mid-Atlantic region, the American Physical Therapy Association Pennsylvania chapter (APTA-PA), and the American Council of Academic Physical Therapy (ACAPT) Educational Research division. 194 physical therapists responded to the survey. The survey included questions regarding how anatomy was learned in physical therapy school and Likert scale questions investigating opinions of anatomy education. Frequencies were calculated to determine the methods of anatomy education and Likert scale responses. One-way Analysis of Variance (ANOVA) was performed to compare the Likert scale responses from the groupings of survey participants. Respondents across all years of practice felt that their anatomy education was sufficient and relevant to their clinical practice and that schools dedicated enough time to teaching anatomy. Respondents who had a dissection component in their anatomy curriculum were more likely to view dissection as essential. Length of time in practice did not influence opinions on the sufficiency or relevancy of anatomy education. Dissection continues to be included in most physical therapy anatomy courses and perceived as essential for learning. Practicing physical therapists' anatomy education was viewed as sufficient and relevant with few recommendations for change. Perceptions of clinicians should be incorporated into curriculum design and reform and be gathered on an ongoing basis as more students from programs without anatomical donors graduate and enter clinical practice.

The effect of curricular reform on gross anatomy laboratory examination performance: An institutional analysis.

Many medical schools have undergone curricular reform recently. With these reforms, time spent teaching anatomy has been reduced, and there has been a general shift to a pass/fail grading system. At Indiana University School of Medicine (IUSM), a new curriculum was implemented in fall 2016. The year-long human gross anatomy course taught in 2015 was condensed into an integrated, semester-long course starting in 2016. Additionally, the grading scale shifted to pass/fail. This study examined first-year medical student performance on anatomy practical laboratory examinations-specifically, among lower-order (pure identification) questions and higher-order (function, innervation) questions. Participants included medical students from a pre-curricular reform cohort (year 2015, 34 students) and two post-curricular reform cohorts (years 2016, 30 students and 2017, 33 students). A Kruskal-Wallis ANOVA test was used to determine differences of these questions among the three cohorts. Additionally, 40 of the same lower-order questions that were asked on gross anatomy laboratory examinations from medical student cohort year 2015 and year 2016 were further analyzed using an independent samples t-test. Results demonstrated that the pre-curricular reform cohort scored significantly higher on both lower-order (median = 81, p < 0.001) and higher-order questions (median = 82.5, p < 0.05) than both post-curricular reform cohorts. Additionally, when reviewing the selected 40 similar questions, it was found that the pre-curricular reform cohort averaged significantly higher (82.1 ± 16.1) than the post-curricular reform cohort from 2016 (69.3 ± 21.8, p = 0.004). This study provides evidence about the impact of curricular reform on medical student anatomical knowledge.

Cancer of the Paranasal Sinuses.

Sinonasal malignancies rare and pathologically diverse and make up <1% of all malignancies. Due to their anatomical location, they can cause significant morbidity with involvement of surrounding critical structures. They often present at a late stage with insidious onset of symptoms. Treatment of sinonasal malignancies is challenging and they often require a multimodality approach with surgery, radiation, and chemotherapy. Outcomes are poor with 5-year overall survival around 32%, but this varies greatly depending on histologic subtype. There is an urgent need for more randomized controlled trials to better define the appropriate therapeutic regimens and to improve clinical outcomes.

Incidence trends of squamous cell carcinoma of the head and neck (SCCHN) in the aging population--A SEER-based analysis from 2000 to 2016.

BACKGROUND: Tobacco and alcohol use are risk factors for Squamous Cell Carcinoma of the Head and Neck (SCCHN); however, there is growing recognition of HPV as a risk factor for SCCHN. HPV-related SCCHN is thought to affect mostly middle-aged individuals but as the US population ages, it is important to evaluate the change in incidence of HPV- and non-HPV-related SCCHN in individuals who are ≥65 years old. METHODS: This was a retrospective study using data from a population-based cancer registry (SEER) to identify individuals ≥65 years old diagnosed with SCCHN between 2000 and 2016 also stratified by sex, race, and birth cohort. The subgroups of HPV-associated and non-HPV associated sites were analyzed independently. The incidence per year was calculated and joinpoint detection was used to identity significant changes in incidence trends and annual percent change (APC). RESULTS: For HPV-associated sites from 2000 to 2016, there was an average annual rate of 10.8 per 100,000 individuals with an APC of 2.92% (p = <0.05). For HPV- and non-HPV-related SCCHN males had a higher annual rate compared to females, 54.5 versus 18.0 in non-HPV-related and 19.1 versus 4.4 in HPV-related sites. For non-HPV-related sites there was a decrease in APC across all stratified groups. For HPV-related sites there was an increase in APC across all stratified groups, especially males (APC 8.82% 2006-2016 p < 0.05) and White individuals (APC 8.19% 2006-2016 p < 0.05). When stratified by birth cohort, HPV-related SCCHN sites had a higher APC in ages 65-69 (8.38% p < 0.05) and 70-74 (8.54% p < 0.05). CONCLUSION: Among the population ≥65 years old from 2000 to 2016, the incidence rate for HPV-related SCCHN sites has increased across all stratified groups, especially in White individuals, males, and age groups 65-74. The incidence rate for non-HPV-related sites has decreased across all stratified groups during this time.

