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A comparison of the individualized education plan and the individualized family service plan.

The individualized education plan (IEP) and the individualized family service plan (IFSP) are mandated for children with special needs. Occupational therapists participate in the development of both the IEP and the IFSP. This paper summarizes the similarities and the differences in the mandated components. The components addressed are (a) information about the child's status, (b) information about the family, (c) outcomes for the child and family, (d) intervention services, (e) other services, (f) dates and duration of services, (g) selection of a case manager, and (h) transition plans.

Child↗

Physician agreements to control medical prepayment plans: Federal Trade Commission. Adoption and publication of enforcement policy with respect to physician agreements to control medical prepayment plans.

The Federal Trade Commission has adopted, and is publishing with this notice, a statement of enforcement policy with respect to physician agreements to control medical prepayment plans. The statement sets forth the general approach the Commission intends to use in its case-by-case enforcement program for evaluating physician agreements to form, operate, or control such plans and for evaluating the practices of plans that are controlled by a group of physicians.

Economic Competition↗

[Financial planning for surgical research. Project portfolio as an instrument for research planning].

Planning of research funding should assure both volume and continuity of economic support. Funding of new research concepts usually depends largely on the internal budget of the research institution (primary economical resources). More mature projects can be funded by governmental and non-profit (secondary) or industrial sources (tertiary economical resources). In general, a balanced proportion of financial support will assure maximal research independence. The respective funding of a research project should be regarded as extrinsic to the quality of the said project. Portfolio analysis of research projects is introduced as a new means of planning and controlling academic and industrial research. In principle, research projects will be evaluated with regard to the inherent potential of development (e.g. potential impact on clinical or scientific concepts) and the current productivity (e.g. output of results and publications). The 2-dimensional portfolio-matrix will be used to analyse these factors, manifesting both the overall activity of a research unit and the development of new research and funding strategies. In addition, repetitive project-portfolio analyses will enable control of both spending and efficiency in research. The application of the current project-portfolio method is exemplified by an analysis of the research activities of the department of surgery at the university of Basel. To date, project-portfolio analysis is not a mature method: Development of more quantitative portfolio strategies and of multidimensional project-portfolios are proposed. However, project-portfolio analysis is a promising means of planning and controlling research. It should be used and developed further in institutions with a number of concurrent research activities.

Animals↗

Discharge planning revisited: what do social workers actually do in discharge planning?

The professional literature reflects a lack of clarity regarding the activities performed in discharge planning. Does discharge planning primarily focus on the provision of concrete services, counseling, or both? Within a structured interview format, 80 social workers in 36 acute care hospitals were asked to estimate the amount of time they spent on and the importance of 73 discharge planning tasks. Respondents were also asked to locate themselves on an activity continuum. The survey results are discussed in terms of the prospective payment system's emphasis on expeditious discharge and the challenge to social workers in enabling patients and families to have some control over decision making in this climate.

Aged↗

The frequency and spectrum of congenital anomalies in natural family planning users in South America: no increase in a case-control study. NFP-ECLAMC Group. Natural Family Planning. Latin-American Collaborative Study of Congenital Malformations.

Users of natural family planning (NFP) practice periodic abstinence, leading many to reason that such couples should show increased anomalies in offspring as a result of fertilization involving aging gametes. In an effort to complement our NFP cohort study, we currently conducted a case-control study in the same region (South America) in which the largest number of cases have been recruited for our cohort NFP study. During 1992-94, 5324 case-control pairs of mothers were interviewed during the immediate postpartum period in 18 maternity hospitals participating in the Latin-American Collaborative Study of Congenital Malformations: ECLAMC (Spanish acronym for Latin-American Collaborative Study of Congenital Malformations). Natural family planning (NFP) usage was recorded in 6% of mothers in the ECLAMC sample studied (n = 10,648). Overall, no significant differences in frequency of NFP usage were observed between malformed cases (349/5324 = 6.6%) and normal controls (303/5324 = 5.7%) (chi 2 = 3.3; df = 1; p > 0.05). No significant differences in sex ratios were observed between children of NFP user and non-user mothers. Of special interest is the lack of association between NFP and Down syndrome, the sentinel phenotype for the hypothesis of delayed fertilization (aging gametes).

Adult↗

Advance care planning in long-term care facilities.

