Decision-analytic Models for Treatment Optimization in the Presence of Patient Heterogeneity

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Publisher :
ISBN 13 :
Total Pages : 108 pages
Book Rating : 4.:/5 (13 download)

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Book Synopsis Decision-analytic Models for Treatment Optimization in the Presence of Patient Heterogeneity by : Mutita Siriruchatanon

Download or read book Decision-analytic Models for Treatment Optimization in the Presence of Patient Heterogeneity written by Mutita Siriruchatanon and published by . This book was released on 2021 with total page 108 pages. Available in PDF, EPUB and Kindle. Book excerpt: With the ever-increasing complexity in disease etiology, new therapeutics, healthcare service delivery, and clinical guidelines, selecting the appropriate course of treatment for an individual or population can become a great challenge for clinicians and healthcare providers. Applying suboptimal healthcare policies can set a damaging course for infectious disease control on the population level. On the individual level, disease can progress uniquely from patient-to-patient and ignoring a patient's preference may lead to treatment nonadherence or treatment rejection. In this thesis, we address the need for the development of decision-analytic methods for treatment selection that accounts for diversity in the patient population, uncertainty in patient treatment responses, and patients' preferences by studying the following problems: 1) the HIV treatment policy selection in HIV-infected children in sub-Saharan Africa initiating treatment at age >̲ 3 years old in the presence of pre-treatment drug resistance; 2) a personalized treatment selection problem for chronic depression where patient's respond uniquely to treatments whose response level is quantified by their unknown treatment effects; 3) a personalized treatment selection problem with two competing objectives, health outcomes and treatment side effect burden, given the qualitative rankings of sequences of possible patient's treatment and responses For the first problem, we develop and calibrate a microsimulation model of HIV disease progression and treatment. Using the model, we evaluate alternative antiretroviral treatment strategies using cost-effectiveness analyses. The second problem is formulated as a Markov Decision Process (MDP) where the treatment progression is parametrized by an individual's unknown treatment effects. We solved for the personalized treatment policies using two heuristic approaches: a model-based approach that can estimate an individual's treatment effect and a model-free approach using reinforcement learning. Taking into account an individual's preferences over two objectives, we formulate the last problem as an MDP as well. We developed two search algorithms, exhaustive and heuristic search, to estimate a patient's preference and provide an optimal treatment plan. This thesis contributes in developing three decision-analytic models to support decisions in testing, monitoring, and treatment selection for two significant healthcare problems, specifically, HIV and chronic depression, and treatment selection incorporating patient's preference. In addition, our work provides a step towards the design of personalized treatment strategy for patients with chronic diseases in various scenarios.

Improving Diagnosis in Health Care

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Publisher : National Academies Press
ISBN 13 : 0309377722
Total Pages : 473 pages
Book Rating : 4.3/5 (93 download)

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Book Synopsis Improving Diagnosis in Health Care by : National Academies of Sciences, Engineering, and Medicine

Download or read book Improving Diagnosis in Health Care written by National Academies of Sciences, Engineering, and Medicine and published by National Academies Press. This book was released on 2015-12-29 with total page 473 pages. Available in PDF, EPUB and Kindle. Book excerpt: Getting the right diagnosis is a key aspect of health care - it provides an explanation of a patient's health problem and informs subsequent health care decisions. The diagnostic process is a complex, collaborative activity that involves clinical reasoning and information gathering to determine a patient's health problem. According to Improving Diagnosis in Health Care, diagnostic errors-inaccurate or delayed diagnoses-persist throughout all settings of care and continue to harm an unacceptable number of patients. It is likely that most people will experience at least one diagnostic error in their lifetime, sometimes with devastating consequences. Diagnostic errors may cause harm to patients by preventing or delaying appropriate treatment, providing unnecessary or harmful treatment, or resulting in psychological or financial repercussions. The committee concluded that improving the diagnostic process is not only possible, but also represents a moral, professional, and public health imperative. Improving Diagnosis in Health Care, a continuation of the landmark Institute of Medicine reports To Err Is Human (2000) and Crossing the Quality Chasm (2001), finds that diagnosis-and, in particular, the occurrence of diagnostic errorsâ€"has been largely unappreciated in efforts to improve the quality and safety of health care. Without a dedicated focus on improving diagnosis, diagnostic errors will likely worsen as the delivery of health care and the diagnostic process continue to increase in complexity. Just as the diagnostic process is a collaborative activity, improving diagnosis will require collaboration and a widespread commitment to change among health care professionals, health care organizations, patients and their families, researchers, and policy makers. The recommendations of Improving Diagnosis in Health Care contribute to the growing momentum for change in this crucial area of health care quality and safety.

