Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “Planning”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 37 records · Page 2Linked to original sources
PubMedDate not supplied

Is recovery planning any different from treatment planning?

Using process evaluation data, this paper compares the "recovery" planning process of the social model programs with the "treatment" planning process in a comparison medical model program. We consider how the planning process is actually conducted, the role of staff versus clients in the planning process, and how the implementation of the planning process is monitored and evaluated at the programs. Results point to major differences in the actual process of treatment planning and recovery planning. Professional staff at medical model programs generally direct and control the planning process and its implementation. In social model programs, clients are directly responsible for developing their own recovery plans, within a context of help from peers and recovering staff; the latter oversee the process. We conclude that both treatment planning and recovery planning are distinct and defining features of medical and social model philosophies. Treatment planning in medical model programs and recovery planning in social model programs serve similar administrative and programmatic functions. However, the impact on patients/residents is likely to be significantly different. Recovery planning becomes a skill acquired by clients, part of the experiential education characterizing social model programs. Future research is needed to assess whether these planning skills actually aid social model clients in structuring a sober lifestyle in aftercare, and whether differences are obtained by the more passive client role in planning taken at the medical model program.

Humans↗
PubMed2002

Inverse planning for interstitial gynecologic template brachytherapy: truly anatomy-based planning.

PURPOSE: Commercially available optimization schemes generally result in an undesirable dose distribution, because of the particular shapes of tumors extending laterally from the tandem. Dose distribution is therefore manually obtained by adjusting relative dwell time values until an acceptable solution is found. The objective of this work is to present the clinical application of an inverse planning dose optimization tool for the automatic determination of source dwell time values in the treatment of interstitial gynecologic templates. METHODS AND MATERIALS: In cases where the tumor extends beyond the range of the tandem-ovoid applicator, catheters as well as the tandem are inserted into the paravaginal and parametrial region in an attempt to cover the tumor volume. CT scans of these patients are then used for CT-based dose planning. Dose distribution is obtained manually by varying the relative dwell times until adequate dose coverage is achieved. This manual planning is performed by an experienced physician. In parallel, our in-house inverse planning based on simulated annealing is used to automatically determine which of all possible dwell positions will become active and to calculate the dwell time values needed to fulfill dose constraints applied to the tumor volume and to each organ at risk. To compare the results of these planning methods, dose-volume histograms and isodose distributions were generated for the target and each organ at risk. RESULTS: This procedure has been applied for the dose planning of 12 consecutive interstitial gynecologic templates cases. For all cases, once the anatomy was contoured, the routine of inverse planning based on simulated annealing found the solution to the dose constraints within 1 min of CPU time. In comparison, manual planning took more than 45 min. The inverse planning-generated plans showed improved protection to organs at risk for the same coverage compared to manual planning. CONCLUSION: This inverse planning tool reduced the planning time significantly and produced improved plans with reduced dose to the organs at risk. Furthermore, the inverse planning approach improves the physician's control over treatment. The focus becomes the physician's prescription to the target and his or her compromise due to dose to normal structures.

Algorithms↗
PubMed2004

Effect of MLC leaf width on the planning and delivery of SMLC IMRT using the CORVUS inverse treatment planning system.

