scholarly journals Distinguishing variation in referral accuracy from referral threshold: analysis of a national dataset of referrals for suspected cancer

BMJ Open ◽  
2017 ◽  
Vol 7 (8) ◽  
pp. e016439 ◽  
Author(s):  
Christopher D Burton ◽  
David J McLernon ◽  
Amanda J Lee ◽  
Peter Murchie
Keyword(s):  
Fast Track ◽  
Meta Analysis ◽  
Confidence Regions ◽  
New Method ◽  
Detection Rates ◽  
Decision Accuracy ◽  
Referral Behaviour ◽  
General Practices ◽  
Age Profile ◽  
The Cost

ObjectivesTo distinguish between variation in referral threshold and variation in accurate selection of patients for referral in fast-track referrals for possible cancer. To examine factors associated with threshold and accuracy and model the effects of changing thresholds.DesignAnalysis of national data on cancer referrals from general practices in England over a 5-year period. We developed a new method to estimate specificity of referral to complement existing sensitivity. We used bivariate meta-analysis to produce summary measures and described practices in relation to these.Setting5479 general practitioner (GP) practices with data relating to more than 50 cancer cases diagnosed over the 5 years.OutcomesNumber of practices whose 95% confidence regions for sensitivity and specificity indicated that they were outliers in terms of either referral threshold or decision accuracy.Results2019 practices (36.8%) were outliers in relation to referral threshold compared with 1205 practices (22%) in relation to decision accuracy. Practice age profile, cancer incidence and deprivation showed a modest association with decision accuracy but not with thresholds. If all practices shared the referral behaviour of those in the highest quintile of age-standardised referral rate, there would be a 3.3% increase in cancers detected through fast-track pathways at the cost of a 36.9% increase in urgent referrals.ConclusionThis new method permits variation in referral to be described more precisely and quality improvement activities to be targeted. Changing referral thresholds without increasing accuracy will result in modest effects on detection rates and a large increase in demand on diagnostic services.

scholarly journals Cost-Effectiveness Analysis of BCG Vaccination against Tuberculosis in Indonesia: A Model-Based Study

Vaccines ◽  
2020 ◽  
Vol 8 (4) ◽  
pp. 707
Author(s):  
Afifah Machlaurin ◽  
Franklin Christiaan Karel Dolk ◽  
Didik Setiawan ◽  
Tjipke Sytse van der Werf ◽  
Maarten J. Postma
Keyword(s):  
Cost Effectiveness ◽  
Univariate Analysis ◽  
Cost Effective ◽  
Epidemiological Data ◽  
Control Programme ◽  
Detection Rates ◽  
Middle Income ◽  
Bcg Vaccination ◽  
Life Years ◽  
The Cost

Bacillus Calmette–Guerin (BCG), the only available vaccine for tuberculosis (TB), has been applied for decades. The Indonesian government recently introduced a national TB disease control programme that includes several action plans, notably enhanced vaccination coverage, which can be strengthened through underpinning its favourable cost-effectiveness. We designed a Markov model to assess the cost-effectiveness of Indonesia’s current BCG vaccination programme. Incremental cost-effectiveness ratios (ICERs) were evaluated from the perspectives of both society and healthcare. The robustness of the analysis was confirmed through univariate and probabilistic sensitivity analysis (PSA). Using epidemiological data compiled for Indonesia, BCG vaccination at a price US$14 was estimated to be a cost-effective strategy in controlling TB disease. From societal and healthcare perspectives, ICERs were US$104 and US$112 per quality-adjusted life years (QALYs), respectively. The results were robust for variations of most variables in the univariate analysis. Notably, the vaccine’s effectiveness regarding disease protection, vaccination costs, and case detection rates were key drivers for cost-effectiveness. The PSA results indicated that vaccination was cost-effective even at US$175 threshold in 95% of cases, approximating the monthly GDP per capita. Our findings suggest that this strategy was highly cost-effective and merits prioritization and extension within the national TB programme. Our results may be relevant for other high endemic low- and middle-income countries.

