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Results for “Treatment selection”

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PubMed1992

Prostatic cancer: are we closer to rational treatment selection?

Despite the controversies in management for all stages of prostatic cancer, guidelines are emerging that allow for better selection of treatments for individual patients. For early stage disease, prostate-specific antigen determinations in conjunction with other staging procedures have refined our ability to define truly organ-confined disease. The more widespread use of laparoscopic lymph node dissections has spared many patients needless laparotomies. For patients with metastatic disease, the overall effect of potency-sparing antiandrogens as monotherapy needs to be investigated. Most encouraging is that more groups are using prostate-specific antigen changes to assess disease activity and the rapid translation of recent laboratory investigations into the clinic. As our ability to predict the biologic potential of an individual patient's tumor is improved, more individualized treatment recommendations will be possible.

Adult↗

PubMed2005

Effect of comorbidity on quality of life and treatment selection in patients with squamous cell carcinoma of the head and neck.

OBJECTIVES: Comorbidity is significantly associated with diminished survival and quality of life (QOL) after treatment of head and neck squamous cell carcinoma (HNSCC). We sought to determine whether comorbidity influenced pretreatment QOL scores and treatment selection in patients with HNSCC. METHODS: The medical records of all patients diagnosed with HNSCC who participated in pretreatment QOL analysis over a 15-month period were retrospectively reviewed. Patients with a history of prior treatment for head and neck cancer, unresectable, or distant metastatic disease were excluded. The University of Washington (UW) QOL questionnaire, Performance Status Scale (PSS), and Karnofsky score were used to measure pretreatment QOL. Comorbidity was graded using the Modified Medical Comorbidity Index. RESULTS: Of 75 patients who met study criteria, 33 underwent primary surgical therapy, and 42 underwent nonoperative (radiation or chemoradiation) therapy. Treatment groups did not differ with respect to patient demographics, UW QOL scores, PSS scores, Karnofsky score, or comorbidity. Treatment groups differed significantly by disease stage and primary site. Patients with advanced stage disease (III/IV) or oropharyngeal primary tumors were more likely to undergo nonoperative treatment, compared with patients with early stage disease (I/II) or oral cavity primary tumors (P < .005). No significant association was found between comorbidity and pretreatment QOL scores. CONCLUSIONS: Comorbidity was not significantly associated with treatment selection or pretreatment QOL scores in patients with HNSCC. Location of the primary tumor and disease stage were significantly associated with treatment selection. Further studies are required to determine the effect of comorbidity on patient and tumor responses to treatment.

Adaptation, Psychological↗

PubMed1979

Selective treatment of duodenal ulcer with perforation.

Selective treatment of duodenal ulcer with perforation has been based on several premises: 1) The natural history of the ulcer following closure of a perforation is generally favorable with an acute and unfavorable with a chronic ulcer. 2) An upper gastrointestinal series with water soluble contrast media can reliably document a spontaneously sealed perforation. 3) With a spontaneous seal, nonsurgical therapy is an acceptable option and is preferable for an acute ulcer or a chronic ulcer with poor surgical risk. 4) The treatment of choice for an unsealed perforation of an acute ulcer is simple surgical closure. 5) The treatment of choice of perforation of a chronic ulcer with acceptable surgical risk is an ulcer definitive operation. Sixty cases of perforation of duodenal ulcer have been treated. Nonsurgical therapy was employed without complication in eight cases with radiologically documented spontaneous seal. Truncal vagotomy and pyloroplasty in 36 cases and truncal vagotomy and antrectomy in two cases were each without mortality. Four fatalities occurred among 13 cases of closure and omental patch, each a case with severe associated disease. The mortality was 6.7% among the 60 cases; 2.4% for chronic ulcer and 16% for acute ulcer.

Acute Disease↗

PubMed2003

Augmentation of the posterior maxilla: a proposed hierarchy of treatment selection.

Literature is reviewed that discusses treatment results following Cauldwel Luc approach sinus augmentation therapy or osteotome sinus augmentation therapy, with and without simultaneous implant placement. A hierarchy of treatment selection for the augmentation of the posterior maxilla, based upon quantity and position of residual alveolar bone crestal to the floor of the sinus, is proposed.

Alveolar Ridge Augmentation↗

PubMed2000

Relationship between structure and stability of a Halipegus occidualis component population in green frogs: a test of selective treatment.

