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At least 73 records · Page 4Linked to original sources
PubMed2005

Information technology strategic planning: art or science?

It had been almost a decade since the hospitals that make up the Daughters of Charity Health System (DCHS) had engaged in a formal information technology strategic planning process. In the summer of 2002, as the health system re-formed, there was a unique opportunity to introduce a planning process that reflected the governance style of the new health system. DCHS embarked on this journey, with the CIO initiating and formally sponsoring the information technology strategic planning process in a dynamic and collaborative manner The system sought to develop a plan tailored to encompass both enterprise-wide and local requirements; to develop a governance model to engage the members of the local health ministries in plan development, both now and in the future; and to conduct the process in a manner that reflected the values of the Daughters of Charity. The DCHS CIO outlined a premise that the CIO would guide and be continuously involved in the development of this tailored process, in conjunction with an external resource. Together, there would be joint responsibility for introducing a flexible information technology strategic planning methodology; providing an education on the current state of healthcare IT, including future trends and success factors; facilitating support to tap into existing internal talent; cultivating a collaborative process to support both current requirements and future vision; and developing a well-functioning governance structure that would enable the plan to evolve and reflect user community requirements. This article highlights the planning process, including the lessons learned, the benchmarking during and in post-planning, and finally, but most importantly, the unexpected benefit that resulted from this planning process.

Catholicism↗
PubMedDate not supplied

Potential and limitations of invariant kernel conformal therapy.

A treatment planning methodology was developed to investigate the invariant kernel form of conformal therapy proposed by Brahme. Three-dimensional dose distributions were calculated by convolving a rotationally symmetric, invariant kernel with weighting distributions. Fourier transform convolution techniques implemented on an array processor were used to achieve high calculation speeds, thereby allowing iterative techniques in the spatial and frequency domains for computing dose distributions that asymptotically approach a desired dose distribution. To use rotationally symmetric kernels, the generality of the solution is traded for a fast, deterministic, inverse planning approach. The limitations imposed on the dose distributions by this loss of generality are characterized and tentative conclusions are drawn about the potentials and limits of clinical application of this form of the methodology. Further developments of the concept are suggested.

Fourier Analysis↗
PubMed2003

Comparison between two iodine-125 brachytherapy implant techniques: pre-planning and intra-operative by various dosimetry quality indicators.

PURPOSE: To prospectively compare two widely used seed implant techniques: pre-planning and intra-operative planning, based on 1 month post-implant CT-based evaluation. METHODS: We report results of a detailed 1 month post-operative dosimetric evaluation and comparison between 142 consecutive men with prostate adenocarcinoma treated by the pre-planning methodology and 214 men treated with the real-time, intra-operative seed implant method. RESULTS: Baseline parameters patient's age, Gleason score, clinical stage, and gland volume were similar in both groups (p>0.05). Length of physicist time and operating room team time were more than double in the pre-planned group compared to the intra-operative one (205 vs 100 min). Based on day 30 post-implant CT, for patients treated with the pre-planning method, mean V90, V100 and V150 (percent prostate volume receiving 90, 100 and 150% of the prescribed dose) were 67.5, 58.35 and 21.5%, respectively, while for the intra-operative group they were 97.9, 95.2 and 45%, respectively (p<0.01). Mean D90, expressed as percent of target matched peripheral dose (minimal dose covering 90% of the gland volume) was 53% for the pre-planned group and 114% for the intra-operative group of men (p<0.01). Short-term morbidity was minimal in both groups and did not correlate with the technique employed. CONCLUSIONS: This large-scale comparison of implant adequacy favours real-time intra-operative method. While all dosimetric parameters are significantly better with this method, no increased early morbidity was noted. Longer-term PSA-based clinical outcome should substantiate our contention of the superiority of the intra-operative method when compared to the pre-planning one.

Adenocarcinoma↗
PubMed1994

Three-dimensional radiation treatment planning study for patients with carcinoma of the lung.

