Patient Education Practices and Preferences of Interprofessional Radiation Oncology Providers

PURPOSE/OBJECTIVE(S)

Patient understanding of radiotherapy (RT) processes and data regarding optimal approaches to patient education (PE) within radiation oncology (RO) are limited. Our objective was to evaluate PE practices and preferences of interprofessional RO providers to inform recommendations for delivering inclusive, accessible, and patient-centered education.

MATERIALS/METHODS

An anonymous 17-item online survey, approved by an ethics review board, was administered to all members of the Radiation Oncology Education Collaborative Study Group (ROECSG) between 10/5/22 to 11/23/22. Respondent demographics, provider practices/preferences, and institutional practices were collected. Qualitative items explored key strategies, challenges, and desired resources for PE. Descriptive statistics summarized survey responses. Fisher's exact test compared PE practices by provider role and PE timing. Thematic analysis was used for qualitative responses.

RESULTS

A total of 123 ROECSG members, including RO attendings (64%), RO trainees (21%), medical physicists (7%), physician assistants/nurses (2%), and radiation therapists (2%), completed the survey (31% response rate). Most practiced in an academic setting (86%) in North America (82%). The most common PE resources used were custom created institution-specific (61%) and electronic health system generated materials (38%). PE was delivered primarily by one-on-one teaching (72%), paper handouts (69%), and organizational websites (21%) (e.g., RTanswers.org). Almost half (41%) reported that PE practices differed based on type of clinical encounter, for example paper handouts for in-person visits and multimedia for virtual visits. The majority (86%) stated that their institution has disease site-specific PE materials, with nearly all having breast cancer materials (91%). Only 58% reported access to non-English PE materials. RO attendings/trainees were more likely than other team members to deliver PE at consultation (98% vs 71%, p = 0.03). PE practices amongst radiation oncologists differed according to the timing along the RT care path (consultation vs simulation vs first fraction, respectively): one-on-one teaching: 89% vs 49% vs 56%, p<0.01 and paper handouts: 69% vs 28% vs 16%, p<0.01. Key PE strategies included incorporating multimedia resources, personalizing delivery, and repetition at multiple timepoints by the interprofessional team. Limited time, inadequate administrative support, and lack of customized resources were identified as challenges in PE delivery.

CONCLUSION

Interprofessional RO providers engage in PE, with most utilizing institution-specific materials. PE practices differ according to the type of clinical encounter and timing in the RT care path. Increased adoption of multimedia materials and partnerships with patients to tailor PE resources based on language, learning styles, and cultural preferences are needed to foster high-quality, patient-centered PE delivery.

Specific association of growth-associated protein 43 with calcium release units in skeletal muscles of lower vertebrates

Growth-associated protein 43 (GAP43), is a strictly conserved protein among vertebrates implicated in neuronal development and neurite branching. Since GAP43 structure contains a calmodulin-binding domain, this protein is able to bind calmodulin and gather it nearby membrane network, thus regulating cytosolic calcium and consequently calcium-dependent intracellular events. Even if for many years GAP43 has been considered a neuronal-specific protein, evidence from different laboratories described its presence in myoblasts, myotubes and adult skeletal muscle fibers. Data from our laboratory showed that GAP43 is localized between calcium release units (CRUs) and mitochondria in mammalian skeletal muscle suggesting that, also in skeletal muscle, this protein can be a key player in calcium/calmodulin homeostasis. However, the previous studies could not clearly distinguish between a mitochondrion- or a triad-related positioning of GAP43. To solve this question, the expression and localization of GAP43 was studied in skeletal muscle of Xenopus and Zebrafish known to have triads located at the level of the Z-lines and mitochondria not closely associated with them. Western blotting and immunostaining experiments revealed the expression of GAP43 also in skeletal muscle of lower vertebrates (like amphibians and fishes), and that the protein is localized closely to the triad junction. Once more, these results and GAP43 structural features, support an involvement of the protein in the dynamic intracellular Ca2+ homeostasis, a common conserved role among the different species.

Spatial variation of wear on Charité lumbar discs

Total disc replacement (TDR) is a modern technique employed to treat degenerative disc disease that has the benefit of preserving motion compared with the clinically established spinal fusion. The wear performance of implants based on articulating designs is a key factor that determines their longevity and it is hypothesized that this will be the case for TDR devices. A detailed analysis of the surface of Charité lumbar disc replacements during simulated wear for five million cycles (MC), with inputs defined by the ISO18192-1 standard, is presented. After each million cycles the disc asperity heights, asperity curvature radii and their distributions on the surface of the core of the implant were determined at different locations. Two distinct areas on the surface of Charité polyethylene disc were identified based on the surface topography change during the wear simulation process. Within the area corresponding to the dome the initial roughness decreased, but after 2 MC the surface appeared to roughen with material build-up. More peripherally on the dome the surface roughness decreased after the first MC and remained constant. No effect was noticed on the rim. Furthermore, no statistical difference was noticed between the inferior and superior sides of the core of the disc. The study demonstrated that the wear on the two surfaces of the disc was uneven. This spatial variation is important in modelling the wear processes and providing strategies for reducing wear through enhanced design and modifications to the biotribological properties of the device.

Effects of cell surface loading and phase of growth in cold atmospheric gas plasma inactivation of Escherichia coli K12

AIMS

To determine the effects of surface cell concentration and phase of growth on the inactivation of Escherichia coli cells using an atmospheric nonthermal plasma.

METHODS AND RESULTS

Cells of E. coli K12 were deposited onto the surface of membrane filters and exposed to the plume from a cold atmospheric gas plasma. Scanning electron microscopy revealed severe loss in structural integrity of plasma-treated cells, and optical emission spectra indicated that inactivation was brought about by reactive plasma species. The survival of E. coli cells was found to depend on the cell surface density: as the surface density increased from 10(7) to 10(11) CFU cm(-2), the rate constant in the Baranyi inactivation model decreased from 19.59 to 1.03 min(-1). Cells harvested from mid-exponential, late exponential and stationary phases of growth displayed differences in their resistances to the effects of the plasma however, exponential phase cells were not more susceptible than those from the stationary phase.

CONCLUSIONS

High surface concentrations of cells affects the penetration of plasma species and treatment effectiveness. The physiological state of cells, as determined by phase of growth, affects their resistance to plasma inactivation.

SIGNIFICANCE AND IMPACT OF THE STUDY

In designing inactivation treatments, surface concentration and cell physiology need to be taken into account.