Closing the gap: the development of a knowledge translation course designed to improve evidence-based clinical practice for school professionals

Knowledge translation includes the steps of researching and establishing best practices, communicating those findings to stakeholders and consumers, and then using that information effectively in practice (Straus, Tetroe, & Graham, 2009). Knowledge translation usually takes the form of conducting research, creating systematic reviews and other research articles, and publishing in academic journals, all of which are not enough to guarantee that knowledge will actually be used in clinical practice (Straus et al., 2009). Therefore, there needs to be a more explicit process for improving knowledge translation to increase the use of evidence-based interventions in clinical practice (Straus et al., 2009). This doctoral project will focus on improving knowledge translation as it applies to occupational therapy researchers disseminating research knowledge to school-based professionals and will further explore the barriers both occupational therapy researchers and school professionals face with knowledge translation. The proposed solution is an online course titled Closing the Gap: A Knowledge Translation Course Designed to Improve Evidence-Based Clinical Practice for School Professionals. This course will be developed in order to address the current gap between knowledge translation and clinical practice; and to improve research utilization in occupational therapy in school settings in particular. This six-week course utilizes an online learning environment through teachable.com in order to increase accessibility of information to course participants and to allow for weekly self-paced learning to promote participant success. The course will include multiple professional development activities, such as small discussion work through an online discussion board, case studies, and problem-based learning as these are proven methods to effectively promote confidence with integrating research into clinical practice (Anaby, Korner-Bitensky, Law, & Cormier, 2015; Cahill, Egan, Wallingford, Huber-Lee, and Dess-McGuire, 2015). The online course described above aims to improve evidence clinical practice in school settings by increasing direct communication between the school professionals and researchers, by having school professionals practice applying research to relevant clinical cases, and by having researchers practice communicating research findings to other professionals. This online course is critically needed in order to make knowledge translation more intentional, to improve evidence-based clinical practice, and to achieve AOTA’s 2025 Vision of being an effective and evidence-based profession

Kiss the Soul: Ways to Empower Creative Change Leadership and Intuition in Organizations Starting by Creating a Training Module for a Consultancy

One way to Kiss the Soul to empower Creative Change Leadership and Intuition in organizations is by training. This project is about the development and implementation of a new online training module in March 2021 to a small group of an Amsterdam consultancy. It consisted of four two and a half hour zoom sessions on Thursday evenings. The training is placed in a context of kissing the soul for new unexpected beautiful and meaningful organizational impact. This original concept of Kissing the Soul means: making loving contact with what matters deeply to yourself and sharing this with other people to make beautiful organizational impact together. This is grounded in the belief that if people are guided in their work by their creative mind combined with their heart, body and soul - by their own spirit - and make connections with the spirit of other people they work with or for, working life will be more worthwhile and the world will accordingly become more beautiful and meaningful. The literature review is an exploration on what it might take to make training, to lead for creative change in organizations. What tapping into your intuition or inner wisdom might be about. What it takes to be a successful creative change leader, someone who navigates the upsides and downsides of creativity in organizations for productive change. Why making contact with what really matters in inner work life by the deliberate integration of creativity and intuition is essential for joy, energy and creative breakthroughs

Hospice Providers Awareness of the Benefits and Availability of Single-Fraction Palliative Radiotherapy

Radiotherapy effectively palliates malignant sources of pain. However, once enrolled on hospice, patients are rarely referred for this treatment. To develop educational strategies that can improve access to care, a survey of hospice providers investigated potential misconceptions about its benefits and availability. Individual surveys were distributed to administrators, nursing directors, and medical directors at 16 licensed hospices within 25 miles of a radiation oncology facility. Ninety-three percent of hospice professionals stated radiotherapy provides pain relief and is appropriate for patients with more than 1 month of life expectancy. However, less than 1% of their cancer patients had been referred to a radiation oncologist over the past year, citing concerns about cost and travel burden. Whereas most medical directors (75%) were aware it is just as effective when delivered in a single fraction, very few administrators (22%) and nursing directors (21%) had this knowledge. Meanwhile, reluctance of a radiation oncologist to offer single-fraction palliative radiotherapy was experienced by 43%. Access to palliative radiotherapy for this unique population can be increased by improving education for hospice administrators and nursing directors and reminding radiation oncologists that single-fraction palliative radiotherapy is acceptable and ideal for patients with limited financial resources at the end of life

