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Biomedical subjects

D M Eddy

Publications and source records attributed to D M Eddy.

At least 55 records · Page 3Linked to original sources
PubMed1990

Screening for osteoporosis.

PURPOSE: To review evidence that screening for osteoporosis by measuring bone mass in postmenopausal women would reduce fracture incidence. DATA IDENTIFICATION: An English-language literature search using MEDLINE (1966 to 1989), bibliographic reviews of book chapters and review articles, technology assessments of bone mass measurement, and other publications. STUDY SELECTION: We summarize prospective studies of fracture risk prediction done with widely used bone mass measurement techniques, and we document noncontroversial or peripheral points with recent papers and reviews. DATA EXTRACTION: Without osteoporosis screening trials, no quantitative analysis is possible. Instead, we assess the ability of screening tests to measure bone mass and define fracture risk categories, the ability of risk categories to determine treatment, and the ability of treatment to reduce fracture incidence. RESULTS OF DATA SYNTHESIS: Bone mass measurement meets many of the criteria for a screening test, and indirect evidence suggests that a screening program might reduce osteoporosis-related fracture incidence. No trial has shown this directly; however, and questions remain about overall benefits and costs of mass screening. CONCLUSIONS: Although there are clinical indications for bone mass measurement, unselective screening for osteoporosis cannot be recommended until a specific program is formulated and justified.

Absorptiometry, Photon↗
PubMed1990

The challenge.

Explore the source record for details and available documents.

Decision Making↗
PubMed1990

A Bayesian method for synthesizing evidence. The Confidence Profile Method.

This article describes a collection of meta-analysis techniques based on Bayesian statistics for interpreting, adjusting, and combining evidence to estimate parameters and outcomes important to the assessment of health technologies. The result of an analysis by the Confidence Profile Method is a joint posterior probability distribution for the parameters of interest, from which marginal distributions for any particular parameter can be calculated. The method can be used to analyze problems involving a variety of types of outcomes, a variety of measures of effect, and a variety of experimental designs. This article presents the elements necessary for analysis, including prior distributions, likelihood functions, and specific models for experimental designs that include adjustment for biases.

Bayes Theorem↗
PubMed1989

Screening for breast cancer.

There is very good evidence that screening for breast cancer reduces mortality in women older than 50 years and suggestive but inconsistent evidence that screening is effective in reducing long-term mortality in women younger than 50 years. The probability that an average-risk woman will be diagnosed with breast cancer in the coming 10 years is about 130 in 10,000 for a 40-year-old woman, 230 in 10,000 for a 55-year-old woman, and 280 in 10,000 for a 65-year-old woman. The chance of dying from breast cancer diagnosed in the coming 10 years is about 90 in 10,000, 123 in 10,000, and 120 in 10,000 for women age 40, 55, and 65, respectively. Mathematical models based on data from controlled trials of screening programs indicate that screening annually for 10 years with breast physical examination will decrease the probability of death from breast cancer by about 25 in 10,000 for women in the three age groups and increase life expectancy by about 20 days. Adding annual mammography will decrease the probability of death from breast cancer an additional 25 in 10,000 and increase life expectancy an additional 20 days. The actual reductions in mortality observed in controlled trials are slightly lower. If women are screened annually for 10 years with breast physical examination and mammography, the chance for a false-positive result over the 10-year period is approximately 2500 in 10,000. On the population level, if 25% of women age 40 to 75 are screened annually with both examinations, deaths from breast cancer would be decreased by about 4000 in the year 2000. Net annual costs would be approximately $1.3 billion. Recommending a screening strategy requires weighing the benefits against the risks and costs.

Adult↗
PubMed1989

Screening for lung cancer.

Lung cancer is the commonest cause of death from cancer in both men and women, with approximately 152,000 new cases and 139,000 deaths in 1988. The incidence and mortality rates are increasing rapidly in women. Two main tests have been used to screen for lung cancer: chest roentgenography and sputum cytology. Four recent controlled trials and one case-control study failed, however, to show that screening reduces lung cancer mortality even in high-risk persons (smokers). In the Mayo Lung Project, for example, the lung cancer death rate in high-risk men offered sputum cytology and chest roentgenogram every 4 months was 3.1 per 1000 person-years, compared with 3.0 per 1000 person-years in a control group. Chest roentgenograms and sputum cytology lead to false-positive test results in smokers of approximately 5% and 0.5%, respectively. Because of the lack of evidence of benefit and because of its potential harms and costs, screening for lung cancer is not recommended.