PURPOSE: Several reports in the literature suggest that local-regional control and possibly survival could be improved for inoperable nonsmall cell lung cancer if the radiation dose to the target volume could be increased. Higher doses, however, bring with them the potential for increased side effects and complications of normal tissues. Three-dimensional treatment planning has shown significant potential for improving radiation treatment planning in several sites, both for tumor coverage and for sparing of normal tissue from high doses of radiation and, thus, has the potential of developing radiation therapy techniques that result in uncomplicated local-regional control of lung cancer. We have studied the feasibility of large-scale implementation of true three-dimensional technologies in the treatment of patients with cancers of the thorax. METHODS AND MATERIALS: CT scans were performed on 10 patients with inoperable nonsmall cell lung cancer to obtain full volumetric image data, and therapy was planned on our three-dimensional radiotherapy treatment planning system. Target volumes were determined using the new ICRU nomenclature--Gross Tumor Volume, Clinical Target Volume, and Planning Target Volume. Plans were performed according to our standard treatment policies based on traditional two-dimensional radiotherapy treatment planning methodologies and replanned using noncoplanar three-dimensional beam techniques. The results were quantitatively compared using dose-volume histograms, dose-surface displays, and dose statistics. RESULTS: Target volume delineation remains a difficult problem for lung cancer. Defining Gross Tumor Volume and Clinical Target Volume may depend on window and level settings of the three-dimensional radiotherapy treatment planning system, suggesting that target volume delineation on hard copy film is inadequate. Our study shows that better tumor coverage is possible with three-dimensional plans. Dose to critical structures (e.g., the heart) could often be reduced (or at least remain acceptable) using noncoplanar beams even with dose escalation to 75 to 80 Gy for the planning volume surrounding the Gross Target Volume. CONCLUSION: Commonly used beam arrangements for treatment of lung cancer appear to be inadequate to safely deliver tumor doses of higher than 70 Gy. Although conventional treatment techniques may be adequate for tumor coverage, they are inadequate for sparing of normal tissues when the prescription dose is escalated. The ability to use noncoplanar fields for such patients is a major advantage of three-dimensional planning. This capability led to better tumor coverage and reduced dose to critical normal tissues. However, this advantage was achieved at the expense of a greater time commitment by the treatment planning staff (particularly the radiation oncologist) and a greater complexity of treatment delivery. In summary, three-dimensional radiotherapy treatment planning appears to provide the radiation oncologist with the necessary tools to increase tumor dose, which may lead to increased local-regional control in patients with lung cancer while maintaining normal tissue doses at acceptable tolerance levels.

Carcinoma, Non-Small-Cell Lung↗
PubMed1999

The public health care planning problem: a case study using geographic information systems.

We address the problem of designing new networks for the delivery of public health care services in the United States. The paper is based on a case study design conducted with the Fulton County Health Department (Atlanta, GA). The research contribution this paper makes is twofold. First, it presents a planning methodology to deliver health care services through a mix of fixed health centers, satellite facilities, and mobile facilities. Second, it gives insights on how to use geographic information systems to design new health care service networks.

Community Networks↗
PubMedDate not supplied

Common challenges and problems in clinical trials of boron neutron capture therapy of brain tumors.

Clinical trials for binary therapies, like boron neutron capture therapy (BNCT), pose a number of unique problems and challenges in design, performance, and interpretation of results. In neutron beam development, different groups use different optimization parameters, resulting in beams being considerably different from each other. The design, development, testing, execution of patient pharmacokinetics and the evaluation of results from these studies differ widely. Finally, the clinical trials involving patient treatments vary in many aspects such as their dose escalation strategies, treatment planning methodologies, and the reporting of data. The implications of these differences in the data accrued from these trials are discussed. The BNCT community needs to standardize each aspect of the design, implementation, and reporting of clinical trials so that the data can be used meaningfully.

Boron Compounds↗
PubMed1981

Natural family planning IV. The identification of postovulatory infertility.

The estimated time of ovulation (ETO) was correlated with the day of defined postovulatory infertility in 66 hormonally normal menstrual cycles from 24 subjects for each of 15 different natural family planning methodologies. Inherent weaknesses were identified in methods based upon calendar calculations or basal body temperature only. These weaknesses could be removed for the basal body temperature-only methods if symptoms, especially the peak mucus symptom, were added to the temperature records. However, the peak mucus symptom alone had the greatest precision of all methods studied. No advantage could be identified in combining the basal body temperature with the peak symptom.

Adult↗
PubMed1997

[The concept of therapeutic equivalence].

