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"Decision analysis"

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https://www.readbyqxmd.com/read/27914099/discrepancies-between-multicriteria-decision-analysis-based-ranking-and-intuitive-ranking-for-pharmaceutical-benefit-risk-profiles-in-a-hypothetical-setting
#1
K Hoshikawa, S Ono
WHAT IS KNOWN AND OBJECTIVE: Multicriteria decision analysis (MCDA) has been generally considered a promising decision-making methodology for the assessment of drug benefit-risk profiles. There have been many discussions in both public and private sectors on its feasibility and applicability, but it has not been employed in official decision-makings. For the purpose of examining to what extent MCDA would reflect the first-hand, intuitive preference of evaluators in practical pharmaceutical assessments, we conducted a questionnaire survey involving the participation of employees of pharmaceutical companies...
December 2, 2016: Journal of Clinical Pharmacy and Therapeutics
https://www.readbyqxmd.com/read/27909972/can-we-estimate-short-and-intermediate-term-survival-in-patients-undergoing-surgery-for-metastatic-bone-disease
#2
Jonathan A Forsberg, Rikard Wedin, Patrick J Boland, John H Healey
BACKGROUND: Objective means of estimating survival can be used to guide surgical decision-making and to risk-stratify patients for clinical trials. Although a free, online tool ( www.pathfx.org ) can estimate 3- and 12-month survival, recent work, including a survey of the Musculoskeletal Tumor Society, indicated that estimates at 1 and 6 months after surgery also would be helpful. Longer estimates help justify the need for more durable and expensive reconstructive options, and very short estimates could help identify those who will not survive 1 month and should not undergo surgery...
December 1, 2016: Clinical Orthopaedics and related Research
https://www.readbyqxmd.com/read/27900760/choice-of-anaesthesia-for-category-1-caesarean-section-in-women-with-anticipated-difficult-tracheal-intubation-the-use-of-decision-analysis
#3
A J Krom, Y Cohen, J P Miller, T Ezri, S H Halpern, Y Ginosar
A predicted difficult airway is sometimes considered a contra-indication to rapid sequence induction of general anaesthesia, even in an urgent case such as a category-1 caesarean section for fetal distress. However, formally assessing the risk is difficult because of the rarity and urgency of such cases. We have used decision analysis to quantify the time taken to establish anaesthesia, and probability of failure, of three possible anaesthetic methods, based on a systematic review of the literature. We considered rapid sequence induction of general anaesthesia with videolaryngoscopy, awake fibreoptic intubation and rapid spinal anaesthesia...
November 30, 2016: Anaesthesia
https://www.readbyqxmd.com/read/27896680/what-does-a-shoulder-mri-cost-the-consumer
#4
Robert W Westermann, Cameron Schick, Christopher M Graves, Kyle R Duchman, Stuart L Weinstein
BACKGROUND: More than 100 MRIs per 1000 inhabitants are performed in the United States annually, more than almost every other country. Little is known regarding the cost of obtaining an MRI and factors associated with differences in cost. QUESTIONS/PURPOSES: By surveying all hospital-owned and independent imaging centers in Iowa, we wished to determine (1) the cost to the consumer of obtaining a noncontrast shoulder MRI, (2) the frequency and magnitude of discounts provided, and (3) factors associated with differences in cost including location (hospital-owned or independent) and Centers for Medicare & Medicaid Services designation (rural, urban, and critical access)...
November 28, 2016: Clinical Orthopaedics and related Research
https://www.readbyqxmd.com/read/27893924/deciding-how-best-to-treat-cartilage-defects
#5
Lucy Oliver-Welsh, Justin W Griffin, Maximilian A Meyer, Matthew E Gitelis, Brian J Cole
The decision-making regarding and treatment of cartilage abnormalities requires a systematic approach. This article reviews the concepts and principles that guide the management of this complex problem. The precise incidence, demographics, and progression of cartilage lesions have not been clearly delineated. Pursuing a patient-centered approach that considers the available nonsurgical and surgical options remains the cornerstone of patient care. The importance of determining concomitant knee pathologies, the proper interpretation and implications of imaging findings, and an accurate determination of the intra-articular and subchondral findings represent the primary elements of the decision analysis...
