Patient participation in clinical decision-making for treatment of T3 laryngeal cancer: a comparison of state and process utilities.

PURPOSE To study the use of two different approaches, and feasibility of four commonly used utility assessment methods to assess preferences for treatment of T3-laryngeal cancer by surgery or radiation therapy (RT). METHODS Utility assessment methods, namely, time trade-off (TTO), standard reference gamble (SRG), rating scale (RS), and direct comparison (DC), were used to assess utilities in two groups of former cancer patients (n = 10 for both), a group of clinicians (n = 9), and a group from the general population (n = 10). For the treatment modalities, ie, surgery and RT, two types of scenarios were developed and used: the state scenario, which describes a stable health state after treatment, and the process scenario, which describes a dynamic process. First, utilities were assessed based on state scenarios. Next, respondents were thoroughly informed and educated with respect to the relevant aspects of both treatment modalities. Subsequently, utilities were again assessed, but now based on the process scenarios. The outcome of each approach was calculated and expressed in a quality-adjusted life-expectancy (QALE) score for each treatment modality, and the treatment with the highest outcome was said to be the preferred treatment modality. RESULTS In general, a higher QALE score for each treatment modality was found for clinicians and for the general population as compared with the former-cancer-patient groups. When the outcome of both approaches was compared on an individual level dependent on the utility assessment method, 32% to 43% of respondents showed an inconsistent treatment preference. CONCLUSION The approach to assess utilities and the extent to which respondents are informed about treatment modalities have a major effect on individual treatment preferences.

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Treatment Results for Stage III Laryngeal Cancer: Analysis of a Populational Database Using Propensity Scores

International Archives of Otorhinolaryngology ◽

10.1055/s-0041-1726042 ◽

2021 ◽

Author(s):

Hugo Fontan Köhler ◽

Genival Barbosa de Carvalho ◽

Luiz Paulo Kowalski

Keyword(s):

Overall Survival ◽

Propensity Score ◽

Laryngeal Cancer ◽

Treatment Modality ◽

Nearest Neighbor ◽

Stage Iii ◽

Treatment Modalities ◽

Population Database ◽

Significant Difference ◽

Disease Specific

Abstract Introduction Treatment of stage III laryngeal cancer suffered a major paradigm change with surgery being substituted by radiation therapy with chemotherapy. Objective To evaluate the oncological outcome of different treatment modalities for stage III laryngeal cancer using a population database. Methods A population database representing patients treated in the state of São Paulo, Brazil, was analyzed. Demographic, clinical and treatment variables were included, and the outcomes of interest were disease-specific and overall survival. Propensity score with nearest neighbor matching was used to compensate for imbalances in treatment groups. Results We retrieved data from 1,804 patients. In multivariate analysis, age, female gender, payment source, clinical N stage (cN) stages, and treatment modality were significant for disease-specific and overall survival. Patients submitted to surgery treatment had a significantly better disease-specific (p < 0.001) and overall survival (p < 0.001) compared with chemoradiation. Propensity score matching was based on cN stage, gender, age, topography, and payment modality, and allowed the pairing of 685 patients from each treatment modality. There was a significant difference in disease-specific survival favoring surgery-based treatment (p = 0.017). Conclusion The treatment choice has a significant impact on survival in patients with stage III laryngeal cancer with surgery-based treatment being superior to chemoradiotherapy (CRT).

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Preliminary Findings on the Use of Session Questionnaires to Improve Clinician-Client Alliance With Special Consideration to Clinical Education

Perspectives on Administration and Supervision ◽

10.1044/aas25.1.50 ◽

2015 ◽

Vol 25 (1) ◽

pp. 50-60

Author(s):

Anu Subramanian

Keyword(s):

Graduate Students ◽

Clinical Education ◽

Clinical Decision Making ◽

Rating Scale ◽

Treatment Effectiveness ◽

Clinical Decision ◽

Added Value ◽

Therapeutic Outcomes ◽

Specific Feedback ◽

Stakeholder Perspective

ASHA's focus on evidence-based practice (EBP) includes the family/stakeholder perspective as an important tenet in clinical decision making. The common factors model for treatment effectiveness postulates that clinician-client alliance positively impacts therapeutic outcomes and may be the most important factor for success. One strategy to improve alliance between a client and clinician is the use of outcome questionnaires. In the current study, eight parents of toddlers who attended therapy sessions at a university clinic responded to a session outcome questionnaire that included both rating scale and descriptive questions. Six graduate students completed a survey that included a question about the utility of the questionnaire. Results indicated that the descriptive questions added value and information compared to using only the rating scale. The students were varied in their responses regarding the effectiveness of the questionnaire to increase their comfort with parents. Information gathered from the questionnaire allowed for specific feedback to graduate students to change behaviors and created opportunities for general discussions regarding effective therapy techniques. In addition, the responses generated conversations between the client and clinician focused on clients' concerns. Involving the stakeholder in identifying both effective and ineffective aspects of therapy has advantages for clinical practice and education.

