Psychological Safety and Hierarchy in Operating Room Debriefing: Reflexive Thematic Analysis

INTRODUCTION

Debriefing is a team discussion in a constructive, supportive environment. Barriers exist to consistent, effective team debriefing in the clinical setting, especially in operating theaters. The purpose of this study was to gain insights from frontline workers on how to set up an effective debriefing policy for our operating room.

METHODS

This was a qualitative study in which we interviewed operating room workers in a tertiary children's hospital. Interviews were audio-recorded, transcribed, and coded. Data were analysed using the reflexive thematic analysis technique within a critical realism paradigm.

RESULTS

Interviews were analysed from 40 operating room staff: 14 nurses, seven anesthetic technicians, seven anaesthetists, and 12 surgeons; 25 (65%) were female. The three key themes were (1) "commitment to learning"-healthcare workers are committed to teamwork and quality improvement; (2) "it is a safe space"-psychological safety is a prerequisite for, and is enhanced by, debriefing; and (3) "natural leader"-the value of leadership, but also constructs around leadership that maintain hierarchies.

CONCLUSIONS

Psychological safety is both a prerequisite for and a product of debriefing. Leadership, if viewed as a collective responsibility, could help break down power structures. Given the results of this study and evidence in the literature, it is likely that routine debriefing, if well done, will improve psychological safety, facilitate team learning, reduce errors, and improve patient safety.

Development of an Aboriginal Resilience and Recovery Questionnaire - a collaboration between practitioners and help-seeking clients of a Victorian Aboriginal community controlled health service

BACKGROUND

Indigenous experiences and perspectives of resilience, healing and recovery from trauma is gaining increasing attention, with a growing qualitative literature that spans multiple indigenous cultural groups. However, few quantitative measures are available. In this article, development of a preliminary version of the Aboriginal Resilience and Recovery Questionnaire is described.

AIM

The first aim of this study was to describe findings from two focus groups that provided theoretical knowledge and development of items for a draft version of an Aboriginal Resilience Recovery Questionnaire. The second aim of the study was to conduct a preliminary psychometric analysis of the properties of the measure.

DESIGN

Multi-method research design grounded in indigenous research methodologies.

MEASURES

Aboriginal Resilience and Recovery Questionnaire, Australian Aboriginal Version of the Harvard Trauma Questionnaire Trauma symptom subscale, Growth and Empowerment Measure.

RESULTS

(1) Two focus groups with six counselling staff from an Aboriginal health service were run that explored Victorian Aboriginal understandings of resilience, healing, and recovery from trauma. Sixty different protective factors viewed as potentially important to resilience, healing and recovery from trauma were identified by participants. (2) Following a review of the resilience literature, 75 items were reviewed and revised, with additional items developed by the focus group. (3) The final outcome was 60 items selected for a preliminary version of the Aboriginal Resilience Recovery Questionnaire, 50 of which made up 19 different subscales in addition to 10 single items. (4) Structured interviews were conducted with 81 help seeking Aboriginal clients recruited from the same health service. Preliminary psychometric assessment of the Aboriginal Resilience Recovery Questionnaire was undertaken using Principal Components Analysis. Two component subscales were extracted with adequate internal consistency and good convergent and discriminant validity. For both subscales there were moderate to strong positive associations with empowerment, and moderate to strong negative associations with trauma symptom severity.

CONCLUSION

The preliminary results are promising for a strength-based resilience measure developed from the knowledge of Aboriginal practitioners and staff of a counselling service. Further research to address some psychometric limitations in the measure is required. A larger sample size will allow for a common factor analysis to be conducted. The Aboriginal Resilience Recovery Questionnaire has potential to assist Aboriginal Community Controlled Health Organisations and other organisations to evaluate whether services and programs can effectively support community members to strengthen individual, relational, community and cultural resilience resources.

Surgical smoke: how an issue in healthcare fits a planetary health framework

AIM

The smoke generated from electrocautery machines may be harmful to health. Healthcare in general, and surgery in particular, has a large environmental footprint. The aims of this study were to discover what healthcare workers thought about the problem of electrocautery smoke, the idea of a surgical smoke-free policy, and to formulate ideas on how the matter could be approached in an environmentally and socially responsible way.

