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Winer LK, Kader S, Abelson JS, Hammaker AC, Eruchalu CN, Etheridge JC, Cho NL, Foote DC, Ivascu FA, Smith S, Postlewait LM, Greenwell K, Meister KM, Montgomery KB, Zmijewski P, Byrd SE, Kimbrough MK, Stopenski SJ, Nahmias JT, Harvey J, Farr D, Callahan ZM, Marks JA, Stahl CC, Al Yafi M, Sutton JM, Elsaadi A, Campbell SJ, Dodwad SJM, Adams SD, Woeste MR, Martin RC, Patel P, Anstadt MJ, Nasim BW, Willis RE, Patel JA, Newcomb MR, George BC, Quillin RC, Cortez AR. Disparities in the Operative Experience Between Female and Male General Surgery Residents: A Multi-institutional Study From the US ROPE Consortium. Ann Surg 2023; 278:1-7. [PMID: 36994704 PMCID: PMC10896185 DOI: 10.1097/sla.0000000000005847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/31/2023]
Abstract
OBJECTIVE To examine differences in resident operative experience between male and female general surgery residents. BACKGROUND Despite increasing female representation in surgery, sex and gender disparities in residency experience continue to exist. The operative volume of male and female general surgery residents has not been compared on a multi-institutional level. METHODS Demographic characteristics and case logs were obtained for categorical general surgery graduates between 2010 and 2020 from the US Resident OPerative Experience Consortium database. Univariable, multivariable, and linear regression analyses were performed to compare differences in operative experience between male and female residents. RESULTS There were 1343 graduates from 20 Accreditation Council for Graduate Medical Education-accredited programs, and 476 (35%) were females. There were no differences in age, race/ethnicity, or proportion pursuing fellowship between groups. Female graduates were less likely to be high-volume residents (27% vs 36%, P < 0.01). On univariable analysis, female graduates performed fewer total cases than male graduates (1140 vs 1177, P < 0.01), largely due to a diminished surgeon junior experience (829 vs 863, P < 0.01). On adjusted multivariable analysis, female sex was negatively associated with being a high-volume resident (OR = 0.74, 95% CI: 0.56 to 0.98, P = 0.03). Over the 11-year study period, the annual total number of cases increased significantly for both groups, but female graduates (+16 cases/year) outpaced male graduates (+13 cases/year, P = 0.02). CONCLUSIONS Female general surgery graduates performed significantly fewer cases than male graduates. Reassuringly, this gap in operative experience may be narrowing. Further interventions are warranted to promote equitable training opportunities that support and engage female residents.
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Affiliation(s)
- Leah K. Winer
- Department of Surgery, Cincinnati Research on Education in Surgical Training (CREST), University of Cincinnati, Cincinnati, OH
| | - Sarah Kader
- Department of Surgery, Lahey Hospital and Medical Center, Burlington, MA
| | | | - Austin C. Hammaker
- Department of Surgery, Lahey Hospital and Medical Center, Burlington, MA
| | | | | | - Nancy L. Cho
- Department of Surgery, Brigham and Women’s Hospital, Boston, MA
| | - Darci C. Foote
- Department of Surgery, Beaumont Health, Royal Oak, MI
- Department of Surgery, Center for Surgical Training and Research (CSTAR), University of Michigan, Ann Arbor, MI
| | | | | | | | | | | | | | - Polina Zmijewski
- Department of Surgery, University of Alabama at Birmingham, Birmingham, AL
| | - Samuel E. Byrd
- Department of Surgery, University of Arkansas for Medical Sciences, Little Rock, AR
| | - Mary K. Kimbrough
- Department of Surgery, University of Arkansas for Medical Sciences, Little Rock, AR
| | | | | | - Jalen Harvey
- Department of Surgery, University of Texas Southwestern Medical Center, Dallas TX
| | - Deborah Farr
- Department of Surgery, University of Texas Southwestern Medical Center, Dallas TX
| | | | - Joshua A. Marks
- Department of Surgery, Thomas Jefferson University, Philadelphia, PA
| | | | - Motaz Al Yafi
