Prevalence and Prognostic Significance of PIK3CA Mutation and CNV Status and Phosphorylated AKT Expression in Patients With Cervical Cancer Treated With Primary Surgery.

Currently, there are limited and conflicting reports on the prognostic utility of PIK3CA and associated pathway markers for cervical cancers treated with primary surgical management. Moreover, current studies are lacking complete characterization of adjuvant treatment with RT and/or chemotherapy. We aimed to document the prevalence, clinicopathologic, adjuvant treatment details, and prognostic value of PI3K/AKT pathway mutations and copy number variation and phosphorylated AKT status in patients with cervical cancers treated with primary surgery. A clinicopathologic review was performed on a retrospective cohort of 185 patients with cervical cancer, treated with primary surgery at a single tertiary institution. Next-generation sequencing and digital PCR was used to determine PI3K/AKT pathway mutational status and PIK3CA copy number variation, respectively, and fluorescent immunohistochemistry measured phosphorylated AKT expression. In all, 179 of 185 (96.8%) of tumors were successfully sequenced; 48 (26.8%) were positive for PI3K/AKT pathway mutations-the majority (n=37, 77.1%) PIK3CA mutations. PIK3CA mutation was associated with pathologically positive lymph nodes [12 (32%) vs. 22 (16%); P =0.022] and indication for postoperative chemoradiotherapy [17 (45.9%) vs. 32 (22.5%); P =0.004]. On multivariable analysis, PIK3CA status was not associated with overall survival ( P =0.103) or progression-free survival ( P =0.240) at 5 yrs, nor was PIK3CA copy number variation status. phosphorylated AKT ≤ median significantly predicted for progression-free survival [multivariable hazard ratio 0.39 (0.17-0.89; P =0.025)] but not overall survival ( P =0.087). The correlation of PIK3CA with pathologic positive lymph node status yet lack of association with survival outcomes may be due to the use of adjuvant postoperative therapy. PIK3CA assessment before radical hysterectomy may help identify patients with a higher risk of node-positive disease.

Local Prostate Radiation Therapy and Symptomatic Local Events in De Novo Metastatic Prostate Cancer.

PURPOSE: Local prostate radiation therapy (LPRT) for low-burden metastatic prostate cancer (mPCa) improves overall survival and is the standard of care. The role of LPRT in reducing symptomatic local events (SLE) remains unclear. We aimed to identify SLE risk factors and to evaluate the association between LPRT and SLE in mPCa. METHODS AND MATERIALS: We conducted a retrospective, population-based cohort study of patients initially diagnosed with mPCa between 2005 and 2016 in a cancer registry. Patient, tumor, and treatment characteristics were obtained from chart review and the cancer registry. The coprimary endpoints were genitourinary (GU) and gastrointestinal (GI) SLE, identified by physician billing claims between 2004 and 2017 for diagnostic or therapeutic procedures potentially related to GU and GI SLE. The effect of LPRT on SLE was evaluated using both recurrent event (Andersen-Gill model) and time-to-first-event sequential landmark analyses. Risk factors for SLE were assessed by multivariable Cox regression. LPRT was defined as ≥40 Gy within 1 year of diagnosis. Metastatic burden was defined per the STAMPEDE trial. RESULTS: Of 1363 patients, 46 (3.4%) received LPRT. Median follow-up was 27.3 and 28.9 months in the control and LPRT groups, respectively. LPRT was associated with less recurrent GU SLE (hazard ratio [HR], 0.34; 95% confidence interval [CI], 0.17-0.67; P = .002), upper tract obstruction (HR, 0.20; 95% CI, 0.05-0.84; P = .03), and cystoscopy (HR, 0.38; 95% CI, 0.15-0.96; P = .04). Metastatic burden was not associated with SLE. CONCLUSIONS: LPRT in mPCa was associated with less recurrent GU SLE, specifically for upper tract obstruction and cystoscopy.

Semiparametric modelling of two-component mixtures with stochastic dominance.

