Towards artificial intelligence-based automated treatment planning in clinical practice: A prospective study of the first clinical experiences in high-dose-rate prostate brachytherapy.

PURPOSE: This prospective study evaluates our first clinical experiences with the novel ``BRachytherapy via artificial Intelligent GOMEA-Heuristic based Treatment planning'' (BRIGHT) applied to high-dose-rate prostate brachytherapy. METHODS AND MATERIALS: Between March 2020 and October 2021, 14 prostate cancer patients were treated in our center with a 15Gy HDR-brachytherapy boost. BRIGHT was used for bi-objective treatment plan optimization and selection of the most desirable plans from a coverage-sparing trade-off curve. Selected BRIGHT plans were imported into the commercial treatment planning system Oncentra Brachy . In Oncentra Brachy a dose distribution comparison was performed for clinical plan choice, followed by manual fine-tuning of the preferred BRIGHT plan when deemed necessary. The reasons for plan selection, clinical plan choice, and fine-tuning, as well as process speed were monitored. For each patient, the dose-volume parameters of the (fine-tuned) clinical plan were evaluated. RESULTS: In all patients, BRIGHT provided solutions satisfying all protocol values for coverage and sparing. In four patients not all dose-volume criteria of the clinical plan were satisfied after manual fine-tuning. Detailed information on tumour coverage, dose-distribution, dwell time pattern, and insight provided by the patient-specific trade-off curve, were used for clinical plan choice. Median time spent on treatment planning was 42 min, consisting of 16 min plan optimization and selection, and 26 min undesirable process steps. CONCLUSIONS: BRIGHT is implemented in our clinic and provides automated prostate high-dose-rate brachytherapy planning with trade-off based plan selection. Based on our experience, additional optimization aims need to be implemented to further improve direct clinical applicability of treatment plans and process efficiency.

Is Team Resilience More Than the Sum of Its Parts? A Quantitative Study on Emergency Healthcare Teams during the COVID-19 Pandemic.

Due to the COVID-19 pandemic, emergency healthcare workers have come under even more pressure than before, threatening the workers' mental health and the continuity of care delivered by their teams. This study aims to investigate what conditions increase individual and team resilience, referring to the ability to "bounce back" from stressful situations. We also assess whether team resilience is the sum of the individual resilience of team members, or whether other conditions enhance team resilience and thus continuity of care, despite limited individual resilience. We collected survey data from 129 emergency healthcare team members in the Netherlands to examine to what extent transformational leadership and team familiarity influence the level of team resilience, either directly or mediated by individual resilience, accounting for psychological characteristics and social support. The results show two distinct pathways to enhance team resilience, directly by familiarizing team members with each other and by mobilizing family support, and indirectly but with a much weaker effect, by encouraging team members' individual resilience through transformational leadership and staffing optimistic team members with high levels of self-efficacy.

Dilute blood clot lysis time and electrophoretic lipoprotein fractions in a population sample of healthy Romanians.

Serum total lipids and cholesterol, electrophoretically determined lipoprotein concentrations, serum pseudocholinesterase and dilute blood clot lysis time were determined in 630 healthy subjects (287 men and 343 women) aged 20-60, working in the food industry. A high incidence of over-weight was noted ranging from 22.4% in women aged 20-40 to 58.7% in men aged 41-60. Over-weight subjects presenting higher levels of serum cholesterol, total lipids and of the pre-beta electrophoretic fraction also had a higher pseudo-cholinesterase activity and a more delayed clot lysis time than normal-weight subjects matched as to age and sex. When the material was divided into quintiles for pre-beta- and beta-lipoproteins, a highly significant delay of fibrinolysis was noted in the fourth and fifth quintiles for pre-beta-lipoproteins, but no significant changes of lysis time occurred with increasing concentrations of beta-lipoproteins. Possible explanations of the abovementioned findings are briefly discussed.