Ultrasound-guided regional anesthesia facilitates an approach to sensitive targets such as nerve clusters without contact or inadvertent puncture. We compared accuracy of needle placement with a novel passive magnetic ultrasound needle guidance technology (NGT) versus conventional ultrasound (CU) with echogenic needles.
Methods
Sixteen anesthesiologists and 19 residents performed a series of 16 needle insertion tasks each, 8 using NGT (n = 280) and 8 using CU (n = 280), in high-fidelity porcine phantoms. Tasks were stratified based on aiming to contact (target-contact) or place in close proximity with (target-proximity) targets, needle gauge (no. 18/no. 22), and in-plane (IP) or out-of-plane (OOP) approach. Distance to the target, task completion by aim, number of passes, and number of tasks completed on the first pass were reported.
Results
Needle guidance technology significantly improved distance, task completion, number of passes, and completion on the first pass compared with CU for both IP and OOP approaches (P ⩽ 0.001). Average NGT distance to target was lower by 57.1% overall (n = 560, 1.5 ± 2.4 vs 3.5 ± 3.7 mm), 38.5% IP (n = 140, 1.6 ± 2.6 vs 2.6 ± 2.8 mm), and 68.2% OOP (n = 140, 1.4 ± 2.2 vs 4.4 ± 4.3 mm) (all P ⩽ 0.01). Subgroup analyses revealed accuracy gains were largest among target-proximity tasks performed by residents and for OOP approaches. Needle guidance technology improved first-pass completion from 214 (76.4%) per 280 to 249 (88.9%) per 280, a significant improvement of 16.4% (P = 0.001).
Conclusions
Passive magnetic NGT can improve accuracy of needle procedures, particularly among OOP procedures requiring close approach to sensitive targets, such as nerve blocks in anesthesiology practice.
The internal pelvic floor muscles that support the pelvic viscera lie within the external pelvic structures, which support posture and locomotion. The presence of pain in the hip, groin, leg, abdomen, and/or back in patients with pelvic pain suggests that external pelvic sites may act as pain generators that contribute to chronic pelvic pain (CPP). The aim of this study was to report musculoskeletal diagnoses resulting from including a physiatry evaluation as part of a Multidisciplinary Pelvic Pain Clinic for women with complex chronic pain.This retrospective case series was conducted by chart review of all women attending the clinic from February 2016 through March 2018. Variable definitions were created for each demographic and clinical characteristic and used to guide a structured review of the chart. Descriptive statistical analysis was performed.Ninety-six percent of the 68 women (mean age, 51 years) had CPP of 6 months' duration or longer. Levator ani tenderness was present in 81% and obturator internus tenderness in 81%. Seventy-one percent of women had failed pelvic physical therapy. Musculoskeletal diagnoses included osteoarthritis, tendinopathies, enthesopathies, osteitis pubis, ischiofemoral impingement, Paget disease, and other systemic conditions.Musculoskeletal abnormalities were common in this highly selected cohort of complex CPP cases with external pelvic symptoms. The imaging findings and specific diagnoses allowed targeted therapy beyond generalized physical therapy for CPP. The expertise of urogynecologists and physical therapists who evaluate the internal pelvic muscles and viscera combined with the physiatrist's expertise in musculoskeletal assessment and imaging provides an expanded, collaborative approach for managing these patients.
