Predicting a patient's choice of dialysis modality: experience in a United Kingdom renal department

Education and counseling are important aspects of the management of patients starting dialysis. Free choice of modality may enhance patient well-being and, in the absence of clear survival benefits for either hemodialysis (HD) or continuous ambulatory peritoneal dialysis (CAPD), should have the major role in modality selection. This prospective study examines factors influencing this choice. Three hundred thirty-three new patients started renal replacement therapy at Birmingham Heartlands Hospital (Birmingham, UK) between August 1, 1992, and July 31, 1998. Data were incomplete for 14 patients, 11 patients were not counseled, and 54 patients had contraindications to a particular modality. The remaining 254 patients were offered a free choice. One hundred thirty-nine patients (55%) chose HD and 115 patients (45%) chose CAPD. Independent predictors for choosing CAPD rather than HD were being married (P = 0.004), being counseled before the start of dialysis (P = 0.019), and increased distance from the base unit (P < 0.001). Independent predictors for choosing HD were increasing age (P = 0.030) and male sex (P = 0.041). Use of these data should enhance planning of dialysis services and bring nearer the goal that all new patients with ESRD are able to have the dialysis modality of their choice.

Home treatment of exacerbations of chronic obstructive pulmonary disease by an acute respiratory assessment service

BACKGROUND

Exacerbations of chronic obstructive pulmonary disease are a major cause of hospital admissions, but do not require intensive investigation or complex therapy. We investigated the suitability of home care for severe uncomplicated exacerbations.

METHODS

Over 3.5 years we assessed 962 patients with exacerbations of chronic obstructive pulmonary disease after referral to a hospital respiratory department by their family physicians. All patients had chest radiographs, oxygen-saturation or arterial-gas analysis, spirometry, and physical assessment. Unless admission was thought to be essential, patients were allowed home with a customised treatment package. Each patient was visited daily by a respiratory nurse who monitored progress and treatment compliance and provided education and reassurance.

FINDINGS

145 (15%) of 962 required admission at initial referral and 115 (12%) were admitted later. 653 (68%) patients were managed entirely at home and 49 (5%) were referred inappropriately. One patient died at home. All patients had severe disease with a mean forced expiratory volume in 1 s of 1.02 L and 395 (41%) had required hospital admission in the previous year.

INTERPRETATION

After formal assessment in a hospital respiratory unit, many patients with exacerbations of chronic obstructive pulmonary disease can be treated at home by respiratory nurses.

Metabolically healthy and unhealthy obesity: differential effects on myocardial function according to metabolic syndrome, rather than obesity

BACKGROUND

The term 'metabolically healthy obese (MHO)' is distinguished using body mass index (BMI), yet BMI is a poor index of adiposity. Some epidemiological data suggest that MHO carries a lower risk of cardiovascular disease (CVD) or mortality than being normal weight yet metabolically unhealthy.

OBJECTIVES

We aimed to undertake a detailed phenotyping of individuals with MHO by using imaging techniques to examine ectopic fat (visceral and liver fat deposition) and myocardial function. We hypothesised that metabolically unhealthy individuals (irrespective of BMI) would have adverse levels of ectopic fat and myocardial dysfunction compared with MHO individuals.

SUBJECTS

Individuals were categorised as non-obese or obese (BMI ⩾30 kg m(-2)) and as metabolically healthy or unhealthy according to the presence or absence of metabolic syndrome.

METHODS

Sixty-seven individuals (mean±s.d.: age 49±11 years) underwent measurement of (i) visceral, subcutaneous and liver fat using magnetic resonance imaging and proton magnetic resonance spectroscopy, (ii) components of metabolic syndrome, (iii) cardiorespiratory fitness and (iv) indices of systolic and diastolic function using tissue Doppler echocardiography.

