An investigation of dose calculation accuracy in intensity-modulated radiotherapy of sites in the head & neck

Knowledge of the accuracy of dose calculations in intensity-modulated radiotherapy of the head and neck is essential for clinical confidence in these highly conformal treatments. High dose gradients are frequently placed very close to critical structures, such as the spinal cord, and good coverage of complex shaped nodal target volumes is important for long term-local control. A phantom study is presented comparing the performance of standard clinical pencil-beam and collapsed-cone dose algorithms to Monte Carlo calculation and three-dimensional gel dosimetry measurement. All calculations and measurements are normalized to the median dose in the primary planning target volume, making this a purely relative study. The phantom simulates tissue, air and bone for a typical neck section and is treated using an inverse-planned 5-field IMRT treatment, similar in character to clinically used class solutions. Results indicate that the pencil-beam algorithm fails to correctly model the relative dose distribution surrounding the air cavity, leading to an overestimate of the target coverage. The collapsed-cone and Monte Carlo results are very similar, indicating that the clinical collapsed-cone algorithm is perfectly sufficient for routine clinical use. The gel measurement shows generally good agreement with the collapsed-cone and Monte Carlo calculated dose, particularly in the spinal cord dose and nodal target coverage, thus giving greater confidence in the use of this class solution.

Aboriginal community control and decolonizing health policy : a yarn from Australia

This chapter outlines: a brief history of Australian Aboriginal health and health policy and then moves on to demonstrate how the Victorian Aboriginal Community Controlled Health Organisation (VACCHO) undertakes its work and is an example of 'decolonizing policy in action'. Moreover, it highlights how Aboriginal participation in the development of policy and in the planning, delivery, management and evaluation of health programs enables policies and programs to respond effectively to the needs of Aboriginal people and to change future health outcomes for them. It showcases how Aboriginal decision-making has gone some way to decolonizing policymaking and has addressed the power imbalance - both of which have been critical in the improvement in Aboriginal health outcomes.

The use of economic evaluation in CAM : an introductory framework

Background For CAM to feature prominently in health care decision-making there is a need to expand the evidence-base and to further incorporate economic evaluation into research priorities. In a world of scarce health care resources and an emphasis on efficiency and clinical efficacy, CAM, as indeed do all other treatments, requires rigorous evaluation to be considered in budget decision-making. Methods Economic evaluation provides the tools to measure the costs and health consequences of CAM interventions and thereby inform decision making. This article offers CAM researchers an introductory framework for understanding, undertaking and disseminating economic evaluation. The types of economic evaluation available for the study of CAM are discussed, and decision modelling is introduced as a method for economic evaluation with much potential for use in CAM. Two types of decision models are introduced, decision trees and Markov models, along with a worked example of how each method is used to examine costs and health consequences. This is followed by a discussion of how this information is used by decision makers. Conclusions Undoubtedly, economic evaluation methods form an important part of health care decision making. Without formal training it can seem a daunting task to consider economic evaluation, however, multidisciplinary teams provide an opportunity for health economists, CAM practitioners and other interested researchers, to work together to further develop the economic evaluation of CAM.

Potential of St John's Wort for the treatment of depression : the economic perspective

The burden of rising health care expenditures has created a demand for information regarding the clinical and economic outcomes associated with complementary and alternative medicines. Meta-analyses of randomized controlled trials have found Hypericum perforatum preparations to be superior to placebo and similarly effective as standard antidepressants in the acute treatment of mild to moderate depression. A clear advantage over antidepressants has been demonstrated in terms of the reduced frequency of adverse effects and lower treatment withdrawal rates, low rates of side effects and good compliance, key variables affecting the cost-effectiveness of a given form of therapy. The most important risk associated with use is potential interactions with other drugs, but this may be mitigated by using extracts with low hyperforin content. As the indirect costs of depression are greater than five times direct treatment costs, given the rising cost of pharmaceutical antidepressants, the comparatively low cost of Hypericum perforatum extract makes it worthy of consideration in the economic evaluation of mild to moderate depression treatments.

The design environment

This chapter provides an overview of the Editor, which is the core modeling component of the YAWL system. Specifically, it shows how to specify control-flow, data and resourcing requirements in a YAWL workflow model. Moreover, it describes the error reporting capabilities of the Editor and the features of its interchange format.

