Perioperative position management of 46 cases with simultaneous bilateral auricle reconstruction: A summary of experience.

OBJECTIVES: The primary problem in simultaneous bilateral auricle reconstruction is the fragility of the reconstructed ear structure. Postoperative pressure is strictly prohibited to ensure the operation's effectiveness. The study aimed to summarize the experience of perioperative postural management in simultaneous bilateral auricular reconstruction. METHOD: This study summarizes the experience of perioperative postural management, providing preoperative sleeping posture adaptability training, neck movement training, standardization of the head position angles and the head suspension time in surgery, using protective headrests, paying attention to the transfer and handover procedures, and using specially designed pillows. RESULTS: The comprehensive nursing approach in simultaneous bilateral auricular reconstruction significantly reduced complications, improved patient comfort, and optimized postoperative adaptation. Preoperative posture training, standardized intraoperative head positions, and vigilant postoperative care played pivotal roles, demonstrating positive outcomes in 46 cases. DISCUSSION: Perioperative position management can reduce the risk of complications and pressure injuries, improving patients' postoperative comfort, emotional state, tolerance, and adaptability. CONCLUSION: All ears were viable and in good shape after long-term follow-up. The experiences discussed in this study can be broadly applied to technically mature ear reconstruction teams.

The management framework of upright position in the second stage of labour: A qualitative study.

BACKGROUND: Upright positions, as a non-pharmacological, have been well documented in multiple studies to promote normal labor, facilitate favourable birth outcomes and positive childbirth experience. Yet, the application status of upright positions in China, and even globally, is unfavourable. Thus, we have developed the Program for Upright Positions in the Second Stage of Labor (UPSSL program) for the widespread application of upright positions. While there is limited research evidence on the areas of improvement and corresponding strategies for embedding the evidence into midwifery practice. OBJECTIVES: To explore perspectives of health care providers on improvement areas of upright positions in the second stage of labor, and to identify corresponding strategies in order to develop a management framework for successful implementation of upright positions. METHODS: A qualitative descriptive design with semi-structured interviews was conducted in the study. The participants involving 13 midwives, six obstetricians and six department managers were selected from three hospitals in Beijing, China. ATLAS.TI 8 software was utilized to manage, identify the transcript data, and the thematic analysis method guided the data analysis. RESULTS: A management framework of upright positions in the second stage of labor was developed based on our study, which included five improvement areas : (1) promoting the renewal of midwifery notions and the professional training;(2) strengthening maternal health education based on the "trinity" approach; (3) promoting multidisciplinary cooperation and refining the labor procedures in upright positions; (4) optimizing midwifery human resource allocation and formulating incentive policies; (5) encouraging partner involvement and improving the birth environment. CONCLUSIONS: The study findings could provide a comprehensive view to promote UPSSL Program to be utilized in practice. Our study also provided a way for midwives, obstetricians, and other healthcare providers to work together to facilitate high quality maternal care. IMPLICATIONS FOR PRACTICE: Our findings will be useful for nursing managers to carry out the UPSSL program through several strategies, such as strengthening the professional training for assisting labor in the upright positions, reallocating midwifery human resources, and developing the childbirth education on the upright positions.

Reproducibility of chestwall and heart position using surface-guided versus RPM-guided DIBH radiotherapy for left breast cancer.

