Real Clinical Cases Research Articles

Evaluating the performance of ChatGPT in clinical pharmacy: A comparative study of ChatGPT and clinical pharmacists.

To evaluate the performance of chat generative pretrained transformer (ChatGPT) in key domains of clinical pharmacy practice, including prescription review, patient medication education, adverse drug reaction (ADR) recognition, ADR causality assessment and drug counselling. Questions and clinical pharmacist's answers were collected from real clinical cases and clinical pharmacist competency assessment. ChatGPT's responses were generated by inputting the same question into the 'New Chat' box of ChatGPT Mar 23 Version. Five licensed clinical pharmacists independently rated these answers on a scale of 0 (Completely incorrect) to 10 (Completely correct). The mean scores of ChatGPT and clinical pharmacists were compared using a paired 2-tailed Student's t-test. The text content of the answers was also descriptively summarized together. The quantitative results indicated that ChatGPT was excellent in drug counselling (ChatGPT: 8.77 vs. clinical pharmacist: 9.50, P = .0791) and weak in prescription review (5.23 vs. 9.90, P = .0089), patient medication education (6.20 vs. 9.07, P = .0032), ADR recognition (5.07 vs. 9.70, P = .0483) and ADR causality assessment (4.03 vs. 9.73, P = .023). The capabilities and limitations of ChatGPT in clinical pharmacy practice were summarized based on the completeness and accuracy of the answers. ChatGPT revealed robust retrieval, information integration and dialogue capabilities. It lacked medicine-specific datasets as well as the ability for handling advanced reasoning and complex instructions. While ChatGPT holds promise in clinical pharmacy practice as a supplementary tool, the ability of ChatGPT to handle complex problems needs further improvement and refinement.

Towards clinical applicability and computational efficiency in automatic cranial implant design: An overview of the AutoImplant 2021 cranial implant design challenge.

Cranial implants are commonly used for surgical repair of craniectomy-induced skull defects. These implants are usually generated offline and may require days to weeks to be available. An automated implant design process combined with onsite manufacturing facilities can guarantee immediate implant availability and avoid secondary intervention. To address this need, the AutoImplant II challenge was organized in conjunction with MICCAI 2021, catering for the unmet clinical and computational requirements of automatic cranial implant design. The first edition of AutoImplant (AutoImplant I, 2020) demonstrated the general capabilities and effectiveness of data-driven approaches, including deep learning, for a skull shape completion task on synthetic defects. The second AutoImplant challenge (i.e., AutoImplant II, 2021) built upon the first by adding real clinical craniectomy cases as well as additional synthetic imaging data. The AutoImplant II challenge consisted of three tracks. Tracks 1 and 3 used skull images with synthetic defects to evaluate the ability of submitted approaches to generate implants that recreate the original skull shape. Track 3 consisted of the data from the first challenge (i.e., 100 cases for training, and 110 for evaluation), and Track 1 provided 570 training and 100 validation cases aimed at evaluating skull shape completion algorithms at diverse defect patterns. Track 2 also made progress over the first challenge by providing 11 clinically defective skulls and evaluating the submitted implant designs on these clinical cases. The submitted designs were evaluated quantitatively against imaging data from post-craniectomy as well as by an experienced neurosurgeon. Submissions to these challenge tasks made substantial progress in addressing issues such as generalizability, computational efficiency, data augmentation, and implant refinement. This paper serves as a comprehensive summary and comparison of the submissions to the AutoImplant II challenge. Codes and models are available at https://github.com/Jianningli/Autoimplant_II.

The Digital Story Teaching Method for Master of Nursing Specialist Students

As future healthcare professionals, Master of Nursing Specialist (MNS) students will play an important role in nursing and healthcare. MNS education emphasises the cultivation of students’ critical and clinical thinking. Traditional classroom methods often result in students being unable to combine theory with practice and reduce their ability to problem-solve within the scope of clinical or professional services. However, in economically underdeveloped areas with insufficient educational resources, it is difficult to use real clinical situations or virtual reality technology to carry out teaching. To fill this gap, we introduced the digital story teaching method into classroom teaching in Shanxi Province in northern China, which is an economically underdeveloped agricultural province. Real clinical cases were adapted into stories, with integrated digital media elements. A before-and-after study design was adopted to compare the differences between the digital story teaching method group and the traditional teaching method group. The results indicate that students engaged in learning with the digital story teaching method demonstrated more active learning styles, clinical problem-solving skills, and higher academic achievements in classroom performance and examinations. As a continuous and low-cost flexible education method, the digital story teaching method is a teaching mode suitable for popularisation in areas where clinical teaching resources are relatively scarce.

