| 1. |
- Backlund, Lars G., et al.
(författare)
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Improving Fast and Frugal Modeling in Relation to Regression Analysis : Test of 3 Models for Medical Decision Making
- 2009
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Ingår i: Medical decision making. - : Sage Publications. - 0272-989X .- 1552-681X. ; 29:1, s. 140-148
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Tidskriftsartikel (refereegranskat)abstract
- Background. A matching heuristic (MH) model of decision makinghas been evaluated previously in a series of studies on medicaldecision making. The authors' purpose is to evaluate an extendedMH model that considers the prevalence of cue values. Methods.Data from 2 previous studies were reanalyzed, one on judgmentsregarding drug treatment of hyperlipidemia and the other ondiagnosing heart failure. The original MH model and the extendedMH model were compared with logistic regression (LR) in termsof fit to actual judgments, number of cues, and the extent towhich the cues were consistent with clinical guidelines. Results. There was a slightly better fit with LR compared with MH. Theextended MH model gave a significantly better fit than the originalMH model in the drug treatment task. In the diagnostic task,the number of cues was significantly lower in the MH modelscompared to LR, whereas in the therapeutic task, LR could beless or more frugal than the matching heuristic models dependingon the significance level chosen for inclusion of cues. Forthe original MH model, but not for the extended MH model orLR, the most important cues in the drug treatment task wereoften used in a direction contrary to treatment guidelines.Conclusions. The extended MH model represents an improvementin that prevalence of cue values is adequately taken into account,which in turn may result in better fit and in better agreementwith medical guidelines in the evaluation of cues.
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| 2. |
- Kerimi, Neda, 1980-, et al.
(författare)
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Do We Really Need Medical Experts when modelling in Judgment Analysis? : Lack of Difference Between Expert and Non-Expert models in Judgment Analysis
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Tidskriftsartikel (refereegranskat)abstract
- It is assumed that in judgment analysis, experts provide better models than non-experts. In this study we challenge this view by showing that data from non-experts might be equally suitable for building models. We show this by modeling the decisions of 21 medical students, 27 general practitioners, and 22 cardiologists on real patient vignettes regarding diagnosing heart failure. The models used were logistic regression and fast and frugal models. Results showed that there were no differences between any of the expertise groups in terms of fit, prediction, information searched, or percent of actual diagnosis in any of the models. Therefore, it seems, at least for the studied conditions, using models built on decision data from non-experts versus experts might be equally valid in judgment analysis.
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| 3. |
- Kerimi, Neda, 1980-, et al.
(författare)
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Judgment Analysis in the Medical Domain : Making a Fair Comparison Between Logistic Regression and Fast & Frugal Models
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Tidskriftsartikel (refereegranskat)abstract
- Using participant data from the medical domain, the robustness of logistic regression (LR) with different cue inclusion levels and two fast and frugal (F&F) models in terms of predictive accuracy and frugality were tested. Two data sets based on judgments of verbally described patients were used: Heart failure (66 analysts), and Hyperlipidemia (38 analysts). In both data sets, when the models were cross-validated, there was a significant decrease in predictive accuracy for all models, especially when all cues were used in LR. The other models had about equal predictive accuracy, also when comparisons were made with actual diagnoses, with a slight advantage for LR in the Heart failure study. LR using the 5% inclusion level was more frugal than F&F. These results emphasize the importance of using cross-validation and of choosing the proper significance levels for cue inclusion and when comparing different judgment models.
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| 4. |
- Leanderson, Charlotte, et al.
(författare)
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Musculoskeletal injuries in young ballet dancers
- 2011
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Ingår i: Knee Surgery, Sports Traumatology, Arthroscopy. - : Springer Science and Business Media LLC. - 1433-7347 .- 0942-2056. ; 19:9, s. 1531-1535
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Tidskriftsartikel (refereegranskat)abstract
- Purpose The aim of this study was to examine the incidence of musculoskeletal injuries, site and type of injury, and the most common injury diagnoses in young ballet dancers at the Royal Swedish Ballet School, a public school in Stockholm. Methods This retrospective study of 476 students (297 girls and 179 boys) aged 10-21 years was based on medical records for the period August 1988 to June 1995. Data on diagnosis, site of injury and type of injury were collected, and the injuries were classified as traumatic or due to overuse. Results In total, 438 injuries were recorded. The injury incidence rate was 0.8 per 1,000 dance hours in both female and male dancers and tended to increase with increasing age. Most injuries occurred as the result of overuse. Seventy-six per cent of all injuries occurred in the lower extremities. Ankle sprain was the most common traumatic diagnosis, while the most common overuse-related diagnosis was tendinosis pedis. A few gender differences were noted. Conclusions The findings of this study suggest that there is a need to apply primary injury prevention in young ballet dancers. Future studies could aim to identify (1) injury risk factors and (2) injury prevention programmes that are effective at reducing injury rates in young dancers. Level of evidence II.
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| 5. |
- Salminen, Helena, et al.
