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Arango-Piloneta EV, Plaza-Ruiz SP, Quiroga P, León-Lara DF. Simplifying two-vector mechanics calculations for challenging tooth movements. Comput Methods Biomech Biomed Engin 2024; 27:15-23. [PMID: 36625711 DOI: 10.1080/10255842.2023.2165392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 12/31/2022] [Indexed: 01/11/2023]
Abstract
The purpose of this article was to describe a simple graphical driven method for determining the necessary two-vector mechanics (TVM) as an alternative solution to the ideal or single force. In orthodontics, some tooth movements are difficult to achieve, mainly because of the impossibility of getting the point of application for the necessary force system. Given two points in biomechanically accessible areas, adding together two vectors applied to those points will result in an equivalent force system. The method was developed based on previous research, 3,880 hypothetical cases were analyzed to determine the trends between the resulting forces and their relative locations. A graphical driven TVM method (GTVM) for establishing the necessary TVM is presented in a manner that combine different procedures from the traditional method that simplify the analysis and may allow the user to perform more complex orthodontic cases making easier to compare systems of force equivalents.
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Affiliation(s)
- E V Arango-Piloneta
- Orthodontic Department, Fundación Universitaria CIEO-UniCIEO, Bogotá, Colombia
| | - S P Plaza-Ruiz
- Orthodontic Department, Fundación Universitaria CIEO-UniCIEO, Bogotá, Colombia
| | - P Quiroga
- Center for Studies in Structrures and Materials, Civil Engineering Department, Escuela Colombiana de Ingenieros Julio Garavito, Bogotá, Colombia
| | - D F León-Lara
- Escuela Colombiana de Ingenieros Julio Garavito, Bogotá, Colombia
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2
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Sood A, Sangari A, Stoff BK. Recommending expensive treatments: An ethical analysis. J Am Acad Dermatol 2024; 90:216-217. [PMID: 35872260 DOI: 10.1016/j.jaad.2022.07.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Revised: 07/14/2022] [Accepted: 07/17/2022] [Indexed: 11/16/2022]
Affiliation(s)
- Aditya Sood
- Department of Dermatology, Emory University School of Medicine, Atlanta, Georgia
| | - Ayush Sangari
- Renaissance School of Medicine, Stony Brook University, Stony Brook, New York
| | - Benjamin K Stoff
- Department of Dermatology, Emory University School of Medicine, Atlanta, Georgia; Emory Center for Ethics, Atlanta, Georgia.
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Gager Y, Koppe J, Vogl I, Gabert J, Jentsch H. Antibiotic resistance genes in the subgingival microbiome and implications for periodontitis therapy. J Periodontol 2023; 94:1295-1301. [PMID: 37254939 DOI: 10.1002/jper.22-0696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 04/16/2023] [Accepted: 05/26/2023] [Indexed: 06/01/2023]
Abstract
BACKGROUND Antibiotic resistance is emerging as a global public threat. However, it remains poorly investigated in the context of periodontal therapy. The aim of the study was to investigate the complete diversity of antibiotic resistance genes in a German population. METHODS Thirty-nine volunteers with periodontitis contributed to the present study with one to four periodontal pockets for a total of 124 subgingival samples. Samples were analyzed using shotgun metagenomics. RESULTS A total of 19 antibiotic resistance genes from six antibiotic classes were detected in subgingival biofilm. Two thirds of the volunteers (n = 26/39) showed antibiotic resistance genes for at least one of the antibiotic classes used for periodontal treatment in dental practice or research: beta-lactam, lincosamide, macrolide, nitroimidazole, and tetracycline. Macrolide was the most abundant class detected (21/39 patients). CONCLUSIONS Findings from our study suggest a high prevalence of antibiotic resistance genes in periodontal pockets from German volunteers. We recommend the development and broader use of molecular diagnostic tests for antibiotic resistance in dental practice to ensure treatment success and to minimize antibiotic resistance.
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Affiliation(s)
- Yann Gager
- ParoX GmbH, Deutscher Platz 5, Leipzig, Germany
| | - Jonas Koppe
- Centre for Periodontology, Department of Cariology, Endodontology and Periodontology, University Hospital of Leipzig, Leipzig, Germany
| | - Ina Vogl
- ParoX GmbH, Deutscher Platz 5, Leipzig, Germany
| | - Jörg Gabert
- ParoX GmbH, Deutscher Platz 5, Leipzig, Germany
| | - Holger Jentsch
- Centre for Periodontology, Department of Cariology, Endodontology and Periodontology, University Hospital of Leipzig, Leipzig, Germany
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McIntyre M, Wilson P, Gorayski P, Bezak E. A Systematic Review of LET-Guided Treatment Plan Optimisation in Proton Therapy: Identifying the Current State and Future Needs. Cancers (Basel) 2023; 15:4268. [PMID: 37686544 PMCID: PMC10486456 DOI: 10.3390/cancers15174268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 08/16/2023] [Accepted: 08/17/2023] [Indexed: 09/10/2023] Open
Abstract
The well-known clinical benefits of proton therapy are achieved through higher target-conformality and normal tissue sparing than conventional radiotherapy. However, there is an increased sensitivity to uncertainties in patient motion/setup, proton range and radiobiological effect. Although recent efforts have mitigated some uncertainties, radiobiological effect remains unresolved due to a lack of clinical data for relevant endpoints. Therefore, RBE optimisations may be currently unsuitable for clinical treatment planning. LET optimisation is a novel method that substitutes RBE with LET, shifting LET hotspots outside critical structures. This review outlines the current status of LET optimisation in proton therapy, highlighting knowledge gaps and possible future research. Following the PRISMA 2020 guidelines, a search of the MEDLINE® and Scopus databases was performed in July 2023, identifying 70 relevant articles. Generally, LET optimisation methods achieved their treatment objectives; however, clinical benefit is patient-dependent. Inconsistencies in the reported data suggest further testing is required to identify therapeutically favourable methods. We discuss the methods which are suitable for near-future clinical deployment, with fast computation times and compatibility with existing treatment protocols. Although there is some clinical evidence of a correlation between high LET and adverse effects, further developments are needed to inform future patient selection protocols for widespread application of LET optimisation in proton therapy.
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Affiliation(s)
- Melissa McIntyre
- Allied Health & Human Performance Academic Unit, University of South Australia, Adelaide, SA 5000, Australia
| | - Puthenparampil Wilson
- Department of Radiation Oncology, Royal Adelaide Hospital, Adelaide, SA 5000, Australia
- UniSA STEM, University of South Australia, Adelaide, SA 5000, Australia
| | - Peter Gorayski
- Allied Health & Human Performance Academic Unit, University of South Australia, Adelaide, SA 5000, Australia
- Department of Radiation Oncology, Royal Adelaide Hospital, Adelaide, SA 5000, Australia
- Australian Bragg Centre for Proton Therapy and Research, Adelaide, SA 5000, Australia
| | - Eva Bezak
- Allied Health & Human Performance Academic Unit, University of South Australia, Adelaide, SA 5000, Australia
- Department of Physics, University of Adelaide, Adelaide, SA 5005, Australia
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Čehobašić A, Paladino J, Kaučić H, Mišir-Krpan A, Leipold V, Mlinarić M, Kosmina D, Mack A, Schwarz D, Divošević S, Alerić I. Comparison of 116 Radiosurgery Treatment Plans for Multi-Leaf and Cone Collimator on a Varian Edge Linac: Are Cones Superior in the Daily Routine? Life (Basel) 2023; 13:life13041020. [PMID: 37109549 PMCID: PMC10146576 DOI: 10.3390/life13041020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 04/07/2023] [Accepted: 04/13/2023] [Indexed: 04/29/2023] Open
Abstract
Delivering focused radiation doses via linear accelerators is a crucial component of stereotactic radiosurgery (SRS) for brain metastases. The Varian Edge linear accelerator provides highly conformal radiation therapy through a high-definition multi-leaf collimator (HD120 MLC) and conical collimator (CC). HD120 MLC adapts to the shape of the target volume using movable tungsten leaves, while CC has a block of conical shape (cones). CC in SRS treatments of small brain metastases is preferred due to its mechanical stability and steeper dose fall-off, potentially sparing organs at risk (OARs) and the brain better than HD120 MLC. This study aims to determine if CC offers significant advantages over HD120 MLC for SRS treatments. For 116 metastatic lesions, CC and HD120 MLC treatment plans were created in Varian Eclipse TPS and compared based on various dose parameters, robustness tests, and QA measurements. The results indicate that CC provides no significant advantages over HD120 MLC, except for slight, clinically insignificant benefits in brain sparing and dose fall-off for the smallest lesions. HD120 MLC outperforms CC in almost every aspect, making it a better choice for irradiating brain metastases with 0.1 cm3 or higher volumes.
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Affiliation(s)
- Adlan Čehobašić
- Specijalna Bolnica Radiochirurgia Zagreb, Ulica Dr. Franje Tuđmana 4, 10431 Sveta Nedelja, Croatia
- Medicinski Fakultet Osijek, Sveučilište Josipa Jurja Strossmayera u Osijeku, Josipa Huttlera 4, 31000 Osijek, Croatia
| | - Josip Paladino
- Specijalna Bolnica Radiochirurgia Zagreb, Ulica Dr. Franje Tuđmana 4, 10431 Sveta Nedelja, Croatia
| | - Hrvoje Kaučić
- Specijalna Bolnica Radiochirurgia Zagreb, Ulica Dr. Franje Tuđmana 4, 10431 Sveta Nedelja, Croatia
| | - Ana Mišir-Krpan
- Specijalna Bolnica Radiochirurgia Zagreb, Ulica Dr. Franje Tuđmana 4, 10431 Sveta Nedelja, Croatia
- Medicinski Fakultet, Sveučilište u Zagrebu, Šalata 3, 10000 Zagreb, Croatia
| | - Vanda Leipold
- Specijalna Bolnica Radiochirurgia Zagreb, Ulica Dr. Franje Tuđmana 4, 10431 Sveta Nedelja, Croatia
- Medicinski Fakultet Osijek, Sveučilište Josipa Jurja Strossmayera u Osijeku, Josipa Huttlera 4, 31000 Osijek, Croatia
| | - Mihaela Mlinarić
- Specijalna Bolnica Radiochirurgia Zagreb, Ulica Dr. Franje Tuđmana 4, 10431 Sveta Nedelja, Croatia
| | - Domagoj Kosmina
- Specijalna Bolnica Radiochirurgia Zagreb, Ulica Dr. Franje Tuđmana 4, 10431 Sveta Nedelja, Croatia
| | - Andreas Mack
- Swiss NeuroRadiosurgery Center, Bürglistrasse 29, 8002 Zürich, Switzerland
| | - Dragan Schwarz
- Specijalna Bolnica Radiochirurgia Zagreb, Ulica Dr. Franje Tuđmana 4, 10431 Sveta Nedelja, Croatia
- Medicinski Fakultet, Sveučilišta u Rijeci, Braće Branchetta 20/1, 51000 Rijeka, Croatia
- Fakultet za Dentalnu Medicinu i Zdravstvo Osijek, Sveučilište Josipa Jurja Strossmayera u Osijeku, Crkvena Ulica 21, 31000 Osijek, Croatia
| | - Sunčana Divošević
- Specijalna Bolnica Radiochirurgia Zagreb, Ulica Dr. Franje Tuđmana 4, 10431 Sveta Nedelja, Croatia
| | - Ivana Alerić
- Specijalna Bolnica Radiochirurgia Zagreb, Ulica Dr. Franje Tuđmana 4, 10431 Sveta Nedelja, Croatia
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Azeez SM. Evaluating diagnostic performance of three cephalometric vertical parameters. Indian J Dent Res 2023; 34:49-53. [PMID: 37417057 DOI: 10.4103/ijdr.ijdr_233_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/08/2023] Open
Abstract
Objectives The goal of this research was to see how reliable and valid three selected parameters from different analysis were in detecting the vertical skeletal pattern. Methods There were 94 cephalometric x-rays used in all. The vertical skeletal pattern was assessed using the mandibular plane angle by Steiner, Frankfort mandibular angle by Tweed, and facial axis angle by McNamara. According to the diagnostic results of the majority of the measures, the samples were classified as normo-divergent, hypodivergent, or hyperdivergent. Kappa statistics, positive predictive value, and sensitivity were employed to verify the validity and reliability of the analyses. Results A statistically significant weak negative correlation was found between Frankfort mandibular angle and facial axis angle in female group (p value < 0.01). A good agreement was found between mandibular plane angle with final diagnosis (K = 0.726). The mandibular plane angle showed highest sensitivity and positive predictive value in hypodivergent group (0.939, 0.816) and normo-divergent group (0.795, 0.833), respectively. Conclusion For determining the facial vertical growth pattern the most accurate indicators were identified to be mandibular plane angle (SN-GoGn) and Frankfort mandibular angle.
