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The article informs that the Initial experiences with hippocampus-sparing whole-brain radiotherapy for lung cancer patients. Topics discussed include chemo-radiotherapy, depending on the histology, disease stage, and patient performance status and comorbidities; determine if the metastases were situated in or near the hippocampal sparring low-dose volume; and patients were retreated with intracranial stereotactic radiotherapy.

Objective: To explore physical health problems and their causes in patients with severe mental illness, as well as possibilities for prevention and treatment from the patients' and staff's perspectives. Method: We conducted six focus groups with patients and staff separately, from three out-patient clinics treating patients with schizophrenia or substance-use disorder comorbid to another psychiatric disorder. Focus groups were audio-recorded, transcribed verbatim and analysed using a template approach. Results: Paramount physical health problems are weight issues, cardiovascular diseases and poor physical shape. Main causes are lifestyle, the mental disorder and organisational issues. Patients and staff expressed similar opinions regarding physical health problems and their causes. Possibilities for prevention and treatment includes a case manager and binding communities with like-minded, as well as management support and implementation of physical health into daily psychiatric practice. Although patients and staff suggested different possibilities for prevention and treatment, they support one strategy: less fragmentation of the treatment system and cooperation between psychiatric and somatic healthcare. Conclusion: To prevent and treat physical health problems in patients with severe mental illness, support in daily structure and lifestyle changes is needed. Management support is needed to change daily practice and implement routines regarding physical health. [ABSTRACT FROM AUTHOR]

Objective: The time span between knowledge becoming available and its integration into daily clinical routine is lengthy. This phenomenon is explored in this study. Method: We used the outcomes of our activities for investigating and strengthening the research-based activities to improve physical health in the routines of clinical psychiatric wards as examples for our analyses. Results: The time span between new knowledge becoming available and its implementation into general clinical treatment is very long. However, a shortening of this time span is seen through active leadership backup and clinical research experience among psychiatrists and staff in the wards. In particular, the involvement of medical students interested in clinical research activities seems to have a positive impact. Conclusion: Academia needs to be re-implemented into clinical psychiatry. Staff with research experience is needed in all professions to increase evidence-based practice. Leaders must take responsibility for implementing new knowledge into the routines of the department and must support staff in these activities on a daily basis. [ABSTRACT FROM AUTHOR]

The article presents a study concerning the secular trends in examining the physical health of patients with mental illness. Information about the application of Medical Subject Headings (MESH) terms in research of schizophrenia and cardiovascular diseases, is provided. Also emphasized is conducted log-transformed and linear regression in the comparison of coefficients.

The problem with the stability of a smectic A liquid crystal (LC) mixture in a display based on the electrically reversible memory effect is discussed. The degradation of the LC mixture is initiated by the electric field and consists of electrochemical decomposition of one of the mixture components accompanied by gas bubbles arising on the electrodes of the display. The electrochemical degradation was successfully prevented by the introduction of different passivation layers and by the modification of problematic LC mixture component. The obtained results are used for improving the lifetime of a display based on the electrically reversible memory effect. [ABSTRACT FROM AUTHOR]

• Report on an extensive QA-programme for an SBRT trial for central lung tumours. • Small variations in OAR delineation potentially leads to large OAR over-dosage. • Extensive QA decreases variability in OAR delineation and treatment planning. • QA of OAR delineations may lead to a more coherent interpretation of trial outcome. SBRT of central lung tumours implies significant risk of toxicity. We are initiating two phase II trials prescribing 56 Gy/eight fractions to PTV, allowing for dose escalation of GTV. We prioritize organs at risk (OAR) constraints over target coverage, making the treatment plans very sensitive to OAR delineation variations. The aim of this study is to quantify the dosimetric impact of contouring variations and to provide a thorough description of pre-trial quality assurance to be used in upcoming trials to provide consistent clinical care. Delineation: Seven physicians delineated OAR in three rounds, with evaluations in-between. For each patient case, seven treatment plans, repeatedly using each of the OAR structure sets from the seven physicians, were made and compared to evaluate the dosimetric effect of delineation variability. Treatment planning: Treatment plans for seven cases were made at six departments in two rounds, with discussion in-between. OAR delineation variation between centres resulted in high variabilities in OAR dose for simulated plans and led to potential overdosage of the lobar bronchus (constraint: D 0.03cc < 45 Gy), with maximum doses ranging between 58 Gy (first round), and 50 Gy (third round). For mediastinal tissue, the constraint (D 0.03cc < 45 Gy) was violated for the majority of the delineations in all three rounds, with maximum doses of 84 Gy (first round), and 72 Gy (third round). For the treatment planning study, the range of the standard deviation for GTV mean dose was 12.8–18.5 Gy (first round) and 2.8–3.5 Gy (second round). Even small variations in OAR delineation led to high OAR overdosage. The study demonstrates the importance of having extensive QA procedures in place before initiating clinical trials on dose escalation in SBRT. [ABSTRACT FROM AUTHOR]

