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At least 127 records · Page 7Linked to original sources
PubMed1991

Evaluation of high energy photon external beam treatment planning: project summary. Photon Treatment Planning Collaborative Working Group.

A three-year project for the "Evaluation of High Energy Photon External Beam Treatment Planning," sponsored by the National Cancer Institute, is summarized. The participants in this project were determined on a competitive basis and included staff from four institutions: Massachusetts General Hospital; Memorial Sloan-Kettering Cancer Center; the University of Pennsylvania; and Mallinckrodt Institute of Radiation. This project built on the developments in three-dimensional anatomical and dose distribution reconstruction at these institutions and on the clinical guidance at these centers for quantitative evaluation of treatment plans. Protocols for acceptance of patients with lesions at eight different sites were developed and utilized. The technical methodology for interchange of treatment planning tapes, specifications for computerized tomography sections and their reconstruction, and the employment of dose-volume histograms of target regions and specified normal tissues and organs were all developed. Data were accumulated for tumor control probabilities (TCP) and for normal tissue complication probabilities (NTCP) for use in treatment plan design and evaluation. Several treatment parameters were studied as influenced by the availability of three-dimensional treatment planning and specific conclusions were reached.

Humans↗
PubMed1991

Role of inhomogeneity corrections in three-dimensional photon treatment planning. Photon Treatment Planning Collaborative Working Group.

The role of inhomogeneity corrections in three-dimensional (3-D) radiation treatment planning (RTP) was one of the issues addressed in a National Cancer Institute sponsored research contract. In eight selected disease sites, plans calculated with and without inhomogeneity corrections were compared. The one-dimensional Effective Path Length (EPL) method was used by all four participating institutions as the standard inhomogeneity correction method. However, the dose calculation algorithms were different, particularly in the treatment of blocking effects near the edge of the field. Evaluation tools such as dose-volume histogram, dose statistics, 3-D display of dose distributions and others were used in the comparison. Dose distributions were significantly altered by inhomogeneity corrections in the treatment plans for the lung tumors, and, to a lesser degree, for the breast and Hodgkin's diseases. Dose distributions for tumors of the head and neck region and in the abdomen were not significantly affected. The results should be regarded as particular to the EPL calculations. A treatment plan for the tumor of the larynx was calculated using both the EPL method and a 3-D scatter ray-trace Delta Volume method. For that particular site, inhomogeneity corrections were less important than correctly accounting for the effects of blockings on the scatter dose. Perturbations of electron transport were not accounted for by any of the methods used and not reflected in those sites where the effects were expected to be important. Fully quantitative evaluation of the role of inhomogeneity corrections in treatment planning requires an as yet unavailable all-encompassing accurate method of dose calculation.

Humans↗
PubMed2006

Comparison of forward planning with automated inverse planning for three-dimensional conformal radiotherapy of non-small cell lung cancer without IMRT.

The forward and inverse treatment plans of 10 patients with lung cancer were compared in terms of PTV coverage, sparing of normal lung and time required to generate a plan. The inverse planning produced as good treatment plans as an experienced dosimetrist with considerable reduction in staff time. When translated to other complex sites, inverse non-IMRT planning may have considerable impact on manpower requirements.

Algorithms↗
PubMed1998

Treatment planning for radiotherapy in northern Italy: a survey by the National AIFB-AIRO Committee on 3D-Treatment Planning. Italian Association for Biomedical Physics. Italian Association for Radiation Oncology.

BACKGROUND AND PURPOSE: A survey was performed in 1996 to investigate the structures and the process of radiation therapy treatment planning in clinical practice within northern Italy, with particular emphasis on the current and future implementation of 3D equipment and techniques. MATERIALS AND METHODS: Of 57 existing radiation therapy (RT) centres covering a population of 25 million people (45% of the total population of Italy) and treating over 58,000 cancer patients (70% of the cancer cases in Italy) each year, 46 centres were deemed eligible for the survey; a questionnaire was sent to a medical physicist working in each eligible RT centre, 40 of whom responded, making the basis for this report. RESULTS: A dedicated CT scanner was available in 25% of the responding centres and a total of 49 radiation therapy planning systems (RTPS) were reported; none of the RTPS were able to perform 3D calculations, but 50% of the centres had an advanced 2D or 2.5D system. Connection between CT scan and RTPS was by tape or disk in 62% of centres. Immobilization devices were used frequently for head and neck patients (88% of centres), but not for lung (16%) or prostate cancer (24%) patients; the number of contoured slices was largely variable, exceeding 10 in only about 30% of the responding centres. The average working time per patient seemed to closely reflect the number of slices used and the number of critical organs contoured. Finally, the majority of the responding physicists did not favour the use of more than 20 CT slices for 3D treatment planning, nor did they forecast a general spread of this technique in the next 2-3 years. CONCLUSIONS: This survey has shown (1) a heterogeneous picture, with 20% of centres ready to implement 3D techniques and 20% of centres lacking the possibility of planning treatments and (2) a general difficulty in coping with the workload represented by 3D treatment planning.

