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Decision analysis

Nadine Ijaz, Heather Boon, Linda Muzzin, Sandy Welsh
Several United Nations bodies have advised countries to actively preserve Traditional Medicine (TM) knowledge and prevent its misappropriation in regulatory structures. To help advance decision-making around this complex regulatory issue, we examine the relationship between risk discourse, epistemology and policy. This study presents a critical, postcolonial analysis of divergent risk discourses elaborated in two contrasting Ontario (Canada) government reports preceding that jurisdiction's regulation of acupuncture, the world's most widely practised TM therapy...
August 24, 2016: Social Science & Medicine
Camilla Hardeland, Kjetil Sunde, Helge Ramsdal, Susan R Hebbert, Linda Soilammi, Fredrik Westmark, Fredrik Nordum, Andreas E Hansen, Jon E Steen-Hansen, Theresa M Olasveengen
AIM: Explore, understand and address issues that impact upon timely and adequate allocation of prehospital medical assistance and resources to out-of-hospital cardiac arrest (OHCA) patients. METHODS: Mixed-methods: design obtaining data for one year in three emergency medical communication centres (EMCC); Oslo-Akershus (OA), Vestfold-Telemark (VT) and Østfold (Ø). Data collection included quantitative data from analysis of dispatch logs, ambulance records and audio files...
October 18, 2016: Resuscitation
Stephen A Gallo, Joanne H Sullivan, Scott R Glisson
Although the scientific peer review process is crucial to distributing research investments, little has been reported about the decision-making processes used by reviewers. One key attribute likely to be important for decision-making is reviewer expertise. Recent data from an experimental blinded review utilizing a direct measure of expertise has found that closer intellectual distances between applicant and reviewer lead to harsher evaluations, possibly suggesting that information is differentially sampled across subject-matter expertise levels and across information type (e...
2016: PloS One
Nehemiah T Liu, José Salinas, Craig A Fenrich, Maria L Serio-Melvin, George C Kramer, Ian R Driscoll, Martin A Schreiber, Leopoldo C Cancio, Kevin K Chung
INTRODUCTION: The depth of burn has been an important factor often overlooked when estimating the total resuscitation fluid needed for early burn care. The goal of this study was to determine the degree to which full-thickness (FT) involvement affected overall 24-hour burn resuscitation volumes. METHODS: We performed a retrospective review of patients admitted to our burn intensive care unit from December 2007 to April 2013, with significant burns that required resuscitation using our computerized decision support system for burn fluid resuscitation...
November 2016: Journal of Trauma and Acute Care Surgery
Joseph K Maddry, Alejandra G Mora, Shelia Savell, Lauren K Reeves, Crystal A Perez, Vikhyat S Bebarta
BACKGROUND: Medical evacuation (MEDEVAC) is the movement and en route care of injured and medically compromised patients by medical care providers via helicopter. Military MEDEVAC platforms provide lifesaving interventions that improve survival in combat. There is limited evidence to support decision making related to en route care and allocation of resources. The association between provider type and en route care is not well understood. Our objective was to describe MEDEVAC providers and identify associations between provider type, procedures performed, and outcomes...
November 2016: Journal of Trauma and Acute Care Surgery
Ashleigh A McGirr, Kevin L Schwartz, Upton Allen, Melinda Solomon, Beate Sander
Background Children with cystic fibrosis (CF) are at higher risk of severe respiratory syncytial virus (RSV) infection, which can lead to a decline in lung function. A monoclonal antibody, palivizumab (PMB), effectively prevents RSV hospitalizations; however, the high cost of PMB, approximately C$10,000 per patient per RSV season, limits its widespread use. We assess the cost-effectiveness of PMB prophylaxis in CF children less than 2 years of age from the Canadian healthcare payer's perspective. Methods In 2014, a Markov cohort model of CF disease and infant RSV infections in the Canadian setting was developed based on literature data...
October 21, 2016: Human Vaccines & Immunotherapeutics
Robbert D A Weren, Arjen R Mensenkamp, Michiel Simons, Astrid Eijkelenboom, Aisha S Sie, Hicham Ouchene, Monique van Asseldonk, Encarna B Gomez-Garcia, Marinus J Blok, Joanne A de Hullu, Marcel R Nelen, Alexander Hoischen, Johan Bulten, Bastiaan B J Tops, Nicoline Hoogerbrugge, En Marjolijn J L Ligtenberg
With the recent introduction of Poly(ADP-ribose) polymerase (PARP) inhibitors, a promising novel therapy has become available for ovarian carcinoma patients with inactivating BRCA1 or BRCA2 mutations in their tumour. To select patients who may benefit from these treatments, assessment of the mutation status of BRCA1 and BRCA2 in the tumour is required. For reliable evaluation of germline and somatic mutations in these genes in DNA derived from formalin-fixed, paraffin-embedded (FFPE) tissue, we have developed a single molecule molecular inversion probe (smMIP)-based targeted next generation sequencing (NGS) approach...
