Assessment of knowledge, attitude, and practices of research among faculties in medical college

Medical research aims to advance knowledge, skills, and professionalism. Lack of research could lead to the demise of the profession as a viable discipline. Research orientation is a concept that incorporates four subscales and provides insight into faculties' overall perception of research. To assess the knowledge, attitude, and practices regarding research and to identify barriers for research among medical faculty. Our study is a questionnaire-based cross-sectional study covering 110 faculties of medical college. Data collection was done through the Edmonton research orientation survey (EROS), a pre-validated tool. EROS questionnaire consists of 50 questions in two sections –the first section containing demographic variables (12 questions) and the second section (consist of 38 items) asks the respondents to rate on a five-point Likert’s scale. A high response rate (90.9%) was achieved. Sixty-five percent of respondents achieved an overall medium EROS score and 33% of respondents achieved a high EROS score (mean Eros score 132.3+21.7) indicating high research orientation. Respondents showed high subscale scores: valuing research (63%) and being at the leading edge of the profession (66%). While involvement in research (47%) and evidence-based practice (53%) scored lower. The study highlighted important barriers like lack of time, skills and support. The results suggest that although faculties value research they engage less in carrying out and applying research. The positive research orientation provides an opportunity for the profession to use the available potential to increase research output.

Factors Associated with Cardiovascular Disease Risk among Employees at a Portuguese Higher Education Institution

This study aimed to estimate the prevalence of risk factors for cardiovascular disease (CVD) and to assess the CVD risk (CVDRisk) in a sample of workers at a specific workplace: a higher education institution in Portugal. Data were collected using a questionnaire (e.cuidHaMUs.QueST®) with 345 HEI workers from June 2017–June 2018 with a high response rate (93.3%). Two constructs of risks for CVD were considered: (i) metabolic risk and hypertension (CVDRisk1); and (ii) modifiable behavioural risk (CVDRisk2). Logistic regression analyses were used to establish a relationship between risk indexes/constructs (CVDRisk1 and CVDRisk2) and groups of selected variables. The most prevalent CVD risk factor was hypercholesterolaemia (43.2%). Sixty-eight percent of participants were in the construct CVDRisk1 while almost half of the respondents were in CVDRisk2 (45.2%). The consumption of soft drinks twice a week or more contributed to a significantly increased risk of CVD in CVDRisk1. Lack of regular exercise and lack of daily fruit consumption significantly increased the risk of CVD in CVDRisk2. The challenge to decision makers and the occupational medical community is to incorporate this information into the daily practices of health surveillance with an urgent need for health promotional education campaigns in the workplace.

Immunotherapy for Cutaneous Squamous Cell Carcinoma: Results and Perspectives

Although initial surgical excision cures 95% of patients, a minority of cutaneous squamous cell carcinomas (cSCCs) are judged to be unresectable, either locally advanced or with unresectable regional lymph nodes or distant metastases. These patients are offered systemic treatments. Response rate to chemotherapy is relatively low and not durable, as well as the results obtained with epidermal growth factor inhibitors (EGFRi). Like other cutaneous tumors, cSCCs have high immunogenicity, driven by the high mutational burden, the ultraviolet signature, and the overexpressed tumor antigens. Two checkpoint inhibitors, cemiplimab and pembrolizumab, achieved high response rate and survival with fewer toxicities than other available systemic agents. These promising results prompted to investigate new combination strategies of systemic therapy and surgery or radiotherapy. Subgroup analysis showed promising role of immunotherapy to facilitate surgery in locally advanced cSCC and, in a small group of patients, long-term survivals without resection. However, some cSCCs treated with immunotherapy develop either early or late resistance, so new drugs and new combinations are in a clinical study to overcome the mechanism underpinning these resistances. The present review focuses on the progress with immunotherapy to date and on new therapeutic strategies for cSCC.

