Thomas K. Schulz

Sorafenib in Platinum-Treated Patients with Extensive Stage Small Cell Lung Cancer: A Southwest Oncology Group (SWOG 0435) Phase II Trial

Introduction: Sorafenib is a multikinase inhibitor affecting pathways involved in tumor progression and angiogenesis. We conducted a phase II trial of sorafenib in platinum-treated patients with extensive stage small cell lung cancer to determine the tumor response rate, toxicity, and overall survival. Methods: Patients with histologically confirmed, measurable disease, Zubrod performance status 0 to 1, and no more than 1 prior platinum-based treatment were eligible. Patients were stratified by platinum-sensitivity status: sensitive (progression >90 days after platinum) or refractory (progression during or ≤90 days after platinum). Patients were treated with sorafenib 400 mg orally twice a day continuously on a 28-day cycle. Results: Of 89 patients registered, 82 were evaluable for toxicity assessment, and 83 were evaluable for response. There were four partial responses seen among the 38 patients in the platinum-sensitive stratum, for an estimated response rate of 11% (95% confidence interval: 3–25%), and one partial response among the 45 patients in the platinum-refractory stratum, for an estimated response rate of 2% (95% confidence interval: 0–12%). The median overall survival estimates were 6.7 months (95% confidence interval: 6.1–9.1 months) for the platinum-sensitive stratum and 5.3 months (95% confidence interval: 3.3–7.5 months) in the platinum-refractory stratum. Nineteen patients discontinued treatment because of adverse events or side effects from therapy. Conclusions: Based on the lack of disease control seen in our trial, further investigation of single-agent sorafenib in the small cell lung cancer population is not recommended. Combination trials of sorafenib and chemotherapy are ongoing.

Lysis and thrombosis: Manifestation of the same disease

A 19-year-old female patient presented to the emergency department 6 hr after an episode of headache followed by brief loss of consciousness. The episode was associated with jerking of extremities and rapid recovery was reported without confusion or focal neurologic deficit. She reported having tension-like headaches for several months. She denied any fever, chills, nausea, vomiting, or head trauma. Physical examination revealed an obese, pale patient with flat affect. Her temperature was 99°F, pulse: 90 beats per minute, and blood pressure 110/75 mmHg without evidence of orthostasis. Neurological examination was pertinent for right Babinski sign. Her initial complete blood count revealed hemoglobin: 6.0 g/dL, hematocrit: 18%, MCV: 91.8 fl, platelet count: 116 x 10 3 per microliter, and leukocyte count: 6,700 per microliter.

Adult Burkitt-like lymphoma of the colon: a case report and a review of the literature

Total time required was 73 minutes (18 minutes in baseline, 55 minutes in treatment), resulting in a relatively brief treatment. Additionally, the treatment was significantly simpler than previously researched ABA treatments for pill swallowing. Identifying the simplest effective treatment is important because, all other things being equal, a simpler treatment is (1) easier to train nonexperts in, and (2) more likely to be implemented correctly. Pill-swallowing skills will likely increase medication compliance, and in this case made the use of general anesthesia during capsule endoscopy unnecessary. Further replication of this ABA procedure is needed in order to determine the generality of its effectiveness with children with autism. DISCLOSURE

Identifying and Understanding Barriers and Facilitators to Medication Adherence Among Marshallese Adults in Arkansas

Background: Significant health disparities are present in Marshallese adults residing in the United States, most notably a high incidence of type 2 diabetes and other chronic conditions. There is limited research on medication adherence in the Marshallese population. Objective: This study explored perceptions of and experiences with medication adherence among Marshallese adults residing in Arkansas, with the aim of identifying and better understanding barriers and facilitators to medication adherence. Methods: Eligible participants were Marshallese adults taking at least one medication for a chronic health condition. Each participant completed a brief survey and semistructured interview conducted in Marshallese by a bilingual Marshallese staff member. Interviews were recorded, transcribed, and translated from Marshallese to English. Qualitative data were coded for a priori and emergent themes. Results: A total of 40 participants were included in the study. The most common contributing factor for nonadherence was forgetting to take medication (82%). A majority of participants (70%) reported difficulty paying for medicine, 45% reported at least one form of cost-related nonadherence, and 40% engaged in more than one cost-related nonadherence practice. Family support and medication pill boxes were identified as facilitators for medication adherence. The majority of the participants (76.9%) stated that they understood the role of a pharmacist. Participants consistently desired more education on their medications from pharmacy providers. Conclusion: This is the first study to explore barriers and facilitators to medication adherence among Marshallese patients. The findings can be used to develop methods to improve medication adherence among Marshallese.

Novel Clinical Needs Finding Course Brings Biomedical Engineering Students Together with Regional Medical Campus Students, Residents, and Faculty to Solve Real-World Problems

Biomedical engineering is the fastest growing engineering field in the United States, preparing a generation of skilled problem-solvers who, together with healthcare professionals, drive the momentum of novel technologies for the prevention, detection, treatment, and monitoring of disease. It is important to the education of biomedical engineers that the dialogue between healthcare professionals and schools of engineering is seamless, constant, and interactive. Lack of sustainable discourse between those who produce technologies and those who use them could reduce the applicability and relevance of the biomedical engineering education1,2. Reciprocally, for healthcare professionals to optimally harness the expertise of their engineering colleagues, a direct interaction is required. The department of Biomedical Engineering (BMEG) is one of the largest departments within the College of Engineering at the University of Arkansas, with approximately 70 students graduating annually. Established in 2012 as the first and only biomedical engineering program in the state of Arkansas, the department is establishing itself as one of the premier research departments on campus. The department prides itself in its commitment to diversity and has been successful in attracting diverse groups of students to enter the field of science and engineering. In spring of 2018, the BMEG undergraduate student body had the highest percentage of female and underrepresented minorities within the college of engineering: 53% female and 37% minority. The University of Arkansas for Medical Sciences (UAMS) is the only allopathic medical school in the state of Arkansas. In 2007, UAMS established UAMS-Northwest as a regional campus in Fayetteville. UAMS-Northwest extends UAMS’ medical education, research, and clinical mission. UAMS-Northwest has approximately 250 students in the colleges of medicine, nursing, pharmacy, and health professions, as well as 48 family medicine and internal medicine residents. UAMS-Northwest is located more than 200 miles from the main UAMS campus in Little Rock but is only one mile from Arkansas’ land grant university, the University of Arkansas. The proximity of the regional medical campus to the land grant university provides opportunities for collaboration that can benefit the students of both institutions. This article provides an overview of the implementation and preliminary assessment of a novel Clinical Needs Finding course that was recently instituted as a collaboration between the Department of Biomedical Engineering and the University of Arkansas for Medical Sciences– Northwest Campus.