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2.
J Orthop Surg Res ; 14(1): 147, 2019 May 22.
Artigo em Inglês | MEDLINE | ID: mdl-31118052

RESUMO

OBJECTIVES: This study aims to explore the clinical efficacy of applying a new reduction brace in the closed reduction of femoral shaft fracture. METHODS: A total of 18 patients with femoral shaft fracture, who were admitted to the Bone Trauma Surgery, Second Hospital of Shanxi Medical University, from September 2015 to January 2017, were chosen. A novel reduction brace combined with closed reduction intramedullary nail insertion on the traction table adopted for the orthopedic surgery was taken for the fixation. Then, surgical time, bleeding amount, and postoperational fracture healing time were recorded. RESULTS: All 18 patients with femoral shaft fracture successfully received closed reduction femoral nail with the application of the novel reduction brace. The follow-up period was 3-18 months, with an average of 12 months, and the femoral shaft fracture was well healed with good recovery of function. CONCLUSIONS: The design of the closed reduction brace of the femoral shaft fracture was reasonable, simple, and convenient to use and has a short learning curve. Furthermore, it led to little trauma to these patients and fully played the advantages of minimally invasive therapy for femoral fractures.


Assuntos
Fraturas do Fêmur/diagnóstico por imagem , Fraturas do Fêmur/cirurgia , Fixação de Fratura/instrumentação , Fixação de Fratura/métodos , Posicionamento do Paciente/instrumentação , Posicionamento do Paciente/métodos , Adolescente , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Adulto Jovem
3.
Cancer Radiother ; 23(3): 209-215, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31053514

RESUMO

PURPOSE: To evaluate clinical results and the "effect bolus" based on the table design of different linear accelerators in patients with breast cancer treated by previously published whole breast irradiation in the isocentric lateral decubitus position. MATERIAL AND METHODS: We studied 248 consecutive female patients with early stage breast cancer treated by conservative surgery followed by three-dimensional conformal whole breast irradiation in the isocentric lateral decubitus position between January 2013 and February 2014. Radiotherapy was performed on linear accelerators using a Varian. The energy used was 4 and 10MV photons or 6MV photons. All patients were evaluated weekly by the radiation oncologist, acute toxicity was assessed using the NCICTC v 3.0 scale. Late toxicity and cosmetic results were evaluated 18 months after the radiotherapy. Cosmetic results were defined as excellent, good, middle or bad. RESULTS: Among the 248 women included, the median age was 67 years (range: 35-91 years). All received whole breast radiotherapy with boost in 144 patients (58%). One-hundred-twenty patients received normofractionated and 124 patients hypofractionated whole breast radiotherapy. Median follow-up was 18 months. Acute skin toxicity in the whole breast radiotherapy in the isocentric lateral decubitus position was acceptable: there was 47% of grade 1 radiodermatitis, 50% of grade 2 and 3% grade 3 and no grade 4 for normofractionated radiotherapy; 89% of grade 1 dermatitis and 11% of grade 2 for hypofractionated radiotherapy; 89.7% of grade 0-1 dermatitis and 10.3% of grade 2 for the "flash" scheme and did not differ between the three linear accelerators (P=0.2, P=0.9 and P=0.2 respectively for the normofractionated radiotherapy, hypofractionated radiotherapy and the "flash"scheme). Late toxicity was acceptable with 84% of grade 0-1 fibrosis for normofractionated radiotherapy, 94% of patients for hypofractionated radiotherapy and 77% for "flash" scheme and did not differ between the three linear accelerators (P=0.44, P=1 and P=0.22 resp.). Most of patients (81%) had an excellent or a good cosmetic outcome. CONCLUSIONS: Whole breast radiotherapy in the isocentric lateral decubitus position is well tolerated. Clinical results are comparable based on different immobilization device allowed by linear accelerators. Particularly, there was no influence of the couch on skin tolerance and cosmetic results.


Assuntos
Neoplasias da Mama/radioterapia , Imobilização/instrumentação , Posicionamento do Paciente/instrumentação , Radioterapia Conformacional/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Desenho de Equipamento , Feminino , Humanos , Pessoa de Meia-Idade , Radioterapia Conformacional/efeitos adversos , Estudos Retrospectivos , Resultado do Tratamento
4.
World Neurosurg ; 128: e597-e602, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31054343