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Management of thoracic aortic lesions - the future is endovascular

VASA ◽

10.1024/0301-1526/a000183 ◽

2012 ◽

Vol 41 (3) ◽

pp. 163-176 ◽

Cited By ~ 6

Author(s):

Weidenhagen ◽

Bombien ◽

Meimarakis ◽

Geisler ◽

A. Koeppel

Keyword(s):

Thoracic Aorta ◽

Clinical Decision Making ◽

Treatment Options ◽

Clinical Decision ◽

Clinical Results ◽

Treatment Modalities ◽

Traumatic Rupture ◽

Descending Thoracic Aorta ◽

New Treatment ◽

Aneurysm Dissection

Open surgical repair of lesions of the descending thoracic aorta, such as aneurysm, dissection and traumatic rupture, has been the state-of-the-art treatment for many decades. However, in specialized cardiovascular centers, thoracic endovascular aortic repair and hybrid aortic procedures have been implemented as novel treatment options. The current clinical results show that these procedures can be performed with low morbidity and mortality rates. However, due to a lack of randomized trials, the level of reliability of these new treatment modalities remains a matter of discussion. Clinical decision-making is generally based on the experience of the vascular center as well as on individual factors, such as life expectancy, comorbidity, aneurysm aetiology, aortic diameter and morphology. This article will review and discuss recent publications of open surgical, hybrid thoracic aortic (in case of aortic arch involvement) and endovascular repair in complex pathologies of the descending thoracic aorta.

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Structural Equations for Multi-Health State, Multi-Utility Assessment Method Data

PsycEXTRA Dataset ◽

10.1037/e683342011-114 ◽

2006 ◽

Author(s):

Robert Hamm

Keyword(s):

Assessment Method ◽

Structural Equations ◽

Health State ◽

Utility Assessment

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Assessment of Agreement Between Human Ratings and Lexicon-Based Sentiment Ratings of Open-Ended Responses on a Behavioral Rating Scale

Assessment ◽

10.1177/1073191121996466 ◽

2021 ◽

pp. 107319112199646

Author(s):

Olivia Gratz ◽

Duncan Vos ◽

Megan Burke ◽

Neelkamal Soares

Keyword(s):

Sentiment Analysis ◽

Language Processing ◽

Rating Scales ◽

Clinical Decision Making ◽

Rating Scale ◽

Clinical Decision ◽

Assessment System ◽

Word Count ◽

Positive Correlation ◽

Sentiment Score

To date, there is a paucity of research conducting natural language processing (NLP) on the open-ended responses of behavior rating scales. Using three NLP lexicons for sentiment analysis of the open-ended responses of the Behavior Assessment System for Children-Third Edition, the researchers discovered a moderately positive correlation between the human composite rating and the sentiment score using each of the lexicons for strengths comments and a slightly positive correlation for the concerns comments made by guardians and teachers. In addition, the researchers found that as the word count increased for open-ended responses regarding the child’s strengths, there was a greater positive sentiment rating. Conversely, as word count increased for open-ended responses regarding child concerns, the human raters scored comments more negatively. The authors offer a proof-of-concept to use NLP-based sentiment analysis of open-ended comments to complement other data for clinical decision making.

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Survival Associations between Patient Age and Treatment Modality in Olfactory Neuroblastoma: A Retrospective Population-Based Study

Journal of Clinical Medicine ◽

10.3390/jcm10122685 ◽

2021 ◽

Vol 10 (12) ◽

pp. 2685

Author(s):

Andre J. Burnham ◽

Phillip A. Burnham ◽

Edwin M. Horwitz

Keyword(s):