Improving Healthcare Quality in Europe Characteristics, Effectiveness and Implementation of Different Strategies

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Publisher : OECD Publishing
ISBN 13 : 9264805907
Total Pages : 447 pages
Book Rating : 4.2/5 (648 download)

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Book Synopsis Improving Healthcare Quality in Europe Characteristics, Effectiveness and Implementation of Different Strategies by : OECD

Download or read book Improving Healthcare Quality in Europe Characteristics, Effectiveness and Implementation of Different Strategies written by OECD and published by OECD Publishing. This book was released on 2019-10-17 with total page 447 pages. Available in PDF, EPUB and Kindle. Book excerpt: This volume, developed by the Observatory together with OECD, provides an overall conceptual framework for understanding and applying strategies aimed at improving quality of care. Crucially, it summarizes available evidence on different quality strategies and provides recommendations for their implementation. This book is intended to help policy-makers to understand concepts of quality and to support them to evaluate single strategies and combinations of strategies.

Improving and Accelerating Therapeutic Development for Nervous System Disorders

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Publisher : National Academies Press
ISBN 13 : 0309292492
Total Pages : 107 pages
Book Rating : 4.3/5 (92 download)

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Book Synopsis Improving and Accelerating Therapeutic Development for Nervous System Disorders by : Institute of Medicine

Download or read book Improving and Accelerating Therapeutic Development for Nervous System Disorders written by Institute of Medicine and published by National Academies Press. This book was released on 2014-02-06 with total page 107 pages. Available in PDF, EPUB and Kindle. Book excerpt: Improving and Accelerating Therapeutic Development for Nervous System Disorders is the summary of a workshop convened by the IOM Forum on Neuroscience and Nervous System Disorders to examine opportunities to accelerate early phases of drug development for nervous system drug discovery. Workshop participants discussed challenges in neuroscience research for enabling faster entry of potential treatments into first-in-human trials, explored how new and emerging tools and technologies may improve the efficiency of research, and considered mechanisms to facilitate a more effective and efficient development pipeline. There are several challenges to the current drug development pipeline for nervous system disorders. The fundamental etiology and pathophysiology of many nervous system disorders are unknown and the brain is inaccessible to study, making it difficult to develop accurate models. Patient heterogeneity is high, disease pathology can occur years to decades before becoming clinically apparent, and diagnostic and treatment biomarkers are lacking. In addition, the lack of validated targets, limitations related to the predictive validity of animal models - the extent to which the model predicts clinical efficacy - and regulatory barriers can also impede translation and drug development for nervous system disorders. Improving and Accelerating Therapeutic Development for Nervous System Disorders identifies avenues for moving directly from cellular models to human trials, minimizing the need for animal models to test efficacy, and discusses the potential benefits and risks of such an approach. This report is a timely discussion of opportunities to improve early drug development with a focus toward preclinical trials.

Tumor Organoids

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Publisher : Humana Press
ISBN 13 : 3319605119
Total Pages : 225 pages
Book Rating : 4.3/5 (196 download)

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Book Synopsis Tumor Organoids by : Shay Soker

Download or read book Tumor Organoids written by Shay Soker and published by Humana Press. This book was released on 2017-10-20 with total page 225 pages. Available in PDF, EPUB and Kindle. Book excerpt: Cancer cell biology research in general, and anti-cancer drug development specifically, still relies on standard cell culture techniques that place the cells in an unnatural environment. As a consequence, growing tumor cells in plastic dishes places a selective pressure that substantially alters their original molecular and phenotypic properties.The emerging field of regenerative medicine has developed bioengineered tissue platforms that can better mimic the structure and cellular heterogeneity of in vivo tissue, and are suitable for tumor bioengineering research. Microengineering technologies have resulted in advanced methods for creating and culturing 3-D human tissue. By encapsulating the respective cell type or combining several cell types to form tissues, these model organs can be viable for longer periods of time and are cultured to develop functional properties similar to native tissues. This approach recapitulates the dynamic role of cell–cell, cell–ECM, and mechanical interactions inside the tumor. Further incorporation of cells representative of the tumor stroma, such as endothelial cells (EC) and tumor fibroblasts, can mimic the in vivo tumor microenvironment. Collectively, bioengineered tumors create an important resource for the in vitro study of tumor growth in 3D including tumor biomechanics and the effects of anti-cancer drugs on 3D tumor tissue. These technologies have the potential to overcome current limitations to genetic and histological tumor classification and development of personalized therapies.