January 0: Orthopedics
https://www.readbyqxmd.com/read/27890646/laparoscopic-hysterectomy-with-morcellation-versus-abdominal-hysterectomy-for-presumed-fibroids-an-updated-decision-analysis-following-the-2014-fda-safety-communications
#6
Matthew T Siedhoff, Kemi M Doll, Daniel L Clarke-Pearson, Sarah E Rutstein
Previous decision analyses demonstrate the safety of minimally invasive hysterectomy for presumed benign fibroids, accounting for the risk of occult leiomyosarcoma and the differential mortality risk associated with laparotomy. Studies published since the 2014 Food and Drug Administration safety communications offer updated leiomyosarcoma incidence estimates. Incorporating these studies suggests that mortality rates are low following hysterectomy for presumed benign fibroids overall, and a minimally invasive approach remains a safe option...
November 24, 2016: American Journal of Obstetrics and Gynecology
https://www.readbyqxmd.com/read/27882469/influence-of-the-sso-astro-margin-reexcision-guidelines-on-costs-associated-with-breast-conserving-surgery
#7
C R Baliski, R E Pataky
BACKGROUND: The reported reexcision rates vary significantly for patients with invasive breast cancer undergoing breast-conserving surgery (BCS). This variability is a function of both the positive pathologic margin rate and the interpretation of an adequate pathologic margin. The influence of the SSO/ASTRO margin guidelines on reexcision rates and the potential cost savings is of interest from both quality and health economics perspectives. METHODS: A retrospective analysis of all patients undergoing BCS during a 3-year period (January 1, 2010-December 31, 2012) was performed...
November 23, 2016: Annals of Surgical Oncology
https://www.readbyqxmd.com/read/27862134/application-of-graph-theory-to-cost-effective-fire-protection-of-chemical-plants-during-domino-effects
#8
Nima Khakzad, Gabriele Landucci, Genserik Reniers
In the present study, we have introduced a methodology based on graph theory and multicriteria decision analysis for cost-effective fire protection of chemical plants subject to fire-induced domino effects. By modeling domino effects in chemical plants as a directed graph, the graph centrality measures such as out-closeness and betweenness scores can be used to identify the installations playing a key role in initiating and propagating potential domino effects. It is demonstrated that active fire protection of installations with the highest out-closeness score and passive fire protection of installations with the highest betweenness score are the most effective strategies for reducing the vulnerability of chemical plants to fire-induced domino effects...
November 10, 2016: Risk Analysis: An Official Publication of the Society for Risk Analysis
https://www.readbyqxmd.com/read/27861374/a-nomogram-for-predicting-the-likelihood-of-lymph-node-metastasis-in-early-gastric-signet-ring-cell-carcinoma-a-single-center-retrospective-analysis-with-external-validation
#9
Chun Guang Guo, Yan Jia Chen, Hu Ren, Hong Zhou, Ju Fang Shi, Xing Hua Yuan, Ping Zhao, Dong Bing Zhao, Gui Qi Wang
Treatment algorithm has not been established for early gastric cancer with signet ring cell carcinoma (SRC), which has a reported low rate of lymph node metastasis (LNM) similar to differentiated cancer. A cohort of 256 patients with early gastric SRC at our center between January 2002 and December 2015 were retrospectively reviewed. Multivariate logistic regression analysis was used to determine the independent factors of LNM. A nomogram for predicting LNM was constructed and internally validated. Additional external validation was performed using the database from Cancer Institute Ariake Hospital in Tokyo (n = 1273)...
November 2016: Medicine (Baltimore)
https://www.readbyqxmd.com/read/27861253/cry-wolf-and-inflate-medical-urgency-to-expedite-consult-resolution-through-gastrointestinal-endoscopy
#10
Amnon Sonnenberg
BACKGROUND AND AIMS: To expedite a consult resolution, referring physicians sometimes inflate the urgency and need for endoscopic workup. The aim of the present decision analysis was to study the impact of inflationary indication on the expected benefits to gastroenterologists and referring physicians. METHODS: The study aims were pursued in terms of game theory and medical decision analysis using decision trees. Different outcomes associated with true versus false urgent indication in immediate versus delayed endoscopy were ranked according to different preference schemes of gastroenterologists versus referring physicians...
