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Herr DJ, Moncion A, Griffith KA, Marsh R, Grubb M, Bhatt A, Dominello M, Walker EM, Narayana V, Abu-Isa E, Vicini FA, Hayman JA, Pierce LJ. Factors Associated With Cardiac Radiation Dose Reduction After Hypofractionated Radiation Therapy for Localized, Left-Sided Breast Cancer in a Large Statewide Quality Consortium. Int J Radiat Oncol Biol Phys 2024; 118:632-638. [PMID: 37797748 DOI: 10.1016/j.ijrobp.2023.09.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 08/31/2023] [Accepted: 09/09/2023] [Indexed: 10/07/2023]
Abstract
PURPOSE Limiting cardiac radiation dose is important for minimizing long-term cardiac toxicity in patients with left-sided early-stage breast cancer. METHODS AND MATERIALS Prospectively collected dosimetric data were analyzed for patients undergoing moderately hypofractionated radiation therapy to the left breast within the Michigan Radiation Oncology Quality Consortium from 2016 to 2022. The mean heart dose (MHD) goal was progressively tightened from ≤2 Gy in 2016 to MHD ≤ 1.2 Gy in 2018. In 2021, a planning target volume (PTV) coverage goal was added, and the goal MHD was reduced to ≤1 Gy. Multivariate logistic regression models were developed to assess for covariates associated with meeting the MHD goals in 2016 to 2020 and the combined MHD/PTV coverage goal in 2021 to 2022. RESULTS In total, 4165 patients were analyzed with a median age of 64 years. Overall average cardiac metric compliance was 91.7%. Utilization of motion management increased from 41.8% in 2016 to 2020 to 46.5% in 2021 to 2022. Similarly, use of prone positioning increased from 12.2% to 22.2% in these periods. On multivariate analysis in the 2016 to 2020 cohort, treatment with motion management (odds ratio [OR], 5.20; 95% CI, 3.59-7.54; P < .0001) or prone positioning (OR, 3.21; 95% CI, 1.85-5.57; P < .0001) was associated with meeting the MHD goal, while receipt of boost (OR, 0.25; 95% CI, 0.17-0.39; P < .0001) and omission of hormone therapy (OR, 0.65; 95% CI, 0.49-0.88; P = .0047) were associated with not meeting the MHD goal. From 2021 to 2022, treatment with motion management (OR, 1.89; 95% CI, 1.12-3.21; P = .018) or prone positioning (OR, 3.71; 95% CI, 1.73-7.95; P = .0008) was associated with meeting the combined MHD/PTV goal, while larger breast volume (≥1440 cc; OR, 0.34; 95% CI, 0.13-0.91; P = .031) was associated with not meeting the combined goal. CONCLUSIONS In our statewide consortium, high rates of compliance with aggressive targets for limiting cardiac dose were achievable without sacrificing target coverage.
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Affiliation(s)
| | | | - Kent A Griffith
- School of Public Health, University of Michigan, Ann Arbor, Michigan
| | | | | | - Amit Bhatt
- Department of Radiation Oncology, Karmanos Cancer Institute at McLaren Greater Lansing, Lansing, Michigan
| | - Michael Dominello
- Department of Radiation Oncology, Karmanos Cancer Institute, Detroit, Michigan
| | - Eleanor M Walker
- Department of Radiation Oncology, Henry Ford Cancer Institute, Detroit, Michigan
| | - Vrinda Narayana
- Department of Radiation Oncology, Ascension Providence Hospital, Southfield, Michigan
| | - Eyad Abu-Isa
- Department of Radiation Oncology, Ascension Providence Hospital, Southfield, Michigan
| | - Frank A Vicini
- MHP Radiation Oncology Institute/GenesisCare USA, Farmington Hills, Michigan
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Takayesu JSK, Jiang SJ, Marsh R, Moncion A, Smith SR, Pierce LJ, Jagsi R, Lipps DB. Pectoralis Muscle Dosimetry and Posttreatment Rehabilitation Utilization for Patients With Early-Stage Breast Cancer. Pract Radiat Oncol 2024; 14:e20-e28. [PMID: 37768242 DOI: 10.1016/j.prro.2023.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 06/13/2023] [Accepted: 07/11/2023] [Indexed: 09/29/2023]
Abstract
PURPOSE Up to 50% of women treated for localized breast cancer will experience some degree of arm or shoulder morbidity. Although radiation is thought to contribute to this morbidity, the mechanism remains unclear. Prior studies have shown biologic and radiographic changes in the pectoralis muscles after radiation. This study thus aimed to investigate the relationship between radiation to the pectoralis muscles and referrals for rehabilitation services posttreatment for arm and shoulder morbidity. METHODS AND MATERIALS A retrospective 1:1 matched case-control study was conducted for patients with breast cancer who were and were not referred for breast or shoulder rehabilitation services between 2014 and 2019 at a single academic institution. Patients were included if they had a lumpectomy and adjuvant radiation. Patients who underwent an axillary lymph node dissection were excluded. Cohorts were matched based on age, axillary surgery, and use of radiation boost. Muscle doses were converted to equivalent dose in 2 Gy fractions assuming an α:β ratio of 2.5 and were compared between the 2 groups. RESULTS In our cohort of 50 patients of a median age 60 years (interquartile range, 53-68 years), 36 patients (72%) underwent a sentinel lymph node biopsy in addition to a lumpectomy. Although pectoralis muscle doses were generally higher in those receiving rehabilitation services, this was not statistically significant. Pectoralis major V20-40 Gy reached borderline significance, as did pectoralis major mean dose (17.69 vs 20.89 Gy; P = .06). CONCLUSIONS In this limited cohort of patients, we could not definitively conclude a relationship between pectoralis muscle doses and use of rehabilitation services. Given the borderline significant findings, this should be further investigated in a larger cohort.
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Affiliation(s)
- Jamie S K Takayesu
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan.
| | - Shannon J Jiang
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan
| | - Robin Marsh
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan
| | - Alexander Moncion
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan
| | - Sean R Smith
- Department of Physical Medicine & Rehabilitation, University of Michigan, Ann Arbor, Michigan
| | - Lori J Pierce
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan
| | - Reshma Jagsi
- Department of Radiation Oncology, Emory University, Atlanta, Georgia
| | - David B Lipps
- School of Kinesiology, University of Michigan, Ann Arbor, Michigan
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Jiang SJ, Takayesu J, Marsh R, Moncion A, Smith S, Pierce LJ, Jagsi R, Lipps D. Shoulder Muscle Dosimetry and Post-Treatment Rehabilitation Utilization for Early-Stage Breast Cancer Patients. Int J Radiat Oncol Biol Phys 2023; 117:e239. [PMID: 37784944 DOI: 10.1016/j.ijrobp.2023.06.1165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) Rehabilitation services for recovery of impaired physical function following breast cancer treatments are largely underutilized. We previously found that breast cancer survivors treated with radiation who received higher radiation doses to the pectoralis major are more likely to self-report shoulder pain and disability. This study aims to address whether radiation dose delivered to the pectoralis major (Pmaj) and pectoralis minor (Pmin) are correlated with referrals for rehabilitation services post-treatment. MATERIALS/METHODS A retrospective 1:1 matched case-control study was conducted for breast cancer patients who were and were not referred for breast or shoulder rehabilitation services between 2014-2019 at a single academic institution. Patients were included if they had a lumpectomy and adjuvant radiation without regional nodal irradiation. Cohorts were matched based on age, axillary surgery (none vs. sentinel lymph node biopsy (SLNB)), and use of radiation boost. We used non-parametric Mann-Whitney U tests to determine whether Pmaj or Pmin doses (mean, V50Gy, V45Gy, V40Gy, V35Gy, V30Gy, V20Gy) were different between the two groups. Muscle doses were converted to EQD2 assuming an α/β ratio of 2.5. RESULTS In our study of 30 patients of a median age 57 years (IQR 12.75), 20 (66.67%) patients underwent SLNB in addition to lumpectomy. Median tumor size was 1.1cm (range 0.16 - 7.30cm). Stage was 0 for 11 patients (36.67%), I for 14 patients (46.67%), and II for 5 patients (16.67%). 3D conformal radiation was delivered to the whole breast with a moderately hypofractionated (n = 17) or conventionally fractionated regimen (n = 13). The most common rehabilitation diagnoses were lymphedema (n = 8), scar management (n = 7) and shoulder pain (n = 5). Mean dose to both the Pmaj (20.8Gy vs. 18.6Gy; p = 0.02) and Pmin (30.6Gy vs. 24.6Gy; p = 0.01) were significantly higher in patients who received post-treatment rehabilitation compared to those without. The V40Gy, V35Gy, V30Gy and V20Gy (all p<0.02) for the Pmin and V35Gy, V30Gy and V20Gy for the Pmaj (all p<0.04) were also significantly higher in those who underwent rehabilitation. CONCLUSION In this cohort of patients with early-stage breast cancer, increased mean doses to the pectoralis muscles were correlated with increased use of rehabilitation services after radiation. Physicians might consider using these dosimetric data to complement clinical symptoms in the decision-making process for referrals for rehabilitation services. This may help facilitate earlier referral to rehabilitation interventions, which is important since early intervention is correlated with improved shoulder morbidity.
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Affiliation(s)
- S J Jiang
- University of Michigan, Ann Arbor, MI
| | - J Takayesu
- Department of Radiation Oncology, University of Michigan, Ann Arbor, MI
| | - R Marsh
- Department of Radiation Oncology, University of Michigan, Ann Arbor, MI
| | - A Moncion
- Department of Radiation Oncology, University of Michigan, Ann Arbor, MI
| | - S Smith
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI
| | - L J Pierce
- Department of Radiation Oncology, University of Michigan, Ann Arbor, MI
| | - R Jagsi
- Department of Radiation Oncology, University of Emory, Atlanta, GA
| | - D Lipps
- University of Michigan, Ann Arbor, MI
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Moncion A, Griffith K, Walker EM, Jagsi R, Dominello MM, Wilson M, Mietzel M, Grubb M, Marsh R, Vicini FA, Pierce LJ. Impact of Breast Volume on Achieving a Conservative Heart and Target Coverage Metric for Patients Receiving Whole Breast Radiotherapy in a Statewide Consortium. Int J Radiat Oncol Biol Phys 2023; 117:e193-e194. [PMID: 37784833 DOI: 10.1016/j.ijrobp.2023.06.1061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) Radiation to large breast volumes (BV) has been associated with increased dose inhomogeneities, breast fibrosis, and induration. Radiation exposure to the heart during breast radiotherapy has been associated with late cardiovascular morbidity and mortality. This study, therefore, investigates the impact of BV on achieving optimal lumpectomy cavity target coverage (V95% [%] >95) while maintaining mean heart dose constraints (MHD, mean [Gy] <1) across a range of BV from patients enrolled in a statewide consortium. MATERIALS/METHODS A retrospective analysis was conducted for 2,506 patients receiving left-sided whole breast moderately-hypofractionated (2.5-2.8 Gy/fx) radiotherapy without nodal fields between 2018-2022. The BV was calculated for each patient from contours in the treatment planning system, and the volume distribution partitioned into quartiles. Dosimetric parameters were calculated from dose-volume histograms. The percentage of patients in which the metrics were achieved was calculated for each BV quartile for different treatment positions: all positions, supine, supine with breathing motion management, and prone. RESULTS The BV ranges within the quartiles (∼620 patients/quartile) were ≤720.0 cc, 720.1 to ≤1065.0 cc, 1065.1 to ≤1500.0 cc, and >1500.0 cc for quartiles Q1-Q4, respectively. Of the 2,506 patients, 76% were treated supine (of which 41.6% were treated using breathing motion management techniques), 23.5% were treated prone, and 0.5% were treated decubitus. Discrete percentages of patients able to meet the metrics are provided in the table. An increase in BV from Q1 to Q4 correlated with lower percentages of patients meeting the MHD metric, however no correlation was observed between BV and target coverage. Treating supine with breathing motion management resulted in a higher percentage of patients meeting the MHD metric (odds ratio (OR) = 1.96 relative to supine without motion management, p<0.0001), while the prone setup proved to be the superior technique across all quartiles (OR = 3.95 relative to supine, p<0.0001). CONCLUSION Increasing BVs resulted in lower percentages of patients receiving MHD≤1 Gy. Thus, cardiac sparing may be more difficult to achieve in patients with larger BV. Utilization of alternate treatment positions, such as supine with breathing motion management and prone, greatly improved the percentage of patients able to meet the MHD metric without sacrificing target coverage in all quartiles. Prone positioning was the technique least susceptible to BV effects in meeting the MHD≤1 Gy goal.
