Strategies Used to Support Peer Provision in Mental Health: A Scoping Review.

The employment of peer providers (people who draw on their lived experience of mental health challenges) has grown in conjunction with the increased acceptance of recovery as a key principle in mental health policy and practice. Barriers to the integration of peer providers in mental health services have been well documented. This review addresses an under-explored area by consolidating strategies undertaken by mental health organizations for the successful implementation of peer provision. A scoping review was chosen to facilitate the rapid summary and dissemination of research findings that are relevant to policymakers and practitioners. Peer-reviewed articles and grey literature were sourced from three databases, key peer support websites and a hand search of the included studies. Following screening, data were extracted from 28 studies: 25 qualitative and three mixed methods studies. The data were analyzed using thematic analysis and organized into themes. Four themes emerged from the data. Championing of peer provision initiatives by organizational leadership is central to the success and sustainability of peer provision. Leadership undergirds three strategies that were discussed: organizational preparation, recruitment, training and induction, and support and development. When peer provision is championed by organizational leadership, measures can be undertaken to prepare the organization for peer provision; recruit, train and induce peer providers successfully into the organization; and support peer providers on the job.

Organisational contexts and practice developments in mental health peer provision in Western Australia.

PURPOSE: Over the past decade, the push for recovery-oriented services has birthed a growth in the recruitment of peer providers in mental health services: Persons who live with and manage their mental health challenges and are employed to support persons currently using mental health services. The aim of this paper is to compare the responses of government and non-government organisations to the implementation of peer provision. DESIGN/METHODOLOGY/APPROACH: Employing a qualitative study design, 15 people who supervised peer providers or who were strategically involved in peer provision were recruited using snowball sampling. Participants completed an in-depth interview that explored how peer provision services operated at their organisation and factors that shaped the way peer provision operates. The interviews were transcribed and analysed using Moore's Strategic Triangle. Synthesised member checking and researcher triangulation ensued to establish trustworthiness. FINDINGS: The way in which peer provision operated sat along a continuum ranging from adoption (where practices are shaped by the recovery ethos) to co-option (where recovery work may be undertaken, but not shaped by the recovery ethos). Political and legal mandates that affected the operational capacities of each organisation shaped the way peer provision services operated. RESEARCH LIMITATIONS/IMPLICATIONS: The findings of the study highlight the need to reconsider where peer provision services fit in the mental health system. Research investigating the value of peer provision services may attract the support of funders, service users and policy makers alike. ORIGINALITY/VALUE: In employing Moore's strategic triangle to evaluate the alignment of policy (the authorising environment) with the operational capacity and practice of peer provision services (the task environment), this study found that organisational response to peer provision is largely influenced by political and legal mandates externally. The successful implementation of peer provision is mediated by effective supervision of peer providers.

COMP report: CPQR technical quality control guideline for medical linear accelerators and multileaf collimators.

The Canadian Organization of Medical Physicists (COMP), in close partnership with the Canadian Partnership for Quality Radiotherapy (CPQR) has developed a series of Technical Quality Control (TQC) guidelines for radiation treatment equipment. These guidelines outline the performance objectives that equipment should meet in order to ensure an acceptable level of radiation treatment quality. The TQC guidelines have been rigorously reviewed and field tested in a variety of Canadian radiation treatment facilities. The development process enables rapid review and update to keep the guidelines current with changes in technology (the most updated version of this guideline can be found on the CPQR website). This particular TQC details recommended quality control testing for medical linear accelerators and multileaf collimators.

Automated prediction of dosimetric eligibility for hypofractionated prostate radiotherapy.

Clinical implementation of hypofractionated prostate radiotherapy (PROFIT trial, NCT003046759) represents an opportunity to significantly reduce the burden of treatment on the patient and clinic. However, efficacy was only demonstrated among the patient demographic who could meet the trial dose constraints and so it is necessary to emulate this triage step in clinical practice. The purpose of this study was to build a convenient tool to address the challenge of determining patient eligibility for hypofractionated treatment within the clinic. The tool was implemented within the EclipseTM treatment planning system using the scripting environment. Prior to planning a new case, the script computes and displays in a plot the fractional overlap of rectal and bladder wall with the planning target volume. Radial decision boundaries separate the plot into three zones and the new case is then classified as "feasible", "uncertain", or "not feasible". The radial decision boundaries were derived from a retrospective analysis of the overlap values and dosimetric eligibility of 150 patients with intermediate risk prostate cancer. Two-fold cross validation with repetitions demonstrated an average prediction accuracy of over 90%. The tool has been integrated into our clinical planning workflow to enable early identification of the need for planning consults and rapid a-priori determination of dosimetric eligibility for hypofractionated radiotherapy. The tool can be readily adopted by other centres since the underlying metrics can be evaluated without scripting if desired.

Consistency of Organ Geometries during Prostate Radiotherapy with Two Different Bladder and Bowel Regimens.

