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Web Exclusive White Paper Series on Diagnostic Test EvaluationEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
(Source: Medical Decision Making)
Source: Medical Decision Making - November 12, 2009 Category: Health Management Authors: Helfand, M. Tags: Articles Source Type: journals

The German Coronary Artery Disease Risk Screening Model: Development, Validation, and Application of a Decision-Analytic Model for Coronary Artery Disease Prevention with StatinsEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Conclusions. The model provides a valid tool for evaluating the long-term effectiveness of CAD risk screening in Germany. Using statins as a primary prevention intervention for CAD in high-risk individuals identified by screening could improve the long-term health of the German population. (Source: Medical Decision Making)
Source: Medical Decision Making - November 12, 2009 Category: Health Management Authors: Stollenwerk, B., Gerber, A., Lauterbach, K. W., Siebert, U. Tags: Articles Source Type: journals

Diagnostic Certainty as a Source of Medical Practice Variation in Coronary Heart Disease: Results from a Cross-National Experiment of Clinical Decision MakingEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
The authors examined physician diagnostic certainty as one reason for cross-national medical practice variation. Data are from a factorial experiment conducted in the United States, the United Kingdom, and Germany, estimating 384 generalist physicians’ diagnostic and treatment decisions for videotaped vignettes of actor patients depicting a presentation consistent with coronary heart disease (CHD). Despite identical vignette presentations, the authors observed significant differences across health care systems, with US physicians being the most certain and German physicians the least certain (P < 0.0001). Physicia...
Source: Medical Decision Making - November 12, 2009 Category: Health Management Authors: Lutfey, K. E., Link, C. L., Marceau, L. D., Grant, R. W., Adams, A., Arber, S., Siegrist, J., Bonte, M., von dem Knesebeck, O., McKinlay, J. B. Tags: Articles Source Type: journals

The Influence of Treatment Effect Size on Willingness to Adopt a TherapyEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Conclusions. In this study, respondents were less likely to adopt a lifesaving therapy if its associated mortality reduction was 3% compared to 10%. Because most therapies for major medical conditions reduce mortality within or below this range, and because there were no opportunity costs associated with the adoption of the therapy, we believe that this effect represents a bias. Further investigation will be required to determine its prevalence and mechanism. (Source: Medical Decision Making)
Source: Medical Decision Making - November 12, 2009 Category: Health Management Authors: Aberegg, S. K., O'Brien, J. M., Khoury, P., Patel, R., Arkes, H. R. Tags: Articles Source Type: journals

Development of Goal-Sensitive Health-Related Utility Assessment ProceduresEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Conclusions. Nonmedical life goals are important determinants of quality of life. People express willingness to trade off life and health in pursuit of these goals, which are extrinsic to the standard quality-adjusted life-year model. (Source: Medical Decision Making)
Source: Medical Decision Making - November 12, 2009 Category: Health Management Authors: Schwartz, A., Hazen, G. B., Leifer, A., Heckerling, P. S. Tags: Articles Source Type: journals

Incorporating Extrinsic Goals Into Decision and Cost-Effectiveness AnalysesEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
It has not been widely recognized that medical patients as individuals may have goals that are not easily expressed in terms of quality-adjusted life years (QALYs). The QALY model deals with ongoing goals such as reducing pain or maintaining mobility, but goals such as completing an important project or seeing a child graduate from college occur at unique points in time and do not lend themselves to easy expression in terms of QALYs. Such extrinsic goals have been posited as explanations for preferences inconsistent with the QALY model, such as unwillingness to trade away time or accept gambles. In this article, the author...
Source: Medical Decision Making - November 12, 2009 Category: Health Management Authors: Hazen, G. B., Schwartz, A. Tags: Articles Source Type: journals

