Pediatric Treatment Options for Average-Risk Medulloblastoma

75 Background: Rates of unilateral (UM) and contralateral prophylactic mastectomy (CPM) for early-stage breast cancer (ESBC) have been increasing. Both surgeons’ preference and patients’ choice have been suggested to play a role. Methods: A qualitative study was conducted examining surgeon’s practices and patient’s decision-making during treatment for ESBC. The Health-Belief Model was applied identifying factors influential in the choice for UM+/-CPM. Purposive sampling identified non-high-risk women across Toronto, Canada who were candidates for breast conserving therapy (BCT) but underwent UM+/-CPM. Academic and community breast surgeons from across Ontario, Canada and the United States were also recruited. Data were collected through semi-structured interviews. Constant comparative analysis identified key ideas. Results: 29 patients and 45 surgeons were interviewed. The dominant theme was the ‘misperceived threat of ESBC: an overestimated risk’. Surgeons described the high survivability of ESBC, yet patients greatly overestimated the threat of death from their cancer and strived to eliminate this threat by choosing UM+/-CPM. Surgeons described BCT and UM as equivalent treatment options for ESBC, and recommended BCT. In this average-risk population CPM was discouraged by the surgeons describing no survival advantage; despite this, women requested UM+CPM. Personal cancer experiences with family and friends were extremely influential in women’s request for UM+/-CPM. Previous negative experiences translated into an overestimated risk of recurrence, contralateral cancer, metastasisand subsequent death. Patients’ misperceived the severity of ESBC, and believed that by choosing UM+/-CPM they would live longer. Most women did not perceive any risks of undergoing mastectomy, yet many had ongoing issues with skin sensation, cosmesis and body image. Conclusions: Despite surgeons counseling otherwise, women greatly overestimated the risk of ESBC and misperceived the benefits of mastectomy. As undergoing UM+/-CPM is not without risks, improved discussion of patient sources of information and fears around survival may benefit surgical consultations, facilitating informed decision-making.

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Balancing Political and Criminogenic Needs: Evaluating the New Zealand Department of Corrections’ Response to Men Assessed With a Below Average Risk for Sexual Recidivism

Sexual Abuse ◽

10.1177/10790632211042365 ◽

2021 ◽

pp. 107906322110423

Author(s):

Angela E. Carr ◽

Gwenda M. Willis

Keyword(s):

Comparison Group ◽

Treatment Options ◽

Vacuum Treatment ◽

Average Risk ◽

Sexual Offence ◽

Sexual Recidivism ◽

Dynamic Risk ◽

Program Success ◽

Criminogenic Needs ◽

Correctional Settings

Current research provides little evidence for the effectiveness of treatment in reducing sexual offence recidivism amongst low-risk populations. However, in real-world correctional settings, program delivery rarely occurs in a vacuum, treatment may be politically mandated and unidimensional measures of program success may preclude recognition of broader benefits. The current study investigated the effectiveness of a low-intensity treatment program, both in terms of participants’ recidivism outcomes and in terms of broader organizational/systems impacts. The results demonstrated low base rate recidivism across both program participants ( n = 311) and a comparison group of men who were assessed as demonstrating similar static sexual offence recidivism risk ( n = 391), and little evidence of reduced recidivism following treatment. However, program administration led to many potential participants being identified as demonstrating higher levels of dynamic risk and overridden to more intensive treatment options ( n = 101). Given evidence that such options do effectively reduce recidivism in higher risk populations, these findings may suggest an overall positive net effect.

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Examining health beliefs: Why mastectomies are on the rise.