Residents of long-term care facilities are at risk of serious medical illnesses and being unable to express choices when difficult treatment decisions must be made. Advance care planning (ACP) allows residents to consider, make, and communicate their preferences for how medical decisions should be made if they are unable to participate in the decision-making process. This article reviews the three steps in ACP: consideration of options and expression of values, communication of decisions, and documentation of the choices. The article defines and describes the particular value of ACP in long-term care facilities, reviews the literature on successful ACP programs in long-term care, and concludes with practical suggestions on how to develop and implement ACP programs.

Advance Care Planning↗

Prospective European multi-center study of natural family planning (1989-1992): interim results. The European Natural Family Planning Study Groups.

Since 1989 an international multicenter prospective study to evaluate the effectiveness and acceptability of natural family planning (NFP) methods in Europe has been conducted by the NFP Research Center at the University of Düsseldorf in collaboration with the European Zone of the International Federation for Family Life Promotion (IFFLP). Fourteen NFP-organizations from nine European countries participate in the study. Cycle data from women in the fertile age group are transferred to a special standard computer sheet by the respective organizations and forwarded at three-monthly intervals to the study center for analyses. To date, 10,045 cycles from 900 women aged between 19 and 54 years have been analyzed. This paper presents the pregnancy rate for the women aged between 19 and 45 years of age, who contributed 9284 cycles. In the analyses the cycles were subdivided into two categories consequent to sexual practices during the fertile phase: group I (NFP only--4277 cycles) use only NFP to avoid a pregnancy; group II (FA/mix--5007 cycles) where barrier methods or coitus interruptus during the fertile phase, at least in some cycles, were used to avoid a pregnancy. The women used different clinical indicators such as basal body temperature (BBT), cervical mucus, calculations, cyclical cervical changes or combinations of these to determine the beginning and the end of the fertile phase necessitating a further division into four subgroups, A, B, C, D, and different efficiency rates for each of these groups. In group A (symptothermal method, double check) 15 unintended pregnancies (UIP) occurred in 7404 cycles, giving a pregnancy rate of 2.4 Pearl Index (PI); in group B (muco-thermal method) there were 12 UIP in 1352 cycles with a pregnancy rate of 10.6 (PI); in group C (mucus to detect the beginning and mucus and BBT to determine the end of the fertile phase) there was one UIP in 434 cycles, and in group D (mucus method only) there was one IUP in 70 cycles. The numbers in group C and D are too small to calculate a pregnancy rate (PI). No pregnancy was observed in women over 40 years of age. Our conclusion from these preliminary results is that in the continent of Europe, the symptothermal method when used with periodic abstinence (NFP only = group I) and fertility awareness with the use of barriers during the fertile phase (FA/mix = group II) are effective methods of family planning.(ABSTRACT TRUNCATED AT 400 WORDS)

Adult↗

Three-dimensional dose calculations for radiation treatment planning. Photon Treatment Planning Collaborative Working Group.

We discuss geometric and physical aspects of dose calculational methodologies as developed and implemented in three-dimensional treatment planning systems at four institutions participating in an NCI Contract for the Evaluation of High Energy Photon External Beam Treatment Planning. The geometric aspects include such issues as unconventional beam orientations, 3-D patient geometry, image data requirements, and pathlength calculation in 3-D. The physical aspects deal primarily with the formalisms employed in dose calculations. Exact calculation of dose is impractical due to the complex manner in which radiation interacts with matter. Approximations have to be made which limit the accuracy of dose calculations. For a number of situations of clinical interest, especially for regions where electronic equilibrium does not exist, the accuracy of conventional methods of dose calculations is suspect. New, more accurate methods have been proposed but have not been implemented to date. Three-dimensional dose calculations are very time consuming with currently available general purpose computers. With the development of the next generation of computers and other ancillary hardware and with continuously evolving algorithms, accurate and fast three-dimensional dose calculations should become affordable for the radiotherapy community in the near future.

Humans↗

Analysis of interfractional set-up errors and intrafractional organ motions during IMRT for head and neck tumors to define an appropriate planning target volume (PTV)- and planning organs at risk volume (PRV)-margins.

