Management and patient survival in hepatocellular carcinoma: Does the physician's level of experience matter?

Chen, Tsung-Ming; Chang, Tzu-Ming; Huang, Pi‐Teh; Tsai, Ming-Hung; Lin, Lien‐Fu; Liu, Chung-Cheng; Ho, Ka-Sic; Siauw, Chuan-Pau; Chao, Po-Liang; Tung, Jai-Nien

doi:10.1111/j.1440-1746.2008.05341.x

Cited by 13 publications

(14 citation statements)

References 30 publications

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“…3,24 We were able to confirm that baseline peripheral blood NLR, a biomarker comparing tumor inflammation and host immunity, was associated with increased mortality in early stage HCC patients undoing RFA. Therefore, we eliminated important confounders on cancer mortality such as difference in tumor stage, treatment decision and level of physician experience.…”

Section: Discussionmentioning

confidence: 69%

“…3,24 Artificial ascites creation by intra-peritoneal glucose water injection for lesions abutting visceral organ and abdominal wall were routinely performed after July 2008. 3,24 Artificial ascites creation by intra-peritoneal glucose water injection for lesions abutting visceral organ and abdominal wall were routinely performed after July 2008.…”

Section: Index Rfa For Initial Tumorsmentioning

confidence: 99%

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Neutrophil‐to‐lymphocyte ratio associated with mortality in early hepatocellular carcinoma patients after radiofrequency ablation

Chen

Lin

Huang

et al. 2012

J of Gastro and Hepatol

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124

105

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Section: Discussionmentioning

confidence: 69%

Section: Index Rfa For Initial Tumorsmentioning

confidence: 99%

Neutrophil‐to‐lymphocyte ratio associated with mortality in early hepatocellular carcinoma patients after radiofrequency ablation

Chen

Lin

Huang

et al. 2012

J of Gastro and Hepatol

Self Cite

124

105

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show abstract

“…A case-control study of NAFLD patients highlighted a potentially protective role for the Val227Ala variant of PPAR α against obesity compared to subjects with the wild-type receptor (Chen et al, 2008a). The adipocyte differentiation regulator, PPARγ, plays an important role in lipid homeostasis and insulin sensitivity by enhancing fatty acid and insulin-dependent glucose uptake in adipose tissue (Kallwitz et al, 2008).…”

Section: Nafld and Drug Dispositionmentioning

confidence: 99%

Molecular Interactions between NAFLD and Xenobiotic Metabolism

Belič¹,

Zanger²,

Rozman³

2013

Front. Gene.

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Non-alcoholic fatty liver disease (NAFLD), the hepatic manifestation of the metabolic syndrome, is a complex multifactorial disease characterized by metabolic deregulations that include accumulation of lipids in the liver, lipotoxicity, and insulin resistance. The progression of NAFLD to non-alcoholic steatohepatitis and cirrhosis, and ultimately to carcinomas, is governed by interplay of pro-inflammatory pathways, oxidative stress, as well as fibrogenic and apoptotic cues. As the liver is the major organ of biotransformation, deregulations in hepatic signaling pathways have effects on both, xenobiotic and endobiotic metabolism. Several major nuclear receptors involved in the transcription and regulation of phase I and II drug metabolizing enzymes and transporters also have endobiotic ligands including several lipids. Hence, hepatic lipid accumulation in steatosis and NAFLD, which leads to deregulated activation patterns of nuclear receptors, may result in altered drug metabolism capacity in NAFLD patients. On the other hand, genetic and association studies have indicated that a malfunction in drug metabolism can affect the prevalence and severity of NAFLD. This review focuses on the complex interplay between NAFLD pathogenesis and drug metabolism. A better understanding of these relationships is a prerequisite for developing improved drug dosing algorithms for the pharmacotherapy of patients with different stages of NAFLD.

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“…Another study showed that the experience of primary care physicians in managing patients with acquired immunodeficiency syndrome has been significantly associated with the survival of their patients [3]. Similarly, another study reported that the survival of patients with hepatocellular carcinoma depends on the level of experience of the physicians overseeing them [4]. An association of physician experience with tuberculosis and survival in patients with active tuberculosis has also been reported [5].…”

Section: Discussionmentioning

confidence: 94%

Outcomes of the patients in the respiratory care center are not associated with the seniority of the caring resident

Tsai

Huang

Wei

et al. 2012

The Kaohsiung J of Med Scie

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Although many studies show that the experience level of physicians is significantly associated with the outcomes of their patients, little evidence exists to show whether junior residents provide worse care than senior residents. This study was conducted to analyze whether the experience level of residents may affect the outcomes of patients cared for in a well-organized setting. We conducted a 7-year retrospective study utilizing statistical data from a respiratory care center (RCC) in a medical center between October 2004 and September 2011. In addition to the two medical residents who had been trained in the intensive care unit (ICU), the RCC team also included attending physicians in charge, a nurse practitioner, a case manager, a dietitian, a pharmacist, a social worker, registered respiratory therapists, and nursing staff. Weaning from mechanical ventilation was done according to an established weaning protocol. The 84 months analyzed were classified into five groups according to the levels of the two residents working in the RCC: R2 + R1, R2 + R2, R3 + R1, R3 + R2, and R3 + R3. The monthly weaning rate and mortality rate were the major outcomes, while the mean ventilator days, rate of return to the ICU, and nosocomial infection incidence rate were the minor outcomes. The groups did not differ significantly in the monthly weaning rate, mortality rate, mean ventilator days, rate of return to the ICU, or nosocomial infection incidence rate (p > 0.1). Further analysis showed no significant difference in the monthly weaning rate and mortality rate between months with a first-year resident (R1) and those with two senior residents (p > 0.2). Although the weaning rate in the RCC gradually improved over time (p < 0.001), there was no significant difference in the monthly weaning rate between the groups after adjusting for time and disease severity (p > 0.7). Thus, we concluded that in a well-organized setting, the levels (experiences) of residents did not significantly affect patient outcomes. This result may be attributed to the well-developed weaning protocol and teamwork processes in place, which avoid a large effect from any single factor and provide stable and high-quality care to the patients.

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Management and patient survival in hepatocellular carcinoma: Does the physician's level of experience matter?

Abstract: The survival of HCC patients was dependent on the level of experience of the physicians who oversaw these patients.

Cited by 13 publications

References 30 publications

Neutrophil‐to‐lymphocyte ratio associated with mortality in early hepatocellular carcinoma patients after radiofrequency ablation

Neutrophil‐to‐lymphocyte ratio associated with mortality in early hepatocellular carcinoma patients after radiofrequency ablation

Molecular Interactions between NAFLD and Xenobiotic Metabolism

Outcomes of the patients in the respiratory care center are not associated with the seniority of the caring resident

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