Patient reported outcomes in oncology: changing perspectives-a systematic review.

In public health context, oncology is associated with severe negative impact on patients and on their relatives' quality of life. Over the last decades, survival has remained at 50% worldwide for some tumor locations. Patient reported outcomes (PROs) assessment and, the corresponding use in clinical practice, help establishing patient individualized profiling involving caregivers. The purpose of this systematic review was to examine critical success factors for PROs assessment in daily clinical oncology practice. Additionally, we investigated how PROs collection can change oncology perspectives for patients and caregivers. According to PRISMA guidelines, 83 studies were included in this systematic review, whether related with implementation in daily clinical practice or associated with its use in oncology. PROs assessment gathers multi-professional teams, biomedical and clinical expertise, patients, families and caregivers. Institutional involvement, first line for caregiver's adherence, team continuous formation, encompassing training and support, design of clear workflows, continuous monitoring, and data analysis are crucial for implementation. PROs measures are decisive in oncology. Several items were improved, including caregiver-patient-physician communication, patient risk groups identification, unmet problems and needs detection, disease course and treatment tracking, prognostic markers, cost-effectiveness measurement and comfort/support provision for both patients and caregivers. Routine assessment and implementation of PROs in clinical practice are a major challenge and a paradigm transformation for future.

Comparative analysis of hydraulic refrigeration and mechanical vapour compression water cooling technologies in designing a technical system for oysters conservation.

The phenomenon of summer mortality in Pacific oysters cultures also occurs in Brazilian crops, with predominance in the adult phase, generating significant losses for local producers. In the search for a technological solution to mitigate its effects, the mechanical vapour compression and hydraulic refrigeration concepts are evaluated as two proposed cooling technologies. The comparative analysis carried out with numeric simulations indicated that the hydraulic cooling system presents disadvantages regarding both the size of the compression column and the energy efficiency, compared to the mechanical vapour compression cycle. By computing only the compression power, a COP value of 6.9 results for the MVCS at TCOND = 29.5 oC and TEVAP = 7.2 oC, while for HRS the COP value is around 3.1 for identical conditions. Results from the analysis contradict former publications, but are consistent with recent findings reported in literature.

Stress among Portuguese Medical Students: the EuStress Solution.

There has been an increasing attention to the study of stress. Particularly, college students often experience high levels of stress that are linked to several negative outcomes concerning academic functioning, physical, and mental health. In this paper, we introduce the EuStress Solution, that aims to create an Information System to monitor and assess, continuously and in real-time, the stress levels of the students in order to predict burnout. The Information System will use a measuring instrument based on wearable device and machine learning techniques to collect and process stress-related data from the students without their explicit interaction. In the present study, we focus on heart rate and heart rate variability indices, by comparing baseline and stress condition. We performed different statistical tests in order to develop a complex and intelligent model. Results showed the neural network had the better model fit.

Estudio comparativo de la diversidad de las características clínicas dentales en poblaciones militares de Portugal y España / Diversity in dental clinical characteristics in Portuguese and Spanish military populations

Introducción: Se ha realizado una comparación de las características dentales de 2poblaciones militares de Portugal y España. El objetivo principal de esta investigación fue identificar aquellas características dentales que podrían ser de utilidad para diferenciar estas poblaciones en un análisis forense. Material y métodos: El estudio se realizó en una muestra compuesta por 5.136 militares profesionales de las fuerzas armadas, el 31,9% eran militares portugueses y el 68,1% del total de la muestra pertenecían a las fuerzas armadas españolas. Los datos dentales se registraron empleando los símbolos dentales descritos en Forensic Dental Symbols(R), gestionados con la base de datos Dental Encoder(R). Resultados: La población de estudio estaba constituida por un 86,6% de hombres (88,1% en la muestra española y 83,4% en la muestra portuguesa) y un 13,4% de mujeres (11,9% en la muestra española y 16,6% en la muestra portuguesa). La frecuencia de dientes no restaurados fue menor para los primeros molares en todos los cuadrantes, mientras que la mayor frecuencia de esta característica (>90%) se observó en los dientes anteriores, superiores e inferiores, y en los primeros premolares inferiores. Las frecuencias más altas de tratamientos restauradores fueron encontradas para los primeros y segundos molares en todos los cuadrantes, y las mayores frecuencias de ausencias dentarias se observaron en los terceros molares (superior al 28% en todos los cuadrantes). El análisis de concordancia mostró que las correlaciones entre los dientes contralaterales fueron significativamente mayores que entre los dientes antagonistas, para ambas muestras poblacionales de estudio. Conclusiones: Nuestros resultados proporcionan información potencialmente útil sobre la importancia de las bases de datos de registros dentales y el análisis de las características dentales con fines de identificación

