Comparative Effectiveness and Resource Usage in Patients Receiving First-line Taxane-based Chemotherapy for Stage IV Non-Small-cell Lung Cancer in a US Community Oncology Setting.

BACKGROUND: Weekly (qw) nanoparticle albumin-bound (nab)-paclitaxel was approved for advanced non-small-cell lung cancer based on the results from a phase III trial in which nab-paclitaxel/carboplatin demonstrated a significantly greater response rate compared with paclitaxel/carboplatin every 3 weeks (q3w). Little information exists on relative real-world results. MATERIALS AND METHODS: The present retrospective study used data from a national electronic medical record database. Patients receiving first-line nab-paclitaxel qw, paclitaxel qw, or paclitaxel q3w for stage IV non-small-cell lung cancer (NSCLC) were identified. The total cumulative dose, time to treatment discontinuation (TTD), and database persistence (a proxy measure for survival) were analyzed for all patients and for the squamous and elderly subgroups. RESULTS: A total of 114, 208, and 153 patients received nab-paclitaxel qw, paclitaxel qw, and paclitaxel q3w, respectively. In the corresponding treatment arms, the median age was 72, 69, and 67 years; 56%, 48%, and 37% were aged ≥ 70 years; and 75%, 43%, and 23% had squamous cell NSCLC. The total cumulative dose was significantly greater with nab-paclitaxel qw. The TTD was longer with nab-paclitaxel qw than with paclitaxel qw (hazard ratio [HR], 0.54; 95% confidence interval [CI], 0.40-0.72; P < .001) or with paclitaxel q3w (HR, 0.53; 95% CI, 0.38-0.73; P < .001). Database persistence was longer with nab-paclitaxel qw than with paclitaxel qw (HR, 0.56; 95% CI, 0.39-0.79; P = .001) or with paclitaxel q3w (HR, 0.52; 95% CI, 0.34-0.78; P = .002). The TTD after experiencing any hematologic adverse event was longer with nab-paclitaxel qw. The findings were consistent across the subgroup analyses. CONCLUSION: In a real-world setting, nab-paclitaxel qw was associated with a significantly greater cumulative dose and significantly longer TTD and database persistence compared with paclitaxel qw and paclitaxel q3w.

Dental Hygiene Faculty Calibration Using Two Accepted Standards for Calculus Detection: A Pilot Study.

Faculty calibration studies for calculus detection use two different standards for examiner evaluation, yet the only therapeutic modality that can be used for nonsurgical periodontal treatment is scaling/root debridement or planing. In this study, a pretest-posttest design was used to assess the feasibility of faculty calibration for calculus detection using two accepted standards: that established by the Central Regional Dental Testing Service, Inc. (CRDTS; readily detectible calculus) and the gold standard for scaling/root debridement (root roughness). Four clinical dental hygiene faculty members out of five possible participants at Halifax Community College agreed to participate. The participants explored calculus on the 16 assigned teeth (64 surfaces) of four patients. Calculus detection scores were calculated before and after training. Kappa averages using CRDTS criteria were 0.561 at pretest and 0.631 at posttest. Kappa scores using the scaling/root debridement or planing standard were 0.152 at pretest and 0.271 at posttest. The scores indicated improvement from moderate (Kappa=0.41-0.60) to substantial agreement (Kappa=0.61-0.80) following training using the CRDTS standard. Although this result differed qualitatively and Kappas were significantly different from 0, the differences for pre- to post-Kappas for patient-rater dyads using CRDTS were not statistically significant (p=0.778). There was no difference (p=0.913) in Kappa scores pre- to post-training using the scaling/root debridement standard. Despite the small number of participants in this study, the results indicated that training to improve interrater reliability to substantial agreement was feasible using the CRDTS standard but not using the gold standard. The difference may have been due to greater difficulty in attaining agreement regarding root roughness. Future studies should include multiple training sessions with patients using the same standard for scaling/root debridement used for evaluation of students.

Student Physical Therapists' Competence and Self-Confidence in Basic Clinical Assessment and Musculoskeletal Differential Diagnosis.