Personalized Medicine in Oncology

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Publisher :
ISBN 13 : 9783036528205
Total Pages : 174 pages
Book Rating : 4.5/5 (282 download)

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Book Synopsis Personalized Medicine in Oncology by : Ari VanderWalde

Download or read book Personalized Medicine in Oncology written by Ari VanderWalde and published by . This book was released on 2022 with total page 174 pages. Available in PDF, EPUB and Kindle. Book excerpt: Nowhere is the explosion in comprehensive genomic testing more evident than in oncology. Multiple consensus guidelines now recommend molecular testing as the standard of care for most metastatic tumors. To aid in the advancement of this rapidly changing field, we intend this Special Issue of JPM to focus on technical developments in the genomic profiling of cancer, detail promising somatic alterations that either are, or have a high likelihood of being, relevant in the near future, and to address issues related to the pricing and value of these tests.The last few years have seen the cost of molecular testing decrease by orders of magnitude. In 2018, we saw the first “site-agnostic” drug approvals in cancer (for microsatellite unstable cancer (PD-1 inhibitors) and NTRK-fusions (TRK inhibitors)). Research on targetable mutations, determination of genetic “signatures” that can use multiple individual genes/pathways, development of targeted therapy, and insight into the value of new technology remains at the cutting edge of research in this field. We are soliciting papers that present new technologies to assess predictive biomarkers in cancer, original research (pre-clinical or clinical) that demonstrates promise for particular targeted therapies in cancer, and articles that explore the clinical and financial impacts of this paradigmatic shift in cancer diagnostics and treatment.

Pain Management and the Opioid Epidemic

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Publisher : National Academies Press
ISBN 13 : 0309459575
Total Pages : 483 pages
Book Rating : 4.3/5 (94 download)

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Book Synopsis Pain Management and the Opioid Epidemic by : National Academies of Sciences, Engineering, and Medicine

Download or read book Pain Management and the Opioid Epidemic written by National Academies of Sciences, Engineering, and Medicine and published by National Academies Press. This book was released on 2017-09-28 with total page 483 pages. Available in PDF, EPUB and Kindle. Book excerpt: Drug overdose, driven largely by overdose related to the use of opioids, is now the leading cause of unintentional injury death in the United States. The ongoing opioid crisis lies at the intersection of two public health challenges: reducing the burden of suffering from pain and containing the rising toll of the harms that can arise from the use of opioid medications. Chronic pain and opioid use disorder both represent complex human conditions affecting millions of Americans and causing untold disability and loss of function. In the context of the growing opioid problem, the U.S. Food and Drug Administration (FDA) launched an Opioids Action Plan in early 2016. As part of this plan, the FDA asked the National Academies of Sciences, Engineering, and Medicine to convene a committee to update the state of the science on pain research, care, and education and to identify actions the FDA and others can take to respond to the opioid epidemic, with a particular focus on informing FDA's development of a formal method for incorporating individual and societal considerations into its risk-benefit framework for opioid approval and monitoring.

Managing Safety of Heterogeneous Systems

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Publisher : Springer Science & Business Media
ISBN 13 : 3642228844
Total Pages : 390 pages
Book Rating : 4.6/5 (422 download)

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Book Synopsis Managing Safety of Heterogeneous Systems by : Yuri Ermoliev

Download or read book Managing Safety of Heterogeneous Systems written by Yuri Ermoliev and published by Springer Science & Business Media. This book was released on 2012-01-31 with total page 390 pages. Available in PDF, EPUB and Kindle. Book excerpt: Managing safety of diverse systems requires decision-making under uncertainties and risks. Such systems are typically characterized by spatio-temporal heterogeneities, inter-dependencies, externalities, endogenous risks, discontinuities, irreversibility, practically irreducible uncertainties, and rare events with catastrophic consequences. Traditional scientific approaches rely on data from real observations and experiments; yet no sufficient observations exist for new problems, and experiments are usually impossible. Therefore, science-based support for addressing such new class of problems needs to replace the traditional “deterministic predictions” analysis by new methods and tools for designing decisions that are robust against the involved uncertainties and risks. The new methods treat uncertainties explicitly by using “synthetic” information derived by integration of “hard” elements, including available data, results of possible experiments, and formal representations of scientific facts, with “soft” elements based on diverse representations of scenarios and opinions of public, stakeholders, and experts. The volume presents such effective new methods, and illustrates their applications in different problem areas, including engineering, economy, finance, agriculture, environment, and policy making.

