Long-term survivors of glioblastoma: Tumor molecular, clinical, and imaging findings.

Background: Glioblastoma (GBM) is the most aggressive primary brain malignancy with <45% living a year beyond diagnosis. Previously published investigations of long-term survivors (LTS) provided clinical data but rarely incorporated a comprehensive clinical and molecular analysis. Herein, we identify clinical, imaging, molecular, and outcome features for 23 GBM-LTS patients and compare them with a matched cohort of short-term survivors (STS). Methods: Molecularly confirmed Isocitrate Dehydrogenase (IDH) wildtype GBM patients living ≥3 years post-diagnosis (NLTS = 23) or <3 years (NSTS = 75) were identified from our Natural History study. Clinical and demographic characteristics were compared. Tumor tissue was analyzed with targeted next generation sequencing (NGS) (NLTS = 23; NSTS = 74) and methylation analysis (NLTS = 18; NSTS = 28). Pre-surgical MRI scans for a subset of LTS (N = 14) and STS control (N = 28) matched on sex, age, and extent of resection were analyzed. Results: LTS tended to be younger. Diagnostic MRIs showed more LTS with T1 tumor hypointensity. LTS tumors were enriched for MGMTp methylation and tumor protein 53 (TP53) mutation. Three patients with classic GBM histology were reclassified based on NGS and methylation testing. Additionally, there were LTS with typical poor prognostic molecular markers. Conclusions: Our findings emphasize that generalized predictions of prognosis are inaccurate for individual patients and underscore the need for complete clinical evaluation including molecular work-up to confirm the diagnosis. Continued accrual of patients to LTS registries that containcomprehensive clinical, imaging, tumor molecular data, and outcomes measures may pro\vide important insights about individual patient prognosis.

Feasibility and preliminary efficacy of a virtual reality intervention targeting distress and anxiety in primary brain tumor patients at the time of clinical evaluation: Study protocol for a phase 2 clinical trial.

Background: Primary brain tumor (PBT) patients experience higher levels of distress and anxiety than other solid tumor patients, particularly at the time of clinical evaluation when uncertainty about disease status is high ("scanxiety"). There is promising evidence supporting use of virtual reality (VR) to target psychological symptoms in other solid tumor patients, though PBT patients have not been studied extensively in this context. The primary aim of this phase 2 clinical trial is to establish the feasibility of a remote VR-based relaxation intervention for a PBT population, with secondary aims designed to determine preliminary efficacy of improving distress and anxiety symptoms. Methods: PBT patients (N=120) with upcoming MRI scans and clinical appointments who meet eligibility will be recruited to participate in a single arm trial conducted remotely through the NIH. Following completion of baseline assessments, participants will complete a 5-minute VR intervention via telehealth using a head-mounted immersive device while under supervision of the research team. Following the intervention, over the course of 1 month patients can use VR at their discretion with follow-up assessments done immediately post-VR intervention, as well as 1 week and 4 weeks later. Additionally, a qualitative phone interview will be conducted to assess patient satisfaction with the intervention. Discussion: Use of immersive VR is an innovative interventional approach to target distress and scanxiety symptoms in PBT patients who are at high risk for experiencing these symptoms leading into their clinical appointments. Findings from this study may inform design of a future multicenter randomized VR trial for PBT patients and may aid in development of similar interventions for other oncology populations. Trial Registration: clinicaltrials.gov (NCT04301089), registered 9 March 2020.

Feasibility of a virtual reality intervention targeting distress and anxiety symptoms in patients with primary brain tumors: Interim analysis of a phase 2 clinical trial.

PURPOSE: Cancer patients experience distress and anxiety when undergoing imaging studies to monitor disease status, yet these symptoms are not always appropriately identified or well-managed. This interim analysis of a phase 2 clinical trial explored feasibility and acceptability of a virtual reality relaxation (VR) intervention for primary brain tumor (PBT) patients at the time of clinical evaluation. METHODS: English speaking, adult PBT patients with previous reports of distress and upcoming neuroimaging were recruited between March of 2021 and March 2022. A brief VR session was done within 2 weeks prior to neuroimaging with patient-reported outcomes (PROs) collected before and immediately post-intervention. Self-directed VR use over the next 1 month was encouraged with additional PROs assessments at 1 and 4 weeks. Feasibility metrics included enrollment, eligibility, attrition, and device-related adverse effects with satisfaction measured with qualitative phone interviews. RESULTS: Fifty-five patients were approached via email, 40 (73%) responded and 20 (50%) enrolled (9 declines, 11 screen fails). 65% of participants were ≤ 50 years, 50% were male, 90% were White/non-Hispanic, 85% had good KPS (≥ 90), and most were on active treatment. All patients completed the VR intervention, PROs questionnaires, weekly check-ins, and qualitative interview. Most (90%) reported frequent VR use and high satisfaction and only 7 mild AEs were recorded (headache, dizziness, nausea, neck pain). CONCLUSION: This interim analysis supports feasibility and acceptability of a novel VR intervention to target psychological symptoms for PBT patients. Trial enrollment will continue to assess for intervention efficacy. TRIAL REGISTRATION: NCT04301089 registered on 3/9/2020.