Planning Posttherapeutic Oncology Surveillance Visits Based on Individual RiskEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
The main objective of posttherapeutic surveillance in oncology is to detect recurrent disease associated with treatment failure. Current follow-up schedules are easy to apply because they are planned on a regular basis (for instance, every 3 months) but do not take into account prognostic factors associated with time to failure. We propose a 2-stage strategy to individualize surveillance by first identifying prognostic factors for time to failure, then modeling cumulative risk or cumulative incidence to plan visits according to equal quantiles of risk or probability of failure, respectively. Using data from a clinical tria...
Source: Medical Decision Making - November 12, 2009 Category: Health Management Authors: Filleron, T., Barrett, A., Ataman, O., Kramar, A. Tags: Articles Source Type: journals

Incorporating Herd Immunity Effects into Cohort Models of Vaccine Cost-EffectivenessEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Conclusions. This methodology allows for preliminary assessment of herd immunity effects on CEA of universal vaccination for pediatric infectious diseases. The method requires simple adjustments to an existing cohort model and less data than a full dynamic model. (Source: Medical Decision Making)
Source: Medical Decision Making - November 12, 2009 Category: Health Management Authors: Bauch, C. T., Anonychuk, A. M., Van Effelterre, T., Pham, B. Z., Merid, M. F. Tags: Articles Source Type: journals

Effects of Categorizing Continuous Variables in Decision-Analytic ModelsEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Conclusions. Under the assumption of a normally distributed risk factor and reasonable assumption regarding disease risk and moderate values for the relative risk of disease given risk factor category, categorizing continuously valued risk factors in Markov models is associated with less than 4% absolute bias when at least 2 categories are used. (Source: Medical Decision Making)
Source: Medical Decision Making - November 12, 2009 Category: Health Management Authors: Bentley, T. G. K., Weinstein, M. C., Kuntz, K. M. Tags: Articles Source Type: journals

Additional Patient Outcomes and Pathways in Evaluations of TestingEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Before medical tests are introduced into practice, they should be properly evaluated. Randomized trials and other comprehensive evaluations of tests and test strategies can best be designed based on an understanding of how tests can benefit or harm patients. Tests primarily affect patients’ health by guiding clinical decision making and downstream management, such as the decision to order more tests or to start, stop, or modify treatment. In this article, the authors demonstrate that tests can have additional effects on patient outcome, which may be cognitive, emotional, social, or behavioral. They present a framewor...
Source: Medical Decision Making - November 12, 2009 Category: Health Management Authors: Bossuyt, P. M. M., McCaffery, K. Tags: Articles Source Type: journals

Decision-Analytic Modeling to Evaluate Benefits and Harms of Medical Tests: Uses and LimitationsEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
The clinical utility of medical tests is measured by whether the information they provide affects patient-relevant outcomes. To a large extent, effects of medical tests are indirect in nature. In principle, a test result affects patient outcomes mainly by influencing treatment choices. This indirectness in the link between testing and its downstream effects poses practical challenges to comparing alternate test-and-treat strategies in clinical trials. Keeping in mind the broader audience of researchers who perform comparative effectiveness reviews and technology assessments, the authors summarize the rationale for and pitf...
Source: Medical Decision Making - November 12, 2009 Category: Health Management Authors: Trikalinos, T. A., Siebert, U., Lau, J. Tags: Articles Source Type: journals

Proposals for a Phased Evaluation of Medical TestsEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Conclusions. The evaluation frameworks can be useful to distinguish between study types, but they cannot be seen as a necessary sequence of evaluations. The evaluation of tests is most likely not a linear but a cyclic and repetitive process. (Source: Medical Decision Making)
Source: Medical Decision Making - November 12, 2009 Category: Health Management Authors: Lijmer, J. G., Leeflang, M., Bossuyt, P. M. M. Tags: Articles Source Type: journals

Using the Principles of Randomized Controlled Trial Design to Guide Test EvaluationEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
The decision to use a new test should be based on evidence that it will improve patient outcomes or produce other benefits without adversely affecting patients. In principle, long-term randomized controlled trials (RCTs) of test-plus-treatment strategies offer ideal evidence of the benefits of introducing a new test relative to current best practice. However, long-term RCTs may not always be necessary. The authors advocate using the hypothetical RCT as a conceptual framework to identify what types of comparative evidence are needed for test evaluation. Evaluation begins by stating the major claims for the new test and dete...
Source: Medical Decision Making - November 12, 2009 Category: Health Management Authors: Lord, S. J., Irwig, L., Bossuyt, P. M. M. Tags: Articles Source Type: journals

ErrataEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
(Source: Medical Decision Making)
Source: Medical Decision Making - July 23, 2009 Category: Health Management Tags: Article Source Type: journals

Quantitative Risk Stratification in Markov Chains with Limiting Conditional DistributionsEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Conclusions . Limiting conditional distributions exist in most Markov models of progressive diseases and are well suited to represent risk stratification quantitatively. This framework can characterize patient risk in clinical trials and predict outcomes for other populations of risk. (Source: Medical Decision Making)
Source: Medical Decision Making - July 23, 2009 Category: Health Management Authors: Chan, D. C., Pollett, P. K., Weinstein, M. C. Tags: Article Source Type: journals

Offering Chemotherapy and Hospice Jointly: One Solution to Hospice UnderuseEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Conclusions. These findings suggest that interest in hospice may be low because, offered without chemotherapy, hospice is perceived as ineffective at controlling symptoms and avoiding side effects. Chemotherapy and hospice together may be a preferred option for treating advanced lung cancer. Furthermore, preferences for chemotherapy and hospice together best reflect the values people placed on the goals of treatment. (Source: Medical Decision Making)
Source: Medical Decision Making - July 23, 2009 Category: Health Management Authors: Salz, T., Brewer, N. T. Tags: Article Source Type: journals

Construction of Health Preferences: A Comparison of Direct Value Assessment and Personal NarrativesEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Conclusion . Stories have more impact in shaping people's preferences than merely asking for an assessment of attribute importance. The most straightforward explanation for this effect is that stories, particularly when presented in video, provide a better image of potential consequences. (Source: Medical Decision Making)
Source: Medical Decision Making - July 23, 2009 Category: Health Management Authors: Kerstholt, J. H., van der Zwaard, F., Bart, H., Cremers, A. Tags: Article Source Type: journals

The Incorporation of Income and Leisure in Health State Valuations When the Measure Is Silent: An Empirical Inquiry into the Sound of SilenceEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Conclusions. Health state valuation methods that are silent and noninformative regarding leisure and income lead to interrespondent differences regarding how they expect leisure and income to be affected and regarding the inclusion of these effects. This may be especially problematic for leisure if productivity costs are captured at the cost side of the cost-effectiveness ratio. (Source: Medical Decision Making)
Source: Medical Decision Making - July 23, 2009 Category: Health Management Authors: Brouwer, W. B. F., Grootenboer, S., Sendi, P. Tags: Article Source Type: journals

The Half-Cycle Correction: Banish Rather Than Explain ItEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
This article shows that the correction, in addition to being unintuitive, actually produces the wrong results in many circumstances. These include quality-adjusted life year (QALY) weights and unit costs that differ by cycle. The half-cycle correction is also incompatible with discounting of the obtained stream of state membership. It is furthermore shown that the life table method of estimating state membership obtains correct results under these circumstances and is also much more transparent. The article concludes that the half-cycle correction should be dropped in favor of the life table method. (Source: Medical Decision Making)
Source: Medical Decision Making - July 23, 2009 Category: Health Management Authors: Barendregt, J. J. Tags: Article Source Type: journals

A Fair Test of the Fair Innings?Email this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
This article reports a study that presented respondents with a number of abstract health care decision contexts in an attempt to test the extent to which post-treatment health maximization, the fair innings argument, or, indeed other ``decision rules,'' are evident in the respondents' answers. The results indicate that the most commonly observed decision rule differs substantially across health care contexts, and therefore imply that rather than pursue an overarching decision rule, it may be more appropriate to vary the rule according to the particular health care decision context under consideration. (Source: Medical Decision Making)
Source: Medical Decision Making - July 23, 2009 Category: Health Management Authors: Oliver, A. Tags: Article Source Type: journals

Effect of Risk Communication Formats on Risk Perception Depending on NumeracyEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Conclusion. Different communication formats may produce different risk perceptions, but the effect is qualified by patients' numeracy skills. (Source: Medical Decision Making)
Source: Medical Decision Making - July 23, 2009 Category: Health Management Authors: Keller, C., Siegrist, M. Tags: Article Source Type: journals