METHOD

Operating room personnel in a tertiary referral hospital were invited to complete a survey about electrocautery smoke: perceived risks, current exposure, and measures to minimise exposure. Quantitative data were analysed in a generalised linear model, and qualitative data by reflexive thematic analysis within a constructivist theoretical framework.

RESULTS

The survey response rate was 463/1234 (38%). Most supported a smoke-free policy (89%). Support for a policy was positively correlated with the perceived risk of electrocautery smoke (p<0.001. Support was lower amongst males (p<0.05). Themes from the qualitative analysis developed around nature, society and technology. A framework was developed consisting of earth and its ecosystems, human health, governance, economics, society, and the interconnected of these systems.

CONCLUSION

Although smoke-free policies form part of the solution to electrocautery smoke, they are not the whole solution. Healthcare issues, in this case the issue of electrocautery smoke, could be tackled within a planetary health healthcare framework, promoting a systems approach. Applicability of the framework requires confirmation by further research.

Unequal Cumulative Incidence and Mortality Outcome in Childhood Brain and Central Nervous System Malignancy in the USA

BACKGROUND

While survival in overall pediatric malignancy has improved during recent decades, brain/central nervous system (CNS) tumors has not demonstrated comparable survival advantage. Incidence and mortality data in this malignancy continue to illustrate race and sex differences; however, there are few data in the pediatric setting. This study sought to characterize brain/CNS tumors by socio-demographic and assess racial and sex variances in both cumulative incidence and mortality.

METHODS

A retrospective cohort design with Surveillance, Epidemiology and End Results (SEER) 1973-2014 was used for the assessment of children aged < 1-19 years diagnosed with brain/CNS tumors. The age-adjusted incidence rates were used for temporal trends, percent change, and annual percent change. We utilized binomial regression model to determine the exposure effect of race and sex on cancer mortality, adjusting for potential confounders.

RESULTS

Childhood brain/CNS tumor cumulative incidence (CmI) continues to rise in annual percent change, and mortality varied by race, sex, and year of diagnosis. The CmI was highest among whites, intermediate among blacks, and lowest among Asians, as well as lower in females relative to that in males. Compared to whites, blacks were 21% more likely to die from brain/CNS tumors [risk ratio (RR) 1.21, 95% confidence interval (C.I.) 1.13-1.28], while males were 4% more likely to die relative to females (RR 1.04, 95% C.I. 1.00-1.08). After controlling for age, sex, and tumor grade, racial disparities persisted, with 16% increased risk of dying among blacks relative to whites [adjusted risk ratio 1.16, (99% C.I.) 1.08-1.25, p < 0.001].

CONCLUSION

The cumulative incidence of brain/CNS malignancy is higher among whites relative to that in blacks; however, blacks experienced survival disadvantage even after adjustment for potential tumor prognostic and predisposing factors.

Student Perceptions about the Influence of a Perioperative Nursing Elective on Career Preferences

It has been suggested that offering perioperative nursing courses will increase the number of nurses and new graduates who enter the perioperative area. There is little research to support that students’ career choices are influenced by immersion in perioperative content. The purpose of this qualitative study was to describe student perceptions of perioperative nursing as a career option following completion of an elective in perioperative nursing. Two focus groups were held involving students (N=19) who completed the course. One hour sessions were audio taped as students described their perceptions about perioperative nursing. Tapes were transcribed verbatim and analysed for themes. Four themes were identified: 1) opening their eyes: career advantages, 2) being captive: career disadvantages, 3) paradox unrecognized, and 4) I’ll be a better nurse. Although students were not persuaded to alter their primary employment intentions, they acknowledged the possibility of a future career in the perioperative area.

