Prior Course Research Articles

Equecabtagene Autoleucel in Patients With Relapsed or Refractory Multiple Myeloma

Equecabtagene autoleucel (eque-cel), a fully human-derived B-cell maturation antigen-targeting chimeric antigen receptor (CAR) T-cell therapy, has exhibited potential for the treatment of relapsed or refractory multiple myeloma (RRMM), and further investigation in a larger cohort is necessary. To evaluate whether eque-cel can benefit patients with RRMM and determine the overall response rate postinfusion. The FUMANBA-1 trial was a single-arm, open-label, phase 1b/2 trial that evaluated eque-cel in adult patients with RRMM. Enrollment began in April 2020, and patients who received eque-cel will be monitored for a minimum of 15 years following the infusion. As of September 2022, patients with heavily pretreated RRMM who received at least 3 prior courses of therapy from 14 centers were enrolled. Data were analyzed from April 2020 to September 2022. Patients received a single infusion of eque-cel at 1.0 × 106 CAR-positive T cells/kg after the lymphodepletion. Efficacy was the primary objective, and safety, pharmacokinetics, and pharmacodynamics were secondary objectives. Of 103 patients who received an eque-cel infusion, 55 (53.4%) were male, and the median (range) age was 58 (39-70) years. A total of 101 patients were evaluable for efficacy. At a median (range) follow-up of 13.8 (0.4-27.2) months, the overall response rate was 96.0% (97 of 101), with 74.3% (75 of 103) achieving a complete response or better. Among the 12 patients who had prior CAR T-cell treatment, 75% (9 of 12) achieved a response. The median progression-free survival was not reached, with a 12-month progression-free survival rate of 78.8% (95% CI, 68.6-86.0). A total of 96 patients (95.0%) achieved minimal residual disease negativity at a sensitivity threshold of 10-5. Adverse events were favorable: 96 of 103 patients (93.2%) experienced cytokine release syndrome (grade 1 to 2 in 95 patients [92.3%]) and 2 (1.9%) experienced immune effector cell-associated neurotoxicity syndrome (grade 1 to 2). All cases of immune effector cell-associated neurotoxicity syndrome and 94 of 96 cases of cytokine release syndrome resolved with treatment. Additionally, only 20 patients (19.4%) developed antidrug antibodies. Cellular kinetic analysis confirmed CAR-positive T cells in all patients, with the longest duration at 735 days. In this trial, eque-cel led to early, deep, and durable responses in patients with heavily pretreated RRMM with a manageable safety profile. Patients with prior CAR T-cell therapy also benefitted from eque-cel. Chinese Clinical Trial Registry Identifier: ChiCTR2000033946.

Adavosertib in Combination with Olaparib in Patients with Refractory Solid Tumors: An Open-Label, Dose-Finding, and Dose-Expansion Phase Ib Trial.

Adavosertib is a first-in-class, selective small-molecule inhibitor of Wee1. Olaparib is an inhibitor of poly(ADP-ribose) polymerase (PARP). Preclinical data suggest that adavosertib enhances the antitumor effect of PARP inhibitors. The safety, tolerability, and efficacy of adavosertib plus olaparib were evaluated in patients with refractory solid tumors to define the maximum tolerated dose (MTD) and recommended phase II dose (RP2D). Eligible patients in part A (dose finding) had a refractory solid tumor for which there is no established treatment and had received ≥ 1 prior course of systemic therapy; in part B (dose expansion), patients had platinum-sensitive extensive-stage or relapsed small-cell lung cancer (SCLC). Patients received adavosertib [once (qd) or twice daily (bid)] for 3 consecutive days with 4 days off treatment (3/4), or 5 consecutive days with 2 days off (5/2), plus olaparib (bid) for 14 or 21 days of a 21-day cycle. A total of 130 patients were enrolled in the study, 120 in part A and 10 in part B. The MTD for adavosertib bid was 175 mg (days 1-3, 8-10/21-day cycle) plus continuous olaparib 200 mg bid; the once-daily MTD (and RP2D) was adavosertib 200 mg (days 1-3, 8-10/21-day cycle) plus continuous olaparib 200 mg bid. In the MTD/RP2D cohort, one patient (7%) experienced a dose-limiting toxicity (DLT) of thrombocytopenia. The most common treatment-related adverse events (TRAEs) in the cohorts in which MTD/RP2D for bid dosing and RP2D for qd dosing were determined were fatigue (64.3% and 15.4%, respectively), diarrhea (42.9% and 30.8%), decreased appetite (35.7% and 23.1%), nausea (35.7% and 15.4%), and anemia (35.7% and 38.5%). In the SCLC dose-expansion cohort, TRAEs occurred in eight patients (88.9%), including thrombocytopenia (66.7%) and anemia (55.6%). In part A, objective response rate (ORR) was 14.8% [95% confidence interval (CI) 8.7-22.9] overall; for the cohorts in which MTD/RP2D for bid dosing and RP2D for qd dosing were determined, ORR was 30.8% (9.1-61.4) and 9.1% (0.2-41.3), respectively. ORR was 11.1% [95% CI 0.3-48.2; one partial response (PR)], disease control rate was 22.2% (2.8-60.0; one PR, one stable disease), and median progression-free survival was 1.5 months (1.3-4.2) in the SCLC dose-expansion cohort. Adverse events and DLTs observed in the bid MTD and once-daily MTD/RP2D dosing schedules were manageable and consistent with known adavosertib and olaparib safety profiles. Limited antitumor activity was observed with adavosertib plus olaparib combination therapy. ClinicalTrials.gov, NCT02511795 (registration: 28 July 2015).

