Dissertations / Theses on the topic 'Medical statistics Evaluation'
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1
Helmersson, Teresa. "Evaluation of Synthetic MRI for Clinical Use." Thesis, Linköpings universitet, Institutionen för medicin och hälsa, 2010. http://urn.kb.se/resolve?urn=urn:nbn:se:liu:diva-64359.
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Conventional Magnetic Resonance Imaging (MRI) is a qualitative method for obtaining images of softtissues in patients. Conventional MRI is the standard method used today and it results in gray-scaleimages in which the different magnetic properties of biological tissues determine the image contrast. However, the magnitude of the measured signal is only relative and therefore not directlycomparable between images. Synthetic MRI is a relatively new technique which can be used to postsynthesizedifferent images based on absolute measurement of several magnetic properties oftissues. Synthetic MRI can therefore provide quantitative information together with the contrastimages. In order to use synthetic MRI clinically an evaluation of the image quality and diagnostic ability isrequired. The purpose of this thesis is to evaluate if synthetic MRI and conventional MRI produceimages with equal contrast. A study was designed and conducted for statistical evaluation of contrast and Contrast-to-Noise Ratio(CNR) generated with different imaging methods. A total of 22 patients were examined using bothconventional MRI and synthetic MRI and the results were pairwise analyzed. The contrast and CNR could not be stated as equal for the imaging methods. Typically the contrastwas higher in the synthetic images for the T1 and T2 weighted images. This was not observed withCNR which suggests that the noise is higher in the synthetic images. The higher contrast obtained insynthetic images resulted in a better separation of different tissues using synthetic MRI. Thesynthetic T2 FLAIR images contained artifacts that are not good for clinical use. However the fact thatthe different imaging methods produce different image quality is not proven to be clinically decisive.
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Dakin, Helen A. "Economic evaluation of factorial randomised controlled trials." Thesis, University of Oxford, 2015. http://ora.ox.ac.uk/objects/uuid:77eda1f6-dd8c-439a-8871-75fd57a4c7f5.
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Factorial randomised controlled trials (RCTs) evaluate two or more interventions simultaneously, enabling assessment of interactions between treatments. This thesis presents literature reviews, methodological reviews, simulation studies and applied case studies that explore methods for assessing cost-effectiveness based on factorial RCTs. My systematic review suggests that factorial RCTs account for around 3% of trial-based economic evaluations, although there is currently no guidance or methodological work indicating the most appropriate methods. Around 40% of published studies assumed no interaction between treatments and many were poorly-reported. Various mechanisms are likely to produce large interactions within economic endpoints such as costs, quality-adjusted life-years (QALYs) and net benefits. Failing to take account of interactions can introduce bias and prevent efficient allocation of healthcare resources. I developed the opportunity cost of ignoring interactions as a measure of the implications of this bias. However, allowing for small, chance interactions is inefficient, potentially leading to over-investment in research if trial-based evaluations are used to inform decisions about subsequent research. Nonetheless, analyses on simulated trial data suggest that the opportunity cost of adopting a treatment that will not maximise health gains from the healthcare budget is minimised by including all interactions regardless of magnitude or statistical significance. Different approaches for conducting economic evaluations of factorial RCTs (including regression techniques, extrapolation using patient-level simulation, and considering different components of net benefit separately) are evaluated within three applied studies, including both full and partial factorials with 2x2 and 2x2x2 designs. I demonstrate that within both trial-based and model-based economic evaluation, efficient allocation of healthcare resources requires consideration of interactions between treatments, and joint decisions about interacting treatments based on incremental cost-effectiveness evaluated “inside-the-table” on a natural scale. I make recommendations for the design, analysis and reporting of factorial trial-based economic evaluations based on the results of this thesis.
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Majeke, Lunga. "Preliminary investigation into estimating eye disease incidence rate from age specific prevalence data." Thesis, University of Fort Hare, 2011. http://hdl.handle.net/10353/464.
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This study presents the methodology for estimating the incidence rate from the age specific prevalence data of three different eye diseases. We consider both situations where the mortality may differ from one person to another, with and without the disease. The method used was developed by Marvin J. Podgor for estimating incidence rate from prevalence data. It delves into the application of logistic regression to obtain the smoothed prevalence rates that helps in obtaining incidence rate. The study concluded that the use of logistic regression can produce a meaningful model, and the incidence rates of these diseases were not affected by the assumption of differential mortality.
