Association of XRCC3 and XPD751 SNP with efficacy of platinum-based chemotherapy in advanced NSCLC patients

INTRODUCTION: The aim of this study was to investigate whe- ther X-ray repair cross-complementing group 3 (XRCC3) and xeroderma pigmentosum group D (XPD) single nucleotide polymorphism (SNP) affects the outcome of platinum- based chemotherapy in advanced non-small-cell lung cancer (NSCLC) patients. MATERIAL AND METHODS: From September 2005 to June 2009, 355 advanced-stage NSCLC patients were accrued to compare the SNP variants with the outcome of platinum-based chemotherapy. TaqMan RT-PCR was used to evaluate the SNPs of the XRCC3 codon241 (Thr/Met) and XPD codon751 (Lys/Gln) DNA repair genes. RESULTS: There was a lack of association between the studied SNPs and the response rate, progression-free survival or overall survival (OS) in the whole population. However, subgroup analysis revealed that XRCC3 241 Thr/Met or Met/Met allele was associated with marginally significantly longer OS than XRCC3 Thr/Thr allele (19.0 m vs. 12.5 m, p=0.081) in the patients treated with gemcitabine/ cisplatin or carboplatin (GP/GC) while it was correlated with a significantly shorter OS in the patients treated with non GP/GC (9.3 m vs. 16 m, p=0.003). XPD751 Lys/Lys had an association with statistical significantly longer OS than XPD751 Lys/Gln or Gln/Gln in the subgroup of elderly patients (14.10 m vs. 10 m, p=0.019) and patients with non-adenocarcinoma (12.6 m vs. 9 m, p=0.042). CONCLUSIONS: XRCC3 Thr241Met played an opposite role in predicting prognosis of chemotherapy in NSCLC patients according to the first-line regimens. XPD 751 Lys/ Lys might be a better prognostic marker of elderly or noncarcinoma NSCLC subgroup treated with platinum-based chemotherapy (AU)

A framework for integrating interprofessional education curriculum in the health sciences.

CONTEXT: Traditionally, the structures of health professional education in Canada and elsewhere have been largely based on "silos" in which health professionals are educated in relative isolation to one another. The curriculum content and structure has followed strict disciplinary lines. Recent commissions, committees and policy documents in Canada have identified the importance of reshaping educational preparation and the professional training of health care professionals (Commission on the Future of Health Care in Canada, 2002; Health Council of Canada, 2005). OBJECTIVES: This brief communication describes an interprofessional curricular approach that combines characteristics of Barr et al.'s (2005) extracurricular and crossbar models of interprofessional education curriculum. METHODS: An interprofessional education curriculum that combines principles of an integrative, continuous, early-to-late and blended learning approach. DISCUSSION: The curricular approach supports exposing students to interprofessional education at an early stage in their training and then to continue with regular reinforcement. Another guiding principle is that interprofessional education is integrative rather than supplementary to the existing core curriculum. Early evaluation results suggest favourable satisfaction amongst students and faculty as well as significant effect on attitudes toward interprofessional teamwork and education. An ongoing evaluation is continuing based upon the various levels of Freeth et al.'s (2002) interprofessional education evaluation framework.

Advances in rural medical education in three countries: Canada, The United States and Australia.

INTRODUCTION: This article documents a number of rural medical education initiatives in Australia, Canada and the United States. A typology is created reflecting the centrality the rural mandate and characterizing different features of each school's program. Interviews with school officials are drawn on to reflect the challenges these schools face. METHOD: Seven schools noted for their rural programs were selected from the three countries and interviews were conducted with senior officials. The interview data was supplemented by published material on the schools. RESULTS: The Typology: Three kinds of school are distinguished: Mixed Urban/Rural Schools (University of Washington, US, the University of British Columbia, Canada, and Flinders University, Australia); DeFacto Rural Schools (University of New Mexico, US and Memorial University, Canada) and Stand Alone Rural Schools (James Cook University, Australia and the Northern Ontario School of Medicine, Canada). The Pipeline Approach: All of the schools adopted in varying degrees a pipeline approach to meeting the need for rural doctors focusing on: (a) early recruitment; (b) admissions; (c) locating clinical education in rural settings; (d) rural health focus to curriculum; and (e) support for rural practice. CONCLUSION: The analysis does not strongly favor one model over others, although the Stand-Alone Rural schools had more opportunities to adopt innovative curricula reflecting rural health issues and to foster positive views of rural practice. Government funding targeting rural health needs will remain critical in the development of all these programs.

Creating a Culture for Interdisciplinary Collaborative Professional Practice.

The future of the health system is dependent on health professionals re-tooling the way we practice together. No longer can a multi-disciplinary model support the complex health needs of many clients nor can any one-health profession have all the knowledge needed to provide total patient-centred care. However, our current education and health systems are structured around a multidisciplinary model of practice with physicians or nurse practitioners as decision-makers and rarely are clients included in care planning. True interdisciplinary practice is defined as a partnership between a team of health professionals and a client in a participatory, collaborative and coordinated approach to shared decision-making around health issues, requires a revamping of how future health professionals are educated and how the system can accommodate shared decision-making. A client-centered collaborative professional practice model is proposed in this paper as a means for fostering and facilitating the culture for this change.

An eclectic model for evaluating web-based continuing medical education courseware systems.

