Computational pathology in cancer diagnosis, prognosis, and prediction - present day and prospects.

Computational pathology refers to applying deep learning techniques and algorithms to analyse and interpret histopathology images. Advances in artificial intelligence (AI) have led to an explosion in innovation in computational pathology, ranging from the prospect of automation of routine diagnostic tasks to the discovery of new prognostic and predictive biomarkers from tissue morphology. Despite the promising potential of computational pathology, its integration in clinical settings has been limited by a range of obstacles including operational, technical, regulatory, ethical, financial, and cultural challenges. Here, we focus on the pathologists' perspective of computational pathology: we map its current translational research landscape, evaluate its clinical utility, and address the more common challenges slowing clinical adoption and implementation. We conclude by describing contemporary approaches to drive forward these techniques. © 2023 The Authors. The Journal of Pathology published by John Wiley & Sons Ltd on behalf of The Pathological Society of Great Britain and Ireland.

Portuguese translation and validation of the Patient Generated Index (PGI) instrument for patients with Chronic Obstructive Pulmonary Disease: individualized quality of life assessment. / Tradução para a língua portuguesa e análise das propriedades psicométricas do instrumento Patient Generated Index (PGI) para pacientes com doença pulmonar obstrutiva crônica: avaliação individualizada de qualidade de vida.

Objective To translate, adapt and validate the Patient Generated Index (PGI) for Brazilians with chronic obstructive pulmonary disease (COPD). Methods 50 volunteers with COPD, mostly men (74%), with 73.1 ± 8.9 years of age, FEV1 of 52.3 ± 14.5% of predicted and FEV1 / FVC of 56.2 ± 8.6% of predicted responded to PGI, to the Saint George Respiratory Questionnaire (SGRQ) and to perform Glittre Activities of Daily Living test (Glittre ADL). After 1-2 weeks, PGI was again applied for the analysis of relative and absolute reliability. Results The translation occurred without changes in the questionnaire. The score obtained in PGI had weak correlation with the SGRQ total score (r = -0.44, p <0.001) and with the impact domain (r = -0.40, p <0.05), presented a moderate correlation with the symptoms domain of the SGRQ (r = -0.55, p <0.001) and weak correlation with the activity domain (r = -0.31, p <0.05). A weak correlation was observed between PGI and Glittre ADL (r = -0.30; p <0.05). It was observed high reliability among the measures of PGI (ICCr = 0.94). Conclusion This study shows that the Brazilian version of PGI is a reliable and valid instrument to measure health-related quality of life (HRQL) in patients with COPD. It is a new and individualized form of evaluation of COPD patient-centered quality of life.

Tradução para a língua portuguesa e análise das propriedades psicométricas do instrumento Patient Generated Index (PGI) para pacientes com doença pulmonar obstrutiva crônica: avaliação individualizada de qualidade de vida / Portuguese translation and validation of the Patient Generated Index (PGI) instrument for patients with Chronic Obstructive Pulmonary Disease: individualized quality of life assessment

RESUMO Objetivo Traduzir, adaptar e validar o Patient Generated Index (PGI) para brasileiros com doença pulmonar obstrutiva crônica (DPOC). Métodos 50 voluntários com DPOC, em sua maioria homens (74%), com 73,1 ± 8,9 anos de idade, VEF1 de 52,3 ± 14,5% do previsto e VEF1/CVF de 56,2 ± 8,6% do previsto, responderam ao PGI e ao Saint George Respiratory Questionnaire (SGRQ) e realizaram teste Glittre Activities of Daily Living (Glittre ADL). Após o período de 7-14 dias, o PGI foi novamente aplicado para análise da confiabilidade relativa e absoluta. Resultados A tradução ocorreu sem alterações no questionário. A pontuação obtida no PGI apontou fraca correlação com a pontuação total do SGRQ (r = −0,44; p < 0,001) e com o domínio impacto (r = −0,40; p < 0,05), moderada correlação com o domínio sintomas do SGRQ (r = −0,55; p < 0,001) e fraca correlação com o domínio atividades (r = −0,31; p < 0,05). Foram observadas fraca correlação entre o PGI e o Glittre ADL (r = −0,30; p < 0,05) e alta confiabilidade entre as medidas do PGI (CCIr = 0,94). Conclusão Este estudo mostra que a versão brasileira do PGI é um instrumento confiável e válido para medir a qualidade de vida relacionada à saúde em pacientes com DPOC. Trata-se de uma nova forma individualizada de avaliação de qualidade de vida centrada no paciente com DPOC.

