The continual reassessment method (CRM) enables full and efficient use of all data and prior information available in a phase I study. However, despite a number of recent enhancements to the method, its acceptance in ...
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The continual reassessment method (CRM) enables full and efficient use of all data and prior information available in a phase I study. However, despite a number of recent enhancements to the method, its acceptance in actual clinical practice has been hampered by several practical difficulties. In this paper, we consider several further refinements in the context of phase I oncology trials. In particular, we allow the trial to stop when the width of the posterior 95 per cent probability interval for the maximum tolerated dose (MTD) becomes sufficiently narrow (that is, when the information accumulating from the trial data reaches a prespecified level). We employ a simulation study to evaluate five such stopping rules under three alternative states of prior knowledge regarding the MTD (accurate, too low and too high). Our results suggest our adaptive designs preserve the CRM's estimation ability while offering the possibility of earlier stopping of the trial. (C) 1999 John Wiley & Sons, Ltd.
In 1995 the Department of Health recommended a minimum standard of five non-surgical oncology sessions per week at Cancer Units. Postal surveys of cancer units in England were conducted in 1996 and 1999 to establish t...
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In 1995 the Department of Health recommended a minimum standard of five non-surgical oncology sessions per week at Cancer Units. Postal surveys of cancer units in England were conducted in 1996 and 1999 to establish the level of provision. Substantial progress has been made from 20-60% of responding units meeting the minimum standard. (C) 2000 Cancer Research Campaign.
Objectives. We sought to determine whether there have been any significant changes in professional satisfaction among gynecologic oncologists over the past 30 years. Methods. We mailed surveys to all U.S. gynecologic ...
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Objectives. We sought to determine whether there have been any significant changes in professional satisfaction among gynecologic oncologists over the past 30 years. Methods. We mailed surveys to all U.S. gynecologic oncologists belonging to the Society of Gynecologic Oncologists to compile data on demographics, training, motivating factors, overall professional satisfaction, and the effect of managed care. We compared these factors among oncologists who completed training in different years and among different demographic groups. We used calculated confidence intervals to determine statistical significance. Results. We surveyed 767 gynecologic oncologists and received 344 evaluable responses, representing 47% of the total eligible, Results show that neither the factor rated most important in looking for a first job nor the factor rated most important in giving job satisfaction once in a job has changed significantly among gynecologic oncologists over time. In addition, the importance placed on salary has not varied across the fellowship graduate classes, although within each class salary increased in importance from the first job to the current job, Our analysis shows that while male and female gynecologic oncologists are similar in their job satisfaction and practice patterns, men report being sued twice as often as women, and men tend to stay in their first jobs significantly longer than women. We also compare the surveyed academic gynecologic oncologists to the private gynecologic oncologists and show that while overall job satisfaction is similar, their ratings of the factors that provide job satisfaction do differ significantly. Our data show that managed care penetration has increased over time among gynecologic oncology practices and that gynecologic oncologists' job satisfaction ratings tend to decrease with the increase in managed care penetration, although not reaching statistical significance. Conclusions. Our results show that changes in practice styles
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