Fricke gel xylenol orange dosimeter layers for stereotactic radiosurgery: A preliminary approach.

Investigations regarding the feasibility, reliability, and accuracy of Fricke gel dosimeter layers for stereotactic radiosurgery are presented. A representative radiosurgery plan consisting of two targets has been investigated. Absorbed dose distributions measured using radiochromic films and gelatin Fricke Gel dosimetry in layers have been compared with dose distributions calculated by using a treatment planning system and Monte Carlo simulations. The different dose distributions have been compared by means of the gamma index demonstrating that gelatin Fricke gel dosimeter layers showed agreements of 100%, 100%, and 93%, with dose and distance tolerances of 2% and 2 mm, with respect to film dosimetry, treatment planning system and Monte Carlo simulations, respectively. The capability of the developed system for three-dimensional dose mapping was shown, obtaining promising results when compared with well-established dosimetry methods. The obtained results support the viability of Fricke gel dosimeter layers analyzed by optical methods for stereotactic radiosurgery.

Reliability and validity of clinical tests to assess posture, pain location, and cervical spine mobility in adults with neck pain and its associated disorders: Part 4. A systematic review from the cervical assessment and diagnosis research evaluation (CADRE) collaboration.

PURPOSE: To determine the reliability and validity of clinical tests to assess posture, pain location, and cervical spine mobility in adults with grades I-IV neck pain and associated disorders (NAD). METHODS: We systematically searched electronic databases to update the systematic review of the Bone and Joint Decade 2000-2010 Task Force on Neck Pain and Its Associated Disorders. Eligible reliability and validity studies were critically appraised using modified versions of the QAREL and QUADAS-2 instruments, respectively. Evidence from low risk of bias studies were synthesized following best evidence synthesis principles. RESULTS: We screened 14302 articles, critically appraised 46 studies, and found 32 low risk of bias articles (14 reliability and 18 validity studies). We found preliminary evidence of: 1) reliability of visual inspection, aided with devices (CROM and digital caliper) to assess head posture; 2) reliability and validity of soft tissue palpation to locate tender/trigger points in muscles; 3) reliability and validity of joint motion palpation to assess stiffness and pain provocation in combination; and 4) range of motion tests using visual estimation (in cervical extension only) or devices (digital caliper, goniometer, inclinometer) to assess cervical mobility. CONCLUSIONS: We found little evidence to support the reliability and validity of clinical tests to assess head posture, pain location and cervical mobility in adults with NAD grades I-III. More advanced validity studies are needed to inform the clinical utility of tests used to evaluate patients with NAD.

Indirect costs associated with glioblastoma: Experience at one hospital. / Costes indirectos asociados al glioblastoma. Experiencia en un centro.

INTRODUCTION: Glioblastoma is the most common primary brain tumour. Despite advances in treatment, its prognosis remains dismal, with a mean survival time of about 14 months. Many articles have addressed direct costs, those associated with the diagnosis and treatment of the disease. Indirect costs, those associated with loss of productivity due to the disease, have seldom been described. MATERIAL AND METHOD: We conducted a retrospective study in patients diagnosed with glioblastoma at Hospital Universitario Donostia between January 1, 2010 and December 31, 2013. We collected demographics, data regarding the treatment received, and survival times. We calculated the indirect costs with the human capital approach, adjusting the mean salaries of comparable individuals by sex and age and obtaining mortality data for the general population from the Spanish National Statistics Institute. Past salaries were updated to 2015 euros according to the annual inflation rate and we applied a discount of 3.5% compounded yearly to future salaries. RESULTS: We reviewed the records of 99 patients: 46 women (mean age 63.53) and 53 men (mean age 59.94); 29 patients underwent a biopsy and the remaining 70 underwent excisional surgery. Mean survival was 18.092 months for the whole series. The total indirect cost for the series was €11 080 762 (2015). Mean indirect cost per patient was €111 926 (2015). DISCUSSION: Although glioblastoma is a relatively uncommon type of tumour, accounting for only 4% of all cancers, its poor prognosis and potential sequelae generate disproportionately large morbidity and mortality rates which translate to high indirect costs. Clinicians should be aware of the societal impact of glioblastoma and indirect costs should be taken into account when cost effectiveness studies are performed to better illustrate the overall consequences of this disease.

Incidence and risk factors for hip fractures in dialysis patients.

UNLABELLED: This study described the incidence of hip fractures, associated diseases, and related costs generated in dialysis versus non-dialysis patients. INTRODUCTION: Skeletal fractures are a great concern in chronic kidney disease patients and, in particular, hip fractures that enhance the mortality. We aimed to accurately determine the incidence of hip fractures and associated diseases and to calculate the costs generated in dialysis patients. METHODS: We obtained data from the 2010 French National Hospital Database. We first extracted the hospital stays related to hip fractures as a primary diagnosis according to the ICD-10 codes and then the hospitalizations for dialysis. We compared the frequency of comorbidities in both populations. RESULTS: Among the 88,962 patients who suffered from hip fractures, 362 were on dialysis. The incidence was significantly higher in dialysis patients (x4) compared to non-dialysis patients. Women on dialysis experienced hip fractures at an earlier age than non-dialysis women. Dementia was identified as a major risk factor in the dialysis patients (72 vs. 26%, p < 0.0001). Moreover, diabetes and cardiovascular diseases were comorbidities strongly associated with hip fractures in both gender, but hypertension and malnutrition were observed exclusively in men on dialysis. Mortality rate and length of hospital stay were increased (5 days) in both genders. CONCLUSION: The incidence of hip fractures is increased in dialysis patients, affecting a larger percentage of men and women on dialysis than in the non-dialysis population and enhancing the financial burden and mortality. Dementia is a major risk factor for hip fractures in dialysis patients in addition to diabetes and cardiovascular diseases.

