Search

A new tissue‐equivalent, reusable material for dosimetric verification of radiotherapy is developed and characterized. The material comprises a hydrogel matrix containing copper‐doped lithium fluoride nanoparticles that exhibit optically stimulated luminescence (OSL). Using a laser light sheet and a sensitive camera equipped with appropriate filters, the OSL signal is read out layer by layer thus constructing the 3D dose distribution. The good tissue equivalence allows the new material to register the dose from a prescribed treatment plan as if delivered to a patient. Cubic dosimeters measuring 50 × 50 × 50 mm3 are developed and used to measure 3D dose distributions (from voxels measuring 0.8 × 0.8 × 1.0 mm3) with a statistical dose precision of 5% at 100 Gy dose levels. The spatial precision of offsets in dose gradients between planned and measured dose distributions is below the voxel size. A 3% / 3 mm gamma analysis between a prescribed treatment plan and the retrieved and corrected readout yields a pass rate of 89.5%. Light scattering within the dosimetric volume affects the dosimeter performance, indicating the potential for future improvements of spatial and dose precision. In conclusion, the dosimeter system shows high promise for future clinical validation of radiotherapy. [ABSTRACT FROM AUTHOR]

Background and Aim Materials and Methods Results Conclusion Vitamin K deficiency is common in persons with kidney disease, which is a known complication of diabetes. We aimed to assess the association of vitamin K status as reflected by plasma dephosphorylated‐uncarboxylated matrix Gla protein (dp‐ucMGP) with mortality, cardiovascular disease (CVD) and progression to end‐stage kidney disease (ESKD) in persons with type 1 diabetes.We analysed plasma dp‐ucMGP in stored baseline samples from a cohort of 667 persons with type 1 diabetes (baseline visit: 2009–2011). Information on mortality and CVD was obtained through linkage to registers. Cox‐proportional hazards models were applied to estimate hazard ratios (HRs) of mortality, CVD and ESKD per one doubling of dp‐ucMGP.A total of 53 deaths were recorded during follow‐up. Persons with higher dp‐ucMGP (reflecting lower vitamin K status) had higher mortality in the unadjusted model (HR: 2.06 [95% confidence interval—CI: 1.22–3.45]), but not in the fully adjusted model (HR: 0.88 [95% CI: 0.44–1.73]). Particularly, adjustment for glomerular filtration rate and urinary albumin excretion rate attenuated the HR. A similar pattern was observed in unadjusted models for incidence of CVD (HR: 1.58 [95% CI: 1.03–2.42]) and risk of ESKD (HR: 7.62 [95% CI: 4.25–13.68]). In the fully adjusted models, the HRs became statistically insignificant.In persons with type 1 diabetes, lower vitamin K status was associated with higher mortality, CVD and progression to ESKD, however, not after adjustment for other risk factors. Interventional studies are needed to elucidate the role of vitamin K in persons with type 1 diabetes. [ABSTRACT FROM AUTHOR]

ABSTRACT Aim Design Data Sources Results Conclusion Practice Implications Patient Contributions To identify and assess the state of knowledge regarding compassion‐based interventions and outcomes, targeted to the organisational level, that aim to improve health professionals' well‐being.Systematic review.Using the PICO model, the clinical question and search strategy were structured. The searches were performed on 20 September 2022 and 26 December 2023 in the Scopus, CINAHL, EMBASE, PsycINFO and ProQuest Dissertations & Theses Global databases. Content analysis was applied to analyse data, and the PRISMA and SWiM guidelines were followed for reporting.Thirty‐eight studies, mostly from the United Kingdom and the United States, met the inclusion criteria and were quality assessed and analysed. Compassion‐based interventions that target the organisational level are quite new, thus representing a burgeoning initiative. In this review, many included quantitative studies revealed significant methodological challenges in effectively measuring organisational compassion (interpersonal relationships, organisational culture and retention/turnover). However, the review findings overall indicate that interpersonal connections between colleagues that foster a sense of community, through shared experiences, mindfulness and (self‐)compassion practices and social activities, may be a protective factor for well‐being. Further, the review emphasises the crucial role of management support in catalysing organisational changes to improve health professionals' well‐being.Evidence strongly suggests that fostering human interconnectedness among health professionals is associated with enhanced well‐being. Further rigorous studies are needed to validate these findings, clarify the organisational cultural aspects of compassion and develop an effective outcome measurement tool for organisational compassion.Organisational compassion‐based interventions may help foster a culture of compassion within organisations, enhance health professionals' capacity for compassion and benefit both their well‐being and the quality of care provided to patients and relatives.This review is part of a larger project about compassion and includes two patient representatives (mothers of children with cancer) in the research team. [ABSTRACT FROM AUTHOR]

