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Kelly D, Barrett J, Brand G, Leech M, Rees C. Factors influencing decision-making processes for intensive care therapy goals: A systematic integrative review. Aust Crit Care 2024:S1036-7314(24)00049-3. [PMID: 38609749 DOI: 10.1016/j.aucc.2024.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Revised: 02/23/2024] [Accepted: 02/27/2024] [Indexed: 04/14/2024] Open
Abstract
BACKGROUND Delivering intensive care therapies concordant with patients' values and preferences is considered gold standard care. To achieve this, healthcare professionals must better understand decision-making processes and factors influencing them. AIM The aim of this study was to explore factors influencing decision-making processes about implementing and limiting intensive care therapies. DESIGN Systematic integrative review, synthesising quantitative, qualitative, and mixed-methods studies. METHODS Five databases were searched (Medline, The Cochrane central register of controlled trials, Embase, PsycINFO, and CINAHL plus) for peer-reviewed, primary research published in English from 2010 to Oct 2022. Quantitative, qualitative, or mixed-methods studies focussing on intensive care decision-making were included for appraisal. Full-text review and quality screening included the Critical Appraisal Skills Program tool for qualitative and mixed methods and the Medical Education Research Quality Instrument for quantitative studies. Papers were reviewed by two authors independently, and a third author resolved disagreements. The primary author developed a thematic coding framework and performed coding and pattern identification using NVivo, with regular group discussions. RESULTS Of the 83 studies, 44 were qualitative, 32 quantitative, and seven mixed-methods studies. Seven key themes were identified: what the decision is about; who is making the decision; characteristics of the decision-maker; factors influencing medical prognostication; clinician-patient/surrogate communication; factors affecting decisional concordance; and how interactions affect decisional concordance. Substantial thematic overlaps existed. The most reported decision was whether to withhold therapies, and the most common decision-maker was the clinician. Whether a treatment recommendation was concordant was influenced by multiple factors including institutional cultures and clinician continuity. CONCLUSION Decision-making relating to intensive care unit therapy goals is complicated. The current review identifies that breadth of decision-makers, and the complexity of intersecting factors has not previously been incorporated into interventions or considered within a single review. Its findings provide a basis for future research and training to improve decisional concordance between clinicians and patients/surrogates with regards to intensive care unit therapies.
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Affiliation(s)
- Diane Kelly
- Intensive Care Unit, Epworth Hospital, Richmond, VIC, Australia; Monash Centre for Scholarship in Health Education, Faculty of Medicine Nursing & Health Sciences, Monash University, Clayton, VIC, Australia; Faculty of Medicine, Nursing & Health Sciences, Monash University, Clayton, VIC, Australia.
| | - Jonathan Barrett
- Intensive Care Unit, Epworth Hospital, Richmond, VIC, Australia; Faculty of Medicine, Nursing & Health Sciences, Monash University, Clayton, VIC, Australia
| | - Gabrielle Brand
- Monash Nursing & Midwifery, Faculty of Medicine, Nursing & Health Sciences, Monash University, Frankston, VIC, Australia
| | - Michelle Leech
- Faculty of Medicine, Nursing & Health Sciences, Monash University, Clayton, VIC, Australia; Monash Medical Centre, Clayton, VIC 3168, Australia
| | - Charlotte Rees
- Monash Centre for Scholarship in Health Education, Faculty of Medicine Nursing & Health Sciences, Monash University, Clayton, VIC, Australia; School of Health Sciences, College of Medicine, Nursing & Wellbeing, The University of Newcastle, Callaghan, NSW, Australia
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Lawlor S, Leech M. Established advanced practice roles in radiation therapy: A scoping review. J Med Imaging Radiat Oncol 2024; 68:342-352. [PMID: 38450863 DOI: 10.1111/1754-9485.13634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Accepted: 02/23/2024] [Indexed: 03/08/2024]
Abstract
Advanced practitioners are healthcare professionals that are highly skilled with a particular area of expertise. These roles have been successfully implemented in many healthcare settings, improving efficiency of the service, as well as enhancing the standard of care received by patients. Although advanced practice roles have been implemented in some radiation therapy departments, their implementation have yet to be facilitated in the majority of countries. The purpose of this review is to scope the literature available regarding established advanced practice roles in radiation therapy. The PRISMA strategy for the identification of relevant literature was adhered to. Two data bases, EMBASE and PubMed, were searched using combinations of the key words 'Advanced', 'Practice', 'APRT', 'Radiation', 'Therapy' and 'Radiotherapy'. Exclusion criteria were applied, and citation lists were also screened for additional relevant sources, including grey literature sources. A total of 35 relevant sources were identified that discussed advanced practice radiation therapy roles in the United Kingdom, Singapore, Canada, Australia and the USA. Means of role establishment and scope of practice were defined, and a number of advantages and challenges for advanced practice radiation therapist roles were identified. There are many benefits of implementing advanced practice roles in radiation therapy departments. Though the implementation of these roles can be challenging, the existing evidence indicates that it would be beneficial for the patient, the radiation therapist and the department as a whole. A more systematic approach, including reporting of quantitative outcomes may assist in the more widespread implementation of these roles.
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Affiliation(s)
- Sarah Lawlor
- Applied Radiation Therapy Trinity, Discipline of Radiation Therapy, Trinity St. James's Cancer Institute, Trinity College Dublin, Dublin, Ireland
| | - Michelle Leech
- Applied Radiation Therapy Trinity, Discipline of Radiation Therapy, Trinity St. James's Cancer Institute, Trinity College Dublin, Dublin, Ireland
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Yeo AL, Kandane-Rathnayake R, Koelmeyer R, Golder V, Louthrenoo W, Chen YH, Cho J, Lateef A, Hamijoyo L, Luo SF, Wu YJJ, Navarra SV, Zamora L, Li Z, An Y, Sockalingam S, Katsumata Y, Harigai M, Hao Y, Zhang Z, Basnayake BMDB, Chan M, Kikuchi J, Takeuchi T, Bae SC, Oon S, O'Neill S, Goldblatt F, Ng KPL, Law A, Tugnet N, Kumar S, Tee C, Tee M, Ohkubo N, Tanaka Y, Lau CS, Nikpour M, Hoi A, Leech M, Morand EF. SMART-SLE: serology monitoring and repeat testing in systemic lupus erythematosus-an analysis of anti-double-stranded DNA monitoring. Rheumatology (Oxford) 2024; 63:525-533. [PMID: 37208196 PMCID: PMC10836977 DOI: 10.1093/rheumatology/kead231] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 04/18/2023] [Accepted: 05/09/2023] [Indexed: 05/21/2023] Open
Abstract
OBJECTIVE Disease activity monitoring in SLE includes serial measurement of anti-double stranded-DNA (dsDNA) antibodies, but in patients who are persistently anti-dsDNA positive, the utility of repeated measurement is unclear. We investigated the usefulness of serial anti-dsDNA testing in predicting flare in SLE patients who are persistently anti-dsDNA positive. METHODS Data were analysed from patients in a multinational longitudinal cohort with known anti-dsDNA results from 2013 to 2021. Patients were categorized based on their anti-dsDNA results as persistently negative, fluctuating or persistently positive. Cox regression models were used to examine longitudinal associations of anti-dsDNA results with flare. RESULTS Data from 37 582 visits of 3484 patients were analysed. Of the patients 1029 (29.5%) had persistently positive anti-dsDNA and 1195 (34.3%) had fluctuating results. Anti-dsDNA expressed as a ratio to the normal cut-off was associated with the risk of subsequent flare, including in the persistently positive cohort (adjusted hazard ratio [HR] 1.56; 95% CI: 1.30, 1.87; P < 0.001) and fluctuating cohort (adjusted HR 1.46; 95% CI: 1.28, 1.66), both for a ratio >3. Both increases and decreases in anti-dsDNA more than 2-fold compared with the previous visit were associated with increased risk of flare in the fluctuating cohort (adjusted HR 1.33; 95% CI: 1.08, 1.65; P = 0.008) and the persistently positive cohort (adjusted HR 1.36; 95% CI: 1.08, 1.71; P = 0.009). CONCLUSION Absolute value and change in anti-dsDNA titres predict flares, including in persistently anti-dsDNA positive patients. This indicates that repeat monitoring of dsDNA has value in routine testing.
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Affiliation(s)
- Ai Li Yeo
- School of Clinical Sciences at Monash Health, Faculty of Medicine, Nursing & Health Sciences, Monash University, Clayton, Victoria, Australia
| | - Rangi Kandane-Rathnayake
- School of Clinical Sciences at Monash Health, Faculty of Medicine, Nursing & Health Sciences, Monash University, Clayton, Victoria, Australia
| | - Rachel Koelmeyer
- School of Clinical Sciences at Monash Health, Faculty of Medicine, Nursing & Health Sciences, Monash University, Clayton, Victoria, Australia
| | - Vera Golder
- School of Clinical Sciences at Monash Health, Faculty of Medicine, Nursing & Health Sciences, Monash University, Clayton, Victoria, Australia
| | - Worawit Louthrenoo
- Department of Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Yi-Hsing Chen
- Division of Allergy, Immunology and Rheumatology, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Jiacai Cho
- Rheumatology Divsion, National University Hospital, Singapore
| | - Aisha Lateef
- Rheumatology Divsion, National University Hospital, Singapore
| | - Laniyati Hamijoyo
- Department of Medicine, University of Padjadjaran, Bandung, Indonesia
| | - Shue-Fen Luo
- Department of Rheumatology, Chang Gung Memorial Hospital, Guishan Township, Taiwan
| | - Yeong-Jian J Wu
- Department of Rheumatology, Chang Gung Memorial Hospital, Guishan Township, Taiwan
| | - Sandra V Navarra
- Joint and Bone Center, University of Santo Tomas Hospital, Manila, Philippines
| | - Leonid Zamora
- Joint and Bone Center, University of Santo Tomas Hospital, Manila, Philippines
| | - Zhanguo Li
- Department of Rheumatology and Immunology, People's Hospital Peking University Health Sciences Centre, Beijing, China
| | - Yuan An
- Department of Rheumatology and Immunology, People's Hospital Peking University Health Sciences Centre, Beijing, China
| | | | - Yasuhiro Katsumata
- Institute of Rheumatology, Tokyo Women's Medical University, Tokyo, Japan
| | - Masayoshi Harigai
- Institute of Rheumatology, Tokyo Women's Medical University, Tokyo, Japan
| | - Yanjie Hao
- Rheumatology and Immunology Department, Peking University First Hospital, Beijing, China
| | - Zhuoli Zhang
- Rheumatology and Immunology Department, Peking University First Hospital, Beijing, China
| | | | - Madelynn Chan
- Department of Rheumatology, Allergy and Immunology Tan Tock Seng Hospital, Singapore
| | - Jun Kikuchi
- Division of Rheumatology, Department of Internal Medicine, Keio University, Tokyo, Japan
| | - Tsutomu Takeuchi
- Division of Rheumatology, Department of Internal Medicine, Keio University, Tokyo, Japan
| | - Sang-Cheol Bae
- Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases and Hanyang University Institute for Rheumatology Research and Hanyang University Institute of Bioscience and Biotechnology, Seoul, South Korea
| | - Shereen Oon
- Department of Medicine, The University of Melbourne at St Vincent's Hospital, Fitzroy, Victoria, Australia
| | - Sean O'Neill
- Rheumatology Department, Level 1 Liverpool Hospital, Liverpool, NSW, Australia
| | - Fiona Goldblatt
- Rheumatology Unit, Royal Adelaide Hospital and Flinders Medical Centre, Adelaide, South Australia, Australia
| | | | - Annie Law
- Singapore General Hospital, Singapore
| | - Nicola Tugnet
- Department of Rheumatology, Auckland District Health Board, Auckland, New Zealand
| | - Sunil Kumar
- Department of Rheumatology, Middlemore Hospital, Auckland, New Zealand
| | - Cherica Tee
- University of the Philippines, Quezon City, Philippines
| | - Michael Tee
- University of the Philippines, Quezon City, Philippines
| | - Naoaki Ohkubo
- The First Department of Internal Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Yoshiya Tanaka
- The First Department of Internal Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Chak Sing Lau
- Division of Rheumatology and Clinical Immunology, University of Hong Kong, Hong Kong, Hong Kong, China
| | - Mandana Nikpour
- Department of Medicine, The University of Melbourne at St Vincent's Hospital, Fitzroy, Victoria, Australia
| | - Alberta Hoi
- School of Clinical Sciences at Monash Health, Faculty of Medicine, Nursing & Health Sciences, Monash University, Clayton, Victoria, Australia
| | - Michelle Leech
- School of Clinical Sciences at Monash Health, Faculty of Medicine, Nursing & Health Sciences, Monash University, Clayton, Victoria, Australia
| | - Eric F Morand
- School of Clinical Sciences at Monash Health, Faculty of Medicine, Nursing & Health Sciences, Monash University, Clayton, Victoria, Australia
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Leijenaar RTH, Walsh S, Aliboni L, Sanchez VL, Leech M, Joyce R, Gillham C, Kridelka F, Hustinx R, Danthine D, Occhipinti M, Vos W, Guiot J, Lambin P, Lovinfosse P. External validation of a radiomic signature to predict p16 (HPV) status from standard CT images of anal cancer patients. Sci Rep 2023; 13:7198. [PMID: 37137947 PMCID: PMC10156720 DOI: 10.1038/s41598-023-34162-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 04/25/2023] [Indexed: 05/05/2023] Open
Abstract
The paper deals with the evaluation of the performance of an existing and previously validated CT based radiomic signature, developed in oropharyngeal cancer to predict human papillomavirus (HPV) status, in the context of anal cancer. For the validation in anal cancer, a dataset of 59 patients coming from two different centers was collected. The primary endpoint was HPV status according to p16 immunohistochemistry. Predefined statistical tests were performed to evaluate the performance of the model. The AUC obtained here in anal cancer is 0.68 [95% CI (0.32-1.00)] with F1 score of 0.78. This signature is TRIPOD level 4 (57%) with an RQS of 61%. This study provides proof of concept that this radiomic signature has the potential to identify a clinically relevant molecular phenotype (i.e., the HPV-ness) across multiple cancers and demonstrates potential for this radiomic signature as a CT imaging biomarker of p16 status.
