ImaGiNe Seldinger: first simulator for Seldinger technique and angiography training

In vascular interventional radiology, procedures generally start with the Seldinger technique to access the vasculature, using a needle through which a guidewire is inserted, followed by navigation of catheters within the vessels. Visual and tactile skills are learnt in a patient apprenticeship which is expensive and risky for patients. We propose a training alternative through a new virtual simulator supporting the Seldinger technique: ImaGiNe (imaging guided interventional needle) Seldinger. It is composed of two workstations: (1) a simulated pulse is palpated, in an immersive environment, to guide needle puncture and (2) two haptic devices provide a novel interface where a needle can direct a guidewire and catheter within the vessel lumen, using virtual fluoroscopy. Different complexities are provided by 28 real patient datasets. The feel of the simulation is enhanced by replicating, with the haptics, real force and flexibility measurements. A preliminary validation study has demonstrated training effectiveness for skills transfer.

Is communication guidance mistaken? Qualitative study of parent-oncologist communication in childhood cancer

BACKGROUND

Guidance encourages oncologists to engage patients and relatives in discussing the emotions that accompany cancer diagnosis and treatment. We investigated the perspectives of parents of children with leukaemia on the role of paediatric oncologists in such discussion.

METHODS

Qualitative study comprising 33 audio-recorded parent-oncologist consultations and semi-structured interviews with 67 parents during the year following diagnosis.

RESULTS

Consultations soon after the diagnosis were largely devoid of overt discussion of parental emotion. Interviewed parents did not describe a need for such discussion. They spoke of being comforted by oncologists' clinical focus, by the biomedical information they provided and by their calmness and constancy. When we explicitly asked parents 1 year later about the oncologists' role in emotional support, they overwhelmingly told us that they did not want to discuss their feelings with oncologists. They wanted to preserve the oncologists' focus on their child's clinical care, deprecated anything that diverted from this and spoke of the value of boundaries in the parent-oncologist relationship.

CONCLUSION

Parents were usually comforted by oncologists, but this was not achieved in the way suggested by communication guidance. Communication guidance would benefit from an enhanced understanding of how emotional support is experienced by those who rely on it.

Accuracies of direct genomic breeding values in Hereford beef cattle using national or international training populations

The objective of this study was to estimate accuracies of direct genomic breeding values (DGV) for nationally evaluated traits of 1,081 American (AMH), 100 Argentine (ARH), 75 Canadian (CAH), and 395 Uruguayan (URH) Hereford animals genotyped using the Illumina BovineSNP50 BeadChip. Deregressed EBV (DEBV) were used as observations in a weighted analysis to derive DGV using BayesB and BayesC methods. The AMH animals were clustered into 4 groups, using either K-means or random clustering. Cross validation was performed with the group not used in training providing validation of the accuracies of estimated DGV. Genomic predictions were also evaluated for AMH animals by training on older animals and validating on younger animals. Bivariate animal models were used for each trait to estimate genetic correlations between DEBV and DGV. Genomic predictions were separately evaluated for foreign animals from each country using marker estimates from training on AMH or pooled international data. Pedigree estimated breeding values were developed for AMH animals, using traditional, pedigree-based BLUP (PBLUP) for comparison purposes. Using BayesB (BayesC) method, the average simple correlations between DGV and DEBV in AMH animals was 0.24 (0.21), 0.39 (0.36), and 0.32 (0.30) when training and validation sets were formed by K-means clustering, random allocation or year of birth of the animals, respectively. Genetic correlations between DEBV and DGV ranged from 0.20 (0.18) to 0.52 (0.45) in AMH animals. The DGV from BayesB were more accurate than from BayesC for most traits in AMH animals. Genomic predictions for foreign animals were less accurate than those obtained in AMH animals. Among foreign animals, genomic predictions were more accurate for CAH animals, which reflect the greater use of AMH sires in CAH in comparison with ARH and URH populations. Small changes in accuracies of DGV were observed for foreign animals by using admixed training populations. On average, genomic predictions across countries were more accurate for CAH and URH animals using BayesB. On average, accuracies of genomic predictions using BayesB (BayesC) method were 66% (55%) greater than those obtained from PBLUP. These results demonstrate the feasibility of developing DGV for American Hereford beef cattle. However, foreign breeders, especially South American Hereford breeders, need to genotype more animals to obtain more accurate genomic predictions.

Abstract P4-17-03: Towards the standardisation of outcome reporting in reconstructive breast surgery: Initial results of the BRAVO (Breast Reconstruction and Valid Outcome) Study–A multicentre consensus process to develop a core outcome set for reconstructive breast surgery

Introduction: Appropriate outcome selection is essential if research is to guide decision-making for patients, professionals and policy makers. Systematic reviews evaluating the clinical, cosmetic and patient-reported outcomes of breast reconstruction, however, have demonstrated marked heterogeneity of outcome reporting such that results from individual studies cannot be compared or combined. Standardising end-points by developing and using core outcome sets - an agreed minimum set of outcomes that should be measured and reported in all research and audit studies – is one way by which outcome reporting may be improved. We therefore report the initial results of the BRAVO (Breast Reconstruction and Valid Outcomes) Study which aims to use a scientifically rigorous Delphi consensus process to develop a core outcome set for reconstructive breast surgery.

