Patient-Type Bayes-Adaptive Treatment Plans

2021 ◽  
Author(s):  
M. Reza Skandari ◽  
Steven M. Shechter
Keyword(s):  
Treatment Plan ◽  
Cost Of Care ◽  
Optimal Timing ◽  
Decision Analytic Model ◽  
Patient Type ◽  
Adaptive Treatment ◽  
Patient Health ◽  
Markov Decision ◽  
Treatment Plans ◽  
The Right

Treatment decisions that explicitly consider patient heterogeneity can lower the cost of care and improve outcomes by providing the right care for the right patient at the right time. “Patient-Type Bayes-Adaptive Treatment Plans” analyzes the problem of designing ongoing treatment plans for a population with heterogeneity in disease progression and response to medical interventions. The authors create a model that learns the patient type by monitoring patient health over time and updates a patient's treatment plan according to the information gathered. The authors formulate the problem as a multivariate state space partially observable Markov decision process (POMDP). They provide structural properties of the optimal policy and develop several approximate policies and heuristics to solve the problem. As a case study, they develop a data-driven decision-analytic model to study the optimal timing of vascular access surgery for patients with progressive chronic kidney disease. They provide further policy insights that sharpen existing guidelines.

Improving oncology quality through the implementation of evidence-based clinical pathways in a payer’s oncology network.

2013 ◽  
Vol 31 (31_suppl) ◽  
pp. 161-161 ◽  
Author(s):  
Daniel McCrone ◽  
Dudley Gill ◽  
Cecilia Tran ◽  
Michael Sturgill
Keyword(s):  
Clinical Pathways ◽  
Treatment Plan ◽  
Clinical Information ◽  
Cost Of Care ◽  
Adherence Rate ◽  
Critical Element ◽  
Evidence Based ◽  
Prior Authorization ◽  
Chemotherapy Treatment ◽  
Treatment Plans

161 Background: Physicians and health plans are collaboratively exploring clinical pathway strategies to improve patient outcomes, reduce treatment variation, and reduce oncology cost. One landmark study found that 33.2% of insured patients did not receive guideline cancer therapy. Additional studies have demonstrated that the use of pathways can lower the cost of care and that oncologist participation is a critical element for success. New Century Health (NCH), in partnership with a leading health plan and one of its Midwestern oncology networks, had two quality goals with the implementation of a chemotherapy prior authorization system: review all chemotherapy regimens for all patients and measure treatment plan adherence to evidence-based clinical pathways. Methods: As one component of a mandatory chemotherapy prior-authorization program, an online prior authorization system was used by oncology practices to submit chemotherapy treatment plans to NCH for approval. The system captured detailed patient clinical information and measured compendium and preferred pathway adherence rates. These data were shared with participating oncology practices on a quarterly basis. For analysis, an average Baseline compendium adherence rate was determined reflecting participating practices for six cancer diagnoses (Breast, Colon, Lung, Lymphoma, Multiple Myeloma, and Prostate). The Baseline rate was compared to the Review period rate. Results: A comparison of the Review and Baseline period metrics indicated a statistically significant increase in the level of compendium-based chemotherapy treatment plans submitted by participating providers. Conclusions: Implementation of an oncology prior authorization system that measures compendia-based adherence rates is associated with increased levels of evidence-based chemotherapy treatment plans by participating providers. [Table: see text]

scholarly journals Analysis of Helicobacter pylori’s Antibiotic Resistance Rate and Research on Its Eradication Treatment Plan

2021 ◽  
Vol 2021 ◽  
pp. 1-8
Author(s):  
Li Jiao ◽  
Junmin Wang ◽  
Huan Ma
Keyword(s):  
Drug Resistance ◽  
Helicobacter Pylori ◽  
Antibiotic Resistance ◽  
Treatment Plan ◽  
Drug Susceptibility ◽  
Resistance Rate ◽  
Clinical Isolates ◽  
Treatment Plans ◽  
H Pylori ◽  
The Right

How to choose the right plan is the key to treatment, and this must take into account the local eradication of Helicobacter pylori and the drug resistance of Helicobacter pylori. In order to better eradicate Helicobacter pylori, in the current clinical treatment process, most of the combined treatments of triple drugs are used, but the therapeutic effect is still not ideal. In addition, many studies have focused on changing the types and dosages of drugs, but they have not yet achieved good results. This paper combines experimental research to analyze the drug resistance rate of Helicobacter pylori and obtains gastric mucosal specimens of patients through gastroscopy to cultivate clinical isolates of H. pylori.. Furthermore, this study used the Kirby-Bauer drug susceptibility disc technique to determine the sensitivity of H. pylori clinical isolates to a range of regularly used clinical antibiotics, as well as a set of instances of H. pylori antibiotic resistance. Finally, this research integrates experimental analyses and various successful eradication treatment plans to provide a unique eradication treatment strategy.

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.

PO-1546 Quality of adaptive treatment plan on a 0.35 T MR-Linac

2021 ◽  
Vol 161 ◽  
pp. S1271
Author(s):  
I. Bessieres ◽  
A. Petitfils ◽  
L. Aubignac ◽  
O. Lorenzo ◽  
J. Boudet
Keyword(s):  
Treatment Plan ◽  
Adaptive Treatment

Assessing HIPAA Compliance of Open Source Electronic Health Record Applications

2021 ◽  
Vol 15 (2) ◽  
pp. 181-195
Author(s):  
Hossain Shahriar ◽  
Hisham M. Haddad ◽  
Maryam Farhadi
Keyword(s):  
Electronic Health Record ◽  
Open Source ◽  
Medical Decision ◽  
Patient Treatment ◽  
Health Record ◽  
Technical Requirements ◽  
Patient Health ◽  
Treatment Plans ◽  
Electronic Health ◽  
Quality In Healthcare

Electronic health record (EHR) applications are digital versions of paper-based patient health information. EHR applications are increasingly being adopted in many countries. They have resulted in improved quality in healthcare, convenient access to histories of patient medication and clinic visits, easier follow up of patient treatment plans, and precise medical decision-making process. The goal of this paper is to identify HIPAA technical requirements, evaluate two open source EHR applications (OpenEMR and OpenClinic) for security vulnerabilities using two open-source scanner tools (RIPS and PHP VulnHunter), and map the identified vulnerabilities to HIPAA technical requirements.

