Actual Treatment Time Research Articles

Influence of radiotherapy interruption on esophageal cancer with intensity-modulated radiotherapy: a retrospective study

BackgroundRadiotherapy interruption (RTI) prolongs the overall total treatment time and leads to local control loss in many cancers, but it is unclear in esophageal cancer. We aimed to evaluate the influence of RTI on the overall survival (OS), progression-free survival (PFS), and local-regional recurrence-free survival (LRFS) of patients with esophageal cancer undergoing chemoradiotherapy.MethodsA total of 299 patients with esophageal squamous cell carcinoma from 2017 to 2019 were retrospectively analyzed to investigate the effect of RTI on OS, PFS, and LRFS. The delayed time of radiotherapy interruption was calculated as the actual radiation treatment time minus the scheduled time. The univariate and multivariate analyses were performed by the COX proportional hazards regression models, and the survival analysis was performed through the Kaplan‒Meier method, and compared with the log-rank test.ResultsThe 3-year OS, PFS, and LRFS rates were 53.0%, 42.0%, and 48.0%, respectively. The univariate and multivariate analyses showed that the delayed time > 3 days was an independent adverse prognostic factor for OS (HR = 1.68, 95% CI 1.10–2.55, p = 0.016), and LRFS (HR = 1.74, 95% CI 1.18–2.57, p = 0.006). The patient with a delayed time of > 3 days had poorer survival rates of OS, and LRFS than patients with a delayed time of ≤ 3 days (OS, p = 0.047; LRFS, p = 0.013), and the survival outcomes of patients with shorter delayed time (1–3 days) were slightly different from the patients without interruptions. The impact of delay time on PFS is not statistically significant, but the survival outcomes of the two groups were slightly different.ConclusionThere was a significant correlation between delayed time and local control of esophageal cancer. The delayed time for more than 3 days might decrease the survival outcome, and increase the local recurrence risk.

Abstract 5808: Designing arrays for delivering tumor treating fields (TTFields) to the mouse head

Abstract Introduction: Tumor Treating Fields (TTFields) therapy is an approved treatment for glioblastoma (GBM), the most abundant malignant brain tumor. TTFields therapy is delivered to patients suffering from GBM continuously by two array pairs placed on their scalp. Since arrays for TTFields application to the mouse head are lacking, and as most GBM animal models are based on mice, in vivo studies of GBM treatment with TTFields are limited. The development of such arrays is challenging due to the small dimensions and specific geometries of the mouse head, but is needed to allow continued preclinical studies to broaden the understanding of the effects of TTFields on GBM. Methods: We tested various array layouts to identify one that will be suited to the specific geometries of the mouse head. For animal well-being, the selected array was required to minimally restrict head movement. Additionally, we investigated adhesive tapes to allow on one hand good adherence of the arrays to the skin, and on the other hand easy array removal. To examine the feasibility of treating mice with these arrays, they were applied to mice for 11 days, while recording the electric currents and the actual treatment time (from which the percent usage could be calculated). To validate that the selected array layout delivers meaningful field intensity to the desired region, we performed field measurements using a floating scope. Results: To tackle the limitation of the small head size, we developed an array layout in which only two arrays were situated on the head, while the opposing arrays were located on the mouse torso. Additionally, the arrays on the head were divided into two smaller disks. We also identified a thin and transparent adhesive tape (facilitating correct arrays positioning), that offered good tackiness and allowed easy removal without leaving residual adhesive on the skin. The arrays met the minimum treatment requirements: current ≥50 mA, usage ≥75%, field intensity ≥1 V/cm RMS. At the posterior side of the mouse head, at a location more directly underneath the arrays, field intensity was higher than at the anterior position. Conclusion: TTFields could be delivered at sufficient intensities to mice heads by utilizing specifically engineered arrays. Our newly developed arrays are flexible and strongly adhering to enable efficient electric field delivery. By allowing TTFields delivery to mice heads, we will facilitate further advancing this research field. Citation Format: Sewar Zbidat, Roni Blatt, Mariell Sellevoll, Martin Gabay, Inbar Schlachet, Shay Cahal, Shiri Davidi, Itai Tzchori, Adi Haber, Moshe Giladi, Yoram Palti. Designing arrays for delivering tumor treating fields (TTFields) to the mouse head [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 5808.

