Design and characterization of a prototype tertiary device for proton beam stereotactic radiosurgery.

Though potentially beneficial, proton beam stereotactic radiosurgery has not been adopted widely secondary to the technical challenge of safely delivering multiple focused beams of proton radiation. In this study, we describe the design and characterization of a proton beam stereotactic radiosurgery system that can be adopted by existing passive scattering systems. This system utilizes a helmet-like device in which patient-specific brass apertures required for final beam collimation are positioned on a scaffold that is separate from the treatment gantry. The proton snout is then fitted with a generic aperture to focus the primary proton beam onto the patient specific apertures that are in the helmet-like device. The patient-specific apertures can all be placed at the start of the treatment, thus treatment with multiple beams can be accomplished without the delay of switching the apertures. In this report we describe a prototype design of this collimation system and dosimetric testing to verify efficacy. Subsequently, we describe a custom 3D printing of a prototype device and report on overall localization accuracy using Winston-Lutz tests. Our results show that it is possible to develop an add-on device for proton beam radiosurgery that is safe and efficient and capable of wide adoption on existing proton delivery systems.

Proton vs Hyperarc™ radiosurgery: A planning comparison.

For many patients, stereotactic radiosurgery (SRS) offers a minimally invasive, curative option when surgical techniques are not possible. To date, the literature supporting the efficacy and safety of SRS treatment techniques uses photon beams. However, with the number of proton therapy facilities exponentially growing and the favorable physical properties of proton beam radiation therapy, there is an opportunity to develop proton therapy techniques for SRS. The goal of this paper is to determine the ability of clinical proton treatment planning systems to model small field dosimetry accurately and to compare various planning metrics used to evaluate photon SRS to determine the optimum beam configurations and settings for proton SRS (PSRS) treatment plans. Once established, these plan settings were used to perform a planning comparison on a variety of different SRS cases and compare SRS metrics between the PSRS plans and HyperArc™ (VMAT) SRS plans.

The competences postulated as requirements for occupational medicine training in Europe as viewed by Polish specialists.

A questionnaire has been developed and disseminated in several European countries to determine common key competences required of occupational medicine specialists. The questionnaire contained 115 subjects relating to eight fields of activity of an occupational medicine physician (occupational hazards to health, assessment of disability and fitness for work, communications, research methods, management, environmental medicine, occupational health law and ethics, and health promotion). Items in each part were classified into three categories: knowledge, skills and experience. For each of the subjects respondents were asked to allocate a score from 0 (not necessary) to 5 (most important or essential). In Poland the questionnaire was distributed among two groups of specialists: (1) chief administrators of occupational health services, and (2) relatively young occupational medicine physicians attending a specialist training. A comprehensive analysis of the completed questionnaires had three dimensions: (a) substantive (classification of the importance of particular key competences, as perceived by Polish specialists in occupational medicine); (b) personal (differences in opinions among occupational medicine physicians and an attempt to explain these differences in sociological terms); and (c) comparative (evaluation and interpretation of similarities and differences between two groups).

[Assurance and assessment of education quality in occupational hygiene in the United Kingdom, United States and Canada]. / Zapewnianie i ocena jakosci ksztalcenia w dziedzinie higieny pracy w Wielkiej Brytanii, USA i Kanadzie.

There is an urgent need to develop and formally recognise the profession of occupational and environmental hygienist in Poland. A high quality of specialist training in occupational hygiene is a prerequisite for any successful action aimed at accomplishing this goal. Assurance and assessment of education quality in this domain is inseparably associated with the problem of accreditation and certification. The first difficulty lies in a limited number of patterns or points of reference, such as systems of accreditation and certification in the area of occupational hygiene that already function. Insufficient dissemination of knowledge of the systems which already exist and function properly is another difficulty. Based on the Anglo-Saxon literature dealing with this subject, the author tries to bridge this gap.

Self-assessment of the competences in occupational medicine as an instrument for improving postgraduate training.

