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Policymakers, practitioners and the public all have a role in health emergency and disaster risk management (Health EDRM). They need to access, understand and use evidence from research to take actions to reduce health risks and harm. They need the best available evidence to maximize their ability to save lives and reduce suffering. Evidence Aid seeks to meet this need through collections of specially prepared plain-language summaries of systematic reviews, freely available online in multiple languages (www.EvidenceAid.org). The summaries and webpages can be linked to reference management software and embedded in other websites.
Evidence Aid has added a substantial number of summaries to its collections since 2020, for example, adding a collection for reviews of relevance to the COVID-19 pandemic and its associated measures. From 2021, Evidence Aid built on its partnership with the Pan American Health Organization (PAHO/WHO) to identify and summarize reviews relevant to building resilience into health systems. This included enhancements enriching the content of each summary with the authors’ implications for practice and research, equity considerations and funding sources.
In November 2022, the Resilient Health Systems collection contained more than 200 summaries relevant to ensuring that health systems are resilient to emergencies, disasters and related challenges. There were also 600 summaries relevant to the COVID-19 pandemic, 150 on the health of refugees and asylum seekers, more than 100 on physical and mental health impacts of disasters and 110 on preventing and treating acute malnutrition.
Evidence Aid’s 1000+ summaries of systematic reviews relevant to Health EDRM provide a unique gateway into this evidence base for policymakers, practitioners and the public wishing to ensure that disaster preparedness, response, recovery and rehabilitation are effective and efficient. It should be a key component in helping people and organizations to care, cope and overcome in an increasingly challenging world.
Training based on the Mental Health Gap Action Programme (mhGAP) is being increasingly adopted by countries to enhance non-specialists’ mental health capacities. However, the influence of these enhanced capacities on referral rates to specialised mental health services remains unknown.
We rely on findings from a longitudinal pilot trial to assess the influence of mental health knowledge, attitudes and self-efficacy on self-reported referrals from primary to specialised mental health services before, immediately after and 18 months after primary care physicians (PCPs) participated in an mhGAP-based training in the Greater Tunis area of Tunisia.
Participants included PCPs who completed questionnaires before (n = 112), immediately after (n = 88) and 18 months after (n = 59) training. Multivariable analyses with linear mixed models accounting for the correlation among participants were performed with the SAS version 9.4 PROC MIXED procedure. The significance level was α < 0.05.
Data show a significant interaction between time and mental health attitudes on referrals to specialised mental health services per week. Higher scores on the attitude scale were associated with more referrals to specialised services before and 18 months after training, compared with immediately after training.
Findings indicate that, in parallel to mental health training, considering structural/organisational supports to bring about a sustainable change in the influence of PCPs’ mental health attitudes on referrals is important. Our results will inform the scale-up of an initiative to further integrate mental health into primary care settings across Tunisia, and potentially other countries with similar profiles interested in further developing task-sharing initiatives.
To assess volume variations in target site due to changes in bladder filling and rectal content including air bubbles during simultaneous-integrated boost intensity-modulated radiotherapy (SIB-IMRT) of patients suffering from squamous cell carcinoma of uterine cervix.
Materials and methods:
A total of ten patients of squamous cell carcinoma of uterine cervix were enrolled in this analysis. All patients were planned to undergo SIB-IMRT using 10 MV beam. Planning target volume of the tumour (PTVtumour) and PTVnodal were prescribed with 5,040 and 4,500 cGy doses, respectively. During planning, PTVtumour V95%, PTVnodal V95% and organs at risk (OARs) (bladder, rectum, femoral heads and small bowel) volumes were measured from initial CT planning scans taken with full bladder. CT scans were acquired once in a week over a treatment period of 5·5 weeks. Intra-treatment scans with full bladder were then fused with the planning scans to determine variations in the target volume and the OAR volume. Changes in radiation dose to the PTVtumour and the PTVnodal were also assessed by comparing intra-treatment scans with the planning (first) scans.
