Sample records for clinical radiobiological experience

  1. Characterization and performances of DOSION, a dosimetry equipment dedicated to radiobiology experiments taking place at GANIL

    NASA Astrophysics Data System (ADS)

    Boissonnat, Guillaume; Fontbonne, Jean-Marc; Balanzat, Emmanuel; Boumard, Frederic; Carniol, Benjamin; Cassimi, Amine; Colin, Jean; Cussol, Daniel; Etasse, David; Fontbonne, Cathy; Frelin, Anne-Marie; Hommet, Jean; Salvador, Samuel

    2017-06-01

    Currently, radiobiology experiments using heavy ions at GANIL (Grand Accélérateur National d‧Ions Lourds) are conducted under the supervision of the CIMAP (Center for research on Ions, MAterials and Photonics). In this context, a new beam monitoring equipment named DOSION has been developed. It allows to perform measurements of accurate fluence and dose maps in near real time for each biological sample irradiated. In this paper, we present the detection system, its design, performances, calibration protocol and measurements performed during radiobiology experiments. This setup is currently available for any radiobiology experiments if one wishes to correlate one's own sample analysis to state-of-the-art dosimetric references.

  2. "Radiobiology of Proton Therapy": Results of an international expert workshop.

    PubMed

    Lühr, Armin; von Neubeck, Cläre; Pawelke, Jörg; Seidlitz, Annekatrin; Peitzsch, Claudia; Bentzen, Søren M; Bortfeld, Thomas; Debus, Jürgen; Deutsch, Eric; Langendijk, Johannes A; Loeffler, Jay S; Mohan, Radhe; Scholz, Michael; Sørensen, Brita S; Weber, Damien C; Baumann, Michael; Krause, Mechthild

    2018-05-31

    The physical properties of proton beams offer the potential to reduce toxicity in tumor-adjacent normal tissues. Toward this end, the number of proton radiotherapy facilities has steeply increased over the last 10-15 years to currently around 70 operational centers worldwide. However, taking full advantage of the opportunities offered by proton radiation for clinical radiotherapy requires a better understanding of the radiobiological effects of protons alone or combined with drugs or immunotherapy on normal tissues and tumors. This report summarizes the main results of the international expert workshop "Radiobiology of Proton Therapy" that was held in November 2016 in Dresden. It addresses the major topics (1) relative biological effectiveness (RBE) in proton beam therapy, (2) interaction of proton radiobiology with radiation physics in current treatment planning, (3) biological effects in proton therapy combined with systemic treatments, and (4) testing biological effects of protons in clinical trials. Finally, important research avenues for improvement of proton radiotherapy based on radiobiological knowledge are identified. The clinical distribution of radiobiological effectiveness of protons alone or in combination with systemic chemo- or immunotherapies as well as patient stratification based on biomarker expressions are key to reach the full potential of proton beam therapy. Dedicated preclinical experiments, innovative clinical trial designs, and large high-quality data repositories will be most important to achieve this goal. Copyright © 2018 Elsevier B.V. All rights reserved.

  3. Monte Carlo studies on photon interactions in radiobiological experiments

    PubMed Central

    Shahmohammadi Beni, Mehrdad; Krstic, D.; Nikezic, D.

    2018-01-01

    X-ray and γ-ray photons have been widely used for studying radiobiological effects of ionizing radiations. Photons are indirectly ionizing radiations so they need to set in motion electrons (which are a directly ionizing radiation) to perform the ionizations. When the photon dose decreases to below a certain limit, the number of electrons set in motion will become so small that not all cells in an “exposed” cell population can get at least one electron hit. When some cells in a cell population are not hit by a directly ionizing radiation (in other words not irradiated), there will be rescue effect between the irradiated cells and non-irradiated cells, and the resultant radiobiological effect observed for the “exposed” cell population will be different. In the present paper, the mechanisms underlying photon interactions in radiobiological experiments were studied using our developed NRUphoton computer code, which was benchmarked against the MCNP5 code by comparing the photon dose delivered to the cell layer underneath the water medium. The following conclusions were reached: (1) The interaction fractions decreased in the following order: 16O > 12C > 14N > 1H. Bulges in the interaction fractions (versus water medium thickness) were observed, which reflected changes in the energies of the propagating photons due to traversals of different amount of water medium as well as changes in the energy-dependent photon interaction cross-sections. (2) Photoelectric interaction and incoherent scattering dominated for lower-energy (10 keV) and high-energy (100 keV and 1 MeV) incident photons. (3) The fractions of electron ejection from different nuclei were mainly governed by the photoelectric effect cross-sections, and the fractions from the 1s subshell were the largest. (4) The penetration fractions in general decreased with increasing medium thickness, and increased with increasing incident photon energy, the latter being explained by the corresponding reduction in

  4. Overview of research and therapy facilities for radiobiological experimental work in particle therapy. Report from the European Particle Therapy Network radiobiology group.

    PubMed

    Dosanjh, Manjit; Jones, Bleddyn; Pawelke, Jörg; Pruschy, Martin; Sørensen, Brita Singers

    2018-04-24

    Particle therapy (PT) as cancer treatment, using protons or heavier ions, can provide a more favorable dose distribution compared to X-rays. While the physical characteristics of particle radiation have been the aim of intense research, less focus has been placed on the actual biological responses arising from particle irradiation. One of the biggest challenges for proton radiobiology is the RBE, with an increasing concern that the clinically-applied generic RBE-value of 1.1 is an approximation, as RBE is a complex quantity, depending on both biological and physical parameters, such as dose, LET, cellular and tissue radiobiological characteristics, as well as the endpoints being studied. Most of the available RBE data derive from in vitro experiments, with very limited in vivo data available, especially in late-reacting tissues, which provide the main constraints and influence the quality of life endpoints in radiotherapy. There is a need for systematic, large-scale studies to thoroughly establish the biology of particle radiation in a number of different experimental models in order to refine biophysical mathematical models that can potentially be used to guide PT. The overall objective of the European Particle Therapy Network (EPTN) WP6 is to form a network of research and therapy facilities in order to coordinate and standardize the radiobiological experiments, to obtain more accurate predictive parameters than in the past. Coordinated research is required in order to obtain the most appropriate experimental data. The aim in this paper is to describe the available radiobiology infrastructure of the centers involved in EPTN WP6. Copyright © 2018 Elsevier B.V. All rights reserved.

  5. Dosimetry in nuclear medicine therapy: radiobiology application and results.

    PubMed

    Strigari, L; Benassi, M; Chiesa, C; Cremonesi, M; Bodei, L; D'Andrea, M

    2011-04-01

    The linear quadratic model (LQM) has largely been used to assess the radiobiological damage to tissue by external beam fractionated radiotherapy and more recently has been extended to encompass a general continuous time varying dose rate protocol such as targeted radionuclide therapy (TRT). In this review, we provide the basic aspects of radiobiology, from a theoretical point of view, starting from the "four Rs" of radiobiology and introducing the biologically effective doses, which may be used to quantify the impact of a treatment on both tumors and normal tissues. We also present the main parameters required in the LQM, and illustrate the main models of tumor control probability and normal tissue complication probability and summarize the main dose-effect responses, reported in literature, which demonstrate the tentative link between targeted radiotherapy doses and those used in conventional radiotherapy. A better understanding of the radiobiology and mechanisms of action of TRT could contribute to describe the clinical data and guide the development of future compounds and the designing of prospective clinical trials.

  6. The significance of the choice of radiobiological (NTCP) models in treatment plan objective functions.

    PubMed

    Miller, J; Fuller, M; Vinod, S; Suchowerska, N; Holloway, L

    2009-06-01

    A Clinician's discrimination between radiation therapy treatment plans is traditionally a subjective process, based on experience and existing protocols. A more objective and quantitative approach to distinguish between treatment plans is to use radiobiological or dosimetric objective functions, based on radiobiological or dosimetric models. The efficacy of models is not well understood, nor is the correlation of the rank of plans resulting from the use of models compared to the traditional subjective approach. One such radiobiological model is the Normal Tissue Complication Probability (NTCP). Dosimetric models or indicators are more accepted in clinical practice. In this study, three radiobiological models, Lyman NTCP, critical volume NTCP and relative seriality NTCP, and three dosimetric models, Mean Lung Dose (MLD) and the Lung volumes irradiated at 10Gy (V10) and 20Gy (V20), were used to rank a series of treatment plans using, harm to normal (Lung) tissue as the objective criterion. None of the models considered in this study showed consistent correlation with the Radiation Oncologists plan ranking. If radiobiological or dosimetric models are to be used in objective functions for lung treatments, based on this study it is recommended that the Lyman NTCP model be used because it will provide most consistency with traditional clinician ranking.

  7. Bringing the heavy: carbon ion therapy in the radiobiological and clinical context

    PubMed Central

    2014-01-01

    Radiotherapy for the treatment of cancer is undergoing an evolution, shifting to the use of heavier ion species. For a plethora of malignancies, current radiotherapy using photons or protons yields marginal benefits in local control and survival. One hypothesis is that these malignancies have acquired, or are inherently radioresistant to low LET radiation. In the last decade, carbon ion radiotherapy facilities have slowly been constructed in Europe and Asia, demonstrating favorable results for many of the malignancies that do poorly with conventional radiotherapy. However, from a radiobiological perspective, much of how this modality works in overcoming radioresistance, and extending local control and survival are not yet fully understood. In this review, we will explain from a radiobiological perspective how carbon ion radiotherapy can overcome the classical and recently postulated contributors of radioresistance (α/β ratio, hypoxia, cell proliferation, the tumor microenvironment and metabolism, and cancer stem cells). Furthermore, we will make recommendations on the important factors to consider, such as anatomical location, in the future design and implementation of clinical trials. With the existing data available we believe that the expansion of carbon ion facilities into the United States is warranted. PMID:24679134

  8. Practical Radiobiology for Proton Therapy Planning

    NASA Astrophysics Data System (ADS)

    Jones, Bleddyn

    2017-12-01

    Practical Radiobiology for Proton Therapy Planning covers the principles, advantages and potential pitfalls that occur in proton therapy, especially its radiobiological modelling applications. This book is intended to educate, inform and to stimulate further research questions. Additionally, it will help proton therapy centres when designing new treatments or when unintended errors or delays occur. The clear descriptions of useful equations for high LET particle beam applications, worked examples of many important clinical situations, and discussion of how proton therapy may be optimized are all important features of the text. This important book blends the relevant physics, biology and medical aspects of this multidisciplinary subject. Part of Series in Physics and Engineering in Medicine and Biology.

  9. Development of a compact laser-produced plasma soft X-ray source for radiobiology experiments

    NASA Astrophysics Data System (ADS)

    Adjei, Daniel; Ayele, Mesfin Getachew; Wachulak, Przemyslaw; Bartnik, Andrzej; Wegrzynski, Łukasz; Fiedorowicz, Henryk; Vyšín, Luděk; Wiechec, Anna; Lekki, Janusz; Kwiatek, Wojciech M.; Pina, Ladislav; Davídková, Marie; Juha, Libor

    2015-12-01

    A desk-top laser-produced plasma (LPP) source of soft X-rays (SXR) has been developed for radiobiology research. The source is based on a double-stream gas puff target, irradiated with the focused beam of a commercial Nd:YAG laser. The source has been optimized to get a maximum photon emission from LPP in the X-ray "water window" spectral wavelength range from 2.3 nm (i.e., an absorption edge of oxygen) to 4.4 nm (i.e., an absorption edge of carbon) (280-540 eV in photon energy units) by using argon gas-puff target and spectral filtering by free-standing thin foils. The present source delivers nanosecond pulses of soft X-rays at a fluence of about 4.2 × 103 photons/μm2/pulse on a sample placed inside the vacuum chamber. In this paper, the source design, radiation output characterization measurements and initial irradiation experiments are described. The source can be useful in addressing observations related to biomolecular, cellular and organisms' sensitivity to pulsed radiation in the "water window", where carbon atoms absorb X-rays more strongly than the oxygen, mostly present in water. The combination of the SXR source and the radiobiology irradiation layout, reported in this article, make possible a systematic investigation of relationships between direct and indirect action of ionizing radiation, an increase of a local dose in carbon-rich compartments of the cell (e.g., lipid membranes), an experimental estimation of a particular role of the Auger effect (in particular in carbon atoms) in the damage to biological systems, and the study of ionization/excitation-density (LET - Linear Energy Transfer) and dose-rate effects in radiobiology.

  10. In vivo radiobiological assessment of the new clinical carbon ion beams at CNAO.

    PubMed

    Facoetti, A; Vischioni, B; Ciocca, M; Ferrarini, M; Furusawa, Y; Mairani, A; Matsumoto, Y; Mirandola, A; Molinelli, S; Uzawa, A; Vilches, Freixas G; Orecchia, R

    2015-09-01

    In this article, the in vivo study performed to evaluate the uniformity of biological doses within an hypothetical target volume and calculate the values of relative biological effectiveness (RBE) at different depths in the spread-out Bragg peak (SOBP) of the new CNAO (National Centre for Oncological Hadrontherapy) carbon beams is presented, in the framework of a typical radiobiological beam calibration procedure. The RBE values (relative to (60)Co γ rays) of the CNAO active scanning carbon ion beams were determined using jejunal crypt regeneration in mice as biological system at the entrance, centre and distal end of a 6-cm SOBP. The RBE values calculated from the iso-effective doses to reduce crypt survival per circumference to 10, ranged from 1.52 at the middle of the SOBP to 1.75 at the distal position and are in agreement with those previously reported from other carbon ion facilities. In conclusion, this first set of in vivo experiments shows that the CNAO carbon beam is radiobiologically comparable with the NIRS (National Institute of Radiological Sciences, Chiba, Japan) and GSI (Helmholtzzentrum für Schwerionenforschung, Darmstadt, Germany) ones. © The Author 2015. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

  11. Novel Radiobiological Gamma Index for Evaluation of 3-Dimensional Predicted Dose Distribution

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Sumida, Iori, E-mail: sumida@radonc.med.osaka-u.ac.jp; Yamaguchi, Hajime; Kizaki, Hisao

    2015-07-15

    Purpose: To propose a gamma index-based dose evaluation index that integrates the radiobiological parameters of tumor control (TCP) and normal tissue complication probabilities (NTCP). Methods and Materials: Fifteen prostate and head and neck (H&N) cancer patients received intensity modulated radiation therapy. Before treatment, patient-specific quality assurance was conducted via beam-by-beam analysis, and beam-specific dose error distributions were generated. The predicted 3-dimensional (3D) dose distribution was calculated by back-projection of relative dose error distribution per beam. A 3D gamma analysis of different organs (prostate: clinical [CTV] and planned target volumes [PTV], rectum, bladder, femoral heads; H&N: gross tumor volume [GTV], CTV,more » spinal cord, brain stem, both parotids) was performed using predicted and planned dose distributions under 2%/2 mm tolerance and physical gamma passing rate was calculated. TCP and NTCP values were calculated for voxels with physical gamma indices (PGI) >1. We propose a new radiobiological gamma index (RGI) to quantify the radiobiological effects of TCP and NTCP and calculate radiobiological gamma passing rates. Results: The mean RGI gamma passing rates for prostate cases were significantly different compared with those of PGI (P<.03–.001). The mean RGI gamma passing rates for H&N cases (except for GTV) were significantly different compared with those of PGI (P<.001). Differences in gamma passing rates between PGI and RGI were due to dose differences between the planned and predicted dose distributions. Radiobiological gamma distribution was visualized to identify areas where the dose was radiobiologically important. Conclusions: RGI was proposed to integrate radiobiological effects into PGI. This index would assist physicians and medical physicists not only in physical evaluations of treatment delivery accuracy, but also in clinical evaluations of predicted dose distribution.« less

  12. Monte Carlo simulations of a low energy proton beamline for radiobiological experiments.

    PubMed

    Dahle, Tordis J; Rykkelid, Anne Marit; Stokkevåg, Camilla H; Mairani, Andrea; Görgen, Andreas; Edin, Nina J; Rørvik, Eivind; Fjæra, Lars Fredrik; Malinen, Eirik; Ytre-Hauge, Kristian S

    2017-06-01

    In order to determine the relative biological effectiveness (RBE) of protons with high accuracy, radiobiological experiments with detailed knowledge of the linear energy transfer (LET) are needed. Cell survival data from high LET protons are sparse and experiments with low energy protons to achieve high LET values are therefore required. The aim of this study was to quantify LET distributions from a low energy proton beam by using Monte Carlo (MC) simulations, and to further compare to a proton beam representing a typical minimum energy available at clinical facilities. A Markus ionization chamber and Gafchromic films were employed in dose measurements in the proton beam at Oslo Cyclotron Laboratory. Dose profiles were also calculated using the FLUKA MC code, with the MC beam parameters optimized based on comparisons with the measurements. LET spectra and dose-averaged LET (LET d ) were then estimated in FLUKA, and compared with LET calculated from an 80 MeV proton beam. The initial proton energy was determined to be 15.5 MeV, with a Gaussian energy distribution of 0.2% full width at half maximum (FWHM) and a Gaussian lateral spread of 2 mm FWHM. The LET d increased with depth, from approximately 5 keV/μm in the entrance to approximately 40 keV/μm in the distal dose fall-off. The LET d values were considerably higher and the LET spectra were much narrower than the corresponding spectra from the 80 MeV beam. MC simulations accurately modeled the dose distribution from the proton beam and could be used to estimate the LET at any position in the setup. The setup can be used to study the RBE for protons at high LET d , which is not achievable in clinical proton therapy facilities.

  13. On the use of published radiobiological parameters and the evaluation of NTCP models regarding lung pneumonitis in clinical breast radiotherapy.

    PubMed

    Svolos, Patricia; Tsougos, Ioannis; Kyrgias, Georgios; Kappas, Constantine; Theodorou, Kiki

    2011-04-01

    In this study we sought to evaluate and accent the importance of radiobiological parameter selection and implementation to the normal tissue complication probability (NTCP) models. The relative seriality (RS) and the Lyman-Kutcher-Burman (LKB) models were studied. For each model, a minimum and maximum set of radiobiological parameter sets was selected from the overall published sets applied in literature and a theoretical mean parameter set was computed. In order to investigate the potential model weaknesses in NTCP estimation and to point out the correct use of model parameters, these sets were used as input to the RS and the LKB model, estimating radiation induced complications for a group of 36 breast cancer patients treated with radiotherapy. The clinical endpoint examined was Radiation Pneumonitis. Each model was represented by a certain dose-response range when the selected parameter sets were applied. Comparing the models with their ranges, a large area of coincidence was revealed. If the parameter uncertainties (standard deviation) are included in the models, their area of coincidence might be enlarged, constraining even greater their predictive ability. The selection of the proper radiobiological parameter set for a given clinical endpoint is crucial. Published parameter values are not definite but should be accompanied by uncertainties, and one should be very careful when applying them to the NTCP models. Correct selection and proper implementation of published parameters provides a quite accurate fit of the NTCP models to the considered endpoint.

  14. Monte Carlo role in radiobiological modelling of radiotherapy outcomes

    NASA Astrophysics Data System (ADS)

    El Naqa, Issam; Pater, Piotr; Seuntjens, Jan

    2012-06-01

    Radiobiological models are essential components of modern radiotherapy. They are increasingly applied to optimize and evaluate the quality of different treatment planning modalities. They are frequently used in designing new radiotherapy clinical trials by estimating the expected therapeutic ratio of new protocols. In radiobiology, the therapeutic ratio is estimated from the expected gain in tumour control probability (TCP) to the risk of normal tissue complication probability (NTCP). However, estimates of TCP/NTCP are currently based on the deterministic and simplistic linear-quadratic formalism with limited prediction power when applied prospectively. Given the complex and stochastic nature of the physical, chemical and biological interactions associated with spatial and temporal radiation induced effects in living tissues, it is conjectured that methods based on Monte Carlo (MC) analysis may provide better estimates of TCP/NTCP for radiotherapy treatment planning and trial design. Indeed, over the past few decades, methods based on MC have demonstrated superior performance for accurate simulation of radiation transport, tumour growth and particle track structures; however, successful application of modelling radiobiological response and outcomes in radiotherapy is still hampered with several challenges. In this review, we provide an overview of some of the main techniques used in radiobiological modelling for radiotherapy, with focus on the MC role as a promising computational vehicle. We highlight the current challenges, issues and future potentials of the MC approach towards a comprehensive systems-based framework in radiobiological modelling for radiotherapy.

  15. AFRRI Neutron Dosimetry and Radiobiology Conference

    DTIC Science & Technology

    1988-11-09

    Neutron Dosimetry and Radiobiology 8 - 9 November 1988 Sponsored by Defense Nuclear Agency ARMED FORCES RADIOBIOLOGY RESEARCH INSTITUTE...neutron radiation is less amenable to amelioration by chemical radioprotectants and more difficult to assess by means of physical dosimetry . These...neutron dosimetry and radiobiology we have witnessed in the past several years,could not have been possible without the sustained efforts of many

  16. Radiobiological effectiveness of laser accelerated electrons in comparison to electron beams from a conventional linear accelerator.

    PubMed

    Laschinsky, Lydia; Baumann, Michael; Beyreuther, Elke; Enghardt, Wolfgang; Kaluza, Malte; Karsch, Leonhard; Lessmann, Elisabeth; Naumburger, Doreen; Nicolai, Maria; Richter, Christian; Sauerbrey, Roland; Schlenvoigt, Hans-Peter; Pawelke, Jörg

    2012-01-01

    The notable progress in laser particle acceleration technology promises potential medical application in cancer therapy through compact and cost effective laser devices that are suitable for already existing clinics. Previously, consequences on the radiobiological response by laser driven particle beams characterised by an ultra high peak dose rate have to be investigated. Therefore, tumour and non-malignant cells were irradiated with pulsed laser accelerated electrons at the JETI facility for the comparison with continuous electrons of a conventional therapy LINAC. Dose response curves were measured for the biological endpoints clonogenic survival and residual DNA double strand breaks. The overall results show no significant differences in radiobiological response for in vitro cell experiments between laser accelerated pulsed and clinical used electron beams. These first systematic in vitro cell response studies with precise dosimetry to laser driven electron beams represent a first step toward the long term aim of the application of laser accelerated particles in radiotherapy.

  17. Radiotherapy of meningioma: a treatment in need of radiobiological research.

    PubMed

    Pinzi, Valentina; Bisogno, Ilaria; Prada, Francesco; Ciusani, Emilio; Fariselli, Laura

    2018-05-18

    Meningiomas account for one third of primary intracranial tumors, nevertheless information on meningioma cell lines and in vivo models is scant. Although radiotherapy is one of the most relevant therapeutic options for the treatment patients with meningioma, radiobiological research to understand tumor responses to this treatment is far from being thoroughly understood. The aim of this report is to provide a comprehensive picture of the current literature on this field, so as to foster s research in this regard. We carried out a review of meningioma radiobiology based on a peer-reviewed PubMed search. As a result of our study, we can confirm that the main limitation of radiobiological research into meningioma is the paucity of robust in vitro and in vivo models. Alternative approaches to overcome the already identified problems, and to allow better understanding of the entire histopathological spectrum of meningiomas have been explored. A radiobiological perspective of meningioma may help to improve clinical results both in terms of tumour control and healthy tissue sparing. Although we are far from drawing any conclusions, this review can lead researchers to identify some cues for future areas of study.

  18. Direct evaluation of radiobiological parameters from clinical data in the case of ion beam therapy: an alternative approach to the relative biological effectiveness.

    PubMed

    Cometto, A; Russo, G; Bourhaleb, F; Milian, F M; Giordanengo, S; Marchetto, F; Cirio, R; Attili, A

    2014-12-07

    The relative biological effectiveness (RBE) concept is commonly used in treatment planning for ion beam therapy. Whether models based on in vitro/in vivo RBE data can be used to predict human response to treatments is an open issue. In this work an alternative method, based on an effective radiobiological parameterization directly derived from clinical data, is presented. The method has been applied to the analysis of prostate cancer trials with protons and carbon ions.Prostate cancer trials with proton and carbon ion beams reporting 5 year-local control (LC5) and grade 2 (G2) or higher genitourinary toxicity rates (TOX) were selected from literature to test the method. Treatment simulations were performed on a representative subset of patients to produce dose and linear energy transfer distribution, which were used as explicative physical variables for the radiobiological modelling. Two models were taken into consideration: the microdosimetric kinetic model (MKM) and a linear model (LM). The radiobiological parameters of the LM and MKM were obtained by coupling them with the tumor control probability and normal tissue complication probability models to fit the LC5 and TOX data through likelihood maximization. The model ranking was based on the Akaike information criterion.Results showed large confidence intervals due to the limited variety of available treatment schedules. RBE values, such as RBE = 1.1 for protons in the treated volume, were derived as a by-product of the method, showing a consistency with current approaches. Carbon ion RBE values were also derived, showing lower values than those assumed for the original treatment planning in the target region, whereas higher values were found in the bladder. Most importantly, this work shows the possibility to infer the radiobiological parametrization for proton and carbon ion treatment directly from clinical data.

  19. [Systemic approach to radiobiological studies].

    PubMed

    Bulanova, K Ia; Lobanok, L M

    2004-01-01

    The principles of information theory were applied for analysis of radiobiological effects. The perception of ionizing radiations as a signal enables living organism to discern their benefits or harm, to react to absolute and relatively small deviations, to keep the logic and chronicle of events, to use the former experience for reacting in presence, to forecast consequences. The systemic analysis of organism's response to ionizing radiations allows explaining the peculiarities of effects of different absorbed doses, hormesis, apoptosis, remote consequences and other post-radiation effects.

  20. Tumour and normal tissue radiobiology in mouse models: how close are mice to mini-humans?

    PubMed

    Koontz, Bridget F; Verhaegen, Frank; De Ruysscher, Dirk

    2017-01-01

    Animal modelling is essential to the study of radiobiology and the advancement of clinical radiation oncology by providing preclinical data. Mouse models in particular have been highly utilized in the study of both tumour and normal tissue radiobiology because of their cost effectiveness and versatility. Technology has significantly advanced in preclinical radiation techniques to allow highly conformal image-guided irradiation of small animals in an effort to mimic human treatment capabilities. However, the biological and physical limitations of animal modelling should be recognized and considered when interpreting preclinical radiotherapy (RT) studies. Murine tumour and normal tissue radioresponse has been shown to vary from human cellular and molecular pathways. Small animal irradiation techniques utilize different anatomical boundaries and may have different physical properties than human RT. This review addresses the difference between the human condition and mouse models and discusses possible strategies for future refinement of murine models of cancer and radiation for the benefit of both basic radiobiology and clinical translation.

  1. Tumour and normal tissue radiobiology in mouse models: how close are mice to mini-humans?

    PubMed Central

    Verhaegen, Frank; De Ruysscher, Dirk

    2017-01-01

    Animal modelling is essential to the study of radiobiology and the advancement of clinical radiation oncology by providing preclinical data. Mouse models in particular have been highly utilized in the study of both tumour and normal tissue radiobiology because of their cost effectiveness and versatility. Technology has significantly advanced in preclinical radiation techniques to allow highly conformal image-guided irradiation of small animals in an effort to mimic human treatment capabilities. However, the biological and physical limitations of animal modelling should be recognized and considered when interpreting preclinical radiotherapy (RT) studies. Murine tumour and normal tissue radioresponse has been shown to vary from human cellular and molecular pathways. Small animal irradiation techniques utilize different anatomical boundaries and may have different physical properties than human RT. This review addresses the difference between the human condition and mouse models and discusses possible strategies for future refinement of murine models of cancer and radiation for the benefit of both basic radiobiology and clinical translation. PMID:27612010

  2. LDR vs. HDR brachytherapy for localized prostate cancer: the view from radiobiological models.

    PubMed

    King, Christopher R

    2002-01-01

    Permanent LDR brachytherapy and temporary HDR brachytherapy are competitive techniques for clinically localized prostate radiotherapy. Although a randomized trial will likely never be conducted comparing these two forms of brachytherapy, a comparative radiobiological modeling analysis proves useful in understanding some of their intrinsic differences, several of which could be exploited to improve outcomes. Radiobiological models based upon the linear quadratic equations are presented for fractionated external beam, fractionated (192)Ir HDR brachytherapy, and (125)I and (103)Pd LDR brachytherapy. These models incorporate the dose heterogeneities present in brachytherapy based upon patient-derived dose volume histograms (DVH) as well as tumor doubling times and repair kinetics. Radiobiological parameters are normalized to correspond to three accepted clinical risk factors based upon T-stage, PSA, and Gleason score to compare models with clinical series. Tumor control probabilities (TCP) for LDR and HDR brachytherapy (as monotherapy or combined with external beam) are compared with clinical bNED survival rates. Predictions are made for dose escalation with HDR brachytherapy regimens. Model predictions for dose escalation with external beam agree with clinical data and validate the models and their underlying assumptions. Both LDR and HDR brachytherapy achieve superior tumor control when compared with external beam at conventional doses (<70 Gy), but similar to results from dose escalation series. LDR brachytherapy as boost achieves superior tumor control than when used as monotherapy. Stage for stage, both LDR and current HDR regimens achieve similar tumor control rates, in agreement with current clinical data. HDR monotherapy with large-dose fraction sizes might achieve superior tumor control compared with LDR, especially if prostate cancer possesses a high sensitivity to dose fractionation (i.e., if the alpha/beta ratio is low). Radiobiological models support the

  3. OFFICE RADIOBIOLOGY AND THE TEST OF DIVIDED-DOSE IRRADIATION

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Scanlon, P.W.

    1963-08-01

    A simple and quantitatively accurate radiobiologic test system for office use by the clinical radiotherapist is described. Radiation inhibition of Lemna minor, or duckweed grown in an aquarium, forms the basis of the test system. Results are reported from radiation-inhibition studies using this system with time-dose variables appropriate to the radiation dose. The system proved adequate for testing the relative biologic effectiveness of the various quantities of radiation employed in clinical radiotherapy. (C.H.)

  4. Comparison of treatment plans: a retrospective study by the method of radiobiological evaluation

    NASA Astrophysics Data System (ADS)

    Puzhakkal, Niyas; Kallikuzhiyil Kochunny, Abdullah; Manthala Padannayil, Noufal; Singh, Navin; Elavan Chalil, Jumanath; Kulangarakath Umer, Jamshad

    2016-09-01

    There are many situations in radiotherapy where multiple treatment plans need to be compared for selection of an optimal plan. In this study we performed the radiobiological method of plan evaluation to verify the treatment plan comparison procedure of our clinical practice. We estimated and correlated various radiobiological dose indices with physical dose metrics for a total of 30 patients representing typical cases of head and neck, prostate and brain tumors. Three sets of plans along with a clinically approved plan (final plan) treated by either Intensity Modulated Radiation Therapy (IMRT) or Rapid Arc (RA) techniques were considered. The study yielded improved target coverage for final plans, however, no appreciable differences in doses and the complication probabilities of organs at risk were noticed. Even though all four plans showed adequate dose distributions, from dosimetric point of view, the final plan had more acceptable dose distribution. The estimated biological outcome and dose volume histogram data showed least differences between plans for IMRT when compared to RA. Our retrospective study based on 120 plans, validated the radiobiological method of plan evaluation. The tumor cure or normal tissue complication probabilities were found to be correlated with the corresponding physical dose indices.

  5. Standards and Methodologies for Characterizing Radiobiological Impact of High-Z Nanoparticles

    PubMed Central

    Subiel, Anna; Ashmore, Reece; Schettino, Giuseppe

    2016-01-01

    Research on the application of high-Z nanoparticles (NPs) in cancer treatment and diagnosis has recently been the subject of growing interest, with much promise being shown with regards to a potential transition into clinical practice. In spite of numerous publications related to the development and application of nanoparticles for use with ionizing radiation, the literature is lacking coherent and systematic experimental approaches to fully evaluate the radiobiological effectiveness of NPs, validate mechanistic models and allow direct comparison of the studies undertaken by various research groups. The lack of standards and established methodology is commonly recognised as a major obstacle for the transition of innovative research ideas into clinical practice. This review provides a comprehensive overview of radiobiological techniques and quantification methods used in in vitro studies on high-Z nanoparticles and aims to provide recommendations for future standardization for NP-mediated radiation research. PMID:27446499

  6. Radiobiological research at JINR's accelerators

    NASA Astrophysics Data System (ADS)

    Krasavin, E. A.

    2016-04-01

    The half-a-century development of radiobiological studies at the Joint Institute for Nuclear Research (JINR) is reviewed on a stage-by-stage basis. With the use of the institute's accelerators, some key aspects of radiation biology have been settled, including the relative biological effectiveness (RBE) of various types of ionizing radiation with different physical characteristics; radiation-induced mutagenesis mechanisms, and the formation and repair of genetic structure damage. Practical space radiobiology problems that can be solved using high-energy charged particles are discussed.

  7. An Expanded Multi-scale Monte Carlo Simulation Method for Personalized Radiobiological Effect Estimation in Radiotherapy: a feasibility study

    NASA Astrophysics Data System (ADS)

    Zhang, Ying; Feng, Yuanming; Wang, Wei; Yang, Chengwen; Wang, Ping

    2017-03-01

    A novel and versatile “bottom-up” approach is developed to estimate the radiobiological effect of clinic radiotherapy. The model consists of multi-scale Monte Carlo simulations from organ to cell levels. At cellular level, accumulated damages are computed using a spectrum-based accumulation algorithm and predefined cellular damage database. The damage repair mechanism is modeled by an expanded reaction-rate two-lesion kinetic model, which were calibrated through replicating a radiobiological experiment. Multi-scale modeling is then performed on a lung cancer patient under conventional fractionated irradiation. The cell killing effects of two representative voxels (isocenter and peripheral voxel of the tumor) are computed and compared. At microscopic level, the nucleus dose and damage yields vary among all nucleuses within the voxels. Slightly larger percentage of cDSB yield is observed for the peripheral voxel (55.0%) compared to the isocenter one (52.5%). For isocenter voxel, survival fraction increase monotonically at reduced oxygen environment. Under an extreme anoxic condition (0.001%), survival fraction is calculated to be 80% and the hypoxia reduction factor reaches a maximum value of 2.24. In conclusion, with biological-related variations, the proposed multi-scale approach is more versatile than the existing approaches for evaluating personalized radiobiological effects in radiotherapy.

  8. Radiobiological compensation: A case study of uterine cervix cancer with concurrent chemotherapy

    NASA Astrophysics Data System (ADS)

    Herrera, Higmar; Yañez, Elvia; López, Jesús

    2012-10-01

    The case of a patient diagnosed with uterine cervix cancer is presented as an example of the clinical application of the radiobiological compensation method implemented at Centro Estatal de Cancerología de Durango. Radiotherapy treatment was initially modified to compensate for the chemotherapy component and, as medical complications arose during treatment delivery resulting in an 18 days gap, new compensation followed. All physical and radiobiological assumptions to calculate the Biologically Effective Dose in the external beam and brachytherapy parts of the treatment are presented. Good local control of the tumor was achieved, the theoretical tolerance limits for the organs at risk were not surpassed and the patient manifested no extensive morbidity.

  9. Radiobiological compensation: A case study of uterine cervix cancer with concurrent chemotherapy

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Herrera, Higmar; Yanez, Elvia; Lopez, Jesus

    2012-10-23

    The case of a patient diagnosed with uterine cervix cancer is presented as an example of the clinical application of the radiobiological compensation method implemented at Centro Estatal de Cancerologia de Durango. Radiotherapy treatment was initially modified to compensate for the chemotherapy component and, as medical complications arose during treatment delivery resulting in an 18 days gap, new compensation followed. All physical and radiobiological assumptions to calculate the Biologically Effective Dose in the external beam and brachytherapy parts of the treatment are presented. Good local control of the tumor was achieved, the theoretical tolerance limits for the organs at riskmore » were not surpassed and the patient manifested no extensive morbidity.« less

  10. The European Radiobiology Archives (ERA)--content, structure and use illustrated by an example.

    PubMed

    Gerber, G B; Wick, R R; Kellerer, A M; Hopewell, J W; Di Majo, V; Dudoignon, N; Gössner, W; Stather, J

    2006-01-01

    The European Radiobiology Archives (ERA), supported by the European Commission and the European Late Effect Project Group (EULEP), together with the US National Radiobiology Archives (NRA) and the Japanese Radiobiology Archives (JRA) have collected all information still available on long-term animal experiments, including some selected human studies. The archives consist of a database in Microsoft Access, a website, databases of references and information on the use of the database. At present, the archives contain a description of the exposure conditions, animal strains, etc. from approximately 350,000 individuals; data on survival and pathology are available from approximately 200,000 individuals. Care has been taken to render pathological diagnoses compatible among different studies and to allow the lumping of pathological diagnoses into more general classes. 'Forms' in Access with an underlying computer code facilitate the use of the database. This paper describes the structure and content of the archives and illustrates an example for a possible analysis of such data.

  11. The Importance of Dosimetry Standardization in Radiobiology

    PubMed Central

    Desrosiers, Marc; DeWerd, Larry; Deye, James; Lindsay, Patricia; Murphy, Mark K; Mitch, Michael; Macchiarini, Francesca; Stojadinovic, Strahinja; Stone, Helen

    2013-01-01

    Radiation dose is central to much of radiobiological research. Precision and accuracy of dose measurements and reporting of the measurement details should be sufficient to allow the work to be interpreted and repeated and to allow valid comparisons to be made, both in the same laboratory and by other laboratories. Despite this, a careful reading of published manuscripts suggests that measurement and reporting of radiation dosimetry and setup for radiobiology research is frequently inadequate, thus undermining the reliability and reproducibility of the findings. To address these problems and propose a course of action, the National Cancer Institute (NCI), the National Institute of Allergy and Infectious Diseases (NIAID), and the National Institute of Standards and Technology (NIST) brought together representatives of the radiobiology and radiation physics communities in a workshop in September, 2011. The workshop participants arrived at a number of specific recommendations as enumerated in this paper and they expressed the desirability of creating dosimetry standard operating procedures (SOPs) for cell culture and for small and large animal experiments. It was also felt that these SOPs would be most useful if they are made widely available through mechanism(s) such as the web, where they can provide guidance to both radiobiologists and radiation physicists, be cited in publications, and be updated as the field and needs evolve. Other broad areas covered were the need for continuing education through tutorials at national conferences, and for journals to establish standards for reporting dosimetry. This workshop did not address issues of dosimetry for studies involving radiation focused at the sub-cellular level, internally-administered radionuclides, biodosimetry based on biological markers of radiation exposure, or dose reconstruction for epidemiological studies. PMID:26401441

  12. Changing paradigms in radiobiology.

    PubMed

    Mothersill, Carmel; Seymour, Colin

    2012-01-01

    The last 25 years have seen a major shift in emphasis in the field of radiobiology from a DNA-centric view of how radiation damage occurs to a much more biological view that appreciates the importance of macro-and micro-environments, hierarchical organization, underlying genetics, evolution, adaptation and signaling at all levels from atoms to ecosystems. The new view incorporates concepts of hormesis, nonlinear systems, bioenergy field theory, uncertainty and homeodynamics. While the mechanisms underlying these effects and responses are still far from clear, it is very apparent that their implications are much wider than the field of radiobiology. This reflection discusses the changing views and considers how they are influencing thought in environmental and medical science and systems biology. Copyright © 2012 Elsevier B.V. All rights reserved.

  13. Transformation of Physical DVHs to Radiobiologically Equivalent Ones in Hypofractionated Radiotherapy Analyzing Dosimetric and Clinical Parameters: A Practical Approach for Routine Clinical Practice in Radiation Oncology

    PubMed Central

    Thrapsanioti, Zoi; Karanasiou, Irene; Platoni, Kalliopi; Efstathopoulos, Efstathios P.; Matsopoulos, George; Dilvoi, Maria; Patatoukas, George; Chaldeopoulos, Demetrios; Kelekis, Nikolaos; Kouloulias, Vassilis

    2013-01-01

    Purpose. The purpose of this study was to transform DVHs from physical to radiobiological ones as well as to evaluate their reliability by correlations of dosimetric and clinical parameters for 50 patients with prostate cancer and 50 patients with breast cancer, who were submitted to Hypofractionated Radiotherapy. Methods and Materials. To achieve this transformation, we used both the linear-quadratic model (LQ model) and the Niemierko model. The outcome of radiobiological DVHs was correlated with acute toxicity score according to EORTC/RTOG criteria. Results. Concerning the prostate radiotherapy, there was a significant correlation between RTOG acute rectal toxicity and D 50 (P < 0.001) and V 60 (P = 0.001) dosimetric parameters, calculated for α/β = 10 Gy. Moreover, concerning the breast radiotherapy there was a significant correlation between RTOG skin toxicity and V ≥60 dosimetric parameter, calculated for both α/β = 2.3 Gy (P < 0.001) and α/β = 10 Gy (P < 0.001). The new tool seems reliable and user-friendly. Conclusions. Our proposed model seems user-friendly. Its reliability in terms of agreement with the presented acute radiation induced toxicity was satisfactory. However, more patients are needed to extract safe conclusions. PMID:24348743

  14. Radiobiological evaluation of the influence of dwell time modulation restriction in HIPO optimized HDR prostate brachytherapy implants.

    PubMed

    Mavroidis, Panayiotis; Katsilieri, Zaira; Kefala, Vasiliki; Milickovic, Natasa; Papanikolaou, Nikos; Karabis, Andreas; Zamboglou, Nikolaos; Baltas, Dimos

    2010-09-01

    One of the issues that a planner is often facing in HDR brachytherapy is the selective existence of high dose volumes around some few dominating dwell positions. If there is no information available about its necessity (e.g. location of a GTV), then it is reasonable to investigate whether this can be avoided. This effect can be eliminated by limiting the free modulation of the dwell times. HIPO, an inverse treatment plan optimization algorithm, offers this option. In treatment plan optimization there are various methods that try to regularize the variation of dose non-uniformity using purely dosimetric measures. However, although these methods can help in finding a good dose distribution they do not provide any information regarding the expected treatment outcome as described by radiobiology based indices. The quality of 12 clinical HDR brachytherapy implants for prostate utilizing HIPO and modulation restriction (MR) has been compared to alternative plans with HIPO and free modulation (without MR). All common dose-volume indices for the prostate and the organs at risk have been considered together with radiobiological measures. The clinical effectiveness of the different dose distributions was investigated by calculating the response probabilities of the tumors and organs-at-risk (OARs) involved in these prostate cancer cases. The radiobiological models used are the Poisson and the relative seriality models. Furthermore, the complication-free tumor control probability, P + and the biologically effective uniform dose ([Formula: see text]) were used for treatment plan evaluation and comparison. Our results demonstrate that HIPO with a modulation restriction value of 0.1-0.2 delivers high quality plans which are practically equivalent to those achieved with free modulation regarding the clinically used dosimetric indices. In the comparison, many of the dosimetric and radiobiological indices showed significantly different results. The modulation restricted clinical

  15. [Radiobiology and the lessons of Chernobyl].

    PubMed

    Baraboĭ, V A

    1990-01-01

    The Chernobyl accident has marked the beginning of a new stage of radiobiology development and revealed scantiness of old concepts. One should (1) search for effective protectors against the long-term influence of low-level radiation and means of removal of radionuclides using criteria that differ principally from those used previously in selecting among nontoxic antioxidants, immunomodulators, and adaptogens; (2) study systematically the synergism of low doses of harmful agents and review the hygienic standardization system with due regard for the risk from their combinations; (3) consider comprehensively, on the basis of the experimental and clinical experience, the problem of "hot" particles and remote consequences of their influence on the respiratory and digestive systems; (4) study independently the problem of chronic stress as a combination of radiation effects and psycho-emotional consequences of the accident and living in the exposed areas; (5) consider it inadmissible to include in the B category the population of the districts influenced by the accident and to use the concept: "35 rads during the lifetime" in standardizing the radiation load; (6) organize a comprehensive analysis of the Chernobyl accident consequences for public health within the contaminated areas as well as for animals and plants using a single approved methodology and programme, the principle of "other equal conditions" being provided.

  16. Radiobiological evaluation of the influence of dwell time modulation restriction in HIPO optimized HDR prostate brachytherapy implants

    PubMed Central

    Katsilieri, Zaira; Kefala, Vasiliki; Milickovic, Natasa; Papanikolaou, Nikos; Karabis, Andreas; Zamboglou, Nikolaos; Baltas, Dimos

    2010-01-01

    Purpose One of the issues that a planner is often facing in HDR brachytherapy is the selective existence of high dose volumes around some few dominating dwell positions. If there is no information available about its necessity (e.g. location of a GTV), then it is reasonable to investigate whether this can be avoided. This effect can be eliminated by limiting the free modulation of the dwell times. HIPO, an inverse treatment plan optimization algorithm, offers this option. In treatment plan optimization there are various methods that try to regularize the variation of dose non-uniformity using purely dosimetric measures. However, although these methods can help in finding a good dose distribution they do not provide any information regarding the expected treatment outcome as described by radiobiology based indices. Material and methods The quality of 12 clinical HDR brachytherapy implants for prostate utilizing HIPO and modulation restriction (MR) has been compared to alternative plans with HIPO and free modulation (without MR). All common dose-volume indices for the prostate and the organs at risk have been considered together with radiobiological measures. The clinical effectiveness of the different dose distributions was investigated by calculating the response probabilities of the tumors and organs-at-risk (OARs) involved in these prostate cancer cases. The radiobiological models used are the Poisson and the relative seriality models. Furthermore, the complication-free tumor control probability, P+ and the biologically effective uniform dose (D¯¯) were used for treatment plan evaluation and comparison. Results Our results demonstrate that HIPO with a modulation restriction value of 0.1-0.2 delivers high quality plans which are practically equivalent to those achieved with free modulation regarding the clinically used dosimetric indices. In the comparison, many of the dosimetric and radiobiological indices showed significantly different results. The modulation

  17. Organ culture as a technique for casual embryology and its application in radiobiology (in German)

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    BORGHESE, ELIO

    1961-11-01

    The classical methods of experimental embryology in amplubia are compared with the more recently introduced technique of culture in vitro of embryonic organs of warmblooded animals. Some isolation and recombination experiments carried out by means of organ culture are described. It is shown, by examples taken from research in progress, how this technique is applicable radiobiological experiments.

  18. Feasibility of BNCT radiobiological experiments at the HYTHOR facility

    NASA Astrophysics Data System (ADS)

    Esposito, J.; Ceballos, C.; Soncin, M.; Fabris, C.; Friso, E.; Moro, D.; Colautti, P.; Jori, G.; Rosi, G.; Nava, E.

    2008-06-01

    HYTHOR (HYbrid Thermal spectrum sHifter tapirO Reactor) is a new thermal-neutron irradiation facility, which was installed and became operative in mid 2005 at the TAPIRO (TAratura PIla Rapida potenza 0) fast reactor, in the Casaccia research centre (near Rome) of ENEA (Ente per le Nuove tecnologie Energia ed Ambiente). The facility has been designed for in vivo radiobiological studies. In HYTHOR irradiation cavity, 1-6 mice can be simultaneously irradiated to study skin melanoma treatments with the BNCT (boron neutron capture therapy). The therapeutic effects of HYTHOR radiation field on mouse melanoma has been studied as a preliminary investigation before studying the tumour local control due to boron neutron capture effect after boronated molecule injection. The method to properly irradiate small animals has been precisely defined. Results show that HYTHOR radiation field is by itself effective in reducing the tumour-growth rate. This finding has to be taken into account in studying the effectiveness of new 10B carriers. A method to properly measure the reduction of the tumour-growth rate is reported and discussed.

  19. Use of the NASA Space Radiation Laboratory at Brookhaven National Laboratory to Conduct Charged Particle Radiobiology Studies Relevant to Ion Therapy

    PubMed Central

    Held, Kathryn D.; Blakely, Eleanor A.; Story, Michael D.; Lowenstein, Derek I.

    2016-01-01

    Although clinical studies with carbon ions have been conducted successfully in Japan and Europe, the limited radiobiological information about charged particles that are heavier than protons remains a significant impediment to exploiting the full potential of particle therapy. There is growing interest in the U.S. to build a cancer treatment facility that utilizes charged particles heavier than protons. Therefore, it is essential that additional radiobiological knowledge be obtained using state-of-the-art technologies and biological models and end points relevant to clinical outcome. Currently, most such ion radiotherapy-related research is being conducted outside the U.S. This article addresses the substantial contributions to that research that are possible at the NASA Space Radiation Laboratory (NSRL) at Brookhaven National Laboratory (BNL), which is the only facility in the U.S. at this time where heavy-ion radiobiology research with the ion species and energies of interest for therapy can be done. Here, we briefly discuss the relevant facilities at NSRL and how selected charged particle biology research gaps could be addressed using those facilities. PMID:27195609

  20. Use of the NASA Space Radiation Laboratory at Brookhaven National Laboratory to Conduct Charged Particle Radiobiology Studies Relevant to Ion Therapy.

    PubMed

    Held, Kathryn D; Blakely, Eleanor A; Story, Michael D; Lowenstein, Derek I

    2016-06-01

    Although clinical studies with carbon ions have been conducted successfully in Japan and Europe, the limited radiobiological information about charged particles that are heavier than protons remains a significant impediment to exploiting the full potential of particle therapy. There is growing interest in the U.S. to build a cancer treatment facility that utilizes charged particles heavier than protons. Therefore, it is essential that additional radiobiological knowledge be obtained using state-of-the-art technologies and biological models and end points relevant to clinical outcome. Currently, most such ion radiotherapy-related research is being conducted outside the U.S. This article addresses the substantial contributions to that research that are possible at the NASA Space Radiation Laboratory (NSRL) at Brookhaven National Laboratory (BNL), which is the only facility in the U.S. at this time where heavy-ion radiobiology research with the ion species and energies of interest for therapy can be done. Here, we briefly discuss the relevant facilities at NSRL and how selected charged particle biology research gaps could be addressed using those facilities.

  1. New challenges in high-energy particle radiobiology

    PubMed Central

    2014-01-01

    Densely ionizing radiation has always been a main topic in radiobiology. In fact, α-particles and neutrons are sources of radiation exposure for the general population and workers in nuclear power plants. More recently, high-energy protons and heavy ions attracted a large interest for two applications: hadrontherapy in oncology and space radiation protection in manned space missions. For many years, studies concentrated on measurements of the relative biological effectiveness (RBE) of the energetic particles for different end points, especially cell killing (for radiotherapy) and carcinogenesis (for late effects). Although more recently, it has been shown that densely ionizing radiation elicits signalling pathways quite distinct from those involved in the cell and tissue response to photons. The response of the microenvironment to charged particles is therefore under scrutiny, and both the damage in the target and non-target tissues are relevant. The role of individual susceptibility in therapy and risk is obviously a major topic in radiation research in general, and for ion radiobiology as well. Particle radiobiology is therefore now entering into a new phase, where beyond RBE, the tissue response is considered. These results may open new applications for both cancer therapy and protection in deep space. PMID:24198199

  2. Radiobiology of systemic radiation therapy.

    PubMed

    Murray, David; McEwan, Alexander J

    2007-02-01

    Although systemic radionuclide therapy (SRT) is effective as a palliative therapy in patients with metastatic cancer, there has been limited success in expanding patterns of utilization and in bringing novel systemic radiotherapeutic agents to routine clinical use. Although there are many factors that contribute to this situation, we hypothesize that a better understanding of the radiobiology and mechanism of action of SRT will facilitate the development of future compounds and the future designs of prospective clinical trials. If these trials can be rationalized to the biological basis of the therapy, it is likely that the long-term outcome would be enhanced therapeutic efficacy. In this review, we provide perspectives of the current state of low-dose-rate (LDR) radiation research and offer linkages where appropriate with current clinical knowledge. These include the recently described phenomena of low-dose hyper-radiosensitivity-increased radioresistance (LDH-IRR), adaptive responses, and biological bystander effects. Each of these areas require a major reconsideration of existing models for radiation action and an understanding of how this knowledge will integrate into the evolution of clinical SRT practice. Validation of a role in vivo for both LDH-IRR and biological bystander effects in SRT would greatly impact the way we would assess therapeutic response to SRT, the design of clinical trials of novel SRT radiopharmaceuticals, and risk estimates for both therapeutic and diagnostic radiopharmaceuticals. We believe that the current state of research in LDR effects offers a major opportunity to the nuclear medicine community to address the basic science of clinical SRT practice, to use this new knowledge to expand the use and roles of SRT, and to facilitate the introduction of new therapeutic radiopharmaceuticals.

  3. Modification of radiobiological effects of 171 MeV protons by elements of physical protection

    NASA Astrophysics Data System (ADS)

    Bulinina, Taisia; Shurshakov, Vyacheslav; Ivanov, Alexander; Molokanov, Alexander

    2016-07-01

    Space radiation includes protons of various energies. Physical protection is effective in the case of low energy protons (50-100 MeV) and becomes insufficient for radiation with a high part of high-energy protons. In the experiment performed on outbred mice, the purpose of the study was to evaluate the radiobiological effect of 171 MeV protons and protons modified by elements of physical protection of the spacecraft, on a complex of indicators of the functional condition of the system hematopoiesis and the central nervous system in 24 hours after irradiation at 20 cGy dose. The spacecraft radiation protection elements used in the experiment were a construction of wet hygiene wipes called a «protective curtain», and a glass plate imitating an ISS window. Mass thickness of the " protective curtain" in terms of water equivalent was ̴ 6,2 g/cm2. Physical shielding along the path of 171 MeV protons increases their linear energy transfer leading to the absorbed dose elevation and strengthening of the radiobiological effect. In the experiment, the two types of shielding together raised the absorbed dose from 20 to 23.2 cGy. Chemically different materials (glass and water in the wipes) were found to exert unequal modifying effects on physical and biological parameters of the proton-irradiated mice. There was a distinct dose-dependent reduction of bone marrow cellularity within the dose range from 20 cGy to 23.2 cGy in 24 hours after exposure. No modifying effect of the radiation protection elements on spontaneous motor activity was discovered when compared with entrance protons. The group of animals protected by the glass plate exhibited normal orientative-trying reactions and weakened grip with the forelimbs. The effects observed in the experiment indicate the necessity to carry out comprehensive radiobiological researches (physical, biological and mathematical) in assessing the effects of physical protection, that are actual for ensuring radiation safety of crews in

  4. Radiobiological Determination of Dose Escalation and Normal Tissue Toxicity in Definitive Chemoradiation Therapy for Esophageal Cancer☆

    PubMed Central

    Warren, Samantha; Partridge, Mike; Carrington, Rhys; Hurt, Chris; Crosby, Thomas; Hawkins, Maria A.

    2014-01-01

    Purpose This study investigated the trade-off in tumor coverage and organ-at-risk sparing when applying dose escalation for concurrent chemoradiation therapy (CRT) of mid-esophageal cancer, using radiobiological modeling to estimate local control and normal tissue toxicity. Methods and Materials Twenty-one patients with mid-esophageal cancer were selected from the SCOPE1 database (International Standard Randomised Controlled Trials number 47718479), with a mean planning target volume (PTV) of 327 cm3. A boost volume, PTV2 (GTV + 0.5 cm margin), was created. Radiobiological modeling of tumor control probability (TCP) estimated the dose required for a clinically significant (+20%) increase in local control as 62.5 Gy/25 fractions. A RapidArc (RA) plan with a simultaneously integrated boost (SIB) to PTV2 (RA62.5) was compared to a standard dose plan of 50 Gy/25 fractions (RA50). Dose-volume metrics and estimates of normal tissue complication probability (NTCP) for heart and lungs were compared. Results Clinically acceptable dose escalation was feasible for 16 of 21 patients, with significant gains (>18%) in tumor control from 38.2% (RA50) to 56.3% (RA62.5), and only a small increase in predicted toxicity: median heart NTCP 4.4% (RA50) versus 5.6% (RA62.5) P<.001 and median lung NTCP 6.5% (RA50) versus 7.5% (RA62.5) P<.001. Conclusions Dose escalation to the GTV to improve local control is possible when overlap between PTV and organ-at-risk (<8% heart volume and <2.5% lung volume overlap for this study) generates only negligible increase in lung or heart toxicity. These predictions from radiobiological modeling should be tested in future clinical trials. PMID:25304796

  5. Radiobiological Determination of Dose Escalation and Normal Tissue Toxicity in Definitive Chemoradiation Therapy for Esophageal Cancer

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Warren, Samantha, E-mail: Samantha.warren@oncology.ox.ac.uk; Partridge, Mike; Carrington, Rhys

    2014-10-01

    Purpose: This study investigated the trade-off in tumor coverage and organ-at-risk sparing when applying dose escalation for concurrent chemoradiation therapy (CRT) of mid-esophageal cancer, using radiobiological modeling to estimate local control and normal tissue toxicity. Methods and Materials: Twenty-one patients with mid-esophageal cancer were selected from the SCOPE1 database (International Standard Randomised Controlled Trials number 47718479), with a mean planning target volume (PTV) of 327 cm{sup 3}. A boost volume, PTV2 (GTV + 0.5 cm margin), was created. Radiobiological modeling of tumor control probability (TCP) estimated the dose required for a clinically significant (+20%) increase in local control as 62.5more » Gy/25 fractions. A RapidArc (RA) plan with a simultaneously integrated boost (SIB) to PTV2 (RA{sub 62.5}) was compared to a standard dose plan of 50 Gy/25 fractions (RA{sub 50}). Dose-volume metrics and estimates of normal tissue complication probability (NTCP) for heart and lungs were compared. Results: Clinically acceptable dose escalation was feasible for 16 of 21 patients, with significant gains (>18%) in tumor control from 38.2% (RA{sub 50}) to 56.3% (RA{sub 62.5}), and only a small increase in predicted toxicity: median heart NTCP 4.4% (RA{sub 50}) versus 5.6% (RA{sub 62.5}) P<.001 and median lung NTCP 6.5% (RA{sub 50}) versus 7.5% (RA{sub 62.5}) P<.001. Conclusions: Dose escalation to the GTV to improve local control is possible when overlap between PTV and organ-at-risk (<8% heart volume and <2.5% lung volume overlap for this study) generates only negligible increase in lung or heart toxicity. These predictions from radiobiological modeling should be tested in future clinical trials.« less

  6. MO-D-BRD-03: Radiobiology and Commissioning of Electronic Brachytherapy for IORT

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Zhang, J.

    2015-06-15

    Electronic brachytherapy (eBT) has seen an insurgence of manufacturers entering the US market for use in radiation therapy. In addition to the established interstitial, intraluminary, and intracavitary applications of eBT, many centers are now using eBT to treat skin lesions. It is important for medical physicists working with electronic brachytherapy sources to understand the basic physics principles of the sources themselves as well as the variety of applications for which they are being used. The calibration of the sources is different from vendor to vendor and the traceability of calibrations has evolved as new sources came to market. In 2014,more » a new air-kerma based standard was introduced by the National Institute of Standards and Technology (NIST) to measure the output of an eBT source. Eventually commercial treatment planning systems should accommodate this new standard and provide NIST traceability to the end user. The calibration and commissioning of an eBT system is unique to its application and typically entails a list of procedural recommendations by the manufacturer. Commissioning measurements are performed using a variety of methods, some of which are modifications of existing AAPM Task Group protocols. A medical physicist should be familiar with the different AAPM Task Group recommendations for applicability to eBT and how to properly adapt them to their needs. In addition to the physical characteristics of an eBT source, the photon energy is substantially lower than from HDR Ir-192 sources. Consequently, tissue-specific dosimetry and radiobiological considerations are necessary when comparing these brachytherapy modalities and when making clinical decisions as a radiation therapy team. In this session, the physical characteristics and calibration methodologies of eBt sources will be presented as well as radiobiology considerations and other important clinical considerations. Learning Objectives: To understand the basic principles of

  7. Treatment plan comparison between helical tomotherapy and MLC-based IMRT using radiobiological measures

    NASA Astrophysics Data System (ADS)

    Mavroidis, Panayiotis; Costa Ferreira, Brigida; Shi, Chengyu; Lind, Bengt K.; Papanikolaou, Nikos

    2007-07-01

    The rapid implementation of advanced treatment planning and delivery technologies for radiation therapy has brought new challenges in evaluating the most effective treatment modality. Intensity-modulated radiotherapy (IMRT) using multi-leaf collimators (MLC) and helical tomotherapy (HT) are becoming popular modes of treatment delivery and their application and effectiveness continues to be investigated. Presently, there are several treatment planning systems (TPS) that can generate and optimize IMRT plans based on user-defined objective functions for the internal target volume (ITV) and organs at risk (OAR). However, the radiobiological parameters of the different tumours and normal tissues are typically not taken into account during dose prescription and optimization of a treatment plan or during plan evaluation. The suitability of a treatment plan is typically decided based on dosimetric criteria such as dose-volume histograms (DVH), maximum, minimum, mean and standard deviation of the dose distribution. For a more comprehensive treatment plan evaluation, the biologically effective uniform dose ({\\bar{\\bar{D}}}) is applied together with the complication-free tumour control probability (P+). Its utilization is demonstrated using three clinical cases that were planned with two different forms of IMRT. In this study, three different cancer types at different anatomical sites were investigated: head and neck, lung and prostate cancers. For each cancer type, a linac MLC-based step-and-shoot IMRT plan and a HT plan were developed. The MLC-based IMRT treatment plans were developed on the Philips treatment-planning platform, using the Pinnacle 7.6 software release. For the tomotherapy HiArt plans, the dedicated tomotherapy treatment planning station was used, running version 2.1.2. By using {\\bar{\\bar{D}}} as the common prescription point of the treatment plans and plotting the tissue response probabilities versus {\\bar{\\bar{D}}} for a range of prescription doses

  8. Three-Dimensional Radiobiologic Dosimetry: Application of Radiobiologic Modeling to Patient-Specific 3-Dimensional Imaging–Based Internal Dosimetry

    PubMed Central

    Prideaux, Andrew R.; Song, Hong; Hobbs, Robert F.; He, Bin; Frey, Eric C.; Ladenson, Paul W.; Wahl, Richard L.; Sgouros, George

    2010-01-01

    Phantom-based and patient-specific imaging-based dosimetry methodologies have traditionally yielded mean organ-absorbed doses or spatial dose distributions over tumors and normal organs. In this work, radiobiologic modeling is introduced to convert the spatial distribution of absorbed dose into biologically effective dose and equivalent uniform dose parameters. The methodology is illustrated using data from a thyroid cancer patient treated with radioiodine. Methods Three registered SPECT/CT scans were used to generate 3-dimensional images of radionuclide kinetics (clearance rate) and cumulated activity. The cumulated activity image and corresponding CT scan were provided as input into an EGSnrc-based Monte Carlo calculation: The cumulated activity image was used to define the distribution of decays, and an attenuation image derived from CT was used to define the corresponding spatial tissue density and composition distribution. The rate images were used to convert the spatial absorbed dose distribution to a biologically effective dose distribution, which was then used to estimate a single equivalent uniform dose for segmented volumes of interest. Equivalent uniform dose was also calculated from the absorbed dose distribution directly. Results We validate the method using simple models; compare the dose-volume histogram with a previously analyzed clinical case; and give the mean absorbed dose, mean biologically effective dose, and equivalent uniform dose for an illustrative case of a pediatric thyroid cancer patient with diffuse lung metastases. The mean absorbed dose, mean biologically effective dose, and equivalent uniform dose for the tumor were 57.7, 58.5, and 25.0 Gy, respectively. Corresponding values for normal lung tissue were 9.5, 9.8, and 8.3 Gy, respectively. Conclusion The analysis demonstrates the impact of radiobiologic modeling on response prediction. The 57% reduction in the equivalent dose value for the tumor reflects a high level of dose

  9. Laser-driven particle acceleration for radiobiology and radiotherapy: where we are and where we are going

    NASA Astrophysics Data System (ADS)

    Giulietti, Antonio

    2017-05-01

    Radiation therapy of tumors progresses continuously and so do devices, sharing a global market of about $ 4 billions, growing at an annual rate exceeding 5%. Most of the progress involves tumor targeting, multi-beam irradiation, reduction of damage on healthy tissues and critical organs, dose fractioning. This fast-evolving scenario is the moving benchmark for the progress of the laser-based accelerators towards clinical uses. As for electrons, both energy and dose requested by radiotherapy are available with plasma accelerators driven by lasers in the power range of tens of TW but several issues have still to be faced before getting a prototype device for clinical tests. They include capability of varying electron energy, stability of the process, reliability for medical users. On the other side hadron therapy, presently applied to a small fraction of cases but within an exponential growth, is a primary option for the future. With such a strong motivation, research on laser-based proton/ion acceleration has been supported in the last decade in order to get performances suitable to clinical standards. None of these performances has been achieved so far with laser techniques. In the meantime a rich crop of data have been obtained in radiobiological experiments performed with beams of particles produced with laser techniques. It is quite significant however that most of the experiments have been performed moving bio samples to laser labs, rather moving laser equipment to bio labs or clinical contexts. This give us the measure that laser community cannot so far provide practical devices usable by non-laser people.

  10. Chasing Ghosts in Space Radiobiology Research: The Lost Focus on Non-Targeted Effects

    NASA Astrophysics Data System (ADS)

    Cucinotta, Francis; Saganti, Premkumar; Cacao, Eliedonna

    2016-07-01

    The doses and dose-rates of astronaut exposures to galactic cosmic rays (GCR) are accurately known, and lead to particle hits per cell nucleus from high charge and energy (HZE) particles of much less than one hit per cell per week. A large number of experiments have shown that additivity of biological effects is a valid assumption for space radiation exposures, while experiments at higher doses and dose-rates than occur in space continue to be a focus of the majority of space radiobiology research. Furthermore HZE particle exposures with mono-energetic particles manifest themselves as a mixed-radiation field due to the contributions of delta-rays and the random impact parameter of a particles track core to DNA and non-DNA targets in cells and tissues. The mixed-field manifestation of mono-energetic HZE particle exposures is well known from theoretical studies of microdosimetry and track structure. Additional mixed-field effects occur for single species experiments due to nuclear fragmentation in particle accelerator beam-lines and biological samples along with energy straggling. In contrast to these well known aspects of space radiobiology there are many open questions on the contribution of non-targeted effects to low dose and dose-rate exposures. Non-targeted effects (NTEs) include bystander effects and genomic instability, and have been shown to be the most important outstanding question for reducing uncertainties in space radiation cancer risk assessment. The dose-rate and radiation quality dependence of NTE's has not been established, while there is an over-arching need to develop 21st century experimental models of human cancer risk. We review possible mechanisms of NTE's and how new experiments to address these issues could be designed.

  11. Radiobiological concepts for treatment planning of schemes that combines external beam radiotherapy and systemic targeted radiotherapy

    NASA Astrophysics Data System (ADS)

    Fabián Calderón Marín, Carlos; González González, Joaquín Jorge; Laguardia, Rodolfo Alfonso

    2017-09-01

    The combination of radiotherapy modalities with external bundles and systemic radiotherapy (CIERT) could be a reliable alternative for patients with multiple lesions or those where treatment planning maybe difficult because organ(s)-at-risk (OARs) constraints. Radiobiological models should have the capacity for predicting the biological irradiation response considering the differences in the temporal pattern of dose delivering in both modalities. Two CIERT scenarios were studied: sequential combination in which one modality is executed following the other one and concurrent combination when both modalities are running simultaneously. Expressions are provided for calculation of the dose-response magnitudes Tumor Control Probability (TCP) and Normal Tissue Complication Probability (NTCP). General results on radiobiological modeling using the linear-quadratic (LQ) model are also discussed. Inter-subject variation of radiosensitivity and volume irradiation effect in CIERT are studied. OARs should be under control during the planning in concurrent CIERT treatment as the administered activity is increased. The formulation presented here may be used for biological evaluation of prescriptions and biological treatment planning of CIERT schemes in clinical situation.

  12. SU-F-T-670: From the OR to the Radiobiology Lab: The Journey of a Small X-Ray Source

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Lehmann, J; The University of Sydney, Sydney, NSW; The University of Newcastle, Newcastle, NSW

    Purpose: Irradiation of small animal tumor models within laboratories is vital to radiobiological experiments. Often the animals are not able to be brought back into the lab after being taken out for irradiation. Cell biology laboratories benefit from irradiation capability available around the clock without regard to patient load in an associated radiotherapy clinic. Commercial systems are available, but bulky and expensive. Methods: An intraoperative kV irradiation system (IntraBeam™) designed to deliver spherical dose distributions to surgical cavities has been repurposed for the irradiation of cell plates and small laboratory animals. An applicator has been altered to allow for simple,more » open fields. Special collimators are being developed. BEAMnrc Monte Carlo simulations with the “NRC swept BEAM” source model have been performed to characterize the dose distributions, to develop optimal collimators and as basis for dose prescription. Measurements with radiochromic film and with an ionization chamber were performed to characterize the beam and to validate the simulations. Results: Using its highest setting (50 kV and 40 µA) the x-ray unit is capable of delivering dose rates over 1 Gy/min homogeneously to standard cell plates even without an optimized collimator. Smaller areas (tumors in animals) can be irradiated with significantly higher dose rates (> 20 Gy/min) depending on distance of the source to the tumor. The HVL was found to be 0.21 mm Al which means the shielding requirements for the device are easily achievable in the lab. Conclusion: A mobile irradiation facility is feasible. It will allow easier access to radiation for radiobiology experiments. The modified system is versatile in that for cell plates homogenous irradiations can be achieved through distance from the source, while for high dose rate small field irradiations the source can be brought in close proximity to the target.« less

  13. Characteristics of Effective Clinical Teachers in Simulated Clinical Experiences Compared to Traditional Clinical Experiences

    ERIC Educational Resources Information Center

    Sieh-Bliss, Selina

    2014-01-01

    While there is evidence in the literature measuring effective clinical teacher characteristics in traditional experiences, little is known of effective characteristics expected from clinical teachers during simulated clinical experiences. This study examined which clinical teaching behaviors and characteristics are perceived by nursing students'…

  14. Grid Block Design Based on Monte Carlo Simulated Dosimetry, the Linear Quadratic and Hug–Kellerer Radiobiological Models

    PubMed Central

    Gholami, Somayeh; Nedaie, Hassan Ali; Longo, Francesco; Ay, Mohammad Reza; Dini, Sharifeh A.; Meigooni, Ali S.

    2017-01-01

    Purpose: The clinical efficacy of Grid therapy has been examined by several investigators. In this project, the hole diameter and hole spacing in Grid blocks were examined to determine the optimum parameters that give a therapeutic advantage. Methods: The evaluations were performed using Monte Carlo (MC) simulation and commonly used radiobiological models. The Geant4 MC code was used to simulate the dose distributions for 25 different Grid blocks with different hole diameters and center-to-center spacing. The therapeutic parameters of these blocks, namely, the therapeutic ratio (TR) and geometrical sparing factor (GSF) were calculated using two different radiobiological models, including the linear quadratic and Hug–Kellerer models. In addition, the ratio of the open to blocked area (ROTBA) is also used as a geometrical parameter for each block design. Comparisons of the TR, GSF, and ROTBA for all of the blocks were used to derive the parameters for an optimum Grid block with the maximum TR, minimum GSF, and optimal ROTBA. A sample of the optimum Grid block was fabricated at our institution. Dosimetric characteristics of this Grid block were measured using an ionization chamber in water phantom, Gafchromic film, and thermoluminescent dosimeters in Solid Water™ phantom materials. Results: The results of these investigations indicated that Grid blocks with hole diameters between 1.00 and 1.25 cm and spacing of 1.7 or 1.8 cm have optimal therapeutic parameters (TR > 1.3 and GSF~0.90). The measured dosimetric characteristics of the optimum Grid blocks including dose profiles, percentage depth dose, dose output factor (cGy/MU), and valley-to-peak ratio were in good agreement (±5%) with the simulated data. Conclusion: In summary, using MC-based dosimetry, two radiobiological models, and previously published clinical data, we have introduced a method to design a Grid block with optimum therapeutic response. The simulated data were reproduced by experimental data

  15. Consequences of anorectal cancer atlas implementation in the cooperative group setting: radiobiologic analysis of a prospective randomized in silico target delineation study.

    PubMed

    Mavroidis, Panayiotis; Giantsoudis, Drosoula; Awan, Musaddiq J; Nijkamp, Jasper; Rasch, Coen R N; Duppen, Joop C; Thomas, Charles R; Okunieff, Paul; Jones, William E; Kachnic, Lisa A; Papanikolaou, Niko; Fuller, Clifton D

    2014-09-01

    The aim of this study is to ascertain the subsequent radiobiological impact of using a consensus guideline target volume delineation atlas. Using a representative case and target volume delineation instructions derived from a proposed IMRT rectal cancer clinical trial, gross tumor volume (GTV) and clinical/planning target volumes (CTV/PTV) were contoured by 13 physician observers (Phase 1). The observers were then randomly assigned to follow (atlas) or not-follow (control) a consensus guideline/atlas for anorectal cancers, and instructed to re-contour the same case (Phase 2). The atlas group was found to have increased tumor control probability (TCP) after the atlas intervention for both the CTV (p<0.0001) and PTV1 (p=0.0011) with decreasing normal tissue complication probability (NTCP) for small intestine, while the control group did not. Additionally, the atlas group had reduced variance in TCP for all target volumes and reduced variance in NTCP for the bowel. In Phase 2, the atlas group had increased TCP relative to the control for CTV (p=0.03). Visual atlas and consensus treatment guideline usage in the development of rectal cancer IMRT treatment plans reduced the inter-observer radiobiological variation, with clinically relevant TCP alteration for CTV and PTV volumes. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

  16. SU-F-T-03: Radiobiological Evaluation of a Directional Brachytherapy Device Surgically Implanted Following EBRT

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Rivard, MJ; Emrich, JG; Poli, J

    2016-06-15

    Purpose: Preceding surgical implantation following external-beam radiotherapy (EBRT) delivery, a radiobiological evaluation was performed for a new LDR Pd-103 directional brachytherapy device (CivaSheet). As this was the first case with the device used in combination with EBRT, there was concern to determine the appropriate prescription dose. Methods: The radiobiological model of Dale (1985, 1989) was used for a permanent LDR implant including radioactive decay. The biological effective dose (BED) was converted to the equivalent dose in 2 Gy fractions (EQD2) for comparison with EBRT prescription expectations. Given IMRT delivery of 50.4 Gy, an LDR brachytherapy dose of approximately 15–20 Gymore » EQD2 was desired. To be specific to the treatment site (leiomyosarcoma T2bN0M0, grade 2 with R1 surgical margin), the radiobiological model required several radiobiological parameters with values taken from the literature. A sensitivity analysis was performed to determine their relative importance on the calculated BED and subsequent EQD2. The Pd-103 decay constant (λ=0.0017 h{sup −1}) was also used. DVHs were prepared for pre- and post-surgical geometries to glean the possible and realized implant geometric configuration. DVHs prepared in VariSeed9 were converted to BEDVHs and subsequently EQD2 values for each volume-element. Results: For a physical dose of 28 Gy to a 0.5 cm depth, BED=21.7 Gy and EQD2=17.6 Gy, which was near the center of the desired EQD2 range. Tumor bed (CTV=4 cm{sup 3}) coverage was 99.2% with 48 sources implanted. In order of decreasing importance from the sensitivity analysis, the radiobiological parameters were α=0.25 Gy{sup −1}, T{sub POT}=23 days, α/β=8.6 Gy, and T=1.5 h. Percentage variations in these values produced EQD2 variations of 40%, 20%, 18%, and 1%, respectively. Conclusion: This radiobiological evaluation indicated that prescription dose may be determined for comparison with the desired EQD2, and that

  17. BNL accelerator-based radiobiology facilities

    NASA Technical Reports Server (NTRS)

    Lowenstein, D. I.

    2001-01-01

    For the past several years, the Alternating Gradient Synchrotron (AGS) at Brookhaven National Laboratory (USA) has provided ions of iron, silicon and gold, at energies from 600 MeV/nucleon to 10 GeV/nucleon, for the US National Aeronautics and Space Administration (NASA) radiobiology research program. NASA has recently funded the construction of a new dedicated ion facility, the Booster Applications Facility (BAF). The Booster synchrotron will supply ion beams ranging from protons to gold, in an energy range from 40-3000 MeV/nucleon with maximum beam intensities of 10(10) to 10(11) ions per pulse. The BAF Project will be described and the future AGS and BAF operation plans will be presented.

  18. BNL accelerator-based radiobiology facilities.

    PubMed

    Lowenstein, D I

    2001-01-01

    For the past several years, the Alternating Gradient Synchrotron (AGS) at Brookhaven National Laboratory (USA) has provided ions of iron, silicon and gold, at energies from 600 MeV/nucleon to 10 GeV/nucleon, for the US National Aeronautics and Space Administration (NASA) radiobiology research program. NASA has recently funded the construction of a new dedicated ion facility, the Booster Applications Facility (BAF). The Booster synchrotron will supply ion beams ranging from protons to gold, in an energy range from 40-3000 MeV/nucleon with maximum beam intensities of 10(10) to 10(11) ions per pulse. The BAF Project will be described and the future AGS and BAF operation plans will be presented.

  19. The radiobiology of laser-driven particle beams: focus on sub-lethal responses of normal human cells

    NASA Astrophysics Data System (ADS)

    Manti, L.; Perozziello, F. M.; Borghesi, M.; Candiano, G.; Chaudhary, P.; Cirrone, G. A. P.; Doria, D.; Gwynne, D.; Leanza, R.; Prise, K. M.; Romagnani, L.; Romano, F.; Scuderi, V.; Tramontana, A.

    2017-03-01

    Accelerated proton beams have become increasingly common for treating cancer. The need for cost and size reduction of particle accelerating machines has led to the pioneering investigation of optical ion acceleration techniques based on laser-plasma interactions as a possible alternative. Laser-matter interaction can produce extremely pulsed particle bursts of ultra-high dose rates (>= 109 Gy/s), largely exceeding those currently used in conventional proton therapy. Since biological effects of ionizing radiation are strongly affected by the spatio-temporal distribution of DNA-damaging events, the unprecedented physical features of such beams may modify cellular and tissue radiosensitivity to unexplored extents. Hence, clinical applications of laser-generated particles need thorough assessment of their radiobiological effectiveness. To date, the majority of studies have either used rodent cell lines or have focussed on cancer cell killing being local tumour control the main objective of radiotherapy. Conversely, very little data exist on sub-lethal cellular effects, of relevance to normal tissue integrity and secondary cancers, such as premature cellular senescence. Here, we discuss ultra-high dose rate radiobiology and present preliminary data obtained in normal human cells following irradiation by laser-accelerated protons at the LULI PICO2000 facility at Laser Lab Europe, France.

  20. SU-F-T-680: Radiobiological Analysis of the Impact of Daily Patient Deformation and Setup Variations Through the Use of the Cone Beam CT and Deformable Image Registration in Lung Cancer IMRT

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Jurkovic, I; Stathakis, S; Markovic, M

    Purpose: To estimate the dose distributions delivered to the patient in each treatment fraction using deformable image registration (DIR) and assess the radiobiological impact of the inter-fraction variations due to patient deformation and setup. Methods: The work is based on the cone beam CT (CBCT) images and treatment plans of two lung cancer patients. Both patients were treated with intensity modulated radiation therapy (IMRT) to 66Gy in 2Gy/fraction. The treatment plans were exported from the treatment planning system (TPS) to the Velocity AI where DIR was performed and the same deformation matrix was used for the deformation of the plannedmore » dose distribution and organ contours to each CBCT dataset. A radiobiological analysis was performed based on the radiobiological parameters of the involved organs at risk (OARs) and planning target volume (PTV). Using the complication free tumor control probability (P+) index, differences in P+ were observed between each CBCT as well as between CBCT and planning dose distributions. Results: The optimal CBCT P? values ranged from 91.6 % to 94.8 % for patient #1 and from 88.8 % to 90.6 % for patient #2. At the dose level of the clinical prescription, the CBCT P+ values ranged from 80.3% to 80.7% for patient #1 and from 80.7% to 81.0% for the patient #2. The planning CT P+ values were 81.0% and 80.7% for the two patients, respectively. These differences emphasize the significance of using the radiobiological analysis when assessing changes in the dose distribution due to the tumor motion and lung deformations. Conclusion: Daily setup variations yield to differences in the actual dose delivered versus the planned one. The observed differences were rather small when only looking at the dosimetric comparison of the dose distributions, however the radiobiology analysis was able to detect clinically relevant differences among the studied dose distributions.« less

  1. Effects of radiobiological uncertainty on shield design for a 60-day lunar mission

    NASA Technical Reports Server (NTRS)

    Wilson, John W.; Nealy, John E.; Schimmerling, Walter

    1993-01-01

    Some consequences of uncertainties in radiobiological risk due to galactic cosmic ray exposure are analyzed to determine their effect on engineering designs for a first lunar outpost - a 60-day mission. Quantitative estimates of shield mass requirements as a function of a radiobiological uncertainty factor are given for a simplified vehicle structure. The additional shield mass required for compensation is calculated as a function of the uncertainty in galactic cosmic ray exposure, and this mass is found to be as large as a factor of 3 for a lunar transfer vehicle. The additional cost resulting from this mass is also calculated. These cost estimates are then used to exemplify the cost-effectiveness of research.

  2. Detailed characterization of the 1087 MeV/nucleon iron-56 beam used for radiobiology at the alternating gradient synchrotron

    NASA Technical Reports Server (NTRS)

    Zeitlin, C.; Heilbronn, L.; Miller, J.

