CME curriculum improves clinician knowledge, competence, and confidence in managing patients with NF1-related tumors.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e23009-e23009
Author(s):  
Michelle Arielle Worst ◽  
Rich Caracio ◽  
Katie Lucero ◽  
Jacob Cohen
Keyword(s):  
Clinical Care ◽  
Neurofibromatosis Type ◽  
Suppressor Gene ◽  
Educational Impact ◽  
Autosomal Dominant Disorder ◽  
Paired Samples ◽  
Assessment Study ◽  
Confidence Assessment ◽  
N 93 ◽  
Post Assessment

e23009 Background: Neurofibromatosis type 1 (NF1) is an uncommon complex autosomal dominant disorder caused by germline mutations in the NF1 tumor suppressor gene. Therapeutic options have historically been limited with surgical debulking being the preferred treatment modality. However, recent clinical data have shown improved outcomes with the use of MEK inhibitors. The objective of this study was to assess the educational impact of a series of continuing medical education (CME) activities on the knowledge, competence, and confidence of physician learners with respect to the treatment of NF1-related tumors. Methods: The educational series consisted of four online, CME-certified activities. For each activity, educational effect was assessed with a repeated pairs pre-/post-assessment study including a 3-item, multiple choice, knowledge/competence questionnaire and one confidence assessment question, with each participant serving as his/her own control. To assess changes in knowledge, competence, and confidence data from all clinicians who completed both pre- and post-questions were aggregated across activities, stratified by learning theme, and evaluated by target specialty. A repeated pairs pre-/post-assessment study design was used and McNemar’s test or paired samples t-test (P < .05) assessed educational effect. The first activity in the series launched Dec. 2019 and the last launched June 2020; data were collected until Dec. 2020. Results: Overall significant improvements were seen after education for oncologists (N = 258, P < .001), neurologists (N = 474, P < .001), surgeons (N = 427, P < .001), neurosurgeons (N = 93, P < .05), and pediatricians (N = 56, P < .001), regardless of practice setting. A sub-analysis of community specialists also showed significant improvements after education: oncologists (N = 117, P < .01), neurologists (N = 188, P < .001), and surgeons (N = 206, P < .001). Outcomes assessed by learning themes and specialty showed relative percent increases, with the majority being statistically significant. Conclusions: This analysis demonstrates that oncologists’ and other specialists’ knowledge, competence, and confidence regarding the treatment of NF1-related tumors improved after education, as measured through a comprehensive analysis of CME outcomes data from a variety of activities designed to achieve these ends. These results have the ability to translate to improvements in clinical care. Despite the improvements, additional educational activities are needed to address residual gaps and further increase clinicians’ ability in this clinical setting.

scholarly journals 959. Online CME Successful at Improving Knowledge, Competence and Confidence on Incorporating mAbs for COVID-19 Among a Global Audience

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S572-S572
Author(s):  
Allison Armagan ◽  
Elaine Bell ◽  
Maria B Uravich ◽  
Shanthi Voorn
Keyword(s):  
Patient Care ◽  
Educational Impact ◽  
Paired Samples ◽  
Global Curriculum ◽  
Assessment Study ◽  
The Us ◽  
Confidence Assessment ◽  
Improving Patient Care ◽  
Relative Change ◽  
Post Assessment

