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Biomedical subjects

H V Fineberg

Publications and source records attributed to H V Fineberg.

71 records · Page 4Linked to original sources
PubMed1980

Decision trees: construction, uses, and limits.

Decision trees are models of the temporal and logical flow of clinical problems. Their purpose is to help the physician choose a clinical management strategy that offers the greatest expected value for the patient. Decision trees help answer questions such as:"should a risky diagnostic test be performed?" "Given our present knowledge, which of several available treatments is best for this patient?" "What are the expected benefits, risks, and financial costs of pursuing different stages of patient care?" Decision trees do not create new information, but they can provide new insights based on existing information. The principles of analyzing a clinical situation from a decision analytic perspective and of constructing and using a decision tree are illustrated with three clinical examples: a patient with possible urinary tract infection, a young man with Hodgkin's disease, and patients with chronic progressive liver failure. We present a simplified quantitative analysis to determine whether the patient with Hodgkin's disease should undergo a staging laparotomy. The last example serves as a prelude to R. Fuhrer's discussion of the expected value of test information. Following R. Fuhrer's presentation, we discuss some of the objections and advantages to medical decision analysis. Despite its limitations we believe decision analysis can be a powerful aid to medical practitioners.

Adolescent↗
PubMed1979

Evaluation of medical practices. The case for technology assessment.

We believe that the systematic evaluation of medical practices, especially those that are risky or costly deserves more attention. Available methods are limited, and definitive assessments of innovative or controversial practices are infrequent. Nevertheless, some evaluations have successfully enhanced the use of effective practices and diminished the reliance on ineffective ones. Greater efforts at evaluation can improve the quality of patient care, avoid waste and promote the more rational use of health resources. The cost of assessing new practices should be viewed as an intrinsic part of the cost of medical care. Physicians and medical societies bear primary responsibility for recognizing the need for this evaluation, for enlisting other experts, participating in technology assessment and working to translate the results of evaluation into practice. The commitment of government agencies, insurance companies and teaching institutions is also essential to an effective program of evaluation.

Adult↗
PubMed1978

Clinical efficacy of computed body tomography.

A method for assessing the effect of computed body tomography on diagnostic understanding and therapeutic decision making is described and the results in the first 184 patients are presented. The patients' referring physicians provided the primary data used for the evaluation. CT improved diagnostic understanding in 41% of patients, reassured the physician about previously planned therapy in 43%, contributed to a change in therapy in 17%, and improved precision of previously planned treatment in an additional 10%. CT contributed to a decision not to perform surgery in 21% of patients in whom an operation had been provisionally planned While CT can play an important role in patient management, its measured value depends on the clinical problems investigated and the level of efficacy on which it is judged.

Adult↗
PubMed1977

Computerized cranial tomography. Effect on diagnostic and therapeutic plans.

The effect of computerized cranial tomography (CCT) on physicians' diagnostic and therapeutic plans in 194 patients scanned consecutively during a 17-day period at the Massachusetts General Hospital was studied. Use of CCT substantially decreased the perceived need for other neurodiagnostic tests in this patient population. There was a reduction of a least 41% in radionuclide scans, 52% angiograms, and 73% in pneumoencephalograms compared to the needs projected had CCT not been available. Therapy was altered after 37 scans in 36 patients (19% of those examined): new treatment was begun after 15 scans, previously planned therapy became more precise after 9 scans, treatment was found to be unnecessary after 7 scans, and treatment was abandoned as worthless after 6 scans.

Brain Neoplasms↗
PubMedDate not supplied

Whose blood is safer? The effect of the stage of the epidemic on screening for HIV.

BACKGROUND: With improvements in HIV antibody test (ELISA) performance, the window of time between infection and seroconversion becomes a major source of error in HIV screening. The authors examined its impact on the false-reassurance rate (FRR). METHODS: Test sensitivity was modeled as the product of two factors: the inherent sensitivity (sensitivity when antibody is present) and the probability that antibody is present in infected blood. A model of HIV and AIDS incidence was used to derive an estimate of the probability of remaining in the seronegative window (pw) among those who are infected. With plausible assumptions, this probability approaches 0.03. The FRR was then estimated as a function of the probability of remaining in the seronegative window, the prevalence of HIV, and the inherent sensitivity of the ELISA test were estimated. RESULTS: The FRRs for two blood donor groups, one with an HIV prevalence of 0.004 and a typical probability of remaining in the seronegative window (pw = 0.03) and the other with a higher prevalence of 0.017 but fewer donors in the window (pw = 0.003), are equal (140 per million donors) if the blood is negative on a single ELISA test. After two negative tests or a single test that can detect antibody more reliably, however, the FRR is much higher in the group with the higher pw (= 120 per million compared with 50 per million), because the greater numbers of donors in the window more than offsets the lower prevalence. CONCLUSION: With improvements in inherent sensitivity of ELISA by virtue of technical progress or retesting, the prevalence of HIV infection may no longer play the critical role in degrading the results of blood screening. As inherent test performance improves, tests are increasingly likely to miss infected blood because of the seronegative-window error rather than because of measurement error. Window error plays a proportionally greater role during the early stages of HIV dissemination in a population where the incidence of new HIV infection is high relative to the incidence of AIDS. These findings may explain, in part, the recent observation that cases of transfusion of contaminated blood often take place in areas where AIDS epidemics have started recently. They also suggest that the traditional strategy of soliciting blood donors from low-prevalence populations may not always be optimal, unless such populations are truly low-risk.

Blood Banks↗
PubMedDate not supplied

[The impact of AIDS on the health care system].

Since the AIDS epidemic was first detected, it has had a profound influence on the organization of health services in the United States. In this essay, some of the more relevant aspects of this process are analyzed, and the main problems that need to be confronted in order to fight successfully against this serious disease are briefly stated.

Acquired Immunodeficiency Syndrome↗
PubMedDate not supplied

[Future strategies for prevention of diseases].

This paper discusses the future strategies for the prevention of disease. The author presents three basic ideas. The first is that in public health it is increasingly important to evaluate critically the costs and benefits of different preventive strategies. Second, it is highly desirable to use new advances in biology to create more effective, safer, and possibly less expensive preventives. Third, it is increasingly important to utilize modern means of communication to reach the public to promote change toward healthier behaviours.

Forecasting↗
PubMedDate not supplied

Commentary.

Explore the source record for details and available documents.

Humans↗