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Affiliation(s)
- A Moncion
- Department of Radiation Oncology, University of Michigan, Ann Arbor, MI
| | - K Griffith
- Department of Biostatistics, University of Michigan, Ann Arbor, MI
| | - E M Walker
- Department of Radiation Oncology, Henry Ford Cancer Institute, Detroit, MI
| | - R Jagsi
- Department of Radiation Oncology, Emory University, Atlanta, GA
| | - M M Dominello
- Department of Radiation Oncology, Barbara Ann Karmanos Cancer Institute, Wayne State University School of Medicine, Detroit, MI
| | - M Wilson
- MHP Radiation Oncology Institute/GenesisCare, Farmington Hills, MI
| | - M Mietzel
- Department of Radiation Oncology, University of Michigan, Ann Arbor, MI
| | - M Grubb
- Department of Radiation Oncology, University of Michigan, Ann Arbor, MI
| | - R Marsh
- Department of Radiation Oncology, University of Michigan, Ann Arbor, MI
| | - F A Vicini
- MHP Radiation Oncology Institute/GenesisCare, Farmington Hills, MI
| | - L J Pierce
- Department of Radiation Oncology, University of Michigan, Ann Arbor, MI
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Herr DJ, Moncion A, Griffith K, Marsh R, Grubb M, Bhatt AK, Dominello MM, Walker EM, Narayana V, Abu-Isa EI, Vicini FA, Hayman JA, Pierce LJ. Factors Associated with Cardiac Radiation Dose Reduction Following Hypofractionated Radiation Therapy for Localized, Left-Sided Breast Cancer in a Large Statewide Quality Consortium. Int J Radiat Oncol Biol Phys 2023; 117:S138. [PMID: 37784352 DOI: 10.1016/j.ijrobp.2023.06.544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) Limiting radiation dose to the heart is important for minimizing the risk of long-term cardiac toxicity in patients with left-sided early-stage breast cancer. MATERIALS/METHODS Prospectively collected dosimetric data were analyzed for patients undergoing hypofractionated radiation therapy to the left breast for localized node-negative breast cancer within the Michigan Radiation Oncology Quality Consortium (MROQC) from 2016-2022. Goals for limiting cardiac dose were adjusted over time. From 2016-2020, the cardiac quality metric focused on total mean heart dose (MHD) from the composite whole breast and boost plans, tightening from a goal of MHD ≤2 Gy to MHD ≤1.2 Gy by 2020. In 2021-2022, the cardiac metric transitioned to a combined goal of MHD ≤1.0 Gy from the whole breast plan and ≥95% lumpectomy cavity planning target volume (PTV) receiving 95% of the prescription dose. Separate multivariate logistic regression models were developed to assess for covariates associated with meeting the MHD goal in 2016-2020 and combined MHD/PTV coverage goal in 2021-2022. RESULTS In total, 4,165 patients were analyzed with a median age of 64 years. Most patients (86%) had either Tis or T1 disease, and 66% received hormone therapy. Baseline demographic and disease characteristics did not change substantially between treatment periods. Use of breath-hold or motion gating increased from 42% in 2016-2020 to 46% in 2021-2022. Similarly, use of prone positioning increased from 12% to 20%. From 2016-2020, 90.9% of plans achieved the MHD goal, compared to 93.6% of plans achieving the composite MHD/PTV goal from 2021-2022. On multivariate analysis in the 2016-2020 cohort, treatment with motion management (OR 5.20, 95% CI [3.59-7.54], p<0.0001) or prone positioning (OR 3.21, 95% CI [1.85-5.57], p < 0.0001) were associated with meeting the MHD goal, while receipt of boost (OR 0.25, 95% CI [0.17-0.39], p<0.0001) and omission of hormone therapy (OR 0.65, 95% CI [0.49-0.88], p = 0.0047), were associated with not meeting the MHD goal. During the era including composite heart dose and PTV coverage goals (2021-2022), treatment with motion management (OR 1.89, 95% CI [1.12-3.21], p = 0.018) or prone positioning (OR 3.71, 95% CI [1.73-7.95], p = 0.0008) were associated with meeting the combined goal, while larger breast volume (≥1440 cc, OR 0.34, 95% CI [0.13 - 0.91], p = 0.031) and treatment at an academic center (OR 0.36, 95% CI [0.22-0.67], p = 0.0009) were associated with not meeting the combined goal. CONCLUSION In our statewide consortium, rates of compliance with aggressive targets for limiting cardiac dose remain high, despite tightening of these goals to include lower mean heart doses and inclusion of a concurrent PTV coverage goal. Treatment using motion management or prone positioning is associated with achieving the cardiac dose goals.
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Affiliation(s)
- D J Herr
- Department of Radiation Oncology, University of Michigan, Ann Arbor, MI
| | - A Moncion
- Department of Radiation Oncology, University of Michigan, Ann Arbor, MI
| | - K Griffith
- Department of Biostatistics, University of Michigan, Ann Arbor, MI
| | - R Marsh
- Department of Radiation Oncology, University of Michigan, Ann Arbor, MI
| | - M Grubb
- Department of Radiation Oncology, University of Michigan, Ann Arbor, MI
| | - A K Bhatt
- Karmanos Cancer Institute at McLaren Greater Lansing, Lansing, MI
| | - M M Dominello
- Department of Radiation Oncology, Barbara Ann Karmanos Cancer Institute, Wayne State University School of Medicine, Detroit, MI
| | - E M Walker
- Department of Radiation Oncology, Henry Ford Cancer Institute, Detroit, MI
| | - V Narayana
- Ascension Providence Hospital, Southfield, MI
| | - E I Abu-Isa
- Department of Radiation Oncology, University of Michigan, Ann Arbor, MI; Ascension Providence Hospital, Southfield, MI
| | - F A Vicini
- MHP Radiation Oncology Institute/GenesisCare, Farmington Hills, MI
| | - J A Hayman
- Department of Radiation Oncology, University of Michigan, Ann Arbor, MI
| | - L J Pierce
- Department of Radiation Oncology, University of Michigan, Ann Arbor, MI
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Ikeda AK, McShay C, Marsh R, Saini S, Sardesai MG, Weaver EM, Boss EF. Patient Factors and Preferences in Choosing Sleep Surgery for Obstructive Sleep Apnea: A Qualitative Study. Otolaryngol Head Neck Surg 2023; 168:514-520. [PMID: 35671145 DOI: 10.1177/01945998221105404] [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: 12/05/2021] [Accepted: 05/18/2022] [Indexed: 11/16/2022]
Abstract
OBJECTIVE There are several obstructive sleep apnea (OSA) treatment options available to patients, including surgery and less invasive therapies. Little is known about the factors that influence patient preferences for treatment. We aimed to understand factors influencing patient experience and decision making for undergoing sleep surgery. STUDY DESIGN Retrospective qualitative study. SETTING Tertiary sleep surgery clinic. METHODS We conducted semistructured interviews with adults who previously underwent any nasal and/or pharyngeal sleep surgery. We asked open-ended questions about their decision-making process within a preconceived thematic framework of chief OSA symptoms, expectations for recovery, and sources of information. The interviews were audio recorded and transcribed, and content was analyzed for defined, emergent, and prevalent themes. RESULTS Ten patients were interviewed from December 11, 2020 through January 29, 2021. Six patients underwent nasal surgery, 1 underwent pharyngeal surgery, and 3 underwent staged nasal and pharyngeal procedures. All patients were beyond the acute recovery phase. Reasons for pursuing surgical consultation varied from sleep apnea burden to external factors, such as recommendations from significant others. Duration of sleep surgery consideration varied from months to years. Major concerns about sleep surgery involved anesthesia and postoperative pain. External factors influencing patients' decisions to pursue sleep surgery included family and friend support. Postoperative outcomes of surgery included patient satisfaction with decision for surgery, given OSA improvements. CONCLUSION Understanding patient factors that influence decision making for sleep surgery may guide clinicians in patient-centered counseling that engages patients in decision making, aligning with clinical symptoms and patient preferences.
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Affiliation(s)
- Allison K Ikeda
- Department of Otolaryngology-Head and Neck Surgery, University of Washington, Seattle, Washington, USA
| | - Crystina McShay
- Department of Human Centered Design and Engineering, University of Washington, Seattle, Washington, USA
| | - Robin Marsh
- Department of Human Centered Design and Engineering, University of Washington, Seattle, Washington, USA
| | - Shireen Saini
- Department of Human Centered Design and Engineering, University of Washington, Seattle, Washington, USA
| | - Maya G Sardesai
- Department of Otolaryngology-Head and Neck Surgery, University of Washington, Seattle, Washington, USA
| | - Edward M Weaver
- Department of Otolaryngology-Head and Neck Surgery, University of Washington, Seattle, Washington, USA
| | - Emily F Boss
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University, Baltimore, Maryland, USA
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Matrosic CK, Dess K, Boike T, Dominello M, Dryden D, Fraser C, Grubb M, Hayman J, Jarema D, Marsh R, Paximadis P, Torolski K, Wilson M, Jolly S, Matuszak M. Knowledge-Based Quality Assurance and Model Maintenance in Lung Cancer Radiation Therapy in a Statewide Quality Consortium of Academic and Community Practice Centers. Pract Radiat Oncol 2023; 13:e200-e208. [PMID: 36526245 DOI: 10.1016/j.prro.2022.11.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 10/19/2022] [Accepted: 11/11/2022] [Indexed: 12/15/2022]
Abstract
PURPOSE Locally advanced lung cancer (LALC) treatment planning is often complex due to challenging tradeoffs related to large targets near organs at risk, making the judgment of plan quality difficult. The purpose of this work was to update and maintain a multi-institutional knowledge-based planning (KBP) model developed by a statewide consortium of academic and community practices for use as a plan quality assurance (QA) tool. METHODS AND MATERIALS Sixty LALC volumetric-modulated arc therapy plans from 2021 were collected from 24 institutions. Plan quality was scored, with high-quality clinical (HQC) plans selected to update a KBP model originally developed in 2017. The model was validated via automated KBP planning, with 20 cases excluded from the model. Differences in dose-volume histogram metrics in the clinical plans, 2017 KBP model plans, and 2022 KBP model plans were compared. Twenty recent clinical cases not meeting consortium quality metrics were replanned with the 2022 model to investigate potential plan quality improvements. RESULTS Forty-seven plans were included in the final KBP model. Compared with the clinical plans, the 2022 model validation plans improved 60%, 65%, and 65% of the lung V20Gy, mean heart dose, and spinal canal D0.03cc metrics, respectively. The 2022 model showed improvements from the 2017 model in hot spot management at the cost of greater lung doses. Of the 20 recent cases not meeting quality metrics, 40% of the KBP model-replanned cases resulted in acceptable plans, suggesting potential clinical plan improvements. CONCLUSIONS A multi-institutional KBP model was updated using plans from a statewide consortium. Multidisciplinary plan review resulted in HQC model training plans and model validation resulted in acceptable quality plans. The model proved to be effective at identifying potential plan quality improvements. Work is ongoing to develop web-based training plan review tools and vendor-agnostic platforms to provide the model as a QA tool statewide.
