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"Decision model"

Xiao Wu, Ajay Malhotra, Bertie Geng, Vivek B Kalra, Khalid Abbed, Howard P Forman, Pina Sanelli
Importance: Magnetic resonance imaging (MRI) continues to be performed for cervical clearance of obtunded blunt trauma, despite poor evidence regarding its utility after a normal computed tomographic (CT) finding. Objective: To evaluate the utility and cost-effectiveness of MRI vs no follow-up after a normal cervical CT finding in patients with obtunded blunt trauma. Design, Setting and Participants: This cost-effectiveness analysis evaluated an average patient aged 40 years with blunt trauma from an institutional practice...
March 14, 2018: JAMA Surgery
Jacqueline Murphy, Mark G Pritchard, Lok Yin Cheng, Roshni Janarthanan, José Leal
INTRODUCTION: Hip and knee replacement represents a significant burden to the UK healthcare system. 'Enhanced recovery' pathways have been introduced in the National Health Service (NHS) for patients undergoing hip and knee replacement, with the aim of improving outcomes and timely recovery after surgery. To support policymaking, there is a need to evaluate the cost-effectiveness of enhanced recovery pathways across jurisdictions. Our aim is to systematically summarise the published cost-effectiveness evidence on enhanced recovery in hip and knee replacement, both as a whole and for each of the various components of enhanced recovery pathways...
March 14, 2018: BMJ Open
Bronwyn K Clark, Elisabeth A Winkler, Charlotte L Brakenridge, Stewart G Trost, Genevieve N Healy
BACKGROUND: Most wearable devices that measure movement in workplaces cannot determine the context in which people spend time. This study examined the accuracy of Bluetooth sensing (10-second intervals) via the ActiGraph GT9X Link monitor to determine location in an office setting, using two simple, bespoke algorithms. METHODS: For one work day (mean±SD 6.2±1.1 hours), 30 office workers (30% men, aged 38±11 years) simultaneously wore chest-mounted cameras (video recording) and Bluetooth-enabled monitors (initialised as receivers) on the wrist and thigh...
2018: PloS One
Akanksha Juneja, Bharti Rana, R K Agrawal
BACKGROUND AND OBJECTIVES: Schizophrenia is a severe brain disorder primarily diagnosed through externally observed behavioural symptoms due to the dearth of established clinical tests. Functional magnetic resonance imaging (fMRI) can capture the distortions caused by schizophrenia in the brain activation. Hence, it can be useful for developing a decision model that performs computer-aided diagnosis of schizophrenia. But, fMRI data is huge in dimension. Therefore dimension reduction is indispensable...
March 2018: Computer Methods and Programs in Biomedicine
Xudong Chen, Zhongwen Xu, Liming Yao, Ning Ma
This study considers the two factors of environmental protection and economic benefits to address municipal sewage treatment. Based on considerations regarding the sewage treatment plant construction site, processing technology, capital investment, operation costs, water pollutant emissions, water quality and other indicators, we establish a general multi-objective decision model for optimizing municipal sewage treatment plant construction. Using the construction of a sewage treatment plant in a suburb of Chengdu as an example, this paper tests the general model of multi-objective decision-making for the sewage treatment plant construction by implementing a genetic algorithm...
March 5, 2018: International Journal of Environmental Research and Public Health
Julian F Guest, Heenal Singh, Peter Vowden
OBJECTIVE: To estimate whether a collagen-containing dressing could potentially afford the UK's National Health Service (NHS) a cost-effective intervention for the management of diabetic foot ulcers (DFUs). METHOD: A decision model depicting the management of a DFU was constructed and populated with a combination of published clinical outcomes, resource use estimates and utilities for DFUs. The model estimated the incremental cost-effectiveness of a collagen-containing dressing plus standard care compared with standard care alone over a period of four months in terms of the incremental cost per quality-adjusted life year (QALY) gained...
March 2, 2018: Journal of Wound Care
Mary Sawtell, Lorna Sweeney, Meg Wiggins, Cathryn Salisbury, Sandra Eldridge, Lauren Greenberg, Rachael Hunter, Inderjeet Kaur, Christine McCourt, Bethan Hatherall, Gail Findlay, Joanne Morris, Sandra Reading, Adrian Renton, Ruth Adekoya, Belinda Green, Belinda Harvey, Sarah Latham, Kanta Patel, Logan Vanlessen, Angela Harden
BACKGROUND: The provision of high-quality maternity services is a priority for reducing inequalities in health outcomes for mothers and infants. Best practice includes women having their initial antenatal appointment within the first trimester of pregnancy in order to provide screening and support for healthy lifestyles, well-being and self-care in pregnancy. Previous research has identified inequalities in access to antenatal care, yet there is little evidence on interventions to improve early initiation of antenatal care...
