1,720,968 research outputs found
IGRT com CBCT: o impacto na precisão em radioterapia
Get PDFMestrado em Radiações Aplicadas às Tecnologias da Saúde.Precision is an imperative in modern radiotherapy. This concept is applied in a day-to-day basis at all levels in planning and delivering treatment to patients, since only by uniting all these aspects is it’s real application possible. Given that I am a radiation technologist in an institution where the purpose is to ensure accuracy in administered treatment, my main focus was to direct this work towards the field in which I dwell daily. Indeed, making sure that all instruments available have a precisely studied role in the quality of the execution of prescribed treatment has become a necessity that justifies the enormous amount of care put in the treatment phase in radiotherapy. This applies, namely, to the recently-implemented cone-beam computed tomography (CBCT) tool. Therefore, computerized tomography dose indices (CTDI) were acquired in order to monitor doses administered to patients through CBCT. This was followed by the selection of twenty one patients of pathologies involving a great amount of precision: fourteen patients with prostate and seven patients with head and neck tumours. This sample was characterized with the acquisition of CBCT pre and post-treatment, as well as after any correction performed on their positioning. This allowed for evaluating intra-fraction errors. From within this sample, patients out of action limits were chosen, as analyzed in control charts for mean and standard deviation of their positioning deviations, as well as patients out of tolerance limits for deviation correction.
Finally, new dosimetric distributions were performed, in which the isocenter accounts for the measured positioning errors. The doses in organs at risk and eventual differences in planning target volume (PTV) coverage with 95% of the dose between these and the planned distributions were compared for each of these patients. This simulation allowed for inferring what would have happened had these errors not been accounted for and corrected. This study also evaluated the feasibility of using CBCT in the imaging verification during the treatment of patients with the aforementioned pathologies, as well as the adequacy of the image acquisition protocol, as currently implemented at the department. The evaluation and quantification of systematic and random translational and rotational errors was also made possible, as defined by current departmental practices. This allowed for adapting not only the mentioned protocol, but also margins currently added to clinical target volumes (CTV) for PTV generation. This will allow to ensure that protocols are based on data obtained locally, which will undoubtedly procure better results in cancer healthcare at the department. It is noteworthy that the Master Comission authorized the presentation of this work as a scientific article, with the purpose of future publication in international, peer-reviewed journals. In order to do so, it is not only written in English, but it also respects criteria related to this objective. In the first part, a review on state-of-the-art literature is rendered (previously submitted in May 2011, even though some aspects have been corrected or updated), as to allow for a contextualization of my work. The feasibility of the IGRT protocol, as implemented at my department, is then assessed. Finally, as previously discussed, systematic and random translational and rotational errors are evaluated
Avaliação da cultura de segurança do doente em meio hospitalar: investigação ação numa unidade de radioterapia
Get PDFRESUMO
Introdução e objetivos
As organizações internacionais responsáveis pela Qualidade na Saúde e Segurança do doente (Organização Mundial da Saúde, União Europeia), recomendam aos Estados membros a avaliação da cultura de segurança, como condição essencial para se introduzir mudanças nos comportamentos dos profissionais e nas organizações prestadoras de cuidados de saúde, e alcançar melhores níveis de segurança e de qualidade nos cuidados de saúde prestados aos doentes.
Constitui objetivo geral deste trabalho contribuir para a implementação da cultura de segurança do doente nos profissionais envolvidos na prestação de cuidados de saúde, concorrendo para a avaliação da cultura de segurança do doente e, consequentemente para a garantia da qualidade dos cuidados prestados.
Metodologia
1ª fase – pré-estudo: através da revisão de literatura identificamos o instrumento mais adequado para avaliar a cultura de segurança do hospital, traduzimos e validámos o instrumento.
2ª fase – desenvolvemos um estudo exploratório-descritivo, transversal, retrospetivo, em 3 hospitais portugueses e um estudo exploratório-descritivo, longitudinal, prospetivo, de investigação-ação, numa unidade de radioterapia.
Resultados
O Hospital Survey on Patient Safety Culture é o instrumento que revela as adequadas características para a avaliação da cultura de segurança nos hospitais portugueses.
No que diz respeito à avaliação da cultura de segurança em três hospitais portugueses, podemos destacar que o trabalho em equipa, a expectativas do supervisor e a aprendizagem organizacional são as dimensões com melhores resultados apesar da frequência das notificações e das respostas ao erro não punitivas apresentarem os piores resultados.
Verificou-se que a URT se encontra em franca evolução, o que se torna visível sobretudo na adesão à notificação que aumentou à medida que o tempo foi passando. O envolvimento de todos no desenho da intervenção e nas atividades a decorrer na unidade, foi preponderante para a melhoria da segurança do doente.
