Grappling For Answers: Exploring the Process of Life Skills Development in Youth Mixed Martial Arts Athletes

Mixed martial arts (MMA) is a form of combat sport that was legalized in Ontario in 2013. Immediately, media began to profile life skill outcomes associated with youth participation in MMA. Evidence in support of these claims is often anecdotal. To date no studies have utilized Positive Youth Development (PYD), a strengths-based approach to youth development (Lerner et al., 2005) to explore youth in MMA. Therefore, the overall objective of this research project was to explore the potential benefits, factors and processes of youths (ages 9-18) life skill development in MMA using a PYD approach. Data was collected in three phases. In phase one data was collected from Toronto MMA gym websites (N=18). One manuscript was written that identified the life skills MMA gyms suggest they can develop in youth. Findings revealed that MMA gym websites included general information, developmental outcomes (4Cs) and processes, resources and not relevant messages. In phase two semi-structured interviews were conducted with youth (n=13) and coaches (n=10) from MMA gyms. Two manuscripts were written, the first manuscript identified the life skills youth developed in MMA and the factors that contributed to their development. The second manuscript explored the role of the MMA coach in the process of facilitating life skills development and transfer of life skills from MMA to non-sport contexts. MMA coaches primarily used explicit techniques to facilitate life skill development and transfer. In phase three, two manuscripts were written. First, a pilot study was conducted to determine the effectiveness of using an online journal and two types of questions (i.e., direct and indirect) as a method of recalling transfer experiences. Second, youth in MMA (N=9) completed an online journal over a one-month period. Findings revealed that MMA coaches facilitated the development of a value for life skills transfer. Participants in the direct and indirect groups demonstrated differences in their description of transfer experiences

Perceptions des résidents sur la formation médicale fondée sur les compétences

Background: Residency training programs in Canada are undergoing a mandated transition to competency-based medical education (CBME).  There is limited literature regarding resident perspectives on CBME.  As upper year residents act as mentors and assessors for incoming cohorts, and are themselves key stakeholders in this educational transition, it is important to understand how they view CBME.  We examined how residents who are not currently enrolled in a competency-based program view that method of training, and what they perceive as potential advantages, disadvantages, and considerations regarding its implementation. Methods: Sixteen residents volunteered to participate in individual semi-structured interviews, with questions focussing on participants’ knowledge of CBME and its implementation.  We used a grounded theory approach to develop explanations of how residents perceive CBME. Results: Residents anticipated improved assessment and feedback, earlier identification of residents experiencing difficulties in training, and greater flexibility to pursue self-identified educational needs.  Disadvantages included logistical issues surrounding CBME implementation, ability of attending physicians to deliver CBME-appropriate feedback, and the possibility of assessment fatigue.  Clear, detailed communication and channels for resident feedback were key considerations regarding implementation. Conclusions: Resident views align with educational experts regarding the practical challenges of implementation.  Expectations of improved assessment and feedback highlight the need for both residents and attending physicians to be equipped in these domains.  Consequently, faculty development and clear communication will be crucial aspects of successful transitioning to CBME

More Than Self-Management: Positive Youth Development at an Inclusive Type 1 Diabetic Camp

Diabetes-focused camps emerged as a way to provide ongoing diabetes self-management education to youth and their families in a physically active context. Past research suggests participation at camp can enhance youths’ glycemic control and glucose monitoring abilities; however, recent studies claim camps can also offer psychological and social benefits. Drawing upon a positive youth development (PYD) approach, the current study examined an inclusive diabetic-focused youth sport camp to (a) identify life skills developed, and (b) explain processes and factors involved in youths’ development of life skills. Focus groups were conducted with 54 youth living with type 1 diabetes mellitus (T1DM) attending an inclusive T1DM sport camp. The model of PYD through sport (Holt et al., 2017) guided the analysis. PYD outcomes (i.e., life skills developed through the camp) were (a) enhanced self-efficacy for self-monitoring of blood glucose, (b) enhanced self-efficacy for sport while living with T1DM, and (c) development of positive relationships. These outcomes were facilitated through the camp’s inclusive approach (i.e., including youth living with and without T1DM), and a PYD climate (implicitly), which included supportive relationships with counsellors and peers, and interestingly, the lack of parental involvement at the camp. The camp’s explicit life skills program focus (i.e., on diabetes self-care skills) also facilitated these outcomes. This study gives camp professionals insight into how an inclusive T1DM sport camp can facilitate life skills, and optimize PYD

Adding 6 months of androgen deprivation therapy to postoperative radiotherapy for prostate cancer: a comparison of short-course versus no androgen deprivation therapy in the RADICALS-HD randomised controlled trial

