BACKGROUND: The measurement of utilities, or preferences, for health states may be affected by the technique used. Unfortunately, in papers reporting utilities, it is often difficult to infer how the utility measurement was carried out. PURPOSE: To present a list of components that, when described, provide sufficient detail of the utility assessment. METHODS: An initial list was prepared by one of the authors. A panel of 8 experts was formed to add additional components. The components were drawn from 6 clusters that focus on the design of the study, the administration procedure, the health state descriptions, the description of the utility assessment method, the description of the indifference procedure, and the use of visual aids or software programs. The list was updated and redistributed among a total of 14 experts, and the components were judged for their importance of being mentioned in a Methods section. RESULTS: More than 40 components were generated. Ten components were identified as necessary to include even in an article not focusing on utility measurement: how utility questions were administered, how health states were described, which utility assessment method(s) was used, the response and completion rates, specification of the duration of the health states, which software program (if any) was used, the description of the worst health state (lower anchor of the scale), whether a matching or choice indifference search procedure was used, when the assessment was conducted relative to treatment, and which (if any) visual aids were used. The interjudge reliability was satisfactory (Cronbach's alpha = 0.85). DISCUSSION: The list of components important for utility papers may be used in various ways, for instance, as a checklist while writing, reviewing, or reading a Methods section or while designing experiments. Guidelines are provided for a few components.

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Incorporating risk attitude into Markov-process decision models: importance for individual decision making.

Most decision models published in the medical literature take a risk-neutral perspective. Under risk neutrality, the utility of a gamble is equivalent to its expected value and the marginal utility of living a given unit of time is the same regardless of when it occurs. Most patients, however, are not risk-neutral. Not only does risk aversion affect decision analyses when tradeoffs between short- and long-term survival are involved, it also affects the interpretation of time-tradeoff measures of health-state utility. The proportional time tradeoff under- or overestimates the disutility of an inferior health state, depending on whether the patient is risk-seeking or risk-averse (it is unbiased if the patient is risk-neutral). The authors review how risk attitude with respect to gambles for survival duration can be incorporated into decision models using the framework of risk-adjusted quality-adjusted life years (RA-QALYs). They present a simple extension of this framework that allows RA-QALYs to be calculated for Markov-process decision models. Using a previously published Markov-process model of surgical vs expectant treatment for benign prostatic hypertrophy (BPH), they show how attitude towards risk affects the expected number of QALYs calculated by the model. In this model, under risk neutrality, surgery was the preferred option. Under mild risk aversion, expectant treatment was the preferred option. Risk attitude is an important aspect of preferences that should be incorporated into decision models where one treatment option has upfront risks of morbidity or mortality.

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Effect of the alpha-adrenoceptor antagonist urapidil on the pacemaker activity of rabbit sino-atrial node preparations.

We studied the effects of the alpha-adrenoceptor antagonist urapidil on the sino-atrial node pacemaker activity of the rabbit. Urapidil (above 10 microM) decreased the spontaneous firing frequency and the maximum rate of rise of the action potential, and prolonged the action potential duration at half-amplitude. Above 100 microM, urapidil also reduced the rate of the diastolic depolarization and the action potential amplitude. On the current systems, urapidil depressed the slow inward current and the time-dependent potassium outward current. The hyperpolarization-activated inward current was also reduced with only a high concentration (300 microM). Furthermore, the agent decreased the current oscillations induced by elevating [Ca]o. It is concluded that urapidil depresses the sinoatrial node pacemaker activity, mainly due to a reduction of Ca2+ influx through the cell membrane and it also eliminates the excessive intracellular Ca2+ load of nodal cells.

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Relationships between pancreatic blood flow and secretion in the dog.

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