Data Collection↗
PubMed2000

The Royal London Space Planning: an integration of space analysis and treatment planning: Part I: Assessing the space required to meet treatment objectives.

The Royal London Space Planning process has evolved since 1985 to ensure a disciplined approach to diagnosis and treatment planning and to provide a record to justify treatment decisions for professional accountability. The analysis takes into consideration most aspects of a given malocclusion and aims to quantify the space required in each dental arch to attain the treatment objectives. Space planning also helps determine whether the objectives are likely to be attainable and helps in the planning of treatment mechanics and the control of anchorage. The process of analysis is divided into 2 sections. The first part consists of assessing the original malocclusion according to various component parts, any of which may have an effect on space if altered during treatment. These components are crowding and spacing, occlusal curves, arch width, anteroposterior position of labial segments, mesiodistal angulation, and incisor inclination. The second part of the analysis, which will be published in a separate article, deals with the effect of treatment procedures, such as extractions, tooth-size modifications, distal or mesial molar movements, as well as natural growth, on the space required. Space planning should be regarded only as a useful guide, as many areas of orthodontics-including growth, biological response, and patient compliance-cannot be controlled with total accuracy.

Cephalometry↗
PubMed2006

Interdisciplinary care planning and the written care plan in nursing homes: a critical review.

PURPOSE: This article is a critical review the history, research evidence, and state-of-the-art technology in interdisciplinary care planning and the written plan of care in American nursing homes. DESIGN AND METHODS: We reviewed educational and empirical literature. RESULTS: Interdisciplinary care planning and the written care plan are mandated processes that are imbedded in the regulatory fabric and routines of the American nursing home. These processes evolved from the discipline of nursing, where care planning has had a long and controversial history. IMPLICATIONS: Practice implications are provided.

Homes for the Aged↗
PubMed1997

Efficiency and rationality in the planning of health care for people with AIDS: an application of the balance of care approach. North-East Italian Group for Planning of AIDS Health Care.

OBJECTIVE: To demonstrate the application of an approach for assessing efficiency and rationality in the use of resources for the care of patients with AIDS (PWA), using data for north-east Italy. DESIGN: An economic methodology, the balance of care (BoC) approach, enabled identification of scenarios for the current, planned and recommended provision of care in the study region. METHODS: Data on the supply and utilization of care by PWA across four locations (inpatient care, day care, home care and sheltered accommodation) was collected for a 6-month period during 1994. The current BoC measured in care contacts across the locations was compared with a planned BoC scenario, derived from the Italian AIDS Health Plan, and a recommended BoC scenario based on a delphi expert panel judgement of the appropriate care location according to sets of hypothetical clinical and social characteristics of PWA. The cost consequences of reallocating patient contacts between the current BoC to the recommended BoC was assessed for inpatient and day care contacts. RESULTS: There is an overprovision of home care in the planned BoC scenario if applied to the study region. The cost consequences of a shift of care contacts according to the recommended scenario results in a potential cost reduction of 9.2% compared with the current scenario, and hence an expected efficiency improvement. CONCLUSION: The BoC approach can be applied to improve the efficiency and rationality of resource use in planning care provision for PWA.

Acquired Immunodeficiency Syndrome↗
PubMed1995

Do birth plans empower women? Evaluation of a hospital birth plan.

In early 1993 a birth plan for the South Western Sydney (Australia) Area Health Service was introduced in two district hospitals. Its ease of use and effectiveness were evaluated from May to July 1993, using a questionnaire that was completed postnatally by the first 100 women who had completed a prenatal birth plan. All women were asked to complete the questionnaire regardless of whether they had used the written birth plan during labor. Ninety-five percent of women said that they would encourage other women to use the plan. It increased their own understanding about the processes of labor and birth, and the hospital options open to them. Women said it was helpful, enabled them to express their needs and preferences, enhanced their confidence, and improved communication between them and staff. Birth plans show the commitment of health caregivers to recognizing and supporting diversity, allow for critical reappraisal of existing hospital policies and practices, and provide an opportunity for quality improvement in the context of client rights and preferences. They empower women by increasing their knowledge and understanding of birth practices, and helping them make informed choices.

