Decision Trees

Publication Title: 
AACN clinical issues

Patients with severe traumatic brain injury resulting in increased intracranial pressure refractory to first-tier interventions challenge the critical care team. After exhausting these initial interventions, critical care practitioners may utilize barbiturate-induced coma in an attempt to reduce the intracranial pressure. Titrating appropriate levels of barbiturate is imperative. Underdosing the drug may fail to control the intracranial pressure, whereas overdosing may lead to untoward effects such as hypotension and cardiac compromise.

Author(s): 
Bader, Mary Kay
Arbour, Richard
Palmer, Sylvain
Publication Title: 
Acta Ortopedica Mexicana

Tissue banks currently warrant an interdisciplinary management leading to detect and address pressure conflicts taking into account ethical aspects, the safety and quality of the tissues provided, behavior under the principles of altruism, solidarity and equity, and the procurement of deceased donor tissues.

Author(s): 
MartÌn Alvarez-San, R.
Publication Title: 
Radiology

PURPOSE: To compare the cost of standard intravenous conscious sedation with that of sedation with adjunct self-hypnotic relaxation during outpatient interventional radiologic procedures. MATERIALS AND METHODS: Data were reviewed from a prospective randomized study in which patients undergoing vascular and renal interventional procedures underwent either standard sedation (n = 79) or sedation with adjunct hypnosis (n = 82). These data were used to construct a decision analysis model to compare the cost of standard sedation with the cost of sedation with adjunct hypnosis.

Author(s): 
Lang, Elvira V.
Rosen, Max P.
Publication Title: 
AACN clinical issues

Patients with severe traumatic brain injury resulting in increased intracranial pressure refractory to first-tier interventions challenge the critical care team. After exhausting these initial interventions, critical care practitioners may utilize barbiturate-induced coma in an attempt to reduce the intracranial pressure. Titrating appropriate levels of barbiturate is imperative. Underdosing the drug may fail to control the intracranial pressure, whereas overdosing may lead to untoward effects such as hypotension and cardiac compromise.

Author(s): 
Bader, Mary Kay
Arbour, Richard
Palmer, Sylvain
Publication Title: 
The American Journal of Tropical Medicine and Hygiene

Artemisinin-based combination therapies (ACTs) are generally regarded as vital in addressing the growing problem posed by the development of antimalarial resistance across sub-Saharan Africa. However, the costs of the new ACTs are likely to be significantly higher than current therapies. Therefore, it is important to examine formally the cost-effectiveness of the more effective yet more expensive ACTs before advocating a switch in policy.

Author(s): 
Coleman, Paul G.
Morel, Chantal
Shillcutt, Sam
Goodman, Catherine
Mills, Anne J.
Publication Title: 
Tropical medicine & international health: TM & IH

INTRODUCTION: There is growing international evidence that artemisinin-based combination therapy (ACT) is one of the few effective measures available to 'Roll Back Malaria'. However, concerns about the costs and affordability of ACT are obstacles to its widespread implementation. This paper explores some economic aspects of the implementation of artemether-lumefantrine (AL) to replace sulphadoxine-pyrimethamine (SP) in the KwaZulu Natal (KZN) province, South Africa.

Author(s): 
Muheki, Charlotte
McIntyre, Di
Barnes, Karen I.
Publication Title: 
Malaria Journal

BACKGROUND: Rapid diagnostic tests (RDTs) for malaria are increasingly being considered for routine use in Africa. However, many RDTs are available and selecting the ideal test for a particular setting is challenging. The appropriateness of RDT choice depends in part on patient population and epidemiological setting, and on decision makers' priorities. The model presented (available online) can be used by decision makers to evaluate alternative RDTs and assess the circumstances under which their use is justified on economic grounds.

Author(s): 
Lubell, Yoel
Hopkins, Heidi
Whitty, Christopher J. M.
Staedke, Sarah G.
Mills, Anne
Publication Title: 
Bulletin of the World Health Organization

OBJECTIVE: To evaluate the relative cost-effectiveness in different sub-Saharan African settings of presumptive treatment, field-standard microscopy and rapid diagnostic tests (RDTs) to diagnose malaria. METHODS: We used a decision tree model and probabilistic sensitivity analysis applied to outpatients presenting at rural health facilities with suspected malaria. Costs and effects encompassed those for both patients positive on RDT (assuming artemisinin-based combination therapy) and febrile patients negative on RDT (assuming antibiotic treatment).

Author(s): 
Shillcutt, Samuel
Morel, Chantal
Goodman, Catherine
Coleman, Paul
Bell, David
Whitty, Christopher J. M.
Mills, A.
Publication Title: 
Malaria Journal

BACKGROUND: The diagnosis and treatment of malaria is often based on syndromic presentation (presumptive treatment) and microscopic examination of blood films. Treatment based on syndromic approach has been found to be costly, and contributes to the development of drug resistance, while microscopic diagnosis of malaria is time-consuming and labour-intensive. Also, there is lack of trained microscopists and reliable equipment especially in rural areas of Nigeria.

Author(s): 
Uzochukwu, Benjamin S. C.
Obikeze, Eric N.
Onwujekwe, Obinna E.
Onoka, Chima A.
Griffiths, Ulla K.
Publication Title: 
The Journal of the American Osteopathic Association

The complications from untreated sinusitis in a 10-month-old male infant, though at the more severe end of the spectrum, brings to light the importance of diagnosis and treatment even in the very young patient. Acute sinusitis should be diagnosed using established guidelines. Appropriate pharmacologic and osteopathic manipulative treatment should be initiated on diagnosis. Initial antibiotic therapy is a 14-day course of amoxicillin. If the sinusitis fails to resolve, a trial of a second-line antibiotic should be considered.

Author(s): 
Shrum, K. M.
Grogg, S. E.
Barton, P.
Shaw, H. H.
Dyer, R. R.

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