November 16, 2016: European Journal of Gastroenterology & Hepatology
https://www.readbyqxmd.com/read/27858260/an-assessment-of-site-suitability-for-marina-construction-in-istanbul-turkey-using-gis-and-ahp-multicriteria-decision-analysis
#11
Mustafa Umit Gumusay, Gokalp Koseoglu, Tolga Bakirman
Marinas play a key role in sea transportation and tourism. The problem of an insufficient marina capacity has revealed in terms of sea traffic due to the demographic structure and increasing tourism potential of Istanbul which is the biggest metropolitan city of Turkey and has around 600-km-long coastline. Therefore, the study area is mainly focused on the Marmara Sea shoreline of Istanbul. Rather than traditional methods, a rapid and cost-effective solution which considers natural and urban environment conditions is essential to satisfy the need for a marina site selection...
December 0: Environmental Monitoring and Assessment
https://www.readbyqxmd.com/read/27844450/measuring-patients-priorities-using-the-analytic-hierarchy-process-in-comparison-with-best-worst-scaling-and-rating-cards-methodological-aspects-and-ranking-tasks
#12
Katharina Schmidt, Ana Babac, Frédéric Pauer, Kathrin Damm, J-Matthias von der Schulenburg
BACKGROUND: Identifying patient priorities and preference measurements have gained importance as patients claim a more active role in health care decision making. Due to the variety of existing methods, it is challenging to define an appropriate method for each decision problem. This study demonstrates the impact of the non-standardized Analytic Hierarchy Process (AHP) method on priorities, and compares it with Best-Worst-Scaling (BWS) and ranking card methods. METHODS: We investigated AHP results for different Consistency Ratio (CR) thresholds, aggregation methods, and sensitivity analyses...
December 2016: Health Economics Review
https://www.readbyqxmd.com/read/27832559/balancing-the-risks-and-benefits-of-using-emergency-diagnostic-radiocontrast-studies-to-diagnose-life-threatening-illness-in-critically-ill-patients-a-decision-analysis
#13
K M Ho
Diagnosis of many life-threatening illnesses, including acute pulmonary embolism, aortic dissection, and ischaemic bowel disease, requires confirmatory radiological imaging with radiocontrast. It is well established that radiocontrast can induce acute kidney injury, especially in patients with pre-existing renal impairment. The decision to proceed with a radiological study with radiocontrast to confirm or exclude a life-threatening, but potentially reversible, illness in patients with renal impairment is difficult...
November 2016: Anaesthesia and Intensive Care
https://www.readbyqxmd.com/read/27832461/weighing-clinical-evidence-using-patient-preferences-an-application-of-probabilistic-multi-criteria-decision-analysis
#14
Henk Broekhuizen, Maarten J IJzerman, A Brett Hauber, Catharina G M Groothuis-Oudshoorn
The need for patient engagement has been recognized by regulatory agencies, but there is no consensus about how to operationalize this. One approach is the formal elicitation and use of patient preferences for weighing clinical outcomes. The aim of this study was to demonstrate how patient preferences can be used to weigh clinical outcomes when both preferences and clinical outcomes are uncertain by applying a probabilistic value-based multi-criteria decision analysis (MCDA) method. Probability distributions were used to model random variation and parameter uncertainty in preferences, and parameter uncertainty in clinical outcomes...
November 10, 2016: PharmacoEconomics
https://www.readbyqxmd.com/read/27814820/performance-goals-for-an-adjunct-diagnostic%C3%A2-test%C3%A2-to-reduce-unnecessary-biopsies%C3%A2-after-screening-mammography-analysis%C3%A2-of-costs-benefits-and-consequences
#15
Christoph I Lee, Mark E Bensink, Kristin Berry, Zahra Musa, Carolyn Bodnar, Robert Dann, Jeffrey G Jarvik, Constance D Lehman, Scott D Ramsey
PURPOSE: Because benign biopsies resulting from false-positive mammographic findings are a known harm of breast cancer screening, physicians and test manufacturers are searching for ways to reduce their frequency. The aim of this study was to estimate potential costs and consequences associated with using an adjunct diagnostic test for triaging women with suspicious mammographic findings before biopsy. METHODS: A decision model was developed to compare the use of an adjunct test before biopsy to the current standard of care for suspicious mammographic findings...
