Better Medicine

https://scholarlyworks.lvhn.org/better-medicine/1025/thumbnail.jp

HAMAMATSU-ICG study: Protocol for a phase III, multicentre, single-arm study to assess the usefulness of indocyanine green fluorescent lymphography in assessing secondary lymphoedema

Introduction Secondary lymphoedema of the extremities is an important quality-of-life issue for patients who were treated for their malignancies. Indocyanine green (ICG) fluorescent lymphography may be helpful for assessing lymphoedema and for planning lymphaticovenular anastomosis (LVA). The objective of the present clinical trial is to confirm whether or not ICG fluorescent lymphography using the near-infrared monitoring camera is useful for assessing the indication for LVA, for the identification of the lymphatic vessels before the conduct of LVA, and for the confirmation of the patency of the anastomosis site during surgery. Methods and analysis This trial is a phase III, multicentre, single-arm, open-label clinical trial to assess the efficacy and safety of ICG fluorescent lymphography when assessing and treating lymphoedema of patients with secondary lymphoedema who are under consideration for LVA. The primary endpoint is the identification rate of the lymphatic vessels at the incision site based on ICG fluorescent lymphograms obtained before surgery. The secondary endpoints are 1) the sensitivity and specificity of dermal back flow determined by ICG fluorescent lymphography as compared with 99mTc lymphoscintigraphy—one of the standard diagnostic methods and 2) the usefulness of ICG fluorescent lymphography when confirming the patency of the anastomosis site after LVA. Ethics and dissemination The protocol for the study was approved by the Institutional Review Board of each institution. The trial was filed for and registered at the Pharmaceuticals and Medical Devices Agency in Japan. The trial is currently on-going and is scheduled to end in June 2020

Anatomical Segmentation of CT images for Radiation Therapy planning using Deep Learning

Radiation therapy is one of the key cancer treatment options. To avoid adverse effect in tissue surrounding the tumor, the treatment plan needs to be based on accurate anatomical models of the patient. In this thesis, an automatic segmentation solution is constructed for the female breast, the female pelvis and the male pelvis using deep learning. The deep neural networks applied performed as well as the current state of the art networks while improving inference speed by a factor of 15 to 45. The speed increase was gained through processing the whole 3D image at once. The segmentations done by clinicians usually take several hours, whereas the automatic segmentation can be done in less than a second. Therefore, the automatic segmentation provides options for adaptive treatment planning

Focal Spot, Winter 2006/2007

https://digitalcommons.wustl.edu/focal_spot_archives/1104/thumbnail.jp

Focal Spot, Summer/Fall 2008

https://digitalcommons.wustl.edu/focal_spot_archives/1109/thumbnail.jp

“The experience of illness in all of its complexity”: breast cancer, healthy-mindedness, and new momism movements at work in the illness narratives of Rosalind MacPhee and Kathlyn Conway

Picasso’s Woman: A Breast Cancer Story (1994) and Ordinary Life: A Memoir of Illness (1997) tell of the breast cancer experiences of Rosalind MacPhee and Kathlyn Conway, respectively. This thesis examines how three particular social movements—the breast cancer, healthy-mindedness, and “new momism” movements, all described in Chapter One—affect how MacPhee and Conway experience breast cancer and then write about it in the 1990s. Chapter Two examines the language of war that MacPhee and Conway adopt to describe illness and how such language leads them to examine the possibility proposed by the healthy-mindedness movement: that they are personally responsible for bringing a “determined killer” (Conway 125) into their lives. Chapter Three studies their active patient behaviours, as advocated by the breast cancer movement, as well as their more passive ones. I consider the relation between these active and passive behaviours in light of the severe nature of mastectomies and the presentation of post-surgical options. Chapter Four investigates how MacPhee and Conway struggle to maintain their roles as supermoms, busily attending to responsibilities at home and work, while simultaneously managing their recoveries. In each Chapter, the influence of the social movements named above becomes apparent as MacPhee and Conway attempt to move themselves and others out of the breast cancer experience and back into “a sense of normality” (MacPhee 106)

EXTERNAL BREAST PROSTHESES IN POST-MASTECTOMY CARE IN GERMANY – WOMENʼS EXPERIENCES: A QUALITATIVE STUDY

Aim: In Germany, external breast prostheses are recognized and funded as medical devices for adjustment and care following a mastectomy due to breast cancer. Nonetheless, there is a lack of awareness of the prostheses-fitting service in German breast centres and outpatient care. In this study breast cancer survivors give voice to their experiences. Design: The study employs qualitative research evaluation methods. Methods: Data was collected via semi-structured interviews. The analysis was carried out via open and axial coding. Results: Women’s experiences and requirements are presented in a two-phase model. Phase one describes their experiences of shock and crisis, and the subsequent initial prosthesis fitting in hospital. Phase two describes the womenʼs desire for normality, which they hope to achieve with the help of a breast prosthesis. Conclusion: The results confirm the consequences of losing a breast, the resulting distress, and the importance of a good-quality prosthesis for body image, femininity, and psychosocial well-being. The study confirms that a lack of information and choice in prosthesis fitting is a common problem. For the first time, the two-phase model demonstrates the differences between the initial hospital treatment and womenʼs long-term needs. Keywords: breast cancer, external breast prostheses, mastectomy, supportive care, qualitative research