Utility For Treatment Planning Research Articles

2.39 Developing a Biopsychosocial Schematic to Aid in Evaluation of Avoidant/Restrictive Food Intake Disorder

2.39 Developing a Biopsychosocial Schematic to Aid in Evaluation of Avoidant/Restrictive Food Intake Disorder

PD48-03 COMPUTATIONAL GONIOMETRY AND VOLUMETRY OF PEYRONIE'S DISEASE DEFORMITIES CAPTURED WITH 3D STRUCTURED LIGHT SCANNING

You have accessJournal of UrologySexual Function/Dysfunction: Peyronie's Disease (PD48)1 Sep 2021PD48-03 COMPUTATIONAL GONIOMETRY AND VOLUMETRY OF PEYRONIE'S DISEASE DEFORMITIES CAPTURED WITH 3D STRUCTURED LIGHT SCANNING Alvaro Santamaria, Dyvon Walker, Tommy Jiang, Renea Sturm, Jesse Mills, and Sriram Eleswarapu Alvaro SantamariaAlvaro Santamaria More articles by this author , Dyvon WalkerDyvon Walker More articles by this author , Tommy JiangTommy Jiang More articles by this author , Renea SturmRenea Sturm More articles by this author , Jesse MillsJesse Mills More articles by this author , and Sriram EleswarapuSriram Eleswarapu More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002070.03AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Peyronie’s disease (PD) deformities are conventionally assessed with manual goniometry, which provides angulation but neglects volume loss and atypical deformities. Inter-rater variability complicates accuracy of assessment. Our aims were to: 1) establish a workflow for digital characterization of penile deformities using 3D structured light scanning, and 2) compare outcomes derived from manual and digital measurement. METHODS: With IRB approval, we prospectively enrolled men age 18+ with PD. Intracavernosal alprostadil was administered, and erect penis underwent conventional goniometry followed by structured light scanning (Artec Space Spider) (Fig. A). Computation of penile angle and volumes were completed by two urologists using Autodesk Meshmixer and Fusion 360 (Fig. B). Wilcoxon rank sum test compared conventional goniometry to digital angle assessment. RESULTS: Of 22 men, 10 (45.5%) had dorsal curve, 9 (40.9%) lateral, and 3 (13.6%) ventral. Goniometric measurements were 50.5° ± 15.0° (range 30.0°-90.0°). Digital angle computations were 46.7° ± 18.4° (range 23.6°-90.9°) (conventional vs. digital, p=0.15). Percent difference between conventional and digital angles was 3.4% ± 30.5% (range in difference 0.5°-56.4°). Inter-rater absolute differences in digital angle computation ranged 0.65°-12.9°. Computed penile volumes were 109 cc ± 34.3 cc (range 47.5-177.5 cc). Inter-rater percent difference for volume computation was 2.7% ± 2.7% (range in difference 0-6.07 cc). CONCLUSIONS: This technique represents a reproducible computational workflow for digital goniometry and volumetric assessment of penile deformities, which may have utility for treatment planning, patient counseling, and tracking of treatment outcomes. Source of Funding: Research grant from Sexual Medicine Society of North America, Research Scholar Award from the Urology Care Foundation & American Urological Association © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e839-e839 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Alvaro Santamaria More articles by this author Dyvon Walker More articles by this author Tommy Jiang More articles by this author Renea Sturm More articles by this author Jesse Mills More articles by this author Sriram Eleswarapu More articles by this author Expand All Advertisement Loading ...

