Conectar
To develop and evaluate the psychometric properties of the Forensic Nursing Competency Scale-Short Form (FNCS-SF) for hospital nurses.
Nurses who care for victims of sexual abuse, domestic violence and elder or child abuse require forensic nursing competencies. However, few valid and reliable tools exist to assess these competencies in hospital settings.
A cross-sectional study.
The study was conducted in two phases. Phase 1 involved the development and refinement of the FNCS-SF with input from 10 nurses. Phase 2 tested the tool's psychometric properties. A total of 420 nurses from two tertiary hospitals in South Korea participated. Participants were divided into two groups: Study 1 (n = 200) for exploratory factor analysis and Study 2 (n = 220) for confirmatory factor analysis.
The FNCS-SF consists of 27 items across six factors: awareness of the medicolegal problem, evidence-based practice in forensic nursing, collaborative forensic nursing with community partners, safety and security, professional career development and multidisciplinary integrated knowledge. An item analysis revealed significant correlations between each item and the total scale score. Criterion validity was supported by significant correlations between the FNCS-SF and attitudes and beliefs towards forensic nursing and the performance of the forensic nursing role. Confirmatory factor analysis supported a six-factor model with good fit indices. Cronbach's alpha indicated strong internal consistency.
The FNCS-SF is a valid and reliable tool for assessing hospital nurses' forensic nursing competencies, which can improve patient safety and treatment outcomes. Further validation in diverse clinical settings is recommended.
The FNCS-SF can be used to improve forensic nursing competency through professional development.
None.
The FNCS-SF provides a standardised framework to evaluate nurses' forensic competency, guiding education and practice to enhance clinical preparedness and deliver victim-centred care.
STROBE guidelines.
To determine the clinical characteristics and identify not only the Korean Triage and Acuity Scale levels of older patients with pneumonia in the emergency department but also the factors associated with their survival.
This study employed a retrospective observational design.
This study was conducted at the emergency department of a university hospital in Seoul, South Korea. It utilised medical data from January 1 to December 31, 2023. The study sample comprised 327 patients aged 65 years or older who received a pneumonia diagnosis (International Classification of Diseases: J10–J18). Binary logistic regression analysis was performed to identify independent factors associated with their survival.
Survival was significantly associated with and influenced by sex (specifically, male sex), initial Korean Triage and Acuity Scale level, oxygen supplementation in the emergency department, consciousness level (specifically, painful response), body temperature (> 37.5°C) and a diagnosis of solid or hematologic malignancies.
The findings highlight the need for improved triage protocols, emphasising consciousness level, body temperature and malignancies. Incorporating geriatric-specific age thresholds and oncologic status into Korean Triage and Acuity Scale classifications may enhance risk stratification, timely intervention and resource allocation in emergency department settings.
This study provides insight into triage accuracy for older pneumonia patients, emphasising early recognition of high-risk individuals and strengthening nursing assessment protocols. Improved Korean Triage and Acuity Scale classifications can optimise resource allocation and emergency care strategies, ultimately reducing mortality rates.
The study provides actionable insights for emergency nurses, triage clinicians and policymakers. The findings support the refinement of KTAS protocols to enhance risk stratification and guide resource allocation for older pneumonia patients, ultimately aiming to reduce mortality rates.
Adhered to STROBE guidelines for observational studies.
Although patients did not directly participate, the findings advocate for patient-centred triage improvements, enhancing early identification of high-risk older patients with pneumonia.
Cognitive impairment is considered a challenge in medication management for both the affected patient as well as their caregiver. Numerous studies have investigated interventions aiming to improve medication therapy safety in this population; however, there is insufficient knowledge on interventions which support patients and caregivers effectively. The aim of this systematic review is to (1) identify interventions to improve medication therapy safety in older patients with cognitive impairment, and (2) to evaluate their effectiveness.
We will conduct a systematic review of literature with participatory elements of public involvement in every step of the process. Five literature databases (PubMed, CENTRAL, Embase, PsycINFO and CINAHL) will be screened to identify interventions to improve medication therapy safety in older (≥65 years of age) adults with cognitive impairment. To support methodology and evidence synthesis, we will conduct expert panel discussions as well as focus group discussions of caregivers and healthcare professionals. Study selection, data extraction and bias assessment will be conducted independently by two reviewers. For data synthesis, studies will be organised by setting (eg, community setting, hospital setting, nursing home setting).
