The technical design and concept of a PET/CT linac for biology-guided radiotherapy.

This is a summary of the design and concept of the RefleXion X1, a system for biology-guided radiotherapy (BgRT). This system is a multi-modal tomography (PET, fan-beam kVCT, and MVD) treatment machine that utilizes imaging and therapy planes for optimized beam delivery of IMRT, SBRT, SRS, and BgRT radiotherapy regimens. For BgRT delivery specifically, annihilation photons emanating outward from a PET-avid tumor are used to guide the delivery of beamlets of radiation to the tumor at sub-second latency. With the integration of PET detectors, rapid beam-station delivery, real-time tracking, and high-frequency multi-leaf collimation, the BgRT system has the potential to deliver a highly conformal treatment to malignant lesions while minimizing dose to surrounding healthy tissues. Furthermore, the potential use of a single radiotracer injection to guide radiotherapy to multiple targets opens avenues for debulking in advanced and metastatic disease states.

Psychometric Assessment of the Malay Version of the 14-Item Resilience Scale (RS-14) in Women With Breast Cancer.

BACKGROUND AND PURPOSE: There are a lack of documentation on psychometric assessments on the Malay version of 14-item Resilience scale (RS-14) in Malaysia. This study was to empirically assess its reliability and validity. METHOD: A prospective test-retest design was employed on Malaysian women with early breast cancer (N = 105). Data were analyzed using SPSS version 24. RESULTS: The results showed overall Cronbach alpha values were .92 and .93 for test-retest, respectively. Intraclass correlation coefficient (ICC) values ranged between .62 and .75. This study accepted three factors and two factors for test-retest, respectively. Individual factors showed Cronbach alpha average ranged from .71 to .91. CONCLUSION: The Malay version RS-14 tool was found to be statistically valid, reliable, and reproducible. It was able to measure resilience level in those women under study.

PeIA-5466: A Novel Peptide Antagonist Containing Non-natural Amino Acids That Selectively Targets α3ß2 Nicotinic Acetylcholine Receptors.

Pharmacologically distinguishing α3ß2 nicotinic acetylcholine receptors (nAChRs) from closely related subtypes, particularly α6ß2, has been challenging due to the lack of subtype-selective ligands. We created analogs of α-conotoxin (α-Ctx) PeIA to identify ligand-receptor interactions that could be exploited to selectively increase potency and selectivity for α3ß2 nAChRs. A series of PeIA analogs were synthesized by replacing amino acid residues in the second disulfide loop with standard or nonstandard residues and assessing their activity on α3ß2 and α6/α3ß2ß3 nAChRs heterologously expressed in Xenopus laevis oocytes. Asparagine11 was found to occupy a pivotal position, and when replaced with negatively charged amino acids, selectivity for α3ß2 over α6/α3ß2ß3 nAChRs was substantially increased. Second generation peptides were then designed to further improve both potency and selectivity. One peptide, PeIA-5466, was ∼300-fold more potent on α3ß2 than α6/α3ß2ß3 and is the most α3ß2-selective antagonist heretofore reported.

Examine the patient not the hernia: identification of an asymptomatic giant primary retroperitoneal pseudocyst. A case report and literature review.

We present the case of a 70-year-old man with a giant right-sided retroperitoneal pseudocyst, confirmed histologically after resection to be benign with appearances dissimilar to pancreatic and adrenal tissue. The cyst was noted incidentally on table at the time of laparoscopic surgery. Retroperitoneal pseudocysts most commonly arise from the pancreas and adrenal glands occurring as a result of an inflammatory process. Primary retroperitoneal pseudocysts are a rare entity. This case highlights the importance of examining the patient thoroughly and not focusing on the obvious. The mass was not palpated on initial review prior to listing for surgery, and the patient was asymptomatic from the mass.

The biology of cancer-related fatigue: a review of the literature.

PURPOSE: Understanding the etiology of cancer-related fatigue (CRF) is critical to identify targets to develop therapies to reduce CRF burden. The goal of this systematic review was to expand on the initial work by the National Cancer Institute CRF Working Group to understand the state of the science related to the biology of CRF and, specifically, to evaluate studies that examined the relationships between biomarkers and CRF and to develop an etiologic model of CRF to guide researchers on pathways to explore or therapeutic targets to investigate. METHODS: This review was completed by the Multinational Association of Supportive Care in Cancer Fatigue Study Group-Biomarker Working Group. The initial search used three terms (biomarkers, fatigue, cancer), which yielded 11,129 articles. After removing duplicates, 9145 articles remained. Titles were assessed for the keywords "cancer" and "fatigue" resulting in 3811 articles. Articles published before 2010 and those with samples <50 were excluded, leaving 75 articles for full-text review. Of the 75 articles, 28 were further excluded for not investigating the associations of biomarkers and CRF. RESULTS: Of the 47 articles reviewed, 25 were cross-sectional and 22 were longitudinal studies. More than half (about 70 %) were published recently (2010-2013). Almost half (45 %) enrolled breast cancer participants. The majority of studies assessed fatigue using self-report questionnaires, and only two studies used clinical parameters to measure fatigue. CONCLUSIONS: The findings from this review suggest that CRF is linked to immune/inflammatory, metabolic, neuroendocrine, and genetic biomarkers. We also identified gaps in knowledge and made recommendations for future research.