Usually, it is the purpose of a clinical trial to demonstrate the superiority of a (new) treatment in comparison to another treatment with regard to a well-defined criterion of efficacy. However, other aspects rather than improved efficacy might be regarded as advantages of a new therapy, i.e. less or less severe adverse events, a more simple applicability, or a lower price. In this case, it may be sufficient to show a "comparable" efficacy (therapeutic equivalence). Unfortunately, equivalence studies can lead to severe problems of interpretation in case of insufficient methodological planning. In general, more detailed information must be available in advance compared to the common (superiority) trials. Very carefully designed trials are necessary to evaluate the therapeutic equivalence of treatments.

Clinical Trials as Topic↗
PubMed2006

Hypofractionated versus conventionally fractionated radiation therapy for prostate carcinoma: updated results of a phase III randomized trial.

PURPOSE: The aim of this study was to compare the toxicity and efficacy of radiation therapy (RT) for localized carcinoma of the prostate, using a hypofractionated (55 Gy/20 fractions/4 weeks) vs. a conventionally fractionated (64 Gy/32 fractions/6.5 weeks) dose schedule. METHODS AND MATERIALS: A total of 217 patients were randomized to either the hypofractionated (108 patients) or the conventional (109 patients) dose schedule, with planning with two-dimensional (2D) CT scan planning methodology in the majority of cases. All patients were followed for a median of 48 (6-108) months. Gastrointestinal (GI) and genitourinary (GU) toxicity was evaluated before RT and after its completion using modified late effects of normal tissue-subjective, objective, management, analytic (LENT-SOMA) scales and the European Organization for Research and Treatment of Cancer sexual function questionnaire. Efficacy of RT based on clinical, radiologic, and prostate-specific antigen data were also evaluated at baseline and after RT. RESULTS: Gastrointestinal and GU toxicity persisted 5 years after RT and did not differ between the two dose schedules other than in regard to urgency of defecation. However, 1-month GI toxicity was not only worse in patients with the hypofractionated RT schedule but also adversely affected daily activities. Nadir prostate-specific antigen values occurred at a median of 18.0 (3.0-54.0) months after RT. A total of 76 biochemical relapses, with or without clinical relapses, have occurred since; of these, 37 were in the hypofractionated and 39 in the conventional schedule. The 5-year biochemical +/- clinical relapse-free and overall survival was 55.9% and 85.3% respectively for all patients, and did not differ between the two schedules. CONCLUSIONS: Radiation therapy for prostate carcinoma causes persistent GI toxicity that is largely independent of the two dose schedules. The hypofractionated schedule is equivalent in efficacy to the conventional schedule.

Adult↗
PubMed2002

Influence of composition variations on the initial alteration rate of vitrified domestic waste incineration fly-ash.

Vitrification as a waste stabilization technology has often been considered applicable only to high-level radioactive waste for which, with the use of suitable additives, it yields a vitreous material with excellent chemical durability. It has become apparent in recent years that some waste forms-notably domestic waste incineration fly-ash purification residues--contain most of the ingredients of a vitrified material, although their composition variations are difficult to control. It is thus important to ensure not only that the materials are suitable for vitrification, but also that the resulting product exhibits acceptable long-term behavior under all circumstances. An initial study showed that, allowing for the compensation changes inherent in the melting process builtby EDF**, the residue collected by a single fly-ash dust separation defines a composition range within which the suitability of the vitrified material can be verified. "Vitrified material" refers to a melted material that contains no unmelted inclusions after cooling, but that may contain a variable fraction of crystallized phases. Five composition parameters were identified for the long-term behavior assessment: the concentrations of the three major elements (silicon, aluminum and calcium), the total alkali metal (sodium and potassium) concentration, and the sum of the concentrations of two toxic elements (zinc and lead). The other elements were assumed constant at molar ratios representative of industrial wastes. The experimentation plan methodology applied to the composition range identified fourteen materials suilable for developing and validating first-order models of the material components. The fly-ash composition had a very significant effect on the degree and kinetics and crystallization in the vitrified material within the experimental composition range; the cooling rate was the determining factor for some of the fourteen materials studied. Two crystailine phases predominated: spinels rich in chromium, zinc, aluminum, magnesium and iron formed quickly on cooling, and accounted for about 2 vol% of the final material. Gehelenite (Ca2Al2SiO7) crystallized massively in some vitrified materials, accounting for more than half the final product and giving it a rock-like appearance. The effect of composition alone must therefore be distinguished from the effect of crystallization on the leaching behavior. Soxhlet tests were conducted for 14 days according to a protocol based on that of the French AFNOR draft standard NF-M 60313 to determine the maximum alteration rate in pure water at 100 degrees C. The measured rate ranged from 4 to 40 gm(-2) day(-1), illustrating the crucial role of the silicon concentration: within the test composition range, a low silicon content (< 30 wt%) tended to result in a significantly higher initial rate. However, the initial rate alone is not sufficient to assess the chemical durability of the material. Further tests will be carried out at 25 degrees C under conditions approximating those of a proposed disposal site to highlight the role of the alteration layer and the effect of rising concentrations in solution on the decreasing alteration rate.

