Adapting an Adolescent and Young Adult Program Housed in a Quaternary Cancer Centre to a Regional Cancer Centre: Creating Equitable Access to Developmentally Tailored Support.

Adolescents and young adults (AYAs) with cancer, representing those between 15 and 39 years of age, face distinctive challenges balancing their life stage with the physical, emotional, and social impacts of a cancer diagnosis. These challenges include fertility concerns, disruptions to educational and occupational pursuits, issues related to body image and sexual health, and the need for age-appropriate psychosocial support within their communities. The Princess Margaret Cancer Centre (PM), a quaternary care center, established a specialized AYA program in 2014, offering holistic and developmentally tailored psychosocial support and currently, efforts are underway to expand this to other regions in the province to address the need for equitable access. The establishment process involves securing funding, conducting an environmental scan, identifying service gaps, developing clinical pathways, and implementing AYA supportive care. An accessible AYA program should also consider social determinants of health, social location, intersectionality, and an interdisciplinary health approach in understanding health inequities in AYA oncology care. This paper describes the processes implemented and challenges faced in creating a community-based AYA program beyond major resource-rich cities and efforts to address intersectionality.

Formative Evaluation of Using Action Learning in a Master of Medical Education Assessment and Measurement Course.

BACKGROUND: The future success of any graduate or professional degree program is dependent upon continuous feedback provided by instructors and students. Various teaching models used by medical educators include didactics, problem/case-based learning, small/large group work, distance/online education, simulation, labs, and service/experiential learning. Action Learning is a process "that involves a small group working on real problems, taking action, and learning as individuals, as a team, and as an organization." Medical school curricula usually begin with a mostly knowledge-based approach to learning the relevant science courses. While it may include some experiential learning, there is limited organized reflection. The idea inherent in Action Learning is "learn while doing" and "reflect on the experience." This paper reports the process and outcomes of using the Action Learning Model (ALM) in teaching a master's level assessment and measurement medical education class. OBJECTIVE: The objective of this quality improvement education study was to ascertain students' knowledge, skills, and attitudes demonstrated in conducting substantive evaluations using the ALM in a graduate medical education assessment and measurement course. METHOD: This study was a formative evaluation of a 16-week master's level medical education assessment and measurement course. The curriculum included teaching the traditional knowledge, skills, and attitudes (KSAs) to conduct formative and summative evaluations in medical education. In addition, students learned applicable quality improvement skills. Specifically, they learned how to identify and work with valid customer (student) requirements, how to map and improve processes, and how to collect and analyze process data. Students were taught the KSAs while conducting a formative evaluation of the class as their major project. They evaluated the class they were taking while reflecting on the experience. In addition to the ALM, the course incorporated both the Bloom Taxonomy (a hierarchical framework for cognition and learning objectives) and the Kirkpatrick Model (a globally recognized method of evaluating the results of training and learning programs). The one-sample significance test was used to evaluate the median of the difference between the pre-and post-test groups. Descriptive statistics were also performed. RESULTS: Nine students who were medical students, dental students, physicians, and simulation lab technicians participated in the course. Students learned medical education assessment and measurement of knowledge, skills, and attitudes (KSAs) and experienced the process of performing a formative evaluation. The post-test results for all students combined revealed that 277 of the 450 (61.6%) data points were greater than zero. A total of 139 data points showed no improvement and 34 results were worse than the pretest.  Discussion: The ALM for teaching assessment and measurement in medical education can be challenging, but it may provide a more realistic and rewarding educational experience. The students gained a greater appreciation of the positive and negative aspects of using an experiential approach. Finally, the weekly formative surveys provided regular feedback that led to instructional improvements. With regards to medical education, action learning is best suited for students during the clinical phase of their education.

A model of cognitive decline and suicidal ideation in adults aging with HIV.

