Gender-related differences have been found among invited speakers in select professional and medical societies. We examined whether similar disparities existed among keynote speakers, plenary ...speakers, and invited lecturers in a broad range of medical specialty conferences from 2013 to 2017.
A cross-sectional study was performed on 27 U.S. medical specialty conferences for which data were available on plenary speakers, keynote speakers, and/or invited lecturers. For each speaker, gender and degree(s) were determined. Fisher's exact test was performed to compare proportions of women among speakers to Association of American Medical Colleges' (AAMC) physician workforce data on gender distribution.
In aggregate, we identified 246 women among 984 speakers, significantly lower than expected when compared with 2015 AAMC data (25.0% vs. 34.0%;
< 0.00001). Compared with AAMC data reported in 2013, 2015, and 2017, women were significantly underrepresented in 2013 (
= 0.0064) and 2015 (
= 0.00004). In 2017, the proportion of women among invited speakers trended lower than AAMC active women physicians but did not reach significance (
= 0.309). Analysis of individual conference data stratified by year indicated that, while the representation of women among all speakers improved between 2015 and 2017, the representation of women among keynote speakers, plenary speakers, and invited lectureships was variable (including zero levels some years during the study period) and remained lower than expected as compared with workforce data for specific medical specialties.
Evaluating for and improving disparities is recommended to ensure gender equity among invited speakers across all medical specialty conferences.
PURPOSE: Radiodermatitis is a side effect of radiation therapy. Evidence-based interventions to minimize severity or delay progression are important for clinical care. This guideline intends to ...support individuals with cancer, clinicians, and others in decisions regarding radiodermatitis treatment. METHODOLOGIC APPROACH: A panel of healthcare professionals with patient representation was convened to develop a national clinical practice guideline for the management of radiodermatitis. GRADE (Grading of Recommendations Assessment, Development and Evaluation) methodology and the National Academies of Sciences, Engineering, and Medicine criteria for trustworthy guidelines were followed. The Cochrane Collaboration risk-of-bias tool was used, and certainty of the evidence was assessed using the GRADE approach. A quantitative and narrative synthesis of the evidence was completed. FINDINGS: The panel agreed on eight recommendations and made a conditional recommendation for deodorant/antiperspirant. Aloe vera and oral curcumin had knowledge gaps and were recommended only in the context of a clinical trial. The panel suggested against emu oil, calendula, and nonsteroidal interventions. IMPLICATIONS FOR NURSING: This guideline summarizes evidence-based interventions for the management of radiodermatitis to guide clinical care. KEYWORDS radiodermatitis; guidelines; GRADE; radiation therapy; symptom management
Purpose
Electron radiation therapy dose distributions are affected by irregular body surface contours. This study investigates the feasibility of three‐dimensional (3D) cameras to substitute for the ...treatment planning computerized tomography (CT) scan by capturing the body surfaces to be treated for accurate electron beam dosimetry.
Methods
Dosimetry was compared for six electron beam treatments to the nose, toe, eye, and scalp using full CT scan, CT scan with Hounsfield Unit (HU) overridden to water (mimic 3D camera cases), and flat‐phantom techniques. Radiation dose was prescribed to a depth on the central axis per physician’s order, and the monitor units (MUs) were calculated. The 3D camera spatial accuracy was evaluated by comparing the 3D surface of a head phantom captured by a 3D camera and that generated with the CT scan in the treatment planning system. A clinical case is presented, and MUs were calculated using the 3D camera body contour with HU overridden to water.
Results
Across six cases the average change in MUs between the full CT and the 3Dwater (CT scan with HU overridden to water) calculations was 1.3% with a standard deviation of 1.0%. The corresponding hotspots had a mean difference of 0.4% and a standard deviation of 1.9%. The 3D camera captured surface of a head phantom was found to have a 0.59 mm standard deviation from the surface derived from the CT scan. In‐vivo dose measurements (213 ± 8 cGy) agreed with the 3D‐camera planned dose of 209 ± 6 cGy, compared to 192 ± 6 cGy for the flat‐phantom calculation (same MUs).
Conclusions
Electron beam dosimetry is affected by irregular body surfaces. 3D cameras can capture irregular body contours which allow accurate dosimetry of electron beam treatment as an alternative to costly CT scans with no extra exposure to radiation. Tools and workflow for clinical implementation are provided.
