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1.
Br J Nurs ; 29(6): 378-379, 2020 Mar 26.
Artigo em Inglês | MEDLINE | ID: mdl-32207641

RESUMO

John Tingle, Lecturer in Law, Birmingham Law School, University of Birmingham, discusses some recent patient safety publications from the World Health Organization and the Care Quality Commission.


Assuntos
Segurança do Paciente/normas , Garantia da Qualidade dos Cuidados de Saúde/normas , Medicina Estatal/normas , Inglaterra , Hospitais Públicos/organização & administração , Hospitais Públicos/normas , Hospitais Universitários/normas , Humanos , Medição de Risco , Medicina Estatal/organização & administração , Organização Mundial da Saúde
2.
Rev Lat Am Enfermagem ; 28: e3252, 2020.
Artigo em Inglês, Português, Espanhol | MEDLINE | ID: mdl-32074211

RESUMO

OBJECTIVE: To validate the quality assessment and performance improvement instrument of US transplant programs to the Brazilian reality. METHOD: Methodological study developed for semantic validation and cultural adaptation of the Quality assessment and Performance Improvement instrument in the following steps: 1) translation; 2) synthesis; 3) back translation; 4) review by expert committee; 5) pretest and 6) content validation. To evaluate the agreement between the five judges, the Kappa coefficient was used and for content validation, the content validation index. RESULTS: Kappa coefficient showed the agreement of the judges for semantic, idiomatic, cultural and conceptual equivalences. Content validation index values for relevance and item sequence of at least 0.80 for all blocks. CONCLUSION: The instrument of Quality Evaluation and Performance Improvement of Transplantation Programs proved to be valid and reliable. This instrument will contribute to the development of quality assurance programs for transplant teams in Brazil.


Assuntos
Transplante de Órgãos/normas , Garantia da Qualidade dos Cuidados de Saúde/normas , Melhoria de Qualidade/normas , Inquéritos e Questionários , Brasil , Características Culturais , Humanos , Reprodutibilidade dos Testes , Traduções
3.
Int J Radiat Oncol Biol Phys ; 106(3): 639-647, 2020 03 01.
Artigo em Inglês | MEDLINE | ID: mdl-31983560

RESUMO

PURPOSE: We sought to develop a quality surveillance program for approximately 15,000 US veterans treated at the 40 radiation oncology facilities at the Veterans Affairs (VA) hospitals each year. METHODS AND MATERIALS: State-of-the-art technologies were used with the goal to improve clinical outcomes while providing the best possible care to veterans. To measure quality of care and service rendered to veterans, the Veterans Health Administration established the VA Radiation Oncology Quality Surveillance program. The program carries forward the American College of Radiology Quality Research in Radiation Oncology project methodology of assessing the wide variation in practice pattern and quality of care in radiation therapy by developing clinical quality measures (QM) used as quality indices. These QM data provide feedback to physicians by identifying areas for improvement in the process of care and identifying the adoption of evidence-based recommendations for radiation therapy. RESULTS: Disease-site expert panels organized by the American Society for Radiation Oncology (ASTRO) defined quality measures and established scoring criteria for prostate cancer (intermediate and high risk), non-small cell lung cancer (IIIA/B stage), and small cell lung cancer (limited stage) case presentations. Data elements for 1567 patients from the 40 VA radiation oncology practices were abstracted from the electronic medical records and treatment management and planning systems. Overall, the 1567 assessed cases passed 82.4% of all QM. Pass rates for QM for the 773 lung and 794 prostate cases were 78.0% and 87.2%, respectively. Marked variations, however, were noted in the pass rates for QM when tumor site, clinical pathway, or performing centers were separately examined. CONCLUSIONS: The peer-review protected VA-Radiation Oncology Surveillance program based on clinical quality measures allows providers to compare their clinical practice to peers and to make meaningful adjustments in their personal patterns of care unobtrusively.


Assuntos
Institutos de Câncer/normas , Hospitais de Veteranos/normas , Desenvolvimento de Programas , Garantia da Qualidade dos Cuidados de Saúde/normas , Radioterapia (Especialidade)/normas , Carcinoma Pulmonar de Células não Pequenas/radioterapia , Medicina Baseada em Evidências/normas , Humanos , Neoplasias Pulmonares/radioterapia , Masculino , Revisão por Pares , Avaliação de Programas e Projetos de Saúde/normas , Neoplasias da Próstata/radioterapia , Garantia da Qualidade dos Cuidados de Saúde/métodos , Melhoria de Qualidade/normas , Indicadores de Qualidade em Assistência à Saúde/normas , Carcinoma de Pequenas Células do Pulmão/radioterapia , Sociedades Médicas/normas , Estados Unidos , Veteranos
4.
Occup Environ Med ; 77(1): 15-18, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31740489

