Dosimetric evaluation of different planning strategies for hypofractionated whole-breast irradiation technique.

Purpose.The dose hotspot areas in hypofractionated whole-breast irradiation (WBI) greatly increase the risk of acute skin toxicity because of the anatomical peculiarities of the breast. In this study, we presented several novel planning strategies that integrate multiple sub-planning target volumes (sub-PTVs), field secondary placement, and RapidPlan models for right-sided hypofractionated WBI.Methods.A total of 35 cases of WBI with a dose of 42.5 Gy for PTVs using tangential intensity-modulated radiotherapy (IMRT) were selected. Both PTVs were planned for simultaneous treatment using the original manual multiple sub-PTV plan (OMMP) and the original manual single-PTV plan (OMSP). The manual field secondary placement multiple sub-PTV plan (m-FSMP) with multiple objects on the original PTV and the manual field secondary placement single-objective plan (m-FSSP) were initially planned, which were distribution-based of V105 (volume receiving 105% of the prescription dose). In addition, two RapidPlan-based plans were developed, including the RapidPlan-based multiple sub-PTVs plan (r-FSMP) and the RapidPlan-based single-PTV plan (r-FSSP). Dosimetric parameters of the plans were compared, and V105 was evaluated using multivariate analysis to determine how it was related to the volume of PTV and the interval of lateral beam angles (ILBA).Results.The lowest mean V105 (5.64 ± 6.5%) of PTV was observed in m-FSMP compared to other manual plans. Upon validation, r-FSSP demonstrated superior dosimetric quality for OAR compared to the two other manual planning methods, except for V5(the volume of ipsilateral lung receiving 5 Gy) of the ipsilateral lung. While r-FSMP showed no significant difference (p = 0.06) compared to r-FSSP, it achieved the lowest V105 value (4.3 ± 4.5%), albeit with a slight increase in the dose to some OARs. Multivariate GEE linear regression showed that V105 is significantly correlated with target volume and ILBA.Conclusions.m-FSMP and r-FSMP can substantially enhance the homogeneity index (HI) and reduce V105, thereby minimizing the risk of acute skin toxicities, even though there may be a slight dose compromise for certain OARs.

[Arthroscopic treatment of tibial intercondylar ridge avulsion fracture with double-root line double tunnel fixation technique].

OBJECTIVE: To discuss arthroscopic technique of double-root line double tunnel fixation for tibial intercondylar ridge avulsion fracture and its short-term followvup observational results. METHODS: From May 2012 to June 2017, 21 cases of tibial intercondylar ridge avulsion fractures were treated with arthroscope double line double tunnel. Among the patients, 16 males and 5 females were ranging in age from 17 to 45 years old, with an average of 29.6 years old, and injury to surgery time 3 to 6 days, with an average of 3.6 days. All the patients underwent arthroscopic exploration, fracture reduction, double root line fixation. The knee function was assessed at 3 and 6 months postoperatively using the Lysholm knee score, and the healing and resection of the patients were followed by X-ray examination. RESULTS: All patients were followed up for 7 to 23 months, with an average of 12.8 months. All patients after fracture were bone healing, knee activity were gained their previous normal levels (ranged, 0° to 130 °), and no limb dysfunction. The average scores of Lysholm knee were(93.52±7.10) and(95.95±6.34) points in 3 months and 6 months after operation. CONCLUSIONS: Arthroscopic treatment of tibial intercondylar ridge avulsion fractures with double root line is simple and reliable, and can provide an ideal internal fixation method for tibial intercondylar ridge avulsion fractures.

Validation of the Chinese version of the Problem Areas in Diabetes (PAID-C) scale.

OBJECTIVE: To examine the psychometric properties of a Chinese version of the Problem Areas In Diabetes (PAID-C) scale. RESEARCH DESIGN AND METHODS: The reliability and validity of the PAID-C were evaluated in a convenience sample of 205 outpatients with type 2 diabetes. Confirmatory factor analysis, Bland-Altman analysis, and Spearman's correlations facilitated the psychometric evaluation. RESULTS: Confirmatory factor analysis confirmed a one-factor structure of the PAID-C (chi(2)/df ratio = 1.894, goodness-of-fit index = 0.901, comparative fit index = 0.905, root mean square error of approximation = 0.066). The PAID-C was associated with A1C (r(s) = 0.15; P < 0.05) and diabetes self-care behaviors in general diet (r(s) = -0.17; P < 0.05) and exercise (r(s) = -0.17; P < 0.05). The 4-week test-retest reliability demonstrated satisfactory stability (r(s) = 0.83; P < 0.01). CONCLUSIONS: The PAID-C is a reliable and valid measure to determine diabetes-related emotional distress in Chinese people with type 2 diabetes.

Factors that affect health outcomes in adults with type 2 diabetes: a cross-sectional study.