Experiences of women referred for urgent assessment of postmenopausal bleeding (PMB)

Women with postmenopausal bleeding (PMB) are referred for specialist assessment within 2 weeks of presentation to their GP. No research has previously examined women's experiences of expedited referral. This was investigated in the present study using questionnaires (6-item State Anxiety Inventory (6-STAI)) and focus groups. A total of 55 women completed questionnaires. Results showed high levels of anxiety at first hospital visit (mean 47.0 (SD 14.27); 95% CI 43.14-50.93). Scores declined by 90 days, but were higher in those not undergoing hysteroscopy. Fifteen women who underwent hysteroscopy attended focus groups. Women recalled fear of cancer from symptom onset until receipt of results. Anxiety was exacerbated by poor knowledge of PMB and lack of awareness of expedited referral. Post-discharge, those with unexplained or recurrent symptoms expressed frustration and upset. Effective strategies to raise awareness of PMB and its causes are needed, including reasons for expedited referral. Women without cancer may also need more support.

Energy cost of walking in children with spastic cerebral palsy: relationship with age, body composition and mobility capacity

The energy cost (EC) of walking is different for typically developing (TD) and children with cerebral palsy (CP). The associated factors of EC are not fully understood in children with CP. We assessed the relationship between EC and age, body surface area (BSA), and gross motor function measure (GMFM). We retrospectively examined data collected between 2003 and 2011 on 276 children aged 4-18 years who were classified as Gross Motor Function Classification System level I, n=79; II, n=123; and III, n=74. Energy cost was assessed while children walked 6-8 min at a comfortable, self-selected speed using their typical walking aids and/or orthoses as part of a clinical gait analysis. During the test, participants wore a breath-by-breath portable gas analysis system, measuring oxygen consumption. To calculate EC (J/kg/m), oxygen consumption was converted to J/kg/min and divided by walking speed. Data were analyzed using linear regression model. Energy cost correlated inversely with age (β=-0.16, R2=0.02, P=0.01), BSA (β=-3.35, R2=0.11, P<0.0001), and GMFM (β=-0.12, R2=0.42, P<0.0001). In the multiple linear regression model, GMFM was the most potent correlate of EC, BSA explained another 10% of the variance (R2=0.53), and age was a marginally significant correlate of EC (P=0.08). In summary, in children with CP in our study, EC decreased as GMFM and BSA increased, and GMFM was the most potent correlate of EC.

Racial/Ethnic Variability in Hypertension Prevalence and Risk Factors in National Health Interview Survey

Objective. Hypertension is one of the leading causes of death attributed to cardiovascular diseases, and the prevalence varies across racial/ethnic groups, with African Americans being disproportionately affected. The underlying causes of these disparities are not fully understood despite volume of literature in this perspective. We aimed in this current study to examine ethnic/racial disparities in hypertension utilizing Hispanics as the base racial/ethnic group for comparison. Research Design and Methods. We utilized the National Health Interview Survey (NHIS), which is a large cross-sectional survey of the United States non-institutionalized residents to investigate the racial/ethnic disparities in hypertension after the adjustment of other socio-economic, demographic, and prognostic risk factors. The study participants were adults (n = 30,852). Data were analyzed using Chi square statistic, and logistic regression model. Results. There were statistically significant differences by race/ethnicity with respect to income, education, marital status, smoking, alcohol, physical activities, body mass index, and age, P < 0.01, but not insurance coverage, P > 0.01. Hispanic ethnicity (18.9%) compared to either non-Hispanic white (27.7%) or non-Hispanic black (35.5%) was associated with the lowest prevalence of hypertension. Race/ethnicity was a single independent predictor of hypertension, with non-Hispanic black more likely to be hypertensive compare with Hispanic, prevalence odds ratio (POR), 2.38, 99% Confidence Interval (CI), 2.17–2.61 and non-Hispanic white, POR, 1.64, 99% CI, 1.52–1.77. After controlling for the confounding variables, the racial/ethnic differences in hypertension persisted. Conclusions. Racial/ethnic disparities in hypertension persisted after controlling for potential predictors of hypertension in NHIS, implying the inability of known hypertension risk factors to account for racial/ethnic variability in hypertension in US.