Purpose: Collaboration on documents and manuscripts plays a central role in conveying medical physics concepts between interdisciplinary teams, necessary for knowledge‐building, acquiring funding, and translating scientific concepts to applied medical solutions. Conventional tools and emerging internet‐based solutions are used in generating and disseminating physics documents among teams. This research aimed to gain insights on how medical physics professionals and educators are using collaborative documentation software and team practices. Methods: An online survey based on a modified version of the Noel & Roberts (2004) collaborative documentation survey in 'Computer Supported Cooperative Work’ was used to collect data from 102 industry practitioners and educators engaged primarily in medical physics. Items includes 30 scaled and qualitative assessments of software use, inputs, time spent on documentation tasks and related activities (meetings, leadership, task assignment, etc.), number of collaborators, documentation volume and practices, revision and publication strategies, and attitudes toward documentation software. Results: Of 102 respondents, 74 completed all survey sections, and 58/74 (78%) reported using collaborative document technologies, but only 35% of these were fully satisfied with the technology. A total of 27/58 (47.37%) reported collaborative documentation tools assisted in meeting established deadlines. Most collaborative documentation projects spanned weeks, and required a commitment of 17.68 hours/week (2 – 80, median 15). Between 2–100 synchronous meetings lasting 1–5 hr/meeting were required, most commonly held before starting writing (43.64%) to discuss technical contents (85.96%), document requirements (61.40%), assign tasks (54.39%), or resolve team conflicts (52.63%). Results were presented as a visual infographic, potentially useful as a teaching aid. Conclusion: While reportedly easy to use, most online collaborative tools did not fully meet physicist documentation needs, including deficiencies in security, load times, information presentation capabilities, and role assignment. These insights can help improve collaborative documentation software development and training programs for new authors in medical physics fields. The author is an employee of GE Healthcare. This study was completed through the author's academic doctoral work and no funding or other interests were provided by the author's employer.
e14537 Background: Interspecies allometric scaling is used to extrapolate pharmacokinetics (PK) from preclinical data to human PK and dosing. Efficacy of BXQ-350, a novel Saposin C phosphatidylserine lipid nanovesicle therapy that targets tumor cell phospholipids, has been demonstrated in murine tumors, and pharmacokinetic and toxicokinetic (PK/TK) parameters have been derived in animal models. This study compares predictions based on allometric scaling of animal PK/TK data with FIH data for BXQ-350. Methods: PK was assessed over 24 hr after IV BXQ-350 doses in mice (30 mg/m2) and rats/monkeys (60 mg/m2). TK was assessed at day 1 and 24 in rats/monkeys (24, 72 and 240 mg/m2 5 days/wk). Saposin C was analyzed by ELISA, and noncompartmental PK methods were used. Preclinical PK/TK was allometrically scaled to predict human PK and exposure (AUC) at 0.7-2.4 mg/kg therapeutic doses. Values were compared to actual FIH Phase 1 data (NCT02859857). Results: Human clearance, terminal volume of distribution (Vz), half-life, and AUC (at 0.7 and 2.4 mg/kg doses) were within predicted ranges, though human ranges were somewhat narrower for clearance (63-114 vs 81-102 mL/kg/hr), Vz (135-650 vs 285-380 mL/kg), and half-life (0.8-4.5 vs 2.0-3.4 hr). Notably, actual vs predicted AUC hr*ng/mL at 0.7 and 2.4 mg/kg were not significantly different (7,100 vs 6,100 and 38,000 vs 36,000, respectively). Efficacy occurred in murine models at 4-16 mg/kg (AUC 7,400-29,600), aligned with human exposure at 0.7-2.4 mg/kg doses. Conclusions: Allometric scaling of animal PK/TK data provided reasonable estimates of human PK and exposure (AUC) for BXQ-350 and can thus be expected to have good predictive utility for extrapolating drug dose and pharmacokinetic parameters. Table. Predicted vs Actual PK/TK Predicted1 Actual2 Clearance, mL/kg/hr 63-114 81-102 Volume of distribution (Vz), mL/kg 135-650 285-380 Half-life, hrs 0.8-4.5 2-3.4 AUC at 0.7 mg/kg, hr*ng/mL 6100 7100 AUC at 2.4 mg/kg, hr*ng/mL 36000 38000 Murine Efficacy-associated AUC (~4-16 mg/kg), hr*ng/mL 7,400-29,600 - 13-animal composite PK/TK models2High/low geometric mean for 0.7-2.4 mg/kg Phase 1 cohorts