Challenging frontiers in neuroplastic cranial reconstruction: addressing neurosurgical wound healing complications through interdisciplinary collaboration – an observational study

Background and objectivesAlthough rare, complications like skin dehiscence and necrosis after neurosurgery pose significant challenges by increasing the risk of infections spreading to the epidural, subdural, or intracerebral spaces. This retrospective, single-center study aims to assess the prior clinical courses, neuroplastic repair, and outcomes of patients with skin defects following cranial neurosurgical procedures, and to outline our interdisciplinary reconstructive protocol.MethodsA retrospective analysis was performed on cranial surgeries conducted at the Department of Neurosurgery, spanning from 2017 to 2023. Patients with skin defects requiring the combined expertise of neurosurgery and plastic surgery for effective treatment were included. The sizes of the skin defects were measured using intraoperative photographs analyzed with the freeware ImageJ software, version 2018. All patients provided informed consent for the surgeries. If informed consent was not possible due to neurological deterioration, consent was sought from adult representatives or next of kin except for acute circumstances. All patients admitted to our hospital agree to the pseudonymized use of their medical data and tissue specimens for research purposes in their treatment contract.ResultsA cohort of 24 patients experiencing wound healing complications after neurosurgical procedures underwent a total of 29 interdisciplinary surgeries for the reconstruction of skin, dural, and bone defects. After the neuroplastic surgery, 8 out of 24 patients (33.3%) developed surgical complications, with 6 of these requiring revision surgeries due to persistent cranial infection. In all cases, permanent wound closure was successfully achieved following adherence to the proposed treatment algorithm.ConclusionsOur study underscores the necessity of an integrated neurosurgical and plastic surgical approach to effectively manage wound healing complications in a single stage surgery. Key interventions include differentiation between necrosis and gaping lesions, alongside precise management of neurosurgical issues like cerebrospinal fluid fistulas and hydrocephalus. Plastic surgical expertise in assessing the possibilities and limitations of both local and free flap surgeries is essential.

Safety of 177Lu-DOTATATE administration in a patient with recurrent meningioma complicated by radiation necrosis: a case report

Radiation-associated meningiomas are characterized by high rates of recurrence. 177Lu-DOTATATE may represent a treatment option for these tumors, but safety of this agent for patients with a history of radiation necrosis is unknown. In this case report, we describe the preliminary safety of 177Lu-DOTATATE administration for a patient with prior history of radiation necrosis. The patient was diagnosed with central nervous system (CNS) germinoma at age 17, managed with chemoradiation. Twenty years later, a left-parietal extra-axial mass was identified within the prior radiation field, with diagnosis of atypical meningioma established on subtotal resection. He received additional radiation therapy (RT, 60 Gy, 30 fractions). Seventeen months later, tumor progression was treated with gamma knife radiosurgery (GKRS, 15 Gy, single fraction). Seven months after GKRS, seizures recurred, with imaging consistent with radiation necrosis. The patient was treated with bevacizumab (7.5 mg/kg, every 3 weeks, 4 doses). One year later, magnetic resonance imaging (MRI) brain revealed tumor progression within the treatment field. 68 Ga-DOTATATE positron emission tomography demonstrated that the meningioma was DOTATATE-avid with no evidence of metastasis. The patient was treated with 177Lu-DOTATATE (two infusions, two months apart), which was well tolerated with no significant toxicities and no recurrence of radiation necrosis. Two months after the second infusion, the patient experienced disease progression and was transitioned to bevacizumab. In this patient with three prior courses of intracranial radiation and subsequent radiation necrosis, 177Lu-DOTATATE was well-tolerated. 177Lu-DOTATATE administration may be feasible for patients with a history of radiation necrosis.