RESULTS

Cardiorespiratory fitness was similar between all groups; abdominal and visceral fat was highest in the obese groups. Compared with age- and BMI-matched metabolically healthy counterparts, the unhealthy (lean or obese) individuals had higher liver fat and decreased early diastolic strain rate, early diastolic tissue velocity and systolic strain indicative of subclinical systolic and diastolic dysfunction. The magnitude of dysfunction correlated with the number of components of metabolic syndrome but not with BMI or with the degree of ectopic (visceral or liver) fat deposition.

CONCLUSIONS

Myocardial dysfunction appears to be related to poor metabolic health rather than simply BMI or fat mass. These data may partly explain the epidemiological evidence on CVD risk relating to the different obesity phenotypes.

Variations in morphology of the lumbosacral junction on sagittal MRI: correlation with plain radiography

OBJECTIVE

To identify on sagittal magnetic resonance imaging (MRI) scans of the lumbar spine the features that indicate the presence of a lumbosacral transitional vertebra (LSTV).

DESIGN

One hundred consecutive sagittal T1-and T2-weighted MRI scans of the lumbar spine were reviewed and separated into four types depending upon the absence or presence of disc material between what was considered to be the uppermost sacral segment and the remainder of the sacrum, as follows: type 1: no disc material present; type 2: a small residual disc, not extending for the whole anteroposterior (AP) diameter of the sacrum; type 3: a well-formed disc extending for the whole AP diameter of the sacrum; type 4: a well-formed disc extending for the whole AP diameter of the sacrum with, in addition, an abnormal upper sagittal sacral outline. The corresponding plain radiographs of each patient were than reviewed and assessed for the presence of an LSTV. These were classified according to the method of Castellvi et al.

PATIENTS

All patients had been referred for MRI of the lumbar spine, usually because of back pain with or without radiculopathy. There were 51 male and 49 female patients with a mean age of 42 years and an age range of 18-85 years.

RESULTS AND CONCLUSIONS

With regard to sacral morphology on MRI, 30 patients had type 1, 42 patients type 2, 16 patients type 3 and 12 patients type 4 morphology. Fifteen patients had an LSTV. There was a good correlation between the presence of a fused LSTV and a type 4 MRI appearance, indicating that this type of LSTV can be identified on sagittal MRI scans.

Action on the social determinants of health: a historical perspective

A renewed concern with social factors has emerged in global public health, spearheaded by the World Health Organization's Commission on Social Determinants of Health. The coming decade may see significant health gains for disadvantaged populations if policies tackle the social roots of health inequities. To improve chances of success, global action on social determinants must draw lessons from history. This article reviews milestones in public health action on social determinants over the past 50 years. The goal is to bring into sharper focus the persistent challenges faced by social determinants agendas, along with distinctive opportunities now emerging. The historical record highlights the vulnerability of health policy approaches incorporating social determinants to resistance from entrenched interests. The Commission on Social Determinants of Health can consolidate political support by building collaborative relationships with policymakers in partner countries. However, this strategy must be complemented by engaging civil society constituencies. Historically, successful action on social determinants has been spurred by organized civil society demand.

Reduction of mismatch of global ventilation and perfusion on exercise is related to exercise capacity in chronic heart failure

BACKGROUND

The inability to match lung perfusion to ventilation because of a reduced cardiac output on exercise contributes to reduced exercise capacity in chronic heart failure.

OBJECTIVE

To quantify ventilation to perfusion matching at rest and at peak exercise in patients with chronic heart failure and relate this to haemodynamic and ventilatory variables of exercise capacity.

DESIGN

Eight men in New York Heart Association class II underwent maximal bicycle ergometry with expired gas analysis.

MAIN OUTCOME MEASURES

On separate days, ventilation and perfusion gamma camera imaging was performed at rest, and at 80% of previous peak exercise heart rate during bicycle ergometry. The vertical distribution of mismatch between ventilation and perfusion (V/Q) was estimated from subtracted profiles of activity (ventilation and perfusion) to derive a numerical index of global mismatch.