ABSTRACT Objective To translate, adapt and validate the Patient Generated Index (PGI) for Brazilians with chronic obstructive pulmonary disease (COPD). Methods 50 volunteers with COPD, mostly men (74%), with 73.1 ± 8.9 years of age, FEV1 of 52.3 ± 14.5% of predicted and FEV1 / FVC of 56.2 ± 8.6% of predicted responded to PGI, to the Saint George Respiratory Questionnaire (SGRQ) and to perform Glittre Activities of Daily Living test (Glittre ADL). After 1-2 weeks, PGI was again applied for the analysis of relative and absolute reliability. Results The translation occurred without changes in the questionnaire. The score obtained in PGI had weak correlation with the SGRQ total score (r = -0.44, p <0.001) and with the impact domain (r = -0.40, p <0.05), presented a moderate correlation with the symptoms domain of the SGRQ (r = -0.55, p <0.001) and weak correlation with the activity domain (r = -0.31, p <0.05). A weak correlation was observed between PGI and Glittre ADL (r = -0.30; p <0.05). It was observed high reliability among the measures of PGI (ICCr = 0.94). Conclusion This study shows that the Brazilian version of PGI is a reliable and valid instrument to measure health-related quality of life (HRQL) in patients with COPD. It is a new and individualized form of evaluation of COPD patient-centered quality of life.

The Daily Mile as a public health intervention: a rapid ethnographic assessment of uptake and implementation in South London, UK.

BACKGROUND: Existing evidence identifies health benefits for children of additional daily physical activity (PA) on a range of cardiovascular and metabolic outcomes. The Daily Mile (TDM) is a popular scheme designed to increase children's PA within the school day. Emerging evidence indicates that participation in TDM can increase children's PA, reduce sedentarism and reduce skinfold measures. However, little is known about the potential effects of TDM as a public health intervention, and the benefits and disbenefits that might flow from wider implementation in 'real world' settings. METHODS: We aimed to identify how TDM is being implemented in a naturalistic setting, and what implications this has for its potential impact on population health. We undertook a rapid ethnographic assessment of uptake and implementation in Lewisham, south London. Data included interviews (n = 22) and focus groups (n = 11) with stakeholders; observations of implementation in 12 classes; and analysis of routine data sources to identify school level factors associated with uptake. RESULTS: Of the 69 primary schools in one borough, 33 (48%) had adopted TDM by September 2018. There were no significant differences between adopters and non-adopters in mean school population size (means 377 vs 397, P = 0.70), mean percentage of children eligible for free school meals (16.2 vs 14.3%, P = 0.39), or mean percentage of children from Black and Minority Ethnic populations (76.3 vs 78.2%, P = 0.41). Addressing obesity was a key incentive for adoption, although a range of health and educational benefits were also hypothesised to accrue from participation. Mapping TDM to the TIDierR-PHP checklist to describe the intervention in practice identified that considerable adaption happened at the level of borough, school, class and pupil. Population health effects are likely to be influenced by the interaction of intervention and context at each of these levels. CONCLUSIONS: Examining TDM in 'real world' settings surfaces adaptions and variations in implementation. This has implications for the likely effects of TDM, and points more broadly to an urgent need for more appropriate methods for evaluating public health impact and implementation in complex contexts.

Priority setting in healthcare: towards guidelines for the program budgeting and marginal analysis framework.

Economists' approaches to priority setting focus on the principles of opportunity cost, marginal analysis and choice under scarcity. These approaches are based on the premise that it is possible to design a rational priority setting system that will produce legitimate changes in resource allocation. However, beyond issuing guidance at the national level, economic approaches to priority setting have had only a moderate impact in practice. In particular, local health service organizations - such as health authorities, health maintenance organizations, hospitals and healthcare trusts - have had difficulty implementing evidence from economic appraisals. Yet, in the context of making decisions between competing claims on scarce health service resources, economic tools and thinking have much to offer. The purpose of this article is to describe and discuss ten evidence-based guidelines for the successful design and implementation of a program budgeting and marginal analysis (PBMA) priority setting exercise. PBMA is a framework that explicitly recognizes the need to balance pragmatic and ethical considerations with economic rationality when making resource allocation decisions. While the ten guidelines are drawn from the PBMA framework, they may be generalized across a range of economic approaches to priority setting.

Actuarial life-table analysis of lower impacted wisdom teeth in general dental practice.

