Multicriteria optimization of radiation therapy: Towards empowerment and standardization of reverse planning for head and neck squamous cell carcinoma

PURPOSE

The purpose of this study was to assess if multicriteria optimization could limit interoperator variability in radiation therapy planning and assess if this method could contribute to target volume coverage and sparing of organ at risk for intensity-modulated curative radiation therapy of head and neck cancers.

MATERIAL AND METHODS

We performed a retrospective analysis on 20 patients treated for an oropharyngeal or oral cavity squamous cell carcinoma. We carried out a comparative dosimetric study of manual plans produced with Precision® software, compared with the plans proposed using the multicriteria optimization method (RayStation®). We assessed interoperator reproducibility on the first six patients, and dosimetric contribution in sparing organs at risk using the multicriteria optimization method.

RESULTS

Median age was 69 years, most lesions were oropharyngeal carcinoma (65%), and 35% lesions were stage T3. First, we obtained a high degree of similarity between the four operator measurements for each patient at the level of each organ. Intraclass correlation coefficients were greater than 0.85. Second, we observed a significant dosimetric benefit for contralateral parotid gland, homolateral and contralateral masseter muscles, homolateral and contralateral pterygoid muscles and for the larynx (P<0.05). For the contralateral parotid gland, the mean dose difference between the multicriteria optimization and manual plans was -2.0Gy (P=0.01). Regarding the larynx, the mean dose difference between the two plans was -4.6Gy (P<0.001).

CONCLUSION

Multicriteria optimization is a reproducible technique and faster than manual optimization. It allows dosimetric advantages on organs at risk, especially for those not usually taken into consideration in manual dosimetry. This may lead to improved quality of life.

The effectiveness of a dialogical family guidance intervention regarding child treatment response in families with a child with neurodevelopmental disorders

BACKGROUND

Children with neurodevelopmental disorders (NDD) can have emotional and behavioral symptoms affecting not only the child, but the whole family. Since family members have a strong impact on each other, studies highlight the need to offer effective family interventions to strengthen the wellbeing of the family. The aim of the current study is to clarify whether there is a difference between parents` opinions regarding their child`s emotional and behavioral condition immediately after Dialogical Family Guidance (DFG) has ended and after a three and six month follow-up.

METHOD

Fifty families with a child with NDD were randomized into two groups. Group 1 received DFG with an immediate starting point, and Group 2 received DFG after a three-month waiting period. Parent experiences of treatment response regarding their children`s emotional and behavioral symptoms were estimated before and after DFG using the parent version of the Strengths and Difficulties Questionnaire (SDQ-p) at baseline, and after three and six months. Additionally, comparisons between boys and girls, and the age of the child were analyzed.

RESULTS

The total difficulties score between Group 1 and Group 2 showed no difference immediately after DFG, or after three months. Regarding subdomains boys had more peer problems than girls, and at baseline, children between 3 and 6 years appeared to have more conduct problems than children between 7 and 13 years. Subdomain prosocial behavior increased statistically significantly during the study period in Group 1. Other SDQ-p subdomains remained constant in both groups between baseline and three and six month follow-up.

CONCLUSIONS

The result does not show any differences between parents` opinions regarding their child immediately after or three months after DFG regarding SDQ-p total difficulties scores in either group. The difference between younger and older children regarding conduct problems at baseline, and the difference between boys and girls regarding peer problems is worth paying attention to in the clinical setting. Because of the small sample, it is not possible to draw relevant conclusions regarding the intervention`s effect regarding the child`s mental health dimensions, gender, or age. Nevertheless, Dialogical family Guidance represents one intervention that can be used.

TRIAL REGISTRATION

ClinicalTrials.gov NCT04892992 (retrospectively registered May 18th 2021).

Effects of third-neighbor interactions on the frustrated quantum Ising model

We investigate thermal and quantum phase transitions of the J_{1}-J_{2}-J_{3} transverse Ising model on the square lattice. The model is studied within a cluster mean-field decoupling, which allows us to describe phase diagrams and the free-energy landscape in the neighborhood of phase transitions. Our findings indicate that the third-neighbor coupling (J_{3}) can affect the nature of phase transitions of the model. In particular, ferromagnetic third-neighbor couplings favor the onset of continuous order-disorder phase transitions, eliminating the tricritical point of the superantiferromagnetic-paramagnetic (SAFM-PM) phase boundary. On the other hand, the enhancement of frustration introduced by weak antiferromagnetic J_{3} gives rise to the staggered dimer phase favoring the onset of discontinuous classical phase transitions. Moreover, we find that quantum annealed criticality (QAC), which takes place when the classical discontinuous phase transition becomes critical by the enhancement of quantum fluctuations introduced by the transverse magnetic field, is eliminated from the SAFM-PM phase boundary by a relatively weak ferromagnetic J_{3}. Nevertheless, this change in the nature of phase transitions can still be observed in the presence of antiferromagnetic third-neighbor couplings being also found in the staggered-dimer phase boundary. Therefore, our findings support that QAC persists under the presence of frustrated antiferromagnetic third-neighbor couplings and is suppressed when these couplings are ferromagnetic, suggesting that frustration plays a central role in the onset of QAC.