Costs and Cost Analysis↗
PubMed1989

Selecting technologies for assessment.

This article describes criteria used by several organizations to select technologies for assessment and the factors that are common to most lists of criteria. It presents a framework or model (called TAPSS) that relates the most important factors. The model can be used to estimate the expected impact of an assessment on health and economic outcomes for a population. It incorporates information on such factors as the health and economic importance of the disease addressed by the technology, the expected impact of the technology on health and economic outcomes, variations in the technology's current use, and factors affecting the production and reception of an assessment. The article includes an example of an application of the method--screening for maple syrup urine disease.

Cost-Benefit Analysis↗
PubMed1989

A confidence profile analysis of the results of femoropopliteal percutaneous transluminal angioplasty in the treatment of lower-extremity ischemia.

The many reports on the use of percutaneous transluminal angioplasty (PTA) for treating lower-extremity ischemia were analyzed to determine the outcomes of femoropopliteal PTA used in patients with intermittent claudication (IC) and with more severe limb-threatening ischemia ("salvage"). The Confidence Profile Method was used to interpret and adjust the evidence from 12 selected clinical reports, and to combine the data into single best estimates of the outcomes that were considered important for decision making. The following combined estimates were obtained: The early success rate was 89% +/- 2.5% after PTA for IC, compared with 77% +/- 4% after PTA for salvage. The largest decline in patency occurred during the first 6 to 12 months. After 2 years there was little further attrition. Three-year patency was 62% +/- 9% for IC and 43% +/- 7% for salvage. The risk of procedure-related mortality and limb loss was low, estimated at 0.5% and 1%, respectively. The risk of serious complications requiring surgical repair was about 2.5%. The Confidence Profile Method is a novel way of obtaining this information from the imperfect clinical literature. The method incorporates subjective judgments and assumptions and gives quantitative and visual representations of both the magnitude of the estimated outcome and the uncertainty associated with it. The results are as strong as the assumptions incorporated in them are valid. The estimates derived in this study can be used for any decision on the use of PTA in the femoropopliteal segment.

Angioplasty, Balloon↗
PubMed1988

The value of mammography screening in women under age 50 years.

Two quantitative methods, Confidence Profiles and CAN*TROL, are used to analyze evidence and estimate the health and economic consequences of adding annual mammography to annual breast physical examinations in asymptomatic women aged 40 to 49 years who are at average risk for breast cancer. Such women have about a 128 in 10,000 chance of having breast cancer in the next ten years and about an 82 in 10,000 chance of dying of such a cancer. Adding annual mammograms to annual breast physical examinations each year during that age decade would reduce the probability of death to about 60 in 10,000, a reduction of about 26%. Screening would increase the expected lifetime of a woman destined to get breast cancer between ages 40 and 49 years by about 3.5 years. Ten years of screening with mammography in that age decade carries a risk of radiation-induced cancer of about one in 25,000 and a risk of a surgery recommendation for a lesion that is not cancer of about one in ten. If 25% of the women in this age group in the United States were screened every year, breast cancer mortality in the year 2000 would be decreased by about 373 deaths. In 1984 dollars, the cost of screening, workups, and continuing care in the year 2000 would be about $408 million. Treatment costs would be decreased by about $6 million, leaving a net increase in costs in the year 2000 of approximately $402 million (1984 dollars).

Adult↗
PubMed1987

The frequency of cervical cancer screening. Comparison of a mathematical model with empirical data.

The results of a mathematical model used to analyze the frequency of the Pap smear are compared with a recently published independent empirical study of data from large screening programs in Europe and North America. The model's predictions of the reduced incidence of invasive cervical cancer achieved with different screening frequencies match the empirical results closely--the predictions were within 1% of the empirical results for screening frequencies ranging from 1 to 10 years. The data indicate that compared with annual screening, screening every 2, 3, 5, and 10 years retains 99%, 97%, 89%, and 69%, respectively, of the effectiveness measured as a reduction in frequency of invasive cancer. The mathematical model underestimated the effectiveness of screening every 3 years, compared with screening every year.

Europe↗