Prescription Schemes Research Articles

Hybrid ultra-high and conventional dose rate treatments with electrons and photons for the clinical transfer of FLASH-RT to deep-seated targets: A treatment planning study

PurposeThis study explores the dosimetric feasibility and plan quality of hybrid ultra-high dose rate (UHDR) electron and conventional dose rate (CDR) photon (HUC) radiotherapy for treating deep-seated tumours with FLASH-RT. MethodsHUC treatment planning was conducted optimizing a broad UHDR electron beam (between 20–250 MeV) combined with a CDR VMAT for a glioblastoma, a pancreatic cancer, and a prostate cancer case. HUC plans were based on clinical prescription and fractionation schemes and compared against clinically delivered plans. Considering a HUC boost treatment for the glioblastoma consisting of a 15-Gy-single-fraction UHDR electron boost supplemented with VMAT, two scenarios for FLASH sparing were assessed using FLASH-modifying-factor-weighted doses. ResultsFor all three patient cases, HUC treatment plans demonstrated comparable dosimetric quality to clinical plans, with similar PTV coverage (V95% within 0.5 %), homogeneity, and critical OAR-sparing. At the same time, HUC plans delivered a substantial portion of the dose to the PTV (Dmedian of 50–69 %) and surrounding tissues at UHDR. For the HUC boost treatment of the glioblastoma, the first FLASH sparing scenario showed a moderate FLASH sparing magnitude (10 % for D2%,PTV) for the 15-Gy UHDR electron boost, while the second scenario indicated a more substantial sparing of brain tissues inside and outside the PTV (32 % for D2%,PTV, 31 % for D2%,Brain). ConclusionsFrom a planning perspective, HUC treatments represent a feasible approach for delivering dosimetrically conformal UHDR treatments, potentially mitigating technical challenges associated with delivering conformal FLASH-RT for deep-seated tumours. While further research is needed to optimize HUC fractionation and delivery schemes for specific patient cohorts, HUC treatments offer a promising avenue for the clinical transfer of FLASH-RT.

Stereotactic body radiotherapy for spinal oligometastases: a survey on patterns of practice on behalf of the Italian Association of Clinical Oncology and Radiotherapy (AIRO).

The Study Group for the Biology and Treatment of the OligoMetastatic Disease on behalf of the Italian Association of Radiotherapy and Clinical Oncology (AIRO) has conducted a national survey with the aim to depict the current patterns of practice of stereotactic body radiotherapy (SBRT) for spinal oligometastases. The Surveymonkey platform was used to send a 28-items questionnaire focused on demographic, clinical and technical aspects related to SBRT for spinal oligometastases. All the AIRO members were invited to fill the questionnaire. Data were then centralized to a single center for analysis and interpretation. 53 radiation oncologists from 47 centers fulfilled the survey. A complete agreement was observed in proposing SBRT for spinal oligometastases, with the majority considering up to 3 concurrent spine oligometastases feasible for SBRT (73.5%), regardless of spine site (70%), vertebral segment (85%) and morphological features of the lesion (71.7%). Regarding dose prescription, fractionated regimens resulted as the preferred option, either in 3 (58.4%) or five sessions (34%), with a substantial agreement in applying a PTV-margin larger than 1mm (almost 90% of participants), and ideally using both MRI and PET imaging to improve target volume and organs-at-risk delineation (67.9%). This national italian survey illustrates the patterns of practice and the main issues for the indication of SBRT for spinal oligometastases. A substantial agreement in the numerical cut-off and vertebral segment involved for SBRT indication was reported, with a slight heterogeneity in terms of dose prescription and fractionation schemes.

Social Prescribing Schemes in Primary Care in Spain (EvalRA Project): a mixed-method study protocol to build an evaluation model