The aggregated nature of helminth parasite populations has led to the suggestion that selectively treating heavily infected hosts can efficiently reduce parasite abundance and morbidity within a host population. Moreover, it has been postulated that a selective treatment protocol might have long-term effects on parasite transmission by disrupting the stability attributed to aggregated parasite population distributions by theoretical models. Long-term investigation has demonstrated year-to-year consistency in the population dynamics of Halipegus occidualis in green frogs from Charlie's Pond, North Carolina. In 1996, removal of all but 1 worm from each frog with > or =15 worms reduced the estimated component worm population by 45%, thereby decreasing mean intensity and aggregation (variance-to-mean ratio) of H. occidualis in the frogs by 85% and 63%, respectively. The following year, mean intensity, aggregation, and host colonization trends returned to pretreatment levels, indicating no effect of worm removal and demonstrating the stability of this host-parasite system. Although this result might be attributable to inefficient treatment or the presence of infection reservoirs, it is suggested that parasite population stability in this system might be governed by prevalence rather than intensity of adult worms. Therefore, repeated selective treatment might effectively modify intensity-dependent morbidity in similar host-parasite systems but should not affect further parasite transmission.

Analysis of Variance↗

PubMed1995

Selective treatment and targeted chemotherapy: effect on prevalence and intensity of infection for two intestinal helminths in Nepalese children.

The study examines the effect of mebendazole distribution (2 x 100 mg x 3 days) either as mass chemotherapy targeted to children 1 to 10 years old, or selective treatment of heavily infected children, over a two year period in sixteen rural villages of Nepal. Eight villages were covered with six monthly mass chemotherapy, provided by Community Health Volunteers, other eight with yearly selective treatment of heavily infected children based on clinical signs. Prevalence and intensity of infection, indirectly measured as the number of eggs per gram of faeces, were measured for A. lumbricoides and hookworms utilising the Kato thick-smear technique. At the end of two year intervention, the effect of both activities was similar on worm prevalence with a slightly significant difference (p < 0.05) on worm load in favour of mass chemotherapy. Furthermore a greater effect of mebendazole was reported, regardless of the type of intervention, on hookworms present at baseline with a lower prevalence (23.4%) than A. lumbricoides (47.6%). The study suggests that clinical diagnosis of heavily infected children may be a feasible way to direct selective treatment. Baseline prevalence seems to influence effectiveness of control programs. Further studies are needed to substantiate these observations.

Animals↗

PubMed2005

Proper treatment selection may improve survival in patients with clinical early-stage nonsmall cell lung cancer.

BACKGROUND: In patients with early-stage nonsmall cell lung cancer treatment selection is rarely assessed. Many surgical papers report only the outcome of patients who underwent surgery although selection may influence the outcome. In this report, treatment selection and the outcome of both surgically and nonsurgically treated patients is evaluated. METHODS: Three hundred sixty patients (269 surgically treated and 91 nonsurgically treated) with clinical stage I and II were included. Risk factors were scaled according to the Charlson comorbidity index (CCI). Hospital morbidity and long-term survival were evaluated. RESULTS: Mean age was 64 years for the surgical and 74 for the nonsurgical patients. Mean CCI score was 1.3 and 2.4, and 5-year survival was 47% and 3%, respectively. Male sex, pneumonectomy, and CCI score of 3 or more were predictive for major postoperative complications. For the nonsurgical patients receiving radiotherapy, the 2-year survival was 40%; for the patients receiving no radiotherapy, 2-year survival was 5%. Male sex, age, treatment, and clinical stage were prognostic for survival. Patients with a CCI score of 3 or more showed a better survival after surgery than after radiotherapy. Patients with a CCI score of 3 or more who were surgically treated had a higher prevalence of forced expiratory volume in 1 second of 70% or more compared with the patients receiving radiotherapy. CONCLUSIONS: Patients with a CCI score of 3 or more have an increased risk of major postoperative complications. Nevertheless, patients with a CCI score of 3 or more show a better survival after surgery than after radiotherapy. For patients with significant comorbidity but with sufficient pulmonary reserve, surgery offers the best outcome. For patients with a high CCI score and insufficient pulmonary reserve or for those who refuse surgery curative, radiotherapy is a good alternative.

Adult↗

PubMed2005

Treatment options following single-rooted tooth removal: a literature review and proposed hierarchy of treatment selection.

BACKGROUND: Alveolar bone changes following tooth extraction have been well documented and have given rise to a number of treatment approaches. Included in these approaches are placement of various grafting materials, immediate implant placement, and a combination of both. METHODS: A review of all pertinent literature discussing regenerative therapy at the time of tooth extraction or immediate implant placement with or without concomitant regenerative therapy was carried out. RESULTS: A clinically-based hierarchy of treatment selection following extraction of single rooted teeth is proposed, based upon the available literature and clinical experience. The role of patient phenotype is considered. CONCLUSION: Utilization of the proposed hierarchy of treatment selection affords a logical framework within which to predictably treat a variety of patients.

