Robotic Systems in Radiotherapy and Radiosurgery

Purpose of Review This review provides an overview of robotic systems in radiotherapy and radiosurgery, with a focus on medical devices and recently proposed research systems. We summarize the key motivation for using robotic systems and illustrate the potential advantages. Recent Findings. Robotic systems have been proposed for a variety of tasks in radiotherapy, including the positioning of beam source, patients, and imaging devices. A number of systems are cleared for use in patients, and some are widely used, particularly for beam and patient positioning. Summary The need for precise and safe delivery of focused high doses to the target region motivates the use of robots in radiotherapy. Flexibility in the arrangement of beams and the ability to compensate for target motion are key advantages of robotic systems. While robotic patient couches are widely used and robotic beam positioning is well established, brachytherapy robots are mostly considered in a research context.

Bio-electrospraying assessment toward in situ chondrocyte-laden electrospun scaffold fabrication

Electrospinning has been widely used to fabricate fibrous scaffolds for cartilage tissue engineering, but their small pores severely restrict cell infiltration, resulting in an uneven distribution of cells across the scaffold, particularly in three-dimensional designs. If bio-electrospraying is applied, direct chondrocyte incorporation into the fibers during electrospinning may be a solution. However, before this approach can be effectively employed, it is critical to identify whether chondrocytes are adversely affected. Several electrospraying operating settings were tested to determine their effect on the survival and function of an immortalized human chondrocyte cell line. These chondrocytes survived through an electric field formed by low needle-to-collector distances and low voltage. No differences in chondrocyte viability, morphology, gene expression, or proliferation were found. Preliminary data of the combination of electrospraying and polymer electrospinning disclosed that chondrocyte integration was feasible using an alternated approach. The overall increase in chondrocyte viability over time indicated that the embedded cells retained their proliferative capacity. Besides the cell line, primary chondrocytes were also electrosprayed under the previously optimized operational conditions, revealing the higher sensitivity degree of these cells. Still, their post-electrosprayed viability remained considerably high. The data reported here further suggest that bio-electrospraying under the optimal operational conditions might be a promising alternative to the existent cell seeding techniques, promoting not only cells safe delivery to the scaffold, but also the development of cellularized cartilage tissue constructs.

Oxytocin Regimens for Labour Augmentation and Its Effect on Perinatal Outcomes: A Narrative Review

Background: The issue of childbirth, stimulation of labor is very important for successful childbirth and the birth of healthy babies. Obstetricians play main role in providing and rising Maternal and Child Health (MCH) care facilities. One amongst the goal of MCH care is safe delivery with smart feto-maternal outcome. The hormone plays vital role to cut back rates of caesarean birth once used for management of dystocia. Interventions with oxytocin particularly at high doses would lead to adverse effects on fetal heart rate and uterine tachsystole which occurs due to reduction in blood flow during contraction in intervillousspaces. The purpose of use of oxytocin is for physiological birth and for successful delivery practices. For augmentation of labour hormone regimens are low-dose (1-3 milli units/min) and high dose (4-7 milli units/min). Studies have shown high-dose of hormone causes hyperstimulation to womb. It's been mentioned that there's decrease in induction to delivery time at meta-analysis. Augmentation of labour is that the method of accelerating the frequency of contractions to facilitate a labour. The principal methodology for achieving augmentation of labour varies in the use and approach. Oxytocin is widely used for each induction and augmentation of labour. Interventions with oxytocin particularly at high doses would lead to adverse effects on fetal heart rate and uterine tachsystole which occurs due to reduction in blood flow during contraction in intervillous spaces. The purpose of use of oxytocin is for physiological birth and for successful delivery practices. These results reinforce the need to reflect on a change in care during delivery. Thus,this will help health care professional for better understanding on use and its effect during labour which will help in proper decision making for augmentation of labour.