BackgroundSocial Prescribing is a Primary Health Care service that provides people with non-clinical care alternatives that may have an impact on their health. Social Prescribing can be more or less formal and structured.Social Prescribing Schemes are formal Social Prescribing of health assets by Primary Health Care teams in coordination and follow-up of patients with providers.The emerging evidence suggests that this service can improve people’s health and well-being, create value and provide sustainability for the healthcare system. However, some evaluations note that the current evidence regarding social prescribing is insufficient and needs further investigation.The EvaLRA project aims to elaborate an evaluation model of Social Prescribing Schemes in Primary Health Care based on a set of structure, process, and outcomes indicators.MethodsIn the region of Aragon, the Community Health Care Strategy aims to promote the development of social prescription schemes in Primary Health Care teams.This study is divided into two stages. Stage 1: identification of primary health care teams that implement social prescribing schemes and establish a first set of indicators to evaluate social prescribing using qualitative consensus techniques with experts. Stage 2 evaluation of the relevance, feasibility and sensitivity of selected indicators after 6 and 12 months in primary health care teams. The results will provide a set of indicators considering structure, process and outcomes for social prescribing schemes.DiscussionCurrent evaluations of the application of social prescribing schemes use different criteria and indicators. A set of agreed indicators and its piloting in primary health care teams will provide a tool to evaluate the implementation of social prescription schemes. In addition, the scorecard created could be of interest to other health systems in order to assess the service and improve its information system, deployment and safety.

ВЛИЯНИЕ ИММУНОМОДУЛИРУЮЩЕЙ ТЕРАПИИ С ИСПОЛЬЗОВАНИЕМ ДЕЗОКСИРИБОНУКЛЕАТА НАТРИЯ НА МИКРОБИОТУ РОТОГЛОТКИ У ДЕТЕЙ C РЕКУРРЕНТНЫМИ РЕСПИРАТОРНЫМИ ИНФЕКЦИЯМИ В ВОЗРАСТЕ 1–6 ЛЕТ

Respiratory infections are one of the leading diseases currently and almost 2/3 of these infectious processes occur in childhood. The pathogenesis of recurrent respiratory infections is based on the failure of the links of the immune system, mainly caused by a violation of the immune homeostasis of the mucous membranes of the nasopharynx and oropharynx. The purpose of this research was to determine the effect of the immunomodulatory therapy using sodium deoxyribonucleate on the microbiota of the oropharynx in children with recurrent respiratory infections. A single-center randomized placebo-controlled closed experimental study was performed in 90 pediatric patients with recurrent respiratory infections aged 1 to 6 y/o in May 2021-Nov. 2021 on the basis of the private medical center “Center for Modern Pediatrics” located in Voronezh, Russia. The main group consisted of 46 (23 boys and 23 girls aged 4 [3; 5] y/o) who had been given the sodium deoxyribonucleate drug nasally for 30 days. The control group of 44 (22 boys and 22 girls aged 4 [3; 5] y/o) had been given a placebo (a sterile 0.1% sodium chloride fluid) according to the same prescription scheme. The concentration of secretory immunoglobulin was determined by the enzyme immunoassay; the composition of the microbiota was studied by the genetic sequencing of the 16S ribosomal RNA gene. All of the participants in both groups were examined twice: at the start of the study and 90 days after. A statistically significant decrease in the relative amount of Proteobacteria and an increase in the relative amount of Firmicutes and Actinobacteriota, an increase in the concentration of sIgA was found against the background of the use of the drug, which in tis turn indicates an increase in the activity of mucosal immunity (p<0.001). Conclusion: thus, the use of sodium deoxyribonucleate in children aged 1 to 6 years old with recurrent respiratory infections leads to a statistically significant decrease in the relative amount of Proteobacteria and an increase in the relative amount of Firmicutes and Actinobacteriota in the oropharynx; increased activity of mucosal immunity, as evidenced by an increase in the concentration of sIgA.

Предпочтения практикующих российских врачей-офтальмологов при определении стратегии лечения пациентов с первичной открытоугольной глаукомой (результаты многоцентрового научно-аналитического исследования)

