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M9630321.TXT
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1996-02-27
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Document 0321
DOCN M9630321
TI [What to do in a 60-year-old HIV-positive woman with a cerebral
arteriovenous malformation? Decision analysis]
DT 9603
AU Dippel DW; Avezaat CJ; van der Ende ME; Habbema JD; Afd. Neurologie,
Academisch Ziekenhuis Rotterdam-Dijkzigt.
SO Ned Tijdschr Geneeskd. 1995 Nov 18;139(46):2362-9. Unique Identifier :
AIDSLINE MED/96090890
AB OBJECTIVE. To illustrate how clinical decision analysis can contribute
to modern medical practice. DESIGN. Clinical decision analysis. SETTING.
Academic Hospital Rotterdam-Dijkzigt, Rotterdam, the Netherlands.
METHOD. Three treatment options (no treatment, neurosurgery and
radiosurgery) for a 60-year-old HIV-positive woman with a once-ruptured
cerebral arteriovenous malformation were compared using clinical
decision analysis, with respect to the discounted quality adjusted life
expectancy. Estimates of the risk of bleeding and its complications, of
the efficacy and complications of treatment, and of the risk of
developing AIDS and its consequences were based on the clinical
literature. RESULTS. Differences between no treatment and neurosurgery
or radiosurgery amounted to 0.1 (plausible range: 0.27 to 0.84) and 0.2
(plausible range: -0.29 to 0.76) discounted quality adjusted life years,
in favour of no treatment. The limited life expectancy of the patient,
leading to a relatively low cumulative risk of haemorrhage, did not
appear to justify the risks of treatment. CONCLUSION. Clinical decision
consultation may provide a rational, thorough and explicit decision
procedure which takes into account the complexity of medical care.
DE Acquired Immunodeficiency Syndrome/*COMPLICATIONS *Algorithms Case
Report Cerebral Angiography Cerebral Arteriovenous
Malformations/*COMPLICATIONS/DIAGNOSIS/ *THERAPY Decision Trees
English Abstract Female Human Life Expectancy Magnetic Resonance
Imaging Middle Age Risk Factors Subarachnoid Hemorrhage/ETIOLOGY
JOURNAL ARTICLE REVIEW REVIEW, TUTORIAL
SOURCE: National Library of Medicine. NOTICE: This material may be
protected by Copyright Law (Title 17, U.S.Code).