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Affiliation(s)
- Saya M Azeez
- Department of Orthodontics, Faculty of Dentistry, Tishk International University-Erbil, Kurdistan Region, Iraq
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Yuan S, Zhou JY, Yang BZ, Xie ZL, Zhu TJ, Hu HX, Li R. Prediction of cardiovascular adverse events in newly diagnosed multiple myeloma: Development and validation of a risk score prognostic model. Front Oncol 2023; 13:1043869. [PMID: 37025590 PMCID: PMC10070977 DOI: 10.3389/fonc.2023.1043869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 02/28/2023] [Indexed: 04/08/2023] Open
Abstract
Background Multiple myeloma (MM) is the second most common hematological malignancy, and the treatments markedly elevate the survival rate of the patients in recent years. However, the prevalence of cardiovascular adverse events (CVAEs) in MM had been increasing recently. CVAEs in MM patients are an important problem that we should focus on. Clinical tools for prognostication and risk-stratification are needed. Patients and methods This is a retrospective study that included patients who were newly diagnosed with multiple myeloma (NDMM) in Shanghai Changzheng Hospital and Affiliated Jinhua Hospital, Zhejiang University School of Medicine from June 2018 to July 2020. A total of 253 patients from two medical centers were divided into training cohort and validation cohort randomly. Univariable analysis of the baseline factors was performed using CVAEs endpoints. Multivariable analysis identified three factors for a prognostic model that was validated in internal validation cohorts. Results Factors independently associated with CVAEs in NDMM were as follows: age>61 years old, high level of baseline office blood pressure, and left ventricular hypertrophy (LVH). Age contributed 2 points, and the other two factors contributed 1 point to a prognostic model. The model distinguished the patients into three groups: 3-4 points, high risk; 2 points, intermediate risk; 0-1 point, low risk. These groups had significant difference in CVAEs during follow-up days in both training cohort (p<0.0001) and validation cohort (p=0.0018). In addition, the model had good calibration. The C-indexes for the prediction of overall survival of CVAEs in the training and validation cohorts were 0.73 (95% CI, 0.67-0.79) and 0.66 (95% CI, 0.51-0.81), respectively. The areas under the receiver operating characteristic curve (AUROCs) of the 1-year CVAEs probability in the training and validation cohorts were 0.738 and 0.673, respectively. The AUROCs of the 2-year CVAE probability in the training and validation cohorts were 0.722 and 0.742, respectively. The decision-curve analysis indicated that the prediction model provided greater net benefit than the default strategies of providing assessment or not providing assessment for all patients. Conclusion A prognostic risk prediction model for predicting CVAEs risk of NDMM patients was developed and internally validated. Patients at increased risk of CVAEs can be identified at treatment initiation and be more focused on cardiovascular protection in the treatment plan.
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Affiliation(s)
- Shuai Yuan
- Shanghai Institute of Cardiovascular Disease, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Jie-Yi Zhou
- Department of Nuclear Radiation Injury Protection and Treatment Department, Naval Medical Center, Naval Medical University, Shanghai, China
| | - Ben-Zhao Yang
- Department of Cardiology, Naval Medical Center, Naval Medical University, Shanghai, China
| | - Zhong-Lei Xie
- Shanghai Institute of Cardiovascular Disease, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Ting-Jun Zhu
- Department of Hematology, Affiliated Jinhua Hospital, Zhejiang University School of Medicine, Jinhua, Zhejiang, China
| | - Hui-Xian Hu
- Department of Hematology, Affiliated Jinhua Hospital, Zhejiang University School of Medicine, Jinhua, Zhejiang, China
- *Correspondence: Hui-Xian Hu, ; Rong Li,
| | - Rong Li
- Department of Nuclear Radiation Injury Protection and Treatment Department, Naval Medical Center, Naval Medical University, Shanghai, China
- Department of Hematology, The Myeloma and Lymphoma Center, Shanghai Changzheng Hospital, Naval Medical University, Shanghai, China
- *Correspondence: Hui-Xian Hu, ; Rong Li,
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Kakar A, Blanchard S, Shin D, Maupomé G, Eckert GJ, John V. Periodontal diagnosis and treatment planning - An assessment of the understanding of the new classification system. J Dent Educ 2022; 86:1573-1580. [PMID: 35830257 DOI: 10.1002/jdd.13037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2022] [Revised: 06/24/2022] [Accepted: 06/29/2022] [Indexed: 12/14/2022]
Abstract
OBJECTIVES Substantial variations are seen among clinicians in the diagnosis and treatment planning of periodontal diseases. Accurate diagnosis and treatment planning are fundamental requirements for effective outcome-based patient care. The aim of this study was to evaluate the understanding of the American Academy of Periodontology and the European Federation of Periodontology 2017 periodontal disease classifications in diagnoses and treatment plans across four study groups. METHODS The study recruited at least 20 participants in each of the four study groups. These included 1) Periodontal faculty and residents at Indiana University School of Dentistry (IUSD-PF) 2) IUSD general practice faculty (IUSD-GPF), 3) private practice periodontists (PPP), and 4) general practitioners (GP). The participants were provided with 10 HIPPA de-identified case records and a link to a survey. The survey comprised five demographic questions and two questions on diagnosis and treatment plan for each case along with a fixed list of responses. The responses were then compared against gold standards that were determined by a group of three board-certified periodontists. RESULTS Overall, for diagnostic questions, GP (69%) were correct significantly less often than IUSD-PF (86%, p < 0.001), IUSD-GPF (79%, p = 0.002), and PPP (80%, p = 0.001). No significant differences (p > 0.05) in the overall correct treatment plan responses were found among the four groups (IUSD-PF: 69%, IUSD-GPF: 62%, PPP: 68%, and GP: 60%). The multi-rater kappas for with-in-group agreement on overall diagnosis ranged from 0.36 (GP) to 0.55 (IUSD-PF) and on overall treatment plan ranged from 0.32 (IUSD-GPF) to 0.42 (IUSD-PF). Overall agreement for diagnosis and treatment plans among the four groups was relatively low and none of the groups were statistically different from each other (p > 0.05). CONCLUSION Regular participation in calibration sessions may lead to more accurate adoption of the 2017 periodontal classification and thereby help provide consistent diagnosis and treatment.
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Affiliation(s)
- Arushi Kakar
- Department of Periodontology, Indiana University School of Dentistry, Indianapolis, Indiana, USA
| | - Steven Blanchard
- Department of Periodontology, Indiana University School of Dentistry, Indianapolis, Indiana, USA
| | - Daniel Shin
- Department of Periodontology, Indiana University School of Dentistry, Indianapolis, Indiana, USA
| | - Gerardo Maupomé
- Department of Periodontology, Indiana University School of Dentistry, Indianapolis, Indiana, USA.,Department of Global Health, Richard M. Fairbanks School of Public Health, Indianapolis, Indiana, USA
| | - George J Eckert
- Department of Biostatistics and Health Data Science, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Vanchit John
- Department of Periodontology, Indiana University School of Dentistry, Indianapolis, Indiana, USA
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Khodaveisi T, Sadoughi F, Novin K, Hosseiniravandi M, Dehnad A. Development and evaluation of a teleoncology system for breast cancer during the COVID-19 pandemic. Future Oncol 2022; 18:1437-1448. [PMID: 35129376 PMCID: PMC8842715 DOI: 10.2217/fon-2021-0822] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Background: The present study describes the steps of developing a hybrid teleoncology system to provide treatment plans for breast cancer patients. Materials & methods: This research was conducted in four stages, including developing a proposal for experts, identifying and analyzing system requirements, designing a prototype and implementing and evaluating the final version of the hybrid teleoncology system. Results: The results of the usability evaluation showed that the users evaluated the system at a good level and, in practice, the implemented system was perceived to be useful by specialists in providing treatment plans for cancer patients. Conclusion: The hybrid teleoncology system is a practical alternative to traditional methods for providing treatment plans to breast cancer patients.
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Affiliation(s)
- Taleb Khodaveisi
- Department of Health Information Technology, School of Allied Medical Sciences, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Farahnaz Sadoughi
- School of Health Management & Information Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Kambiz Novin
- Department of Radiotherapy and Oncology, Faculty of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Mohammad Hosseiniravandi
- Department of Health Information Technology, School of Paramedical Sciences, Torbat Heydariyeh University of Medical Sciences, Torbat Heydariyeh, Iran
| | - Afsaneh Dehnad
- Center for Educational Research in Medical Sciences (CERMS), School of Health Management & Information Sciences, Iran University of Medical Sciences, Tehran, Iran
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Henstra C, Dekkers BGJ, Olgers TJ, Ter Maaten JC, Touw DJ. Managing intoxications with nicotine-containing e-liquids. Expert Opin Drug Metab Toxicol 2022; 18:115-121. [PMID: 35345955 DOI: 10.1080/17425255.2022.2058930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Nicotine is an addictive and poisonous agent. The recent development of e-cigarettes has caused a new demand for highly concentrated nicotine-containing solutions. These concentrated nicotine solutions have also increased the risk of nicotine overdoses. AREAS COVERED Essential factors for nicotine exposure are the concentration of the nicotine-containing e-liquid solution and its pharmacokinetics. Liquid nicotine refills contain nicotine in varying concentrations, which vary widely between and within products. The pharmacokinetics of nicotine are dependent on the route of administration, renal/hepatic clearance and urinary pH. The dose is another essential determinant of nicotine exposure. There is a considerable discrepancy between the generally accepted lethal dose and symptoms reported in case studies. Ingested doses correlate poorly to clinical symptoms. Symptoms of liquid nicotine toxicity vary from mild to severe between patients and are the result of overstimulation of nicotinic acetylcholine receptors, which may lead to fatal respiratory failure and cardiovascular collapse. EXPERT OPINION The literature on nicotine-containing e-liquid intoxications originating from vaping device refills are mainly case reports. Based on these case reports, we propose a treatment plan which is primarily symptomatic. Research should focus on providing insight on its toxicity, based on oral and transdermal pharmacokinetics and on toxicodynamics.
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Affiliation(s)
- Charlotte Henstra
- Department of Clinical Pharmacy and Pharmacology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.,Department of Pharmaceutical Analysis, University of Groningen, Groningen Research Institute of Pharmacy, Groningen, The Netherlands
| | - Bart G J Dekkers
- Department of Clinical Pharmacy and Pharmacology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Tycho J Olgers
- Department of Internal Medicine, Emergency Department, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Jan C Ter Maaten
- Department of Internal Medicine, Emergency Department, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Daan J Touw
- Department of Clinical Pharmacy and Pharmacology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.,Department of Pharmaceutical Analysis, University of Groningen, Groningen Research Institute of Pharmacy, Groningen, The Netherlands
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Aljaffary A, Alsheddi F, Alzahrani R, Alamoudi S, Aljuwair M, Alrawiai S, Aljabri D, Althumairi A, Hariri B, Alumran A. Shared Decision-Making: A Cross-Sectional Study Assessing Patients Awareness and Preferences in Saudi Arabia. Patient Prefer Adherence 2022; 16:1005-1015. [PMID: 35444407 PMCID: PMC9013678 DOI: 10.2147/ppa.s332638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 01/28/2022] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND AND AIM Shared decision-making (SDM) has become broadly accepted during the consultation, especially when there are many options of treatment. This study aims to assess patients' levels of awareness and preferences of SDM in Saudi Arabia. METHODS This is a cross-sectional study targeting patients in Saudi Arabia. Two validated questionnaires were used, the first validated questionnaire focuses on measuring knowledge, attitude and experiences of shared-decision making. The second questionnaire is the the Autonomy-Preference-Index focusing on patients' preferences for being involved in SDM. Relevant items to the study aim were chosen and translated into Arabic. Psychometric testing was conducted for Arabic and English versions and tested for content and face validity. The questionnaire administered online via social media channels, between February 2021 and May 2021. A total of 411 respondents completed the questionnaire. RESULTS The findings showed a positive association between awareness and preferences of SDM among patients in Saudi Arabia. In the awareness of the SDM domain, females reported higher scores than male participants (t = -4.504, P < 0.001). Saudis reported higher scores in their awareness of SDM than non-Saudis (t = 2.569, P = 0.011). Participants without health insurance reported higher scores in their awareness of SDM than those insured (t = -2.130, P = 0.034). Participants with degree have higher knowledge levels than participants with no degree (f = 10.034, P < 0.001). Females reported higher scores in their preferences of SDM than the male (t = -2.099, P = 0.036). Participants who visited private health-care settings in their last clinical encounter reported higher preferences of SDM than participants who received care in other settings (f = 2.653, P = 0.048). CONCLUSION The study concludes that the more aware a patient is, the more likely they prefer SDM practice. This finding can support health-care policymakers in developing SDM policies that enhance patient-centered care.