RESUMO

A scoping project was funded by the Food and Agriculture Organization in 2017 on the health and safety of aquaculture workers. This project developed a template covering basic types of aquaculture production, health and safety hazards and risks, and related data on injuries and occupational ill health, regulations, social welfare conditions, and labour and industry activity in the sector. Profiles using the template were then produced for key aquaculture regions and nations across the globe where information could be obtained. These revealed both the scale and depth of occupational safety and health (OSH) challenges in terms of data gaps, a lack of or poor risk assessment and management, inadequate monitoring and regulation, and limited information generally about aquaculture OSH. Risks are especially high for offshore/marine aquaculture workers. Good practice as well as barriers to improving aquaculture OSH were noted. The findings from the profiles were brought together in an analysis of current knowledge on injury and work-related ill health, standards and regulation, non-work socioeconomic factors affecting aquaculture OSH, and the role of labour and industry in dealing with aquaculture OSH challenges. Some examples of governmental and labour, industry and non-governmental organisation good practice were identified. Some databases on injury and disease in the sector and research initiatives that solved problems were noted. However, there are many challenges especially in rural and remote areas across Asia but also in the northern hemisphere that need to be addressed. Action now is possible based on the knowledge available, with further research an important but secondary objective.


Assuntos
Aquicultura , Doenças Profissionais/prevenção & controle , Saúde do Trabalhador/normas , Garantia da Qualidade dos Cuidados de Saúde/normas , Humanos , Gestão da Segurança/normas
5.
Medicina (B Aires) ; 79(6): 468-476, 2019.
Artigo em Espanhol | MEDLINE | ID: mdl-31829949

RESUMO

The integrated care pathways for the last days of life propose quality standards optimizing the care of patients and families. The Pallium Multidisciplinary Assistance Program (PAMPA ©) was implemented based on standards of the International Collaborative for Best Care for the Dying Person in 4 phases: induction, implementation, dissemination and sustainability, in five health centres in Argentina, between 2008 and 2018. A total of 1237 adult patients in the last days of life were included and cared for by palliative care teams trained in PAMPA©. An audit was conducted before and after the implementation of the Program, which is still going on. The median range of follow up into five centres from the beginning of the pathway until death varied from 16 to 178 hours. Care goals were compared: symptom control, communication, multidimensional needs, hydration and nutrition, documentation of interventions and post-mortem care. The overall analysis showed an improvement in the number of records (p = 0.001). The goal of communication on care plan to the patient showed no difference (p = 0.173). Continuous training, support and permanent teams supervision were carried out and perceptions and impact of the implementation were registered. The main emerging items of the qualitative analysis were: attitudes towards the program, fundamental contributions, strengths, weaknesses and subjective definition of the program, recognition of institutional cultural singularities and its influence on care. PAMPA© demonstrated its feasibility as a model of end of life care for patients and families, based on international quality standards.


Assuntos
Cuidados Paliativos/normas , Avaliação de Programas e Projetos de Saúde , Garantia da Qualidade dos Cuidados de Saúde/normas , Assistência Terminal/normas , Adulto , Idoso , Idoso de 80 Anos ou mais , Argentina , Procedimentos Clínicos/normas , Feminino , Implementação de Plano de Saúde/métodos , Implementação de Plano de Saúde/normas , Humanos , Masculino , Pessoa de Meia-Idade , Cuidados Paliativos/métodos , Reprodutibilidade dos Testes , Assistência Terminal/métodos , Fatores de Tempo
6.
Radiat Oncol ; 14(1): 235, 2019 Dec 23.
Artigo em Inglês | MEDLINE | ID: mdl-31870403

RESUMO

BACKGROUND: Comprehensively textural feature performance test from volumetric modulated arc therapy (VMAT) fluences to predict plan delivery accuracy. METHODS: A total of 240 VMAT plans for various treatment sites were analyzed, with Trilogy and TrueBeam STx systems. Fluence maps superposed fluences at each control point per plan. The textural features were the angular second moment (ASM), inverse difference moment (IDM), contrast, variance, correlation, and entropy, calculated from fluence maps using three displacement distances. Correlation analysis of textural feature performance as predictors of VMAT delivery accuracy used global gamma passing rates with MapCHECK2 and ArcCHECK dosimeters, and mechanical delivery errors calculated from machine log files. RESULTS: Spearman's rank correlation coefficients (r) of the ASM (d = 10) to the gamma passing rates with 1%/2 mm using the MapCHECK2 were 0.358 and 0.519, respectively (p <  0.001). For the ArcCHECK, they were 0.273 (p = 0.001) and 0.259 (p = 0.009), respectively. The r-values of the ASM (d = 10) to the Trilogy and TrueBeam STx MLC errors were - 0.843 and - 0.859, respectively (p <  0.001), and those to the MU delivery errors were - 0.482 and - 0.589, respectively (p <  0.001). The ASM (d = 10) showed better performance in predicting VMAT delivery accuracy. CONCLUSIONS: The ASM (d = 10) calculated from VMAT plan fluence maps were strongly correlated with global gamma passing rates and MLC delivery errors, and can predict VMAT delivery accuracy.