This study compared the reproducibility of chestwall and heart position using surface-guided versus RPM (real-time position management)-guided deep inspiration breath hold (DIBH) radiotherapy for left sided breast cancer. Forty DIBH patients under either surface-guided radiotherapy (SGRT) or RPM guidance were studied. For patients treated with tangential fields, reproducibility was measured as the displacements in central lung distance (CLD) and heart shadow to field edge distance (HFD) between pretreatment MV (megavoltage) images and planning DRRs (digitally reconstructed radiographs). For patients treated with volumetric modulated arc therapy (VMAT), sternum to isocenter (ISO) distance (StID), spine to rib edge distance (SpRD), and heart shadow to central axis (CAX) distance (HCD) between pretreatment kV images and planning DRRs were measured. These displacements were compared between SGRT and RPM-guided DIBH. In tangential patients, the mean absolute displacements of SGRT versus RPM guidance were 0.19 versus 0.23 cm in CLD, and 0.33 versus 0.62 cm in HFD. With respect to planning DRR, heart appeared closer to the field edge by 0.04 cm with surface imaging versus 0.62 cm with RPM. In VMAT patients, the displacements of surface imaging versus RPM guidance were 0.21 versus 0.15 cm in StID, 0.24 versus 0.19 cm in SpRD, and 0.72 versus 0.41 cm in HCD. Heart appeared 0.41 cm further away from CAX with surface imaging, whereas 0.10 cm closer to field CAX with RPM. None of the differences between surface imaging and RPM guidance was statistically significant. In conclusion, the displacements of chestwall were small and were comparable with SGRT- or RPM-guided DIBH. The position deviations of heart were larger than those of chestwall with SGRT or RPM. Although none of the differences between SGRT and RPM guidance were statistically significant, there was a trend that the position deviations of heart were smaller and more favorable with SGRT than with RPM guidance in tangential patients.

Evaluation of the voluntary deep inspiration breath-hold reproducibility in left-sided breast radiotherapy.

PURPOSE: Voluntary deep inspiration breath hold (v-DIBH) reduces cardiac dose during left-sided breast irradiation. The purpose of this study is to evaluate the reproducibility and variability of breath-hold level (BHL) using breath-hold curves and lateral kV setup images together. MATERIAL/METHOD: A retrospective analysis of 30 left breast cancer patients treated using the v-DIBH technique in our department is performed. The BHL difference is measured from breath hold curves and lateral (LAT) kilo-Voltage (kV) setup images. The planning CT image and the selected treatment fraction data are collected. If the changes in BHL relate to the displacement of various bones in the kV setup, images are assessed. Furthermore, the maximum heart distance inside the treatment field is compared from LAT MV portal images. RESULTS: The median and mean values of the BHL are nearly identical in different fractions (good reproducibility). However, the mean BHL values between planning and all measured fractions are statistically different; 16.3 vs. 20.8 mm for the planning and measured fractions (p < 0.001), which indicates that the variability of BHL is significantly different. CONCLUSION: While reproducibility testing shows good agreement for inter-fractional breath-hold level, the variability between planning and fractions is relatively poor.

Heart Sparing Radiotherapy Techniques in Breast Cancer: A Focus on Deep Inspiration Breath Hold.

Adjuvant radiation therapy is a critical component of breast cancer management. However, when breast cancer patients receive incidental radiation to the heart, there is an increased risk of cardiac disease and mortality. This is most common for patients with left-sided breast cancers and those receiving nodal irradiation as part of treatment. The overall risk of cardiac toxicity increases 4-16% with each Gray increase in mean heart radiation dose, with data suggesting that no lower limit exists which would eliminate cardiac risk entirely. Radiation techniques have improved over time, leading to lower cardiac radiation exposure than in the past. This decline is expected to reduce the incidence of radiation-induced heart dysfunction in patients. Deep inspiration breath hold (DIBH) is one such technique that was developed to reduce the risk of cardiac death and coronary events. DIBH is a non-invasive approach that capitalizes on the natural physiology of the respiratory cycle to increase the distance between the heart and the therapeutic target throughout the course of radiation therapy. DIBH has been shown to decrease the mean incidental radiation doses to the heart and left anterior descending coronary artery by approximately 20-70%. In this review, we summarize different techniques for DIBH and discuss recent data on this technique.

