Choice Of Doctor Research Articles

Practice networks in Germany: structure, cooperation and priorities

The outpatient sector in Germany is characterised by special features, including organisational separation from the inpatient sector, the free choice of doctor for patients and the lack of standardised communication channels between service providers (1). This makes coordination and continuity of care more difficult, which can ultimately lead to cuts in the quality of care for patients. Examples of negative consequences of uncoordinated care include excessive utilisation of healthcare services, interruptions to treatment pathways or incorrect medication. In particular, multimorbid patients with a high demand for healthcare services are at risk of inappropriate care. There is potential for development with regard to collaborative professional practice in the outpatient sector and care models are needed that improve cooperation and coordination in care.

Beliefs of Peers' Behavior, Clinical Guidelines, and Private Attitudes to Antibiotics as Drivers of Antibiotic Prescribing

ABSTRACTThis study examines how doctors' personal views and norms on antibiotics affect their choices when prescribing antibiotics in Sweden. We analyze answers from two surveys, one in 2018 with 357 doctors about their own use and attitudes of antibiotics and another in 2019–2020 with 255 doctors about their prescription behavior. We find that doctors have more knowledge, and concern about antibiotic resistance and use than ordinary citizens, but they also use more antibiotics and are less ready to reduce their personal use of antibiotics. A doctor's choice not to prescribe antibiotics is strongly correlated with the descriptive treatment norms, that is, the perception of what most doctors would do when considering prescribing antibiotics and the guidelines for using antibiotics. There is also a strong correlation between professional and private attitudes: Although doctors themselves use more antibiotics than average people on average, those who are willing to refrain from using antibiotics as a private person are also more willing to avoid prescribing antibiotics to their patients.

Specialty choices among new generation of doctors - insights from a Polish survey study

The choice of medical specialty for future doctors is a multidimensional issue, associated with many factors. This study aimed to explore the factors influencing the specialty choices of doctors entering the Polish healthcare system. A nationwide cross-sectional survey was conducted from May until August 2023. The data was gathered via an online nationwide survey among recent medical school graduates. We explored respondents’ preferences regarding medical specialties (in two categories: surgical and non-surgical), and the factors that drive their choices. The U-Mann Whitney test was used to compare the distribution of 19 analysed factors, and the chi-squared test was used if a trend was not observed. 737 responses were collected, and 698 were included in the study. The respondents (60.5% female) preferred non-surgical specialties over surgical ones. The main factors influencing doctors’ choices were remuneration, the ability to maintain work-life balance, interest in the medical field, the ability to start a private practice, skills possessed, and doctor-patient interactions. Doctors pursuing a career in surgical fields are driven by slightly different factors than those who chose a non-surgical specialty. The youngest generation values a healthy work-life balance, and their non-professional life remains crucial.

Choice Between Free Combination of Antihypertensive Agents and Fixed Dosed Combinations in the Treatment of Arterial Hypertension

Most patients with arterial hypertension require more than one antihypertensive drug for blood pressure target achievement. Some patients are recommended for a multi-pill antihypertensive regimen, others — treatment with fixed dosed combinations in one tablet. Analysis of elibrary and PubMed publications in the period mostly from 2014 to 2024 concerning the choice of two-component combined antihypertensive agents containing renin-angiotensin system inhibitor and diuretic or calcium channel blocker, revealed that fixed-dose combinations (FDC) use and taking one tablet once a day improves adherence to treatment and facilitates blood pressure control. Although the cost of FDC containing the renin-angiotensin-aldosterone system inhibitor and a thiazide/thiazide-like diuretic or calcium channel blocker is in most cases higher than the same drugs taken separately, the use of fixed combinations, increasing patient adherence to therapy, has clinical advantage in terms of the effectiveness of lowering blood pressure, which confirms their economic feasibility. On the other hand, the use of free combination therapy in two different tablets, when taken separately during the day, can sometimes provide a more sustained antihypertensive effect over 24 hours. Evidence of the effectiveness of blood pressure control for FDCs is often extrapolated from data on free combinations. In addition, FDCs are characterized by less detection of possible ineffectiveness of one of the components. The range of FDCs and the dosage ratios of the components presented in them is gradually expanding, but the choice among free combinations is still wider. In addition, the list of vital and essential drugs (VED) for 2024 does not contain FDCs for antihypertensive drugs, which excludes the possibility of free receiving them on a preferential basis and gives the opportunity for the manufacturer to set prices for them. Despite the fact that recently the scientific community has recommended the use of FDC antihypertensive drugs as initial therapy due to better compliance with the regimen, and therefore clinical effectiveness and economic feasibility, it cannot be said that there is no space left for free combinations of antihypertensive drugs in the treatment of arterial hypertension. The choice of doctor, frequency of prescription, share of purchases of the FDCs in the Russian Federation, review of their consumption requires further analysis.

