Despite benefits of safety event reporting, few are trainee initiated. A comprehensive intervention was created to increase trainee reporting, partnering a trainee safety council with high-level ...faculty. Data were collected for 12 months pre intervention and 30 months post intervention, including short-term (1-12 mo) and long-term (13-30 mo) follow-up. A total of 2337 trainee events were submitted over the study period, primarily communication-related (40%) and on the medicine service (39%). Monthly submissions increased from 29.3 pre intervention to 66.2, 77.7, and 58.6 events/mo at post intervention, short-term follow-up, and long-term follow-up, respectively (P < 0.001). Proportion of hospital events submitted by trainees increased from 2.3% pre intervention to 4.1%, 4.9%, and 3.6% at post intervention, short-term, and long-term follow-up, respectively (P < 0.001). Trainee monthly submissions (P = 0.015) and proportion of hospital events (P < 0.001) declined from short- to long-term follow-up. Low- and intermediate-level harm events significantly increased post intervention (P < 0.001) while high-level events did not (P = 0.15-1.0). Our comprehensive intervention increased trainee event submissions at long-term follow-up.
Context: Pelvic radiation with concurrent chemotherapy is associated with toxicities that worsen the cachectic state of the patient.
Aims: The aim of this study is to quantify skeletal muscle changes ...on computed tomography (CT) images helps in assessing the same which could be correlated with the toxicities.
Settings and Design: The study design was s prospective study.
Subjects and Methods: Forty-one patients were treated with chemoradiation followed by brachytherapy (BT) for cervical cancer. Preexternal beam and preBT CT scans were used to assess skeletal muscle index (SMI). The changes in the SMI were correlated with enteritis, dyselectrolytemia, and hematological toxicities.
Statistical Analysis Used: Paired t-test was used to compare pre- and post-treatment SMI. Chi-square test would be used to study the association between toxicity and SMI change.
Results: The mean SMI was 57.41 cm2/m2 (42.5-73) in the preexternal beam radiotherapy (EBRT) scans and 54.5 cm2/m2 (40.9-71.07) in the post-EBRT scans. Twenty-two patients (53.7%), 14 patients (34.1%), and five patients (12.2%) belonged to <5%, 5%-10%, and >10% loss in SMI groups, respectively. Grade III enteritis was seen in 31.7% of the patients, hyponatremia in 26.8% of the patients in the 4th week, and leukopenia and neutropenia were seen in 26.8% of cases in the 5th week. Enteritis correlated significantly with the change in SMI (P = 0.047).
Conclusion: Patients with cancer cachexia are at higher risk for radiation enteritis during chemoradiation for cervical cancer.
Background
The value of dynamic contrast‐enhanced (DCE) sequences in prostate MRI compared with noncontrast MRI is controversial.
Purpose
To evaluate the population net benefit of risk stratification ...using DCE‐MRI for detection of high‐grade prostate cancer (HGPCA), with or without high spatiotemporal resolution DCE imaging.
Study Type
Decision curve analysis.
Population
Previously published patient studies on MRI for HGPCA detection, one using DCE with golden‐angle radial sparse parallel (GRASP) images and the other using standard DCE‐MRI.
Field Strength/Sequence
GRASP or standard DCE‐MRI at 3 T.
Assessment
Each study reported the proportion of lesions with HGPCA in each Prostate Imaging Reporting and Data System version 2 (PI‐RADS v2) category (1–5), before and after reclassification of peripheral zone lesions from PI‐RADS 3–4 based on contrast‐enhanced images. This additional risk stratifying information was translated to population net benefit, when biopsy was hypothetically performed for: all lesions, no lesions, PI‐RADS ≥3 (using NC‐MRI), and PI‐RADS ≥4 on DCE.
Statistical Tests
Decision curve analysis was performed for both GRASP and standard DCE‐MRI data, translating the avoidance of unnecessary biopsies and detection of HGPCA to population net benefit. We standardized net benefit values for HGPCA prevalence and graphically summarized the comparative net benefit of biopsy strategies.
