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At least 973 records · Page 54Linked to original sources
PubMed2005

Robust treatment planning for intensity modulated radiotherapy of prostate cancer based on coverage probabilities.

BACKGROUND AND PURPOSE: To evaluate an optimization approach where coverage probabilities are incorporated into the optimization of intensity modulated radiotherapy (IMRT) to overcome the problem of margin definition in the case of overlapping planning target volume and organs at risk. PATIENTS AND METHODS: IMRT plans were generated for three optimization approaches: based on a planning CT plus margin (A), on prostate and rectum contours from five pre-treatment CT plus margin (B), and on coverage probabilities (C). For approach (C), the probability of organ occupation was computed for each voxel from five pre-treatment CTs and the population distribution of systematic setup error and it was used as local weight in the costfunctions. Monte Carlo simulations of treatment courses were used to compute the probability distribution of prostate and rectal wall equivalent uniform dose (EUD). RESULTS: Treatment simulations showed best and most robust results for prostate and rectal wall EUD within the population for (C). For (A) the rectal wall EUD was on average about 1.5 Gy greater than in (C), while the prostate EUD was lower than those from (C) for most of the patients for (B) (especially for those with great organ motion). CONCLUSIONS: The incorporation of coverage probabilities as local weights allows for dose escalation as well as improved rectal sparing and results in a safer and more robust IMRT treatment.

Computer Simulation↗
PubMed2005

Hyped biomedical science or uncritical reporting? Press coverage of genomics (1992-2001) in Québec.

Genomics integrates the promises and perils of modern biomedical science. Canada and the province of Québec embarked late but aggressively in genomics research based on the 'discourse of promise' in which genomics is embedded. This did not prevent the emergence of a 'discourse of concerns', and debates on the wider meaning of genomics and on the risks related to genomics applications such as gene therapy and gene testing. Given this context, this study aims to understand the evolution of genomics press coverage from the early days up to the publication of the draft sequence of the human genome. Accordingly, we performed a press content analysis on 749 articles reporting genomics research in Québec from 1992 to 2001. We focused on coverage of benefits and ethical issues, tone, and differences in reporting practices between press agencies and journalists. Results show an increasing number of articles, a general decline in the proportion of articles featuring ethical issues, an increased focus on the economy, and greater optimism from 1992 to 2001. In comparison to articles written by journalists, articles signed by press agencies are more optimistic and less often feature ethical issues. Results are discussed following two non-exclusive interpretations: (1) the successes of genomics and its institutionalization in Québec and Canada brought hype and greater social acceptance, and (2) uncritical reporting practices have emerged under pressures for expedient and consumable writing. We are left with two concerns: given worldwide media concentration movements, what are the challenges for the dissemination of diversified and critical information in print media? And, given limited coverage of ethical issues, and concerns about bioethics being too narrowly focused, should public debates on frontier biomedical science be promoted to broaden the scope of biomedical ethics?

Bibliometrics↗
PubMed2005

Influenza vaccination coverage and related factors among Spanish patients with chronic obstructive pulmonary disease.

This study sought: to describe influenza vaccination coverages among COPD patients treated in a primary-care setting; and to analyse the factors linked to compliance with vaccination recommendations. This was a descriptive study in a primary-care (PC) setting. Each of the 2422 randomly selected medical practitioners included in the study was required to recruit five COPD patients. Information was drawn from patients' clinical histories and personal interviews. As the dependent variable, we took the answer (yes or no) to the question, "did you have an influenza vaccination in the most recent campaign?"; and as independent variables, we analysed socio-demographic data, health-status related variables, lifestyles and history of pneumococcal vaccination. A total of 10,711 patients were enrolled 87.2% reported having been vaccinated in the most recent campaign. In conclusion, Spanish COPD patients treated in a primary-care setting can be said to enjoy good vaccine coverages against the influenza virus. More frequent contact with the general practitioner and a history of pneumococcal vaccination increase the likelihood of being vaccinated considerably, and measures should be implemented with the aim of improving coverages among younger subjects and those who lead less healthy lifestyles.

Adult↗
PubMed2005

Influenza vaccination coverage and reasons to refrain among high-risk persons in four European countries.