Feasibility and preliminary efficacy of a virtual reality intervention targeting distress and anxiety in primary brain tumor patients at the time of clinical evaluation: Study protocol for a phase 2 clinical trial.

BACKGROUND: Primary brain tumor (PBT) patients experience higher levels of distress and anxiety than other solid tumor patients, particularly at the time of clinical evaluation when uncertainty about disease status is high ("scanxiety"). There is promising evidence supporting use of virtual reality (VR) to target psychological symptoms in other solid tumor patients, though PBT patients have not been studied extensively in this context. The primary aim of this phase 2 clinical trial is to establish the feasibility of a remote VR-based relaxation intervention for a PBT population, with secondary aims designed to determine preliminary efficacy of improving distress and anxiety symptoms. METHODS: PBT patients (N = 120) with upcoming MRI scans and clinical appointments who meet eligibility will be recruited to participate in a single arm trial conducted remotely through the NIH. Following completion of baseline assessments, participants will complete a 5-min VR intervention via telehealth using a head-mounted immersive device while under supervision of the research team. Following the intervention, over the course of 1 month patients can use VR at their discretion with follow-up assessments done immediately post-VR intervention, as well as 1 week and 4 weeks later. Additionally, a qualitative phone interview will be conducted to assess patient satisfaction with the intervention. DISCUSSION: Use of immersive VR is an innovative interventional approach to target distress and scanxiety symptoms in PBT patients who are at high risk for experiencing these symptoms leading into their clinical appointments. Findings from this study may inform design of a future multicenter randomized VR trial for PBT patients and may aid in development of similar interventions for other oncology populations. TRIAL REGISTRATION: Clinicaltrials.gov (NCT04301089), registered 9 March 2020.

Formation of Interpersonal Competencies Through Interprofessional Simulation: Nursing and Medicine.

AIM: The aim of this study was to analyze the process of interpersonal competencies formation in nursing and medical students who participated in a standardized interprofessional clinical simulation. BACKGROUND: Interprofessional education in health sciences has had an important impact on the development of relational qualities centered on the patient. METHOD: The study followed a qualitative interpretive approach with students. Students who participated in clinical simulation activities were asked about their experiences and their learning process with respect to interpersonal competencies. A thematic analysis of the data was performed. RESULTS: Three themes emerged: 1) approaching the practice with uncertainty and fear of new relationships, 2) reflecting on decisions while recognizing distinctive roles, and 3) recognizing the human sense of practice while developing skills for caring and curing. CONCLUSION: Students underwent this process and learned about empathy, communication, critical reflexive thinking, and teamwork.

Association of Employment Status With Symptom Burden and Health-Related Quality of Life in People Living With Primary CNS Tumors.

BACKGROUND AND OBJECTIVES: Financial toxicity significantly affects many patients, especially cancer survivors. We evaluated the association of unemployment as a major contributor to financial toxicity with patient-reported outcomes (PROs) assessing multiple illness experience domains in a primary CNS tumor (PCNST) cohort. METHODS: Patient and disease characteristics and PROs measuring symptom burden, interference, psychologic distress, functional impairment, and health-related quality of life (HRQOL) from participants enrolled in an institutional review board-approved observational study at the US NIH's Neuro-Oncology Branch were collected between September 2016 and December 2019. Descriptive statistics, tests of association, and comparison of group mean values were used to describe and evaluate PROs. RESULTS: Of the 277 participants diagnosed with a PCNST, 57% were male and 43% were female. Participants reported their race as White, non-Hispanic (78%); White, Hispanic/Latino (9%); Asian (7%); Black (4%); Native Hawaiian/Pacific Islander (1%); and other (2%) with 8% missing. The median age of the overall cohort was 45 years (range 18-74). Hispanic participants in the overall sample were 2.3 times more likely, and in the brain tumor group 3.2 times more likely, to report unemployment (p = 0.043, odds ratio [OR] 2.3, 95% CI 1.0-5.4 and p = 0.008, OR 3.2, 95% CI 1.3-7.9, respectively). 77 (28%) individuals unemployed due to tumor reported more functional impairment with walking, washing, dressing, and performing usual activities and reduced HRQOL (p < 0.001). More unemployed participants in the total sample reported moderate-to-severe depressive symptoms (25%) than those employed (8%) (χ2(1) = 13.9, p < 0.001, OR 3.7, 95% CI 1.8-7.8) and more moderate-to-severe anxiety symptoms (30%) than those employed (15%) (χ2(1) = 7.8, p = 0.005, OR 2.4, 95% CI 1.3-4.5). Unemployed participants with brain tumor reported on average 3 more symptoms as moderate-to-severe compared with those employed (t(83) = -4.0, 95% CI [Formula: see text] difference -5 to -2, p < 0.001, Hedge g = 0.70). DISCUSSION: Being unemployed due to a PCNST strongly correlated with high symptom burden, functional impairment, psychological distress, and reduced HRQOL, which may be impediments to returning to work that warrant intervention. Lack of employer-based health insurance and reduced earnings are financial sequelae of unemployment superimposed on the physical, social, and cognitive effects of living with a PCNST. Innovations to screen for and address financial toxicity and its contributing factors are needed.

From Relational Uncertainty to Interpersonal Sensitivity: A Substantive Grounded Theory for Nursing Education.

