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The application of evidence-based dentistry to diagnosis should result in a reduction of errors in decision making. The frequency of errors is dependent not only on the accuracy of a diagnostic test for pathology, but also on the prior chance of disease being present. If this chance is low and below a certain threshold, then, for example, applying a diagnostic test can result in more decision errors and therefore inappropriate treatment than omitting to use the test. In deciding on the usefulness of a diagnostic test an additional factor to take into account is the relative value of the possible health states resulting from diagnosis and subsequent therapy. These can be determined by eliciting from the patient the numerical values of the possible dental health conditions using a visual analogue scale technique. Clinical decision analysis can then be carried out to calculate the most appropriate diagnostic strategy for the patient. Clinical decision analysis is starting to influence the development of guidelines for the diagnostic use of radiographs although its application in dentistry needs further refinement and development. [ABSTRACT FROM AUTHOR]

Objectives: To evaluate a new decision aid to improve restorative treatment decision making for proximal caries from bitewing radiographs. Methods: Dental teachers involved in patient treatment and clinical caries diagnosis (n531) viewed a computerized decision aid. Whilst using the aid, measures of the teachers' diagnostic and treatment accuracy, and also their decision-making knowledge and values were recorded. After completing the aid, they evaluated its performance on ten aspects using visual analogue scales. We carried out two linear regression analyses, using ''Overall usefulness'' of the aid as the dependent variable. The independent variables were (1) nine decision-making variables and (2) the nine other aspects of aid performance. Results: The teachers gave the program a mean overall usefulness score of 70% (median 73%, standard deviation (SD) 15%). Information presentation scored lowest (mean 58.9 %, median 64.5%, SD 19%) and aesthetic appearance of the aid scored highest (mean 77.4%, median 80.5%, SD 11.5%). The teachers' diagnostic and treatment decision-making acumen was not related to the score for overall usefulness (P > 0.14). Dentists with a lower subjective estimate of the probability of disease or a higher subjective estimate of 10-year restoration survival valued the aid more highly (P ≤ 0.001). Conclusions: The basic decision-making variables from which the aid provides individual feedback and advice may need additional improvement in presentation. Despite shortcomings and irrespective of the users' diagnostic ability, the aid was valued as generally useful. [ABSTRACT FROM AUTHOR]

Introduction: Aggression and violent incidents are a major concern in psychiatric inpatient care, potentially leading to physical and psychological consequences for both patients and staff. Nutritional supplementation was found to reduce aggressive incidents and rule violations in forensic populations and children with behavioural problems. Objectives: To assess whether multivitamin, mineral and n-3 PUFA supplementation is effective in reducing the number of aggressive incidents among psychiatric patients who are chronically admitted. Methods: In a pragmatic, multicentre, randomized, double-blind, placebo-controlled study, psychiatric inpatients were randomized to receive either three supplements containing multivitamins, minerals, and n-3 PUFA or placebo. During the intervention period of six months, aggressive incidents were assessed using the StaffObservation Aggression Scale - Revised (SOAS-R). Secondary outcome parameters were the patients' quality of life and affective symptoms. The trial was registered in the Clinical Trials Register (NCT02498106). Results: A total of 176 patients were enrolled and randomly assigned to receive supplements (n=87) or placebo (n=89). They were on average 49.3 years old (SD=14.5), and 64.2% were male. Most patients had a psychotic disorder (60.8%). Supplementation versus placebo significantly increased circulating micronutrient levels. The primary outcome of SOAS-R incidents was similar in those assigned to supplements (1.03 incidents per month; 95% confidence interval [CI]: 0.74-1.37) and placebo (0.90; 95%CI: 0.65-1.19), with a rate ratio of 1.08 (95%CI: 0.67-1.74; p=0.75). Differential effects were neither found in sensitivity analyses on the SOAS-R, nor on secondary outcomes. Conclusions: Six months of nutritional supplementation did not reduce aggressive incidents among chronically admitted psychiatric inpatients. [ABSTRACT FROM AUTHOR]