This study investigates the influence of multileaf collimator (MLC) leaf width on intensity modulated radiation therapy (IMRT) plans delivered via the segmented multileaf collimator (SMLC) technique. IMRT plans were calculated using the Corvus treatment planning system for three brain, three prostate, and three pancreas cases using leaf widths of 0.5 and 1 cm. Resulting differences in plan quality and complexity are presented here. Plans calculated using a 1 cm leaf width were chosen over the 0.5 cm leaf width plans in seven out of nine cases based on clinical judgment. Conversely, optimization results revealed a superior objective function result for the 0.5 cm leaf width plans in seven out of the nine comparisons. The 1 cm leaf width objective function result was superior only for very large target volumes, indicating that expanding the solution space for plan optimization by using narrower leaves may result in a decreased probability of finding the global minimum. In the remaining cases, we can conclude that we are often not utilizing the objective function as proficiently as possible to meet our clinical goals. There was often no apparent clinically significant difference between the two plans, and in such cases the issue becomes one of plan complexity. A comparison of plan complexity revealed that the average 1 cm leaf width plan required roughly 60% fewer segments and over 40% fewer monitor units than required by 0.5 cm leaf width plans. This allows a significant decrease in whole body dose and total treatment time. For very complex IMRT plans, the treatment delivery time may affect the biologically effective dose. A clinically significant improvement in plan quality from using narrower leaves was evident only in cases with very small target volumes or those with concavities that are small with respect to the MLC leaf width. For the remaining cases investigated in this study, there was no clinical advantage to reducing the MLC leaf width from 1 to 0.5 cm. In such cases, there is no justification for the increased treatment time and whole body dose associated with the narrower MLC leaf width.

Algorithms↗
PubMed2002

On the selection of optimization parameters for an inverse treatment planning replacement of a forward planning technique for prostate cancer.

The influence of organ volume sampling, lateral scatter inclusion, and the selection of objectives and constraints on the inverse treatment planning process with a commercial treatment planning system is investigated and suitable parameters are identified for an inverse treatment planning replacement of a clinical forward planning technique for prostate cancer. For the beam geometries of the forward technique, a variable set of parameters is used for the calculation of dose from pencil beams. An optimal set is identified after the evaluation of optimized plans that correspond to different sets of pencil-beam parameters. This set along with a single, optimized set of objectives and constraints is used to perform inverse planning on ten randomly selected patients. The acceptability of the resulting plans is verified by comparisons to the clinical ones calculated with the forward techniques. For the particular commercial treatment planning system, the default values of the pencil beam parameters are found adequate for inverse treatment planning. For all ten patients, the optimized, single set of objectives and constraints results in plans with target coverage comparable to that of the forward plans. Furthermore inverse treatment planning reduces the overall mean rectal and bladder doses by 4.8% and 5.8% of the prescription dose respectively. The study indicates that (i) inverse treatment planning results depend implicitly on the sampling of the dose distribution, (ii) inverse treatment planning results depend on the method used by the dose calculation model to account for scatter, and (iii) for certain sites, a single set of optimization parameters can be used for all patient plans.

Dose Fractionation, Radiation↗
PubMed2000

Do consumer reports of health plan quality affect health plan selection?

OBJECTIVE: To learn whether consumer reports of health plan quality can affect health plan selection. DATA SOURCES: A sample of 311 privately insured adults from Los Angeles County. STUDY DESIGN: The design was a fractional factorial experiment. Consumers reviewed materials on four hypothetical health plans and selected one. The health plans varied as to cost, coverage, type of plan, ability to keep one's doctor, and quality, as measured by the Consumer Assessment of Health Plans Study (CAHPS) survey. DATA ANALYSIS: We used multinomial logistic regression to model each consumer's choice among health plans. PRINCIPAL FINDINGS: In the absence of CAHPS information, 86 percent of consumers preferred plans that covered more services, even though they cost more. When CAHPS information was provided, consumers shifted to less expensive plans covering fewer services if CAHPS ratings identified those plans as higher quality (59 percent of consumers preferred plans covering more services). Consumer choices were unaffected when CAHPS ratings identified the more expensive plans covering more services as higher quality (89 percent of consumers preferred plans covering more services). CONCLUSIONS: This study establishes that, under certain realistic conditions, CAHPS ratings could affect consumer selection of health plans and ultimately contain costs. Other studies are needed to learn how to enhance exposure and use of CAHPS information in the real world as well as to identify other conditions in which CAHPS ratings could make a difference.

Adolescent↗
PubMed2003

Comparative analysis of intensity modulation inverse planning modules of three commercial treatment planning systems applied to head and neck tumour model.