Background Previous evidence indicates that adjuvant, short-course androgen deprivation therapy (ADT) improves metastasis-free survival when given with primary radiotherapy for intermediate-risk and high-risk localised prostate cancer. However, the value of ADT with postoperative radiotherapy after radical prostatectomy is unclear. Methods RADICALS-HD was an international randomised controlled trial to test the efficacy of ADT used in combination with postoperative radiotherapy for prostate cancer. Key eligibility criteria were indication for radiotherapy after radical prostatectomy for prostate cancer, prostate-specific antigen less than 5 ng/mL, absence of metastatic disease, and written consent. Participants were randomly assigned (1:1) to radiotherapy alone (no ADT) or radiotherapy with 6 months of ADT (short-course ADT), using monthly subcutaneous gonadotropin-releasing hormone analogue injections, daily oral bicalutamide monotherapy 150 mg, or monthly subcutaneous degarelix. Randomisation was done centrally through minimisation with a random element, stratified by Gleason score, positive margins, radiotherapy timing, planned radiotherapy schedule, and planned type of ADT, in a computerised system. The allocated treatment was not masked. The primary outcome measure was metastasis-free survival, defined as distant metastasis arising from prostate cancer or death from any cause. Standard survival analysis methods were used, accounting for randomisation stratification factors. The trial had 80% power with two-sided α of 5% to detect an absolute increase in 10-year metastasis-free survival from 80% to 86% (hazard ratio [HR] 0·67). Analyses followed the intention-to-treat principle. The trial is registered with the ISRCTN registry, ISRCTN40814031, and ClinicalTrials.gov, NCT00541047. Findings Between Nov 22, 2007, and June 29, 2015, 1480 patients (median age 66 years [IQR 61–69]) were randomly assigned to receive no ADT (n=737) or short-course ADT (n=743) in addition to postoperative radiotherapy at 121 centres in Canada, Denmark, Ireland, and the UK. With a median follow-up of 9·0 years (IQR 7·1–10·1), metastasis-free survival events were reported for 268 participants (142 in the no ADT group and 126 in the short-course ADT group; HR 0·886 [95% CI 0·688–1·140], p=0·35). 10-year metastasis-free survival was 79·2% (95% CI 75·4–82·5) in the no ADT group and 80·4% (76·6–83·6) in the short-course ADT group. Toxicity of grade 3 or higher was reported for 121 (17%) of 737 participants in the no ADT group and 100 (14%) of 743 in the short-course ADT group (p=0·15), with no treatment-related deaths. Interpretation Metastatic disease is uncommon following postoperative bed radiotherapy after radical prostatectomy. Adding 6 months of ADT to this radiotherapy did not improve metastasis-free survival compared with no ADT. These findings do not support the use of short-course ADT with postoperative radiotherapy in this patient population

Duration of androgen deprivation therapy with postoperative radiotherapy for prostate cancer: a comparison of long-course versus short-course androgen deprivation therapy in the RADICALS-HD randomised trial

Background Previous evidence supports androgen deprivation therapy (ADT) with primary radiotherapy as initial treatment for intermediate-risk and high-risk localised prostate cancer. However, the use and optimal duration of ADT with postoperative radiotherapy after radical prostatectomy remains uncertain. Methods RADICALS-HD was a randomised controlled trial of ADT duration within the RADICALS protocol. Here, we report on the comparison of short-course versus long-course ADT. Key eligibility criteria were indication for radiotherapy after previous radical prostatectomy for prostate cancer, prostate-specific antigen less than 5 ng/mL, absence of metastatic disease, and written consent. Participants were randomly assigned (1:1) to add 6 months of ADT (short-course ADT) or 24 months of ADT (long-course ADT) to radiotherapy, using subcutaneous gonadotrophin-releasing hormone analogue (monthly in the short-course ADT group and 3-monthly in the long-course ADT group), daily oral bicalutamide monotherapy 150 mg, or monthly subcutaneous degarelix. Randomisation was done centrally through minimisation with a random element, stratified by Gleason score, positive margins, radiotherapy timing, planned radiotherapy schedule, and planned type of ADT, in a computerised system. The allocated treatment was not masked. The primary outcome measure was metastasis-free survival, defined as metastasis arising from prostate cancer or death from any cause. The comparison had more than 80% power with two-sided α of 5% to detect an absolute increase in 10-year metastasis-free survival from 75% to 81% (hazard ratio [HR] 0·72). Standard time-to-event analyses were used. Analyses followed intention-to-treat principle. The trial is registered with the ISRCTN registry, ISRCTN40814031, and ClinicalTrials.gov , NCT00541047 . Findings Between Jan 30, 2008, and July 7, 2015, 1523 patients (median age 65 years, IQR 60–69) were randomly assigned to receive short-course ADT (n=761) or long-course ADT (n=762) in addition to postoperative radiotherapy at 138 centres in Canada, Denmark, Ireland, and the UK. With a median follow-up of 8·9 years (7·0–10·0), 313 metastasis-free survival events were reported overall (174 in the short-course ADT group and 139 in the long-course ADT group; HR 0·773 [95% CI 0·612–0·975]; p=0·029). 10-year metastasis-free survival was 71·9% (95% CI 67·6–75·7) in the short-course ADT group and 78·1% (74·2–81·5) in the long-course ADT group. Toxicity of grade 3 or higher was reported for 105 (14%) of 753 participants in the short-course ADT group and 142 (19%) of 757 participants in the long-course ADT group (p=0·025), with no treatment-related deaths. Interpretation Compared with adding 6 months of ADT, adding 24 months of ADT improved metastasis-free survival in people receiving postoperative radiotherapy. For individuals who can accept the additional duration of adverse effects, long-course ADT should be offered with postoperative radiotherapy. Funding Cancer Research UK, UK Research and Innovation (formerly Medical Research Council), and Canadian Cancer Society