- Department of Surgery, University of Toledo, Toledo, OH
| | - Jeffrey M. Sutton
- Division of Oncologic and Endocrine Surgery, Department of Surgery, Medical University of South Carolina, Charleston, SC
| | - Ali Elsaadi
- Texas Tech University Health Sciences Center School of Medicine Lubbock, TX
| | - Samuel J. Campbell
- Texas Tech University Health Sciences Center School of Medicine Lubbock, TX
| | | | - Sasha D. Adams
- Department of Surgery, McGovern Medical School at UTHealth, Houston, TX
| | | | | | - Purvi Patel
- Department of Surgery, Loyola University, Maywood, IL
| | | | - Bilal Waqar Nasim
- Department of Surgery, University of Texas Health Science Center at San Antonio, San Antonio, TX
| | - Ross E. Willis
- Department of Surgery, University of Texas Health Science Center at San Antonio, San Antonio, TX
| | - Jitesh A. Patel
- Department of Surgery, University of Kentucky, Lexington, KY
| | | | - Brian C. George
- Department of Surgery, Center for Surgical Training and Research (CSTAR), University of Michigan, Ann Arbor, MI
| | - Ralph C. Quillin
- Department of Surgery, Cincinnati Research on Education in Surgical Training (CREST), University of Cincinnati, Cincinnati, OH
| | - Alexander R. Cortez
- Department of Surgery, Cincinnati Research on Education in Surgical Training (CREST), University of Cincinnati, Cincinnati, OH
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Hammaker AC, Dodwad SJM, Salyer CE, Adams SD, Foote DC, Ivascu FA, Kader S, Abelson JS, Al Yafi M, Sutton JM, Smith S, Postlewait LM, Stopenski SJ, Nahmias JT, Harvey J, Farr D, Callahan ZM, Marks JA, Elsaadi A, Campbell SJ, Stahl CC, Hanseman DJ, Patel P, Woeste MR, Martin RCG, Patel JA, Newcomb MR, Greenwell K, Meister KM, Etheridge JC, Cho NL, Thrush CR, Kimbrough MK, Nasim BW, Willis RE, George BC, Quillin RC, Cortez AR. A multi-institutional study from the US ROPE Consortium examining factors associated with directly entering practice upon residency graduation. Surgery 2022; 172:906-912. [PMID: 35788283 DOI: 10.1016/j.surg.2022.05.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 05/16/2022] [Accepted: 05/30/2022] [Indexed: 10/17/2022]
Abstract
BACKGROUND There is concern regarding the competency of today's general surgery graduates as a large proportion defer independent practice in favor of additional fellowship training. Little is known about the graduates who directly enter general surgery practice and if their operative experiences during residency differ from graduates who pursue fellowship. METHODS Nineteen Accreditation Council for Graduate Medical Education-accredited general surgery programs from the US Resident OPerative Experience Consortium were included. Demographics, career choice, and case logs from graduates between 2010 to 2020 were analyzed. RESULTS There were 1,264 general surgery residents who graduated over the 11-year period. A total of 248 (19.6%) went directly into practice and 1,016 (80.4%) pursued fellowship. Graduates directly entering practice were more likely to be a high-volume resident (43.1% vs 30.5%, P < .01) and graduate from a high-volume program (49.2% vs 33.0%, P < .01). Direct-to-practice graduates performed 53 more cases compared with fellowship-bound graduates (1,203 vs 1,150, P < .01). On multivariable analysis, entering directly into practice was positively associated with total surgeon chief case volume (odds ratio = 1.47, 95% confidence interval 1.18-1.84, P < .01) and graduating from a US medical school (odds ratio = 2.54, 95% confidence interval 1.45-4.44, P < .01) while negatively associated with completing a dedicated research experience (odds ratio = 0.31, 95% confidence interval 0.22-0.45, P < .01). CONCLUSION This is the first multi-institutional study exploring resident operative experience and career choice. These data suggest residents who desire immediate practice can tailor their experience with less research time and increased operative volume. These data may be helpful for programs when designing their experience for residents with different career goals.
