Wellington Blood and Cancer Center

Wellington, New Zealand

Wellington Blood and Cancer Center

Wellington, New Zealand
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Holt A.,Netherlands Cancer Institute | Holt A.,University of Duisburg - Essen | Van Gestel D.,University of Antwerp | Arends M.P.,Radiotherapeutic Institute Friesland | And 6 more authors.
Radiation Oncology | Year: 2013

Background: Compared to static beam Intensity-Modulated Radiation Therapy (IMRT), the main advantage of Volumetric Modulated Arc Therapy (VMAT) is a shortened delivery time, which leads to improved patient comfort and possibly smaller intra-fraction movements. This study aims at a treatment planner-independent comparison of radiotherapy treatment planning of IMRT and VMAT for head-and-neck cancer performed by several institutes and based on the same CT- and contouring data. Methods: Five institutes generated IMRT and VMAT plans for five oropharyngeal cancer patients using either Pinnacle3 or Oncentra Masterplan to be delivered on Elekta linear accelerators. Results: Comparison of VMAT and IMRT plans within the same patient and institute showed significantly better sparing for almost all OARs with VMAT. The average mean dose to the parotid glands and oral cavity was reduced from 27.2 Gy and 39.4 Gy for IMRT to 25.0 Gy and 36.7 Gy for VMAT, respectively. The dose conformity at 95% of the prescribed dose for PTVboost and PTVtotal was 1.45 and 1.62 for IMRT and 1.37 and 1.50 for VMAT, respectively. The average effective delivery time was reduced from 13:15 min for IMRT to 5:54 min for VMAT. Conclusions: Independently of institution-specific optimization strategies, the quality of the VMAT plans including double arcs was superior to step-and-shoot IMRT plans including 5-9 beam ports, while the effective treatment delivery time was shortened by ~50% with VMAT. © 2013 Holt et al; licensee BioMed Central Ltd.

Collings S.,University of Otago | Collings S.,Malaghan Institute of Medical Research | Thompson O.,Callaghan Innovation | Hirst E.,Callaghan Innovation | And 5 more authors.
PLoS ONE | Year: 2016

Background and Aims Anaemia is a major health burden worldwide. Although the finding of conjunctival pallor on clinical examination is associated with anaemia, inter-observer variability is high, and definitive diagnosis of anaemia requires a blood sample.We aimed to detect anaemia by quantifying conjunctival pallor using digital photographs taken with a consumer camera and a popular smartphone. Our goal was to develop a non-invasive screening test for anaemia. Patients and Methods The conjunctivae of haemato-oncology in- and outpatients were photographed in ambient lighting using a digital camera (Panasonic DMC-LX5), and the internal rear-facing camera of a smartphone (Apple iPhone 5S) alongside an in-frame calibration card. Following image calibration, conjunctival erythema index (EI) was calculated and correlated with laboratorymeasured haemoglobin concentration. Three clinicians independently evaluated each image for conjunctival pallor. Results Conjunctival EI was reproducible between images (average coefficient of variation 2.96%). EI of the palpebral conjunctiva correlated more strongly with haemoglobin concentration than that of the forniceal conjunctiva. Using the compact camera, palpebral conjunctival EI had a sensitivity of 93% and 57% and specificity of 78% and 83% for detection of anaemia (haemoglobin <110 g/L) in training and internal validation sets, respectively. Similar results were found using the iPhone camera, though the EI cut-off value differed. Conjunctival EI analysis compared favourably with clinician assessment, with a higher positive likelihood ratio for prediction of anaemia. Conclusions Erythema index of the palpebral conjunctiva calculated from images taken with a compact camera or mobile phone correlates with haemoglobin and compares favourably to clinician assessment for prediction of anaemia. If confirmed in further series, this technique may be useful for the non-invasive screening for anaemia. © 2016 Collings et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Jolly D.,Wellington Blood and Cancer Center | Jolly D.,University of Canterbury | Alahakone D.,Wellington Blood and Cancer Center | Meyer J.,University of Canterbury
Journal of Applied Clinical Medical Physics | Year: 2011

Since the clinical implementation of novel rotational forms of intensity-modulated radiotherapy, a variety of planning studies have been published that reinforce the major selling points of the technique. Namely, comparable or even improved dose distributions with a reduction in both monitor units and treatment times, when compared with static gantry intensity-modulated radiotherapy. Although the data are promising, a rigorous approach to produce these plans has yet to be established. As a result, this study outlines a robust and streamlined planning strategy with a concentration on RapidArc class solutions for prostate with a simultaneous integrated boost. This planning strategy outlines the field setup, recommended starting objectives, required user interactions to be made throughout optimization and post-optimization adjustments. A comparative planning study, with static gantry IMRT, is then presented as justification for the planning strategy itself. A variety of parameters are evaluated relating to both the planning itself (optimization and calculation time) and the plans that result. Results of this comparative study are in line with previously published data, and the planning process is streamlined to a point where the RapidArc optimization time takes 15 ± 1.3 minutes. Application of this planning strategy reduces the dependence of the produced plan on the experience of the planner, and has the potential to streamline the planning process within radiotherapy departments.