The responsible Ethics Committee of the Medical Faculty of Heidelberg granted approval for the public involvement strategies in this project (S-562/2024). Results will be presented by publication in an academic journal and at scientific conferences.
CRD42024623352.
To explore the optimal timing of patient-reported outcome assessment, defined as the collection and use of patient-reported outcomes at clinically meaningful points such as before or during encounters, treatment initiation and follow-up, and to identify the facilitators and barriers to timely use.
A qualitative analysis of semi-structured interviews with healthcare professionals across diverse US health systems.
Thematic analysis was used to identify key themes related to the timing and implementation of patient-reported outcomes assessments. Interviews were analysed iteratively to develop a coding framework and synthesise overarching themes.
Fourteen healthcare professionals, including nurse practitioners, cardiologists and health informatics experts across seven U.S. health systems from academic and community hospitals, were interviewed in February 2024. Three major themes emerged: (1) value proposition of timely patient-reported outcome data collection (2) key facilitators for timely implementation and (3) multilevel barriers. The value proposition focused on the use of patient-reported outcomes for prevention and active disease management. Critical facilitators for the timely implementation of patient-reported outcomes included the involvement of research and clinical coordinators, strategies for pre-visit and on-site patient-reported outcome collection, the use of standardised templates within EHRs and the alignment of patient-reported outcome collection with patients' long-term treatment goals. Finally, multilevel barriers included time constraints, patient-level challenges (e.g., fatigue, literacy, language) and systemic issues (e.g., technical limitations, lack of reimbursement and unclear guidelines).
Timely collection and use of patient-reported outcomes is critical for improving symptom monitoring and supporting patient-centered clinical decision-making. However, multilevel barriers hinder consistent implementation across health care settings.
Integrating patient-reported outcomes into clinical workflows can improve the patient-centeredness of patient-healthcare professional interactions, and provide a more holistic picture of a patient's health status. Addressing barriers to patient-reported outcome implementation, including lack of time, poor health literacy and workflow integration barriers, is crucial for improving clinical outcomes.
This study adhered to the COREQ (Consolidated Criteria for Reporting Qualitative Research) checklist, in accordance with EQUATOR Network guidelines.
No patient or public involvement: This study did not include patient or public involvement in its design, conduct or reporting.
by Sang Ah Lee, Jin-Myung Kim, Hye Eun Kwon, Youngmin Ko, Joo Hee Jung, Sung Shin, Young Hoon Kim, Sung-Han Kim, Hyunwook Kwon
PurposeOptimal perioperative antibiotic prophylaxis in kidney transplantation remains undefined despite routine antibiotic administration to prevent infections. In this retrospective observational cohort study with historical comparison, we compared the clinical efficacy of 6 days of ampicillin/sulbactam vs. a single dose of cefazolin.
Materials and methodsWe retrospectively analyzed 2322 kidney transplantation recipients at a single center, with the evaluation period spanning from 2015 through 2021. Patients were divided into 2 groups based on the perioperative antibiotic regimen received: 971 patients received ampicillin/sulbactam, and 1351 received cefazolin. This study focused on evaluating the impact of these regimens on postoperative infection incidence and the 6-month acute rejection (AR) rates.
ResultsThe cefazolin group exhibited a tendency toward higher urinary tract infection rates within 1 month after transplantation (3.4% vs. 2.2%, p= = 0.078). There were no significant differences in surgical site infections between the groups. The 6-month AR rates were significantly lower in the cefazolin group than in the ampicillin/sulbactam group (5.1% vs. 7.9%, p= = 0.009). Cefazolin was also confirmed to be significantly associated with reduced 6-month AR rates in the multivariable logistic regression analysis (odds ratio 0.63, 95% confidence interval [0.45-0.89], p= = 0.009).
ConclusionIn this study, we observed that a single dose of cefazolin as perioperative antibiotic prophylaxis may lead to higher rates of postoperative urinary tract infections, but it could potentially lower the incidence of acute rejection within six months.
This study aimed to investigate whether psychological distress mediates the relationship between secondary traumatic stress (STS) and post-traumatic stress symptoms (PTSS) among clinical nurses, and whether perceived emotional support moderates this mediating effect.