Rise in Node-Positive Prostate Cancer Incidence in Context of Evolving Use and Extent of Pelvic Lymphadenectomy.

BACKGROUND: The incidence of node-positive prostate cancer has risen and might be partially explained by evolving use of lymphadenectomy at a population level. We assessed trends of node-positive prostate cancer in context of extent of lymphadenectomy among men treated surgically for prostate cancer. PATIENTS AND METHODS: This was a retrospective study using data from a population-based cancer registry to identify men older than 50 years of age diagnosed with prostate cancer from 2010 to 2015 without distant metastases. We considered extent of node dissection as ordinal (1-4, 5-9, 10-14, 15-19, ≥20) and dichotomous (1-14, ≥15) variables. We fit multivariable models to assess trends in receipt of extended lymphadenectomy and then estimated odds of node-positive cancer on the basis of extent of lymphadenectomy. RESULTS: We identified 280,156 men diagnosed from 2010 to 2015; 5355 men (1.9%) had positive lymph nodes. Incidence of positive nodes increased from 6.4 to 8.4 cases per 100,000 men from 2010 to 2015 (standardized rate ratio, 1.31; 95% confidence interval [CI], 1.20-1.44). Compared with 2010, prostatectomy patients with high-risk (odds ratio [OR], 1.66; 95% CI, 1.42-1.95) and intermediate-risk tumors (OR, 1.66; 95% CI, 1.47-1.88) were more likely to undergo extended lymphadenectomy in 2015. Among high-risk patients, men with ≥20 nodes removed were 7 times more likely to have positive nodes, versus <5 removed (6.1% for 1-4 vs. 32.4% for ≥20; OR, 7.32; 95% CI, 6.16-8.71). After adjusting for extent of dissection, odds of node-positive disease did not increase between 2010 and 2015 (OR, 1.17; 95% CI, 0.98-1.39) among high-risk patients. CONCLUSION: Increased incidence of node-positive prostate cancer in the United States is partially explained by more frequent use of extended lymphadenectomy.

Breaking with Tradition: A Scoping Meta-Analysis Analyzing the Effects of Student-Centered Learning and Computer-Aided Instruction on Student Performance in Anatomy.

While prior meta-analyses in anatomy education have explored the effects of laboratory pedagogies and histology media on learner performance, the effects of student-centered learning (SCL) and computer-aided instruction (CAI) have not been broadly evaluated. This research sought to answer the question, "How effective are student-centered pedagogies and CAI at increasing student knowledge gains in anatomy compared to traditional didactic approaches?" Relevant studies published within the past 51 years were searched using five databases. Predetermined eligibility criteria were applied to the screening of titles and abstracts to discern their appropriateness for study inclusion. A summary effect size was estimated to determine the effects of SCL and CAI on anatomy performance outcomes. A moderator analysis of study features was also performed. Of the 3,035 records screened, 327 underwent full-text review. Seven studies, which comprised 1,564 participants, were included in the SCL analysis. An additional 19 studies analyzed the effects of CAI in the context of 2,570 participants. Upon comparing SCL to traditional instruction, a small positive effect on learner performance was detected (standardized mean difference (SMD = 0.24; [CI = 0.07, 0.42]; P = 0.006). Likewise, students with CAI exposure moderately outscored those with limited or no access to CAI (SMD = 0.59; [CI = 0.20, 0.98]; P = 0.003). Further analysis of CAI studies identified effects (P ≤ 0.001) for learner population, publication period, interventional approach, and intervention frequency. Overall, learners exposed to SCL and supplemental CAI outperformed their more classically-trained peers as evidenced by increases in short-term knowledge gains. Anat Sci Educ. © 2018 American Association of Anatomists.