All patients showed intra-treatment bladder volume larger than the planning bladder volume. Difference between planning bladder and intra-treatment bladder volumes ranged from 4·5 to 49%. Rectal volume varied from 17 to 60 cc. A wide variation between planning and intra-treatment air volumes was found in most of the patients. When comparing initial and inter-fraction air volumes, the maximum difference was 366·67%. Due to bladder and rectal volume variations, PTVtumour V95% and PTVnodal V95% doses did not remain constant throughout the treatment. The maximum discrepancy between intra-treatment PTVtumour dose and planning PTVtumour dose was 12·15%. The maximum difference between planning and inter-fraction PTV V95% was 48·28%. PTVnodal dose observed from scan taken in last week of treatment was 12·87% less than planning PTVnodal dose analysed from planning CT scan. Maximum difference in planning and inter-fraction PTVnodal V95% was 57·78%.
Inconsistent bladder and rectal volumes had a significant impact on target volume and dosage during an entire course of SIB-IMRT. For radiotherapy of gynaecological malignancies, data on variations in PTV should be acquired on daily basis to target radiation dose to the tumour site with accuracy.
The emergence of advanced radiotherapy techniques, such as intensity-modulated radiotherapy (IMRT), brachytherapy, conformal radiotherapy, magnetic resonance-guided radiotherapy (MRgRT), stereotactic synchrotron radiotherapy (SSRT) and microbeam radiotherapy (MRT), has increased the importance of the verification of volumetric dose distribution. The verification of dose distribution is usually done by 2D films and 3D gel dosimeters, but PRESAGE® due to its affordability, reproducibility, precision, accuracy, unique dosimetric and physical properties is considered as an effective candidate in providing 3D dose data. PRESAGE® is insensitive to oxygen contamination, machinable and can be molded to a variety of shapes and sizes. It is absorbing rather than scattering light which facilitates high-accuracy readout by optical computed tomography (OP-CT). This review focuses on the feasibility of using PRESAGE® in various complicated radiotherapy techniques by comparing its measured doses with 2D films and treatment planning system (TPS) calculated doses.
The aim of this work was to study the acceptability of plans prepared for prostate patients treated by volumetric modulated arc therapy (VMAT) with the vision to evaluate the quality of plans and test pre-treatment quality assurance (QA).
VMAT plans of 35 patients, planned on the Eclipse Treatment Planning System (Aria 15), were included in the study. Plan acceptability was checked using statistical analysis, which includes homogeneity index, radical and median homogeneity index, coverage and uniformity index. Dose–volume histograms (DVH) of the plans were also studied to check prescribed dose (PD), Dmax, Dmin, D5 and D95. Portal dosimetry was also done by gamma analysis using 3%/3 mm criterion. SD and mean SD error were also calculated and analysed.
Statistical analysis showed a mean HI of 1·054, coverage 0·959, UI 1·055, mDHI 0·962 and rDHI 0·866. SD of HI, coverage, UI, mDHI and rDHI was 0·019, 0·019, 0·014, 0·013 and 0·030, respectively. From the DVHs, mean of D5, D95, Dmin and Dmax was calculated at 6,252·9, 5,757·4, 6,413·3 and 5,657·7 cGy, respectively, with a prescribed dose of 6,000 cGy. According to gamma analysis, area gamma < 1 was 99·12% with a tolerance limit of 95%, maximum gamma was 1·466 with a tolerance limit of 3·5, average gamma was 0·388 with a tolerance limit of 0·5, area gamma > 1·2 was 0·242% with a tolerance limit of 0·5%, maximum dose difference was 0·6 with a tolerance limit of 1·0 and average dose difference was 0·029 with a tolerance limit of 0·2.
All three computations showed the results to be within acceptable limits. VMAT possesses a unique feature of delivering the whole treatment with only two rotations of the gantry. VMAT has an improved efficiency of delivery for equivalent dosimetric quality.
This exploration is intended to analyse the dosimetric characteristics of proton beams of multiple energies using different snout sizes.
Materials and methods
A synchrotron was used for the extraction of eight proton beam energies (100–250 MeV). Dosimetric measurements were taken in a water phantom that was irradiated with a proton beam emanating from the gantry system at angles 0, 90, 180 and 270 degree using a large and a medium snout. The range of beam energies in the phantom, their corresponding centre modulation depth (CMD) and the width of spread out Bragg peak (SOBP) were measured by Markus chamber. Double scattering technique was employed for the creation of SOBPs.
