Intake Interviews—The “Real” Problem and the Best Way to Fix It

2020 ◽  
pp. 123-144
Author(s):  
Jeffrey A. Kottler ◽  
Richard S. Balkin
Keyword(s):  
Treatment Plan ◽  
Real Problem ◽  
Formal Process ◽  
The Real ◽  
Intake Interview ◽  
Treatment Plans ◽  
Unrealistic Expectations ◽  
Intake Session

In Intake Interviews, the “Real” Problem, and How to Fix It, the authors identify the process and unrealistic expectations of the intake interview. With a 60 to 90 minute framework, the clinician is to identify problems, diagnose, and document a treatment plan. The intake interview often is a formal or standardized process for therapy—a process that may neither be formal nor standardized. Moreover, there is very poor consistency on how to interpret information form an intake session. Clinicians will often disagree on diagnoses and problem areas. Therapists inevitably will develop very diverse treatment plans. Diagnoses tend to be highly inconsistent among clinicians and often contribute more to client stigma than care. Moreover, the formal process of the intake interview may take away from the client’s agenda, which is important to understanding the client and the client returning for therapy.

scholarly journals Dosimetric Evaluation of the QFix kVueTM Calypso Couch Top

2021 ◽  
Vol 20 ◽  
pp. 153303382110119
Author(s):  
Lingtong Hou ◽  
Huiqin Zhang ◽  
Xiaomei Sun ◽  
Qianqian Liu ◽  
Tingfeng Chen ◽  
...  
Keyword(s):  
Treatment Plan ◽  
Field Size ◽  
Planning System ◽  
Treatment Planning System ◽  
The Real ◽  
Depth Dose ◽  
Dosimetric Accuracy ◽  
Treatment Plans ◽  
The Difference ◽  
A Minor

Purpose: To evaluate the dosimetric accuracy of the default couch model of the QFix kVueTM Calypso couch top in the treatment planning system. Methods: With the gantry 180°, field size 20 × 20 cm, 6 MV, we measured the depth dose, off-axis dose, and dose plane of different depths in the phantom with the couch rails in and out, respectively. Isocenter doses at different angles were also obtained. The results were compared to the doses calculated using the default couch top model and the real scanned couch top model. Then we revised the default model according to the measured results. Results: With “Rails In,” the depth dose, off-axis dose, and dose plane of the default couch top model had a big difference with the dose of the real scanned couch top model and the measured result. The dose of the real scanned couch top model was much closer to the measured result, but in the region of the rail edge, the difference was still significant. With “Rails Out,” there was a minor difference between the measured result, the dose of the default couch top model and the real scanned couch top model. The difference between the measurement and the default couch top model became very small after being revised. Conclusions: It is better to avoid the beam angle passing through the couch rails in treatment plans, or you should revise the parameter of the QFix kVueTM Calypso couch top model based on the measured results, and verify the treatment plan before clinical practice.

Managing the Transition to Edentulousness Using Partial Transitional Dentures for First Time Prosthodontic Patients: Addressing Unrealistic Expectations – A Case Report

2017 ◽  
Vol 1 (1) ◽  
Keyword(s):  
Case Report ◽  
Treatment Outcomes ◽  
Treatment Planning ◽  
Clinical Relevance ◽  
Treatment Plan ◽  
Sequential Treatment ◽  
Aesthetic Result ◽  
Abutment Teeth ◽  
First Time ◽  
Unrealistic Expectations

Aim: The aim of this report is to describe the management of a prosthodontic patient expressing unrealistic expectations with respect to the transition to edentulousness. Objectives: To outline (1) the diagnosis and explicit expectations of the patient on presentation (2) considerations made during treatment planning to address the wishes of the first time prosthodontic patient (3) a sequential treatment plan utilizing transitional partial removable dentures to manage the change to edentulousness (4) functional and aesthetic result achieved. Results: Delivery of immediate removable partial dentures retaining key abutment teeth in upper and lower arches was a viable prosthodontic solution in the transition to edentulousness of a patient expecting unrealistic treatment outcomes. Conclusions: Addressing impractical expectations and devising a treatment plan amenable to both clinician and patient is difficult. Strategies to manage these wishes in prosthodontic dentistry can include transitional partial dentures. Clinical relevance: Practitioners who encounter similar situations may consider this report valuable.

Discounting and the Paradox of the Indefinitely Postponed Splurge

2018 ◽  
Author(s):  
Matthew Rendall
Keyword(s):  
Real Problem ◽  
Costs And Benefits ◽  
The Real ◽  
Reductio Ad Absurdum ◽  
The World ◽  
The Future ◽  
End Of The World

It is sometimes argued in support of discounting future costs and benefits that if we gave the same weight to the future as to the present, we would invest nearly all our income, but never spend it. Rather than enjoying the fruits of our investments, we would always do better to reinvest them. Undiscounted utilitarianism (UU), so the argument goes, is collectively self-defeating. This attempted reductio ad absurdum fails. Regardless of whether each generation successfully followed UU, or merely attempted to follow it, we could never get trapped in endless saving. The real problem is different: without the ability to foresee the end of the world, UU cannot tell us how much to save. Discounting is a defensible response, but only when coupled with a rule against risking catastrophe.

