scholarly journals Who gets referred for knee or hip replacement? A theoretical model of the potential impact of evidence-based referral thresholds using data from a retrospective review of clinic records from an English musculoskeletal referral hub

BMJ Open ◽  
2020 ◽  
Vol 10 (7) ◽  
pp. e028915
Author(s):  
Helen A Dakin ◽  
Peter Eibich ◽  
Alastair Gray ◽  
James Smith ◽  
Karen L Barker ◽  
...  
Keyword(s):  
Hip Osteoarthritis ◽  
Patient Characteristics ◽  
Evidence Based ◽  
Tree Model ◽  
Current Frequency ◽  
Referral Decisions ◽  
Life Years ◽  
Hip Replacements ◽  
Using Data ◽  
Referral Tool

ObjectivesTo estimate the relationship between patient characteristics and referral decisions made by musculoskeletal hubs, and to assess the possible impact of an evidence-based referral tool.DesignRetrospective analysis of medical records and decision tree model evaluating policy changes using local and national data.SettingOne musculoskeletal interface clinic (hub) in England.Participants922 adults aged ≥50 years referred by general practitioners with symptoms of knee or hip osteoarthritis.InterventionsWe assessed the current frequency and determinants of referrals from one hub and the change in referrals that would occur at this centre and nationally if evidence-based thresholds for referral (Oxford Knee and Hip Scores, OKS/OHS) were introduced.Main outcome measureOKS/OHS, referrals for surgical assessment, referrals for arthroplasty, costs and quality-adjusted life years.ResultsOf 110 patients with knee symptoms attending face-to-face hub consultations, 49 (45%) were referred for surgical assessment; the mean OKS for these 49 patients was 18 (range: 1–41). Of 101 hip patients, 36 (36%) were referred for surgical assessment (mean OHS: 21, range: 5–44). No patients referred for surgical assessment were above previously reported economic thresholds for OKS (43) or OHS (45). Setting thresholds of OKS ≤31 and OHS ≤35 might have resulted in an additional 22 knee referrals and 26 hip referrals in our cohort. Extrapolating hub results across England suggests a possible increase in referrals nationally, of around 13 000 additional knee replacements and 4500 additional hip replacements each year.ConclusionsMusculoskeletal hubs currently consider OKS/OHS and other factors when making decisions about referral to secondary care for joint replacement. Those referred typically have low OHS/OKS, and introducing evidence-based OKS/OHS thresholds would prevent few inappropriate (high-functioning, low-pain) referrals. However, our findings suggest that some patients not currently referred could benefit from arthroplasty based on OKS/OHS. More research is required to explore other important patient characteristics currently influencing hub decisions.

scholarly journals First-Line Atezolizumab Plus Bevacizumab versus Sorafenib in Hepatocellular Carcinoma: A Cost-Effectiveness Analysis

Cancers ◽  
2021 ◽  
Vol 13 (5) ◽  
pp. 931
Author(s):  
Chi-Leung Chiang ◽  
Sik-Kwan Chan ◽  
Shing-Fung Lee ◽  
Horace Cheuk-Wai Choi
Keyword(s):  
Hepatocellular Carcinoma ◽  
Cost Effectiveness ◽  
Lifetime Cost ◽  
Cost Effective ◽  
First Line ◽  
First Line Therapy ◽  
Payer Perspective ◽  
Life Years ◽  
Using Data

Background: The IMbrave 150 trial revealed that atezolizumab plus bevacizumab (atezo–bev) improves survival in patients with unresectable hepatocellular carcinoma (HCC) (1 year survival rate: 67.2% vs. 54.6%). We assessed the cost-effectiveness of atezo–bev vs. sorafenib as first-line therapy in patients with unresectable HCC from the US payer perspective. Methods: Using data from the IMbrave 150, we developed a Markov model to compare the lifetime cost and efficacy of atezo–bev as first-line systemic therapy in HCC with those of sorafenib. The main outcomes were life-years, quality-adjusted life-years (QALYs), lifetime costs, and incremental cost-effectiveness ratio (ICER). Results: Atezo–bev demonstrated a gain of 0.44 QALYs, with an additional cost of USD 79,074. The ICER of atezo–bev was USD 179,729 per QALY when compared with sorafenib. The model was most sensitive to the overall survival hazard ratio and body weight. If we assumed that all patients at the end of the IMbrave 150 trial were cured of HCC, atezo–bev was cost-effective (ICER USD 53,854 per QALY). However, if all patients followed the Surveillance, Epidemiology, and End Results data, the ICER of atezo–bev was USD 385,857 per QALY. Reducing the price of atezo–bev by 20% and 29% would satisfy the USD 150,000/QALY and 100,000/QALY willingness-to-pay threshold. Moreover, capping the duration of therapy to ≤12 months or reducing the dosage of bev to ≤10 mg/kg would render atezo–bev cost-effective. Conclusions: The long-term effectiveness of atezo–bev is a critical but uncertain determinant of its cost-effectiveness. Price reduction would favorably influence cost-effectiveness, even if long-term clinical outcomes were modest. Further studies to optimize the duration and dosage of therapy are warranted.