Treatment-related symptom severity and occurrences among oncology adults in Australia.

OBJECTIVE: Cancer treatments cause a range of distressing symptoms that can be well managed with pharmacological and nonpharmacological interventions. Treatment-related symptom screening and management by health care professionals is required to provide appropriate guidance to help patients to complete successfully their treatment regimen and achieve the best possible outcomes for patients. The aims of this study were to explore treatment-related symptom severity and occurrences among oncology adults in Australia and compare the results with the Chinese and Filipino studies. METHODS: A cross-sectional descriptive survey of 84 adult patients over 18 years of age undergoing chemotherapy (CT) and/or radiotherapy (RT) in the Radiation Oncology and Medical Oncology Departments in one public teaching hospital in Canberra, Australia using the 25-item treatment-related symptom checklist (TRSC) was used in this study. RESULTS: Six symptom clusters emerged from combining the 25 symptoms. Patients receiving CT experienced highest fatigue symptom occurrences (95.8%) and greater symptom severity (mean = 2.59) for fatigue symptom cluster for patients receiving a combination of CT-RT. Australians treatment-related symptom severity and occurrences were higher compared with the Filipino and Chinese adult cancer patients. CONCLUSIONS: Nurses in oncology settings are uniquely placed to assess patients' therapy-related symptoms that will assist them to target education to cancer patients' individual needs. For all types of cancer, it is important to assess treatment-related symptoms and to provide the most appropriate interventions in consideration to the patients' preferences.

Spirituality, religiosity, and personal beliefs of Australian undergraduate nursing students.

PURPOSE: To explore Australian nursing students' perceptions of spirituality, religiosity, and personal belief. BACKGROUND: Spiritual and religious literature support the benefits to patients' physical and mental health. Nurses have an ethical obligation to understand and incorporate patient's spiritual beliefs and values into the care plan. METHOD: A cross-sectional survey was conducted using the 32-item WHO-QOL-SRPB questionnaire. SAMPLE: The sample consisted of 483 undergraduate nursing students in Sydney, Australia. RESULTS: There were 21% male and 79% female students; age ranged from 18 to 56 years, with a mean age of 26.53 (SD = 7.32). There were no significant difference between male and female nursing students, but there were difference in SRPB scores between first-, second-, and third-year students and between religious affiliations. CONCLUSIONS AND IMPLICATIONS: Spirituality is multidimensional and multilevel and is interconnected with religiosity and personal belief. Nurses need to understand their own spirituality before they can incorporate spirituality in their patient care.

Managing cancer-related fatigue in men with prostate cancer: a systematic review of non-pharmacological interventions.

The aim of this systematic review was to synthesize the best available evidence informing the effectiveness of non-pharmacological interventions for managing cancer-related fatigue in men treated for prostate cancer. This review considered experimental studies that included men with prostate cancer (regardless of staging, previous treatment or comorbidities), aged 18 years and over who were undergoing any treatment, or had completed any treatment for prostate cancer within the previous 12 months. Three interventions were identified for the management of cancer-related fatigue in men with prostate cancer. Evidence from five studies including 447 participants demonstrates the effectiveness of physical activity, both aerobic and resistance exercise, and from three studies including 153 participants suggesting the benefits of psychosocial interventions including education and cognitive behavioural therapy. Health professionals require knowledge of a range of effective interventions aimed at reducing cancer-related fatigue in men with prostate cancer and should incorporate those interventions into their patient management. Although physical activity appears to show the greatest benefit, other non-pharmacological interventions such as education and cognitive behavioural therapy have demonstrated benefit and should also be considered as a strategy in treating this debilitating side effect of cancer and its treatment.

Advance care planning in the oncology settings.

BACKGROUND: Self-determination and patient choice of end-of-life care are emphasised in palliative care. Advance care planning (ACP) is an approach to enabling patients' choices. The use of ACP has not been extensively studied in our current context. Little is known about oncology care nurses' views and the barriers they face in the implementation of ACP. OBJECTIVE: The aims of this study were to assess the uptake of ACP by health professionals and explore nurses' perceived barriers for implementing ACP. METHODS: This study employed a pre- and post-implementation audit design using the Joanna Briggs Institute (JBI) Practical Application of Clinical Evidence System (PACES) and Getting Research into Practice (GRIP) programs. An education programme on ACP was provided between pre-and post-implementation audits. Nurses and medical professionals (pre-audit, n = 32; post-audit, n = 30) working in oncology departments were invited to complete a questionnaire based on the audit criteria. A convenience sample of 25 nurses participated in the focus group interview. Interview data were analysed by content analysis. RESULTS: The post-audit results were lower than the pre-audit results with a range of decreased compliance from 1% for criterion 5 to 14% for criterion 6. Lack of time to implement ACP was the most frequently raised barrier by oncology nurses. CONCLUSIONS: The study findings were disappointing, but this first audit is significant to provide insights for future dissemination and implementation of ACP interventions. An ongoing mandatory professional development programme in ACP for healthcare staff is promising to promote the uptake of ACP in healthcare settings.