CANDIED: A Pan-Canadian Cohort of Immune Checkpoint Inhibitor-Induced Insulin-Dependent Diabetes Mellitus

Immune checkpoint inhibitor (ICI)-induced insulin-dependent diabetes mellitus (IDDM) is a rare but potentially fatal immune-related adverse event (irAE). In this multicentre retrospective cohort study, we describe the characteristics of ICI-induced IDDM in patients treated across five Canadian cancer centres, as well as their tumor response rates and survival. In 34 patients identified, 25 (74%) were male and 19 (56%) had melanoma. All patients received anti-programed death 1 (anti-PD1) or anti-programmed death ligand-1 (anti-PD-L1)-based therapy. From ICI initiation, median time to onset of IDDM was 2.4 months (95% CI 1.1–3.6). Patients treated with anti-PD1/PD-L1 in combination with an anti-cytotoxic T lymphocyte antigen 4 antibody developed IDDM earlier compared with patients on monotherapy (1.4 vs. 3.9 months, p = 0.05). Diabetic ketoacidosis occurred in 21 (62%) patients. Amongst 30 patients evaluable for response, 10 (33%) had a complete response and another 10 (33%) had a partial response. Median overall survival was not reached (95% CI NE; median follow-up 31.7 months). All patients remained insulin-dependent at the end of follow-up. We observed that ICI-induced IDDM is an irreversible irAE and may be associated with a high response rate and prolonged survival.

Waning Humoral Response 3 to 6 Months after Vaccination with the SARS-COV-2 BNT162b2 mRNA Vaccine in Dialysis Patients

Background and objectives: The short-term reported antibody response to SARS-COV-2 vaccination in dialysis patients is high, with a seroconversion response rate up to 97%. Data on the long-term durability of this response are scarce. Our objective was to characterize the long-term anti-spike antibody level in dialysis patients. Design, setting, participants, and measurements: In an observational study, we measured SARS-COV-2 anti-spike antibody levels in dialysis patients who completed 2 doses of the BNT162b2 mRNA SAR S-COV-2 vaccine at 1, 3 and 6 months after the second vaccine dose. We compared the response to dialysis patients who were infected with COVD-19 and to a control group of healthcare-employees. Results: One hundred and forty-two dialysis patients who had been vaccinated (ages 64 ± 11.9 years, 61% male), 33 dialysis patients who had COVID-19 infection (ages 54 ± 14.3 years, 55% male) and 104 individuals in the control group (ages 50 ± 12.2 years, 44% male) were included. The response rate in the vaccinated dialysis patients was 94%, 78% and 73% at 1, 3 and 6 months after the second vaccine dose. In the COVID-19 infected dialysis group and in the control group, the response rate remained at 100% over 6 months. The percentage of change in antibody levels between one and 6 months was −66% in the vaccinated dialysis group, −28% in the control group (p < 0.001) and +48% in dialysis patients who had been infected with COVID-19 (p < 0.001). A non-responder status at 6 months was associated with a lower albumin level. No serious adverse events following vaccination were reported. In conclusion: the initially high response rate to the BNT162b2 vaccine in dialysis patients decreases rapidly. Our results indicate that an early booster (3rd) dose, at three months after the second dose, may be advised for this population to preserve the humoral immunity.

ML-11 Tirabrutinib treatment for recurrent or refractory PCNSL

Since 2020, tirabrutinib which is a Bruton’s tyrosine kinase (BTK) inhibitor has been available for recurrent or refractory PCNSL cases. The number of studies reporting efficiency and adverse effect of tirabrutinib treatment for recurrent or refractory PCNSL has been limited yet. In this study, we investigated clinical course of eight refractory or recurrent PCNSL cases treated with tirabrutinib in our institute. Eight PCNSL cases treated with tirabrutinib included four recurrent cases and four refractory cases. Five cases obtained CR or PR after 26.8 days administration of tirabrutinib and other two cases also exhibited obvious improvement of clinical symptoms after 23.5 days administration of tirabrutinib. Among three cases exhibiting intraocular lesions, two cases revealed improvement of visual dysfunction and the other case obtained SD status of intraocular lesion. The most frequently found adverse effect was the skin rash. CTCAE grade 2 (n=2) or 3 (n=2) rash was found after mean 16 days or 94 days of tirabrutinib administration, respectively. Two cases with grade 3 rash could start taking the low-dose tirabrutinib after improvement of rash. Althouth one case experienced shingles, no other case experienced serious adverse effects. Although adverse effect of rash was frequently found, we could obtain high response rate of tirabrutinib treatment for recurrent or refractory PCNSL cases. We need to establish quantitative assessment method for analysis of treatment response of tirabrutinib for intraocular lesions.