The aim of the study was to establish the preferences of domestic ophthalmologists in the selection of prescribing schemes and approaches in the treatment of patients with different stages of primary open-angle glaucoma (POAG). The results of a questionnaire survey of 472 ophthalmologists conducted during the period from August to November 2022 were analyzed. The main part of the questionnaire contained questions concerning the preferences of specialists in selecting the tactics of treatment of patients with glaucoma, for example, treatment schemes for patients with different stages of POAG, including priorities of particular prescriptions (groups of drugs and other approaches), details of current clinical practice — patients' compliance with the prescribed treatment and its cost, expediency of using combined antiglaucoma drugs in the form of their fixed combinations (FC), as well as preservative-free drugs. It was established that 328 (69.5%) ophthalmologists prefer to use the possibility of combined mechanism of action of antiglaucoma hypotensive drugs, 92 (19.5%) - the possibility of targeted influence on uveoscleral outflow. In patients with the initial stage of glaucoma the prescription of monotherapy with the use of prostaglandin analogs (PGAs) is used, in persons with the advanced stage of glaucoma the priority in the prescription of combined forms of drugs is determined, and at the highly advanced stage of the disease surgical treatment is performed. Polypragmasy in prescriptions of antiglaucoma topical drugs impedes effective treatment, and in this regard, ¾ of respondents were in favor of a more active use of FC drugs, considering their use more justified to achieve the goal of treatment than the use of separate prescription schemes. The use of preservative-free forms of drugs allows to keep the ocular surface of glaucoma patients intact for a long time, to predict the results of the expected (and imminent) surgical treatment and to increase the compliance to treatment. The results of the study indicate a confident adherence of ophthalmologists to the guidelines of current clinical recommendations when choosing drug regimens and treatment regimens in patients with different stages of glaucoma.

Knowledge-Based Treatment Planning Model Improves Organ-at-Risk Sparing and Plan Consistency across Clinics for Prostate Radiation Therapy

<h3>Purpose/Objective(s)</h3> The quality of volumetric modulated arc therapy (VMAT) plans highly depends on the planner's preference and experience. A commercially available knowledge-based planning (KBP) module has been widely implemented to estimate the patient-specific optimal dose-volume histogram and enable semi-automatic treatment planning. The purpose of this study was to investigate whether the KBP clinical implementations have improved organ-at-risk (OAR) sparing and plan quality consistency across clinics within our institution for prostate cancer VMAT treatments. <h3>Materials/Methods</h3> A cohort of 1,484 prostate cancer VMAT treatment plans delivered across three different clinics within our institution from January 2016 to January 2022 were retrospectively identified. The prescription (Rx) schemes of 45 Gy and 70 Gy were selected for statistical investigations since these were the only Rx schemes containing more than 50 VMAT plans created with KBP models. Dosimetric parameters of the bladder, rectum, left/right femoral heads, penile bulb, and volume ratio of 50% isodose line to PTV (R50) were extracted. <h3>Results</h3> Since its first adoption in the last quarter of 2018, KBP planning remained at a low application rate from 0% to 20.0% in each quarter. After publishing KBP models clinically at the beginning of 2021, the application rate of prostate KBP models raised to levels from 53.5% to 71.0% in each quarter. For the 70 Gy Rx scheme, parameters of R50 (w/ KBP: 3.67±4.35 vs w/o KBP: 4.17±6.25, <i>p</i>=0.009), bladder (V_40Gy: 25.49%±13.02% vs 30.50%±16.52%, <i>p</i>=0.002; D_mean: 26.47±9.17 Gy vs 30.51±10.11 Gy, <i>p</i>=0.003) and rectum (V_45Gy: 17.45%±9.25% vs 25.23%±10.40%, <i>p</i><0.001; D_mean: 25.41±5.97 Gy vs 30.59±6.77 Gy, <i>p</i><0.001) were all statistically significantly improved with KBP planning. For the 45 Gy Rx scheme, the results were consistent with the 70 Gy Rx scheme. Across the three different clinics, the investigated parameters became more consistent after the adoption of KBP planning (e.g., bladder D_mean in Gy, w/ KBP: 27.52±10.21, 26.47±9.15 and 31.10±9.83 for clinic 1, 2 and 3, respectively, <i>p</i>₁₂=0.646, <i>p</i>₁₃=0.276, <i>p</i>₂₃=0.453; w/o KBP: 28.03±12.52, 27.02±13.97 and 39.85±23.27 for clinic 1, 2 and 3, respectively, <i>p</i>₁₂=0.425, <i>p</i>₁₃<0.001, <i>p</i>₂₃<0.001). This indicates that, with KBP implementations, we have achieved improved OAR-sparing across the institution as well as increased levels of plan quality standardization. <h3>Conclusion</h3> This study demonstrated that KBP models could improve OAR sparing and plan quality consistency across clinics for prostate VMAT radiation therapy. Clinical adoptions of KBP could potentially reduce inter-planner variations and facilitate the standardization of VMAT treatment planning.