Snapshots of sameness: Characterizations of mathematical sameness across student groups

Sameness is foundational to mathematics but has only recently become an area of focus in mathematics education research. In this paper, we describe characterizations of sameness generated by four student groups: discrete mathematics students, linear algebra students, abstract algebra students, and graduate students. Based on qualitative analysis of open response surveys, we compare these groups’ characterizations of sameness; note the subcomponents discussed and variation within each dimension; and highlight experiences influential to students’ perceptions of sameness. Findings include interpretability of sameness as a big idea, nascent development of thematic connections across courses, emphases on current course material rather than connections to prior courses for students solicited from a particular course, greater reflectiveness from the graduate student group, and abstract algebra as an impactful course. Implications include a need for thoughtful examinations of how “big ideas” develop among students and what experiences might support such development.

Pointing to success: a discussion of the role of professional achievements in the selection of specialist surgical trainees

In Australia and New Zealand, competitive selection processes for surgical specialty training programs often use a standardized curriculum vitae (CV) to assess criteria such as professional achievements. This review aims to assess the predictive validity, standardization, and implicit biases of these selection methods, as well as their implications for trainees and the diversity of surgical cohorts. The 2023 CV scoring criteria were collected for all available specialty surgical programs in Australia and New Zealand. In 2023, each of the 11 surgical craft programs published publicly available standardized CV scoring criteria. In this study, scored items that constitute 'professional achievements' were recorded and tabulated. Observational analysis of the collected data was then conducted. In 2023, each of the 11 specialty surgical craft programs published publicly available structured CVs, of which 10/11 allocated points for professional achievements. Designated points for professional achievements were classified as awards, scholarships, committee positions, and prior training courses: 4/11 programs offered points for scholarships/grants, 6/11 programs offered points for academic and/or non-academic prizes, and 8/11 programs offered points for professional development courses. Observational analysis of these findings suggests that professional achievements are desired in training program applicants. Variability in medical school opportunities and inherent heterogeneity reduce the CV's efficacy, unfairly disadvantaging some applicants. Observational analysis of hence highlights the need for future research to assess potential updates in CV parameters to enhance predictive validity, reduce bias, and promote diversity.

Exploring pain management practices among nurses in a provincial city of Vietnam: A cross-sectional investigation of influential factors

Background & Aim: There is limited evidence regarding pain management practice and its associated factors among nurses in Vietnam. Therefore, the study aimed 1) To examine the current state of pain management practices among nurses at Hai Duong Provincial General Hospital, Vietnam; and 2) to identify its associated factors. Methods & Materials: A cross-sectional study design was performed on 200 nurses and 200 medical records needed to be reviewed to match the number of nursing samples. The data collection was conducted from May to June 2022. The modified Cancer Pain Practice Index included 13 evidence-based pain management Indicators applied to measure nurses’ pain management practice by reviewing medical records, and the Knowledge and Attitudes Survey Regarding Pain tool was used to assess the pain management knowledge and attitude of nurses by self-completed questionnaire. Results: A significant majority, comprising 146 nurses (73%), demonstrated inadequate pain management practices. Several crucial indicators of pain management were suboptimally performed by the majority of nurses. These included failure to document the execution of pain assessments for new patients, inadequate monitoring for side effects of opioid analgesics, and insufficient assessment and care for bowel status when opioids were prescribed. Additionally, participation in prior pain management training courses, along with knowledge and attitude toward pain management, emerged as significant variables associated with pain management practices (p<0.001). Conclusion: The study highlighted widespread poor pain management practices among nurses. Participation in training courses and good knowledge and attitude correlate with better practices.