March 5, 2018: Trials
Roger Ratcliff, Chelsea Voskuilen, Andrei Teodorescu
We present a model-based analysis of two-alternative forced-choice tasks in which two stimuli are presented side by side and subjects must make a comparative judgment (e.g., which stimulus is brighter). Stimuli can vary on two dimensions, the difference in strength of the two stimuli and the magnitude of each stimulus. Differences between the two stimuli produce typical RT and accuracy effects (i.e., subjects respond more quickly and more accurately when there is a larger difference between the two). However, the overall magnitude of the pair of stimuli also affects RT and accuracy...
March 1, 2018: Cognitive Psychology
V Schetinin, L Jakaite, W Krzanowski
INTRODUCTION: For making reliable decisions, practitioners need to estimate uncertainties that exist in data and decision models. In this paper we analyse uncertainties of predicting survival probability for patients in trauma care. The existing prediction methodology employs logistic regression modelling of Trauma and Injury Severity Score (TRISS), which is based on theoretical assumptions. These assumptions limit the capability of TRISS methodology to provide accurate and reliable predictions...
April 2018: International Journal of Medical Informatics
Jason D Wright, Laura J Havrilesky, David E Cohn, Yongmei Huang, Jill Rathbun, Laurel W Rice, Carol L Brown, Ronald D Alvarez, Emily M Ko
OBJECTIVE: To design an endometrial cancer (EC) alternative payment (ECAP) model focused on surgical management of EC, as well as identify drivers of cost in order to develop opportunities for cost-savings while maintaining quality of care. METHODS: National practice patterns and reimbursements were compared between private payers (MarketScan data, years 2009-13) and public payers (Medicare, year 2014) of EC patients who underwent hysterectomy. An episode of care for EC included the hysterectomy, stratified by surgical approach (laparotomy versus robotic versus laparoscopy), and in- and outpatient reimbursements from 30days preoperatively to 60days postoperatively...
February 26, 2018: Gynecologic Oncology
Grace Baik, Scott E Brietzke
Objectives To use decision analysis modeling to compare utility and cost outcomes of intracapsular tonsillectomy (ICT) and extracapsular tonsillectomy (ECT). To use sensitivity analysis to determine the most important factors influencing outcomes favoring one surgical method versus another. Study Design Decision analysis model. Setting Hypothetical cohort. Subjects and Methods A decision analysis model was created with computer software comparing the results of ICT and ECT. The model featured complications with completion tonsillectomy, such as postsurgical bleed, dehydration, and tonsillar regrowth...
February 1, 2018: Otolaryngology—Head and Neck Surgery
Pim Wetzelaer, Tim Bouwens VAN DER Vlis, Mehmet Tönge, Linda Ackermans, Pieter Kubben, Silvia Evers, Ersoy Kocabiçak, Yasin Temel
AIM: One of the most distressing hardware-related complications of deep brain stimulation is an infection. These infections can be either treated with antibiotics or with removal of the infected hardware followed by reimplantation. In our experience the success of antibiotic therapy was about 50%. Here, we have investigated the costs of treating the infection with antibiotics only with the risk of surgery when unsuccessful versus immediate removal followed by reimplantation. MATERIAL AND METHODS: We calculated the costs of the different strategies through a standard costing procedure...
January 22, 2018: Turkish Neurosurgery
Blayne Welk, Wanrudee Isaranuwatchai, Andrei Krassioukov, Louise Husted Torp, Dean Elterman
STUDY DESIGN: A Markov model was used to analyze cost-effectiveness over a lifetime horizon. OBJECTIVE: To investigate the cost-effectiveness of hydrophilic-coated intermittent catheters (HCICs) compared with uncoated catheters (UCs) among individuals with neurogenic bladder dysfunction (NB) due to spinal cord injury (SCI). SETTING: A Canadian public payer perspective based on data from Ontario; including a scenario analysis from the societal perspective...
