Terapia Ocupacional em contextos hospitalares: práticas em estágio supervisionado / Occupational therapy in hospital contexts: practical experiences in supervised internship / Terapia ocupacional en contextos hospitalarios: experiencias prácticas supervisadas

Contextualização: O presente artigo apresenta vivências práticas desenvolvidas no Estágio Supervisionado de Terapia Ocupacional em um hospital localizado no interior do Rio Grande do Sul. Processo de intervenção/acompanhamento: Foram realizados atendimentos a pacientes, pediátricos e adultos, acometidos por diversas patologias, com o objetivo de proporcionar escuta terapêutica, realização de atividades significativas para o paciente, medidas de conforto e alívio da dor, bem como o acolhimento dos familiares e cuidadores. Análise crítica da prática: As intervenções foram voltadas, principalmente, para a adaptação de lidar com o contexto hospitalar, causada pela interrupção da rotina e pelo afastamento de papéis ocupacionais assumidos antes da hospitalização, assim como o auxílio na minimização do estresse manifestado pela condição de adoecimento. Síntese das considerações: Assim, percebe-se a importante contribuição do Terapeuta Ocupacional nesse contexto, com foco na reorganização do cotidiano e na prevenção e promoção da saúde da pessoa hospitalizada.(AU)

Background: This article presents the practical experiences developed in the Supervised Internship of Occupational Therapy in a hospital located in the interior of Rio Grande do Sul. Intervention/follow-up process: Pediatric and adult patients affected by various pathologies were attended to, with the aim of providing therapeutic listening, performing meaningful activities for the patient, comfort measures and pain relief, as well as welcoming family members and caregivers. Critical analysis of the practice: The interventions were mainly aimed at adapting to deal with the hospital context, caused by the interruption of the routine and the removal of occupational roles assumed before hospitalization, and helping to minimize the stress manifested by the illness condition.Summary of considerations: TThus, we can see the important contribution of the Occupational Therapist in this context, focusing on the reorganization of daily life and on the prevention and health promotion of the hospitalized person.(AU)

Fundamento: Este artículo presenta las experiencias prácticas desarrolladas en el Internado Supervisado de Terapia Ocupacional en un hospital ubicado en el interior de Rio Grande do Sul. Proceso de intervención/seguimiento: Se atendió a pacientes pediátricos y adultos afectados por diversas patologías, con el objetivo de brindar escucha terapéutica, realizar actividades significativas para el paciente, medidas de confort y alivio del dolor, así como acogida de familiares y cuidadores.Análisis crítico de la práctica: Las intervenciones se orientaron principalmente a la adaptación al contexto hospitalario, provocado por la interrupción de la rutina y la eliminación de los roles ocupacionales asumidos antes de la hospitalización, y ayudar a minimizar el estrés manifestado por la condición de enfermedad. Resumen de consideraciones: Así, podemos ver la importante contribución del Terapeuta Ocupacional en este contexto, centrándose en la reorganización de la vida cotidiana y en la prevención y promoción de la salud de la persona hospitalizada.(AU)

Automated lung cancer assessment on 18F-PET/CT using Retina U-Net and anatomical region segmentation.

OBJECTIVES: To develop and test a Retina U-Net algorithm for the detection of primary lung tumors and associated metastases of all stages on FDG-PET/CT. METHODS: A data set consisting of 364 FDG-PET/CTs of patients with histologically confirmed lung cancer was used for algorithm development and internal testing. The data set comprised tumors of all stages. All lung tumors (T), lymphatic metastases (N), and distant metastases (M) were manually segmented as 3D volumes using whole-body PET/CT series. The data set was split into a training (n = 216), validation (n = 74), and internal test data set (n = 74). Detection performance for all lesion types at multiple classifier thresholds was evaluated and false-positive-findings-per-case (FP/c) calculated. Next, detected lesions were assigned to categories T, N, or M using an automated anatomical region segmentation. Furthermore, reasons for FPs were visually assessed and analyzed. Finally, performance was tested on 20 PET/CTs from another institution. RESULTS: Sensitivity for T lesions was 86.2% (95% CI: 77.2-92.7) at a FP/c of 2.0 on the internal test set. The anatomical correlate to most FPs was the physiological activity of bone marrow (16.8%). TNM categorization based on the anatomical region approach was correct in 94.3% of lesions. Performance on the external test set confirmed the good performance of the algorithm (overall detection rate = 88.8% (95% CI: 82.5-93.5%) and FP/c = 2.7). CONCLUSIONS: Retina U-Nets are a valuable tool for tumor detection tasks on PET/CT and can form the backbone of reading assistance tools in this field. FPs have anatomical correlates that can lead the way to further algorithm improvements. The code is publicly available. KEY POINTS: • Detection of malignant lesions in PET/CT with Retina U-Net is feasible. • All false-positive findings had anatomical correlates, physiological bone marrow activity being the most prevalent. • Retina U-Nets can build the backbone for tools assisting imaging professionals in lung tumor staging.

Rapid and sustained control of itch and reduction in Th2 bias by dupilumab in a patient with Sézary syndrome.