Sharing Clinical Trial Data

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Publisher : National Academies Press
ISBN 13 : 0309316324
Total Pages : 236 pages
Book Rating : 4.3/5 (93 download)

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Book Synopsis Sharing Clinical Trial Data by : Institute of Medicine

Download or read book Sharing Clinical Trial Data written by Institute of Medicine and published by National Academies Press. This book was released on 2015-04-20 with total page 236 pages. Available in PDF, EPUB and Kindle. Book excerpt: Data sharing can accelerate new discoveries by avoiding duplicative trials, stimulating new ideas for research, and enabling the maximal scientific knowledge and benefits to be gained from the efforts of clinical trial participants and investigators. At the same time, sharing clinical trial data presents risks, burdens, and challenges. These include the need to protect the privacy and honor the consent of clinical trial participants; safeguard the legitimate economic interests of sponsors; and guard against invalid secondary analyses, which could undermine trust in clinical trials or otherwise harm public health. Sharing Clinical Trial Data presents activities and strategies for the responsible sharing of clinical trial data. With the goal of increasing scientific knowledge to lead to better therapies for patients, this book identifies guiding principles and makes recommendations to maximize the benefits and minimize risks. This report offers guidance on the types of clinical trial data available at different points in the process, the points in the process at which each type of data should be shared, methods for sharing data, what groups should have access to data, and future knowledge and infrastructure needs. Responsible sharing of clinical trial data will allow other investigators to replicate published findings and carry out additional analyses, strengthen the evidence base for regulatory and clinical decisions, and increase the scientific knowledge gained from investments by the funders of clinical trials. The recommendations of Sharing Clinical Trial Data will be useful both now and well into the future as improved sharing of data leads to a stronger evidence base for treatment. This book will be of interest to stakeholders across the spectrum of research-from funders, to researchers, to journals, to physicians, and ultimately, to patients.

Healthcare Analytics

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Publisher : John Wiley & Sons
ISBN 13 : 1119374669
Total Pages : 632 pages
Book Rating : 4.1/5 (193 download)

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Book Synopsis Healthcare Analytics by : Hui Yang

Download or read book Healthcare Analytics written by Hui Yang and published by John Wiley & Sons. This book was released on 2016-10-10 with total page 632 pages. Available in PDF, EPUB and Kindle. Book excerpt: Features of statistical and operational research methods and tools being used to improve the healthcare industry With a focus on cutting-edge approaches to the quickly growing field of healthcare, Healthcare Analytics: From Data to Knowledge to Healthcare Improvement provides an integrated and comprehensive treatment on recent research advancements in data-driven healthcare analytics in an effort to provide more personalized and smarter healthcare services. Emphasizing data and healthcare analytics from an operational management and statistical perspective, the book details how analytical methods and tools can be utilized to enhance healthcare quality and operational efficiency. Organized into two main sections, Part I features biomedical and health informatics and specifically addresses the analytics of genomic and proteomic data; physiological signals from patient-monitoring systems; data uncertainty in clinical laboratory tests; predictive modeling; disease modeling for sepsis; and the design of cyber infrastructures for early prediction of epidemic events. Part II focuses on healthcare delivery systems, including system advances for transforming clinic workflow and patient care; macro analysis of patient flow distribution; intensive care units; primary care; demand and resource allocation; mathematical models for predicting patient readmission and postoperative outcome; physician–patient interactions; insurance claims; and the role of social media in healthcare. Healthcare Analytics: From Data to Knowledge to Healthcare Improvement also features: • Contributions from well-known international experts who shed light on new approaches in this growing area • Discussions on contemporary methods and techniques to address the handling of rich and large-scale healthcare data as well as the overall optimization of healthcare system operations • Numerous real-world examples and case studies that emphasize the vast potential of statistical and operational research tools and techniques to address the big data environment within the healthcare industry • Plentiful applications that showcase analytical methods and tools tailored for successful healthcare systems modeling and improvement The book is an ideal reference for academics and practitioners in operations research, management science, applied mathematics, statistics, business, industrial and systems engineering, healthcare systems, and economics. Healthcare Analytics: From Data to Knowledge to Healthcare Improvement is also appropriate for graduate-level courses typically offered within operations research, industrial engineering, business, and public health departments.