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Affiliation(s)
- Charles K Matrosic
- Medical School, Radiation Oncology, University of Michigan, Ann Arbor, Michigan.
| | - Kathryn Dess
- Medical School, Radiation Oncology, University of Michigan, Ann Arbor, Michigan
| | | | - Michael Dominello
- Barbara Ann Karmanos Cancer Institute, Wayne State University, Detroit, Michigan
| | | | | | - Margaret Grubb
- Medical School, Radiation Oncology, University of Michigan, Ann Arbor, Michigan
| | - James Hayman
- Medical School, Radiation Oncology, University of Michigan, Ann Arbor, Michigan
| | - David Jarema
- Medical School, Radiation Oncology, University of Michigan, Ann Arbor, Michigan
| | - Robin Marsh
- Medical School, Radiation Oncology, University of Michigan, Ann Arbor, Michigan
| | | | - Kelly Torolski
- Medical School, Radiation Oncology, University of Michigan, Ann Arbor, Michigan
| | | | - Shruti Jolly
- Medical School, Radiation Oncology, University of Michigan, Ann Arbor, Michigan
| | - Martha Matuszak
- Medical School, Radiation Oncology, University of Michigan, Ann Arbor, Michigan
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Ikeda AK, McShay C, Marsh R, Saini S, Sardesai M, Boss EF, Weaver EM. Barriers and communication behaviors impacting referral to sleep surgery: qualitative patient perspectives. J Clin Sleep Med 2023; 19:111-117. [PMID: 36591793 PMCID: PMC9806776 DOI: 10.5664/jcsm.10260] [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: 03/15/2022] [Revised: 08/19/2022] [Accepted: 08/23/2022] [Indexed: 02/01/2023]
Abstract
STUDY OBJECTIVES Physician-patient interactions influence the immediate encounter and leave lasting impressions for future health care encounters. We aimed to understand patient experiences and decision-making for considering sleep surgery, in terms of barriers and communication behaviors that facilitate or hinder referral for consideration of sleep surgery management of obstructive sleep apnea (OSA) when continuous positive airway pressure (CPAP) therapy has failed. METHODS We employed qualitative methods, using semistructured interviews of adults with OSA who presented for sleep surgery consultation after unsatisfactory therapy with CPAP. Open-ended questions traced symptoms and progression of sleep apnea burden, trials of noninvasive OSA therapies, outcomes, and patient expectations and concerns. The interviews were audio-recorded, transcribed, and analyzed using content analysis to identify themes. RESULTS Ten adult patients with OSA were enrolled March through April 2021 and reached predominant thematic saturation. Barriers to sleep surgery consultation included: (1) delays in OSA diagnosis due to limited OSA awareness among patients or primary providers and patients' perceived inconvenience of sleep testing, (2) patients faulted for slow progress, (3) patient-reported lack of urgency by providers in troubleshooting noninvasive management options, (4) scheduling delays and waitlists, and (5) cost. Patients were receptive to noninvasive treatment options, but inadequate improvement led to frustration after multiple encounters. Patients appreciated empathetic providers who shared information through transparent and understandable explanations and who presented multiple treatment options. CONCLUSIONS Experiences of patients with OSA highlight the need for shared decision-making through improved communication of unresolved concerns and alternative management options, including timely referral for sleep surgery consultation when indicated. CITATION Ikeda AK, McShay C, Marsh R, et al. Barriers and communication behaviors impacting referral to sleep surgery: qualitative patient perspectives. J Clin Sleep Med. 2023;19(1):111-117.
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Affiliation(s)
- Allison K. Ikeda
- University of Washington, Department of Otolaryngology–Head and Neck Surgery, Seattle, Washington
| | - Crystina McShay
- University of Washington, Department of Human Centered Design and Engineering, Seattle, Washington
| | - Robin Marsh
- University of Washington, Department of Human Centered Design and Engineering, Seattle, Washington
| | - Shireen Saini
- University of Washington, Department of Human Centered Design and Engineering, Seattle, Washington
| | - Maya Sardesai
- University of Washington, Department of Otolaryngology–Head and Neck Surgery, Seattle, Washington
| | - Emily F. Boss
- Johns Hopkins University, Department of Otolaryngology–Head and Neck Surgery, Baltimore, Maryland
| | - Edward M. Weaver
- University of Washington, Department of Otolaryngology–Head and Neck Surgery, Seattle, Washington
- Seattle Veterans Affairs Medical Center, Surgery Service, Seattle, Washington
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Marsh R, Hanson L, Ng C, Mitchell-Whyte M, Dellschaft N, Hoad C, Marciani L, Gowland P, Spiller R, Major G, Smyth A, Rivett D, van der Gast C. 565 Relationships between tezacaftor/ivacaftor administration, gut microbiota composition, and intestinal function in cystic fibrosis. J Cyst Fibros 2022. [DOI: 10.1016/s1569-1993(22)01255-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Måren IE, Wiig H, McNeal K, Wang S, Zu S, Cao R, Fürst K, Marsh R. Diversified Farming Systems: Impacts and Adaptive Responses to the COVID-19 Pandemic in the United States, Norway and China. Front Sustain Food Syst 2022. [DOI: 10.3389/fsufs.2022.887707] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
The COVID-19 pandemic fully exposed the vulnerability of the global agri-food system to shocks and stresses, highlighting the need for transformation and action to make it more resilient and inclusive. This paper offers a unique insight into the global nature of the COVID-19 pandemic by examining impacts and responses in the agri-food sector within three very distinct contexts, namely the United States, Norway, and China. Focusing on small, diversified farms, the study builds on prior research with the same farmers and support organizations from an on-going collaboration. Firstly, we conducted a short review of policy adaptations to understand how governments, the private sector, non-profit organizations, and communities “stepped up” to provide emergency relief, specialized training, and recovery support for farmers, support that was instrumental in preventing more devastating impacts in all three countries. Secondly, drawing from in-depth interviews with farmers (23) and government and non-governmental support organizations (19), we mapped the vulnerability and resiliency of selected farmers to shocks that severely disrupted traditional supply chains during the COVID-19 pandemic. Data were collected on both the negative and positive impacts of the pandemic to farmer inputs, including labor, operations, and markets, how these changed from the initial lockdowns in early 2020 and through 2021, and on farmer adaptive responses to these impacts. In some contexts, innovation and adaptive responses counteracted negative impacts. We saw diversifying markets, catering to consumer safety concerns, switching to direct and e-markets, hiring in more labor or relying on family labor, and switching to high demand crops and products as the most prominent adaptive responses. Farmers who lacked access to information and government programs, in large part because of language, technology and institutional barriers, missed out on pandemic related opportunities and suffered the most. As we enter the post-pandemic new normal it is important to take stock of lessons learned, and to continue to support those initiatives and innovations that were pivotal not only for weathering the storm, but for building a more inclusive and resilient agri-food system in the long-run.
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Shakoory B, Geerlinks A, Wilejto M, Kernan K, Demirkaya E, Ravelli A, Sinha R, Goldbach-Mansky R, De Benedetti F, Marsh R, Canna S. POS0339 POINTS TO CONSIDER AT THE EARLIEST STAGES OF THE DIAGNOSIS AND MANAGEMENT OF HEMOPHAGOCYTIC LYMPHOHISTIOCYTOSIS/MACROPHAGE ACTIVATION SYNDROME (HLH/MAS). Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.5193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BackgroundHemophagocytic Lymphohistiocytosis (HLH) and Macrophage Activation Syndrome (MAS) are life-threatening systemic hyperinflammatory syndromes that occur in many contexts and are often called by many names. They nevertheless can progress rapidly, and early identification and management are critical for preventing organ failure and mortality.ObjectivesThe purpose of this effort was to develop a series of ‘points to consider’ to assist clinicians at the earliest stages of evaluation and diagnosis, management, and monitoring of patients with HLH/MAS in order to improve patient outcomes.MethodsA working group of adult and pediatric rheumatologists (14), hematologist/oncologists (4), immunologists (2), infectious disease specialists (2), intensivists (3), allied health care professionals (1), and patients/parents (2) formulated relevant research questions for a systematic literature review (SLR). We then used the SLR results, Delphi questionnaires, and consensus methodology to devise and refine overarching and specific ‘points to consider’ statements.ResultsThe group arrived at six overarching statements and 24 specific points-to-consider relevant to early decision-making in diagnostics, initial management, and monitoring of HLH/MAS. Major themes included the a) need for prompt recognition, evaluation, and management of underlying triggers and conditions, b) multi-disciplinary/expert input, and c) early, tailored intervention with the goals of halting disease progression and preventing life- and organ-threatening immunopathologyConclusionThese 2022 EULAR/ACR Points to Consider provide guidance on the initial evaluation, management, and monitoring of patients during the initial consideration of HLH/MAS.Disclosure of InterestsBita Shakoory: None declared, Ashley Geerlinks: None declared, Marta Wilejto: None declared, Kate Kernan: None declared, Erkan Demirkaya: None declared, Angelo Ravelli: None declared, Rashmi Sinha: None declared, Raphaela goldbach-mansky Grant/research support from: SOBI, Novartis, Regneneron, IFM, Lilly, Pfizer, Fabrizio De Benedetti Consultant of: abbvie, sobi, novimmune, novartis, roche, sanofi, Grant/research support from: sobi novimmune novartis roche sanofi, Rebecca Marsh: None declared, Scott Canna Consultant of: Simcha Therapeutics, Grant/research support from: Immvention therapeutics, AB2Bio Ltd, Novartis
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12
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Marsh R, Hanson L, Ng C, Mitchell-Whyte M, Dellschaft N, Hoad C, Marciani L, Gowland P, Spiller R, Major G, Smyth A, Rivett D, van der Gast C. P116 Effects of SymkeviTM(tezacaftor/ivacaftor) on the lung and gut microbiota in cystic fibrosis. J Cyst Fibros 2022. [DOI: 10.1016/s1569-1993(22)00449-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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13
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Ikeda A, McShay C, Marsh R, Saini S, Weaver E. 0794 Understanding Barriers and Communication Behaviors Impacting Referral to Sleep Surgery: Qualitative Patient Perspectives. Sleep 2022. [DOI: 10.1093/sleep/zsac079.790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Introduction
Shared decision-making is a process when patients, families, and clinicians work together to make optimal, personalized medical choices in the face of more than one reasonable treatment option. These interactions can influence the joint decision and may have lasting impressions for future healthcare encounters. Considering the American Academy of Sleep Medicine’s recent clinical practice guideline on the referral of adults with obstructive sleep apnea (OSA) for surgical consultation, we aimed to understand patient experiences, in terms of barriers and communication behaviors in the referral process to sleep surgery consultation.
Methods
We performed a qualitative study consisting of in-depth semi-structured virtual interviews with adult patients (aged ≥18 years) with OSA (apnea-hypopnea index ≥5 events per hour of sleep, scored by AASM-accredited standards) and who were recommended for sleep surgery at a tertiary Sleep Surgery Clinic. Open ended questions focused on patient experiences during healthcare encounters from diagnosis, trials with noninvasive management options and ultimate referral to sleep surgery. The interviews were audio-recorded, transcribed, and analyzed using content analysis to identify themes.
Results
Ten adult patients with OSA who were evaluated in sleep surgery clinic were approached and enrolled from March through April 2021. Barriers to sleep surgery clinic included delays in OSA diagnosis due to limited OSA awareness and perceived inconvenience of sleep study, providers faulting patient for persistent sleep symptoms, patient-reported lack of urgency by providers in troubleshooting noninvasive management options, scheduling delays and waitlists, and cost. Patients were open to trialing noninvasive treatment options, though opportunities for reevaluation and shared decision-making may address unmet needs, as inadequate improvements led to frustration after multiple encounters. Patients appreciated providers who were empathetic and provided information sharing, in terms of transparent and understandable explanations.
Conclusion
This study focused on experiences of patients with OSA and barriers faced to reach sleep surgery consultation. Improved communication structure to discuss unresolved concerns and remaining management options, as well as vetted resources, would set the foundation for effective shared decision-making and timely referral for sleep surgery consultation.
Support (If Any)
Academy of Otolaryngology Head and Neck Surgery Resident Research Centralized Otolaryngology Research Efforts (CORE). NIH T32 DC000018.
