1,721,078 research outputs found
Rectal movement during neoadjuvant irradiation: introduction to the adaptive radiotherapy
No full textUvod: Tumorje rektuma glede na višino vznika razdelimo v tri podskupine: spodnja, srednja in zgornja tretjina rektuma. Pri bolnikih z rakom rektuma in pri bolnikih z drugimi malignomi v mali medenici vsakodnevne spremembe rektuma in polnjenosti sečnega mehurja pogosto povzročajo velike deformacije tarčnih volumnov, ki jih ni mogoče popraviti s prilagoditvijo obsevalne mize. Namen: Namen magistrskega dela je bil pridobiti celovit vpogled v gibanje rektuma v zgornji, srednji in spodnji tretjini med neoadjuvantnim obsevanjem pri bolnikih s karcinomom rektuma. Metode dela: V raziskavo smo vključili 50 predoperativno obsevanih bolnikov. Izvedbo raziskave smo razdelili na štiri poglavitne dele: pregled baze podatkov, vrisovanje anatomskih struktur na posnetke CBCT, zbiranje podatkov odstopanj in izpis podatkov, kjer smo ločeno izvajali poravnavo na kostne strukture – sakrum in poravnava na zadnjo rektalno steno. Na koncu je sledila še statistična analiza in obdelava podatkov. Rezultati: Analiza je pokazala, da so pri poravnavi na kostne strukture – sakrum statistično značilne razlike v posteriorni, levi in desni smeri, medtem ko sta pri poravnavi na zadnjo rektalno steno statistično značilne razlike v levi in desni smeri. Pri ugotavljanju razlik med poravnavo na kostne strukture – sakrum/zadnjo rektalno steno smo opazili, da so statistično značilno odstopale razlike v levi smeri in pri kostnih strukturah. Odstopanja so v zgornji, srednji in spodnji tretjini rektuma medsebojno različna. Največje odstopanje je bilo izraženo v zgornji, sledila je srednja in nato spodnja tretjina rektuma. Analiza premera rektuma po osi X in Y je pokazala, da je dnevna vrednost rektuma lahko večja ali manjša od referenčne vrednosti, kar nakazuje na dnevno nihanje v polnjenosti rektuma. Rezultati analize razlik med dnevnim in referenčnim volumnom rektuma in sečnega mehurja so pokazali, da je dnevni volumen rektuma v povprečju manjši od referenčnega volumna za 2 cm3, medtem ko je volumen sečnega mehurja v poprečju manjši za 10 cm3 od referenčnega volumna sečnega mehurja. Razprava in zaključek: Položaj rektuma v zgornji, srednji in spodnji tretjini se vsakodnevno spreminja pri poravnavi na kostne strukture – sakrum, kot tudi pri poravnavi na zadnjo rektalno steno.Introduction: Rectal tumors are divided into three subgroups according to the location or height of their origin: the lower, middle and upper third of the rectum. In patients with rectal cancer and in patients with other pelvic malignancies, daily variations in rectal and bladder volume often result in large deformations of target volumes that cannot be corrected by adjusting the radiation couch. Purpose: The aim of the Master\u27s thesis was to obtain a comprehensive insight into the movement of the rectum in the upper, middle and lower third during neoadjuvant irradiation in patients with rectal carcinoma. Methods: Fifty preoperatively irradiated patients were included in the study. The implementation of the research was divided into four main parts: database review, drawing of anatomical structures on CBCT images, data collection of deviations and data output, where alignment to bone structures – the sacrum and alignment to the posterior rectal wall were performed separately. The final stage included statistical analysis and data processing. Results: The analysis revealed that there are statistically significant differences in the posterior, left and right directions when aligning to the bone structures – sacrum, while when aligning to the posterior rectal wall there are statistically significant differences in the left and right directions. When determining the difference between the alignments to the bone structures – sacrum/posterior rectal wall, we noticed that there were statistically significant differences in the left direction and in the bone structures. Deviations were mutually different in the upper, middle and lower third of the rectum. The greatest deviation was expressed in the upper, followed by the middle and then the lower third of the rectum. The analysis of the diameter of the rectum along the X and Y axes showed that the daily value of the rectum can be greater or less than the reference value, which indicates a daily variation in the rectal filling. The results of the analysis of the variations between the daily and reference volumes of the rectum and urinary bladder showed that the daily rectal volume is, on average, smaller than the reference volume by 2 cm3, while the bladder volume, on average, is smaller than the reference bladder volume by 10 cm3. Discussion and conclusion: The position of the rectum in the upper, middle and lower thirds changes daily in alignment with the bone structures – sacrum, as well as in alignment with the posterior rectal wall
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
Dosimetric comparison of radiotherapy techniques for left-sided breast cancer after breast conserving surgery
Get PDFNajpogostejši neželeni učinki obsevanja so zgodnje spremembe na koži in v področju žleznega tkiva dojke, redkejši pa pozne reakcije na koži, pljučih ali srcu. Stopnja srčne okvare je s sodobnim načrtovanjem obsevanja sicer nizka, vendar je ob vse daljši pričakovani življenjski dobi in sočasni višji prevalenci raka dojk vse več žensk izpostavljenih morebitnim poznim posledicam zdravljenja. Srčna obolenja, pogosteje povzročena z dopolnilnim obsevanjem leve strani prsnega koša, postajajo eden izmed glavnih vzrokov smrti pri ozdravljenih bolnicah z rakom dojk.
Z raziskavo smo primerjali dozno-volumske parametre tarčnih volumnov in zdravih organov za tri različne obsevalne tehnike in želeli ugotoviti najbolj primerno tehniko za bolnice z različno velikimi obsevalnimi volumni. Za izbrane bolnice po operaciji zaradi raka leve dojke, smo primerjali tridimenzionalno konfromno obsevanje (3D-CRT), tangencialno obliko intenzitetne modulirane terapije (T-IMRT) in hibridno obliko, ki predstavlja kombinacijo tehnik 3D-CRT ter IMRT (H-IMRT). Dodatni cilj je bila poglobljena analiza dozno-volumskih parametrov srčnih votlin in koronarnih arterij. V analizo smo vključili 60 CT-posnetkov bolnic, ki so se med letoma 2014 in 2015 zdravile z obsevanjem po operaciji raka leve dojke. Na vsak set CT-slik smo vrisali kritične zdrave organe, vključno s posameznimi strukturami srca ter tarčne volumne. Analizirali smo 180 obsevalnih načrtov. CT-posnetke smo razvrstili v skupino z majhnim, srednjim in velikim kliničnim tarčnim volumnom (CTV).
V prvi skupini je srednja velikost CTV znašala 425,7 cm3, v drugi 867 cm3 in v tretji 1586,8 cm3. 95-odstotna pokritost načrtovalnega tarčnega volumna za oceno doze (PTVeval)je s tehnikama 3D-CRT in H-IMRT znašala 100 % in s T-IMRT v 88,3 %. Relativni deleži odvečne predpisane doze v načrtovalnem tarčnem volumnu PTVeval (V105–107 %) so bili najnižji s 3D-CRT, absolutni deleži pa s T-IMRT ali H-IMRT. Vrednosti indeksov konfomnosti, homogenosti ter konformacijskega števila so bile najbolj optimalne pri tehniki H-IMRT. Za celotno skupino obsevalnih načrtov smo potrdili prednost dozne razporeditve v strukturi koža za obe IMRT tehniki.