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Affiliation(s)
- Austin C Hammaker
- Department of Surgery, Cincinnati Research on Education in Surgical Training (CREST), University of Cincinnati, Cincinnati, OH. https://twitter.com/HammakerAustin
| | - Shah-Jahan M Dodwad
- Department of Surgery, McGovern Medical School at UTHealth, Houston, TX. https://twitter.com/shahofsurgery
| | - Christen E Salyer
- Department of Surgery, Cincinnati Research on Education in Surgical Training (CREST), University of Cincinnati, Cincinnati, OH. https://twitter.com/salyerchristen
| | - Sasha D Adams
- Department of Surgery, McGovern Medical School at UTHealth, Houston, TX. https://twitter.com/SashaTrauma
| | - Darci C Foote
- Department of Surgery, Beaumont Health, Royal Oak, MI
| | | | - Sarah Kader
- Department of Surgery, Lahey Hospital and Medical Center, Burlington, MA
| | - Jonathan S Abelson
- Department of Surgery, Lahey Hospital and Medical Center, Burlington, MA. https://twitter.com/jabelsonmd
| | - Motaz Al Yafi
- Department of Surgery, University of Toledo, Toledo, OH
| | - Jeffrey M Sutton
- Department of Surgery, Division of Surgical Oncology, Medical University of South Carolina, Charleston, SC. https://twitter.com/J_M_Sutton
| | | | | | | | - Jeffry T Nahmias
- Department of Surgery, University of California, Irvine, Orange, CA. https://twitter.com/jnahmias1
| | - Jalen Harvey
- Department of Surgery, University of Texas Southwestern Medical Center, Dallas TX. https://twitter.com/JHarvMD20
| | - Deborah Farr
- Department of Surgery, University of Texas Southwestern Medical Center, Dallas TX. https://twitter.com/DVFelaine
| | - Zachary M Callahan
- Department of Surgery, Thomas Jefferson University, Philadelphia, PA. https://twitter.com/zmcallahan
| | - Joshua A Marks
- Department of Surgery, Thomas Jefferson University, Philadelphia, PA
| | - Ali Elsaadi
- Department of Surgery, Texas Tech University Health Sciences Center, Lubbock, TX
| | - Samuel J Campbell
- Department of Surgery, Texas Tech University Health Sciences Center, Lubbock, TX
| | | | - Dennis J Hanseman
- Department of Surgery, Cincinnati Research on Education in Surgical Training (CREST), University of Cincinnati, Cincinnati, OH
| | - Purvi Patel
- Department of Surgery, Loyola University, Maywood, IL. https://twitter.com/pppatelmd
| | | | | | - Jitesh A Patel
- Department of Surgery, University of Kentucky, Lexington, KY. https://twitter.com/Patel_Wildcat
| | | | | | | | | | - Nancy L Cho
- Department of Surgery, Brigham and Women's Hospital, Boston, MA. https://twitter.com/NancyLCho
| | - Carol R Thrush
- Department of Surgery, University of Arkansas for Medical Sciences, Little Rock, AR
| | - Mary K Kimbrough
- Department of Surgery, University of Arkansas for Medical Sciences, Little Rock, AR. https://twitter.com/kimbrough_katie
| | - Bilal Waqar Nasim
- Department of Surgery, University of Texas Health Science Center at San Antonio, San Antonio, TX
| | - Ross E Willis
- Department of Surgery, University of Texas Health Science Center at San Antonio, San Antonio, TX
| | - Brian C George
- Department of Surgery, Center for Surgical Training and Research (CSTAR), University of Michigan, Ann Arbor, MI. https://twitter.com/bcgeorge
| | - Ralph C Quillin
- Department of Surgery, Cincinnati Research on Education in Surgical Training (CREST), University of Cincinnati, Cincinnati, OH
| | - Alexander R Cortez
- Department of Surgery, Cincinnati Research on Education in Surgical Training (CREST), University of Cincinnati, Cincinnati, OH.
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Steele M, Howells L, Santer M, Sivyer K, Lawton S, Roberts A, Teasdale E, Muller I, Greenwell K. How has the COVID-19 pandemic affected eczema self-management and help seeking? A qualitative interview study with young people and parents/carers of children with eczema. Skin Health Dis 2021; 1:e59. [PMID: 34514465 PMCID: PMC8420339 DOI: 10.1002/ski2.59] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Revised: 06/07/2021] [Accepted: 06/15/2021] [Indexed: 01/31/2023]
Abstract
Background Eczema can have a considerable impact on quality of life. Treatments can improve this, but management is complex. Barriers to eczema self‐management may be impacted upon by environmental context, such as the COVID‐19 pandemic. Objectives To explore experiences of eczema, self‐management, and accessing healthcare and advice during the COVID‐19 pandemic among young people with eczema and parents/carers of children with eczema. Methods Qualitative semi‐structured interviews were carried out with 36 participants recruited from general practices as part of randomised controlled trials of online eczema resources. Results Changes to everyday life—Periods of staying at home due to the pandemic alter the burden of eczema, with reports of an improved routine and application of topical treatments for many, but difficulties with handwashing for others. Parents/carers reported improved eczema control due to closures of educational settings. Young people reported higher stress that may have triggered eczema flare‐ups. Changes to access to advice and treatment—There was a reluctance to seek medical appointments in a non‐emergency situation. Participants reported a lack of trust in the outcome of telephone consultations because health professionals were unable to see or feel the skin. Delays or difficulties when obtaining appointments and treatments caused frustration. Access to an online eczema resource was reported to have extra value in the context of the pandemic. Conclusion Changes to lifestyle and access to healthcare during the pandemic have affected eczema and self‐management. Healthcare settings may want to consider providing extra reassurance around remote consultations.