A cross-sectional study.
A total of 205 clinical nurses who had direct patient contact and trauma-related experience were included. Data were collected using validated instruments: the Secondary Traumatic Stress Scale (STSS), Depression Anxiety Stress Scale-12 (DASS-12), Impact of Event Scale-Revised (IES-R), and the Multidimensional Scale of Perceived Social Support (MSPSS). All scales demonstrated high internal consistency (Cronbach's α = 0.88–0.97).
Psychological distress significantly mediated the relationship between STS and PTSS. Perceived emotional support moderated the path from STS to psychological distress, such that higher emotional support amplified the association. However, emotional support did not significantly moderate the relationship between psychological distress and PTSS.
Psychological distress plays a central role in translating STS into PTSS among clinical nurses. Although emotional support may buffer early psychological distress, it does not attenuate PTSS development once distress is established.
Early detection and management of psychological distress can prevent STS from progressing to PTSS. Nurses frequently exposed to trauma require timely psychological support. We recommend implementing routine screening and early interventions focused on distress, along with peer-support programmes and supervisory encouragement to enhance resilience. Trauma-informed care training and organisational awareness should also be strengthened to foster a supportive environment.
This study shows that managing early emotional symptoms is critical in preventing PTSS among nurses exposed to secondary trauma. Findings can inform global policies, peer-support initiatives, and early screening systems to enhance resilience and safeguard patient care.
The study adhered to the STROBE checklist for cross-sectional studies.
No patient or public contribution.
Lynch syndrome (LS) carriers have a 20–46% lifetime risk of colorectal cancer (CRC) due to mismatch repair gene variants. Mesalamine (5-ASA, 5-aminosalicylic acid), used safely in patients with ulcerative colitis, may reduce CRC risk in LS by decreasing microsatellite instability, a key driver of LS-related cancer. This study evaluates 5-ASA’s efficacy as a tolerable chemopreventive drug, aiming to improve long-term CRC prevention in LS.
This multicentre, multinational, randomised, double-blind, two-arm, phase II clinical study will compare the effects of a 2-year daily intake of 5-ASA (2000 mg) to placebo in LS carriers. The primary objective is to assess whether mesalamine reduces colorectal neoplasia, both benign and malignant, compared with placebo in LS carriers, as detected by colonoscopy at the end of the treatment period (24 months±1 month) and on study completion. Secondary objectives include evaluating whether 5-ASA reduces neoplasia/tumour multiplicity and progression compared with placebo at specified time points, examining variations in the effects of 5-ASA versus placebo based on cancer history, sex and age (
The trial is currently open for enrolment, having received ethical approval from the Regional Ethical Review Board in Stockholm and funding from the Swedish Research Council. The study protocol is the finalised V.10.0 (11 April 2024), transitioned to the European Clinical Trials Information System. LS remains underdiagnosed, which may limit recruitment. The results are of global interest and will be published in peer-reviewed journals and presented at scientific conferences.
ClinicalTrials.gov: NCT04920149. EudraCT: 2019-003011-55. EU CT: 2024-514765-19-01.
by Rubin Pooni, Silva Arslanian, Heather Edgell, Hala Tamim, SoJung Lee, Jennifer L. Kuk
ObjectiveAttenuated heart rate recovery (HRR) immediately after exercise is an independent predictor of cardiovascular disease and mortality in adults. We examined the effects of aerobic exercise (AE), resistance exercise (RE), and combined AE and RE on HRR, and the relationship of HRR with body composition and metabolic risk factors in adolescents with overweight or obesity.
Research design and methodsWe included 147 adolescents (BMI ≥ 85th percentile, 12–18 years) who participated in exercise intervention studies (3–6 months), and had a complete data set including VO2peak, body composition by dual-energy X-ray absorptiometry, and cardiometabolic risk factors before and after the interventions. HRR was calculated as the difference between peak HR during the maximal treadmill test and HR at 1-, 2-, 3-, 4-, and 5-min after the cessation of the test.
ResultsAfter interventions, a faster HRR at 2–5 min was observed following AE (17.3–25.6% change, P P P P P 2peak. Changes in HRR were not associated with the changes in % body fat or metabolic risk factors.
