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  • 1
    Online Resource
    Online Resource
    Can the Standard Gamble Be Used to Determine Utilities for Uncertain Health States? : An Example Using Postoperative Maintenance Therapy in Crohn's Disease
    SAGE Publications ; 2000
    In:  Medical Decision Making Vol. 20, No. 1 ( 2000-01), p. 72-78
    Details
    In: Medical Decision Making, SAGE Publications, Vol. 20, No. 1 ( 2000-01), p. 72-78
    Abstract: The objective of this study was to determine whether patients with Crohn's disease (CD) value the absolute reduction in postoperative recurrence risk attributable to therapy with mesalamine (5-ASA). One hundred subjects evaluated state A (taking 5-ASA; 25% risk of recurrence), state B (not taking 5-ASA; 40% risk of recurrence), and state C (100% risk of recurrence) by rank order, visual analog scale (VAS), and standard gamble (SG). Sixty-five of 91 patients (71 %) with completed and usable questionnaires had the same preference order for state A (25% risk), state B (40% risk), and state C (100% risk) on both the VAS and the SG. The mean scores for state A (25% risk), state B (40% risk), and state C (100% risk), respectively, were 67.5, 49.8, and 19.8 on the VAS and 0.977, 0.972, and 0.910 on the SG. Subgroup analyses using stepwise logistic regression showed that risk attitude seemed to be predictive of subjects' preferences for 5-ASA. These results suggest that most subjects seem to value the 15% absolute risk reduction offered by 5-ASA. Furthermore, the SG seems to be a feasible method for measuring utilities for uncertain health states in patients with CD. Key words: standard gamble; risk attitude; treatment interventions; uncertain health states. (Med Decis Making 2000;20:72-78)
    Type of Medium: Online Resource
    ISSN: 0272-989X , 1552-681X
    URL: Article
    DOI: 10.1177/0272989X0002000109
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2000
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  • 2
    Online Resource
    Online Resource
    An Economic Analysis of Strategies for the Use of Contrast Media for Diagnostic Cardiac Catheterization
    SAGE Publications ; 1994
    In:  Medical Decision Making Vol. 14, No. 4 ( 1994-10), p. 325-335
    Details
    In: Medical Decision Making, SAGE Publications, Vol. 14, No. 4 ( 1994-10), p. 325-335
    Abstract: A decision tree model was used to estimate the incremental cost per quality-adjusted life year (QALY) of low- as opposed to high-osmolality contrast media for cardiac angiography. Analyses were done from the viewpoints of a third-party payer and society using data from a randomized trial and the literature. Assuming low-osmolality media reduce the risk of myocardial infarction and stroke, the incremental cost per QALY gained with these media is $17,264 in high-risk or $47,874 in low-risk patients for a third-party payer. From a societal viewpoint, the corresponding costs are $649 and $35,509. These estimates are sensitive to the cost and volume of the contrast medium employed and to the estimate of reduction in severe adverse events with low-osmolality media. The authors conclude that, in the context of restricted budgets, limiting the use of low-osmolality media to high-risk patients is justifiable, as the incremental cost per QALY in high-risk patients may be reasonable and it is not certain that low-osmolality media prevent severe or fatal events. A considerable reduction in the cost per QALY gained is possible by minimizing the volume of contrast medium used. Key words: contrast media; low-osmolality; high-osmolality; cardiac angiography; cost-utility; cost-benefit; cost-effectiveness; economic analysis. (Med Decis Making 1994;14:325- 335)
    Type of Medium: Online Resource
    ISSN: 0272-989X , 1552-681X
    URL: Article
    DOI: 10.1177/0272989X9401400403
    Language: English
    Publisher: SAGE Publications
    Publication Date: 1994
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  • 3
    Online Resource
    Online Resource
    Is There a Role for Surgery in the Acute Management of Infectiue Endocarditis? : A Decision Analysis and Medical Claims Database Approach
    SAGE Publications ; 1988
    In:  Medical Decision Making Vol. 8, No. 3 ( 1988-08), p. 165-174
    Details
    In: Medical Decision Making, SAGE Publications, Vol. 8, No. 3 ( 1988-08), p. 165-174
    Abstract: In the absence of good clinical evidence from a randomized trial, the authors performed a decision analysis to determine the potential value of early elective surgery (OPNOW) for patients with left-sided Staphylococcus aureus infective endocarditis. Initial impressions (before per formance of decision analysis) and initial runs at the formal models using probability estimates derived from clinicians suggested that OPNOW (i.e., within a few days of starting antibiotics) offered no advantage over attempted medical cure (WAIT) (life expectancy: WAIT = 325 weeks; OPNOW = 255 weeks). Extensive sensitivity analyses identified critical variables that needed further empirical estimation. The Manitoba Health Services Commission database identified 127 incident cases of endocarditis between April 1, 1979, and March 31, 1985, enabling estimation of values for these critical variables. With these estimates, the early surgery strategy appeared much better than the previous analyses had suggested (life expectancy: WAIT = 208 weeks, OPNOW = 256 weeks). The authors believe that this approach of com bining decision analysis with medical claims databases is useful as an alternative or precursor to randomized trials, especially where the resource requirements and logistic difficulties of performing randomized trials are great. Key words: infective endocarditis; valve replacement; therapy; databases. (Med Decis Making 8:165-174, 1988)