Pilot Feasibility Assessment of a Tailored Physical Activity Prescription in Overweight and Obese People in a Public Hospital.

We aimed to evaluate the feasibility of a tailored physical activity (PA) prescription in overweight and obese people in a tertiary hospital in Lima, Peru. A feasibility pre–post-pilot study was conducted using mixed methods. Participants received a tailored prescription scheme for PA that lasted twelve weeks. It included two prescription sessions, three follow-up phone calls, and three evaluations. Primary feasibility outcomes were recruitment, visits, and phone call adherence. Primary intervention outcomes were self-reported PA levels and the 6 min walk test. Out of 228 people invited to participate, 30 were enrolled and received the first session of prescription, 11 went to the second session, and 21 went to the final evaluation; phone call participation decreased progressively during follow-up. There were no differences in the 6th week and the 12th week compared to the baseline for all the measures, except in the 6 min walk test. The participants considered the intervention was well designed, but they suggested complementing it with dietary instructions. The prescription of PA in overweight and obese people is feasible for promoting PA, but its implementation requires refinements to anticipate possible barriers to changing behavior.

Towards the social prescription of the arts: The arts in health and social care in Malta

Recently, the notion of arts as therapy has been of growing interest to sociologists. The aim of this article is to evaluate community-based arts funded projects in terms of their priorities and effectiveness and discuss possibilities for enabling Arts on Prescription schemes in Malta. Thematically, this article explores discourse on the potential of the arts on promoting well-being. Methodologically, this article draws on primary data collected from focus groups, interviews and an online survey with project leaders and artists of funded arts projects targeting mental health, disability or old age. Specifically, this research evaluates all national funded community-based arts projects in Malta between 2014 to 2018 under a national scheme of the President’s Award for Creativity fund, managed by the national Arts Council Malta. Analysis of this data was used to inform the new national cultural policy on the implantation of the Arts on Prescription scheme in Malta.

Analysis of Hepatocellular Carcinoma Stereotactic Body Radiation Therapy Dose Prescription Method Using Uncomplicated Tumor Control Probability Model

PurposeThis work was to establish an uncomplicated tumor control probability (UTCP) model using hepatocellular carcinoma (HCC) stereotactic body radiation therapy (SBRT) clinical data in our institution. The model was then used to analyze the current dose prescription method and to seek the opportunity for improvement. Methods and MaterialsA tumor control probability (TCP) model was generated based on local clinical data using the maximum likelihood method. A UTCP model was then formed by combining the established TCP model with the normal tissue complication probability model based on the study by Dawson et al. The authors investigated the dependence of maximum achievable UTCP on planning target volume equivalent uniform dose (EUD) at various ratio between planning target volume EUD and normal liver EUD (T/N EUD ratios). A new term uncomplicated tumor control efficiency (UTCE) was also introduced to analyze the outcome. A UTCE value of 1 implied that the theoretical maximum UTCP for the corresponding T/N EUD ratio was achieved. ResultsThe UTCE of the HCC SBRT patients based on the current dose prescription method was found to be 0.93 ± 0.05. It was found that the UTCE could be increased to 0.99 ± 0.03 by using a new dose prescription scheme, for which the UTCP could be maximized while keeping the normal tissue complication probability value smaller than 5%. ConclusionsThe dose prescription method of the current HCC SBRT in our institution was analyzed using a UTCP model established based on local clinical data. It was shown that there could be a potential to increase the prescription dose of HCC SBRT. A new dose prescription scheme was proposed to achieve better UTCP. Additional clinical trials would be required to validate the proposed dose prescription scheme in the future.

Physical activity referral scheme components: a study protocol for systematic review and meta-regression

IntroductionIn its attempt to establish effective physical activity promotion methods, research on physical activity referral schemes (PARS) is attracting significant attention. Sometimes known as physical activity on prescription schemes, PARS...