UNLABELLED: Student physical therapists are expected to learn and confidently perform technical skills while integrating nontechnical behavioral and cognitive skills in their examinations and interventions. OBJECTIVE: The purpose of this study was to compare the self-confidence of entry-level doctoral student physical therapists during foundational assessment and musculoskeletal differential diagnosis courses and the students' competencies based on skills examinations. DESIGN: Methods using qualitative and quantitative procedures. METHODS: Student physical therapists (n=27) participated in a basic assessment course followed by a musculoskeletal differential diagnosis course. The students completed confidence surveys prior to skills examinations in both courses. A random sample of students participated in focus groups, led by a researcher outside the physical therapy department. RESULTS: Student confidence did not correlate with competency scores. At the end of the basic clinical assessment course and the beginning of the differential diagnosis course, students' confidence was significantly below baseline. However, by the end of the differential diagnosis course, student confidence had returned to original baseline levels. CONCLUSIONS: Over three semesters, the students lost confidence and then regained confidence in their abilities. Additional experience and practice influenced perceived confidence. However, increased competence may have been associated with poor self-appraisal skills instead of increased competency.

Burnout in Rural Physician Assistants: An Initial Study.

PURPOSE: To assess the prevalence and causes of burnout in rural physician assistants. (PA in this article refers to personal accomplishment. To avoid confusion, we will spell out physician assistant throughout the article, instead of using PA to refer to both physician assistant and personal accomplishment.) METHODS: Physician assistants who practice in rural communities were asked to complete the Maslach Burnout Inventory. A preliminary assessment of burnout was determined using the 3 Maslach Burnout Inventory subscale scores: emotional exhaustion, depersonalization, and personal accomplishment, as well as causes of burnout assessed for a correlation to personal and professional factors. RESULTS: Burnout within the rural physician assistant population responding to this survey (response rate = 11.3%) was measured to have high to moderate emotional exhaustion and depersonalization subscores (64% each) and a low to moderate personal accomplishment subscore (46%). CONCLUSIONS: The rural physician assistant population who responded to this survey exhibited burnout correlating to feelings of professional isolation and various workplace conditions such as the adequacy of administrative support and control over workload. To begin addressing burnout within this community, we suggest adjusting rural physician assistant workload and support, enhancing professional communications, and addressing burnout prevention techniques within physician assistant training programs.

Understanding the Structural, Human Resource, Political, and Symbolic Dimensions of Implementing and Sustaining Interprofessional Education.

UNLABELLED: This study investigated the perceptions of deans and faculty members of the Association of Schools of Allied Health Professions (ASAHP) concerning the degree to which their institutions implement and integrate the structural, human resource, political, and symbolic frames or dimensions of interprofessional education (IPE). The study identified correlations among these frames/dimensions, including their relationship with overall IPE program progress and success. METHODS: This study utilized a nonexperimental comparative descriptive and correlational survey design. The instrument was developed by the researchers and administered online using a readily accessible data collection process. Data were analyzed using descriptive and inferential statistics. Content validity and reliability were established prior to full implementation of the survey. RESULTS: Results revealed high levels of interest but lower levels of progress and success in implementing the various frames/dimensions of IPE. Strong correlations existed between the structural, human resource, political, and symbolic dimensions of IPE, and these dimensions individually and collectively predicted overall IPE program progress and success. CONCLUSION: The differences between interest and performance raised important questions and led to conclusions about leadership effectiveness, organizational clarity, and the process of implementing the organizational change needed for effective IPE at ASAHP institutions.

Spatial and Census Data to Evaluate Obese Persons and their Environment (SCOPE).

OBJECTIVE: To evaluate the built environment and its relationship to BMI for individuals in eastern Idaho. METHODS: Geospatial analyses were coupled to demographic data of adult individuals. ArcGIS Community Analyst was used to compare demographics relative to median BMI. RESULTS: For every kilometer increase in distance to prepared food sites, BMI went down by 1.3% and every kilometer increase in distance to green space, BMI went down by 0.8% (p < .001). For every kilometer increase in distance to trails, BMI went up by 1.5%. No other built environment variables had a statistically significant association with BMI. CONCLUSION: The distance to prepared foods and trails was associated with expected changes in BMI. Conversely, increased distance to green space was associated with a lower BMI.

A faculty development course to enhance dental hygiene distance education: a pilot study.