Abstract Background The incorporation of effective treatments is critical to improving patient care for COVID-19. We assessed the educational impact of a series of continuing medical education (CME) activities on knowledge, competence, and confidence changes in US and OUS physicians related to the use of monoclonal antibodies (mAbs) for COVID-19. Methods 10 online, CME-certified activities were delivered in multiple formats. For individual activities, educational effect was assessed with a repeated pairs pre-/post-assessment study including a 1 to 7-item, multiple choice, knowledge/competence questionnaire and one confidence assessment question. To assess changes in knowledge, competence, and confidence, data were aggregated across activities and stratified by learning theme. McNemar’s test or paired samples t-test (P&lt; .05) assessed educational effect. The activities launched between November 2020 and May 2021; data were collected through May 2021. Results To date, the 10 activities have reached over 50,000 clinicians, including 24,627 physicians. Selected improvement/reinforcement in knowledge/competence measured as relative % change in correct responses pre/post education across the learning themes are reported. (i) 89% improvement/reinforcement among US ID specialists in knowledge/competence incorporating mAbs into patient care and 83% improvement among outside the US (OUS) ID specialists (P &lt; .001). (ii) 70% improvement/reinforcement among US PCPs in knowledge/competence incorporating mAbs into patient care and 55% improvement among OUS PCPs (P &lt; .001). (iii) 52% improvement/reinforcement in knowledge/competence among US PCPs regarding clinical data for mAbs and 44% among OUS PCPs (P &lt; .001). (iv) 42% of US ID specialists and 29% of OUS ID specialists had a measurable improvement in confidence in identifying patients who would benefit from mAbs (P &lt; .001). Conclusion This series of online, CME-certified educational activities resulted in significant improvements in knowledge, competence, and confidence regarding the appropriate use of mAbs for SARS-CoV-2 in clinical practice. These results demonstrate the effectiveness of global curriculum-based education for clinicians designed to address specific gaps in care. Disclosures All Authors: No reported disclosures

Radiation-induced rhabdomyosarcoma of the brainstem in a patient with neurofibromatosis Type 2

2010 ◽  
Vol 112 (1) ◽  
pp. 81-87 ◽  
Author(s):  
Matthew L. Carlson ◽  
Dusica Babovic-Vuksanovic ◽  
Ludwine Messiaen ◽  
Bernd W. Scheithauer ◽  
Brian A. Neff ◽  
...  
Keyword(s):  
Tumor Suppressor ◽  
Stereotactic Radiosurgery ◽  
Tumor Suppressor Gene ◽  
Neurofibromatosis Type ◽  
Suppressor Gene ◽  
Neurofibromatosis Type 2 ◽  
Benign Tumors ◽  
Autosomal Dominant Disorder ◽  
Peripheral Nerve Sheath Tumors

Neurofibromatosis Type 2 (NF2) is a rare autosomal dominant disorder characterized by the development of benign tumors of the peripheral nervous system and the CNS, including schwannomas, meningiomas, and ependymomas. The gene responsible for the development of NF2 acts as a tumor suppressor gene. Stereotactic radiotherapy (SRT) or single-fraction stereotactic radiosurgery has been increasingly used in the past decades to treat benign tumors in patients with NF2. These radiotherapy methods are less invasive and can be potentially used to treat multiple tumors in a single session. The risk of inducing malignancy is unclear. Few reports exist of malignant peripheral nerve sheath tumors, meningiomas, or ependymomas occurring after SRT or stereotactic radiosurgery in patients with NF2. The authors present the first documented case of rhabdomyosarcoma following SRT for multiple NF2-associated schwannomas. Compared with patients with sporadic tumors, NF2 patients having a germline tumor suppressor gene defect may be more prone to secondary malignancies after treatment involving radiation therapy.

Optimizing management of glioblastoma: Educational impact on clinicians.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. 11026-11026
Author(s):  
Michelle Arielle Worst ◽  
Ann Carothers ◽  
Kinjal Parikh ◽  
Lisa Brauer ◽  
Giuseppe Lombardi ◽  
...  
Keyword(s):  
Clinical Care ◽  
Statistical Significance ◽  
Treatment Options ◽  
Educational Activity ◽  
Molecular Testing ◽  
Chi Square ◽  
Assessment Scores ◽  
Confidence Assessment ◽  
Investigational Agents ◽  
Post Assessment

