Consideration of image guidance in patterns of failure analyses of intensity-modulated radiotherapy for head and neck cancer: a systematic review.

BACKGROUND Intensity-modulated radiation therapy (IMRT) is considered standard of care for head and neck squamous cell carcinoma (HNSCC). Improved conformity of IMRT and smaller margins, however, have led to concerns of increased rates of marginal failures. We hypothesize that while patterns of failure (PoF) after IMRT for HNSCC have been published before, the quality of patient positioning and image guided radiotherapy (IGRT) have rarely been taken into account, and their importance remains unclear. This work provides a systematic review of the consideration of IGRT in PoF studies after IMRT for HNSCC. MATERIALS AND METHODS A systematic literature search according to PRISMA guidelines was performed on PubMed for HNSCC, IMRT and PoF terms and conference abstracts from ESTRO and ASTRO 2020 and 2021 were screened. Studies were included if they related PoF of HNSCC after IMRT to the treated volumes. Data on patient and treatment characteristics, IGRT, treatment adaptation, PoF and correlation of PoF to IGRT was extracted, categorized and analyzed. RESULTS One-hundred ten studies were included. The majority (70) did not report any information on IGRT. The remainder reported daily IGRT (18), daily on day 1-3 or 1-5, then weekly (7), at least weekly (12), or other schemes (3). Immobilization was performed with masks (78), non-invasive frames (4), or not reported (28). The most common PoF classification was "in-field/marginal/out-of-field", reported by 76 studies. Only one study correlated PoF in nasopharyngeal cancer patients to IGRT. CONCLUSION The impact of IGRT on PoF in HNSCC is severely underreported in existing literature. Only one study correlated PoF to IGRT measures and setup uncertainty. Further, most PoF studies relied on outdated terminology ("in/out-of-field"). A clearly defined and up-to-date PoF terminology is necessary to evaluate PoFs properly, as is systematic and preferably prospective data generation. PoF studies should consistently and comprehensively consider and report on IGRT

Ateliers de formation culinaire interprofessionnelle à l’Université de Saskatchewan

Implication Statement If you want to offer your students an enjoyable and worthwhile interprofessional activity to learn about issues in community nutrition, your university can cook up these interprofessional culinary education workshops. Start with a few enthusiastic students from various health professional programs who can organize, promote, and lead. Include faculty and/or staff to support the students and apply for internal funding. Find workshop facilitators (e.g., chefs), and arrange for program evaluation. It is best to choose workshop topics and themes relevant to your local situation. Ensure workshops are structured to facilitate cooperative and experiential learning. Students will find these sessions informative, practical, and enjoyable.Énoncé des implications de la recherche Les ateliers culinaires sont une activité interprofessionnelle agréable et intéressante que votre université peut proposer aux étudiants qui souhaitent se familiariser avec les enjeux de la nutrition communautaire. Il suffit de réunir, pour commencer, quelques étudiants motivés issus de divers programmes de santé pour organiser, promouvoir et diriger les ateliers. Il s’agit ensuite de trouver les enseignants ou le personnel pour les soutenir, et de s’assurer d’un financement interne.  Il faut ensuite trouver des animateurs d’ateliers (par exemple, un chef) et planifier l’évaluation du programme. Il est préférable d’axer les ateliers sur des thèmes adaptés à votre milieu. Les ateliers doivent être structurés de manière à faciliter l’apprentissage coopératif et expérientiel. Les étudiants trouveront ces séances instructives, pratiques et agréables

Diagnostic workup of cancer in patients with new-onset anaemia:a Danish cohort study in general practice

