Towards optimal use of antithrombotic therapy of people with cancer at the end of life: A research protocol for the development and implementation of the SERENITY shared decision support tool.

Background: Even though antithrombotic therapy has probably little or even negative effects on the well-being of people with cancer during their last year of life, deprescribing antithrombotic therapy at the end of life is rare in practice. It is often continued until death, possibly resulting in excess bleeding, an increased disease burden and higher healthcare costs.

Methods: The SERENITY consortium comprises researchers and clinicians from eight European countries with specialties in different clinical fields, epidemiology and psychology.

Extensively drug-resistant bacteria: Which ethical issues?

Objective: The increased bacterial resistance to antibiotics has now become a public health concern. How can we preserve the well-being of patients presenting with infections caused by extensively drug-resistant bacteria (EDRBs) and that of their contacts without inducing any loss of chance of survival, all the while living together and controlling the spread of these EDRBs?

Method: Terre d'éthique, a French territorial ethics committee, was asked to reflect on this topic by the infection control unit of a French University Hospital as it raises many ethical issues.

Results: Patients are at the core of any ethical approach, and respecting their autonomy is fundamental.

Bleeding risk of terminally ill patients hospitalized in palliative care units: the RHESO study.

Unlabelled: Essentials Bleeding incidence as hemorrhagic risk factors are unknown in palliative care inpatients. We conducted a multicenter observational study (22 Palliative Care Units, 1199 patients). At three months, the cumulative incidence of clinically relevant bleeding was 9.

Return home at the end of life: Patients' vulnerability and risk factors.

Although most of the people in good health questioned about the subject said they would like to die at home, in the western world between 60 and 80% of deaths occur in hospital. Most authors consider that the indispensable conditions for a return home are the patient's desire and presence of the family and caregivers with the appropriate skills. The assessment of other factors predictive of a return home is inadequate.

[Image fusion methods for the repositioning of the patient in radiotherapy].

Conformal radiotherapy requires the accurate and reproducible setup of the patient for each fraction delivery. Megavoltage imaging could enable this. This requires the development of image processing and data fusion algorithms.

Patient set-up using portal images: 2D/2D image registration using mutual information.

Objective: Conformal radiation therapy requires accurate patient set-up for each fraction delivery. Electronic portal imaging devices allow the acquisition of portal images just before and even during dose delivery. However, the quantitative interpretation of these images in determining and correcting the patient's position remains uncertain, and automated methods are therefore being developed.

The use of a semi-customized phantom for verification of conformal plans.

We have developed a technique for inverse treatment planning of prostate therapy designed to improve the degree of conformation between the dose distribution and the target volume. We compared the inverse plan with a "standard" four-field box technique as well as a four-field technique using oblique fields ("cross technique"). We validated the dosimetry of the inverse plan using Fricke gel solution in phantom specifically designed for this purpose.

[Multicenter study on sensitization to Alternaria mold].

The reality emerged of a non-negligible frequency of positive tests to "Alternaria". This was conducted by the inclusion of this mould in the standard allergy assessment, especially if a summer predominance of symptoms was known. A significant difference emerged between seasonal peaks which had to do with mono or polysensitisation.

[3-D conformal radiotherapy procedure and registration of pre- and intra-radiotherapeutic data].

The authors describe the different steps of 3-D conformal external irradiation. They mention as well two procedures of isocentric repositioning which are mandatory for the matching of anatomical data: the first one is acquired before the simulation and the second one just before the radiotherapy session.

Patient setup optimization for external conformal radiotherapy.

The aim of conformal radiotherapy is to deliver precisely a specific dose of radiation to a planning target volume, concurrently radiating as little healthy tissue and organs as possible. This can be accomplished only with the accurate positioning of the patient with respect to the radiotherapy system. In this paper, we describe a system to achieve a higher overall accuracy in the delivery of a prostatic radiation boost for treatment of carcinoma of the prostate.

Conformal external radiotherapy of prostatic carcinoma: requirements and experimental results.

The aim of conformal radiotherapy is to deliver, with high precision, a specific dose (which may be a high dose) to a planning target volume, concurrently with irradiating as little as possible healthy tissue and organs at risk. Radiation therapy may suffer from a number of problems that result in both over- or under-sizing the irradiation fields, making over-rough simplifications of the irradiation ballistics and delivering an insufficient tumoral dose (to spare critical organs and reduce toxicity). One of these problems lies in the accurate positioning of the planning target volume with respect to the irradiation system, thence in the correct execution of the ballistics.