BACKGROUND: The appropriateness of extraction of asymptomatic impacted third molars has been much debated and as a result the number of extractions has fallen in the UK in the past few years. As a direct consequence of this decrease more impacted third molars are left in situ and yet, little is known about the natural history of these teeth. OBJECTIVE: The aim of this study was to create an actuarial life-table and related survival analysis that would shed light on the natural history of an impacted lower third molar. METHODS: Panoramic radiographs taken in 14 different general dental practices in Scotland were analysed and matched with their respective case notes in order to generate a sample of patients with asymptomatic impacted lower third molars. Subjects were assessed to confirm the presence of impaction and absence of symptoms and then re-assessed 1 year later for the development of symptoms during the study period to relate the incidence of symptoms within 1 year in the sample studied to age. Logistic regression was used to construct a life table based on the survival of symptom-free teeth (independently of extraction) during the study period. RESULTS: The number of patients included in the study was 583 and 421 for the baseline and follow-up assessments respectively. The total number of teeth analysed in both appointments was 676; from those 37 (5.47%) were extracted during the study period. About 562 teeth (83.13%) survived the study period symptom-free. There was a statistically significant inverse association between the development of symptoms studied and age. There was no statistically significant association between extraction and age. CONCLUSIONS: The study indicates that older patients are less likely to develop the symptoms studied. In addition the authors believe that there is evidence to suggest that general dental practitioners might not be following current guidelines when deciding whether or not to extract an impacted lower third molar in the centres studied.

Priority setting in practice: what is the best way to compare costs and benefits?

Prioritizing candidates for health-care expenditure using cost per Quality-Adjusted Life Year (QALY) is a helpful but insufficient means of ranking alternative uses for scarce health-care funds at the local level. This is because QALYs do not by themselves capture all criteria decision makers need to take into account. Other criteria such as reducing inequalities, meeting national and local priorities and public acceptability also feature in the decision maker's utility function. Programme budgeting and marginal analysis (PBMA) is an established framework for systematic priority setting in which a 'weighted benefit score' for each option is calculated based on all relevant decision-making criteria. Ranking options as a ratio of cost to benefit is desirable and necessary to ensure efficiency. In this paper we review a number of approaches to scoring costs and benefits of options in a PBMA context. Several approaches rank by benefit score alone, rather than efficiency (cost per unit of benefit). Of those that do rank by efficiency, we discuss the benefits and drawbacks. The optimal approach is far from clear, with each technique having its own strengths and weaknesses. A deliberative approach using summaries of costs and benefits of options as a basis for discussion may be preferable.

'Translation is not enough': using the Global Person Generated Index (GPGI) to assess individual quality of life in Bangladesh, Thailand, and Ethiopia.

Currently few subjective measures of Quality of Life (QoL) are available for use in developing countries, which limits their theoretical, methodological, and practical contribution (for example, exploring the relationship between economic development and QoL, and ensuring effective and equitable service provision). One reason for this is the difficulty of ensuring that translated measures preserve conceptual, item, semantic, operational, measurement; and functional equivalence (Herdman, M., Fox-Rushby, J., & Badia, X. (1998). Quality of Life Research, 7, 331), which is illustrated by an account of the translation, pre-piloting, and administration of a new individualised QoL measure, the Global Person Generated Index or 'GPGI'. The GPGI is based on the widely used Patient Generated Index (Ruta, Camfield, & Martin, (2004) Quality of Life Research, 13, 1545.) and offers many of the advantages of the participatory approaches commonly used in developing countries, with added methodological rigour, and quantitative outcomes. It was successfully validated in Bangladesh, Thailand, and Ethiopia, using quantitative and qualitative methods--open-ended, semi-structured interviews (SSIs), conducted immediately post-administration. Both the measure and method of 'qualitative validation' described later in the paper offer an exciting alternative for future researchers and practitioners in this field. The quantitative results suggest the GPGI shows cultural sensitivity, and is able to capture both the areas that are important to respondents, and aspects of life one would expect to impact on QoL in developing countries. There were strong correlation between scores from the GPGI and SSIs for the area of health, and moderate correlations for 'material wellbeing' (MWB)('Material wellbeing' refers to respondents' perceptions of their achievement in the areas of farming, debt reduction, assets, crops, livestock, job, land, property, and agriculture) and children. Weak to moderate correlations were observed between the Satisfaction with Life Scale and the GPGI; however, the highest coefficient was between the GPGI and the most conceptually similar item. Statistically significant differences were seen in GPGI scores between rich and poor, urban and rural respondents, and different countries. Health and material wellbeing scores, derived from the SSIs, also showed a linear relationship with GPGI scores, with a suggestion of curvilinearity at the higher levels, as predicted by a general QoL causal model. In conclusion, the GPGI has great potential for use in this area, especially when supported by extensive interviewer training, and supplemented with a cognitive appraisal schedule.

