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https://www.readbyqxmd.com/read/29777617/simulation-in-urology-to-train-non-technical-skills-in-ward-rounds
#1
K Somasundram, H Spence, A J Colquhoun, C Mcilhenny, C S Biyani, S Jain
OBJECTIVE: We have designed an exercise to train newly appointed Urology trainees in non-technical skills on ward rounds as a part of a simulation 'boot camp'. This paper reports our experience, including a qualitative analysis of participant feedback on the utility of this method of training. PATIENTS AND METHODS: The simulations took place in a high-fidelity simulated ward bay. Forty-eight doctors with formal Urology training ranging between 2-60 months (mean 19...
May 19, 2018: BJU International
https://www.readbyqxmd.com/read/29777595/a-ring-based-compensator-imrt-system-optimized-for-low-and-middle-income-countries-design-and-treatment-planning-study
#2
Jonathon Van Schelt, Daniel Smith, Nicholas Fong, Dolla Toomeh, Patricia A Sponseller, Derek W Brown, Meghan W Macomber, Nina A Mayr, Shilpen Patel, Adam Shulman, G V Subrahmanyam, K Govindarajan, Eric C Ford
PURPOSE: We propose a novel compensator-based IMRT system designed to provide a simple, reliable, and cost-effective adjunct technology, with the goal of expanding global access to advanced radiotherapy techniques. The system would employ easily-reusable tungsten bead compensators that operate independent of a gantry (e.g. mounted in a ring around the patient). Thereby the system can be retrofitted to existing linac and cobalt teletherapy units. This study explores the quality of treatment plans from the proposed system and the dependence on associated design parameters...
May 19, 2018: Medical Physics
https://www.readbyqxmd.com/read/29777308/theoretical-analysis-of-evaporative-cooling-of-classic-heat-stroke-patients
#3
Abdulaziz H Alzeer, E H Wissler
Heat stroke is a serious health concern globally, which is associated with high mortality. Newer treatments must be designed to improve outcomes. The aim of this study is to evaluate the effect of variations in ambient temperature and wind speed on the rate of cooling in a simulated heat stroke subject using the dynamic model of Wissler. We assume that a 60-year-old 70-kg female suffers classic heat stroke after walking fully exposed to the sun for 4 h while the ambient temperature is 40 °C, relative humidity is 20%, and wind speed is 2...
May 18, 2018: International Journal of Biometeorology
https://www.readbyqxmd.com/read/29776892/technique-for-the-administration-of-high-dose-rate-brachytherapy-to-the-bile-duct-using-a-nasobiliary-catheter
#4
Christopher L Deufel, Keith M Furutani, Robert A Dahl, Michael P Grams, Luke B McLemore, Christopher L Hallemeier, Michelle Neben-Wittich, James A Martenson, Michael G Haddock
PURPOSE: Cholangiocarcinoma patients who are potential candidates for liver transplantation may be treated with high-dose-rate (HDR) brachytherapy using a minimally invasive nasobiliary catheter in an effort to escalate the radiotherapy dose to the tumor and maximize local control rates. This work describes the equipment, procedures, and quality assurance (QA) that enables successful administration. METHODS AND MATERIALS: This work describes the nasobiliary catheter placement, simulation, treatment planning, treatment delivery, and QA...
May 16, 2018: Brachytherapy
https://www.readbyqxmd.com/read/29776841/-medical-simulation-as-a-tool-in-the-training-of-perinatal-professionals
#5
B Tosello, J Blanc, C Kelway, V Pellegrin, E Quarello, F Comte, C Zakarian, C D'Ercole
Though technology plays an increasingly important role in modern health systems, human performance remains a major determinant of safety, effectiveness and efficiency of patient care. This is especially true in the delivery room. Thus, the training of professionals must aim not only for the acquisition of theory and practical skills on an individual basis, but also for the learning of teamwork systematically. Training health professionals with simulation enhances their theoretical knowledge and meets formal requirements in literacy, technical skills and communication...