RESUMO

BACKGROUND AND OBJECTIVE: Increased intra-abdominal pressure with prone positioning for spinal surgery is associated with intraoperative hemodynamic alterations and the potential for postoperative complications. This study investigated the incidence of postoperative acute kidney injury (AKI) in patients undergoing spine surgery on a Jackson spinal table or a Wilson frame. METHODS: A total of 1374 patients who underwent spine surgery were divided into 2 groups: Jackson spinal table (n = 598) and Wilson frame group (n = 776). After 1:1 propensity score matching, a final analysis was performed on 970 patients. The primary endpoint was a comparison of the incidence of AKI in the 2 groups. RESULTS: After propensity score matching analysis, the mean ± standard deviations of spine surgery invasiveness index were 4.7 ± 3.5 and 2.1 ± 1.4 in patients with the Jackson spinal table and the Wilson frame, respectively (P < 0.001). Considering the differences in surgical invasiveness, operative time, estimated blood loss, and administration of packed red blood cells were higher in the Jackson spinal table group than in the Wilson frame group (P < 0.001). However, the incidence of AKI was less with the Jackson spinal table than with the Wilson frame (1.7% vs. 3.7%, 2.25 [0.978-5.175], P = 0.056), not reaching statistical significance. CONCLUSION: This analysis showed that postoperative AKI in patients undergoing spine surgery in the prone position was not different with the Wilson frame than in the Jackson spinal table despite higher surgical severity, longer operative times, and more blood loss in the latter group. In spine surgery, the appropriate selection of prone positioning apparatus can potentially be an important consideration in reducing the risk of AKI.


Assuntos
Cavidade Abdominal , Lesão Renal Aguda/epidemiologia , Mesas Cirúrgicas/estatística & dados numéricos , Posicionamento do Paciente/instrumentação , Complicações Pós-Operatórias/epidemiologia , Pressão , Decúbito Ventral , Coluna Vertebral/cirurgia , Adulto , Idoso , Perda Sanguínea Cirúrgica , Transfusão de Eritrócitos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Posicionamento do Paciente/métodos , Pontuação de Propensão
5.
J Int Adv Otol ; 15(1): 146-150, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31058604

RESUMO

OBJECTIVES: Despite increasing utilization of reposition devices in the management of benign paroxysmal positional vertigo (BPPV), knowledge on subjective outcomes is insufficient. The objective of the present study was to evaluate subjective vertigo complaints and vertigo-associated emotional distress during reposition chair management for refractory BPPV. MATERIALS AND METHODS: This was a prospective observational cohort study of subjective and objective data of 31 patients suffering from refractory BPPV representing failed conventional repositioning treatment. At the beginning of each visit, the patients filled out the Dizziness Handicap Inventory (DHI), the Visual Analog Scale (VAS), and the Hospital Anxiety and Depression Scale (HADS). Treatment and re-evaluation were repeated every 2 weeks until the patient was declared disease-free. RESULTS: Complete remission of BPPV required a mean of two treatments. Mean DHI score decreased from 45 points prior to first treatment to 22 points by finished treatment (p<0.001). Similarly, mean VAS score was reduced from 58 to 25 points (p<0.001), and HADS decreased from 8 to 5 points (p<0.001). Patients with cupulolithiasis reported worse vertigo complaints than those with canalolithiasis. All scores correlated positively. CONCLUSION: Patients with refractory BPPV improved significantly by reposition chair management according to all subjective outcomes. Thus, the reposition device could significantly reduce disease burden in the group of patients with BPPV who failed to respond to conventional management. The strong correlation between the scores suggests VAS as a useful tool for vertigo-related patient complaints.


Assuntos
Vertigem Posicional Paroxística Benigna/diagnóstico , Vertigem Posicional Paroxística Benigna/terapia , Posicionamento do Paciente/instrumentação , Vertigem/terapia , Adulto , Idoso , Ansiedade/etiologia , Ansiedade/psicologia , Vertigem Posicional Paroxística Benigna/fisiopatologia , Estudos de Coortes , Tontura/fisiopatologia , Tontura/psicologia , Tontura/terapia , Feminino , Movimentos da Cabeça/fisiologia , Humanos , Masculino , Pessoa de Meia-Idade , Nistagmo Patológico/complicações , Nistagmo Patológico/diagnóstico , Nistagmo Patológico/fisiopatologia , Nistagmo Fisiológico , Posicionamento do Paciente/métodos , Modalidades de Fisioterapia , Estudos Prospectivos , Canais Semicirculares/patologia , Vertigem/complicações , Vertigem/fisiopatologia , Vertigem/psicologia , Escala Visual Analógica
6.
Nurs Womens Health ; 23(3): 245-252, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31077640