The main goal of the postgraduate training in occupational medicine is to make already experienced students develop appropriate competences to deal with health problems existing and emerging in the realities of different spheres of occupational health. The task requires checking on and evaluation of the students' learning process and its results. Thirteen types of competence transmitted to the students were made the points of reference in a special self-assessment questionnaire. The respondents were asked to assess the contribution of particular lectures and seminars to the acquirement or improvement of each type of competence. The results obtained in a group of students suggest that some modifications and improvements in the educational objectives and programmes should be introduced.

[The efficacy of postgraduate occupational health education: tools and results]. / Ocena skutecznosci ksztalcenia podyplomowego w zakresie medycyny pracy. Narzedzia i rezultaty.

One of the most important aspects of the education quality assessment is to measure the efficacy of the educational process. A number of measurement tools may serve this purpose, for example forms to be completed after concluding training or postgraduate studies used to assess the educational process and for self-assessment of the competencies acquired. In the study presented, students who were completing their basic course in occupational medicine were asked to assess whether, and to what extent the completed course at large, and its individual components, contributed to acquiring (adjusting or expanding) various kinds of their competencies (knowledge, skills, etc.). The results obtained suggest the need for certain modifications in the curricula, and/or in the set of educational goals.

[Assurance and assessment of quality education in occupational medicine in selected countries of western Europe and in the United States. 1. Western Europe]. / Zapewnianie i ocena jakosci ksztalcenia w dziedzinie medycyny pracy w wybranych krajach Europy Zachodniej i w USA I. Europa Zachodnia.

The author discusses the studies undertaken with the general aim to provide education in occupational medicine and assure and assess its quality in some countries of Western Europe advanced more than Poland in this area. It becomes quite evident that despite a widespread interest in quality of education, there is a lack of basic systemic solutions. A gap between basic theoretical and methodological guidelines and a large number of dispersed reports on concrete analytical and evaluation studies can be still observed. In addition to the presentation of an inside view of research activities carried out in some countries of Western Europe and the United States, based on selected professional publications, the author formulates general conclusions on how the assurance and quality assessment of education in occupational medicine function in those countries.

[Assurance and assessment of education quality in occupational medicine of selected countries of Western Europe and the United States. II. USA]. / Zapewnianie i ocena jakosci ksztalcenia w dziedzinie medycyny pracy w wybranych krajach Europy Zachodniej i w USA. Czesc II. USA.

The author discusses the studies undertaken with the general aim to provide education in occupational medicine and assure its quality assessment in some countries of Western Europe advanced more than Poland in this area. It becomes quite evident that despite a widespread interest in quality of education, there is a lack of basic systemic solutions, and a gap between basic theoretical and methodological guidelines and a large number of dispersed reports on concrete analytical and evaluation studies can be still observed. In addition to the presentation of an inside view of research activities carried out in some countries of Western Europe and the United States, based on selected professional publications, the author formulates general conclusions on how the assurance and quality assessment of education in occupational medicine function in those countries.

Occupational health education in Poland: new needs, new requirements, new programmes.

The conditions of modern work environment in Poland generate new problems, new needs and new expectations in the area of occupational health. They are associated not only with the rapidly changing technologies and new professions but also with the psychosocial factors pertaining to extensive transformations of the political and economic systems. New needs and expectations determine a new approach: firstly, to the responsibilities of the occupational health specialists; secondly, to the organisation and management of the workers health care; and thirdly, to the general principles of the occupational health, including in particular relevant legislation. The new requirements concerning the operation of the occupational health system in all the three dimensions must be addressed in the design of the new training programmes in occupational health whether under- or postgraduate. Subjects to updating and modification should be not only the content of the training but also its forms and methodology. Competence-based learning should be accompanied by the modern methods of problem solving, distant learning, organised self-education and self-assessment. The growing interest in the quality of the training should be expressed, first of all, in the activities aiming at the development of procedures to assess the effectiveness of the training. It seems also necessary to adopt the active learning approach intensifying acquisition and verification of the knowledge and skills. This approach would also lead to deeper changes in the students' mentality and behaviour, e.g. to make them able to estimate their own and others' level of professional competence or shape the personal system of professional values under the conditions of the free-market economy in the health care which entails quality requirements for the services and the competition among its providers.