Pencil Beam Scanning Proton Stereotactic Body Radiation Therapy (SBRT): A Robust Single Institution Experience

To describe the feasibility of treating a complex and diverse group of patients using pencil beam scanning (PBS) proton stereotactic body radiation therapy (SBRT: 5 or fewer fractions, with a fraction size of at least 5 Gy). Our center treats on average 105-120 PBS proton treatments daily, of which 9.5% of treatment courses are proton SBRT. Statistics of disease sites, treatment planning parameters (target volume, prescriptions, number of fields, SFO vs. MFO), and treatment efficiencies (scheduled time slots, actual treatment time) are presented for 305 consecutive SBRT patients receiving 1507 fractions in the past three years. Thermoplastic masks or Vacuum-lock bags are used to immobilize SBRT patients and index the patients' treatment position. Imaging guidance of orthogonal kV images and volumetric cone-beam CT is routinely used for patient setup. SBRT patients are grouped based on the target locations: pelvis (31%), liver (17%), thoracic (13%), spine (8%), abdominal (8%), brain (7%), non-spine bone (7%), ocular (6%), and head and neck (2%). Only 112 patients (37%) were receiving their 1st RT course, whereas 113 (37%) had one prior in-field RT course, and 80 (26%) had multiple prior in-field RT courses. The median [IQR] target volume was 65.4 [29.3, 168] cc (range: 0.3-2475 cc). 72% of cases were planned with SFO and 28% with MFO. On average, 3.76 fields (range: 2 to 12) were planned for each treatment. 44% of the treatments were planned with three or fewer fields, and 10% received more than five fields, most of which involved repainting for moving targets. Over 97% of treatments were delivered in 5 fractions, with ∼3% delivered in 3 fractions. The median [IQR] prescription per treatment was 8 [7, 10] Gy (range: 5-18 Gy per treatment). 85% (84%) of the SBRT treatments were scheduled (delivered) in a 45-minute or shorter slot, and 6% (7%) of treatments were scheduled (delivered) in over a one-hour slot, most commonly for multiple isocenter treatments. 93% of treatments were delivered within 15 minutes of the planned treatment time or shorter. Deep-inspiration breath-hold (DIBH) was applied to 45% of liver SBRT cases, with the remaining 55% planned on 4D CT with (14%) or without (86%) abdominal compression. DIBH was applied in 13% of lung SBRT cases. The application of other motion mitigation approaches, such as volumetric repainting, was determined by the target motion amplitude and whether the patient could tolerate DIBH. In the most diverse and largest proton SBRT experience delivered in the world over the past 3 years, over 300 patients were treated, demonstrating the feasibility and efficiency of delivering proton SBRT in a very busy center. The planning and treatment parameter statistics reported serve as a helpful reference for the proton community.

Estimation of patient-size dependent imaging dose for stereoscopic/monoscopic real-time kV image guidance in lung and prostate SBRT

Purpose. The purpose of this work is to quantify the dependence of patient-specific imaging dose on patient-size from ExacTrac stereoscopic/monoscopic real-time tumor monitoring during lung and prostate stereotactic body radiotherapy (SBRT). Approach. Thirty lung and 30 prostate SBRT patients that were treated with volumetric modulated arc therapy (VMAT) were selected and divided into three patient size categories. Imaging doses from all SBRT fractions were calculated retrospectively assuming patients went through real-time tumor monitoring during their actual VMAT treatment times. Treatment times were divided into periods of stereoscopic and monoscopic real-time imaging depending on the imaging view with linac gantry blockage. The computed tomography (CT) images and contours of the planning target volume (PTV) and organs at risk (OARs) were exported from the treatment planning system. Based on the CT data, patient-specific 3D imaging dose distributions were calculated in a validated Monte Carlo model using DOSEXYZnrc. Vendor-recommended imaging protocols (lung: 120–140 kV, 16–25 mAs; prostate: 110–130 kV, 25 mAs) were used for each patient size category. Patient-specific imaging doses received by PTV and OARs were evaluated using dose volume histograms, dose delivered to 50% of organ volume (D50), and 2% of organ volume (D2). Results. Bone and skin received the highest imaging dose. For the lung patients, the highest D2 for bone and skin were 4.30% and 1.98% of the prescription dose respectively. For prostate patients, the highest D2 were 2.53% and 1.35% of the prescription for bone and skin. Additional imaging dose to PTV as a percentage of the prescribed dose was at most 2.42% for lung and 0.29% for prostate patients. T-test results showed statistically significant difference in D2 and D50 between at least two patient size categories for PTVs and all the OARs. Larger patients received more skin dose in both lung and prostate patients. For the internal OARs, larger patients received more dose in lung treatment while the trend was opposite in prostate treatment. Conclusion. Patient-specific imaging dose was quantified for monoscopic/stereoscopic real-time kV image guidance in lung and prostate patients with respect to patient size. Additional skin dose was 1.98% (in lung patients) and 1.35% (in prostate patients) of the prescription which is within 5% recommended value by the AAPM Task Group 180. For internal OARs, larger patients received more dose in lung patients while the trend was the opposite for prostate patients. Patient size was an important factor to determine additional imaging dose.

