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At least 19 recordsLinked to original sources
PubMed2000

Planned caesarean section for term breech delivery.

BACKGROUND: Routine use of caesarean section for breech presentation is widespread. However poor outcomes after breech birth may be the result of underlying conditions causing breech presentation rather than damage during delivery. OBJECTIVES: The objective of this review was to assess the effects of planned caesarean section for breech presentation on measures of pregnancy outcome. SEARCH STRATEGY: We searched the Cochrane Pregnancy and Childbirth trials register and the Cochrane Controlled Trials register. Date of last search: October 1997. SELECTION CRITERIA: Randomised trials comparing planned caesarean section for breech presentation with planned vaginal delivery. DATA COLLECTION AND ANALYSIS: Reviewers assessed trial eligibility and quality. MAIN RESULTS: Two studies involving 313 women were included. Caesarean section was done in 93% (119/128) of women allocated to planned caesarean section and 54% (99/185) of women in the planned vaginal delivery groups. The policy of planned caesarean section was associated with significantly increased maternal morbidity (relative risk 1.31, 95% confidence interval 1.02 to 1.68) and reduced short term neonatal morbidity (relative risk 0.26, 95% confidence interval 0.08 to 0.88). The studies were unable to detect differences in brachial plexus injuries, low Apgar scores or perinatal mortality. REVIEWER'S CONCLUSIONS: There is not enough evidence to evaluate the use of a policy of planned caesarean section for breech presentation. A large Canadian trial addressing this question is currently underway.

Breech Presentation↗
PubMed2004

Slower and incomplete retrieval of speech motor plans is the proximal source of stuttering: stutters occur when syllable motor plans stored in memory are concatenated to produce the utterance motor plan.

This paper describes a hypothesis about stuttering that distinguishes between two methods of assembling the speech motor plan for an utterance - speech construction, which involves real-time preparation of the speech motor plan and speech concatenation, which involves retrieval and chaining of syllable motor plans stored in memory. It is hypothesized that stutters are significantly reduced when people who stutter (PWS) speak in novel speaking patterns such as whispering and prolonged speech because these unaccustomed speaking tasks require speech construction. In contrast, when PWS speak in their habitual speech pattern, concatenating syllable motor plans stored in memory, they stutter. Reaction time studies and the effect of word frequency on stutter rate show that PWS are slower in retrieving stored motor plans during speech concatenation. On the other hand, conditions that positively prime the retrieval of motor plans - phonological priming, reading, production of serial speech, speech shadowing, and stuttering adaptation tasks - speed up the retrieval of motor plans and, therefore, reduce the amount of stutters. The slower retrieval of syllable motor plans may lead to an incomplete specification of the utterance motor plan. Stutters result when the articulatory system attempts to execute an underspecified utterance motor plan.

Adaptation, Psychological↗
PubMed2006

Failing to plan is planning to fail: improving the quality of care with survivorship care plans.

The recent Institute of Medicine report "From Cancer Patient to Cancer Survivor: Lost in Transition" recommended the creation of survivorship care plans for patients as they complete primary therapy for cancer to ensure clarity for all involved about patients' diagnoses, treatments received, and surveillance plans. Any previously existing follow-up guidelines for cancer survivors have been largely restricted to surveillance for recurrence of the primary disease. An important message of the Institute of Medicine report is that survivorship care plans must surpass this and address the chronic effects of cancer (pain, fatigue, premature menopause, depression/anxiety), monitoring for and preventing late effects like osteoporosis, heart disease, and second malignancies, and promoting healthy lifestyles. It should explicitly identify the providers responsible for each aspect of ongoing care and provide information on resources available for psychosocial and other practical issues that may arise as a result of the prior cancer diagnosis. Although having some sort of a plan is clearly necessary to achieve high quality care, there are practical barriers to formal off-treatment consultations and the creation of written documents that may become part of the medical record. This article reviews the elements of the proposed survivorship care plan and discusses areas of research and development needed to make them part of standard oncology practice.

Aftercare↗
PubMed1990

[3-D-irradiation planning based on the TOMOSCAN CX (Philips) computed tomograph. I. Principles of the CT-irradiation planning program. II. CT-irradiation planning for after-irradiation of breast cancer].

