Outcome of definitive fractionated radiation followed by exenteration of the nasal cavity in dogs with sinonasal neoplasia: 16 cases

Local control is a major challenge in treating canine nasal tumours. Surgical cytoreduction prior to radiation therapy has not been shown to offer a survival advantage. Only one study has previously evaluated the outcome when surgery is performed after radiation, which demonstrated an improved survival time compared with radiation alone. The purpose of this study was to investigate the outcome of surgery after definitive radiation on survival times in dogs with sinonasal tumours. Medical records were retrospectively reviewed for dogs with nasal tumours that received definitive radiation followed by surgery. Information obtained from medical record review included signalment, diagnosis, treatment and outcome. The median survival time was 457 days. No long-term side effects were observed. These findings suggest that exenteration of the nasal cavity following definitive radiation for treatment of dogs with nasal tumours is well-tolerated and provides a similar survival duration to previous reports of radiation alone.

Abstract PD4-8: Prevalence of gene mutations among hereditary breast and ovarian cancer patients using a 25 gene panel

Identifying individuals at increased risk for hereditary cancer leads to early detection and prevention opportunities with the ability to reduce both cancer incidence and mortality. Hereditary cancer syndromes have genetic heterogeneity and new susceptibility genes have been recently identified. Next generation sequencing allows testing of multiple target genes simultaneously, can reduce the time and cost of sequential gene testing, and may improve mutation detection. To date, no large scale studies have reported the mutation prevalence of multiple cancer susceptibility genes among patients referred for BRCA1/BRCA2 testing.

A study was performed to determine the mutation prevalence in 25 cancer susceptibility genes among a large U.S. patient population referred to a diagnostic laboratory for BRCA1/BRCA2 testing. DNA from 1955 prospectively accrued cases was anonymized after testing was complete. Patients with Ashkenazi Jewish heritage were excluded in order to determine the relative prevalence of mutations in a generalizable population. In addition, an independent external validation set of 405 patients, including those of Ashkenazi ancestry, with history consistent with hereditary breast and ovarian cancer (HBOC) syndrome and who had previously tested negative for BRCA1/BRCA2 mutations was assessed. Extracted genomic DNA from blood was PCR amplified with a custom amplicon library on a Raindance ThunderStorm instrument. The DNA products were sequenced on an Illumina HiSeq2500. Sequence variations and large rearrangements among the 25 genes were detected and classified for pathogenicity.

Among the 1955 anonymized patients referred for BRCA1/BRCA2 testing, 275 (14.07%) patients were mutation carriers in at least one of the 25 genes. 182 (9.31%) patients had a mutation in BRCA1 or BRCA2, and 96 of 1955 (4.91%) patients had a mutation in other genes (Table 1).

Table 1GenePatients with mutation (n = 96)%ATM1414.58%BARD177.29%BRIP177.29%CHEK23031.25%MSH222.08%MSH622.08%MUTYH11.04%NBN1414.58%PALB21313.54%PMS244.17%TP5322.08%

No mutations were found in CDH1, PTEN, STK11, RAD51C, RAD51D, BMPR1A, SMAD4, MLH1, EPCAM, CDKN2A, CDK4, or APC. 1738 of 1955 patients had a personal history of breast cancer (BC), with 63% diagnosed prior to age 50, and 37% at or after age 50. Mutation prevalence for patients with BC, ovarian cancer (OC), both BC and OC, or other HBOC cancers is listed in Table 2.

Table 2Patient Cancer HistoryPatients (n)BRCA1/2Other GeneBreast CA < 50 years1091116* (10.63%)51 (4.67%)Breast CA ≥ 50 years64740** (6.18%)30 (4.64%)Ovarian CA16217 (10.49%)6 (3.70%)Breast and Ovarian CA408 (20.00%)4 (10.00%)Other HBOC Cancer151 (6.67%)2 (13.33%)*2 and **1 patients had an additional mutation in a non-BRCA1/2 gene

1902 (97.29%) patients had a variant of uncertain significance in at least one of the genes tested and an average of three variants was found per patient. As of June 11, 2013 the independent external validation cases results are pending.

Compared with BRCA1/BRCA2 testing alone, using the 25 gene panel increased the identification of mutations in cancer susceptibility genes by 4.76% (95% CI: 2.71% – 6.81%), which represents a 51.1% increase in mutation detection for this population with suspected HBOC.

Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr PD4-8.