Targeting the TGF-β1 Pathway to Prevent Normal Tissue Injury After Cancer Therapy

Evidence supporting the critical role of transforming growth factor β1 in the development of normal tissue injury after cancer therapy is reviewed and the results of recent research aimed at preventing normal tissue injury by targeting the transforming growth factor β1 pathway are presented

Physical Activity and Sedentary Behavior of Cancer Survivors and Non-Cancer Individuals: Results from a National Survey

Increasing physical activity and decreasing sedentary behavior are associated with a higher quality of life and lower mortality rates for cancer survivors, a growing population group. Studies detailing the behavior of cancer survivors are limited. Therefore, we investigated physical activity and sedentary behavior of cancer survivors using data from the National Health and Nutrition Examination Survey (NHANES) 2007–2010. Participants were those who provided physical activity and sedentary behavior data. Those who were pregnant,old, or10,472 non-cancer participants. After adjustment for age, race, gender, education status, body mass index, and smoking status, cancer survivors (n = 10,472) reported significantly longer duration of sedentary behavior (OR = 1.42, 95% CI (1.12, 1.80) for 8 or more hours, p-value for trend = 0.09), compared to non-cancer participants (n = 741). They also reported non-significant increases in maximum intensity, duration, frequency, and energy expenditure, whereas they reported significant increases in moderate intensity (OR = 1.26, 95% CI (1.01, 1.57)), moderate frequency (1–4 times/week) (OR = 1.32, 95% CI (1.00, 1.74)), and moderate energy expenditure (4018.5–7623.5 kcal) (OR = 1.30, 95% CI (1.00, 1.71)) of physical activity, compared to non-cancer participants. These patterns are similar for breast and prostate cancer survivors, with prostate cancer survivors more likely to engage in physical activity for more than one hour per day (OR = 1.98, 95% CI (1.05, 3.71)). Our findings suggest that cancer survivors tend to have more physical activity, but they are also more likely to engage in sedentary behavior

Residual disease after re-excision lumpectomy for close margins

Introduction While a positive margin after an attempt at breast conservation therapy (BCT) is a reason for concern, there is more controversy regarding close margins. When re-excisions are performed, there is often no residual disease in the new specimen, calling into question the need for the procedure. We sought to examine the incidence of residual disease after re-excision for close margins and to identify predictive factors that may better select patients for re-excision. Methods Our IRB-approved prospective breast cancer database was queried for all breast cancer patients who underwent a re-excision lumpectomy for either close or positive margins after an attempt at BCT. Close margins are defined as ≤2 mm for invasive carcinoma and ≤3 mm for DCIS. Clinicopathologic features were correlated with the presence of residual disease in the re-excision specimen. Results Three hundred three patients (32%) underwent re-operation for either close (173) or positive (130) margins. Overall, 33% had residual disease identified, 42% of DCIS patients and 29% of patients with invasive disease, nearly identical to patients with positive margins. For patients with DCIS, only younger age was significantly related to residual disease. For patients with invasive cancer, only multifocality was significantly associated with residual disease (OR 3.64 [1.26–10.48]). However, patients without multifocality still had a substantial risk of residual disease. Discussion The presence of residual disease appears equal between re-excisions for close and positive margins. No subset of patients with either DCIS or invasive cancer could be identified with a substantially lower risk of residual disease. J. Surg. Oncol. 2009;99: 99–103. © 2008 Wiley-Liss, Inc.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/61535/1/21215_ftp.pd

Cytokine Plasma Levels: Reliable Predictors for Radiation Pneumonitis?