scholarly journals Overnight in-hospital observation following tonsillectomy: retrospective study of post-operative intervention

2017 ◽  
Vol 132 (1) ◽  
pp. 46-52 ◽  
Author(s):  
S Morris ◽  
E Hassin ◽  
M Borschmann
Keyword(s):  
Patient Characteristics ◽  
University Hospital ◽  
Evidence Based ◽  
Airway Compromise ◽  
Day Case ◽  
Day Case Surgery ◽  
Case Surgery ◽  
American Society ◽  
Evidence Based Guidelines ◽  
Critical Intervention

AbstractObjective:The safety of day-case tonsillectomy is widely documented in the literature; however, there are no evidence-based guidelines recommending patient characteristics that are incompatible with day-case tonsillectomy. This study aimed to identify which patients should be considered unsafe for day-case tonsillectomy based on the likelihood of needing critical intervention.Method:Retrospective review of 2863 tonsillectomy procedures performed at University Hospital Geelong from 1998 to 2014.Results:Of the patients, 7.81 per cent suffered a post-tonsillectomy complication and 4.15 per cent required intervention. The most serious complications, haemorrhage requiring a return to the operating theatre and airway compromise, occurred in 0.56 per cent and 0.11 per cent of patients respectively. The following patient characteristics were significantly associated with poorer outcomes: age of two years or less (p < 0.01), tonsillectomy indicated for neoplasm (p < 0.01) and quinsy (p < 0.05).Conclusion:The authors believe that all elective tonsillectomy patients should be considered for day-case surgery, with the following criteria necessitating overnight observation: age of two years or less; an indication for tonsillectomy of neoplasm or quinsy; and an American Society of Anesthesia score of more than 2.

scholarly journals Using Evidence-Based Practice and Data-Based Decision Making in Inclusive Education

2021 ◽  
Vol 11 (3) ◽  
pp. 129
Author(s):  
Gabrielle Wilcox ◽  
Cristina Fernandez Conde ◽  
Amy Kowbel
Keyword(s):  
Decision Making ◽  
Inclusive Education ◽  
Evidence Based ◽  
Teacher Capacity ◽  
Evidence Based Practices ◽  
Full Inclusion ◽  
Current State ◽  
Inclusive Settings ◽  
Using Data ◽  
Data Based Decision Making

There are longstanding calls for inclusive education for all regardless of student need or teacher capacity to meet those needs. Unfortunately, there are little empirical data to support full inclusion for all students and even less information on the role of data-based decision making in inclusive education specifically, even though there is extensive research on the effectiveness of data-based decision making. In this article, we reviewed what data-based decision making is and its role in education, the current state of evidence related to inclusive education, and how data-based decision making can be used to support decisions for students with reading disabilities and those with intellectual disabilities transitioning to adulthood. What is known about evidence-based practices in supporting reading and transition are reviewed in relationship to the realities of implementing these practices in inclusive education settings. Finally, implications for using data-based decisions in inclusive settings are discussed.

Evidence-Based Sentencing

Criminology ◽  
2021 ◽  
Author(s):  
James C. Oleson
Keyword(s):  
Risk Assessment ◽  
Decision Making ◽  
Risk Measures ◽  
Criminal History ◽  
Community Safety ◽  
Assessment Instruments ◽  
Evidence Based ◽  
Criminogenic Needs ◽  
Actuarial Risk ◽  
Using Data