Effect of Z type in patients with stroke-related pneumonia / 中国实用护理杂志

Objective:To explore the effect of Z type lateral decubitus position in patients with stroke-related pneumonia.Methods:Totally 52 patients with stroke-related pneumonia admitted to the neurology care unit in Qilu Hospital of Shandong University (Qingdao) were randomly divided into the control group and the observation group with 26 cases in each group from February to December 2021.The control group adopted routine position management, and the observation group adopted the Z type lateral decubitus position to observe. The differences in sputum volume, clinical pulmonary infection score (CPIS), blood oxygen saturation change, and hospital stay between the two groups were compared.Results:The SpO 2 was 0.966 ± 0.210 in the observation group and 0.948 ± 0.223 in the control group on the 7th day after the implementation of the measures. There was a significant difference between the two groups ( t=3.07, P<0.01). The sputum aspiration volume of the observation group was (30.65 ± 10.01), (39.27 ± 11.30), (36.92 ± 12.94) ml on the 1st, 3rd, 7th day after the implementation of the measures, which were significantly higher than those of the control group (24.81 ± 9.55), (28.92 ± 9.40), (27.65 ± 7.85) ml. The differences were statistically significant ( t=2.16, 3.59, 3.12, P<0.05). On the 7th day after implementation, the CPIS score of the observation group was 4.54 ± 1.63, which was better than that of the control group 5.46±1.61 ( t=-2.06, P<0.05). The average length of stay in the observation group was (13.35 ± 2.74) d, which was significantly shorter than (15.46 ± 4.42) d in the control group ( t=-2.07, P<0.05). Conclusions:The use of Z type lateral decubitus position has a positive significance for the rehabilitation and recovery of patients with stroke-related pneumonia. This position can promote sputum drainage and improve patients pulmonary function, accelerate the dissipation of patient inflammation, and reduce the length of hospital stay.

Impact of the Varian real-time position management respiratory gating system on radiotherapy planning dosimetry / 中华放射医学与防护杂志

Objective:To study the impact of the Varian real-time position management (RPM) respiratory gating system on radiotherapy planning dosimetry.Methods:The radiotherapy plans of 40 cases with thoracic or abdominal tumors were retrospectively selected in this study. The motion phantom for quality control was adopted to generate respiratory gating signals, and the 30%-60% stable phase at the end of expiratory was selected as the respiratory gating window. The dose verification for the abovementioned radiotherapy plans was performed using the Portal Dosimetry (PD) system under RPM respiratory gating mode with the Edge accelerator. Afterwards, dose analysis was performed with different γ passing rate criteria and the distribution characteristics of γ values were analyzed. Finally, the verification results between the non-gating mode and the gating mode were compared.Results:Under the respiratory gating mode, the passing rates of all intensity-modulated radiation therapy/volumetric-modulated arc therapy (IMRT/VMAT) plans with or without flattening filters were over 95.5% by γ criteria of (3%, 3 mm) or (3%, 2 mm) and were over 90% by stricter γ criteria of (2%, 2 mm). All plans met the clinical requirements recommended by the American Association of Physicists in Medicine (AAPM). The passing rates of dose verification under non-gating mode were slightly better than those under respiratory gating mode, and the differences between the two modes were statistically significant (3%/3 mm, Z =-1.45; 3%/2 mm, Z =-2.86; 2%/2 mm, Z =-3.70; 1%/1 mm, Z =-4.52; P<0.05). There was no significant difference in the minimum and maximum values of γ and the share of γ > 1.5 of plan verification result under the two modes. However, the average value and standard deviation of the γ were generally smaller under the non-gating mode. Conclusions:The impact of the introduction of RPM respiratory gating technology on dose is clinically acceptable, and the execution of these plans in this gating mode is safe and reliable.

Discussion of full-time research assistants in China′s large hospitals: current development status and management review / 中华医学科研管理杂志

Objective:To discuss the development and management of full-time research assistants in China′s large hospitals.Methods:Through the methods of policy sorting, literature research, summarization, and classification, this study focused on the policy background, development opportunities, and the needs of the times for the position establishment of research assistants in China′s large hospitals, comprehensively classified the practical exploration and existing problems of employing and managing full-time research assistants in typical large hospitals in the country, and discussed the relevant management strategies learned from international experience.Results:In addition to hospitals directly affiliated with colleges and universities, dozens of large local hospitals in more than ten provinces have carried out beneficial practices of establishing the employment, management, and assessment systems for research assistants positions and achieved some progress. However, there are still common problems such as limited cognition of ″temporary positions″, insufficient coverage of the positions, low salary and welfare, and lack of training and development mechanisms as well as promotion and career development paths.Conclusions:The development and management of research assistants in large hospitals have gradually shifted their purpose from alleviating the employment issue of the graduates to reserving talented people in medical teaching, researching and managing, forming a high-quality, professional, and full-time medical scientific team, and continuously innovating. This article puts forward some suggestions about establishing the management system of research assistants, strengthening the standardized training for talented people, and constructing a diversified incentive mechanism combining performance appraisal and target management for research assistants.