Contributors to frequent telehealth alerts including false alerts for patients with heart failure: a mixed methods exploration

BACKGROUND

Telehealth data overload through high alert generation is a significant barrier to sustained adoption of telehealth for managing HF patients.

OBJECTIVE

To explore the factors contributing to frequent telehealth alerts including false alerts for Medicare heart failure (HF) patients admitted to a home health agency.

MATERIALS AND METHODS

A mixed methods design that combined quantitative correlation analysis of patient characteristic data with number of telehealth alerts and qualitative analysis of telehealth and visiting nurses' notes on follow-up actions to patients' telehealth alerts was employed. All the quantitative and qualitative data was collected through retrospective review of electronic records of the home heath agency.

RESULTS

Subjects in the study had a mean age of 83 (SD = 7.6); 56% were female. Patient co-morbidities (p<0.05) of renal disorders, anxiety, and cardiac arrhythmias emerged as predictors of telehealth alerts through quantitative analysis (n = 168) using multiple regression. Inappropriate telehealth measurement technique by patients (54%) and home healthcare system inefficiencies (37%) contributed to most telehealth false alerts in the purposive qualitative sub-sample (n = 35) of patients with high telehealth alerts.

CONCLUSION

Encouraging patient engagement with the telehealth process, fostering a collaborative approach among all the clinicians involved with the telehealth intervention, tailoring telehealth alert thresholds to patient characteristics along with establishing patient-centered telehealth outcome goals may allow meaningful generation of telehealth alerts. Reducing avoidable telehealth alerts could vastly improve the efficiency and sustainability of telehealth programs for HF management.

Primary diagnosis and surveillance of white spot syndrome virus in wild and farmed crawfish (Procambarus clarkii, P. zonangulus) in Louisiana, USA

This is the first report of natural white spot syndrome virus (WSSV) infection in wild and large-scale farmed crawfish. In the spring of 2007, 3 crawfish farms experienced heavy mortality in ponds populated by Procambarus clarkii and P. zonangulus. Histological examination revealed findings consistent with severe viral infection characterized by numerous intranuclear inclusions in ectodermal and mesodermal tissues. Samples tested by in situ hybridization, injection bioassay in Litopenaeus vannamei, and PCR (nested and real time) were all positive for WSSV. Samples were sent to the National Veterinary Services Laboratory in Ames, Iowa, USA, where WSSV was verified. Subsequently, a multi-parish survey of 184 sites in Louisiana (including farm and wild basin samples) using real-time PCR determined that >60% of sites sampled were positive for WSSV, including wild basin samples.

Building a vision for the future: strategic planning in a shared governance nursing organization

Today's health care delivery environment is marked by extreme turbulence and ever-increasing complexity. Now, more than ever, an organization's strategic plan must do more than outline a business plan. Rather, the strategic plan is a fundamental tool for building and sustaining an organizational vision for the future. The strong, dynamic strategic plan (1) represents a long-range vision for improving organizational performance, (2) provides a model for planning and implementing structures and processes for the management of outcomes, (3) reflects and shapes the organizational culture and customer focus, (4) provides decision support for difficult operational choices made day to day, and (5) integrates and aligns the work of the organization. This article describes the development, implementation, and evaluation of a methodology for strategic planning within a shared governance nursing organization. Built upon the strategic plan of the hospital, the process undertaken by the nursing organization reflects the following commitments: (1) to develop a strategic plan that is meaningful and part of daily work life at all levels of the nursing organization, (2) to make the plan practical and realistic through incremental building, (3) to locate and articulate accountability for each step, and (4) to build in a process for checking progress toward goal achievement and readjusting the plan as necessary.

Developing student evaluation instruments to measure instructor effectiveness

The authors detail the process of developing four specific tools for student evaluation of faculty performance at the master's and baccalaureate levels. To accomplish the desired goal of improving instruction, these authors believe student evaluation tools should be tailor-made to the educational setting and mode of delivery. The tools described in this article were developed to evaluate faculty performance in clinical-direct, on-campus laboratory, clinically precepted, and didactic settings.

Managing organizational challenge and change: closing an inpatient unit

The effects of a turbulent health care delivery market have impacted the day-to-day reality of acute care hospitals. One effect is that the supply of acute care hospital beds currently exceeds the demand, a trend that is expected to continue to the year 2000 and beyond. Nursing administrators at St. Marys Hospital Medical Center made the decision to close an inpatient unit in order to better match acute care bed supply to existing demand. Decision support for closure, organizational change, and lessons learned from the closure process are discussed.