Is There a Role for Decision Aids in Advanced Breast Cancer?Email this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Conclusions. It is feasible to perform a clinical trial of a DA with advanced BC patients. Most participants wanted to participate in decisions about their care and found the DA acceptable. This study highlights several issues in developing and implementing DAs in this vulnerable population facing complex decisions. (Source: Medical Decision Making)
Source: Medical Decision Making - July 23, 2009 Category: Health Management Authors: Sepucha, K. R., Ozanne, E. M., Partridge, A. H., Moy, B. Tags: Article Source Type: journals

Should Clinicians Deliver Decision Aids? Further Exploration of the Statin Choice Randomized Trial ResultsEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Conclusions. Delivery of decision aids by clinicians during the visit improves knowledge and shows a trend toward better acceptability and less decisional conflict. (Source: Medical Decision Making)
Source: Medical Decision Making - July 23, 2009 Category: Health Management Authors: Jones, L. A., Weymiller, A. J., Shah, N., Bryant, S. C., Christianson, T. J. H., Guyatt, G. H., Gafni, A., Smith, S. A., Montori, V. M. Tags: Article Source Type: journals

Long-Term Health Outcomes of a Decision Aid: Data from a Randomized Trial of Adjuvant! in Women with Localized Breast CancerEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Conclusions. Expected benefit from treatment is a key variable in understanding patient behavior. A small number of women refuse adjuvant treatment associated with large increases in predicted survival, even when they are explicitly informed about the degree of benefit they would forgo. Investigation of the effects of decision aids on cancer survival is unlikely to be fruitful due to power considerations. (Source: Medical Decision Making)
Source: Medical Decision Making - July 23, 2009 Category: Health Management Authors: Vickers, A. J., Elkin, E. B., Peele, P. B., Dickler, M., Siminoff, L. A. Tags: Article Source Type: journals

Recommendations for Modeling Disaster Responses in Public Health and Medicine: A Position Paper of the Society for Medical Decision MakingEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Conclusions. Quantitative models are critical tools for planning effective health sector responses to disasters. The proposed recommendations can increase the applicability and interpretability of future models, thereby improving strategic, tactical, and operational aspects of preparedness planning and response. (Source: Medical Decision Making)
Source: Medical Decision Making - July 23, 2009 Category: Health Management Authors: Brandeau, M. L., McCoy, J. H., Hupert, N., Holty, J.-E., Bravata, D. M. Tags: Article Source Type: journals

Predicting Hospital Surge after a Large-Scale Anthrax Attack: A Model-Based Analysis of CDC's Cities Readiness Initiative Prophylaxis RecommendationsEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Conclusion. Delays in detecting and initiating response to large-scale, covert aerosol anthrax releases in a major city would render even highly effective CRI-compliant mass prophylaxis campaigns unable to prevent unsustainable levels of surge hospitalizations. Although outcomes may improve with more rapid epidemiological identification of affected subpopulations and increased collaboration across regional public health and hospital systems, these findings support an increased focus on prevention of this public health threat. (Source: Medical Decision Making)
Source: Medical Decision Making - July 23, 2009 Category: Health Management Authors: Hupert, N., Wattson, D., Cuomo, J., Hollingsworth, E., Neukermans, K., Xiong, W. Tags: Article Source Type: journals

Evaluating the Capability and Cost of a Mass Influenza and Pneumococcal Vaccination Clinic via Computer SimulationEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Conclusion. The clinic could reach their target of 15,000 vaccinees with 2 fewer staff members by rearranging staff assignments from ``Special'' to ``Medicare'' and ``Cash'' stations. Computer simulation can help public health officials determine the most efficient use of staff, machinery, supplies, and time. (Source: Medical Decision Making)
Source: Medical Decision Making - July 23, 2009 Category: Health Management Authors: Washington, M. L. Tags: Article Source Type: journals