Dosimetric analysis of Deep Inspiratory Breath-hold technique (DIBH) in left-sided breast cancer radiotherapy and evaluation of pre-treatment predictors of cardiac doses for guiding patient selection for DIBH.

INTRODUCTION: The risk of radiotherapy-associated cardiovascular disease has been a concern for decades in breast cancer survivors. The objective of our study is to evaluate the dosimetric benefit of Deep Inspiratory Breath-hold technique (DIBH) on organs-at-risk (OAR) sparing in left-sided breast cancer radiotherapy and to find out pre-treatment predictors of cardiac doses for guiding patient selection for DIBH. MATERIAL AND METHODS: Pre-radiotherapy planning CT scans were done in Free Breathing (FB) and in DIBH [using Active Breathing Coordinator system (ABC™)] in 31 left sided breast cancer patients. 3DCRT plans were generated for both scans. Comparison of anatomical and dosimetric variables were done using paired t test and correlation was evaluated using Pearson correlation. Linear regression was used to get independent predictors of cardiac sparing and Receiver Operating Characteristic (ROC) curve analysis was done to find out the specific threshold of the predictors. RESULTS: There was a 39.15% reduction in mean heart dose in DIBH compared to FB (2.4 Gy vs 4.01 Gy) (p < 0.001), 19% reduction in maximum Left Anterior Descending (LAD) dose and a 9.9% reduction in ipsilateral lung mean dose (p = 0.036) with DIBH. A significant correlation was observed between reduction in Heart Volume in Field (HVIF) and Maximum Heart Depth (MHD) with reduction in mean heart dose. Reduction in HVIF (ΔHVIF) independently predicted cardiac sparing. CONCLUSION: DIBH leads to significant reduction in OAR doses and is suggested for all patients of left-sided breast cancer undergoing radiotherapy. However, HVIF and MHD predicted for cardiac sparing and threshold criteria of ΔHVIF and ΔMHD may be used by centres with high workload to select patients for DIBH.

Clinical effectiveness of position management and manual rotation of the fetal position with a U-shaped birth stool for vaginal delivery of a fetus in a persistent occiput posterior position.

OBJECTIVE: To examine the effects of position management, manual rotation of the fetal position, and using a U-shaped birth stool in primiparous women with a fetus in a persistent occiput posterior position. METHODS: This was a prospective pilot study of women who delivered at Gansu Provincial Maternity and Child-care Hospital between January and June 2018. The women were divided into the position management ([PM] position management, manual rotation of fetal position, use of a U-shaped birth stool at different stages, and routine nursing) and control groups (position selected by women and routine nursing). RESULTS: There were 196 women in the PM group and 188 in the control group. There were no significant differences in maternal age, gestational weeks, newborn weight, and the neonatal asphyxia rate between the PM and control groups. The duration of labor was shorter in the PM group than in the control group. Pain and blood loss 2 hours after delivery and the episiotomy rate were significantly lower in the PM group than in the control group. CONCLUSION: Applying position management, manual rotation of the fetal position, and using a U-shaped birth stool should be considered for women with a fetus in a persistent occiput posterior position.

[Impact of Respiratory Waveform on Gate Signal Generation on Respiratory Gated Irradiation and Evaluation Method of Respiratory Waveform to Be Used].