ConclusionAE training is more beneficial than RE or combined AE and RE training for improving HRR in adolescents with overweight or obesity.
by Claire Verkuyl, Ari Belotserkovsky, Thomas Zerbes, Declan Williams, Medha R. Krishnan, Sabrina Zhu, Sophie Grunnesjӧ, Shehab Eid, Cunjie Zhang, Wenda Zhao, Leo Xu, Eleanore Lin, Teaghan O’Shea, Benjamin Draper, Andreas Jungman, Patrick Most, Gerold Schmitt-Ulms
Any strategy that can selectively and persistently lower the brain levels of the cellular prion protein (PrPC) is expected to extend survival in prion diseases. Recent advances in the virus-mediated delivery of gene therapies prompted us to explore if a recombinant adeno-associated virus (rAAV) vector delivering a CRISPR-Cas-based gene editor can be devised that induces a functional knockout of the prion gene. Whereas the eventual objective is to assess the therapeutic potency of an optimized vector in prion-infected mice, in this proof-of-concept study, we evaluated tools and methods that are suited to achieve this goal. The result of these efforts is a first-generation all-in-one rAAV vector that codes for a prion gene-specific guide RNA and a small Cas9 endonuclease, whose expression is controlled by a truncated neural cell adhesion molecule 1 (NCAM1) promoter that is active in PrPC expressing cells. We also constructed a second rAAV vector coding for a prion gene-specific ‘traffic light reporter’ (TLR). The TLR can be used to monitor prion gene-editing efficacy by coding for red and green fluorescent proteins separated by a segment of the prion gene that is targeted by the gene editor. For the purification of AAVs, we adopted a robust and scalable rAAV vector assembly pipeline and undertook proof-of-concept prion gene editing experiments in human cells and mice, which to date yielded prion gene editing rates of approximately 20% and 5%, respectively. Finally, we compared brain distributions of rAAV vectors following intrathalamic versus retro-orbital injection, and selected the 9P31 capsid for future studies based on a 7.5-fold higher heterologous gene expression level as compared to the PHP.eB capsid.To assess the association of normal systolic blood pressure maintenance (SBPmaintain) with coronary artery calcification (CAC) progression in non-diabetic and diabetic subjects at low to intermediate cardiovascular risk.
Retrospective cohort study with a mean follow-up of 3.3 years.
Data from the Korea Initiatives on Coronary Artery Calcification registry were analysed.
10 754 asymptomatic Korean adults (51.5±8.6 years; 84.5% male; 14.2% diabetes) were enrolled. Participants were divided into two groups: normal SBPmaintain (maintain (≥120 mmHg) at the time of follow-up CAC scan.
CAC progression was defined as a difference of ≥2.5 between the square roots () of the baseline and follow-up coronary artery calcium score (CACS) (transformed CACS). Annualised transformed CACS was defined as transformed CACS divided by the interscan period.
Compared with non-diabetics, the incidence of CAC progression was higher in diabetics (28.4% vs 47.3%, pmaintain was inversely associated with an annualised transformed CACS (β: –0.18, 95% CI: –0.25 to –0.12, pmaintain showed a lower risk of CAC progression than ≥elevated SBPmaintain in non-diabetics; however, this association was not observed in patients with diabetes.
Maintaining normal systolic blood pressure was associated with a significantly attenuated CAC progression, especially in clinical conditions without established diabetes.
To identify a frame of reference for resident safety management in nursing homes.
Q-methodology.
This study was conducted using Q-methodology to identify shared perspectives about resident safety management among nursing home professionals. Data were collected from 13 May 2023, through 29 August 2023. Thirty-four professionals, including nurses, care workers, social workers and physical therapists, classified Q-samples into a normal distribution grid through Q-sorting. Data analysis was performed using the PQmethod programme. Q-factors were interpreted by integrating interview transcripts, demographic data and factor arrays that organised the analysis results.
The analysis included the Q-sort of 33 professionals, with an average age of 46.03 years and 6.53 years of nursing home experience, after excluding one individual who did not fit any Q-factor. Four Q factors explaining 63% of the total variance were identified: constructing individualised possible risk trajectories, utilising ingrained safety principles, creating supportive safety environments and coordinating safety principles with individual needs.
Understanding the diverse subjectivities of professionals can help develop strategies that promote collaboration among nursing home professionals and support preventive safety management practices.