Izkazalo se je, da tehnika obsevanja pomembno vpliva tudi na povprečno absorbirano dozo srca (srce Dmean). Najnižje vrednosti smo beležili pri tehniki 3D-CRT, in sicer 1,9 Gy, sledila je T-IMRT z 2,3 Gy in kot najslabša se je izkazala H-IMRT s 3,1 Gy povprečne absorbirane doze srca (p < 0,0005). Nasprotno pa smo najnižje vrednosti visokodoznih območij za parametra srce (V35–40 Gy) ter za levo sprednjo koronarno arterijo (angl. left anterior descending coronary artery, LADCA) (V40 Gy) zabeležili prav pri tehniki H-IMRT. Naši rezultati nakazujejo, da so lahko razlike v povprečni absorbirani dozi srca ali levega prekata posledica uporabljene tehnike obsevanja ali pa telesne konstitucije bolnice. Tudi ob zelo nizki vrednosti srce Dmean (< 2,5 Gy) pa lahko posamezni srčni segmenti, predvsem srednji in distalni segment LADCA ter apikalni in sprednji predel levega prekata, prejmejo bistveno višje doze, celo 30–40 Gy. Pri analizi povprečne absorbirane doze priležnega pljučnega krila smo ugotovili, da najnižje srednje vrednosti dosegamo s tehniko 3D-CRT, in sicer 5,6 Gy, višje pri T-IMRT s 5,7 Gy in najvišje ponovno pri tehniki H-IMRT z 8,7 Gy (p = 0,012).
Obsevalna tehnika izbire za večino bolnic po ohranitveni operaciji zaradi raka leve dojke je 3D-CRT, saj smo z njo pri večini obsevalnih načrtov dosegli potrebne zahteve pri načrtovanju. Predvsem za bolnice s srednje velikimi tarčnimi volumni je optimalna tehnika izbire tudi T-IMRT. Za bolnice z izjemno velikimi ali kompleksneje oblikovanim tarčnimi volumni pa sta tehniki izbire 3D-CRT in izjemoma tudi H-IMRT. Pri bolnicah, pri katerih ugotovimo višjo absorbirano dozo na posamezne srčne segmente, pri mlajših bolnicah in pri tistih s pridruženimi dejavniki tveganja za okvaro srca, svetujemo skrbnejše sledenje morebitnih okvar na srcu.Breast cancer is typically treated with lumpectomy, where the tumor is removed with safety margins, followed by adjuvant radiotherapy. Combined treatment allows excellent local control rates and improves survival. In the past years, improvements in multimodal therapy have contributed to increased overall survival rates and prevalence. Most common acute radiotherapy side effects include radiodermatitis and reactions affecting breast tissue. The long-term sequelae of radiation treatment, affecting lung and heart, are rare, and cumulative incidences of cardiovascular diseases after breast radiotherapy are relatively low but must be considered in the context of global increases in the number of breast cancer survivors. Today, one of the biggest challenges in breast cancer adjuvant radiotherapy is to maintain at least the same rates of the locoregional control and at the same time limiting the incidential radiation to healthy normal tissues. Cardiovascular diseases are becoming the most critical competing mortality risk in women with early breast cancer treated with contemporary radiotherapy.
We aimed to compare target volume coverage and healthy tissue dose exposure, using three radiotherapy techniques to establish an optimal solution for women with different breast sizes. We compared three-dimensional conformal radiotherapy (3D-CRT), tangential intensity modulated radiotherapy (T-IMRT) and hybrid technique (H-IMRT) after left-sided breast cancer conserving surgery. Sixty patients treated at our institute between 2014 and 2015 were included. On every simulation CT set, we delineated target volumes and organs at risk, including cardiac substructures. Regarding the size of the clinical target volume (CTV), we separately investigated the group with small, medium and large target volumes. In total, 180 treatment plans were evaluated and analysed.
Median volumes of the CTV were 425.7 cm3, 867 cm3 and 1586.8 cm3 for the small, medium and large group, respectively. For all three analyzed techniques, we have demonstrated good coverage of the planning target volume for evaluation (PTVeval). The proportion of plans, meeting PTVeval V95%>95% objective was 100% (3D-CRT), 88.3% (T-IMRT) and 100% (H-IMRT). The lowest volumes of relative excessive PTVeval dose (V105–107 %) were generated with 3D-CRT, compared to the lowest absolute volumes, which were generated with T-IMRT or H-IMRT. Best plan quality indexes, such as conformity index, homogeneity index, and confirmation number were demonstrated with H-IMRT. The lowest excessive dose to the skin was achieved with both IMRT techniques.
