Online Graduate Student Retention: Integrative Review With a Theoretically Framed Case Exemplar.

BACKGROUND: Retention of online nursing students in graduate education is essential as the need for nurses exceeds the current supply. METHOD: The factors contributing to student attrition are reviewed, and a real-world case exemplar is presented to demonstrate the theoretical design and implementation of an orientation to support retention. RESULTS: Knowles' theory of adult learning and Cooper's PECS (purpose, expectations, connections, and support) model for an evidence-based orientation framework guided the design of the orientation. Knowles' theory was aligned with the PECS model to further describe how student and environmental factors can be addressed in an orientation framework and provide strategies for implementation. Additionally, these PECS definitions were applied to specific activities within a conceptual, theoretical, and empirical framework for development of orientations. CONCLUSION: This case exemplar demonstrated an orientation framework for a feasible application of theory and evidence-based strategies for graduate online nursing programs. [J Nurs Educ. 2022;61(6):314-321.].

Proposed Hydrogel-Implant Quality Score and a Matched-Pair Study for Prostate Radiation Therapy.

PURPOSE: SpaceOAR hydrogel has been Food and Drug Administration approved to reduce rectal toxicity in prostate radiation therapy. Training and certification for this procedure is performed by the manufacturer, without independent quality measures. We propose a Hydrogel-Implant Quality Score (HIQS) as a surrogate to quantify hydrogel placement accuracy, to assist clinicians in tracking their implant proficiency, and to support quality improvement. A matched-pair study was designed to investigate the benefit of SpaceOAR in rectal dose reduction for low-dose-rate brachytherapy and to validate the principle of the proposed HIQS. METHODS: Eighty-one prostate patients were retrospectively selected for this study. Each patient had SpaceOAR implantation under manufacturer supervision. Postprocedure computed tomography and T2-weighted magnetic resonance imaging were acquired for radiation planning. A HIQS system was proposed to evaluate the hydrogel placement quality. Hydrogel implantation was performed immediately after LDR seed placement. For each LDR patient, a non-SpaceOAR patient was matched based upon intraoperative rectal dose and prostate coverage. Intraoperative and postoperative rectal dose reduction was compared between SpaceOAR and non-SpaceOAR groups. RESULTS: The average HIQS was 77 ± 10.8 (range, 49-97). Rectal anatomic distortions were seen in 17 cases. Significant rectal dose reductions between intraoperative and postoperative plans were found for SpaceOAR patients compared with non-SpaceOAR patients (25.1 Gy vs -5.0 Gy for ΔD2cc and 65.7 Gy vs 13.0 for ΔD0.1cc). Additional rectal dose reductions (8.4 Gy for ΔD2cc and 12.7 Gy for ΔD0.1cc) were found for patients without rectal distortion when SpaceOAR was used. CONCLUSIONS: The proposed HIQS system measured the hydrogel placement quality and provided insights into clinician learning and DVH outcome. SpaceOAR was shown to be effective in reducing rectal dose for LDR patients.

Can automated treatment plans gain traction in the clinic?

Recently, there has been an increased interest in the feasibility and impact of automation within the field of medical dosimetry. While there have been many commercialized solutions for automatic treatment planning, the use of an application programming interface to achieve complete plan generation for specific treatment sites is a process only recently available for certain commercial vendors. Automatic plan generation for 20 prostate patients was achieved via a stand-alone automated planning script that accessed a knowledge-based planning solution. Differences between the auto plans and clinically treated, baseline plans were analyzed and compared. The planning script successfully initialized a treatment plan, accessed the knowledge-based planning model, optimized the plan, assessed for constraint compliance, and normalized the treatment plan for maximal coverage while meeting constraints. Compared to baseline plans, the auto-generated plans showed significantly improved rectal sparing with similar coverage for targets and comparable doses to the remaining organs-at-risk. Utilization of a script, with its associated time saving and integrated process management, can quickly and automatically generate an acceptable clinical treatment plan for prostate cancer with either improved or similar results compared to a manually created plan.

Evaluation of offline adaptive planning techniques in image-guided brachytherapy of cervical cancer.