11026 Background: Glioblastoma multiforme (GBM) is a rare, malignant tumor of the central nervous system (CNS) with poor prognosis. Nearly all patients experience recurrence due to GBM’s heterogeneity and there is currently no standard approach to treatment. Despite having few targeted agents with demonstrated efficacy, molecular testing is utilized due to its value in improving diagnostic accuracy and prognostic stratification. Moreover, recent data has shown an increase in promising data with regards to treating GBM using various mechanisms. Because of the clinical conundrum GBM poses and the lack of available treatment options, clinicians are challenged to stay current with new data and how best to integrate new agents into treatment paradigms. The objective of this study was to assess the changes in oncologists’ and pathologists’ knowledge through participation in education regarding optimal GBM treatment. Methods: The educational activity was a 30-minute online, video discussion segmented into 3 parts with synchronized slides and 2 faculty. Educational effect was assessed with a repeated pairs pre-/post-assessment study with a 3-item, multiple choice, knowledge questionnaire and one confidence assessment question. For all questions, each participant served as his/her own control. Pre- and post-assessment scores were compared to determine the relative changes in the proportion of correct responses. A chi-square test assessed statistical significance at the P < 0.05 level. The activity launched 26th June 2019; data were collected until 19th August 2019. Results: Overall significant improvements were seen after education for oncologists (N = 62, P < .001) and pathologists (N = 67, P < .01). The relative improvement was 67% for oncologists and 45% for pathologists (pre-/post-assessment average correct response rates were 30%/50% and 29%/42%, respectively). Following the activity, 55% of oncologists and 51% of pathologists had a measurable improvement in confidence in their ability to differentiate among late-stage investigational agents for GBM based on mechanism of action. Conclusions: Participation in an online, CME intervention consisting of a series of video discussions, totaling 30-minutes, resulted in statistically significant improvements in knowledge and confidence of oncologists and pathologists, that may lead to improvements in clinical care. As new data and agents emerge, new educational activities are necessary to reinforce knowledge, close persistent gaps, and increase oncologists’ and pathologists’ confidence in this clinical setting.

Understanding the expanding armamentarium for GIST: Engaged learning outcomes.

2020 ◽  
Vol 38 (4_suppl) ◽  
pp. 837-837
Author(s):  
Michelle Arielle Worst ◽  
Emily Sherene Van Laar ◽  
Mindy Tanzola ◽  
Michael C. Heinrich ◽  
Victor Manuel Villalobos
Keyword(s):  
Clinical Care ◽  
Statistical Significance ◽  
Soft Tissue Sarcomas ◽  
Educational Activity ◽  
Chi Square ◽  
Assessment Scores ◽  
Confidence Assessment ◽  
Resistance Patterns ◽  
Chi Square Test ◽  
Post Assessment

837 Background: Gastrointestinal stromal tumors (GIST) are rare soft-tissue sarcomas that harbor specific genomic alterations, making GIST an ideal model for targeted therapy. Common oncogenic drivers include mutations in the KIT and PDGFR tyrosine kinase. Due to varying resistance patterns to existing TKIs, clinicians are challenged to stay current with new data and how best to integrate new agents into treatment paradigms. The objective of this study was to assess the changes in oncologists’ and gastroenterologists’ knowledge, competence, and confidence through participation in education regarding optimal GIST treatment. Methods: The educational activity consisted of a 30-minute online, 2 faculty, video discussion with synchronized slides. Educational effect was assessed with a repeated pairs pre-/post-assessment study with a 3-item, multiple choice, knowledge/competence questionnaire and one confidence assessment question. For all questions, each participant served as his/her own control. Pre- and post-assessment scores were compared to determine the relative changes in the proportion of correct responses. A chi-square test assessed statistical significance at the P < 0.05 level. The activity launched 25th June 2019; data were collected until 19th August 2019. Results: Overall significant improvements were seen after education for oncologists (N=52, P < 0.001) and gastroenterologists (N=127, P < 0.01). The relative improvement was 79% for oncologists and 44% for gastroenterologists (pre-/post-assessment average correct response rates were 24%/43% and 23%/33%, respectively). Following the activity, 44% of oncologists and 37% of gastroenterologists were more confident in their ability to select appropriate therapy for patients with metastatic GIST. Conclusions: Participation in an online, 30-minute video discussion CME intervention resulted in statistically significant improvements in knowledge, competence, and confidence of oncologists and gastroenterologists, that may lead to improvements in clinical care. As new data and agents emerge, new educational activities are necessary to reinforce knowledge, close persistent gaps, and increase oncologists’ confidence in this clinical setting.