The frame of reference derived from nursing home professionals' perspectives suggests a resident-tailored framework.
This study supports the development of interprofessional education tailored to the specific needs of nursing home settings by identifying shared perspectives among nursing home professionals. The findings highlight the need for clear guidelines to help professionals balance resident autonomy with safety and assess the impact of family involvement.
Reporting involved qualitative and quantitative approaches, in compliance with the MMAT criteria for mixed-method research.
No Patient or Public Contribution.
Progress at the intersection of artificial intelligence and paediatric neuroimaging necessitates large, heterogeneous datasets to generate robust and generalisable models. Retrospective analysis of clinical brain MRI scans offers a promising avenue to augment prospective research datasets, leveraging the extensive repositories of scans routinely acquired by hospital systems in the course of clinical care. Here, we present a systematic protocol for identifying ‘scans with limited imaging pathology’ through machine-assisted manual review of radiology reports.
The protocol employs a standardised grading scheme developed with expert neuroradiologists and implemented by non-clinician graders. Categorising scans based on the presence or absence of significant pathology and image quality concerns facilitates the repurposing of clinical brain MRI data for brain research. Such an approach has the potential to harness vast clinical imaging archives—exemplified by over 250 000 brain MRIs at the Children’s Hospital of Philadelphia—to address demographic biases in research participation, to increase sample size and to improve replicability in neurodevelopmental imaging research. Ultimately, this protocol aims to enable scalable, reliable identification of clinical control brain MRIs, supporting large-scale, generalisable neuroimaging studies of typical brain development and neurogenetic conditions.
Studies using datasets generated from this protocol will be disseminated in peer-reviewed journals and at academic conferences.
Adolescence is a critical period marked by rapid brain development and the onset of many mental health disorders. Brain MRI studies during adolescence, especially when paired with behavioural phenotypes and information about genetic risk factors, hold promise to advance early identification of mental health risk and spur the creation of targeted treatments to improve patient function, prognosis and quality of life. However, prospective neuroimaging is costly and time-intensive, and individuals who participate may not be reflective of the general population. These challenges are compounded when examining adolescents, as many families lack the time, energy or resources to participate in studies that use research-grade imaging. Repurposing clinical MRIs obviates many of the challenges of neuroimaging research. Here, we describe the brain-behaviour-genetics study protocol. This protocol describes procedures used to recruit participants with recent high-quality clinical brain MRIs and prospectively acquire genetic and sociobehavioural data, resulting in a highly cost-efficient design that harnesses a vast and underused neuroscientific resource.
The brain-behaviour-genetics protocol aims to recruit 1000 adolescents who have clinical brain MRIs contained in Children’s Hospital of Philadelphia’s electronic health record. One or both parents of the adolescent proband will be recruited when possible. Parents and adolescents will complete a series of self-report scales spanning the domains of mental health, trauma, risk and resilience. Saliva samples will be collected from the adolescent and at least one biological parent, using an at-home saliva collection kit. Subsequent analysis will examine associations between brain development, genetics and behavioural measures in adolescence.
Approval for the study had been obtained from the Children’s Hospital of Philadelphia’s institutional review board (IRB #23–0 20 851). Results will be published in peer-reviewed journals.
This study aims to provide guidance for nursing college students to enhance their overall happiness and to support the development of internal resources that contribute to improved physical and psychological health as they progress in their nursing careers.
A descriptive survey design was employed.
The study was conducted among nursing students enrolled at four nursing colleges in South Korea.
The final sample comprised 302 nursing students who met the following criteria: (1) enrolled in their third or fourth year of study, (2) engaged in club activities for more than 6 months within the previous year—considering the period during which face-to-face classes resumed following the COVID-19 pandemic— and (3) voluntarily consented to participate after receiving detailed information about the study.
The dependent variable was happiness. Candidate explanatory variables included college life adaptation, leisure satisfaction from club activities and family strengths. Data were collected between 5 and 30 June 2023, and analysed using SPSS/WIN V.22.0 software in accordance with the study objectives.
