| 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. |
- Ejeby, Kersti, et al.
(författare)
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Randomized controlled trial of transdiagnostic group treatments for primary care patients with common mental disorders
- 2014
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Ingår i: Family Practice. - : Oxford University Press (OUP). - 0263-2136 .- 1460-2229. ; 31:3, s. 273-280
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Tidskriftsartikel (refereegranskat)abstract
- Background. The purpose was to test the effectiveness of two transdiagnostic group interventions compared to care as usual (CAU) for patients with anxiety, depressive or stress-related disorders within a primary health care context. Objectives. To compare the effects of cognitive-based-behavioural therapy (CBT) and multimodal intervention (MMI) on the quality of life and relief of psychological symptoms of patients with common mental disorders or problems attending primary health care centre. Methods. Patients (n = 278), aged 18-65 years, were referred to the study by the GPs and 245 were randomized to CAU or one of two group interventions in addition to CAU: (i) group CBT administered by psychologists and (ii) group MMI administered by assistant nurses. The primary outcome measure was the Mental Component Summary score of short form 36. Secondary outcome measures were Perceived Stress Scale and Self-Rating Scale for Affective Syndromes. The data were analysed using intention-to-treat with a linear mixed model. Results. On the primary outcome measure, the mean improvement based on mixed model analyses across post-and follow-up assessment was significantly larger for the MMI group than for the CBT (4.0; P = 0.020) and CAU (7.5; P = .001) groups. Participants receiving CBT were significantly more improved than those in the CAU group. On four of the secondary outcome measures, the MMI group was significantly more improved than the CBT and CAU groups. The course of improvement did not differ between the CBT group and the CAU group on these measures. Conclusions. Transdiagnostic group treatment can be effective for patients with common mental disorders when delivered in a primary care setting. The group format and transdiagnostic approach fit well with the requirements of primary care.
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| 3. |
- Ejeby, Kersti, et al.
(författare)
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Symptom reduction due to psychosocial interventions is not accompanied by a reduction in sick leave : Results from a randomized controlled trial in primary care
- 2014
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Ingår i: Scandinavian Journal of Primary Health Care. - : Informa UK Limited. - 0281-3432 .- 1502-7724. ; 32:2, s. 67-72
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Tidskriftsartikel (refereegranskat)abstract
- Objective. To investigate whether interventions that have positive effects on psychological symptoms and quality of life compared with usual care would also reduce days on sick leave. Design. A randomized controlled trial. Setting. A large primary health care centre in Stockholm, Sweden. Intervention. Patients with common mental disorders were recruited by their GPs and randomized into one of two group interventions that took place in addition to usual care. These group interventions were: (a) group cognitive behavioural therapy (CBT), and (b) group multimodal intervention (MMI). Both types of intervention had previously shown significant effects on quality of life, and MMI had also shown significant effects on psychological symptoms. Patients. Of the 245 randomized patients, 164 were employed and had taken sick leave periods of at least two weeks in length during the study period of two years. They comprised the study group. Main outcome measures. The odds, compared with usual care, for being sick-listed at different times relative to the date of randomization. Results. The mean number of days on sick leave increased steadily in the two years before randomization and decreased in the two years afterwards, showing the same pattern for all three groups. The CBT and MMI interventions did not show the expected lower odds for sick-listing compared with usual care during the two-year follow-up. Conclusion. Reduction in psychological symptoms and increased well-being did not seem to be enough to reduce sickness absence for patients with common mental problems in primary care. The possibility of adding workplace-oriented interventions is discussed.
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| 4. |
- 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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| 5. |
- 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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| 6. |
- Selinus, Olle, et al.
(författare)
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12. Metal Flows and Environmental Impact
- 2003. - 1
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Ingår i: Environmental Science. - Uppsala : Baltic University Press. - 9197001708 ; , s. 356-383, s. 356-383 of 824
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Bokkapitel (populärvet., debatt m.m.)
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| 7. |
- 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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| 8. |
- Strawbridge, Rona J., et al.
(författare)
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Identification of a novel proinsulin-associated SNP and demonstration that proinsulin is unlikely to be a causal factor in subclinical vascular remodelling using Mendelian randomisation
- 2017
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Ingår i: Atherosclerosis. - : Elsevier BV. - 0021-9150 .- 1879-1484. ; 266, s. 196-204
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Tidskriftsartikel (refereegranskat)abstract
- Background and aims: Increased proinsulin relative to insulin levels have been associated with subclinical atherosclerosis (measured by carotid intima-media thickness (cIMT)) and are predictive of future cardiovascular disease (CVD), independently of established risk factors. The mechanisms linking proinsulin to atherosclerosis and CVD are unclear. A genome-wide meta-analysis has identified nine loci associated with circulating proinsulin levels. Using proinsulin-associated SNPs, we set out to use a Mendelian randomisation approach to test the hypothesis that proinsulin plays a causal role in subclinical vascular remodelling.Methods: We studied the high CVD-risk IMPROVE cohort (n = 3345), which has detailed biochemical phenotyping and repeated, state-of-the-art, high-resolution carotid ultrasound examinations. Genotyping was performed using Illumina Cardio-Metabo and Immuno arrays, which include reported proinsulin-associated loci. Participants with type 2 diabetes (n = 904) were omitted from the analysis. Linear regression was used to identify proinsulin-associated genetic variants.Results: We identified a proinsulin locus on chromosome 15 (rs8029765) and replicated it in data from 20,003 additional individuals. An 11-SNP score, including the previously identified and the chromosome 15 proinsulin-associated loci, was significantly and negatively associated with baseline IMTmean and IMTmax (the primary cIMT phenotypes) but not with progression measures. However, MR-Eggers refuted any significant effect of the proinsulin-associated 11-SNP score, and a non-pleiotropic SNP score of three variants (including rs8029765) demonstrated no effect on baseline or progression cIMT measures.Conclusions: We identified a novel proinsulin-associated locus and demonstrated that whilst proinsulin levels are associated with cIMT measures, proinsulin per se is unlikely to have a causative effect on cIMT.
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| 9. |
- 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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| 10. |
- 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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