Adult↗
PubMed1996

Differences in dental treatment plan and planning for drug-addicted and non-drug-addicted patients.

This study investigated whether dental treatment plans and planning of general practitioners are different for addicted and identical non-addicted patients. Dental practitioners (n = 500) were sent a questionnaire with information on and questions about treatment for either an addicted or an identical non-addicted patient; response rate was 41 %. Loglinear analysis showed that after controlling for the influence of four demographic variables (sex, age number of patients and number of National Health Service insured patients), the treatment plans made for addicted patients were less elaborate than those for non-addicted. For the addicted, fillings or frames were proposed more often, whereas for non-addicted patients more often crowns or bridges were proposed. Extraction instead of filling was more often proposed for the addicted patient. Less elaborate treatment for addicted patients corresponds to the way dentists specialized in treating drug addicts work, with one exception: extraction should be avoided whether a patient is addicted or not. Treatment planning did not differentiate for addicted and non-addicted patients, whereas dentists specialized in treating addicted patients do recommend an adjusted treatment plan for the addicted.

Adult↗
PubMed2006

Mind-mapped care plans: integrating an innovative educational tool as an alternative to traditional care plans.

Teaching nursing students how to think critically when planning patient care is vital to their professional success. Traditionally, the nursing care plan has been used to apply steps of the nursing process in planning patient care. However, nursing has evolved into a more complex profession that requires expanded ways of thinking and reasoning beyond the linear methods used in the past. Mind-mapped care plans provide an alternative method of teaching holistic, patient-centered care. This article describes the process used to integrate the mind-mapped care plan as an innovative educational tool, as well as formative and summative outcomes of its use.

Attitude of Health Personnel↗
PubMed1998

The Community Adaptive Planning Assessment: a clinical tool for documenting future planning with clients.

OBJECTIVES: The objectives of this article are to (a) identify features needed in a clinical tool in order to organize collaborative planning for the future between therapist and client; (b) describe the structure and procedures for use of the Community Adaptive Planning Assessment (CAPA), which was developed to meet these needs; (c) summarize research on the usability, trustworthiness, and clinical effectiveness of the CAPA; and (d) consider future work to further evaluate qualitative tools like the CAPA for clinical and research purposes. METHOD: Initial and revised versions of the CAPA were evaluated through several studies. Usability was examined through questionnaires completed by therapists who used the CAPA in acute care, rehabilitation, home health, and community programs with a total of 105 clients who had a variety of acute and chronic disabilities. Trustworthiness was evaluated through comparison of information gathered from 21 clients with that from their family members. Clinical effectiveness was evaluated for discharge planning through content analysis of community outcomes of goals and plans established before discharge. RESULTS: Initial studies indicate that the CAPA has sound usability, trustworthiness, and clinical effectiveness for a variety of service delivery systems and with a variety of clients when used by experienced therapists. Findings support use of these three criteria for evaluation of tools designed to document qualitative consultation-based practice. CONCLUSIONS: Results are related to broader issues in the profession, including a need for further study of collaborative planning for the future between clients and therapists, ways in which qualitative aspects of practice can be documented efficiently, ways in which outcomes of consultation-based practice can be evaluated, and establishment of criteria for evaluation of emerging qualitative assessments and intervention tools.

Disability Evaluation↗
PubMed2003

Health plan diagnostics: what plan sponsors and trustees need to know.

The needed information for diagnosing the cost-effectiveness of the health plan includes understanding where cost pressures are coming from, how the plan compares to other plans and the key characteristics of the covered group. Allocating resources for the staff or consultants to produce and analyze this information is a wise investment. Two case studies illustrate the power of plan diagnostics to lead to positive solutions that address cost increases--without hurting plan members.

Actuarial Analysis↗
PubMed2003

Evaluating health plan quality 2: survey design principles for measuring health plan quality.

OBJECTIVE: To develop principles for measuring the quality of specific health plans from a physician's perspective. STUDY DESIGN: Literature review, expert review, cognitive interviews. METHODS: We did a literature review on the use of physician surveys about managed care to determine the contributions and weaknesses of those surveys. Then, an expert review of prior survey efforts to measure health plan quality from the physician's perspective was performed. RESULTS: A survey instrument based on a conceptual model of health plan quality was developed. Its purpose was to measure health plan quality from the physician's perspective. Principles for surveying physicians guided the structure of the survey. CONCLUSION: Survey instruments can be designed to take into account a physician's unique perspective on health plan quality and can include measures that control for potential biases such as anti-managed care bias.

