Impact of Carotid Artery Stenosis on Quality of Life: A Systematic Review

© 2018, Springer Nature Switzerland AG. Objectives: The aim of this study was to identify themes that determine health-related quality of life (HRQoL) in patients with carotid artery stenosis and identify the patient-reported outcome measures (PROMs) that best cover the identified themes. Methods: A systematic review of the main six databases from inception to September 2018 was undertaken to identify primary qualitative studies reporting on the HRQoL of patients with carotid artery stenosis. The quality of studies was assessed using the Critical Appraisal Skills Programme (CASP) criteria. Findings from the included studies were analysed using framework analysis methodology. The identified themes were mapped against the items/domains from the PROMs used previously in patients with carotid artery stenosis. Results: The systematic review identified four papers that fulfilled the inclusion criteria. The included papers reported the views of 62 patients with symptomatic carotid artery stenosis; 24 of the patients were awaiting assessment for intervention, 26 had carotid endarterectomy, and 12 were turned down for intervention and received best medical therapy. The overall quality of the included studies was good based on CASP criteria. Framework analysis identified 16 themes that were divided into five main domains: anxiety, impact on personal roles and activities, effect on independence, psychological impact, and symptoms. The best-fit generic and disease-specific PROMs were the Medical Outcomes Study 36-Item Short Form (SF-36®) and the Carotid Stenosis Specific Outcome Measure (CSSOM), respectively. None of the PROMs covered all the themes identified in the qualitative systematic review. Conclusion: The findings from the review identified the important themes that affect patients with carotid stenosis disease. The current generic and disease-specific PROMs do not cover all themes that impact the HRQoL of patients suffering with this disease. The proposed themes can be used to develop a new disease-specific PROM to measure HRQoL

Foreign competition, domestic competition and innovation in Chinese private high-tech new ventures

Competition plays an important role in creating conditions favourable to innovation. However, is this the case for all types of competition? While recognizing the importance of competition in innovation, we address this question by examining the impact of foreign and domestic competition on the innovation performance of private high-tech new ventures. We argue that the impact of foreign and domestic competition on the innovation performance of local private firms may vary, due to the different types of resource interdependence with their competitors and learning gained by private firms. To test these arguments, we conducted a multilevel analysis of 805 Chinese private high-tech firms over the period 2001-2007. Our findings suggest that foreign competition has a U-shaped relationship with the innovation performance of private firms, whereas competition from state-owned enterprises positively affects private firms' innovation performance. Our study moves beyond the debate on whether competition increases or decreases innovation by unpacking the differential effects exerted by different types of competitors on the innovation performance of local private firms in the context of a transition economy