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      Interfield dysbalances in research input and output benchmarking: Visualisation by density equalizing procedures

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          Abstract

          Background

          Historical, social and economic reasons can lead to major differences in the allocation of health system resources and research funding. These differences might endanger the progress in diagnostic and therapeutic approaches of socio-economic important diseases. The present study aimed to assess different benchmarking approaches that might be used to analyse these disproportions. Research in two categories was analysed for various output parameters and compared to input parameters. Germany was used as a high income model country. For the areas of cardiovascular and respiratory medicine density equalizing mapping procedures visualized major geographical differences in both input and output markers.

          Results

          An imbalance in the state financial input was present with 36 cardiovascular versus 8 respiratory medicine state-financed full clinical university departments at the C4/W3 salary level. The imbalance in financial input is paralleled by an imbalance in overall quantitative output figures: The 36 cardiology chairs published 2708 articles in comparison to 453 articles published by the 8 respiratory medicine chairs in the period between 2002 and 2006. This is a ratio of 75.2 articles per cardiology chair and 56.63 articles per respiratory medicine chair. A similar trend is also present in the qualitative measures. Here, the 2708 cardiology publications were cited 48337 times (7290 times for respiratory medicine) which is an average citation of 17.85 per publication vs. 16.09 for respiratory medicine. The average number of citations per cardiology chair was 1342.69 in contrast to 911.25 citations per respiratory medicine chair. Further comparison of the contribution of the 16 different German states revealed major geographical differences concerning numbers of chairs, published items, total number of citations and average citations.

          Conclusion

          Despite similar significances of cardiovascular and respiratory diseases for the global burden of disease, large input and output imbalances have been revealed in the present study which point to a need for changes in funding policies. The present study supplies data that could be used for decision making in the field of health systems funding.

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          A randomized comparison of a sirolimus-eluting stent with a standard stent for coronary revascularization.

          Marie-Claude Morice, Patrick W. Serruys, J. Eduardo Sousa … (2002)
          The need for repeated treatment of restenosis of a treated vessel remains the main limitation of percutaneous coronary revascularization. Because sirolimus (rapamycin) inhibits the proliferation of lymphocytes and smooth-muscle cells, we compared a sirolimus-eluting stent with a standard uncoated stent in patients with angina pectoris. We performed a randomized, double-blind trial to compare the two types of stents for revascularization of single, primary lesions in native coronary arteries. The trial included 238 patients at 19 medical centers. The primary end point was in-stent late luminal loss (the difference between the minimal luminal diameter immediately after the procedure and the diameter at six months). Secondary end points included the percentage of in-stent stenosis of the luminal diameter and the rate of restenosis (luminal narrowing of 50 percent or more). We also analyzed a composite clinical end point consisting of death, myocardial infarction, and percutaneous or surgical revascularization at 1, 6, and 12 months. At six months, the degree of neointimal proliferation, manifested as the mean (+/-SD) late luminal loss, was significantly lower in the sirolimus-stent group (-0.01+/-0.33 mm) than in the standard-stent group (0.80+/-0.53 mm, P<0.001). None of the patients in the sirolimus-stent group, as compared with 26.6 percent of those in the standard-stent group, had restenosis of 50 percent or more of the luminal diameter (P<0.001). There were no episodes of stent thrombosis. During a follow-up period of up to one year, the overall rate of major cardiac events was 5.8 percent in the sirolimus-stent group and 28.8 percent in the standard-stent group (P<0.001). The difference was due entirely to a higher rate of revascularization of the target vessel in the standard-stent group. As compared with a standard coronary stent, a sirolimus-eluting stent shows considerable promise for the prevention of neointimal proliferation, restenosis, and associated clinical events.
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            Sildenafil for treatment of lung fibrosis and pulmonary hypertension: a randomised controlled trial.