Assuntos
Algoritmos , Neoplasias/radioterapia , Aceleradores de Partículas/instrumentação , Garantia da Qualidade dos Cuidados de Saúde/normas , Planejamento da Radioterapia Assistida por Computador/métodos , Radioterapia de Intensidade Modulada/métodos , Humanos , Processamento de Imagem Assistida por Computador/métodos , Neoplasias/diagnóstico por imagem , Órgãos em Risco/efeitos da radiação , Dosagem Radioterapêutica , Estudos Retrospectivos , Estatísticas não Paramétricas , Tomografia Computadorizada por Raios X/métodos
7.
Chiropr Man Therap ; 27: 49, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31687129

RESUMO

Background: Accreditation of educational programs involves an independent agency assessing quality against a set of defined standards. Site inspection teams are appointed by an accrediting agency and compile a report with the intention of identifying deficiencies and making recommendations for their rectification and continued improvement. For chiropractic programs accreditation is carried out by Councils on Chiropractic Education (CCEs). However, the reliability of their site inspection teams remains unknown. Recent research has suggested that variability in chiropractic practice may be partially traced back to the education provider. This raises the possibility of deficient accreditation procedures that may include unsatisfactory site inspection standards or processes or the accreditation standards by which they work to.We sought to compare the various CCEs documented standards and processes for site inspection teams for similarities and differences with the intent of making recommendations to create uniform and high quality standards. Further, we sought to compare a sample of CCEs site inspection team surveys / reports for commonly identified recommendations and quality improvements and determine if they are adequately described in their accreditation standards. Method: In December of 2018 invitation emails were sent to 4 CCEs through their website portals outlining a proposed study investigating site inspection teams' standards and processes. Access was requested to all appropriately redacted documentation relating to site inspection teams and their chiropractic program reports. Follow up emails were sent several weeks later. Results: Only one of four of the CCEs responded by providing the requested information. Conclusion and recommendations: Three CCEs did not cooperate with this educational research. The possible reasons for the non-engagement is discussed.


Assuntos
Quiroprática/educação , Quiroprática/normas , Acreditação/normas , Quiroprática/organização & administração , Humanos , Garantia da Qualidade dos Cuidados de Saúde/normas , Melhoria de Qualidade
8.
Int J Med Inform ; 131: 103932, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31557700

RESUMO

BACKGROUND: Poorly designed infusion pumps can lead to user errors and adverse incidents. Therefore, assessments of their usability and performance that can inform managerial decisions about the selection of appropriate medical devices are essential. OBJECTIVE: This study aimed to identify design deficiencies and evaluate the usability and performance of four infusion pump models and thus inform decisions about infusion pump selection. METHODS: Four evaluators evaluated the interface designs of the pumps according to a series of design principles in a heuristic evaluation in order to identify pump design deficiencies. Additionally, 60 registered nurses participated in simulated use testing to perform a series of tasks using the pumps in order to examine the pump performances. Outcome measures included task completion time, frequency of deviations, frequency of requests for assistance, and nurses' perceptions. RESULTS: Design issues identified included system status visibility, information access, and error prevention. The results of simulated use testing favored some pumps over others, depending on which outcome measures were considered. CONCLUSIONS: Heuristic evaluations and simulated use testing can provide information about the basic usability of medical devices and related operational issues. However, practitioners should select appropriate evaluation principles, testing tasks, and outcome measures based on the tested medical devices and contexts.


Assuntos
Segurança de Equipamentos/métodos , Heurística , Bombas de Infusão/estatística & dados numéricos , Erros Médicos/prevenção & controle , Enfermeiras e Enfermeiros/estatística & dados numéricos , Garantia da Qualidade dos Cuidados de Saúde/normas , Gestão da Segurança/organização & administração , Simulação por Computador , Segurança de Equipamentos/normas , Humanos , Variações Dependentes do Observador
9.
J Appl Clin Med Phys ; 20(9): 163-165, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31536666

RESUMO

PURPOSE: Compliance with TG-263 nomenclature standards can be challenging. We introduce an open source solution to this problem and evaluate its impact on compliance within our institution. MATERIALS/METHODS: The TG-236 nomenclature standards were implemented in our clinic in two phases. In phase 1, we deployed TG-263 compliant templates for each disease site. In phase 2, we developed and deployed a script for evaluating compliance which presented errors to the user. After each phase the compliance was recorded. RESULTS: Mean compliance errors prior to phase 1 was 31.8% ± 17.4%. Error rates dropped to 8.1% ± 12.2% across phase 1 and dropped further to 2.2% ± 6.9% during the automation system deployed in phase 2. CONCLUSION: Both structure templates and automation scripts are very useful for increasing compliance with structure naming standards. Our software solution is made available on GitHub for other institutions to implement.