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Jagsi R, Griffith KA, Moran JM, Matuszak MM, Marsh R, Grubb M, Abu-Isa E, Dilworth JT, Dominello MM, Heimburger D, Lack D, Walker EM, Hayman JA, Vicini F, Pierce LJ. Comparative Effectiveness Analysis of 3D-Conformal Radiation Therapy Versus Intensity Modulated Radiation Therapy (IMRT) in a Prospective Multicenter Cohort of Patients With Breast Cancer. Int J Radiat Oncol Biol Phys 2022; 112:643-653. [PMID: 34634437 DOI: 10.1016/j.ijrobp.2021.09.053] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 09/22/2021] [Accepted: 09/30/2021] [Indexed: 11/24/2022]
Abstract
PURPOSE Simple intensity modulation of radiation therapy reduces acute toxicity compared with 2-dimensional techniques in adjuvant breast cancer treatment, but it remains unknown whether more complex or inverse-planned intensity modulated radiation therapy (IMRT) offers an advantage over forward-planned, 3-dimensional conformal radiation therapy (3DCRT). METHODS AND MATERIALS Using prospective data regarding patients receiving adjuvant whole breast radiation therapy without nodal irradiation at 23 institutions from 2011 to 2018, we compared the incidence of acute toxicity (moderate-severe pain or moist desquamation) in patients receiving 3DCRT versus IMRT (either inverse planned or, if forward-planned, using ≥5 segments per gantry angle). We evaluated associations between technique and toxicity using multivariable models with inverse-probability-of-treatment weighting, adjusting for treatment facility as a random effect. RESULTS Of 1185 patients treated with 3DCRT and conventional fractionation, 650 (54.9%) experienced acute toxicity; of 774 treated with highly segmented forward-planned IMRT, 458 (59.2%) did; and of 580 treated with inverse-planned IMRT, 245 (42.2%) did. Of 1296 patients treated with hypofractionation and 3DCRT, 432 (33.3%) experienced acute toxicity; of 709 treated with highly segmented forward-planned IMRT, 227 (32.0%) did; and of 623 treated with inverse-planned IMRT, 164 (26.3%) did. On multivariable analysis with inverse-probability-of-treatment weighting, the odds ratio for acute toxicity after inverse-planned IMRT versus 3DCRT was 0.64 (95% confidence interval, 0.45-0.91) with conventional fractionation and 0.41 (95% confidence interval, 0.26-0.65) with hypofractionation. CONCLUSIONS This large, prospective, multicenter comparative effectiveness study found a significant benefit from inverse-planned IMRT compared with 3DCRT in reducing acute toxicity of breast radiation therapy. Future research should identify the dosimetric differences that mediate this association and evaluate cost-effectiveness.
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Affiliation(s)
- Reshma Jagsi
- Department of Radiation Oncology, Medical School, University of Michigan, Ann Arbor, Michigan.
| | - Kent A Griffith
- Department of Biostatistics, University of Michigan, Ann Arbor, Michigan
| | - Jean M Moran
- Department of Radiation Oncology, Medical School, University of Michigan, Ann Arbor, Michigan
| | - Martha M Matuszak
- Department of Radiation Oncology, Medical School, University of Michigan, Ann Arbor, Michigan
| | - Robin Marsh
- Department of Radiation Oncology, Medical School, University of Michigan, Ann Arbor, Michigan
| | - Margaret Grubb
- Department of Radiation Oncology, Medical School, University of Michigan, Ann Arbor, Michigan
| | - Eyad Abu-Isa
- Department of Radiation Oncology, Medical School, University of Michigan, Ann Arbor, Michigan; Department of Radiation Oncology, Providence Ascension, Novi, Michigan
| | - Joshua T Dilworth
- Department of Radiation Oncology, Beaumont Health, Royal Oak, Michigan
| | - Michael M Dominello
- Department of Radiation Oncology, Karmanos Cancer Center, Wayne State University, Detroit, Michigan
| | - David Heimburger
- Department of Radiation Oncology, Munson Healthcare, Traverse City, Michigan
| | - Danielle Lack
- Department of Radiation Oncology, Beaumont Health, Royal Oak, Michigan
| | - Eleanor M Walker
- Department of Radiation Oncology, Henry Ford Health System, Detroit, Michigan
| | - James A Hayman
- Department of Radiation Oncology, Medical School, University of Michigan, Ann Arbor, Michigan
| | - Frank Vicini
- Department of Radiation Oncology, GenesisCare, Farmington Hills, Michigan
| | - Lori J Pierce
- Department of Radiation Oncology, Medical School, University of Michigan, Ann Arbor, Michigan
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Moncion A, Wilson M, Ma R, Marsh R, Burmeister J, Dryden D, Lack D, Grubb M, Mayville A, Jursinic P, Dess K, Kamp J, Young K, Dilworth JT, Kestin L, Jagsi R, Mietzel M, Vicini F, Pierce LJ, Moran JM. Evaluation of Dose Accuracy in the Near-Surface Region for Whole Breast Irradiation Techniques in a Multi-Institutional Consortium. Pract Radiat Oncol 2022; 12:e317-e328. [DOI: 10.1016/j.prro.2022.01.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 11/02/2021] [Accepted: 01/10/2022] [Indexed: 11/29/2022]
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16
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Marsh R, Gavillet H, Hanson L, Ng C, Major G, Smyth A, Rivett D, van der Gast C. 465: Intestinal function and transit relates to microbial dysbiosis in the CF gut. J Cyst Fibros 2021. [DOI: 10.1016/s1569-1993(21)01889-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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17
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Speers C, Murthy VL, Walker EM, Glide-Hurst CK, Marsh R, Tang M, Morris EL, Schipper MJ, Weinberg RL, Gits HC, Hayman J, Feng M, Balter J, Moran J, Jagsi R, Pierce LJ. Cardiac Magnetic Resonance Imaging and Blood Biomarkers for Evaluation of Radiation-Induced Cardiotoxicity in Patients With Breast Cancer: Results of a Phase 2 Clinical Trial. Int J Radiat Oncol Biol Phys 2021; 112:417-425. [PMID: 34509552 DOI: 10.1016/j.ijrobp.2021.08.039] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Revised: 08/23/2021] [Accepted: 08/27/2021] [Indexed: 12/25/2022]
Abstract
PURPOSE Radiation therapy (RT) can increase the risk of cardiac events in patients with breast cancer (BC), but biomarkers predicting risk for developing RT-induced cardiac disease are currently lacking. We report results from a prospective clinical trial evaluating early magnetic resonance imaging (MRI) and serum biomarker changes as predictors of cardiac injury and risk of subsequent cardiac events after RT for left-sided disease. METHODS Women with node-negative and node-positive (N-/+) left-sided BC were enrolled on 2 institutional review board (IRB)-approved protocols at 2 institutions. MRI was conducted pretreatment (within 1 week of starting radiation), at the end of treatment (last day of treatment ±1 week), and 3 months after the last day of treatment (±2 weeks) to quantify left and right ventricular volumes and function, myocardial fibrosis, and edema. Perfusion changes during regadenoson stress perfusion were also assessed on a subset of patients (n = 28). Serum was collected at the same time points. Whole heart and cardiac substructures were contoured using CT and MRI. Models were constructed using baseline cardiac and clinical risk factors. Associations between MRI-measured changes and dose were evaluated. RESULTS Among 51 women enrolled, mean heart dose ranged from 0.80 to 4.7 Gy and mean left ventricular (LV) dose from 1.1 to 8.2 Gy, with mean heart dose 2.0 Gy. T1 time, a marker of fibrosis, and right ventricular (RV) ejection fraction (EF) significantly changed with treatment; these were not dose dependent. T2 (marker of edema) and LV EF did not significantly change. No risk factors were associated with baseline global perfusion. Prior receipt of doxorubicin was marginally associated with decreased myocardial perfusion after RT (P = .059), and mean MHD was not associated with perfusion changes. A significant correlation between baseline IL-6 and mean heart dose (MHD) at the end of RT (ρ 0.44, P = .007) and a strong trend between troponin I and MHD at 3 months post-treatment (ρ 0.33, P = .07) were observed. No other significant correlations were identified. CONCLUSIONS In this prospective study of women with left-sided breast cancer treated with contemporary treatment planning, cardiac radiation doses were very low relative to historical doses reported by Darby et al. Although we observed significant changes in T1 and RV EF shortly after RT, these changes were not correlated with whole heart or substructure doses. Serum biomarker analysis of cardiac injury demonstrates an interesting trend between markers and MHD that warrants further investigation.
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Affiliation(s)
- Corey Speers
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan; Comprehensive Cancer Center, University of Michigan, Ann Arbor, Michigan
| | - Venkatesh L Murthy
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan; Frankel Cardiovascular Center, University of Michigan, Ann Arbor, Michigan
| | - Eleanor M Walker
- Department of Radiation Oncology, Henry Ford Cancer Institute, Detroit, Michigan
| | - Carri K Glide-Hurst
- Department of Human Oncology, School of Medicine and Public Heath, University of Wisconsin-Madison, Madison, Wisconsin
| | - Robin Marsh
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan
| | - Ming Tang
- Department of Biostatistics, University of Michigan, Ann Arbor, Michigan
| | - Emily L Morris
- Department of Biostatistics, University of Michigan, Ann Arbor, Michigan
| | - Matthew J Schipper
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan; Department of Biostatistics, University of Michigan, Ann Arbor, Michigan
| | - Richard L Weinberg
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan; Frankel Cardiovascular Center, University of Michigan, Ann Arbor, Michigan
| | - Hunter C Gits
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota
| | - James Hayman
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan; Comprehensive Cancer Center, University of Michigan, Ann Arbor, Michigan
| | - Mary Feng
- Department of Radiation Oncology, University of California San Francisco, San Francisco, California
| | - James Balter
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan
| | - Jean Moran
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan
| | - Reshma Jagsi
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan; Comprehensive Cancer Center, University of Michigan, Ann Arbor, Michigan
| | - Lori J Pierce
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan; Comprehensive Cancer Center, University of Michigan, Ann Arbor, Michigan.
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Ikeda A, Marsh R, McShay C, Saini S, Sardesai M, Weaver E, Boss E. 452 Patient Factors and Preferences in Decision for Sleep Surgery: A Qualitative Analysis. Sleep 2021. [DOI: 10.1093/sleep/zsab072.451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Introduction
Patients with obstructive sleep apnea (OSA) are offered many treatment options spanning the spectrum of lifestyle modification, device therapy, and surgery. Sleep surgery, while often effective, results in moderate morbidity and has variable effectiveness on OSA improvement. Little is known about what patients consider when choosing treatment. We aim to identify factors that influenced the decision for sleep surgery among adults with OSA.
Methods
We conducted semi-structured virtual interviews with patients (≥18 years) with OSA (apnea-hypopnea index ≥5 events per hour of sleep) who underwent sleep surgery at a tertiary academic center, querying patients about factors in their decision for OSA treatment. Interviews were audio-recorded, transcribed, and analyzed for thematic content. We anticipate enrolling 10–18 total participants based on previously reported sample size in specialty groups for thematic saturation in specialty groups (ie, when no new concepts or factors emerge from interviews). Here we report pilot qualitative analysis results.
Results
Of nine eligible patients, eight enrolled (mean +/- standard deviation age 45.8 +/- 13.4 years, 2 female/6 males). Four patients underwent nasal surgery only, two patients underwent staged procedures, one underwent pharyngeal surgery only, and the last underwent nasal surgery with tori removal. Patients reported decision making duration of days to years for scheduling surgery. Reasons for pursuing sleep surgery included fatigue, quality of life, work performance, and safety. Overarching thematic domains related to decision for surgery were (1) major concerns, (2) external factors influencing decision, and (3) retrospective satisfaction/regret with decision. Major concerns involved factors beyond surgeon’s control, such as anesthesia and postoperative pain management, not surgery itself. Family and friends were reported to be highly influential in the process, both in favor and against surgery. Social media features and celebrity patients with OSA heightened awareness of sleep surgery and set preconceived expectations. Patients were mostly satisfied with outcomes, despite unanticipated acute recovery challenges.
Conclusion
This pilot qualitative analysis identifies factors influencing patients’ OSA treatment decisions. Understanding patients’ major concerns and sources of information may help to guide physician counseling, set realistic expectations, offer peri-operative support, and better engage parents in shared decision-making for sleep surgery.
Support (if any)
None.
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Affiliation(s)
- Allison Ikeda
- Department of Otolaryngology-Head and Neck Surgery, University of Washington
| | - Robin Marsh
- Human Centered Design and Engineering, University of Washington
| | - Crystina McShay
- Human Centered Design and Engineering, University of Washington
| | - Shireen Saini
- Human Centered Design and Engineering, University of Washington
| | - Maya Sardesai
- Department of Otolaryngology-Head and Neck Surgery, University of Washington
| | - Edward Weaver
- Department of Otolaryngology-Head and Neck Surgery, University of Washington
| | - Emily Boss
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University
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Seshadri P, Chiang S, Chaturvedi V, Marsh R, Le T. M226 STAT2 DEFICIENCY: A NOVEL MUTATION AND PHENOTYPE. Ann Allergy Asthma Immunol 2020. [DOI: 10.1016/j.anai.2020.08.254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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20
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Marsh R, Pilkington P, Marco E, Rice L. Engaging a wider public health workforce: bringing public health into architecture education. Eur J Public Health 2019. [DOI: 10.1093/eurpub/ckz187.175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Current public health challenges necessitate the closer working of public health with built environment professionals. Despite growing evidence of benefits, there remains little progress in practice. Architects can play a key role in ensuring urban and building design is health promoting, however there is no requirement to teach health by architectural accreditation bodies across Europe.