    1998-01-01

    We report beam characterization and dosimetric measurements made using a 56Fe beam extracted from the Brookhaven National Laboratory Alternating Gradient Synchrotron (AGS) with a kinetic energy of 1087 MeV/nucleon. The measurements reveal that the depth-dose distribution of this beam differs significantly from that obtained with a 600 MeV/nucleon iron beam used in several earlier radiobiology experiments at the Lawrence Berkeley National Laboratory's BEVALAC. We present detailed measurements of beam parameters relevant for radiobiology, including track- and dose-averaged linear energy transfer (LET), fragment composition and LET spectra measured behind sample holders used in irradiations of biological samples. We also report measurements of fluence behind three depths (1.94, 4.68 and 9.35 g cm(-2)) of polyethylene targets with the 1087 MeV/nucleon beam, and behind 1.94 g cm(-2) of polyethylene with a 610 MeV/nucleon beam delivered by the AGS. These results are compared to earlier measurements with the 600 MeV/nucleon beam at the BEVALAC.

  3. Issues for Simulation of Galactic Cosmic Ray Exposures for Radiobiological Research at Ground-Based Accelerators

    PubMed Central

    Kim, Myung-Hee Y.; Rusek, Adam; Cucinotta, Francis A.

    2015-01-01

    For radiobiology research on the health risks of galactic cosmic rays (GCR) ground-based accelerators have been used with mono-energetic beams of single high charge, Z and energy, E (HZE) particles. In this paper, we consider the pros and cons of a GCR reference field at a particle accelerator. At the NASA Space Radiation Laboratory (NSRL), we have proposed a GCR simulator, which implements a new rapid switching mode and higher energy beam extraction to 1.5 GeV/u, in order to integrate multiple ions into a single simulation within hours or longer for chronic exposures. After considering the GCR environment and energy limitations of NSRL, we performed extensive simulation studies using the stochastic transport code, GERMcode (GCR Event Risk Model) to define a GCR reference field using 9 HZE particle beam–energy combinations each with a unique absorber thickness to provide fragmentation and 10 or more energies of proton and 4He beams. The reference field is shown to well represent the charge dependence of GCR dose in several energy bins behind shielding compared to a simulated GCR environment. However, a more significant challenge for space radiobiology research is to consider chronic GCR exposure of up to 3 years in relation to simulations with animal models of human risks. We discuss issues in approaches to map important biological time scales in experimental models using ground-based simulation, with extended exposure of up to a few weeks using chronic or fractionation exposures. A kinetics model of HZE particle hit probabilities suggests that experimental simulations of several weeks will be needed to avoid high fluence rate artifacts, which places limitations on the experiments to be performed. Ultimately risk estimates are limited by theoretical understanding, and focus on improving knowledge of mechanisms and development of experimental models to improve this understanding should remain the highest priority for space radiobiology research. PMID:26090339

  4. Dosimetry for radiobiological studies of the human hematopoietic system

    NASA Technical Reports Server (NTRS)

    Beck, W. L.; Stokes, T. R.; Lushbaugh, C. C.

    1972-01-01

    A system for estimating individual bone marrow doses in therapeutic radiation exposures of leukemia patients was studied. These measurements are used to make dose response correlations and to study the effect of dose protraction on peripheral blood cell levels. Three irradiators designed to produce a uniform field of high energy gamma radiation for total body exposures of large animals and man are also used for radiobiological studies.

  5. Influence of oxygen on the chemical stage of radiobiological mechanism

    NASA Astrophysics Data System (ADS)

    Barilla, Jiří; Lokajíček, Miloš V.; Pisaková, Hana; Simr, Pavel

    2016-07-01

    The simulation of the chemical stage of radiobiological mechanism may be very helpful in studying the radiobiological effect of ionizing radiation when the water radical clusters formed by the densely ionizing ends of primary or secondary charged particle may form DSBs damaging DNA molecules in living cells. It is possible to study not only the efficiency of individual radicals but also the influence of other species or radiomodifiers (mainly oxygen) being present in water medium during irradiation. The mathematical model based on Continuous Petri nets (proposed by us recently) will be described. It makes it possible to analyze two main processes running at the same time: chemical radical reactions and the diffusion of radical clusters formed during energy transfer. One may study the time change of radical concentrations due to the chemical reactions running during diffusion process. Some orientation results concerning the efficiency of individual radicals in DSB formation (in the case of Co60 radiation) will be presented; the influence of oxygen present in water medium during irradiation will be shown, too.

  6. SU-E-T-275: Radiobiological Evaluation of Intensity Modulated Radiotherapy Treatment for Locally Advanced Head and Neck Squamous Cell Carcinomas

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Rekha Reddy, B.; Ravikumar, M.; Tanvir Pasha, C.R

    2014-06-01

    Purpose: To evaluate the radiobiological outcome of Intensity Modulated Radiotherapy Treatment (IMRT) for locally advanced head and neck squamous cell carcinomas using HART (Histogram Analysis in Radiation Therapy; J Appl Clin Med Phys 11(1): 137–157, 2010) program and compare with the clinical outcomes. Methods: We have treated 20 patients of stage III and IV HNSCC Oropharynx and hypopharynx with accelerated IMRT technique and concurrent chemotherapy. Delineation of tumor and normal tissues were done using Danish Head and Neck Cancer Group (DAHANCA) contouring guidelines and radiotherapy was delivered to a dose of 70Gy in 35 fractions to the primary and involvedmore » lymph nodes, 63Gy to intermediate risk areas and 56 Gy to lower risk areas, Monday to Saturday, 6 Days/week using 6 MV Photons with an expected overall treatment time of 6 weeks. The TCP and NTCP's were calculated from the dose-volume histogram (DVH) statistics using the Poisson Statistics (PS) and JT Lyman models respectively and the Resultwas correlated with clinical outcomes of the patients with mean follow up of 24 months. Results: Using HART program, the TCP (0.89± 0.01) of primary tumor and the NTCP for parotids (0.20±0.12), spinal cord (0.05±0.01), esophagus (0.30±0.2), mandible (0.35±0.21), Oral cavity (0.37±0.18), Larynx (0.30±0.15) were estimated and correlated with clinical outcome of the patients. Conclusion: Accelerated IMRT with Chemotherapy is a clinical feasible option in the treatment of locally advanced HNSCC with encouraging initial tumour response and acceptable acute toxicities. The correlation between the clinical outcomes and radiobiological model estimated parameters using HART programs are found to be satisfactory.« less

  7. Apoptosis, energy metabolism, and fraction of radiobiologically hypoxic cells: a study of human melanoma multicellular spheroids.

    PubMed

    Rofstad, E K; Eide, K; Skøyum, R; Hystad, M E; Lyng, H

    1996-09-01

    The magnitude of the fraction of radiobiologically hypoxic cells in tumours is generally believed to reflect the efficiency of the vascular network. Theoretical studies have suggested that the hypoxic fraction might also be influenced by biological properties of the tumour cells. Quantitative experimental results of cell energy metabolism, hypoxia- induced apoptosis, and radiobiological hypoxia are reported here. Human melanoma multicellular spheroids (BEX-c and WIX-c) were used as tumour models to avoid confounding effects of the vascular network. Radiobiological studies showed that the fractions of hypoxic cells in 1000-microM spheroids were 32 +/- 12% (BEX-c) and 2.5 +/- 1.1% (WIX-c). The spheroid hypoxic volume fractions (28 +/- 6% (BEX-c) and 1.4 +/- 7% (WIX-c)), calculated from the rate of oxygen consumption per cell, the cell packing density, and the thickness of the viable rim, were similar to the fractions of radiobiologically hypoxic cells. Large differences between tumours in fraction of hypoxic cells are therefore not necessarily a result of differences in the efficiency of the vascular network. Studies of monolayer cell cultures, performed to identify the biological properties of the BEX-c and WIX-c cells leading to this large difference in fraction of hypoxic cells, gave the following results: (1) WIX-c showed lower cell surviving fractions after exposure to hypoxia than BEX-c, (2) WIX-c showed higher glucose uptake and lactate release rates than BEX-c both under aerobic and hypoxic conditions, and (3) hypoxia induced apoptosis in WIX-c but not in BEX-c. These observations suggested that the difference between BEX-c and WIX-c spheroids in fraction of hypoxic cells resulted partly from differences in cell energy metabolism and partly from a difference in capacity to retain viability under hypoxic stress. The induction of apoptosis by hypoxia was identified as a phenomenon which has an important influence on the magnitude of the fraction of

  8. Successful Teaching of Radiobiology Students in the Medical Management of Acute Radiation Effects From Real Case Histories Using Clinical Signs and Symptoms and Taking Advantage of Recently Developed Software Tools.

    PubMed

    Majewski, Matthäus; Combs, Stephanie E; Trott, Klaus-Rüdiger; Abend, Michael; Port, Matthias

    2018-07-01

    In 2015, the Bundeswehr Institute of Radiobiology organized a North Atlantic Treaty Organization exercise to examine the significance of clinical signs and symptoms for the prediction of late-occurring acute radiation syndrome. Cases were generated using either the Medical Treatment Protocols for Radiation Accident Victims (METREPOL, n = 167) system or using real-case descriptions extracted from a database system for evaluation and archiving of radiation accidents based on case histories (SEARCH, n = 24). The cases ranged from unexposed [response category 0 (RC 0, n = 89)] to mild (RC 1, n = 45), moderate (RC 2, n = 19), severe (RC 3, n = 20), and lethal (RC 4, n = 18) acute radiation syndrome. During the previous exercise, expert teams successfully predicted hematological acute radiation syndrome severity, determined whether hospitalization was required, and gave treatment recommendations, taking advantage of different software tools developed by the North Atlantic Treaty Organization teams. The authors provided the same data set to radiobiology students who were introduced to the medical management of acute effects after radiation exposure and the software tools during a class lasting 15 h. Corresponding to the previous results, difficulties in the discrimination between RC 0/RC 1 and RC 3/RC 4, as well as a systematic underestimation of RC 1 and RC 2, were observed. Nevertheless, after merging reported response categories into clinically relevant groups (RC 0-1, RC 2-3, and RC 3-4), it was found that the majority of cases (95.2% ± 2.2 standard deviations) were correctly identified and that 94.7% (±2.6 standard deviations) developing acute radiation syndrome and z96.4% (±1.6 standard deviations) requiring hospitalization were identified correctly. Two out of three student teams also provided a dose estimate. These results are comparable to the best-performing team of the 2015 North Atlantic Treaty Organization exercise (response category: 92.5%; acute

  9. A study of the radiobiological modeling of the conformal radiation therapy in cancer treatment

    NASA Astrophysics Data System (ADS)

    Pyakuryal, Anil Prasad

    Cancer is one of the leading causes of mortalities in the world. The precise diagnosis of the disease helps the patients to select the appropriate modality of the treatments such as surgery, chemotherapy and radiation therapy. The physics of X-radiation and the advanced imaging technologies such as positron emission tomography (PET) and computed tomography (CT) plays an important role in the efficient diagnosis and therapeutic treatments in cancer. However, the accuracy of the measurements of the metabolic target volumes (MTVs) in the PET/CT dual-imaging modality is always limited. Similarly the external beam radiation therapy (XRT) such as 3D conformal radiotherapy (3DCRT) and intensity modulated radiation therapy (IMRT) is the most common modality in the radiotherapy treatment. These treatments are simulated and evaluated using the XRT plans and the standard methodologies in the commercial planning system. However, the normal organs are always susceptible to the radiation toxicity in these treatments due to lack of knowledge of the appropriate radiobiological models to estimate the clinical outcomes. We explored several methodologies to estimate MTVs by reviewing various techniques of the target volume delineation using the static phantoms in the PET scans. The review suggests that the more precise and practical method of delineating PET MTV should be an intermediate volume between the volume coverage for the standardized uptake value (SUV; 2.5) of glucose and the 50% (40%) threshold of the maximum SUV for the smaller (larger) volume delineations in the radiotherapy applications. Similarly various types of optimal XRT plans were designed using the CT and PET/CT scans for the treatment of various types of cancer patients. The qualities of these plans were assessed using the universal plan-indices. The dose-volume criteria were also examined in the targets and organs by analyzing the conventional dose-volume histograms (DVHs). The biological models such as tumor

  10. Towards a Clinical Decision Support System for External Beam Radiation Oncology Prostate Cancer Patients: Proton vs. Photon Radiotherapy? A Radiobiological Study of Robustness and Stability

    PubMed Central

    Walsh, Seán; Roelofs, Erik; Kuess, Peter; van Wijk, Yvonka; Lambin, Philippe; Jones, Bleddyn; Verhaegen, Frank

    2018-01-01

    We present a methodology which can be utilized to select proton or photon radiotherapy in prostate cancer patients. Four state-of-the-art competing treatment modalities were compared (by way of an in silico trial) for a cohort of 25 prostate cancer patients, with and without correction strategies for prostate displacements. Metrics measured from clinical image guidance systems were used. Three correction strategies were investigated; no-correction, extended-no-action-limit, and online-correction. Clinical efficacy was estimated via radiobiological models incorporating robustness (how probable a given treatment plan was delivered) and stability (the consistency between the probable best and worst delivered treatments at the 95% confidence limit). The results obtained at the cohort level enabled the determination of a threshold for likely clinical benefit at the individual level. Depending on the imaging system and correction strategy; 24%, 32% and 44% of patients were identified as suitable candidates for proton therapy. For the constraints of this study: Intensity-modulated proton therapy with online-correction was on average the most effective modality. Irrespective of the imaging system, each treatment modality is similar in terms of robustness, with and without the correction strategies. Conversely, there is substantial variation in stability between the treatment modalities, which is greatly reduced by correction strategies. This study provides a ‘proof-of-concept’ methodology to enable the prospective identification of individual patients that will most likely (above a certain threshold) benefit from proton therapy. PMID:29463018

  11. Mixed-field GCR Simulations for Radiobiological Research using Ground Based Accelerators

    NASA Astrophysics Data System (ADS)

    Kim, Myung-Hee Y.; Rusek, Adam; Cucinotta, Francis

    Space radiation is comprised of a large number of particle types and energies, which have differential ionization power from high energy protons to high charge and energy (HZE) particles and secondary neutrons produced by galactic cosmic rays (GCR). Ground based accelerators such as the NASA Space Radiation Laboratory (NSRL) at Brookhaven National Laboratory (BNL) are used to simulate space radiation for radiobiology research and dosimetry, electronics parts, and shielding testing using mono-energetic beams for single ion species. As a tool to support research on new risk assessment models, we have developed a stochastic model of heavy ion beams and space radiation effects, the GCR Event-based Risk Model computer code (GERMcode). For radiobiological research on mixed-field space radiation, a new GCR simulator at NSRL is proposed. The NSRL-GCR simulator, which implements the rapid switching mode and the higher energy beam extraction to 1.5 GeV/u, can integrate multiple ions into a single simulation to create GCR Z-spectrum in major energy bins. After considering the GCR environment and energy limitations of NSRL, a GCR reference field is proposed after extensive simulation studies using the GERMcode. The GCR reference field is shown to reproduce the Z and LET spectra of GCR behind shielding within 20 percents accuracy compared to simulated full GCR environments behind shielding. A major challenge for space radiobiology research is to consider chronic GCR exposure of up to 3-years in relation to simulations with cell and animal models of human risks. We discuss possible approaches to map important biological time scales in experimental models using ground-based simulation with extended exposure of up to a few weeks and fractionation approaches at a GCR simulator.

  12. Mixed-field GCR Simulations for Radiobiological Research Using Ground Based Accelerators

    NASA Technical Reports Server (NTRS)

    Kim, Myung-Hee Y.; Rusek, Adam; Cucinotta, Francis A.

    2014-01-01

    Space radiation is comprised of a large number of particle types and energies, which have differential ionization power from high energy protons to high charge and energy (HZE) particles and secondary neutrons produced by galactic cosmic rays (GCR). Ground based accelerators such as the NASA Space Radiation Laboratory (NSRL) at Brookhaven National Laboratory (BNL) are used to simulate space radiation for radiobiology research and dosimetry, electronics parts, and shielding testing using mono-energetic beams for single ion species. As a tool to support research on new risk assessment models, we have developed a stochastic model of heavy ion beams and space radiation effects, the GCR Event-based Risk Model computer code (GERMcode). For radiobiological research on mixed-field space radiation, a new GCR simulator at NSRL is proposed. The NSRL-GCR simulator, which implements the rapid switching mode and the higher energy beam extraction to 1.5 GeV/u, can integrate multiple ions into a single simulation to create GCR Z-spectrum in major energy bins. After considering the GCR environment and energy limitations of NSRL, a GCR reference field is proposed after extensive simulation studies using the GERMcode. The GCR reference field is shown to reproduce the Z and LET spectra of GCR behind shielding within 20% accuracy compared to simulated full GCR environments behind shielding. A major challenge for space radiobiology research is to consider chronic GCR exposure of up to 3-years in relation to simulations with cell and animal models of human risks. We discuss possible approaches to map important biological time scales in experimental models using ground-based simulation with extended exposure of up to a few weeks and fractionation approaches at a GCR simulator.

  13. Past and Future Work on Radiobiology Mega-Studies: A Case Study At Argonne National Laboratory

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Haley, Benjamin; Wang, Qiong; Wanzer, Beau

    2011-09-06

    Between 1952 and 1992, more than 200 large radiobiology studies were conducted in research institutes throughout Europe, North America, and Japan to determine the effects of external irradiation and internal emitters on the lifespan and tissue toxicity development in animals. At Argonne National Laboratory, 22 external beam studies were conducted on nearly 700 beagle dogs and 50,000 mice between 1969 and 1992. These studies helped to characterize the effects of neutron and gamma irradiation on lifespan, tumorigenesis, and mutagenesis across a range of doses and dosing patterns. The records and tissues collected at Argonne during that time period have beenmore » carefully preserved and redisseminated. Using these archived data, ongoing statistical work has been done and continues to characterize quality of radiation, dose, dose rate, tissue, and gender-specific differences in the radiation responses of exposed animals. The ongoing application of newly-developed molecular biology techniques to the archived tissues has revealed gene-specific mutation rates following exposure to ionizing irradiation. The original and ongoing work with this tissue archive is presented here as a case study of a more general trend in the radiobiology megastudies. These experiments helped form the modern understanding of radiation responses in animals and continue to inform development of new radiation models. Recent archival efforts have facilitated open access to the data and materials produced by these studies, and so a unique opportunity exists to expand this continued research.« less

  14. Ill-posed problem and regularization in reconstruction of radiobiological parameters from serial tumor imaging data

    NASA Astrophysics Data System (ADS)

    Chvetsov, Alevei V.; Sandison, George A.; Schwartz, Jeffrey L.; Rengan, Ramesh

    2015-11-01

    The main objective of this article is to improve the stability of reconstruction algorithms for estimation of radiobiological parameters using serial tumor imaging data acquired during radiation therapy. Serial images of tumor response to radiation therapy represent a complex summation of several exponential processes as treatment induced cell inactivation, tumor growth rates, and the rate of cell loss. Accurate assessment of treatment response would require separation of these processes because they define radiobiological determinants of treatment response and, correspondingly, tumor control probability. However, the estimation of radiobiological parameters using imaging data can be considered an inverse ill-posed problem because a sum of several exponentials would produce the Fredholm integral equation of the first kind which is ill posed. Therefore, the stability of reconstruction of radiobiological parameters presents a problem even for the simplest models of tumor response. To study stability of the parameter reconstruction problem, we used a set of serial CT imaging data for head and neck cancer and a simplest case of a two-level cell population model of tumor response. Inverse reconstruction was performed using a simulated annealing algorithm to minimize a least squared objective function. Results show that the reconstructed values of cell surviving fractions and cell doubling time exhibit significant nonphysical fluctuations if no stabilization algorithms are applied. However, after applying a stabilization algorithm based on variational regularization, the reconstruction produces statistical distributions for survival fractions and doubling time that are comparable to published in vitro data. This algorithm is an advance over our previous work where only cell surviving fractions were reconstructed. We conclude that variational regularization allows for an increase in the number of free parameters in our model which enables development of more

  15. Radiobiological studies using gamma and x rays.

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Potter, Charles Augustus; Longley, Susan W.; Scott, Bobby R.

    2013-02-01

    There are approximately 500 self-shielded research irradiators used in various facilities throughout the U.S. These facilities use radioactive sources containing either 137Cs or 60Co for a variety of biological investigations. A report from the National Academy of Sciences[1] described the issues with security of particular radiation sources and the desire for their replacement. The participants in this effort prepared two peer-reviewed publications to document the results of radiobiological studies performed using photons from 320-kV x rays and 137Cs on cell cultures and mice. The effectiveness of X rays was shown to vary with cell type.

  16. Fluctuations in energy loss and their implications for dosimetry and radiobiology

    NASA Technical Reports Server (NTRS)

    Baily, N. A.; Steigerwalt, J. E.

    1972-01-01

    Serious consideration of the physics of energy deposition indicates that a fundamental change in the interpretation of absorbed dose is required at least for considerations of effects in biological systems. In addition, theoretical approaches to radiobiology and microdosimetry seem to require statistical considerations incorporating frequency distributions of the magnitude of the event sizes within the volume of interest.

  17. ‘Survival’: a simulation toolkit introducing a modular approach for radiobiological evaluations in ion beam therapy

    NASA Astrophysics Data System (ADS)

    Manganaro, L.; Russo, G.; Bourhaleb, F.; Fausti, F.; Giordanengo, S.; Monaco, V.; Sacchi, R.; Vignati, A.; Cirio, R.; Attili, A.

    2018-04-01

    One major rationale for the application of heavy ion beams in tumour therapy is their increased relative biological effectiveness (RBE). The complex dependencies of the RBE on dose, biological endpoint, position in the field etc require the use of biophysical models in treatment planning and clinical analysis. This study aims to introduce a new software, named ‘Survival’, to facilitate the radiobiological computations needed in ion therapy. The simulation toolkit was written in C++ and it was developed with a modular architecture in order to easily incorporate different radiobiological models. The following models were successfully implemented: the local effect model (LEM, version I, II and III) and variants of the microdosimetric-kinetic model (MKM). Different numerical evaluation approaches were also implemented: Monte Carlo (MC) numerical methods and a set of faster analytical approximations. Among the possible applications, the toolkit was used to reproduce the RBE versus LET for different ions (proton, He, C, O, Ne) and different cell lines (CHO, HSG). Intercomparison between different models (LEM and MKM) and computational approaches (MC and fast approximations) were performed. The developed software could represent an important tool for the evaluation of the biological effectiveness of charged particles in ion beam therapy, in particular when coupled with treatment simulations. Its modular architecture facilitates benchmarking and inter-comparison between different models and evaluation approaches. The code is open source (GPL2 license) and available at https://github.com/batuff/Survival.

  18. Radiobiological evaluation of simultaneously dose-escalated versus non-escalated intensity-modulated radiation therapy for patients with upper thoracic esophageal cancer.

    PubMed

    Huang, Bao-Tian; Wu, Li-Li; Guo, Long-Jia; Xu, Liang-Yu; Huang, Rui-Hong; Lin, Pei-Xian; Chen, Jian-Zhou; Li, De-Rui; Chen, Chuang-Zhen

    2017-01-01

    To compare the radiobiological response between simultaneously dose-escalated and non-escalated intensity-modulated radiation therapy (DE-IMRT and NE-IMRT) for patients with upper thoracic esophageal cancer (UTEC) using radiobiological evaluation. Computed tomography simulation data sets for 25 patients pathologically diagnosed with primary UTEC were used in this study. DE-IMRT plan with an escalated dose of 64.8 Gy/28 fractions to the gross tumor volume (GTV) and involved lymph nodes from 25 patients pathologically diagnosed with primary UTEC, was compared to an NE-IMRT plan of 50.4 Gy/28 fractions. Dose-volume metrics, tumor control probability (TCP), and normal tissue complication probability for the lung and spinal cord were compared. In addition, the risk of acute esophageal toxicity (AET) and late esophageal toxicity (LET) were also analyzed. Compared with NE-IMRT plan, we found the DE-IMRT plan resulted in a 14.6 Gy dose escalation to the GTV. The tumor control was predicted to increase by 31.8%, 39.1%, and 40.9% for three independent TCP models. The predicted incidence of radiation pneumonitis was similar (3.9% versus 3.6%), and the estimated risk of radiation-induced spinal cord injury was extremely low (<0.13%) in both groups. Regarding the esophageal toxicities, the estimated grade ≥2 and grade ≥3 AET predicted by the Kwint model were increased by 2.5% and 3.8%. Grade ≥2 AET predicted using the Wijsman model was increased by 14.9%. The predicted incidence of LET was low (<0.51%) in both groups. Radiobiological evaluation reveals that the DE-IMRT dosing strategy is feasible for patients with UTEC, with significant gains in tumor control and minor or clinically acceptable increases in radiation-induced toxicities.

  19. SU-F-J-11: Radiobiologically Optimized Patient Localization During Prostate External Beam Localization

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Huang, Y; Gardner, S; Liu, C

    2016-06-15

    Purpose: To present a novel positioning strategy which optimizes radiation delivery with radiobiological response knowledge, and to evaluate its application during prostate external beam radiotherapy. Methods: Ten patients with low or intermediate risk prostate cancer were evaluated retrospectively in this IRB-approved study. For each patient, a VMAT plan was generated on the planning CT (PCT) to deliver 78 Gy in 39 fractions with PTV = prostate + 7 mm margin, except for 5mm in the posterior direction. Five representative pretreatment CBCT images were selected for each patient, and prostate, rectum, and bladder were delineated on all CBCT images. Each CBCTmore » was auto-registered to the corresponding PCT. Starting from this auto-matched position (AM-position), a search for optimal treatment position was performed utilizing a score function based on radiobiological and dosimetric indices (D98-DTV, NTCP-rectum, and NTCP-bladder) for the daily target volume (DTV), rectum, and bladder. DTV was defined as prostate + 4 mm margin to account for intra-fraction motion as well as contouring variability on CBCT. We termed the optimal treatment position the radiobiologically optimized couch shift position (ROCS-position). Results: The indices, averaged over the 10 patients’ treatment plans, were (mean±SD): 77.7±0.2 Gy (D98-PTV), 12.3±2.7% (NTCP-rectum), and 53.2±11.2% (NTCP-bladder). The corresponding values calculated on all 50 CBCT images at the AM-positions were 72.9±11.3 Gy (D98-DTV), 15.8±6.4% (NTCP-rectum), and 53.0±21.1% (NTCP-bladder), respectively. In comparison, calculated on CBCT at the ROCS-positions, the indices were 77.0±2.1 Gy (D98-DTV), 12.1±5.7% (NTCP-rectum), and 60.7±16.4% (NTCP-bladder). Compared to autoregistration, ROCS-optimization recovered dose coverage to target volume and lowered the risk to rectum. Moreover, NTCPrectum for one patient remained high after ROCS-optimization and therefore could potentially benefit from adaptive planning

  20. Radiobiological modeling of two stereotactic body radiotherapy schedules in patients with stage I peripheral non-small cell lung cancer.

    PubMed

    Huang, Bao-Tian; Lin, Zhu; Lin, Pei-Xian; Lu, Jia-Yang; Chen, Chuang-Zhen

    2016-06-28

    This study aims to compare the radiobiological response of two stereotactic body radiotherapy (SBRT) schedules for patients with stage I peripheral non-small cell lung cancer (NSCLC) using radiobiological modeling methods. Volumetric modulated arc therapy (VMAT)-based SBRT plans were designed using two dose schedules of 1 × 34 Gy (34 Gy in 1 fraction) and 4 × 12 Gy (48 Gy in 4 fractions) for 19 patients diagnosed with primary stage I NSCLC. Dose to the gross target volume (GTV), planning target volume (PTV), lung and chest wall (CW) were converted to biologically equivalent dose in 2 Gy fraction (EQD2) for comparison. Five different radiobiological models were employed to predict the tumor control probability (TCP) value. Three additional models were utilized to estimate the normal tissue complication probability (NTCP) value for the lung and the modified equivalent uniform dose (mEUD) value to the CW. Our result indicates that the 1 × 34 Gy dose schedule provided a higher EQD2 dose to the tumor, lung and CW. Radiobiological modeling revealed that the TCP value for the tumor, NTCP value for the lung and mEUD value for the CW were 7.4% (in absolute value), 7.2% (in absolute value) and 71.8% (in relative value) higher on average, respectively, using the 1 × 34 Gy dose schedule.

  1. Cell irradiation setup and dosimetry for radiobiological studies at ELBE

    NASA Astrophysics Data System (ADS)

    Zeil, K.; Beyreuther, E.; Lessmann, E.; Wagner, W.; Pawelke, J.

    2009-07-01

    The radiation source ELBE delivers different types of secondary radiation, which is used for cell irradiation studies in radiobiological research. Thereby an important issue is the determination of the biological effectiveness of photon radiation as a function of photon energy by using low-energetic, monochromatic channeling radiation (10-100 keV) and high-energetic bremsstrahlung (up to 40 MV). Radiobiological studies at the research facility ELBE demand special technical and dosimetric prerequisites. Therefore, a cell irradiation system (CIS) has been designed, constructed and installed at the beam line. The CIS allows automatic irradiation of a larger cell sample number and the compensation of spatial inhomogeneity of the dose distribution within the beam spot. The recently introduced GafChromic ® EBT radiochromic film model has been used to verify the cell irradiation dose deposition achieving a dose uncertainty of <5%. Both, the installed cell irradiation system and the developed dosimetric procedure based on the use of the EBT film have been experimentally tested at ELBE. The biological effectiveness of 34 MV bremsstrahlung with respect to 200 kV X-rays from a conventional X-ray tube has been determined. An RBE value of 0.75 has been measured in good agreement with literature.

  2. Cell survivor: Modeling radiobiological phenomena with a new kind of simulation

    NASA Astrophysics Data System (ADS)

    Spencer, Melissa A.

    Despite widespread societal fear of radiation, whether justified or unjustified, and whether related to medicine (e.g., CT scans) or other forms of nuclear and atomic radiation (e.g., nuclear power) there is a fundamental lack of basic understanding of radiation effects on the human body. Different types of radiation are psychologically grouped into the same general fear category irrespective of their different potential to do harm, and this fear is not balanced by their potential beneficial effects. By modeling certain types of radiation biology experiments within a game engine, it is possible to enhance the player's intuitive understanding of radiobiology, both the effects of different types of radiation as well as different environmental factors that can enhance or suppress repair. For this dissertation, a game/simulation has been developed that intends to narrow the gap between public perception and the reality of these physical processes. The building blocks of this simulation are cells, which are damaged by incident radiation, accumulating either single or double strand breaks. They grow and reproduce, and are especially vulnerable during certain phases of the cell cycle (e.g. mitosis). Two dominant damage mechanisms are modeled, along with multiple repair mechanisms, for example, double strand breaks can be repaired by either non-homologous end joining or homologous repair. The output of the developed simulation was compared to data collected in experimental studies and the simulation appears to be a valid representation of the dominant mechanisms of radiobiology, as far as can be determined within the scope of this dissertation. Cell survival curves generated from playtest data display shoulders that depend on the LET of incident radiation, and rest time restores repair capability. In addition to public outreach, the presented code can be used to aid investigators by collecting data during play that can be used as a distributed Monte Carlo simulation

  3. Comparison of cytogenetic effects in bone marrow of mice after the flight on the biosatellite "BION-M1" and the ground-based radiobiological experiment

    NASA Astrophysics Data System (ADS)

    Dorozhkina, Olga; Vorozhtsova, Svetlana; Ivanov, Alexander

    2016-07-01

    During space flight, the astronauts are exposed to radiation exposure at low doses with low dose rates, so one of the actual areas of Radiobiology is research of action of ionizing radiation in low and ultra-low doses. Violation of the chromosome apparatus of living biosystems, ranging from viruses and bacteria to humans, is the most reliable evidence of exposure to ionizing radiation. In this regard, the study of cytogenetic damage in the cells of humans and animals is central to space radiobiology (Fedorenko B.S., 2006). In experiment "BION - M1" by anaphase method was determined level of chromosomal aberrations in bone marrow cells of tibia of mice. Flight duration biosatellite "BION - M1" (Sychev V.N. et al., 2014) was 30 days in Earth orbit. Euthanasia of experimental animals was carried out after 12 hours from the moment of landing satellite by method of cervical dislocation. The level of chromosomal aberrations in vivarium-housed control mice was 1,75 ± 0,6% and 1,8 ± 0,45%, while the mitotic index 1,46 ± 0,09% and 1,53 ± 0,05%. The content of animals in the experiment with onboard equipment led to some increase in aberrant mitosis (2,3 ± 0,4%) and reduction of the mitotic index (1,37 ± 0,02%). In the flight experiment "BION-M1" was a statistically significant increase in level of chromosome aberrations (29,7 ± 4,18%) and a decrease in the mitotic index (0,74 ± 0,07%). According to VA Shurshakova (2014), the radiation dose to mice ranged from 32 to 72 mGy and relate to a range of small doses (ICRP, 2012). In this connection we conducted a series of experiments in the ground conditions, the aim of which was the study of earliest effects of ionizing radiation in vivo in mice irradiated with low doses of γ-irradiation of 10 to 200 mGy in the first 24 hours after exposure, i.e. within the first post-radiation exposure cell cycle. Studies were carried out on adult female mice outbred ICR (CD-1) - SPF category at the age of 4-4.5 months with an average

  4. Radiobiologically optimized couch shift: A new localization paradigm using cone-beam CT for prostate radiotherapy

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Huang, Yimei, E-mail: yhuang2@hfhs.org; Gardner, Stephen J.; Wen, Ning

    2015-10-15

    Purpose: To present a novel positioning strategy which optimizes radiation delivery by utilizing radiobiological response knowledge and evaluate its use during prostate external beam radiotherapy. Methods: Five patients with low or intermediate risk prostate cancer were evaluated retrospectively in this IRB-approved study. For each patient, a VMAT plan with one 358° arc was generated on the planning CT (PCT) to deliver 78 Gy in 39 fractions. Five representative pretreatment cone beam CTs (CBCT) were selected for each patient. The CBCT images were registered to PCT by a human observer, which consisted of an initial automated registration with three degrees-of-freedom, followedmore » by manual adjustment for agreement at the prostate/rectal wall interface. To determine the optimal treatment position for each CBCT, a search was performed centering on the observer-matched position (OM-position) utilizing a score function based on radiobiological and dosimetric indices (EUD{sub prostate}, D99{sub prostate}, NTCP{sub rectum}, and NTCP{sub bladder}) for the prostate, rectum, and bladder. We termed the optimal treatment position the radiobiologically optimized couch shift position (ROCS-position). Results: The dosimetric indices, averaged over the five patients’ treatment plans, were (mean ± SD) 79.5 ± 0.3 Gy (EUD{sub prostate}), 78.2 ± 0.4 Gy (D99{sub prostate}), 11.1% ± 2.7% (NTCP{sub rectum}), and 46.9% ± 7.6% (NTCP{sub bladder}). The corresponding values from CBCT at the OM-positions were 79.5 ± 0.6 Gy (EUD{sub prostate}), 77.8 ± 0.7 Gy (D99{sub prostate}), 12.1% ± 5.6% (NTCP{sub rectum}), and 51.6% ± 15.2% (NTCP{sub bladder}), respectively. In comparison, from CBCT at the ROCS-positions, the dosimetric indices were 79.5 ± 0.6 Gy (EUD{sub prostate}), 77.3 ± 0.6 Gy (D99{sub prostate}), 8.0% ± 3.3% (NTCP{sub rectum}), and 46.9% ± 15.7% (NTCP{sub bladder}). Excessive NTCP{sub rectum} was observed on Patient 5 (19.5% ± 6.6%) corresponding to localization

  5. The Safe use of Radioactive Isotopes in Teaching Experiments

    ERIC Educational Resources Information Center

    Hawcroft, D. M.; Stewart, J. C.

    1974-01-01

    This article briefly discusses some of the dangers involved in the use of radioisotopes and includes a comprehensive list of precautions and laboratory rules for use during radiobiology experiments. (Author)

  6. Heavy Charged Particle Radiobiology: Using Enhanced Biological Effectiveness and Improved Beam Focusing to Advance Cancer Therapy

    PubMed Central

    Allen, Christopher; Borak, Thomas B.; Tsujii, Hirohiko; Nickoloff, Jac A.

    2011-01-01

    Ionizing radiation causes many types of DNA damage, including base damage and single- and double-strand breaks. Photons, including X-rays and γ-rays, are the most widely used type of ionizing radiation in radiobiology experiments, and in radiation cancer therapy. Charged particles, including protons and carbon ions, are seeing increased use as an alternative therapeutic modality. Although the facilities needed to produce high energy charged particle beams are more costly than photon facilities, particle therapy has shown improved cancer survival rates, reflecting more highly focused dose distributions and more severe DNA damage to tumor cells. Despite early successes of charged particle radiotherapy, there is room for further improvement, and much remains to be learned about normal and cancer cell responses to charged particle radiation. PMID:21376738

  7. Present Status of Radiotherapy in Clinical Practice

    NASA Astrophysics Data System (ADS)

    Duehmke, Eckhart

    Aims of radiation oncology are cure from malignant diseases and - at the same time preservation of anatomy (e.g. female breast, uterus, prostate) and organ functions (e.g. brain, eye, voice, sphincter ani). At present, methods and results of clinical radiotherapy (RT) are based on experiences with natural history and radiobiology of malignant tumors in properly defined situations as well as on technical developments since World War II in geometrical and biological treatment planning in teletherapy and brachytherapy. Radiobiological research revealed tolerance limits of healthy tissues to be respected, effective total treatment doses of high cure probability depending on histology and tumor volume, and - more recently - altered fractionation schemes to be adapted to specific growth fractions and intrinsic radiosensitivities of clonogenic tumor cells. In addition, Biological Response Modifiers (BRM), such as cis-platinum, oxygen and hyperthermia may steepen cell survival curves of hypoxic tumor cells, others - such as tetrachiordekaoxid (TCDO) - may enhance repair of normal tissues. Computer assisted techniques in geometrical RT-planning based on individual healthy and pathologic anatomy (CT, MRT) provide high precision RT for well defined brain lesions by using dedicated linear accelerators (Stereotaxy). CT-based individual tissue compensators help with homogenization of distorted dose distributions in magna field irradiation for malignant lymphomas and with total body irradiation (TBI) before allogeneic bone marrow transplantation, e.g. for leukemia. RT with fast neutrons, Boron Neutron Capture Therapy (BNCT), RT with protons and heavy ions need to be tested in randomized trials before implementation into clinical routine.

  8. Radioecology, radiobiology, and radiological protection: frameworks and fractures.

    PubMed

    Pentreath, R J

    2009-12-01

    A framework for the protection of the general public has been in existence for a very long time, although steps have recently been made by the ICRP to ensure that it is more fully comprehensive with regard to all actual and potential exposure situations. Protection of the environment, however, has only recently begun to be addressed in a structured manner, and is still an evolving subject. Nevertheless, it needs to be centred around some form of parallel framework to that which has evolved for the protection of human beings, although clearly on a different scale. It also needs to be embedded within the basic science of radiobiology, and form a central part of radioecology.

  9. Assessing student clinical learning experiences.

    PubMed

    Nehyba, Katrine; Miller, Susan; Connaughton, Joanne; Singer, Barbara

    2017-08-01

    This article describes the use of an activity worksheet and questionnaire to investigate the learning experience of students on clinical placement. The worksheet measures the amount of time students spend in different learning activities, and the questionnaire explores student satisfaction and preferred learning activities. An activity worksheet and questionnaire … investigate[d] the learning experiences of students on clinical placement METHODS: The activity worksheet and questionnaire were used in a cohort pilot study of physiotherapy students on clinical placement. The activity worksheet provides details of the amount of time students engage in a range of clinical and non-clinical tasks while on placement, such as time spent treating patients, working individually, working with their peers and engaging in reflective practice. In combination with the questionnaire results, it allows clinicians to gain an understanding of the clinical learning environment experienced by their students. The data collected using these tools provide a description of the students' activities while undertaking the clinical placement. This information may guide the refinement of the clinical experience, and offers an opportunity to individualise learning activities to match students' needs and preferences. © 2016 John Wiley & Sons Ltd and The Association for the Study of Medical Education.

  10. [From microdosimetry to nanodosimetry--the link between radiobiology and radiation physics].

    PubMed

    Fu, Yuchuan; Li, Ping

    2014-06-01

    The link between micro- and macro-parameters for radiation interactions that take place in living biological systems is described in this paper. Meanwhile recent progress and development in microdosimetry and nanodosimetry are introduced, including the methods to measure and calculate these micro- or nano-parameters. The relationship between radiobiology and physical quantities in microdosimetry and nanodosimetry was presented. Both the current problems on their applications in radiation protection and radiotherapy and the future development direction are proposed.

  11. Radiobiological studies with the nematode Caenorhabditis elegans. Genetic and developmental effects of high LET radiation

    NASA Technical Reports Server (NTRS)

    Nelson, G. A.; Schubert, W. W.; Marshall, T. M.

    1992-01-01

    The biological effects of heavy charged particle (HZE) radiation are of particular interest to travellers and planners for long-duration space flights where exposure levels represent a potential health hazard. The unique feature of HZE radiation is the structured pattern of its energy deposition in targets. There are many consequences of this feature to biological endpoints when compared with effects of ionizing photons. Dose vs response and dose-rate kinetics may be modified, DNA and cellular repair systems may be altered in their abilities to cope with damage, and the qualitative features of damage may be unique for different ions. The nematode Caenorhabditis elegans is being used to address these and related questions associated with exposure to radiation. HZE-induced mutation, chromosome aberration, cell inactivation and altered organogenesis are discussed along with plans for radiobiological experiments in space.

  12. Heavy charged particle radiobiology: using enhanced biological effectiveness and improved beam focusing to advance cancer therapy.

    PubMed

    Allen, Christopher; Borak, Thomas B; Tsujii, Hirohiko; Nickoloff, Jac A

    2011-06-03

    Ionizing radiation causes many types of DNA damage, including base damage and single- and double-strand breaks. Photons, including X-rays and γ-rays, are the most widely used type of ionizing radiation in radiobiology experiments, and in radiation cancer therapy. Charged particles, including protons and carbon ions, are seeing increased use as an alternative therapeutic modality. Although the facilities needed to produce high energy charged particle beams are more costly than photon facilities, particle therapy has shown improved cancer survival rates, reflecting more highly focused dose distributions and more severe DNA damage to tumor cells. Despite early successes of charged particle radiotherapy, there is room for further improvement, and much remains to be learned about normal and cancer cell responses to charged particle radiation. 2011 Elsevier B.V. All rights reserved.

  13. Scientific experiments on the flight of the 1979 biological satellite, draft plan

    NASA Technical Reports Server (NTRS)

    1979-01-01

    The various physiological, biological, radiobiological, and radiation physics experiments to be conducted onboard the 1979 biological satellite are described. These experiments deal with the effects of space flight on living organisms, measurement of radiation, and possible methods of shielding spacecraft against such radiation.

  14. Radiobiological characterization of post-lumpectomy focal brachytherapy with lipid nanoparticle-carried radionuclides

    NASA Astrophysics Data System (ADS)

    Hrycushko, Brian A.; Gutierrez, Alonso N.; Goins, Beth; Yan, Weiqiang; Phillips, William T.; Otto, Pamela M.; Bao, Ande

    2011-02-01

    Post-operative radiotherapy has commonly been used for early stage breast cancer to treat residual disease. The primary objective of this work was to characterize, through dosimetric and radiobiological modeling, a novel focal brachytherapy technique which uses direct intracavitary infusion of β-emitting radionuclides (186Re/188Re) carried by lipid nanoparticles (liposomes). Absorbed dose calculations were performed for a spherical lumpectomy cavity with a uniformly injected activity distribution using a dose point kernel convolution technique. Radiobiological indices were used to relate predicted therapy outcome and normal tissue complication of this technique with equivalent external beam radiotherapy treatment regimens. Modeled stromal damage was used as a measure of the inhibition of the stimulatory effect on tumor growth driven by the wound healing response. A sample treatment plan delivering 50 Gy at a therapeutic range of 2.0 mm for 186Re-liposomes and 5.0 mm for 188Re-liposomes takes advantage of the dose delivery characteristics of the β-emissions, providing significant EUD (58.2 Gy and 72.5 Gy for 186Re and 188Re, respectively) with a minimal NTCP (0.046%) of the healthy ipsilateral breast. Modeling of kidney BED and ipsilateral breast NTCP showed that large injected activity concentrations of both radionuclides could be safely administered without significant complications.

  15. Radiobiological effects of heavy ions and protons. [on cells of mammals, bacteria and viruses

    NASA Technical Reports Server (NTRS)

    Ryzhov, N. I.; Vorozhtsova, S. V.; Krasavin, Y. A.; Mashinskaya, T. Y.; Savchenko, N. Y.; Fedorov, B. S.; Khlaponina, V. F.; Shelegedin, V. N.; Gut, L.; Sabo, L.

    1974-01-01

    Radiobiological effects of heavy ions and protons are studied on cells of mammals, bacteria, viruses and DNA of bacteria. Results show that the dose effect dependence bears an exponential character; the reduction of RBE as LET of particle increases reflects the different character of microdistribution of absorbed energy in biological objects with different levels of biological organization.

  16. WE-H-BRA-02: Radiobiological Modeling of Tumor Control Probability (TCP) and Radiation-Induced Pneumonitis (RP) for Lung Cancer Patients Treated with Monte Carlo-Based Lung SBRT

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Pokhrel, D; Sood, S; Shen, X

    2016-06-15

    Purpose: To present radiobiological modeling of TCP using tumor size-adjusted BED(s-BED)and PTV(D99) to lung SBRT patients treated with X-ray Voxel Monte Carlo(XVMC) algorithm, apply parameterized Lyman-NTCP model to predict grade-2 RP and subsequently, compare with clinical outcomes/observations. Methods: Dosimetric parameters and clinical follow-up for XVMC-based lung-SBRT patients were retrospectively evaluated. Patients were treated at Novalis-TX with hybrid(2 non-coplanar partial-arcs plus 3–6 static-beams)plan using HD-MLC/6MV-SRS-beam.For TCP,s-BED modelling was utilized: TCP=EXP[sBED-TCD50]/k/(1.0+EXP[sBED-TCD50]/k), where k=31Gy corresponding to TCD50=0Gy and s-BED was defined as BED10 minus 10 times the tumor diameter(in centimeters)by Ohri et al.(IJROBP,2012). For 2-yr local-control, we used more-realistic MC-computed PTVD99 as amore » predictive parameter, s-BED(D99).Due to relatively shorter median follow-up interval(12-months),Kaplan-Meier curves were generated to estimate 2-yr observed local-control and compared to predicted-rate by TCP modeling. For NTCP, we employed parameterized Lyman-NTCP model utilizing normal-lung DVH and α/β=3Gy fitted to predict grade-2 RP after lung-SBRT. Results: Total 108 patients (137 tumors) treated for 35–70Gy in 3–5 fractions, either primary-lung(n=74)or metastatic-lung(n=53)tumors were included.F or the given prescription dose with MC-computed MUs, 2-yr local-control rates with s-BED(D99) was 87±8%. Kaplan-Meier generated observed local-control rate at 2-yr was 87.5%,suggesting that PTV(D99) could be a potential predictor (p-value=0.38). Observed vs predicted TCP for primary-lung tumors and metastatic tumors were 97% vs 88±7% and 94% vs 86±9%.NTCP model predicted well for symptomatic-RP with predicted vs observed (3±5% vs 2%). Radiographic and clinically significant RP was observed in 13% and 2% of patients. Higher rates of radiographic change were observed in patients who received >50Gy compared to

  17. Computational modeling of radiobiological effects in bone metastases for different radionuclides.

    PubMed

    Liberal, Francisco D C Guerra; Tavares, Adriana Alexandre S; Tavares, João Manuel R S

    2017-06-01

    Computational simulation is a simple and practical way to study and to compare a variety of radioisotopes for different medical applications, including the palliative treatment of bone metastases. This study aimed to evaluate and compare cellular effects modelled for different radioisotopes currently in use or under research for treatment of bone metastases using computational methods. Computational models were used to estimate the radiation-induced cellular effects (Virtual Cell Radiobiology algorithm) post-irradiation with selected particles emitted by Strontium-89 ( 89 Sr), Samarium-153 ( 153 Sm), Lutetium-177 ( 177 Lu), and Radium-223 ( 223 Ra). Cellular kinetics post-irradiation using 89 Sr β - particles, 153 Sm β -  particles, 177 Lu β -  particles and 223 Ra α particles showed that the cell response was dose- and radionuclide-dependent. 177 Lu beta minus particles and, in particular, 223 Ra alpha particles, yielded the lowest survival fraction of all investigated particles. 223 Ra alpha particles induced the highest cell death of all investigated particles on metastatic prostate cells in comparison to irradiation with β -  radionuclides, two of the most frequently used radionuclides in the palliative treatment of bone metastases in clinical routine practice. Moreover, the data obtained suggest that the used computational methods might provide some perception about cellular effects following irradiation with different radionuclides.

  18. Radiobiological Effectiveness of Ultrashort Laser-Driven Electron Bunches: Micronucleus Frequency, Telomere Shortening and Cell Viability.

    PubMed

    Andreassi, Maria Grazia; Borghini, Andrea; Pulignani, Silvia; Baffigi, Federica; Fulgentini, Lorenzo; Koester, Petra; Cresci, Monica; Vecoli, Cecilia; Lamia, Debora; Russo, Giorgio; Panetta, Daniele; Tripodi, Maria; Gizzi, Leonida A; Labate, Luca

    2016-09-01

    Laser-driven electron accelerators are capable of producing high-energy electron bunches in shorter distances than conventional radiofrequency accelerators. To date, our knowledge of the radiobiological effects in cells exposed to electrons using a laser-plasma accelerator is still very limited. In this study, we compared the dose-response curves for micronucleus (MN) frequency and telomere length in peripheral blood lymphocytes exposed to laser-driven electron pulse and X-ray radiations. Additionally, we evaluated the effects on cell survival of in vitro tumor cells after exposure to laser-driven electron pulse compared to electron beams produced by a conventional radiofrequency accelerator used for intraoperative radiation therapy. Blood samples from two different donors were exposed to six radiation doses ranging from 0 to 2 Gy. Relative biological effectiveness (RBE) for micronucleus induction was calculated from the alpha coefficients for electrons compared to X rays (RBE = alpha laser/alpha X rays). Cell viability was monitored in the OVCAR-3 ovarian cancer cell line using trypan blue exclusion assay at day 3, 5 and 7 postirradiation (2, 4, 6, 8 and 10 Gy). The RBE values obtained by comparing the alpha values were 1.3 and 1.2 for the two donors. Mean telomere length was also found to be reduced in a significant dose-dependent manner after irradiation with both electrons and X rays in both donors studied. Our findings showed a radiobiological response as mirrored by the induction of micronuclei and shortening of telomere as well as by the reduction of cell survival in blood samples and cancer cells exposed in vitro to laser-generated electron bunches. Additional studies are needed to improve preclinical validation of the radiobiological characteristics and efficacy of laser-driven electron accelerators in the future.

  19. SU-E-T-398: Evaluation of Radiobiological Parameters Using Serial Tumor Imaging During Radiotherapy as An Inverse Ill-Posed Problem

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Chvetsov, A; Sandison, G; Schwartz, J

    Purpose: Combination of serial tumor imaging with radiobiological modeling can provide more accurate information on the nature of treatment response and what underlies resistance. The purpose of this article is to improve the algorithms related to imaging-based radiobilogical modeling of tumor response. Methods: Serial imaging of tumor response to radiation therapy represents a sum of tumor cell sensitivity, tumor growth rates, and the rate of cell loss which are not separated explicitly. Accurate treatment response assessment would require separation of these radiobiological determinants of treatment response because they define tumor control probability. We show that the problem of reconstruction ofmore » radiobiological parameters from serial imaging data can be considered as inverse ill-posed problem described by the Fredholm integral equation of the first kind because it is governed by a sum of several exponential processes. Therefore, the parameter reconstruction can be solved using regularization methods. Results: To study the reconstruction problem, we used a set of serial CT imaging data for the head and neck cancer and a two-level cell population model of tumor response which separates the entire tumor cell population in two subpopulations of viable and lethally damage cells. The reconstruction was done using a least squared objective function and a simulated annealing algorithm. Using in vitro data for radiobiological parameters as reference data, we shown that the reconstructed values of cell surviving fractions and potential doubling time exhibit non-physical fluctuations if no stabilization algorithms are applied. The variational regularization allowed us to obtain statistical distribution for cell surviving fractions and cell number doubling times comparable to in vitro data. Conclusion: Our results indicate that using variational regularization can increase the number of free parameters in the model and open the way to development of more advanced

  20. Design of a radiation facility for very small specimens used in radiobiology studies

    NASA Astrophysics Data System (ADS)

    Rodriguez, Manuel; Jeraj, Robert

    2008-06-01

    A design of a radiation facility for very small specimens used in radiobiology is presented. This micro-irradiator has been primarily designed to irradiate partial bodies in zebrafish embryos 3-4 mm in length. A miniature x-ray, 50 kV photon beam, is used as a radiation source. The source is inserted in a cylindrical brass collimator that has a pinhole of 1.0 mm in diameter along the central axis to produce a pencil photon beam. The collimator with the source is attached underneath a computer-controlled movable table which holds the specimens. Using a 45° tilted mirror, a digital camera, connected to the computer, takes pictures of the specimen and the pinhole collimator. From the image provided by the camera, the relative distance from the specimen to the pinhole axis is calculated and coordinates are sent to the movable table to properly position the samples in the beam path. Due to its monitoring system, characteristic of the radiation beam, accuracy and precision of specimen positioning, and automatic image-based specimen recognition, this radiation facility is a suitable tool to irradiate partial bodies in zebrafish embryos, cell cultures or any other small specimen used in radiobiology research.

  1. Radiobiological Optimization of Combination Radiopharmaceutical Therapy Applied to Myeloablative Treatment of Non-Hodgkin’s Lymphoma

    PubMed Central

    Hobbs, Robert F; Wahl, Richard L; Frey, Eric C; Kasamon, Yvette; Song, Hong; Huang, Peng; Jones, Richard J; Sgouros, George

    2014-01-01

    Combination treatment is a hallmark of cancer therapy. Although the rationale for combination radiopharmaceutical therapy was described in the mid ‘90s, such treatment strategies have only been implemented clinically recently, and without a rigorous methodology for treatment optimization. Radiobiological and quantitative imaging-based dosimetry tools are now available that enable rational implementation of combined targeted radiopharmaceutical therapy. Optimal implementation should simultaneously account for radiobiological normal organ tolerance while optimizing the ratio of two different radiopharmaceuticals required to maximize tumor control. We have developed such a methodology and applied it to hypothetical myeloablative treatment of non-hodgkin’s lymphoma (NHL) patients using 131I-tositumomab and 90Y-ibritumomab tiuxetan. Methods The range of potential administered activities (AA) is limited by the normal organ maximum tolerated biologic effective doses (MTBEDs) arising from the combined radiopharmaceuticals. Dose limiting normal organs are expected to be the lungs for 131I-tositumomab and the liver for 90Y-ibritumomab tiuxetan in myeloablative NHL treatment regimens. By plotting the limiting normal organ constraints as a function of the AAs and calculating tumor biological effective dose (BED) along the normal organ MTBED limits, the optimal combination of activities is obtained. The model was tested using previously acquired patient normal organ and tumor kinetic data and MTBED values taken from the literature. Results The average AA values based solely on normal organ constraints was (19.0 ± 8.2) GBq with a range of 3.9 – 36.9 GBq for 131I-tositumomab, and (2.77 ± 1.64) GBq with a range of 0.42 – 7.54 GBq for 90Y-ibritumomab tiuxetan. Tumor BED optimization results were calculated and plotted as a function of AA for 5 different cases, established using patient normal organ kinetics for the two radiopharmaceuticals. Results included AA ranges

  2. Carbon Ion Radiotherapy: A Review of Clinical Experiences and Preclinical Research, with an Emphasis on DNA Damage/Repair

    PubMed Central

    Mohamad, Osama; Sishc, Brock J.; Saha, Janapriya; Pompos, Arnold; Rahimi, Asal; Story, Michael D.; Davis, Anthony J.; Kim, D.W. Nathan

    2017-01-01

    Compared to conventional photon-based external beam radiation (PhXRT), carbon ion radiotherapy (CIRT) has superior dose distribution, higher linear energy transfer (LET), and a higher relative biological effectiveness (RBE). This enhanced RBE is driven by a unique DNA damage signature characterized by clustered lesions that overwhelm the DNA repair capacity of malignant cells. These physical and radiobiological characteristics imbue heavy ions with potent tumoricidal capacity, while having the potential for simultaneously maximally sparing normal tissues. Thus, CIRT could potentially be used to treat some of the most difficult to treat tumors, including those that are hypoxic, radio-resistant, or deep-seated. Clinical data, mostly from Japan and Germany, are promising, with favorable oncologic outcomes and acceptable toxicity. In this manuscript, we review the physical and biological rationales for CIRT, with an emphasis on DNA damage and repair, as well as providing a comprehensive overview of the translational and clinical data using CIRT. PMID:28598362

  3. Carbon Ion Radiotherapy: A Review of Clinical Experiences and Preclinical Research, with an Emphasis on DNA Damage/Repair.

    PubMed

    Mohamad, Osama; Sishc, Brock J; Saha, Janapriya; Pompos, Arnold; Rahimi, Asal; Story, Michael D; Davis, Anthony J; Kim, D W Nathan

    2017-06-09

    Compared to conventional photon-based external beam radiation (PhXRT), carbon ion radiotherapy (CIRT) has superior dose distribution, higher linear energy transfer (LET), and a higher relative biological effectiveness (RBE). This enhanced RBE is driven by a unique DNA damage signature characterized by clustered lesions that overwhelm the DNA repair capacity of malignant cells. These physical and radiobiological characteristics imbue heavy ions with potent tumoricidal capacity, while having the potential for simultaneously maximally sparing normal tissues. Thus, CIRT could potentially be used to treat some of the most difficult to treat tumors, including those that are hypoxic, radio-resistant, or deep-seated. Clinical data, mostly from Japan and Germany, are promising, with favorable oncologic outcomes and acceptable toxicity. In this manuscript, we review the physical and biological rationales for CIRT, with an emphasis on DNA damage and repair, as well as providing a comprehensive overview of the translational and clinical data using CIRT.

  4. Professor Hassan K. Awwad; The Father of Radiation Oncology and Radiobiology in Egypt and the Arab World, His Good Deeds Last Forever and Inspire us for the Future.

    PubMed

    Zaghloul, Mohamed S; El-Badawi, Samy A; Abd Elbaky, Hoda

    2007-03-01

    Our most respected professor Hassan K. Awwad passed away on January 5th, 2007, at the age of 81. He was considered as the father of radiotherapy in Egypt. He was always named "The Professor", as he was the founder of the radiotherapy departments at the National Cancer Institute, Cairo University&Faculty of Medicine, Alexandria University. He also shared in developing NEMROCK (Kasr El Aini Center of Radiation Oncology and Nuclear Medicine), the place where he graduated and worked during his early years of experience. He, together with professor Reda Hamza, dean of NCI, Cairo at that time, had initiated 7 oncology centers all over Egypt, from Aswan in the South to Dammietta and Damanhour in the North. These 7 centers were developed by the Ministry of Health. Prof. Awwad and Prof. Hamza were responsible for facility providing and plans. They chose all the necessary equipment, tools and personnel. These centers were in action since 1988 and are currently taking care of the oncology patients in a wide area of the country. Prof. Awwad graduated from the Faculty of medicine, Cairo University, in 1949. He had his Medical Doctorate (MD) in Radiotherapy from Alexandria University in 1956. The International Atomic Energy Agency (IAEA) awarded him fellowships in France (Institute Gustave Rossy) to gain experience in brachytherapy in 1956 and 1971, England 1956, 1959. Another fellowship was awarded to Prof Awwad in Harvard University (Peter Bent Brigham Hospital) in radiobiology and radiotherapy during the years 1964-1965. He personally and with other members of the National Cancer Institute gave much of their efforts and time to teach, train and guide young radiotherapists, biologists, physicists and radiation therapists through direct on-hand teaching and training as well as holding training courses for radiation oncologists, physicists and technologists. He insisted to ensure its regularity 4 times yearly. These courses trained a lot of personnel from all over Egypt, Sudan

  5. The alfa and beta of tumours: a review of parameters of the linear-quadratic model, derived from clinical radiotherapy studies.

    PubMed

    van Leeuwen, C M; Oei, A L; Crezee, J; Bel, A; Franken, N A P; Stalpers, L J A; Kok, H P

    2018-05-16

    Prediction of radiobiological response is a major challenge in radiotherapy. Of several radiobiological models, the linear-quadratic (LQ) model has been best validated by experimental and clinical data. Clinically, the LQ model is mainly used to estimate equivalent radiotherapy schedules (e.g. calculate the equivalent dose in 2 Gy fractions, EQD 2 ), but increasingly also to predict tumour control probability (TCP) and normal tissue complication probability (NTCP) using logistic models. The selection of accurate LQ parameters α, β and α/β is pivotal for a reliable estimate of radiation response. The aim of this review is to provide an overview of published values for the LQ parameters of human tumours as a guideline for radiation oncologists and radiation researchers to select appropriate radiobiological parameter values for LQ modelling in clinical radiotherapy. We performed a systematic literature search and found sixty-four clinical studies reporting α, β and α/β for tumours. Tumour site, histology, stage, number of patients, type of LQ model, radiation type, TCP model, clinical endpoint and radiobiological parameter estimates were extracted. Next, we stratified by tumour site and by tumour histology. Study heterogeneity was expressed by the I 2 statistic, i.e. the percentage of variance in reported values not explained by chance. A large heterogeneity in LQ parameters was found within and between studies (I 2  > 75%). For the same tumour site, differences in histology partially explain differences in the LQ parameters: epithelial tumours have higher α/β values than adenocarcinomas. For tumour sites with different histologies, such as in oesophageal cancer, the α/β estimates correlate well with histology. However, many other factors contribute to the study heterogeneity of LQ parameters, e.g. tumour stage, type of LQ model, TCP model and clinical endpoint (i.e. survival, tumour control and biochemical control). The value of LQ parameters for

  6. Radiobiological Impact of Planning Techniques for Prostate Cancer in Terms of Tumor Control Probability and Normal Tissue Complication Probability

    PubMed Central

    Rana, S; Cheng, CY

    2014-01-01

    Background: The radiobiological models describe the effects of the radiation treatment on cancer and healthy cells, and the radiobiological effects are generally characterized by the tumor control probability (TCP) and normal tissue complication probability (NTCP). Aim: The purpose of this study was to assess the radiobiological impact of RapidArc planning techniques for prostate cancer in terms of TCP and normal NTCP. Subjects and Methods: A computed tomography data set of ten cases involving low-risk prostate cancer was selected for this retrospective study. For each case, two RapidArc plans were created in Eclipse treatment planning system. The double arc (DA) plan was created using two full arcs and the single arc (SA) plan was created using one full arc. All treatment plans were calculated with anisotropic analytical algorithm. Radiobiological modeling response evaluation was performed by calculating Niemierko's equivalent uniform dose (EUD)-based Tumor TCP and NTCP values. Results: For prostate tumor, the average EUD in the SA plans was slightly higher than in the DA plans (78.10 Gy vs. 77.77 Gy; P = 0.01), but the average TCP was comparable (98.3% vs. 98.3%; P = 0.01). In comparison to the DA plans, the SA plans produced higher average EUD to bladder (40.71 Gy vs. 40.46 Gy; P = 0.03) and femoral heads (10.39 Gy vs. 9.40 Gy; P = 0.03), whereas both techniques produced NTCP well below 0.1% for bladder (P = 0.14) and femoral heads (P = 0.26). In contrast, the SA plans produced higher average NTCP compared to the DA plans (2.2% vs. 1.9%; P = 0.01). Furthermore, the EUD to rectum was slightly higher in the SA plans (62.88 Gy vs. 62.22 Gy; P = 0.01). Conclusion: The SA and DA techniques produced similar TCP for low-risk prostate cancer. The NTCP for femoral heads and bladder was comparable in the SA and DA plans; however, the SA technique resulted in higher NTCP for rectum in comparison with the DA technique. PMID:24761232

  7. The Radiobiology of Proton Therapy: Challenges and Opportunities Around Relative Biological Effectiveness.

    PubMed

    Jones, B; McMahon, S J; Prise, K M

    2018-05-01

    With the current UK expansion of proton therapy there is a great opportunity for clinical oncologists to develop a translational interest in the associated scientific base and clinical results. In particular, the underpinning controversy regarding the conversion of photon dose to proton dose by the relative biological effectiveness (RBE) must be understood, including its important implications. At the present time, the proton prescribed dose includes an RBE of 1.1 regardless of tissue, tumour and dose fractionation. A body of data has emerged against this pragmatic approach, including a critique of the existing evidence base, due to choice of dose, use of only acute-reacting in vivo assays, analysis methods and the reference radiations used to determine the RBE. Modelling systems, based on the best available scientific evidence, and which include the clinically useful biological effective dose (BED) concept, have also been developed to estimate proton RBEs for different dose and linear energy transfer (LET) values. The latter reflect ionisation density, which progressively increases along each proton track. Late-reacting tissues, such as the brain, where α/β = 2 Gy, show a higher RBE than 1.1 at a low dose per fraction (1.2-1.8 Gy) at LET values used to cover conventional target volumes and can be much higher. RBE changes with tissue depth seem to vary depending on the method of beam delivery used. To reduce unexpected toxicity, which does occasionally follow proton therapy, a more rational approach to RBE allocation, using a variable RBE that depends on dose per fraction and the tissue and tumour radiobiological characteristics such as α/β, is proposed. Copyright © 2018. Published by Elsevier Ltd.

  8. Effects of radiobiological uncertainty on vehicle and habitat shield design for missions to the moon and Mars

    NASA Technical Reports Server (NTRS)

    Wilson, John W.; Nealy, John E.; Schimmerling, Walter; Cucinotta, Francis A.; Wood, James S.

    1993-01-01

    Some consequences of uncertainties in radiobiological risk due to galactic cosmic ray (GCR) exposure are analyzed for their effect on engineering designs for the first lunar outpost and a mission to explore Mars. This report presents the plausible effect of biological uncertainties, the design changes necessary to reduce the uncertainties to acceptable levels for a safe mission, and an evaluation of the mission redesign cost. Estimates of the amount of shield mass required to compensate for radiobiological uncertainty are given for a simplified vehicle and habitat. The additional amount of shield mass required to provide a safety factor for uncertainty compensation is calculated from the expected response to GCR exposure. The amount of shield mass greatly increases in the estimated range of biological uncertainty, thus, escalating the estimated cost of the mission. The estimates are used as a quantitative example for the cost-effectiveness of research in radiation biophysics and radiation physics.

  9. A model to describe potential effects of chemotherapy on critical radiobiological treatments

    NASA Astrophysics Data System (ADS)

    Rodríguez-Pérez, D.; Desco, M. M.; Antoranz, J. C.

    2016-08-01

    Although chemo- and radiotherapy can annihilate tumors on their own. they are also used in coadjuvancy: improving local effects of radiotherapy using chemotherapy as a radiosensit.izer. The effects of radiotherapy are well described by current radiobiological models. The goal of this work is to describe a discrete radiotherapy model, that has been previously used describe high radiation dose response as well as unusual radio-responses of some types of tumors (e.g. prostate cancer), to obtain a model of chemo+radiotherapy that can describe how the outcome of their combination is a more efficient removal of the tumor. Our hypothesis is that, although both treatments haven different mechanisms, both affect similar key points of cell metabolism and regulation, that lead to cellular death. Hence, we will consider a discrete model where chemotherapy may affect a fraction of the same targets destroyed by radiotherapy. Although radiotherapy reaches all cells equally, chemotherapy diffuses through a tumor attaining lower concentration in its center and higher in its surface. With our simulations we study the enhanced effect of combined therapy treatment and how it depends on the tissue critical parameters (the parameters of the lion-extensive radiobiological model), the number of “targets” aimed at by chemotherapy, and the concentration and diffusion rate of the drug inside the tumor. The results show that an equivalent, cliemo-radio-dose can be computed that allows the prediction of the lower radiation dose that causes the same effect than a radio-only treatment.

  10. Radiological and Environmental Research Division, Center for Human Radiobiology. Annual report, July 1980-June 1981. [Lead abstract

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Not Available

    1982-03-01

    Separate abstracts were prepared for the 22 papers of this annual report of the Center for Human Radiobiology. Abstracts were not written for 2 appendices which contain data on the exposure and radium-induced malignancies of 2259 persons whose radium content has been determined at least once. (KRM)

  11. Statistical methods for clinical verification of dose response parameters related to esophageal stricture and AVM obliteration from radiotherapy

    NASA Astrophysics Data System (ADS)

    Mavroidis, Panayiotis; Lind, Bengt K.; Theodorou, Kyriaki; Laurell, Göran; Fernberg, Jan-Olof; Lefkopoulos, Dimitrios; Kappas, Constantin; Brahme, Anders

    2004-08-01

    The purpose of this work is to provide some statistical methods for evaluating the predictive strength of radiobiological models and the validity of dose-response parameters for tumour control and normal tissue complications. This is accomplished by associating the expected complication rates, which are calculated using different models, with the clinical follow-up records. These methods are applied to 77 patients who received radiation treatment for head and neck cancer and 85 patients who were treated for arteriovenous malformation (AVM). The three-dimensional dose distribution delivered to esophagus and AVM nidus and the clinical follow-up results were available for each patient. Dose-response parameters derived by a maximum likelihood fitting were used as a reference to evaluate their compatibility with the examined treatment methodologies. The impact of the parameter uncertainties on the dose-response curves is demonstrated. The clinical utilization of the radiobiological parameters is illustrated. The radiobiological models (relative seriality and linear Poisson) and the reference parameters are validated to prove their suitability in reproducing the treatment outcome pattern of the patient material studied (through the probability of finding a worse fit, area under the ROC curve and khgr2 test). The analysis was carried out for the upper 5 cm of the esophagus (proximal esophagus) where all the strictures are formed, and the total volume of AVM. The estimated confidence intervals of the dose-response curves appear to have a significant supporting role on their clinical implementation and use.

  12. Medical management of radiation accidents: capabilities and deployment principles of the Bundeswehr Institute of Radiobiology.

    PubMed

    Dörr, Harald; Meineke, Viktor

    2012-10-01

    Radiation accidents are fortunately infrequent occurrences, but since their consequences can be very serious as in the Chernobyl and the Fukushima nuclear accidents, medical management of radiation accidents is of great importance. Besides several other tasks, medical management of radiation accidents is one of the key tasks of the Bundeswehr Institute of Radiobiology. Within a Task Force Unit for medical chemical, biological, radiological, and nuclear (CBRN) Defense, the institute provides designated personnel who will perform clinical investigations on the scene and will liaise with the institute, where different methods for biological dosimetry and dose reconstruction will be performed. The most important aspects of efficient medical management of radiation accidents are diagnosis of radiation-induced health damage, determination of the cause, dealing with contamination/incorporation, pathophysiological and therapeutic principles, preparatory planning, national and international cooperation and training. Military and non-military institutions have to work closely together when it comes to radiation accidents and since national resources are limited and could be exhausted, international networks can help to ensure medical treatment for radiation accident victims.

  13. Designing a Curriculum for Clinical Experiences

    ERIC Educational Resources Information Center

    Henning, John E.; Erb, Dorothy J.; Randles, Halle Schoener; Fults, Nanette; Webb, Kathy

    2016-01-01

    The purpose of this article is to describe a collaborative effort among five teacher preparation programs to create a conceptual tool designed to put clinical experiences at the center of our programs. The authors refer to the resulting product as a clinical curriculum. The clinical curriculum describes a developmental sequence of clinical…

  14. A modular approach for assessing the effect of radiation environments on man in operational systems. The radiobiological vulnerability of man during task performance

    NASA Technical Reports Server (NTRS)

    Ewing, D. E.

    1972-01-01

    A modular approach for assessing the affects of radiation environments on man in operational systems has been developed. The feasibility of the model has been proved and the practicality has been assessed. It has been applied to one operational system to date and information obtained has been submitted to systems analysts and mission planners for the assessment of man's vulnerability and impact on systems survivability. In addition, the model has been developed so that the radiobiological data can be input to a sophisticated man-machine interface model to properly relate the radiobiological stress with other mission stresses including the effects of a degraded system.

  15. Heavy-ion radiobiology: new approaches to delineate mechanisms underlying enhanced biological effectiveness.

    PubMed

    Blakely, E A; Kronenberg, A

    1998-11-01

    Shortly after the discovery of polonium and radium by Marie Curie and her husband and colleague, Pierre Curie, it was learned that exposure to these alpha-particle emitters produced deleterious biological effects. The mechanisms underlying the increased biological effectiveness of densely ionizing radiations, including alpha particles, neutrons and highly energetic heavy charged particles, remain an active area of investigation. In this paper, we review recent advances in several areas of the radiobiology of these densely ionizing radiations, also known as heavy ions. Advances are described in the areas of DNA damage and repair, chromosome aberrations, mutagenesis, neoplastic transformation in vitro, genomic instability, normal tissue radiobiology and carcinogenesis in vivo. We focus on technical innovations, including novel applications of pulsed-field gel electrophoresis, fluorescence in situ hybridization (FISH), linkage analysis, and studies of gene expression and protein expression. We also highlight the use of new cellular and animal systems, including those with defined DNA repair deficiencies, as well as epithelial cell model systems to assess neoplastic transformation both in vitro and in vivo. The studies reviewed herein have had a substantial impact on our understanding of the genotoxic effects of heavy ions as well as their distinct effects on tissue homeostasis. The use of these radiations in cancer therapy is also discussed. The use of both heavy-ion and proton therapy is on the upswing in several centers around the world, due to their unique energy deposition characteristics that enhance the therapeutic effect and help reduce damage to normal tissue.

  16. Heavy-ion radiobiology: new approaches to delineate mechanisms underlying enhanced biological effectiveness

    NASA Technical Reports Server (NTRS)

    Blakely, E. A.; Kronenberg, A.; Chatterjee, A. (Principal Investigator)

    1998-01-01

    Shortly after the discovery of polonium and radium by Marie Curie and her husband and colleague, Pierre Curie, it was learned that exposure to these alpha-particle emitters produced deleterious biological effects. The mechanisms underlying the increased biological effectiveness of densely ionizing radiations, including alpha particles, neutrons and highly energetic heavy charged particles, remain an active area of investigation. In this paper, we review recent advances in several areas of the radiobiology of these densely ionizing radiations, also known as heavy ions. Advances are described in the areas of DNA damage and repair, chromosome aberrations, mutagenesis, neoplastic transformation in vitro, genomic instability, normal tissue radiobiology and carcinogenesis in vivo. We focus on technical innovations, including novel applications of pulsed-field gel electrophoresis, fluorescence in situ hybridization (FISH), linkage analysis, and studies of gene expression and protein expression. We also highlight the use of new cellular and animal systems, including those with defined DNA repair deficiencies, as well as epithelial cell model systems to assess neoplastic transformation both in vitro and in vivo. The studies reviewed herein have had a substantial impact on our understanding of the genotoxic effects of heavy ions as well as their distinct effects on tissue homeostasis. The use of these radiations in cancer therapy is also discussed. The use of both heavy-ion and proton therapy is on the upswing in several centers around the world, due to their unique energy deposition characteristics that enhance the therapeutic effect and help reduce damage to normal tissue.

  17. Comparison of dosimetric and radiobiological parameters on plans for prostate stereotactic body radiotherapy using an endorectal balloon for different dose-calculation algorithms and delivery-beam modes

    NASA Astrophysics Data System (ADS)

    Kang, Sang-Won; Suh, Tae-Suk; Chung, Jin-Beom; Eom, Keun-Yong; Song, Changhoon; Kim, In-Ah; Kim, Jae-Sung; Lee, Jeong-Woo; Cho, Woong

    2017-02-01

    The purpose of this study was to evaluate the impact of dosimetric and radiobiological parameters on treatment plans by using different dose-calculation algorithms and delivery-beam modes for prostate stereotactic body radiation therapy using an endorectal balloon. For 20 patients with prostate cancer, stereotactic body radiation therapy (SBRT) plans were generated by using a 10-MV photon beam with flattening filter (FF) and flattening-filter-free (FFF) modes. The total treatment dose prescribed was 42.7 Gy in 7 fractions to cover at least 95% of the planning target volume (PTV) with 95% of the prescribed dose. The dose computation was initially performed using an anisotropic analytical algorithm (AAA) in the Eclipse treatment planning system (Varian Medical Systems, Palo Alto, CA) and was then re-calculated using Acuros XB (AXB V. 11.0.34) with the same monitor units and multileaf collimator files. The dosimetric and the radiobiological parameters for the PTV and organs at risk (OARs) were analyzed from the dose-volume histogram. An obvious difference in dosimetric parameters between the AAA and the AXB plans was observed in the PTV and rectum. Doses to the PTV, excluding the maximum dose, were always higher in the AAA plans than in the AXB plans. However, doses to the other OARs were similar in both algorithm plans. In addition, no difference was observed in the dosimetric parameters for different delivery-beam modes when using the same algorithm to generate plans. As a result of the dosimetric parameters, the radiobiological parameters for the two algorithm plans presented an apparent difference in the PTV and the rectum. The average tumor control probability of the AAA plans was higher than that of the AXB plans. The average normal tissue complication probability (NTCP) to rectum was lower in the AXB plans than in the AAA plans. The AAA and the AXB plans yielded very similar NTCPs for the other OARs. In plans using the same algorithms, the NTCPs for delivery

  18. Clinical radiobiology of stage T2-T3 bladder cancer.

    PubMed

    Majewski, Wojciech; Maciejewski, Boguslaw; Majewski, Stanislaw; Suwinski, Rafal; Miszczyk, Leszek; Tarnawski, Rafal

    2004-09-01

    To evaluate the relationship between total radiation dose and overall treatment time (OTT) with the treatment outcome, with adjustment for selected clinical factors, in patients with Stage T2-T3 bladder cancer treated with curative radiotherapy (RT). The analysis was based on 480 patients with Stage T2-T3 bladder cancer who were treated at the Center of Oncology in Gliwice between 1975 and 1995. The mean total radiation dose was 65.5 Gy, and the mean OTT was 51 days. In 261 patients (54%), planned and unplanned gaps occurred during RT. Four fractionation schedules were used: (1) conventional fractionation (once daily, 1.8-2.5 Gy/fraction); (2) protracted fractionation (pelvic RT, once daily, 1.6-1.7 Gy/fraction, boost RT, once daily, 2.0 Gy/fraction); (3) accelerated hyperfractionated boost (pelvic RT, once daily, 2.0 Gy/fraction; boost RT, twice daily, 1.3-1.4 Gy/fraction); and (4) accelerated hyperfractionation (pelvic and boost RT, twice daily, 1.2-1.5 Gy/fraction). In all fractionation schedules, the total radiation dose was similar (average 65.5 Gy), but the OTT was different (mean 53 days for conventional fractionation, 62 days for protracted fractionation, 45 days for accelerated hyperfractionated boost, and 41 days for accelerated hyperfractionation). A Cox proportional hazard model and maximum likelihood logistic model were used to evaluate the relationship between the treatment-related parameters (total radiation dose, dose per fraction, and OTT) and clinical factors (clinical T stage, hemoglobin level and bladder capacity before RT) and treatment outcome. With a median follow-up of 76 months, the actuarial 5-year local control rate was 47%, and the overall survival rate was 40%. The logistic analysis, which included the total dose, OTT, and T stage, revealed that all of these factors were significantly related to tumor control probability (p = 0.021 for total radiation dose, p = 0.038 for OTT, and p = 0.00068 for T stage). A multivariate Cox model, which

  19. Students' clinical experience on outreach placements.

    PubMed

    Smith, M; Lennon, M A; Robinson, P G

    2010-02-01

    Primary care outreach placements increasingly feature in UK undergraduate dental curricula. The profile of clinical work undertaken on placement may differ from traditional hospital-based programmes and between outreach settings. An appreciation of any differences could inform curriculum development. To compare the profiles of clinical work experienced on a traditional hospital-based programme and outreach placements in different settings. One dental hospital and eight existing primary care block placements in England. Subjects were four cohorts of senior dental students in one UK dental school. Departmental records provided data on students' clinical experience in different settings and their achievement of placement learning objectives. Descriptive statistics for groups were compared. (1) Counts of patients encountered and of clinical procedures completed in the following categories: simple plastic restorations, endodontics, cast restorations, dentures, extractions and children's dentistry. (2) Student perceptions of placement learning reported via Likert scales. Outreach students encountered twice as many patients and typically completed about three times as much clinical work as students in the hospital, e.g. 44 cf 16 simple plastic restorations, seven cf two endodontic procedures. There were variations in profiles by setting. For example, amalgam being more likely to be used on outreach especially in the General Dental Service; more children's dentistry in community services and more extractions in Dental Access Centres. Students reported learning outcomes generally being achieved (average 94%) although with some variation by setting. Dental outreach training greatly increases the quantity of students' clinical experience in everyday dentistry compared to a hospital-based programme. Placements also increase awareness of service delivery and develop clinical skills. There are appreciable variations between outreach settings possibly reflecting their purposes

  20. Low LET protons focused to submicrometer shows enhanced radiobiological effectiveness

    NASA Astrophysics Data System (ADS)

    Schmid, T. E.; Greubel, C.; Hable, V.; Zlobinskaya, O.; Michalski, D.; Girst, S.; Siebenwirth, C.; Schmid, E.; Molls, M.; Multhoff, G.; Dollinger, G.