The evidence-based practice (EBP) movement can be traced to a 1992 article in the Journal of the American Medical Association, although decision-making with empirical evidence (rather than tradition, anecdote, or intuition) is obviously much older. Neverthless, for the last twenty-five years, EBP has played a pivotal role in criminal justice, particularly within community corrections. While the prediction of recidivism in parole or probation decisions has attracted relatively little attention, the use of risk measures by sentencing judges is controversial. This might be because sentencing typically involves both backward-looking decisions, related to the blameworthiness of the crime, as well as forward-looking decisions, about the offender’s prospective risk of recidivism. Evidence-based sentencing quantifies the predictive aspects of decision-making by incorporating an assessment of risk factors (which increase recidivism risk), protective factors (which reduce recidivism risk), criminogenic needs (impairments that, if addressed, will reduce recidivism risk), the measurement of recidivism risk, and the identification of optimal recidivism-reducing sentencing interventions. Proponents for evidence-based sentencing claim that it can allow judges to “sentence smarter” by using data to distinguish high-risk offenders (who might be imprisoned to mitigate their recidivism risk) from low-risk offenders (who might be released into the community with relatively little danger). This, proponents suggest, can reduce unnecessary incarceration, decrease costs, and enhance community safety. Critics, however, note that risk assessment typically looks beyond criminal conduct, incorporating demographic and socioeconomic variables. Even if a risk factor is facially neutral (e.g., criminal history), it might operate as a proxy for a constitutionally protected category (e.g., race). The same objectionable variables are used widely in presentence reports, but their incorporation into an actuarial risk score has greater potential to obfuscate facts and reify underlying disparities. The evidence-based sentencing literature is dynamic and rapidly evolving, but this bibliography identifies sources that might prove useful. It first outlines the theoretical foundations of traditional (non-evidence-based) sentencing, identifying resources and overviews. It then identifies sources related to decision-making and prediction, risk assessment logic, criminogenic needs, and responsivity. The bibliography then describes and defends evidence-based sentencing, and identifies works on sentencing variables and risk assessment instruments. It then relates evidence-based sentencing to big data and identifies data issues. Several works on constitutional problems are listed, the proxies problem is described, and sources on philosophical issues are described. The bibliography concludes with a description of validation research, the politics of evidence-based sentencing, and the identification of several current initiatives.

scholarly journals The Costs and Benefits of Covid-19 Lockdowns in New Zealand

2021 ◽  
Author(s):  
Martin Lally
Keyword(s):  
New Zealand ◽  
Vaccination Campaign ◽  
Quality Adjusted Life Year ◽  
Mitigation Strategy ◽  
Health Interventions ◽  
Costs And Benefits ◽  
Quality Adjusted Life Years ◽  
Life Years ◽  
Using Data ◽  
Quality Adjusted Life

This paper considers the costs and benefits of New Zealand's Covid-19 nation-wide lockdown strategy relative to pursuit of a mitigation strategy in March 2020. Using data available up to 28 June 2021, the estimated additional deaths from a mitigation strategy are 1,750 to 4,600, implying a Cost per Quality Adjusted Life Year saved by locking down in March 2020 of at least 13 times the generally employed threshold figure of $62,000 for health interventions in New Zealand; the lockdowns do not then seem to have been justified by reference to the standard benchmark. Using only data available to the New Zealand government in March 2020, the ratio is similar and therefore the same conclusion holds that the nation-wide lockdown strategy was not warranted. Looking forwards from 28 June 2021, if a new outbreak occurs that cannot be suppressed without a nation-wide lockdown, the death toll from adopting a mitigation strategy at this point would be even less than had it done so in March 2020, due to the vaccination campaign and because the period over which the virus would then inflict casualties would now be much less than the period from March 2020; this would favour a mitigation policy even more strongly than in March 2020. This approach of assessing the savings in quality adjusted life years and comparing them to a standard benchmark figure ensures that all quality adjusted life years saved by various health interventions are treated equally, which accords with the ethical principle of equity across people.

scholarly journals ‘Silent Pandemic’: Evidence-Based Environmental and Public Health Practices to Respond to the COVID-19 Crisis

2021 ◽  
Author(s):  
Raimi Morufu Olalekan ◽  
Aziba-anyam Gift Raimi ◽  
Teddy Charles Adias
Keyword(s):  
Public Health ◽  
Population Health ◽  
Environmental Research ◽  
Evidence Based ◽  
Health Practices ◽  
Environmental Public Health ◽  
Health Action ◽  
Conducting Research ◽  
Using Data ◽  
Uncertain Time

