Highlights

Abstract

Keywords

References

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Abstract

Purpose
To design and describe a management and control tool and the human resources needed to efficiently manage the imaging process within clinical trials for a better quality of care for the patient.

Methods
A unit was created to efficiently organise the participation of our Medical Imaging Department in clinical trials. This entity was defined and monitored using a customized, flexible and modular software package that provides the necessary information to execute and monitor requests (appointments, protocols, reports, complaints, billing). Various indicators of activity and professional satisfaction were parameterised.

Results
From 2016 to 2020, 367 trials were participated and monitored, 50% of all the hospital clinical trials. The budget of the Medical Imaging Department grew by 47% in this period. The coordination with other departments and principal investigators improved, as shown by surveys (62% fluid and 38% very fluid), with a high perception of collaboration (86%).

Conclusions
The implementation of a Medical Imaging Clinical Trials Unit involve identifying the tasks, personnel, organisational needs, workflow, monitoring and invoicing. The creation of this Unit has improved the control and traceability of clinical trials within the Department.

1. Introduction

Most clinical trials are randomised experimental studies aiming to evaluate the efficacy and safety of a treatment in a select group of patients [1]. Clinical imaging plays a fundamental role in many clinical trials. Different imaging modalities are often used for the initial detection and staging of lesions, to assess response to treatment, and to define adverse effects. In addition, imaging biomarkers are becoming useful to evaluate the biological effects of treatments [2].

Both Radiology and Nuclear Medicine departments are actively involved to carry out the scheduled imaging studies, although the addition of these exams increases the burden of daily workflow [3]. Different organisational strategies have been adopted to establish clinical trials units that act independently on an operational and financial level. In our university hospital, we created a Medical Imaging Clinical Trials Unit (MICTU) in 2016 (Fig. 1) to adequate the participation of the department in trials and to generate resources to foster internal continuous education and research. The unit hired a multidisciplinary team of 8 people with different profiles (1 Nurse, 1 Nursing Assistant, 4 Technicians, 1 Biomedical Engineer, and 1 Business Administration with total costs of 259 K €).

Abstract

Keywords

1. Introduction

2. DNA damage response

3. DDR and radiotherapy failure

4. DDR inhibitors decrease radio-resistance

5. DDR roles in chemotherapy failure

6. DDR inhibitors decrease chemo-resistance

7. Conclusions

Funding

Availability of data and material

Ethics approval and consent to participate

Consent for publication

Declaration of Competing Interest

Acknowledgements

References

Abstract

Up to now, many improvements have been made in providing more therapeutic strategies for cancer patients. The lack of susceptibility to common therapies like chemo- and radio-therapy is one of the reasons why we need more methods in the field of cancer therapy. DNA damage response (DDR) is a set of mechanisms which identifies DNA lesions and triggers the repair process for restoring DNA after causing an arrest in the cell cycle. The ability of DDR in maintaining the genome stability and integrity can be favorable to cancerous cells which are exposed to radiation therapy or are treated with chemotherapeutic agents. When DDR mechanisms are error-free in cancer cells, they can escape the expected cellular death and display resistance to treatment. In this regard, targeting different components of DDR can help to increase the susceptibility of advanced tumors to chemo- and radio-therapy.

1. Introduction

DNA-damaging agents originating whether from endogenous or exogenous resources are known to threat the viability of every cell of our body [1]. Besides to the cellular issues arising from the great number of mutations and genome instability, the lack of proper responses can establish generations of these defective cells and put our whole body in danger [1]. DNA damage response or DDR is a precise mechanism which contains sensing the lesions, establishing signals, and finally initiating repair processes by the means of these signals [2]. During DDR, cell cycle is also affected by the mediators of DDR and is temporarily stopped in order to inhibit the replication of a defective DNA [3]. In some cases, DNA deteriorations are irreparable and thus, cell death is the only option on the table [3].

In addition to normal cells, cancerous cells are also able to use the same mechanisms for their chemotherapy- and/or radiotherapy-induced damaged DNA. Until DDR is working properly in a cancerous cell, DNA damages would not lead to cell death and thus, treatment would not be considered successful [1]. This means that despite all the advantageous impacts of DDR, it stands in the way of overcoming a great challenge in cancer therapy: resistance to our common methods, chemo- and radio-therapy. Recently, a great number of researchers have worked on targeting distinct components of DDR for enhancing the efficacy of cytotoxic treatments [4]. In this paper, we review the process of DDR briefly and explain the role of its key players in decreasing the susceptibility of cancer cells to common therapeutic procedures. Additionally, the usage of DDR inhibitors on different types of cancer would be discussed for giving an insight for the treatment of advanced stages of this lethal disease.

