RESUMO
CONTEXT: This review focuses on the most widely used risk stratification and prediction tools for non-muscle-invasive bladder cancer (NMIBC). OBJECTIVE: To assess the clinical use and relevance of risk stratification and prediction tools to enhance clinical decision making and counselling of patients with NMIBC. EVIDENCE ACQUISITION: The most frequent, currently used risk stratification tools and prognostic models for NMIBC patients were identified by the members of the European Association of Urology (EAU) Guidelines Panel on NMIBC. EVIDENCE SYNTHESIS: The 2006 European Organization for Research and Treatment of Cancer (EORTC) risk tables are the most widely used and validated tools for risk stratification and prognosis prediction in NMIBC patients. The EAU risk categories constitute a simple alternative to the EORTC risk tables and can be used for comparable risk stratification. In the subgroup of NMIBC patients treated with a short maintenance schedule of bacillus Calmette-Guerin (BCG), the Club Urológico Español de Tratamiento Oncológico (CUETO) scoring model is more accurate than the EORTC risk tables. Both the EORTC risk tables and the CUETO scoring model overestimate the recurrence and progression risks in patients treated according to current guidelines. The new concept of conditional recurrence and progression estimates is very promising during follow-up but should be validated. CONCLUSIONS: Risk stratification and prognostic models enable outcome comparisons and standardisation of treatment and follow-up. At present, none of the available risk stratification and prognostic models reflects current standards of treatment. The EORTC risk tables and CUETO scoring model should be updated with previously unavailable data and recalculated. PATIENT SUMMARY: Non-muscle-invasive bladder cancer is a heterogeneous disease. A risk-based therapeutic approach is recommended. We present available risk stratification and prediction tools and the degree of their validation with the aim to increase their use in everyday clinical practice.
Assuntos
Medição de Risco/métodos , Neoplasias da Bexiga Urinária/epidemiologia , Europa (Continente) , Humanos , Modelos Estatísticos , Invasividade Neoplásica , Guias de Prática Clínica como Assunto , Prognóstico , Sociedades Médicas , Neoplasias da Bexiga Urinária/patologia , UrologiaRESUMO
INTRODUCTION: Active surveillance (AS) seems to be a cost-effective strategy. However, most publications are based on simulation models of theoretical cohorts, and long-term implications are not usually considered. OBJECTIVE: To assess the real cost differences of two cohorts of men with low-risk prostate cancer (PCa) treated with AS or laparoscopic radical prostatectomy (LRP) in a public health system. MATERIALS AND METHODS: Patients diagnosed from 2005 to 2009 were included in an AS program (Group 1) or treated with LRP at diagnosis (Group 2), with a minimum follow-up of 5 years. Actual costs for each patient were calculated on an individual basis: Group 1: semiannual PSA measurements and repeat biopsies are scheduled every 1-3 years. Costs of outpatient clinic visits were calculated, as well as all tests required for monitoring or active treatment. Group 2: costs of the procedure, emergency visits, re-admissions and outpatient clinic visits were calculated, as well as costs of oncological salvage therapies or functional surgical procedures. RESULTS: Out of 151 men diagnosed with low-risk PC, 54 (35.8%) were included in an AS (Group 1) and 97 (64.2%) were submitted to LRP (Group 2). Mean follow-up for both groups was 6.5 years (SD 1.8) and 6.7 years (SD 1.4), respectively, p = 0.49. Group 1 had a total cost per patient of 2970.47. Group 2 had a total cost per patient of 5694.06. CONCLUSIONS: AS was associated with cost-saving over LRP. This cost reduction of AS in the management of low-risk PCa is based on the accounting of real costs of individual patients and confirms previously published estimation-based reports.
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Custos de Cuidados de Saúde , Prostatectomia/economia , Neoplasias da Próstata/terapia , Conduta Expectante/economia , Idoso , Assistência Ambulatorial/economia , Biópsia/economia , Custos e Análise de Custo , Serviço Hospitalar de Emergência/economia , Hospitalização/economia , Humanos , Laparoscopia/economia , Masculino , Pessoa de Meia-Idade , Readmissão do Paciente/economia , Terapia de Salvação/economia , EspanhaRESUMO
Numerous studies acknowledge that the well-being of our nation hinges on the health of its people. There is specific concern about children because they represent the future. Ignoring children's health needs can compromise their educational preparedness, occupational pursuits, productivity, and longevity. Current science demonstrates that developmental, emotional, or behavioral limitations experienced during the early years of life and over the life course are associated with poor adult health outcomes. Poverty, restricted access to health insurance and health care services, cultural and linguistic barriers, neighborhood conditions, and racial and class inequalities exacerbate poor health outcomes and contribute to child health inequality. To respond to the complexities and threats of child health inequality, social workers must be sensitized to the physical and material constraints that support them and join forces with other disciplines in comprehensive approaches to reduce and prevent them. This article focuses on current knowledge about child health inequality and recommends how social workers can effect change in this area through practice, policy, and research that adheres to the profession's ethical principles and standards and promotes the public health.
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Proteção da Criança/economia , Disparidades nos Níveis de Saúde , Disparidades em Assistência à Saúde/economia , Pobreza , Classe Social , Criança , Acessibilidade aos Serviços de Saúde/economia , Acessibilidade aos Serviços de Saúde/estatística & dados numéricos , Disparidades em Assistência à Saúde/estatística & dados numéricos , Humanos , Lactente , Mortalidade Infantil , Pessoas sem Cobertura de Seguro de Saúde/estatística & dados numéricos , Obesidade/economia , Serviço Social/métodos , Serviço Social/normas , Estresse Psicológico/economia , Estados Unidos/epidemiologiaRESUMO
The purpose of this multisite exploratory research study involving focus groups of consumers and service providers was to generate stakeholder input for a statewide strategic plan for genetic services in the southwestern region of the United States. This article describes the qualitative methods by which the data were collected and summarizes major themes in participants' perceptions about genetic services. It also describes processes related to obtaining genetic services and characteristics of an ideal service delivery system for children affected by genetic disorders and the families that care for them. Implications for practice and policy are also reviewed.