1,720,987 research outputs found
Inequality in outcome for oesophago-gastric cancer in England : is there an association with gastroscopy rates in general practice populations?
No full textIntroduction: Oesophago-gastric (OG) cancers remain a worldwide challenge with little sign of major improvements in survival rates. Modern guidelines focus on alarm (or ‘red flag’) symptoms as key triggers for gastroscopy and recommend empirical symptomatic treatment and non-invasive H. pylori testing in those with simple dyspepsia. However, the early symptoms of OG cancer are very common and non-specific, and the traditional alarm symptoms have poor sensitivity or specificity for malignancy. Diagnosis therefore necessitates investigation of symptoms though upper GI endoscopy in a relatively large group of patients, most of whom do not have malignant disease. This has fuelled considerable controversy regarding the role for gastroscopy in detecting cancer at a treatable stage.
Objectives: Firstly, to develop data extraction and linkage methods for studying OG cancer outcome, and General Practice population rates of elective diagnostic gastroscopy, using administrative data for English hospitals (Hospital Episode Statistics). Secondly, to confirm the face-validity of the methodology using external sources of information and local audit data. Thirdly, to test the hypothesis that variations in rates of gastroscopy in English General Practice (GP) populations are associated with inequalities in OG cancer outcome. Fourthly, to explore whether practices with lower rates of gastroscopy exhibit a higher yield of serious pathology, consistent with more selective referral practice. Fifthly, to confirm the existence of wide variation in gastroscopy rate between practices in close geographical proximity,
Design and methods: Analysis of Hospital Episode Statistics (2006-8) linked to death registry and practice population data. General practices with new cases of OG cancer were included, grouped into tertiles according to standardised elective gastroscopy rate per capita (low, medium or high). Outcome measures for cancer cases were: emergency admission during diagnostic pathway; major surgical resection and mortality at 1 year. Co-variates were age, gender, co-morbidity, and deprivation. Associations between the gastroscopy rate at the patient’s general practice and cancer outcomes were tested in binary logistic regression models, with extensive sensitivity testing of gastroscopy rate ‘exposure’ variable. An algorithm was developed to analyse coded diagnoses for all first elective gastroscopies, using both national and local audit data. Practices were mapped based on postal code.
Results: 22,488 incident cases of OG cancer from 6,513 general practices. Mean OGD rate for Low, Middle, High practices: 4.4 vs 8.1 vs 12.9 per 1,000. Mean age of patients undergoing OGD was highest for low tertile practices (60.2 vs 59.5 vs 58.4 yrs;
The IBD Control Questionnaire : the development and psychometric validation of a questionnaire for measuring inflammatory bowel disease control from the patient's perspective
Full text linkIntroduction: The importance of patient reported outcome measures (PROMs) is increasingly recognised. However, their use in inflammatory bowel disease (IBD) care is not widespread. The aim of this research was to develop and validate a PROM for use in day to day clinical practice. Methods: (1) Questionnaire development: Questionnaire specification was determined by a multidisciplinary steering group. Literature review of existing PROMs was undertaken. Focus groups meetings and one-to-one patient interviews were performed. Participants were asked to discuss the concept of 'control' of their IBD. Thematic analysis of field notes and transcribed quotes was performed. A draft questionnaire was designed and a pilot study of 30 patients was undertaken. (2) Prospective validation of the IBD Control Questionnaire: Patients completed the IBD-Control Questionnaire and the following established measures: a quality of life questionnaire (UK-IBD-Q), EuroQol (EQ-5D) and the Hospital Anxiety and Depression Score. Disease activity indices were recorded (Harvey-Bradshaw Index or Simple Clinical Colitis Activity Index). A global physician assessment (blinded to questionnaire score) was also performed. Data were recorded at ... (continues
Analysis of routine hospital administrative data (including hospital episode statistics) to assess variation in process and outcomes in gastroenterology
No full textBackground and Aims
To explore outcomes following gastrointestinal endoscopy using a clinical dataset and then routinely collected administrative data linked to death registry data. Predictors of outcome were studied and variations in crude mortality were analysed.
Methods
Endoscopy cases from a single tertiary centre were identified retrospectively using a clinical endoscopy database. Sedation levels, type of procedure and demographic data were analysed. Adverse events following the procedures, including mortality were assessed before and after changes in sedation practice were introduced.
For subsequent chapters national administrative data in the form of Hospital Episode Statistics (HES) were linked to the Office of National Statistics Death Registry. Data from 2006 – 2008 were analysed. Episodes of care containing codes for therapeutic endoscopic procedures were extracted (Endoscopic retrograde cholangio-pancreatography (ERCP) and percutaneous endoscopic gastrostomy (PEG)). Finally, episodes of care containing new stroke diagnoses were extracted to analyse the use of percutaneous gastrostomies in the stroke population in England. Factors associated with death following endoscopy were identified. Crude and case-mix adjusted mortality were analysed at institutional level.
Results
7,234 endoscopy cases were identified from the endoscopy clinical database. Following changes in sedation practice 7,071 cases were assessed. Significant reductions in sedation doses were achieved but mortality rates did not fall (0.7% in 2004 and 0.8% in 2006 (p=0.5)).
40,938 episodes of care containing ERCP procedures were identified within the HES data. Logistic regression analysis confirmed age, sex, cancer, emergency admission, and non-cancer co-morbidity as independent predictors of 30-day death after ERCP. Adjusted odds ratios for age were 6.2 for ≥85 yrs vs
Going Beyond Counting First Authors in Author Co-citation Analysis
Full text linkThe 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
Variations on the Author
Full text link“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
Full text linkWe 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
Cost-effectiveness modelling for benefit-risk assessment
Full text linkIntroduction and aims: Benefit-risk assessment is important for summarising the effectiveness and safety profile of an intervention. Current methods for benefit-risk assessment are based upon flawed clinical trial data. For biosimilars, regulatory approval is given on the basis of extrapolated evidence assessed in qualitative benefit-risk frameworks, leading to uncertainties. This thesis aimed to investigate methods for assessing the benefit-risk balance of therapies, including identifying harms data and developing a quantitative framework for assessing whether the cost savings of biosimilars justify the increased uncertainties regarding efficacy and safety. Methods: This thesis reports a novel systematic review of the efficacy and harm outcomes reported in Crohn's disease (CD) randomised clinical trials (RCTs) to 2015. Extracted outcomes and adverse events data were categorised and the results benchmarked against a core outcome set (COS) for inflammatory bowel disease and the commonly used outcome measurement tools in CD RCTs. Summaries of Product Characteristics (SPCs) were investigated as a source of harms data with the use of standardised MedDRA (Medical Dictionary for Regulatory Activities) queries (SMQs). ... (continues
Dispelling the Myths Behind First-author Citation Counts
Full text linkWe 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
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