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Affiliation(s)
| | - Sean Walsh
- Radiomics (Oncoradiomics SA), Liège, Belgium
| | | | | | - Michelle Leech
- Applied Radiation Therapy, Discipline of Radiation Therapy, Trinity St. James's Cancer Institute, Trinity College, Dublin, Ireland
| | - Ronan Joyce
- Department of Radiation Oncology, St. Luke's Radiation Oncology Network and St James's Hospital, Dublin, Ireland
| | - Charles Gillham
- Department of Radiation Oncology, St. Luke's Radiation Oncology Network and St James's Hospital, Dublin, Ireland
| | - Frédéric Kridelka
- Department of Obstetrics and Gynecology, University Hospital of Liège, Liège, Belgium
| | - Roland Hustinx
- Department of Nuclear Medicine and Oncological Imaging, University Hospital of Liège, Liège, Belgium
| | - Denis Danthine
- Department of Nuclear Medicine and Oncological Imaging, University Hospital of Liège, Liège, Belgium
| | | | - Wim Vos
- Radiomics (Oncoradiomics SA), Liège, Belgium
| | - Julien Guiot
- Department of Pneumology, University Hospital of Liège, Liège, Belgium
| | - Philippe Lambin
- The D-Lab, Department of Precision Medicine, GROW-School for Oncology and Reproduction, Maastricht University, Maastricht, The Netherlands
- Department of Radiology and Nuclear Medicine, GROW-School for Oncology and Reproduction, Maastricht University, Maastricht, The Netherlands
| | - Pierre Lovinfosse
- Department of Nuclear Medicine and Oncological Imaging, University Hospital of Liège, Liège, Belgium.
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Vandemaele M, Aznar M, Blanchard P, Borras JM, Leech M, Aggarwal A, Lievens Y. A systematic literature review of definitions and classification systems for radiotherapy innovation: A first step towards building a value-based assessment tool for radiation oncology. Radiother Oncol 2023; 183:109602. [PMID: 36889594 DOI: 10.1016/j.radonc.2023.109602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 02/24/2023] [Accepted: 02/26/2023] [Indexed: 03/08/2023]
Abstract
INTRODUCTION Timely access to radiotherapy innovations remains suboptimal, partly because there is no commonly agreed appraisal system suitable for the broad range of radiotherapy interventions. The Health Economics in Radiation Oncology (HERO) programme of ESTRO therefore engaged in building a radiotherapy-specific value-based framework. We report on a first step towards that aim, documenting the available definitions and classification systems for radiotherapy interventions. METHODS A systematic literature search was carried out in Pubmed and Embase, following PRISMA methodology and using search terms on 'innovation', 'radiotherapy', 'definition' and 'classification'. Data were extracted from articles that met prespecified inclusion criteria. RESULTS Out of 13,353 articles, 25 met the inclusion criteria, resulting in the identification of 7 definitions of innovation and 15 classification systems applicable to radiation oncology. Iterative appraisal divided the classification systems into two groups. A first group of 11 systems categorized innovations according to the perceived magnitude of innovation, typically 'minor' versus 'major'. The remaining 4 systems categorised innovations according to radiotherapy-specific characteristics, such as the type of radiation equipment or radiobiological properties. Here, commonly used terms as 'technique' or 'treatment' were found to be used in different meanings. DISCUSSION There is no widely accepted definition or classification system for radiotherapy innovations. The data however suggest that unique properties of radiotherapy interventions can be used to categorise innovations in radiation oncology. Still, there remains a need for clear terminology denoting radiotherapy-specific characteristics. CONCLUSION Building on this review, the ESTRO-HERO project will define what is required for a radiotherapy-specific value-based assessment tool.
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Affiliation(s)
- Miet Vandemaele
- Radiation Oncology Department, Ghent University Hospital and Ghent University, Ghent, Belgium.
| | - Marianne Aznar
- Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, UK
| | - Pierre Blanchard
- Department of Radiation Oncology, Gustave Roussy Cancer Campus, Oncostat U1018 INSERM, Université Paris-Saclay, Gustave-Roussy, Villejuif, France
| | - Josep M Borras
- Department of Clinical Sciences, University of Barcelona and Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Spain
| | - Michelle Leech
- Applied Radiation Therapy Trinity, Discipline of Radiation Therapy, School of Medicine, Trinity St. James's Cancer Institute, Trinity College Dublin, Ireland
| | - Ajay Aggarwal
- Institute of Cancer Policy, King's College London, London, UK; Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Yolande Lievens
- Radiation Oncology Department, Ghent University Hospital and Ghent University, Ghent, Belgium
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Yeo AL, Leech M, Ojaimi S, Morand E. Utility of repeat extractable nuclear antigen antibody testing: a retrospective audit. Rheumatology (Oxford) 2023; 62:1248-1253. [PMID: 35916723 DOI: 10.1093/rheumatology/keac437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 07/27/2022] [Accepted: 07/27/2022] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Autoantibodies to ENA are frequently ordered during the workup of suspected autoimmune connective tissue diseases. There are no current guidelines for repeat test ordering. The objective of this study was to assess the utility of repeat ENA testing after an initial negative result. METHODS A retrospective study was conducted in a single, multicentre tertiary health network in Melbourne, Australia. Results of all ENA tests were extracted from the hospital laboratory information system. For patients who had a change in ENA result from negative to positive, clinical information was obtained from the hospital records regarding new diagnosis of an ANA-associated rheumatic disease (AARD). RESULTS A total of 23 438 ENA tests were performed in 19 603 patients from 29 July 2013 to 28 September 2020. In total, 20 918 (89.2%) were negative with 215 (0.9%) being equivocal. Of the 2305 positive tests, the most common ENA auto-antibody specificity detected was anti-Ro52 (1185, 51.4%). A total of 2636 of 19 603 patients (13.4%) had more than one ENA test performed during the study period. Of these, most (2523, 95.7%) had stable ENA results with no change compared with the first test. Only 53 patients (2.2%) had an ENA result that changed from negative to positive. Excluding patients with pre-existing rheumatic conditions and those under 18, there were five new AARDs found in the remaining 34 patients. CONCLUSION Repeat ENA test results rarely change or result in a new diagnosis of an AARD, with repeated testing only warranted if there is a change in clinical manifestations.
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Affiliation(s)
- Ai Li Yeo
- School of Clinical Sciences at Monash Health, Monash University.,Department of Rheumatology
| | - Michelle Leech
- School of Clinical Sciences at Monash Health, Monash University.,Department of Rheumatology
| | - Samar Ojaimi
- Immunology Laboratory, Monash Pathology, Monash Health, Clayton, Australia
| | - Eric Morand
- School of Clinical Sciences at Monash Health, Monash University.,Department of Rheumatology
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Leech M, Leijenaar RTH, Hompland T, Gaffney J, Lyng H, Marignol L. Exploring Hypoxia in Prostate Cancer With T2-weighted Magnetic Resonance Imaging Radiomics and Pimonidazole Scoring. Anticancer Res 2023; 43:351-357. [PMID: 36585179 DOI: 10.21873/anticanres.16170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 12/08/2022] [Accepted: 12/12/2022] [Indexed: 01/01/2023]
Abstract
BACKGROUND/AIM Radiomics involves high throughput extraction of mineable precise quantitative imaging features that serve as non-invasive prognostic or predictive biomarkers. High levels of hypoxia are associated with a poorer prognosis in prostate cancer and limit radiation therapy efficacy. Most patients with prostate cancer undergo magnetic resonance imaging (MRI) as a part of their diagnostics, and T2 imaging is the most utilised imaging method. The aim of this study was to determine whether hypoxia in prostate tumors could be identified using a radiomics model extracted from T2-weighted MR images. MATERIALS AND METHODS Eighty eight intermediate or high-risk prostate cancer patients were evaluated. Prior to radical prostatectomy, all patients received pimonidazole (PIMO). PIMO hypoxic scores were assigned in whole-mount sections from prostatectomy specimens by an experienced pathologist who was blinded to MRI. The region of interest used for radiomics analysis included the prostatic index tumor. Radiomics extraction yielded 165 features using a special evaluation version of RadiomiX [RadiomiX Research Toolbox version 20180831 (OncoRadiomics SA, Liège, Belgium)] for non-clinical use. Multivariable logistic regression with Elastic Net regularization was utilised using 10 times repeated 10-fold cross-validation to select the best model hyperparameters, optimizing for area under the receiver operating characteristic curve (AUC). RESULTS The average (out of sample) performance based on the repeated cross validation using the ONESE model yielded an AUC of 0.60±0.2. Shape-based features were the most prominent in the model. CONCLUSION The development of a radiomics hypoxia model using T2 weighted MR images, standard in the staging of prostate cancer, is possible.
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Affiliation(s)
- Michelle Leech
- Applied Radiation Therapy Trinity, Trinity St. James's Cancer Institute, Discipline of Radiation Therapy, Trinity College, Dublin, Ireland;
| | | | - Tord Hompland
- Radiumhospitalet, Oslo University Hosptial, Oslo, Norway
| | - John Gaffney
- St. Luke's Radiation Oncology Network, Dublin, Ireland
| | - Heidi Lyng
- Radiumhospitalet, Oslo University Hosptial, Oslo, Norway
| | - Laure Marignol
- Applied Radiation Therapy Trinity, Trinity St. James's Cancer Institute, Discipline of Radiation Therapy, Trinity College, Dublin, Ireland
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Forde ME, Robert C, Marignol L, Leech M. SPATIAL RESAMPLING COMBINED WITH INTENSITY DISCRETIZATION IMPROVES REPRODUCIBILITY OF RADIOMIC FEATURES OF THE PAROTID GLAND. Phys Med 2022. [DOI: 10.1016/s1120-1797(22)02418-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
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Turner S, Benstead K, Millar BA, Morris L, Seel M, Leech M, Eriksen JG, Giuliani M. A new wave of leaders: Early evaluation of the interdisciplinary Foundations of Leadership in Radiation Oncology (FLiRO) program. Tech Innov Patient Support Radiat Oncol 2022; 24:94-100. [PMID: 36338012 PMCID: PMC9633739 DOI: 10.1016/j.tipsro.2022.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Revised: 09/04/2022] [Accepted: 09/15/2022] [Indexed: 12/23/2022] Open
Abstract
PURPOSE Effective leadership across all areas of radiation oncology (RO) is vital to fully realise the benefits of radiation therapy in cancer care. We report outcomes of a novel interdisciplinary leadership program designed for RO professionals under a global joint society initiative. METHODS The Foundations of Leadership in RO (FLiRO) program was designed for aspiring RO leaders. Initially delivered in a blended learning format, it was adapted to fully virtual in 2021. It comprised a webinar tutorial, on-line modules and homework followed by 'live' in-person/virtual workshops over an approximately 6-week period. Topics included personal awareness, effective teamwork, quality improvement skills, leading change and conflict management. An immediate post-program online survey was performed using Likert scales to measure self-reported educational value, interaction with others and the likely application of learning to practice. Open comments were invited. RESULTS 170 participants from 36 countries and 6 continents took part from 2018 to 2021 (99 doctors, 36 physicists, 32 radiation therapists/RTTs and 3 others). 141 (83%) participants responded to the post-program survey. Average weightings for responders' views on whether pre-determined learning objectives were met ranged from 4.30 to 4.61 on a 5-point scale (1 = 'not met at all' and 5 = completely met). For the question addressing potential value of learning for application to their workplace, 124 of 130 (95%) of responders indicated that FLIRO would be 'very useful' or 'extremely useful'. CONCLUSION Initial evaluation of the FLiRO program supports its continuation and expansion with ongoing evolution based on emerging evidence around leadership education and participant feedback.
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Affiliation(s)
- Sandra Turner
- Sydney West Radiation Oncology Network, Westmead, NSW, Australia,University of Sydney, Faculty of Health Sciences and Medicine, NSW, Australia,Corresponding author at: Department of Radiation Oncology, Crown Princess Mary Cancer Centre, Westmead Hospital, Hawksbury and Darcy Rds, Westmead NSW 2145, Australia.
| | - Kim Benstead
- Gloucestershire Hospitals NHS Foundation Trust, United Kingdom
| | - Barbara-Ann Millar
- Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, Canada,Department of Radiation Oncology, University of Toronto, Toronto, Canada
| | | | | | - Michelle Leech
- Applied Radiation Therapy Trinity, Trinity St. James’s Cancer Institute, Discipline of Radiation Therapy, Trinity College, Dublin, Ireland
| | - Jesper G Eriksen
- Department of Experimental Clinical Oncology, Aarhus University Hospital, Aarhus, Denmark
| | - Meredith Giuliani
- Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, Canada
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10
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Carr SE, Canny BJ, Wearn A, Carmody D, Celenza A, Diug B, Leech M, Wilkinson TJ. Twelve tips for medical students experiencing an interruption in their academic progress. Med Teach 2022; 44:1081-1086. [PMID: 33969788 DOI: 10.1080/0142159x.2021.1921134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
For every commencing cohort of medical students, a small but significant number will experience an interruption to their academic progression because of academic difficulties, health concerns or external influences outside of the students' control. During the process of researching the factors surrounding difficulties with academic progression, students told us many ways that they have learned from that experience, which then allowed most of them to graduate. This paper combines the shared experiences of students who have had an interruption, and those of the authors as medical educators.