Introduction: Dental characteristics were compared in population samples of Spanish and Portuguese military personnel. The main aim of this study was to identify those dental characteristics that could potentially serve to differentiate between these populations in a forensic analysis. Material and methods: A sample of 5136 individuals belonging to the professional military staff of the Portuguese and Spanish armed forces was studied. Dental data were recorded with the Forensic Dental Symbols(R) for the Dental Encoder(R) database. The population sample analysed in this study consisted of 68.1% Spanish and 31.9% Portuguese individuals. Results: The population was mostly male, with 86.6% men (88.1% in the Spanish sample versus 83.4% in the Portuguese sample), and 13.4% women (11.9% Spanish and 16.6% Portuguese). The frequency of unrestored teeth was lowest for first molars in all quadrants, and the highest frequency of unrestored teeth (>90%) was for the upper and lower anterior teeth and lower first premolars. The highest frequencies of restorative treatment were found for the first and second molars in all quadrants, and the highest frequencies of missing teeth were found for the third molars (always >28%). Concordance analysis showed that correlations between contralateral teeth were significantly higher than between antagonist teeth in both samples. Conclusions: Our findings provide potentially useful information on the importance of dental record databases and their value for identification purposes

A Review of Commercial and Medical-Grade Physiological Monitoring Devices for Biofeedback-Assisted Quality of Life Improvement Studies.

With the rise in wearable technology and "health culture", we are seeing an increasing interest and affordances in studying how to not only prolong life expectancy but also in how to improve individuals' quality of life. On the one hand, this attempts to give meaning to the increasing life expectancy, as living above a certain threshold of pain and lack of autonomy or mobility is both degrading and unfair. On the other hand, it lowers the cost of continuous care, as individuals with high quality of life indexes tend to have lower hospital readmissions or secondary complications, not to mention higher physical and mental health. In this paper, we evaluate the current state of the art in physiological therapy (biofeedback) along with the existing medical grade and consumer grade hardware for physiological research. We provide a quick primer on the most commonly monitored physiologic metrics, as well as a brief discussion on the current state of the art in biofeedback-assisted medical applications. We then go on to present a comparative analysis between medical and consumer grade biofeedback devices and discuss the hardware specifications and potential practical applications of each consumer grade device in terms of functionality and adaptability for controlled (laboratory) and uncontrolled (field) studies. We end this article with some empirical observations based on our study so that readers might use take them into consideration when arranging a laboratory or real-world experience, thus avoiding costly time delays and material expenditures.

Forensic Medicine and the Military Population: International Dental Records and Personal Identification Concerns.

INTRODUCTION: The first goal of this research was to perceive the global commitment towards the organization and archiving of dental records and to compare it with each country's security risk rating. The second one was to study dental records in a sample of the Portuguese military population, using the available national dental records. MATERIAL AND METHODS: An e-mail was sent to representative dentistry associations in several countries, requesting some information concerning the professionals' awareness of this issue. After obtaining permission from the Ethics Committee, the information was collected through the Forensic Dental Symbols® system into the Dental Encoder®, as an extension of a Spanish study, and a generic codification was used (unrestored, restored, missing and crowned teeth). RESULTS: The most common dental record retention period is ten years after treatment. Observing the samples' dental records (595 files), we found a total of 19 040 analyzed teeth, with the following frequencies: unrestored (89.6%), restored (7.0%), missing (2.2%) and crowned (1.1%). DISCUSSION: There is a wide range of guidelines on how long dentists should keep dental records. Especially for the military population, dental records must include detailed information concerning each tooth situation, in order to support the process of human identification. CONCLUSION: This article reinforces the need for mandatory quality dental records in all countries, which must be efficiently stored and easily accessible in case dental identification is necessary. For the military population, these requirements are especially important, due to the added risks to which this group is subject.