scholarly journals NCOG-13. THE IMPACT OF CME ON THE KNOWLEDGE OF NEUROFIBROMATOSIS TYPE 1-RELATED TUMORS

2020 ◽  
Vol 22 (Supplement_2) ◽  
pp. ii132-ii132
Author(s):  
Michelle Worst ◽  
Kinjal Parikh ◽  
Rich Caracio ◽  
Sara Fagerlie
Keyword(s):  
Neurofibromatosis Type 1 ◽  
Wide Spectrum ◽  
Clinical Care ◽  
Statistical Significance ◽  
Multidisciplinary Treatment ◽  
Neurofibromatosis Type ◽  
Educational Activity ◽  
The Impact ◽  
Post Assessment

Abstract BACKGROUND Neurofibromatosis type 1 (NF1) is an autosomal dominant genetic condition characterized by a wide spectrum of clinical findings. Patients with NF1 develop benign and malignant tumors along the nerves of the skin, brain, and other body parts. Due to the unique presentation of each patient, clinicians are challenged to stay current with emerging data and how best to integrate new agents into multidisciplinary treatment paradigms. The objective of this study was to assess changes in neurologists’ and pediatricians’ knowledge and confidence through participation in education regarding NF1 treatment. METHODS The educational activity consisted of a 30-minute online enduring, 1 faculty, chapterized summary of a live symposium. Educational effect was assessed with a repeated pairs pre-/post-assessment study with a 3-item, multiple choice, knowledge questionnaire and one confidence assessment question. For all questions, each participant served as his/her own control. Pre- and post-assessment scores were compared to determine relative changes in the proportion of correct responses. A chi-square test assessed statistical significance at the P &lt; 0.05 level. The activity launched 23rd December 2019; data were collected until 2nd April 2020. RESULTS Overall, statistically significant improvements were seen after education for neurologists (N=171, P &lt; 0.05) and pediatricians (N=260, P &lt; 0.01). The relative improvement in correct answers was 26% for neurologists and 48% for pediatricians (percent of total correct responses pre-/post-assessment were 27%/34% and 23%/34%, respectively). Following the activity, 16% of neurologists and 22% of pediatricians had a measurable increase in confidence regarding their understanding of multidisciplinary management of NF1. CONCLUSIONS Participation in an online, 30-minute enduring CME intervention resulted in statistically significant improvements in knowledge and confidence of neurologists and pediatricians, that result in improvements in clinical care. Continued educational activities are paramount to address residual gaps and further increase clinicians’ confidence in this clinical setting.

scholarly journals New Developments in Neurofibromatosis Type 2 and Vestibular Schwannoma

2020 ◽  
Author(s):  
Yin Ren ◽  
Divya A Chari ◽  
Sasa Vasilijic ◽  
D Bradley Welling ◽  
Konstantina M Stankovic
Keyword(s):  
Treatment Options ◽  
Neurofibromatosis Type ◽  
Suppressor Gene ◽  
Severe Form ◽  
Neurofibromatosis Type 2 ◽  
Future Research ◽  
Autosomal Dominant Disorder ◽  
Management Options ◽  
Stereotactic Radiation

Abstract Neurofibromatosis type 2 (NF2) is a rare autosomal dominant disorder characterized by the development of multiple nervous system tumors due to mutation in the NF2 tumor suppressor gene. The hallmark feature of the NF2 syndrome is the development of bilateral vestibular schwannomas (VS). Although there is nearly 100% penetrance by 60 years of age, some patients suffer from a severe form of the disease and develop multiple tumors at an early age, while others are asymptomatic until later in life. Management options for VS include surgery, stereotactic radiation, and observation with serial imaging; however, currently there are no FDA-approved pharmacotherapies for NF2 or VS. Recent advancements in the molecular biology underlying NF2 have led to a better understanding of the etiology and pathogenesis of VS. These novel signaling pathways may be used to identify targeted therapies for these tumors. This review discusses the clinical features and treatment options for sporadic- and NF2-associated VS, the diagnostic and screening criteria, completed and ongoing clinical trials, quality of life metrics, and opportunities for future research.