Modern three-dimensional image-guided intracavitary high dose rate (HDR) brachytherapy is often used in combination with external beam radiotherapy (EBRT) to manage cervical cancer. Intrafraction motion of critical organs relative to the HDR applicator in the time between the planning CT and treatment delivery can cause marked deviations between the planned and delivered doses. This study examines offline adaptive planning techniques that may reduce intrafraction uncertainties by shortening the time between the planning CT and treatment delivery. Eight patients who received EBRT followed by HDR boosts were retrospectively reviewed. A CT scan was obtained for each insertion. Four strategies were simulated: (A) plans based on the current treatment day CT; (B) plans based on the first fraction CT; (C) plans based on the CT from the immediately preceding fraction; (D) plans based on the closest anatomically matched previous CT, using all prior plans as a library. Strategies B, C, and D allow plans to be created prior to the treatment day insertion, and then rapidly compared with the new CT. Equivalent doses in 2 Gy for combined EBRT and HDR were compared with online adaptive plans (strategy A) at D90 and D98 for the high-risk CTV (HR-CTV), and D2 cc for the bladder, rectum, sigmoid, and bowel. Compared to strategy A, D90 deviations for the HR-CTV were -0.5 ± 2.8 Gy, -0.9 ± 1.0 Gy, and -0.7 ± 1.0 Gy for Strategies B, C, and D, respectively. D2 cc changes for rectum were 2.7 ± 5.6 Gy, 0.6 ± 1.7 Gy, and 1.1 ± 2.4 Gy for Strategies B, C, and D. With the exception of one patient using strategy B, no notable variations for bladder, sigmoid, and bowel were found. Offline adaptive planning techniques can shorten time between CT and treatment delivery from hours to minutes, with minimal loss of dosimetric accuracy, greatly reducing the chance of intrafraction motion.

A hybrid planning strategy for stereotactic body radiation therapy of early stage non-small-cell lung cancer.

Currently dynamic conformal arcs (DCA) and volumetric modulated arc therapy (VMAT) are two popular planning techniques to treat lung stereotactic body radiation therapy (SBRT) patients. Of the two, DCA has advantages in terms of multi-leaf collimator (MLC) motion, positioning error, and delivery efficiency. However, VMAT is often the choice when critical organ sparing becomes important. We developed a hybrid strategy to incorporate DCA component into VMAT planning, results were compared with DCA and VMAT plans. Four planning techniques were retrospectively simulated for 10 lung SBRT patients: DCA, Hybrid-DCA (2/3 of the doses from DCA beams), Hybrid-VMAT (2/3 of the doses from VMAT beams) and VMAT. Plan complexity was accessed by modulation complexity score (MCS). Conformity index (CI) for the planning target volume (PTV), V20 and V5 for the lung, V30 for the chestwall, and maximum dose to all other critical organs were calculated. Plans were compared with regard to these metrics and measured agreement between the planned and delivered doses. DCA technique did not result in acceptable plan quality due to target location for five patients. Hybrid-DCA produced one unacceptable plan, and Hybrid-VMAT and VMAT produced no unacceptable plans. The CI improved with increasing VMAT usage, as did the dose sparing to critical structures. Compared to the VMAT technique, a total MU reduction of 14%, 25% and 37% were found for Hybrid-VMAT, Hybrid-DCA and DCA techniques for 54 Gy patient group, and 9%, 23% and 34% for 50 Gy patient group, suggesting improvement in delivery efficiency with increasing DCA usage. No significant variations of plan complexity were observed between Hybrid-DCA and Hybrid-VMAT (P = 0.46 from Mann-Whitney U-test), but significant differences were found among DCA, Hybrid and VMAT (P < 0.05). Better agreements between the planned and delivered doses were found with more DCA contributions. By adding DCA components to VMAT planning, hybrid technique offers comparable dosimetry to full VMAT, while increasing delivery efficiency and minimizing MLC complexity.

Comparison of the progressive resolution optimizer and photon optimizer in VMAT optimization for stereotactic treatments.