AIM: The aim of our study was to understand how nursing students develop interpersonal competencies during a faculty-supervised practicum. BACKGROUND: Researchers have studied the interpersonal competencies of nursing students in a fragmented way. METHOD: A constructivist grounded theory approach was used for the study. RESULTS: Four categories emerged from the data: Coping With Practicum-Related Challenges and Insecurities, Learning to Identify the Interpersonal Dimension of Nursing Care, Pedagogical Influence: Promoting (De)constructive Processes for Learning and Care, and Transforming the Self as a Nurse Through Interpersonal Relationships. A core category, From Relational Uncertainty to Interpersonal Sensitivity: A Transition of the Nursing Self Within Reflective Environments of Practice, also emerged. CONCLUSION: The interpersonal competencies of nursing students develop in reflective environments within practicums because of interactions with patients and under the influence and modeling of the educator. Acknowledging the importance of interactions with the educator and patients within practicums can contribute to promoting more thoughtful follow-up processes from educators.

Feasibility of a virtual reality intervention targeting distress and anxiety symptoms in patients with primary brain tumors: Interim analysis of a phase 2 clinical trial.

Purpose: Cancer patients experience distress and anxiety when undergoing imaging studies to monitor disease status, yet these symptoms are not always appropriately identified or well-managed. This interim analysis of a phase 2 clinical trial explored feasibility and acceptability of a virtual reality relaxation (VR) intervention for primary brain tumor (PBT) patients at the time of clinical evaluation. Methods: English speaking, adult PBT patients with previous reports of distress and upcoming neuroimaging were recruited between March of 2021 and March 2022. A brief VR session was done within 2 weeks prior to neuroimaging with patient-reported outcomes (PROs) collected before and immediately post-intervention. Self-directed VR use over the next 1 month was encouraged with additional PROs assessments at 1 and 4 weeks. Feasibility metrics included enrollment, eligibility, attrition, and device-related adverse effects with satisfaction measured with qualitative phone interviews. Results: 55 patients were approached via email, 40 (73%) responded and 20 (50%) enrolled (9 declines, 11 screen fails). 65% of participants were ≤ 50 years, 50% were male, 90% were White/non-Hispanic, 85% had good KPS (≥ 90), and most were on active treatment. All patients completed the VR intervention, PROs questionnaires, weekly check-ins, and qualitative interview. Most (90%) reported frequent VR use and high satisfaction and only 7 mild AEs were recorded (headache, dizziness, nausea, neck pain). Conclusion: This interim analysis confirmed feasibility and acceptability of a novel VR intervention to target psychological symptoms for PBT patients. Trial enrollment will continue to assess for intervention efficacy. Trial Registration: NCT04301089 registered on 3/9/2020.

Relationship between RANO-PRO Working Group standardised priority constructs and disease progression among malignant glioma patients: A retrospective cohort study.

Background: Recognising the importance of clinical outcomes assessments (COAs), the Response Assessment in Neuro-Oncology-Patient Reported Outcome (RANO-PRO) Working Group recommended inclusion of core symptoms and functions in clinical care or research for malignant glioma patients. This study evaluated the association of the recommended symptoms (pain, perceived cognition, seizures, aphasia, symptomatic adverse events) and functions (weakness, walking, work, usual activities) with disease progression in these patients. Methods: In this retrospective cohort study, patients with malignant glioma were included from the US National Cancer Institute Neuro-Oncology Branch Natural History Study (NOB-NHS) which follows primary central nervous system tumour patients aged 18 years and older throughout their disease trajectory. The M.D. Anderson Symptom Inventory-Brain Tumor (MDASI-BT), EQ-5D-3L, Karnofsky Performance Status (KPS), and Neurologic Function scores (NFS) were evaluated in relation to disease progression by chi-square tests, independent- and paired-samples t-tests, adjusted for multiple comparisons at first assessment and over time to a second assessment. Radiographic disease progression was determined on the interpretation of the imaging study by a radiologist and neuro-oncologist using standard criteria as part of clinical trial participation or routine standard of care. The priority constructs were evaluated to provide initial evidence of their relevance, relationship to disease status over time, and sensitivity to change in a diverse group of patients with malignant glioma. Findings: Seven hundred and sixty-five patients had enrolled into the NOB-NHS between September 1, 2016 and January 31, 2020. Three hundred and thirty-six patients had a diagnosis of a malignant glioma (anaplastic astrocytoma, anaplastic oligodendroglioma, glioblastoma, and gliosarcoma) and were included in the current study. The sample was 64% male (n = 215), 36% female (n = 121), median age of 52 years (IQR = 18.75), 82% White (n = 276), and 65% had tumour recurrence (n = 219). One hundred and fifty-four (46%) had radiographic disease progression. Difficulty remembering, fatigue, and weakness were worse in the group whose imaging was interpreted as radiographic disease progression versus stable disease, as well as the functions of walking, work, activity, and self-care (1.1 < difference < 1.8). Patients with disease progression were four times more likely to have a poor KPS (≤80) and worse NFS. Among patients with disease progression at a second assessment (n = 112), all symptoms, except seizures, worsened between first assessment and disease progression and up to 22% of patients (n = 25) reported worsening mobility, self-care, and usual activity; 46% (n = 51) and 35% (n = 30) had worsened KPS and NFS, respectively. On average, 4 symptoms or functions (SD = 3) were reported as moderate-to-severe and 30% (n = 33) and 23% (n = 26) had a change to moderate-to-severe fatigue and walking, respectively, at time of disease progression. Over 7% of patients with worsening (n = 7 of 100) reported every symptom and function as having changed the most severely including seizures with fatigue and activity reported as the top symptom and function, respectively. Interpretation: The identified core symptoms and functions worsened at the time of progression, supporting the relevance and sensitivity of the priority constructs identified by the RANO-PRO Working Group for clinical care and clinical trials for malignant glioma patients. Funding: The Natural History Study is supported by Intramural Project 1ZIABC011786-03.

