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    Economic evaluation of two therapeutic sequences in the treatment of relapsed/refractory multiple myeloma

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    Multiple myeloma is a rare, incurable hematologic malignancy. It has a tendency to develop subsequent relapses, so affected patients are likely to undergo more than one line of treatment. Rather than evaluating the cost-effectiveness of individual therapeutic agents, it becomes therefore recommendable for decision-makers-from both a clinical and an economic perspective-identifying an optimal sequencing of such agents. Lenalidomide and bortezomib are the most used drugs in Italy for the treatment of relapsed/refractory multiple myeloma (rrMM). In the present work a cost-analysis was conducted, comparing two alternative strategies: bortezomib as a second-line therapy followed by lenalidomide+dexamethasone (len/dex) after progression (sequence A) vs len/dex followed by bortezomib (sequence B). Only drug costs were considered in the analysis. Based on outcomes from phase III trials, total time to progression (TTP) was longer in sequence B (17.1+4.9=22 months) as compared to sequence A (7+10.6=17.6 months). Average costs per progression-free month in the respective sequences were quite comparable: €4,109 vs €4,061. Sensitivity analysis on a couple of scenarios (assuming patient pooling when using bortezomib and assuming the association of bortezomib with pegylated liposomal doxorubicin) provided similar conclusions as regards costs. Though sequences A and B look equivalent in terms of cost per progression-free month, it should be considered that with a longer total TTP (as in sequence B) costs for a fourth-line treatment, together with other medical costs (diagnostics, hospitalisations) following progression, are postponed; moreover, a longer TTP means a better quality of life for the concerned patient. Despite the simplifications adopted in this study, len/dex as second-line treatment appears a recommendable strategy in the treatment of rrMM. © 2013 Springer International Publishing Switzerland

    Going Beyond Counting First Authors in Author Co-citation Analysis

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    The 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

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    “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
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