RESUMO

OBJECTIVE: To examine the effect of a nurse-driven intervention using a peanut ball (PB) with position changes on length of labor and incidence of cesarean birth among women who receive epidural anesthesia. DESIGN: Quasiexperimental comparison group design. SETTING/LOCAL PROBLEM: A 407-bed, nonprofit, Magnet-designated, Baby-Friendly Hospital Initiative-designated hospital with 8 labor and delivery suites and an average of 100 births per month. PARTICIPANTS: A total of 343 participants were included, with 164 women in the PB group. INTERVENTION/MEASUREMENTS: The PB was placed after epidural administration; women were repositioned a minimum of every 1 to 2 hours, and the PB was removed at second stage of labor; duration was recorded. RESULTS: Overall, women in the PB group were 50% less likely to have cesarean birth. For women with cervical dilation of 4 cm or less, rates of vaginal birth were 61% with use of the peanut ball. A multivariate analysis of outcomes was used. A multiple linear regression model showed, after adjusting for other variables, that PB placement alone did not shorten labor length (p = .4684). However, a stratified analysis indicated that for women with cervical dilation of 4 cm or less, length of the first stage of labor was affected by parity (p = .0042) and frequency of position change (p < .001). For women with cervical dilation greater than 4 cm, length of the first stage of labor was influenced by frequency of position changes (p = .0130) and effacement (p = .0050). Length of the second state of labor was affected by the frequency of position change (p = .0416). CONCLUSION: The PB may be an effective intervention to reduce the incidence of cesarean birth. Changing position frequently was associated with reduced length of first and second stages of labor.


Assuntos
Analgesia Epidural/métodos , Trabalho de Parto , Posicionamento do Paciente/instrumentação , Adulto , Analgesia Epidural/normas , Feminino , Humanos , Posicionamento do Paciente/métodos , Gravidez , Fatores de Tempo
7.
Neurol Sci ; 40(10): 2073-2080, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31129775

RESUMO

The recovery of the orthostatism after a severe acquired brain injury (sABI) is an essential objective to pursue in order to avoid the occurrence of secondary complications resulting from prolonged immobilization to which the patient is subjected during the acute phase. This randomized controlled trial aims to evaluate the effect of verticalization with the lower limb robot-assisted training system Erigo® versus conventional neurorehabilitation in 44 adult subjects affected by sequelae of sABI in the acute rehabilitation phase, related to cardiorespiratory signs and measures of impairment and activity. At the end of the study (20 treatment sessions, 5 sessions per week), in both groups of patients, there were no dropouts nor adverse events. In subject verticalized with Erigo®, there were no episodes of (pre)syncope from orthostatic hypotension nor postural orthostatic tachycardia and cardiorespiratory signs remained stable; moreover, there were no increase in muscle tone nor reduction in range of motion at lower limbs. Results obtained show improved outcomes on the whole and in a similar way in both groups; however, the improvement in scores of the National Institutes of Health Stroke Scale, the Tinetti scale, and the Functional Independence Measure from the enrollment to the end of the treatment cycle being equal, the evaluation performed at the 10th session allows to establish that the improvement appears earlier in the intervention group and later in the control group. The more rapid recovery of impairments and some activities in subjects treated with Erigo® could allow a "time-saver" to devote to the rehabilitation of sensory-motor functions which are more complex and subordinated to the preliminary reacquisition of elementary postures and motor strategies.


Assuntos
Lesões Encefálicas/reabilitação , Reabilitação Neurológica/instrumentação , Posicionamento do Paciente/instrumentação , Robótica/instrumentação , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Intolerância Ortostática/epidemiologia , Intolerância Ortostática/etiologia , Posicionamento do Paciente/efeitos adversos , Adulto Jovem
8.
Phys Med ; 60: 162-167, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31000078

RESUMO

Total Marrow Irradiation (TMI) with Helical Tomotherapy is a radiotherapy treatment technique that targets bone marrow and sanctuary sites prior to stem cell or bone marrow transplantation (SCT/BMT). TMI is a complex procedure that involves several critical steps that all need to be carefully addressed for a successful implementation, such as dose homogeneity in field junctions, choice of target margins, integrity of treatment and back-up planning. In this work we present our solution for a robust and reproducible workflow throughout the treatment chain and data for twenty-three patients treated to date. MATERIAL & METHODS: Patients were immobilized in a whole body vacuum cushion and thermoplastic mask. CT-scanning and treatment were performed in two parts with field matching at the upper thigh. Target consisted of marrow containing bone and sanctuary sites. Lungs, kidneys, bowel, heart and liver were defined as organs at risk (OAR). A fast surface scanning system was used to position parts of the body not covered by the imaging system (MVCT) as well as to reduce treatment time. RESULTS: All patients completed their treatment and could proceed with SCT/BMT. Doses to OARs were significantly reduced and target dose homogeneity was improved compared to TBI. Robustness tests performed on field matching and patient positioning support that the field junction technique is adequate. Replacing MVCT with optical surface scanning reduced the treatment time by 25 min per fraction. CONCLUSION: The methodology presented here has shown to provide a safe, robust and reproducible treatment for Total Marrow Irradiation using Tomotherapy.


