Comparison of 2 Invisalign tray generations using the Peer Assessment Rating index.

INTRODUCTION: This study aimed to establish if there is a significant difference in effectiveness between 2 generations of Invisalign trays in terms of Peer Assessment Rating (PAR) score reduction for finished patients from a graduate orthodontic clinic. METHODS: Forty-five pretreatment and posttreatment patients treated with the previous Invisalign material and 49 pretreatment and posttreatment patients treated with SmartTrack material were scored using the Peer Assessment Rating (PAR) index. Both groups were controlled for initial weighted PAR score, age, gender, and treatment time. The 2 generations were compared in regard to absolute reduction, percent reduction, and great improvement in PAR score. RESULTS: The mean absolute reduction in weighted PAR score between the groups was not statistically significant (P = 0.526). The mean percent reduction in weighted PAR score between the groups was not statistically significant (P = 0.210). The proportion of great improvement between the groups was not significant (P = 0.526). Only 6 of the 8 components of occlusion had enough variation to be modeled. An absolute reduction in unweighted PAR score was not significantly different between the groups for maxillary anterior alignment, overjet, or mandibular anterior alignment (P = 0.996, 1.000, and 0.114, respectively). Percent reduction in unweighted PAR score was not significantly different between the 2 groups for an anteroposterior, overbite, or transverse (P = 1.000, 1.000, and 1.000, respectively) relationships. CONCLUSIONS: Our study indicates that both generations of Invisalign aligners improved the malocclusion to a similar degree according to the PAR index. Patient-centric benefits of SmartTrack aligner should also be considered by the provider.

Patient-reported outcomes of a multicenter phase 2 study investigating gemcitabine and stereotactic body radiation therapy in locally advanced pancreatic cancer.

PURPOSE: We previously reported clinical outcomes and physician-reported toxicity of gemcitabine and hypofractionated stereotactic body radiation therapy (SBRT) in locally advanced pancreatic cancer (LAPC). Here we prospectively investigate the impact of gemcitabine and SBRT on patient-reported quality of life (QoL). METHODS AND MATERIALS: Forty-nine LAPC patients received 33 Gy SBRT (6.6 Gy daily fractions) upfront or after ≤3 doses of gemcitabine (1000 mg/m2) followed by gemcitabine until progression. European Organization for Research and Treatment of Cancer QoL core cancer (QLQ-C30) and pancreatic cancer-specific (European Organization for Research and Treatment of Cancer QLQ-PAN26) questionnaires were administered to patients pre-SBRT and at 4 to 6 weeks (first follow-up [1FUP]) and 4 months (2FUP) post-SBRT. Changes in QoL scores were deemed clinically relevant if median changes were at least 5 points in magnitude. RESULTS: Forty-three (88%) patients completed pre-SBRT questionnaires. Of these, 88% and 51% completed questionnaires at 1FUP and 2FUP, respectively. There was no change in global QoL from pre-SBRT to 1FUP (P = .17) or 2FUP (P > .99). Statistical and clinical improvements in pancreatic pain (P = .001) and body image (P = .007) were observed from pre-SBRT to 1FUP. Patients with 1FUP and 2FUP questionnaires reported statistically and clinically improved body image (P = .016) by 4 months. Although pancreatic pain initially demonstrated statistical and clinical improvement (P = .020), scores returned to enrollment levels by 2FUP (P = .486). A statistical and clinical decline in role functioning (P = .002) was observed in patients at 2FUP. CONCLUSIONS: Global QoL scores are not reduced with gemcitabine and SBRT. In this exploratory analysis, patients experience clinically relevant short-term improvements in pancreatic cancer-specific symptoms. Previously demonstrated acceptable clinical outcomes combined with these favorable QoL data indicate that SBRT can be easily integrated with other systemic therapies and may be a potential standard of care option in patients with LAPC.

Phase 2 multi-institutional trial evaluating gemcitabine and stereotactic body radiotherapy for patients with locally advanced unresectable pancreatic adenocarcinoma.