Introduction This work provides outcomes of an evidence-based Spanish-language sleep education program for two groups at a university in central Mexico. Methods Advanced training in sleep disorders ...and sleep health promotion was adapted from a lay health educator progam. Data stemmed from pre/post ratings regarding knowledge of obstructive sleep apnea (OSA), insomnia, restless legs syndrome (RLS), short sleep duration (SSD), circadian rhythm disorders (CRD), and drowsy driving (DD) on a 5-point Likert-like scale, and five true/false questions regarding misconceptions about sleep. Data were analyzed with frequencies for profession, sex, and sources of sleep information, and paired t-tests using SPSS (V24) with significance set at p<.05. Results Volunteer participants (N=164; 72% women) were recruited from five semester-long diabetes educator certificate programs (n=127; doctors, nurses, nutritionists, exercise, mental health specialists) and an undergraduate nursing class (n=37). There were no differences for any variables between student and certificate groups; therefore, survey data were combined. Means with standard deviations showed significant learning for all sleep disorders across groups following the training (OSA: 2.6±1.0 to 4.4±0.79; Insomnia: 3.1±0.84 to 4.5±0.71; RLS: 1.6±0.87 to 4.3±0.84; SSD: 2.6 ±1.0 to 4.4±0.68; CRD: 2.2±1.0 to 4.3±0.76; DD: 2.4±1.0 to 4.4±0.71, all p<.0001). The total pre- to post-scores (range=0 to 30) for sleep disorders moved from 14.4±4.0 to 26.3±4.0, p<.0001. Participants also demonstrated significant learning regarding misconceptions about sleep pre- 4.2±0.70 to post-testing 4.8±0.41, p<.0001. Respondents reported most of their sleep information came from the internet (33%), doctors (26%), and books (15%) or articles (15%). Conclusion Results suggest that this evidence-based Spanish-language sleep program is a salient and cost-effective approach to preparing diabetes educators and undergraduate nursing students regarding sleep disorders across the lifespan in Mexico. Pre-to-post analyses of true/false items suggest significant learning in the areas of sleep needs for adults and the misconception that daytime sleep can make up for lack of sleep at night. Given the high prevalence of DM in Mexico, the behaviorally based sleep promotion strategies included in the training could help decrease sleep-associated comorbidities, thereby reducing health care costs. Support (If Any) N/A
Local recurrence (LR) after surgical debulking of nodal or subcutaneous melanoma deposits defeats the purpose of operation and may worsen prognosis if the procedure was performed for stage III ...disease. To decrease LR rates in this setting, we extended the previously described role of hypofractionated radiation for melanoma deposits of the neck to all situations where the patient was felt to be at high risk for postoperative relapse after resection of bulky disease.
Hypofractionated external beam radiation was administered in 6-Gy doses for 5 fractions (total dose 30 Gy, given over a median of 15 elapsed days) to 42 resected melanoma deposit sites in 41 patients.
Stages of the 41 patients at the time of treatment were: 22 stage III and 19 stage IV. All patients had complete gross resection of disease at the radiation site before radiation. Mean time between operation and initiation of radiation was 4 weeks. The 42 sites of treatment included 27 neck, 9 axilla, 3 groin, and 3 subcutaneous deposits. There were no treatment-related deaths; side effects were minimal and self-limited. Transient erythema, desquamation, fibrosis, telangiectasias, and mucositis, parotiditis, and xerostomia (for head and neck radiation) were reported, but no patient required interruption of therapy for these events. Of the 42 treated sites, only 2 recurred in the treatment field (one neck, one axilla) during the mean follow-up time of 22.4 months, for a treatment failure rate of 4.8%. This represents improved local control compared with patients treated with surgery alone at our institution and with published recurrence rates.
The addition of hypofractionated radiation therapy after resection of nodal and subcutaneous melanoma deposits at a variety of sites is a rapid and well-tolerated method of providing excellent local control.