    2012-10-01

    This study shows that enhanced radiobiological effectiveness (RBE) values can be generated focusing low linear energy transfer (LET) radiation and thus changing the microdose distribution. 20 MeV protons (LET = 2.65 keV µm-1) are focused to submicrometer diameter at the ion microprobe superconducting nanoprobe for applied nuclear (Kern) physics experiments of the Munich tandem accelerator. The RBE values, as determined by measuring micronuclei (RBEMN = 1.48 ± 0.07) and dicentrics (RBED = 1.92 ± 0.15), in human-hamster hybrid (AL) cells are significantly higher when 117 protons were focused to a submicrometer irradiation field within a 5.4 × 5.4 µm2 matrix compared to quasi homogeneous in a 1 × 1 µm2 matrix applied protons (RBEMN = 1.28 ± 0.07; RBED = 1.41 ± 0.14) at the same average dose of 1.7 Gy. The RBE values are normalized to standard 70 kV (dicentrics) or 200 kV (micronuclei) x-ray irradiation. The 117 protons applied per point deposit the same amount of energy like a 12C ion with 55 MeV total energy (4.48 MeV u-1). The enhancements are about half of that obtained for 12C ions (RBEMN = 2.20 ± 0.06 and RBED = 3.21 ± 0.10) and they are attributed to intertrack interactions of the induced damages. The measured RBE values show differences from predictions of the local effect model (LEM III) that is used to calculate RBE values for irradiation plans to treat tumors with high LET particles.

  1. SU-G-TeP3-11: Radiobiological-Cum-Dosimetric Quality Assurance of Complex Radiotherapy Plans

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Paudel, N; Narayanasamy, G; Zhang, X

    2016-06-15

    Purpose: Dosimetric gamma-analysis used for QA of complex radiotherapy plans tests the dosimetric equivalence of a delivered plan with the treatment planning system (TPS) optimized plan. It does not examine whether a dosimetric difference results in any radiobiological difference. This study introduces a method to test the radiobiological and dosimetric equivalence between a delivered and the TPS optimized plan. Methods: Six head and neck and seven lung cancer VMAT or IMRT plans optimized for patient treatment were calculated and delivered to an ArcCheck phantom. ArcCheck measured dose distributions were compared with the TPS calculated dose distributions using a 2-D gamma-analysis.more » Dose volume histograms (DVHs) for various patient structures were obtained by using measured data in 3DVH software and compared against the TPS calculated DVHs using 3-D gamma analysis. DVH data were used in the Poisson model to calculate tumor control probability (TCP) for the treatment targets and in the sigmoid dose response model to calculate normal tissue complication probability (NTCP) for the normal structures. Results: Two-D and three-D gamma passing rates among six H&N patient plans differed by 0 to 2.7% and among seven lung plans by 0.1 to 4.5%. Average ± SD TCPs based on measurement and TPS were 0.665±0.018 and 0.674±0.044 for H&N, and 0.791±0.027 and 0.733±0.031 for lung plans, respectively. Differences in NTCPs were usually negligible. The differences in dosimetric results, TCPs and NTCPs were insignificant. Conclusion: The 2-D and 3-D gamma-analysis based agreement between measured and planned dose distributions may indicate their dosimetric equivalence. Small and insignificant differences in TCPs and NTCPs based on measured and planned dose distributions indicate the radiobiological equivalence between the measured and optimized plans. However, patient plans showing larger differences between 2-D and 3-D gamma-analysis can help us make a more definite

  2. Radiation transport codes for potential applications related to radiobiology and radiotherapy using protons, neutrons, and negatively charged pions

    NASA Technical Reports Server (NTRS)

    Armstrong, T. W.

    1972-01-01

    Several Monte Carlo radiation transport computer codes are used to predict quantities of interest in the fields of radiotherapy and radiobiology. The calculational methods are described and comparisions of calculated and experimental results are presented for dose distributions produced by protons, neutrons, and negatively charged pions. Comparisons of calculated and experimental cell survival probabilities are also presented.

  3. Prostate volumetric‐modulated arc therapy: dosimetry and radiobiological model variation between the single‐arc and double‐arc technique

    PubMed Central

    Jiang, Runqing

    2013-01-01

    This study investigates the dosimetry and radiobiological model variation when a second photon arc was added to prostate volumetric‐modulated arc therapy (VMAT) using the single‐arc technique. Dosimetry and radiobiological model comparison between the single‐arc and double‐arc prostate VMAT plans were performed on five patients with prostate volumes ranging from 29−68.1 cm3. The prescription dose was 78 Gy/39 fractions and the photon beam energy was 6 MV. Dose‐volume histogram, mean and maximum dose of targets (planning and clinical target volume) and normal tissues (rectum, bladder and femoral heads), dose‐volume criteria in the treatment plan (D99% of PTV; D30%,D50%,V17Gy and V35Gy of rectum and bladder; D5% of femoral heads), and dose profiles along the vertical and horizontal axis crossing the isocenter were determined using the single‐arc and double‐arc VMAT technique. For comparison, the monitor unit based on the RapidArc delivery method, prostate tumor control probability (TCP), and rectal normal tissue complication probability (NTCP) based on the Lyman‐Burman‐Kutcher algorithm were calculated. It was found that though the double‐arc technique required almost double the treatment time than the single‐arc, the double‐arc plan provided a better rectal and bladder dose‐volume criteria by shifting the delivered dose in the patient from the anterior–posterior direction to the lateral. As the femoral head was less radiosensitive than the rectum and bladder, the double‐arc technique resulted in a prostate VMAT plan with better prostate coverage and rectal dose‐volume criteria compared to the single‐arc. The prostate TCP of the double‐arc plan was found slightly increased (0.16%) compared to the single‐arc. Therefore, when the rectal dose‐volume criteria are very difficult to achieve in a single‐arc prostate VMAT plan, it is worthwhile to consider the double‐arc technique. PACS number: 87.55.D‐, 87.55.dk, 87.55.K

  4. Clinical Experiences in Athletic Training.

    ERIC Educational Resources Information Center

    Knight, Kenneth L.

    This book offers a systematic approach to teaching athletic training. Modules are separated into 10 content areas: direct clinical experience; policies and procedures; emergency procedures; modality operation; advanced modality operation; taping, wrapping, bracing, and padding; management of specific injuries; examination; supervision; and…

  5. Preliminary results of the scientific experiments on the Kosmos-936 biosatellite

    NASA Technical Reports Server (NTRS)

    1977-01-01

    The scientific equipment and experiments on the Kosmos-936 biosatellite are described, including various ground controls and the lab unit for studies at the descent vehicle landing site. Preliminary results are presented of the physiological experiment with rats, biological experiments with drosophila and higher and lower plants, and radiation physics and radiobiology studies for the planning of biological protection on future space flights. The most significant conclusion from the preliminary data is that rats tolerate space flight better with an artificial force of gravity.

  6. Scientific experiments in the flight of the 1977 biological satellite (draft plan)

    NASA Technical Reports Server (NTRS)

    1977-01-01

    The physiological, biological, radiobiological and radiophysical experiments planned for the 1977 biological satellite are described. The biological experiments will involve rats, higher and lower plants, insects and other biological specimens carried on the biosatellite. The responses of these organisms to weightlessness, artificial gravity, cosmic radiation particles and general flight factors will be studied. The radiophysical experiments will investigate certain properties of cosmic radiation as well as the possibility of creating electrostatic and dielectric radiation shields under actual space-flight conditions.

  7. Dosimetric and radiobiological comparison of TG-43 and Monte Carlo calculations in 192Ir breast brachytherapy applications.

    PubMed

    Peppa, V; Pappas, E P; Karaiskos, P; Major, T; Polgár, C; Papagiannis, P

    2016-10-01

    To investigate the clinical significance of introducing model based dose calculation algorithms (MBDCAs) as an alternative to TG-43 in 192 Ir interstitial breast brachytherapy. A 57 patient cohort was used in a retrospective comparison between TG-43 based dosimetry data exported from a treatment planning system and Monte Carlo (MC) dosimetry performed using MCNP v. 6.1 with plan and anatomy information in DICOM-RT format. Comparison was performed for the target, ipsilateral lung, heart, skin, breast and ribs, using dose distributions, dose-volume histograms (DVH) and plan quality indices clinically used for plan evaluation, as well as radiobiological parameters. TG-43 overestimation of target DVH parameters is statistically significant but small (less than 2% for the target coverage indices and 4% for homogeneity indices, on average). Significant dose differences (>5%) were observed close to the skin and at relatively large distances from the implant leading to a TG-43 dose overestimation for the organs at risk. These differences correspond to low dose regions (<50% of the prescribed dose), being less than 2% of the prescribed dose. Detected dosimetric differences did not induce clinically significant differences in calculated tumor control probabilities (mean absolute difference <0.2%) and normal tissue complication probabilities. While TG-43 shows a statistically significant overestimation of most indices used for plan evaluation, differences are small and therefore not clinically significant. Improved MBDCA dosimetry could be important for re-irradiation, technique inter-comparison and/or the assessment of secondary cancer induction risk, where accurate dosimetry in the whole patient anatomy is of the essence. Copyright © 2016 Associazione Italiana di Fisica Medica. Published by Elsevier Ltd. All rights reserved.

  8. Opportunity to discuss ethical issues during clinical learning experience.

    PubMed

    Palese, Alvisa; Gonella, Silvia; Destrebecq, Anne; Mansutti, Irene; Terzoni, Stefano; Morsanutto, Michela; Altini, Pietro; Bevilacqua, Anita; Brugnolli, Anna; Canzan, Federica; Ponte, Adriana Dal; De Biasio, Laura; Fascì, Adriana; Grosso, Silvia; Mantovan, Franco; Marognolli, Oliva; Nicotera, Raffaela; Randon, Giulia; Tollini, Morena; Saiani, Luisa; Grassetti, Luca; Dimonte, Valerio

    2018-01-01

    Undergraduate nursing students have been documented to experience ethical distress during their clinical training and felt poorly supported in discussing the ethical issues they encountered. Research aims: This study was aimed at exploring nursing students' perceived opportunity to discuss ethical issues that emerged during their clinical learning experience and associated factors. An Italian national cross-sectional study design was performed in 2015-2016. Participants were invited to answer a questionnaire composed of four sections regarding: (1) socio-demographic data, (2) previous clinical learning experiences, (3) current clinical learning experience quality and outcomes, and (4) the opportunity to discuss ethical issues with nurses in the last clinical learning experience (from 0 - 'never' to 3 - 'very much'). Participants and research context: Participants were 9607 undergraduate nursing students who were attending 95 different three-year Italian baccalaureate nursing programmes, located at 27 universities in 15 Italian regions. Ethical considerations: This study was conducted in accordance with the Human Subject Research Ethics Committee guidelines after the research protocol was approved by an ethics committee. Overall, 4707 (49%) perceived to have discussed ethical issues 'much' or 'very much'; among the remaining, 3683 (38.3%) and 1217 (12.7%) students reported the perception of having discussed, respectively, 'enough' or 'never' ethical issues emerged in the clinical practice. At the multivariate logistic regression analysis explaining 38.1% of the overall variance, the factors promoting ethical discussion were mainly set at the clinical learning environment levels (i.e. increased learning opportunities, self-directed learning, safety and nursing care quality, quality of the tutorial strategies, competences learned and supervision by a clinical nurse). In contrast, being male was associated with a perception of less opportunity to discuss ethical issues

  9. Clinical learning experiences of nursing students using an innovative clinical partnership model: A non-randomized controlled trial.

    PubMed

    Chan, Aileen W K; Tang, Fiona W K; Choi, Kai Chow; Liu, Ting; Taylor-Piliae, Ruth E

    2018-06-05

    Clinical practicum is a major learning component for pre-registration nursing students. Various clinical practicum models have been used to facilitate students' clinical learning experiences, employing both university-based and hospital-based clinical teachers. Considering the strengths and limitations of these clinical practicum models, along with nursing workforce shortages, we developed and tested an innovative clinical partnership model (CPM) in Hong Kong. To evaluate an innovative CPM among nursing students actual and preferred clinical learning environment, compared with a conventional facilitation model (CFM). A non-randomized controlled trial examining students' clinical experiences, comparing the CPM (supervised by hospital clinical teacher) with the CFM (supervised by university clinical teacher). One university in Hong Kong. Pre-registration nursing students (N = 331), including bachelor of nursing (n = 246 year three-BN) and masters-entry nursing (n = 85 year one-MNSP). Students were assigned to either the CPM (n = 48 BN plus n = 85 MNSP students) or the CFM (n = 198 BN students) for their clinical practice experiences in an acute medical-surgical ward. Clinical teachers supervised between 6 and 8 students at a time, during these clinical practicums (duration = 4-6 weeks). At the end of the clinical practicum, students were invited to complete the Clinical Learning Environment Inventory (CLEI). Analysis of covariance was used to compare groups; adjusted for age, gender and prior work experience. A total of 259 students (mean age = 22 years, 76% female, 81% prior work experience) completed the CLEI (78% response rate). Students had higher scores on preferred versus actual experiences, in all domains of the CLEI. CPM student experiences indicated a higher preferred task orientation (p = 0.004), while CFM student experiences indicated a higher actual (p < 0.001) and preferred individualization (p = 0

  10. Learning community health nursing concepts from clinical experience.

    PubMed

    Lasater, Kathie; Luce, Linda; Volpin, Miriam; Terwilliger, Allison; Wild, Jackson

    2007-01-01

    Clinical faculty often struggle to design competency demonstrations that promote quality learning experiences. A nursing program in Oregon combined mental health and community health nursing practica and required well-planned, integrated competency demonstrations. This requirement became the impetus for students to promote the health of clients and learn clinical concepts that are difficult to experience in a typical term. Faculty coached students to make a significant contribution that would last beyond their clinical practica. A case study in competency demonstration design is described, and implications for curriculum development are presented.

  11. Low LET protons focused to submicrometer shows enhanced radiobiological effectiveness.

    PubMed

    Schmid, T E; Greubel, C; Hable, V; Zlobinskaya, O; Michalski, D; Girst, S; Siebenwirth, C; Schmid, E; Molls, M; Multhoff, G; Dollinger, G

    2012-10-07

    This study shows that enhanced radiobiological effectiveness (RBE) values can be generated focusing low linear energy transfer (LET) radiation and thus changing the microdose distribution. 20 MeV protons (LET = 2.65 keV µm(-1)) are focused to submicrometer diameter at the ion microprobe superconducting nanoprobe for applied nuclear (Kern) physics experiments of the Munich tandem accelerator. The RBE values, as determined by measuring micronuclei (RBE(MN) = 1.48 ± 0.07) and dicentrics (RBE(D) = 1.92 ± 0.15), in human-hamster hybrid (A(L)) cells are significantly higher when 117 protons were focused to a submicrometer irradiation field within a 5.4 × 5.4 µm(2) matrix compared to quasi homogeneous in a 1 × 1 µm(2) matrix applied protons (RBE(MN) = 1.28 ± 0.07; RBE(D) = 1.41 ± 0.14) at the same average dose of 1.7 Gy. The RBE values are normalized to standard 70 kV (dicentrics) or 200 kV (micronuclei) x-ray irradiation. The 117 protons applied per point deposit the same amount of energy like a (12)C ion with 55 MeV total energy (4.48 MeV u(-1)). The enhancements are about half of that obtained for (12)C ions (RBE(MN) = 2.20 ± 0.06 and RBE(D) = 3.21 ± 0.10) and they are attributed to intertrack interactions of the induced damages. The measured RBE values show differences from predictions of the local effect model (LEM III) that is used to calculate RBE values for irradiation plans to treat tumors with high LET particles.

  12. Transfer of Minibeam Radiation Therapy into a cost-effective equipment for radiobiological studies: a proof of concept.

    PubMed

    Prezado, Y; Dos Santos, M; Gonzalez, W; Jouvion, G; Guardiola, C; Heinrich, S; Labiod, D; Juchaux, M; Jourdain, L; Sebrie, C; Pouzoulet, F

    2017-12-11

    Minibeam radiation therapy (MBRT) is an innovative synchrotron radiotherapy technique able to shift the normal tissue complication probability curves to significantly higher doses. However, its exploration was hindered due to the limited and expensive beamtime at synchrotrons. The aim of this work was to develop a cost-effective equipment to perform systematic radiobiological studies in view of MBRT. Tumor control for various tumor entities will be addressable as well as studies to unravel the distinct biological mechanisms involved in normal and tumor tissues responses when applying MBRT. With that aim, a series of modifications of a small animal irradiator were performed to make it suitable for MBRT experiments. In addition, the brains of two groups of rats were irradiated. Half of the animals received a standard irradiation, the other half, MBRT. The animals were followed-up for 6.5 months. Substantial brain damage was observed in the group receiving standard RT, in contrast to the MBRT group, where no significant lesions were observed. This work proves the feasibility of the transfer of MBRT outside synchrotron sources towards a small animal irradiator.

  13. Fifteen symposia on microdosimetry: implications for modern particle-beam cancer radiotherapy.

    PubMed

    Wambersie, A; Menzel, H; Gueulette, J; Pihet, P

    2015-09-01

    The objective of microdosimetry was, and still is, to identify physical descriptions of the initial physical processes of ionising radiation interacting with biological matter which correlate with observed radiobiological effects with a view to improve the understanding of radiobiological mechanisms and effects. The introduction of therapy with particles starting with fast neutrons followed by negative pions, protons and light ions necessitated the application of biological weighting factors for absorbed dose in order to account for differences of the relative biological effectiveness (RBE). Dedicated radiobiological experiments in therapy beams with mammalian cells and with laboratory animals provided sets of RBE values which are used to evaluate empirical 'clinical RBE values'. The combination of such experiments with microdosimetric measurements in identical conditions offered the possibility to establish semi-empirical relationships between microdosimetric parameters and results of RBE studies. © The Author 2015. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

  14. [Ethic review on clinical experiments of medical devices in medical institutions].

    PubMed

    Shuai, Wanjun; Chao, Yong; Wang, Ning; Xu, Shining

    2011-07-01

    Clinical experiments are always used to evaluate the safety and validity of medical devices. The experiments have two types of clinical trying and testing. Ethic review must be done by the ethics committee of the medical department with the qualification of clinical research, and the approval must be made before the experiments. In order to ensure the safety and validity of clinical experiments of medical devices in medical institutions, the contents, process and approval criterions of the ethic review were analyzed and discussed.

  15. Radiobiological study by using laser-driven proton beams

    NASA Astrophysics Data System (ADS)

    Yogo, A.; Sato, K.; Nishikino, M.; Mori, M.; Teshima, T.; Numasaki, H.; Murakami, M.; Demizu, Y.; Akagi, S.; Nagayama, S.; Ogura, K.; Sagisaka, A.; Orimo, S.; Nishiuchi, M.; Pirozhkov, A. S.; Ikegami, M.; Tampo, M.; Sakaki, H.; Suzuki, M.; Daito, I.; Oishi, Y.; Sugiyama, H.; Kiriyama, H.; Okada, H.; Kanazawa, S.; Kondo, S.; Shimomura, T.; Nakai, Y.; Tanoue, M.; Sugiyama, H.; Sasao, H.; Wakai, D.; Kawachi, T.; Nishimura, H.; Bolton, P. R.; Daido, H.

    2009-07-01

    Particle acceleration driven by high-intensity laser systems is widely attracting interest as a potential alternative to conventional ion acceleration, including ion accelerator applications to tumor therapy. Recent works have shown that a high intensity laser pulse can produce single proton bunches of a high current and a short pulse duration. This unique feature of laser-ion acceleration can lead to progress in the development of novel ion sources. However, there has been no experimental study of the biological effects of laser-driven ion beams. We describe in this report the first demonstrated irradiation effect of laser-accelerated protons on human lung cancer cells. In-vitro A549 cells are irradiated with a proton dose of 20 Gy, resulting in a distinct formation of γ-H2AX foci as an indicator of DNA double-strand breaks. This is a pioneering result that points to future investigations of the radiobiological effects of laser-driven ion beams. The laser-driven ion beam is apotential excitation source for time-resolved determination of hydroxyl (OH) radical yield, which will explore relationship between the fundamental chemical reactions of radiation effects and consequent biological processes.

  16. Emotional Intelligence in Intensive Clinical Experiences for Nursing Students

    ERIC Educational Resources Information Center

    Zoromski, Lorraine M.

    2017-01-01

    This study looked for associations between measures of emotional intelligence in an intensive clinical experience for nursing students in their final semester of an associate's degree program. The theory of emotional labor was used to make connections between nursing clinical experience and emotional intelligence. Twenty nursing students from a…

  17. Status and Prospects of Hirfl Experiments on Nuclear Physics

    NASA Astrophysics Data System (ADS)

    Xu, H. S.; Zheng, C.; Xiao, G. Q.; Zhan, W. L.; Zhou, X. H.; Zhang, Y. H.; Sun, Z. Y.; Wang, J. S.; Gan, Z. G.; Huang, W. X.; Ma, X. W.

    HIRFL is an accelerator complex consisting of 3 accelerators, 2 radioactive beams lines, 1 storage rings and a number of experimental setups. The research activities at HIRFL cover the fields of radio-biology, material science, atomic physics, and nuclear physics. This report mainly concentrates on the experiments of nuclear physics with the existing and planned experimental setups such as SHANS, RIBLL1, ETF, CSRe, PISA and HPLUS at HIRFL.

  18. MO-A-BRC-00: TG167: Clinical Recommendations for Innovative Brachytherapy Devices and Applicators

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    NONE

    Although a multicenter, Phase III, prospective, randomized trial is the gold standard for evidence-based medicine, it is rarely used to evaluate innovative radiotherapy devices because of many practical and ethical reasons. It is usually sufficient to compare the dose distributions and dose rates for determining equivalence of the innovative device to an existing one. Thus, quantitative evaluation of the dosimetric characteristics of an innovative brachytherapy device or application is a critical part in which physicists are actively involved. The physicist’s role, along with physician colleagues, in this process is highlighted for innovative products or applications and includes evaluation of 1)more » dosimetric considerations for clinical implementation (including calibrations, dose calculations, and radiobiological aspects) to comply with existing societal dosimetric prerequisites for sources in routine clinical use, 2) risks and benefits from regulatory and safety perspectives, and 3) resource assessment and preparedness. Further, calibration methods should be traceable to a primary standards dosimetry laboratory such as NIST in the U.S. or to other primary standards dosimetry laboratory located elsewhere. Clinical users should follow standards as approved by their country’s regulatory agencies that approved such a brachytherapy device. Integration of this system into the medical source calibration infrastructure of secondary standard dosimetry laboratories such as the ADCLs is encouraged before a source is introduced into widespread routine clinical use. The AAPM and GEC-ESTRO have developed guidelines for the safe and consistent application of brachytherapy using innovative brachytherapy devices and applications. The current report covers regulatory approvals, calibration, dose calculations, radiobiological issues, and overall safety concerns that should be addressed during the commissioning stage preceding clinical use. These guidelines are based on

  19. Radiobiological basis of SBRT and SRS.

    PubMed

    Song, Chang W; Kim, Mi-Sook; Cho, L Chinsoo; Dusenbery, Kathryn; Sperduto, Paul W

    2014-08-01

    Stereotactic body radiation therapy (SBRT) and stereotactic radiosurgery (SRS) have been demonstrated to be highly effective for a variety of tumors. However, the radiobiological principles of SBRT and SRS have not yet been clearly defined. It is well known that newly formed tumor blood vessels are fragile and extremely sensitive to ionizing radiation. Various lines of evidence indicate that irradiation of tumors with high dose per fraction, i.e. >10 Gy per fraction, not only kills tumor cells but also causes significant damage in tumor vasculatures. Such vascular damage and ensuing deterioration of the intratumor environment then cause ischemic or indirect/secondary tumor cell death within a few days after radiation exposure, indicating that vascular damage plays an important role in the response of tumors to SBRT and SRS. Indications are that the extensive tumor cell death due to the direct effect of radiation on tumor cells and the secondary effect through vascular damage may lead to massive release of tumor-associated antigens and various pro-inflammatory cytokines, thereby triggering an anti-tumor immune response. However, the precise role of immune assault on tumor cells in SBRT and SRS has not yet been clearly defined. The "4 Rs" for conventional fractionated radiotherapy do not include indirect cell death and thus 4 Rs cannot account for the effective tumor control by SBRT and SRS. The linear-quadratic model is for cell death caused by DNA breaks and thus the usefulness of this model for ablative high-dose SBRT and SRS is limited.

  20. Comparison of different fractionation schedules toward a single fraction in high-dose-rate brachytherapy as monotherapy for low-risk prostate cancer using 3-dimensional radiobiological models.

    PubMed

    Mavroidis, Panayiotis; Milickovic, Natasa; Cruz, Wilbert F; Tselis, Nikolaos; Karabis, Andreas; Stathakis, Sotirios; Papanikolaou, Nikos; Zamboglou, Nikolaos; Baltas, Dimos

    2014-01-01

    The aim of the present study was the investigation of different fractionation schemes to estimate their clinical impact. For this purpose, widely applied radiobiological models and dosimetric measures were used to associate their results with clinical findings. The dose distributions of 12 clinical high-dose-rate brachytherapy implants for prostate were evaluated in relation to different fractionation schemes. The fractionation schemes compared were: (1) 1 fraction of 20 Gy; (2) 2 fractions of 14 Gy; (3) 3 fractions of 11 Gy; and (4) 4 fractions of 9.5 Gy. The clinical effectiveness of the different fractionation schemes was estimated through the complication-free tumor control probability (P+), the biologically effective uniform dose, and the generalized equivalent uniform dose index. For the different fractionation schemes, the tumor control probabilities were 98.5% in 1×20 Gy, 98.6% in 2×14 Gy, 97.5% in 3×11 Gy, and 97.8% in 4×9.5 Gy. The corresponding P+ values were 88.8% in 1×20 Gy, 83.9% in 2×14 Gy, 86.0% in 3×11 Gy, and 82.3% in 4×9.5 Gy. With use of the fractionation scheme 4×9.5 Gy as reference, the isoeffective schemes regarding tumor control for 1, 2, and 3 fractions were 1×19.68 Gy, 2×13.75 Gy, and 3×11.05 Gy. The optimum fractionation schemes for 1, 2, 3, and 4 fractions were 1×19.16 Gy with a P+ of 91.8%, 2×13.2 Gy with a P+ of 89.6%, 3×10.6 Gy with a P+ of 88.4%, and 4×9.02 Gy with a P+ of 86.9%. Among the fractionation schemes 1×20 Gy, 2×14 Gy, 3×11 Gy, and 4×9.5 Gy, the first scheme was more effective in terms of P+. After performance of a radiobiological optimization, it was shown that a single fraction of 19.2 to 19.7 Gy (average 19.5 Gy) should produce at least the same benefit as that given by the 4×9.5 Gy scheme, and it should reduce the expected total complication probability by approximately 40% to 55%. Copyright © 2014 Elsevier Inc. All rights reserved.

  1. Comparison of Different Fractionation Schedules Toward a Single Fraction in High-Dose-Rate Brachytherapy as Monotherapy for Low-Risk Prostate Cancer Using 3-Dimensional Radiobiological Models

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Mavroidis, Panayiotis, E-mail: mavroidis@uthscsa.edu; Department of Medical Radiation Physics, Karolinska Institutet and Stockholm University, Stockholm; Milickovic, Natasa

    2014-01-01

    Purpose: The aim of the present study was the investigation of different fractionation schemes to estimate their clinical impact. For this purpose, widely applied radiobiological models and dosimetric measures were used to associate their results with clinical findings. Methods and Materials: The dose distributions of 12 clinical high-dose-rate brachytherapy implants for prostate were evaluated in relation to different fractionation schemes. The fractionation schemes compared were: (1) 1 fraction of 20 Gy; (2) 2 fractions of 14 Gy; (3) 3 fractions of 11 Gy; and (4) 4 fractions of 9.5 Gy. The clinical effectiveness of the different fractionation schemes was estimatedmore » through the complication-free tumor control probability (P{sub +}), the biologically effective uniform dose, and the generalized equivalent uniform dose index. Results: For the different fractionation schemes, the tumor control probabilities were 98.5% in 1 × 20 Gy, 98.6% in 2 × 14 Gy, 97.5% in 3 × 11 Gy, and 97.8% in 4 × 9.5 Gy. The corresponding P{sub +} values were 88.8% in 1 × 20 Gy, 83.9% in 2 × 14 Gy, 86.0% in 3 × 11 Gy, and 82.3% in 4 × 9.5 Gy. With use of the fractionation scheme 4 × 9.5 Gy as reference, the isoeffective schemes regarding tumor control for 1, 2, and 3 fractions were 1 × 19.68 Gy, 2 × 13.75 Gy, and 3 × 11.05 Gy. The optimum fractionation schemes for 1, 2, 3, and 4 fractions were 1 × 19.16 Gy with a P{sub +} of 91.8%, 2 × 13.2 Gy with a P{sub +} of 89.6%, 3 × 10.6 Gy with a P{sub +} of 88.4%, and 4 × 9.02 Gy with a P{sub +} of 86.9%. Conclusions: Among the fractionation schemes 1 × 20 Gy, 2 × 14 Gy, 3 × 11 Gy, and 4 × 9.5 Gy, the first scheme was more effective in terms of P{sub +}. After performance of a radiobiological optimization, it was shown that a single fraction of 19.2 to 19.7 Gy (average 19.5 Gy) should produce at least the same benefit as that given by the 4 × 9.5 Gy scheme, and it should reduce the expected total complication probability by

  2. SU-E-T-248: An Extended Generalized Equivalent Uniform Dose Accounting for Dose-Range Dependency of Radio-Biological Parameters.

    PubMed

    Troeller, A; Soehn, M; Yan, D

    2012-06-01

    Introducing an extended, phenomenological, generalized equivalent uniform dose (eEUD) that incorporates multiple volume-effect parameters for different dose-ranges. The generalized EUD (gEUD) was introduced as an estimate of the EUD that incorporates a single, tissue-specific parameter - the volume-effect-parameter (VEP) 'a'. As a purely phenomenological concept, its radio-biological equivalency to a given inhomogeneous dose distribution is not a priori clear and mechanistic models based on radio-biological parameters are assumed to better resemble the underlying biology. However, for normal organs mechanistic models are hard to derive, since the structural organization of the tissue plays a significant role. Consequently, phenomenological approaches might be especially useful in order to describe dose-response for normal tissues. However, the single parameter used to estimate the gEUD may not suffice in accurately representing more complex biological effects that have been discussed in the literature. For instance, radio-biological parameters and hence the effects of fractionation are known to be dose-range dependent. Therefore, we propose an extended phenomenological eEUD formula that incorporates multiple VEPs accounting for dose-range dependency. The eEUD introduced is a piecewise polynomial expansion of the gEUD formula. In general, it allows for an arbitrary number of VEPs, each valid for a certain dose-range. We proved that the formula fulfills required mathematical and physical criteria such as invertibility of the underlying dose-effect and continuity in dose. Furthermore, it contains the gEUD as a special case, if all VEPs are equal to 'a' from the gEUD model. The eEUD is a concept that expands the gEUD such that it can theoretically represent dose-range dependent effects. Its practicality, however, remains to be shown. As a next step, this will be done by estimating the eEUD from patient data using maximum-likelihood based NTCP modelling in the same way

  3. The effect of dose escalation on gastric toxicity when treating lower oesophageal tumours: a radiobiological investigation.

    PubMed

    Carrington, Rhys; Staffurth, John; Warren, Samantha; Partridge, Mike; Hurt, Chris; Spezi, Emiliano; Gwynne, Sarah; Hawkins, Maria A; Crosby, Thomas

    2015-11-19

    Using radiobiological modelling to estimate normal tissue toxicity, this study investigates the effects of dose escalation for concurrent chemoradiation therapy (CRT) in lower third oesophageal tumours on the stomach. 10 patients with lower third oesophageal cancer were selected from the SCOPE 1 database (ISCRT47718479) with a mean planning target volume (PTV) of 348 cm(3). The original 3D conformal plans (50 Gy3D) were compared to newly created RapidArc plans of 50 GyRA and 60 GyRA, the latter using a simultaneous integrated boost (SIB) technique using a boost volume, PTV2. Dose-volume metrics and estimates of normal tissue complication probability (NTCP) were compared. There was a significant increase in NTCP of the stomach wall when moving from the 50 GyRA to the 60 GyRA plans (11-17 %, Wilcoxon signed rank test, p = 0.01). There was a strong correlation between the NTCP values of the stomach wall and the volume of the stomach wall/PTV 1 and stomach wall/PTV2 overlap structures (R = 0.80 and R = 0.82 respectively) for the 60 GyRA plans. Radiobiological modelling suggests that increasing the prescribed dose to 60 Gy may be associated with a significantly increased risk of toxicity to the stomach. It is recommended that stomach toxicity be closely monitored when treating patients with lower third oesophageal tumours with 60 Gy.

  4. 3D-modelling of radon-induced cellular radiobiological effects in bronchial airway bifurcations: direct versus bystander effects.

    PubMed

    Szőke, István; Farkas, Arpád; Balásházy, Imre; Hofmann, Werner; Madas, Balázs G; Szőke, Réka

    2012-06-01

    The primary objective of this paper was to investigate the distribution of radiation doses and the related biological responses in cells of a central airway bifurcation of the human lung of a hypothetical worker of the New Mexico uranium mines during approximately 12 hours of exposure to short-lived radon progenies. State-of-the-art computational modelling techniques were applied to simulate the relevant biophysical and biological processes in a central human airway bifurcation. The non-uniform deposition pattern of inhaled radon daughters caused a non-uniform distribution of energy deposition among cells, and of related cell inactivation and cell transformation probabilities. When damage propagation via bystander signalling was assessed, it produced more cell killing and cell transformation events than did direct effects. If bystander signalling was considered, variations of the average probabilities of cell killing and cell transformation were supra-linear over time. Our results are very sensitive to the radiobiological parameters, derived from in vitro experiments (e.g., range of bystander signalling), applied in this work and suggest that these parameters may not be directly applicable to realistic three-dimensional (3D) epithelium models.

  5. Clinical Needs Finding: Developing the Virtual Experience, A Case Study

    PubMed Central

    Mittal, Vaishali; Thompson, Megan; Altman, Stuart M; Taylor, Peter; Summers, Alexander; Goodwin, Kelsey; Louie, Angelique Y

    2013-01-01

    We describe an innovative program at the University of California, Davis for students to engage in clinical needs finding. Using a team-based approach, students participated in clinical rotations to observe firsthand the needs of clinicians at the university affiliated medical center. The teams were asked to develop documentary-style videos to capture key experiences that would allow future viewers to use the videos as “virtual” clinical rotations. This was conceived as a strategy to allow students in prohibitively large classes, or students in programs at institutions without associated medical or veterinary school programs, to experience clinical rotations and perform needs assessments. The students' perspectives on the experience as well as instructor analysis of best practices for this type of activity are presented and discussed. We found that the internship experience was valuable to the students participating, by not only introducing the practice of needs finding but for increasing the students' confidence in the practice of engineering design and their ability to work independently. The videos produced were of such high quality that instructors from other institutions have requested copies for instructional use. Virtual clinical rotations through video experiences may provide a reasonable substitute for students who do not have the ability to participate in rotations in person. PMID:23483373

  6. Biological effective dose evaluation in gynaecological brachytherapy: LDR and HDR treatments, dependence on radiobiological parameters, and treatment optimisation.

    PubMed

    Bianchi, C; Botta, F; Conte, L; Vanoli, P; Cerizza, L

    2008-10-01

    This study was undertaken to compare the biological efficacy of different high-dose-rate (HDR) and low-dose-rate (LDR) treatments of gynaecological lesions, to identify the causes of possible nonuniformity and to optimise treatment through customised calculation. The study considered 110 patients treated between 2001 and 2006 with external beam radiation therapy and/or brachytherapy with either LDR (afterloader Selectron, (137)Cs) or HDR (afterloader microSelectron Classic, (192)Ir). The treatments were compared in terms of biologically effective dose (BED) to the tumour and to the rectum (linear-quadratic model) by using statistical tests for comparisons between independent samples. The difference between the two treatments was statistically significant in one case only. However, within each technique, we identified considerable nonuniformity in therapeutic efficacy due to differences in fractionation schemes and overall treatment time. To solve this problem, we created a Microsoft Excel spreadsheet allowing calculation of the optimal treatment for each patient: best efficacy (BED(tumour)) without exceeding toxicity threshold (BED(rectum)). The efficacy of a treatment may vary as a result of several factors. Customised radiobiological evaluation is a useful adjunct to clinical evaluation in planning equivalent treatments that satisfy all dosimetric constraints.

  7. Clinical Environment as a Learning Environment: Student Nurses' Perceptions Concerning Clinical Learning Experiences.

    ERIC Educational Resources Information Center

    Papp, Inkeri; Markkanen, Marjatta; von Bonsdorff, Mikaela

    2003-01-01

    Finnish student nurses (n=16) described their clinical learning experiences. Several themes were identified: feeling appreciated and supported, the quality of mentoring and patient care, and self-directedness. School and clinical staff cooperation helped create a good learning environment in which theory and practice complemented each other.…

  8. The Importance of Early Experiences: Clinical, Research, and Policy Perspectives

    ERIC Educational Resources Information Center

    Zeanah, Charles H.

    2009-01-01

    The degree to which early adverse experiences exert long term effects on development and how much early adversity may be overcome through subsequent experiences are important mental health questions. The clinical, research and policy perspectives on these questions lead to different answers. From a clinical perspective, change is always possible,…

  9. Transnational science and collaborative networks. The case of Genetics and Radiobiology in Mexico, 1950-1970.

    PubMed

    Barahona, Ana

    2015-01-01

    The transnational approach of the science and technology studies (S&TS) abandons the nation as a unit of analysis in order to understand the development of science history. It also abandons Euro-US-centred narratives in order to explain the role of international collaborative networks and the circulation of knowledge, people, artefacts and scientific practices. It is precisely under this perspective that the development of genetics and radiobiology in Mexico shall be analyzed, together with the pioneering work of the Mexican physician-turned-geneticist Alfonso León de Garay who spent two years in the Galton Laboratory in London under the supervision of Lionel Penrose. Upon his return de Garay funded the Genetics and Radiobiology Program of the National Commission of Nuclear Energy based on local needs and the aim of working beyond geographical limitations to thus facilitate the circulation of knowledge, practices and people. The three main lines of research conducted in the years after its foundation that were in line with international projects while responding to the national context were, first, cytogenetic studies of certain abnormalities, and the cytogenetics and anthropological studies of the Olympic Games held in Mexico in 1968; second, the study of the effects of radiation on hereditary material; and third, the study of population genetics in Drosophila and in Mexican indigenous groups. The program played a key role in reshaping the scientific careers of Mexican geneticists, and in transferring locally sourced research into broader networks. This case shows the importance of international collaborative networks and circulation in the constitution of national scientific elites, and also shows the national and transnational concerns that shaped local practices.

  10. Microdosimetric investigation of a fast neutron radiobiology facility utilising the d(4)-9Be reaction.

    PubMed

    Waker, A J; Maughan, R L

    1986-11-01

    * which, for a 2 micron simulated diameter, is related to the dose mean lineal energy corrected for saturation y* by zeta* = y* keV micron-1 X 0.51 X 10(-2) Gy. Values of y* determined for each of the collimator arrangements used at the Gray Laboratory show a spread of some 6% (table 1) and, as the dose fraction between lineal energies 5 and 150 keV micron-1 (the recoil proton component) do not alter by more than 3%, radiobiological experiments performed with different collimator arrangements would show no observable differences.(ABSTRACT TRUNCATED AT 400 WORDS)

  11. Client Accounts of Corrective Experiences in Psychotherapy: Implications for Clinical Practice.

    PubMed

    Angus, Lynne; Constantino, Michael J

    2017-02-01

    The Patient Perceptions of Corrective Experiences in Individual Therapy (PPCEIT; Constantino, Angus, Friedlander, Messer, & Moertl, 2011) posttreatment interview guide was developed to provide clinical researchers with an effective mode of inquiry to identify and further explore clients' firsthand accounts of corrective and transformative therapy experiences and their determinants. Not only do findings from the analysis of client corrective experience (CE) accounts help identify what and how CEs happen in or as a result of psychotherapy, but the measure itself may also provide therapists with an effective tool to further enhance clients' awareness, understanding, and integration of transformative change experiences. Accordingly, we discuss in this afterword to the series the implications for clinical practice arising from (a) the thematic analysis of client CE accounts, drawn from a range of clinical samples and international research programs and (b) the clinical effect of completing the PPCEIT posttreatment interview inquiry. We also identify directions for future clinical training and research. © 2016 Wiley Periodicals, Inc.

  12. Physiotherapy clinical educators' perceptions and experiences of clinical prediction rules.

    PubMed

    Knox, Grahame M; Snodgrass, Suzanne J; Rivett, Darren A

    2015-12-01

    Clinical prediction rules (CPRs) are widely used in medicine, but their application to physiotherapy practice is more recent and less widespread, and their implementation in physiotherapy clinical education has not been investigated. This study aimed to determine the experiences and perceptions of physiotherapy clinical educators regarding CPRs, and whether they are teaching CPRs to students on clinical placement. Cross-sectional observational survey using a modified Dillman method. Clinical educators (n=211, response rate 81%) supervising physiotherapy students from 10 universities across 5 states and territories in Australia. Half (48%) of respondents had never heard of CPRs, and a further 25% had never used CPRs. Only 27% reported using CPRs, and of these half (51%) were rarely if ever teaching CPRs to students in the clinical setting. However most respondents (81%) believed CPRs assisted in the development of clinical reasoning skills and few (9%) were opposed to teaching CPRs to students. Users of CPRs were more likely to be male (p<0.001), have post-professional qualifications (p=0.020), work in private practice (p<0.001), and work in the area of musculoskeletal physiotherapy (p<0.001) compared with non-users. The CPRs most commonly known, used and taught were the Ottawa Ankle Rule, the Ottawa Knee Rule, and Wells' Rule for Deep Vein Thrombosis. Students are unlikely to be learning about CPRs on clinical placement, as few clinical educators use them. Clinical educators will require training in CPRs and assistance in teaching them if students are to better learn about implementing CPRs in physiotherapy clinical practice. Copyright © 2015 Chartered Society of Physiotherapy. Published by Elsevier Ltd. All rights reserved.

  13. Preparing for practice: Nursing intern and faculty perceptions on clinical experiences.

    PubMed

    AlThiga, Hanan; Mohidin, Sharifah; Park, Yoon Soo; Tekian, Ara

    2017-04-01

    Clinical experience and exposure to real patients are required elements of nursing education. Trainees in nursing are expected to be prepared adequately for the hard-working environment, increasing patient complexity, and higher-level competencies. This study investigates differences between nursing interns and clinical faculty on actual and perceived importance of educational preparation and development of clinical competencies, focusing on the nursing curriculum and transition to practice. A convenient sampling technique with a mixed-methods design was used to collect quantitative and qualitative data, by surveying and interviewing nursing interns and faculty members from King Abdul-Aziz University in Saudi Arabia; data collection occurred in December 2015. The survey (23 items) and focused interviews measured perceptions of clinical instruction and experience. Descriptive statistics and t-tests were used to analyze differences in mean ratings between actual and perceived importance. Themes collected from narrative interview data were summarized. Significant differences were found between nursing interns (n = 46) and faculty (n = 29) perceptions of actual clinical teaching and experiences and its importance including the clinical teaching and the development of clinical competence, p < .01. Moreover, nursing interns rated actual experiences of knowledge base and skills significantly lower than faculty perceptions, p = .001. Narrative data provided in-depth information on factors contributing and hindering the learning and teaching environment. Findings from this study call for clinical instruction and experiences to take a step further to meet current practice standards and to improve patient safety in the health professions education of nurses.

  14. Dental Students' Clinical Expectations and Experiences Treating Persons with Disabilities.

    PubMed

    Perusini, Darsi J; Llacuachaqui, Marcia; Sigal, Michael J; Dempster, Laura J

    2016-03-01

    Persons with disabilities (PWDs) have a disproportionate level of dental disease relative to the general population. Access to care is a cause along with dentists' willingness to treat PWDs. The aim of this study was to investigate the expectations and experiences of dental students in providing treatment to these patients in a hospital-based dental clinic for PWDs. Senior dental students at the Faculty of Dentistry, University of Toronto (n=92) were surveyed prior to (Phase I) and at the end of (Phase II) mandatory clinical rotations at the Mount Sinai Hospital's Dentistry Clinic for Persons with Special Needs. Response rates were 88% for Phase I and 58% for Phase II. Before the rotations, 70% of the respondents reported little or no experience with PWDs, and 46% said they did not feel comfortable providing basic dental treatment to PWDs. However, in Phase II, significantly more students reported being comfortable than in Phase I (p=0.001). Overall, the majority of respondents (Phase I 95%; Phase II 98%) indicated they would at least attempt to provide basic dental care to PWDs after graduation. The majority also identified the opportunity to provide care and interact with PWDs as the most enjoyable aspect of their experience at the clinic. They reported that the experience helped reduce their concerns about treating PWDs including being more realistic about the time required and ideal quality of the treatment they could provide. These results suggest that their experience in the clinic significantly increased students' comfort in treating PWDs. The respondents expressed a willingness to treat PWDs once graduated and generally identified their experience as being more positive than their expectations.

  15. Preceptor-guided clinical practica and the learning experiences of nursing students.

    PubMed

    Jiang, Ru-Shang; Chou, Chuan-Chiang; Tsai, Pi-Lan

    2012-06-01

    In Taiwan, nearly one third of newly graduated nurses quit their first nursing job within 3 months and many never return to nursing. Because traditional clinical practice designs do not offer adequate opportunities for students to work independently, many senior nursing students lack self-confidence in their nursing skills and are not familiar with the day-to-day realities of nursing even after completing all their required clinical practica. A model for a preceptor-guided clinical practicum was designed to address this concern. The aim of this study was to explore the learning experiences of senior nursing students who worked with preceptors during their clinical practica. Thirteen female nursing students were interviewed to discover their perceptions of their preceptor-guided clinical practicum. All interviews were tape recorded and transcribed. Descriptions were analyzed using Colaizzi's phenomenological methodology. Four themes emerged from the data that described the preceptorship experience in the clinical practicum: (1) information and new experience overload, (2) feelings of loneliness and stress, (3) questioning whether strict preceptors achieve the best results, and (4) beginning to feel like a nurse. Findings suggest that it is important for nurse educators to be clear and precise about the expectations of the preceptorship experience. Orientation for both preceptors and students is essential. Support and encouragement throughout the entire practicum experience for preceptors and students is necessary to ensure program success.

  16. Influence of Clinical Experience and Productivity on Emergency Medicine Faculty Teaching Scores

    PubMed Central

    Clyne, Brian; Smith, Jessica L.; Napoli, Anthony M.

    2012-01-01

    Background Commonly cited barriers to effective teaching in emergency medicine include lack of time, competing demands for patient care, and a lack of formal teaching experience. Teaching may be negatively affected by demands for increased clinical productivity, or positively influenced by clinical experience. Objective To examine the association between faculty teaching scores and clinical productivity, years of clinical experience, and amount of clinical contact with resident physicians. Methods We conducted a retrospective, observational study with existing data on full-time faculty at a high-volume, urban emergency medicine residency training program for academic year 2008–2009. Residents rated faculty on 9 domains of teaching, including willingness to teach, enthusiasm for teaching, medical knowledge, preparation, and communication. Clinical productivity data for relative value units per hour and number of patients per hour, years of clinical experience, and annual clinical hours were obtained from existing databases. Results For the 25 core faculty members included in the study, there was no relationship between faculty teaching scores and clinical productivity measures (relative value units per hour: r2  =  0.01, P  =  .96, patients per hour: r2  =  0.00, P  =  .76), or between teaching scores and total clinical hours with residents (r2  =  0.07, P  =  .19). There was a significant negative relationship between years of experience and teaching scores (r2  =  0.27, P < .01). Conclusions Our study demonstrated that teaching scores for core emergency medicine faculty did not correlate with clinical productivity or amount of clinical contact with residents. Teaching scores were inversely related to number of years of clinical experience, with more experienced faculty earning the lowest teaching scores. Further study is necessary to determine if there are clinical measures that identify good educators

  17. Planning a study abroad clinical experience.

    PubMed

    Wright, Dolores J

    2010-05-01

    Not only is globalization expanding areas of human activity, it is also influencing the variety of educational offerings in universities. Therefore, globalization must be considered by nurse educators as they reevaluate ways of preparing nursing students to meet the health care needs of populations they currently serve and will care for in the future. Study abroad programs have been encouraged to be part of the college experience in the United States for more than 30 years; however, these programs have been relatively lacking in nursing education. Most of the study abroad programs described in the nursing literature are research-based or first-person accounts of an experience and provide little information about planning a study abroad program. This article describes a study abroad learning experience for senior nursing students and discusses the issues such as student selection, student safety, and available clinical experiences that need to be considered before undertaking such an endeavor.

  18. Interprofessional student experiences on the HAVEN free clinic leadership board.

    PubMed

    Scott, Elizabeth Anne; Swartz, Martha K

    2015-01-01

    In this study, we examined the experiences of students serving on the leadership board of HAVEN - the student-run free clinic of the Yale University health professional schools. Open-ended responses were collected from 18 of the 28 members of the 2011-2012 leadership board through an online survey. Students reported an overall positive experience participating on the board and valued the opportunity to be part of a committed community creating change. The majority of students reported that their time as a board member had improved their attitude towards interprofessional collaboration (78%) and had also fostered their leadership skills (67%). Around two thirds (67%) reported that their experience had positively impacted their future career plans, either reinforcing their desire to work with underserved populations or encouraging them to pursue leadership roles. Based on these data, it is suggested that the HAVEN Free Clinic offers a useful opportunity for students to experience the demands of clinical care leadership while working together in an interprofessional context.

  19. Dental Students' Clinical Experience Across Three Successive Curricula at One U.S. Dental School.

    PubMed

    White, Joel M; Jenson, Larry E; Gansky, Stuart A; Walsh, Cameron J; Accurso, Brent T; Vaderhobli, Ram M; Kalenderian, Elsbeth; Walji, Muhammad F; Cheng, Jing

    2017-04-01

    As dental schools continue to seek the most effective ways to provide clinical education for students, it is important to track the effects innovations have on students' clinical experience to allow for quantitative comparisons of various curricula. The aim of this study was to compare the impact of three successive clinical curricula on students' experience at one U.S. dental school. The three were a discipline-based curriculum (DBC), a comprehensive care curriculum (CCC), and a procedural requirement curriculum plus externships (PRCE). Students' clinic experience data from 1992 to 2013 were analyzed for total experience and in five discipline areas. Clinic experience metrics analyzed were patient visits (PVs), relative value units (RVUs), and equivalent amounts (EQAs). A minimum experience threshold (MET) and a high experience threshold (HET) were set at one standard deviation above and below the mean for the DBC years. Students below the MET were designated as low achievers; students above the HET were designated as high achievers. The results showed significant differences among the three curricula in almost all areas of comparison: total PVs, total EQAs, total RVUs, RVUs by discipline, and number of high and low achievers in total clinical experience and by discipline. The comprehensive care approach to clinical education did not negatively impact students' clinical experience and in many cases enhanced it. The addition of externships also enhanced student total clinical experience although more study is needed to determine their effectiveness. The insights provided by this study suggest that the methodology used including the metrics of PVs, EQAs, and RVUs may be helpful for other dental schools in assessing students' clinical experience.

  20. The Meta-Analysis of Clinical Judgment Project: Effects of Experience on Judgment Accuracy

    ERIC Educational Resources Information Center

    Spengler, Paul M.; White, Michael J.; Aegisdottir, Stefania; Maugherman, Alan S.; Anderson, Linda A.; Cook, Robert S.; Nichols, Cassandra N.; Lampropoulos, Georgios K.; Walker, Blain S.; Cohen, Genna R.; Rush, Jeffrey D.

    2009-01-01

    Clinical and educational experience is one of the most commonly studied variables in clinical judgment research. Contrary to clinicians' perceptions, clinical judgment researchers have generally concluded that accuracy does not improve with increased education, training, or clinical experience. In this meta-analysis, the authors synthesized…

  1. A Medical Student-Run Child and Adolescent Psychiatry Clinic: One Institution's Experience.

    PubMed

    Murzl, Cassandra A; Durns, Tyler A; Mowrey, Lorin T; Tubbs, Andrew S; Boeve, Sally A

    2017-10-01

    This report examines the experience of one institution's development of the first student-run psychiatry clinic that serves both adult and pediatric populations. The clinic is held weekly with pre-clinical and clinical medical student volunteers under the supervision of board-certified adult and child psychiatrists. The development and evolution of the clinic over time are evaluated with particular attention to obstacles overcome. Medical student volunteers were surveyed retrospectively to evaluate their experience with patients with psychiatric illness, skill development, and interest in psychiatry. Since January 2016, the clinic has scheduled 90 patients, 32% of which were pediatric patients. Ninety-six medical students have volunteered, with roughly equal parts from all four medical school classes. Respondents to the experience survey showed marked improvement in their comfort working with patients with mental illness. Additionally, 40% "strongly agreed" or "agreed" that their experience influenced their interest in pursuing psychiatry as a career. This report describes a student-run psychiatry clinic with a dual mission of education and service, and the challenges associated with these sometimes competing goals. This clinic serves a vital need within our community and may be an example of the role that student-run clinics can have in fostering interdisciplinary care, psychiatric recruitment, and training for medical students.

  2. The Lived-Experience of Novice Nurse's Actualizing Clinical Reasoning in Academic Simulation

    ERIC Educational Resources Information Center

    Brinker, Mary Catherine

    2016-01-01

    The purpose of this existential-phenomenological study was to address the first-person perspective of what it is like to experience clinical reasoning during a simulation. It was not known how a novice nurse would describe the experience of actualizing clinical reasoning during the academic simulation experience. In order to maintain the…

  3. Development of an International Clinical Education Extracurricular Experience Through a Collaborative Partnership.

    PubMed

    Mandich, MaryBeth; Erickson, Mia; Nardella, Beth

    2017-01-01

    Participating in global health care through international clinical education may enhance the development of cultural competence and professionalism. Many logistical issues need to be resolved in the development of international clinical education experiences that meet program requirements. The purpose of this case report is to describe how a university developed such an experience for students by partnering with Amizade Global Service-Learning (Amizade), an organization that facilitates global learning experiences. Medical, nursing, and pharmacy students were already participating in a 4-week international health-related service learning rotation through Amizade. The preexisting relationship and contractual agreement with the university provided the necessary legal framework. Amizade staff assisted in finding a physical therapist qualified and willing to host a student. The academic coordinator for clinical education at the university and Amizade liaisons determined living arrangements, schedule, clinical settings, and patient population. The selected student had expressed interest and had met all clinical education placement requirements. The academic coordinator for clinical education had ongoing electronic communications with all parties. The student demonstrated predicted attributes of cultural competence and professionalism; through the partnership with Amizade, the student was exposed to several unique interprofessional experiences. The steps used by the university faculty in developing this interprofessional, international clinical education experience through a collaborative partnership may provide guidance for other institutions. © 2017 American Physical Therapy Association

  4. Cultural sensitivity or professional acculturation in early clinical experience?

    PubMed

    Whitford, David L; Hubail, Amal Redha

    2014-11-01

    This study aimed to explore the early clinical experience of medical students following the adaptation of an Early Patient Contact curriculum from a European culture in Ireland to an Arab culture in Bahrain. Medical students in Bahrain took part in an Early Patient Contact module modelled on a similar module from a partner medical school in Ireland. We used a qualitative approach employing thematic analysis of 54 student reflective logbooks. Particular attention was placed on reflections of cultural influences of experience in the course. Medical students undergoing this module received reported documented benefits of early clinical experience. However, students in Bahrain were exposed to cultural norms of the local Arab society including gender values, visiting the homes of strangers, language barriers and generous hospitality that led to additional challenges and learning for the medical students in acculturating to norms of the medical profession. Modules intended for curriculum adaptation between two cultures would be best served by a group of "core" learning outcomes with "secondary" outcomes culturally appropriate to each site. Within the context of the Arab culture, early clinical experience has the added benefit of allowing students to learn about both local and professional cultural norms, thereby facilitating integration of these two cultures.

  5. Radiobiological Implications of Fukushima Nuclear Accident for Personalized Medical Approach.

    PubMed

    Fukunaga, Hisanori; Yokoya, Akinari; Taki, Yasuyuki; Prise, Kevin M

    2017-05-01

    On March 11, 2011, a devastating earthquake and subsequent tsunami caused serious damage to areas of the Pacific coast in Fukushima prefecture and prompted fears among the residents about a possible meltdown of the Fukushima Daiichi Nuclear Power Plant reactors. As of 2017, over six years have passed since the Fukushima nuclear crisis and yet the full ramifications of the biological exposures to this accidental release of radioactive substances remain unclear. Furthermore, although several genetic studies have determined that the variation in radiation sensitivity among different individuals is wider than expected, personalized medical approaches for Fukushima victims have seemed to be insufficient. In this commentary, we discuss radiobiological issues arising from low-dose radiation exposure, from the cell-based to the population level. We also introduce the scientific utility of the Integrative Japanese Genome Variation Database (iJGVD), an online database released by the Tohoku Medical Megabank Organization, Tohoku University that covered the whole genome sequences of 2,049 healthy individuals in the northeastern part of Japan in 2016. Here we propose a personalized radiation risk assessment and medical approach, which considers the genetic variation of radiation sensitivity among individuals, for next-step developments in radiological protection.

  6. Undergraduate nursing students' experience related to their clinical learning environment and factors affecting to their clinical learning process.

    PubMed

    Arkan, Burcu; Ordin, Yaprak; Yılmaz, Dilek

    2018-03-01

    Clinical education is an essential part of nursing education. The purpose of this study was to explore nurse students' experiences related to cinical learning environments, factors effecting to clinical learning process. Descriptive qualitative design was used in this study, and data were collected from 2nd class nursing student (n = 14). The study took the form of in-depth interviews between August-October 2015. The qualitative interviews were analyzed by using simple content analysis. Data were analyzed manually. Experiences nurse students are described five themes. The themes of the study are (1) effecting persons to clinical learning, (2) educational atmosphere, (3) students' personal charactering, (4) the impact of education in school, and (5) students' perceptions related to clinical learning. Participants stated that they experienced many difficulties during clinical learning process. All students importantly stated that nurse teacher is very effecting to clinical learning. This study contributes to the literature by providing data on beginner nursing student' experiences about clinical learning process. The data of this present study show to Turkish nursing student is affecting mostly from persons in clinical learning. The data of this present study will guide nurse teacher when they plan to interventions to be performed to support student during clinical learning process. Copyright © 2017 Elsevier Ltd. All rights reserved.

  7. Nurses’ experiences of humour in clinical settings

    PubMed Central

    Ghaffari, Fatemeh; Dehghan-Nayeri, Nahid; Shali, Mahboubeh

    2015-01-01

    Background: Providing holistic nursing care when there is a shortage of personnel and equipment exposes nurses to stress and a higher risk of occupational burnout. Humour can promote nurses’ health and influence nursing care. The aim of this study was to describe nurses’ experiences of humour in clinical settings and factors affecting it. Methods: This qualitative study investigated nurses’ experiences of humour. Five hospitals affiliated to Tehran University of Medical Sciences provided the setting for this study. The participants comprised of 17 nurses with master’s and Baccalaureate degrees (BSN) in nursing. These nurses worked at educational hospitals affiliated to Tehran University of Medical Sciences and had minimum work experience of 12 months in various clinical wards. Nurses from all wards were invited to participate in this study. The data were collected through semi structure interviews using guides comprising probing questions. Telephonic interviews were used to further supplement the data. The data were analysed using conventional content analysis. Results: The data were classified into five themes including the dynamics of humour, condition enforcement, Risk making probability, Instrumental use and Change: opportunities and threats. Conclusion: Understanding nurses’ perceptions and experiences of humour helps identify its contributing factors and provides valuable guidelines for enhancing nurses and patients’ mental, emotional and physical health. Spreading a culture of humour through teaching methods can improve workplace cheerfulness and highlights the importance of humour in patient care in nurses and nursing students. PMID:26034735

  8. Management Control Systems and Clinical Experience of Managers in Public Hospitals

    PubMed Central

    Naranjo-Gil, David

    2018-01-01

    Healthcare authorities are encouraging managers in hospitals to acquire clinical experience and knowledge in order to better carry out and coordinate healthcare service delivery. The main objective of this paper is to analyse how the clinical experience of hospital managers is related to public health institutions’ performance. It is proposed that the effect of the clinical experience on operative and financial organizational performance is indirect through the mediating variables of perceived utility of management information and horizontal management control system. This paper analyses how these variables impact hospital performance through the data from a survey sent to 364 hospital managers in Brazil. The results show that managers’ clinical experience is related to higher perceived utility of historical, financial, short-term, and internal information, but not with horizontal control adoption in hospitals. Furthermore, our results show that, in hospitals, perceived utility of forecasted, non-financial, long-term, and external managerial information positively affects hospitals’ financial performance, while adoption of horizontal control management positively affects operational performance. Through showing evidence that clinical background could explain the differences not only in hospital service management but also in information capabilities and management control processes, this study offer meaningful implications for healthcare authorities and hospital managers involved in the development and implementation of strategies in the health sector. PMID:29673192

  9. Application of lean methods improves surgical clinic experience.

    PubMed

    Waldhausen, John H T; Avansino, Jeffrey R; Libby, Arlene; Sawin, Robert S

    2010-07-01

    A quality visit in high volume surgery clinics is challenging. There is variability in numbers of patients seen and care provider behavior. Documentation, regulatory and compliance issues and computerization of patient care systems may decrease clinic efficiency and throughput. We tried to reduce variability and improve patient experience. Baseline data included: patients seen, time in exam rooms, and spent with providers, and patient satisfaction surveys. Two Rapid Process Improvement Workshops (RPIWs) were conducted to apply lean methods. 5S techniques helped standardize exam rooms. Similar data were collected at 30 days, 60 days, and 1 year. Satisfaction surveys were followed at 6 months and 1 year. Median pre-RPIW room time was 49 minutes. Post-RPIW times were 33 minutes at 30 days, 41 minutes at 60 days, and 42 minutes at 1 year. Face to face provider-patient time increased 30% to 61% at 30 days, 58% at 60 days, and 59% at 1 year. The median number of patients in a 4-hour clinic increased from 10 to 12. Satisfaction survey Problem Scores improved and were sustained. Lean methodology may be used to improve clinic efficiency as well as patient and staff's experience. Copyright 2010. Published by Elsevier Inc.

  10. Enhancing an introductory Pharmacy Practice Experience at free medical clinics.

    PubMed

    Morello, Candis M; Singh, Renu F; Chen, Karen J; Best, Brookie M

    2010-02-01

    The aim of the study was to assess and improve first-year student pharmacists' satisfaction and learning experience in a Student-Run Free Medical Clinic Project (SFMCP) providing medical care to an underserved population. Two consecutive classes of first-year student pharmacists at the University of California San Diego (UCSD) Skaggs School of Pharmacy and Pharmaceutical Sciences participated in an Introductory Pharmacy Practice Experience (IPPE) at the UCSD SFMCP. This IPPE involved two inter-professional evening free clinics which provide medical care to an underserved population and opportunities for healthcare professional training and service. Year 1 students completed a self-assessment survey instrument and year 2 students completed the survey instrument plus a new competency checklist tool. Average scores from the self-assessment survey instrument were compared between years 1 and 2. Initial survey results showed that students felt the SFMCP was worthwhile; however, they did not experience enough involvement in the patient assistance programme or non-pharmacy-related clinic activities. After the competency checklist tool implementation, overall student pharmacist satisfaction of the SFMCP IPPE remained high (88%), participation in identified weak areas improved and students agreed that the tool helped focus their clinic experience. Areas of improvement were identified with the survey instrument and the competency checklist tool increased achievement of learning objectives. Overall, student pharmacists felt the SFMCP IPPE was a good learning experience. Practising pharmacists can employ these or similar tools in specific practice settings, to evaluate and help ensure that student pharmacists or interns are achieving applicable learning objectives.

  11. An Exploration of Dental Students' Assumptions About Community-Based Clinical Experiences.

    PubMed

    Major, Nicole; McQuistan, Michelle R

    2016-03-01

    The aim of this study was to ascertain which assumptions dental students recalled feeling prior to beginning community-based clinical experiences and whether those assumptions were fulfilled or challenged. All fourth-year students at the University of Iowa College of Dentistry & Dental Clinics participate in community-based clinical experiences. At the completion of their rotations, they write a guided reflection paper detailing the assumptions they had prior to beginning their rotations and assessing the accuracy of their assumptions. For this qualitative descriptive study, the 218 papers from three classes (2011-13) were analyzed for common themes. The results showed that the students had a variety of assumptions about their rotations. They were apprehensive about working with challenging patients, performing procedures for which they had minimal experience, and working too slowly. In contrast, they looked forward to improving their clinical and patient management skills and knowledge. Other assumptions involved the site (e.g., the equipment/facility would be outdated; protocols/procedures would be similar to the dental school's). Upon reflection, students reported experiences that both fulfilled and challenged their assumptions. Some continued to feel apprehensive about treating certain patient populations, while others found it easier than anticipated. Students were able to treat multiple patients per day, which led to increased speed and patient management skills. However, some reported challenges with time management. Similarly, students were surprised to discover some clinics were new/updated although some had limited instruments and materials. Based on this study's findings about students' recalled assumptions and reflective experiences, educators should consider assessing and addressing their students' assumptions prior to beginning community-based dental education experiences.

  12. Physiotherapy students' perceptions and experiences of clinical prediction rules.

    PubMed

    Knox, Grahame M; Snodgrass, Suzanne J; Stanton, Tasha R; Kelly, David H; Vicenzino, Bill; Wand, Benedict M; Rivett, Darren A

    2017-09-01

    Clinical reasoning can be difficult to teach to pre-professional physiotherapy students due to their lack of clinical experience. It may be that tools such as clinical prediction rules (CPRs) could aid the process, but there has been little investigation into their use in physiotherapy clinical education. This study aimed to determine the perceptions and experiences of physiotherapy students regarding CPRs, and whether they are learning about CPRs on clinical placement. Cross-sectional survey using a paper-based questionnaire. Final year pre-professional physiotherapy students (n=371, response rate 77%) from five universities across five states of Australia. Sixty percent of respondents had not heard of CPRs, and a further 19% had not clinically used CPRs. Only 21% reported using CPRs, and of these nearly three-quarters were rarely, if ever, learning about CPRs in the clinical setting. However most of those who used CPRs (78%) believed CPRs assisted in the development of clinical reasoning skills and none (0%) was opposed to the teaching of CPRs to students. The CPRs most commonly recognised and used by students were those for determining the need for an X-ray following injuries to the ankle and foot (67%), and for identifying deep venous thrombosis (63%). The large majority of students in this sample knew little, if anything, about CPRs and few had learned about, experienced or practiced them on clinical placement. However, students who were aware of CPRs found them helpful for their clinical reasoning and were in favour of learning more about them. Copyright © 2016 Chartered Society of Physiotherapy. Published by Elsevier Ltd. All rights reserved.

  13. The Relationship Between Levels of Fidelity in Simulation, Traditional Clinical Experiences and Objectives.

    PubMed

    Gore, Teresa

    2017-06-15

    The purpose of this study was to explore the relationship of baccalaureate nursing students' (BSN) perceived learning effectiveness using the Clinical Learning Environments Comparison Survey of different levels of fidelity simulation and traditional clinical experiences. A convenience sample of 103 first semester BSN enrolled in a fundamental/assessment clinical course and 155 fifth semester BSN enrolled in a leadership clinical course participated in this study. A descriptive correlational design was used for this cross-sectional study to evaluate students' perceptions after a simulation experience and the completion of the traditional clinical experiences. The subscales measured were communication, nursing leadership, and teaching-learning dyad. No statistical differences were noted based on the learning objectives. The communication subscale showed a tendency toward preference for traditional clinical experiences in meeting students perceived learning for communication. For student perceived learning effectiveness, faculty should determine the appropriate level of fidelity in simulation based on the learning objectives.

  14. Early experiences of accredited clinical informatics fellowships.

    PubMed

    Longhurst, Christopher A; Pageler, Natalie M; Palma, Jonathan P; Finnell, John T; Levy, Bruce P; Yackel, Thomas R; Mohan, Vishnu; Hersh, William R

    2016-07-01

    Since the launch of the clinical informatics subspecialty for physicians in 2013, over 1100 physicians have used the practice and education pathways to become board-certified in clinical informatics. Starting in 2018, only physicians who have completed a 2-year clinical informatics fellowship program accredited by the Accreditation Council on Graduate Medical Education will be eligible to take the board exam. The purpose of this viewpoint piece is to describe the collective experience of the first four programs accredited by the Accreditation Council on Graduate Medical Education and to share lessons learned in developing new fellowship programs in this novel medical subspecialty. © The Author 2016. Published by Oxford University Press on behalf of the American Medical Informatics Association. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

  15. Practice-based learning experience to develop residents as clinical faculty members.

    PubMed

    Slazak, Erin M; Zurick, Gina M

    2009-07-01

    A practice-based learning experience designed to expose postgraduate year 1 (PGY1) and 2 (PGY2) residents to and prepare them for a career as clinical faculty is described. A practice-based learning experience was designed to give PGY1 and PGY2 residents exposure to the responsibilities of a clinical faculty member, integrating clinical practice, preceptor duties, and other academia-related responsibilities. The learning experience is a four-week, elective rotation for PGY1 and PGY2 residents. The rotation is designed to correspond to a four-week advanced pharmacy practice experience (APPE) rotation, allowing the resident to work continuously with the same one or two APPE students for the entire rotation. The resident is required to design and implement a rotation for the students and provide clinical services while integrating students into daily tasks, facilitating topic and patient discussions, evaluating assignments, providing constructive feedback, and assigning a final rotation grade. The resident also attends all academic and committee meetings and teaching obligations with his or her residency director, if applicable. The resident is mentored by the residency director throughout all phases of the rotation and is evaluated using goals and objectives tailored to this experience. The development of a formal, structured rotation to give postgraduate residents experience as a preceptor provided an opportunity for residents to further explore their interests in academia and allowed them to serve as a primary preceptor while being guided and evaluated by a mentor.

  16. Management Control Systems and Clinical Experience of Managers in Public Hospitals.

    PubMed

    Lunkes, Rogério Joao; Naranjo-Gil, David; Lopez-Valeiras, Ernesto

    2018-04-17

    Healthcare authorities are encouraging managers in hospitals to acquire clinical experience and knowledge in order to better carry out and coordinate healthcare service delivery. The main objective of this paper is to analyse how the clinical experience of hospital managers is related to public health institutions’ performance. It is proposed that the effect of the clinical experience on operative and financial organizational performance is indirect through the mediating variables of perceived utility of management information and horizontal management control system. This paper analyses how these variables impact hospital performance through the data from a survey sent to 364 hospital managers in Brazil. The results show that managers’ clinical experience is related to higher perceived utility of historical, financial, short-term, and internal information, but not with horizontal control adoption in hospitals. Furthermore, our results show that, in hospitals, perceived utility of forecasted, non-financial, long-term, and external managerial information positively affects hospitals’ financial performance, while adoption of horizontal control management positively affects operational performance. Through showing evidence that clinical background could explain the differences not only in hospital service management but also in information capabilities and management control processes, this study offer meaningful implications for healthcare authorities and hospital managers involved in the development and implementation of strategies in the health sector.

  17. [Application of portfolio in teaching dermatology clinic: an experience in teaching of medicine].

    PubMed

    de Cabalier, M E; Chalub, D M

    2009-01-01

    We present a learning experience conducted in the Chair of Dermatology Clinic of the Faculty of Medical Sciences, National University of Cordoba in the context of curriculum change. For comprehension,present a theoretical framework and practical from the conceptualization of the "portfolio" teaching and its role teaching and learning paradigms sustained constructivist medical education. The portfolio Teach-ing is not a collection of papers, but a coherent set of experiences led thoughtful learning between teachers and students. This resource allows to account for the "qualitative achievements" of students from their work produced, sorted and evaluated in a carefully planned sequence of experiences and case Dermatology Clinic. To introduce the teaching portfolio, the planned new student grouping shapes and a sequence of learning experiences for the construction of this resource, namely: "The development of theoretical material iconographic resources and working guidelines for students. "The clinical reasoning on a case or laboratory experience-Clinical case Discussion and bibliography. -The development of records to from observation of patients. "The study of clinical cases: diagnosis and evolution of clinical cases. Interconsultations-Registration and referrals. "The magazine room and sharing experiences. In each of these, production, tutorial feedback Team teaching and assessment tasks allowed assessment approach to learning and improving he achievements of the students to the approval of the subject.

  18. South Asian patients' views and experiences of clinical trial participation.

    PubMed

    Hussain-Gambles, Mah

    2004-12-01

    This paper explores South Asian patients' views and experiences of clinical trial participation, as part of a larger study which sought to assess British South Asian under-representation in clinical trials. The study was based on semi-structured interviews with South Asian trial participants in primary care and specialist treatment centres in the north of England. Fifteen South Asian patients who had participated in one of six different clinical trials to test pharmaceutical products comprised the study cohort. South Asian motivations to participate in clinical trials are similar to those of the majority 'White' population. Clear and concise trial information (provided by caring and understanding trial staff) was considered an important aspect of the respondents' experiences. Appealing to South Asian peoples' altruistic nature by making them aware of South Asian under-representation (especially in clinical trials that investigate illnesses prevalent in their community) was also identified as a strong motivational factor. Potential barriers to their participation included: trial burden (which bears heavily on the poor), language, and discriminatory practices in the NHS, which can lead to mistrust of health professionals. In addition, female modesty and preference for female trial staff was recognized as a 'cultural' barrier to participation. There are more similarities than differences between the experiences of British South Asians and 'White' trial participants. Present findings suggest that ethnicity operates at different levels. In addition to South Asian trial participants' culture, social class and gender are also as likely to affect their participation in clinical trials. To improve South Asian accrual rates, strategies should be designed to take into consideration linguistic differences and improving overall trust in the clinical trial team.

  19. An Interlaboratory Comparison of Dosimetry for a Multi-institutional Radiobiological

    PubMed Central

    Seed, TM; Xiao, S; Manley, N; Nikolich-Zugich, J; Pugh, J; van den Brink, M; Hirabayashi, Y; Yasutomo, K; Iwama, A; Koyasu, S; Shterev, I; Sempowski, G; Macchiarini, F; Nakachi, K; Kunugi, KC; Hammer, CG; DeWerd, LA

    2016-01-01

    Purpose An interlaboratory comparison of radiation dosimetry was conducted to determine the accuracy of doses being used experimentally for animal exposures within a large multi-institutional research project. The background and approach to this effort are described and discussed in terms of basic findings, problems and solutions. Methods Dosimetry tests were carried out utilizing optically stimulated luminescence (OSL) dosimeters embedded midline into mouse carcasses and thermal luminescence dosimeters (TLD) embedded midline into acrylic phantoms. Results The effort demonstrated that the majority (4/7) of the laboratories was able to deliver sufficiently accurate exposures having maximum dosing errors of ≤ 5%. Comparable rates of ‘dosimetric compliance’ were noted between OSL- and TLD-based tests. Data analysis showed a highly linear relationship between ‘measured’ and ‘target’ doses, with errors falling largely between 0–20%. Outliers were most notable for OSL-based tests, while multiple tests by ‘non-compliant’ laboratories using orthovoltage x-rays contributed heavily to the wide variation in dosing errors. Conclusions For the dosimetrically non-compliant laboratories, the relatively high rates of dosing errors were problematic, potentially compromising the quality of ongoing radiobiological research. This dosimetry effort proved to be instructive in establishing rigorous reviews of basic dosimetry protocols ensuring that dosing errors were minimized. PMID:26857121

  20. Physiotherapy students' experiences of bullying on clinical internships: a qualitative study.

    PubMed

    Whiteside, Diana; Stubbs, Brendon; Soundy, Andy

    2014-03-01

    To consider the experiences of final-year physiotherapy students who have experienced workplace bullying on a clinical internship. Qualitative methodology using individual semi-structured interviews. A university in the Midlands region of the UK. Eight undergraduate physiotherapy students who had experienced one incident of bullying on a clinical internship. Thematic analysis of semi-structured interviews. Four main themes were identified: (1) external and situational influences of bullying; (2) students' reactions to the experience of bullying; (3) inability to reveal the experience; and (4) overcoming problems. Bullying had a range of adverse effects on the students, with many expressing self-doubt in their competence and viewing their supervisor as unapproachable and unsupportive. Five students were not initially able to recognise the experience as bullying. In addition, students did not feel able to report the experience and use the support mechanisms in place. This may have been a result of having concerns that the problem would escalate if they reported the experience and, as a consequence, have a negative effect on their grade. Students were keen to offer a range of strategies for clinical practice in order to prevent bullying for future generations of students. Students' health, security and confidence in their ability as a physiotherapist can be at great risk from bullying. Steps are needed to ensure that students are better protected from bullying, and feel more able to address bullying behaviour during clinical internships. Copyright © 2013 Chartered Society of Physiotherapy. Published by Elsevier Ltd. All rights reserved.

  1. Our clinical experience in low-energy laser medical treatments

    NASA Astrophysics Data System (ADS)

    Antipa, Ciprian; Bruckner, Ion I.; Crangulescu, Nicolae; Moldovan, Corneliu I.; Podoleanu, Adrian G.; Stanciulescu, Viorica; Ionescu, Elena

    1996-05-01

    In clinical research the efficiency of low-energy laser (LEL) therapy remains controversial. We present here some of the most important results of our clinical experience in this field. We summarize our opinions about the LEL effects in rheumatic diseases, in chronic pelvic inflammatory disorders, in the treatment of some dermatological disorders, and in the recovery of the distal forearm nerve from traumatic lesion after surgical suture. We conclude that these results may be important evidence for the real clinical efficiency of the LEL.

  2. Experiences of clinical teaching for dental core trainees working in hospital.

    PubMed

    Mannion, C J; Brotherton, P

    2014-07-11

    There is recognition that the provision of excellence in education and training results in a skilled and competent workforce. However, the educational experiences of dental core trainees (DCT's) working in the hospital oral and maxillofacial surgery (OMFS) setting have not been previously investigated. In this paper, we examine DCT's learning experiences both 'formal' and 'non-formal' within the hospital setting of ward and clinic-based teaching. Are hospital dental core trainees receiving a meaningful educational experience? To conclude this paper, the authors recommend methods, based upon sound educational principles, to maximise the value of clinical sessions for teaching.

  3. Experience with Fingolimod in Clinical Practice

    PubMed Central

    Hersh, Carrie M.; Hara-Cleaver, Claire; Rudick, Richard A.; Cohen, Jeffrey A.; Bermel, Robert A.; Ontaneda, Daniel

    2015-01-01

    Aim To report experience with fingolimod in clinical practice. Design/Methods Patients in an academic medical center who were prescribed fingolimod from October 2010 to August 2011 were identified through the electronic medical record and followed for 12 months after fingolimod initiation. Adverse effects, clinical measures, MRI data, and quality of life measures were assessed. Results Three hundred seventeen patients started fingolimod. Eleven patients were treatment naïve (3.5%) and 76 (24.0%) had remote disease modifying therapy use prior to fingolimod. One hundred fifty-one (47.6%) switched because of patient preference and 79 (24.9%) switched because of breakthrough disease. About 11.6% transitioned from natalizumab. Follow-up data were available for 306 patients (96.5%) with mean follow-up time 332 days. Fingolimod was discontinued in 76 of 306 patients (24.8%) at mean 248 days after fingolimod start. Discontinuation most often was due to adverse effects (n=40) or breakthrough disease (n=22). Among patients who started fingolimod with available 12 month follow-up data, 267 (87.3%) remained relapse free and 256 (83.7%) had no relapses or gadolinium enhancement. Time to first relapse occurred at mean 282 days after fingolimod initiation. Quality of life measures remained stable at follow-up. Conclusions Fingolimod was discontinued at a higher rate in clinical practice than in clinical trials. Discontinuation was primarily due to adverse effects or breakthrough disease. Disease activity was adequately controlled in most patients who started fingolimod. This clinical practice cohort is consistent with efficacy data from phase 3 trials and describes the most common tolerability issues in clinical practice. PMID:25271798

  4. Fostering new relational experience: clinical process in couple psychotherapy.

    PubMed

    Marmarosh, Cheri L

    2014-03-01

    One of the most critical goals for couple psychotherapy is to foster a new relational experience in the session where the couple feels safe enough to reveal more vulnerable emotions and to explore their defensive withdrawal, aggressive attacking, or blaming. The lived intimate experience in the session offers the couple an opportunity to gain integrative insight into their feelings, expectations, and behaviors that ultimately hinder intimacy. The clinical processes that are necessary include empathizing with the couple and facilitating safety within the session, looking for opportunities to explore emotions, ruptures, and unconscious motivations that maintain distance in the relationship, and creating a new relational experience in the session that has the potential to engender integrative insight. These clinical processes will be presented with empirical support. Experts from a session will be used to highlight how these processes influence the couple and promote increased intimacy. (PsycINFO Database Record (c) 2014 APA, all rights reserved).