Estimation of Domain Means from Business Surveys in the Presence of Stratum Jumpers and Nonresponse

Misclassified frame records (also called stratum jumpers) and low response rates are characteristic for business surveys. In the context of estimation of the domain parameters, jumpers may contribute to extreme variation in sample weights and skewed sampling distributions of the estimators, especially for domains with a small number of observations. There is limited literature about the extent to which these problems may affect the performance of the ratio estimators with nonresponse-adjusted weights. To address this gap, we designed a simulation study to explore the properties of the Horvitz-Thompson type ratio estimators, with and without smoothing of the weights, under different scenarios. The ratio estimator with propensity-adjusted weights showed satisfactory performance in all scenarios with a high response rate. For scenarios with a low response rate, the performance of this estimator improved with an increase in the proportion of jumpers in the domain. The smoothed estimators that we studied performed well in scenarios with non-informative weights, but can become markedly biased when the weights are informative, irrespective of response rate. We also studied the performance of the ’doubled half’ bootstrap method for variance estimation. We illustrated an application of the methods in a real business survey.

Requests made under the Official Information Act 1982 : a survey at the agency level

<p>The Official Information Act (OIA) has been in force for almost two decades. During these years there has been little research published about how citizens use this legislation, or how agencies have responded to requests made under the Act. The aim of this project is to produce basic research data from a range of agencies to quantify use made of the Act, and to examine what other request information sample agencies hold. The study uses the Act as a survey instrument to produce a high response rate to the questionnaire and to produce qualitative and quantitative data about the request process. The results show that only a minority of surveyed agencies records the number of requests they receive or the category of information requesters e.g., news media and political parties. Compared to the detailed information recorded by the Ombudsmen there appears to be little consistency of request record keeping across sampled agencies. This record keeping gap has implications for our ability to either assess the effectiveness of the OIA against its original purpose, or to review it in the context of government information policy.</p>

Requests made under the Official Information Act 1982 : a survey at the agency level

<p>The Official Information Act (OIA) has been in force for almost two decades. During these years there has been little research published about how citizens use this legislation, or how agencies have responded to requests made under the Act. The aim of this project is to produce basic research data from a range of agencies to quantify use made of the Act, and to examine what other request information sample agencies hold. The study uses the Act as a survey instrument to produce a high response rate to the questionnaire and to produce qualitative and quantitative data about the request process. The results show that only a minority of surveyed agencies records the number of requests they receive or the category of information requesters e.g., news media and political parties. Compared to the detailed information recorded by the Ombudsmen there appears to be little consistency of request record keeping across sampled agencies. This record keeping gap has implications for our ability to either assess the effectiveness of the OIA against its original purpose, or to review it in the context of government information policy.</p>

Difference in Therapeutic Effects between Roxadustat and Daprodustat, HIF-Ph Inhibitors, Depending on the Blood Type in Hemodialysis (HD) Patients

Human blood group antigens are glycoproteins and glycolipids expressed on the surface of red blood cells and a variety of human tissues. This study aimed to determine if there is an association between ABO blood type and the efficacy of HIF-PH inhibitors. Roxadustat and daprodustat are potent inhibitors of HIF-PH and capable of stimulating erythropoiesis in patients on patients with impaired renal function. These two compounds are reported to act mechanistically similar but display differences in their effects on cells, and the differences may affect their efficacy in the treatment of renal anemia in HD patients. In this study we compared the response rate by blood type between roxadustat and daprodustat, respectively. Sixty-eight HD patients treated with roxadustat (20-100mg, 3/week) and ninety-five treated with daprodustat (1-12mg, daily) were recruited in our observational study. We defined &gt;1.5g/dL increase in hemoglobin as effective, and &lt;1.5g/dL decrease as ineffective. As shown in the figure, type A had a significantly high response rate at 47% in HD patients treated with roxadustat. On the other hand, type O had a significantly high response rate at 55% in those who were treated with daprodustat. We found the association in the effectiveness of roxadustat on the treatment for anemia in HD patients in type A, while the effectiveness was higher in type O treated with daprodustat. The results suggest that the therapeutic effect of HIF-PH inhibitors may differ depending on the blood type. Figure 1 Figure 1. Disclosures No relevant conflicts of interest to declare.