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Zullig, Keith J., Laura Lander, Rebecca J. White, Carl Sullivan, Clara Shockley, Lili Dong, Robert P. Pack, and Tara Surber Fedis. "Preliminary Evaluation of the WV Prescription Drug Abuse Quitline." Digital Commons @ East Tennessee State University, 2010. https://dc.etsu.edu/etsu-works/6335.
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Purpose: To evaluate the effectiveness of the West Virginia Prescription Drug Abuse Quitline (WVPDAQ). Methods: Descriptive data and inferential analyses are provided for the period of operations from 9/11/2008 to 3/1/2010. Chi-square tests for Independence compared differences between callers completing at least one follow-up survey against callers completing only the baseline intake survey were observed. A Wilcoxon signed rank sum test tested differences between the scores of intake callers and follow-up callers at the one-week (n=177) and one-month (n=89) intervals. Results: A total of 1,056 calls were received, including 670 intakes, 177 1st follow-ups, 89 2nd follow-ups, and 36 3rd follow ups, and 84 caller satisfaction surveys. Chi-square analyses determined that callers who only completed the intake survey tended to have initiated drug use at a younger age ([less than or equal to] 39 years of age, [chi square]=7.63, p=.02). Longitudinal findings indicated significant self-reported declines in daily drug use (p<.0001), increased intentions to quit in the next 30 days (p<.0001), and declines in requesting a referral for treatment (p<.0001) at the one-month follow-up. Finally, approximately 19% (n=17) of callers reported obtaining a counseling/ treatment appointment as a result of calling the WVPDAQ at the one-month follow up. Conclusions: Preliminary results suggest the WVPDAQ has established itself as a meaningful resource to combat prescription drug abuse in West Virginia. Sustainable funding and greater integration of the WVPDAQ into existing and developing treatment infrastructure could provide more affordable options for the state of West Virginia and its citizens.
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Reddy, Hari Mallam. "Case study on costs and efficiency of Urgent Care Center Desert Valley Medical Group, Victorville." CSUSB ScholarWorks, 2001. https://scholarworks.lib.csusb.edu/etd-project/1733.
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Rodriguez, M. "Knowledge Discovery in a Review of Monograph Acquisitions at an Academic Health Sciences Library." Thesis, School of Information and Library Science, 2008. http://hdl.handle.net/1901/528.
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This study evaluates monograph acquisition decisions at an academic health sciences library using circulation and acquisitions data. The goal was to provide insight regarding how to allocate library funds to support research and education in disciplines of interest to the library user base. Data analysis revealed that allocations in 13 subject areas should be reviewed as the cost of circulation was greater than the average cost of circulation of the sample and the average cost of monographs was higher in these subject areas than the average cost of monographs in the sample. In contrast, 13 subjects returned cost of circulation rates lower than the average cost of circulation of the sample. These subjects merit stable budget allocation or increased allocation depending upon collection needs. Overall, this study found that this library is allocating a majority of resources to subjects with above average rates of use.
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Mayaud, Louis. "Prediction of mortality in septic patients with hypotension." Thesis, University of Oxford, 2014. http://ora.ox.ac.uk/objects/uuid:55a57418-de16-4932-8a42-af56bd380056.
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Sepsis remains the second largest killer in the Intensive Care Unit (ICU), giving rise to a significant economic burden ($17b per annum in the US, 0.3% of the gross domestic product). The aim of the work described in this thesis is to improve the estimation of severity in this population, with a view to improving the allocation of resources. A cohort of 2,143 adult patients with sepsis and hypotension was identified from the MIMIC-II database (v2.26). The implementation of state-of-the-art models confirms the superiority of the APACHE-IV model (AUC=73.3%) for mortality prediction using ICU admission data. Using the same subset of features, state-of-the art machine learning techniques (Support Vector Machines and Random Forests) give equivalent results. More recent mortality prediction models are also implemented and offer an improvement in discriminatory power (AUC=76.16%). A shift from expert-driven selection of variables to objective feature selection techniques using all available covariates leads to a major gain in performance (AUC=80.4%). A framework allowing simultaneous feature selection and parameter pruning is developed, using a genetic algorithm, and this offers similar performance. The model derived from the first 24 hours in the ICU is then compared with a “dynamic” model derived over the same time period, and this leads to a significant improvement in performance (AUC=82.7%). The study is then repeated using data surrounding the hypotensive episode in an attempt to capture the physiological response to hypotension and the effects of treatment. A significant increase in performance (AUC=85.3%) is obtained with the static model incorporating data both before and after the hypotensive episode. The equivalent dynamic model does not demonstrate a statistically significant improvement (AUC=85.6%). Testing on other ICU populations with sepsis is needed to validate the findings of this thesis, but the results presented in it highlight the role that data mining will increasingly play in clinical knowledge generation.