BACKGROUND: This phase 2 multi-institutional study was designed to determine whether gemcitabine (GEM) with fractionated stereotactic body radiotherapy (SBRT) results in acceptable late grade 2 to 4 gastrointestinal toxicity when compared with a prior trial of GEM with single-fraction SBRT in patients with locally advanced pancreatic cancer (LAPC). METHODS: A total of 49 patients with LAPC received up to 3 doses of GEM (1000 mg/m(2)) followed by a 1-week break and SBRT (33.0 gray [Gy] in 5 fractions). After SBRT, patients continued to receive GEM until disease progression or toxicity. Toxicity was assessed using the National Cancer Institute Common Terminology Criteria for Adverse Events [version 4.0] and the Radiation Therapy Oncology Group radiation morbidity scoring criteria. Patients completed the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (QLQ-C30) and pancreatic cancer-specific QLQ-PAN26 module before SBRT and at 4 weeks and 4 months after SBRT. RESULTS: The median follow-up was 13.9 months (range, 3.9-45.2 months). The median age of the patients was 67 years and 84% had tumors of the pancreatic head. Rates of acute and late (primary endpoint) grade ≥ 2 gastritis, fistula, enteritis, or ulcer toxicities were 2% and 11%, respectively. QLQ-C30 global quality of life scores remained stable from baseline to after SBRT (67 at baseline, median change of 0 at both follow-ups; P>.05 for both). Patients reported a significant improvement in pancreatic pain (P = .001) 4 weeks after SBRT on the QLQ-PAN26 questionnaire. The median plasma carbohydrate antigen 19-9 (CA 19-9) level was reduced after SBRT (median time after SBRT, 4.2 weeks; 220 U/mL vs 62 U/mL [P<.001]). The median overall survival was 13.9 months (95% confidence interval, 10.2 months-16.7 months). Freedom from local disease progression at 1 year was 78%. Four patients (8%) underwent margin-negative and lymph node-negative surgical resections. CONCLUSIONS: Fractionated SBRT with GEM results in minimal acute and late gastrointestinal toxicity. Future studies should incorporate SBRT with more aggressive multiagent chemotherapy.

Baseline metabolic tumor volume and total lesion glycolysis are associated with survival outcomes in patients with locally advanced pancreatic cancer receiving stereotactic body radiation therapy.

PURPOSE: Although previous studies have demonstrated the prognostic value of positron emission tomography (PET) parameters in other malignancies, the role of PET in pancreatic cancer has yet to be well established. We analyzed the prognostic utility of PET for patients with locally advanced pancreatic cancer (LAPC) undergoing fractionated stereotactic body radiation therapy (SBRT). MATERIALS AND METHODS: Thirty-two patients with LAPC in a prospective clinical trial received up to 3 doses of gemcitabine, followed by 33 Gy in 5 fractions of 6.6 Gy, using SBRT. All patients received a baseline PET scan prior to SBRT (pre-SBRT PET). Metabolic tumor volume (MTV), total lesion glycolysis (TLG), and maximum and peak standardized uptake values (SUVmax and SUVpeak) on pre-SBRT PET scans were calculated using custom-designed software. Disease was measured at a threshold based on the liver SUV, using the equation Livermean + [2 × Liversd]. Median values of PET parameters were used as cutoffs when assessing their prognostic potential through Cox regression analyses. RESULTS: Of the 32 patients, the majority were male (n=19, 59%), 65 years or older (n=21, 66%), and had tumors located in the pancreatic head (n=27, 84%). Twenty-seven patients (84%) received induction gemcitabine prior to SBRT. Median overall survival for the entire cohort was 18.8 months (95% confidence interval [CI], 15.7-22.0). An MTV of 26.8 cm(3) or greater (hazard ratio [HR] 4.46, 95% CI 1.64-5.88, P<.003) and TLG of 70.9 or greater (HR 3.08, 95% CI 1.18-8.02, P<.021) on pre-SBRT PET scan were associated with inferior overall survival on univariate analysis. Both pre-SBRT MTV (HR 5.13, 95% CI 1.19-22.21, P=.029) and TLG (HR 3.34, 95% CI 1.07-10.48, P=.038) remained independently associated with overall survival in separate multivariate analyses. CONCLUSIONS: Pre-SBRT MTV and TLG are potential predictive factors for overall survival in patients with LAPC and may assist in tailoring therapy.