Abstract

Graphical abstract

Keywords

1. Introduction

2. Materials and methods

3. Results and discussion

4. Conclusions

Author contributions

Declaration of Competing Interest

Acknowledgments

Appendix A. Supplementary data

References

Abstract

Precisely delivering combinational therapeutic agents has become a crucial challenge for anti-tumor treatment. In this study, a novel redox-responsive polymeric prodrug (MW: 93.5 kDa) was produced by reversible addition-fragmentation chain transfer (RAFT) polymerization. The amphiphilic block polymer-doxorubicin (DOX) prodrug was employed to deliver a hydrophobic photosensitizer (PS), chlorin e6 (Ce6), and the as-prepared nanoscale system [NPs(Ce6)] was investigated as a chemo-photodynamic anti-cancer agent. The glutathione (GSH)-cleavable disulfide bond was inserted into the backbone of the polymer for biodegradation inside tumor cells, and DOX conjugated onto the polymer with a disulfide bond was successfully released intracellularly. NPs(Ce6) released DOX and Ce6 with their original molecular structures and degraded into segments with low MWs of 41.2 kDa in the presence of GSH. NPs(Ce6) showed a chemo-photodynamic therapeutic effect to kill 4T1 murine breast cancer cells, which was confirmed from a collapsed cell morphology, a lifted level in the intracellular reactive oxygen species, a reduced viability and induced apoptosis. Moreover, ex vivo fluorescence images indicated that NPs(Ce6) retained in the tumor, and exhibited a remarkable in vivo anticancer efficacy. The combinational therapy showed a significantly increased tumor growth inhibition (TGI, 58.53%). Therefore, the redox-responsive, amphiphilic block polymeric prodrug could have a great potential as a chemo-photodynamic anti-cancer agent.

1. Introduction

Chemotherapy is generally considered to be one of the most efficient methods for antitumor therapy, while photodynamic therapy (PDT), which uses light to excite photosensitizers (PSs) to generate reactive oxygen species (ROS) for oxidizing intracellular biomacromolecules to induce the death of tumor cells, offers minimal invasive treatment for assisting in chemotherapy1,2. However, a low antitumor efficiency and severe systemic toxic effects of chemotherapeutics and poor water solubility and insufficient tumor accumulation of PDT agents have hampered their application3. To overcome these challenges, nanomedicines derived from liposomes, micelles, nanoparticles, dendrimers and other polymers have been applied as drug delivery systems (DDSs) for anti-tumor agents4, 5, 6, 7, 8, 9, 10. These nanomedicines have improved their accumulation owing to the enhanced permeability and retention (EPR) effect, which can decrease side effects and enhance therapeutic efficacies11, 12, 13, 14. Among these reported systems, functional polymers in response to the tumor microenvironment have been designed as smart DDSs with great potential for cancer diagnosis and therapy.

Highlights

Abstract

Keywords

Introduction

Methods

Results

Discussion

Limitations and future directions

Conclusion

Funding

Declaration of competing interest

References

abstract

Background: Our study investigates how general surgery residency programs utilized social media to adapt to the challenges of COVID-19. Methods: 319 participating general surgery residency programs provided by the Electronic Residency Application Service were analyzed in this study. Associated Twitter, Instagram, and Facebook accounts were assessed to find virtual open houses and externships. Results: Of the 319 program, 188 (59%) were found to have a social media presence. A total of 348 social media accounts were found, as some of the programs had separate residency and department accounts. Of all the social media accounts, 112 (32%) of the accounts were created after March 1, 2020. Virtual open houses opportunities were found to be advertised across all platforms. Conclusion: Many general surgery programs responded to the physical limitations of COVID-19 pandemic by increasingly utilizing social media during the COVID-19 pandemic. Virtual opportunities should be considered as a novel approach for future outreach and recruitment.

