Cost-effectiveness analysis of stereotactic body radiotherapy and radiofrequency ablation for medically inoperable liver metastases from colorectal cancer

This report describes the development of a Markov model for comparing percutaneous radiofrequency ablation (RFA) and stereotactic body radiation therapy (SBRT) in terms of their cost-utility in treating isolated liver metastases from colorectal cancer. The model is based on data from multiple retrospective and prospective studies, available data on different utility states associated with treatment and complications, as well as publicly available Medicare costs. The purpose of this report is to establish a well-justified model for clinical management decisions. In comparison with SBRT, RFA is the most cost-effective treatment for this patient population. From the societal perspective, SBRT may be an acceptable alternative with an ICER of $28,673/QALY. ^

AN EVALUATION OF THE CONSISTENCY OF IMRT PATIENT-SPECIFIC QA TECHNIQUES

To ensure the integrity of an intensity modulated radiation therapy (IMRT) treatment, each plan must be validated through a measurement-based quality assurance (QA) procedure, known as patient specific IMRT QA. Many methods of measurement and analysis have evolved for this QA. There is not a standard among clinical institutions, and many devices and action levels are used. Since the acceptance criteria determines if the dosimetric tools’ output passes the patient plan, it is important to see how these parameters influence the performance of the QA device. While analyzing the results of IMRT QA, it is important to understand the variability in the measurements. Due to the different form factors of the many QA methods, this reproducibility can be device dependent. These questions of patient-specific IMRT QA reproducibility and performance were investigated across five dosimeter systems: a helical diode array, radiographic film, ion chamber, diode array (AP field-by-field, AP composite, and rotational composite), and an in-house designed multiple ion chamber phantom. The reproducibility was gauged for each device by comparing the coefficients of variation (CV) across six patient plans. The performance of each device was determined by comparing each one’s ability to accurately label a plan as acceptable or unacceptable compared to a gold standard. All methods demonstrated a CV of less than 4%. Film proved to have the highest variability in QA measurement, likely due to the high level of user involvement in the readout and analysis. This is further shown by how the setup contributed more variation than the readout and analysis for all of the methods, except film. When evaluated for ability to correctly label acceptable and unacceptable plans, two distinct performance groups emerged with the helical diode array, AP composite diode array, film, and ion chamber in the better group; and the rotational composite and AP field-by-field diode array in the poorer group. Additionally, optimal threshold cutoffs were determined for each of the dosimetry systems. These findings, combined with practical considerations for factors such as labor and cost, can aid a clinic in its choice of an effective and safe patient-specific IMRT QA implementation.

Investigation of the mechanism of increased melanoma incidence in UV -irradiated mouse skin

The availability of transplantable, syngeneic murine melanomas made it possible to study the potential effects of UV radiation on the growth and progression of melanomas in an animal model. The purpose of my study was to determine how UV-irradiation increases the incidence of melanoma out-growth, when syngeneic melanoma cells are transplanted into a UV-irradiated site. Short term intermittent UVB exposure produces a transitory change in the mice which allows the increased outgrowth of melanoma cells injected into the UV-irradiated site. One possible mechanism is an immunomodulatory effect of UVR on the host. An alternative mechanism to account for the increased tumor incidence in the UV-irradiated site, is the release of inflammatory mediators from UV-irradiated epidermal cells. A third possibility is that UVR could induce the production and/or release of melanoma-specific growth factors resulting in increased melanoma outgrowth.^ My first step in distinguishing among these different possible mechanisms was to characterize further the conditions leading to increased development of melanoma cells in UV-irradiated mouse skin. Next, I attempted to determine which of the 3 proposed mechanisms was most likely. To do this, I defined the specificity of the effect by examining the growth of additional C3H tumorigenic cell lines in UV-irradiated skin. Second, I determined the immunogenicity of these tumor cell lines. The tumor cell lines exhibiting increased tumor incidence are restricted to those tumor cell lines which are immunogenic in normal C3H mice. Third, I determined the effect of UVR on melanoma development did not occur in immunosuppressed mice.^ Because of results from these three lines of investigation suggested that the effect was immunologically mediated, I then investigated whether specific immune reactions were affected by local UV irradiation. To accomplish this, I investigated the effect of UVR on cutaneous immune cells and on induction of contact hypersensitivity (CHS), and I also determined the effect of UVR on the development and the expression of systemic immunity against the melanoma cells. There is no clear cut relationship between the number of Langerhans or Thy1+ cells and the UV effect on tumor incidence. Furthermore, there was no suppression of CHS in the UV-irradiated mice. While the development of systemic immunity is significantly reduced, it appears to be sufficient to provide in vivo immunity to tumor challenge. However the elicitation of tumor immunity in immunized mice can be abrogated if tumor challenge occurs in the site of UV irradiation. This investigation provides new information on an effect of UVR on the elicitation of tumor immunity. Furthermore, it indicates that UV radiation can play a role in the development of melanoma other than just in the transformation of melanocytes. ^

