Cancer and Reproducibility of Decisions

Cancer and Reproducibility of Decisions Ur ologic ca n cer : W h a t a bo u t re p r odu c ib i l i ty of d ec i s ion m a de a t m ultidi sci plin a r y t e a m m a n a g e m e nt? BAYOUD Y, LOOCK PY, MENARD J, MESSAOUDI R, RIPERT T, PIERREVELCIN J, KOZAL S, LEON P, KAMDOUM M, CHOLET I, LARRE S . Â   Abstract: I nt r odu c t i on : The prostate cancer (PCa) treatment is multimodal. Thus multidisciplinary team management (MDTM) decision-making process appears as a tool to answer all aspects of PCa. To evaluate the reproducibility of therapeutic decisions made at MDTM. M a t erials a n d M e thod s : We compared therapeutic decisions of PCa by presenting the same file of patient under a fake identity after 6 to 12 months from the first presentation. Forty-nine files of radical prostatectomy (RP) (28 pT2, 21 pT3) performed for clinical localized PCa were represented at MDTM which included urologist, oncologist, pathologist and radiologist. Analysis of therapeutic decisions comprised criteria as: TNM stage, Gleason score, margin status and comorbidities. The reproducibility was assessed statistically by Kappa coefficient. R es u l t s: Forty-nine file of radical prostatectomy (RP). The mean age was similar in both groups. The mean PSA was 8,32 ng/ ml (3,56-19,5) in pT2 group and 9.4ng/ml (3,8-22) in pT3 group. The margin status was positive in 25% and 47,6% respectively in pT2 and pT3 group. Decision made for pT2 group were the same in 100% case (k=1). In the group of pT3 (n=21), 33% of decision were different at second MDTM, especially for pT3b with only 29% reproducible decision (k= 0,1). Concerning pT3a, 86% of decision were reproducible (k= 0,74). Con cl u s i on : We showed a reliability and reproducibility of decision made at MDTM when guidelines are well defined. The therapeutic attitudes were less reproducible in locally advanced PCa but decision concerning those cases should be made in the setting of guidelines. K e y w o r d s : Cancer, Kappa coefficient, Prostate , multidisciplinary, Reproducibility. INTRODUCTION: The prostate cancer (PCa) is the most frequent cancer in men as well in Europe and USA (1). The PCa counts for 11% of all men cancers and it’s responsible for 9% of the mortality by cancer in men in Europe. In France in 2010, the incidence of PCa was 71577 cases and the related mortality of PCa at the same year was 8791 deaths which represent a 2.5% less mortality per year during last years (2). The multidisciplinary team management becomes an obligation for all oncologic fields as mentioned by the French government law: cancer program 2003-2007, this program stipulate that each new patient should benefit from MDTM decision-making process, organize the setting of MDTM and also gives tools to develop trials of research for a new diagnosis and therapeutic arsenal (3). Some urologists express some doubt about the interest of MDTM because of it’s a new burden without assigned budget while others see in the MDTM an equalit y of chance of patients, and possibility to include patients in trials and protocols. Number of European study showed the interest of MDTM and its beneficial impact on survival (4, 5). The efficiency of decisions made at MDTM is obvious but the evidence about their reproducibility remains doubtful. Through patients underwent a radical prostatectomy (RP) for localized prostate cancer (PCa) and represented identically, we evaluated a reproducibility of decision made at MDTM.

Weekly Discussion Essay Example | Topics and Well Written Essays - 250 words

Weekly Discussion - Essay Example In this regard, the reason why Klein and Zeljka have to respond to the counter-arguments posed to the original study was to further make the issue clear. Klein published the article I Was Wrong, and So Are You in The Atlantic, and objected to publishing in The Wall Street Journal. This can be considered as a deliberate attempt of ensuring that the information is tailored to the appropriate audience. In doing this, Klein must have been aware that The Atlantic and The Wall Street Journal command different audience. It is widely argued that The Wall Street Journal is most read by policy makers, including the politicians. On the other hand, The Atlantic is read by the general public, which may not necessarily counter as policy makers, but inform the decision making process. These include parents, students and businessmen. In my view, the reason why information as well as the media should be changed is to assure information objectivity. This is in reference to the fact that people have different points of view and interest. This means that for the objectives of the information to be realized, adjustments for inclusivity should be

Reviews and reaction on a film Essay Example | Topics and Well Written Essays - 250 words

Reviews and reaction on a film - Essay Example ocumentary’s primary focus is Sally Mann; however, the documentary takes the viewer through Mann’s personal life with her children, husband, mother, and friends. In effect, the documentary reveals Mann’s personality to the viewer, which makes the viewer understand her photography work. The documentary provides the viewer with an understanding of the factors behind the personal nature of Mann’s photographs. In this case, her preoccupation and strong relationship with her family are instrumental in Mann’s photography since some of work may appear provocative, which underlines her open-mindedness. As earlier indicated, Mann uses old equipment in the contemporary technological era. In this regard, her large format camera requires exposure times of a number of minutes before use. In effect, this shows her patience and calmness, which provides her with the impulse to capture beautiful photographs. In addition, Mann produces her photos in a fragile and old process that makes her lose some photographs in the process. In this case, this is a depiction of a strong sense of idiosyncrasy, which implies her remarkable willingness to pursue unconventional ideas. In conclusion, the documentary depicts Mann as a remarkable individual intent on pursuing her goals. Although she uses old procedures and equipment, Mann’s work is humbling to photographers and all artists since she exploits the flaws of old procedures to produce unintended patterns that enhance her concept and aesthetic values in