A Pilot Study of Augmented Intelligence Risk-Based Stratification for Endocrine Surgical Waiting List Prioritisation.

Introduction The New Deal for Surgery report encouraged using new technology in healthcare to address the 377,689 patients in England awaiting National Health Service (NHS) hospital treatment in July 2022. During the pandemic's second wave, this pilot study investigated the utility of COMPASS Surgical List Triage (COMPASS SLT; C2-Ai, Cambridge, England), an augmented intelligence-based system, in assisting surgical decision-making on patient prioritisation. Data generated from COMPASS SLT was compared to data from the British Association of Endocrine and Thyroid Surgeons' (BAETS) and Federation of Surgical Specialties Associations' (FSSA) prioritisation guidance. Methods A cohort of thyroidectomy and parathyroidectomy patients on the surgical waiting list at Imperial College Healthcare NHS Trust, London, United Kingdom, was used. COMPASS SLT calculated individuals' mortality and significant morbidity risk (risk >2.5%).Significant morbidity risk was set at 2.5% or above following internal model validation, thus reducing the risk of model overfitting occurring with COMPASS SLT. The additional increase in mortality and morbidity due to treatment delay was calculated. Actual treatment time was aligned to the treatment delay (in weeks) experienced by each patient. Results Twenty-nine patients, with a median age of 43 years and a waiting time of 18 weeksat the onset of the second wave, were enrolled. Non-statistically significant differences (p=0.937) between the FSSA and BAETS classifications were identified. However, cohort size could promote a type II error. An increase in median mortality and morbidity risk (p<0.001) arising from treatment delay and decisions based on the FSSA and BAETS classifications were identified. Conclusion COMPASS SLT can supplement clinical decision-making. An augmented intelligence tool can provide clinicians objectivity and flexibility in prioritising patients, with information on individual morbidity and mortality.

Retrospective Analysis of Treatment Workflow in Frame-Based and Frameless Gamma Knife Radiosurgery.

ObjectiveTo improve the efficiency of frame-based and frameless Gamma Knife® Icon™ (GKI) treatments by analyzing the workflows of both treatment approaches and identifying steps that lead to prolonged patient in-clinic or treatment time.MethodsThe treatment processes of 57 GKI patients, 16 frame-based and 41 frameless cases were recorded and analyzed. For frame-based treatments, time points were recorded for various steps in the process, including check-in, magnetic resonance imaging (MRI) completion, plan approval, and treatment start/end times. The time required for completing each step was calculated and investigated. For frameless treatments, the actual and planned treatment times were compared to evaluate the patient tolerance of the treatment. In addition, the time spent on room cleaning and preparation between treatments was also recorded and analyzed.ResultsFor frame-based cases, the average in-clinic time was 6.3 hours (ranging from 4 to 8.7 hours). The average time from patient check-in to plan approval was 4.2 hours (ranging from 2.8 to 5.5 hours), during which the frame was placed, stereotactic reference MRI images were taken, target volumes were contoured, and the treatment plan was developed and second-checked. For patients immobilized with a mask, treatment pauses triggered by the intra-fractional motion monitoring system resulted in a significantly longer actual treatment time than the planned time. In 50 (or 55%) of the 91 frameless treatments, the patient on-table time was longer than the planned treatment time by more than 10 minutes, and in 19 (or 21%) of the treatments the time difference was larger than 20 minutes. Major treatment interruptions, defined as pauses leading to a longer than 10-minute delay, were more commonly encountered in patients with a planned treatment time longer than 40 minutes, which accounted for 64% of the recorded major interruptions.ConclusionFor frame-based cases, the multiple pretreatment steps (from patient check-in to plan approval) in the workflow were time-consuming and resulted in prolonged patient in-clinic time. These pretreatment steps may be shortened by performing some of these steps before the treatment day, e.g., pre-planning the treatment using diagnostic MRI scans acquired a few days earlier. For frameless patients, we found that a longer planned treatment time is associated with a higher chance of treatment interruption. For patients with a long treatment time, a planned break or consideration of fractionated treatments (i.e., 3 to 5 fractionated stereotactic radiosurgery) may optimize the workflow and improve patient satisfaction.

Phase I trial of adjuvant autogene cevumeran, an individualized mRNA neoantigen vaccine, for pancreatic ductal adenocarcinoma.