THE UTILITY OF STABILITY AND TEAR LOCATION IN A CLASSIFICATION SYSTEM FOR DISCOID MENISCUS SURGICAL PLANNING

Background Discoid meniscus (DM) is a congenital variant that typically affects the lateral meniscus of the knee. Despite the presence of multiple classification systems for DM, no system has demonstrated utility in treatment planning. We performed a retrospective review of discoid menisci that underwent surgical intervention at our institution to assess for discoid meniscus characteristics associated with surgical treatment with or without repair. Next, we propose a new method of classifying lateral discoid meniscus and demonstrate its efficacy in predicting surgical treatment. Methods We searched the orthopedic database at our institution for patients who underwent surgical treatment for lateral discoid meniscus between 1991 and 2017. Clinical records were reviewed to determine the type of DM surgery performed (surgery with or without repair) as well as DM morphology, stability, tear presence, tear location, and tear type. Univariate associations between DM characteristics and surgery type were calculated and multivariable logistic regression models of surgery type were created. Based on the univariate analysis and logistic regression models, we propose a new classification system for discoid meniscus. Results There were 434 knees with discoid lateral menisci that received surgical treatment at our institution between 1991 and 2017. In univariate analysis, unstable menisci (93%, p<0.001) and menisci with a tear including the periphery (75%, p<0.001) were more likely to receive surgery with repair. By itself, instability demonstrated 89% sensitivity and 94% specificity in predicting surgery with repair. The main effects logistic regression model including stability and tear showed that that the odds of unstable lateral discoid menisci receiving surgery with repair was 133.1 times higher than stable menisci (p<0.001) while lateral discoid menisci that had a tear including the periphery had 6.54 times higher odds of receiving repair than those that had a tear in the central portion only (p<0.001). Conclusions/Significance Lateral discoid menisci stability and tear location were associated with surgical treatment type in both univariate analysis and logistic regression models (Table 1). Based on our results and clinical relevance, we propose a classification system for DM with utility in surgical treatment planning. Menisci are classified by stability (Stable (S0), Unstable (S1)), morphology (Incomplete (M0), Complete (M1)), and Tear (No tear (T0), Central tear (T1), or Peripheral tear (T2)) (Figure 1). Tables and Figures [Table: see text][Figure: see text]

Classifications in Brief: Watson and Ballet Classification of Scapholunate Advanced Collapse Wrist Arthritis.

Classifications in Brief: Watson and Ballet Classification of Scapholunate Advanced Collapse Wrist Arthritis.

Clinician judgments of clinical utility: A comparison of DSM-IV-TR personality disorders and the alternative model for DSM-5 personality disorders.

This study compared the perceived clinical utility of DSM-IV-TR personality disorder diagnoses (retained in DSM-5) with the alternative model presented in DSM-5 Section III, using a national sample of clinicians applying both systems to their own patients. A sample of 337 mental health clinicians (26% psychiatrists, 63% psychologists, and 11% other professional disciplines) provided a complete assessment of all personality disorder features listed in DSM-IV-TR and DSM-5 Section III. After applying each diagnostic model, clinicians evaluated the clinical utility of that model with respect to communication with patients and with other professionals, comprehensiveness, descriptiveness, ease of use, and utility for treatment planning. These perceptions were compared across DSM-IV-TR and the 3 components of the DSM-5 Section III model, and between psychiatrists and nonpsychiatrists. Although DSM-IV-TR was seen as easy to use and useful for professional communication, in every other respect the DSM-5 Section III model was viewed as being equally or more clinically useful than DSM-IV-TR. In particular, the DSM-5 dimensional trait model was seen as more useful than DSM-IV-TR in 5 of 6 comparisons-by psychiatrists as well as other professionals. Although concerns were expressed about the clinical utility of the DSM-5 personality disorder system during its development, these criticisms were offered without data on the proposed system. The results of this study demonstrate that aside from the current familiarity of the DSM-IV-TR approach, it offers little advantage in perceived clinical utility over the DSM-5 Section III system, whereas the latter is viewed as being more useful in several respects.

