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At least 19 recordsLinked to original sources
PubMed2026

Robust optimisation for photon radiotherapy: A scoping review of models, paradigms, and reporting.

BACKGROUND AND PURPOSE: Robust optimisation offers an alternative to conventional margin-based photon radiotherapy planning by explicitly modelling uncertainty, but practice is variable and not standardised. MATERIALS AND METHODS: A scoping review was conducted to map robust optimisation for photon external beam radiotherapy. Electronic searches of Scopus, PubMed and Google Scholar (2000-2025, English language) identified planning studies that incorporated modelled uncertainties into the optimisation process and reported at least one robustness-related outcome. Data were charted on clinical context, uncertainty models, optimisation paradigms, robustness metrics and evidence for clinical implementation. RESULTS: Seventy-one studies were included. Most investigated prostate, breast or lung cancer and used intensity-modulated radiotherapy or volumetric-modulated arc therapy in commercial or research treatment planning systems. Scenario-based worst-case (minimax) optimisation was the dominant paradigm in clinically oriented work, while chance-constrained, conditional value at-risk, distributionally robust and adaptive formulations were confined to small methodological series. Uncertainty modelling focused mainly on rigid set-up error; fewer studies incorporated respiratory motion, inter-fraction anatomical change, dose-calculation uncertainty or biological variation. Robustness was evaluated with diverse scenario-based dose-volume metrics, probabilistic coverage measures, composite robustness indices and, less often, biological endpoints. Direct clinical implementation reports were scarce. CONCLUSION: Robust photon planning is technically feasible and generally maintains or improves target coverage and organ sparing compared with margin-based planning. However, heterogeneity in uncertainty models, optimisation configuration and robustness reporting limits comparison and synthesis. Pragmatic minimum standards are proposed to support future consensus and wider clinical adoption.

Humans↗
PubMed1975

A long term follow-up of Moore arthroplasty in femoral neck fractures.

Moore arthroplasty was performed for medial femoral neck fractures in 169 patients. The mortality rate was 21.3 per cent within 3 months. The general postoperative complication rate (39.6 per cent) was dominated by cardiopulmonary (17.2 per cent) and thromboembolic (16.0 per cent) events. Of local complications, wound infection was found in 4.7 per cent and osteitis in 3.0 per cent of cases. A total of 60 patients were followed up with a mean observation time of 4.9 years. Of these, 8.3 per cent sustained femoral fractures during this period. The results classified according to the criteria of the American Academy of Orthopedic Surgeons showed 52 per cent excellent or good, 43 per cent fair and 5 per cent poor results. The roentgenological finding of settling or osteolysis along the prosthesis was significantly correlated to reduced hip mobility. Ossification in the prosthetic fenestres gave significantly diminished settling, and was correlated to better hip mobility and less pain. In our opinion, Moore arthroplasty has proved to be an acceptable method for the treatment of femoral neck fractures in elderly patients, as 73 per cent had an acceptable range of motion, 40 per cent managed walking distances of more than 500 m and 70 per cent had minimal or no pain. Although 25 per cent became nursing home patients, this reduction of vitality could be related to the hip arthroplasty in only two cases.

Aged↗
PubMed1976

Cor pulmonale: pathophysiology and management.

Pulmonary disease may set in motion a chain of events that ultimately leads to hypertrophy--or even failure--of the heart's right ventricle. The most common cause is chronic obstructive disease, which deprives the lungs of oxygen and produces pulmonary hypertension. But other disorders that raise pulmonary artery pressure also may be responsible. The thin right ventricle, which must work harder to overcome this increased resistance, ends up resembling the thick left ventricle. Comprehensive treatment of the primary lung condition at home usually enables the patient with chronic cor pulmonale to be more active and prevents frequent hospitalizations. Controlled-dose supplemental oxygen therapy is particularly effective, according to recent studies. Bronchospasm or bronchial infection super-imposed on the chronic lung condition may prove too much for the already strained right ventricle. Right ventricular failure calls for hospitalization and vigorous treatment, which may include mechanical ventilation, phlebotomy, antibiotics, steroids, digitalis, diuretics, and correction of electrolyte disturbances.