BACKGROUND: Factors that individually influence blood sugar control, health-related quality of life, and diabetes self-care behaviors have been widely investigated; however, most previous diabetes studies have not tested an integrated association between a series of factors and multiple health outcomes. OBJECTIVES: The purposes of this study are to identify risk factors and protective factors and to examine the impact of risk factors and protective factors on adaptive outcomes in people with type 2 diabetes. DESIGN: A descriptive correlational design was used to examine a theoretical model of risk factors, protective factors, and adaptive outcomes. SETTINGS: This study was conducted at the endocrine outpatient departments of three hospitals in Taiwan. PARTICIPANTS: A convenience sample of 334 adults with type 2 diabetes aged 40 and over. METHODS: Data were collected by a self-reported questionnaire and physiological examination. Using the structural equation modeling technique, measurement and structural regression models were tested. RESULTS: Age and life events reflected the construct of risk factors. The construct of protective factors was explained by diabetes symptoms, coping strategy, and social support. The construct of adaptive outcomes comprised HbA1c, health-related quality of life, and self-care behaviors. Protective factors had a significant direct effect on adaptive outcomes (beta=0.68, p<0.001); however, risk factors did not predict adaptive outcomes (beta=-0.48, p=0.118). CONCLUSIONS: Identifying and managing risk factors and protective factors are an integral part of diabetes care. This theoretical model provides a better understanding of how risk factors and protective factors work together to influence multiple adaptive outcomes in people living with type 2 diabetes.

Psychometric evaluation of the Chinese version of the Diabetes Coping Measure scale.

PURPOSE: To evaluate the psychometric properties of a Chinese version of the Diabetes Coping Measure scale (DCM-C). METHODS: A self-administered questionnaire was completed by 205 people with type 2 diabetes from the endocrine outpatient departments of three hospitals in Taiwan. Confirmatory factor analysis, criterion validity, and internal consistency reliability were conducted to evaluate the psychometric properties of the DCM-C. FINDINGS: Confirmatory factor analysis confirmed a four-factor structure (chi(2)/df ratio = 1.351, good of fit index (GFI) = .904, comparitive fit index (CFI) = .902, root mean square error of approximation (RMSEA) = .041). The DCM-C was significantly associated with hemoglobin A1c and diabetes self-care behaviors. Internal consistency reliability of the total DCM-C scale was .74. Cronbach's alpha coefficients for each subscale of the DCM-C ranged from .37 (tackling spirit) to .66 (diabetes integration). CONCLUSIONS: The DCM-C demonstrated satisfactory reliability and validity to determine the use of diabetes coping strategies. The tackling spirit dimension needs further refinement when applying this scale to Chinese populations with diabetes. CLINICAL RELEVANCE: Healthcare providers who treat Chinese people with diabetes can use the DCM-C to implement an early determination of diabetes coping strategies.

Development of the simplified Tai Chi exercise program (STEP) for frail older adults.

OBJECTIVE: To develop a simplified Tai Chi exercise program for frail older adults. DESIGN: For phase I, using a focus group, 40 frail Taiwanese older adults were interviewed to explore their viewpoints on Tai Chi and have been reported elsewhere. This paper emphasized on the phase II of the study in which the older adults' perspectives were validated by 10 experts using an evaluation survey. SETTING: Long-term care facilities. RESULTS: The newly developed simplified Tai Chi exercise program (STEP) included three stages-(1) warm-up: comprised nine exercises specifically designed to loosen up the body from head to toe; (2) Tai Chi movements: encompassed 12 easy-to-learn and easy-to-perform movements; (3) cool-down: included three activities to cease the chi and rest the body. CONCLUSIONS: The STEP should be further evaluated for its effectiveness in enhancing the relative well being and quality of life of frail older adults and its applicability as a floor activity in long-term care facilities.

Frail elders' views of Tai Chi.

The beneficial effects of Tai Chi on an elder's well-being have been well documented; however, not many frail elders practice it. The purpose of this descriptive study was to explore the perspectives frail elders have about Tai Chi, including its movements, practice frequency and duration, and practice preferences. Using focus groups, 40 frail elders who lived in long-term care facilities were interviewed. Results indicated that Tai Chi styles with slow and large motions were manageable. Subjects preferred to practice Tai Chi in a group of 10 to 20 people, twice a week with 31 to 60 minutes of practice in the early morning or in the afternoon after napping. The practice locations should be wide, flat, non-disturbed, and well-ventilated. Tai Chi instructors should be experienced, gentle, considerate, and have clarity in expression. Findings can be used to design a simple Tai Chi program that is specifically tailored to the needs of frail elders.

[Using focus groups among the elderly].

Focus groups are important tools for assessing markets, making public policy and researching applied science. The use of focus groups can enable us to gather large volumes of data in short periods of time. The need for focus groups, because of the economical and efficient way in which they generate information, has grown recently in nursing. Focus groups can be used among different groups within a population, including teenagers, healthy adults, elderly people, patients and nurses. The manner in which they are used, however, must be adjusted to take account of the characteristics of each group. This article discusses the preparation, implementation, analysis and reporting of the use of focus groups among elderly people. It was important to observe the elderly subjects' physical and psychological states, work and rest habits, and interaction, and carefully arrange the detail of each group in accordance with the findings of such observation. This article is intended to enable the experience of using focus groups among the elderly to be shared with other researchers.