Introdução: Esta investigação teve o intuito de procurar conhecer o comprometimento global relativamente à organização e arquivo dos registos dentários e compará-lo com o risco de segurança de cada país. Por outro lado, procurou-se estudar os processos clínicos de uma amostra da população militar Portuguesa, utilizando-se para o efeito os registos dentários. Material e Métodos: Foi enviado um e-mail para associações dentárias e solicitada informação sobre o tempo de guarda dos registos dentários. Após autorização prévia da Comissão de Ética, a informação foi recolhida através do sistema Forensic Dental Symbols® para Dental Encoder®, como uma extensão de uma investigação realizada em Espanha e utilizada a codificação genérica (dentes sãos, com restaurações, ausentes e coroas). Resultados: Globalmente, dez anos após o último tratamento, foi o procedimento mais comum relativamente ao tempo de guarda dos documentos. Após observação dos registos dentários da amostra (595 militares) verificou-se um total de 19 040 dentes analisados, com as seguintes frequências: dentes sãos (89,6%), com restauração (7,0%), ausentes (2,2%) e coroas (1,1%). Discussão: Existe grande variedade de orientações sobre quanto tempo têm que ser guardados pelos profissionais de saúde os seus registos. Nos registos dentários da população militar deve-se incluir informação detalhada de cada dente, de maneira a suportar o processo de identificação humana. Conclusão: Este artigo reforça a necessidade de registos dentários de qualidade em todos os países, com manutenção eficiente para a identificação humana. Na população militar torna-se especialmente importante, devido ao facto de este ser um grupo sujeito a riscos acrescidos.

A model for the evaluation of data quality in health unit websites.

This article presents a research work, the goal of which was to achieve a model for the evaluation of data quality in institutional websites of health units in a broad and balanced way. We have carried out a literature review of the available approaches for the evaluation of website content quality, in order to identify the most recurrent dimensions and attributes, and we have also carried out a Delphi method process with experts in order to reach an adequate set of attributes and their respective weights for the measurement of content quality. The results obtained revealed a high level of consensus among the experts who participated in the Delphi process. In addition, the different statistical analysis and techniques implemented are robust and attach confidence to our results and consequent model obtained.

A Clinical Support System Based on Quality of Life Estimation.

Quality of life is a concept influenced by social, economic, psychological, spiritual or medical state factors. More specifically, the perceived quality of an individual's daily life is an assessment of their well-being or lack of it. In this context, information technologies may help on the management of services for healthcare of chronic patients such as estimating the patient quality of life and helping the medical staff to take appropriate measures to increase each patient quality of life. This paper describes a Quality of Life estimation system developed using information technologies and the application of data mining algorithms to access the information of clinical data of patients with cancer from Otorhinolaryngology and Head and Neck services of an oncology institution. The system was evaluated with a sample composed of 3013 patients. The results achieved show that there are variables that may be significant predictors for the Quality of Life of the patient: years of smoking (p value 0.049) and size of the tumor (p value < 0.001). In order to assign the variables to the classification of the quality of life the best accuracy was obtained by applying the John Platt's sequential minimal optimization algorithm for training a support vector classifier. In conclusion data mining techniques allow having access to patients additional information helping the physicians to be able to know the quality of life and produce a well-informed clinical decision.

Which Factors Influence the Type of Delivery and Cesarean Section Rate in Women with Gestational Diabetes?