The workplace culture in addiction psychiatry in Finland as described by healthcare personnel

Purpose

The purpose of this study is to describe the workplace culture and factors associated with it from the viewpoint of the personnel providing care to patients with dual diagnosis.

Design/methodology/approach

Data were collected from six organizations using an electronic survey in 2019. The respondents (n = 75) worked in addiction psychiatry in specialized health care and provided care to patients. The data were statistically analyzed.

Findings

Workplace culture was evaluated as positive. Stress was experienced occasionally (Md = 2.58, Q1 = 1.96, Q3 = 3.03), job satisfaction levels were moderate (Md = 4.83, Q1 = 4.28, Q3 = 5.44) and the practice environment was evaluated as neutral (Md = 4.46, Q1 = 4.00, Q3 = 5.04). Gender, age in years, employment relationship, work time, staffing, number of patients and the participants’ experience in health care and experience in their current workplace had statistically significant associations with workplace culture.

Originality/value

In Finland, there have been attempts to reform service structures that also influence mental health and substance addiction services. Workplace culture is one approach to promote service development. Yet, there has been no research on workplace culture in the context of the care of patients with dual diagnosis. The results of this study bring knowledge about how health-care personnel perceives stress, job satisfaction and their practice environment in addiction psychiatry, which can be used to further develop services and workplace culture.

Challenging and redesigning a new model to explain intention to leave nursing

BACKGROUND

It is important to have a full and detailed understanding of the factors that influence intention to leave nursing. It has been shown to be the best predictor of actual turnover, and turnover has a significant financial impact and also on the provision of care.

AIMS

The aim is to examine the impact of predictive work environment factors on nurses' intention to leave their position and to explore contributing factors.

METHODS

Cross-sectional survey using a convenience sample (n = 605) of Finnish nurses drawn from five clinical settings. The Nursing Context Index, an internationally used and psychometrically validated tool, was used to measure workplace practice environment, work stress, job satisfaction and intention to leave. A response rate of 29.4% was achieved, exceeding power calculation estimates.

RESULTS

Personal satisfaction and satisfaction with profession and resources, and organisational commitment were significantly related to intention to leave. Younger nurses reported higher levels of intention to leave and there was variability among clinical specialties. Measures of stress and practice environment had no significant relationship with intention to leave.

DISCUSSION

This study provides a new theoretical model for understanding intention to leave. Having a better understanding of the factors that may help reduce intention to leave allows for targeted interventions to be developed and implemented. This would help reduce the personal and financial implications associated with turnover.

IMPLICATIONS FOR PRACTICE, POLICY, MANAGEMENT AND EDUCATION

The findings have significant implications for all aspects of nursing. Educators need to prepare new nursing staff for the working environment; policymakers must ensure that nursing satisfaction is promoted to strengthen organisational commitment and nurse managers and leaders respond accordingly in implementing effective interventions.

P3341Micro and macrovascular damage across the glycemic spectrum among women and men from general population

Background

Type 2 diabetes mellitus (T2DM) is a global epidemic that is strongly associated with micro- and macrovascular complications. Head to head comparisons of micro- and macrovascular dysfunction across the glycaemic spectrum among women and men from large population-based cohorts are sparse.

Purpose

To investigate associations of impaired serum fasting glucose (IFG) and T2DM with markers of micro- and macrovascular damage among women and men from general population.

Methods

We included 10,920 women and men (>45 years) from a large prospective population-based study. We applied linear and logistic regression analyses to examine the cross-sectional associations between IFG and T2DM with markers of micro- and macrovascular damage including estimated glomerular filtration rate (eGFR), retinopathy, carotid intima-media thickness (cIMT), carotid plaque (CP), carotid-femoral pulse-wave velocity (PWV), and ankle-brachial index (ABI), adjusted for cardiovascular risk factors.