November 2016: Journal of the American College of Radiology: JACR
https://www.readbyqxmd.com/read/27812299/on-determining-the-most-appropriate-test-cut-off-value-the-case-of-tests-with-continuous-results
#16
REVIEW
Farrokh Habibzadeh, Parham Habibzadeh, Mahboobeh Yadollahie
There are several criteria for determination of the most appropriate cut-off value in a diagnostic test with continuous results. Mostly based on receiver operating characteristic (ROC) analysis, there are various methods to determine the test cut-off value. The most common criteria are the point on ROC curve where the sensitivity and specificity of the test are equal; the point on the curve with minimum distance from the left-upper corner of the unit square; and the point where the Youden's index is maximum...
October 15, 2016: Biochemia Medica: časopis Hrvatskoga Društva Medicinskih Biokemičara
https://www.readbyqxmd.com/read/27807111/cost-analysis-of-ceramic-heads-in-primary-total-hip-arthroplasty
#17
Keith J Carnes, Susan M Odum, Jennifer L Troyer, Thomas K Fehring
BACKGROUND: The advent of adverse local tissue reactions seen in metal-on-metal bearings, and the recent recognition of trunnionosis, have led many surgeons to recommend ceramic-on-polyethylene articulations for primary total hip arthroplasty. However, to our knowledge, there has been little research that has considered whether the increased cost of ceramic provides enough benefit over cobalt-chromium to justify its use. The primary purpose of this study was to compare the cost-effectiveness of ceramic-on-polyethylene implants and metal-on-polyethylene implants in patients undergoing total hip arthroplasty...
November 2, 2016: Journal of Bone and Joint Surgery. American Volume
https://www.readbyqxmd.com/read/27803595/reoperation-costs-in-attempted-breast-conserving-surgery-a-decision-analysis
#18
R E Pataky, C R Baliski
BACKGROUND: Breast-conserving surgery (bcs) is the preferred surgical approach for most patients with early-stage breast cancer. Frequently, concerns arise about the pathologic margin status, resulting in an average reoperation rate of 23% in Canada. No consensus has been reached about the ideal reoperation rate, although 10% has been suggested as a target. Upon undergoing reoperation, many patients choose mastectomy and breast reconstruction, which add to the morbidity and cost of patient care...
October 2016: Current Oncology
https://www.readbyqxmd.com/read/27800166/an-assessment-of-the-future-impact-of-alternative-technologies-on-antibiotics-markets
#19
Ejike Nwokoro, Ross Leach, Christine Årdal, Enrico Baraldi, Kellie Ryan, Jens Plahte
BACKGROUND: The increasing threat of antimicrobial resistance combined with the paucity of new classes of antibiotics represents a serious public health challenge. New treatment technologies could, in theory, have a significant impact on the future use of traditional antibiotics, be it by facilitating rational and responsible use or by product substitution in the existing antibiotics markets, including by reducing the incidence of bacterial infections through preventative approaches. The aim of this paper is to assess the potential of alternative technologies in reducing clinical use of and demand for antibiotics, and to briefly indicate which segments of the antibiotics market that might be impacted by these technologies...
2016: Journal of Pharmaceutical Policy and Practice
https://www.readbyqxmd.com/read/27791981/advancing-alternative-analysis-integration-of-decision-science
#20
REVIEW
Timothy F Malloy, Virginia M Zaunbrecher, Christina Batteate, Ann Blake, William F Carroll, Charles J Corbett, Steffen Foss Hansen, Robert Lempert, Igor Linkov, Roger McFadden, Kelly D Moran, Elsa Olivetti, Nancy Ostrom, Michelle Romero, Julie Schoenung, Thomas Seager, Peter Sinsheimer, Kristina Thayer
BACKGROUND: Decision analysis-a systematic approach to solving complex problems-offers tools and frameworks to support decision making that are increasingly being applied to environmental challenges. Alternatives analysis is a method used in regulation and product design to identify, compare, and evaluate the safety and viability of potential substitutes for hazardous chemicals. OBJECTIVES: Assess whether decision science may assist the alternatives analysis decision maker in comparing alternatives across a range of metrics...
October 28, 2016: Environmental Health Perspectives
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