Background "Door to treatment" time affects outcomes of acute ischemic stroke (AIS) patients undergoing endovascular treatment (EVT). However, the correlation between staff education and accessible technology with stroke outcomes has not been demonstrated. Objective The objective of this paper is to demonstrate the five-year impact of the Stroke Triage Education, Procedure Standardization, and Technology (STEPS-T) program on time-to-treat and clinical outcomes. Methods The study analyzed a prospectively maintained database of AIS patients who benefited from EVT through implementation of STEPS-T. Demographics, clinical characteristics, and modified Rankin Score at three months were analyzed. Thrombolysis in Cerebral Infarction (TICI) scale was used to grade pre- and post-procedure angiographic recanalization. Using electronic hemodynamic recording, stepwise workflow times were collected for door time (TD), entering angiography suite (TA), groin puncture (TG), first DSA (TDSA), microcatheter placement (TM), and final recanalization (TR). Median intervention time (TA to TR) and recanalization time (TG to TR) were compared through Year 1 to Year 5. Results A total of 230 individuals (age 74 ± 12, between 30 to 95) were enrolled. Median intervention and recanalization times were significantly reduced, from 121 minutes to 52 minutes and from 83 minutes to 36 minutes respectively from Year 1 to Year 5, ( p < 0.001). Across the study period, annual recruitment went up from 12 to 66 patients, and modified Rankin Score between 0 and 2 increased from 36% to 59% ( p = 0.024). Conclusions STEPS-T improved time-to-treat in patients undergoing mechanical thrombectomy for AIS. During the observation period, clinical outcomes significantly improved.
To evaluate the association between the image quality of cancer staging whole-body magnetic resonance imaging (WB-MRI) and patient demographics, distress, and perceived scan burden.
This study examined whether college students' perceptions of the positive and negative attributes of group work are associated with their tolerance for ambiguity, tolerance for disagreement, conversational sensitivity, and cognitive flexibility. Participants were 192 undergraduate students who completed a series of quantitative measures referencing their feelings toward group work and their communicative and personality traits. Results indicated that (a) students' perceptions of the positive attributes of group work were correlated positively with tolerance for ambiguity, tolerance for disagreement, conversational sensitivity, and cognitive flexibility and (b) students' perceptions of the negative attributes of group were correlated positively with conversational sensitivity. Future research should continue to explore the impact of students' traits on their perceptions of classroom group work. ********** Despite the pedagogical value associated with small group work in the college classroom (Allen & Plax, 2002), one downside to group work is the range of perceptions students have about group work (Myers & Goodboy, 2005). These perceptions, however, may be differentiated by the personality and communication predispositions students have toward working on tasks in general, which then may affect how students approach group work, a specific group task, or group members. The purpose of this study is to examine whether college students' perceptions of the positive and negative attributes of group work are associated with their tolerance for ambiguity, tolerance for disagreement, conversational sensitivity, and cognitive flexibility. Review of Literature For many college students, small group work is an inevitable component of their coursework. Used extensively across academic disciplines (Adams & Slater, 2002; McKinney & Graham-Buxton, 1993; Payne & Monk-Turner, 2006; Vik, 2001; Warnemunde, 1986), small