Influencing factors of metabolic syndrome among adults in Nanjing， China： an analysis based on decision tree and logistic regress models / 上海预防医学

ObjectiveWe analyzed the prevalence of metabolic syndrome in adult residents of Nanjing and explored its influencing factors in order to provide technical references for the prevention of metabolic syndrome. MethodsBased on the data of the Nanjing adult chronic disease thematic survey from January 2017 to June 2018， the influencing factors of metabolic syndrome were analyzed using multifactorial logistic regression model and decision tree model. ResultsThe weighted prevalence of metabolic syndrome among people aged 18 years and over in Nanjing was 16.14%（95%CI：16.12%‒16.16%）. Prevalence of metabolic syndrome was statistically different（P<0.05）among respondents with different demographic characteristics. Logistic regression model analysis showed that age， gender， education， physical activity level， marriage status， smoking status， drinking status， weight status， diabetes and hypertension family history were the influencing factors for the prevalence of metabolic syndrome（P<0.05）. The results of the decision tree model showed that weight status was the most influential factor for metabolic syndrome， followed by age， gender， diabetes family history and smoking status. ConclusionThe prevalence of metabolic syndrome is high among the adult population in Nanjing， and special attention should be paid to middle-aged and elderly men who are overweight and obese， have a family history of diabetes and smoking.

Effectiveness of early warning management of nosocomial infection based on neural network model and decision tree model / 公共卫生与预防医学

Objective To predict the effectiveness of nosocomial infection management and effectively control the risk of nosocomial infection. Methods In this study, with the population of ICU patients in a Grade A hospital , 345 ICU patients seen from June 2020 to June 2021 were included in the analysis to collect the infection data in the hospital. Based on the use of the decision tree model to analyze the influencing factors of nosocomial infection, the neural network model was also used to predict the risk of developing nosocomial infection. Results The decision tree model showed that advanced age (age> 80 years) influenced the root node. Type 2 diabetes, gender by male, and BMI level were child nodes, which had different synergistic effects on the occurrence of nosocomial infection. At the same time, random forest (RF), support vector machine (SVM), logical regression (LR) and K nearest neighbor (KNN) algorithms were used to construct a neural network prediction model of nosocomial infection risk, suggesting that the condition, sex and body size of basic diseases are related to the occurrence of nosocomial infection. The combined use of the above model in parallel can effectively increase the specificity and reduce the missed diagnosis. Conclusion The neural network model joint decision tree model in parallel and joint early warning of nosocomial infection risk have excellent effect, and can effectively provide information support for the prevention, management and disposal of nosocomial infection.

Study on DRG grouping of acute myeloid leukemia based on decision tree model / 中华医院管理杂志

Objective:To explore the influencing factors of hospitalization cost of acute myeloid leukemia, to group the cases based on decision tree model and to provide reference for improving the DRG management in this regard.Methods:Homepage data were retrieved from the medical records with acute myeloid leukemia as the main diagnosis (the top four ICD codes were C92.0, C92.4, C92.5, and C93.0). These patients were discharged from the clinical hematology department of the Fujian Institute of Hematology from January 2020 to December 2021. Then the influencing factors of hospitalization expenses were identified using Wilcoxon rank sum test or Kruskal-Wallis rank sum test and multiple linear stepwise regression analysis, with such factors used as classification nodes. The decision tree model of χ2 automatic interactive testing method was used to group the cases so included. At the same time, the included cases were grouped according to the trial run C-DRG version in Fujian province, for comparison of the differences between the two grouping methods. Results:The length of stay, the type of treatment, whether associated complications and age of patients were found as the influencing factors for the hospitalization costs of patients with acute myeloid leukemia, and such factors were included in the decision tree model to form 9 case mixes. The variance reduction of this model was 75.77%, featuring a high inter-group heterogeneity, and the coefficient of variation was 0.33-0.61, featuring a low in-group difference. The patients were divided into two groups according to the C-DRG version in Fujian province. The variance reduction of this method was 27.57%, featuring a low inter-group heterogeneity, and the coefficients of variation were 0.59 and 1.25, featuring high in-group difference.Conclusions:The cases of acute myeloid leukemia were grouped based on length of stay, type of treatment, whether accompanied by complications, and age proved reasonable enough to serve as reference for DRG management and cost control of this disease.