May 15, 2018: Gynecologie, Obstetrique, Fertilite & Senologie
https://www.readbyqxmd.com/read/29776819/corrective-osteotomy-for-hyperextended-elbow-with-limited-flexion-due-to-supracondylar-fracture-malunion
#6
Keiichiro Oura, Atsuo Shigi, Kunihiro Oka, Hiroyuki Tanaka, Tsuyoshi Murase
BACKGROUND: Extension deformity of the distal humerus after a malunited supracondylar fracture can restrict elbow flexion. Here we report a computer-assisted operative procedure and review the results of clinical cases in which corrective surgery was performed. METHODS: The medical records of the patients who underwent corrective osteotomy for hyperextended elbow malunion of the distal humerus with limited elbow flexion (flexion angle ≤100°) were reviewed retrospectively...
May 15, 2018: Journal of Shoulder and Elbow Surgery
https://www.readbyqxmd.com/read/29776710/pharmacokinetics-pharmacodynamics-computer-decision-support-technologies-and-antimicrobial-stewardship-the-compass-and-rudder
#7
REVIEW
Robert C Owens, Catharine C Bulik, David R Andes
The first guidelines for conducting antimicrobial stewardship in the hospitalized setting were published in 2007. These guidelines recommend that stewardship programs employ the science of pharmacokinetics-pharmacodynamics (PK-PD) as well as adopting computerized decision support technologies when possible. The United States Food and Drug Administration have adopted PK-PD as a cornerstone in the evaluation of antimicrobial agents during clinical development. The core principles of PK-PD center around describing the relationship between drug exposure indexed to the susceptibility of the infecting bacterial pathogen and patient response...
April 13, 2018: Diagnostic Microbiology and Infectious Disease
https://www.readbyqxmd.com/read/29776399/simulation-based-power-calculations-for-planning-a-two-stage-individual-participant-data-meta-analysis
#8
Joie Ensor, Danielle L Burke, Kym I E Snell, Karla Hemming, Richard D Riley
BACKGROUND: Researchers and funders should consider the statistical power of planned Individual Participant Data (IPD) meta-analysis projects, as they are often time-consuming and costly. We propose simulation-based power calculations utilising a two-stage framework, and illustrate the approach for a planned IPD meta-analysis of randomised trials with continuous outcomes where the aim is to identify treatment-covariate interactions. METHODS: The simulation approach has four steps: (i) specify an underlying (data generating) statistical model for trials in the IPD meta-analysis; (ii) use readily available information (e...
May 18, 2018: BMC Medical Research Methodology
https://www.readbyqxmd.com/read/29776351/a-computational-study-of-hedgehog-signalling-involved-in-basal-cell-carcinoma-reveals-the-potential-and-limitation-of-combination-therapy
#9
Antoine Buetti-Dinh, Rebecca Jensen, Ran Friedman
BACKGROUND: The smoothened (SMO) receptor is an essential component of the Sonic hedgehog (SHH) signalling, which is associated with the development of skin basal cell carcinoma (BCC). SMO inhibitors are indicated for BCC patients when surgical treatment or radiation therapy are not possible. Unfortunately, SMO inhibitors are not always well tolerated due to severe side effects, and their therapeutical success is limited by resistance mutations. METHODS: We investigated how common are resistance-causing mutations in two genomic databases which are not linked to BCC or other cancers, namely 1000 Genomes and ExAC...
May 18, 2018: BMC Cancer
https://www.readbyqxmd.com/read/29776017/pharmacokinetics-and-c-reactive-protein-modelling-of-anti-il-6-antibody-pf-04236921-in-healthy-volunteers-and-patients-with-autoimmune-disease
#10
Cheryl Li, Satoshi Shoji, Jean Beebe
AIMS: The purpose of this study was to characterize pharmacokinetics (PK) of PF-04236921, a novel anti-IL-6 monoclonal antibody, and its pharmacokinetics/pharmacodynamics (PK/PD) relationship on serum C-Reactive Protein (CRP) in healthy volunteers and patients with rheumatoid arthritis (RA), systemic lupus erythematosus (SLE), and Crohn's disease (CD) METHODS: Population modelling analyses were conducted using nonlinear mixed effects modelling. Data from 2 phase 1 healthy volunteer studies, a phase 1 RA study, a Phase 2 CD study, and a Phase 2 SLE study were included...