Simulation-based team training improves door-to-needle time for intravenous thrombolysis

PurposeThere is a clinical need for shortened door-to-needle time (DNT) for intravenous thrombolysis, but effective training methods are missing. Simulation training improves teamwork and logistics in numerous fields. Still, it...

Choroidal Neovascular Membranes in Retinal and Choroidal Tumors: Origins, Mechanisms, and Effects.

Choroidal neovascularizations are historically associated with exudative macular degeneration, nonetheless, they have been observed in nevus, melanoma, osteoma, and hemangioma involving the choroid and retina. This review aimed to elucidate the possible origins of neovascular membranes by examining in vivo and in vitro models compared to real clinical cases. Among the several potential mechanisms examined, particular attention was paid to histologic alterations and molecular cascades. Physical or biochemical resistance to vascular invasion from the choroid offered by Bruch's membrane, the role of fibroblast growth factor 2 and vascular endothelial growth factor, resident or recruited stem-like/progenitor cells, and other angiogenic promoters were taken into account. Even if the exact mechanisms are still partially obscure, experimental models are progressively enhancing our understanding of neovascularization etiology. Choroidal neovascularization (CNV) over melanoma, osteoma, and other tumors is not rare and is not contraindicative of malignancy as previously believed. In addition, CNV may represent a late complication of either benign or malignant choroidal tumors, stressing the importance of a long follow-up.

Effectiveness of case-based learning among medical interns using microbiology laboratory report as a tool

Background: Due to lack of consensus of teaching learning methods during undergraduate period, intern doctors face many challenges in clinical settings. Knowledge gaps related to clinical application of laboratory medicine leads to poor case management. Active learner centered training with real clinical cases is a need to help the interns to link their basic science knowledge into a practical context. Aims and Objectives: The present study was done to evaluate the effect of case based learning (CBL) on the interns’ knowledge and clinical decision-making skill of interpretation of laboratory investigation reports and to assess perception of participants about CBL. Materials and Methods: CBL method was used to train the interns in clinical application microbiology reports. This is a pre- and post-test type study, carried out for 2 months with 43 Medical interns, willing to participate. The process included evaluation of CBL by pre-validated questionnaires by multiple choice questions, clinical case scenarios before, immediately after and 10 days after the intervention and perception toward CBL was assessed. Statistical analysis was done using Student’s t-test and SPSS 17 software. The value of P < 0.05 was considered as significant. Results: A significant improvement in the interns’ knowledge and problem solving following CBL sessions had been observed in present study. The post-test scores of all the CBL sessions were significantly higher than pre-test scores (P < 0.05). The perception of interns toward CBL was assessed and it was responded positively. It helped in strengthening the critical skills of interns such as problem solving, critical thinking, and teamwork. Conclusion: The present study proved that interns during internship require to be trained in laboratory medicine. CBL is an effective teaching method to train interns in enhancing their problem solving skill with correct use of laboratory test results and strengthening critical thinking, teamwork, and time management skills.

Оценка возможности определения поперечного профиля медицинского электронного пучка методом многоуглового сканирования для повышения точности проведения радиотерапевтических процедур

This study is aimed at assessing the applicability of the proposed method of multiangle beam scanning for determining the transverse profile of an electron beam. The application area of the proposed approach will be control of the therapeutic beams spatial and dose characteristics in order to increase the irradiation accuracy and, as a result, reduce the side effects of radiation therapy. One of the main applied problems to be solved by the proposed approach is to determine the beam characteristics during electron beam therapy. For carrying out of electron beam therapy procedures it is necessary to form electron beams with the complex shape of transverse profile. The need to precisely control beam shapes throughout all irradiation stages determines the relevance of this study. The integral transform method was used in this study to obtain distributions of medical electron beam intensity. For the study, we used electron beam transverse pro-files calculated on the basis of a radiation therapy planning system for real clinical cases. The method was applied both theoretical beam profiles with sharp edge and to ones experimentally obtained with real medical electron beams. Integral transforms were performed for a different number of scan projections. Due to this, the optimal number of projections was calculated for each considered profile. The results of the study demonstrate that the multiangle beam scanning method needs 12 scan projections which corresponds to an angular displacement of 15° to control the medical electron beam profile.