Abstract Background Sciatica is a common condition worldwide that is characterized by radiating leg pain and regularly caused by a herniated disc with nerve root compression. Sciatica patients with persisting leg pain after six to eight weeks were found to have similar clinical outcomes and associated costs after prolonged conservative treatment or surgery at one year follow-up. Guidelines recommend that the team of professionals involved in sciatica care and patients jointly decide about treatment options, so-called interprofessional shared decision making (SDM). However, there are strong indications that SDM for sciatica patients is not integrated in daily practice. We designed a study aiming to explore the barriers and facilitators associated with the everyday embedding of SDM for sciatica patients. All related relevant professionals and patients are involved to develop a tailored strategy to implement SDM for sciatica patients. Methods The study consists of two phases: identification of barriers and facilitators and development of an implementation strategy. First, barriers and facilitators are explored using semi-structured interviews among eight professionals of each (para)medical discipline involved in sciatica care (general practitioners, physical therapists, neurologists, neurosurgeons, and orthopedic surgeons). In addition, three focus groups will be conducted among patients. Second, the identified barriers and facilitators will be ranked using a questionnaire among a representative Dutch sample of 200 GPs, 200 physical therapists, 200 neurologists, all 124 neurosurgeons, 200 orthopedic surgeons, and 100 patients. A tailored team-based implementation strategy will be developed based on the results of the first phase using the principles of intervention mapping and an expert panel. Discussion Little is known about effective strategies to increase the uptake of SDM. Most implementation strategies only target a single discipline, whereas multiple disciplines are involved in SDM among sciatica patients. The results of this study can be used as an example for implementing SDM in other patient groups receiving multidisciplinary complex care (e.g., elderly) and can be generalized to other countries with similar context, thereby contributing to a worldwide increase of SDM in preference sensitive choices.

Abstract Background MUTYH associated polyposis (MAP) is an autosomal recessive inherited disorder. Carriers of bi-allelic MUTYH germline mutations have a risk of approximately 60% to develop colorectal carcinoma (CRC). In the general population about 1.5% is a heterozygous MUTYH mutation carrier. Children of MAP patients have an increased risk of inheriting two MUTYH mutations compared to the general population, implicating an increased risk for developing CRC. Methods Using data from the literature and Dutch MAP patients (n = 40), we constructed a Markov model to perform a societal cost-utility analysis of genetic screening in MAP families. Genetic screening was done by testing the spouse first and, in case of a heterozygous spouse, also testing of the children. Results The cost of genetic screening of families of MAP patients, when compared to no genetic screening, was estimated at €25,000 per quality-adjusted life year (QALY). The presence of Fecal Occult Blood testing (FOBT) population screening only slightly increased this cost-utility ratio to €25,500 per QALY. For a MUTYH heterozygote index-patient, the ratio was €51,500 per QALY. The results of our analysis were sensitive to several of the parameters in the model, including the cost assumed for molecular genetic testing. Conclusion The costs per QALY of genetic screening in families of MAP patients are acceptable according to international standards. Therefore, genetic testing of spouses and/or children should be discussed with and offered to counselees.

An abstract of the article "Internet-Based Self-management Plus Education Compared With Usual Care in Asthma. A Randomized Trial," by V. van der Meer, M.J. Bakker, W.B. van den Hout, K.F. Rabe, P.J. Sterk, J. Kievit, W.J.J. Assendelft and J.K. Sont is presented.

Objective: To evaluate the cost-effectiveness of longstanding personalized exercise therapy compared with usual care in people with rheumatoid arthritis (RA) and severe functional disability., Method: In this cost-utility analysis of a randomized controlled trial (n = 215), with 1 year follow-up, the study population comprised individuals with RA and reported severe difficulties in performing basic daily activities. Assessments were at baseline, 12, 26, and 52 weeks, with measurements of costs including medical and non-medical costs as recorded by patients and healthcare providers. Quality-adjusted life-years (QALYs) were estimated using the EuroQol 5 dimensions 5 levels (EQ-5D-5L) and EuroQol Visual Analogue Scale (EQ-VAS). Costs and QALY differences were analysed according to the intention-to-treat principle using cost-effectiveness acceptability curves., Results: The 1 year societal costs were non-significantly in favour of the usual care group, with a small difference of €180 [95% confidence interval (CI) €-4493 to €4852]. The QALYs were non-significantly in favour of the intervention group, by 0.02 according to the EQ-5D-5L (95% CI -0.05 to 0.09) and by 0.04 according to the EQ-VAS (95% CI 0.00 to 0.08). For a willingness-to-pay threshold of €50 000 per QALY, the intervention was the cost-effective strategy with 60% certainty., Conclusion: This economic evaluation showed no clear economic preference for either group, as the intervention costs were higher in the intervention group, but partly compensated by other cost savings and improved QALYs. Despite severe RA, patients had better clinical outcomes compared with usual care, suggesting no economic reasons to refrain from exercise therapy., Trial Registration Number: Netherlands Trial Register NL8235, included in the International Clinical Trial Registry Platform (ICTRP) (https://trialsearch.who.int/Trial2.aspx?TrialID=NL8235).