Alveolar Bone Loss↗

PubMed1981

Results of selective treatment of spina bifida cystica.

The results of selective treatment in 120 infants with open spina bifida, admitted between May 1971 and December 1976, were prospectively studied. Seventy-one infants had adverse criteria at birth and were not treated. They all died, more than 90% of them within 6 months of birth. Seven had meningocele. All were treated and survived without handicap. Forty-two infants with myelomeningocele were actively treated. Thirty-six survive at follow-up after 3 to 9 years. The quality of survival is much better than when selection was not used but 8 children have moderate or severe handicaps. The parents were fully informed and consulted at every decision-making step; they fully supported the principle of selection and the action taken on behalf of their own child.

Persons with Disabilities↗

PubMed2004

Helminths in horses: use of selective treatment for the control of strongyles.

The current level of anthelmintic resistance in the horse-breeding industry is extremely high and therefore more emphasis is being placed on studies that focus on the judicious use of anthelmintic products. The aims of the study were to: 1) establish if there is variation in the egg excretion pattern of strongyles between the different age classes of Thoroughbred horses in the Western Cape Province (WCP), 2) test if a selective treatment approach successfully reduces the number of anthelmintic treatments and maintains acceptably low helminth burdens in adult Thoroughbred horses, and 3) evaluate the efficacy of subsampling large horse herds for faecal egg counts (FECs) to monitor the strongyle burden. In 2001 the FECs of 4 adult mare, 5 yearling and 3 weanling herds from 8 different farms were compared in the WCP Within the mare herds there were generally fewer egg-excreting individuals with lower mean FECs compared with the younger age classes. Individual faecal samples were collected every 3-4 weeks from 52 adult Thoroughbred mares from 1 farm in the WCP during a 12-month period (2002/2003). Animals with strongyle FECs > or =100 eggs per gram (epg ) were treated with an ivermectin-praziquantel combination drug (Equimax oral paste, Virbac). The mean monthly strongyle FEC for the entire group was <300 epg throughout the study and the number of treatments was reduced by 50 %. Resampling methods showed that an asymptote to mean FEC was reached at 55 animals for each of the pooled weanling, yearling and mare egg counts. Resampling within 4 different mare herds recorded asymptotes of between 24 and 28 animals. Subsampling entire herds for FECs therefore provided an effective approach to treatment management. This study demonstrates that selective treatment is both a practical and an effective approach to the management of anthelmintic resistance.

Age Factors↗

PubMed2006

The multidisciplinary team meeting improves staging accuracy and treatment selection for gastro-esophageal cancer.

The object of this article is to assess current staging accuracies for individual modalities and to investigate the influence of the multidisciplinary team (MDT) on clinical staging accuracies and treatment selection for patients with gastro-esophageal cancer. Patients newly diagnosed with gastric or esophageal cancer and who were deemed suitable for surgical resection by the MDT were studied. Patients were staged with a combination of computerized tomography (CT), endoscopic ultrasound (EUS) and laparoscopic ultrasound (LUS). Additionally, the MDT determined an overall clinical stage for each patient after discussion at the MDT meeting. Treatments were selected according to this final clinical stage. Final histopathological staging (pTNM) was available for all patients and was used as the gold standard for determining staging accuracy. Suitability of treatment selection was assessed once final pTNM was available. One hundred and eighteen patients were studied. Endoscopic ultrasound was the most accurate individual staging modality for the loco-regional assessment of esophageal tumors (T stage accuracy 78%, N stage accuracy 70%). Laparoscopic ultrasound was the most accurate modality in T staging of gastric cancers (91%). The MDT stage was more accurate than each individual staging modality for T and N staging for both gastric and esophageal cancers (accuracy range: 88-89%) and was better for the assessment of nodal disease than each individual modality (CT P < 0.001, EUS P < 0.01, LUS P < 0.01). Overall staging accuracy as determined at the MDT meeting was increased and resulted in only 2/118 (2%) patients being under-treated. The MDT significantly improves staging accuracy for gastro-esophageal cancer and ensures that correct management decisions are made for the highest number of individual patients.

Adenocarcinoma↗

PubMed2007

Analysis of observational studies in the presence of treatment selection bias: effects of invasive cardiac management on AMI survival using propensity score and instrumental variable methods.

