Screening, brief intervention, and referral to treatment (SBIRT) expansion of training to non-physician healthcare graduate students: Counseling psychology, nursing, occupational therapy, physical therapy, and physician assistant studies.

BACKGROUND: Although Screening, Brief Intervention and Referral to Treatment (SBIRT) has now been disseminated in many areas of the United States (US), much remains to be discovered about the training outcomes of non-physician professional trainees such as nurses, physician assistants, physical therapists, occupational therapists, and psychologists following SBIRT training. Methods: Training in SBIRT, an evidence-based approach to screening substance use, was embedded into five health science graduate curricula: Physician Assistant Studies, Nursing, Occupational Therapy, Physical Therapy, and Psychology. The SBIRT curriculum was adapted for each profession to include a brief introductory module addressing SBIRT's relevance for each profession, as well as profession-specific case examples and terminology. Using a nonequivalent group design, participants completed pre-and post-training assessments of substance use related attitudes, perceived competency and knowledge. Data were analyzed using a parametric test to compare pre- and post-differences. Results: Findings suggest improved attitudes as well as increased perceived competencies and core knowledge following the graduate-curriculum embedded SBIRT training, as well as between group differences on the same variables. Conclusions: SBIRT training of non-physician healthcare graduate student-trainees is a feasible training activity and results in improved trainee attitudes, perceived competency, and knowledge. SBIRT training embedded into graduate health science curricula offers an early foundation to this well-established, universal screening approach.

Genomic Heterogeneity as a Barrier to Precision Medicine in Gastroesophageal Adenocarcinoma.

Gastroesophageal adenocarcinoma (GEA) is a lethal disease where targeted therapies, even when guided by genomic biomarkers, have had limited efficacy. A potential reason for the failure of such therapies is that genomic profiling results could commonly differ between the primary and metastatic tumors. To evaluate genomic heterogeneity, we sequenced paired primary GEA and synchronous metastatic lesions across multiple cohorts, finding extensive differences in genomic alterations, including discrepancies in potentially clinically relevant alterations. Multiregion sequencing showed significant discrepancy within the primary tumor (PT) and between the PT and disseminated disease, with oncogene amplification profiles commonly discordant. In addition, a pilot analysis of cell-free DNA (cfDNA) sequencing demonstrated the feasibility of detecting genomic amplifications not detected in PT sampling. Lastly, we profiled paired primary tumors, metastatic tumors, and cfDNA from patients enrolled in the personalized antibodies for GEA (PANGEA) trial of targeted therapies in GEA and found that genomic biomarkers were recurrently discrepant between the PT and untreated metastases. Divergent primary and metastatic tissue profiling led to treatment reassignment in 32% (9/28) of patients. In discordant primary and metastatic lesions, we found 87.5% concordance for targetable alterations in metastatic tissue and cfDNA, suggesting the potential for cfDNA profiling to enhance selection of therapy.Significance: We demonstrate frequent baseline heterogeneity in targetable genomic alterations in GEA, indicating that current tissue sampling practices for biomarker testing do not effectively guide precision medicine in this disease and that routine profiling of metastatic lesions and/or cfDNA should be systematically evaluated. Cancer Discov; 8(1); 37-48. ©2017 AACR.See related commentary by Sundar and Tan, p. 14See related article by Janjigian et al., p. 49This article is highlighted in the In This Issue feature, p. 1.

Occult perineal endometrioma diagnosed by endoanal ultrasound and treated by excision: a report of 3 cases.

BACKGROUND: Isolated perineal endometrioma is a rare entity and often causes diagnostic uncertainty. CASES: Three premenopausal women, none with a prior history of endometriosis, presented with vague perineal pain 3-6 months following obstetric delivery with episiotomy. The latency periods between the onset of symptoms and definitive diagnosis were 3 months, 18 months and 3 years despite multiple physician evaluations in the interim. Patient presentation and management were virtually identical in all cases. Detailed questioning revealed that the pain was located adjacent to the episiotomy incision and waxed and waned with menses. Physical examination revealed a vague fullness adjacent to the episiotomy incision. Endoanal ultrasound revealed a mass of mixed echogenicity adjacent to the external anal sphincter. Transperineal exploration revealed a tumor with the gross appearance of an endometrioma, which was confirmed histologically. Excision of the mass with preservation of the anal sphincter muscle resulted in resolution of symptoms in all patients without the need for hormonal manipulation. No patient suffered diminution of fecal continence. CONCLUSION: Occult perineal endometriosis should be considered when a woman presents with cyclic pain in the perineum following delivery and episiotomy. Endoanal ultrasound can assist with the diagnosis. Transperineal excision with sparing of the anal sphincter can be curative, without compromising continence.