Introduction: The electronic collection of patient data is used for a large variety of conditions. The boundaries of its use in initial diagnostics and the extent to which it can replace specialist contact, however, remain vague. Our newly developed virtual diagnostic process for common sleep disorders involves digital questionnaire administration, neurophysiological diagnostic studies, and virtual consultation with a sleep specialist. In this study, we evaluated patients' virtual diagnostic process experiences as part of a full evaluation of this process. Methods: Patients who completed the virtual diagnostic process participated in online semi-structured interviews based on the following criteria: age ≥ 18 years, no obvious cognitive deficits, and access to the internet. Patients who did not complete the virtual diagnostic process were contacted by telephone and given the opportunity to explain why. Results: Of the 24 patients included, 14 completed the virtual diagnostic process. Most participants understood the concept of the virtual diagnostic process, could navigate the process, and felt that the combined use of a questionnaire and virtual consultation was meaningful. Although participants could provide information as free text, the simplified closed questions, required for diagnostic classification, triggered feelings of insecurity and the inability to sufficiently describe symptoms, thereby evoking concern. All patients deemed the complementary personal contact important. Discussion: The findings demonstrate that the virtual diagnostic process is feasible and highly accepted by most patients. However, (virtual) personal (telephone or video) contact is mandatory to address patients' concerns. The virtual diagnostic process application evaluated here likely represents the outer limit of the use of electronic data collection in virtual diagnostic procedures. [ABSTRACT FROM AUTHOR]

Aim: To explore registered nurses' perspectives on challenges and facilitators to implementing a telephone‐based self‐management support (SMS) intervention (Proactive Health Support) as an everyday healthcare practice, during the early stages of implementation. Design: Data were collected using a qualitative research design involving focus‐group interviews and participant observations. Methods: We conducted participant observation following nine nurses and four focus group interviews with 14 nurses. Data were analysed using thematic analyses. Results: Proactive Health Support was implemented in units organized independently of the existing organizational units within healthcare services. This independent organization, along with the intervention's generic (non‐disease specific) design, empowered nurses to become autonomous practitioners capable of prioritizing the operationalization of SMS as an everyday healthcare practice. However, unlearning already embedded medical practices and establishing new nursing roles necessary to accommodate the intervention in practice was experienced a challenge. Education and supervision were identified as valuable tools for successful implementation. Conclusion: Our study highlights the significance of organizational context and autonomy in successful SMS implementation. Balancing external factors like organizational context, priority and time is vital, but navigating the internal shift in professional practice is equally crucial. Role transition processes can constitute challenges demanding accommodation. Implications for the Profession: From a nursing perspective, this study highlights that practising SMS requires substantial training and education. Generic SMS interventions can introduce higher levels of contingency due to their versatile nature. Thus, equipping nurses with competencies that enable them to navigate this unpredictability flexibly is crucial. Impact: Policymakers and administrators should allocate resources and support implementation processes in ways that accommodate both internal and external conditions to facilitate nurses in delivering effective SMS. Reporting Method: This study adheres to the SRQR guideline. Patient or Public Contribution: No patient or public contribution. [ABSTRACT FROM AUTHOR]