Median heart mean (heart-Dmean) values were 1.9 Gy, 2.3 Gy and 3.1 Gy for 3D-CRT, T-IMRT and H-IMRT, respectively (p30–40 Gy. Higher radiation doses to segments may lead to a higher probability of cardiac injury. Ipsilateral lung dose was similarly reduced by 3D-CRT (5.6 Gy) as compared to T-IMRT (5.7 Gy) or H-IMRT (8.7 Gy) (p=0.012).
For breast cancer patients after conservative surgery with an average body habitus, 3D-CRT is the treatment of choice. T-IMRT is also an optimal technique for the group of patients with medium-sized CTV. 3D-CRT also seems viable technique for large target volumes CTV. With H-IMRT, it is possible to achieve the best target coverage in patients with largest and complexly shaped CTV
Evaluation of inter- and intrafraction movements prostatae carcinoma during radiation therapy
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Acute toxicity in anal canal radiotherapy with IMRT or VMAT radiation technique
No full textUvod: Rak analnega kanala je redko maligno obolenje. Temeljno zdravljenje je kombinacija radioterapije in kemoterapije. Kombinirano zdravljenje omogoča boljšo ozdravljivost bolnika, hkrati pa tudi večjo toksičnost z več neželenimi učinki, tako akutnimi kot kroničnimi. Z razvojem strojne in programske opreme v radioterapiji se uporabljajo vse naprednejše obsevale tehnike, ki omogočajo boljšo dozno porazdelitev v tumorju in manjšo obsevanost okolnih zdravih tkiv. Namen: Namen magistrskega dela je bil ugotoviti vrsto takojšnjih neželenih učinkov in njihovo pojavnost ter izraženost pri bolnikih z rakom analnega kanala, ki so zdravljeni z IMRT (intenzitetno modulirana radioterapija) ali VMAT (volumetrična ločna terapija) obsevalno tehniko in jih primerjati s starejšo 3D CRT (3- dimenzionalna konformna radioterapija) obliko zdravljenja. Metode dela: Izvedli smo retrospektivno raziskavo s pregledom medicinske dokumentacije iz kliničnega informacijskega sistema WebDoctor in ThinClinical. Pregledali in pridobili smo podatke za 93 bolnikov, ki so se v času od novembra 2012 do novembra 2019 radikalno zdravili na Onkološkem inštitutu v Ljubljani zaradi raka analnega kanala. Za statistično obdelavo podatkov smo uporabili osnovno frekvenčno statistiko porazdelitve podatkov akutne toksičnosti. Za oceno preživetja smo uporabili Kaplan-Maierjevo krivuljo preživetja. Izračunali smo Coxov regresijski model. Rezultati: Kompleten odgovor na zdravljenje je bil zabeležen pri 79,1 % bolnikov, pri 20,9 % bolnikih pa je bil potrjen ostanek oziroma ponovitev bolezni, najpogosteje na mestu vznika tumorja, sledijo oddaljeni zasevki in najredkeje ponovitev bolezni v področnih bezgavkah. Petletno PBPBLR (preživetje brez ponovitve bolezni lokoregionalno) znaša 83 %, petletno PBPB (preživetje brez ponovitve bolezni) pa 77 %. Novejšim obsevalnim tehnikam smo dokazali statistično značilen boljši izid zdravljenja (p=0,0026). Življenjsko ogrožajočih akutnih neželenih učinkov pri naših bolnikih nismo beležili. Kot resnejši neželeni učinek stopnje 3 je bil najpogosteje opisan radiodermatitis, kar pri 65,6 % bolnikov, sledi okužba pri 31,2 % bolnikov, radiomukozitis pri 7,7 % bolnikih in slabost z bruhanjem pri 1,1 % bolnikov. Ostali neželeni učinki so bili blažje izraženi. Pri primerjavi izraženosti neželenih učinkov zdravljenja med novejšimi in starejšimi tehnikami obsevanja ugotavljamo, da se le-ti z izjemo radiodermatitisa pojavljajo pri uporabi novejših obsevalnih tehnik v blažji obliki. Zaključek: Pri uporabi sodobnih, novejših obsevalnih tehnikah imajo bolniki blažje akutne neželene učinke zdravljenja, kar omogoča zdravljenje brez škodljivih prekinitev in posledično uspešnejše zdravljenje.Introduction: Anal cancer is a rare type of malignancy. Basic treatment is a combination of radiotherapy and chemotherapy. Combined therapy allows better healing of the patient, but also causes greater toxicity, with