BACKGROUND AND PURPOSE: To analyze the interfractional set-up errors and intrafractional organ motions and to define appropriate planning target volume (PTV)- and planning organs at risk volume (PRV)-margins in intensity-modulated radiotherapy (IMRT) for head and neck tumors. PATIENTS AND METHODS: Twenty-two patients with head and neck or brain tumors who were treated with IMRT were enrolled. The set-up errors were defined as the displacements of the coordinates of bony landmarks on the beam films from those on the simulation films. The organ motions were determined as the displacements of the coordinates of the landmarks on the images recorded every 3 min for 15 min on the X-ray simulator from those on the initial image. RESULTS: The standard deviations (SDs) of the systematic set-up errors (Sigma-INTER) and organ motions (Sigma-intra) distributed with a range of 0.7-1.3 and 0.2-0.8 mm, respectively. The average of the SDs of the random set-up errors (sigma-INTER) and organ motions (sigma-intra) ranged from 0.7 to 1.6 mm and from 0.3 to 0.6 mm, respectively. Appropriate PTV-margins and PRV-margins for all the landmarks ranged from 2.0 to 3.6 mm and from 1.8 to 2.4 mm, respectively. CONCLUSIONS: We have adopted a PTV-margin of 5mm and a PRV-margin of 3mm for head and neck IMRT at our department.

Adult↗

Family planning in the 21st century: perspective of the International Planned Parenthood Federation.

Many women still die as a result of pregnancy or childbirth and yet there are an increasing number of women who wish to regulate their fertility and space or limit their child-bearing. This paper, outlining some success stories, elucidates the family planning challenges and identifies key messages to indicate the role that IPPF can play in the 21st century. Issues such as advocacy for sexual and reproductive health and rights, increased male participation, serving the interests of marginalized groups, appropriate technology, quality of care and cooperation between various partners, all need to be addressed to improve sexual and reproductive health including family planning in the 21st century.

Developing Countries↗

Planning for the rising tides: the Humber Estuary Shoreline Management Plan.

The Humber Estuary Shoreline Management Plan provides the framework for investment in defences to reduce the risk of flooding to people, property and the environment. A key issue is the rise in sea level, which is reducing the standard of protection provided and is increasing erosion. The plan is developed from detailed geomorphological and ecological studies, and extensive consultation with interested organisations and the community. It takes into account the urban and industrial development on the floodplain, high-grade agricultural land, the historic environment and the Humber's status as an outstanding site for wildlife, which is protected under the Habitats Directive. A key aim is wherever possible to work with natural processes. Another is to ensure that there is no net loss of protected inter-tidal habitat. The options investigated include changes to the existing alignment of the embankments. The overall strategy provides for a continuing line of defence around the estuary and tidal rivers but with the use of managed retreat in some places. The creation of new inter-tidal habitat by this means is to gain more stable and cost-effective defences, and to offset the loss of protected sites, including by coastal squeeze. Further studies are in progress to appraise potential managed retreat sites.

Animals↗

TBI treatment planning using the ADAC pinnacle treatment planning system.

The use of total-body irradiation (TBI) for the purpose of bone marrow transplant is an established procedure at many institutions. In our institution, the TBI monitor unit (MU) calculation starts with the calibration done at the same conditions of the treatment source-axis distance (SAD) = 350 cm for the field size of 40 x 40 cm at a depth of 10 cm). The dose rate in the central axis of the beam at this distance is measured in cGy/MU. A tissue phantom ratio table obtained in the condition of treatment together with off-axis factors is used in the MU calculation for each particular patient. The treatment is done with the patient lying on his/her back and the beam is delivered using right-to-left lateral beams. Due to different thickness' of the patient, a lead compensator is built to compensate for the different parts of the body. Eighteen or 10-MV x-ray photons are used in the TBI treatment, and a 1-cm-thick lucite plate is placed near the patient to increase the dose to the surface. In vivo dosimetry using diodes is done to verify the calculations. The Rando-Phantom was computed-tomography scanned from the head to the abdomen with 1-cm-thick slices covering 70 cm of the phantom. This simulated the TBI treatment and correlated the calculations done by the ADAC treatment planning system to film measurements at the pelvis and lung levels. These results agreed within 5% of the measured dose. The use of the upper arms to reduce the dose to the lungs and optimization of dose using special compensators has been studied using the treatment planning system. Use of the multileaf collimator to compensate the dose received by the patient has been explored in this paper.

Humans↗

Effective treatment plan for maxillary protraction: is the bone age useful to determine the treatment plan?