BACKGROUND: The majority of Ontario cancer centres incorporate bladder and bowel preparation protocols for the treatment of prostate cancer with radical radiotherapy. Differing methods are used to achieve a full bladder and empty rectum for planning and treatment. We compared the effects of two different bladder and bowel preparation regimens on bladder, rectum, and prostate +/- seminal vesicle geometries through a course of radiotherapy. An optimal preparation would achieve reliable spatial arrangements and a high therapeutic ratio. METHODS: This prospective longitudinal study involved 59 prostate cancer patients treated with radical radiotherapy, of which half followed cohort 1 (laxative cohort) and the other cohort 2 (consistent timing cohort) bladder and bowel preparation regimen. Participants were asked to maintain an empty rectum for both planning and daily treatment appointments in cohort 1 through a fleet enema the morning of the planning appointment, and intake milk of magnesium during daily treatments. No specific bowel preparation was provided to cohort 2 patients. Instead, their appointment times were aligned with their natural bowel habits. This information was collected through a prescreening tool before treatment booking. All cohort 1 and 2 participants were asked to drink 250 mL of water 1 hour before planning and daily treatment appointments. Cohort 2 participants who identified no pre-existing urinary conditions were also asked to drink 2 L of water within 24 hours before the planning session and to continue this during treatment trajectory unless unable to do so because of treatment-induced bladder toxicities later in the treatment. A total of 1,335 structures (bladder, rectum +/- gas, and prostate +/- seminal vesicles) were contoured on the cone beam computerized tomography scans by three radiotherapists. A stringent quality assurance process was performed to assure quality and consistency of contours. Organ volumes were measured and evaluated for consistency over time from planning to completion of radiotherapy. Data analysis included the Fischer exact test and mixed effect modelling for total and subvolumes for bladder, rectum, rectal gas, and prostate +/- seminal vesicles. RESULTS: Baseline total volumes for bladder ranged from 132 mL to 501 mL with means of 325 mL and 315 mL in cohorts 1 and 2, respectively. Bladder volume declined 3.6 mL per fraction and 2.4 mL per fraction in cohorts 1 and 2, respectively. The volume of the bladder structure inside the planning target volume (PTV) on simulation showed no difference by cohort (P = .095) but there was an effect of time (linear P < .0005). Baseline total volumes for rectum ranged from 19.2 mL to 106.3 mL with means of 52.0 mL and 54.7 mL in cohorts 1 and 2, respectively. The volume of the rectum inside the PTV on simulation showed no difference by cohort (P = .12) or time (P = .30) during the treatment course. Volume of gas in the rectum did not vary by cohort (P = .6) or time (P = .08). Baseline total volumes for the clinical prostate +/- seminal vesicles target ranged from 37.1 mL to 167.5 mL with means of 76.2 mL and 66.0 mL in cohorts 1 and 2, respectively. The clinical target decreased by 3% in total volume during the course of radiotherapy in both cohorts, with similar rates of the target falling outside the planned PTV structure. CONCLUSIONS: No significant difference was found between cohorts for rectal volume, gas volume, target coverage, and rectal and bladder volumes in the PTV. Hence, patients should be offered a choice between cohort 1 and 2 bowel preparation regimens to allow for patient preference customization. Cohort 2 bladder preparation regimen was shown to be superior for consistency with slightly larger volume over time.

A method to analyze the cord geometrical uncertainties during head and neck radiation therapy using cone beam CT.

We developed a method to analyze quantitatively the residual cord geometrical uncertainties after image registration during head and neck radiation therapy by using sequential cone beam CT (CBCT). The geometrical centroid line of cervical spinal canal was computed to serve as a cord surrogate. We found that the cord motions were non-uniform from C1 to C6, and that the patterns of motion were variable across patients. This method has potential applications in monitoring cord setup accuracy and in designing treatment margins.

Calcifications are potential surrogates for prostate localization in image-guided radiotherapy.

PURPOSE: To investigate the feasibility of using calcifications as surrogates for the prostate position during cone-beam computed tomography (CBCT) image-guided radiotherapy. METHODS AND MATERIALS: The twice-weekly CBCT images taken during the treatment course of 4 patients were retrospectively studied for the stability of the calcifications. The geometric center of three fiducial markers was used as the reference. The planning CT images of 131 prostate patients recently treated with external beam radiotherapy at our center were reviewed to estimate the calcification occurrence rate. Analysis was conducted using the Varian Eclipse treatment planning system. Two patients were treated using prostate calcifications as the landmark in on-line registration. Both the Varian standard and the low-dose CBCT modes were used for imaging. RESULTS: The calcifications were found to be stable during the treatment course. At the 95% confidence interval, the difference between the distance from an identified calcification to the fiducial markers on CBCT and the distance on the planning CT scans was 0.2 +/- 2.0 mm, 0.8 +/- 2.2 mm, and 0.4 +/- 2.4 mm in the left-right, anteroposterior, and superoinferior direction, respectively. Of the 131 patients, 46 (35%) had well-defined calcifications either inside the prostate or near the borders. Our experience in treating the first 2 patients demonstrated that the calcifications are easily distinguished on low-dose scans and that calcification registration can be precisely performed. CONCLUSION: The results of our study have shown that calcifications can be reliable markers of prostate position and allow for precise image guidance with a low-imaging dose. With this approach, potentially about one-third of prostate patients could benefit from precise image guidance without the invasive use of markers.