  5. Implementation of an intraoperative clinical experience for senior level baccalaureate nursing students.

    PubMed

    Mott, Jason

    2012-04-01

    Perioperative nursing is a specialty that has been eliminated from many nursing education programs. With the loss of perioperative clinical experiences, the number of students pursuing a career in perioperative nursing after graduation has declined. A faculty member at one Midwestern school of nursing developed and implemented a perioperative clinical experience for senior-level baccalaureate nursing students in a critical care nursing course. This program, developed with the assistance of four local hospitals and the college of nursing, included an eight-hour OR orientation and 56 clinical hours. Students were placed in the OR under preceptor guidance and supervision. Feedback from evaluations was positive and provided recommendations for improving the program, in particular, to allow more clinical hours and more hands-on experience for the students. Copyright © 2012 AORN, Inc. Published by Elsevier Inc. All rights reserved.

  6. Light ion production for a future radiobiological facility at CERN: preliminary studies.

    PubMed

    Stafford-Haworth, Joshua; Bellodi, Giulia; Küchler, Detlef; Lombardi, Alessandra; Röhrich, Jörg; Scrivens, Richard

    2014-02-01

    Recent medical applications of ions such as carbon and helium have proved extremely effective for the treatment of human patients. However, before now a comprehensive study of the effects of different light ions on organic targets has not been completed. There is a strong desire for a dedicated facility which can produce ions in the range of protons to neon in order to perform this study. This paper will present the proposal and preliminary investigations into the production of light ions, and the development of a radiobiological research facility at CERN. The aims of this project will be presented along with the modifications required to the existing linear accelerator (Linac3), and the foreseen facility, including the requirements for an ion source in terms of some of the specification parameters and the flexibility of operation for different ion types. Preliminary results from beam transport simulations will be presented, in addition to some planned tests required to produce some of the required light ions (lithium, boron) to be conducted in collaboration with the Helmholtz-Zentrum für Materialien und Energie, Berlin.

  7. Coordination of Scheduling Clinical Externship or Clinical Practice Experiences for Students in Physical Therapy Educational Programs.

    ERIC Educational Resources Information Center

    Patterson, Robert K.; Kass, Susan H.

    A project to coordinate the scheduling of allied health occupations students for clinical practice or externship experiences in Southeast Florida is described. A model clinical facility utilization and time schedule matrix was developed for four programs: the physical therapy programs at Florida International University (FIU) and the University of…

  8. Clinical reasoning of Filipino physical therapists: Experiences in a developing nation.

    PubMed

    Rotor, Esmerita R; Capio, Catherine M

    2018-03-01

    Clinical reasoning is essential for physical therapists to engage in the process of client care, and has been known to contribute to professional development. The literature on clinical reasoning and experiences have been based on studies from Western and developed nations, from which multiple influencing factors have been found. A developing nation, the Philippines, has distinct social, economic, political, and cultural circumstances. Using a phenomenological approach, this study explored experiences of Filipino physical therapists on clinical reasoning. Ten therapists working in three settings: 1) hospital; 2) outpatient clinic; and 3) home health were interviewed. Major findings were: a prescription-based referral system limited clinical reasoning; procedural reasoning was a commonly experienced strategy while diagnostic and predictive reasoning were limited; factors that influenced clinical reasoning included practice setting and the professional relationship with the referring physician. Physical therapists' responses suggested a lack of autonomy in practice that appeared to stifle clinical reasoning. Based on our findings, we recommend that the current regulations governing PT practice in the Philippines may be updated, and encourage educators to strengthen teaching approaches and strategies that support clinical reasoning. These recommendations are consistent with the global trend toward autonomous practice.

  9. Influence of Prostatic Edema on {sup 131}CS Permanent Prostate Seed Implants: A Dosimetric and Radiobiological Study

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Kehwar, Than S., E-mail: kehwarts@upmc.ed; Jones, Heather A.; Huq, M. Saiful

    2011-06-01

    Purpose: To study the influence of prostatic edema on postimplant physical and radiobiological parameters using {sup 131}Cs permanent prostate seed implants. Methods and Materials: Thirty-one patients with early prostate cancer who underwent {sup 131}Cs permanent seed implantation were evaluated. Dose-volume histograms were generated for each set of prostate volumes obtained at preimplantation and postimplantion days 0, 14, and 28 to compute quality indices (QIs) and fractional doses at level x (FD{sub x}). A set of equations for QI, FD{sub x}, and biologically effective doses at dose level D{sub x} (BED{sub x}) were defined to account for edema changes with timemore » after implant. Results: There were statistically significant differences found between QIs of pre- and postimplant plans at day 0, except for the overdose index (ODI). QIs correlated with postimplant time, and FD{sub x} was found to increase with increasing postimplant time. With the effect of edema, BED at different dose levels showed less improvement due to the short half-life of {sup 131}Cs, which delivers about 85% of the prescribed dose before the prostate reaches its original volume due to dissipation of edema. Conclusions: Results of the study show that QIs, FD{sub x}, and BEDs at the level of D{sub x} changed from preneedle plans to postimplant plans and have statistically significant differences (p < 0.05), except for the ODI (p = 0.106), which suggests that at the time of {sup 131}C seed implantation, the effect of edema must be accounted for when defining the seed positions, to avoid the possibility of poor dosimetric and radiobiologic results for {sup 131}Cs seed implants.« less

  10. Feedback in clinical practice: Enhancing the students' experience through action research.

    PubMed

    Adamson, Elizabeth; King, Linda; Foy, Lynn; McLeod, Margo; Traynor, Jennifer; Watson, Wendy; Gray, Morag

    2018-05-01

    Feedback within clinical practice is known to be central to the learning and development of student nurses and midwives. A study that focused on student experience of assessment identified that a high proportion of students reported that they had received insufficient feedback whilst on clinical placement. In response to this academics and members of the clinical education team set out to explore this with a view to improving the student experience using action research. Key findings indicated that responsibility for feedback on clinical placement lies with both students and mentors, distinct factors can enable effective feedback and that positive outcomes for mentors and students resulted through engaging with the project. The process, outcomes and actions taken to improve practice are the focus of this paper. Copyright © 2018 Elsevier Ltd. All rights reserved.

  11. Some results of radiobiological studies performed on Cosmos-110 biosatellite.

    PubMed

    Antipov, V V; Delone, N L; Nikitin, M D; Parfyonov, G P; Saxonov, P P

    1969-01-01

    The experiment carried out on the Cosmos 110 biosatellite is a step further in radiobiological investigations performed in outer space and differs appreciably from flight experiments conducted on board the Vostok and Voskhod spacecraft. The difference lies, firstly, in the integral dose of cosmic radiation. According to the onboard dosimeter readings, it was 12 rad at an average dose rate of 500 mrad/day during the biosatellite flight, whereas in previous biological flight experiments, as is well known, the total dose was below 80 mrad (on a five-day flight of Vostok 5) at a dose rate of 80 to 20 mrad/day. Secondly, during the biosatellite mission, cosmic radiation originated not from the primary cosmic radiation as was the case in the Vostok and Voskhod flights but mainly from the Earth's radiation belts. Thirdly, the duration of the Cosmos 110 flight was far longer than that of any previous mission: the effect of weightlessness lasted for about 22 days. The paper presents results of investigations performed on E. coli K-12 lambda lysogenic bacteria, Tradescantia microspores, dry seeds of higher plants, different Chlorella strains and an intact plant of Tradescantia paludosa. The biological effect of space flight factors was evaluated by various physiological, cytogenetic, genetic and microbiological techniques. Similar to previous experiments carried out on board the Vostok 3-6 spacecraft, tests with lysogenic bacteria revealed a statistically significant induction of moderate bacteriophage. The induction value was shown to lag behind the mission duration dependence level. This seems to be related to a change of inducibility properties of lysogenic bacteria and a reduction of the yield range of phages per bacterial cell. Other tests (duration of the latent period, formation pattern of phage components) indicated no significant differences between test and control objects (N.N. Zhukov-Verezhnikov, N.I. Rybakov, V.A. Kozlov et al.). A study of protective properties

  12. Evaluation of the Clinical Learning Experience of Nursing Students: a Cross-Sectional Descriptive Study.

    PubMed

    Gurková, Elena; Žiaková, Katarína

    2018-05-18

    The purpose of the cross-sectional descriptive study was to explore and compare the students' experiences of the clinical environment and supervision in Slovakia. Students' clinical learning experience were measured by the valid and reliable clinical learning instrument. A higher frequency of successful supervisory experience was found in the universities which provided accredited mentor preparation programmes or courses and individualised supervisory approaches. Frequency of supervision meetings, the occupational title of a supervisor and mainly the supervision model have an association with students 'perceptions of different domains of clinical learning environment. The duration of the placement was not related to students' experience and perceptions of the learning environment. Slovak students reported higher score regarding the quality of nursing care or ward culture than in the supervisory relationships between students, clinical and school staff. Further studies in this field, extended to different Eastern European countries and clinical settings, may help us to understand factors affecting workplace training.

  13. Predicting medical school and internship success: does the quality of the research and clinical experience matter?

    PubMed

    Paolino, Nathalie D; Artino, Anthony R; Saguil, Aaron; Dong, Ting; Durning, Steven J; DeZee, Kent J

    2015-04-01

    This article explores specific aspects of self-reported clinical and research experience and their relationship to performance in medical training. This is a retrospective cohort study conducted at the Uniformed Services University. The American Medical College Application Service application was used to discern students' self-reported clinical and research experience. Two authors applied a classification scheme for clinical and research experience to the self-reported experiences. Study outcomes included medical school grade point average (GPA), U.S. Medical Licensing Examination (USMLE) scores, and intern expertise and professionalism scores. A linear regression analysis was conducted for each outcome while controlling for prematriculation GPA. Data were retrieved on 1,020 matriculants. There were several statistically significant but small differences across outcomes when comparing the various categories of clinical experience with no clinical experience. The technician-level experience group had a decrease of 0.1 in cumulative GPA in comparison to students without self-reported clinical experience (p = 0.004). This group also performed 5 points lower on the USMLE Step 2 than students who did not report clinical experience (p = 0.013). The various levels of self-reported research experience were unrelated to success in medical school and graduate medical education. These findings indicate that self-reported technician-level clinical experience is related to a small reduction in typically reported outcomes in medical school. Reprint & Copyright © 2015 Association of Military Surgeons of the U.S.

  14. Clinical experience does not correlate with the perceived need for cardiopulmonary resuscitation training.

    PubMed

    Lunz, Dirk; Brandl, Anita; Lang, Klaus; Weiss, Berthold; Haneya, Assad; Pühler, Thomas; Graf, Bernhard M; Zausig, York A

    2013-02-01

    The efficiency of cardiopulmonary resuscitation (CPR) training is dependent upon different influencing factors, such as the presented concepts, the participants' willingness to learn, and the interval between training sessions. However, the optimal interval for refreshing CPR training is less clear. We evaluated the perceived need of simulator-based CPR training for nurses and correlated it with their clinical experience. The 60 invited nurses were trained in simulator-based CPR. Knowledge about adult advanced life support was evaluated using a questionnaire after training, and participants rated their desired individual frequency of simulator-based training as well as the value of the presented training using a six-point Likert scale. The same questions were asked again after 1 year. All participants agreed about the usefulness of this type of simulator-based training. The average number of correct answers about typical facts in adult advanced life support showed an almost bell-shaped distribution, with the highest point at 6-15 years of clinical experience and the lowest points at≤5 and≥21 years. The desired training-frequency need was inversely correlated with clinical experience. There is a high interest in CPR training among nursing staff. Self-assessment about the training-frequency need was inversely correlated with clinical experience. However, the average number of correct answers on resuscitation questions decreased with clinical experience. Therefore, the training effectiveness seems to be extremely dependent on clinical experience, and therefore, training experienced senior nurses might be more challenging than training novice nurses. Copyright © 2013 Elsevier Inc. All rights reserved.

  15. Clinicians' experiences with the fragile X clinical and research consortium.

    PubMed

    Liu, Jessica A; Hagerman, Randi J; Miller, Robert M; Craft, Lisa T; Finucane, Brenda; Tartaglia, Nicole; Berry-Kravis, Elizabeth M; Sherman, Stephanie L; Kidd, Sharon A; Cohen, Jeffrey

    2016-12-01

    The objectives of the study were to assess the attitudes and experiences of clinicians involved in a consortium of clinics serving people with fragile X-associated disorders to gauge satisfaction with the consortium and its efforts to improve quality of life for patients and the community. An internet survey was sent to 26 fragile X (FX) clinic directors participating in the Fragile X Clinical and Research Consortium (FXCRC). Respondents were asked to complete 19 questions on consortium performance and outcomes relevant for their own clinic. The response rate was 84% (22/26), with two surveys providing incomplete data. Assistance with clinic establishment, opportunities for research collaborations, and access to colleagues and information were highly valued. Approximately 76% of clinicians reported improvements in patient care and 60% reported an increase in patient services. There was a 57% increase in participation in a FX-related clinical trial among clinics since joining the FXCRC (24% vs. 81%). Overall, respondents reported primarily positive experiences from participation in the FXCRC. Common suggestions for improvement included additional financial support and increased utilization of collected patient data for research purposes. Additionally, a Clinic Services Checklist was administered annually to examine changes in services offered over time. There were several important changes regarding the provision of services by clinics, often with multiple clinics changing with respect to a service. In conclusion, the FXCRC has led to the establishment and sustainment of fragile X clinics in the U.S., fostered cooperation among fragile X clinicians, and provided clinics with a platform to share recommendations and best practices to maximize quality of life for their patients and the overall fragile X community. The results from the survey and checklist also provide suggestions to strengthen the FXCRC and enhance future collaborations among FXCRC members. © 2016

  16. Practicum and clinical experiences: postpracticum students' views.

    PubMed

    Ralph, Edwin; Walker, Keith; Wimmer, Randolph

    2009-08-01

    The clinical or practicum component of preservice undergraduate education across all disciplines typically is rated by prebaccalaureate students as the most important phase of their entire professional preparation. This study collected e-mail survey responses from 63 post-practicum nursing students who had just completed their culminating fourth-year clinical course. Students identified the most positive and the most negative aspects of that final practicum experience. These responses were compared with those reported by postpracticum students from the disciplines of engineering and teacher education. The cross-disciplinary similarity of these data related to postpracticum students' perceptions of this experiential learning phase of their preservice professional training was noted. The student voice provides a critical dimension to the program-enhancement process for all professional disciplines, and practicum organizers across the disciplines should value such student input and collaborate to improve the clinical phase of preservice education for all professions. Copyright 2009, SLACK Incorporated.

  17. Learning Clinical Procedures Through Internet Digital Objects: Experience of Undergraduate Students Across Clinical Faculties.

    PubMed

    Li, Tse Yan; Gao, Xiaoli; Wong, Kin; Tse, Christine Shuk Kwan; Chan, Ying Yee

    2015-04-14

    Various digital learning objects (DLOs) are available via the World Wide Web, showing the flow of clinical procedures. It is unclear to what extent these freely accessible Internet DLOs facilitate or hamper students' acquisition of clinical competence. This study aimed to understand the experience of undergraduate students across clinical disciplines-medicine, dentistry, and nursing-in using openly accessible Internet DLOs, and to investigate the role of Internet DLOs in facilitating their clinical learning. Mid-year and final-year groups were selected from each undergraduate clinical degree program of the University of Hong Kong-Bachelor of Medicine and Bachelor of Surgery (MBBS), Bachelor of Dental Surgery (BDS), and Bachelor of Nursing (BNurs). All students were invited to complete a questionnaire on their personal and educational backgrounds, and their experiences and views on using Internet DLOs in learning clinical procedures. The questionnaire design was informed by the findings of six focus groups. Among 439 respondents, 97.5% (428/439) learned a variety of clinical procedures through Internet DLOs. Most nursing students (107/122, 87.7%) learned preventive measures through Internet DLOs, with a lower percentage of medical students (99/215, 46.0%) and dental students (43/96, 45%) having learned them this way (both P<.001). Three-quarters (341/439, 77.7%) of students accessed DLOs through public search engines, whereas 93.2% (409/439) accessed them by watching YouTube videos. Students often shared DLOs with classmates (277/435, 63.7%), but rarely discussed them with teachers (54/436, 12.4%). The accuracy, usefulness, and importance of Internet DLOs were rated as 6.85 (SD 1.48), 7.27 (SD 1.53), and 7.13 (SD 1.72), respectively, out of a high score of 10. Self-exploration of DLOs in the unrestricted Internet environment is extremely common among current e-generation learners and was regarded by students across clinical faculties as an important supplement to

  18. Teachers' Clinical Experiences and Attitudes toward Technology Inclusion

    ERIC Educational Resources Information Center

    Paganelli, Andrea Lynch

    2010-01-01

    The purpose of this qualitative multisite case study is to examine participants' attitudes toward technology, types of technology available for participant use, and the extent to which technology is used by preservice and mentor teachers during clinical experiences. Research supports the benefit of improved attitudes toward technology integration…

  19. Korean speech-language pathologists' attitudes toward stuttering according to clinical experiences.

    PubMed

    Lee, Kyungjae

    2014-11-01

    Negative attitudes toward stuttering and people who stutter (PWS) are found in various groups of people in many regions. However the results of previous studies examining the influence of fluency coursework and clinical certification on the attitudes of speech-language pathologists (SLPs) toward PWS are equivocal. Furthermore, there have been few empirical studies on the attitudes of Korean SLPs toward stuttering. To determine whether the attitudes of Korean SLPs and speech-language pathology students toward stuttering would be different according to the status of clinical certification, stuttering coursework completion and clinical practicum in stuttering. Survey data from 37 certified Korean SLPs and 70 undergraduate students majoring in speech-language pathology were analysed. All the participants completed the modified Clinician Attitudes Toward Stuttering (CATS) Inventory. Results showed that the diagnosogenic view was still accepted by many participants. Significant differences were found in seven out of 46 CATS Inventory items according to the certification status. In addition significant differences were also found in three items and one item according to stuttering coursework completion and clinical practicum experience in stuttering, respectively. Clinical and educational experience appears to have mixed influences on SLPs' and students' attitudes toward stuttering. While SLPs and students may demonstrate more appropriate understanding and knowledge in certain areas of stuttering, they may feel difficulty in their clinical experience, possibly resulting in low self-efficacy. © 2014 Royal College of Speech and Language Therapists.

  20. Understanding the potentiality of accelerator based-boron neutron capture therapy for osteosarcoma: dosimetry assessment based on the reported clinical experience.

    PubMed

    Bortolussi, Silva; Postuma, Ian; Protti, Nicoletta; Provenzano, Lucas; Ferrari, Cinzia; Cansolino, Laura; Dionigi, Paolo; Galasso, Olimpio; Gasparini, Giorgio; Altieri, Saverio; Miyatake, Shin-Ichi; González, Sara J

    2017-08-15

    Osteosarcoma is the most frequent primary malignant bone tumour, and its incidence is higher in children and adolescents, for whom it represents more than 10% of solid cancers. Despite the introduction of adjuvant and neo-adjuvant chemotherapy that markedly increased the success rate in the treatment, aggressive surgery is still needed and a considerable percentage of patients do not survive due to recurrences or early metastases. Boron Neutron Capture Therapy (BNCT), an experimental radiotherapy, was investigated as a treatment that could allow a less aggressive surgery by killing infiltrated tumour cells in the surrounding healthy tissues. BNCT requires an intense neutron beam to ensure irradiation times of the order of 1 h. In Italy, a Radio Frequency Quadrupole (RFQ) proton accelerator has been designed and constructed for BNCT, and a suitable neutron spectrum was tailored by means of Monte Carlo calculations. This paper explores the feasibility of BNCT to treat osteosarcoma using this neutron source based on accelerator. The therapeutic efficacy of BNCT was analysed evaluating the dose distribution obtained in a clinical case of femur osteosarcoma. Mixed field dosimetry was assessed with two different formalisms whose parameters were specifically derived from radiobiological experiments involving in vitro UMR-106 osteosarcoma cell survival assays and boron concentration assessments in an animal model of osteosarcoma. A clinical case of skull osteosarcoma treated with BNCT in Japan was re-evaluated from the point of view of dose calculation and used as a reference for comparison. The results in the case of femur osteosarcoma show that the RFQ beam would ensure a suitable tumour dose painting in a total irradiation time of less than an hour. Comparing the dosimetry between the analysed case and the treated patient in Japan it turns out that doses obtained in the femur tumour are at least as good as the ones delivered in the skull osteosarcoma. The same is

  1. Medical students' clerkship experiences and self-perceived competence in clinical skills.

    PubMed

    Katowa-Mukwato, P; Andrews, B; Maimbolwa, M; Lakhi, S; Michelo, C; Mulla, Y; Banda, S S

    2014-01-01

    In a traditional curriculum, medical students are expected to acquire clinical competence through the apprenticeship model using the Halstedian "see one, do one, and teach one, approach". The University of Zambia School of Medicine used a traditional curriculum model from 1966 until 2011 when a competence-based curriculum was implemented. To explore medical students' clerkships experiences and self-perceived competence in clinical skills. A cross-sectional survey was conducted on 5th, 6 th , and 7 th year medical students of the University of Zambia, School of Medicine two months prior to final examinations. Students were asked to rate their clerkship experiences with respect to specific skills on a scale of 1 to 4 and their level of self-perceived competence on a scale of 1 to 3. Skills evaluated were in four main domains: history taking and communication, physical examination, procedural, and professionalism, team work and medical decision making. Using Statistical Package for Social Scientist (SPSS), correlations were performed between experiences and self-perceived competence on specific skills, within domains and overall. Out of 197 clinical students 138 (70%) participated in the survey. The results showed significant increase in the proportion of students performing different skills and reporting feeling very competent with each additional clinical year. Overall correlations between experience and self-perceived competence were moderate (0.55). On individual skills, the highest correlation between experience and self-perceived competence were observed on mainly medical and surgical related procedural skills with the highest at 0.82 for nasal gastric tube insertion and 0.76 for endotracheal intubation. Despite the general improvement in skills experiences and self-perceived competence, some deficiencies were noted as significant numbers of final year students had never attempted common important procedures especially those performed in emergency situations

  2. Radiobiological experiments with plant seeds aboard the biosatellite Kosmos 1887

    NASA Technical Reports Server (NTRS)

    Anikeeva, I. D.; Vaulina, E. N.; Kostina, L. N.; Marenny, A. M.; Portman, A. I.; Rusin, S. V.; Benton, E. V.

    1990-01-01

    The effects of spaceflight factors on the seeds of Arabidopsis thaliana and Crepis capillaris were studied provided with various protective measures: the seeds were located inside the satellite and in open space, protected with aluminium foil and also exposed without the foil cover. When the seeds were in open space without any protection, their viability was found to be suppressed; the survival rate and fertility of plants grown from these seeds were also diminished. An increase in the frequency of chromosome aberrations (CA) and in the number of multiple injuries was registered in this case. Experiments with the aluminium foil shielding showed a decrease in the suppression of the seeds' viability, but mutational changes were found to be even more increased, while the survival and fertility of the plants decreased. An increase in the thickness of shielding resulted in a decrease in the effects up to the level of the control, except for the effects connected with CA and fertility of the plants. Analysis of the results shows that these impairments can be ascribed to the action of single heavy charged particles (HCP). The seeds can be thus regarded as an integral biological 'dosimeter' which allows estimation of the total effects of radiation, ecological and biological factors.

  3. Radiobiological experiments with plant seeds aboard the biosatellite Cosmos 1887

    NASA Technical Reports Server (NTRS)

    Benton, E. V.; Anikeeva, I. D.; Akatov, Yu. A.; Vaulina, E. N.; Kostina, L. N.; Marenny, A.; Portman, A. I.; Rusin, S. V.

    1995-01-01

    The effects of spaceflight factors on the seeds of Arabidopsis thaliana and Crepis capillaris were studied. The seeds were located inside the satellite in an open space, protected with aluminum foil and also exposed without the foil cover. When the seeds were in open space without any protection, their viability was found to be suppressed; the survival rate and fertility of plants grown from these seeds were also diminished. An increase in the frequency of chromosome aberrations (CA) and in the number of multiple injuries was registered in this case. Experiments with the aluminum foil shielding showed a decrease in the suppression of the seeds' viability, but mutational changes were found to be even more increased, while the survival rate and fertility of the plants decreased. An increase in the thickness of shielding resulted in a decrease in the effects up to the level of the control, except for the effects connected with CA and fertility of the plants. Analysis of the results shows that these impairments can be ascribed to the action of single heavy charged particles (HCP). The seeds can thus be regarded as an integral biological 'dosimeter' which allows estimation of the total effects of radiation, ecological and biological factors.

  4. Radiobiological experiments with plant seeds aboard the biosatellite Kosmos 1887.

    PubMed

    Anikeeva, I D; Akatov YuA; Vaulina, E N; Kostina, L N; Marenny, A M; Portman, A I; Rusin, S V; Benton, E V

    1990-01-01

    The effects of spaceflight factors on the seeds of Arabidopsis thaliana and Crepis capillaris were studied provided with various protective measures: the seeds were located inside the satellite and in open space, protected with aluminium foil and also exposed without the foil cover. When the seeds were in open space without any protection, their viability was found to be suppressed; the survival rate and fertility of plants grown from these seeds were also diminished. An increase in the frequency of chromosome aberrations (CA) and in the number of multiple injuries was registered in this case. Experiments with the aluminium foil shielding showed a decrease in the suppression of the seeds' viability, but mutational changes were found to be even more increased, while the survival and fertility of the plants decreased. An increase in the thickness of shielding resulted in a decrease in the effects up to the level of the control, except for the effects connected with CA and fertility of the plants. Analysis of the results shows that these impairments can be ascribed to the action of single heavy charged particles (HCP). The seeds can be thus regarded as an integral biological 'dosimeter' which allows estimation of the total effects of radiation, ecological and biological factors.

  5. Animation and radiobiological analysis of 3D motion in conformal radiotherapy.

    PubMed

    MacKay, R I; Graham, P A; Moore, C J; Logue, J P; Sharrock, P J

    1999-07-01

    To allow treatment plans to be evaluated against the range of expected organ motion and set up error anticipated during treatment. Planning tools have been developed to allow concurrent animation and radiobiological analysis of three dimensional (3D) target and organ motion in conformal radiotherapy. Surfaces fitted to structures outlined on CT studies are projected onto pre-treatment images or onto megavoltage images collected during the patient treatment. Visual simulation of tumour and normal tissue movement is then performed by the application of three dimensional affine transformations, to the selected surface. Concurrent registration of the surface motion with the 3D dose distribution allows calculation of the change in dose to the volume. Realistic patterns of motion can be applied to the structure to simulate inter-fraction motion and set-up error. The biologically effective dose for the structure is calculated for each fraction as the surface moves over the course of the treatment and is used to calculate the normal tissue complication probability (NTCP) or tumour control probability (TCP) for the moving structure. The tool has been used to evaluate conformal therapy plans against set up measurements recorded during patient treatments. NTCP and TCP were calculated for a patient whose set up had been corrected after systematic deviations from plan geometry were measured during treatment, the effect of not making the correction were also assessed. TCP for the moving tumour was reduced if inadequate margins were set for the treatment. Modelling suggests that smaller margins could have been set for the set up corrected during the course of the treatment. The NTCP for the rectum was also higher for the uncorrected set up due to a more rectal tissue falling in the high dose region. This approach provides a simple way for clinical users to utilise information incrementally collected throughout the whole of a patient's treatment. In particular it is possible to

  6. MO-D-BRD-01: Clinical Implementation of An Electronic Brachytherapy Program for the Skin

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Ouhib, Z.

    2015-06-15

    Electronic brachytherapy (eBT) has seen an insurgence of manufacturers entering the US market for use in radiation therapy. In addition to the established interstitial, intraluminary, and intracavitary applications of eBT, many centers are now using eBT to treat skin lesions. It is important for medical physicists working with electronic brachytherapy sources to understand the basic physics principles of the sources themselves as well as the variety of applications for which they are being used. The calibration of the sources is different from vendor to vendor and the traceability of calibrations has evolved as new sources came to market. In 2014,more » a new air-kerma based standard was introduced by the National Institute of Standards and Technology (NIST) to measure the output of an eBT source. Eventually commercial treatment planning systems should accommodate this new standard and provide NIST traceability to the end user. The calibration and commissioning of an eBT system is unique to its application and typically entails a list of procedural recommendations by the manufacturer. Commissioning measurements are performed using a variety of methods, some of which are modifications of existing AAPM Task Group protocols. A medical physicist should be familiar with the different AAPM Task Group recommendations for applicability to eBT and how to properly adapt them to their needs. In addition to the physical characteristics of an eBT source, the photon energy is substantially lower than from HDR Ir-192 sources. Consequently, tissue-specific dosimetry and radiobiological considerations are necessary when comparing these brachytherapy modalities and when making clinical decisions as a radiation therapy team. In this session, the physical characteristics and calibration methodologies of eBt sources will be presented as well as radiobiology considerations and other important clinical considerations. Learning Objectives: To understand the basic principles of

  7. Effect of experience on clinical decision making by cardiorespiratory physiotherapists in acute care settings.

    PubMed

    Smith, Megan; Higgs, Joy; Ellis, Elizabeth

    2010-02-01

    This article investigates clinical decision making in acute care hospitals by cardiorespiratory physiotherapists with differing degrees of clinical experience. Participants were observed as they engaged in their everyday practice and were interviewed about their decision making. Texts of the data were interpreted by using a hermeneutic approach that involved repeated reading and analysis of fieldnotes and interview transcripts to develop an understanding of the effect of experience on clinical decision making. Participants were classified into categories of cardiorespiratory physiotherapy experience: less experienced (<2 years), intermediate experience (2.5-4 years), and more experienced (>7 years). Four dimensions characteristic of increasing experience in cardiorespiratory physiotherapy clinical decision making were identified: 1) an individual practice model, 2) refined approaches to clinical decision making, 3) working in context, and 4) social and emotional capability. Underpinning these dimensions was evidence of reflection on practice, motivation to achieve best practice, critique of new knowledge, increasing confidence, and relationships with knowledgeable colleagues. These findings reflect characteristics of physiotherapy expertise that have been described in the literature. This study adds knowledge about the field of cardiorespiratory physiotherapy to the existing body of research on clinical decision making and broadens the existing understanding of characteristics of physiotherapy expertise.

  8. Concept-Based Learning in Clinical Experiences: Bringing Theory to Clinical Education for Deep Learning.

    PubMed

    Nielsen, Ann

    2016-07-01

    Concept-based learning is used increasingly in nursing education to support the organization, transfer, and retention of knowledge. Concept-based learning activities (CBLAs) have been used in clinical education to explore key aspects of the patient situation and principles of nursing care, without responsibility for total patient care. The nature of best practices in teaching and the resultant learning are not well understood. The purpose of this multiple-case study research was to explore and describe concept-based learning in the context of clinical education in inpatient settings. Four clinical groups (each a case) were observed while they used CBLAs in the clinical setting. Major findings include that concept-based learning fosters deep learning, connection of theory with practice, and clinical judgment. Strategies used to support learning, major teaching-learning foci, and preconditions for concept-based teaching and learning will be described. Concept-based learning is promising to support integration of theory with practice and clinical judgment through application experiences with patients. [J Nurs Educ. 2016;55(7):365-371.]. Copyright 2016, SLACK Incorporated.

  9. Pediatricians' Experience with Clinical Ethics Consultation: A National Survey.

    PubMed

    Morrison, Wynne; Womer, James; Nathanson, Pamela; Kersun, Leslie; Hester, D Micah; Walsh, Corbett; Feudtner, Chris

    2015-10-01

    To conduct a national survey of pediatricians' access to and experience with clinical ethics consultation. We surveyed a randomly selected sample of 3687 physician members of the American Academy of Pediatrics. We asked about their experiences with ethics consultation, the helpfulness of and barriers to consultation, and ethics education. Using a discrete choice experiment with maximum difference scaling, we evaluated which traits of ethics consultants were most valuable. Of the total sample of 3687 physicians, 659 (18%) responded to the survey. One-third of the respondents had no experience with clinical ethics consultation, and 16% reported no access to consultation. General pediatricians were less likely to have access. The vast majority (90%) who had experience with consultation had found it helpful. Those with fewer years in practice were more likely to have training in ethics. The most frequently reported issues leading to consultation concerned end-of-life care and conflicts with patients/families or among the team. Intensive care unit physicians were more likely to have requested consultation. Mediation skills and ethics knowledge were the most highly valued consultant characteristics, and representing the official position of the hospital was the least-valued characteristic. There is variability in pediatricians' access to ethics consultation. Most respondents reported that consultation had been helpful in the past. Determining ethically appropriate end-of-life care and mediation of disagreements are common reasons that pediatricians request consultation. Copyright © 2015 Elsevier Inc. All rights reserved.

  10. Water versus DNA: New insights into proton track-structure modeling in radiobiology and radiotherapy

    DOE PAGES

    Champion, Christophe; Quinto, Michele A.; Monti, Juan M.; ...

    2015-09-25

    Water is a common surrogate of DNA for modelling the charged particle-induced ionizing processes in living tissue exposed to radiations. The present study aims at scrutinizing the validity of this approximation and then revealing new insights into proton-induced energy transfers by a comparative analysis between water and realistic biological medium. In this context, a self-consistent quantum mechanical modelling of the ionization and electron capture processes is reported within the continuum distorted wave-eikonal initial state framework for both isolated water molecules and DNA components impacted by proton beams. Their respective probability of occurrence-expressed in terms of total cross sections-as well asmore » their energetic signature (potential and kinetic) are assessed in order to clearly emphasize the differences existing between realistic building blocks of living matter and the controverted water-medium surrogate. Thus the consequences in radiobiology and radiotherapy will be discussed in particular in view of treatment planning refinement aiming at better radiotherapy strategies.« less

  11. Water versus DNA: new insights into proton track-structure modelling in radiobiology and radiotherapy.

    PubMed

    Champion, C; Quinto, M A; Monti, J M; Galassi, M E; Weck, P F; Fojón, O A; Hanssen, J; Rivarola, R D

    2015-10-21

    Water is a common surrogate of DNA for modelling the charged particle-induced ionizing processes in living tissue exposed to radiations. The present study aims at scrutinizing the validity of this approximation and then revealing new insights into proton-induced energy transfers by a comparative analysis between water and realistic biological medium. In this context, a self-consistent quantum mechanical modelling of the ionization and electron capture processes is reported within the continuum distorted wave-eikonal initial state framework for both isolated water molecules and DNA components impacted by proton beams. Their respective probability of occurrence-expressed in terms of total cross sections-as well as their energetic signature (potential and kinetic) are assessed in order to clearly emphasize the differences existing between realistic building blocks of living matter and the controverted water-medium surrogate. Consequences in radiobiology and radiotherapy will be discussed in particular in view of treatment planning refinement aiming at better radiotherapy strategies.

  12. SU-E-T-385: 4D Radiobiology

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Fourkal, E; Hossain, M; Veltchev, I

    2014-06-01

    Purpose: The linear-quadratic model is the most prevalent model for planning dose fractionation in radiation therapy in the low dose per fraction regimens. However for high-dose fractions, used in SRS/SBRT/HDR treatments the LQ model does not yield accurate predictions, due to neglecting the reduction in the number of sublethal lesions as a result of their conversion to lethal lesions with subsequent irradiation. Proper accounting for this reduction in the number of sublethally damaged lesions leads to the dependence of the survival fraction on the temporal structure of the dose. The main objective of this work is to show that themore » functional dependence of the dose rate on time in each voxel is an important additional factor that can significantly influence the TCP. Methods: Two SBRT lung plans have been used to calculate the TCPs for the same patient. One plan is a 3D conformal plan and the other is an IMRT plan. Both plans are normalized so that 99.5% of PTV volume receives the same prescription dose of 50 Gy in 5 fractions. The dose rate in each individual voxel is calculated as a function of treatment time and subsequently used in the calculation of TCP. Results: The calculated TCPs show that shorter delivery times lead to greater TCP, despite all delivery times being short compared to the repair half-time for sublethal lesions. Furthermore, calculated TCP(IMRT) =0.308 for the IMRT plan is smaller than TCP(3D) =0.425 for 3D conformal, even though it shows greater tumor hot spots and equal PTV coverage. The calculated TCPs are considerably lower compared to those based on the LQ model for which TCP=1 for both plans. Conclusion: The functional dependence of the voxel-by-voxel dose rate on time may be an important factor in predicting the treatment outcome and cannot be neglected in radiobiological modeling.« less

  13. Experiences from an interprofessional student-assisted chronic disease clinic.

    PubMed

    Frakes, Kerrie-Anne; Brownie, Sharon; Davies, Lauren; Thomas, Janelle; Miller, Mary-Ellen; Tyack, Zephanie

    2014-11-01

    Faced with significant health and workforce challenges in the region, the Central Queensland Health Service District (CQHSD) commenced a student-assisted clinical service. The Capricornia Allied Health Partnership (CAHP) is an interprofessional clinical placement program in which pre-entry students from exercise physiology, nutrition and dietetics, occupational therapy, pharmacy, podiatry and social work are embedded in a collaborative chronic disease service delivery model. The model coordinates multiple student clinical placements to: address service delivery gaps for previously underserved people with chronic disease in need of early intervention and management; provide an attractive clinical placement opportunity for students that will potentially lead to future recruitment success, and demonstrate leadership in developing future health workforce trainees to attain appropriate levels of interprofessional capacity. The CAHP clinic commenced student placements and client services in February 2010. This report provides early evaluative information regarding student experiences included self-reported changes in practice.

  14. Swedish nursing students' experience of stress during clinical practice in relation to clinical setting characteristics and the organisation of the clinical education.

    PubMed

    Blomberg, Karin; Bisholt, Birgitta; Kullén Engström, Agneta; Ohlsson, Ulla; Sundler Johansson, Annelie; Gustafsson, Margareta

    2014-08-01

    To describe nursing students' experience of stress during clinical practice and evaluate the risk of stress in relation to the clinical setting characteristics and the organisation of the clinical education. Stress during clinical practice is well documented, but there is a lack of knowledge concerning whether the clinical setting characteristics and the organisation of the education make a difference. A cross-sectional study with evaluative design. Data were collected by means of a numerical rating scale for the assessment of stress and questions about the clinical setting characteristics and the organisation of the education. One hundred and eighty-four students who had completed their final year on the nursing programme at three universities in Sweden were included. Nearly half of the students (43%) experienced high level of stress during clinical practice. Measured by decision in the tree analysis, the absolute risk of stress was 57% in students with placements in hospital departments, as compared to 13% in students with placements in other clinical settings. The risk of stress increased to 71% if the students with placement in a hospital took the national clinical final examination. Performance of practice in a hospital department overcrowded with patients was also associated with increased risk of stress. The organisation of supervision and number of students at the clinical placement had an effect on the experience of stress, but did not prove to be risk factors in the analysis. The risk of stress in nursing students during their clinical practice differs depending on clinical setting characteristics. The taking of the national clinical final examination could be a source of stress, but this requires further investigation. It is important that supervisors are aware that students in hospital departments overcrowded with patients are at risk of stress and may have increased need of support. © 2014 John Wiley & Sons Ltd.

  15. Light ion production for a future radiobiological facility at CERN: Preliminary studies

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Stafford-Haworth, Joshua, E-mail: Joshua.Stafford-Haworth@cern.ch; John Adams Institute at Royal Holloway, University of London, Egham, Surrey TW20 0EX; Bellodi, Giulia

    2014-02-15

    Recent medical applications of ions such as carbon and helium have proved extremely effective for the treatment of human patients. However, before now a comprehensive study of the effects of different light ions on organic targets has not been completed. There is a strong desire for a dedicated facility which can produce ions in the range of protons to neon in order to perform this study. This paper will present the proposal and preliminary investigations into the production of light ions, and the development of a radiobiological research facility at CERN. The aims of this project will be presented alongmore » with the modifications required to the existing linear accelerator (Linac3), and the foreseen facility, including the requirements for an ion source in terms of some of the specification parameters and the flexibility of operation for different ion types. Preliminary results from beam transport simulations will be presented, in addition to some planned tests required to produce some of the required light ions (lithium, boron) to be conducted in collaboration with the Helmholtz-Zentrum für Materialien und Energie, Berlin.« less

  16. Learning Clinical Procedures Through Internet Digital Objects: Experience of Undergraduate Students Across Clinical Faculties

    PubMed Central

    Li, Tse Yan; Wong, Kin; Tse, Christine Shuk Kwan; Chan, Ying Yee

    2015-01-01

    Background Various digital learning objects (DLOs) are available via the World Wide Web, showing the flow of clinical procedures. It is unclear to what extent these freely accessible Internet DLOs facilitate or hamper students’ acquisition of clinical competence. Objective This study aimed to understand the experience of undergraduate students across clinical disciplines—medicine, dentistry, and nursing—in using openly accessible Internet DLOs, and to investigate the role of Internet DLOs in facilitating their clinical learning. Methods Mid-year and final-year groups were selected from each undergraduate clinical degree program of the University of Hong Kong—Bachelor of Medicine and Bachelor of Surgery (MBBS), Bachelor of Dental Surgery (BDS), and Bachelor of Nursing (BNurs). All students were invited to complete a questionnaire on their personal and educational backgrounds, and their experiences and views on using Internet DLOs in learning clinical procedures. The questionnaire design was informed by the findings of six focus groups. Results Among 439 respondents, 97.5% (428/439) learned a variety of clinical procedures through Internet DLOs. Most nursing students (107/122, 87.7%) learned preventive measures through Internet DLOs, with a lower percentage of medical students (99/215, 46.0%) and dental students (43/96, 45%) having learned them this way (both P<.001). Three-quarters (341/439, 77.7%) of students accessed DLOs through public search engines, whereas 93.2% (409/439) accessed them by watching YouTube videos. Students often shared DLOs with classmates (277/435, 63.7%), but rarely discussed them with teachers (54/436, 12.4%). The accuracy, usefulness, and importance of Internet DLOs were rated as 6.85 (SD 1.48), 7.27 (SD 1.53), and 7.13 (SD 1.72), respectively, out of a high score of 10. Conclusions Self-exploration of DLOs in the unrestricted Internet environment is extremely common among current e-generation learners and was regarded by students

  17. Clinical Experience and Learning Style of Flight Nurse and Aeromedical Evacuation Technician Students.

    PubMed

    De Jong, Marla J; Dukes, Susan F; Dufour, Karey M; Mortimer, Darcy L

    2017-01-01

    The clinical experience and preferred learning style of U.S. Air Force flight nurses and aeromedical evacuation technicians are unknown. Using a cross-sectional survey design, we gathered data regarding the clinical experience, level of comfort providing clinical care, and preferred learning style of 77 active duty (AD), Air Force Reserve (AFR), and Air National Guard (ANG) nurses enrolled in the U.S. Air Force School of Aerospace Medicine Flight Nurse course, and 121 AD, AFR, and ANG medical technicians enrolled in the Aeromedical Evacuation Technician course. Nurses and medical technicians reported 7.6 ± 5.5 and 3.9 ± 4.5 yr of experience, respectively. AD, AFR, and ANG nurses had comparable years of experience: 5.8 ± 3.2, 8.3 ± 6.6, and 7.9 ± 4.2 yr, respectively; however, AD medical technicians had more years of experience (5.6 ± 4.4 yr) than AFR (3.1 ± 4.8 yr) and ANG (1.9 ± 2.8 yr) medical technicians. Both nurses and medical technicians reported infrequently caring for patients with various disease processes and managing equipment or devices that they will routinely encounter when transporting patients as an aeromedical evacuation clinician. Nurses and medical technicians preferred a kinesthetic learning style or a multimodal learning style that included kinesthetic learning. Nearly all (99%) nurses and 97% of medical technicians identified simulation as their preferred teaching method. These findings confirm faculty concerns regarding the clinical experience of flight nurse and aerospace evacuation technician students.De Jong MJ, Dukes SF, Dufour KM, Mortimer DL. Clinical experience and learning style of flight nurse and aeromedical evacuation technician students. Aerosp Med Hum Perform. 2017; 88(1):23-29.

  18. How do general practice registrars learn from their clinical experience? A critical incident study.

    PubMed

    Holmwood, C

    1997-01-01

    This preliminary study of RACGP registrars in the period of subsequent general practice experience examines the types of clinical experiences from which registrars learn, what they learn from the experiences and the process of learning from such experiences. A critical incident method was used on a semi structured interview process. Registrars were asked to recall clinical incidents where they had learnt something of importance. Data were sorted and categorised manually. Nine registrars were interviewed before new categories of data ceased to develop. Registrars learnt from the opportunity to follow up patients. An emotional response to the interaction was an important part of the learning process. Learning from such experiences is haphazard and unstructured. Registrars accessed human resources in response to their clinical difficulties rather than text or electronic based information sources. Registrars should be aware of their emotional responses to interactions with patients; these emotional responses often indicate important learning opportunities. Clinical interactions and resultant learning could be made less haphazard by structuring consultations with patients with specific problems. These learning opportunities should be augmented by the promotion of follow up of patients.

  19. Authenticity in Learning--Nursing Students' Experiences at a Clinical Education Ward

    ERIC Educational Resources Information Center

    Manninen, Katri; Henriksson, Elisabet Welin; Scheja, Max; Silen, Charlotte

    2013-01-01

    Purpose: This study aims to explore and understand first year nursing students' experiences of learning at a clinical education ward. Design/methodology/approach: The setting is a clinical education ward for nursing students at a department of infectious diseases. A qualitative study was carried out exploring students' encounters with patients,…

  20. Evidence That a Psychopathology Interactome Has Diagnostic Value, Predicting Clinical Needs: An Experience Sampling Study

    PubMed Central

    van Os, Jim; Lataster, Tineke; Delespaul, Philippe; Wichers, Marieke; Myin-Germeys, Inez

    2014-01-01

    Background For the purpose of diagnosis, psychopathology can be represented as categories of mental disorder, symptom dimensions or symptom networks. Also, psychopathology can be assessed at different levels of temporal resolution (monthly episodes, daily fluctuating symptoms, momentary fluctuating mental states). We tested the diagnostic value, in terms of prediction of treatment needs, of the combination of symptom networks and momentary assessment level. Method Fifty-seven patients with a psychotic disorder participated in an ESM study, capturing psychotic experiences, emotions and circumstances at 10 semi-random moments in the flow of daily life over a period of 6 days. Symptoms were assessed by interview with the Positive and Negative Syndrome Scale (PANSS); treatment needs were assessed using the Camberwell Assessment of Need (CAN). Results Psychotic symptoms assessed with the PANSS (Clinical Psychotic Symptoms) were strongly associated with psychotic experiences assessed with ESM (Momentary Psychotic Experiences). However, the degree to which Momentary Psychotic Experiences manifested as Clinical Psychotic Symptoms was determined by level of momentary negative affect (higher levels increasing probability of Momentary Psychotic Experiences manifesting as Clinical Psychotic Symptoms), momentary positive affect (higher levels decreasing probability of Clinical Psychotic Symptoms), greater persistence of Momentary Psychotic Experiences (persistence predicting increased probability of Clinical Psychotic Symptoms) and momentary environmental stress associated with events and activities (higher levels increasing probability of Clinical Psychotic Symptoms). Similarly, the degree to which momentary visual or auditory hallucinations manifested as Clinical Psychotic Symptoms was strongly contingent on the level of accompanying momentary paranoid delusional ideation. Momentary Psychotic Experiences were associated with CAN unmet treatment needs, over and above PANSS

  1. WE-F-BRB-01: The Power of Ontologies and Standardized Terminologies for Capturing Clinical Knowledge

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Gabriel, P.

    2015-06-15

    Advancements in informatics in radiotherapy are opening up opportunities to improve our ability to assess treatment plans. Models on individualizing patient dose constraints from prior patient data and shape relationships have been extensively researched and are now making their way into commercial products. New developments in knowledge based treatment planning involve understanding the impact of the radiation dosimetry on the patient. Akin to radiobiology models that have driven intensity modulated radiotherapy optimization, toxicity and outcome predictions based on treatment plans and prior patient experiences may be the next step in knowledge based planning. In order to realize these predictions, itmore » is necessary to understand how the clinical information can be captured, structured and organized with ontologies and databases designed for recall. Large databases containing radiation dosimetry and outcomes present the opportunity to evaluate treatment plans against predictions of toxicity and disease response. Such evaluations can be based on dose volume histogram or even the full 3-dimensional dose distribution and its relation to the critical anatomy. This session will provide an understanding of ontologies and standard terminologies used to capture clinical knowledge into structured databases; How data can be organized and accessed to utilize the knowledge in planning; and examples of research and clinical efforts to incorporate that clinical knowledge into planning for improved care for our patients. Learning Objectives: Understand the role of standard terminologies, ontologies and data organization in oncology Understand methods to capture clinical toxicity and outcomes in a clinical setting Understand opportunities to learn from clinical data and its application to treatment planning Todd McNutt receives funding from Philips, Elekta and Toshiba for some of the work presented.« less

  2. An Enzymatic Clinical Chemistry Laboratory Experiment Incorporating an Introduction to Mathematical Method Comparison Techniques

    ERIC Educational Resources Information Center

    Duxbury, Mark

    2004-01-01

    An enzymatic laboratory experiment based on the analysis of serum is described that is suitable for students of clinical chemistry. The experiment incorporates an introduction to mathematical method-comparison techniques in which three different clinical glucose analysis methods are compared using linear regression and Bland-Altman difference…

  3. [Clinical experience with 53 consecutive heart transplants].

    PubMed

    Villavicencio, Mauricio; Rossel, Víctor; Larrea, Ricardo; Peralta, Juan Pablo; Larraín, Ernesto; Sung Lim, Jong; Rojo, Pamela; Gajardo, Francesca; Donoso, Erika; Hurtado, Margarita

    2013-12-01

    Heart transplantation is the therapy of choice for advance heart failure. Our group developed two transplant programs at Instituto Nacional del Tórax and Clínica Dávila. We report our clinical experience based on distinctive clinical policies. Fifty-three consecutive patients were transplanted between November 2008 and April 2013, representing 51% of all Chilean cases. Distinctive clinical policies include intensive donor management, generic immunosuppression and VAD (ventricular assist devices) insertion. Ischemic or dilated cardiomyopathy were the main indications (23 (43%) each), age 48 ± 13 years and 48 (91%) were male. Transplant listing Status: IA 14 (26%) (VAD or 2 inotropes), IB 14 (26%) (1 inotrope) and II25 (47%) (no inotrope). Mean waiting time 70 ± 83 days. Twelve (24%) were transplanted during VAD support (median support: 36 days). orthotopic bicaval transplant with ischemia time: 175 ± 54 min. Operative mortality: 3 (6%), all due to right ventricular failure. Re-exploration for bleeding 2 (4%), stroke 3 (6%), mediastinitis 0 (0%), pneumonia 4 (8%), and transient dialysis 6 (11%). Mean follow-up was 21 ± 14 months. Three-year survival was 86 ± 6%. One patient died of Pneumocystis jirovecii pneumonia and the other died suddenly (non-compliance). Freedom from rejection requiring specific therapy was 80 ± 7% at 3 years of follow-up. Four hundred eighty four endomyocardial biopsies were done: 11 (2.3%) had 2R rejection. All survivors are in NYHA (New York Heart Association) functional class I and all but one have normal biventricular function. Mid-term results are similar to those reported by the registry of the International Society for Heart and Lung Transplantation. This experience has a higher proportion of VAD support than previous national series. Rejection rates are low in spite of generic immunosuppression.

  4. Clinical exposures during internal medicine acting internship: profiling student and team experiences.

    PubMed

    Smith, Todd I; LoPresti, Charles M

    2014-07-01

    The clinical learning model in medical education is driven by knowledge acquisition through direct patient-care experiences. Despite the emphasis on experiential learning, the ability of educators to quantify the clinical exposures of learners is limited. To utilize Veterans Affairs (VA) electronic medical record information through a data warehouse to quantify clinical exposures during an inpatient internal medicine rotation. We queried the VA clinical data warehouse for the patients encountered by each learner completing an acting internship rotation at the Cleveland VA Medical Center from July 2008 to November 2011. We then used discharge summary information to identify team exposures-patients seen by the learner's inpatient team who were not primarily assigned to the learner. Based on the learner and team exposures, we complied lists of past medical problems, medications prescribed, laboratory tests that resulted, radiology evaluated, and primary discharge diagnoses. Primary learner and team-based clinical exposures were evaluated for a total of 128 acting internship students. The percentage of learners who had a primary exposure to a medication/lab value/imaging result/diagnosis was calculated. The percentage of learners with at least 1 primary or team-based exposure to an item was also calculated. The most common exposures in each category are presented. Analysis of the clinical exposures during an inpatient rotation can augment the ability of educators to understand learners' experiences. These types of analyses could provide information to improve learner experience, implement novel curricula, and address educational gaps in clinical rotations. © 2014 Society of Hospital Medicine.

  5. Clinical nursing leaders', team members' and service managers' experiences of implementing evidence at a local level.

    PubMed

    Kitson, Alison; Silverston, Heidi; Wiechula, Rick; Zeitz, Kathryn; Marcoionni, Danni; Page, Tammy

    2011-05-01

    To describe the experiences of 14 clinical nursing leaders introducing a knowledge translation (KT) project into one metropolitan acute care hospital in South Australia. The study also explored team members' and service managers' experiences. KT strategies assume that local (nursing) clinical leaders have the capacity and capability to champion innovation combining positional leadership roles (ward leader) with a project lead role. There is limited evidence to support these assumptions. Semi-structured interviews of clinical nursing leaders and managers were undertaken at month 4 and 12 of the project. Data were also collected from the interdisciplinary team members (n = 28). Clinical nursing leaders identified risks and anxieties associated with taking on an additional leadership role, whereas managers acknowledged the multiple pressures on the system and the need for local level innovation. Team members generally reported positive experiences. With support, clinical nursing leaders can effectively embrace KT project leadership roles that complement their positional leadership roles. Clinical nursing leaders' experiences differed from nursing and medical managers' experiences.   Managers need to be more attuned to the personal risks local leaders experience, providing support for leaders to experiment and innovate. Managers need to integrate local priorities with broader system wide agendas. © 2011 The Authors. Journal compilation © 2011 Blackwell Publishing Ltd.

  6. [Leadership Experience of Clinical Nurses: Applying Focus Group Interviews].

    PubMed

    Lee, Byoung Sook; Eo, Yong Sook; Lee, Mi Aie

    2015-10-01

    The purpose of this study was to understand and describe the leadership experience of clinical nurses. During 2014, data were collected using focus group interviews. Three focus group interviews were held with a total of 20 clinical nurses participating. All interviews were recorded as they were spoken and transcribed and data were analyzed using qualitative content analysis. Fifteen categories emerged from the five main themes. 1) Thoughts on the leadership category: to lead others, to cope with problem situations adequately and to serve as a shield against difficulties. 2) Situations requiring leadership: situation that requires correct judgement, coping and situations that need coordination and cooperation. 3-1) Leadership behaviors: other-oriented approach and self-oriented approach. 3-2) Leadership behavior consequences: relevant compensation and unfair termination. 4-1) Facilitators of leadership: confidence and passion for nursing and external support and resources. 4-2) Barriers to leadership: non-supportive organization culture and deficiency in own leadership competencies. 5) Strategies of leadership development: strengthen leadership through self-development and organizational leadership development. In conclusion, the results indicate that it is necessary to enhance clinical nurses' leadership role in healthcare. Enhancement can be achieved through leadership programs focused on enlarging leadership experience, constant self-development, leadership training, and development of leadership competencies suited to the nursing environment.

  7. AWBAT: early clinical experience.

    PubMed

    Vandenberg, Victoria B

    2010-03-15

    The purpose of this article is to describe the early clinical experience with AWBAT. Burn patients requiring (1) donor sites or (2) treatment of a superficial burn wound injury were treated. A total of 45 patients with 69 distinct wounds were included. AWBAT-D was evaluated in donor sites and AWBAT-S was evaluated in superficial partial-thickness burns. Days to healing, pain, hematoma/seroma formation, and infection were noted. Ease of application, adherence, transparency, and physical adaptability details were collected. Average period to healing of donor sites treated with AWBAT-D (n=22 patients with n=26 wounds) was 11.2 days, sigma =1.95, with a range of 8-15 days and a median of 11 days. Pain rating at 24 hours was 1.2, sigma =0.43 (n=18) and at 48 hours mean was 1.2, sigma =0.46 (n=15). Average period to healing of superficial burns treated with AWBAT-S (n=15 patients with n=18 wounds) was 8.1 days, sigma =2.48, with a range of 5-13 days and a median of 7 days. Pain rating at 24 hours was 1.5, sigma =0.85 (n=10) and at 48 hours mean was 1.75, sigma =0.89 (n=8). There was zero incidence of hematoma/seroma. No infections were seen. Results indicate that AWBAT was easily applied with good initial adherence. It was noted to be transparent, conformant, and pliable. Early experience demonstrates that AWBAT performs well on donor sites and superficial partial-thickness burns and delivers the desired attributes of a temporary skin substitute including good adherence, infection control, transparency, adapatability, and pain control.

  8. Nursing Faculty Experiences of Virtual Learning Environments for Teaching Clinical Reasoning

    ERIC Educational Resources Information Center

    Zacharzuk-Marciano, Tara

    2017-01-01

    Nurses need sharp, clinical reasoning skills to respond to critical situations and to be successful at work in a complex and challenging healthcare system. While past research has focused on using virtual learning environments to teach clinical reasoning, there has been limited research on the experiences of nursing faculty and there is a need for…

  9. Diagnostic games: from adequate formalization of clinical experience to structure discovery.

    PubMed

    Shifrin, Michael A; Kasparova, Eva I

    2008-01-01

    A method of obtaining well-founded and reproducible results in clinical decision making is presented. It is based on "diagnostic games", a procedure of elicitation and formalization of experts' knowledge and experience. The use of this procedure allows formulating decision rules in the terms of an adequate language, that are both unambiguous and clinically clear.

  10. Association Between Medicare Summary Star Ratings for Patient Experience and Clinical Outcomes in US Hospitals.

    PubMed

    Trzeciak, Stephen; Gaughan, John P; Bosire, Joshua; Mazzarelli, Anthony J

    2016-03-01

    In 2015, the Centers for Medicare and Medicaid Services (CMS) released new summary star ratings for US hospitals based on patient experience. We aimed to test the association between CMS patient experience star ratings and clinical outcomes. We analyzed risk-adjusted data for more than 3000 US hospitals from CMS Hospital Compare using linear regression. We found that better patient experience was associated with favorable clinical outcomes. Specifically, a higher number of stars for patient experience had a statistically significant association with lower rates of many in-hospital complications. A higher patient experience star rating also had a statistically significant association with lower rates of unplanned readmissions to the hospital within 30 days. Better patient experience according to the CMS star ratings is associated with favorable clinical outcomes. These results support the inclusion of patient experience data in the framework of how hospitals are paid for services.

  11. Expertise in Clinical Psychology. The Effects of University Training and Practical Experience on Expertise in Clinical Psychology

    PubMed Central

    Vollmer, Sabine; Spada, Hans; Caspar, Franz; Burri, Salome

    2013-01-01

    How do university training and subsequent practical experience affect expertise in clinical psychology? To answer this question we developed methods to assess psychological knowledge and the competence to diagnose, construct case conceptualizations, and plan psychotherapeutic treatment: a knowledge test and short case studies in a first study, and a complex, dynamically evolving case study in the second study. In our cross-sectional studies, psychology students, trainees in a certified postgraduate psychotherapist curriculum, and behavior therapists with more than 10 years of experience were tested (100 in total: 20 each of novice, intermediate, and advanced university students, postgraduate trainees, and therapists). Clinical knowledge and competence increased up to the level of trainees but unexpectedly decreased at the level of experienced therapists. We discuss the results against the background of expertise research and the training of clinical psychologists (in Germany). Important factors for the continuing professional development of psychotherapists are proposed. PMID:23543213

  12. New beam monitoring tool for radiobiology experiments at the cyclotron ARRONAX.

    PubMed

    Schwob, L; Koumeir, C; Servagent, N; Cherel, M; Guertin, A; Haddad, F; Métivier, V; Michel, N; Poirier, F; Rahmani, A; Varmenot, N

    2015-09-01

    The ARRONAX cyclotron is able to deliver alpha particles at 68 MeV. In the frame of radiological research, a new method is studied to infer in situ the deposited dose: it is based on the online measurement of the bremsstrahlung (>1 keV) produced by the interaction of the incident particle with the medium. Experiments are made using bombarded poly(methyl methacrylate) (PMMA)-equivalent water targets in order to characterise this continuous X-ray spectrum. The intensity of the bremsstrahlung spectrum allows for the beam monitoring. A simulation code of the bremsstrahlung has been built, and a good agreement is found with the experimental spectra. With this simulation, it is possible to predict the sensibility of this method: it varies with the target thickness, showing a good sensibility for thin target (<1000 µm) and saturation for thicker ones. Bremsstrahlung spectrum also shows a sensibility on the target's chemical composition. © The Author 2015. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

  13. The Group Objective Structured Clinical Experience: building communication skills in the clinical reasoning context.

    PubMed

    Konopasek, Lyuba; Kelly, Kevin V; Bylund, Carma L; Wenderoth, Suzanne; Storey-Johnson, Carol

    2014-07-01

    Students are rarely taught communication skills in the context of clinical reasoning training. The purpose of this project was to combine the teaching of communication skills using SPs with clinical reasoning exercises in a Group Objective Structured Clinical Experience (GOSCE) to study feasibility of the approach, the effect on learners' self-efficacy and attitude toward learning communication skills, and the effect of providing multiple sources of immediate, collaborative feedback. GOSCE sessions were piloted in Pediatrics and Medicine clerkships with students assessing their own performance and receiving formative feedback on communication skills from peers, standardized patients (SPs), and faculty. The sessions were evaluated using a retrospective pre/post-training questionnaire rating changes in self-efficacy and attitudes, and the value of the feedback. Results indicate a positive impact on attitudes toward learning communication skills and self-efficacy regarding communication in the clinical setting. Also, learners considered feedback by peers, SPs, and faculty valuable in each GOSCE. The GOSCE is an efficient and learner-centered method to attend to multiple goals of teaching communication skills, clinical reasoning, self-assessment, and giving feedback in a formative setting. The GOSCE is a low-resource, feasible strategy for experiential learning in communication skills and clinical reasoning. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

  14. A memory of an aesthetic experience transferred to clinical practice.

    PubMed

    Wikström, Britt-Maj

    2003-03-01

    To examine the usefulness of writing about a memory of an aesthetic experience, and then transfer the aesthetic experience to a health care situation. The study was accomplished at two university colleges of health sciences in Sweden. It started with student nurses (N=291) writing about a memory of an aesthetic experience. Then they transferred the aesthetic experience to a purposeful clinical practice. The results showed that each student could report on a positive memory of an aesthetic experience. Embedded in each story was an aesthetic experience that was meaningful to the student. Domains of memory most frequently reported were music, work of art and nature. Themes derived from the aesthetic memory were happiness and awareness. The awareness theme comprized the value of aesthetic experiences for the patients, and for student nurses. The process of writing about a memory of an aesthetic experience provided an alternative model for nursing education that could improve patient care.

  15. Experience of Adjunct Novice Clinical Nursing Faculty: An Interpretive Case Study

    ERIC Educational Resources Information Center

    Mann, Carol

    2013-01-01

    The purpose of this qualitative interpretive case study was to describe the experience of adjunct novice clinical nursing faculty who has less than three years teaching experience or feels novice in this setting. The nursing shortage in the United States is well documented and is forecasted to have significant impacts on the health care delivery…

  16. Nursing students' reflections on the learning experience of a unique mental health clinical placement.

    PubMed

    Patterson, Christopher; Moxham, Lorna; Brighton, Renee; Taylor, Ellie; Sumskis, Susan; Perlman, Dana; Heffernan, Tim; Hadfield, Louise

    2016-11-01

    There exists a need for innovative thinking to identify new clinical placement opportunities for nursing students. Recovery-based clinical placements for mental health nurse students remain unique and require investigation. To examine the learning experience of Bachelor of Nursing students who undertook an innovative mental health clinical placement known as Recovery Camp. This study incorporated qualitative analysis of written reflections. Using Braun and Clarke's (2006) six phases of thematic analysis the corpus of student reflections were reviewed by three members of the research team independent to each other. Four themes emerged. The theme of Pre-placement Expectations incorporates participant foci on pre-conceptions of Recovery Camp. The theme of Student Learning incorporates the ways in which participants recognised the experience of Recovery Camp influenced learning. Reflections themed under the title Placement Setting include discussion of the Recovery Camp as a clinical placement. The theme of Future Practice incorporates students' reflections on how they plan to practice as nurses as a result the learning experiences of Recovery Camp. An immersive clinical placement such as Recovery Camp can influence students' perceptions of people with mental illness, have a positive impact on student learning and influence students' decisions about future practice. The learning experience of nursing students whom attend unique, recovery-orientated clinical placements can be both positive and educative. Copyright © 2016 Elsevier Ltd. All rights reserved.

  17. Students' description of factors contributing to a meaningful clinical experience in entry-level physical therapist professional education.

    PubMed

    Rindflesch, Aaron; Hoversten, Kelsey; Patterson, Britta; Thomas, Laura; Dunfee, Heidi

    2013-01-01

    The objective of this study was to identify student, clinical instructor (CI), and environmental characteristics and behaviors that make for positive clinical experiences as perceived by physical therapy students. Nine third-year physical therapist students from entry-level physial therapist education programs around the United States participated in this study. In this phenomenologic study, participants were interviewed using open-ended questions designed to facilitate rich description. Interviews were recorded, transcribed, validated, and analyzed. Themes were identified through collaborative analysis using constant comparative coding. Students described student, CI, and environmental factors and behaviors that contribute to a quality clinical experience, including: the students' demonstration of initiative to prepare for the clinical experience and preparation after clinic hours; the importance of the CI's insight, allowing CIs to ascertain how much guidance to give in order to foster independence in the student; and the clinical environment's ability to welcome a student and provide the student with novel learning experiences. The student descriptions, including positive and negative examples shared by the interviewees, demonstrate essential characteristics that contribute to a positive clinical experience. Many of the factors identified by students can be influenced by student and CI training and preparation prior to the clinical experience.

  18. A systematic review of evidence on the links between patient experience and clinical safety and effectiveness

    PubMed Central

    Doyle, Cathal; Lennox, Laura; Bell, Derek

    2013-01-01

    Objective To explore evidence on the links between patient experience and clinical safety and effectiveness outcomes. Design Systematic review. Setting A wide range of settings within primary and secondary care including hospitals and primary care centres. Participants A wide range of demographic groups and age groups. Primary and secondary outcome measures A broad range of patient safety and clinical effectiveness outcomes including mortality, physical symptoms, length of stay and adherence to treatment. Results This study, summarising evidence from 55 studies, indicates consistent positive associations between patient experience, patient safety and clinical effectiveness for a wide range of disease areas, settings, outcome measures and study designs. It demonstrates positive associations between patient experience and self-rated and objectively measured health outcomes; adherence to recommended clinical practice and medication; preventive care (such as health-promoting behaviour, use of screening services and immunisation); and resource use (such as hospitalisation, length of stay and primary-care visits). There is some evidence of positive associations between patient experience and measures of the technical quality of care and adverse events. Overall, it was more common to find positive associations between patient experience and patient safety and clinical effectiveness than no associations. Conclusions The data presented display that patient experience is positively associated with clinical effectiveness and patient safety, and support the case for the inclusion of patient experience as one of the central pillars of quality in healthcare. It supports the argument that the three dimensions of quality should be looked at as a group and not in isolation. Clinicians should resist sidelining patient experience as too subjective or mood-oriented, divorced from the ‘real’ clinical work of measuring safety and effectiveness. PMID:23293244

  19. A Thematic Inquiry into the Burnout Experience of Australian Solo-Practicing Clinical Psychologists.

    PubMed

    Hammond, Trent E; Crowther, Andrew; Drummond, Sally

    2017-01-01

    Objective: Burnout is conceptualized as a syndrome that consists of emotional exhaustion, depersonalization, and decreased personal accomplishment. Despite the increased frequency and severity of burnout in the Western world, there is limited published research regarding the experiences of clinical psychologists who have had burnout. The present study examines clinical psychologists' different experiences of burnout in Australia. Design and Methods: In the year 2015, six privately practicing and solo-employed clinical psychologists provided rich qualitative data by participating in semi-structured interviews. Thematic analysis was the method used to analyze clinical psychologists' natural accounts of their burnout experiences. Using NVivo, emerging themes were identified through coding 'first order constructs' and then axial code 'second order constructs.' Findings: Clinical psychologists indicated that their roles are demanding and a diverse range of symptoms, including the enduring effects of burnout, mental stress, fatigue, decreased personal accomplishment, negative affect, depersonalization, reduced productivity and motivation, and insomnia. They identified precursors of burnout, including excessive workload and hours of work, life stresses, mismanaged workload, and transference. Clinical psychologists suggested that protective factors of burnout include knowledge and years worked in direct care, and trusting and long-term relationships. They indicated that the barriers to overcoming burnout include the fallacy that their clients' expectations and needs are more important than their own, the financial cost of working in private practice, contemporary knowledge and inadequate education regarding self-care, and time constraints. Discussion and Conclusion: The findings presented in this study provide psychologists and other health professionals with an insight about the burnout experience and inform professionals of the mental shortcomings of working as a solo

  20. A Thematic Inquiry into the Burnout Experience of Australian Solo-Practicing Clinical Psychologists

    PubMed Central

    Hammond, Trent E.; Crowther, Andrew; Drummond, Sally

    2018-01-01

    Objective: Burnout is conceptualized as a syndrome that consists of emotional exhaustion, depersonalization, and decreased personal accomplishment. Despite the increased frequency and severity of burnout in the Western world, there is limited published research regarding the experiences of clinical psychologists who have had burnout. The present study examines clinical psychologists’ different experiences of burnout in Australia. Design and Methods: In the year 2015, six privately practicing and solo-employed clinical psychologists provided rich qualitative data by participating in semi-structured interviews. Thematic analysis was the method used to analyze clinical psychologists’ natural accounts of their burnout experiences. Using NVivo, emerging themes were identified through coding ‘first order constructs’ and then axial code ‘second order constructs.’ Findings: Clinical psychologists indicated that their roles are demanding and a diverse range of symptoms, including the enduring effects of burnout, mental stress, fatigue, decreased personal accomplishment, negative affect, depersonalization, reduced productivity and motivation, and insomnia. They identified precursors of burnout, including excessive workload and hours of work, life stresses, mismanaged workload, and transference. Clinical psychologists suggested that protective factors of burnout include knowledge and years worked in direct care, and trusting and long-term relationships. They indicated that the barriers to overcoming burnout include the fallacy that their clients’ expectations and needs are more important than their own, the financial cost of working in private practice, contemporary knowledge and inadequate education regarding self-care, and time constraints. Discussion and Conclusion: The findings presented in this study provide psychologists and other health professionals with an insight about the burnout experience and inform professionals of the mental shortcomings of

  1. Building workplace social capital: A longitudinal study of student nurses' clinical placement experiences.

    PubMed

    Materne, Michelle; Henderson, Amanda; Eaton, Emma

    2017-09-01

    Quality clinical placement experiences have been associated with nurses' workplace social capital. Social capital is broadly understood as the social organisation of trust, norms and networks that benefit society. Building social capital in the workplace may benefit experiences of staff and students. The aim of this study was to assess the impact of building workplace social capital on student nurse perceptions of clinical learning experiences. A quality improvement process was measured through repeated student surveys. First, second, third year students (n = 1176) from three universities completed a validated Student Clinical Learning Culture Survey (SCLCS) following their placement, at the commencement of quality improvement initiatives and five years later. The SCLCS measured students' perceptions of social affiliation, their motivation, satisfaction and dissatisfaction with clinical contexts. The first year of systematic changes focused on increasing student numbers along with improving communication, trust and knowledge sharing, antecedents to workplace social capital. No change was evident after the first year. Six years after commencement of building workplace social capital differences across all subscales, except dissatisfaction, were significant (p < 0.001). Leadership that promotes open communication and connections across staff and students to achieve common goals can build workplace social capital that enhances student placement experiences. Copyright © 2017 Elsevier Ltd. All rights reserved.

  2. Learning on clinical placement: the experience of six Australian student nurses.

    PubMed

    Nolan, C A

    1998-11-01

    Concerns about the adequacy of clinical education in nursing courses in Australia have escalated since the transfer of pre-registration nursing education into the tertiary sector. This descriptive, interpretative study, informed by the tradition of critical social science, sought to understand the clinical learning experiences of undergraduate nursing students. At the same time, it fostered an active participation of students in their own learning. Daily post-clinical conferences with the students were taped and transcribed verbatim to provide data for the study. Additional data was collected from informal discussions and observations of the students during the placement. Analysis revealed three main categories, which reflected the students' experiences. These included: (1) I don't belong; (2) doing and practising: progress at last; and (3) transitions in thinking. Feeling part of the team was closely linked to the opportunity to learn, emphasizing the important role not only of educators but also clinicians in undergraduate learning on clinical placement. Though the findings reflect age-long problems associated with student learning in the clinical field, it serves to remind all nurses of the importance they play in the learning process. This study reflects the importance of effective communication between the health and education sectors and the need to concentrate on strategies which will strengthen this bond.

  3. Challenging clinical learning environments: experiences of undergraduate nursing students.

    PubMed

    O'Mara, Linda; McDonald, Jane; Gillespie, Mary; Brown, Helen; Miles, Lynn

    2014-03-01

    Clinical learning is an essential component of becoming a nurse. However at times, students report experiencing challenging clinical learning environments (CCLE), raising questions regarding the nature of a challenging clinical learning environment, its impact on students' learning and how students might respond within a CCLE. Using an Interpretive Descriptive study design, researchers held focus groups with 54 students from two Canadian sites, who self-identified as having experienced a CCLE. Students defined a CCLE as affected by relationships in the clinical area and by the context of their learning experiences. CCLE decreased students' learning opportunities and impacted on them as persons. As students determined which relationships were challenging, they tapped other resources and they used strategies to rebuilt, reframe, redirect and/or retreat relative to the specific challenge. Relationships also acted as buffers to unsupportive practice cultures. Implications for practice and research are addressed. Copyright © 2013 Elsevier Ltd. All rights reserved.

  4. Sacubitril/Valsartan: From Clinical Trials to Real-world Experience.

    PubMed

    Joly, Joanna M; Desai, Akshay S

    2018-04-23

    Compared to enalapril, use of angiotensin-receptor blocker and neprilysin inhibitor sacubitril/valsartan to treat patients with heart failure and reduced ejection fraction (HFrEF) is associated with substantial reductions in both cardiovascular mortality and heart failure progression. The purpose of this review is to discuss the real-world experience of sacubitril/valsartan. In the years following the publication of the landmark PARADIGM-HF trial in 2014 and its subsequent FDA approval, a growing evidence base supports the safety and efficacy of sacubitril/valsartan in a broad spectrum of patients with HFrEF. Updated clinical practice guidelines have embraced the use of sacubitril/valsartan in preference to ACE inhibitors or ARBs in selected patients. In this review, we highlight the clinical trials that led to these key updates to clinical guidelines, offer practical strategies for patient selection and utilization in clinical practice, and identify important areas of uncertainty that require future research.

  5. AWBATTM: Early Clinical Experience

    PubMed Central

    Vandenberg, Victoria B.

    2010-01-01

    Objective: The purpose of this article is to describe the early clinical experience with AWBAT. Methods: Burn patients requiring (1) donor sites or (2) treatment of a superficial burn wound injury were treated. A total of 45 patients with 69 distinct wounds were included. AWBATTM-D was evaluated in donor sites and AWBATTM-S was evaluated in superficial partial-thickness burns. Days to healing, pain, hematoma/seroma formation, and infection were noted. Ease of application, adherence, transparency, and physical adaptability details were collected. Results: Average period to healing of donor sites treated with AWBAT-D (n=22 patients with n=26 wounds) was 11.2 days, σ =1.95, with a range of 8–15 days and a median of 11 days. Pain rating at 24 hours was 1.2, σ =0.43 (n=18) and at 48 hours mean was 1.2, σ =0.46 (n=15). Average period to healing of superficial burns treated with AWBAT-S (n=15 patients with n=18 wounds) was 8.1 days, σ =2.48, with a range of 5–13 days and a median of 7 days. Pain rating at 24 hours was 1.5, σ =0.85 (n=10) and at 48 hours mean was 1.75, σ =0.89 (n=8). There was zero incidence of hematoma/seroma. No infections were seen. Results indicate that AWBAT was easily applied with good initial adherence. It was noted to be transparent, conformant, and pliable. Discussion: Early experience demonstrates that AWBAT performs well on donor sites and superficial partial-thickness burns and delivers the desired attributes of a temporary skin substitute including good adherence, infection control, transparency, adapatability, and pain control. PMID:20361005

  6. Predoctoral Dental Students' Perceptions of Dental Implant Training: Effect of Preclinical Simulation and Clinical Experience.

    PubMed

    Prasad, Soni; Bansal, Naveen

    2017-04-01

    The aims of this study were to assess 1) differences in perceptions of dental implant training between dental students who received didactic training alone (control group) and those who received didactic plus simulation training (test group); 2) differences in response between students with and without clinical experience in implant dentistry; and 3) the interaction effect of simulation training and clinical experience on students' satisfaction. A survey was distributed to the control group in 2014 and to the test group in 2015; both groups were at the same U.S. dental school. Data were collected on confidence levels with various implant restorative procedures along with overall satisfaction and number of implant restorations performed by each student. The response rate was 78.7% in the control group and 81.3% in the test group. In the control group, 85.7% of students reported being satisfied with implant training compared to 90.8% of students in the test group. The interaction effect of simulation training and clinical experience on overall student satisfaction was OR=1.5 at 95% CI: 0.8, 3.0. The students who had clinical experience with implant restorative procedures had significantly greater satisfaction than those who did not (OR=4.8, 95% CI: 2.1, 11.1, p<0.01). This study found that both the simulation and clinical experience affected these students' confidence and satisfaction levels with implant education: they were almost five times more satisfied with implant training when clinical experience in implant restorative procedures was a part of their implant education.

  7. Radiation dosimetry in cell biology: comparison of calculated and measured absorbed dose for a range of culture vessels and clinical beam qualities.

    PubMed

    Claridge Mackonis, Elizabeth; Hammond, Lauren; Esteves, Ana I S; Suchowerska, Natalka

    2018-02-01

    Cell culture studies are frequently used to evaluate the effects of cancer treatments such as radiotherapy, hormone therapy, chemotherapy, nanoparticle enhancement, and to determine any synergies between the treatments. To achieve valid results, the absorbed dose of each therapy needs to be well known and controlled. In this study, we aim to determine the uncertainty associated with radiation exposure in different experimental conditions. We have performed an in-depth evaluation of the absorbed dose and dose distribution that would be delivered to a cell sample when cultivated in a number of the more popular designs of culture vessels. We focus on exposure to two beam types: a kilovoltage x-ray beam and a megavoltage photon beam, both of which are routinely used to treat cancer patients in the clinical environment. Our results identify large variations of up to 16% in the absorbed dose across multi-well culture plates, which if ignored in radiobiological experiments, have the potential to lead to erroneous conclusions.

  8. Facilitative and obstructive factors in the clinical learning environment: Experiences of pupil enrolled nurses.

    PubMed

    Lekalakala-Mokgele, Eucebious; Caka, Ernestine M

    2015-03-31

    The clinical learning environment is a complex social entity that influences student learning outcomes in the clinical setting. Students can experience the clinical learning environment as being both facilitative and obstructive to their learning. The clinical environment may be a source of stress, creating feelings of fear and anxiety which in turn affect the students' responses to learning. Equally, the environment can enhance learning if experienced positively. This study described pupil enrolled nurses' experiences of facilitative and obstructive factors in military and public health clinical learning settings. Using a qualitative, contextual, exploratory descriptive design, three focus group interviews were conducted until data saturation was reached amongst pupil enrolled nurses in a military School of Nursing. Data analysed provided evidence that acceptance by clinical staff and affordance of self-directed learning facilitated learning. Students felt safe to practise when they were supported by the clinical staff. They felt a sense of belonging when the staff showed an interest in and welcomed them. Learning was obstructed when students were met with condescending comments. Wearing of a military uniform in the public hospital and horizontal violence obstructed learning in the clinical learning environment. Students cannot have effective clinical preparation if the environment is not conducive to and supportive of clinical learning, The study shows that military nursing students experience unique challenges as they are trained in two professions that are hierarchical in nature. The students experienced both facilitating and obstructing factors to their learning during their clinical practice. Clinical staff should be made aware of factors which can impact on students' learning. Policies need to be developed for supporting students in the clinical learning environment.