Crystallization↗
PubMed1979

Relevant curriculum planning in health education: a methodology.

Procedures proposed to present a methodology for planning relevant health education curriculum included having students write out questions they felt their peers had about health in the specific content areas of community health, consumer health, diseases, drugs, alcohol, and tobacco, ecology, family life, nutrition, mental health, personal health and safety and first aid. A sample survey was presented where 80 junior high school students wrote a total of 981 questions and 74 senior high school students wrote 786 questions. Implications for the health education curriculum would be as follows: (1) Curriculum can be made relevant if the specific content covered is directly related to problems of daily living: (2) Provide needed cognitive information to meet real or potential problems of students; and (3) Provide guidance for the health educator in planning the kind and the amount of emphasis within the total health education program.

Adolescent↗
PubMed2001

Regional shipping strategy assessment based on installing a refuse-derived-fuel process in a municipal incinerator.

The rising prices of raw materials and the concerns of energy recovery have resulted in an increasing interest in processing the waste streams. In recent years, a number of credible surveys have shown that recycling and waste-to-energy processes appear to work well together. Compatibility exists for several reasons related to economic, environmental, political, and social aspects. However, the regional impacts of installing a centralised refused-derived fuel (RDF) process prior to waste-to-energy facilities remain unclear due to the inherent complexity of solid waste composition, generation rate, energy and material recovery goals, and the existing shipping patterns. This paper illustrates a thorough evaluation for a RDF pilot study from both quantitative and qualitative aspects. Such a process, consisting of the standard unit operations of shredding, magnetic separation, trommel screening, and air classification, might be useful for integrating the recycling and presorting efforts with a large-scale municipal incinerator in a region. A series of sampling and analyses of the waste streams were performed in Taipei County, Taiwan in order to characterise its potentials for recycling. Based on the proper estimation of solid waste generation, the goal programming modelling analysis not only focuses on an evaluation of how the waste inflows with different rates of generation, physical and chemical compositions, and heating values in the service areas can be processed by a centralised RDF facility to meet both the energy recovery and throughput requirements in different municipal incinerators but also indicates the optimal shipping pattern associated with several incinerators due to such an installation in a regional sense. A case study designed to explore the regional impacts on shipping patterns in the southwestern of Taipei County, Taiwan verifies the application potential of such a planning methodology.

Conservation of Natural Resources↗
PubMed2005

[Participatory evaluation in health programs: a proposal for the Adolescent Health Care Program].

This article presents a model for participatory evaluation of the Adolescent Health Program (PROSAD) in Brazil. The study focuses on the concept of participation, with a review of internationally validated planning methodologies (RAP, logFRAME, ZOPP, PCM) and the programmatic characteristics of PROSAD. The proposed model comprises 4 steps, involving the constitution of the analytical matrix, a self-evaluation workshop, a summary of results, and graphic representation. The model promotes participatory practice in health program management by using techniques that allow a workshop to be held in 70 minutes (mean time), producing results that are recognized and easily grasped by the local team.

Adolescent↗
PubMedDate not supplied

Outcomes of a statewide anti-tobacco industry youth organizing movement.