High Quality Care for All

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Publisher : The Stationery Office
ISBN 13 : 9780101743228
Total Pages : 92 pages
Book Rating : 4.7/5 (432 download)

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Book Synopsis High Quality Care for All by : Secretary of State for Health

Download or read book High Quality Care for All written by Secretary of State for Health and published by The Stationery Office. This book was released on 2008 with total page 92 pages. Available in PDF, EPUB and Kindle. Book excerpt: This review incorporates the views and visions of 2,000 clinicians and other health and social care professionals from every NHS region in England, and has been developed in discussion with patients, carers and the general public. The changes proposed are locally-led, patient-centred and clinically driven. Chapter 2 identifies the challenges facing the NHS in the 21st century: ever higher expectations; demand driven by demographics as people live longer; health in an age of information and connectivity; the changing nature of disease; advances in treatment; a changing health workplace. Chapter 3 outlines the proposals to deliver high quality care for patients and the public, with an emphasis on helping people to stay healthy, empowering patients, providing the most effective treatments, and keeping patients as safe as possible in healthcare environments. The importance of quality in all aspects of the NHS is reinforced in chapter 4, and must be understood from the perspective of the patient's safety, experience in care received and the effectiveness of that care. Best practice will be widely promoted, with a central role for the National Institute for Health and Clinical Excellence (NICE) in expanding national standards. This will bring clarity to the high standards expected and quality performance will be measured and published. The review outlines the need to put frontline staff in control of this drive for quality (chapter 5), with greater freedom to use their expertise and skill and decision-making to find innovative ways to improve care for patients. Clinical and managerial leadership skills at the local level need further development, and all levels of staff will receive support through education and training (chapter 6). The review recommends the introduction of an NHS Constitution (chapter 7). The final chapter sets out the means of implementation.

Treatment Planning of High Dose-Rate Brachytherapy - Mathematical Modelling and Optimization

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Publisher : Linköping University Electronic Press
ISBN 13 : 9179297382
Total Pages : 53 pages
Book Rating : 4.1/5 (792 download)

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Book Synopsis Treatment Planning of High Dose-Rate Brachytherapy - Mathematical Modelling and Optimization by : Björn Morén