RESULTS

Maximal mean (SD) oxygen consumption on bicycle ergometry was 16.0 (4.5) ml min-1 kg-1. There was a reduction in the global V/Q mismatch index from 23.96 (5.90) to 14.88 (7.90) units (p < 0.01) at rest and at peak exercise. Global V/Q mismatch index at peak exercise correlated negatively with maximal minute ventilation (R = -0.90, p < 0.01) and with maximal mean arterial pressure (R = -0.79, p < 0.05), although no relation was seen with maximal oxygen consumption. The reduction in global V/Q mismatch index from rest to peak exercise correlated with maximal oxygen consumption (R = 0.88, p < 0.01), and with maximal minute ventilation (R = 0.87, p < 0.01).

CONCLUSIONS

During exercise in patients with chronic heart failure, there is a reduction in the global V/Q mismatch index. A lower global V/Q mismatch index at peak exercise is associated with higher maximal ventilation. The reduction in global V/Q mismatch index on exercise correlates well with maximal exercise capacity. This may imply that the inability to perfuse adequately all regions of lung on exercise and match this to ventilation is a factor determining exercise capacity in chronic heart failure.

Calculated glomerular filtration rate is a useful screening tool to identify scleroderma patients with renal impairment

OBJECTIVES

Although it only occurs in a minority of patients, renal involvement is a life-threatening complication of scleroderma (SSc). We have investigated the utility of two formulae to calculate glomerular filtration rate (GFR) in a population of SSc patients.

METHODS

Twenty-six patients (20 female, 6 male, median age 58 yr, age range 12-80 yr) satisfied our criteria for inclusion in a retrospective comparison of measured and calculated GFR. GFR was measured using (51)Cr-EDTA. The modified Cockcroft and Gault formula and equation 7 from the Modification of Diet in Renal Disease (MDRD) were used to calculate GFR.

RESULTS

Eighteen out of 19 patients analysed with a serum creatinine concentration less than the upper limit of the normal range had a measured GFR outside the normal range. Three patients with a normal creatinine concentration had a measured GFR <60 ml/min and in each of these the calculated GFR was also abnormal. All patients with a measured GFR <60 ml/min were identified using both the MDRD and the modified Cockcroft and Gault formula to calculate GFR. The greatest correlation between measured and calculated GFR was seen when the MDRD formula, which employs demographic and serum variables, was used in patients with body surface area (BSA) >1.4 m(2) who were not taking Iloprost (r=0.91). Use of the Cockcroft and Gault formula to calculate creatinine clearance with a correction factor for GFR, the inclusion of patients taking Iloprost and the inclusion of patients with BSA <1.4 m(2) were all associated with a lower degree of correlation.

CONCLUSION

Serum creatinine is a poor marker of renal function in SSc patients. Calculating GFR from demographic and serum variables is a simple technique to identify SSc patients who have abnormal renal function. The authors recommend the use of the MDRD formula.

The nurse's role in the management of aggression

Although research into the phenomenon of aggression within psychiatric inpatient settings has established a strong casual link with mental illness, there is widespread agreement that diagnostic or demographic characteristics cannot accurately predict such behaviours. In addition, studies have consistently failed to establish how nursing management responses influence the course of aggression within these environments. Therefore, an assumption can be made that specific contextual factors are significant, and that management responses have an effect on outcomes. This review examines the nurses' impact on inpatient aggression and how management strategies affect the therapeutic value of intervention.