964. Physicians' acceptable treatment failure rates and interpretation of antibiogram for Gram-negative infections: A pilot survey study of infectious diseases specialists

Abstract Background The recommendations of many clinical guidelines include an antibiogram as a key component when making empiric therapy decisions. However, little is known about how clinicians interpret antibiograms. We aim to characterize the threshold of the acceptable risk of selecting inappropriate antibiotics among clinicians through clinical case-based questionnaires. Methods We conducted an online survey of infectious diseases (ID) specialists at the University of Iowa, as an internal pilot study. We created realistic clinical case scenarios and asked clinicians to provide the desired minimum percentage of susceptible isolates on an antibiogram for them to feel comfortable with selecting that agent for empiric therapy. We included four scenarios in the questionnaire: i) a patient with urinary tract infection (UTI) in an outpatient setting, ii) a patient with UTI in an inpatient setting, iii) a patient with Gram-negative rod bloodstream infection (GNR-BSI) in an intensive care unit (ICU) setting, iv) a patient with GNR-BSI in a non-ICU setting. Results Of the 16 of 26 providers (62%) who responded, 15 were considered effective responses. ID Physicians reported wide ranges in thresholds of minimum percentage to feel comfortable with prescribing a hypothetical antibiotic and higher thresholds for patients with more severe illnesses (outpatient with UTI: 85% [range: 75-100%]; inpatient with UTI: 95% [range: 50-99%]; inpatient with GNR-BSI in non-ICU settings: 90% [range: 80-95%]; inpatient with GNR-BSI in ICU: 95% [range: 88-100%]) (Figure 1). Figure 1.The distribution of physicians’ acceptable likelihood of susceptibility in four realistic clinical case-scenarios. Abbreviations: GNR-BSI, Gram-negative rod bloodstream infection; ICU, intensive care unit; UTI, urinary tract infection. Conclusion There were wide ranges in thresholds for interpretation of antibiogram among frontline clinicians, especially for less severe infections. Understanding physicians’ antibiogram usage can be helpful to determine how and if antibiogram guides clinicians toward more appropriate empiric therapy decisions. As this was a preliminary study, we plan to conduct a study with a larger sample size to better characterize the use of antibiogram among clinicians from diverse practice settings. Disclosures Michihiko Goto, MD MSCI, Merck & Co.: Grant/Research Support.

HPB P62 Is it time to introduce intraoperative ultrasound into surgical training?

