1,721,025 research outputs found
Quality of Life Is Associated with Survival in Patients with Cirrhosis and Hepatocellular Carcinoma
No full textThe general metadata -- e.g., title, author, abstract, subject headings, etc. -- is publicly available, but access to the submitted files is restricted to UT Southwestern campus access and/or authorized UT Southwestern users.Pages 1-24 are misnumbered as pages 2-25.BACKGROUND: Prior studies assessing quality of life (QOL) in patients with hepatocellular carcinoma (HCC) primarily included patients with preserved liver function and/or early HCC, leading to overestimation of QOL.
OBJECTIVE: To characterize QOL among a diverse cohort of cirrhotic patients with HCC and evaluate its association with survival.
METHODS: We conducted a prospective cohort study among cirrhotic patients with HCC from a large urban safety-net hospital between April 2011 and September 2013. Patients completed two self-administered surveys, the EORTC QLQ-C30, and QLQ-HCC18, prior to HCC-directed treatment. We used generalized linear models to identify correlates of QOL. Survival curves were generated using Kaplan-Meier analysis and compared using log rank test to determine if QOL is associated with survival.
RESULTS: 130 treatment-naïve patients were enrolled and completed both surveys. Patients reported fair global QOL (median score 50%), high cognitive and social function (median scores 67%), but poor role function (median score 50%). QOL was associated with both cirrhosis-related (p=0.02) and tumor-related (p=0.02) components of Barcelona Clinic Liver Cancer (BCLC) stage. QOL was associated with survival on univariate analysis (HR 0.37, 95%CI 0.16-0.85) but became non-significant (HR 0.82, 95%CI 0.37-1.80) after adjusting for BCLC stage and treatment. Role functioning was significantly associated with survival (HR 0.40, 95%CI 0.20-0.81), after adjusting for Caucasian race (HR 0.31, 95%CI 0.16-0.59), BCLC stage (HR 1.51, 95%CI 0.21-1.89), and treatment (HR 0.57, 95%CI 0.33-0.97).
CONCLUSION: QOL and role function have prognostic significance and are important to assess in cirrhotic patients with HCC
Effect of Fragmentation of Cancer Care on Treatment Use and Survival in Hepatocellular Carcinoma
No full textThe general metadata -- e.g., title, author, abstract, subject headings, etc. -- is publicly available, but access to the submitted files is restricted to UT Southwestern campus access and/or authorized UT Southwestern users.BACKGROUND: Fragmentation of care (FC) refers to treatment received at multiple facilities. Implications of FC include increased health care costs and amplification of existing healthcare disparities. This study aimed to identify patient and hospital-level factors associated with FC and analyze the effect of FC on patient outcome measures (overall survival and time to treatment).
OBJECTIVE: Fragmented care in HCC patients is associated with worse overall survival and increased time to treatment compared to patients receiving non-fragmented care.
METHODS: The Texas Cancer Registry (TCR) was queried from 2004-2015 for a 12-year study span. Patient- and hospital-level factors were characterized within 2 groups: patients receiving fragmented care (FC) and those receiving non-fragmented care (NFC). Cox proportional hazards regression models were used to identify those factors that were independently and significantly associated with overall survival and time to treatment. Kaplan-Meier curves were generated to evaluate differences in overall survival between the FC and NFC groups, as well as between every type of transition within the FC group (stratified on the basis of safety net hospital status or volume status). All statistical analyses were performed with SPSS.
RESULTS: Of our cohort (n = 4329), 72.6% received NFC, and 27.4% received FC. In comparison to patients receiving NFC, patients receiving FC had larger median tumor sizes at diagnosis (≥4 cm, 52.6% vs 35.2%; p < .001). NFC patients also tended to present with regional or metastatic disease (35.9% vs 26.7%; P < .001). A subset analysis of patients with localized stage HCC who received curative therapy showed that FC was associated with decreased odds of curative therapy (odds ratio, 0.83; 95% confidence interval [CI], 0.7-0.9). In this subgroup analysis, FC was associated with worse OS (median survival, 67 vs 43 months; HR, 1.2; 95% CI, 1.0-1.4) and increased TTT (HR, 0.74; 95% CI, 0.7-0.8). Ultimately, in our global cohort, FC was associated with worse OS (hazard ratio [HR], 1.14; 95% CI, 1.05-1.24) and increased TTT (HR, 0.76; 95% CI, 0.7-0.8).
CONCLUSION: Patients receiving FC had worse OS and increased TTT compared to patients receiving NFC. Several patient and hospital-level factors were found to be associated with FC, including age, insurance, non-safety net hospital status, accreditation, and disease stage. This work has implications for encouraging initiatives geared toward increasing care coordination, especially when managing cancer. Future work may aim to elucidate the reasons for the associations described and delineate steps by which to mitigate FC in the context of these factors
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
Underutilization of Palliative Care in Metastatic Foregut Cancer Patients Is Associated with Socioeconomic Disparities
No full textThe general metadata -- e.g., title, author, abstract, subject headings, etc. -- is publicly available, but access to the submitted files is restricted to UT Southwestern campus access and/or authorized UT Southwestern users.BACKGROUND: Metastatic foregut cancers are frequently associated with debilitating symptoms that significantly impact patient's quality of life. Palliative care aims to mitigate disease-, psychosocial- and treatment-related effects. Despite numerous reported benefits and current guidelines and recommendations, palliative care remains heavily underutilized in patients with metastatic cancers.
OBJECTIVE: Our aim was to determine the rate of palliative care utilization among patients with metastatic foregut neoplasms and determine the socioeconomic factors associated with receipt of palliative care.
METHODS: A retrospective review of the National Cancer Database (NCDB) was conducted to identify patients diagnosed with metastatic foregut cancers between 2004-2013. The NCDB captures over 70% of all incident cancer cases in the United States. We identified patients with stage IV gastric, pancreatic, biliary, gallbladder and esophageal adenocarcinoma. Receipt of PC as defined by the NCDB participant use file was correlated to demographic and clinicopathologic factors. PC treatment included surgery, radiation, systemic therapy, and pain management to alleviate symptoms. Logistic regression was performed to assess the impact of factors on the likelihood of receiving PC. Overall survival was estimated using the Kaplan-Meier method and compared using log-rank tests.
RESULTS: Palliative care utilization rates increased among all groups over time (12.3% 2004-2006 vs. 14.7% 2007-2010 vs. 16.4% 2011-2013 for all cancers). Female sex, Medicaid, median income < USD 46,000/year, higher education level, higher Charlson/Deyo Score, and pancreatic or biliary cancers were associated with increased likelihood of palliative care interventions. Additionally, patients treated at an academic center or integrated network cancer program were more likely to receive palliative care than patients treated in the community setting. When receipt of palliative care was stratified by race, Hispanics were significantly less likely to have undergone palliative interventions compared to non-Hispanic Whites (OR 0.70, 95% CI 0.66-0.73). Patients with Medicare or private insurance were less likely to receive palliative care than uninsured patients (OR 0.92, 95% CI 0.87-0.97 and 0.81, 95% CI 0.77-0.89, respectively)
CONCLUSION: Although PC use has increased over time, it remains significantly underutilized in MFC. Disparities exist in receipt of PC with regards to demographic and socioeconomic factors such as age, race, gender, insurance status, education, comorbidities and year of diagnosis. These identified factors can serve as targeted interventions aimed at increasing palliative care utilization. Additional research is necessary to better optimize PC use in metastatic cancers of the foregut and mitigate potential disparities
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
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
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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