Methods: The Delphi process involves the sequential completion of questionnaires to allow stakeholder opinions to be synthesised using item responses to prioritise outcome domains.

The questionnaire was developed from a long list of 148 outcomes generated from literature reviews and qualitative work with stakeholders. The outcomes were categorised into 34 domains in six categories (short-term complications; late complications; symptoms; psychosocial issues; practical issues and cosmesis) and each domain operationalised.

Key stakeholders were identified as patients, surgeons, specialist nurses and psychologists and participants were sampled purposively to ensure a breadth of perspectives. Each participant was sent a questionnaire and asked to prioritise the outcomes on a nine-point likert scale from 1(not important) to 9(extremely important).

The number of respondents in each group rating each outcome as not important(scores 1–3); equivocal(scores 4–6) or very important(score 7–9) were calculated for each item and compared between groups. The proportions of respondents rating each item as very important(score 7–9) was used to rank the items.

Results: 213 of the 430 questionnaires were returned(126/274 patients and 87/156 professionals) giving a response rate of 49.5%.

Patient participants had a median age of 53.4 years(range 34–76) and had undergone a full range of reconstructive procedures. The professional group included 39 breast surgeons, 20 plastic surgeons and 18 clinical nurse specialists.

There was agreement between 7 of the 10 outcomes that each group rated most highly. Items with consensus included patient-reported cosmesis, cosmetic satisfaction and early complications. Patients, but not professionals, considered generic complications such as bleeding to be important while professionals valued psychosocial issues such as self-esteem more highly than patients.

Conclusions: Patients and professionals prioritise similar outcomes, but areas of discrepancy with regard to complications and psychosocial outcomes remain. A further Delphi round asking participants to re-prioritise outcomes and a consensus meeting to ratify the final decisions will be necessary to determine a final core outcome set for reconstructive breast surgery.

Citation Information: Cancer Res 2012;72(24 Suppl):Abstract nr P4-17-03.

Methadone maintenance treatment in prisons: The New South Wales Experience

This paper uses the New South Wales experience with methadone maintenance treatment in prison to address the question: should methadone maintenance treatment be provided in Australian prisons for opioid-dependent prisoners? First, it outlines three rationales for providing drug dependence treatment in prisons: as a way of giving prisoners access to community-based forms of drug treatment in the prison setting; as a measure to reduce recidivism in opioid-dependent prisoners; and as a measure to prevent the transmission of HIV and other infectious diseases within prisons, and to the sexual partners of prisoners on their release. Secondly, it reviews the kind of research evidence that supports the effectiveness of community-based methadone maintenance treatment in Australia. Thirdly, the effectiveness of the New South Wales Prison Methadone Programme, one of the few prison-based methadone programmes in the world, is evaluated in the light of the available research evidence.

WE-G-BRA-06: Calibrating an Ionisation Chamber: Gaining Experience Using a Dosimetry 'flight Simulator'

PURPOSE

Recently there has been great interest in the use of simulation training, with the view to enhance safety within radiotherapy practice. We have developed a Virtual Environment for Radiotherapy Training (VERT) which facilitates this, including the simulation of a number of 'Physics practices'. One such process is the calibration of an ionisation chamber for use in Linac photon beams.

METHODS

The VERT system was used to provide a life sized 3D virtual environment within which we were able to simulate the calibration of a departmental chamber for 6MV and 15 MV beams following the UK 1990 Code of Practice. The characteristics of the beams are fixed parameters in the simulation, whereas default (Absorbed dose to water) correction factors of the chambers are configurable thereby dictating their response in the virtual x-ray beam. When the simulation is started, a random, realistic temperature and pressure is assigned to the bunker. Measurement and chamber positional errors are assigned to the chambers. A virtual water phantom was placed on the Linac couch and irradiated through the side using a 10 × 10 field. With a chamber at the appropriate depths and irradiated iso-centrically, the Quality Indices (QI) of the beams were obtained. The two chambers were 'inter-compared', allowing the departmental chamber calibration factor to be calculated from that of the reference chamber.

RESULTS

For the virtual 6/15 MV beams, the QI were found to be 0.668/ 0.761 and the inter-comparison ratios 0.4408/ 0.4402 respectively. The departmental chamber calibration factors were calculated; applying these and appropriate environmental corrections allowed the output of the Linac to be confirmed.

CONCLUSIONS

We have shown how a virtual training environment can be used to demonstrate practical processes and reinforce learning. The UK CoP was used here, however any relevant protocol could be demonstrated. Two of the authors (Beavis and Ward) are Founders of Vertual Ltd, a spin-out company created to commercialise the research presented in this abstract.