OBJECTIVE: To discover the differences between women with gestational diabetes mellitus (GDM) who delivered vaginally and those who delivered by cesarean section, and to assess the cesarean rate in this group of women. STUDY DESIGN: We divided all pregnant women with GDM into 2 groups: those who had vaginal delivery and those who gave birth by cesarean section (retrospective study of 6 years). RESULTS: We evaluated 460 births at term (≥ 37 weeks' gestation), for a total of 240 vaginal births and 220 cesarean births. All occurred in our institution. Of all the variables that were compared between the 2 groups, we found statistically significant differences (p < 0.05) in the following factors: previous history of macrosomia and gestational age at the time of beginning insulin treatment. CONCLUSION: Pregnant women with GDM and previous history of macrosomia are more likely to be submitted to cesarean section. Also, the initiation of insulin treatment at an early gestational age is associated with a higher chance of a woman delivering by cesarean section. The cesarean section rate in women with GDM was 47.8%.

[Head and neck cancer: health related quality of life assessment considering clinical and epidemiological perspectives]. / Oncologia de Cabeça e Pescoço: enquadramento epidemiológico e clínico na avaliação da Qualidade de Vida Relacionada com a Saúde.

The importance of oncology diseases as a cause of morbidity and mortality is increasing worldwide, and their social impact is being recognized due to economic and social costs involved in prevention, treatment and rehabilitation. Head and neck cancer is one of the six most prevalent neoplasms worldwide, with an estimated 900,000 new cases diagnosed annually. Regardless of tumor site, deterioration of basic functions affecting head and neck areas are perceived and affect patients' lives. Appropriate cancer registration may provide a better analysis of health-related quality of life outcomes. In this study, 380 head and neck cancer patients were evaluated. The study showed that women have lower overall Quality of Life results. It also emphasizes the importance of early diagnosis, which often relates to stages with better prognosis and better Quality of Life outcomes. The study concluded that tumor location has an impact on Quality of Life self-perception. Values of Health Related Quality of Life should be analyzed along with socio-demographic and clinical variables in order to better understand the epidemiology, pathogenesis, and prevention of Head and Neck Cancer.

Oncologia de Cabeça e Pescoço: enquadramento epidemiológico e clínico na avaliação da Qualidade de Vida Relacionada com a Saúde / Head and Neck Cancer: Health Related Quality of Life Assessment considering clinical and epidemiological perspectives

A importância das doenças oncológicas como causa de morbilidade e mortalidade está em crescimento, sendo reconhecido o seu impacto social e peso global pelos custos económicos e sociais envolvidos na sua prevenção, tratamento e reabilitação. As patologias oncológicas de cabeça e pescoço representam um dos seis tumores malignos mais prevalentes em todo o mundo, com um valor estimado de 900.000 novos casos diagnosticados anualmente em escala mundial. Estes doentes oncológicos apresentam deterioração de funções básicas que, quando percepcionadas, têm impacto negativo na sua Qualidade de Vida. Um registo oncológico adequado permite uma análise mais rigorosa dos resultados obtidos na avaliação da Qualidade de Vida Relacionada com a Saúde. Este estudo incluiu 380 doentes oncológicos de cabeça e pescoço e demonstra que as mulheres apresentam resultados de Qualidade de Vida globalmente inferiores. Salienta-se ainda a importância do diagnóstico precoce em oncologia, que se relaciona frequentemente com melhores scores e conclui-se que a localização do tumor tem impacto sobre a autopercepção de Qualidade de Vida. Os valores de Qualidade de Vida Relacionada com a Saúde devem ser interpretados à luz das variáveis sociodemográficas e clínicas, para melhor se avaliar a Patologia Oncológica de Cabeça e Pescoço numa perspectiva epidemiológica no sentido de melhor compreender o processo saúde - doença.

The importance of oncology diseases as a cause of morbidity and mortality is increasing worldwide, and their social impact is being recognized due to economic and social costs involved in prevention, treatment and rehabilitation. Head and neck cancer is one of the six most prevalent neoplasms worldwide, with an estimated 900,000 new cases diagnosed annually. Regardless of tumor site, deterioration of basic functions affecting head and neck areas are perceived and affect patients' lives. Appropriate cancer registration may provide a better analysis of health-related quality of life outcomes. In this study, 380 head and neck cancer patients were evaluated. The study showed that women have lower overall Quality of Life results. It also emphasizes the importance of early diagnosis, which often relates to stages with better prognosis and better Quality of Life outcomes. The study concluded that tumor location has an impact on Quality of Life self-perception. Values of Health Related Quality of Life should be analyzed along with socio-demographic and clinical variables in order to better understand the epidemiology, pathogenesis, and prevention of Head and Neck Cancer.

