Parker Adventist Hospital

This paper aimed to evaluate the integration of Cherenkov imaging into radiation therapy practices, focusing on its utility in enhancing treatment precision, patient safety, and clinical decision-making. The research highlights its application in quality and safety verification, breast treatment, and dose visualization, confirming the absence of radiation in unintended areas and its broader clinical impact. We employed 2 commercially available Cherenkov imaging systems, BeamSite and DoseRT, integrated with Varian and Elekta linear accelerators. The methodology involved real-time imaging during radiation therapy sessions for various treatments, capturing Cherenkov light with time-gated cameras synchronized with radiation pulses. Posttreatment, images were analyzed to assess treatment accuracy, dose distribution, and any deviations from the intended plan. Cherenkov imaging consistently provided high-quality images that allowed immediate visualization of the radiation dose distribution, detection of deviations in real time, and ensured no radiation was delivered to unintended areas. The results are presented, focusing on 5 main topics: quality and patient safety verification; breast treatment applications; dose visualization for treatment verification; verification of a negative dose in areas of concern; and observations with clinical impact. It was particularly beneficial in complex scenarios like breast cancer treatments and in cases where patient positioning was challenging. The technology facilitated immediate treatment adjustments, improved patient safety, and offered insights into treatment response without adding significant time to the clinical workflow. Cherenkov imaging has shown substantial promise in enhancing radiation therapy by providing real-time, visual feedback on treatment delivery. It complements traditional verification methods by offering continuous monitoring, which can lead to fewer treatment errors and better patient outcomes. The findings suggest that Cherenkov imaging should be considered for broader clinical adoption to elevate the standard of care in radiation oncology, although further refinement of image processing and camera positioning could enhance its effectiveness.

Background/Objectives: To prevent potential complications for patients with metal hypersensitivity requiring total knee arthroplasty (TKA), implant coatings have been developed. Thermal nitriding of the titanium surface creates a TiN layer that increases hardness and wear resistance while preventing release of cobalt and chromium ions. The aim of this study was to evaluate the clinical safety and performance of an anatomic implant system comprised of thermally nitrided Ti-6Al-4V. Methods: This is an ongoing prospective, multicenter observational cohort study of primary and revision TKA patients. Patient-reported outcome measures including the Oxford Knee Score (OKS), Knee Society Score (KSS) Expectations subscale, EQ-5D-5L, physical exams, and radiographic assessments to document abnormalities were investigated in 94 patients who provided at least two years of follow-up data. The primary endpoint was improvement in the Oxford Knee Score (OKS), defined as the minimal clinically important difference (MCID, 7.0 points). Results: All outcome measures including patient-reported function (OKS) demonstrated significant improvements (19.4–22.6 points) exceeding the MCID with no between-group differences by bearing types utilized. Health-related quality of life as measured by EQ-5D-5L improved over the cohort and was maintained at 2-years post-operative. In total, three (1.4%) radiographic abnormalities were observed, all of which resolved at two-year follow-up. 12 (5.3%) serious complications were reported, none of which were related to the device. Two revisions have occurred, one due to infection and one due to a fall, in the ultracongruent bearing cohort (survivorship 98.1%, 95%CI 87.4–99.7). Implant survivorship was 100% in all other bearing cohorts. Conclusions: This anatomically designed, thermally nitrided titanium alloy implant demonstrated clinically significant improvements in function, PROMs, and quality of life in patients undergoing TKA regardless of bearing type. Excellent two-year implant survivorship between 98.1% and 100% across cohorts were observed, with no radiographic abnormalities at 2 years.

To gather preliminary data on correlations among psycholinguistic measures, self-report of cognitive function, and performance on neurocognitive tests in breast cancer survivors. Participants were breast cancer survivors who reported issues with cognitive function after completion of chemotherapy. This secondary analysis used data from participants in parent studies at two National Cancer Institute-designated cancer centers. Qualitative interview transcripts (N = 52) underwent psycholinguistic analyses for grammatical and semantic complexity. Relationships among six psycholinguistic variables, self-report of cognitive function, and performance on neurocognitive tests were examined. Three grammatical complexity variables had a significant positive correlation to self-report of cognitive function. One semantic complexity variable had a significant positive correlation to delayed recall neurocognitive tests. Results suggest that psycholinguistic analysis may be used to assess cognitive function among breast cancer survivors. Confirmatory studies are needed to establish the correlation between psycholinguistic measures, self-report of cognitive function, and domain-specific tests of neurocognitive performance, as well as to evaluate longitudinal sensitivity to change.

