Genomic, Pathway Network, and Immunologic Features Distinguishing Squamous Carcinomas

This integrated, multiplatform PanCancer Atlas study co-mapped and identified distinguishing molecular features of squamous cell carcinomas (SCCs) from five sites associated with smokin

Comprehensive and Integrated Genomic Characterization of Adult Soft Tissue Sarcomas

Sarcomas are a broad family of mesenchymal malignancies exhibiting remarkable histologic diversity. We describe the multi-platform molecular landscape of 206 adult soft tissue sarcomas representing 6 major types. Along with novel insights into the biology of individual sarcoma types, we report three overarching findings: (1) unlike most epithelial malignancies, these sarcomas (excepting synovial sarcoma) are characterized predominantly by copy-number changes, with low mutational loads and only a few genes (, , ) highly recurrently mutated across sarcoma types; (2) within sarcoma types, genomic and regulomic diversity of driver pathways defines molecular subtypes associated with patient outcome; and (3) the immune microenvironment, inferred from DNA methylation and mRNA profiles, associates with outcome and may inform clinical trials of immune checkpoint inhibitors. Overall, this large-scale analysis reveals previously unappreciated sarcoma-type-specific changes in copy number, methylation, RNA, and protein, providing insights into refining sarcoma therapy and relationships to other cancer types

Multiplatform Analysis of 12 Cancer Types Reveals Molecular Classification within and across Tissues of Origin

Recent genomic analyses of pathologically-defined tumor types identify “within-a-tissue” disease subtypes. However, the extent to which genomic signatures are shared across tissues is still unclear. We performed an integrative analysis using five genome-wide platforms and one proteomic platform on 3,527 specimens from 12 cancer types, revealing a unified classification into 11 major subtypes. Five subtypes were nearly identical to their tissue-of-origin counterparts, but several distinct cancer types were found to converge into common subtypes. Lung squamous, head & neck, and a subset of bladder cancers coalesced into one subtype typified by TP53 alterations, TP63 amplifications, and high expression of immune and proliferation pathway genes. Of note, bladder cancers split into three pan-cancer subtypes. The multi-platform classification, while correlated with tissue-of-origin, provides independent information for predicting clinical outcomes. All datasets are available for data-mining from a unified resource to support further biological discoveries and insights into novel therapeutic strategies

Data-Driven Graduate Curriculum Redesign: A Case Study

This article discusses the use of Knowles\u27 adult learning theory as the framework for a curriculum redesign within the leadership and management track of a master\u27s of science in nursing program. Health care executives within the university service area were surveyed regarding their organizational needs for advanced practice nurses. A second survey was mailed to a sampling of all RNs in the university service area. In response to perceived community needs, the curriculum of the leadership and management track was redesigned to allow for role specialization within the program. In addition, the university has an infrastructure to support distance learning and an experienced staff able to support distributive learning, providing wide geographical access to students in distant locations

The Effect Of A Critical Pathway On Patients\u27 Outcomes After Carotid Endarterectomy

• BACKGROUND In 1996, an integrated plan of care was implemented to improve quality of care for patients undergoing elective carotid endarterectomy. Goals were to reduce length of stay, costs, number of preoperative and intensive care unit admissions, and use of diagnostic procedures yet maintain good outcomes. • OBJECTIVES To determine whether use of the integrated plan of care met the goals. • METHODS Data on financial and process outcomes, use of angiographic diagnostic procedures, and demographics were retrieved from the hospital\u27s database for all patients who had elective carotid endarterectomy without cerebral infarction. • RESULTS A total of 783 patients met inclusion criteria: 129 before implementation of the plan of care, 66 during the 6-month transition, and 588 after implementation. Preoperative angiography was done in 32% of patients before implementation, 11% during the transition, and 4% after implementation. Percentages of patients admitted to the intensive care unit were 77% before implementation, 24% during transition, and 9% after implementation. Mean lengths of stay were 2.93 days before implementation, 2.12 days during transition, and 1.68 days after implementation. Costs per case were $7798 before implementation,$5750 during transition, and $5387 after implementation. Analysis of variance revealed significant differences between groups in total length of stay (P=.001), preoperative length of stay (P\u3c.001), and costs (P\u3c.001). • CONCLUSION Use of the integrated plan of care reduced length of stay, costs, admissions to intensive care units, and use of cerebral angiography. Use of the plan improved resource utilization while maintaining quality of care

