206 research outputs found
Esiselvitys säteilylaissa tarkoitettujen lähettämissuositusten kehittämistä varten : Työryhmän loppuraportti sosiaali- ja terveysministeriölle
No full textTässä esiselvityksessä tehtyjen lääkäreille ja hammaslääkäreille suunnattujen kyselytutkimusten perusteella Suomeen tarvitaan terveydenhuollon tietojärjestelmiin ja sähköisiin lähetejärjestelmiin integroitu lähettämissuositus, joka sisältää myös päätöksenteon tuen. Kansallisen lähettämissuosituksen valmistelemiseksi, käyttöönottamiseksi ja ylläpitämiseksi tarvitaan moniammatillista yhteistyötä, johon osallistuvat useat tahot päättäjistä loppukäyttäjiin.
Esiselvityksessä perehdyttiin käytettävissä oleviin eurooppalaisiin lähettämissuosituksiin. Lisäksi vertailtiin eri lähettämissuositusten ominaisuuksia ja arvioituja kustannuksia ja hyötyjä. Vertailussa oli mukana mahdollinen itse kehitettävä järjestelmä.
Esiselvityksen perusteella lähettämissuosituksen valmisteluun ja käyttöönottoon tarvittaisiin ensin pilotointihanke. Tämä kannattaisi tehdä vastaavasti kuin muiden terveydenhuollon järjestelmien kehitystyö, esimerkiksi THL:n koordinoimana hankkeena. Pilotissa luotaisiin tai suomennettaisiin ohjeisto, joka linkitettäisiin käytössä olevaan tutkimuskoodistoon (Radiologisten tutkimusten ja toimenpiteiden nimikkeistö, Kuntaliitto). Lisäksi kehitettäisiin järjestelmä tai testattaisiin olemassa olevaa, hankittavaa järjestelmää tekniseltä kannalta. Järjestelmän laajempana tavoitteena on tukea terveydenhuollon kliinistä toiminnanohjausta sekä vaikuttavuuden mittausta.
Lähettämissuosituksen tekeminen ja ylläpitäminen vaatii paljon resursseja. Suosituksen tekeminen alkaa kirjallisuuteen perehtymisellä. Asiantuntijatyöryhmän yksimielisen kannan jälkeen tehdään laaja konsultaatio. Jos lähettämissuositus toteutetaan siten, että hankitaan valmis ohjelmisto, sen kustannuksista pääosa koostuu käyttömaksuista. Jos taas lähettämissuositus kehitetään itse ulkomaisten suositusten pohjalta, lähettämissuosituksen hankintahinta on suurehko, mutta käyttökustannukset ovat kohtuulliset. Tämän esiselvityksen perusteella molemmat vaihtoehdot ovat elinkaarikustannuksiltaan yhdenvertaiset, mutta itse kehitettävän järjestelmän riskit ovat suuremmat, erityisesti tarvittavien asiantuntijaresurssien osalta
Robert Bly
No full textRobert Bly visited The College at Brockport in March 1970, December 1971, and April 1974. He is a poet, author, and activist known for Iron John: A Book About Men (1990).Archived web contentSUNY BrockportWriters Forum Author Photo
Patient safety in external beam radiotherapy, results of the ACCIRAD project: Current status of proactive risk assessment, reactive analysis of events, and reporting and learning systems in Europe
No full textTo describe the current status of implementation of European directives for risk management in radiotherapy and to assess variability in risk management in the following areas: 1) in-country regulatory framework; 2) proactive risk assessment; (3) reactive analysis of events; and (4) reporting and learning systems
Robert Bly
No full textRobert Bly visited The College at Brockport in March 1970, December 1971, and April 1974. He is a poet, author, and activist known for Iron John: A Book About Men (1990).https://digitalcommons.brockport.edu/writers_photos/1005/thumbnail.jp
Robert Bly and the Twofold Consciousness
No full textHow beautiful to walk out at midnight in the moonlight/ dreaming of animals. It is samplings of Robert Bly\u27s poetry such as these which have prompted Eliot Weinberger to wonder, What kind of windbag and language slob would write such a line? But there are also such fine and startling images as The bare trees more dignified than ever or lamplight that falls on all fours in the grass, which Ian Hamilton admires. Hayden Carruth has encapsulated the view of many of Bly\u27s readers, who regard him as one of the most annoying and exciting poets of the 1960\u27s and 1970\u27s. Paul Ramsey has seen him as a political crank who invents wantonly cruel lies in the process of charging the government with cruelty and lies. William Heyen believes he is a Romantic in the Yeats strain, his Silence in the Snowy Fields comparable to a cluster of gnats. This converts Heyen unwillingly to praise of Bly\u27s poems: It will be impossible for me to discuss my change of mind rationally, but I\u27ve come to believe that my reservations about Bly were only nigglings, that measuring the accomplishment of his work against petty objections is something like dismissing Moby Dick because Melville loses track of his point of view. Bly is free from the inhibitions of critical dictates many of us have regarded as truths. These are not the voices of critics talking in their usual calm, confident tones about the tenor of an author \u27s work. Who is the poet Robert Bly who so influenced a generation of readers among which he was widely read and whose work has been the source of so much vexation and praise by critics and readers alike? He is a 58 year old Madison, Minnesota, farmer\u27s son. Bly was the second son his brother James was one and a half years older. Their mother, Alice Aws Bly, worked at the courthouse in Madison for many years, and the Bly children were cared for by Marie Schmidt. In addition, a hired farm hand named Art Nelson lived with the Bly’s for nine years. Bly described his father, Jacob, as a man who was both a reader and a farmer. Later it was Robert who became the reader of books and his brother James who became the farmer
Patient safety in external beam radiotherapy - Guidelines on risk assessment and analysis of adverse error-events and near misses: Introducing the ACCIRAD project
No full textIn 2011 the European Commission launched a tender to develop guidelines for risk analysis of accidental and unintended exposures in external beam radiotherapy. This tender was awarded to a consortium of 6 institutions, including the ESTRO, in late 2011. The project, denominated "ACCIRAD", recently finished the data collection phase. Data were collected by surveys administered in 38 European countries. Results indicate non-uniform implementation of event registration and classification, as well as incomplete or zero implementation of risk assessment and events analysis. Based on the survey results and analysis thereof, project leaders are currently drafting proposed guidelines entitled "Guidelines for patient safety in external beam radiotherapy - Guidelines on risk assessment and analysis of adverse-error events and near misses". The present article describes the aims and current status of the project, including results of the surveys