Actually CT-cross-sections are the best base for irradiation planning. Bases are represented to use CT-picture matrices of scanner TOMOSCAN CX (Philips) for irradiation planning. The direct application of CT-pictures is done in "off-line"-running with the magnetic tape set. For figuring on colour display and estimation of density matrix limits of Hounsfield values are given. Adjustment of the CT to take off scan planes requires a special work-regime for irradiation planning. Repair and use of defective CT-pictures are realized by input of specific outlines. In daily routine the output of sagittal dose distribution is most advantageous in form of a table. Application of this CT-irradiation planning system, being implemented on microcalculator K 1630, is shown for telecobalt irradiation of mammary carcinoma.

Breast Neoplasms↗
PubMed2005

Using the State Plan Index to evaluate the quality of state plans to prevent obesity and other chronic diseases.

INTRODUCTION: Implicit in public health planning models is the assumption that good public health plans lead to good programs, and good programs lead to desired health outcomes. Despite considerable resources that are devoted to developing plans, public health agencies and organizations have lacked a tool for evaluating the finished product of their planning efforts -- the written plan itself -- as an important indicator of progress. To address the need for an instrument to assess the quality of state plans designed to prevent and control chronic diseases, we created and tested the State Plan Index and used it to evaluate the quality of nine state plans aimed at preventing and reducing obesity. METHODS: The State Plan Index was developed under the auspices of the Centers for Disease Control and Prevention (CDC) in collaboration with public health experts in federal, state, and academic settings. The State Plan Index included 55 items related to plan quality arranged into nine components. Each item was rated on a Likert scale from 0 to 5, with 5 being the highest rating. Each plan also received a separate overall plan quality score using the same scale. Each state plan was evaluated by four or five raters using the State Plan Index. For each plan, the 55 items were averaged to calculate an item average score, and a subscore was calculated for each State Plan Index component. Finally, five states also self-rated their own plans (self score). RESULTS: The mean item average score for all plans was 2.4 out of 5.0. The range of item average scores was 1.0 to 3.0. The component of the State Plan Index with the highest mean component score (3.3) was Presentation of Epidemiologic Data on Disease Burden. The components with the lowest component scores were Resources for Plan Implementation (0.7); Integration of Obesity Efforts with Other Chronic Disease Efforts (1.7); and Program Evaluation (2.0). Plan quality was rated higher when based on the single overall plan quality score assigned by raters. In addition, self scores were consistently and substantially higher than rater-assigned scores. CONCLUSION: Evaluation of plans early in the life of programs can be used to strengthen existing programs and to guide programs newly engaged in chronic disease prevention planning. The CDC has used the State Plan Index evaluation results to guide technical assistance, plan training sessions, and enhance communication with state staff about plan content, quality, and public health approach. Some state program directors self-evaluated their obesity draft plan and used the evaluation results to strengthen their planning process and to guide plan revisions. Other states have adapted the State Plan Index as a framework for new planning efforts to prevent obesity as well as other chronic diseases.

Centers for Disease Control and Prevention, U.S.↗
PubMed2000

Gamma knife radiosurgery as a primary treatment for prolactinomas.

OBJECT: The purpose of this study was to estimate the efficacy of gamma knife radiosurgery (GKS) in controlling tumor growth and endocrinopathy associated with prolactinomas. METHODS: Between 1993 and 1997, 164 of 469 patients with pituitary adenomas treated by GKS harbored prolactinomas. The dose to the tumor margin ranged from 9 to 35 Gy (mean 31.2 Gy), and the visual pathways were exposed to a dose of less than 10 Gy. The mean tumor diameter was 13.4 mm. The mean follow-up time for 128 cases was 33.2 months (range 6-72 months). Tumor control was observed in all but two patients who underwent surgery 18 and 36 months, respectively, after GKS. Clinical cure was achieved in 67 cases. Clinical improvement was noted with a decrease in the hyperprolactinemia after GKS. Nonetheless, in 31 (29%) of 108 patients who were followed for more than 2 years no improvement in serum prolactin levels was demonstrated, although this could be normalized by bromocriptine administration after treatment. Nine infertile women became pregnant 2 to 13 months after GKS and all gave birth to normal children. There was no visual deterioration related to GKS. Five women experienced premature menopause. In these patients there was subtotal disappearance of the tumor and an empty sella developed. CONCLUSIONS: Gamma knife radiosurgery as a primary treatment for prolactinomas can be safe and effective both for controlling tumor growth and for normalization of prolactin hypersecretion. A higher margin dose (> or = 30 Gy) seemed to be associated with a better clinical outcome. Gamma knife radiosurgery may make prolactinomas more sensitive to the bromocriptine.

