The value of molecular stratification for CEBPA_DM and NPM1_MUT_FLT3_WT genotypes in older patients with acute myeloid leukaemia

Older adult patients (≥60 years) with acute myeloid leukaemia (AML) are generally considered to be poor-risk and there is limited information available regarding risk stratification based on molecular characterization in this age group, particularly for the double-mutant CEBPA (CEBPADM) genotype. To investigate whether a molecular favourable-risk genotype can be identified, we investigated CEBPA, NPM1 and FLT3 status and prognostic impact in a cohort of 301 patients aged 60 years or more with intermediate-risk cytogenetics, all treated intensively. Overall survival (OS) at 1 year was highest in the 12 patients (4%) that were CEBPADM compared to the 76 (28%) with a mutant NPM1 and wild-type FLT3 (NPM1MUTFLT3WT) genotype or all other patients (75%, 54%, 33% respectively), with median survival 15·2, 13·6 and 6·6 months, although the benefit was short-term (OS at 3 years 17%, 29%, 12% respectively). Combination of the CEBPADM and NPM1MUTFLT3WT genotype patients defined a molecular group with favourable prognosis (P < 0·0001 in multivariate analysis), with 57% of patients alive at 1 year compared to 33% for all other patients. Knowledge of genotype in older cytogenetically intermediate-risk patients might influence therapy decisions

Improving the quality of your measurement system by bringing it up to date

NRC publication: Ye

Improving the quality of your measurement system by bringing it up to date

NRC publication: Ye

Updates to the NRC gauge block interferometer

NRC publication: Ye

Why do trainees leave hospital based specialty training? A nationwide survey study investigating factors involved in attrition and subsequent career choices in the Netherlands

Objective To gain insight into factors involved in attrition) from) hospital-based medical specialty training and future career plans of trainees who prematurely left their specialty training programme.Design Nationwide online survey study.Setting Postgraduate education of all hospital-based specialties in the Netherlands.Participants 174 trainees who prematurely left hospital-based medical specialty training between January 2014 and September 2017.Main outcome measures Factors involved in trainees' decisions to leave specialty training and their subsequent career plans.Results The response rate was 38 /0. Of the responders, 25% left their programme in the first training year, 50% in year 2-3 and 25% in year 4-6. The most frequently reported factors involved in attrition were: work-life balance, job content, workload and specialty culture. Of the leaving trainees, 66% switched to another specialty training programme, of whom two-thirds chose a non-hospital -based training programme. Twelve per cent continued their career in a non-clinical role and the remainder had no specific plans yet.Conclusions This study provides insight in factors involved in attrition and in future career paths. Based on our findings, possible interventions to reduce attrition are: (1) enable candidates to develop a realistic view on job characteristics and demands, prior to application; (2) provide individual guidance during specialty training, with emphasis on work-life balance and fit with specialty.Obstetric

Quality of life during occlusion therapy for amblyopia from the perspective of the children and from that of their parents, as proxy

Background: Parents pity their amblyopic child when they think that they suffer from occlusion therapy. We measured health-related quality of life during occlusion therapy. Methods: We developed the Amblyopia Parents and Children Occlusion Questionnaire (APCOQ). It was designed by a focus group of patients, orthoptists and ophthalmologists and consisted of twelve items concerning skin contact of patch, activities, contact with other children, emotions and awareness of necessity to patch. Parents filled out the Proxy Version shortly before the Child Version was obtained from their child. Child Version item scores were compared with Proxy Version item scores and related to the child’s age, visual acuity, refraction, angle of strabismus, and cause of amblyopia. Results: 63 children were recruited by orthoptists, and their parents agreed to participate. Three children were excluded: one child with Down-syndrome, one child with cerebral palsy, and one child who had been treated by occlusion therapy. Included were 60 children (mean age 4.57 ± 1.34 SD) and 56 parents. Children had occluded 128 ± 45 SD days at interview. Prior to occlusion, 54 children had worn glasses. Cronbach’s α was 0.74 for the Child Version and 0.76 for the Proxy Version. Children judged their quality of life better than their parents did, especially pertaining to skin contact and activities like games and watching TV. Notably, 13 children with initial visual acuity ≥ 0.6 logMAR in the amblyopic eye experienced little trouble with games during occlusion. Quality of life in eight children with strabismus of five years and older correlated negatively (Spearman rank mean rho = -0.43) with angle of strabismus. Children with amblyopia due to both refractive error and strabismus (n = 14) had, relatively, lowest quality of life, also according to their parents, as proxy. Several children did not know why they wore a patch, contrary to what their parents thought. Conclusions: Children’s quality of life during occlusion therapy is affected less than their parents think, especially regarding skin contact, playing games and watching TV during occlusion. Quality of life correlates negatively with the angle of strabismus in children five years and older. Children do not know why they wear a patch, contrary to what their parents think. Notably, children with low visual acuity in the amblyopic eye, had little difficulty playing games

Values and beliefs on trainee selection: What counts in the eye of the selector? A qualitative study exploring the program director’s perspective

Objectives: Postgraduate trainee selection is a high-stakes process. While many studies focused on selection methods and psychometrics, little is known about the influence of selectors’ personal values and beliefs in the judgment and decision-making process. A better understanding of these factors is vital since selectors determine the future workforce. Methods: We interviewed programme directors (PDs) from 11 specialties in one University Hospital. Thematic analysis was conducted with a combined approach of generic and in-vivo coding. Results: PDs value excellence, ‘fit’ and personal characteristics. The content of these values are subject to personal interpretation and differ between PDs. PDs use various ‘proxies’ as alternative indicators of performance. They consider intuition, teamwork and autonomy important in judgement and decision-making. PDs find selection challenging and feel great accountability towards candidates and society. Conclusions: Selectors criteria of judgement- and decision-making often remain implicit and focus on prior achievements and ‘fit’ with the current trainee-pool, possibly compromising the workforce’s diversity. Implicit ‘proxies’ and intuitive decision-making may be an unwitting source of judgemental bias. ‘Making the implicit explicit’, by increasing awareness of personal values and beliefs and structuring the selection interview, may improve the quality of trainee selection.Science Education and Communicatio

Simulator training in fetoscopic laser surgery for twin-twin transfusion syndrome: a pilot randomized controlled trial

To evaluate the effect of a newly developed training curriculum on the performance of fetoscopic laser surgery for twin-twin transfusion syndrome (TTTS) using an advanced high-fidelity simulator model.status: publishe

Simulator training in fetoscopic laser surgery for twin-twin transfusion syndrome: a pilot randomized controlled trial

Developmen