Assuntos
Medula Óssea , Radioterapia de Intensidade Modulada/métodos , Adolescente , Adulto , Medula Óssea/efeitos da radiação , Criança , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias/terapia , Órgãos em Risco , Equipe de Assistência ao Paciente , Posicionamento do Paciente/instrumentação , Dosagem Radioterapêutica , Planejamento da Radioterapia Assistida por Computador , Radioterapia de Intensidade Modulada/instrumentação , Transplante de Células-Tronco , Fatores de Tempo , Tomografia Computadorizada por Raios X , Adulto Jovem
9.
Phys Med ; 59: 55-63, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30928066

RESUMO

PURPOSE: At Centro Nazionale di Adroterapia Oncologica (CNAO, Pavia, Italy) ocular proton therapy (OPT) is delivered using a non-dedicated beamline. This paper describes the novel clinical workflow as well as technologies and methods adopted to achieve accurate target positioning and verification during ocular proton therapy at CNAO. METHOD: The OPT clinical protocol at CNAO prescribes a treatment simulation and a delivery phase, performed in the CT and treatment rooms, respectively. The patient gaze direction is controlled and monitored during the entire workflow by means of an eye tracking system (ETS) featuring two optical cameras and an embedded fixation diode light. Thus, the accurate alignment of the fixation light provided to the patient to the prescribed gazed direction is required for an effective treatment. As such, a technological platform based on active robotic manipulators and IR optical tracking-based guidance was developed and tested. The effectiveness of patient positioning strategies was evaluated on a clinical dataset comprising twenty patients treated at CNAO. RESULTS: According to experimental testing, the developed technologies guarantee uncertainties lower than one degree in gaze direction definition by means of ETS-guided positioning. Patient positioning and monitoring strategies during treatment effectively mitigated set-up uncertainties and exhibited sub-millimetric accuracy in radiopaque markers alignment. CONCLUSION: Ocular proton therapy is currently delivered at CNAO with a non-dedicated beamline. The technologies developed for patient positioning and motion monitoring have proven to be compliant with the high geometrical accuracy required for the treatment of intraocular tumors.


Assuntos
Neoplasias Oculares/radioterapia , Movimento , Posicionamento do Paciente/instrumentação , Terapia com Prótons/instrumentação , Planejamento da Radioterapia Assistida por Computador/instrumentação , Neoplasias Oculares/diagnóstico por imagem , Humanos , Síncrotrons , Tomografia Computadorizada por Raios X
10.
Urol Int ; 103(1): 89-94, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30965347

RESUMO

BACKGROUND: The oblique-supine position for percutaneous nephrolithotomy (PCNL) has advantages, but the position fixation methods are inadequate. This study aimed to analyze the PCNL outcomes using a patented self-made frame for oblique-supine position. METHODS: This was a prospective study of patients scheduled to undergo PCNL at 2 hospitals in China between November 2009 and December 2016. The patients underwent PCNL in the oblique-supine position using the self-made position frame (n = 94). Operative time, stone clearance rate, intraoperative average systolic pressure, intraoperative average heart rate, intraoperative average airway pressure, intraoperative average intrapelvic pressure, and complications were observed. RESULTS: The patients were 45.3 ± 19.7 years old and 71% were male. Stones were of the size 2.5 ± 1.1 cm. The operative time was 95.6 min and the stone clearance rate was 81.9%. Intraoperative systolic blood pressure was 15.13 ± 1.68 kPa. Intraoperative airway pressure was 15.5 ± 2.3 cm H2O. Postoperative fever was observed in 3.2% of the patients. None had organ injury. Postoperative stay was 4.8 ± 0.6 days. The nephrostomy tube was routinely removed on the 5th day after surgery and the patients were discharged on the following day. CONCLUSION: The self-made surgical position frame met the position requirements for the oblique-supine PCNL operation. This surgical position frame deserves clinical application and promotion.


Assuntos
Cálculos Renais/cirurgia , Nefrostomia Percutânea/instrumentação , Nefrostomia Percutânea/métodos , Posicionamento do Paciente/instrumentação , Adulto , Idoso , Pressão Sanguínea , China , Desenho de Equipamento , Feminino , Febre , Frequência Cardíaca , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias , Decúbito Ventral , Estudos Prospectivos , Decúbito Dorsal , Resultado do Tratamento
11.
J Cancer Res Ther ; 15(1): 204-210, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30880779