Assuntos
Neoplasias/classificação , Neoplasias/radioterapia , Garantia da Qualidade dos Cuidados de Saúde/normas , Radioterapia (Especialidade) , Planejamento da Radioterapia Assistida por Computador/normas , Terminologia como Assunto , Humanos , Dosagem Radioterapêutica
10.
J Appl Clin Med Phys ; 20(9): 143-148, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31538717

RESUMO

PURPOSE: To evaluate a scintillator detector for patient-specific quality assurance of VMAT radiosurgery plans. METHODS: The detector was comprised of a 1 mm diameter, 1 mm high scintillator coupled to an acrylic optical fiber. Sixty VMAT SRS plans for treatment of single targets having sizes ranging from 3 mm to 30.2 mm equivalent diameter (median 16.3 mm) were selected. The plans were delivered to a 20 cm × 20 cm x 15 cm water equivalent plastic phantom having either the scintillator detector or radiochromic film at the center. Calibration films were obtained for each measurement session. The films were scanned and converted to dose using a 3-channel technique. RESULTS: The mean difference between scintillator and film was -0.45% (95% confidence interval -0.1% to 0.8%). For target equivalent diameter smaller than the median, the mean difference was 1.1% (95% confidence interval 0.5% to 1.7%). For targets larger than the median, the mean difference was -0.2% (95% confidence interval -0.7% to 0.1%). CONCLUSIONS: The scintillator detector response is independent of target size for targets as small as 3 mm and is well-suited for patient-specific quality assurance of VMAT SRS plans. Further work is needed to evaluate the accuracy for VMAT plans that treat multiple targets using a single isocenter.


Assuntos
Imagens de Fantasmas , Plásticos , Garantia da Qualidade dos Cuidados de Saúde/normas , Radiocirurgia/instrumentação , Radiocirurgia/normas , Planejamento da Radioterapia Assistida por Computador/métodos , Radioterapia de Intensidade Modulada/métodos , Contagem de Cintilação/instrumentação , Calibragem , Humanos , Órgãos em Risco/efeitos da radiação , Dosagem Radioterapêutica
11.
J Appl Clin Med Phys ; 20(9): 133-142, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31520517

RESUMO

PURPOSE: Assessment of the accuracy of geometric tests of a linac used in external beam therapy is crucial for ensuring precise dose delivery. In this paper, a new simulation-based method for assessing accuracy of such geometric tests is proposed and evaluated on a set of testing procedures. METHODS: Linac geometry testing methods used in this study are based on an established design of a two-module phantom. Electronic portal imaging device (EPID) images of fiducial balls contained in these modules can be used to automatically reconstruct linac geometry. The projection of the phantom modules fiducial balls onto the EPID detector plane is simulated for assumed nominal geometry of a linac. Then, random errors are added to the coordinates of the projections of the centers of the fiducial balls and the linac geometry is reconstructed from these data. RESULTS: Reconstruction is performed for a set of geometric test designs and it is shown how the dispersion of the reconstructed values of geometric parameters depends on the design of a geometric test. Assuming realistic accuracy of EPID image analysis, it is shown that for selected testing plans the reconstruction accuracy of geometric parameters can be significantly better than commonly used action thresholds for these parameters. CONCLUSIONS: Proposed solution has the potential to improve geometric testing design and practice. It is an important part of a fully automated geometric testing solution.


Assuntos
Simulação por Computador , Aceleradores de Partículas/instrumentação , Aceleradores de Partículas/normas , Imagens de Fantasmas , Garantia da Qualidade dos Cuidados de Saúde/normas , Controle de Qualidade , Radioterapia de Intensidade Modulada/normas , Algoritmos , Equipamentos e Provisões Elétricas , Humanos
12.
Glob Health Action ; 12(1): 1646036, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31405363

