scholarly journals Promoting Equity When Using the SNOT-22 Score: A Scoping Review and Literature Review

Sinusitis ◽  
2022 ◽  
Vol 6 (1) ◽  
pp. 15-20
Author(s):  
Abigail Weaver ◽  
Andrew Wood
Keyword(s):  
Quality Of Life ◽  
Ethnic Differences ◽  
Scoping Review ◽  
Clinical Decision Making ◽  
Local Population ◽  
Clinical Decision ◽  
White People ◽  
Patient Reported ◽  
Snot 22

It is established that non-white people experience worse health outcomes than white people within the same population. Equity addresses differences between patient subgroups, allowing needs-based distribution of resources. The use of quality-of-life (QoL) tools to assist clinical decision making such as the SNOT-22 for chronic rhinosinusitis promotes equality, not equity, as quality-of-life (QoL) tools provide the same criteria of symptom scoring across diverse populations. We considered the effects of ethnicity and race on SNOT-22 scores and whether these scores should be adjusted to improve equity. PubMed and MEDLINE provided papers for a scoping review. A combination of the following search terms was used: patient-reported outcome measures (PROM) (OR) quality of life; (AND) race (OR) ethnicity (OR) disparities; (AND) otolaryngology (OR) SNOT-22 (OR) sinusitis. The first study identified no evidence of ethnic variability in SNOT-22 scores. However, the study did not represent the local population, including 86% white people. Other studies identified baseline SNOT-22 disparities with respect to population demographics, gender, and age. Ethnic differences appear to exist in acute sinusitis symptomatology. In other fields both within and outside of otorhinolaryngology, ethnic differences exist with regard to QoL tools. This scoping review identified a paucity of data in rhinology. However, evidence implies some form of correction to QoL scores could help promote equity for non-white patients.

scholarly journals Opioid Analgesia: Perspectives on Right Use and Utility

2007 ◽  
Vol 3;10 (5;3) ◽  
pp. 479-491 ◽  
Author(s):  
Jane C. Ballantyne
Keyword(s):  
Quality Of Life ◽  
Chronic Pain ◽  
Side Effects ◽  
Clinical Decision Making ◽  
Analgesic Efficacy ◽  
Clinical Decision ◽  
Opioid Analgesia ◽  
Opioid Treatment

The ability of opioids to effectively and safely control acute and cancer pain has been one of several arguments used to support extending opioid treatment to patients with chronic pain, against a backdrop of considerable caution that has been based upon fears of addiction. Of course, opioids may cause addiction, but the “principle of balance” may justify that “…efforts to address abuse should not interfere with legitimate medical practice and patient care.” Yet, situations are increasingly encountered in which opioid-maintained patients are refractory to analgesia during periods of pain, or even during the course of chronic treatment. The real question is whether analgesic efficacy of opioids can be maintained over time. Overall, the evidence supporting long-term analgesic efficacy is weak. The putative mechanisms for failed opioid analgesia may be related to tolerance or opioid-induced hyperalgesia. Advances in basic sciences may help in understanding these phenomena, but the question of whether long-term opioid treatment can improve patients’ function or quality of life remains a broader issue. Opioid side effects are well known, but with chronic use, most (except constipation) subside. Still, side effects can negatively affect the outcomes and continuity of therapy. This paper addresses 1) what evidence supports the long-term utility of opioids for chronic pain; 2) how side effects may alter quality of life; 3) the nature of addiction and why it is different in pain patients, and 4) on what grounds could pain medication be denied? These questions are discussed in light of patients’ rights, and warrant balancing particular responsibilities with risks. These are framed within the Hippocratic tradition of “producing good for the patient and protecting from harm,” so as to enable 1) more informed clinical decision making, and 2) progress towards right use and utility of opioid treatment for chronic pain. Key Words: Opioids, chronic pain, addiction, side effects, utility, ethics

scholarly journals Quality of life of elderly patients with solid tumours undergoing adjuvant cancer therapy: a systematic review