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Ramaboa, Kutlwano K. K. M. "A comparative evaluation of data mining classification techniques on medical trauma data." Master's thesis, University of Cape Town, 2004. http://hdl.handle.net/11427/5973.
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Includes bibliographical references (leaves 109-113).The purpose of this research was to determine the extent to which a selection of data mining classification techniques (specifically, Discriminant Analysis, Decision Trees, and three artifical neural network models - Backpropogation, Probablilistic Neural Networks, and the Radial Basis Function) are able to correctly classify cases into the different categories of an outcome measure from a given set of input variables (i.e. estimate their classification accuracy) on a common database.
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Chai, Shan, and shan chai@optusnet com au. "Performance Evaluation of Perceptually Lossless Medical Image Coder." RMIT University. Electrical and Computer Engineering, 2007. http://adt.lib.rmit.edu.au/adt/public/adt-VIT20080205.120648.
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Medical imaging technologies offer the benefits of faster and accurate diagnosis. When the medical imaging combined with the digitization, they offer the advantage of permanent storage and fast transmission to any geographical location. However, there is a need for efficient compression algorithms that alleviate the taxing burden of both large storage space and transmission bandwidth requirements. The Perceptually Lossless Medical Image Coder is a new image compression technique. It provides a solution to challenge of delivering clinically critical information in the shortest time possible. It embeds the visual pruning into the JPEG 2000 coding framework to achieve the optimal compression without losing the visual integrity of medical images. However, the performance of the PLMIC under certain medical image operation is still unknown. In this thesis, we investigate the performance of the PLMIC by applying linear, quadratic and cubic standard and centered B-spline interpolation filters. In order to evaluate the visual performance, a subjective assessment consisting of 30 medical images and 6 image processing experts was conducted. The perceptually lossless medical image coder was compared to the state-of-the-art JPEG-LS compliant LOCO and NLOCO image coders. The results have shown overall, there were no perceivable differences of statistical significance when the medical images were enlarged by a factor of 2. The findings of the thesis may help the researchers to further improve the coder. Additionally, it may also notify the radiologists the performance of the PLMIC coder to help them with correct diagnosis.
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Sithole, Jabulani S. "Longitudinal data models for evaluating change in prescribing patterns." Thesis, Keele University, 2000. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.327702.
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Henderson, Neil James Kerr. "Extending the clinical and economic evaluations of a randomised controlled trial the IONA study /." Connect to e-thesis, 2008. http://theses.gla.ac.uk/418/.
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Thesis (Ph.D.) - University of Glasgow, 2008.Ph.D. thesis submitted to the Department of Statistics, Faculty of Information and Mathematical Sciences, University of Glasgow, 2008. Includes bibliographical references. Print version also available.
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Ismail, Noor Azina. "Statistical methods for the improvement of health care." Thesis, Queensland University of Technology, 1999.
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Müller, Oleg. "Evaluation multimedialer Teachware mit Kontrollgruppe /." Aachen : Shaker, 2005. http://bvbr.bib-bvb.de:8991/F?func=service&doc_library=BVB01&doc_number=014599547&line_number=0001&func_code=DB_RECORDS&service_type=MEDIA.
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Chace, Meredith Joy. "Evaluating Intended and Unintended Consequences of Health Policy and Regulation in Vulnerable Populations." Thesis, Harvard University, 2012. http://dissertations.umi.com/gsas.harvard:10725.
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The objective of this dissertation is to evaluate whether two different types of policy interventions in the United States are associated with health service utilization and economic outcomes. Paper 1: The number of government lawsuits accusing pharmaceutical companies of off-label marketing has risen in recent years. We use Medicare and Medicaid claims data to evaluate how an off-label marketing lawsuit and its accompanying media coverage affected utilization and spending on gabapentin as well as other anticonvulsant medications. In this interrupted time series analysis of dual eligible patients with bipolar disorder, we found that the lawsuit and accompanying media coverage corresponded with a decrease in market share of gabapentin, a substitution of newer and expensive anticonvulsants, and a substantial increase in overall spending on anticonvulsants. Paper 2: Medicare Part D was a major expansion of Medicare benefits to cover pharmaceuticals. There were initial concerns about how the dually eligible population who previously had drug coverage through Medicaid would fare after transitioning to Part D plans. Using a nationally representative longitudinal panel survey of Medicare Beneficiaries that are dually eligible for Medicaid, we investigated whether differences in generosity of Medicaid drug benefits were associated with differential changes in drug utilization and out-of-pocket spending for duals after they transitioned to Part D. Our finding suggest that those who previously encountered a monthly drug cap prior to Part D implementation experienced a differentially higher increase in annual prescription drug fills compared with those who did not face a cap.