Given the unprecedented novel nature and scale of coronavirus and the global nature of this public health crisis, which upended many public/environmental research norms almost overnight. However, with further waves of the virus expected and more pandemics anticipated. The COVID-19 pandemic of 2020 opened our eyes to the ever-changing conditions and uncertainty that exists in our world today, particularly with regards to environmental and public health practices disruption. This paper explores environmental and public health evidence-based practices toward responding to Covid-19. A literature review tried to do a deep dive through the use of various search engines such as Mendeley, Research Gate, CAB Abstract, Google Scholar, Summon, PubMed, Scopus, Hinari, Dimension, OARE Abstract, SSRN, Academia search strategy toward retrieving research publications, “gray literature” as well as reports from expert working groups. To achieve enhanced population health, it is recommended to adopt widespread evidence-based strategies, particularly in this uncertain time. As only together can evidence-informed decision-making (EIDM) can become a reality which include effective policies and practices, transparency and accountability of decisions, and equity outcomes; these are all more relevant in resource-constrained contexts, such as Nigeria. Effective and ethical EIDM though requires the production as well as use of high-quality evidence that are timely, appropriate and structured. One way to do so is through co-production. Co-production (or co-creation or co-design) of environmental/public health evidence considered as a key tool for addressing complex global crises such as the high risk of severe COVID-19 in different nations. A significant evidence-based component of environmental/public health (EBEPH) consist of decisions making based on best accessible, evidence that is peer-reviewed; using data as well as systematic information systems; community engagement in policy making; conducting sound evaluation; do a thorough program-planning frameworks; as well as disseminating what is being learned. As researchers, scientists, statisticians, journal editors, practitioners, as well as decision makers strive to improve population health, having a natural tendency toward scrutinizing the scientific literature aimed at novel research findings serving as the foundation for intervention as well as prevention programs. The main inspiration behind conducting research ought to be toward stimulating and collaborating appropriately on public/environmental health action. Hence, there is need for a “Plan B” of effective behavioral, environmental, social as well as systems interventions (BESSI) toward reducing transmission.

scholarly journals Burden of disease due to hip, knee, and unspecified osteoarthritis in the Peruvian social health insurance system (EsSalud), 2016

F1000Research ◽  
2020 ◽  
Vol 9 ◽  
pp. 238
Author(s):  
Roger V. Araujo-Castillo ◽  
Carlos Culquichicón ◽  
Risof Solis Condor
Keyword(s):  
Health Insurance ◽  
Burden Of Disease ◽  
Hip Osteoarthritis ◽  
Social Health Insurance ◽  
Social Health ◽  
World Health ◽  
Health Insurance System ◽  
Insurance System ◽  
Life Years ◽  
Social Health Insurance System

Introduction: Since its introduction by the World Health Organization (WHO), the concept of burden of disease has been evolving. The current method uses life expectancy projected to 2050 and does not consider age-weighting and time-discounting. Our aim is to estimate the burden of disease due to hip, knee, and unspecified osteoarthritis using this new method in the Peruvian Social Health Insurance System (EsSalud) during 2016. Methods: We followed the original 1994 WHO study and the current 2015 Global Burden of Disease (GBD) methods to estimate disability adjusted life years (DALY) due to osteoarthritis, categorized by sex, age, osteoarthritis type, and geographical area. We used disability weights employed by the Peruvian Ministry of Health, and the last update issued by WHO. Results: Overall, EsSalud reported 17.9 new cases of osteoarthritis per 1000 patients per year. Annual incidence was 23.7/1000 among women, and 72.6/1000 in people above 60 years old. Incidence was 5.6/1000 for knee osteoarthritis and 1.1/1000 for hip. According to the 1994 WHO method, there were 399,884 DALYs or 36.6 DALYs/1000 patients per year due to osteoarthritis. 12.4 and 2.2 DALYs/1000 patients per-year were estimated for knee and hip osteoarthritis, respectively. Using the 2015 GBD method, there were 1,037,865 DALYs or 94.9 DALYs/1000 patients per year. 31.4 and 5.3 DALYs/1000 patients per year were calculated for knee and hip osteoarthritis, respectively. Conclusions: In the Peruvian social health insurance subsystem, hip, knee, and unspecified osteoarthritis produced a high burden of disease, especially among women and patients over 60. The 2015 GBD methodology yields values almost three times higher than the original recommendations.

