Development of a core outcome set for cutaneous squamous cell carcinoma trials: identification of core domains and outcomes

BACKGROUND

The lack of uniformity in the outcomes reported in clinical studies of the treatment of cutaneous squamous cell carcinoma (cSCC) complicates efforts to compare treatment effectiveness across trials.

OBJECTIVES

To develop a core outcome set (COS), a minimum set of agreed-upon outcomes to be measured in all clinical trials of a given disease or outcome, for the treatment of cSCC.

METHODS

One hundred and nine outcomes were identified via a systematic literature review and interviews with 28 stakeholders. After consolidation of this long list, 55 candidate outcomes were rated by 19 physician and 10 patient stakeholders, in two rounds of Delphi exercises. Outcomes scored 'critically important' (score of 7, 8 or 9) by ≥ 70% of patients and ≥ 70% of physicians were provisionally included. At the consensus meeting, after discussion and voting of 44 international experts and patients, the provisional list was reduced to a final core set, for which consensus was achieved among all meeting participants.

RESULTS

A core set of seven outcomes was finalized at the consensus meeting: (i) serious or persistent adverse events, (ii) patient-reported quality of life, (iii) complete response, (iv) partial response, (v) recurrence-free survival, (vi) progression-free survival and (vii) disease-specific survival.

CONCLUSIONS

In order to increase the comparability of results across trials and to reduce selective reporting bias, cSCC researchers should consider reporting these core outcomes. Further work needs to be performed to identify the measures that should be reported for each of these outcomes.

A comparative evaluation of pulmonary artery balloon counterpulsation and a centrifugal flow pump in an experimental model of right ventricular infarction

To compare the efficiency of pulmonary artery balloon counterpulsation and a centrifugal flow pump in reversing the hemodynamic consequences of acute right-sided heart failure, we employed both devices in 14 Yorkshire pigs in which right ventricular infarction was created via surgical ligation of branches of the right coronary artery. Pulmonary artery balloon counterpulsation improved some of the indicators of right heart failure, as manifested by significantly decreased right atrial pressure and increased mean systemic blood pressure. In contrast, the centrifugal flow pump consistently and significantly reversed all of the hemodynamic consequences of right ventricular infarction. In comparison to pulmonary artery balloon counterpulsation, the centrifugal flow pump resulted in lower right atrial pressures (p=0.020), lower mean pulmonary pressures (p less than 0.0001), increased left atrial pressures (p=0.026), increased cardiac output (p less than 0.0001), and increased mean systemic blood pressures (p less than 0.0001). Possible mechanisms to explain the superiority of the centrifugal flow pump include better hemodynamic unloading of the failing myocardium and independence from right ventricular output.

Projective drawings of brain-injured subjects

The House-Tree-Person drawings of 90 Ss were evaluated with respect to diagnosed brain injury. Seven objective items such as window drawn on house edge and relative size of door were selected and weighted to give a scale of 22 points. This scale then yielded a mean score of 6.0 for 30 brain-injured Ss, 2.8 for Ss with various forms of physical disability, and 1.6 for 30 University of Washington students. The differences among these means were significant beyond the .001 level. A mean score of 4.8, obtained for a cross-validation group of an additional 10 brain-injured Ss, was significantly higher than the means for the control groups but not significantly different from the mean for the first brain-injured group. The relationship of diagnosed brain injury to Circular Pencil Maze scores and WAIS subtest scores on Digit Span, Vocabulary, and Block Design, as well as MMPI T scores on the schizophrenic scale were also investigated. Three illustrative cases showed that quality of drawing and “intelligence” were not major factors in the H-T-P scores for brain-injury.