Download or read book Treatment Planning of High Dose-Rate Brachytherapy - Mathematical Modelling and Optimization written by Björn Morén and published by Linköping University Electronic Press. This book was released on 2021-01-12 with total page 53 pages. Available in PDF, EPUB and Kindle. Book excerpt: Cancer is a widespread class of diseases that each year affects millions of people. It is mostly treated with chemotherapy, surgery, radiation therapy, or combinations thereof. High doserate (HDR) brachytherapy (BT) is one modality of radiation therapy, which is used to treat for example prostate cancer and gynecologic cancer. In BT, catheters (i.e., hollow needles) or applicators are used to place a single, small, but highly radioactive source of ionizing radiation close to or within a tumour, at dwell positions. An emerging technique for HDR BT treatment is intensity modulated brachytherapy (IMBT), in which static or dynamic shields are used to further shape the dose distribution, by hindering the radiation in certain directions. The topic of this thesis is the application of mathematical optimization to model and solve the treatment planning problem. The treatment planning includes decisions on catheter placement, that is, how many catheters to use and where to place them, as well as decisions for dwell times. Our focus is on the latter decisions. The primary treatment goals are to give the tumour a sufficiently high radiation dose while limiting the dose to the surrounding healthy organs, to avoid severe side effects. Because these aims are typically in conflict, optimization models of the treatment planning problem are inherently multiobjective. Compared to manual treatment planning, there are several advantages of using mathematical optimization for treatment planning. First, the optimization of treatment plans requires less time, compared to the time-consuming manual planning. Secondly, treatment plan quality can be improved by using optimization models and algorithms. Finally, with the use of sophisticated optimization models and algorithms the requirements of experience and skill level for the planners are lower. The use of optimization for treatment planning of IMBT is especially important because the degrees of freedom are too many for manual planning. The contributions of this thesis include the study of properties of treatment planning models, suggestions for extensions and improvements of proposed models, and the development of new optimization models that take clinically relevant, but uncustomary aspects, into account in the treatment planning. A common theme is the modelling of constraints on dosimetric indices, each of which is a restriction on the portion of a volume that receives at least a specified dose, or on the lowest dose that is received by a portion of a volume. Modelling dosimetric indices explicitly yields mixed-integer programs which are computationally demanding to solve. We have therefore investigated approximations of dosimetric indices, for example using smooth non-linear functions or convex functions. Contributions of this thesis are also a literature review of proposed treatment planning models for HDR BT, including mathematical analyses and comparisons of models, and a study of treatment planning for IMBT, which shows how robust optimization can be used to mitigate the risks from rotational errors in the shield placement. Cancer är en grupp av sjukdomar som varje år drabbar miljontals människor. De vanligaste behandlingsformerna är cellgifter, kirurgi, strålbehandling eller en kombination av dessa. I denna avhandling studeras högdosrat brachyterapi (HDR BT), vilket är en form av strålbehandling som till exempel används vid behandling av prostatacancer och gynekologisk cancer. Vid brachyterapibehandling används ihåliga nålar eller applikatorer för att placera en millimeterstor strålkälla antingen inuti eller intill en tumör. I varje nål finns det ett antal så kallade dröjpositioner där strålkällan kan stanna en viss tid för att bestråla den omkringliggande vävnaden, i alla riktningar. Genom att välja lämpliga tider för dröjpositionerna kan dosfördelningen formas efter patientens anatomi. Utöver HDR BT studeras också den nya tekniken intensitetsmodulerad brachyterapi (IMBT) vilket är en variation på HDR BT där skärmning används för att minska strålningen i vissa riktningar vilket gör det möjligt att forma dosfördelningen bättre. Planeringen av en behandling med HDR BT omfattar hur många nålar som ska användas, var de ska placeras samt hur länge strålkällan ska stanna i de olika dröjpositionerna. För HDR BT kan dessa vara flera hundra stycken medan det för IMBT snarare handlar om tusentals möjliga kombinationer av dröjpositioner och inställningar av skärmarna. Planeringen resulterar i en dosplan som beskriver hur hög stråldos som tumören och intilliggande frisk vävnad och riskorgan utsätts för. Dosplaneringen kan formuleras som ett matematiskt optimeringsproblem vilket är ämnet för avhandlingen. De övergripande målsättningarna för behandlingen är att ge en tillräckligt hög stråldos till tumören, för att döda alla cancerceller, samt att undvika att bestråla riskorgan eftersom det kan ge allvarliga biverkningar. Då alla målsättningarna inte samtidigt kan uppnås fullt ut så fås optimeringsproblem där flera målsättningar behöver prioriteras mot varandra. Utöver att dosplanen uppfyller kliniska behandlingsriktlinjer så är också tidsaspekten av planeringen viktig eftersom det är vanligt att den görs medan patienten är bedövad eller sövd. Vid utvärdering av en dosplan används dos-volymmått. För en tumör anger ett dosvolymmått hur stor andel av tumören som får en stråldos som är högre än en specificerad nivå. Dos-volymmått utgör en viktig del av målen för dosplaner som tas upp i kliniska behandlingsriktlinjer och ett exempel på ett sådant mål vid behandling av prostatacancer är att 95% av prostatans volym ska få en stråldos som är minst den föreskrivna dosen. Dos-volymmått utläses ur de kliniskt betydelsefulla dos-volym histogrammen som för varje stråldosnivå anger motsvarande volym som erhåller den dosen. En fördel med att använda matematisk optimering för dosplanering är att det kan spara tid jämfört med manuell planering. Med väl utvecklade modeller så finns det också möjlighet att skapa bättre dosplaner, till exempel genom att riskorganen nås av en lägre dos men med bibehållen dos till tumören. Vidare så finns det även fördelar med en process som inte är lika personberoende och som inte kräver erfarenhet i lika stor utsträckning som manuell dosplanering i dagsläget gör. Vid IMBT är det dessutom så många frihetsgrader att manuell planering i stort sett blir omöjligt. I avhandlingen ligger fokus på hur dos-volymmått kan användas och modelleras explicit i optimeringsmodeller, så kallade dos-volymmodeller. Detta omfattar såväl analys av egenskaper hos befintliga modeller, utvidgningar av tidigare använda modeller samt utveckling av nya optimeringsmodeller. Eftersom dos-volymmodeller modelleras som heltalsproblem, vilka är beräkningskrävande att lösa, så är det också viktigt att utveckla algoritmer som kan lösa dem tillräckligt snabbt för klinisk användning. Ett annat mål för modellutvecklingen är att kunna ta hänsyn till fler kriterier som är kliniskt relevanta men som inte ingår i dos-volymmodeller. En sådan kategori av mått är hur dosen är fördelad rumsligt, exempelvis att volymen av sammanhängande områden som får en alldeles för hög dos ska vara liten. Sådana områden går dock inte att undvika helt eftersom det är typiskt för dosplaner för brachyterapi att stråldosen fördelar sig ojämnt, med väldigt höga doser till små volymer precis intill strålkällorna. Vidare studeras hur små fel i inställningarna av skärmningen i IMBT påverkar dosplanens kvalitet och de olika utvärderingsmått som används kliniskt. Robust optimering har använts för att säkerställa att en dosplan tas fram som är robust sett till dessa möjliga fel i hur skärmningen är placerad. Slutligen ges en omfattande översikt över optimeringsmodeller för dosplanering av HDR BT och speciellt hur optimeringsmodellerna hanterar de motstridiga målsättningarna.