Simulación interprofesional en estudiantes de enfermería y medicina, experiencias de sus protagonistas / Interprofessional Simulation with Nursing and Medical Students: The Protagonists' Experiences

Introducción: El impacto que ha tenido la implementación y avance de la educación interprofesional en las ciencias de la salud, ha demostrado que, articulado a diferentes estrategias didácticas, como la simulación clínica estandarizada, optimiza el aprendizaje colaborativo y el trabajo en equipo. Objetivo: Comprender los significados que estudiantes de enfermería y medicina le otorgaron a la educación interprofesional, desarrollada a través de simulación clínica estandarizada. Métodos: Estudio cualitativo interpretativo, donde a través de una determinación a priori basadas en criterios, se seleccionaron 40 estudiantes de enfermería y medicina que participaron de cuatro casos dentro de simulación clínica estandarizada, durante el segundo semestre del año 2019. Estas interacciones fueron videograbadas y luego se realizaron grupos focales para indagar la experiencia que los estudiantes habían tenido en la actividad simulada. Se realizó análisis de contenido de los videos y los grupos focales hasta que no se encontraron nuevos códigos. Resultado: Emergieron tres categorías principales: 1) Identificar las habilidades relacionales necesarias para la atención, 2) Aprender a colaborar a través de la educación interprofesional y 3) Sensaciones implícitas dentro de la simulación interprofesional. Conclusiones: La experiencia y significado que los estudiantes de enfermería y medicina le otorgaron a esta didáctica interprofesional les ayudó a reconocer la reflexión como punto de partida para el aprendizaje significativo y a descubrir en el compañero saberes que podían nutrir su proceso de formación, así como impactarlos en el desarrollo de habilidades interpersonales importantes en la práctica y que aplicarán en su futuro profesional(AU)

Introduction: The impact of the implementation and advancement of interprofessional education in health sciences has shown that, in articulation with different didactic strategies (such as standardized clinical simulation), collaborative learning and teamwork are optimized. Objective: To understand the meanings that nursing and medical students gave to interprofessional education, developed through standardized clinical simulation. Methods: An interpretive qualitative study was conducted, by means of an a priori determination based on criteria; 40 nursing and medical students were selected to participate in four cases within standardized clinical simulation, during the second semester of 2019. These interactions were recorded and focus groups were then held to delve into the students' experience of the simulated activity. Content analysis was applied to the videos and focus groups until new codes were found. Results: Three main categories emerged: 1) identifying relational skills needed for care, 2) Learning how to collaborate through interprofessional education, and 3) implicit feelings within interprofessional simulation. Conclusions: The experience and meaning that nursing and medical students gave to this interprofessional didactic resource helped them recognize thinking as a starting point for meaningful learning, as well as discover, in their partners, knowledge that could nurture their training process and impact them in the development of important interpersonal skills in practice and that they will apply in their professional future(AU)

Adopting the Role of Caregiver of Chronic Patients: Specific Situation Theory / Adopción del rol del cuidador del paciente crónico: teoría de situación específica / Adoção do papel do cuidador do paciente crônico: teoria de situação específica

Abstract Objective: To present the proposal for a specific situation theory on adopting the role of caregiver of chronic patients. Materials and methods: Based on Meleis and Im's integrating strategy, multiple information sources were employed to develop this theory. Results: This prescriptive theory derives from Meleis' mid-range theory based on an exhaustive literature review and the authors' practical and research experience. The information was integrated into core concepts such as caregiver's transition, caregiver role insufficiency, nature and conditions of the transition, nursing transitional care for the caregiver, and healthy transition. Assertions were also derived, such as the adoption of the caregiver role influencing the response patterns or the result indicators related to the caregiver's quality of life and perception of burden. Finally, a theoretical process and an empirical indicator called ROLE are described. Conclusions: This theoretical development recognizes the process faced by caregivers in adopting their role in the care of chronic patients and guides possible nursing interventions to favor a healthy transition.

