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Differences in Healthcare Expenditure, Health-Related Quality of Life, Perceived Quality, Medication Access, and Provider Respect Between Opioid and Non-Opioid Users Among a National Sample of Community-Based Older United States Adults with Pain, 2015
No full textIntroduction: Increasing numbers of older adults, coupled with increasing use of opioids and opioid-related deaths, presents considerable healthcare challenges in the United States (US). This study compared the healthcare expenditure, health-related quality of life (HRQoL), perceived healthcare quality, access to medications, and perceived respect shown by provider between older US adults (≥50 years) with pain who use opioid medications and those who do not use opioid medications.
Methods: This study employed a retrospective, cross-sectional database design using Medical Expenditure Panel Survey (MEPS) data from 2015. Eligible participants were those alive for the calendar year, aged 50 years or older, and reported having chronic pain in the past four weeks. The key independent variable was opioid use status (opioid users were defined as those who had a Multum Lexicon therapeutic class code of 60 or 191; the remainder was deemed non-opioid users). Hierarchical linear regression models were constructed to assess healthcare expenditures (inpatient, outpatient, office-based, emergency room, prescription medications, other, and total), HRQoL (short form 12 version 2 physical component summary [SF-12v2-PCS], short form 12 version 2 mental component summary [SF-12v2-MCS], and Kessler 6 [K6] scores), and perceived quality between opioid users and non-opioid users, adjusting for appropriate covariates. Hierarchical logistic regression models were constructed to assess access to medications (unable to receive prescription medications, delayed receiving prescription medications) and perceived respect shown by provider between opioid users and non-opioid users, adjusting for appropriate covariates. National estimates were obtained by adjusting for the complex survey design of MEPS. An alpha level of 0.05 was set a priori for all analyses. All analyses were conducted using SAS version 9.4. This study was deemed exempt from the human subject protection program.
Results: The study cohort consisted of 4,759 subjects - 1,525 opioid users and 3,234 non-opioid users. The weighted total number of non-institutionalized adults alive aged 50 or older with pain in the US in the year 2015 was 50,898,592 - 16,757,516 (32.9%) were opioid users and 34,141,076 (67.1%) were non-opioid users. Opioid use was associated with all personal characteristics (p0.05).
Conclusions: This study estimated that the number of older US adults (≥50 years) with pain in 2015 was approximately 51 million, and that the estimated prevalence of opioid use among older US adults (≥50 years) with pain in 2015 was approximately 17 million. Opioid use was associated with all personal characteristics, except gender and race. Adjusted healthcare expenditures were greater among opioid users compared to non-opioid users for all categories of expenditure, except inpatient expenditures. Adjusted perceived healthcare quality measures and perceived respect shown by healthcare provider measures were greater among opioid users compared to non-opioid users. Adjusted health-related quality of life measures and access to prescription medication measures were not associated with opioid use status. Future research is warranted to investigate reasons why some of these findings exist, and to explore these variables in greater depth, over longer periods of time, and in additional populations
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Development and Validation of a Tool to Calculate an Exposure Score for All Pain Self-Management Strategies Used By Individuals with Chronic Pain
No full textObjectives: To develop a tool to calculate the exposure scores for all pain self-management strategies used by individuals with chronic pain, and to test the validity of the tool by assessing associations between exposure and pain outcomes using regression. Methods: Survey data of pharmacists’ pain self-management strategies were used to calculate the exposure score. One point was assigned for every: 100mg of morphine used (opioid medications); 25% of the maximum recommended dose used (non-opioid medications); and any use of another strategy. Points were summed to calculate each individual’s exposure. Regressions assessed associations between exposure and pain outcomes. Results: Data for 149 individuals with chronic pain were included in the study. Individuals with chronic pain used a mean of 12.7 (SD=4.7) strategies to manage their pain, and had a mean exposure score of 16.8 (SD=9.1). Exposure score was positively associated in the multivariate models with the self-reported pain outcomes: adverse events experienced due to pain; workdays lost in the last six months due to pain; and pain interference on relationships (p<0.05). Conclusions: This validity study showed positive associations between the exposure score calculated by our tool, and adverse events experienced due to pain, workdays lost in the last six months due to pain, and pain interference with relationships. The personalized exposure profile produced by the tool may assist patients and providers when determining the most appropriate pain self-management strategies to use.Release after 14-Dec-201
Going Beyond Counting First Authors in Author Co-citation Analysis
Get PDFThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
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Role of Systemic Therapy for Advanced/Metastatic Gastric Carcinoma in the First-line Setting
No full textIntroduction: Globally, gastric cancer is sixth most common cancer and ranks third in mortality, with a 5-year survival rate of 32% for advanced/metastatic gastric cancer (A/MGC). Systemic therapy is often the preferred treatment for A/MGC since it offers survival benefits. Exploration of immunotherapies and/or targeted agents in A/MGC offer more treatment combinations than standard systemic chemotherapies. Nivolumab, an immune checkpoint inhibitor was approved by United States (US) Food and Drug as a first-line systemic therapy for A/MGC. The purpose of this study is to: to summarize the clinical, safety, and humanistic outcomes of first-line systemic chemotherapy for adult patients with locally A/MGC; quantitatively synthesize outcomes data from identified studies using network meta-analysis (NMA) and, to evaluate cost-effectiveness of nivolumab-chemotherapy combination versus chemotherapy alone as first-line therapy from a US payer perspective.