RESUMO

Background: Namibia, a middle-income country in sub-Saharan Africa (SSA), plans to use the Maternal Near Miss (MNM) approach. Adaptations of the World Health Organization (WHO) MNM defining criteria ('WHO MNM criteria') were previously proposed for low-income settings in sub-Saharan Africa ('SSA MNM criteria'), but whether these adaptations are required in middle-income settings is unknown. Objective: To establish MNM criteria suitable for use in Namibia, a middle-income country in SSA. Methods: Cross-sectional study from 1 March 2018 to 31 May 2018 in four Namibian hospitals. Pregnant women or within 42 days of termination of pregnancy or birth, fulfilling at least one WHO or SSA MNM criterion were included. Records of women identified by either only WHO criteria or only SSA criteria were assessed in detail. Results: 194 Women fulfilled any MNM criterion. WHO criteria identified 61 MNM, the SSA criteria 184 MNM. Of women who only fulfilled any of the unique SSA MNM criteria, 18 fulfilled the criterion 'eclampsia', one 'uterine rupture' and five 'laparotomy'. These women were assessed to be MNM. Thresholds for blood transfusion to define MNM due to haemorrhage were two units in the SSA and five in WHO set. Two or three units were given to 95 women for mild/moderate haemorrhage or chronic anaemia who did not fulfil any WHO criterion and were not considered MNM. Fourteen women who were assessed to be MNM from severe haemorrhage received four units. Conclusions: WHO MNM criteria may underestimate and SSA MNM criteria overestimate the prevalence of MNM in a middle-income country such as Namibia, where MNM criteria 'in between' may be more appropriate. Namibia opts to apply a modification of the WHO criteria, including eclampsia, uterine rupture, laparotomy and a lower threshold of four units of blood to define MNM. We recommend that other middle-income countries validate our criteria for their setting.


Assuntos
Guias como Assunto , Mortalidade Materna , Near Miss/estatística & dados numéricos , Near Miss/normas , Complicações na Gravidez/epidemiologia , Complicações na Gravidez/mortalidade , Garantia da Qualidade dos Cuidados de Saúde/normas , Adulto , África ao Sul do Saara , Estudos Transversais , Feminino , Humanos , Namíbia/epidemiologia , Gravidez , Prevalência , Organização Mundial da Saúde , Adulto Jovem
13.
J Appl Clin Med Phys ; 20(8): 65-77, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31364798

RESUMO

PURPOSE: To assess three advanced radiation therapy treatment planning tools on the intensity-modulated radiation therapy (IMRT) quality and consistency when compared to the clinically approved plans, referred as manual plans, which were planned without using any of these advanced planning tools. MATERIALS AND METHODS: Three advanced radiation therapy treatment planning tools, including auto-planning, knowledge-based planning, and multiple criteria optimization, were assessed on 20 previously treated clinical cases. Three institutions participated in this study, each with expertise in one of these tools. The twenty cases were retrospectively selected from Cleveland Clinic, including five head-and-neck (HN) cases, five brain cases, five prostate with pelvic lymph nodes cases, and five spine cases. A set of general planning objectives and organs-at-risk (OAR) dose constraints for each disease site from Cleveland Clinic was shared with other two institutions. A total of 60 IMRT research plans (20 from each institution) were designed with the same beam configuration as in the respective manual plans. For each disease site, detailed isodoseline distributions and dose volume histograms for a randomly selected representative case were compared among the three research plans and manual plan. In addition, dosimetric endpoints of five cases for each site were compared. RESULTS: Compared to the manual plans, the research plans using advanced tools showed substantial improvement for the HN patient cases, including the maximum dose to the spinal cord and brainstem and mean dose to the parotid glands. For the brain, prostate, and spine cases, the four types of plans were comparable based on dosimetric endpoint comparisons. CONCLUSION: With minimal planner interventions, advanced treatment planning tools are clinically useful, producing a plan quality similarly to or better than manual plans, improving plan consistency. For difficult cases such as HN cancer, advanced planning tools can further reduce radiation doses to numerous OARs while delivering adequate dose to the tumor targets.


Assuntos
Neoplasias Encefálicas/radioterapia , Neoplasias de Cabeça e Pescoço/radioterapia , Neoplasias da Próstata/radioterapia , Garantia da Qualidade dos Cuidados de Saúde/normas , Planejamento da Radioterapia Assistida por Computador/métodos , Radioterapia de Intensidade Modulada/métodos , Neoplasias da Coluna Vertebral/radioterapia , Humanos , Masculino , Órgãos em Risco/efeitos da radiação , Prognóstico , Dosagem Radioterapêutica , Estudos Retrospectivos
14.
Int J Radiat Oncol Biol Phys ; 105(4): 893-902, 2019 11 15.
Artigo em Inglês | MEDLINE | ID: mdl-31377162

