ABSTRACT
Esophageal adenocarcinoma has poor 5-year survival rates. Increased survival might be achieved with earlier treatment, but requires earlier identification of the precursor, Barrett's esophagus. Population screening is not cost effective, this may be improved by targeted screening directed at individuals more likely to have Barrett's esophagus. To develop a risk prediction tool for Barrett's esophagus, this study compared individuals with Barrett's esophagus against population controls. Participants completed a questionnaire comprising 35 questions addressing medical history, symptom history, lifestyle factors, anthropomorphic measures, and demographic details. Statistical analysis addressed differences between cases and controls, and entailed initial variable selection, checking of model assumptions, and establishing calibration and discrimination. The area under the curve (AUC) was used to assess overall accuracy. One hundred and twenty individuals with Barrett's esophagus and 235 population controls completed the questionnaire. Significant differences were identified for age, gender, reflux history, family reflux history, history of hypertension, alcoholic drinks per week, and body mass index. These were used to develop a risk prediction model. The AUC was 0.82 (95% CI 0.78-0.87). Good calibration between predicted and observed risk was noted (Hosmer-Lemeshow test P = 0.67). At the point minimizing false positives and false negatives, the model achieved a sensitivity of 84.96% and a specificity of 66%. A well-calibrated risk prediction model with good discrimination has been developed to identify patients with Barrett's esophagus. The model needs to be externally validated before consideration for clinical practice.
Subject(s)
Barrett Esophagus/diagnosis , Decision Support Techniques , Medical History Taking/statistics & numerical data , Risk Assessment/statistics & numerical data , Symptom Assessment/statistics & numerical data , Adenocarcinoma/etiology , Adult , Aged , Area Under Curve , Australia , Barrett Esophagus/etiology , Calibration , Case-Control Studies , Esophageal Neoplasms/etiology , Female , Gastroesophageal Reflux/complications , Humans , Logistic Models , Male , Middle Aged , Risk Assessment/methods , Risk Factors , Surveys and Questionnaires , Symptom Assessment/methodsABSTRACT
BACKGROUND: Men's experience of recovery from treatment for prostate cancer has been extensively researched with reports highlighting the physical side effects of treatments such as erectile dysfunction and incontinence. The psychological, emotional and spiritual burden of prostate cancer on men and their partners has received far less attention. DESIGN: In this study, a secondary thematic analysis of data from a series of separate but related qualitative studies with prostate cancer survivors and their partners was conducted to further explore themes of love, hope and faith within this population. RESULTS: This study identified unresolved needs related to the emotive concepts of love, hope and faith. The findings from this study can be employed to refine psychosocial assessments of men with prostate cancer, and provide a more comprehensive understanding of prostate cancer survivors supportive care needs.
Subject(s)
Hope , Prostatic Neoplasms/nursing , Prostatic Neoplasms/psychology , Sexual Partners/psychology , Social Support , Stress, Psychological/nursing , Survivors/psychology , Adaptation, Psychological , Aged , Aged, 80 and over , Australia , Female , Humans , Male , Middle Aged , Qualitative Research , Quality of LifeABSTRACT
Assessment guidelines for nurses on the subject of eating disorders (EDs) focus primarily on evaluating the severity and progress of the problem for females who have already received a formal ED diagnosis. We argue that, because there is scant research into men with eating disorders and men strive to conceal this health problem, nurses should be equipped with information that will support earlier detection of EDs among men and boys before they manifest as a serious health problem. We advocate the use of epidemiological data to identify groups of men most at risk and the use of qualitative interview data as a means of grounding the nurse on the issues these men face when seeking to modify their body image.
