BackgroundTo review the experience and to evaluate the treatment plan of using helical tomotherapy (HT) for the treatment of cervical cancer.MethodsBetween November 1st, 2006 and May 31, 2009, 10 cervical cancer patients histologically confirmed were enrolled. All of the patients received definitive concurrent chemoradiation (CCRT) with whole pelvic HT (WPHT) followed by brachytherapy. During WPHT, all patients were treated with cisplatin, 40 mg/m2 intravenously weekly. Toxicity of treatment was scored according to the Common Terminology Criteria for Adverse Events v3.0 (CTCAE v3.0).ResultsThe mean survival was 25 months (range, 3 to 27 months). The actuarial overall survival, disease-free survival, locoregional control and distant metastasis-free rates at 2 years were 67%, 77%, 90% and 88%, respectively. The average of uniformity index and conformal index was 1.06 and 1.19, respectively. One grade 3 of acute toxicity for diarrhea, thrombocytopenia and three grade 3 leucopenia were noted during CCRT. Only one grade 3 of subacute toxicity for thrombocytopenia was noted. There were no grade 3 or 4 subacute toxicities of anemia, leucopenia, genitourinary or gastrointestinal effects. Compared with conventional whole pelvic radiation therapy (WPRT), WPHT decreases the mean dose to rectum, bladder and intestines successfully.ConclusionHT provides feasible clinical outcomes in locally advanced cervical cancer patients. Long-term follow-up and enroll more locally advanced cervical carcinoma patients by limiting bone marrow radiation dose with WPHT technique is warranted.

BackgroundTo review our experience and evaluate treatment planning using intensity-modulated radiotherapy (IMRT) and helical tomotherapy (HT) for the treatment of elderly patients with bladder cancer.MethodsFrom November 2006 through November 2009, we enrolled 19 elderly patients with histologically confirmed bladder cancer, 9 in the IMRT and 10 in the HT group. The patients received 64.8 Gy to the bladder with or without concurrent chemotherapy. Conventional 4-field "box" pelvic radiation therapy (2DRT) plans were generated for comparison.ResultsThe median patient age was 80 years old (range, 65-90 years old). The median survival was 21 months (5 to 26 months). The actuarial 2-year overall survival (OS) for the IMRT vs. the HT group was 26.3% vs .37.5%, respectively; the corresponding values for disease-free survival were 58.3% vs. 83.3%, respectively; for locoregional progression-free survival (LRPFS), the values were 87.5% vs. 83.3%, respectively; and for metastases-free survival, the values were 66.7% vs. 60.0%, respectively. The 2-year OS rates for T1, 2 vs. T3, 4 were 66.7% vs. 35.4%, respectively (p = 0.046). The 2-year OS rate was poor for those whose RT completion time greater than 8 weeks when compared with the RT completed within 8 wks (37.9% vs. 0%, p = 0.004).ConclusionIMRT and HT provide good LRPFS with tolerable toxicity for elderly patients with invasive bladder cancer. IMRT and HT dosimetry and organ sparing capability were superior to that of 2DRT, and HT provides better sparing ability than IMRT. The T category and the RT completion time influence OS rate.

This study investigated the level of management's perception of the importance of indoor environment indicators at long-term care facilities as well as the differences between the level of perceived importance and the level of implementation. This study also analyzed the indicators for improving indoor environments. This study selected Taiwanese long-term care facility managers as its subjects to whom questionnaires were distributed by mail Descriptive statistics, a one-way analysis of variance (ANOVA), and an importance-performance analysis were used to conduct analyses on the data retrieved from the questionnaires. The results indicate that, of the indoor environment indicators of four facility spaces, bedrooms had the highest perceived level of importance. The lounge was the easiest space in which to implement the indicators. Differences were found between the perceived level of importance and the level of implementation for six of the indoor environment indicators of the four facility spaces. In these four spaces, the ventilation indicator was the most important, whereas implementing the temperature and humidity indicators was the most difficult. The highest priority for indicator improvement was given to the temperature in the bedrooms and bathrooms, whereas control over temperature, humidity, and sound had a low priority. The indicators seen as requiring continuous maintenance were lighting and ventilation. Facility managers had a high level of awareness and competence in implementing the ventilation indicator. However, although they were aware of the importance of the temperature, humidity, and sound indicators, their implementation was difficult, suggesting that they needed to be improved.

This study used a two-round modified Delphi technique with a questionnaire survey in order to reach a consensus for the questionnaire; the survey was conducted from September to December 2009. The six indicators for the environmental quality of longterm care institutions in Taiwan are (1) indoor environmental quality, (2) safety equipment for the prevention and management of disasters occurring in residents' daily lives, (3) provision for assistive devices for residents' daily use, (4) provision for privacy and individualized space, (5) provision for comfortable and decorated indoor environments, and (6) provision for social interaction space. The scale included 34 items with an acceptable number of panel members and acceptable construct validity. Panel members all highly approved of Indicators 1, 2, and 6. Although they approved of Indicator 3, they suggested that caregivers at institutions should replace the functions of living assistive devices. They approved of Indicator 5; however, they questioned the method for providing comfortable and decorated environments. They approved of Indicator 4; however, they suggested that private space need not be provided in the living room of the institution. In terms of long-term care institution environments in Taiwan, Indicators 1, 2, and 6 were important for protecting residents' physical and psychological well-being and improving

PurposeThis paper demonstrates how effectively developing visual skills from observing and analyzing works of art applies in developing leadership skills and examines one application where these artistic skills are viewed as specific thinking skills that are regularly used in new product development.Design/methodology/approachThe lead author adapted a successful collaborative program of the Cincinnati Art Museum and the University of Cincinnati Medical School into a program for doctoral students at Union Institute and University, then taught the course numerous times, recording the results.FindingsThe anticipated results were observed, judging from qualitative measures such as instructor and student evaluations.Research limitations/implicationsThis is a study of one course. To become an accepted practice, further study is needed in similar museum‐based learning situations.Practical implicationsAt Union, the program has been adapted into a full course and should stimulate others in business, academia, and nonprofits to replicate the program.Originality/valueThe use of museum‐based training is widely used in medical training to increase diagnostic skills and empathy. It is less widely practiced in business and we believe this is the first program to adapt a successful medical training program to a successful leadership training program.