RESUMO

PURPOSE: To assess the accuracy of machine learning to predict and classify quality assurance (QA) results for volumetric modulated arc therapy (VMAT) plans. METHODS AND MATERIALS: Three hundred three VMAT plans, including 176 gynecologic cancer and 127 head and neck cancer plans, were chosen in this study. Fifty-four complexity metrics were extracted from the QA plans and considered as inputs. Patient-specific QA was performed, and gamma passing rates (GPRs) were used as outputs. One Poisson lasso (PL) regression model was developed, aiming to predict individual GPR, and 1 random forest (RF) classification model was developed to classify QA results as "pass" or "fail." Both technical validation (TV) and clinical validation (CV) were used to evaluate the model reliability. GPR prediction accuracy of PL and classification performance of PL and RF were evaluated. RESULTS: In TV, the mean prediction error of PL was 1.81%, 2.39%, and 4.18% at 3%/3 mm, 3%/2 mm, and 2%/2 mm, respectively. No significant differences in prediction errors between TV and CV were observed. In QA results classification, PL had a higher specificity (accurately identifying plans that can pass QA), whereas RF had a higher sensitivity (accurately identifying plans that may fail QA). By using 90% as the action limit at a 3%/2 mm criterion, the specificity of PL and RF was 97.5% and 87.7% in TV and 100% and 71.4% in CV, respectively. The sensitivity of PL and RF was 31.6% and 100% in TV and 33.3% and 100% in CV, respectively. With 100% sensitivity, the QA workload of 81.2% of plans in TV and 62.5% of plans in CV could be reduced by RF. CONCLUSIONS: The PL model could accurately predict GPR for most VMAT plans. The RF model with 100% sensitivity was preferred for QA results classification. Machine learning can be a useful tool to assist VMAT QA and reduce QA workload.


Assuntos
Neoplasias dos Genitais Femininos/radioterapia , Neoplasias de Cabeça e Pescoço/radioterapia , Aprendizado de Máquina/normas , Garantia da Qualidade dos Cuidados de Saúde/normas , Planejamento da Radioterapia Assistida por Computador/normas , Radioterapia de Intensidade Modulada/normas , Confiabilidade dos Dados , Feminino , Humanos , Distribuição de Poisson , Garantia da Qualidade dos Cuidados de Saúde/classificação , Análise de Regressão , Reprodutibilidade dos Testes , Sensibilidade e Especificidade , Carga de Trabalho
15.
J Appl Clin Med Phys ; 20(9): 122-132, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31385436

RESUMO

Transmission detectors meant to measure every beam delivered on a linear accelerator are now becoming available for monitoring the quality of the dose distribution delivered to the patient daily. The purpose of this work is to present results from a systematic evaluation of the error detection capabilities of one such detector, the Delta4 Discover. Existing patient treatment plans were modified through in-house-developed software to mimic various delivery errors that have been observed in the past. Errors included shifts in multileaf collimator leaf positions, changing the beam energy from what was planned, and a simulation of what would happen if the secondary collimator jaws did not track with the leaves as they moved. The study was done for simple 3D plans, static gantry intensity modulated radiation therapy plans as well as dynamic arc and volumetric modulated arc therapy (VMAT) plans. Baseline plans were delivered with both the Discover device and the Delta4 Phantom+ to establish baseline gamma pass rates. Modified plans were then delivered using the Discover only and the predicted change in gamma pass rate, as well as the detected leaf positions were evaluated. Leaf deviations as small as 0.5 mm for a static three-dimensional field were detected, with this detection limit growing to 1 mm with more complex delivery modalities such as VMAT. The gamma pass rates dropped noticeably once the intentional leaf error introduced was greater than the distance-to-agreement criterion. The unit also demonstrated the desired drop in gamma pass rates of at least 20% when jaw tracking was intentionally disabled and when an incorrect energy was used for the delivery. With its ability to find errors intentionally introduced into delivered plans, the Discover shows promise of being a valuable, independent error detection tool that should serve to detect delivery errors that can occur during radiotherapy treatment.


Assuntos
Órgãos em Risco/efeitos da radiação , Aceleradores de Partículas/instrumentação , Imagens de Fantasmas , Garantia da Qualidade dos Cuidados de Saúde/normas , Planejamento da Radioterapia Assistida por Computador/métodos , Radioterapia de Intensidade Modulada/instrumentação , Humanos , Processamento de Imagem Assistida por Computador/métodos , Neoplasias/radioterapia , Dosagem Radioterapêutica , Software , Tomografia Computadorizada por Raios X/métodos
16.
J Appl Clin Med Phys ; 20(9): 78-85, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31454148

