Background Variability in standard-of-care classifications precludes accurate predictions of early tumor recurrence for individual patients with meningioma, limiting the appropriate selection of patients who would benefit from adjuvant radiotherapy to delay recurrence. We aimed to develop an individualized prediction model of early recurrence risk combining clinical and molecular factors in meningioma. Methods DNA methylation profiles of clinically annotated tumor samples across multiple institutions were used to develop a methylome model of 5-year recurrence-free survival (RFS). Subsequently, a 5-year meningioma recurrence score was generated using a nomogram that integrated the methylome model with established prognostic clinical factors. Performance of both models was evaluated and compared with standard-of-care models using multiple independent cohorts. Results The methylome-based predictor of 5-year RFS performed favorably compared with a grade-based predictor when tested using the 3 validation cohorts (ΔAUC = 0.10, 95% CI: 0.03–0.018) and was independently associated with RFS after adjusting for histopathologic grade, extent of resection, and burden of copy number alterations (hazard ratio 3.6, 95% CI: 1.8–7.2, P < 0.001). A nomogram combining the methylome predictor with clinical factors demonstrated greater discrimination than a nomogram using clinical factors alone in 2 independent validation cohorts (ΔAUC = 0.25, 95% CI: 0.22–0.27) and resulted in 2 groups with distinct recurrence patterns (hazard ratio 7.7, 95% CI: 5.3–11.1, P < 0.001) with clinical implications. Conclusions The models developed and validated in this study provide important prognostic information not captured by previously established clinical and molecular factors which could be used to individualize decisions regarding postoperative therapeutic interventions, in particular whether to treat patients with adjuvant radiotherapy versus observation alone.
Standardization of communication has been suggested as an effective approach to improve communication during patient handoffs such as shift report. Using the clinical microsystem framework, unit leaders and nursing staff developed and pilot tested the medical intensive care unit communication tool. Findings from the pilot study indicated that perceived communication among nurses in general and communication specific to shift report improved significantly following implementation of the tool.
In a study of 117 patients under the age of 20 with acute leukemia, vincristine (VCR), at 2 mg. per square meter body surface per week, produced complete remissions in 55 per cent and partial remissions in 15 per cent. The drug also induced second remissions. Patients entering complete remission with VCR were randomly allocated to maintenance therapy with VCR or placebo. The median duration of remission was short: 9 weeks for VCR compared with 6 weeks for placebo. The probability of serious neurological toxicity computed according to the time of exposure to VCR, based on the supposition that VCR was not used for maintenance therapy, indicated that the minimal theoretical risk of toxicity for the highest complete remission rate occurred at 4 weeks (38 per cent remissions with 5 per cent toxicity). At 6 weeks, the corresponding probabilities were 54 and 16 per cent.
Background: Student peer evaluation is widely used as a form of formative or summative evaluation in a variety of classroom settings; however, the utilization of peer evaluation is not well reported in the nursing literature as part of the clinical evaluation process. Purpose: The purpose of this pilot study was to examine relationships between student peer and faculty evaluations of clinical performance in a baccalaureate nursing program. Participants consisted of clinical faculty (n = 2) and their nursing students (n = 23) enrolled in their first clinical course in a pre-licensure baccalaureate nursing program. The specific research questions were: 1) Is there a relationship between nursing student peer and faculty evaluation of clinical performance? 2) And if there is a relationship between the two groups, is there a difference between nursing student peer and faculty evaluations? Methods: A peer evaluation tool was developed with a 5-point Likert scale consisting of 21 items that comprised five domains of clinical performance (communication, professionalism, teamwork, nursing process, and patient safety). Content validity of the tool was established using a panel of nurses with expertise in clinical performance and psychometric measurement. At midterm, students were asked to evaluate each other's performance using the tool and the faculty also evaluated each student using the same tool. A subscore for each of the domains was created for both student peer and faculty evaluations. The relationships between student peer and faculty evaluation scores were assessed using Pearson's product-moment correlation coefficients. Comparisons between student peer and faculty evaluations were made using paired t-tests. A p-value < 0.05 was considered statistically significant. Findings: Significant positive correlations were found between peer and faculty evaluations for all domains. Statistically significant differences between the two groups were found in all of the domains, with students evaluating their peers highest in the domains of patient safety and communication; faculty scored students highest in the domains of patient safety and teamwork. The findings suggest that student peer evaluation can be valuable for students and faculty in clinical education. Conclusion: Previous studies provided that peer evaluation is a valid and reliable evaluation procedure in dentistry, medicine, pharmacy, and social behavioral sciences. This pilot study has demonstrated that student peer evaluation as part of a formative assessment can be also used for faculty to evaluate students' clinical performance in a baccalaureate nursing program. www.sciedu.ca/jnep
The Institute of Medicine (IOM) Reports of To Err is Human andCrossing the Quality Chasm have called for more interprofessional and coordinated hospital care. For over 20 years, Acute Care for Elders (ACE) Units and models of care that disseminate ACE principles have demonstrated outcomes in-line with the IOM goals. The objective of this overview is to provide a concise summary of studies that describe outcomes of ACE models of care published in 1995 or later. Twenty-two studies met the inclusion. Of these, 19 studies were from ACE Units and three were evaluations of ACE Services, or teams that cared for patients on more than one hospital unit. Outcomes from these studies included increased adherence to evidence-based geriatric care processes, improved patient functional status at time of hospital discharge, and reductions in length of stay and costs in patients admitted to ACE models compared to usual care. These outcomes represent value-based care. As interprofessional team models are adopted, training in successful team functioning will also be needed.
SummaryThe systematic application of guidelines derived from the British National Formulary resulted in a substantial reduction of the amount and frequency of medication used in two hospitals for the mentally handicapped.
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