Testicular Seminoma: The M. D. Anderson Experience. An Analysis of Pathological and Patient Characteristics, and Treatment Recommendations

418 Background: Most men with Stage I testicular seminoma are cured with surgery alone, now a preferred strategy per national guidelines. The current pattern of practice among US radiation oncologists (RO) is unknown. Methods: We have surveyed practicing US RO via a short online questionnaire. Respondents’ characteristics, self-rated knowledge, perceived patient (pt) compliance rates with observation protocols and expected rate of infertility with and without adjuvant treatments were analyzed for association with treatment recommendations. Results: We received 353 responses from practicing US RO, of whom 23% consider themselves experts. Recommendations are summarized in the table. 34% believe that survival is jeopardized in case of recurrence on observation, but this belief does not impact the recommendation. Over 70% of respondents rate non-compliance with observation at > = 30%. Responders with a higher perceived non-compliance rate are more likely to recommend adjuvant therapy (Fisher’s exact p < 0.01). 52% routinely advise fertility assessment and/or sperm banking for pts who elect observation or chemotherapy, and 74% advise for pts undergoing RT. Respondents are more likely to recommend fertility assessment if they perceive a higher rate of infertility (Mantel-Haenszel Chi-square p < 0.01). 45% administer adjuvant RT in pts with elevated pre-orchiectomy alpha-fetoprotein levels. Conclusions: There is a dramatic uptake of observation as the recommended approach to pts with Stage I seminoma in US RO practices, despite a significant concern among practitioners about pt compliance. Further clinical work must establish best practices to minimize the effect on fertility, as well as guidelines for pts with Stage IS testicular seminoma. [Table: see text]

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Estimating and evaluating personalized treatment recommendations from randomized trials with ptr

The Stata Journal Promoting communications on statistics and Stata ◽

10.1177/1536867x211025799 ◽

2021 ◽

Vol 21 (2) ◽

pp. 348-359

Author(s):

Matthias Pierce ◽

Richard Emsley

Keyword(s):

Randomized Trials ◽

Patient Characteristics ◽

Treatment Recommendations ◽

Trial Data ◽

Personalized Treatment ◽

Treatment Recommendation ◽

Bootstrap Resampling ◽

Recommendation Algorithm ◽

Continuous Outcome ◽

Alternative Regime

One of the targets of personalized medicine is to provide treatment recommendations using patient characteristics. We present the command ptr, which both predicts a personalized treatment recommendation algorithm and evaluates its effectiveness versus an alternative regime, using randomized trial data. The command allows for multiple (continuous or categorical) biomarkers and a binary or continuous outcome. Confidence intervals for the evaluation parameter are provided using bootstrap resampling.

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The Impact of Selected Patient Characteristics on Practitioners?? Treatment Recommendations for End-stage Renal Disease

Medical Care ◽

10.1097/00005650-198502000-00001 ◽

1985 ◽

Vol 23 (2) ◽

pp. 95-109 ◽

Cited By ~ 14

Author(s):

Raisa B. Deber ◽

Ilsa N. Blidner ◽

Luby M. Carr ◽

Janet M. Barnsley

Keyword(s):

Renal Disease ◽

End Stage Renal Disease ◽

Patient Characteristics ◽

Treatment Recommendations ◽

Stage Renal Disease ◽

End Stage ◽

The Impact

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0604 Comorbidities and Admission Rates in Inpatients Undergoing Sleep Studies

SLEEP ◽

10.1093/sleep/zsaa056.601 ◽

2020 ◽

Vol 43 (Supplement_1) ◽

pp. A231-A231

Author(s):

K G Johnson ◽

N Ravikumar ◽

N Scuderi ◽

A Sharma ◽

V Rastegar ◽

...