Long-term outcome of reconstruction of the hip in young children with cerebral palsy

We reviewed the long-term radiological outcome, complications and revision operations in 19 children with quadriplegic cerebral palsy and hip dysplasia who underwent combined peri-iliac osteotomy and femoral varus derotation osteotomy. They had a mean age of 7.5 years (1.6 to 10.9) and comprised 22 hip dislocations and subluxations. We also studied the outcome for the contralateral hip. At a mean follow-up of 11.7 years (10 to 15.1) the Melbourne cerebral palsy (CP) hip classification was grade 2 in 16 hips, grade 3 in five, and grade 5 in one. There were five complications seen in four hips (21%, four patients), including one dislocation, one subluxation, one coxa vara with adduction deformity, one subtrochanteric fracture and one infection. A recurrent soft-tissue contracture occurred in five hips and ten required revision surgery.

In pre-adolescent children with quadriplegic cerebral palsy good long-term outcomes can be achieved after reconstruction of the hip; regular follow-up is required.

Cite this article: Bone Joint J 2013;95-B:259–65.

Sex variability in pediatric leukemia survival: large cohort evidence

Purpose. Sex disparities in pediatric leukemia have been previously reported, and male children continue to present with poorer survival. However, the observed disparities are not fully understood. This current study sought to examine disparities in survival by the sex, and to determine if tumor prognostic factors impact on these disparities. Patients and Methods. We used the Surveillance Epidemiology and End Results dataset of pediatric leukemia patients (ages 0–19 years) diagnosed in the United States from 1973 to 2006. There were 15,215 patients of whom 8,622 (65.7%) were boys and 6,593 (43.3%) were girls. The Kaplan-Meier survival estimates, log rank test, and Cox proportional hazard methods were used to assess the data. Results. The overall (both sexes) five-year survival rate was 67.9%. Girls had a survival rate of 70.1%, while the rate was 66.3% in boys. Girls had a significant 14% decreased risk of dying relative to boys, hazard ratio (HR) = 0.86, 99% CI = 0.80–0.93. There were significant differences between boys and girls with respect to tumor cell type, race, age at diagnosis, year of diagnosis, and number of primaries, P < 0.001. After controlling for these factors, the sex differences in survival persisted, with girls still less likely to die from leukemia compared to boys, adjusted HR (AHR) = 0.85, 99% CI = 0.72–1.00, P < 0.01. Conclusion. In a large population-based pediatric leukemia study, boys continued to show poorer survival. These disparities were not completely explained by treatment received, tumor prognostic or socio-demographic factors.

Aspergillus sensitization is associated with airflow limitation and bronchiectasis in severe asthma

BACKGROUND

Abnormalities, including bronchiectasis, that are detectable on high-resolution computed tomography (HRCT) have been associated with severe asthma. Bronchiectasis is associated with the diagnosis of allergic bronchopulmonary aspergillosis (ABPA), which also occurs in patients with severe asthma. We sought to determine the frequency and pattern of HRCT abnormality and the relationship with Aspergillus fumigatus sensitization in one severe asthma population.

METHODS

We examined our database of patients attending a supraregional severe asthma service (Manchester, UK). Clinical, physiological and immunological characteristics were compared between those with HRCT evidence of airway disease (specifically bronchiectasis) and those with no radiological abnormality.

RESULTS

Of 133 patients analysed, 111 (83.4%) had an abnormal HRCT with bronchial wall thickening (41.3%), bronchiectasis (35.3%), air trapping (20.3%) and bronchial dilatation (16.5%) occurring most frequently. Radiological evidence of airway disease was associated with more obstructive spirometry (postbronchodilator FEV₁/FVC ratio 73.2%vs 64.8% [difference -8.5%, 95% CI -16.9 to -0.1, P = 0.048]). A. fumigatus sensitization was associated with a 2.01 increased hazard ratio of bronchiectasis (95% CI 1.26 to 3.22, P = 0.005), and more obstructive spirometry (postbronchodilator FEV₁/FVC ratio 57.6 vs 70.3 [difference -12.8, 95% CI -19.8 to -5.7, P = 0.001]). Patients with A. fumigatus sensitization had variable clinical and radiological characteristics that frequently did not conform to the conventional diagnostic criteria for ABPA.

CONCLUSION

Patients with severe asthma frequently have radiological abnormalities on HRCT. Sensitization to A. fumigatus is associated with bronchiectasis and greater airflow obstruction, even when diagnostic criteria for ABPA are not met.

