Preference between medical outcomes and travel times: an analysis of liver transplantation.

BACKGROUND: There is evidence of a volume outcome relationship for liver transplantation. In Germany, there is a minimum volume threshold of 20 transplantations per year for each center. Thresholds potentially lead to centralization of the healthcare supply, generating longer travel times. OBJECTIVE: This study assessed whether patients are willing to travel longer times to transplantation centers for better outcomes (lower hospital mortality and higher 3-year survival) and identified patient characteristics influencing their choices. METHODS: Participants were recruited in hospitals and via random samples at registration offices. Discrete choice experiments were used to identify trade-offs in their choices between local and regional centers. Descriptive statistics and logistic regression models were used to measure patients' preferences and quantify potentially influencing characteristics. RESULTS: Overall, 82.22% (in-hospital mortality) and 84.44% (3-year survival) of the participants opted to accept a longer travel time in order to receive a liver transplantation with better outcomes. CONCLUSION: Most participants were willing to trade shorter travel times for lower mortality risks and higher 3-year survival in cases of liver transplantation.

Conversion Surgery for Unresectable Advanced Gastric Cancer: A Systematic Review and Meta-Analysis.

For patients with unresectable advanced gastric cancer, induction chemotherapy could down-stage primary tumors, resulting in conversion surgery becoming possible. However, the feasibility and therapeutic benefit of conversion surgery remains controversial. Therefore, this meta-analysis aimed to systematically review and investigate the efficacy of conversion surgery followed by chemotherapy for unresectable AGC.

H2H rehabilitation care promotes high quality recovery of patients with lung cancer comorbid with chronic obstructive pulmonary disease.

H2H is a patient and family-centered approach that integrates hospital and home care, emphasizing continuity, individualized rehabilitation training, and the active participation of patients and their families. However, it is still unclear whether H2H improves the efficacy for patients with COPD and lung cancer. This study investigated the efficacy of Hospital-to-Home (H2H) rehabilitation nursing for lung cancer patients with Chronic Obstructive Pulmonary Disease (COPD). We conducted a retrospective analysis to the clinical data of 95 patients treated in the Pingdingshan University Medical College from January 2018 to January 2020. We compared the effects of conventional nursing (control group, n=45) and H2H nursing (observation group, n=50) on the clinical efficacy for the patients. In this study, after nursing intervention, the quality of life and adverse emotions in the observation group were significantly improved compared to the control group (P<0.0001). Moreover, the lung function and blood oxygen saturation of patients in the H2H nursing model improved after the intervention (P<0.0001). In addition, there was no difference in the 3-year survival rate between the control group and the observation group (P=0.260). Multivariate COX regression analysis showed that the nursing scheme had no effect on the patients' 3-year survival, but the SAS score, SDS score, and CEA were independent prognostic factors affecting the 3-year survival rate (P<0.05). These results demonstrate that H2H rehabilitation care significantly improves the quality of life, emotional health, and lung function of patients with COPD and lung cancer, but does not affect the patients' 3-year survival rate.

Effects of ß-blockers therapy on the 28-day and 3-year survival rates of end-stage renal disease patients with cardiovascular disease: a retrospective cohort study.

Background: ß-blockers have been used in the treatment of end-stage renal disease (ESRD) patients and cardiovascular disease (CVD) patients, separately. However, the effects of ß-blockers on ESRD patients with CVD have not been fully investigated. This study sought to investigate the effects of ß-blockers therapy on the 28-day and 3-year survival rates of ESRD patients with pre-existing CVD who were admitted to the intensive care unit (ICU). Methods: After excluding patients without CVD, receiving a kidney transplant, not admitted to the ICU, and with missing baseline data, this cohort study included 1081 ESRD participants with CVD from the Medical Information Mark for Intensive Care III database. Baseline characteristics, including demographic data and clinical data, were collected. The outcomes were 28-day and 3-year survival rates of the patients. At the 28-day of ICU hospitalization, patients had a mean inpatient hospital stay of 24.7 days. At 3-year, the patients had a median survival time of 489.2 days. Univariate and multivariate Cox regression analyses were used to evaluate the effects of ß-blockers therapy on the 28-day and 3-year survival outcomes of ESRD patients with CVD. Results: The 28-day and 3-year survival rates were 82.8% and 37.9%, respectively. The mean age of the all patients was 68 years, and 642 were male. After adjusting for age, race, hyperlipidemia, dialysis, simplified acute physiological score (SAPS) II, sequential organ failure assessment (SOFA) score, glucocorticoid, hemoglobin, diabetes, hypertension, the 28-day survival rate of the ESRD patients with CVD requiring intensive care who received ß-blockers therapy was higher than that of the patients who did not receive the treatment. Similarly, after adjusting for age, race, hyperlipidemia, dialysis, SAPS II, SOFA score, glucocorticoid, hemoglobin, diabetes, hypertension, creatinine, the long-term survival rate of the patients who received ß-blockers therapy was also higher than that of those who did not. Conclusions: ß-blockers therapy was associated with increased 28-day and 3-year survival rates in ESRD patients with CVD requiring intensive care. Our findings may provide a theoretical basis for the prognostic impact of ß-blockers therapy among patients with ESRD and CVD who were admitted to the ICU.