Am Anfang war die Vision. Die Geburt eines eigenen Basis-Lehrmittels.

«Was wäre, wenn wir im Hebammenstudium mit einem eigenen Lehrmittel evidenzbasiert und nach unseren beruflichen Grundsätzen unterrichten könnten?» Wie Dozentinnen der BFH und ZHAW diese Vision umgesetzt und vier Buchbände herausgebracht haben, erfahren Sie hier

Pre-orchiectomy tumor marker levels should not be used for International Germ Cell Consensus Classification (IGCCCG) risk group assignment

PURPOSE To investigate whether the use of pre-orchiectomy instead of pre-chemotherapy tumor marker (TM) levels has an impact on the International Germ Cell Consensus Classification (IGCCCG) risk group assignment in patients with metastatic germ cell tumors (GCT). METHODS Demographic and clinical information of all patients treated for primary metastatic testicular non-seminomatous GCT in our tertiary care academic center were extracted from medical charts. IGCCCG risk group assignment was correctly performed with pre-chemotherapy marker levels and additionally with pre-orchiectomy marker levels. Agreement between pre-chemotherapy and pre-orchiectomy risk group assignments was assessed using Cohen's kappa. RESULTS Our cohort consisted of 83 patients. The use of pre-orchiectomy TMs resulted in an IGCCCG risk group upstaging in 12 patients (16%, 8 patients from good to intermediate risk and 4 patients from intermediate to poor risk) and a downstaging in 1 patient (1.2%, from intermediate- to good-risk). The agreement between pre-orchiectomy and pre-chemotherapy IGCCCG risk groups resulted in a Cohen's kappa of 0.888 (p < 0.001). CONCLUSIONS Using pre-orchiectomy TMs can result in incorrect IGCCCG risk group assignment, which in turn can impact on the clinical management and follow-up of patients with metastatic GCT. Thus, adherence to the IGCCCG standard using pre-chemotherapy TMs levels is recommended

Synthetic computed tomography for low-field magnetic resonance-only radiotherapy in head-and-neck cancer using residual vision transformers

BACKGROUND AND PURPOSE Synthetic computed tomography (sCT) scans are necessary for dose calculation in magnetic resonance (MR)-only radiotherapy. While deep learning (DL) has shown remarkable performance in generating sCT scans from MR images, research has predominantly focused on high-field MR images. This study presents the first implementation of a DL model for sCT generation in head-and-neck (HN) cancer using low-field MR images. Specifically, the use of vision transformers (ViTs) was explored. MATERIALS AND METHODS The dataset consisted of 31 patients, resulting in 196 pairs of deformably-registered computed tomography (dCT) and MR scans. The latter were obtained using a balanced steady-state precession sequence on a 0.35T scanner. Residual ViTs were trained on 2D axial, sagittal, and coronal slices, respectively, and the final sCTs were generated by averaging the models' outputs. Different image similarity metrics, dose volume histogram (DVH) deviations, and gamma analyses were computed on the test set (n = 6). The overlap between auto-contours on sCT scans and manual contours on MR images was evaluated for different organs-at-risk using the Dice score. RESULTS The median [range] value of the test mean absolute error was 57 [37-74] HU. DVH deviations were below 1% for all structures. The median gamma passing rates exceeded 94% in the 2%/2mm analysis (threshold = 90%). The median Dice scores were above 0.7 for all organs-at-risk. CONCLUSIONS The clinical applicability of DL-based sCT generation from low-field MR images in HN cancer was proved. High sCT-dCT similarity and dose metric accuracy were achieved, and sCT suitability for organs-at-risk auto-delineation was shown

Les compétences des sages-femmes selon la loi

Deutsch: Seit Anfang Jahr ist das Gesundheitsberufegesetz in Kraft und definiert die Kom­petenzen von Hebammen und sechs weiteren Berufsgruppen. Ein Gesetz regelt nicht nur Pflichten, es beinhaltet auch Rechte und bietet Schutz. Entstanden ist es in mehrjähriger, intensiver Zusammenarbeit von Behörden und Vertreterinnen aus der Berufskonferenz sowie unter Einbezug von Hebammen aus verschiedenen Bereichen der Praxis und der Lehre. Sie haben mit grosser Umsicht und Sorgfalt die grund­legenden Formulierungen erarbeitet und in den Vernehmlassungen verteidigt Français: La loi sur les professions de la santé est en vigueur depuis le début de l’année et définit les compétences des sages-femmes et de six autres professions. Une telle loi règle non seulement les devoirs mais aussi les droits et offre une protection. Elle a été créée après plusieurs années de coopération intensive entre les autorités et les représentants de la Conférence professionnelle ainsi qu'avec la participation de sages-femmes de divers domaines de la pratique et de l'enseignement. Celles-ci ont élaboré les formulations de base avec grand soin et diligence et les ont défendues lors des consultations