  9. Iodine 125 source in interstitial tumor therapy. Clinical and biological considerations.

    PubMed

    Kim, J H; Hilaris, B

    1975-01-01

    Our clinical experience with interstitial tumor therapy is presented in 2 groups of patients: 98 patients with metastatic carcinoma in neck lymph nodes implanted with iodine 125, iridium 192 or radon 222 encapsulated sources, and 105 patients with primary unresectable lung tumors, which were implanted either with radon 222 or iodine 125 seeds. The local tumor control rates with iodine 125, radon 222 and iridium 192 were 78 per cent (38/49), 65 per cent (15/23) and 58 per cent (7/12), while the local complication rates were 17 per cent, 35 per cent and 43 per cent, respectively. An analysis of the tumor control rate as a function of the implanted tumor dose shows that the iodine 125 implants with a delivery of the minimal effective tumor dose of 16,000 rads have a higher therapeutic effect than either radon 222 or iridium 192. The results of the patients with unresectable lung tumors similarly show that the implants with iodine 125 sources are superior to those with radon 222. The advantages could stem from the better spatial dose distribution, and from radiobiologic considerations associated with low dose rates, continous irradiation, and possibly gains in RBE. There present clinical data clearly demonstrate that iodine 125 seeds have a higher therapeutic ratio than radon 222 seeds. There are, in addition, distinct physical advantages making iodine 125 an attractive substitute for radon 222 for the interstitial implantation of malignant tumors.

  10. The Impact of Clinical Experiences from Athletic Training Student and Preceptor Perspectives

    ERIC Educational Resources Information Center

    Benes, Sarah S.; Mazerolle, Stephanie M.; Bowman, Thomas G.

    2014-01-01

    Context: Clinical education is an integral part of athletic training programs. This is where students should develop their professional identities and become socialized into the profession. Understanding the student and preceptor perspectives of the impact that clinical experiences have on students can provide valuable insight into this aspect of…

  11. The effect of alternative clinical teaching experience on preservice science teachers' self-efficacy

    NASA Astrophysics Data System (ADS)

    Klett, Mitchell Dean

    The purpose of this study was to compare different methods of alternative clinical experience; family science nights and Saturday science (authentic teaching) against micro-teaching (peer teaching) in terms of self-efficacy in science teaching and teaching self-efficacy. The independent variable, or cause, is teaching experiences (clinical vs. peer teaching); the dependent variable, or effect, is two levels of self-efficacy. This study was conducted at the University of Idaho's main campus in Moscow and extension campus in Coeur d'Alene. Four sections of science methods were exposed to the same science methods curriculum and will have opportunities to teach. However, each of the four sections were exposed to different levels or types of clinical experience. One section of preservice teachers worked with students in a Saturday science program. Another section worked with students during family science nights. The third worked with children at both the Saturday science program and family science nights. The last section did not have a clinical experience with children, instead they taught in their peer groups and acted as a control group. A pre-test was given at the beginning of the semester to measure their content knowledge, teaching self-efficacy and self-efficacy in science teaching. A post-test was given at the end of the semester to see if there was any change in self-efficacy or science teaching self-efficacy. Throughout the semester participants kept journals about their experiences and were interviewed after their alternative clinical teaching experiences. These responses were categorized into three groups; gains in efficacy, no change in efficacy, and drop in efficacy. There was a rise in teaching efficacy for all groups. The mean scores for personal teaching efficacy dropped for the Monday-Wednesday and Tuesday-Thursday group while the both Coeur D'Alene groups remained nearly unchanged. There was no significant change in the overall means for science

  12. Time Keeps on Ticking: The Experience of Clinical Judgment

    ERIC Educational Resources Information Center

    Spengler, Paul M.; White, Michael J.; Aegisdottir, Stefania; Maugherman, Alan S.

    2009-01-01

    The reactions by Ridley and Shaw-Ridley (EJ832451) and Lichtenberg (EJ832452) to the authors' meta-analysis on the effects of experience on judgment accuracy add positively to what is hoped will become an ever more focused discourse on this most basic question: How can mental health clinical decision making be improved? In this rejoinder, the…

  13. BRIEF REPORT: Beyond Clinical Experience: Features of Data Collection and Interpretation That Contribute to Diagnostic Accuracy

    PubMed Central

    Nendaz, Mathieu R; Gut, Anne M; Perrier, Arnaud; Louis-Simonet, Martine; Blondon-Choa, Katherine; Herrmann, François R; Junod, Alain F; Vu, Nu V

    2006-01-01

    BACKGROUND Clinical experience, features of data collection process, or both, affect diagnostic accuracy, but their respective role is unclear. OBJECTIVE, DESIGN Prospective, observational study, to determine the respective contribution of clinical experience and data collection features to diagnostic accuracy. METHODS Six Internists, 6 second year internal medicine residents, and 6 senior medical students worked up the same 7 cases with a standardized patient. Each encounter was audiotaped and immediately assessed by the subjects who indicated the reasons underlying their data collection. We analyzed the encounters according to diagnostic accuracy, information collected, organ systems explored, diagnoses evaluated, and final decisions made, and we determined predictors of diagnostic accuracy by logistic regression models. RESULTS Several features significantly predicted diagnostic accuracy after correction for clinical experience: early exploration of correct diagnosis (odds ratio [OR] 24.35) or of relevant diagnostic hypotheses (OR 2.22) to frame clinical data collection, larger number of diagnostic hypotheses evaluated (OR 1.08), and collection of relevant clinical data (OR 1.19). CONCLUSION Some features of data collection and interpretation are related to diagnostic accuracy beyond clinical experience and should be explicitly included in clinical training and modeled by clinical teachers. Thoroughness in data collection should not be considered a privileged way to diagnostic success. PMID:17105525

  14. Use of the experience sampling method in the context of clinical trials

    PubMed Central

    Verhagen, Simone J W; Hasmi, Laila; Drukker, Marjan; van Os, J; Delespaul, Philippe A E G

    2016-01-01

    Objective The experience sampling method (ESM) is a structured diary technique to appraise subjective experiences in daily life. It is applied in psychiatric patients, as well as in patients with somatic illness. Despite the potential of ESM assessment, the improved logistics and its increased administration in research, its use in clinical trials remains limited. This paper introduces ESM for clinical trials in psychiatry and beyond. Methods ESM is an ecologically valid method that yields a comprehensive view of an individual's daily life. It allows the assessment of various constructs (eg, quality of life, psychopathology) and psychological mechanisms (eg, stress-sensitivity, coping). These constructs are difficult to assess using cross-sectional questionnaires. ESM can be applied in treatment monitoring, as an ecological momentary intervention, in clinical trials, or in single case clinical trials. Technological advances (eg, smartphone applications) make its implementation easier. Results Advantages of ESM are highlighted and disadvantages are discussed. Furthermore, the ecological nature of ESM data and its consequences are explored, including the potential pitfalls of ambiguously formulated research questions and the specificities of ESM in statistical analyses. The last section focuses on ESM in relation to clinical trials and discusses its future use in optimising clinical decision-making. Conclusions ESM can be a valuable asset in clinical trial research and should be used more often to study the benefits of treatment in psychiatry and somatic health. PMID:27443678

  15. Experience inheritance from famous specialists based on real-world clinical research paradigm of traditional Chinese medicine.

    PubMed

    Song, Guanli; Wang, Yinghui; Zhang, Runshun; Liu, Baoyan; Zhou, Xuezhong; Zhou, Xiaji; Zhang, Hong; Guo, Yufeng; Xue, Yanxing; Xu, Lili

    2014-09-01

    The current modes of experience inheritance from famous specialists in traditional Chinese medicine (TCM) include master and disciple, literature review, clinical-epidemiology-based clinical research observation, and analysis and data mining via computer and database technologies. Each mode has its advantages and disadvantages. However, a scientific and instructive experience inheritance mode has not been developed. The advent of the big data era as well as the formation and practice accumulation of the TCM clinical research paradigm in the real world have provided new perspectives, techniques, and methods for inheriting experience from famous TCM specialists. Through continuous exploration and practice, the research group proposes the innovation research mode based on the real-world TCM clinical research paradigm, which involves the inheritance and innovation of the existing modes. This mode is formulated in line with its own development regularity of TCM and is expected to become the main mode of experience inheritance in the clinical field.

  16. Research needed for improving heavy-ion therapy

    NASA Astrophysics Data System (ADS)

    Kraft, G; Kraft, S D

    2009-02-01

    The large interest in heavy-ion therapy is stimulated from its excellent clinical results. The bases of this success are the radiobiological and physical advantages of heavy-ion beams and the active beam delivery used for an intensity-modulated particle radiotherapy (IMPT). Although heavy-ion therapy has reached a high degree of perfection for clinical use there is still large progress possible to improve this novel technique: in order to extend IMPT to more tumor entities and to tailor the planning more individually for each patient in an adaptive way, radiobiological work is required both experimentally and theoretically. It is also not clear whether the neighboring ions to carbon could have a clinical application as well. For this extension basic biological studies as well as physics experiments have to be performed. On the technical side, many improvements of the equipment used seem to be possible. Two major topics are the extension of IMPT to moving organs and the transition to more compact and therefore cheaper particle accelerators. In the present paper, these topics are treated to some extent in order to give an outline of the great future potential of ion-beam therapy.

  17. Characterizing Clinical Genetic Counselors' Countertransference Experiences: an Exploratory Study.

    PubMed

    Reeder, Rebecca; Veach, Patricia McCarthy; MacFarlane, Ian M; LeRoy, Bonnie S

    2017-10-01

    Countertransference (CT) refers to conscious and unconscious emotions, fantasies, behaviors, perceptions, and psychological defenses genetic counselors experience in response to any aspect of genetic counseling situations (Weil 2010). Some authors theorize about the importance of recognizing and managing CT, but no studies solely aim to explore genetic counselors' experiences of the phenomenon. This study examined the extent to which clinical genetic counselors' perceive themselves as inclined to experience CT, gathered examples of CT encountered in clinical situations, and assessed their CT management strategies. An anonymous online survey, sent to NSGC members, yielded 127 usable responses. Participants completed Likert-type items rating their CT propensities; 57 of these individuals also provided examples of CT they experienced in their practice. Factor analysis of CT propensities tentatively suggested four factors: Control, Conflict Avoidance, Directiveness, and Self-Regulation, accounting for 38.5% of response variance. Thematic analysis of CT examples yielded five common triggers: general similarity to patient, medical/genetic similarity, angry patients, patient behaves differently from counselor expectations, and disclosing bad news; six common manifestations: being self-focused, projecting feelings onto the patient, intense emotional reaction to patient, being overly invested, disengagement, and physical reaction; five CT effects: disruption in rapport building, repaired empathy, over-identification, conversation does not reach fullest potential, and counselor is drained emotionally; and three management strategies: recognizing CT as it occurs, self-reflection, and consultation. Results suggest CT is a common experience, occurring in both "routine" and emotionally complex cases. Training programs, continuing education, and peer supervision might include discussion of CT, informed by examples from the present study, to increase genetic counselor awareness

  18. Experience from mental health clinics held during medical service camps in Fiji.

    PubMed

    Sivakumaran, Hemalatha; George, Kuruvilla; Naker, Gunu; Nadanachandran, Kathir

    2015-12-01

    We aim to describe the experience and findings of mental health clinics held during medical service camps in the rural settings of Fiji. Descriptive data collated at the end of the medical camps across 2011-2014 are used to highlight the main findings. The exposure to mental health assessments and brief interventions at these camps was a validating experience for both individuals and medical students attending the clinics. The most common presentations can be categorised under symptoms of depression, anxiety and relationship problems. The accessibility of mental health support services is a challenge in Fiji. Medical service camps can form an important pathway in promoting mental health awareness, especially amongst the rural communities of Fiji, and a useful platform for medical students to acquire some clinical exposure. © The Royal Australian and New Zealand College of Psychiatrists 2015.

  19. Antiproton radiotherapy.

    PubMed

    Bassler, Niels; Alsner, Jan; Beyer, Gerd; DeMarco, John J; Doser, Michael; Hajdukovic, Dragan; Hartley, Oliver; Iwamoto, Keisuke S; Jäkel, Oliver; Knudsen, Helge V; Kovacevic, Sandra; Møller, Søren Pape; Overgaard, Jens; Petersen, Jørgen B; Solberg, Timothy D; Sørensen, Brita S; Vranjes, Sanja; Wouters, Bradly G; Holzscheiter, Michael H

    2008-01-01

    Antiprotons are interesting as a possible future modality in radiation therapy for the following reasons: When fast antiprotons penetrate matter, protons and antiprotons have near identical stopping powers and exhibit equal radiobiology well before the Bragg-peak. But when the antiprotons come to rest at the Bragg-peak, they annihilate, releasing almost 2 GeV per antiproton-proton annihilation. Most of this energy is carried away by energetic pions, but the Bragg-peak of the antiprotons is still locally augmented with approximately 20-30 MeV per antiproton. Apart from the gain in physical dose, an increased relative biological effect also has been observed, which can be explained by the fact that some of the secondary particles from the antiproton annihilation exhibit high-LET properties. Finally, the weakly interacting energetic pions, which are leaving the target volume, may provide a real time feedback on the exact location of the annihilation peak. We have performed dosimetry experiments and investigated the radiobiological properties using the antiproton beam available at CERN, Geneva. Dosimetry experiments were carried out with ionization chambers, alanine pellets and radiochromic film. Radiobiological experiments were done with V79 WNRE Chinese hamster cells. The radiobiological experiments were repeated with protons and carbon ions at TRIUMF and GSI, respectively, for comparison. Several Monte Carlo particle transport codes were investigated and compared with our experimental data obtained at CERN. The code that matched our data best was used to generate a set of depth dose data at several energies, including secondary particle-energy spectra. This can be used as base data for a treatment planning software such as TRiP. Our findings from the CERN experiments indicate that the biological effect of antiprotons in the plateau region may be reduced by a factor of 4 for the same biological target dose in a spread-out Bragg-peak, when comparing with protons. The

  20. [Introduction of a Clinical Research Experience Program in Hospital Practical Training for Pharmacy Students and Its Evaluation].

    PubMed

    Takahashi, Katsuyuki; Suda, Yasuki; Kawaguchi, Hiroshi; Nakamura, Yasutaka; Kawabata, Shiho; Kawakami, Noriko; Nishikawa, Takeshi; Nagayama, Katsuya

    2015-01-01

    Long-term clinical training based on a model core curriculum was conducted to nurture highly competent pharmacists in the clinical field. Pharmacists' responsibilities are expanding, and a system has been developed to help pharmacists gain accreditation, identify specialties, and improve their training. However, this system requires research competency. Therefore clinical research should be considered a part of clinical training to encourage high competency among pharmacists. Because the model core curriculum does not include a section on clinical research. Osaka City University Hospital introduced a hands-on clinical research experience program and evaluated its usefulness. A significant improvement in the level of knowledge and awareness of clinical research was seen among students who underwent the clinical research experience program. In addition, the level of student satisfaction was higher. These findings suggest that a clinical research experience program may be useful to nurture a greater awareness of clinical research and knowledge acquisition among pharmacists.

  1. Cosmic-ray interaction data for designing biological experiments in space.

    PubMed

    Straume, T; Slaba, T C; Bhattacharya, S; Braby, L A

    2017-05-01

    There is growing interest in flying biological experiments beyond low-Earth orbit (LEO) to measure biological responses potentially relevant to those expected during a human mission to Mars. Such experiments could be payloads onboard precursor missions, including unmanned private-public partnerships, as well as small low-cost spacecraft (satellites) designed specifically for biosentinel-type missions. It is the purpose of this paper to provide physical cosmic-ray interaction data and related information useful to biologists who may be planning such experiments. It is not the objective here to actually design such experiments or provide radiobiological response functions, which would be specific for each experiment and biological endpoint. Nuclide-specific flux and dose rates were calculated using OLTARIS and these results were used to determine particle traversal rates and doses in hypothetical biological targets. Comparisons are provided between GCR in interplanetary space and inside the ISS. Calculated probabilistic estimates of dose from solar particle events are also presented. Although the focus here is on biological experiments, the information provided may be useful for designing other payloads as well if the space radiation environment is a factor to be considered. Published by Elsevier Ltd.

  2. Cosmic-ray interaction data for designing biological experiments in space

    NASA Astrophysics Data System (ADS)

    Straume, T.; Slaba, T. C.; Bhattacharya, S.; Braby, L. A.

    2017-05-01

    There is growing interest in flying biological experiments beyond low-Earth orbit (LEO) to measure biological responses potentially relevant to those expected during a human mission to Mars. Such experiments could be payloads onboard precursor missions, including unmanned private-public partnerships, as well as small low-cost spacecraft (satellites) designed specifically for biosentinel-type missions. It is the purpose of this paper to provide physical cosmic-ray interaction data and related information useful to biologists who may be planning such experiments. It is not the objective here to actually design such experiments or provide radiobiological response functions, which would be specific for each experiment and biological endpoint. Nuclide-specific flux and dose rates were calculated using OLTARIS and these results were used to determine particle traversal rates and doses in hypothetical biological targets. Comparisons are provided between GCR in interplanetary space and inside the ISS. Calculated probabilistic estimates of dose from solar particle events are also presented. Although the focus here is on biological experiments, the information provided may be useful for designing other payloads as well if the space radiation environment is a factor to be considered.

  3. Work Experience Program at a Metropolitan Paediatric Hospital: Assisting Rural and Metropolitan Allied Health Professionals Exchange Clinical Skills.

    ERIC Educational Resources Information Center

    Parkin, Ann E.; McMahon, Sandra; Upfield, Nancy; Copley, Jodie; Hollands, Karen

    2001-01-01

    A clinical experience program provided 29 rural Australian allied health professionals with experience in pediatric clinical areas and opportunities to share clinical knowledge and develop networks with metropolitan peers. Questionnaires and focus groups indicated that networking, clinical skills, knowledge, confidence, and awareness of rural…

  4. A short version of the revised 'experience of close relationships questionnaire': investigating non-clinical and clinical samples.

    PubMed

    Wongpakaran, Tinakon; Wongpakaran, Nahathai

    2012-01-01

    This study seeks to investigate the psychometric properties of the short version of the revised 'Experience of Close Relationships' questionnaire, comparing non-clinical and clinical samples. In total 702 subjects participated in this study, of whom 531 were non-clinical participants and 171 were psychiatric patients. They completed the short version of the revised 'Experience of Close Relationships' questionnaire (ECR-R-18), the Perceived Stress Scale-10(PSS-10), the Rosenberg Self-Esteem Scale (RSES) and the UCLA Loneliness scale. A retest of the ECR-R-18 was then performed at four-week intervals. Then, confirmatory factor analyses were performed to test the validity of the new scale. The ECR-R-18 showed a fair to good internal consistency (α 0.77 to 0.87) for both samples, and the test-retest reliability was found to be satisfactory (ICC = 0.75). The anxiety sub-scale demonstrated concurrent validity with PSS-10 and RSES, while the avoidance sub-scale showed concurrent validity with the UCLA Loneliness Scale. Confirmatory factor analysis using method factors yielded two factors with an acceptable model fit for both groups. An invariance test revealed that the ECR-R-18 when used on the clinical group differed from when used with the non-clinical group. The ECR-R-18 questionnaire revealed an overall better level of fit than the original 36 item questionnaire, indicating its suitability for use with a broader group of samples, including clinical samples. The reliability of the ECR-R- 18 might be increased if a modified scoring system is used and if our suggestions with regard to future studies are followed up.

  5. Clinical evaluation of music perception, appraisal and experience in cochlear implant users.

    PubMed

    Drennan, Ward R; Oleson, Jacob J; Gfeller, Kate; Crosson, Jillian; Driscoll, Virginia D; Won, Jong Ho; Anderson, Elizabeth S; Rubinstein, Jay T

    2015-02-01

    The objectives were to evaluate the relationships among music perception, appraisal, and experience in cochlear implant users in multiple clinical settings and to examine the viability of two assessments designed for clinical use. Background questionnaires (IMBQ) were administered by audiologists in 14 clinics in the United States and Canada. The CAMP included tests of pitch-direction discrimination, and melody and timbre recognition. The IMBQ queried users on prior musical involvement, music listening habits pre and post implant, and music appraisals. One-hundred forty-five users of Advanced Bionics and Cochlear Ltd cochlear implants. Performance on pitch direction discrimination, melody recognition, and timbre recognition tests were consistent with previous studies with smaller cohorts, as well as with more extensive protocols conducted in other centers. Relationships between perceptual accuracy and music enjoyment were weak, suggesting that perception and appraisal are relatively independent for CI users. Perceptual abilities as measured by the CAMP had little to no relationship with music appraisals and little relationship with musical experience. The CAMP and IMBQ are feasible for routine clinical use, providing results consistent with previous thorough laboratory-based investigations.

  6. A Mandala: A Diagram of the Clinical Education Experience in Athletic Training

    ERIC Educational Resources Information Center

    Cernohous, Steve; West, Sharon

    2007-01-01

    Objective: The objective of this paper is to present the practical use of a Mandala that: 1) provides opportunities for athletic training students to explore, reflect on and appreciate their clinical experiences; 2) provides educators with a model to understand and value athletic training student experiences; 3) organizes and captures factors and…

  7. Cellular changes in microgravity and the design of space radiation experiments

    NASA Technical Reports Server (NTRS)

    Morrison, D. R.

    1994-01-01

    Cell metabolism, secretion and cell-cell interactions can be altered during space flight. Early radiobiology experiments have demonstrated synergistic effects of radiation and microgravity as indicated by increased mutagenesis, increased chromosome aberrations, inhibited development, and retarded growth. Microgravity-induced changes in immune cell functions include reduced blastogenesis and cell-mediated, delayed-type hypersensitivity responses, increased cytokine secretions, but inhibited cytotoxic effects an macrophage differentiation. These effects are important because of the high radiosensitivity of immune cells. It is difficult to compare ground studies with space radiation biology experiments because of the complexity of the space radiation environment, types of radiation damage and repair mechanisms. Altered intracellular functions and molecular mechanisms must be considered in the design and interpretation of space radiation experiments. Critical steps in radiocarcinogenesis could be affected. New cell systems and hardware are needed to determine the biological effectiveness of the low dose rate, isotropic, multispectral space radiation and the potential usefulness of radioprotectants during space flight.

  8. Student agreement regarding adequacy of didactic content and practical experiences of vaccination clinic business operations.

    PubMed

    George, David L; Johnson, Eric J; O'Neal, Katherine S; Smith, Michael J

    2018-04-01

    To report student perceived adequacy regarding didactic content and practical experiences of vaccination clinic business operations. Didactic content, a case study, and practical experiences regarding vaccination clinic business operations were implemented in related lectures of a Pharmacy Business and Entrepreneurship (PBE) elective and the college of pharmacy sponsored vaccination clinics. An online survey was used to evaluate student perceived adequacy of didactic content and practical experiences of vaccination clinic business operations. Mean scaled agreement was compared between students in the PBE elective versus those not in the elective. Student confidence in performing business operations was also assessed. Students in the PBE had higher mean confidence than non-elective students regarding staff management (3.23 vs. 2.73, p = 0.04). Success of the interventions may be attributed to students in the PBE elective that reported a higher mean perceived adequacy of content and practical experiences and confidence in performing nearly all business operations. Still, further evaluation of interventions is being considered to assess effectiveness of learning. Published by Elsevier Inc.

  9. Dosimetry and radiobiology at the new RA-3 reactor boron neutron capture therapy (BNCT) facility: application to the treatment of experimental oral cancer.

    PubMed

    Pozzi, E; Nigg, D W; Miller, M; Thorp, S I; Heber, E M; Zarza, L; Estryk, G; Monti Hughes, A; Molinari, A J; Garabalino, M; Itoiz, M E; Aromando, R F; Quintana, J; Trivillin, V A; Schwint, A E

    2009-07-01

    The National Atomic Energy Commission of Argentina (CNEA) constructed a novel thermal neutron source for use in boron neutron capture therapy (BNCT) applications at the RA-3 research reactor facility located in Buenos Aires. The aim of the present study was to perform a dosimetric characterization of the facility and undertake radiobiological studies of BNCT in an experimental model of oral cancer in the hamster cheek pouch. The free-field thermal flux was 7.1 x 10(9) n cm(-2)s(-1) and the fast neutron flux was 2.5 x 10(6) n cm(-2)s(-1), indicating a very well-thermalized neutron field with negligible fast neutron dose. For radiobiological studies it was necessary to shield the body of the hamster from the neutron flux while exposing the everted cheek pouch bearing the tumors. To that end we developed a lithium (enriched to 95% in (6)Li) carbonate enclosure. Groups of tumor-bearing hamsters were submitted to BPA-BNCT, GB-10-BNCT, (GB-10+BPA)-BNCT or beam only treatments. Normal (non-cancerized) hamsters were treated similarly to evaluate normal tissue radiotoxicity. The total physical dose delivered to tumor with the BNCT treatments ranged from 6 to 8.5 Gy. Tumor control at 30 days ranged from 73% to 85%, with no normal tissue radiotoxicity. Significant but reversible mucositis in precancerous tissue surrounding tumors was associated to BPA-BNCT. The therapeutic success of different BNCT protocols in treating experimental oral cancer at this novel facility was unequivocally demonstrated.

  10. Understanding Clinical Expertise: Nurse Education, Experience, and the Hospital Context

    PubMed Central

    McHugh, Matthew D.; Lake, Eileen T.

    2010-01-01

    Clinical nursing expertise is central to quality patient care. Research on factors that contribute to expertise has focused largely on individual nurse characteristics to the exclusion of contextual factors. To address this, we examined effects of hospital contextual factors and individual nurse education and experience on clinical nursing expertise in a cross-sectional analysis of data from 8,611 registered nurses. In a generalized ordered logistic regression analysis, the composition of the hospital staff, particularly the proportion of nurses with at least a bachelor of science in nursing degree, was associated with significantly greater odds of a nurse reporting a more advanced expertise level. Our findings suggest that, controlling for individual characteristics, the hospital context significantly influences clinical nursing expertise. PMID:20645420

  11. An investigation of nurse educator's perceptions and experiences of undertaking clinical practice.

    PubMed

    Williams, Angela; Taylor, Cathy

    2008-11-01

    Educational policy (DOH, 1999. Making a difference: strengthening the nursing, midwifery and health visiting contribution to health and healthcare. Department of Health, London; UKCC, 1999. Fitness for Practice. United Kingdom Central Council for Nursing, Midwifery and Health Visiting, London; Nursing and Midwifery Council, 2006. Standards to support learning and assessment in practice. Nursing and Midwifery Council, London) and current nursing literature (Griscti, O., Jacono, B., Jacono, J., 2005. The nurse educator's clinical role. Journal of Advanced Nursing 50 (1), 84-92; Owen, S., Ferguson, K., Baguley, I., 2005. The clinical activity of mental health nurse lecturers. Journal of Psychiatric and Mental Health Nursing 12, 310-316), place increasing emphasis on nurse educators undertaking clinical practice to facilitate their clinical confidence and competence. This study investigated nurse educators' perceptions and experiences of undertaking clinical practice. A qualitative design and descriptive, exploratory approach were used. A purposive sample of 11 nurse educators in one nursing department, took part in two focus group interviews, one with 5 and the other with 6 respondents, to identify and discuss their perceptions and experiences of undertaking clinical practice. A process of thematic content analysis revealed three broad themes relating to the meaning and importance of clinical practice, perceived benefits and barriers which are examined and discussed. The paper concludes that despite policy recommendations, barriers highlighted in this study such as insufficient time, heavy workload and a lack of valuing of the clinical role have been raised over the past few decades. The effect of undertaking clinical practice, particularly on the quality of teaching is argued to be valuable armoury in the battle to secure sufficient resources to support engagement in clinical practice. Financial and organisational commitment; valuing of clinical practice and research

  12. A discussion of nursing students' experiences of culture shock during an international clinical placement and the clinical facilitators' role.

    PubMed

    Maginnis, Cathy; Anderson, Judith

    2017-06-01

    This paper examines the meaning and experience of culture shock for nursing students undertaking an international clinical placement (ICP) and the role of the clinical facilitator. Oberg's four stages of adapting to culture shock were aligned to anecdotal conversations with nursing students on an ICP. All four stages were identified in anecdotal conversations with the students. Support by the accompanying clinical facilitator is pivotalin overcoming culture shock and maximising the learning experience. It is essential that students are prepared for the change in cultural norms and are supported by the academic staff to work through the processes required to adapt to culture shock. Planning and preparation prior to departure is essential to assist with managing culture shock with an emphasis on the inclusion of cultural norms and beliefs. The role of the facilitator is crucial to guide and support the students through the culture shock process.

  13. Exploring nursing students’ experience of peer learning in clinical practice

    PubMed Central

    Ravanipour, Maryam; Bahreini, Masoud; Ravanipour, Masoumeh

    2015-01-01

    Background: Peer learning is an educational process wherein someone of the same age or level of experience level interacts with other students interested in the same topic. There is limited evidence specifically focusing on the practical use of peer learning in Iran. The aim of this study was to explore nursing students’ experiences of peer learning in clinical practice. Materials and Methods: A qualitative content analysis was conducted. Focus groups were used to find the students’ experiences about peerlearning. Twenty-eight baccalaureate nursing students at Bushehr University of Medical Sciences were selected purposively, and were arranged in four groups of seven students each. The focus group interviews were conducted using a semi-structured interview schedule. All interviews were tape-recorded, transcribed verbatim, and analyzed using conventional content analysis method. Results: The analysis identified four themes: Paradoxical dualism, peer exploitation, first learning efficacy, and socialization practice. Gained advantages and perceived disadvantages created paradoxical dualism, and peer exploitation resulted from peer selection and peer training. Conclusion: Nursing students reported general satisfaction concerning peer learning due to much more in-depth learning with little stress than conventional learning methods. Peer learning is a useful method for nursing students for practicing educational leadership and learning the clinical skills before they get a job. PMID:26097860

  14. Charged-particle therapy in cancer: clinical uses and future perspectives.

    PubMed

    Durante, Marco; Orecchia, Roberto; Loeffler, Jay S

    2017-08-01

    Radiotherapy with high-energy charged particles has become an attractive therapeutic option for patients with several tumour types because this approach better spares healthy tissue from radiation than conventional photon therapy. The cost associated with the delivery of charged particles, however, is higher than that of even the most elaborate photon-delivery technologies. Reliable evidence of the relative cost-effectiveness of both modalities can only come from the results of randomized clinical trials. Thus, the hurdles that currently limit direct comparisons of these two approaches in clinical trials, especially those related to insurance coverage, should be removed. Herein, we review several randomized trials of charged-particle therapies that are ongoing, with results that will enable selective delivery to patients who are most likely to benefit from them. We also discuss aspects related to radiobiology, including the immune response and hypoxia, which will need to be taken into consideration in future randomized trials to fully exploit the potential of charged particles.

  15. Developing a leadership pipeline: the Cleveland Clinic experience.

    PubMed

    Hess, Caryl A; Barss, Christina; Stoller, James K

    2014-11-01

    The complexity of health care requires excellent leadership to address the challenges of access, quality, and cost of care. Because competencies to lead differ from clinical or research skills, there is a compelling need to develop leaders and create a talent pipeline, perhaps especially in physician-led organizations like Cleveland Clinic. In this context, we previously reported on a cohort-based physician leadership development course called Leading in Health Care and, in the current report, detail an expanded health care leadership development programme called the Cleveland Clinic Academy (CCA). CCA consists of a broad suite of offerings, including cohort-based learning and 'a la carte' half- or full-day courses addressing specific competencies to manage and to lead. Academy attendance is optional and is available to all physicians, nurses, and administrators with the requisite experience. Course selection is guided by competency matrices which map leadership competencies to specific courses. As of December 2012, a total of 285 course sessions have been offered to 6,050 attendees with uniformly high ratings of course quality and impact. During the past 10 years, Cleveland Clinic's leadership and management curriculum has successfully created a pipeline of health care leaders to fill executive positions, search committees, board openings, and various other organizational leadership positions. Health care leadership can be taught and learned.

  16. Brachytherapy optimization using radiobiological-based planning for high dose rate and permanent implants for prostate cancer treatment

    NASA Astrophysics Data System (ADS)

    Seeley, Kaelyn; Cunha, J. Adam; Hong, Tae Min

    2017-01-01

    We discuss an improvement in brachytherapy--a prostate cancer treatment method that directly places radioactive seeds inside target cancerous regions--by optimizing the current standard for delivering dose. Currently, the seeds' spatiotemporal placement is determined by optimizing the dose based on a set of physical, user-defined constraints. One particular approach is the ``inverse planning'' algorithms that allow for tightly fit isodose lines around the target volumes in order to reduce dose to the patient's organs at risk. However, these dose distributions are typically computed assuming the same biological response to radiation for different types of tissues. In our work, we consider radiobiological parameters to account for the differences in the individual sensitivities and responses to radiation for tissues surrounding the target. Among the benefits are a more accurate toxicity rate and more coverage to target regions for planning high-dose-rate treatments as well as permanent implants.

  17. Role of Clinical Education Experiences on Athletic Training Students' Development of Professional Commitment

    ERIC Educational Resources Information Center

    Mazerolle, Stephanie M.; Dodge, Thomas

    2015-01-01

    Context: Limited evidence exists on the role clinical education can play in the development of athletic training student commitment for the profession. Objective: Investigating the role clinical education experiences play on the development of passion for athletic training. Design: Exploratory qualitative study. Setting: Athletic training…

  18. Geriatric Medicine Fellows' Experiences and Attitudes toward an Objective Structured Clinical Examination (OSCE)

    ERIC Educational Resources Information Center

    Bagri, Anita S.; Zaw, Khin M.; Milanez, Marcos N.; Palacios, Juan J.; Qadri, Syeda S.; Bliss, Linda A.; Roos, Bernard A.; Ruiz, Jorge G.

    2009-01-01

    A total of 8 geriatric medicine fellows participated in an objective structured clinical examination (OSCE) assessing communication skills and clinical reasoning in common geriatric syndromes. To determine their perceptions about the experience, we conducted surveys and semistructured interviews. We analyzed the survey data using descriptive…

  19. The Student Trainer Clinical Experience at Lock Haven State College.

    ERIC Educational Resources Information Center

    Tomasi, David

    An integral part of the clinical experience for athletic trainers at Lock Haven State College (Pennsylvania) is training in first aid and learning to evaluate not only sport-related injuries but all injuries. Thorough knowledge is expected of athletic trainers in the areas of cardiopulmonary resuscitation, first aid, and treatment of…

  20. Dosimetric and radiobiological characterizations of prostate intensity-modulated radiotherapy and volumetric-modulated arc therapy: A single-institution review of ninety cases

    PubMed Central

    Khan, Muhammad Isa; Jiang, Runqing; Kiciak, Alexander; ur Rehman, Jalil; Afzal, Muhammad; Chow, James C. L.

    2016-01-01

    This study reviewed prostate volumetric-modulated arc therapy (VMAT) plans with intensity-modulated radiotherapy (IMRT) plans after prostate IMRT technique was replaced by VMAT in an institution. Characterizations of dosimetry and radiobiological variation in prostate were determined based on treatment plans of 40 prostate IMRT patients (planning target volume = 77.8–335 cm3) and 50 VMAT patients (planning target volume = 120–351 cm3) treated before and after 2013, respectively. Both IMRT and VMAT plans used the same dose-volume criteria in the inverse planning optimization. Dose-volume histogram, mean doses of target and normal tissues (rectum, bladder and femoral heads), dose-volume points (D99% of planning target volume; D30%, D50%, V30 Gy and V35 Gy of rectum and bladder; D5%, V14 Gy, V22 Gy of femoral heads), conformity index (CI), homogeneity index (HI), gradient index (GI), prostate tumor control probability (TCP), and rectal normal tissue complication probability (NTCP) based on the Lyman-Burman-Kutcher algorithm were calculated for each IMRT and VMAT plan. From our results, VMAT plan was found better due to its higher (1.05%) CI, lower (0.83%) HI and (0.75%) GI than IMRT. Comparing doses in normal tissues between IMRT and VMAT, it was found that IMRT mostly delivered higher doses of about 1.05% to the normal tissues than VMAT. Prostate TCP and rectal NTCP were found increased (1%) for VMAT than IMRT. It is seen that VMAT technique can decrease the dose-volume evaluation criteria for the normal tissues. Based on our dosimetric and radiobiological results in treatment plans, it is concluded that our VMAT implementation could produce comparable or slightly better target coverage and normal tissue sparing with a faster treatment time in prostate radiotherapy. PMID:27651562

  1. The Mini Alcohol Craving Experience Questionnaire: Development and Clinical Application.

    PubMed

    Coates, Jason M; Gullo, Matthew J; Feeney, Gerald F X; Kavanagh, David J; Young, Ross McD; Dingle, Genevieve A; May, Jon; Andrade, Jackie; Statham, Dixie J; Connor, Jason P

    2017-01-01

    Standardized alcohol craving scales are rarely used outside of research environments despite recognized clinical utility. Scale length is a key barrier to more widespread application. A brief measure of alcohol craving is needed to improve research and treatment of alcohol use disorders (AUDs). Grounded in the Elaborated Intrusion Theory of Desire, the Alcohol Craving Experience (ACE) Questionnaire comprises two 11-item self-report scales that assess past-week frequency and maximum strength of alcohol craving. This study aimed to create a brief version of the ACE while maintaining psychometric integrity and clinical utility. Patients attending a university hospital alcohol and drug outpatient service for the treatment of AUD completed the ACE as part of a questionnaire battery. Three patient samples were utilized: 519 patients with pretreatment and outcome data, 228 patients with pretreatment data, and 66 patients who completed the ACE at treatment sessions 1 and 2. The Frequency scale of the ACE possessed greater clinical utility and predictive validity than the Strength scale. Revision of the Frequency measure produced a 5-item "Mini Alcohol Craving Experience" (MACE) Questionnaire. Satisfactory validity (construct, predictive, concurrent, convergent, and incremental) and reliability (internal and test-retest) were maintained. A 1 standard deviation increase in pretreatment MACE score was associated with a 54 percentage increase in the odds of patient lapse or dropout. The MACE provides a brief, theoretically, and psychometrically robust measure of alcohol craving suitable for use with AUD populations in time-limited clinical and research settings. Copyright © 2016 by the Research Society on Alcoholism.

  2. Physics and biophysics experiments needed for improved risk assessment in space

    NASA Astrophysics Data System (ADS)

    Sihver, L.

    To improve the risk assessment of radiation carcinogenesis, late degenerative tissue effects, acute syndromes, synergistic effects of radiation and microgravity or other spacecraft factors, and hereditary effects, on future LEO and interplanetary space missions, the radiobiological effects of cosmic radiation before and after shielding must be well understood. However, cosmic radiation is very complex and includes low and high LET components of many different neutral and charged particles. The understanding of the radiobiology of the heavy ions, from GCRs and SPEs, is still a subject of great concern due to the complicated dependence of their biological effects on the type of ion and energy, and its interaction with various targets both outside and within the spacecraft and the human body. In order to estimate the biological effects of cosmic radiation, accurate knowledge of the physics of the interactions of both charged and non-charged high-LET particles is necessary. Since it is practically impossible to measure all primary and secondary particles from all projectile-target-energy combinations needed for a correct risk assessment in space, accurate particle and heavy ion transport codes might be a helpful instrument to overcome those difficulties. These codes have to be carefully validated to make sure they fulfill preset accuracy criteria, e.g. to be able to predict particle fluence and energy distributions within a certain accuracy. When validating the accuracy of the transport codes, both space and ground-based accelerator experiments are needed. In this paper current and future physics and biophysics experiments needed for improved risk assessment in space will be discussed. The cyclotron HIRFL (heavy ion research facility in Lanzhou) and the new synchrotron CSR (cooling storage ring), which can be used to provide ion beams for space related experiments at the Institute of Modern Physics, Chinese Academy of Sciences (IMP-CAS), will be presented together with

  3. Culturally and linguistically diverse healthcare students' experiences of learning in a clinical environment: A systematic review of qualitative studies.

    PubMed

    Mikkonen, Kristina; Elo, Satu; Kuivila, Heli-Maria; Tuomikoski, Anna-Maria; Kääriäinen, Maria

    2016-02-01

    Learning in the clinical environment of healthcare students plays a significant part in higher education. The greatest challenges for culturally and linguistically diverse healthcare students were found in clinical placements, where differences in language and culture have been shown to cause learning obstacles for students. There has been no systematic review conducted to examine culturally and linguistically diverse healthcare students' experiences of their learning in the clinical environment. This systematic review aims to identify culturally and linguistically diverse healthcare students' experiences of learning in a clinical environment. The search strategy followed the guidelines of the Centre of Reviews and Dissemination. The original studies were identified from seven databases (CINAHL, Medline Ovid, Scopus, Web of Science, Academic Search Premiere, Eric and Cochrane Library) for the period 2000-2014. Two researchers selected studies based on titles, abstracts and full texts using inclusion criteria and assessed the quality of studies independently. Twelve original studies were chosen for the review. The culturally and linguistically diverse healthcare students' learning experiences were divided into three influential aspects of learning in a clinical environment: experiences with implementation processes and provision; experiences with peers and mentors; and experiences with university support and instructions. The main findings indicate that culturally and linguistically diverse healthcare students embarking on clinical placements initially find integration stressful. Implementing the process of learning in a clinical environment requires additional time, well prepared pedagogical orientation, prior cultural and language education, and support for students and clinical staff. Barriers to learning by culturally and linguistically diverse healthcare students were not being recognized and individuals were not considered motivated; learners experienced the

  4. Retention in HIV care depends on patients' perceptions of the clinic experience.

    PubMed

    Wessinger, Matthew H; Hennink, Monique M; Kaiser, Bonnie N; Mangal, Jed P; Gokhale, Runa H; Ruchin, Lauren; Moanna, Abeer; Rimland, David; Farber, Eugene W; Marconi, Vincent C

    2017-10-01

    Institutional barriers in HIV primary care settings can contribute substantially to disparities in retention in HIV treatment and HIV-related outcomes. This qualitative study compared the perceptions of clinic experiences of persons living with HIV (PLWH) in a Veterans Affairs HIV primary care clinic setting who were retained in care with the experiences of those who were not retained in care. Qualitative data from 25 in-depth interviews were analyzed to identify facilitators and barriers to retention in HIV care. Results showed that participants not retained in care experienced barriers to retention involving dissatisfaction with clinic wait times, low confidence in clinicians, and customer service concerns. For participants retained in care, patience with procedural issues, confidence in clinicians, and interpersonal connections were factors that enhanced retention despite the fact that these participants recognized the same barriers as those who were not retained in care. These findings can inform interventions aimed at improving retention in HIV care.

  5. Self-perception but not peer reputation of bullying victimization is associated with non-clinical psychotic experiences in adolescents.

    PubMed

    Gromann, P M; Goossens, F A; Olthof, T; Pronk, J; Krabbendam, L

    2013-04-01

    Bullying victimization may be linked to psychosis but only self-report measures of victimization have been used so far. This study aimed (a) to investigate the differential associations of peer-nominated versus self-reported victim status with non-clinical psychotic experiences in a sample of young adolescents, and (b) to examine whether different types of self-reported victimization predict non-clinical psychotic experiences in these adolescents. Method A combination of standard self-report and peer nomination procedures was used to assess victimization. The sample (n = 724) was divided into four groups (exclusively self-reported victims, self- and peer-reported victims, exclusively peer-reported victims, and non-victims) to test for a group effect on non-clinical psychotic experiences. The relationship between types of victimization and non-clinical psychotic experiences was examined by a regression analysis. Self-reported victims, along with self- and peer-reported victims, scored higher than peer-reported victims and non-victims on non-clinical psychotic experiences. Self-reports of direct relational, indirect relational and physical victimization significantly improved the prediction of non-clinical psychotic experiences whereas verbal and possession-directed victimization had no significant predictive value. The relationship between victimization and non-clinical psychotic experiences is only present for self-reported victimization, possibly indicative of an interpretation bias. The observed discrepancy between self-report and peer-report highlights the importance of implementing a combination of both measures for future research.

  6. [Professor WANG Fuchun's experience in the acupoint selection of clinical treatment with acupuncture and moxibustion].

    PubMed

    Jiang, Hailin; Liu, Chengyu; Ha, Lijuan; Li, Tie

    2017-11-12

    Professor WANG Fuchun 's experience in the acupoint selection of clinical treatment with acupuncture and moxibustion was summarized. The main acupoints are selected by focusing on the chief symptoms of disease, the supplementary points are selected by differentiating the disorders. The acupoints are modified in terms of the changes of sickness. The effective acupoints are selected flexibly in accordance with the specific effects of points. The summary on the acupoint selection reflects professor WANG Fuchun 's academic thoughts and clinical experience and effectively instructs the clinical practice of acupuncture and moxibustion.

  7. Encountering aged care: a mixed methods investigation of medical students' clinical placement experiences.

    PubMed

    Annear, Michael J; Lea, Emma; Lo, Amanda; Tierney, Laura; Robinson, Andrew

    2016-02-04

    Residential aged care is an increasingly important health setting due to population ageing and the increase in age-related conditions, such as dementia. However, medical education has limited engagement with this fast-growing sector and undergraduate training remains primarily focussed on acute presentations in hospital settings. Additionally, concerns have been raised about the adequacy of dementia-related content in undergraduate medical curricula, while research has found mixed attitudes among students towards the care of older people. This study explores how medical students engage with the learning experiences accessible in clinical placements in residential aged care facilities (RACFs), particularly exposure to multiple comorbidity, cognitive impairment, and palliative care. Fifth-year medical students (N = 61) completed five-day clinical placements at two Australian aged care facilities in 2013 and 2014. The placements were supported by an iterative yet structured program and academic teaching staff to ensure appropriate educational experiences and oversight. Mixed methods data were collected before and after the clinical placement. Quantitative data included surveys of dementia knowledge and questions about attitudes to the aged care sector and working with older adults. Qualitative data were collected from focus group discussions concerning medical student expectations, learning opportunities, and challenges to engagement. Pre-placement surveys identified good dementia knowledge, but poor attitudes towards aged care and older adults. Negative placement experiences were associated with a struggle to discern case complexity and a perception of an aged care placement as an opportunity cost associated with reduced hospital training time. Irrespective of negative sentiment, post-placement survey data showed significant improvements in attitudes to working with older people and dementia knowledge. Positive student experiences were explained by in

  8. [Facing, accepting, growing and expecting: the practical experience of nursing students during their first clinical practice].

    PubMed

    Sun, Jia-Jing; Sun, Hui-Lin

    2011-04-01

    Clinical practice experiences, while important, can be highly stressful for nursing students and have a deep effect on their subsequent professional development. This study explored nursing student experiences during their first clinical practice. The study used exploratory and descriptive research methodologies, and researchers selected a phenomenological approach to analysis. Nine nursing students described experiences centered on their first clinical practices using daily dairies and assignments. Transcripts were analyzed using interpretative phenomenological analysis. Four major themes emerged from the data, including: (1) Joining an exciting and intimidating journey in which participants anticipated a precious learning opportunity while fearing failure; (2) Identifying professional role models in which participants learned about nursing content from nursing staff and through step by step instruction from teachers; (3) Growing into caring relationships in which participants increasingly realized the importance of communication, gave empathy and caring to patients, and discovered that patients are the best teachers; and (4) Insight into self-professional capacity and the expectation of their future learning in which participants learned from actual experience, evaluated self-performance and encouraged themselves. Such facilitated self-improvement and instilled the learning necessary to advance to the next stage. Nursing student clinical practice experiences may be used to both advance academic studies and enhance understanding of student feelings, difficulties and experiences. Such can assist nursing students to gain greater positive experiences in their profession.

  9. Clinical evaluation of music perception, appraisal and experience in cochlear implant users

    PubMed Central

    Drennan, Ward. R.; Oleson, Jacob J.; Gfeller, Kate; Crosson, Jillian; Driscoll, Virginia D.; Won, Jong Ho; Anderson, Elizabeth S.; Rubinstein, Jay T.

    2014-01-01

    Objectives The objectives were to evaluate the relationships among music perception, appraisal, and experience in cochlear implant users in multiple clinical settings and to examine the viability of two assessments designed for clinical use. Design Background questionnaires (IMBQ) were administered by audiologists in 14 clinics in the United States and Canada. The CAMP included tests of pitch-direction discrimination, and melody and timbre recognition. The IMBQ queried users on prior musical involvement, music listening habits pre and post implant, and music appraisals. Study sample One-hundred forty-five users of Advanced Bionics and Cochlear Ltd cochlear implants. Results Performance on pitch direction discrimination, melody recognition, and timbre recognition tests were consistent with previous studies with smaller cohorts, as well as with more extensive protocols conducted in other centers. Relationships between perceptual accuracy and music enjoyment were weak, suggesting that perception and appraisal are relatively independent for CI users. Conclusions Perceptual abilities as measured by the CAMP had little to no relationship with music appraisals and little relationship with musical experience. The CAMP and IMBQ are feasible for routine clinical use, providing results consistent with previous thorough laboratory-based investigations. PMID:25177899

  10. Women's Management of Recurrent Bacterial Vaginosis and Experiences of Clinical Care: A Qualitative Study.

    PubMed

    Bilardi, Jade; Walker, Sandra; McNair, Ruth; Mooney-Somers, Julie; Temple-Smith, Meredith; Bellhouse, Clare; Fairley, Christopher; Chen, Marcus; Bradshaw, Catriona

    2016-01-01

    Few data are available on how women manage recurring bacterial vaginosis (BV) and their experiences of the clinical care of this condition. This study aimed to explore women's recurrent BV management approaches and clinical care experiences, with a view to informing and improving the clinical management of BV. A descriptive, social constructionist approach was chosen as the framework for the study. Thirty-five women of varying sexual orientation who had experienced recurrent BV in the past 5 years took part in semi-structured interviews. The majority of women reported frustration and dissatisfaction with current treatment regimens and low levels of satisfaction with the clinical management of BV. Overall, women disliked taking antibiotics regularly, commonly experienced adverse side effects from treatment and felt frustrated at having symptoms recur quite quickly after treatment. Issues in clinical care included inconsistency in advice, misdiagnosis and inappropriate diagnostic approaches and insensitive or dismissive attitudes. Women were more inclined to report positive clinical experiences with sexual health physicians than primary care providers. Women's frustrations led most to try their own self-help remedies and lifestyle modifications in an attempt to treat symptoms and prevent recurrences, including well-known risk practices such as douching. In the face of considerable uncertainty about the cause of BV, high rates of recurrence, unacceptable treatment options and often insensitive and inconsistent clinical management, women are trying their own self-help remedies and lifestyle modifications to prevent recurrences, often with little effect. Clinical management of BV could be improved through the use of standardised diagnostic approaches, increased sensitivity and understanding of the impact of BV, and the provision of evidence based advice about known BV related risk factors.

  11. Application of optimal design methodologies in clinical pharmacology experiments.

    PubMed

    Ogungbenro, Kayode; Dokoumetzidis, Aristides; Aarons, Leon

    2009-01-01

    Pharmacokinetics and pharmacodynamics data are often analysed by mixed-effects modelling techniques (also known as population analysis), which has become a standard tool in the pharmaceutical industries for drug development. The last 10 years has witnessed considerable interest in the application of experimental design theories to population pharmacokinetic and pharmacodynamic experiments. Design of population pharmacokinetic experiments involves selection and a careful balance of a number of design factors. Optimal design theory uses prior information about the model and parameter estimates to optimize a function of the Fisher information matrix to obtain the best combination of the design factors. This paper provides a review of the different approaches that have been described in the literature for optimal design of population pharmacokinetic and pharmacodynamic experiments. It describes options that are available and highlights some of the issues that could be of concern as regards practical application. It also discusses areas of application of optimal design theories in clinical pharmacology experiments. It is expected that as the awareness about the benefits of this approach increases, more people will embrace it and ultimately will lead to more efficient population pharmacokinetic and pharmacodynamic experiments and can also help to reduce both cost and time during drug development. Copyright (c) 2008 John Wiley & Sons, Ltd.

  12. Students' Experiences of Clinic-Based Learning during a Final Year Veterinary Internship Programme

    ERIC Educational Resources Information Center

    Matthew, Susan M.; Taylor, Rosanne M.; Ellis, Robert A.

    2010-01-01

    This study investigated veterinary students' experiences of clinic-based learning (CBL) during a comprehensive final year internship programme. Open-ended surveys (n = 93) were used to gather qualitative data about students' conceptions of what is learned during CBL and their approaches to learning in clinics. Phenomenography was used for detailed…

  13. An exploration of the clinical learning experience of nursing students in nine European countries.

    PubMed

    Warne, Tony; Johansson, Unn-Britt; Papastavrou, Evridiki; Tichelaar, Erna; Tomietto, Marco; Van den Bossche, Koen; Moreno, Maria Flores Vizcaya; Saarikoski, Mikko

    2010-11-01

    The overall aim of the study was to develop a composite and comparative view of what factors enhance the learning experiences of student nurses whilst they are in clinical practice. The study involved students undertaking general nurse training programmes in nine Western European countries. The study focused on: (1) student nurse experiences of clinical learning environments, (2) the supervision provided by qualified nurses in clinical placements, and (3) the level of interaction between student and nurse teachers. The study utilised a validated theoretical model: the Clinical Learning Environment, Supervision and Nurse Teacher (CLES+T) evaluation scale. The evaluation scale has a number of sub-dimensions: Pedagogical atmosphere on the ward; Supervisory Relationships; the Leadership Style of Ward Managers; Premises of Nursing; and the Role of the Nurse Teacher. Data (N=1903) was collected from Cyprus, Belgium, England, Finland, Ireland, Italy, Netherlands, Spain and Sweden using web-based questionnaire 2007-2008. The findings revealed that respondents were generally satisfied with their clinical placements. There was clear support for the mentorship approach; 57% of respondents had a successful mentorship experience although some 18% of respondents experienced unsuccessful supervision. The most satisfied students studied at a university college, and had at least a seven week clinical placement supported by individualised mentorship relationships. Learning to become a nurse is a multidimensional process that requires both significant time being spent working with patients and a supportive supervisory relationship. Copyright © 2010 Elsevier Ltd. All rights reserved.

  14. Next generation multi-scale biophysical characterization of high precision cancer particle radiotherapy using clinical proton, helium-, carbon- and oxygen ion beams

    PubMed Central

    Niklas, Martin; Zimmermann, Ferdinand; Chaudhri, Naved; Krunic, Damir; Tessonnier, Thomas; Ferrari, Alfredo; Parodi, Katia; Jäkel, Oliver; Debus, Jürgen; Haberer, Thomas; Abdollahi, Amir

    2016-01-01

    The growing number of particle therapy facilities worldwide landmarks a novel era of precision oncology. Implementation of robust biophysical readouts is urgently needed to assess the efficacy of different radiation qualities. This is the first report on biophysical evaluation of Monte Carlo simulated predictive models of prescribed dose for four particle qualities i.e., proton, helium-, carbon- or oxygen ions using raster-scanning technology and clinical therapy settings at HIT. A high level of agreement was found between the in silico simulations, the physical dosimetry and the clonogenic tumor cell survival. The cell fluorescence ion track hybrid detector (Cell-Fit-HD) technology was employed to detect particle traverse per cell nucleus. Across a panel of radiobiological surrogates studied such as late ROS accumulation and apoptosis (caspase 3/7 activation), the relative biological effectiveness (RBE) chiefly correlated with the radiation species-specific spatio-temporal pattern of DNA double strand break (DSB) formation and repair kinetic. The size and the number of residual nuclear γ-H2AX foci increased as a function of linear energy transfer (LET) and RBE, reminiscent of enhanced DNA-damage complexity and accumulation of non-repairable DSB. These data confirm the high relevance of complex DSB formation as a central determinant of cell fate and reliable biological surrogates for cell survival/RBE. The multi-scale simulation, physical and radiobiological characterization of novel clinical quality beams presented here constitutes a first step towards development of high precision biologically individualized radiotherapy. PMID:27494855

  15. Health care provider experiences in primary care memory clinics: a phenomenological study.

    PubMed

    Sheiban, Linda; Stolee, Paul; McAiney, Carrie; Boscart, Veronique

    2018-05-19

    There is a growing need for community-based services for persons with Alzheimer's disease and related dementias (ADRD). Memory clinic (MC) teams in primary care settings have been established to provide care to people with ADRD. To consider wider adoption of these MC teams, insight is needed into the experiences of practitioners working in these models. The purpose of the current study is to explore the experiences of health care providers (HCPs) who work in primary care Memory Clinic (MC) teams to provide care to persons with Alzheimer's disease and related dementias (ADRD). This study utilized a phenomenological methodology to explore experiences of 12 HCPs in two primary care MCs. Semi-structured interviews were completed with each HCP. Interviews were recorded and transcribed verbatim. Colaizzi's steps for analyzing phenomenological data was utilized by the authors. Three themes emerged from the analysis to describe HCP experiences: supporting patients and family members during ADRD diagnosis and treatment, working in a team setting, and personal and professional rewards of caring for people with ADRD and their family members. Findings provide insight into current practices in primary care MCs and on the motivation of HCPs working with persons with ADRD.

  16. [Clinical Work Experience of Korean Immigrant Nurses in U.S. Hospitals].

    PubMed

    Seo, Kumsook; Kim, Miyoung

    2016-04-01

    The purpose of this qualitative study was to explore the meaning of the experience of Korean immigrant nurses working in US hospitals. Purposive sampling yielded 15 Korean immigrant nurses who had more than one year of clinical experience in US hospitals. Data were collected from March to August 2012 through in-depth interviews and thematic analysis was conducted using van Manen's hermeneutic phenomenological approach. The findings were classified into eight themes: 'struggling from staff at workplace being territorial to outsiders', 'feeling oppressed due to language barrier', 'accepting rational and horizontal relationships at work', 'staying alert in the environment where lawsuits are rife', 'feeling a sense of stability from the social system that values human dignity', 'maintaining self-confidence from prominent nursing practices and senior Korean nurses' professional reputation', 'performing essential comprehensive nursing care', 'promoting self-development to be equipped with professionalism.' The findings indicate that the Korean immigrant nurses were able to excel in their workplace when their clinical experience at US hospitals was combined with the lived space in US politics and environment, lived time of patience, lived body to be alert, and lived others with multi cultural characteristics.

  17. Radiobiology of hypofractionated stereotactic radiotherapy: what are the optimal fractionation schedules?

    PubMed Central

    Shibamoto, Yuta; Miyakawa, Akifumi; Otsuka, Shinya; Iwata, Hiromitsu

    2016-01-01

    In hypofractionated stereotactic radiotherapy (SRT), high doses per fraction are usually used and the dose delivery pattern is different from that of conventional radiation. The daily dose is usually given intermittently over a longer time compared with conventional radiotherapy. During prolonged radiation delivery, sublethal damage repair takes place, leading to the decreased effect of radiation. In in vivo tumors, however, this decrease in effect may be counterbalanced by rapid reoxygenation. Another issue related to hypofractionated SRT is the mathematical model for dose evaluation and conversion. The linear–quadratic (LQ) model and biologically effective dose (BED) have been suggested to be incorrect when used for hypofractionation. The LQ model overestimates the effect of high fractional doses of radiation. BED is particularly incorrect when used for tumor responses in vivo, since it does not take reoxygenation into account. Correction of the errors, estimated at 5–20%, associated with the use of BED is necessary when it is used for SRT. High fractional doses have been reported to exhibit effects against tumor vasculature and enhance host immunity, leading to increased antitumor effects. This may be an interesting topic that should be further investigated. Radioresistance of hypoxic tumor cells is more problematic in hypofractionated SRT, so trials of hypoxia-targeted agents are encouraged in the future. In this review, the radiobiological characteristics of hypofractionated SRT are summarized, and based on the considerations, we would like to recommend 60 Gy in eight fractions delivered three times a week for lung tumors larger than 2 cm in diameter. PMID:27006380

  18. The patient as experience broker in clinical learning.

    PubMed

    Stockhausen, Lynette J

    2009-05-01

    A review of the literature reveals deficit information on patient's involvement in student's learning. The study presented in this paper investigates how the educationally unprepared patient engages with students and experienced clinicians to become involved in learning and teaching encounters. As a qualitative study 14 adult patients were interviewed to determine how they perceived experienced clinicians and students engage in learning and teaching moments and how the patient contributes to students learning to care. Revealed is a new and exciting dimension in learning and teaching in the clinical environment. Patients as experience brokers are positioned in a unique learning triad as they mediate and observe teaching and learning to care between students and experienced clinicians whilst also becoming participants in teaching to care. Further investigation is warranted to determine the multi-dimensional aspects of patients' involvement in student learning in various clinical environments. Future studies have the potential to represent a new educational perspective (andragogy).

  19. The clinical nurse leader in the perioperative setting: a preceptor experience.

    PubMed

    Wesolowski, Michael S; Casey, Gwendolyn L; Berry, Shirley J; Gannon, Jane

    2014-07-01

    The U.S. Veterans Administration (VA) has implemented the clinical nurse leader (CNL) role nationwide. Nursing leaders at the Malcolm Randall VA Medical Center in Gainesville, Florida, implemented the development of the CNL role in the perioperative setting during the summer of 2012. The perioperative department developed the position in partnership with the University of Florida College of Nursing, Gainesville, Florida. The team developed a description of the roles and experiences of the preceptors, the clinical nurse leader resident, and the University of Florida faculty member. The clinical nurse leader resident's successes and the positive outcomes, such as improved patient outcomes, experienced by the perioperative department demonstrated the importance of the CNL role. Published by Elsevier Inc.

  20. Undergraduate student nurses' lived experiences of anxiety during their first clinical practicum: A phenomenological study.

    PubMed

    Sun, Fan-Ko; Long, Ann; Tseng, Yun Shan; Huang, Hui-Man; You, Jia-Hui; Chiang, Chun-Ying

    2016-02-01

    The Fundamental Nursing clinical practicum is an essential module for nursing students. Some feel stress or anxiety about attending this first placement; however, evidence demonstrates that it is rare to explore the feelings of anxiety felt by the nursing students concerning their first clinical practicum. This study was designed to explore student nurses' experiences of anxiety felt regarding their initial clinical practicum while studying for their University degree. A phenomenological approach was used. A university in Southern Taiwan. A purposive sampling of fifteen student nurses with anxiety reactions who had completed their first clinical practicum. Data were collected using a semi-structured guide and deep interview. Data were analyzed using Colaizzi's seven-step phenomenological method. Three themes surfaced in the findings. The first theme was anxiety around their first clinical practicum, which stirred up anxiety about: self-doubt, worry and fear; difficulty coping with the learning process; worry hampered establishing therapeutic relationships with patients; the progress of the patients' illness could not be predicted; and anxiety felt about lecturer-student interactions. The second theme was three phases of anxiety reactions, which included increasing anxiety before clinical practicum; exacerbated anxiety during clinical practicum, and relief of anxiety after clinical practicum. The third theme was coping behaviors. This comprised: self-reflection in preparation for clinical practicum; finding ways to release emotions; distractions from the anxiety; and, also facing their difficulties head-on. The findings could help raise the awareness of lecturers and students by understanding student nurses' anxiety experiences and facilitating a healthy preparation for their initial clinical practicum, consequently proactively helping reduce potential anxiety experiences. Copyright © 2015 Elsevier Ltd. All rights reserved.

  1. The Lived Experience and Training Needs of Librarians Serving at the Clinical Point-of-Care

    PubMed Central

    Kuntz, Gretchen M.; Edwards, Mary E.; Butson, Linda C.; Auten, Beth

    2016-01-01

    This study examines the emotional experiences and perceptions of librarians embedded into clinical care teams and how those perceptions affect their training and preparation needs. Qualitative research methodologies were applied to textual data drawn from focus groups (n=21), interviews (n=2), and an online survey (n=167), supplemented by quantitative survey data. Phenomenological results show librarians experience strongly effective responses to clinical rounding. Important factors include personal confidence; relationships with team members, patients, and families; and the stressful environment. Analysis of librarians’ perceived educational needs indicates that training must address specialized subjects including medical knowledge, clinical culture, and institutional politics. PMID:26211792

  2. The Lived Experience and Training Needs of Librarians Serving at the Clinical Point-of-Care.

    PubMed

    Lyon, Jennifer A; Kuntz, Gretchen M; Edwards, Mary E; Butson, Linda C; Auten, Beth

    2015-01-01

    This study examines the emotional experiences and perceptions of librarians embedded into clinical care teams and how those perceptions affect their training and preparation needs. Qualitative research methodologies were applied to textual data drawn from focus groups (n = 21), interviews (n = 2), and an online survey (n = 167), supplemented by quantitative survey data. Phenomenological results show librarians experience strongly affective responses to clinical rounding. Important factors include personal confidence; relationships with team members, patients, and families; and the stressful environment. Analysis of librarians' perceived educational needs indicates that training must address specialized subjects including medical knowledge, clinical culture, and institutional politics.

  3. Dental Student Hand Hygiene Decreased With Increased Clinical Experience.

    PubMed

    Yaembut, Nanmanas; Ampornaramveth, Ruchanee S; Pisarnturakit, Pagaporn P; Subbalekha, Keskanya

    2016-01-01

    To investigate the effectiveness, related knowledge, attitudes, and practices of hand hygiene (HH) among dental students with different levels of clinical experience. This was a cross-sectional analytical study. Bacterial samples on the participants' hands were obtained using a swab technique before and after handwashing, for oral surgical procedures. After culturing, the colony-forming units were counted. Self-reported questionnaires reflecting the knowledge, attitudes, and practices related to HH were completed by the participants. This study was performed in a primary oral health care institution, Faculty of Dentistry, Chulalongkorn University (Bangkok, Thailand). Bacterial samples and self-reported questionnaires were collected in the Department of Oral and Maxillofacial Surgery. Bacterial culture was performed in the Department of Microbiology. The 120 participants comprised first, second, third-year clinical training students (CTs), and postgraduate dental students (PGs) (32, 34, 30, and 24 participants, respectively). More than 99% of the bacteria were eliminated from the participants' hands after handwashing. Significantly higher numbers of bacteria were recovered from the hands of the PGs compared with those of the CTs, and the hands of the third-year CTs compared with those of the first-year CTs (p < 0.001), after HH. The first-year CTs had the highest attitude scores, whereas the PGs had the lowest practice scores. The knowledge scores were similar in all groups. HH effectiveness, attitudes, and practices of dental students decreased as students gained more clinical experience, whereas knowledge did not. Our results suggest that HH instruction should be given throughout the duration of dental students' education. Copyright © 2016 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

  4. Developing more positive attitudes towards mental health nursing in undergraduate students: part 2--The impact of theory and clinical experience.

    PubMed

    Happell, B; Robins, A; Gough, K

    2008-09-01

    Previous research examining the impact of education on nursing students' attitudes towards mental health nursing as a career has highlighted clinical experience as the primary influencing factor and generally has not considered the impact of theory. The current study compared a cohort of second-year and a cohort of third-year nursing students from the same university. Second-year students had received more theory and clinical experience than their counterparts. Questionnaires were distributed to the total population of students before commencement of, and after completion of clinical placement. This paper examines students' perceived preparedness for and satisfaction with clinical experience, attitudes towards people with mental illness, and attitudes towards mental health nursing as a career option following the completion of differing amounts of theory and clinical experience. The results demonstrate some statistically significant differences with increased amounts of theory and clinical experience in the second-year cohort being positively influential. The findings suggest that an increased component of theoretical and clinical experience in psychiatric/mental health nursing is likely to produce more positive attitudes towards people with mental illness and psychiatric/mental health nursing. However, little difference in perceived preparedness for and satisfaction with clinical experience was noted between the two cohorts.

  5. NBME subject examination in surgery scores correlate with surgery clerkship clinical experience.

    PubMed

    Myers, Jonathan A; Vigneswaran, Yalini; Gabryszak, Beth; Fogg, Louis F; Francescatti, Amanda B; Golner, Christine; Bines, Steven D

    2014-01-01

    Most medical schools in the United States use the National Board of Medical Examiners Subject Examinations as a method of at least partial assessment of student performance, yet there is still uncertainty of how well these examination scores correlate with clinical proficiency. Thus, we investigated which factors in a surgery clerkship curriculum have a positive effect on academic achievement on the National Board of Medical Examiners Subject Examination in Surgery. A retrospective analysis of 83 third-year medical students at our institution with 4 unique clinical experiences on the general surgery clerkship for the 2007-2008 academic year was conducted. Records of the United States Medical Licensing Examination Step 1 scores, National Board of Medical Examiners Subject Examination in Surgery scores, and essay examination scores for the groups were compared using 1-way analysis of variance testing. Rush University Medical Center, Chicago IL, an academic institution and tertiary care center. Our data demonstrated National Board of Medical Examiners Subject Examination in Surgery scores from the group with the heavier clinical loads and least time for self-study were statistically higher than the group with lighter clinical services and higher rated self-study time (p = 0.036). However, there was no statistical difference of National Board of Medical Examiners Subject Examination in Surgery scores between the groups with equal clinical loads (p = 0.751). Students experiencing higher clinical volumes on surgical services, but less self-study time demonstrated statistically higher academic performance on objective evaluation, suggesting clinical experience may be of higher value than self-study and reading. Copyright © 2014 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

  6. Trichomycosis (Trichobacteriosis): Clinical and Microbiological Experience with 56 Cases

    PubMed Central

    Bonifaz, Alexandro; Váquez-González, Denisse; Fierro, Leonel; Araiza, Javier; Ponce, Rosa María

    2013-01-01

    Background: Trichomycosis is asymptomatic bacterial infection of the axillary hairs caused by Corynebacterium sp. Objective: to bring a series of cases of trichomycosis, its clinical and microbiological experience. Materials and Methods: This report consists in a linear and observational retrospective study of 15 years of cases of trichomycosis confirmed clinically and microbiologically. Results: Fifty six confirmed cases of trichomycosis were included in this report. The majority were men 53/56 (94.6%), mean age was 32.5 years. The most commonly affected area was the axilla (92%), trichomycosis flava was the principal variant 55/56 (98.2%) and signs and symptoms associated were hyperhidrosis (87.5%), hairs’ texture change (57.1%) and odor (35.7%). Bacterial concretions were observed in all cases, and the predominant causative agent in 89.3% of all cases was Corynebacterium sp. Thirty patients were included in therapeutic portion of the study, and 28 (93.3%) of them experienced a clinical and microbiological cure. Conclusion: Trichomycosis is asymptomatic, superficial infection, which primarily affects axillary hairs. PMID:23960390

  7. Johnson Space Center Flight Medicine Clinic Experience

    NASA Technical Reports Server (NTRS)

    Landry, Trela

    2006-01-01

    Being a member of the Flight Medicine Clinic (FMC) Staff is a great experience. I joined the FMC staff 2 years ago when I became part of the Kelsey-Seybold team. The FMC staff consists of Flight Surgeons, Family Clinic Physician, Nursing staff, Wellness Coordinator and Support staff. We serve as the Primary Care Physicians for the astronauts and their families and provide annual physicals for the retired astronauts. We have approximately 800 patients in the FMC. As the Family Clinic Physician, I care for the astronaut spouses and children and provide annual physicals for the retired astronauts. Since we have a small patient population, we have the opportunity to spend increased personal time with our patients, which I enjoy. We have a pretty healthy patient population, who are very interested in their overall health and preventive care. In preparation for a shuttle launch, our nursing staff assists the flight surgeons with the astronaut physical exams, which occur 10 days prior to launch and again 3 days after their return. We also provide Primary Contact physicals for the families and guests, who will be in close contact with shuttle crew members. During these physicals, we provide education, emphasizing the importance of preventing the spread of communicable diseases to shuttle crew members. Being a part of the Space Medicine Program is an honor. To know that you contribute in some way to our nation s Space Program is very special. (This article was prepared by Dr. Trela Landry, M.D. for inclusion in a Kelsey-Seybold newsletter on 25 OCT 2006.)

  8. The significance of clinical experience on learning outcome from resuscitation training-a randomised controlled study.

    PubMed

    Jensen, Morten Lind; Lippert, Freddy; Hesselfeldt, Rasmus; Rasmussen, Maria Birkvad; Mogensen, Simon Skibsted; Jensen, Michael Kammer; Frost, Torben; Ringsted, Charlotte

    2009-02-01

    The impact of clinical experience on learning outcome from a resuscitation course has not been systematically investigated. To determine whether half a year of clinical experience before participation in an Advanced Life Support (ALS) course increases the immediate learning outcome and retention of learning. This was a prospective single blinded randomised controlled study of the learning outcome from a standard ALS course on a volunteer sample of the entire cohort of newly graduated doctors from Copenhagen University. The outcome measurement was ALS-competence assessed using a validated composite test including assessment of skills and knowledge. The intervention was half a year of clinical work before an ALS course. The intervention group received the course after a half-year of clinical experience. The control group participated in an ALS course immediately following graduation. Invitation to participate was accepted by 154/240 (64%) graduates and 117/154 (76%) completed the study. There was no difference between the intervention and control groups with regard to the immediate learning outcome. The intervention group had significantly higher retention of learning compared to the control group, intervention group mean 82% (CI 80-83), control group mean 78% (CI 76-80), P=0.002. The magnitude of this difference was medium (effect size=0.57). Half a year of clinical experience, before participation in an ALS course had a small but statistically significant impact on the retention of learning, but not on the immediate learning outcome.

  9. Confirmatory Factor Analysis of Scores on the Clinical Experience Rubric: A Measure of Dispositions for Preservice Teachers

    ERIC Educational Resources Information Center

    Flowers, Claudia

    2006-01-01

    This study examines the underlying structure of the Clinical Experience Rubric (CER), which is designed to assess preservice teachers' dispositions during the clinical experiences. Dispositions were conceptualized as being a multidimensional construct with three related factors: (a) professionalism, (b) teaching quality, and (c) relationship with…

  10. Nursing students' experiences of and satisfaction with the clinical learning environment: the role of educational models in the simulation laboratory and in clinical practice.

    PubMed

    Cremonini, Valeria; Ferri, Paola; Artioli, Giovanna; Sarli, Leopoldo; Piccioni, Enrico; Rubbi, Ivan

    2015-01-01

    Student satisfaction is an important element of the effectiveness of clinical placement, but there is little consensus in the literature as to the preferred model of clinical experience for undergraduate nursing students. The aim of this study was assess, for each academic year, students' perception of the roles of nurse teachers (NT) and clinical nurse supervisors (CNS) who perform tutoring in both apprenticeship and laboratories and to identify and evaluate students' satisfaction with the environment of clinical learning. This analytic cross-sectional study was conducted in a sample of 173 nursing students in the Northern Italy. The research instrument used is the Clinical learning environment, supervision and nurse teacher (CLES+T) evaluation scale. Data were statistically analysed. 94% of our sample answered questionnaires. Students expressed a higher level of satisfaction with their training experiences. The highest mean value was in the sub-dimension "Pedagogical atmosphere on the ward". Third year students expressed higher satisfaction levels in their relationship with the CNS and lower satisfaction levels in their relationship with the NT. This result may be due to the educational model that is adopted in the course, in which the simulation laboratory didactic activities of the third year are conducted by CNS, who also supervises experiences of clinical learning in the clinical practice. The main finding in this study was that the students' satisfaction with the supervisory relationship and the role of NT depend on how supervision in the clinical practice and in the simulation laboratory is organized.

  11. Using experience sampling methods/ecological momentary assessment (ESM/EMA) in clinical assessment and clinical research: introduction to the special section.

    PubMed

    Trull, Timothy J; Ebner-Priemer, Ulrich W

    2009-12-01

    This article introduces the special section on experience sampling methods and ecological momentary assessment in clinical assessment. We review the conceptual basis for experience sampling methods (ESM; Csikszentmihalyi & Larson, 1987) and ecological momentary assessment (EMA; Stone & Shiffman, 1994). Next, we highlight several advantageous features of ESM/EMA as applied to psychological assessment and clinical research. We provide a brief overview of the articles in this special section, each of which focuses on 1 of the following major classes of psychological disorders: mood disorders and mood dysregulation (Ebner-Priemer & Trull, 2009), anxiety disorders (Alpers, 2009), substance use disorders (Shiffman, 2009), and psychosis (Oorschot, Kwapil, Delespaul, & Myin-Germeys, 2009). Finally, we discuss prospects, future challenges, and limitations of ESM/EMA.

  12. Impact of Nursing Students' Free-Clinic Experiences on Subsequent Professional Nursing Practice

    ERIC Educational Resources Information Center

    Bell, Christina Lynn

    2017-01-01

    Bachelors of Science Nursing students at a small liberal arts college in the upper Midwest volunteer with an instructor at a free clinic as part of their curriculum. This study's purpose was to identify the impact of nursing students' free-clinic experiences on their subsequent professional nursing practice and their ability to attend to: (a)…

  13. Evaluation of the impact of resident work hour restrictions on resident outpatient clinical experience.

    PubMed

    Patel, Shweta V; Driggers, Rita W; Zahn, Christopher M

    2011-01-01

    To estimate the effect of work hour restrictions on resident outpatient clinical experience. Schedule templates from academic years 1998-1999 (before work hour restrictions), 2002-2003 (when night float rotation was added in anticipation of work hour restrictions), and 2008-2009 (during work hour restrictions) were compared for outpatient clinic experience before and after work hour restrictions were implemented. Actual clinics on specific rotations and estimated patient encounters per scheduled clinic were considered. Between academic year (AY) 1998-1999 and AY 2008-2009 there was a generalized downward trend in average outpatient encounters for postgraduate year (PGY)-2, PGY-3 and PGY-4 residents (45%, 34% and 36%, respectively). For obstetrics, gynecology and ambulatory rotations, there was a downward trend in average outpatient encounters for each rotation type (61%, 14% and 63%, respectively). The average number of scheduled clinics per week was slightly decreased when comparing AY 1998-1999 to either AY 2002-2003 or AY 2008-2009. Rotation schedules before and after work hour restrictions demonstrated a downward trend in the number of scheduled outpatient encounters. These findings indicate a potential negative impact on preparation for clinical practice.

  14. Resident Evaluation of a Required Telepsychiatry Clinical Experience.

    PubMed

    Teshima, John; Hodgins, Michael; Boydell, Katherine M; Pignatiello, Antonio

    2016-04-01

    The authors explored resident experiences of telepsychiatry clinical training. This paper describes an analysis of evaluation forms completed by psychiatry residents following a required training experience in telepsychiatry. Retrospective numeric and narrative data were collected from 2005 to 2012. Using a five-point Likert-type scale (1 = strongly disagree and 5 = strongly agree), residents ranked the session based on the following characteristics: the overall experience, interest in participating in telepsychiatry in the future, understanding service provision to underserved areas, telepsychiatry as mode of service delivery, and the unique aspects of telepsychiatry work. The authors also conducted a content analysis of narrative comments in response to open-ended questions about the positive and negative aspects of the training experience. In all, 88% of residents completed (n = 335) an anonymous evaluation following their participation in telepsychiatry consultation sessions. Numeric results were mostly positive and indicated that the experience was interesting and enjoyable, enhanced interest in participating in telepsychiatry in the future, and increased understanding of providing psychiatric services to underserved communities. Narrative data demonstrated that the most valuable aspects of training included the knowledge acquired in terms of establishing rapport and engaging with patients, using the technology, working collaboratively, identifying different approaches used, and awareness of the complexity of cases. Resident desire for more training of this nature was prevalent, specifically a wish for more detail, additional time for discussion and debriefing, and further explanation of the unique aspects of telepsychiatry as mode of delivery. More evaluation of telepsychiatry training, elective or required, is needed. The context of this training offered potential side benefits of learning about interprofessional and collaborative care for the

  15. Peer Experiences of Anxious and Socially Withdrawn Youth: An Integrative Review of the Developmental and Clinical Literature

    ERIC Educational Resources Information Center

    Kingery, Julie Newman; Erdley, Cynthia A.; Marshall, Katherine C.; Whitaker, Kyle G.; Reuter, Tyson R.

