Comparing two strategies of dynamic intensity modulated radiation therapy (dIMRT) with 3-dimensional conformal radiation therapy (3DCRT) in the hypofractionated treatment of high-risk prostate cancer

<p>Abstract</p> <p>Background</p> <p>To compare two strategies of dynamic intensity modulated radiation therapy (dIMRT) with 3-dimensional conformal radiation therapy (3DCRT) in the setting of hypofractionated high-risk prostate cancer treatment.</p> <p>Methods</p> <p>3DCRT and dIMRT/Helical Tomotherapy(HT) planning with 10 CT datasets was undertaken to deliver 68 Gy in 25 fractions (prostate) and simultaneously delivering 45 Gy in 25 fractions (pelvic lymph node targets) in a single phase. The paradigms of pelvic vessel targeting (iliac vessels with margin are used to target pelvic nodes) and conformal normal tissue avoidance (treated soft tissues of the pelvis while limiting dose to identified pelvic critical structures) were assessed compared to 3DCRT controls. Both dIMRT/HT and 3DCRT solutions were compared to each other using repeated measures ANOVA and post-hoc paired t-tests.</p> <p>Results</p> <p>When compared to conformal pelvic vessel targeting, conformal normal tissue avoidance delivered more homogenous PTV delivery (2/2 t-test comparisons; p < 0.001), similar nodal coverage (8/8 t-test comparisons; p = ns), higher and more homogenous pelvic tissue dose (6/6 t-test comparisons; p < 0.03), at the cost of slightly higher critical structure dose (D_dose, 1–3 Gy over 5/10 dose points; p < 0.03). The dIMRT/HT approaches were superior to 3DCRT in sparing organs at risk (22/24 t-test comparisons; p < 0.05).</p> <p>Conclusion</p> <p>dIMRT/HT nodal and pelvic targeting is superior to 3DCRT in dose delivery and critical structure sparing in the setting of hypofractionation for high-risk prostate cancer. The pelvic targeting paradigm is a potential solution to deliver highly conformal pelvic radiation treatment in the setting of nodal location uncertainty in prostate cancer and other pelvic malignancies.</p

Oseltamivir-Resistant Influenza A Pandemic (H1N1) 2009 Virus, Hong Kong, China

Resistance to oseltamivir was observed in influenza A pandemic (H1N1) 2009 virus isolated from an untreated person in Hong Kong, China. Investigations showed a resistant virus with the neuraminidase (NA) 274Y genotype in quasi-species from a nasopharyngeal aspirate. Monitoring for the naturally occurring NA 274Y mutation in this virus is necessary

A Gestão Estratégica dos Recursos Humanos nas Autarquias Locais: estudo de caso na Câmara Municipal de Cantanhede