    Type of Medium: Online Resource
    ISSN: 0272-989X , 1552-681X
    URL: Article
    DOI: 10.1177/0272989X8800800303
    Language: English
    Publisher: SAGE Publications
    Publication Date: 1988
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  • 4
    Online Resource
    Online Resource
    The Seventh Annual Meeting of the Society for Medical Decision Making : "Challenges for Decision Analysis"
    SAGE Publications ; 1985
    In:  Medical Decision Making Vol. 5, No. 3 ( 1985-08), p. 259-261
    Details
    In: Medical Decision Making, SAGE Publications, Vol. 5, No. 3 ( 1985-08), p. 259-261
    Type of Medium: Online Resource
    ISSN: 0272-989X , 1552-681X
    URL: Article
    DOI: 10.1177/0272989X8500500301
    Language: English
    Publisher: SAGE Publications
    Publication Date: 1985
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  • 5
    Online Resource
    Online Resource
    Guidelines for Verbal Presentations of Medical Decision Analyses
    SAGE Publications ; 1997
    In:  Medical Decision Making Vol. 17, No. 2 ( 1997-04), p. 228-230
    Details
    In: Medical Decision Making, SAGE Publications, Vol. 17, No. 2 ( 1997-04), p. 228-230
    Abstract: Individuals new to decision analysis often have difficulty with oral presentations of original research projects. This article provides general guidelines on how to present effectively. Points include: 1) articulating the research issue, 2) reviewing current beliefs, 3) portraying the study question, 4) listing the main assumptions, 5) presenting the base-case analysis, 6) showing sensitivity analyses, and 7) discussing the implications. The guidelines comment on what to exclude from presentation and how best to handle audience questions. The guidelines do not replace general instruction in public speaking (or rigorous training in decision analysis), but may help students present research projects effectively. Key words: decision analysis; verbal presentations; medical education; public speaking; communication skills. (Med Decis Making 1997; 17:228-230)
    Type of Medium: Online Resource
    ISSN: 0272-989X , 1552-681X
    URL: Article
    DOI: 10.1177/0272989X9701700214
    Language: English
    Publisher: SAGE Publications
    Publication Date: 1997
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  • 6
    Online Resource
    Online Resource
    Book Reviews : Doctors' Decisions and the Cost of Medical Care. By JOHN M. EISENBERG. Ann Arbor, MI, Health Administration Press Perspectives, 1986. 190 pages. $18.00 US
    SAGE Publications ; 1987
    In:  Medical Decision Making Vol. 7, No. 3 ( 1987-08), p. 198-199
    Details
    In: Medical Decision Making, SAGE Publications, Vol. 7, No. 3 ( 1987-08), p. 198-199
    Type of Medium: Online Resource
    ISSN: 0272-989X , 1552-681X
    URL: Article
    DOI: 10.1177/0272989X8700700311
    Language: English
    Publisher: SAGE Publications
    Publication Date: 1987
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  • 7
    Online Resource
    Online Resource
    A province-wide study of the association between hospital resource allocation and length of stay
    SAGE Publications ; 2003
    In:  Health Services Management Research Vol. 16, No. 3 ( 2003-08-01), p. 155-166
    Details
    In: Health Services Management Research, SAGE Publications, Vol. 16, No. 3 ( 2003-08-01), p. 155-166
    Abstract: The relationship between hospital resource allocation and clinical efficiency is poorly understood. Within the single-payer healthcare system in Ontario, Canada, the association between hospital spending patterns and length of stay was studied using data from 1117 090 patient discharges in 1997/8 at 162 of 171 acute care hospitals. A weighted regression model was created using an overall hospital length of stay index (actual length of stay divided by predicted length of stay) as the dependent variable. Control variables included: hospital size, teaching activity, occupancy rate, rural location and geographic region. Four independent spending variables were defined as a percentage of total hospital spending: nursing, ambulatory care, administration and support, and diagnostics and therapeutics. The reduced regression model had an r-squared of 0.45. Across all spending variables, hospitals spending relatively too little or too much had significantly longer length of stay. Hospitals' overall pattern of resource allocation was also significantly associated with length of stay. Thus, measurable clinical effects can be seen with resource allocation decisions made by hospital management, supporting the need for rigorous decision-making processes. Future research should focus on exploring the nature of this relationship and the potential interdependencies among hospital services that cause this effect.