The number of older adults with HIV continues to grow primarily because of the effectiveness of highly active antiretroviral therapy. Despite this welcomed benefit from pharmaceutical advances, aging with this disease presents an entirely new set of problems. The combination of aging and HIV can create a variety of stressors that may weaken one's resolve and further debilitate already compromised cognitive systems, which may increase rates of depression, suicidal ideation, and suicide. Studies indicate that older adults with HIV experience higher levels of depression and suicidal ideation than other older adults do or than younger adults with HIV do. Cognitive declines associated with both HIV and aging may provide insight into this phenomenon. A model of cognitive decline and suicidal ideation in adults aging with HIV is provided. Implications for nursing practice and research are discussed.

Are we testing a true thin liquid?

The purpose of this study was to examine the effects on a patient's swallowing of diluting E-Z-EM's Varibar((R)) Thin liquid barium product (which is often used in videofluoroscopic swallow studies) to achieve a consistency closer to water. Forty patients who were 18 years and older participated in this study. Their varied medical diagnoses included stroke, pneumonia, TBI, and cancer as well as diagnoses not usually associated with dysphagia such as abdominal pain and rhabdomyolysis. To screen for aspiration, E-Z-EM's Varibar Thin liquid was presented to patients to swallow as 2 cc, 5 cc, cup, and straw drinking trials. If no aspiration occurred, the patient was given the Varibar Thin liquid diluted by 50% using water (referred to as Ultrathin) to swallow in the same amounts. Then occurrence of aspiration with the Ultrathin liquid was compared to the occurrence of aspiration when the patient swallowed the Varibar Thin liquid. Fifty percent of patients aspirated on the Ultrathin liquid but not on the Varibar Thin liquid, across at least one of the test conditions. From these results we suggest that although E-Z-EM Varibar Thin liquid may have a low-viscosity range, it still may not be "thin enough" to identify all patients who aspirate or who are at risk for aspiration on thin liquids.

Development of an operational fitness test for the Royal Air Force.

Since 2002, the Royal Air Force (RAF) has been working towards developing role-related physical tests for use as an operational fitness test (OFT). The purpose of this study was to establish reliability of the OFT (comprising four tests), investigate gym-based tests as predictors of performance and establish performance standards. Fifty-eight RAF personnel performed the OFT on three occasions. A separate cohort carried out fitness and anthropometric tests before performing the OFT, by way of establishing performance predictors. Documented evidence and views of an expert panel were used to determine OFT standards. Reliability ranged from moderate to good for three tests, with one test (Dig) showing poor reliability. The 95% limits of agreement for the prediction models ranged from good to poor (6.7-34.2%). The prediction models were not sufficiently accurate to estimate confidently OFT performance, but could be used as a guide to quantify likely outcome and training needs.

Radiotherapy for pediatric central nervous system tumors: a regional cancer centre experience.

INTRODUCTION: The purpose of this review was to analyze outcomes for pediatric patients treated for more common (non-low grade glioma) primary central nervous system (CNS) tumors at a Regional (tertiary) Cancer Center. Comparison to reported results from other regional centres and results from the contemporary literature were made. MATERIAL AND METHODS: The records of pediatric patients treated with radiotherapy at the London Regional Cancer Center (LRCC) for more common (non-low grade glioma) primary CNS tumors between 1980 and 2001 were reviewed. Details regarding tumor presentation, treatment and outcome were analyzed. RESULTS: Eighty-eight patients were eligible for the review. Twenty-nine patients with malignant glioma, 37 patients with medulloblastoma or primitive neuroectodermal tumor (PNET), 15 patients with brainstem glioma, 4 with ependymoma and 3 with germ cell tumors were treated during this time period. Average follow-up for the group was 5 years (range 4 months to 19 years). Five-year overall, progression free and cause specific survival were 45, 42 and 50%, respectively. For patients with malignant glioma median progression free and overall survival was 20 and 29 months. For patients with brainstem glioma median progression free and overall survival was 9 and 13 months. For medulloblastoma, 5-year progression free, and overall survival was 60 and 59%. CONCLUSIONS: RESULTS of this retrospective review of pediatric patients treated at a regional cancer center for primary CNS tumors (other than low grade glioma) were comparable to contemporary results reported by other Canadian centers and North American co-operative group trials.