The photon optimization (PO) algorithm was recently released by Varian Medical Systems to improve volumetric modulated arc therapy (VMAT) optimization within Eclipse (Version 13.5). The purpose of this study is to compare the PO algorithm with its predecessor, progressive resolution optimizer (PRO) for lung SBRT and brain SRS treatments. A total of 30 patients were selected retrospectively. Previously, all the plans were generated with the PRO algorithm within Eclipse Version 13.6. In the new version of PO algorithm (Version 15), dynamic conformal arcs (DCA) were first conformed to the target, then VMAT inverse planning was performed to achieve the desired dose distributions. PTV coverages were forced to be identical for the same patient for a fair comparison. SBRT plan quality was assessed based on selected dose-volume parameters, including the conformity index, V20 for lung, V30 Gy for chest wall, and D0.035 cc for other critical organs. SRS plan quality was evaluated based on the conformity index and normal tissue volumes encompassed by the 12 and 6 Gy isodose lines (V12 and V6 ). The modulation complexity score (MCS) was used to compare plan complexity of two algorithms. No statistically significant differences between the PRO and PO algorithms were found for any of the dosimetric parameters studied, which indicates both algorithms produce comparable plan quality. Significant improvements in the gamma passing rate (increased from 97.0% to 99.2% for SBRT and 96.1% to 98.4% for SRS), MCS (average increase of 0.15 for SBRT and 0.10 for SRS), and delivery efficiency (MU reduction of 29.8% for SBRT and 28.3% for SRS) were found for the PO algorithm. MCS showed a strong correlation with the gamma passing rate, and an inverse correlation with total MUs used. The PO algorithm offers comparable plan quality to the PRO, while minimizing MLC complexity, thereby improving the delivery efficiency and accuracy.

Do we need a new CT scan for retreatment of intracranial SRS patients?

PURPOSE: To determine if the treatment planning computed tomography scan (CT) from an initial intracranial stereotactic radiosurgery (SRS) treatment can be used for repeat courses of SRS. METHODS AND MATERIALS: Twenty-five patients with 40 brain metastases that received multiple courses of SRS were retrospectively studied. Magnetic resonance scans from repeat SRS (rMR) courses were registered to CT scans from the initial SRS (iCT) and repeat SRS (rCT). The CT scans were then registered to find the displacement of the rMR between iCT and rCT registrations. The distance from each target to proximal skull surface was measured in 16 directions on each CT scan after registration. The mutual information (MI) coefficients from the registration process were used to evaluate image set similarity. Targets and plans from the rCTs were transferred to the iCTs, and doses were recalculated on the iCT for repeat plans. The two dose distributions were compared through 3D gamma analysis. RESULTS: The magnitude of the mean linear translations from the MR registrations was 0.6 ± 0.3 mm. The mean differences in distance from target to skull on a per target basis were 0.3 ± 0.2 mm. The MI was 0.582 ± 0.042. Registration between a comparison group of 30 CT scans that had the same data resampled and 30 scans that were intercompared with different patients gave MI = 0.721 ± 0.055 and MI = 0.359 ± 0.031, respectively. The mean gamma passing rates were 0.997 ± 0.007 for 1 mm/1% criteria. CONCLUSIONS: The rMR can be aligned to the iCT to accurately define targets. The skull shows minimal change between scans so the iCT can be used for set-up at repeat treatments. The dosimetry provided by the iCT dose calculation is adequate for repeat SRS. Treatment based on iCT is feasible.

Making Research Delicious: An Evaluation of Nurses' Knowledge, Attitudes, and Practice Using the Great American Cookie Experiment With Mobile Device Gaming.

In the current healthcare environment, nurses must have a basic understanding of research to lead change and implement evidence-based practice. The purpose of this study was to evaluate the effectiveness of an educational intervention formulated on the framework of the Great American Cookie Experiment measuring nurses' research knowledge, attitudes, and practice using mobile device gaming. This multisite quantitative study provides insight into promotion of research and information about best practices on innovative teaching strategies for nurses.

Integration of leadership competencies in a community health simulation.

AIM: The purpose of this article is to address ways in which a nursing faculty can build nursing leadership competencies into a nursing programme. This article describes the use of simulation as a compelling learning strategy. BACKGROUND: Nurses need to be prepared to meet the demands of mass casualty events. With the growing need for major incident training, leadership competency development is a critical gap in the literature. EVALUATION: A collaborative simulation was used to help students apply classroom knowledge. In this simulation, students participated in major incident triage and the application of leadership competencies to appropriately manage victims' care. CONCLUSION: Collaboration among faculty members when designing simulation scenarios is a powerful approach to nursing education. Students were able to engage in necessary skills for their future nursing practice.