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Affiliation(s)
- Afnan Aljaffary
- Department of Health Information Management & Technology, College of Public Health, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
- Correspondence: Afnan Aljaffary, Email
| | - Fatimah Alsheddi
- Department of Health Information Management & Technology, College of Public Health, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Raghad Alzahrani
- Department of Health Information Management & Technology, College of Public Health, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Somayyah Alamoudi
- Department of Health Information Management & Technology, College of Public Health, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Mona Aljuwair
- Department of Health Information Management & Technology, College of Public Health, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Sumaiah Alrawiai
- Department of Health Information Management & Technology, College of Public Health, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Duaa Aljabri
- Department of Health Information Management & Technology, College of Public Health, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Arwa Althumairi
- Department of Health Information Management & Technology, College of Public Health, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Bayan Hariri
- Department of Health Information Management & Technology, College of Public Health, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Arwa Alumran
- Department of Health Information Management & Technology, College of Public Health, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
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12
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Hayashi H, Nadal E, Gray JE, Ardizzoni A, Caria N, Puri T, Grohe C. Overall Treatment Strategy for Patients With Metastatic NSCLC With Activating EGFR Mutations. Clin Lung Cancer 2021; 23:e69-e82. [PMID: 34865963 DOI: 10.1016/j.cllc.2021.10.009] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 09/18/2021] [Accepted: 10/13/2021] [Indexed: 02/07/2023]
Abstract
Epidermal growth factor receptor (EGFR) tyrosine kinase inhibitors (EGFR-TKIs) are standard of care in the first-line (1L) setting for patients with metastatic non-small cell lung cancer (mNSCLC) with activating EGFR mutations. EGFR-activating mutations are a predictive factor for response to EGFR-TKIs. Meta-analyses have shown that patients with exon 21_L858R mutations exhibit reduced sensitivity to EGFR-TKIs, resulting in inferior patient outcomes compared to those with exon 19 deletion mutations, with worse overall survival, progression-free survival, objective response, and disease control rates. Clinical activity observed with 1L therapy with first-generation (1G), second-generation (2G), and third-generation (3G) EGFR-TKIs is not permanent, and resistance inevitably develops in all cases, supporting the importance of overall treatment planning. The introduction of the 3G EGFR-TKI, osimertinib, provides an opportunity to overcome T790M-mediated resistance to 1G, and 2G EGFR-TKIs. Additionally, with the use of osimertinib, fewer T790M mutations are being detected as T790M is not a reported resistance mechanism to 3G EGFR-TKIs. However, there are currently no approved targeted therapies after 3G EGFR-TKIs. In order to further improve patient outcomes, there is a need to explore additional options for the overall treatment strategy for patients, including 1L and beyond. Combination of vascular endothelial growth factor (VEGF) inhibitors and EGFR-TKIs or chemotherapy and EGFR-TKIs may be a potential therapeutic approach in the 1L setting. This review discusses current treatment options for mNSCLC with activating EGFR mutations based on tumor, patient, and treatment characteristics and how an overall treatment plan may be developed.
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Affiliation(s)
- Hidetoshi Hayashi
- Department of Medical Oncology, Kindai University Faculty of Medicine, Osaka-Sayama, Osaka, Japan.
| | - Ernest Nadal
- Catalan Institute of Oncology, IDIBELL, L'Hospitalet, Barcelona, Spain
| | - Jhanelle E Gray
- Department of Thoracic Oncology, Moffitt Cancer Center, Tampa, FL, USA
| | - Andrea Ardizzoni
- Medical Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Nicola Caria
- Eli Lilly and Company, Indianapolis, Indiana, United States
| | - Tarun Puri
- Eli Lilly and Company, Indianapolis, Indiana, United States
| | - Christian Grohe
- Klinik fur Pneumologie, Evangelische Lungenlinik, Berlin, Germany
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13
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Colombi S, Rovituso M, Scifoni E, Schuy C, Eichhorn A, Kraemer M, Durante M, La Tessa C. Interaction of therapeutic 12C ions with bone-like targets: physical characterization and dosimetric effect at material interfaces. Phys Med Biol 2021; 66. [PMID: 34438376 DOI: 10.1088/1361-6560/ac215f] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 08/26/2021] [Indexed: 11/11/2022]
Abstract
Carbon therapy is a promising treatment option for cancer. The physical and biological properties of carbon ions can theoretically allow for the delivery of curative doses to the tumor, while simultaneously limiting risks of toxicity to adjacent healthy structures. The treatment effectiveness can be further improved by decreasing the uncertainties stemming from several sources, including the modeling of tissue heterogeneity. Current treatment plans employ density-based conversion methods to translate patient-specific anatomy into a water system, where dose distribution is calculated. This approach neglects differences in nuclear interactions stemming from the elemental composition of each tissue. In this work, we investigated the interaction of therapeutic carbon ions with bone-like materials. The study concentrated on nuclear interactions and included attenuation curves of 200 and 400 AMeV beams in different types of bones, as well as kinetic energy spectra of all charged fragments produced up to 29 degrees from the beam direction. The comparison between measurements and calculations of the treatment planning system TRiP98 indicated that bone tissue causes less fragmentation of carbon ions than water. Overall, hydrogen and helium particles were found to be the most abundant species, while heavier fragments were mostly detected within 5 degrees from the beam direction. We also investigated how the presence of a soft tissue-bone interface could affect the depth-dose profile. The results revealed a dose spike in the transition region, that extended from the entry channel to the target volume. The findings of this work indicated that the tissue-to-water conversion method based only on density considerations can result in dose inaccuracies. Tissue heterogeneity regions containing bones can potentially produce dose spikes, whose magnitude will depend on the patient anatomy. Dose uncertainties can be decreased by modeling nuclear interactions directly in bones, without applying the tissue-to-water conversion.
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Affiliation(s)
- S Colombi
- University of Trento, Via Sommarive 14, I-38123 Trento, Italy.,Trento Institute of Fundamental Physics and Applications (TIFPA), Via Sommarive 14, I-38123 Trento, Italy
| | - M Rovituso
- HollandPTC Proton Therapy Center, Delft, The Netherlands
| | - E Scifoni
- Trento Institute of Fundamental Physics and Applications (TIFPA), Via Sommarive 14, I-38123 Trento, Italy
| | - C Schuy
- GSI Helmholtzzentrum für Schwerionenforschung, Planckstrasse 1, D-64291 Darmstadt, Germany
| | | | - M Kraemer
- GSI Helmholtzzentrum für Schwerionenforschung, Planckstrasse 1, D-64291 Darmstadt, Germany
| | - M Durante
- GSI Helmholtzzentrum für Schwerionenforschung, Planckstrasse 1, D-64291 Darmstadt, Germany.,Technische Universität Darmstadt, Darmstadt, Germany
| | - C La Tessa
- University of Trento, Via Sommarive 14, I-38123 Trento, Italy.,Trento Institute of Fundamental Physics and Applications (TIFPA), Via Sommarive 14, I-38123 Trento, Italy
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14
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Panicacci S, Donati M, Lubrano A, Vianello A, Ruiu A, Melani L, Tomei A, Fanucci L. Telemonitoring in the Covid-19 Era: The Tuscany Region Experience. Healthcare (Basel) 2021; 9:healthcare9050516. [PMID: 33946633 PMCID: PMC8145703 DOI: 10.3390/healthcare9050516] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 04/23/2021] [Accepted: 04/26/2021] [Indexed: 12/16/2022] Open
Abstract
Covid-19 has brought many difficulties in the management of infected and high-risk patients. Telemedicine platforms can really help in this situation, since they allow remotely monitoring Covid-19 patients, reducing the risk for the doctors, without decreasing the efficiency of the therapies and while alleviating patients’ mental issues. In this paper, we present the entire architecture and the experience of using the Tel.Te.Covid19 telemedicine platform. Projected for the treatment of chronic diseases, it has been technologically updated for the management of Covid-19 patients with the support of a group of doctors in the territory when the pandemic arrived, introducing new sensors and functionalities (e.g., the familiar use and video calls). In Tuscany (Central Italy), during the first wave of outbreak, a model for enrolling patients was created and tested. Because of the positive results, the latter has been then adopted in the second current wave. The Tel.Te.Covid19 platform has been used by 40 among general practitioners and doctors of continuity care and about 180 symptomatic patients since March 2020. Both patients and doctors have good opinion of the platform, and no hospitalisations or deaths occurred for the monitored patients, reducing also the impact on the National Healthcare System.
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Affiliation(s)
- Silvia Panicacci
- Department of Information Engineering, University of Pisa, Via G. Caruso 16, 56122 Pisa, Italy; (M.D.); (A.L.); (A.V.); (L.F.)
- Correspondence:
| | - Massimiliano Donati
- Department of Information Engineering, University of Pisa, Via G. Caruso 16, 56122 Pisa, Italy; (M.D.); (A.L.); (A.V.); (L.F.)
| | - Alberto Lubrano
- Department of Information Engineering, University of Pisa, Via G. Caruso 16, 56122 Pisa, Italy; (M.D.); (A.L.); (A.V.); (L.F.)
| | - Annamaria Vianello
- Department of Information Engineering, University of Pisa, Via G. Caruso 16, 56122 Pisa, Italy; (M.D.); (A.L.); (A.V.); (L.F.)
| | | | - Luca Melani
- AFT Pisa 2, Azienda USL Toscana Nord-Ovest, 56121 Pisa, Italy;
| | - Antonella Tomei
- Dipartimento Sanità Territoriale, Azienda USL Toscana Nord-Ovest, 56121 Pisa, Italy;
| | - Luca Fanucci
- Department of Information Engineering, University of Pisa, Via G. Caruso 16, 56122 Pisa, Italy; (M.D.); (A.L.); (A.V.); (L.F.)
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15
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Belgrano V, Ramello M, Montroni I, Audisio RA. Surgical oncology in the elderly. Acta Chir Belg 2020; 120:401-403. [PMID: 31328639 DOI: 10.1080/00015458.2019.1642598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Poor cancer-specific outcomes in the elderly group are primarily a surgical failure. Surgeons are insufficiently trained to draw a line between fit and frail patients; this results in over-treatment of the frail patient, as well as under-treatment of the fit one. Communication skills should be improved to better understand the patient's requests. The timing of the surgical procedure is crucially important; all efforts should be put in place to optimize the patient's conditions before the surgery takes place.
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Affiliation(s)
- Valerio Belgrano
- Department of Surgical Sciences and Integrated Diagnostics (DISC), Policlinico San Martino, University General Hospital, University of Genoa, Genoa, Italy
| | - Monica Ramello
- Department of Medical Oncology, Azienda Sanitaria Universitaria Integrata di Trieste, Ospedale Maggiore, Trieste, Italy
| | - Isacco Montroni
- Colorectal Surgery and General Surgery, Ospedale per gli Infermi, Faenza, Italy
| | - Riccardo A. Audisio
- Department of Surgery, Institute of Clinical Sciences, Sahlgrenska University Hospital, Göteborg, Sweden
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16
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Katelaris CH. Self-Management Plans in Patients with Hereditary Angioedema: Strategies, Outcomes and Integration into Clinical Care. J Asthma Allergy 2020; 13:153-158. [PMID: 32431520 PMCID: PMC7198399 DOI: 10.2147/jaa.s200900] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Accepted: 04/14/2020] [Indexed: 01/31/2023] Open
Abstract
Chronic conditions, whether genetic or acquired, impose a significant burden on health care systems with high utilisation of hospital and emergency department resources. Self-management is increasingly recognised as one of the pillars in models of care for those with long-term medical conditions. Hereditary angioedema (HAE) is a rare genetic disorder inherited in an autosomal dominant fashion. It is characterised by the occurrence of unpredictable attacks of swelling (angioedema) affecting many body parts including subcutaneous tissues, the gut mucosa and the upper airway. For those affected, it is associated with a high burden of illness and poor quality of life as a result of its unpredictability and the threat of asphyxiation from upper airway oedema or severe pain from abdominal involvement. Prompt recognition and appropriate treatment are necessary to avoid the pain and suffering associated with attacks and to manage life-threatening laryngeal swellings that around 50% of HAE patients will experience in their lifetime. Since the early 2000s, a number of very effective, albeit expensive, treatment options have become available, at least in some countries. Utilisation of these options within a written patient self-management plan provides the most satisfactory treatment outcomes and improves patient quality of life. Successful self-management depends on a productive partnership between patient and health care professional, with patient education the cornerstone of a successful outcome. This is a dynamic process, particularly in a condition such as HAE where frequency and severity of attacks may vary given different life circumstances.