RESUMO

Purpose: The aim of the present study was to compare the positional accuracy of varian's exact-arm (E-arm) and retractable-arm (R-arm) supporting electronic portal imaging device (EPID) systems (amorphous silicon flat-panel detector) using the intensity-modulated radiotherapy (IMRT) graticule phantom. Materials and Methods: The known shifts of 0.5, 1.0, and 1.5 cm were introduced to the given phantom in longitudinal, lateral, and vertical directions, respectively, with respect to treatment couch of medical linear accelerator. The experiment was repeated for different gantry angle and varying source to imager distances (SIDs). The images were acquired for each shift at varying SIDs and beam orientations for both EPID supporting systems. The corresponding shifts obtained from treatment planning system (TPS) were recorded and compared. Results: The known (expected) and observed (recorded from TPS) shifts obtained for different beam angles (namely, 0°, 90°, 180°, and 270° for anterior, left lateral, posterior, and right-lateral portal images, respectively) in the longitudinal, lateral, and vertical direction at varying SID were compared. The maximum shift in the observed value from the expected one was 3 and 2 mm, respectively, out of the all beam configuration for R-arm and E-arm. These shifts were randomly observed for all imager position and beam orientation. Conclusion: The IMRT graticule phantom is an effective tool to check the mechanical characteristic and consistency of different EPID supporting arms. The effect of EPID sag due to gravity (gantry and treatment couch) was not significant for detection of shift in patient's position. The E-arm support EPID has better mechanical stability and accuracy in detection of patient's position than that of R-arm.


Assuntos
Equipamentos e Provisões Elétricas , Posicionamento do Paciente/instrumentação , Radioterapia de Intensidade Modulada/instrumentação , Humanos , Neoplasias/radioterapia , Aceleradores de Partículas , Imagens de Fantasmas , Radiometria , Dosagem Radioterapêutica , Planejamento da Radioterapia Assistida por Computador/instrumentação , Planejamento da Radioterapia Assistida por Computador/métodos , Radioterapia de Intensidade Modulada/métodos
12.
Cancer Res Treat ; 51(4): 1370-1379, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-30776884

RESUMO

PURPOSE: This first Korean prospective study is to evaluate the feasibility of prone breast radiotherapy after breast conserving surgery for left breast cancer patients who have relatively small breast size and we present dosimetric comparison between prone and supine positions. Materials and Methods: Fifty patients underwent two computed tomography (CT) simulations in supine and prone positions. Whole breast, ipsilateral lung, heart, and left-anterior-descending coronary artery were contoured on each simulation CT images. Tangential-fields treatment plan in each position was designed with total 50 Gy in 2-Gy fractions, and then one of the positions was designated for the treatment by comparing target coverage and dose to normal organs. Also, interfractional and intrafractional motion was evaluated using portal images. RESULTS: In total 50 patients, 32 cases were decided as prone-position-beneficial group and 18 cases as supine-position-beneficial group based on dosimetric advantage. Target dose homogeneity was comparable, but target conformity in prone position was closer to optimal than in supine position. For both group, prone position significantly increased lung volume. However, heart volumewas decreased by prone position for prone-position-beneficial group but was comparable between two positions for supine-position-beneficial group. Lung and heart doses were significantly decreased by prone position for prone-position-beneficial group. However, prone position for supine-position-beneficial group increased heart dose while decreasing lung dose. Prone position showed larger interfractional motion but smaller intra-fractional motion than supine position. CONCLUSION: Prone breast radiotherapy could be beneficial to a subset of small breast patients since it substantially spared normal organs while achieving adequate target coverage.


Assuntos
Neoplasias da Mama/radioterapia , Posicionamento do Paciente/instrumentação , Planejamento da Radioterapia Assistida por Computador/métodos , Tomografia Computadorizada por Raios X/métodos , Adulto , Neoplasias da Mama/diagnóstico por imagem , Neoplasias da Mama/cirurgia , Simulação por Computador , Estudos de Viabilidade , Feminino , Humanos , Mastectomia Segmentar , Pessoa de Meia-Idade , Estudos Prospectivos , Dosagem Radioterapêutica , República da Coreia
13.
J Minim Invasive Gynecol ; 26(2): 244-252.e1, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30176363

RESUMO

In this review, we evaluate techniques, devices, and equipment for patient positioning and their effect on patient outcomes, such as cephalad slide and neuropathy, in laparoscopic and robotic-assisted gynecologic surgery. We conducted a systematic review by searching MEDLINE, Embase, and Cochrane Library for relevant articles published over a 15-year period. Study selection, data extraction, and quality assessment were performed by 2 reviewers independently. Seven articles, including 3 randomized controlled trials and 4 case series, were included in our analysis. Four studies evaluated cephalad patient slide. In 2 randomized controlled trials (n = 103), the mean slide with various devices (i.e., memory foam, bean bag with shoulder braces, egg crate, and gel pad) ranged from 1.07 ± 1.93 cm to 4.5 ± 4.0 cm. The use of a bean bag with shoulder supports/braces was associated with minimal slide, with a median slide of 0 cm (range, 0-2 cm) in a retrospective series and with mean slide of 1.07 ± 1.93 cm in a randomized controlled trial (vs memory foam). No conclusive effect of body mass index on slide could be identified. Five studies evaluating the incidence of neuropathy found an overall incidence of 0.16% and no differences among slide-preventing devices. The minimal slide described across studies supports the conclusion that any of the currently used devices and techniques for safe patient positioning are within reason. The low overall incidence of neuropathy is also reassuring. Best evidence recommendations cannot be made for a specific device or technique; our findings suggest the importance of strict adherence to the basic tenets of safe patient positioning to minimize slide and prevent nerve injury.


