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https://www.readbyqxmd.com/read/29777595/a-ring-based-compensator-imrt-system-optimized-for-low-and-middle-income-countries-design-and-treatment-planning-study
#1
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/29775553/influence-of-photobiomodulation-therapy-on-gingivitis-induced-by-multi-bracket-appliances-a-split-mouth-randomized-controlled-trial
#2
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/29771338/cost-effectiveness-analysis-of-an-adherence-promotion-intervention-for-children-with-leukemia-a-markov-model-based-simulation
#3
Meghan E McGrady, Mark H Eckman, Maureen M O'Brien, Ahna L H Pai
Objective: Improving medication adherence among children with B-cell precursor acute lymphoblastic leukemia (B-ALL) has the potential to reduce relapse rates but requires an investment in resources. An economic evaluation is needed to understand the potential costs and benefits of delivering adherence-promotion interventions (APIs) as part of standard clinical care. Methods: A Markov decision analytic model was used to simulate the potential incremental cost-effectiveness per quality-adjusted life year (QALY) to be gained from an API for children with B-ALL in first continuous remission compared with treatment as usual (TAU, no intervention)...
May 15, 2018: Journal of Pediatric Psychology
https://www.readbyqxmd.com/read/29769198/mathematical-modeling-predicts-response-to-chemotherapy-and-drug-combinations-in-ovarian-cancer
#4
Emilia Kozłowska, Anniina Färkkilä, Tuulia Vallius, Olli Carpén, Jukka Kemppainen, Seija Grénman, Rainer Lehtonen, Johanna Hynninen, Sakari Hietanen, Sampsa Hautaniemi
Platinum-based chemotherapy constitutes the backbone of clinical care in advanced solid cancers such as high-grade serous ovarian cancer (HGSOC) and has prolonged survival of millions of cancer patients. Most of these patients, however, become resistant to chemotherapy, which generally leads to a fatal refractory disease. We present a comprehensive stochastic mathematical model and simulator approach to describe platinum resistance and standard-of-care (SOC) therapy in HGSOC. We used pre- and post-treatment clinical data, including 18F-FDG-PET/CT images, to reliably estimate the model parameters and simulate "virtual HGSOC patients...
May 16, 2018: Cancer Research
https://www.readbyqxmd.com/read/29768698/financial-viability-of-emergency-department-observation-unit-billing-models
#5
Christopher W Baugh, Pawan Suri, Christopher G Caspers, Michael A Granovsky, Keith Neal, Michael A Ross
BACKGROUND: Outpatients receive observation services to determine the need for inpatient admission. These services are usually provided without the use of condition-specific protocols and in an unstructured manner, scattered throughout a hospital in areas typically designated for inpatient care. Emergency department observation units (EDOUs) use protocolized care to offer an efficient alternative with shorter lengths of stay, lower costs and higher patient satisfaction. EDOU growth is limited by existing policy barriers that prevent a "two-service" model of separate professional billing for both emergency and observation services...
May 16, 2018: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://www.readbyqxmd.com/read/29767569/teaching-tip-development-of-veterinary-anesthesia-simulations-for-pre-clinical-training-design-implementation-and-evaluation-based-on-student-perspectives
#6
Jana L Jones, Jim Rinehart, Jacqueline Jordan Spiegel, Ryane E Englar, Brian K Sidaway, Joie Rowles
Anesthesia simulations have been used in pre-clinical medical training for decades to help learners gain confidence and expertise in an operating room environment without danger to a live patient. The authors describe a veterinary anesthesia simulation environment (VASE) with anesthesia scenarios developed to provide a re-creation of a veterinarian's task environment while performing anesthesia. The VASE uses advanced computer technology with simulator inputs provided from standard monitoring equipment in common use during veterinary anesthesia and a commercial canine training mannequin that allows intubation, ventilation, and venous access...
