Balancing properties. A need for the application of propensity score methods in estimation of treatment effects

There has been recently a striking increase in the use of propensity score methods in health sciences research as a tool to adjust for selection bias in making causal inferences from observational controlled studies. However, reviews of published studies that use these techniques suggest that investigators often do not pay proper attention to thorough verification of appropriate fulfilment of propensity score adjusting properties. By using a case study in which balance is not achieved, we illustrate the need to systematically asses the accomplishment of the balancing property of the propensity score as a critical requirement for obtaining unbiased treatment effects estimatesPeer Reviewe

Balancing properties. A need for the application of propensity score methods in estimation of treatment effects

There has been recently a striking increase in the use of propensity score methods in health sciences research as a tool to adjust for selection bias in making causal inferences from observational controlled studies. However, reviews of published studies that use these techniques suggest that investigators often do not pay proper attention to thorough verification of appropriate fulfilment of propensity score adjusting properties. By using a case study in which balance is not achieved, we illustrate the need to systematically asses the accomplishment of the balancing property of the propensity score as a critical requirement for obtaining unbiased treatment effects estimate

Detection of risk factors that influence weight loss in patients undergoing radiotherapy

AbstractAimTo identify risk factors that influence weight loss in patients receiving radiotherapy.BackgroundIt is a well-known fact that cancer patients can be affected by malnutrition at the onset of the disease and during treatment due to the toxicity. Pretreatment weight loss alone does not predict those who will need nutritional supplementation. Instead, a variety of nutritional and tumor related factors needs to be taken into account.Material and methodsA retrospective study was conducted on 129 patients with different tumor locations. Weight loss was evaluated during radiotherapy and one month after treatment. The impact of age, ECOG, chemotherapy, pretreatment weight loss, tumor location, previous surgery and TNM were analyzed. We aimed to identify a high-risk group of patients before starting treatment.ResultsThe average net weight loss during radiotherapy and one month after treatment for this group of patients was 0.68kg and 1.6kg, respectively. Median weight loss during radiotherapy was 2.6 kg for head and neck (HN) patients and 0.27 kg for other tumor sites (p=0.028). Median weight loss one month after radiotherapy was 3.7kg for HN patients and 1.1kg for the rest of the patients (p=0.034). The median weight loss one month after treatment was 3.2 kg for patients receiving chemotherapy and 0.5kg for those patients who did not receive chemotherapy (p<0.001). A regression analysis determined that HN tumor location and the use of chemotherapy were independent risk factors.ConclusionsNutritional status must be monitored and managed before, during and after treatment. A variety of nutritional and tumor-related factors must be considered. According to our results, head and neck tumors and the use of chemotherapy are the only two factors considered statistically significant. Because patients continue to lose weight after treatment, we recommend close surveillance after radiotherapy

Effect of vitamin E administered to men in infertile couples on sperm and assisted reproduction outcomes: a double-blind randomized study

Objective: To evaluate the influence on sperm parameters and invitro fertilization (IVF) outcomes of the administration of 400 mg/day of vitamin E for 3 months to men from infertile couples who are undergoing IVF. Design: Double-blind, placebo-controlled, randomized study. Setting: Human reproduction unit of a university hospital. Patients: A total of 101 couples, 50 in the vitamin E group and 51 in the placebo group, undergoing IVF, among whom 64.4% of cases had an abnormal spermiogram according to World Health Organization (WHO) criteria. Interventions: Vitamin E (alpha-tocopherol), 400 mg daily by mouth for 3 months, with sperm analysis performed immediately before starting the treatment and 3 months later on the day of IVF. Main Outcome Measures: WHO sperm parameters and IVF outcomes. Results: Although there was a statistically significant increase in progressive motility in the vitamin E group compared with before-treatment values, a similar increase occurred in the placebo group. Normal morphology was even better in the placebo group. Regarding IVF outcomes, better fertilization rates were observed in the placebo group, but the live-birth rate per transfer was statistically significantly higher in the vitamin E group: 17 (41.46%) of 41 versus 9 (20.46%) of 44 in the placebo group. Although the clinical pregnancy rates (both per transfer and per cycle started) and the implantation rate were somewhat higher in the vitamin E group (43.9% and 25%; 36.0% and 22.0%; and 24.7% and 14.1%, respectively), the increase was not statistically significant. Conclusions: The effect of vitamin E on classic sperm parameters was not an improvement over placebo. Nonetheless, vitamin E administration was associated with a statistically significantly higher live-birth rate, and there was a trend toward better results in other IVF parameters

Balancing properties. A need for the application of propensity score methods in estimation of treatment effects

There has been recently a striking increase in the use of propensity score methods in health sciences research as a tool to adjust for selection bias in making causal inferences from observational controlled studies. However, reviews of published studies that use these techniques suggest that investigators often do not pay proper attention to thorough verification of appropriate fulfilment of propensity score adjusting properties. By using a case study in which balance is not achieved, we illustrate the need to systematically asses the accomplishment of the balancing property of the propensity score as a critical requirement for obtaining unbiased treatment effects estimatesPeer Reviewe