Attitude of Health Personnel↗
PubMed1991

A process for implementation of the strategic plan: from strategic planning toward strategic management.

Although the principles and process for developing a strategic plan are well established, little information exists on how organizations can implement these plans. The authors developed a framework and methodology for The Ontario Cancer Institute/Princess Margaret Hospital that connects the implementation of the strategic plan with resource allocation and the budget; thus, the budget is a quantified expression of the strategic plan. To accomplish this, a specific cycle of events leading to the development of a corporate calendar was undertaken, which results in the establishment of the annual budget.

Cancer Care Facilities↗
PubMed2004

Maternal outcomes at 2 years after planned cesarean section versus planned vaginal birth for breech presentation at term: the international randomized Term Breech Trial.

OBJECTIVE: This study was undertaken to compare maternal outcomes at 2 years postpartum after planned cesarean section and planned vaginal birth for the singleton fetus in breech presentation at term. STUDY DESIGN: In selected centers in the Term Breech Trial, mothers completed a structured questionnaire at 2 or more years postpartum to determine their health in the previous 3 to 6 months. RESULTS: A total of 917 of 1159 (79.1%) mothers from 85 centers completed a follow-up questionnaire at 2 years postpartum. There were no differences between groups in breast feeding, relationship with child or partner, pain, subsequent pregnancy, incontinence, depression, urinary, menstrual or sexual problems, fatigue, or distressing memories of the birth experience. Planned cesarean section was associated with a higher risk of constipation (P = .02). CONCLUSION: Maternal outcomes at 2 years postpartum are similar after planned cesarean section and planned vaginal birth for the singleton breech fetus at term.

Adult↗
PubMed2001

The effect of public long-term care insurance plan on care management and care planning in Japanese geriatric hospitals.

Japan, a society facing demographic aging at an incomparable speed, decided to introduce a new public long-term care insurance system to meet the expected need for elders to be cared for in the near future. The purpose of this study was to examine the change in knowledgeability on the side of managers of Japanese geriatric hospitals regarding (1) the concept of care-management as the methodology to supply care services to the elderly smoothly, and (2) comprehensive assessment for the elders as the technical skill in the process of materializing care management. Subjects were interviewed and questioned over the telephone according to a structural questionnaire. Managers (directors and office managers) of geriatric hospitals in 1996 and 1999. In 1996, the rate of knowledgeability for care management on the side of managers of geriatric hospitals was 70.0% (28/40) as a whole, increasing to 97.3% (71/73) in 1999. With regard to MDS-RAPs, the knowledgeability rate increased from 57.5% (23/40) in 1996 to 95.9% (70/73) in 1999. However, regarding care planning, almost all of the hospitals that performed care planning were those in the category required to submit care plans to the municipal government. Geriatric hospitals that were not required to submit such plans did not perform such planning either in 1996 or in 1999. It can be concluded that the decision to introduce a long-term care insurance system in Japan has led to a deeper understanding of the methodology of care management and a comprehensive assessment on the side of managers of geriatric hospitals.

Journal Article↗
PubMed2002

Black applicants' reactions to affirmative action plans: effects of plan content and previous experience with discrimination.

This study examined the effects of plan content and previous experience with discrimination on Black respondents' reactions to affirmative action plans. Black engineering students (N = 1,173) were randomly assigned to 1 of 6 plans implemented by a hypothetical organization and were asked to provide ratings of perceived fairness and intention to pursue a position at the organization. There were significant effects of plan content on perceived faimess and job pursuit intentions. Perceived fairness mediated the effect of content on intentions. Furthermore, previous experience with discrimination interacted with content to affect intentions. Individuals who had experienced relatively more discrimination in the workplace reported stronger intentions to pursue a position at an organization whose plan specified special training opportunities for minorities.

Adult↗
PubMedDate not supplied

Planning for change: an alternative to treatment planning with sexual offenders.

This article describes how a change plan can be helpful in defining intervention goals and objectives. The change-plan concept derives from lifestyle theory and deviates from the traditional treatment plan in its delineation of roles, point of focus, and attention to process. A case example is used to illustrate how the change plan can be implemented with sexually offending clients. Several potential limitations of the change-plan concept are also discussed.

Humans↗