Conclusões
Temos consciência que existem muitas questões por responder e que na realidade não há receitas nem diretrizes que possam afirmar que existem relações de causalidade, confrontando uma determinada ação com a consequente mudança cultural. No entanto, estamos convictos que o envolvimento de todos os membros da organização/unidade, o compromisso forte da liderança, uma comunicação efetiva e uma notificação não punitiva são ingredientes essenciais para a melhoria contínua da cultura de segurança do doente.ABSTRACT
Introduction and purpose
The international organizations responsible for Quality in Health Care and Patient Safety (World Health Organization, European Union) recommend member states the assessment of safety culture as an essential condition to endorse changes in the professionals and healthcare organizations performance, and therefore achieve greater levels of quality and safety in healthcare provided to patients and citizens.
The aim of this study is to contribute to the implementation of patient safety culture in the professionals involved in healthcare, contributing to the patient safety culture assessment and therefore to guarantee the quality of care.
Methodology
Phase 1 - pre-study: through literature review we identified the most appropriate instrument to assess the hospital safety culture, translated and validated the instrument.
Phase 2 - develop a descriptive exploratory study, transversal, retrospective, in three Portuguese hospitals and an exploratory-descriptive, longitudinal, prospective, research-action in a radiotherapy unit.
Results
The Hospital Survey on Patient Safety Culture is an instrument that exposes the appropriate characteristics for the assessment of patient safety culture in Portuguese hospitals.
Regarding the assessment of safety culture in three Portuguese hospitals, we can highlight teamwork, the supervisor's expectations and organizational learning as the dimensions with better results despite the frequency of reports and non punitive response to error, obtained the worse results.
We found that the URT is in frank evolution, which becomes particularly visible in the compliance to the reporting system that increased as time went on. The involvement of all staff in the design of intervention and activities taking place in the unit, was foremost to improved patient safety.
Conclusions
We are aware that there are many unanswered questions and that in reality there are no formulas or guidelines that can declare that there are causal relations, confronting a particular action and the consequent cultural change. However, we believe that the involvement of all members of the organization/unit, a strong leadership commitment, effective communication and a non-punitive reporting are essential ingredients for a culture of continuous patient safety improvement
Avaliação da cultura de segurança do doente em meio hospitalar: investigação ação numa unidade de radioterapia
No full textRESUMO
Introdução e objetivos
As organizações internacionais responsáveis pela Qualidade na Saúde e Segurança do doente (Organização Mundial da Saúde, União Europeia), recomendam aos Estados membros a avaliação da cultura de segurança, como condição essencial para se introduzir mudanças nos comportamentos dos profissionais e nas organizações prestadoras de cuidados de saúde, e alcançar melhores níveis de segurança e de qualidade nos cuidados de saúde prestados aos doentes.
Constitui objetivo geral deste trabalho contribuir para a implementação da cultura de segurança do doente nos profissionais envolvidos na prestação de cuidados de saúde, concorrendo para a avaliação da cultura de segurança do doente e, consequentemente para a garantia da qualidade dos cuidados prestados.
Metodologia
1ª fase – pré-estudo: através da revisão de literatura identificamos o instrumento mais adequado para avaliar a cultura de segurança do hospital, traduzimos e validámos o instrumento.
2ª fase – desenvolvemos um estudo exploratório-descritivo, transversal, retrospetivo, em 3 hospitais portugueses e um estudo exploratório-descritivo, longitudinal, prospetivo, de investigação-ação, numa unidade de radioterapia.
Resultados
O Hospital Survey on Patient Safety Culture é o instrumento que revela as adequadas características para a avaliação da cultura de segurança nos hospitais portugueses.
No que diz respeito à avaliação da cultura de segurança em três hospitais portugueses, podemos destacar que o trabalho em equipa, a expectativas do supervisor e a aprendizagem organizacional são as dimensões com melhores resultados apesar da frequência das notificações e das respostas ao erro não punitivas apresentarem os piores resultados.
Verificou-se que a URT se encontra em franca evolução, o que se torna visível sobretudo na adesão à notificação que aumentou à medida que o tempo foi passando. O envolvimento de todos no desenho da intervenção e nas atividades a decorrer na unidade, foi preponderante para a melhoria da segurança do doente.