The Triple Threat of Recurrence after Breast Conserving Therapy: Race, Receptor Status and Age

PurposeThe purpose of this study is to evaluate the impact of race, receptor status, and age on recurrence in patients undergoing breast conserving therapy (BCT).MethodsThe study population consisted of 510 primary invasive female breast cancer patients (excluding Stage IV), who resided in Fulton-Dekalb counties, in Atlanta, GA. These patients were diagnosed in 2003-2004 and treated within the Emory University Affiliated Hospitals. Data was obtained from the SEER cancer registry and augmented with medical record abstraction. Median follow-up was 3.5 and 4.4 years for recurrence and survival, respectively. Breast tumors were categorized as either triple negative (TN), which were estrogen, progesterone, and Her2-neu receptor negative tumors, versus (vs) non-TN, all other possible iterations. Women were evaluated for recurrence and death by TN status, race (African American (AA) vs Caucasian (C)), age, grade, tumor size, nodal status, socioeconomic status (SES), and receipt of chemotherapy. Both recurrence and survival were evaluated using chi-square, fisher exact, and cox regression analyses, p ≤ 0.05 significance.ResultsOf the 510 women, 193 received BCT. Of the 193, 92% completed radiation therapy and 45% received chemotherapy. Of the 184 women with known recurrence status, 11 recurred locally, 11 distantly, and none regionally. Compared to patients with non-TN tumors, TN patients had significantly higher local (13% vs 5%) and distant (16% vs 4%) recurrence rates. AA women had non-significant higher local recurrence than C women (7% vs 4%) and a higher distant recurrence rate (8% vs 3%). Finally, compared to women ≥50 years old, women age &lt;50 had a significantly higher local and distant recurrence rates, (13% vs 4%) and (9% vs 5%) respectively.Unadjusted hazard ratios (HR) and 95% confidence intervals (CI) for any recurrence were calculated: TN status (HR=2.8, 95%CI 1.2-6.5), AA race (HR=2.3, 95% CI 0.9-5.8), age &lt;50 years (HR= 2.3, 95%CI 1.0-5.1), grade 2/3 vs 1 (HR=2.3, 95%CI 1.0-5.1), and chemotherapy receipt (HR=3.0, 95%CI 1.2-7.4). Factors that were highly non-statistically significant included stage, tumor size, nodal status, and SES.In a multivariate model including receptor status, race, and age results were similar (HR = 2.5, 2.1, and 2.1 respectively). When tumor size, nodal status, grade, SES, and chemotherapy status were included in the previous model, only AA race independently predicted recurrence (HR=3.4, 95%CI 1.1-11.1), while TN status demonstrated a trend (HR=1.9, 95%CI 0.8-5.7).In survival analyses, neither TN status, AA race, nor age &lt;50 years predicted outcome in any of the models described above. However, TN status did show a trend for significance (HR=2.6, 95%CI 0.8-9.0).ConclusionWe observed that there was a significant increase in local and distant metastatic recurrence rates after BCT among patients diagnosed with TN breast cancers, AA women, and women &lt;50 years old. In contrast, we did not observe differences in survival, with the exception of TN breast cancers. This study suggests that among women who receive BCT, current standard radiation and systemic therapies may not be adequate in preventing recurrence among women with TN breast cancers, of AA race, or younger age.

Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 6045.

Practice parameter update: management issues for women with epilepsy--focus on pregnancy (an evidence-based review): vitamin K, folic acid, blood levels, and breastfeeding: report of the Quality Standards Subcommittee and Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology and American Epilepsy Society

OBJECTIVE

To reassess the evidence for management issues related to the care of women with epilepsy (WWE) during pregnancy, including preconceptional folic acid use, prenatal vitamin K use, risk of hemorrhagic disease of the newborn, clinical implications of placental and breast milk transfer of antiepileptic drugs (AEDs), risks of breastfeeding, and change in AED levels during pregnancy.

METHODS

A 20-member committee evaluated the available evidence based on a structured literature review and classification of relevant articles published between 1985 and October 2007.