Safe obstetric anesthesia practice-COVID-19

COVID-19 or Corona virus disease 2019 was declared a pandemic by the WHO on 11th March 2020. Cesarean delivery is a commonly performed major surgery around the world. Important considerations while performing a cesarean section on a confirmed or suspected case of COVID19 are safety of the woman and the fetus; and prevention of transmission of SARS-CoV2 infection to the fetus as well as the healthcare providers. Woman and her birthing partner should be screened for the symptoms of COVID-19 before scheduled admission. Cesarean section in a woman suffering from COVID-19 should be managed by a multidisciplinary team consisting of anesthetists, obstetricians, labor and delivery nurses, neonatologist, critical care experts and infectious disease specialists, all members working in tandem with each other. General changes in workflow, reorganization of obstetric anesthesia services and proper use of personal protective equipment (PPE) are required for safe delivery of obstetric anesthesia during the COVID pandemic. Regional anesthesia is the preferred method of anesthesia for cesarean delivery. Using regional anesthesia reduces the need of aerosol generating procedures and avoids the use of mechanical ventilation. It also decreases the possibility of exacerbating the respiratory complications due to intubation. General anesthesia is recommended when a COVID-19 parturient presents with desaturation (oxygen saturation≤ 93%) for emergency cesarean delivery. Use of mechanical barriers around patient’s head during intubation and extubation might reduce exposure. The patient should be allowed to remain in the operating room itself till sufficiently recovered to be shifted directly to the isolation room.

Intra-natal care practices of staff nurses with compliance to professional protocols

Background: Intranatal care refers to care given throughout the process of all four stages of labor and is important for both mother and newborn. Safe delivery practice and compliance to intranatal care protocol by trained staff nurses is essential. The objectives were to identify the intra-natal care practices of staff nurses, compare intranatal care practices among the three selected hospitals and explore the barriers to compliance of intranatal care practices by staff nurses.Methods: Cross-sectional observation design was used for the present study. The study was conducted in two phases to fulfil the objectives. Three hospitals were conveniently selected and about 42 delivery events were observed in phase I and 15 staff nurses were interviewed through semi-structured interview schedule to identify the barriers to compliance in phase II.Results: It was found that majority of 8 (57.1%) staff nurses were in the age group of (25-42) years and maximum 13 (86.7%) staff nurses had attended training program related to intranatal care practices. In majority 24 (57.1%) deliveries, sterile technique for vaginal examination was not followed, in 33 (78.6%) deliveries cord pulsation was not assessed and in 39 (92.9%) deliveries baby was not placed on mother’s chest. Lack of required facilities leading to referral and non-cooperation of women during procedures were some identified barriers.Conclusions: The present study findings revealed that the intranatal care practices were inappropriate, they were missing most essential practices that might harm to the mother or baby in future.

PSMA-PET/MRI-Based Focal Dose Escalation in Patients with Primary Prostate Cancer Treated with Stereotactic Body Radiation Therapy (HypoFocal-SBRT): Study Protocol of a Randomized, Multicentric Phase III Trial

Technical advances in radiotherapy (RT) treatment planning and delivery have substantially changed RT concepts for primary prostate cancer (PCa) by (i) enabling a reduction of treatment time, and by (ii) enabling safe delivery of high RT doses. Several studies proposed a dose–response relationship for patients with primary PCa and especially in patients with high-risk features, as dose escalation leads to improved tumor control. In parallel to the improvements in RT techniques, diagnostic imaging techniques like multiparametric magnetic resonance imaging (mpMRI) and positron-emission tomography targeting prostate-specific-membrane antigen (PSMA-PET) evolved and enable an accurate depiction of the intraprostatic tumor mass for the first time. The HypoFocal-SBRT study combines ultra-hypofractionated RT/stereotactic body RT, with focal RT dose escalation on intraprostatic tumor sides by applying state of the art diagnostic imaging and most modern RT concepts. This novel strategy will be compared with moderate hypofractionated RT (MHRT), one option for the curative primary treatment of PCa, which has been proven by several prospective trials and is recommended and carried out worldwide. We suspect an increase in relapse-free survival (RFS), and we will assess quality of life in order to detect potential changes.