Modeling Bioterrorism and Disaster Preparedness: SMDM's Recommendations for Design and ReportingEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
(Source: Medical Decision Making)
Source: Medical Decision Making - July 23, 2009 Category: Health Management Authors: Sanders, G. D. Tags: Article Source Type: journals

Getting Down to Details in the Design and Use of Decision AidsEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
(Source: Medical Decision Making)
Source: Medical Decision Making - July 23, 2009 Category: Health Management Authors: Fagerlin, A. Tags: Article Source Type: journals

Laypersons' Responses to the Communication of Uncertainty Regarding Cancer Risk EstimatesEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Conclusions. Laypersons' responses to the communication of uncertainty regarding cancer risk estimates differ, and include both heightened and diminished risk perceptions. These differences may be attributable to personality, cognitive, and motivational factors. (Source: Medical Decision Making)
Source: Medical Decision Making - June 8, 2009 Category: Health Management Authors: Han, P. K. J., Klein, W. M. P., Lehman, T. C., Massett, H., Lee, S. C., Freedman, A. N. Tags: Article Source Type: journals

Weighing Harm in Therapeutic Decisions of Smear-Negative Pulmonary TuberculosisEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Conclusion. The weight of a false negative is more important than the weight of a false positive for therapeutic decisions in pulmonary tuberculosis. The ratio of the intuitively estimated weights was much lower than the calculation based on intuitively estimated influencing factors. Clinicians were accurate in estimating probabilities but failed to incorporate them into therapeutic decisions. (Source: Medical Decision Making)
Source: Medical Decision Making - June 8, 2009 Category: Health Management Authors: Moreira, J., Bisig, B., Muwawenimana, P., Basinga, P., Bisoffi, Z., Haegeman, F., Kishore, P., Van den Ende, J. Tags: Article Source Type: journals

The Hippocratic Oath, Effect Size, and Utility TheoryEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
To be consistent with the Hippocratic Oath, this article proposes that a physician choose that treatment that has the greatest chance of giving the patient an outcome no worse than the uncertain outcome an untreated patient would experience. As this article shows, this specifies the utility function that the physician should use in choosing among treatments. This utility function, although varying with the life circumstances of the patient, need not reflect the patient's utility function. This Hippocratic utility function can be estimated with an effect size measure similar to the stochastic superiority and common language...
Source: Medical Decision Making - June 8, 2009 Category: Health Management Authors: Bordley, R. F. Tags: Article Source Type: journals

The Effect of Erroneous Computer Interpretation of ECGs on Resident Decision MakingEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Conclusions. Erroneous computer interpretations of ECGs affected residents' clinical decision making in the absence of an effect on the actual interpretation of the ECG. Measuring the impact of computer misinterpretations by examining only physician interpretations will underestimate the effect of computer misinterpretations on clinical decision making. (Source: Medical Decision Making)
Source: Medical Decision Making - June 8, 2009 Category: Health Management Authors: Southern, W. N., Arnsten, J. H. Tags: Article Source Type: journals

Natural Frequencies Help Older Adults and People with Low Numeracy to Evaluate Medical Screening TestsEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Conclusions. Natural frequencies help elderly and young patients—including those with lower numeracy skills—to understand positive predictive values of medical screening tests. (Source: Medical Decision Making)
Source: Medical Decision Making - June 8, 2009 Category: Health Management Authors: Galesic, M., Gigerenzer, G., Straubinger, N. Tags: Article Source Type: journals

Optimizing the Start Time of Statin Therapy for Patients with DiabetesEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Conclusions. In addition to age, gender, and metabolic state, the choice of cardiovascular risk model influences the apparent optimal time for starting statins in patients with diabetes. (Source: Medical Decision Making)
Source: Medical Decision Making - June 8, 2009 Category: Health Management Authors: Denton, B. T., Kurt, M., Shah, N. D., Bryant, S. C., Smith, S. A. Tags: Article Source Type: journals

