The document discusses reasons for offering medical treatment and measuring health-related quality of life (HRQoL). It provides three key reasons for treatment: to increase longevity, prevent future illness, and improve how patients feel. Measuring HRQoL directly assesses patients' physical and mental health over time and daily functioning. Investigators have developed questionnaires to measure HRQoL domains like physical, psychological, and social functioning. Choosing the right HRQoL measure depends on the study purpose, with generic measures used for population surveys and disease-specific ones for clinical trials.
Geriatric Oncology
1. Relationship between aging and cancer
2. Constructs of frailty and multimorbidity
3. Evidence for geriatric assessment in older adults living with cancer
Geriatric Oncology
1. Relationship between aging and cancer
2. Constructs of frailty and multimorbidity
3. Evidence for geriatric assessment in older adults living with cancer
“Cancer Anorexia Cachexia (originally Cancer Cachexia) is a multifactorial syndrome defined by:
Ongoing loss of skeletal muscle mass (with or without loss of fat mass)
Cannot be fully reversed by conventional nutritional support
Leads to progressive functional impairment”.
Hyperthermic Intraperitoneal Chemotherapy is more effective in killing the cancer cells which are spread in the tummy region. This technique needs a specialized, dedicated team, HIPEC machine and trained doctors and is done immediately after the cytoreductive surgery.
Radiotherapy and Cetuximab in head and neck cancer.pptxNamrata Das
Radiotherapy and Cetuximab in head and neck cancer
Bonner trial
RTOG 0522
TREMPLIN
RTOG 1016
De-Escalate trial
TROG
HN.6
PembroRAD
Nimotuzumab
Panitimumab
“Cancer Anorexia Cachexia (originally Cancer Cachexia) is a multifactorial syndrome defined by:
Ongoing loss of skeletal muscle mass (with or without loss of fat mass)
Cannot be fully reversed by conventional nutritional support
Leads to progressive functional impairment”.
Hyperthermic Intraperitoneal Chemotherapy is more effective in killing the cancer cells which are spread in the tummy region. This technique needs a specialized, dedicated team, HIPEC machine and trained doctors and is done immediately after the cytoreductive surgery.
Radiotherapy and Cetuximab in head and neck cancer.pptxNamrata Das
Radiotherapy and Cetuximab in head and neck cancer
Bonner trial
RTOG 0522
TREMPLIN
RTOG 1016
De-Escalate trial
TROG
HN.6
PembroRAD
Nimotuzumab
Panitimumab
Valuing health states associated with chronic disorders of consciousness shah...Office of Health Economics
This presentation reviews current methods for capturing how the general public values health states as background for discussion on applying these to chronic disorders of consciousness.
Quality of life (QoL) and Wellbeing (WB) - differences and similaritiesStella I. Tsartsara
Well-being is about Quality of Life. In Health related evaluation both are Patient Reported Outcome (PRO) tools, measuring population health and relate therefore strongly with Behavioral Economics. Both are lowering Healthcare costs, raising productivity and therefore community competitiveness . They also relate to Active and Healthy Ageing (AHA) theory for elderly population, and Gerontology/Geriatric Assessment.
Health: objective, subjective, or other?Mark Sullivan
In this presentation, I examine how we define and perceive health. Is it an objective, observed phenomenon? Is it a subjective, experienced phenomenon? Or some combination of the two, captured by Health-Related Quality of Life (HRQL) measures? Here, I argue that health is not objective or subjective or a combination, but the capacity for meaningful action.
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
Acute scrotum is a general term referring to an emergency condition affecting the contents or the wall of the scrotum.
There are a number of conditions that present acutely, predominantly with pain and/or swelling
A careful and detailed history and examination, and in some cases, investigations allow differentiation between these diagnoses. A prompt diagnosis is essential as the patient may require urgent surgical intervention
Testicular torsion refers to twisting of the spermatic cord, causing ischaemia of the testicle.
Testicular torsion results from inadequate fixation of the testis to the tunica vaginalis producing ischemia from reduced arterial inflow and venous outflow obstruction.
The prevalence of testicular torsion in adult patients hospitalized with acute scrotal pain is approximately 25 to 50 percent
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
2. Reasons of offering Treatment
• Our interventions increase longevity, prevent
future morbidity, or make patients feel better.
• The first two of these three endpoints are
relatively easy to measure.