Effective succession planning in nursing: a review of the literature.

AIM: This review summarizes and evaluates succession planning initiatives in nursing and proposes a new, comprehensive succession planning model for nursing. BACKGROUND: A major challenge facing nursing is maintaining leadership capital. In the U.SA. and elsewhere, this challenge is complicated by current and projected nursing shortages and uncertainty associated with political, economic and social factors affecting health-care delivery. Evaluation databases and the Internet contributed information to this review. Because the problems of identifying, recruiting, developing and retaining nursing leaders are related to the global nursing shortage, sources from several countries and international organizations were used. KEY ISSUES: The current and projected global nursing shortage and economic, political and social factors affecting health-care delivery world-wide make effective succession planning an absolute necessity for the nursing profession. CONCLUSIONS: Nursing leaders must plan for succession at all management levels. To validate benefits of this planning, three topics for future research are suggested. IMPLICATIONS FOR NURSING MANAGEMENT: Succession planning should incorporate the identification, recruitment, retention, development, coaching and mentoring of potential nurse leaders as early as high school. Communication, cooperation and coordination between academia and practice that complements the academic preparation of new nurses is essential.

Alternate reality conceptualization: venturing along the fine line between genius and madness.

Using A Beautiful Mind, a film about the troubled life of Nobel laureate John Forbes Nash as its focal source, this paper considers the difficulties people with mental illness struggle with in perceiving and experiencing reality. Relationships among the concepts of genius, madness, and alternate reality conceptualization are explored to establish perspective for a model illustrating the progression of paranoid schizophrenia. The importance of empathy in treating mental illness and the role that psychiatric mental health advanced practice nurses play in managing the care of people with paranoid schizophrenia are underscored. Topics for additional research are suggested.

Crying that heals: concept evaluation.

Although much has been written about the healing power of tears, the research into this phenomenon has been fragmented, uncoordinated, and inconclusive. Nonetheless, a substantial amount of the literature across multiple disciplines has addressed the subject, both directly and indirectly. In this article, the authors submit crying that heals (CTH) as a concept of possible significance to health care and evaluate CTH using the criteria for concept evaluation proposed by Morse, Mitcham, Hupcey, and Tasón (1996). Using these criteria, CTH is tentatively defined, and its characteristics, boundaries, preconditions, and outcomes are proposed and examined in the context of this definition. Suggestions for additional analysis and research are offered, and the potential importance of CTH to health care professions, especially nursing, is discussed.

Impact of noise on domain growth in electroconvection.

The growth and ordering of striped domains has recently received renewed attention due in part to experimental studies in diblock copolymers and electroconvection. One surprising result has been the relatively slow dynamics associated with the growth of striped domains. One potential source of the slow dynamics is the pinning of defects in the periodic potential of the stripes. Of interest is whether or not external noise will have a significant impact on the domain ordering, perhaps by reducing the pinning and increasing the rate of ordering. In contrast, we present experiments using electroconvection in which we show that a particular type of external noise decreases the rate of domain ordering.

Identity of Mesophilic Anaerobic Sporeformers Cultured from Recycled Cannery Cooling Water.

Chlorinated, recycled water for cooling of containers in still retorts was sampled over a 27-month period at one food processing plant. Of 274 samples taken, 28 contained mesophilic, anaerobic spores in numbers that ranged from 0.04-4.6/ml (MPN). Though all isolates were characterized as Clostridium species, 11% could not be matched with named species. Clostridium butyricum and Clostridium barati (synonyms: C. paraperfringens , C. perenne ) comprised 55% of isolates. Excepting Clostridium sticklandii , which is neither proteolytic nor saccharolytic, all isolates were saccharolytic. This contrasted with the finding of both proteolytic and saccharolytic clostridial spores in the municipal water feeding the recycle water reservoir. An apparent selection for saccharolytic strains could not be explained on the basis of published resistance of anaerobic spores to free available chlorine.