Quantification of Multi-Ion Mixtures Using a Machine Learning Assisted Integrated Electronic Tongue Leveraging Mobile and Cloud Platforms

Quantification of Multi-Ion Mixtures Using a Machine Learning Assisted Integrated Electronic Tongue Leveraging Mobile and Cloud Platforms

Ultrahypofractionated radiotherapy for localized prostate cancer with simultaneous boost to the dominant intraprostatic lesion: a plan comparison

To compare different stereotactic body techniques-intensity-modulated radiotherapy with photons and protons, applied to radiotherapy of prostatic cancer-with simultaneous integrated boost (SIB) on the dominant intraprostatic lesion (DIL). Ten patients were selected for this planning study. Dosimetric results were compared between volumetric modulated arc therapy, intensity-modulated radiation therapy (IMRT), and intensity-modulated proton therapy both with two (IMPT 2F) and five fields (IMPT 5F) planning while applying the prescription schemes of 7.25 Gy/fraction to the prostate gland and 7.5 Gy/fraction to the DIL in 5 fractions. Comparison of the coverages of the planning target volumes showed that small differences exist. The IMPT-2F-5F techniques allowed higher doses in the targets; conformal indexes resulted similar; homogeneity was better in the photon techniques (2%-5%). Regarding the organs at risk, all the techniques were able to maintain the dose well below the prescribed constraints: in the rectum, the IMPT-2F-5F and IMRT were more efficient in lowering the intermediate doses; in the bladder, the median dose was significantly better in the case of IMPT (2F-5F). In the urethra, the best sparing was achieved only by IMPT-5F. Stereotactic radiotherapy with SIB for localized prostate cancer is feasible with all the investigated techniques. Concerning IMPT, the two-beam technique does not seem to have a greater advantage compared to the standard techniques; the 5-beam technique seems more promising also accounting for the range uncertainty.

Modulation of Streptomycin Killing Rate against Mature Escherichia Coli Biofilms in the Presence of Medicinal Plant Extracts

Background. Medicinal plant extracts exhibiting pro- and antioxidant properties may affect antibiotic-induced killing of biofilm-producing bacteria in both synergistic and antagonistic modes. Better understanding of these alternations is required to adjust antibiotic therapy and herbal medicine in order to exclude unwanted losses of antibiotic efficiency.Aim: to study modulation modes of streptomycin killing rate against mature biofilms of Escherichia coli in the presence of different doses of commonly used medicinal plant extracts.Materials and methods. Pharmacodynamic parameter killing rate and mass biofilm formation were determined in the presence of streptomycin and medicinal plant extracts.Results. Synergism was found between 100 mg/ml streptomycin and low doses (0.83 mg of dry herb/ml) of green, black tea, Arctostaphylos uva-ursi, Betula pendula and Laminaria japonica against killing mature biofilms. Alternatively, high doses (6.64 mg of dry herb/ml) of green, black tea and Vaccinium vitis-ideae demonstrated antagonism, decreasing killing rate and enhancing biofilm formation. Presumably, high doses of the extracts were sufficient to enhance biofilm formation blocking penetration of streptomycin through enlarged biofilm matrix and diminishing the killing rate.Conclusions. Widely consumed as soft beverages or for prophylactic purposes green, black tea and V. vitis-ideae could promote strong antagonistic effects with streptomycin. These extracts can stimulate biofilm production, making benefit for commensal microbiota, but have clinical relevance due to a significant reduction in the lethal efficiency of streptomycin in biofilms of pathogenic strains. This highlights the need of careful antibiotic prescription scheme adjustment when choosing appropriate combinations of plant extracts and antibiotics to achieve a synergistic effect.

The use of fuzzy cognitive maps in the development of an experimental model of automation of production accounting of material flows

Automation of enterprise management on the basis of economic and mathematical models, information technology is one of the main stages of development for all enterprises. The use of cognitive modeling allows making management decisions under uncertainty. The article considers the construction of an experimental model of automation of production accounting of material flows based on the use of fuzzy cognitive maps. The algorithm of cognitive modeling is presented. The main advantages of cognitive tools are noted: 1) the ability to study the fine structure of management decisions (the necessary sequence of management actions, the necessary degree of activity of these actions, the study of the dynamic stability of strategies, etc.); 2) the opportunity to explore the dynamics of management decisions at a qualitative level, without attracting for this purpose hard-to-access and not always reliable quantitative information, which is extremely important in a rapidly changing business environment and the growing pace of technological innovation.It is emphasized that none of the known management support tools has the above capabilities. Cognitive dynamic analysis significantly expands the tool base of management, based today mainly on the means of static situational analysis and prescription schemes of decision-making.In the construction of the experimental model, the target factors of the cognitive map are determined, the connectivity analysis is carried out and the process of propagation of disturbances on the graph is studied.The analysis showed that the proposed model is quite efficient and can be used to predict economic activity and determine the expected values of a number of parameters that need to be monitored to diagnose trends in the development of an industrial enterprise. The results of the work should be considered as a solution to a number of management tasks.