Objectives
In the United Kingdom in 2010, the Public Health Practitioner in Residence programme (PHPiR) was established to address this situation. Public health professionals are embedded within the Faculty of Environment and Technology at the University of the West of England, and contribute to research, pedagogic programme development, teaching and mentoring. The aim was to embed public health concepts and issues into architecture training, to empower the profession as part of the wider workforce, to improve health and wellbeing when designing buildings and places. The PHPiR was evaluated using the Reach, Effectiveness, Adoption, Implementation, Maintenance (RE-AIM) framework. Data was collected (questionnaires, focus group, semi-structured interviews, programme documentation) on a Masters of Architecture cohort (N = 34) at intervals from 2011-2019 to see if the PHPiR has long lasting effects as students enter practice.
Results
Public health concepts including; inequalities, life course approach, and social capital, became embedded into the architecture curriculum. Projects produced had increased reference to wider health promoting issues and participants thinking shifted from the building itself to who would use the building, suggesting the intervention achieved its aims.
Conclusions
The PHPiR offers a novel approach for built environment professions to better understand public health issues and the relevance to their chosen fields. This model could be applied to other courses and replicated in educational institutions and public health training programmes across Europe.
Key messages
The PHPiR influenced the architecture curriculum, improved architects understanding and public health issues and concepts, and empowered them to create more health promoting environments. Embedding public health professionals into training for other disciplines may be an effective, sustainable method for increasing the wider public health workforce.
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Affiliation(s)
- R Marsh
- Department of Health and Social Sciences, University of the West of England, Bristol, UK
- WHO Collaborating Centre, University of the West of England, Bristol, UK
| | - P Pilkington
- Department of Health and Social Sciences, University of the West of England, Bristol, UK
- WHO Collaborating Centre, University of the West of England, Bristol, UK
| | - E Marco
- Department of Planning and Architecture, University of the West of England, Bristol, UK
| | - L Rice
- WHO Collaborating Centre, University of the West of England, Bristol, UK
- Department of Planning and Architecture, University of the West of England, Bristol, UK
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Speers C, Murthy V, Walker E, Morris E, Glide-Hurst C, Schipper M, Marsh R, Weinberg R, Gits H, Moran J, Hayman J, Feng M, Griffith K, Balter J, Jagsi R, Pierce L. Cardiac MRI for Evaluation of Radiation-Induced Cardiotoxicity in Breast Cancer Patients: A Phase II Clinical Trial. Int J Radiat Oncol Biol Phys 2019. [DOI: 10.1016/j.ijrobp.2019.06.2398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Ali M, Marsh R, Beasant E. 31QUALITY IMPROVEMENT PROJECT TO STANDARDISE THE IMMEDIATE ASSESSMENT OF INPATIENTS WHO FALL WITHIN THE ROYAL GWENT HOSPITAL. Age Ageing 2019. [DOI: 10.1093/ageing/afz055.31] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- M Ali
- Royal Gwent Hospital, Newport, Wales
| | - R Marsh
- Royal Gwent Hospital, Newport, Wales
| | - E Beasant
- Royal Gwent Hospital, Newport, Wales
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Cattrell AD, Srokosz M, Moat BI, Marsh R. Seasonal intensification and trends of rogue wave events on the US western seaboard. Sci Rep 2019; 9:4461. [PMID: 30872716 PMCID: PMC6418161 DOI: 10.1038/s41598-019-41099-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2018] [Accepted: 02/11/2019] [Indexed: 11/16/2022] Open
Abstract
Studies of changes in wave climate typically consider trends in sea state statistics, such as the significant wave height. However, the temporal variability of individual rogue waves, which pose a hazard to users of the sea and coastal environment has not been investigated. We use time series of continuous surface elevation over 124–270 months (spanning 1994–2016), from 15 wave buoys along the US western seaboard, to investigate regional trends in significant wave height and individual rogue waves. We find high spatial variability in trends in significant wave height and rogue waves across the region. Rogue wave occurrence displays a mostly decreasing trend, but the relative height – or severity – of the waves is increasing. We also identify seasonal intensification in rogue waves with increased rogue wave occurrence, of higher severity, in the winter than in the summer. Therefore, the common practice of stating a single occurrence likelihood for an ocean basin is not valid. In addition, the buoy data show that the magnitude and significance of trends in significant wave height increases towards higher percentiles, supporting previous findings.
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Affiliation(s)
- A D Cattrell
- Fluid Structure Interactions, Engineering and the Environment, Boldrewood Innovation Campus, University of Southampton, Southampton, SO17 1BJ, UK.
| | - M Srokosz
- National Oceanography Centre, University of Southampton Waterfront Campus, European Way, Southampton, SO14 3ZH, UK
| | - B I Moat
- National Oceanography Centre, University of Southampton Waterfront Campus, European Way, Southampton, SO14 3ZH, UK
| | - R Marsh
- Ocean and Earth Science, University of Southampton, National Oceanography Centre Southampton, Southampton, SO14 3ZH, UK
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DiCarlo J, Epstein K, Marsh R, Måren I. Post-disaster agricultural transitions in Nepal. Ambio 2018; 47:794-805. [PMID: 29460256 PMCID: PMC6188971 DOI: 10.1007/s13280-018-1021-3] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/09/2017] [Revised: 01/19/2018] [Accepted: 01/23/2018] [Indexed: 06/08/2023]
Abstract
In Spring 2015, a series of earthquakes and aftershocks struck Nepal. The earthquakes caused significant changes in labor and land availability, cash income needs, and land quality. We examine how these post-earthquake impacts converged with ongoing agricultural shifts. Earthquake-related socio-economic and landscape changes specifically motivate the adoption of cardamom, Amomum subulatum, a high-value ecologically beneficial, and low labor commercial crop. We investigate reasons for the increased interest in cardamom post-earthquake, and challenges associated with it. We find that adopting cardamom serves as an important post-disaster adaptation. However, more broadly, unevenly distributed interventions coupled with the high capital costs of agricultural transition exacerbate social differentiation in communities after the disaster. Adoption is often limited to economically better off smallholder farmers. This paper extends previous research on disasters and smallholder farming by highlighting the specific potential of disasters to accelerate agricultural transitions and resulting inequality from the changes.
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Affiliation(s)
- Jessica DiCarlo
- Department of Geography, University of Colorado Boulder, 110 Guggenheim Building, Boulder, CO 80301 USA
| | - Kathleen Epstein
- Department of Earth Sciences, Montana State University, 221 Traphagen, Bozeman, MT 59718-4001 USA
| | - Robin Marsh
- Institute for Study of Societal Issues, University of California Berkeley, 2428 Bowditch Street, Berkeley, CA 94704 USA
| | - Inger Måren
- Department of Biological Sciences, University of Bergen, Thormøhlensgt 53A, 5007 Bergen, Norway
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Matuszak M, Grubb M, Marsh R, Masi K, Lack D, Dryden D, Wilson M, Jarema D, Tatro D, Short E, Bichay T, Moran J, Paximadis P, Dominello M, Radawski J, Kestin L, Pierce L, Jolly S, Hayman J, Boike T. Knowledge Based Quality Assurance and Improvement in Locally Advanced Lung Cancer Radiation Therapy in a Statewide Consortium of Academic and Community Practice Centers. Int J Radiat Oncol Biol Phys 2018. [DOI: 10.1016/j.ijrobp.2018.07.136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Jagsi R, Griffith KA, Moran JM, Ficaro E, Marsh R, Dess RT, Chung E, Liss AL, Hayman JA, Mayo CS, Flaherty K, Corbett J, Pierce L. A Randomized Comparison of Radiation Therapy Techniques in the Management of Node-Positive Breast Cancer: Primary Outcomes Analysis. Int J Radiat Oncol Biol Phys 2018; 101:1149-1158. [PMID: 30012527 DOI: 10.1016/j.ijrobp.2018.04.075] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Revised: 04/23/2018] [Accepted: 04/25/2018] [Indexed: 11/19/2022]
Abstract
PURPOSE Although inverse-planned intensity modulated radiotherapy (IMRT) and deep inspiration breath hold (DIBH) may allow for more conformal dose distributions, it is unknown whether using these technologies reduces cardiac or pulmonary toxicity of breast radiotherapy. METHODS AND MATERIALS A randomized controlled trial compared IMRT-DIBH versus standard, free-breathing, forward-planned, three-dimensional conformal radiotherapy in patients with left-sided, node-positive breast cancer in whom the internal mammary nodal region was targeted. Endpoints included dosimetric parameters and changes in pulmonary and cardiac perfusion and function, measured by single photon emission computed tomography (SPECT) scans and pulmonary function testing performed at baseline and 1 year post treatment. RESULTS Of 62 patients randomized, 54 who completed all follow-up procedures were analyzed. Mean doses to the ipsilateral lung, left ventricle, whole heart, and left anterior descending coronary artery were lower with IMRT-DIBH; the percent of left ventricle receiving ≥5 Gy averaged 15.8% with standard radiotherapy and 5.6% with IMRT-DIBH (P < .001). SPECT revealed no differences in perfusion defects in the left anterior descending coronary artery territory, the study's primary endpoint, but did reveal statistically significant differences (P = .02) in left ventricular ejection fraction (LVEF), a secondary endpoint. No differences were found for lung perfusion or function. CONCLUSION The small but statistically significant benefit in preservation of cardiac LVEF observed here should motivate future studies that include LVEF as a potentially meaningful endpoint. Future studies should disaggregate the impact of IMRT from that of DIBH. Clinical practice should recognize the importance of minimizing cardiac dose, even when already low in comparison to historical levels.
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Affiliation(s)
- Reshma Jagsi
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan.
| | - Kent A Griffith
- Center for Cancer Biostatistics, University of Michigan School of Public Health, Ann Arbor, Michigan
| | - Jean M Moran
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan
| | - Edward Ficaro
- Department of Radiology, University of Michigan, Ann Arbor, Michigan
| | - Robin Marsh
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan
| | - Robert T Dess
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan
| | - Eugene Chung
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan
| | - Adam L Liss
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan
| | - James A Hayman
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan
| | - Charles S Mayo
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan
| | - Kevin Flaherty
- Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan
| | - James Corbett
- Department of Radiology, University of Michigan, Ann Arbor, Michigan; Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan
| | - Lori Pierce
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan
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Chen A, Ferral H, Alonzo M, Regalado S, Farrell T, Dalag L, Marsh R, Aquisto T. Abstract No. 436 Partial splenic embolization for thrombocytopenia recovery to facilitate chemotherapy. J Vasc Interv Radiol 2018. [DOI: 10.1016/j.jvir.2018.01.481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
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Cox J, Spratt J, Ajith A, Haydar S, Gordon G, Elwell S, Marsh R. Radiology-led lung escalation pathway: a streamlined innovative service expediting the diagnosis of lung cancer. Clin Radiol 2018; 73:320.e9-320.e12. [DOI: 10.1016/j.crad.2017.10.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2017] [Revised: 10/06/2017] [Accepted: 10/12/2017] [Indexed: 11/27/2022]
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Croudace IW, Warwick PE, Marsh R. A Suite of Robust Radioanalytical Techniques for the Determination of Tritium and Other Volatile Radionuclides in Decommissioning Wastes and Environmental Matrices. Fusion Science and Technology 2017. [DOI: 10.1080/15361055.2017.1293450] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- I. W. Croudace
- GAU-Radioanalytical Laboratories, OES, University of Southampton, NOCS, Southampton SO14 3ZH United Kingdom
| | - P. E. Warwick
- GAU-Radioanalytical Laboratories, OES, University of Southampton, NOCS, Southampton SO14 3ZH United Kingdom
| | - R. Marsh
- GAU-Radioanalytical Laboratories, OES, University of Southampton, NOCS, Southampton SO14 3ZH United Kingdom
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Moran JM, Feng M, Benedetti LA, Marsh R, Griffith KA, Matuszak MM, Hess M, McMullen M, Fisher JH, Nurushev T, Grubb M, Gardner S, Nielsen D, Jagsi R, Hayman JA, Pierce LJ. Development of a model web-based system to support a statewide quality consortium in radiation oncology. Pract Radiat Oncol 2016; 7:e205-e213. [PMID: 28196607 DOI: 10.1016/j.prro.2016.10.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2016] [Revised: 09/23/2016] [Accepted: 10/10/2016] [Indexed: 12/25/2022]
Abstract
PURPOSE A database in which patient data are compiled allows analytic opportunities for continuous improvements in treatment quality and comparative effectiveness research. We describe the development of a novel, web-based system that supports the collection of complex radiation treatment planning information from centers that use diverse techniques, software, and hardware for radiation oncology care in a statewide quality collaborative, the Michigan Radiation Oncology Quality Consortium (MROQC). METHODS AND MATERIALS The MROQC database seeks to enable assessment of physician- and patient-reported outcomes and quality improvement as a function of treatment planning and delivery techniques for breast and lung cancer patients. We created tools to collect anonymized data based on all plans. RESULTS The MROQC system representing 24 institutions has been successfully deployed in the state of Michigan. Since 2012, dose-volume histogram and Digital Imaging and Communications in Medicine-radiation therapy plan data and information on simulation, planning, and delivery techniques have been collected. Audits indicated >90% accurate data submission and spurred refinements to data collection methodology. CONCLUSIONS This model web-based system captures detailed, high-quality radiation therapy dosimetry data along with patient- and physician-reported outcomes and clinical data for a radiation therapy collaborative quality initiative. The collaborative nature of the project has been integral to its success. Our methodology can be applied to setting up analogous consortiums and databases.
