Defining a standard set of patient-centered outcomes for men with localized prostate cancer

Background Value-based health care has been proposed as a unifying force to drive improved outcomes and cost containment. Objective To develop a standard set of multidimensional patient-centered health outcomes for tracking, comparing, and improving localized prostate cancer (PCa) treatment value. Design, setting, and participants We convened an international working group of patients, registry experts, urologists, and radiation oncologists to review existing data and practices. Outcome measurements and statistical analysis The group defined a recommended standard set representing who should be tracked, what should be measured and at what time points, and what data are necessary to make meaningful comparisons. Using a modified Delphi method over a series of teleconferences, the group reached consensus for the Standard Set. Results and limitations We recommend that the Standard Set apply to men with newly diagnosed localized PCa treated with active surveillance, surgery, radiation, or other methods. The Standard Set includes acute toxicities occurring within 6 mo of treatment as well as patient-reported outcomes tracked regularly out to 10 yr. Patient-reported domains of urinary incontinence and irritation, bowel symptoms, sexual symptoms, and hormonal symptoms are included, and the recommended measurement tool is the Expanded Prostate Cancer Index Composite Short Form. Disease control outcomes include overall, cause-specific, metastasis-free, and biochemical relapse-free survival. Baseline clinical, pathologic, and comorbidity information is included to improve the interpretability of comparisons. Conclusions We have defined a simple, easily implemented set of outcomes that we believe should be measured in all men with localized PCa as a crucial first step in improving the value of care. Patient summary Measuring, reporting, and comparing identical outcomes across treatments and treatment centers will provide patients and providers with information to make informed treatment decisions. We defined a set of outcomes that we recommend being tracked for every man being treated for localized prostate cancer

Impact of Neoadjuvant Chemoradiation on Adverse Events After Bronchial Sleeve Resection

Background. We analyzed the association between neoadjuvant chemoradiation in patients undergoing bronchial sleeve resection with the incidence of postoperative pulmonary and airway complications. Methods. After instructional review board approval we performed a retrospective review of a prospectively maintained database of 136 patients who underwent sleeve resection in our institution between January 1998 and December 2016. Administration of neoadjuvant chemoradiation treatment was the studied exposure. Outcomes of interest were rates of postoperative pulmonary and airway complications. Nonparametric testing of demographic, surgical, and pathologic characteristics and morbidity was performed. Logistic regression models evaluated postoperative pulmonary complications and airway complications. Analysis was performed using Stata/IC 15. Results. We analyzed 136 patients (18 underwent neoadjuvant chemoradiation), 77 (57%) of whom had nonsmall cell lung cancer. Postoperative pulmonary complications were observed in 44 of 136 patients (32%). Incidences of pulmonary complications were higher in the neoadjuvant chemoradiation group compared with the non–neoadjuvant radiation group (15/18 patients [83%] vs 29/118 patients [25%], respectively; P < .001). Likewise, rates of pneumonia, atelectasis, respiratory insufficiency, bronchial stenosis, prolonged air leak, bronchopleural fistula, and completion pneumonectomy (2/18 [11%]) were higher in the neoadjuvant chemoradiation group, reaching statistical significance in all cases except bronchial stenosis and prolonged air leak. Only neoadjuvant chemoradiation therapy remained significant for postoperative pulmonary and airway complications on logistic regression (both P < .05) Conclusions. Patients who undergo neoadjuvant chemoradiation before sleeve resection are at an increased risk of pulmonary and airway complications

NSERC's HydroNet: A National Research Network to Promote Sustainable Hydropower and Healthy Aquatic Ecosystems

NSERC's HydroNet is a collaborative national fiveyear research program initiated in 2010 involving academic, government, and industry partners. The overarching goal of HydroNet is to improve the understanding of the effects of hydropower operations on aquatic ecosystems, and to provide scientifically defensible and transparent tools to improve the decision-making process associated with hydropower operations. Multiple projects are imbedded under three themes: 1) Ecosystemic analysis of productive capacity of fish habitats (PCFH) in rivers, 2) Mesoscale modelling of the productive capacity of fish habitats in lakes and reservoirs, and 3) Predicting the entrainment risk of fish in hydropower reservoirs relative to power generation operations by combining behavioral ecology and hydraulic engineering. The knowledge generated by HydroNet is essential to balance the competing demands for limited water resources and to ensure that hydropower is sustainable, maintains healthy aquatic ecosystems and a vibrant Canadian economy

Cultural intelligence: Domain and assessment

The construct of cultural intelligence, recently introduced to the management literature, has enormous potential in helping to explain effectiveness in cross cultural interactions. However, at present, no generally accepted definition or operationalization of this nascent construct exists. In this article, we develop a conceptualization of cultural intelligence that addresses a number of important limitations of previous definitions. We present a concise definition of cultural intelligence as a system of interacting abilities, describe how these elements interact to produce culturally intelligent behavior, and then identify measurement implications