Factors affecting microvascular complications among patients with type 2 diabetes mellitus / 预防医学

Objective @#To identify the factors affecting microvascular complications among patients with type 2 diabetes (T2DM), so as to provide insights into the management of microvascular complications of T2DM.@*Methods@#T2DM patients hospitalized in the Department of Endocrinology of a tertiary hospital in Weifang City, Shandong Province from January 2021 to January 2022 were enrolled, and subjects' basic information, lifestyle and medical history were collected using questionnaire surveys. Fasting insulin, fasting blood glucose and glycated hemoglobin were measured, and factors affecting microvascular complications were identified among T2DM patients using a multivariable logistic regression model and a decision tree model.@*Results@#Totally 1 003 T2DM inpatients were enrolled, including 515 men (51.35%) and 488 women (48.65%), and the prevalence of microvascular complications was 40.18%. Multivariable logistic regression analysis showed that age of 60 years and older (OR=2.510, 95%CI: 1.441-4.374), T2DM duration of 10 years and longer (OR=3.205, 95%CI: 2.242-4.581), fasting insulin of lower than 3.21 μIU/mL (OR=1.749, 95%CI: 1.239-2.469), using of agents or insulin to control blood glucose (OR=1.880, 95%CI: 1.143-3.092), glycated hemoglobin level of 7% and higher (OR=1.751, 95%CI: 1.172-2.615) as factors affecting microvascular complications among T2DM patients. Decision tree analysis identified course of T2DM as a major factor affecting the risk of microvascular complications among T2DM patients, and the prevalence of microvascular complications was 70.22% among T2DM patients with disease course of 10 years and longer and fasting insulin of lower than 3.21 μIU/mL or 16.32 μIU/mL and higher, 44.23% among T2DM patients with disease course of 5 to 10 years and at ages of 60 years and older, and 43.10% among T2DM patients with disease course of less than 5 years and fasting insulin of lower than 3.21 μIU/mL. @*Conclusion@#Advanced age, long course of T2DM, low fasting insulin and high glycated hemoglobin may increase the risk of microvascular complications among T2DM patients.

Comparación de la costo-efectividad de la nefrolitotomía percutánea y de la nefrolitotomía retrógrada flexible con láser de holmio en pacientes con litiasis renal de 20 a 30 mm en Colombia / Comparison of the Cost-effectiveness of Percutaneous Nephrolithotomy and Flexible Retrograde Holmium Laser Nephrolithotomy in Patients with Kidney Stones of 20 to 30 mm in Colombia

Introducción y Objetivo Con el advenimiento de nuevas tecnologías, vienen controversias respecto al espectro de sus aplicaciones. El costo derivado de estas tecnologías juega un papel muy importante en el momento de la toma de decisiones terapéuticas. Es por esto que consideramos relevante estimar la costo-efectividad de la nefrolitotomía percutánea comparada con la nefrolitotomía retrógrada flexible con láser de holmio en pacientes con litiasis renal de 20 mm a 30 mm en Colombia. Materiales y Métodos Por medio de la construcción de un modelo de árbol de decisión usando el programa Treeage (TreeAge Software, LLC, Williamstown, MA, EE.UU.), se realizó una comparación entre la nefrolitotomía percutánea y la nefrolitotomía retrógrada flexible con láser de holmio en pacientes con litiasis renal de 20 mm a 30 mm. La perspectiva fue la del tercer pagador, y se incluyeron los costos directos. Las cifras fueron expresadas en pesos colombianos de 2018. La mejoría clínica, definida como el paciente libre de cálculos, fue la unidad de resultado. Se hizo una extracción de datos de efectividad y seguridad por medio de una revisión sistemática de la literatura. La razón de costo-efectividad incremental fue calculada. Resultados El modelo final indica que la nefrolitotomía percutánea puede ser considerada como la alternativa más costo-efectiva. Los hallazgos fueron sensibles a la probabilidad de mejoría clínica de la nefrolitotomía percutánea. Conclusión Teniendo en cuenta las variables económicas, los supuestos del modelo y desde la perspectiva del tercer pagador, la nefrolitotomía percutánea para el tratamiento de pacientes con cálculos renales de 20 mm a 30 mm es costo-efectiva en nuestro país. Estos hallazgos fueron sensibles a los costos y a la efectividad de los procedimientos quirúrgicos.