Results

Mean age was 65.09±10.0 years, 11.8% had IFG and 12.2% were T2DM patients. The majority of population were women (57.2%). In the fully adjusted models, compared to individuals with normal glucose levels (<6.1 mmol/l), IFG was independently associated with PWV (β; 95% CI: 0.011; 0.002–0.021) among men. T2DM was independently associated with larger burden of CP (Odds ratio (OR); 95% CI: 1.57; 1.13–2.17), and higher eGFR (β; 95% CI: 2.17; 0.62–3.72) among women and with larger burden of retinopathy (OR; 95% CI: 1.92; 1.30–2.85), higher cIMT (β; 95% CI: 0.010; 0.01–0.02), and PWV (β; 95% CI: 0.03; 0.01–0.04) among men.

Conclusions

IFG and T2DM were associated with micro- and macrovascular damage. Compared to non-diabetics, diabetic men had larger burden for markers of microvascular damage including retinopathy while diabetic women had larger burden of macrovascular damage including CP. Both IGF and T2DM were also associated with age-related macrovascular markers such as cIMT and PWV. Proper screening of macrovascular changes at earlier stages of dysglycemia and before the overt T2DM is crucial for prevention and early treatment of end-organ damage

Appreciative management assessed by physiotherapists working in public or private sector: A cross-sectional study

PURPOSE

To describe how appreciative management occurs in the working environment of physiotherapists.

METHODS

Cross-sectional survey. The data was collected with an electronic questionnaire. The survey instrument was Appreciative Management Scale. The participants were 474 physiotherapists working in clinical or managerial positions from public or private sector.

RESULTS

Appreciative management was realized on an average level within physiotherapy. The highest scoring dimension was Equality and the weakest was Systematic Management. Appreciative management and all of its four categories were associated with the management education received by the manager, the respondent's position, and his or her current duties. The dimension of Appreciation of Know-how and its subdimensions of Guidance and Autonomy were recognized more often when the manager's basic training was in physiotherapy rather than another field.

CONCLUSIONS

It is important that managers in physiotherapy recognize the characteristics of appreciative management, so they can include them as part of their good practice and as part of their own leadership style. Managers in physiotherapy need to be encouraged to participate in management education and also enable the participation of others. A background in physiotherapy can be seen to further the practice and development of physiotherapy. Offering physiotherapists challenging assignments and enabling their career development in physical therapy units is therefore of great importance.

International Nursing: Nurse Managers' Leadership and Management Competencies Assessed by Nursing Personnel in a Finnish Hospital

The aim of this research was to describe nurse managers' leadership and management competencies (NMLMC) from the perspective of nursing personnel. Nurse managers are responsible for the management of the largest professional group in social and health care. The assessment of NMLMC is needed because of their powerful influence on organizational effectiveness. An electronic survey was conducted among the nursing personnel (n = 166) of 1 Finnish hospital in spring 2016. Nursing personnel assessed their manager using a NMLMC scale consisting of general and special competences. The data were statistically analyzed. Leadership and management competencies were assessed as being quite good by the nursing personnel. The best-assessed area of general competence was professional competence and credibility and the weakest was service initiation and innovation. The best-assessed area of special competence was substance knowledge and the weakest was research and development. The nursing personnel's assessment of their nurse manger's competencies was associated with the personnel's education level, working experience, and with their knowledge of the manager's education. Conclusion was made that nursing personnel highly value professional competence as part of nursing leadership and management. To achieve more appreciation, nurse managers have to demonstrate their education and competence. They must also work in more open and versatile ways with their nursing personnel.

[Epicardial ablation of ventricular tachycardias]

Ventricular tachycardias (VT) in patients with structural heart diseases have predominantly a scar-associated reentry mechanism so that substrate-based ablation approaches also have to be used in nearly all procedures. In many VT cases-especially in nonischemic cardiomyopathy (NICM) and arrhythmogenic right ventricular cardiomyopathy-a critical epicardial substrate can be identified as an essential component of the reentry circuit so that for the ablation-based modification of the substrate in these cases an epicardial approach is necessary. In cases of redo-VT ablation procedures in ischemic cardiomyopathy (after a previously endocardial ablation), an epicardial approach should also be considered. There are also cases in whom no endocardial substrate can be identified and an isolated epicardial substrate can be identified. Worldwide epicardial VT ablations are usually performed after gaining epicardial access using subxyphoidal puncture. The results of recent studies show a higher efficiency with stabilization of cardiac rhythm and reduction of recurrent VT episodes (about 70% event-free survival at the 2‑year follow-up) after endo-plus epicardial substrate modification. In electrical storm cases, an early epicardial VT ablation approach also appears to be relevant, especially in NICM. Epicardial instrumentation and ablation represents a complex procedure which should only be performed in experienced centers with cardiac surgery back-up. In these experienced centers, the complications rate is less than 5%.