This paper examines influenza vaccine coverage using a population base of an average of 2300 persons in each of four European countries (Germany, Spain, Poland and Sweden). The reasons for non-vaccination of those in the high-risk groups were explored by questionnaire. The vaccine coverage rate (VCR) for elderly ranged from 18% in Poland to 67% in Spain. The VCR for high-risk population under 65 was 10% in Poland, 13% in Sweden, 27% in Germany and 30% in Spain. The most important reasons mentioned for not being vaccinated were: perceived sufficient resistance to flu (33-42%) in all countries; financial barriers in Poland (25%), and not to qualify for the vaccination (30%) and forgetfulness (20%) in Germany. Receiving a personal invitation for the vaccination, results in higher coverage rates in all four countries. We think that future interventions could be directed towards: an information campaign with special attention to the high-risk groups due to disease; promotion of personal invitations; and, for Poland, solving financial barriers to vaccination.

Aged↗
PubMed1998

Strategies to improve insurance coverage for infertility services.

Various studies repeatedly have demonstrated that in the United States, only a minority of couples with infertility receive medical treatment and even fewer receive such treatment from specialists. Primarily couples of higher socioeconomic status receive such treatment. It is therefore obvious that a lack of insurance coverage greatly contributes to this country's disproportionately low utilization of fertility services compared with other developed nations. Such low utilization raises significant ethical and economic issues. For example, if the treatment of infertility is to be perceived as the treatment of a disease stage (a notion widely supported in our professional community), then how can we defend the fact that services are principally available only to the affluent? Moreover, by having access to only a fraction of the potential national market for infertility services, the national overhead for these services is distributed over only a fraction of potential buyers, greatly increasing unit costs. In short, obtaining a larger market for our services through better insurance coverage would solve ethical quandaries and, at the same time, reduce fertility costs on a unit level. How, then, can such improved insurance coverage be achieved? A number of possible strategies come to mind.

Ethics, Medical↗
PubMed1999

Equation for calculating surface coverage from end-capping of chromatographic bonded phases.

An equation was derived to calculate the surface density of trimethylsilyl groups (alphaTMS) on bonded chromatographic stationary phases that have undergone primary as well as secondary ('end-capping') chemical modification. The new equation is an extension of that published by Berendsen-de Galan for calculating primary surface coverage and, likewise, alphaTMS is calculated in terms of the carbon content (% by weight) of the bonded material before and after end-capping, specific surface area of the starting silica and structural information (molecular weight and number of carbon atoms) of the anchored groups. The new equation is valuable when a thorough characterization of bonded stationary phases is desirable and, if used along with the Berendsen-de Galan equation, it affords total ligand coverage information. Application of the new equation to correct for measurable carbon content of the starting support leads to a more accurate expression for surface coverage from primary as well as secondary bonding. The scope and limitations of the new equation are discussed.

Chromatography, Liquid↗
PubMed1998

The effect of random vaccine response on the vaccination coverage required to prevent epidemics.

The response people have to vaccination varies because their immune systems differ and vaccine failures occur. Here we consider the effect that a random response, independent for each vaccinee, has on the vaccination coverage required to prevent epidemics in a large community. For a community of uniformly mixing individuals an explicit expression is found for the critical vaccination coverage (CVC) and the effect of the vaccine response is determined entirely by the mean E(AB), where A and B, respectively, reflect the infectivity and susceptibility of a vaccinated individual. This result shows that the usual concept of vaccine efficacy, which focuses on the amount of protection the vaccine provides the vaccinee against infection, is not adequate to describe the requirements for preventing epidemics when vaccination affect infectivity. The estimation of E(AB) poses a problem because A and B refer to the vaccine response of the same individual. Similar results are found when there are different types of individual, but now the mean E(AB) may differ between types. However, for a community made up of households it is shown that the CVC also depends on other characteristics of the vaccine response distribution. In practice this means that estimating a single measure of vaccine effectiveness is generally not enough to determine the CVC. For a specific community of households it is found that the vaccination coverage required to prevent epidemics decreases as the variation in the vaccine response increases.

Disease Outbreaks↗
PubMed1986

Soft-tissue coverage for the treatment of osteomyelitis of the lower part of the leg.

For treatment of chronic osteomyelitic wounds of the lower part of the leg, a three-stage approach is necessary: (1) adequate debridement of bone and soft tissue, (2) control of infection by open packing with frequent dressing changes and use of intravenously administered antibiotics, and (3) healthy soft-tissue coverage and obliteration of dead space. If the bone is unstable, it can be immobilized temporarily by means of external fixation. Bone grafting can be accomplished by use of conventional bone grafting after healing of the soft tissues, a vascularized bone graft, or open bone grafting. Soft-tissue coverage is provided by a local muscle flap or a free muscle flap. We prefer to cover the muscle with a skin graft. The muscle flaps described in this article obliterate dead space, provide soft-tissue coverage, act as a bed for skin grafts, and improve the vascularity of the wound.