Donnelly S.,Wellington Public Hospital | Dickson M.,Wellington Blood and Cancer Center
QJM | Year: 2013

Background: Although the majority of deaths occur in hospital it has been suggested that dying in hospital is largely a negative experience. Aim: To explore the experience of relatives and staffof patients dying in hospital using qualitative grounded theory. Methods: Patients receiving palliative care were identified who were likely to die in hospital. Family members were met by the researcher prior to the patient's death. The ward nurse and doctor (excluding palliative care team) most involved at that time were interviewed within 48 h of the death. The family were interviewed 2 weeks later. Interviewees described their experience of the patient's dying and death. Recruitment and thematic analysis of interviews occurred concurrently. Results: Twelve triads over 6 months (relative, nurse and doctor) were interviewed in relation to 12 patients. Dying patients and families need a guide to attend to their needs. Every detail is remembered by the family who take up residence in the hospital. Families value acts of kindness by staff. Hospital may offer benefits for the dying patient and family. However, there are gaps in care identified by families and staff. After death is critical time for the family. Junior doctors are often uncertain of their role, expressing grief and guilt. Young nurses inexperienced in care of dying patients value support and guidance by senior colleagues. Conclusion: Leadership from nursing and medical staffis required for seamless provision of competent and compassionate care at this life changing time for grieving families. © The Author 2013. Published by Oxford University Press on behalf of the Association of Physicians. All rights reserved.

Kusters M.,Radboud University Nijmegen | Louwe R.,Radboud University Nijmegen | Louwe R.,Wellington Blood and Cancer Center | Biemans-van Kastel L.,Radboud University Nijmegen | And 5 more authors.
Journal of Applied Clinical Medical Physics | Year: 2015

For specific radiation therapy (RT) treatments, it is advantageous to use the isocenter-to-couch distance (ICD) for initial patient setup.(1) Since sagging of the treatment couch is not properly taken into account by the electronic readout of the treatment machine, this readout cannot be used for initial patient positioning using the isocenter-to-couch distance (ICD). Therefore, initial patient positioning to the prescribed ICD has been carried out using a ruler prior to each treatment fraction in our institution. However, the ruler method is laborious and logging of data is not possible. The objective of this study is to replace the ruler-based setup of the couch height with an independent, user-friendly, optical camera-based method whereby the radiation technologists have to move only the couch to the correct couch height, which is visible on a display. A camera-based independent couch height measurement system (ICHS) was developed in cooperation with Panasonic Electric Works Western Europe. Clinical data showed that the ICHS is at least as accurate as the application of a ruler to verify the ICD. The camera-based independent couch height measurement system has been successfully implemented in seven treatment rooms, since 10 September 2012. The benefits of this system are a more streamlined workflow, reduction of human errors during initial patient setup, and logging of the actual couch height at the isocenter. Daily QA shows that the systems are stable and operate within the set 1 mm tolerance. Regular QA of the system is necessary to guarantee that the system works correctly.

Roohullah A.,Wellington Blood and Cancer Center | Moniwa A.,Wellington Blood and Cancer Center | Wood C.,Wellington Blood and Cancer Center | Wood C.,Malaghan Institute of Medical Research | And 7 more authors.
Internal Medicine Journal | Year: 2013

Australian guidelines for neutropenic fever recommend piperacillin/tazobactam (PIP-TAZ) or cefepime for first-line empiric treatment of neutropenic fever. We compared outcomes among haematology patients before and after changing our first-line neutropenic fever treatment from imipenem to PIP-TAZ. Forty-five patients received imipenem and 60 PIP-TAZ. Despite a higher rate of antibiotic modification in the PIP-TAZ cohort, treatment success and time to defervescence were similar, with a trend towards fewer Clostridium difficile infections in the PIP-TAZ cohort. © 2013 Royal Australasian College of Physicians.

Jolliffe E.,Wellington Blood and Cancer Center | Romeril K.,Wellington Blood and Cancer Center
Internal Medicine Journal | Year: 2014

Autoimmune manifestations are a common occurrence with chronic lymphocytic leukaemia (CLL). We describe a case of CLL-associated immune thrombocytopenia (ITP) that had a loss of response to standard treatment for ITP. The thrombopoeitin receptor agonist, eltrombopag, was successfully used preoperatively to increase the platelet count to a safer level, in this instance to facilitate laparoscopic splenectomy. © 2014 Royal Australasian College of Physicians.