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Affiliation(s)
- Constance H Katelaris
- Immunology & Allergy Unit, Department of Medicine, Campbelltown Hospital, Western Sydney University, Sydney, CampbelltownNSW 2560, Australia
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17
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Lu L, Ouyang Z, Lin S, Mastroianni A, Stephans KL, Xia P. Dosimetric assessment of patient-specific breath-hold reproducibility on liver motion for SBRT planning. J Appl Clin Med Phys 2020; 21:77-83. [PMID: 32337841 PMCID: PMC7386188 DOI: 10.1002/acm2.12887] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Revised: 03/02/2020] [Accepted: 03/25/2020] [Indexed: 01/22/2023] Open
Abstract
PURPOSE To investigate the impact of breath-hold reproducibility on liver motion using a respiratory motion management device. METHODS Forty-four patients with hepatic tumors, treated with SBRT with breath-hold, were randomly selected for this study. All patients underwent three consecutive computed tomography (CT) scans using active breath-hold coordinator (ABC) with three repeated single breath-hold during simulation. The three CT scans were labeled as ABC1-CT, ABC2-CT, and ABC3-CT. Displacements of centroids of the entire livers among the three ABC-CTs were measured as a surrogate for intrafractional motion. For each patient, two different treatment plans were prepared: (a) a clinical plan using a 5-mm expansion of an ITV that encompassed all three GTVs from each of the three ABC-CTs, and (b) a research plan using a 5-mm expansion of the GTV from only ABC1-CT to create PTV. The clinical plan acceptance criteria were that 95% of the PTV and 99% of the GTV received 100% of the prescription dose. Dosimetric endpoints were analyzed and compared for the two plans. RESULTS All shifts in the medial-lateral direction (range: -3.9 to 2.0 mm) were within 5 mm while 7% of shifts in the anterior-posterior direction (range: -10.5 to 16.7 mm) and 11% of shifts in the superior-inferior direction (range: -17.0 to 8.7 mm) exceeded 5 mm. Six patients (14%) had an intrafraction motion greater than 5 mm in any direction. For these six patients, if a plan was created based on a PTV from a single CT (ex. ABC1-CT), 5 of 12 GTVs captured from other ABC-CTs would fail to meet the clinical acceptance criteria due to poor breath-hold reproducibility. CONCLUSIONS Non-negligible intrafractional motion occurs in patients with poor breath-hold reproducibility. To identify this subgroup of patients, acquiring three CTs with active breath-hold during simulation is a feasible practical method.
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Affiliation(s)
- Lan Lu
- Department of Radiation Oncology, Taussig Cancer Center, Cleveland Clinic, Cleveland, OH, USA
| | - Zi Ouyang
- Department of Radiation Oncology, Taussig Cancer Center, Cleveland Clinic, Cleveland, OH, USA
| | - Sara Lin
- Department of Radiation Oncology, Taussig Cancer Center, Cleveland Clinic, Cleveland, OH, USA
| | - Anthony Mastroianni
- Department of Radiation Oncology, Taussig Cancer Center, Cleveland Clinic, Cleveland, OH, USA
| | - Kevin L Stephans
- Department of Radiation Oncology, Taussig Cancer Center, Cleveland Clinic, Cleveland, OH, USA
| | - Ping Xia
- Department of Radiation Oncology, Taussig Cancer Center, Cleveland Clinic, Cleveland, OH, USA
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18
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Abstract
This paper describes an alternative computer-aided design/computer-aided manufacturing (CAD/CAM) technique for the creation of a combined prosthetic restoration with orthodontic appliance (PROA). This concept allows the use of orthodontic appliances such as brackets, attachments, or any other type of appliance over different types of prosthetic restorations. The PROA concept aims to mitigate problems associated with performing restorative treatment when orthodontic treatment is necessary. This proposed concept provides the clinicians with proper control and planning of the interdisciplinary treatment that will lead to the final tooth shape, form, and proportions while performing orthodontic tooth movements.
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19
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Schwartz CL. Creating a bridge for transition: From pediatric cancer survival to life-long, risk-based health care of the adult cancer survivor. Cancer 2020; 126:473-476. [PMID: 31626326 DOI: 10.1002/cncr.32569] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2019] [Revised: 09/16/2019] [Accepted: 09/16/2019] [Indexed: 11/06/2022]
Affiliation(s)
- Cindy L Schwartz
- Division of Pediatric Hematology, Oncology, and Bone Marrow Transplant, Department of Pediatrics, Medical College of Wisconsin/Children's Hospital of Wisconsin, Milwaukee, Wisconsin
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20
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Tsuruya K, Chino O, Tanaka Y, Shimma Y, Tsuda S, Kikuchi M, Shiozawa H, Aoki J, Nakamura T, Hanashi T, Suzuki T, Matsushima M. Successful combination of endoscopic and laparoscopic removal of multiple ingested needles: A case report. Medicine (Baltimore) 2020; 99:e19343. [PMID: 32080155 PMCID: PMC7034740 DOI: 10.1097/md.0000000000019343] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
RATIONALE Foreign body (FB) ingestion is a relatively common clinical situation in the emergency department. However, multiple sharply pointed foreign bodies located in different organs are rare conditions and no definite treatment guidelines has been established. PATIENT CONCERNS A 31-year-old amateur magician visited the outpatient clinic with a chief complaint of epigastric discomfort. He might have accidentally swallowed some needles while practicing a magic trick 2 days before. DIAGNOSIS Imaging tests revealed 1 needle was stuck in the left liver lobe through the stomach wall, 1 was in the third portion of the duodenum, 3 were in the ascending colon, and 2 were in the transverse colon. INTERVENTIONS A needle in the duodenum and 5 in the colon were removed by endoscopy. The needle stuck in the liver from the stomach was not visible inside the stomach and was successfully removed by laparoscopy a few days later. OUTCOMES The patient was able to tolerate an oral diet and was discharged on postoperative day 4 without any complications. LESSONS Developing a treatment plan in cases of multiple sharp FB may be difficult. A multidisciplinary team of endoscopists and surgeons is needed to determine the best possible treatment plan. This experience illustrates the importance of the planning of the sequence and method of removal of multiple foreign bodies from the gastrointestinal tract.
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Affiliation(s)
- Kota Tsuruya
- Department of Internal Medicine, Digestive and Liver Disease Center, Tokai University Tokyo Hospital, Tokyo
- Department of Internal Medicine (Gastroenterology), Tokai University School of Medicine, Isehara
| | - Osamu Chino
- Department of Surgery, Digestive and Liver Disease Center, Tokai University Tokyo Hospital
| | - Yoichi Tanaka
- Department of Surgery, Digestive and Liver Disease Center, Tokai University Tokyo Hospital
| | - Yoshimasa Shimma
- Department of Internal Medicine, Digestive and Liver Disease Center, Tokai University Tokyo Hospital, Tokyo
- Department of Internal Medicine (Gastroenterology), Tokai University School of Medicine, Isehara
| | - Shingo Tsuda
- Department of Internal Medicine, Digestive and Liver Disease Center, Tokai University Tokyo Hospital, Tokyo
- Department of Internal Medicine (Gastroenterology), Tokai University School of Medicine, Isehara
| | - Masahiro Kikuchi
- Department of Internal Medicine, Digestive and Liver Disease Center, Tokai University Tokyo Hospital, Tokyo
- Department of Gastroenterology, National Hospital Organization Tokyo Medical Center, Tokyo, Japan
| | - Hirokazu Shiozawa
- Department of Internal Medicine, Digestive and Liver Disease Center, Tokai University Tokyo Hospital, Tokyo
| | - Jun Aoki
- Department of Internal Medicine, Digestive and Liver Disease Center, Tokai University Tokyo Hospital, Tokyo
| | - Tomoki Nakamura
- Department of Surgery, Digestive and Liver Disease Center, Tokai University Tokyo Hospital
| | - Tomoko Hanashi
- Department of Surgery, Digestive and Liver Disease Center, Tokai University Tokyo Hospital
| | - Takayoshi Suzuki
- Department of Internal Medicine, Digestive and Liver Disease Center, Tokai University Tokyo Hospital, Tokyo
- Department of Internal Medicine (Gastroenterology), Tokai University School of Medicine, Isehara
| | - Masashi Matsushima
- Department of Internal Medicine, Digestive and Liver Disease Center, Tokai University Tokyo Hospital, Tokyo
- Department of Internal Medicine (Gastroenterology), Tokai University School of Medicine, Isehara
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21
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Lee JH, Kim SH, Yoon HI, Yeo ISL, Han JS. Implant-assisted removable prosthetic rehabilitation after distraction osteogenesis in a patient with ameloblastoma recurrence: A case report. Medicine (Baltimore) 2019; 98:e18290. [PMID: 31804373 PMCID: PMC6919522 DOI: 10.1097/md.0000000000018290] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION A resected mandibular edentulous ridge resulting from an ameloblastoma and marginal mandibulectomy is a restorative challenge. To maintain oral hygiene, recurrent examinations, and for long-term maintenance, a removable dental prosthesis is preferred to an implant-supported fixed dental prosthesis. PATIENT CONCERNS A 28-year-old Asian man was referred for evaluation of a radiolucent area on the right side of the mandible. The right mandibular area had increasingly enlarged over a period of ≥5 months. Marginal resection and inferior alveolar nerve repositioning of the mandible were performed by oral surgeons, followed by reconstruction of the resected mandible with distraction osteogenesis. After 6 years, the patient presented with swelling of the same area. DIAGNOSIS Histopathological examination revealed recurrence of benign ameloblastoma in the mandible. After mass excision of the recurrent benign tumor, dental implants were installed. To aid with recurrent examinations and oral hygiene maintenance, a treatment plan using implant-assisted removable dental prosthesis, instead of a fixed prosthesis, was formulated. INTERVENTIONS The edentulous area was rehabilitated with a tooth- and implant-assisted removable partial denture. Due to the insufficient intermaxillary clearance, the removable prosthesis was designed in such a manner that retention, support, and stability could be ensured by separate components. OUTCOMES The tooth- and implant-assisted removable partial denture showed satisfactory function and esthetics. No complications were observed in the dental prosthesis and supporting tissues during the 3-year follow-up period. CONCLUSION In recurrent ameloblastoma cases, a removable dental prosthesis may be an effective treatment option for oral rehabilitation. The type of denture design used in this study is novel for implant-assisted removable partial denture rehabilitation.
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Affiliation(s)
- Jae-Hyun Lee
- Department of Prosthodontics, One-Stop Specialty Center, Seoul National University Dental Hospital
| | - Sung-Hun Kim
- Department of Prosthodontics and Dental Research Institute, School of Dentistry, Seoul National University, Seoul, South Korea
| | - Hyung-In Yoon
- Department of Prosthodontics and Dental Research Institute, School of Dentistry, Seoul National University, Seoul, South Korea
| | - In-Sung Luke Yeo
- Department of Prosthodontics and Dental Research Institute, School of Dentistry, Seoul National University, Seoul, South Korea
| | - Jung-Suk Han
- Department of Prosthodontics and Dental Research Institute, School of Dentistry, Seoul National University, Seoul, South Korea
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22
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Peng J, Gong J, Wang X, Mou J, Xu H, Dai J, Zhou F, Zhou Y. 4-Dimensional computed tomography analysis of clinical target volume displacement in adjuvant radiation of patients with gastric cancer and its implication on radiotherapy. Oncol Lett 2019; 17:3641-3648. [PMID: 30881488 PMCID: PMC6403517 DOI: 10.3892/ol.2019.10037] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Accepted: 11/13/2018] [Indexed: 12/24/2022] Open
Abstract
The present study aimed to accurately measure the displacement magnitude of the radiotherapy subsite target due to respiration, and to evaluate its implication on 4-dimensional computed tomography (4D-CT) in adjuvant radiation of gastric cancer. To investigate this, 10 patients with gastric cancer receiving adjuvant radiotherapy were enrolled. 4D-CT scans were performed on all patients and respiratory signals were recorded simultaneously. The clinical target volume (CTV) and 7 regions of interest (ROIs) were delineated in all phases of the CT imaging. The displacements of all ROIs in the cephalic-caudal, anterior-posterior and left-right directions were measured and analyzed. Two sets of plans based on planning target volume 3D (PTV3D) and PTV4D, were generated for each patient and PTV3Dcal was calculated by expanding the non-uniform margin on CTV3D according to the displacement analysis data. The dosimetric parameters and target volumes of the 3 radiotherapy treatment plans were compared. The displacement of the various ROIs varied widely. The mean PTV4D was smaller than the PTV3D and PTV3Dcal. Compared with Plan3D, Plan4D reduced the mean dose of radiation to the liver and left kidney by 23.2 and 43.5%, respectively. The liver volume receiving ≥30 Gy and the left kidney volume receiving ≥20 Gy were decreased by 10.8 and 29.7%, respectively. No differences were observed in the PTV coverage and protection of organs at risk (OARs) between Plan3Dcal and Plan4D. In conclusion, the breathing-induced displacement patterns of the subsite targets in patients with gastric cancer vary. The individualized CTV margins of expansion based on 4D-CT lead to a decrease PTV and radiation dose to OARs. The non-uniform margins in various directions should be considered as areas for further investigation.