more side effects, acute as well as chronic. With the development of hardware and software in radiotherapy over the years, increasingly advanced irradiation techniques are being used that allow for a better dosage concentrated more on the tumor and less on the surrounding healthy tissue. Purpose: Our purpose was to determine the type of direct toxic effects and their incidence and severity in patients with anal cancer who were undergoing a treatment of IMRT (Intensity Modulated Radiotherapy) or VMAT (Volumetric Modulated Arc Therapy) radiation therapy and compare them with the results of the older 3D CRT (Three-Dimensional Conformal Radiation Therapy) type of treatment. Methods: We conducted a retrospective study, which included review of physical medical records as well as records from the clinical information system WebDoctor and ThinClinical for 93 patients with anal canal cancer who were undergoing a radiotherapy at the Oncology Institute in Ljubljana between November 2012 and November 2019. For statistical data processing, we used the basic frequency statistics for the distribution of acute toxicity and to asses survival rates we used the Kaplan-Meier survival curve. Also we calculated the Cox regression model. Results: Complete response to treatment was reported in 79.1% of patients, while in 20.9% of patients residual or recurrent disease was confirmed, most commonly at the site of tumor onset, followed by distant metastases and least commonly in regional lymph nodes. Locoregional relapse-free survival at five years is 83% and five-year disease-free survival is 77%. Modern radiation techniques demonstrated statistically significant improvements in treatment outcome (p=0,0026). No life-threatening acute side effects were reported in our patients. Grade 3 radiodermatitis was most commonly reported as a more serious adverse reaction in 65.6% of patients, followed by infection in 31.2% of patients, radiomucositis in 7.7% of patients, and nausea with vomiting in 1.1% of patients. Other side effects were milder. When comparing the severity of side effects of the newer and older irradiation techniques, we find that, with the exception of radiodermatitis, they occur in a milder form when using newer radiation techniques. Discussion and conclusion: When using modern, advanced radiation techniques, patients experience milder acute side effects of treatment, which allows for a treatment without detrimental interruptions and consequently more successful treatment
Importance of the introduction of stereotactic radiotherapy in pancreatic cancer
No full textUvod: Rak trebušne slinavke je bolezen, ki jo praviloma odkrijemo šele v napredovali obliki. Kakovost življenja bolnikov je zelo okrnjena, saj jih pogosto spremljajo številne težave. Stereotaktična radioterapija je ena izmed možnosti zdravljenja, ki se izvede v zelo kratkem časovnem obdobju. Kot samostojna metoda zdravljenja omogoča odlično lokalno kontrolo bolezni, ki je primerljiva operaciji, v sklopu predoperativnega zdravljenja pa omogoča večjo možnost popolne odstranitve tumorja ter na koncu zmanjša bolnikove težave, ter mu izboljša kvaliteto življenja. Namen: Namen magistrskega dela je predstaviti rak trebušne slinavke in zdravljenje s poudarkom na stereotaktični radioterapiji. Metode dela: Pri izdelavi magistrskega dela smo uporabili deskriptivno metodo in sistematični pregled literature. V namen pisanja uvoda, teoretičnih izhodišč in razprave smo uporabili 78 virov znanstvene literature, za sistematični pregled pa smo od skupno identificiranih 16536 virov, s pomočjo presejalne metode, obdržali 22 virov. Rezultati: Rezultati zajemajo potek izbire dokumentov za sistematični pregled in analizo 22 virov znanstvene literature, ki smo jih analizirali glede na namen, ugotovitve in morebitne zaznamke, ter še natančneje glede na število udeležencev, najpogostejšo