Effectivity and applicability of the German DEGRO/DGK-guideline for radiotherapy in CIED-bearing patients.

BACKGROUND AND PURPOSE: No evidence has been presented until now whether recommendations given in recently issued guidelines concerning CIED-bearing patients significantly decrease RT-related complications. MATERIALS AND METHODS: 160 RT-cases were prospectively treated with 3D-CRT, IMRT, SBRT using exclusively 6 MV photons (n = 146) and electrons (n = 14) according to the 2015 issued German DEGRO/DGK-guideline for CIED-bearing patients and compared to 40 RT-cases (3D-CRT, 10-23 MV photons (n = 39) and electrons (n = 1)) of CIED-bearing patients which were treated in concordance to the 1994 issued AAPM-guideline. RESULTS: With AAPM-recommendations, complications occurred in 7/39 (17.95%) photon-RT cases, one patient experienced inadequate defibrillation therapy. For all patients treated with photon energies between 6 and 23 MV, a relative risk for CIED failure if treated with > 6 MV was calculated to be 9.03 (95% CI 5.24-15.55). After implementation of the DEGRO/DGK guideline, no complications were noted in 147 cases treated with photons, even though CIED-doses were as high as 5.37 Gy. In 13 cases treated with electrons, one PM lost patient-related data in a patient receiving antiproliferative RT to mammary glands. CONCLUSIONS: Implementation of the German DEGRO/DGK-guideline effectively prevented radiation-associated CIED failures in patients treated with photons. Limitation of photon energy to 6 MV, suspension of defibrillation therapy in ICDs, surveillance of patients according to risk stratification and avoidance of direct irradiation of CIEDs should become standard of care.

Smart Glasses in Nursing Training - Redundant Gadget or Precious Tool? A Pilot Study.

INTRODUCTION: Heavy workloads in nursing care and high employee turnover call for efficient methods to support on-the-job training. Within the Witra Care project - aiming to develop mobile technologies to support knowledge transfer between experienced and inexperienced nurses - the objective was to investigate the feasibility and perceived usefulness of advanced smart glasses for an exemplary, specific activity in nursing training - preparation of a surgical instrument table in an operating room. METHODS: Four trainee nurses performed different tasks using speech-command operated smart glasses within an operating room setting and were asked for their expectations towards this technology, their experiences and perceptions. RESULTS: All tasks could be achieved by the trainee nurses, and the overall perception was that the technology is supportive and helpful. DISCUSSION: Our results indicate interest in new wearable technologies for supporting training in nursing care. Limitations include small sample size, selection bias and several technical issues such as speech recognition accuracy or short battery lifetime. More research is necessary to evaluate the usefulness and usability of advanced wearable devices for supporting knowledge transfer and training in nursing care.

Developing a mobile application for recording learning experiences in nursing practice.

OBJECTIVE: In complex clinical on-the-job training a seamless and target-oriented incorporation is crucial to assure a good medical care. The reliable transmission of specific and relevant facts, besides education knowledge, is a key factor to ensure sustainable quality in care processes. MATERIALS AND METHODS: We present the clinical field study WITRA care. A possible way to capture hidden clinical care knowledge with assistance of mobile devices will be described. RESULTS: Basic functions to collect learning experiences with mobile devices as well as a secure and confidential manner to support a reliable transmission procedure in the hospital network area are implemented. A user experience questionnaire and a semi-standardized interview illustrate first positive acceptance evaluations and time-saving effects. DISCUSSION AND CONCLUSION: With mobile devices, tacit knowledge gaps can be tapped in a clinical care unit. The study provided first insights and proved its feasibility in general. However, advanced problems and questions arose and will be considered in the future.