The multiple regression model was statistically significant (F=28.60, p
These variables collectively explained 42.0% of the variance in happiness. Future interventions aiming to enhance mental health and happiness among nursing students should consider these key influencing factors.
by Andrea C. Aplasca, Peter B. Johantgen, Christopher Madden, Kilmer Soares, Randall E. Junge, Vanessa L. Hale, Mark Flint
Amphibian skin is integral to promoting normal physiological processes in the body and promotes both innate and adaptive immunity against pathogens. The amphibian skin microbiota is comprised of a complex assemblage of microbes and is shaped by internal host characteristics and external influences. Skin disease is a significant source of morbidity and mortality in amphibians, and increasing research has shown that the amphibian skin microbiota is an important component in host health. The Eastern hellbender (Cryptobranchus alleganiensis alleganiensis) is a giant salamander declining in many parts of its range, and captive-rearing programs are important to hellbender recovery efforts. Survival rates of juvenile hellbenders in captive-rearing programs are highly variable, and mortality rates are overall poorly understood. Deceased juvenile hellbenders often present with low body condition and skin abnormalities. To investigate potential links between the skin microbiota and body condition, we collected skin swab samples from 116 juvenile hellbenders and water samples from two holding tanks in a captive-rearing program. We used 16s rRNA gene sequencing to characterize the skin and water microbiota and observed significant differences in the skin microbiota by weight class and tank. The skin microbiota of hellbenders that were housed in tanks in close proximity were generally more similar than those housed physically distant. A single taxa, Parcubacteria, was differentially abundant by weight class only and observed in higher abundance in low weight hellbenders. These results suggest a specific association between this taxa and Low weight hellbenders. Additional research is needed to investigate how husbandry factors and potential pathogenic organisms, such as Parcubacteria, impact the skin microbiota of hellbenders and ultimately morbidity and mortality in the species.by Xinyu Zhang, Yoo Jung Oh, Yunhan Zhang, Jianfeng Zhu
The digital age has fueled a surge in ADHD self-diagnosis as people turn to online platforms for mental health information. However, the relationship between validation-seeking behaviors and self-perception in these online communities and users’ self-perception has received limited scholarly focus. Drawing on self-verification theory and utilizing natural language processing to analyze 452,026 posts from the r/ADHD subreddit, our study uncovers distinct patterns in validation-seeking behaviors. Results show that (a) self-diagnosed individuals with ADHD are more likely to seek social validation and media validation and to report higher levels of negative self-image and internalized stigma than clinically diagnosed individuals, (b) social validation was strongly associated with both positive and negative self-perceptions; and (c) diagnosis status significantly moderated these relationships, such that the effects of social validation on self-image and stigma were consistently weaker for the self-diagnosed group. Theoretically, this study extends self-verification theory by demonstrating that professional verification hierarchically moderates self-verification effectiveness. This implies a practical need for clinicians to acknowledge online validation seeking and for digital communities to affirm user experiences while mitigating stigma.To identify the barriers and facilitators in the implementation of fertility preservation (FP) shared decision-making (SDM) in oncology care.
Qualitative descriptive study.
Qualitative interviews with 16 female patients with cancer and seven healthcare providers were conducted between July 2022 and April 2024. Data were analyzed using directed content analysis, guided by the implementation science framework.
We identified 22 categories comprising 38 codes as barriers to SDM implementation and 17 categories comprising 26 codes as facilitators. Findings revealed that, at the innovation level, accessibility, feasibility, interdisciplinary collaboration, and quality improvement efforts were decisive in the implementation of FP SDM. At the individual level, healthcare providers' awareness and attitudes towards FP and SDM, as well as patients' knowledge, attitudes, and capabilities in FP SDM, were crucial factors in the implementation of FP SDM. In social, economic, and organizational contexts, support from significant others, social awareness about FP, multidisciplinary care, financial assistance, and educational resources were determinants in implementing FP SDM.
Implementing FP SDM among female patients with cancer necessitates a strategic approach that considers barriers and facilitators. Educating and promoting FP SDM among the public and healthcare providers, combined with incentivizing policies, can enhance individual knowledge and awareness while achieving systemic improvements, facilitating its successful implementation.
This study provides insights into barriers and facilitators and proposes strategic approaches to enhancing FP SDM implementation, contributing to improved quality of life for cancer survivors and advancements in clinical practice.