scholarly journals The effects of a preoperative multidisciplinary conference on outcomes for high-risk patients with challenging surgical treatment options: a retrospective study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Masayoshi Koike ◽  
Mie Yoshimura ◽  
Yasushi Mio ◽  
Shoichi Uezono
Keyword(s):  
Patient Safety ◽  
Retrospective Study ◽  
High Risk ◽  
Treatment Plan ◽  
Treatment Options ◽  
High Risk Patients ◽  
Appropriate Treatment ◽  
Risk Patients ◽  
Treatment Plans ◽  
Multidisciplinary Conference

Abstract Background Surgical options for patients vary with age and comorbidities, advances in medical technology and patients’ wishes. This complexity can make it difficult for surgeons to determine appropriate treatment plans independently. At our institution, final decisions regarding treatment for patients are made at multidisciplinary meetings, termed High-Risk Conferences, led by the Patient Safety Committee. Methods In this retrospective study, we assessed the reasons for convening High-Risk Conferences, the final decisions made and treatment outcomes using conference records and patient medical records for conferences conducted at our institution from April 2010 to March 2018. Results A total of 410 High-Risk Conferences were conducted for 406 patients during the study period. The department with the most conferences was cardiovascular surgery (24%), and the reasons for convening conferences included the presence of severe comorbidities (51%), highly difficult surgeries (41%) and nonmedical/personal issues (8%). Treatment changes were made for 49 patients (12%), including surgical modifications for 20 patients and surgery cancellation for 29. The most common surgical modification was procedure reduction (16 patients); 4 deaths were reported. Follow-up was available for 21 patients for whom surgery was cancelled, with 11 deaths reported. Conclusions Given that some change to the treatment plan was made for 12% of the patients discussed at the High-Risk Conferences, we conclude that participants of these conferences did not always agree with the original surgical plan and that the multidisciplinary decision-making process of the conferences served to allow for modifications. Many of the modifications involved reductions in procedures to reflect a more conservative approach, which might have decreased perioperative mortality and the incidence of complications as well as unnecessary surgeries. High-risk patients have complex issues, and it is difficult to verify statistically whether outcomes are associated with changes in course of treatment. Nevertheless, these conferences might be useful from a patient safety perspective and minimize the potential for legal disputes.

scholarly journals Multicriterial CNN based beam generation for robotic radiosurgery of the prostate

2020 ◽  
Vol 6 (1) ◽  
Author(s):  
Stefan Gerlach ◽  
Christoph Fürweger ◽  
Theresa Hofmann ◽  
Alexander Schlaefer
Keyword(s):  
Deep Learning ◽  
Treatment Planning ◽  
Treatment Plan ◽  
Plan Quality ◽  
New Approach ◽  
Beam Generation ◽  
Radiological Features ◽  
Improve Treatment ◽  
Robotic Radiosurgery ◽  
Treatment Plans

AbstractAlthough robotic radiosurgery offers a flexible arrangement of treatment beams, generating treatment plans is computationally challenging and a time consuming process for the planner. Furthermore, different clinical goals have to be considered during planning and generally different sets of beams correspond to different clinical goals. Typically, candidate beams sampled from a randomized heuristic form the basis for treatment planning. We propose a new approach to generate candidate beams based on deep learning using radiological features as well as the desired constraints. We demonstrate that candidate beams generated for specific clinical goals can improve treatment plan quality. Furthermore, we compare two approaches to include information about constraints in the prediction. Our results show that CNN generated beams can improve treatment plan quality for different clinical goals, increasing coverage from 91.2 to 96.8% for 3,000 candidate beams on average. When including the clinical goal in the training, coverage is improved by 1.1% points.

scholarly journals Outcomes of Peer Review for Radiotherapy Treatment Plans With Palliative Intent

2018 ◽  
Vol 14 (12) ◽  
pp. e794-e800
Author(s):  
Dina Thompson ◽  
Kimberly Cox ◽  
James Loudon ◽  
Ivan Yeung ◽  
Woodrow Wells
Keyword(s):  
Peer Review ◽  
Treatment Plan ◽  
Palliative Radiotherapy ◽  
Cancer Center ◽  
Palliative Intent ◽  
Treatment Plans ◽  
Important Quality ◽  
Radiation Medicine ◽  
Radiotherapy Treatment

Purpose: Peer review of a proposed treatment plan is increasingly recognized as an important quality activity in radiation medicine. Although peer review has been emphasized in the curative setting, applying peer review for treatment plans that have palliative intent is receiving increased attention. This study reports peer review outcomes for a regional cancer center that applied routine interprofessional peer review as a standard practice for palliative radiotherapy. Methods and Materials: Peer review outcomes for palliative radiotherapy plans were recorded prospectively for patients who began radiotherapy between October 1, 2015, and September 30, 2017. Recommended and implemented changes were recorded. The content of detailed discussions was recorded to gain insight into the complexities of palliative treatment plans considered during peer review. Results: Peer review outcomes were reviewed for 1,413 treatment plans with palliative intent. The proportions of detailed discussions and changes recommended were found to be 139 (9.8%) and 29 (2.1%), respectively. The content of detailed discussions and changes recommended was categorized. Major changes represented 75.9% of recommended changes, of which 84.2% were implemented clinically. Conclusion: Many complexities exist that are specific to palliative radiotherapy. Interprofessional peer review provides a forum for these complexities to be openly discussed and is an important activity to optimize the quality of care for patients with treatment plans that have palliative intent.

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