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Affiliation(s)
- Jean M Moran
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan.
| | - Mary Feng
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan
| | - Lisa A Benedetti
- Department of Radiation Oncology, William Beaumont Hospital, Royal Oak, Michigan
| | - Robin Marsh
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan
| | - Kent A Griffith
- Department of Biostatistics, University of Michigan, Ann Arbor, Michigan
| | - Martha M Matuszak
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan
| | - Michael Hess
- School of Information, University of Michigan, Ann Arbor, Michigan
| | - Matthew McMullen
- Radiation Oncology, St. Joseph Mercy Hospital, Ypsilanti, Michigan
| | - Jennifer H Fisher
- Johnson Family Center for Cancer Care, Mercy Health Partners, Muskegon, Michigan
| | | | - Margaret Grubb
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan
| | - Stephen Gardner
- Radiation Oncology Department, Henry Ford Health System, Detroit, Michigan
| | - Daniel Nielsen
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan
| | - Reshma Jagsi
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan
| | - James A Hayman
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan
| | - Lori J Pierce
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan
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Jagsi R, Griffith K, Moran J, Matuszak M, Feng M, Marsh R, Boike T, Grills I, Gustafson G, Heimburger D, Nurushev T, Radawski J, Walker E, Hayman J, Pierce L. Comparative Effectiveness Analysis of 3DCRT versus Intensity Modulated Radiation Therapy in a Prospective Multicenter Cohort of Breast Cancer Patients. Int J Radiat Oncol Biol Phys 2016. [DOI: 10.1016/j.ijrobp.2016.06.516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Marsh R, Silosky M. SU-G-206-11: The Effect of Table Height On CTDIvol and SSDE in CT Scanning: A Phantom Study. Med Phys 2016. [DOI: 10.1118/1.4956952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Masi K, Ditman M, Marsh R, Dai J, Huberts M, Khadija M, Tatro D, Archer P, Matuszak M. SU-G-TeP4-14: Quality Control of Treatment Planning Using Knowledge-Based Planning Across a System of Radiation Oncology Practices. Med Phys 2016. [DOI: 10.1118/1.4957139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Silosky M, Marsh R. SU-F-I-37: How Fat Distribution and Table Height Affect Estimates of Patient Size in CT Scanning: A Phantom Study. Med Phys 2016. [DOI: 10.1118/1.4955865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Abstract
Introduction In 2011 the National Institute for Health and Care Excellence (NICE) published guidelines suggesting that clinicians offer total hip replacement (THR) to patients with displaced intracapsular hip fractures who could walk independently outside with no aids or one stick, who are not cognitively impaired and are ASA (American Society of Anesthesiologists) grade ≤2. They also stated that best practice is operating within 36 hours of presentation. This audit aimed to determine whether Scarborough Hospital was following these guidelines and compared the results with the national average. Methods Two years of data (January 2012 - December 2013) were collected retrospectively from Scarborough Hospital's hip fracture database on all patients presenting with an intracapsular hip fracture. Data were analysed to determine whether patients who had a THR fulfilled NICE criteria. Furthermore, patients with hemiarthroplasties who were eligible for THRs were identified. Finally, the time to surgery was calculated to examine whether patients receiving THRs waited longer than patients receiving hemiarthroplasties. Results In 2012, 48.6% of all eligible patients received a THR while in 2013 the figure was 55.9%. These percentages are much higher than the national average. However, 36 (53.7%) of the 67 patients who received a THR did not fulfil all the NICE criteria, mainly owing to high ASA grade. The mean time from presentation to theatre for THR was 8 hours and 37 minutes longer for THR patients than for hemiarthroplasty in 2012. This difference was reduced to 2 hours and 12 minutes in 2013. Conclusions Small general hospitals can meet and even exceed the standards regarding treatment strategies for hip factures. However, there is still room for improvement. Departmental training may be useful in achieving this aim. The anaesthetic team should be involved at the earliest opportunity, to help optimise patients preoperatively and determine whether patients listed for THR with higher ASA grades are suitable for this surgery.
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Affiliation(s)
- A Fishlock
- York Teaching Hospital NHS Foundation Trust , UK
| | - C Scarsbrook
- York Teaching Hospital NHS Foundation Trust , UK
| | - R Marsh
- York Teaching Hospital NHS Foundation Trust , UK
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Sulzberger L, Baillie R, Itinteang T, de Jong S, Marsh R, Leadbitter P, Tan S. Serum levels of renin, angiotensin-converting enzyme and angiotensin II in patients treated by surgical excision, propranolol and captopril for problematic proliferating infantile haemangioma. J Plast Reconstr Aesthet Surg 2016; 69:381-6. [DOI: 10.1016/j.bjps.2015.10.020] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2015] [Revised: 10/08/2015] [Accepted: 10/15/2015] [Indexed: 11/25/2022]
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Liss A, Griffith K, Moran J, Marsh R, Jagsi R, Koelling T, Pierce L. Association Between Ischemic Cardiac Events and Treatment of the Internal Mammary Nodal Region Using Contemporary RT Planning. Int J Radiat Oncol Biol Phys 2015. [DOI: 10.1016/j.ijrobp.2015.07.606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Moran J, Feng M, Marsh R, Griffith K, Benedetti L, Grills I, Walker E, Fraser C, Raymond S, Blauser J, Gielda B, Vicini F, Wilson M, Dryden D, Parent K, Ewald A, Matuszak M, Jagsi R, Grubb M, Pierce L. Impact of Cardiac Sparing Techniques on Cardiac Doses for Left Breast Cancer Patients: A Multicenter Analysis. Int J Radiat Oncol Biol Phys 2015. [DOI: 10.1016/j.ijrobp.2015.07.609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Foy J, Marsh R, Owen D, Matuszak M. SU-E-T-97: An Analysis of Knowledge Based Planning for Stereotactic Body Radiation Therapy of the Spine. Med Phys 2015. [DOI: 10.1118/1.4924458] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Silosky M, Lowry P, Smith J, Marsh R. TH-AB-201-07: Reducing Fluoroscopy Operator Dose by Placing Lead Aprons On the Patient: Does It Live Up to the Hype? Med Phys 2015. [DOI: 10.1118/1.4926191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Steiner F, Evans J, Marsh R, Rigby P, James S, Sutherland K, Wickens R, Nedev N, Kelly B, Tan S. Mouth opening and trismus in patients undergoing curative treatment for head and neck cancer. Int J Oral Maxillofac Surg 2015; 44:292-6. [DOI: 10.1016/j.ijom.2014.12.009] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2014] [Revised: 11/03/2014] [Accepted: 12/10/2014] [Indexed: 11/16/2022]
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Silosky M, Marsh R. SU-C-12A-07: Effect of Vertical Position On Dose Reduction Using X-Care. Med Phys 2014. [DOI: 10.1118/1.4887856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Stenmark MH, Conlon AS, Johnson S, Daignault S, Litzenberg D, Marsh R, Ritter T, Vance S, Kazzi N, Feng FY, Sandler H, Sanda MG, Hamstra DA. Dose to the inferior rectum is strongly associated with patient reported bowel quality of life after radiation therapy for prostate cancer. Radiother Oncol 2014; 110:291-7. [DOI: 10.1016/j.radonc.2014.01.007] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2013] [Revised: 12/17/2013] [Accepted: 01/05/2014] [Indexed: 11/24/2022]
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He BJ, Nolte G, Nagata K, Takano D, Yamazaki T, Fujimaki Y, Maeda T, Satoh Y, Heckers S, George MS, Lopes da Silva F, de Munck JC, Van Houdt PJ, Verdaasdonk RM, Ossenblok P, Mullinger K, Bowtell R, Bagshaw AP, Keeser D, Karch S, Segmiller F, Hantschk I, Berman A, Padberg F, Pogarell O, Scharnowski F, Karch S, Hümmer S, Keeser D, Paolini M, Kirsch V, Koller G, Rauchmann B, Kupka M, Blautzik J, Pogarell O, Razavi N, Jann K, Koenig T, Kottlow M, Hauf M, Strik W, Dierks T, Gotman J, Vulliemoz S, Lu Y, Zhang H, Yang L, Worrell G, He B, Gruber O, Piguet C, Hubl D, Homan P, Kindler J, Dierks T, Kim K, Steinhoff U, Wakai R, Koenig T, Kottlow M, Melie-García L, Mucci A, Volpe U, Prinster A, Salvatore M, Galderisi S, Linden DEJ, Brandeis D, Schroeder CE, Kayser C, Panzeri S, Kleinschmidt A, Ritter P, Walther S, Haueisen J, Lau S, Flemming L, Sonntag H, Maess B, Knösche TR, Lanfer B, Dannhauer M, Wolters CH, Stenroos M, Haueisen J, Wolters C, Aydin U, Lanfer B, Lew S, Lucka F, Ruthotto L, Vorwerk J, Wagner S, Ramon C, Guan C, Ang KK, Chua SG, Kuah WK, Phua KS, Chew E, Zhou H, Chuang KH, Ang BT, Wang C, Zhang H, Yang H, Chin ZY, Yu H, Pan Y, Collins L, Mainsah B, Colwell K, Morton K, Ryan D, Sellers E, Caves K, Throckmorton S, Kübler A, Holz EM, Zickler C, Sellers E, Ryan D, Brown K, Colwell K, Mainsah B, Caves K, Throckmorton S, Collins L, Wennberg R, Ahlfors SP, Grova C, Chowdhury R, Hedrich T, Heers M, Zelmann R, Hall JA, Lina JM, Kobayashi E, Oostendorp T, van Dam P, Oosterhof P, Linnenbank A, Coronel R, van Dessel P, de Bakker J, Rossion B, Jacques C, Witthoft N, Weiner KS, Foster BL, Miller KJ, Hermes D, Parvizi J, Grill-Spector K, Recanzone GH, Murray MM, Haynes JD, Richiardi J, Greicius M, De Lucia M, Müller KR, Formisano E, Smieskova R, Schmidt A, Bendfeldt K, Walter A, Riecher-Rössler A, Borgwardt S, Fusar-Poli P, Eliez S, Schmidt A, Sekihara K, Nagarajan SS, Schoffelen JM, Guggisberg AG, Nolte G, Balazs S, Kermanshahi K, Kiesenhofer W, Binder H, Rattay F, Antal A, Chaieb L, Paulus