skupno dozo, število frakcij, lokalno kontrolo tumorja v 1 letu, razred in delež akutne toksičnosti ter mediano preživetja. Razprava in zaključek: Pri mejno operabilnih bolnikih lahko stereotaktična radioterapija pripomore k zmanjšanju tumorja in zajetega žilja in omogoči popolno kirurško odstranitev bolezni. Pri lokalno napredovalih tumorjih, ki so neresektabilni, pa omogoči visoko stopnjo lokalne kontrole, ki je po uspešnosti primerljiva kirurški resekciji. Stereotaktična radioterapija je primerna pri ponovitvi raka trebušne slinavke po prehodni radikalni resekciji (z resekcijskim robom R0), ter za reiradiacijo po ponovitvi raka trebušne slinavke, ki je bil predhodno zdravljen s konvencionalno radioterapijo, saj ponuja tudi lajšanje težav, ki jih povzroča tumor. Sodeč po sistematičnem pregledu literature, lahko s stereotaktično radioterapijo raka trebušne slinavke dosežemo odlično enoletno lokalno kontrolo tumorja (73 %), ob zadovoljljivo nizki stopnji toksičnosti.Introduction: Pancreatic cancer is a disease that is usually discovered at an advanced stage. The patients\u27 quality of life is greatly reduced, as they are often accompanied by problems. Stereotactic radiotherapy is one of the treatment options that is performed in a very short period of time. As an independent method of treatment, it provides excellent local control of the disease, which is comparable to surgery, and as a part of preoperative treatment, it provides a greater chance of complete removal of the tumor and ultimately reduces the patient\u27s problems and improves his quality of life. Purpose: The purpose of the master\u27s thesis is to present pancreatic cancer and its treatment with an emphasis on stereotactic radiotherapy. Methods: We used a descriptive method and systematic review of literature in the preparation of the master\u27s thesis. For the purpose of writing the introduction, theoretical starting points and discussion, we used 78 sources of scientific literature, for the systematic review, we retained 22 sources, of total of 16536 identified sources, using the screening method. Results: The results include a document selection process for a systematic review and analysis of 22 sources of scientific literature, which we analyzed according to the purpose, findings and possible comments, and more specifically the number of participants, the most common total dose, the number of fractions, local control within 1 year, grade and proportion of acute toxicity and median survival. Discussion and conclusion: In borderline resectable patients, stereotactic radiotherapy can help to shrink the tumor and the involved vessel and enable complete surgical removal of the disease. In locally advanced tumors, that are unresectable, however, it enables a high level of local control, which is comparable in success to surgical resection. Steterotactic radiotherapy is suitable for pancreatic cancer recurrence after transitional radical resection (with an R0 resection margin) and for reirradiation after pancreatic cancer recurrence previously treated with conventional radiotherapy, as it also offers relief of problems, caused by tumour. Judging from a systematic review of literature, stereotactic radiotherpy for pancreatic cancer can achieve excellent one-year local control (73%) with a satisfactorily low level of toxicity
Patient satisfaction at teleradiotherapeutic (TRT) department of the Institut of Oncology Ljubljana
Get PDFUvod: V zdravstvenih organizacijah, usmerjenih k bolniku, je zadovoljstvo bolnikov ključno pri načrtovanju, izvajanju in ocenjevanju opravljanja storitev. Raziskave o zadovoljstvu bolnikov so osebju v zdravstvenih organizacijah v pomoč pri odkrivanju organizacijskih problemov in pomanjkljivosti pri zdravstveni oskrbi bolnika, ugotavljanju izobraževalnih potreb osebja ter nagrajevanju in krepitvi delovne motivacije osebja.