Background Anaemia is associated with adverse outcomes, including increased morbidity and all-cause mortality. Diagnostic workup of patients with anaemia is essential to detect underlying disease, especially undiagnosed malignancy. Objective To describe the cancer-relevant diagnostic workup in patients with new-onset anaemia detected in general practice. An additional aim was to analyse associations between patient characteristics and the diagnostic workup. Design Observational population-based cohort study using electronic laboratory and register data. Setting Danish general practice. Subjects Patients aged 40–90 years with new-onset anaemia (no anaemia in the preceding 15 months) detected in general practice. Patients were identified in Danish laboratory information systems and nationwide registries in 2014–2018. Main outcome measures We measured the proportion of patients receiving predefined diagnostic investigations, that is, cancer patient pathway, colonoscopy, gastroscopy, computerised tomography (CT) scan, faecal test for haemoglobin, and bone marrow examination within three months of the anaemia index date. Results We included 59,993 patients, and around half of the patients with ‘iron deficiency anaemia’, ‘anaemia of inflammation’, or ‘combined inflammatory iron deficiency anaemia’ had no cancer-relevant diagnostic investigations performed. Patients aged 60–79 years and patients with severe anaemia were more likely to have investigations performed, while patients with comorbidity were less likely to have investigations performed. Conclusion Around half of the patients with anaemia subtypes that may indicate underlying cancer had no cancer-relevant diagnostic investigations performed. This may represent missed diagnostic opportunities. Future interventions are needed to improve the diagnostic workup of cancer in patients with anaemia, for example, laboratory alert systems and clinical decision support.KEY POINTS The general practitioners are often the first to detect anaemia and its underlying disease (e.g. undiagnosed malignancy). Large-scale studies are needed on the diagnostic workup of patients with anaemia in general practice in relation to an underlying malignancy. This study shows that the majority of patients with anaemia had no cancer-relevant diagnostic investigations performed, which may cause diagnostic delay. Interventions seems needed to improve the diagnostic workup of cancer in these patients to ensure timely diagnosis

Cancer risk in persons with new-onset anaemia:a population-based cohort study in Denmark

Abstract Background The time interval from first symptom and sign until a cancer diagnosis significantly affects the prognosis. Therefore, recognising and acting on signs of cancer, such as anaemia, is essential. Evidence is sparse on the overall risk of cancer and the risk of specific cancer types in persons with new-onset anaemia detected in an unselected general practice population. We aimed to assess the risk of cancer in persons with new-onset anaemia detected in general practice, both overall and for selected cancer types. Methods This observational population-based cohort study used individually linked electronic data from laboratory information systems and nationwide healthcare registries in Denmark. We included persons aged 40–90 years without a prior history of cancer and with new-onset anaemia (no anaemia during the previous 15 months) detected in general practice in 2014–2018. We measured the incidence proportion and standardised incidence ratios of a new cancer diagnosis (all cancers except for non-melanoma skin cancers) during 12 months follow-up. Results A total of 48,925 persons (median [interquartile interval] age, 69 [55–78] years; 55.5% men) were included in the study. In total, 7.9% (95% confidence interval (CI): 7.6 to 8.2) of men and 5.2% (CI: 4.9 to 5.5) of women were diagnosed with cancer during 12 months. Across selected anaemia types, the highest cancer incidence proportion was seen in women with ‘anaemia of inflammation’ (15.3%, CI: 13.1 to 17.5) (ferritin > 100 ng/mL and increased C-reactive protein (CRP)) and in men with ‘combined inflammatory iron deficiency anaemia’ (19.3%, CI: 14.5 to 24.1) (ferritin < 100 ng/mL and increased CRP). For these two anaemia types, the cancer incidence across cancer types was 10- to 30-fold higher compared to the general population. Conclusions Persons with new-onset anaemia detected in general practice have a high cancer risk; and markedly high for ‘combined inflammatory iron deficiency anaemia’ and ‘anaemia of inflammation’. Anaemia is a sign of cancer that calls for increased awareness and action. There is a need for research on how to improve the initial pathway for new-onset anaemia in general practice

Synthetic data of simulated microcalcification clusters to train and explain deep learning detection models in contrast-enhanced mammography