Safety and efficacy of nurse led intravitreal injection service with Precivia® injection assist device

Introduction Intravitreal anti-VEGF injections are the most frequently performed outpatient procedure in the UK. Ophthalmic allied healthcare professionals are replacing medical professionals in delivering injections nationwide. The use of injection assist devices such as Precivia® has been well established and increasingly adopted to aid in their safe delivery. We present outcomes of nurse-led intravitreal injections using the Precivia® injection assist device over a five-year period in the UK. Methods A retrospective review was completed of all anti-VEGF intravitreal injections delivered at the Great Western Hospital between May 2015 and May 2020. Results Over the five-year study period, 2318 patients underwent a total of 26,923 intravitreal injections; 20,421 (75.8%) of which were delivered by appropriately trained ophthalmic nurses. The annual number of injections increased year-on-year from 2112 injections in 2015-2016 to 5410 injections in 2019-2020. The mean age of patients was 75.7±12.2 years with a female-to-male ratio was 1.17:1. Wet age-related macular degeneration represented the major indication for injections followed by retinal vein occlusion and diabetic maculopathy respectively. Three cases of post-injection endophthalmitis out of 20,421 (0.015%) injections in nurse injection group were identified during the study period. There were no cases of lens touch, retinal detachment or systemic thromboembolic events. Conclusion Use of the Precivia® intravitreal injection assist device by trained ophthalmic allied health professionals is a safe and cost-effective way to deliver intravitreal injections service.

Outfacing second wave of pandemic in COVID-19 positive mothers at Gandhi hospital

The novel coronavirus is a single stranded RNA virus with spike proteins triggering an immune response leading to cytokine storm and coagulopathy. Pregnancy is an immunocompromised and hypercoagulable state, with predisposition to severe illness. An insight into impact of COVID-19 in pregnancy is essential to combat its future.This study was conducted at a tertiary care centre. Analytical study was conducted from the data collected regarding COVID-19 positive labour room admissions, deliveries and deaths during the second wave of pandemic.There was a discharge rate of 88.14% after safe delivery. Among COVID-19 maternal mortalities, most deaths were due to ARDS. Quick SOFA score was a good predictor for morbidity and mortality. Deranged coagulation profile and D-Dimer levels more than 500 ng/ml were good predictors of mortality. Silent hypoxia needs to be identified and corrected at admission. Delay in seeking medical advice was a major contributory risk factor.Increasingawareness among public about seeking medical advice during early stages of disease. Early identification and treatment according to latest guidelines for a positive outcome.Making aware the policy makers regarding risk-benefits of vaccination in mothers can come a long way in changing the fate of COVID-19 in pregnancy.

Speech-Language Pathologist Perspectives of the Implementation of Telepractice-Delivered Stuttering Treatment for School-Age Children

Purpose: The impact of stuttering can be significant, and effective treatment is critical. Despite evidence supporting direct treatment approaches for school-age children who stutter, a complex set of barriers can prevent access at school. One potential solution is telepractice. To date, however, there is no published evidence regarding the use of telepractice to deliver the Lidcombe Program within a school setting. Method: In this pilot study, a telepractice service was established and the perspectives of the five treating speech-language pathologists (SLPs) were evaluated before, during, and after the trial through focus groups and recorded telesupervision sessions. Results: An inductive and reflexive thematic analysis identified four main themes: (a) Understanding and managing technology is critical; (b) logistical considerations can be time-consuming and challenging; (c) preparation and support are essential; and (d) family engagement, acceptance, and independence with telepractice services can be facilitated by external support and coaching. Initially, the SLPs shared feelings of uncertainty, fear, and apprehension. Yet, despite this concern, the SLPs ultimately reported that telepractice can play an important role in their service. Conclusions: In order to maximize the potential value of telepractice, SLPs require training and support to (a) manage the technology and troubleshoot problems that invariably arise, (b) have the opportunity to watch demonstrations of the technology, and (c) clearly explain the roles, responsibilities, and expectations of the parent engaging in treatment. These findings have particular relevance now, as schools and support services navigate a COVID-safe delivery model for the indefinite future.