Open fractures of the tibia in children

The results of the treatment of open tibial fractures in 58 children aged between 3 and 15 years are reviewed. There were 25 Gustilo Type I, 22 Type II and 10 Type III fractures. At operation 37 wounds were closed primarily and 21 wounds were left open. Of these 21, 13 healed by secondary intention and eight required split skin grafting or soft tissue flap coverage. Stable fractures were immobilized in an above-knee plaster in 48 cases (83 per cent) and six fractures treated with external fixation (10 per cent). Two patients (3.5 per cent) had cast immobilization of the tibial fracture and traction for an ipsilateral femoral fracture. Two patients (3.5 per cent) with Gustilo Type IIIc injuries required an amputation, one 'de novo' as the limb was not salvageable and one 4 days after failed vascular reconstruction. All fractures healed primarily without bone grafting, although there were three cases of delayed union and seven cases of malunion. Six children had superficial wound infections but there were no cases of deep infection or osteomyelitis. There was one case of compartment syndrome.

The projected costs and benefits of a supervised injection facility in Seattle, WA, USA

BACKGROUND

As one strategy to improve the health and survival of people who inject drugs, the King County Heroin & Opioid Addiction Task Force recommended the establishment of supervised injection facilities (SIF) where people can inject drugs in a safe and hygienic environment with clinical supervision. Analyses for other sites have found them to be cost-effective, but it is not clear whether these findings are transferable to other settings.

METHODS

We utilized local estimates and other data sources deemed appropriate for our setting to implement a mathematical model that assesses the impact of a hypothetical SIF on overdose deaths, non-fatal overdose health service utilization, skin and soft tissue infections, bacterial infections, viral infections, and enrollment in medication assisted treatment (MAT). We estimated the costs and savings that would occur on an annual basis for a small-scale pilot site given current overdose rates, as well as three other scenarios of varying scale and underlying overdose rates.

RESULTS

Assuming current overdose rates, a hypothetical Seattle SIF in a pilot phase is projected to annually reverse 167 overdoses and prevent 6 overdose deaths, 45 hospitalizations, 90 emergency department visits, and 92 emergency medical service deployments. Additionally, the site would facilitate the enrollment of 41 SIF clients in medication assisted treatment programs. These health benefits correspond to a monetary value of $5,156,019. The annual estimated cost of running the SIF is $1,222,332. The corresponding cost-benefit ratio suggests that the pilot SIF would generate $4.22 for every dollar spent on SIF operational costs. The pilot SIF is projected to save the healthcare system $534,453. If Seattle experienced elevated overdose rates and Seattle SIF program were scaled up, the health benefits and financial value would be considerably greater.

CONCLUSION

This analysis suggests that a SIF program in Seattle would save lives and result in considerable health benefits and cost savings.

Relation of boron to the composition and mechanical properties of bone

A review of the experimental studies relating boron to biological effects on appendicular and axial bones in animal models suggests that numerous influences, known and unknown, affect the responsiveness of bone to dietary boron. Degrees of skeletal response to boron are modified by other nutritional variables that include calcium, magnesium, vitamin D, and fluoride. Evidence suggests that appendicular and axial bones may differ in their responses. Tests of the mechanical properties of bones may provide useful criteria for assessing the impacts of boron status on bone. These tests might resolve questions about optimal intakes of boron because mechanical properties sometimes respond to boron when composition of bones does not. Difficulty in interpreting some of the existing research arises because of the incipient state of knowledge regarding boron nutriture, to analytical problems associated with determining accurately the small quantities of boron in feed and tissues, and to technological difficulties in controlling extraneous exposure of experimental animals to boron. Yet there is considerable evidence that both compositional and functional properties of bone are affected by boron status.

The non-technical skills used by anaesthetic technicians in critical incidents reported to the Australian Incident Monitoring System between 2002 and 2008