Results
For a clinically relevant range of risk thresholds for HGPCA (>11%), GRASP DCE‐MRI with biopsy of PI‐RADS ≥4 lesions provided the highest net benefit, while biopsy of PI‐RADS ≥3 lesions provided highest net benefit at low personal risk thresholds (2–11%). In the same range of risk thresholds using standard DCE‐MRI, the optimal strategy was biopsy for all lesions (0–15% risk threshold) or PI‐RADS ≥3 on NC‐MRI (16–33% risk threshold).
Data Conclusion
GRASP DCE‐MRI may potentially enable biopsy of PI‐RADS ≥4 lesions, providing relatively preserved detection of HGPCA and avoidance of unnecessary biopsies compared with biopsy of all PI‐RADS ≥3 lesions.
J. Magn. Reson. Imaging 2019;49:1400–1408.
Objective: The aim of the present study was to formulate and optimize the PLGA polymeric nanoparticle of Nebivolol Hydrochloride for sustain release of drug
Methods: The drug-excipients interaction ...was explored by molecular docking studies by in silico tools. The drug-loaded polymeric nanoparticles prepared by emulsion solvent evaporation method using 32 factorial design and characterized for particle size, zeta potential, and entrapment efficiency. Shape and surface morphology was analysed by SEM and TEM. In vitro drug release study was performed by using a diffusion membrane.
Results: The docking analysis inferred that the drug has interacted well with PLGA and PF-68, which could prevent the drug crystal formation. The optimized polymeric nanoparticles had a particle size of 291 nm and entrapment efficiency of 83.4% and were found to be within 95% of CI of the predicted value, which is acceptable. SEM and TEM studies showed that the formed polymeric nanoparticles were smooth, spherical in shape and uniform in size. In vitro drug release study of optimized formulation showed sustained release for prolonged time period
Conclusion: Based on the computational studies and in vitro release studies, the developed Nebivolol hydrochloride loaded in PLGA nanoparticles could be a promising formulation in oral drug delivery for the treatment of hypertension.
Produce prescription programs are gaining traction in the U.S.; however, data on the impact of such approaches in pediatric populations are limited. The purpose of our clinic-based comparative ...effectiveness randomized controlled trial (CE RCT) is to evaluate the preliminary effectiveness of two produce prescription strategies (at-home delivery and grocery store vouchers) implemented by the Brighter Bites non-profit organization in improving obesity-related health outcomes and dietary behaviors among low-income 5-12-year-olds in Houston, Texas. This paper presents the study design, intervention components, and the study measures.
Participants (n = 150) are being recruited from two pediatric clinics in Houston, Texas. Child eligibility criteria are aged 5-12 years, Medicaid recipients, body-mass index (BMI) percentile ≥85 and living within 10 miles of a Brighter Bites distribution site. Following consent and baseline measures, children are randomized into one of three arms: (1) Bi-weekly $25 vouchers redeemable for produce at stores (n = 50), (2) Bi-weekly produce delivery to participants' homes through DoorDash (n = 50), and (3) wait-list usual care controls (n = 50). Intervention participants also receive Brighter Bites nutrition education materials. Main child outcome measures are BMI z-scores, blood pressure, hemoglobin A1c, liver panels, and lipid panels. Other outcomes including household food insecurity, child diet quality, and home nutrition environment will be collected through parent surveys. Outcome measures are collected at baseline and post-intervention. Process evaluation will measure program dosage, reach, acceptability, and feasibility.
Our paper presents the design and next steps to ensure the successful implementation of a produce prescription program in a pediatric clinic setting.
Texture features are proposed for classification and prognostication, with lacking information about variability. We assessed 3 T liver MRI feature variability.
Five volunteers underwent standard 3 T ...MRI, and repeated with identical and altered parameters. Two readers placed regions of interest using 3DSlicer. Repeatability (between standard and repeat scan), robustness (between standard and parameter changed scan), and reproducibility (two reader variation) were computed using coefficient of variation (CV).
