Physical and psychological symptoms of quality of life in the CHART randomized trial in head and neck cancer: short-term and long-term patient reported symptoms

The randomized multicentre trial of continuous hyperfractionated accelerated radiotherapy (CHART) versus conventional radiotherapy in patients with advanced head and neck cancer showed no good evidence of a difference in any of the major clinical outcomes of survival, freedom from metastases, loco-regional control and disease-free survival. Therefore an assessment of the effect of treatment on physical and psychological symptoms is vital to balance the costs and benefits of the two treatments. A total of 615 patients were asked to complete a Rotterdam Symptom Checklist and the Hospital Anxiety and Depression Scale, which cover a variety of physical and psychological symptoms, at a total of ten time points. The data consisted of short-term data (the initial 3 months) and long-term data (1 and 2 years). The short-term data was split into an exploratory data set and a confirmatory data set, and analysed using subject-specific and group-based methods. Differences were only claimed if hypotheses generated in the exploratory data set were confirmed in the confirmatory data set. The long-term data was not split into two data sets and was analysed using a group-based approach. There was evidence of significantly worse symptoms of pain at day 21 in those treated with CHART and significantly worse symptoms of cough and hoarseness at 6 weeks in those treated conventionally. There was also evidence to suggest a higher degree of decreased sexual interest at 1 year and sore muscles at 2 years in those treated with conventional radiotherapy. There is no clear indication that one regimen is superior to the other in terms of ‘quality of life’, generally the initially more severe reaction in the CHART group being offset by the longer duration of symptoms in the conventionally treated group. © 1999 Cancer Research Campaig

Is personality a determinant of patient satisfaction with hospital care?

Objective. We investigated to what extent personality is associated with patient satisfaction with hospital care. A sizeable association with personality would render patient satisfaction invalid as an indicator of hospital care quality. Design. Overall satisfaction and satisfaction with aspects of care were regressed on the Big Five dimensions of personality, controlled for patient characteristics as possible explanatory variables of observed associations. Participants. A total of 237 recently discharged inpatients aged 18-84 years (M = 50, SD = 17 years), 57% female, who were hospitalized for an average of 8 days. Instruments. The Satisfaction with Hospital Care Questionnaire addressing 12 aspects of care ranging from admission procedures to discharge and aftercare and the Five-Factor Personality Inventory assessing a person's standing on Extraversion, Agreeableness, Conscientiousness, Emotional stability, and Autonomy. Results. Agreeableness significantly predicted patient satisfaction in about half of the scales. After controlling for shared variance with age and educational level, the unique contribution of Agreeableness shrank to a maximum of 3-5% explained variance. When one outlier was dropped from the analysis, the contribution of Agreeableness was no longer statistically significant. Conclusion. Patient satisfaction seems only marginally associated with personality, at least at the level of the broad Big Five dimension

Understanding Palliative Cancer Chemotherapy: About Shared Decisions and Shared Trajectories

Most models of patient-physician communication take decision-making as a central concept. However, we found that often the treatment course of metastatic cancer patients is not easy to describe in straightforward terms used in decision-making models but is instead frequently more erratic. Our aim was to analyse these processes as trajectories. We used a longitudinal case study of 13 patients with metastatic colorectal and pancreatic cancer for whom palliative chemotherapy was a treatment option, and analysed 65 semi-structured interviews. We analysed three characteristics of the treatment course that contributed to the ‘erraticness’ of the course: (1) The treatment (with or without chemotherapy) contained many options; (2) these options were not stable entities to be decided upon, but changed identity over the course of treatment, and (3) contrary to the closure (option X means no option Y, Z, etc.) a decision implies, the treatment course was a continuous process in which options instead remained open. When the treatment course is characterised by these many and changeable options that do not result in closure, the shared decision-making model should take these into account. More attention needs to be paid to the erratic character of the process in which the doctor has to provide continuous information that is related to the changing situation of the patient; also, flexibility in dealing with protocols is warranted, as is vigilance about the overall direction of the process