2018: Journal of Veterinary Medical Education
https://www.readbyqxmd.com/read/29767239/time%C3%A2-dependent-and-independent-effects-of-thyroid-hormone-administration-following-myocardial-infarction-in-rats
#7
Ioanna Iliopoulou, Iordanis Mourouzis, George I Lambrou, Dimitra Iliopoulou, Dimitrios-Dionysios Koutsouris, Constantinos Pantos
Cardiac function is reduced following myocardial infarction (MI) due to myocardial injury and alterations in the viable non‑ischemic myocardium, a process known as cardiac remodeling. The current treatments available for patients with acute MI (AMI) reduce infarct size, preserve left ventricular (LV) function and improve survival; however, these treatments do not prevent remodeling, which can lead to heart failure. The aim of the present study was to investigate the effects of thyroid hormone (TH) treatment following MI in an in vivo rat model...
May 11, 2018: Molecular Medicine Reports
https://www.readbyqxmd.com/read/29765459/the-number-of-strata-in-propensity-score-stratification-for-a-binary-outcome
#8
Markus Neuhäuser, Matthias Thielmann, Graeme D Ruxton
Introduction: Non-interventional and other observational studies have become important in medical research. In such observational, non-randomized studies, groups usually differ in some baseline covariates. Propensity scores are increasingly being used in the statistical analysis of these studies. Stratification, also called subclassification, based on propensity scores is one of the possible methods. There is the quasi-standard of using five strata. In this paper we focus on a binary outcome and evaluate the above-mentioned standard of using five strata...
April 2018: Archives of Medical Science: AMS
https://www.readbyqxmd.com/read/29765004/a-comparison-of-the-adjustable-ranges-of-inspiratory-pressurization-during-pressure-controlled-continuous-mandatory-ventilation-of-5-icu-ventilators
#9
Yukiko Koyama, Akinori Uchiyama, Junko Yoshida, Takeshi Yoshida, Tomonori Yamashita, Yuji Fujino
BACKGROUND: Faster inspiratory pressurization can improve patient-ventilator synchrony and reduce the patient's work of breathing during pressure controlled continuous mandatory (PC-CMV) ventilation. The characteristics of the pressurization ramp settings are not standardized across ventilators from different manufacturers. We performed a bench test of 5 models of ICU ventilators to examine the effects of pressurization ramp settings on the actual pressurization. METHODS: A twin-bellows lung model was used, in which one bellow simulates inspiratory muscle activity and the other simulates an adult normal lung model...
May 15, 2018: Respiratory Care
https://www.readbyqxmd.com/read/29762798/a-prenatal-standardized-patient-experience-for-medical-students-on-their-family-medicine-clerkship
#10
Sarah E Stumbar, Suzanne Minor, Marquita Samuels
BACKGROUND AND OBJECTIVES: Students on their family medicine clerkship at Herbert Wertheim College of Medicine get little clinical exposure to obstetric care, which is not commonly provided by family physicians in urban settings. To address this, we added to our clerkship didactic curriculum a 2-hour session involving a standardized patient (SP). The SP is collectively interviewed by the student group during four simulated prenatal visits, each of which present a different complication of pregnancy...
May 2018: Family Medicine
https://www.readbyqxmd.com/read/29760144/personalizing-polymyxin-b-dosing-using-an-adaptive-feedback-control-algorithm
#11
Elizabeth A Lakota, Cornelia B Landersdorfer, Roger L Nation, Jian Li, Keith S Kaye, Gauri G Rao, Alan Forrest
Polymyxin B is used as an antibiotic of last resort for patients with multidrug-resistant Gram-negative bacterial infections; however, it carries a significant risk of nephrotoxicity. Herein we present a polymyxin B therapeutic window based on target area under the concentration-time curve (AUC) values and an adaptive feedback control algorithm (algorithm) which allows for the personalization of polymyxin B dosing. The upper bound of this therapeutic window was determined through a pharmacometric meta-analysis of polymyxin B nephrotoxicity data, and the lower bound was derived from murine thigh-infection pharmacokinetic/pharmacodynamic studies...