Twelve years' experience with the Patient Generated Index (PGI) of quality of life: a graded structured review.

The Patient Generated Index (PGI) is an individualised quality of life (QoL) measure that has been in use since 1994. Various adaptations have been made to suit a variety of client groups. The PGI's psychometric properties have been studied but their review is necessary to inform instrument choice. This article provides a structured review, using grading criteria adapted from those developed to aid outcome measure selection for use with older people. These criteria grade quality of evidence and strength of findings for psychometric validity, providing a useful model for future reviews. All published articles providing data addressing validity, reliability and/or responsiveness were included in the review. Eighteen relevant articles were identified and analysed using the grading criteria. Variable results and quality of investigation were seen. Generally the measure was found to be adequately reliable for group comparisons. The PGI appeared valid but evidence for responsiveness was unclear. Those versions of the measure using fewer points in their Likert scales may have higher reliability. Cognitions involved in QoL judgements remain little understood and investigations of psychometric properties may be enhanced by examination of appraisal processes.

Assessing oral health-related quality of life in general dental practice in Scotland: validation of the OHIP-14.

OBJECTIVES: To validate the Oral Health Impact Profile (OHIP)-14 in a sample of patients attending general dental practice. METHODS: Patients with pathology-free impacted wisdom teeth were recruited from six general dental practices in Tayside, Scotland, and followed for a year to assess the development of problems related to impaction. The OHIP-14 was completed at baseline and at 1-year follow-up, and analysed using three different scoring methods: a summary score, a weighted and standardized score and the total number of problems reported. Instrument reliability was measured by assessing internal consistency and test-retest reliability. Construct validity was assessed using a number of variables. Linear regression was then used to model the relationship between OHIP-14 and all significantly correlated variables. Responsiveness was measured using the standardized response mean (SRM). Adjusted R(2)s and SRMs were calculated for each of the three scoring methods. Estimates for the differences between adjusted R(2)s and the differences between SRMs were obtained with 95% confidence intervals. RESULTS: A total of 278 and 169 patients completed the questionnaire at baseline and follow-up, respectively. Reliability - Cronbach's alpha coefficients ranged from 0.30 to 0.75. Alpha coefficients for all 14 items were 0.88 and 0.87 for baseline and follow-up, respectively. Test-retest coefficients ranged from 0.72 to 0.78. Validity - OHIP-14 scores were significantly correlated with number of teeth, education, main activity, the use of mouthwash, frequency of seeing a dentist, the reason for the last dental appointment, smoking, alcohol intake, pain and symptoms. Adjusted R(2)s ranged from 0.123 to 0.202 and there were no statistically significant differences between those for the three different scoring methods. Responsiveness - The SRMs ranged from 0.37 to 0.56 and there was a statistically significant difference between the summary scores method and the total number of problems method for symptomatic patients. CONCLUSIONS: The OHIP-14 is a valid and reliable measure of oral health-related quality of life in general dental practice and is responsive to third molar clinical change. The summary score method demonstrated performance as good as, or better than, the other methods studied.

Implementation strategies for a Scottish national epilepsy guideline in primary care: results of the Tayside Implementation of Guidelines in Epilepsy Randomized (TIGER) trial.

PURPOSE: To determine the effectiveness of two dissemination and implementation strategies to implement a national guideline for epilepsy management in primary care settings. METHODS: Three-arm cluster-randomized controlled trial. The participants were general practitioners from 68 practices in Tayside, Scotland, and 1,133 of their patients with self-reported epilepsy treated with antiepileptic medications (AEDs). Practices were randomized blind to a control, intermediate, or intensive intervention. CONTROL: Postal dissemination of a nationally developed clinical guideline. Intermediate intervention: Postal dissemination of the guideline supported by interactive, accredited workshops, and dedicated, structured protocol documents. Intensive intervention: Intermediate intervention plus a nurse specialist who supported and educated practices in the establishment of epilepsy review clinics. The primary outcome was the SF-36 health-related quality-of-life instrument. Secondary measures were a battery of prevalidated epilepsy-specific quality-of-life instruments. These were administered at baseline and after the intervention phase. Process of care was assessed by case-note review on number of review meetings and counseling sessions for epilepsy before and after the interventions. RESULTS: None of the intervention groups showed any change in the primary or secondary outcome measures or process-of-care measures. CONCLUSIONS: None of the intervention strategies led to improvements in patient quality of life or quality of epilepsy care. Further research is needed to discover why the interventions failed, to identify barriers to adoption of guidelines, and to develop strategies that might improve implementation and uptake in the future.