Assuntos
Procedimentos Cirúrgicos em Ginecologia/instrumentação , Laparoscopia/instrumentação , Posicionamento do Paciente/instrumentação , Procedimentos Cirúrgicos Robóticos/instrumentação , Feminino , Procedimentos Cirúrgicos em Ginecologia/efeitos adversos , Procedimentos Cirúrgicos em Ginecologia/métodos , Humanos , Complicações Intraoperatórias/etiologia , Complicações Intraoperatórias/prevenção & controle , Laparoscopia/efeitos adversos , Laparoscopia/métodos , Posicionamento do Paciente/efeitos adversos , Posicionamento do Paciente/métodos , Segurança do Paciente , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/prevenção & controle , Procedimentos Cirúrgicos Robóticos/efeitos adversos , Procedimentos Cirúrgicos Robóticos/métodos , Resultado do Tratamento
15.
Int Wound J ; 16(2): 424-432, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30560571

RESUMO

This pilot study aimed to evaluate the clinical efficacy and feasibility of a fluidised positioning device to reduce occipital pressure injuries (PIs). A post-test design with a historical control group was used in a 54-bed intensive care unit between September 2017 and August 2018. Patients who were receiving either extracorporeal membrane oxygenation, were mechanically ventilated, or had raised intracranial pressure (≥20) were recruited. The intervention consisted of a fluidised positioning device under the patient's head, and a skin assessment every 8 h. Outcome measures included the occurrence of occipital PIs and registered nurses (RNs)' perspectives of the intervention. Data collected from patients in the intervention group were compared with data obtained from the historical control group between May 2016 and April 2017. Sixty-four patients were recruited in the intervention phase and 63 were in the historical control group. Results showed a statistically significant reduction in occipital PIs by 87.7% (16/63; 25.4% historical control vs 2/64; 3.13% interventional group). Bedside RNs provided positive evaluation of the fluidised positioning device. The findings demonstrate that the fluidised positioning device is a feasible and effective intervention in reducing the risk of occipital PIs in intensive care patients, which merits the continuation of use and further evaluation through a larger-scale study.


Assuntos
Cuidados Críticos/métodos , Desenho de Equipamento/normas , Cabeça , Lobo Occipital/lesões , Posicionamento do Paciente/instrumentação , Posicionamento do Paciente/normas , Lesão por Pressão/prevenção & controle , Adulto , Idoso , Idoso de 80 Anos ou mais , Austrália , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Projetos Piloto , Estresse Mecânico
16.
Pract Radiat Oncol ; 9(1): e110-e117, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30355524

RESUMO

PURPOSE: The Radiation Oncology Incident Learning System demonstrated that incorrect or omitted patient shifts during treatment are common near-misses or incidents. This single pediatric hospital quality improvement experience evaluated a markless isocenter localization workflow to improve safety and streamline treatment, obviating the need for daily shifts. METHODS AND MATERIALS: Patients undergoing radiation therapy were simulated and treated with indexed immobilization devices. User origins were established at simulation based on a limited set of fixed couch-top references. In treatment planning, shifts from the user origin to the planned isocenter were converted to absolute couch parameters and embedded in the setup field parameters. Thus, the first fraction did not require any shifts. Before kilovoltage imaging, setup verification was often supplemented with surface-guided imaging. After image guidance and final couch adjustments, couch parameters could be reacquired and used for subsequent treatments. No skin marks were used. RESULTS: Over 3 years, approximately 300 patients were treated with over 5000 treatment fractions using this workflow. There were no wrong-site treatment errors. Approximately a dozen near-miss events related to the daily setup process occurred, largely on the first treatment. Root-cause analysis attributed errors to user origin misidentification, couch parameter miscalculation, incorrect immobilization device use, and immobilization device indexed at the wrong indexing position. Skin marks and tattoos were unnecessary. Continuous quality improvement added additional quality assurance checks, resulting in no near-miss incidents or adverse events in the preceding 12 months. CONCLUSION: We minimized near-miss incidents by using limited simulation user origins, converting user origin-to-isocenter shifts to absolute couch parameters, and enforcing restrictive tolerance tables to limit delivery parameter changes, coupled with surface guidance and quality assurance tools. This technique can be applied across institutions, age ranges, and tumor types and with or without surface guidance. This workflow has removed a common treatment setup error and the need for skin marks.