Namen: Namen magistrskega dela je ugotoviti, kakšno je zadovoljstvo bolnikov na teleradioterapevtskem oddelku (TRT) na Onkološkem inštitutu Ljubljana (OIL). Ugotavljali smo, kako bolniki ocenjujejo različne poklicne profile (receptorke, medicinske sestre, radiološke inženirje, zdravnike radioterapevte onkologe) in zdravstveno oskrbo.
Metode dela: Empirični del magistrskega dela obsega kvantitativno metodo in zbiranje podatkov z anketnim vprašalnikom, ki vsebuje Likertovo 5-stopenjsko lestvico zadovoljstva. Enodnevna presečna raziskava se je izvajala 3.11.2015 na TRT oddelku. Vključili smo vse tisti dan obsevane bolnike, ne glede na namen zdravljenja, stadij bolezni, režim obsevanja, starostno ali izobrazbeno strukturo, itd., anketne vprašalnike je rešilo 282 bolnikov od predvidenih 359 bolnikov (78,6 %).
Rezultati in razprava: Bolniki so v povprečju podajali visoke ocene zadovoljstva (nad stopnjo 4 – zadovoljen) pri vseh navedenih dejavnikih delovanja OIL. Na zadovoljstvo bolnikov v veliki meri vpliva zaznana kakovost dela radioloških inženirjev (β = 0,489, p < 0,05), če primerjamo zgolj vidike dela radioloških inženirjev. Ko so v modelu linearne regresije pridruženi vsi preučevani dejavniki, rezultati kažejo, da na zadovoljstvo bolnikov z delovanjem celotnega OIL v največji meri vplivajo delo radioloških inženirjev (β = 0,436 , p < 0,05), delo medicinskih sester (β = 0,384, p < 0,01), ter prijaznost zdravnikov (β = 0,572, p < 0,01).
Zaključek: Zadovoljstvo bolnikov se ustvari s kombinacijo odzivnosti bolnikovih pogledov in potreb ter nenehnimi izboljšavami zdravstvenih storitev, pa tudi nenehnimi izboljšavami odnosov med zdravstvenim osebjem in bolniki.Introduction: Patient satisfaction is of key importance for planning, performing and assessing the services of patient-directed health organisations. Researches on patient satisfaction are used to discover organisational problems and patient health care deficiencies, educational needs of the staff and to enhance work motivation of the staff.
Purpose: The purpose of this master thesis is to discover the amount of patient satisfaction in Department for teleradiotherapy at Institute of Oncology Ljubljana. The aim was to learn how patients assess different professions (receptionists, nurses, radiotherapists, radiation oncologists) and how satisfied they are with the staff and health care.
Methods: The empirical part of this thesis consists of a quantitive method and questionnaire method of data collection, which includes Likert’s 5 point scale of satisfaction. Cross sectional survey was performed on November 3, 2015 in the Department for teleradiotherapy. It included patients who were irradiated that day regardless of the stage of disease, radiation regime, age or education etc. 282 of 359 patients were questioned which is 78,6 %.
Results and discussion: On average, patients highly agreed (above level 4 – satisfied) with all questioned factors of performance of Institute of Oncology. The study shows that patients’ satisfaction highly depends on the work of radiotherapists (β = 0,489, p < 0,05) when work aspects of radiotherapists only are compared. When other factors are considered in the linear regression, the results show that patients’ satisfaction highly depends on the work of radiotherapists (β = 0,436 , p < 0,05), the work of nurses (β = 0,384, p < 0,01), and kindness of doctors (β = 0,572, p < 0,01).
Conclusion: Patients’ satisfaction is created with the combination of patients’ need and constant health care improvements, and also constant improvements of doctor – patient relations
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
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