May 14, 2018: Antimicrobial Agents and Chemotherapy
https://www.readbyqxmd.com/read/29757380/simultaneous-population-pharmacokinetic-modelling-of-plasma-and-intracellular-pbmc-miltefosine-concentrations-in-new-world-cutaneous-leishmaniasis-and-exploration-of-exposure-response-relationships
#12
Anke E Kip, María Del Mar Castro, Maria Adelaida Gomez, Alexandra Cossio, Jan H M Schellens, Jos H Beijnen, Nancy Gore Saravia, Thomas P C Dorlo
Objectives: Leishmania parasites reside within macrophages and the direct target of antileishmanial drugs is therefore intracellular. We aimed to characterize the intracellular PBMC miltefosine kinetics by developing a population pharmacokinetic (PK) model simultaneously describing plasma and intracellular PBMC pharmacokinetics. Furthermore, we explored exposure-response relationships and simulated alternative dosing regimens. Patients and methods: A population PK model was developed with NONMEM, based on 339 plasma and 194 PBMC miltefosine concentrations from Colombian cutaneous leishmaniasis patients [29 children (2-12 years old) and 22 adults] receiving 1...
May 10, 2018: Journal of Antimicrobial Chemotherapy
https://www.readbyqxmd.com/read/29757360/decision-analysis-supports-the-use-of-drain-amylase-based-enhanced-recovery-method-after-esophagectomy
#13
B Jiang, V P Ho, J Ginsberg, S J Fu, Y Perry, L Argote-Greene, P A Linden, C W Towe
Postesophagectomy anastomotic leak is a common postsurgical complication. The current standard method of detecting leak is esophagram usually late in the postoperative period. Perianastomotic drain amylase level had shown promising results in early detection anastomosis leak. Previous studies have shown that postoperative day 4 amylase level is more specific and sensitive than esophagram. The purpose of this study is to determine if implementing a drain amylase-based screening method for anastomotic leak can reduce length of stay and hospital cost relative to a traditional esophagram-based pathway...
May 10, 2018: Diseases of the Esophagus: Official Journal of the International Society for Diseases of the Esophagus
https://www.readbyqxmd.com/read/29754389/cost-effectiveness-of-forced-air-warming-during-sedation-in-the-cardiac-catheterisation-laboratory
#14
Aaron Conway, Jed Duff, Joanna Sutherland
AIM: To determine the cost-effectiveness of forced air warming during sedation in a cardiac catheterisation laboratory. BACKGROUND: Forced air warming improves thermal comfort in comparison with standard care. It is not known whether the extra costs required for forced air warming are good value. DESIGN: Cost-effectiveness analysis alongside a randomised controlled trial conducted in 2016-2017. METHODS: A cost-effectiveness analysis was undertaken using Monte Carlo simulations from input distributions to estimate costs and effects associated with using forced air warming to reduce risk of thermal discomfort for patients receiving sedation in a cardiac catheterisation laboratory...
May 13, 2018: Journal of Advanced Nursing
https://www.readbyqxmd.com/read/29754155/-real-patients-in-virtual-reality-the-link-between-phantom-heads-and-clinical-dentistry
#15
C M Serrano, P R Wesselink, J M Vervoorn
Preclinical training in phantom heads has until now been considered the 'gold standard' for restorative dental education, but the transition from preclinic to the treatment of real patients has remained a challenge. With the introduction of the latest generation of virtual reality simulators, students and dental practitioners can make digital impressions of their patients in virtual reality models and practice procedures in virtual reality before clinically performing them. In this way, clinical decisions can be investigated and practiced prior to actual treatment, enhancing the safety of the treatment and the self-confidence to perform it...