Utilizing the Ex-Vivo Bovine Model in Retrograde Intrarenal Surgery Training

ObjectivesTo present an ex-vivo bovine model for retrograde intrarenal surgery (RIRS) training. Materials and MethodsThe model was specifically developed for a pre-congress course organized as part of the National Pediatric Urology Congress. The course involved a two-day online theoretical segment followed by hands-on training. Bovine kidneys were chosen for their anatomical resemblance to human kidneys. The kidneys were sourced from a local slaughterhouse, ensuring the intactness of the pelvis, ureters, and perirenal fat. A Modified Larssen solution was used for tissue preservation. The tissue was positioned within a cardboard box, with specific preparation techniques to ensure realism. During the hands-on training, participants utilized a flexible ureterorenoscope for practice. After the course, participants completed an 18-question survey assessing the model and training experience. Results24 participants completed the training and survey. Four out of eight procured kidneys were suitable. The model's cost was 18 euros. 87.5% of participants reported increased RIRS confidence. Those with prior course experience rated the model's anatomical resemblance higher (p=0.016). No significant difference was observed in feedback on the model's durability or tactile feedback based on prior experience (p>0.05). ConclusionThe ex-vivo bovine model provides a promising alternative for RIRS training. While further studies are needed to validate its widespread application, initial feedback suggests it offers a balance between cost-effectiveness and realistic training experience.

Concentrated transdiagnostic and cross-disciplinary micro-choice based group treatment for patients with depression and with anxiety leads to lasting improvements after 12 months: a pilot study

BackgroundA concentrated transdiagnostic and micro choice-based group treatment for patients with depression and anxiety has previously shown to yield significant reduction in symptoms and increased level of functioning from pre to 3-month follow-up. In the present study, we report the results after 12 months follow-up.MethodsThis was a non-randomized clinical intervention pilot study, conducted in line with a published protocol. Sixty-seven consecutively referred patients, aged 19–47 (mean age 32.5, SD = 8.0) were included and completed treatment. All had a severity of their problems that entitled them to care in the specialist public mental health care. Self-reported age at onset of symptoms was 17.6 (SD = 7.9) years. Mean number of prior treatment courses was 3.5 (SD = 3.3; range 0–20). The main objective was to assess the treatment effectiveness by questionnaires measuring relevant symptoms at pre-treatment, 7 days-, 3 months-, 6 months- and at 12-months follow-up.ResultsValidated measures of functional impairment (WSAS), depression (PHQ9), anxiety (GAD7), worry (PSWQ), fatigue (CFQ), insomnia (BIS) and illness perception (BIPQ) improved significantly (p < .0005) from before treatment to 12 months follow-up, yielding mostly large to extremely large effect sizes (0.89–3.68), whereas some moderate (0.60–0.76). After 12 months, 74% report an overall improvement in problems related to anxiety and depression. Utilization of specialist, public and private mental health care was reported as nonexistent or had decreased for 70% of the patients at 12-month follow up.ConclusionsThe concentrated, micro-choice based group treatment approach yielded a highly clinically significant reduction in a wide range of symptoms already one week after treatment, and the positive results persisted at 12-month follow-up.Trial registrationClinicalTrials.gov Identifier: NCT05234281, first posted date 10/02/2022.

A Student Teaching Assistant Program for Diversity, Equity, Inclusion, and Antiracism Curricular Enhancement.

In the United States, physician bias is exhibited early in medical training and contributes to systemic inequities within the field of medicine. A lack of diversity, equity, inclusion, and antiracism (DEI-AR) content within medical curricula drives critical gaps in knowledge and deficiencies when preparing medical students to serve patients of diverse backgrounds. At the Mayo Clinic Alix School of Medicine (MCASOM), student-led curricular reviews between 2017 to 2018 and 2020 to 2021 revealed opportunities to improve DEI-AR content within preclinical courses. Course directors expressed concern of limited expertise and time to enact effective changes. The MCASOM DEI-AR teaching assistant (TA) program aims to curate a collaborative partnership between course directors and compensated student TAs to facilitate course enhancements responsive to the prior preclinical course review while centering standardized DEI-AR best practices. As of January 2024, the program has engaged 14 TAs and partnered with 24 preclinical courses. Postcourse student evaluation responses were collected from 8 courses for 2021 to 2022 (before enhancements) and 2022 to 2023 (after enhancements). Student satisfaction with DEI-AR content is tracked through postcourse evaluations, with preliminary data demonstrating improvement after DEI-AR curricular integration (improvement of mean preenhancement and postenhancement scores of 3.81 to 4.05; t12 = 1.79, P = .21). Qualitative student comments were sorted into general categories of positive, negative, or neutral, showing a 6.25% median increase in positive perception of DEI. Plans for the MCASOM DEI-AR TA program include application of quality improvement strategies to improve program processes and outcomes. Development of a centralized dashboard that integrates course enhancement progress and ongoing feedback from evaluations is anticipated to facilitate this effort. The program additionally aims to develop partnerships with clinical clerkships, which would allow for a more comprehensive enhancement of the overall medical education experience related to DEI-AR.

