What Tinnitus Therapy Outcome Measures Are Important for Patients?– A Discrete Choice Experiment

Introduction: The therapeutic rationale varies among tinnitus therapies. A recent study identified which outcome measures should be used for different types of interventions. What patients consider the most important outcome measure in tinnitus therapy is unclear.Objectives: To study the preference of the tinnitus patient for different outcome measures in tinnitus therapy.Methods: A discrete choice experiment was conducted. Participants were provided with two alternatives per choice set (nine choice sets total). Each choice-set consisted of four attributes (tinnitus loudness, tinnitus acceptance, quality of sleep and concentration). With a difference in one of three levels (increased, similar or decreased after treatment) between the alternatives. Results were analyzed with a mixed logit model. Preference heterogeneity was explored with covariates, correlating attributes and a latent class analysis.Results: One hundred and twenty-seven participants took part. In the mixed logit models we found that the choice for a tinnitus therapy was significantly affected by all levels of the outcomes, except for a similar level in concentration and tinnitus acceptance. Tinnitus loudness was considered the most important outcome measure relative to the other attributes. Preference heterogeneity was not explained by correlating attributes. The latent class analysis identified two classes. The first class was similar to the mixed logit analysis, except for a non-significance of similar quality of sleep and tinnitus acceptance. The second class showed a statistical significant preference only for increased tinnitus acceptance and similar quality of sleep.Conclusion: Based on this study, tinnitus patients consider loudness the most important outcome measure. However, there is a variance in preference as indicated by the latent class analysis. This study underlines the importance of research into tinnitus heterogeneity. Next, this study highlights the need for research into tinnitus therapies that focus on diminishing tinnitus loudness.

Preliminary exploration of a computerized cognitive battery and comparison with traditional testing in patients with high-grade glioma

Background Cognitive function is an important outcome measure in many brain tumor clinical trials, and investigators are interested in employing the most efficient methods of cognitive assessment for this purpose. Computerized testing can be appealing because of the perceived ease of use and electronic data generated. Traditional tests may have the advantage of accumulated validity evidence and comparability across historic trials. Methods We evaluated feasibility of a Cogstate battery in 39 patients with high-grade glioma, and compared it with a commonly used paper-and-pencil battery. Results Both batteries were well tolerated and rated equally likeable. Correlations between the batteries were low to low-moderate. More patients showed impairment at baseline and decline across trials on traditional tests. Conclusions Both batteries were well tolerated, but the most complicated tasks (from both batteries) could not be completed by all subjects. Preliminary validity evidence for the Cogstate tasks was mixed, but a larger sample is needed.

The implementation of a cystic fibrosis annual review process in a tertiary paediatric hospital

We evaluated the implementation of a cystic fibrosis annual review process in a tertiary paediatric hospital. After implementation, there was demonstrated improvement in an important outcome measure—the use of inhaled mucolytic agents.

Factors Influencing Patients' Satisfaction

In complex systems, such as healthcare, patient satisfaction is identified as the patient experience of care and has been referred to as the “indispensable outcome.” The main goals of ED practitioners are the patient satisfaction along with maintaining optimal outcomes. Patient satisfaction has become a very important outcome measure when assessing healthcare systems performance. Nevertheless, it is a complex confusing concept. Some providers suggest several activities in order to enhance the satisfaction without being sure if these actions really improve satisfaction or no. Also, patient satisfaction enhancement activities should not conflict with cost efficacy. Several factors fall under patient satisfaction. Interviews with physicians prove that patients have specific expectations during a clinical encounter; being aware of these expectations, physicians can fulfill patient satisfaction. The goal of this chapter is to determine the contribution and effect of these factors in influencing patient satisfaction.

Graphic vs. Text-Only Résumés: Effects of Design Elements on Simulated Employment Decisions

Résumés sometimes contain graphical elements, and the use of such “graphical résumés” may be increasing. The purpose of this study was to compare the effect of including different types of graphical elements in a résumé on the most important outcome measure from the perspective of the applicant – the probability of a positive selection decision by the evaluator. There was a reliable preference for a textual résumé when participants asked which design they thought would be most effective. However, there was no reliable effect of résumé design on evaluator’s decisions about the applicant whose qualifications were represented.

Flashy or Functional

Résumés sometimes contain graphical elements, and the use of such “graphical résumés” may be increasing. The purpose of this study was to compare the effect of including different types of graphical elements in a résumé on the most important outcome measure from the perspective of the applicant – the probability of a positive selection decision by the evaluator. There was a reliable preference for a textual résumé when participants asked which design they thought would be most effective. However, there was no reliable effect of résumé design on evaluator’s decisions about the applicant whose qualifications were represented.

Reliability of Three Disability Scales for Detection of Independence Loss in Parkinson’s Disease

Background.Loss of independence is considered an important outcome measure in Parkinson’s disease (PD), but tools to assess dependency have not been tested in PD.Methods.In this study of 158 PD patients, we examined the two most widely used scales and cut-offs for dependency evaluation in PD, the Hoehn and Yahr (HY) stage > 3 and the Schwab and England (SE) scale score < 80%, against a standardized clinical interview assessing dependency in activities of daily living (ADL). We also examined the performance of the generic Barthel ADL index. In addition, we determined whether alternative cut-offs improved the utility of these tools.Results.Compared to clinical interview as gold standard, HY stage > 3 had 21% sensitivity and 98% specificity in detecting dependency in ADL. Corresponding figures for SE score < 80% were 55% and 92%, respectively. Using alternative cut-off values improved the overall diagnostic accuracy only slightly. Barthel ADL index had 67% sensitivity and 78% specificity in detecting dependency at its optimal cut-off value.Conclusion.Both the disease-specific HY staging and SE scale and the generic Barthel ADL index are suboptimal tools for assessing independence loss in PD. Clinical interview should be the assessment of choice in studies of dependency.