Prolongation of overall treatment time as a cause of treatment failure in early breast cancer: an analysis of the UK START (Standardisation of Breast Radiotherapy) trials of radiotherapy fractionation

AbstractBackgroundTests of tumour treatment time effect in patients prescribed post-operative radiotherapy for early breast cancer have focussed on time to start of radiotherapy rather than overall treatment time. The START randomised trials of radiotherapy fractionation provide an opportunity to directly estimate the effect of treatment acceleration.MethodsBetween 1986 and 2002, a total of 5861 women with early breast cancer were recruited into the UK START pilot (START-P), START-A and START-B randomised trials. START-P and START-A tested 13 fractions of 3.0–3.3Gy against 25 fractions of 2.0Gy with a fixed treatment duration of 5weeks for all schedules; START-B tested 15 fractions of 2.67Gy in 3weeks against 25 fractions of 2.0Gy over 5weeks. Estimates of the effect of length of treatment for local–regional relapse and for a measure of late normal tissue effects (change in photographic breast appearance, for patients following breast conserving surgery) were obtained from Cox proportional hazards regression analyses stratified according to trial.ResultsAt a median follow-up of 10years, 444/5831 (7.6%) patients with data available had a local–regional relapse, and 1135/3185 (35.6%) had mild or marked change in photographic breast appearance by 5years. Adjusting for prognostic factors, the estimate of the overall treatment time effect for local–regional relapse was 0.60Gy/day (95%CI 0.10 to 1.18Gy/day, p=0.02), and 0.14Gy/day (95%CI −0.09 to 0.34Gy/day, p=0.29) for change in photographic breast appearance.ConclusionsCombined analysis of the START trials generates the hypothesis that overall treatment time is a significant determinant of local cancer control after adjuvant whole breast radiotherapy, with approximately 0.6Gy per day ‘wasted’ in compensating for tumour cell proliferation

Relative validity of a web-based food frequency questionnaire for patients with type 1 and type 2 diabetes in Denmark

BACKGROUND: Diet has an important role in the management of diabetes. However, little is known about dietary intake in Danish diabetes patients. A food frequency questionnaire (FFQ) focusing on most relevant nutrients in diabetes including carbohydrates, dietary fibres and simple sugars was developed and validated. OBJECTIVES: To examine the relative validity of nutrients calculated by a web-based food frequency questionnaire for patients with diabetes. DESIGN: The FFQ was validated against a 4-day pre-coded food diary (FD). Intakes of nutrients were calculated. Means of intake were compared and cross-classifications of individuals according to intake were performed. To assess the agreement between the two methods, Pearson and Spearman's correlation coefficients and weighted kappa coefficients were calculated. SUBJECTS: Ninety patients (64 with type 1 diabetes and 26 with type 2 diabetes) accepted to participate in the study. Twenty-six were excluded from the final study population. SETTING: 64 volunteer diabetes patients at the Steno Diabetes Center. RESULTS: Intakes of carbohydrates, simple sugars, dietary fibres and total energy were higher according to the FFQ compared with the FD. However, intakes of nutrients were grossly classified in the same or adjacent quartiles with an average of 82% of the selected nutrients when comparing the two methods. In general, moderate agreement between the two methods was found. CONCLUSION: The FFQ was validated for assessment of a range of nutrients. Comparing the intakes of selected nutrients (carbohydrates, dietary fibres and simple sugars), patients were classified correctly according to low and high intakes. The FFQ is a reliable dietary assessment tool to use in research and evaluation of patient education for patients with diabetes

Orthopaedic Physical Therapy Residency and Fellowship Program Mentoring Structure: A Survey of Program Directors

Purpose/Hypothesis: Mentoring is a required component of physical therapy residency and fellowship training, and a primary reason applicants pursue training in these programs. Resources outlining core competencies for effective mentoring, mentor and mentee characteristics, and recommendations for effective mentoring have been described. However, little is known about the timing, structure, and process of how mentoring and feedback is implemented across residency and fellowship programs. The purpose of this study was to better understand the structure, timing, and delivery of mentoring and the role mentors and program directors (PDs) play in orthopaedic physical therapy residency and fellowship programs. A secondary purpose was to identify the influence of the COVID-19 pandemic on mentoring delivery. Number of Subjects: A survey was sent to 135 accredited orthopaedic physical therapy residency and fellowship program directors Materials and Methods: A practice committee of the Academy of Orthopaedic Physical Therapy Orthopaedic Residency and Fellowship Special Interest Group developed survey questions. Forty-eight questions about program background, mentoring logistics, structure, delivery, transitions, training, selection, feedback, communication, mentor roles, and impacts of COVID-19 on mentoring were asked. Questions were entered into a secure Red Cap survey and a recruitment email with survey link was sent to PDs from accredited programs on three separate occasions over two months. Descriptive statistics and survey responses were analyzed. Results: PDs submitted 32 surveys (23.7% response rate), had 15.9 (8.5) years’ experience as a physical therapist and a mean program involvement of 6.3 (3.2) years. Programs most often schedule 1:1 mentoring weekly (63%) or several days/week (25.9%); most often in four hour blocks (44.4%) for a mean of 157.6 (60.3) hours. Mentee feedback was delivered before, during, or after the mentoring session verbally 92.3%, and feedback was shared with the resident in front of the patient often 26.9%, sometimes 61.5% and rarely 11.5%. Mentoring was delivered 100% in-person by programs and virtually by 42.3%. Mentor and mentee paired assignments varied with 65.4% assigning more than one mentor. Most programs (84.6%) do not have a career development ladder for mentors. The COVID-19 pandemic influenced mentoring delivery with 53.8% using increased virtual mentoring, 19.2% using increased asynchronous mentoring, and 42.3% decreasing mentoring hours during the pandemic. Conclusions: Orthopaedic physical therapy residency and fellowship mentoring is delivered using a variety of methods, and mentors and program directors cross-cover multiple positions in residency and fellowship programs. Identifying the structure and delivery of mentoring commonly used in residency and fellowship programs provides baseline data to better understand optimal mentoring approaches and influence of mentoring structure on resident and fellowship outcomes