Introduction and Objective The advent of new technologies leads to controversies regarding the spectrum of their applications and their cost. The cost of these technologies plays a very important role when making therapeutic decisions. Therefore, we consider it relevant to estimate the cost-effectiveness of percutaneous nephrolithotomy compared with flexible retrograde holmium laser nephrolithotomy in patients with kidney stones of 20 mm to 30 mm in Colombia. Materials and Methods Through the development of a decision tree model using the Treeage (TreeAge Software, LLC, Williamstown, MA, US) software, we compared percutaneous nephrolithotomy with flexible holmium laser retrograde nephrolithotomy in patients with kidney stones of 20 mm to 30 mm. The perspective was that of the third payer, and all direct costs were included. The figures were expressed in terms of 2018 Colombian pesos. Clinical improvement, which was defined as a stone-free patient, was the outcome unit. We extracted data on effectiveness and safety through a systematic review of the literature. The incremental cost-effectiveness ratio was calculated. Results In terms of cost-effectiveness the final model indicates that percutaneous nephrolithotomy may be considered the best alternative. These findings were sensitive to the probability of clinical improvement of the percutaneous nephrolithotomy. Conclusion Taking into account the economic variables, the assumptions of the model, and through the perspective of the third payer, percutaneous nephrolithotomy for the treatment of patients with kidney stones of 20 mm to 30mm is cost-effective in our country. These findings were sensitive to the costs and effectiveness of the surgical procedures.

Pharmacoeconomic Evaluation of Perospirone in the Treatment of Schizophrenia ：A Study Based on Major Adverse Events / 中国药房

OBJECTIVE：To evaluate the economy of pe rospirone in the treatment of schizophrenia ，to provide guidance for clinically proper use of medications more cost-effectively ，and related health decision-making . METHODS ：A short-term decision tree model was constructed from the perspective of medical insurance payer to calculate the cost and health outcomes of different treatment plans considering major adverse events including extrapyramidal reaction ，weight gain ，diabetes，hyperlipidemia. The cost-utility of perospirone were compared with quetiapine ，aripiprazole and olanzapine respectively ，using QALYs as the measure of health outcomes ，3 times GDP per capita as the willingness-to-pay threshold ；probability sensitivity analysis was performed. RESULTS：The results of base-case analysis showed that the cost of perospirone （6 688.25 yuan）was lower than those of quetiapine （9 887.45 yuan），aripiprazole（13 284.65 yuan）and olanzapine （15 332.80 yuan）. The utility of perospirone （0.79 QALYs）was better than those of quetiapine （0.76 QALYs），aripiprazole（0.77 QALYs）and olanzapine （0.75 QALYs）. Compared with quetiapine ， aripiprazole and olanzapine ，peropirone had lower cost and higher health outcome ，which indicated that strong dominance favors perospirone over the other 3 drugs. The results of sensitivity analysis were consistent with those of base-case analysis. CONCLUSIONS：Perospirone has economic advantages in treating schizophrenia patients compared to other commonly used atypical antipsychotic drugs.

Classification of hepatocellular carcinoma diameter by statistical technology and prognostic evaluation in patients after the combined use of transarterial chemoembolization and radiofrequency ablation