The value of pre-hospital trauma life support courses for medical personnel-a questionnaire study.

The aim of the study was to determine the impact that PHTLS® course participation had on self-confidence of emergency personnel, regarding the pre-hospital treatment of patients who had suffered severe trauma. Furthermore, the goal was to determine the impact of specific medical profession, work experience and prior course participation had on the benefits of PHTLS® training. A structured questionnaire study was performed. Healthcare providers from local emergency services involved in pre-hospital care in the metropolitan area of Zurich (Switzerland, Europe) who completed a PHTLS® course were included. Altered self-confidence, communication, and routines in the treatment of severe trauma patients were examined. The impact of prior course participation, work experience and profession on course benefits were evaluated. The response rate was 76%. A total of 6 transport paramedics (TPs), 66 emergency paramedics (EPs) and 15 emergency doctors (EDs) were included. Emergency paramedics had significantly more work experience compared with EDs (respectively 7.1 ± 5.7 yrs. vs. 4.5 ± 2.1 yrs., p = 0.004). 86% of the participants reported increased self-confidence in the pre-hospital management of severe trauma upon PHTLS® training completion. Moreover, according to 84% of respondents, extramural treatment of trauma changed upon course completion. PHTLS® course participants had improved communication in 93% of cases. This was significantly more frequent in EPs than TPs (p = 0.03). Multivariable analysis revealed emergency paramedics benefit the most from PHTLS® course participation. The current study shows that PHTLS® training is associated with improved self-confidence and enhanced communication, with regards to treatment of severe trauma patients in a pre-hospital setting, among medical emergency personnel. Additionally, emergency paramedics who took the PHTLS® course improved in overall self-confidence. These findings imply that all medical personal involved in the pre-hospital care of trauma patients, in a metropolitan area in Europe, do benefit from PHTLS® training. This was independent of the profession, previous working experience or prior alternative course participation.

Development of an intervention to support parents receiving treatment in psychiatric inpatient hospital using participatory design methods.

When parents of dependent children are treated in psychiatric inpatient hospital, it typically involves separation of parent and child for the duration of treatment, which can be highly distressing to the dyad and can result in disruption to the parent-child relationship. Parents who have experienced hospitalisation have expressed a desire for their parenting identity to be recognized and appropriately engaged with during their treatment. This recognition includes provision of interventions which support them as parents to limit the impact of their mental health on their children. The current study, the first of its kind known to have taken place, details a collaborative intervention development project for parents receiving inpatient care. The current study, the first of its kind known to have taken place, details a collaborative intervention development project for parents receiving inpatient care. This project involved the adaptation and extension of a prior parenting-focused course for parents high in anxiety to meet the needs of parents being treated in inpatient settings. In the first two stages of the three-phase project, patients, carers and mental health practitioners contributed to the revision and delivery plan for the course including developing new content for the intervention. In the final stage, which took the form of a participatory evaluation, the intervention was delivered to 11 parents receiving inpatient treatment who then provided extensive feedback. A series of iterative adaptations to the intervention were made in response to this feedback alongside stakeholder input. The final intervention comprises five modules focused on exploring the experience of parents alongside specific learning and skills orientated toward boosting their connection with their children during hospitalisation and in readiness for discharge. Preliminary feedback from patients and ward staff has been positive and the process of delivering the project on inpatient wards was associated with no increase in negative clinical outcomes. The successful development of a targeted intervention within inpatient psychiatric units offers a signal that parents treated in this setting welcome the opportunity to be supported in their parenting role. As the first known UK intervention of its kind to be developed in partnership with patients, ward staff and management, it is specifically tailored to the context and needs of this group with the potential to be delivered by a range of health professionals in this setting.

Targeted therapeutic options in early and metastatic NSCLC-overview.

