This decline is hazardous not only to the medical profession but also to society. Reforms consisting of balanced rescheduling of medical curricula and optimum resource allocation have been proposed to improve the standard of education of doctors.

a b s t r a c tObjective. There is a need to develop and validate biomarkers for treatment response and survival in tuboovarian high-grade serous carcinoma (HGSC). The chemotherapy response score (CRS) stratifies patients into Gynecologic Oncology 154 (2019) 441-448 complete/near-complete (CRS3), partial (CRS2), and no/minimal (CRS1) response after neoadjuvant chemotherapy (NACT). Our aim was to review current evidence to determine whether the CRS is prognostic in women with tubo-ovarian HGSC treated with NACT.Methods. We established an international collaboration to conduct a systematic review and meta-analysis, pooling individual patient data from 16 sites in 11 countries. Patients had stage IIIC/IV HGSC, 3-4 NACT cycles and N6-months follow-up. Random effects models were used to derive combined odds ratios in the pooled population to investigate associations between CRS and progression free and overall survival (PFS and OS).Results. 877 patients were included from published and unpublished studies. Median PFS and OS were 15 months (IQR 5-65) and 28 months (IQR 7-92) respectively. CRS3 was seen in 249 patients (28%). The pooled hazard ratios (HR) for PFS and OS for CRS3 versus CRS1/CRS2 were 0·55 (95% CI, 0·45-0·66; P b 0·001) and 0·65 (95% CI 0·50-0·85, P = 0·002) respectively; no heterogeneity was identified (PFS: Q = 6·42, P = 0·698, I2 = 0·0%; OS: Q = 6·89, P = 0·648, I2 = 0·0%). CRS was significantly associated with PFS and OS in multivariate models adjusting for age and stage. Of 306 patients with known germline BRCA1/2 status, those with BRCA1/2 mutations (n = 80) were more likely to achieve CRS3 (P = 0·027).Conclusions. CRS3 was significantly associated with improved PFS and OS compared to CRS1/2. This validation of CRS in a real-world setting demonstrates it to be a robust and reproducible biomarker with potential to be incorporated into therapeutic decision-making and clinical trial design.• The Chemotherapy response score (CRS) assesses histological effect in ovarian cancer after neoadjuvant chemotherapy (NACT). • The CRS is associated with progression-free and overall survival.• CRS could provide useful information to estimate a patient's probability of early vs. late relapse.• The CRS is an appealing primary endpoint in clinical trials as a surrogate for survival as it can be measured earlier. • We recommend the CRS be incorporated as an endpoint in clinical trials of novel therapeutic agents that have a NACT arm.

A well-planned needs assessment is an essential element to initiating a successful organizational performance improvement project. There are many theoretical frameworks on needs assessment; however, most of the current models are shortsighted, deficiency-oriented, and advocate training-based approaches that are not very practical to implement in real organizational settings. Gupta's A Practical Guide to Needs Assessment is an important work bridging the divide between theory and practice, and it is written in a reader-friendly manner. Research on Needs AssessmentIn general, a need is defined as a gap or discrepancy between a present state and a desired state. Typically, the needs assessment process is used to identify and measure gaps between what is and what ought to be, prioritize the gaps, and determine which of the gaps to work on to obtain closure. However, the concept has been attacked as being too fuzzy and negative (Witkin, 1991) and criticized as focusing on deficits and weakness instead of strengths (Roth, 1978). Furthermore, each needs assessment expert has developed different frameworks.For example, Sleezer (1993) interprets needs assessment and analysis as being basically the same process. However, Kaufman and English (1975) propose an overarching needs assessment methodology after distinguishing among needs assessment and analysis processes. And Rossett (1997) defines needs assessment as a method for finding training interventions.Even though each of these approaches has its own strengths, researchers tend to emphasize identifying the gap rather than developing interventions to close the gap.Hence, indepth analysis tools or methodologies for identifying the gap correctly and efficiently are to be employed. It can take quite a bit of time to follow step-by-step procedures for conducting a needs assessment project. The more complicated the needs assessment methodologies, the harder it is for practitioners to apply them to real organizational contexts. The gap between theoretical frameworks and practical

Improper rotation of sites and reuse of needles are the leading causes of LH in Indian T1DM patients, which, in turn, significantly increases the risk of GV and UH.

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