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Affiliation(s)
- Jin Peng
- Department of Radiation and Medical Oncology, Zhongnan Hospital of Wuhan University, Wuhan, Hubei 430071, P.R. China.,Hubei Cancer Clinical Study Center, Wuhan, Hubei 430071, P.R. China.,Key Laboratory of Tumor Biology Behavior of Hubei Province, Wuhan, Hubei 430071, P.R. China
| | - Jun Gong
- Department of Radiation and Medical Oncology, Central Hospital of Huangshi City, Huangshi, Hubei 430000, P.R. China
| | - Xiaoyong Wang
- Department of Radiation and Medical Oncology, Zhongnan Hospital of Wuhan University, Wuhan, Hubei 430071, P.R. China.,Hubei Cancer Clinical Study Center, Wuhan, Hubei 430071, P.R. China.,Key Laboratory of Tumor Biology Behavior of Hubei Province, Wuhan, Hubei 430071, P.R. China
| | - Jingjing Mou
- Department of Radiation and Medical Oncology, Zhongnan Hospital of Wuhan University, Wuhan, Hubei 430071, P.R. China.,Hubei Cancer Clinical Study Center, Wuhan, Hubei 430071, P.R. China.,Key Laboratory of Tumor Biology Behavior of Hubei Province, Wuhan, Hubei 430071, P.R. China
| | - Hui Xu
- Department of Radiation and Medical Oncology, Zhongnan Hospital of Wuhan University, Wuhan, Hubei 430071, P.R. China.,Hubei Cancer Clinical Study Center, Wuhan, Hubei 430071, P.R. China.,Key Laboratory of Tumor Biology Behavior of Hubei Province, Wuhan, Hubei 430071, P.R. China
| | - Jing Dai
- Department of Radiation and Medical Oncology, Zhongnan Hospital of Wuhan University, Wuhan, Hubei 430071, P.R. China.,Hubei Cancer Clinical Study Center, Wuhan, Hubei 430071, P.R. China.,Key Laboratory of Tumor Biology Behavior of Hubei Province, Wuhan, Hubei 430071, P.R. China
| | - Fuxiang Zhou
- Department of Radiation and Medical Oncology, Zhongnan Hospital of Wuhan University, Wuhan, Hubei 430071, P.R. China.,Hubei Cancer Clinical Study Center, Wuhan, Hubei 430071, P.R. China.,Key Laboratory of Tumor Biology Behavior of Hubei Province, Wuhan, Hubei 430071, P.R. China
| | - Yunfeng Zhou
- Department of Radiation and Medical Oncology, Zhongnan Hospital of Wuhan University, Wuhan, Hubei 430071, P.R. China.,Hubei Cancer Clinical Study Center, Wuhan, Hubei 430071, P.R. China.,Key Laboratory of Tumor Biology Behavior of Hubei Province, Wuhan, Hubei 430071, P.R. China
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Boc N, Edhemovic I, Kos B, Music MM, Brecelj E, Trotovsek B, Bosnjak M, Djokic M, Miklavcic D, Cemazar M, Sersa G. Ultrasonographic changes in the liver tumors as indicators of adequate tumor coverage with electric field for effective electrochemotherapy. Radiol Oncol 2018; 52:383-91. [PMID: 30352044 DOI: 10.2478/raon-2018-0041] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Accepted: 10/04/2018] [Indexed: 12/21/2022] Open
Abstract
Background The aim of the study was to characterize ultrasonographic (US) findings during and after electrochem-otherapy of liver tumors to determine the actual ablation zone and to verify the coverage of the treated tumor with a sufficiently strong electric field for effective electrochemotherapy. Patients and methods US findings from two representative patients that describe immediate and delayed tumor changes after electrochemotherapy of colorectal liver metastases are presented. Results The US findings were interrelated with magnetic resonance imaging (MRI). Electrochemotherapy-treated tumors were exposed to electric pulses based on computational treatment planning. The US findings indicate immediate appearance of hyperechogenic microbubbles along the electrode tracks. Within minutes, the tumors became evenly hyperechogenic, and simultaneously, an oedematous rim was formed presenting as a hypoechogenic formation which persisted for several hours after treatment. The US findings overlapped with computed electric field distribution in the treated tissue, indicating adequate coverage of tumors with sufficiently strong electric field, which may predict an effective treatment outcome. Conclusions US provides a tool for assessment of appropriate electrode insertion for intraoperative electrochemo-therapy of liver tumors and assessment of the appropriate coverage of a tumor with a sufficiently strong electric field and can serve as predictor of the response of tumors.
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Tarpomanov Y, Rimalovska S, Belcheva A, Yordanova M, Yordanova S, Kukleva M. Root Development of Permanent Incisors and Mandibular Molars in Correlation with Treatment Plan. Folia Med (Plovdiv) 2018; 60:283-290. [PMID: 30355817 DOI: 10.1515/folmed-2017-0093] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2017] [Accepted: 09/11/2017] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND The incisors and molars play a major role in the formation and function of permanent dentition. Much research has been devoted to investigating the eruption of teeth and their root development. AIM To study the root development of permanent incisors and mandibular molars in correlation with treatment plan and proper treatment protocols. MATERIALS AND METHODS The Demirjian's method was used to assess the root development of incisors and mandibular molars in children between 7 and 12 years old. RESULTS In 7-year-old children most of the lower first mandibular molars (76%) had complete root length, but open apices. Eighty-two percent of the roots of the first mandibular molars of the 8-year-old children and 54% of these molars of the 9-year-old children were with open apices. The first mandibular molars had incomplete roots in the 10-year-olds (6%) and even in the 11-year-old children (4%). We detected Stage E in 32% of the 10-year-olds and in 24% of the 11-year-old children. Even in 12-year-old children we found Stage E in 4% of them from their panoramic X-rays. We detected complete root development in all of the children at the age of 12. CONCLUSIONS Dental practitioners have to wait until the age of 10, 11 and even 12 to extract the first molars, when the furcation is formed. Proper clinical examination and diagnostic radiographs should be done before the beginning of the treatment of molars and incisors at the age between 7 and 12.
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Affiliation(s)
- Yordan Tarpomanov
- Department of Pediatric Dentistry, Faculty of Dental Medicine, Medical University of Plovdiv, Plovdiv, Bulgaria
| | - Sevda Rimalovska
- Department of Pediatric Dentistry, Faculty of Dental Medicine, Medical University of Plovdiv, Plovdiv, Bulgaria
| | - Ani Belcheva
- Department of Pediatric Dentistry, Faculty of Dental Medicine, Medical University of Plovdiv, Plovdiv, Bulgaria
| | - Miroslava Yordanova
- Department of Orthodontics, Faculty of Dental Medicine, Medical University of Plovdiv, Plovdiv, Bulgaria
| | - Svetla Yordanova
- Department of Orthodontics, Faculty of Dental Medicine, Medical University of Plovdiv, Plovdiv, Bulgaria
| | - Maria Kukleva
- Department of Pediatric Dentistry, Faculty of Dental Medicine, Medical University of Plovdiv, Plovdiv, Bulgaria
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Marlow AK, Hamada Y, Maupome G, Eckert GJ, John V. Periodontal Diagnosis and Treatment Planning Among Indiana Dental Faculty, Periodontists, and General Practice Dentists: A Multi-Group Comparison. J Dent Educ 2018; 82:291-298. [PMID: 29496808 DOI: 10.21815/jde.018.029] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2017] [Accepted: 09/27/2017] [Indexed: 11/20/2022]
Abstract
Diagnosis and treatment planning for periodontal disease are fraught with challenges because of the complex and multifactorial nature of the disease as well as the inherent variability in interpretation of clinical findings. It is important for all practitioners to be accurate and consistent in formulating diagnoses based on the American Academy of Periodontology classification guidelines and to implement treatment plans to adequately address patients' needs. The aim of this study was to compare diagnoses and treatment plans among four groups of participants: full-time and part-time periodontology faculty at Indiana University School of Dentistry (IUSD), full-time and part-time IUSD general practice faculty, full-time periodontists in private practice, and full-time general practitioners in private practice. The study, conducted September 2016 to February 2017, also sought to determine if the calibrated participants had more correct diagnoses and treatment plans than those who had not received calibration training. Each of the four groups had 20 participants each. Participants evaluated ten de-identified case records and selected a diagnosis and treatment plan for each case. In the results, the 20 IUSD periodontal faculty members, most of whom had participated in calibration sessions, had overall better agreement and more correct responses for diagnoses and treatment plans than the IUSD general practice faculty members, private practice general practitioners, and private practice periodontists (only one of those 60 participants had participated in calibration sessions). The results supported the notion that periodic calibration is needed to standardize faculty criteria, facilitate better agreement and accuracy, and enhance consistency in the use of clinical criteria during training for dental students and in practice.
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Affiliation(s)
- Allison K Marlow
- Dr. Marlow is in private practice in Florence, KY; this study was conducted while she was a resident, Department of Periodontics and Allied Dental Program, Indiana University School of Dentistry; Dr. Hamada is Clinical Assistant Professor, Department of Periodontics and Allied Dental Program, Indiana University School of Dentistry; Dr. Maupome is Professor, Department of Social and Behavioral Sciences, Richard M. Fairbanks School of Public Health, Indiana University; Mr. Eckert is Biostatistician Supervisor, Department of Biostatistics, Indiana University School of Medicine; and Dr. John is Chair, Department of Periodontics and Allied Dental Programs, Indiana University School of Dentistry
| | - Yusuke Hamada
- Dr. Marlow is in private practice in Florence, KY; this study was conducted while she was a resident, Department of Periodontics and Allied Dental Program, Indiana University School of Dentistry; Dr. Hamada is Clinical Assistant Professor, Department of Periodontics and Allied Dental Program, Indiana University School of Dentistry; Dr. Maupome is Professor, Department of Social and Behavioral Sciences, Richard M. Fairbanks School of Public Health, Indiana University; Mr. Eckert is Biostatistician Supervisor, Department of Biostatistics, Indiana University School of Medicine; and Dr. John is Chair, Department of Periodontics and Allied Dental Programs, Indiana University School of Dentistry
| | - Gerardo Maupome
- Dr. Marlow is in private practice in Florence, KY; this study was conducted while she was a resident, Department of Periodontics and Allied Dental Program, Indiana University School of Dentistry; Dr. Hamada is Clinical Assistant Professor, Department of Periodontics and Allied Dental Program, Indiana University School of Dentistry; Dr. Maupome is Professor, Department of Social and Behavioral Sciences, Richard M. Fairbanks School of Public Health, Indiana University; Mr. Eckert is Biostatistician Supervisor, Department of Biostatistics, Indiana University School of Medicine; and Dr. John is Chair, Department of Periodontics and Allied Dental Programs, Indiana University School of Dentistry
| | - George J Eckert
- Dr. Marlow is in private practice in Florence, KY; this study was conducted while she was a resident, Department of Periodontics and Allied Dental Program, Indiana University School of Dentistry; Dr. Hamada is Clinical Assistant Professor, Department of Periodontics and Allied Dental Program, Indiana University School of Dentistry; Dr. Maupome is Professor, Department of Social and Behavioral Sciences, Richard M. Fairbanks School of Public Health, Indiana University; Mr. Eckert is Biostatistician Supervisor, Department of Biostatistics, Indiana University School of Medicine; and Dr. John is Chair, Department of Periodontics and Allied Dental Programs, Indiana University School of Dentistry
| | - Vanchit John
- Dr. Marlow is in private practice in Florence, KY; this study was conducted while she was a resident, Department of Periodontics and Allied Dental Program, Indiana University School of Dentistry; Dr. Hamada is Clinical Assistant Professor, Department of Periodontics and Allied Dental Program, Indiana University School of Dentistry; Dr. Maupome is Professor, Department of Social and Behavioral Sciences, Richard M. Fairbanks School of Public Health, Indiana University; Mr. Eckert is Biostatistician Supervisor, Department of Biostatistics, Indiana University School of Medicine; and Dr. John is Chair, Department of Periodontics and Allied Dental Programs, Indiana University School of Dentistry.
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Li J, To D, Gunn V, Shi W, Yu Y, Liu H. Evaluation of Hybrid Arc and Volumetric-Modulated Arc Therapy Treatment Plans for Fractionated Stereotactic Intracranial Radiotherapy. Technol Cancer Res Treat 2018; 17:1533033818802804. [PMID: 30343652 PMCID: PMC6198396 DOI: 10.1177/1533033818802804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Purpose: The study was aimed to compare hybrid arc and volumetric-modulated arc therapy treatment plans for fractionated stereotactic radiotherapy of brain tumors. Methods: Treatment plans of 22 patients were studied. Hybrid arc and volumetric-modulated arc therapy plans were generated using Brainlab iPlanDose and Varian Eclipse treatment planning systems, respectively, with 6 MV photon beams on a Varian TrueBeam STx linear accelerator (Palo Alto, CA). Prescription dose was 54 Gy. The fractionation was 1.8 Gy per fraction and 30 fractions in total, or 2 Gy per fraction and 27 fractions in total. Planning target volume ranged from 2.4 to 28.6 cm3. Dose conformity index, gradient index, homogeneity index, and maximum doses in organs at risk were compared. Wilcoxon signed rank test was used to determine statistical significance in paired comparison. Results: Conformity indexes of hybrid arc and volumetric-modulated arc therapy plans are 1.10 ± 0.10 and 1.14 ± 0.07, respectively (P = .4); gradient indexes are 5.02 ± 1.20 and 5.64 ± 1.28, respectively (P = .0001); homogeneity indexes are 1.02 ± 0.01 and 1.05 ± 0.01, respectively (P = .0001); brainstem maximum doses are 53.87 ± 1.63 Gy and 54.06 ± 3.17 Gy, respectively (P = .1); and optic chiasm maximum doses are 53.86 ± 1.28 Gy and 53.95 ± 1.81, respectively (P = .4). The monitor unit efficiencies of hybrid arc and volumetric-modulated arc therapy plans are 2.57 ± 0.25 MU/cGy and 2.68 ± 0.24 MU/cGy, respectively (P = .2). The differences of conformity index, gradient index, and homogeneity index between hybrid arc and volumetric-modulated arc therapy plans are small: 0.08 ± 0.05, 0.65 ± 0.46, and 0.02 ± 0.01, respectively. The maximum doses in organs at risks are similar between hybrid arc and volumetric-modulated arc therapy plans. Hybrid arc and volumetric-modulated arc therapy plans, which have similar monitor unit efficiencies, present similar dosimetric results in the fractionated intracranial radiotherapy.
