However, little attention has been paid to explaining such effects, probably because PRN1371 supplier techniques for mediation analysis existing so far have not been applicable to survival data.
Methods: We investigated
the underlying mechanisms using a recently developed method for mediation analysis of survival data. Our analysis of the effect of research activity on patient survival was based on 352 patients who had been diagnosed with advanced ovarian cancer at 149 hospitals in 2001. All hospitals took part in a quality assurance program of the German Cancer Society. Patient outcomes were compared between hospitals participating in clinical trials and non-trial hospitals. Surgical outcome and chemotherapy selection were explored as potential mediators of the effect of hospital research activity on patient survival.
Results: The 219 patients treated in hospitals participating in clinical trials had more complete surgical debulking, were more likely to receive the recommended platinum-taxane combination, and had better survival than the 133 patients treated in non-trial hospitals. Taking into account baseline confounders, the overall adjusted hazard ratio of death was 0.58 (95% confidence interval: 0.42 to 0.79). This effect was decomposed https://www.selleckchem.com/products/hmpl-504-azd6094-volitinib.html into a direct effect of research activity of 0.67 and two indirect effects of 0.93 each mediated through either optimal surgery
Taken PLX3397 ic50 together, about 26% of the beneficial effect of research activity was mediated through the proposed pathways.
Conclusions: Mediation analysis allows proceeding from the question “”Does it work?”" to the question “”How does it work?”" In particular, we have shown that the research activity of a hospital contributes to superior patient survival through better use of surgery and chemotherapy. This methodology may be applied to analyze direct and indirect natural effects for almost any combination of variable types.”
“The association of patent foramen ovale (PFO) and atrial septal aneurysm (ASA) with migraine headache attack (MHA) has been clearly shown. The same findings have been recently demonstrated also in cluster headache. Although tension-type headaches (TTH) are the most common kind of headache, their association with these atrial septal abnormalities has never been studied before. The study was conducted to clarify whether there was a significant association between the presence of such atrial septal abnormalities and tension headache, when compared with migraineurs. One hundred consecutive patients with migraine and 100 age- and sex-matched subjects with TTH and 50 healthy volunteers with no headache were enrolled in the study and underwent a complete transesophageal echocardiographic study with contrast injections at rest and with the Valsalva maneuver.