The range of proton beams varied from 4·3 cm for 100 MeV beam to 28·5 cm for 250 MeV beam with the medium snout and from 4·3 cm for 100 MeV to 25 cm for 250 MeV beam with large snout in the water phantom. SOBP width showed a variation from 4 to 10 cm with medium and large snout. While determining the output with medium snout, the discrepancy of 1·1% was observed between the maximum and minimum mean values of output for all the given set of energies and angles. There occurred a difference of 0·9% between the maximum and minimum mean values of output with the large snout. Beam output at SOBP centre was 12% higher with large snout as compared to that with medium snout for all the given beam energies. Flatness and symmetry were found within ±2·5% tolerance limits with medium and large snouts.
Flatness and symmetry were found within explicit limits with both medium and large snouts. Large snout produced higher beam output than that of medium snout at the centre of SOBP. This exploration can be extended to the determination of beam output, flatness and symmetry with a small snout.
This study is primarily aimed at the analysis of various dose homogeneity indices (HIs) essential for the evaluation of therapeutic plans by employing intensity-modulated radiation therapy (IMRT) on patients with cervix cancer. Also integral dose (ID) to healthy surrounding organs is computed.
Materials and methods
Effectiveness of different HIs (A, B, C, D) was explored for IMRT plans using 15 MV photon beam. In total, 18 patients were selected at random for treatment of cervix cancer, and dose of 5,040 cGy was delivered in 28 equal fractions.
The study was undertaken to compare four HI formulas and coefficient of determination between each set of HI was known by calculating R2 value. Mean±SD of HI A, HI B, HI C and HI D were 1·12±0·02, 0·13±0·04, 0·10±0·02 and 0·99±0·03, respectively. Mean value of ID for rectum is 3·16 and for bladder is 10·3.
Our data suggested that HI calculated using four formulas provided good plan quality. The results advocate that all the studied HIs can be effectively used for assessment of uniformity inside the target volume. However, values of HI C were closest to ideal value as compared with other three formulas; hence, it is considered a better measure to compute homogeneity of dose within target volume. The ID gives satisfactory results for surrounding normal tissues such as rectum and bladder and significant critical tissue sparing was achieved by using IMRT technique.
Parasites reside inside or outside their hosts and get host nutrition and blood. Here, we have emphasized economic losses in cattle caused by parasitic diseases due to ecto- and endo- parasites (flies, ticks, mites and helminths). We have outlined different methods/models including economic evaluation techniques and dynamic analysis as a major class, used for the calculation of economic losses caused by parasites in cattle. According to already conducted studies, a decrease in production is mentioned in quantity and percentage while financial losses are expressed in the form of account with respect to per head, herd or for the specific study area. The parasites cause the reduced production and financial losses due to control, treatment and mortality costs. We calculated the average decrease in milk production and organ condemnation as 1.16 L animal−1 day−1 and 12.95%, respectively, from overall cattle parasitic infections. Moreover, the average calculated financial and percentage losses were US$ 50.67 animal−1 year−1 and 17.94%, respectively. Economically important parasitic diseases mentioned here are caused by specific spp. of protozoans and helminths according to data collected from the literature. Protozoan diseases include tick-borne diseases, coccidiosis, neosporosis, trypanosomiasis and cryptosporidiosis. Losses due to tick-borne infections were encountered for decreased milk production, mortality, treatment and control. Losses from coccidiosis were due to decreased weight gain, treatment costs and mortality. While abortion losses were encountered in neosporosis. Trypanosomiasis caused losses due to a decrease in milk yield. Moreover, only diagnostic (conventional or molecular techniques) cost was taken into account for cryptosporidiosis. Economically important nematode parasites are Oesophagostomum spp., Cooperia spp., Trichostrongylus spp., Strongyloides spp., Ostertagia spp. and Haemonchus placei. Due to the zoonotic importance of echinococcosis, Echinococcus granulosus is the most economically important cestode parasite. Losses caused by echinococcosis were due to organ condemnation, carcass weight loss and decreases hide value, milk production and fecundity. While, fascioliasis is one of the most economically important trematodal disease, which causes cirrhosis of the liver due to parasite migration, and thus, the organ becomes inedible. So, it would be helpful for farmers and researchers to approach these methods/models for calculation of parasitic losses and should adopt suitable measures to avoid long-term economic losses.