A Systematic Review of Online Medical Consultation Research.

Online medical consultation is a form of medical service that facilitates interactions between patients and doctors online, offering significant utility and value. This review aims to retrieve, screen, and analyze articles related to online medical consultations, formulating a theoretical framework and proposing future research directions. According to PRISMA guidelines, a systematic search was conducted in Web of Science, EBSCO, ScienceDirect, PubMed, and Scopus, retrieving a total of 4072 English records on 16 December 2023. After rigorous screening, 75 articles were included in this review. Among these, 8 articles focused on patients utilizing online medical consultation platforms, 5 on doctors participating in online medical platforms, 18 on patients' choice of doctors, 12 on doctors providing services, 7 on online reviews of patients, 14 on service quality for patients, 8 on rewards to doctors, and 11 on the spillover effect between online and offline services. These themes comprise the theoretical framework of the starting point, process, and outcomes of the online medical consultation system, providing a comprehensive understanding of the field and a foundation for future research.

DIAGNOSTIC ACCURACY OF RIPASA SCORE FOR DIAGNOSING ACUTE APPENDICITIS KEEPING HISTOPATHOLOGY AS GOLD STANDARD

The objective of the study was to determine the diagnostic accuracy of the RIPASA score in diagnosing acute appendicitis using histopathology as the gold standard. The cross-sectional study was conducted at the General Surgery Department of Lady Reading Hospital, Peshawar, between 17-03-2020 and 16-092020. A total of 171 patients were enrolled in the study. Each patient underwent the RIPASA score, followed by an appendectomy. The appendix specimen obtained during the appendectomy was sent to the laboratory for histopathology. After receiving the histopathology study's objective, which was to determine the report, the results of histopathology, RIPASA score, and other information, including name, age, gender, and age group, were recorded. The age distribution in the sample varied from 15-65 years, with a mean age of 25.8±11.0 years. There were 114 males (66.7%) and 57 females (33.3%). The RIPASA score had a sensitivity of 94.9%, specificity of 64.2%, PPV of 96.7%, NPV of 52.9%, and accuracy of 92.4%. Stratification was also carried out for age and gender. Age 15-25 showed a sensitivity of 94%, specificity of 57.1%, PPV of 97.3%, NPV of 36.3%, and accuracy of 91.9%. Similarly, the age 26-65 group revealed a sensitivity of 97.5%, specificity of 71.4%, PPV of 65.1%, NPV of 83.3%, and accuracy of 93.6%. Stratification by gender showed a sensitivity of 94.2%, specificity of 66.6%, PPV of 97%, NPV of 50%, and accuracy of 92.1% for males, while for females, the sensitivity was 96.1%, specificity was 60%, PPV was 96.1%, NPV was 60%, and accuracy was 92.9%. In conclusion, the study suggests that the RIPASA scoring system is a good choice for doctors in the emergency department to aid in diagnosing acute appendicitis with good sensitivity, albeit with a slightly high profile and specificity, albeit with a bit low profile.

A Survey on the Machine Learning Techniques for Automated Diagnosis from Ultrasound Images.

