Multi-institutional evaluation of a Pareto navigation guided automated radiotherapy planning solution for prostate cancer

\ua9 The Author(s) 2024.Background: Current automated planning solutions are calibrated using trial and error or machine learning on historical datasets. Neither method allows for the intuitive exploration of differing trade-off options during calibration, which may aid in ensuring automated solutions align with clinical preference. Pareto navigation provides this functionality and offers a potential calibration alternative. The purpose of this study was to validate an automated radiotherapy planning solution with a novel multi-dimensional Pareto navigation calibration interface across two external institutions for prostate cancer. Methods: The implemented ‘Pareto Guided Automated Planning’ (PGAP) methodology was developed in RayStation using scripting and consisted of a Pareto navigation calibration interface built upon a ‘Protocol Based Automatic Iterative Optimisation’ planning framework. 30 previous patients were randomly selected by each institution (IA and IB), 10 for calibration and 20 for validation. Utilising the Pareto navigation interface automated protocols were calibrated to the institutions’ clinical preferences. A single automated plan (VMATAuto) was generated for each validation patient with plan quality compared against the previously treated clinical plan (VMATClinical) both quantitatively, using a range of DVH metrics, and qualitatively through blind review at the external institution. Results: PGAP led to marked improvements across the majority of rectal dose metrics, with Dmean reduced by 3.7 Gy and 1.8 Gy for IA and IB respectively (p < 0.001). For bladder, results were mixed with low and intermediate dose metrics reduced for IB but increased for IA. Differences, whilst statistically significant (p < 0.05) were small and not considered clinically relevant. The reduction in rectum dose was not at the expense of PTV coverage (D98% was generally improved with VMATAuto), but was somewhat detrimental to PTV conformality. The prioritisation of rectum over conformality was however aligned with preferences expressed during calibration and was a key driver in both institutions demonstrating a clear preference towards VMATAuto, with 31/40 considered superior to VMATClinical upon blind review. Conclusions: PGAP enabled intuitive adaptation of automated protocols to an institution’s planning aims and yielded plans more congruent with the institution’s clinical preference than the locally produced manual clinical plans

Farmers' bulletin (United States. Dept. of Agriculture); no. 840

This bulletin describes methods for raising sheep to farmers who have no experience with sheep. Topics discussed include flock size, breeding, seasonal care and behaviors, and the lambing season

Characterization of Errors Detected During Central Order Review

ABSTRACTCharacterization of prescribing errors detected by dispensary pharmacists in a tertiary-care teaching hospital is described. During the 25 week study period, 1330 prescribing errors were identified from a total of 237,798 medication orders processed by the pharmacy, representing a rate of 5.6 errors per 1000 orders. Resident physicians wrote more errant medication orders than any other physician class. Errors most often occurred on the general medicine teaching wards. The most common drug classes implicated were non-formulary medications and antibiotics.Approximately 11 % of errors were defined as potentially fatal or severe (Type A) errors, 7% were potentially serious (Type B), 21 % were potentially significant (Type C) and 61 % were problem orders (Type D) based on a classification system of severity. The most common error types were inappropriate dosing of antibiotics and the prescribing of medications for patients who had a potential conflicting allergy history. The acceptance of pharmacists' suggestions was 67%. The study identified three major areas where future educational and corrective measures could be aimed: adherence to the formulary, antibiotic prescribing and allergy validation.RÊSUMÉSuit une analyse descriptive des erreurs de prescription décelées par les pharmaciens du dispensaire d'un hôpital universitaire de soins tertiaires. Au cours des 25 semaines qu'a durée l'étude, on a relevé 1 330 erreurs de prescription sur les 237 798 ordonnances traitées, soit un taux de 5,6 erreurs pour 1 000 ordonnances. Les médecins résidents font plus d'erreurs que leurs collègues. Les erreurs surviennent le plus fréquemment dans les services où l'on enseigne la médecine générale. Les médicaments  les plus couramment concernés sont les médicaments ne faisant pas partie du formulaire et les antibiotiques. Environ 11 % des erreurs peuvent être qualifiées de potentiellement fatales ou graves (type A), 7 % de potentiellement graves (type B), 21 % de potentiellement dangereuses (type C) et 61% de problématiques (type D), conformént au système de classification des erreurs selon leur gravité retenu. Les erreurs les plus courantes consiste en posologies inappropriées d'antibiotiques et en prescriptions de médicaments à des malades qui peuvent y être allergiques. Dans 67 % des cas, le médecin a accepté la suggestion du pharmacien. L'étude a identifié trois secteurs majeurs où il faudrait prendre des mesures correctrices ou procéder à une sensibilisation : le respect du formulaire, la prescription des antibiotiques et la vérification des allergies

CaseStudy Report: Implementing Climate Change Adaptation in the Dame Pattie Menzies Centre

The case study report is a co-developed research output between researchers at RMIT University and individuals from the Dame Pattie Menzies Centre (DPMC) which was funded by the Victorian Government through VCCCAR. The report was produced as part of a project entitled 'Implementing tools to increase adaptive capacity in the community and natural resources management sectors' which has been conducted to gain a better understanding of the adaptation capabilities and needs of three types of government service providers and funded agencies. The report describes six months of action research where climate change adaptation tools were tested and implemented with the Dame Pattie Menzies Centre, one of five organisations that participated in the research. It explains the chosen tool, the implementation of the tool and what the organisations learnt during the research process

Farm sheep raising for beginners /

no.840 (1917