Objective: Assessing the construct validity of the Patient-Reported Outcomes Measurement Information System Physical Function 10-Item Short Form (PROMIS PF-10) in a subpopulation of rheumatoid arthritis (RA) or axial spondyloarthritis (axSpA) patients with severe limitations in physical functioning (PF)., Method: RA/axSpA patients with severe functional limitations completed the PROMIS PF-10, Health Assessment Questionnaire - Disability Index (HAQ-DI for RA) or Bath Ankylosing Spondylitis Functional Index (BASFI for axSpA), 36-item Short Form Health Survey (SF-36), EuroQol 5-dimensions 5-level (index score, EQ-VAS), and performed the Six-Minute Walk Test (6MWT). Construct validity was assessed by computing Spearman rank or Pearson correlation coefficients and testing hypotheses about correlations between the PROMIS PF-10 and measures of PF and quality of life., Results: Data from 316 patients (180 RA/136 axSpA, 91.7%/47.8% female, mean ± sd age 58.6 ± 13.2/54.0 ± 11.3 years) were analysed. The median (IQR) PROMIS PF-10 score was 34.5 (31.4-37.6) in RA and 36.0 (32.8-38.3) in axSpA patients. The PROMIS PF-10 correlated strongly with the HAQ-DI, BASFI, and EQ-5D-5L index score (r > 0.6), moderately with the SF-36 Physical Component Summary score, EQ-VAS, and 6MWT (0.30 ≤ r ≤ 0.60), and weakly with the SF-36 Mental Component Summary score (r < 0.30). Five of six hypotheses (83%) were confirmed in both groups., Conclusion: The overall strong correlation of the PROMIS PF-10 with measures of PF and moderate to weak correlations with outcomes measuring different constructs were confirmed in subpopulations of RA and axSpA patients with severe functional limitations, supporting its construct validity.

Background: Even though antithrombotic therapy has probably little or even negative effects on the well-being of people with cancer during their last year of life, deprescribing antithrombotic therapy at the end of life is rare in practice. It is often continued until death, possibly resulting in excess bleeding, an increased disease burden and higher healthcare costs., Methods: The SERENITY consortium comprises researchers and clinicians from eight European countries with specialties in different clinical fields, epidemiology and psychology. SERENITY will use a comprehensive approach combining a realist review, flash mob research, epidemiological studies, and qualitative interviews. The results of these studies will be used in a Delphi process to reach a consensus on the optimal design of the shared decision support tool. Next, the shared decision support tool will be tested in a randomised controlled trial. A targeted implementation and dissemination plan will be developed to enable the use of the SERENITY tool across Europe, as well as its incorporation in clinical guidelines and policies. The entire project is funded by Horizon Europe., Results: SERENITY will develop an information-driven shared decision support tool that will facilitate treatment decisions regarding the appropriate use of antithrombotic therapy in people with cancer at the end of life., Conclusions: We aim to develop an intervention that guides the appropriate use of antithrombotic therapy, prevents bleeding complications, and saves healthcare costs. Hopefully, usage of the tool leads to enhanced empowerment and improved quality of life and treatment satisfaction of people with advanced cancer and their care givers., Competing Interests: Declaration of competing interest AAH reports grants, speaking, or consulting fees from Bayer, MSD, LEO-Pharma and Bristol-Myers Squibb/Pfizer. MS reports grants and consulting fees from Bayer. JJB is a speaker for Abbott and Edwards Lifesciences. GJG is vice-chair of the Dutch Federation of Thrombosis services, and reports grants from Bayer, BMS, Pfizer and Daiichi-Sankyo, The Dutch Research Council, The Netherlands Organisation for Health Research and Development, and the Dutch Heart Foundation, all unrelated to this work and paid to his institution. MVH reports grants from Dutch Heart Foundation, ZonMw, Bayer Health Care, Pfizer-BMS, and Leo Pharma, all unrelated to this work. FAK reports grants or contracts from Bayer, BMS, BSCI, MSD, Leo Pharma, Actelion, Varm-X, The Netherlands Organisation for Health Research and Development, the Dutch Thrombosis Association, The Dutch Heart Foundation and the Horizon Europe Program, all unrelated to this work and paid to his institution. AM reports advisory board honoraria from Bayer, BMS Sanofi and Pfizer, speaker's bureau for BMS and Bayer and an educational grant from Bayer. DM reports contracts from BMS, Leo Pharma, Pfizer and Sanofi. MJHAK reports grants from Sobi, The Netherlands Organisation for Health Research and Development and the Dutch Thrombosis Association and speakers fee from Roche, Sobi and BMS, all unrelated to this work and paid to his institution. FEMM reports grants from Yorkshire Cancer Research, Marie Curie Cancer Care, the UK National Institute of Health and Care Research, and Hull Clinical Commissioning Group, all unrelated to this work. LV reports a grant from the Dutch Cancer Society, the Netherlands Organization for Health Service Research and Development, and the Dutch Research Council, all unrelated to this work. All others report no conflicts of interest related to this project., (Copyright © 2023 The Authors. Published by Elsevier Ltd.. All rights reserved.)