1659 – The development of a case formulation training package for probation staff

Introduction A recent UK Government initiative has sought to address the management of personality disordered (PD) offenders, aiming to improve public protection by reducing reoffending whilst simultaneously improving the psychological health of offenders with PD. Case formulation (CF) is given primacy here as it enhances offender management through a psychologically informed approach and informs pathway planning through Criminal Justice System or NHS services. Probation services are given an important role in formulating cases as part of the new strategy. Objectives Develop a consensus amongst professionals as to what makes a good Case Formulation (CF). Investigate whether probation services can be taught CF skills, and to enhance these skills. Aims Develop a case formulation training package for probation staff and evaluate the training. Method The training package was informed by the results of a Delphi survey amongst professionals, and focus groups with probation staff, offenders and carers of individuals with PD. Results There was consensus that CF allows for collaboration between client and therapist, helps with complexity through organisation of case notes and has utility in treatment planning. Themes highlighted for effective CF included background, trauma, offending, risk and current lifestyle. The theoretical model gaining most support was a CBT model. The assessment of formulations was identified as challenging. The CF training package is currently being evaluated and findings will be presented at the conference, alongside outcomes of all phases of the research. Conclusions CF has the potential to enhance treatment planning. Its suitability for probation staff will be discussed.

Cognitive profiles in persons with chronic schizophrenia

Cognitive heterogeneity has been a key barrier to clarifying the neuropathologic underpinnings of schizophrenia. We used an idiographic method for cluster analysis of neuropsychological data from 144 middle-aged and older people with schizophrenia to characterize and group the patterns of relative (within-person) profiles of cognitive strength and weakness. Results indicated a 5-cluster solution as most appropriate, with relatively even distribution across the 5 clusters in terms of the proportion of patients in each cluster. Cognitive subtyping may be useful in imaging and genetic research on schizophrenia, as well as having practical utility in treatment planning and cognitive rehabilitation.

2213 SEMI-AUTOMATED VOLUMETRIC MEASUREMENT OF RENAL STONES: A SIMPLE AND MORE COMPLETE DESCRIPTION OF STONE BURDEN

INTRODUCTION AND OBJECTIVES: In nephrolithiasis, the decisions for treatment and the modality chosen are largely determined by the size and configuration of renal stones. While the greatest stone length and two-dimensional area in a single plane are commonly reported measures of stone burden, stone volume provides the most complete description of stone size. We sought to characterize the performance of standard stone measurement methods including greatest diameter and area on computed tomography (CT) imaging of stone phantoms and actual stones in a clinical cohort of patients versus a new semi-automated computerized volume calculation software. METHODS: Both actual and CT-derived in vitro measurements of four irregularly shaped and differently sized stone phantoms were performed. Actual length, area and volume were determined by straight line ruler, Image-J analysis of stone perimeter and water-displacement techniques, respectively. CT length and area in a single coronal view were derived using standard Centricity PACS system tools (GE Healthcare). CT volume was determined with a novel threshold-based, semiautomatic segmentation algorithm that additionally allowed for image rendering. All measurements were repeated x5. CT values were retrospectively obtained for a cohort of 17 patients with complete staghorn calculi that underwent PCNL between March 2006 and March 2010 for comparison. RESULTS: As noted in the Table, CT volume calculations of phantom stones had the lowest mean difference (13%) with actual measurements as compared to diameter (18%) or area (25%). Additionally, relative standard deviation between measurements was lowest with CT volume (0–0.46%) as compared to diameter (1.48–3.16%) and area (1.58–5.37%). In the clinical analysis of 17 patients (mean age 53, 53% male), large variations in stone size were noted: diameter (23.8–70.3mm), area (431– 2585mm), volume (3737–37714mm). CONCLUSIONS: In the evaluation of renal stones, stone volume provides the most descriptive measurement of overall stone burden. Our early studies using a novel semi-automated computer program may provide a more accurate and precise tool to determine stone size than is currently being utilized. Further clinical application will determine its utility in treatment planning, patient counseling and clinical outcomes. Source of Funding: None

Treatment induced necrosis versus recurrent/progressing brain tumor: going beyond the boundaries of conventional morphologic imaging

Brain tumor patients undergo various combinations therapies, leading to very complex and confusing imaging appearances on follow up MR imaging and hence, differentiating recurrent or progressing tumors from treatment induced necrosis or effects has always been a challenge in neuro-oncologic imaging. This particular topic has become more relevant these days because of the advent of newer anti-angiogenic and anti-neoplastic chemotherapeutic agents as well as use of salvage radiation therapy. Various clinically available functional imaging modalities can provide additional physiologic and metabolic information about the tumors which could be useful in identifying viable tumor from treatment induced necrosis and hence, can guide treatment planning. In this review we will discuss various functional neuro-imaging modalities, their advantages and limitations and also their utility in treatment planning.