67%, 49%, and 61% of features had good-to-excellent (CV ≤ 10%) repeatability on ADC, T1, and T2, respectively, least frequently for first order (19–35%). 22%, 19%, and 21% of features had good-to-excellent robustness on ADC, T1, and T2, respectively. 52%, 35%, and 25% of feature measurements had good-to-excellent inter-reader reproducibility on ADC, T1, and T2, respectively, with highest good-to-excellent reproducibility for first order features on ADC/T1.
We demonstrated large variations in texture features on 3 T liver MRI. Further study should evaluate methods to reduce variability.
•49–67% of texture feature measurements had good-to-excellent repeatability.•Only 19–22% of texture features had good-to-excellent robustness to parameter change.•Only 25–52% of texture features had good-to-excellent interreader reproducibility.•First order features were least repeatable, but were most frequently reproducible.•Different parameter changes had varying effects on texture feature outputs.
Purpose
To assess the impact of patient race and age on the performance of apparent diffusion coefficient (ADC) values for assessment of prostate cancer aggressiveness.
Materials and methods
457 ...prostate cancer patients who underwent 3T phased-array coil prostate MRI including diffusion-weighted imaging (DWI; maximal
b
-value 1000 s/mm
2
) before prostatectomy were included. Mean ADC of a single dominant lesion was measured in each patient, using histopathologic findings from the prostatectomy specimen as reference. In subsets defined by race and age, ADC values were compared between Gleason score (GS) ≤ 3 + 4 and GS ≥ 4 + 3 tumors.
Results
81% of patients were Caucasian, 12% African-American, 7% Asian-American. 13% were <55 years, 42% 55–64 years, 41% 65–74 years, and 4% ≥75 years. 63% were GS ≤ 3 + 4, 37% GS ≥ 4 + 3. ADC was significantly lower in GS ≥ 4 + 3 tumors than in GS ≤ 3 + 4 tumors in the entire cohort, as well as in Caucasian, African-American, and all four age groups (
P
≤ 0.015). AUC for differentiation of GS ≤ 3 + 4 and GS ≥ 4 + 3 as well as optimal ADC threshold was Caucasian: 0.73/≤848; African-American: 0.76/≤780; Asian-American: 0.66/≤839: <55 years, 0.73/≤830; 55–64 years, 0.71/≤800; 65–74 years, 0.74/≤872; ≥75 years, 0.79/≤880. A race-optimized ADC threshold resulted in higher specificity in African-American than Caucasian men (84.9% vs. 67.1%,
P
= 0.045); age-optimized ADC threshold resulted in higher sensitivity in patients aged ≥75 years than <55 years or 55–64 years (100.0% vs. 53.6%–73.3%;
P
< 0.001).
Conclusion
Patients’ race and age may impact the diagnostic performance and optimal threshold when applying ADC values for evaluation of prostate cancer aggressiveness.
ObjectiveTo examine public and media response to the draft (October 2011) and finalised (May 2012) recommendations of the United States Preventive Services Task Force (USPSTF) against ...prostate‐specific antigen (PSA) testing via Twitter, a popular social network with over 200 million active users.
Materials and Methods
We used a mixed‐methods design to analyse posts on Twitter, known as ‘tweets’. Using the search term ‘prostate cancer’, we archived tweets in the 24‐h periods following the release of both the draft and the finalised USPSTF recommendations. We recorded tweet rate per h and developed a coding system to assess the type of user and sentiment expressed in tweets and linked articles.
Results
After the draft and finalised USPSTF recommendations were released, 2042 and 5357 tweets focused on the USPSTF report, respectively. The tweet rate nearly doubled within 2 h of both announcements. Fewer than 10% of tweets expressed an opinion about screening, and the majority of these were pro‐screening during both periods. By contrast, anti‐screening articles were tweeted more frequently in both the draft and finalised study periods. Between the draft and the finalised recommendations, the proportion of anti‐screening tweets and anti‐screening article links increased (P = 0.03 and P < 0.01, respectively).
Conclusions
There was increased Twitter activity surrounding the USPSTF draft and finalised recommendations. The percentage of anti‐screening tweets and articles appeared to increase, perhaps due to the interval public comment period. Despite this, most tweets did not express an opinion, suggesting a missed opportunity in this important arena for advocacy.
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