Humans↗
PubMedDate not supplied

When new employee orientation doesn't go as planned. "It is time for Plan B ... but, what is Plan B?".

Although organizations have standard orientation programs for newly hired registered nurses, there are times when orientees are unable to meet expectations. When this happens, it is important to implement a Plan B--a revised orientation program that includes individualized strategies and content--to meet the needs of the orientee who is not progressing. This article will identify factors that may predict the need for increased orientation time and strategies to assist the new employee to complete orientation successfully.

Clinical Competence↗
PubMed2004

A study of planning dose constraints for treatment of nasopharyngeal carcinoma using a commercial inverse treatment planning system.

PURPOSE: The purpose of this study was to develop and test planning dose constraint templates for tumor and normal structures in the treatment of nasopharyngeal carcinoma (NPC) using a specific commercial inverse treatment planning system. METHODS AND MATERIALS: Planning dose constraint templates were developed based on the analyses of dose-volume histograms (DVHs) of tumor targets and adjacent sensitive structures by clinically approved treatment plans of 9 T1-2 and 16 T3-4 NPC patients treated with inverse planned intensity-modulated radiation therapy (IP-IMRT). DVHs of sensitive structures were analyzed by examining multiple defined endpoints, based on the characteristics of each sensitive structure. For each subgroup of patients with T1-2 and T3-4 NPC, the resulting mean values of these defined endpoint doses were considered as templates for planning dose constraints and subsequently applied to a second group of patients, 5 with T1-2 NPC and 5 with T3-4 NPC. The 10 regenerated plans (called new plans) were compared to the original clinical plans that were used to treat the second group of patients, based on plan conformity index and DVHs. RESULTS: The conformity indices of the new plans were comparable to the original plans with no statistical difference (p = 0.85). Among the serial sensitive structures evaluated, there was a significant decrease with the new plans in the dose to the spinal cord when analyzed by the maximum dose (p = 0.001), doses encompassing 1 cc of the spinal cord volume (p = 0.001) and 3 cc of the spinal cord volume (p = 0.001). There was no significant difference in the mean maximum dose to the brainstem between the new plans and the original plans (p = 0.36). However, a significant difference in the mean maximum dose to the brainstem was seen among the different T-stages (p = 0.04). A decrease with the new plan to the brainstem in the doses encompassing 5% and 10% of the volume was of borderline statistical significance (p = 0.08 and p = 0.06, respectively). There were no statistical differences between the new plans and the original plans in the mean doses to the chiasm, optic nerve, or eye for each of the endpoints considered. For parallel sensitive structures in the new plans, there was a significant increase in the average mean dose to the parotid glands (p = 0.01), a decrease that was of borderline significance in the average mean dose to the temporomandibular joint (p = 0.07), but no difference in the average mean dose to the ear. CONCLUSIONS: The statistical analysis showed that new plans are comparable to the original plans for most of the sensitive structures except for a trade-off between a dose reduction to the spinal cord in the new plans and an increase in the mean dose to the parotid glands. These tested planning dose constraint templates can serve as good "starting points" for an inverse plan of NPC using a specific commercial inverse treatment planning system.

Brain Stem↗
PubMed2002

Plan space: representation of treatment plans in multidimensional space.

PURPOSE: Treatment planning balances the need to provide adequate radiation coverage of the target with the need to reduce against the risk of overdosing normal tissues. An acceptable plan fulfills minimum dose-volume criteria for irradiation of tumor and normal tissues. However, multiple plans can satisfy these minimum criteria, and some plans provide for better protection of normal tissue than others. Here, we present a method to help the planner compare plans and decide whether a particular plan is the "best" plan on the basis of a set of certain dose-volume conditions. METHODS AND MATERIALS: Treatment plans are represented as points in multidimensional space. One dimension is assigned to the target and one to normal tissues of each anatomic structure under consideration. Minimum target dose is used as the target axis coordinate and the percentage volume of each normal structure receiving more than a specified dose as each normal-tissue coordinate. Images of plan space are developed for model phantom anatomy as well as for two clinical cases in the thorax and abdomen. RESULTS: When a sufficient number of plans have been plotted, a feasibility boundary becomes evident. This hypersurface in plan space represents the limit of the given treatment technique. By using a plan on this boundary, the benefits of a given treatment modality are maximized, providing assurance that the selected plan is the "best" plan. The beam angles and relative weights of a plan can be changed to alter its position in plan space, allowing improvements in an existing plan. Frequently, plans with normal-tissue dose distributions superior to the minimum acceptable criteria can be selected. The benefits of using plan-space images have been demonstrated at sites in the thorax and abdomen. CONCLUSION: Instead of defining dose-volume criteria at the outset, it is possible to select the best achievable plans by first evaluating the space of possible plans for a particular patient's unique anatomy and then choosing the plan with the optimum dose-volume characteristics. No attempt is made to arrive at a single plan score so that explicit judgments about the relative worth of individual structures are avoided. Visualization of plan-space images allows physicians to make choices based on their assessment of the relative significance of irradiation of each normal structure.

