Nursing leadership and influence in practice domains at a Veterans Affairs Health Care System.

BACKGROUND: Studies in Veteran populations have examined disparities in health service use, care quality, outcomes and increased demands for behavioral health. PURPOSE: The purpose is to describe the development of nursing leadership roles that influenced practice improvements and demonstrated outcomes related to health disparities in a Veterans Affairs (VA) population over a 12-year period. METHODS: The Sundean and colleagues' concept analysis of nurse leadership influence was applied to frame the initiative process and impacts. DISCUSSION: Antecedents and processes that facilitated leadership development included mentorship, disparities expertise, partnerships, consultation, scholarship, dissemination, advocacy, education, and strong coauthor collaboration. Improvements and outcomes included access to services, improved health indicators, tools, workforce, funding, innovations, and nurse investigator studies, consistent with VA priorities and policy related to disparities and equity. Limitations and barriers were addressed. CONCLUSION: This initiative models' strategies to increase nurse leadership in health equity and care transformation in health systems and community practices.

Medical dosimetry virtual clinical education: Mentors' perspectives.

The COVID-19 pandemic affected the United States in early 2020, and many universities began offering their curriculum remotely. The majority of medical dosimetry programs started to offer both didactic and clinical education in a virtual setting. With COVID-19 social distancing and patient protective measures, many clinical medical dosimetrists also began to work in a remote or hybrid setting. Medical dosimetry students interact and learn from their clinical mentors in this remote clinical environment. The purpose of this study was to investigate the perspective of medical dosimetry mentors concerning the effectiveness of virtual clinical education for medical dosimetry students as a result of COVID-19. The Medical Dosimetry Mentor Perspective on Virtual Clinical Education (MedDos_VCE) survey measured medical dosimetry mentors' perceptions of the students' virtual clinical experience during the COVID-19 pandemic. The subject of the study was medical dosimetry mentors who participated in a remote clinic due to the COVID-19 pandemic since March 2020. The MedDos_VCE questionnaire measured (1) the mentors' assessment of instructional quality in remote clinical education; (2) opportunities for and quality of interaction between students and medical dosimetry mentors; and (3) suggestions for success from medical dosimetry mentors for students and other mentors who are participating in virtual clinical education. The majority of the clinical mentors were satisfied with the quality of virtual clinical education and students' learning outcomes. They felt that students experienced a good mix of patients, problems, and clinical experience and engaged in the day-to-day activities of a medical dosimetrist. Challenges exist and mentors offered practical suggestions for success for students and mentors in the virtual clinical environment.

The Impact of COVID-19 on Medical Dosimetry Education: Students' Perception on the Effectiveness of Program's Immediate Response.

In early 2020, many medical dosimetry programs began to offer lectures and clinical rotations remotely in response to COVID-19. Faculty instituted an IRB-approved study to investigate the effectiveness of medical dosimetry educational programs' immediate response to COVID-19 and modifications to teaching practices during the pandemic. The Program Response to COVID-19 Effectiveness Questionnaire (PRCEQ) survey was developed to measure students' perceptions of their learning experience during COVID-19. The subject of the study was the medical dosimetry current and former student population who received modified education delivery during the COVID-19 pandemic. This study suggests that generally students are satisfied with the quality of their virtual didactic and clinical education as well as communication between faculty and students and students to students. Programs should develop strategies to engage students during the virtual classes to motivate them to learn; utilize a variety of formats for the evaluation of students' learning, incorporate activities to help students make connections with real-world clinical situations, and schedule clinical visits for students to learn tasks that require their physical presence in clinic.

Kinetic and Structural Characterization of Sialidases (Kdnases) from Ascomycete Fungal Pathogens.