RESUMO

PURPOSE: This case series represents an initial experience with implementing 3-dimensional (3D) surface scanning, digital design, and 3D printing for bolus fabrication for patients with complex surface anatomy where traditional approaches are challenging. METHODS AND MATERIALS: For 10 patients requiring bolus in regions with complex contours, bolus was designed digitally from 3D surface scanning data or computed tomography (CT) images using either a treatment planning system or mesh editing software. Boluses were printed using a fused deposition modeling printer with polylactic acid. Quality assurance tests were performed for each printed bolus to verify density and shape. RESULTS: For 9 of 10 patients, digitally designed boluses were used for treatment with no issues. In 1 case, the bolus was not used because dosimetric requirements were met without the bolus. QA tests revealed that the bulk density was within 3% of the reference value for 9 of 12 prints, and with more judicious selection of print settings this could be increased. For these 9 prints, density uniformity was as good as or better than our traditional sheet bolus material. The average shape error of the pieces was less than 0.5 mm, and no issues with fit or comfort were encountered during use. CONCLUSIONS: This study demonstrates that new technologies such as 3D surface scanning, digital design and 3D printing can be safely and effectively used to modernize bolus fabrication.


Assuntos
Impressão Tridimensional/instrumentação , Garantia da Qualidade dos Cuidados de Saúde/normas , Planejamento da Radioterapia Assistida por Computador/métodos , Radioterapia de Intensidade Modulada/instrumentação , Radioterapia de Intensidade Modulada/métodos , Neoplasias Cutâneas/radioterapia , Idoso , Idoso de 80 Anos ou mais , Carcinoma Basocelular/diagnóstico por imagem , Carcinoma Basocelular/radioterapia , Carcinoma de Células Escamosas/diagnóstico por imagem , Carcinoma de Células Escamosas/radioterapia , Desenho de Equipamento , Feminino , Humanos , Processamento de Imagem Assistida por Computador/métodos , Masculino , Pessoa de Meia-Idade , Órgãos em Risco/efeitos da radiação , Prognóstico , Dosagem Radioterapêutica , Neoplasias Cutâneas/diagnóstico por imagem , Tomografia Computadorizada por Raios X/métodos
17.
J Appl Clin Med Phys ; 20(8): 56-64, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31423729

RESUMO

PURPOSE: To develop and implement an automated plan check (APC) tool using a Six Sigma methodology with the aim of improving safety and efficiency in external beam radiotherapy. METHODS: The Six Sigma define-measure-analyze-improve-control (DMAIC) framework was used by measuring defects stemming from treatment planning that were reported to the departmental incidence learning system (ILS). The common error pathways observed in the reported data were combined with our departmental physics plan check list, and AAPM TG-275 identified items. Prioritized by risk priority number (RPN) and severity values, the check items were added to the APC tool developed using Varian Eclipse Scripting Application Programming Interface (ESAPI). At 9 months post-APC implementation, the tool encompassed 89 check items, and its effectiveness was evaluated by comparing RPN values and rates of reported errors. To test the efficiency gains, physics plan check time and reported error rate were prospectively compared for 20 treatment plans. RESULTS: The APC tool was successfully implemented for external beam plan checking. FMEA RPN ranking re-evaluation at 9 months post-APC demonstrated a statistically significant average decrease in RPN values from 129.2 to 83.7 (P < .05). After the introduction of APC, the average frequency of reported treatment-planning errors was reduced from 16.1% to 4.1%. For high-severity errors, the reduction was 82.7% for prescription/plan mismatches and 84.4% for incorrect shift note. The process shifted from 4σ to 5σ quality for isocenter-shift errors. The efficiency study showed a statistically significant decrease in plan check time (10.1 ± 7.3 min, P = .005) and decrease in errors propagating to physics plan check (80%). CONCLUSIONS: Incorporation of APC tool has significantly reduced the error rate. The DMAIC framework can provide an iterative and robust workflow to improve the efficiency and quality of treatment planning procedure enabling a safer radiotherapy process.


Assuntos
Automação , Neoplasias/radioterapia , Garantia da Qualidade dos Cuidados de Saúde/normas , Planejamento da Radioterapia Assistida por Computador/métodos , Planejamento da Radioterapia Assistida por Computador/normas , Software , Lista de Checagem , Humanos , Órgãos em Risco/efeitos da radiação , Estudos Prospectivos , Dosagem Radioterapêutica , Radioterapia de Intensidade Modulada/métodos , Gestão da Qualidade Total
18.
Am J Health Syst Pharm ; 76(12): 874-887, 2019 Jun 03.
Artigo em Inglês | MEDLINE | ID: mdl-31361855

