Development and Implementation of a Peer Mentoring Program for Early Career Gerontological Faculty: Mentoring Early Career Gerontological Faculty

In conjunction with the National Hartford Centers of Gerontological Nursing Excellence (NHCGNE), formerly known as the Building Academic Geriatric Nursing Capacity Initiative (BAGNC), the Hartford Gerontological Nursing Leaders (HGNL) developed and executed a program beginning in 2011 to enhance both (a) the experience of newly selected scholars and fellows to the NHCGNE and (b) the ongoing professional development of the HGNL. The purpose of this article is to describe key strategies used to develop and execute the mentoring program and to present the formative and summative program evaluation

31st Annual Meeting and Associated Programs of the Society for Immunotherapy of Cancer (SITC 2016) : part two

Background The immunological escape of tumors represents one of the main ob- stacles to the treatment of malignancies. The blockade of PD-1 or CTLA-4 receptors represented a milestone in the history of immunotherapy. However, immune checkpoint inhibitors seem to be effective in specific cohorts of patients. It has been proposed that their efficacy relies on the presence of an immunological response. Thus, we hypothesized that disruption of the PD-L1/PD-1 axis would synergize with our oncolytic vaccine platform PeptiCRAd. Methods We used murine B16OVA in vivo tumor models and flow cytometry analysis to investigate the immunological background. Results First, we found that high-burden B16OVA tumors were refractory to combination immunotherapy. However, with a more aggressive schedule, tumors with a lower burden were more susceptible to the combination of PeptiCRAd and PD-L1 blockade. The therapy signifi- cantly increased the median survival of mice (Fig. 7). Interestingly, the reduced growth of contralaterally injected B16F10 cells sug- gested the presence of a long lasting immunological memory also against non-targeted antigens. Concerning the functional state of tumor infiltrating lymphocytes (TILs), we found that all the immune therapies would enhance the percentage of activated (PD-1pos TIM- 3neg) T lymphocytes and reduce the amount of exhausted (PD-1pos TIM-3pos) cells compared to placebo. As expected, we found that PeptiCRAd monotherapy could increase the number of antigen spe- cific CD8+ T cells compared to other treatments. However, only the combination with PD-L1 blockade could significantly increase the ra- tio between activated and exhausted pentamer positive cells (p= 0.0058), suggesting that by disrupting the PD-1/PD-L1 axis we could decrease the amount of dysfunctional antigen specific T cells. We ob- served that the anatomical location deeply influenced the state of CD4+ and CD8+ T lymphocytes. In fact, TIM-3 expression was in- creased by 2 fold on TILs compared to splenic and lymphoid T cells. In the CD8+ compartment, the expression of PD-1 on the surface seemed to be restricted to the tumor micro-environment, while CD4 + T cells had a high expression of PD-1 also in lymphoid organs. Interestingly, we found that the levels of PD-1 were significantly higher on CD8+ T cells than on CD4+ T cells into the tumor micro- environment (p < 0.0001). Conclusions In conclusion, we demonstrated that the efficacy of immune check- point inhibitors might be strongly enhanced by their combination with cancer vaccines. PeptiCRAd was able to increase the number of antigen-specific T cells and PD-L1 blockade prevented their exhaus- tion, resulting in long-lasting immunological memory and increased median survival

The effects of a palliative care team on mortality, utilization, and cost in a large non-profit teaching hospital.

Overview: Over the past five years the number of inpatient palliative care teams (PCTs) has grown drastically in the United States. However, 70% of U.S. hospitals continue to provide end-of-life healthcare services in the absence of a PCT. While studies have shown that PCTs contribute to improved quality of life, patient satisfaction, and short-term utilization and costs, few have examined whether these consultations have long-term effects. Methods: This study utilized a matched cohort design to examine mortality, cost, and utilization up to one year after an initial PCT consultation. Patients admitted to a large non-profit hospital between June 2004 and December 2007 were included. Patients seen by the PCT during that time were matched to 'usual care' patients based on age, risk of mortality, prior year hospitalized days, and disease. Utilization and cost measures were abstracted from hospital administrative claims and cost accounting data; mortality data were collected from the social security death index. Analyses were performed using summary statistics, chi square analysis, regression models, Kaplan-Meier survival analysis, and Cox proportional hazard models. Results: A total of 361 intervention subjects were matched to a total of 361 usual care subjects. Results revealed patients receiving a PCT consultation were associated with a 2.5 times greater likelihood of dying during the follow-up period, most of which was likely caused by decreased intervention in the first 60 days post consultation. No differences were found in inpatient mortality. Decreases were found in the likelihood of hospitalization at 12 months (OR 0.68, p&lt;.01) and overall length of stay (OR 0.65, p&lt;.05) over the follow-up period when subjects were initially seen by the PCT. Additionally, patients receiving an initial PCT consultation had lower costs to the hospital over the follow-up period (4433, p<.0001), saving approximately 1.6 million among the study population.Conclusion: These findings suggest that use of inpatient PCTs decreases hospital utilization and costs of a vulnerable end-of-life population, having no effect on inpatient mortality rates. Therefore, the implementation and maintenance of inpatient PCTs has the possibility to improve hospital net income while also improving the quality of patient care for those at the end-of-life

Development and Implementation of a Peer Mentoring Program for Early Career Gerontological Faculty

PurposeThe Hartford Gerontological Nursing Leaders (HGNL) formerly known as the Building Academic Geriatric Nursing Capacity Initiative (BAGNC), in conjunction with the National Hartford Centers of Gerontological Nursing Excellence (NHCGNE), developed and executed a peer mentoring program beginning in 2011 to enhance both (a) the experience of newly selected scholars and fellows to the NHCGNE and (b) the ongoing professional development of HGNL members. The purpose of this article is to describe key strategies used to develop and execute the peer mentoring program and to present formative program evaluation.DesignThe program was launched in January 2011 with seven peer mentor and mentee matches. In June 2012, the peer mentoring committee solicited feedback on the development of the peer mentoring program and changes were made for the subsequent cohorts.FindingsAn additional 12 matches were made in the following 2 years (2012 and 2013), for a total of 31 matches to date. We have learned several key lessons from our three cohorts regarding how to structure, implement, and carefully evaluate a peer mentoring program.ConclusionsInformal evaluation of our peer mentoring program noted several challenges for both peer mentors and mentees. Having knowledge of and addressing those challenges may increase the overall quality and effectiveness of peer mentoring programs and, in turn, benefit academic nursing by strengthening the faculty workforce.Clinical relevanceFindings from development and implementation of a peer mentoring program for gerontological faculty could lead to new and adaptable programs in a variety of clinical and education settings