Adult↗
PubMed1996

Factors associated with influenza vaccination coverage among the elderly: role of health care personnel.

Factors associated with acceptance of influenza vaccination in an elderly population were investigated in order to find ways of improving vaccination coverage. Three administrative districts with different vaccination coverages were selected, and a random sample of 10 percent (N = 497) of the elderly population living outside institutions was taken from the official lists maintained by the Central Statistical Office. The data were collected by means of a postal questionnaire. The questionnaire inquired about influenza vaccination status during the autumn 1992 campaign, demographic factors, health status, previous experiences and beliefs about influenza vaccination and influenza as a disease, and source of information about the vaccination campaign. The highest positive associations were found between a high influenza vaccination acceptance rate and the perceived need for vaccination (Relative risk (RR) 4.6, 95% confidence interval (CI) 2.7-7.9), belief in its effectiveness (RR 3.6, 95% CI 2.1-6.1) and information received from health visitors (RR 2.2, 95% CI 1.8-2.6). Vaccination acceptance was negatively associated with a belief in its adverse effects, (RR 0.4, 95% CI 0.2-0.6). Information received from health visitors was associated with more frequent occurrence of positive beliefs about influenza vaccination and with higher acceptance of vaccination irrespective of positive or negative beliefs regarding it. In order to obtain high vaccination coverage health care personnel should be carefully informed about the importance of influenza vaccination and encouraged to inform the public.

Aged↗
PubMed1995

Effect of a final alcohol rinse on sealer coverage of obturated root canals.

An endodontic sealer is required to provide an apical and coronal seal in root canals. No previously reported methods of sealer placement completely coated canal walls. The purpose of this study was to dehydrate canal walls with alcohol and determine if this permitted better sealer coverage. Forty single-rooted teeth were prepared and divided into 4 groups of 10 teeth according to method of sealer placement and final irrigant: (a) by lentulo spiral and (b) file NaOCl, (c) lentulo and alcohol, and (d) file and alcohol. After canal preparation, groups 1 and 2 were irrigated with 1 ml of NaOCl and dried with paper points. Groups 3 and 4 were irrigated with 1 ml of alcohol and dried. AH26 (0.04 ml) dyed with charcoal black was applied to the apical end of the file or lentulo and placed in the canal to coat the walls. Gutta-percha without additional sealer was laterally condensed. Teeth were cleared and evaluated for location and amount of sealer visible. Data were evaluated by Kruskal-Wallis and analysis of variance. The results showed (a) no significant differences among the four groups, (b) all areas had sealer present, (c) the coronal third had > 50% sealer coverage in nearly all teeth, and (d) the middle and apical thirds showed the most variability in sealer coverage.

Analysis of Variance↗
PubMed1983

Pertussis: herd immunity and vaccination coverage in St Lucia.

In a single complete epidemic in St Lucia, an island too small to support constant clinical pertussis, the pertussis case rates in small communities (villages and small towns) with differing levels of vaccination coverage of young children were compared. The association between greater vaccination coverage and greater herd immunity was clear, despite the imperfect protection given to individuals. An analysis in terms of population dynamics is evidence against the theory that endemic subclinical pertussis maintains transmission in a highly vaccinated population. We suggest that with a homogeneous vaccination coverage of 80% of 2-year-old children pertussis might be eradicated from the island, and that this is a practicable experiment.

Adolescent↗
PubMed2002

The identification of depression and the coverage of antidepressant drug prescriptions in Italian general practice.

BACKGROUND: Studies on antidepressant prescriptions in general practice need to assess the level of prescriptions relative to the need for them ('coverage'), and the variability among doctors. METHODS: Two different cut-off scores on a screening test for depression (the Personal Health Questionnaire, PHQ) are used to predict rates for depression, and rates for depressive patients thought likely to benefit from antidepressants (according to a severity criterion) in primary care patients. These two rates are compared with assessments by 11 GPs of recognised depression, as well as with rates of drug prescribed. RESULTS: The rate for depression thought likely to be treated with antidepressants estimated with the PHQ is broadly comparable with the rate for conspicuous depressive illness, and much lower than that predicted by the PHQ for depression. There was great variability between GPs in their ability to detect depression, and their preparedness to prescribe antidepressants. Antidepressants were only prescribed for 3.5% of the patients, compared to the 8.9% thought to need them. However, antidepressants, mostly SSRIs, are much more likely to be prescribed than tranquillisers. LIMITATIONS: The limitations of the study are that the PHQ is able to estimate 'coverage' but not 'focusing' (the proportion of those receiving antidepressants who needed them). CONCLUSIONS: Although the rate for conspicuous depression is similar to that for depressions thought to be treated with antidepressants, the 'coverage' of antidepressants was only 39.3%. The variability between physicians confirm the need of good practice guidelines and training packages for the identification and management of depression. Large epidemiological studies are needed to overcome the current lack of clinically relevant data on the quality of antidepressant prescriptions in general practice.