BACKGROUND AND PURPOSE: Three commercial treatment planning modules for intensity modulated radiation therapy (IMRT) Inverse Planning, MDS-Nordion Helax-TMS, Varian Cadplan-Helios, and CMS Focus, were compared in an attempt to determine potential application limits or dosimetric differences among various optimisation algorithms. MATERIALS AND METHODS: A comparative analysis of intensity modulated dose distributions was conducted at planning level on a group of four patients presenting advanced head and neck cancers. In the study, we analysed primarily the static 'step and shoot' multileaf implementation of modulation realisation with some investigation, on the Cadplan-Helios implementation of the 'sliding window', the Varian dynamic approach to IMRT delivery. The whole study was carried out using the inverse planning tools implemented by vendors fully optimising each plan to obtain the best dosimetry given some general plan objectives. To achieve adequate target coverage, optimisation was carried out on Helax-TMS and CMS Focus adding extra margins of 5 or 6mm to the planning target volume (PTV). Beam arrangements were set with five and nine equally spaced fields. The study was conducted with two complexity levels. At the first level, dose-volume constraints were applied only to the target volume and to the spinal cord, while parotid glands were added at the second level. The relative values of dose distributions and dose-volume histograms were compared, together with an estimate of the biological implications in terms of Equivalent Uniform Dose to the target. In the Cadplan-Helios system also the dosimetric implications of the number of intensity levels selected for the discretisation of the fluence matrix were investigated. RESULTS: With the application of common planning strategies and the proper consideration of treatment planning system (TPS) specific features (e.g. the PTV margin problem), no substantial differences among the three algorithms were demonstrated at the first level for PTV and spinal cord. At the second level of the study differences were outlined for Helax-TMS, where sub-optimal results were obtained with the 5-field geometry. Mainly due to the differences in optimisation volumes, Cadplan-Helios presented significant better sparing of healthy tissue around the PTV, in terms of mean dose to healthy tissue and Irradiated Volume at 50% dose level. Finally, to achieve dosimetrically acceptable and stable results on target, a minimum of eight intensity levels should be applied for the multileaf collimator (MLC) segmentation, giving an average of 1.5 segments per field and per intensity level. CONCLUSIONS: Results obtained for the three IMRT TPS show in first instance that the optimisation algorithms analysed, as well as the conversion from computed fluences to multileaf sequences implemented in the planning systems can produce substantially equivalent dose plans (for target coverage and organs at risk sparing) if planning is performed with common strategies and once a strong understanding of each system feature is achieved. Secondly, a limited number of dose levels (about eight) is adequate at planning level.

Brachytherapy↗
PubMed2005

Intensity-modulated radiotherapy planning from limited anatomical information: is Sim-CT sufficient for planning women with breast cancer receiving intensity-modulated radiotherapy?

AIMS: To investigate intensity-modulated radiotherapy (IMRT) plans for women with carcinoma of the breast, using a small number of Sim-CT slices, thus avoiding changing the patient's position and potential problems with CT capacity. MATERIALS AND METHODS: Ten CT scans of women with breast cancer were obtained for use in the study. IMRT plans based on an open tangent pair and additional top-up segment fields were created using the full CT scan, and represented the gold standard treatment plan for comparison purposes. Five-slice CT simulator scans were artificially created by omitting intermediate slices from the full CT scans. Additionally, the intermediate CT slices were recreated via interpolation of the five slices using a standard interpolation algorithm. IMRT plans were created in the same way as for the full CT scans. To allow a suitable plan comparison to be made, the beam segments and monitor units were transferred to the full CT scans, and the dose distribution calculated. RESULTS: The interpolated five-slice plans showed no significant difference in the volume of tissue receiving dose outside the range 95-105%, compared with the IMRT plans created using the full CT data set (1.3 +/- 2.2%, P = 0.092). In contrast, the discrete slice CT simulator plans increased by 6.3 +/- 5.4%, P = 0.0054, showing a statistically significant difference in the dose distribution produced and a clinically inferior plan. CONCLUSIONS: Plans created using five discrete slice CT scans were inferior to full CT-derived IMRT treatment plans, and are therefore not acceptable for IMRT. However, interpolating five CT simulator slices provides adequate anatomical information to produce comparable IMRT plans to those created by full CT scans of the patient. This allows the introduction of IMRT for this patient group without the need to change treatment position to accommodate CT scanning.