    2010-01-01

    Prior research indicates that both anxious youth and socially withdrawn youth tend to experience challenges and difficulties in various aspects of their peer relationships and social functioning. While clinical psychology researchers have examined how anxiety relates to peer experiences using normative and clinically anxious samples, developmental…

  16. Does recruitment lead to retention? Rural Clinical School training experiences and subsequent intern choices.

    PubMed

    Eley, D; Baker, P

    2006-01-01

    The Australian Rural Clinical Schools, established nationally in 2000-2001, have provided an opportunity for medical students to undertake their clinical training across a network of hospitals, general practice surgeries and community medical centres in locations throughout Australia. The Rural Clinical School at the University of Queensland was established in 2002, as the Rural Clinical Division (RCD) of the School of Medicine, which provides a four-year graduate MB BS program. Students may elect to train in their 3rd and/or 4th year in one of three clinical divisions, namely Central, Southern (both based in Brisbane) or Rural which comprises teaching sites in south west Queensland and central Queensland region. Training must be of an equivalent nature throughout these three divisions, because students all sit the same examinations. Rigorous evaluation of the RCD teaching program underpins the goals of continuing improvement of both education and resources, and is also a key component of the reporting mechanisms linked to ongoing Commonwealth funding. Students' perception of their medical education at the RCD is the major focus of such evaluations in order to assist both educational improvement and required student recruitment. With this in mind, a questionnaire, the 'Year 4 Exit Survey' was developed to evaluate medical student perceptions of their 4th year experience at the RCD. Coupled to this was an analysis of internship choices to evaluate the important related issue of medical graduate retention. The increasing popularity of the RCD has prompted further investigation into the intern placement choice by these students. The provision of a positive medical education experience in a Rural Clinical School might be expected to influence this intern choice to favour a rural location. This preliminary report provides the results of the evaluations by one cohort of year 4 students and explores the relationship between rural undergraduate medical training experiences

  17. Maternity groups in the postpartum period at well child clinics - mothers' experiences.

    PubMed

    Glavin, Kari; Tveiten, Sidsel; Økland, Toril; Hjälmhult, Esther

    2017-10-01

    To explore mothers' experiences as participants in maternity groups at well child clinics (WCCs). The level of psychological distress that new mothers have may be related to the quantity of social support they receive. Maternity groups to support new parents have a long tradition at WCCs in Norway, and most of the clinics have offered these groups. However, there is little knowledge about mothers' experiences of participating in these groups. Qualitative design. Focus group interviews with mothers who had participated in maternity groups facilitated by public health nurses (PHNs) at WCCs. Interpretive description was used to analyse the transcripts from the interviews. Eight focus group interviews were conducted with a total of 30 mothers who had participated in maternity groups at WCCs in two counties in eastern Norway. The analysis resulted in one main category, 'The maternity group's salutogenic importance' and three subcategories, 'Networks that can last for many years', 'Fellowship with others in the same situation' and 'Become confident in mothering'. Mothers wanted fellowship and found it important to share experiences with other mothers. Maternity groups offered to parents are essential to meet parents' need to discuss experiences and challenges related to parenting. Maternity groups can also create a basis for establishing a social network for those who want it. Well child clinics should offer all mothers the opportunity to participate in groups to strengthen their social relations and their confidence in parenting. PHNs play an important role in facilitating groups for first-time parents. Group leadership can influence how mothers in a group connect and whether the parental role is affected. © 2016 John Wiley & Sons Ltd.

  18. Key Issues in an International Clinical Experience for Graduate Students in Education: Implications for Policy and Practice

    ERIC Educational Resources Information Center

    Gaudino, Ann C.; Moss, David M.; Wilson, Eleanor V.

    2012-01-01

    This study examines international clinical experiences in England with graduate education students from The University of Connecticut (UConn) and The University of Virginia (UVA) in the United States of America. Limited research available about international clinical experiences in the field of Education focuses primarily to only describe programs…

  19. Optimization of the temporal pattern of applied dose for a single fraction of radiation: Implications for radiation therapy

    NASA Astrophysics Data System (ADS)

    Altman, Michael B.

    given radiation pattern by concentrating the highest doses in the middle of a fraction (a "Triangle" pattern), or minimizing cell kill by placing the highest doses near the beginning and end (a "V-shaped" pattern). The conditions under which temporal optimization effects are most acute are also identified: irradiation of low alpha/beta tissues, long fraction durations, and high doses/fx. An in vitro study is then performed which verifies that the temporal effects and trends predicted by the modeling study are clearly manifested in human cells. Following this a phantom which could allow similar in vitro radiobiological experiments in a 3-dimensional clinically-based environment is designed, created, and dosimetrically assessed using TLDs, film, and biological assay-based techniques. The phantom is found to be a useful and versatile tool for such experiments. A scheme for utilizing the phantom in a clinical treatment environment is then developed. This includes a demonstration of prototype methods for optimizing the temporal pattern of applied dose in clinical IMRT plans to manipulate tissue-dependent effects. Looking toward future experimental validation of such plans using the phantom, an analysis of the suitability of biological assays for use in phantom-based in vitro experiments is performed. Finally, a discussion is provided about the steps necessary to integrate temporal optimization into in vivo experiments and ultimately into a clinical radiation therapy environment. If temporal optimization is ultimately shown to have impact in vivo, the successful implementation of the methods developed in this study could enhance the efficacy and care of thousands of patients receiving radiotherapy.

  20. Nursing faculty teaching a module in clinical skills to medical students: a Lebanese experience.

    PubMed

    Abdallah, Bahia; Irani, Jihad; Sailian, Silva Dakessian; Gebran, Vicky George; Rizk, Ursula

    2014-01-01

    Nursing faculty teaching medical students a module in clinical skills is a relatively new trend. Collaboration in education among medical and nursing professions can improve students' performance in clinical skills and consequently positively impact the quality of care delivery. In 2011, the Faculty of Medicine in collaboration with the Faculty of Health Sciences at the University of Balamand, Beirut, Lebanon, launched a module in clinical skills as part of clinical skills teaching to first-year medical students. The module is prepared and delivered by nursing faculty in a laboratory setting. It consists of informative lectures as well as hands-on clinical practice. The clinical competencies taught are hand-washing, medication administration, intravenous initiation and removal, and nasogastric tube insertion and removal. Around sixty-five medical students attend this module every year. A Likert scale-based questionnaire is used to evaluate their experience. Medical students agree that the module provides adequate opportunities to enhance clinical skills and knowledge and favor cross-professional education between nursing and medical disciplines. Most of the respondents report that this experience prepares them better for clinical rotations while increasing their confidence and decreasing anxiety level. Medical students highly appreciate the nursing faculties' expertise and perceive them as knowledgeable and resourceful. Nursing faculty participating in medical students' skills teaching is well perceived, has a positive impact, and shows nurses are proficient teachers to medical students. Cross professional education is an attractive model when it comes to teaching clinical skills in medical school.

  1. Structured learning and self-reflection: strategies to decrease anxiety in the psychiatric mental health clinical nursing experience.

    PubMed

    Ganzer, Christine Anne; Zauderer, Cheryl

    2013-01-01

    The purpose of this qualitative study was to test a teaching-learning strategy to help nursing students decrease stress and anxiety that may be brought about by the psychiatric mental health clinical experience. Undergraduate nursing students are known to experience affective stress prior to their first psychiatric mental health clinical practicum. A stressful learning environment can affect the success of the student's clinical performance. Thirty nursing students participated in this study. A structured preclinical workshop combined with self-reflection provided insight into students' perceptions of the psychiatric mental health clinical experience. Overall, students reported that participating in the teaching-learning strategy and self-reflection helped mitigate Combining structured learning with self-reflection is a useful tool for helping nursing students increase self-awareness and ease anxiety that may interfere with learning.

  2. Junior physicians' workplace experiences in clinical fields in German-speaking Switzerland.

    PubMed

    Buddeberg-Fischer, Barbara; Klaghofer, Richard; Abel, Thomas; Buddeberg, Claus

    2005-01-08

    To date, there have been several prospective cohort studies investigating the workplace experiences of junior physicians, but with limited focus on gender issues. The objective of the present study is to explore the workplace experiences of first-year residents according to gender, type of training hospital, and clinical field. Data reported are from the second assessment of the longitudinal Swiss physicians' career development study, begun in 2001. In 2003, 497 residents (54.7% females, 45.3% males) assessed their workplace conditions, social support at work, and effort-reward imbalance. There are few, but relevant, gender related differences in workplace experiences, with female physicians experiencing less mentoring and higher over-commitment, yet more positive social relationships at work. In a multivariate model, significant differences in some workplace variables with regard to type of training hospital and/or clinical field are found: workplace conditions are rated worse in type "A" hospitals (university and cantonal hospitals) than in type "B"/"C"/"D" hospitals (regional hospitals and highly specialised units), and in surgical fields than in internal medicine. In "A" hospitals mentoring is assessed as better, but positive social relationships as worse. Both scales are rated worse in surgical fields than in internal medicine. The effort-reward imbalance (ERI) is rated significantly higher (unfavourable) in "A" hospitals than in "B"/"C"/"D" hospitals, regardless of gender and clinical field. Significantly more subjects with an ERI quotient above 1 (which is unfavourable) work in "A" hospitals, and in surgical fields regardless of hospital type. Of the total sample, 81 subjects (16.3%), 41 males and 40 females, show an ERI quotient above 1. The greater the workload, the worse the rating of workplace conditions, effort-reward imbalance, and over-commitment. Institutional determinants are crucial factors for the workplace experiences and first career steps of

  3. Does clinical supervision of healthcare professionals improve effectiveness of care and patient experience? A systematic review.

    PubMed

    Snowdon, David A; Leggat, Sandra G; Taylor, Nicholas F

    2017-11-28

    To ensure quality of care delivery clinical supervision has been implemented in health services. While clinical supervision of health professionals has been shown to improve patient safety, its effect on other dimensions of quality of care is unknown. The purpose of this systematic review is to determine whether clinical supervision of health professionals improves effectiveness of care and patient experience. Databases MEDLINE, PsychINFO, CINAHL, EMBASE and AMED were searched from earliest date available. Additional studies were identified by searching of reference lists and citation tracking. Two reviewers independently applied inclusion and exclusion criteria. The quality of each study was rated using the Medical Education Research Study Quality Instrument. Data were extracted on effectiveness of care (process of care and patient health outcomes) and patient experience. Seventeen studies across multiple health professions (medical (n = 4), nursing (n = 7), allied health (n = 2) and combination of nursing, medical and/or allied health (n = 4)) met the inclusion criteria. The clinical heterogeneity of the included studies precluded meta-analysis. Twelve of 14 studies investigating 38,483 episodes of care found that clinical supervision improved the process of care. This effect was most predominant in cardiopulmonary resuscitation and African health settings. Three of six studies investigating 1756 patients found that clinical supervision improved patient health outcomes, namely neurological recovery post cardiopulmonary resuscitation (n = 1) and psychological symptom severity (n = 2). None of three studies investigating 1856 patients found that clinical supervision had an effect on patient experience. Clinical supervision of health professionals is associated with effectiveness of care. The review found significant improvement in the process of care that may improve compliance with processes that are associated with enhanced patient health

  4. Feasibility study for a biomedical experimental facility based on LEIR at CERN.

    PubMed

    Abler, Daniel; Garonna, Adriano; Carli, Christian; Dosanjh, Manjit; Peach, Ken

    2013-07-01

    In light of the recent European developments in ion beam therapy, there is a strong interest from the biomedical research community to have more access to clinically relevant beams. Beamtime for pre-clinical studies is currently very limited and a new dedicated facility would allow extensive research into the radiobiological mechanisms of ion beam radiation and the development of more refined techniques of dosimetry and imaging. This basic research would support the current clinical efforts of the new treatment centres in Europe (for example HIT, CNAO and MedAustron). This paper presents first investigations on the feasibility of an experimental biomedical facility based on the CERN Low Energy Ion Ring LEIR accelerator. Such a new facility could provide beams of light ions (from protons to neon ions) in a collaborative and cost-effective way, since it would rely partly on CERN's competences and infrastructure. The main technical challenges linked to the implementation of a slow extraction scheme for LEIR and to the design of the experimental beamlines are described and first solutions presented. These include introducing new extraction septa into one of the straight sections of the synchrotron, changing the power supply configuration of the magnets, and designing a new horizontal beamline suitable for clinical beam energies, and a low-energy vertical beamline for particular radiobiological experiments.

  5. Feasibility study for a biomedical experimental facility based on LEIR at CERN

    PubMed Central

    Abler, Daniel; Garonna, Adriano; Carli, Christian; Dosanjh, Manjit; Peach, Ken

    2013-01-01

    In light of the recent European developments in ion beam therapy, there is a strong interest from the biomedical research community to have more access to clinically relevant beams. Beamtime for pre-clinical studies is currently very limited and a new dedicated facility would allow extensive research into the radiobiological mechanisms of ion beam radiation and the development of more refined techniques of dosimetry and imaging. This basic research would support the current clinical efforts of the new treatment centres in Europe (for example HIT, CNAO and MedAustron). This paper presents first investigations on the feasibility of an experimental biomedical facility based on the CERN Low Energy Ion Ring LEIR accelerator. Such a new facility could provide beams of light ions (from protons to neon ions) in a collaborative and cost-effective way, since it would rely partly on CERN's competences and infrastructure. The main technical challenges linked to the implementation of a slow extraction scheme for LEIR and to the design of the experimental beamlines are described and first solutions presented. These include introducing new extraction septa into one of the straight sections of the synchrotron, changing the power supply configuration of the magnets, and designing a new horizontal beamline suitable for clinical beam energies, and a low-energy vertical beamline for particular radiobiological experiments. PMID:23824122

  6. Use of Tablet Computers to Promote Physical Therapy Students' Engagement in Knowledge Translation During Clinical Experiences.

    PubMed

    Tilson, Julie K; Loeb, Kathryn; Barbosa, Sabrina; Jiang, Fei; Lee, Karin T

    2016-04-01

    Physical therapists strive to integrate research into daily practice. The tablet computer is a potentially transformational tool for accessing information within the clinical practice environment. The purpose of this study was to measure and describe patterns of tablet computer use among physical therapy students during clinical rotation experiences. Doctor of physical therapy students (n = 13 users) tracked their use of tablet computers (iPad), loaded with commercially available apps, during 16 clinical experiences (6-16 weeks in duration). The tablets were used on 70% of 691 clinic days, averaging 1.3 uses per day. Information seeking represented 48% of uses; 33% of those were foreground searches for research articles and syntheses and 66% were for background medical information. Other common uses included patient education (19%), medical record documentation (13%), and professional communication (9%). The most frequently used app was Safari, the preloaded web browser (representing 281 [36.5%] incidents of use). Users accessed 56 total apps to support clinical practice. Physical therapy students successfully integrated use of a tablet computer into their clinical experiences including regular activities of information seeking. Our findings suggest that the tablet computer represents a potentially transformational tool for promoting knowledge translation in the clinical practice environment.Video Abstract available for more insights from the authors (see Supplemental Digital Content 1, http://links.lww.com/JNPT/A127).

  7. Changes in patient satisfaction related to hospital renovation: experience with a new clinical building.

    PubMed

    Siddiqui, Zishan K; Zuccarelli, Rebecca; Durkin, Nowella; Wu, Albert W; Brotman, Daniel J

    2015-03-01

    There is an increasing trend toward designing hospitals with patient-centered features like reduced noise, improved natural light, visitor friendly facilities, well-decorated rooms, and hotel-like amenities. It has also been suggested that because patients cannot reliably distinguish positive experiences with the physical environment from positive experience with care, an improved hospital environment leads to higher satisfaction with physicians, nursing, food service, housekeeping, and higher overall satisfaction. To characterize changes in patient satisfaction that occurred when clinical services (comprised of stable nursing, physician, and unit teams) were relocated to a new clinical building with patient-centered features. We hypothesized that new building features would positively impact provider, ancillary staff, and overall satisfaction, as well as improved satisfaction with the facility. Natural experiment utilizing a pre-post design with concurrent controls. Academic tertiary care hospital. We included all patients discharged from 12 clinical units that relocated to the new clinical building who returned surveys in the 7.5-month period following the move. Premove baseline data were captured from the year prior to the move. Patients on unmoved clinical units who returned satisfaction surveys served as concurrent controls. Patient-centered design features incorporated into the new clinical building. All patients during the baseline period and control patients during the study period were located in usual patient rooms with standard hospital amenities. The primary outcome was satisfaction scores on the Press Ganey and Hospital Consumer Assessment of Healthcare Providers and Systems survey, dichotomized at highest category versus lower categories. We performed logistic regression to identify predictors of "top-box" scores. The move was associated with improved room- and visitor-related satisfaction without significant improvement in satisfaction with clinical

  8. WE-AB-202-11: Radiobiological Modeling of Tumor Response During Radiotherapy Based On Pre-Treatment Dynamic PET Imaging Data

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Crispin-Ortuzar, M; Grkovski, M; Beattie, B

    Purpose: To evaluate the ability of a multiscale radiobiological model of tumor response to predict mid-treatment hypoxia images, based on pretreatment imaging of perfusion and hypoxia with [18-F]FMISO dynamic PET and glucose metabolism with [18-F]FDG PET. Methods: A mechanistic tumor control probability (TCP) radiobiological model describing the interplay between tumor cell proliferation and hypoxia (Jeong et al., PMB 2013) was extended to account for intra-tumor nutrient heterogeneity, dynamic cell migration due to nutrient gradients, and stromal cells. This extended model was tested on 10 head and neck cancer patients treated with chemoradiotherapy, randomly drawn from a larger MSKCC protocol involvingmore » baseline and mid-therapy dynamic PET scans. For each voxel, initial fractions of proliferative and hypoxic tumor cells were obtained by finding an approximate solution to a system of linear equations relating cell fractions to voxel-level FDG uptake, perfusion (FMISO K{sub 1}) and hypoxia (FMISO k{sub 3}). The TCP model then predicted their evolution over time up until the mid treatment scan. Finally, the linear model was reapplied to predict each lesion’s median hypoxia level (k{sub 3}[med,sim]) which in turn was compared to the FMISO k{sub 3}[med] measured at mid-therapy. Results: The average k3[med] of the tumors in pre-treatment scans was 0.0035 min{sup −1}, with an inter-tumor standard deviation of σ[pre]=0.0034 min{sup −1}. The initial simulated k{sub 3}[med,sim] of each tumor agreed with the corresponding measurements within 0.1σ[pre]. In 7 out of 10 lesions, the mid-treatment k{sub 3}[med,sim] prediction agreed with the data within 0.3σ[pre]. The remaining cases corresponded to the most extreme relative changes in k{sub 3}[med]. Conclusion: This work presents a method to personalize the prediction of a TCP model using pre-treatment kinetic imaging data, and validates the modeling of radiotherapy response by predicting changes in median

  9. Nurses' Lived Experience of Working with Nursing Students in Clinical Wards: a Phenomenological Study

    PubMed Central

    Parvan, Kobra; Shahbazi, Shahla; Ebrahimi, Hossein; Valizadeh, Susan; Rahmani, Azad; Jabbarzadeh Tabrizi, Faranak; Esmaili, Fariba

    2018-01-01

    Introduction: Despite being aware of the importance of nurses’ role in providing clinical training to nursing students, studies show that sufficient research has not yet been conducted on the experience of clinical nurses who are engaged in training nursing students outside their normal working hours. The present study aim to describe the experience of these nurses who are training outside their routine working hours. Methods: This study was conducted using descriptive-phenomenology method. Twelve nurses was participated in this research. Data were collected using purposive sampling method and face to face interviews based on nurses’ real life experience of students’ learning in clinical settings through answering open-ended questions. Spiegel burg analysis method was used to analyze the data. Results: The result of data analysis was the derivation of four themes and eight sub-themes. Themes included "nurses as teaching sources", "changes in the balance of doing routine tasks", "professional enthusiasm", and "nurses as students' professional socialization source of inspiration". Sub-themes included "efficient education", "poor education", "support", "interference in the role," "self-efficacy development", "inner satisfaction", "positive imaging" and "being a model". Conclusion: It is necessary that academic centers plan for teaching nurses working on a contractual basis in the field of the evaluation method and various methods of teaching. The findings also suggested the development of individual self-efficacy in clinical nurses who train students. PMID:29637056

  10. Breaking significant news: The experience of clinical nurse specialists in cancer and palliative care.

    PubMed

    Mishelmovich, Nina; Arber, Anne; Odelius, Anki

    2016-04-01

    The aim of the research was to explore specialist cancer and palliative care nurses experience of delivering significant news to patients with advanced cancer. A qualitative phenomenological research study was conducted to capture nurses' experiences with the aim of understanding how cancer and palliative care clinical nurse specialists work towards disclosure of advanced and terminal cancer. Data were collected through semi-structured interviews with 10 clinical nurse specialists working in one acute NHS trust. Clinical nurse specialists were recruited from the following specialities: lung cancer, breast cancer, gynaecological cancer, upper and lower gastrointestinal cancer and palliative care. Four themes emerged from the data: importance of relationships; perspective taking; ways to break significant news; feeling prepared and putting yourself forward. The findings revealed that highly experienced clinical nurse specialists (CNSs) felt confident in their skills in delivering significant news and they report using patient centred communication to build a trusting relationship so significant news was easier to share with patients. CNSs were aware of guidelines and protocols for breaking significant and bad news but reported that they used guidelines flexibly and it was their years of clinical experience that enabled them to be effective in disclosing significant news. Some areas of disclosure were found to be challenging in particular news of a terminal prognosis to patients who were of a younger age. CNSs have become more directly involved in breaking significant news to those with advanced cancer by putting themselves forward and feeling confident in their skills. Copyright © 2015 Elsevier Ltd. All rights reserved.

  11. The relationship between voice climate and patients’ experience of timely care in primary care clinics

    PubMed Central

    Nembhard, Ingrid M.; Yuan, Christina T.; Shabanova, Veronika; Cleary, Paul D.

    2017-01-01

    Background Aspects of the patient care experience, despite being central to quality care, are often problematic. In particular, patients frequently report problems with timeliness of care. As yet, research offers little insight on setting characteristics that contribute to patients’ experience of timely care. Purpose The aims of this study were to assess the relationship between organizational climate and patients’ reports of timely care in primary care clinics and to broadly examine the link between staff’s work environment and patient care experiences. We test hypotheses about the relationship between voice climate—staff feeling safe to speak up about issues—and reported timeliness of care, consistency in reported voice climate across professions, and how climate differences for various professions relate to timely care. Methodology We conducted a cross-sectional study of employees (n = 1,121) and patients (n = 8,164) affiliated with 37 clinics participating in a statewide reporting initiative. Employees were surveyed about clinics’ voice climate, and patients were surveyed about the timeliness of care. Hypotheses were tested using analysis of variance and generalized estimating equations. Findings Clinical and administrative staff (e.g., nurses and office assistants) reported clinics’ climates to be significantly less supportive of voice than did clinical leaders (e.g., physicians). The greater the difference in reported support for voice between professional groups, the less patients reported experiencing timely care in three respects: obtaining an appointment, seeing the doctor within 15 minutes of appointment time, and receiving test results. In clinics where staff reported climates supportive of voice, patients indicated receiving more timely care. Clinical leaders’ reports of voice climate had no relationship to reported timeliness of care. Practical Implications Our findings suggest the importance of clinics developing a strong climate for

  12. Use of Tablet Computers to Promote Physical Therapy Students' Engagement in Knowledge Translation During Clinical Experiences

    PubMed Central

    Loeb, Kathryn; Barbosa, Sabrina; Jiang, Fei; Lee, Karin T.

    2016-01-01

    Background and Purpose: Physical therapists strive to integrate research into daily practice. The tablet computer is a potentially transformational tool for accessing information within the clinical practice environment. The purpose of this study was to measure and describe patterns of tablet computer use among physical therapy students during clinical rotation experiences. Methods: Doctor of physical therapy students (n = 13 users) tracked their use of tablet computers (iPad), loaded with commercially available apps, during 16 clinical experiences (6-16 weeks in duration). Results: The tablets were used on 70% of 691 clinic days, averaging 1.3 uses per day. Information seeking represented 48% of uses; 33% of those were foreground searches for research articles and syntheses and 66% were for background medical information. Other common uses included patient education (19%), medical record documentation (13%), and professional communication (9%). The most frequently used app was Safari, the preloaded web browser (representing 281 [36.5%] incidents of use). Users accessed 56 total apps to support clinical practice. Discussion and Conclusions: Physical therapy students successfully integrated use of a tablet computer into their clinical experiences including regular activities of information seeking. Our findings suggest that the tablet computer represents a potentially transformational tool for promoting knowledge translation in the clinical practice environment. Video Abstract available for more insights from the authors (see Supplemental Digital Content 1, http://links.lww.com/JNPT/A127). PMID:26945431

  13. Relationships of perceived public stigma of mental illness and psychosis-like experiences in a non-clinical population sample.

    PubMed

    Lien, Yin-Ju; Kao, Yu-Chen; Liu, Yia-Ping; Chang, Hsin-An; Tzeng, Nian-Sheng; Lu, Chien-Wen; Lin, Shwu-Jon; Loh, Ching-Hui

    2015-02-01

    Studies on the association between psychopathology, perceived public stigma, and labeling in mental illness have focused primarily on severe but rare mental disorders, especially schizophrenia, or other clinically defined psychotic disorders. Although evidence is mounting that psychosis-like experiences show high prevalence in the general population and lead to an increased risk of psychotic disorders, little is known about how psychosis-like experiences independently affect perceived public stigma in the non-clinical population. The aim of the present study was to examine the relationship between psychosis-like experiences and perceived public stigma in a non-clinical sample. For this cross-sectional study, we recruited 524 individuals (239 male, 285 female) who had no lifetime history of psychiatric disorder. Participants completed questionnaires that asked for sociodemographic and clinical information, a measure of perceived public stigma (Perceived Psychiatric Stigma Scale [PPSS]), and two measures of psychosis-like experiences (Peters et al. Delusions Inventory [PDI]; Cardiff Anomalous Perceptions Scale [CAPS]). Of the sociodemographic characteristics analyzed in this study-gender, age, education level, marital status, and religion-only age simultaneously influenced PPSS, PDI, and CAPS scores. As hypothesized, perceived public stigma was positively correlated with measures of psychosis-like experiences, even after controlling for age. Furthermore, the perceived stigma was more strongly associated with delusion proneness than with anomalous perceptual experiences. The association between psychopathology and perceived public stigma appears to extend beyond clinically defined psychosis to more common psychosis-like experiences in a sample drawn from the general Han Chinese population.

  14. Comprehensive experiment-clinical biochemistry: determination of blood glucose and triglycerides in normal and diabetic rats.

    PubMed

    Jiao, Li; Xiujuan, Shi; Juan, Wang; Song, Jia; Lei, Xu; Guotong, Xu; Lixia, Lu

    2015-01-01

    For second year medical students, we redesigned an original laboratory experiment and developed a combined research-teaching clinical biochemistry experiment. Using an established diabetic rat model to detect blood glucose and triglycerides, the students participate in the entire experimental process, which is not normally experienced during a standard clinical biochemistry exercise. The students are not only exposed to techniques and equipment but are also inspired to think more about the biochemical mechanisms of diseases. When linked with lecture topics about the metabolism of carbohydrates and lipids, the students obtain a better understanding of the relevance of abnormal metabolism in relation to diseases. Such understanding provides a solid foundation for the medical students' future research and for other clinical applications. © 2014 Biochemistry and Molecular Biology Education.

  15. Impact of the University of Colorado's Advanced Clinical Training and Service (ACTS) Program on dental students' clinical experience and cognitive skills, 1994-2006.

    PubMed

    Berg, Rob; Call, Richard L; Maguire, Kerry; Berkey, Douglas B; Karshmer, Bernard A; Guyton, Brad; Tawara-Jones, Karen

    2010-04-01

    The University of Colorado Denver School of Dental Medicine has operated a community-based dental education program for all of its students since 1985. A database of student productivity has been maintained in a standardized format, capable of multiyear compilation, since 1994. This study utilizes twelve years of these data to profile the type and amount of clinical treatment that can be provided by a typical fourth-year dental student during a 100-day community-based training experience. Between 1994 and 2006, the school's 423 graduates provided a mean of 922 treatment procedures per student at a mean of 498 patient visits per student. During a typical four-week clinical affiliation, each student provided a mean of approximately twenty-seven restorations on permanent teeth, sixteen restorations on primary teeth, and twenty-four oral surgery procedures (extractions). Students also gained considerable experience in periodontics, fixed and removable prosthodontics, and endodontics. Self-assessed competency ratings tended to increase after completing the program, as did willingness to treat underserved populations after graduation. About 16 percent of graduates reported planning to practice in the public sector after completing dental school. A community-based experience such as this appears to offer an opportunity to substantially augment dental students' clinical training experiences.

  16. Integrating Doulas Into First-Trimester Abortion Care: Physician, Clinic Staff, and Doula Experiences.

    PubMed

    Chor, Julie; Lyman, Phoebe; Ruth, Jean; Patel, Ashlesha; Gilliam, Melissa

    2018-01-01

    Balancing the need to provide individual support for patients and the need for an efficient clinic can be challenging in the abortion setting. This study explores physician, staff, and specially trained abortion doula perspectives on doula support, one approach to patient support. We conducted separate focus groups with physicians, staff members, and doulas from a high-volume, first-trimester aspiration abortion clinic with a newly established volunteer abortion doula program. Focus groups explored 1) abortion doula training, 2) program implementation, 3) program benefits, and 4) opportunities for improvement. Interviews were transcribed and computer-assisted content analysis was performed; salient findings are presented. Five physicians, 5 staff members, and 4 abortion doulas participated in separate focus group discussions. Doulas drew on both their prior personal skills and experiences in addition to their abortion doula training to provide women with support at the time of abortion. Having doulas in the clinic to assist with women's emotional needs allowed physicians and staff to focus on technical aspects of the procedure. In turn, both physicians and staff believed that introducing doulas resulted in more patient-centered care. Although staff did not experience challenges to integrating doulas, physicians and doulas experienced initial challenges in incorporating doula support into the clinical flow. Staff and doulas reported exchanging skills and techniques that they subsequently used in their interactions with patients. Physicians, clinic staff, and doulas perceive abortion doula support as an approach to provide more patient-centered care in a high-volume aspiration abortion clinic. © 2018 by the American College of Nurse-Midwives.

  17. Instant messaging and nursing students' clinical learning experience.

    PubMed

    Pimmer, Christoph; Brühlmann, Florian; Odetola, Titilayo Dorothy; Dipeolu, Oluwafemi; Gröhbiel, Urs; Ajuwon, Ademola J

    2018-05-01

    Although learning in clinical settings is a key element of nursing education, for many learners these are challenging developmental contexts often marked by isolation and a lack of belongingness. Despite the massive appropriation of mobile instant messaging (MIM) platforms and the connective properties attendant to them, very little is known about their role in and impact on nursing students' clinical learning experiences. To address this gap, the study, which was part of a multinational research project on the use of mobile social media in health professions education in developing countries, examined the use of the instant messaging platform WhatsApp by nursing students during placements and potential associations with socio-professional indicators. The survey involved a total number of 196 nursing students from 5 schools in Oyo State, Nigeria. The findings suggest that students used WhatsApp relatively frequently and they perceived that this platform strongly enhanced their communication with other students and nurses. WhatsApp use during placements was positively associated with students' maintained social capital with peer students, the development of a professional identity, placement satisfaction and with reduced feelings of isolation from professional communities. The determinants that influenced WhatsApp use during placements were perceived usefulness and perceived ease of use. No associations were found between WhatsApp use during placement and age, attitude, subjective norms and placement duration. This study is one of the first of its kind that points to the relevance of mobile instant messaging as part of nursing students' (inter)personal learning environments in clinical settings and, particularly, in the development setting under investigation. Further research is needed to corroborate these findings, to enhance the understanding of the impact mechanisms, and to evaluate a more systematic use of MIM in clinical learning contexts. Copyright © 2018

  18. First experience with clinical use of an original hemoperfusion system.

    PubMed

    Horký, J; Horák, J; Tlustáková, M; Kálal, J

    1981-01-01

    1. The authors present their experience with the use of an original charcoal hemoperfusion system Hemosorb in clinical application, in 9 patients with a heavy metabolic disturbance (failure of the liver and kidney) and after an intoxication with drugs. 2. In two patients the consciousness was remarkably recovered and in one patient it was improved already in the course of the hemoperfusion process, in further two cases the consciousness was recovered in short time after the Hemosorb was used, 7 were completely healed. 3. During the hemoperfusion with Hemosorb there were no symptoms of bad tolerance and no complications except for temporary pyretic reaction in one case. In unique cases manifestations of an enhanced bleeding occurred at the end of the long-term process, which were, however, rather easily corrected. The drop of thrombocytes was essentially reasonable and their restriction after the hemoperfusion was good. 4. Out of metabolic parameters of interest, in the patients with the heavy metabolic failure the drop of total phenol substances, uric acid and creatinine in the blood serum were observed at first stages of the hemoperfusion. The clearance of the total phenol substances and creatinine in the hemoperfusion system was ever rather high. 5. In a patient intoxicated with drugs, there was a remarkable drop of the metaqualone in the blood serum in the course of the hemoperfusion with Hemosorb; the clearance of this compound in the hemoperfusion system was still high after 4 hrs. 6. The first experiences with the clinical application of a new, original hemoperfusion system demonstrated its non-harmful character and biocompatibility as well as clinical, metabolic and toxicologic efficiency.

  19. Decontamination and decorporation: the clinical experience

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Poda, G.A.

    1979-01-01

    Decontamination and decorporation are quite interrelated when dealing with a contaminated person. Some clinical experiences from a transuranium production facility are offered. Skin decontamination is accomplished by washing with detergent and water. Stubborn cases are treated with sodium hypochlorite followed by rinsing, and emery cloth is used on more stubborn nail or finger pad contamination. If inhaled, the usual skin cleansing followed by nasal douche with normal saline decontaminates reachable areas and one of the DTPA salts given via aerosol both decontaminates and decorporates the inner recesses. Saline laxative reduces the time inhaled, and ingested particles remain in the gastro-intestinalmore » tract. Conservatism prevails in general, but most persons found to have inhaled contamination are given a single chelation within the hour of discovery and if subsequently found to have over 10% M.P.P.B. of a soluble actinide are offered further chelation. Single dose chelation has been found to be relatively innocuous and usually sufficient. The longest case of chelation therapy spanned 2-1/4 years and encompassed 123 doses of CaNa-DTPA.« less

  20. Dosimetric and radiobiologic comparison of 3D conformal versus intensity modulated planning techniques for prostate bed radiotherapy.

    PubMed

    Koontz, Bridget F; Das, Shiva; Temple, Kathy; Bynum, Sigrun; Catalano, Suzanne; Koontz, Jason I; Montana, Gustavo S; Oleson, James R

    2009-01-01

    Adjuvant radiotherapy for locally advanced prostate cancer improves biochemical and clinical disease-free survival. While comparisons in intact prostate cancer show a benefit for intensity modulated radiation therapy (IMRT) over 3D conformal planning, this has not been studied for post-prostatectomy radiotherapy (RT). This study compares normal tissue and target dosimetry and radiobiological modeling of IMRT vs. 3D conformal planning in the postoperative setting. 3D conformal plans were designed for 15 patients who had been treated with IMRT planning for salvage post-prostatectomy RT. The same computed tomography (CT) and target/normal structure contours, as well as prescription dose, was used for both IMRT and 3D plans. Normal tissue complication probabilities (NTCPs) were calculated based on the dose given to the bladder and rectum by both plans. Dose-volume histogram and NTCP data were compared by paired t-test. Bladder and rectal sparing were improved with IMRT planning compared to 3D conformal planning. The volume of the bladder receiving at least 75% (V75) and 50% (V50) of the dose was significantly reduced by 28% and 17%, respectively (p = 0.002 and 0.037). Rectal dose was similarly reduced, V75 by 33% and V50 by 17% (p = 0.001 and 0.004). While there was no difference in the volume of rectum receiving at least 65 Gy (V65), IMRT planning significant reduced the volume receiving 40 Gy or more (V40, p = 0.009). Bladder V40 and V65 were not significantly different between planning modalities. Despite these dosimetric differences, there was no significant difference in the NTCP for either bladder or rectal injury. IMRT planning reduces the volume of bladder and rectum receiving high doses during post-prostatectomy RT. Because of relatively low doses given to the bladder and rectum, there was no statistically significant improvement in NTCP between the 3D conformal and IMRT plans.

  1. Internal Medicine Residents' Clinical and Didactic Experiences After Work Hour Regulation

    PubMed Central

    Horwitz, Leora I; Krumholz, Harlan M; Huot, Stephen J; Green, Michael L

    2006-01-01

    BACKGROUND Work hour regulations for house staff were intended in part to improve resident clinical and educational performance. OBJECTIVE To characterize the effect of work hour regulation on internal medicine resident inpatient clinical experience and didactic education. DESIGN Cross-sectional mail survey. PARTICIPANTS Chief residents at all accredited U.S. internal medicine residency programs outside New York. MEASUREMENTS AND MAIN RESULTS The response rate was 62% (202/324). Most programs (72%) reported no change in average patient load per intern after work hour regulation. Many programs (48%) redistributed house staff admissions through the call cycle. The number of admissions per intern on long call (the day interns have the most admitting responsibility) decreased in 31% of programs, and the number of admissions on other days increased in 21% of programs. Residents on outpatient rotations were given new ward responsibilities in 36% of programs. Third-year resident ward and float time increased in 34% of programs, while third-year elective time decreased in 22% of programs. The mean weekly hours allotted to educational activities did not change significantly (12.7 vs 12.4, P = .12), but 56% of programs reported a decrease in intern attendance at educational activities. CONCLUSIONS In response to work hour regulation, many internal medicine programs redistributed rather than reduced residents' inpatient clinical experience. Hours allotted to educational activities did not change; however, most programs saw a decrease in intern attendance at conferences, and many reduced third-year elective time. PMID:16918742

  2. How do clinical clerkship students experience simulator-based teaching? A qualitative analysis.

    PubMed

    Takayesu, James K; Farrell, Susan E; Evans, Adelaide J; Sullivan, John E; Pawlowski, John B; Gordon, James A

    2006-01-01

    To critically analyze the experience of clinical clerkship students exposed to simulator-based teaching, in order to better understand student perspectives on its utility. A convenience sample of clinical students (n = 95) rotating through an emergency medicine, surgery, or longitudinal patient-doctor clerkship voluntarily participated in a 2-hour simulator-based teaching session. Groups of 3-5 students managed acute scenarios including respiratory failure, myocardial infarction, or multisystem trauma. After the session, students completed a brief written evaluation asking for free text commentary on the strengths and weaknesses of the experience; they also provided simple satisfaction ratings. Using a qualitative research approach, the textual commentary was transcribed and parsed into fragments, coded for emergent themes, and tested for inter-rater agreement. Six major thematic categories emerged from the qualitative analysis: The "Knowledge & Curriculum" domain was described by 35% of respondents, who commented on the opportunity for self-assessment, recall and memory, basic and clinical science learning, and motivation. "Applied Cognition and Critical Thought" was highlighted by 53% of respondents, who commented on the value of decision-making, active thought, clinical integration, and the uniqueness of learning-by-doing. "Teamwork and Communication" and "Procedural/Hands-On Skills" were each mentioned by 12% of subjects. Observations on the "Teaching/Learning Environment" were offered by 80% of students, who commented on the realism, interactivity, safety, and emotionality of the experience; here they also offered feedback on format, logistics, and instructors. Finally, "Suggestions for Use/Place in Undergraduate Medical Education" were provided by 22% of subjects, who primarily recommended more exposure. On a simple rating scale, 94% of students rated the quality of the simulator session as "excellent," whereas 91% felt the exercises should be "mandatory

  3. Senior dental students' experience with Cariogram in a pediatric dentistry clinic.

    PubMed

    Gonzalez, Cesar D; Okunseri, Christopher

    2010-02-01

    The study objective was to assess predoctoral dental students' experience with a caries risk assessment computer program in the pediatric dentistry clinic at Marquette University School of Dentistry. In 2005, spring semester sophomore dental students (class of 2008) were introduced to the caries risk assessment computer program "Cariogram." The students received a fifty-minute lecture on caries risk assessment and a demonstration on how to use Cariogram in the clinic. After two years of clinical exposure to Cariogram, sixty-six out of eighty senior dental students completed an anonymous eleven-item questionnaire on their experience with the tool. Each item on the questionnaire was scored on a five-point Likert scale with the exception of two questions. Full- and part-time faculty members in the pediatric dentistry clinic were involved in teaching and supervising students in the use of Cariogram for caries risk assessment after their training and calibration. Forty-five percent of the students who participated in the study agreed that Cariogram was easy to understand, and 18 percent disagreed. Thirty-six percent felt that it was easy to apply, and 25 percent reported that it was useful in determining caries preventive procedures. The students reported that 60 percent of full-time and 33 percent of part-time faculty were knowledgeable about Cariogram use. A majority of the students felt that Cariogram was not easy to understand, and eighty-two percent of them reported that they would not be using Cariogram in their private offices. Future studies should explore reasons why students do not feel inclined to use Cariogram as a caries risk assessment tool in their private practices even after being exposed to the tool in dental school.

  4. What Students Really Learn: Contrasting Medical and Nursing Students' Experiences of the Clinical Learning Environment

    ERIC Educational Resources Information Center

    Liljedahl, Matilda; Boman, Lena Engqvist; Fält, Charlotte Porthén; Bolander Laksov, Klara

    2015-01-01

    This paper explores and contrasts undergraduate medical and nursing students' experiences of the clinical learning environment. Using a sociocultural perspective of learning and an interpretative approach, 15 in-depth interviews with medical and nursing students were analysed with content analysis. Students' experiences are described using a…

  5. Comprehensive Experiment--Clinical Biochemistry: Determination of Blood Glucose and Triglycerides in Normal and Diabetic Rats

    ERIC Educational Resources Information Center

    Jiao, Li; Xiujuan, Shi; Juan, Wang; Song, Jia; Lei, Xu; Guotong, Xu; Lixia, Lu

    2015-01-01

    For second year medical students, we redesigned an original laboratory experiment and developed a combined research-teaching clinical biochemistry experiment. Using an established diabetic rat model to detect blood glucose and triglycerides, the students participate in the entire experimental process, which is not normally experienced during a…

  6. Reformulation of a clinical-dose system for carbon-ion radiotherapy treatment planning at the National Institute of Radiological Sciences, Japan

    NASA Astrophysics Data System (ADS)

    Inaniwa, Taku; Kanematsu, Nobuyuki; Matsufuji, Naruhiro; Kanai, Tatsuaki; Shirai, Toshiyuki; Noda, Koji; Tsuji, Hiroshi; Kamada, Tadashi; Tsujii, Hirohiko

    2015-04-01

    At the National Institute of Radiological Sciences (NIRS), more than 8,000 patients have been treated for various tumors with carbon-ion (C-ion) radiotherapy in the past 20 years based on a radiobiologically defined clinical-dose system. Through clinical experience, including extensive dose escalation studies, optimum dose-fractionation protocols have been established for respective tumors, which may be considered as the standards in C-ion radiotherapy. Although the therapeutic appropriateness of the clinical-dose system has been widely demonstrated by clinical results, the system incorporates several oversimplifications such as dose-independent relative biological effectiveness (RBE), empirical nuclear fragmentation model, and use of dose-averaged linear energy transfer to represent the spectrum of particles. We took the opportunity to update the clinical-dose system at the time we started clinical treatment with pencil beam scanning, a new beam delivery method, in 2011. The requirements for the updated system were to correct the oversimplifications made in the original system, while harmonizing with the original system to maintain the established dose-fractionation protocols. In the updated system, the radiation quality of the therapeutic C-ion beam was derived with Monte Carlo simulations, and its biological effectiveness was predicted with a theoretical model. We selected the most used C-ion beam with αr = 0.764 Gy-1 and β = 0.0615 Gy-2 as reference radiation for RBE. The C-equivalent biological dose distribution is designed to allow the prescribed survival of tumor cells of the human salivary gland (HSG) in entire spread-out Bragg peak (SOBP) region, with consideration to the dose dependence of the RBE. This C-equivalent biological dose distribution is scaled to a clinical dose distribution to harmonize with our clinical experiences with C-ion radiotherapy. Treatment plans were made with the original and the updated clinical-dose systems, and both

  7. The experience of clinical supervision for nurses and healthcare assistants in a secure adolescent service: Affecting service improvement.

    PubMed

    McCarron, R H; Eade, J; Delmage, E

    2018-04-01

    WHAT IS KNOWN ON THE SUBJECT?: Regular and effective clinical supervision for mental health nurses and healthcare assistants (HCAs) is an important tool in helping to reduce stress and burnout, and in ensuring safe, effective and high-quality mental health care. Previous studies of clinical supervision within secure mental health environments have found both a low availability of clinical supervision, and a low level of staff acceptance of its value, particularly for HCAs. WHAT DOES THIS PAPER ADD TO EXISTING KNOWLEDGE?: In previous studies, the understanding shown by HCAs and nurses around the benefits of clinical supervision may have been limited by the methods used. This study was specifically designed to help them best express their views. In contrast to previous studies, both nurses and HCAs showed a good understanding of the function and value of clinical supervision. Significant improvements in the experience of, and access to, clinical supervision for nurses and HCAs working in secure mental health services may be achieved by raising staff awareness, demonstrating organizational support and increasing monitoring of clinical supervision. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Organizations should consider reviewing their approach to supervision to include raising staff awareness, multidisciplinary supervision, group supervision, and recording and tracking of supervision rates. Organizations should be mindful of the need to provide effective clinical supervision to HCAs as well as nurses. Introduction Studies have found a low availability and appreciation of clinical supervision, especially for healthcare assistants (HCAs). Qualitative research is needed to further understand this. Aims Increase understanding of nurses' and HCAs' experiences of, and access to, clinical supervision. Identify nurses' and HCAs' perceptions of the value and function of clinical supervision. Assess how interventions affect staff's experiences of clinical supervision. Methods In

  8. Experiences of Student Speech-Language Pathology Clinicians in the Initial Clinical Practicum: A Phenomenological Study

    ERIC Educational Resources Information Center

    Nelson, Lori A.

    2011-01-01

    Speech-language pathology literature is limited in describing the clinical practicum process from the student perspective. Much of the supervision literature in this field focuses on quantitative research and/or the point of view of the supervisor. Understanding the student experience serves to enhance the quality of clinical supervision. Of…

  9. [Threats to Identity: A Grounded Theory Approach on Student Nurses' Experience of Incivility during Clinical Placement].

    PubMed

    Kang, Jiyeon; Jeong, Yeon Jin; Kong, Kyoung Ran

    2018-02-01

    This qualitative study aimed to explore the experience of incivility among nursing students. Sixteen nursing students who had experienced incivility during their clinical placement were invited for one-on-one interviews until the point of theoretical saturation. The grounded theory approach of Corbin and Strauss was adopted to analyze transcribed interview contents. Incivility occurred in the context of a hierarchical organizational culture, due to nursing students' position as outsiders, non-systematic clinical education, and poor nursing work environment. The experience of incivility was identified as "being mistreated as a marginal person," and nursing students responded to this phenomenon in the following three steps: reality shock, passive action, and submissive acceptance. This process caused students to lose self-esteem and undergo role conflict. Furthermore, nursing students' experience of incivility could eventually lead to workplace bullying in nurses. The results of this study suggest that nursing students' experience of incivility can be a process that threatens their identity. It is necessary to develop educational programs and provide appropriate counseling services so that nursing students can actively cope with the incivility. In addition, institutional plans are needed to ensure safe and supportive clinical learning environments. © 2018 Korean Society of Nursing Science.

  10. Constructing Baccalaureate Nursing Students' Ethical Experiences of Classroom Lessons and Clinical Practice

    ERIC Educational Resources Information Center

    Knowles, Amy J. B.

    2014-01-01

    Ethics is an integral component of the nursing profession. This phenomenological study aimed to describe how baccalaureate nursing students experience learning ethics both in the classroom and clinical setting. The interviews in this study were conducted with eight second semester senior nursing students. Four themes emerged from analyses of the…

  11. [Ovarian tissue cryopreservation in cancer patients--six years of clinical experience].

    PubMed

    Huser, M; Záková, J; Crha, I; Smardová, L; Král, Z; Revel, A; Ventruba, P

    2012-04-01

    Presentation of clinical results and experience with this technique during past six years. Original paper. Gynekologicko-porodnická klinika LF MU a FN Brno, Interní hemato-onkologická klinika LF MU a FN Brno, Department of Obstetrics and Gynecology. Hadassah University Hospital Ein-Karem, Jerusalem, Izrael. Ovarian tissue cryopreservation (OTC) and its future auto-transplantation becomes an alternative for patients to prevent serious damage of ovarian function by oncology treatment. Patient is indicated to OTC in case of high risk of ovarian failure due to planned chemotherapy and impossibility to use other oncofertility techniques. Ovarian tissue harvesting is done by laparoscopy in short-term general anesthesia. After tissue processing the samples are cryopreserved in programmable automatic freezer or by vitrification. The auto-transplantation of ovarian tissue is planned after the complete cure of patient's malignancy. Our workplace doesn't have own experience with tissue transplantation - until now cryopreserved tissue has not yet been utilized by the patients. Clinical experience with this technique gained by our team during academic stay in abroad Israeli clinic is presented. During the years of 2005-2011 the OTC was performed in 19 cancer patients before chemotherapy. In majority of cases, patients suffered from blood or lymph node systemic malignancy (84%). Average age of women was 26 years. The patient set consisted of mostly nulliparous women (88%). Patient's average body mass index was 23,9 kg/m2. The length of systemic chemotherapy averaged 7.1 months. Time from fertility preservation counseling to chemotherapy was not exceeding one week (7.2 days on average). Ovarian tissue harvesting was conducted by laparoscopic surgery in all cases. The length of surgery did not exceed 60 minutes and no surgical complications were observed. The case of ovarian tissue transplantation performed on abroad university settings is discussed. In the consensus of with

  12. Seeing Students Squirm: Nursing Students’ Experiences of Bullying Behaviors During Clinical Rotations

    PubMed Central

    Smith, Carolyn R.; Gillespie, Gordon Lee; Brown, Kathryn C.; Grubb, Paula L.

    2016-01-01

    Background Bullying remains a troubling problem in the nursing profession. Nursing students may encounter bullying behavior in clinical settings. However nursing students may not be adequately prepared to recognize and handle bullying behavior when it occurs. The purpose of this study was to gain greater understanding of nursing students’ experiences of bullying behaviors in the clinical setting. Method Using a descriptive qualitative approach, eight focus groups were held with 56 undergraduate baccalaureate nursing students from four college campuses. Focus group data were coded and analyzed for themes. Results Four categories of themes were identified: bullying behaviors, rationale for bullying, response to bullying, and recommendations to address bullying. Each category and its corresponding themes are presented. Conclusion Interventions for nurse educators to address bullying of nursing students in clinical settings are presented. PMID:27560118

  13. Clinicians' experiences of becoming a clinical manager: a qualitative study.

    PubMed

    Spehar, Ivan; Frich, Jan C; Kjekshus, Lars Erik

    2012-11-22

    There has been an increased interest in recruiting health professionals with a clinical background to management positions in health care. We know little about the factors that influence individuals' decisions to engage in management. The aim of this study is to explore clinicians' journeys towards management positions in hospitals, in order to identify potential drivers and barriers to management recruitment and development. We did a qualitative study which included in-depth interviews with 30 clinicians in middle and first-line management positions in Norwegian hospitals. In addition, participant observation was conducted with 20 of the participants. The informants were recruited from medical and surgical departments, and most had professional backgrounds as medical doctors or nurses. Interviews were analyzed by systemic text condensation. We found that there were three phases in clinicians' journey into management; the development of leadership awareness, taking on the manager role and the experience of entering management. Participants' experiences suggest that there are different journeys into management, in which both external and internal pressure emerged as a recurrent theme. They had not anticipated a career in clinical management, and experienced that they had been persuaded to take the position. Being thrown into the position, without being sufficiently prepared for the task, was a common experience among participants. Being left to themselves, they had to learn management "on the fly". Some were frustrated in their role due to increasing administrative workloads, without being able to delegate work effectively. Path dependency and social pressure seems to influence clinicians' decisions to enter into management positions. Hospital organizations should formalize pathways into management, in order to identify, attract, and retain the most qualified talents. Top managers should make sure that necessary support functions are available locally, especially

  14. Clinicians’ experiences of becoming a clinical manager: a qualitative study

    PubMed Central

    2012-01-01

    Background There has been an increased interest in recruiting health professionals with a clinical background to management positions in health care. We know little about the factors that influence individuals’ decisions to engage in management. The aim of this study is to explore clinicians’ journeys towards management positions in hospitals, in order to identify potential drivers and barriers to management recruitment and development. Methods We did a qualitative study which included in-depth interviews with 30 clinicians in middle and first-line management positions in Norwegian hospitals. In addition, participant observation was conducted with 20 of the participants. The informants were recruited from medical and surgical departments, and most had professional backgrounds as medical doctors or nurses. Interviews were analyzed by systemic text condensation. Results We found that there were three phases in clinicians’ journey into management; the development of leadership awareness, taking on the manager role and the experience of entering management. Participants’ experiences suggest that there are different journeys into management, in which both external and internal pressure emerged as a recurrent theme. They had not anticipated a career in clinical management, and experienced that they had been persuaded to take the position. Being thrown into the position, without being sufficiently prepared for the task, was a common experience among participants. Being left to themselves, they had to learn management “on the fly”. Some were frustrated in their role due to increasing administrative workloads, without being able to delegate work effectively. Conclusions Path dependency and social pressure seems to influence clinicians’ decisions to enter into management positions. Hospital organizations should formalize pathways into management, in order to identify, attract, and retain the most qualified talents. Top managers should make sure that necessary

  15. Management Development in Health Care: Exploring the Experiences of Clinical Nurse Managers

    ERIC Educational Resources Information Center

    Purcell, Laura; Milner, Brigid

    2005-01-01

    Purpose--The purpose of this paper is to investigate the dramatic reforms in the health service in recent years. Design/methodology/approach--Examines management development in health care, and explores the experiences of clinical nurse managers. Findings--Duplication of agencies and multiplication of roles have led to tensions in terms of both…

  16. SU-E-T-375: Passive Scattering to Pencil-Beam-Scanning Comparison for Medulloblastoma Proton Therapy: LET Distributions and Radiobiological Implications

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Giantsoudi, D; MacDonald, S; Paganetti, H

    2014-06-01

    Purpose: To compare the linear energy transfer (LET) distributions between passive scattering and pencil beam scanning proton radiation therapy techniques for medulloblastoma patients and study the potential radiobiological implications. Methods: A group of medulloblastoma patients, previously treated with passive scattering (PS) proton craniospinal irradiation followed by prosterior fossa or involved field boost, were selected from the patient database of our institution. Using the beam geometry and planning computed tomography (CT) image sets of the original treatment plans, pencil beam scanning (PBS) treatment plans were generated for the cranial treatment for each patient, with average beam spot size of 8mm (sigmamore » in air at isocenter). 3-dimensional dose and LET distributions were calculated by Monte Carlo methods (TOPAS) both for the original passive scattering and new pencil beam scanning treatment plans. LET volume histograms were calculated for the target and OARs and compared for the two delivery methods. Variable RBE weighted dose distributions and volume histograms were also calculated using a variable dose and LET-based model. Results: Better dose conformity was achieved with PBS planning compared to PS, leading to increased dose coverage for the boost target area and decreased average dose to the structures adjacent to it and critical structures outside the whole brain treatment field. LET values for the target were lower for PBS plans. Elevated LET values for OARs close to the boosted target areas were noticed, due to end of range of proton beams falling inside these structures, resulting in higher RBE weighted dose for these structures compared to the clinical RBE value of 1.1. Conclusion: Transitioning from passive scattering to pencil beam scanning proton radiation treatment can be dosimetrically beneficial for medulloblastoma patients. LET–guided treatment planning could contribute to better decision making for these cases, especially

  17. A Comprehensive Lifestyle Randomized Clinical Trial: Design and Initial Patient Experience.

    PubMed

    Arun, Banu; Austin, Taylor; Babiera, Gildy V; Basen-Engquist, Karen; Carmack, Cindy L; Chaoul, Alejandro; Cohen, Lorenzo; Connelly, Lisa; Haddad, Robin; Harrison, Carol; Li, Yisheng; Mallaiah, Smitha; Nagarathna, Raghuram; Parker, Patricia A; Perkins, George H; Reuben, James M; Shih, Ya-Chen Tina; Spelman, Amy; Sood, Anil; Yang, Peiying; Yeung, Sai-Ching J

    2017-03-01

    Although epidemiological research demonstrates that there is an association between lifestyle factors and risk of breast cancer recurrence, progression of disease, and mortality, no comprehensive lifestyle change clinical trials have been conducted to determine if changing multiple risk factors leads to changes in biobehavioral processes and clinical outcomes in women with breast cancer. This article describes the design, feasibility, adherence to the intervention and data collection, and patient experience of a comprehensive lifestyle change clinical trial (CompLife). CompLife is a randomized, controlled trial of a multiple-behavior intervention focusing on diet, exercise, and mind-body practice along with behavioral counseling to support change. The initial exposure to the intervention takes place during the 4 to 6 weeks of radiotherapy (XRT) for women with stage III breast cancer and then across the subsequent 12 months. The intervention group will have 42 hours of in-person lifestyle counseling during XRT (7-10 hours a week) followed by up to 30 hours of counseling via video connection for the subsequent 12 months (weekly sessions for 6 months and then monthly for 6 months). The primary outcome is disease-free survival. Multiple secondary outcomes are being evaluated, including: (1) biological pathways; (2) overall survival; (3) patient-reported outcomes; (4) dietary patterns/fitness levels, anthropometrics, and body composition; and (5) economic outcomes. Qualitative data of the patient experience in the trial is collected from exit interviews, concluding remarks, direct email correspondences, and web postings from patients. Fifty-five patients have been recruited and randomized to the trial to date. Accrual of eligible patients is high (72%) and dropout rates extremely low (5%). Attendance to the in-person sessions is high (95% attending greater than 80% of sessions) as well as to the 30 hours of video counseling (88% attending more than 70% of sessions

  18. Medical academia clinical experiences of Ward Round Teaching curriculum.

    PubMed

    Haghani, Fariba; Arabshahi, Seyed Kamran Soltani; Bigdeli, Shoaleh; Alavi, Mousa; Omid, Athar

    2014-01-01

    Medical students spend most of their time in hospital wards and it is necessary to study clinical educational opportunities. This study was aimed to explore faculty members' experience on Ward Round Teaching content. This qualitative study was conducted by purposive sampling with the maximum variation of major clinical departments faculty members in Isfahan University of Medical Sciences (n = 9). Data gathering was based on deep and semi-structured interviews. Data gathering continued till data saturation. Data was analyzed through the Collaizzi method and validated. Strategies to ensure trustworthiness of data (credibility, dependability, conformability, transferability) were employed (Guba and Lincoln). Basic codes extracted from the analyzed data were categorized into two main themes and related subthemes, including (1) tangible teachings (analytic intelligence, technical intelligence, legal duties) and (2) implied teachings (professionalism, professional discipline, professional difficulties). Ward round teaching is a valuable opportunity for learners to learn not only patient care aspects but also ethical values. By appropriate planning, opportunities can be used to teach capabilities that are expected of general practitioners.

  19. Medical academia clinical experiences of Ward Round Teaching curriculum

    PubMed Central

    Haghani, Fariba; Arabshahi, Seyed Kamran Soltani; Bigdeli, Shoaleh; Alavi, Mousa; Omid, Athar

    2014-01-01

    Background: Medical students spend most of their time in hospital wards and it is necessary to study clinical educational opportunities. This study was aimed to explore faculty members’ experience on Ward Round Teaching content. Methods and Materials: This qualitative study was conducted by purposive sampling with the maximum variation of major clinical departments faculty members in Isfahan University of Medical Sciences (n = 9). Data gathering was based on deep and semi-structured interviews. Data gathering continued till data saturation. Data was analyzed through the Collaizzi method and validated. Strategies to ensure trustworthiness of data (credibility, dependability, conformability, transferability) were employed (Guba and Lincoln). Results: Basic codes extracted from the analyzed data were categorized into two main themes and related subthemes, including (1) tangible teachings (analytic intelligence, technical intelligence, legal duties) and (2) implied teachings (professionalism, professional discipline, professional difficulties). Conclusion: Ward round teaching is a valuable opportunity for learners to learn not only patient care aspects but also ethical values. By appropriate planning, opportunities can be used to teach capabilities that are expected of general practitioners. PMID:24627858

  20. Preservice Special Education Teachers' Perceptions: The Influence of University Coursework, Context, and Relationships, during the Clinical Teaching Experience

    ERIC Educational Resources Information Center

    McElwee, Christine B.; Regan, Kelley; Baker, Pamela Hudson; Weiss, Margaret P.

    2018-01-01

    The purpose of this study was to investigate to what extent context and relationships influence preservice teachers' appropriation of coursework during the clinical experience. While there is a dearth of research regarding the clinical experience in teacher preparation programs, there are even fewer studies investigating special education teacher…

  1. Who am I now? The experience of being a post-registration children's student nurse in the first clinical placement.

    PubMed

    Begley, Thelma

    2007-07-01

    Role transition from staff nurse to post-registration student is not a well researched area of nursing. Two previous Irish studies have been reported of the experiences of post-registration midwifery students [McCrea, H., Thompson, K., Carswell, L., Whittington, D., 1994. Student midwives' learning experience on the wards. Journal of Clinical Nursing 3, 97-102; Begley, C., 1997. Midwives in the making: a longitudinal study of the experiences of student midwives during their two-year training in Ireland. Unpublished PhD Thesis, School of Nursing and Midwifery, Trinity College, Dublin.] but there is limited research into post-registration children's student nurses experiences. A broadly phenomenological approach was employed to interpret what it means to be a post-registration children's student nurse during the first clinical placement. Data was collected from a purposive sample of six students, using unstructured tape recorded interviews. Thematic content analysis was utilised to produce an interpretation of nurses' experience within the first clinical placement. The findings reflect the participants' role confusion when changing from being a staff nurse in one discipline of nursing to being a post-registration student in another. They find previous experience is not recognised and that students originating from different disciplines in nursing have different experiences within the first placement. Coping mechanisms are discussed along with preparation for and supports available in the clinical area.

  2. An eight-year clinic experience with clozapine use in a Parkinson's disease clinic setting.

    PubMed

    Hack, Nawaz; Fayad, Sarah M; Monari, Erin H; Akbar, Umer; Hardwick, Angela; Rodriguez, Ramon L; Malaty, Irene A; Romrell, Janet; Shukla, Aparna A Wagle; McFarland, Nikolaus; Ward, Herbert E; Okun, Michael S

    2014-01-01

    To examine our eight year clinic-based experience in a Parkinson's disease expert clinical care center using clozapine as a treatment for refractory psychosis in Parkinson's disease (PD). The study was a retrospective chart review which covered eight years of clozapine registry use. Statistical T-tests, chi-square, correlations and regression analysis were used to analyze treatment response for potential associations of age, disease duration, and Hoehn & Yahr (H&Y) score, and degree of response to clozapine therapy. There were 36 participants included in the analysis (32 PD, 4 parkinsonism-plus). The characteristics included 30.6% female, age 45-87 years (mean 68.3±10.15), disease duration of 17-240 months (mean 108.14±51.13) and H&Y score of 2 to 4 (mean 2.51±0.51). The overall retention rate on clozapine was 41% and the most common reasons for discontinuation were frequent blood testing (28%), nursing home (NH) placement (11%) and leucopenia (8%). Responses to clozapine across the cohort were: complete (33%), partial (33%), absent (16%), and unknown (16%). Age (r = -0.36, p<0.01) and H&Y score (r = -0.41, p<0.01) were shown to be related to response to clozapine therapy, but disease duration was not an associated factor (r = 0.21, p>0.05). This single-center experience highlights the challenges associated with clozapine therapy in PD psychosis. Frequent blood testing remains a significant barrier for clozapine, even in patients with therapeutic benefit. Surprisingly, all patients admitted to a NH discontinued clozapine due to logistical issues of administration and monitoring within that setting. Consideration of the barriers to clozapine therapy will be important to its use and to its continued success in an outpatient setting.

  3. Fundamental space radiobiology

    NASA Technical Reports Server (NTRS)

    Nelson, Gregory A.

    2003-01-01

    The unique feature of the space radiation environment is the dominance of high-energy charged particles (HZE or high LET radiation) emitted by the Sun and galactic sources, or trapped in the Van Allen radiation belts. These charged particles present a significant hazard to space flight crews, and accelerator-based experiments are underway to quantify the health risks due to unavoidable radiation exposure. There are three principal properties of charged particles that distinguish them from conventional radiation, i.e. gamma rays and x-rays. First, they have a defined range in matter rather than an exponential absorption profile. Second, they undergo nuclear reactions to produce secondary particles. Third, and most important, they deposit their energy along well-defined linear paths or tracks rather than diffuse fields. The structured energy deposition pattern interacts on multiple scales with the biological structures of DNA, cells and tissues to produce correlated patterns of damage that evade repair systems. Traditional concepts of dose and its associated normalization parameter, RBE (relative biological effectiveness), break down under experimental scrutiny, and probabilistic models of risk based on the number of particle traversals per cell may be more appropriate. Unique patterns of DNA damage, gene expression, mobilization of repair proteins, activation of cytokines and remodeling of cellular microenvironment are observed following exposure to high LET radiation. At low levels of exposure the communication of bioactive substances from irradiated to unirradiated "bystander" cells can amplify the damage and cause a significant deviation from linearity in dose vs. response relations. Under some circumstances, there is even a multigenerational delay in the expression of radiation-induced genetic damage (genomic instability) which is not strictly dose dependent. These issues and the experimental evidence derived from ground based experiments at particle

  4. Radiobiological long-term accumulation of environmental alpha radioactivity in extracted human teeth and animal bones in Malaysia.

    PubMed

    Almayahi, B A; Tajuddin, A A; Jaafar, M S

    2014-03-01

    In this study, the radiobiological analysis of natural alpha emitters in extracted human teeth and animal bones from Malaysia was estimated. The microdistributions of alpha particles in tooth and bone samples were measured using CR-39 alpha-particle track detectors. The lowest and highest alpha emission rates in teeth in the Kedah and Perak states were 0.0080 ± 0.0005 mBq cm(-2) and 0.061 ± 0.008 mBq cm(-2), whereas those of bones in the Perlis and Kedah states were 0.0140 ± 0.0001 mBq cm(-2) and 0.7700 ± 0.0282 mBq cm(-2), respectively. The average alpha emission rate in male teeth was 0.0209 ± 0.0008 mBq cm(-2), whereas that of female teeth was 0.0199 ± 0.0010 mBq cm(-2). The alpha emission rate in teeth is higher in smokers (0.0228 ± 0.0008 mBq cm(-2)) than in non-smokers (0.0179 ± 0.0008 mBq cm(-2)). Such difference was found statistically significant (p < 0.01). Copyright © 2014 Elsevier Ltd. All rights reserved.

  5. Seeing Students Squirm: Nursing Students' Experiences of Bullying Behaviors During Clinical Rotations.

    PubMed

    Smith, Carolyn R; Gillespie, Gordon Lee; Brown, Kathryn C; Grubb, Paula L

    2016-09-01

    Bullying remains a troubling problem in the nursing profession. Nursing students may encounter bullying behavior in clinical settings. However, they may not be adequately prepared to recognize and handle bullying behavior when it occurs. This study's purpose was to gain a greater understanding of nursing students' experiences of bullying behaviors in the clinical setting. Using a descriptive qualitative approach, eight focus groups were held with 56 undergraduate baccalaureate nursing students from four college campuses. Focus group data were coded and analyzed for themes. Four categories were identified: Bullying Behaviors, Rationale for Bullying, Response to Bullying, and Recommendations to Address Bullying. Each category and its corresponding themes are presented. Interventions for nurse educators to address the bullying of nursing students in clinical settings are presented. [J Nurs Educ. 2016;55(9):505-513.]. Copyright 2016, SLACK Incorporated.

  6. Experience with the lathe cut Bausch & Lomb SOFLENS: Part 1--Clinical study.

    PubMed

    Weissman, B A; Levinson, A

    1978-03-01

    This study consists of clinical experience with the recently produced lathe cut Bausch & lomb SOFTLENS. Sixteen patients were fitted with the spin cast and then lathe cut lens. Visual acuities were better with the lathe cut lens. Comfort was good with both lenses. Some degree of circum-corneal injection was noted with the larger lathe cut design.

  7. Children's Views Matter Too! A Pilot Project Assessing Children's and Adolescents' Experiences of Clinical Psychology Services

    ERIC Educational Resources Information Center

    Gordon, Michael; Russo, Kate

    2009-01-01

    This pilot study explored the experiences and understanding of clinical psychology practices and services of children and adolescents attending clinical psychology outpatient appointments. Fifteen young participants took part in the study. A content analysis indicated that young children and adolescents have an appropriate understanding of the…

  8. Midwifery students' experiences of learning clinical skills in Iran: a qualitative study.

    PubMed

    Ahmadi, Golnoosh; Shahriari, Mohsen; Keyvanara, Mahmood; Kohan, Shahnaz

    2018-03-09

    A qualitative study was used. Midwifery students from three universities in Iran participated. The study used a convenience sample of eighteen students. Data for this study was collected using semi-structured interviews (N=12) and focus groups (N=6). Data were recorded on a digital audio recorder and then transcribed. The qualitative data were analyzed using a content analysis approach. Six broad themes emerged from the analysis: Limited opportunities to experience skills, difficulties with course plan gaps, need for creating a supportive clinical environment, learning drives, confusion between different methods, and stress in the clinical setting. Short verbatim quotations from the participants were presented to provide evidence for the interpretation of data. The findings of this study have provided a clear picture of the factors and mechanisms involved in learning clinical skills by midwifery students. This study showed that students had some difficulties and concerns during learning of clinical midwifery skills. The findings of this study suggest that midwifery educators conduct further studies to tackle these issues in clinical skills learning. The findings of this study are subject to some limitations which are discussed.

  9. Mental health pre-registration nursing students' experiences of group clinical supervision: a UK longitudinal qualitative study.

    PubMed

    Carver, Neil; Clibbens, Nicola; Ashmore, Russell; Sheldon, Julie

    2014-03-01

    There is widespread international interest in the use of clinical supervision in nursing as well as recognition of the need to introduce nursing students to its concepts and value. This article reports on a three-year longitudinal qualitative focus group study which explored students' views and experiences of a group clinical supervision initiative. Students attended supervision groups facilitated by teaching staff over their three year pre-registration mental health nursing course, with a main aim of developing skills, knowledge and attitudes as supervisees. The findings showed that students derived benefit from the experience, gained greater awareness of the nature of supervision and became active supervisees within their groups. These benefits took time to emerge and were not universal however. While the findings support the value of exposing students to the experience of group clinical supervision educators wishing to implement such a programme need to address a host of issues. These include; the preparation of students, structural and resource concerns, and issues relating to group dynamics. Copyright © 2013 Elsevier Ltd. All rights reserved.

  10. International students in speech-language pathology clinical education placements: Perceptions of experience and competency development.

    PubMed

    Attrill, Stacie; Lincoln, Michelle; McAllister, Sue

    2015-06-01

    This study aimed to describe perceptions of clinical placement experiences and competency development for international speech-language pathology students and to determine if these perceptions were different for domestic students. Domestic and international students at two Australian universities participated in nine focus group interviews. Thematic analysis led to the identification of two themes shared by international and domestic students and several separate themes. Shared themes identified the important influence of students' relationships with clinical educators, unique opportunities and learning that occurs on placement. International student themes included concerns about their communication skills and the impact of these skills on client progress. They also explored their adjustment to unfamiliar placement settings and relationships, preferring structured placements to assist this adjustment. Domestic student themes explored the critical nature of competency attainment and assessment on placement, valuing placements that enabled them to achieve their goals. The findings of this study suggest that international students experience additional communication, cultural and contextual demands on clinical placement, which may increase their learning requirements. Clinical education practices must be responsive to the learning needs of diverse student populations. Strategies are suggested to assist all students to adjust to the professional and learning expectations of clinical education placements.

  11. Charged Particle Therapy Steps Into the Clinical Environment

    NASA Astrophysics Data System (ADS)

    Haberer, Th.

    Beams of heavy charged particles like protons or carbon ions represent the ideal tool for the treatment of deep-seated, inoperable and radioresistant tumors. For more than 4 decades research with beams of charged particles has been performed. In total more than 40000 patients have been treated, mostly using protons being delivered by accelerators that were designed for basic research centers. In Berkeley, USA heavier particles like helium or neon ions were used to conduct clinical trials until 1992. Based on that somewhat limited technological standard and triggered by the promising results from Berkeley the first dedicated charged particle facilities were constructed. In order to maximally exploit the advantageous physical and radiobiological characteristics of these beams enormous effort was put into developing dynamic beam delivery techniques and tailoring the capabilities of the accelerators, the planning systems and the quality assurance procedures and equipment to the requirements resulting from these new treatment modalities. Active beam delivery systems integrated in rotating gantries, if necessary, will allow the production of superior dose distributions that precisely follow the medical prescription. The technological progress being made during the last 10 years defines the state of the art of the upcoming next-generation facilities for the clinical environment in Europe and Japan.

  12. Pediatric residents' experiences of a clinical rotation in Adolescent Medicine

    PubMed Central

    2010-01-01

    Background Although Adolescent Medicine is a pediatric subspecialty, it addresses many issues that differ from other aspects of pediatrics clinical training. The aim of this study was to explore the general experiences of pediatric residents during their rotations in Adolescent Medicine. Methods Qualitative methods were applied. Semi-structured individual interviews were conducted with pediatric residents who had completed a rotation in Adolescent Medicine. Emergent themes were identified. Results Three key themes emerged: gaining exposure, taking on a professional role, and achieving self-awareness. Subcategories were also identified. There was particular emphasis on the multidisciplinary team and the biopsychosocial approach to adolescent health care. Conclusions The experiences in Adolescent Medicine reflected residents' learning, notably gains in the "non-expert" as well as "medical expert" physician competencies. Future studies should explore how the interprofessional nature of an Adolescent Medicine team and the patient populations themselves contribute to this learning. PMID:21122143

  13. Beginning level nursing students' experiences with cancer patients in their first clinical placement: a qualitative appraisal in Turkey.

    PubMed

    Yildiz, Hicran; Akansel, Neriman

    2011-01-01

    This study was conducted to evaluate beginning nursing students' point of view related to caring cancer patients in their first clinical placement. Data were collected by evaluating the diaries kept by four beginning level nursing students who were assigned to do their fundamentals of nursing clinical practice in hematology clinic from February to May 2011. A qualitative research method was used and data were analyzed using inductive method. Nursing students experienced anxiety, had difficulties while communicating with cancer patients and observed some negative practices related to patient care and treatment. During their clinical placement nursing students were able to differentiate right and wrong practices in clinical environment, they tried to tailor their theoretical knowledge to the clinical practice and reported decrease in their anxiety by the end of clinical rotation. Being assigned to care for cancer patients was a stressful experience for the first year students. According to these results, it can be said that clinics such as hematology can be used as a clinical placement only in mandatory conditions for beginning level nursing students because of their limited clinical experience and the knowledge requirement related to these patients.

  14. Radiobiology of Small Hive Beetle (Coleoptera: Nitidulidae) and Prospects for Management Using Sterile Insect Releases.

    PubMed

    Downey, Danielle; Chun, Stacey; Follett, Peter

    2015-06-01

    Small hive beetle, Aethina tumida Murray (Coleoptera: Nitidulidae), is considered a serious threat to beekeeping in the Western Hemisphere, Australia, and Europe mainly due to larval feeding on honey, pollen, and brood of the European honeybee, Apis mellifera L. Control methods are limited for this pest. Studies were conducted to provide information on the radiobiology of small hive beetle and determine the potential for sterile insect releases as a control strategy. Adult males and females were equally sensitive to a radiation dose of 80 Gy and died within 5-7 d after treatment. In reciprocal crossing studies, irradiation of females only lowered reproduction to a greater extent than irradiation of males only. For matings between unirradiated males and irradiated females, mean reproduction was reduced by >99% at 45 and 60 Gy compared with controls, and no larvae were produced at 75 Gy. Irradiation of prereproductive adults of both sexes at 45 Gy under low oxygen (1-4%) caused a high level of sterility (>99%) while maintaining moderate survivorship for several weeks, and should suffice for sterile insect releases. Sterile insect technique holds potential for suppressing small hive beetle populations in newly invaded areas and limiting its spread. Published by Oxford University Press on behalf of Entomological Society of America 2015. This work is written by US Government employees and is in the public domain in the US.

  15. Learning by playing: A cross-sectional descriptive study of nursing students' experiences of learning clinical reasoning.

    PubMed

    Koivisto, Jaana-Maija; Multisilta, Jari; Niemi, Hannele; Katajisto, Jouko; Eriksson, Elina

    2016-10-01

    Clinical reasoning is viewed as a problem-solving activity; in games, players solve problems. To provide excellent patient care, nursing students must gain competence in clinical reasoning. Utilising gaming elements and virtual simulations may enhance learning of clinical reasoning. To investigate nursing students' experiences of learning clinical reasoning process by playing a 3D simulation game. Cross-sectional descriptive study. Thirteen gaming sessions at two universities of applied sciences in Finland. The prototype of the simulation game used in this study was single-player in format. The game mechanics were built around the clinical reasoning process. Nursing students from the surgical nursing course of autumn 2014 (N=166). Data were collected by means of an online questionnaire. In terms of the clinical reasoning process, students learned how to take action and collect information but were less successful in learning to establish goals for patient care or to evaluate the effectiveness of interventions. Learning of the different phases of clinical reasoning process was strongly positively correlated. The students described that they learned mainly to apply theoretical knowledge while playing. The results show that those who played digital games daily or occasionally felt that they learned clinical reasoning by playing the game more than those who did not play at all. Nursing students' experiences of learning the clinical reasoning process by playing a 3D simulation game showed that such games can be used successfully for learning. To ensure that students follow a systematic approach, the game mechanics need to be built around the clinical reasoning process. Copyright © 2016 Elsevier Ltd. All rights reserved.

  16. Quantifying medical student clinical experiences via an ICD Code Logging App.

    PubMed

    Rawlins, Fred; Sumpter, Cameron; Sutphin, Dean; Garner, Harold R

    2018-03-01

    The logging of ICD Diagnostic, Procedure and Drug codes is one means of tracking the experience of medical students' clinical rotations. The goal is to create a web-based computer and mobile application to track the progress of trainees, monitor the effectiveness of their training locations and be a means of sampling public health status. We have developed a web-based app in which medical trainees make entries via a simple and quick interface optimized for both mobile devices and personal computers. For each patient interaction, users enter ICD diagnostic, procedure, and drug codes via a hierarchical or search entry interface, as well as patient demographics (age range and gender, but no personal identifiers), and free-text notes. Users and administrators can review and edit input via a series of output interfaces. The user interface and back-end database are provided via dual redundant failover Linux servers. Students master the interface in ten minutes, and thereafter complete entries in less than one minute. Five hundred-forty 3rd year VCOM students each averaged 100 entries in the first four week clinical rotation. Data accumulated in various Appalachian clinics and Central American medical mission trips has demonstrated the public health surveillance utility of the application. PC and mobile apps can be used to collect medical trainee experience in real time or near real-time, quickly, and efficiently. This system has collected 75,596 entries to date, less than 2% of trainees have needed assistance to become proficient, and medical school administrators are using the various summaries to evaluate students and compare different rotation sites. Copyright © 2017. Published by Elsevier B.V.

  17. Social justice as a framework for undergraduate community health clinical experiences in the United States.

    PubMed

    Boutain, Doris M

    2008-01-01

    Educating future registered nurses for social justice is an urgent, yet complex undertaking in undergraduate education. Although the need for social justice education is often highlighted, few articles describe practical teaching strategies for ensuring that undertaking. The purpose of this article is to illustrate how a curricular focus on social justice framed and supported the development of a clinical evaluation tool for undergraduate community health clinical experiences. First, social justice is defined and its relationship to baccalaureate nursing education explained. Then a description is provided of how social justice was highlighted in the vision, curriculum, and community health clinical evaluation tool of a College of Nursing. The article subsequently showcases the content and evaluation of students' journal entries about social justice. The development of the social justice component presented in this article may be useful to nurse educators striving to match theory and practice in the evaluation of social justice in students' community health experience.

  18. Vertigo in childhood: proposal for a diagnostic algorithm based upon clinical experience.

    PubMed

    Casani, A P; Dallan, I; Navari, E; Sellari Franceschini, S; Cerchiai, N

    2015-06-01

    The aim of this paper is to analyse, after clinical experience with a series of patients with established diagnoses and review of the literature, all relevant anamnestic features in order to build a simple diagnostic algorithm for vertigo in childhood. This study is a retrospective chart review. A series of 37 children underwent complete clinical and instrumental vestibular examination. Only neurological disorders or genetic diseases represented exclusion criteria. All diagnoses were reviewed after applying the most recent diagnostic guidelines. In our experience, the most common aetiology for dizziness is vestibular migraine (38%), followed by acute labyrinthitis/neuritis (16%) and somatoform vertigo (16%). Benign paroxysmal vertigo was diagnosed in 4 patients (11%) and paroxysmal torticollis was diagnosed in a 1-year-old child. In 8% (3 patients) of cases, the dizziness had a post-traumatic origin: 1 canalolithiasis of the posterior semicircular canal and 2 labyrinthine concussions, respectively. Menière's disease was diagnosed in 2 cases. A bilateral vestibular failure of unknown origin caused chronic dizziness in 1 patient. In conclusion, this algorithm could represent a good tool for guiding clinical suspicion to correct diagnostic assessment in dizzy children where no neurological findings are detectable. The algorithm has just a few simple steps, based mainly on two aspects to be investigated early: temporal features of vertigo and presence of hearing impairment. A different algorithm has been proposed for cases in which a traumatic origin is suspected.

  19. Healthcare students' experiences of an interprofessional, student-led neuro-rehabilitation community-based clinic.

    PubMed

    Gustafsson, Louise; Hutchinson, Laura; Theodoros, Deborah; Williams, Katrina; Copley, Anna; Fagan, Amy; Desha, Laura

    2016-01-01

    Student-led clinics are becoming more prominent as educators seek alternate models of clinical education for health professionals. The purpose of this study was to evaluate healthcare students' experiences of an interprofessional student-led clinic for clients with neurological conditions. Thirteen students representing occupational therapy, physiotherapy, and speech pathology were recruited for the study. A sequential mixed-methods evaluation was employed and the results from the Interprofessional Education Scale and focus group revealed that the students experienced positive perceptions of working collaboratively with other professions, forming good relationships with others, as well as an increased respect for the roles of other professions. The findings suggest that providing a capstone opportunity, where students can work as part of an interprofessional team with a real client, in a format they may come across in future clinical practice, may be beneficial in providing them with essential interprofessional skills as new graduate health professionals.