BACKGROUND: Radiotherapy (RT) is the primary treatment modality for inoperable, locally advanced non-small-cell lung cancer (NSCLC), but even with highly conformal treatment planning, radiation pneumonitis (RP) remains the most serious, dose-limiting complication. Previous clinical reports proposed that cytokine plasma levels measured during RT allow to estimate the individual risk of patients to develop RP. The identification of such cytokine risk profiles would facilitate tailoring radiotherapy to maximize treatment efficacy and to minimize radiation toxicity. However, cytokines are produced not only in normal lung tissue after irradiation, but are also over-expressed in tumour cells of NSCLC specimens. This tumour-derived cytokine production may influence circulating plasma levels in NSCLC patients. The aim of the present study was to investigate the prognostic value of TNF-alpha, IL-1beta, IL-6 and TGF-beta1 plasma levels to predict radiation pneumonitis and to evaluate the impact of tumour-derived cytokine production on circulating plasma levels in patients irradiated for NSCLC. METHODOLOGY/PRINCIPAL FINDINGS: In 52 NSCLC patients (stage I-III) cytokine plasma levels were investigated by ELISA before and weekly during RT, during follow-up (1/3/6/9 months after RT), and at the onset of RP. Tumour biopsies were immunohistochemically stained for IL-6 and TGF-beta1, and immunoreactivity was quantified (grade 1-4). RP was evaluated according to LENT-SOMA scale. Tumour response was assessed according to RECIST criteria by chest-CT during follow-up. In our clinical study 21 out of 52 patients developed RP (grade I/II/III/IV: 11/3/6/1 patients). Unexpectedly, cytokine plasma levels measured before and during RT did not correlate with RP incidence. In most patients IL-6 and TGF-beta1 plasma levels were already elevated before RT and correlated significantly with the IL-6 and TGF-beta1 production in corresponding tumour biopsies. Moreover, IL-6 and TGF-beta1 plasma levels measured during follow-up were significantly associated with the individual tumour responses of these patients. CONCLUSIONS/SIGNIFICANCE: The results of this study did not confirm that cytokine plasma levels, neither their absolute nor any relative values, may identify patients at risk for RP. In contrast, the clear correlations of IL-6 and TGF-beta1 plasma levels with the cytokine production in corresponding tumour biopsies and with the individual tumour responses suggest that the tumour is the major source of circulating cytokines in patients receiving RT for advanced NSCLC

The TGF-β/Smad Repressor TG-Interacting Factor 1 (TGIF1) Plays a Role in Radiation-Induced Intestinal Injury Independently of a Smad Signaling Pathway

Despite advances in radiation delivery protocols, exposure of normal tissues during the course of radiation therapy remains a limiting factor of cancer treatment. If the canonical TGF-β/Smad pathway has been extensively studied and implicated in the development of radiation damage in various organs, the precise modalities of its activation following radiation exposure remain elusive. In the present study, we hypothesized that TGF-β1 signaling and target genes expression may depend on radiation-induced modifications in Smad transcriptional co-repressors/inhibitors expressions (TGIF1, SnoN, Ski and Smad7). In endothelial cells (HUVECs) and in a model of experimental radiation enteropathy in mice, radiation exposure increases expression of TGF-β/Smad pathway and of its target gene PAI-1, together with the overexpression of Smad co-repressor TGIF1. In mice, TGIF1 deficiency is not associated with changes in the expression of radiation-induced TGF-β pathway-related transcripts following localized small intestinal irradiation. In HUVECs, TGIF1 overexpression or silencing has no influence either on the radiation-induced Smad activation or the Smad3-dependent PAI-1 overexpression. However, TGIF1 genetic deficiency sensitizes mice to radiation-induced intestinal damage after total body or localized small intestinal radiation exposure, demonstrating that TGIF1 plays a role in radiation-induced intestinal injury. In conclusion, the TGF-β/Smad co-repressor TGIF1 plays a role in radiation-induced normal tissue damage by a Smad-independent mechanism