Self-assessment of competence in public health management as a measure of effectiveness of postgraduate training.

The main goal of the postgraduate training in public health is to make already experienced students develop appropriate competence to deal with health problems existing and emerging within different spheres of social reality. The task involves the checking on and evaluation of the students' learning process and the didactic qualifications of teaching personnel. A serious problem is posed here by the specificity of the postgraduate training in the course of which new competences have to be transmitted in the context of competence already possessed, which should be also improved refreshed, revised etc. Moreover, the influence of the experience and attitude components is here stronger than in the case of undergraduate studies. All these need to be reflected in the curricula, teaching methods, and assessment procedures. In the introductory part of the paper the authors discuss briefly an approach to and the adopted definition of professional competence. The body is devoted to the assessment of competence acquired and the methods applied after a 2-year postgraduate studies for public health managers. Seventeen types of competence transmitted to the students were made the points of reference in a special self-assessment questionnaire. The respondents were asked to assess the contribution of particular courses to the acquisition or improvement of each type of competence. The results obtained in a group of students suggest that some modifications and improvements in the educational objectives and programmes should be introduced.

Requirements for occupational medicine training in Europe postulated by Polish professionals.

In order to determine common key competences required for occupational medicine specialists across Europe, a questionnaire has been developed and disseminated in several European countries. The questionnaire contained 115 subjects relating to eight fields of activity of an occupational medicine physician (occupational hazards to health, assessment of disability and fitness for work, communications, research methods, management, environmental medicine, occupational health law and ethics, and health promotion). Items in each part were classified into three categories: knowledge, experience and skills. For each of the subjects respondents were asked to allocate a score from 0 to 5, where 0 = not necessary, 1 = of minimal importance and 5 = most important or essential. In Poland the questionnaire was distributed between two groups of specialists: group I--chief administrators of occupational health services, and group II--relatively younger occupational medicine physicians participating in a specialist training. A comprehensive analysis of the completed questionnaires had three dimensions: (a) substantive (classification of the importance of particular key competences, as perceived by Polish specialists in occupational medicine), (b) personal (differences in opinions among occupational medicine physicians and an attempt to explain these differences in sociological terms), (c) comparative (evaluation and interpretation of similarities and differences between two groups). A hierarchy of requirements for occupational medicine training in Poland was constructed, with one set of competences recognized by the respondents as needless and others as useful with different grade of importance. Surprisingly, a wide diversity of opinions among respondents has given rise to the explanation hypotheses, some of them being verified using the material gathered.

[Attitudes of Polish occupational medicine physicians towards a proposal of requirements for occupational medicine training in Europe]. / Postawy polskich lekarzy medycyny pracy wobec europejskiego projektu wymagan szkoleniowych w tej dziedzinie.

In order to determine key competences required of occupational medicine specialists, common throughout Europe, a questionnaire has been developed and distributed among several European countries. The questionnaire contained 115 subjects related to 8 fields of activities carried out by occupational medicine physicians (occupational hazards to health, assessment of disability and fitness for work, communications, research methods, management, environmental medicine, occupational health law and ethics, and health promotion). In each of these fields, competences were classified into three following categories: knowledge, experience and skills. Respondents were asked to allocate a score from 0 to 5 for each subject, where 0 = not necessary; 1 = of minimum importance, and 5 = most important or essential. In Poland the questionnaire was distributed among two groups of specialists: group I--experienced specialists in occupational medicine (leading representatives of occupational health care management), and group II--relatively younger and less experienced occupational medicine physicians, participating in the specialist training, organised by The Nofer Institute of Occupational Medicine. A comprehensive analysis of the completed questionnaires was carried out in two dimensions: substantive (the importance of individual competences as perceived by Polish specialists in occupational medicine), and comparative (evaluation and interpretation of similarities and differences between two groups of respondents). A hierarchy of requirements, occupational medicine training in Poland is to satisfy, was reconstructed with two sets of competences, one recognised by respondents as needless and the other recognised as useful with different grades of importance. Some characteristic differences in opinions between two groups studies were highlighted.