Methods: Systematic literature review was performed in PubMed, Embase, Web of Science, Cochrane Central Register of Controlled Trials, and the American Society of Clinical Oncology meeting library using an English language restriction from inception to March 2022. Specifically, phase II and III randomized control trials (RCTs) conducted among western population diagnosed with metastatic phase III and IV stages of gastric cancer were included if they assessed comparative efficacy, safety, or humanistic outcomes of systemic therapies. Two investigators independently reviewed the studies, conducted data extraction, and assessed risk of bias in accordance with PRISMA guidelines. For the quantitative network meta-analysis, inclusion criteria were trials conducted in western populations and published before March 2022. NMA included regimens recommended in 2022 National Comprehensive Cancer Network guidelines. Overall survival (OS), objective response rate (ORR), progression-free survival (PFS), and treatment-related adverse events (AEs) were captured. Comparative effectiveness results of both direct and indirect evidence were summarized in the network structures using hazard ratios (HR) and odds ratios (OR). P-scores were used to rank treatments. NMA was conducted using R software netmeta package (version 4.2.0). Economic evaluation was conducted in Microsoft Excel® using a partitioned survival model with the CheckMate-649 trial data. Three discrete mutually exclusive health states were included in model; progression-free, post-progression and death. This reflected the disease course of the CheckMate-649 patients. Outcomes were measured as quality-adjusted life-years (QALYs) and incremental cost-effectiveness ratio (ICER). Deterministic and probabilistic sensitivity analyses (D/PSA) assessed the uncertainty of the model parameters.
Results: A total of 24 RCTs of 8,705 patients were included in the SR. Across active treatment arms, median overall survival ranged from 5.0 to 13.1 months, median progression-free survival from 2.0 to 7.7 months and objective response from 13.0% to 64.1%. Two studies reported higher quality of life outcomes and grade 3/4 AEs were reported in most included studies. In the NMA, 13 studies were included for the analysis and nivolumab-chemotherapy was associated with significantly better OS (HR=0.71, 95% confidence interval [CI]=0.59-0.86) and PFS (HR=0.68, 95%=CI 0.57-0.82) than 5-fluorouracil-oxaliplatin. Nivolumab-chemotherapy had the highest probability of being best treatment among all included regimens for improvement in overall survival (OS) (P-score=0.948) and progression-free survival (PFS) (P-score=0.969) outcomes. No heterogeneity and inconsistencies were observed. Cost-effectiveness analysis showed that nivolumab-chemotherapy provided an additional 0.25 life years compared to chemotherapy alone. The QALYs were 0.701 and 0.561 for nivolumab-chemotherapy and chemotherapy respectively, producing a gain of 0.140 QALYs and an ICER of US150,000/QALY. Future research should re-evaluate this model outputs and ICERs using long-term follow-up data from real-world settings.Release after 08/05/202
Variations on the Author
Get PDF“Variations on the Author” discusses two of Eduardo Coutinho’s recent films (Um Dia na Vida, from 2010, and Últimas Conversas, posthumously released in 2015) and their contribution to the general question of documentary authorship. The director’s filmography is characterized by a consistent yet self-effacing form of authorial self-inscription: Coutinho often features as an interviewer that rather than express opinions propels discourses; an interviewer that is good at listening. This mode of self-inscription characterizes him as an author who is not expressive but who is nonetheless markedly present on the screen. In Um Dia na Vida, however, Coutinho is completely absent form the image, while Últimas Conversas, on the contrary, includes a confessional prologue that moves the director from the margins to the center of his films. This article examines the ways in which these works stand out in the filmography of a director who offers new insights into the notion of cinematic authorship
Appropriate Similarity Measures for Author Cocitation Analysis
Get PDFWe provide a number of new insights into the methodological discussion about author cocitation analysis. We first argue that the use of the Pearson correlation for measuring the similarity between authors’ cocitation profiles is not very satisfactory. We then discuss what kind of similarity measures may be used as an alternative to the Pearson correlation. We consider three similarity measures in particular. One is the well-known cosine. The other two similarity measures have not been used before in the bibliometric literature. Finally, we show by means of an example that our findings have a high practical relevance.information science;Pearson correlation;cosine;similarity measure;author cocitation analysis
Dispelling the Myths Behind First-author Citation Counts
Get PDFWe conducted a full-scale evaluative citation analysis study of scholars in the XML research field to explore just how different from each other author rankings resulting from different citation counting methods actually are, and to demonstrate the capability of emerging data and tools on the Web in supporting more realistic citation counting methods. Our results contest some common arguments for the continued
use of first-author citation counts in the evaluation of scholars, such as high correlations between author rankings by first-author citation counts and other citation
counting methods, and high costs of using more realistic citation counting methods that are not well-supported by the ISI databases. It is argued that increasingly available digital full text research papers make it possible for citation analysis studies to go beyond what the ISI databases have directly supported and to employ more
sophisticated methods
koamabayili/VECTRON-author-checklist: VECTRON author checklist
No full textWe have done our best to complete the author checklist relating to the use of animals in the hut study. Note that the objective for the hut study was to evaluate the IRS treatment applications for residual efficacy against Anopheles mosquitoes, including the local An. coluzzii mosquito population. Cows were only used to attract mosquitoes into the huts and no tests were carried out directly on the cows. The author checklist is intended for use with studies where experiments are carried out on animals, which is why we have had such difficulty in completing this for the hut study, as many of the questions do not relate to how the cows were used
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