World Wide Web and compact disc-read only memory technologies have introduced new prospects for delivering continuing medical education (CME) to rural and remote physicians. However, evidence concerning the effectiveness of these technologies in providing CME, and approaches to their evaluation, is limited. The rationale for this study was to design a model for evaluating the effectiveness of computer-mediated CME courseware. An eclectic, evaluation-planning matrix was designed by selecting various concepts from the literature and was used in planning and developing the evaluation model. The model was field-tested by evaluating a computer-mediated courseware program on dermatological office procedures, and a meta-evaluation was conducted to assess the effectiveness of the evaluation methods and procedures. The findings suggest that the model was useful in collecting data to inform decision making and to improve the instructional product. The field test results revealed that computer-mediated instruction was effective in delivering CME at a distance.

Web-based continuing medical education. (II): Evaluation study of computer-mediated continuing medical education.

BACKGROUND: Over the years, various distance learning technologies and methods have been applied to the continuing medical education needs of rural and remote physicians. They have included audio teleconferencing, slow scan imaging, correspondence study, and compressed videoconferencing. The recent emergence and growth of Internet, World Wide Web (Web), and compact disk read-only-memory (CD-ROM) technologies have introduced new opportunities for providing continuing education to the rural medical practitioner. This evaluation study assessed the instructional effectiveness of a hybrid computer-mediated courseware delivery system on dermatologic office procedures. METHODS: A hybrid delivery system merges Web documents, multimedia, computer-mediated communications, and CD-ROMs to enable self-paced instruction and collaborative learning. Using a modified pretest to post-test control group study design, several evaluative criteria (participant reaction, learning achievement, self-reported performance change, and instructional transactions) were assessed by various qualitative and quantitative data collection methods. RESULTS: This evaluation revealed that a hybrid computer-mediated courseware system was an effective means for increasing knowledge (p < .05) and improving self-reported competency (p < .05) in dermatologic office procedures, and that participants were very satisfied with the self-paced instruction and use of asynchronous computer conferencing for collaborative information sharing among colleagues.

Web-based continuing medical education (I): field test of a hybrid computer-mediated instructional delivery system.

BACKGROUND: The Internet and the World Wide Web (the Web) present exciting new possibilities for distributing educational materials at a distance and facilitating collaborative learning among geographically isolated physicians. This article provides a brief overview of the Web as an instructional delivery platform and discusses its strengths and weaknesses as a potential medium for enhancing distance learning opportunities for rural and remote physicians. It also describes an innovative hybrid instructional delivery model that was field tested by the Telemedicine Centre to determine its efficiency and effectiveness for providing Web-based instruction. A hybrid model merges the Web and CD-ROMs (compact disk read-only memory) to use several of the more valuable instructional components of Web-based education (i.e., multimedia, interactive forms, hypermedia, and computer-mediated communications). The results of the field test indicate that the hybrid delivery model was an efficient means for delivering computer-mediated continuing medical education instruction on dermatologic office procedures to a group of rural physicians in low telecommunication bandwidth regions.

A study of rural women's satisfaction with a breast cancer self-help network.

The impact of breast cancer on the emotional and social health of women and their families is an important issue for the cancer field. Nevertheless, many patients do not avail themselves of support programmes. In rural communities there is often a lack of services, which, for many, leads to a perception of 'being alone' in the struggle to become better. This paper reports an evaluation of a pilot project to facilitate a self-help peer support group network: an extensive provincial audio teleconferencing network for rural breast cancer survivors, established by the Telemedicine Centre of the Memorial University of Newfoundland. A satisfaction questionnaire was distributed to participants in the pilot programme. Responses suggested that they were very satisfied with the use of audio teleconferencing for the facilitation of a social support programme. The programme appeared to help bridge the isolation gap that rural women with breast cancer often experience. The results have implications for the provision of self-help social support services through audio teleconferencing, as well as for the quality of life and wellbeing of rural women.

Differential effects of flumazenil in alcoholic and nonalcoholic cirrhotic patients.

Ligands to the benzodiazepine receptor (BZR) accumulate in hepatic encephalopathy; the benzodiazepine antagonist flumazenil can reverse some manifestations of this condition. This study was designed to explore the effects of flumazenil on cognitive function and anxiety levels in cirrhotic patients without hepatic encephalopathy. Twenty such patients--ten alcoholic, ten nonalcoholics--and ten normal volunteers matched for age and sex were randomly allocated to treatment order (flumazenil or placebo first) in a double-blind cross-over trial. Cognitive function was evaluated with a battery of psychological tests shown previously to be sensitive to the impairment induced by liver disease. Cirrhotic patients performed worse than controls on several tests: digit cancellation, digit symbol substitution, key tapping and Reitan's trail B test. Flumazenil did not reverse these cognitive impairments but it did induce anxiety in nonalcoholic cirrhotics. On one index of memory--delayed word recall--alcoholics performed worse than nonalcoholic cirrhotics. Flumazenil reversed this memory impairment in the alcoholic cirrhotic group. These results suggest that alcohol consumption induces changes at the BZR that are different from changes induced solely by liver impairment.

Psychological assessment of catatonic schizophrenia.

Probably due to the rarity of the disorder and the general inability of catatonic patients to cooperate with standardized assessment, no data exist documenting the psychological features associated with catatonic schizophrenia that may appear on psychological tests. This study utilized standard assessment techniques to examine clinical hypotheses regarding the psychogenic correlates of catatonic conditions from the performance of one man on psychological tests. In accordance with previous theory, test findings indicated frequent constriction, rigidity, and negativism in conjunction with compulsive traits. Experiences of cognitive and self-fragmentation were juxtaposed with a formal, mechanistic body ego; disorganization and discontinuity were countered with attempts at self-cohesion. Depressed feelings and human interest were apparent, although interpersonal relatedness was frequently characterized by an avoidant, distancing style.