Terminal Delirium in Hospice: The Experiences and Perspectives of Caregivers Providing Care to Terminally Ill Patients in Home Settings.

Objectives: Little is known about the experiences of caregivers who provide care to persons with terminal delirium (TD) in home settings. This scarcity of information is suggestive that further research is needed about care for hospice patients with delirium in the home and community.

Aim: To elicit views, feelings, and end-of-life care experiences of primary caregivers assisting dying persons with TD in hospice at home.

Deactivating a Pacemaker in Home Care Hospice: Experiences of the Family Caregivers of a Terminally Ill Patient.

Objectives: Although the experiences of family members who care for relatives at the end of life have been researched extensively, little is known about the needs and experiences of families caring for hospice patients with pacemakers.

Aim: To better understand the experiences of family caregivers of a terminally ill patient who received hospice care at home and chose deactivation of a pacemaker.

Design: The exploratory, cross-sectional design involved semistructured, in-depth interviews.

Spiritual Care at the End of Life: Does Educational Intervention Focused on a Broad Definition of Spirituality Increase Utilization of Chaplain Spiritual Support in Hospice?

Research shows that religion and spirituality are important when persons cope with serious and life-threatening illness. Patients who receive good spiritual care report greater quality of life and better coping, and such support is strongly associated with greater well-being, hope, optimism, and reduction of despair at end of life. Despite these benefits, evidence shows that many patients and caregivers (P/C) refuse spiritual care when a hospice team offers it, possibly resulting in unnecessary suffering.

Geoffrey Keynes's Two-Fold Vision: Medical Savant-Connoisseur and Literary Bibliographer.

During the 1920s and 1930s, the British surgeon Geoffrey Keynes (1887-1982) treated breast cancer with radium instead of the hegemonic radical mastectomy, while vehemently attacking the "radicalists" for mutilating women. Keynes was also a leading bibliographer of literary figures from Sir Thomas Browne to William Blake through Jane Austen. This article argues that these endeavors did not inhabit separate worlds, but rather his bibliographic methods of collecting and sorting were deeply interwoven with his therapeutic practices and medical ways of knowing.

Quantitative ultrasonic evaluation of radiation-induced late tissue toxicity: pilot study of breast cancer radiotherapy.

Purpose: To investigate the use of advanced ultrasonic imaging to quantitatively evaluate normal-tissue toxicity in breast-cancer radiation treatment.

Methods And Materials: Eighteen breast cancer patients who received radiation treatment were enrolled in an institutional review board-approved clinical study. Radiotherapy involved a radiation dose of 50.

Framing change for high-value healthcare systems.

Healthcare providers are challenged by forces that are driving change at an accelerated rate. Unfortunately, organizational structures, system inertia, and the lack of shared values in many organizations thwart change. Systems that do not understand the principles of change management for complex adaptive systems (CAS) continue to apply change models that have little chance of success.

A feasibility study of novel ultrasonic tissue characterization for prostate-cancer diagnosis: 2D spectrum analysis of in vivo data with histology as gold standard.

This study demonstrates the feasibility of using a novel 2D spectrum ultrasonic tissue characterization (UTC) technique for prostate-cancer diagnosis. Normalized 2D spectra are computed by performing Fourier transforms along the range (beam) and the cross-range directions of the digital radio-frequency echo data, then dividing by a reference spectrum. This 2D spectrum method provides axial and lateral information of tissue microstructures, an improvement over the current 1D spectrum analysis which only provides axial information.

Implementation and validation of an ultrasonic tissue characterization technique for quantitative assessment of normal-tissue toxicity in radiation therapy.

The goal of this study was to implement and validate a noninvasive, quantitative ultrasonic technique for accurate and reproducible measurement of normal-tissue toxicity in radiation therapy. The authors adapted an existing ultrasonic tissue characterization (UTC) technique that used a calibrated 1D spectrum based on region-of-interest analysis. They modified the calibration procedure by using a reference phantom instead of a planar reflector.

Measurements of Radiation-Induced Skin Changes in Breast-Cancer Radiation Therapy Using Ultrasonic Imaging.

Skin injury is a common side effect of breast-cancer radiation therapy. Although physicians often observe skin toxicity, quantifying its severity remains a challenge. We present a novel quantitative ultrasonic technique to evaluate skin changes associated with radiotherapy.

Incorporate imaging characteristics into an arteriovenous malformation radiosurgery plan evaluation model.

Purpose: To integrate imaging performance characteristics, specifically sensitivity and specificity, of magnetic resonance angiography (MRA) and digital subtraction angiography (DSA) into arteriovenous malformation (AVM) radiosurgery planning and evaluation.

Methods And Materials: Images of 10 patients with AVMs located in critical brain areas were analyzed in this retrospective planning study. The image findings were first used to estimate the sensitivity and specificity of MRA and DSA.

Ultrasonic tissue characterization via 2-D spectrum analysis: theory and in vitro measurements.

A theoretical model is described for application in ultrasonic tissue characterization using a calibrated 2-D spectrum analysis method. This model relates 2-D spectra computed from ultrasonic backscatter signals to intrinsic physical properties of tissue microstructures, e.g.

How does performance of ultrasound tissue typing affect design of prostate IMRT dose-painting protocols?

Purpose: To investigate how the performance characteristics of ultrasound tissue typing (UTT) affect the design of a population-based prostate dose-painting protocol.

