Primary palliative care is a core component of nursing practice for which all students must receive formal education. Through competency-based education, nursing students develop the knowledge, attitudes, and skills to deliver quality primary palliative care before they transition to practice. Nurse educators in academic and practice settings should use reliable and valid means to evaluate student learning across cognitive, affective, and psychomotor domains. Expert faculty conducted a literature review to identify published instruments that evaluate primary palliative care student learning outcomes. Selected articles were required to include instrument reliability, validity, or both. The literature search yielded 20 articles that report on the development and testing of 21 instruments. Findings are organized into 3 learning domains that encompass 5 outcomes. Four instruments assess knowledge within the cognitive domain. In the affective domain, 3 instruments assess attitudes about caring for seriously ill or dying patients, 7 assess attitudes about death, and 5 assess self-efficacy. Competence and competency are evaluated in the psychomotor domain with 4 tools. Instrument implementation considerations within each domain are discussed. Faculty are encouraged to use robust evaluation measures such as those identified in the literature review to measure primary palliative care learning outcomes within a competency-based education framework.
We reviewed outcomes of patients with loco-regionally recurrent (LRR) or new primary (NP) squamous cell carcinoma of the head and neck (SCCHN) treated at our institution with reirradiation (RRT). Patients received definitive RRT (DRRT) or post-operative RRT following salvage surgery (PRRT) from 2003 to 2011. Measured survival outcomes included loco-regional relapse free survival (LRFS) and overall survival (OS). Among 81 patients (PRRT, 42; DRRT, 39), median PRRT and DRRT doses were 60 Gy (12–70 Gy) and 69.6 Gy (48–76.8 Gy). The majority of patients received IMRT-based RRT (n = 77, 95 %). With median follow-up of 78.1 months (95 % CI, 56–96.8 months), 2-year OS was 53 % with PRRT and 48 % with DRRT (p = 0.12); 23 % of patients were alive at last follow-up. LRFS at 2 years was 60 %, and did not differ significantly between PRRT and DRRT groups. A trend toward inferior LRFS was noted among patients receiving chemotherapy with RRT versus RRT alone (p = 0.06). Late serious toxicities were uncommon, including osteoradionecrosis (2 patients) and carotid artery bleeding (1 patient, non-fatal). OS of PRRT- and DRRT-treated patients in this series appears superior to the published literature. We used IMRT for the majority of patients, in contrast to several series and trials previously reported, which may account in part for this difference. Future studies should seek to improve outcomes among patients with LRR/NP SCCHN via alternative therapeutic modalities such as proton radiotherapy and by incorporating novel systemic agents.
Background. Metronidazole treats obligate anaerobic bacterial and protozoal infections, with an elimination half-life of around eight hours. The long elimination half-life, the favorable ratio of steady-state serum levels to minimum inhibitory concentration, and the presence of active metabolites lead to consideration of metronidazole use at 12-hour dosage intervals. This systematic review aimed to compare the clinical outcomes of twice-daily and thrice-daily metronidazole dosing. Methods. We used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist. PubMed, Scopus, Science Direct, the Cochrane Database of Systematic Reviews, and the Cochrane Central Register of Controlled Trials to systematically identify all relevant studies published up to June 16, 2023. Results. The final analysis included two published retrospective cohort studies; a single site (n = 200) and a multisite study (n = 85) of ‘good’ quality, as measured by the Newcastle-Ottawa scale. The reported baseline characteristics of the 8-hour and 12-hour dosing groups were comparable, and neither study identified significant differences in primary and secondary clinical outcomes. Meta-analysis of the need to escalate antibiotic therapy also showed no statistically significant differences using the Mantel-Haenszel fixed-effect method (95% CI: 47.6% lower to 6.4 times higher risk, p = 0.342) and inverse-variance method (RR: 1.87, 95% CI: 0.52-6.65, p = 0.336). Conclusions. Dosing metronidazole every 12 hours is as effective as every 8-hour dosing for anaerobic infections. Healthcare systems may consider the adoption of every 12-hour metronidazole dosing with continued evaluation of patient outcomes.
6064 Background: RRT is offered as definitive (DRRT) or post-operative (PRRT) treatment for patients (pts) with loco-regionally recurrent (LRR) or new primary (NP) HNSCC in previously irradiated volumes. We report the results of a retrospective chart review of all consecutive pts with LRR and NP HNSCC treated with DRRT and PRRT at Mayo Clinic. Methods: We included LRR and NP HNSCC pts treated with DRRT/PRRT from 2003-2011 at all Mayo Clinic campuses. Patient and treatment related data were collected. Loco-regional recurrence rate (LR) and distant metastases rate (DM) at 2 years, and overall survival (OS) from end of RRT using Kaplan-Meier methods, were calculated. Results: We identified 89 pts (68 M, 21 F). 67 pts had LRR; 22 NP. Treatment included salvage surgery with PRRT (47 pts) and DRRT (42 pts). 30 pts received concurrent chemotherapy (CT) with PRRT; 33 DRRT pts received CT. Median prior RT dose was 66 Gy (26.4 – 79.2 Gy). Median PRRT dose was 60 Gy (11 – 70 Gy). Median DRRT dose was 69.6 Gy (18 – 76.8 Gy). LR occurred in 42 pts (47%) after RRT; 35 pts (39%) had LR by 2 years (95% CI, 30 – 50%). DM occurred in 20 pts (22%) after RRT; 16 pts (18%) had DM by 2 years (95% CI, 11 – 27%). Median OS was 22.2 mos (95% CI, 17.0 – 29.8 mos), with 2- and 5-year OS 47% and 16%. No difference in OS between LRR- and NP-HNSCC or PRRT and DRRT was found. CT was associated with shorter time to LR (4.3 vs. 12.1 mos, p = 0.008), but not with time to distant metastases or OS. At last follow-up (median 78.1 mos) 21 pts (24%) were alive, with 43.3 mos (95% CI, 27.6 – 52.9 mos) median OS from time of LRR/NP. Among surviving pts, 2 cases of osteoradionecrosis (10%) and 1 carotid artery pseudoaneurysm with sentinel bleed (5%) were reported, with no reported spinal cord injuries. OS was better among 70 pts treated to at least 60 Gy (n = 70) vs. pts treated with less than 60 Gy (median OS 25.2 mos, 95% CI, 19.4 – 32.0 mos; vs. median OS 9.5 mos, 95% CI, 6.8 – 28.7 mos; p = 0.06). Conclusions: RRT cures a small number of pts. 2-year OS of LRR/NP HNSCC pts treated with RRT in the time frame of this study appears superior to published outcomes. Shorter time to LR among pts receiving CT warrants further study, but may signify selection bias toward more aggressive therapy for pts with high risk LRR/NP HNSCC.