The purpose of this study was to analyse the comparison of intensity-modulated radiation therapy quality assurance (IMRT QA) using Gafchromic® EBT3 film, Electronic portal imaging device (EPID) and MapCHECK®2.
Pretreatment authentication is the main apprehension in advanced radiation therapy treatment plans such as IMRT.
Materials and methods
A total of 20 patients were planned on Eclipse treatment planning system using 6 and 15 MV separately.
Gamma index of EBT3 film results shows the following average passing rates: 97% for 6 MV and 96·6% for 15 MV using criteria of ±5% of 3 mm, ±3% of 3 mm and ±3% of 2 mm for brain. However, by using ±5% of 3 mm and ±3% of 3 mm criteria, the average passing rates were 95·4% on 6 MV and 95·2% on 15 MV for prostate. For EPID, the results show the average passing rates as 97·8% for 6 MV and 97·2% for 15 MV in for brain. In cases in which ±5% of 3 mm and ±3% of 3 mm were used, the average passing rates were 96·6% for 6 MVand 96·1% for 15 MV for prostate. MapCHECK®2 results show average passing rates of 96·4% for 6 and 96·2% for 15 MV, respectively, for brain using criteria of ±5% of 3 mm, ±3% of 3 mm and ±3% of 2 mm, whereas for ±5% of 3 mm and ±3% of 3 mm the average rates are 95·2% for 6 and 94·7% for 15 MV in prostate.
The EPID results are better than the other methods, and hence EPID can be used effectively for IMRT pretreatment verifications.
To determine the feasibility of an anthropomorphic breast polyurethane-based three-dimensional (3D) dosimeter with cavity to measure dose distributions and skin dose for a commercial strut-based applicator strut-adjusted volume implant (SAVI™) 6–1.
Materials and methods
An anthropomorphic breast 3D dosimeter was created with a cavity to accommodate the SAVI™ strut-based device. 2 Gy was prescribed to the breast dosimeter having D95 to planning target volume evaluation (PTV_EVAL) while limiting 125% of the prescribed dose to the skin. Independent dose distribution verification was performed with GAFCHROMIC® EBT2 film. The dose distribution from the 3D dosimeter was compared to the distributions from commercial brachytherapy treatment planning system (TPS) and film. Point skin doses, line profiles and dose–volume histogram (DVHs) for the skin and PTV_EVAL were compared.
The maximum difference in skin dose for TPS and the 3D dosimeter was 4% whereas 41% between the TPS and EBT2 film. The maximum dose difference for line profiles between TPS, 3D dosimeter, and film was 4·1%. DVHs of skin and PTV_EVAL for TPS and 3D dosimeter differed by a maximum of 4% at 5 mm depth and skin differed by a maximum 1·5% between TPS and 3D dosimeter. The criterion for gamma analysis comparison was 92·5% at ±5%±3 mm criterion. The TPS demonstrated at least ±5% comparability in predicting dose to the skin, PTV_EVAL and normal breast tissue.
3D anthropomorphic polyurethane dosimeter with cavity gives comparable results to the TPS dose predictions and GAFCHROMIC® EBT2 film results in the context of HDR brachytherapy.
This exploration is intended to measure tissue maximum ratios (TMRs) in smaller fields through CC01 detector and to compare CC01 measured TMRs with Pinnacle treatment planning software (TPS) calculated TMRs.
Materials and methods
CC01 compact chamber detector was used to measure TMR in water phantom for 6 and 18 MV beam delivered from Varian linear accelerator. Pinnacle TPS was employed in this study to calculate TMR from the measured percentage depth doses data. CC01 measured TMR data was compared with the calculated TMR data at depths from 5 to 20 cm for field sizes varying from 1 to 10 cm2.
For the smallest given field size of 1 cm2, CCO1 measured 13·95% higher TMR value for 18 MV beam than that for 6 MV beam. At 20 cm depth for 1 cm2 field size, TMR due to 18 MV beam was 52·4% higher than the TMR due to 6 MV beam. For 6 MV beam, the maximum difference appeared between the measured TMR and pinnacle calculated TMR was 2·8% and for 18 MV beam, the maximum difference was 4%.
For both 6 and 18 MV beam, there was good agreement between CC01 measured and Pinnacle calculated TMRs for the field sizes ranging from 1 to 10 cm2. This exploration can be extended to the determination of other dosimetric parameters like TARs, TPRs in small fields.
