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https://www.readbyqxmd.com/read/28081860/long-term-outcomes-after-bladder-preserving-tri-modality-therapy-for-patients-with-muscle-invasive-bladder-cancer-an-updated-analysis-of-the-massachusetts-general-hospital-experience
#1
Nicholas J Giacalone, William U Shipley, Rebecca H Clayman, Andrzej Niemierko, Michael Drumm, Niall M Heney, Marc D Michaelson, Richard J Lee, Philip J Saylor, Matthew F Wszolek, Adam S Feldman, Douglas M Dahl, Anthony L Zietman, Jason A Efstathiou
BACKGROUND: Tri-modality therapy (TMT) is a recognized treatment strategy for selected patients with muscle-invasive bladder cancer (MIBC). OBJECTIVE: Report long-term outcomes of patients with MIBC treated by TMT. DESIGN, SETTING, AND PARTICIPANTS: Four hundred and seventy-five patients with cT2-T4a MIBC were enrolled on protocols or treated as per protocol at the Massachusetts General Hospital between 1986 and 2013. INTERVENTION: Patients underwent transurethral resection of bladder tumor followed by concurrent radiation and chemotherapy...
January 9, 2017: European Urology
https://www.readbyqxmd.com/read/28074589/on-patient-well-being-and-professional-authority
#2
Mildred Z Solomon
Two papers in this issue address the limits of surrogates' authority when making life-and-death decisions for dying family members or friends. Using palliative sedation as an example, Jeffrey Berger offers a conceptual argument for bounding surrogate authority. Since freedom from pain is an essential interest, when imminently dying, cognitively incapacitated patients are in duress and their symptoms are not manageable in any other way, clinicians should be free to offer palliative sedation without surrogate consent, although assent should be sought and every effort made to work with surrogates as harmoniously as possible...
January 2017: Hastings Center Report
https://www.readbyqxmd.com/read/28074587/after-the-dnr-surrogates-who-persist-in-requesting-cardiopulmonary-resuscitation
#3
Ellen M Robinson, Wendy Cadge, Angelika A Zollfrank, M Cornelia Cremens, Andrew M Courtwright
Some health care organizations allow physicians to withhold cardiopulmonary resuscitation from a patient, despite patient or surrogate requests that it be provided, when they believe it will be more harmful than beneficial. Such cases usually involve patients with terminal diagnoses whose medical teams argue that aggressive treatments are medically inappropriate or likely to be harmful. Although there is state-to-state variability and a considerable judicial gray area about the conditions and mechanisms for refusals to perform CPR, medical teams typically follow a set of clearly defined procedures for these decisions...
January 2017: Hastings Center Report
https://www.readbyqxmd.com/read/28074576/decisions-and-authority
#4
Gregory E Kaebnick
This issue of the Hastings Center Report (January-February 2017) features three articles exploring aspects of decision-making for others. In the first two, the focus is on the limits of surrogate decision-makers' authority when the surrogates' judgments about a patient's treatment conflict with the physicians'. If a physician decides that a patient will not benefit from CPR, for example, but the patient's surrogate insists on it, is the physician obliged to proceed with the procedure? Or can the physician, pointing to a duty to provide good care to the patient and not to cause the patient to suffer, get a do-not-resuscitate order for the patient-even in the face of the surrogate's objections? These are the questions that animate the first article, in which a group of authors report on a policy implemented at Massachusetts General Hospital to help doctors who face this dilemma...
January 2017: Hastings Center Report
https://www.readbyqxmd.com/read/28073753/migraine-and-risk-of-perioperative-ischemic-stroke-and-hospital-readmission-hospital-based-registry-study
#5
Fanny P Timm, Timothy T Houle, Stephanie D Grabitz, Anne-Louise Lihn, Janne B Stokholm, Katharina Eikermann-Haerter, Ala Nozari, Tobias Kurth, Matthias Eikermann
OBJECTIVE:  To evaluate whether patients with migraine are at increased risk of perioperative ischemic stroke and whether this may lead to an increased hospital readmission rate. DESIGN:  Prospective hospital registry study. SETTING:  Massachusetts General Hospital and two satellite campuses between January 2007 and August 2014. PARTICIPANTS:  124 558 surgical patients (mean age 52.6 years; 54.5% women). MAIN OUTCOME MEASURES:  The primary outcome was perioperative ischemic stroke occurring within 30 days after surgery in patients with and without migraine and migraine aura...