October 21, 2016: Human Mutation
Marcos Augusto Bastos Dias, Rosa Maria Soares Madeira Domingues, Arthur Orlando Corrêa Schilithz, Marcos Nakamura-Pereira, Maria do Carmo Leal
BACKGROUND: The rate of cesarean delivery (CD) in Brazil has increased over the past 40 years. The CD rate in public services is three times above the World Health Organization recommended values. Among strategies to reduce CD, the most important is reduction of primary cesarean. This study aimed to describe factors associated with CD during labor in primiparous women with a single cephalic pregnancy assisted in the Brazilian Public Health System (SUS). METHODS: This study is part of the Birth in Brazil survey, a national hospital-based study of 23,894 postpartum women and their newborns...
October 17, 2016: Reproductive Health
Eeva-Liisa Paattiniemi, Santra Karumaa, Anna-Mari Viita, Pauliina Kärpänoja, Marjukka Mäkelä, Jaana Isojärvi, Hannu Sarkkinen
Urine culture samples comprise a large proportion of the workload in clinical microbiology laboratories, and most of the urine samples show no growth or insignificant growth. A flow cytometry-based analyzer (Sysmex Corporation, Japan) has been used to screen out negative urine samples prior to culture in the Päijät-Häme district. We applied decision analytic modelling to analyze, from a laboratory perspective, the economic feasibility of the screening method as compared to culture only (conventional method) for diagnosis of urinary tract infection...
October 21, 2016: Infectious Diseases
Nirav H Amin, Alex Volpi, T Sean Lynch, Ronak M Patel, Douglas L Cerynik, Mark S Schickendantz, Morgan H Jones
BACKGROUND: Anatomic reinsertion of the distal biceps is critical for restoring flexion and supination strength. Single- and double-incision surgical techniques have been reported, analyzing complications and outcomes measures. Which technique results in superior clinical outcomes and the lowest associated complications remains unclear. HYPOTHESIS: We hypothesized that rerupture rates would be similar between the 2 techniques, while nerve complications would be higher for the single-incision technique and heterotopic ossification would be more frequent with the double-incision technique...
October 2016: Orthopaedic Journal of Sports Medicine
Jane Mills, Jennifer Chamberlain-Salaun, Helena Harrison, Karen Yates, Andrea O'Shea
BACKGROUND: A core objective of the Australian health system is to provide high quality, safe health care that meets the needs of all Australians. To achieve this, an adequate and effective workforce must support the delivery of care. With rapidly changing health care systems and consumer demographics, demand for care is increasing and retention of sufficient numbers of skilled staff is now a critical priority to meet current and future health care demands. Nurses are the largest cohort of professionals within the health workforce...
2016: BMC Nursing
Jason W Beckstead
BACKGROUND: Brunswik's Lens Model and lens model equation (LME) have been applied extensively in medical decision making. Clinicians often face the dual challenge of formulating a judgment of patient risk for some adverse outcome and making a yes or no decision regarding a particular risk-reducing treatment option. OBJECTIVE: In this article, I examine the correlation between clinical risk judgments and treatment-related decisions, referring to this linkage as "cohesion"...
October 20, 2016: Medical Decision Making: An International Journal of the Society for Medical Decision Making
Evgenii Belykh, Alexander V Krutko, Evgenii S Baykov, Morgan B Giers, Mark C Preul, Vadim A Byvaltsev
BACKGROUND CONTEXT: Recurrence of lumbar disc herniation (rLDH) is one of the unfavorable outcomes after microdiscectomy. Prediction of the patient population with increased risk of rLDH is important because patients may benefit from preventive measures or other surgical options. PURPOSE: The study assessed preoperative factors associated with rLDH after microdiscectomy and created a mathematical model for estimation of chances for rLDH. STUDY DESIGN/SETTING: This is a retrospective case-control study...