In this work, we studied a two-component mixture model with stochastic dominance constraint, a model arising naturally from many genetic studies. To model the stochastic dominance, we proposed a semiparametric modelling of the log of density ratio. More specifically, when the log of the ratio of two component densities is in a linear regression form, the stochastic dominance is immediately satisfied. For the resulting semiparametric mixture model, we proposed two estimators, maximum empirical likelihood estimator (MELE) and minimum Hellinger distance estimator (MHDE), and investigated their asymptotic properties such as consistency and normality. In addition, to test the validity of the proposed semiparametric model, we developed Kolmogorov-Smirnov type tests based on the two estimators. The finite-sample performance, in terms of both efficiency and robustness, of the two estimators and the tests were examined and compared via both thorough Monte Carlo simulation studies and real data analysis. Supplementary Information: The online version contains supplementary material available at 10.1007/s10463-022-00835-5.

A Comparison of Patients' and Physicians' Knowledge and Expectations Regarding Precision Oncology Tests.

(1) Background: As genomic testing is becoming a part of the mainstream oncology practice, it is vital to ensure that our patients fully understand the implications of these tests. This study aimed to compare the attitudes and expectations of cancer patients with those of their physicians regarding the role of biomarker testing in clinical decision making. (2) Methods: Two separate, complimentary, self-administered questionnaires for patients with cancer and their physicians, respectively, were collected in Calgary, Alberta, Canada. Out of 117, 113 completed patient surveys were included in the statistical analysis, constituting a 96.4% response rate. These surveys were subsequently matched with those of their corresponding oncologists to determine the concordance rates. (3) Results: Overall, patients demonstrated a good understanding of general cancer biology (80.0%) and diagnostic processes (90.0%) associated with precision oncology. Most patients wanted their tumours to be tested to guide treatment, and the oncologists broadly shared these views (concordance 65.1%). However, there were discrepancies between the knowledge and expectations regarding the applications of test results on actual diagnosis and prognosis between patients and their oncologists (concordance 26.1% and 36.0%, respectively). While only 28.0% of patients thought they had enough knowledge to make informed decisions, the majority (68.0%) said they needed more information. (4) Conclusion: Our study shows that patients and cancer physicians do not always agree with the roles and applications of genomic tests, which could lead to misplaced expectations and poor health outcomes. More research is needed to devise strategies to improve education and communication to align these expectations and improve the quality of clinical decision making.

Radiation Therapy With Cyclin-Dependent Kinase 4/6 Inhibitors: A Multi-institutional Safety and Toxicity Study.

PURPOSE: Our purpose was to investigate radiation therapy (RT) toxicity when given with cyclin-dependent kinase 4/6 inhibitors (CDK4/6i) compared with RT alone. METHODS AND MATERIALS: We conducted a retrospective cohort study of patients with hormonal receptor-positive and human epidermal growth factor-2 negative metastatic breast cancer treated with RT at 4 cancer centers in Alberta, Canada, between 2016 and 2020. Toxicity in patients treated with RT within 30 days of initiating to discontinuing CDK4/6i (RT + CDK4/6i) was compared with toxicity of RT in CDK4/6i-naïve patients (RT alone). The primary outcome was acute grade (G) 2 or higher, nonhematological toxicity within 30 days of RT. We also explored toxicity based on the timing of RT (prior, concurrent, post) in relation to CDK4/6i. Propensity score matching was applied to create comparable cohorts. A generalized linear mixed model was used to evaluate factors associated with acute toxicity. RESULTS: One hundred thirty-two patients (220 RT sites) in the RT + CDK4/6i and 53 patients (93 RT sites) in RT alone were eligible. The rate of acute G2 or higher nonhematological toxicity was 11.5% versus 7%, respectively (P = .439), and acute G3 or higher nonhematological toxicity was 3.7% versus 0%, respectively (P = .151). Acute toxicity in RT + CDK4/6i group was mainly observed when RT was given concurrently (67%), with most of the G3 toxicity recorded. After propensity score matching, the association of acute toxicity with RT + CDK4/6i versus RT alone was not significant on multivariable analysis (odds ratio, 3.13; 95% confidence interval, 0.74-13.2; P = .121). CONCLUSIONS: We did not observe a significant association between CDK4/6i use and acute G2 or higher nonhematological toxicity in women with metastatic breast cancer receiving palliative RT. Given the findings of G3 toxicity, caution is advised whenever CDK4/6i is given concurrently with RT.