The outcome of critical incidents in the operating theatre has been shown to be influenced by the behaviour of anaesthetic technicians (ATs) assisting anaesthetists, but the specific non-technical skills involved have not been described. We performed a review of critical incidents (n=1433) reported to the Australian Incident Monitoring System between 2002 and 2008 to identify which non-technical skills were used by ATs. The reports were assessed if they mentioned anaesthetic assistance or had the boxes ticked to identify "inadequate assistance" or "absent supervision or assistance". A total of 90 critical incidents involving ATs were retrieved, 69 of which described their use of non-technical skills. In 20 reports, the ATs ameliorated the critical incident, whilst in 46 they exacerbated the critical incident, and three cases had both positive and negative non-technical skills described. Situation awareness was identified in 39 reports, task management in 23, teamwork in 21 and decision-making in two, but there were no descriptions of issues related to leadership, stress or fatigue management. Situation awareness, task management and teamwork appear to be important non-technical skills for ATs in the development or management of critical incidents in the operating theatre. This analysis has been used to support the development of a non-technical skills taxonomy for anaesthetic assistants.

Chinese farmers' attitude towards the improvement of animal welfare in their facilities

This study sought to investigate Chinese farmers' attitude towards animal welfare by using the Theory of Planned Behaviour (TPB). According to the TPB, an individual's intention to behave in a certain way is determined by his/her attitude towards the behaviour (specific attitude — importance — and general attitudes), the perceived behavioural control (easiness), and the supposed opinion of the people who are important to him/her (subjective norms). A total of 253 questionnaires are used, which included the three main animal productions in chena (swine, poultry and cattle). Chinese farmers have perceived the improvement of animal welfare as two abstracts: general attitudes (reward-seeking, and empathic farmer); and four specific categories of actions (favourable environment, animal health, humane treatment of animals and farmers' well-being). Our analysis revealted that general and specific attitudes were the strongest predictors of farmers' intentions to improve animal welfare in the questionnaire study. In fact, Chinese farmers considered it fairly important to improve the animal welfare meaures considered in the survey. In contrast, the same animal welfare measures were considered difficult to improve by the farmers as indicated by the lack of association between the easiness of improving animal welfare and the intentions. In addition, veterinarians, agricultural advisers, and scientific experts were considered to be relatively influential subjective norms as regards the activities of the farmers. This is the first study to provide an insight into the underlying meanings and values of Chinese farmers views on improvements to animal welfare.

Modified Burton and Pellegrini procedure for trapezium excision, ligament reconstruction and interposition arthroplasty of the tendon of flexor Carpi radialis

GOAL OF SURGERY

Relieve of pain and increased stability at the base of 1st metacarpal.

INDICATIONS

Painful degenerative and inflammatory arthritis in trapeziometacarpal joint (TMCJ).

CONTRAINDICATIONS

Patients not willing to undergo lengthy intensive postoperative rehabilitation. Rheumatoid arthritis (relative).

POSITIONING AND ANAESTHESIA

Supine. Hand table. General or regional anaesthesia.

SURGICAL TECHNIQUE

Modification of the Burton-Pelligrini operation by using half of the flexor carpi radialis for interposition between base of 1st metacarpal and scaphoid. Stabilization with a Kirschner wire. In the presence of scaphotrapezoid arthritis an arthrodesis of this joint is performed for better pain control.

POSTOPERATIVE MANAGEMENT

Immobilization in a below elbow cast for 6 weeks. Then active physiotherapy, night splint for another 6 weeks.

POSSIBLE COMPLICATIONS

Fracture while drilling the base of the 1st metacarpus, migration of Kirschner wires, injury to the radial artery and cutaneous nerves.

RESULTS

Out of 15 patients 12 (14 thumbs) were followed for at least 6 months. In 11 patients the shape of the hand was normal and 10 patients were satisfied with the result of the operation. Complications included: twice postoperative migration of Kirschner wires, and once intraoperative tearing of the tendon which had to be sutured.

Through a dark glass more clearly? Health information managers and strategic planning in the 1990s

This article considers the application of a formal strategic planning approach to the health information management profession. After a brief discussion of the two main strategic planning models, the process adopted by the Health Information Management Association of Australia at its recent strategic planning workshop is described and the planning outcomes are outlined. The merits of explicitly expressing strategic intent through the creation of a vision of the future and the establishment of strategies and an action plan to realise the vision are discussed.