January 10, 2017: BMJ: British Medical Journal
https://www.readbyqxmd.com/read/28063957/initial-development-and-validation-of-a-patient-reported-symptom-survey-for-small-fiber-polyneuropathy
#6
Roi Treister, Mette Lodahl, Magdalena Lang, Shelley S Tworoger, Shlomo Sawilowsky, Anne Louise Oaklander
: Small-fiber polyneuropathy SFPN affects unmyelinated and thinly myelinated peripheral axons. Several questionnaires have been developed to assess polyneuropathy from diabeties or chemotherapy, but none for SFPN from other or unknown causes. A comprehensive survey could help clinicians diagnose and assess treatment responses, define prevalence natural history and cures, and identify research subjects. Thus, we developed the one-page Small-fiber Symptom Survey (SSS), using input from patients and 21 medical/scientific experts...
January 4, 2017: Journal of Pain: Official Journal of the American Pain Society
https://www.readbyqxmd.com/read/28060868/non-communicable-disease-preventive-screening-by-hiv-care-model
#7
Corinne M Rhodes, Yuchiao Chang, Susan Regan, Virginia A Triant
IMPORTANCE: The Human Immunodeficiency Virus (HIV) epidemic has evolved, with an increasing non-communicable disease (NCD) burden emerging and need for long-term management, yet there are limited data to help delineate the optimal care model to screen for NCDs for this patient population. OBJECTIVE: The primary aim was to compare rates of NCD preventive screening in persons living with HIV/AIDS (PLWHA) by type of HIV care model, focusing on metabolic/cardiovascular disease (CVD) and cancer screening...
2017: PloS One
https://www.readbyqxmd.com/read/28048707/mo-fg-campus-jep1-05-water-equivalent-path-length-calculations-using-scatter-corrected-head-and-neck-cbct-images-to-evaluate-patients-for-adaptive-proton-therapy
#8
J Kim, Y Park, G Sharp, B Winey
PURPOSE: To establish a method to evaluate the dosimetric impact of anatomic changes in head and neck patients during proton therapy by using scatter-corrected cone-beam CT (CBCT) images. METHODS: The water equivalent path length (WEPL) was calculated to the distal edge of PTV contours by using tomographic images available for six head and neck patients received photon therapy. The proton range variation was measured by calculating the difference between the distal WEPLs calculated with the planning CT and weekly treatment CBCT images...
June 2016: Medical Physics
https://www.readbyqxmd.com/read/28048551/we-fg-brb-02-spatial-mapping-of-the-rbe-of-scanned-particle-beams
#9
D Grosshans
: The physical pattern of energy deposition and the enhanced relative biological effectiveness (RBE) of protons and carbon ions compared to photons offer unique and not fully understood or exploited opportunities to improve the efficacy of radiation therapy. Variations in RBE within a pristine or spread out Bragg peak and between particle types may be exploited to enhance cell killing in target regions without a corresponding increase in damage to normal tissue structures. In addition, the decreased sensitivity of hypoxic tumors to photon-based therapies may be partially overcome through the use of more densely ionizing radiations...
June 2016: Medical Physics
https://www.readbyqxmd.com/read/28048239/th-e-209-01-fluoroscopic-dose-monitoring-and-patient-follow-up-program-at-massachusetts-general-hospital
#10
B Liu
: Radiation dose monitoring solutions have opened up new opportunities for medical physicists to be more involved in modern clinical radiology practices. In particular, with the help of comprehensive radiation dose data, data-driven protocol management and informed case follow up are now feasible. Significant challenges remain however and the problems faced by medical physicists are highly heterogeneous. Imaging systems from multiple vendors and a wide range of vintages co-exist in the same department and employ data communication protocols that are not fully standardized or implemented making harmonization complex...