Medical diagnostic systems has recently been very popular and reliable because of possible automatic detections. The machine learning algorithm is evolved as a core tool of computer-aided diagnosis (CAD) for automatic early and accurate disease detections. The algorithm follows region of interest (ROI) selection followed by specific feature extractions and selection from medical images. The selected features are then fed to suitable classifiers for disease identification. The machine learning algorithm's performance depends on the features selected and the classifiers employed for the job. This paper reviews different feature extraction selection and classification techniques for CAD from ultrasound images. Ultrasonography (USG), due to its portability and its non-invasive nature, is the prime choice of doctors for prescribing as an imaging test. A survey on the USG imaging based on four major diseases is performed in this paper, whose diagnosis followed by automatic detection. Various techniques applied for feature extraction, selection, and classification by different authors to achieve improved accuracy are tabulated. For medical images, we found texture based gray-level extracted features and SVM (support vector machine) classifiers to be more significant in improving classification accuracy, even achieving 100% accuracy in many research articles. However, many research articles also suggest the importance of student's t-test in improving classification accuracy by selecting significant features from extracted features. The proposed algorithm's accuracy also depends on the quality of medical images, which are frequently degraded by the introduction of noise and artifacts while imaging acquisition. So, challenges in denoising are added in this paper as a separate topic to highlight the role of the machine learning algorithm in removing noise and artifacts from the USG images.

Professional choice as a moral dilemma for doctors in the context of COVID-19

Introduction. The COVID-19 pandemic has added new semantic trend to the problem of the professional choice of doctors through a change in the conditions of their activities in the direction of intensifying tasks, complicating the possibilities for their implementation, and multiplying the uncertainty of the efforts made.
 The purpose of the study. Assessing the professional choice of doctors in the context of COVID-19 when solving moral dilemmas.
 Material and methods. The total sample size was four hundred twenty nine people (doctors of various surgical and therapeutic specialties) aged of 25–32 years. All doctors had at least 1.5 years of practical experience in COVID-19 conditions. The study was conducted using a questionnaire developed by the author, containing 24 moral dilemmas related to professional decision-making.
 Results. Regardless of the doctor’s profile, professional choice is made in favour of patients of the same gender as the doctor. At the same time, both male and female doctors strive to save young patients (up to 50 years old) with chronic diseases. At the same time, it should be noted that the profile (therapeutic or surgical) of a doctor and his specialty also influence the criteria for choosing professional decisions. Clear criteria in the situation of moral choice have not been established only in the group of ophthalmologists.
 Limitations. Excluded from participation in the study were pediatricians and dentists, as well as doctors who lack professional experience in the context of COVID-19. 
 Conclusion. As a result of the study, it was found that regardless of the working conditions (in the red zone for COVID-19, in the green zone), both male and female doctors choose in favour of patients of the same gender. At the same time, doctors working in the red zone on COVID-19 make a professional choice in a situation of moral choice in favour of young patients of the same gender with chronic diseases. Physicians working in the green zone make the choice to rescue elderly patients of the same gender as physicians.

Treatment Outcomes for Patients With Amyotrophic Lateral Sclerosis Receiving Intravenous Edaravone From a Home and Alternative-Site Infusion Provider (P6-4.005)

<h3>Objective:</h3> To describe real-world treatment outcomes in patients with ALS treated with IV edaravone collected by a provider of home/alternative-site infusions. <h3>Background:</h3> Intravenous (IV) edaravone was US Food and Drug Administration approved in May 2017 after it was shown to slow the rate of physical functional decline in patients with amyotrophic lateral sclerosis (ALS). Information on real-world use of IV edaravone is limited. <h3>Design/Methods:</h3> A retrospective cohort study was conducted utilizing de-identified data collected from Amerita Specialty Infusion Services, a US-based provider of home/alternative-site infusions that has treated and collected data from patients with ALS receiving IV edaravone since the time of commercial availability. Patients with ALS who received their first IV edaravone dose between September 25, 2017, and December 31, 2020, were included. Patient status was confirmed through March 31, 2021. Variables collected included patient demographics, revised ALS Functional Rating Scale (ALSFRS-R) and forced vital capacity (FVC) scores, and treatment outcomes. <h3>Results:</h3> Patients (N=153) receiving IV edaravone were included in this analysis; 66.0% were male, mean±SD age was 61.4±10.8 years, and 27.5% were covered by commercial insurance. In patients who had healthcare provider-recorded ALSFRS-R (n=61) and FVC (n=38) assessed ±100 days from start of care, mean±SD scores were 33.7±9.3 and 66%±24%, respectively. At the end of the study period, 105 (68.6%) patients had discontinued treatment. The most frequent reason for discontinuation was death/hospice (42.9%), doctor choice (19.0%), patient choice (18.1%), and insurance/care change (14.3%). Mean±SD treatment duration for patients who discontinued was 314±260 days. As of March 31, 2021, 48 (31.4%) patients were still receiving treatment with IV edaravone and their mean±SD treatment duration was 446±292 days. <h3>Conclusions:</h3> This analysis describes treatment outcomes in IV edaravone-treated patients with ALS in a real-world setting. This information may be useful to clinicians who prescribe IV edaravone for patients with ALS. <b>Disclosure:</b> Mrs. Da Silva has nothing to disclose. Malgorzata Ciepielewska has received personal compensation for serving as an employee of Mitsubishi Tanable Pharma America . Mr. Do has nothing to disclose. Miss Anderson has nothing to disclose. Mrs. Martin has received personal compensation for serving as an employee of Amerita Specialty Infusion. Dr. Ortlip has nothing to disclose.

