A phase 2 trial of consolidation pembrolizumab following concurrent chemoradiation for patients with unresectable stage III non–small cell lung cancer: Hoosier Cancer Research Network LUN 14-179

Background Five-year overall survival (OS) for patients with unresectable stage III non–small cell lung cancer (NSCLC) is poor. Until recently, a standard of care was concurrent chemoradiation alone. Patients with metastatic NSCLC treated with anti–programmed death 1 antibodies have demonstrated improved OS. This trial evaluated pembrolizumab as consolidation therapy after concurrent chemoradiation in patients with unresectable stage III disease. Methods Patients with unresectable stage III NSCLC received concurrent chemoradiation with cisplatin and etoposide, cisplatin and pemetrexed, or carboplatin and paclitaxel and 59.4 to 66.6 Gy of radiation. Patients with nonprogression of disease were enrolled and received pembrolizumab (200 mg intravenously every 3 weeks for up to 12 months). The primary endpoint was the time to metastatic disease or death (TMDD). Secondary endpoints included progression-free survival (PFS) and OS. Results The median follow-up for 93 patients (92 for efficacy) was 32.2 months (range, 1.2-46.6 months). The median TMDD was 30.7 months (95% confidence interval [CI], 18.7 months to not reached), which was significantly longer than the historical control of 12 months (P < .0001). The median PFS was 18.7 months (95% CI, 12.4-33.8 months), and the median OS was 35.8 months (95% CI, 24.2 months to not reached). The 1-, 2-, and 3-year OS estimates were 81.2%, 62.0%, and 48.5%, respectively. Forty patients (43.5%) completed 12 months of treatment (median number of cycles, 13.5). Symptomatic pneumonitis (grade 2 or higher) was noted in 16 patients (17.2%); these cases included 4 grade 3 events (4.3%), 1 grade 4 event (1.1%), and 1 grade 5 event (1.1%). Conclusions Consolidation pembrolizumab after concurrent chemoradiation improves TMDD, PFS, and OS in comparison with historical controls of chemoradiation alone. Rates of grade 3 to 5 pneumonitis were similar to those reported with chemoradiation alone

Cellular immunotherapy using dendritic cells against multiple myeloma

Cellular therapy with dendritic cells (DCs) is emerging as a useful immunotherapeutic tool to treat multiple myeloma (MM). DC-based idiotype vaccination was recently suggested to induce idiotype-specific immune responses in MM patients. However, the clinical results so far have been largely disappointing, and the clinical effectiveness of such vaccinations in MM still needs to be demonstrated. DC-based therapies against MM may need to be boosted with other sources of tumor-associated antigens, and potent DCs should be recruited to increase the effectiveness of treatment. DCs with both high migratory capacity and high cytokine production are very important for effective DC-based cancer vaccination in order to induce high numbers of Th1-type CD4+ T cells and CD8+ cytotoxic T lymphocytes. The tumor microenvironment is also important in the regulation of tumor cell growth, proliferation, and the development of therapeutic resistance after treatment. In this review, we discuss how the efficacy of DC vaccination in MM can be improved. In addition, novel treatment strategies that target not only myeloma cells but also the tumor microenvironment are urgently needed to improve treatment outcomes

Developing nursing leadership talent - views from the NHS nursing leadership for South East England

Aim: This article explores the views of current National Health Service (NHS) nursing leaders on actions and resources required to develop and maintain nursing leadership talent. Background: Although there is considerable talent and expertise within the nursing leadership community, there are numerous unfilled vacancies and identified gaps in competence and capability, with national analysis (Janjua, 2014) indicating nearly a third of NHS Directorial posts filled by interim appointments or vacant. Nursing Director posts are amongst those vacant for the longest. Method: Semi-structured interviews were conducted with NHS Directors of Nursing, Chief Nurses, Directors of Quality and their deputies in South East England to explore the characteristics of their roles, development needs, barriers to applying or staying in post, future talent identification and support networks. Results: Nursing leadership roles are perceived as demanding, poorly remunerated, isolating and representing a major increase in responsibility and career risk. Too much development is currently informal. Conclusions: Talent identification and support needs to be timely, structured, based experientially and focused on building resilience and confidence. Coaching, mentoring and support networks are considered crucial. Implications: Nursing leadership talent needs to be formally identified, developed and supported within organisations and networks should be maintained to reduce professional isolation and counter negative perceptions

Theory and Practice of Discipline: A Study of Boys\u27 Catholic High Schools

Abstract not availabl

Weiterentwicklung des Edukationsprogramms FIBS im Sinne von Machbarkeit und Evaluierbarkeit zum Management von Cancer-related Fatigue