2516 Background: Pancreas ductal adenocarcinoma (PDAC) is a lethal cancer that claims ̃90% of patients in &lt;24 months of diagnosis. PDAC is also refractory to immunotherapy as most tumors exhibit an immune excluded/desert phenotype. However, although characterized by low mutation rates, most PDACs harbor mutations that can generate immunogenic neoantigens. Here, we report the results of a phase-I trial of autogene cevumeran, a systemic RNA-lipoplex individualized neoantigen-specific immunotherapy (iNeST) vaccine, to stimulate immunity against neoantigens in resected PDAC patients. Methods: We conducted an investigator-initiated, single-center, phase-I trial of adjuvant autogene cevumeran containing up to 20 neoantigens in each individualized vaccine, identified from resected PDACs using real-time next generation sequencing and bioinformatic neoantigen discovery. Following surgery, patients received atezolizumab (1 dose; week 6), autogene cevumeran (8 weekly doses starting week 9; doses 9,10 – weeks 17, 46), and modified (m) FOLFIRINOX (12 cycles; starting week 21). Primary endpoint: safety. Other endpoints: feasibility (actual vs. target treatment time), vaccine response (responder = positivity by two independent blood assays: IFNg ELISpot and T cell clonal expansion), and recurrence-free survival (RFS). Target accrual: n=20. Results: n=19 patients underwent surgery and received atezolizumab at 6.3 weeks (median; 95% CI 6.0–6.57) after surgery with no ≥ grade 3 (Gr3) adverse events. n=16/19 patients (84%) received autogene cevumeran at 9.4 weeks (median; 95% CI 9–10) after surgery. n=1/19 (5%) had insufficient neoantigens for vaccine manufacture. n=1/16 (6%) developed a vaccine-related Gr3 fever and hypertension. n=15/16 vaccinated patients (94%) received mFOLFIRINOX (median 12 cycles; 95% CI 7–12). Autogene cevumeran expanded polyclonal (median 7.5 clones, 95% CI 2–28), IFNg-producing neoantigen-specific CD8+ T cells in 50% (n=8/16) of patients from undetectable levels to large fractions (median 2.9%, Table) of all blood T cells. At an early median follow-up of 15 months, vaccine responders (n=8) had a longer RFS vs. non-responders (n=8) (median not reached vs. 13.7 months, HR 0.08, 95% CI 0.01-0.5, P = 0.007). Conclusions: Autogene cevumeran is safe, feasibly manufactured in a clinically relevant timeframe, and immunogenic in PDAC. Vaccine induced neoantigen-specific immunity preliminarily correlates with improved PDAC outcome. Further clinical trials in PDAC are warranted. (This imCORE Network project was funded by Genentech Inc and BioNTech; additional funding from Stand Up To Cancer, Lustgarten Foundation). Clinical trial information: NCT04161755. [Table: see text]

Development and Validation of a Prediction Model for the Treatment Time of Deformational Head Shapes Using a Cranial Remolding Orthosis

The cranial remolding orthosis (CRO) has been shown in previous studies to be an effective method of treatment for deformational head shapes. Many studies have shown younger infants achieve greater correction than older infants and generally have a shorter treatment duration. The goal of this study is to develop and validate a prediction equation for the maximum treatment time for deformational head shapes when utilizing a CRO. This retrospective study included subjects with deformational plagiocephaly (DP), deformational brachycephaly (DB), or deformational asymmetrical brachycephaly (DAB) who began CRO treatment between 3 and 18 months of gestational age. Prediction models were derived from 1250 subjects with DP, DB, and DAB and the validation used data from 210 different subjects. Actual treatment time was less than or equal to predicted treatment time in 85.19% (DP), 56.67% (DB), and 75.40% (DAB) of the cases when rounding the prediction up to the nearest month. The prediction equation has moderate accuracy for predicting the likely maximum amount of CRO treatment time for patients with DP, DB, and DAB and may be used clinically to give caregivers an estimated treatment duration for a patient who is indicated for a CRO, if treatment was initiated immediately.

120 Artificial Intelligence (AI) Risk-Based Stratification for Surgical Waiting List Prioritisation: A Pilot Study Addressing the NHS Growing Waiting Times

Abstract Aim 336,733 patients in England awaited NHS hospital treatment in May 2021. The Royal College of Surgeons of England’s New Deal for Surgery report encouraged utilising new technology in healthcare to address this. During the pandemic’s second wave, this pilot study investigated utilising COMPASS Surgical List Triage (COMPASS SLT), an artificial intelligence-based system, in assisting surgical decision-making on patient prioritisation. Data generated from COMPASS SLT was compared to data from the British Association of Endocrine and Thyroid Surgeons’ prioritisation guidance. Method A cohort of Thyroidectomy and Parathyroidectomy patients on the surgical waiting list at Imperial College Healthcare NHS Trust was used. COMPASS SLT calculated individuals’ mortality and significant morbidity risk (risk &amp;gt;2.5%). Additional increase in mortality and morbidity due to treatment delay were calculated. Actual treatment time was aligned to the treatment delay (in weeks) experienced by each patient. Results 29 patients, with a median age and waiting time at the onset of the second wave of 43 years and 18 weeks respectively, were enrolled. Non-statistically significant differences (p=0.937) between the FSSA and BAETS classification existed. However, cohort size could promote a type II error. There was an increase in mean mortality and morbidity risk (p&amp;lt;0.001) arising from treatment delay, and decisions based on the FSSA and BAETS classifications. Conclusions COMPASS SLT can supplement clinical decision making. The FSSA and BAETS guidance lacks precision and responsiveness to solely inform patient prioritisation. An AI tool provides clinicians objectivity and flexibility in prioritising patients, with information on individual morbidity, mortality, and treatment delay costs.