Introduction

The physical limitations imposed on fourth year medical students and residency programs by the COVID-19 pandemic have created new challenges in an increasingly competitive general surgery residency application process.1,2 In 2014e2015, well over half of fourth year medical students completed an away rotation.3 The Coalition of Physician Accountability, which the American Association of Medical Colleges (AAMC) is a member of, recommended the immediate suspension of in-person visiting rotations and interviews for the 2020e2021 application cycle in response to the COVID-19 pandemic.4 Alterations to the 2021 match process and outcomes are anticipated due to the abrupt decrease of inperson opportunities. The disruption caused by the COVID-19 pandemic has forced general surgery residency programs to shift to a novel form of interviews by way of virtual interaction.5e9 This contrasts traditional in-person evaluations which allowed programs to directly assess an applicant’s interpersonal skills and interactions with faculty and house staff.10,11 For applicants, the traditional interview played a significant role on the order of the rank list as it allowed for applicants to evaluate important factors such as a program’s fit, location, and character.

Previous papers have examined the shift from a traditional inperson interview process to an online format.9,11,13e16 However, to our knowledge there is no current literature that analyzes the frequency and magnitude to which general surgery residency programs are creating and implementing social media accounts to publicize virtual opportunities. We hypothesize that there has been, and will continue to be, a sharp increase in all forms of social media accounts (Facebook, Twitter, and Instagram) secondary to strict physical barriers imposed on prospective applicants and residency programs. Herein, we explain the extent of this virtual transition among general surgery residencies by evaluating their social media presence on Twitter, Facebook, and Instagram, advertisement of virtual open house opportunities, and offerings of virtual sub-internships to prospective applicants.

Purpose: In this study, we used time-driven activity-based costing to increase efficiency in our ultrasound-guided breast biopsy practice by understanding costs associated with this procedure. Methods: We assembled a multidisciplinary team of all relevant stakeholders involved in ultrasound-guided breast biopsies, including a radiologist, a lead technologist, a clinical assistant, a licensed practical nurse, and a procedural support assistant. The team mapped each step in an ultrasound-guided breast biopsy from the time of scheduling a biopsy to patient checkout. We completed on average 20 time observations of each step involved in these biopsies from a provider’s perspective. Using capacity cost rate, we calculated the cost of all resources including personnel, supply, room, and equipment costs. Several costly steps were identified in the process, which led to the intervention of changing our overlapping biopsy times to staggered biopsy times. Time observations for each step and cost calculations were repeated postintervention. Results: Our postintervention data showed that the total time spent by the radiologist in an ultrasound breast biopsy decreased by 28%, accounting for 56% of the total cost in comparison with 63% pre-intervention. The radiologist’s wait time decreased by 38%, accounting for 28% of the total cost in comparison with 35% pre-intervention. Our total cost of the procedure decreased by 20%, and the personnel cost decreased by 25%. Conclusions: Time-driven activity-based costing is a practical way to calculate costs and identify non-value-added steps, which can foster strategies to improve efficiency and minimize waste.

Introduction

With increasing health care costs and evolving payment models, it is more critical than ever that medical providers maximize value by increasing efficiency and decreasing costs. Although value is difficult to define in health care, Porter’s widely cited definition of value is outcomes achieved relative to costs (outcomes/cost) [1]. To enhance value, one must improve outcomes or decrease cost. Although there has been a significant focus on improving patient outcomes in the recent past through regulatory and financial incentive models, there has been scant emphasis on decreasing cost. To decrease cost, one must be able to evaluate the true cost of a medical process or procedure. Calculating the cost of a medical process or procedure is challenging because various shareholders in the health care arena often define costs differently. Health care policy makers may refer to cost as the money paid to providers for medical services, and providers may define their costs by their reimbursement, but these are not necessarily the costs incurred by the health care system for a medical process or procedure [2,3]. Not knowing true costs prevents one from truly decreasing costs, which can have substantial negative downstream consequences such as the inability to adequately negotiate reimbursement in a bundled payment model.

Key Words

1. Key learning points

2.Conclusions

Acknowledgments

References

Abstract

Endoscope auditing is unique from other types of auditing normally completed as part of ongoing quality initiatives. When auditors walk into an endoscopy processing area, they are confronted with a variety of complex processes generally packed into a small space. Auditors are challenged to become experts on the processes they are evaluating, and must stay current with changes in practice and equipment. In our 10 years of endoscope processing assessments completed by infection prevention and accreditation staff, we learned a great deal regarding how to approach auditing and interact with staff to improve the quality of endoscope processing.