The cost of chemotherapy administration: a systematic review and meta-analysis

2021 ◽  
Author(s):  
Gursharan K. Sohi ◽  
Jordan Levy ◽  
Victoria Delibasic ◽  
Laura E. Davis ◽  
Alyson L. Mahar ◽  
...  
Keyword(s):  
Systematic Review ◽  
Meta Analysis ◽  
Chemotherapy Administration ◽  
The Cost

Diplomacy Beyond History: Analytic-Violence, Producer-Centred Research, India

2021 ◽  
pp. 097492842098307
Author(s):  
Deep K. Datta-Ray
Keyword(s):  
New Method ◽  
The West ◽  
History Of ◽  
The Right ◽  
Nuclear Diplomacy ◽  
The Cost ◽  
Insight Into

The history of Indian diplomacy conceptualises diplomacy racially—as invented by the West—and restrictively—to offence. This is ‘analytic-violence’ and it explains the berating of Indians for mimicking diplomacy incorrectly or unthinkingly, and the deleting, dismissing, or denigrating, of diplomatic practices contradicting history’s conception. To relieve history from these offences, a new method is presented, ‘Producer-Centred Research’ (PCR). Initiating with abduction, an insight into a problem—in this case Indian diplomacy’s compromised historicisation—PCR solves it by converting history’s racist rationality into ‘rationalities’. The plurality renders rationality one of many, permitting PCR’s searching for rationalities not as a function of rationality but robust practices explicable in producer’s terms. Doing so is exegesis. It reveals India’s nuclear diplomacy as unique, for being organised by defence, not offence. Moreover, offence’s premise of security as exceeding opponent’s hostility renders it chimerical for such a security is, paradoxically, reliant on expanding arsenals. Additionally, doing so is a response to opponents. This fragments sovereignty and abdicates control for one is dependent on opponent’s choices. Defence, however, does not instigate opponents and so really delivers security by minimising arsenals since offence is eschewed. Doing so is not a response to opponents and so maintains sovereignty and retains control by denying others the right to offense. The cost of defence is courage, for instance, choosing to live in the shadow of nuclear annihilation. Exegesis discloses Balakot as a shift from defence to offence, so to relieve the Bharatiya Janata Party’s (BJP) leadership of having to be courageous. The intensity of the intention to discard courage is apparent in the price the BJP paid. This included equating India with Pakistan, permitting it to escalate the conflict, and so imperiling all humanity in a manner beyond history.

scholarly journals Endotoxemia as a Diagnostic Tool for Patients with Suspected Bacteremia Caused by Gram-Negative Organisms: a Meta-Analysis of 4 Decades of Studies

2015 ◽  
Vol 53 (4) ◽  
pp. 1183-1191 ◽  
Author(s):  
James C. Hurley ◽  
Piotr Nowak ◽  
Lars Öhrmalm ◽  
Charalambos Gogos ◽  
Apostolos Armaganidis ◽  
...  
Keyword(s):  
Confidence Interval ◽  
Meta Analysis ◽  
Inclusion Criteria ◽  
Summary Receiver Operating Characteristic ◽  
Detection Rates ◽  
Gram Negative ◽  
Content Type ◽  
E Coli ◽  
Patient Groups ◽  
Gram Negative Organisms

The clinical significance of endotoxin detection in blood has been evaluated for a broad range of patient groups in over 40 studies published over 4 decades. The influences of Gram-negative (GN) bacteremia species type and patient inclusion criteria on endotoxemia detection rates in published studies remain unclear. Studies were identified after a literature search and manual reviews of article bibliographies, together with a direct approach to authors of potentially eligible studies for data clarifications. The concordance between GN bacteremia and endotoxemia expressed as the summary diagnostic odds ratios (DORs) was derived for three GN bacteremia categories across eligible studies by using a hierarchical summary receiver operating characteristic (HSROC) method. Forty-two studies met broad inclusion criteria, with between 2 and 173 GN bacteremias in each study. Among all 42 studies, the DORs (95% confidence interval) were 3.2 (1.7 to 6.0) and 5.8 (2.4 to 13.7) in association with GN bacteremias withEscherichia coliand those withPseudomonas aeruginosa, respectively. Among 12 studies of patients with sepsis, the proportion of endotoxemia positivity (95% confidence interval) among patients withP. aeruginosabacteremia (69% [57 to 79%];P= 0.004) or withProteusbacteremia (76% [51 to 91%];P= 0.04) was significantly higher than that among patients without GN bacteremia (49% [33 to 64%]), but this was not so for patients bacteremic withE. coli(57% [40 to 73%];P= 0.55). Among studies of the sepsis patient group, the concordance of endotoxemia with GN bacteremia was surprisingly weak, especially forE. coliGN bacteremia.

scholarly journals Evaluation of StrepBSelectChromogenic Medium and the Fast-Track Diagnostics Group B Streptococcus (GBS) Real-Time PCR Assay Compared to Routine Culture for Detection of GBS during Antepartum Screening

2017 ◽  
Vol 55 (7) ◽  
pp. 2137-2142 ◽  
Author(s):  
Deirdre L. Church ◽  
Heather Baxter ◽  
Tracie Lloyd ◽  
Oscar Larios ◽  
Daniel B. Gregson
Keyword(s):  
Real Time ◽  
Real Time Pcr ◽  
Fast Track ◽  
Group B Streptococcus ◽  
Culture Method ◽  
Predictive Values ◽  
Content Type ◽  
Standard Culture ◽  
Group B ◽  
The Cost

