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PubMed2003

CT-based surgical planning software improves the accuracy of total hip replacement preoperative planning.

The present study is aimed to compare accuracy and the repeatability in planning total hip replacements with the conventional templates on radiographs to that attainable on the same clinical cases when using CT-based planning software. The sizes of the cementless components planned with new computer aided preoperative planning system called Hip-Op and with standard templates were compared to those effectively implanted. The study group intentionally included only difficult clinical cases. The most common aetiology was congenital dysplasia of hip (65.6%). The Hip-Op planning system allowed the surgeons to obtain a preoperative planning more accurate than with templates, especially for the socket. Assuming correct a size planned one calliper above or below that implanted the accuracy increased from 83% for the stem and 69% for the socket when using templates to 86% for the stem and 93% for the socket when using the Hip-Op system. The repeatability of the Hip-Op system was found comparable to that of the template procedure, which is much more familiar to the surgeons. Furthermore, the repeatability of the preoperative planning with the Hip-Op system was consistent between surgeons, independently from their major or minor experience. The study clearly shows the advantages of a three-dimensional computer-based preoperative planning over the traditional template planning, especially when deformed anatomies are involved. The surgical planning performed with the Hip-Op system is accurate and repeatable, especially for the socket and for less experienced surgeons.

Arthroplasty, Replacement, Hip↗

PubMed2002

Dimensions of plan performance for sick and healthy members on the Consumer Assessments of Health Plans Study 2.0 survey.

BACKGROUND: The quality of health plan care may differ for members in good and poor health. OBJECTIVE: To determine whether reports from sick and healthy members reflect distinct aspects of plan performance. RESEARCH DESIGN: Mean health plan scores were analyzed on the 1998 and 1999 Medicare Managed Care (MMC) Consumer Assessments of Health Plans (CAHPS) surveys, treating responses from sick and healthy members as separate plan measures. Alternative definitions of health were compared and the one that defined groups with the most distinct experiences was selected. Using factor analysis, composites of report items defined for these groups were identified. Mean ratings were regressed on these composites. SUBJECTS: Two hundred ninety thousand seven hundred thirty-nine Medicare managed care beneficiaries from 381 health plan-reporting units. MEASURES: MMC-CAHPS survey responses, including four overall ratings and 30 specific report items. RESULTS: A question about general health status best defined subgroups with distinct experiences. Report items grouped into eight factors: care for healthy members, care for sick members, finding and communicating with a doctor for sick members, plan customer service, plan-provided medical services and equipment, vaccinations, prescriptions, and smoking cessation advice. Ratings by each subgroup were generally most strongly predicted by reports on care for the same subgroup and by customer service and plan-provided services (for ratings of plan) and access to doctors. CONCLUSIONS: Reports from sick and healthy members measure distinct dimensions of health plan quality, especially in the domain of patient care. Distinguishing these dimensions might help in informing consumers and targeting quality improvement efforts.

Aged↗

PubMed2006

Village family planning volunteers in Indonesia: their role in the family planning programme.

Family planning was once a sensitive issue in Indonesia, but today it is considered essential. This paper reports on a study in 1997-98 of the role of village family planning volunteers and the cadres who worked under them in West Java, Central Java and DI Yogyakarta, in implementing the national family planning programme in Indonesia. A total of 108 village family planning volunteers, 108 family planning cadres, 108 local leaders and 324 couples eligible for family planning from 36 villages in the three provinces were interviewed. The volunteers and cadres have made a significant contribution to the implementation of the family planning programme. They promote family planning, organise meetings, provide information, organise income-generation activities, give savings and credit assistance, collect and report data and deliver other family welfare services. Teachers, wives of government officials and others recognised by the community as better off in terms of education and living conditions were most often identified to become family planning volunteers. Because they are women and because they are the most distant arm of the programme, their work is taken for granted. As their activities are directed towards women, especially in women's traditional roles, the programme tends to entrench the existing gender gap in responsibility for family planning and family welfare.

Community Health Services↗

PubMed1985

Brainstorming: an application for programme planning in family welfare planning.

There have been many participatory devices developed and applied for programme planning in a variety of fields by the social scientists in the recent past, of which brainstorming is one. This device has been widely used in interpretive structural modelling to higher education programme planning, programme planning for housing in urban development, etc. Following these studies, application of brainstorming to develop a preliminary operational value system as a structural model for programme planning in Family planning was attempted. The products of a sequence of three sessions of approximately 5 hours each generated 39 needs, 28 alterables, and 22 constraints, all of which were used to set Family Planning objectives /34/. The objectives thus derived were used in building an intent structure to understand their priorities in plan formulation and eventual implementation.

Communication↗

PubMed1994

Retrospective reconstruction of three-dimensional radiotherapy treatment plans of the thorax from two dimensional planning data.