KEY LEARNING POINTS

1. Never audit a “clean” scope. It is important to identify a time to audit when you know the service area is open and has patients scheduled. This will increase the likelihood of observing the entire process from point-of-use cleaning through storage. You will gain an accurate picture of their process, versus if you ask an employee to demonstrate how to clean a scope that is already in clean storage. We have experienced this, and staff will generally walk through the steps in a high-level overview. If you inquire about a missed step, the popular response is, “Yes, of course I would do that if I was actually cleaning a scope.” Having staff demonstrate the process on a soiled endoscope assures that you are auditing the actual process and not just a hypothetical demonstration.

1. Introduction

2. Case report

3. Discussion

References

Abstract

The purpose of this case report is to describe the imaging and associated clinical features of an asymptomatic novel coronavirus pneumonia (COVID -19) patient outside WuHan, China. The principle findings are that in this patient with laboratory -confirmed COVID -19, CT findings preceded symptoms and included bilateral pleural effusions, previously not reported in association with COVID -19. The role of this case report is promotion of potential recognition amongst radiologists of this new disease, which has been declared a global health emergency by the World Health Organization (WHO).

Introduction

In Wuhan, China, in December 2019, a series of pneumonia cases of unknown etiology appeared, soon after diagnosed as being caused by a novel coronavirus initially titled 2019 novel coronavirus (2019 -nCoV) and subsequently officially named COVID -19 by the WHO on February 11, 2020 [1].

As of February 14, 2020, there are 49,053 laboratory -confirmed cases globally [2], 15 of which are in the United States [3]. There is a small but growing body of literature regarding the imaging findings of COVID -19, and the purpose of this case report is to describe the imaging and associated clinical features of an asymptomatic COVID -19 patient outside Wuhan, China, including an imaging finding previously not reported.

Graphical abstract

Background

SARS: Epidemiology and Imaging

MERS: Epidemiology and Imaging

NCIP: What Do We Know?

Precautions for Radiology Department Personnel

Take-Home Points

References

Abstract

In December 2019, a novel coronavirus pneumonia emerged in Wuhan, China. Since then, this highly contagious coronavirus has been spreading worldwide, with a rapid rise in the number of deaths. Novel coronavirus–infected pneumonia (NCIP) is characterized by fever, fatigue, dry cough, and dyspnea. A variety of chest imaging features have been reported, similar to those found in other types of coronavirus syndromes. The purpose of the present review is to briefly discuss the known epidemiology and the imaging findings of coronavirus syndromes, with a focus on the reported imaging findings of NCIP. Moreover, the authors review precautions and safety measures for radiology department personnel to manage patients with known or suspected NCIP. Implementation of a robust plan in the radiology department is required to prevent further transmission of the virus to patients and department staff members.

Background

Coronaviruses are nonsegmented, enveloped, positive-sense, single-strand ribonucleic acid viruses, belonging to the Coronaviridae family [1]. Six types of coronavirus have been identified that cause human disease: four cause mild respiratory symptoms, whereas the other two, Middle East respiratory syndrome (MERS) coronavirus and severe acute respiratory syndrome (SARS) coronavirus, have caused epidemics with high mortality rates.

In December 2019, a new type of coronavirus called 2019 novel coronavirus was extracted from lower respiratory tract samples of several patients in Wuhan, China. These patients presented with symptoms of severe pneumonia, including fever, fatigue, dry cough, and respiratory distress. Novel coronavirus–infected pneumonia (NCIP) is believed to have originated in a wet “seafood market” in Wuhan. The virus, which has been reported in 28 countries as of this writing, has shown human-to-human transmission and is feared to have the potential to cause a pandemic [2,3]. The mean incubation period is estimated to be 5.2 days, which allows air travelers to spread the disease globally [4]. Evidence shows that virus transmission can occur during the incubation period in asymptomatic patients. Moreover, high sputum viral loads were found in a patient with NCIP during the recovery phase [5]. As of February 5, 2020, more than 25,000 confirmed cases have been reported worldwide, with a rapid rise in the number of deaths. The Word Health Organization has announced the outbreak a global health emergency.