Abstract Background Gallstone disease is one of the most common causes of abdominal pain and emergency hospital admissions in the UK. Those patients that have symptomatic gallstones in the gallbladder will be offered a laparoscopic cholecystectomy (LC) as treatment and therefore reduce the risk of developing further complications. Confirmation of bile duct stones before or at the time of LC is essential in order to prevent complications. There are three main ways to identify bile duct stones intraoperatively: x-ray cholangiography, fluoroscopic cholangiography and intraoperative ultrasound (IOUS). X-ray cholangiography is the most commonly used method intraoperatively as it is effective in identifying biliary anatomy and bile duct stones, can be repeated and has good deep tissue penetration. However, it is an invasive procedure that requires the use of ionising radiation. IOUS on the other hand is non-invasive, does not involve ionising radiation, is able to detect vascular anatomy and arguably has a shorter learning curve compared to the other two methods. Methods IOUS is not currently taught on the surgical curriculum. In response to this, we have set up the Laparoscopic Hands-on Intra-operative Ultrasound (L-HOUS) course which takes place over a two-day period. The first day is delivered through interactive seminars and practice on phantom models. The topics covered are: the basic principles of the technique; the relevant anatomy; the role of IOUS in gallstone disease; and the role of IOUS in biliary surgery and various other non-HPB conditions. The afternoon is dedicated to demonstrating how to set up the equipment, the step-wise approach to IOUS of the biliary system, and hands-on practice using phantom models. The second day takes place in the operating theatre and offers delegates the opportunity to perform IOUS of the bile duct in real clinical cases. Delegates rotate around to practice their IOUS skills under the supervision of the operating surgeon, while un-scrubbed delegates are able to watch the surgery via a video link from the seminar room. Results The course has been run on four occasions and attracted 21 delegates since its inception in 2017. The vast majority of delegates have been senior general surgical trainees or post-CCT fellows, in addition to one consultant. The feedback received was overwhelmingly positive and the course has evolved at each iteration to reflect the comments from delegates. Conclusions This is the only course in Europe that offers delegates hands-on experience in developing IOUS skills under specialist guidance. Crucially, hands-on experience has been shown to have better outcomes in relation to ultrasound training when compared to simulation or classroom-based methods. This concept fits in unity with Edgar Dale's pyramid of learning whereby students are more likely to retain information that they have practiced ‘doing’ compared to other visual or auditory methods of teaching. Given the benefits of IOUS in terms of cost, and reduction in additional procedures or investigations, we argue that the technique should be included in the surgical training curriculum. One of the main reasons for poor uptake of a one-stage approach to bile duct stones using IOUS is lack of formal training. Given there will likely be an increase in the adoption of the IOUS technique in coming years, it is vital to equip current trainees with the necessary skills within their training pathway. However, prior to this it is imperative that trainees have access to high-fidelity training opportunities to develop skills that will be used routinely in future practice.

Real-Life Cases in Student-Family Environment as a New Model for Case-Based Learning for Dental Students in Pathology: Students’ Perspective

Background: Case-based learning is a widely accepted technique to promote critical thinking in health care students. This paper focuses on active learning through real life clinical cases as opposed to hypothetical cases in the dental academic curricula. The overall experience of the faculty as well as the students throughout the case assignment has been reported in this study. Objective: This study provides a student’s perspective and insight into an innovative real-life case-based approach in online learning of pathology. Material and Methods: A real-life case of hypertension, diabetes or both was assigned to the Bachelor of Dentistry students in their second academic year of Pathology. The case was then presented by the students, followed by an open discussion involving peers and faculty members. Students’ responses were obtained for the assignment. Results: The response of students towards case assignment was promising and their feedback on each aspect of the assignment has been described. Faculty perception has also been included in order to share feedback about the students’ participation in the assignment from a faculty viewpoint. Conclusion: The present study introduces an innovative teaching method in medical education which can be utilized in the online learning of pre-clinical subjects and even clinical subjects during adverse situations when patient exposure is less. The real-life case-based learning method discussed in this paper offers real potential in developing critical diagnostic skills in students under a realistic clinical environment

Overview on advantages & disadvantages of alternative matrices

To describe the advantages and disadvantages of alternative matrices in the field of clinical and forensic toxicology. A review of the characteristics and limitations of the most relevant alternative matrices have been conducted. Moreover, the main applications of the analysis of alternative matrices have been detail focusing on its usefulness in the resolution of real forensic and clinical cases. The advance in more sensible testing methodologies have been permitted the analysis of other biological specimens, traditionally inaccessible. Different alternative biological matrices can be used in clinical and forensic toxicological cases to obtain additional information to those obtain by the analysis of traditional matrices. Moreover, these matrices can be used to resolve problems or impediments of traditional matrices, such as invasive sample collection, detection of long-term exposure, contamination or postmortem redistribution… Some of the most used alternative matrices nowadays are hair, oral fluid, meconium or vitreous humor. The main advantage of hair analysis is the possibility to extend the window of detection to months or even years and perform a chronological profile of drug consumption. Hair analysis is applied to cases of driving license regranting, drug-facilitated crimes, determination of gestational drug exposure or verification of drug-use history, among others. Its main limitation is the lack of dose/concentration correlation and the issue of external contamination. Oral fluid has a comparable window of detection with blood, but with an easier and non-invasive sample collection. However, oral fluid has a limited dose/concentration correlation and there is the possibility of buccal and passive exposure contamination. The use of oral fluid for investigating impaired driving at the roadside and for testing drug-use at workplace has exponentially increased recently, showing the potential of this matrix as an alternative to blood in detecting recent consumption. Meconium can provide information of in utero drug exposure from the second and mainly third trimester of pregnancy, with an easy and non-invasive collection. However, in some cases this matrix cannot be available, is a non-homogenous sample and require sensitive and complex methodologies. Finally, vitreous humor is a very interesting postmortem sample for determining ethanol, but also other drugs of abuse, due to it is anatomically isolated (minimizing postmortem redistribution) and protected from putrefaction. Vitreous humor volume is low and data about drug concentrations in this matrix is limited and the interpretation is complex. The analysis of alternative matrices in isolation or in combination with traditional matrices can improve the resolution of clinical and forensic toxicological cases. The main advantages of alternative samples are an easy and non-invasive collection, while the main disadvantages are the necessity of sensitive methodologies and the lack of dose/concentration correlation. Moreover, the interpretation of the information provided by alternative matrices should be performed taking into account the characteristics of those samples. The use of alternative matrices in clinical and forensic toxicology complements the information provide by traditional matrices, specially when traditional matrices are not available, their collection is invasive, or drugs are no longer detect in them.