Correlation of treatment time to target volume for GammaPod treatments: A simple second calculation.

PurposeThe GammaPod is a novel device for stereotactic breast treatments that employs 25 rotating Co‐60 sources while the patient is continuously translated in three axes to deliver a highly conformal dose to the target. There is no commercial software available for independent second calculations. The purpose of this study is to determine an efficient way to estimate GammaPod treatment times based on target volume and use it as a second calculation for patient‐specific quality assurance.MethodsFifty‐nine GammaPod (Xcision Medical Systems, LLC.) breast cancer patient treatments were used as the fitting dataset for this study. Similar to the Curie‐seconds concept in brachytherapy, we considered dose‐rate × time/(prescribed dose) as a function of target volumes. Using a MATLAB (Mathworks, Natick, MA, USA) script, we generated linear (with 95% confidence interval (CI)) and quadratic fits and tested the resulting equations on an additional set of 30 patients.ResultsWe found a strong correlation between the dose‐rate × time/(prescribed dose) and patients’ target volumes for both the linear and quadratic models. The linear fit was selected for use and using the polyval function in MATLAB, a 95% CI graph was created to depict the accuracy of the prediction for treatment times. Testing the model on 30 additional patients with target volumes ranging from 20 to 188 cc yielded treatment times from 10 to 25 min that in all cases were within the predicted CI. The average absolute difference between the predicted and actual treatment times was 1.0 min (range 0–3.3 min). The average percent difference was 5.8% (range 0%–18.4%).ConclusionThis work has resulted in a viable independent calculation for GammaPod treatment times. This method has been implemented as a spreadsheet that is ready for clinical use to predict and verify the accuracy of breast cancer treatment times.

Daily waiting and treatment times at an advanced radiation oncology setup: A 4-year audit of consecutive patients from single institution.

We present our data for every single fraction for every patient treated at our center for the past 4 years, analyzing the waiting and treatment times. Between January 2014 and February 2018, all patients and their corresponding recorded measurements of waiting time and machine treatment time were analyzed. Times recorded included actual arrival time, designated arrival time, linac entry time, and last beam treatment time. The complete waiting time information was divided into two categories (1) first day treatments and (2) subsequent day treatments. SPSS version 18 was used for statistical calculations, correlations, and assessing significance. First day treatments - of 1982 patients following treatments were carried out; 1557 volumetric-modulated arc therapy (78.6%), 88 three-dimensional conformal radiotherapy (RT) (4.4%), 14 electron (0.7%), 10 intensity-modulated RT (0.5%), 264 stereotactic irradiation (13.3%), 17 stereotactic body RT (0.7%), and 32 total body irradiation (1.6%). The mean (± standard deviation) times for early/late time, total spent time (TST), wait time gross (WTG), and wait time net (WTN) were 11.0 ± 49.6 min, 74.7 ± 44.8 min, 47.46 ± 43.9 min, and 24.1 ± 44.4 min, respectively. Subsequent day treatments - a total of 34,438 sessions of treatment delivery were recorded. Overall average WTG was 37.4 ± 32.7 min. Overall WTN was 12.1 ± 62.7 min. Overall mean total spent time (TST) was 52.4 ± 33.0 min, overall mean setup and treatment time was 15.1 ± 10.9 min. We have presented our results of patient-related times during RT. Our study covers the daily waiting times before RT as well as the actual treatment times during modern-day RT. This consecutive patient data from a large series shall be an important resource tool for future planners and policymakers.