Cumulative incidence of subsequent malignancy after allo-HCT conditioned with or without low-dose total body irradiation.

Subsequent malignancies (SMs) present a significant burden of morbidity and are a common cause of late mortality in survivors of allogeneic hematopoietic cell transplant (allo-HCT). Previous studies have described total body irradiation (TBI) as a risk factor for the development of SMs in allo-HCT survivors. However, most studies of the association between TBI and SM have examined high-dose TBI regimens (typically ≥600 cGy), and thus little is known about the association between low-dose TBI regimens and risk of SMs. Our goal, therefore, was to compare the cumulative incidence of SMs in patients of Alberta, Canada, who received busulfan/fludarabine alone vs busulfan/fludarabine plus 400 cGy TBI. Of the 674 included patients, 49 developed a total of 56 malignancies at a median of 5.9 years' posttransplant. The cumulative incidence of SMs at 15 years' post-HCT in the entire cohort was 11.5% (95% confidence interval [CI], 8.5-15.6): 13.4% (95% CI, 9.1-19.3) in the no-TBI group and 10.8% (95% CI, 6.6-17.4) in the TBI group. In the multivariable model, TBI was not associated with SMs, whereas there was an association with number of pre-HCT cycles of chemotherapy. The standardized incidence ratio for the entire cohort, compared with the age-, sex-, and calendar year-matched general population, was 1.75. allo-HCT conditioning that includes low-dose TBI does not seem to increase risk of SMs compared with chemotherapy-alone conditioning.

Breast cancer screening literacy information on online platforms: A content analysis of YouTube videos.

BACKGROUND: The YouTube platform has great potential of serving as a healthcare resource due to its easy accessibility, navigability and wide audience reach. Breast cancer screening is an important preventative measure that can reduce breast cancer mortality by 40%. Therefore, platforms being used as a healthcare resources, such as YouTube, can and should be used to advocate for essential preventative measures such as breast cancer screening. METHODS: In this study, the usefulness of videos related to breast cancer and breast cancer screening were analyzed. Videos were first screened for inclusion and then were categorized into very useful, moderately useful, somewhat useful, and not useful categories according to a 10-point criteria scale developed by medical professionals based on existing breast cancer screening guidelines. Two reviewers independently assessed each video using the scale. RESULTS: 200 videos were identified in the preliminary analysis (100 for the search phrase 'breast cancer' and 100 for the search phrase 'breast cancer screening'). After exclusion of duplicates and non-relevant videos, 162 videos were included in the final analysis. We found the following distribution of videos: 4.3% very useful, 17.9% moderately useful, 39.5% somewhat useful, and 38.3% not useful videos. There was a significant association between each of the following and the video's level of usefulness: video length, the number of likes, and the uploading source. Longer videos were very useful, somewhat useful videos were the most liked, personally produced videos were the most not useful, and advertisements produced the highest ratio of very useful to not useful videos. CONCLUSION: It is necessary to create more reliable and useful healthcare resources for the general population as well as to monitor health information on easily accessible social platforms such as YouTube.

Impact of Value Frameworks on the Magnitude of Clinical Benefit: Evaluating a Decade of Randomized Trials for Systemic Therapy in Solid Malignancies.

