Joaquim Gonçalves

A decision support system for quality of life in head and neck oncology patients

BackgroundThe assessment of Quality of Life (QoL) is a Medical goal; it is used in clinical research, medical practice, health-related economic studies and in planning health management measures and strategies. The objective of this project is to develop an informational platform to achieve a patient self-assessment with standardized QoL measuring instruments, through friendly software, easy for the user to adapt, which should aid the study of QoL, by promoting the creation of databases and accelerating its statistical treatment and yet generating subsequent useful results in graphical format for the physician analyzes in an appointment immediately after the answers collection.MethodsFirst, a software platform was designed and developed in an action-research process with patients, physicians and nurses. The computerized patient self-assessment with standardized QoL measuring instruments was compared with traditional one, to verify if its use did not influence the patients answers. For that, the Wilcoxon and t-Student tests were applied. After, we adopted and adapted the mathematic Rash model to make possible the use of QoL measure in the routine appointments.ResultsThe results show that the computerized patient self-assessment does not influence the patients answers and can be used as a suitable tool in the routine appointment, because indicates problems which are more difficult to identify in a traditional appointment, improving thus the physicians decisions.ConclusionsThe possibility of representing graphically useful results that physician needs to analyze in the appointment, immediately after the answer collection, in an useful time, makes this QoL assessment platform a diagnosis instrument ready to be used routinely in clinical practice.

Geriatric oncology: comparing health related quality of life in head and neck cancer patients.

BackgroundPopulation ageing is increasing the number of people annually diagnosed with cancer worldwide, once most types of tumours are age-dependent. High-quality healthcare in geriatric oncology requires a multimodal approach and should take into account stratified patient outcomes based on factors other than chronological age in order to develop interventions able to optimize oncology care.This study aims to evaluate the Health Related Quality of Life in head and neck cancer patients and compare the scores in geriatric and younger patients.MethodsTwo hundred and eighty nine head and neck cancer patients from the Oncology Portuguese Institute participated in the Health Related Quality of Life assessment. Two patient groups were considered: the geriatric (≥ 65 years old, n = 115) and the younger (45-60 years old, n= 174). The EORTC QLQ-C30 and EORTC QLQ-H&N35 questionnaires were used.ResultsHead and neck cancer patients were mostly males, 77.4% within geriatric group and 91.4% among younger patients group.The most frequent tumour locations were similar in both groups: larynx, oral cavity and oropharynx - base of the tongue.At the time of diagnosis, most of younger male patients were at disease stage III/IV (55.9%) whereas the majority of younger female patients were at disease stage I/II (83.4%). The geriatric patient distribution was found to be similar in any of the four disease stages and no gender differences were observed.We found that age (geriatrics scored generally worse), gender (females scored generally worse), and tumour site (larynx tumours denounce more significant problems between age groups) clearly influences Health Related Quality of Life perceptions.ConclusionsGeriatric oncology assessments signalize age-independent indicators that might guide oncologic geriatric care optimization. Decision-making in geriatric oncology must be based on tumour characteristics and chronological age but also on performance status evaluation, co-morbidity, and patient reported outcomes assessment.

Patient reported outcomes in head and neck cancer: selecting instruments for quality of life integration in clinical protocols

BackgroundHealth Related Quality of Life has been used in medical research for more than twenty years, being progressively accepted during the last decade as an important patient reported outcome. Considering the multidimensional approach involved in Health Related Quality of Life assessment, instrument applicability and cultural adaptation must be tested for each population. In order to select the most appropriate instrument for Head and Neck cancer patients, two major Health Related Quality of Life specific questionnaires for Head and Neck cancer patients were compared. Conceptual differences, psychometric characteristics, scores, reliability, construct validity and sensitivity to symptomatology, tumour location, tumour size were analyzed.Methods102 consecutive Head and Neck cancer patients completed two different Health Related Quality of Life questionnaires: EORTC QLQ-C30 and its specific head and neck module QLQ-H&N35 and the Functional Assessment of Cancer Therapy Scales (FACT-H&N). Patients completed the questionnaires, immediately before consultation as a part of the routine evaluation.ResultsA greater variability was always found in the EORTC QLC-C30 questionnaires scores for all comparable domains. Both instruments revealed a good internal consistency and demonstrated to be good tools to distinguish symptomatic patients. The EORTC questionnaires still demonstrated sensitivity to distinguish T3 and T4 staging. Conceptual differences and the psychometric characteristics are discussed. Our results suggest that these two instruments assess different aspects of Health Related Quality of Life - the questionnaires should be used separately and chosen according to the study objectives and methodology.ConclusionsThis study emphases the importance in selecting the appropriate tool as a critical success factor in implementing routine Health Related Quality of Life assessment in clinical practice. This decision assumes particularly importance when utilization of results in real time and integration into clinical protocols are considered.

Towards a model for the measurement of data quality in websites

Websites are, nowadays, the face of institutions, but they are often neglected, especially when it comes to contents. In the present paper, we put forth an investigation work whose final goal is the development of a model for the measurement of data quality in institutional websites for health units. To that end, we have carried out a bibliographic review of the available approaches for the evaluation of website content quality, in order to identify the most recurrent dimensions and the attributes, and we are currently carrying out a Delphi Method process, presently in its second stage, with the purpose of reaching an adequate set of attributes for the measurement of content quality.