O'Brien I.,Cancer Control New Zealand | Britton E.,Cancer Control New Zealand | Sarfati D.,University of Otago | Naylor W.,Palliative Care Council of New Zealand | And 5 more authors.
New Zealand Medical Journal | Year: 2010

Aims: The 2009 Cancer Care Survey aimed to gather information from patients about their experiences receiving outpatient cancer care. Methods: In mid-2009, Cancer Control New Zealand sent an NRC+Picker postal survey to a stratified sample of 3251 eligible adults, who had received outpatient cancer care between October 2008 and March 2009. Eight cancer treatment facilities across New Zealand provided patient lists from which potential respondents were selected. Results: The final response rate to the survey was 68%. Most of the patients surveyed responded very positively to questions related to specialist care coordination (91% positive response; 95%CI: 90-93), the level of privacy (87% positive response; 95%CI: 85-89), and the dignity and respect provided by healthcare professionals (86% positive response; 95%CI: 85-88). However, patients tended to be much less positive about the level of information they received on the effects of cancer treatment on their day-to-day life (responses ranging between 30% and 40% positive) and the level of emotional support provided (36% positive response; 95%CI: 33-39). Responses from different cancer services tended to follow similar patterns, although for twelve questions there was at least a 20% difference in response between services. Conclusions: Overall, patients rated their outpatient cancer care experiences as positive, but important gaps exist in the provision of information, emotional support, and treating patients within the context of their living situation. Cancer patient experience surveys can achieve high response rates and generate useful information on patient perceptions of their care. This data can be used to inform quality improvement efforts at both national and cancer treatment service levels. ©NZMA.

Jolliffe E.,Wellington Blood and Cancer Center | Flanagan P.,New Zealand Blood Service
New Zealand Medical Journal | Year: 2014

Aims In March 2013 the Australasian Society of Thrombosis and Haemostasis published an update of the Consensus Guidelines for Warfarin Reversal.3 We reviewed the prescribing practices at Capital and Coast District Health Board (CCDHB), following publication of the updated guidelines. Methods Patients were identified through multiple sources. CCDHB Medical Records identified admissions coded as “Haemorrhagic disorder due to circulating anticoagulants” or “Anticoagulants causing adverse effects in therapeutic use”. CCDHB Haematology Laboratory identified International Normalised Ratio (INR) results _4.5. Wellington Hospital Pharmacy identified patients dispensed vitamin K. New Zealand Blood Service identified recipients of Prothrombinex®-VF and Fresh Frozen Plasma (FFP). Results The management of patients with elevated INR results or bleeding on warfarin therapy was consistent with the updated guidelines in 81/149 episodes. Thirty one patients received FFP unnecessarily and 24 patients did not receive Prothrombinex®-VF when indicated. The greatest variability in management occurred in patients with bleeding complications and in patients requiring urgent warfarin reversal to allow acute surgery to proceed with only 5/31 patients and 5/21 patients having warfarin reversed as recommended. In some episodes more than one error was identified. Conclusions The audit identified the suboptimal use of Prothrombinex®-VF and the unnecessary use of FFP in the management of warfarin reversal. © NZMA.

Weinkove R.,Malaghan Institute of Medical Research | Weinkove R.,Wellington Blood and Cancer Center | Weinkove R.,University of Otago | Brooks C.R.,Massey University | And 5 more authors.
Journal of Immunological Methods | Year: 2013

Functional studies of cellular immunity in patients with leukemia often require separation of leukemic cells from other peripheral blood mononuclear cells (PBMCs). This can pose a challenge when the number of leukemic cells is very high, such as in untreated patients with chronic lymphocytic leukemia (CLL). We found that when leukemia cell frequency was very high, anti-CD19 coated immunomagnetic beads did not thoroughly deplete B cells when used according to manufacturer's instructions. In this study, we depleted leukemic B cells using a modified protocol comprising serial rounds of depletion using immunomagnetic beads at reduced bead to cell ratios. This resulted in more effective B cell depletion with the use of fewer immunomagnetic beads, and without affecting viability or yield of non-B cells. CD19. - PBMC subsets were retained, and serial depletion rounds did not activate T cells and monocytes. The positively isolated CLL cells were of high purity and were available for downstream analysis. This is a convenient and cost-effective method to enable in vitro analysis of immunocompetent cells from patients with leukemia. © 2013 Elsevier B.V.

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