Dataset Information

Intuitive Staging Correlates With King's Clinical Stage.

ABSTRACT: Background: Clinical stage in amyotrophic lateral sclerosis (ALS) can be assigned using King's staging with a simple protocol based on the number of CNS regions involved and the presence of significant nutritional or respiratory failure. It is important that the assigned clinical stage matches expectations, and generally corresponds with how a health care professional would intuitively stage the patient. We therefore investigated the relationship between King's clinical ALS stage and ALS stage as intuitively assigned by health care professionals. Methods: We wrote 17 case vignettes describing people with ALS at different disease stages from very early limited disease involvement through to severe, multi-domain disease. During two workshops, we asked health care professionals to intuitively stage the vignettes and compared the answers with the actual King's clinical ALS stage. Results: There was a good correlation between King's clinical ALS stage and intuitively assigned stage, with a Spearman's Rank correlation coefficient of 0.64 (p < 0.001). There was no difference in the intuitive stages assigned by practitioners of different types or at different levels of experience. Conclusions: Across a spectrum of ALS scenarios, King's clinical ALS stage corresponds to intuitive ALS stage as assigned by a range of health care professionals.

SUBMITTER: Al Khleifat A

PROVIDER: S-EPMC7611335 | biostudies-literature | 2021 Aug

REPOSITORIES: biostudies-literature

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Intuitive Staging Correlates With King's Clinical Stage.

Al Khleifat Ahmad A Balendra Rubika R Fang Ton T Al-Chalabi Ammar A

Amyotrophic lateral sclerosis & frontotemporal degeneration 20210406 5-6

<i>Background:</i> Clinical stage in amyotrophic lateral sclerosis (ALS) can be assigned using King's staging with a simple protocol based on the number of CNS regions involved and the presence of significant nutritional or respiratory failure. It is important that the assigned clinical stage matches expectations, and generally corresponds with how a health care professional would intuitively stage the patient. We therefore investigated the relationship between King's clinical ALS stage and ALS ...[more]

PMID: 33821690

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Project description:BackgroundPositron emission tomography (PET) is the standard of care for non-small cell lung cancer (NSCLC) clinical staging, but it may have limited utility in evaluating subsolid lung adenocarcinomas that can have relatively indolent behavior without hypermetabolic activity.MethodsThe sensitivity and specificity of PET for determining pathologic lymph node status and disease-free survival were assessed in patients operated on for cT1 N0 subsolid lung adenocarcinoma from January 2006 to June 2022 (at Stanford University School of Medicine, Stanford, CA). Patients with clinical or pathologic tumor size >30 mm, hilar or mediastinal lymph node size >1cm, and purely solid tumors were excluded.ResultsPET was available in 498 of 534 (93.2%) patients and more often was used in older patients with larger and more solid tumors. The overall pathologic lymph node-positive rate was 8.4% (45 of 534). PET specificity was 95.1%, but sensitivity was only 20.0%. A tumor diameter of 18.5 mm and a solid component percentage of 62.5% had the maximum predictive accuracy for pathologic lymph node positivity, with a 0% and 1.5% rate of pathologic and PET lymph node positivity, respectively, for tumors with values lower than those thresholds. There was no significant difference in 5-year disease-free survival between individuals who did and did not undergo PET scanning (76.6% vs 96.8%; P = .07). Conversely, 134 (26.9%) patients who underwent PET scanning had 171 incidentally detected hypermetabolic lesions unrelated to lung cancer, with only 13 of 134 (9.7%) patients identified as having non-NSCLC premalignant or malignant conditions requiring further therapy.ConclusionsPET scan use for subsolid lung adenocarcinoma has high specificity but limited sensitivity for predicting pathologic lymph node positivity. PET also has no association with disease-free survival and often detects clinically unimportant findings rather than changing lung cancer management, particularly for patients with smaller and less solid tumors.

Project description:BackgroundMedical decision-making is critical to patient survival and well-being. Patients with end stage renal disease (ESRD) are faced with incrementally complex decision-making throughout their treatment journey. The extent to which patients seek involvement in the decision-making process and factors which influence these in ESRD need to be understood.Methods535 ESRD patients were enrolled into the cross-sectional study arm and 30 patients who started dialysis were prospectively evaluated. Patients were enrolled into 3 groups- 'predialysis' (group A), 'in-centre' haemodialysis (HD) (group B) and self-care HD (93 % at home-group C) from across five tertiary UK renal centres. The Autonomy Preference Index (API) has been employed to study patient preferences for information-seeking (IS) and decision-making (DM). Demographic, psychosocial and neuropsychometric assessments are considered for analyses.Results458 complete responses were available. API items have high internal consistency in the study population (Cronbach's alpha > 0.70). Overall and across individual study groups, the scores for information-seeking and decision-making are significantly different indicating that although patients had a strong preference to be well informed, they were more neutral in their preference to participate in DM (p < 0.05). In the age, education and study group adjusted multiple linear regression analysis, lower age, female gender, marital status; higher API IS scores and white ethnicity background were significant predictors of preference for decision-making. DM scores were subdivided into tertiles to identify variables associated with high (DM > 70: and low DM (≤30) scores. This shows association of higher DM scores with lower age, lower comorbidity index score, higher executive brain function, belonging in the self-caring cohort and being unemployed. In the prospectively studied cohort of predialysis patients, there was no change in decision-making preference scores after commencement of dialysis.ConclusionESRD patients prefer to receive information, but this does not always imply active involvement in decision-making. By understanding modifiable and non-modifiable factors which affect patient preferences for involvement in healthcare decision-making, health professionals may acknowledge the need to accommodate individual patient preferences to the extent determined by the individual patient factors.

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Intuitive Staging Correlates With King's Clinical Stage.

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Intuitive Staging Correlates With King's Clinical Stage.

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