A Social-Emotional Assessment Method for Young Children in Foster and Residential Care: The Attachment-Based Narrative Story-Stem Technique

Summary Standardized clinical assessments from the point of view of children are rare. A standardized narrative assessment measure, developed to assess children's perceptions of their caregiving environments, the Narrative Story‐Stem Technique (NSST), was used with two fraternal twins, age 8, with histories of severe maltreatment and multiple foster placements. Their responses to the NSST indicate that they perceived their caregiving environments as unstable and unpredictable, though in noticeably different ways. Representations of certain family strengths were also evident. The NSST can provide highly detailed information of great utility for treatment planning and intervention regarding children's perceptions of, and experiences in, their caregiving environments.

A social‐emotional assessment method for young children in foster and residential care: The attachment‐based narrative story‐stem technique

Summary Standardized clinical assessments from the point of view of children are rare. A standardized narrative assessment measure, developed to assess children's perceptions of their caregiving environments, the Narrative Story‐Stem Technique (NSST), was used with two fraternal twins, age 8, with histories of severe maltreatment and multiple foster placements. Their responses to the NSST indicate that they perceived their caregiving environments as unstable and unpredictable, though in noticeably different ways. Representations of certain family strengths were also evident. The NSST can provide highly detailed information of great utility for treatment planning and intervention regarding children's perceptions of, and experiences in, their caregiving environments.

Options for radionuclide therapy: from fixed activity to patient-specific treatment planning.

The therapeutic use of radioisotopes in medicine as unsealed sources has a long history dating back to the 1930s. The established and continuing objectives are to provide radiation dose to the target tissue at the desired cytotoxic level while avoiding or minimizing toxic effects. Selected radionuclide therapy protocols including 32P for polycythemia vera, 131I for Graves' disease, and 131I for postsurgical ablation of thyroid remnants in the management of differentiated thyroid cancer are presented for historical review with the focus on protocols for administering the radiopharmaceuticals and the role played by dosimetry. The discussion also includes consideration of complications and the assessment of outcome for these diseases. The vista for radionuclide therapy today is reviewed along with the options for determining the administered activity. Patient specific dosimetry encompasses a number of levels ranging from basic measurement of relevant biokinetic parameters and use of standard models to calculate (and extrapolate) radiation dose to sophisticated three-dimensional techniques employing fusion of physiologic and high-resolution anatomic images coupled with advanced 3-D voxel patient representation and Monte Carlo techniques for use in radiation dose calculation. The role of patient specific dosimetry in clinical trials (Phase I, II, III trials) along with its utility in treatment planning, follow-up evaluation, and elucidation of dose-response relationships is discussed. The challenge ahead for those who advocate patient specific dosimetry is to assemble the outcome data and perform the analysis to support this contention.

Rating scales for measuring the interpersonal circle in forensic psychiatric patients.

Two studies are reported on nurses' assessments of interpersonal style in hospitalized male forensic psychiatric patients. In Study 1, interpersonal behaviors were rated on a Chart of Interpersonal Reactions in Closed Living Environments (CIRCLE) in a derivation sample (n=210) and a replication sample (n = 102). Rating items generated a circular arrangement within both samples consistent with recent conceptualizations of the Leary interpersonal circle (T. Leary, 1957), and scales constructed to measure the octants of the circle demonstrated acceptable psychometric properties. Study 2 showed that the 8 scales met the geometric requirements of a circumplex in the same 2 samples. As measures of dysfunctional interpersonal style, CIRCLE scales may have some utility in treatment planning, risk assessment, and the evaluation of personality disorders in inpatient populations.