Lo que sabemos acerca de la toma de decisiones en cáncer ovárico

Objectives: To describe what is known about the three stages of treatment decision making (TDM) in the medical encounter: (1) information exchange, (2) deliberation, and (3) making the treatment decision for ovarian cancer (OC). Methods: A literature search was completed including original research on TDM as it pertained to the disease continuum of OC. Results: Information exchange shows that patients and physicians feel that life expectancy is the most important issue. Physicians report that they do not discuss this at initial diagnosis. Decision aids could be used as a tool to ensure that information. The deliberation stage is the least researched. There is no information on the role that patients and physicians take. With the exception of one internet based tool, there is no research on how to elicit patient preferences. During making the treatment decision, women do not perceive that they have treatment options yet they feel they are making the decision. “No treatment” is not considered to be an option. Conclusions: TDM in OC is increasingly being evaluated. The stage of information exchange has been assessed in greater depth compared to that of the other stages.Objetivos: exponer lo que se conoce acerca de tres niveles de toma de decisión sobre tratamiento en el encuentro medico: (1) intercambio de información, (2) deliberación, y (3) toma de decisión en el cáncer ovárico. Métodos: Se completó una búsqueda bibliográfica que incluía investigación original acerca de la toma de decisión del tratamiento médico sobre el proceso de enfermedad del cáncer de ovario. Resultados: el intercambio de información mostró que los pacientes y los médicos sienten que la expectativa de vida es el tema más importante. Los médicos informan que no discuten esto en el diagnóstico inicial. Las ayudas a la decisión pueden emplearse como una herramienta para asegurar la información. El nivel de deliberación es el menos investigado. No hay información sobre el rol que los pacientes y médicos toman. Con la excepción de una herramienta basada en Internet, no hay investigación sobre como elicitar las preferencias del paciente. Durante la toma de decisión del tratamiento, las mujeres no perciben que ellas tengan opciones de tratamiento aunque sienten que están tomando una decisión. El “no tratamiento” no se considera una opción. Conclusiones: la toma de decisión sobre los tratamientos en cáncer de ovario esta progresivamente siendo valorada. El nivel de intercambio de información ha sido evaluado en mayor profundidad comparado con otros niveles

What we know about treatment decision making in ovarian cancer

Objectives: To describe what is known about the three stages of treatment decision making (TDM) in the medical encounter: (1) information exchange, (2) deliberation, and (3) making the treatment decision for ovarian cancer (OC). Methods: A literature search was completed including original research on TDM as it pertained to the disease continuum of OC. Results: Information exchange shows that patients and physicians feel that life expectancy is the most important issue. Physicians report that they do not discuss this at initial diagnosis. Decision aids could be used as a tool to ensure that information. The deliberation stage is the least researched. There is no information on the role that patients and physicians take. With the exception of one internet based tool, there is no research on how to elicit patient preferences. During making the treatment decision, women do not perceive that they have treatment options yet they feel they are making the decision. “No treatment” is not considered to be an option. Conclusions: TDM in OC is increasingly being evaluated. The stage of information exchange has been assessed in greater depth compared to that of the other stages

Balancing workload, motivation and job satisfaction in Rwanda: assessing the effect of adding family planning service provision to community health worker duties

BackgroundTask shifting from higher cadre providers to CHWs has been widely adopted to address healthcare provider shortages, but the addition of any service can potentially add to an already considerable workload for CHWs. Objective measures of workload alone, such as work-related time and travel may not reflect howCHWs actually perceive and react to their circumstances. This study combined perception and objectivemeasures of workload to examine their effect on quality of services, worker performance, and job and clientsatisfaction.MethodsThree hundred eighty-three CHWs from control and intervention districts, where the intervention group was trained to provide contraceptive resupply, completed diaries of work-related activities for one month. Interviews were also conducted with a subset of CHWs and their clients.ResultsCHW diaries did not reveal significant differences between intervention and control groups in time spent on service provision or travel. Over 90% of CHWs reported workload manageability, job satisfaction, and motivation to perform their jobs. Clients were highly satisfied with CHW services and most stated preference for future services from CHWs.ConclusionThe study demonstrated that adding resupply of hormonal contraceptives to CHWs’ tasks would not place undue burden on them. Accordingly, the initiative was scaled upin all 30 districts in the country

Prospectus, April 18, 1979

SPRING AT PARKLAND! IS IT REALLY HERE?; Kelly wins UPI award; PC students discuss Canteen; Stu-go discusses many subjects at last meeting; The Looking Glass: Spiritual awakening of women; Equine Club to host horse show at PC; Soap operas--A way of life for millions of Americans; Classified Advertising; Parkland student body to vote May 2 and 3; Trout steps down as coach; Walkathon to be April 28; Reader\u27s theatre to perform at PC; Cobras split double-header; Girl\u27s softball has slow start; Two Cobra tracksters place secondhttps://spark.parkland.edu/prospectus_1979/1019/thumbnail.jp

Sequencing of 53,831 diverse genomes from the NHLBI TOPMed Program

The Trans-Omics for Precision Medicine (TOPMed) programme seeks to elucidate the genetic architecture and biology of heart, lung, blood and sleep disorders, with the ultimate goal of improving diagnosis, treatment and prevention of these diseases. The initial phases of the programme focused on whole-genome sequencing of individuals with rich phenotypic data and diverse backgrounds. Here we describe the TOPMed goals and design as well as the available resources and early insights obtained from the sequence data. The resources include a variant browser, a genotype imputation server, and genomic and phenotypic data that are available through dbGaP (Database of Genotypes and Phenotypes)(1). In the first 53,831 TOPMed samples, we detected more than 400 million single-nucleotide and insertion or deletion variants after alignment with the reference genome. Additional previously undescribed variants were detected through assembly of unmapped reads and customized analysis in highly variable loci. Among the more than 400 million detected variants, 97% have frequencies of less than 1% and 46% are singletons that are present in only one individual (53% among unrelated individuals). These rare variants provide insights into mutational processes and recent human evolutionary history. The extensive catalogue of genetic variation in TOPMed studies provides unique opportunities for exploring the contributions of rare and noncoding sequence variants to phenotypic variation. Furthermore, combining TOPMed haplotypes with modern imputation methods improves the power and reach of genome-wide association studies to include variants down to a frequency of approximately 0.01%