This study aimed to investigate tolerance dose to organs at risk (OARs) as well as degree of conformity and homogeneity for head and neck cancer patients by using simultaneous integrated boost intensity-modulated radiotherapy technique (SIB IMRT).
Materials and methods
This study analysed 15 head and neck cancer patients receiving treatment using inverse planned SIB IMRT technique. Using a beam energy of 6 MV, two dose levels of 70 and 55·4 Gy were used to treat the tumour. Doses of 2 Gy in 35 fractions and 1·68 Gy in 33 fractions were simultaneously delivered for effective planning target volume (PTV1) and boost planning target volume (PTV2), respectively.
Dose distribution in PTV and critical organs lies within tolerance dose guidelines protecting spinal cord, brain stem, optic chiasm, optic nerve, thus reducing the risk of damage to normal tissues. Minor deviation from tolerance limit was observed for parotid glands. This technique provided highly conformal and homogenous dose distribution as well as better sparing of OARs, hence verifying quality assurance results to be satisfactory.
SIB IMRT technique offers best solution for preserving organ function by keeping dose below tolerance level. Treatment of head and neck carcinoma using SIB IMRT is feasible, more efficient, and dose escalation is achieved in a single plan.
Whole-breast external beam radiotherapy results in significant reduction in the risk for breast cancer-related death, but this may be offset by an increase in deaths from other causes and toxicity to surrounding organs. Partial breast irradiation techniques are approaches that treat only the lumpectomy area rather than the whole breast. Quality assurance in the radiation therapy treatment planning process is essential to ensure accurate dose delivery to the patient. For this purpose, this article compares the results from an anthropomorphic PRESAGE® dosimeter, radiation treatment planning system and from the GAFCHROMIC® EBT2 film.
Materials and methods
A breast dosimeter was created and a three-field partial plan was generated in the Pinnacle3 treatment planning system. Dose distribution comparisons were made between Pinnacle3 treatment planning system, GAFCHROMIC® EBT2 film and PRESAGE® dosimeter. Dose–volume histograms (DVHs), gamma maps and line profiles were used to evaluate the comparison.
DVHs of gross tumour volume, clinical tumour volume and planning tumour volume for the PRESAGE® dosimeter and Pinnacle3 treatment planning system shows that both measured and calculated statistics were in agreement, with a value of 97.8% of the prescribed dose. Gamma map comparisons showed that all three distributions passed 95% at the ±3%/±3 mm criteria. Comparisons of isodose line distribution between the PRESAGE® dosimeter, EBT2 film and planning system demonstrated agreement, with an average difference of 1.5%.
This work demonstrated the feasibility of PRESAGE® to function as an anthropomorphic phantom and laid the foundation for research studies in PRESAGE®/optical-computed tomography three-dimensional dosimetry with the most complex anthropomorphic phantoms.
This study aimed to examine the dosimetric properties of Gafchromic® EBT3 film and intensity-modulated radiation therapy quality assurance (IMRT QA).
Materials and methods
Beams characteristics dosimetric properties and 20 IMRT plans were created and irradiated on Varian dual-energy DHX-S Linac for 6 and 15 MV energies. EBT3 films were analysed using ‘film Pro QA 2014’ software.
The dosimetric comparison of EBT3 film (for red channel dosimetry) and ionisation ion chamber measurement showed that average deviations of symmetry, flatness, central axis, penumbra (left) and penumbra (right) of dose profile were 0·18, 1·34, 0·49%, 3·68 and 3·61 mm for 6 MV and 0·10, 1·3, 0·45, 2·65 and 2·71 mm for 15 MV, respectively. The blue and green channels dosimetry showed greater dose deviation as compared with red channel. IMRT QA verification plan complied about 95% at all different criteria. Reproducibility, stability and face orientation of film were within 1·4% for red channel.
The results advocate that the film can be used not only for dosimetric assessment but also as a reliable IMRT QA tool.
Small field dosimetry is complicated and accuracy in the measurement of total scatter factor (TSF) is crucial for dosimetric calculations, in making optimum intensity-modulated radiotherapy plans for treating small target volumes. In this study, we intended to determine the TSF measuring properties of CC01 and CC04 detectors for field sizes ranging from sub-centimetre to the centimetre fields.