Journal of Clinical Oncology ◽

10.1200/jco.2014.32.30_suppl.192 ◽

2014 ◽

Vol 32 (30_suppl) ◽

pp. 192-192 ◽

Cited By ~ 1

Author(s):

Andrea Marie Covelli ◽

Nancy N. Baxter ◽

Margaret Fitch ◽

Frances Catriona Wright

Keyword(s):

Health Beliefs ◽

Prophylactic Mastectomy ◽

Early Stage ◽

Treatment Options ◽

Contralateral Prophylactic Mastectomy ◽

The United States ◽

Breast Conserving Therapy ◽

Average Risk ◽

Sources Of Information ◽

Structured Interviews

192 Background: Rates of unilateral (UM) and contralateral prophylactic mastectomy (CPM) for early-stage breast cancer (ESBC) have been increasing. To understand this increase we sought the perspectives of patients who chose UM+/-CPM and treating surgeons. Methods: Applying the Health-Belief Model, we completed a qualitative study examining the surgeon’s practice and patient’s decision-making that resulted in the choice for mastectomy. Purposive sampling identified women across Toronto, Canada who were candidates for breast conserving therapy (BCT) but underwent UM+/-CPM. Academic and community breast surgeons from across Ontario, Canada and the United States were also recruited. Data were collected through semi-structured interviews, this continued until data saturation was reached. Constant comparative analysis identified key ideas. Results: 29 patients and 45 surgeons completed interviews. The dominant theme was a ‘misperceived threat’. Despite surgeons describing the high survivability of ESBC, patients greatly overestimated the threat of ESBC and strived to eliminate this threat by choosing mastectomy. Surgeons described BCT and UM as equivalent treatment options for ESBC, and often recommended BCT. In this average-risk population CPM was discouraged by the surgeons describing no survival advantage; despite this, women requested UM+CPM. Personal cancer experiences with family and friends were extremely influential in women’s request for UM+/-CPM. Previous negative experiences translated into an overestimated risk of recurrence, contralateral cancer, metastasisand subsequent death. Despite evidence-based consultations, patients misperceived the risks and severity of ESBC, and believed that by choosing UM+/-CPM they would live longer. Most women did not perceive any risks of undergoing mastectomy, yet many had ongoing issues with disturbed skin sensation, cosmesis and body image. Conclusions: A previous cancer experience was influential in the choice for UM+CPM. Despite surgeons counseling otherwise, women greatly overestimated the risk of ESBC and misperceived the benefits of mastectomy. Improved discussion of patient sources of information and fears around survival would benefit surgical consultations.

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The Collaborative Network Approach: a model for advancing patient-centric research for Castleman disease and other rare diseases

Emerging Topics in Life Sciences ◽

10.1042/etls20180178 ◽

2019 ◽

Vol 3 (1) ◽

pp. 97-105

Author(s):

Mary Zuccato ◽

Dustin Shilling ◽

David C. Fajgenbaum

Keyword(s):

Rare Diseases ◽

Treatment Options ◽

Castleman Disease ◽

High Impact ◽

Collaborative Network ◽

Network Approach ◽

Grant Applications ◽

Research Questions ◽

Novel Strategy ◽

Patient Centric

Abstract There are ∼7000 rare diseases affecting 30 000 000 individuals in the U.S.A. 95% of these rare diseases do not have a single Food and Drug Administration-approved therapy. Relatively, limited progress has been made to develop new or repurpose existing therapies for these disorders, in part because traditional funding models are not as effective when applied to rare diseases. Due to the suboptimal research infrastructure and treatment options for Castleman disease, the Castleman Disease Collaborative Network (CDCN), founded in 2012, spearheaded a novel strategy for advancing biomedical research, the ‘Collaborative Network Approach’. At its heart, the Collaborative Network Approach leverages and integrates the entire community of stakeholders — patients, physicians and researchers — to identify and prioritize high-impact research questions. It then recruits the most qualified researchers to conduct these studies. In parallel, patients are empowered to fight back by supporting research through fundraising and providing their biospecimens and clinical data. This approach democratizes research, allowing the entire community to identify the most clinically relevant and pressing questions; any idea can be translated into a study rather than limiting research to the ideas proposed by researchers in grant applications. Preliminary results from the CDCN and other organizations that have followed its Collaborative Network Approach suggest that this model is generalizable across rare diseases.