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Affiliation(s)
- Sandra E Carr
- Division of Health Professions Education, The University of Western Australia, Perth, Australia
| | - Ben J Canny
- The University of Tasmania, Hobart, Australia
- Monash University, Clayton, Australia
| | - Andy Wearn
- The University of Auckland, Auckland, New Zealand
| | - Dianne Carmody
- Division of Health Professions Education, The University of Western Australia, Perth, Australia
| | - Antonio Celenza
- Division of Health Professions Education, The University of Western Australia, Perth, Australia
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Coffey M, Naseer A, Leech M. Exploring radiation therapist education and training. Tech Innov Patient Support Radiat Oncol 2022; 24:59-62. [PMID: 36238200 PMCID: PMC9552092 DOI: 10.1016/j.tipsro.2022.09.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Accepted: 09/26/2022] [Indexed: 11/29/2022] Open
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Carr SE, Wearn A, Canny BJ, Carmody D, Balmer D, Celenza A, Diug B, Leech M, Wilkinson TJ. When the wheels fall off - Medical students' experiences of interrupted academic progression. Med Teach 2022; 44:1015-1022. [PMID: 35343860 DOI: 10.1080/0142159x.2022.2055455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
INTRODUCTION There is limited published research on medical students' perspectives of a significant interruption to their academic progression. This study sought to identify the factors that contribute to difficulties with academic progression and to understand how medical students successfully respond. METHODS This interpretive phenomenological study reports on the findings from in-depth interviews of 38 final year medical students who had experienced a significant academic interruption. RESULTS The two superordinate themes were: the factors contributing to the interruption and their experience of the interruption. Factors identified as contributing to the interruption were: workload, learning in medicine, motivation for medicine, isolation, adapting to local culture, health and external factors. Their experience of the interruption focused on stages of working through the process: 'what happened,' 'how it felt,' 'managing the failure,' 'accepting the failure' and 'making some changes.' DISCUSSION Each factor affected how the participants reacted and responded to the interruption. Regardless of the origins of the interruption, most reacted and responded in a comparable process, albeit with varying timespans. These reactions and responses were in a state of fluctuation. In order to succeed many stated they shifted their motivation from external to internal, in direct response to the interruption, resulting in changed learning behaviours. CONCLUSIONS The process of working through an interruption to academic progression for students may benefit from a model of interval debriefing, restorative academic and personal development support. Facilitation of this process could enable students to face an interruption constructively rather than as an insurmountable emotionally burdensome barrier. Medical schools could utilise these findings to implement further support strategies to reduce the number of significant academic disruptions.
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Affiliation(s)
- Sandra E Carr
- Division of Health Professions Education, The University of Western Australia, Perth, Australia
| | - Andy Wearn
- Faculty of Medical and Health Sciences, Clinical Skills Centre, The University of Auckland, Auckland, New Zealand
| | - Ben J Canny
- The University of Tasmania, Melbourne, Australia
- Monash University, Clayton, Australia
| | - Dianne Carmody
- Division of Health Professions Education, The University of Western Australia, Perth, Australia
| | - Deborah Balmer
- Faculty of Medical and Health Sciences, Clinical Skills Centre, The University of Auckland, Auckland, New Zealand
| | - Antonio Celenza
- Division of Health Professions Education, The University of Western Australia, Perth, Australia
| | | | | | - Tim J Wilkinson
- Medical School, Christchurch School of Medicine & Health Sciences, The University of Otago, Dunedin, New Zealand
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Yeo AL, Ojaimi S, Le S, Leech M, Morand E. Frequency and Clinical Utility of Antibodies to Extractable Nuclear Antigen in the Setting of a Negative Antinuclear Antibody Test. Arthritis Care Res (Hoboken) 2022. [PMID: 35904968 DOI: 10.1002/acr.24990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 07/20/2022] [Accepted: 07/26/2022] [Indexed: 01/24/2023]
Abstract
OBJECTIVE Simultaneous antibody testing during screening for autoimmune conditions is discouraged. The incidence of positive extractable nuclear antigen (ENA) in the setting of a negative antinuclear antibody (ANA) has been reported as low. Our objective was to characterize the frequency of diagnosis of new ANA-associated rheumatic disease (AARD) in the setting of a negative ANA with a positive ENA. METHODS This was a 7-year retrospective study from a multicenter tertiary health network in Australia. Clinical information was sought on patients over 18 years old who had a negative ANA but positive ENA test result. Results were extracted from hospital computer systems. RESULTS From March 19, 2011, to July 23, 2018, ENA testing was ordered simultaneously with an ANA test on 4,248 occasions in 3,484 patients. ANA was positive in 2,520 patients (59.3%) and ENA was positive in 1,980 patients (46.6%). Among positive ANA patients, ENA was positive in 1,563 patients (62.0%). Among 1,728 negative ANA tests, ENA was positive in 417 (24.1%) (P < 0.001). A total of 328 patients with discordant ANA/ENA results had data available for further analysis, of whom 279 had no pre-established rheumatologic condition. A new AARD was diagnosed in 17 of 279 patients, yielding a positive predictive value of 6.09% (95% confidence interval 3.59-9.58). CONCLUSION Despite the higher-than-expected incidence of positive ENA in the setting of a negative ANA, the yield of newly diagnosed rheumatic diseases was low. Our findings support the stepwise addition of ENA requests when an ANA test result is positive and clinical suspicion of an AARD is high.
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Affiliation(s)
- Ai Li Yeo
- Monash University and Monash Health, Clayton, Victoria, Australia
| | - Samar Ojaimi
- Monash University and Monash Health, Clayton, Victoria, Australia
| | - Suong Le
- Monash University and Monash Health, Clayton, Victoria, Australia
| | - Michelle Leech
- Monash University and Monash Health, Clayton, Victoria, Australia
| | - Eric Morand
- Monash University and Monash Health, Clayton, Victoria, Australia
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Rees CE, Ottrey E, Kemp C, Brock TP, Leech M, Lyons K, Monrouxe LV, Morphet J, Palermo C. Understanding Health Care Graduates' Conceptualizations of Transitions: A Longitudinal Qualitative Research Study. Acad Med 2022; 97:1049-1056. [PMID: 34879008 DOI: 10.1097/acm.0000000000004554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
PURPOSE Although transitions have been defined in various ways in the higher education literature (e.g., inculcation, development, becoming), little research exists exploring health care learners' conceptualizations of transitions across their transition from final year to new graduate. How they understand transitions is important because such conceptualizations will shape how they navigate their transitions and vice versa. METHOD The authors conducted a 3-month longitudinal qualitative research study with 35 health care learners from 4 disciplines (medicine, dietetics, nursing, and pharmacy) across their final year to new graduate transition to explore how they conceptualized transitions. Data collection occurred between July 2019 and April 2020 at Monash University in Victoria, Australia. The authors employed framework analysis to interrogate the interview and longitudinal audio diary data cross-sectionally and longitudinally. RESULTS The authors found 10 different conceptualizations of transitions broadly categorized as time bound and linear (one-off events, systems, linear, adaptation, linked to identities), ongoing and complex (ongoing processes, multifaceted, complex), or related to transition shock (labor, linked to emotions). The adaptation conceptualization increased in dominance over time, the linear conceptualization was more apparent in the interviews (time points 1 and 3), and the multifaceted and emotion-linked conceptualizations were more dominant in the longitudinal audio diaries (time point 2). CONCLUSIONS This novel study illustrates conceptualizations of transitions as broadly consistent with existing higher education literature but extends this research considerably by identifying differences in conceptualizations across time. The authors encourage health care learners, educators, and policy makers to develop expanded and more sophisticated understandings of transitions to ensure that health care learners can better navigate often challenging graduate transitions. Further research should explore stakeholders' transition conceptualizations over lengthier durations beyond the new graduate transition.
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Affiliation(s)
- Charlotte E Rees
- C.E. Rees is head of school, School of Health Sciences, College of Health, Medicine and Wellbeing, The University of Newcastle, Callaghan, New South Wales, Australia, and adjunct professor, Monash Centre for Scholarship in Health Education, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Victoria, Australia; ORCID: https://orcid.org/0000-0003-4828-1422
| | - Ella Ottrey
- E. Ottrey is postdoctoral fellow, Monash Centre for Scholarship in Health Education, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Victoria, Australia; ORCID: https://orcid.org/0000-0002-2979-548X
| | - Caitlin Kemp
- C. Kemp is research assistant, Monash Centre for Scholarship in Health Education, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Victoria, Australia; ORCID: https://orcid.org/0000-0002-4056-2230
| | - Tina P Brock
- T.P. Brock is professor of pharmacy education and practice, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, Victoria, Australia; ORCID: https://orcid.org/0000-0001-7455-4063
| | - Michelle Leech
- M. Leech is deputy dean and head of medical course, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Victoria, Australia
| | - Kayley Lyons
- K. Lyons is Ware fellow for pharmacy education and leadership, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, Victoria, Australia; ORCID: https://orcid.org/0000-0003-2224-1107
| | - Lynn V Monrouxe
- L.V. Monrouxe is professor for work integrated learning and academic lead of health professions education research, Faculty of Medicine and Health, The University of Sydney, Camperdown, Sydney, New South Wales, Australia; ORCID: https://orcid.org/0000-0002-4895-1812
| | - Julia Morphet
- J. Morphet is associate professor, Monash Nursing and Midwifery, and affiliate, Monash Centre for Scholarship in Health Education, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Victoria, Australia; ORCID: https://orcid.org/0000-0001-7056-6526
| | - Claire Palermo
- C. Palermo is director, Monash Centre for Scholarship in Health Education, and head of education and education research, Department of Nutrition, Dietetics and Food, Monash University, Clayton, Victoria, Australia; ORCID: https://orcid.org/0000-0002-9423-5067
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15
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Naidoo W, Leech M. Feasibility of surface guided radiotherapy for patient positioning in breast radiotherapy versus conventional tattoo-based setups- a systematic review. Tech Innov Patient Support Radiat Oncol 2022; 22:39-49. [PMID: 35481261 PMCID: PMC9035716 DOI: 10.1016/j.tipsro.2022.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 02/07/2022] [Accepted: 03/09/2022] [Indexed: 11/17/2022] Open
Abstract
Background Traditionally tattoos are used for patient setup in radiotherapy. However they may pose challenges for the radiotherapists to achieve precise patient alignment, and serve as a permanent visual reminder of the patient’s diagnosis and often challenging cancer journey. The psychological impact of tattoos has been recognized in recent years. The increasing complexity of treatment techniques and the utilization of hypofractionated regimes, requires an enhanced level of accuracy and safety. Surface guided radiotherapy (SGRT) enables improvements in the accuracy and reproducibility of patient isocentric and postural alignment, enhanced efficiency, and safety in breast radiotherapy. Purpose The aim of this review was to compare the accuracy and reproducibility of SGRT to conventional tattoo-based setups in free-breathing breast radiotherapy and to determine if SGRT can reduce the frequency of routine image guided radiotherapy (IGRT). Materials and Methods A systematic literature review was performed as per PRISMA guidelines. Papers identified through PubMed, Embase, Web of Science and Google Scholar database searches between 2010 and 2021, were critically appraised. Systematic, random, mean residual errors and 3D vector shifts as determined by IGRT verification were analysed. Results A review of 13 full papers suggests SGRT improves the accuracy and reproducibility of patient setup in breast radiotherapy with consistent reductions in the residual errors. There appears to be a good correlation between SGRT setups and radiographic imaging. The frequency of IGRT and the corresponding dose could potentially be reduced. Additionally, SGRT improves treatment efficiency. Conclusion SGRT appears to have improved the accuracy and reproducibility of patient setup and treatment efficiency of breast radiotherapy compared to conventional tattoo/laser-based method, with the potential to reduce the frequency of routine IGRT. The reliance on tattoos in breast radiotherapy are likely to become obsolete with positive implications for both patients and clinical practice.
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16
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Blaszczak W, Ahmed A, Leithner K, Schubert A, Leech M, Bonder C, Tsagakis I. Outlook of women in science: an interview with our authors. Mol Oncol 2022; 16:1047-1056. [PMID: 35122410 PMCID: PMC8895441 DOI: 10.1002/1878-0261.13189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 02/03/2022] [Accepted: 02/03/2022] [Indexed: 11/16/2022] Open
Abstract
Diversity in research teams ties alternative perspectives into research projects, and this can fast-forward scientific progress. Concerted efforts have been aimed at encouraging and supporting women to pursue a career in science, yet a gender disparity can still be observed at senior positions, with fewer women in leadership roles. To get insight into how the current landscape for women in science is perceived by different career stages, we interviewed female authors of Molecular Oncology from diverse career stages and disciplines about their inspiration, challenges they have faced as scientists as well as their thoughts on how gender diversity can be further enhanced.