May 18, 2018: British Journal of Clinical Pharmacology
https://www.readbyqxmd.com/read/29775814/composite-self-expanding-bioresorbable-prototype-stents-with-reinforced-compression-performance-for-congenital-heart-disease-application-computational-and-experimental-investigation
#11
Fan Zhao, Wen Xue, Fujun Wang, Laijun Liu, Haoqin Shi, Lu Wang
Stents are vital devices to treat vascular stenosis in pediatric patients with congenital heart disease. Bioresorbable stents (BRSs) have been applied to reduce challenging complications caused by permanent metal stents. However, it remains almost a total lack of BRSs with satisfactory compression performance specifically for children with congenital heart disease, leading to importantly suboptimal effects. In this work, composite bioresorbable prototype stents with superior compression resistance were designed by braiding and annealing technology, incorporating poly (p-dioxanone) (PPDO) monofilaments and polycaprolactone (PCL) multifilament...
May 8, 2018: Journal of the Mechanical Behavior of Biomedical Materials
https://www.readbyqxmd.com/read/29775553/influence-of-photobiomodulation-therapy-on-gingivitis-induced-by-multi-bracket-appliances-a-split-mouth-randomized-controlled-trial
#12
Steffen Stein, Michael Schauseil, Andreas Hellak, Heike Korbmacher-Steiner, Andreas Braun
OBJECTIVE: The objective of this split-mouth trial was to investigate the influence of photobiomodulation therapy (PBMT) on adjuvant treatment of gingivitis induced by multi-bracket appliances, after bracket debonding and professional tooth cleaning. MATERIALS AND METHODS: Thirteen patients (mean age 16.15 years; standard deviation ±2.12 years) who had completed active orthodontic treatment with fixed orthodontic appliances in an orthodontic clinic were included on a randomized basis...
May 18, 2018: Photomedicine and Laser Surgery
https://www.readbyqxmd.com/read/29775203/optimal-two-stage-dynamic-treatment-regimes-from-a-classification-perspective-with-censored-survival-data
#13
Rebecca Hager, Anastasios A Tsiatis, Marie Davidian
Clinicians often make multiple treatment decisions at key points over the course of a patient's disease. A dynamic treatment regime is a sequence of decision rules, each mapping a patient's observed history to the set of available, feasible treatment options at each decision point, and thus formalizes this process. An optimal regime is one leading to the most beneficial outcome on average if used to select treatment for the patient population. We propose a method for estimation of an optimal regime involving two decision points when the outcome of interest is a censored survival time, which is based on maximizing a locally efficient, doubly robust, augmented inverse probability weighted estimator for average outcome over a class of regimes...
May 18, 2018: Biometrics
https://www.readbyqxmd.com/read/29775201/tacrolimus-population-pharmacokinetics-and-multiple-cyp3a5-genotypes-in-black-and-white-renal-transplant-recipients
#14
Olivia Campagne, Donald E Mager, Daniel Brazeau, Rocco C Venuto, Kathleen M Tornatore
Tacrolimus exhibits inter-patient pharmacokinetic variability attributed to CYP3A5 isoenzymes and the efflux transporter, P-glycoprotein. Most black renal transplant recipients require higher tacrolimus doses compared to whites to achieve similar troughs when race-adjusted recommendations are used. An established guideline provides tacrolimus genotype dosing recommendations based on CYP3A5*1(W/T) and loss of protein function variants: CYP3A5*3 (rs776746), CYP3A5*6 (rs10264272), CYP3A5*7 (rs41303343) and may provide more comprehensive race-adjusted dosing recommendations...
May 18, 2018: Journal of Clinical Pharmacology
https://www.readbyqxmd.com/read/29775080/mindfulness-meditation-and-interprofessional-cardiopulmonary-resuscitation-a-mixed-methods-pilot-study
#15
Diana J Kelm, Jennifer L Ridgeway, Becca L Gas, Monali Mohan, David A Cook, Darlene R Nelson, Roberto P Benzo
PROBLEM: Mindfulness training includes mindfulness meditation, which has been shown to improve both attention and self-awareness. Medical providers in the intensive care unit often deal with difficult situations with strong emotions, life-and-death decisions, and both interpersonal and interprofessional conflicts. The effect of mindfulness meditation training on healthcare providers during acute care tasks such as cardiopulmonary resuscitation remains unknown. Mindfulness meditation has the potential to improve provider well-being and reduce stress in individuals involved in resuscitation teams, which could then translate into better team communication and delivery of care under stress...