Keyword(s):

Average Length ◽

Medical Center ◽

Central Sleep Apnea ◽

Patient Characteristics ◽

Median Number ◽

Treatment Recommendations ◽

Subsequent Treatment ◽

Sleep Study ◽

Sleep Studies ◽

Obesity Hypoventilation

Abstract Introduction Uncontrolled sleep-disordered breathing (SDB) and hypoventilation, which are common in COPD, CHF and obesity hypoventilation patients can lead to death and readmissions. It is unknown whether inpatient sleep studies to diagnose and optimize treatment improve care and prevent readmissions. Methods All patients > 18 years old with sleep studies while inpatient at Baystate Medical Center between October 2015 and September 2017 were included. Patient characteristics, comorbidities, sleep study diagnoses, and treatment recommendations were evaluated. Admission (inpatient or observation) and death rates were determined for 1-year before admit date and 1-year after discharge date of index admission. Results 326 adult inpatients had 120 portable and 304 in-laboratory tests performed. Average age was 62.9±14.4, mean BMI was 37.2±12.3 and 56% were male. Principal diagnoses were CHF (50%), COPD (39%), both COPD and CHF (20%) and obesity hypoventilation (27%). 31 used PAP and 71 used oxygen prior to admission. Sleep diagnoses included OSA (73%), central sleep apnea (CSA) (29%), treatment emergent CSA (8%), hypoxia (48%), hypoventilation (41%), and normal or non-diagnostic (6%). Treatment recommendations included CPAP (25%), BiPAP (18%), BiPAP ST (3%), ASV (4%), iVAPS (22%), oxygen only (5%) and further titration (20%). The average length of stay was 11.6 ± 9.6 days. There was no difference in the percentage of patients who had an admission before or after their sleep study (53% vs 56%, respectively). In addition, no difference was seen in the median number of admissions before and after the sleep study (median=1.0, IQI=0-2, p=0.77). 90-day readmission rate was 19%. 14% died. Conclusion SDB, hypoxia and hypoventilation were common in inpatients evaluated with sleep studies with PAP therapy recommended in most patients. Further research is needed to determine whether inpatient testing and subsequent treatment can result in decreased readmissions and death. Support None

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A demonstration of a multi-method variable selection approach for treatment selection: Recommending cognitive-behavioral versus psychodynamic therapy for mild to moderate adult depression

10.31234/osf.io/njus6 ◽

2017 ◽

Author(s):

Zachary Daniel Cohen ◽

Thomas Kim ◽

Henricus Van ◽

Jack Dekker ◽

Ellen Driessen

Keyword(s):

Variable Selection ◽

Rating Scale ◽

Psychological Treatment ◽

Selection Procedure ◽

Patient Characteristics ◽

Treatment Recommendations ◽

Psychodynamic Therapy ◽

Treatment Selection ◽

Cognitive Behavioral ◽

Treatment Needs

Objective: We use a new variable selection procedure for treatment selection which generates treatment recommendations based on pre-treatment characteristics for adults with mild-to-moderate depression deciding between cognitive behavioral (CBT) versus psychodynamic therapy (PDT).Method: Data are drawn from a randomized comparison of CBT versus PDT for depression (N=167, 71%-female, mean-age=39.6). The approach combines four different statistical techniques to identify patient characteristics associated consistently with differential treatment response. Variables are combined to generate predictions indicating each individual’s optimal-treatment. The average outcomes for patients who received their indicated treatment versus those who did not were compared retrospectively to estimate model utility.Results: Of 49 predictors examined, depression severity, anxiety sensitivity, extraversion, and psychological treatment-needs were included in the final model. The average post-treatment Hamilton-Depression-Rating-Scale score was 1.6 points lower (95%CI=[0.5:2.8]; d=0.21) for those who received their indicated-treatment compared to non-indicated. Among the 60% of patients with the strongest treatment recommendations, that advantage grew to 2.6 (95%CI=[1.4:3.7]; d=0.37). Conclusions: Variable selection procedures differ in their characterization of the importance of predictive variables. Attending to consistently-indicated predictors may be sensible when constructing treatment selection models. The small-N and lack of separate validation sample indicate a need for prospective tests before this model is used.

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