RESULTS

Preconceptional folic acid supplementation is possibly effective in preventing major congenital malformations in the newborns of WWE taking AEDs. There is inadequate evidence to determine if the newborns of WWE taking AEDs have a substantially increased risk of hemorrhagic complications. Primidone and levetiracetam probably transfer into breast milk in amounts that may be clinically important. Valproate, phenobarbital, phenytoin, and carbamazepine probably are not transferred into breast milk in clinically important amounts. Pregnancy probably causes an increase in the clearance and a decrease in the concentration of lamotrigine, phenytoin, and to a lesser extent carbamazepine, and possibly decreases the level of levetiracetam and the active oxcarbazepine metabolite, the monohydroxy derivative.

RECOMMENDATIONS

Supplementing women with epilepsy with at least 0.4 mg of folic acid before they become pregnant may be considered (Level C). Monitoring of lamotrigine, carbamazepine, and phenytoin levels during pregnancy should be considered (Level B) and monitoring of levetiracetam and oxcarbazepine (as monohydroxy derivative) levels may be considered (Level C). A paucity of evidence limited the strength of many recommendations.

Practice parameter update: management issues for women with epilepsy--focus on pregnancy (an evidence-based review): obstetrical complications and change in seizure frequency: report of the Quality Standards Subcommittee and Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology and American Epilepsy Society

OBJECTIVE

To reassess the evidence for management issues related to the care of women with epilepsy (WWE) during pregnancy, including the risk of pregnancy complications or other medical problems during pregnancy in WWE compared to other women, change in seizure frequency, the risk of status epilepticus, and the rate of remaining seizure-free during pregnancy.

METHODS

A 20-member committee including general neurologists, epileptologists, and doctors in pharmacy evaluated the available evidence based on a structured literature review and classification of relevant articles published between 1985 and February 2008.

RESULTS

For WWE taking antiepileptic drugs, there is probably no substantially increased risk (greater than two times expected) of cesarean delivery or late pregnancy bleeding, and probably no moderately increased risk (greater than 1.5 times expected) of premature contractions or premature labor and delivery. There is possibly a substantially increased risk of premature contractions and premature labor and delivery during pregnancy for WWE who smoke. Seizure freedom for at least 9 months prior to pregnancy is probably associated with a high likelihood (84%-92%) of remaining seizure-free during pregnancy.

RECOMMENDATIONS

Women with epilepsy (WWE) should be counseled that seizure freedom for at least 9 months prior to pregnancy is probably associated with a high rate (84%-92%) of remaining seizure-free during pregnancy (Level B). However, WWE who smoke should be counseled that they possibly have a substantially increased risk of premature contractions and premature labor and delivery during pregnancy (Level C).

Practice parameter update: management issues for women with epilepsy--focus on pregnancy (an evidence-based review): teratogenesis and perinatal outcomes: report of the Quality Standards Subcommittee and Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology and American Epilepsy Society

OBJECTIVE

To reassess the evidence for management issues related to the care of women with epilepsy (WWE) during pregnancy.

METHODS

Systematic review of relevant articles published between January 1985 and June 2007.

RESULTS

It is highly probable that intrauterine first-trimester valproate (VPA) exposure has higher risk of major congenital malformations (MCMs) compared to carbamazepine and possible compared to phenytoin or lamotrigine. Compared to untreated WWE, it is probable that VPA as part of polytherapy and possible that VPA as monotherapy contribute to the development of MCMs. It is probable that antiepileptic drug (AED) polytherapy as compared to monotherapy regimens contributes to the development of MCMs and to reduced cognitive outcomes. For monotherapy, intrauterine exposure to VPA probably reduces cognitive outcomes. Further, monotherapy exposure to phenytoin or phenobarbital possibly reduces cognitive outcomes. Neonates of WWE taking AEDs probably have an increased risk of being small for gestational age and possibly have an increased risk of a 1-minute Apgar score of <7.