Time-Driven Activity-Based Costing Comparison of Stereotactic Radiosurgery to Multiple Brain Lesions Using Single-Isocenter Versus Multiple-Isocenter Technique

Stereotactic radiosurgery (SRS) historically has been used to treat multiple brain lesions using a multiple-isocenter technique-frequently associated with significant complexity in treatment planning and long treatment times. Recently, given innovations in planning algorithms, patients with multiple brain lesions may now be treated with a single-isocenter technique using fewer total arcs and less time spent during image guidance (though with stricter image guided radiation therapy tolerances). This study used time-driven activity-based costing to determine the difference in cost to a provider for delivering SRS to multiple brain lesions using single-isocenter versus multiple-isocenter techniques. Process maps, consisting of discrete steps, were created for each phase of the SRS care cycle and were based on interviews with department personnel. Actual treatment times (including image guidance) were extracted from treatment record and verify software. Additional sources of data to determine costs included salary/benefit data of personnel and average list price/maintenance costs for equipment. Data were collected for 22 patients who underwent single-isocenter SRS (mean lesions treated, 5.2; mean treatment time, 30.2 minutes) and 51 patients who underwent multiple-isocenter SRS (mean lesions treated, 4.4; mean treatment time, 75.2 minutes). Treatment time for multiple-isocenter SRS varied substantially with increasing number of lesions (11.8 minutes/lesion; P < .001), but to a much lesser degree in single-isocenter SRS (1.8 minutes/lesion; P = .029). The resulting cost savings from single-isocenter SRS based on number of lesions treated ranged from $296 to $3878 for 2 to 10 lesions treated. The 2-mm planning treatment volume margin used with single-isocenter SRS resulted in a mean 43% increase of total volume treated compared with a 1-mm planning treatment volume expansion. In a comparison of time-driven activity-based costing assessment of single-isocenter versus multiple-isocenter SRS for multiple brain lesions, single-isocenter SRS appears to save time and resources for as few as 2 lesions, with incremental benefits for additional lesions treated.

Características y tiempos del proceso de atención en consulta externa de un Hospital Nivel III

Objetivo: Describir las características y tiempos del proceso de atención de los pacientes atendidos en el área de consulta externa durante el año 2014 en el Hospital Base Almanzor Aguinaga Asenjo. Material y métodos: Se realizó un estudio descriptivo transversal, con una muestra de 379 pacientes nuevos en los servicios de consulta externa. Se utilizó el aplicativo web del Sistema de Referencias y Contrarreferencias, y el Sistema de Gestión Hospitalaria para obtener la muestra y los datos. Resultados: Los tiempos de referencia real y efectivo presentaron una mediana de 36 días y 39 días calendario, respectivamente; el tiempo de diagnóstico tuvo una mediana de 0 días, los tiempos de tratamiento real y efectivo tuvieron una mediana de 0 días, los tiempos de laboratorio real y efectivo, con medianas de 45 y 48 día; y, por último, el tiempo de espera radiológico tiene una mediana de 73 días y el tiempo de espera para resultado radiológico cuenta con una mediana de 0 días. Conclusiones: Los tiempos de espera más prolongados fueron los de referencia y ayuda diagnóstica; los que deben ser especialmente estudiados para identificar los principales factores que influyen sobre ellos y mejorar así nuestro sistema de salud.

Assessment of Watercare Efficacy on Treatment of Water for Human Consumption in Makurdi Metropolis Nigeria

Assessment of the efficacy of Water-Care in the treatment of water to safe health level was carried out on water samples from different water sources within six populated communities of Makurdi Metropolis. Thirty six (36) water samples were collected and treated with WaterCare based on the product manufacturer’s instructions. Treated water stored for 30 minutes and 24 hours were tested for coliforms using Multiple Tube Fermentation technique. Analysis of variance (ANOVA) was used with the Tukey Honestly Significant Difference (HSD) for multiple comparisons of the data variables. Most probable Number (MPN) of coliforms /100mL of sampled water ranged from 43 to &gt;1,100cfu/100ml. Mean MPN of treated water for30 minutes and 24 hours interval was 37.7±33.0cfu/100ml and 16.17±14.8cfu/100ml respectively. Improved/deep sources such as boreholes show 3cfu/100ml and 0cfu/100ml respectively for 30 minutes and 24 hours treatment while unimproved/shallow sources such as wells show ≤120 cfu/100ml and ≤53 cfu/100ml respectively for 30 minutes and 24 hour interval. A significant difference between treated samples and the untreated was observed (F = 6.321, P = 0.005). Tukey multiple comparison test revealed that MPN index/100ml in the water samples was significantly lower (P =0.015, P =0.009) after treating for 30 minutes and 24 hour time interval respectively as compared to untreated water. But there was no significant difference between the 30 minute and 24 hour time interval (P =0.970). The study found that, drinking water sources in Makurdi Township were heavily contaminated, and that 30 minutes and 24 hours’ time interval was not a sufficient time for total elimination of bacteria contaminants after treatment with WaterCare. Future research should ascertain the actual treatment time for inactivation of all bacteria in water treated with WaterCare.