¿Qué determina la elección público-privada en la sanidad española?

Introduction and objectivesThe aim of the study was to analyze, which individual characteristics (sociodemographic, attitudinal and political factors) mediates in the choice in Spain in 2022, of a private versus public health care alternative for family doctor, doctor specialist, hospital admissions and emergencies. MethodsUsing the health barometers of the Centro de Investigaciones Sociológicas (CIS), we carried out four logistic regressions (then, average marginal effects [AMEs]) whose dependent variables are the preference for a private choice of family doctor versus a public one, the preference for a private choice of doctor specialist versus a public one; the preference for a private choice of hospital admission versus a public one and the preference for a private choice of emergency admission versus a public one. The dependent variables are binary (1=private; 0=public). The sample consisted of more than 4,500 individuals older than 18years old distributed representatively throughout Spain. ResultsThe probability of choosing private rather than public is correlated with the age of the individual: those over 50years are less likely to opt for a private alternative (P<.01), as well as by ideology and satisfaction with the way that the national health system (NHS) works. Patients with a conservative ideology are more likely to choose private options (P<.01) and individuals with greater satisfaction with the NHS are less likely to choose private ones (P<.01). ConclusionsSatisfaction with the NHS and patient ideology are the most relevant factors for private versus public choice.

Female birth companion for labor support: Perception and experience of health care providers

Background: The International Childbirth Initiatives aims to provide a respectful, evidence-based, and positive birthing experience to women. So, it is important that the women are counseled well before, during the antenatal period, and during labor and are given a choice of companion, doctor, hospital, and choice of her alternative birthing position. The aim was to assess the perceptions and experience of healthcare providers with the presence of a female Birth Companion (BC) for labor support. Method: A mixed-method observational study was conducted. The laboring women included in the study were mostly from rural areas, as the tertiary care hospital is situated in a rural area. Perceptions and experiences of health providers about 213 BCs were collected. The validated questionnaire was used to assess the perceptions of health providers through Google form. The information was downloaded as a Comma Separated Values (CSV) file. Data was analysed using Microsoft Excel. Result: On evaluating the responses to each BC, 92.95% senior nurses were highly beneficial, 4.6% were somewhat beneficial, and 2.34% were not beneficial. The junior nurses were of the opinion that 79.81% were highly beneficial, 16.9% were somewhat beneficial, and 3.28% were not beneficial. Junior resident doctors said that 77.46% were highly beneficial, 19.71% were somewhat beneficial, and 2.81% were not beneficial. The senior resident doctors said that they were highly beneficial 86.38%, 11.73% were somewhat beneficial, and 1.87% were not beneficial. Most healthcare providers' perceived that BC gave physical,emotional support and confidence to laboring women. Some health providers had challenges like rude behavior,inattentiveness, and disturbing behavior of BCs. Conclusion: Most of the BCs during continuous laboring support were highly beneficial as per the perceptions and experience of the health care providers.

Is the criminalization of informal payment a good idea? The role of the free choice of physician in the elimination of the phenomenon

