Background: Conjoint Analysis (CA) can serve as an important tool to study health disparities and unique factors underlying decision-making in diverse subgroups. However, methodological advancements are needed in exploiting this application of CA. We compared the internal and external predictive validity and inter-temporal stability of Choice-based-Conjoint (CBC) analysis between African-Americans and Whites in the clinical context of preferences for analgesic treatment for cancer pain. Methods: We conducted a prospective study with repeated-measures at two time-points (T1 = baseline; T2 = 3-months). African-Americans (n = 102); and Whites (n = 139) with cancer-related pain were recruited from outpatient oncology clinics in Philadelphia. Informed by pilot work, a computer-assisted CBC experiment was developed using 5 attributes of analgesic treatment: type of analgesic; expected pain relief; type of side-effects; severity of side-effects; and out-of-pocket cost. The design included 2 choice alternatives, 12 random tasks, 2 holdout tasks, and maximum of 6 levels per attribute. The internal and external predictive validity of CBC was estimated using Root Likelihood (RLH) and Mean Absolute Error (MAE), respectively. Inter-temporal stability was assessed using Cohen's kappa. Results: Whites predominantly traded based on "pain relief" whereas African-Americans traded based on "type of side-effects". At both time-points, the internal validity (RLH) was slightly higher for Whites than for AfricanAmericans. The RLH for African-Americans improved at T2, possibly due to the learning effect. Lexicographic (dominant) behavior was observed in 29% of choice datasets; Whites were more likely than African-Americans to engage in a lexicographic behavior (60% vs. 40%). External validity (MAE) was slightly better for African-Americans than for Whites at both time-points (MAE: T1 = 3.04% for African-Americans and 4.02% for Whites; T2 = 8.04% for African-Americans; 10.24% for Whites). At T2, the MAE increased for both groups possibly reflecting an increase in the complexity of pain treatment decision-making based on expectations (T1) as opposed to reality (T2). The intertemporal stability was fair for CBC attributes between T1 and T2 (kappa = 0.28, 95% CI: 0.24-0.32) and was not predicted by demographics including race.
Objectives: Evaluate how learning progression affects outcomes for the use of sialendoscopy for sialolithiasis. Methods: A retrospective chart review was conducted on 79 patients presenting with sialolithiasis between 2008 and 2012 who underwent sialendoscopy on 86 salivary glands at a tertiary medical center. Outcomes compared between the first 43 cases (40 patients) and second 43 cases (39 patients) included successful removal, surgical method, and any further need for intervention. Results: For the first 40 patients (group A), the mean age was 50.6 years (range, 21-87), and 55.8% were male. For the second 39 patients (group B), the mean age was 50.8 (range, 15-77), and 46.5% were male. Sialolithiasis was diagnosed based on physical exam or imaging. Mean stone size was similar in both groups: 8 versus 8.6mm, respectively. Where a stone was visualized, complete removal was accomplished in 88.6% of cases in group A versus 97.4% in Group B. Endoscopic removal occurred in 20.0% of the patients in group A, versus 35.9% in group B. A combined approach was used in 45.7% in group A versus 64.1% in group B. 34.3% in group A required gland removal versus 0.0% in group B ( P = 0.005). Seventeen point nine percent of patients in group A needed further intervention (medical or surgical) versus 9.3% in group B. Conclusions: This study documents a clear learning curve for sialendoscopy for the management of sialolithiasis. With experience, the success of sialendoscopy increases, and there is a significant decrease in the number of gland excisions.
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