Utility of 3D printed models as adjunct in acetabular fracture teaching for Orthopaedic trainees

ObjectiveTo evaluate the use of 3-D printed models as compared to didactic lectures in the teaching of acetabular fractures for Orthopaedic trainees.MethodsThis was a randomised prospective study conducted in a tertiary hospital setting which consisted of 16 Orthopaedic residents. Ten different cases of acetabular fracture patterns were identified and printed as 3-D models. The baseline knowledge of orthopaedic residents regarding acetabular fracture classification and surgical approach was determined by an x-ray based pre-test. Trainees were then randomly assigned into two groups. Group I received only lectures. Group II were additionally provided with 3-D printed models during the lecture. Participants were then assessed for comprehension and retention of teaching.ResultsSixteen trainees participated in the trial. Both Group 1 and 2 improved post teaching with a mean score of 2.5 and 1.9 to 4.4 and 6 out of 10 respectively. The post test score for fracture classification and surgical approach were significantly higher for 3-D model group (p < 0.05). Trainees felt that the physical characteristics of the 3-D models were a good representation of acetabular fracture configuration, and should be used routinely for teaching and surgical planning.Conclusion3-D printed model of real clinical cases have significant educational impact compared to lecture-based learning towards improving young trainees’ understanding of complex acetabular fractures.

Strategies for recognizing pneumonia look-alikes.

Community-acquired pneumonia is a common diagnosis in children. Among the many children whose symptoms and/or chest X-ray is consistent with community-acquired pneumonia, it can be difficult to distinguish the rare cases of differential diagnoses that require specific management. The aim of this educational article is to provide clinicians with a series of questions to ask themselves in order to detect a possible differential diagnosis of pneumonia in children. The value of this approach is illustrated by 13 real clinical cases in which a child was misdiagnosed as having lobar pneumonia. What is Known: •When a lobar pneumonia is diagnosed, an appropriate antibiotic treatment leads to the resolution of the clinical signs in most cases. • However, several diseases can be look-alikes for pneumonia and mislead the practitioner. What is New: •This article provides a new approach to identify differential diagnoses of pneumonia in children. •It is illustrated by 13 real-life situations of children misdiagnosed as having pneumonia.

Case-method in the Training of Practical Healthcare Professionals in the Russian Federation

The Medical Simulation Center of the Botkin Hospital is actively developing towards creating unique educational content in medicine. Applying the Case method in the education of medical workers, we bring the academic training of practical health care specialists of the Russian Federation as close as possible to the field of their professional activity by discussing real clinical cases from medical practice (cases) aimed at a deep and multifaceted understanding of a specific situational problem in the context of real life, thereby improving the quality of medical care to the population.