February 20, 2018: Journal of Medical Economics
Kivilcim Afacan-Seref, Natalie A Steinemann, Annabelle Blangero, Simon P Kelly
In dynamic environments, split-second sensorimotor decisions must be prioritized according to potential payoffs to maximize overall rewards. The impact of relative value on deliberative perceptual judgments has been examined extensively [1-6], but relatively little is known about value-biasing mechanisms in the common situation where physical evidence is strong but the time to act is severely limited. In prominent decision models, a noisy but statistically stationary representation of sensory evidence is integrated over time to an action-triggering bound, and value-biases are affected by starting the integrator closer to the more valuable bound...
February 12, 2018: Current Biology: CB
Julian F Guest, Karan Rana, Heenal Singh, Peter Vowden
OBJECTIVE: To estimate whether collagen-containing dressings could potentially afford the UK's National Health Service (NHS) a cost-effective intervention for the management of non-healing venous leg ulcers (VLUs). METHOD: This was a modelling study performed from the perspective of the UK's NHS. A combination of published clinical outcomes, resource utilisation estimates and utilities for VLUs enabled the construction of a decision model, depicting the management of a chronic VLU with standard care or with a collagen-containing dressing plus compression therapy followed by standard care, over a period of 6 months...
February 2, 2018: Journal of Wound Care
Kyle Zanocco, David J Kaltman, James X Wu, Abbey Fingeret, Keith S Heller, James A Lee, Michael W Yeh, Julie Ann Sosa, Cord Sturgeon
BACKGROUND: Some surgeons perform flexible fiberoptic laryngoscopy (FFL) in all patients prior to thyroid cancer operations. Given the low likelihood of recurrent laryngeal nerve (RLN) or aerodigestive invasion in clinically low-risk thyroid cancers, the value of routine FFL in this group is controversial. We hypothesized that routine preoperative FFL would not be cost effective in low-risk differentiated thyroid cancer (DTC). METHODS: A decision model was constructed comparing preoperative FFL versus surgery without FFL in a clinical stage T2 N0 DTC patient without voice symptoms...
February 7, 2018: Annals of Surgical Oncology
Bernadette Li, Alec Miners, Haleema Shakur, Ian Roberts
BACKGROUND: Sub-Saharan Africa and southern Asia account for almost 85% of global maternal deaths from post-partum haemorrhage. Early administration of tranexamic acid, within 3 h of giving birth, was shown to reduce the risk of death due to bleeding in women with post-partum haemorrhage in the World Maternal Antifibrinolytic (WOMAN) trial. We aimed to assess the cost-effectiveness of early administration of tranexamic acid for treatment of post-partum haemorrhage. METHODS: For this economic evaluation we developed a decision model to assess the cost-effectiveness of the addition of tranexamic acid to usual care for treatment of women with post-partum haemorrhage in Nigeria and Pakistan...
February 2018: Lancet Global Health
Heiner Stuke, Veith Andreas Weilnhammer, Philipp Sterzer, Katharina Schmack
Predictive coding theories state an aberrant weighting of prior beliefs and present sensory information as a core computational pathology in psychosis. Specifically, it has been proposed that the influence of prior beliefs which attenuate improbable sensory information is weakened, resulting in an overweighing of this potentially misleading information. However, it is currently unclear whether this alteration is specific to perceptual processes or whether it represents a more pervasive deficit that extends to cognitive processes...
January 20, 2018: Schizophrenia Bulletin
Vida Hamidi, Elisabeth Couto, Tove Ringerike, Marianne Klemp
Background: Several disease-modifying drug therapies are available for the treatment of multiple sclerosis (MS). To ensure the most appropriate MS management, we assessed the effectiveness and cost-effectiveness of the disease-modifying medicines used for MS. Methods: We conducted a systematic review including 11 disease-modifying drugs used for treatment of adult patients diagnosed with relapsing-remitting MS. We performed a network meta-analysis using both direct and indirect evidence...
February 2018: Journal of Clinical Medicine Research
Viktor Bergion, Andreas Lindhe, Ekaterina Sokolova, Lars Rosén
Waterborne outbreaks of gastrointestinal diseases can cause large costs to society. Risk management needs to be holistic and transparent in order to reduce these risks in an effective manner. Microbial risk mitigation measures in a drinking water system were investigated using a novel approach combining probabilistic risk assessment and cost-benefit analysis. Lake Vomb in Sweden was used to exemplify and illustrate the risk-based decision model. Four mitigation alternatives were compared, where the first three alternatives, A1-A3, represented connecting 25, 50 and 75%, respectively, of on-site wastewater treatment systems in the catchment to the municipal wastewater treatment plant...
December 27, 2017: Water Research
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