Analysis of drug utilization and health care resource consumption in patients with psoriasis and psoriatic arthritis before and after treatment with biological therapies.

ObjectivesTo describe the therapeutic pathways of patients with psoriasis (PSO) and psoriatic arthritis (PsA) before and after treatment with biological therapies in a real-world setting and to determine the relative consumption of health care resources.DesignRetrospective observational study.SettingReal-life clinical setting in 5 Italian local health units.ParticipantsA total of 351 male and female patients with at least 1 prescription for a biological drug from January 1, 2010 to December 31, 2013; patients with concomitant rheumatoid arthritis, ankylosing spondylitis, or Crohn’s disease were excluded.ResultsThe major health care cost (excluding drug costs) was represented by hospitalizations, mainly related to PSO /PsA-associated disorders and cardiometabolic disorders. Use of conventional drugs among biologics-naïve patients reached 50% in PSO and 80% in PsA; their use decreased following initiation of biological therapy. After the start of biological treatment, the incidence of hospitalization decreased both for PSO (from 12.3% to 3.2% in day hospital regimen and from 2.4% to 0.4% for conventional admission) and for PsA (from 11.1% to 8.1% and from 10.1% to 3.0%, respectively). Mean annual costs for hospitalization before biological treatment were €217 and €537 for PSO and PsA, respectively, while mean annual cost for concomitant drugs slightly increased after biologics initiation: from €249.8 to €269.4 for PSO and from €331.8 to €346.9 for PsA. The major consumption of health care resources occurred in the quarter preceding the beginning of biological treatment.ConclusionThe consumption of health resources is mostly related to hospitalization, seems to peak during the quarter before the beginning of biologics therapies, and subsequently decreases after biologics initiation. Further studies should focus on prescription scheme and economic burden of PSO and PsA in Italy to help optimize health care resources and potentiate services for patients.

Positive Psychology for Overcoming Symptoms of Depression: A Pilot Study Exploring the Efficacy of a Positive Psychology Self-Help Book versus a CBT Self-Help Book.

Depression is an extremely common mental health disorder, with prevalence rates rising. Low-intensity interventions are frequently used to help meet the demand for treatment. Bibliotherapy, for example, is often prescribed via books on prescription schemes (for example 'Reading Well' in England) to those with mild to moderate symptomology. Bibliotherapy can effectively reduce symptoms of depression (Naylor et al., 2010). However, the majority of self-help books are based on cognitive behavioural therapy (CBT), which may not be suitable for all patients. Research supports the use of positive psychology interventions for the reduction of depression symptoms (Bolier et al., 2013) and as such self-help books from this perspective should be empirically tested. This study aimed to test the efficacy of 'Positive Psychology for Overcoming Depression' (Akhtar, 2012), a self-help book for depression that is based on the principles of positive psychology, in comparison with a CBT self-help book that is currently prescribed in England as part of the Reading Well books on prescription scheme. Participants (n = 115) who were not receiving treatment, but had symptoms of depression, read the positive psychology or the CBT self-help book for 8 weeks. Depression and well-being were measured at baseline, post-test and 1-month follow-up. Results suggest that both groups experienced a reduction in depression and an increase in well-being, with no differences noted between the two books. Future directions are discussed in terms of dissemination, to those with mild to moderate symptoms of depression, via books on prescription schemes.

Guideline-compliant prescription of biologicals and possible barriers in dermatological practices in Bavaria.