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Affiliation(s)
| | - Asma Ahmed
- Cancer Research UK Beatson InstituteGlasgowUK
- Institute of Cancer SciencesUniversity of GlasgowUK
| | | | - Antonia Schubert
- Division Signaling and Functional GenomicsGerman Cancer Research Center (DKFZ) and Heidelberg UniversityGermany
- National Center for Tumor Diseases (NCT)Medical OncologyHeidelbergGermany
| | - Michelle Leech
- Discipline of Radiation TherapyTrinity St. James’s Cancer InstituteTrinity College DublinIreland
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17
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Johnson CE, Leech M. Co-designing for success: Fostering psychological safety with learners to optimise learning, collaboration and performance. Med Educ 2022; 56:242-244. [PMID: 34978099 DOI: 10.1111/medu.14723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Revised: 12/20/2021] [Accepted: 12/22/2021] [Indexed: 06/14/2023]
Affiliation(s)
- Christina E Johnson
- Faculty of Medicine, Nursing & Health Sciences, Monash University, Melbourne, Victoria, Australia
- Monash Doctors Education, Monash Health, Melbourne, Victoria, Australia
| | - Michelle Leech
- Faculty of Medicine, Nursing & Health Sciences, Monash University, Melbourne, Victoria, Australia
- Monash Doctors Education, Monash Health, Melbourne, Victoria, Australia
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18
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Lee Y, Cao K, Leech M, De Ponti F. Developing medical artificial intelligence leaders: International university consortium approach. Med Educ 2021; 55:1321-1322. [PMID: 34467539 PMCID: PMC9291590 DOI: 10.1111/medu.14635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Accepted: 08/05/2021] [Indexed: 06/13/2023]
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19
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Ottrey E, Rees CE, Kemp C, Brock TP, Leech M, Lyons K, Monrouxe LV, Morphet J, Palermo C. Exploring health care graduates' conceptualisations of preparedness for practice: A longitudinal qualitative research study. Med Educ 2021; 55:1078-1090. [PMID: 33617656 DOI: 10.1111/medu.14475] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 02/12/2021] [Accepted: 02/18/2021] [Indexed: 05/27/2023]
Abstract
INTRODUCTION Although preparedness for practice (P4P) has been variously described, little shared understanding exists about what P4P is across the health professions. How P4P is conceptualised matters, because this shapes how stakeholders think, talk about and act towards it. Further, multiple understandings can result in diverse expectations for graduate performance. This study therefore explores health care learners' solicited and unsolicited conceptualisations of P4P over their early graduate transition. METHODS We conducted longitudinal qualitative research including individual and group entrance interviews (phase 1: n = 35), longitudinal audio-diaries (phase 2: n = 30), and individual and group exit interviews (phase 3: n = 22) with learners from four disciplines (dietetics, medicine, nursing and pharmacy). We employed framework analysis to interrogate data cross-sectionally and longitudinally. RESULTS We found 13 conceptualisations of P4P (eg knowledge, confidence), broadly similar across the disciplines. We found some conceptualisations dominant in both solicited and unsolicited talk (eg skills), some dominant only in solicited talk (eg competence) and others dominant only in unsolicited talk (eg experience). Although most conceptualisations appeared relatively stable across time, some appeared to dominate at certain time points only (eg employability and skills in phases 1 and 2, and competence in phase 3). DISCUSSION This novel study extends previous uniprofessional work by illustrating a broader array of conceptualisations, differences between professions, solicited versus unsolicited talk and longitudinal cohort patterns. We encourage health care educators to discuss these different P4P understandings in graduate transition interventions. Further research is needed to explore other stakeholders' conceptualisations, and over a duration beyond the early graduate transition.
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Affiliation(s)
- Ella Ottrey
- Monash Centre for Scholarship in Health Education (MCSHE), Faculty of Medicine, Nursing & Health Sciences, Monash University, Clayton, Vic., Australia
| | - Charlotte E Rees
- Monash Centre for Scholarship in Health Education (MCSHE), Faculty of Medicine, Nursing & Health Sciences, Monash University, Clayton, Vic., Australia
- College of Science, Health, Engineering & Education, Murdoch University, Murdoch, WA, Australia
| | - Caitlin Kemp
- Monash Centre for Scholarship in Health Education (MCSHE), Faculty of Medicine, Nursing & Health Sciences, Monash University, Clayton, Vic., Australia
| | - Tina P Brock
- Monash Centre for Scholarship in Health Education (MCSHE), Faculty of Medicine, Nursing & Health Sciences, Monash University, Clayton, Vic., Australia
- Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, Vic., Australia
| | - Michelle Leech
- Medicine, Nursing & Health Sciences Medicine Course, Faculty of Medicine, Nursing & Health Sciences, Monash University, Clayton, Vic, Australia
| | - Kayley Lyons
- Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, Vic., Australia
| | - Lynn V Monrouxe
- School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Camperdown, NSW, Australia
| | - Julia Morphet
- Monash Centre for Scholarship in Health Education (MCSHE), Faculty of Medicine, Nursing & Health Sciences, Monash University, Clayton, Vic., Australia
- Monash Nursing & Midwifery, Faculty of Medicine, Nursing & Health Sciences, Monash University, Clayton, Vic., Australia
| | - Claire Palermo
- Monash Centre for Scholarship in Health Education (MCSHE), Faculty of Medicine, Nursing & Health Sciences, Monash University, Clayton, Vic., Australia
- Department of Nutrition, Dietetics and Food, School of Clinical Sciences at Monash Health, Monash University, Clayton, Vic., Australia
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Leech M, Leijenaar R, Hompland T, Gaffney J, Lyng H, Marignol L. PO-1800 Exploring hypoxia in prostate cancer with T2-weighted MRI radiomics and pimonidazole scoring. Radiother Oncol 2021. [DOI: 10.1016/s0167-8140(21)08251-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Leech M, Cardone A, Ceka K, Hoving C, Poole C. OC-0180 Empowering Patients in Radiation Oncology: Educating cancer patients about Radiation Oncology. Radiother Oncol 2021. [DOI: 10.1016/s0167-8140(21)06795-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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22
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Johnson CE, Keating JL, Leech M, Congdon P, Kent F, Farlie MK, Molloy EK. Development of the Feedback Quality Instrument: a guide for health professional educators in fostering learner-centred discussions. BMC Med Educ 2021; 21:382. [PMID: 34253221 PMCID: PMC8276464 DOI: 10.1186/s12909-021-02722-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Accepted: 05/06/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND Face-to-face feedback plays an important role in health professionals' workplace learning. The literature describes guiding principles regarding effective feedback but it is not clear how to enact these. We aimed to create a Feedback Quality Instrument (FQI), underpinned by a social constructivist perspective, to assist educators in collaborating with learners to support learner-centred feedback interactions. In earlier research, we developed a set of observable educator behaviours designed to promote beneficial learner outcomes, supported by published research and expert consensus. This research focused on analysing and refining this provisional instrument, to create the FQI ready-to-use. METHODS We collected videos of authentic face-to-face feedback discussions, involving educators (senior clinicians) and learners (clinicians or students), during routine clinical practice across a major metropolitan hospital network. Quantitative and qualitative analyses of the video data were used to refine the provisional instrument. Raters administered the provisional instrument to systematically analyse educators' feedback practice seen in the videos. This enabled usability testing and resulted in ratings data for psychometric analysis involving multifaceted Rasch model analysis and exploratory factor analysis. Parallel qualitative research of the video transcripts focused on two under-researched areas, psychological safety and evaluative judgement, to provide practical insights for item refinement. The provisional instrument was revised, using an iterative process, incorporating findings from usability testing, psychometric testing and parallel qualitative research and foundational research. RESULTS Thirty-six videos involved diverse health professionals across medicine, nursing and physiotherapy. Administering the provisional instrument generated 174 data sets. Following refinements, the FQI contained 25 items, clustered into five domains characterising core concepts underpinning quality feedback: set the scene, analyse performance, plan improvements, foster learner agency, and foster psychological safety. CONCLUSIONS The FQI describes practical, empirically-informed ways for educators to foster quality, learner-centred feedback discussions. The explicit descriptions offer guidance for educators and provide a foundation for the systematic analysis of the influence of specific educator behaviours on learner outcomes.
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Affiliation(s)
- Christina E Johnson
- Department of Medical Education, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Victoria, Australia.
| | - Jennifer L Keating
- Department of Physiotherapy, School of Primary and Allied Health Care, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
| | - Michelle Leech
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Monash Health, Melbourne, Victoria, Australia
| | - Peter Congdon
- Royal Australian and New Zealand College of Psychiatrists, Melbourne, Victoria, Australia
| | - Fiona Kent
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
| | - Melanie K Farlie
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Monash Health, Melbourne, Victoria, Australia
| | - Elizabeth K Molloy
- Department of Medical Education, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Victoria, Australia
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Kearney M, Leech M, O'Neill M, Davis S. Evaluation of an eLearning teaching innovation to assist clinical radiation therapy educators in the provision of student feedback. J Med Imaging Radiat Sci 2021; 52:S57-S67. [PMID: 34261615 DOI: 10.1016/j.jmir.2021.03.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Revised: 03/19/2021] [Accepted: 03/23/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Clinical placement is an integral part of the Radiation Therapy undergraduate programme. Feedback and formative assessment during clinical placement are regarded as key to developing clinical skills and competencies. Students regularly report dissatisfaction with the feedback process while clinical educators report heavy clinical workloads and a lack of guidance on feedback mechanisms as barriers to providing meaningful student feedback. METHODS An eLearning teaching intervention was developed to support radiation therapists in the provision of student feedback in the clinic. Thematic analysis was used to report attitudes to feedback and feedback practices collected in a pre and a post intervention evaluation. RESULTS 30 radiation therapists completed the module and pre and post intervention evaluations. Prior to taking the module just over half of respondents stated that they offered regular and on-going feedback throughout the student's placement. Positive attitudes to feedback were reported. Following completion of the eLearning tool respondents reported a higher level of confidence in the provision of student feedback and almost 70% said the module had changed how they would approach the feedback process by using feedback models in the future. DISCUSSION Good and timely feedback is essential and allows a student opportunity to improve prior to the end of the placement. It also teaches students how to self-assess and self-reflect - skills that they can use in continuous professional development after they graduate. Radiation therapists appreciate the structure that using a model in the feedback process offers. CONCLUSION This eLearning teaching intervention was received favourably by radiation therapists who are key to creating a culture of feedback in the clinical environment that will facilitate students in becoming competent healthcare professionals.
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Affiliation(s)
- Maeve Kearney
- Applied Radiation Therapy Trinity, Discipline of Radiation Therapy, School of Medicine, Trinity College Dublin, Ireland.
| | - Michelle Leech
- Applied Radiation Therapy Trinity, Discipline of Radiation Therapy, School of Medicine, Trinity College Dublin, Ireland
| | - Mary O'Neill
- School of Medicine, Trinity College, Dublin, Ireland
| | - Siobhan Davis
- School of Dental Science, Dublin Dental University Hospital, Trinity College, Dublin, Ireland
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Wang D, Yeo AL, Dendle C, Morton S, Morand E, Leech M. Severe infections remain common in a real-world rheumatoid arthritis cohort: A simple clinical model to predict infection risk. Eur J Rheumatol 2021; 8:133-138. [PMID: 33372891 PMCID: PMC9770411 DOI: 10.5152/eurjrheum.2020.20172] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVE This study aimed to investigate the incidence of severe infections in patients of a dedicated rheumatoid arthritis (RA) clinic, identify the associated risk factors, and derive an infection risk screening tool. METHODS Between January and July 2019, 263 eligible patients with a diagnosis of RA were recruited retrospectively and consecutively from an RA clinic of an Australian tertiary hospital. The primary outcome was severe infection (requiring hospital admission) between January 2018 and July 2019. We collected data from medical records and pathology results. We used validated scores, such as the disease activity score of 28 joints (DAS28) and the Charlson comorbidity index, to assess the disease activity and comorbidity burden. Multivariable logistic regression was used for statistical analysis. RESULTS A total of 45 severe infection episodes occurred in 34 (13%) patients, corresponding to 10.8 infections per 100 patient-years. Respiratory (53%) and urinary (13%) tract infections were the most common. In the multivariable analysis, significant risk factors included low lymphocyte count (odds ratio [OR], 4.08; 95% confidence interval [CI], 1.16-14.29), severe infection in the past 3 years (OR, 3.58; 95% CI, 1.28-9.97), Charlson comorbidity index >2 (OR, 2.69; 95% CI, 1.03-7.00), and higher DAS28 (OR, 1.35/0.5-unit increment; 95% CI, 1.10-1.67). A model incorporating these factors and age had an area under receiver operating characteristic curve of 0.82. CONCLUSION To the best of our knowledge, this was one of the first Australian studies to evaluate severe infection rates in a real-world RA cohort. The rates remained high and comparable with those of the older studies. Lymphopenia, disease activity, comorbidity burden, and previous severe infection were the independent risk factors for infection. A model comprising easily assessable clinical and biological parameters has an excellent predictive potential for severe infection. Once validated, it may be developed into a screening tool to help clinicians rapidly identify the high-risk patients and inform the tailored clinical decision making.