Anatomy, Cross-Sectional↗
PubMed2004

Planned elective repeat caesarean section versus planned vaginal birth for women with a previous caesarean birth.

BACKGROUND: When a woman has had a previous caesarean birth, there are two options for her care in a subsequent pregnancy: planned elective repeat caesarean or planned vaginal birth. While there are risks and benefits for both planned elective repeat caesarean birth and planned vaginal birth after caesarean, current sources of information are limited to non-randomised cohort studies. Studies designed in this way have significant potential for bias and consequently conclusions based on these results are limited in their reliability and should be interpreted with caution. OBJECTIVES: To assess, using the best available evidence, the benefits and harms of a policy of planned elective repeat caesarean section with a policy of planned vaginal birth after caesarean section for women with a previous caesarean birth. SEARCH STRATEGY: We searched the Cochrane Pregnancy and Childbirth Group trials register (24 June 2004), the Cochrane Central Register of Controlled Trials (The Cochrane Library, Issue 1, 2004), and PubMed (1966 to 24 June 2004). SELECTION CRITERIA: Randomised controlled trials with reported data that compared outcomes in mothers and babies who planned a repeat elective caesarean section with outcomes in women who planned a vaginal birth, where a previous birth had been by caesarean. DATA COLLECTION AND ANALYSIS: Two reviewers independently assessed trial quality and extracted data. MAIN RESULTS: There were no randomised controlled trials identified. REVIEWERS' CONCLUSIONS: Planned elective repeat caesarean section and planned vaginal birth after caesarean section for women with a prior caesarean birth are both associated with benefits and harms. Evidence for these care practices is drawn from non-randomised studies, associated with potential bias. Any results and conclusions must therefore be interpreted with caution. Randomised controlled trials are required to provide the most reliable evidence regarding the benefits and harms of both planned elective repeat caesarean section and planned vaginal birth for women with a previous caesarean birth.

Cesarean Section, Repeat↗
PubMed2005

IMRT treatment planning:- a comparative inter-system and inter-centre planning exercise of the ESTRO QUASIMODO group.

BACKGROUND AND PURPOSE: The purpose of this work was a comparison of realistic IMRT plans based on the same CT-image data set and a common predefined set of dose objectives for the planning target volume and the organs at risk. This work was part of the larger European QUASIMODO IMRT verification project. MATERIALS AND METHODS: Eleven IMRT plans were produced by nine different European groups, each applying a representative set of clinically used IMRT treatment planning systems. The plans produced were to be deliverable in a clinically acceptable treatment time with the local technical equipment. All plans were characterized using a set of different quality measures such as dose-volume histograms, number of monitor units and treatment time. RESULTS: Only one plan was able to fulfil all dose objectives strictly; six plans failed some of the objectives but were still considered to be clinically acceptable; four plans were not able to reach the objectives. Additional quality scores such as the number of monitor units and treatment time showed large variations, which mainly depend on the delivery technique. CONCLUSION: The presented planning study showed that with nearly all presently available IMRT planning and delivery systems comparable dose distributions could be achieved if the planning goals are clearly defined in advance.

Anthropometry↗
PubMed1981

Out-of-plan use under two prepaid plans.

This analysis of out-of-plan use of physician and paramedical services under a Kaiser plan and under a prepaid option offered by a predominantly fee-for-service group practice (Clinic plan) deals primarily with services that members could have obtained from plan providers ("covered services"). The extent and pattern of out-of-plan use were found to be similar. While 16-20 per cent of plan members used some out-of-plan covered services and the mean number of such services was about one half visit per member per year, most out-of-plan user were occasional user, 10-12 per cent of user (or 2 per cent of plan members) accounting for 50 per cent of all out-of-plan covered services. The principal members characteristics associated with out-of-plan use were dissatisfaction, health status and having other insurance. The literature on out-of-plan use is also reviewed.