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Affiliation(s)
- M Steele
- Primary Care, Population Sciences and Medical Education Faculty of Medicine University of Southampton Southampton UK.,Centre for Clinical and Community Applications of Health Psychology School of Psychology Faculty of Environmental and Life Sciences University of Southampton Southampton UK
| | - L Howells
- Centre of Evidence Based Dermatology School of Medicine University of Nottingham Nottingham UK
| | - M Santer
- Primary Care, Population Sciences and Medical Education Faculty of Medicine University of Southampton Southampton UK
| | - K Sivyer
- Department of Psychology Faculty of Science and Health University of Portsmouth Portsmouth UK
| | - S Lawton
- Rotherham NHS Foundation Trust Rotherham UK
| | - A Roberts
- Nottingham Support Group for Carers of Children with Eczema Nottingham UK
| | - E Teasdale
- Primary Care, Population Sciences and Medical Education Faculty of Medicine University of Southampton Southampton UK
| | - I Muller
- Primary Care, Population Sciences and Medical Education Faculty of Medicine University of Southampton Southampton UK
| | - K Greenwell
- Centre for Clinical and Community Applications of Health Psychology School of Psychology Faculty of Environmental and Life Sciences University of Southampton Southampton UK
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4
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Teasdale E, Muller I, Sivyer K, Ghio D, Greenwell K, Wilczynska S, Roberts A, Ridd M, Francis N, Yardley L, Thomas K, Santer M. Views and experiences of managing eczema: systematic review and thematic synthesis of qualitative studies*. Br J Dermatol 2020; 184:627-637. [DOI: 10.1111/bjd.19299] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/03/2020] [Indexed: 02/06/2023]
Affiliation(s)
- E. Teasdale
- Department of Primary Care, Population Science and Medical Education Faculty of MedicineUniversity of Southampton SouthamptonUK
| | - I. Muller
- Department of Primary Care, Population Science and Medical Education Faculty of MedicineUniversity of Southampton SouthamptonUK
| | - K. Sivyer
- Centre for Clinical and Community Applications of Health Psychology University of Southampton Southampton UK
| | - D. Ghio
- Department of Primary Care, Population Science and Medical Education Faculty of MedicineUniversity of Southampton SouthamptonUK
| | - K. Greenwell
- Centre for Clinical and Community Applications of Health Psychology University of Southampton Southampton UK
| | - S. Wilczynska
- Department of Primary Care, Population Science and Medical Education Faculty of MedicineUniversity of Southampton SouthamptonUK
| | - A. Roberts
- Patient and Public Contributor Nottingham UK
| | - M.J. Ridd
- Department of Population Health SciencesUniversity of Bristol BristolUK
| | - N. Francis
- Department of Primary Care, Population Science and Medical Education Faculty of MedicineUniversity of Southampton SouthamptonUK
| | - L. Yardley
- Centre for Clinical and Community Applications of Health Psychology University of Southampton Southampton UK
- School of Experimental Psychology University of Bristol Bristol UK
| | - K.S. Thomas
- Centre for Evidence Based Dermatology University of Nottingham Nottingham UK
| | - M. Santer
- Department of Primary Care, Population Science and Medical Education Faculty of MedicineUniversity of Southampton SouthamptonUK
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Greenwell K, Hussain L, Lee D, Bramlage M, Bills G, Mehta A, Jackson A, Wexelman B. Complete pathologic response rate to neoadjuvant chemotherapy increases with increasing HER2/CEP17 ratio in HER2 overexpressing breast cancer: analysis of the National Cancer Database (NCDB). Breast Cancer Res Treat 2020; 181:249-254. [PMID: 32277375 DOI: 10.1007/s10549-020-05599-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2019] [Accepted: 03/18/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND HER2-positive breast cancer is an aggressive subtype of breast cancer that overexpresses human epidermal growth factor receptor 2 promoting cancer cell growth. Monoclonal antibodies targeting the HER2 receptor have improved survival for this patient population. Achieving pathologic complete response (pCR) to neoadjuvant chemotherapy (NAC) has correlated with disease-free survival in multiple trials, but we do not know why some HER2-positive tumors