Deep learning (DL) models can be trained on contrast-enhanced mammography (CEM) images to detect and classify lesions in the breast. As they often put more emphasis on the masses enhanced in the recombined image, they can fail in recognizing microcalcification clusters since these are hardly enhanced and are mainly visible in the (processed) lowenergy image. Therefore, we developed a method to create synthetic data with simulated microcalcification clusters to be used for data augmentation and explainability studies when training DL models. At first 3-dimensional voxel models of simulated microcalcification clusters based on descriptors of the shape and structure were constructed. In a set of 500 simulated microcalcification clusters the range of the size and of the number of microcalcifications per cluster followed the distribution of real clusters. The insertion of these clusters in real images of non-delineated CEM cases was evaluated by radiologists. The realism score was acceptable for single view applications. Radiologists could more easily categorize synthetic clusters into benign versus malignant than real clusters. In a second phase of the work, the role of synthetic data for training and/or explaining DL models was explored. A Mask R-CNN model was trained with synthetic CEM images containing microcalcification clusters. After a training run of 100 epochs the model was found to overfit on a training set of 192 images. In an evaluation with multiple test sets, it was found that this high level of sensitivity was due to the model being capable of recognizing the image rather than the cluster. Synthetic data could be applied for more tests, such as the impact of particular features in both background and lesion models

How Low Can We Go? A Double-Blinded Randomized Controlled Trial to Compare Bupivacaine 5 mg and Bupivacaine 7.5 mg for Spinal Anesthesia in Cesarean Delivery in Indonesian Population

Background: Maternal hypotension in cesarean delivery related to spinal anesthesia results in increasing morbidity of both mothers and children. Studies show that low dose spinal anesthesia was able to prevent hypotension while providing adequate analgesia. However, the dose used in those studies varies and this leaves the debate of the dose scheme of spinal anesthesia open. Objectives: This study aimed to compare the effectiveness of 5mghyperbaric bupivacaine 0.5% and 25 mcg of fentanyl with 7.5mg hyperbaric bupivacaine 0.5% and 25 mcg of fentanyl to prevent hypotension in spinal anesthesia for cesarean delivery. Methods: This study was a double-blinded randomized controlled trial of 112 mothers undergoing cesarean delivery with spinal anesthesia. The intervention group received 5mgbupivacaine and 25 mcg fentanyl. The comparison group received of 7.5mgbupivacaine and 25 mcg fentanyl. The primary outcome was the incidence of hypotension. The adequacy of anesthesia, duration of recovery from the motoric block, the quality of analgesia as perceived by patients and surgeons, and the side effects of anesthesia were also recorded. Results: There was no difference of effectiveness to prevent hypotension in both groups. The 7.5 mgdose provided better adequacy of anesthesia as reflected in lower incidence of conversion into general anesthesia. More surgeons reported adequacy of relaxation in the 7.5 mg dose. The 5 mg dose offered faster motoric recovery and fewer side effects. Conclusions: The dose of 7.5 mg hyperbaric bupivacaine 0.5% and 25 mcg of fentanyl can be used as a prevention measure against hypotension due to spinal anesthesia cesarean delivery

Insufficient classification of anaemia in general practice:a Danish register-based observational study