Multiple Criteria Decision Analysis

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Publisher : Springer Science & Business Media
ISBN 13 : 1461514959
Total Pages : 381 pages
Book Rating : 4.4/5 (615 download)

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Book Synopsis Multiple Criteria Decision Analysis by : Valerie Belton

Download or read book Multiple Criteria Decision Analysis written by Valerie Belton and published by Springer Science & Business Media. This book was released on 2012-12-06 with total page 381 pages. Available in PDF, EPUB and Kindle. Book excerpt: The field of multiple criteria decision analysis (MCDA), also termed multiple criteria decision aid, or multiple criteria decision making (MCDM), has developed rapidly over the past quarter century and in the process a number of divergent schools of thought have emerged. This can make it difficult for a new entrant into the field to develop a comprehensive appreciation of the range of tools and approaches which are available to assist decision makers in dealing with the ever-present difficulties of seeking compromise or consensus between conflicting inter ests and goals, i.e. the "multiple criteria". The diversity of philosophies and models makes it equally difficult for potential users of MCDA, i.e. management scientists and/or decision makers facing problems involving conflicting goals, to gain a clear understanding of which methodologies are appropriate to their particular context. Our intention in writing this book has been to provide a compre hensive yet widely accessible overview of the main streams of thought within MCDA. We aim to provide readers with sufficient awareness of the underlying philosophies and theories, understanding of the practi cal details of the methods, and insight into practice to enable them to implement any of the approaches in an informed manner. As the title of the book indicates, our emphasis is on developing an integrated view of MCDA, which we perceive to incorporate both integration of differ ent schools of thought within MCDA, and integration of MCDA with broader management theory, science and practice.

Registries for Evaluating Patient Outcomes

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Publisher : Government Printing Office
ISBN 13 : 1587634333
Total Pages : 385 pages
Book Rating : 4.5/5 (876 download)

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Book Synopsis Registries for Evaluating Patient Outcomes by : Agency for Healthcare Research and Quality/AHRQ

Download or read book Registries for Evaluating Patient Outcomes written by Agency for Healthcare Research and Quality/AHRQ and published by Government Printing Office. This book was released on 2014-04-01 with total page 385 pages. Available in PDF, EPUB and Kindle. Book excerpt: This User’s Guide is intended to support the design, implementation, analysis, interpretation, and quality evaluation of registries created to increase understanding of patient outcomes. For the purposes of this guide, a patient registry is an organized system that uses observational study methods to collect uniform data (clinical and other) to evaluate specified outcomes for a population defined by a particular disease, condition, or exposure, and that serves one or more predetermined scientific, clinical, or policy purposes. A registry database is a file (or files) derived from the registry. Although registries can serve many purposes, this guide focuses on registries created for one or more of the following purposes: to describe the natural history of disease, to determine clinical effectiveness or cost-effectiveness of health care products and services, to measure or monitor safety and harm, and/or to measure quality of care. Registries are classified according to how their populations are defined. For example, product registries include patients who have been exposed to biopharmaceutical products or medical devices. Health services registries consist of patients who have had a common procedure, clinical encounter, or hospitalization. Disease or condition registries are defined by patients having the same diagnosis, such as cystic fibrosis or heart failure. The User’s Guide was created by researchers affiliated with AHRQ’s Effective Health Care Program, particularly those who participated in AHRQ’s DEcIDE (Developing Evidence to Inform Decisions About Effectiveness) program. Chapters were subject to multiple internal and external independent reviews.