Assuntos
Neoplasias/radioterapia , Posicionamento do Paciente/instrumentação , Posicionamento do Paciente/métodos , Planejamento da Radioterapia Assistida por Computador/métodos , Planejamento da Radioterapia Assistida por Computador/normas , Radioterapia Conformacional/instrumentação , Tatuagem , Simulação por Computador , Humanos , Movimento , Neoplasias/diagnóstico por imagem , Dosagem Radioterapêutica , Radioterapia de Intensidade Modulada/métodos , Pele , Tomografia Computadorizada por Raios X/métodos
17.
J Appl Clin Med Phys ; 20(1): 168-174, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30512231

RESUMO

PURPOSE: Our purpose was to explore which immobilization is more suitable for clinical practice in postmastectomy intensity modulation radiotherapy, the single-pole position or the double-pole position? METHODS: Patients treated with postmastectomy intensity modulation radiotherapy were eligible. They were selected randomly for single-pole position or double-pole position. Dose-volume histogram (DVH) was used to evaluate plans. After their first radiotherapy, the physicians asked a question about the comfort level of their position. The dosimetric parameters, comfort levels, and reproducibility of the two immobilization techniques were collected and analyzed after all patients had finished the whole radiotherapy. RESULTS: Totally, 94 patients were enrolled. Of these, 54 patients were treated with the single-pole position, 28 (51.9%)had left-sided lesions. While 40 patients were treated with the double-pole position, 20 (50%) had left-sided lesions. Patients' characteristics in two groups were comparable. The single-pole and double-pole immobilizations had similar conformity (0.60 ± 0.05 vs 0.60 ± 0.06, P = 0.887) and homogeneity index (0.14 ± 0.03 vs 0.13 ± 0.03, P = 0.407). Compared to single-pole position, double-pole position typically increased the mean dose, V20 , and V30 of heart (P < 0.05). Moreover, patients in the single-pole group felt more comfortable than another group (P < 0.05). There was no difference in reproducibility between the two groups (P > 0.05). CONCLUSIONS: Single-pole position seems to be more comfortable and can reduce dose coverage to heart. Both devices allow for reproducible setup and acceptable dosimetry.


Assuntos
Neoplasias da Mama/radioterapia , Posicionamento do Paciente/instrumentação , Cuidados Pós-Operatórios , Planejamento da Radioterapia Assistida por Computador/métodos , Radioterapia de Intensidade Modulada/métodos , Adulto , Idoso , Neoplasias da Mama/cirurgia , Feminino , Humanos , Mastectomia , Pessoa de Meia-Idade , Órgãos em Risco/efeitos da radiação , Dosagem Radioterapêutica , Restrição Física
18.
Med Phys ; 46(3): 1331-1340, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30582751

RESUMO

PURPOSE: Compared to conventional linacs with rotating gantries, a fixed-beam radiotherapy system could be smaller, more robust and more cost-effective. In this work, we developed and commissioned a prototype x-ray radiotherapy system utilizing a fixed vertical radiation beam and horizontal patient rotation. METHODS: The prototype system consists of an Elekta Synergy linac with gantry fixed at 0° and a custom-built patient rotation system (PRS). The PRS was designed to immobilize patients and safely rotate them about the horizontal axis. The interlocks and emergency stops of the linac and PRS were connected. Custom software was developed to monitor the system status, control the motion of the PRS and modify treatment plans for the fixed-beam configuration. Following installation, the prototype system was commissioned for three-dimensional (3D) conformal therapy based on guidelines specified in AAPM TG-45 and TG-142, with modifications for the fixed-beam geometry made where necessary. RESULTS: The system and control software was tested in a variety of machine states and executed motion, stop and beam gating commands as expected. Interlocks and emergency stops of the linac and PRS were found to correctly stop PRS motion and both kV and MV radiation beams when triggered. For 3D conformal treatments, the prototype system met all AAPM TG-45 and TG-142 specifications for geometric and dosimetric accuracy. Motion of the PRS was within 0.6 ± 0.3 mm and 0.10° ± 0.07° of input values for translation and rotation respectively. The axis of rotation of the PRS was coincident with the radiation beam axis to less than 1 mm. End-to-end treatment verification for 6 MV conformal treatments showed less than 2% difference between planned and delivered dose for all fields. CONCLUSION: In this work, we have developed and commissioned a radiotherapy system that utilizes a fixed vertical radiation beam and horizontal patient rotation. This system is a proof-of-concept prototype for a fixed-beam treatment system without a rotating gantry. Fixed-beam systems that are smaller and more cost-effective could help in improving global access to radiotherapy.