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Establishing a Group Educational Session for Hyperacusis Patients

American Journal of Audiology ◽

10.1044/2019_aja-18-0148 ◽

2019 ◽

Vol 28 (2) ◽

pp. 245-250

Author(s):

Ann E. Perreau ◽

Richard S. Tyler ◽

Patricia C. Mancini ◽

Shelley Witt ◽

Mohamed Salah Elgandy

Keyword(s):

Therapeutic Process ◽

Treatment Options ◽

Clinical Group ◽

Education Session ◽

Group Approach ◽

Treatment Protocols ◽

Educational Session ◽

Evidence Based Treatment ◽

Relationship Of ◽

The Relationship

Purpose Audiologists should be treating hyperacusis patients. However, it can be difficult to know where to begin because treatment protocols and evidence-based treatment studies are lacking. A good place to start in any tinnitus and hyperacusis clinic is to incorporate a group educational session. Method Here, we outline our approach to establishing a hyperacusis group educational session that includes specific aspects of getting to know each patient to best meet their needs, understanding the problems associated with hyperacusis, explaining the auditory system and the relationship of hyperacusis to hearing loss and tinnitus, describing the influence of hyperacusis on daily life, and introducing treatment options. Subjective responses from 11 adults with hyperacusis, who participated in a recent clinical group education session, were discussed to illustrate examples from actual patients. Conclusions Due to the devastating nature of hyperacusis, patients need to be reassured that they are not alone and that they can rely on audiologists to provide support and guidance. A group approach can facilitate the therapeutic process by connecting patients with others who are also affected by hyperacusis, and by educating patients and significant others on hyperacusis and its treatment options. Supplemental Material https://doi.org/10.23641/asha.8121197

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Surgery for Lung Cancer and the Consequences for the Swallow

Perspectives of the ASHA Special Interest Groups ◽

10.1044/persp1.sig13.162 ◽

2016 ◽

Vol 1 (13) ◽

pp. 162-168

Author(s):

Pippa Hales ◽

Corinne Mossey-Gaston

Keyword(s):

Lung Cancer ◽

Treatment Options ◽

Vocal Cord Palsy ◽

Subsequent Treatment ◽

Physiological Reserve ◽

Palliative Phase ◽

And Function ◽

The Impact ◽

Swallow Function

Lung cancer is one of the most commonly diagnosed cancers across Northern America and Europe. Treatment options offered are dependent on the type of cancer, the location of the tumor, the staging, and the overall health of the person. When surgery for lung cancer is offered, difficulty swallowing is a potential complication that can have several influencing factors. Surgical interaction with the recurrent laryngeal nerve (RLN) can lead to unilateral vocal cord palsy, altering swallow function and safety. Understanding whether the RLN has been preserved, damaged, or sacrificed is integral to understanding the effect on the swallow and the subsequent treatment options available. There is also the risk of post-surgical reduction of physiological reserve, which can reduce the strength and function of the swallow in addition to any surgery specific complications. As lung cancer has a limited prognosis, the clinician must also factor in the palliative phase, as this can further increase the burden of an already compromised swallow. By understanding the surgery and the implications this may have for the swallow, there is the potential to reduce the impact of post-surgical complications and so improve quality of life (QOL) for people with lung cancer.

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An Overview of Dementias

Perspectives on Swallowing and Swallowing Disorders (Dysphagia) ◽

10.1044/sasd21.3.75 ◽

2012 ◽

Vol 21 (3) ◽

pp. 75-84

Author(s):

Venkata Vijaya K. Dalai ◽

Jason E. Childress ◽

Paul E Schulz

Keyword(s):

Clinical Presentation ◽

Treatment Options ◽

Current Treatment ◽

Great Variability ◽

Health Concern ◽

Public Health Concern ◽

Life Threatening ◽

The Common ◽

Neurodegenerative Dementias ◽

Made In

Dementia is a major public health concern that afflicts an estimated 24.3 million people worldwide. Great strides are being made in order to better diagnose, prevent, and treat these disorders. Dementia is associated with multiple complications, some of which can be life-threatening, such as dysphagia. There is great variability between dementias in terms of when dysphagia and other swallowing disorders occur. In order to prepare the reader for the other articles in this publication discussing swallowing issues in depth, the authors of this article will provide a brief overview of the prevalence, risk factors, pathogenesis, clinical presentation, diagnosis, current treatment options, and implications for eating for the common forms of neurodegenerative dementias.

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