June 2016: Medical Physics
https://www.readbyqxmd.com/read/28048194/we-fg-brb-01-clinical-significance-of-rbe-variations-in-proton-therapy
#11
H Paganetti
: The physical pattern of energy deposition and the enhanced relative biological effectiveness (RBE) of protons and carbon ions compared to photons offer unique and not fully understood or exploited opportunities to improve the efficacy of radiation therapy. Variations in RBE within a pristine or spread out Bragg peak and between particle types may be exploited to enhance cell killing in target regions without a corresponding increase in damage to normal tissue structures. In addition, the decreased sensitivity of hypoxic tumors to photon-based therapies may be partially overcome through the use of more densely ionizing radiations...
June 2016: Medical Physics
https://www.readbyqxmd.com/read/28048080/su-f-t-80-a-mobile-application-for-intra-operative-electron-radiotherapy-treatment-planning
#12
C Williams, E Crowley, J Wolfgang
PURPOSE: Intraoperative electron radiotherapy (IORT) poses a unique set of challenges for treatment planning. Planning must be performed in a busy operating room environment over a short timeframe often with little advance knowledge of the treatment depth or applicator size. Furthermore, IORT accelerators can have a large number of possible applicators, requiring extensive databooks that must be searched for the appropriate dosimetric parameters. The goal of this work is to develop a software tool to assist in the planning process that is suited to the challenges faced in the IORT environment...
June 2016: Medical Physics
https://www.readbyqxmd.com/read/28047638/su-f-p-09-a-global-medical-physics-collaboration-for-implementation-of-modern-radiotherapy-in-botswana
#13
R Makufa, M Bvochora-Nsingo, T Karumekayi, R J Schneider, J A Efstathiou, S Dryden-Peterson, A Odom, A Shulman, Y Pipman, D P Gierga
PURPOSE: The global burden of cancer is considerable, particularly in low and middle-income countries. Massachusetts General Hospital (MGH) and Botswana-Harvard AIDS Institute have partnered with the oncology community and government of Botswana to form BOTSOGO (BOTSwana Oncology Global Outreach) to address the rising burden of cancer in Botswana. Currently, radiation therapy (RT) is only available at a single linear accelerator (LINAC) in Gaborone Private Hospital (GPH). BOTSOGO worked to limit the absence of RT during a LINAC upgrade and ensure a safe transition to modern radiotherapy techniques...
June 2016: Medical Physics
https://www.readbyqxmd.com/read/28047303/tu-fg-brb-06-a-prompt-gamma-ray-spectroscopy-system-for-clinical-studies-of-in-vivo-proton-range-verification
#14
J Verburg, T Bortfeld
PURPOSE: We present a new system to perform prompt gamma-ray spectroscopy during proton pencil-beam scanning treatments, which enables in vivo verification of the proton range. This system will be used for the first clinical studies of this technology. METHODS: After successful pre-clinical testing of prompt gamma-ray spectroscopy, a full scale system for clinical studies is now being assembled. Prompt gamma-rays will be detected during patient treatment using an array of 8 detector modules arranged behind a tungsten collimator...
June 2016: Medical Physics
https://www.readbyqxmd.com/read/28046959/we-fg-brb-03-challenges-and-opportunities-for-implementing-biological-optimization-in-particle-therapy
#15
D Carlson
: The physical pattern of energy deposition and the enhanced relative biological effectiveness (RBE) of protons and carbon ions compared to photons offer unique and not fully understood or exploited opportunities to improve the efficacy of radiation therapy. Variations in RBE within a pristine or spread out Bragg peak and between particle types may be exploited to enhance cell killing in target regions without a corresponding increase in damage to normal tissue structures. In addition, the decreased sensitivity of hypoxic tumors to photon-based therapies may be partially overcome through the use of more densely ionizing radiations...