(författare)
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The effect of transvaginal estradiol on bone in aged women; a randomised controlled trial
- 2007
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Ingår i: Maturitas. - Ireland : Elsevier Ireland Ltd. - 0378-5122 .- 1873-4111. ; 57, s. 370-381
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: To investigate the effect of transvaginal estradiol on bone mineral density and bone metabolism. Methods: One hundred and fifteen women (mean age 73.8 ± 3.2 years) were randomly assigned to a 2-year open-label parallel group clinical trial and were treated with either transvaginal estradiol (7.5 μg/24 h), or no estradiol. Both groups received 400 IU vitamin D and 500 mg calcium/day. The bone mineral density (BMD) was assessed in the hip and spine using DXA technique and in the heel using DXL technique. Results: The intention to treat analysis showed that the increase in BMD in the estradiol group was significant at total hip by 0.6% (P = 0.04) while the control group decreased in their BMD by 0.7%. At lumbar spine the estradiol group increased in BMD by 2.6% (P = 0.011) while the control group increased by 2.2%. Bone turnover markers and PTH-levels decreased while 25-OH vitamin D levels increased in both groups, a probable effect of the calcium and vitamin D supplementation. The bone resorption marker CTx decreased more significantly in the treatment group (P = 0.016). Conclusions: The transvaginal estradiol treatment of 7.5 μg/24 h had a small but significant effect on the BMD of total hip and lumbar spine after a follow-up of 2 years.
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| 6. |
- Skånér, Ylva, et al.
(författare)
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General practitioners’ reasoning when considering the diagnosis heart failure : A think-aloud study.
- 2005
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Ingår i: BMC Family Practice. - : Springer Science and Business Media LLC. - 1471-2296. ; 6:4
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Tidskriftsartikel (refereegranskat)abstract
- Diagnosing chronic heart failure is difficult, especially in mild cases or early in the course of the disease, and guidelines are not easily implemented in everyday practice. The aim of this study was to investigate general practitioners' diagnostic reasoning about patients with suspected chronic heart failure in comparison with recommendations in European guidelines. The think-aloud technique was used. Fifteen general practitioners reasoned about six case vignettes, representing authentic patients with suspected chronic heart failure. Information about each case was added successively in five steps. The general practitioners said their thoughts aloud while reasoning about the probability of the patient having chronic heart failure, and tried to decide about the diagnosis. Arguments for and against chronic heart failure were analysed and compared to recommendations in guidelines. Information about ejection fraction was the most frequent diagnostic argument, followed by information about cardiac enlargement or pulmonary congestion on chest X-ray. However, in a third of the judgement situations, no information about echocardiography was utilized in the general practitioners' diagnostic reasoning. Only three of the 15 doctors used information about a normal electrocardiography as an argument against chronic heart failure. Information about other cardio-vascular diseases was frequently used as a diagnostic argument. It was concluded that the clinical information was not utilized to the extent recommended in guidelines. Some implications of our study are that 1) general practitioners need more information about how to utilize echocardiography when diagnosing chronic heart failure, 2) guidelines ought to give more importance to information about other cardio-vascular diseases in the diagnostic reasoning, and 3) guidelines ought to treat the topic of diastolic heart failure in a clearer way.
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| 7. |
- Vancheri, Federico, et al.
(författare)
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Coronary risk estimates and decisions on lipid-lowering treatment in primary prevention : Comparison between general practitioners, internists, and cardiologists
- 2009
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Ingår i: European journal of internal medicine. - : Elsevier. - 0953-6205 .- 1879-0828. ; 20:6, s. 601-606
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Tidskriftsartikel (refereegranskat)abstract
- Background: Quantitative assessment of an individual's absolute cardiovascular risk is essential for primary prevention. Although risk-scoring tools have been developed for this task, risk estimates are usually made subjectively. We investigated whether general practitioners (GPs), internists and cardiologists differ in their quantitative estimates of cardiovascular risk and their recommendations about lipid-lowering treatment for the same set of patients. Methods: Mail survey. Nine written clinical vignettes, four rated high-risk and five rated low-risk according to the Framingham equation, were mailed to 90 randomly selected GPs and to the same number of internists and cardiologists in Sicily. The doctors were then asked to estimate the 10-year coronary risk in each case and to decide whether they would recommend a lipid-lowering treatment. Results: In the majority of the nine cases, the cardiologists' risk estimates were significantly lower than those of the other two groups. A higher proportion of internists (mean value 0.68) decided to start treatment than GPs (0.54) or cardiologists (0.57). In all three groups, the doctors' willingness to begin treatment was over 90% when their risk estimate was above 20%, and less than 50% when it fell below this level. Internists were more prone to treat than the other two groups even when their patients' estimated risk was below 20%. Conclusion: When presented with the same set of clinical cases, GPs, internists and cardiologists make different quantitative risk estimates and come to different conclusions about the need for lipid-lowering treatment. This may result in over- or under-prescription of lipid-lowering drugs and inconsistencies in the care provided by different categories of doctors.
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| 8. |
- Vancheri, Federico, et al.