PURPOSE: The respiratory gated irradiation using the real-time position management system (RPM) was used to clarify the generation of the gated signal when the respiration waveform changed, and also the evaluation method of the respiration waveform was also examined. METHODS: The respiratory waveform was changed using a moving phantom. Respiratory waveform was analyzed from the data recorded in RPM, and the out-of-phase gated rate was examined. Analysis was made by focusing on the coefficient of variation of the respiratory wavelength in the evaluation of respiratory waveform. RESULTS: Immediately after the change of respiratory wavelength from the short cycle to the long cycle, a gated signal was generated at a phase before the set gated phase, and a maximum advance of 1.259 ± 0.212 s occurred. Immediately after the change of respiratory wavelength from the long cycle to the short cycle, the gated signal was generated at the phase exceeding the set gated phase, and a delay of 0.997 ± 0.180 s occurred at the maximum. As the value of the coefficient of variation increased, the gated rate which was out of setting also increased. CONCLUSION: In respiratory gated irradiation using RPM, it became clear that the gated signal is generated out of the phase set by the respiratory waveform change. Coefficient of variation of the respiratory wavelength is considered to be an indicator for evaluating the respiratory waveform to be used in the respiratory gated irradiation.

Deep Inspiration Breath Hold: Techniques and Advantages for Cardiac Sparing During Breast Cancer Irradiation.

Historically, heart dose from left-sided breast radiotherapy has been associated with a risk of cardiac injury. Data suggests that there is not a threshold for the deleterious effects from radiation on the heart. Over the past several years, advances in radiation delivery techniques have reduced cardiac morbidity due to treatment. Deep inspiration breath hold (DIBH) is a technique that takes advantage of a more favorable position of the heart during inspiration to minimize heart doses over a course of radiation therapy. In the accompanying review article, we outline several methods used to deliver treatment with DIBH, quantify the benefits of DIBH treatment, discuss considerations for patient selection, and identify challenges associated with DIBH techniques.

Dosimetric Considerations in Respiratory-Gated Deep Inspiration Breath-Hold for Left Breast Irradiation.

PURPOSE: To present our clinical workflow of incorporating AlignRT for left breast deep inspiration breath-hold treatments and the dosimetric considerations with the deep inspiration breath-hold protocol. MATERIAL AND METHODS: Patients with stage I to III left-sided breast cancer who underwent lumpectomy or mastectomy were considered candidates for deep inspiration breath-hold technique for their external beam radiation therapy. Treatment plans were created on both free-breathing and deep inspiration breath-hold computed tomography for each patient to determine whether deep inspiration breath-hold was beneficial based on dosimetric comparison. The AlignRT system was used for patient setup and monitoring. Dosimetric measurements and their correlation with chest wall excursion and increase in left lung volume were studied for free-breathing and deep inspiration breath-hold plans. RESULTS: Deep inspiration breath-hold plans had significantly increased chest wall excursion when compared with free breathing. This change in geometry resulted in reduced mean and maximum heart dose but did not impact lung V20 or mean dose. The correlation between chest wall excursion and absolute reduction in heart or lung dose was found to be nonsignificant, but correlation between left lung volume and heart dose showed a linear association. It was also identified that higher levels of chest wall excursion may paradoxically increase heart or lung dose. CONCLUSION: Reduction in heart dose can be achieved for many left-sided breast and chest wall patients using deep inspiration breath-hold. Chest wall excursion as well as left lung volume did not correlate with reduction in heart dose, and it remains to be determined what metric will provide the most optimal and reliable dosimetric advantage.

Medical Ethical Analysis of Management Mode of Correspondence of Potencyscale- Taking the Department of Neurology as an Example / 中国医学伦理学

Objective:To explore the effect of management mode of correspondence of potencyscale on impro-ving the nurses′job satisfaction and patient satisfaction in the department of neurology and analyze the medical eth-ics. Methods:We selected 37 nurses in the department of neurology. From July 2013 to March 2014, they were provided with the traditional management mode, whereas from March 2014 to June 2015 with management mode of correspondence of potencyscale. The questionnaire survey was conducted to measure the job satisfaction of nurses and the satisfaction degree of patients. Results:After the implementation of management mode of correspondence of potencyscale, the research indexes were significantly higher than before. Conclusion:The management mode of correspondence of potencyscale can improve the nursing staff′s work enthusiasm, patient satisfaction, and the quali-ty of care. Meanwhile, it is the specific practice of nursing ethics.

Cardiac dose reduction with breathing adapted radiotherapy using self respiration monitoring system for left-sided breast cancer.

