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International journal of radiation oncology biology physics. 2021:S.DOI: 10.1016/j.ijrobp.2021.07.1047
Low-Cost, Multi-Center, Longitudinal Remote Training Improves Confidence in Head and Neck Contouring
PURPOSE/OBJECTIVE(S): Remote training programs have been shown as a cost-effective way to bridge education and training gaps for radiation oncology providers in low- and middle-income countries (LMICs) and could be used to improve contouring skill. Given the expansion of 3D and intensity-modulated radiotherapy and high interest in contouring training in the Philippines, we seek to measure and report the efficacy of a pilot head and neck contouring curriculum. MATERIALS/METHODS: A 13-week, 13-session remote training program on head and neck contouring and plan evaluation was provided at no cost to 8 participating radiation oncology residency programs in the Philippines. The program consisted of weekly 1-hour live video conferencing sessions with interactive didactics and case-based learning through a cloud-based contouring platform. Resident participants were assigned a pre-curriculum and a post-curriculum stage T3N2M0 oropharynx cancer case with 27 OARs. The cases were respectively rated as 2.67/5 and 3.83/5 in difficulty by 6 U.S. educator head and neck radiation oncologists involved in the curriculum. Participants self-rated their confidence in their performance according to a 1-5 Likert scale at the time of each submission regarding three categories: organs at risk (OARs), nodal contouring, and primary target contouring. A team of 4 educators later independently graded contours, according to a 1-5 grading rubric for the same three categories. Cases received 1-2 grades total, which were averaged for analysis. Contour submission was required for a certificate of participation, however no incentives for higher scores were provided.
RESULT(S): 41 residents in the Philippines (10 R1, 12 R2, 11 R3, and 9 R4) participated in the curriculum. Average participation per session was 26 (range 12-39, SD=7.2). 26 (63.4%) participants completed pre-contours for evaluation and 17 (41.5%) post-contours for evaluation. Of these, 14 participants were eligible for paired pre- vs. post-curriculum analysis. Paired pre- and post-curriculum confidence scores (out of 5) were 3.0 and 3.77 for OARs (P=0.003), 3.08 and 3.54 for nodal stations (P=0.056), and 2.85 and 3.31 for primary target contouring (P=0.027), respectively. Overall confidence in contouring the assigned case rose from 2.85 to 3.54 (P < 0.001). Paired pre- and post-curriculum educator grades were 2.96 and 3.38 for OARs (P=0.135), 2.61 and 1.96 for nodal coverage (P=0.019), and 2.54 and 2.73 for primary target contours (P=0.292), respectively. Qualitative observations included greater participant uniformity of left and right parotid glands.
CONCLUSION(S): Longitudinal telehealth training integrating cloud-based tools for radiation oncology professionals is a viable and scalable method for providing head and neck contouring education in a LMIC setting. Our findings suggest that work remains to assess the concordance of confidence with performance, especially in challenging cases, and that further contouring education is needed in LMIC regions.
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RESULT(S): 41 residents in the Philippines (10 R1, 12 R2, 11 R3, and 9 R4) participated in the curriculum. Average participation per session was 26 (range 12-39, SD=7.2). 26 (63.4%) participants completed pre-contours for evaluation and 17 (41.5%) post-contours for evaluation. Of these, 14 participants were eligible for paired pre- vs. post-curriculum analysis. Paired pre- and post-curriculum confidence scores (out of 5) were 3.0 and 3.77 for OARs (P=0.003), 3.08 and 3.54 for nodal stations (P=0.056), and 2.85 and 3.31 for primary target contouring (P=0.027), respectively. Overall confidence in contouring the assigned case rose from 2.85 to 3.54 (P < 0.001). Paired pre- and post-curriculum educator grades were 2.96 and 3.38 for OARs (P=0.135), 2.61 and 1.96 for nodal coverage (P=0.019), and 2.54 and 2.73 for primary target contours (P=0.292), respectively. Qualitative observations included greater participant uniformity of left and right parotid glands.
CONCLUSION(S): Longitudinal telehealth training integrating cloud-based tools for radiation oncology professionals is a viable and scalable method for providing head and neck contouring education in a LMIC setting. Our findings suggest that work remains to assess the concordance of confidence with performance, especially in challenging cases, and that further contouring education is needed in LMIC regions.