Os Recursos Humanos são fundamentais para o prosseguimento da missão e dos objetivos de qualquer organização. A Gestão Estratégica dos Recursos Humanos, permite que uma organização alcance os seus objetivos, através do aumento da probabilidade de realização dos mesmos. Esta lógica de Gestão dos Recursos Humanos, revela-se como uma promessa explícita de eficácia organizacional, que pode ser alcançada pelo desenvolvimento do conjunto de práticas de RH internamente consistentes e adequadas aos contextos organizacionais. O concretizar de uma Gestão Estratégica dos Recursos Humanos nas organizações da Administração Pública, considerando a complexidade humana e o valor inerente, é uma via para o desenvolvimento a todos os níveis. Nas Câmaras Municipais, enquanto órgãos executivos de uma das formas de Autarquias Locais que é o Município, a Gestão Estratégica dos Recursos Humanos torna-se um investimento necessário para a melhoria contínua na prestação de serviços públicos. Isso, tendo em conta que a descentralização de competências da Administração Pública Central, para as Autarquias Locais, acarreta um aumento de responsabilidades e requer maior capacidade de resposta às demandas sociais. É no contexto da Administração Pública, em particular das Autarquias Locais, que se realiza o estudo de caso na Câmara Municipal de Cantanhede. O objetivo desta investigação é compreender a dinâmica do sector dos Recursos Humanos nas Autarquias Locais, sob a perspetiva da Gestão Estratégica dos Recursos Humanos, e perceber a importância que esta tem no desempenho global dessas organizações. O tipo de pesquisa que se materializa é qualitativo e exploratório, com a realização de observação direta, análise documental e entrevistas semiestruturadas. Verifica-se com este estudo, que é preocupação da Câmara Municipal de Cantanhede e do sector dos Recursos Humanos, desenvolver procedimentos estratégicos de Gestão dos Recursos Humanos. Apesar de ser um processo limitado pelos problemas relativos à atualização das carreiras, baixa remuneração, ausência de compensações e prémio de desempenho. Para que a Gestão Estratégica dos Recursos Humanos tenha efetivamente campo de ação, é preciso que a Gestão dos Recursos Humanos seja desmistificada enquanto conceito e experienciada de forma expressiva nas Autarquias Locais, em conjunto com o reforço da autonomia dessas organizações. / Human Resources are fundamental for the pursuit of the mission and goals of any organization. The Strategic Management of Human Resources allows an organization to achieve its objectives by increasing the probability of achieving them. This Human Resource Management logic is an explicit promise of organizational effectiveness that can be achieved by developing a set of HR practices that are internally consistent and appropriate to organizational contexts. The realization of a Strategic Management of Human Resources in Public Administration organizations, considering the human complexity and the inherent value, is a way for development at all levels. In the Municipal Councils, as an executive bodies of one of the forms of Local Authorities that is the Municipality, the Strategic Management of Human Resources becomes a necessary investment for the continuous improvement in the provision of public services. This, taking into account that the decentralization of competences of the Central Public Administration, for Local Authorities, entails an increase in responsibilities and requires greater capacity to respond to social demands. It is in the context of the Public Administration, in particular the Local Authorities, that the case study is carried out in Cantanhede Town Hall. The objective of this research is to understand the dynamics of the Human Resources sector in Local Authorities, from the perspective of the Strategic Management of Human Resources, and realize the importance it has in the overall performance of these organizations. The type of research that materializes is qualitative and exploratory, with direct observation, documental analysis and semi-structured interviews. It is verified with this study, that is concern of the Cantanhede Town Hall and of the Human Resources sector to develop strategic human resources management procedures. Although it is a process limited by the problems related to the updating of the careers, low remuneration, absence of compensations and performance bonus. In order for the Strategic Management of Human Resources to have an effective field of action, it is necessary that the Human Resources Management be demystified as a concept and experienced in an expressive way in Local Authorities, together with the reinforcement of the autonomy of these organizations

Sequential introduction of single room isolation and hand hygiene campaign in the control of methicillin-resistant Staphylococcus aureus in intensive care unit

<p>Abstract</p> <p>Background</p> <p>After renovation of the adult intensive care unit (ICU) with installation of ten single rooms, an enhanced infection control program was conducted to control the spread of methicillin-resistant <it>Staphylococcus aureus </it>(MRSA) in our hospital.</p> <p>Methods</p> <p>Since the ICU renovation, all patients colonized or infected with MRSA were nursed in single rooms with contact precautions. The incidence of MRSA infection in the ICU was monitored during 3 different phases: the baseline period (phase 1); after ICU renovation (phase 2) and after implementation of a hand hygiene campaign with alcohol-based hand rub (phase 3). Patients infected with extended spectrum beta-lactamase (ESBL)-producing <it>Escherichia coli </it>and <it>Klebsiella species </it>were chosen as controls because they were managed in open cubicles with standard precautions.</p> <p>Results</p> <p>Without a major change in bed occupancy rate, nursing workforce, or the protocol of environmental cleansing throughout the study period, a stepwise reduction in ICU onset nonbacteraemic MRSA infection was observed: from 3.54 (phase 1) to 2.26 (phase 2, p = 0.042) and 1.02 (phase 3, p = 0.006) per 1000-patient-days. ICU onset bacteraemic MRSA infection was significantly reduced from 1.94 (phase 1) to 0.9 (phase 2, p = 0.005) and 0.28 (phase 3, p = 0.021) per 1000-patient-days. Infection due to ESBL-producing organisms did not show a corresponding reduction. The usage density of broad-spectrum antibiotics and fluoroquinolones increased from phase 1 to 3. However a significant trend improvement of ICU onset MRSA infection by segmented regression analysis can only be demonstrated when comparison was made before and after the severe acute respiratory syndrome (SARS) epidemic. This suggests that the deaths of fellow healthcare workers from an occupational acquired infection had an overwhelming effect on their compliance with infection control measures.</p> <p>Conclusion</p> <p>Provision of single room isolation facilities and promotion of hand hygiene practice are important. However compliance with infection control measures relies largely on a personal commitment, which may increase when personal safety is threatened.</p

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Re: "Local steroid injection for management of different types of acute idiopathic orbital inflammation: An 8-year study"

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