RECOMMENDATIONS

If possible, avoidance of valproate (VPA) and antiepileptic drug (AED) polytherapy during the first trimester of pregnancy should be considered to decrease the risk of major congenital malformations (Level B). If possible, avoidance of VPA and AED polytherapy throughout pregnancy should be considered to prevent reduced cognitive outcomes (Level B). If possible, avoidance of phenytoin and phenobarbital during pregnancy may be considered to prevent reduced cognitive outcomes (Level C). Pregnancy risk stratification should reflect that the offspring of women with epilepsy taking AEDs are probably at increased risk for being small for gestational age (Level B) and possibly at increased risk of 1-minute Apgar scores of <7 (Level C).

Triple negative breast cancer confers higher recurrence rates after breast conserving therapy

Abstract #5127

Purpose&#x2028; There has been a recent surge of information regarding the treatment outcomes for women with estrogen receptor (ER) negative, progesterone receptor (PR) negative, and human epidermal growth factor receptor 2 (HER2) negative breast cancer; known as the triple negative (TN) subtype. The purpose of this study is to evaluate the impact of these receptor expressions on local, regional and distant recurrences, and overall survival (OS) in patients undergoing breast conserving therapy (BCT).&#x2028; Patients and Methods&#x2028; The study population included 475 primary invasive female breast cancer patients (excluding Stage IV); who were residents of Fulton-Dekalb counties in Atlanta when diagnosed in 2003-2004 and treated within the Emory University affiliated hospitals. Data was obtained from the SEER cancer registry and augmented with medical record abstraction. Median follow-up was 3.4 years. The endpoints of the study were local, regional and distant recurrences, and OS. Tumors were subgrouped as: ER-/PR-/HER2- (TN), ER+/PR+/HER2-, ER+/PR+/HER2+, ER+/PR+/HER2-. Chi-square and Fisher exact tests were employed.&#x2028; Results&#x2028; For the entire population, median age was 58 years. TN tumors accounted for 17% of the cases. Of the TN patients, 78% were African-American (p&lt;0.01) and 40% had BCT. The majority of TN tumors were high grade (71%), p&lt; 0.01. Total recurrence was 33% among the TN patients vs. 14% in the combined non-TN patient group, p&lt; 0.01. Death occurred among 29% of TN vs. 14% of non-TN, p&lt; 0.01.&#x2028; For the patients that were treated with BCT, 94% of TN patients completed their adjuvant radiation therapy and 73% received chemotherapy. Of those receiving BCT, recurrence was 28% for TN patients and 6% for non-TN patients (p&lt;0.01). Local recurrence was 9% and 4% for TN and non-TN patients, respectively and distant metastatic rate was 16% versus 2% respectively (p&lt; 0.01). There were no regional recurrences in the BCT group. Time to recurrence, OS, time to death, and breast cancer specific death did not differ between the two groups.&#x2028; Conclusion&#x2028; A significant increase in local recurrence and distant metastatic rates were observed after BCT among patients diagnosed with TN breast cancers; however there was not a significant short-term survival difference between the TN and non-TN receptor groups. The complexity of this patient population within the conventional treatment algorithm warrants further investigation to reduce local and distant recurrences.

Citation Information: Cancer Res 2009;69(2 Suppl):Abstract nr 5127.

Is dental care utilization associated with oral cavity cancer in a large sample of community-based United States residents?

OBJECTIVES

Cancer of the oral cavity and pharynx remains one of the 10 leading causes of cancer deaths in US. Besides smoking and alcohol consumption, there are no well-established risk factors. While poor dental care had been implicated, it is unknown if lack of dental care, implying poor dental hygiene predisposes to oral cavity cancer. This study aimed to assess the relationship between dental care utilization during the past 12 months and the prevalence of oral cavity cancer.

METHODS

A cross-sectional design of the National Health Interview Survey of Adult, noninstitutionalized US residents (n=30 475) was used to assess the association between dental care utilization and self-reported diagnosis of oral cavity cancer. Chi-square statistic was used to examine the crude association between the explanatory variable, dental care utilization and other covariates, while unconditional logistic regression was used to assess the relationship between oral cavity cancer and dental care utilization.