respond better to these therapies. We evaluated the correlation between HER2/CEP17 ratio and partial versus complete response following NAC. We evaluated whether patients with higher HER2/CEP17 ratios would have higher rates of pCR after NAC. METHODS Using the National Cancer Database (NCDB), we performed a retrospective review comparing pCR rates after NAC based on HER2 ratio between 2005 and 2014. Patients were excluded if they were HER2 negative, did not undergo NAC, or if the HER2 ratio was not recorded. Trends in percentage of pCR versus partial response were analyzed using SPSS. RESULTS The NCDB included 237,118 patients with HER2 equivocal or HER2-positive breast tumors. 29,291 of these patients underwent NAC, and HER2/CEP17 ratios were recorded in 14,597 of the NAC cases. A pCR was noted in 9752 patients and 11,402 patients had a partial response. The ratios were significantly different between complete vs. partial response groups (include ratios), P < 0.001. Using linear regression analysis, we identified a direct relationship between increasing the ratio and response to NAC. CONCLUSION Our study demonstrates a linear relationship between HER2/CEP17 ratio and pCR to NAC in patients included in the NCDB. The NCDB reflects current clinical practices across the country, and in this patient population, higher HER2 ratio is predictive of pCR to NAC and thus may be used in guiding decisions regarding the therapies that a patient receives in order to enhance pCR.
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Affiliation(s)
| | - Lala Hussain
- TriHealth Cancer Institute, 3676 Wilshire Ave., Cincinnati, OH, 45208, USA
| | - David Lee
- TriHealth Cancer Institute, 3676 Wilshire Ave., Cincinnati, OH, 45208, USA
| | - Matthew Bramlage
- TriHealth Cancer Institute, 3676 Wilshire Ave., Cincinnati, OH, 45208, USA
| | - Gordon Bills
- TriHealth Cancer Institute, 3676 Wilshire Ave., Cincinnati, OH, 45208, USA
| | - Apurva Mehta
- TriHealth Cancer Institute, 3676 Wilshire Ave., Cincinnati, OH, 45208, USA
| | - Amie Jackson
- TriHealth Cancer Institute, 3676 Wilshire Ave., Cincinnati, OH, 45208, USA
| | - Barbara Wexelman
- TriHealth Cancer Institute, 3676 Wilshire Ave., Cincinnati, OH, 45208, USA
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Ghio D, Muller I, Greenwell K, Roberts A, McNiven A, Langan S, Santer M. How young people adapt to living with eczema. Br J Dermatol 2020. [DOI: 10.1111/bjd.18649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Ghio D, Muller I, Greenwell K, Roberts A, McNiven A, Langan S, Santer M. 年轻人如何适应与湿疹共存. Br J Dermatol 2020. [DOI: 10.1111/bjd.18666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Mellion K, Greenwell K, Heyob J, Fellner A, O'Connor B, Tymitz K, Kerlakian G, Meister K. A444 Opioid Sparing Protocol Allows Minimal Narcotic Requirement in Patients Undergoing Laparoscopic Roux-en-Y Gastric Bypass. Surg Obes Relat Dis 2019. [DOI: 10.1016/j.soard.2019.08.382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Greenwell K, Mellion K, Heyob J, Fellner A, O'Connor B, Tymitz K, Kerlakian G, Meister K. A462 Opioid Sparing Protocol Allows Minimal Narcotic Requirement in Patients Undergoing Laparoscopic Sleeve Gastrectomy. Surg Obes Relat Dis 2019. [DOI: 10.1016/j.soard.2019.08.400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Ghio D, Muller I, Greenwell K, Roberts A, McNiven A, Langan SM, Santer M. 'It's like the bad guy in a movie who just doesn't die': a qualitative exploration of young people's adaptation to eczema and implications for self-care. Br J Dermatol 2019; 182:112-118. [PMID: 31021418 PMCID: PMC6972719 DOI: 10.1111/bjd.18046] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/23/2019] [Indexed: 01/19/2023]
Abstract
BACKGROUND Eczema is a common childhood inflammatory skin condition, affecting more than one in five children. A popular perception is that children 'outgrow eczema', although epidemiological studies have shown that, for many, eczema follows a lifelong episodic course. OBJECTIVES To explore the perceptions of young people about the nature of their eczema and how these perceptions relate to their self-care and adapting to living with eczema. METHODS This is a secondary inductive thematic analysis of interviews conducted for Healthtalk.org. In total 23 interviews with young people with eczema were included. Of the 23 participants, 17 were female and six male, ranging