Objective: This study aimed to classify hepatocellular carcinomas (HCCs) according to their diameter using statistic technology and evaluate the prognosis of the classified groups after the combined use of transarterial chemoembolization (TACE) and radiofrequency ablation (RFA). Materials and Methods: Electronic medical records of 128 consecutive patients who underwent TACE-RFA as the initial treatment for HCC from January 2010 to April 2018 were retrospectively analyzed. TACE was initially performed with subsequent RFA performed after 3–7 days. The decision tree model was used to classify overall survival (OS), progression-free survival (PFS), local recurrence rate (LRR), and treatment complications in HCC. Results: The tumors were divided into three groups of sizes ≤2.9 cm, 2.9–4.8 cm, and >4.8 cm. The group of tumors >4.8 cm showed inferior OS, PFS, and LRR than the other two groups (P < 0.05) on long-term follow-up but not in thefirst 6 months (P > 0.05). The groups of tumors ≤2.9 cm and 2.9–4.8 cm showed no statistically significant difference in OS, PFS, and LRR (P > 0.05). Conclusions: The cutoff points of 2.9 and 4.8 cm were achieved using the objective decision tree model rather than the artificial division of 3 and 5 cm. The prognosis was not significantly different between the groups of tumors ≤2.9 cm and 2.9–4.8 cm, and the prognosis of the two groups was better than the group of tumors >4.8 cm in the long-term follow-up but not in thefirst 6 months

Economic Evaluation of Two Preparations of Mycophenolate Mofetil for Immunosuppressive Therapy after Renal Transplantation / 中国药房

OBJECTIVE：To evaluate the cost-effectiveness between Mycophenolate mofetil （MMF）dispersible tablets versus MMF capsules for the immunosuppressive therapy after renal transplantation ，and to provide reference for selecting more economical MMF preparations. METHODS ：Based on a systematic review about MMF dispersible tablets and MMF capsules for immunosuppressive therapy after renal transplantation （involving 6 clinical studies ），with simulation period of 6 months，Treeage 2010 software was used to establish decision tree model ，which included four states of graft normal ，acute rejection ，graft loss and death. Using QALYs as effect measurement index ，the cost-effectiveness analysis of two MMF preparations was carried out in combination with the cost data of West China Hospital of Sichuan University. Signal factor sensitivity analysis and probability sensitivity analysis were performed . RESULTS ：The incremental cost-effectiveness ratio of MMF capsules group to MMF dispersible tablets group was 623 111.614 0 yuan/QALY，which was higher than Chinese willing-to-pay value （212 676 yuan/QALY）；the results of sensitivity analysis supported the above results. CONCLUSIONS ：MMF dispersible tablets are better than MMF capsules in cost-effectiveness of immunosuppressive therapy after renal transplantation.

Analysis of Risk Factors for Ganciclovir-Induced Thrombocytopenia and Construction of Risk-Prediction Models Using a Decision Tree Analysis / 医薬品情報学

Objective: Hematological toxicity, including neutropenia and thrombocytopenia, is a typical side effect of ganciclovir (GCV). We previously developed a risk-prediction model for GCV-induced neutropenia using decision tree (DT) analysis. By employing the DT model, which is a flowchart-like framework, users can predict the combination of factors that may increase neutropenia risk. However, a risk-prediction model for thrombocytopenia has not been established. Here, we aimed to identify the risk factors associated with GCV-induced thrombocytopenia and construct risk-prediction models.Method: We retrospectively evaluated the medical records of 386 patients who received GCV between April 2008 and March 2018 at Hokkaido University Hospital. Thrombocytopenia is defined as a decrease in the platelet count (PLT) to ＜50,000 cells/mm3 and to a ＜75% decrease. Risk factors of thrombocytopenia were extracted from the medical records using a multiple logistic regression analysis. Moreover, we employed chi-squared automatic interaction detection (CHAID) and classification and regression tree (CRT) algorithms to develop the DT models. The accuracies of the established models were evaluated to assess their reliability.Results: Thrombocytopenia occurred in 47 (12.2%) patients. In the multiple logistic regression analysis, data of patients with white blood cells ＜7,000 cells/mm3,PLT＜101,000 cells/mm3 and total bilirubin ≥ 0.8 mg/dL were extracted. Two risk-prediction models were constructed, and patients were divided into six and seven subgroups. In both algorithms, data on hematopoietic stem cell transplantations, PLT ＜101,000 cells/mm3, serum albumin ＜ 2.8 g/dL, total bilirubin ≥ 0.8 mg/dL, and residence in intensive care unit were extracted. The predictive accuracy of both the CHAID algorithm and the logistic regression models was 87.8% and that of the CRT algorithm was 88.3%, indicating they were reliable.Conclusion: We successfully identified the factors associated with GCV-induced thrombocytopenia and constructed useful flowchartlike risk-prediction models.