Efficacy of anlotinib for advanced SCLC patients: A real-world study.

e20621 Background: Anlotinib is a novel small molecule multi-target tyrosine kinase inhibitor, which has been approved as a third-line therapy for patients with advanced small cell lung cancer (SCLC) by NMPA in Aug 2019. ALTER 1202 trial has demonstrated that anlotinib significantly prolonged progress-free survival (PFS) and improved disease control rate (DCR) of advanced SCLC patients. Since the efficacy of patients in real clinical practice is affected by many factors, the objective of this study was to assess the efficacy of anlotinib for patients with advanced SCLC in real world. Methods: This is a multi-center, non-interventional, prospective real-world study and all registered data are collected from real clinical practice cases. Patients diagnosed as advanced SCLC and treated with anlotinib were included. The primary endpoint was PFS, and secondary endpoints included overall survival (OS), objective response rate (ORR), DCR and safety. Results: Until Dec 2021, a total of 44 eligible patients were included, with a median age of 62 years, including 34 males (77.3%) and 10 females (22.7%). Among them, 38 patients (86.4%) were diagnosed as a limited stage SCLC and 6 patients (13.6%) diagnosed extensive stage. All patients have not received other targeted therapies before. The median PFS was 6.0 months (95%CI 2.4-5.8), and the median OS was 15.9 months (95%CI 9.1-18.83). At the data cut-off date, 1 patient was assessed as CR, 22 patients were assessed as PR, 15 patients were assessed as SD and 4 patients were assessed as PD. The ORR was 52.3% and the DCR was 86.4%. Conclusions: Significant improvement in OS and PFS were found for advanced SCLC patients in this real-world study. This exhibited that anlotinib has a potential efficacy over previous treatment models. Of course, safety must be further observed subsequently.

Non-technical skills in pre-hospital care in the Czech Republic: a prospective multicentric observational study (NTS study)

BackgroundNon-technical skills (NTS) are important for the proper functioning of emergency medical ambulance crews but have hardly been researched in the conditions of clinical pre-hospital care.The primary objective of this study, therefore, is to describe the use of NTS in practice. The secondary objective is to compare if the performance of NTS varies according to the type of case.MethodsIn this multicentric observational study the modified Team Emergency Assessment Measure (TEAM) score was used to assess the performed NTS of two or more crews on site. The evaluation consisted of leadership, teamwork and task management, rated by a field supervisor.The study observations took place in real clinical pre-hospital emergency medical cases when two or more crews were dispatched between October 2019 and August 2020. The sample size was determined by researchers prior to the study to at least 100 evaluated events per each of the three participating emergency medical services.The results are presented as median and interquartile range. The internal reliability, consistency and validity of test items and results were evaluated. The Kruskal–Wallis test and the post hoc Mann-Whitney U test with Bonferroni correction were used for multiple comparisons of three groups.ResultsA total of 359 events were evaluated. Surprisingly, the median value for all eight items was as high as 3.0 with a similar interquartile range of 1.0. There were no differences observed by case type (CPR vs. TRAUMA vs. MEDICAL) except from item 1. A post hoc analysis revealed that this difference is in favour of a higher rated performance of non-technical skills in CPR.ConclusionsThe overall result of the performance of non-technical skills can be regarded as very good and can serve for further evaluations. The crews achieved better parameters of NTS in leadership in resuscitation situations in comparison with general medical events.Trial RegistrationThe study is registered at Clinical Trials under the ID: NCT04503369.

Modified Geometry of 106Ru Asymmetric Eye Plaques to Improve Dosimetric Calculations in Ophthalmic Brachytherapy.

Ru/Rh asymmetric plaques for ophthalmic brachytherapy have special geometric designs with a cutout intended to prevent irradiation of critical ocular structures proximal to the tumor. In this work, we present new geometric models for PENELOPE+PenEasy Monte Carlo simulations of these applicators, differing from the vendor-reported geometry, that better match their real geometry to assess their dosimetric impact. Simulation results were benchmarked to experimental dosimetric data from radiochromic film measurements, data provided by the manufacturer in the calibration certificates, and other experimental results published in the literature, obtaining, in all cases, better agreement with the modified geometries. The clinical impact of the new geometric models was evaluated by simulating real clinical cases using patient-specific eye models. The cases calculated using the modified geometries presented higher doses to the critical structures proximal to the cutout region. The modified geometric models presented in this work provide a more accurate representation of the asymmetric plaques, greatly improving the agreement between Monte Carlo calculations and experimental measurements. Lack of consideration of accurate geometric models has been shown to be translated into notable increases in dose to organs at risk in clinical cases.