Resumen Objetivo: dar a conocer una propuesta de teoría de situación específica sobre la adopción del rol del cuidador del paciente crónico. Materiales y métodos: basados en la estrategia integradora de Meleis e Im, se emplearon múltiples fuentes de información para el desarrollo de esta teoría. Resultados: esta teoría de carácter prescriptivo se deriva de la teoría de rango medio de las transiciones de Meleis, a partir de una exhaustiva revisión de literatura y de la experiencia práctica e investigativa de las autoras. Se integró la información en conceptos centrales como: transición del cuidador, insuficiencia del rol de cuidador, naturaleza de la transición, condiciones de transición, cuidado transicional de enfermería al cuidador y transición saludable; se derivaron afirmaciones como que la adopción del rol de cuidador influencia los patrones de respuesta o indicadores de resultado relacionados con la calidad de vida y la percepción de sobrecarga del cuidador; se describe un proceso teórico y un indicador empírico denominado ROL. Conclusiones: este desarrollo teórico permite reconocer el proceso que el cuidador enfrenta para adoptar su rol en el cuidado al paciente crónico y orientar posibles intervenciones de enfermería para favorecer una transición saludable.

Resumo Objetivo: apresentar uma proposta de teoria de uma situação específica sobre a adoção do papel de cuidador do paciente crônico. Materiais e métodos: com base na estratégia integrativa de Meleis e Im, foram utilizadas múltiplas fontes de informação para o desenvolvimento desta teoria. Resultados: esta teoria prescritiva deriva da teoria de médio alcance das transições de Meleis, a partir de uma exaustiva revisão da literatura e da experiência prática e de pesquisa dos autores. As informações foram integradas em conceitos centrais como: transição do cuidador, insuficiência do papel do cuidador, natureza da transição, condições de transição, cuidados de transição de enfermagem para o cuidador e transição saudável; com afirmações que indicam que a adoção do papel de cuidador influencia os padrões de resposta ou indicadores de resultados relacionados à qualidade de vida e à percepção de sobrecarga do cuidador; apresenta-se a descrição de um processo teórico e um indicador empírico denominado ROL. Conclusões: este desenvolvimento teórico permite reconhecer o processo que o cuidador enfrenta para adotar seu papel no cuidado ao paciente crônico e orientar possíveis intervenções de enfermagem para favorecer uma transição saudável.

Exploring the prevalence and burden of sleep disturbance in primary brain tumor patients.

Background: Sleep disturbance (SD) is common in patients with cancer and has been associated with worse clinical outcomes. This cross-sectional study explored the prevalence of SD in a primary brain tumor (PBT) population, identified associated demographic and clinical characteristics, and investigated co-occurrence of SD with other symptoms and mood disturbance. Methods: Demographic, clinical characteristics, MD Anderson Symptom Inventory-Brain Tumor, and Patient Reported Outcome Measurement Information System Depression and Anxiety Short-Forms were collected from PBT patients at study entry. Descriptive statistics, Chi-square tests, and independent t-tests were used to report results. Results: The sample included 424 patients (58% male, 81% Caucasian) with a mean age of 49 years (range 18-81) and 58% with high-grade gliomas. Moderate-severe SD was reported in 19% of patients and was associated with younger age, poor Karnofsky Performance Status, tumor progression on MRI, and active corticosteroid use. Those with moderate-severe SD had higher overall symptom burden and reported more moderate-severe symptoms. These individuals also reported higher severity in affective and mood disturbance domains, with 3 to 4 times higher prevalence of depressive and anxiety symptoms, respectively. The most frequently co-occurring symptoms with SD were, drowsiness, and distress, though other symptoms typically associated with tumor progression also frequently co-occurred. Conclusions: PBT patients with moderate-severe SD are more symptomatic, have worse mood disturbance, and have several co-occurring symptoms. Targeting interventions for sleep could potentially alleviate other co-occurring symptoms, which may improve life quality for PBT patients. Future longitudinal work examining objective and detailed subjective sleep reports, as well as underlying genetic risk factors, will be important.

The Montreal Cognitive Assessment (MoCA) in neuro-oncology: A pilot study of feasibility and utility in telehealth and in-person clinical assessments.

Background: Cognitive impairments are a common burden for patients with primary CNS tumors. Neuropsychological assessment batteries can be too lengthy, which limits their use as an objective measure of cognition during routine care. The purpose of this study was to evaluate the feasibility and utility of the brief Montreal Cognitive Assessment (MoCA) in routine in-person and telehealth visits (as a result of the global COVID-19 pandemic) with neuro-oncology patients. Methods: Seventy-one adults with primary CNS tumors completed MoCA testing in person (n = 47) and via telehealth (n = 24). Correlation analysis and patient-reported outcomes (PROs), including symptom burden and interference, perceived cognition, general health status, and anxiety and depression, were included in this study. Feasibility was assessed through a provider satisfaction questionnaire. Results: Patients were primarily White (83%), college-educated (71%) males (54%) with high-grade tumors (66%). The average total score on the MoCA administered in person was 25 (range: 6-30), with 34% classified as abnormal, and the average total score via telehealth was 26 (range: 12-30), with 29% classified as abnormal. Providers reported satisfaction in using the MoCA during routine clinical care, both in person and via telehealth. Lower MoCA scores correlated with worse symptom severity, KPS, age, education, and previous treatment. Conclusions: The MoCA was feasible in clinical and telehealth settings, and its relationship to clinical characteristics and PROs highlights the need for both objective and patient-reported measures of cognition to understand the overall cognitive profile of a patient with a CNS tumor.

Evaluation of the key geriatric assessment constructs in primary brain tumor population - a descriptive study.