Radiation protection issues in radionuclide therapy – workers (medical staff), third persons, waste management
No full textRadionuclide therapies for treatment of diseases is common practice worldwide, while new radionuclides create new challenges for radiation protection. Many guidelines are still applicable for implementing dose constraints, using appropriate calibrated instruments for dose rate and contaminations measurements and following good practices of waste management. Special caution and considerations are needed to prevent annual dose limits to be exceeded in some situations with new radionuclide therapies. In fractionated therapies, dose constraints should be set considering anticipated repetition of the treatment. In handling of alpha emitters all contamination pathways need to be considered and training of workers is essential both to prevent contamination and to detect and measure contaminations. Waste management is an issue if there are radionuclides of long half-lives considering also possible impurities. In case there is a need for cremation after a radionuclide therapy with alpha emitters, it may be necessary to wait even several months prior to cremation
Patient exposure levels and collective effective dose to the population from radiological examinations - changes from 2008 to 2018 in Finland
No full textMedical exposures from x-rays and nuclear medicine (NM) have been the largest man-made source of population exposure to ionizing radiation in developed countries for many years. A collective effective dose can be assessed by summarizing effective doses from all radiological examinations together. The collective effective dose is the product of the mean effective dose in a group and the number of individuals in that group. The most common method to assess effective doses per radiological examinations is to use application specific measurable quantities that are multiplied by predefined effective dose conversion factors. Frequencies of radiological examinations can be surveyed by questionnaires.
In Finland the total collective effective dose from x-ray and NM procedures has increased 59% in 2008–2018, mainly due to the increase of collective effective doses from computed tomography (CT) and interventional radiology. The collective effective dose from NM examinations has slightly increased and its relative proportion is only 5% of the total collective dose from radiological examinations.
About 70% of the collective effective dose from x-ray examinations was caused by CT in 2018, while the proportion of CT procedures was only 17%. CT procedures are the major and increasing source of collective effective dose from x-ray procedures. While the use of new tissue weighting factors (ICRP 103) increases the population dose from plain radiography, it has minimal effect on the population dose from CT examinations.
There was a large amount of variation in the exposure levels and exposure parameters used for radiotherapy simulations. Patient exposure levels were generally much higher than those used for diagnostics. Exposure parameters should be reviewed and optimized together with the exposure level also for radiotherapy CT simulations.
Effective doses per radiological examinations can be used to compare medical exposures from different methodologies or between different units or hospitals. Per caput doses can be compared between countries. In comparison with 36 European countries is was shown that frequencies of both x-ray and NM examinations in Finland were less than in average in Europe. This indicates that the level of justification in Finland is at least at the average European level. The comparison of per caput effective doses showed that the dose in Finland was on the lowest quarter among European countries. Despite of the increased collective effective dose from x-ray and NM examinations the overall per caput effective
dose in Finland in 2018 was still well below the average of European countries in 2008 and only a third of the per caput effective dose in USA in 2016. This indicates that both justification and optimization of examinations in Finland is at a good European level
Radiation safety of current European practices of therapeutic nuclear medicine : survey results from 20 HERCA countries
No full textThe purpose of this study was to acquire up-to-date information on nuclear medicine treatments in Europe and on the implementation of the requirements of the Basic Safety Standards Directive in HERCA Heads of the European Radiological Protection Competent Authorities (HERCAs) member states. An electronic survey was distributed to competent authorities of 32 HERCA member states. The questionnaire addressed 33 explicitly considered treatments using 13 different radionuclides, and for each treatment, a similar set of questions was included. Questions covered the use of treatments, hospitalisation of patients and radioactive waste management related to therapeutic nuclear medicine involving other radionuclides than the well-known 131I. The survey also covered justification of treatments, individual treatment planning, involvement of a medical physics expert (MPE) and radiation protection instructions given to the patient at the time of release. Responses were obtained from 20 HERCA countries. All of these countries used Na[131I]I for benign thyroid diseases and thyroid ablation of adults. 223RaCl2 (Xofigo®) for bone metastases, 177Lu-somatostatin analogues for neuroendocrine tumours and 177Lu-labelled PSMA for castration resistant prostate cancer (PC) and PC-metastases were used in 90%, 65% and 55% of countries, respectively. Only a few countries had specific criteria for hospitalisation and waste management for new therapeutic nuclear medicine. Regulatory requirements for justification of new therapeutic nuclear medicine were in place in almost all countries. Individual treatment planning was required for all therapies in 55% and for some therapies in 28% of the responding countries. Implementation of the requirement for MPEs to be closely involved in nuclear medicine practices varied to a great extend among countries. Almost all responding countries answered that some radiation protection instructions existed for patients released after treatment with radionuclides other than 131I treatment, however only few countries had developed specific guidelines in the field
Nelly Bly
No full textA man sings about his wife adn their home.https://egrove.olemiss.edu/kgbsides_uk/1761/thumbnail.jp
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