from 17 to 25 years old. RESULTS Participants generally experienced eczema as an episodic long-term condition and reported a mismatch between information received about eczema and their experiences. The experience of eczema as long term and episodic had implications for self-care, challenging the process of identifying triggers of eczema flare-ups and evaluating the success of treatment regimens. Participants' experiences of eczema over time also had implications for adaptation and finding a balance between accepting eczema as long term and hoping it would go away. This linked to a gradual shift in treatment expectations from 'cure' to 'control' of eczema. CONCLUSIONS For young people who continue to experience eczema beyond childhood, a greater focus on self-care for a long-term condition may be helpful. Greater awareness of the impact of early messages around 'growing out of' eczema and provision of high-quality information may help patients to manage expectations and support adaptation to treatment regimens. What's already known about this topic? There is a common perception that people 'grow out of' eczema, but for many people eczema follows a lifelong episodic course. Qualitative work has shown that parents can find that being told their child will grow out of eczema is dismissive, and that they have difficulty with messages about 'control not cure' of eczema. It is unclear how young people perceive their eczema and the implications of this perception for their adaptation and self-care. What does this study add? The message that many people 'grow out of' eczema has a potentially detrimental effect for young people where the condition persists. This has implications for young people's perceptions of their eczema, their learning to self-care and how they adapt to living with eczema and eczema treatments. What are the clinical implications of this work? Clinicians need to promote awareness among young people that eczema is a long-term episodic condition in order to engage them with effective self-care. Young people transitioning to self-care need evidence-based information that is specific and relatable to them.
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Affiliation(s)
- D Ghio
- Primary Care and Population Science, Faculty of Medicine, University of Southampton, Southampton, U.K
| | - I Muller
- Primary Care and Population Science, Faculty of Medicine, University of Southampton, Southampton, U.K
| | - K Greenwell
- Centre for Clinical and Community Applications of Health Psychology, Faculty of Social and Human Sciences, University of Southampton, Southampton, U.K
| | - A Roberts
- Centre of Evidence Based Dermatology, School of Medicine, University of Nottingham, Nottingham, U.K
| | - A McNiven
- Nuffield Department of Primary Care Health Sciences, Radcliffe Observatory Quarter, Woodstock Road, Oxford, OX2 6GG, U.K
| | - S M Langan
- Faculty of Epidemiology & Population Health, London School of Hygiene and Tropical Medicine, London, U.K.,Health Data Research U.K., London, U.K
| | - M Santer
- Primary Care and Population Science, Faculty of Medicine, University of Southampton, Southampton, U.K
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11
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Greenwell K, Hussain L, Ho C, Dunki-Jacobs E, Lee D, Bramlage M, Bills G, Mehta A, Jones J, Jackson A, Wexelman B. Abstract PD3-04: Complete pathologic response rate to neoadjuvant chemotherapy increases with increasing HER2 ratio in HER2 over-expressing breast cancer: Analysis of the National cancer database (NCDB). Cancer Res 2018. [DOI: 10.1158/1538-7445.sabcs17-pd3-04] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: HER2-positive (HER2+) breast cancer is an aggressive subtype that overexpresses human epidermal growth factor receptor 2 promoting cancer cell growth. Monoclonal antibodies targeting the HER2 receptor have improved survival for this patient population, and current NCCN guidelines recommend consideration of neoadjuvant anti-HER2 therapy (NAC) in Stage 2 & 3 HER2+ breast cancer. Pathologic complete response (pCR) to NAC has correlated with longer disease free survival in multiple trials.
Per ASCO-CAP guidelines tumors are considered HER2+ if HER2 copy number≥ 6/cell, HER2/CEP17 ratio≥ 2, or ratio<2 & HER2 copy number ≥6/cell. We hypothesize that patients with higher HER2 ratios will have higher rates of pCR after NAC.