Sialidases catalyze the release of sialic acid from the terminus of glycan chains. We previously characterized the sialidase from the opportunistic fungal pathogen, Aspergillus fumigatus, and showed that it is a Kdnase. That is, this enzyme prefers 3-deoxy-d-glycero-d-galacto-non-2-ulosonates (Kdn glycosides) as the substrate compared to N-acetylneuraminides (Neu5Ac). Here, we report characterization and crystal structures of putative sialidases from two other ascomycete fungal pathogens, Aspergillus terreus (AtS) and Trichophyton rubrum (TrS). Unlike A. fumigatus Kdnase (AfS), hydrolysis with the Neu5Ac substrates was negligible for TrS and AtS; thus, TrS and AtS are selective Kdnases. The second-order rate constant for hydrolysis of aryl Kdn glycosides by AtS is similar to that by AfS but 30-fold higher by TrS. The structures of these glycoside hydrolase family 33 (GH33) enzymes in complex with a range of ligands for both AtS and TrS show subtle changes in ring conformation that mimic the Michaelis complex, transition state, and covalent intermediate formed during catalysis. In addition, they can aid identification of important residues for distinguishing between Kdn and Neu5Ac substrates. When A. fumigatus, A. terreus, and T. rubrum were grown in chemically defined media, Kdn was detected in mycelial extracts, but Neu5Ac was only observed in A. terreus or T. rubrum extracts. The C8 monosaccharide 3-deoxy-d-manno-oct-2-ulosonic acid (Kdo) was also identified in A. fumigatus and T. rubrum samples. A fluorescent Kdn probe was synthesized and revealed the localization of AfS in vesicles at the cell surface.

RapidPlan development of VMAT plans for cervical cancer patients in low- and middle-income countries.

Cervical cancer has a high incidence and mortality rate in low- and middle-income countries (LMICs) largely due to limited resources and insufficient staffing. Knowledge-based planning (KBP) could alleviate understaffing issues by streamlining the radiotherapy treatment planning process. Varian's KBP system (RapidPlan) was used to develop a model capable of producing volumetric modulated arc therapy (VMAT) plans for cervical cancer patients. Plan data from 46 patients previously treated at MD Anderson Cancer Center (MDACC) were used to create and train the model which was then applied to 32 patients excluded from the training process. Dose volume histogram (DVH) values for the planning target volume (PTV_High), bladder, rectum, and bowel were evaluated for the validation plans and found to have satisfied the required PTV coverage and organ-at-risk (OAR) dose constraints. The average value for PTV_High D95.0% was 48.0 Gy (sd = 3.0 Gy) for existing clinical plans and 48.4 Gy (sd = 2.6 Gy) for the validation plans. The mean dose for the bladder, rectum, and bowel was 39.8 Gy (sd = 3.9 Gy), 41.6 Gy (sd = 5.2 Gy), and 21.6 Gy (sd = 5.0 Gy) for existing clinical plans and 38.9 Gy (sd = 4.0 Gy), 40.3 Gy (sd = 4.8 Gy), and 21.5 Gy (sd = 4.6 Gy) for validation plans, respectively. A TOST test showed that the p values for the PTV_High D95.0% (p < 0.001), rectum V30Gy (p = 0.039), and mean dose to the bladder (p = 0.0014), rectum (p = 0.025), and bowel (p = 0.006) were statistically significant within a 5% equivalence margin of the clinical value thereby providing strong evidence of equivalence. Based on this statistical analysis, it was determined that the model was capable of generating treatable VMAT plans for cervical cancer patients.

Relationship between student selection criteria and learner success for medical dosimetry students.

Medical dosimetry education occupies a specialized branch of allied health higher education. Noted international shortages of health care workers, reduced university funding, limitations on faculty staffing, trends in learner attrition, and increased enrollment of nontraditional students force medical dosimetry educational leadership to reevaluate current admission practices. Program officials wish to select medical dosimetry students with the best chances of successful graduation. The purpose of the quantitative ex post facto correlation study was to investigate the relationship between applicant characteristics (cumulative undergraduate grade point average (GPA), science grade point average (SGPA), prior experience as a radiation therapist, and previous academic degrees) and the successful completion of a medical dosimetry program, as measured by graduation. A key finding from the quantitative study was the statistically significant positive correlation between a student׳s previous degree and his or her successful graduation from the medical dosimetry program. Future research investigations could include a larger research sample, representative of more medical dosimetry student populations, and additional studies concerning the relationship of previous work as a radiation therapist and the effect on success as a medical dosimetry student. Based on the quantitative correlation analysis, medical dosimetry leadership on admissions committees could revise student selection rubrics to place less emphasis on an applicant׳s undergraduate cumulative GPA and increase the weight assigned to previous degrees.

Use of 3D printers to create a patient-specific 3D bolus for external beam therapy.