Traumatic brain injury (TBI) is an extremely complex condition due to heterogeneity in injury mechanism, underlying conditions, and secondary injury. Pre-clinical and clinical researchers face challenges with reproducibility that negatively impact translation and therapeutic development for improved TBI patient outcomes. To address this challenge, TBI Pre-clinical Working Groups expanded upon previous efforts and developed common data elements (CDEs) to describe the most frequently used experimental parameters. The working groups created 913 CDEs to describe study metadata, animal characteristics, animal history, injury models, and behavioral tests. Use cases applied a set of commonly used CDEs to address and evaluate the degree of missing data resulting from combining legacy data from different laboratories for two different outcome measures (Morris water maze [MWM]; RotorRod/Rotarod). Data were cleaned and harmonized to Form Structures containing the relevant CDEs and subjected to missing value analysis. For the MWM dataset (358 animals from five studies, 44 CDEs), 50% of the CDEs contained at least one missing value, while for the Rotarod dataset (97 animals from three studies, 48 CDEs), over 60% of CDEs contained at least one missing value. Overall, 35% of values were missing across the MWM dataset, and 33% of values were missing for the Rotarod dataset, demonstrating both the feasibility and the challenge of combining legacy datasets using CDEs. The CDEs and the associated forms created here are available to the broader pre-clinical research community to promote consistent and comprehensive data acquisition, as well as to facilitate data sharing and formation of data repositories. In addition to addressing the challenge of standardization in TBI pre-clinical studies, this effort is intended to bring attention to the discrepancies in assessment and outcome metrics among pre-clinical laboratories and ultimately accelerate translation to clinical research.

An article by Izumi et al. (2019) in the current issue describes the effect of a brief educational intervention for nurses to increase confidence in their knowledge of advance care planning (ACP). The description of this project offers a useful exemplar for those wishing to implement ACP interventions. This commentary raises questions about the role of nurses in ACP and the design of effective, sustainable ACP programs within complex health systems.

Acute stroke can result in neurological impairment or death. The Colorado Stroke Alliance and the Colorado Stroke Registry have made progress toward improving stroke care through their statewide quality improvement efforts. This report is a follow-up to a previous publication in the Journal of Neuroscience Nursing. The previous report focused on the organization and structure of the Colorado Stroke Alliance. The present report describes some of the successes and insights that have been achieved, including adherence to stroke quality indicators, gender disparities, process times for intravenous recombinant tissue plasminogen activator/alteplase, the impact of emergency medical services, and the role that nurses continue to have as agents of change in improving hospital care.

BackgroundTraumatic pneumothoraces are common. Many are managed with tube thoracostomy. However, there is a high complication rate from chest tube placement, particularly in patients with HIV, TB, or both.AimsWe sought to investigate the literature on the conservative management of traumatic pneumothorax in patients with HIV and/or TB.MethodsThe literature search was broken into two parts. In the first part, we searched for articles comparing tube thoracostomy versus conservative management in traumatic pneumothorax. In the second part, we sought articles describing the incidence and outcome of pneumothoraces in patients with pre-existing HIV or tuberculosis. In both, relevant articles were reviewed, and citations were hand-searched.ResultsFor the first portion, we identified 384 papers. From these, six studies were relevant. For the second portion, we identified 327 articles. A total of four unique articles were selected. The heterogeneity of the studies did not allow any pooled analysis. The studies of conservative management demonstrated a low percentage of patients with small pneumothoraces (most often <1.5 cm or less than 10%) later required tube thoracostomy for clinical deterioration (range 6–25%). No studies focused exclusively on pneumothoraces in patients with TB. In patients with HIV, there were no prospective trials of conservative management. Mortality for all HIV-infected patients with pneumothorax was high (25–50%), and the rate of complications from tube thoracostomy was also high. Pneumocystits carinii pneumonia (PCP) independently increased mortality.ConclusionsA review of the literature suggests that selected small pneumothoraces may be managed conservatively and that there is a high rate of complications related to tube thoracostomy in HIV patients. We propose a trial of the safety of conservative management of traumatic pneumothoraces in an area with a high prevalence of HIV and TB.