In vitro performance assessment of new brushite-forming Zn- and ZnSr-substituted beta-TCP bone cements.

The present study investigated the in vitro performance of brushite-forming Zn- and ZnSr-substituted beta-TCP bone cements in terms of wet mechanical strength and biological response. Quantitative phase analysis and structural refinement of the powdered samples were performed by X-ray powder diffraction and Rietveld refinement technique. Initial and final setting times of the cement pastes, measured using Gilmore needles technique, showed that ZnSrCPC sets faster than ZnCPC. The measured values of the wet strength after 48 h of immersion in PBS solution at 37 degrees C showed that ZnSrCPC cements are stronger than ZnCPC cements. Human osteosarcoma-derived MG63 cell line proved the nontoxicity of the cement powders, using the resazurin metabolic assay.

Caracterización del proceso productivo, logístico y regulatorio de los medicamentos / Characterization of manufacture, logistic and regulatory provess of medicines

Este artículo identifica, caracteriza y describe las etapas del proceso productivo, logístico y regulatorio de medicamentos y las relaciona entre las mismas desde un enfoque de valor. Para la caracterización se adaptan el concepto de cadena de valor y la metodología de análisis de funciones básicas para los procesos de medicamentos innovadores. El concepto de valor mostró ser un paradigma de caracterización importante para este proceso particular. El trabajo descriptivo pretende servir de base para futuras investigaciones aplicadas a la cadena industrial de medicamentos y el sector académico

Spectral sensitivity study of dose distributions for a commercial convolution/superposition algorithm.

The focus of this study is to validate whether the sensitivity of dose distribution following the interface of different media can be used to distinguish between small variations of photon energy spectra in the context of the convolution/superposition algorithm in the polyenergetic implementation (Philips Pinnacle3, ADAC Laboratories, Milpitas, CA). Calculations were performed in homogeneous water and heterogeneous lung/water phantoms. Spectra were generated, in which the weights of the low-, medium- and high-energy components were adjusted sequentially. The heterogeneity correction factor CFlung, the D20/D10 ratio for homogeneous water and logarithmic derivative in buildup region LDbuildup were assessed for their relative ability to discriminate between different spectra for various field sizes. In accordance with another study (Charland et al 2004), the superior discrimination ability of the CFlung and LDbuildup tests over the D20/D10 test was observed for changes in an energy component as small as 0.3% of the total weight in the energy spectrum. Furthermore, new tests utilizing transverse dose profile data for discriminating between spectra, Fringe Index (FI) and Penumbra Index (PI), were introduced. The discrimination ability of the PI and FI tests was superior when a medium containing interface effects was exploited to obtain the transverse profile data (water/lung phantom for PIhung and FIlung tests) as opposed to when a homogeneous water medium was used (PIwater and FIwater tests).

[Characteristics of those individuals requesting to be seen by a physician without first having made an appointment ahead of time]. / Características de las personas que acuden a las consultas de demanda del centro de salud sin citación previa.

BACKGROUND: Waiting time to see a physician is considered to be an indicator of user satisfaction. Non-emergency visits made without an appointment ahead of time result in longer waiting times for the patients who have appointments, resulting in the consequent in satisfaction thereof. The purpose of this study is aimed at conducting a quantitative assessment of this type of visits and at ascertaining the characteristics thereof for the purpose of putting measures into practice for the correction and rationalization thereof. METHODS: Descriptive study. A record was made which would gather the characteristics of those patients seeing physicians without having made an appointment, such as age, gender and the characteristics related to the visit (reason, modality, working hours and whether made directly or indirectly). RESULTS: No appointment had been made ahead of time for 14.19% of all non-emergency patient-requested visits. Based on the factorial analysis of multiple correlations, two visit profiles are identified, that is, the direct visits requested by young patients due to illness or red tape at the end of the physician's morning hours, said young patients being present, and the indirect visits during the visits for which appointments have been made ahead of time by patients requesting prescriptions. CONCLUSIONS: There are a large number of visits for which no appointment has been made ahead of time. Measures must be taken for the purpose of channeling the use of the appointment organization system and of improving those situations involving a lack of accessibility for the end purpose of improving the degree of satisfaction of those using the public health care services.

Rapid, low-technology MIC determination with clinical Mycobacterium tuberculosis isolates by using the microplate Alamar Blue assay.

A colorimetric, microplate-based Alamar Blue assay (MABA) method was used to determine the MICs of isoniazid (INH), rifampin, streptomycin (SM), and ethambutol (EMB) for 34 Peruvian Mycobacterium tuberculosis isolates (including both pansensitive and multidrug-resistant strains) and the H37Rv strain by using bacterial suspensions prepared directly from solid media. Results for all isolates were available within 8 days. Discordant results were observed on initial tests for 3 of 16 INH-susceptible isolates, 5 of 31 EMB-susceptible isolates, and 2 of 4 SM-resistant isolates (by the BACTEC 460 system). The overall agreements between the MICs obtained by MABA and the results obtained with the BACTEC 460 system were 87.9% for initial results and 93.6% after retesting 12 of 17 samples with discrepant results. Interpretation of MABA endpoints improved with technical experience. The MABA is a simple, rapid, low-cost, appropriate technology which does not require expensive instrumentation and which makes use of a nontoxic, temperature-stable reagent.