• In the last 20 years, however, clinicians have
recognized the importance of direct
measurement of how people are feeling, and
how they are able to function in daily
activities. Investigators have developed
increasingly sophisticated methods of
making these measurements.
3. Health Related QoL
• Refers to a person or group's perceived
physical and mental health over time.
• To measure the effects of chronic
illness in their patients to better
understand how an illness interferes
with a person's day-to-day life.
• To measure the effects of numerous
disorders, short- and long-term
disabilities, and diseases in different
populations.
4. What is Health-Related Quality of Life?
• Health-related quality of life
represents the functional effects
of an illness and its consequent
therapy upon a patient, as
perceived by the patient
DOMAINS
• Physical
• Psychological
• Social
5. Knowledge defined as “coded information in
the brain”
- but 100 billion neurons, synapses in the brain
- and the working of the brain only partially known
- and we have evolutionary learning and hidden knowledge
(interaction brain and environment over time)
- hence always limited knowledge
- hence behaviour is always systematic and random
6. Knowledge and science create value and
reduce cost
• Uncured diseases ranked by cost to society:
– Heart disease
– Cancer
– Alzheimer´s
– Diabetes
– Arthritis
– Depression
– Stroke
– Osteoporosis
• The expected benefits from investment in
medical science are enormous and will remain
so
7. Quality of Life: Cancer Survival Rates
• Acute Lymphatic Leukaemia
– 1964-66: 4 %
– 1994-96 89%
• Breast Cancer
– 1964-66 65%
– 1994-96 84%
• Prostate Cancer
– 1964-66 45%
– 1994-96 72%
• Testicle Cancer
– 1964-66 49%
– 1994-96 95%
• Lung Cancer women men
– 1964-66 11% 8%
– 1994-96 10% 10%
8. Why is HRQoL Important?
• One of the aims of treating patients
must be to enable them to feel better
and to function better in their day-to-
day activities.
• The importance of incorporating health-
related quality of life into their routine
clinical practice and into clinical
studies.
9. Reasons of offering Treatment
We believe our interventions:
• increase longevity
• prevent future morbidity
• make patients feel better.
• The first two of these three endpoints are
relatively easy to measure.
• Investigators have developed increasingly
sophisticated methods of direct
measurement of how people are feeling, and
how they are able to function in daily
activities.
10. Measuring HRQL
• Investigators measure HRQL using
questionnaires that typically include
questions about how patients are
feeling or what they are experiencing
associated with response options such
as yes-no, or seven-point scales
• Investigators aggregate responses to
these questions into domains or
dimensions (such as physical or
emotional function) that yield an overall
score.
11. Clinical Scenario
• You are a physician following a 35 year-old man who has had
active Crohn's disease for 8 years.
• The symptoms were severe enough to require resectional
surgery four years ago, and despite treatment with
sulphasalazine and metronidazole, the patient has had active
disease requiring oral steroids for the last two years.
• Repeated attempts to decrease the prednisone have failed,
and the patient has required doses of greater than 15 mg. per
day to control symptoms.
• You are impressed by both the methodology and results of a
recent report documenting that such patients benefit from
oral methotrexate and suggest to the patient that he consider
this medication. When you explain some of the risks of
methotrexate, particularly potential liver toxicity, the patient is
hesitant. How much better, he asks, am I likely to feel while
taking this medication?
12. • Users' Map for an Article about HRQL
Are the recommendations valid?
» Primary Guides 1. Have the investigators measured aspects
of patients' lives that patients consider important? 2. Did the
HRQL instruments work in the way they are supposed to?
» Secondary Guides 3. Are there important aspects of HRQL
that have been omitted? 4. If there were tradeoffs between
quality and quantity of life, or an economic evaluation, have
they used the right measures?
What are the results?
What was the magnitude of effect on HRQL?
Will the results help me in caring for my patients?
• 1. Will the information from the study help me inform my
patients?
• 2. Did the study design simulate clinical practice?
13. Measuring HRQoL
• Health status, functional status, and
quality of life are three concepts often
used interchangeably to refer to the
same domain of "health”
• The health domain ranges from
negatively valued aspects of life,
including death, to the more positively
valued aspects such as role function or
happiness
14. Measuring HRQoL
• Health-related quality-of-life questionnaires
are either administered by trained
interviewers or self-administered.