This article describes the implementation and evaluation of a dental hygiene faculty development course to enhance online teaching practices that foster a sense of community and satisfaction. The sampled population was drawn from the forty-seven U.S. dental hygiene programs that the American Dental Hygienists' Association identified as offering bachelor's degree completion or master's degree programs with 76-100 percent of coursework delivered in an online format. This requirement was applied to exclude programs using hybrid instruction (combination of online and face-to-face). Of the thirty-four faculty members who self-identified as meeting the criteria, seven agreed to participate (21 percent response rate); however, only five completed all parts of the study (a final response rate of 15 percent). A Community of Inquiry framework was the basis for the author-designed Distance Education Best Practices Survey used as a pretest and posttest to assess participants' use of and perceived importance of twenty-five best practices before and after taking the online faculty development course. Frequency of use ratings ranged from 4.0 (regularly) to 5.0 (always) on a response scale from 1.0 to 5.0. The results showed significant increases from before to after the course in participants' perceptions of the importance of four practices: activities promoting relevant, lifelong learning (p=0.03); faculty communication fostering a sense of community (p=0.04); encouraging students' self-introduction (p=0.04); and encouraging productive dialogue and respecting diverse opinions (p=0.04). The findings indicate a potential value for a faculty development course designed to enhance online teaching, sense of community, and satisfaction, even for faculty members with high self-ratings regarding best practices.

Oral health champions in long-term care facilities-a pilot study.

This preintervention/postintervention pilot study examined impact of onsite support by a dental hygiene champion (DHC) on oral health and quality of life (QOL) of elderly residents in three long-term care facilities (LTCFs) in Arkansas. Oral health and oral health-related QOL were operationalized using the Oral Health Assessment Tool (OHAT) and Geriatric Oral Health Assessment Index (GOHAI), respectively. CNAs in Facility A received standardized oral health education/materials with onsite DHC support. Facility B received education/materials only. Facility C served as control. Data analyses included Wilcoxon-signed rank tests (OHAT) and repeated measures ANOVA (GOHAI) (p ≤ .05). OHAT postintervention data in Facility A showed significant improvements in three measured areas (tongue health, denture status, and oral cleanliness); in Facility B, one area (tongue health); and none in Facility C. No significant differences were found in GOHAI scores across facilities. Findings suggest that the presence of DHCs in LTCFs may positively impact the oral health of CNA-assisted residents.

Developing dental hygiene students as future leaders in legislative advocacy.

The purpose of this investigation was to determine the effect of a legislative advocacy project on the knowledge, values, and actions of dental hygiene students enrolled in a leadership course. A quasi-experimental design was employed with a convenience sample of twenty-one undergraduate and seventeen graduate students. The data collection instrument was designed by the authors with three scales (knowledge, values, and actions), a section on barriers to future advocacy actions, and two open-ended questions. Content validity of the instrument was established before it was administered with an online survey tool. Students scored their pre-project and post-project status on the three scales. Cronbach's alphas revealed internal consistency of the three scales at 0.95 or higher. Pre-project scores and post-project scores were analyzed by parametric tests and confirmed using nonparametric tests. Knowledge, values, and actions statements were statistically significant; however, actions were rated the lowest. Multiple barriers for future advocacy actions were identified. Implementation of a legislative advocacy project in an undergraduate and graduate leadership course can positively influence the development of knowledge, values, and actions; however, mentorship in the professional association is needed after graduation to continue the development of future leaders.

Perceived risk, severity of abuse, expectations, and needs of women experiencing intimate partner violence.

This prospective, descriptive, correlational study examined perceived risk, severity of abuse, expectations, and needs of women experiencing intimate partner violence (IPV) with arrest of the offender occurring at the time of incident. This study builds on previous research completed on fear and expectations of female victims/survivors of IPV that come to the attention of police, to expand knowledge of women's experiences once they enter the criminal justice system and to create a comprehensive response to this recognized public health problem (). Forty-three women were interviewed regarding the incident, relationship, and experience. Most of the women in this study reported experiencing mild violence and varied forms of threats. There was a significant relationship between the experience of mild violence, serious violence, sexual violence, threats to victims, threats to objects, and others and nonverbal threats with fear of the offender. However, there were no significant correlations between levels of violence or threats with perceived risk of future physical abuse. As the criminal justice response to this crime has changed with the development of legislation and laws aimed at keeping women safe and holding offenders accountable, further research is needed to understand the experience of IPV victims and support an informed response. Forensic nurses are critical interdisciplinary team members in these efforts and play a significant role in providing expertise, sharing of knowledge, and application of evidence fostering victim-centered approaches to addressing IPV.

Predictors of intention to use condoms among Chinese college students.