PURPOSE: A method for the retrospective reconstruction of three-dimensional (3-D) radiotherapy treatment plans from two-dimensional (2-D) planning data is detailed in this paper. METHODS AND MATERIALS: With these techniques the user can register an arbitrarily shaped portal on a simulation film with a diagnostic computed tomography study of the patient and then generate the resultant 3-D dose distribution or dose-volume histogram. Seven treatment plans were reconstructed of patients who had previously undergone 3-D treatment planning for fields involving the thorax and who had had a diagnostic computed tomography (CT) scan. The dose-volume histograms and the spatial positions of the beams on the reconstructed plans were then compared to those of the original 3-D plan, which until then, were not made available to the investigators. RESULTS: The dose-volume histograms of the reconstructed plans did not differ from those of the original plans by more than 3% except in the low dose region. The error in positioning the beam in the reconstructed plan was determined to be approximately 5 mm. CONCLUSION: The technique of 3-D treatment plan reconstruction can be used, through retrospective studies, to obtain better assessments of normal tissue complication probabilities and tumor control probabilities.

Humans↗

PubMed2000

Planned caesarean section versus planned vaginal birth for breech presentation at term: a randomised multicentre trial. Term Breech Trial Collaborative Group.

BACKGROUND: For 3-4% of pregnancies, the fetus will be in the breech presentation at term. For most of these women, the approach to delivery is controversial. We did a randomised trial to compare a policy of planned caesarean section with a policy of planned vaginal birth for selected breech-presentation pregnancies. METHODS: At 121 centres in 26 countries, 2088 women with a singleton fetus in a frank or complete breech presentation were randomly assigned planned caesarean section or planned vaginal birth. Women having a vaginal breech delivery had an experienced clinician at the birth. Mothers and infants were followed-up to 6 weeks post partum. The primary outcomes were perinatal mortality, neonatal mortality, or serious neonatal morbidity; and maternal mortality or serious maternal morbidity. Analysis was by intention to treat. FINDINGS: Data were received for 2083 women. Of the 1041 women assigned planned caesarean section, 941 (90.4%) were delivered by caesarean section. Of the 1042 women assigned planned vaginal birth, 591 (56.7%) delivered vaginally. Perinatal mortality, neonatal mortality, or serious neonatal morbidity was significantly lower for the planned caesarean section group than for the planned vaginal birth group (17 of 1039 [1.6%] vs 52 of 1039 [5.0%]; relative risk 0.33 [95% CI 0.19-0.56]; p<0.0001). There were no differences between groups in terms of maternal mortality or serious maternal morbidity (41 of 1041 [3.9%] vs 33 of 1042 [3.2%]; 1.24 [0.79-1.95]; p=0.35). INTERPRETATION: Planned caesarean section is better than planned vaginal birth for the term fetus in the breech presentation; serious maternal complications are similar between the groups.

Adult↗

PubMed2006

Action plans and coping plans for physical exercise: A longitudinal intervention study in cardiac rehabilitation.

OBJECTIVES: The aim of the present study was to test two brief planning interventions designed to encourage cardiac patients to engage in regular physical exercise following discharge from rehabilitation. The interventions comprised action plans on (a) when, where, and how to act, and (b) coping plans on how to deal with anticipated barriers. DESIGN AND METHOD: An experimental longitudinal trial was conducted to test two interventions that either focused on action planning alone, or on a combination of action planning and coping planning. A total of 211 participants completed assessments at baseline and 2 months after discharge. Participants were randomly assigned to either one of the intervention groups or a standard-care control group. RESULTS: Participants in the combined planning group did significantly more physical exercise 2 months post-discharge than those in the other groups. CONCLUSIONS: The theoretical distinction between action planning and coping planning as introduced in the present study has proven useful in explaining changes in health-related behaviour. The combined planning intervention can be applied in the context of cardiac rehabilitation programmes.

Adaptation, Psychological↗

PubMed2004

IMRT for the treatment of prostate cancer: a comparison of a forward-planned technique and an inverse-planned technique utilizing a dose gradient method.

Radiation therapy has been a major treatment option for patients with prostate cancer with documented efficacy over the last 30 years. Recent research has shown a correlation between improved local control, disease-free survival, and overall survival and dose delivered. Excessive dose to the rectum is one of the leading causes of morbidity in the treatment of prostate cancer. The RTOG and others have suggested dose limitations based on various treatment parameters. Intensity-modulated radiation therapy (IMRT) is becoming more widely used, with the goal of improving dose coverage while limiting morbidity. In an effort to evaluate our inverse-planning technique relative to our forward-planned technique based on rectal dose, 2 plans were generated on 10 patients. One plan was generated with 9-field forward planning, using 2 posterior obliques to decrease dose to the rectum. The other plan utilized inverse IMRTplanning. To evaluate dose to the rectum, we compared the dose gradient from the posterior edge of the prostate across the anterior third of the rectal wall. This gradient, which is not part of the IMRT planning objectives, proved useful in assessing plan differences, and led to new dose objectives for certain IMRT plans.

Disease-Free Survival↗

PubMed1981