A major skeletal effect of reverse-pull headgear is a forward movement of maxilla, via remodeling of the circummaxillary sutures. We hypothesized that an evaluation of bone age would help to determine the effective planning and optimum timing using reverse-pull headgear. Differences in the cephalometric measurements between the initiation of treatment and after 1 year of treatment were calculated from 60 Japanese patients in mixed dentition with skeletal Class III malocclusions. Bone age was appraised by the Tanner-Whitehouse 2 method using hand-wrist radiographs at the initiation of treatment. The control groups (mean chronologic age, male 10.3 years and female 9.6 years) were treated by lingual arch and/or chincup, and the reverse-pull headgear groups (mean chronologic age, male 9.7 years and female 9.4 years) by reverse-pull headgear. The forward movement of the maxilla and increase in the palatal length were larger in the bone age-based younger male reverse-pull headgear subgroup than in the bone age-based older male reverse-pull headgear subgroup. The increase of SNA in the male reverse-pull headgear group was significantly larger than that of the female reverse-pull headgear group, which had a more mature skeletal status than the former. In the male reverse-pull headgear group, the forward movement of the maxilla and increase in the palatal length showed significant inverse correlation with the bone age, but not with the chronologic age. These results support our hypothesis that the bone age is a useful clinical indicator to determine the effective treatment plan with reverse-pull headgear.

Adolescent↗

The evaluation of family planning services given in Erzurum mother-child health and family planning centerin Eastern Turkey.

OBJECTIVES: This study was done on women who attended to Mother-Child Health and Family Planning (MCH-FP) center asking for FP services or materials. Data were collected about their opinion of the services and about the performance of the service itself. METHODS: This is a descriptive and cross-sectional study composed of 235 women. RESULTS: In Family Planning, counseling was done by midwifes in 67.3%, by nurses in 26.6%, and only 4.5% by doctors. Proper hygienic conditions were confirmed by 89% of the women, about the equipment the percentage was 91%. Privacy was taken care of properly in 95.5% of the cases. The quality of service with regard to waiting was expressed as not waiting at all in 22.6%, and 76.6% found free seats while waiting. The cleanliness of the waiting hall was appreciated by 97.4%. In general 95.7% of the attendants appreciated the kindliness of the staff. CONCLUSIONS: This study reveals that the performances of the MCH-FP service are well appreciated by the public.

Adolescent↗

Treatment planning for brachytherapy: an integer programming model, two computational approaches and experiments with permanent prostate implant planning.

An integer linear programming model is proposed as a framework for optimizing seed placement and dose distribution in brachytherapy treatment planning. The basic model involves using 0/1 indicator variables to describe the placement or non-placement of seeds in a prespecified three-dimensional grid of potential locations. The dose delivered to each point in a discretized representation of the diseased organ and neighbouring healthy tissue can then be modelled as a linear combination of the indicator variables. A system of linear constraints is imposed to attempt to keep the dose level at each point to within specified target bounds. Since it is physically impossible to satisfy all constraints simultaneously, each constraint uses a variable to either record when the target dose level is achieved, or to record the deviation from the desired level. These additional variables are embedded into an objective function to be optimized. Variations on this model are discussed and two computational approaches--a branch-and-bound algorithm and a genetic algorithm--for finding 'optimal' seed placements are described. Results of computational experiments on a collection of prostate cancer cases are reported. The results indicate that both optimization algorithms are capable of producing good solutions within 5 to 15 min, and that small variations in model parameters can have a measurable effect on the dose distribution of the resulting plans.

Algorithms↗

Inpatient hospital utilization in three prepaid comprehensive health care plans compared with a regular Blue Cross plan.

The evidence is substantial that comprehensive, HMO-type prepayment plans can significiantly reduce hospitalization rates. Yet it remains unclear which factors contribute to this phenomenon. This study focuses on organizational characteristics of four plans with different hospitalization experiences. Regular medical staff review and frequent use of second opinions and economies of scale achieved by providing care at one well-equipped, large health center appear to have the largest impact. However, such organizational advantages can easily be wiped out by adverse self-selection of patients during open-enrollment periods. Evidence of selection based on predictable high obstetrical and newborn care costs is presented.

Blue Cross Blue Shield Insurance Plans↗

Dose calculation accuracy of lung planning with a commercial IMRT treatment planning system.

The dose calculation accuracy of a commercial pencil beam IMRT planning system is evaluated by comparison with Monte Carlo calculations and measurements in an anthropomorphic phantom. The target volume is in the right lung and mediastinum and thus significant tissue inhomogeneities are present. The Monte Carlo code is an adaptation of the MCNP code and the measurements were made with TLD and film. Both the Monte Carlo code and the measurements show very good agreement with the treatment planning system except in regions where the dose is high and the electron density is low. In these regions the commercial system shows doses up to 10% higher than Monte Carlo and film. The average calculated dose for the CTV is 5% higher with the commercial system as compared to Monte Carlo.

Algorithms↗