Exploring attitudes towards use of technology to support stroke survivors living at home: A quantitative and qualitative content analysis study in Spain

PurposeThe aim of this study was to better understand the attitudes towards the use of technology to support chronic stroke survivors in a home-based setting.MethodsA quantitative study was used on the data obtained from a face to face survey with the sample group, incorporating quantitative statistical analysis.ResultsParticipants reported positive attitudes towards using technology for their own independent health management. The purpose of the home-based technology was different: source of information, supporting self-management, pharmacological treatment reminders… and differed according to age, educational level and survivor disability. Installing devices and sharing information remains a challenge.Conclusions100% of stroke survivors living in the community with any type of disability, reported that they would like to use technology as a tool to help improve their health status

Detection of risk factors that influence weight loss in patients undergoing radiotherapy

AimTo identify risk factors that influence weight loss in patients receiving radiotherapy.BackgroundIt is a well-known fact that cancer patients can be affected by malnutrition at the onset of the disease and during treatment due to the toxicity. Pretreatment weight loss alone does not predict those who will need nutritional supplementation. Instead, a variety of nutritional and tumor related factors needs to be taken into account.Material and methodsA retrospective study was conducted on 129 patients with different tumor locations. Weight loss was evaluated during radiotherapy and one month after treatment. The impact of age, ECOG, chemotherapy, pretreatment weight loss, tumor location, previous surgery and TNM were analyzed. We aimed to identify a high-risk group of patients before starting treatment.ResultsThe average net weight loss during radiotherapy and one month after treatment for this group of patients was 0.68[[ce:hsp sp="0.25"/]]kg and 1.6[[ce:hsp sp="0.25"/]]kg, respectively. Median weight loss during radiotherapy was 2.6 kg for head and neck (HN) patients and 0.27 [[ce:hsp sp="0.25"/]]kg for other tumor sites (p[[ce:hsp sp="0.25"/]]=[[ce:hsp sp="0.25"/]]0.028). Median weight loss one month after radiotherapy was 3.7[[ce:hsp sp="0.25"/]]kg for HN patients and 1.1[[ce:hsp sp="0.25"/]]kg for the rest of the patients (p[[ce:hsp sp="0.25"/]]=[[ce:hsp sp="0.25"/]]0.034). The median weight loss one month after treatment was 3.2 kg for patients receiving chemotherapy and 0.5[[ce:hsp sp="0.25"/]]kg for those patients who did not receive chemotherapy (p[[ce:hsp sp="0.25"/]

Quality of life improvement in patients with bone metastases undergoing palliative radiotherapy

Background: The aim of the study was to analyze the impact of palliative radiotherapy on quality of life (QoL) in patients with symptomatic bone metastases. Materials and methods: We present the results from a prospective multicentric study including 128 patients who provided pre- and post-radiotherapy (one month after treatment) brief pain inventory (BPI) assessments. Worst pain was recorded using the BPI (range: 0–10). Pain response was described according to the International Bone Metastases Consensus on palliative radiation. Regarding QoL, for each pre- and post-radiation BPI-questionnaire, scores from the interference domains were summed and averaged to obtain an overall interference score. Results: There was a significant correlation between radiation treatment response and improvement in all functional interference domains except sleeping. Patients &gt; 75 years old presented a significantly higher improvement in general activity, mood and relationships with others compared to patients ≤ 75 years old. Patients presenting a baseline pain score ≥ 8 showed a higher improvement in the general activity item (p = 0.049). There was no statistically significant association between pretreatment ECOG, chemotherapy, primary tumor location and radiation schedule with any of the functional interference items. Conclusions: Patients who report pain relief after palliative radiotherapy also present a better quality of life including physical and psychosocial aspects

Quality of life improvement in patients with bone metastases undergoing palliative radiotherapy.

The aim of the study was to analyze the impact of palliative radiotherapy on quality of life (QoL) in patients with symptomatic bone metastases. We present the results from a prospective multicentric study including 128 patients who provided pre- and post-radiotherapy (one month after treatment) brief pain inventory (BPI) assessments. Worst pain was recorded using the BPI (range: 0-10). Pain response was described according to the International Bone Metastases Consensus on palliative radiation. Regarding QoL, for each pre- and post-radiation BPI-questionnaire, scores from the interference domains were summed and averaged to obtain an overall interference score. There was a significant correlation between radiation treatment response and improvement in all functional interference domains except sleeping. Patients > 75 years old presented a significantly higher improvement in general activity, mood and relationships with others compared to patients ≤ 75 years old. Patients presenting a baseline pain score ≥ 8 showed a higher improvement in the general activity item (p = 0.049). There was no statistically significant association between pretreatment ECOG, chemotherapy, primary tumor location and radiation schedule with any of the functional interference items. Patients who report pain relief after palliative radiotherapy also present a better quality of life including physical and psychosocial aspects