• The former method is resource intensive but
ensures compliance, decreases errors, and
decreases missing items.
• The latter approach is much less expensive
but increases the number of missing
subjects and increases missing responses.
• A compromise between the two approaches
is to have instruments completed with
supervision.
15. What makes a Good HRQL Instrument
• The goals of HRQL measures
include differentiating between
people who have a better HRQL
and those who have a worse
HRQL (a discriminative
instrument) as well as measuring
how much the HRQL has
changed (an evaluative
instrument)
16. Types of HRQL Measures
Generic Instruments
• Health Profiles
• Two basic approaches characterize the
measurement of HRQL: generic
instruments (including single indicators,
health profiles, and utility measures) and
specific instruments
• Health profiles are instruments that
attempt to measure all important
aspects of HRQL.
17. Example of Health Profile
• The Sickness Impact Profile is an example
of a health profile and includes a physical
dimension (with categories of ambulation,
mobility, as well as body care and
movement); a psychosocial dimension
(with categories including social
interaction, alertness behavior,
communication, and emotional behavior);
and five independent categories including
eating, work, home management, sleep
and rest, as well as recreations and
pastimes.
18. Generic Instrument
• Utility Measures
• The other type of generic instrument, utility
measures of quality of life, are derived from
economic and decision theory; they reflect
the preferences of patients for treatment
process and outcome.
• They can be used in cost–utility analyses
that combine duration and quality of life. In
utility measures, HRQL is summarized as a
single number along a continuum that
usually extends from death (0.0) to full health
(1.0)
• Utility scores reflect both the health status and
the value of that health status to the patient.
19. Specific Instruments
• The second basic approach to quality-of-
life measurement focuses on aspects of
health status that are specific to the area
of primary interest.
• The instrument may be specific to the
disease (such as heart failure or asthma),
to a population of patients (such as the
frail elderly), to a certain function (such as
sleep or sexual function), or to a problem
(such as pain).
20. Choosing the Appropriate HRQL Measure
Health Status Surveys
• The choice of an HRQL measure
depends on the purpose of the
study
• Generic measures may be
particularly useful for surveys that
attempt to document the range of
disability in a general population or
a patient group
21. Instruments (contd)
• Clinical Trials
• Initially, when studying a new therapy
(such as a new drug), investigators rely on
disease-specific measures.
• Disease-specific measures are clinically
sensible in that patients and clinicians
intuitively find the items directly relevant;
their increased potential for
responsiveness is particularly compelling
in the clinical trial setting
22. Using instruments
• A number of specific measures can be
used together in a battery to obtain a
comprehensive picture of the impact of
different interventions on HRQL.
• A variety of instruments, including
measures of well-being, physical
function, emotional function, sleep,
sexual function, and side effects, were
used to show that antihypertensive
agents have a differential impact on
many aspects of HRQL
23. Evaluating QoL
STUDY DESIGNS
• Cross-Sectional (Non-Randomised
Longitudinal) Study: describes the
predictors of QoL (Specialty vs PHC)
• Randomized Study of a Clinical
Intervention: measure reflects the nature
of disease
• Cost effectiveness & Cost-benefit
Analysis (measuring QALYs)
24. Selecting an Assessment Instrument
Instruments used vary according to:
• The identity of the respondent (clinician,
patient, relative)
• The setting of the evaluation
• The type of questionnaire used (short
form, interview, survey)
• The General approach to the evaluation
25. Selecting an Assessment Instrument
• General Instruments are used in general
population to assess a wide range of
domains applicable to a variety of health
states, conditions & disease (Gen. Health
Surveys)
• Disease Specific Instruments focus on the
domains most relevant to the disease and
on the characteristics of the patients in
whom the condition is most prevalent
(Clinical trials/specific therapeutic
interventions)
26. Indicators of QoL
• Functional ability
• Health Status
• Symptoms and Somatic State
• Psychosocial Well-being
• Social support & life satisfaction
• Morale
• Independence
• Control over life
• Coping & adjustment abilities
27. Types of QoL Measures
• Generic
• Dimension-specific
• Disease – specific
• Item- specific
28. HRQ Instruments
• Sickness Impact Profile
• Nottingham Health Profile
• McMaster Health Index Questionnaire
• WHOQOL Assessment
• DALYs: Disability Adjusted Life Years
• The Quality of Well being Scale