PURPOSE: To quantify the cardiac dose reduction during breathing adapted radiotherapy using Real-time Position Management (RPM) system in the treatment of left-sided breast cancer. MATERIALS AND METHODS: Twenty-two patients with left-sided breast cancer underwent CT scans during breathing maneuvers including free breathing (FB), deep inspiration breath-hold (DIBH), and end inspiration breath-hold (EIBH). The RPM system was used to monitor respiratory motion, and the in-house self respiration monitoring (SRM) system was used for visual feedback. For each scan, treatment plans were generated and dosimetric parameters from DIBH and EIBH plans were compared to those of FB plans. RESULTS: All patients completed CT scans with different breathing maneuvers. When compared with FB plans, DIBH plans demonstrated significant reductions in irradiated heart volume and the heart V25, with the relative reduction of 71% and 70%, respectively (p < 0.001). EIBH plans also resulted in significantly smaller irradiated heart volume and lower heart V25 than FB plans, with the relative reduction of 39% and 37%, respectively (p = 0.002). Despite of significant expansion of lung volume using inspiration breath-hold, there were no significant differences in left lung V25 among the three plans. CONCLUSION: In comparison with FB, both DIBH and EIBH plans demonstrated a significant reduction of radiation dose to the heart. In the training course, SRM system was useful and effective in terms of positional reproducibility and patient compliance.

Study on responsibility of the clinical nursing post in wards based on the post management / 中国实用护理杂志

Objective To study the responsibilities of nurses at different levels in providing clini cal care for patients in wards.Methods On the basis of conducting hierarchical management on nurses,the tasks of nurses in providing patients in wards with clinical care were summed up by means of data analysis and field observation.According to the tasks,a questionnaire about the responsibilities of nurses at all levels was designed.The 132 nurses from a Grade-3 Class-A general hospital in Chongqing Municipality who were responsible for providing clinical cares for patients in wards completed these questionnaires.Results Nurses in charge of providing clinical care for patients in wards usually undertook 11 tasks which could be divided into four aspects,which were,clinical nursing,nursing management,teaching on nursing and research into nursing.Based on the 11 tasks,44 responsibilities these nurses shouldered were defined,which included 4 responsibilities for N0-level nurses,6 for N1-level nurses,10 for N2-level nurses,11 for N3-level nurses,8 for N4-level nurses and 5 for N5-level nurses.Conclusions By defining in a scientific and systematic way the responsibilities and tasks of nurses at different levels in providing clinical cares for patients in wards,the research offered clinical nurses clear guidance on their work,and provided basis for the hospital's decision on clinical nurses,such as the personnel allocation,performance assessment and training; it could also help promote the position management on the work of nurses in China.

Cardiac dose reduction with breathing adapted radiotherapy using self respiration monitoring system for left-sided breast cancer

PURPOSE: To quantify the cardiac dose reduction during breathing adapted radiotherapy using Real-time Position Management (RPM) system in the treatment of left-sided breast cancer. MATERIALS AND METHODS: Twenty-two patients with left-sided breast cancer underwent CT scans during breathing maneuvers including free breathing (FB), deep inspiration breath-hold (DIBH), and end inspiration breath-hold (EIBH). The RPM system was used to monitor respiratory motion, and the in-house self respiration monitoring (SRM) system was used for visual feedback. For each scan, treatment plans were generated and dosimetric parameters from DIBH and EIBH plans were compared to those of FB plans. RESULTS: All patients completed CT scans with different breathing maneuvers. When compared with FB plans, DIBH plans demonstrated significant reductions in irradiated heart volume and the heart V25, with the relative reduction of 71% and 70%, respectively (p < 0.001). EIBH plans also resulted in significantly smaller irradiated heart volume and lower heart V25 than FB plans, with the relative reduction of 39% and 37%, respectively (p = 0.002). Despite of significant expansion of lung volume using inspiration breath-hold, there were no significant differences in left lung V25 among the three plans. CONCLUSION: In comparison with FB, both DIBH and EIBH plans demonstrated a significant reduction of radiation dose to the heart. In the training course, SRM system was useful and effective in terms of positional reproducibility and patient compliance.