A flexible and extensible object-oriented 3D architecture: application in the development of virtual anatomy lessons

"Anatomic VisualizeR" represents the first application to be developed using a 3D architectural framework created at the University of California, San Diego, School of Medicine. This application combines 3D anatomic models (based on the Visible Human dataset) with supporting 2D media (e.g., diagnostic imagery, surgical videos, etc.) to establish a comprehensive learning environment for anatomy. "Guided lessons" are being created to address complex curricular and learning objectives. Faculty expertise is represented in these preconfigured lessons, in part through the specification of appropriate content and the incorporation of activities to enhance visualization. These lessons are an intellectual framework which ensures that clinically-relevant issues and ancillary learning opportunities are available. The curricular exercises are non-sequential and can be interrupted at any time; users are encouraged to freely explore the environment. At the core of Anatomic VisualizeR's object-oriented architecture is the ability to identify, access, view, and manipulate heterogeneous content. The capacity to query a database gateway to retrieve specified resources has been built into the application. Encapsulation of individual elements to form 3D display objects ("blocks") enables Anatomic VisualizeR to efficiently manage 3D models, 2D images, text, sound, and video. The "block" paradigm also allows Anatomic VisualizeR to associate contextually appropriate display characteristics and behaviors with the various content elements. For example, the anatomic model block provides the capability to "link" and "unlink" the anatomic models and to alter their transparencies. The anatomic models can be displayed concurrently with other blocks to facilitate structural comparisons. Anatomic VisualizeR marks a major milestone in our developmental efforts. While lessons and database content are still not complete, we are confident that it will become the first tangible realization of our vision.

Consensus Nomenclature for Radionuclide Therapy: Initial Recommendations from Nuclear Medicine Global Initiative

Since its inception in 2012, the Nuclear Medicine Global Initiative (NMGI) of the Society of Nuclear Medicine and Molecular Imaging has played an important role in addressing significant challenges in the field of nuclear medicine and molecular imaging. The first 3 projects were dedicated to standardizing pediatric nuclear medicine practices, addressing the global challenges of radionuclide access and availability, and assessing the educational and training initiatives on theranostics across the globe. These efforts aimed to advance human health, foster worldwide educational collaboration, and standardize procedural guidelines to enhance quality and safety in nuclear medicine practice. In its latest project, NMGI aimed to develop a unified nomenclature for systemic radionuclide therapy in nuclear medicine, addressing the diverse terminology currently used. An online survey was distributed to NMGI member organizations, drawing participation from various geographical locations and disciplines. The survey anonymously collected responses from physicians, physicists, scientists, radiopharmacists, radiopharmaceutical scientists, dosimetrists, technologists, and nurse managers, totaling 240 responses from 30 countries. Findings revealed a prevailing use of the term targeted radionuclide therapy for radionuclide therapy, with 52% of respondents expressing a preference for this term. In contrast, approximately 37% favored "radiopharmaceutical therapy," whereas 11% favored "molecular radionuclide therapy." Other key terms under the umbrella of targeted radionuclide therapy were also discussed to achieve a consensus on terminology. NMGI efforts to standardize terminology in this dynamic and fluid field should improve communication within the field, better reflect the technology used, enable comparison of results, and ultimately lead to improved patient outcomes.

Developing a Prototype Behavioural Marker System for Farmer Non-Technical Skills (FLINTS)

OBJECTIVE

Non-technical skills, the social and cognitive skills thought necessary for safe and effective working, have been studied within the farming context over the past six years. However, these skills are not yet taught as part of a safety curriculum for farmers, due, in part, to a lack of defined framework and assessment system. The current paper describes the development of the FLINTS behavioral marker system for discussion, observation, evaluation and feedback on non-technical skills for farmers.

