Prediction model for small-cell lung cancer in the Lambert-Eaton myasthenic syndrome

Medical Decision Makin

Clinical Dutch-English Lambert-Eaton Myasthenic syndrome (LEMS) tumor association prediction score accurately predicts small-cell lung cancer in the LEMS.

PURPOSE: Approximately one half of patients with Lambert-Eaton myasthenic syndrome (LEMS) have small-cell lung carcinomas (SCLC), aggressive tumors with poor prognosis. In view of its profound impact on therapy and survival, we developed and validated a score to identify the presence of SCLC early in the course of LEMS. PATIENTS AND METHODS: We derived a prediction score for SCLC in LEMS in a nationwide cohort of 107 Dutch patients, and validated it in a similar cohort of 112 British patients. A Dutch-English LEMS Tumor Association Prediction (DELTA-P) score was developed based on multivariate logistic regression. RESULTS: Age at onset, smoking behavior, weight loss, Karnofsky performance status, bulbar involvement, male sexual impotence, and the presence of Sry-like high-mobility group box protein 1 serum antibodies were independent predictors for SCLC in LEMS. A DELTA-P score was derived allocating 1 point for the presence of each of the following items at or within 3 months from onset: age at onset ≥ 50 years, smoking at diagnosis, weight loss ≥ 5%, bulbar involvement, erectile dysfunction, and Karnofsky performance status lower than 70. The area under the curve of the receiver operating curve was 94.4% in the derivation cohort and 94.6% in the validation set. A DELTA-P score of 0 or 1 corresponded to a 0% to 2.6% chance of SCLC, whereas scores of 4, 5, and 6 corresponded to chances of SCLC of 93.5%, 96.6%, and 100%, respectively. CONCLUSION: The simple clinical DELTA-P score discriminated patients with LEMS with and without SCLC with high accuracy early in the course of LEMS

Strategic decision making in higher education: an analysis of the new planning system in Dutch higher education

One of the main objects of the recently developed policy for Dutch higher education regards the creation of a more diversified higher education system with flexible and adaptive institutions. The nature of the proposed system should, among other things, reveal itself in meaningful and discriminating institutional profiles, based on strategic institutional choices. This article reflects on the degree to which these objects are realized. After the introduction of the new planning system in Dutch higher education, the article deals with the possibility of strategic planning in higher education institutions in general. Three different, but not necessary independent, models are distinguished: the linear strategy model, the adaptive strategy model and the interpretive strategy model. It is argued that the latter model can be applied best to higher education institutions. Some evidence on strategic planning in Dutch higher education illustrates the practice in this field. Empirical evidence shows that the governmental aim to increase the diversity in Dutch higher education is not very successful up till now. On the contrary, it seems that various homogenizing developments emerge. The concept of institutional isomorphism helps to explain some of the problems institutions encounter when trying to formulate and implement their strategies