ABSTRACT
Objective：This study aimed to clarify the objective criteria for assessing walking independence using cane in patients with stroke in the convalescent rehabilitation ward.Methods：Participants were in-patients with hemiparetic stroke who could walk with a cane, and they were categorized into the independent (ID) and supervised (SV) walking groups. Stroke impairment assessment set-motor for lower extremity (SIAS-LE), trunk control test (TCT), Berg balance scale (BBS), 10-m walking speed (m/s), and functional independence measure-cognitive (FIM-C) were assessed. ID and SV used the scores at the time of independent walking and at the discharge time, respectively. Additionally, falls after independence were investigated. Statistical analysis was performed using univariate analysis and decision tree analysis.Results：In total, 148 patients (ID：n=101, 68±13 years, SV：n=47, 79±12) were included. Significant differences were observed in walking speed, TCT score, BBS score, and FIM-C score between the groups. Moreover, walking speed, FIM-C score, and BBS score were selected in the decision tree analysis in this order and divided into five groups namely：1) walking speed ≥ 0.42 and FIM-C ≥ 22 (percentage of independent patients 97％/percentage of fallers 5％), 2.) walking speed ≥ 0.42, FIM-C＜22, and BBS ≥ 50 (100％/0％), 3.) walking speed ≥ 0.42, FIM-C＜22, and BBS＜50 (52％/8％), 4.) walking speed＜0.42, and BBS ≥ 28 (49％/28％), and 5) walking speed＜0.42 and BBS＜28 (0％/0％). The overall percentage of fallers was 8.9％, with group 4 having the highest number of fallers.Conclusion：Walking speed, FIM-C, and BBS, in decreasing order, were involved in walking independence. Patients with low walking speed were more likely to fall. Therefore, careful assessment of walking independence is particularly required.
ABSTRACT
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.
ABSTRACT
Objective To evaluate the diagnostic value of serum tumors CA72-4,CA242,CA19-9 and carcino-embryonic anti-gen (CEA)for patients with gastric cancer based on principle component analysis (PCA)-decision tree analysis.Methods Serum levels of CA72-4,CA242,CA19-9 and CEA in 193 patients with gastric cancer,106 patients with benign gastric disea-ses and 86 nornal controls were measured by electrochemiluminescence assay,and data were analyzed by the receiver operat-ing characteristic (ROC)curve,PCA and PCA-decision tree analysis.Results The area under the ROC curve of CA72-4, CA242,CA19-9 and CEA was 0.741[95% confidence interval (95%CI),0.692~0.791],0.863 (95%CI,0.827~0.898), 0.783 (95%CI,0.737~0.828)and 0.827 (95%CI,0.785~0.869),respectively.The combined four serum tumor markers in the PCA-AUC model was 0.935 (95%CI,0.912~0.958)at the cutoff value (PC score)of 44.13 with 78.2% of sensi-tivity and 94.8% of specificity.The accuracy of serum CA72-4,CA242,CA19-9 and CEA for the diagnosis of gastric cancer group and nongastric cancer group (benign gastric diseases and nornal controls)in the decision tree model were 76.2% and 94.8%,56.5% and 96.5% for prediction,respectively.The combined four serum tumors for the diagnosis of gastric cancer group and nongastric cancer group in PCA-decision tree model were 90.3% and 100%,72.4% and 92.2% for prediction,re-spectively.Conclusion The PCA-decision tree model based on serum CA72-4,CA242,CA19-9 and CEA were helpful for the diagnosis of gastric cancer.
ABSTRACT
Objective To evaluate the diagnostic value of serum tumors CA72-4,CA242,CA19-9 and carcino-embryonic antigen(CEA)in patients with gastric cancer based on pattern recognition techniques.Methods Data of serum concentrations of CA72-4,CA242,CA19-9 and CEA of 212 patients with gastric cancer,116 patients with benign gastric disease and 117 healthy subjects were retrospectively analyzed;and the diagnostic performance of each tumor marker,four tumor markers based principle component analysis(PCA),decision tree,PCA-decision tree and the fisher discriminant analysis models were established.Results CA242 had the best diagnostic effect on gastric cancer,and the area under the ROC curve(AUC)was 0.841(95％CI:0.804-0.877).PCA model showed that the serum levels of four tumor markers in patients with gastric cancer were significantly different from those in benign and healthy patients,and obvious metabolic disorders of serum with four tumor markers were found among the patients with gastric cancer.The diagnosis accuracy of the decision tree,PCA-decision tree and the Fisher discriminant analysis models for gastric cancer patients was 58.6％,65.5％and 58.6％respectively,and for non-gastric cancer patients(benign gastric diseases and healthy controls)was 94.7％,99.4％and 97.6％.And the prediction accuracy of the decision tree,PCA-decision tree and the fisher discriminant analysis models for gastric cancer patients was 65.7％,77.6％and 73.1％,and for non-gastric cancer patients was 87.5％,96.9％and 96.9％,respectively.Conclusion The PCA-decision tree model of serum CA72-4,CA242,CA19-9 and CEA might be helpful for the diagnosis and prediction of patients with gastric cancer.
ABSTRACT
OBJECTIVE:To evaluate the pharmacoeconomics of cefathiamidine, ceftriaxone sodium, cefuroxime sodium, amoxicillin sodium/clavulanate potassium and cefoperazone sodium/sulbactam sodium in the treatment of pediatric bronchopneumo-nia,and to provide reference for rational drug use in the clinic. METHODS:By retrospective study,338 children with broncho-pneumonia were divided into groups A,B,C,D and E according to different therapy regimens. There were 75,65,76,66 and 56 cases in groups A,B,C,D and E,and they were given cefathiamidine,ceftriaxone sodium,cefuroxime sodium,amoxicillin sodium/clavulanate potassium and cefoperazone sodium/sulbactam sodium intravenously. The pharmacoeconomics of therapy regi-mens in group A,B,C,D and E were evaluated by cost-effectiveness analysis and decision tree analysis model. RESULTS:The effective rates of groups A,B,C,D and E were 93.33%,90.77%,96.05%,87.88% and 87.50%,respectively. The treatment cost of those groups were 1 929.09,2 173.73,1 611.91,1 661.42,1 801.32 yuan,respectively. The cost/effectiveness(C/E)ratio of those groups were 20.67,23.95,16.78,18.91,20.59,respectively. The treatment cost of group C was the smallest,so was the C/E. Results of cost-effectiveness analysis were supported by sensitivity analysis. CONCLUSIONS:Cefuroxime sodium is the best treatment for pediatric bronchopneumonia among 5 antibiotics in respect of cost-effectiveness.
ABSTRACT
OBJECTIVE:To evaluate 3 therapeutic schemes for the infections of urinary tract and look for the more rational one METHODS:To use pharmacoeconomic decision tree analysis RESULTS:By means of therapeutic schemes A,B,C,the anticipant costs for curing one case of urinary tract infection were 1 586 36 yuans,931 13 yuans and 899 24 yuans respectively CONCLUSION:The scheme C is the best one among 3 therapeutic schemes for infection of urinary tract