METHOD

The development of the behavioral marker system proceeded through three key stages. First, the current research knowledge on non-technical skills was synthesized to compile a list of non-technical skill categories and elements. Second, a series of discussion groups with subject matter experts was conducted to develop behavioral markers for each element. Lastly, refinement and review of the system was undertaken by academics and experts.

RESULTS

The prototype FLINTS taxonomy containing five non-technical skill categories and 16 elements was produced. The non-technical skill categories comprised situation awareness, teamwork & communication, leadership, task management and decision-making each with specific elements and behavioral markers.

CONCLUSION

FLINTS represents the first behavioral marker system for farmer non-technical skills, constructed through expert knowledge and advice via discussion and review groups, combined with underpinning research findings. This represents the first step towards the development of non-technical training and assessment for farmers. The current version of the FLINTS system is freely available to all potential users (https://research.abdn.ac.uk/nts-farming/flints/).

Abstract P6-14-05: Phase 2 study evaluating the efficacy and safety of eribulin mesylate administered biweekly for patients with human epidermal growth factor receptor 2-negative metastatic breast cancer

Background: Eribulin mesylate, a microtubule inhibitor, is approved in the US for the treatment of patients (pts) with metastatic breast cancer (MBC) who have previously received at least 2 chemotherapeutic regimens for the treatment of metastatic disease, including an anthracycline and a taxane. The recommended dose is 1.4 mg/m2 (equivalent to 1.23 mg/m2 eribulin [expressed as free base]) on day (D) 1 and D8 of a 21-D cycle. However, this schedule can result in dose delays and reductions due to myelosuppression. A dosing regimen of eribulin (1.4 mg/m2) administered intravenously (IV) biweekly (Q2W; on D1 and D15) in 28-D cycles was evaluated with the intent of improving eribulin's safety profile without compromising efficacy.

Methods: Female pts with human epidermal growth factor receptor (HER)2-negative MBC, who had received 2-5 prior chemotherapy regimens and had ECOG PS ≤2 were enrolled in 12 sites in the US. Prophylactic granulocyte colony-stimulating factor (G-CSF) was not allowed. If neutropenia occurred, growth factors were used during eribulin treatment at the physician's discretion. Primary endpoints were objective response rate (ORR) and disease control rate (DCR). Secondary endpoints were progression-free survival (PFS), overall survival (OS), dose intensity (measured by feasibility rate), safety and tolerability.

Results: Median age of the 58 enrolled pts was 64 yrs (range: 38-85). The majority of pts (93%) had ECOG PS ≤1, and 12% of pts had triple-negative MBC. Number of prior chemotherapeutic regimens: 2 (17% of patients), 3 (24%), 4 (27%), and 5 (31%). 76% Of pts had visceral disease and 86% had previous taxane therapy. ORR (95% confidence interval [CI]) was 12% (5-24), DCR (CR+PR+SD) was 65% (95% CI: 51-77), and CBR (CR+PR+SD ≥23 weeks) was 30% (95% CI: 18-43) [n=57]. Median PFS (95% CI) was 3.6 mo (2.9-4.1). Median OS (95% CI) was 13.2 mo (10.6-not estimable). 6-Month and 12-month OS rates were 84% and 54%, respectively. Dose intensity measured by the feasibility rate (defined as the percentage of pts completing the first 2 and 4 cycles without a dose delay &gt;5 days or dose reduction due to an adverse event [AE]) was 70% and 46%, respectively.

The most frequent AEs (all grades) were neutropenia (69%), fatigue (48%), alopecia (45%), and constipation (36%). 22% Of pts had grade (G) 1 alopecia and 22% of pts had G2 alopecia. 72% Of pts had G3/4 AEs: neutropenia, 57%, and peripheral neuropathy, 12%. G3 peripheral sensory neuropathy occurred in 9% of pts, with no G4 incidence. There were 2 deaths (1 sepsis, 1 acute respiratory failure), which were considered not related to treatment. 50% (29/58) Of all patients received at least 1 dose of growth factor and 70% (28/40) of patients with neutropenia received growth-factor support.