Einleitung: Die Versorgung von Menschen mit einer onkologischen Erkrankung wird durch den medizinischen Fortschritt zunehmend komplexer. Cancer-related Fatigue (CrF) zählt zu jener Belastung die häufig von Betroffenen vor, während und nach erfolgter Therapie genannt wird. Die Wirksamkeit von edukativen Maßnahmen zur Behandlung von CrF wurde bereits bestätigt, jedoch fehlt es an Wissen über die Machbarkeit und Implementierung solcher Programme ebenso wie zur theoriegeleiteten Evaluierung von komplexen Interventionen. Ziel: Das Gesamtziel des Forschungsvorhabens ist die Implementierung und Evaluierung einer edukativen Maßnahme zum Management von CrF. Dieser Teil des Forschungsvorhabens konzentriert sich darauf nach den Grundsätzen des MRC Frameworks eine komplexe Intervention zu entwickeln und einer Überprüfung der Machbarkeit aus der Sicht von Pflegepersonen zu unterziehen. Ein weiteres Ziel ist die Entwicklung eines logischen Modells und einer Theory of Change. Methode: Ein partizipativer Forschungsansatz wurde zur Entwicklung des Programms in einem speziellen Kontext (AKH Wien, onkologische Bettenstation) ausgewählt. Eine Gruppe an Expertinnen und Experten aus der onkologischen Pflege arbeitete in einer zyklischen Abfolge zusammen um die praktische Durchführbarkeit gemeinsam zu beobachten, zu reflektieren und in das bestehende Programm einzuarbeiten. Die Machbarkeit wurde anhand eines strukturierten Fragebogens überprüft. Ergebnisse: Im Rahmen von vier Workshops wurden die Schlüsselinterventionen in Zusammenhang mit den Beobachtungen der Pflegeexpertinnen und des Pflegeexperten diskutiert. Die Interventionen wurden in sieben Module aufgeteilt. Ein profundes Screening und Assessment durch Pflegende der Station, führt zur Einleitung der weiteren sechs Modulen die sich mit Basisinformationen, Einflussfaktoren und der Bedeutung von körperlicher Aktivität befassen. Zu weiteren Inhalten zählen Energiemanagement, gesunder Schlaf, Umgang mit Emotionen und Body-Mind Interventionen welche im Rahmen einer weiterführenden Beratung durch erfahrene Onkologiepflegende mit spezieller Ausbildung, angeboten werden. Schlussfolgerung: Die Ergebnisse zeigen, dass Pflegende hohe Motivation in sich tragen das Programm in der entwickelten Form anzubieten. Herausforderungen bei der Implementierung liegen weiterhin im Bereich der verfügbaren Ressourcen bspw. der Zeit. Ebenso kann die Evaluierung des Programms mittels Wirksamkeitsüberprüfung zur Herausforderung werden, weshalb für weitere Untersuchungen ein Methodenmix zu empfehlen ist.Introduction: The care for patients with oncological diseases in acute hospitals is becoming more complex as the progress of modern treatment accelerates. One of the most widely reported side effects by patients before, during and after treatment is Cancer related fatigue (CrF). While the effectiveness of educational programs for CrF has already been proven, there is a lack of knowledge on the feasibility and implementation of such programs as well as the theoretical evaluation of such complex interventions. Objectives: The overall aim of this research proposal is the implementation and theory-based evaluation of an educational intervention for the management of CrF (FIBS). The developed intervention, based on the MRC (Medical Research Council) framework, would pass a nurse practitioner feasibility test (practicability and applicability). A secondary goal would be development of a logic model and a Theory of Change. Methods: A participatory research approach was chosen to develop program in a special context (General Hospital in Vienna, Division of Oncology) based on the program FIBS. A group of nursing experts in oncology worked together in cyclical phases to test out the practical implementation, to observe, reflect and finalize the program. Finally, the feasibility of the program was tested via a detailed questionnaire (Bowen et al., 2009). Results: A total of four workshops were held to discuss and finalize the key interventions linked to the findings of the oncology nurses. The key interventions are divided into seven modules. A detailed screening and assessment are followed by six further teaching modules focused on basic information about manifestation, influencing factors and the meaning of physical activity. Special content like energy conservation, healthy sleep, emotional influence and a body mind intervention, which needs more in-depth consultation, will be delivered by advanced oncology nurses with a specialised training. All key interventions follow the recommendations of actual guidelines for the management of CrF in adult patients. Conclusions: The findings showed that oncology nurses are highly motivated to deliver the above proposed program to patients affected by CrF. Some implementation challenges could be the lack of time or resources available. A concern to be voiced is the success evaluation of the program based on effectiveness measurements only. Therefore, the overall evaluation of the program should be based on the principles of a mixed method approach