INTRODUCTION: Despite an increasing aging population, older adults (≥ 65 years) with primary brain tumors (PBTs) are not routinely assessed for geriatric vulnerabilities. Recent reports of geriatric assessment (GA) in patients with glioblastomas demonstrated that GA may serve as a sensitive prognosticator of overall survival. Yet, current practice does not include routine evaluation of geriatric vulnerabilities and the relevance of GA has not been previously evaluated in broader cohorts of PBT patients. The objective of this descriptive study was to assess key GA constructs in adults with PBT dichotomized into older versus younger groups. MATERIALS AND METHODS: A cross-sectional analysis of data collected from 579 participants with PBT recruited between 2016 and 2020, dichotomized into older (≥ 65 years, n = 92) and younger (≤ 64 years, n = 487) from an ongoing observational trial. GA constructs were evaluated using socio-demographic characteristics, Charlson Comorbidity Index (CCI), polypharmacy (>5 daily medications), Karnofsky Performance Status (KPS), Neurologic Function Score (NFS), and patient-reported outcome assessments including general health, functional status, symptom burden and interference, and mood. Descriptive statistics, t-tests, chi-square tests, and Pearson correlations were used to evaluate differences between age groups. RESULTS: Older participants were more likely to have problems with mobility (58% vs. 44%), usual activities (64% vs 50%) and self-care (38% vs 26%) compared to the younger participants (odds ratios [ORs] = 1.3-1.4, ps < 0.05), while older participants were less likely to report feeling distressed (OR = 0.4, p < 0.05). Older participants also had higher CCI and were more likely to have polypharmacy (OR = 1.7, ps < 0.05). Increasing age strongly correlated with worse KPS score (r = -0.232, OR = 1.4, p < 0.001) and worse NFS (r = 0.210, OR = 1.5, p < 0.001). No differences were observed in overall symptom burden, symptom interference, and anxiety/depression scores. DISCUSSION: While commonly used GA tools were not available, the study employed patient- and clinician-reported outcomes to identify potential future research directions for the use of GA in the broader neuro-oncology population. Findings illustrate missed opportunities in neuro-oncology practice and underscore the need for incorporation of GA into routine care of this population. Future studies are warranted to further evaluate the prognostic utility of GA and to better understand functional aging outcomes in this patient population.

Experimental Infection of Captive Red Foxes (Vulpes vulpes) with Mycobacterium bovis.

In Europe, animal tuberculosis (TB) due to Mycobacterium bovis involves multi-host communities that include cattle and wildlife species, such as wild boar (Sus scrofa), badgers (Meles meles) and red deer (Cervus elaphus). Red fox (Vulpes vulpes) infections have also been recently reported in some TB endemic regions in the Iberian Peninsula and France, with some of the infected animals shedding M. bovis in urine and feces. In order to understand the pathogenesis of M. bovis infection in foxes and the associated risk of transmission, 12 captive foxes (6 females and 6 males) were inoculated orally with 2 × 107 colony-forming units of a French field isolate of M. bovis. Clinical samples (urine, feces and oropharyngeal swabs) were collected every four weeks and tested for molecular diagnosis and bacteriology. Serological responses were measured by IDEXX M. bovis Ab Test and Multi Antigen Print Immunoassay (MAPIA). At a post-mortem examination performed 12 weeks post infection (wpi), tissues were tested for the presence of M. bovis and associated gross and microscopic TB-like lesions. M. bovis was detected by PCR in bladder swabs of 3 animals at 12 wpi. It was also detected pre-mortem at different time points of the experiment in the oropharyngeal mucus of three individuals and in the feces of nine foxes, with two of them confirmed by bacteriology. All 12 foxes had at least 4 PCR positive samples (out of the 23 tested), and all but 1 fox had at least 1 culture positive sample. The culture negative fox was PCR positive in both retropharyngeal and mesenteric lymph nodes, in line with the results of the other animals. Seroconversion was observed in all foxes except one during the experiment, and in nine at the final time point. No gross visible lesions were found in any animal at the post-mortem examination. The histology showed small granulomas within the lymph nodes, tonsils, liver and lungs from eight animals, with the presence of few acid-fast bacilli. These results confirmed that all orally-infected foxes developed mild TB lesions but they were able to shed mycobacteria in about 75% of cases, 1 month post-infection (9 out 12 foxes). These results show that it is possible to induce typical TB infection experimentally in captive foxes, with measurable M. bovis excretion; such an experimental system could be useful for future evaluations of diagnostics and vaccines in this species.

Challenges of imaging interpretation to predict oligodendroglioma grade: a report from the Neuro-Oncology Branch.

Background: To illustrate challenges of imaging interpretation in patients with oligodendroglioma seen at a referral center and evaluate interrater reliability. Methods: Two neuro-oncologists reviewed diagnostic preradiation MRIs of oligodendroglioma patients; interrater reliability was calculated with the kappa coefficient (k). A neuroradiologist measured presurgical apparent diffusion coefficient (ADC), if available. Results: Extensive enhancement was noted in four of 58 patients, k = 0.7; necrosis in seven of 58, k = 0.61; calcification in seven of 17, k = 1.0; diffusion restriction in two of 39 patients, k = 1.0 (all only in grade 3). ADC values with receiver operator characteristic analysis for area under the curve were 0.473, not significantly different from the null hypothesis (p = 0.14). Conclusions: Extensive enhancement, necrosis and calcification correlated with grade 3 oligodendroglioma in our sample. However, interrater variability is an important limitation when assessing radiographic features, supporting the need for standardization of imaging protocols and their interpretation.