W, Bodis-Wollner I, Maurer K, Fein G, Camchong J, Johnstone J, Cardenas-Nicolson V, Fiederer LDJ, Lucka F, Yang S, Vorwerk J, Dümpelmann M, Cosandier-Rimélé D, Schulze-Bonhage A, Aertsen A, Speck O, Wolters CH, Ball T, Fuchs M, Wagner M, Kastner J, Tech R, Dinh C, Haueisen J, Baumgarten D, Hämäläinen MS, Lau S, Vogrin SJ, D'Souza W, Haueisen J, Cook MJ, Custo A, Van De Ville D, Vulliemoz S, Grouiller F, Michel CM, Malmivuo J, Aydin U, Vorwerk J, Küpper P, Heers M, Kugel H, Wellmer J, Kellinghaus C, Scherg M, Rampp S, Wolters C, Storti SF, Boscolo Galazzo I, Del Felice A, Pizzini FB, Arcaro C, Formaggio E, Mai R, Manganotti P, Koessler L, Vignal J, Cecchin T, Colnat-Coulbois S, Vespignani H, Ramantani G, Maillard L, Rektor I, Kuba R, Brázdil M, Chrastina J, Rektorova I, van Mierlo P, Carrette E, Strobbe G, Montes-Restrepo V, Vonck K, Vandenberghe S, Ahmed B, Brodely C, Carlson C, Kuzniecky R, Devinsky O, French J, Thesen T, Bénis D, David O, Lachaux JP, Seigneuret E, Krack P, Fraix V, Chabardès S, Bastin J, Jann K, Gee D, Kilroy E, Cannon T, Wang DJ, Hale JR, Mayhew SD, Przezdzik I, Arvanitis TN, Bagshaw AP, Plomp G, Quairiaux C, Astolfi L, Michel CM, Mayhew SD, Mullinger KJ, Bagshaw AP, Bowtell R, Francis ST, Schouten AC, Campfens SF, van der Kooij H, Koles Z, Lind J, Flor-Henry P, Wirth M, Haase CM, Villeneuve S, Vogel J, Jagust WJ, Kambeitz-Ilankovic L, Simon-Vermot L, Gesierich B, Duering M, Ewers M, Rektorova I, Krajcovicova L, Marecek R, Mikl M, Bracht T, Horn H, Strik W, Federspiel A, Schnell S, Höfle O, Stegmayer K, Wiest R, Dierks T, Müller TJ, Walther S, Surmeli T, Ertem A, Eralp E, Kos IH, Skrandies W, Flüggen S, Klein A, Britz J, Díaz Hernàndez L, Ro T, Michel CM, Lenartowicz A, Lau E, Rodriguez C, Cohen MS, Loo SK, Di Lorenzo G, Pagani M, Monaco L, Daverio A, Giannoudas I, La Porta P, Verardo AR, Niolu C, Fernandez I, Siracusano A, Flor-Henry P, Lind J, Koles Z, Bollmann S, Ghisleni C, O'Gorman R, Poil SS, Klaver P, Michels L, Martin E, Ball J, Eich-Höchli D, Brandeis D, Salisbury DF, Murphy TK, Butera CD, Mathalon DH, Fryer SL, Kiehl KA, Calhoun VC, Pearlson GD, Roach BJ, Ford JM, McGlashan TH, Woods SW, Volpe U, Merlotti E, Vignapiano A, Montefusco V, Plescia GM, Gallo O, Romano P, Mucci A, Galderisi S, Mingoia G, Langbein K, Dietzek M, Wagner G, Smesny, Scherpiet S, Maitra R, Gaser C, Sauer H, Nenadic I, Gonzalez Andino S, Grave de Peralta Menendez R, Grave de Peralta Menendez R, Sanchez Vives M, Rebollo B, Gonzalez Andino S, Frølich L, Andersen TS, Mørup M, Belfiore P, Gargiulo P, Ramon C, Vanhatalo S, Cho JH, Vorwerk J, Wolters CH, Knösche TR, Watanabe T, Kawabata Y, Ukegawa D, Kawabata S, Adachi Y, Sekihara K, Sekihara K, Nagarajan SS, Wagner S, Aydin U, Vorwerk J, Herrmann C, Burger M, Wolters C, Lucka F, Aydin U, Vorwerk J, Burger M, Wolters C, Bauer M, Trahms L, Sander T, Faber PL, Lehmann D, Gianotti LRR, Pascual-Marqui RD, Milz P, Kochi K, Kaneko S, Yamashita S, Yana K, Kalogianni K, Vardy AN, Schouten AC, van der Helm FCT, Sorrentino A, Luria G, Aramini R, Hunold A, Funke M, Eichardt R, Haueisen J, Gómez-Aguilar F, Vázquez-Olvera S, Cordova-Fraga T, Castro-López J, Hernández-Gonzalez MA, Solorio-Meza S, Sosa-Aquino M, Bernal-Alvarado JJ, Vargas-Luna M, Vorwerk J, Magyari L, Ludewig J, Oostenveld R, Wolters CH, Vorwerk J, Engwer C, Ludewig J, Wolters C, Sato K, Nishibe T, Furuya M, Yamashiro K, Yana K, Ono T, Puthanmadam Subramaniyam N, Hyttinen J, Lau S, Güllmar D, Flemming L, Haueisen J, Sonntag H, Vorwerk J, Wolters CH, Grasedyck L, Haueisen J, Maeß B, Freitag S, Graichen U, Fiedler P, Strohmeier D, Haueisen J, Stenroos M, Hauk O, Grigutsch M, Felber M, Maess B, Herrmann B, Strobbe G, van Mierlo P, Vandenberghe S, Strobbe G, Cárdenas-Peña D, Montes-Restrepo V, van Mierlo P, Castellanos-Dominguez G, Vandenberghe S, Lanfer B, Paul-Jordanov I, Scherg M, Wolters CH, Ito Y, Sato D, Kamada K, Kobayashi T, Dalal SS, Rampp S, Willomitzer F, Arold O, Fouladi-Movahed S, Häusler G, Stefan H, Ettl S, Zhang S, Zhang Y, Li H, Kong X, Montes-Restrepo V, Strobbe G, van Mierlo P, Vandenberghe S, Wong DDE, Bidet-Caulet A, Knight RT, Crone NE, Dalal SS, Birot G, Spinelli L, Vulliémoz S, Seeck M, Michel CM, Emory H, Wells C, Mizrahi N, Vogrin SJ, Lau S, Cook MJ, Karahanoglu FI, Grouiller F, Caballero-Gaudes C, Seeck M, Vulliemoz S, Van De Ville D, Spinelli L, Megevand P, Genetti M, Schaller K, Michel C, Vulliemoz S, Seeck M, Genetti M, Tyrand R, Grouiller F, Vulliemoz S, Spinelli L, Seeck M, Schaller K, Michel CM, Grouiller F, Heinzer S, Delattre B, Lazeyras F, Spinelli L, Pittau F, Seeck M, Ratib O, Vargas M, Garibotto V, Vulliemoz S, Vogrin SJ, Bailey CA, Kean M, Warren AE, Davidson A, Seal M, Harvey AS, Archer JS, Papadopoulou M, Leite M, van Mierlo P, Vonck K, Boon P, Friston K, Marinazzo D, Ramon C, Holmes M, Koessler L, Rikir E, Gavaret M, Bartolomei F, Vignal JP, Vespignani H, Maillard L, Centeno M, Perani S, Pier K, Lemieux L, Clayden J, Clark C, Pressler R, Cross H, Carmichael DW, Spring A, Bessemer R, Pittman D, Aghakhani Y, Federico P, Pittau F, Grouiller F, Vulliémoz S, Gotman J, Badier JM, Bénar CG, Bartolomei F, Cruto C, Chauvel P, Gavaret M, Brodbeck V, van Leeuwen T, Tagliazzuchi E, Melloni L, Laufs H, Griskova-Bulanova I, Dapsys K, Klein C, Hänggi J, Jäncke L, Ehinger BV, Fischer P, Gert AL, Kaufhold L, Weber F, Marchante Fernandez M, Pipa G, König P, Sekihara K, Hiyama E, Koga R, Iannilli E, Michel CM, Bartmuss AL, Gupta N, Hummel T, Boecker R, Holz N, Buchmann AF, Blomeyer D, Plichta MM, Wolf I, Baumeister S, Meyer-Lindenberg A, Banaschewski T, Brandeis D, Laucht M, Natahara S, Ueno M, Kobayashi T, Kottlow M, Bänninger A, Koenig T, Schwab S, Koenig T, Federspiel A, Dierks T, Jann K, Natsukawa H, Kobayashi T, Tüshaus L, Koenig T, Kottlow M, Achermann P, Wilson RS, Mayhew SD, Assecondi S, Arvanitis TN, Bagshaw AP, Darque A, Rihs TA, Grouiller F, Lazeyras F, Ha-Vinh Leuchter R, Caballero C, Michel CM, Hüppi PS, Hauser TU, Hunt LT, Iannaccone R, Stämpfli P, Brandeis D, Dolan RJ, Walitza S, Brem S, Graichen U, Eichardt R, Fiedler P, Strohmeier D, Freitag S, Zanow F, Haueisen J, Lordier L, Grouiller F, Van de Ville D, Sancho Rossignol A, Cordero I, Lazeyras F, Ansermet F, Hüppi P, Schläpfer A, Rubia K, Brandeis D, Di Lorenzo G, Pagani M, Monaco L, Daverio A, Giannoudas I, Verardo AR, La Porta P, Niolu C, Fernandez I, Siracusano A, Tamura K, Karube C, Mizuba T, Matsufuji M, Takashima S, Iramina K, Assecondi S, Ostwald D, Bagshaw AP, Marecek R, Brazdil M, Lamos M, Slavícek T, Marecek R, Jan J, Meier NM, Perrig W, Koenig T, Minami T, Noritake Y, Nakauchi S, Azuma K, Minami T, Nakauchi S, Rodriguez C, Lenartowicz A, Cohen MS, Rodriguez C, Lenartowicz A, Cohen MS, Iramina K, Kinoshita H, Tamura K, Karube C, Kaneko M, Ide J, Noguchi Y, Cohen MS, Douglas PK, Rodriguez CM, Xia HJ, Zimmerman EM, Konopka CJ, Epstein PS, Konopka LM, Giezendanner S, Fisler M, Soravia L, Andreotti J, Wiest R, Dierks T, Federspiel A, Razavi N, Federspiel A, Dierks T, Hauf M, Jann K, Kamada K, Sato D, Ito Y, Okano K, Mizutani N, Kobayashi T, Thelen A, Murray M, Pastena L, Formaggio E, Storti SF, Faralli F, Melucci M, Gagliardi R, Ricciardi L, Ruffino G, Coito A, Macku P, Tyrand R, Astolfi L, He B, Wiest R, Seeck M, Michel C, Plomp G, Vulliemoz S, Fischmeister FPS, Glaser J, Schöpf V, Bauer H, Beisteiner R, Deligianni F, Centeno M, Carmichael DW, Clayden J, Mingoia G, Langbein K, Dietzek M, Wagner G, Smesny S, Scherpiet S, Maitra R, Gaser C, Sauer H, Nenadic I, Dürschmid S, Zaehle T, Pannek H, Chang HF, Voges J, Rieger J, Knight RT, Heinze HJ, Hinrichs H, Tsatsishvili V, Cong F, Puoliväli T, Alluri V, Toiviainen P, Nandi AK, Brattico E, Ristaniemi T, Grieder M, Crinelli RM, Jann K, Federspiel A, Wirth M, Koenig T, Stein M, Wahlund LO, Dierks T, Atsumori H, Yamaguchi R, Okano Y, Sato H, Funane T, Sakamoto K, Kiguchi M, Tränkner A, Schindler S, Schmidt F, Strauß M, Trampel R, Hegerl U, Turner R, Geyer S, Schönknecht P, Kebets V, van Assche M, Goldstein R, van der Meulen M, Vuilleumier P, Richiardi J, Van De Ville D, Assal F, Wozniak-Kwasniewska A, Szekely D, Harquel S, Bougerol T, David O, Bracht T, Jones DK, Horn H, Müller TJ, Walther S, Sos P, Klirova M, Novak T, Brunovsky M, Horacek J, Bares M, Hoschl C C, Fellhauer I, Zöllner FG, Schröder J, Kong L, Essig M, Schad LR, Arrubla J, Neuner I, Hahn D, Boers F, Shah NJ, Neuner I, Arrubla J, Hahn D, Boers F, Jon Shah N, Suriya Prakash M, Sharma R, Kawaguchi H, Kobayashi T, Fiedler P, Griebel S, Biller S, Fonseca C, Vaz F, Zentner L, Zanow F, Haueisen J, Rochas V, Rihs T, Thut G, Rosenberg N, Landis T, Michel C, Moliadze V, Schmanke T, Lyzhko E, Bassüner S, Freitag C, Siniatchkin M, Thézé R, Guggisberg AG, Nahum L, Schnider A, Meier L, Friedrich H, Jann K, Landis B, Wiest R, Federspiel A, Strik W, Dierks T, Witte M, Kober SE, Neuper C, Wood G, König R, Matysiak A, Kordecki W, Sieluzycki C, Zacharias N, Heil P, Wyss C, Boers F, Arrubla J, Dammers J, Kawohl W, Neuner I, Shah NJ, Braboszcz C, Cahn RB, Levy J, Fernandez M, Delorme A, Rosas-Martinez L, Milne E, Zheng Y, Urakami Y, Kawamura K, Washizawa Y, Hiyoshi K, Cichocki A, Giroud N, Dellwo V, Meyer M, Rufener KS, Liem F, Dellwo V, Meyer M, Jones-Rounds JD, Raizada R, Staljanssens W, Strobbe G, van Mierlo P, Van Holen R, Vandenberghe S, Pefkou M, Becker R, Michel C, Hervais-Adelman A, He W, Brock J, Johnson B, Ohla K, Hitz K, Heekeren K, Obermann C, Huber T, Juckel G, Kawohl W, Gabriel D, Comte A, Henriques J, Magnin E, Grigoryeva L, Ortega JP, Haffen E, Moulin T, Pazart L, Aubry R, Kukleta M, Baris Turak B, Louvel J, Crespo-Garcia M, Cantero JL, Atienza M, Connell S, Kilborn K, Damborská A, Brázdil M, Rektor I, Kukleta M, Koberda JL, Bienkiewicz A, Koberda I, Koberda P, Moses A, Tomescu M, Rihs T, Britz J, Custo A, Grouiller F, Schneider M, Debbané M, Eliez S, Michel C, Wang GY, Kydd R, Wouldes TA, Jensen M, Russell