In Hungary, the new act on the employment status of health workers aims at the elimination of informal payments by the strict separation of public and private care, by a significant increase of the salary of medical doctors and with the criminalization of giving and accepting informal payments. In this study, which is based on our former research, an analysis of the Hungarian judicial practice and an internet research focused on obstetrics, we examine whether the chosen tools are appropriate to achieve this goal, and if not, how the provisions of law should be modified. Both the theoretical considerations and the empirical evidence suggest that the approach the act took is wrong, because the majority of patients are not paying to compensate the doctors for their low salary. Patients pay because they think that they will not get the necessary care without it. This fee-for-service type informal payment is not corruption and it originates from health system shortages, which is not addressed by the act. On the contrary, the full implementation of the provisions of the act might even increase these shortages, which paradoxically can lead to the amplification of the phenomenon. According to the international experiences, long-term measures aiming at the easing of shortages, in themselves, are not sufficient to roll back this undesirable phenomenon, if they are not coupled with a short-term quick fix intervention, which creates a formal substitution mechanism allowing patients to buy the services associated with informal payments legally. The free choice of doctor is perceived to be an additional service to be paid for by the majority of patients and doctors, despite that, according to the current regulations, it is part of the public benefit package and should be available free of charge. Hence, informal payments could be formalized in the frame of the free choice of doctor and health care provider by making it a chargeable service. Such an approach is not unfamiliar in the Hungarian health policy, judicial practice, and even private obstetric care. Moreover, there is a government-supported obstetric model program in the public system in Hungary, where an explicit goal is to replace informal payments with formal fees to be paid by the patients for the free choice of the obstetrician who attends the delivery. All of these seem to be realistic starting points to introduce a technically and politically feasible pilot project, but the detailed regulations should be designed so that the involved health workers have no financial interest to discriminate against non-paying patients. To achieve this, we recommend that the attending physicians are also paid a fee even if they care for a patient, who did not choose them and pay them out of pocket, but live in the catchment area of the health service delivery organization, which is obliged to care for the local residents. Obviously, the source of this fee, which is eventually a performance-based component of the income of physicians, in this case, has to be the social health insurance scheme.

Internal or External Word-of-Mouth (WOM), Why Do Patients Choose Doctors on Online Medical Services (OMSs) Single Platform in China?

(1) Background: Word-of-mouth (WOM) can influence patients’ choice of doctors in online medical services (OMSs). Previous studies have explored the relationship between internal WOM in online healthcare communities (OHCs) and patients’ choice of doctors. There is a lack of research on external WOM and position ranking in OMSs. (2) Methods: We develop an empirical model based on the data of 4435 doctors from a leading online healthcare community in China. We discuss the influence of internal and external WOM on patients’ choice of doctors in OMSs, exploring the interaction between internal and external WOM and the moderation of doctor position ranking. (3) Results: Both internal and external WOM had a positive impact on patients’ choice of doctors; there was a significant positive interaction between internal and third-party generated WOM, but the interaction between internal and relative-generated WOM, and the interaction between internal and doctor-generated WOM were both nonsignificant. The position ranking of doctors significantly enhanced the impact of internal WOM, whereas it weakened the impact of doctor recommendations on patients’ choice of doctors. (4) The results emphasize the importance of the research on external WOM in OMSs, and suggest that the moderation of internal WOM may be related to the credibility and accessibility of external WOM, and the impact of doctor position ranking can be explained by information search costs.

Provincializing bioethics

ABSTRACTSince the 1980s, anthropologists have criticized a US‐centric view of bioethics that presents individual autonomy as a universal principle without acknowledging its embeddedness in time and place. A recent turn in this critique points out how this view has gained dominance across the world, traveling alongside clinical trials and global health interventions. Here, centering a competing bioethical vision disrupts this division between the Global North as a site of ethical conceptualization and the South as the recipient of its diffusion. Indian legal bioethics—concerned with protecting the critically ill body in intensive care—rejects the primacy of autonomy, instead empowering courts to override the choices of patients, families, and doctors. This competing bioethics commits its own harms, misrepresenting vulnerability as a problem of sociomoral underdevelopment rather than as the outcome of increasing inflows of global capital, new patterns of land acquisition, and a growing public‐private health care divide. [bioethics, end of life, norms, ethics, medicine, law, intensive care, Delhi, India]

Exit, voice or neglect: Understanding the choices faced by doctors experiencing barriers to leading health system change through the case of Sierra Leone

This paper presents a study from Sierra Leone that explored the experiences of doctors as they endeavored to improve the health care systems in which they worked. Twenty-eight interviews were conducted with doctors in Sierra Leone, complemented by long-standing experience of national health provision and research by the authors. Drawing on Hirschman's theory of ‘exit, voice and loyalty’, the paper's framework analysis elaborates the doctor's career decisions and choices under systematic political and economic constraints, and in particular, the specter of retribution, including posting to undesirable jobs and withholding of salaries. This retribution was considered a driver of exit by doctors from the system, and few examples were given of doctors successfully advocating for change through advocacy (‘voice’). We suggest that the relevance of Hirschman's theory to this setting is in drawing attention to the critical themes of retribution, opportunity, loyalties, and partial exits, ones often neglected in efforts to reduce emigration of doctors and strengthen their leadership. Ultimately, this paper critiques the overemphasis of mechanistic ‘capacity building’ in global health and recommends that health system strengthening must be viewed as a jointly political as well as technical exercise.