The meanings of diabetes, healthy lifestyle and barriers to healthy lifestyle among Filipino immigrants in the United States

@#The purpose of this study was to explore the knowledge, perception, and beliefs of newly arrived Filipino immigrants regarding Type 2 Diabetes Mellitus (T2DM), healthy lifestyle, and perceived barriers to healthy lifestyle. This is a qualitative study. A sample (n=40) of newly-arrived (less than six years in United States) first generation Filipino immigrants, not diagnosed with T2DM, living in southeastern part of United States were the focus of the study. Face to face interviews were conducted using an interview guide. No further interviews were conducted after data were saturated. The data sources were field notes and audio-recorded interviews, which were transcribed verbatim by the researcher. This study complied with the protocol for human subjects’ protection as obtained from the institutional review board. Prior to analyses of the transcripts, each transcript was read at least twice and compared to the recordings to ensure accuracy and completeness. To ensure trustworthiness, selected transcripts were reviewed and coded by two experience qualitative researchers to ensure inter-coder reliability. A significant number of the participants had little knowledge and few beliefs about T2DM. The perceptions of T2DM were varied, but several beliefs were widely held: (a) T2DM is a “sugar disease” that is based on sweet food intake, (b) participants were aiming to achieved healthy lifestyles through diet, exercise and prayers and (c) T2DM can result from several factors, including barriers to healthy lifestyle that includes stress, possible discrimination, and not enough information to navigate health resources. Although immigration brings opportunities, there are also numerous risks. Some of the diabetes beliefs that this study delineates provide anchors for future culturally appropriate intervention programs for recent Filipino immigrants. One of the major findings in this study was the low diabetes literacy among the participants. Immigrants with low diabetes literacy may have lower awareness of the disease condition, which may have a negative impact on their disease prevention behaviors. Migratory background is also an important factor influencing beliefs about disease prevention. These results provide information for the design of health programs for the prevention of T2DM in the Philippines and United States.

Examining the emerging ideas of connection within nursing practice and education

@#<p style="text-align: justify;"><strong>AIM:</strong> The purposes are to (a) examine the emerging concepts of connection within nursing practice and education; (b) evaluate current measures of connections within nursing practice and education; and c) identify strategies for enhancing connections between nursing educators and students and for nurses and patients.</p> <p style="text-align: justify;"><strong>BACKGROUND:</strong> Nursing and other disciplines rely on connections, although the term has evolved significantly in recent years due to changes of perceptions and expectations within other disciplines and within society. The lack of an empirical tool and defined attributes has constrained research and knowledge development. The initial exploration provided the first step in understanding the context and meaning of the word connect within the nursing profession. Three specific components were identified in this initial exploration within the nursing perspective: (a) respect, (b) trust, and (c) mutuality. Although the foundation of nursing care is based on the relationship and connections between the nurse and the patient, it is further identified in the first article that the need to further investigate the emerging ideas of connection within nursing practice and education.</p> <p style="text-align: justify;"><strong>METHODS:</strong> A detailed literature review was used to explore the phenomena of connection. The review of literature was performed through searches of CINAHL, EBSCO, and PubMed utilizing resources from the disciplines of transportation, business, technology, and nursing. Criteria for inclusion were (a) peer--reviewed articles; (b) articles published in English; and c) articles published between 2000 and 2014. Search terms included: connect, connection, connected, connectedness, and nursing. The search yielded a total of 114 articles; 33 were selected for inclusion. Definitions and related attributes were organized and classified based on relevance and frequency within the literature.</p> <p style="text-align: justify;"><strong>RESULTS:</strong> The attributes that were consistently found in the literature within the nurse to patient connection were: (a) interactions between the person and the object of connection; (b) an inherent need to be part of a social system; (c) use of communication in verbal, written, non­verbal, physical or virtual format; (d) the occurrence of meaningfulness, trust, mutuality and respect; (e) polychronicity; and (f) technology based emphasis. Instruments that measure connections and connectedness provide valuable insight into the concept. However, they do not adequately address the concept of connection as it relates to nursing practice and education with current technological.</p> <p style="text-align: justify;"><strong>CONCLUSIONS:</strong> While connection is a common term and fundamental to the role of the nurse/patient relationship, the defining attributes of connect have dynamically changed, and therefore require new understanding. It is critical to restructure the nurse to patient connection and to redefine the term within nursing practice and education with the inclusion of the multifaceted technological advances that define our current generations. Strategies that would enhance the nursing educator and student connection include: a) creation of additional nursing educational based Apps and Apps that focus on self-instruction tutorials and remediation techniques for non-successful students; b) integration of technological learning modalities into nursing curricula in both undergraduate and graduate programs; c) reduction of use of textbooks and inclusion of technology based learning; d) development of learning communities inside and outside of the classroom; e) creation of virtual resource support with simultaneous communication and valuable nursing information; f) and increased use of virtual environment and virtual communication.</p>