Online CME closes gaps in CSCC management revealed in a virtual patient simulation.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e23013-e23013
Author(s):  
Shari Dermer ◽  
Briana Betz ◽  
Piyali Chatterjee-Shin ◽  
Vishal Patel ◽  
Nikhil I. Khushalani
Keyword(s):  
Patient Simulation ◽  
Virtual Patient ◽  
Cancer Type ◽  
Educational Impact ◽  
Paired Samples ◽  
Confidence Assessment ◽  
Assessment And Treatment ◽  
Common Skin ◽  
Practice Assessment ◽  
Relative Change

e23013 Background: Cutaneous squamous cell carcinoma (CSCC) is the second most common skin cancer type. Although highly curable in its early stages, advanced or metastatic CSCC has been associated with mortality rates as high as 70%. The objective of this study was to assess the educational impact of a series of continuing medical education (CME) activities on the knowledge, competence, and confidence of oncologists on the assessment and management of CSCC. Methods: The educational series consisted of 4 online, CME-certified activities in multiple delivery formats, including an initial virtual patient simulation, followed by a clinical practice assessment (CPA) and 2 video discussions with synchronized slides. For the video discussions, educational effect was assessed with a repeated pairs pre-/post-assessment study including a 3-item, multiple choice, knowledge/competence questionnaire and one confidence assessment question, with each participant serving as his/her own control. To assess changes in knowledge, competence, and confidence data from all clinicians who completed both pre- and post-questions were aggregated across activities and stratified by learning theme. McNemar’s test or paired samples t-test ( P <.05) assessed educational effect. The first activity launched June 2019 and the last launched August 2020; data were collected until December 2020. Results: Following education oncologists had significant improvements in knowledge and competence compared with responses from the CPA. Improvement in knowledge and competence measured as relative % change in correct responses pre/post education across the learning themes identified in the virtual patient simulation are reported: Identifying patients who are not candidates for surgical intervention: 9% increase (56% CPA/ 77% pre/ 84% post; n=123-314; P <.05). Tailoring treatment: 30% increase (41% CPA/ 56% pre/ 73% post; n=119-314; P <.05). Tailoring treatment–cemiplimab: 22% increase (32% CPA/ 55% pre/ 67% post; n=123-314; P <.05). Tailoring treatment–cetuximab: 16% increase (15% CPA/ 37% pre/ 43% post; n=123-314; P <.05). New and emerging immunotherapies for CSCC: 47% increase (28% CPA/ 30% pre/ 44% post; n=119-314; P <.05). Conclusions: These results demonstrate the effectiveness of curriculum-based education for oncologists to address specific gaps in care as identified in a virtual patient simulation. This series of CME-certified online educational activities resulted in significant improvements in knowledge and competence in the assessment and treatment of patients with CSCC.

scholarly journals Cutaneous Findings in Neurofibromatosis Type 1

Cancers ◽  
2021 ◽  
Vol 13 (3) ◽  
pp. 463
Author(s):  
Bengisu Ozarslan ◽  
Teresa Russo ◽  
Giuseppe Argenziano ◽  
Claudia Santoro ◽  
Vincenzo Piccolo
Keyword(s):  
Neurofibromatosis Type 1 ◽  
Neurofibromatosis Type ◽  
Suppressor Gene ◽  
Mitogen Activated Protein Kinase ◽  
Juvenile Xanthogranuloma ◽  
Autosomal Dominant Disorder ◽  
Mitogen Activated Protein ◽  
Dermatologic Manifestations ◽  
Kinase Pathway