Treatment Modality ◽

Age Groups ◽

Olfactory Neuroblastoma ◽

Population Based ◽

Treatment Modalities ◽

Long Term Outcomes ◽

Patient Age ◽

Population Based Study ◽

Patient Âgé

Olfactory neuroblastoma (ONB) is a rare neuroepithelial-derived malignancy that usually presents in the nasal cavity. The rarity of ONB has led to conflicting reports regarding associations of patient age and ONB survival and outcome. Moreover, long-term outcomes of chemotherapy and other treatment modalities are speculated. Here, we aimed to compare survival outcomes across age groups through time and determine associations between treatment modality and survival. In this retrospective population-based study, we analyzed the SEER 2000–2016 Database for patients with ONB tumors. Using Kaplan–Meier survival analysis, a significant effect of age and cancer-specific survival (CSS) was observed; geriatric ONB patients had the lowest CSS overall. Generalized linear models and survival analyses demonstrated that CSS of the pediatric patient population was similar to the geriatric group through 100 months but plateaued thereafter and was the highest of all age groups. Radiation and surgery were associated with increased CSS, while chemotherapy was associated with decreased CSS. GLM results showed that tumor grade, stage and lymph node involvement had no CSS associations with age or treatment modality. Our results provide insight for future investigations of long-term outcomes associated with ONB patient age and treatment modality, and we conclude that survival statistics of ONB patients should be analyzed in terms of trends through time rather than fixed in time.

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Development of the Mental, Emotional, and Bodily Toughness Inventory in Collegiate Athletes and Nonathletes

Journal of Athletic Training ◽

10.4085/1062-6050-43.2.125 ◽

2008 ◽

Vol 43 (2) ◽

pp. 125-132 ◽

Cited By ~ 12

Author(s):

Mick G. Mack ◽

Brian G. Ragan

Keyword(s):

Undergraduate Students ◽

Rating Scale ◽

Collegiate Athletes ◽

Rehabilitation Program ◽

Mental Toughness ◽

Individual Treatment ◽

Model Data ◽

Fit Statistics ◽

The People ◽

The Individual

Abstract Context: The assessment of an individual's mental toughness would assist clinicians in enhancing an individual's performance, improving compliance with the rehabilitation program, and improving the individual treatment program. However, no sound measure of mental toughness exists. Objective: To develop a new measure of mental toughness, the Mental, Emotional, and Bodily Toughness Inventory (MeBTough). Design: Participants were invited to complete a 45-item questionnaire. Setting: University research laboratory. Patients or Other Participants: A total of 261 undergraduate students were recruited to complete the questionnaire. Main Outcome Measure(s): The Rasch-calibrated item difficulties, fit statistics, and persons' mental toughness ability estimates were examined for model-data fit of the MeBTough. Results: Forty-three of the 45 items had good model-data fit with acceptable fit statistics. Results indicated that the distribution of items was fittingly targeted to the people and the collapsed rating scale functioned well. The item separation index (6.31) and separation reliability statistic (.98) provided evidence that the items had good variability with a high degree of confidence in replicating placement of the items from another sample. Conclusions: Results provided support for using the new measure of mental, emotional, and bodily toughness.

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Review of recent treatment trends of laryngeal cancer in Poland: a population-based study

BMJ Open ◽

10.1136/bmjopen-2020-045308 ◽

2021 ◽

Vol 11 (4) ◽

pp. e045308

Author(s):

Anna Rzepakowska ◽

Michał Żurek ◽

Kazimierz Niemczyk

Keyword(s):

Laryngeal Cancer ◽

Radical Resection ◽

Population Based ◽

Treatment Modalities ◽

Secondary Outcome ◽

Partial Laryngectomy ◽

Population Based Study ◽

New Diagnosis ◽

Treatment Trends ◽

Subsequent Rise

ObjectivesTo investigate the utilisation of different treatment modalities for patients with laryngeal cancer (LC) during last decade in Poland.SettingRetrospective population-based study.ParticipantsPatients with LC treated between January 2009 and December 2018.Primary and secondary outcome measuresThe contemporary utilisation of treatment modalities of LC: surgery with intent of radical resection (total or partial laryngectomy), radiotherapy (RT) and chemoradiotherapy (CRT).ResultsThere was determined the overall number of 22 957 new diagnosis of LC from 2010 to 2018 and confirmed the steady decrease in the incidence rate of LC in the following years from 7.7 to 6.03. The mean age of patients with LC was raising by an average of 0.3832 of year per year. There was observed decrease in number of total laryngectomies (TLs) in subsequent years (from 1122 in 2009 to 776 in 2018). The number of procedures involving partial laryngeal resection was within stable ranges however the upward trend was observed separately for vocal cordectomy. There was established decreased involvement of surgery in LC treatment from 52.8% in 2009 to 24.3% in 2016 with the subsequent rise to 33.7% in 2018. The percentage of patients receiving RT increased from 23.8% in 2009 to 42.1% in 2013 with the next decrease to 25.7% in 2018. The utilisation of CRT in LC treatment was progressively increasing over analysed years from 23.4% in 2009 reaching 40.6% in 2018.ConclusionsThe presented data revealed an increase in total number of organs preserving treatment modality with CRT in subsequent years with decreasing number of TLs in Polish patients with LC.

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