Grand Rapids, MI, United States
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PubMed | University of Michigan, Northwestern University, Mercy Health Partners, Saint Mary Mercy Hospital and 6 more.
Type: Journal Article | Journal: Implementation science : IS | Year: 2016

Guided by the Reach,Effectiveness,Adoption,Implementation, andMaintenance (RE-AIM) implementation framework, a National Institutes of Health-sponsored study compared the nurse-administered Tobacco Tactics intervention to usual care. A prior paper describes the effectiveness of the Tobacco Tactics intervention. This subsequent paper provides data describing the remaining constructs of the RE-AIM framework.This pragmatic study used a mixed methods, quasi-experimental design in five Michigan community hospitals of which three received the nurse-administered Tobacco Tactics intervention and two received usual care. Nurses and patients were surveyed pre- and post-intervention. Measures included reach (patient participation rates, characteristics, and receipt of services), adoption (nurse participation rates and characteristics), implementation (pre-to post-training changes in nurses attitudes, delivery of services, barriers to implementation, opinions about training, documentation of services, and numbers of volunteer follow-up phone calls), and maintenance (continuation of the intervention once the study ended).Reach: Patient participation rates were 71.5%. Compared to no change in the control sites, there were significant pre- to post-intervention increases in self-reported receipt of print materials in the intervention hospitals (n=1370, p<0.001). Adoption: In the intervention hospitals, all targeted units and several non-targeted units participated; 76.0% (n=1028) of targeted nurses and 317 additional staff participated in the training, and 92.4% were extremely or somewhat satisfied with the training.Nurses in the intervention hospitals reported increases in providing advice to quit, counseling, medications, handouts, and DVD (all p<0.05) and reported decreased barriers to implementing smoking cessation services (p<0.001). Qualitative comments were very positive (user friendly, streamlined, or saves time), although problems with showing patients the DVD and charting in the electronic medical record were noted. Maintenance: Nurses continued to provide the intervention after the study ended.Given that nurses represent the largest group of front-line providers, this intervention, which meets Joint Commission guidelines for treating inpatient smokers, has the potential to have a wide reach and to decrease smoking, morbidity, and mortality among inpatient smokers. As we move toward more population-based interventions, the RE-AIM framework is a valuable guide for implementation.ClinicalTrials.gov, NCT01309217.


Farina E.,University of Bologna | Monari F.,University of Bologna | Tallini G.,University of Bologna | Repaci A.,University of Bologna | And 10 more authors.
Endocrine Pathology | Year: 2016

The most common sites of metastatic differentiated thyroid cancer are the neck lymph nodes, while distant metastases typically involve the lungs, the bones, and less frequently the brain. Uncommon metastatic sites include the liver, adrenal gland, kidney, pancreas, and skin. The epidemiological aspects of thyroid metastases in rare sites are largely unknown and their identification could have a significant impact on patients management. A mini-series of unusual metastatic sites of thyroid carcinoma is proposed as a contribution to current knowledge on anatomopathological characteristics and clinical outcome. Of the six cases that were assessed, the metastases were the following: skin metastases (2), skin and pancreas metastases (1), renal metastasis (1), adrenal metastasis (1), and liver metastasis (1). In our experience, metastases in rare sites do not always represent a negative prognostic factor for disease outcome. In fact they can occur as single distant lesion and if surgically resectable, their treatment can also lead to local disease remission. © 2015, Springer Science+Business Media New York.


Digesu C.,John Paul II University | Cilla S.,John Paul II University | De Gaetano A.,CNR Institute for System Analysis and Computer Science Antonio Ruberti | Massaccesi M.,John Paul II University | And 12 more authors.
Medical Dosimetry | Year: 2011

The aim of this study was to compare intensity-modulated radiation therapy (IMRT) with 3D conformal technique (3D-CRT), with respect to target coverage and irradiation of organs at risk for high dose postoperative radiotherapy (PORT) of the prostate fossa. 3D-CRT and IMRT treatment plans were compared with respect to dose to the rectum and bladder. The dosimetric comparison was carried out in 15 patients considering 2 different scenarios: (1) exclusive prostate fossa irradiation, and (2) pelvic node irradiation followed by a boost on the prostate fossa. In scenario (1), a 3D-CRT plan (box technique) and an IMRT plan were calculated and compared for each patient. In scenario (2), 3 treatment plans were calculated and compared for each patient: (a) 3D-CRT box technique for both pelvic (prophylactic nodal irradiation) and prostate fossa irradiation (3D-CRT only); (b) 3D-CRT box technique for pelvic irradiation followed by an IMRT boost to the prostatic fossa (hybrid 3D-CRT and IMRT); and (c) IMRT for both pelvic and prostate fossa irradiation (IMRT only). For exclusive prostate fossa irradiation, IMRT significantly reduced the dose to the rectum (lower Dmean, V50%, V75%, V90%, V100%, EUD, and NTCP) and the bladder (lower Dmean, V50%, V90%, EUD and NTCP). When prophylactic irradiation of the pelvis was also considered, plan C (IMRT only) performed better than plan B (hybrid 3D-CRT and IMRT) as respect to both rectum and bladder irradiation (reduction of Dmean, V50%, V75%, V90%, equivalent uniform dose [EUD], and normal tissue complication probability [NTCP]). Plan (b) (hybrid 3D-CRT and IMRT) performed better than plan (a) (3D-CRT only) with respect to dose to the rectum (lower Dmean, V75%, V90%, V100%, EUD, and NTCP) and the bladder (Dmean, EUD, and NTCP). Postoperative IMRT in prostate cancer significantly reduces rectum and bladder irradiation compared with 3D-CRT. © 2011 American Association of Medical Dosimetrists.


PubMed | The Lacks Cancer Center
Type: Journal Article | Journal: Cureus | Year: 2016

Stereotactic radiosurgery (SRS) treatment is characterized by high doses per fraction and extremelysteep dose gradients. This requires a great degree of accurate localization to the appropriate treatment position, and continuous immobilization during the treatment session. In the case of Trigeminal Neuralgia (TGN) treatment this is especially true as the very small target volume makes positional accuracy critical. In this study we carried out a quantitative analysis of patient motion during the full treatment fraction within a radiosurgery immobilization mask system. Patient cranial movement was assessed by using the image guidance stereo x-ray cameras on a CyberKnife (CK) M6 robotic radiosurgery system (Accuray, Sunnyvale, CA).A total of five patients received treatments for either right or left TGN. The duration of treatment varied from 24-64 minutes. Orthogonal images were taken every 15 seconds during the treatment to assess patient movement. Approximately 60 stereo images were taken per patient and a total of 560 images were analyzed in this study. The mean absolute movement in each of longitudinal, lateral or vertical directions was approximately 0.3 mm for the duration of the treatment; however, on occasion much greater movement was observed during a fraction. The maximum displacement was in the longitudinal direction and reached 2.4 mm compared to the initial setup. Images taken at the end of the treatment session showed that the patients typically return to a position closer to the original setup position than the maximum excursion that occurred. This data suggests that although this mask system appears stable during much of the treatment session; for some patients there may be momentary patient movements that take place.Frequent imaging and correction can help mitigate the effect of this movement. It is important to understand the limitations of non-invasive mask systems when used for very high precision treatment.

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