Staff experiences of appreciative management in the institutional care of people with intellectual and developmental disabilities - a cross-sectional study

PURPOSE/DESIGN

This cross-sectional descriptive study describes staff experiences of appreciative management.

METHODS

Data were collected by way of e-survey from staff (n = 87) working in the institutional care of people with intellectual and developmental disabilities. The Appreciative Management Scale (AMS 1.0) was used and data were analysed by statistical methods.

FINDINGS

Overall, respondents experienced appreciative management as being well implemented, with equality as the best implemented dimension and systematic management the worst. The promotion of well-being at work was associated with age. Appreciation staff received from management had a positive correlation with systematic management, equality, appreciation of know-how and the promotion of well-being at work.

CONCLUSIONS

The knowledge of weak systematic management in this study may be utilised in developing management strategies. The managers should use the concept of appreciative management to help young and less experienced nurses to increase their competency and willingness to work in this field.

A complication probability planning study to predict the safety of a new protocol for intracranial tumour radiotherapy in dogs

Technical advances make it possible to deliver radiation therapy for canine intracranial tumours in fewer fractions, under the assumption of equivalent tumour control. With the aim of estimating the late toxicity risk profile for various tumour sizes and locations, the present paper evaluates the normal tissue complication probability (NTCP) values for the intracranial organs at risk. By making isoeffect calculations, a new 10-fraction radiation protocol was developed with the same tumour control probability (TCP) as a currently used 20-fraction standard protocol, and complication risk profiles for brain, brainstem and optic chiasm were modelled using a representative population of 64 dogs with brain tumours. For >59% of cases, the new 10-fraction protocol yielded an acceptable, low risk estimate of late toxicity (<10%). Our calculations suggest that it may be safe to treat small to intermediate-sized tumours that are neither located near the optic chiasm nor at the brainstem with 10 daily fractions of 4.35 Gy.

Transient binding accounts for apparent violation of the generalized Stokes-Einstein relation in crowded protein solutions

The effect of high concentration, also referred to as crowding conditions, on Brownian motion is of central relevance for the understanding of the physical, chemical and biological properties of proteins in their native environment. Specifically, the simple inverse relationship between the translational diffusion coefficient and the macroscopic solution viscosity as predicted by the generalized Stokes-Einstein (GSE) relation has been the subject of many studies, yet a consensus on its applicability has not been reached. Here, we use isotope-filtered pulsed-field gradient NMR to separately assess the μm-scale diffusivity of two proteins, BSA and an SH3 domain, in mixtures as well as single-protein solutions, and demonstrate that transient binding can account for an apparent violation of the GSE relation. Whereas GSE behavior applies for the single-protein solutions, it does not hold for the protein mixtures. Transient binding behavior in the concentrated mixtures is evidenced by calorimetric experiments and by a significantly increased apparent activation energy of diffusion. In contrast, the temperature dependence of the viscosity, as well as of the diffusivity in single-component solutions, is always dominated by the flow activation energy of pure water. As a practically relevant second result, we further show that, for high protein concentrations, the diffusion of small molecules such as dioxane or water is not generally a suitable probe for the viscosity experienced by the diffusing proteins.

Outcome in dogs with advanced (stage 3b) anal sac gland carcinoma treated with surgery or hypofractionated radiation therapy

Stage 3b anal sac gland carcinoma (ASGC) can be life-threatening. A surgical approach is not always possible or may be declined. Dogs with stage 3b ASGC treated with surgery or conformal radiation therapy (RT) with 8 × 3.8 Gy (total dose 30.4 Gy, over 2.5 weeks) were retrospectively evaluated. Patient characteristics, median progression-free interval (PFI) and median survival time (MST) were compared. Twenty-eight dogs were included; 15 underwent surgery, 13 underwent RT. At the time of presentation, 21% showed life-threatening obstipation and 25% showed hypercalcaemia. PFI and MST for surgery cases were 159 days (95% CI: 135-184 days) and 182 days (95% CI: 146-218 days), both significantly lower than for RT cases with 347 days (95% CI: 240-454 days) and 447 days (95% CI: 222-672 days), (P = 0.01, P = 0.019). Surgery as well as RT led to a fast relief of symptoms. PFI and survival of surgical patients were significantly inferior to that of a comparable patient group treated with conformal hypofractionated RT.