PHP132 - Value of multi-criteria decision analysis in early assessment of medical diagnostic devices

OBJECTIVES:\ud Multicriteria decision analytic (MCDA) techniques are a powerful tool in evaluating health care interventions where multiple, often competing, factors need to be considered. The analytic hierarchy process (AHP) is one such technique. We have applied AHP to evaluate medical diagnostic technologies as to support product development and market access. The main objective of this study is to show feasibility of AHP in terms of applicability and outcome. We therefore have studied the expected performance of the Photoacoustic Mammoscope (PAM), a new imaging device for detection of breast cancer based on photoacoustic imaging.\ud \ud METHODS:\ud Before starting the study we defined different diagnostic and screening scenarios for the PAM including criteria that are important in the acceptance of the device. We finally defined four strategies including mammography, ultrasound and MRI imaging. The Analytic Hierarchy Process (AHP) analysis was then used to identify the relative importance of evaluation criteria, and to identify the relative performance of four different breast cancer imaging techniques.\ud \ud RESULTS:\ud According to the expert panel the most important criterion in the design of a diagnostic breast imaging device is sensitivity (overall weight was 54%). Factors that mainly determine the performance on sensitivity are the visualization of mass margins, mass shape and vascularization. Second most important criterion was safety.\ud \ud CONCLUSIONS:\ud From an early assessment of photoacoustic imaging it may be concluded that the potential clinical performance justifies further development and implementation of PAM. However, further research on the use of AHP in medical product development is required. We present and discuss some ideas to further integrate clinical evidence into MCDA using Bayesian techniques as well as sensitivity analyses on the model inputs

PP1 - A systematic review of the analytic hierarchy process in health care decision making

OBJECTIVES:\ud The analytic hierarchy process (AHP), a technique for multi-criteria decision analysis, is increasingly being used to support health care decision making. These decisions mainly relate to the application and coverage of health care technologies, and its use as a patient-reported outcome measure. The objective of this study is to review the use of this upcoming technique in health care; the Analytic Hierarchy Process.\ud \ud METHODS:\ud We conducted a systematic review of the relevant medical, health-economical, psycho-sociological, managerial, and applied mathematical literature. We used the keywords “Analytic Hierarchy Process” AND (“patient” OR “patients” OR “health” OR “health care” OR “medical” OR “clinical” OR “hospital”) to search in the general topic of the articles within in the databases PubMed and Web of Science. RESULTS: We found 57 distinctive AHP applications in health care. Of the retrieved applications, 13 % focus on shared decision-making between patient and clinician, 25 % on the development of clinical practice guidelines, 5 % on the development of medical devices and pharmaceuticals, 44 % on management decisions in health care organizations, and 13 % on the development of national health care policy.\ud \ud CONCLUSIONS:\ud From the review it is concluded that the AHP is frequently used and provides valuable support in complex health care decisions. The AHP is suitable to apply in case of complex health care decision problems, a need to improve decision making instead of explain decision outcomes, a need to share information among experts or between clinicians and patients, and in case of a limited availability of informed respondents. We also foresee the use of the AHP in conducting comprehensive Health Technology Assessments involving multiple stakeholders. Only for these specific types of decision problems, we recommend the use of the AHP

PCV96 - Acceptability of technological treatment and the effect of respondent characteristics on treatment preference

OBJECTIVES:\ud Surgical and/or technological treatment such as nerve stimulation is becoming increasingly popular in the treatment of acquired ankle-foot deformity in rehabilitation medicine. It is known that the older and impaired population can be technology adverse. The purpose of this study was to determine the acceptability of invasive technological treatment to patients and healthy controls and to study the influence of respondent characteristics on the preference for treatment.\ud \ud METHODS:\ud A total of 204 Respondents participated in a conjoint analysis discrete choice experiment. Ankle-foot impairment was related to either central neurological (n = 58), or peripheral neurological disease (n = 54). Healthy respondents were also included (n = 92). The amount of information on the decision problem\ud which was provided to the healthy controls varied. A multinomial logit regression model was used to estimate part worth utilities for the attribute levels of 8 criteria (treatment duration, treatment impact, duration and ease of use of aids, complication severity and rate, comfort & cosmetics, result type and success rate on choice of treatment) with 2–4 levels and attribute importance and to study the influence of age, gender, educational level, cognitive impairment, physical impairment and extent of information provision prior to the experiment on the fit of the regression model.\ud \ud RESULTS:\ud All treatment attributes have a significant influence on treatment choice. Most important are impact of treatment (20%) and duration & ease of use of aids (19%). No operation (0.46) and minimal use of aids (0.39) is preferred. Age has a significant influence (W = 4.92; p = 0.026). No effect of cognitive impairment or ankle-foot impairment was found.\ud \ud CONCLUSIONS:\ud It could be concluded that 1) surgical treatment and the use of technology are considered negative aspects of treatment, and 2) age-matched healthy respondents’ preferences can be used as predictors for cognitively and physically impaired patients