Humans↗
PubMed2005

CT-guided intracavitary radiotherapy for cervical cancer: Comparison of conventional point A plan with clinical target volume-based three-dimensional plan using dose-volume parameters.

PURPOSE: To perform an intracavitary radiotherapy (ICR) plan comparison between the conventional point A plan (conventional plan) and computed tomography (CT)-guided clinical target volume-based plan (CTV plan) by analysis of the quantitative dose-volume parameters and irradiated volumes of organs at risk in patients with cervical cancer. METHODS AND MATERIALS: Thirty plans for 192Ir high-dose-rate ICR after 30-40-Gy external beam radiotherapy were investigated. CT images were acquired at the first ICR session with artifact-free applicators in place. The gross tumor volume, clinical target volume (CTV), point A, and International Commission on Radiation Units and Measurements Report 38 rectal and bladder points were defined on reconstructed CT images. A fractional 100% dose was prescribed to point A in the conventional plan and to the outermost point to cover all CTVs in the CTV plan. The reference volume receiving 100% of the prescribed dose (V(ref)), and the dose-volume parameters of the coverage index, conformal index, and external volume index were calculated from the dose-volume histogram. The bladder, rectal point doses, and percentage of volumes receiving 50%, 80%, and 100% of the prescribed dose were also analyzed. RESULTS: Conventional plans were performed, and patients were categorized on the basis of whether the 100% isodose line of point A prescription dose fully encompassed the CTV (Group 1, n = 20) or not (Group 2, n = 10). The mean gross tumor volume (11.6 cm3) and CTV (24.9 cm3) of Group 1 were smaller than the corresponding values (23.7 and 44.7 cm3, respectively) for Group 2 (p = 0.003). The mean V(ref) for all patients was 129.6 cm(3) for the conventional plan and 97.0 cm3 for the CTV plan (p = 0.003). The mean V(ref) in Group 1 decreased markedly with the CTV plan (p < 0.001). For the conventional and CTV plans in all patients, the mean coverage index, conformal index, and external volume index were 0.98 and 1.0, 0.23 and 0.34, and 3.86 and 2.15, respectively. Statistical analysis showed that the conformal index and external volume index improved significantly with the CTV plan, and this improvement was more marked in Group 1. The mean values of the bladder and rectal point doses and volume fractions receiving 50%, 80%, and 100% of the reference dose did not differ between plans for all patients. The reduction in the mean rectal and bladder point doses and irradiated volumes for the CTV plan was statistically significant in Group 1. CONCLUSION: Computed tomography-guided CTV planning of ICR is superior to conventional point A planning in terms of conformity of target coverage and avoidance of overdosed normal tissue volume. To ascertain the potential benefit of treatment outcome, ICR with image-guided three-dimensional plans will be pursued and correlated with the dose-volume parameters.

Antineoplastic Agents↗
PubMed2005

State Plan Index: a tool for assessing the quality of state public health plans.

INTRODUCTION: The State Plan Index is an evaluation instrument that uses a Likert scale to assess 60 indicators of the quality of state public health plans. The State Plan Index was needed to enable evaluation of plans that were developed using a variety of public health planning models. METHODS: Federal, state, and academic partners participated in developing and testing the instrument. The authors conducted a literature review, interviews with experts, and several rounds of formative evaluation to assess item inclusion, coverage, weighting, organization of items, and content validity. In two rounds of field testing, public health practitioners at the federal and state levels rated 10 state public health plans for obesity prevention. RESULTS: Field-test raters took an average of two hours to rate a plan and indicated that the State Plan Index was "easy to use," "comprehensive," and "fair." Mean Cronbach alpha for components of the State Plan Index was 0.88 (median 0.93). Component scores among the 10 plans rated ranged from 0.2 to 4.8, indicating that raters made distinctions in quality among the components and the plans they rated. Correlations between component scores and overall scores were statistically significant (P < .001), except for one component. CONCLUSION: Public health professionals at the federal and state levels found the State Plan Index to be a useful tool for evaluating public health plans that were developed by states using various planning approaches. After the field tests, state staff reported adapting the State Plan Index for use as a planning tool, an evaluation tool for local plans, and a self-assessment tool for drafts of state plans. In addition, the State Plan Index can be revised easily for use in other chronic disease areas.

