Debriefers are observers too: leveraging learning objectives to focus debriefer observations and frame the debriefing conversation

Debriefing is challenging and daunting for the novice debriefer. Debriefing literature is focused on the debrief conversation and the process of debriefing, with little guidance provided on how to observe the scenario and prepare for the debrief. Research in the simulation learner observer role reveals that engagement with the scenario through directed observation primes the learner to notice actions and events which may have been otherwise overlooked. Similarly, using the scenario learning objectives to prime and focus their attention, novice debriefers can develop their own observation tool to support data gathering during the scenario. By engaging with the learning objectives to clarify what they may expect to see or hear if the learning objectives are achieved, debriefers are better positioned to notice and collect relevant observational data and frame a debriefing conversation anchored to the scenario objectives.</jats:p

Salvage lenalidomide in four rare oncological diseases

In rare disorders, there are often no standard therapy recommendations. Patients with refractory disease may require novel experimental approaches. Applied as second- up to fourth-line treatment, lenalidomide (10–25 mg perorally on days 1–21 in a 28-day cycle) was used in our cohort of four adult patients with aggressive, multisystem and relapsing diseases. Complete and long-lasting remissions (more than 1 year, no maintenance therapy) were achieved in patients with Langerhans cell histiocytosis (11 cycles, combination with dexamethasone and etoposide, consolidated by allogeneic blood stem cell transplant) and plasma-cell Castleman disease (15 cycles, monotherapy). Mixed response with complete disappearance of brain infiltrates was reached in Erdheim-Chester disease (6 cycles, monotherapy) and gastrointestinal bleeding was well controlled in multiple angiomatosis (9 cycles, combination with thalidomide). For disease activity evaluation each patient underwent fluorine-18-fluorodeoxyglucose positron emission tomography/computed tomography scan imaging, which was complemented by clinical and laboratory investigations. </jats:p

Radiotherapy of glioblastoma 15 years after the landmark Stupp’s trial: more controversies than standards?

The current standard of care of glioblastoma, the most common primary brain tumor in adults, has remained unchanged for over a decade. Nevertheless, some improvements in patient outcomes have occurred as a consequence of modern surgery, improved radiotherapy and up-to-date management of toxicity. Patients from control arms (receiving standard concurrent chemoradiotherapy and adjuvant chemotherapy with temozolomide) of recent clinical trials achieve better outcomes compared to the median survival of 14.6 months reported in Stupp’s landmark clinical trial in 2005. The approach to radiotherapy that emerged from Stupp’s trial, which continues to be a basis for the current standard of care, is no longer applicable and there is a need to develop updated guidelines for radiotherapy within the daily clinical practice that address or at least acknowledge existing controversies in the planning of radiotherapy