Conclusões
Temos consciência que existem muitas questões por responder e que na realidade não há receitas nem diretrizes que possam afirmar que existem relações de causalidade, confrontando uma determinada ação com a consequente mudança cultural. No entanto, estamos convictos que o envolvimento de todos os membros da organização/unidade, o compromisso forte da liderança, uma comunicação efetiva e uma notificação não punitiva são ingredientes essenciais para a melhoria contínua da cultura de segurança do doente.ABSTRACT
Introduction and purpose
The international organizations responsible for Quality in Health Care and Patient Safety (World Health Organization, European Union) recommend member states the assessment of safety culture as an essential condition to endorse changes in the professionals and healthcare organizations performance, and therefore achieve greater levels of quality and safety in healthcare provided to patients and citizens.
The aim of this study is to contribute to the implementation of patient safety culture in the professionals involved in healthcare, contributing to the patient safety culture assessment and therefore to guarantee the quality of care.
Methodology
Phase 1 - pre-study: through literature review we identified the most appropriate instrument to assess the hospital safety culture, translated and validated the instrument.
Phase 2 - develop a descriptive exploratory study, transversal, retrospective, in three Portuguese hospitals and an exploratory-descriptive, longitudinal, prospective, research-action in a radiotherapy unit.
Results
The Hospital Survey on Patient Safety Culture is an instrument that exposes the appropriate characteristics for the assessment of patient safety culture in Portuguese hospitals.
Regarding the assessment of safety culture in three Portuguese hospitals, we can highlight teamwork, the supervisor's expectations and organizational learning as the dimensions with better results despite the frequency of reports and non punitive response to error, obtained the worse results.
We found that the URT is in frank evolution, which becomes particularly visible in the compliance to the reporting system that increased as time went on. The involvement of all staff in the design of intervention and activities taking place in the unit, was foremost to improved patient safety.
Conclusions
We are aware that there are many unanswered questions and that in reality there are no formulas or guidelines that can declare that there are causal relations, confronting a particular action and the consequent cultural change. However, we believe that the involvement of all members of the organization/unit, a strong leadership commitment, effective communication and a non-punitive reporting are essential ingredients for a culture of continuous patient safety improvement
Going Beyond Counting First Authors in Author Co-citation Analysis
Get PDFThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
Variations on the Author
Get PDF“Variations on the Author” discusses two of Eduardo Coutinho’s recent films (Um Dia na Vida, from 2010, and Últimas Conversas, posthumously released in 2015) and their contribution to the general question of documentary authorship. The director’s filmography is characterized by a consistent yet self-effacing form of authorial self-inscription: Coutinho often features as an interviewer that rather than express opinions propels discourses; an interviewer that is good at listening. This mode of self-inscription characterizes him as an author who is not expressive but who is nonetheless markedly present on the screen. In Um Dia na Vida, however, Coutinho is completely absent form the image, while Últimas Conversas, on the contrary, includes a confessional prologue that moves the director from the margins to the center of his films. This article examines the ways in which these works stand out in the filmography of a director who offers new insights into the notion of cinematic authorship
Appropriate Similarity Measures for Author Cocitation Analysis
Get PDFWe provide a number of new insights into the methodological discussion about author cocitation analysis. We first argue that the use of the Pearson correlation for measuring the similarity between authors’ cocitation profiles is not very satisfactory. We then discuss what kind of similarity measures may be used as an alternative to the Pearson correlation. We consider three similarity measures in particular. One is the well-known cosine. The other two similarity measures have not been used before in the bibliometric literature. Finally, we show by means of an example that our findings have a high practical relevance.information science;Pearson correlation;cosine;similarity measure;author cocitation analysis
Dispelling the Myths Behind First-author Citation Counts
Get PDFWe conducted a full-scale evaluative citation analysis study of scholars in the XML research field to explore just how different from each other author rankings resulting from different citation counting methods actually are, and to demonstrate the capability of emerging data and tools on the Web in supporting more realistic citation counting methods. Our results contest some common arguments for the continued
use of first-author citation counts in the evaluation of scholars, such as high correlations between author rankings by first-author citation counts and other citation
counting methods, and high costs of using more realistic citation counting methods that are not well-supported by the ISI databases. It is argued that increasingly available digital full text research papers make it possible for citation analysis studies to go beyond what the ISI databases have directly supported and to employ more
sophisticated methods
koamabayili/VECTRON-author-checklist: VECTRON author checklist
No full textWe have done our best to complete the author checklist relating to the use of animals in the hut study. Note that the objective for the hut study was to evaluate the IRS treatment applications for residual efficacy against Anopheles mosquitoes, including the local An. coluzzii mosquito population. Cows were only used to attract mosquitoes into the huts and no tests were carried out directly on the cows. The author checklist is intended for use with studies where experiments are carried out on animals, which is why we have had such difficulty in completing this for the hut study, as many of the questions do not relate to how the cows were used
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