Willingness to Travel for Cellular Therapy: The Influence of Follow-Up Care Location, Oncologist Continuity, and Race

2021 ◽  
pp. OP.21.00312
Author(s):  
Zachary A. K. Frosch ◽  
Esin C. Namoglu ◽  
Nandita Mitra ◽  
Daniel J. Landsburg ◽  
Sunita D. Nasta ◽  
...  
Keyword(s):  
Travel Time ◽  
Cellular Therapy ◽  
Treatment Plan ◽  
Admission Rate ◽  
B Cell Lymphoma ◽  
Travel Times ◽  
Importance Weights ◽  
Follow Up Care ◽  
Treatment Plans

PURPOSE Patients weigh competing priorities when deciding whether to travel to a cellular therapy center for treatment. We conducted a choice-based conjoint analysis to determine the relative value they place on clinical factors, oncologist continuity, and travel time under different post-treatment follow-up arrangements. We also evaluated for differences in preferences by sociodemographic factors. METHODS We administered a survey in which patients with diffuse large B-cell lymphoma selected treatment plans between pairs of hypothetical options that varied in travel time, follow-up arrangement, oncologist continuity, 2-year overall survival, and intensive care unit admission rate. We determined importance weights (which represent attributes' value to participants) using generalized estimating equations. RESULTS Three hundred and two patients (62%) responded. When all follow-up care was at the center providing treatment, plans requiring longer travel times were less attractive ( v 30 minutes, importance weights [95% CI] of –0.54 [–0.80 to –0.27], –0.57 [–0.84 to –0.29], and –0.17 [–0.49 to 0.14] for 60, 90, and 120 minutes). However, the negative impact of travel on treatment plan choice was mitigated by offering shared follow-up (importance weights [95% CI] of 0.63 [0.33 to 0.93], 0.32 [0.08 to 0.57], and 0.26 [0.04 to 0.47] at 60, 90, and 120 minutes). Black participants were less likely to choose plans requiring longer travel, regardless of follow-up arrangement, as indicated by lower value importance weights for longer travel times. CONCLUSION Reducing travel burden through shared follow-up may increase patients' willingness to travel to receive cellular therapies, but additional measures are required to facilitate equitable access.

scholarly journals A Creature Called CIH: From a Quantum Explanation of Psychological Disorders to a Classical Limit of Behavior

2017 ◽  
Author(s):  
Saeideh Mohseni Nezhad
Keyword(s):  
Impulse Control ◽  
Classical Limit ◽  
Treatment Plan ◽  
Psychological Disorders ◽  
Conduct Disorders ◽  
Quantum Limit ◽  
Quantum Model ◽  
Quantum Field Theories ◽  
Treatment Plans ◽  
Suitable Treatment

The objective of this study is to present a Quantum Model for designing and predicting suitable treatment plans for different psychological disorders. The theory has been extracted from Quantum Field Theories and is modeled on a Conceptual Isolated Human (CIH), which is a totally abstract idea. The Quantum limit of the model explains the way disorders are formed, and its classical limit forecasts the observable CIH behavior. Then, a pattern has been presented for treatment plans based on the CIH Quantum Model, which is named ‘Systematic Balancing’. Finally, Systematic Balancing is presented in this article in order to explain and predict the treatment plan for the category of 'Disruptive, Impulse-Control, and Conduct Disorders in DSM-5'.

scholarly journals The Relationship between Palatal Displacement of Upper Canines and Incisors Widths in a Syrian Sample of Patients with Uncrowded Arches

2015 ◽  
Vol 16 (11) ◽  
pp. 873-875 ◽  
Author(s):  
Luai Mahaini
Keyword(s):  
Orthodontic Treatment ◽  
Matched Control ◽  
Control Sample ◽  
Tooth Size ◽  
Orthodontic Patients ◽  
Treatment Plans ◽  
The Right ◽  
The Relationship ◽  
Mandibular Incisors ◽  
Dental Casts

ABSTRACT The aim of this study investigates mesiodistal crown size of the maxillary and mandibular incisors of patients with palatally impacted canines (PDC). Pretreatment dental casts of orthodontic patients with PDC of one or both maxillary canines (N: 33) were collected. This PDC sample was matched according to age and sex with pretreatment dental casts from unaffected orthodontic patients. For the PDC and matched control samples, maximum mesiodistal crown diameters were recorded for the four incisors on the right side only. The results showed that, on average, the mesiodistal crown diameters for the maxillary and mandibular incisors measured smaller in the PDC sample than in the control sample. These findings of statistically significant tooth-size reductions associated with PDC occurrence indicate a generalized pattern of reduced tooth size as a characteristic associated with the PDC anomaly. Further, the presence of generalized tooth-size reduction in cases with palatally displaced canines help explain why most orthodontic treatment plans for PDC patients are of the nonextraction type. How to cite this article Mahaini L. The Relationship between Palatal Displacement of Upper Canines and Incisors Widths in a Syrian Sample of Patients with Uncrowded Arches. J Contemp Dent Pract 2015;16(11):873-875

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