China is experiencing one of the fastest growing human immunodeficiency virus (HIV) epidemics in the world. Condom use is consistently low among Chinese college students. The purpose of this study was to identify the predictors that determine the intention to use condoms among Chinese college students applying the theory of planned behavior (TPB). A non-probability convenience sample of 433 participants was drawn from three universities in Central, Eastern, and Southwestern China, respectively. An anonymous written questionnaire was self-administered. Data were collected and analyzed descriptively and statistically using Predictive Analytical Software 19.0. Multiple linear regression was performed to identify the predictors among 402 participants with non-missing data. Eighteen percent (78/433) of the participants reported being sexually active in the past 6 months. The percentage of times these individuals reported using condoms during intercourse was 38.19%. Intention to use condoms was statistically significantly (R(2) = 50.4%) predicted by attitudes (ß = 0.213), subjective norms (ß = 0.259), and perceived behavior control (PBC) (ß = 0.332). All predictors were statistically significant at the 0.001 level (p < 0.001). PBC was the strongest predictor of intention to use condoms. The study findings indicated that the TPB could be used as a framework to determine the predictors of intention to use condoms among the Chinese college students. It is recommended that the HIV education programs should increase the intention to use condoms through promoting positive attitudes, subjective norms and PBC of condom use in Chinese college students.

Effects of periodontal instrumentation on quality of life and illness in patients with chronic obstructive pulmonary disease: a pilot study.

PURPOSE: To assess if patients with chronic obstructive pulmonary disease (COPD) receiving periodontal debridement for treatment of chronic periodontitis with ultrasonic or hand instrumentation experienced changes in quality of life or incidents of illness following treatment or no treatment. METHODS: The study design was a 3 group, randomized, controlled pre- and post-test experimental pilot study. Volunteers with COPD and chronic periodontitis (n=30) were recruited from physician offices or fliers and randomly assigned to 1 of 3 groups. Of those, 2 groups had periodontal debridement using either magnetostrictive ultrasonic instrumentation (n=10) or hand instrumentation (n=10). A control group (n=10) received no treatment. Primary outcomes, quality of life and illness were measured by the St. George's Respiratory Questionnaire (SGRQ-A) and Illness Questionnaire, respectively. Subjects completed the questionnaires as pre-tests at baseline and as post-tests 4 weeks post-treatment/no treatment. Repeated measures ANOVA was used to compare groups on continuous variables (p ≤ 0.05) measured by SGRQ-A total scores and symptoms, activities and impacts subscales. Percentages, frequencies and cross tabulations were calculated for categorical data. RESULTS: SGRQ-A and Illness Questionnaire scores showed no significant differences between groups in quality of life or illness following periodontal debridement. Total SGRQ-A scores decreased slightly for all groups with no significant difference among groups (p=0.138) and no interaction (p=0.794). Cross tabulations showed no relationship between indicators of self-reported illness before and after treatment/no treatment. No adverse events were reported. CONCLUSION: Based on this small-scale study, it seems periodontal debridement for chronic periodontitis has no effect on quality of life and illness in patients with COPD, and it may be performed with ultrasonic or hand instruments without adverse events.

Hospital missions and the education of our future health care workforce.

Today's U.S. health care industry is facing unprecedented shortages of health personnel in a great variety of disciplines and locations. An adequate supply of well-educated and trained health professionals is imperative to ensure sufficient access to health care for our citizenry. Hospital mission statements reflect the character, strategic direction, and priorities of the organization; thus, we might expect these statements to address the position and strategy of the organizations in regard to education of future health professionals. To investigate hospitals' publicly stated attention and commitment to the education of health professionals, we analyzed publicly available mission statements from a random stratified sample of 402 hospitals. The hospitals were stratified on the basis of teaching status, rural or urban, and profit status. The percentage of hospitals mentioning an education-related keyword was estimated using a 95% confidence interval with a finite population correction factor on the proportion within each stratum. As expected, teaching hospitals were significantly more likely to include language about education in their mission statements than nonteaching hospitals, with 74% of teaching hospitals mentioning education at least once. We found no significant difference in the use of education language among the mission statements of nonteaching hospitals, where 20% mentioned education at least once. From these findings, we conclude that despite the key importance of health professionals, strategies and policy regarding the education of future health personnel have not yet become "mission level" in importance to hospitals.

Students' perceptions of the interprofessional team in practice through the application of servant leadership principles.

This study examined students' perceptions of interprofessional practice within a framework of servant leadership principles, applied in the care of rural older adults utilizing a service learning model. Mobile wellness services were provided through the Idaho State University Senior Health Mobile project in a collaborative team approach in the community-based setting. Students from varied health professional programs were placed in teams for the provision of wellness care, with communication among team members facilitated by a health professions faculty member serving as field coordinator. The Interdisciplinary Education Perception Scale (IEPS) was used to measure students' perceptions of interprofessional practice using a pretest post-test research design. Multivariate analysis was performed revealing a significant pretest to post-test effect on students' perceptions as measured by factors inherent in the IEPS and deemed essential to effective interprofessional practice. Univariate analysis revealed a significant change in students' perception of professional competence and autonomy, actual cooperation and resource sharing within and across professions, and an understanding of the value and contributions of other professionals from pretest to post-test.

