AIM:To examine the infuence of gynecologic oncolo-gists(GO)in the United States on surgical/chemothe-rapeutic standard of care(SOC),and how this translates into improved survival among women with ovarian cancer(OC).ME...AIM:To examine the infuence of gynecologic oncolo-gists(GO)in the United States on surgical/chemothe-rapeutic standard of care(SOC),and how this translates into improved survival among women with ovarian cancer(OC).METHODS:Surveillance,Epidemiology,and End Result(SEER)-Medicare data were used to identify 11688 OC patients(1992-2006).Only Medicare recipients with an initial surgical procedure code(n=6714)were included.Physician specialty was identified by linking SEER-Medicare to the American Medical Association Masterfile.SOC was defined by a panel of GOs.Mul-tivariate logistic regression was used to determine predictors of receiving surgical/chemotherapeutic SOC and proportional hazards modeling to estimate the effect of SOC treatment and physician specialty on survival.RESULTS:About 34%received surgery from a GO and 25%received the overall SOC.One-third of women had a GO involved sometime during their care.Women receiving surgery from a GO vs non-GO had 2.35 times the odds of receiving the surgical SOC and 1.25 times the odds of receiving chemotherapeutic SOC(P〈0.01).Risk of mortality was greater among women not receiving surgical SOC compared to those who did[hazard ratio=1.22(95%CI:1.12-1.33),P〈0.01],and also was higher among women seen by non-GOs vs GOs(for surgical treatment)after adjusting for covariates.Median survival time was 14 mo longer for women receiving combined SOC.CONCLUSION:A survival advantage associated with receiving surgical SOC and overall treatment by a GO is supported.Persistent survival differences,particularly among those not receiving the SOC,require further investigation.展开更多
The coronavirus disease-19(COVID-19)pandemic has been a wake-up call in which has forced us to react worldwide.Health policies and practices have attracted particular attention in terms of human and financial cost.Bef...The coronavirus disease-19(COVID-19)pandemic has been a wake-up call in which has forced us to react worldwide.Health policies and practices have attracted particular attention in terms of human and financial cost.Before COVID-19,chronic kidney disease was already considered a risk multiplier in patients with diabetes and hypertension,the two now being the major risk factors for COVID-19 infection and adverse outcome.In contrast to the urgent need for action,the nephrology field is considered to be in a state of stagnation regarding the management of chronic kidney disease patients who still experience unacceptably high morbidity and mortality.Ironically and paradoxically in a field lacking robust clinical trials,clinical practice is driven by guidelines-based medicine on weak evidence.The Emperor’s syndrome,referring to Hans Christian Andersen’s fairy tale,has been described in medicine as voluntary blindness to an obvious truth,being a weak evidence-based therapeutic intervention or weak health care.A promising positive example of improving heart and kidney outcomes is the emerging treatment with sodium-glucose cotransporter 2 inhibitors.COVID-19 could boost actions for patient-centered care as a positive shift in nephrology care.展开更多
基金Supported by The United States Federal Government,Centers for Disease Control and Prevention,Atlanta,GA,United States
文摘AIM:To examine the infuence of gynecologic oncolo-gists(GO)in the United States on surgical/chemothe-rapeutic standard of care(SOC),and how this translates into improved survival among women with ovarian cancer(OC).METHODS:Surveillance,Epidemiology,and End Result(SEER)-Medicare data were used to identify 11688 OC patients(1992-2006).Only Medicare recipients with an initial surgical procedure code(n=6714)were included.Physician specialty was identified by linking SEER-Medicare to the American Medical Association Masterfile.SOC was defined by a panel of GOs.Mul-tivariate logistic regression was used to determine predictors of receiving surgical/chemotherapeutic SOC and proportional hazards modeling to estimate the effect of SOC treatment and physician specialty on survival.RESULTS:About 34%received surgery from a GO and 25%received the overall SOC.One-third of women had a GO involved sometime during their care.Women receiving surgery from a GO vs non-GO had 2.35 times the odds of receiving the surgical SOC and 1.25 times the odds of receiving chemotherapeutic SOC(P〈0.01).Risk of mortality was greater among women not receiving surgical SOC compared to those who did[hazard ratio=1.22(95%CI:1.12-1.33),P〈0.01],and also was higher among women seen by non-GOs vs GOs(for surgical treatment)after adjusting for covariates.Median survival time was 14 mo longer for women receiving combined SOC.CONCLUSION:A survival advantage associated with receiving surgical SOC and overall treatment by a GO is supported.Persistent survival differences,particularly among those not receiving the SOC,require further investigation.
文摘The coronavirus disease-19(COVID-19)pandemic has been a wake-up call in which has forced us to react worldwide.Health policies and practices have attracted particular attention in terms of human and financial cost.Before COVID-19,chronic kidney disease was already considered a risk multiplier in patients with diabetes and hypertension,the two now being the major risk factors for COVID-19 infection and adverse outcome.In contrast to the urgent need for action,the nephrology field is considered to be in a state of stagnation regarding the management of chronic kidney disease patients who still experience unacceptably high morbidity and mortality.Ironically and paradoxically in a field lacking robust clinical trials,clinical practice is driven by guidelines-based medicine on weak evidence.The Emperor’s syndrome,referring to Hans Christian Andersen’s fairy tale,has been described in medicine as voluntary blindness to an obvious truth,being a weak evidence-based therapeutic intervention or weak health care.A promising positive example of improving heart and kidney outcomes is the emerging treatment with sodium-glucose cotransporter 2 inhibitors.COVID-19 could boost actions for patient-centered care as a positive shift in nephrology care.