Perioperative adverse events increase morbidity and mortality. The rate and severity of complications and the risk for subsequent mortality are increased after high-risk procedures and in elevated-risk patients. Over the past decades, a multitude of prognostic studies identified perioperative risk factors at the population level. However, to allow for the advancement of precision surgery strategies, improved risk prediction on the individual patient level is warranted. Comprehensive, consecutive, multisource, structured, high-quality patient-related and procedure-related data sets, together with thorough follow-up and combined with state-of-the-art machine-learning analyses, are needed to facilitate precise prediction of perioperative complications. Therefore, we designed and currently conduct the Heidelberg Perioperative Deep Data study (HeiPoDD). Here, we report the rationale and design of the HeiPoDD study.
HeiPoDD is a prospective, single-centre, exploratory cohort study aiming to build up a large-scale deep-data base and corresponding biomaterial collection. 1040 adult patients planned for elective high-risk, non-cardiac surgery for any indication at Heidelberg University Hospital, Germany will be included. The obtained study-specific data set includes clinical data, lab values, genome- and proteome analysis as well as plasma, serum and peripheral blood mononuclear cells (PBMC) collected before and at days 1, 3 and 7 postsurgery. Urine samples are collected before and at day 1 postsurgery. Structured follow-up for perioperative complications such as redo-surgery, length of intensive care stay or length of hospital stay is conducted at days 30, 90 and 1 year postsurgery and for disease progression and survival after 3 and 5 years postsurgery. All study data will be transferred to the HeiPoDD registry to allow merging with all available routine clinical data from the hospital information system including imaging studies as well as haemodynamic and respiratory biosignals. Biomaterials will be stored in the HeiPoDD biomaterial bank to allow further analyses.
The trial protocol and amendments were approved by the ethics committee of the University of Heidelberg (S-758/2021). The protocol is registered with the German Clinical Trial Register (DRKS00024625). Participating patients’ data will be recorded only in pseudonymised form. After completion of the study, data collected during the study will be kept on file for up to 30 years. Biomedical samples collected during the study and entered into the biobank will be held for the same amount of time. The findings will be disseminated in peer-reviewed academic journals.
by Dong Min Jung, Yong Jae Kwon, Yong Wan Cho, Jong Geol Baek, Dong Jae Jang, Yongdo Yun, Seok-Ho Lee, Gahee Son, Hyunjong Yoo, Min Cheol Han, Jin Sung Kim
Volumetric modulated arc therapy (VMAT) for lung cancer involves complex multileaf collimator (MLC) motion, which increases sensitivity to interplay effects with tumour motion. Current dynamic conformal arc methods address this issue but may limit the achievable dose distribution optimisation compared with standard VMAT. This study examined the clinical utility of a VMAT technique with monitor unit limits (VMATliMU) to mimic conformal arc delivery and reduce interplay effects while maintaining plan quality. VMATliMU was implemented by applying monitor unit limitations during VMAT reoptimisation to minimise MLC encroachment into target volumes. Using mesh-type reference computational phantom CT images, treatment plans were generated for a simulated stage I lung cancer case prescribed to 45 Gy in three fractions. VMATliMU, conventional VMAT, VMAT with leaf speed limitations, dynamic conformal arc therapy, and constant dynamic conformal arc therapy were compared. Plans were optimised for multiple isodose line prescriptions (50%, 60%, 70%, 80%, and 90%) to investigate the impact of dose distribution. Evaluation parameters included MLC positional accuracy using area difference ratios, dosimetric indices, gradient metrics, and organ-at-risk doses. VMATliMU prevented MLC encroachment into the internal target volume across 60%–90% isodose lines, showing superior MLC accuracy compared with other methods. At the challenging 50% isodose line, VMATliMU had 4.5 times less intrusion than VMAT with leaf speed limits. VMAT plans had better dosimetric indices than dynamic conformal arc plans. VMATliMU reduced monitor units by 5.1%–19.2% across prescriptions. All plans met the clinical dose constraints, with the aortic arch below tolerance and acceptable lung doses. VMATliMU combines VMAT’s dosimetric benefits with the dynamic conformal arcs’s simplicity, minimising MLC encroachment while maintaining plan quality. Reduced monitor units lower low-dose exposure, treatment time, and interplay effects. VMATliMU is usable in existing planners with monitor unit limits, offering a practical solution for lung stereotactic body radiation therapy.
FreshRSS 