RESULTS

There were statistically significant differences between those who utilized dental care during the past 12 months and those who did not with respect to education, income, age, marital status, and gender (P<0.05), but not health insurance coverage (P=0.53). In addition, those who utilized dental care relative to those who did not were 65% less likely to present with oral cavity cancer, prevalence odds ratio (POR), 0.35, 95% confidence interval (CI), 0.12-0.98. Further, higher income, advanced age, people of African heritage, and unmarried status were statistically significantly associated with oral cavity cancer (P<0.05), but health insurance coverage, alcohol use, and smoking were not, P>0.05. After simultaneously controlling for the relevant covariates, the association between dental care and oral cavity cancer did persist but imprecise. Thus, when compared with those who did not use dental care, those who did were 62% less likely to be diagnosed with oral cavity cancer, adjusted POR, 0.38, 95% CI, and 0.13-1.10.

CONCLUSIONS

Among US adults residing in community settings, use of dental care during the past 12 months was marginally statistically significantly associated with oral cavity cancer, but clinically relevant in assessing oral cavity cancer prevalence in this sample. However, because of the nature of our data, which restricts temporal sequence, a large sample prospective study that may identify modifiable factors associated with oral cavity cancer development, namely poor dental care is needed.

Potential markers of female condom use among inner city African-American women

Despite the availability of the female condoms and theoretically based interventions to promote its use, studies have indicated a low level of acceptability of their use among women in most populations. We aimed to determine female condom use prevalence and the potential markers among African-American women. In an intervention trial to test the efficacy of the Information-Motivation-Behavioral Skills model in increasing condom use, we utilized the baseline data of 280 subjects and examined the potential predictors of female condom use. Chi square statistic and unconditional logistic regression were used to test for group independence among users and non-users of the female condom and to assess the potential markers of female condom use respectively. After adjustment for relevant covariates associated independently with female condom use, the significant potential markers for female condom use were age, multiple sexual relationships, knowledge of female condom, and educational status. Women having multiple sexual relationships compared with a monogamous relationship were five times more likely to use the female condom, while women with high school education were three times more likely to use the female condom; prevalence odds ratio, POR=5.32, 95% CI=1.79-15.83 and POR=3.01, 95% CI=1.01-8.93. Women who were not knowledgeable of the female condom, compared to those who were, were 81% less likely to use the female condom, POR=0.19, 95% CI=0.08-0.45. Among African-American women in this sample, knowledge of female condom use, age, educational status, and multiple sexual relationships were significant markers of female condom use. This study is therefore suggestive of the need to educate African-American women on female condom use, given the obstacles in male condom negotiation, especially among the socio-economically challenged.

Effectiveness of androgen deprivation therapy in prolonging survival of older men treated for locoregional prostate cancer

Epidemiologic and experimental evidence suggests the effectiveness of androgen deprivation therapy (ADT) in prostate cancer (CaP) management. Although ADT has been increasingly used as mono-therapy in CaP, the survival benefit of ADT remains unclear. We examined the effectiveness of ADT in prolonging survival in a community-based cohort of 64 475 older men diagnosed with locoregional CaP, in 1992-1999 with last follow-up through December 2002, in 11 Surveillance Epidemiology and End Results (SEER) registries. The effect of ADT on survival was assessed using Kaplan-Meier's method, log-rank test and Cox proportional hazards. After adjustment for propensity to receive ADT, the ADT and non-ADT groups were significantly different in the distribution of covariates except for comorbidity score and SEER registries. The crude overall mortality was significantly higher in cases with ADT compared with cases that received no ADT, hazard ratio (HR=1.54; 95% CI=1.50-1.58). However, mortality was substantially reduced (1.04, 1.00-1.08) after adjusting for standard care, socio-demographics, tumor characteristics, prognostic factors and chemotherapy. Therefore, ADT was not associated with significantly increased survival benefit for older men with locoregional CaP. Further studies may be needed to explore whether ADT is associated with other health benefits and the cost-effectiveness of these benefits.

Aspects of sample preparation for the determination of actinoids in soil

In the frame of the re-certification measurements of the IAEA-375 soil reference material the activity concentration of four actinoids (U, Th, Pu and Am) was determined. The method is based on microwave digestion or aqua regia leaching, separation by extraction chromatography and alpha-particle counting source preparation by co-precipitation or electro-deposition. This article describes some of the problems encountered during the validation of the sample preparation method and their solutions.