Automatic framework for patient-specific modelling of tumour resection-induced brain shift

Our motivation is to enable non-biomechanical engineering specialists to use sophisticated biomechanical models in the clinic to predict tumour resection-induced brain shift, and subsequently know the location of the residual tumour and its boundary. To achieve this goal, we developed a framework for automatically generating and solving patient-specific biomechanical models of the brain. This framework automatically determines patient-specific brain geometry from MRI data, generates patient-specific computational grid, assigns material properties, defines boundary conditions, applies external loads to the anatomical structures, and solves differential equations of nonlinear elasticity using Meshless Total Lagrangian Explicit Dynamics (MTLED) algorithm. We demonstrated the effectiveness and appropriateness of our framework on real clinical cases of tumour resection-induced brain shift.

Adaptation of clinical subjects in Dentistry to virtual environments during the COVID-19 pandemic in a Spanish University: A case study.

The evolution of the pandemic has generated a crisis in all areas, also including the faculties of dentistry. We detail how the teaching guides for clinical subjects have been adapted in the Department of Clinical Dentistry at the Universidad Europea of Madrid, moving to a 100% online environment. Students in the fourth and fifth year of DDS degree take the courses "Introduction to Clinical Practice" and "Supervised Practice." Within the framework of continuous assessment, different systems and procedures are used to evaluate knowledge, skills or competences. CURRICULAR ADAPTATION DURING THE PERIOD OF THE COVID-19 PANDEMIC: It was necessary to adapt the practical contents to virtual contents. 35% of the course (12weeks) was adapted to a 100% online environment. Several activities were carried out that could be evaluated in real time, including lectures, clinical cases and resolution of multidisciplinary dental treatments. DEVELOPMENT OF CLINICAL PRACTICES IN HEALTH EDUCATION IN OTHER INSTITUTIONS DURING THE PANDEMIC: A narrative review was conducted to identify how this situation has been addressed in other institutions and countries; finding that similarly, it has been possible to establish monitoring of clinical practices in a virtual environment. An online questionnaire was conducted to the fourth and fifth year students of DDS degree to stablish the acceptance of the adaptation during the pandemic. Despite the limitations of online training for the development of clinical practice, a system has been established to ensure appropriate clinical training for undergraduate students in dentistry. Some of the developments were well accepted by the students.

Adjustment of multi-leaf collimator parameters in 4-MV and 6-MV IMRT: A study of veterinary clinical cases.

Background:For optimal treatment, it is important to maintain optimal multi-leaf collimator (MLC) transmission in intensity-modulated radiation therapy (IMRT). However, adjustment of transmissions has not been reported in veterinary medicine.Aim:To demonstrate that appropriate MLC parameter adjustment for IMRT using 4- and 6-MV energy can reduce the need for quality assurance revalidation in real companion animal clinical cases.Methods:The MLC parameters (leaf transmission and leaf offset) of the treatment planning system were adjusted by evaluating seven plans (10 × 10 cm, 3ABUT, DMLC, 7segA, FOURL, HDMLC, and HIMRT) and 20 preclinical cases (10 cases each in 4- and 6-MV groups). Subsequently, 101 IMRT plans of 88 cases (77 dogs and 11 cats) were evaluated for absolute dose of plan target volume (PTV) and organs at risk (OAR) and were analyzed for the relative dose distribution by gamma analysis (3%/3 mm, >10%) using EBT3 film.Results:After adjustment of the MLC parameters (leaf transmission and leaf offset, 4 MV: 0.008 and 0, 6 MV: 0.005 and 0, respectively), the data from 101 plans (4 MV: 64 plans and 6 MV: 37 plans) treated with IMRT showed PTV <3%, OAR <5%, and gamma analysis pass rates ≥95% in all cases.Conclusion:Clinically meaningful dose distributions can be created even with a limited validation device if the treatment parameters are adjusted appropriately, even for tumors in canines and felines, where the irradiation field is small, the target is adjacent to the OAR, and the target is often superficial.