Cost-effectiveness Analysis of Domestic and Imported Vancomycin in the Treatment of Intracranial Infection Induced by MRSA by Using Decision Tree Model / 中国药房

OBJECTIVE： To analyze effectiveness and economy of domestic vancomycin hydrochloride for injection （trade name： Laikexin） vs. imported vancomycin hydrochloride for injection （trade name： Vancocin） in treatment of intracranial infection induced by MRSA， and to provide decision-making reference for the selection of clinical drugs. METHODS： Clinical data of patients with suspected MRSA intracranial infections receiving Laikexin or Vancocin were collected by retrospective study method from neurosurgery department of our hospital during Jan. 2016 to Jun. 2017， including 115 cases of Laikexin and 42 cases of Vancocin. Using response rate （including clinical cure and clinical improvement） as indexes， cost-effectiveness analysis was performed for Laikexin and Vancocin in the treatment of intracranial infection induced by MRSA by using decision tree model. Sensitivity analysis was conducted for 10％ decrease of cost and response rate. RESULTS： Response rate and excepted cost of Laikexin were 85.21％ and 13 125.96 yuan， cost-effectiveness ratio （CER） was 15 404.25. Response rate and excepted cost of Vancocin were 78.57％ and 15 619.17 yuan， CER was 19 879.31. There was no statistical significance in response rate between Laikexin and Vancocin （P＜0.05）. There was no difference between sensitivity analysis and cost-effectiveness analysis. CONCLUSIONS： The efficacy of Laikexin and Vancocin in the treatment of MRSA intracranial infection is similar， but the CER of Laikexin is lower than that of Wenkexin.

Case Control Study Identifying the Predictors of Unplanned Intensive Care Unit Readmission After Discharge / 중환자간호학회지

PURPOSE: This study was performed to identify the influencing factors of unplanned intensive care unit (ICU) readmission.METHOD: The study adopted a Rretrospective case control cohort design. Data were collected from the electronic medical records of 844 patients who had been discharged from the ICUs of a university hospital in Incheon from June 2014 to December 2014.RESULTS: The study found the unplanned ICU readmission rate was to be 6.4%(n=54). From the univariate analysis revealed that, major symptoms at 1(st) ICU admission, severity at 1(st) ICU admission (CPSCS and APACHEII), duration of applying ventilator application during 1(st) ICU admission, severity at 1(st) discharge from ICU (CPSCS, APACHEII, and GCS), and application of FiO₂ with oxygen therapy, implementation of sputum expectoration methods, and length of stay of ICU at 1(st) ICU discharge were appeared to be significant; further, decision tree model analysis revealed that while only 4 variables (sputum expectoration methods, length of stay of ICU, FiO₂ with oxygen therapy at 1(st) ICU discharge, and major symptoms at 1(st) ICU admission) were shown to be significant.CONCLUSION: Since sputum expectoration method was the most important factor to predictor of unplanned ICU readmission, a assessment tool for the patients' capability of sputum expectoration needs to should be developed and implemented, and standardized ICU discharge criteria, including the factors identified from the by empirical evidences, might should be developed to decrease the unplanned ICU readmission rate.

Economic Evaluation of Caspofungin vs. Voriconazole in Initial Empirical Antifungal Therapy of Febrile Neutropenia / 中国药房

OBJECTIVE:To evaluate the economics of caspofungin vs. voriconazole in initial empirical antifungal therapy of fe-brile neutropenia(FN). METHODS:Based on two international multiple center clinical trials about caspofungin vs. voriconazole in initial empirical antifungal therapy of FN,combined with domestic clinical experts'opinions about drug selection,a decision tree model was developed. TreeAge Pro 2011 software was used to analyze the cost and effectiveness of 10-day therapy of caspofungin or voriconazole as initial empirical antifungal therapy. RESULTS:The direct medical cost of caspofungin group was lower than that of voriconazole group(52826.71 yuan vs. 58246.70 yuan). The success rate and survival rate were higher than voriconazole group(33.95% vs. 25.63%、92.36% vs. 91.87%). Whether the success rate or the survival rate of patients as the effect indicators, cost-effectiveness ratio of caspofungin group was lower than that of voriconazole group. Moreover,incremental cost effectiveness ra-tio and sensitivity analysis confirmed this conclusion. CONCLUSIONS:Caspofungin has more advantages than voriconazole in cost and effectiveness as initial empirical antifungal therapy in patients with FN.