RESUMO

PURPOSE: Pharmacists are accountable for medication-related services provided to patients. As payment models transition from reimbursement for volume to reimbursement for value, pharmacy departments must demonstrate improvements in patient care outcomes and quality measure performance. The transition begins with an awareness of quality measures for which pharmacists and pharmacy personnel can demonstrate accountability across the continuum of care. The objective of the Pharmacy Accountability Measures (PAM) Work Group is to identify measures for which pharmacy departments can and should assume accountability. SUMMARY: The National Quality Forum (NQF) Quality Positioning System (QPS) was queried for NQF-endorsed medication-related measures. Included measures were curated into a data set of 6 therapeutic categories: antithrombotic safety, cardiovascular control, glucose control, pain management, behavioral health, and antimicrobial stewardship. Subject matter expert (SME) panels assigned to each area analyzed each measure according to a predetermined ranking system developed by the PAM Work Group. Measures remaining after SME review were disseminated during a public comment period for review and ballot. Over 1,000 measures are captured in the NQF QPS; 656 of the measures were found to be endorsed and medication use related or impacted by medication management services. A single reviewer categorized 140 measures into therapeutic categories for SME review; the remaining measures were unrelated to those clinical domains. The SME groups identified 28 measures for inclusion. CONCLUSION: An understanding of the endorsed quality measures available for public reporting programs provides an opportunity for pharmacists to demonstrate accountability for performance, thus improving quality and safety and demonstrating value of care provided.


Assuntos
Conduta do Tratamento Medicamentoso/organização & administração , Assistência Farmacêutica/organização & administração , Garantia da Qualidade dos Cuidados de Saúde/normas , /economia , Humanos , Conduta do Tratamento Medicamentoso/economia , Conduta do Tratamento Medicamentoso/normas , Assistência Farmacêutica/economia , Assistência Farmacêutica/normas , Farmacêuticos/economia , Farmacêuticos/organização & administração , Farmacêuticos/psicologia , /normas , Papel Profissional/psicologia , Garantia da Qualidade dos Cuidados de Saúde/economia , Reembolso de Incentivo/economia , Reembolso de Incentivo/normas , Responsabilidade Social , Estados Unidos
19.
J Appl Clin Med Phys ; 20(7): 193-200, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31282112

RESUMO

PURPOSE: In this work we have developed a novel method of dose distribution comparison, the inverse gamma (IG) evaluation, by modifying the commonly used gamma evaluation method. METHODS: The IG evaluation calculates the gamma criteria (dose difference criterion, ΔD, or distance-to-agreement criterion, Δd) that are needed to achieve a predefined pass rate or gamma agreement index (GAI). In-house code for evaluating IG with a fixed ΔD of 3% was developed using Python (v3.5.2) and investigated using treatment plans and measurement data from 25 retrospective patient specific quality assurance tests (53 individual arcs). RESULTS: It was found that when the desired GAI was set to 95%, approximately three quarters of the arcs tested were able to achieve Δd within 1 mm (mean Δd: 0.7 ± 0.5 mm). The mean Δd required in order for all points to pass the gamma evaluation (i.e., GAI = 100%) was 4.5 ± 3.1 mm. The possibility of evaluating IG by fixing the Δd or ΔD/Δd, instead of fixing the ΔD at 3%, was also investigated. CONCLUSION: The IG method and its indices have the potential to be implemented clinically to quantify the minimum dose and distance criteria based on a specified GAI. This method provides additional information to augment standard gamma evaluation results during patient specific quality assurance testing of individual treatment plans. The IG method also has the potential to be used in retrospective audits to determine an appropriate set of local gamma criteria and action levels based on a cohort of patient specific quality assurance plans.


Assuntos
Algoritmos , Raios gama , Neoplasias/radioterapia , Garantia da Qualidade dos Cuidados de Saúde/normas , Planejamento da Radioterapia Assistida por Computador/normas , Radioterapia de Intensidade Modulada/normas , Humanos , Controle de Qualidade , Dosagem Radioterapêutica , Estudos Retrospectivos , Software
20.
Health Phys ; 117(3): 306-312, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31283547

RESUMO

Radiation therapy departments are faced with the challenge of tracking numerous quality control tests as well as monitoring service events affecting radiation therapy treatment units. Service events, in particular, pose a challenge since the clinic must be able to provide evidence to the regulatory body that both the service work and any required follow-up tests were recorded and authorized by the appropriate staff. This article presents an integrated approach to tracking quality control tests and service event logs using QATrack+. The newly developed version of this quality assurance software integrates quality control tracking with the service event log, allowing a direct link between a service event and any initiating routine tests or follow-up tests that are performed. This improves the ability of a licensee to ensure compliance with regulations and permits a simple platform from which to access all machine equipment tests and service events. Furthermore, this improves the ability of a department to assess the service record of equipment and to identify trends in failure modes.


Assuntos
Garantia da Qualidade dos Cuidados de Saúde/normas , Proteção Radiológica/legislação & jurisprudência , Proteção Radiológica/normas , Serviço Hospitalar de Radiologia/normas , Gestão da Segurança/organização & administração , Software , Humanos
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