Assessment of Watercare Efficacy on Treatment of Water for Human Consumption in Makurdi Metropolis Nigeria

Assessment of the efficacy of Water-Care in the treatment of water to safe health level was carried out on water samples from different water sources within six populated communities of Makurdi Metropolis. Thirty six (36) water samples were collected and treated with WaterCare based on the product manufacturer’s instructions. Treated water stored for 30 minutes and 24 hours were tested for coliforms using Multiple Tube Fermentation technique. Analysis of variance (ANOVA) was used with the Tukey Honestly Significant Difference (HSD) for multiple comparisons of the data variables. Most probable Number (MPN) of coliforms /100mL of sampled water ranged from 43 to &gt;1,100cfu/100ml. Mean MPN of treated water for30 minutes and 24 hours interval was 37.7±33.0cfu/100ml and 16.17±14.8cfu/100ml respectively. Improved/deep sources such as boreholes show 3cfu/100ml and 0cfu/100ml respectively for 30 minutes and 24 hours treatment while unimproved/shallow sources such as wells show ≤120 cfu/100ml and ≤53 cfu/100ml respectively for 30 minutes and 24 hour interval. A significant difference between treated samples and the untreated was observed (F = 6.321, P = 0.005). Tukey multiple comparison test revealed that MPN index/100ml in the water samples was significantly lower (P =0.015, P =0.009) after treating for 30 minutes and 24 hour time interval respectively as compared to untreated water. But there was no significant difference between the 30 minute and 24 hour time interval (P =0.970). The study found that, drinking water sources in Makurdi Township were heavily contaminated, and that 30 minutes and 24 hours’ time interval was not a sufficient time for total elimination of bacteria contaminants after treatment with WaterCare. Future research should ascertain the actual treatment time for inactivation of all bacteria in water treated with WaterCare.

Assessment of Watercare Efficacy on Treatment of Water for Human Consumption in Makurdi Metropolis Nigeria

Assessment of the efficacy of Water-Care in the treatment of water to safe health level was carried out on water samples from different water sources within six populated communities of Makurdi Metropolis. Thirty six (36) water samples were collected and treated with WaterCare based on the product manufacturer’s instructions. Treated water stored for 30 minutes and 24 hours were tested for coliforms using Multiple Tube Fermentation technique. Analysis of variance (ANOVA) was used with the Tukey Honestly Significant Difference (HSD) for multiple comparisons of the data variables. Most probable Number (MPN) of coliforms /100mL of sampled water ranged from 43 to &gt;1,100cfu/100ml. Mean MPN of treated water for30 minutes and 24 hours interval was 37.7±33.0cfu/100ml and 16.17±14.8cfu/100ml respectively. Improved/deep sources such as boreholes show 3cfu/100ml and 0cfu/100ml respectively for 30 minutes and 24 hours treatment while unimproved/shallow sources such as wells show ≤120 cfu/100ml and ≤53 cfu/100ml respectively for 30 minutes and 24 hour interval. A significant difference between treated samples and the untreated was observed (F = 6.321, P = 0.005). Tukey multiple comparison test revealed that MPN index/100ml in the water samples was significantly lower (P =0.015, P =0.009) after treating for 30 minutes and 24 hour time interval respectively as compared to untreated water. But there was no significant difference between the 30 minute and 24 hour time interval (P =0.970). The study found that, drinking water sources in Makurdi Township were heavily contaminated, and that 30 minutes and 24 hours’ time interval was not a sufficient time for total elimination of bacteria contaminants after treatment with WaterCare. Future research should ascertain the actual treatment time for inactivation of all bacteria in water treated with WaterCare.

Improved outpatient haemodialysis adequacy using queued schedules.

Although technical advances help achieve haemodialysis adequacy, we hypothesise remediable non-therapy factors exacerbate patient dissatisfaction, non-adherence to treatment time and failure to meet dialysis goals. Scheduling inefficiencies lead to the total time in the unit far greater than actual treatment time, impacting facility efficiency and patient frustration. We used queuing theorem principles to optimise schedules by incorporating timing and workflow for every dialysis process step to design a new schedule, rather than the whole-shift blocks at baseline. The goals were to: (1) craft schedules that maximised efficiency and economics from a facility perspective, and (2) minimise total time in the dialysis unit from a patient viewpoint. As dialysis units are held to a national standard of urea clearance, reduction ratios (URRs) were measured for the 3 months before and after the new scheduling was implemented. Dialysis staff and process parameters were measured to craft queued schedules of staggered small groups of patients instead of baseline blocks of 2 large shifts, 24 each. A total of 65 patients changed to groups of 8, with entry-to-exit at 290 minutes for four hours treatments. The URRs improved from 72.8 ± 6.9 to 75.2 ± 5.4% (p < 0.001). Before implementation, only 89% of subjects reached the URR facility compliance target of 65%, and afterwards 97% (p < 0.001). Queuing theorem principles can be successfully adopted to optimise haemodialysis scheduling. The resultant staggered timing increases facility efficiency, minimises the long wait time dissatisfier, and is associated with improved URRs with more patients reaching target clearance thresholds.