Ultraviolet radiation modulates the immune system through the platelet -activating factor receptor

Ultraviolet radiation plays a critical role in the induction of non-melanoma skin cancer. UV radiation is also immune suppressive. Moreover, UV-induced systemic immune suppression is a major risk factor for skin cancer induction. Previous work had shown that UV exposure in vivo activates a cytokine cascade involving PGE2, IL-4, and IL-10 that induces immune suppression. However, the earliest molecular events that occur immediately after UV-exposure, especially those upstream of PGE2, were not well defined. To determine the initial events and mediators that lead to immune suppression after a pathological dose of UV, mouse keratinocytes were analyzed after sunlamp irradiation. It is known that UV-irradiated keratinocytes secrete the phospholipid mediator of inflammation, platelet-activating factor (PAF). Since PAF stimulates the production of immunomodulatory compounds, including PGE2, the hypothesis that UV-induced PAF activates cytokine production and initiates UV-induced immune suppression was tested. Both UV and PAF activated the transcription of cyclooxygenase (COX)-2 and IL-10 reporter gene constructs. A PAF receptor antagonist blocked UV-induced IL, 10 and COX-2 transcription. PAF mimicked the effects of UV in vivo and suppressed delayed-type hypersensitivity (DTH), and immune suppression was blocked when UV-irradiated mice were injected with a PAF receptor antagonist. This work shows that UV generates PAF-like oxidized lipids, that signal through the PAF receptor, activate cytokine transcription, and induce systemic immune suppression. ^

A rural virtual health sciences library project: research findings with implications for next generation library services*

Purpose: The Shared Hospital Electronic Library of Southern Indiana (SHELSI) research project was designed to determine whether access to a virtual health sciences library and training in its use would support medical decision making in rural southern Indiana and achieve the same level of impact seen by targeted information services provided by health sciences librarians in urban hospitals.

Building a retrospective collection in pharmacy: a brief history of the literature with some considerations for U.S. health sciences library professionals

This paper argues that historical works in pharmacy are important tools for the clinician as well as the historian. With this as its operative premise, delineating the tripartite aspects of pharmacy as a business enterprise, a science, and a profession provides a conceptual framework for primary and secondary resource collecting. A brief history and guide to those materials most essential to a historical collection in pharmacy follows. Issues such as availability and cost are discussed and summarized in checklist form. In addition, a glossary of important terms is provided as well as a list of all the major U.S. dispensatories and their various editions. This paper is intended to serve as a resource for those interested in collecting historical materials in pharmacy and pharmaco-therapeutics as well as provide a history that gives context to these classics in the field. This should provide a rationale for selective retrospective collection development in pharmacy.

Health sciences libraries in Kuwait: a study of their resources, facilities, and services

The purpose of this study was to examine the current status of health sciences libraries in Kuwait in terms of their staff, collections, facilities, use of information technology, information services, and cooperation. Seventeen libraries participated in the study. Results show that the majority of health sciences libraries were established during the 1980s. Their collections are relatively small. The majority of their staff is nonprofessional. The majority of libraries provide only basic information services. Cooperation among libraries is limited. Survey results also indicate that a significant number of health sciences libraries are not automated. Some recommendations for the improvement of existing resources, facilities, and services are made.

