Less Is More: Parathyroidectomy and Association with Postoperative Hypocalcemia in Dialysis Patients.

BACKGROUND: Parathyroidectomy (PTx) is the most effective treatment for secondary hyperparathyroidism. Literature regarding the effect of surgical approaches on postoperative hypocalcemia is limited and mainly focuses on postoperative calcium levels. This study aims to evaluate the association of subtotal PTx and total PTx with autotransplantation for secondary hyperparathyroidism with postoperative hypocalcemia. STUDY DESIGN: We reviewed all dialysis patients who underwent PTx (n = 143) at our institution from 2010 to 2021. Postoperative hypocalcemia adverse events were defined as postoperative intravenous calcium requirement or 30-day readmission due to hypocalcemia. Postoperative hypocalcemia adverse events, length of stay, and oral calcium requirement at 1-month follow-up were compared between the 2 groups. RESULTS: Of the 143 patients, 119 (83.2%) underwent total PTx with autotransplantation, and 24 (16.8%) underwent subtotal PTx. Patients who underwent subtotal PTx had shorter mean ± SD length of stay (1.8 ± 1.7 vs 3.5 ± 3.2, p = 0.002), were less likely to develop hypocalcemia adverse events (8.3% vs 47.1%, p < 0.001), and required less median elemental calcium supplementation at 1-month follow-up (1,558 vs 3,193 mg, p < 0.001). There was no significant difference in surgical success between the 2 groups (91.7% vs 89.1%, p = 0.706). Stepwise multivariable regression demonstrated that patients who underwent total PTx with autotransplantation were 11.9 times more likely to develop hypocalcemia adverse events (adjusted odds ratio 11.9, 95% CI 2.2 to 66.2, p = 0.004), had 1.24 days longer length of stay (95% CI 0.04 to 2.44, p = 0.044), and required 1,776.1 mg more elemental calcium (95% CI 661.5 to 2,890.6 mg, p = 0.002). CONCLUSIONS: Subtotal parathyroidectomy is associated with less postoperative hypocalcemia and provides similar surgical cure for dialysis patients with secondary hyperparathyroidism.

Oncologist-Reported Barriers and Facilitators to Enrolling Patients in Optimization Trials That Test Less Intense Cancer Treatment.

PURPOSE: As outcomes improve in early-stage breast cancer, clinical trials are undergoing a paradigm shift from intensification trials (more therapy) to improve survival to optimization trials, which assess the potential for using less toxic therapy while preserving survival outcomes. However, little is known about physician perspectives in community and academic settings about possible barriers and facilitators that could affect accrual to optimization clinical trials and the generalizability of future findings. METHODS: We conducted a qualitative study with semistructured interviews of medical oncologists from different academic and community practices to assess their perspectives on optimization trials. Interviews were audio-recorded and transcribed. Three independent coders used a content analysis approach to analyze transcripts using NVivo. Major themes and exemplary quotes were extracted. RESULTS: All 39 physicians reported that they would enroll patients in optimization clinical trials. Oncologists highlighted specific reasons to consider optimization trials. These included quality-of-life improvement by reducing toxicity, reduction in financial toxicity, fertility preservation, ability to avoid chemotherapy, minimization of overtreatment in patients with comorbid conditions, personalized treatment, opportunities to test novel therapies, and leveraging the availability of targeted therapies. Oncologists also identified accrual barriers, such as tumor-specific biology, individual (host) factors, prognostic markers of risk, access to therapies, provider experience, and system constraints. They voiced recommendations regarding preliminary data, trial design, and tools to support enrollment in optimization trials. CONCLUSION: Although oncologists are generally willing to enroll patients on optimization clinical trials, barriers affect their acceptance. A scientific focus on overcoming these barriers is needed to support future enrollment on trials tailoring therapy on the basis of risk and potential benefit to allow true personalization of treatment.

Physician Perspectives on Reducing Curative Cancer Treatment Intensity for Populations Underrepresented in Clinical Trials.

BACKGROUND: Historically, clinical trials involved adding novel agents to standard of care to improve survival. There has been a shift to an individualized approach with testing less intense treatment, particularly in breast cancer where risk of recurrence is low. Little is known about physician perspectives on delivering less intense treatment for patients who are not well represented in clinical trials. METHODS: Open-ended, individual qualitative interviews with medical oncologists explored their perspectives on trials that test less intense treatment for patients with cancer, with a focus on breast cancer. Interviews were audio-recorded and transcribed. Four independent coders utilized a content analysis approach to analyze transcripts using NVivo. Major themes and exemplary quotes were extracted. RESULTS: Of the 39 participating physicians, 61.5% felt comfortable extrapolating, 30.8% were hesitant, and 7.7% would not feel comfortable extrapolating trial outcomes to underrepresented populations. Facilitators of comfort included the sentiment that "biology is biology" (such that the cancer characteristics were what mattered), the strength of the evidence, inclusion of subset analysis on underrepresented populations, and prior experience making decisions with limited data. Barriers to extrapolation included potential harm over the patient's lifetime, concerns about groups that had minimal participants, application to younger patients, and extending findings to diverse populations. Universally, broader inclusion in trials testing lowering chemotherapy was desired. CONCLUSIONS: The majority (92%) of physicians reported that they would de-implement treatment for patients poorly represented in clinical trials testing less treatment, while expressing concerns about applicability to specific subpopulations. Further work is needed to increase clinical trial representation of diverse populations to safely and effectively optimize treatment for patients with cancer. TRIAL REGISTRATION: NCT03248258.