Background The heterogeneous nature and determinants of stroke among different Hispanic groups was examined by comparing hospitalized Hispanic stroke patients in Miami, where the Hispanic population ...is largely of Caribbean origin, to a Mestizo population in Mexico City. Methods Consecutive Hispanic patients who were admitted with stroke or transient ischemic attack (TIA) and included in the prospective stroke registries of 2 tertiary care teaching hospitals were studied. Demographic factors, stroke subtypes, vascular risk factors, stroke severity, and outcomes were compared. Vascular risk factor definitions were standardized. Results A total of 928 patients (520 Mexicans and 408 Miami Hispanics) were analyzed. Mexicans were younger, with a greater proportion of women. More cerebral venous thromboses (CVTs) were admitted in Mexico, while TIA and stroke mimics were more commonly admitted in Miami; cardioembolic strokes were more commonly ascertained in Miami, and more cryptogenic strokes in Mexico. Stroke severity was similar for intracerebral hemorrhages, but more severe ischemic strokes and CVTs were included in the Mexican registry. Outcome at 1 and 3 months was similar in both registries after adjusting for age and baseline stroke severity. After adjusting for age and sex, hypertension, dyslipidemia, and atrial fibrillation were more frequent, and diabetes mellitus was less frequent, among Miami Hispanics compared to Mexicans. Conclusions We found significant differences in the frequency of hypertension, diabetes, dyslipidemia, and atrial fibrillation in Miami Hispanics and Mexican stroke patients, highlighting the heterogeneity of the Hispanic ethnic group. Future studies are needed to clarify the relative contribution of genetic and environmental disparities amongst Mexican and Caribbean Hispanic stroke patients.
Karnofsky Performance Status (KPS) is a commonly used scale to assess a patient's functional status.
Between September 1999 and March 2000, 117 patients were independently evaluated and assigned KPS ...scores by both an attending physician and a resident physician at the time of radiation therapy simulation.
Both attending and resident median assigned KPS score was 80. Attending and resident KPS scores were identical for 50 patients (43%). When KPS scores differed, this difference was of the smallest incremental value (10 points) in 50 patients (75%). The Pearson correlation coefficient is 0.85, significant at the 0.01 level.
KPS scoring by radiation oncology attending physicians is similar to that by resident physicians.
Introduction
Extramedullary leukemia (EML) will develop in approximately 3% of the patients with acute leukemia. Only a few retrospective studies, and no prospective or randomized studies, have ...assessed the effectiveness and toxicity of radiation for EML. Here we review the EML patients treated with radiation therapy at the Oregon Health and Sciences University (OHSU) Radiation Oncology department.
Methods and Materials
From 1987 to 2005, 17 patients with EML underwent 20 radiation courses at the OHSU Radiation Oncology department. All patients had either biopsy-proven EML or had pre-established diagnoses of leukemia and were treated for EML as presumptive relapse. Patient data and disease history were either extracted from the patient chart or obtained from the cancer tumor registry. Variables used for analysis included patient age, gender, histological diagnosis, tumor location, radiation dose, fraction size, acute toxicities, last follow up or date of death, disease recurrence site after radiation therapy, initial symptom with presenting EML, effect of radiation on symptom(s), and time to EML. Univariate and multivariate analyses were done. Kaplan-Meier survival curves and Cox regression analyses were generated.
Results
The mean age of our patients was 37.5 years, with a range from 7.4 to 78.5 years. Males made up 76% of the patients population. The most common location for an EML was soft tissue (25%), followed by central nervous system (20%), and mucosal (15%). Surgical intervention was performed in only 5 of the 17 EML patients. The 17 patients received 20 treatment courses. The most frequently used radiation energy was 6 Megavoltage photons (55% of the cases), while the next most common was cobalt 60 (10%) and a mixed energy beam (10%). Radiation therapy was quite effective at relieving symptoms with a 94% response rate and 61% having a complete response. Pain was palliated in 88% of patients, while mass effect was decreased in 100% of patients. The mean radiation dose given was 21.8 Gray (range 10–39.6 Gy). We did not observe a radiation dose response to symptom palliation (Table 1). Leukemia recurrence of any type occurred at a median of 5.8 months from the last day of radiation treatment. There was a low incidence of acute grade 1 or 2 toxicities (39%) and no acute grade 3 or 4 toxicities or late toxicities. Our 17 patients had a mean and median overall survival of 20.7 months and 5.6 months, ranging from less than 1 month to 149 months. Regression and correlation models failed to show any significant prognostic factor (age, gender, quality of radiation, total radiation dose, initial presenting EML symptom, or time from diagnosis of leukemia to diagnosis to EML) influencing overall survival.