Waterjet Ablation Therapy for Endoscopic Resection of prostate tissue trial (WATER) vs WATER II: comparing Aquablation therapy for benign prostatic hyperplasia in 30–80 and 80–150 mL prostates

ObjectiveTo compare the outcomes of Aquablation in 30–80 mL prostates with those in 80–150 mL prostates. Surgical options, especially with short learning curves, are limited when treating large prostates for lower urinary tract symptoms (LUTS) due to benign prostatic hyperplasia (BPH). Aquablation (AquaBeam System, PROCEPT BioRobotics Inc., Redwood City, CA, USA) could solve this issue with global reproducibility, independent of prostate volume.Patients and MethodsWaterjet Ablation Therapy for Endoscopic Resection of prostate tissue (WATER [W‐I]; NCT02505919) is a prospective, double‐blind, multicentre, international clinical trial comparing Aquablation and transurethral resection of the prostate (TURP) for the treatment of LUTS/BPH in prostates between 30 and 80 mL. WATER II (W‐II; NCT03123250) is a prospective, multicentre, single‐arm international clinical trial of Aquablation in prostates between 80 and 150 mL. We compare baseline parameters and 12‐month outcomes in 116 W‐I and 101 W‐II study patients. Students’ t‐test or Wilcoxon tests were used for continuous variables and Fisher’s test for binary variables.ResultsThe mean (SD) operative time was 33 (17) and 37 (13) min in W‐I and W‐II, respectively. Actual treatment time was 4 and 8 min in W‐I and W‐II, respectively. The mean change in the International Prostate Symptom Score was substantial averaging (at 12 months) 15.1 in W‐I and 17.1 in W‐II (P = 0.605). By 3 months, Clavien–Dindo grade ≥II events occurred in 19.8% of W‐I patients and 34.7% of W‐II patients (P = 0.468).ConclusionAquablation clinically normalises outcomes between patients with 30–80 mL prostates and patients with 80–150 mL prostates treated for LUTS/BPH, with an expected increase in the risk of complications in larger prostates. Long‐term outcomes of procedure durability are needed.

Micro-invasive surgery combined with intraoperative radiotherapy for the treatment of spinal metastasis.

This is a retrospective analysis of the strategy and clinical results of surgery combined with intraoperative radiotherapy (IORT) to treat spinal metastases. We delivered tumour-conformal IORT in 40 patients with 52 metastatic vertebrae based on our surgical classification system. The strategies were evaluated with respect to neurologic function and spinal stability. The EORTC QLQ-BM22, visual analogue scale (VAS) and the Frankel Scale were used to assess quality of life, pain and neurologic function. Local control was evaluated every 3months using X-rays and MRI. Micro-invasive IORT was performed in 42 vertebrae (80.8%), and open surgery with IORT was performed in 10 vertebrae (19.2%). Single-level, 2-level and 3-level IORT was performed in 30, 8 and 2 cases, respectively. The delivered dose was 9.2±3.6Gy (8-15Gy) with a depth of 10.1±2.1mm. The actual IORT treatment time was 5min and 16s. The follow-up period was 6-23months (mean: 12.5months). The local control rate was 92.3%. The EORTC QLQ-BM22 scores showed that patients had significant improvements in pain location, degree and function after treatment (P<0.01). Thirty-five patients (89.7%) achieved pain relief throughout the follow-up period. VAS scores were significantly reduced by 3.4 points 3months after treatment. Neurological function was improved in 7 patients (87.5%). No radiation-related complications were observed. Surgery combined with tumour-conformal IORT can effectively relieve pain, achieve good local control and improve QOL.

Current Clinical Status of Telehealth in Korea: Categories, Scientific Basis, and Obstacles.

ObjectivesThrough telehealth, medical services have expanded beyond spatial boundaries and are now available in living spaces outside of hospitals. It can also contribute to patient medical knowledge improvement because patients can access their hospital records and data from home. However, concepts of telehealth are rather vague in Korea.MethodsWe refer to several clinical reports to determine the current clinical status of and obstacles to telehealth in Korea.ResultsPatients' health conditions are now reported regularly to doctors remotely, and patients can receive varied assistance. Self-improvement based on minute details that are beyond medical staff's reach is another possible benefit that may be realized with the help of a variety of medical equipment (sensors). The feasibility, clinical effect, and cost-benefit of telehealth have been verified by scientific evidence.ConclusionsPatients will be able to improve their treatment adherence by receiving help from various professionals, such as doctors, nurses, nutritionists, and sports therapists. This means that the actual treatment time per patient will increase as well. Ultimately, this will increase the quality of patients' self-administration of care to impede disease progression and prevent complications.