Open source software for workflow management : the case of YAWL

"This column is distinguished from previous Impact columns in that it concerns the development tightrope between research and commercial take-up and the role of the LGPL in an open source workflow toolkit produced in a University environment. Many ubiquitous systems have followed this route, (Apache, BSD Unix, ...), and the lessons this Service Oriented Architecture produces cast yet more light on how software diffuses out to impact us all." Michiel van Genuchten and Les Hatton Workflow management systems support the design, execution and analysis of business processes. A workflow management system needs to guarantee that work is conducted at the right time, by the right person or software application, through the execution of a workflow process model. Traditionally, there has been a lack of broad support for a workflow modeling standard. Standardization efforts proposed by the Workflow Management Coalition in the late nineties suffered from limited support for routing constructs. In fact, as later demonstrated by the Workflow Patterns Initiative (www.workflowpatterns.com), a much wider range of constructs is required when modeling realistic workflows in practice. YAWL (Yet Another Workflow Language) is a workflow language that was developed to show that comprehensive support for the workflow patterns is achievable. Soon after its inception in 2002, a prototype system was built to demonstrate that it was possible to have a system support such a complex language. From that initial prototype, YAWL has grown into a fully-fledged, open source workflow management system and support environment

Goreen Narrkwarren Ngrn-tuora : healthy family air : a literature review

This paper will focus on the literature review for Goreen Narrkwarren Ngrn-toura- Healthy Family Air, formerly known as Reducing smoking amongst pregnant Aboriginal women in Victoria: An Holistic Approach. Before we outline the findings from the literature review, we will provide some background information on the project, including why it is important and what and who are involved.

Establishing Aboriginal health research priorities in Victoria

Short overview of the VACCHO Social Determinants Research Forum (2010).

The art of careful listening : children as co-artists in the making of live performance

Since 2007 Kite Arts Education Program (KITE), based at Queensland Performing Arts Centre (QPAC), has been engaged in delivering a series of theatre-based experiences for children in low socio-economic primary schools in Queensland. The twelve-week workshop experience culminates in a performance developed by the children with the assistance of the teacher artists from KITE for their community and parents/carers in a peak community cultural institution. Using Wartella’s notion of the socially competent child this analysis interrogates the performance product Precious, child participation modes, the intersection between the professional artists, teacher artists and child artists and outcomes in terms of building capacities for the development of social competencies in children.

Workflow support for scheduling in surgical care processes

Real-world business processes rely on the availability of scarce, shared resources, both human and non-human. Current workflow management systems support allocation of individual human resources to tasks but lack support for the full range of resource types used in practice, and the inevitable constraints on their availability and applicability. Based on past experience with resource-intensive workflow applications, we derive generic requirements for a workflow system which can use its knowledge of resource capabilities and availability to help create feasible task schedules. We then define the necessary architecture for implementing such a system and demonstrate its practicality through a proof-of-concept implementation. This work is presented in the context of a real-life surgical care process observed in a number of German hospitals.

Working up a smoking policy

This paper explains how the smoking policy at the Victorian Aboriginal Community Controlled Health Organisation (VACCHO) was developed as part of the Goreen Narrkwarren Ngrn-toura - Healthy Family Air project.

Performance analysis of business process models with advanced constructs

The importance of actively managing and analysing business processes is acknowledged more than ever in organisations nowadays. Business processes form an essential part of an organisation and their application areas are manifold. Most organisations keep records of various activities that have been carried out for auditing purposes, but they are rarely used for analysis purposes. This paper describes the design and implementation of a process analysis tool that replays, analyses and visualises a variety of performance metrics using a process definition and its corresponding execution logs. The replayer uses a YAWL process model example to demonstrate its capacity to support advanced language constructs.

Lessons learnt : complementing good clinical renal questions with an appropriate research strategy

The purpose of this article is to present lessons learnt by nurses when conducting research to encourage colleagues to ask good clinical research questions. This is accomplished by presenting a study designed to challenge current practice which included research flaws. The longstanding practice of weighing renal patients at 0600 hours and then again prior to receiving haemodialysis was examined. Nurses believed that performing the assessment twice, often within a few hours, was unnecessary and that patients were angry when woken to be weighed. An observational study with convenience sampling collected data from 46 individuals requiring haemodialysis, who were repeatedly sampled to provide 139 episodes of data. Although the research hypotheses were rejected, invaluable experience was gained, with research and clinical practice lessons learnt, along with surprising findings.