In the era of rapid development of new, expensive cancer therapies, value frameworks have been developed to quantify clinical benefit (CB). We assessed the evolution of CB since the 2015 introduction of The American Society of Clinical Oncology and The European Society of Medical Oncology value frameworks. Randomized clinical trials (RCTs) assessing systemic therapies for solid malignancies from 2010 to 2020 were evaluated and CB (Δ) in 2010-2014 (pre-value frameworks (PRE)) were compared to 2015-2020 (POST) for overall survival (OS), progression-free survival (PFS), response rate (RR), and quality of life (QoL). In the 485 studies analyzed (12% PRE and 88% POST), the most common primary endpoint was PFS (49%), followed by OS (20%), RR (12%), and QoL (6%), with a significant increase in OS and decrease in RR as primary endpoints in the POST era (p = 0.011). Multivariable analyses revealed significant improvement in ΔOS POST (OR 2.86, 95% CI 0.46 to 5.26, p = 0.02) while controlling for other variables. After the development of value frameworks, median ΔOS improved minimally. The impact of value frameworks has yet to be fully realized in RCTs. Efforts to include endpoints shown to impact value, such as QoL, into clinical trials are warranted.

Developing a clinical-pathologic model to predict genomic risk of recurrence in patients with hormone receptor positive, human epidermal growth factor receptor-2 negative, node negative breast cancer.

INTRODUCTION: Patients with hormone receptor (HR)-positive, human epidermal growth factor receptor-2 (HER2)-negative, node negative (NN) breast cancer may be offered a gene expression profiling (GEP) test to determine recurrence risk and benefit of adjuvant chemotherapy. We developed a clinical-pathologic (CP) model to predict genomic recurrence risk and examined its performance characteristics. METHODS: Patients diagnosed with HR-positive, HER2-negative, NN breast cancer with a tumour size < 30 mm and who underwent a GEP test [OncotypeDX or Prosigna] in Alberta from October 2017 through March 2019 were identified. Patients were classified as low or high genomic risk. Multivariable logistic regression analysis was performed to examine the associations of CP factors with genomic risk. A CP model was developed using coefficients of regression and sensitivity analyses were performed. RESULTS: A total of 366 patients were eligible (135 were tested using OncotypeDX and 231 with Prosigna). Of these, 64 (17.5%) patients were classified as high genomic risk. On multivariable logistic regression, tumour size > 20 mm (odds ratio [OR], 3.58; 95% confidence interval [CI], 1.84-6.98; P<0.001), low expression of progesterone receptor (OR, 3.46; 95% CI, 1.76-6.82; P<0.001), and histological grade III (OR, 7.24; 95% CI, 3.82-13.70; P<0.001) predicted high genomic risk. A CP model using these variables was developed to provide a score of 0-4. A CP cut-point of 0, identified 56% of genomic low risk patients with a specificity of 98.4%. CONCLUSIONS: A CP model could be used to narrow the population of breast cancer patients undergoing GEP testing.

Online Information for Colorectal Cancer Screening: A Content Analysis of YouTube Videos.

Preventive care is a form of healthcare that aims to prevent diseases or detect diseases in an eary stage, especially for diseases like colorectal cancer. YouTube is a platform with great reach and opportunity to educate the public through preventive healthcare-related resources. However, understanding on current YouTube resources, specifically related to colorectal cancer screening, are inadequate in terms of informational quality. In this study, videos related to colorectal cancer and colorectal cancer screening were identified and analyzed by two reviewers. Very useful (4.5%), moderately useful (18.5%), somewhat useful (38.9%), and not useful (38.2%) videos were categorized based on a usefulness scale compiled by medical professionals. Less useful videos are paralleled with more views and public engagement in comparison with more useful videos which had been released by more credible sources. There is a significant association between video length and level of usefulness as well between video source and usefulness. This study illustrates the need for better educational healthcare resources and/or filtration on widely accessible platforms such as YouTube.

Community engagement with immigrant communities involving health and wellness research: a systematic review protocol towards developing a taxonomy of community engagement definitions, frameworks, and methods.