Non-pharmacological interventions for cancer-related fatigue in men treated for prostate cancer: A systematic review.

BACKGROUND: Cancer-related fatigue is the most common, distressing complaint reported by cancer patients and the most frequently reported long-term side effect of treatment for prostate cancer. Despite this, cancer-related fatigue has not received serious attention from health professionals or researchers, particularly in relation to men with prostate cancer. It is important for healthcare professionals to understand effective non-pharmacological interventions for treating cancer-related fatigue. OBJECTIVE: To synthesize the best available evidence on the effectiveness of non-pharmacological interventions for managing cancer-related fatigue in men with prostate cancer who are undergoing or have completed treatment. INCLUSION CRITERIA: This review considered men with prostate cancer (regardless of staging, any previous treatment or co morbidities), aged 18 years and over who were undergoing any treatment, or had completed any treatment for prostate cancer within the previous 12 months.This review considered non-pharmacological interventions, including exercise, diet modification, counselling, education, and cognitive behavioral therapy, using other non-pharmacological interventions or standard care as comparators.Fatigue, as measured by validated tools.This review considered randomized controlled trials and experimental studies. SEARCH STRATEGY: A three-step search strategy was used to find published studies and papers, limited to English language reports, published between 1990 and March 2012. DATA COLLECTION: Data was extracted using a standardized extraction tool from the Joanna Briggs Institute. DATA ANALYSIS: Narrative synthesis of the results of included studies was conducted due to the heterogeneous nature of participant populations, interventions and methodologies encountered that precluded statistical meta-analysis. RESULTS: Eight studies with 600 participants were included in this review. Three interventions were found to be effective for the management of cancer-related fatigue in men with prostate cancer, either undergoing treatment or having completed treatment within the previous twelve months. The available evidence demonstrated the effectiveness of physical activity, both aerobic and resistance exercise, and psychosocial interventions, including education and cognitive behavioral therapy for improving fatigue in men treated for prostate cancer CONCLUSION: The management of cancer-related fatigue in men treated for prostate cancer requires health professionals to provide patients with a range of options. While physical activity has been shown to have the strongest benefit, other non-pharmacological interventions are beneficial and should also be considered as a strategy in treating this debilitating side effect of cancer and its treatment.Health professionals need to be aware of the high likelihood of cancer-related fatigue in men treated for prostate cancer. They also need to have knowledge of a range of effective interventions aimed at reducing cancer-related fatigue in men with prostate cancer and should incorporate those interventions into their patient management.More research should be conducted to evaluate effective non-pharmacological interventions for cancer-related fatigue in men with prostate cancer. Particular focus should be on psychosocial and educational interventions rather than activity-based interventions, as these have been well studied and shown to be effective in men with prostate cancer. Further research is needed in specific prostate cancer populations, including those defined by stage of disease, treatment type and phase of treatment.

Skin tear prevention and management among patients in the acute aged care and rehabilitation units in the Australian Capital Territory: a best practice implementation project.

BACKGROUND: A skin tear is a traumatic wound that results from the separation of the skin layers due to shearing forces, friction or blunt trauma that affects all people. Numerous preventative measures aim to reduce the skin tears and minimise conditions that predispose the epidermis to injury. With the increasing elderly population in acute aged care, implementation of an evidence-based guideline is critical as changes to ageing skin integrity make this population more susceptible to skin tear. AIMS/OBJECTIVES: The aim of this project was to ensure the practice of skin tear assessment, prevention and management among acute aged care causes and rehabilitation patients was performed according to best available evidence. METHODS: This project utilised a pre- and post-implementation audit design using the Joanna Briggs Institute Practical Application of Clinical Evidence System and Getting Research into Practice programs. The project was conducted from June to November 2010 with the audits conducted in the acute aged care and rehabilitation units of two public hospitals in the Australian Capital Territory involving a sample size of 96 patients at pre-audit and 95 patient at post-audit admitted during the audit period. A convenience sample of 20 nurses also consented to be observed. The audits were conducted after obtaining ethics approval and consent from patients and nurses. RESULTS: The results showed a significant change in compliance to the skin tear guidelines at post-implementation audit. Staff education in particular had a dramatic increase from 20% to 98% and the point prevalence rate of hospital-acquired skin tear decreased from 10% to 0.15%. DISCUSSION/CONCLUSION: This project emphasised the importance of education of all personnel involved in patient care and that a simple assessment of skin integrity is critical in preventing and managing skin tear especially among the susceptible elderly population.