The Effects Of Harp Music In Vascular And Thoracic Surgical Patients

Context • Music has been used in the acute clinical care setting as an adjunct to current treatment modalities. Previous studies have indicated that some types of music may benefit patients by reducing pain and anxiety, and may have an effect on physiological measures. Objective • To evaluate the scientific foundation for the implementation of a complementary therapy, harp playing. The research questions for this pilot study were: Does live harp playing have an effect on patient perception of anxiety, pain, and satisfaction? Does live harp playing produce statistically and clinically significant differences in physiological measures of heart rate, systolic and diastolic blood pressure, respiratory rate, and oxygen saturation? Design • A prospective, quasiexperimental, repeated measures design was used with a convenience sampling. Setting • Orlando Regional Medical Center, Orlando Fla. Patients • Subjects were eligible for the study if they were postoperative and admitted to a hard-wired-bedside-monitored room of the Vascular Thoracic Unit within the days of the study period. Intervention • A single 20-minute live harp playing session. Main Outcome Measures • Visual analog scales (VAS) were used to measure patient anxiety and pain. Patient satisfaction was measured with a 4-item questionnaire. Physiological measures (heart rate, systolic and diastolic blood pressure, respiratory rate, and oxygen saturation) were recorded from the bedside monitor. Methods • Visual analog scales (VAS) were completed just before harp playing, 20 minutes after harp playing was started, and 10 minutes after completion. Patient satisfaction with the experience was measured with a 4-item questionnaire. Physiological measures (heart rate, systolic and diastolic blood pressure, respiratory rate, and oxygen saturation) were recorded from the bedside monitor at baseline (5 minutes before study setup), at zero, 5, 10, 15, and 20 minutes after harp playing began, and at 5 and 10 minutes after harp playing stopped. Results • Seventeen patients were used in this study, with a retrospective power of .91. Results indicate that listening to live harp music has a positive effect on patient perception of anxiety (P=.000), pain (P= .000) and satisfaction. Live harp playing also produced statistically significant differences in physiological measures of systolic blood pressure (P =.046), and oxygen saturation (P =.011). Although all values over time trended downward, the changes of other variables were not adequate to achieve statistical or clinical significance. Conclusion • Subjects in this study experienced decreased pain and anxiety with the harp intervention, and slight reductions in physiologic variable values. It is not possible in this study to determine if the results were due to the harp music, the presence of the harpist and data collector, or both. Future research is recommended using a control group and comparison of live versus recorded harp music with a wider variety of diagnoses and procedures

Bacterial Growth In Secretions And On Suctioning Equipment Of Orally Intubated Patients: A Pilot Study

BACKGROUND Contamination of equipment, colonization of the oropharynx, and microaspiration of secretions are causative factors for ventilator-associated pneumonia. Suctioning and airway management practices may influence the development of ventilator-associated pneumonia. OBJECTIVES To identify pathogens associated with ventilator-associated pneumonia in oral and endotracheal aspirates and to evaluate bacterial growth on oral and endotracheal suctioning equipment. METHODS Specimens were collected from 20 subjects who were orally intubated for at least 24 hours and required mechanical ventilation. At baseline, oral and sputum specimens were obtained for culturing, and suctioning equipment was changed. Specimens from the mouth, sputum, and equipment for culturing were obtained at 24 hours (n=18) and 48 hours (n=10). RESULTS After 24 hours, all subjects had potential pathogens in the mouth, and 67% had sputum cultures positive for pathogens. Suctioning devices were colonized with many of the same pathogens that were present in the mouth. Nearly all (94%) of tonsil suction devices were colonized within 24 hours. Most potential pathogens were gram-positive bacteria. Gram-negative bacteria and antibiotic-resistant organisms were also present in several samples. CONCLUSIONS The presence of pathogens in oral and sputum specimens in most patients supports the notion that microaspiration of secretions occurs. Colonization is a risk factor for ventilator-associated pneumonia. The equipment used for oral and endotracheal suctioning becomes colonized with potential pathogens within 24 hours. It is not known if reusable oral suction equipment contributes to colonization; however, because many bacteria are exogenous to patients\u27 normal flora, equipment may be a source of cross-contamination

Use Of Project Impact® To Identify Factors Related To Ventilator-Associated Pneumonia

Introduction: Development of ventilator-associated pneumonia (VAP) increases morbidity and mortality. Using available databases, identification of factors associated with VAP can assist clinicians in development and implementation of prevention strategies. Method: A retrospective, descriptive design was used for this study. Power analysis for correlations with an α of .05, determined that the statistical power for a sample of 120 was .93. A convenience sample of 120 mechanically ventilated patients admitted to the critical care units of a level I trauma center from 5/1/98-7/31/98 was used. Data were obtained from the Project IMPACT®, infection control and financial databases. Variables included demographic data, VAP organism, medications, comorbidities, complications, days of therapies, length of stay and cost/case. Results: The average patient was a 49 year old male. The sample was 48% trauma patients. The incidence of VAP was 16.7% (n= 20). Factors significantly associated with VAP included intubation days (r= .275, p= .005), ventilation days (r= .255, p = .005) feeding tube days (r= .295, p = .001), trauma (φ= .239, p= .009), atelectasis (φ= -.186, p= .042) and histamine-2 (H 2) receptor antagonists (φ= -.253, p= .006). Variables that increased the odds ratio for VAP included tube feeding, H2 receptor antagonists, and atelectasis. Tracheotomy decreased the odds ratio for VAP, but early (day 1-7) tracheotomy did not decrease the incidence of VAP (χ2= .256, p= .613). Patients who developed VAP had a 16-day increase in length of stay (t= -2.68, p = .008) and a $29,369 increase in cost/ case (t= -3.649, p= .000) compared to patients without VAP. Conclusion: Using Project IMPACT and other databases to analyze risk factors for VAP, the findings support previous studies and provide a baseline for discussions regarding potential practice changes in this setting. This study is the first step towards clinical performance improvement and research activities aimed at reducing the rate of VAP in our patients