Adolescent↗
PubMed2006

Consumer determinants of the use of health plan information in plan selection.

One of the major issues in achieving optimum levels of performance in health-care markets is to enhance consumer understanding of their health plan choices in order to facilitate the expansion of 'high-value' health plans at the expense of 'low-value' health plans. The Federal government offers employees many choices of health plans and provides large amounts of information on all of these options through (1) comparative written health plan information, (2) information from the health plans themselves, and (3) comparative health plan information on the Internet. The present study examines the degree to which 1722 Federal employees in the Department of Health and Human Services utilized health plan information from the above three sources in making their annual health plan selection. Results indicate that most employees (64%) used at least one information source, with written information from health plans the most common (53%), followed by comparative written information in The Guide (32%) and the Internet (16%). Those employees who regularly search for information prior to making an important purchase, those with a short time in their current plan, those with family coverage, Whites, African-Americans, and men were all more likely to use health plan information to make their annual choice. The Internet was accessed more often by younger and higher paid employees. Implications for policy and future research are discussed.

Adult↗
PubMed1999

[A comparison of CT-supported 3D planning with simulator planning in the pelvic irradiation of primary cervical carcinoma].

BACKGROUND: Using standardized simulator planning guided by bony landmarks for pelvic irradiation of primary cervical carcinoma with some patients a geographical miss regarding tumor or potential tumor spread can happen because of insufficient knowledge of the individual anatomical situation. The question arises whether for patients with this indication the higher effort in terms of time and personnel for 3D treatment planning is justified. PATIENTS AND METHOD: In a prospective study on 20 subsequent patients with primary cervical carcinoma in Stages I to III simulator planning of a 4-field box-technique was performed. After defining the planning target volume (PTV) in the 3D planning system the field configuration of the simulator planning was transmitted. The resulting plan was compared to a second one based on the defined PTV and evaluated regarding a possible geographical miss and encompassment of the PTV by the treated volume (ICRU). Volumes of open and shaped portals were calculated for both techniques. RESULTS: Planning by simulation resulted in 1 geographical miss and in 10 more cases the encompassment of the PTV by the treated volume was inadequate. For a PTV of mean 1,729 cm3 the mean volume defined by simulation was 3,120 cm3 for the open portals and 2,702 cm3 for the shaped portals (Figure 1). The volume reduction by blocks was 13.4% (mean). With CT-based 3D treatment planning the volume of the open portals was 3.3% (mean) enlarged to 3,224 cm3 (Figure 2). The resulting mean volume of the shaped portals was 2,458 ccm. The reduction compared to the open portals was 23.8% (mean). The treated volumes were 244 cm3 or 9% (mean) smaller compared to simulator planning. The "treated volume/planning target volume ratio" was decreased from 1.59 to 1.42. CONCLUSION: The introduction of 3D treatment planning for pelvic irradiation of cervical carcinoma is to be recommended for reasons of quality assurance. Reduction of the treated volume is possible but further research has to be done to determine whether the rate of complications can be decreased as well.

Brachytherapy↗
PubMedDate not supplied

Strategic planning: the first step in the planning process.

Strategic planning is a systematic process through which an organization builds commitment among key stakeholders to goals and priorities which are essential to its mission and vision, and responsive to the operating environment. Strategic planning is the first step in a comprehensive planning process that also includes business planning and implementation planning. If all three steps are carried out in sequence, strategic planning can be a very effective means of educating the stakeholders about where the cancer program is and where it is going, gaining support and commitment for the direction that the cancer program will take, and assuring that everyone's expectations can be managed effectively. Unfortunately, some organizations and cancer program leaders misunderstand the process. Too often, strategic planning is used as a stand-alone activity. This article will describe what strategic planning is, how it should smoothly lead into business planning and implementation planning, and how to avoid the pitfalls that sometimes arise during the strategic planning effort.

