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Lower-Extremity Soft-Tissue Sarcoma Functional Outcome and Quality of Life after Treatment
No full textBackground
Soft-tissue sarcomas (STS) represent approximately 1% of all solid malignancies in adults. More than 50% of STSs are localized in the extremities. The aim of extremity STS treatment is survival and limb salvage with the best possible quality of life (QoL) and functional outcome.
There has been increasing interest to report the health-related quality of life (HRQL) and functional outcome after treatment. Measures should be valid, reliable, accurate, and clinically meaningful for the population in question.
A few studies have focused on patient-related factors or assessment using multiple metrics in analyzing long-term functional outcome and HRQL in surgically treated lower-extremity STS patients.
Materials and methods
The dissertation is based on four papers that are focused on different aspects of functional outcome and HRQL in lower-extremity STS. The first paper was a pilot study in which the Toronto Extremity Salvage Score (TESS) and the Musculoskeletal Tumor Society (MSTS) score were translated to Finnish language according to accepted guidelines.
The second paper was a systematic literature review that was based on the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. Results on measurement types, measures, and time of measurement of functional outcome were compiled from the included studies. Validity of the used measures was reported.
The third paper was a cross-sectional validation study that was based on STS limb-salvage patients. Assessments of functional outcome and HRQL were performed using the TESS, the QLQ-C30 Function and QoL modules, the 15D, and the MSTS score. The TESS was repeated twice at a 2- to 4-week interval.
The fourth paper was a cross-sectional study in which functional outcome and HRQL analysis were performed using STS limb-salvage patients. The TESS, QLQ-C30, and 15D measures were used. Functional outcome and HRQL data were collected prospectively and other data retrospectively.
Results
Finnish versions of the TESS and the MSTS questionnaires were translated and culturally adapted. No problems or difficulties were reported by the patients in completing the Finnish versions of TESS or MSTS questionnaires.
The systematic literature review search found 3461 publications, of which 37 met the inclusion criteria. The measurement types used were clinician-reported outcomes (n=27), patient-reported outcomes (PRO) (n=20), and observer-reported outcomes (n=2). The most frequently used measures were the TESS (n=16) and the MSTS (1993) (n=12) scores. Three of the ten previously reported measures provided validated functional outcome scores.
The TESS questionnaire’s ceiling effect was noted, as 21% of the patients scored maximum points. The intraclass correlation coefficient between first and second administration of the TESS was very high (0.96). The results of exploratory factor analysis together with high Cronbach’s α (0.98) supported a unidimensional structure. The TESS correlated moderately with the MSTS score ( = 0.59, p < 0.001) and strongly with the mobility dimension in the 15D HRQL instrument ( = 0.76, p < 0.001) and physical function in QLQ-C30 ( = 0.83, p < 0.001).
A total of 141 patients undergoing limb-salvage surgery were included in the fourth study. Based on our sample, lower functional outcome was statistically significantly associated with older age, higher body mass index (BMI), and need for reconstructive surgery and radiotherapy. Lower HRQL was statistically significantly associated with older age, higher BMI, and reconstructive surgery.
Conclusion
Translation and cultural adaptation of questionnaires should be performed according to internationally accepted guidelines. The current thesis is the first to validate the TESS distinctly for lower-extremity STS patients. In addition, the thesis demonstrates that the TESS measure is valid and reliable in Finnish.
Based on the systematic review, several different methods exist for assessing functional outcome in patients with lower-extremity sarcoma. The most frequently used measure is a validated TESS. The postoperative functional outcome in patients with lower-extremity STSs seems to increase back to the preoperative baseline level during long-term follow-up evaluation. Post-treatment functional outcome of patients with lower-extremity STS is affected by BMI, age, and need for reconstructive surgery and radiotherapy. The most significant predictors affecting HRQL are BMI, age, and need for reconstructive surgery. Although tumor- and treatment-related factors had an impact, patient-related factors such as age and BMI were the most consistent and significant determinants of both functional outcome and HRQL.Background
Soft-tissue sarcomas (STS) represent approximately 1% of all solid malignancies in adults. More than 50% of STSs are localized in the extremities. The aim of extremity STS treatment is survival and limb salvage with the best possible quality of life (QoL) and functional outcome.