Adult↗
PubMed2001

Improvements in target coverage and reduced spinal cord irradiation using intensity-modulated radiotherapy (IMRT) in patients with carcinoma of the thyroid gland.

BACKGROUND AND PURPOSE: External beam radiotherapy for thyroid carcinoma poses a significant technical challenge as the target volume lies close to or surrounds the spinal cord. The potential of intensity-modulated radiotherapy (IMRT) to improve the dose distributions was investigated. MATERIALS AND METHODS: A planning study was performed on patients with thyroid carcinoma. Plans were generated to irradiate the thyroid bed alone or to treat the thyroid bed and the loco-regional lymph nodes in two phases. Conventional plans with minimal beam shaping were compared to three-dimensional conformal radiotherapy (3DCRT) and inverse-planned IMRT plans to assess target coverage and normal tissue sparing. IMRT techniques were optimized to find the minimum number of equispaced beams required to achieve the clinical benefit and a concomitant boost technique was explored. RESULTS: For the thyroid bed alone and the thyroid bed plus loco-regional lymph nodes, conventional and conformal techniques produced low minimum doses to the planning target volume (PTV) if spinal cord tolerance was respected. 3DCRT reduced the irradiated volume of normal tissue (P=0.01). IMRT plans achieved the goal dose to the PTV (P<0.01) and also reduced the spinal cord maximum dose (P<0.01). IMRT, using a concomitant boost technique, produced better target coverage than a two-phase technique. For both the two-phase and concomitant boost techniques, IMRT plans with seven and five equispaced fields produced similar dose distributions to nine fields, but three fields were significantly worse. CONCLUSIONS: 3DCRT reduced normal tissue irradiation compared to conventional techniques, but did not improve PTV or spinal cord doses. IMRT improved the PTV coverage and reduced the spinal cord dose. A simultaneous integrated boost technique with five equispaced fields produced the best dose distribution. IMRT should reduce the risk of myelopathy or may allow dose escalation in patients with thyroid cancer.

Humans↗
PubMed2002

The impact of patient positioning on the adequate coverage of the uterus in the primary irradiation of cervical carcinoma: a prospective analysis using magnetic resonance imaging.

BACKGROUND AND PURPOSE: The intention of this prospective study is to assess the influence of different patient positionings and the use of belly boards on the coverage of the uterus by standard radiation fields. MATERIAL AND METHODS: In 21 women with carcinoma of the uterine cervix magnetic resonance imaging (MRI) scans in prone patient position with and without belly board and computed tomography (CT) scans in supine position were analysed after superimposing standard pelvic box fields. Further, all patients underwent a second MRI field control in prone position with belly board to detect intraindividual variations in the uterus position during treatment. RESULTS: Standard portals did not completely cover the uterus in supine position in 7/21 (33%), in prone position with belly board in 7/21 (33%) and without belly board in 5/21 (24%). Insufficient uterine coverage was found only in the anteroposterior direction. The mean distance (+/- standard deviation) between the field borders of the lateral portals and the uterus was in supine position anteriorly 3.4 cm (+/-2.2 cm) and posteriorly 1.8 cm (+/-1.3 cm), in prone position with belly board anteriorly 2.2 cm (+/-2.7 cm) and posteriorly 2.6 cm (+/-1.6 cm), prone without belly board anteriorly 3.3 cm (+/-2.4 cm) and posteriorly 1.9 cm (+/-1.1 cm). The difference was statistically significant between supine and prone position with belly board and between prone position with and without belly board. Repeated MRI controls during therapy showed no significant changes compared to the MRIs at the beginning of therapy. CONCLUSIONS: The use of standard radiation fields results in a high percentage of geographical misfits. Three-dimensional treatment planning is a prerequisite for adequate uterus coverage.

Adult↗
PubMed1999

Clarifying the scope of Italian NHS coverage. Is it feasible? Is it desirable?