Material and methods
CC01 and CC04 chamber detectors were used to measure TSF for 6 and 18 MV photon beam delivered from the linear accelerator, through small fields in a water phantom. Small fields were created by collimator jaws and multi-leaf collimators separately, with field sizes ranging from 0·6 to 10 cm2 and 0·5 to 20 cm2, respectively.
CC01 measured TSF at all the given field sizes created by jaws and multi-leaf collimators for both 6 and 18 MV beams whereas CC04 could not measure TSF for field sizes <1 cm2 due to volume averaging and perturbation effects.
CC01 was shown to be effective for measurement of TSF in sub-centimetre field sizes. CC01 can be employed to measure other dosimetric quantities in small fields using different energy beams.
To deliver radiation doses with higher accuracy, radiation treatment through megavoltage photon beams from linear accelerators, is accepted widely for treating malignancies. Before calibrating the linear accelerators, it is essential to make a complete analysis of all photon beam profile parameters. The main objective of this exploration was to investigate the 6 and 15 MV photon beam profile characteristics to improve the accuracy of radiation treatment plans.
In this exploration, treatment parameters like depth, field size and beam energy were varied to observe their effect on dosimetric characteristics of beam profiles in a water phantom, generated by linear accelerator Varian Clinac.
The results revealed that Dmax and Dmin decreased with increasing depth but increased with increasing field sizes. Both left and right penumbras increased with increasing depth, field size and energy. Homogeneity increased with field size but decreased with depth. Symmetry had no dependence on depth, energy and field size.
All the characteristics of photon beam dosimetry were analysed and the characteristics like homogeneity and symmetry measured by an ion chamber in a water phantom came within clinically acceptable level of 3 and 103%, respectively, thus fulfilled the requirements of standard linear accelerator specifications. This exploration can be extended to the determination of beam profile characteristics of electron and photon beams of other energies at various depths and field sizes for designing optimum treatment plans.
Background: Cognitive Behaviour Therapy (CBT) has an established evidence base and is recommended by the national organizations in United Kingdom and the United States. CBT remains under utilized in low and middle income countries. CBT was developed in the west and it has been suggested that it is underpinned by western values. It therefore follows that to make CBT accessible for non western clients, it needs adapting into a given culture. Aims: Our aim was to develop guidelines for adapting CBT for psychosis in Pakistan by incorporating the views of the patients, their carers and mental health professionals. Method: We conducted a series of qualitative studies in Pakistan to adapt CBT for psychosis (a total of 92 interviews). The data were analyzed by systematic content and question analysis. Analysis started by identifying emerging themes and categories. Themes emerging from the analyses of interviews by each interviewer were compared and contrasted with others interviewers constantly. Triangulation of themes and concepts was undertaken to further compare and contrast the data from the different participating groups. Results: The results of these studies highlighted the barriers in therapy as well as strengths while working with this patient group. Patients and their carers in Pakistan use a bio-psycho-spiritual-social model of illness. They seek help from various sources. Therapists make minor adjustments in therapy. Conclusions: The findings from this study will help therapists working with this client group using CBT for psychosis in Pakistan. These results need to be tested through controlled trials.
This paper describes a pilot project in which (for the first time, worldwide) psychiatry was taught to undergraduate medical students in Somalia using an evidence-based intervention – the World Health Organization's Mental Health Gap Action Programme Intervention Guide.
The Eastern Mediterranean Region of the World Health Organization has recently developed a comprehensive strategy and action plan to promote mental health and provide for the integrated prevention, treatment and rehabilitation of mental, neurological and substance use disorders. By strengthening national mental health policies, plans and legislation, scaling up integrated services, capacity-building, promoting human rights and prioritising vulnerable groups, the strategy aims to improve mental health and to help countries achieve their national development objectives.
This paper reports on the training of primary care physicians in the family medicine programme at the University of Gezira, Sudan, using the World Health Organization's Mental Health Gap Action Programme Intervention Guide (mhGAP-IG). The training had a positive impact on their knowledge of and attitudes to mental disorder. More field tests of the mhGAP-IG would be useful to make further recommendations on its cultural relevance and its adaptation for use in low- and middle-income countries. Distance supervision of training of primary care physicians by internal facilitators is seen as critical for the sustainability of the intervention.