The purpose of this paper is to demonstrate that an inexpensive 3D printer can be used to manufacture patient-specific bolus for external beam therapy, and to show we can accurately model this printed bolus in our treatment planning system for accurate treatment delivery. Percent depth-dose measurements and tissue maximum ratios were used to determine the characteristics of the printing materials, acrylonitrile butadiene styrene and polylactic acid, as bolus material with physical density of 1.04 and 1.2 g/cm3, and electron density of 3.38 × 10²³ electrons/cm3 and 3.80 × 10²³ electrons/ cm3, respectively. Dose plane comparisons using Gafchromic EBT2 film and the RANDO phantom were used to verify accurate treatment planning. We accurately modeled a printing material in Eclipse treatment planning system, assigning it a Hounsfield unit of 260. We were also able to verify accurate treatment planning using gamma analysis for dose plane comparisons. With gamma criteria of 5% dose difference and 2 mm DTA, we were able to have 86.5% points passing, and with gamma criteria of 5% dose difference and 3 mm DTA, we were able to have 95% points passing. We were able to create a patient-specific bolus using an inexpensive 3D printer and model it in our treatment planning system for accurate treatment delivery.

Involved field radiation for Hodgkin's lymphoma: the actual dose to breasts in close proximity.

To decrease the risk of late toxicities in Hodgkin's lymphoma (HL) patients treated with radiation therapy (RT) (HL), involved field radiation therapy (IFRT) has largely replaced the extended fields. To determine the out-of-field dose delivered from a typical IFRT to surrounding critical structures, we measured the dose at various points in an anthropomorphic phantom. The phantom is divided into 1-inch-thick slices with the ability to insert TLDs at 3-cm intervals grid spacing. Two treatment fields were designed, and a total of 45 TLDs were placed (equally spaced) at the margin of the each of the 2 radiation fields. After performing a computed tomography simulation, 2 treatment plans targeting the mediastinum, a typical treatment field in patients with early stage HL, were generated. A total dose of 3060 cGy was delivered to the gross tumor volume for each field consecutively. The highest measured dose detected at 1 cm from the field edge in the planning target volume was 496 cGy, equivalent to 16% of the isocentric dose. The dose dropped significantly with increasing distance from the field edge. It ranged from 1.1-3.9% of the isocentric dose at a distance of 3.2-4 cm to <1.6% at a distance of >6 cm. Although the computer treatment planning system (CTPS) frequently underestimated the dose delivered, the difference in dose between measured and generated by CTPS was <2.5% in 90 positions measured. The collateral dose of radiation to breasts from IFRT is minimal. The out-of-field dose, although mildly underestimated by CTPS, becomes insignificant at >3 cm from the field edge of the radiation field.

Induction and concurrent taxanes enhance both the pulmonary metabolic radiation response and the radiation pneumonitis response in patients with esophagus cancer.

PURPOSE: The primary aim of this study was to assess pulmonary radiation toxicity quantitatively in patients who received thoracic radiotherapy combined with induction and/or concurrent chemotherapy with or without taxanes for esophageal cancer. METHODS AND MATERIALS: The study subjects were 139 patients treated at the University of Texas M.D. Anderson Cancer Center for esophageal cancer and who had undergone [(18)F]-fluorodeoxyglucose positron emission tomography/computed tomography between November 1, 2003 and December 15, 2007 for disease restaging after chemoradiotherapy. The patients were grouped into those who had not received taxanes (Group 1), those who had received induction or concurrent taxanes (Group 2), and those who had received both induction and concurrent taxanes (Group 3). Clinical pulmonary toxicity was scored using the National Cancer Institute Common Terminology Criteria for Adverse Events, version 3. Linear regression was applied to the fluorodeoxyglucose uptake vs. radiation dose to determine the pulmonary metabolic radiation response (PMRR) for each case. The clinical toxicity scores and PMRR among the groups were evaluated for significance differences. RESULTS: The crude rate of pneumonitis symptoms was 46%, 62%, and 74% for Group 1, 2, and 3, respectively. The analysis of variance test of log(PMRR) by treatment was significant (p = .0046). Group 3 had a 61% greater PMRR compared with Group 1 (p = .002). Group 2 had a 38% greater PMRR compared with Group 1 (p = .015). Finally, Group 3 had a 17% greater PMRR compared with Group 2 (p = .31). A PMRR enhancement ratio of 1.60 (95% confidence interval, 1.19-2.14) was observed for Group 3 vs. Group 1. CONCLUSION: Patients given induction and concurrent taxane chemotherapy had a significantly greater PMRR and clinical pneumonitis symptoms compared with the patients whose chemotherapy regimen did not include taxanes.