Quality of Life After Transoral Laser Microresection of Laryngeal Cancer: A Longitudinal Study.

Quality of life after transoral laser microresection of laryngeal cancer: A longitudinal study.

J Surg Oncol. 2013 Apr 23;
Vilaseca I, Ballesteros F, Martínez-Vidal BM, Lehrer E, Bernal-Sprekelsen M, Blanch JL

BACKGROUND AND METHODS: In the treatment of early to moderate laryngeal carcinoma, both, transoral laser surgery and radiation-based protocols have demonstrated good survival and preservation rates. In this scenario, quality of life (QOL) may become an important tool for treatment planning. We aimed to evaluate QOL changes after transoral laser microsurgery (TLM). Prospective longitudinal study. Ninety-three consecutive disease-free patients were evaluated using UW-QOL v4 and SF-12, before and 12 months after treatment. Changes over time were assessed according to age, gender, location, tumor size, and adjuvant treatment. RESULTS: UW-QOL improved from 1,051.5?±?133.7 to 1,121.7?±?92.1 (P?=?0.000), suggesting that the impact of the treatment was favorable in most of the patients. Voice quality significantly improved after TLM, but speech was still the most important variable for 46% of the patients. Tumor location (P?=?0.002) was an independent factor for preoperative total score of UW-QOL, whereas adjuvant radiation (P?=?0.03) and neck dissection (P?=?0.02), were the only postoperative negative factors. CONCLUSION: One year after TLM patients present a very good QOL. Relevant voice impairment is detected especially in locally advanced tumors, reinforcing the necessity of preoperative counseling and postoperative rehabilitation. Adjuvant radiotherapy and neck dissection negatively influenced disease-specific QOL. J. Surg. Oncol. 2013 9999:XX-XX. © 2013 Wiley Periodicals, Inc. HubMed – rehab


Rehabilitation psychology’s role in the Level I trauma center.

J Trauma Acute Care Surg. 2013 May; 74(5): 1357-62
Warren AM, Stucky K, Sherman JJ

HubMed – rehab


A comparison of methods to obtain a composite performance indicator for evaluating clinical processes in trauma care.

J Trauma Acute Care Surg. 2013 May; 74(5): 1344-50
Moore L, Lavoie A, Sirois MJ, Belcaid A, Bourgeois G, Lapointe J, Sampalis JS, Le Sage N, Emond M

Process performance indicators that evaluate trauma centers in clinical case management provide information essential to the improvement of trauma care. However, multiple indicators are needed to adequately evaluate process performance, which renders comparisons cumbersome. Several methods are available for generating composite indicators that measure global performance. The goal of this study was to compare three composite methods that are widely used in other health care domains to identify the most appropriate for trauma care process performance evaluation.In this retrospective, multicenter cohort study, 15 process performance indicators were implemented using data from a Canadian provincial trauma registry (19,853 patients; 59 centers) on patients with an Injury Severity Score (ISS) greater than 15. Composite scores were derived using three methods as follows: the indicator average, the opportunity model, and a latent variable model. Composite scores were evaluated in terms of discrimination, construct validity (association with an indicator of trauma center structural performance), criterion predictive validity (association with clinical outcomes), and forecasting (correlation over time).All composite scores discriminated well between trauma centers. Only the average indicator score was correlated with improved structure (r = 0.29; 95% confidence interval [CI], 0.07-0.53), lower risk-adjusted mortality (r = -0.22; 95% CI, -0.46 to 0.04), and lower risk-adjusted complication rate (r = -0.48; 95% CI, -0.65 to -0.25). Composite scores calculated with 1999 to 2002 data all correlated with those calculated with 2003 to 2006 data (r = 0.49, 0.87, and 0.84 for the indicator average, the opportunity model, and the latent variable model, respectively).Results suggest that of the three composite scores evaluated, only the indicator average demonstrates content and predictive criterion validity, discriminates between centers, and has good forecasting properties. In addition, this score is simple and intuitive and not subject to variation in weights over trauma systems and time. The observed association between higher indicator average scores and lower risk-adjusted mortality and complication rates suggests that improving process performance may improve patient outcome.Epidemiologic and prognostic study, level III. HubMed – rehab