Early Stopping Rules in Clinical Trials Based on Sequential Monitoring of Serious Adverse EventsEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Several multistage or group sequential statistical methods have been developed for defining stopping rules in terms of efficacy in phase II and III clinical trials, but they rely on interim analyses after the inclusion of a fixed number of patients. These methods, however, need to be adapted for the evaluation of serious adverse events (SAEs), which can occur relatively early in the trial. A high frequency of their occurrence may require the trial to close early. The methods developed here define stopping rules after the occurrence of each SAE by comparing the number of patients included to the number of patients satisfyin...
Source: Medical Decision Making - June 8, 2009 Category: Health Management Authors: Kramar, A., Bascoul-Mollevi, C. Tags: Article Source Type: journals

Valuing Health: Does Enriching a Scenario Lead to Higher Utilities?Email this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Conclusion. The hypothesis that disparities in valuation can be attributed to EQ-5D description being too sparse was not confirmed. (Source: Medical Decision Making)
Source: Medical Decision Making - June 8, 2009 Category: Health Management Authors: Peeters, Y., Stiggelbout, A. M. Tags: Article Source Type: journals

Long-Term Cost-Effectiveness of Disease Management in Systolic Heart FailureEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Conclusions. Estimation of the clinical benefits and financial burden of disease management can be enhanced by model-based analyses to project costs and effectiveness. Our results suggest that disease management of heart failure patients can be cost-effective over the long term. (Source: Medical Decision Making)
Source: Medical Decision Making - June 8, 2009 Category: Health Management Authors: Miller, G., Randolph, S., Forkner, E., Smith, B., Galbreath, A. D. Tags: Article Source Type: journals

Will Insistence on Practicing Medicine According to Expected Utility Theory Lead to an Increase in Diagnostic Testing? Reply to DeKay's Commentary: Physicians' Anticipated Regret and Diagnostic TestingEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
(Source: Medical Decision Making)
Source: Medical Decision Making - June 8, 2009 Category: Health Management Authors: Hozo, I., Djulbegovic, B. Tags: Article Source Type: journals

Physicians' Anticipated Regret and Diagnostic Testing: Comment on Hozo and Djulbegovic, 2008Email this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
(Source: Medical Decision Making)
Source: Medical Decision Making - June 8, 2009 Category: Health Management Authors: DeKay, M. L. Tags: Article Source Type: journals

A Hybrid Cohort Individual Sampling Natural History Model of Age-Related Macular Degeneration: Assessing the Cost-Effectiveness of Screening Using Probabilistic CalibrationEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Conclusions. The extent of the uncertainty around the mean results, and the additional resources and possible reorganization of services required to implement screening, indicate that it may be preferable to reduce the level of uncertainty before implementing screening for AMD. Initial actions may be best targeted at assessing how routine data may be used to describe clinical presentation, a screening pilot study, and a secondary costing study. (Source: Medical Decision Making)
Source: Medical Decision Making - June 8, 2009 Category: Health Management Authors: Karnon, J., Czoski-Murray, C., Smith, K. J., Brand, C. Tags: Article Source Type: journals

Estimating Preference-Based Health Utilities Index Mark 3 Utility Scores for Childhood Conditions in England and ScotlandEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Conclusion . Our estimates and their associated distributions can be used for the purposes of QALY estimation by analysts conducting economic evaluations within the childhood context. (Source: Medical Decision Making)
Source: Medical Decision Making - June 8, 2009 Category: Health Management Authors: Petrou, S., Kupek, E. Tags: Article Source Type: journals

Missing Celiac Disease in Family Medicine: The Importance of Hypothesis GenerationEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Conclusions. Most physicians never considered celiac disease. Information inconsistent with the favorite IBS diagnosis was overlooked. Reviewing the case did not prompt physicians to consider celiac disease, re-evaluate the evidence, or rethink the IBS diagnosis. (Source: Medical Decision Making)
Source: Medical Decision Making - June 8, 2009 Category: Health Management Authors: Kostopoulou, O., Devereaux-Walsh, C., Delaney, B. C. Tags: Article Source Type: journals

How Far Do You Go? Efficient Searching for Indirect EvidenceEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Conclusions. The iterative strategies presented offer a means of identifying such evidence and allow the researcher to determine the optimal scope of the search by estimating the value of additional indirect evidence. (Source: Medical Decision Making)
Source: Medical Decision Making - June 8, 2009 Category: Health Management Authors: Hawkins, N., Scott, D. A., Woods, B. Tags: Article Source Type: journals