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Affiliation(s)
- Jun Li
- 1 Department of Radiation Oncology, Thomas Jefferson University, Philadelphia, PA, USA
| | - David To
- 1 Department of Radiation Oncology, Thomas Jefferson University, Philadelphia, PA, USA
| | - Vickie Gunn
- 1 Department of Radiation Oncology, Thomas Jefferson University, Philadelphia, PA, USA
| | - Wenyin Shi
- 1 Department of Radiation Oncology, Thomas Jefferson University, Philadelphia, PA, USA
| | - Yan Yu
- 1 Department of Radiation Oncology, Thomas Jefferson University, Philadelphia, PA, USA
| | - Haisong Liu
- 1 Department of Radiation Oncology, Thomas Jefferson University, Philadelphia, PA, USA
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Trivedi M, Fung V, Kharbanda EO, Larkin EK, Butler MG, Horan K, Lieu TA, Wu AC. Racial disparities in family-provider interactions for pediatric asthma care. J Asthma 2017; 55:424-429. [PMID: 28708958 DOI: 10.1080/02770903.2017.1337790] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE Black and Latino children experience significantly worse asthma morbidity than their white peers for multifactorial reasons. This study investigated differences in family-provider interactions for pediatric asthma, based on race/ethnicity. METHODS This was a cross-sectional study of parent surveys of asthmatic children within the Population-Based Effectiveness in Asthma and Lung Diseases Network. Our study population comprised 647 parents with survey response data. Data on self-reported race/ethnicity of the child were collected from parents of the children with asthma. Outcomes studied were responses to the questions about family-provider interactions in the previous 12 months: (1) number of visits with asthma provider; (2) number of times provider reviewed asthma medications with patient/family; (3) review of a written asthma treatment plan with provider; and (4) preferences about making asthma decisions. RESULTS In multivariate adjusted analyses controlling for asthma control and other co-morbidities, black children had fewer visits in the previous 12 months for asthma than white children: OR 0.63 (95% CI 0.40, 0.99). Additionally, black children were less likely to have a written asthma treatment plan given/reviewed by a provider than their white peers, OR 0.44 (95% CI 0.26, 0.75). There were no significant differences by race in preferences about asthma decision-making nor in the frequency of asthma medication review. CONCLUSION Black children with asthma have fewer visits with their providers and are less likely to have a written asthma treatment plan than white children. Asthma providers could focus on improving these specific family-provider interactions in minority children.
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Affiliation(s)
- Michelle Trivedi
- a Division of Pediatric Pulmonology and Quantitative Health Sciences , University of Massachusetts Medical School , Worcester , MA , USA
| | - Vicki Fung
- b Mongan Institute for Health Policy , Massachusetts General Hospital and Harvard Medical School , Boston , MA , USA
| | | | - Emma K Larkin
- d Vanderbilt University School of Medicine , Nashville , TN , USA
| | - Melissa G Butler
- e Center for Clinical Outcomes & Research - Southeast , Kaiser Permanente Georgia , Atlanta , GA , USA.,f Roivant Sciences , Hamilton , Bermuda
| | - Kelly Horan
- g Center for Healthcare Research in Pediatrics, Department of Population Medicine , Harvard Pilgrim Health Care Institute and Harvard Medical School , Boston , MA , USA
| | - Tracy A Lieu
- h Division of Research , Kaiser Permanente Northern California , Oakland , CA , USA
| | - Ann Chen Wu
- g Center for Healthcare Research in Pediatrics, Department of Population Medicine , Harvard Pilgrim Health Care Institute and Harvard Medical School , Boston , MA , USA
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Abstract
This study investigated the dosimetric differences in treatment plans from flattened and flattening filter-free (FFF) beams from the TrueBeam System. A total of 104 treatment plans with static (sliding window) intensity-modulated radiotherapy beams and volumetric-modulated arc therapy (VMAT) beams were generated for 15 patients involving three cancer sites. In general, the FFF beam provides similar target coverage as the flattened beam with improved dose sparing to organ-at-risk (OAR). Among all three cancer sites, the head and neck showed more important differences between the flattened beam and FFF beam. The maximum reduction of the FFF beam in the mean dose reached up to 2.82 Gy for larynx in head and neck case. Compared to the 6 MV flattened beam, the 10 MV FFF beam provided improved dose sparing to certain OARs, especially for VMAT cases. Thus, 10 MV FFF beam could be used to improve the treatment plan.
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Affiliation(s)
- Yue Yan
- Department of Medical Physics, University of Wisconsin, Madison, USA; Department of Human Oncology, University of Wisconsin, Madison, USA
| | - Poonam Yadav
- Department of Human Oncology, University of Wisconsin, Madison, USA; Riverview Cancer Center, University of Wisconsin, Wisconsin Rapids, Wisconsin, USA
| | - Michael Bassetti
- Riverview Cancer Center, University of Wisconsin, Wisconsin Rapids, Wisconsin, USA
| | - Kaifang Du
- Riverview Cancer Center, University of Wisconsin, Wisconsin Rapids, Wisconsin, USA
| | - Daniel Saenz
- Department of Medical Physics, University of Wisconsin, Madison, USA; Department of Human Oncology, University of Wisconsin, Madison, USA
| | - Paul Harari
- Riverview Cancer Center, University of Wisconsin, Wisconsin Rapids, Wisconsin, USA
| | - Bhudatt R Paliwal
- Department of Medical Physics, University of Wisconsin, Madison, USA; Department of Human Oncology, University of Wisconsin, Madison, USA
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Abstract
Introduction: For fabricating dental prostheses that meet patients' demands and have good longevity and function, appropriate treatment planning and decision-making are required. Therefore, not only technical skills and clinical judgment of the dentist are needed, but also patients' attitude toward treatment plays a critical role in posttreatment satisfaction. Aim: The aim of this study is to investigate the factors affecting decision-making and the selection of dental prosthesis by the patients. Materials and Methods: A cross-sectional survey to determine patients' attitudes about replacement of teeth was conducted. This survey was performed with the help of a prevalidated questionnaire, which contained the demographic data of every patient, whether or not they accept the treatment plan proposed by the dentist, and a close-ended multiple choice question stating the reasons cited by them if they decline the proposed treatment plan. Results: The data were subjected to statistical analysis by Chi-square test at a significance level of P < 0.05. A relationship between the demographical information such as age, gender, educational status, marital status, and monthly income of each patient and the single best reason opted by them to not undergo the proposed treatment plan was established. Conclusions: In the sample of population studied, most of the patients declined the proposed treatment plan and accepted the alternate one. High expenditure is the most common reason for this rejection.
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Affiliation(s)
- Nupur D Shrirao
- Department of Prosthodontics and Implantology, VSPM Dental College, Nagpur, Maharashtra, India
| | - Saee P Deshmukh
- Department of Prosthodontics and Implantology, VSPM Dental College, Nagpur, Maharashtra, India
| | - Neelam A Pande
- Department of Prosthodontics and Implantology, VSPM Dental College, Nagpur, Maharashtra, India
| | - Usha M Radke
- Department of Prosthodontics and Implantology, VSPM Dental College, Nagpur, Maharashtra, India
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Koncicki HM, Schell JO. Communication Skills and Decision Making for Elderly Patients With Advanced Kidney Disease: A Guide for Nephrologists. Am J Kidney Dis 2015; 67:688-95. [PMID: 26709108 DOI: 10.1053/j.ajkd.2015.09.032] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2015] [Accepted: 09/18/2015] [Indexed: 11/11/2022]
Abstract
Elderly patients comprise the most rapidly growing population initiating dialysis therapy and may derive particular benefit from comprehensive assessment of geriatric syndromes, coexisting comorbid conditions, and overall prognosis. Palliative care is a philosophy that aims to improve quality of life and assist with treatment decision making for patients with serious illness such as kidney disease. Palliative skills for the nephrology provider can aid in the care of these patients. This review provides nephrology providers with 4 primary palliative care skills to guide treatment decision making: (1) use prognostic tools to identify patients who may benefit from conservative management, (2) disclose prognostic information to patients who may not do well with dialysis therapy, (3) incorporate patient goals and values to outline a treatment plan, and (4) prepare patients and families for transitions and end of life.
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Affiliation(s)
- Holly M Koncicki
- Division of Kidney Diseases and Hypertension, Hofstra North Shore-LIJ School of Medicine, North Shore LIJ Health Systems, Great Neck, NY.
| | - Jane O Schell
- Section of Palliative Care and Medical Ethics, Renal-Electrolyte Division, University of Pittsburgh School of Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA
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Abstract
Almost no literature addresses treatment planning for the forensic psychiatric patient. In the absence of such guidance, recovery-oriented multifocal treatment planning has been imported into forensic mental health systems from community psychiatric settings, despite the fact that conditions of admission and discharge are vastly different for forensic psychiatry inpatients. We propose that instead of focusing on recovery, forensic treatment planning should prioritize forensic outcomes, such as restoration of trial competence or mitigation of violence risk, as the first steps in a continuum of care that eventually leads to the patient's ability to resolve forensic issues and return to the community for recovery-oriented care. Here we offer a model for treatment planning in the forensic setting.
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Lane BA, Luepke P, Chaves E, Maupome G, Eckert GJ, Blanchard S, John V. Assessment of the calibration of periodontal diagnosis and treatment planning among dental students at three dental schools. J Dent Educ 2015; 79:16-24. [PMID: 25576548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Calibration in diagnosis and treatment planning is difficult to achieve due to variations that exist in clinical interpretation. To determine if dental faculty members are consistent in teaching how to diagnose and treat periodontal disease, variations among dental students can be evaluated. A previous study reported high variability in diagnoses and treatment plans of periodontal cases at Indiana University School of Dentistry. This study aimed to build on that one by extending the research to two additional schools: Marquette University School of Dentistry and West Virginia University School of Dentistry. Diagnosis and treatment planning by 40 third- and fourth-year dental students were assessed at each of the schools. Students were asked to select the diagnosis and treatment plans on a questionnaire pertaining to 11 cases. Their responses were compared using chi-square tests, and multirater kappa statistics were used to assess agreement between classes and between schools. Logistic regression models were used to evaluate the effects of school, class year, prior experience, and GPA/class rank on correct responses. One case had a statistically significant difference in responses between third- and fourth-year dental students. Kappas for school agreement and class agreement were low. The students from Indiana University had higher diagnosis and treatment agreements than the Marquette University students, and the Marquette students fared better than the West Virginia University students. This study can help restructure future periodontal courses for a better understanding of periodontal diagnosis and treatment planning.