Concept Analysis of Interpersonal Skills in Nursing / Análisis del concepto de competencia interpersonal en enfermería / Análise do conceito de competência interpessoal em enfermagem

Objective: To determine a broad definition of the term interpersonal skills in nursing. Materials and methods: This theoretical study follows Walker and Avant's method of concept analysis to examine the defining attributes of the concept. A literature search on interpersonal aspects of nursing was conducted in databases, e-books, and institutional repositories to recognize the uses, attributes, antecedents, consequences, and empirical referents of the concept. Experts on professional and relationship skills were consulted between 2009 and 2019. Results: This information was analyzed, concluding that interpersonal skills in nursing are defined as the abilities of professional nurses to express their knowledge, abilities, attitudes, and values in relationships with colleages, patients, and their relatives and achieve a humane and person- centered practice. Conclusion: The concept of interpersonal skills in nursing is limited, given a lack of clarity in practice and research on the indistinct use of terms related to interpersonal skills and interpersonal knowledge. This analysis advances nursing theory towards practice and research.

Objetivo: determinar una definición amplia del término competencia interpersonal en enfermería. Materiales y métodos: en el presente estudio teórico, se aplica el método de análisis de conceptos de Walker y Avant para examinar los atributos definitorios del concepto. Se realizó una búsqueda bibliográfica sobre aspectos interpersonales de la enfermería en bases de datos, libros electrónicos y repositorios institucionales para reconocer los usos, los atributos, los antecedentes, las consecuencias y las referencias empíricas del concepto. Además, se consultó a expertos en habilidades profesionales y relacionales entre 2009 y 2019. Resultados: se analizó esta información y se concluyó que la competencia interpersonal en enfermería se define como la habilidad de los enfermeros profesionales para expresar sus conocimientos, destrezas, actitudes y valores en las relaciones con los colegas, los pacientes y sus familiares a fin de lograr una práctica humana y centrada en la persona. Conclusión: el concepto de competencia interpersonal en enfermería es limitado, dada la falta de claridad en la práctica y la investigación sobre el uso indistinto de términos relacionados con la competencia interpersonal y el conocimiento interpersonal. El presente análisis lleva la teoría de la enfermería hacia la práctica y la investigación.

Objetivo: determinar uma definição ampla da expressão "competência interpessoal em enfermagem". Materiais e métodos: neste estudo teórico, é aplicado o método de análise de conceitos de Walker e Avant para examinar os atributos que definem o conceito. Foi realizada busca bibliográfica sobre aspectos interpessoais da enfermagem em bases de dados, livros eletrônicos e repositórios institucionais para reconhecer os usos, os atributos, os antecedentes, as consequências e as referências empíricas do conceito. Além disso, especialistas em habilidades profissionais e relacionais foram consultados entre 2009 e 2019. Resultados: as informações foram analisadas e concluiu-se que a competência interpessoal em enfermagem é definida como a habilidade dos enfermeiros profissionais de expressar seus conhecimentos, destrezas, atitudes e valores nas relações com os colegas, com os pacientes e seus familiares a fim de atingir uma prática humana e focada na pessoa. Conclusões: o conceito de competência interpessoal em enfermagem é limitado, tendo em vista a falta de clareza na prática e na pesquisa sobre o uso indiscriminado de termos relacionados com competência interpessoal e conhecimento interpessoal. Esta análise leva a teoria da enfermagem à prática e à pesquisa.

Living with a central nervous system (CNS) tumor: findings on long-term survivorship from the NIH Natural History Study.

BACKGROUND: Primary central nervous system (CNS) tumors are often associated with high symptom burden and a poor prognosis from the time of diagnosis. The purpose of this study is to describe patient-reported outcomes (PRO) data from long-term survivors (LTS; ≥5-year survival post-diagnosis). METHODS: Clinical/treatment/molecular characteristics and PROs (symptom burden/interference (MDASI-BT/SP), perceived cognition (Neuro-QoL), anxiety/depression (PROMIS), and general health status (EQ-5D-3L)) were collected on 248 adult LTS between 9/2016 and 8/2019. Descriptive statistics and regression analysis were used to report results. RESULTS: Participants had a median age of 47 years (19-82) and were primarily White (83%) males (51%) with high-grade tumors (59%) and few mutations. Forty-two percent of the 222 brain tumor LTS reported no moderate-to-severe symptoms, whereas 45% reported three or more; most common symptoms were fatigue (40%), difficulty remembering (29%), and drowsiness (28%). Among spine tumor LTS (n = 42), nearly half reported moderate-to-severe weakness, pain, fatigue, and numbness/tingling, with 72% experiencing activity-related interference. Severe anxiety, depression, and cognitive symptoms were reported in up to 23% of the sample. Brain tumor LTS at higher risk for severe symptoms were more likely to be young, unemployed, and have poor KPS (Karnofsky Performance Status), whereas high symptom-risk spinal cord tumor LTS had poor KPS and received any tumor treatment. CONCLUSIONS: Findings indicate LTS fall into distinct cohorts with no significant symptoms or very high symptom burden, regardless of tumor grade or mutational profile. These LTS data demonstrate the need for survivorship care programs and future studies to explore the symptom trajectory of all CNS tumor patients for prevention and early interventions.