Beyond Efficacy and Effectiveness: Clinical Efficiency Is Necessary for Dissemination

2021 ◽  
Vol 35 (3) ◽  
pp. 221-231
Author(s):  
Alessandro S. De Nadai ◽  
Joseph L. Etherton
Keyword(s):  
Stepped Care ◽  
Insurance Companies ◽  
Evidence Based ◽  
Efficiency Ratio ◽  
Low Intensity ◽  
Clinical Efficiency ◽  
Referral Decisions ◽  
New Perspective ◽  
Evidence Based Care ◽  
Widespread Dissemination

Nearly all patients interact with critical gatekeepers—insurance companies or centralized healthcare systems. For mental health dissemination efforts to be successful, these gatekeepers must refer patients to evidence-based care. To make these referral decisions, they require evidence about the amount of resources expended to achieve therapeutic gains. Without this information, a bottleneck to widespread dissemination of evidence-based care will remain. To address this need for information, we introduce a new perspective, clinical efficiency. This approach directly ties resource usage to clinical outcomes. We highlight how cost-effectiveness approaches and other strategies can address clinical efficiency, and we also introduce a related new metric, the incremental time efficiency ratio (ITER). The ITER is particularly useful for quantifying the benefits of low-intensity and concentrated interventions, as well as stepped-care approaches. Given that stakeholders are increasingly requiring information on resource utilization, the ITER is a metric that can be estimated for past and future clinical trials. As a result, the ITER can allow researchers to better communicate desirable aspects of treatment, and an increased focus on clinical efficiency can improve our ability to deliver high-quality treatment to more patients in need.

Spam Mail Filtering Using Data Mining Approach

2020 ◽  
pp. 253-282 ◽  
Author(s):  
Ajay Kumar Gupta
Keyword(s):  
Decision Tree ◽  
Classification Accuracy ◽  
Time Complexity ◽  
Identification Accuracy ◽  
Tree Model ◽  
Swarm Optimization ◽  
Spam Filter ◽  
Data Mining Approach ◽  
Lower Complexity ◽  
Using Data

This chapter presents an overview of spam email as a serious problem in our internet world and creates a spam filter that reduces the previous weaknesses and provides better identification accuracy with less complexity. Since J48 decision tree is a widely used classification technique due to its simple structure, higher classification accuracy, and lower time complexity, it is used as a spam mail classifier here. Now, with lower complexity, it becomes difficult to get higher accuracy in the case of large number of records. In order to overcome this problem, particle swarm optimization is used here to optimize the spam base dataset, thus optimizing the decision tree model as well as reducing the time complexity. Once the records have been standardized, the decision tree is again used to check the accuracy of the classification. The chapter presents a study on various spam-related issues, various filters used, related work, and potential spam-filtering scope.

scholarly journals A Cost-Effectiveness Analysis of Newborn Screening for Severe Combined Immunodeficiency in the UK

2019 ◽  
Vol 5 (3) ◽  
pp. 28 ◽  
Author(s):  
Alice Bessey ◽  
James Chilcott ◽  
Joanna Leaviss ◽  
Carmen de la Cruz ◽  
Ruth Wong
Keyword(s):  
Cost Effectiveness ◽  
Severe Combined Immunodeficiency ◽  
Cost Effective ◽  
Sensitivity Analyses ◽  
Combined Immunodeficiency ◽  
Tree Model ◽  
Life Years ◽  
The Uk ◽  
The Cost ◽  
The Impact

Severe combined immunodeficiency (SCID) can be detected through newborn bloodspot screening. In the UK, the National Screening Committee (NSC) requires screening programmes to be cost-effective at standard UK thresholds. To assess the cost-effectiveness of SCID screening for the NSC, a decision-tree model with lifetable estimates of outcomes was built. Model structure and parameterisation were informed by systematic review and expert clinical judgment. A public service perspective was used and lifetime costs and quality-adjusted life years (QALYs) were discounted at 3.5%. Probabilistic, one-way sensitivity analyses and an exploratory disbenefit analysis for the identification of non-SCID patients were conducted. Screening for SCID was estimated to result in an incremental cost-effectiveness ratio (ICER) of £18,222 with a reduction in SCID mortality from 8.1 (5–12) to 1.7 (0.6–4.0) cases per year of screening. Results were sensitive to a number of parameters, including the cost of the screening test, the incidence of SCID and the disbenefit to the healthy at birth and false-positive cases. Screening for SCID is likely to be cost-effective at £20,000 per QALY, key uncertainties relate to the impact on false positives and the impact on the identification of children with non-SCID T Cell lymphopenia.

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