June 2016: Medical Physics
https://www.readbyqxmd.com/read/28046622/su-f-t-214-re-thinking-the-useful-clinical-beam-energy-in-proton-therapy-an-opportunity-for-cost-reduction
#16
El H Bentefour, H Lu
PURPOSE: We conducted a retrospective study of the useful clinical proton beam energy based on the beam range data of patients treated over the last 10 years at Massachusetts General Hospital Proton Therapy Center. METHODS: Treatment field information were collected for all patients treated over the last 10 years (2005-2015) in the two gantry treatment rooms at MGH. The beam ranges for these fields were retrieved and categorized per treatment site. The 10 prostate patients that required the highest beam range (lateral fields) were selected...
June 2016: Medical Physics
https://www.readbyqxmd.com/read/28046508/we-fg-brb-00-the-challenges-of-predicting-rbe-effects-in-particle-therapy-and-opportunities-for-improving-cancer-therapy
#17
David Carlson
: The physical pattern of energy deposition and the enhanced relative biological effectiveness (RBE) of protons and carbon ions compared to photons offer unique and not fully understood or exploited opportunities to improve the efficacy of radiation therapy. Variations in RBE within a pristine or spread out Bragg peak and between particle types may be exploited to enhance cell killing in target regions without a corresponding increase in damage to normal tissue structures. In addition, the decreased sensitivity of hypoxic tumors to photon-based therapies may be partially overcome through the use of more densely ionizing radiations...
June 2016: Medical Physics
https://www.readbyqxmd.com/read/28046299/we-fg-brb-04-rbes-for-human-lung-cancer-cells-exposed-to-protons-and-heavier-ions-implications-for-clinical-use-of-charged-particles-in-cancer-therapy
#18
K Held
: The physical pattern of energy deposition and the enhanced relative biological effectiveness (RBE) of protons and carbon ions compared to photons offer unique and not fully understood or exploited opportunities to improve the efficacy of radiation therapy. Variations in RBE within a pristine or spread out Bragg peak and between particle types may be exploited to enhance cell killing in target regions without a corresponding increase in damage to normal tissue structures. In addition, the decreased sensitivity of hypoxic tumors to photon-based therapies may be partially overcome through the use of more densely ionizing radiations...
June 2016: Medical Physics
https://www.readbyqxmd.com/read/28031981/drug-delivery-biomaterials-and-nanomedicine-an-interview-with-daniel-s-kohane
#19
Daniel S Kohane
Daniel Kohane speaks to Francesca Lake, Managing Editor: Obtaining his MD and PhD in Physiology from Boston University (MA, USA), Dan Kohane went on to complete residencies in Pediatrics at Boston Children's Hospital (MA, USA) and Anesthesiology at Massachusetts General Hospital (USA), followed by a fellowship in Pediatric Critical Care at Boston Children's Hospital. He is currently a Professor of Anesthesia at Harvard Medical School (MA, USA) and a Senior Associate in Pediatric Critical Care at Boston Children's Hospital, where he directs the Laboratory for Biomaterials and Drug Delivery...
September 2016: Future Science OA
https://www.readbyqxmd.com/read/28013099/gender-differences-in-substance-abuse-ptsd-and-intentional-self-harm-among-veterans-health-administration-patients
#20
Jaimie L Gradus, Sarah Leatherman, Andrew Curreri, Lisa G Myers, Ryan Ferguson, Matthew Miller
BACKGROUND: Epidemiologic studies have reported substance abuse and posttraumatic stress disorder (PTSD) diagnoses as risk factors for suicide among Veterans Health Administration (VHA) patients. Research on risk factors for suicide may not generalize to our understanding of non-fatal intentional self-harm (ISH), given the evidence that these outcomes have unique risk factors. The aims of this study were to examine (1) gender-stratified rates of non-fatal ISH in VHA patients with alcohol abuse/dependence, drug abuse/dependence, and PTSD and (2) gender-stratified interaction between alcohol abuse and dependence and drug abuse and dependence and PTSD in predicting non-fatal ISH...
November 21, 2016: Drug and Alcohol Dependence
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