May 2018: Nederlands Tijdschrift Voor Tandheelkunde
https://www.readbyqxmd.com/read/29753643/evaluation-of-community-pharmacists-preparedness-for-the-provision-of-cardiovascular-disease-risk-assessment-and-management-services-a-study-with-simulated-patients-in-qatar
#16
Monica Zolezzi, Oraib Abdallah, Nadir Kheir, Abdelsalam Gomaa Abdelsalam
BACKGROUND: Individuals who suffer from major cardiovascular events every year have one or more risk factors. Cardiovascular disease (CVD) risk assessment is an important strategy for the early identification of modifiable risk factors and their management. There is substantial evidence that shifting the focus from treatment to primary prevention reduces the burden of CVD. OBJECTIVES: To evaluate the preparedness of community pharmacists in Qatar for the provision of CVD risk assessment and management services; and to explore the pharmacists' views on the provision of these services...
April 28, 2018: Research in Social & Administrative Pharmacy: RSAP
https://www.readbyqxmd.com/read/29752249/virtual-antenatal-encounter-and-standardized-simulation-assessment-vanessa-pilot-study
#17
Patrick Motz, Megan Gray, Taylor Sawyer, Jennifer Kett, Douglas Danforth, Kellen Maicher, Rachel Umoren
BACKGROUND: Prenatal counseling at the limits of newborn viability involves sensitive interactions between neonatal providers and families. Empathetic discussions are currently learned through practice in times of high stress. Decision aids may help improve provider communication but have not been universally adopted. Virtual standardized patients are increasingly recognized as a modality for education, but prenatal counseling simulations have not been described. To be valuable as a tool, a virtual patient would need to accurately portray emotions and elicit a realistic response from the provider...
May 11, 2018: JMIR Serious Games
https://www.readbyqxmd.com/read/29751104/usability-evaluation-of-a-medication-reconciliation-tool-embedding-safety-probes-to-assess-users-detection-of-medication-discrepancies
#18
Alissa L Russ, Michelle A Jahn, Himalaya Patel, Brian W Porter, Khoa A Nguyen, Alan J Zillich, Amy Linsky, Steven R Simon
OBJECTIVE: An electronic medication reconciliation tool was previously developed by another research team to aid provider-patient communication for medication reconciliation. To evaluate the usability of this tool, we integrated artificial safety probes into standard usability methods. The objective of this article is to describe this method of using safety probes, which enabled us to evaluate how well the tool supports users' detection of medication discrepancies. MATERIALS AND METHODS: We completed a mixed-method usability evaluation in a simulated setting with 30 participants: 20 healthcare professionals (HCPs) and 10 patients...
May 8, 2018: Journal of Biomedical Informatics
https://www.readbyqxmd.com/read/29749882/low-cost-endoscopic-third-ventriculostomy-simulator-with-mimetic-endoscope
#19
Richard Justin Garling, Xin Jin, Jianzhong Yang, Ahmad H Khasawneh, Carolyn Anne Harris
OBJECTIVE Hydrocephalus affects approximately 1 in 500 people in the US, yet ventricular shunting, the gold standard of treatment, has a nearly 85% failure rate. Endoscopic third ventriculostomy (ETV) is an alternative surgical approach for a specific subset of hydrocephalic patients, but can be limited by the inability of neurosurgical residents to practice prior to patient contact. The goal of this study was to create an affordable ETV model and endoscope for resident training. METHODS Open-source software was used to isolate the skull and brain from the CT and MR images of a 2-year-old boy with hydrocephalus...
May 11, 2018: Journal of Neurosurgery. Pediatrics
https://www.readbyqxmd.com/read/29748967/bivariate-random-effects-meta-analysis-models-for-diagnostic-test-accuracy-studies-using-arcsine-based-transformations
#20
Zelalem F Negeri, Mateen Shaikh, Joseph Beyene
Diagnostic or screening tests are widely used in medical fields to classify patients according to their disease status. Several statistical models for meta-analysis of diagnostic test accuracy studies have been developed to synthesize test sensitivity and specificity of a diagnostic test of interest. Because of the correlation between test sensitivity and specificity, modeling the two measures using a bivariate model is recommended. In this paper, we extend the current standard bivariate linear mixed model (LMM) by proposing two variance-stabilizing transformations: the arcsine square root and the Freeman-Tukey double arcsine transformation...
May 11, 2018: Biometrical Journal. Biometrische Zeitschrift
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