Methods: The National Cancer Database is supported by the American College of Surgeons and the American Cancer Society containing de-identified patient treatment data from over 1,500 US facilities. We performed a retrospective review comparing pCR rates after NAC based on HER2 ratio. Patients were excluded if they were HER2 negative, did not undergo NAC, or if the HER2 ratio was not recorded. Chi-squared and Fisher's exact test were used to compare pCR versus partial response between deciles of HER2 ratios.
Results: The NCDB included 237,118 patients with HER2 equivocal or HER2+ breast tumors. 29,291 of these patients underwent NAC, and HER2 ratios were recorded in 14,597 of the NAC cases. The majority (98%) of included cases were from 2010-2014. A pCR was noted in 9,752 patients and 11,402 patients had a partial response. No response was observed in 1,735 patients and 6,402 patients had a response but the degree was not recorded.
HER2 ratios were significantly different between pCR vs. partial response groups, p <0.001. We identified a direct relationship between increasing HER2 ratio and response to NAC. For ratios 2-2.9, 23.6% achieved pCR and 44.7% had a partial response. For ratio of 5-5.9, 40.7% achieved pCR and even higher rates of pCR were noted for ratios 8-8.9; 49.5% achieved pCR. While both estrogen receptor (ER) positive and ER negative tumors demonstrated this trend, ER negative tumors had higher rates of pCR (ER negative pCR range 37.6% to 59.4% vs ER positive pCR range 16.9% to 42.3%, p<0.01).
Conclusion: Contrary to current dogma, not all HER2+ tumors respond similarly to NAC. We demonstrate a linear relationship between HER2 ratio and pCR in over 14,000 patients. Those with HER2 ratios ≥5.0 were more likely to achieve pCR compared to patients with ratio ≤4.9. The NCDB reflects current clinical practice across the country not restricted to confines of clinical trials, and in this population higher HER2 ratios are predictive of pCR after NAC.
Response to NAC by Her2 Ratio- Complete vs Partial Response Response to NAC p ValueHER2 Ratio Complete Response- pCR (N) Partial Response (N) 1.00- 1.99141819.5%343047.2%<0.01 2.00- 2.9951423.6%97444.7%<0.01 3.00- 3.9928328.7%41942.4%<0.01 4.00- 4.9926533.2%30638.2%<0.01 5.00- 5.9929940.7%24333.1%<0.01 6.00- 6.9929241.0%25435.5%<0.01 7.00- 7.9924746.2%17432.5%<0.01 8.00- 8.9918749.5%12132.0%<0.01 9.00- 9.87 and greater44143.9%31431.3%<0.01TOTAL 394627.0%623542.7%<0.01
Citation Format: Greenwell K, Hussain L, Ho C, Dunki-Jacobs E, Lee D, Bramlage M, Bills G, Mehta A, Jones J, Jackson A, Wexelman B. Complete pathologic response rate to neoadjuvant chemotherapy increases with increasing HER2 ratio in HER2 over-expressing breast cancer: Analysis of the National cancer database (NCDB) [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr PD3-04.
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Affiliation(s)
- K Greenwell
- Trihealth Cancer Institute, Cincinnati, OH; Trihealth Hatton Research Institute, Cincinnati, OH; Trihealth, Cincinnati, OH
| | - L Hussain
- Trihealth Cancer Institute, Cincinnati, OH; Trihealth Hatton Research Institute, Cincinnati, OH; Trihealth, Cincinnati, OH
| | - C Ho
- Trihealth Cancer Institute, Cincinnati, OH; Trihealth Hatton Research Institute, Cincinnati, OH; Trihealth, Cincinnati, OH
| | - E Dunki-Jacobs
- Trihealth Cancer Institute, Cincinnati, OH; Trihealth Hatton Research Institute, Cincinnati, OH; Trihealth, Cincinnati, OH
| | - D Lee
- Trihealth Cancer Institute, Cincinnati, OH; Trihealth Hatton Research Institute, Cincinnati, OH; Trihealth, Cincinnati, OH
| | - M Bramlage
- Trihealth Cancer Institute, Cincinnati, OH; Trihealth Hatton Research Institute, Cincinnati, OH; Trihealth, Cincinnati, OH
| | - G Bills
- Trihealth Cancer Institute, Cincinnati, OH; Trihealth Hatton Research Institute, Cincinnati, OH; Trihealth, Cincinnati, OH
| | - A Mehta
- Trihealth Cancer Institute, Cincinnati, OH; Trihealth Hatton Research Institute, Cincinnati, OH; Trihealth, Cincinnati, OH
| | - J Jones
- Trihealth Cancer Institute, Cincinnati, OH; Trihealth Hatton Research Institute, Cincinnati, OH; Trihealth, Cincinnati, OH
| | - A Jackson
- Trihealth Cancer Institute, Cincinnati, OH; Trihealth Hatton Research Institute, Cincinnati, OH; Trihealth, Cincinnati, OH
| | - B Wexelman
- Trihealth Cancer Institute, Cincinnati, OH; Trihealth Hatton Research Institute, Cincinnati, OH; Trihealth, Cincinnati, OH
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Crump WJ, Fricker RS, Flick KF, Gerwe-Wickham K, Greenwell K, Willen KL. A rural pathways program for high school students: reinforcing a sense of place. Fam Med 2014; 46:713-717. [PMID: 25275283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