BACKGROUND: Anaemia can be a pointer of underlying severe disease, including undiagnosed malignancy. Subsequent blood tests are essential to classify the anaemia into subtypes and to facilitate targeted diagnostic investigation to ensure timely diagnosis of underlying disease. OBJECTIVE: We aimed to describe and classify anaemia based on laboratory tests from patients with new-onset anaemia detected in general practice. An additional aim was to analyse associations between patient characteristics and unclassified anaemia (not classifiable according to an algorithm). DESIGN: Population-based cross-sectional study. SETTING: Danish general practice. SUBJECTS: A total of 62,731 patients (age: 40–90 years) with new-onset anaemia were identified in Danish laboratory information systems and nationwide registries, and data were obtained for 2014–2018. MAIN OUTCOME MEASURES: We measured the proportion of patients classified into subtypes of anaemia based on blood tests requested by general practitioners within 31 days of the anaemia index date. RESULTS: Of the 62,731 patients with new-onset anaemia, we identified unclassified anaemia in 78.9% (95% confidence interval (CI): 77.3–80.5) of men and 65.1% (CI: 63.4–66.9) of women. The likelihood of unclassified anaemia increased with age, increasing comorbidity and decreasing severity of anaemia. CONCLUSION: The majority of patients with new-onset anaemia could not be classified through a simple algorithm due to missing blood tests, which highlights a potential missed opportunity for diagnosis. Standardised laboratory testing of patients with anaemia is warranted to ensure adequate follow-up and early detection of underlying severe disease. KEY POINTS: Anaemia can be a sign of malignancy, and anaemia classification is an important step in the diagnosis of underlying disorders. The majority of patients with anaemia could not be classified according to a simple algorithm due to missing blood tests. Some patient characteristics were associated with a high risk of unclassified anaemia: high age, high comorbidity, and severe anaemia. Standardised laboratory testing in patients with anaemia is needed to inform targeted diagnostic investigation to ensure timely diagnosis

Efectos del maltrato infantil en el desarrollo emocional de niños y niñas de 3 a 6 años.

Analizar los efectos del maltrato infantil sobre el desarrollo emocional de niños y niñas de 3 a 6 añosEl presente documento tiene como objetivo analizar la incidencia del maltrato infantil en el desarrollo emocional en los niños y niñas de 3 a 6 años de edad, comprendiendo maltrato como un hecho que violenta y agrede la integridad o el adecuado desarrollo del niño o niña, así mismo, el reconocimiento de esos factores desencadenantes que se lograron identificar durante la revisión documental desarrollada en el proceso de construcción de la monografía. En primer lugar, comprender que esta es una de las situaciones que se ha visto desde los inicios de la humanidad, pero no se había tomado como una problemática ya que no eran tan visibles los efectos que esta trae consigo, de igual manera, era una corriente cultural que pasaba desapercibida ya que el niño no era considerado importante en el desarrollo social, pero ha sido expuesto a diversas formas de maltratos como abusos y atropellos, que influye de manera emocional y social en su desarrollo. Por consiguiente, este fenómeno que vivencian los menores en los diversos contextos que interactúa afecta su desarrollo integral, tomado desde lo físico, emocional, cognitivo y social, que durante sus primeros años de vida son de gran importancia para la construcción de aprendizajes personales y sociales de muchos niños y niñas generando en ellos efectos adversos a corto y a largo plazo, y así provocando alteraciones en la parte cognitiva, espiritual, emocional y desarrollo a nivel social. Para terminar, esta revisión documental y literaria permitió tomar diversas fuentes que aportaron nuevas posturas, conceptos que permitieron reflexionar ante la problemática abordada, algunas de estas fuentes fueron; tesis, artículos, páginas web, libros y monografías.This document aims to analyze the incidence of child abuse in emotional development in children from 3 to 6 years of age, understanding abuse as an act that violates and attacks the integrity or proper development of the child, as well as the recognition of those triggering factors that were identified during the documentary review developed during the monograph construction process. In the first place, understand that this is one of the situations that has been seen since the beginning of humanity, but it had not been taken as a serious problem because of the effects that it brings after were not so visible at the time, it was also a cultural current that went unnoticed since the child development was not considered important in our social growth, but certainly has been exposed to various forms of mistreatment and abuse, which can happen verbally, physically and emotionally. This phenomenon that minors experience affects both their development and the emotional response of many boys and girls in the short and long term, causing alterations in the cognitive, spiritual, emotional and social development. Our statements are exposed with the certainty of an extensive documentary and literary review from various sources that provided new perspectives and concepts that allowed reflection on the problem addressed, some of these sources were; post graduate theses, articles, web pages, books and monographs