Prognostic Role of Androgen Receptor in Triple Negative Breast Cancer: A Multi-Institutional Study

Background: Androgen Receptor (AR) has emerged as a potential therapeutic target for AR-positive triple-negative breast cancer (TNBC). However, conflicting reports regarding AR’s prognostic role in TNBC are putting its usefulness in question. Some studies conclude that AR positivity indicates a good prognosis in TNBC whereas others suggest the opposite, and some show that AR status has no significant bearing on the patients’ prognosis. Methods: We evaluated the prognostic value of AR in resected primary tumors from TNBC patients from six international cohorts {US (n=420), UK (n=239), Norway (n=104), Ireland (n=222), Nigeria (n=180), and India (n=242); total n=1407}. All TNBC samples were stained with the same anti-AR antibody using the same immunohistochemistry protocol, and samples with ≥1% of AR-positive nuclei were deemed AR-positive TNBCs. Results: AR status shows population-specific patterns of association with patients’ overall survival after controlling for age, grade, population, and chemotherapy. We found AR-positive status to be a marker of good prognosis in US and Nigerian cohorts, a marker of poor prognosis in Norway, Ireland and Indian cohorts, and neutral in UK cohort. Conclusion: AR status, on its own, is not a reliable prognostic marker. More research to investigate molecular subtype composition among the different cohorts is warranted

Telepsychiatry: effectiveness and feasibility

Amy Gajaria,1 David K Conn,1,2 Robert Madan1,2 1Department of Psychiatry, University of Toronto, Toronto, ON, Canada; 2Department of Psychiatry, Baycrest Health Sciences, Toronto, ON, Canada Abstract: Providing psychiatric services by real-time videoconferencing has been increasingly adopted as a method of reaching hard-to-serve populations since the early 1990s. As the field has expanded, a growing body of research has developed investigating both how telepsychiatry compares to in-person psychiatric care and how effectively telepsychiatry can be implemented in routine clinical care. A narrative review was performed to consider the evidence that telepsychiatry is feasible and effective across a variety of patient populations and clinical settings. There is a growing body of evidence investigating the efficacy of telepsychiatry when used for psychiatric assessment and treatment in the adult, child, and geriatric populations. Though studies vary in quality, they generally demonstrate that telepsychiatry is effective across multiple age groups and clinical settings. Telepsychiatry is generally well accepted by patients and clinicians and is feasible to implement, with the suggestion that some patients may actually prefer telepsychiatry to in-person treatment. Issues to consider in the implementation of telepsychiatry services include funding and reimbursement, medico-legal issues when provision crosses legislative boundaries, incorporation into existing health systems, and crosscultural considerations. Future directions for research and practice include a need for higher-quality efficacy studies, consideration of data security, increased attention to low- and middle-income countries, and the introduction of novel technological approaches. Keywords: efficacy, service delivery, telemental health, videoconferencing&nbsp

Factors associated with staff and physician influenza immunization at a children's hospital in Ontario, Canada

Raywat Deonandan, Ghada Al-Sulaiti, Asha Gajaria, Kathryn N SuhSchool of Interdisciplinary Health Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, CanadaAbstract: In 2005, employees and physicians of the Children's Hospital of Eastern Ontario were surveyed about their experiences with and receipt of the 2003–2004 influenza vaccination. With a 29% response rate, 91% of respondents stated that they had received the 2003–2004 vaccine, and physicians were the most likely to have done so (97.2%). Using logistic regression, the only factor significantly predictive of whether an employee or physician received the vaccine was whether they had awareness of a previous formal influenza immunization campaign.Keywords: influenza vaccination, staff, pediatric hospita

An Integrated Care Pathway for depression in adolescents: protocol for a Type 1 Hybrid Effectiveness-implementation, Non-randomized, Cluster Controlled Trial

Abstract Introduction Our group developed an Integrated Care Pathway to facilitate the delivery of evidence-based care for adolescents experiencing depression called CARIBOU-2 (Care for Adolescents who Receive Information ‘Bout OUtcomes, 2nd iteration). The core pathway components are assessment, psychoeducation, psychotherapy options, medication options, caregiver support, measurement-based care team reviews and graduation. We aim to test the clinical and implementation effectiveness of the CARIBOU-2 pathway relative to treatment-as-usual (TAU) in community mental health settings. Methods and analysis We will use a Type 1 Hybrid Effectiveness-Implementation, Non-randomized Cluster Controlled Trial Design. Primary participants will be adolescents (planned n = 300, aged 13–18 years) with depressive symptoms, presenting to one of six community mental health agencies. All sites will begin in the TAU condition and transition to the CARIBOU-2 intervention after enrolling 25 adolescents. The primary clinical outcome is the rate of change of depressive symptoms from baseline to the 24-week endpoint using the Childhood Depression Rating Scale—Revised (CDRS-R). Generalized mixed effects modelling will be conducted to compare this outcome between intervention types. Our primary hypothesis is that there will be a greater rate of reduction in depressive symptoms in the group receiving the CARIBOU-2 intervention relative to TAU over 24 weeks as per the CDRS-R. Implementation outcomes will also be examined, including clinician fidelity to the pathway and its components, and cost-effectiveness. Ethics and dissemination Research ethics board approvals have been obtained. Should our results support our hypotheses, systematic implementation of the CARIBOU-2 intervention in other community mental health agencies would be indicated