PURPOSE: To outline the design and present select findings from an evaluation of a statewide anti-tobacco industry youth organizing movement. DESIGN: A telephone survey was administered to teenagers to assess associations between exposure to anti-industry youth organizing activities and tobacco-related attitudes and behaviors. A group-level comparison between areas high and low in youth organizing activities was planned. Methodological obstacles necessitated a subject-level analytic approach, with comparisons being made between youth at higher and lower levels of exposure. SETTING: Six rural areas (comprising 13 counties) and two urban regions of Minnesota were selected for survey. SUBJECTS: The study comprised 852 youth, aged 15 to 17 years old, randomly selected from county-specific sampling frames constructed from a marketing research database. MEASURES: Exposure index scores were developed for two types of activities designed to involve youth in the anti-industry program: branding (creating awareness of the movement in general) and messaging (informing about the movement's main messages). Attitudinal outcomes measured attitudes about the tobacco industry and the effectiveness of youth action. Behavioral outcomes included taking action to get involved in the organization, spreading an anti-industry message, and smoking susceptibility. RESULTS: Branding index scores were significantly correlated with taking action to get involved (p < or = .001) and spreading an anti-industry message (p < or = .001). Messaging index scores were significantly correlated with all five attitudinal constructs (all associations, p < or = .001), taking action to get involved (p < or = .001), and spreading an anti-industry message (p < or = . 01). The hypothesized association between messaging scores and susceptibility was not significant. CONCLUSION: A youth organizing effort, in combination with an intensive countermarketing media campaign, can be an effective strategy for involving youth in tobacco prevention and generating negative attitudes about the industry.

Adolescent↗
PubMedDate not supplied

[AIDS prevention by a youth association in Ivory Coast: impact, successes and disappointments].

Over the last few years, the number of associations involved in AIDS prevention has dramatically increased in Ivory Coast, especially in Abidjan. This article describes an experiment in the prevention of AIDS and STDs among young people in Abidjan by means of peer education. It follows the management and progress of a youth organization for AIDS prevention, CESAM (Cellule Scolaire Anti-SIDA et MST), the School-based Anti-AIDS and STD Unit. Critical review of the activities of this association identifies a number of methodological, planning, human and material problems, which have received little attention in the past. CESAM is one of the first anti-AIDS associations in Ivory Coast to target young people and to have young members. This may be the reason for some of its successes and some of its failures and disappointments. The association's successes include the provision of information to more than 25,000 people between 1992 and 1996, and the overall satisfaction of the public and local AIDS institutions. The young people involved have taken on a new social identity, which has developed from the motivation of association members and the personal experiences of some with respect to AIDS, STDs and problems associated with contraception. However, this new identity is threatened by rivalry between members and the search for funding, as the substantial funding obtained in 1994-1995 can show it.

Acquired Immunodeficiency Syndrome↗
PubMedDate not supplied

[Professional Master: nurse coordinator University of Milan].

This article is intended to illustrate the experience of the Medical Faculty of the University of Milan, as regards the Master s Program for Nursing Coordinator funded by the FSE of the European Union for the Academic year 2003/2004. Specifically, this article highlights: Organizational aspects: admission policy, theoretical and practical formative planning Methodology used, as applied to adult education Course evaluation and observations by the participants.

Curriculum↗
PubMed1990

[The clinical quality evaluation of radiopharmaceutical preparations for diagnostic use].

The authors issued some recommendations for assessment of new radiopharmaceuticals (RP) at the stage of clinical trials. The most decisive thing is to determine the clinico-diagnostic efficacy of a radiopharmaceutical and its safety. Direct extrapolation of the results of experimental investigation of biodistribution of labeled compounds on man was shown to be fraught with serious errors. Differences in RP pharmacokinetics necessitate a planned, methodologically correct and clinically substantiated study of a RP in selected groups of patients taking into account the functional purpose of a drug. The assessment of RP quality is based upon a study of functional suitableness resulting from pharmacokinetic data and the determination of optimum methodological conditions and safety of a new RP, including the calculation of radiation a patient is exposed to during a diagnostic procedure. The stages of clinical trials are given in detail, their unification is aimed at raising their quality and improved clinical assessment of a RP.

Clinical Trials as Topic↗
PubMed1985

Women and arson: a demographic study.

This study describes women accused of setting fires in the City of New York who were evaluated between 1980 and 1983 at the Forensic Psychiatry Clinic for the New York Criminal and Supreme Courts. Consideration is given to their age, ethnicity, history of prior mental illness, abuse of controlled substances, economic status, family background, education, and employment. Their methodology, planning, and targeting for their firesetting behavior, as well as reported motivations for engaging in arson, are also considered.

Adolescent↗