BACKGROUND AND OBJECTIVES The affinity model predicts that students from rural areas who train in smaller towns will be more likely to choose rural practice. Most pipeline programs based on this model begin in college or medical school. Many rural students first encounter academic and career planning challenges prior to college, and a few programs are focused on high school students. METHODS We report pre- and post-program opinions and American College Testing (ACT) practice scores from 151 participants in a high school rural scholar program over the first 10 years of the program. RESULTS After participation, the students showed significantly more positive opinions about their county's health care resources and their knowledge of career options, and they knew more names of the providers in their county. Their practice ACT scores increased slightly, and their assessment that they were well prepared to take the ACT improved. Seventy-five percent have pursued a health career, and 10% have entered medical school. CONCLUSIONS A summer program that allows high school students to shadow health professionals in their hometown and study in a virtual classroom can accomplish modest academic gains while producing more positive opinions about the health care in their county. They also report better understanding of the career options available to them.
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Affiliation(s)
- William J Crump
- University of Louisville School of Medicine, Trover Campus at Baptist Health Madisonville, Madisonville, KY
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13
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Cohen MB, Saxton RE, Lake RR, Cagle L, Graham LS, Nizze A, Yamada LS, Gan M, Bronca G, Greenwell K. Detection of malignant melanoma with iodine-123 iodoamphetamine. J Nucl Med 1988; 29:1200-6. [PMID: 3392580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Iodoamphetamine (IMP) was shown by in vitro assay to have a high uptake by human melanotic melanoma cells, as compared to amelanotic melanoma cells. Eleven patients with proven malignant melanoma (MM) and 3 normal subjects were imaged at 2-4 hr and 16-24 hr after the i.v. injection 5 mCi (185 MBq) of [123I]IMP. One patient had a recurrent tumor that was subsequently shown to be squamous cell carcinoma. The index lesion was not visualized in the three patients with amelanotic melanomas. The index lesion/lesions were visualized in six of the seven other patients, except for 4/16 nodules in one patient. The seventh patient had a large, necrotic melanotic tumor that was not visualized, but an unsuspected lesion in the iliac nodes was detected. Multiple unsuspected lesions were detected in a second patient. While many lesions were seen at 2-4 hr, all lesions (other than a patient with small bowel disease) were seen best at 16-24 hr. No eye uptake was observed in any patient or control subject. Testicular uptake was seen in all males at 16-24 hr. Iodine-123 IMP appears to be a useful agent for the detection and follow-up of patients with melanotic MM.
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Affiliation(s)
- M B Cohen
- Research Service, V.A. Medical Center, Sepulveda, California 91343
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14
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La Fontaine R, Graham LS, Behrendt D, Greenwell K. Personnel exposure from flood phantoms and point sources during quality assurance procedures. J Nucl Med 1983; 24:629-32. [PMID: 6864317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Nuclear medicine technologists routinely use flood phantoms containing 5 to 10 mCi (185-370 MBq) of Tc-99m to perform quality assurance tests on scintillation cameras. This paper presents the results of a study that measured the radiation exposure received by three individuals from a Tc-99m flood phantom during the daily performance of flood-field uniformity tests on three scintillation cameras. The extrapolated annual personnel exposure to the anterior trunk and the back of the hand were 172 mR and 220 mR, respectively. Additional measurements indicate that personnel performing these tests with a 10-mCi Co-57 flood disk source or a 200-muCi point source would receive approximately 25% and 1%, respectively, of the exposure from a 10-mCi Tc-99m flood phantom. These exposure levels should be considered when evaluating personnel radiation exposure in a nuclear medicine clinic.
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