    Type of Medium: Online Resource
    ISSN: 0951-4848 , 1758-1044
    URL: Article
    DOI: 10.1258/095148403322167915
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2003
    detail.hit.zdb_id: 2035604-3
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  • 8
    Online Resource
    Online Resource
    The Meaning of Author Order in Medical Research
    SAGE Publications ; 2007
    In:  Journal of Investigative Medicine Vol. 55, No. 4 ( 2007-05), p. 174-180
    Details
    In: Journal of Investigative Medicine, SAGE Publications, Vol. 55, No. 4 ( 2007-05), p. 174-180
    Abstract: Manuscript authorship and author placement have important implications for accountability and allocation of credit. The objective of this study was to assess the relationship between an author's place in the author list and the type of contribution reported by that author. This pattern was then used to develop a method by which author responsibility and accountability can be clarified. Methods The published contributions of each author of original research articles with a minimum of four authors published in the Journal of the American MedicalAssociation, the British Medical Journal, TheLancet, and the Canadian Medical Association Journal in a 3-year period after author contribution forms were required were coded into 1 of eleven contribution categories. The contributions were grouped according to first, second, middle, and last author and compared by position. Results For most categories of contribution, the levels of participation were highest for first authors, followed by last and then second authors. Middle authors had lower levels particularly in conception, drafts of the manuscript, supervision, and being a guarantor. Conclusions Current patterns of author order and contribution suggest a consistent theme. Based on the results, a proposal is put forth by which author accountability is clarified. In this proposal, authors are classified as either “primary,” “contributing,” or “senior or supervisory,” each with specified contributions. More than one author may be classified into each author category.
    Type of Medium: Online Resource
    ISSN: 1081-5589 , 1708-8267
    URL: Article
    DOI: 10.2310/6650.2007.06044
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2007
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  • 9
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    Online Resource
    Primer on Medical Decision Analysis: Part 1—Getting Started
    SAGE Publications ; 1997
    In:  Medical Decision Making Vol. 17, No. 2 ( 1997-04), p. 123-125
    Details
    In: Medical Decision Making, SAGE Publications, Vol. 17, No. 2 ( 1997-04), p. 123-125
    Abstract: This paper is Part 1 of a five-part series covering practical issues in the performance of decision analysis. The intended audience is individuals who are learning how to perform decision analyses, not just read them. The series assumes familiarity with the basic concepts of decision analysis. It imparts many of the recommendations the authors have learned in teaching a one-semester course in decision analysis to graduate students. Part 1 introduces the topic and covers questions such as choosing an appropriate question, determining the tradeoff between accuracy and simplicity, and deciding on a time frame. Key words: decision analysis; expected value; utility; sensitivity analysis; decision trees; probability. (Med Decis Making 1997;17:123-125)
    Type of Medium: Online Resource
    ISSN: 0272-989X , 1552-681X
    URL: Article
    DOI: 10.1177/0272989X9701700201
    Language: English
    Publisher: SAGE Publications
    Publication Date: 1997
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  • 10
    Online Resource
    Online Resource
    Primer on Medical Decision Analysis: Part 5—Working with Markov Processes
    SAGE Publications ; 1997
    In:  Medical Decision Making Vol. 17, No. 2 ( 1997-04), p. 152-159
    Details
    In: Medical Decision Making, SAGE Publications, Vol. 17, No. 2 ( 1997-04), p. 152-159
    Abstract: Clinical decisions often have long-term implications. Analysts encounter difficulties when employing conventional decision-analytic methods to model these scenarios. This occurs because probability and utility variables often change with time and conventional decision trees do not easily capture this dynamic quality. A Markov analysis performed with current computer software programs provides a flexible and convenient means of modeling long-term scenarios. However, novices should be aware of several potential pitfalls when attempting to use these programs. When deciding how to model a given clinical problem, the analyst must weigh the simplicity and clarity of a conventional tree against the fidelity of a Markov analysis. In direct comparisons, both approaches gave the same qualitative answers. Key words: decision analysis; expected value; utility; sensitivity analysis; decision trees; probability. (Med Decis Making 1997; 17:152-159)
    Type of Medium: Online Resource
    ISSN: 0272-989X , 1552-681X
    URL: Article
    DOI: 10.1177/0272989X9701700205
    Language: English
    Publisher: SAGE Publications
    Publication Date: 1997
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