Interpretation and reporting of process capability results: focus on improvement

A global financial services company followed a software-mediated process assessment (SMPA) approach based on ISO/IEC 15504, ISO/IEC 20000 and the IT Infrastructure Library (ITIL®). Using an action research approach, the Incident Management, Problem Management, and Change Management processes were assessed at two points in time during an ITSM process improvement project. This paper analyzes the results of the process assessments, highlights issues with the interpretation of the results, and offers an alternative method to report process capability results to motivate process improvement. The study found that by using the proportion of SMPA recommendations as a proxy measure for process improvement, the processes did improve yielding fewer recommendations in cycle 2 when compared to cycle 1 of the action research

Requirements for IT Governance in Organizations Experiencing Decentralization

International audienceDecentralization of organizations and subsequent change of their management and operation styles require changes in organization's processes and heavily involve IT. Enterprise Architecture (EA) frameworks fit to primarily centralized organizational structures, and as such have shortcomings when used in decentralized organizations. We illustrate this idea on the example of one organization in the Higher Education sector that faces decentralization of its structure and has to adapt to it. Overcoming these challenges requires some new principles to be introduced and incorporated into the EA knowledge. In particular for IT governance, in this study we argue that peer-to-peer principles can offer more suitable governance over current EA frameworks as they are able to better align with decentralized components of an organizational structure

Localized Surface Plasmon Resonance Biosensing with Large Area of Gold Nanoholes Fabricated by Nanosphere Lithography

Localized surface plasmon resonance (LSPR) has been extensively studied as potential chemical and biological sensing platform due to its high sensitivity to local refractive index change induced by molecule adsorbate. Previous experiments have demonstrated the LSPR generated by gold nanoholes and its biosensing. Here, we realize large uniform area of nanoholes on scale of cm2 on glass substrate by nanosphere lithography which is essential for mass production. The morphology of the nanoholes is characterized using scanning electron microscope and atomic force microscope. The LSPR sensitivity of the nanoholes to local refractive index is measured to be 36 nm/RIU. However, the chip has demonstrated high sensitivity and specificity in biosensing: bovine serum albumin adsorption is detected with LSPR peak redshift of 27 nm, and biotin-streptavidin immunoassay renders a LSPR redshift of 11 nm. This work forms a foundation toward the cost-effective, high-throughput, reliable and robust chip-based LSPR biosensor

On the relative importance of monetary transmission channels in Turkey

The main objective of this study is to provide additional evidence on the operation and relative importance of monetary transmission channels in Turkey. The results of the VAR analysis conducted using monthly data between January 2004 and November 2013 suggest that the traditional channels of interest rates, exchange rates, and credit do work in Turkish economy. However, the most striking finding of the study is the relative importance of exchange rate channel in the transmission of monetary policy decision into real economy. Variance decomposition analysis shows that the explained variance by real effective exchange rates is higher for all variables as compared to the variance explained by interest rates. However, interest rates seem to be still a useful tool to manage monetary policy given its role in controlling the changes in exchange rates. The granger causality analysis points into the fact that while interest rates have a role in leading the volatility of exchange rates, exchange rates have an impact on foreign debt holdings of banks and credit growth. On the other hand, foreign debt positions of banks and other sector firms together with credit growth granger causes industrial production. The study has some remarkable ramifications in terms of monetary policy design

Patient's needs and preferences in routine follow-up after treatment for breast cancer

The purpose of the study was to analyse the needs of women who participated in a routine follow-up programme after treatment for primary breast cancer. A cross-sectional survey was conducted using a postal questionnaire among women without any sign of relapse during the routine follow-up period. The questionnaire was sent 2-4 years after primary surgical treatment. Most important to patients was information on long-term effects of treatment and prognosis, discussion of prevention of breast cancer and hereditary factors and changes in the untreated breast. Patients preferred additional investigations (such as X-ray and blood tests) to be part of routine follow-up visits. Less satisfaction with interpersonal aspects and higher scores on the Hospital Anxiety and Depression Scale (HADS) scale were related to stronger preferences for additional investigation. Receiving adjuvant hormonal or radiotherapy was related to a preference for a more intensive follow-up schedule. There were no significant differences between patients treated with mastectomy compared to treated with breast-conserving therapy. During routine follow-up after a diagnosis of breast cancer, not all patients needed all types of information. When introducing alternative follow-up schedules, individual patients' information needs and preferences should be identified early and incorporated into the follow-up routine care, to target resources and maximise the likelihood that positive patient outcomes will result