The complex therapeutic strategy of non-small cell lung cancer (NSCLC) has changed significantly in recent years. Disease-free survival increased significantly with immunotherapy and chemotherapy registered in perioperative treatments, as well as adjuvant registered immunotherapy and targeted therapy (osimertinib) in case of EGFR mutation. In oncogenic-addictive metastatic NSCLC, primarily in adenocarcinoma, the range of targeted therapies is expanding, with which the expected overall survival increases significantly, measured in years. By 2021, the FDA and EMA have approved targeted agents to inhibit EGFR activating mutations, T790 M resistance mutation, BRAF V600E mutation, ALK, ROS1, NTRK and RET fusion. In 2022, the range of authorized target therapies was expanded. With therapies that inhibit KRASG12C, EGFR exon 20, HER2 and MET. Until now, there was no registered targeted therapy for the KRAS mutations, which affect 30% of adenocarcinomas. Thus, the greatest expectation surrounded the inhibition of the KRAS G12C mutation, which occurs in ∼15% of NSCLC, mainly in smokers and is characterized by a poor prognosis. Sotorasib and adagrasib are approved as second-line agents after at least one prior course of chemotherapy and/or immunotherapy. Adagrasib in first-line combination with pembrolizumab immunotherapy proved more beneficial, especially in patients with high expression of PD-L1. In EGFR exon 20 insertion mutation of lung adenocarcinoma, amivantanab was registered for progression after platinum-based chemotherapy. Lung adenocarcinoma carries an EGFR exon 20, HER2 insertion mutation in 2%, for which the first targeted therapy is trastuzumab deruxtecan, in patients already treated with platinum-based chemotherapy. Two orally administered selective c-MET inhibitors, capmatinib and tepotinib, were also approved after chemotherapy in adenocarcinoma carrying MET exon 14 skipping mutations of about 3%. Incorporating reflex testing with next-generation sequencing (NGS) expands personalized therapies by identifying guideline-recommended molecular alterations.

Increasing incidence of mastoidectomies in children : Result of reduced antibiotic therapy or late COVID-19 sequela?

An increasing number of pediatric patients with mastoiditis and aconsequent increase in mastoidectomy rates was noted in 2022 and 2023. This study aimed to analyze the increase in the number of children presenting with mastoiditis and subsequent mastoidectomy, to assess correlations with prior antibiotic treatment or COVID-19 infection, and to provide an overview of involved pathogens, treatment, and disease course. Aretrospective analysis of all patients with mastoidectomy since 2012 was conducted. Data collected comprised type and duration symptoms, prior antibiotic therapy, diagnostic tests and disease course, causal pathogens, length of hospitalization, and complications. Ahighly significant increase in mastoidectomies in children could be demonstrated from 2022. Neither the pathogens involved nor the course of disease or complications showed differences. An increase in the number of patients with prior outpatient antibiotic therapy could be shown. About ahalf of the patients becoming ill after fall 2022 had apositive history of COVID. Hyperplasia of adenoid tissue was afar less frequent causal mechanism than in the years before COVID. No clear correlation with reduced outpatient antibiotic therapy could be found. Whether there exists an association with prior COVID infection cannot be judged at this time, due to the high number of asymptomatic and therefore unknown COVID infections.

Bichronous scientific writing course for medical faculty during Covid-19: a SWOT analysis experience

IntroductionWriting and publishing scholarly articles in international peer-reviewed journals can be a challenging undertaking for medical and healthcare professionals in universities, especially in non-English speaking countries. Surprisingly, very few faculty members report receiving guidance on scientific writing. To encourage more faculty engagement in professional development courses aimed at enhancing their writing abilities, we have revamped scientific writing courses to incorporate bichronous (a combination of asynchronous and synchronous) teaching methods.MethodsAfter forming a team, we performed a SWOT (strengths, weaknesses, opportunities, and threats) study of the medical faculty’s present programs and proposed alternatives to prior course issues. In this interventional study, fifty-nine eligible medical educators selected by purposeful sampling underwent a two-and-a-half-month bichronous scientific writing course from March to August 2021. The perspectives of the participants were evaluated through a SWOT analysis. The data were collected through online semi-structured interviews, and data collection continued until data saturation was achieved (40 participants). Data were then coded and analyzed based on conventional qualitative content analysis principles.ResultsOur planned blending sequence and e-feedback increased the medical faculty’s drive to learn, self-confidence, and autonomy while improving their writing skills. Poor ICT and network infrastructure hindered course adoption. Due to the course’s time and the faculty’s own online teaching, many battled with computer vision syndrome, self-discipline, and distractions. Our participants struggled with self-discipline and distractions, so setting a daily time limit may help them concentrate.DiscussionGiven the faculty’s demanding professional lives, this designed course provided a learning opportunity for many that would not have been feasible otherwise.

