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Quantifying Glucocorticoid Plasticity Utilizing Impulse Tradition Strategies: There 's still Much to Discover!
Health-related quality of life (HRQoL) is an important outcome measure and prognostic indicator in hepatocellular carcinoma (HCC). KEYNOTE-240 (NCT02702401) assessed the efficacy and safety of pembrolizumab plus best supportive care (BSC) versus placebo plus BSC in patients with HCC who previously received sorafenib. This study presents the results of a prespecified exploratory analysis of patient-reported outcomes.

Patients completed the European Organization for Research and Treatment of Cancer Core Quality of Life Questionnaire (EORTC QLQ-C30) and its HCC supplement (EORTC QLQ-HCC18) electronically at baseline; at weeks 2, 3, 4, 6, 9, 12, and 18; and then every 9 weeks until 1 year or end of treatment, and at the 30-day safety follow-up visit.

The HRQoL population included 271 and 127 patients randomly assigned to pembrolizumab and placebo, respectively. From baseline to week 12, changes in both scores were similar between pembrolizumab and placebo; global health status/QoL scores were stable. The proportions of patients who improved, remained stable, or deteriorated across all functional domain and symptom scores were generally similar between pembrolizumab and placebo. Time to deterioration was similar between the 2 arms based on the prespecified analysis of EORTC QLQ-HCC18 domains of abdominal swelling, fatigue, and pain.

Pembrolizumab preserved HRQoL during treatment for advanced HCC. Combined with efficacy and safety results from KEYNOTE-240, these findings support a positive benefit/risk profile for pembrolizumab in a second-line treatment setting for patients with HCC who previously received sorafenib.
Pembrolizumab preserved HRQoL during treatment for advanced HCC. Combined with efficacy and safety results from KEYNOTE-240, these findings support a positive benefit/risk profile for pembrolizumab in a second-line treatment setting for patients with HCC who previously received sorafenib.We present an inexpensive and robust theoretical approach based on the fragment molecular orbital methodology and the spin-ratio scaled second-order Møller-Plesset perturbation theory to predict the lattice energy of benzene crystals within 2 kJ⋅mol-1 . Pralsetinib price Inspired by the Harrison method to estimate the Madelung constant, the proposed approach calculates the lattice energy as a sum of two- and three-body interaction energies between a reference molecule and the surrounding molecules arranged in a sphere. The lattice energy converges rapidly at a radius of 13 Å. Adding the corrections to account for a higher correlated level of theory and basis set superposition for the Hartree Fock (HF) level produced a lattice energy of -57.5 kJ⋅mol-1 for the benzene crystal structure at 138 K. This estimate is within 1.6 kJ⋅mol-1 off the best theoretical prediction of -55.9 kJ⋅mol-1 . We applied this approach to calculate lattice energies of the crystal structures of phase I and phase II-polymorphs of benzene-observed at a higher temperature of 295 K. The stability of these polymorphs was correctly predicted, with phase II being energetically preferred by 3.7 kJ⋅mol-1 over phase I. The proposed approach gives a tremendous potential to predict stability of other molecular crystal polymorphs.
Undergraduate health assessment courses aim to prepare nursing students to conduct systematic physical assessment of patients. Competency in the undergraduate health assessment course is traditionally validated by student demonstration of a memorized, comprehensive physical examination.

Often, this validation requires performance of an exhaustive list of physical examination skills rather than the typical physical assessment performed by the generalist nurse in the hospital setting. This precedent to "do it all" does not align with competency-based education and may cause students to be ill-prepared for clinical practice.

Faculty in a 12-month second-degree accelerated BSN program adapted the comprehensive physical assessment validation to better reflect a clinically relevant bedside assessment. The process, results, challenges, and recommendations are described. Here, the redefined comprehensive physical assessment included evaluation of the patient's general appearance, activity, vital sign measurements, pain, and key assessment of the neurologic, respiratory, cardiovascular, integumentary, gastrointestinal, and genitourinary systems. In alignment with the AACN recommendations, students were also validated on focused assessments.

This change improved the students transition to clinical practice. We challenge faculty to prepare students for real-world nursing assessment by adapting validations to closely mirror bedside practice.
This change improved the students transition to clinical practice. We challenge faculty to prepare students for real-world nursing assessment by adapting validations to closely mirror bedside practice.Educators are challenged to engage in dramatic reformation and innovation including learning, teaching, and curriculum design. A PhD level quantitative nursing research course was redesigned using the Andersen Behavioral Model of Health Services (ABMHS) to guide data assignments. Students navigated through levels of theoretical abstraction from constructs to concepts to variables. Subsequent assignments offered students the opportunity to operationalize, code, and manage the variables in their models. Outcomes were positive and resulted in student confidence as they progressed to the dissertation phase. This article adds novel information to the literature about attention to theory, models, or frameworks, and specifically the ABMHS, in a doctoral quantitative course.
Nurse educators need strategies to help develop nursing students' clinical judgment skills to practice safely. Guided reflective writing is an active learning strategy that can increase learning and promote clinical judgment in patient care.

The purpose of this qualitative descriptive study, guided by Tanner's Evidence Based Clinical Judgment Model, was to examine nursing student and faculty perspectives of the benefits and challenges of guided reflective writing for clinical judgment development following clinical experiences.

Junior- and senior-level students participated in an open-ended survey regarding their experience of the guided reflective writing assignment postclinical. A focus group gained faculty perspectives of the assignment.

A final theme for each student group was developed (1) organizes basic nursing care (Junior One students) and (2) sense of wholeness (Senior Two students). Progression in clinical judgment from Junior One to Senior Two students was noted. Faculty concurred with students' perspectives with their final theme, encourages deep thinking.
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