Postnatal quality of life: a pilot study using the Mother-Generated Index.

BACKGROUND: Although postnatal morbidity has been well documented in recent years, postnatal quality of life has not been addressed. A newly derived subjective measurement of postnatal quality of life (the Mother-Generated Index) combines a quantitative and qualitative evaluation. AIMS: This part of our pilot study aimed to compare the aspects of their lives nominated by women with low and high quality of life (Primary Index) scores, and to examine the respective importance of these areas. METHODS: The Mother-Generated Index was tested using the Edinburgh Postnatal Depression Scale, Short Form 12, and an established maternal and neonatal physical morbidity index as validators. Four health visitors administered these at 6-8 weeks and 8 months postpartum to 103 women by structured face-to-face interviews between June 2000 and March 2001. Data were entered into Epi-Info, and exported to Microsoft Excel and SPSS for analysis. RESULTS: A wide variety of quality of life aspects were reported, including emotional, social and financial concerns. Tiredness was prevalent in all groups, but other physical problems were rare at 8 months. Mothers with low quality of life (Primary Index) scores at 6-8 weeks and 8 months commonly reported having less personal time. Low scoring areas, which health professionals might consider in greatest need of attention, were often not the ones mothers deemed most important. LIMITATIONS: The study involved only 103 participants, and did not assess the degree of support experienced by the mothers. CONCLUSIONS: The Mother-Generated Index helps mothers to identify the areas of their lives which are of most concern to them. This pilot suggests that mothers with high and low quality of life scores have markedly divergent experiences.

Patient generated index: new instrument for measuring quality of life in patients with rectal cancer.

The objective of this study was to assess the validity and responsiveness of a new quality of life instrument, the Patient Generated Index (PGI), in patients with rectal cancer. Thirty-three patients with rectal cancer were administered the PGI, the European Organisation for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaires QLQ-C30 and QLQ-CR38, and the Medical Outcomes Study short form SF-36 questionnaire preoperatively and at 3 months postoperatively. The PGI was assessed in this group of patients for validity and responsiveness. PGI scores achieved significant correlations with a number of domains on the three quality of life (QOL) questionnaires. Stepwise regression analysis showed that 91.3% of the variation in PGI scores could be explained by three health-related QOL variables alone: pain, role limitations due to physical problems, and a global rating of health and QOL. The mean PGI score showed significant improvement 3 months following surgery. The PGI was found to be more responsive to change than the SF-36, the QLQ-C30, or the QLQ-CR38 items except the micturition item. The PGI assesses the extent to which the expectations of patients suffering from rectal cancer are matched by reality; and it satisfies the criteria of validity and responsiveness of this instrument for this cancer. Further studies are needed to determine its psychometric properties in other areas of surgery and oncology. If these studies support our findings, we believe that patient-centered measures such as the PGI may provide a meaningful assessment of the outcome of surgery for patients with cancer.

Postnatal quality of life assessment: introducing the mother-generated index.

BACKGROUND: The extent of postnatal morbidity has become increasingly apparent over the last 15 years, but currently no tool is available that measures postnatal quality of life. This pilot study introduces a subjective tool, the Mother-Generated Index, which assesses the woman's quality of life and identifies those aspects that are of most concern to her. METHODS: The Mother-Generated Index was administered by structured interview to 60 participants at 6 to 8 weeks and to 43 participants at 8 months postpartum. Validation was sought through concurrent use of the Edinburgh Postnatal Depression Scale, the SF12, and two indexes related to maternal and neonatal physical morbidity. The Mother-Generated Index gives a primary index (quality of life) score, which is reported here, and a secondary index, which identifies the areas considered most important by the mother. RESULTS: The primary index was more sensitive at 8 months. The highest and lowest quartile scores were compared. Statistically significant differences in were found in the mothers' Edinburgh Postnatal Depression scores at 6 to 8 weeks, and in their Edinburgh Postnatal Depression and SF12 mental component scores and their physical morbidity index at 8 months. Although physical problems were only a small feature at 8 months, social and psychological issues were prominent in both groups. Age, parity, and mode of delivery had no significant effect on the women's scores or the areas they identified as most important. CONCLUSION: Quality of life of is a complex and personal area, affected by many different aspects of health and well-being. From this pilot study the primary index appears to be a useful step in assessing a mother's quality of life. It identifies which areas of her life are most important to her, and allows her to indicate where she would like to see improvements.