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Affiliation(s)
- Dorothy Wang
- Centre for Inflammatory Diseases, Monash University, Clayton, Victoria,
Australia
| | - Ai Li Yeo
- Centre for Inflammatory Diseases, Monash University, Clayton, Victoria,
Australia,Department of Rheumatology, Monash Health, Clayton, Victoria,
Australia,Department of Infectious Disease, Monash Health, Clayton, Victoria,
Australia
| | - Claire Dendle
- Centre for Inflammatory Diseases, Monash University, Clayton, Victoria,
Australia,Department of Infectious Disease, Monash Health, Clayton, Victoria,
Australia
| | - Susan Morton
- Department of Rheumatology, Monash Health, Clayton, Victoria,
Australia
| | - Eric Morand
- Centre for Inflammatory Diseases, Monash University, Clayton, Victoria,
Australia,Department of Rheumatology, Monash Health, Clayton, Victoria,
Australia
| | - Michelle Leech
- Centre for Inflammatory Diseases, Monash University, Clayton, Victoria,
Australia,Department of Rheumatology, Monash Health, Clayton, Victoria,
Australia
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Leijenaar RT, Walsh S, Vaidyanathan A, Zerka F, Occhipinti M, Danthine D, Kridelka F, Hustinx R, Vos W, Guiot J, Leech M, Gillham C, Lyons CA, Flavin A, Lambin P, Lovinfosse P. External validation of a radiomic signature to predict HPV (p16) status from standard CT images of anal and vulvar cancer patients. J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.15_suppl.e15502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e15502 Background: HPV status of anal and vulvar cancers cannot be predicted by visual inspection as well as for oropharyngeal cancers. Radiomics applied on computed tomography images can extract features that may better characterize the structure and the underlying biology of the tumor. Methods: In this multi-center study, we validated a CT based radiomic signature to predict HPV (p16) status, developed in head & neck cancer, in anal and vulvar cancer patients. The patients cohort was composed of 68 anal cancer patients and 7 vulvar cancer patients, with p16 status determined by immunohistochemistry, while a control cohort was composed of 422 lung cancer patients. The patient cohorts come from 4 different centers (Maastro Clinic - the Netherlands, CHU Liege – Belgium, St Luke’s Hospital – Ireland, Cork University Hospital - Ireland). The primary tumor volume was manually delineated for each patient on axial CT images. Prior to analysis, all images were resampled to isotropic voxels of 2 mm, using linear interpolation. A total of 37 radiomics features were calculated from five groups: tumor intensity, shape, texture, Wavelet and Laplacian of Gaussian. The signature was built using regularized logistic regression [1]. The signature was evaluated according to the Transparent Reporting of a multivariable prediction model for Individual Prognosis or Diagnosis (TRIPOD) and the Radiomics Quality Score (RQS). Results: The signature classified anal and vulvar cancers based on their HPV status (positive or negative), with an AUROC of 0.760 comparable to the performance of the original signature developed in oropharyngeal squamous cell carcinomas (AUROC of 0.764) [1]. The model, tested in the control cohort of lung cancer patients, predicted the HPV positive status of 1% of the patients which is in line with expected European prevalence (0 – 10%). This signature is TRIPOD level 4 (57%) with an RQS of 61%. Conclusions: This study supplies an additional insight into HPV imaging phenotype, providing a proof of concept that molecular information can be inferred from standard medical images by means of radiomics. These preliminary but encouraging results may pave the road for further generalization of CT image features of HPV-related tumors and aid in the optimization of future therapy developments [2]. Reference [1] Ralph TH Leijenaar et al., The British Journal of Radiology 2018 91:1086 [2] Immunotherapy Drug with Two Targets Shows Promise against HPV-Related Cancers - accessed on 12/02/2021 - https://www.cancer.gov/
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Affiliation(s)
| | | | - Akshayaa Vaidyanathan
- The D-Lab, Department of Precision Medicine, Department of Nuclear Medicine, GROW–School for Oncology, Maastricht University, Maastricht, Netherlands
| | | | | | - Denis Danthine
- Department of Nuclear Medicine and Oncological Imaging, University Hospital of Liège, Liege, Belgium
| | - Frederic Kridelka
- Department of Obstetrics and Gynecology, University Hospital of Liège, Liege, Belgium
| | - Roland Hustinx
- Department of Nuclear Medicine and Oncological Imaging, University Hospital of Liège, Liege, Belgium
| | | | - Julien Guiot
- Department of Pneumology, University Hospital of Liège, Liege, Belgium
| | - Michelle Leech
- Discipline of Radiation Therapy, Trinity College Dublin, University of Dublin, Dublin, Ireland
| | - Charles Gillham
- Department of Radiation Oncology, St Luke's Hospital, Dublin, Ireland
| | - Ciara A. Lyons
- Department of Radiation Oncology, Cork University Hospital, Cork, Ireland
| | - Aileen Flavin
- Department of Radiation Oncology, Cork University Hospital, Cork, Ireland
| | - Philippe Lambin
- The D-Lab, Department of Precision Medicine, Department of Nuclear Medicine, GROW–School for Oncology, Maastricht University, Maastricht, Netherlands
| | - Pierre Lovinfosse
- Department of Nuclear Medicine and Oncological Imaging, University Hospital of Liège, Liege, Belgium
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Kovitwanichkanont T, Raghunath S, Wang D, Kyi L, Pignataro S, Morton S, Morand E, Leech M. Who is afraid of biosimilars? Openness to biosimilars in an Australian cohort of patients with rheumatoid arthritis. Intern Med J 2021; 50:374-377. [PMID: 32141205 DOI: 10.1111/imj.14753] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2019] [Revised: 09/09/2019] [Accepted: 09/28/2019] [Indexed: 11/27/2022]
Abstract
Biosimilars are increasingly adopted to improve affordability of biologics. An effective introduction of biosimilars requires an understanding of patient acceptance of these agents. We performed a cross-sectional study of 132 patients with rheumatoid arthritis prior to the introduction of biosimilar switching or prescribing in this cohort. Despite being unfamiliar with biosimilars, most patients are willing to accept biosimilar medicines if recommended by their rheumatologist. Patient concerns about biosimilar uptake mainly focus on concerns about its efficacy. There is a significant correlation between patient attitudes towards biosimilar and generic medicines.
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Affiliation(s)
- Tom Kovitwanichkanont
- Department of Rheumatology, Monash Health, Melbourne, Victoria, Australia.,Centre for Inflammatory Diseases, School of Clinical Sciences, Monash University, Melbourne, Victoria, Australia
| | - Sudha Raghunath
- Department of Rheumatology, Monash Health, Melbourne, Victoria, Australia.,Centre for Inflammatory Diseases, School of Clinical Sciences, Monash University, Melbourne, Victoria, Australia
| | - Dorothy Wang
- Centre for Inflammatory Diseases, School of Clinical Sciences, Monash University, Melbourne, Victoria, Australia
| | - Leo Kyi
- Department of Rheumatology, Monash Health, Melbourne, Victoria, Australia
| | - Silvana Pignataro
- Department of Rheumatology, Monash Health, Melbourne, Victoria, Australia
| | - Susan Morton
- Department of Rheumatology, Monash Health, Melbourne, Victoria, Australia
| | - Eric Morand
- Department of Rheumatology, Monash Health, Melbourne, Victoria, Australia.,Centre for Inflammatory Diseases, School of Clinical Sciences, Monash University, Melbourne, Victoria, Australia
| | - Michelle Leech
- Department of Rheumatology, Monash Health, Melbourne, Victoria, Australia.,Centre for Inflammatory Diseases, School of Clinical Sciences, Monash University, Melbourne, Victoria, Australia
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Wong C, van den Broek W, Doody G, Fischer M, Leech M, De Ponti F, Gerbes A, Nishigori H, Lee YM, Frens M, Kasuya H, Bazzoli F, Hickel R, Lee HS, van Leeuwen J, Mitchell C, Kadomatsu K, Atherton J, Chan F. Continuing medical education during pandemic waves of COVID-19: Consensus from medical faculties in Asia, Australia and Europe. MedEdPublish (2016) 2021; 10:64. [PMID: 38486552 PMCID: PMC10939633 DOI: 10.15694/mep.2021.000064.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/17/2024] Open
Abstract
This article was migrated. The article was marked as recommended. Medical faculties have the responsibility to train tomorrow's doctors and in a crisis face the challenge of delivering students into the workforce promptly and safely. Worldwide, medical faculties have faced unprecedented disruptions from viral outbreaks and pandemics including SARS, Ebola, H1N1 and COVID-19 which bring unique challenges. Currently there is worldwide disruption to medical faculties and medical education due to COVID-19. Despite close links with clinical medicine and the known risks of pandemics, many medical faculties have been caught off guard without pandemic planning in place, to deal with an exponential rise in infections and deaths, overwhelmed health services and widespread community risk of transmission. Assessing transmission risk of COVID-19 in teaching, clinical and community attachments and continuing medical education is paramount as medical faculties face subsequent pandemics waves. Consensus statements based on best available evidence and international expertise from medical faculties in Asia, Australia and Europe were developed to help guide the protection of staff and students, priorities on teaching activities and further educational development. Infection prevention, infection control, contact tracing and medical surveillance are detailed to minimise transmission and to enhance safety. Recommendations on teaching activities planning can enhance responsiveness of medical faculties to tackle subsequent waves of COVID-19 infection. A global approach and dialogue are encouraged.
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Forde E, Leech M, Robert C, Herron E, Marignol L. Influence of inter-observer delineation variability on radiomic features of the parotid gland. Phys Med 2021; 82:240-248. [PMID: 33677385 DOI: 10.1016/j.ejmp.2021.01.084] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 01/06/2021] [Accepted: 01/29/2021] [Indexed: 12/14/2022] Open
Abstract
PURPOSE This study aimed to quantify the variability in the values of radiomic features extracted from a right parotid gland (RPG) delineated by a series of independent observers. METHODS This was a secondary analysis of anonymous data from a delineation workshop. Inter-observer variability of the RPG from 40 participants was quantified using DICE similarity coefficient (DSC) and Hausdorff distance (HD). An additional contour was generated using Varian SmartSegmentation. Radiomic features extracted include four shape features, six histogram features, and 32 texture features. The absolute mean paired percentage difference (PPD) in feature values from the expert and participants were ranked . Feature robustness was classified using pre- determined thresholds. RESULTS 63% of participants achieved a DSC > 0.7, the auto- segmentation DSC was 0.76. The average HD for the participants was 16.16 mm ± 0.66 mm, and 15.16 mm for the auto-segmentation. 48% (n = 20) and 33% (n = 14) of features were deemed to be robust with a mean absolute PPD < 5%, for the auto-segmentation and manual delineations respectively; the majority of which were from the grey-run length matrix family. 7% (n = 3) of features from the auto- segmentation and 10% (n = 4) from the manual contours were deemed to be unstable with a mean absolute PPD > 50%. The value of the most robust feature was not related to DSC and HD. CONCLUSION Inter-observer delineation variability affects the value of the radiomic features extracted from the RPG. This study identifies the radiomic features least sensitive to these uncertainties. Further investigation of the clinical relevance of these features in prediction of xerostomia is warranted.
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Affiliation(s)
- E Forde
- Applied Radiation Therapy Trinity, Discipline of Radiation Therapy, Trinity St James' Cancer Institute, Trinity College Dublin, Dublin, Ireland.
| | - M Leech
- Applied Radiation Therapy Trinity, Discipline of Radiation Therapy, Trinity St James' Cancer Institute, Trinity College Dublin, Dublin, Ireland
| | - C Robert
- Molecular Radiotherapy and Innovative Therapeutics, INSERM UMR1030, Gustave Roussy Cancer Campus, Université Paris Salcay, Villejuif, France
| | - E Herron
- Department of Psychiatry School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - L Marignol
- Applied Radiation Therapy Trinity, Discipline of Radiation Therapy, Trinity St James' Cancer Institute, Trinity College Dublin, Dublin, Ireland
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O'Donovan A, Leech M. Personalised treatment for older adults with cancer: The role of frailty assessment. Tech Innov Patient Support Radiat Oncol 2020; 16:30-38. [PMID: 33102819 PMCID: PMC7568178 DOI: 10.1016/j.tipsro.2020.09.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 09/04/2020] [Accepted: 09/04/2020] [Indexed: 12/13/2022] Open
Abstract
It is widely accepted in clinical practice that chronological age is a poor predictor of treatment tolerance and outcomes in older adults with cancer. Intrinsic vulnerability is more a function of underlying frailty, rather than chronological age. Frailty is a state of increased vulnerability to stressors, such as cancer and its treatment, which can lead to adverse health outcomes for patients. Capturing this heterogeneity in reserve capacity is the cornerstone of management in geriatricmedicine, but remains poorly understood or adopted in radiation oncology. A two-step approach, using a shorter screening tool, followed by full assessment for those who need it, is the mostresourceful way of implementing frailty assessment in radiotherapy departments. It is important for radiation oncology professionals to identify frailty and to use this information in multidisciplinary decision making in order to develop a personalised radiotherapy approach for the older person. There are many ways we can effectively use this information, such as considering treatment fractionation schedules that would limit the burden of travel for those with social frailty, or reviewing the range of modalities at our disposal, which might limit toxicity in the older person at high risk of deterioration during treatment. Frailty assessment is not carried out in many radiotherapy departments presently, but there are many international models to use as exemplars as to how it may be implemented in clinical practice. There are many opportunities for further research and role development in this field at the current time.
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Leech M, Osman S, Jain S, Marignol L. Mini review: Personalization of the radiation therapy management of prostate cancer using MRI-based radiomics. Cancer Lett 2020; 498:210-216. [PMID: 33160001 DOI: 10.1016/j.canlet.2020.10.033] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 10/14/2020] [Accepted: 10/21/2020] [Indexed: 12/21/2022]
Abstract
Decisions on how to treat prostate cancer with radiation therapy are guideline-based but as such guidelines have been developed for populations of patients, this invariably leads to overly aggressive treatment in some patients and insufficient treatment in others. Heterogeneity within prostate tumors and in metastatic sites, even within the same patient, is believed to be a major cause of treatment failure. Radiomics biomarkers, more commonly referred to as radiomics 'features", provide readily available, cost-effective, non-invasive tools for screening, detecting tumors and serial monitoring of patients, including assessments of response to therapy and identification of therapeutic complications. Radiomics offers the potential to analyse whole tumors in 3D, as well as sub-regions or 'habitats' within tumors. Combining quantitative information from imaging with pathology, demographic details and other biomarkers will pave the way for personalised treatment selection and monitoring in prostate cancer. The aim of this review is to consider if MRI-based radiomics can bridge the gap between population-based management and personalised management of prostate cancer.
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Affiliation(s)
- Michelle Leech
- Applied Radiation Therapy Trinity, Discipline of Radiation Therapy, School of Medicine, Trinity St. James's Cancer Institute, Trinity College, Dublin, Ireland.
| | - Sarah Osman
- Centre for Cancer Research and Cell Biology, Queen's University Belfast, Lisburn Road, Belfast, BT9 7AE, United Kingdom
| | - Suneil Jain
- Centre for Cancer Research and Cell Biology, Queen's University Belfast, Lisburn Road, Belfast, BT9 7AE, United Kingdom
| | - Laure Marignol
- Applied Radiation Therapy Trinity, Discipline of Radiation Therapy, School of Medicine, Trinity St. James's Cancer Institute, Trinity College, Dublin, Ireland
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31
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Leech M. SP-0002: The ultimate truth on how to get your paper published in an ESTRO journal-ethical considerations. Radiother Oncol 2020. [DOI: 10.1016/s0167-8140(21)00028-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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32
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Leech M. SP-0036: Leading RTT teaching, research and advocacy programmes in the academic setting. Radiother Oncol 2020. [DOI: 10.1016/s0167-8140(21)00062-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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33
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Tse WC, Leder K, Leech M. Humanising medicine in the era of universal masking. Intern Med J 2020; 50:1297. [DOI: 10.1111/imj.15008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Accepted: 08/09/2020] [Indexed: 11/28/2022]
Affiliation(s)
- Wai Chung Tse
- School of Medicine Monash University Melbourne Victoria Australia
| | - Karin Leder
- Infectious Diseases Epidemiology Unit, School of Public Health and Preventive Medicine Monash University Melbourne Victoria Australia
| | - Michelle Leech
- School of Medicine Monash University Melbourne Victoria Australia
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Tsang Y, Duffton A, Leech M, Rossi M, Scherer P. Meeting the challenges imposed by COVID-19: Guidance document by the ESTRO Radiation TherapisT Committee (RTTC). Tech Innov Patient Support Radiat Oncol 2020; 15:6-10. [PMID: 32514473 PMCID: PMC7242958 DOI: 10.1016/j.tipsro.2020.05.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 05/14/2020] [Accepted: 05/14/2020] [Indexed: 01/31/2023] Open
Abstract
COVID-19 - a novel coronavirus was firstly reported in December 2019. In response to threats imposed by COVID-19, the European society for radiotherapy and oncology Radiation TherapisT Committee (ESTRO RTTC) prepared this document in conjunction with an infographic with four main domains: patient care, RTT workflow, remote working and RT practice. In the context of the current COVID-19 pandemic, RTTs should be empowered with appropriate guidance and personal protection equipment in order to provide a safe radiotherapy service by limiting potential viral exposure to patients, healthcare workers and general public.