Application of data mining techniques to explore predictors of upper urinary tract damage in patients with neurogenic bladder

This study proposed a decision tree model to screen upper urinary tract damage (UUTD) for patients with neurogenic bladder (NGB). Thirty-four NGB patients with UUTD were recruited in the case group, while 78 without UUTD were included in the control group. A decision tree method, classification and regression tree (CART), was then applied to develop the model in which UUTD was used as a dependent variable and history of urinary tract infections, bladder management, conservative treatment, and urodynamic findings were used as independent variables. The urethra function factor was found to be the primary screening information of patients and treated as the root node of the tree; Pabd max (maximum abdominal pressure, >14 cmH2O), Pves max (maximum intravesical pressure, ≤89 cmH2O), and gender (female) were also variables associated with UUTD. The accuracy of the proposed model was 84.8%, and the area under curve was 0.901 (95%CI=0.844-0.958), suggesting that the decision tree model might provide a new and convenient way to screen UUTD for NGB patients in both undeveloped and developing areas.

Cost-effectiveness Analysis of Xiyanping Injection and Ribavirin Injection for Common Type Hand-foot-mouth Disease in Children / 中国药房

OBJECTIVE:To compare cost-effectiveness of Xiyanping injection and Ribavirin injection in the treatment of com-mon type hand-foot-mouth disease (HFMD) in children,and to provide evidence for rational drug use in the clinic. METHODS:The literatures about Xiyanping injection in the treatment of common type HFMD in children using Ribavirin injection as control were retrieved from CNKI,VIP,Wanfang,PubMed,Cochrane library and other databases. The decision tree was established with TreeAge Pro 2011 software to conduct cost-effectiveness analysis. Tornado diagram was used to analyze sensitive factors;single fac-tor and double factors sensitivity analysis were also conducted. RESULTS & CONCLUSIONS:The total cost of Xiyanping injection and Ribavirin injection were 2 887.53 and 3 058.72 yuan,respectively. The total effective rates were 92.49% and 78.12%. Xiyan-ping injection shows cost-effectiveness advantage. The results of cost-effectiveness analysis were supported by sensitivity analysis.

Analysis of Shenzhen Universal Infant Hepatitis B Immunization Strategy：Cost-effectiveness Analysis Based on Markov Model / 中国卫生经济

Objective: To optimize the Shenzhen universal infant hepatitis B immunization method. Methods: To analyze the long effectiveness of different immunization strategies and disease transition after hepatitis B virus infection by using cost-effectiveness method through decision-tree and Markov models among the Shenzhen newborns cohort in 2010 based on the local parameters. Results:Through the current strategies, the program of screening all pregnant women for HBsAg and vaccinating newborns of single-positive mothers combing with HBIG and vaccine would not only prevent more new cases, hepatic carcinoma and related deaths; but also gain more living years and QALYs. From the social prospect, it will save about RMB 40 million compared with the current program. Conclusion: It is suggested that Shenzhen Government should amend the current universal infant hepatitis B immunization program to gain more economic and social benefits.

FURTHER STUDY ON HEPATITIS B VACCINATION STRATEGY / 西安交通大学学报(医学版)

With decision tree model, both net utility and cost-benefit were analysed to comprehensively assess hepatitis B vaccination strategy in China. The result showed that neonates shoulUbe taken as the most favourable vaccinated population, infants aged 0～3 years the next, and immediate vaccination scheme was recommended. Although vaccination would result in negative benefit in the population aged 7 and over, certain net utility was also gained, Therefore we suggest that the subjects to be vaccinated be extended in due course.