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Affiliation(s)
- Brittany A Lane
- Dr. Lane is in private practice in Indianapolis, IN; this study was conducted while she was a resident, Department of Periodontics and Allied Dental Programs, Indiana University School of Dentistry; Dr. Luepke is Chair, Department of Surgical Sciences, Marquette University School of Dentistry; Dr. Chaves is Chair, Department of Periodontics, University of Oklahoma School of Dentistry; Dr. Maupome is Professor, Department of Preventive and Community Dentistry, Indiana University School of Dentistry; Mr. Eckert is Biostatistician Supervisor, Department of Biostatistics, Indiana University School of Medicine; Dr. Blanchard is Director of Graduate Periodontics, Indiana University School of Dentistry; and Dr. John is Chair, Department of Periodontics and Allied Dental Programs, Indiana University School of Dentistry
| | - Paul Luepke
- Dr. Lane is in private practice in Indianapolis, IN; this study was conducted while she was a resident, Department of Periodontics and Allied Dental Programs, Indiana University School of Dentistry; Dr. Luepke is Chair, Department of Surgical Sciences, Marquette University School of Dentistry; Dr. Chaves is Chair, Department of Periodontics, University of Oklahoma School of Dentistry; Dr. Maupome is Professor, Department of Preventive and Community Dentistry, Indiana University School of Dentistry; Mr. Eckert is Biostatistician Supervisor, Department of Biostatistics, Indiana University School of Medicine; Dr. Blanchard is Director of Graduate Periodontics, Indiana University School of Dentistry; and Dr. John is Chair, Department of Periodontics and Allied Dental Programs, Indiana University School of Dentistry
| | - Eros Chaves
- Dr. Lane is in private practice in Indianapolis, IN; this study was conducted while she was a resident, Department of Periodontics and Allied Dental Programs, Indiana University School of Dentistry; Dr. Luepke is Chair, Department of Surgical Sciences, Marquette University School of Dentistry; Dr. Chaves is Chair, Department of Periodontics, University of Oklahoma School of Dentistry; Dr. Maupome is Professor, Department of Preventive and Community Dentistry, Indiana University School of Dentistry; Mr. Eckert is Biostatistician Supervisor, Department of Biostatistics, Indiana University School of Medicine; Dr. Blanchard is Director of Graduate Periodontics, Indiana University School of Dentistry; and Dr. John is Chair, Department of Periodontics and Allied Dental Programs, Indiana University School of Dentistry
| | - Gerardo Maupome
- Dr. Lane is in private practice in Indianapolis, IN; this study was conducted while she was a resident, Department of Periodontics and Allied Dental Programs, Indiana University School of Dentistry; Dr. Luepke is Chair, Department of Surgical Sciences, Marquette University School of Dentistry; Dr. Chaves is Chair, Department of Periodontics, University of Oklahoma School of Dentistry; Dr. Maupome is Professor, Department of Preventive and Community Dentistry, Indiana University School of Dentistry; Mr. Eckert is Biostatistician Supervisor, Department of Biostatistics, Indiana University School of Medicine; Dr. Blanchard is Director of Graduate Periodontics, Indiana University School of Dentistry; and Dr. John is Chair, Department of Periodontics and Allied Dental Programs, Indiana University School of Dentistry
| | - George J Eckert
- Dr. Lane is in private practice in Indianapolis, IN; this study was conducted while she was a resident, Department of Periodontics and Allied Dental Programs, Indiana University School of Dentistry; Dr. Luepke is Chair, Department of Surgical Sciences, Marquette University School of Dentistry; Dr. Chaves is Chair, Department of Periodontics, University of Oklahoma School of Dentistry; Dr. Maupome is Professor, Department of Preventive and Community Dentistry, Indiana University School of Dentistry; Mr. Eckert is Biostatistician Supervisor, Department of Biostatistics, Indiana University School of Medicine; Dr. Blanchard is Director of Graduate Periodontics, Indiana University School of Dentistry; and Dr. John is Chair, Department of Periodontics and Allied Dental Programs, Indiana University School of Dentistry
| | - Steven Blanchard
- Dr. Lane is in private practice in Indianapolis, IN; this study was conducted while she was a resident, Department of Periodontics and Allied Dental Programs, Indiana University School of Dentistry; Dr. Luepke is Chair, Department of Surgical Sciences, Marquette University School of Dentistry; Dr. Chaves is Chair, Department of Periodontics, University of Oklahoma School of Dentistry; Dr. Maupome is Professor, Department of Preventive and Community Dentistry, Indiana University School of Dentistry; Mr. Eckert is Biostatistician Supervisor, Department of Biostatistics, Indiana University School of Medicine; Dr. Blanchard is Director of Graduate Periodontics, Indiana University School of Dentistry; and Dr. John is Chair, Department of Periodontics and Allied Dental Programs, Indiana University School of Dentistry
| | - Vanchit John
- Dr. Lane is in private practice in Indianapolis, IN; this study was conducted while she was a resident, Department of Periodontics and Allied Dental Programs, Indiana University School of Dentistry; Dr. Luepke is Chair, Department of Surgical Sciences, Marquette University School of Dentistry; Dr. Chaves is Chair, Department of Periodontics, University of Oklahoma School of Dentistry; Dr. Maupome is Professor, Department of Preventive and Community Dentistry, Indiana University School of Dentistry; Mr. Eckert is Biostatistician Supervisor, Department of Biostatistics, Indiana University School of Medicine; Dr. Blanchard is Director of Graduate Periodontics, Indiana University School of Dentistry; and Dr. John is Chair, Department of Periodontics and Allied Dental Programs, Indiana University School of Dentistry.
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Abstract
This study evaluated how often the treatment plan for carpal tunnel syndrome (CTS) changed based on electrodiagnostic test results. Secondly, we assessed factors associated with a change in the treatment plan for CTS. One-hundred-and-thirty English-speaking adult patients underwent electrodiagnostic testing in a prospective cohort study. Treatment plan was recorded before and after testing. Treatment plan changed in 25 patients (19%) based on electrodiagnostic test results. The plan for operative treatment before testing decreased significantly after testing (83% versus 72%). The best logistic regression model for no change in treatment plan included a prolonged or non-recordable median distal sensory latency (normal, prolonged, or non-recordable), and explained 24% of the variation. For surgeons that manage CTS on the basis of objective pathophysiology rather than symptoms, electrodiagnostic test results often lead to changes in recommended treatment.
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Affiliation(s)
- S J E Becker
- Orthopaedic Hand and Upper Extremity Service, Harvard Medical School, Massachusetts General Hospital, Boston, USA
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Augusti D, Augusti G, Re D. Prosthetic restoration in the single-tooth gap: patient preferences and analysis of the WTP index. Clin Oral Implants Res 2013; 25:1257-1264. [PMID: 24021020 DOI: 10.1111/clr.12264] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/11/2013] [Indexed: 11/29/2022]
Abstract
OBJECTIVE The objective of this study was to evaluate the preference of a patients' population, according to the index of willingness to pay (WTP), against two treatments to restore a single-tooth gap: the implant-supported crown (ISC) and the 3-unit fixed partial denture prosthesis (FPDP) on natural teeth. MATERIALS AND METHODS Willingness to pay values were recorded on 107 subjects by asking the WTP from a starting bid of €2000 modifiable through monetary increases or decreases (€100). Data were collected through an individually delivered questionnaire. The characteristics of the population and choices made, the median values and WTP associations with socio-demographic parameters (Mann-Whitney and Kruskal-Wallis tests), correlations between variables (chi-square test in contingency tables) and significant parameters for predicting WTP values obtained in a multiple linear regression model were revealed. RESULTS The 64% of patients expressed a preference for ISC, while the remaining 36% of the population chose the FPDP. The current therapeutic choice and those carried out in the past were generally in agreement (>70% of cases, P = 0.0001); a relationship was discovered between the anterior and posterior area to the same method of rehabilitation (101 of 107 cases, 94.4%). The WTP median values for ISC were of €3000 and of €2500 in the anterior and posterior areas, respectively. The smallest amount of money has been allocated for FPDP in posterior region (median of €1500). The "importance of oral care" for the patient was a significant predictor, in the regression model analysis, for the estimation of both anterior (P = 0.0003) and posterior (P < 0.0001) WTP values. The "previous therapy" variable reached and was just close to significance in anterior (P = 0.0367) and posterior (P = 0.0511) analyses, respectively. CONCLUSIONS Within the limitations of this study, most of the population (64%) surveyed indicated the ISC as a therapeutic solution for the replacement of a single missing tooth, showing a higher WTP index in the anterior area. Among investigated socio-demographic variables, the importance assigned by the patient to oral care appeared to influence WTP values of the rehabilitation, regardless the location of the single gap in the mouth.
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Affiliation(s)
- Davide Augusti
- Division of Oral Rehabilitation, Istituto Stomatologico Italiano, University of Milan, Milan, Italy
| | - Gabriele Augusti
- Division of Oral Rehabilitation, Istituto Stomatologico Italiano, University of Milan, Milan, Italy
| | - Dino Re
- Division of Oral Rehabilitation, Istituto Stomatologico Italiano, University of Milan, Milan, Italy
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Sivakumar A, Thangaswamy V, Ravi V. Treatment planning in conservative dentistry. J Pharm Bioallied Sci 2012; 4:S406-9. [PMID: 23066299 PMCID: PMC3467905 DOI: 10.4103/0975-7406.100305] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2011] [Revised: 01/02/2012] [Accepted: 01/26/2012] [Indexed: 11/04/2022] Open
Abstract
A patient attending for treatment of a restorative nature may present for a variety of reasons. The success is built upon careful history taking coupled with a logical progression to diagnosis of the problem that has been presented. Each stage follows on from the preceding one. A fitting treatment plan should be formulated and should involve a holistic approach to what is required.
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Affiliation(s)
- Andamuthu Sivakumar
- Department of Conservative Dentistry and Endodontics, Vivekanandha Dental College for Women, Tiruchengodu, India
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Pąchalska M, Mańko G, Chantsoulis M, Knapik H, Mirski A, Mirska N. The quality of life of persons with TBI in the process of a comprehensive rehabilitation program. Med Sci Monit 2012; 18:CR432-42. [PMID: 22739733 PMCID: PMC3560765 DOI: 10.12659/msm.883211] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2012] [Accepted: 04/19/2012] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND The aim of the research was to evaluate the effectiveness of the phased rehabilitation program in patients after traumatic brain injury, one developed by the authors and controlled by the strategic plan, pertaining to their quality of life compared to patients treated according to a standard, phased rehabilitation program. MATERIAL/METHODS The study included 40 patients of post traumatic brain injury treated at the Rehabilitation Clinic of the L. Rydygier Academy of Medical Sciences in Bydgoszcz and the Department of Medical Rehabilitation of the Cracow Rehabilitation Centre. An experimental group included 20 patients rehabilitated by a strategic approach and a control group consisted of 20 patients treated before the introduction of this approach. In assessing the effectiveness of rehabilitation, a structured interview was used with clinical observation and the Battery of Quality of Life Assessment. The study was conducted twice: before and after eight weeks of rehabilitation. RESULTS The quality of life of people after brain injury is affected by self-service difficulties, difficulties in meeting the physiological needs and loss of psychophysical comfort, decreased mobility, impaired cognitive functions and executive and social functions. There is no consistency between the stated (subjective) level of quality of life of the patient, and the depth of objectively measured disability resulting from the injury sustained. CONCLUSIONS A rehabilitation program controlled by a strategic plan, in collaboration with the patient treated subjectively is more effective in improving the quality of life, since the cooperating patient is more motivated to carry out individually designed goals. A rehabilitation program based on a strategic plan is worthy of recommendation for the treatment and improvement of patients after cranio-cerebral trauma.
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Palmer A, Hayman O, Muscat S. Treatment planning study of the 3D dosimetric differences between Co-60 and Ir-192 sources in high dose rate (HDR) brachytherapy for cervix cancer. J Contemp Brachytherapy 2012; 4:52-9. [PMID: 23346140 DOI: 10.5114/jcb.2012.27952] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2012] [Revised: 02/24/2012] [Accepted: 03/19/2012] [Indexed: 11/17/2022] Open
Abstract
Purpose To evaluate whether Co-60 is equivalent to Ir-192 for HDR cervical brachytherapy, through 3D-DVH dose comparisons in standard and optimised plans. Previous studies have only considered 2D dosimetry, point dose comparisons or identical loading. Typical treatment times and economics are considered. Material and methods Plans were produced for eight cervix patients using Co-60 and Ir-192 sources, CT imaging and IU/two-channel-ring applicator (Eckert Ziegler BEBIG). The comparison was made under two conditions: (A) identical dwell positions and loading, prescribed to Point A and (B) optimised source dwells, prescribed to HR-CTV. This provided a direct comparison of inherent differences and residual differences under typical clinical plan optimisation. The DVH (target and OAR), ICRU reference points and isodose distributions were compared. Typical treatment times and source replacement costs were compared. Results Small differences (p < 0.01) in 3D dosimetry exist when using Co-60 compared to Ir-192, prescribed to Point A with identical loading patterns, particularly 3.3% increase in rectum D2cc. No significant difference was observed in this parameter when prescribing to the HR-CTV using dwell-time optimisation. There was no statistically significant difference in D90 between the two isotopes. Co-60 plans delivered consistently higher V150% (mean +4.4%, p = 0.03) and V400% (mean +11.6%, p < 0.01) compared to Ir-192 in optimised plans. Differences in physical source properties were overwhelmed by geometric effects. Conclusions Co-60 may be used as an effective alternative to Ir-192 for HDR cervix brachytherapy, producing similar plans of equivalent D90, but with logistical benefits. There is a small dose increase along the extension of the source axis when using Co-60 compared to Ir-192, leading to small rectal dose increases for identical loading patterns. This can be eliminated by planning optimisation techniques. Such optimisation may also be associated with increases in the overdose volume (V150-V400) with Co-60 compared to Ir-192.
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te Stroet MAJ, Holla M, Biert J, van Kampen A. The value of a CT scan compared to plain radiographs for the classification and treatment plan in tibial plateau fractures. Emerg Radiol 2011; 18:279-83. [PMID: 21394519 PMCID: PMC3139878 DOI: 10.1007/s10140-010-0932-5] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2010] [Accepted: 12/23/2010] [Indexed: 11/24/2022]
Abstract
This study aimed to evaluate the intra- and interobserver agreement for both fracture classification according to Schatzker and treatment plan of tibial plateau fractures using plain radiographs alone and with computed tomography (CT) scans. The study was carried out prospectively to assess the impact of an advanced radiographic study on the agreement of treatment plan and fracture classification of tibial plateau fractures. Eight experienced observers (six surgeons and two radiologists) classified 15 tibial plateau fractures with plain radiographs and CT scans and set up a treatment plan. Agreement was measured using kappa coefficients. Using plain radiographs alone, the mean interobserver kappa coefficient for classification was 0.47, which decreased to 0.46 after addition of CT scans. Using plain films alone for formulating a treatment plan, the mean interobserver kappa coefficient was 0.40, which decreased to 0.30 after addition of CT scans. The mean intraobserver kappa coefficient for fracture classification using plain radiographs was 0.60, which decreased to 0.57 with addition of CT scans. The mean intraobserver kappa coefficient for treatment plan based on plain radiographs alone was 0.53, which decreased to 0.45 after addition of CT scans. In contrast with other recent publications, there is no increase in inter- and intra-agreement of a CT scan compared to plain radiographs for the classification and treatment plan in tibial plateau fractures. Routine CT scanning of the knee for tibial plateau fractures is not supported by this study.