The aim in radiotherapy treatment planning is to have sufficient target coverage and as low a dose to the Organs at Risk (OARs) as possible, adhering to the relevant guidelines. A high and consistent radiotherapy plan quality is vital when treatment plans are used as the foundation for patient selection in clinical trials. Proton therapy, being a substantially newer treatment modality than conventional photon therapy, is at risk of having a steeper learning curve in treatment planning. This inequality is important to investigate in a clinical study comparing the two, as this could influence the trial results. This study aims to evaluate the development of radiotherapy treatment plan quality for head and neck cancer patients receiving photon and proton therapy over time in the context of the DAHANCA 35 trial. From May 2019 to June 2023,189 patients were included in the ongoing DAHANCA 35 trial, with 63 patients in the pilot phase and 126 in the subsequent randomisation phase. In the pilot phase, all included patients were offered proton treatment, and in the randomisation phase, patients were randomised 1:2 (photon:proton). Patients were first seen at a local treatment centre, where a photon and comparative proton plan were prepared. If patients were offered proton treatment, a new clinical proton plan was made at the proton treatment centre and subsequently used for treatment. This study analysed 189 photon plans, 189 comparative proton plans, and 140 clinical proton plans. The treatment plans were prepared conforming to the DAHANCA guidelines [1] to ensure the clinical relevance of all treatment plans The plan quality was assessed separately for photon plans, comparative proton plans, and clinical proton plans in three time intervals. The mean dose was investigated individually for 13 OARs relevant for head and neck cancer: oesophagus, glottic larynx, supraglottic larynx, mandible, extended oral cavity, left and right parotid glands, upper-, middle-, and lower pharyngeal constrictor muscles, left and right submandibular glands, and thyroid gland. Furthermore, treatment plan quality was analysed using a new metric called Normalised Toxicity Index (NTI), calculated as a normalised average of the mean dose to the OARs compared to the threshold mean dose recommended by the DAHANCA guidelines. An NTI > 1 indicated that the OARs, on average, received a dose higher than the recommended thresholds, and an NTI < 1 indicated that the OARs received a dose below the thresholds. Hence, a lower NTI indicated better plan quality concerning OAR doses. The Kruskal-Wallis test was used to investigate a potential difference in the intervals for mean dose and NTI for each treatment type. The significance level was Bonferroni adjusted to account for multiple testing. The three time intervals were defined with 63 patients in the pilot phase constituting one interval (Pilot phase), the subsequent 64 patients from the randomisation phase in the next interval (Randomisation 1), and the remaining 62 patients from the randomisation phase in the third interval (Randomisation 2). The periods were 22 months for the Pilot phase, 19 months for Randomisation 1, and 14 months for Randomisation 2. Across the 13 OARs, the mean dose to individual OARs did not show a general time-dependent change, except for the right parotid gland in the clinical proton plans. Figure 1 shows a box plot with samples overlaid for the mean dose to the extended oral cavity as an example of the OARs. [Display omitted] The NTI was not significantly different for the photon plans, comparative proton plans, and clinical proton plans in the three consecutive intervals, as shown in Figure 2. The median NTI for the clinical proton plans was 0.88 (interquartile range [0.70,1.00]) for the Pilot phase, 0.83 [0.75,0.89] for Randomization 1, and 0.79 [0.67,0.98] for Randomization 2. The plan quality of the clinical proton plans appears stable from this new NTI metric. [Display omitted] The analyses conducted in this study did not show a general time-dependent change in plan quality in any of the three types of plans. This could be caused by the nationally developed proton treatment planning template. A stable treatment plan quality can help ensure a consistent selection for clinical trials, thus providing transparency for analysis of the outcome of the trials. The plan quality will continuously be followed to ensure consistency. [ABSTRACT FROM AUTHOR]

Background A small share of patients account for a large proportion of costs to the healthcare system in Denmark as in many Western countries. A telephone-based self-management support, proactive health support (PaHS), was suggested for prevention of hospitalisations for persons at risk of hospital admission. These persons have chronic diseases, unplanned hospitalisations and age ≥ 65 years. However, evidence is limited on whether this type of intervention is cost-effective. Aim The aim of this study was to assess the incremental cost-utility ratio (ICER) of PaHS, compared with standard care. Methods The economic evaluation was nested within a randomised controlled trial, and was based on a health system perspective, with follow-up and time horizon of 12 months. We measured incremental costs per quality-adjusted life years (QALY) gained. Total average costs per patient included PaHS programme costs, and costs in hospitals, primary care and municipalities. We analysed differences by generalised linear models with Gamma distribution for costs and mixed models for QALY. Results We analysed data on 6,139 patients, where 3,041 received PaHS and 3,098 received usual care. We found no difference in healthcare costs, and programme costs were on average €1,762 per patient, providing incremental costs of €2,075. Incremental effects on QALY were 0.007, resulting in an ICER of €296,389 per QALY gained. Conclusion We found no evidence of PaHS being cost-effective in this study, but the results will be used to identify new ways to organise similar interventions and identify patients with the objective to reduce health system costs per patient. [ABSTRACT FROM AUTHOR]