BMJ Open ◽  
2018 ◽  
Vol 8 (1) ◽  
pp. e018101 ◽  
Author(s):  
Karis Kin-Fong Cheng ◽  
Ethel Yee-Ting Lim ◽  
Ravindran Kanesvaran
Keyword(s):  
Quality Of Life ◽  
Systematic Review ◽  
Adjuvant Chemotherapy ◽  
Adjuvant Therapy ◽  
Elderly Patients ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Risk Of Bias ◽  
Solid Tumours

ObjectivesThe measurement of quality of life (QoL) in elderly cancer population is increasingly being recognised as an important element of clinical decision-making and the evaluation of treatment outcome. This systematic review aimed to summarise the evidence of QoL during and after adjuvant therapy in elderly patients with cancer.MethodsA systematic search was conducted of studies published in CINAHL plus, CENTRAL, PubMed, PsycINFO and Web of Science from the inception of these databases to December 2016. Eligible studies included RCTs and non-RCTs in which QoL was measured in elderly patients (aged 65 years or above) with stage I–III solid tumours who were undergoing adjuvant chemotherapy and/or radiotherapy. Because of the heterogeneity and the insufficient data among the included studies, the results were synthesised narratively.ResultsWe included 4 RCTs and 14 non-RCTs on 1785 participants. In all four RCTs, the risk of bias was low or unclear for most items but high for detection. Of the 14 non-RCTs, 5 studies were judged to have a low or moderate risk of bias for all domains, and the other 9 studies had a serious risk of bias in at least one domain. The bias was observed mainly in the confounding and in the selection of participants for the study. For most elderly patients with breast cancer, the non-significant negative change in the QoL was transient. A significant increase in the QoL during the course of temozolomide in elderly patients with glioblastoma but a decreasing trend in QoL after radiotherapy was shown. This review also shows a uniform trend of stable or improved QoL during adjuvant therapy and at follow-up evaluations across the studies with prostate, colon or cervical cancer population.ConclusionsThis review suggests that adjuvant chemotherapy and radiotherapy may not have detrimental effects on QoL in most elderly patients with solid tumours.

Goals of palliative cancer therapy.

1993 ◽  
Vol 11 (2) ◽  
pp. 378-381 ◽  
Author(s):  
F Porzsolt ◽  
I Tannock
Keyword(s):  
Quality Of Life ◽  
Decision Making ◽  
Cost Effectiveness ◽  
Cancer Therapy ◽  
Health Professionals ◽  
Palliative Treatment ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Oncology Practice

The major conclusions of the Workshop on Goals of Palliative Cancer Therapy are as follows: 1. The goals of any cancer therapy should be stated explicitly. 2. If the goal of treatment is palliation, this should be documented according to one of the established and validated methods for assessment of quality of life. Several validated methods are available, and although imperfect, have been shown to give reliable information. 3. The use of simple measures of quality of life (eg, symptom checklists, pain assessment cards) should become routine in oncology practice. The act of introducing such measures improves palliation. 4. Measures of cost-effectiveness should be used more widely in clinical decision making to ensure the appropriate deployment of resources. 5. There must be improved education of all health professionals with regard to the multiple methods for provision of palliative treatment to cancer patients and the assessment of palliation.

scholarly journals Routine administration of Health Related Quality of Life (HRQoL) and needs assessment instruments to improve psychological outcome – a systematic review

2002 ◽  
Vol 32 (8) ◽  
pp. 1345-1356 ◽  
Author(s):  
S. M. GILBODY ◽  
A. O. HOUSE ◽  
T. SHELDON
Keyword(s):  
Quality Of Life ◽  
Systematic Review ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Assessment Instruments ◽  
Health Related Quality ◽  
Routine Administration ◽  
Related Quality ◽  
Health Related