The reduction in National Health Service (NHS) expenditure as a share of total health care expenditure, the fragmentation of the NHS into 21 regional systems and the implementation of a 'quasi-market' on the provider side of the system has pressed the government to define and specify, in detail, the set of services that are to be guaranteed by the public sector. To understand whether rationing can be more rational and explicit in the Italian NHS, the following are analysed: (i) the new positive list of drugs, as a major example of limiting and making more rational NHS pharmaceutical coverage; (ii) the Di Bella case, as an example of the difficulties of rational policy-making on sensitive issues; (iii) what Italian people think about health care rationing and priority setting (using the 1998 Eurobarometer Survey);( iv) the criteria defining the set of 'essential services' to be guaranteed to all Italian citizens, which are contained in the recently released National Health Plan. The 'revolution' that has taken place in the pharmaceutical sector shows it is feasible to limit, in an explicit and rational way, the extent of NHS coverage. However, the re-classification of the positive list should be regarded as an exceptional event in the history of Italian social policy. The 'Di Bella' case, on the contrary, shows that limiting NHS coverage can be very unpopular, and that the Italian cultural and social context can be unfavourable for the implementation of hard choices. Public attitude toward rationing seems to confirm that Italians are not familiar with rationing issues. Thus, it is very difficult to predict whether the national government will really go ahead with the implementation of a 'list of essential services' and whether this attempt will be successful. Rationing and priority setting should be discussed in the context of a general debate concerning the future of the Italian NHS.

Health Care Rationing↗
PubMed2003

The information network of senior citizens in Geneva, Switzerland, and progress in flu vaccination coverage between 1991 and 2000.

Switzerland has lagged behind other industrialized countries in increasing vaccination coverage against flu in the elderly population. The information campaign "United against Flu", started in Geneva in 1993, gradually extended to other French and Italian speaking cantons in Switzerland and indirectly affected German-speaking cantons. Activities developed include the production of TV spots, press conferences, information forwarded to health professionals, an Internet site and information material such as leaflets and posters to risk groups. The campaign is evaluated by repeated surveys that measure vaccination coverage as well as network of informants, knowledge and perceptions in the geriatric population. Vaccination coverage of the geriatric population in Geneva canton has increased from 29% in 1991 to 59% in the year 2000.

Aged↗
PubMed2003

Influenza coverages in Spain and vaccination-related factors in the subgroup aged 50-64 years.

This study sought to describe influenza vaccination coverages for different Spanish population subgroups, stressing the analysis of vaccination-related factors in subjects aged 50-64 years and estimating the possible beneficial effect of extending universal vaccination to this age group. A total of 6,400 surveys, targeting subjects over the age of 16 years and drawn from the 1997 Spanish National Health Survey, were used for study purposes. Influenza coverage was observed to rise significantly with age, and the reason cited by most subjects for seeking vaccination was medical indication. Coverage of the 50-64 age group was 21.6% (95% CI 19.4-23.8) and the variables associated with a greater probability of being vaccination were: residence in towns or cities with <10,000 inhabitants (OR 1.45); monthly income of less than 600 (OR 1.71); and presence of associated chronic disease (OR 3.07.) It is estimated that in Spain, 524,514 (40.7%) persons aged 50-64 years with associated chronic disease receive and 764,218 persons aged 50-64 years with associated chronic disease do not receive influenza vaccine. We conclude that the extremely high number of subjects in the 50-64 age range susceptible to influenza-related complications each year constitutes good grounds for universal vaccination being extended to said age group.

Adolescent↗
PubMed1999

Cultured composite autografts as coverage for an extensive body surface area burn: case report and review of the technology.

Cultured epithelial autografts (CEA) have been used as an adjunct in the surgical management of extensive thermal burns. Unfortunately, the lack of a dermal matrix makes CEA susceptible to infection, shearing forces and limits their incorporation into the burn wound. A cultured composite autograft (CCA) has been developed in which autologous keratinocytes and fibroblasts are surgically harvested from the burn patient's normal skin. These components are proliferated and then combined to form an epidermal and dermal matrix, grown to confluence then applied. Standard wound coverage techniques as well as CCA technology were utilized for successful wound closure in a 12 yr-old female with an 81% third degree burn. After fascial excision and allograft coverage, autografts were placed on her posterior burns and then 7500 cm2 of CCA was placed onto her anterior thorax, abdomen and lower extremities. Sixty percent of the burn was covered with CCA resulting in a success rate of 40%. No evidence of infection was noted, even in areas where CCA failed, although in those areas random epithelialization appeared to occur which then seemed to facilitate autograft placement. Early debridement and allografting followed by conventional autografts and CCA placement may provide an effective skin coverage strategy in patients with extensive deep burns.

Burns↗