ABSTRACTLife-threatening infection in neonates due to group BStreptococcus(GBS) is preventable by screening of near-term pregnant women and treatment at delivery. A total of 295 vaginal-rectal swabs were collected from women attending antepartum clinics in Calgary, Alberta, Canada. GBS colonization was detected by the standard culture method (Strep B Carrot Broth subcultured to blood agar with a neomycin disk) and compared to recovery with Strep Group B Broth (Dalynn Biologicals) subcultured to StrepBSelectchromogenic medium (CM; Bio-Rad Laboratories) and the Fast-Track Diagnostics GBS real-time PCR (quantitative PCR [qPCR]) assay (Phoenix Airmid Biomedical Corp.) performed with broth-enriched samples and the Abbottm2000sp/m2000rt system. A total of 62/295 (21%) women were colonized with GBS; 58 (19.7%) cases were detected by standard culture, while CM and qPCR each found 61 (20.7%) cases. The qPCR and CM were similar in performance, with sensitivities, specificities, and positive and negative predictive values of 98.4 and 98.4%, 99.6 and 99.6%, 98.4 and 98.4%, and 99.6 and 99.6%, respectively, compared to routine culture. Both qPCR and CM would allow more rapid reporting of routine GBS screening results than standard culture. Although the cost per test was similar for standard culture and CM, the routine use of qPCR would cost approximately four times as much as culture-based detection. Laboratories worldwide should consider implementing one of the newer methods for primary GBS testing, depending on the cost limitations of different health care jurisdictions.

Inferring age from otolith measurements: a review and a new approach

2004 ◽  
Vol 61 (7) ◽  
pp. 1269-1284 ◽  
Author(s):  
RIC Chris Francis ◽  
Steven E Campana
Keyword(s):  
Simulation Experiment ◽  
Cost Benefit Analysis ◽  
Cost Benefit ◽  
New Method ◽  
Population Parameters ◽  
Benefit Analysis ◽  
Mixture Analysis ◽  
New Approach ◽  
Individual Fish ◽  
The Cost

In 1985, Boehlert (Fish. Bull. 83: 103–117) suggested that fish age could be estimated from otolith measurements. Since that time, a number of inferential techniques have been proposed and tested in a range of species. A review of these techniques shows that all are subject to at least one of four types of bias. In addition, they all focus on assigning ages to individual fish, whereas the estimation of population parameters (particularly proportions at age) is usually the goal. We propose a new flexible method of inference based on mixture analysis, which avoids these biases and makes better use of the data. We argue that the most appropriate technique for evaluating the performance of these methods is a cost–benefit analysis that compares the cost of the estimated ages with that of the traditional annulus count method. A simulation experiment is used to illustrate both the new method and the cost–benefit analysis.

scholarly journals Concealed correlations meta-analysis: A new method for synthesizing standardized regression coefficients

2018 ◽  
Vol 51 (1) ◽  
pp. 316-331 ◽  
Author(s):  
Belén Fernández-Castilla ◽  
Ariel M. Aloe ◽  
Lies Declercq ◽  
Laleh Jamshidi ◽  
Patrick Onghena ◽  
...  
Keyword(s):  
Meta Analysis ◽  
New Method ◽  
Regression Coefficients ◽  
Standardized Regression Coefficients

scholarly journals Impact of acetylsalicylic acid on primary prevention of cardiovascular diseases: A meta-analysis of randomized trials

2018 ◽  
Vol 26 (7) ◽  
pp. 746-749 ◽  
Author(s):  
Sunil Upadhaya ◽  
Seetharamprasad Madala ◽  
Ramkaji Baniya ◽  
Kalyan Saginala ◽  
Jahangir Khan
Keyword(s):  
Primary Prevention ◽  
Acetylsalicylic Acid ◽  
Hemorrhagic Stroke ◽  
Meta Analysis ◽  
Cardiovascular Death ◽  
Vascular Events ◽  
Individual Participant ◽  
The Cost ◽  
The Impact ◽  
Key Questions

Numerous studies have investigated use of acetylsalicylic acid (ASA) for prevention of cardiovascular deaths. The vast majority of the work in this area has focused on secondary prevention. However, underuse of ASA still remains a major issue. Fewer studies have investigated the impact of ASA on primary prevention of cardiovascular death. A meta-analysis of individual participant data from six randomized studies, published in 2009, showed decrease in serious vascular events but at the cost of causing increased bleeding and hemorrhagic stroke. Recent studies have raised a number of key questions regarding the benefits and risks of using ASA for primary prevention.

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