  20. Clinical experience of surgically treating giant neurofibromatosis-1.

    PubMed

    Chen, Baoguo; Xu, Minghuo; Song, Huifeng; Gao, Quanwen

    2017-02-01

    The surgical treatment for giant neurofibromatosis-1 (NF-1) requires comprehensive measures. Presently, there is no systematic description of surgical treatment. Because of its high level of risk, we want to share our clinical experience. From 2011 to 2014, patients (n = 8, 5 female and 3 male patients, aging from 31 to 45 years-old) were included in the study. The tumours were located on the trunk (n = 5) or face (n = 3). In addition to routine examination, blood storage was also prepared. Preoperative consultation from related departments was critical at first. Related artery embolisation was also carried out. In the operation, we checked thromboelastography, based on which reasonable blood component transfusion was implemented. Autologous blood transfusion was also ready. An instrument of copper needle or ring ligation was used to reduce haemorrhage before the surgery. Protruding or drooping portions of the tumours were excised. A pressurised bandage was applied when the surgery was completed. After the surgery, besides the routine monitoring of vital signs, re-haemorrhage should be detected in time. Then, we should decide whether blood transfusion or surgery was required again. Expanders were implanted in one female patient with facial injuries before removing the tumour. Then, expanded flaps were applied to repair the secondary wound. According to the above clinical route, after an average of 1-year follow-up, no patients died, and other unforeseen events did not occur. Wounds healed well in all patients. The tumor was excised as much as possible. No facial nerve paralysis occurred in the facial sites. Expanded flaps necrosis WAS not encountered. It is essential to design the educational clinical route for treating NF-1 when a giant protruding tumour is advised to be excised, which can minimise the risk of surgery and assure us of the maximum range of resection. © 2016 Medicalhelplines.com Inc and John Wiley & Sons Ltd.

  1. Asian Americans and Cancer Clinical Trials: A Mixed-Methods Approach to Understanding Awareness and Experience

    PubMed Central

    Paterniti, Debora A.; Chen, Moon S.; Chiechi, Christine; Beckett, Laurel A.; Horan, Nora; Turrell, Corinne; Smith, Ligaya; Morain, Claudia; Montell, Lisa; Gonzalez, Jose Luis; Davis, Sharon; Lara, Primo N.

    2006-01-01

    Cancer clinical trials have been based on low accrual rates. Barriers to recruitment of minority populations affect the generalizability and impact of trial findings for those populations. The authors undertook a mixed-methods approach to understanding levels of awareness and experiences with cancer clinical trials. A survey was administered to new cancer patients and their caretakers (family, close friends, or other social support) at outpatient oncology clinics. Field observations of the trial accrual process also were conducted by employing the grounded theory approach in qualitative methods. Comparison of survey results for Asian-American respondents and non-Asian respondents indicated that Asians were less likely to have heard the term “clinical trial” and were more likely to define a clinical trial as “an experiment” or “a test procedure in a clinic” than non-Asians. Asians were more likely to have employer-based insurance and to report understanding issues related to cost reimbursement. Asians were less likely to have been involved in or to know someone in a trial and reported less willingness than white respondents to consider trial participation. Qualitative observations suggested that Asians who presented for a potential trial were interested in the availability of a novel cancer therapy but were not eligible for available trials. Multiple strategies will be necessary to enhance awareness of and experience with accrual to cancer clinical trials for Asians, including richer understanding and increased involvement of Asians in cancer clinical trials and greater attention to the location and diversity of the Asian population in structuring study centers and evaluating trial results. PMID:16247795

  2. Predictive power of individual factors and clinical learning experience on academic success: findings from a longitudinal study.

    PubMed

    Dante, Angelo; Fabris, Stefano; Palese, Alvisa

    2015-01-01

    Academic failure is the inability of a nursing student to graduate or to complete the nursing degree on time. This longitudinal cohort study, involving 2 Italian universities, documents the effects of selected individual variables and the quality of the clinical learning experience as perceived by students on academic success. Factors related to the clinical learning experience were the quality of the supervisory relationship, pedagogical atmosphere, and commitment of the ward related to the level of personalized nursing care delivered and clarity of nursing documentation.

  3. Eight months of clinical experience with the Self-Adjusting File system.

    PubMed

    Solomonov, Michael

    2011-06-01

    The Self-Adjusting File (SAF) system (ReDent-Nova, Ra'anana, Israel) has been recently introduced for the simultaneous instrumentation and irrigation of root canals. The SAF is claimed to adapt itself three dimensionally to the root canal, including its cross-section. It is operated with a continuous flow of sodium hypochlorite that is delivered into the root canal through the hollow file and claimed to be activated by sonic agitation of the irrigant. Our aim was to present for the first time clinical cases prepared with the SAF system and to describe a clinical classification of canals, according to their difficulty, with recommendations for endodontic treatment sequences for each category. This report is based on the experience of a single endodontist, who used the system to treat more than 50 consecutive primary endodontic cases over the prior 8 months. A clinical classification was developed which enabled the operator to select a treatment protocol for easy and optimal glide path preparation to be effectively used with the SAF file in the various root canals encountered in the clinical environment. Clinical classification of canal difficulty makes root canal treatment sequences with the SAF simple and predictable. Many types of cases can be treated with the SAF system although a novice user is advised to advance slowly along the learning curve from simpler to more complicated canals. Copyright © 2011 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.

  4. A Radiobiological Analysis of Multicenter Data for Postoperative Keloid Radiotherapy

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Flickinger, John C., E-mail: flickingerjc@upmc.ed

    2011-03-15

    Purpose: To identify factors significantly affecting recurrence rates after postoperative external beam radiotherapy (XRT) of keloids, and to delineate any radiation dose response and effects of radiation dose per fraction. Methods and Materials: A comprehensive literature review was performed to compile a database of 2,515 resected keloids (36.9% earlobe). Postoperative XRT was 45- to 100-kV X-rays in 27.0% or 120- to 250-kV X-rays in 11.1%, Co-60 in 1.9%, Sr-90 in 4.7%, 1.5- to 9-MeV electrons in 26.5%, and no XRT in 28.8%. In the 1,791 irradiated patients, the median radiation parameters were as follows: total dose, 15 Gy (range, 6-30more » Gy); dose per fraction, 5.0 Gy (range, 2-15 Gy); fractions, 3 (range, 1-10); and time, 7 days (range, 0-33 days). Results: Multivariate stepwise logistic regression correlated decreased keloid recurrence with earlobe location (p = 1.98E-10; odds ratio, 0.34), biologically effective dose (p = 1.01E-27), and treatment with electron beam or Co-60 vs. other techniques (p = 0.0014; odds ratio, 0.72). Different radiobiological models calculated values of {alpha}/{beta} = 1.12 to 2.86 (mean, 2.08) and time (repopulation) correction factors for biologically effective dose from 0.98 to 2.13 Gy per day (mean, 1.34) starting 10 days after surgery. Different models (with {alpha}/{beta} = 2.08) predicted that doses needed for 90% and 95% control with 3 fractions of postoperative electron beam were 16.0 to 16.2 Gy and 18.3 to 19.2 Gy, respectively, in less than 10 days for earlobe keloids and 21.5 to 22.2 Gy and 23.4 to 24.8 Gy, respectively, in less than 10 days for other sites. Conclusions: Postoperative keloid radiotherapy requires moderately high doses and optimal technique to be effective. The relatively low {alpha}/{beta} ratio indicates that radiotherapy with a limited number of fractions and high doses per fraction is the best strategy.« less

  5. Mentor experiences of international healthcare students' learning in a clinical environment: A systematic review.

    PubMed

    Mikkonen, Kristina; Elo, Satu; Tuomikoski, Anna-Maria; Kääriäinen, Maria

    2016-05-01

    Globalisation has brought new possibilities for international growth in education and professional mobility among healthcare professionals. There has been a noticeable increase of international degree programmes in non-English speaking countries in Europe, creating clinical learning challenges for healthcare students. The aim of this systematic review was to describe mentors' experiences of international healthcare students' learning in a clinical environment. The objective of the review was to identify what influences the success or failure of mentoring international healthcare students when learning in the clinical environment, with the ultimate aim being to promote optimal mentoring practice. A systematic review was conducted according to the guidelines of the Centre for Reviews and Dissemination. Seven electronic databases were used to search for the published results of previous research: CINAHL, Medline Ovid, Scopus, the Web of Science, Academic Search Premiere, Eric, and the Cochrane Library. Search inclusion criteria were planned in the PICOS review format by including peer-reviewed articles published in any language between 2000 and 2014. Five peer-reviewed articles remained after the screening process. The results of the original studies were analysed using a thematic synthesis. The results indicate that a positive intercultural mentor enhanced reciprocal learning by improving the experience of international healthcare students and reducing stress in the clinical environment. Integrating international healthcare students into work with domestic students was seen to be important for reciprocal learning and the avoidance of discrimination. Many healthcare students were found to share similar experiences of mentoring and learning irrespective of their cultural background. However, the role of a positive intercultural mentor was found to make a significant difference for international students: such mentors advocated and mediated cultural differences and

  6. Learning experience of Chinese nursing students in an online clinical English course: qualitative study.

    PubMed

    Tang, Anson C Y; Wong, Nick; Wong, Thomas K S

    2015-02-01

    The low English proficiency of Chinese nurse/nursing students affects their performance when they work in English-speaking countries. However, limited resources are available to help them improve their workplace English, i.e. English used in a clinical setting. To this end, it is essential to look for an appropriate and effective means to assist them in improving their clinical English. The objective of this study is to evaluate the learning experience of Chinese nursing students after they have completed an online clinical English course. Focus group interview was used to explore their learning experience. 100 students in nursing programs at Tung Wah College were recruited. The inclusion criteria were: (1) currently enrolled in a nursing program; and (2) having clinical experience. Eligible participants self-registered for the online English course, and were required to complete the course within 3 months. After that, semi-structured interviews were conducted on students whom completed the whole and less than half of the course. One of the researchers joined each of the interviews as a facilitator and an observer. Thematic analysis was used to analyze the data. Finally, 7 themes emerged from the interviews: technical issues, adequacy of support, time requirement, motivation, clarity of course instruction, course design, and relevancy of the course. Participants had varied opinions on the 2 themes: motivation and relevancy of the course. Overall, results of this study suggest that the online English course helped students improve their English. Factors which support their learning are interactive course design, no time constraint, and relevancy to their work/study. Factors which detracted from their learning are poor accessibility, poor technical and learning support and no peer support throughout the course. Copyright © 2014. Published by Elsevier Ltd.

  7. Evaluation of dose response models and parameters predicting radiation induced pneumonitis using clinical data from breast cancer radiotherapy

    NASA Astrophysics Data System (ADS)

    Tsougos, Ioannis; Mavroidis, Panayiotis; Rajala, Juha; Theodorou, Kyriaki; Järvenpää, Ritva; Pitkänen, Maunu A.; Holli, Kaija; Ojala, Antti T.; Lind, Bengt K.; Hyödynmaa, Simo; Kappas, Constantin

    2005-08-01

    The purpose of this work is to evaluate the predictive strength of the relative seriality, parallel and LKB normal tissue complication probability (NTCP) models regarding the incidence of radiation pneumonitis, in a large group of patients following breast cancer radiotherapy, and furthermore, to illustrate statistical methods for examining whether certain published radiobiological parameters are compatible with a clinical treatment methodology and patient group characteristics. The study is based on 150 consecutive patients who received radiation therapy for breast cancer. For each patient, the 3D dose distribution delivered to lung and the clinical treatment outcome were available. Clinical symptoms and radiological findings, along with a patient questionnaire, were used to assess the manifestation of radiation-induced complications. Using this material, different methods of estimating the likelihood of radiation effects were evaluated. This was attempted by analysing patient data based on their full dose distributions and associating the calculated complication rates with the clinical follow-up records. Additionally, the need for an update of the criteria that are being used in the current clinical practice was also examined. The patient material was selected without any conscious bias regarding the radiotherapy treatment technique used. The treatment data of each patient were applied to the relative seriality, LKB and parallel NTCP models, using published parameter sets. Of the 150 patients, 15 experienced radiation-induced pneumonitis (grade 2) according to the radiation pneumonitis scoring criteria used. Of the NTCP models examined, the relative seriality model was able to predict the incidence of radiation pneumonitis with acceptable accuracy, although radiation pneumonitis was developed by only a few patients. In the case of modern breast radiotherapy, radiobiological modelling appears to be very sensitive to model and parameter selection giving clinically

  8. Dosimetric and radiobiological comparison of volumetric modulated arc therapy, high-dose rate brachytherapy, and low-dose rate permanent seeds implant for localized prostate cancer.

    PubMed

    Yang, Ruijie; Zhao, Nan; Liao, Anyan; Wang, Hao; Qu, Ang

    2016-01-01

    To investigate the dosimetric and radiobiological differences among volumetric modulated arc therapy (VMAT), high-dose rate (HDR) brachytherapy, and low-dose rate (LDR) permanent seeds implant for localized prostate cancer. A total of 10 patients with localized prostate cancer were selected for this study. VMAT, HDR brachytherapy, and LDR permanent seeds implant plans were created for each patient. For VMAT, planning target volume (PTV) was defined as the clinical target volume plus a margin of 5mm. Rectum, bladder, urethra, and femoral heads were considered as organs at risk. A 78Gy in 39 fractions were prescribed for PTV. For HDR and LDR plans, the dose prescription was D90 of 34Gy in 8.5Gy per fraction, and 145Gy to clinical target volume, respectively. The dose and dose volume parameters were evaluated for target, organs at risk, and normal tissue. Physical dose was converted to dose based on 2-Gy fractions (equivalent dose in 2Gy per fraction, EQD2) for comparison of 3 techniques. HDR and LDR significantly reduced the dose to rectum and bladder compared with VMAT. The Dmean (EQD2) of rectum decreased 22.36Gy in HDR and 17.01Gy in LDR from 30.24Gy in VMAT, respectively. The Dmean (EQD2) of bladder decreased 6.91Gy in HDR and 2.53Gy in LDR from 13.46Gy in VMAT. For the femoral heads and normal tissue, the mean doses were also significantly reduced in both HDR and LDR compared with VMAT. For the urethra, the mean dose (EQD2) was 80.26, 70.23, and 104.91Gy in VMAT, HDR, and LDR brachytherapy, respectively. For localized prostate cancer, both HDR and LDR brachytherapy were clearly superior in the sparing of rectum, bladder, femoral heads, and normal tissue compared with VMAT. HDR provided the advantage in sparing of urethra compared with VMAT and LDR. Copyright © 2016 American Association of Medical Dosimetrists. Published by Elsevier Inc. All rights reserved.

  9. Dosimetric and radiobiological comparison of volumetric modulated arc therapy, high-dose rate brachytherapy, and low-dose rate permanent seeds implant for localized prostate cancer

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Yang, Ruijie, E-mail: ruijyang@yahoo.com; Zhao, Nan; Liao, Anyan

    To investigate the dosimetric and radiobiological differences among volumetric modulated arc therapy (VMAT), high-dose rate (HDR) brachytherapy, and low-dose rate (LDR) permanent seeds implant for localized prostate cancer. A total of 10 patients with localized prostate cancer were selected for this study. VMAT, HDR brachytherapy, and LDR permanent seeds implant plans were created for each patient. For VMAT, planning target volume (PTV) was defined as the clinical target volume plus a margin of 5 mm. Rectum, bladder, urethra, and femoral heads were considered as organs at risk. A 78 Gy in 39 fractions were prescribed for PTV. For HDR andmore » LDR plans, the dose prescription was D{sub 90} of 34 Gy in 8.5 Gy per fraction, and 145 Gy to clinical target volume, respectively. The dose and dose volume parameters were evaluated for target, organs at risk, and normal tissue. Physical dose was converted to dose based on 2-Gy fractions (equivalent dose in 2 Gy per fraction, EQD{sub 2}) for comparison of 3 techniques. HDR and LDR significantly reduced the dose to rectum and bladder compared with VMAT. The D{sub mean} (EQD{sub 2}) of rectum decreased 22.36 Gy in HDR and 17.01 Gy in LDR from 30.24 Gy in VMAT, respectively. The D{sub mean} (EQD{sub 2}) of bladder decreased 6.91 Gy in HDR and 2.53 Gy in LDR from 13.46 Gy in VMAT. For the femoral heads and normal tissue, the mean doses were also significantly reduced in both HDR and LDR compared with VMAT. For the urethra, the mean dose (EQD{sub 2}) was 80.26, 70.23, and 104.91 Gy in VMAT, HDR, and LDR brachytherapy, respectively. For localized prostate cancer, both HDR and LDR brachytherapy were clearly superior in the sparing of rectum, bladder, femoral heads, and normal tissue compared with VMAT. HDR provided the advantage in sparing of urethra compared with VMAT and LDR.« less

  10. Perceptions of Co-Teaching in the Clinical Experience: How Well Is It Working?

    ERIC Educational Resources Information Center

    Kinne, Lenore J.; Ryan, Carol; Faulkner, Shawn A.

    2016-01-01

    This study examined the perceptions of teacher candidates, cooperating teachers, and university supervisors in the first year of state-mandated co-teaching in the clinical experience. Study results suggest the need (a) to emphasize the importance of the teacher candidate exerting leadership, (b) to develop and communicate specific criteria for…

  11. Simultaneous integrated intensity-modulated radiotherapy boost for locally advanced gynecological cancer: Radiobiological and dosimetric considerations

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Guerrero, Mariana; Li, X. Allen; Ma Lijun

    2005-07-01

    Purpose: Whole-pelvis irradiation (WPI) followed by a boost to the tumor site is the standard of practice for the radiotherapeutic management of locally advanced gynecologic cancers. The boost is frequently administered by use of brachytherapy or, occasionally, external-beam radiotherapy (EBRT) when brachytherapy does not provide sufficient coverage because of the size of the tumor or the geometry of the patient. In this work, we propose using an intensity-modulated radiotherapy (IMRT) simultaneous integrated boost (SIB), which is a single-phase process, to replace the conventional two-phase process involving WPI plus a boost. Radiobiological modeling is used to design appropriate regimens for themore » IMRT SIB. To demonstrate feasibility, a dosimetric study is carried out on an example patient. Methods and Materials: The standard linear-quadratic (LQ) model is used to calculate the biologically effective dose (BED) and equivalent uniform dose (EUD). A series of regimens that are biologically equivalent to those conventional two-phase treatments is calculated for the proposed SIB. A commercial inverse planning system (Corvus) was used to generate IMRT SIB plans for a sample patient case that used the newly designed fractionations. The dose-volume histogram (DVH) and EUD of both the target and normal structures for conventional treatments and the SIB are compared. A sparing factor was introduced to characterize the sparing of normal structures. Results: Fractionation regimes that are equivalent to the conventional treatments and are suitable for the IMRT SIB are deduced. For example, a SIB plan with 25 x 3.1 Gy (77.5 Gy) to a tumor is equivalent to a conventional treatment of EBRT of 45 Gy to the whole pelvis in 25 fractions plus a high-dose rate (HDR) brachytherapy boost with 30 Gy in 5 fractions. The normal tissue BED is found to be lower for the SIB plan than for the whole-pelvis plus HDR scheme when a sparing factor for the critical structures is considered

  12. Basic principles of molecular effects of irradiation.

    PubMed

    Selzer, Edgar; Hebar, Alexandra

    2012-02-01

    In order to understand the consequences of radiation a thorough understanding of the radiobiological mechanisms of the molecular up to the clinical level is of importance. Radiobiology therefore combines the basic principles of physics as well as biology and medicine and is concerned with the action of radiation from the subcellular level up to the living organism. Topics of interest and relevance are covered in much more broadness as is possible in the short following article in the literature to which the interested reader is referred to. Classical books in this field were written by Steel et al. (1989) as well as by Hall (1994). Topics usually covered by radiobiological reviews are the classification of different types of radiation, cell cycle dependency of radiation effects, types of radiation damage and cell death, dose response curves, measurement of radiation damage, the oxygen effect, relative biological effectiveness, the influence of dose rate, and several other important research areas. This short overview will concentrate on a subset of radiobiological topics of high importance and relative novelty.

  13. Internet-based virtual classroom and educational management software enhance students' didactic and clinical experiences in perfusion education programs.

    PubMed

    Riley, Jeffrey B; Austin, Jon W; Holt, David W; Searles, Bruce E; Darling, Edward M

    2004-09-01

    A challenge faced by many university-based perfusion education (PE) programs is the need for student clinical rotations at hospital locations that are geographically disparate from the main educational campus. The problem has been addressed through the employment of distance-learning environments. The purpose of this educational study is to evaluate the effectiveness of this teaching model as it is applied to PE. Web-based virtual classroom (VC) environments and educational management system (EMS) software were implemented independently and as adjuncts to live, interactive Internet-based audio/video transmission from classroom to classroom in multiple university-based PE programs. These Internet environments have been used in a variety of ways including: 1) forum for communication between the university faculty, students, and preceptors at clinical sites, 2) didactic lectures from expert clinicians to students assigned to distant clinical sites, 3) small group problem-based-learning modules designed to enhance students analytical skills, and 4) conversion of traditional face-to-face lectures to asynchronous learning modules. Hypotheses and measures of student and faculty satisfaction, clinical experience, and learning outcomes are proposed, and some early student feedback was collected. For curricula that emphasize both didactic and clinical education, the use of Internet-based VC and EMS software provides significant advancements over traditional models. Recognized advantages include: 1) improved communications between the college faculty and the students and clinical preceptors, 2) enhanced access to a national network of clinical experts in specialized techniques, 3) expanded opportunity for student distant clinical rotations with continued didactic course work, and 4) improved continuity and consistency of clinical experiences between students through implementation of asynchronous learning modules. Students recognize the learning efficiency of on

  14. The importance of surgeon experience for clinical and economic outcomes from thyroidectomy.

    PubMed Central

    Sosa, J A; Bowman, H M; Tielsch, J M; Powe, N R; Gordon, T A; Udelsman, R

    1998-01-01

    OBJECTIVE: To determine whether individual surgeon experience is associated with improved short-term clinical and economic outcomes for patients with benign and malignant thyroid disease who underwent thyroid procedures in Maryland between 1991 and 1996. SUMMARY BACKGROUND DATA: There is a prevailing belief that surgeon experience affects patient outcomes in endocrine surgery, but there is a paucity of objective evidence outside of clinical series published by experienced surgeons that supports this view. METHODS: A cross-sectional analysis of all patients who underwent thyroidectomy in Maryland between 1991 and 1996 was conducted using a computerized statewide hospital discharge data base. Surgeons were categorized by volume of thyroidectomies over the 6-year study period: A (1 to 9 cases), B (10 to 29 cases), C (30 to 100 cases), and D (>100 cases). Multivariate regression was used to assess the relation between surgeon caseload and in-hospital complications, length of stay, and total hospital charges, adjusting for case mix and hospital volume. RESULTS: The highest-volume surgeons (group D) performed the greatest proportion of total thyroidectomies among the 5860 discharges, and they were more likely to operate on patients with cancer. After adjusting for case mix and hospital volume, highest-volume surgeons had the shortest length of stay (1.4 days vs. 1.7 days for groups B and C and 1.9 days for group A) and the lowest complication rate (5.1 % vs. 6.1% for groups B and C and 8.6% for group A). Length of stay and complications were more determined by surgeon experience than hospital volume, which had no consistent association with outcomes. CONCLUSIONS: Individual surgeon experience is significantly associated with complication rates and length of stay for thyroidectomy. PMID:9742915

  15. Exploring factors related to the translation of collaborative research learning experiences into clinical practice: Opportunities and tensions.

    PubMed

    Fletcher, Simon; Whiting, Cheryl; Boaz, Annette; Reeves, Scott

    2017-07-01

    Providing training opportunities to develop research skills for clinical staff has been prioritised in response to the need for improving the evidence base underpinning the delivery of care. By exploring the experiences of a number of former participants of a multidisciplinary postgraduate research course, this article explores the factors that have enabled and impeded staff to translate their learnt research skills into clinical practice. Adopting an exploratory case study approach, 16 interviews with 5 cohorts of Masters by Research in Clinical Practice (MResCP) graduates were undertaken. The interviews explored graduates' course experiences and their subsequent attempts to undertake clinical research. Analysis of the data indicated that although participants valued their interactions with colleagues from different professions and felt they gained useful research skills/knowledge, upon returning to clinical practice, they encountered a number of barriers which restricted their ability to apply their research expertise. Professional isolation, issues of hierarchy, and a lack of organisational support were key to limiting their ability to undertake clinical research. Further work is needed to explore in more depth how (i) these barriers can be overcome and (ii) how taught collaborative research skills can be more effectively translated into practice.

  16. Clinical Experience in Late Antiquity: Alexander of Tralles and the Therapy of Epilepsy

    PubMed Central

    Bouras-vallianatos, Petros

    2014-01-01

    Alexander of Tralles, writing in the late sixth century, combined his wide-ranging practical knowledge with earlier medical theories. This article shows how clinical experience is used in Alexander’s works by concentrating on his therapeutic advice on epilepsy and, in particular, on pharmacology and the group of so-called natural remedies. I argue that clinical testing is used not only for the introduction of new medicines but also as an instrument for checking the therapeutic effect of popular healing practices. On another level, this article discusses Alexander’s role as the author of a medical compendium; it suggests that by marking the cases of clinical testing with a set of recurrent expressions, Alexander leads his audience to reflect on his medical authority and personal contribution. PMID:25045178

  17. 42 CFR 482.80 - Condition of participation: Data submission, clinical experience, and outcome requirements for...

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... center. (3) A pancreas transplant center is not required to comply with the clinical experience... pancreas transplants performed at the center. (4) A center that is requesting initial Medicare approval to...

  18. An Eight-Year Clinic Experience with Clozapine Use in a Parkinson’s Disease Clinic Setting

    PubMed Central

    Hack, Nawaz; Fayad, Sarah M.; Monari, Erin H.; Akbar, Umer; Hardwick, Angela; Rodriguez, Ramon L.; Malaty, Irene A.; Romrell, Janet; Shukla, Aparna A. Wagle.; McFarland, Nikolaus; Ward, Herbert E.; Okun, Michael S.

    2014-01-01

    Background To examine our eight year clinic-based experience in a Parkinson’s disease expert clinical care center using clozapine as a treatment for refractory psychosis in Parkinson's disease (PD). Methods The study was a retrospective chart review which covered eight years of clozapine registry use. Statistical T-tests, chi-square, correlations and regression analysis were used to analyze treatment response for potential associations of age, disease duration, and Hoehn & Yahr (H&Y) score, and degree of response to clozapine therapy. Results There were 36 participants included in the analysis (32 PD, 4 parkinsonism-plus). The characteristics included 30.6% female, age 45–87 years (mean 68.3±10.15), disease duration of 17–240 months (mean 108.14±51.13) and H&Y score of 2 to 4 (mean 2.51±0.51). The overall retention rate on clozapine was 41% and the most common reasons for discontinuation were frequent blood testing (28%), nursing home (NH) placement (11%) and leucopenia (8%). Responses to clozapine across the cohort were: complete (33%), partial (33%), absent (16%), and unknown (16%). Age (r = −0.36, p<0.01) and H&Y score (r = −0.41, p<0.01) were shown to be related to response to clozapine therapy, but disease duration was not an associated factor (r = 0.21, p>0.05). Conclusions This single-center experience highlights the challenges associated with clozapine therapy in PD psychosis. Frequent blood testing remains a significant barrier for clozapine, even in patients with therapeutic benefit. Surprisingly, all patients admitted to a NH discontinued clozapine due to logistical issues of administration and monitoring within that setting. Consideration of the barriers to clozapine therapy will be important to its use and to its continued success in an outpatient setting. PMID:24646688

  19. Experience of isolated sleep paralysis in clinical practice in Nigeria.

    PubMed

    Ohaeri, J U

    1992-06-01

    The supernatural fears associated with the experience of isolated sleep paralysis in the culture of developing countries is sometimes associated with the evolution of somatic symptoms of psychological origin in patients predisposed to neurotic illness. Patients rarely spontaneously volunteer these fears and doctors pay them scant attention. Illustrative case histories that demonstrate the dynamics of the clinical presentation, as well as the treatment approach, are highlighted. It is hoped that doctors in general medical practice and in psychological medicine in developing countries where belief in supernatural causation of illness is rife will consider these factors in order to provide more effective treatment.

  20. Outcomes of transoral robotic surgery: a preliminary clinical experience.

    PubMed

    Hurtuk, Agnes; Agrawal, Amit; Old, Matthew; Teknos, Theodoros N; Ozer, Enver

    2011-08-01

    To report a single institution's experience with transoral robotic surgery (TORS) and its clinical outcomes. Preliminary clinical data from a prospective TORS study. University tertiary care facility. Patients who underwent TORS at The Ohio State University Medical Center. Demographic, intraoperative, clinicopathological, and follow-up functional data were collected. Sixty-four patients underwent TORS with a median age of 56.9 years. A total of 113 TORS procedures were performed. Fifty-four patients with squamous cell cancer (SCCA) were included in the final analysis. Mean follow-up time was 11.8 months (range, 2-29). There was a trend toward longer TORS setup time, operative time, estimated blood loss, and hospital length of stay with advanced (T(3)) compared with early-stage tumors (T(1-2)). There were no major intraoperative complications, and none of the procedures were aborted because of inability to remove the tumor. Negative resection margins were achieved in 93% of cases of SCCA. No patients experienced immediate postoperative complications, and all of the patients tolerated an oral diet without any airway compromise on the day of surgery. Forty-nine patients (91%) underwent adjuvant radiation therapy (RT), with 11 patients requiring gastrostomy tube placement during RT. Addition of TORS to overall management of head and neck SCCA spared adjuvant RT or combined chemotherapy and RT (CRT) in 50% of stage I/II tumors and spared chemotherapy in 34% of stage III/IV tumors. TORS is a safe procedure with minimal complications and favorable clinical and functional outcomes. It is a promising future alternative surgical treatment for laryngopharyngeal tumors.

  1. DOE Office of Scientific and Technical Information (OSTI.GOV)

    Granzotto, Adeline; Benadjaoud, Mohamed Amine; Vogin, Guillaume

    Purpose: Whereas post–radiation therapy overreactions (OR) represent a clinical and societal issue, there is still no consensual radiobiological endpoint to predict clinical radiosensitivity. Since 2003, skin biopsy specimens have been collected from patients treated by radiation therapy against different tumor localizations and showing a wide range of OR. Here, we aimed to establish quantitative links between radiobiological factors and OR severity grades that would be relevant to radioresistant and genetic hyperradiosensitive cases. Methods and Materials: Immunofluorescence experiments were performed on a collection of skin fibroblasts from 12 radioresistant, 5 hyperradiosensitive, and 100 OR patients irradiated at 2 Gy. The numbers ofmore » micronuclei, γH2AX, and pATM foci that reflect different steps of DNA double-strand breaks (DSB) recognition and repair were assessed from 10 minutes to 24 hours after irradiation and plotted against the severity grades established by the Common Terminology Criteria for Adverse Events and the Radiation Therapy Oncology Group. Results: OR patients did not necessarily show a gross DSB repair defect but a systematic delay in the nucleoshuttling of the ATM protein required for complete DSB recognition. Among the radiobiological factors, the maximal number of pATM foci provided the best discrimination among OR patients and a significant correlation with each OR severity grade, independently of tumor localization and of the early or late nature of reactions. Conclusions: Our results are consistent with a general classification of human radiosensitivity based on 3 groups: radioresistance (group I); moderate radiosensitivity caused by delay of nucleoshuttling of ATM, which includes OR patients (group II); and hyperradiosensitivity caused by a gross DSB repair defect, which includes fatal cases (group III).« less

  2. CDC Kerala 5: Developmental therapy clinic experience--use of Child Development Centre grading for motor milestones.

    PubMed

    Nair, M K C; Resmi, V R; Krishnan, Rajee; Harikumaran Nair, G S; Leena, M L; Bhaskaran, Deepa; George, Babu; Russell, Paul Swamidhas Sudhakar

    2014-12-01

    To document the experiences of the intervention given to children who attended the developmental therapy clinic of Child Development Centre (CDC) Kerala, a specialized clinic for providing developmental intervention/therapy for babies less than two years with developmental delay/disability. All the babies referred to this speciality clinic from developmental screening/evaluation clinics of CDC were registered in the clinic and re-evaluation was done using CDC grading for head holding, sitting, standing, Amiel Tison passive angles, and Trivandrum Developmental Screening Chart (TDSC) 0-2 y. Out of a total of 600 consecutive babies below 2 y with developmental delay/disability referred to developmental therapy clinic, on comparing the test results at enrollment and after 6 mo of intervention, a statistically significant reduction was observed (i) in the 2-4 mo age group with regard to abnormal TDSC (25.5%), (ii) in the 4-8 mo age group with regard to abnormal head holding grade (87.1%) and abnormal TDSC (19.4%), (iii) in the 8-12 mo age group, with regard to abnormal sitting grade (71.7%) and (iv) in the above 12 mo age group with regard to abnormal sitting grade (35.3%) and abnormal standing grade (78.8%). The experience of organizing the developmental intervention/therapy clinic at CDC Kerala has shown that therapy services by developmental therapists in a centre and supportive therapy by mother at home is useful in improving the developmental status of children with developmental delay.

  3. Does reflective web-based discussion strengthen nursing students' learning experiences during clinical training?

    PubMed

    Mettiäinen, Sari; Vähämaa, Kristiina

    2013-09-01

    The aim of this research was to study how a web-based discussion forum can be used as a supervision tool during nursing students' clinical training. The study emphasises peer support and its importance for the students. The empirical research was carried out at a Finnish university of applied sciences. 25 nursing students took part in web-based discussion during their eight-week clinical training period. All in all, 395 comments were submitted. The material was analysed by using categorisation and a thematic analysis process. Finally, the results were reported using a modified Salmon's (2002) 5-stage model of Teaching and Learning On-line and Mezirow's (1981) levels of reflection. The students motivated each other by sharing their feelings and experiences. They noticed the value of peer support and started to learn from each other as well. By reflecting on their experiences, the students progressed in their learning process and at the same time advanced their reflective thinking process. This combination of theoretical knowledge and practice, based on the students' needs and interests, could lead to a deeper understanding which could also result in better clinical skills. This method offers the lecturers the possibility to support and follow the professional growth process in a new evidence-based manner. Copyright © 2012 Elsevier Ltd. All rights reserved.

  4. A radiobiology-based inverse treatment planning method for optimisation of permanent l-125 prostate implants in focal brachytherapy.

    PubMed

    Haworth, Annette; Mears, Christopher; Betts, John M; Reynolds, Hayley M; Tack, Guido; Leo, Kevin; Williams, Scott; Ebert, Martin A

    2016-01-07

    Treatment plans for ten patients, initially treated with a conventional approach to low dose-rate brachytherapy (LDR, 145 Gy to entire prostate), were compared with plans for the same patients created with an inverse-optimisation planning process utilising a biologically-based objective. The 'biological optimisation' considered a non-uniform distribution of tumour cell density through the prostate based on known and expected locations of the tumour. Using dose planning-objectives derived from our previous biological-model validation study, the volume of the urethra receiving 125% of the conventional prescription (145 Gy) was reduced from a median value of 64% to less than 8% whilst maintaining high values of TCP. On average, the number of planned seeds was reduced from 85 to less than 75. The robustness of plans to random seed displacements needs to be carefully considered when using contemporary seed placement techniques. We conclude that an inverse planning approach to LDR treatments, based on a biological objective, has the potential to maintain high rates of tumour control whilst minimising dose to healthy tissue. In future, the radiobiological model will be informed using multi-parametric MRI to provide a personalised medicine approach.

  5. A radiobiology-based inverse treatment planning method for optimisation of permanent l-125 prostate implants in focal brachytherapy

    NASA Astrophysics Data System (ADS)

    Haworth, Annette; Mears, Christopher; Betts, John M.; Reynolds, Hayley M.; Tack, Guido; Leo, Kevin; Williams, Scott; Ebert, Martin A.

    2016-01-01

    Treatment plans for ten patients, initially treated with a conventional approach to low dose-rate brachytherapy (LDR, 145 Gy to entire prostate), were compared with plans for the same patients created with an inverse-optimisation planning process utilising a biologically-based objective. The ‘biological optimisation’ considered a non-uniform distribution of tumour cell density through the prostate based on known and expected locations of the tumour. Using dose planning-objectives derived from our previous biological-model validation study, the volume of the urethra receiving 125% of the conventional prescription (145 Gy) was reduced from a median value of 64% to less than 8% whilst maintaining high values of TCP. On average, the number of planned seeds was reduced from 85 to less than 75. The robustness of plans to random seed displacements needs to be carefully considered when using contemporary seed placement techniques. We conclude that an inverse planning approach to LDR treatments, based on a biological objective, has the potential to maintain high rates of tumour control whilst minimising dose to healthy tissue. In future, the radiobiological model will be informed using multi-parametric MRI to provide a personalised medicine approach.

  6. Athletic Training Students' and Preceptors' Perceptions of Active Learning Time and Bug-in-Ear Technology during Clinical Education Experiences

    ERIC Educational Resources Information Center

    Nottingham, Sara L.; Kasamatsu, Tricia M.; Montgomery, Melissa M.

    2017-01-01

    Context: Engaging clinical experiences that allow extensive active learning and patient care interactions are important for the professional development of athletic training students. Understanding students' use of clinical time is important when attempting to improve these experiences. Objective: To gain participants' perspectives on active…

  7. Doctors' experience with handheld computers in clinical practice: qualitative study.

    PubMed

    McAlearney, Ann Scheck; Schweikhart, Sharon B; Medow, Mitchell A

    2004-05-15

    To examine doctors' perspectives about their experiences with handheld computers in clinical practice. Qualitative study of eight focus groups consisting of doctors with diverse training and practice patterns. Six practice settings across the United States and two additional focus group sessions held at a national meeting of general internists. 54 doctors who did or did not use handheld computers. Doctors who used handheld computers in clinical practice seemed generally satisfied with them and reported diverse patterns of use. Users perceived that the devices helped them increase productivity and improve patient care. Barriers to use concerned the device itself and personal and perceptual constraints, with perceptual factors such as comfort with technology, preference for paper, and the impression that the devices are not easy to use somewhat difficult to overcome. Participants suggested that organisations can help promote handheld computers by providing advice on purchase, usage, training, and user support. Participants expressed concern about reliability and security of the device but were particularly concerned about dependency on the device and over-reliance as a substitute for clinical thinking. Doctors expect handheld computers to become more useful, and most seem interested in leveraging (getting the most value from) their use. Key opportunities with handheld computers included their use as a stepping stone to build doctors' comfort with other information technology and ehealth initiatives and providing point of care support that helps improve patient care.

  8. Running a postmortem service--a business case and clinical experience.

    PubMed

    Cohen, Marta C; Whitby, Elspeth; Fink, Michelle A; Collett, Jacquelene M; Offiah, Amaka C

    2015-04-01

    The purpose of the postmortem examination is to offer answers to explain the cause and manner of death. In the case of perinatal, infant and paediatric postmortem examinations, the goal is to identify unsuspected associated features, to describe pathogenic mechanisms and new conditions, and to evaluate the clinical management and diagnosis. Additionally, the postmortem examination is useful to counsel families regarding the probability of recurrence in future pregnancies and to inform family planning. Worldwide the rate of paediatric autopsy examinations has significantly declined during the last few decades. Religious objections to postmortem dissection and organ retention scandals in the United Kingdom provided some of the impetus for a search for non-invasive alternatives to the traditional autopsy; however, until recently, imaging studies remained an adjunct to, rather than a replacement for, the traditional autopsy. In 2012, Sheffield Children's Hospital National Health Service Foundation Trust set up the service provision of minimally invasive fetal, perinatal and neonatal autopsy, while a postmortem imaging service has been running in Melbourne, Australia, since 2008. Here we summarise the essentials of a business case and practical British and Australian experiences in terms of the pathological and radiologic aspects of setting up a minimally invasive clinical service in the United Kingdom and of developing a clinical postmortem imaging service as a complementary tool to the traditional autopsy in Australia.

  9. Building capacity in Clinical Epidemiology in Africa: experiences from Masters programmes.

    PubMed

    Young, Taryn; Naude, Celeste; Brodovcky, Tania; Esterhuizen, Tonya

    2017-02-27

    To describe and contrast programmatic offering of Clinical Epidemiology Masters programmes in Africa, to evaluate experiences of graduates and faculty, and assess if graduates are playing roles in research, practice and teaching of Clinical Epidemiology. We searched and identified relevant programmes, reviewed programmatic documentation, interviewed convenors and surveyed graduates. Participants provided informed consent, interviews with faculty were recorded and transcribed for analysis purposes, and graduates participated in an online survey. Five structured Masters programmes requiring health science professionals to complete modules and research projects were assessed. Demand for programmes was high. Graduates enjoyed the variety of modules, preferred blended teaching, and regarded assessments as fair. Graduates felt that career paths were not obvious after graduating. Despite this, some have gone on to promote and teach evidence-based health care, and conduct and disseminate research. Areas of concern raised by faculty were quality assurance; research project initiation, implementation and supervisory capacity; staff availability; funding to support implementation and lack of experiential learning. Although faced with challenges, these programmes build capacity of health professionals to practice in an evidence-informed way, and conduct rigorous research, which are central to advancing the practice of Clinical Epidemiology in Africa.

  10. The role of religiosity, coping strategies, self-efficacy and personality dimensions in the prediction of Iranian undergraduate rehabilitation interns' satisfaction with their clinical experience.

    PubMed

    Mirsaleh, Y R; Rezai, H; Kivi, S R; Ghorbani, R

    2010-12-01

    to investigate the relationship between religiosity, coping styles, self-efficacy and personality dimensions as predictors of satisfaction with clinical experience in rehabilitation interns during transition from academic study to clinical internship. a cross-sectional survey design. five rehabilitation faculties. three hundred and eighteen undergraduate rehabilitation interns, including physical therapy, occupational therapy and speech and language pathology students. Islamic Religiosity Scale, Ways of Coping Questionnaire, General Self-efficacy Scale, NEO Five Factor Inventory, and Satisfaction with Clinical Experiences Questionnaire. religiosity, problem-focused coping and general self-efficacy had significant positive correlation with satisfaction with clinical internship in rehabilitation students. Among personality dimensions, openness, agreement and consciousness had significant positive correlation with satisfaction with clinical experience and neuroticism had significant negative correlation with satisfaction with clinical experience. The results of regression analysis demonstrated that religiosity and self-efficacy had important roles in the prediction of satisfaction with clinical experience in all the rehabilitation intern students of three disciplines (physical therapy, occupational therapy, and speech and language pathology). religiosity, problem-focused coping and general self-efficacy seem to be good predictors of satisfaction with clinical internship in rehabilitation students.

  11. Introductory Laboratory Exercises in Radiobiology

    ERIC Educational Resources Information Center

    Williams, J. R. Parry; Servant, D. M.

    1970-01-01

    Describes experiments suitable for introducing use of radioisotopes in biology. Includes demonstrations of tracing food chains, uptake of ions by plants, concentration of elements by insects, tracing photosynthetic reactions, activation analysis of copper, and somatic and genetic effects. Uses autoradiographic and counting techniques. (AL)

  12. Clinical experiences with an ASP model backup archive for PACS images

    NASA Astrophysics Data System (ADS)

    Liu, Brent J.; Cao, Fei; Documet, Luis; Huang, H. K.; Muldoon, Jean

    2003-05-01

    Last year we presented a Fault-Tolerant Backup Archive using an Application Service Provider (ASP) model for disaster recovery. The purpose of this paper is to update and provide clinical experiences related towards implementing the ASP model archive solution for short-term backup of clinical PACS image data as well as possible applications other than disaster recovery. The ASP backup archive provides instantaneous, automatic backup of acquired PACS image data and instantaneous recovery of stored PACS image data all at a low operational cost and with little human intervention. This solution can be used for a variety of scheduled and unscheduled downtimes that occur on the main PACS archive. A backup archive server with hierarchical storage was implemented offsite from the main PACS archive location. Clinical data from a hospital PACS is sent to this ASP storage server in parallel to the exams being archived in the main server. Initially, connectivity between the main archive and the ASP storage server is established via a T-1 connection. In the future, other more cost-effective means of connectivity will be researched such as the Internet 2. We have integrated the ASP model backup archive with a clinical PACS at Saint John's Health Center and has been operational for over 6 months. Pitfalls encountered during integration with a live clinical PACS and the impact to clinical workflow will be discussed. In addition, estimations of the cost of establishing such a solution as well as the cost charged to the users will be included. Clinical downtime scenarios, such as a scheduled mandatory downtime and an unscheduled downtime due to a disaster event to the main archive, were simulated and the PACS exams were sent successfully from the offsite ASP storage server back to the hospital PACS in less than 1 day. The ASP backup archive was able to recover PACS image data for comparison studies with no complex operational procedures. Furthermore, no image data loss was

  13. E-Alerts: Environmental pollution and control (environmental health and safety). E-mail newsletter

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    NONE

    Topics of discussion include the following: Effects of pollution on public health and safety; Toxicology; Industrial health; Physiology; Psychology; Clinical medicine; Radiobiology; Animals used as research experimental models.

  14. Student Reflection Papers on a Global Clinical Experience: A Qualitative Study.

    PubMed

    Margolis, Carmi Z; Rohrbaugh, Robert M; Tsang, Luisa; Fleischer, Jennifer; Graham, Mark J; Kellett, Anne; Hafler, Janet P

    Many of the 70,000 graduating US medical students [per year] have reported participating in a global health activity at some stage of medical school. This case study design provided a method for understanding the student's experience that included student's learning about culture, health disparities, exposure and reaction to a range of diseases actually encountered. The broad diversity of themes among students indicated that the GCE provided a flexible, personalized experience. We need to understand the student's experience in order to help design appropriate curricular experiences [and valid student assessment]. Our research aim was to analyze medical student reflection papers to understand how they viewed their Global Clinical Experience (GCE). A qualitative case study design was used to analyze student reflection papers. All 28 students who participated in a GCE from 2008-2010 and in 2014-2015 and submitted a reflection paper on completion of the GCE were eligible to participate in the study. One student did not submit a reflection paper and was not included in the study. All 27 papers were coded by paragraph for reflection and for themes. System of Care/Range of Care was mentioned most often, Aids to Adjustment Process was mentioned least. The theme, "Diseases," referred to any mention of a disease in the reflection papers, and 44 diseases were mentioned in the papers. The analysis for depth of reflection yielded the following data: Observation, 81/248 paragraphs; Observation and Interpretation, 130/248 paragraphs; and Observation, Interpretation, and Suggestions for change, 36/248 paragraphs; 9 reflection papers contained 27 separate accounts of a transformational experience. This study provided a method for understanding the student's experience that included student's learning about culture, health disparities, and exposure and reaction to a range of diseases actually encountered. The broad diversity of themes among students indicated that the GCE provided a

  15. Osteopontin and splice variant expression level in human malignant glioma: radiobiologic effects and prognosis after radiotherapy.

    PubMed

    Güttler, Antje; Giebler, Maria; Cuno, Peter; Wichmann, Henri; Keßler, Jacqueline; Ostheimer, Christian; Söling, Ariane; Strauss, Christian; Illert, Jörg; Kappler, Matthias; Vordermark, Dirk; Bache, Matthias

    2013-09-01

    We investigated the role of the hypoxia-associated secreted glycoprotein osteopontin (OPN) in the response of malignant glioma to radiotherapy by characterizing OPN and its splice variants in vitro and in patient material. The effect of siRNA knockdown of OPN splice variants on cellular and radiobiologic behavior was analyzed in U251MG cells using OpnS siRNA (inhibition of all OPN splice variants) and OpnAC siRNA (knockdown only of OPNa and OPNc). OPN and splice variant mRNA levels were quantified in archival material of 41 glioblastoma tumor samples. Plasma OPN was prospectively measured in 33 malignant glioma patients. Inhibition of OPNa and OPNc (OpnAC) reduced clonogenic survival in U251MG cells but did not affect proliferation, migration or apoptosis. Knockdown of all OPN splice variants (OpnS) resulted in an even stronger inhibition of clonogenic survival, while cell proliferation and migration were reduced and rate of apoptosis was increased. Additional irradiation had additive effects with both siRNAs. Plasma OPN increased continuously in malignant glioma patients and was associated with poor survival. OPNb is partially able to compensate the effects of OPNa and OPNc knockdown in U251MG cells. High OPN plasma levels at the end of radiotherapy are associated with poor survival. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

  16. Teachers' Perceptions of Their Mentoring Role in Three Different Clinical Settings: Student Teaching, Early Field Experiences, and Entry Year Teaching

    ERIC Educational Resources Information Center

    Gut, Dianne M.; Beam, Pamela C.; Henning, John E.; Cochran, Deborah C.; Knight, Rhonda Talford

    2014-01-01

    The purpose of this study was to determine the differences in mentoring across three different clinical settings: student teaching, early field experiences, and entry year teachers. Eighteen teachers with mentoring experience in all three clinical settings were selected and interviewed. The teachers' expectations for teacher development,…

  17. Diversity characteristics and the experiences of nursing students' during clinical placements: A qualitative study of students and supervisors views.

    PubMed

    Koch, Jane; Everett, Bronwyn; Phillips, Jane; Davidson, Patricia M

    2014-11-10

    Abstract Background: Little is known about which diversity characteristics if any, impact on nursing students' clinical placements or how these may affect the quality of their learning experiences. There is therefore a need to better understand these effects not only from the student's perspective but also from the perspective of the staff who supervise them, in order to ensure students obtain maximal benefit from their placements. Aim: To describe the clinical experiences of nursing students and the diversity characteristics that affect this learning experience. Methods: Data were collected from a series of open-ended questions embedded within a larger anonymous web-based survey, from August 2011 to March 2012. Participants included first, second and third year undergraduate Bachelor of Nursing students (N=704) and faculty members involved in the clinical learning environment (N = 165) from seven Australian universities. Findings: Qualitative findings were clustered into three main themes, differences, difficulty and discrimination, each with three subthemes. Conclusion: Findings suggest a need to offer appropriate support for nursing students who feel different because of diversity characteristics. Whilst some of the participant perceptions are confronting they provide valuable insights for universities developing curricula and the clinical placement facilities where students obtain their experience.

  18. Experience with the Implementation of Clinical Pharmacy Services and Processes in a University Hospital in Belgium.

    PubMed

    Somers, Annemie; Claus, Barbara; Vandewoude, Koen; Petrovic, Mirko

    2016-03-01

    This article summarizes the experience with the development of clinical pharmacy services in the Ghent University Hospital in Belgium. Implementation of clinical pharmacy services in Belgian hospitals has not been evident because these activities were initially not structurally financed. The aim is to describe the strengths and weaknesses of the clinical pharmacy development process, and the milestones that enhanced the progress. Furthermore, the organisation of clinical pharmacy in the Ghent University Hospital is explained, including back- and front-office activities, seamless pharmaceutical care and medication safety improvement. Some working methods, procedures and tools are explained for different clinical pharmacy services. In particular, the clinical pharmacy projects for geriatric patients as well as the preparation of clinical pharmacy services for the accreditation process are explained. We also reflect on the organisation model and the future development of clinical pharmacy, taking into consideration facilitators and potential barriers.

  19. Evaluating the impact of a pre-rotation workshop on student preparation for clinical advanced pharmacy practice experiences.

    PubMed

    Medina, Melissa S; Stark, Jennifer E; Vesta, Kimi S; Lockhart, Staci M

    2008-10-01

    This pilot study was designed to evaluate the impact of a pre-rotation workshop (PRW) on pharmacy students' clinical skills and preparation for clinical Advanced Pharmacy Practice Experiences (APPE) involving direct patient care. Randomized controlled trial of an educational intervention with Institutional Review Board approval. PRW activities designed to simulate rotation activities around five competencies, patient charts, medication histories, SOAP notes, patient presentations, and professionalism. Endpoints were evaluated using clinical rotation preceptors' evaluation of performance and students' performance on objective structured clinical exams (OSCE). Eight fourth-year students and eight GPA matched controls (20% of the total class) were selected to voluntarily participate. The PRW demonstrated a positive impact on students' clinical skills and preparation for rotations by improving OSCE performance. However, no significant differences were found between groups when comparing preceptor evaluations of skills on rotations. These results are limited by the small sample size, potential OSCE "test-wiseness" effects, lack of OSCE evaluator blinding to study groups, potential case specificity effects due to the limited number of cases used on the OSCE and possible lack of sensitivity of the rotation evaluation tool to capture true differences among the experimental and control group participants. The PRW was successful at advancing students' clinical skills and preparation for rotations and may be considered as a tool to help bridge didactic to clinical experiences in the Pharm.D. curriculum.

  20. Role of particle radiotherapy in the management of head and neck cancer.

    PubMed

    Laramore, George E

    2009-05-01

    Modern imaging techniques and powerful computers allow a radiation oncologist to design treatments delivering higher doses of radiation than previously possible. Dose distributions imposed by the physics of 'standard' photon and electron beams limit further dose escalation. Hadron radiotherapy offers advantages in either dose distribution and/or improved radiobiology that may significantly improve the treatment of certain head and neck malignancies. Clinical studies support the effectiveness of fast-neutron radiotherapy in the treatment of major and minor salivary gland tumors. Data show highly favorable outcomes with proton radiotherapy for skull-base malignancies and tumors near highly critical normal tissues compared with that expected with standard radiotherapy. Heavy-ion radiotherapy clinical studies are mainly being conducted with fully stripped carbon ions, and limited data seem to indicate a possible improvement over proton radiotherapy for the same subset of radioresistant tumors where neutrons show a benefit over photons. Fast-neutron radiotherapy has different radiobiological properties compared with standard radiotherapy but similar depth dose distributions. Its role in the treatment of head and neck cancer is currently limited to salivary gland malignancies and certain radioresistant tumors such as sarcomas. Protons have the same radiobiological properties as standard radiotherapy beams but more optimal depth dose distributions, making it particularly advantageous when treating tumors adjacent to highly critical structures. Heavy ions combine the radiobiological properties of fast neutrons with the physical dose distributions of protons, and preliminary data indicate their utility for radioresistant tumors adjacent to highly critical structures.

  1. Web-based objective structured clinical examination with remote standardized patients and Skype: resident experience.

    PubMed

    Langenau, Erik; Kachur, Elizabeth; Horber, Dot

    2014-07-01

    Using Skype and remote standardized patients (RSPs), investigators sought to evaluate user acceptance of a web-based objective structured clinical examination (OSCE) among resident physicians. After participating in four web-based clinical encounters addressing pain with RSPs, 59 residents from different training programs, disciplines and geographic locations completed a 52-item questionnaire regarding their experience with Skype and RSPs. Open-ended responses were solicited as well. The majority of participants (97%) agreed or strongly agreed the web-based format was convenient and a practical learning exercise, and 90% agreed or strongly agreed the format was effective in teaching communication skills. Although 93% agreed or strongly agreed they could communicate easily with RSPs using Skype, 80% preferred traditional face-to-face clinical encounters, and 58% reported technical difficulties during the encounters. Open-ended written responses supported survey results. Findings from this study expose challenges with technology and human factors, but positive experiences support the continued investigation of web-based OSCEs as a synchronous e-learning initiative for teaching and assessing doctor-patient communication. Such educational programs are valuable but unlikely to replace face-to-face encounters with patients. This web-based OSCE program provides physician learners with additional opportunity to improve doctor-patient communication. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

  2. What factors facilitate good learning experiences in clinical studies in nursing: bachelor students' perceptions.

    PubMed

    Dale, Bjørg; Leland, Arne; Dale, Jan Gunnar

    2013-12-17

    Clinical studies constitute 50% of the bachelor program in nursing education in Norway, and the quality of these studies may be decisive for the students' opportunities to learn and develop their professional competences. The aim of this study was to explore what bachelor students' in nursing perceived to be important for having good learning experiences in clinical studies. Data was collected in a focus group interview with eight nursing students who were in the last year of the educational program. The interview was transcribed verbatim, and qualitative content analysis was used for exploring and interpreting the content of the interview text. One main theme emerged from the analysis: "being in a vulnerable and exposed position characterized by conflicting needs." Four categories were found: "aspects related to the clinical setting", "aspects related to the nurse supervisor," "aspects related to the student," and "aspects related to the student-supervisor relationship". The findings revealed that the students' learning experiences and motivation were related to individual, relational, and organizational aspects. The students highlighted their own as well as their supervisors' attitudes and competences and the importance of positive relationships. In addition, feeling welcomed, included, and valued in the ward improved their motivation, self-confidence, and self-respect.

  3. Monte Carlo studies on neutron interactions in radiobiological experiments

    PubMed Central

    Shahmohammadi Beni, Mehrdad; Hau, Tak Cheong; Krstic, D.; Nikezic, D.

    2017-01-01

    Monte Carlo method was used to study the characteristics of neutron interactions with cells underneath a water medium layer with varying thickness. The following results were obtained. (1) The fractions of neutron interaction with 1H, 12C, 14N and 16O nuclei in the cell layer were studied. The fraction with 1H increased with increasing medium thickness, while decreased for 12C, 14N and 16O nuclei. The bulges in the interaction fractions with 12C, 14N and 16O nuclei were explained by the resonance spikes in the interaction cross-section data. The interaction fraction decreased in the order: 1H > 16O > 12C > 14N. (2) In general, as the medium thickness increased, the number of “interacting neutrons” which exited the medium and then further interacted with the cell layer increased. (3) The area under the angular distributions for “interacting neutrons” decreased with increasing incident neutron energy. Such results would be useful for deciphering the reasons behind discrepancies among existing results in the literature. PMID:28704557

  4. Diversity characteristics and the experiences of nursing students during clinical placements: A qualitative study of student, faculty and supervisors' views.

    PubMed

    Koch, Jane; Everett, Bronwyn; Phillips, Jane; Davidson, Patricia M

    2014-01-01

    Abstract Background: Little is known about which diversity characteristics if any, impact on nursing students' clinical placements or how these may affect the quality of their learning experiences. There is therefore a need to better understand these effects not only from the student's perspective but also from the perspective of the staff who supervise them, in order to ensure students obtain maximal benefit from their placements. To describe the clinical experiences of nursing students and the diversity characteristics that affect this learning experience. Data were collected from a series of open-ended questions embedded within a larger anonymous web-based survey, from August 2011 to March 2012. Participants included first, second and third year undergraduate Bachelor of Nursing students (N = 704) and faculty members involved in the clinical learning environment (N = 165) from seven Australian universities. Qualitative findings were clustered into three main themes: differences, difficulty and discrimination, each with three sub-themes. FINDINGS suggest a need to offer appropriate support for nursing students who feel different because of diversity characteristics. Whilst some of the participant perceptions are confronting they provide valuable insights for universities developing curricula and the clinical placement facilities where students obtain their experience.

  5. Experiences of undergraduate nursing students in peer assisted learning in clinical practice: a qualitative systematic review.

    PubMed

    Carey, Matthew C; Kent, Bridie; Latour, Jos M

    2018-05-01

    The objective of this qualitative systematic review was to identify and synthesize the best available evidence on experiences of peer assisted learning (PAL) among student nurses in clinical practice so as to understand the value of PAL for this population. Peer-assisted learning considers the benefits of peers working in collaboration and supporting each other in professional roles. This approach to facilitate learning is effective within universities, but there is limited exploration within the clinical practice environment. Within the UK, 50% of student nurses' learning is undertaken within clinical practice, providing a large portion of student allocation within these areas, but is unexplored in relation to PAL. Therefore, existing evidence examining PAL in clinical practice needs further exploration for a better understanding of its value to student nurses' learning. The systematic review considered studies that included male and female nursing students aged 18-50 years that explored undergraduate nursing students' experiences of PAL within the clinical practice environment. Studies that utilized designs such as phenomenology, grounded theory, ethnography, action research and feminist research were considered. Other text such as opinion papers and reports were to be considered if no qualitative studies could be located. The review excluded quantitative studies, as well as those addressing PAL outside the nursing profession and students within the nursing profession but not including undergraduate student nurses. This review considered studies that included aspects related to experiences of PAL in the clinical practice setting, as seen by undergraduate nursing students and the researcher. A three-step search strategy was undertaken to find both published and unpublished studies in English from 2003 to 2017 in various databases, and included searching of reference lists within articles selected for appraisal. Each of the included studies were assessed for

  6. Physiotherapy students' experiences of bullying on clinical internships: an exploratory study.

    PubMed

    Stubbs, Brendon; Soundy, Andy

    2013-06-01

    To consider the prevalence and type of bullying behaviours experienced whilst on clinical placement in a cohort of final-year BSc undergraduate students. Cross-sectional survey. University in the West Midlands, UK. Fifty-two final-year undergraduate students. Prevalence of incivility and bullying behaviours. Twenty-five percent of students reported at least one incident of bullying behaviour. The perpetrator of the bullying behaviour was most often the clinical educator (8/13, 62%). Despite the negative effects caused, the majority of students (11/13, 84%) did not report this experience to the university. Bullying behaviour may take many forms and can have a negative effect on the well-being of students. It should be addressed by all stakeholders including universities, National Health Service trusts and researchers. Possible strategies to move forwards and better protect the future of the physiotherapy profession are briefly considered. Copyright © 2013 Chartered Society of Physiotherapy. Published by Elsevier Ltd. All rights reserved.

  7. Doctors' experience with handheld computers in clinical practice: qualitative study

    PubMed Central

    McAlearney, Ann Scheck; Schweikhart, Sharon B; Medow, Mitchell A

    2004-01-01

    Objective To examine doctors' perspectives about their experiences with handheld computers in clinical practice. Design Qualitative study of eight focus groups consisting of doctors with diverse training and practice patterns. Setting Six practice settings across the United States and two additional focus group sessions held at a national meeting of general internists. Participants 54 doctors who did or did not use handheld computers. Results Doctors who used handheld computers in clinical practice seemed generally satisfied with them and reported diverse patterns of use. Users perceived that the devices helped them increase productivity and improve patient care. Barriers to use concerned the device itself and personal and perceptual constraints, with perceptual factors such as comfort with technology, preference for paper, and the impression that the devices are not easy to use somewhat difficult to overcome. Participants suggested that organisations can help promote handheld computers by providing advice on purchase, usage, training, and user support. Participants expressed concern about reliability and security of the device but were particularly concerned about dependency on the device and over-reliance as a substitute for clinical thinking. Conclusions Doctors expect handheld computers to become more useful, and most seem interested in leveraging (getting the most value from) their use. Key opportunities with handheld computers included their use as a stepping stone to build doctors' comfort with other information technology and ehealth initiatives and providing point of care support that helps improve patient care. PMID:15142920

  8. Clinical Interpretations of Patient Experience in a Trial of Psilocybin-Assisted Psychotherapy for Alcohol Use Disorder.

    PubMed

    Bogenschutz, Michael P; Podrebarac, Samantha K; Duane, Jessie H; Amegadzie, Sean S; Malone, Tara C; Owens, Lindsey T; Ross, Stephen; Mennenga, Sarah E

    2018-01-01

    After a hiatus of some 40 years, clinical research has resumed on the use of classic hallucinogens to treat addiction. Following completion of a small open-label feasibility study, we are currently conducting a double-blind placebo-controlled clinical trial of psilocybin-assisted treatment of alcohol use disorder. Although treatment effects cannot be analyzed until the study is complete, descriptive case studies provide a useful window into the therapeutic process of psychedelic-assisted treatment of addiction. Here we describe treatment trajectories of three participants in the ongoing trial to illustrate the range of experiences and persisting effects of psilocybin treatment. Although it is difficult to generalize from a few cases, several qualitative conclusions can be drawn from the data presented here. Although participants often find it difficult to describe much of their psilocybin experience, pivotal moments tend to be individualized, extremely vivid, and memorable. Often, the qualitative content extends beyond the clinical problem that is being addressed. The participants discussed in this paper experienced acute and lasting alterations in their perceptions of self, in the quality of their baseline consciousness, and in their relationship with alcohol and drinking. In these cases, experiences of catharsis, forgiveness, self-compassion, and love were at least as salient as classic mystical content. Finally, feelings of increased "spaciousness" or mindfulness, and increased control over choices and behavior were reported following the drug administration sessions. Ultimately, psilocybin-assisted treatment appears to elicit experiences that are extremely variable, yet seem to meet the particular needs of the individual.

  9. Clinical Interpretations of Patient Experience in a Trial of Psilocybin-Assisted Psychotherapy for Alcohol Use Disorder

    PubMed Central

    Bogenschutz, Michael P.; Podrebarac, Samantha K.; Duane, Jessie H.; Amegadzie, Sean S.; Malone, Tara C.; Owens, Lindsey T.; Ross, Stephen; Mennenga, Sarah E.

    2018-01-01

    After a hiatus of some 40 years, clinical research has resumed on the use of classic hallucinogens to treat addiction. Following completion of a small open-label feasibility study, we are currently conducting a double-blind placebo-controlled clinical trial of psilocybin-assisted treatment of alcohol use disorder. Although treatment effects cannot be analyzed until the study is complete, descriptive case studies provide a useful window into the therapeutic process of psychedelic-assisted treatment of addiction. Here we describe treatment trajectories of three participants in the ongoing trial to illustrate the range of experiences and persisting effects of psilocybin treatment. Although it is difficult to generalize from a few cases, several qualitative conclusions can be drawn from the data presented here. Although participants often find it difficult to describe much of their psilocybin experience, pivotal moments tend to be individualized, extremely vivid, and memorable. Often, the qualitative content extends beyond the clinical problem that is being addressed. The participants discussed in this paper experienced acute and lasting alterations in their perceptions of self, in the quality of their baseline consciousness, and in their relationship with alcohol and drinking. In these cases, experiences of catharsis, forgiveness, self-compassion, and love were at least as salient as classic mystical content. Finally, feelings of increased “spaciousness” or mindfulness, and increased control over choices and behavior were reported following the drug administration sessions. Ultimately, psilocybin-assisted treatment appears to elicit experiences that are extremely variable, yet seem to meet the particular needs of the individual. PMID:29515439

  10. Who benefits most from THC:CBD spray? Learning from clinical experience.

    PubMed

    Koehler, Jürgen

    2014-01-01

    Patients with multiple sclerosis (MS) represent a diverse and heterogeneous population varying in terms of disease type, its severity and variable progression/time-course, and with regard to the wide range of presenting symptoms. Consequently, detailed experience with individual patients is important to provide examples of therapy to specific patient types. In this article, real-life data from clinical practice showing specific aspects relating to use of 9-delta-tetrahydocannabinol and cannabidiol (THC:CBD) oromucosal spray (Sativex®) in patients with moderate to severe spasticity resistant to usual therapy will be presented. Three common clinical scenarios will be considered: MS patients with resistance to usual spasticity therapies; patients with impairment in MS spasticity symptoms; MS patients with relevant impairment in quality of life/activities of daily living (QoL/ADL). These case reports highlight the diverse nature of the MS spasticity population and they show the possible usefulness of THC:CBD oromucosal spray in individual patients with moderate to severe spasticity resistant to existing therapies, within the frame of use approved after large clinical trial results. Perhaps the most important finding is the possibility of obtaining relevant improvements in QoL/ADL in some patients with resistant MS spasticity, allowing them to engage back in physical and social activities. © 2014 S. Karger AG, Basel.

  11. DPT Student Perceptions of the Physical Therapist Assistant's Role: Effect of Collaborative Case-Based Learning Compared to Traditional Content Delivery and Clinical Experience.

    PubMed

    Colgrove, Yvonne M; VanHoose, Lisa D

    2017-01-01

    Doctor of physical therapy (DPT) student learning about role delineation of physical therapist assistants (PTAs) is essential to ethical and legal practice. Survey assessment of three DPT student cohorts compared collaborative interprofessional case-based learning with PTA students to traditional curriculum delivery strategies. Control cohorts were assessed one time. The intervention group was assessed pre-intervention, immediately post-intervention, and after completing a full-time clinical experience. The case-based learning covered 46% of survey content, allowing for the assessment of content-specific material and potential learning through collaboration. Following the educational intervention, the intervention group improved significantly in areas inside and outside the case-based study content, outscoring both control groups on 25-34% of the survey items. Following the clinical experience, the intervention group declined answer accuracy for patient evaluation and treatment implementation, suggesting unlearning. Improvement in the administrative section was observed after the clinical experience. Perceptions of the tasks within the PTA role were diminished while tasks outside the scope of practice appeared clarified following the clinical experience. While case-based collaborative intraprofessional learning proves effective in student learning about the PTA role, changes following the clinical experience raise questions about the influence of the clinical environment on learning and the practical application of recently learned knowledge.

  12. Midwifery students׳ experiences of an innovative clinical placement model embedded within midwifery continuity of care in Australia.

    PubMed

    Carter, Amanda G; Wilkes, Elizabeth; Gamble, Jenny; Sidebotham, Mary; Creedy, Debra K

    2015-08-01

    midwifery continuity of care experiences can provide high quality clinical learning for students but can be challenging to implement. The Rural and Private Midwifery Education Project (RPMEP) is a strategic government funded initiative to (1) grow the midwifery workforce within private midwifery practice and rural midwifery, by (2) better preparing new graduates to work in private midwifery and rural continuity of care models. this study evaluated midwifery students׳ experience of an innovative continuity of care clinical placement model in partnership with private midwifery practice and rural midwifery group practices. a descriptive cohort design was used. All students in the RPMEP were invited to complete an online survey about their experiences of clinical placement within midwifery continuity models of care. Responses were analysed using descriptive statistics. Correlations between total scale scores were examined. Open-ended responses were analysed using content analysis. Internal reliability of the scales was assessed using Cronbach׳s alpha. sixteen out of 17 completed surveys were received (94% response rate). Scales included in the survey demonstrated good internal reliability. The majority of students felt inspired by caseload approaches to care, expressed overall satisfaction with the mentoring received and reported a positive learning environment at their placement site. Some students reported stress related to course expectations and demands in the clinical environment (e.g. skill acquisition and hours required for continuity of care). There were significant correlations between scales on perceptions of caseload care and learning culture (r=.87 p<.001) and assessment (r=.87 p<.001). Scores on the clinical learning environment scale were significantly correlated with perceptions of the caseload model (rho=.86 p<.001), learning culture (rho=.94 p<.001) and assessment (rho=.65 p<.01) scales. embedding students within midwifery continuity of care models

  13. Experience of quality management system in a clinical laboratory in Nigeria

    PubMed Central

    Sylvester-Ikondu, Ugochukwu; Onwuamah, Chika K.; Salu, Olumuyiwa B.; Ige, Fehintola A.; Meshack, Emily; Aniedobe, Maureen; Amoo, Olufemi S.; Okwuraiwe, Azuka P.; Okhiku, Florence; Okoli, Chika L.; Fasela, Emmanuel O.; Odewale, Ebenezer. O.; Aleshinloye, Roseline O.; Olatunji, Micheal; Idigbe, Emmanuel O.

    2012-01-01

    Issues Quality-management systems (QMS) are uncommon in clinical laboratories in Nigeria, and until recently, none of the nation’s 5 349 clinical laboratories have been able to attain the certifications necessary to begin the process of attaining international accreditation. Nigeria’s Human Virology Laboratory (HVL), however, began implementation of a QMS in 2006, and in 2008 it was determined that the laboratory conformed to the requirements of ISO 9001:2000 (now 2008), making it the first diagnostic laboratory to be certified in Nigeria. The HVL has now applied for the World Health Organization (WHO) accreditation preparedness scheme. The experience of the QMS implementation process and the lessons learned therein are shared here. Description In 2005, two personnel from the HVL spent time studying quality systems in a certified clinical laboratory in Dakar, Senegal. Following this peer-to-peer technical assistance, several training sessions were undertaken by HVL staff, a baseline assessment was conducted, and processes were established. The HVL has monitored its quality indicators and conducted internal and external audits; these analyses (from 2007 to 2009) are presented herein. Lessons learned Although there was improvement in the pre-analytical and analytical indicators analysed and although data-entry errors decreased in the post-analytical process, the delay in returning laboratory test results increased significantly. There were several factors identified as causes for this delay and all of these have now been addressed except for an identified need for automation of some high-volume assays (currently being negotiated). Internal and external audits showed a trend of increasing non-conformities which could be the result of personnel simply becoming lax over time. Application for laboratory accreditation, however, could provide the renewed vigour needed to correct these non-conformities. Recommendation This experience shows that sustainability of the QMS

  14. Clinical experience of scoring criteria for Familial Hypercholesterolaemia (FH) genetic testing in Wales.

    PubMed

    Haralambos, K; Whatley, S D; Edwards, R; Gingell, R; Townsend, D; Ashfield-Watt, P; Lansberg, P; Datta, D B N; McDowell, I F W

    2015-05-01

    Familial Hypercholesterolaemia (FH) is caused by mutations in genes of the Low Density Lipoprotein (LDL) receptor pathway. A definitive diagnosis of FH can be made by the demonstration of a pathogenic mutation. The Wales FH service has developed scoring criteria to guide selection of patients for DNA testing, for those referred to clinics with hypercholesterolaemia. The criteria are based on a modification of the Dutch Lipid Clinic scoring criteria and utilise a combination of lipid values, physical signs, personal and family history of premature cardiovascular disease. They are intended to provide clinical guidance and enable resources to be targeted in a cost effective manner. 623 patients who presented to lipid clinics across Wales had DNA testing following application of these criteria. The proportion of patients with a pathogenic mutation ranged from 4% in those scoring 5 or less up to 85% in those scoring 15 or more. LDL-cholesterol was the strongest discriminatory factor. Scores gained from physical signs, family history, coronary heart disease, and triglycerides also showed a gradient in mutation pick-up rate according to the score. These criteria provide a useful tool to guide selection of patients for DNA testing when applied by health professionals who have clinical experience of FH. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  15. Supervising international students in clinical placements: perceptions of experiences and factors influencing competency development.

    PubMed

    Attrill, Stacie; Lincoln, Michelle; McAllister, Sue

    2016-07-16

    Health professional education programs attract students from around the world and clinical supervisors frequently report that international students find learning in clinical placement contexts particularly challenging. In existing literature clinical supervisors, who support international students on placement have identified concerns about their communication and interactions within clinical environments. However, clinical supervisors' perspectives about their experiences with international students on placement and the strategies they utilise to facilitate international student learning have not been described. As a result we have little insight into the nature of these concerns and what clinical supervisors do to support international students' competency development. Five focus group interviews were conducted with twenty Speech-Language Pathology clinical supervisors, recruited from 2 Australian universities. Interview data were analysed thematically. Themes identified were interpreted using cognitive load and sociocultural learning theories to enhance understanding of the findings. Four themes were identified: 'Complex teaching and learning relationships', 'Conceptions of students as learners'; Student communication skills for professional practice', and 'Positive mutual learning relationships'. Findings indicated that clinical supervisors felt positive about supporting international students in clinical placements and experienced mutual learning benefits. However, they also identified factors inherent to international students and the placement environment that added to workload, and made facilitating student learning complex. Clinical supervisors described strategies they used to support international students' cultural adjustment and learning, but communication skills were reported to be difficult to facilitate within the constraints of placements. Future research should address the urgent need to develop and test strategies for improving international

  16. Nursing students' experiences of the clinical learning environment in nursing homes: a questionnaire study using the CLES+T evaluation scale.

    PubMed

    Carlson, Elisabeth; Idvall, Ewa

    2014-07-01

    One major challenge facing the health care systems worldwide is the growing demand for registered nurses able to provide qualified nursing care for a vulnerable population. Positive learning experiences during clinical practice influence not only learning outcomes, but also how students reason in relation to future career choices. To investigate student nurses' experiences of the clinical learning environment during clinical practice in nursing homes, and to compare perceptions among student nurses with or without prior work experience as health care assistants in elderly care. A cross-sectional study was designed, utilising the Swedish version of the CLES+T evaluation scale. 260 student nurses (response rate 76%) who had completed a five week long clinical placement in nursing homes returned the questionnaire during the data collection period in 2011-2012. Data were analysed using descriptive statistics. Mann-Whitney U-test was used to examine differences in relation to students with or without prior experience of elderly care. Overall, the clinical learning environment was evaluated in a predominantly positive way. The sub-dimension Supervisory relationship displayed the highest mean value, and the lowest score was calculated for the sub-dimension Leadership style of the ward manager. Statistical significant differences between sub-groups were displayed for four out of 34 items. The supervisory relationship had the greatest impact on how student nurses experienced the clinical learning environment in nursing homes. It is therefore, of utmost importance that collaborative activities, between educational and nursing home settings, supporting the work of preceptors are established and maintained. Copyright © 2014 Elsevier Ltd. All rights reserved.

  17. Teacher Candidates' Experiences with Clinical Teaching in Reading Instruction: A Comparison between the Professional Development School Environment and the Non-Professional Development School Environment

    ERIC Educational Resources Information Center

    Hopper, Cynthia J.

    2016-01-01

    Teacher candidates experience a variety of school settings when enrolled in teacher education methods courses. Candidates report varied experiences when in public school classrooms. This dissertation investigated clinical experiences of teacher candidates when placed in two different environments for clinical teaching. The two environments were a…

  18. Early experiences in evolving an enterprise-wide information model for laboratory and clinical observations.

    PubMed

    Chen, Elizabeth S; Zhou, Li; Kashyap, Vipul; Schaeffer, Molly; Dykes, Patricia C; Goldberg, Howard S

    2008-11-06

    As Electronic Healthcare Records become more prevalent, there is an increasing need to ensure unambiguous data capture, interpretation, and exchange within and across heterogeneous applications. To address this need, a common, uniform, and comprehensive approach for representing clinical information is essential. At Partners HealthCare System, we are investigating the development and implementation of enterprise-wide information models to specify the representation of clinical information to support semantic interoperability. This paper summarizes our early experiences in: (1) defining a process for information model development, (2) reviewing and comparing existing healthcare information models, (3) identifying requirements for representation of laboratory and clinical observations, and (4) exploring linkages to existing terminology and data standards. These initial findings provide insight to the various challenges ahead and guidance on next steps for adoption of information models at our organization.

  19. Evaluation of chest tomosynthesis for the detection of pulmonary nodules: effect of clinical experience and comparison with chest radiography

    NASA Astrophysics Data System (ADS)

    Zachrisson, Sara; Vikgren, Jenny; Svalkvist, Angelica; Johnsson, Åse A.; Boijsen, Marianne; Flinck, Agneta; Månsson, Lars Gunnar; Kheddache, Susanne; Båth, Magnus

    2009-02-01

    Chest tomosynthesis refers to the technique of collecting low-dose projections of the chest at different angles and using these projections to reconstruct section images of the chest. In this study, a comparison of chest tomosynthesis and chest radiography in the detection of pulmonary nodules was performed and the effect of clinical experience of chest tomosynthesis was evaluated. Three senior thoracic radiologists, with more than ten years of experience of chest radiology and 6 months of clinical experience of chest tomosynthesis, acted as observers in a jackknife free-response receiver operating characteristics (JAFROC-1) study, performed on 42 patients with and 47 patients without pulmonary nodules examined with both chest tomosynthesis and chest radiography. MDCT was used as reference and the total number of nodules found using MDCT was 131. To investigate the effect of additional clinical experience of chest tomosynthesis, a second reading session of the tomosynthesis images was performed one year after the initial one. The JAFROC-1 figure of merit (FOM) was used as the principal measure of detectability. In comparison with chest radiography, chest tomosynthesis performed significantly better with regard to detectability. The observer-averaged JAFROC-1 FOM was 0.61 for tomosynthesis and 0.40 for radiography, giving a statistically significant difference between the techniques of 0.21 (p<0.0001). The observer-averaged JAFROC-1 FOM of the second reading of the tomosynthesis cases was not significantly higher than that of the first reading, indicating no improvement in detectability due to additional clinical experience of tomosynthesis.

  20. Is there a relationship between the diversity characteristics of nursing students and their clinical placement experiences? A literature review.

    PubMed

    Koch, Jane; Everett, Bronwyn; Phillips, Jane; Davidson, Patricia M

    2015-01-01

    There has been an increase in ethno-cultural, linguistic, and socio-demographical diversity in students enrolling in undergraduate nursing programs. Diversity also involves other characteristics, but little is known about how diversity impacts on the clinical experiences of nursing students. The aim of this review is to identify studies which describe the clinical placement experiences of nursing students who have a broad range of diversity characteristics. Major databases were searched and original studies published from 2003 to 30 June 2013 were eligible for inclusion. An expanded definition of diversity was used to include characteristics such as ethnicity, language, age, religion, gender, socioeconomic status, carer responsibilities, sexual orientation and special needs/disability. Male gender and speaking English as a second language are diversity characteristics associated with a less positive clinical experience. These students are also more likely to leave their nursing program. Mature-aged students and those from ethnic minority groups were also noted to have a less positive clinical experience and in some cases, this also increased attrition. However, it was difficult to determine the impact of these characteristics alone as they appeared to be linked with other characteristics such as financial difficulties and carer responsibilities in the case of mature-aged students, and language and international student status in the case of ethnicity. Given the significant benefits associated with preparing a diverse nursing workforce, it is an imperative to better understand the impact of diversity on nursing students to ensure that every placement becomes a positive and valuable learning experience.