[Analysis of education processes in areas of public health and occupational medicine. Introductory premises and hypotheses]. / Analiza procesów ksztalcenia w zakresie medycyny pracy i ochrony zdrowia pracujacych. Wstepne zalozenia i hipotezy.

In the first section of the work the premise encouraging the analysis of educational systems in the areas of public health and occupational medicine is presented. There is an urgent need for the education of highly personnel in these two fields, and the adhering of educational systems to the current needs requires an in-depth historical and sociological analyses as well as the evaluation and comparative studies. The model analysis and the research hypothesis are subject of the two other sections.

[Evaluation of training quality in the field of occupational medicine. Methodologic principles and a perspective of assessment tool development]. / Ocena jakosci ksztalcenia w zakresie medycyny pracy. Zalozenia metodologiczne i perspektywa opracowania narzedzi.

Bearing in mind a growing interest in the quality of educational processes the authors stressed the need for addressing this issue in the field of occupational medicine. They discussed major principles of the internal system of quality assessment and the possibility of adopting two instruments for evaluating (controling) the quality of teaching and learning: a questionnaire for self-assessment of acquired/transmitted competences and a test for assessing the progress in acquiring knowledge and skills necessary to solve problems.

[On the need for analysis of the occupational health education system]. / O potrzebie analizy systemu ksztalcenia w dziedzinie medycyny pracy.

The paper includes conceptual premises on which the analysis of the occupational health education system is based as well as the outcome of an attempt to perform a comparative study in this area. The authors present some of the features which characterize the education system designed for occupational health physicians. A comparative approach adopted in the analysis (Poland vs some other countries) seems to be the simplest and the most effective way to draw appropriate conclusions. The analysis covered both undergraduate and postgraduate studies, including specialisation in the area of occupational health. Finally, the work highlights theoretical and methodological aspects of further analyses.

[Certain behavior and attitudes of workers associated with dental care provided in the workplace]. / Niektóre zachowania i postawy pracowników zwiazane z funkcjonowaniem opieki stomatologicznej w miejscu pracy.

Dental care at places of employment was assessed under the Polish edition of the International Collaborating Studies of Oral Health Outcomes. The study was focused particularly on the use of primary conservative dental care (accessibility of dental care in polyclinics provided by institutions), reasons why workers are not willing to see dentists in their polyclinics as well as the judgement of the quality of primary dental care (the degree to which this kind of care is available for and approved by workers, the extent of positive judgements of primary conservative dental care). The analysis indicated rather strong disapproval of dental care rendered by polyclinics with view to ill-functioning of polyclinics rather than to their existence.

[Professional consciousness of dentists in occupational health care]. / Swiadomosc zawodowa lekarzy stomatologów pracujacych w przemyslowej sluzbie zdrowia.

The specific nature of activities of dentists employed in occupational health care (OHC) has often been questioned. At the same time, there is a general opinion that the status of OHC dentists is superior in respect of dental surgery equipment, room space, relations with patients, etc. Based on the results of the Polish episode of international comparative study on dental care effectiveness, an attempt was made to answer the question about the professional characteristics of dentists employed in OHC units. The study referred both to OHC dentists and those who work primarily in the public health service. It was assumed that the professional consciousness of the respondents would be reflected in their opinions on: 1. professional satisfaction, 2. compatibility of professional duties, 3. disadvantages of the profession, 4. prospects for hereditary continuation of the profession, 5. patient behaviour, 6. significance of preventive activities in dental health care, 7. dental health care in Poland. The results of the study indicate that there is some sense of professional distinctiveness among the OHC dentists. This can be traced to different technical, organizational and economic conditions under which that group of dentists performs their duties.