Reimer Yates (sortstool7)

Conclusions During spine stereotactic body radiotherapy by volumetric modulated arc therapy, the dose CGS of 1 mm improved the dose calculation accuracy and increased the dose to the epidural space target compared with the dose CGS of 2 mm.The Leksell GammaPlan (LGP) with an inverse planning (IP) tool has been upgraded to version 11.1 since its launch in 2010. We evaluated its IP planning performance by re-planning 16 targets that had been planned using forward planning (FP). The FP and IP plans were compared. A planning guideline for IP process was developed aiming for an unbiased comparison. Sixteen brain metastases (BMs) without nearby critical structures were included in the study (size > 1 cm for all targets). All prior FP were re-planned in the LGP using IP and maintaining the same beam-on time and coverage. The dose to all the targets was scaled to 20 Gy in a single fraction at 50% isodose line (IDL) for FP and IP comparison purpose. The coverage and beam-on time were nearly the same for both the FP and IP plans. For all the IP plans, the mean selectivity was 0.85 ± 0.04 (vs 0.83 ± 0.04 in FP plans, p = 0.02), the mean GI was 2.92 ± 0.21 (vs 3.18 ± 0.60 in FP plans, p = 0.047), the mean V12Gy was 8.18 ± 8.57 cc (vs 9.09 ± 9.08 cc in FP plans, p = 0.001), the mean V8Gy was 14.63 ± 15.14 cc (vs 16.34 ± 16.17 cc in FP plans, p = 0.001), and the mean V5Gy was 29.01 ± 28.77 cc (vs 32.77 ± 31.41 cc in FP plans, p = 0.001). The number of shots was higher in IP plans (means of 16.69 ± 8.11 vs 10.81 ± 6.87 in FP plans, p = 0.001). We retrospectively re-planned 16 FP plans using the IP tool while meeting the quality limiting factors for the FP plans. The dosimetry parameters from the IP plans outperformed the treated FP plans and the IP tool should be preferred for tumors with size > 1 cm.This feasibility study examined Dreampad™, a sleeping device, on sleep, wandering and agitated behaviors in people living with dementia. Four nursing home residents (2 males and 2 females; mean age = 89.8 years (SD = 7.2); mean MMSE scores = 9.3 (SD = 8.7)) used Dreampad™ daily over 4-weeks when they slept. Agitation was assessed pre- and post-intervention. Wandering and sleeping patterns were assessed using a wearable actigraphy device over 24 hours at baseline and every week during the intervention. Dreampad™ was deemed acceptable and feasible for use with people living with dementia by family and care staff. No support for Dreampad™ in improving sleep or behaviors of agitation and wandering was found. Challenges in using the wearable actigraphy device are reported. Attention is needed to ensure consistent use of Dreampad™ by people living with dementia and their wear adherence of the actigraphy device. Further rigorous research is warranted and can be guided by the study outcomes.Embarrassment is commonly felt by older adults experiencing a fall, and embarrassment may cause older adults to adopt maladaptive behaviors by not implementing fall prevention strategies. Clarifying the concept of embarrassment for nursing and defining the concept as it relates to accidental falls and fall prevention among older adults was conducted using Walker and Avant's eight-step concept analysis process. The proposed definition of embarrassment experienced by older adults in relation to accidental falls is The feeling of physical discomfort and exposure in a social situation due to the loss of control and self-esteem, as well as the inconsistency between one's personal identity as an independent and dignified person and the accidental fall or near fall behavior that threatens independence and dignity leading to emotional distress. Nurses recognizing older adults' potential fall-related embarrassment may increase older adults' adherence to fall prevention strategies and improve health outcomes.Assisted living is a popular alternative to residential care, promoting independence and enabling self-care through a supportive living environment. Practitioner u