Determining Clinical Patient Selection Guidelines for Head and Neck Adaptive Radiation Therapy Using Random Forest Modelling and a Novel Simplification Heuristic.

PURPOSE: To determine which head and neck adaptive radiotherapy (ART) correction objectives are feasible and to derive efficient ART patient selection guidelines. METHODS: We considered various head and neck ART objectives including independent consideration of dose-sparing of the brainstem/spinal cord, parotid glands, and pharyngeal constrictor, as well as prediction of patient weight loss. Two-hundred head and neck cancer patients were used for model development and an additional 50 for model validation. Patient chart data, pre-treatment images, treatment plans, on-unit patient measurements, and combinations thereof were assessed as potential predictors of each objective. A stepwise approach identified combinations of predictors maximizing the Youden index of random forest (RF) models. A heuristic translated RF results into simple patient selection guidelines which were further refined to balance predictive capability and practical resource costs. Generalizability of the RF models and simplified guidelines to new data was tested using the validation set. RESULTS: Top performing RF models used various categories of predictors, however, final simplified patient selection guidelines only required pre-treatment information for ART predictions, indicating the potential for significant ART process streamlining. The simplified guidelines for each objective predicted which patients would experience increases in dose to: brainstem/spinal cord with sensitivity = 1.0, specificity = 0.66; parotid glands with sensitivity = 0.82, specificity = 0.70; and pharyngeal constrictor with sensitivity = 0.84, specificity = 0.68. Weight loss could be predicted with sensitivity = 0.60 and specificity = 0.55. Furthermore, depending on the ART objective, 28%-58% of patients required replan assessment, less than for previous studies, indicating a step towards more effective patient selection. CONCLUSIONS: The above ART objectives appear to be practically achievable, with patients selected for ART according to simple clinical patient selection guidelines. Explicit ART guidelines are rare in the literature, and our guidelines may aid in balancing the potential clinical gains of ART with high associated resource costs, formalizing ART trials, and ensuring the reproducibility of clinical successes.

A comparison of long-term clinical outcomes of accelerated partial breast irradiation using interstitial brachytherapy as per GEC-ESTRO, ASTRO, updated ASTRO, and ABS guidelines.

PURPOSE: The purpose of this study is to evaluate long-term clinical outcomes of women treated with accelerated partial breast irradiation (APBI) using multicatheter interstitial brachytherapy (MIB-APBI) with risk groups defined by Groupe Européen de Curie-thérapie and the European Society for Radiotherapy & Oncology (GEC-ESTRO), American Society for Radiation Oncology (ASTRO), updated ASTRO, and American Brachytherapy Society (ABS) guidelines and to elucidate the most appropriate guideline that could differentiate outcomes among its risk groups. METHODS AND MATERIALS: Two hundred forty women underwent MIB-APBI during July 2000 to March 2013. Comparisons of long-term clinical outcomes (local control [LC], disease-free survival [DFS], cause-specific survival [CSS], and overall survival [OAS]) stratified by the risk groups proposed by the aforementioned patient selection guidelines were carried out on a prospectively maintained database. RESULTS: At a median follow-up of 114 months, 10-year LC, DFS, and OAS were 90%, 81%, and 83.5%, respectively, for the entire group. There was no statistically significant difference in the LC rates for risk groups by ESTRO, ASTRO, updated ASTRO and ABS guidelines. The 10-year DFS and OAS for GEC-ESTRO low-, intermediate-, and high-risk group was 75%, 88%, and 60% (p = 0.02) and 86%, 93%, and 62% (p = 0.001), respectively. Ten-year DFS and OAS in the ABS 2018-acceptable and ABS 2018-unacceptable group were 78% and 67% (p = 0.01) and 88% and 69% (p = 0.001), respectively. No significant difference in any of the outcomes was observed with risk groups suggested by ASTRO or updated ASTRO consensus guidelines. CONCLUSIONS: None of the current patient selection guidelines for APBI could differentiate LC (main APBI endpoint) among its risk groups, whereas GEC-ESTRO and ABS guideline could differentiate DFS and OAS.

Research on the doctoral application review system of medical university — based on Capital Medical University / 中华医学教育探索杂志

Based on the data obtained from the questionnaire survey and personal in-depth interviews,this study preliminarily formulated the "selection guidelines for the doctoral application review system of Capital Medical University"(draft).In addition,through Delphi method and chi-square test,the author formulated the "selection guidelines for the doctoral application review system of Capital Medical University".The guide contained four primary indicators of scientific literacy,academic ability,scientific research ability and personality quality and 27 secondary indicators.The respondents generally believed that quality,ability and moral character were the core contents of the doctoral selection guide.The doctoral advisors attached great importance to the personality quality of the applicants while having high requirements on the quality and ability.Meanwhile,the doctoral advisors also had high requirements on the scientific research ability of doctoral students in professional degrees.

Research on the doctoral application review system of medical university—based on Capital Medical University / 中华医学教育探索杂志

Based on the data obtained from the questionnaire survey and personal in-depth interviews, this study preliminarily formulated the "selection guidelines for the doctoral application review system of Capital Medical University" (draft). In addition, through Delphi method and chi-square test, the author formulated the "selection guidelines for the doctoral application review system of Capital Medical University". The guide contained four primary indicators of scientific literacy, academic ability, scientific research ability and personality quality and 27 secondary indicators. The respondents generally believed that quality, ability and moral character were the core contents of the doctoral selection guide. The doctoral advisors attached great importance to the personality quality of the applicants while having high requirements on the quality and ability. Meanwhile, the doctoral advisors also had high requirements on the scientific research ability of doctoral students in professional degrees.

Pragmatic, consensus-based minimum standards and structured interview to guide the selection and development of cancer support group leaders: a protocol paper.

INTRODUCTION: Across the globe, peer support groups have emerged as a community-led approach to accessing support and connecting with others with cancer experiences. Little is known about qualities required to lead a peer support group or how to determine suitability for the role. Organisations providing assistance to cancer support groups and their leaders are currently operating independently, without a standard national framework or published guidelines. This protocol describes the methods that will be used to generate pragmatic consensus-based minimum standards and an accessible structured interview with user manual to guide the selection and development of cancer support group leaders. METHODS AND ANALYSIS: We will: (A) identify and collate peer-reviewed literature that describes qualities of support group leaders through a systematic review; (B) content analyse eligible documents for information relevant to requisite knowledge, skills and attributes of group leaders generally and specifically to cancer support groups; (C) use an online reactive Delphi method with an interdisciplinary panel of experts to produce a clear, suitable, relevant and appropriate structured interview comprising a set of agreed questions with behaviourally anchored rating scales; (D) produce a user manual to facilitate standard delivery of the structured interview; (E) pilot the structured interview to improve clinical utility; and (F) field test the structured interview to develop a rational scoring model and provide a summary of existing group leader qualities. ETHICS AND DISSEMINATION: The study is approved by the Department Human Ethics Advisory Group of The University of Melbourne. The study is based on voluntary participation and informed written consent, with participants able to withdraw at any time. The results will be disseminated at research conferences and peer review journals. Presentations and free access to the developed structured interview and user manual will be available to cancer agencies.