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EMBASE:636624521
ISSN: 1879-355x
CID: 5082252
Triggering final oocyte maturation with gonadotropin-releasing hormone agonist (GnRHa) versus human chorionic gonadotropin (hCG) in breast cancer patients undergoing fertility preservation: an extended experience
PURPOSE: To analyze the cycle outcomes and the incidence of ovarian hyperstimulation syndrome (OHSS), when oocyte maturation was triggered by gonadotropin-releasing hormone agonist (GnRHa) versus human chorionic gonadotropin (hCG) in breast cancer patients undergoing fertility preservation. METHODS: One hundred twenty-nine women aged
PMCID:4096878
PMID: 24854484
ISSN: 1573-7330
CID: 2633872
Ovarian stimulation and fertility preservation with the use of aromatase inhibitors in women with breast cancer
Breast cancer is the most common malignancy diagnosed in women in the United States. Many breast cancer survivors are concerned that cancer treatment will compromise their reproductive potential. Despite this concern, most women receive limited information addressing preservation of fertility before initiating adjuvant chemotherapy. Historically, the supraphysiologic levels of estrogens associated with ovarian stimulation have precluded the use of assisted reproductive technologies in the presence of breast cancer. In an effort to mitigate the potential effects of elevated estrogen levels during ovulation induction, we developed a novel ovarian stimulation protocol for women with breast cancer, with the use of aromatase inhibitors. Our studies suggest that in the short term, aromatase inhibitors plus gonadotropins are safe and effective agents for ovarian stimulation in fertility preservation cycles. In this review, we outline the data supporting the use of aromatase inhibitors for ovarian hyperstimulation in women with breast cancer before initiating adjuvant chemotherapy.
PMID: 23058686
ISSN: 1556-5653
CID: 2633862
Revisiting case-control confusion REPLY [Letter]
ISI:000298369200009
ISSN: 0002-9378
CID: 2633812
Lower abdominal and pelvic pain with advanced pelvic organ prolapse: a case-control study
OBJECTIVE: The objective of the study was to compare the relative frequencies of pain in women with and without pelvic organ prolapse (POP). STUDY DESIGN: This was an ancillary analysis of a case-control study investigating functional bowel disorders in women with and without POP. Cases were defined as subjects with stage 3 or 4 POP and controls were subjects with normal pelvic support. RESULTS: Women with POP were more likely to experience lower abdominal or pelvic pain that was significantly bothersome and interfered with daily activities (odds ratio [OR], 9.7; 95% confidence interval [CI], 4.7-20.4). After controlling for confounders, women with prolapse were more likely to report pressure in the lower abdomen (OR, 2.3; 95% CI, 1.6-3.2), heaviness in the pelvic region (OR, 3.3; 95% CI, 2.3-4.3), and pain in the lower abdomen (OR, 2.6; 95% CI, 1.8-4.1). CONCLUSION: Women with prolapse are more likely to report pain, pressure, or heaviness in the lower abdomen or pelvis compared with women with normal support.
PMID: 21345412
ISSN: 1097-6868
CID: 2633852
Operative experience during residency training in obstetrics and gynecology: Is there a trend towards fewer surgical cases?
OBJECTIVE: Surgical experience in the operating room is an essential component of the education and training of residents in Obstetrics and Gyne- cology. With the revolution in minimally invasive technologies, the medical management of conditions that were previously surgically managed, and the introduction of the 80-hour work week, the time available to residents for the development of surgical skills has become more limited. The aim of our study is to quantify the changes over time in the operative experiences of graduating residents in Obstetrics and Gynecology. DESIGN: The Accreditation Council for Graduate Medical Education (ACGME) Resident Statistics Summary reports from the academic year 2002-2003 till the present were retrospectively reviewed. MATERIALS AND METHODS: The mean number of cases performed during the chief year as the primary surgeon for both abdominal hysterectomy and vaginal hysterectomy were analyzed. Statistical analysis was carried out using unpaired t tests and the analysis of variance (ANOVA). All statistical tests were performed using SAS 9.2 (SAS Institute, Cary, NC) and statistical significance was set at P<0.05. RESULTS: The mean number of abdominal hysterectomies performed by a graduating resident was 89.1 in 2002-2003 as compared to 68.6 in 20092010 (P< 0.001). The mean number of vaginal hysterectomies performed by a graduating resident was 34.9 in 2002-2003 as compared to 19.7 in 2009-2010 (P< 0.001). In addition, there was a statistically significant decrease in the operative experience of graduating chief residents during the study period (P<0.001). CONCLUSION: Current graduating residents are more likely to be performing fewer abdominal and vaginal hysterectomies than previous generations. To develop the technical skills required to be a competent and independently practicing gynecologic surgeon, graduating residents should consider additional fellowship training
EMBASE:70650764
ISSN: 0015-0282
CID: 150882
Hypertrophic labia minora
PMID: 19608442
ISSN: 1873-4332
CID: 2633842
Advantage of conservative surgical management of large ovarian neoplasms in adolescents
OBJECTIVE: To measure the postoperative size and volume of the ovary after cystectomy for a neoplasm >or=10 cm. DESIGN: Retrospective case series. SETTING: Academic medical center. PATIENT(S): Nine patients who underwent surgical management for an ovarian neoplasm at Children's Hospital Boston between November 2003 and November 2007. INTERVENTION(S): Patients were evaluated by ultrasound postoperatively. MAIN OUTCOME MEASURE(S): Sonographic size and volume of the ovary after cystectomy for an ovarian neoplasm >or=10 cm. RESULT(S): The mean age of the patients was 14.2 +/- 2.2 years, ranging between 10 and 17 years. The mean preoperative size of the ovarian neoplasm was 14.8 +/- 3.8 cm, ranging between 10 and 20 cm. Serum tumor markers were negative in seven out of nine patients. There were no borderline tumors or malignancies identified. There was no statistically significant difference between the size or volume of the affected ovary and the contralateral ovary at the time of postoperative evaluation. CONCLUSION(S): Postoperative ultrasound revealed that the affected ovary resumed its normal size and volume despite the attenuated appearance of the ovarian cortex at the time of surgery. Ovarian cystectomy should be the preferred surgical approach for adolescents to ensure conservation of ovarian tissue.