Health Insurance Ad Messages Targeted to English- and Spanish-Speaking Populations in a Period of Limited Federal Investment in Marketplace Outreach.

Federal funding cuts to enrollment outreach and marketing of the Affordable Care Act (ACA) marketplace options in 2017 has raised questions about the adequacy of the information the public has received, especially among populations vulnerable to uninsurance. Using health insurance ads aired from January 1, 2018, through December 21, 2018, we conducted a content analysis focused on (a) the messaging differences by ad language (English vs. Spanish) and (b) the messaging appeals used by nonfederally sponsored health insurance ads in 2018. The results reveal that privately sponsored ads focused on benefit appeals (e.g., prescription drugs), while publicly sponsored ads emphasized financial assistance subsidies. Few ads, regardless of language, referenced the ACA explicitly and privately sponsored Spanish-language ads emphasized benefits (e.g., choice of doctor) over enrollment-relevant details. This study emphasizes that private-sponsored television marketing may not provide specific and actionable health insurance information to the public, especially for the Spanish-speaking populations.

Методологические проблемы нравственного воспитания в медицинском университете

The article tells instructive stories that might be useful for discussingthe optimal moral choice for both future doctors and their patients. The author consider morality through a system of values that reminds that a part cannot be larger than the whole, re-spectively, a person as part of a social organism finds a harmonious existence with the whole through moral reflection, personally choosing between benefit and harm, between good and evil.

Lurking or active? The influence of user participation behavior in online mental health communities on the choice and evaluation of doctors

Background: Web-based psychological counseling sites have become an important source of health information and expert assistance. Although many studies have suggested the feasibility and effectiveness of online consultation, there is an insufficient understanding of the influence of the distinction of users' participation behaviors online on health behavior decision-making.Objective: This study aimed to investigate whether and how the differences in the online participation behaviors of users affect their doctor selection and evaluation characteristics.Methods: First, we collected information from 7,781 paid consultation clients from a professional mental health service platform in China. Effective indicators and variables were formed through data cleaning and classification. Next, we used a mixed methods research approach that included qualitative text analysis (topic and sentiment) and quantitative statistical analysis (ANOVA).Results: The ANOVA results show that differences in online participation behaviors (diving, searching and socializing) have a significant impact on doctor selection based on consultation price (F7,780=6.05; P = 0.00), online service volume (F7,780=4.76; P = 0.00), online reputation (F7,780=4.30; P = 0.01) and online answers (F7,780=5.76; P = 0.00). When evaluating doctors, the frequency of reviews (F7,780=69.62; P = 0.00) and the average length of the text (F7,780=15.33; P = 0.00) were significantly different among users. Two of the three topics, namely, service attitude (F7,780=28.63; P = 0.00) and self-expression (F7,780=40.83; P = 0.00), had significant effects. In addition, our results show that differences in participating behaviors have a significant impact on both the positive (F7,780=7.30; P = 0.00) and negative (F7,780=9.44; P = 0.00) emotions involved in evaluating doctors.Conclusions: Our findings provide preliminary insights for establishing the relationship between users' online information behavior and health decision-making. Further research should be conducted to verify the validity of the results and help apply them to the design of personalized customized services for the users in an online health community.

Efficacy and safety of raltitrexed plus S-1 versus regorafenib in patients with refractory metastatic colorectal cancer: a real-world propensity score matching study.