Methods And Materials: The performance of UTT is evaluated using the receiver operating characteristic curve. As the imager's sensitivity increases, more tumors are detected, but the specificity worsens, causing more false-positive results.

Novel lung IMRT planning algorithms with nonuniform dose delivery strategy to account for respiratory motion.

To effectively deliver radiation dose to lung tumors, respiratory motion has to be considered in treatment planning. In this paper we first present a new lung IMRT planning algorithm, referred as the dose shaping (DS) method, that shapes the dose distribution according to the probability distribution of the tumor over the breathing cycle to account for respiratory motion. In IMRT planning a dose-based convolution method was generally adopted to compensate for random organ motion by performing 4-D dose calculations using a tumor motion probability density function.

Use of simulated annealing for optimization of alignment parameters in limited MRI acquisition volumes of the brain.

Studies suggest that clinical outcomes are improved in repeat trigeminal neuralgia (TN) Gamma Knife radiosurgery if a different part of the nerve from the previous radiosurgery is treated. The MR images taken in the first and repeat radiosurgery need to be coregistered to map the first radiosurgery volume onto the second treatment planning image. We propose a fully automatic and robust three-dimensional (3-D) mutual information- (MI-) based registration method engineered by a simulated annealing (SA) optimization technique.

Ultrasonic tissue characterization using 2-D spectrum analysis and its application in ocular tumor diagnosis.

We are investigating the utility of a new ultrasonic tissue characterization technique, specifically two-dimensional (2-D) spectrum analysis of radio-frequency backscatter signals, which promises to provide quantitative measures of the physical properties of tissue microstructures. Previously successful 1-D spectrum analysis is expanded to 2-D to more fully characterize diagnostically significant features of biological tissue. Two new spectral functions, radially integrated spectral power (RISP) and angularly integrated spectral power (AISP), are defined to quantitatively characterize tissue properties.

A study of the effects of internal organ motion on dose escalation in conformal prostate treatments.

Background And Purpose: To assess the effect of internal organ motion on the dose distributions and biological indices for the target and non-target organs for three different conformal prostate treatment techniques.

Materials And Methods: We examined three types of treatment plans in 20 patients: (1) a six field plan, with a prescribed dose of 75.6 Gy; (2) the same six field plan to 72 Gy followed by a boost to 81 Gy; and (3) a five field plan with intensity modulated beams delivering 81 Gy.

Quality assurance in intensity modulated radiotherapy by identifying standards and patterns in treatment preparation: a feasibility study on prostate treatments.

Background And Purpose: Quality assurance (QA) in intensity modulated treatments is a complex and time-consuming process. In spite of intensive quality control procedures some types of errors still can go undetected through the course of a treatment. This study aims to develop an objective QA filter for fast, automatic detection of errors, based on the creation of a global platform monitoring treatment parameters by comparison with existing local standards.

Pre-treatment dosimetric verification by means of a liquid-filled electronic portal imaging device during dynamic delivery of intensity modulated treatment fields.

Background And Purpose: Although intensity modulated radiation therapy is characterized by three-dimensional dose distributions which are often superior to those obtained with conventional treatment plans, its routine clinical implementation is partially held back by the complexity of the beam verification. This is even more so when a dynamic multileaf collimator (dMLC) is used instead of a segmented beam delivery. We have therefore investigated the possibility of using a commercially available, liquid-filled electronic portal imaging device (EPID) for the pre-treatment quality assurance of dynamically delivered dose distributions.

The utility of SPECT in determining the relationship between radiation dose and salivary gland dysfunction after radiotherapy.

Salivary gland scintigraphy (SGS) is used to depict salivary gland dysfunction after radiotherapy (RT). The aim of this study was to investigate the utility of SGS combined with single photon emission computed tomography (SPECT). Twenty-one patients with a carcinoma of head and neck underwent SGS before and 1 month after RT.

Late rectal bleeding after conformal radiotherapy of prostate cancer. II. Volume effects and dose-volume histograms.

Purpose And Objective: Late rectal bleeding is a potentially dose limiting complication of three-dimensional conformal radiotherapy (3D-CRT) for prostate cancer. The frequency of late rectal bleeding has been shown to increase as the prescription dose rises above 70 Gy. The purpose of this study is to identify features of the cumulative dose-volume histogram (DVH) for the rectal wall that correlate with late rectal bleeding after 3D-CRT for prostate cancer.

Differences in palliative radiotherapy for bone metastases within Western European countries.

Purpose: To evaluate the differences in palliative radiotherapy for painful bone metastases amongst different Western European countries.

Materials And Methods: A questionnaire was sent to 565 radiotherapy centres in 19 Western European countries, based on the 1997 ESTRO directory. In this questionnaire the current local palliative radiotherapy practice for bone metastases was assessed in terms of total dose, fractionation, treatment complexity (use of shielding blocks, frequency of isodose calculations, field set-up) and type of machine used.

Palliative radiotherapy practice within Western European countries: impact of the radiotherapy financing system?

Purpose: To analyze the reimbursement modalities for radiotherapy in the different Western European countries, as well as to investigate if these differences have an impact on the palliative radiotherapy practice for bone metastases.

Materials And Methods: A questionnaire was sent to 565 radiotherapy centres included in the 1997 ESTRO directory. In this questionnaire the reimbursement strategy applied in the different centres was assessed, with respect to the use of a budget (departmental or hospital budget), case payment and/or fee-for-service reimbursement.