            Horst Olschewski, Ralf T Schermuly, Falk Wiedemann … (2002)
            Lung fibrosis can be complicated by pulmonary hypertension, limiting exercise tolerance and life expectancy. Furthermore, vasodilators might cause deterioration in gas exchange. Our aim was to compare acute effects of sildenafil, nitric oxide, and epoprostenol in individuals with pulmonary hypertension secondary to lung fibrosis. We did a randomised controlled, open-label trial, in 16 individuals admitted to our hospital with pulmonary hypertension secondary to lung fibrosis. After inhalation of nitric oxide (10-20 ppm), we assigned patients to either maximum tolerated dose of intravenous epoprostenol (mean 8.0 ng/kg per min; n=8) or oral sildenafil (50 mg; n=8). Our primary objective was to assess pulmonary vasodilative potency (decrease in pulmonary vascular resistance index) of sildenafil by comparison with inhaled nitric oxide and infused epoprostenol. Analyses were by intention to treat. Pulmonary vascular resistance index was reduced by nitric oxide (-21.9%, 95% CI -14.1 to -36.2), epoprostenol (-36.9%, -24.4 to -59.6), and sildenafil (-32.5%, -10.2 to -54.1). However, ratio of pulmonary to systemic vascular resistance decreased only in individuals who received nitric oxide and sildenafil. Baseline measurement of multiple-inert-gas elimination showed right-to-left shunt flow (4.8%, 0.0-28.2) and little perfusion of low ventilation(V)/perfusion(Q) areas (0.1%, 0.0-13.0). Prostacyclin increased V/Q mismatch (shunt 16.8%, 10.8-35.9; low V/Q 3.8%, 0.0-13.0) and decreased arterial oxygenation. By contrast, nitric oxide (4.5%, 0.0-18.0; 0.0%, 0.0-17.3) and sildenafil (3.3%, 0.0-11.3; 0.0%, 0.0-12.4) maintained V/Q matching, with raised arterial partial pressure of oxygen (14.3 mm Hg, -1.7 to 31.3) noted for sildenafil. We recorded no adverse events. Sildenafil causes preferential pulmonary vasodilation and improves gas exchange in patients with severe lung fibrosis and secondary pulmonary hypertension.
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              Diffusion-based method for producing density equalizing maps

              , (2004)
              Map makers have long searched for a way to construct cartograms -- maps in which the sizes of geographic regions such as countries or provinces appear in proportion to their population or some other analogous property. Such maps are invaluable for the representation of census results, election returns, disease incidence, and many other kinds of human data. Unfortunately, in order to scale regions and still have them fit together, one is normally forced to distort the regions' shapes, potentially resulting in maps that are difficult to read. Many methods for making cartograms have been proposed, some of them extremely complex, but all suffer either from this lack of readability or from other pathologies, like overlapping regions or strong dependence on the choice of coordinate axes. Here we present a new technique based on ideas borrowed from elementary physics that suffers none of these drawbacks. Our method is conceptually simple and produces useful, elegant, and easily readable maps. We illustrate the method with applications to the results of the 2000 US presidential election, lung cancer cases in the State of New York, and the geographical distribution of stories appearing in the news.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Int J Health Geogr
                Title: International Journal of Health Geographics
                Publisher: BioMed Central
                ISSN (Electronic): 1476-072X
                Publication date Collection: 2008
                Publication date (Electronic): 25 August 2008
                Volume: 7
                Page: 48
                Affiliations
                [1 ]Otto-Heubner-Centre, Charité-Universitätsmedizin Berlin, Free University Berlin and Humboldt-University Berlin, Germany
                [2 ]Department of Respiratory Medicine, Hannover Medical School, Hannover, Germany
                [3 ]Institute of Occupational Medicine, Charité-Universitätsmedizin Berlin, Free University Berlin and Humboldt-University Berlin, Germany
                Article
                Publisher ID: 1476-072X-7-48
                DOI: 10.1186/1476-072X-7-48
                PMC ID: 2533656
                PubMed ID: 18724868
                SO-VID: 89dd9c9c-cb54-4f4c-9d29-78a9679ca6c2
                Copyright © Copyright © 2008 Groneberg-Kloft et al; licensee BioMed Central Ltd.
                License:

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Date received : 13 June 2008
                Date accepted : 25 August 2008
                Categories
                Subject: Research

                ScienceOpen disciplines: Public health
                Data availability:
                ScienceOpen disciplines: Public health

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