A Powerful Statistical Framework for Generalization Testing in GWAS, with Application to the HCHS/SOL

In GWAS, “generalization” is the replication of genotype-phenotype association in a population with different ancestry than the population in which it was first identified. The standard for reporting findings from a GWAS requires a two-stage design, in which discovered associations are replicated in an independent follow-up study. Current practices for declaring generalizations rely on testing associations while controlling the Family Wise Error Rate (FWER) in the discovery study, then separately controlling error measures in the follow-up study. While this approach limits false generalizations, we show that it does not guarantee control over the FWER or False Discovery Rate (FDR) of the generalization null hypotheses. In addition, it fails to leverage the two-stage design to increase power for detecting generalized associations. We develop a formal statistical framework for quantifying the evidence of generalization that accounts for the (in)consistency between the directions of associations in the discovery and follow-up studies. We develop the directional generalization FWER (FWERg) and FDR (FDRg) controlling r-values, which are used to declare associations as generalized. This framework extends to generalization testing when applied to a published list of SNP-trait associations. We show that our framework accommodates various SNP selection rules for generalization testing based on p-values in the discovery study, and still control FWERg or FDRg. A key finding is that it is often beneficial to use a more lenient p-value threshold then the genome-wide significance threshold. For instance, in a GWAS of Total Cholesterol (TC) in the Hispanic Community Health Study/Study of Latinos (HCHS/SOL), when testing all SNPs with p-values\u3c 5 × 10−8 (15 genomic regions) for generalization in a large GWAS of whites, we generalized SNPs from 15 regions. But when testing all SNPs with p-values\u3c 6.6×10−5 (89 regions), we generalized SNPs from 27 regions

Genome-wide association study of dental caries in the Hispanic Communities Health Study/Study of Latinos (HCHS/SOL)

Dental caries is the most common chronic disease worldwide, and exhibits profound disparities in the USA with racial and ethnic minorities experiencing disproportionate disease burden. Though heritable, the specific genes influencing risk of dental caries remain largely unknown. Therefore, we performed genome-wide association scans (GWASs) for dental caries in a population-based cohort of 12 000 Hispanic/Latino participants aged 18–74 years from the HCHS/SOL. Intra-oral examinations were used to generate two common indices of dental caries experience which were tested for association with 27.7 M genotyped or imputed single-nucleotide polymorphisms separately in the six ancestry groups. A mixed-models approach was used, which adjusted for age, sex, recruitment site, five principal components of ancestry and additional features of the sampling design. Meta-analyses were used to combine GWAS results across ancestry groups. Heritability estimates ranged from 20–53% in the six ancestry groups. The most significant association observed via meta-analysis for both phenotypes was in the region of the NAMPT gene (rs190395159; P-value = 6 × 10−10), which is involved in many biological processes including periodontal healing. Another significant association was observed for rs72626594 (P-value = 3 × 10−8) downstream of BMP7, a tooth development gene. Other associations were observed in genes lacking known or plausible roles in dental caries. In conclusion, this was the largest GWAS of dental caries, to date and was the first to target Hispanic/Latino populations. Understanding the factors influencing dental caries susceptibility may lead to improvements in prediction, prevention and disease management, which may ultimately reduce the disparities in oral health across racial, ethnic and socioeconomic strata

Exile Vol. XX No. 1

ARTWORK by Sue Sartarelli cover, 24 by Chris Schulze 5, 24, 29 by Heather Richey 6 by Katheryn Riedl 7 by Jane Joldersma 10 by Jan Mosher 12 Pat Victory 15 Rona Rosen 20, 31 Arthur Ernst 21 Kim McMullen 24 FICTION First Time by Bud Foufos 3-4 Father\u27s Last Party by Vic Coccimiglio 11 untitled by Catherine Bader 16-17 God and Sergeant Mays by J. Frank Burkhard 22 Pages of a Story by Peter Porteous 27-31 POETRY The Rest by Ezra Pound (preface) In the Midst of an Echo by Phil Mercurio 4 Sierra Madre Prose by John Purcell 5 untitled by Sue Payne 6 untitled by Cathy Graff 6 untitled by Sharon Singleton 7 Big Al by Phil Mercurio 9-10 untitled by Sharon Singleton 12 Folksinger by Alison Orleans 13 Sweat Rebellion by S. Hunt 13 Blackgrey by Laurie Wharton 14 What is she to you? by Peter Porteous 18 Pojects by Mary Mueller 21 untitled by Dawn Patnode 25 The Barn by Mary Schloss 25 PHOTOGRAPHY by Bruce Andre 1, 18 by Jane Joldersma 4, 23, 26 by Breese Olander 8 by Pam Purcell 8 by Loree Ruman 13, 14 Foster Schmidt 19 Chip Andreae 19, 23 Nancy Pickenson 26 Nancy Chorpenning 32 Many thanks to the advertising agencie -2 Pgs. 25 and 26 are out of order in the published edition and can be found between pages 8 and 9