Providing health information to the general public: a survey of current practices in academic health sciences libraries*

A questionnaire was mailed to 148 publicly and privately supported academic health sciences libraries affiliated with Association of American Medical Colleges (AAMC)–accredited medical schools in the United States and Canada to determine level of access and services provided to the general public. For purposes of this study, “general public” was defined as nonaffiliated students or health care professionals, attorneys and other nonhealth-related professionals, patients from affiliated or other hospitals or clinics, and general consumers. One hundred five (71%) libraries responded. Results showed 98% of publicly supported libraries and 88% of privately supported libraries provided access to some or all of the general public. Publicly supported libraries saw greater numbers of public patrons, often provided more services, and were more likely to circulate materials from their collections than were privately supported libraries. A significant number of academic health sciences libraries housed a collection of consumer-oriented materials and many provided some level of document delivery service, usually for a fee. Most allowed the public to use some or all library computers. Results of this study indicated that academic health sciences libraries played a significant role in serving the information-seeking public and suggested a need to develop written policies or guidelines covering the services that will be provided to minimize the impact of this service on primary clientele.

Monograph use at an academic health sciences library: the first three years of shelf life

Objective: To study the circulation of monographs during the first three years of shelf life at an academic health sciences library.

Enjeux éthiques en radiologie diagnostique : comment la bioéthique peut-elle contribuer à une meilleure radioprotection du patient?

Bien que les technologies d’imagerie soient un acquis réel de la médecine moderne, leur introduction ne semble pas avoir été précédée d’une démarche réflexive suffisante qui aurait permis d’anticiper les multiples enjeux que rencontre la pratique radiologique actuelle. En effet, à force de se focaliser sur les acquis techniques et scientifiques, le cadre de radioprotection en place semble ne pas avoir suffisamment considéré l’apport essentiel que représente la connaissance des aspects sociaux, éthiques et humains que peuvent amener des domaines comme la bioéthique. Cette insuffisance fait en sorte que l’on se retrouve aujourd’hui face à des enjeux importants relatifs à la radioprotection du patient comme la surutilisation des examens radiologiques ou encore le manque d’information des acteurs du milieu face aux risques des rayonnements. Après un état des lieux des enjeux éthiques en radiologie diagnostique ayant un impact sur la radioprotection médicale des patients, un enjeu majeur de la pratique actuelle, qui est la justification inadéquate des prescriptions d’examens radiologiques, sera analysé selon une approche par principes. De cet exercice, visant à démontrer comment l’éthique peut concrètement contribuer à la radioprotection, découle l’impératif d’une vision nouvelle et globale permettant de proposer des pistes de solution aux controverses liées à l’utilisation actuelle de l’imagerie. Dans une perspective de santé des populations, il est important de contribuer à la diminution de la banalisation du recours au rayonnement ionisant dans la pratique médicale diagnostique en alliant bioéthique et radioprotection. Ce projet de recherche se veut être une étape limitée, mais nécessaire dans l’établissement de ce dialogue interdisciplinaire.

Florida International University Appoints College of Medicine Founding Dean, Former Chancellor of LSU's Health Sciences Center boasts Impressive Research and Administrative Experience

Press Release from Florida International University 's Office of Media Relations announcing the appointment of Dr. John Rock as founding Dean of Florida International University 's College of Medicine.

Cognitive and noncognitive variables that predict Florida community college radiography program graduates' success on the Registry

This study examined the predictive merits of selected cognitive and noncognitive variables on the national Registry exam pass rate using 2008 graduates (n = 175) from community college radiography programs in Florida. The independent variables included two GPAs, final grades in five radiography courses, self-efficacy, and social support. The dependent variable was the first-attempt results on the national Registry exam. The design was a retrospective predictive study that relied on academic data collected from participants using the self-report method and on perceptions of students' success on the national Registry exam collected through a questionnaire developed and piloted in the study. All independent variables except self-efficacy and social support correlated with success on the national Registry exam ( p < .01) using the Pearson Product-Moment Correlation analysis. The strongest predictor of the national Registry exam success was the end-of-program GPA, r = .550, p < .001. The GPAs and scores for self-efficacy and social support were entered into a logistic regression analysis to produce a prediction model. The end-of-program GPA (p = .015) emerged as a significant variable. This model predicted 44% of the students who failed the national Registry exam and 97.3% of those who passed, explaining 45.8% of the variance. A second model included the final grades for the radiography courses, self efficacy, and social support. Three courses significantly predicted national Registry exam success; Radiographic Exposures, p < .001; Radiologic Physics, p = .014; and Radiation Safety & Protection, p = .044, explaining 56.8% of the variance. This model predicted 64% of the students who failed the national Registry exam and 96% of those who passed. The findings support the use of in-program data as accurate predictors of success on the national Registry exam.