Cancer Care Facilities↗
PubMed2005

Preparing strategic information management plans for hospitals: a practical guideline SIM plans for hospitals: a guideline.

OBJECTIVES: Systematic information management in hospitals demands for a strategic information management plan (SIM plan). As preparing a SIM plan is a considerable challenge we provide a practical guideline that is directly applicable when a SIM plan is going to be prepared. METHODS: The guideline recommends a detailed structure of a SIM plan and gives advice about its content and the preparation process. It may be used as template, which can be adapted to the individual demands of any hospital. RESULTS: The guideline was used in several hospitals preparing a SIM plan. Experiences showed that the SIM plans could be prepared very efficiently and timely using the guideline, that the proposed SIM plan structure suited well, that the guideline offers enough flexibility to meet the requirements of the individual hospitals and that the specific recommendations of the guideline were very helpful. CONCLUSIONS: Nevertheless, we must strive for a more comprehensive theory of strategic information management planning which -- in the sense of enterprise architecture planning -- represents the intrinsic correlations of the different parts of a SIM plan to a greater extent.

Hospital Information Systems↗
PubMed2000

Providing consumers with information about the quality of health plans: the Consumer Assessment of Health Plans demonstration in Washington State.

BACKGROUND: In 1995 the Agency for Health Care Policy and Research began a five-year project, Consumer Assessment of Health Plans (CAHPS), to create instruments to collect data from consumers about their health care experiences, to develop sophisticated methods to convey these data to consumers, and to evaluate the value of these data to consumers who are selecting health plans. Results were obtained from one of the first CAHPS demonstration sites, the Washington State Health Care Authority. METHODS: The survey was distributed in May-June 1997 to 15,885 enrollees in 20 health plans; 8,204 (51.6%) surveys were completed. Survey results were summarized in a report that described the performance of plans, which was distributed to 97,000 enrollees, and reactions to the report were obtained from more than 1,500 individuals. RESULTS: Nearly everyone who was mailed the report said they saw it. A large proportion said they read most or all of it, and most thought the report was easy to understand, contained information needed to rate plans, and was helpful to learning about differences between plans. Those who used the CAHPS performance report were more likely to switch plans and to report that they were confident they had selected the best plan for their situation. DISCUSSION: The study was unique in that it attempted to evaluate whether employees read the performance report, how they reacted to it, and whether reading it influenced their decision to switch plans or their confidence that they had selected a suitable plan. Choosing a new plan probably stimulated more intense scrutiny of the report than not anticipating switching.

Adult↗
PubMed1998

Health plan report cards: exploring differences in plan ratings.

BACKGROUND: Despite the considerable attention paid to the collection of data and the publication of health plan report cards, there is no available study on the comparability of published report cards. Ratings from seven health plan report cards publicly available in fall 1996 were compared--including those produced by major periodicals, a large national employer, a nonprofit consumer group, a health maintenance organization accreditation agency, and a consortium of employers. METHODS: Dimensions of plan performance common to the seven report cards were identified. Spearman rank correlation coefficients were computed for each pair of report cards for each of the three dimensions that were evaluated. COMPARABILITY OF REPORT CARDS: Although plan ratings tended to be positively correlated as hypothesized, the magnitude of the estimated correlation coefficients varied. For example, the estimated correlation coefficient between two periodicals' overall plan ratings was 0.48. The ranges of estimated correlations were 0.18-0.70 for preventive care (among four report cards) and 0.19-0.73 for enrollee satisfaction (among three report cards). DISCUSSION: Discrepancies in ratings may reflect methodologic issues pertaining to the sample of health plans used, plan performance measures included, and the processes by which individual measures were aggregated to construct indices and ratings. Health plan report cards may be sending mixed signals to consumers. These inconsistencies may explain why focus group studies have found that despite the widespread indication that plan performance measures would be useful, relatively few of those who had seen such information report using it in making their plan choice. Future efforts to evaluate health plans should clearly identify assumptions, methods, normative judgments, and limitations.

Accreditation↗