Somatosensory and nociceptive changes in chronic post-stroke shoulder pain

Preliminary results from a cross-sectional study that investigated the relation between the presence of post-stroke shoulder pain and somatosensory and nociceptive changes are presented. The main finding is that both abnormal somatosensation and nociception are more frequently observed in stroke patients with pain as compared to pain-free stroke patients and healthy controls

Cortical processing of electrocutaneous stimuli in chronic stroke patients: a relationship with post-stroke shoulder pain.

Cerebral stroke is often associated with changes in cognitive-evaluative and somatosensory functions which may play a role in the development and maintenance of post-stroke pain

The influence of voluntary upper body exercise on the performance of stimulated paralysed human quadriceps

In this study the influence of voluntary upper body exercise on the performance of stimulated paralysed human quadriceps was investigated in five subjects with spinal cord lesions in the thoracic spine. The experimental setup consisted of computer-controlled stimulation of the quadriceps using electrodes on the surface of the skin, a dynamometer for isometric or isokinetic loading of the lower leg, and a rowing ergometer for upper body exercise. In all subjects, quadriceps fatigue tests were conducted to study the influence of upper body exercise on knee torque during sustained continuous or intermittent stimulation of quadriceps. The relative asymptotic torque appeared to be significantly higher with the presence of upper body exercise than without. This was consistently found both between trials (starting with or without upper body exercise) as well as within trials, when upper body exercise was started or stopped during the trial. No significant influence of upper body exercise on the time constant of initial torque decline was found

Analytical modeling of light transport in scattering materials with strong absorption

We have investigated the transport of light through slabs that both scatter and strongly absorb, a situation that occurs in diverse application fields ranging from biomedical optics, powder technology, to solid-state lighting. In particular, we study the transport of light in the visible wavelength range between $420$ and $700$ nm through silicone plates filled with YAG:Ce$^{3+}$ phosphor particles, that even re-emit absorbed light at different wavelengths. We measure the total transmission, the total reflection, and the ballistic transmission of light through these plates. We obtain average single particle properties namely the scattering cross-section $\sigma_s$, the absorption cross-section $\sigma_a$, and the anisotropy factor $\mu$ using an analytical approach, namely the P3 approximation to the radiative transfer equation. We verify the extracted transport parameters using Monte-Carlo simulations of the light transport. Our approach fully describes the light propagation in phosphor diffuser plates that are used in white LEDs and that reveal a strong absorption ($L/\ell_{\mathrm{a}} > 1$) up to $L/\ell_{\mathrm{a}} = 4$, where $L$ is the slab thickness, $\ell_{\mathrm{a}}$ is the absorption mean free path. In contrast, the widely used diffusion theory fails to describe this parameter range. Our approach is a suitable analytical tool for industry, since it provides a fast yet accurate determination of key transport parameters, and since it introduces predictive power into the design process of white light emitting diodes

A bumpy train ride: A field experiment on insult, culture of honor, and emotional reactions

The present research examined the relationship between adherence to honor norms and emotional reactions after an insult. Participants were 42 Dutch male train travelers, half of whom were insulted by a confederate who bumped into the participant and made a degrading remark. Compared with insulted participants with a weak adherence to honor norms, insulted participants with a strong adherence to honor norms were (a) more angry, (b) less joyful, (c) less fearful, and (d) less resigned. Moreover, insulted participants with a strong adherence to honor norms perceived more anger in subsequent stimuli than not-insulted participants with a strong adherence to these norms. The present findings support a direct relationship among insult, adherence to honor norms, and emotional reactions. © 2007 American Psychological Association