Heart Ventricles↗
PubMedDate not supplied

Pseduarthrosis of a tibial plateau fracture: report of a case.

In an elderly woman a tibial condylar pseudarthrosis was angulated with disabling pain, significant deformity, and progressive articular deterioration. The treatment of this non-union consisted of arthrotomy, mobilization of the ununited medial condyle, slight over-elevation of the tibial plateau, iliac bone grafting to reconstitute loci of bone loss, and rigid interfragmentary and buttress plate fixation. Postoperative management consisted of early knee motion and delayed weight-bearing to facilitate functional restoration of the extremity. Within 3 months, union occurred in anatomic position.

Aged↗
PubMed1979

Resurfacing arthroplasty of the hip. Biomechanical, morphological, and clinical aspects based on the results of a preliminary clinical study.

As an alternative in total hip replacement the so called resurfacing arthroplasty of the hip is gaining wider acceptance. The procedure can be said to be a modernisation of the original Smith-Pedersen operation and is suggested in young people with degenerative hip disease, congenital hip dysplasia or Perthes' disease. The advantages are that the femoral head and neck are retained and thus no femoral stem prosthesis is necessary. The greatest disadvantage is that in case of socket loosening a secondary operation might not remain as successful as could the initial operation with a socket which is not as large as those recommended for the resurfacing procedure. In this presentation a preliminary report of a one-year material is presented together with a presentation of advantages, disadvantages, and the biomechanical appraisal of resurfacing of the hip. Fifteen patients with 17 hips have been operated and followed-up and by using the Merle d'Aubigné evaluation there was an improvement of some 3--4 points in pain, walking, and total motion. Patient opinion indicated 80% satisfaction. The management of two serious complications is also described.

Adult↗
PubMedDate not supplied

Closed rupture of the anterior tibial tendon. A case report and review of the literature.

Closed rupture of the anterior tibial tendon is an unusual injury. It occurs in middle-aged to elderly males following forced plantar flexion of the ankle. A case is presented of a 69-year-old man with spondylolisthesis whose tendon ruptured during a physical examination. The injury was thought initially to represent an acute L5 root compression secondary to a herniated intervertebral disc at the level of his spondylolisthesis. The correct diagnosis was made after admission to the hospital. Surgical repair of the tendon resulted in normal ankle motion and strength. A review of the 12 previously reported cases indicates that treatment has been either surgical repair or conservative management. All patients recovered a normal gait but those treated surgically had more motion and dorsiflexion strength. This condition emphasizes the importance of exact history taking and thorough physical examination.

Aged↗
PubMed1976

Nutritional implications in wound healing.

Healing of wounds is one of the life functions which is intended as a defense mechanism to maintain the integrity of the body. Understanding basic factors that guide the healing process will help the clinician to propitiate those nutritional measures known to enhance the repair function. Nutrients are normally required for growth, development, and maintenance of the integrity of the tissue. The sum total of the nutritional requirements of all tissues and organs constitutes the requirements of the individual. Recommended dietary allowances have been defined for population groups in the United States for different ages and sex. These allowances involve some 17 different nutrients, but many others (up to 50) are now considered essential, although their exact requirement may not be known. When trauma of any sort is inflicted on an individual, both local and general metabolic changes take place which may lead to nutritional inadequacy. These reactions are normally intended to set into motion the mechanisms designed to repair injured tissues. Nutritional management of the individual requires that the clinican determines what, how, when, and how much nutritional supplementation should be given to the patient. Guidelines for the amounts of proteins, vitamins, and certain minerals to be administered have been discussed. Where there are impediments that make it impossible to feed the patient orally, the clinician should resort to parenteral feeding to insure that nutrients are provided for the convalescing patient. Because the trophic environment will determine to a large extent the speed with which tissues will recover, nutritional care of the patient is important and should be interrelated to the total care of the patient.