El rol del cuidador a distancia de personas con enfermedad crónica: scoping review / The role of the distance caregiver of people with chronic disease: scoping review / Papel do cuidador à distância de pessoas com doenças crônicas: scoping review

Introducción: Se ha explorado poco sobre el rol del cuidador a dis-tancia o cuidador secundario de las personas con enfermedad cró-nica, por ello se hace necesario conocer el avance de la evidencia científica sobre este tipo de cuidadores, con el fin de determinar los aportes y los vacíos presentes en la literatura. Metodología: Revi-sión descriptiva tipo scoping review, en la que se realizó una bús-queda en las siguientes bases de datos: de Embase, Science direct, Pubmed, Medline, Academic search complete y Scopus, limitando el tiempo entre 2005 ­ 2020. Se utilizaron los términos: DeCS y MeSH de Long distance caregiver, distance caregiver, secondary caregiver y chronic disease. Además, se seleccionaron 20 artículos originales, una vez realizado el proceso de crítica con CASPe. Re-sultados. Emergieron 4 núcleos temáticos: experiencias y percep-ciones del cuidador a distancia, características del rol del cuidador a distancia, soporte social del cuidador a distancia por medio de Tec-nologías de la información y la comunicación TICs y estrategias de afrontamiento del cuidador a distancia. Conclusión: es un fenómeno poco explorado, por lo que son amplios los vacíos que existen, em-pezando por su autoreconocimiento en el desempeño de su rol hasta las intervenciones específicas que lo favorezcan.

Introduction: Little has been explored about the role of remote caregiver or secondary caregiver of people with chronic disease, so it is relevant to know the progress of scientific evidence on remote or secondary family caregivers, in order to determine the contributions and knowledge gaps present in the literature. Metodology: Descriptive review type scoping review, in which a search was performed in databases of Embase, Science direct, Pubmed, Medline, Academic search complete and Scopus, limiting between 2005 - 2020 using the terms DeCS and MeSH de Long-distance caregiver, distance caregiver, secondary caregiver and chronic disease, selected 20 original articles after completing the review process with CASPe. Results: 4 thematic nuclei emerged that were Experiences and perceptions of the remote caregiver, Characteristics of the role of the remote caregiver, Social support of the remote caregiver through information and communication technologies, ICTs and coping strategies of the remote caregiver. Conclusion: this is a phenomenon little explored, so the gaps that exist are wide, starting with their self-rec-ognition in the role performance up to the specific interventions that favor their performance.

Introdução: Tem se explorado pouco sobre o papel do cuidador à distância ou cuidador secundá-rio das pessoas com doenças crônicas, por isso, faz-se necessário conhecer o avanço da evidência científica sob este tipo de cuidadores, com o intuito de determinar os aportes e os vazios presentes na literatura. Materiais e Métodos: Revisão descritiva tipo Scoping review, realizou-se a busca nas seguintes bases de dados: Embase, Science direct, Pubmed, Medline, Academic search com-plete e Scopus, limitando o tempo entre 2005 ­ 2020. Usaram-se os descritores: DeCS e MeSH "Long distance caregiver, distance caregiver, secondary caregiver" e "chronic disease". Alem disso, selecionaram-se 20 artigos originais, uma vez realizado o processo de crítica com CASPe. Resultados: Surgiram 4 núcleos temáticos: experiências e percepções do cuidador à distância por meio de tecnologias da informação e a comunicação e estratégias de afrontamento do cui-dador à distância. Conclusão: é um fenômeno pouco explorado, pelo que são amplos os vazios existentes, começando pelo auto reconhecimento no desempenho do seu papel até as interven-ções específicas que o favorecem.

Formation in Interprofessional Education in Nursing and Medical Students Globally. Scoping review.

OBJECTIVES: This work sought to know the state of the art related to the theme of Interprofessional Education (IPE) in the training of Nursing and Medical students and the level of evidence developed thus far. METHODS: This was an exploratory systematic review, declared as scoping review by the Joanna Briggs Institute, JBI, in which a search was performed in Embase, Science direct, Pubmed-Medline, Academic search complete, BVS, Scopus and ERIC databases, limiting between 2009 - 2019 by using the DeCS and MeSH terms of Interprofessional education, education research, healthcare professionals, nursing and medicine, selecting 39 original articles after carrying out the review process with the criteria by the JBI. RESULTS: Four thematic nuclei emerged: Experiences and perceptions of interprofessional learning, Didactics related with IPE, Empirical indicators related with IPE, and Development of professional skills. The highest level of evidence is presented by the articles dealing with didactics; on the contrary, no articles were found that dealt with topics related with early inclusion of IPE in the medical and nursing curricula, which are currently necessary to complement the focus of patient-centered care. CONCLUSIONS: The thematic nuclei show that the level of evidence in the literature is varied, although mostly descriptive in scope, highlighting the development of professional skills as a result of interprofessional education.