Neurofibromatosis type 1 (NF1) is a complex autosomal dominant disorder associated with germline mutations in the NF1 tumor suppressor gene. NF1 belongs to a class of congenital anomaly syndromes called RASopathies, a group of rare genetic conditions caused by mutations in the Ras/mitogen-activated protein kinase pathway. Generally, NF1 patients present with dermatologic manifestations. In this review the main features of café-au-lait macules, freckling, neurofibromas, juvenile xanthogranuloma, nevus anemicus and other cutaneous findings will be discussed.

scholarly journals Birt–Hogg–Dubé syndrome

2020 ◽  
Vol 29 (157) ◽  
pp. 200042
Author(s):  
Cécile Daccord ◽  
Jean-Marc Good ◽  
Marie-Anne Morren ◽  
Olivier Bonny ◽  
Daniel Hohl ◽  
...  
Keyword(s):  
Index Patient ◽  
Suppressor Gene ◽  
Tumour Suppressor Gene ◽  
Autosomal Dominant Disorder ◽  
Cystic Lung ◽  
Pulmonary Langerhans Cell Histiocytosis ◽  
Renal Tumours ◽  
Pulmonary Cysts ◽  
Chronic Respiratory Insufficiency ◽  
Diagnostic Work

Birt–Hogg–Dubé syndrome (BHD) is a rare inherited autosomal dominant disorder caused by germline mutations in the tumour suppressor gene FLCN, encoding the protein folliculin. Its clinical expression typically includes multiple pulmonary cysts, recurrent spontaneous pneumothoraces, cutaneous fibrofolliculomas and renal tumours of various histological types. BHD has no sex predilection and tends to manifest in the third or fourth decade of life. Multiple bilateral pulmonary cysts are found on chest computed tomography in >80% of patients and more than half experience one or more episodes of pneumothorax. A family history of pneumothorax is an important clue, which suggests the diagnosis of BHD. Unlike other cystic lung diseases such as lymphangioleiomyomatosis and pulmonary Langerhans cell histiocytosis, BHD does not lead to progressive loss of lung function and chronic respiratory insufficiency. Renal tumours affect about 30% of patients during their lifetime, and can be multiple and recurrent. The diagnosis of BHD is based on a combination of genetic, clinical and/or skin histopathological criteria. Management mainly consists of early pleurodesis in the case of pneumothorax, periodic renal imaging for tumour detection, and diagnostic work-up in search of BHD in relatives of the index patient.

scholarly journals Secondary Sarcomas: Biology, Presentation, and Clinical Care

2020 ◽  
pp. 463-474
Author(s):  
Vanessa Eulo ◽  
Harry Lesmana ◽  
Leona A. Doyle ◽  
Kim E. Nichols ◽  
Angela C. Hirbe
Keyword(s):  
Genetic Disorders ◽  
Clinical Care ◽  
Immunosuppressive Agents ◽  
Chemical Exposure ◽  
Neurofibromatosis Type ◽  
Li Fraumeni Syndrome ◽  
Patients With Cancer ◽  
Dicer1 Syndrome ◽  
Prompt Diagnosis

Secondary sarcomas are a subset of sarcomas that occur in patients with prior cancer diagnoses and are associated with environmental or genetic factors. Although secondary sarcomas are rare in general, there are predisposing factors that can substantially increase this risk in certain populations. Herein, we review the environmental factors with the strongest association of sarcoma risk, including chemical exposure, certain viruses, cytotoxic and immunosuppressive agents, chronic edema, and radiation exposure. Additionally, the most common genetic disorders that carry a predisposition for sarcoma development will be discussed, including hereditary retinoblastoma (RB), Li-Fraumeni syndrome (LFS), neurofibromatosis type 1 (NF1), and DICER1 syndrome. Although treatment does not generally differ for sporadic versus secondary sarcomas, awareness of the risk factors can alter therapeutic strategies to minimize risk, aid prompt diagnosis by increasing clinical suspicion, and allow for appropriate surveillance and genetic counseling for those patients with cancer predisposition syndromes.

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