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Affiliation(s)
- Yat Tsang
- Radiotherapy Department, Mount Vernon Cancer Centre, Northwood, Middlesex, United Kingdom
| | - Aileen Duffton
- Radiotherapy Department, Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom
| | - Michelle Leech
- Applied Radiation Therapy Trinity, Discipline of Radiation Therapy, School of Medicine, Trinity College, Dublin 2, Ireland
| | - Maddalena Rossi
- Department of Radiation Oncology, The Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Philipp Scherer
- Department of Radiotherapy and Radio-Oncology, Paracelsus Medical University Hospital Salzburg, Landeskrankenhaus, Salzburg, Austria
| | - on behalf of ESTRO RTTC
- Radiotherapy Department, Mount Vernon Cancer Centre, Northwood, Middlesex, United Kingdom
- Radiotherapy Department, Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom
- Applied Radiation Therapy Trinity, Discipline of Radiation Therapy, School of Medicine, Trinity College, Dublin 2, Ireland
- Department of Radiation Oncology, The Netherlands Cancer Institute, Amsterdam, the Netherlands
- Department of Radiotherapy and Radio-Oncology, Paracelsus Medical University Hospital Salzburg, Landeskrankenhaus, Salzburg, Austria
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35
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Barrett S, Simpkin AJ, Walls GM, Leech M, Marignol L. Geometric and Dosimetric Evaluation of a Commercially Available Auto-segmentation Tool for Gross Tumour Volume Delineation in Locally Advanced Non-small Cell Lung Cancer: a Feasibility Study. Clin Oncol (R Coll Radiol) 2020; 33:155-162. [PMID: 32798158 DOI: 10.1016/j.clon.2020.07.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 06/24/2020] [Accepted: 07/24/2020] [Indexed: 12/25/2022]
Abstract
AIMS To quantify the reliability of a commercially available auto-segmentation tool in locally advanced non-small cell lung cancer using serial four-dimensional computed tomography (4DCT) scans during conventionally fractionated radiotherapy. MATERIALS AND METHODS Eight patients with serial 4DCT scans (n = 44) acquired over the course of radiotherapy were assessed. Each 4DCT had a physician-defined primary tumour manual contour (MC). An auto-contour (AC) and a user-adjusted auto-contour (UA-AC) were created for each scan. Geometric agreement of the AC and the UA-AC to the MC was assessed using the dice similarity coefficient (DSC), the centre of mass (COM) shift from the MC and the structure volume difference from the MC. Bland Altman analysis was carried out to assess agreement between contouring methods. Dosimetric reliability was assessed by comparison of planning target volume dose coverage on the MC and UA-AC. The time trend analysis of the geometric accuracy measures from the initial planning scan through to the final scan for each patient was evaluated using a Wilcoxon signed ranks test to assess the reliability of the UA-AC over the duration of radiotherapy. RESULTS User adjustment significantly improved all geometric comparison metrics over the AC alone. Improved agreement was observed in smaller tumours not abutting normal soft tissue and median values for geometric comparisons to the MC for DSC, tumour volume difference and COM offset were 0.80 (range 0.49-0.89), 0.8 cm3 (range 0.0-5.9 cm3) and 0.16 cm (range 0.09-0.69 cm), respectively. There were no significant differences in dose metrics measured from the MC and the UA-AC after Bonferroni correction. Variation in geometric agreement between the MC and the UA-AC were observed over the course of radiotherapy with both DSC (P = 0.035) and COM shift from the MC (ns) worsening. The median tumour volume difference from the MC improved at the later time point. CONCLUSIONS These findings suggest that the UA-AC can produce geometrically and dosimetrically acceptable contours for appropriately selected patients with non-small cell lung cancer. Larger studies are required to confirm the findings.
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Affiliation(s)
- S Barrett
- Applied Radiation Therapy Trinity, Discipline of Radiation Therapy, Trinity College Dublin, Dublin, Ireland.
| | - A J Simpkin
- School of Mathematics, Statistics and Applied Mathematics, National University of Ireland, Galway, Ireland
| | - G M Walls
- Patrick G Johnston Centre for Cancer Research, Queen's University Belfast, Belfast, UK
| | - M Leech
- Applied Radiation Therapy Trinity, Discipline of Radiation Therapy, Trinity College Dublin, Dublin, Ireland
| | - L Marignol
- Applied Radiation Therapy Trinity, Discipline of Radiation Therapy, Trinity College Dublin, Dublin, Ireland
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36
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Li Wen Y, Leech M. Review of the Role of Radiomics in Tumour Risk Classification and Prognosis of Cancer. Anticancer Res 2020; 40:3605-3618. [PMID: 32620600 DOI: 10.21873/anticanres.14350] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 05/18/2020] [Accepted: 05/23/2020] [Indexed: 11/10/2022]
Abstract
Radiomics, an emerging field in radiation therapy, is hypothesized to improve classification of tumour risk and prognosis. Despite encouraging results, there are issues of practicality and interpretation of radiomic data. This study investigates the emerging role of radiomics in tumour risk classification and prognosis of breast and prostate cancer. A literature search was conducted using predefined terms to retrieve studies related to radiomics. Studies were evaluated and selected upon meeting the criteria defined. A total of 19 relevant publications were selected from 63 publications identified. Data from studies revealed significant area under the curve (AUC) values and high discriminative power. Significant AUC values for biochemical recurrence of disease and disease-free survival were reported for prognosis. Radiomics show promising potential in discriminating tumour risk and predicting prognosis of cancer using specified features. It is an alternative to conventional predictive tools and has the ability to improve with the use of existing tools.
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Affiliation(s)
- Yeo Li Wen
- Applied Radiation Therapy Trinity, Discipline of Radiation Therapy, Trinity College, Dublin, Ireland.,National University Cancer Institute, Singapore, Singapore
| | - Michelle Leech
- Applied Radiation Therapy Trinity, Discipline of Radiation Therapy, Trinity College, Dublin, Ireland
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Yeo AL, Le S, Ong J, Connelly K, Ojaimi S, Nim H, Morand EF, Leech M. Utility of repeated antinuclear antibody tests: a retrospective database study. Lancet Rheumatol 2020; 2:e412-e417. [PMID: 38273605 DOI: 10.1016/s2665-9913(20)30084-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/25/2020] [Revised: 03/15/2020] [Accepted: 03/17/2020] [Indexed: 12/31/2022]
Abstract
BACKGROUND Anti-nuclear antibody (ANA) testing is frequently used as a diagnostic or screening test in patients with inflammatory or musculoskeletal symptoms. The value of repeat testing is unclear. We sought to evaluate the frequency, utility, and cost of repeat ANA testing. The main objective was to assess the positive predictive value of a repeat ANA test for the diagnosis of rheumatological conditions associated with ANA. METHODS In this retrospective cohort study, we analysed data from a single, multisite tertiary health network in Australia across a 7-year period. ANA and other autoimmune test results were obtained from the hospital pathology system with a positive ANA titre cutoff set at 1:160. Clinical information was sourced from clinical information systems on any patient who had a change in ANA result from negative to positive on repeat testing. The cost of repeated ANA testing was calculated using the Australian Government Medicare Benefits Schedule. FINDINGS From March 19, 2011, to July 23, 2018, a total of 36 715 ANA tests were done in 28 840 patients at a total cost of US$675 029 (2018 equivalent). 14 058 (38·3%) of these ANA tests were positive. 7875 (21·4%) of the ordered tests were repeats in 4887 (16·9%) of the patients, among whom 2683 (54·9%) had initially negative tests, and 2204 (45·1%) had initially positive tests. 511 (19·0%) of the 2683 patients with initially negative tests had a positive result on at least one repeat test, with a median time to first positive result of 1·74 years (IQR 0·54-3·60). A change from negative to positive ANA was associated with a new diagnosis in only five (1·1%) of the 451 patients with clinical information available and no previous diagnosis of an ANA-associated rheumatological condition, yielding a positive predictive value of 1·1% (95% CI 0·4-2·7). INTERPRETATION Repeat ANA testing after a negative result has low utility and results in high cost. FUNDING Monash Health.
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Affiliation(s)
- Ai Li Yeo
- Centre for Inflammatory Diseases, Monash University, Clayton, VIC, Australia; Department of Rheumatology, Monash Health, Clayton, VIC, Australia
| | - Suong Le
- Centre for Inflammatory Diseases, Monash University, Clayton, VIC, Australia
| | - Jason Ong
- Centre for Inflammatory Diseases, Monash University, Clayton, VIC, Australia
| | - Kathryn Connelly
- Centre for Inflammatory Diseases, Monash University, Clayton, VIC, Australia; Department of Rheumatology, Monash Health, Clayton, VIC, Australia
| | - Samar Ojaimi
- Department of Immunology, Monash Health, Clayton, VIC, Australia
| | - Hieu Nim
- School of Biological Sciences, Monash University, Clayton, VIC, Australia
| | - Eric F Morand
- Centre for Inflammatory Diseases, Monash University, Clayton, VIC, Australia; Department of Rheumatology, Monash Health, Clayton, VIC, Australia.
| | - Michelle Leech
- Centre for Inflammatory Diseases, Monash University, Clayton, VIC, Australia; Department of Rheumatology, Monash Health, Clayton, VIC, Australia
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Wang D, Yeo AL, Dendle C, Morton S, Leech M. SAT0067 SEVERE INFECTIONS REMAIN COMMON IN A REAL-WORLD RHEUMATOID ARTHRITIS COHORT: A SIMPLE CLINICAL MODEL TO PREDICT INFECTION RISK. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.1906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Background:Patients with rheumatoid arthritis (RA) have a higher risk of infection due to immunological dysfunction, immunosuppressive use, and coexisting comorbidities1. An understanding of these risk factors has helped develop infection risk calculators2. However, there are currently no screening tools available torapidlyidentify patients with high infection risk.Objectives:To investigate the incidence of severe infection in a real-world RA cohort, identify associated risk factors, and propose a simple infection risk screening tool.Methods:Between January and July 2019, patients were recruited consecutively from an Australian tertiary hospital’s RA clinic. We included all adult patients with RA. The primary outcome was a severe infection (any infection requiring hospital admission) between January 2018 and July 2019. We collected data using hospital notes, medical records and pathology results. We used validated scores such as the disease activity score of 28 joints (DAS28) and the Charlson comorbidity index to assess disease activity and comorbidity burden. Multivariable regression was used for statistical analysis.Results:We recruited 263 eligible patients. 45 severe infections occurred in 34 patients (13%), corresponding to 10.8 infections per 100 patient years. Respiratory (53%) and urinary tract infections (13%) were the most common. On multivariable analysis, the most significant risk factors for severe infection included low lymphocyte counts (odds ratio (OR) 4.08), a previous infection within the last three years (OR 3.58), a Charlson comorbidity index of two or more (OR 2.69) and higher disease activity (OR 1.35 per 0.5-increase in DAS-28). The multivariable model incorporating these factors had a large area under receiver operating characteristic (ROC) curve of 0.82. Glucocorticoid and biologic use were not significantly associated with infection.Conclusion:To our knowledge, this was one of the first Australian studies to evaluate severe infection rates in a real-world RA cohort. Rates remained high and comparable with older studies3. Lymphopenia, high disease activity, comorbidity burden and a previous infection were independent risk factors for infection. Our multivariable model is a composite of easily assessible clinical and biological parameters, with excellent predictive potential for infection. Once validated, it may be developed into a screening tool to help clinicians rapidly identify high risk patients and inform tailored clinical decision making.References:[1] Listing J, Gerhold K, Zink A. The risk of infections associated with rheumatoid arthritis, with its comorbidity and treatment. Rheumatology. 2012;52(1):53-61.[2] Strangfeld A, Eveslage M, Schneider M, Bergerhausen HJ, Klopsch T, Zink A, et al. Treatment benefit or survival of the fittest: What drives the time-dependent decrease in serious infection rates under TNF inhibition and what does this imply for the individual patient? Ann Rheum Dis. 2011;70(11):1914-20.[3] Doran MF, Crowson CS, Pond GR, O’Fallon WM, Gabriel SE. Frequency of infection in patients with rheumatoid arthritis compared with controls: A population-based study. Arthritis Rheum. 2002;46(9):2287-93.Table 1.Cohort DemographicsCharacteristicMedian (Interquartile Range) or Number (%)Age (years)62 (50-70)Sex (female)191 (73)Length of diagnosis (years)9 (5-18)Biologic use over study period106 (40)Steroid use over study period77 (29)Charlson comorbidity index (excluding age)0 (0-1)Table 2.multivariable logistic regression model for severe infectionVariablesOdds RatiopvalueAge ≥50*0.600.368Charlson comorbidity index (≥2)2.690.043Previous severe infection in last 3 years3.580.015Disease activity score of 28 joints (per 0.5 increase)1.350.005Low lymphocyte counts (<1)4.080.028*Age was included despite insignificance due to ana prioridecision about its clinical relevanceFigure 1.Receiver operating characteristic curve (ROC) of the multivariable model for infectionDisclosure of Interests:None declared
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Zhang B, Leech M. A Review of Stereotactic Body Radiation Therapy in the Management of Oligometastatic Prostate Cancer. Anticancer Res 2020; 40:2419-2428. [PMID: 32366385 DOI: 10.21873/anticanres.14211] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Revised: 03/17/2020] [Accepted: 03/18/2020] [Indexed: 11/10/2022]
Abstract
BACKGROUND/AIM Management strategies such as surgery and systemic therapy (androgen-deprivation therapy and chemotherapy) are considered a standard of care for patients with oligometastatic prostate cancer and have shown some positive results in many patients. However, they are often accompanied by side-effects that can negatively affect patients. The aim of this study is to review the potential of stereotactic body radiation therapy (SBRT) in the management of oligometastatic prostate cancer and to compare treatment outcomes with SBRT to those under standard of care management regarding progression-free survival (PFS), androgen-deprivation therapy (ADT)-free survival and local control rate (LCR) as well as a comparison of toxicity profiles. MATERIALS AND METHODS MEDLINE (PubMed), EMBASE, and Clinicaltrials.gov databases were searched to identify prospective randomised controlled trials as well as retrospective studies investigating SBRT and standard of care management for oligometastatic prostate cancer. Data on treatment outcomes and toxicity profiles were extracted. RESULTS A total of 18 studies were included: 14 reported on the use of SBRT and four reported on the use of standard of care management. For SBRT, median PFS was 7.36-24 months. Median ADT-free survival was 12.3-39.7 months. The LCR varied, with some reports of 100% at 6 months and others of 92% at 5 years. No significant grade 3 toxicity was reported, with only five grade 3 events reported in two studies. For standard of care management, most of the studies reported 3-year PFS of 46.9-58.6%, with one study reporting a median PFS of 38.6 months. No standard of care study reported on LCR and ADT-free survival. Although different toxicity grading systems were used depending on the treatment modality, there were some reports of grade 3 events using standard of care management. CONCLUSION SBRT appears to be a safe and effective modality for treating oligometastatic prostate cancer, having the potential to defer palliative ADT. Although LCR is excellent compared to conventional therapies, the PFS rate is reportedly inferior to standard of care therapies. No significant grade 3 toxicity was observed with SBRT.