To investigate the outcomes of precision-radiotherapy (RT) with 15 × 2.633 Gy (EQD2 = 41.6 Gy for tumor cell kill, α/β = 10 Gy) or 18 × 2.333 Gy (EQD2 = 43.2 Gy) in patients with metastatic spinal cord compression (MSCC) and favorable survival prognoses (>35 points on a validated survival score). In addition, these patients were compared to a historical control group of patients with favorable prognoses treated with 10 × 3 Gy (EQD2 = 32.5 Gy). In a multi-center phase 2 study (RAMSES-01), patients with MSCC and favorable survival prognoses receiving 15 × 2.633 Gy or 18 × 2.333 Gy of precision-RT alone (no upfront surgery) were mainly evaluated for local progression-free survival (LPFS), defined as no deterioration of motor function during RT and no in-field recurrence of MSCC following RT, at 12 months (primary endpoint). Secondary endpoints included improvement of motor and sensory functions, post-RT ambulatory status, relief of pain and distress, toxicity, and survival (OS). The maximum relative doses allowed to the spinal cord were 101.5 % of the prescribed dose for 18 × 2.333 Gy and 101.2% for 15 × 2.633 Gy, respectively (both representing an EQD2 of 46.6 Gy for myelopathy, α/β = 2 Gy). In addition, the RAMSES-cohort was compared to a historical control group (N = 266) irradiated with 10 × 3 Gy (propensity score adjusted Cox regression). In the RAMSES-cohort, 50 (of 62 planned) patients were evaluable for LPFS and included in the analyses. Since OS was worse than expected, a new survival score was developed, which was more precise in predicting OS than a previous tool. As a consequence, the RAMSES-trial, which was based on the previous score, was terminated. In the 50 patients included so far, 12-month rates of LPFS and OS were 97.6% and 69.9%, respectively. Improvement of motor function occurred in 28 patients (56.0%), and 47 patients (94.0%) were ambulatory following RT. Within 3 months following RT, 12 of 21 patients (57.2%) with pre-RT sensory deficits improved, 38 of 45 patients (84.4%) with pre-RT pain experienced at least partial relief, and 39 of 50 patients (78.0%) reported relief of distress. Ten of 50 patients (20.0%) experienced grade 2 toxicities (mainly esophagitis/dysphagia) and another two patients (4.0%) grade 3 toxicities (1 diarrhea, 1 esophagitis). After propensity score adjustment, the RAMSES-cohort showed significantly better LPFS than the control group (hazard ratio = 0.125, 95% confidence interval = 0.016 – 0.962, p = 0.046) and a strong trend regarding improvement of motor function (hazard ratio = 1.943, 95% confidence interval = 0.981 – 3.850, p = 0.057). Post-RT ambulatory rates (p = 0.56) and OS rates (p = 0.62) were not significantly different. Precision-RT with 15 × 2.633 Gy or 18 × 2.333 Gy was sufficiently well tolerated and resulted in significantly better long-term LPFS than 10 × 3 Gy in patients with MSCC and favorable survival prognoses. Thus, the dose-fractionation regimens of the RAMSES-01 trial appear preferable for these patients. [ABSTRACT FROM AUTHOR]

To improve treatment personalization of patients irradiated for metastatic spinal cord compression (MSCC), a score predicting post-treatment ambulatory status after radiotherapy (RT) alone (without surgery) was presented in 2008. Since then, upfront decompressive surgery has become more popular, which may decrease the predictive value of this score. A new scoring tool may be helpful. Data of 283 patients treated with RT alone for MSCC in three prospective trials since 2010 were re-evaluated. Dose-fractionation of RT and 12 factors were analyzed including age (<=67 vs >67 years), gender, tumor type (breast ca. vs prostate ca. vs myeloma/lymphoma vs lung ca. vs others), interval from tumor diagnosis to MSCC (<=6 vs >6 months), number of affected vertebrae (1-2 vs >=3), further bone lesions (no vs yes), visceral metastases (no vs yes), time developing motor deficits (<=7 vs >7 days), pre-RT ambulatory status (ambulatory without aid vs ambulatory with aid vs not ambulatory), performance score (ECOG-PS 1-2 vs 3-4), sensory deficits (no vs yes), and sphincter dysfunction (no vs yes). For each factor that achieved significance in the multivariate analysis (logistic regression model) after backward regression modelling, scoring points were calculated by dividing the post-RT ambulatory rates (in %) by 10. The scoring points of these factors were added for each patient. The new score was compared to the previous tool for prediction (positive predictive value, PPV) of ambulatory and non-ambulatory status after RT. In the multivariate analysis, primary tumor type (p=0.010), sensory deficits (p=0.002), sphincter dysfunction (p=0.017), pre-RT ambulatory status (p<0.001) and ECOG-PS (p<0.001) were significant; a trend was found for the time developing motor deficits (p=0.054). Five of these factors were included in the score and available for 278 patients. ECOG-PS was not included, since ambulatory status and ECOG-PS were confounding variables. For internal validation, bootstrapping with 1000 replications was used. Corrected C-statistic accounting for overfitting was 0.91, which demonstrated good predictive performance of the model. Based on post-RT ambulatory rates, three prognostic groups (25-29, 30-38 and 39-45 points) were designed with ambulatory rates of 11% (5/44), 64% (49/77) and 97% (152/157), respectively. Rates of local control of MSCC were 100%, 82% and 94% at 1 year, and 100%, 82% and 87% at 2 years. Survival rates were 20%, 21% and 55% at 1 year, and 13%, 12% and 39% at 2 years. PPVs of the new score to predict ambulatory and non-ambulatory status were 97% and 89% vs 98% and 79% when using the previous score. The new score appeared more precise than the previous one in predicting non-ambulatory status after RT. Depending on survival prognosis, patients with <=38 points likely benefit from upfront surgery. Since patients of the 39-45 points group had very high rates of post-RT ambulatory status and local control, they may not require surgery. [ABSTRACT FROM AUTHOR]