Patient preferences and predicted relative uptake for targeted therapies in metastatic colorectal cancer: a discrete choice experiment

Abstract

Objective

Ras wild-type metastatic colorectal cancers (mCRC) may be treated with anti-vascular endothelial growth factor (VEGF) or anti-epidermal growth factor receptor (EGFR) agents. We aim to estimate patients’ preferences for mCRC treatment and relative importance of cost, efficacy improvement, avoidance of side effects and therapy convenience, and relative uptake between profiles that resemble Bevacizumab (anti-VEGF) and Cetuximab (anti-EGFR), two commonly prescribed mCRC targeted therapies.     

Dysphagia,an unrecognized handicap

The aim of this study was to examine whether esophageal dysphagia can be described as a handicap and to grade the severity of handicap as the discrepancy between the subject's own eating goals and his or her eating disability. The severity of the disability-goal-handicap (DGH) regarding dysphagia was expressed on a scale ranging from 0 to 48 points. Nineteen patients with dysphagia of differing causes were selected from a patient register at a laboratory for diagnostic procedures of the esophagus. The severity of handicap for the 19 patients was, on average, 33 points (range, 20–44). The DGH score correlated significantly with the patients' own evaluation of the severity of their dysphagia (p=0.008). The DGH scores did not differ markedly based on patient's sex, age, or cause of dysphagia. Patients who were operated upon because of dysphagia had significantly more points on the DGH scale prior to operation than patients who were not (p=0.001). Denial of dysphagia (N=18), concealment of dysphagia (N=18), and lack of confirmation by the patient's physician (N=15) were common but did not influence the severity of handicap as assessed by the DGH scale. It was shown that dysphagia affects all aspects of life as expressed by reduction in self-esteem (N=13), security (N=16), work capacity (N=8), exercise (N=7), and leisure time (N=6). Esophageal dysphagia may therefore be regarded as a handicap when assessed using the DGH code described in this study.     

A guide to upwardly mobile spermatozoa

Morphological comparison of sperm in raw ejaculates and swim-ups showed that the swim-up process does not simply increase the proportion of 'normal' sperm. Rather, sperm of specific morphologies have characteristic grades of upward motility.     

Management of hip dislocations in children with arthrogryposis

From a review of 131 children with arthrogryposis, we studied 18 patients with hip dislocations. Fourteen patients (10 unilateral, four bilateral) were treated by open reduction. Mean age at surgery was 9.7 months, and follow-up ranged from 9 to 245 months. Range of motion of patients treated by open reduction following the medial approach was greater than in those treated by anterolateral incision and greater than in bilateral cases treated by closed reduction. Acetabular development was satisfactory following the medial approach and there were no re-dislocations, but one hip developed avascular necrosis.     

Investigation and treatment of female urinary incontinence

There are four main types of urinary incontinence in the female namely stress incontinence, urge incontinence, overflow incontinence due to retention of urine and total incontinence. It is important to differentiate them to institute proper treatment. It is the aim of this paper to present a simple clinical evaluation of an incontinent woman. The different methods of surgical correction of stress incontinence are discussed. The latest trend is the paraurethral suspension of the bladder neck. 39 cases of Grade II stress incontinence were treated by paraurethral suspension of the bladder neck at "A" Unit, Kandang Kerbau Hospital and Dept. of Urology, SGH. 33 cases were cured. 4 improved with occasional stress incontinence, frequency and urgency. Of these, 3 were cured with imipramine. One failed because of a fixed, "lead pipe" rigid urethra from previous multiple operations to the bladder neck.     

Detection of diacetyl (caramel odor) in presumptive identification of the "Streptococcus milleri" group.

The caramel odor associated with the "Streptococcus milleri" group was shown to be attributable to the formation of the metabolite diacetyl. Levels of diacetyl in the 22- to 200-mg/liter range were produced by 68 strains of the "S. milleri" group; apart from one strain of Streptococcus mutans, all 92 other strains of streptococci belonging to 12 species produced < 13 mg of diacetyl per liter. Quantitation of diacetyl levels from cultures of streptococci is suggested as a rapid presumptive test for the "S. milleri" group.