Assuntos
Neoplasias/radioterapia , Aceleradores de Partículas/instrumentação , Posicionamento do Paciente/instrumentação , Imagens de Fantasmas , Planejamento da Radioterapia Assistida por Computador/métodos , Radioterapia Conformacional/métodos , Algoritmos , Desenho de Equipamento , Humanos , Posicionamento do Paciente/métodos , Dosagem Radioterapêutica , Rotação
19.
J Neurosurg ; 129(Suppl1): 133-139, 2018 12 01.
Artigo em Inglês | MEDLINE | ID: mdl-30544303

RESUMO

OBJECTIVEThe Leksell Gamma Knife Icon (GK Icon) radiosurgery system can utilize cone-beam computed tomography (CBCT) to evaluate motion error. This study compares the accuracy of frame-based and frameless mask-based fixation using the Icon system.METHODSA retrospective cohort study was conducted to evaluate patients who had undergone radiosurgery with the GK Icon system between June and December 2017. Patients were immobilized in either a stereotactic head frame or a noninvasive thermoplastic mask with stereotactic infrared (IR) camera monitoring. Setup error was defined as displacement of the skull in the stereotactic space upon setup as noted on pretreatment CBCT compared to its position in the stereotactic space defined by planning MRI for frame patients and defined as skull displacement on planning CBCT compared to its position on pretreatment CBCT for mask patients. For frame patients, the intrafractionation motion was measured by comparing pretreatment and posttreatment CBCT. For mask patients, the intrafractionation motion was evaluated by comparing pretreatment CBCT and additional CBCT obtained during the treatment. The translational and rotational errors were recorded.RESULTSData were collected from 77 patients undergoing SRS with the GK Icon. Sixty-four patients underwent frame fixation, with pre- and posttreatment CBCT studies obtained. Thirteen patients were treated using mask fixation to deliver a total of 33 treatment fractions. Mean setup and intrafraction translational and rotation errors were small for both fixation systems, within 1 mm and 1° in all axes. Yet mask fixation demonstrated significantly larger intrafraction errors than frame fixation. Also, there was greater variability in both setup and intrafraction errors for mask fixation than for frame fixation in all translational and rotational directions. Whether the GK treatment was for metastasis or nonmetastasis did not influence motion uncertainties between the two fixation types. Additionally, monitoring IR-based intrafraction motion for mask fixation-i.e., the number of treatment stoppages due to reaching the IR displacement threshold-correlated with increasing treatment time.CONCLUSIONSCompared to frame-based fixation, mask-based fixation demonstrated larger motion variations. The variability in motion error associated with mask fixation must be taken into account when planning for small lesions or lesions near critical structures.


Assuntos
Tomografia Computadorizada de Feixe Cônico , Posicionamento do Paciente/instrumentação , Radiocirurgia , Planejamento da Radioterapia Assistida por Computador/métodos , Tomografia Computadorizada de Feixe Cônico/métodos , Cabeça , Humanos , Movimento (Física) , Radiocirurgia/métodos , Restrição Física/instrumentação , Estudos Retrospectivos
20.
Rev Lat Am Enfermagem ; 26: e3083, 2018 Nov 29.
Artigo em Inglês, Português, Espanhol | MEDLINE | ID: mdl-30517574

RESUMO

OBJECTIVE: to evaluate the interface pressure (IP) of support surfaces (SSs) on bony prominences. METHOD: a quasi-experimental study with repeated measures on each SS. Twenty healthy adult volunteers participated in the study. The participants were placed in the supine position on a standard operating table for evaluation of IP on the bony prominences of the occipital, subscapular, sacral, and calcaneal regions using sensors. Seven evaluations were performed for each bony prominence: one on a standard operating table, and the others on tables containing SSs made of viscoelastic polymer, soft foam, or sealed foam. Descriptive statistics and analysis of variance were used to analyze the data. RESULTS: the mean IP was higher on the viscoelastic polymer-based SS compared to the other SSs (p<0.001). The mean IP was relatively lower on the density-33 sealed foam and density-18 soft foam. In addition, this variable was comparatively higher in the sacral region (42.90 mmHg) and the calcaneal region (15.35 mmHg). CONCLUSION: IP was relatively lower on foam-based SSs, especially on density-18 soft foam and density-33 sealed foam. Nonetheless, IP was not reduced on the viscoelastic polymer SS compared to the control SS.


Assuntos
Salas Cirúrgicas , Mesas Cirúrgicas , Posicionamento do Paciente/instrumentação , Assistência Perioperatória , Lesão por Pressão/prevenção & controle , Adulto , Desenho de Equipamento , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Adulto Jovem
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