Conclusions
The role of radiation in EML is for symptom relief. Low dose radiation provides excellent palliation with minimal toxicity. A radiation dose response was not seen in our small patient population.
Table 1Radiation Dose response in Extramedullary LeukemiaDose# Patients# Symptoms# symptoms with a response# symptoms with a complete response10–19.9 Gy677 (100%)4 (57%)20–29.9 Gy455 (100%)3 (60%)30 Gy or more465 (83%)4 (80%)
Children in America today are at an unacceptably high risk of developing neurodevelopmental disorders that affect the brain and nervous system including autism, attention deficit hyperactivity ...disorder, intellectual disabilities, and other learning and behavioral disabilities. These are complex disorders with multiple causes--genetic, social, and environmental. The contribution of toxic chemicals to these disorders can be prevented. APPROACH: Leading scientific and medical experts, along with children's health advocates, came together in 2015 under the auspices of Project TENDR: Targeting Environmental Neuro-Developmental Risks to issue a call to action to reduce widespread exposures to chemicals that interfere with fetal and children's brain development. Based on the available scientific evidence, the TENDR authors have identified prime examples of toxic chemicals and pollutants that increase children's risks for neurodevelopmental disorders. These include chemicals that are used extensively in consumer products and that have become widespread in the environment. Some are chemicals to which children and pregnant women are regularly exposed, and they are detected in the bodies of virtually all Americans in national surveys conducted by the U.S. Centers for Disease Control and Prevention. The vast majority of chemicals in industrial and consumer products undergo almost no testing for developmental neurotoxicity or other health effects. CONCLUSION: Based on these findings, we assert that the current system in the United States for evaluating scientific evidence and making health-based decisions about environmental chemicals is fundamentally broken. To help reduce the unacceptably high prevalence of neurodevelopmental disorders in our children, we must eliminate or significantly reduce exposures to chemicals that contribute to these conditions. We must adopt a new framework for assessing chemicals that have the potential to disrupt brain development and prevent the use of those that may pose a risk. This consensus statement lays the foundation for developing recommendations to monitor, assess, and reduce exposures to neurotoxic chemicals. These measures are urgently needed if we are to protect healthy brain development so that current and future generations can reach their fullest potential.
COVID-19 oral treatments require initiation within 5 days of symptom onset. Although antigen tests are less sensitive than RT-PCR, rapid results could facilitate entry to treatment. We collected ...anterior nasal swabs for BinaxNOW and RT-PCR testing and clinical data at a walk-up, community site in San Francisco, California between January and June 2022. SARS-CoV-2 genomic sequences were generated from positive samples and classified according to subtype and variant. Monte Carlo simulations were conducted to estimate the expected proportion of SARS-CoV-2 infected persons who would have been diagnosed within 5 days of symptom onset using RT-PCR versus BinaxNOW testing. Among 25,309 persons tested with BinaxNOW, 2,799 had concomitant RT-PCR. 1137/2799 (40.6%) were SARS-CoV-2 RT-PCR positive. We identified waves of predominant omicron BA.1, BA.2, BA.2.12, BA.4, and BA.5 among 720 sequenced samples. Among 1,137 RT-PCR positive samples, 788/1137 (69%) were detected by BinaxNOW; 94% (669/711) of those with Ct value <30 were detected by BinaxNOW. BinaxNOW detection was consistent over lineages. In analyses to evaluate entry to treatment, BinaxNOW detected 81.7% (361/442, 95% CI: 77-85%) of persons with COVID-19 within 5 days of symptom onset. In comparison, RT-PCR (24-hour turnaround) detected 84.2% (372/442, 95% CI: 80-87%) and RT-PCR (48-hour turnaround) detected 67.0% (296/442, 95% CI: 62-71%) of persons with COVID-19 within 5 days of symptom onset. BinaxNOW detected high viral load from anterior nasal swabs consistently across omicron sublineages emerging between January and June of 2022. Simulations support BinaxNOW as an entry point for COVID-19 treatment in a community field setting.
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