Impact of Surgical and Medical Treatment on Survival of Patients with Cerebral Aspergillosis: Systematic Review of the Literature

Objective: Cerebral aspergillosis carries a high mortality. Rapid diagnosis and treatment can increase survival, but symptoms and imaging findings are nonspecific. The literature on cerebral aspergillosis consists mostly of case reports and case series and lacks large-scale review of data. Methods: We performed a review of the literature using PubMed in March 2019. We recorded the year of publication, age and sex of patients, neurosurgical involvement, the antifungals administered, use of intrathecal antifungals, and the outcome of patients. The relationships among variables were tested using bivariant statics and linear regression. Results: A total of 324 studies met the eligibility criteria, and 198 studies including 248 patients were included. Surgical resection (odds ratio [OR], 0.45; 95% confidence interval [CI], 0.25–0.80; P < 0.01) and administration of voriconazole (OR, 0.32; 95% CI, 0.18–0.55; P < 0.001) or itraconazole (OR, 0.36; 95% CI, 0.16–0.72; P < 0.001) were shown to be significantly associated with survival. Conclusions: Given the significant survival benefits for patients who received voriconazole and surgical intervention, we suggest early antifungal medical treatment and resection

FACTORS INFLUENCING LEGISLATORS'USE OF POLICY INFORMATION AND IMPLICATIONS FOR PROMOTING GREATER USE

Despite a tremendous growth in the volume of policy analysis in the past decade, recent research indicates governmental decisionmakers make little direct use of such research; at best, policy-oriented research alters a decisionmaker's conceptualization of the policy problem over the long term. Previous efforts to explain policymakers'limited use of policy research have generally not considered the opportunities and constraints presented by specific decisionmaking contexts. To a large extent, the research utilization literature has focused on attitudinal and demographic characteristics of decisionmakers and has adopted as a central focus the "two-communities" theory which asserts that frequent, direct use of policy research by policymakers is unlikely because of the competing worldview and belief systems of policy researchers and policymakers. While the two-communities theory may partially explain the limited use of policy research, it ignores the institutional incentives motivating decisionmakers. More specifically, this earlier research does not consider the different motivations of policymakers and their relative impact on use of policy information. To expand the explanation of decisionmakers'use of policy information, I postulate a model of legislators'use of policy information that includes four types of factors that influence legislators'propensity to use policy information. These factors-worldview and attitude toward social science, perception of the way policy issues are considered in the legislature, perception of the legislative structure, and legislative orientations-combine two-communities type of independent variables and perceptions of the legislative environment. In this way, policymakers'use of policy information can be examined more realistically and comprehensively. Copyright 1987 by The Policy Studies Organization.