Background:Raltitrexed plus S-1 (RS) and regorafenib both showed considerable efficacy for metastatic colorectal cancer (mCRC) patients. This study aims to compare the effectiveness and safety of two different regimens in patients with refractory mCRC.Methods:This retrospective cohort study included mCRC patients who were treated with RS or regorafenib from February 2017 to June 2021. A propensity score matching (PSM) analysis was conducted to balance the baseline characteristics of all patients. Progression-free survival (PFS), overall survival (OS), tumor response, and safety of two regimens were evaluated.Results:A total of 187 patients were included in our study, with 107 patients in the RS group and 80 patients in the regorafenib group. After PSM, 78 pairs were recognized. Patients treated with RS had a semblable PFS compared to those treated with regorafenib before PSM (4.8 months vs 5.5 months, p = 0.400) and after PSM (4.7 months vs 5.4 months, p = 0.430). Patients in the RS group were associated with a longer OS than those in the regorafenib group (13.4 months vs 10.1 months, p = 0.010). A similar trend of OS was also obtained in the matched cohort (13.3 months vs 10.0 months, p = 0.024). Both objective response rate (12.8% vs 5.1%, p = 0.093) and disease control rate (53.8% vs 46.2%, p = 0.337) in the RS cohort were higher than those in the regorafenib group, without significant differences. Adverse events (AEs) of each group were well tolerated.Conclusion:Patients treated with RS demonstrated a longer OS than those treated with regorafenib and had manageable AEs, which could be recognized as a primary choice for refractory mCRC.Plain Language SummaryEfficacy and Safety of Raltitrexed plus S-1 Versus Regorafenib in Patients with Refractory Metastatic Colorectal Cancer: A Real-world Propensity Score Matching StudyBoth raltitrexed plus S-1 (RS) and regorafenib showed considerable efficacy for metastatic colorectal cancer (mCRC) patients. No study has compared the two regimens yet. Therefore, we compare the efficacy and safety between RS and regorafenib to provide an optimal treatment option. We retrospectively included patients with mCRC who failed at least two standard treatments. All enrolled patients received RS or regorafenib treatments. We conducted a propensity score matching to eliminate differences in the enrolled patients. After the analysis, we found no significant differences in progression-free survival in patients between the two groups. However, patients treated with RS had a longer OS than those treated with regorafenib, whether before matching (13.4 months vs 10.1 months, p = 0.010) or after matching (13.3 months vs 10.0 months, p = 0.024). In addition, the adverse effects caused by cancer-related therapy were tolerable for the patient. Certainly, this is a non-randomized retrospective study with a small sample size, so we conducted a propensity score matching to minimize potential bias. Importantly, this is the first research comparing the two treatments, and we believe that the results of this article could present a primary choice for clinical doctors dealing with patients with standard treatments that failed mCRC.

Brain White Matter Microstructure as a Risk Factor for Cognitive Decline After Chemotherapy for Breast Cancer.

Cognitive decline is frequently observed after chemotherapy. As chemotherapy is associated with changes in brain white matter microstructure, we investigated whether white matter microstructure before chemotherapy is a risk factor for cognitive decline after chemotherapy. Neuropsychologic tests were administered before and 6 months (n = 49), 2 years (n = 32), and 3 years (n = 32) after chemotherapy in patients with breast cancer receiving anthracycline-based chemotherapy (BC + CT group), at matched intervals to patients with BC who did not receive systemic therapy (BC - CT group: n = 39, 23, and 19, respectively) and to no-cancer controls (NC group: n = 37, 29, and 28, respectively). Using multivariate normative comparison, we evaluated to what extent the cognitive profiles of patients deviated from those of controls. Fractional anisotropy (FA), derived from magnetic resonance diffusion tensor imaging, was used to measure white matter microstructure before treatment. FA was evaluated as a risk factor for cognitive decline, in addition to baseline age, fatigue, cognitive complaints, and premorbid intelligence quotient. We subsequently ran voxel-wise diffusion tensor imaging analyses to investigate white matter microstructure in specific nerve tracts. Low FA independently predicted cognitive decline early (6 months, P = .013) and late (3 years, P < .001) after chemotherapy. FA did not predict cognitive decline in the BC - CT and NC groups. Voxel-wise analysis indicated involvement of white matter tracts essential for cognitive functioning. Low FA may reflect low white matter reserve. This may be a risk factor for cognitive decline after chemotherapy for BC. If validated in future trials, identification of patients with low white matter reserve could improve patient care, for example, by facilitating targeted, early interventions or even by influencing choices of patients and doctors for receiving chemotherapy.