Local failure after radical radiotherapy of non-small cell lung cancer in relation to the planning FDG-PET/CT.

OBJECTIVES: Local recurrence (rec) in lung cancer is associated with poor survival. This study examined whether the pattern of failure is associated with the most PET avid volume in the planning-FDG-PET/CT scan (p-PET/CT). METHODS: 162 consecutive inoperable NSCLC patients (pts) receiving radiotherapy between January 2012 and April 2014 were reviewed. Radiotherapy was delivered in 2 Gy/fraction (5f/week) to a total dose of 60-66 Gy. Pts were followed with CT scans every third month. Patients with local rec as first event were analyzed. For the primary tumor (T) the overlap-fraction (OF) between 50% of SUVpeak on p-PET/CT and the volume of T-rec was calculated: OF = (SUVp50∩T-rec)/min(SUVp50, T-rec). Similarly for the GTV on the p-CT: OF = (GTV∩T-rec)/min(GTV, T-rec). OF was based on a rigid registration between p-PET/CT and rec-CT with PET guided delineation of T- rec. For lymph nodes (LN), the correlation between the location of treated-LN and the location of recurrence-LN was evaluated. RESULTS: 67 patients developed local rec. 51 pts had rec in T-site, 45 pts in LN-site. Due to anatomical changes, reliable registration between p-CT and rec-CT was only obtained in 26 pts with T-rec. The median OFSUVp50 was 52, 8% [range 26; 100%] and the median OFGTV was 80.5% [19.7; 100%]. Eleven pts had higher OFSUVp50 than OFGTV. LN-rec predominantly occurred in the station 2R (32%), 4R (46%), 7 (46%) and right hilum (36%). Pts with malignant LNs in station 4R or 7 on p-CT had a high risk of rec in these stations; 4R (55%) and 7 (83%). CONCLUSIONS: This study indicates that the most PET active volume on p-PET-CT is a driver for rec at T-site. LN-recurrences predominantly appear in station 2R, 4R, 7 and right hilum. Additional confirmatory studies regarding lymph node mapping and selective lymph node irradiation is needed.

Development of a "First Five Minutes" Program to Improve Staff Response to Pediatric Codes.

BACKGROUND: Delayed or inadequate cardiopulmonary resuscitation during cardiopulmonary arrest is associated with adverse resuscitation outcomes in pediatric patients. Therefore, a "First Five Minutes" program was developed to train all inpatient acute care nurses in resuscitation skills. The program focused on steps to take during the first 5 minutes. OBJECTIVE: To improve response of bedside personnel in the first few minutes of a cardiopulmonary emergency. METHODS: A simulation-based in situ educational program was developed that focused on the components of the American Heart Association's "Get With the Guidelines" recommendations. The program was implemented in several phases to improve instruction and focus on necessary skills. RESULTS: The program garnered positive feedback from participants and was deemed helpful in preparing nurses and other staff members to respond to a patient in cardiopulmonary arrest. Time to chest compressions improved after training, and postintervention responses to questions regarding future code performance indicated participant recognition of the priority of the interventions addressed, such as backboard use, timely initiation of chest compressions, and timely administration of medications. Preliminary data show staff improvements in mock code performance. CONCLUSIONS: The First Five Minutes program has proved to be a successful educational initiative and is expected to be continued indefinitely, with additional phases incorporated as needed. A rigorous study on best teaching methods for the program is planned.

Nurse Vigilance: A Three-Part Simulation Course to Decrease Cardiopulmonary Arrests Outside Intensive Care Units.

Early recognition of and prompt intervention for the deteriorating pediatric patient remains paramount in preventing cardiac arrests from occurring outside intensive care units. To decrease these events, we developed a three-part simulation-based blended learning course consisting of a computer-based training module, a simulation scenario, and follow-up in situ scenarios for inpatient nurses. After initiation of the course, our facility has seen a decrease in the number of codes outside critical care areas.

Beliefs and social norms about ephedra onset and perceived addiction among college male and female athletes.

In Spring 2003, a qualitative approach was used to investigate relevant beliefs and norms associated with ephedra initiation and perceived addiction to the drug among 43 primarily minority athletes, attending a historically Black university in the southwestern region of the United States, who self-identified as past users. In general, participants stated that their second ephedra use event occurred on the same day as or the day after initiation. The majority of participants perceived that addiction was established by routine and eccentric behavior. Male athletes stated they used ephedra for improved athletic performance while females stated they used the drug for weight loss. Male participants stated it is difficult to quit ephedra use because of the resulting decrease in athletic performance, sickness, and weight gain. Female athletes were more concerned with their appearance. These findings are important in determining the early extent to which addiction is self-identified.

Quantitative anomaloscopy and optical coherence tomography scanning in central serous chorioretinopathy.

BACKGROUND: Dyschromatopsia is a prominent sign in a variety of central retinal diseases, such as central serous chorioretinopathy (CSC). The changes in colour vision may be due to either optical or neuronal factors in the diseased retina. The relative contribution from the two causes is unknown, but may be elucidated by obtaining knowledge of the anatomical derangement in the diseased retina in CSC. METHODS: Twenty-six normal persons had their colour vision tested using the Tomey anomaloscope. The calculation of setting range (SR) and central mean point (CMP) for Rayleigh match and Moreland match was optimized, and normal ranges for these values were defined. Subsequently 24 patients with CSC were examined by anomaloscopy and optical coherence tomography scanning, and the measures of colour vision were related to the anatomical changes observed on the scans. RESULTS: The algorithm for calculating SR and CMP which is integrated into the Tomey anomaloscope could be considerably improved to increase sensitivity and reproducibility of these measures. Fifteen patients had abnormal colour vision. Nine patients had pseudo-protanomaly, seven patients had pseudo-tritanomaly, and three patients had abnormalities in both matches. There was no relation between these colour vision abnormalities and the anatomical derangement as seen by OCT in the diseased central retina. CONCLUSION: The findings argue against the notion that the density of retinal cell nuclei, the orientation of photoreceptors, or the size of the central serous detachment are related to the colour vision abnormalities in CSC. The question of whether these abnormalities are due to optical or neuronal factors remains open.