CONTEXT: Comparisons of outcomes between patients treated and untreated in observational studies may be biased due to differences in patient prognosis between groups, often because of unobserved treatment selection biases. OBJECTIVE: To compare 4 analytic methods for removing the effects of selection bias in observational studies: multivariable model risk adjustment, propensity score risk adjustment, propensity-based matching, and instrumental variable analysis. DESIGN, SETTING, AND PATIENTS: A national cohort of 122,124 patients who were elderly (aged 65-84 years), receiving Medicare, and hospitalized with acute myocardial infarction (AMI) in 1994-1995, and who were eligible for cardiac catheterization. Baseline chart reviews were taken from the Cooperative Cardiovascular Project and linked to Medicare health administrative data to provide a rich set of prognostic variables. Patients were followed up for 7 years through December 31, 2001, to assess the association between long-term survival and cardiac catheterization within 30 days of hospital admission. MAIN OUTCOME MEASURE: Risk-adjusted relative mortality rate using each of the analytic methods. RESULTS: Patients who received cardiac catheterization (n = 73 238) were younger and had lower AMI severity than those who did not. After adjustment for prognostic factors by using standard statistical risk-adjustment methods, cardiac catheterization was associated with a 50% relative decrease in mortality (for multivariable model risk adjustment: adjusted relative risk [RR], 0.51; 95% confidence interval [CI], 0.50-0.52; for propensity score risk adjustment: adjusted RR, 0.54; 95% CI, 0.53-0.55; and for propensity-based matching: adjusted RR, 0.54; 95% CI, 0.52-0.56). Using regional catheterization rate as an instrument, instrumental variable analysis showed a 16% relative decrease in mortality (adjusted RR, 0.84; 95% CI, 0.79-0.90). The survival benefits of routine invasive care from randomized clinical trials are between 8% and 21%. CONCLUSIONS: Estimates of the observational association of cardiac catheterization with long-term AMI mortality are highly sensitive to analytic method. All standard risk-adjustment methods have the same limitations regarding removal of unmeasured treatment selection biases. Compared with standard modeling, instrumental variable analysis may produce less biased estimates of treatment effects, but is more suited to answering policy questions than specific clinical questions.

Aged↗

PubMed2003

Sequential designs for phase III clinical trials incorporating treatment selection.

Most statistical methodology for phase III clinical trials focuses on the comparison of a single experimental treatment with a control. An increasing desire to reduce the time before regulatory approval of a new drug is sought has led to development of two-stage or sequential designs for trials that combine the definitive analysis associated with phase III with the treatment selection element of a phase II study. In this paper we consider a trial in which the most promising of a number of experimental treatments is selected at the first interim analysis. This considerably reduces the computational load associated with the construction of stopping boundaries compared to the approach proposed by Follman, Proschan and Geller (Biometrics 1994; 50: 325-336). The computational requirement does not exceed that for the sequential comparison of a single experimental treatment with a control. Existing methods are extended in two ways. First, the use of the efficient score as a test statistic makes the analysis of binary, normal or failure-time data, as well as adjustment for covariates or stratification straightforward. Second, the question of trial power is also considered, enabling the determination of sample size required to give specified power.

Alzheimer Disease↗

PubMed2006

Targeted selective treatment of lungworm infection in an organic dairy herd in Sweden.

The effect of targeted selective anthelmintic treatment on the seroprevalence of the lungworm Dictyocaulus viviparus in cattle was investigated. The study was commenced on an organic dairy enterprise in Sweden in November 1998 after the observation of an outbreak dictyocaulosis in the herd, and then continued for almost 3 years. The first year sampling was conducted on a monthly basis and then biannually with the exception of between August and November 2000 when sampling was performed monthly following a second outbreak of dictyocaulosis. Throughout the study, blood samples were examined for specific IgG(1) levels from all animals in the herd that had been grazing for more than 3 months. At the first sampling occasion, 13% out of the 90 blood samples were seropositive. One month later, after targeted selective treatment with eprinomectin (Eprinex), Merial), the whole herd was seronegative. Seroprevalence then gradually increased and 1 year later it returned to levels similar to those observed at the start of the study. At turnout in April 2000, seroprevalence was 1.3% but it then rapidly increased to 28% and 30% in August and September, respectively. This increase was mainly due to an increase in FSG animals of which many were coughing. Consequently, all seropositive animals were injected with ivermectin (Ivomec), Merial) at 0.05 mg/kg body weight in late August 2000. Although all animals recovered, seroprevalence was only reduced to 12% 1 month later. The differences in seroprevalence after both of these anthelmintic treatments were probably attributed to the timing. The first deworming with eprinomectin was conducted in November when the infection already was transient, whereas ivermectin in connection with the second outbreak was injected in a more acute phase of the infection cycle. Infection levels in 2001 were low with seroprevalences of 2.3% and 5.6% in May and September, respectively. These results show that dictyocaulosis in Sweden can be effectively controlled by the use of macrocyclic lactones. However, the infection was not eradicated from the herd despite close monitoring of the seroprevalence and targeted selective treatment of every seropositive animal on two occasions.