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Affiliation(s)
- Bonan Zhang
- Applied Radiation Therapy Trinity, Discipline of Radiation Therapy, School of Medicine, Trinity College, Dublin, Ireland.,Singapore Institute of Technology, Singapore, Singapore
| | - Michelle Leech
- Applied Radiation Therapy Trinity, Discipline of Radiation Therapy, School of Medicine, Trinity College, Dublin, Ireland
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Leech M, Katz MS, Kazmierska J, McCrossin J, Turner S. Empowering patients in decision-making in radiation oncology - can we do better? Mol Oncol 2020; 14:1442-1460. [PMID: 32198967 PMCID: PMC7332211 DOI: 10.1002/1878-0261.12675] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Revised: 01/27/2020] [Accepted: 03/18/2020] [Indexed: 02/06/2023] Open
Abstract
The decision as to whether or not a patient should receive radiation therapy as part of their cancer treatment is based on evidence‐based practice and on recommended international consensus treatment guidelines. However, the merit of involving the patients' individual preferences and values in the treatment decision is frequently overlooked. Here, we review the current literature pertaining to shared decision‐making (SDM) in the field of radiation oncology, including discussion of the patient's perception of radiation therapy as a treatment option and patient involvement in clinical trials. The merit of decision aids during the SDM process in radiation oncology is considered, as are patient preferences for active or passive involvement in decisions about their treatment. Clarity of terminology, a better understanding of effective strategies and increased resources will be needed to ensure SDM in radiation oncology becomes a reality.
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Affiliation(s)
- Michelle Leech
- Applied Radiation Therapy Trinity Research GroupDiscipline of Radiation TherapySchool of MedicineTrinity CollegeDublinIreland
| | - Matthew S. Katz
- Department of Radiation MedicineLowell General HospitalMAUSA
| | | | | | - Sandra Turner
- Voluntary Patron, Targeting Cancer, BeyondFiveTROG Cancer ResearchSydneyNSWAustralia
- Radiation Oncology DepartmentWestmead HospitalSydneyNSWAustralia
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Roseby R, Adams K, Leech M, Taylor K, Campbell D. Not just a policy; this is for real. An affirmative action policy to encourage Aboriginal and Torres Strait Islander peoples to seek employment in the health workforce. Intern Med J 2020; 49:908-910. [PMID: 31295778 DOI: 10.1111/imj.14345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2018] [Revised: 03/02/2019] [Accepted: 03/13/2019] [Indexed: 11/30/2022]
Abstract
Delivery of culturally safe healthcare is critical to ensuring access to high-quality care for indigenous people. A key component of this is for Aboriginal and Torres Strait Islander people to be participants in the health workforce. The proportion of indigenous people in the health workforce should at least equate to the proportion in the population served. We describe the development and implementation of a successful affirmative action employment policy at Monash Health, one of Australia's largest Academic Health Centres, and provide perspective on its adoption.
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Affiliation(s)
- Robert Roseby
- Monash Children's Hospital, Monash Health, Melbourne, Victoria, Australia.,Department of Paediatrics, School of Clinical Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
| | - Karen Adams
- Gukwonderuk Unit, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
| | - Michelle Leech
- School of Clinical Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia.,Rheumatology, Monash Health, Melbourne, Victoria, Australia
| | - Karinda Taylor
- Aboriginal Health, Monash Health, Melbourne, Victoria, Australia
| | - Don Campbell
- Department of Medicine, School of Clinical Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia.,Community Health, Monash Health, Melbourne, Victoria, Australia
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Barrett S, Thirion P, Harper D, Simpkin AJ, Leech M, Hickey K, Ryan L, Marignol L. Dosimetric impact of uncorrected systematic yaw rotation in VMAT for peripheral lung SABR. Rep Pract Oncol Radiother 2019; 24:520-527. [PMID: 31516398 DOI: 10.1016/j.rpor.2019.07.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Revised: 07/02/2019] [Accepted: 07/30/2019] [Indexed: 12/25/2022] Open
Abstract
Aim This study aimed to evaluate the dosimetric impact of uncorrected yaw rotational error on both target coverage and OAR dose metrics in this patient population. Background Rotational set up errors can be difficult to correct in lung VMAT SABR treatments, and may lead to a change in planned dose distributions. Materials and methods We retrospectively applied systematic yaw rotational errors in 1° degree increments up to -5° and +5° degrees in 16 VMAT SABR plans. The impact on PTV and OARs (oesophagus, spinal canal, heart, airway, chest wall, brachial plexus, lung) was evaluated using a variety of dose metrics. Changes were assessed in relation to percentage deviation from approved planned dose at 0 degrees. Results Target coverage was largely unaffected with the largest mean and maximum percentage difference being 1.4% and 6% respectively to PTV D98% at +5 degrees yaw.Impact on OARs was varied. Minimal impact was observed in oesophagus, spinal canal, chest wall or lung dose metrics. Larger variations were observed in the heart, airway and brachial plexus. The largest mean and maximum percentage differences being 20.77% and 311% respectively at -5 degrees yaw to airway D0.1cc, however, the clinical impact was negligible as these variations were observed in metrics with minimal initial doses. Conclusions No clinically unacceptable changes to dose metrics were observed in this patient cohort but large percentage deviations from approved dose metrics in OARs were noted. OARs with associated PRV structures appear more robust to uncorrected rotational error.
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Affiliation(s)
- Sarah Barrett
- Applied Radiation Therapy Trinity, Discipline of Radiation Therapy, Trinity College Dublin, Ireland
| | | | - Dean Harper
- St Luke's Radiation Oncology Network, Dublin, Ireland
| | - Andrew J Simpkin
- School of Mathematics, Statistics and Applied Mathematics, National University of Ireland, Galway, Ireland
| | - Michelle Leech
- Applied Radiation Therapy Trinity, Discipline of Radiation Therapy, Trinity College Dublin, Ireland
| | - Kim Hickey
- St Luke's Radiation Oncology Network, Dublin, Ireland
| | - Laoise Ryan
- St Luke's Radiation Oncology Network, Dublin, Ireland
| | - Laure Marignol
- Applied Radiation Therapy Trinity, Discipline of Radiation Therapy, Trinity College Dublin, Ireland
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Mangan S, Leech M. Proton therapy- the modality of choice for future radiation therapy management of Prostate Cancer? Tech Innov Patient Support Radiat Oncol 2019; 11:1-13. [PMID: 32095544 PMCID: PMC7033803 DOI: 10.1016/j.tipsro.2019.08.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Revised: 08/09/2019] [Accepted: 08/30/2019] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Proton Therapy (PR) is an emerging treatment for prostate cancer (Pca) patients. However, limited and conflicting data exists regarding its ability to result in fewer bladder and rectal toxicities compared to Photon Therapy (PT), as well as its cost efficiency and plan robustness. MATERIALS AND METHODS An electronic literature search was performed to acquire eligible studies published between 2007 and 2018. Studies comparing bladder and rectal dosimetry or Gastrointestinal (GI) and Genitourinary (GU) toxicities between PR and PT, the plan robustness of PR relative to motion and its cost efficiency for Pca patients were assessed. RESULTS 28 studies were eligible for inclusion in this review. PR resulted in improved bladder and rectal dosimetry but did not manifest as improved GI/GU toxicities clinically compared to PT. PR plans were considered robust when specific corrections, techniques, positioning or immobilisation devices were applied. PR is not cost effective for intermediate risk Pca patients; however PR may be cost effective for younger or high risk Pca patients. CONCLUSION PR offers improved bladder and rectal dosimetry compared to PT but this does not specifically translate to improved GI/GU toxicities clinically. The robustness of PR plans is acceptable under specific conditions. PR is not cost effective for all Pca patients.
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Key Words
- 3DC-PR, 3D Conformal- Proton Therapy
- BT, Brachytherapy
- CT, Computed Tomography
- CTCAE, Common Terminology Criteria Adverse Effects
- EPIC, Expanded Prostate Cancer Index Composite
- GI, Gastrointestinal
- GU, Genitourinary
- HT, Helical Tomography
- IGRT, Image Guidance Radiation Therapy
- IMPR, Intensity Modulated Proton Therapy
- IMRT, Intensity Modulated Radiation Therapy
- IPSS, International Prostate Symptom Scale
- ITV, Internal Target Volume
- LR, Low Risk
- MFO-IMPR, Multi Field Optimisation-Intensity Modulated Proton Therapy
- PBS, Pencil Beam Scanning
- PR, Proton Therapy
- PT, Photon Therapy
- Photon therapy
- Prostate cancer
- Proton therapy
- QALY, Quality-Adjusted Life Year
- RA, Rapid Arc
- RBE, Radiobiological Effectiveness
- RTOG, Radiation Therapy Oncology Group
- SBRT, Stereotactic Body Radiation
- SFUD, Single Field Uniform-Dose
- SW, Sliding Window
- US, Uniform Scanning
- USPT, Uniform Scanning Proton Therapy
- VMAT, Volumetric Modulated Arc Therapy
- int/HR, intermediate/High risk
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Affiliation(s)
| | - Michelle Leech
- Applied Radiation Therapy Trinity, Discipline of Radiation Therapy, Trinity College Dublin, Dublin 2, Ireland
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Coffey M, Leech M, Hentschel H, Kristensen I, Boejen A, Scherer P. Guest Editorial: RTT Workshops-Preparing the RTT profession for the future. Tech Innov Patient Support Radiat Oncol 2019; 10:13-15. [PMID: 32095542 PMCID: PMC7033758 DOI: 10.1016/j.tipsro.2019.06.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Affiliation(s)
- Mary Coffey
- Discipline of Radiation Therapy, School of Medicine, Trinity College, Dublin 2, Ireland
- EBG MedAustron Ion Therapy Center, Wiener Neustadt, Austria
- Department of Hematology, Oncology and Radiation Physics, Skåne University Hospital, Sweden
- Department of Oncology, Aarhus University Hospital, Denmark
- Department of Radiotherapy and Radio-Oncology, Paracelsus Medical University Hospital Salzburg, Landeskrankenhaus, Salzburg, Austria
| | - Michelle Leech
- Discipline of Radiation Therapy, School of Medicine, Trinity College, Dublin 2, Ireland
- EBG MedAustron Ion Therapy Center, Wiener Neustadt, Austria
- Department of Hematology, Oncology and Radiation Physics, Skåne University Hospital, Sweden
- Department of Oncology, Aarhus University Hospital, Denmark
- Department of Radiotherapy and Radio-Oncology, Paracelsus Medical University Hospital Salzburg, Landeskrankenhaus, Salzburg, Austria
| | - Harald Hentschel
- EBG MedAustron Ion Therapy Center, Wiener Neustadt, Austria
- Department of Hematology, Oncology and Radiation Physics, Skåne University Hospital, Sweden
- Department of Oncology, Aarhus University Hospital, Denmark
- Department of Radiotherapy and Radio-Oncology, Paracelsus Medical University Hospital Salzburg, Landeskrankenhaus, Salzburg, Austria
| | - Ingrid Kristensen
- Department of Hematology, Oncology and Radiation Physics, Skåne University Hospital, Sweden
- Department of Oncology, Aarhus University Hospital, Denmark
- Department of Radiotherapy and Radio-Oncology, Paracelsus Medical University Hospital Salzburg, Landeskrankenhaus, Salzburg, Austria
| | - Annette Boejen
- Department of Oncology, Aarhus University Hospital, Denmark
- Department of Radiotherapy and Radio-Oncology, Paracelsus Medical University Hospital Salzburg, Landeskrankenhaus, Salzburg, Austria
| | - Philipp Scherer
- Department of Radiotherapy and Radio-Oncology, Paracelsus Medical University Hospital Salzburg, Landeskrankenhaus, Salzburg, Austria
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Affiliation(s)
- Aileen Duffton
- Radiotherapy Department, Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom
| | - Lynsey Devlin
- Radiotherapy Department, Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom
| | - Yatman Tsang
- Radiotherapy Department, Mount Vernon Cancer Centre, Northwood, United Kingdom
| | - Mirjam Mast
- Radiation Therapy Department, Haaglanden Medical Center, Burg Banninglaan 1, 2262 BA Leidschendam, the Netherlands
| | - Michelle Leech
- Applied Radiation Therapy Trinity, Discipline of Radiation Therapy, Trinity College, Dublin 2, Ireland
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Briggs AM, Hinman RS, Darlow B, Bennell KL, Leech M, Pizzari T, Greig AM, MacKay C, Bendrups A, Larmer PJ, Francis-Cracknell A, Houlding E, Desmond LA, Jordan JE, Minaee N, Slater H. Confidence and Attitudes Toward Osteoarthritis Care Among the Current and Emerging Health Workforce: A Multinational Interprofessional Study. ACR Open Rheumatol 2019; 1:219-235. [PMID: 31777798 PMCID: PMC6857979 DOI: 10.1002/acr2.1032] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Objective To measure confidence and attitudes of the current and emerging interprofessional workforce concerning osteoarthritis (OA) care. Methods Study design is a multinational (Australia, New Zealand, Canada) cross-sectional survey of clinicians (general practitioners [GPs], GP registrars, primary care nurses, and physiotherapists) and final-year medical and physiotherapy students. GPs and GP registrars were only sampled in Australia/New Zealand and Australia, respectively. The study outcomes are as follows: confidence in OA knowledge and skills (customized instrument), biomedical attitudes to care (Pain Attitudes Beliefs Scale [PABS]), attitudes toward high- and low-value care (customized items), attitudes toward exercise/physical activity (free-text responses). Results A total of 1886 clinicians and 1161 students responded. Although a number of interprofessional differences were identified, confidence in OA knowledge and skills was consistently greatest among physiotherapists and lowest among nurses (eg, the mean difference [95% confidence interval (CI)] for physiotherapist-nurse analyses were 9.3 [7.7-10.9] for knowledge [scale: 11-55] and 14.6 [12.3-17.0] for skills [scale: 16-80]). Similarly, biomedical attitudes were stronger in nurses compared with physiotherapists (6.9 [5.3-8.4]; scale 10-60) and in medical students compared with physiotherapy students (2.0 [1.3-2.7]). Some clinicians and students agreed that people with OA will ultimately require total joint replacement (7%-19% and 19%-22%, respectively), that arthroscopy is an appropriate intervention for knee OA (18%-36% and 35%-44%), and that magnetic resonance imaging is informative for diagnosis and clinical management of hip/knee OA (8%-61% and 21%-52%). Most agreed (90%-98% and 92%-97%) that exercise is indicated and strongly supported by qualitative data. Conclusion Workforce capacity building that de-emphasizes biomedical management and promotes high-value first-line care options is needed. Knowledge and skills among physiotherapists support leadership roles in OA care for this discipline.