A model for the evaluation of data quality in health unit websites

This article presents a research work, the goal of which was to achieve a model for the evaluation of data quality in institutional websites of health units in a broad and balanced way. We have carried out a literature review of the available approaches for the evaluation of website content quality, in order to identify the most recurrent dimensions and attributes, and we have also carried out a Delphi method process with experts in order to reach an adequate set of attributes and their respective weights for the measurement of content quality. The results obtained revealed a high level of consensus among the experts who participated in the Delphi process. In addition, the different statistical analysis and techniques implemented are robust and attach confidence to our results and consequent model obtained.

A platform to study the quality of life in oncology patients

The perception that an individual holds about his place in life, which depends upon his culture and values, defines this individual|s quality of life (QoL). When applied in a health context, this is known as: health-related quality of life (HRQoL). The assessment of HRQoL is a medical goal; it is used in clinical research, medical practice, health-related economic studies and in planning health management measures and strategies. Obtaining a patient self-assessment with QoL measuring instruments on the platform developed in this project, through friendly software, easy for the user to adapt to, aids the study, promotes the creation of databases, and accelerates its statistical treatment. The possibility of graphically representing results that physician needs to analyse, immediately after the answer collection, makes this assessment a diagnosis instrument ready to be used routinely in clinical practice.

Data mining and electronic devices applied to quality of life related to health data

The development of new technologies, information systems, decision support systems and clinical parameters prediction algorithms using machine learning and data mining opens a new perspective in many area of health. In this context, relevance presents the concept of Quality of Life (QOL) in health and the possibility of developing Support Systems Clinical Decision (SADC) that use it. Through individual expectation of physical well-being, psychological, mental, emotional and spiritual patients, discussed variables and measures the quality of research area of life, we intend to make a study of data to establish correlations with laboratory, pharmaceutical data, socio-economic, among others, obtaining knowledge in terms of behavioral patterns of chronic patients, achieving a number of reliable data and easily accessible, capable of enhancing the decision-making process by the specialized medical teams, seeking to improve treatments and consequently the related quality of life with the Health chronically ill. This paper studied and compared related studies that develop systems for decision support and prediction in the clinical area, with emphasis on studies in the area of quality of life.

A Clinical Support System Based on Quality of Life Estimation

Quality of life is a concept influenced by social, economic, psychological, spiritual or medical state factors. More specifically, the perceived quality of an individual’s daily life is an assessment of their well-being or lack of it. In this context, information technologies may help on the management of services for healthcare of chronic patients such as estimating the patient quality of life and helping the medical staff to take appropriate measures to increase each patient quality of life. This paper describes a Quality of Life estimation system developed using information technologies and the application of data mining algorithms to access the information of clinical data of patients with cancer from Otorhinolaryngology and Head and Neck services of an oncology institution. The system was evaluated with a sample composed of 3013 patients. The results achieved show that there are variables that may be significant predictors for the Quality of Life of the patient: years of smoking (p value 0.049) and size of the tumor (p value < 0.001). In order to assign the variables to the classification of the quality of life the best accuracy was obtained by applying the John Platt’s sequential minimal optimization algorithm for training a support vector classifier. In conclusion data mining techniques allow having access to patients additional information helping the physicians to be able to know the quality of life and produce a well-informed clinical decision.

Mobile application for stress assessment

The use of information and communication technologies, mobile devices and wearable devices have had great growth in recent years. Chronic stress is a disease that affects millions of individuals and has a great growth with enormous economic and social impact. Prevention in this area of health is, increasingly, a fundamental aspect for the improvement of the quality of life of each one and the public health in general. The objective of the present study is to understand how stress can be continuously monitored, especially in individuals who perform occupations that present a high risk of stress, in order to predict and alert the occurrence of chronic or pathological stress and burnout situations. For this purpose a non-invasive measurement instrument will be developed for the individual using biometric signals, measured through a wearable device, collected in a mobile device and later sent to an information system that will handle this information. In the experiment carried out, a prototype of a mobile application was developed that synchronizes the data coming from smartbands directly linked to the individuals with smartphones, to continuously monitor the physical and quality of life related to the health of the person. Of course, data collection is only of importance if the data are analyzed with consequent production of results for the individual and health professionals. Some technologies normally used to elaborate a system of this magnitude will also be analyzed and, with the support of the health professionals and individuals for whom the evaluation is intended, various forms of feedback on stress levels will be evaluated in order to develop a set of Dashboards with information of stress, distinguishing the information destined to the professional of health of that made available to the own individual.

Towards an Evaluation Model for the Quality of Local Government Online Services: Preliminary Results

This paper sets forth the results obtained after applying a first round of the Delphi Method process towards the development of an evaluation model for the quality of local government online services. In this first round, we submitted a list of thirty quality dimensions divided amongst four domains to a group of fifty local e-government experts. The results obtained led us to exclude one dimension and assign a set of twenty two dimensions to their respective domains. Additionally, the results reveal a certain degree of hesitation as to the domain assigned to seven dimensions. Three new dimensions emerged.