BR, Dissanayaka N, Au T, Angwin A, O'Sullivan J, Byrne G, Silburn P, Marsh R, Mellic G, Copland D, Bänninger A, Kottlow M, Díaz Hernàndez L, Koenig T, Díaz Hernàndez L, Bänninger A, Koenig T, Hauser TU, Iannaccone R, Mathys C, Ball J, Drechsler R, Brandeis D, Walitza S, Brem S, Boeijinga PH, Pang EW, Valica T, Macdonald MJ, Oh A, Lerch JP, Anagnostou E, Di Lorenzo G, Pagani M, Monaco L, Daverio A, Verardo AR, Giannoudas I, La Porta P, Niolu C, Fernandez I, Siracusano A, Shimada T, Matsuda Y, Monkawa A, Monkawa T, Hashimoto R, Watanabe K, Kawasaki Y, Matsuda Y, Shimada T, Monkawa T, Monkawa A, Watanabe K, Kawasaki Y, Stegmayer K, Horn H, Federspiel A, Razavi N, Bracht T, Laimböck K, Strik W, Dierks T, Wiest R, Müller TJ, Walther S, Koorenhof LJ, Swithenby SJ, Martins-Mourao A, Rihs TA, Tomescu M, Song KW, Custo A, Knebel JF, Murray M, Eliez S, Michel CM, Volpe U, Merlotti E, Vignapiano A, Montefusco V, Plescia GM, Gallo O, Romano P, Mucci A, Galderisi S, Laimboeck K, Jann K, Walther S, Federspiel A, Wiest R, Strik W, Horn H. Abstracts of Presentations at the International Conference on Basic and Clinical Multimodal Imaging (BaCI), a Joint Conference of the International Society for Neuroimaging in Psychiatry (ISNIP), the International Society for Functional Source Imaging (ISFSI), the International Society for Bioelectromagnetism (ISBEM), the International Society for Brain Electromagnetic Topography (ISBET), and the EEG and Clinical Neuroscience Society (ECNS), in Geneva, Switzerland, September 5-8, 2013. Clin EEG Neurosci 2013; 44:1550059413507209. [PMID: 24368763 DOI: 10.1177/1550059413507209] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- B J He
- National Institutes of Health, Bethesda, MD, USA
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Dissanayaka N, Au T, Angwin A, O'Sullivan J, Byrne G, Silburn P, Marsh R, Mellick G, Copland D. Blunted responses to emotional stimuli in Parkinson's disease: An EEG study of visual affective word processing. J Neurol Sci 2013. [DOI: 10.1016/j.jns.2013.07.598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Williams MR, Marsh R, Macdonald CD, Jain J, Pearce RKB, Hirsch SR, Ansorge O, Gentleman SM, Maier M. Neuropathological changes in the nucleus basalis in schizophrenia. Eur Arch Psychiatry Clin Neurosci 2013; 263:485-95. [PMID: 23229688 DOI: 10.1007/s00406-012-0387-7] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2012] [Accepted: 11/27/2012] [Indexed: 12/12/2022]
Abstract
The nucleus basalis has not been examined in detail in severe mental illness. Several studies have demonstrated decreases in glia and glial markers in the cerebral cortex in schizophrenia, familial bipolar disorder and recurrent depression. Changes in neocortical neuron size and shape have also been reported. The nucleus basalis is a collection of large cholinergic neurons in the basal forebrain receiving information from the midbrain and limbic system, projecting to the cortex and involved with attention, learning and memory, and receives regulation from serotonergic inputs. Forty-one cases aged 41-60 years with schizophrenia or major depressive disorder with age-matched controls were collected. Formalin-fixed paraffin-embedded coronal nucleus basalis sections were histologically stained for oligodendrocyte identification with cresyl-haematoxylin counterstain, for neuroarchitecture with differentiated cresyl violet stain and astrocytes were detected by glial fibrillary acid protein immunohistochemistry. Cell density and neuroarchitecture were measured using Image Pro Plus. There were larger NB oval neuron soma in the combined schizophrenia and major depression disorder groups (p = 0.038), with no significant change between controls and schizophrenia and major depression disorder separately. There is a significant reduction in oligodendrocyte density (p = 0.038) in the nucleus basalis in schizophrenia. The ratio of gemistocytic to fibrillary astrocytes showed a greater proportion of the former in schizophrenia (18.1 %) and major depressive disorder (39.9 %) than in controls (7.9 %). These results suggest glial cell abnormalities in the nucleus basalis in schizophrenia possibly leading to cortical-limbic disturbance and subcortical dysfunction.
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Affiliation(s)
- M R Williams
- King's College London, Institute of Psychiatry, De Crespigny Park, London, SE5 8AF, UK.
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Stenmark MH, Conlon AS, Daignault S, Bassetti MF, Vance S, Marsh R, Litzenberg D, Ritter T, Feng FYC, Sandler HM, Sanda MG, Hamstra DA. Prediction of patient-reported bowel quality of life (QOL) after dose-escalated radiation therapy (RT) for prostate cancer by rectal dosimetry. J Clin Oncol 2013. [DOI: 10.1200/jco.2013.31.6_suppl.84] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
84 Background: Rectal dose-volume histogram (DVH) parameters and a consensus normal tissue complication probability (NTCP) model predict physician scored toxicity but have not been well studied for patient reported outcomes (PRO) following external beam RT for prostate cancer. Methods: PRO were prospectively collected at baseline and 12 month intervals by expanded prostate cancer index composite (EPIC) for 98 patients from 2004-2009. Linear regression modeling for bowel score at 1 and 2 years was performed using pre-treatment bowel score and DVH parameters [V80 (% of rectal volume >80 Gy), V75, V70, V50, V25, and NTCP]. Results: Median RT dose was 78 Gy with image-guidance in 81%, intensity-modulation in 72%, and pelvic RT in 11%. Rectal DVH parameters are presented in the Table. Pretreatment and 2 year PRO were available for 92% of patients. The mean pretreatment bowel summary score declined from 96.0 (sd 8.0) to 91.8 (13.5) at 2 years. Acute proctitis (grade 1-2) during RT was associated with a decline in 2 year bowel QOL, while acute diarrhea (grade 1-2) was not. At 2 years 63% of patients had a decline <4 points while the remainder had a mean decline of 15.9 (14.2) with 4-6 points having been defined as the minimal clinically significant change. Linear regression modeling, adjusted for pretreatment bowel function, revealed an association between increasing Vdose, NTCP and bowel QOL (Table). Akaike information criterion analysis followed by leave-one-out cross validation, indicated that V75 provided the best predictive model for 2 year bowel QOL followed by NTCP and V70. Conclusions: Most previous studies have highlighted V70 for toxicity (such as rectal bleeding). The association with V75 and rectal QOL has not been previously reported and supports potential changes in how prostate plans are designed to maintain QOL. This is also the first validation of a consensus NTCP model for bowel QOL. [Table: see text]
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Affiliation(s)
| | | | | | | | - Sean Vance
- University of Michigan Medical Center, Ann Arbor, MI
| | - Robin Marsh
- University of Michigan Medical Center, Ann Arbor, MI
| | | | | | | | - Howard Mark Sandler
- Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA
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Hamstra DA, Stenmark MH, Ritter T, Litzenberg D, Jackson W, Johnson S, Albrecht-Unger L, Donaghy A, Phelps L, Blas K, Halverson S, Marsh R, Olson K, Feng FY. Age and comorbid illness are associated with late rectal toxicity following dose-escalated radiation therapy for prostate cancer. Int J Radiat Oncol Biol Phys 2012; 85:1246-53. [PMID: 23265567 DOI: 10.1016/j.ijrobp.2012.10.042] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2012] [Revised: 10/25/2012] [Accepted: 10/28/2012] [Indexed: 10/27/2022]
Abstract
PURPOSE To assess the impacts of patient age and comorbid illness on rectal toxicity following external beam radiation therapy (EBRT) for prostate cancer and to assess the Qualitative Analysis of Normal Tissue Effects in the Clinic (QUANTEC) normal tissue complication probability (NTCP) model in this context. METHODS AND MATERIALS Rectal toxicity was analyzed in 718 men previously treated for prostate cancer with EBRT (≥75 Gy). Comorbid illness was scored using the Charlson Comorbidity Index (CCMI), and the NTCP was evaluated with the QUANTEC model. The influence of clinical and treatment-related parameters on rectal toxicity was assessed by Kaplan-Meier and Cox proportional hazards models. RESULTS The cumulative incidence of rectal toxicity grade ≥2 was 9.5% and 11.6% at 3 and 5 years and 3.3% and 3.9% at 3 and 5 years for grade ≥3 toxicity, respectively. Each year of age predicted an increasing relative risk of grade ≥2 (P<.03; hazard ratio [HR], 1.04 [95% confidence interval {CI}, 1.01-1.06]) and ≥3 rectal toxicity (P<.0001; HR, 1.14 [95% CI,1.07-1.22]). Increasing CCMI predicted rectal toxicity where a history of either myocardial infarction (MI) (P<.0001; HR, 5.1 [95% CI, 1.9-13.7]) or congestive heart failure (CHF) (P<.0006; HR, 5.4 [95% CI, 0.6-47.5]) predicted grade ≥3 rectal toxicity, with lesser correlation with grade ≥2 toxicity (P<.02 for MI, and P<.09 for CHF). An age comorbidity model to predict rectal toxicity was developed and confirmed in a validation cohort. The use of anticoagulants increased toxicity independent of age and comorbidity. NTCP was prognostic for grade ≥3 (P=.015) but not grade ≥2 (P=.49) toxicity. On multivariate analysis, age, MI, CHF, and an NTCP >20% all correlated with late rectal toxicity. CONCLUSIONS Patient age and a history of MI or CHF significantly impact rectal toxicity following EBRT for the treatment of prostate cancer, even after controlling for NTCP.
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Affiliation(s)
- Daniel A Hamstra
- Department of Radiation Oncology, University of Michigan Medical Center, Ann Arbor, Michigan, USA
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