May 18, 2018: Teaching and Learning in Medicine
https://www.readbyqxmd.com/read/29774638/loss-of-sirtuin-1-and-mitofusin-2-contributes-to-enhanced-ischemia-reperfusion-injury-in-aged-livers
#16
Sung Kook Chun, Sooyeon Lee, Joseph Flores-Toro, Rebecca Y U, Ming-Jim Yang, Kristina L Go, Thomas G Biel, Catherine E Miney, Schiley Pierre Louis, Brian K Law, Mary E Law, Elizabeth M Thomas, Kevin E Behrns, Christiaan Leeuwenburgh, Jae-Sung Kim
Ischemia/reperfusion (I/R) injury is a causative factor contributing to morbidity and mortality during liver resection and transplantation. Livers from elderly patients have a poorer recovery from these surgeries, indicating reduced reparative capacity with aging. Mechanisms underlying this age-mediated hypersensitivity to I/R injury remain poorly understood. Here, we investigated how sirtuin 1 (SIRT1) and mitofusin 2 (MFN2) are affected by I/R in aged livers. Young (3 months) and old (23-26 months) male C57/BL6 mice were subjected to hepatic I/R in vivo...
May 17, 2018: Aging Cell
https://www.readbyqxmd.com/read/29774571/clustering-and-variable-selection-in-the-presence-of-mixed-variable-types-and-missing-data
#17
C B Storlie, S M Myers, S K Katusic, A L Weaver, R G Voigt, P E Croarkin, R E Stoeckel, J D Port
We consider the problem of model-based clustering in the presence of many correlated, mixed continuous, and discrete variables, some of which may have missing values. Discrete variables are treated with a latent continuous variable approach, and the Dirichlet process is used to construct a mixture model with an unknown number of components. Variable selection is also performed to identify the variables that are most influential for determining cluster membership. The work is motivated by the need to cluster patients thought to potentially have autism spectrum disorder on the basis of many cognitive and/or behavioral test scores...
May 17, 2018: Statistics in Medicine
https://www.readbyqxmd.com/read/29774550/efficacy-of-vaporized-hydrogen-peroxide-for-repeated-sterilization-of-a-single-use-single-incision-laparoscopic-surgery-port
#18
Valery F Scharf, Brian Dent, Megan E Jacob, Brandon Moore
OBJECTIVE: To determine the ability of vaporized hydrogen peroxide (VHP) to sterilize a single-use single-incision laparoscopic surgery port and its associated components after repeated simulated uses. STUDY DESIGN: Prospective in vitro experimental study. SAMPLE POPULATION: Six single-use single-incision laparoscopic surgery ports with associated cannulas and insufflation tubing. METHODS: Ports, cannulas, and tubing were subjected to 10 cycles of simulated use, bacterial inoculation with Staphylococcus pseudintermedius and Escherichia coli, decontamination and sterilization, and testing via culture based on their treatment group designation...
May 17, 2018: Veterinary Surgery: VS
https://www.readbyqxmd.com/read/29774342/the-distinct-structural-preferences-of-tau-protein-repeat-domains
#19
Xuhua Li, Xuewei Dong, Guanghong Wei, Martin Margittai, Ruth Nussinov, Buyong Ma
The tau fibrillar structures from the brain of an Alzheimer's patient have a core with a C-shaped motif of the third and fourth repeat domains (R3-R4). Our simulations indicated that the C-shaped motif is only stable for R3-R4, while R1-R2 tends to be linear in shape. These two structural motifs appear in the most stable K18 protofilament. Heparin can further stabilize the C-shaped R3-R4 motif, but not other repeats.
May 18, 2018: Chemical Communications: Chem Comm
https://www.readbyqxmd.com/read/29774184/a-systematic-review-of-clinical-value-of-three-dimensional-printing-in-renal-disease
#20
Zhonghua Sun, Dongting Liu
The aim of this systematic review is to analyse current literature related to the clinical value of three-dimensional (3D) printed models in renal disease. A literature search of PubMed and Scopus databases was performed to identify studies reporting the clinical application and usefulness of 3D printed models in renal disease. Fifteen studies were found to meet the selection criteria and were included in the analysis. Eight of them provided quantitative assessments with five studies focusing on dimensional accuracy of 3D printed models in replicating renal anatomy and tumour, and on measuring tumour volume between 3D printed models and original source images and surgical specimens, with mean difference less than 10%...
April 2018: Quantitative Imaging in Medicine and Surgery
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