INTRODUCTION: The importance of community engagement has been established globally in health and wellness research. A certain degree of ambiguity remains, however, regarding the meaning of community engagement, which term has been used for various purposes and implemented in various forms. In this study, we aimed to explore the different definitions of community engagement, discuss the various objectives that have been proposed and uncover the diverse ways this concept has been implemented among researchers working for the betterment of the health and wellness of immigrant communities in host countries. METHODS AND ANALYSIS: Taxonomy is a process for classifying complex and multifaceted matters using logical conceptual domains and dimensions for clearer way of contextualising. We will develop a taxonomy to organise the available literature on community engagement in immigrant health and wellness research in a way that captures user knowledge and understanding of its various meanings and processes. Specific methodological and analytical frameworks for systematic review and taxonomy development will guide each step. We will conduct a comprehensive systematic search in relevant databases, from inception to December 2019, using appropriate keywords followed by snowball search (single-citation tracking, reference lists). Papers will be included if they fall within predefined inclusion criteria (seen as most likely informative on elements pertaining to community engagement) and are written in English, regardless of design (conceptual, qualitative and quantitative). Two reviewers will independently employ two-stage screening (title-abstract screening followed by screening of the full text to determine inclusion). Finally, information that helps to develop taxonomy of the concept and practice of community engagement will be abstracted and used towards taxonomy development, where different levels of stakeholder research team members will be involved. ETHICS AND DISSEMINATION: Ethical approval is not required for this systematic review. We have opted for an integrated knowledge translation or a community-engaged knowledge mobilisation approach where we are engaged with community-based citizen researchers from the inception of our programme. We plan to disseminate the results of our review through meetings with key stakeholders, followed by journal publications and presentations at applicable platforms.

Barriers to Breast Cancer Screening Among Immigrant Populations in Canada.

The objective of this study is to summarize the current knowledge about barriers to breast cancer screening among immigrant and ethnic women and to determine future research opportunities in this area. A scoping review of the literature was conducted following a five-stage framework. Electronic databases of peer-reviewed articles and grey literature were searched based on comprehensive sets of key words, without restricting the time period or language. Barriers were classified into six themes: socioeconomic, cultural, communication, healthcare-system-related, knowledge-related, and personal barriers. Lack of education, lack of physicians' recommendation, a preference for female physicians, the inability to speak one of the official languages, and embarrassment were some of the common barriers identified. The reported barriers can be used as a source of information for policymakers, healthcare providers, and researchers to decide the future direction of research in this field.

A Framework for Clinical Validation of Automatic Contour Propagation: Standardizing Geometric and Dosimetric Evaluation.

PURPOSE: The objective of this work was to outline and demonstrate a standardized framework for evaluating automatically propagated contour quality against expert contours. A 2-pronged approach is used to evaluate contour quality: a geometric evaluation to identify geometric and spatial discrepancies between propagated and expert contours, and a comprehensive dosimetric comparison to provide clinical context for the results. METHODS AND MATERIALS: The standardized framework requires a primary image, with reference contours and a radiation therapy treatment plan, and a secondary image. Reference contours are automatically propagated onto the secondary image anatomy and compared with expert contours obtained in an interobserver study. The standardized framework outlines geometric and dosimetric evaluation methodologies for determining indistinguishability between propagated and expert contours in a cohort analysis. Propagated contours are geometrically compared with expert contours in terms of the Dice similarity coefficient and the mean distance to agreement. Statistical analysis is performed on the central tendency and variability of Dice similarity coefficient and mean distance to agreement values over the patient cohort. Dosimetric evaluation involves computing the mean and 95% confidence intervals for the differences in cumulative dose-volume histograms for propagated and expert contours. A case study in accelerated partial breast irradiation was shown to demonstrate the framework. RESULTS: The standardized framework was applied to a case study of 24 patient data sets with 3 radiation oncologists providing the expert contours. Cohort analysis indicated that propagated contours were geometrically indistinguishable and dosimetrically distinguishable from expert contours. CONCLUSIONS: The recommended framework standardizes the comparison of geometric and dosimetric parameters to demonstrate indistinguishability of propagated contours from expert contours. Adoption of this framework is vital for consistent and comprehensive validation of automatic contour propagation for use in large-scale cohort analyses.

Sex-specific, high-sensitivity cardiac troponin T cut-off concentrations for ruling out acute myocardial infarction with a single measurement.