Psoriasis and urticaria are chronic inflammatory skin diseases, which account for a substantial socioeconomic burden and severely affect patients' quality of life. According to the respective German guidelines, biologicals can be used for the treatment of severe forms of these diseases. However, only a minority of patients receive this advised treatment. To analyse the prescription of biologicals according to the German national guidelines for psoriasis and chronic spontaneous urticaria and to assess possible barriers to prescription. Cross-sectional, questionnaire-based study including all Bavarian dermatologists based in private practices. Linear and logistic regression models were used to identify significant influencing factors on the perception of possible barriers. Between January 2017 and February 2017, a total of 137 (of 499) dermatologists participated. Of all patients with moderate to severe psoriasis and chronic spontaneous urticaria, participating dermatologists indicated treating 14.2% and 6.9% with biologicals, respectively. The most prevalent barriers to prescription were the high cost of the therapy, the low reimbursement and the fear of recourse. Analysis showed that age, years spent working in a dermatological hospital and the number of patients treated with moderate to severe psoriasis affect the perception of many barriers. Furthermore, age and barriers related to physician factors and external factors were identified as modifiers to the prescription scheme of dermatologists. The role of clinical education and the importance of external and economic barriers in comparison with medical barriers have to be emphasised. Guideline-compliant use of biologicals has to be optimised. Further research is needed to ascertain not only a barrier pattern for Bavaria but also for wider settings. Actions based on this for psoriasis are needed to achieve the goal of the WHO Global Psoriasis Report to strengthen the role of patient-centred care and improve the quality of life of affected patients. Analogue, this applies also for urticaria.

Social prescribing: community-based referral in public health.

Social prescribing is a term used with increasing frequency to describe the process of enabling healthcare professionals to refer patients to a link worker, to co-design a non-clinical social prescription to improve their health and wellbeing.1 Original descriptions of social prescribing involved three components to a scheme: a referral from a healthcare professional, a consultation with a link worker and an agreed referral into the third sector.2–4 Social prescribing has developed to incorporate referrals into the arts, the natural environment, reading on prescription schemes and schemes to support health behaviour changes especially for long-term conditions. Other social prescribing schemes work to develop community cohesion such as time-banking, or address the social determinants of health by providing support for welfare, debt advice, housing and employment. In recent years, social prescribing has emerged as a strategy for tackling health inequities through partnerships between primary care and third sector organisations, and augmenting standard health and social care services. In practice, social prescribing provides an architecture to allow a person to move between professional sectors into their community; this was recently recognised in the General Practice Forward View which listed social prescribing as one of the 10 high-impact actions.5 Social prescribing is, therefore, able to address physiological, physical, psychological, psychosocial or socioeconomic issues, as well as enhancing community wellbeing and social inclusion.

Bibliotherapy

This article discusses the historical development of bibliotherapy and how books can be used in the treatment of a range of minor mental health conditions. The article provides a brief historical account of how books have been used in institutions through the centuries and how the bibliotherapuetic process works through the use of texts from which the reader gains an insight into their personal situation by identifying with a character experiencing similar problems. Bibliotherapy as both clinical and community-based treatment is discussed through a number of case studies from the critical literature, in particular the Ayrshire Read Yourself Well scheme and the Reading Well/Books on Prescription scheme. The results of a medical trial on the benefits of reading a novel based on MRI (magnetic resonance imaging) scans of readers are then discussed.

Finer leaf resolution and steeper beam edges using a virtual isocentre in concurrence to PTV-shaped collimators in standard distance \u2013 a planning study

PurposeInvestigation of a reduced source to target distance to improve organ at risk sparing during stereotactic irradiation (STX).MethodsThe authors present a planning study with perfectly target-volume adapted collimator compared with multi-leaf collimator (MLC) at reduced source to virtual isocentre distance (SVID) in contrast to normal source to isocentre distance (SID) for stereotactic applications. The role of MLC leaf width and 20–80% penumbra was examined concerning the healthy tissue sparing. Several prescription schemes and target diameters are considered.ResultsPaddick’s gradient index (GI) as well as comparison of the mean doses to spherical shells at several distances to the target is evaluated. Both emphasize the same results: the healthy tissue sparing in the high dose area around the planning target volume (PTV) is improved at reduced SVID ≤ 70 cm. The effect can be attributed more to steeper penumbra than to finer leaf resolution. Comparing circular collimators at different SVID just as MLC-shaped collimators, always the GI was reduced. Even MLC-shaped collimator at SVID 70 cm had better healthy tissue sparing than an optimal shaped circular collimator at SID 100 cm.Regarding penumbra changes due to varying SVID, the results of the planning study are underlined by film dosimetry measurements with Agility™ MLC.ConclusionPenumbra requires more attention in comparing studies, especially studies using different planning systems. Reduced SVID probably allows usage of conventional MLC for STX-like irradiations.