A decision support system for quality of life in head and neck oncology patients.

BACKGROUND: The assessment of Quality of Life (QoL) is a Medical goal; it is used in clinical research, medical practice, health-related economic studies and in planning health management measures and strategies. The objective of this project is to develop an informational platform to achieve a patient self-assessment with standardized QoL measuring instruments, through friendly software, easy for the user to adapt, which should aid the study of QoL, by promoting the creation of databases and accelerating its statistical treatment and yet generating subsequent useful results in graphical format for the physician analyzes in an appointment immediately after the answers collection. METHODS: First, a software platform was designed and developed in an action-research process with patients, physicians and nurses. The computerized patient self-assessment with standardized QoL measuring instruments was compared with traditional one, to verify if its use did not influence the patient's answers. For that, the Wilcoxon and t-Student tests were applied. After, we adopted and adapted the mathematic Rash model to make possible the use of QoL measure in the routine appointments. RESULTS: The results show that the computerized patient self-assessment does not influence the patient's answers and can be used as a suitable tool in the routine appointment, because indicates problems which are more difficult to identify in a traditional appointment, improving thus the physician's decisions. CONCLUSIONS: The possibility of representing graphically useful results that physician needs to analyze in the appointment, immediately after the answer collection, in an useful time, makes this QoL assessment platform a diagnosis instrument ready to be used routinely in clinical practice.

A knowledge management system to study the quality of life in head and neck oncology patients.

The perception that an individual holds about his place in life, which depends upon his culture and values, defines this individual's Quality of Life (QoL). When applied in a health context this known as: Health-Related Quality of Life (HRQoL). The assessment of HRQoL is a Medical goal; it is used in clinical research, medical practice, health-related economic studies and in planning health management measures and strategies. Obtaining a patient self-assessment with QoL measuring instruments on the platform developed in this project, through user-friendly software, aids the study, promotes the creation of databases, and accelerates its statistical treatment. The possibility of graphically representing results that physician needs to analyze, immediately after the answer collection, makes this assessment a diagnosis instrument ready to be used routinely in clinical practice. Knowledge Management Systems (KMS) applied to this context enable knowledge creation and storage, and guide therapeutic decisions.

Geriatric oncology: comparing health related quality of life in head and neck cancer patients.

BACKGROUND: Population ageing is increasing the number of people annually diagnosed with cancer worldwide, once most types of tumours are age-dependent. High-quality healthcare in geriatric oncology requires a multimodal approach and should take into account stratified patient outcomes based on factors other than chronological age in order to develop interventions able to optimize oncology care.This study aims to evaluate the Health Related Quality of Life in head and neck cancer patients and compare the scores in geriatric and younger patients. METHODS: Two hundred and eighty nine head and neck cancer patients from the Oncology Portuguese Institute participated in the Health Related Quality of Life assessment. Two patient groups were considered: the geriatric (≥ 65 years old, n = 115) and the younger (45-60 years old, n= 174). The EORTC QLQ-C30 and EORTC QLQ-H&N35 questionnaires were used. RESULTS: Head and neck cancer patients were mostly males, 77.4% within geriatric group and 91.4% among younger patients group.The most frequent tumour locations were similar in both groups: larynx, oral cavity and oropharynx - base of the tongue.At the time of diagnosis, most of younger male patients were at disease stage III/IV (55.9%) whereas the majority of younger female patients were at disease stage I/II (83.4%). The geriatric patient distribution was found to be similar in any of the four disease stages and no gender differences were observed.We found that age (geriatrics scored generally worse), gender (females scored generally worse), and tumour site (larynx tumours denounce more significant problems between age groups) clearly influences Health Related Quality of Life perceptions. CONCLUSIONS: Geriatric oncology assessments signalize age-independent indicators that might guide oncologic geriatric care optimization. Decision-making in geriatric oncology must be based on tumour characteristics and chronological age but also on performance status evaluation, co-morbidity, and patient reported outcomes assessment.