OBJECTIVE: Sex-specific diagnostic cut-offs may improve the test characteristics of high-sensitivity troponin assays for the diagnosis of myocardial infarction (MI). The objective of this study was to quantify test characteristics of sex-specific cut-offs of a single, high-sensitivity cardiac troponin T (hs-cTnT) assay for 7-day MI in patients with chest pain. METHODS: This observational cohort study included consecutive emergency department (ED) patients with suspected cardiac chest pain from four Canadian EDs who had an hs-cTnT assay performed within 60 minutes of ED arrival. The primary outcome was MI at 7 days. We quantified test characteristics (sensitivity, negative predictive value [NPV], likelihood ratios and proportion of patients ruled out) for multiple combinations of sex-specific, rule-out cut-offs. We calculated the net reclassification index compared to universal rule-out cut-offs. RESULTS: In 7,130 patients (3,931 men and 3,199 women), the 7-day MI incidence was 7.38% among men and 3.78% among women. Optimal sex-specific cut-offs (<8 ng/L for men and <7 ng/L for women) had a 98.5% sensitivity for MI and ruled out MI in 55.8% of patients. This would enable an absolute increase in the proportion of patients who were able to be ruled out with a single hs-cTnT of 13.2% to 22.2%, depending on the universal rule-out concentration used as a comparator. CONCLUSIONS: Sex-specific hs-cTnT cut-offs for ruling out MI at ED arrival may improve classification performance, enabling more patients to be safely ruled out at ED arrival. However, differences between sex-specific and universal cut-off concentrations are within the variation of the assay, limiting the clinical utility of this approach. These findings should be confirmed in other data sets.

Barriers to cervical cancer screening faced by immigrant women in Canada: a systematic scoping review.

BACKGROUND: The objective of this scoping study is to review the published literature and summarize findings related to barriers experienced by immigrant women in Canada while accessing cervical cancer screening. METHODS: Electronic databases of peer-reviewed articles and grey literature were searched using comprehensive sets of keywords, without restricting the time period or language. Articles were selected based on the following criteria: (a) the study population consisted of Canadian immigrant women and healthcare providers and other stakeholders serving immigrant women, (b) the research focused on the barriers to accessing cervical cancer screening, and (c) the study was conducted in Canada. RESULTS: Extracted data were grouped and analyzed, resulting in barriers comprised of six themes: economic barriers, cultural barriers, language barriers, healthcare system-related barriers, knowledge-related barriers, and individual-level barriers. Lack of education, low income, preference for a female physician, lack of knowledge, lack of effective communication, and embarrassment were some of the most common barriers mentioned. CONCLUSIONS: Immigrant access to health services, including cervical cancer screening, is a complex issue concerning a wide range of barriers. Our findings offer insights into barriers to cervical cancer screening in immigrant communities in Canada that can be used to assist policymakers, healthcare providers, and researchers enhance the health and well-being of these populations by mitigating barriers and improving screening.

Risk factors associated with injury and concussion in sanctioned amateur and professional mixed martial arts bouts in Calgary, Alberta.

BACKGROUND: There is limited literature that examines risk factors for injury and mild traumatic brain injury (mTBI) in mixed martial arts (MMA). An examination of previously unstudied bout and athlete characteristics that may pose health risks while partaking in this sport is warranted. HYPOTHESIS/PURPOSE: To determine the incidence of injury and concussion, along with the identification of risk factors that contribute to injury and mTBI in amateur and professional MMA bouts in Calgary, Alberta. STUDY DESIGN: A retrospective cohort study with case-control design. METHODS: Calgary amateur and professional MMA records were examined from 1 January 2010 to 31 December 2015. Descriptive statistics were used to describe the incidence of injury and concussion, along with univariate and multivariable logistic regression to identify risk factors for injury and mTBI. RESULTS: The injury rate per 100 athlete exposure (AE), the injury rate per 100 min of exposure and the concussion rate per 100 AE were 23.6 (95% CI 20.5 to 27.0), 4.1 (95% CI 3.48 to 4.70) and 14.7 (95% CI 11.8 to 17.2), respectively. The most common location of injury was the head and mTBI was the most common type of injury. Athletes whose bout was finished by a knockout/technical knockout, corner stoppage, draw, no contest or physician, and those whose country of origin was non-Canadian, were more likely to sustain an injury. No risk factors for concussion were shown to be significant. CONCLUSION: Engaging in MMA exposes athletes to inherent risk and several recommendations are proposed to reduce these risks. Future prospective investigations are necessary to better delineate the findings in this study.