(författare)
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General practitioners’ coronary risk assessments and lipid-lowering treatment decisions in primary prevention : Comparison between two European areas with different cardiovascular risk levels
- 2008
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Ingår i: Primary Health Care Research and Development. - : Cambridge University Press. - 1463-4236 .- 1477-1128. ; 9:4, s. 248-256
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Tidskriftsartikel (refereegranskat)abstract
- Aim: To investigate whether general practitioners (GPs) in countries with different levels of cardiovascular risk would make different risk estimates and choices about lipid-lowering treatment when assessing the same patients. Background: Primary prevention of coronary heart disease should be based on the quantitative assessment of an individual’s absolute risk. Risk-scoring charts have been developed, but in clinical practice risk estimates are often made on a subjective basis. Methods: Mail survey: Nine written case simulations of four cases rated by the Framingham equations as high risk, and five rated as low-risk were mailed to 90 randomly selected GPs in Stockholm, as a high-risk area, and 90 in Sicily as a low-risk area. GPs were asked to estimate the 10-year coronary risk and to decide whether to start a lipid-lowering drug treatment. Findings: Overall risk estimate was lower in Stockholm than in Sicily for both high-risk cases (median 20.8; interquartile range (IQR) 13.5–30.0 versus 29.1; IQR 21.8–30.6; P = 0.033) and low-risk cases (6.4; IQR 2.2–9.6 versus 8.5; IQR 6.0–14.5; P = 0.006). Swedish GPs were less likely than Sicilian GPs to choose to treat when their estimate of risk was above the recommended cut-off limit for treatment, both for the entire group (means of GPs’ decision proportions: 0.64 (0.45) and 0.92 (0.24), respectively, P = 0.001) and for high-risk cases (0.65 (0.45) and 0.93 (0.23), P = 0.001). Conclusions: The cardiovascular risk level in the general population influences GPs’ evaluations of risk and subsequent decisions to start treatment. GPs’ risk estimates seem to be inversely related to the general population risk level, and may lead to inappropriate over- or under-treatment of patients.
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| 9. |
- Vancheri, Federico, et al.
(författare)
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Time trends in ischaemic heart disease incidence and mortality over three decades (1990-2019) in 20 Western European countries: systematic analysis of the Global Burden of Disease Study 2019
- 2022
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Ingår i: European Journal of Preventive Cardiology. - : Oxford University Press. - 2047-4873 .- 2047-4881. ; 29:2, s. 396-403
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Tidskriftsartikel (refereegranskat)abstract
- AIMS: To investigate and compare changes in the rates of ischaemic heart disease (IHD) incidence and mortality between 1990 and 2019 in 20 high-income Western European countries with similar public health systems and low cardiovascular risk.METHODS AND RESULTS: The 2020 updated version of the Global Burden of Disease database was searched. Variability and differences in IHD incidence and mortality rates (per 100 000) between countries over time, were calculated. A piecewise linear (join point) regression model was used to identify the slopes of these trends and the points in time at which significant changes in the trends occur. Ischaemic heart disease incidence and mortality rates varied widely between countries but decreased for all between 1990 and 2019. The relative change was greater for mortality than for incidence. Ischaemic heart disease incidence rates declined by approximately 36% between 1990 and 2019, while mortality declined by approximately 60%. Breakpoint analysis showed that the largest decreases in incidence and mortality occurred between 1990 and 2009 (-32%, -52%, respectively), with a much slower decrease after that (-5.9%, -17.6%, respectively), and even a slight increase for some countries in recent years. The decline in both incidence and mortality was lower in the Mediterranean European countries compared to the Nordic and Central European regions.CONCLUSIONS: In the Western European countries studied, the decline in age-standardized IHD incidence over three decades was slower than the decline in age-standardized IHD mortality. Decreasing trends of both IHD incidence and mortality has substantially slowed, and for some countries flattened, in more recent years.
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| 10. |
- Axelson, Christian, et al.
(författare)
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Using medical knowledge sources on handheld computers--a qualitative study among junior doctors
- 2007
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Ingår i: Medical teacher. - : Informa UK Limited. - 0142-159X .- 1466-187X. ; 29:6, s. 611-618
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Tidskriftsartikel (refereegranskat)abstract
- Background: The emergence of mobile computing could have an impact on how junior doctors learn. To exploit this opportunity it is essential to understand their information seeking process. Aim: To explore junior doctors' experiences of using medical knowledge sources on handheld computers. Method: Interviews with five Swedish junior doctors. A qualitative manifest content analysis of a focus group interview followed by a qualitative latent content analysis of two individual interviews. Results: A focus group interview showed that users were satisfied with access to handheld medical knowledge sources, but there was concern about contents, reliability and device dependency. Four categories emerged from individual interviews: (1) A feeling of uncertainty about using handheld technology in medical care; (2) A sense of security that handhelds can provide; (3) A need for contents to be personalized; (4) A degree of adaptability to make the handheld a versatile information tool. A theme was established to link the four categories together, as expressed in the Conclusion section. Conclusion: Junior doctors' experiences of using medical knowledge sources on handheld computers shed light on the need to decrease uncertainty about clinical decisions during medical internship, and to find ways to influence the level of self-confidence in the junior doctor's process of decision-making.
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