Cross-curricular project-based laboratory learning enables hands-on interdisciplinary education for chemical engineering students

To enhance students’ interdisciplinary awareness and understanding of (i) high-pressure reactors, (ii) zeolites as catalysts and (iii) analysis of complex reactor effluents with unknown compounds, the laboratory exercises of two courses are coupled into a cross-curricular Project-Based laboratory Learning trajectory. The alkylation of anisole with 1-hexene proves to be an excellent case study for students to learn new objectives and strengthen the skills acquired in prior courses, emulating the work of expert engineers and analytical chemists. The time-efficient cross-curricular project proves effective in fostering teamwork and addressing complex engineering and analytical challenges. Student testimonials highlight the integrated project's success in providing new insights and cultivating advanced decision-making skills during experimentation. This approach also encourages future interdisciplinary collaborations between chemical engineering and analytical practice classes.

National Continuing Professional Development (CPD) training needs of pharmacists in Ethiopia

BackgroundContinuing Professional Development (CPD) in pharmacy is a lifelong learning approach whereby individual pharmacists are responsible for updating and broadening their knowledge, skills, and attitudes. This is vital to ensure the delivery of high-quality patient care services. However, there is a lack of available data revealing the CPD needs of Ethiopian pharmacists. Thus, the objective of this study was to identify CPD training needs of pharmacists practicing in Ethiopia.MethodsAn institution-based cross-sectional study design with a quantitative approach was employed in this study. This assessment involved 640 pharmacists representing various sectors of the profession. Data were collected through a combination of an online platform and a face-to-face questionnaire administered in person.ResultA total of 634 participants completed and returned the questionnaires, resulting in an impressive response rate of 99.1%. A significant majority (74.1%) of the participants possessed bachelor’s degree in pharmacy (B. Pharm). Pharmaceutical Logistics and Pharmacy administration was preferentially selected as a prior CPD course by 36% of participants, of them while Pharmacotherapy (17%), Leadership/Governance (13%), Community Pharmacy (12%), Research and Development (11%) were also the subsequent top choices by participants. Off-site face-to-face lectures (59.2%), Hybrid (face-to-face + e-learning) (54.8%), and on-site on-the-job training (45.5%) were the most convenient means of CPD course delivery. On the other hand, the participants least favored print-based or correspondence programs for CPD course delivery.ConclusionsCPD holds great importance in the professional lives of pharmacists. It is critical for pharmacists, CPD providers, and those responsible for accrediting CPD programs to recognize the specific CPD requirements, preferred methods of delivery, and obstacles involved. This understanding is vital for establishing priorities and effectively planning CPD activities. In light of this, our study identified the most preferred CPD training courses and convenient delivery methods for pharmacists in Ethiopia. We recommend that CPD providers and accrediting bodies in Ethiopia refer to our findings when approving CPD courses.

Evaluating a digital hybrid training-of-trainers (TOT) approach for lay first responder trauma education in urban Nigeria during the COVID-19 pandemic

IntroductionRoad traffic injuries (RTIs) are the largest contributor to the global burden of injury, and in 2016 were among the five leading causes of global disability-adjusted life years (DALYs). In regions with limited emergency medical services (EMS), training lay first responders (LFRs) has been shown to increase availability of prehospital care for RTIs, but sustainable mechanisms to scale these programs remain unstudied. MethodsUsing a training of trainers (TOT) model, a 5.5-h LFR training program was launched in Lagos, Nigeria. The course was taught in a hybrid fashion with primary didactics using videoconferencing software and practical breakout sessions in-person concurrently. Thirty TOTs proceeded to train 350 transportation providers as LFRs over one month. A 23-question, pre- and post-assessment was administered digitally to assess knowledge acquisition. Participants responded to a five-point Likert survey assessing instruction quality and post-course confidence. ResultsTOTs scored a median of 56.5 % (IQR:43.5 %,71.7 %) and 91.3 % (IQR:88.0 %,95.7 %) on the pre- and post-assessments, respectively, with bleeding control scores increasing most (+69.4 %). LFR course trainees scored a median of 34.8 % (IQR: 26.0 %, 43.5 %) and 73.9 % (IQR: 65.2 %, 82.6 %) on the pre- and post-assessments respectively, with airway and breathing increasing the most (+48.6 %). All score increases were statistically significant with p < 0.001. All 30 TOT trainers instructed at least one training session after their initial session. LFR participants’ rated confidence in first aid skills went from 3/5 (IQR 3, 4) pre-course to 5/5 (IQR:5,5) post-course, and in emergency transportation it went from 4/5 (IQR:3, 4) to 5/5 (IQR:5, 5), (p < 0.001). LFR course participants rated the quality of education content and TOT instructors to be 5/5 (IQR:5,5). 144 responders provided emergency care in the six-months following training for a total of 351 interventions. Active responders provided a median of 2 (IQR:1,3) interventions. ConclusionsThis is the first time that a digital hybrid instruction for first responder trainers in low- and middle-income countries has been investigated. Our findings demonstrate negligible attrition, high educational quality ratings, equally effective knowledge acquisition to that of prior in-person courses, and high post-training skill usage. Future work will examine the cost-effectiveness of the training of LFRs and the effect of LFRs on trauma outcomes.