Centers for Disease Control and Prevention, U.S.↗
PubMed1995

A comparison of conventional 'forward planning' with inverse planning for 3D conformal radiotherapy of the prostate.

A radiotherapy treatment plan optimisation algorithm has been applied to 48 prostate plans and the results compared with those of an experienced human planner. Twelve patients were used in the study, and 3-, 4-, 6- and 8-field plans (with standard coplanar beam angles for each plan type) were optimised by both the human planner and the optimisation algorithm. The human planner 'optimised' the plan by conventional forward planning techniques. The optimisation algorithm was based on fast simulated annealing using a cost-function designed to achieve a homogenous dose in the 'planning-target-volume' and to minimise the integral dose to the organs at risk. 'Importance factors' assigned to different regions of the patient provide a method for controlling the algorithm, and it was found that the same values gave good results for almost all plans. A study of the convergence of the algorithm is presented and optimal convergence parameters are determined. The plans were compared on the basis of both dose statistics and 'normal-tissue-complication-probability' (NTCP) and 'tumour-control-probability' (TCP). The results of the comparison study show that the optimisation algorithm yielded results that were at least as good as the human planner for all plan types, and on the whole slightly better. A study of the beam-weights chosen by the optimisation algorithm and the planner revealed differences that increased with the number of beams in the plan. The planner was found to make small perturbations about a conceived optimal beam-weight set. The optimisation algorithm showed much greater showed much greater variation, in response to individual patient geometry, frequently deselecting certain beams altogether from the plan. The algorithm is shown to be a useful tool for radiotherapy treatment planning. For simple (e.g., three-field) plans it was found to consistently achieve slightly higher TCP and lower NTCP values. For more complicated (e.g., eight-field) plans the optimisation also achieved slightly better results with generally less numbers of beams, unfavourable beams being deselected from the plan. Probably the greatest benefit is the reduced time taken by the optimisation to compute optimised beam-weights. This time always < or = 5 min; a factor of up to 20-times faster than the human planner.

Algorithms↗
PubMed2006

Dosimetric comparisons of helical tomotherapy treatment plans and step-and-shoot intensity-modulated radiosurgery treatment plans in intracranial stereotactic radiosurgery.

PURPOSE: To evaluate dose conformity, dose homogeneity, and dose gradient in helical tomotherapy treatment plans for stereotactic radiosurgery, and compare results with step-and-shoot intensity-modulated radiosurgery (IMRS) treatment plans. METHODS AND MATERIALS: Sixteen patients were selected with a mean tumor size of 14.65 +/- 11.2 cm3. Original step-and-shoot IMRS treatment plans used coplanar fields because of the constraint of the beam stopper. Retrospective step-and-shoot IMRS plans were generated using noncoplanar fields. Helical tomotherapy treatment plans were generated using the tomotherapy planning station. Dose conformity index, dose gradient score index, and homogeneity index were used in plan intercomparisons. RESULTS: Noncoplanar IMRS plans increased dose conformity and dose gradient, but not dose homogeneity, compared with coplanar IMRS plans. Tomotherapy plans increased dose conformity and dose gradient, yet increased dose heterogeneity compared with noncoplanar IMRS plans. The average dose conformity index values were 1.53 +/- 0.38, 1.35 +/- 0.15, and 1.26 +/- 0.10 in coplanar IMRS, noncoplanar IMRS, and tomotherapy plans, respectively. The average dose homogeneity index values were 1.15 +/- 0.05, 1.13 +/- 0.04, and 1.18 +/- 0.09 in coplanar IMRS, noncoplanar IMRS, and tomotherapy plans, respectively. The mean dose gradient score index values were 1.37 +/- 19.08, 22.32 +/- 19.20, and 43.28 +/- 13.78 in coplanar IMRS, noncoplanar IMRS, and tomotherapy plans, respectively. The mean treatment time in tomotherapy was 42 +/- 16 min. CONCLUSIONS: We were able to achieve better dose conformity and dose gradient in tomotherapy plans compared with step-and-shoot IMRS plans for intracranial stereotactic radiosurgery. However, tomotherapy treatment time was significantly larger than that in step-and-shoot IMRS.

Algorithms↗