[Computer-based quality-of-life monitoring in head and neck cancer patients: a validation model using the EORTC-QLQ C30 and EORTC- H&N35 Portuguese PC-software version]. / Avaliação da qualidade de vida em doentes com patologia oncológica da cabeça e pescoço: modelo de validação da versão electrónica Portuguesa do EORTC-QLQ C30 e EORTC- H&N35.

Quality of Life is a distinct and important emerging health focus, guiding practice and research. The routine Quality of Life evaluation in clinical, economic, and epidemiological studies and in medical practice promises a better Quality of Life and improved health resources optimization. The use of information technology and a Knowledge Management System related to Quality of Life assessment is essential to routine clinical evaluation and can define a clinical research methodology that is more efficient and better organized. In this paper, a Validation Model using the Quality of Life informatics platform is presented. Portuguese PC-software using European Organization for Research and Treatment of Cancer questionnaires (EORTC-QLQ C30 and EORTC-H&N35), is compared with the original paper-pen approach in the Quality of Life monitoring of head and neck cancer patients. The Quality of Life informatics platform was designed specifically for this study with a simple and intuitive interface that ensures confidentiality while providing Quality of Life evaluation for all cancer patients. For the Validation Model, the sample selection was random. Fifty-four head and neck cancer patients completed 216 questionnaires (108 using the informatics platform and 108 using the original paper-pen approach) with a one-hour interval in between. Patient preferences and computer experience were registered. Quality of Life informatics platform showed high usability as a user-friendly tool. This informatics platform allows data collection by auto-reply, database construction, and statistical data analysis and also facilitates the automatic listing of the questionnaires. When comparing the approaches (Wilcoxon test by item, percentile distribution and Cronbach's alpha), most of the responses were similar. Most of the patients (53.6%) reported a preference for the software version. The Quality of Life informatics platform has revealed to be a powerful and effective tool, allowing a real time analysis of Quality of Life data. Computer-based quality-of-life monitoring in head and neck cancer patients is essential to get clinically meaningful data that can support clinical decisions, identify potential needs, and support a stepped-care model. This represents a fundamental step for routine Quality of Life implementation in the Oncology Portuguese Institute (IPO-Porto), ORL and C&P department services clinical practice. Finally, we propose a diagram of diagnostic performance, considerating the generalized lack of mycological diagnosis in Portugal, which emphasizes the need for a careful history, focused on quantifying the latency period.

Patient reported outcomes in head and neck cancer: selecting instruments for quality of life integration in clinical protocols.

BACKGROUND: Health Related Quality of Life has been used in medical research for more than twenty years, being progressively accepted during the last decade as an important patient reported outcome. Considering the multidimensional approach involved in Health Related Quality of Life assessment, instrument applicability and cultural adaptation must be tested for each population. In order to select the most appropriate instrument for Head and Neck cancer patients, two major Health Related Quality of Life specific questionnaires for Head and Neck cancer patients were compared. Conceptual differences, psychometric characteristics, scores, reliability, construct validity and sensitivity to symptomatology, tumour location, tumour size were analyzed. METHODS: 102 consecutive Head and Neck cancer patients completed two different Health Related Quality of Life questionnaires: EORTC QLQ-C30 and its specific head and neck module QLQ-H&N35 and the Functional Assessment of Cancer Therapy Scales (FACT-H&N). Patients completed the questionnaires, immediately before consultation as a part of the routine evaluation. RESULTS: A greater variability was always found in the EORTC QLC-C30 questionnaire's scores for all comparable domains. Both instruments revealed a good internal consistency and demonstrated to be good tools to distinguish symptomatic patients. The EORTC questionnaires still demonstrated sensitivity to distinguish T3 and T4 staging. Conceptual differences and the psychometric characteristics are discussed. Our results suggest that these two instruments assess different aspects of Health Related Quality of Life - the questionnaires should be used separately and chosen according to the study objectives and methodology. CONCLUSIONS: This study emphases the importance in selecting the appropriate tool as a critical success factor in implementing routine Health Related Quality of Life assessment in clinical practice. This decision assumes particularly importance when utilization of results in real time and integration into clinical protocols are considered.