Background. Routine administration of Health Related Quality of Life (HRQoL) and needs assessment instruments has been advocated as part of clinical care to aid the recognition of psychosocial problems, to inform clinical decision making, to monitor therapeutic response and to facilitate patient–doctor communication. However, their adoption is not without cost and the benefit of their use is unclear.Method. A systematic review was conducted. We sought experimental studies that examined the addition of routinely administered measures of HRQoL to care in both psychiatric and non-psychiatric settings. We searched the following databases: MEDLINE, EMBASE, CINAHL, PsycLIT and Cochrane Controlled Trials Register (to 2000). Data were extracted independently and a narrative synthesis of results was presented.Results. Nine randomized and quasi-randomized studies conducted in non-psychiatric settings were found. All the instruments used included an assessment of mental well-being, with specific questions relating to depression and anxiety. The routine feedback of these instruments had little impact on the recognition of mental disorders or on longer term psychosocial functioning. While clinicians welcomed the information these instruments imparted, their results were rarely incorporated into routine clinical decision making. No studies were found that examined the value of routine assessment and feedback of HRQoL or patient needs in specialist psychiatric care settings.Conclusions. Routine HRQoL measurement is a costly exercise and there is no robust evidence to suggest that it is of benefit in improving psychosocial outcomes of patients managed in non-psychiatric settings. Major policy initiatives to increase the routine collection and use of outcome measures in psychiatric settings are unevaluated.

Hazards of Quality-of-Life Data for Clinical Decision Making

2001 ◽  
Vol 19 (2) ◽  
pp. 594-595 ◽  
Author(s):  
Mark Somerfield ◽  
Aminah Jatoi ◽  
Phuong L. Nguyen ◽  
Shaji Kumar ◽  
Jeff Sloan ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Decision Making ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Life Data

scholarly journals How Much? How Frequent? How Long? A Clinical Guide to New Therapies in Myelodysplastic Syndromes

Hematology ◽  
2010 ◽  
Vol 2010 (1) ◽  
pp. 314-321 ◽  
Author(s):  
William Blum
Keyword(s):  
Quality Of Life ◽  
Myelodysplastic Syndromes ◽  
Clinical Decision Making ◽  
Treatment Options ◽  
Clinical Decision ◽  
Clinical Results ◽  
Improve Quality ◽  
Substantial Impact ◽  
History Of

AbstractAdvances in the treatment of myelodysplastic syndromes (MDSs) over the last decade have given patients and their hematologists a multitude of treatment options. Therapeutic options now exist that reduce disease-related symptoms, improve quality of life, and alter the natural history of the disease. Three drugs are now specifically Food and Drug Administration-approved for treatment of MDS: (1) azacitidine, (2) decitabine, and (3) lenalidomide. Clinical results with each of these agents, plus results with immunosuppressive therapy, are reviewed to guide clinical decision making. Although each therapy has made a substantial impact in improving the care of patients with MDS, unfortunately MDS treatment in 2010 ultimately fails in most patients, but these therapies provide a foundation on which we can build to further improve outcomes.

scholarly journals Cronic Kidney Disease, Life Quality Assessment Of Patients

2016 ◽  
Vol 12 (6) ◽  
pp. 103
Author(s):  
Marsida Duli ◽  
Qamil Dika ◽  
Matilda Bushati
Keyword(s):  
Quality Of Life ◽  
Chronic Kidney Disease ◽  
Decision Making ◽  
Kidney Disease ◽  
Clinical Decision Making ◽  
Well Being ◽  
Clinical Decision ◽  
Healthy Population ◽  
Important Indicator

Assessing quality of life in patients with varying degrees of chronic kidney disease is an important issue because of its impact on clinical decision-making as increasing the efficiency of resources in the health system. Through this survey provided an attempt to assess the quality of life of patients with chronic kidney disease undergoing dialysis. Commitment to maximize their functioning and well-being constitutes the essence of the purpose of health care. In recent decades elaborate SF 36 is cut by a gauge derive so simple and basic that helps to evaluate the function of the target of researchers, a certain age group, a disease or a treatment group. Short questionnaire forms SF36 instrument gauge is used to determine the level of quality of life in patients with chronic renal failure under the different stages of treatment with dialysis. The study involved 206 people, 112 from patients to Tirana and Shkodra and 94 healthy persons, who collaborated consensually for completing the questionnaires. Based on the results, the quality of life of dialysis patients is significantly worse than that of the healthy population and patients with other injuries less severe of renal function. Survey indicates that a more holistic approach to be used in the treatment of patients with chronic kidney disease including clinical decision making and patient perception. Precisely for this it is recommended to enter the practice of clinical interest that a set of questionnaires that provide information on patients' perception of health as an important indicator that facilitates the physician-patient collaboration in order to better treatment of the disease and increase the quality the life of the patient.

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