Selection for family medicine residency training in Canada: How consistently are the same students ranked by different programs?

OBJECTIVE: To examine the consistency of the ranking of Canadian and US medical graduates who applied to Canadian family medicine (FM) residency programs between 2007 and 2013. DESIGN: Descriptive cross-sectional study. SETTING: Family medicine residency programs in Canada. PARTICIPANTS: All 17 Canadian medical schools allowed access to their anonymized program rank-order lists of students applying to FM residency programs submitted to the first iteration of the Canadian Resident Matching Service match from 2007 to 2013. MAIN OUTCOME MEASURES: The rank position of medical students who applied to more than 1 FM residency program on the rank-order lists submitted by the programs. Anonymized ranking data submitted to the Canadian Resident Matching Service from 2007 to 2013 by all 17 FM residency programs were used. Ranking data of eligible Canadian and US medical graduates were analyzed to assess the within-student and between-student variability in rank score. These covariance parameters were then used to calculate the intraclass correlation coefficient (ICC) for all programs. Program descriptions and selection criteria were also reviewed to identify sites with similar profiles for subset ICC analysis. RESULTS: Between 2007 and 2013, the consistency of ranking by all programs was fair at best (ICC = 0.34 to 0.39). The consistency of ranking by larger urban-based sites was weak to fair (ICC = 0.23 to 0.36), and the consistency of ranking by sites focusing on training for rural practice was weak to moderate (ICC = 0.16 to 0.55). CONCLUSION: In most cases, there is a low level of consistency of ranking of students applying for FM training in Canada. This raises concerns regarding fairness, particularly in relation to expectations around equity and distributive justice in selection processes.

Undetectable Concentrations of a Food and Drug Administration-approved High-sensitivity Cardiac Troponin T Assay to Rule Out Acute Myocardial Infarction at Emergency Department Arrival.

BACKGROUND: The objective of this study was to quantify the sensitivity of very low concentrations of high-sensitivity cardiac troponin T (hsTnT) at ED arrival for acute myocardial infarction (AMI) in a large cohort of chest pain patients evaluated in real-world clinical practice. METHODS: This retrospective study included consecutive ED patients with suspected cardiac chest pain evaluated in four urban EDs, excluding those with ST-elevation AMI, cardiac arrest or abnormal kidney function. The primary outcomes were AMI at 7, 30, and 90 days. Secondary outcomes included major adverse cardiac events (MACE; all-cause mortality, AMI, and revascularization) and the individual MACE components. Test characteristics were calculated for hsTnT values from 3 to 200 ng/L . RESULTS: A total of 7,130 patients met inclusion criteria. AMI incidences at 7, 30, and 90 days were 5.8, 6.0, and 6.2%. When the hsTnT assay was performed at ED arrival, the limit of blank of the assay (3 ng/L) ruled out 7-day AMI in 15.5% of patients with 100% sensitivity and negative predictive value (NPV). The limit of detection of the assay (5 ng/L) ruled out AMI in 33.6% of patients with 99.8% sensitivity and 99.95% NPV for 7-day AMI. The limit of quantification (the Food and Drug Administration [FDA]-approved cutoff for lower the reportable limit) of 6 ng/L ruled out AMI in 42.2% of patients with 99.8% sensitivity and 99.95% NPV. The sensitivities of the cutoffs of <3, <5, and <6 ng/L for 7-day MACE were 99.6, 97.4, and 96.6%, respectively. The NPVs of the cutoffs of <3, <5, and <6 ng/L for 7-day MACE were 99.8, 99.5, and 99.4%, respectively. A secondary analysis was performed in a subgroup of 3,549 higher-risk patients who underwent serial troponin testing. In this subgroup, a cutoff of 3 ng/L ruled out 7-day AMI in 9.6% of patients with 100% sensitivity and NPV, a cutoff of 5 ng/L ruled out 7-day AMI in 23.3% of patients with 99.7% sensitivity and 99.9% NPV, and a cutoff of 6 ng/L ruled out 7-day AMI in 29.8% of patients with 99.7 and 99.9% NPV. In the higher-risk subgroup, the sensitivities of cutoffs of <3, <5, and <6 ng/L for 7-day MACE were 99.8, 97.4, and 96.6%, respectively. In this higher-risk subgroup, the NPV of cutoffs of <3, <5, and <6 ng/L for 7-day MACE were 99.7, 98.5, and 98.4%, respectively. CONCLUSIONS: When used in real-world clinical practice conditions, hsTnT concentrations < 6 ng/L (below the lower reportable limit for an FDA-approved assay) at the time of ED arrival can rule out AMI with very high sensitivity and NPV. The sensitivity for MACE is unacceptably low, and thus a single-troponin rule-out strategy should only be used in the context of a structured risk evaluation.