Impact of the Scale Upper Anchor on Health State PreferencesEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Conclusions. Similar to earlier findings in patients with a degenerative spine condition, this validation study showed that preferences for current health in patients with cerebral aneurysms are different when measured on the Q and q scales. Investigators should be mindful of the impact of the scale's upper anchor point on preference values when conducting and interpreting preference studies. (Source: Medical Decision Making)
Source: Medical Decision Making - April 10, 2009 Category: Health Management Authors: King, J. T., Tsevat, J., Roberts, M. S. Tags: Article Source Type: journals

Validation of an Automated Safety Surveillance System with Prospective, Randomized Trial DataEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Conclusion. Both SPC and LR-SPC methods correctly identified the majority of months during which the cumulative event rates were elevated in trial A but were susceptible to false positive alerts in trial B. The BUS method did not result in any alerts in either trial and requires revision. (Source: Medical Decision Making)
Source: Medical Decision Making - April 10, 2009 Category: Health Management Authors: Matheny, M. E., Morrow, D. A., Ohno-Machado, L., Cannon, C. P., Sabatine, M. S., Resnic, F. S. Tags: Article Source Type: journals

Development of a Clinical Prediction Model to Calculate Patient Life Expectancy: The Measure of Actuarial Life Expectancy (MALE)Email this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Conclusions. The evidence-based actuarial data utilized in this computer program design represent a valuable resource for use in the clinical decision-making process, where an accurate objective assessment of patient LE can so often make the difference between patients being offered or denied medical and surgical treatment. Ongoing development to incorporate additional comorbidities and enable Web-based access will enhance its use further. (Source: Medical Decision Making)
Source: Medical Decision Making - April 10, 2009 Category: Health Management Authors: Clarke, M.G., Kennedy, K.P., MacDonagh, R.P. Tags: Article Source Type: journals

The Cost-Effectiveness of Screening for Hereditary Hemochromatosis in Germany: A Remodeling StudyEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
This study synthesizes the most current evidence to examine whether screening in the broader population is cost-effective and to identify the best choice of initial and follow-up screening tests. Methods. A probabilistic decision-analytic model was constructed to calculate cost per life year gained (LYG) for HH screening among male Caucasians aged 30. Three strategies were considered in both the general population and male offspring of HH patients: phenotypic (transferrin saturation, TS), genotypic (C282Y mutation), and sequential (genotype if TS is elevated) screening. Results. The incremental cost-effectiveness of sequen...
Source: Medical Decision Making - April 10, 2009 Category: Health Management Authors: Rogowski, W. H. Tags: Article Source Type: journals

Competence of General Practitioners in Giving Advice about Changes in Lifestyle to Hypertensive PatientsEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Conclusions. Despite the existence of well-known guidelines for the treatment of hypertension in Poland, GPs rarely give complete lifestyle advice, particularly for patients with cardiovascular risk due to high-normal blood pressure and diabetes. (Source: Medical Decision Making)
Source: Medical Decision Making - April 10, 2009 Category: Health Management Authors: Windak, A., Gryglewska, B., Tomasik, T., Narkiewicz, K., Grodzicki, T. Tags: Article Source Type: journals

Value for Money in Changing Clinical Practice: Should Decisions about Guidelines and Implementation Strategies Be Made Sequentially or Simultaneously?Email this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
This article demonstrates that the decision to use a sequential v. an integral approach affects the need for detailed information and the complexity of the decision analytic process. More importantly, it may lead to different choices of guidelines and implementation strategies for clinical practice change. The differences in decision making and decision analysis between the alternative approaches are comprehensively illustrated using 2 hypothetical examples. We argue that, in most cases, an integral approach to deciding about change in clinical practice is preferred, as this provides more efficient use of scarce health-car...
Source: Medical Decision Making - April 10, 2009 Category: Health Management Authors: Hoomans, T., Severens, J. L., Evers, S. M. A. A., Ament, A. J. H. A. Tags: Article Source Type: journals