Heterogeneity in Breast Cancer: Clinical and Therapeutic Implications

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Author :
Publisher : Frontiers Media SA
ISBN 13 : 2832537928
Total Pages : 216 pages
Book Rating : 4.8/5 (325 download)

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Book Synopsis Heterogeneity in Breast Cancer: Clinical and Therapeutic Implications by : Anna Diana

Download or read book Heterogeneity in Breast Cancer: Clinical and Therapeutic Implications written by Anna Diana and published by Frontiers Media SA. This book was released on 2024-02-29 with total page 216 pages. Available in PDF, EPUB and Kindle. Book excerpt: Breast cancer is a highly heterogeneous disease. Despite advances in early detection and treatment, breast cancer (BC) is the leading cause of cancer death in women worldwide. Heterogeneity negatively affects a patient’s prognosis, treatment sensitivity, and clinical outcome. In particular, the development of drug resistance mechanisms and the failure of anticancer drugs (initially or subsequently) could lie in the heterogeneity among BC patients and tumors. The major international guidelines have adopted an immunophenotypic sub-classification of BC to maximize patient eligibility for personalized therapy but do not take into account the extreme diversity existing between breast tumors (intratumor heterogeneity).

Platform Trial Designs in Drug Development

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Author :
Publisher : CRC Press
ISBN 13 : 1351683926
Total Pages : 286 pages
Book Rating : 4.3/5 (516 download)

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Book Synopsis Platform Trial Designs in Drug Development by : Zoran Antonijevic

Download or read book Platform Trial Designs in Drug Development written by Zoran Antonijevic and published by CRC Press. This book was released on 2018-12-07 with total page 286 pages. Available in PDF, EPUB and Kindle. Book excerpt: Platform trials test multiple therapies in one indication, one therapy for multiple indications, or both. These novel clinical trial designs can dramatically increase the cost-effectiveness of drug development, leading to life-altering medicines for people suffering from serious illnesses, possibly at lower cost. Currently, the cost of drug development is unsustainable. Furthermore, there are particular problems in rare diseases and small biomarker defined subsets in oncology, where the required sample sizes for traditional clinical trial designs may not be feasible. The editors recruited the key innovators in this domain. The 20 articles discuss trial designs from perspectives as diverse as quantum computing, patient’s rights to information, and international health. The book begins with an overview of platform trials from multiple perspectives. It then describes impacts of platform trials on the pharmaceutical industry’s key stakeholders: patients, regulators, and payers. Next it provides advanced statistical methods that address multiple aspects of platform trials, before concluding with a pharmaceutical executive’s perspective on platform trials. Except for the statistical methods section, only a basic qualitative knowledge of clinical trials is needed to appreciate the important concepts and novel ideas presented.

Finding What Works in Health Care

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Author :
Publisher : National Academies Press
ISBN 13 : 0309164257
Total Pages : 267 pages
Book Rating : 4.3/5 (91 download)

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Book Synopsis Finding What Works in Health Care by : Institute of Medicine

Download or read book Finding What Works in Health Care written by Institute of Medicine and published by National Academies Press. This book was released on 2011-07-20 with total page 267 pages. Available in PDF, EPUB and Kindle. Book excerpt: Healthcare decision makers in search of reliable information that compares health interventions increasingly turn to systematic reviews for the best summary of the evidence. Systematic reviews identify, select, assess, and synthesize the findings of similar but separate studies, and can help clarify what is known and not known about the potential benefits and harms of drugs, devices, and other healthcare services. Systematic reviews can be helpful for clinicians who want to integrate research findings into their daily practices, for patients to make well-informed choices about their own care, for professional medical societies and other organizations that develop clinical practice guidelines. Too often systematic reviews are of uncertain or poor quality. There are no universally accepted standards for developing systematic reviews leading to variability in how conflicts of interest and biases are handled, how evidence is appraised, and the overall scientific rigor of the process. In Finding What Works in Health Care the Institute of Medicine (IOM) recommends 21 standards for developing high-quality systematic reviews of comparative effectiveness research. The standards address the entire systematic review process from the initial steps of formulating the topic and building the review team to producing a detailed final report that synthesizes what the evidence shows and where knowledge gaps remain. Finding What Works in Health Care also proposes a framework for improving the quality of the science underpinning systematic reviews. This book will serve as a vital resource for both sponsors and producers of systematic reviews of comparative effectiveness research.