October 17, 2016: Spine Journal: Official Journal of the North American Spine Society
Thomas Martini, Christian Gilfrich, Roman Mayr, Maximilian Burger, Armin Pycha, Atiqullah Aziz, Michael Gierth, Christian G Stief, Stefan C Müller, Florian Wagenlehner, Jan Roigas, Oliver W Hakenberg, Florian Roghmann, Philipp Nuhn, Manfred Wirth, Vladimir Novotny, Boris Hadaschik, Marc-Oliver Grimm, Paul Schramek, Axel Haferkamp, Daniela Colleselli, Birgit Kloss, Edwin Herrmann, Margit Fisch, Matthias May, Christian Bolenz
INTRODUCTION: Guidelines recommend neoadjuvant chemotherapy (NAC) before radical cystectomy (RC) in patients with urothelial carcinoma of the bladder in clinical stages T2-T4a, cN0M0. We examined the frequency and current practice of NAC and sought to identify predictors for the use of NAC in a prospective contemporary cohort. MATERIALS AND METHODS: We analyzed prospective data from 679 patients in the PROMETRICS (PROspective MulticEnTer RadIcal Cystectomy Series 2011) database...
September 19, 2016: Clinical Genitourinary Cancer
Shearwood McClelland, Joseph F Baker, Justin S Smith, Breton G Line, Thomas J Errico, Christopher P Ames, R Shay Bess
Parkinson's disease (PD) is a neurodegenerative disorder manifesting over time to result in reduced mobility. The impact of PD on spinal fusion has yet to be addressed on a nationwide level. The Nationwide Inpatient Sample (NIS) from 2001 to 2012 was used for analysis. Admissions with spinal fusion of two or more vertebrae (ICD-9 codes=81.62, 81.63 and 81.64) were included and then stratified based on the presence or absence of PD (ICD-9 code=332.0); patients with cancer (ICD-9 codes=140-239) or trauma (ICD-9 codes=805...
October 17, 2016: Journal of Clinical Neuroscience: Official Journal of the Neurosurgical Society of Australasia
Robert F Riley, Chadwick D Miller, Gregory B Russell, Erin N Harper, Brian C Hiestand, James W Hoekstra, Cedric W Lefebvre, Bret A Nicks, David M Cline, Kim L Askew, Simon A Mahler
INTRODUCTION: The HEART Pathway is a diagnostic protocol designed to identify low-risk patients presenting to the emergency department with chest pain that are safe for early discharge. This protocol has been shown to significantly decrease health care resource utilization compared with usual care. However, the impact of the HEART Pathway on the cost of care has yet to be reported. METHODS AND RESULTS: We performed a cost analysis of patients enrolled in the HEART Pathway trial, which randomized participants to either usual care or the HEART Pathway protocol...
October 5, 2016: American Journal of Emergency Medicine
G Guidi, N Maffei, B Meduri, E D'Angelo, G M Mistretta, P Ceroni, A Ciarmatori, A Bernabei, S Maggi, M Cardinali, V E Morabito, F Rosica, S Malara, A Savini, G Orlandi, C D'Ugo, F Bunkheila, M Bono, S Lappi, C Blasi, F Lohr, T Costi
PURPOSE: To predict patients who would benefit from adaptive radiotherapy (ART) and re-planning intervention based on machine learning from anatomical and dosimetric variations in a retrospective dataset. MATERIALS AND METHODS: 90 patients (pts) treated for head-neck cancer (H&N) formed a multicenter data-set. 41 H&N pts (45.6%) were considered for learning; 49 pts (54.4%) were used to test the tool. A homemade machine-learning classifier was developed to analyze volume and dose variations of parotid glands (PG)...
October 17, 2016: Physica Medica: PM
Yasmine Mendes Pupo, Leticia Lopes Quirino Pantoja, Flavia Fusco Veiga, José Stechman-Neto, Liete Figueiredo Zwir, Paulo Vitor Farago, Graziela De Luca Canto, André Luís Porporatti
OBJECTIVE: To evaluate the diagnostic validity of clinical examination protocols compared with magnetic resonance imaging (MRI) in adults with temporomandibular joint disk displacement disorders. STUDY DESIGN: According to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, a systematic review was undertaken using a selection process in 2 phases; 283 different references were identified, and 10 articles were included for qualitative analysis and 7 for meta-analysis...
November 2016: Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology
Jill Duerr Berrick, Jonathan Dickens, Tarja Pösö, Marit Skivenes
No abstract text is available yet for this article.
October 2016: Child Abuse & Neglect
Eric Smart, Adeeta Aulakh, Carolyn McDougall, Patty Rigby, Gillian King
PURPOSE: Identify strategies youth perceive will optimize their engagement in goal pursuit in life skills and transition programs using an engagement framework involving affective, cognitive, and behavioral components. METHODS: A qualitative descriptive design was used. Two semi-structured interviews were conducted with seven youth. The first was informed by a prior observation session, and the second occurred after the program ended and explored youths' perceptions of whether and how their engagement changed...
October 21, 2016: Disability and Rehabilitation
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