PMID: 18410934
ISSN: 1556-5653
CID: 2633822
Development of a high-throughput Alamar blue assay for the determination of influenza virus infectious dose, serum antivirus neutralization titer and virus ca/ts phenotype
FluMist is an intranasal influenza live vaccine containing two Influenza A strains (currently H1N1 and H3N2) and one B strain (Yamagata or Victoria lineage). Characterization of the vaccine requires determination of the median tissue culture infectious dose (TCID(50)) titer, serum antivirus neutralization titer and vaccine cold adapted/temperature sensitive (ca/ts) phenotype. Visual cytopathic effect (CPE) readings are used widely in viral assays, but these are subjective and labor intensive. In response to the need for an efficient, inexpensive and high-throughput assay, a 96-well microplate assay was developed that uses Alamar blue dye staining as a replacement for CPE observation in the determination of influenza virus infectious dose, serum antivirus neutralization titer and virus ca/ts phenotype. Relative operating characteristic curves verified that there was a clear distinction between the fluorescence readings of the Alamar blue stained CPE positive and CPE negative wells. Virus titer was determined by use of both Alamar blue staining and CPE-based TCID(50) assays for wild-type and FluMist influenza vaccine strains as well as a plasmid-rescued influenza FluMist A strain containing a H5N1 derived hemmaglutinin and neuramidinase. Correlation of the two assays was measured by regression analysis and resulted in R(2) values of 0.814 (Influenza A), 0.983 (Influenza B) and 1.000 (H5N1), respectively. Serum microneutralization as well as virus ca/ts phenotype assays also showed a high concordance between readings based on CPE observation and Alamar blue staining. The Alamar blue dye assay is user friendly, environmentally safe and sensitive. Also, it is adaptable to automation, which could provide a high-throughput platform for analysis of pre-clinical and clinical samples.
PMID: 18423899
ISSN: 0166-0934
CID: 2633832
Reduced bone mineral density is associated with breast arterial calcification
BACKGROUND: Arterial calcification, a marker of atherosclerosis, results from a complex process of biomineralization resembling bone formation. Breast arterial calcification (BAC) has been associated with angiographic and clinical cardiovascular disease. The purpose of this study was to determine the association between reduced bone mineral density (BMD) and BAC, which may share a common pathophysiology. METHODS: We conducted a retrospective study of 228 women (55% Hispanic, mean age 64 +/-10 yr) who had both mammography and BMD evaluation at Columbia University Medical Center from 2001-2003. Each mammogram was reviewed for the presence of BAC using standardized methods. BMD was measured using dual-energy x-ray absorptiometry and categorized as normal, low bone density (osteopenia), or osteoporosis as defined by the World Health Organization. Univariate and multivariate logistic regression analyses were performed to evaluate the association between reduced BMD and BAC. RESULTS: The prevalence of BAC, low bone density (osteopenia), and osteoporosis was 39, 42, and 29%, respectively. Women with BAC were significantly more likely to be older, Hispanic, and postmenopausal and have osteoporosis as compared with women without BAC. In age-adjusted analyses, women with BAC were more likely to have reduced BMD (odds ratio 3.0, P < 0.01) as compared with women without BAC. Furthermore, osteoporosis was strongly associated with the presence of BAC (odds ratio 3.5, P < 0.01). CONCLUSION: These data suggest that osteoporosis and arterial calcification are strongly and independently correlated. Reduced BMD may identify women at risk of vascular disease.
PMCID:2190738
PMID: 17971427
ISSN: 0021-972x
CID: 2633882