Conclusions: Tumor response rates and OS of this treatment schedule in a heavily pretreated patient population were similar compared to previously reported phase 3 studies of eribulin. The toxicities associated with biweekly eribulin were manageable.

Citation Format: Smith II J, Irwin A, Jensen L, Tedesco K, Misir S, Zhu W, Almonte A, He Y, Olivo M, O'Shaughnessy J. Phase 2 study evaluating the efficacy and safety of eribulin mesylate administered biweekly for patients with human epidermal growth factor receptor 2-negative metastatic breast cancer [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P6-14-05.

Not all uncivil behaviours are equal: exploring responses to incivility in veterinary practice using vignettes

Workplace incivility is considered a common workplace stressor, linked to a range of adverse impacts such as reduced wellbeing. However, there is a lack of research focused on how targets of incivility respond. The current study addresses that gap by examining responses to incivility within veterinary practice. Veterinarians and veterinary nurses (n = 132) evaluated six scenarios depicting two types of incivility (direct e.g. demeaning comments/indirect, for example, ignoring someone) across three instigators (clients, co-workers, senior colleagues), reporting their perception and appraisal of the uncivil behaviour depicted along with potential responses. Direct incivility was linked to responses such as reciprocation, exit, and support seeking, whereas indirect incivility was associated with affiliative and ignoring responses. Negative appraisal of incivility predicted a higher likelihood of exit, avoidance, support seeking and reporting responses. These findings suggest that incivility targets utilise a broad range of response options and adapt their response dependent on the situation.

Scientific support for nuclear medicine

This report was prepared on behalf of the British Nuclear Medicine Society (BNMS). Information included builds upon a previous BNMS report and also brings together information from a variety of sources to reflect current good scientific practice in this BNMS guidance. Training and career pathways are defined. Roles and functions provided by physicists are described, and the risks associated with inadequate scientific staffing are explored. Published staffing guidance has been reviewed and a recent publication on provision of Medical Physics Expert (MPE) support has been endorsed. The service models used in that publication have been populated with general physics support so that requirements for MPE and overall scientific provision may be assessed. In summary, this report is intended as a resource for those in a variety of roles including scientists considering a career in nuclear medicine and clinical scientists already practicing. It is also likely that some aspects of the document will be of interest to other clinical and medical professionals and to those involved in commissioning and managing nuclear medicine services.

Hospital at home services for acute exacerbation of chronic obstructive pulmonary disease: a survey of British practice

OBJECTIVES

To identify the prevalence of and attitudes towards hospital at home services for acute exacerbation of chronic obstructive pulmonary disease (COPD) in Great Britain. To identify the models of service in existence, in particular staff numbers and the workload experienced.

DESIGN

A postal survey was used to locate existing schemes. Telephone interviews were conducted with each of the hospital at home services identified.

SUBJECTS & SETTING

A questionnaire was sent to one consultant in each of 223 respiratory departments in Great Britain. Thirty six departments were subsequently contacted by telephone.

OUTCOME MEASURES

Awareness and prevalence of hospital at home services. Perceived problems with starting a service. Details of organisation of existing services.

RESULTS

We received 186 replies to the postal questionnaire. Of these respiratory departments, 179 (96%) were aware of hospital at home services for acute exacerbation of COPD and, in November 1999, 30 (16%) were running such a service. Difficulty in obtaining funding was the main reason for not setting up a service rather than lack of evidence of benefit or unsuitability of local circumstances. Median staffing level was two nurses (range one to six) looking after a median number of new patients of five per week (range 0.5 to 12). There was wide variation in the organisation of services.

CONCLUSIONS

Despite lack of objective evidence of effectiveness, there was a high level of awareness of and interest in starting hospital at home services for acute exacerbation of COPD in British respiratory departments when assessed in November 1999.