There has been increasing interest to report the health-related quality of life (HRQL) and functional outcome after treatment. Measures should be valid, reliable, accurate, and clinically meaningful for the population in question.
A few studies have focused on patient-related factors or assessment using multiple metrics in analyzing long-term functional outcome and HRQL in surgically treated lower-extremity STS patients.
Materials and methods
The dissertation is based on four papers that are focused on different aspects of functional outcome and HRQL in lower-extremity STS. The first paper was a pilot study in which the Toronto Extremity Salvage Score (TESS) and the Musculoskeletal Tumor Society (MSTS) score were translated to Finnish language according to accepted guidelines.
The second paper was a systematic literature review that was based on the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. Results on measurement types, measures, and time of measurement of functional outcome were compiled from the included studies. Validity of the used measures was reported.
The third paper was a cross-sectional validation study that was based on STS limb-salvage patients. Assessments of functional outcome and HRQL were performed using the TESS, the QLQ-C30 Function and QoL modules, the 15D, and the MSTS score. The TESS was repeated twice at a 2- to 4-week interval.
The fourth paper was a cross-sectional study in which functional outcome and HRQL analysis were performed using STS limb-salvage patients. The TESS, QLQ-C30, and 15D measures were used. Functional outcome and HRQL data were collected prospectively and other data retrospectively.
Results
Finnish versions of the TESS and the MSTS questionnaires were translated and culturally adapted. No problems or difficulties were reported by the patients in completing the Finnish versions of TESS or MSTS questionnaires.
The systematic literature review search found 3461 publications, of which 37 met the inclusion criteria. The measurement types used were clinician-reported outcomes (n=27), patient-reported outcomes (PRO) (n=20), and observer-reported outcomes (n=2). The most frequently used measures were the TESS (n=16) and the MSTS (1993) (n=12) scores. Three of the ten previously reported measures provided validated functional outcome scores.
The TESS questionnaire’s ceiling effect was noted, as 21% of the patients scored maximum points. The intraclass correlation coefficient between first and second administration of the TESS was very high (0.96). The results of exploratory factor analysis together with high Cronbach’s α (0.98) supported a unidimensional structure. The TESS correlated moderately with the MSTS score ( = 0.59, p < 0.001) and strongly with the mobility dimension in the 15D HRQL instrument ( = 0.76, p < 0.001) and physical function in QLQ-C30 ( = 0.83, p < 0.001).
A total of 141 patients undergoing limb-salvage surgery were included in the fourth study. Based on our sample, lower functional outcome was statistically significantly associated with older age, higher body mass index (BMI), and need for reconstructive surgery and radiotherapy. Lower HRQL was statistically significantly associated with older age, higher BMI, and reconstructive surgery.
Conclusion
Translation and cultural adaptation of questionnaires should be performed according to internationally accepted guidelines. The current thesis is the first to validate the TESS distinctly for lower-extremity STS patients. In addition, the thesis demonstrates that the TESS measure is valid and reliable in Finnish.
Based on the systematic review, several different methods exist for assessing functional outcome in patients with lower-extremity sarcoma. The most frequently used measure is a validated TESS. The postoperative functional outcome in patients with lower-extremity STSs seems to increase back to the preoperative baseline level during long-term follow-up evaluation. Post-treatment functional outcome of patients with lower-extremity STS is affected by BMI, age, and need for reconstructive surgery and radiotherapy. The most significant predictors affecting HRQL are BMI, age, and need for reconstructive surgery. Although tumor- and treatment-related factors had an impact, patient-related factors such as age and BMI were the most consistent and significant determinants of both functional outcome and HRQL.ei saavutettav
ASO Author Reflection : Demographic Conditions are the Major Determinants for Functional Outcome and Quality of Life in Lower Extremity Soft Tissue Sarcoma Patients
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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
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
Author-wise bibliometric analysis based on entropy.
No full textAuthor-wise bibliometric analysis based on entropy.</p
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