Social Media as a Platform for Information About Diabetes Foot Care: A Study of Facebook Groups.

BACKGROUND: Diabetes is one of the most challenging chronic health conditions in the current era. Diabetes-related foot problems need proper patient education, and social media could a play role to disseminate proper information. METHOD: A systematic search was performed on Facebook groups using the key words "diabetes foot care", "diabetes foot", "diabetes foot management" and "podiatric care". The search resulted in 57 groups and detailed activity information was collected from those groups. Usefulness of each relevant post was determined. Regression analysis was performed to explore the factors associated with the level of usefulness of diabetes foot care-related Facebook groups. RESULTS: Our search resulted in a total of 16 eligible diabetes foot care-related Facebook groups with a total of 103 eligible posts. The average number of group members for the selected groups were 265.75 with an interquartile range of 3.5-107.75. Of the total 103 timeline posts, 45.6% posts were categorized as useful, while the remaining posts were not useful. Top mentioned diabetes foot care practice was "Checking feet daily". Multivariable logistic regression analysis showed that the level of usefulness of diabetes foot care-related Facebook groups were significantly associated with the type of posts and no association was found with presence of "likes" and presence of comment. CONCLUSION: Facebook being a widely used social networking system, patient welfare organizations, doctors, nurses and podiatrists could use this platform to provide support to educating diabetes patients and their caregivers by disseminating useful and authentic knowledge and information related to diabetes foot care.

Social Networking Sites for Peer-Driven Health Communication: Diabetes-Related Communities in Google.

OBJECTIVE: Google+ is one of the most actively used Social Networking Sites in the world. The aim of our study is to characterize the Google+ communities related to diabetes and identify the factors associated with the activity level of these communities. METHODS: We conducted a systematic search for diabetes-related Google+ communities. We categorized the principal objective of eligible communities into six themes: (1) awareness creation, (2) providing support and sharing experience, (3) product or service promotion, (4) diet-related topics, (5) exercise-related topics, and (6) others. The themes for the posts were: (1) asking for information, (2) providing information, (3) expressing emotion, and (4) advertisement. RESULTS: We included 145 Google+ communities and 378 posts for analysis. Majority (80.0%) of the communities were focused on "General Diabetics", 11.8% were focused on "Type 1 diabetes", 6.2% were focused on "Type 2 diabetes", and 2.1% were focused on "Gestational diabetes". Majority of the communities (35.2%) had the principal objective "Provide support and share experience". Regarding the user-generated posts, 29.6% posts had at least one "+" ("+" is similar to "like" in Facebook), 17.7% posts had comments, and 89.2% posts had external links. Majority of the posts (69.6%) were focused on "General diabetes", 16.9% were focused on "Type 1 diabetes", 12.4% were focused on "Type 2 diabetes" and 1.15 were focused on "gestational diabetes". The top two themes of the posts were "Providing information" (72.8%) and "Advertisement" (31.5%). CONCLUSION: Our study revealed that major activity of diabetes-related Google+ communities was related to providing support and information. However, the accuracy and effectiveness of the information in the communities need to be scrutinized further from clinical perspective.