BACKGROUND: Sézary syndrome is a leukaemic variant of cutaneous T-cell lymphoma with poor prognosis. With the exception of stem cell transplantation, current treatments for SS are not curative. Rather, they aim at reducing disease burden and improving quality of life. Yet, pruritus - the major cause for impaired quality of life in these patients - is notoriously difficult to treat. Thus, supportive treatments addressing agonizing pruritus are urgently needed. OBJECTIVES: To explore the clinical and immunological effects of type 2 cytokine blockade with dupilumab as supportive treatment in Sézary syndrome. METHODS: A Sézary syndrome patient with stable disease but intractable pruritus was treated with dupilumab in combination with continued extracorporeal photopheresis. Close clinical and immunological monitoring on blood and skin samples from the patient was performed over 44 weeks. In vitro assays with patient's lymphoma cells were performed to address effects of dupilumab on Sézary cell's response to Th2 cytokines. RESULTS: Clinically, dupilumab treatment induced rapid and sustained reduction in itch and improvement of skin and lymph node involvement. In both blood and skin, a reduction in Th2 bias was observed. Intriguingly, lymphocyte counts and Sézary cells in blood increased and later stabilized under dupilumab treatment. In vitro, dupilumab abrogated the anti-apoptotic and activating effects of Th2 cytokines on Sézary cells. CONCLUSIONS: In this Sézary patient, inhibition of IL-4 and IL-13 signalling was associated with striking clinical benefit in terms of quality of life, pruritus and use of topical corticosteroids. While safety remains an important concern, our data support the future exploration of Th2 modulation for supportive care in Sézary Syndrome.

Structured reporting of prostate magnetic resonance imaging has the potential to improve interdisciplinary communication.

BACKGROUND: Effective interdisciplinary communication of imaging findings is vital for patient care, as referring physicians depend on the contained information for the decision-making and subsequent treatment. Traditional radiology reports contain non-structured free text and potentially tangled information in narrative language, which can hamper the information transfer and diminish the clarity of the report. Therefore, this study investigates whether newly developed structured reports (SRs) of prostate magnetic resonance imaging (MRI) can improve interdisciplinary communication, as compared to non-structured reports (NSRs). METHODS: 50 NSRs and 50 SRs describing a single prostatic lesion were presented to four urologists with expert level experience in prostate cancer surgery or targeted MRI TRUS fusion biopsy. They were subsequently asked to plot the tumor location in a 2-dimensional prostate diagram and to answer a questionnaire focusing on information on clinically relevant key features as well as the perceived structure of the report. A validated scoring system that distinguishes between "major" and "minor" mistakes was used to evaluate the accuracy of the plotting of the tumor position in the prostate diagram. RESULTS: The mean total score for accuracy for SRs was significantly higher than for NSRs (28.46 [range 13.33-30.0] vs. 21.75 [range 0.0-30.0], p < 0.01). The overall rates of major mistakes (54% vs. 10%) and minor mistakes (74% vs. 22%) were significantly higher (p < 0.01) for NSRs than for SRs. The rate of radiologist re-consultations was significantly lower (p < 0.01) for SRs than for NSRs (19% vs. 85%). Furthermore, SRs were rated as significantly superior to NSRs in regard to determining the clinical tumor stage (p < 0.01), the quality of the summary (4.4 vs. 2.5; p < 0.01), and overall satisfaction with the report (4.5 vs. 2.3; p < 0.01), and as more valuable for further clinical decision-making and surgical planning (p < 0.01). CONCLUSIONS: Structured reporting of prostate MRI has the potential to improve interdisciplinary communication. Through SRs, expert urologists were able to more accurately assess the exact location of single prostate cancer lesions, which can facilitate surgical planning. Furthermore, structured reporting of prostate MRI leads to a higher satisfaction level of the referring physician.

Development and clinical introduction of automated radiotherapy treatment planning for prostate cancer.

To develop an automated radiotherapy treatment planning and optimization workflow to efficiently create patient specifically optimized clinical grade treatment plans for prostate cancer and to implement it in clinical practice. A two-phased planning and optimization workflow was developed to automatically generate 77Gy 5-field simultaneously integrated boost intensity modulated radiation therapy (SIB-IMRT) plans for prostate cancer treatment. A retrospective planning study (n = 100) was performed in which automatically and manually generated treatment plans were compared. A clinical pilot (n = 21) was performed to investigate the usability of our method. Operator time for the planning process was reduced to <5 min. The retrospective planning study showed that 98 plans met all clinical constraints. Significant improvements were made in the volume receiving 72Gy (V72Gy) for the bladder and rectum and the mean dose of the bladder and the body. A reduced plan variance was observed. During the clinical pilot 20 automatically generated plans met all constraints and 17 plans were selected for treatment. The automated radiotherapy treatment planning and optimization workflow is capable of efficiently generating patient specifically optimized and improved clinical grade plans. It has now been adopted as the current standard workflow in our clinic to generate treatment plans for prostate cancer.

Detection limits for a GC determination of methanol and methylene chloride residues on film-coated tablets.

A GC assay was developed that quantitates methanol and methylene chloride at the lowest detectable levels for this mode of analysis. A statistical limit of detection was determined for both methanol and methylene chloride. This method is sensitive and reliable for detecting possible residues of these solvents on film-coated tablets.