Current Trends in Robotics in Nursing Patents-A Glimpse Into Emerging Innovations.

The purpose of this study was to describe the current evidence found through a patent search about robotics used to assist nurses in providing care. The authors used a modified seven-step strategy of searching patents according to the US Patent and Trademark Office guidelines. The nursing robotic search was performed in four databases including the US Patent and Trademark Office issued patent database, the US Patent and Trademark Office published patent application database, the European Patent Office database, and Relecura. Keywords reflecting the scope of the term "robot" were defined for the purposes of this specific search. This broad search yielded large numbers of patents germane to nursing care. These results were narrowed using keywords and the Cooperative Patent Classification schemes to determine relevance, ensure rigor, and capture the most relevant results. This review of patents suggests robots for nursing care are proliferating. The opportunity for robotics in nursing is emerging in industry. Although nursing will likely benefit from robotics, we must determine the appropriate place to include robots in nursing care delivery.

Robotics in Nursing: A Bibliometric Analysis.

PURPOSE: The purpose of this study was to describe the current evidence found in the nursing literature about robotics used to assist or augment nursing care. METHODS: A bibliometric analysis of published research focused on robotics in nursing care was conducted to analyze the trends of publications. A search of the Cumulative Index to Nursing and Allied Health Literature database was conducted. This analysis was used to determine the types and extent of robotic research presented in nursing and allied health literature, journals that publish robotic research, and the origins of the study. FINDINGS: Twenty-one articles met inclusion criteria and spanned the years 2004 to 2016. The main disciplines represented by first authors in these 21 articles were medicine (n = 4, 9%), nursing (n = 4, 9%), and psychiatric medicine (n = 4, 9%). Nine countries were represented by the first author. The majority of the specific studies reported using qualitative research methods (n = 4, 19%) with reports of other research designs being used. Further analysis of subsequent citations found that 248 subsequent citations were generated from these articles. CONCLUSIONS: The application of robots has been used beyond typical physical day-to-day processes as many definitions of robotics suggest. Eleven (52%) of the 21 articles described the use of robots with aged patients. In some cases, robots were used as companions for older adults, as opposed to replacing mechanical and repetitive motions. CLINICAL RELEVANCE: Robotics are being used globally in nursing care areas. While a limited amount of research on this topic in nursing exists, this study of the literature offers reports of applications of robots within nursing care areas.

Mechanism of bismuth telluride exfoliation in an ionic liquid solvent.

Bismuth telluride (Bi2Te3) is a well-known thermoelectric material that has a layered crystal structure. Exfoliating Bi2Te3 to produce two-dimensional (2D) nanosheets is extremely important because the exfoliated nanosheets possess unique properties, which can potentially revolutionize several material technologies such as thermoelectrics, heterogeneous catalysts, and infrared detectors. In this work, ionic liquid (IL) 1-butyl-3-methylimidazolium chloride ([C4mim]Cl) is used to exfoliate Bi2Te3 nanoplatelets. In both experiments and in molecular dynamics (MD) simulations, the Bi2Te3 nanoplatelets yield a stable dispersion of 2D nanosheets in the IL solvent, and our MD simulations provide molecular-level insight into the kinetics and thermodynamics of the exfoliation process. An analysis of the dynamics of Bi2Te3 during exfoliation indicates that the relative translation (sliding apart) of adjacent layers caused by IL-induced forces plays an important role in the process. Moreover, an evaluation of the MD trajectories and electrostatic interactions indicates that the [C4mim](+) cation is primarily responsible for initiating Bi2Te3 layer sliding and separation, while the Cl(-) anion is less active. Overall, our combined experimental and computational investigation highlights the effectiveness of IL-assisted exfoliation, and the underlying molecular-level insights should accelerate the development of future exfoliation techniques for producing 2D chalcogenide materials.

Graphene and graphene oxide can "lubricate" ionic liquids based on specific surface interactions leading to improved low-temperature hypergolic performance.

Space-qualified lubricants: Graphene and graphene oxide (r-GO) can strongly improve the low-temperature performance of hypergolic ionic liquids by reduction of viscosity. Key to success is to match the graphene type to the specific ionic-liquid functionality.

Recent progress in graphene-related nanotechnologies.

Currently there is great interest in graphene-based devices and applications. The main advantages of graphene include excellent conductive and mechanical properties. The applications of graphene cover a wide range of possibilities, from next-generation transistors to light-weight, high-strength composite materials. However, commercial use of graphene will depend on the development of an industrially-viable method of fabricating and handling graphene. The recent advances in manipulating graphene and patents will be reviewed with a focus on the progress of graphene nanoparticle synthesis and applications.