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Background: The treatment landscape of metastatic renal cell carcinoma (mRCC) has evolved over recent years with several systemic anti-cancer therapies (SACT) licensed across different lines of treatment. There is ongoing discussion amongst oncology professionals about how best to optimise treatments in terms of sequencing to maximise the potential number of lines or to give the best treatments first. A previous south-west UK audit was completed in 2021 reviewing the drop off rates across 5 UK sites identifying that 69% of patients were able to receive second line therapy and 34% were able to receive third line therapy. Method(s): In this study we conducted retrospective analysis of all patients who commenced treatment with SACT for mRCC between 1st January 2018 and 30th June 2021 in 18 centres across the 4 nations of the United Kingdom. All NHS reimbursed treatment options including the COVID interim treatment guideline options were included. Patients who received SACT as part of a clinical trial were also included. Patients who continued on their respective lines of treatment were censored. We also identified patients who had been on a period of active surveillance before staring SACT in this cohort. Result(s): 1549 patients (71% male: 29% female) were included. IMDC subgroup patients included 21.6%favourable, 52.3% intermediate, 25.1%poor and 1% unavailable. 9.1% of patients had been on active surveillance before starting SACT - defined as a period of longer than 3 months from mRCC diagnosis to starting SACT. Of those patients that started SACT 60.5% of eligible patients had 2nd line therapy, 25.3% had 3rd line, 7.2% received 4th line therapy and only 1% had 5th line therapy. In the 1st line setting 58.9% received single agent VEGF TKI, 24.5% received combination ipilimumab and nivolumab (IO-IO) immunotherapy, 14 % received IO/ VEGF TKI combination and 2.6% received other/trial treatment. The single agent VEGF TKI ratio for 1st line SACT declined year by year with rising IO-IO and IO/VEGF TKI combination ratios seen. In the secondand third-line settings cabozantinib (33.2% 2nd line and 44.4% 3rd line) and nivolumab (32.8% 2nd line and 22.6% 3rd line) were the most common options. Disease progression or death was the most common cause of SACT discontinuation amounting to 57.4%, 62.5% and 79% of SACT cessation in the 1st, 2nd and 3rd lines respectively. Treatment toxicity SACT discontinuation rates were 22.8%, 21.4% and 10.9% for 1st, 2nd and 3rd lines respectively. Conclusion(s): These results suggest that with more treatment options available, including combination/immunotherapy therapies, more patients are able to receive second- and third-line therapies. That said there remains significant drop off rates mostly driven by disease progression that would support the use of our most effective therapies in the upfront setting.
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Organizational trauma theory endeavors to examine the psychological and physical effects of trauma on individuals and groups within an organization. Individual trauma, the individual mental and emotional disruptions that affect the well-being of self, often contributes to organizational trauma. Or sometimes, the disruptions are external and caused by societal, economic, or political changes. Recent traumatic events such as the COVID-19 pandemic and racial tensions stemming from social injustices present even greater challenges for organizations as leaders seek to facilitate healing, restoration, and renewal. Organizational trauma is currently playing out in our organizations, and organizational scholars, leaders, and managers are looking for ways to mitigate this trauma without having explicit knowledge or understanding of how to deal with it. Despite the increasing need to better understand organizational trauma and how to address it, this body of research has not played a prominent role in mainstream organization and management theory. Role of Leadership in Facilitating Healing and Renewal in Times of Organizational Trauma and Change examines the importance of dealing with trauma in organizations and related topics of interest. The chapters highlight global perspectives and present new and significant information and observations about organizational trauma and offer insights derived from a solidly and sufficiently broad knowledge base of theory, research, and practice. This book will also grant a basis of understanding trauma, its antecedents and outcomes, as well as how it can be mitigated and will provide information and insights regarding organizational trauma and how it interacts with and influences other organizational phenomena. This book is ideally intended for managers, human resources officers, academicians, practitioners, executives, professionals, researchers, and students interested in examining the ways in which organizational trauma is impacting the workplace. © 2021 by IGI Global. All rights reserved.
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Most of the states in the U.S. are slowly transitioning back to "normal", and educational institutions must weigh in the decision of maintaining the quality of the courses while protecting the health of students in the academic years ahead. We are interested in investigating the circumstances that would help schools stay open during COVID-19, creating safe educational conditions under such a severe situation. Our goal is to move a certain number of courses online to achieve a satisfactory infection rate most efficiently. At the same time, we attempt to maximize the number of face-to-face classroom experiences as most students prefer attending courses on campus over attending them online. In our model, we introduce three parameters to evaluate the risk of every course and determine the most suitable set of courses to be converted online. The parameters include Degree Centrality, Closeness Centrality, and Betweenness Centrality. Those parameters are aggregated in a rectified value. We describe the methodology of our approach and future work, in which we will conduct simulation and sensitivity analyses. © 2021 Copyright for this paper by its authors.
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Many U.S. universities are embracing the hybrid teaching modality thanks to the start of the COVID- 19 vaccinations and availability of online teaching tools. This work presents a continuation of our previous research, in which we analyzed and developed a methodology to inhibit COVID-19 spread on a university campus. We simulate the virus spread on campus, comparing SIR and SEIR models, and examine how different course policies can affect the number of infected students. We demonstrate that we can achieve a safer environment on campus by moving a certain number of courses with the highest centrality values. Additionally, we analyze how the student flow rate can help reduce the R0 value representing the metric of how many other people an infected individual could infect. This work also presents the simulation analysis of the opened public places on campus and the application of the sensitivity analysis to develop the most efficient approach determining the exact courses that need to be moved online. We conclude with the recommendations and analysis results. © 2021 Copyright for this paper by its authors.
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Introduction: There remains a paucity of data comparing ambulatory initiation of home non-invasive ventilation (NIV) with a model requiring inpatient admission. In our institution, a Quality Improvement (QI) project was performed where an ambulatory model for NIV initiation was developed and evaluated. Methods: Ambulatory pathways were formulated for NIV initiation in the outpatient setting, alongside outreach and initiation of NIV for inpatients referred within regional hospitals. The primary outcome measure was 'compliance with NIV' defined as NIV use ≥4 hours/night for ≥75% of nights. Results: Between 6.1.20 and 1.7.20, 76 referrals for home NIV were assessed within the ambulatory model. Of these, NIV was not indicated in 3 cases and contraindicated in 1 case, while 2 trialled NIV and declined it, leaving 70 patients who commenced home NIV (n=36 following COVID-19 ward 'closure'). Neuromuscular disease was the principal diagnosis in 41% (29/70) with MND comprising 20/29 neuromuscular cases;see table 1. Ventilator interaction data was available for 68 patients where mean NIV use was 5.21 (SD 3.98) hours/night. Of those established by ambulatory pathway, 62% (42/68) were deemed 'compliant' with NIV in comparison to previous data reporting compliance in 62% (56/90) of subjects established through inpatient admission. It was calculated that delivery of the ambulatory pathway resulted in a cost saving of £197,967 (Table presented) for this period, achieved principally by admission avoidance based on previous length of stay data and Level 2 bed costings. Conclusions: An ambulatory model for initiation of home NIV appears to be as effective in achieving compliance as inpatient admission, while carrying health economic benefits. Ambulatory treatment pathways enabled us to deliver service continuity during the COVID-19 pandemic.