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Affiliation(s)
| | - Micha Holla
- Radboud University Nijmegen Medical Centre, Postbox 9101, 6501 HB Nijmegen, The Netherlands
| | - Jan Biert
- Radboud University Nijmegen Medical Centre, Postbox 9101, 6501 HB Nijmegen, The Netherlands
| | - Albert van Kampen
- Radboud University Nijmegen Medical Centre, Postbox 9101, 6501 HB Nijmegen, The Netherlands
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Knaup C, Mavroidis P, Esquivel C, Baltas D, Stathakis S, Swanson G, Papanikolaou N. Radiobiologically based treatment plan evaluation for prostate seed implants. J Contemp Brachytherapy 2011; 3:74-83. [PMID: 27895673 DOI: 10.5114/jcb.2011.23201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2011] [Accepted: 06/20/2011] [Indexed: 11/25/2022] Open
Abstract
Purpose Accurate prostate low dose-rate brachytherapy treatment plan evaluation is important for future care decisions. Presently, an evaluation is based on dosimetric quantifiers for the tumor and organs at risk. However, these do not account for effects of varying dose-rate, tumor repopulation and other biological effects. In this work, incorporation of the biological response is used to obtain more clinically relevant treatment plan evaluation. Material and methods Eleven patients were evaluated. Each patient received a 145 Gy implant. Iodine-125 seeds were used and the treatment plans were created on the Prowess system. Based on CT images the post-implant plan was created. In the post-plan, the tumor, urethra, bladder and rectum were contoured. The biologically effective dose was used to determine the tumor control probability and the normal tissue complication probabilities for the urethra, bladder, rectum and surrounding tissue. Results The average tumor control probability and complication probabilities for the urethra, bladder, rectum and surrounding tissue were 99%, 29%, 0%, 12% and 6%, respectively. These measures provide a simpler means for evaluation and since they include radiobiological factors, they provide more reliable estimation of the treatment outcome. Conclusions The goal of this work was to create more clinically relevant prostate seed-implant evaluation by incorporating radiobiological measures. This resulted in a simpler descriptor of treatment plan quality and was consistent with patient outcomes.
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Hoopes PJ, Petryk AA, Giustini AJ, Stigliano RV, D'Angelo RN, Tate JA, Cassim SM, Foreman A, Bischof JC, Pearce JA, Ryan T. Nanoparticle based cancer treatment: can delivered dose and biological dose be reliably modeled and quantified? ACTA ACUST UNITED AC 2011; 7901. [PMID: 24392199 DOI: 10.1117/12.877026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Essential developments in the reliable and effective use of heat in medicine include: 1) the ability to model energy deposition and the resulting thermal distribution and tissue damage (Arrhenius models) over time in 3D, 2) the development of non-invasive thermometry and imaging for tissue damage monitoring, and 3) the development of clinically relevant algorithms for accurate prediction of the biological effect resulting from a delivered thermal dose in mammalian cells, tissues, and organs. The accuracy and usefulness of this information varies with the type of thermal treatment, sensitivity and accuracy of tissue assessment, and volume, shape, and heterogeneity of the tumor target and normal tissue. That said, without the development of an algorithm that has allowed the comparison and prediction of the effects of hyperthermia in a wide variety of tumor and normal tissues and settings (cumulative equivalent minutes/ CEM), hyperthermia would never have achieved clinical relevance. A new hyperthermia technology, magnetic nanoparticle-based hyperthermia (mNPH), has distinct advantages over the previous techniques: the ability to target the heat to individual cancer cells (with a nontoxic nanoparticle), and to excite the nanoparticles noninvasively with a non-injurious magnetic field, thus sparing associated normal cells and greatly improving the therapeutic ratio. As such, this modality has great potential as a primary and adjuvant cancer therapy. Although the targeted and safe nature of the noninvasive external activation (hysteretic heating) are a tremendous asset, the large number of therapy based variables and the lack of an accurate and useful method for predicting, assessing and quantifying mNP dose and treatment effect is a major obstacle to moving the technology into routine clinical practice. Among other parameters, mNPH will require the accurate determination of specific nanoparticle heating capability, the total nanoparticle content and biodistribution in the target cells/tissue, and an effective and matching alternating magnetic field (AMF) for optimal and safe excitation of the nanoparticles. Our initial studies have shown that appropriately delivered and targeted nanoparticles are capable of achieving effective tumor cytotoxicity at measured thermal doses significantly less than the understood thermal dose values necessary to achieve equivalent treatment effects using conventional heat delivery techniques. Therefore conventional CEM based thermal dose - tissues effect relationships will not hold for mNPH. The goal of this effort is to provide a platform for determining the biological and physical parameters that will be necessary for accurately planning and performing safe and effective mNPH, creating a new, viable primary or adjuvant cancer therapy.
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Affiliation(s)
- P Jack Hoopes
- Thayer School of Engineering, Dartmouth College, Hanover, NH USA 03755-8000 ; Dartmouth Medical School, Dartmouth College, Hanover, NH USA 03755-8000
| | - Alicia A Petryk
- Thayer School of Engineering, Dartmouth College, Hanover, NH USA 03755-8000
| | - Andrew J Giustini
- Thayer School of Engineering, Dartmouth College, Hanover, NH USA 03755-8000 ; Dartmouth Medical School, Dartmouth College, Hanover, NH USA 03755-8000
| | - Robert V Stigliano
- Thayer School of Engineering, Dartmouth College, Hanover, NH USA 03755-8000
| | - Robert N D'Angelo
- Thayer School of Engineering, Dartmouth College, Hanover, NH USA 03755-8000
| | - Jennifer A Tate
- Thayer School of Engineering, Dartmouth College, Hanover, NH USA 03755-8000
| | - Shiraz M Cassim
- Thayer School of Engineering, Dartmouth College, Hanover, NH USA 03755-8000
| | - Allan Foreman
- Thayer School of Engineering, Dartmouth College, Hanover, NH USA 03755-8000
| | - John C Bischof
- University of Minnesota School of Engineering, Minneapolis, MN, 55455
| | - John A Pearce
- University of Texas at Austin, Austin, TX, 78712-0240
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Zhang GG, Ku L, Michael Yu HH, Sarangkasiri S, Zhang RR, Li W, Feygelman V. Dosimetric analysis of modulated and hybrid arcs in stereotactic radiosurgery. J Radiosurg SBRT 2011; 1:177-182. [PMID: 29296315 PMCID: PMC5725314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 07/06/2011] [Accepted: 09/27/2011] [Indexed: 06/07/2023]
Abstract
PURPOSE Forward-planned conformal arcs (termed dynamic arcs in the BrainLab iPlan system) have been routinely used in cranial stereotactic radiosurgery (SRS) for many yeras. This study compares dosimetric parameters of the newer, inversely-planned volumetric modulated arc therapy (VMAT) and VMAT-conformal hybrid plans with conformal arc plans. In the hybrid plans, various numbers of conformal arcs in a conformal plan are replaced with VMAT arcs. METHODS Ten brain cancer cases previously treated on a Novalis accelerator for frameless cranial stereotactic radiosurgery using conformal arcs generated by BrainLab iPlan treatment planning system were retrospectively studied with various numbers of VMAT arcs replacing the conformal arcs. Pure VMAT plans of different numbers of arcs were also generated using the same angle and arc length setup for all or part of the conformal arcs and compared with both the original and hybrid plans. Pinnacle version 9.0 was used for treatment plan generation. SmartArc was used for the VMAT planning for a Novalis accelerator. The conformity index (CI), defined as the ratio of the isodose volume to the isodose covered target volume, gradient index (GI), defined as the ratio of the 50% isodose volume (V50) to the 100% isodose volume, volume covered by 12 Gy isodose (V12), mean dose and standard deviation of dose in target were studied. RESULTS With one of the conformal arcs replaced with a VMAT arc of the same weighting and geometric setup, the average CI with one standard deviation was improved from 1.35 ± 0.18 to 1.29 ± 0.15 (p-value 0.03), while the average GI degraded from 3.8 ± 1.0 to 4.9 ± 1.5 (p-value < 0.01). The degraded GI in the VMAT plans is due to the absence of beam margin limit in SmartArc planning. Pure VMAT plans usually demonstrated better CI values than the hybrid and conformal arc plans when the number of arcs was greater than 2. The GI value was improved with increasing number of arcs in VMAT plans. For target volumes greater than 1 cc, VMAT plans demonstrated improved CI and smaller V50 and V12 than that in conformal arc plans. Better dose fall-off in normal tissue in VMAT plans is accompanied with higher dose heterogeneity in the target volume. CONCLUSION VMAT and conformal-VMAT hybrid plans usually offer better target conformity. The dose fall-off in normal tissue is also better in VMAT plans when the number of arcs is greater than 3 and target volume is greater than 1 cc, but compromise the dose homogeneity in target volumes. VMAT plans are the best option for targets that are greater than 1 cc for cranial radiosurgery treatments, while for very small targets, conformal arc technique may still be the better choice based on data of dose fall-off in normal tissues.
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Affiliation(s)
| | - Lichung Ku
- Radiation Oncology, Salem Hospital, Salem, Oregon, USA
| | | | | | - Ray R Zhang
- School of Medicine and Public Health, University of Wisconsin, Madison, USA
| | - Weiqi Li
- Radiation Oncology, Moffitt Cancer Center, Tampa, Florida, USA
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Mavroidis P, Katsilieri Z, Kefala V, Milickovic N, Papanikolaou N, Karabis A, Zamboglou N, Baltas D. Radiobiological evaluation of the influence of dwell time modulation restriction in HIPO optimized HDR prostate brachytherapy implants. J Contemp Brachytherapy 2010; 2:117-28. [PMID: 27853473 DOI: 10.5114/jcb.2010.16923] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2010] [Accepted: 09/01/2010] [Indexed: 12/25/2022] Open
Abstract
Purpose One of the issues that a planner is often facing in HDR brachytherapy is the selective existence of high dose volumes around some few dominating dwell positions. If there is no information available about its necessity (e.g. location of a GTV), then it is reasonable to investigate whether this can be avoided. This effect can be eliminated by limiting the free modulation of the dwell times. HIPO, an inverse treatment plan optimization algorithm, offers this option. In treatment plan optimization there are various methods that try to regularize the variation of dose non-uniformity using purely dosimetric measures. However, although these methods can help in finding a good dose distribution they do not provide any information regarding the expected treatment outcome as described by radiobiology based indices. Material and methods The quality of 12 clinical HDR brachytherapy implants for prostate utilizing HIPO and modulation restriction (MR) has been compared to alternative plans with HIPO and free modulation (without MR). All common dose-volume indices for the prostate and the organs at risk have been considered together with radiobiological measures. The clinical effectiveness of the different dose distributions was investigated by calculating the response probabilities of the tumors and organs-at-risk (OARs) involved in these prostate cancer cases. The radiobiological models used are the Poisson and the relative seriality models. Furthermore, the complication-free tumor control probability, P+ and the biologically effective uniform dose (D¯¯) were used for treatment plan evaluation and comparison. Results Our results demonstrate that HIPO with a modulation restriction value of 0.1-0.2 delivers high quality plans which are practically equivalent to those achieved with free modulation regarding the clinically used dosimetric indices. In the comparison, many of the dosimetric and radiobiological indices showed significantly different results. The modulation restricted clinical plans demonstrated a lower total dwell time by a mean of 1.4% that was proved to be statistically significant (p = 0.002). The HIPO with MR treatment plans produced a higher P+ by 0.5%, which stemmed from a better sparing of the OARs by 1.0%. Conclusions Both the dosimetric and radiobiological comparison shows that the modulation restricted optimization gives on average similar results with the optimization without modulation restriction in the examined clinical cases. Concluding, based on our results, it appears that the applied dwell time regularization technique is expected to introduce a minor improvement in the effectiveness of the optimized HDR dose distributions.
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Amand RS, Sackett DL. An approach to difficult clinical problems. Can Fam Physician 1986; 32:619-625. [PMID: 21267159 PMCID: PMC2327657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Often physicians use an intuitive approach to treatment, based on years of clinical experience and discussion with colleagues. However, some complex clinical problems in family practice require a formal, structured, rational apprach to decision making. This article describes how clinical decision analysis was used in a family practice unit, for a patient with a suspected loose hip prosthesis. The use of probabilities and working through a 'decision tree' assisted in the formation of a successful treatment plan.
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