124,869 research outputs found
Would compliance with cancer care standards improve survival for breast, colorectal and lung cancers?
No full textOBJECTIVE: To investigate whether cancer service standards are associated with survival for breast, colorectal and lung cancers at population level. METHODS: Standards of hospital cancer services in England, measured in 2001, were aggregated for 30 cancer networks covering populations of between 500 000 and 3 million people, and compared with 1-year and 5-year relative cancer survival for the incident period 1996-2001, using rank correlation. RESULTS: Relative survival and the cancer standards each showed statistically significant differences across cancer networks. For tumour-specific services, the total score of 35 standards was associated with longer relative survival for both colorectal and lung cancers (p<0.05), but not breast cancer, while colorectal cancer survival was strongly (p<0.01) associated with the specific standard "written agreement describing referral guidelines", and lung cancer (p<0.05) with two other guideline standards. There were also associations of longer survival with two measures of nursing staff specialist qualifications. Compliance with general standards for cancer services was not associated with survival for breast cancer, and showed only borderline (p<0.1) associations for colo-rectal cancer, while some standards on medical and management lead staff were significantly associated (p<0.05) with poorer survival for lung cancer. Overall, compliance with standards for hospital pathology and radiology services also showed no associations with survival. CONCLUSION: This study suggests that compliance with some clinical service standards, such as guidelines, could contribute to better survival at population level, while more general organisational aspects of cancer services may not directly improve survival
Going Beyond Counting First Authors in Author Co-citation Analysis
No full textThe 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
Dispelling the Myths Behind First-author Citation Counts
No full textWe 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
Comparative indicators for cancer network management in England: availability, characteristics and presentation
No full textBackground: In 2000, the national cancer plan for England created 34 cancer networks, new organisational structures to coordinate services across populations varying between a half and three million people. We investigated the availability of data sets reflecting measures of structure, process and outcome that could be used to support network management.Methods: We investigated the properties of national data sets relating to four common cancers - breast, colorectal, lung and prostate. We reviewed the availability and completeness of these data sets, identified leading items within each set and put them into tables of the 34 cancer networks. We also investigated methods of presentation.Results: Acute Hospitals Portfolio and the National Cancer Peer Review recorded structural characteristics at hospital and cancer service level. Process measures included Hospital Episode Statistics, recording admissions, and Cancer Waiting List data. Patient outcome measures included the National Survey: Cancer Patients, and Cancer Survival, drawn from cancer registration.Conclusion: While not as yet used together in practice, comparative indicators are available within the National Health Service in England for use in performance assessment by cancer networks
Opportunities for reducing emergency diagnoses of colon cancer in women and men: A data-linkage study on pre-diagnostic symptomatic presentations and benign diagnoses
No full textObjectives: To identify opportunities for reducing emergency colon cancer diagnoses, we evaluated symptoms and benign diagnoses recorded before emergency presentations (EP). Methods: Cohort of 5,745 colon cancers diagnosed in England 2005–2010, with individually linked cancer registry and primary care data for the 5-year pre-diagnostic period. Results: Colon cancer was diagnosed following EP in 34% of women and 30% of men. Among emergency presenters, 20% of women and 15% of men (p = 0.002) had alarm symptoms (anaemia/rectal bleeding/change in bowel habit) 2–12 months pre-diagnosis. Women with abdominal symptoms (change in bowel habit/constipation/diarrhoea) received a benign diagnosis (irritable bowel syndrome (IBS)/diverticular disease) more frequently than men in the year before EP: 12% vs. 6% among women and men (p = 0.002). EP was more likely in women (OR = 1.20; 95% CI 1.1–1.4), independently of socio-demographic factors and symptoms. Benign diagnoses in the pre-diagnostic year (OR = 2.01; 95% CI 1.2–3.3) and anaemia 2–5 years pre-diagnosis (OR = 1.91; 95% CI 1.2–3.0) increased the risk of EP in women but not men. The risk was particularly high for women aged 40–59 with a recent benign diagnosis vs. none (OR = 4.41; 95% CI 1.3–14.9). Conclusions: Women have an increased risk of EP, in part due to less specific symptoms and their more frequent attribution to benign diagnoses. For women aged 40–59 years with new-onset IBS/diverticular disease innovative diagnostic strategies are needed, which might include use of quantitative faecal haemoglobin testing (FIT) or other colorectal cancer investigations. One-fifth of women had alarm symptoms before EP, offering opportunities for earlier diagnosis
Contrasting effects of comorbidities on emergency colon cancer diagnosis: A longitudinal data-linkage study in England
No full textBackground: One in three colon cancers are diagnosed as an emergency, which is associated with worse cancer outcomes. Chronic conditions (comorbidities) affect large proportions of adults and they might influence the risk of emergency presentations (EP). Methods: We aimed to evaluate the effect of specific pre-existing comorbidities on the risk of colon cancer being diagnosed following an EP rather than through non-emergency routes. The cohort study included 5745 colon cancer patients diagnosed in England 2005-2010, with individually-linked cancer registry, primary and secondary care data. In addition to multivariable analyses we also used potential-outcomes methods. Results: Colon cancer patients with comorbidities consulted their GP more frequently with cancer symptoms during the pre-diagnostic year, compared with non-comorbid cancer patients. EP occurred more frequently in patients with 'serious' or complex comorbidities (diabetes, cardiac and respiratory diseases) diagnosed/treated in hospital during the years pre-cancer diagnosis (43% EP in comorbid versus 27% in non-comorbid individuals; multivariable analysis Odds Ratio (OR), controlling for socio-demographic factors and symptoms: men OR = 2.40; 95% CI 2.0-2.9 and women OR = 1.98; 95% CI 1.6-2.4. Among women younger than 60, gynaecological (OR = 3.41; 95% CI 1.2-9.9) or recent onset gastro-intestinal conditions (OR = 2.84; 95% CI 1.1-7.7) increased the risk of EP. In contrast, primary care visits for hypertension monitoring decreased EPs for both genders. Conclusions: Patients with comorbidities have a greater risk of being diagnosed with cancer as an emergency, although they consult more frequently with cancer symptoms during the year pre-cancer diagnosis. This suggests that comorbidities may interfere with diagnostic reasoning or investigations due to 'competing demands' or because they provide 'alternative explanations'. In contrast, the management of chronic risk factors such as hypertension may offer opportunities for earlier diagnosis. Interventions are needed to support the diagnostic process in comorbid patients. Appropriate guidelines and diagnostic services to support the evaluation of new or changing symptoms in comorbid patients may be useful
- …