Adolescent↗
PubMed1975

Preliminary studies in measuring range of motion in normal and painful stiff shoulders.

This study has been prompted by the need to provide basic data for prospective studies in the management of the painful stiff shoulder. We have used a hydrogoniometric technique of proven accuracy to measure passive movement at the gleno-humeral joint in a normal population, patients currently attending with a painful stiff shoulder, and a retrospective group. We have shown that there are significant age and sex differences in the range of motion of normal and affected groups. A significant number (42 per cent) of patients had persisting limitation of range of the gleno-humeral joint six years after the onset of the disability. The study indicates the importance of matching patients for age and sex, and the need for long-term follow-up for meaningful results.

Adult↗
PubMed2026

Immune Checkpoint Inhibitor-related Adverse Events in Publicly Accessible United States Malpractice Records: A Systematic Legal Database Review, 2015 to 2026.

OBJECTIVES: By 2023, an estimated 56.7% of US patients with advanced or metastatic cancer were eligible for immune checkpoint inhibitor (ICI) therapy. Grade 3 to 4 immune-related adverse events (irAEs) occur in ∼14% to 21% of patients depending on regimen, yet publicly accessible malpractice records involving ICI administration or irAE management have not been systematically described. METHODS: We searched Lexis+ and Westlaw Advantage for publicly accessible US malpractice records filed from January 1, 2015, through March 31, 2026. Sources included jury verdicts and settlement databases, federal and state dockets, and briefs, pleadings, and motions databases. Cases were included only when ICI administration, indication selection, toxicity counseling, toxicity recognition, toxicity monitoring, or irAE management was causally central to the alleged negligence. RESULTS: Among 38 legal matters identified after cross-platform deduplication, 4 met eligibility criteria. These matters reflected 4 pleaded negligence theories: inappropriate ICI indication, toxicity counseling and informed-consent failure, irAE mismanagement, and treatment-related multiorgan toxicity. Publicly visible irAE-centered malpractice records were rare relative to the clinical burden, but the data do not support a national litigation incidence estimate. CONCLUSIONS: Publicly accessible irAE-centered malpractice records appear rare. As ICI use expands, litigation risk may increasingly focus on indication documentation, individualized toxicity counseling, and structured monitoring.

immune checkpoint inhibitors↗
PubMedDate not supplied

Therapy evaluation and management of patients with hemiplegia.

Appropriate treatment of the hemiplegic patient depends on a thorough evaluation of sensation and motion in the affected extremities. Realistic goals for self-care, mobility, home, and community skills may be then established. The basic role of therapy when dealing with a stroke patient includes preventing and correcting deformities, improving a patient's functional ability, and increasing strength, control, and upper extremity use when appropriate. Medical intervention may be necessary to augment the occupational and physical therapy programs in the areas of relief of pain and correction of deformities.

Activities of Daily Living↗
PubMed1979

Cost analysis in a CMHC: determining the cost of staff time.

The program evaluation and research unit of a community mental health center developed and field-tested a survey form to measure how employees spend their time. The form is divided into direct patient care activities, which include interviewing and testing, conducting therapy, and prescribing medications, and administrative or support activities, which include filling out charts, attending meetings, and training staff. All staff record daily, for one week, the hours and minutes they spend in each activity. Using that data as a base, the evaluation unit can determine the percentage of time staff spend in each activity and the cost of each activity based on staff members' paychecks.

Community Mental Health Centers↗
PubMed1978

Work load management system ensures stable nurse-patient ratio.

The concept of adjusting work load to staffing is the reverse of most currently accepted practices. However, that is precisely how this management and measurement system works. Patient care units (PCU'S) are estimated for all incoming admissions, and patients are assigned to the units that have the lowest PCU count, the goal being an even distribution of work load among nursing units.

Efficiency↗