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Affiliation(s)
- Andrew M Briggs
- School of Physiotherapy and Exercise Science Curtin University Perth Australia
| | - Rana S Hinman
- Department of Physiotherapy University of Melbourne Melbourne Australia
| | - Ben Darlow
- Department of Primary Health Care and General Practice University of Otago Wellington New Zealand
| | - Kim L Bennell
- Department of Physiotherapy University of Melbourne Melbourne Australia
| | - Michelle Leech
- Faculty of Medicine Nursing and Health Sciences Monash University Melbourne Australia
| | - Tania Pizzari
- La Trobe Sport and Exercise Medicine Research Centre La Trobe University Melbourne Australia
| | - Alison M Greig
- Department of Physical Therapy University of British Columbia Vancouver Canada
| | - Crystal MacKay
- Toronto Rehabilitation Institute University Health Network Toronto Canada
| | - Andrea Bendrups
- Department of Medicine (Royal Melbourne Hospital) University of Melbourne Melbourne Australia
| | - Peter J Larmer
- School of Clinical Sciences Auckland University of Technology Auckland New Zealand
| | | | - Elizabeth Houlding
- School of Physiotherapy and Exercise Science Curtin University Perth Australia.,Faculty of Science University of Ottawa Ottawa Canada
| | - Lucy A Desmond
- Department of Medicine Western Health Melbourne Australia
| | | | - Novia Minaee
- School of Physiotherapy and Exercise Science Curtin University Perth Australia
| | - Helen Slater
- School of Physiotherapy and Exercise Science Curtin University Perth Australia
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Johnson CE, Keating JL, Farlie MK, Kent F, Leech M, Molloy EK. Educators' behaviours during feedback in authentic clinical practice settings: an observational study and systematic analysis. BMC Med Educ 2019; 19:129. [PMID: 31046776 PMCID: PMC6498493 DOI: 10.1186/s12909-019-1524-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/22/2018] [Accepted: 03/17/2019] [Indexed: 05/30/2023]
Abstract
BACKGROUND Verbal feedback plays a critical role in health professions education but it is not clear which components of effective feedback have been successfully translated from the literature into supervisory practice in the workplace, and which have not. The purpose of this study was to observe and systematically analyse educators' behaviours during authentic feedback episodes in contemporary clinical practice. METHODS Educators and learners videoed themselves during formal feedback sessions in routine hospital training. Researchers compared educators' practice to a published set of 25 educator behaviours recommended for quality feedback. Individual educator behaviours were rated 0 = not seen, 1 = done somewhat, 2 = consistently done. To characterise individual educator's practice, their behaviour scores were summed. To describe how commonly each behaviour was observed across all the videos, mean scores were calculated. RESULTS Researchers analysed 36 videos involving 34 educators (26 medical, 4 nursing, 4 physiotherapy professionals) and 35 learners across different health professions, specialties, levels of experience and gender. There was considerable variation in both educators' feedback practices, indicated by total scores for individual educators ranging from 5.7 to 34.2 (maximum possible 48), and how frequently specific feedback behaviours were seen across all the videos, indicated by mean scores for each behaviour ranging from 0.1 to 1.75 (maximum possible 2). Educators commonly provided performance analysis, described how the task should be performed, and were respectful and supportive. However a number of recommended feedback behaviours were rarely seen, such as clarifying the session purpose and expectations, promoting learner involvement, creating an action plan or arranging a subsequent review. CONCLUSIONS These findings clarify contemporary feedback practice and inform the design of educational initiatives to help health professional educators and learners to better realise the potential of feedback.
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Affiliation(s)
- Christina E. Johnson
- Monash Doctors Education, Monash Health and Department of Medical Education, Melbourne Medical School, University of Melbourne, Melbourne, Victoria Australia
| | - Jennifer L. Keating
- Department of Physiotherapy, School of Primary and Allied Health Care, Faculty of Medicine Nursing and Health Science, Monash University, Melbourne, Australia
| | - Melanie K. Farlie
- Allied Health Workforce Innovation, Strategy, Education & Research (WISER) Unit, Monash Health, and School of Primary and Allied Health Care, Faculty of Medicine, Nursing and Health Sciences at Monash University, Melbourne, Australia
| | - Fiona Kent
- Education Portfolio, Faculty Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
| | - Michelle Leech
- Monash School of Medicine, Faculty of Medicine, Nursing & Health Sciences, Monash University and Monash Health, Melbourne, Australia
| | - Elizabeth K. Molloy
- Department of Medical Education, Melbourne Medical School, University of Melbourne, Melbourne, Australia
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Dendle C, Baulch J, Pellicano R, Hay M, Lichtwark I, Ayoub S, Clarke DM, Morand EF, Kumar A, Leech M, Horne K. Medical student psychological distress and academic performance. Med Teach 2018; 40:1257-1263. [PMID: 29355074 DOI: 10.1080/0142159x.2018.1427222] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
INTRODUCTION The impact of medical student psychological distress on academic performance has not been systematically examined. This study provided an opportunity to closely examine the potential impacts of workplace and study related stress factors on student's psychological distress and their academic performance during their first clinical year. METHODS This one-year prospective cohort study was performed at a tertiary hospital based medical school in Melbourne, Australia. Students completed a questionnaire at three time points during the year. The questionnaire included the validated Kessler psychological distress scale (K10) and the General Health Questionnaire-28 (GHQ-28), as well as items about sources of workplace stress. Academic outcome scores were aggregated and correlated with questionnaire results. RESULTS One hundred and twenty six students participated; 126 (94.7%), 102 (76.7%), and 99 (74.4%) at time points one, two, and three, respectively. 33.1% reported psychological distress at time point one, increasing to 47.4% at time point three. There was no correlation between the K10 scores and academic performance. There was weak negative correlation between the GHQ-28 at time point three and academic performance. Keeping up to date with knowledge, need to do well and fear of negative feedback were the most common workplace stress factors. CONCLUSIONS Poor correlation was noted between psychological distress and academic performance.
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Affiliation(s)
- Claire Dendle
- a School of Clinical Sciences at Monash Health , Monash University , Clayton , Australia
- b Monash Infectious Diseases, Monash Health , Clayton , Australia
| | - Julie Baulch
- a School of Clinical Sciences at Monash Health , Monash University , Clayton , Australia
| | - Rebecca Pellicano
- a School of Clinical Sciences at Monash Health , Monash University , Clayton , Australia
- c Nephrology Monash Health , Clayton , Australia
| | - Margaret Hay
- d Faculty of Medicine and Health Sciences , Monash Institute for Health and Clinical Education (MIHCE), Monash University , Melbourne , Australia
| | - Irene Lichtwark
- d Faculty of Medicine and Health Sciences , Monash Institute for Health and Clinical Education (MIHCE), Monash University , Melbourne , Australia
| | - Sally Ayoub
- a School of Clinical Sciences at Monash Health , Monash University , Clayton , Australia
| | - David M Clarke
- a School of Clinical Sciences at Monash Health , Monash University , Clayton , Australia
| | - Eric F Morand
- a School of Clinical Sciences at Monash Health , Monash University , Clayton , Australia
| | - Arunaz Kumar
- a School of Clinical Sciences at Monash Health , Monash University , Clayton , Australia
- e Department of Obstetrics and Gynaecology , Monash Health , Clayton , Australia
| | - Michelle Leech
- f Faculty of Medicine, Nursing and Health Sciences , Monash University , Clayton , Australia
| | - Kylie Horne
- a School of Clinical Sciences at Monash Health , Monash University , Clayton , Australia
- b Monash Infectious Diseases, Monash Health , Clayton , Australia
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Coffey M, Leech M. The European Society of Radiotherapy and Oncology (ESTRO) European Higher Education Area levels 7 and 8 postgraduate benchmarking document for Radiation TherapisTs (RTTs). Tech Innov Patient Support Radiat Oncol 2018; 8:22-40. [PMID: 32095587 PMCID: PMC7033774 DOI: 10.1016/j.tipsro.2018.09.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
This guideline details the European Higher Education Area Levels 7 and 8 Postgraduate benchmarking document for Radiation TherapisTs (RTTs). The purpose of this benchmarking document is to assist higher education institutes in the development of radiation therapy-specific curricula for RTTs engaging in postgraduate education, with a view to working at an advanced level in radiation therapy departments. The document specifies the knowledge, skills and competences that are required to work in specific areas of RTT practice, at levels 7 and 8. These include: advanced delineation and volume determination, advanced treatment planning, advanced imaging, quality and risk management, management and service development, patient care and support, brachytherapy and research.
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Affiliation(s)
- Mary Coffey
- Applied Radiation Therapy Trinity, Discipline of Radiation Therapy, Trinity College, Dublin 2, Ireland
| | - Michelle Leech
- Applied Radiation Therapy Trinity, Discipline of Radiation Therapy, Trinity College, Dublin 2, Ireland
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Coffey M, Rosenblatt E, Vandevelde G, Osztavics A, Pasini D, Scherer P, Dickie C, Karadza V, Van Egten V, Leech M. A review of the Best Practice in Radiation Oncology project from 2008 to 2018. Tech Innov Patient Support Radiat Oncol 2018; 8:3-7. [PMID: 32095580 PMCID: PMC7033773 DOI: 10.1016/j.tipsro.2018.09.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
The European Society of Radiotherapy and Oncology (ESTRO)/International Atomic Energy Agency (IAEA) Best Practice in Radiation Oncology-a project to train RTT trainers has reached its ten year anniversary and will commence its fifth iteration in 2018. This project commenced as a novel way to address the issue of limited RTT education throughout Europe. In many countries the profession of RTT is not officially recognised and there is no formal education programme. RTT education is frequently a very short component of a broader programme such as diagnostic imaging, nursing or a technical discipline. To date, fifty-nine short courses have been delivered, two RTT-specific National societies have been developed, a South East European cooperation with biannual conferences has evolved and significant progress has been made on improving the radiotherapy-specific content of national educational programmes, which will continue with future iterations of this project.
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Affiliation(s)
- Mary Coffey
- Applied Radiation Therapy Trinity, Discipline of Radiation Therapy, Trinity College, Dublin 2, Ireland
| | - Eduardo Rosenblatt
- Applied Radiation Biology and Radiotherapy Section, Division of Human Health, International Atomic Energy Agency, Wagramer Strasse 5, 1400 Vienna, Austria
| | | | | | - Danilo Pasini
- Policlinico Universitario Agostino Gemelli, Radiotherapy, Rome, Italy
| | - Philipp Scherer
- University Clinic for Radiotherapy and RadioOncology, University Clinics Salzburg, Müllner Hauptstr 48a, 5020 Salzburg, Austria
| | - Colleen Dickie
- Princess Margaret Cancer Centre, 610 University Avenue, Toronto, ON M5G 2M9, Canada
| | - Velimir Karadza
- Radiotherapy Unit, Clinic of Oncology, University Hospital Center Zagreb, Kispaticeva 12, Croatia
| | - Viviane Van Egten
- European Society for Radiotherapy and Oncology, Rue Martin V 40, 1200 Brussels, Belgium
| | - Michelle Leech
- Applied Radiation Therapy Trinity, Discipline of Radiation Therapy, Trinity College, Dublin 2, Ireland
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