group work is believed, at least from the perspective of course instructors, to provide multiple benefits to students. These benefits include developing an extensive understanding and retention of small group concepts (Young & Henquinet, 2000) and course content (Wardrope & Bayless, 1999), becoming more proficient in social and interpersonal communication skills (Kendall, 1999; Winter & Neal, 1995), and becoming adequately prepared for future vocational and career endeavors (Monk-Turner & Payne, 2005; Page & Donelon, 2003). Although many students feel they accomplish more by working in a group than by working alone (Payne & Monk-Turner, 2006; Payne, Monk-Turner, Smith, & Sumter, 2006; Winter & Neal, 1995), not all college students recognize the benefits associated with small group work nor do all college students appreciate group work (Keyton, 1994; Schullery & Gibson, 2001). Keyton, Harmon, and Frey (1996) posited that the impressions students hold about group work fall into two categories: the identification of positive attributes of group work and the identification of negative attributes of group work. Some positive attributes are being able to contribute to the group task, learning something from group members, sharing the workload with their group members, and perceiving the group experience as helpful for their future careers; some negative attributes are problems with task assignment and coordination, group member conflict, and group members who are uncooperative, who fail to participate or contribute to the group task, or who do not attend group meetings (Colbeck, Campbell, & Bjorklund, 2000; Duin, 1990; Dyrud, 2001; Livingstone & Lynch, 2000; Payne & Monk-Turner, 2006; Winter & Neal, 1995). Students' impressions also are influenced by issues such as time constraints, a focus on grades, and competing demands such as jobs, friends, and romantic relationships (Freeman, 1996; Monk-Turner & Payne, 2005). …
2517 Background: BXQ-350 is a novel agent composed of the multifunctional, lysosomal activator protein Saposin C and phosphatidylserine. BXQ-350 demonstrated antitumor effects in vitro and in vivo, particularly in glioma and pancreatic cancer models. Methods: A phase 1a dose-escalation trial (NCT02859857; Phase 1b ongoing) was conducted in refractory solid tumors/high-grade glioma (HGG) patients (Pt) by administering escalating IV BXQ-350 doses of 0.7, 1.1, 1.4, 1.8, or 2.4 mg/kg on days 1-5, 8, 10, 12, 15, 22 (cycle 1) and at 28-day cycles thereafter. Response was assessed at day 113 by RECIST or RANO. Results: 17 Pt (age 24-67) with a median 7 (range, 2-12) prior systemic therapies completed a median 2 (range, 1-6) cycles without DLTs or treatment-related serious adverse events (AEs). Moderately severe related AEs occurred in 3 (100%), 1 (33%), 1 (33%), and 2 (25%) Pt at 1.1, 1.4, 1.8, and 2.4 mg/kg cohort doses, respectively. The most common treatment-related AEs was transient fatigue (n = 4, 23.5%). At 2.4 mg/kg, 1 Pt had moderate blood pressure elevation. Best response in 7 Pt completing to day 113 was 1 PR (appendiceal carcinoma) at 2.4 mg/kg, and 6 SD (1 HGG Pt at 0.7 mg/kg had stable disease >12+ months, and 6 had improved day 113 RANO/RECIST). BXQ-350 pharmacokinetics was dose proportional with half-life and Cmax, consistent with preclinical data. Conclusions: BXQ-350 showed clinical activity in heavily pre-treated patients with advanced solid and brain tumors. BXQ-350 has a tolerable safety profile with no significant DLT at the highest planned dose, supporting continued monotherapy dose expansion at 2.4 mg/kg. Clinical trial information: NCT 02859857.DOSE (mg/kg) N 0.7 1 1.1 3 1.4 3 1.8 3 2.4 8 Mean Age, F:M 64, 0:1 53, 0:3 58, 2:1 49, 1:2 54, 2.2 Prior systemic therapy, # cycles, range 7, 6 5-7, 2-4 2-12, 1-3 3-8, 2-6 4-12, 1-4 Solid Tumor n, Improved RANO n/N D 113 1, 0 2, 1/1 1, 1/2 1, 0 5, 0 HGG n, Improved RECIST, n/N D 113 1, 1/1 1, 0 2, 0 2, 0 3, 2/2 Adverse Event (n case, n event) 1, 15 3, 54 3, 37 3, 32 8, 80 Moderate severity related 3, 6 1, 1 1, 2 2, 2 Fatigue 2, 2 1, 2 1, 1 Neutropenia, EKG, Balance, Nerv, Dysarthria, Urin, BP 3, 4 Serious non-related – GI, hyponatremia, weak 1, 1 1, 4 1, 3 1, 3 3, 5
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