Interventions for Speech and Language Outcomes for Children with ANSD: A Systematic Review

Purpose or Research Questions: In children with ANSD, how does amplification compared to cochlear implantation affect speech and language outcomes? Background: Auditory Neuropathy Spectrum Disorder, or ANSD is a sensorineural hearing loss characterized by an impairment of the auditory nerve. This generally means that while sound is able to travel through the outer, middle, and inner ear, it is unable to successfully reach the brain. Cochlear Implants (CIs) and hearing aids have both become common interventions for children with ANSD. The purpose of this systematic review is to investigate differences in speech and language outcomes between the two interventions. Methods/Proposed Methods: A literature search was conducted using the following search string: (ANSD OR CND OR Auditory Neuropathy OR Cochlear Nerve Deficiency) AND (children OR pediatric OR school) AND (amplification OR Hearing aids OR hearing amplification OR acoustic stimulation) AND (cochlear implant* OR electric stimulation). Three major databases were searched; PubMed, Ovid, and MedlinePlus. Studies including speech and language outcomes of this population of children were included. Exclusion criteria included children with comorbities, non-English speaking populations, and studies that only considered academic achievement outcomes. 12 studies met the inclusion criteria by addressing one or more of the aspects of our research questions. Eleven of the 12 studies addressed the use of cochlear implantation, and 5 addressed the use of hearing aids. Studies were evaluated for quality using the Cincinnati Children’s LEGEND Appraisal Forms. Data regarding participant, intervention, and outcome variables are reported. Results/Anticipated Results: All studies included were observational in design, including cohort studies and comparisons between children with ANSD and SNHL. The literature supports both hearing aids and CIs as acceptable intervention measures for ANSD. Evidence of favorable outcomes were demonstrated for both types of intervention in children with ANSD. Speech and language outcomes for both the hearing aid subjects and cochlear implant subjects were similar. All participants showed an improved auditory performance to some degree, yet all 12 studies were considered exploratory with methodological limitations and confounding issues. Discussion (e.g., interpretation of results; potential contribution of anticipated results) Due to the wide variety of outcomes for children with ANSD, it is important to identify children who will benefit from amplification and those who are appropriate candidates for cochlear implantation. The clinical evidence determining the differences in speech and language outcomes between CI and HA interventions in the ANSD population is limited. Stronger evidence is needed to demonstrate any important differences in cochlear implant benefit compared to hearing aid benefit as it pertains to speech and language outcomes in children with ANSD

Quality of life outcomes after primary treatment for clinically localised prostate cancer: A systematic review

Context: Current evidence-based management for clinically localised prostate cancer includes active surveillance, surgery, external beam radiotherapy (EBRT) and brachytherapy. The impact of these treatment modalities on quality of life (QoL) is uncertain. Objective: To systematically review comparative studies investigating disease-specific QoL outcomes as assessed by validated cancer-specific patient-reported outcome measures with at least 1 yr of follow-up after primary treatment for clinically localised prostate cancer. Evidence acquisition: MEDLINE, EMBASE, AMED, PsycINFO, and Cochrane Library were searched to identify relevant studies. Studies were critically appraised for the risk of bias. A narrative synthesis was undertaken. Evidence synthesis: Of 11. 486 articles identified, 18 studies were eligible for inclusion, including three randomised controlled trials (RCTs; follow-up range: 60-72 mo) and 15 nonrandomised comparative studies (follow-up range: 12-180 mo) recruiting a total of 13. 604 patients. Two RCTs recruited small cohorts and only one was judged to have a low risk of bias. The quality of evidence from observational studies was low to moderate. For a follow-up of up to 6 yr, active surveillance was found to have the lowest impact on cancer-specific QoL, surgery had a negative impact on urinary and sexual function when compared with active surveillance and EBRT, and EBRT had a negative impact on bowel function when compared with active surveillance and surgery. Data from one small RCT reported that brachytherapy has a negative impact on urinary function 1 yr post-treatment, but no significant urinary toxicity was reported at 5 yr. Conclusions: This is the first systematic review comparing the impact of different primary treatments on cancer-specific QoL for men with clinically localised prostate cancer, using validated cancer-specific patient-reported outcome measures only. There is robust evidence that choice of primary treatment for localised prostate cancer has distinct impacts on patients' QoL. This should be discussed in detail with patients during pretreatment counselling. Patient summary: Our review of the current evidence suggests that for a period of up to 6 yr after treatment, men with localised prostate cancer who were managed with active surveillance reported high levels of quality of life (QoL). Men treated with surgery reported mainly urinary and sexual problems, while those treated with external beam radiotherapy reported mainly bowel problems. Men eligible for brachytherapy reported urinary problems up to a year after therapy, but then their QoL returned gradually to as it was before treatment. This is the first systematic review comparing the impact on cancer-specific quality of life (QoL) of different primary treatments for clinically localised prostate cancer (PCa), using validated cancer-specific patient-reported outcome measures only. There is robust evidence that the choice of primary treatment for localised PCa has a distinct impact on patients' QoL. These aspects should be discussed in detail with patients during pretreatment counselling

Striking increase in incidence of prostate cancer in men aged < 60 years without improvement in prognosis

Increased awareness and improved diagnostic techniques have led to earlier diagnosis of prostate cancer and increased detection of subclinical cases, resulting in improved prognosis. We postulated that the considerable increase in incidence under age 60 is not attributable only to increased detection. To test this hypothesis, we studied incidence, mortality and relative survival among middle-aged patients diagnosed in south-east Netherlands and East Anglia (UK) between 1971 and 1994. Prostate-specific antigen (PSA) testing did not occur before 1990. Between 1971 and 1989, the age-standardized incidence at ages40–59 increased from 8.8 to 12.5 per 105 in The Netherlands and from 7.0 to 11.6 per 105 in East Anglia.Five-year relative survival did not improve in East Anglia and even declined in south-east Netherlands from 65% [95% confidence interval (CI) 47–83) in 1975–79 to 48% (CI 34–62) in 1985–89. Mortality due to prostate cancer among men aged 45–64 years increased by 50% in south-east Netherlands and by 61% in East Anglia between 1971 and 1989, but decreased slightly in the 1990s. Because other factors adversely influencing the prognosis are unlikely, our results indicate an increase in the incidence of fatal prostate cancer among younger men in the era preceding PSA testing. © 1999 Cancer Research Campaig

Androgen deprivation for prostate cancer

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/92046/1/26624_ftp.pd

Chemotherapy decisions and patient experience with the recurrence score assay for early‐stage breast cancer

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/135174/1/cncr30324_am.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/135174/2/cncr30324.pd

Quality of life and satisfaction among prostate cancer patients followed in a dedicated survivorship clinic

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/111256/1/cncr29215.pd

Incidence trends of prostate cancer in East Anglia, before and during the era of PSA diagnostic testing

We investigated prostate cancer incidence in East Anglia from 1971 to 2000. Using age-period-cohort modelling, the number of cases expected in 1991–2000, based on pre-PSA trends, 1971–1990, was compared with that observed. Based on pre-1991 trends, 9203 new cases were expected in 1991–2000, but 9788 cases were observed, an excess of 6%