The sum of all parts: an Australian experience in improving clinical partnerships.

AIM: To create a collaborative partnership between the education provider (University) and the placement provider (Hospital) to facilitate the identification and development of strategies to improve capacity and capability for nursing clinical placements. This partnership was labelled (TULIP) to identify the two partners and it purpose as a learning investment project. BACKGROUND: The quality of clinical learning is interdependent on the collaborative clinical health partnerships between Hospital, University, preceptors/facilitators and students. Success is dependent on communication between all key stakeholders within the partnership, to meet capacity and capability demand. DESIGN: Collaborative quality assurance project in combination with two research projects. METHOD: Quantitative and qualitative measurements of student perceptions, preceptor understanding and organisation partnership capacity and capability over a three year period in an acute care hospital. RESULTS: Qualitative and quantitative data from students and preceptors, and hospital quality assurance data linked to become the TULIP framework for a clinical placement development model that addresses the key components of strategic communication, resourcing and staff acknowledgement between stakeholders. CONCLUSIONS: The outcomes achieved demonstrated student engagement, clinical leadership from registered nursing staff, and the establishment of a collaborative partnership between hospital executives and staff, and the university resulting in an increased capacity. The TULIP project has provided both partners with a sustainable plan for growth in student placements, improved strategies to develop clinical leadership practice in individual nurses and a better clinical learning environment for staff that uses a framework that is transferrable to other health settings.

Clinical evaluation tools for dual track adult and gerontology nurse practitioner students.

PURPOSE: To describe the development of a dual track offering for the Adult Health and Gerontology Nurse Practitioner (AGNP) Programs at the University of Pennsylvania School of Nursing and share clinical evaluation tools used with nurse practitioner students in this curriculum. DATA SOURCES: Selected research and clinical articles. CONCLUSIONS: A variety of evaluation approaches are utilized in the AGNP student clinical performance evaluation. These incorporate the extended clinical practicum sequence for the dual track curriculum in addition to each individual program's objectives. Formative and summative evaluations include reflective logs, clinical documentation of patient encounters, preceptor evaluation, and faculty site visits. Self-evaluative skills of the student and quality faculty feedback are two additional integral components that facilitate learning outcomes in the cognitive, psychomotor, and affective learning domains. IMPLICATIONS FOR PRACTICE: The summary of evaluation tools presented here is an example of how the AGNP Programs at the University of Pennsylvania School of Nursing effectively measure student progress in a curriculum model for dual track enrollment.

Ren1c homozygous null mice are hypotensive and polyuric, but heterozygotes are indistinguishable from wild-type.

Mice lacking Ren1c were generated using C57BL/6-derived embryonic stem cells. Mice homozygous for Ren1c disruption (Ren1c-/-) are born at the expected ratio, but approximately 80% die of dehydration within a few days. The surviving Ren1c-/- mice have no renin mRNA expression in the kidney, hydronephrosis, thickening of renal arterial walls, and fibrosis in the kidney. Plasma renin and angiotensins I and II are undetectable. Urinary aldosterone is 6% wild-type. They have low tail-cuff BP (84 +/- 4 versus 116 +/- 5 mmHg in +/+) and excrete large amounts of urine (5.2 +/- 0.8 ml/d, 725 +/- 34 mOsm versus 1.1 +/- 0.1 ml/d, 2460 +/- 170 mOsm in +/+). After 5 d of drinking 5% dextrose, desmopressin does not increase the osmolality of the urine in -/- mice (624 +/- 19 to 656 +/- 25 mOsm), whereas in +/+, it increases severalfold (583 +/- 44 to 2630 +/- 174 mOsm). Minipump infusion of angiotensin II to Ren1c-/- mice restores BP to wild-type level, but preexisting damage to the medulla prevents complete restoration of the ability of the kidney to concentrate urine. Heterozygous Ren1c+/- mice, in contrast, are indistinguishable from +/+ in BP, urine volume, and osmolality. Kidney renin mRNA, the number of kidney cells producing renin, and plasma renin concentration in the Ren1c+/- mice are also indistinguishable from +/+. These results demonstrate that renin is the only enzyme capable of maintaining plasma angiotensins and that renin expression in the kidney is very tightly regulated at the mRNA level.