Changes in students' perceptions of interdisciplinary practice reaching the older adult through mobile service delivery.

This study examined students' perceptions of interdisciplinary health care practice in a facilitated, community-based practicum experience. Students' perceptions of interdisciplinary practice relative to their own profession and other health disciplines were examined before and after involvement in mobile service delivery to the older adult in a collaborative team approach. The Interdisciplinary Education Perception Scale was used to collect data before and after planned and facilitated interdisciplinary experiences of students enrolled in health professional programs (nursing, dietetics, physical therapy, occupational therapy, pharmacy, health education, social work, and physician assistant). Univariate repeated-measures analysis of variance revealed significant pretest to posttest and discipline effects following the interdisciplinary interaction of students in the practicum experience. Univariate analysis revealed a significant change in students' perceptions of professional competence and autonomy, actual cooperation and resource sharing within and across professions, and understanding of the value and contributions of other professionals from pretest to posttest. The findings support the need for educators to facilitate communication through innovative interdisciplinary clinical opportunities for health professions students to influence perceptions that promote active participation in a team approach to care delivery in an increasingly complex health care system.

Gender interactions and success.

Does gender by itself, or does gender's interaction with career variables, better explain the difference between women and men's careers in healthcare management? US healthcare managers were surveyed regarding career and personal experiences. Gender was statistically interacted with explanatory variables. Multiple regression with backwards selection systematically removed non-significant variables. All gender interaction variables were non-significant. Much of the literature proposes that work and career factors impact working women differently than working men. We find that while gender alone is a significant predictor of income, it does not significantly interact with other career variables.

Blood pressure control and factors predicting control in a treatment-compliant male veteran population.

STUDY OBJECTIVE: To estimate blood pressure control and identify treatment variables predicting control in treatment-compliant, hypertensive, male veterans. SETTING: Outpatient clinic of a Veterans Affairs medical center. DESIGN: Retrospective review of computerized patient records over a 12-month period for demographics, comorbidities, patient-specific blood pressure goals, blood pressure history, antihypertensive therapy, and refill history. PATIENTS: Two hundred fifty hypertensive men aged 39-90 years whose antihypertensive regimen remained unchanged over 12 months. MEASUREMENTS AND MAIN RESULTS: The proportion of patients with blood pressures below 160/90 mm Hg was 86%; only 34.8% had pressures below 140/90 mm Hg. Blood pressure control was less common with advancing age (42.1%, 33.7%, and 29.4% for patients aged < 60, 60-75, and > 75 yrs, respectively, p = 0.057 for trend). Treatment intensity was highest in obese men, those aged 60-75 years, and those with a history of chronic heart failure or angina, and lowest in men older than 75 years or with a history of stroke. Blood pressure control was independently associated with therapy with beta-blockers (odds ratio [OR] 3.5, 95% confidence interval [CI] 1.5-10.2, p = 0.005), loop diuretics (OR 4.3, 95% CI 1.6-12.1, p = 0.005), angiotensin-converting enzyme inhibitors (OR 3.1, 95% CI 1.2-8.2, p = 0.025), and long-term simvastatin therapy (OR 3.7, 95% CI 1.9-7.4, p = 0.0001), and with a diagnosis of coronary artery disease (OR 3.2, 95% CI 1.35-7.69, p = 0.009). The relationship between simvastatin therapy and blood pressure control persisted after controlling for the higher treatment intensity in patients taking the drug. Factors predicting poor control included a history of stroke (OR for control 0.36, 95% CI 0.19-0.69, p = 0.002), age over 75 years (OR 0.43, 95% CI 0.18-0.98, p = 0.046), highest low-density lipoprotein tertile (OR 0.37, 95% CI 0.17-0.80, p = 0.013), highest body mass index tertile (OR 0.46, 95% CI 0.21-1.00, p = 0.05), and therapy with two or fewer antihypertensives (OR 0.14, 95% CI 0.04-0.61, p = 0.009). CONCLUSION: In a compliant veteran population, control of blood pressure appeared inadequate but was significantly more likely in those receiving at least three antihypertensive agents. Long-term therapy with simvastatin was independently associated with increased odds of control.