  1. Dasatinib first-line: Multicentric Italian experience outside clinical trials.

    PubMed

    Breccia, Massimo; Stagno, Fabio; Luciano, Luigiana; Abruzzese, Elisabetta; Annunziata, Mario; D'Adda, Mariella; Maggi, Alessandro; Sgherza, Nicola; Russo-Rossi, Antonella; Pregno, Patrizia; Castagnetti, Fausto; Iurlo, Alessandra; Latagliata, Roberto; Cedrone, Michele; Di Renzo, Nicola; Sorà, Federica; Rege-Cambrin, Giovanna; La Nasa, Giorgio; Scortechini, Anna Rita; Greco, Giovanna; Franceschini, Luca; Sica, Simona; Bocchia, Monica; Crugnola, Monica; Orlandi, Esther; Guarini, Attilio; Specchia, Giorgina; Rosti, Gianantonio; Saglio, Giuseppe; Alimena, Giuliana

    2016-01-01

    Dasatinib was approved for the treatment of chronic phase (CP) chronic myeloid leukemia (CML) patients in first line therapy based on the demonstration of efficacy and safety reported in patients enrolled in clinical trials. We describe a multicentric Italian "real-life" experience of dasatinib used as frontline treatment outside clinical trials. One hundred and nine patients (median age 54 years) were treated from January 2012 to December 2013. Increased incidence of high risk patients were detected according to stratification (26% according to Sokal score, 19% according to Euro score and 16% according to EUTOS) when compared to company sponsored studies. Median time from diagnosis to start of dasatinib was 18 days. Ten patients received unscheduled starting dose (6 patients 50mg and 4 patients 80 mg QD), whereas 99 patients started with 100mg QD. At 3 months, 92% of patients achieved a BCR-ABL ratio less than 10%. At 6 months, the rate of CCyR was 91% and the rate of MR3 was 40%, with 8% of the patients reaching MR4.5. Ninety-three patients were evaluable at 12 months: the rate of MR3 was 62%, with MR4.5 being achieved by 19% of the patients. At a median follow-up of 12 months, 27 patients (24.7%) were receiving the drug at reduced dose. Two patients (1.8%) experienced a lymphoid blast crisis and the overall incidence of resistance was 8%. As regards safety, the major side effects recorded were thrombocytopenia, neutropenia and pleural effusions, which occurred in 22%, 10% and 8% of patients, respectively. Present results, achieved in a large cohort of patients treated outside clinical trials, further confirm the efficacy and safety of dasatinib as firstline treatment in CML. Copyright © 2015 Elsevier Ltd. All rights reserved.

  2. Average stopping powers for electron and photon sources for radiobiological modeling and microdosimetric applications

    NASA Astrophysics Data System (ADS)

    Vassiliev, Oleg N.; Kry, Stephen F.; Grosshans, David R.; Mohan, Radhe

    2018-03-01

    This study concerns calculation of the average electronic stopping power for photon and electron sources. It addresses two problems that have not yet been fully resolved. The first is defining the electron spectrum used for averaging in a way that is most suitable for radiobiological modeling. We define it as the spectrum of electrons entering the sensitive to radiation volume (SV) within the cell nucleus, at the moment they enter the SV. For this spectrum we derive a formula that combines linearly the fluence spectrum and the source spectrum. The latter is the distribution of initial energies of electrons produced by a source. Previous studies used either the fluence or source spectra, but not both, thereby neglecting a part of the complete spectrum. Our derived formula reduces to these two prior methods in the case of high and low energy sources, respectively. The second problem is extending electron spectra to low energies. Previous studies used an energy cut-off on the order of 1 keV. However, as we show, even for high energy sources, such as 60Co, electrons with energies below 1 keV contribute about 30% to the dose. In this study all the spectra were calculated with Geant4-DNA code and a cut-off energy of only 11 eV. We present formulas for calculating frequency- and dose-average stopping powers, numerical results for several important electron and photon sources, and tables with all the data needed to use our formulas for arbitrary electron and photon sources producing electrons with initial energies up to  ∼1 MeV.

  3. Evaluation of the radiobiological gamma index with motion interplay in tangential IMRT breast treatment

    PubMed Central

    Sumida, Iori; Yamaguchi, Hajime; Das, Indra J.; Kizaki, Hisao; Aboshi, Keiko; Tsujii, Mari; Yamada, Yuji; Tamari, Kiesuke; Suzuki, Osamu; Seo, Yuji; Isohashi, Fumiaki; Yoshioka, Yasuo; Ogawa, Kazuhiko

    2016-01-01

    The purpose of this study was to evaluate the impact of the motion interplay effect in early-stage left-sided breast cancer intensity-modulated radiation therapy (IMRT), incorporating the radiobiological gamma index (RGI). The IMRT dosimetry for various breathing amplitudes and cycles was investigated in 10 patients. The predicted dose was calculated using the convolution of segmented measured doses. The physical gamma index (PGI) of the planning target volume (PTV) and the organs at risk (OAR) was calculated by comparing the original with the predicted dose distributions. The RGI was calculated from the PGI using the tumor control probability (TCP) and the normal tissue complication probability (NTCP). The predicted mean dose and the generalized equivalent uniform dose (gEUD) to the target with various breathing amplitudes were lower than the original dose (P < 0.01). The predicted mean dose and gEUD to the OARs with motion were higher than for the original dose to the OARs (P < 0.01). However, the predicted data did not differ significantly between the various breathing cycles for either the PTV or the OARs. The mean RGI gamma passing rate for the PTV was higher than that for the PGI (P < 0.01), and for OARs, the RGI values were higher than those for the PGI (P < 0.01). The gamma passing rates of the RGI for the target and the OARs other than the contralateral lung differed significantly from those of the PGI under organ motion. Provided an NTCP value <0.05 is considered acceptable, it may be possible, by taking breathing motion into consideration, to escalate the dose to achieve the PTV coverage without compromising the TCP. PMID:27534793

  4. The Influence of Clinical Experience and Photographic Presentation on Age Assessment of Women.

    PubMed

    Nielsen, Barbara Rubek; Linneberg, Allan; Christensen, Kaare; Forman, Julie Lyng; Schwarz, Peter

    2016-01-01

    Epidemiological studies have reported that a higher perceived age is associated with poor health and higher mortality. However, the method used for the assessment of perceived age differs between studies with regard to age, gender, the number and occupation of assessors as well as the presentation of participants. It is not known whether the clinical experience of the assessor or photographic presentation have an influence on the assessment of perceived age, which the present study aimed to investigate. In a cross-sectional study of 460 women aged 25-93 years, 10 consultants and 10 residents were asked to estimate the age of each participant using three different photographic presentations: facial photograph, whole-body photograph, and combined facial and whole-body photographs. Data were analyzed by means of summary statistics and linear mixed models. The inter-class correlation coefficient within each assessor group and photographic presentation varied from 0.66 to 0.75. Limits of agreement were in a broad range but were similar in the two assessor groups. The best inter-assessor agreement was obtained from photographs of both the face and the whole body. Intra- and inter-assessor agreements between photographic presentations were similar among both assessor groups. The accuracy in age assessment was significantly influenced by the photographic presentation but not by the clinical experience of the assessor. The difference in the mean perceived age of a participant of average age was estimated as +0.40 years (95% CI: -1.80; 2.59) for consultants versus residents, -2.05 years (95% CI: -2.90; -1.19) for facial photographs versus both facial and whole-body photographs, and -1.44 years (95% CI: -2.30; -0.58) for whole-body photographs versus both facial and whole-body photographs. A regression towards the mean age was seen. The assessment of perceived age was influenced by the photographic presentation but not by the clinical experience of the assessor. © 2015 S

  5. Nursing Clinical Instructor Experiences of Empowerment in Rwanda: Applying Kanter's and Spreitzer's Theories.

    PubMed

    Thuss, Mary; Babenko-Mould, Yolanda; Andrusyszyn, Mary-Anne; Laschinger, Heather K S

    2016-10-15

    The purpose of this study was to explore Rwandan nursing clinical instructors' (CIs) experiences of structural and psychological empowerment. CIs play a vital role in students' development by facilitating learning in health care practice environments. Quality nursing education hinges on the CI's ability to enact a professional role. A descriptive qualitative method was used to obtain an understanding of CIs empowerment experiences in practice settings. Kanter's Theory of Structural Power in Organizations and Spreitzer's Psychological Empowerment Theory were used as theoretical frameworks to interpret experiences. Interview data from 21 CIs were used to complete a secondary analysis. Most participants perceived the structural components of informal power, resources, and support while formal power and opportunity were limited, diminishing their sense of structural empowerment. Psychological empowerment for CIs stemmed from a sense of competence, meaning, impact and self-determination they had for their teaching roles and responsibilities in the practice setting.

  6. Two decades of pharmacovigilance and clinical experience with highly purified rabies immunoglobulin F(ab')2 fragments.

    PubMed

    Reveneau, Elisa; Cottin, Pascale; Rasuli, Anvar

    2017-03-01

    Rabies is a worldwide zoonotic viral disease with no specific treatment once symptoms occur; manifest disease is almost always fatal. WHO recommendations for exposed individuals include immediate attention to the wound and use of rabies immunoglobulin and/or vaccine for post-exposure prophylaxis (PEP). Here, we provide an overview of the clinical experience with a highly purified preparation of F(ab') 2 fragments from equine rabies immunoglobulin (F(ab') 2 pERIG; Favirab TM ) in rabies PEP. Areas covered: Our review comprises a retrospective analysis of adverse event reports in the Sanofi Pasteur global pharmacovigilance database for F(ab') 2 pERIG, including adverse event reports from eight Sanofi Pasteur-sponsored clinical trials and post-market surveillance data collected between 1995 and 2014. The general safety profile of F(ab') 2 pERIG is discussed, as are the occurrence of rare anaphylactic reactions, and suspected intervention failure. Expert commentary: Over 20 years of clinical development and post-licensure experience has established the safety and effectiveness of F(ab') 2 pERIG (Favirab TM ) in rabies PEP.

  7. Medical students' and residents' clinical and educational experiences with defensive medicine.

    PubMed

    O'Leary, Kevin J; Choi, Jennifer; Watson, Katie; Williams, Mark V

    2012-02-01

    To assess medical students' and residents' experiences with defensive medicine, which is any deviation from sound medical practice due to a perceived threat of liability through either assurance or avoidance behaviors. Assurance behaviors include providing additional services of minimal clinical value. Avoidance behaviors include withholding services that are, or avoiding patients who are, perceived as high risk. The authors conducted a cross-sectional survey of fourth-year medical students and third-year residents in 2010. Respondents rated how often malpractice liability concerns caused their teams to engage in four types of assurance and two types of avoidance behaviors using a four-point scale (never, rarely, sometimes, often). Respondents also rated how often their attending physicians explicitly recommended that liability concerns be taken into account when making clinical decisions. Overall, 126 of 194 medical students (65%) and 76 of 141 residents (54%) completed the survey. Of the responding medical students, 116 (92%) reported sometimes or often encountering at least one assurance practice, and 43 (34%) reported encountering at least one avoidance practice. Of the responding residents, 73 (96%) reported encountering at least one assurance practice, and 33 (43%) reported encountering at least one avoidance practice. Overall, 50 of 121 medical students (41%) and 36 of 68 residents (53%) reported that their attending physicians sometimes or often explicitly taught them to take liability into account when making clinical decisions. Medical trainees reported frequently encountering defensive medicine practices and often being taught to take malpractice liability into consideration during clinical decision making.

  8. Experiences from the Merger of Clinics in the Swedish Public Dental Service - the Employee Perspective

    PubMed Central

    Gustafsson, Christina Hassel; Östberg, Anna-Lena

    2017-01-01

    Objectives: The purpose of this study was to investigate the experiences of employees regarding the merger of clinics within the Public Dental Service (PDS), Västra Götaland Region, Sweden. Methods: Employees (dentists, dental hygienists, dental nurses) affected by both administrative and geographical mergers of dental clinics answered a web-based survey about experiences and effects of the merger process (n = 99, 47%). The Swedish short-form version of “The Nordic Questionnaire for Psychological and Social Factors at Work” (QPSNordic), the QPSNordic-34+ was used. Chi-squared tests and logistic regression analyses were used. Results: Two thirds of the participants were aged ≥ 50 years. The respondents stated that the reasons for the merger were often made clear (78%). Satisfaction with and involvement in the merger process received lower scores (45%). Work was often perceived as stressful, irrespective of the merger. Job demands and engagement scored positively, but control at work was given a low score (one fifth stated fairly high or high control). Dentists (OR 5.9; 95%, CI 1.1-32.3), but not dental hygienists (OR 2.8; 95%, CI 0.9-9.0), indicated stress significantly more often than dental nurses (reference) (adjusted for age and gender). Conclusion: Employees in the Public Dental Service (PDS) in a Swedish region had mainly positive experiences after the merger of clinics; however, their involvement in the process was low. Work demands were perceived as high. These findings should be considered when planning mergers in dental organizations. PMID:29151991

  9. Hospital Value-Based Purchasing: The Association Between Patient Experience and Clinical Outcome.

    PubMed

    Haley, D Rob; Hamadi, Hanadi; Zhao, Mei; Xu, Jing; Wang, Yi

    The Affordable Care Act of 2010 introduced a Hospital Value-Based Purchasing Total Performance Score for payment purposes and to evaluate hospital quality of care. In fiscal year 2016, Total Performance Score was composed of (1) Clinical Processes of Care, (2) Patient Experience of Care, (3) Outcome, and (4) Efficiency domains. The objective of this study was to examine the association between the Patient Experience of Care and Outcome domains. The Donabedian model of structure, process, and outcome was used as a conceptual framework for this study. Data from the 2015-2016 Area Health Resource File, the 2016 American Hospital Association database, and the 2016 Hospital Value-Based Purchasing were used. Univariate, bivariate, and multivariate analyses were conducted to examine the impact of patient experience on outcome of care and hospitals. From a sample of 1866 hospitals across the United States, patient experience was significantly and positively associated with patient outcome. In addition, for-profit hospitals, hospitals with more beds, nonteaching hospitals, and hospitals located in less competitive markets were found to have a significant association with better outcomes. The study's findings are important as policy makers consider additional or alternative indicators that may better represent and encourage higher quality of care within acute care hospitals.

  10. An interlaboratory comparison of dosimetry for a multi-institutional radiobiological research project: Observations, problems, solutions and lessons learned.

    PubMed

    Seed, Thomas M; Xiao, Shiyun; Manley, Nancy; Nikolich-Zugich, Janko; Pugh, Jason; Van den Brink, Marcel; Hirabayashi, Yoko; Yasutomo, Koji; Iwama, Atsushi; Koyasu, Shigeo; Shterev, Ivo; Sempowski, Gregory; Macchiarini, Francesca; Nakachi, Kei; Kunugi, Keith C; Hammer, Clifford G; Dewerd, Lawrence A

    2016-01-01

    An interlaboratory comparison of radiation dosimetry was conducted to determine the accuracy of doses being used experimentally for animal exposures within a large multi-institutional research project. The background and approach to this effort are described and discussed in terms of basic findings, problems and solutions. Dosimetry tests were carried out utilizing optically stimulated luminescence (OSL) dosimeters embedded midline into mouse carcasses and thermal luminescence dosimeters (TLD) embedded midline into acrylic phantoms. The effort demonstrated that the majority (4/7) of the laboratories was able to deliver sufficiently accurate exposures having maximum dosing errors of ≤5%. Comparable rates of 'dosimetric compliance' were noted between OSL- and TLD-based tests. Data analysis showed a highly linear relationship between 'measured' and 'target' doses, with errors falling largely between 0 and 20%. Outliers were most notable for OSL-based tests, while multiple tests by 'non-compliant' laboratories using orthovoltage X-rays contributed heavily to the wide variation in dosing errors. For the dosimetrically non-compliant laboratories, the relatively high rates of dosing errors were problematic, potentially compromising the quality of ongoing radiobiological research. This dosimetry effort proved to be instructive in establishing rigorous reviews of basic dosimetry protocols ensuring that dosing errors were minimized.

  11. An image-guided precision proton radiation platform for preclinical in vivo research

    NASA Astrophysics Data System (ADS)

    Ford, E.; Emery, R.; Huff, D.; Narayanan, M.; Schwartz, J.; Cao, N.; Meyer, J.; Rengan, R.; Zeng, J.; Sandison, G.; Laramore, G.; Mayr, N.

    2017-01-01

    There are many unknowns in the radiobiology of proton beams and other particle beams. We describe the development and testing of an image-guided low-energy proton system optimized for radiobiological research applications. A 50 MeV proton beam from an existing cyclotron was modified to produce collimated beams (as small as 2 mm in diameter). Ionization chamber and radiochromic film measurements were performed and benchmarked with Monte Carlo simulations (TOPAS). The proton beam was aligned with a commercially-available CT image-guided x-ray irradiator device (SARRP, Xstrahl Inc.). To examine the alternative possibility of adapting a clinical proton therapy system, we performed Monte Carlo simulations of a range-shifted 100 MeV clinical beam. The proton beam exhibits a pristine Bragg Peak at a depth of 21 mm in water with a dose rate of 8.4 Gy min-1 (3 mm depth). The energy of the incident beam can be modulated to lower energies while preserving the Bragg peak. The LET was: 2.0 keV µm-1 (water surface), 16 keV µm-1 (Bragg peak), 27 keV µm-1 (10% peak dose). Alignment of the proton beam with the SARRP system isocenter was measured at 0.24 mm agreement. The width of the beam changes very little with depth. Monte Carlo-based calculations of dose using the CT image data set as input demonstrate in vivo use. Monte Carlo simulations of the modulated 100 MeV clinical proton beam show a significantly reduced Bragg peak. We demonstrate the feasibility of a proton beam integrated with a commercial x-ray image-guidance system for preclinical in vivo studies. To our knowledge this is the first description of an experimental image-guided proton beam for preclinical radiobiology research. It will enable in vivo investigations of radiobiological effects in proton beams.

  12. Clinical psychologists' experiences of reflective staff groups in inpatient psychiatric settings: a mixed methods study.

    PubMed

    Heneghan, Cara; Wright, John; Watson, Gilli

    2014-01-01

    Background Reflective practice groups have been recommended for improving staff wellbeing and team functioning in inpatient psychiatric services, and clinical psychologists have been identified as potential leaders in this type of work. Research is limited with little information about reflective practice group guidelines, prevalence and effectiveness. Aims The aims of this study were to describe clinical psychologists' practice in reflective groups for staff in inpatient psychiatric services and to explore how such groups are conceptualized and implemented. Methods Online questionnaires and follow-up interviews were used to gain broad descriptions of practice and in-depth information about participants' experiences. The sample consisted of 73 clinical psychologists working in the UK, six of whom were interviewed. Data were analysed using descriptive statistics, content analysis and thematic analysis. Results Clinical psychologists regularly facilitate reflective staff groups in inpatient psychiatric settings in the UK. Common outcomes related to staff wellbeing, service culture and teamwork. Engagement, group dynamics and lack of management support were common challenges. Group experiences were influenced by the organizational context. Conclusions Clinical psychologists' practices regarding reflective staff groups were in line with recent professional developments. Several difficulties were described, which may be indicative of both a difficulty inherent to the task and a training gap in reflective staff group process. The study had methodological limitations but offers a useful contribution to the literature, and enables practice and training implications to be drawn. The need for further research exploring facilitator characteristics, views of group participants and the impact of reflective staff groups on patients is indicated. The term 'reflective practice group' encompasses a range of practices, but a typical group structure was found with common aims

  13. A balancing act: a phenomenological exploration of medical students' experiences of using mobile devices in the clinical setting

    PubMed Central

    Rashid-Doubell, F; Mohamed, S; Elmusharaf, K; O'Neill, C S

    2016-01-01

    Objective The aims of this study were to describe the experiences of senior students using mobile devices in a clinical setting while learning and interacting with clinical teachers, patients and each other, and to identify challenges that facilitated or impeded the use of such devices in the hospital. Design Interpretative phenomenology was chosen to guide our enquiry. Semi-structured interviews were conducted to examine the experiences of five senior medical students using mobile devices in the clinical setting. Setting and participants Senior medical students at an international medical school in the Middle East. Results Three main themes emerged from the data analysis: learning; professional identity and transitioning from student to doctor. The findings showed that using mobile devices in the clinical area as a learning tool was not a formalised process. Rather, it was opportunistic learning at the bedside and on occasion a source of distraction from clinical teaching. Students needed to negotiate relationships between themselves, the clinical teacher and patients in order to ensure that they maintained an acceptable professional image. Participants experienced and negotiated the change from student to doctor making them mindful of using their devices at the bedside. Conclusions Mobile devices are part of daily life for a medical student and there is a need to adapt medical education in the clinical setting, to allow the students to use their devices in a sensitive manner. PMID:27142860

  14. Integration of radiobiological modeling and indices in comparative plan evaluation: A study comparing VMAT and 3D-CRT in patients with NSCLC.

    PubMed

    Roy, Soumyajit; Badragan, Iulian; Ahmed, Sheikh Nisar; Sia, Michael; Singh, Jorawur; Bahl, Gaurav

    2018-03-01

    The purpose of this article was to generate an algorithm to calculate radiobiological endpoints and composite indices and use them to compare volumetric modulated arc therapy (VMAT) and 3-dimensional conformal radiation therapy (3D-CRT) techniques in patients with locally advanced non-small cell lung cancer. The study included 25 patients with locally advanced non-small cell lung cancer treated with 3D-CRT at our center between January 1, 2010, and December 31, 2014. The planner generated VMAT plans using clones of the original computed tomography scans and regions of interest volumes, which did not include the original 3D plans. Both 3D-CRT and VMAT plans were generated using the same dose-volume constraint worksheet. The dose-volume histogram parameters for planning target volume and relevant organs at risk (OAR) were reviewed. The calculation engine was written in the R programming language; the user interface was developed with the "shiny" R Web library. Dose-volume histogram data were imported into the calculation engine and tumor control probability (TCP), normal tissue complication probability (NTCP), composite cardiopulmonary toxicity index (CPTI), morbidity index: MI = ∑ j = 1 #ofrelevantOARs (w j  ∗ NTCP j ), uncomplicated TCP (UTCP=TCP∗∏k=1#ofOARs1-NTCP K 100, and therapeutic gain (TG): ie, TG = TCP ∗ (100 - MI) were calculated. TCP was better with 3D-CRT (12.62% vs 11.71%, P < .001), whereas VMAT demonstrated superior NTCP esophagus (4.45% vs 7.39%, P = .02). NTCP spinal cord (0.001% vs 0.009%, P = .001), and NTCP heart/perfusion defect (44.57% vs 56.42%, P = .016). There was no difference in NTCP lung (6.27% vs 7.62%, P = .221) and NTCP heart/pericarditis (0.001% vs 0.15%, P = .129) between 2 techniques. VMAT showed substantial improvement in morbidity index (11.06% vs. 14.31%, P = 0.01), CPTI (47.59% vs 59.41%, P = .03), TG (P = .035), and trend toward superiority in UTCP (5.89 vs 4.75, P

  15. Challenges of the ward round teaching based on the experiences of medical clinical teachers.

    PubMed

    Arabshahi, Kamran Soltani; Haghani, Fariba; Bigdeli, Shoaleh; Omid, Athar; Adibi, Peyman

    2015-03-01

    Holding educational sessions in a clinical environment is a major concern for faculty members because of its special difficulties and restrictions. This study attempts to recognize the challenges of the ward round teaching through investigating the experiences of clinical teachers in 2011. This qualitative research is carried out through purposive sampling with maximum variation from among the clinical teachers of major departments in Isfahan University of Medical Sciences (9 persons). The sampling continued until data saturation. Data were collected through semi-structured interview and analyzed through Collaizzi method. Data reliability and validity was confirmed through the four aspects of Lincoln and Guba method (credibility, conformability, transferability, and dependability). Three major themes and their related sub-themes (minor themes) were found out including the factors related to the triad of clinical teaching (patient, learner, and clinical teacher) (concern about patient's welfare, poor preparation, lack of motivation, ethical problems), factors related to the educational environment (stressful environment, humiliating environment and poor communication) and the factors related to the educational system of the clinical environment (poor organizing and arrangement of resources, poor system's monitoring, bad planning and inadequate resource). Ward round teaching has many concerns for teachers, and this should be recognized and resolved by authorities and teachers. If these problems are not resolved, it would affect the quality of clinical teaching.

  16. Challenges of the ward round teaching based on the experiences of medical clinical teachers

    PubMed Central

    Arabshahi, Kamran Soltani; Haghani, Fariba; Bigdeli, Shoaleh; Omid, Athar; Adibi, Peyman

    2015-01-01

    Background: Holding educational sessions in a clinical environment is a major concern for faculty members because of its special difficulties and restrictions. This study attempts to recognize the challenges of the ward round teaching through investigating the experiences of clinical teachers in 2011. Materials and Methods: This qualitative research is carried out through purposive sampling with maximum variation from among the clinical teachers of major departments in Isfahan University of Medical Sciences (9 persons). The sampling continued until data saturation. Data were collected through semi-structured interview and analyzed through Collaizzi method. Data reliability and validity was confirmed through the four aspects of Lincoln and Guba method (credibility, conformability, transferability, and dependability). Results: Three major themes and their related sub-themes (minor themes) were found out including the factors related to the triad of clinical teaching (patient, learner, and clinical teacher) (concern about patient's welfare, poor preparation, lack of motivation, ethical problems), factors related to the educational environment (stressful environment, humiliating environment and poor communication) and the factors related to the educational system of the clinical environment (poor organizing and arrangement of resources, poor system's monitoring, bad planning and inadequate resource). Conclusion: Ward round teaching has many concerns for teachers, and this should be recognized and resolved by authorities and teachers. If these problems are not resolved, it would affect the quality of clinical teaching. PMID:26109975

  17. Environmental factors that distinguish between clinical and healthy samples with childhood experiences of abuse and neglect.

    PubMed

    Infurna, Maria Rita; Giannone, Francesca; Guarnaccia, Cinzia; Lo Cascio, Maria; Parzer, Peter; Kaess, Michael

    2015-01-01

    Childhood maltreatment is associated with a wide range of problems in adulthood. However, specific environmental factors (either positive or negative) influence mental health outcomes in maltreated children. The present study investigated the effect of environmental factors by comparing a group of clinical participants with experiences of abuse/neglect with a healthy group with similar patterns of experiences. Environmental factors selected were: separation from parents, financial hardship, parental psychiatric disorders, and low social involvement. The study included 55 mixed clinical participants and 23 healthy participants. All participants were investigated using the Childhood Experience of Care and Abuse (CECA) interview. The two groups were specifically matched with regard to patterns of childhood maltreatment. The findings indicated that psychopathological outcome was associated with a greater presence of negative environmental factors (p < 0.001). In particular, lack of social support seemed to be the only one predictor (OR = 27.86). This study is the first to investigate the influence of specific environmental factors in two groups with similar childhood experiences of abuse/neglect but different mental health outcomes. These findings suggest that efforts should be made to incorporate both familial and external sources of social support in promoting mental health for maltreated children. © 2015 S. Karger AG, Basel.

  18. The experience of adolescents participating in a randomised clinical trial in the field of mental health: a qualitative study.

    PubMed

    Midgley, Nick; Isaacs, Danny; Weitkamp, Katharina; Target, Mary

    2016-07-28

    This descriptive study aimed to investigate adolescents' motivations for participating in a randomised controlled trial (RCT), to explore the understanding that the young people had regarding a number of aspects of the trial design, to examine whether or not they found participation in the trial to be acceptable and what affected this, and to identify whether and how the young people felt that their participation in the RCT impacted on their experience of therapy and on therapeutic change. Seventy-six adolescents who were taking part in a large-scale RCT to evaluate the clinical and cost effectiveness of psychological therapies for depression were interviewed at two time-points after completing therapy. The semi-structured interviews, which included a focus on the young people's experience of the research study, were analysed using framework analysis. The vast majority of adolescents found it acceptable to participate in the clinical trial, and many agreed to participate for reasons of 'conditional altruism'. However consent was often given without great understanding of the key elements of the trial, including the difference between treatment arms and the randomisation process. Although the adolescents were largely positive about their experiences from taking part, the study raises questions about whether clinical outcomes may be influenced by participation in the research elements of the trial. Although adolescents are under-represented in clinical trials, those who do participate are generally positive about the experience; however, careful thought needs to be given to key elements of the trial design and the potential impact of the research participation on clinical outcomes. ISRCTN registry, ISRCTN83033550 . Registered on 15 October 2009.

  19. A Decade of Experience in Creating and Maintaining Data Elements for Structured Clinical Documentation in EHRs

    PubMed Central

    Zhou, Li; Collins, Sarah; Morgan, Stephen J.; Zafar, Neelam; Gesner, Emily J.; Fehrenbach, Martin; Rocha, Roberto A.

    2016-01-01

    Structured clinical documentation is an important component of electronic health records (EHRs) and plays an important role in clinical care, administrative functions, and research activities. Clinical data elements serve as basic building blocks for composing the templates used for generating clinical documents (such as notes and forms). We present our experience in creating and maintaining data elements for three different EHRs (one home-grown and two commercial systems) across different clinical settings, using flowsheet data elements as examples in our case studies. We identified basic but important challenges (including naming convention, links to standard terminologies, and versioning and change management) and possible solutions to address them. We also discussed more complicated challenges regarding governance, documentation vs. structured data capture, pre-coordination vs. post-coordination, reference information models, as well as monitoring, communication and training. PMID:28269927

  20. Experiences of Master's Students Regarding Clinical Supervision in an Applied Psychology Programme in South Africa

    ERIC Educational Resources Information Center

    Nel, Lindi; Fouche, Paul

    2017-01-01

    This study explored and described the experiences regarding clinical supervision of master's students in professional psychology programmes in South Africa. Four participants were purposively selected from four different universities. The participants engaged in reflective writings and in-depth interviews over a one-year span. Data were analysed…

  1. Experiences of women with a diagnosis of breast cancer: a clinical pathway approach.

    PubMed

    Lindop, E; Cannon, S

    2001-06-01

    The study presented in this paper formed the first part of a large survey of breast cancer patients in one health authority in England, UK looking at individual needs expressed by women with a diagnosis of breast cancer. The paper provides an account of the experiences of 12 women with a diagnosis of breast cancer. The women represent a wide age range and different stages of illness. The transcribed accounts of the women were analysed by means of Qualitative Solutions and Research, Non-Numerical Unstructured Data Indexing Searching and Theorising (QSR*NUDIST). The study examined the individual experiences of women with a diagnosis of breast cancer and its aftermath as they passed through different stages related to it. The women's experiences are presented within the conceptual framework of the clinical pathway and their accounts represent their journey along the pathway. Various significant points in this journey are portrayed representing the women's reactions to diagnosis, treatment, femininity and body image, support, family and friends, information and after care.

  2. Novel technologies and theoretical models in radiation therapy of cancer patients using 6.3 MeV fast neutrons produced by U-120 cyclotron

    NASA Astrophysics Data System (ADS)

    Musabaeva, L. I.; Startseva, Zh. A.; Gribova, O. V.; Velikaya, V. V.; Lisin, V. A.

    2016-08-01

    The analysis of clinical use of neutron therapy with 6 MeV fast neutrons compared to conventional radiation therapy was carried out. The experience of using neutron and mixed neutron and photon therapy in patients with different radio-resistant malignant tumors shows the necessity of further studies and development of the novel approaches to densely-ionizing radiation. The results of dosimetry and radiobiological studies have been the basis for planning clinical programs for neutron therapy. Clinical trials over the past 30 years have shown that neutron therapy successfully destroys radio-resistant cancers, including salivary gland tumors, adenoidcystic carcinoma, inoperable sarcomas, locally advanced head and neck tumors, and locally advanced prostate cancer. Radiation therapy with 6.3 MeV fast neutrons used alone and in combination with photon therapy resulted in improved long-term treatment outcomes in patients with radio-resistant malignant tumors.

  3. Clinical profiles and outcomes in idiopathic duct-centric chronic pancreatitis (type 2 autoimmune pancreatitis): the Mayo Clinic experience.

    PubMed

    Hart, Phil A; Levy, Michael J; Smyrk, Thomas C; Takahashi, Naoki; Abu Dayyeh, Barham K; Clain, Jonathan E; Gleeson, Ferga C; Pearson, Randall K; Petersen, Bret T; Topazian, Mark D; Vege, Santhi S; Zhang, Lizhi; Chari, Suresh T

    2016-10-01

    Idiopathic duct-centric chronic pancreatitis (IDCP), also known as type 2 autoimmune pancreatitis (AIP), is an uncommon subtype of AIP. International Consensus Diagnostic Criteria for IDCP propose that the diagnosis requires pancreatic histology and/or concurrent IBD. We examined our experience with IDCP (type 2 AIP) to assess the appropriateness of these criteria, and identify unique characteristics in patients presenting with acute pancreatitis. We reviewed the Mayo Clinic AIP database through May 2014 to identify subjects with either definitive (n=31) or probable (n=12) IDCP. We compared demographic and clinical factors based on strength of diagnostic confidence (definitive versus probable), presence of IBD, and acute pancreatitis as the presenting manifestation. Relapse-free survival was determined using the Kaplan-Meier method. The clinical profiles were similar irrespective of the diagnostic criteria fulfilled. Common clinical presentations included acute pancreatitis (n=25, 58.1%, 12 of whom (27.9%) had recurrent pancreatitis) and pancreatic mass/obstructive jaundice (n=15, 34.9%). The cumulative relapse rate was 10.6% at 3 years (median follow-up 2.9 years). Relapse-free survival was similar for the different diagnostic categories, but was decreased in those initially presenting with acute pancreatitis (p=0.047) or treated with steroids (vs surgery, p=0.049). The current diagnostic classification of probable IDCP and the inclusion of IBD as a supportive criterion appear valid, because patients have similar clinical profiles and disease-related outcomes to those with definitive IDCP. Concurrent IBD, especially in young patients, may suggest when IDCP is the underlying cause of recurrent acute pancreatitis, but additional studies are needed for validation. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

  4. Manhattan transfer: lethal radiation, bone marrow transplantation, and the birth of stem cell biology, ca. 1942-1961.

    PubMed

    Kraft, Alison

    2009-01-01

    This study investigates how, in the late 1940s and 1950s, fears of nuclear accidents and nuclear warfare shaped postwar radiobiology. The new and intense forms of radiation generated by nuclear reactor technology, and which would be released in the event of a nuclear war, created concerns about a public-health hazard unprecedented in form and scale. Fears of inadvertent exposure to acute and potentially lethal radiation launched a search for anti-radiation therapies, out of which emerged the new technique of bone marrow transplantation (BMT). This study analyzes the use of BMT first as a research tool to explore the biological effects of ionizing radiation, and then as an adjunct to radiotherapy for the treatment of cancer. In highlighting how BMT became the province of different research and clinical constituencies, this study develops an understanding of the forces and contingencies that shaped its development. Exploring the emergence of BMT and the uses to which it was put, it reveals that BMT remained a technique in the making -- unstable and far from standardized, even as it became both a widely used research tool and rapidly made its way into the clinic. More broadly, it casts new light on one route through which the Manhattan Project influenced postwar radiobiology; it also affords new insights into one means by which radiobiology came to serve the interests of the Cold War state. In its focus on BMT this paper provides a new perspective on the evolving relationship between radiobiology and biomedicine in the postwar period.

  5. The Biostack Experiments I and II aboard Apollo 16 and 17.

    PubMed

    Bucker, H

    1974-01-01

    The concept of the Biostack experiment has become practicable through European scientific collaboration and with help of NASA. The objectives of this experiment flown aboard Apollo 16 and 17 are to study the biological effects of individual heavy cosmic particles of high-energy loss (HZE) not available on earth; to study the influence of additional spaceflight factors; to get some knowledge on the mechanism by which HZE particles damage biological materials; to get information on the spectrum of charge and energy of the cosmic ions in the spacecraft; to estimate the radiation hazards for man in space. For this purpose the Biostack experiment comprises a widespread spectrum of biological objects, and various radiobiological end-points are under investigation. Bacterial spores, protozoa cysts, plant seeds, shrimp eggs, and insect eggs were included in the Biostack experiment packages together with different physical radiation detectors (nuclear emulsions, plastics, AgCl crystals, and LiF thermoluminescence dosimeters). By using special arrangements of biological objects and physical track detectors, individual evaluation of tracks was obtained allowing the identification of each penetrating particle in relation to the possible biological effects on its path. The response of the different biological objects to space flight and HZE ions bombardment was of different degree, presumably depending on the ability of the organism to replace the cells damaged by a hit. The results help to estimate the radiation hazard for astronauts during space missions of long duration.

  6. Caries detection and diagnostics with near-infrared light transillumination: clinical experiences.

    PubMed

    Söchtig, Friederike; Hickel, Reinhard; Kühnisch, Jan

    2014-06-01

    The aim of this paper was to present the function and potential of diagnosing caries lesions using a recently introduced near-infrared (NIR) transillumination technique (DIAGNOcam, KaVo). The study included 130 adolescents and adults with complete permanent dentition (age > 12). All patients underwent visual examination and, if necessary, bitewing radiographs. Proximal and occlusal surfaces, which had not yet been restored, were photographed by a NIR transillumination camera system using light with a wavelength of 780 nm rather than ionizing radiation. Of the study patients, 85 showed 127 proximal dentin caries lesions that were treated operatively. A cross table shows the correlation of radiography and NIR transillumination. Based on our practical clinical experiences to date, a possible classifi cation of diagnosis is introduced. The main result of our study was that NIR light was able to visualize caries lesions on proximal and occlusal surfaces. The study suggests that NIR transillumination is a method that may help to avoid bitewing radiographs for diagnosis of caries in everyday clinical practice.

  7. Junior nursing students' experiences of vertical violence during clinical rotations.

    PubMed

    Thomas, Sandra P; Burk, Renee

    2009-01-01

    Horizontal violence is a form of workplace violence, a phenomenon that is prevalent in the nursing profession. Research has revealed a variety of negative peer-to-peer behaviors that lower morale and lead to turnover. However, little research has been conducted on "eating our young" (violence occurring between individuals with unequal power, such as staff nurse and student). We propose "vertical violence" as the appropriate term when abusive registered nurse (RN) behavior is directed towards students. We report a content analysis of stories written by junior nursing students about incidents of injustice perpetrated by staff RNs during their clinical experiences. Four levels of injustice were described. Nursing leadership, both in hospitals and educational institutions, must become engaged in efforts to eradicate vertical violence towards students.

  8. Preventative health, diversity, and inclusion: a qualitative study of client experience aboard a mobile health clinic in Boston, Massachusetts.

    PubMed

    Bouchelle, Zoe; Rawlins, Yasmin; Hill, Caterina; Bennet, Jennifer; Perez, Leonor Xochitl; Oriol, Nancy

    2017-11-03

    There are approximately 2000 mobile health clinics operating in the United States. While researchers have established that mobile health clinics can be cost effective and improve outcomes, there is scant research examining the healthcare experience on a mobile health clinic from patients' perspectives. Data were gathered from interviews with 25 clients receiving care on a Boston-based mobile health clinic and analyzed using grounded theory methodology. Emerging patterns in the data revealed three relational and three structural factors most significant to participants' experience of care on The Family Van. Relational factors include providers who 1) Communicate understandably, 2) Create a culture of respect and inclusivity, and 3) Are diverse with knowledge of the community. Structural factors include 1) A focus on preventative health and managing chronic disease, 2) Expeditious, free, and multiple services, and 3) Location. The participant accounts in this report serve to expand on prior research exploring mobile health clinics' role in patients' healthcare, to more clearly define the most salient aspects of the mobile health clinic model for the patients they serve, and to give voice to patients too seldom heard in the academic literature.

  9. Augmentative and alternative communication in adolescents with severe intellectual disability: a clinical experience.

    PubMed

    Uliano, D; Falciglia, G; Del Viscio, C; Picelli, A; Gandolfi, M; Passarella, A

    2010-06-01

    Augmentative and alternative communication devices proved to be effective in patients with severe intellectual disability to overcome their communication impairments. In order to give a contribution for design of augmentative and alternative communication systems that better meet the needs of beginning communicators we decided to report our clinical experience about using augmentative and alternative communication in adolescents with severe intellectual disability. Five patients who underwent a long time traditional speech rehabilitation program (at least 5 years) with scant improvements in linguistic function were recruited and evaluated by means of the Vineland Adaptive Behaviour Scale before and after a three years augmentative and alternative communication intervention carried out by a multidisciplinary team. After the rehabilitative intervention patients showed an improvement in communication, daily living skills and socialization as measured by the Vineland Adaptive Behaviour Scale. Augmentative and alternative communication is an effective rehabilitation approach to people with severe intellectual disability and impairments in linguistic expression. Moreover augmentative and alternative communication is a useful tool allowing these patients to increase their social participation also enhancing their self-esteem. Our clinical experience confirmed these topics also in adolescents who underwent a long time traditional speech rehabilitation program with scant improvements, providing practical information to clinicians.

  10. Facilitating Dental Student Reflections: Using Mentor Groups to Discuss Clinical Experiences and Personal Development.

    PubMed

    Koole, Sebastiaan; Christiaens, Veronique; Cosyn, Jan; De Bruyn, Hugo

    2016-10-01

    Despite the consensus on the importance of reflection for dental professionals, a lack of understanding remains about how students and clinicians should develop their ability to reflect. The aim of this study was to investigate dental students' and mentors' perceptions of mentor groups as an instructional method to facilitate students' reflection in terms of the strategy's learning potential, role of the mentor, group dynamics, and feasibility. At Ghent University in Belgium, third- and fourth-year dental students were encouraged to reflect on their clinical experiences and personal development in three reflective mentor sessions. No preparation or reports afterwards were required; students needed only to participate in the sessions. Sessions were guided by trained mentors to establish a safe environment, frame clinical discussions, and stimulate reflection. Students' and mentors' perceptions of the experience were assessed with a 17-statement questionnaire with response options on a five-point Likert scale (1=totally disagree to 5=totally agree). A total of 50 students and eight mentors completed the questionnaire (response rates 81% and 89%, respectively). Both students and mentors had neutral to positive perceptions concerning the learning potential, role of the mentor, group dynamics, and feasibility. The mean ideal total time for sessions in a year was 99 minutes (third-year students), 111 minutes (fourth-year students), and 147 minutes (mentors). Reported reflective topics related to patient management, frustrations, and practice of dentistry. Overall mean appreciation for the experience ranged from 14.50 to 15.14 on the 20-point scale. These findings about students' and mentors' positive perceptions of the experience suggest that mentor groups may be a potentially valuable strategy to promote dental students' reflection.

  11. BASIC RADIATION PROTECTION EDUCATION AND TRAINING FOR MEDICAL PROFESSIONALS; GEORGIAN EXPERIENCE AND FUTURE PERSPECTIVE.

    PubMed

    Todua, F; Nadareishvili, D; Ormotsadze, G; Sanikidze, T

    2016-06-01

    The level of knowledge provided by the Tbilisi State Medical University (TSMU) standard curriculum modules in 'Medical physics' and 'Radiation risk estimates' was assessed as was the learning outcome of modern standards elective course in 'Radiation protection'. Two groups of medical students were examined: Group 1: 5 y students, participants in elective course 'Radiobiology and radiogenic health risk' and Group 2: 1-2 y students, participants in winter and summer schools. Students were tested before and after training courses with the same tests questionnaire. The results of the tests showed the necessity for improvement of the educational curriculum. The changes needed are the inclusion of a basic radiobiological course in the curricula of the faculty of medicine and expansion of the medical physics course through a more detailed presentation of medical imaging methods. © The Author 2016. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

  12. Experiences of the gender climate in clinical training - a focus group study among Swedish medical students.

    PubMed

    Kristoffersson, Emelie; Andersson, Jenny; Bengs, Carita; Hamberg, Katarina

    2016-10-26

    Research shows that medical education is characterized by unequal conditions for women and men, but there is a lack of qualitative studies investigating the social processes that enable and maintain gender inequalities that include both male and female students. In this focus group study, we therefore explored male as well as female medical students' experiences of the gender climate - i.e., how beliefs, values, and norms about gender were communicated - during clinical training and how the students dealt with these experiences. Focus group interviews were conducted with 24 medical students (nine men) at Umeå University, Sweden. The interviews were structured around personal experiences in clinical training where the participants perceived that gender had mattered. Data were analysed using qualitative content analysis. The students described gender-stereotyped expectations, discriminatory treatment, compliments, comments, and demeaning jargon. Female students gave more personal and varied examples than the men. The students' ways of handling their experiences were marked by efforts to fit in, for example, by adapting their appearance and partaking in the prevailing jargon. They felt dependent on supervisors and staff, and due to fear of repercussions they kept silent and avoided unpleasant situations and people rather than challenging humiliating jargon or supervisors who were behaving badly. Everyday communication of gender beliefs combined with students' adaptation to stereotyped expectations and discrimination came across as fundamental features through which unequal conditions for male and female students are reproduced and maintained in the clinic. Because they are in a dependent position, it is often difficult for students to challenge problematic gender attitudes. The main responsibility for improvements, therefore, lies with medical school leadership who need to provide students and supervisors with knowledge about gendered processes, discrimination, and

  13. Initial clinical experience with a sac-anchoring endoprosthesis for aortic aneurysm repair.

    PubMed

    Donayre, Carlos E; Zarins, Christopher K; Krievins, Dainis K; Holden, Andrew; Hill, Andrew; Calderas, Carlos; Velez, Jaime; White, Rodney A

    2011-03-01

    All current aortic endografts depend on proximal and distal fixation to prevent migration. However, migration and rupture can occur, particularly in patients with aortic necks that are short or angulated, or both. We present our initial clinical experience with a new sac-anchoring endoprosthesis designed to anchor and seal the device within the aneurysm sac. The initial worldwide experience using a new endoprosthesis for the treatment of aortic aneurysms (Nellix Endovascular, Palo Alto, Calif) was reviewed. The endoprosthesis consists of dual balloon-expandable endoframes surrounded by polymer-filled endobags designed to obliterate the aneurysm sac and maintain endograft position. Clinical results and follow-up contrast computed tomography (CT) scans at 30 days and 6 and 12 months were reviewed. The endograft was successfully deployed in 21 patients with infrarenal aortic aneurysms measuring 5.7 ± 0.7 cm (range, 4.3-7.4 cm). Two patients with common iliac aneurysms were treated with sac-anchoring extenders that maintained patency of the internal iliac artery. Infusion of 71 ± 37 mL of polymer (range, 19-158 mL) into the aortic endobags resulted in complete aneurysm exclusion in all patients. Mean implant time was 76 ± 35 minutes, with 33 ± 17 minutes of fluoroscopy time and 180 ± 81 mL of contrast; estimated blood loss was 174 ± 116 mL. One patient died during the postoperative period (30-day mortality, 4.8%), and one died at 10 months from non-device-related causes. During a mean follow-up of 8.7 ± 3.1 months and a median of 6.3 months, there were no late aneurysm- or device-related adverse events and no secondary procedures. CT imaging studies at 6 months and 1 year revealed no increase in aneurysm size, no device migration, and no new endoleaks. One patient had a limited proximal type I endoleak at 30 days that resolved at 60 days and remained sealed. One patient has an ongoing distal type I endoleak near the iliac bifurcation, with no change in aneurysm

  14. SU-C-BRE-02: BED Vs. Local Control: Radiobiological Effect of Tumor Volume in Monte Carlo (MC) Lung SBRT Planning

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Pokhrel, D; Badkul, R; Jiang, H

    2014-06-15

    radiobiological effect of target volume and dose calculation algorithm significantly affects TCP for lung SBRT patients. Dose calculation using MC-based algorithm is more realistic with tissue heterogeneities and is routinely performed in our clinic. Patients will be followed up to determine whether TCP prediction correlate clinical outcomes.« less

  15. Transforming Experience: The Potential of Augmented Reality and Virtual Reality for Enhancing Personal and Clinical Change

    PubMed Central

    Riva, Giuseppe; Baños, Rosa M.; Botella, Cristina; Mantovani, Fabrizia; Gaggioli, Andrea

    2016-01-01

    During life, many personal changes occur. These include changing house, school, work, and even friends and partners. However, the daily experience shows clearly that, in some situations, subjects are unable to change even if they want to. The recent advances in psychology and neuroscience are now providing a better view of personal change, the change affecting our assumptive world: (a) the focus of personal change is reducing the distance between self and reality (conflict); (b) this reduction is achieved through (1) an intense focus on the particular experience creating the conflict or (2) an internal or external reorganization of this experience; (c) personal change requires a progression through a series of different stages that however happen in discontinuous and non-linear ways; and (d) clinical psychology is often used to facilitate personal change when subjects are unable to move forward. Starting from these premises, the aim of this paper is to review the potential of virtuality for enhancing the processes of personal and clinical change. First, the paper focuses on the two leading virtual technologies – augmented reality (AR) and virtual reality (VR) – exploring their current uses in behavioral health and the outcomes of the 28 available systematic reviews and meta-analyses. Then the paper discusses the added value provided by VR and AR in transforming our external experience by focusing on the high level of personal efficacy and self-reflectiveness generated by their sense of presence and emotional engagement. Finally, it outlines the potential future use of virtuality for transforming our inner experience by structuring, altering, and/or replacing our bodily self-consciousness. The final outcome may be a new generation of transformative experiences that provide knowledge that is epistemically inaccessible to the individual until he or she has that experience, while at the same time transforming the individual’s worldview. PMID:27746747

  16. Transforming Experience: The Potential of Augmented Reality and Virtual Reality for Enhancing Personal and Clinical Change.

    PubMed

    Riva, Giuseppe; Baños, Rosa M; Botella, Cristina; Mantovani, Fabrizia; Gaggioli, Andrea

    2016-01-01

    During life, many personal changes occur. These include changing house, school, work, and even friends and partners. However, the daily experience shows clearly that, in some situations, subjects are unable to change even if they want to. The recent advances in psychology and neuroscience are now providing a better view of personal change, the change affecting our assumptive world: (a) the focus of personal change is reducing the distance between self and reality (conflict); (b) this reduction is achieved through (1) an intense focus on the particular experience creating the conflict or (2) an internal or external reorganization of this experience; (c) personal change requires a progression through a series of different stages that however happen in discontinuous and non-linear ways; and (d) clinical psychology is often used to facilitate personal change when subjects are unable to move forward. Starting from these premises, the aim of this paper is to review the potential of virtuality for enhancing the processes of personal and clinical change. First, the paper focuses on the two leading virtual technologies - augmented reality (AR) and virtual reality (VR) - exploring their current uses in behavioral health and the outcomes of the 28 available systematic reviews and meta-analyses. Then the paper discusses the added value provided by VR and AR in transforming our external experience by focusing on the high level of personal efficacy and self-reflectiveness generated by their sense of presence and emotional engagement. Finally, it outlines the potential future use of virtuality for transforming our inner experience by structuring, altering, and/or replacing our bodily self-consciousness. The final outcome may be a new generation of transformative experiences that provide knowledge that is epistemically inaccessible to the individual until he or she has that experience, while at the same time transforming the individual's worldview.

  17. [A new psycho-dermatology clinic in Israel: our first year experience].

    PubMed

    Orion, Edith; Ben-Avi, Orit

    2011-01-01

    Psychodermatology involves the interrelationships between the skin and the mind, especially when considering the formation and evolution of certain common skin conditions. It appears that 30-40% of dermatology patients suffer from certain psychological problems as defined by the ICD-10, in a way that influences their disease severity and progression, as well as their quality of Life. Treatment of such cases requires a multi-disciplinary approach and should involve both a dermatologist and a mental health specialist working together In this article, the authors summarize the preliminary experience of the first year of the only psychodermatology clinic in Israel in several decades, work methods and patients' characteristics and preliminary conclusions.

  18. My personal experiences at the BEST Medical Center: A day in the clinic-the morning.

    PubMed

    Cohen, Philip R; Kurzrock, Razelle

    2016-01-01

    Dr. Ida Lystic is a gastroenterologist who trained at the OTHER (Owen T. Henry and Eugene Rutherford) Medical Center, after having completed her MD degree at the prestigious Harvey Medical School (recently renamed the Harvey Provider School). She accepted a faculty position at the BEST (Byron Edwards and Samuel Thompson) Medical Center. Dr. Lystic shares her experiences on a typical morning in gastroenterology clinic. Although her clinic start date was delayed by 2 months after becoming sick following a mandatory flu shot and having to complete more than 70 hours of compliance training modules, she is now familiar with the BEST system. Clinic scheduling priorities include ensuring that the staff can eat lunch together and depart at 5:00 pm. It is a continual challenge to find time to complete the electronic medical record after BEST changed from the SIMPLE (Succinct Input Making Patients Lives Electronic) system to LEGEND (referred to as Lengthy and Excessively Graded Evaluation and Nomenclature for Diagnosis by her colleagues). To maintain clinic punctuality, a compliance spreadsheet is e-mailed monthly to the Wait Time Committee. Their most recent corrective action plan for tardy physicians included placing egg timers on the doors and having nurses interrupt visits that exceed the allotted time. Administrative decisions have resulted in downsizing personnel. Patients are required to schedule their own tests and procedures and follow-up appointments-causing low patient satisfaction scores; however, the money saved lead to a large year-end bonus for the vice president of BEST Efficiency, who holds "providers" accountable for the poor patient experience. Although Dr. Ida Lystic and the gastroenterology clinic at "the BEST Medical Center" are creations of the authors' imagination, the majority of the anecdotes are based on actual events. Copyright © 2016 Elsevier Inc. All rights reserved.

  19. The Appalachian Tri-State Node Experiences with the National Institute on Drug Abuse Clinical Trials Network.

    PubMed

    Kelly, Thomas M; Daley, Dennis C; Byrne, Mimmie; Demarzo, Larry; Smith, Doris; Madl, Stephanie

    2011-07-01

    The National Institute on Drug Abuse (NIDA)-sponsored Clinical Trial Network (CTN) recently celebrated 10 years of conducting "real world" research into the treatment of addiction. This article reviews the history and results of the most recent CTN studies and describes the experiences of one of the 13 participating research affiliates, the Appalachian Tri-State (ATS) Node. We discuss our "bidirectional" collaboration with multiple community treatment programs (CTPs) on research and dissemination activities and include their experiences as a member of our ATS Node.Results of CTN clinical trials have found unexpectedly that treatment as usual (TAU) is often almost as good as evidence-based interventions such as Motivational Interviewing (MI), possibly due to the difficulty in implementing evidence-based practices most effectively among divergent treatment sites and heterogeneous clinical populations. Some expected findings from the reviewed research are that severity of addiction and comorbidity moderate treatment outcomes and must be accounted for in future CTN-sponsored studies. Notwithstanding these results, much has been learned and recommendations are suggested for changes in CTN research designs that will address methodological limitations and increase treatment effectiveness in future CTN studies.

  20. Short-term clinical experience with hip resurfacing arthroplasty.

    PubMed

    Cieliński, Łukasz; Kusz, Damian; Wojciechowski, Piotr; Dziuba, Anna

    2007-01-01

    This paper discusses the authors' experience with hip resurfacing arthroplasty. Although introduced many years ago, the method did not gain wide popularity because of poor long-term outcomes. At present, owing to the introduction of metal-on-metal bearings and hybrid fixation techniques, short- and mid-term results are very good and encourage wider use of this technique, especially in the younger and more active patients whose results with standard total hip replacements would be unsatisfactory. We performed 13 hip resurfacing arthroplasties at our institution between August 1, 2005, and May 1, 2006. Twelve patients reported for the scheduled follow-up and were included in the study. Treatment outcomes were assessed according to the Harris Hip Score. The short-term outcomes of hip resurfacing arthroplasties are encouraging. In the study group there were no intraoperative complications, infections, peripheral nerve palsy, hip dislocations or clinically overt vein thrombosis. All of the patients reported complete or major pain relief. Clinical assessment according to the Harris Hip Score revealed improvement from an average of 57.7 (20.1) points preoperatively to an average of 87.7 (12) points after the surgery. Crutches were used for a maximum of 6 weeks postoperatively. All of the patients are currently able to walk without crutches with full weight-bearing. 1) Hip resurfacing arthroplasty seems to be an advisable method of operative management of younger, active patients, in whom standard THR would be associated with a high risk of failure; it allows THR to be postponed and carried out as a revision surgery with the acetabular component already in place. 2) Despite the good short- and mid-term results, the utility of this method should be evaluated with caution due to the lack of adequate long-term follow-up data.

  1. Against the odds: experiences of nurse leaders in Clinical Development Units (Nursing) in Australia.

    PubMed

    Atsalos, Christine; O'Brien, Louise; Jackson, Debra

    2007-06-01

    This paper is a report of a longitudinal study to develop an understanding of the phenomena of Clinical Development Unit (Nursing) leadership by exploring the experiences of the nurse leaders of nine Australian units as they attempted to develop their existing wards or units into recognized centres of nursing excellence. The concept of Clinical Development Unit (Nursing) in Australia originated in the British Nursing Development Unit movement, which has been widely credited with introducing innovative approaches to developing nurses and nursing. A network of nine Clinical Development Units (Nursing) was set up in a suburban area health service in Australia. The aim was to develop existing wards or units into centres of excellence by disseminating a new vision for Australian nurses that was based on the pioneering work of the British Nursing Development Unit movement. Principles of Heideggerian hermeneutic phenomenology provided a framework for the study. Nine Clinical Development Unit (Nursing) leaders participated in qualitative interviews from 1998 to 2002. These interviews were transcribed into text and thematically analysed. Despite attempts to implement a variety of measures to nurture these Clinical Development Units (Nursing) until they had become well established, the new Clinical Development Unit (Nursing) leaders were unable to maintain the Clinical Development Unit (Nursing) vision with which they had been entrusted. This paper discusses their reactions to the problems they faced and the new understandings they developed of their Clinical Development Unit (Nursing) role over time. The findings illuminate the difficulties involved in maintaining the commitment of all levels of staff and management when attempting to introduce new nursing projects.

  2. Clinical experience with a high-performance ATM-connected DICOM archive for cardiology

    NASA Astrophysics Data System (ADS)

    Solomon, Harry P.

    1997-05-01

    A system to archive large image sets, such as cardiac cine runs, with near realtime response must address several functional and performance issues, including efficient use of a high performance network connection with standard protocols, an architecture which effectively integrates both short- and long-term mass storage devices, and a flexible data management policy which allows optimization of image distribution and retrieval strategies based on modality and site-specific operational use. Clinical experience with such as archive has allowed evaluation of these systems issues and refinement of a traffic model for cardiac angiography.

  3. [Cytogenetic effects in experimental exposure to the heavy charged particles of galactic cosmic radiation on the Kosmos-1129 biosatellite].

    PubMed

    Nevzgodina, L V; Maksimova, E N

    1982-01-01

    The experiment was carried out on lattice (Lactuca sativa) seeds flown in a biocontainer equipped with plastic detectors to record heavy charged particles (HCP). The purpose of the experiment was to determine the yield of aberrant cells as a result of irradiation, and to identify this effect as a function of HCP topography in the seed. The cytogenetic examination of flight seedlings revealed a significant difference between the seeds which were hit with HCP and those that remained intact. This indicates a significant contribution of the heavy component of galactic cosmic rediation into the radiobiological effect. The relationship between the radiobiological effect and the HCP topography in the seed was established: zones of the root and stem meristema proved to be most sensitive targets.

  4. Self-Reported Training Adequacy, Experience, and Comfort Level in Performing Schizophrenia-Related Clinical Skills among Psychiatry Residents and Fellows.

    PubMed

    Greene, Laurence; Moreo, Kathleen; Nasrallah, Henry; Tandon, Rajiv; Sapir, Tamar

    2017-08-01

    In the context of an educational program on schizophrenia for psychiatry trainees, this survey study analyzed associations between self-reported training adequacy, experience in providing patient care, and comfort level in performing schizophrenia-related clinical skills. The influence of the education on comfort level was also assessed for each skill. Survey respondents were psychiatry residents and fellows who participated in a schizophrenia education program at an in-person workshop or through online videos recorded at the workshop. In a pre-program survey, participants reported their experience in providing schizophrenia patient care and rated their training adequacy and comfort level for performing seven clinical skills involved in diagnosing and treating schizophrenia. The post-program survey included items for reassessing comfort level in performing the skills. Across the seven clinical skills, the proportion of respondents (n = 79) who agreed or strongly agreed that their training was adequate ranged from 29 to 88 %. The proportion of high ratings for comfort level in skill performance ranged from 45 to 83 %. Comfort level was significantly associated with training adequacy for all seven clinical skills and with experience in providing patient care for four skills. For all skills, comfort level ratings were significantly higher after versus before the educational workshop. Commonly indicated needs for further training included education on new therapies, exposure to a broader range of patients, and opportunities for longitudinal patient management. Psychiatry trainees' self-reported, disease-specific training adequacy, experiences, and comfort level have unique applications for developing and evaluating graduate medical curriculum.

  5. Experiences of using the Theoretical Domains Framework across diverse clinical environments: a qualitative study.

    PubMed

    Phillips, Cameron J; Marshall, Andrea P; Chaves, Nadia J; Jankelowitz, Stacey K; Lin, Ivan B; Loy, Clement T; Rees, Gwyneth; Sakzewski, Leanne; Thomas, Susie; To, The-Phung; Wilkinson, Shelley A; Michie, Susan

    2015-01-01

    The Theoretical Domains Framework (TDF) is an integrative framework developed from a synthesis of psychological theories as a vehicle to help apply theoretical approaches to interventions aimed at behavior change. This study explores experiences of TDF use by professionals from multiple disciplines across diverse clinical settings. Mixed methods were used to examine experiences, attitudes, and perspectives of health professionals in using the TDF in health care implementation projects. Individual interviews were conducted with ten health care professionals from six disciplines who used the TDF in implementation projects. Deductive content and thematic analysis were used. Three main themes and associated subthemes were identified including: 1) reasons for use of the TDF (increased confidence, broader perspective, and theoretical underpinnings); 2) challenges using the TDF (time and resources, operationalization of the TDF) and; 3) future use of the TDF. The TDF provided a useful, flexible framework for a diverse group of health professionals working across different clinical settings for the assessment of barriers and targeting resources to influence behavior change for implementation projects. The development of practical tools and training or support is likely to aid the utility of TDF.

  6. Experiences of using the Theoretical Domains Framework across diverse clinical environments: a qualitative study

    PubMed Central

    Phillips, Cameron J; Marshall, Andrea P; Chaves, Nadia J; Jankelowitz, Stacey K; Lin, Ivan B; Loy, Clement T; Rees, Gwyneth; Sakzewski, Leanne; Thomas, Susie; To, The-Phung; Wilkinson, Shelley A; Michie, Susan

    2015-01-01

    Background The Theoretical Domains Framework (TDF) is an integrative framework developed from a synthesis of psychological theories as a vehicle to help apply theoretical approaches to interventions aimed at behavior change. Purpose This study explores experiences of TDF use by professionals from multiple disciplines across diverse clinical settings. Methods Mixed methods were used to examine experiences, attitudes, and perspectives of health professionals in using the TDF in health care implementation projects. Individual interviews were conducted with ten health care professionals from six disciplines who used the TDF in implementation projects. Deductive content and thematic analysis were used. Results Three main themes and associated subthemes were identified including: 1) reasons for use of the TDF (increased confidence, broader perspective, and theoretical underpinnings); 2) challenges using the TDF (time and resources, operationalization of the TDF) and; 3) future use of the TDF. Conclusion The TDF provided a useful, flexible framework for a diverse group of health professionals working across different clinical settings for the assessment of barriers and targeting resources to influence behavior change for implementation projects. The development of practical tools and training or support is likely to aid the utility of TDF. PMID:25834455

  7. The visualisation of clinical leadership in the content of nursing education--a qualitative study of nursing students' experiences.

    PubMed

    Démeh, Waddah; Rosengren, Kristina

    2015-07-01

    The aim of this study was to describe nursing students' experiences of clinical leadership during their last year of education. Work as a nurse is complex with several demands from stakeholders who are colleagues, managers, patients and relatives. Therefore, it is important to provide students with tools for a forthcoming professional life as a nurse. A qualitative descriptive study was carried out in Jordan. Narratives (n=20) written by nursing students in their last year before graduation as a registered nurse were collected. The data were analysed by a manifest content analysis. The results formed one category: (Clinical leadership-safety in being a nurse), and three subcategories (eye-opener, a role model and bridging the gap) described the students' clinical leadership experiences due to the preparation process for being a nurse. Clinical leadership applies theory to practice by using a holistic view in nursing. Clinical leadership is a valuable tool for bridging the gap between theory and practice in nursing education. Skills within nursing management clarify and simplify nursing activities, which facilitates the transition from student to nurse. Focus on learning needs in nursing management is needed for stakeholders within education and health care organisations to facilitate graduation of well skilled nurses. Copyright © 2015 Elsevier Ltd. All rights reserved.

  8. Classification of adults with problematic internet experiences: linking internet and conventional problems from a clinical perspective.

    PubMed

    Mitchell, Kimberly J; Finkelhor, David; Becker-Blease, Kathryn A

    2007-06-01

    This article utilizes data from clinical reports of 929 adults to examine whether various problematic Internet experiences are distinctly different from or extensions of conventional problems. A TwoStep Cluster Analysis identified three mutually exclusive groups of adults, those with (1) online relationship problems and victimization; (2) online and offline problems; and (3) marital discord. Results suggest some initial support for the idea that problematic Internet experiences are often extensions of experiences and behaviors that pre-date the Internet. However, the Internet may be introducing some qualitatively new dimensions-such as an increased severity, an increased frequency, or unique dynamics-that require new responses or interventions.

  9. Development of clinical sites.

    PubMed

    O'Brien, Mary

    2015-02-01

    Clinical experiences are vital to all types of healthcare educational programs. Supervised clinical experiences provide the opportunity for the learner to apply didactic knowledge and theory to real world situations and hone skills necessary for entry into practice. Nurse anesthesia programs utilize a wide variety of clinical sites to expose student registered nurse anesthetists to experiences that will prepare them clinically, academically and professionally to enter practice as a Certified Registered Nurse Anesthetist. This article describes the process of developing a clinical site. A thorough evaluation will determine the types of experiences meant to be offered at the site, the resources available to house and educate the students, and how to evaluate the effectiveness of the clinical site. Open communication between the clinical coordinator and the program director or designee is essential to ensure success of the clinical site. The Council on Accreditation of Nurse Anesthesia Educational Programs has resources available to guide those interested in becoming a clinical site, as well as for program administrators who seek to add new experiences to their programs.

  10. The experience of older patients with cancer in phase 1 clinical trials: a qualitative case series.

    PubMed

    Kvale, Elizabeth A; Woodby, Lesa; Williams, Beverly Rosa

    2010-11-01

    This article explores the experiences of older patients with cancer in phase 1 clinical trials. Conducting a case series of face-to-face, in-depth, open-ended interviews and using qualitative methods of analysis, we find that the psychosocial process of social comparison is relevant for understanding older adults' phase 1 clinical trial participation. Social comparison influences decisions to enroll in a phase 1 clinical trial, shapes perceptions of supportive care needs, and encourages the utilization of hope. Additional research should develop strategies for addressing supportive care needs among this patient cohort whose use of social comparison can inhibit articulation of pain, suffering, and symptom burden as well as use of informal support systems.

  11. Quality assurance of research protocols conducted in the community: the National Institute on Drug Abuse Clinical Trials Network experience.

    PubMed

    Rosa, Carmen; Campbell, Aimee; Kleppinger, Cynthia; Sampson, Royce; Tyson, Clare; Mamay-Gentilin, Stephanie

    2009-04-01

    Quality assurance (QA) of clinical trials is essential to protect the welfare of trial participants and the integrity of the data collected. However, there is little detailed information available on specific procedures and outcomes of QA monitoring for clinical trials. This article describes the experience of the National Institute on Drug Abuse's (NIDA) National Drug Abuse Treatment Clinical Trials Network (CTN) in devising and implementing a three-tiered QA model for rigorous multi-site randomized clinical trials implemented in community-based substance abuse treatment programs. The CTN QA model combined local and national resources and was developed to address the unique needs of clinical trial sites with limited research experience. The authors reviewed internal records maintained by the sponsor, a coordinating site (Lead Nodes), and a local site detailing procedural development, training sessions, protocol violation monitoring, and site visit reporting. Between January 2001 and September 2005, the CTN implemented 21 protocols, of which 18 were randomized clinical trials, one was a quality improvement study and two were surveys. Approximately 160 community-based treatment programs participated in the 19 studies that were monitored, with a total of 6560 participants randomized across the sites. During this time 1937 QA site visits were reported across the three tiers of monitoring and the cost depended on the location of the sites and the salaries of the staff involved. One study reported 109 protocol violations (M = 15.6). Examples are presented to highlight training, protocol violation monitoring, site visit frequency and intensity and cost considerations. : QA data from the entire network were not easily available for review as much of the data were not electronically accessible. The authors reviewed and discussed a representative sample of internal data from the studies and participating sites. The lessons learned from the CTN's experience include the need

  12. Quality assurance of research protocols conducted in the community: The National Institute on Drug Abuse Clinical Trials Network Experience

    PubMed Central

    Rosa, Carmen; Campbell, Aimee; Kleppinger, Cynthia; Sampson, Royce; Tyson, Clare; Mamay-Gentilin, Stephanie

    2009-01-01

    Background: Quality assurance (QA) of clinical trials is essential to protect the welfare of trial participants and the integrity of the data collected. However, there is little detailed information available on specific procedures and outcomes of QA monitoring for clinical trials. Purpose: This article describes the experience of the National Institute on Drug Abuse's (NIDA) National Drug Abuse Treatment Clinical Trials Network (CTN) in devising and implementing a three-tiered QA model for rigorous multi-site randomized clinical trials implemented in community-based substance abuse treatment programs. The CTN QA model combined local and national resources and was developed to address the unique needs of clinical trial sites with limited research experience. Methods: The authors reviewed internal records maintained by the sponsor, a coordinating site (Lead Nodes), and a local site detailing procedural development, training sessions, protocol violation monitoring, and site visit reporting. Results: Between January 2001 and September 2005, the CTN implemented 21 protocols, of which 18 were randomized clinical trials, one was a quality improvement study and two were surveys. Approximately 160 community-based treatment programs participated in the 19 studies that were monitored, with a total of 6560 participants randomized across the sites. During this time 1937 QA site visits were reported across the three tiers of monitoring and the cost depended on the location of the sites and the salaries of the staff involved. One study reported 109 protocol violations (M = 15.6). Examples are presented to highlight training, protocol violation monitoring, site visit frequency and intensity and cost considerations. Limitations: QA data from the entire network were not easily available for review as much of the data were not electronically accessible. The authors reviewed and discussed a representative sample of internal data from the studies and participating sites. Conclusions

  13. Direct booking colposcopy clinic -- the Portsmouth experience.

    PubMed

    Lukman, H; Bevan, J R; Greenwood, E

    2004-08-01

    We present 2 years data on direct booking in our colposcopy clinic. The new booking system has improved our efficiency and helped us to achieve the national quality standards on clinic waiting time. The non-attendance (DNA) rate has also improved.

  14. 'Maternity clinic on the net service' and its introduction into practice: experiences of maternity-care professionals.

    PubMed

    Kouri, Pirkko; Turunen, Hannele; Palomäki, Tuula

    2005-06-01

    To describe the experiences of maternity-care professionals using an Internet-based network service, called Net Clinic, and the opportunities and obstacles they encountered in Net Clinic while organising their work and developing their know-how. Qualitative information gathered from semi-structured thematic interviews. Four maternity care units in Eastern Finland (one antenatal ward in a university hospital, one antenatal ward in a central hospital, two maternity clinics in the community). Five midwives, two public health nurses and three doctors. All participants considered adequate privacy protection a prerequisite for development. They anticipated that because of their computer skills, young people would be able to use information and communication technology (ICT) as part of maternity-care services naturally. Managerial support, such as allocation of time and equipment, was extremely important during the introductory phase. The participants were divided into three groups based on their experiences of implementing Net Clinic: (1) 'doubters' did not believe in their own ICT competence and were afraid of using Net Clinic. They also showed resistance to Net Clinic. Doubters wanted versatile and personal guidance in ICT skills; (2) 'accepters' agreed that progress in ICT would inevitably affect their work. Development was considered difficult without awareness of the benefits of ICT, and Net Clinic was expected to increase their workload. Accepters preferred to have one-to-one ICT training; (3) 'future confidents' saw ICT as a useful tool for developing maternity care. They recognised the opportunities implicit in network collaboration and wanted versatile user training in ICT. They wanted successful network service models and were eager to develop them. IMPLICATIONS FOR THE FUTURE: Families will increase their knowledge levels, as those who will be future parents are learning to use public network services at school. The increasing diversity of family structure

  15. Clinical learning environment and supervision: experiences of Norwegian nursing students - a questionnaire survey.

    PubMed

    Skaalvik, Mari Wolff; Normann, Hans Ketil; Henriksen, Nils

    2011-08-01

    To measure nursing students' experiences and satisfaction with their clinical learning environments. The primary interest was to compare the results between students with respect to clinical practice in nursing homes and hospital wards. Clinical learning environments are important for the learning processes of nursing students and for preferences for future workplaces. Working with older people is the least preferred area of practice among nursing students in Norway. A cross-sectional design. A validated questionnaire was distributed to all nursing students from five non-randomly selected university colleges in Norway. A total of 511 nursing students completed a Norwegian version of the questionnaire, Clinical Learning Environment, Supervision and Nurse Teacher (CLES+T) evaluation scale in 2009. Data including descriptive statistics were analysed using the Statistical Program for the Social Sciences. Factor structure was analysed by principal component analysis. Differences across sub-groups were tested with chi-square tests and Mann-Whitney U test for categorical variables and t-tests for continuous variables. Ordinal logistic regression analysis of perceptions of the ward as a good learning environment was performed with supervisory relationships and institutional contexts as independent variables, controlling for age, sex and study year. The participating nursing students with clinical placements in nursing homes assessed their clinical learning environment significantly more negatively than those with hospital placements on nearby all sub-dimensions. The evidence found in this study indicates that measures should be taken to strengthen nursing homes as learning environments for nursing students. To recruit more graduated nurses to work in nursing homes, actions to improve the learning environment are needed. © 2011 Blackwell Publishing Ltd.

  16. A balancing act: a phenomenological exploration of medical students' experiences of using mobile devices in the clinical setting.

    PubMed

    Rashid-Doubell, F; Mohamed, S; Elmusharaf, K; O'Neill, C S

    2016-05-03

    The aims of this study were to describe the experiences of senior students using mobile devices in a clinical setting while learning and interacting with clinical teachers, patients and each other, and to identify challenges that facilitated or impeded the use of such devices in the hospital. Interpretative phenomenology was chosen to guide our enquiry. Semi-structured interviews were conducted to examine the experiences of five senior medical students using mobile devices in the clinical setting. Senior medical students at an international medical school in the Middle East. Three main themes emerged from the data analysis: learning; professional identity and transitioning from student to doctor. The findings showed that using mobile devices in the clinical area as a learning tool was not a formalised process. Rather, it was opportunistic learning at the bedside and on occasion a source of distraction from clinical teaching. Students needed to negotiate relationships between themselves, the clinical teacher and patients in order to ensure that they maintained an acceptable professional image. Participants experienced and negotiated the change from student to doctor making them mindful of using their devices at the bedside. Mobile devices are part of daily life for a medical student and there is a need to adapt medical education in the clinical setting, to allow the students to use their devices in a sensitive manner. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

  17. Dental Students' Perceived Value of Peer-Mentoring Clinical Leadership Experiences.

    PubMed

    Sheridan, Rachel A; Hammaker, Daniel J; de Peralta, Tracy L; Fitzgerald, Mark

    2016-03-01

    This pilot study compared second- and fourth-year dental students' perceived values of newly implemented clinical leadership experiences (CLEs) at one U.S. dental school during the 2012-13 academic year. In the CLEs, fourth-year (D4) students mentored second-year (D2) dental students during faculty-supervised patient treatment. The two cohorts' perceived value of the experiences was measured with questionnaires consisting of five-point Likert scale questions and open text responses. Out of a total of 114 D2 and 109 D4 students, 46 D2 students and 35 D4 students participated (response rates of 40.4% and 32.1%, respectively). While responses from both cohorts showed they highly valued the CLEs, the D2s perceived greater value: 4.07 (0.53) v. 3.51 (0.95), p<0.003. Both cohorts reported feeling that D4s were prepared to mentor D2s, that the CLEs had educational benefits, and that the CLEs increased their comfort with peer communication. Theme analysis of open text questions revealed that the respondents perceived the D4s were more accessible than faculty and provided guidance and individual attention; the CLEs increased student comfort; the CLEs reinforced D4 skills, knowledge, and confidence; and the CLEs provided management, leadership, and collaborative work experience. Theme analysis also highlighted student concerns about a lack of program structure. Overall, the majority of both groups valued CLEs in their dental education. Particular advantages they perceived were increased comfort, guidance, and attention. Further program development should address student concerns. These results suggest that similar programs should be considered and/or expanded in other dental schools' curricula.

  18. Leaflet manual of external beam radiation therapy for hepatocellular carcinoma: a review of the indications, evidences, and clinical trials.

    PubMed

    Rim, Chai Hong; Yoon, Won Sup

    2018-01-01

    The use of external beam radiation therapy (EBRT) in the treatment of hepatocellular carcinoma (HCC), which was rarely performed due to liver toxicity with a previous technique, has increased. Palliation of portal vein thrombosis, supplementation for insufficient transarterial chemoembolization, and provision of new curative opportunities using stereotactic body radiotherapy are the potential indications for use of EBRT. The mechanism of EBRT treatment, with its radiobiological and physical perspectives, differs from those of conventional medical treatment or surgery. Therefore, understanding the effects of EBRT may be unfamiliar to physicians other than radiation oncologists, especially in the field of HCC, where EBRT has recently begun to be applied. The first objective of this review was to concisely explain the indications for use of EBRT for HCC for all physicians treating HCC. Therefore, this review focuses on the therapeutic outcomes rather than the detailed biological and physical background. We also reviewed recent clinical trials that may extend the indications for use of EBRT. Finally, we reviewed the current clinical practice guidelines for the treatment of HCC and discuss the current recommendations and future perspectives.

  19. Early experiences in establishing a regional quantitative imaging network for PET/CT clinical trials.

    PubMed

    Doot, Robert K; Thompson, Tove; Greer, Benjamin E; Allberg, Keith C; Linden, Hannah M; Mankoff, David A; Kinahan, Paul E

    2012-11-01

    The Seattle Cancer Care Alliance (SCCA) is a Pacific Northwest regional network that enables patients from community cancer centers to participate in multicenter oncology clinical trials where patients can receive some trial-related procedures at their local center. Results of positron emission tomography (PET) scans performed at community cancer centers are not currently used in SCCA Network trials since clinical trials customarily accept results from only trial-accredited PET imaging centers located at academic and large hospitals. Oncologists would prefer the option of using standard clinical PET scans from Network sites in multicenter clinical trials to increase accrual of patients for whom additional travel requirements for imaging are a barrier to recruitment. In an effort to increase accrual of rural and other underserved populations to Network trials, researchers and clinicians at the University of Washington, SCCA and its Network are assessing the feasibility of using PET scans from all Network sites in their oncology clinical trials. A feasibility study is required because the reproducibility of multicenter PET measurements ranges from approximately 3% to 40% at national academic centers. Early experiences from both national and local PET phantom imaging trials are discussed, and next steps are proposed for including patient PET scans from the emerging regional quantitative imaging network in clinical trials. There are feasible methods to determine and characterize PET quantitation errors and improve data quality by either prospective scanner calibration or retrospective post hoc corrections. These methods should be developed and implemented in multicenter clinical trials employing quantitative PET imaging of patients. Copyright © 2012 Elsevier Inc. All rights reserved.

  20. Implementation of Electronic Checklists in an Oncology Medical Record: Initial Clinical Experience

    PubMed Central

    Albuquerque, Kevin V.; Miller, Alexis A.; Roeske, John C.

    2011-01-01

    Purpose: The quality of any medical treatment depends on the accurate processing of multiple complex components of information, with proper delivery to the patient. This is true for radiation oncology, in which treatment delivery is as complex as a surgical procedure but more dependent on hardware and software technology. Uncorrected errors, even if small or infrequent, can result in catastrophic consequences for the patient. We developed electronic checklists (ECLs) within the oncology electronic medical record (EMR) and evaluated their use and report on our initial clinical experience. Methods: Using the Mosaiq EMR, we developed checklists within the clinical assessment section. These checklists are based on the process flow of information from one group to another within the clinic and enable the processing, confirmation, and documentation of relevant patient information before the delivery of radiation therapy. The clinical use of the ECL was documented by means of a customized report. Results: Use of ECL has reduced the number of times that physicians were called to the treatment unit. In particular, the ECL has ensured that therapists have a better understanding of the treatment plan before the initiation of treatment. An evaluation of ECL compliance showed that, with additional staff training, > 94% of the records were completed. Conclusion: The ECL can be used to ensure standardization of procedures and documentation that the pretreatment checks have been performed before patient treatment. We believe that the implementation of ECLs will improve patient safety and reduce the likelihood of treatment errors. PMID:22043184