2- Material and Methods

3- Discussion

4- Conclusion

References

Introduction

Glioblastomas (GBMs) are the most common and yet the most aggressive primary intraparenchymal brain tumors in adults [1–9]. Tey occur throughout the central nervous system (CNS) but are most common in the brain [1, 5]. Primary malignant brain tumors are thought to develop through accumulations of genetic alterations that permit cells to evade normal regulatory mechanisms and escape destruction by the immune system [1]. Factors that have positive and negative associations with GBM development have been described. While allergies or atopic disease(s) have been reported by some to decrease the risk, an increased risk has been shown with exposure to ionizing radiation (IR) [3, 10, 11]. An association with high-dose IR and all brain tumors has been observed in atomic bomb survivor studies, nuclear-test fallout data, therapeutic radiation for cancer or for benign conditions, and occupational and environmental studies [1, 10–12]. Like all primary brain tumors, extraneural metastasis of GBM is very rare, reported in less than 2% of all GBM cases [4, 7–9, 13–19]. Te exact mechanisms of spread outside of the CNS of gliomas are not completely understood. Te rarity of this phenomenon has been attributed to the usually short survival of afected patients and also due to intrinsic biological obstacles that prevent the tumor cells from infltrating and surviving beyond the CNS environment [4, 7–9, 13–19]. Furthermore, we present a unique case of a middle-aged Caucasian man with a history of occupational IR exposure who developed a GBM with subsequent metastasis to the lef lung.

2- Materials and Methods

3- Results

4- Discussion

5- Conclusions

References

Introduction

Hepatocellular carcinoma (HCC) is the most common primary cancer of the liver [1]. According to the NCCN guidelines, there are numerous strategies for treating HCC, including resection, transplantation, radiofrequency ablation, transarterial chemoembolization (TACE), radiotherapy (RT), and systemic therapy using sorafenib or lenvatinib [2]. All patients with HCC should be evaluated for potential curative therapies, including resection and transplantation [2]. Locoregional therapy, including ablation, TACE, and RT, is indicated for patients who are not candidates for curative therapy or indicated as a bridge therapy for patients who are candidates for transplantation [2]. Recent reports have described favorable clinical outcomes afer proton beam therapy (PBT) for HCC, based on a 5- year overall survival rate of 24–48% [3, 4] and a 5-year local control rate of approximately 80% [3, 5]. Among the external beam RT modalities, PBT may be superior to X-ray therapy based on excellent dose localization to the therapeutic target [1]. Furthermore, given the good outcomes afer PBT for HCC, some patients may be eligible for TACE treatment of intrahepatic HCC metastasis, while repeated PBT, TACE, or systemic therapy may be feasible in cases of local recurrence afer PBT. Moreover, PBT is efective for patients with HCC who also have portal vein tumor thrombus (PVTT) [6], and the efcacy of combined therapy of TACE and RT for HCC with PVTT has been reported [7, 8]. Terefore, given the growing interest in using PBT for HCC, it is possible that TACE could be used for selected patients who have previously undergone PBT. Te purpose of our study is to evaluate the angiographic fndings from patients with HCC previously treated using PBT.

Methods
Of total, 54 patients with palpable breast mass were enrolled in the study. Using DITI, minimum, average and maximum temperature values of each lesion site and its counterpart were measured, differences were used as a measure of symmetry. 0.5 °C was selected as a reference cut-off. Subsequent to thermal imaging, all patients underwent US examination. Mammographic examination was performed upon clinician request. All lesions were core-biopsied. Results of thermal imaging according to the above-mentioned criteria was compared with histopathological results.

Introduction

Methods

Results

Conclusions

References

Introduction

Emotional intelligence (EI) has been defined as a blend of personal and interpersonal competencies that affect one’s behaviour, thinking and interactions with others.1 Salovey and Mayer2 first coined emotional intelligence defining it as “the ability to monitor one’s own and others’ feelings and emotions, to discriminate among them and to use this information to guide one’s thinking and actions” (p. 189). This definition and the conceptualisation of emotional intelligence has been further developed through research and practice.3 While there are a number of alternate models of emotional intelligence such as the Bar-On,4 and Salovey and Mayer2 models, the Goleman5 model is widely used. The Goleman model of EI organises emotional intelligence into four dimensions; self-awareness and selfmanagement and social awareness and social skills.5 These four dimensions of EI each comprise a suite of personal or interpersonal competencies that are essential for health care professionals in order to provide optimal patient care as well as work synergistically as part of a multidisciplinary team.6 Theorists have viewed EI as a trait rather than a cognitive ability.7–9 According to them trait EI is related to people’s personality and is formed by their emotional self-perceptions and emotional traits. Unlike ability, trait EI involves behavioural characteristics and self-perceived capabilities and is measured through self-report.7–9 Therefore, for this study it was decided that trait EI would be used as a measurement of EI among radiation therapists (RT).