Nudging students' interest in learning a new language: An experimental proof of concept for an online informational-nudge

Motivating students to persist in learning they did not choose is one of the most challenging parts of being an educator. Psychological, classroom-based interventions have been popularized, but less research has explored online support outside the classroom. An experimental test of the efficacy of a programme of informational nudge videos for the support of students' interest in learning a new language during compulsory university course in Japan was conducted. First/second year students (n = 2364; F = 627), participated in the experimental study. The experimental group watched 14 engaging informational videos (mean = 56 s) twice. The control group watched 14 videos that taught a specific an English phrase for the same amount of time. Prior/post individual interest, and prior utility-value for learning English, and their prior course self-efficacy were collected. Students pre/post English knowledge and their persistence in course online learning components was collected. Following latent profile analysis based on prior variables, the full sample and each subgroup was used to test a fully-forward longitudinal Structural Equation Model which tested the impact of the experiment on students' future individual interest in learning English. The LPA reveal three latent subgroups labelled low, moderate and high motivation. SEM test indicated a small, positive experimental effect for full sample (β = .05) and a larger effect for the moderate motivation subgroup (β = .08). Post individual interest for the moderate group was a significant predictor of e-learning persistence (β = .23), which predicted future knowledge (β = 10). This pilot programme of informational nudges presented a small significant longitudinal effect for future individual interest for the full sample and moderate motivation subgroup. This was followed by subsequent mediated links to e-learning persistence and knowledge growth. The informational nudge experiment presented positive results indicating that these informational, “light-touch” nudges have the propensity to support students' interest in learning.

Utility of PSMA PET Guided Metastasis-Directed Radiotherapy

Metastasis-directed radiotherapy (MDT) is becoming a mainstay in the management of oligometastatic prostate cancer (PCa), and PSMA-PET is currently the most sensitive imaging modality for PCa metastasis screening. The efficacy of MDT guided by PSMA-PET imaging has not yet been well characterized. Moreover, the optimal role of androgen deprivation therapy (ADT) in the context of MDT is not known. We sought to assess the efficacy of PSMA PET-guided MDT in patients with metastatic PCa treated with and without ADT. This is a single institutional retrospective study of patients diagnosed with metastatic prostate cancer by PSMA-PET imaging who were treated with MDT. Biochemical progression was defined as a PSA increase of ≥ 25% and ≥ 2 ng/mL if PSA was ≥ 2 ng/mL at time of initiating salvage treatment, or a PSA increase of ≥ 25% if PSA was < 2 ng/mL at time of salvage treatment. Survival analyses were performed using the Kaplan-Meier method with log-rank testing for significance. Cumulative incidence analyses were performed with Gray's testing for significance. Adverse event data were assessed per CTCAE v5 guidelines. A total of 196 PSMA PET-avid lesions from 101 patients were irradiated with stereotactic body radiotherapy (SBRT). Median time from prior definitive locoregional therapy to MDT was 6.2 years. 79 patients had hormone-sensitive PCa (HSPC) and 22 patients had castration-resistant PCa (CRPC) at time of MDT. 47 of 79 (59%) patients with HSPC received ADT along with MDT, and 20 of the 47 patients received augmented ADT. 25 of the 32 (78%) HSPC patients receiving MDT without ADT had undergone at least one prior course of ADT, and none had castrate levels of testosterone at time of MDT with a median testosterone level of 341 ng/dl. With a median follow-up of 22.4 months, 5 of 196 lesions (2.6%) demonstrated radiographic progression. 2-year cumulative incidence of progression from HSPC to CRPC was 11% in patients who received ADT at time of MDT and 35% in those who did not (P = 0.027). Median biochemical progression free survival of patients with CRPC, HSPC treated without ADT, and HSPC treated with ADT following MDT was 5.4, 7.6, and 43.9 months respectively (P<0.0001). 2-year overall survival of the abovementioned groups was 72.2%, 100%, and 97.5% respectively (P<0.001). No Grade 3-5 adverse effects were observed. MDT guided by PSMA-PET imaging is well-tolerated and delays biochemical progression in patients with CRPC and HSPC, with a greater effect observed in patients also receiving ADT.