Animals↗

PubMed1994

Selective treatment decisions and the legal rights of very young infants.

Selective treatment of neonatal infants who are terminally ill or born with profound disabilities is becoming a controversial issue. The potential of medical technology, the practices of doctors and the expectations of parents have moved ahead of the law in this area. The interests of parents, children and medical practitioners would be better served by a clarification of the law. Legal change should be based on an ethical and moral foundation. The application of the "best interests" test should be given further consideration.

Australia↗

PubMed1999

A treatment selection model for weight reduction in adults with acquired brain injury: applications and preliminary findings.

This article presents a unique method for providing weight management assistance to persons who have experienced an acquired brain injury (ABI). Most of the available literature on this topic deals with weight loss methods for individuals who are not faced with the cognitive and behavioural challenges inherent in this population. A treatment selection protocol will be described that allows for appropriate selection of behavioural weight loss interventions. Interventions are based upon specific cognitive and behavioural difficulties that individuals with acquired brain injury may present. A detailed case study will also be presented depicting successful use of the treatment selection model with an adult male with an acquired brain injury.

Adult↗

PubMed1995

Treatment selection factors for stereotactic radiosurgery of intracranial metastases.

PURPOSE: To define treatment selection criteria for patients with intracranial metastases treated with stereotactic radiosurgery. METHODS AND MATERIALS: Between August 1989 and July 1993, 25 patients with intracranial metastases (28 lesions) were treated with stereotactic radiosurgery at the University of Florida. Thirteen patients were treated for progressive intracranial disease after external-beam radiotherapy, and 12 were treated with radiosurgery as an adjunct to initial treatment. Minimum eligibility criteria included histologic verification of primary disease, Karnofsky performance status 50% or greater, three or fewer intracranial metastases, radiographically distinct lesion(s) 4 cm or less in diameter, and reasonably well-controlled primary disease. Univariate and multivariate analyses tested the prognostic significance of Karnofsky performance status, lesion volume, number of lesions, treatment dose (both external beam and stereotactic), histology, site of primary disease, and time interval (less than or greater than 1 year) from primary diagnosis to development of intracranial metastasis or from treatment of intracranial disease to recurrence. RESULTS: Local control was achieved in 84% of 28 lesions treated. The only significant prognostic indicator among the tested variables was the interval to development or recurrence of intracranial metastasis. CONCLUSION: Although stereotactic radiosurgery improves local control rates and is likely to offer improved palliation for a select cohort of patients, the selection criteria for such patients remain poorly defined. Our data suggest that an interval of greater than 1 year from primary disease diagnosis to development of intracranial metastasis, or from treatment of intracranial metastasis to its recurrence, defines a patient cohort that is more likely to benefit from this treatment technique.

Adenocarcinoma↗

PubMed1997

Predictive validity of the Braunwald classification of unstable angina for angiographic findings, short-term prognoses, and treatment selection.

The authors tested the Braunwald classification for its predictive validity for underlying coronary conditions, clinical courses, and responses to treatment. A reliable definition and classification of unstable angina is needed to help physicians make correct diagnoses of patients' conditions and to appraise findings from clinical trials critically. Many clinical trials have been conducted, but it is difficult to compare the results because of different entry criteria. Of 113 consecutive patients admitted with unstable angina, 89 who had primary angina were studied. Braunwald's classification was applied at admission. The outcomes of interest during hospitalization were coronary angiographic findings, short-term prognoses, and the treatment selected. Multivariate analysis showed that the severity class expressed significant positive predictivity for coronary thrombi (adjusted odds ratio [OR], 6.53; 95% confidence interval [CI], 2.82 to 15.1) and progress to impending infarction (OR, 10.43; CI, 3.35 to 32.49). The treatment (OR, 0.02; CI, 0.004 to 0.08) and electrocardiographic (OR, 0.22; CI 0.10 to 0.49) classes showed independent negative predictivity for coronary vasospasm. The treatment (OR, 3.50; CI, 1.94 to 6.33) and electrocardiographic (odds ratio, 3.27; CI, 1.87 to 5.71) classes showed positive predictivity for the necessity for recanalization treatment with coronary angioplasty or bypass grafting. The Braunwald classification used at admission is highly predictive of underlying coronary conditions, progression to impending infarction, and the final selection of treatment. This classification should be considered in determining patient eligibility in clinical trials and studies.

Adult↗