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Shinkins, Bethany. "The evaluation and expansion of methodologies relating to the reporting and analyses of intermediate test results : improving the clinical utility of diagnostic research." Thesis, University of Oxford, 2014. http://ora.ox.ac.uk/objects/uuid:2df7fc16-51f5-4978-80bd-b69efdf9c8a2.
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Background and objectives: It has been argued that the binary framework frequently adopted to analyse test accuracy does not represent the clinical reality of diagnostic practice, and the recognition of an intermediate category of test result could make the utility of diagnostic tests more transparent. The objective of this thesis is to explore the value of moving away from the binary framework when evaluating and interpreting quantitative diagnostic tests. Methods: This thesis starts with an overview of the key arguments against dichotomising quantitative test results and a summary of some of the alternative methods proposed. Four distinct studies are then reported: 1) a systematic review of the methods currently used to evaluate the accuracy of quantitative cancer biomarkers, 2) a survey of GPs exploring preferences for threshold guidance 3) an evaluation of existing methods for identifying an intermediate range of test values, and 4) an assessment of the feasibility of applying these methods to the results of a meta-analysis. Results: The binary framework remains the most common method for evaluating the accuracy of quantitative tests, despite the survey of GPs indicating that a single threshold interpretation is less helpful than identifying rule-in and rule-out thresholds. Existing methods for identifying an intermediate range of values require some adaptation to incorporate the cost trade-offs relating to different outcomes but, given complete reporting at the primary research, could be applied to the results of a meta-analysis. Conclusion: The 2 x 2 diagnostic framework frequently fails to capture many of the realities and complexities of clinical research questions. Standardised methods that facilitate complete reporting of test accuracy in primary diagnostic accuracy studies are required to allow for greater flexibility when producing threshold recommendations further down the evidence pathway.
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Woo, Pao-sun Pauline, and 胡寶璇. "Applications of age-period-cohort and state-transition Markov models in understanding cervical cancer incidence trends and evaluating thecost-effectiveness of cytologic screening." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2006. http://hub.hku.hk/bib/B36900400.
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Jordánová, Ivana. "Hodnocení tepové frekvence a saturace krve kyslíkem pomocí chytrého telefonu." Master's thesis, Vysoké učení technické v Brně. Fakulta elektrotechniky a komunikačních technologií, 2018. http://www.nusl.cz/ntk/nusl-378033.
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Hoffman, Leslie Ann. "An exploration of reflective writing and self-assessments to explain professionalism lapses among medical students." Thesis, 2014. http://hdl.handle.net/1805/5931.
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Indiana University-Purdue University Indianapolis (IUPUI)Background: Recent literature on medical professionalism claims that self-awareness and the ability to reflect upon one’s experiences is a critical component of professionalism; however there is a paucity of empirical evidence to support this claim. This study employed a mixed methods approach to explore the utility of reflective writing and self- and peer assessments in explaining professionalism lapses among medical students. Methods: A retrospective case-control study was conducted using students from Indiana University School of Medicine (IUSM) who had been disciplined for unprofessional behavior between 2006-2013 (case group; n=70). A randomly selected control group (n=230) was used for comparison. Reflective ability was assessed using a validated rubric to score students’ professionalism journals. Mean reflection scores and assessment scores were compared using t-tests. Logistic regression analysis was used to determine the impact of reflection scores and self- and peer assessment scores on the likelihood of having been disciplined for unprofessional behavior. Subsequent qualitative analysis further explored when and how students learned professionalism during their clinical experiences. Results: The study found that students in the case group exhibited lower reflective ability than control students. Furthermore, reflective ability was a significant factor in explaining the odds that a student had been cited for professionalism lapses. There were no differences in self-assessment scores between the two groups, but students in the case group had significantly lower peer assessment scores than control students. Peer assessment scores also had the greatest influence on the odds that a student had been cited for professionalism deficiencies during medical school. Qualitative analysis revealed that students learn professionalism from role models who demonstrated altruism and respect (or lack thereof). Conclusions: These findings suggest that students should be provided with guidance and feedback on their reflective writing to promote higher levels of reflection, which may reduce the number of students who are cited for professionalism lapses. These findings also indicate that peer assessments can be used to provide students with insightful feedback regarding their professional development. Finally, role models have a strong influence on students’ professional development, and therefore must be cognizant of the implicit messages their behaviors convey.
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Severns, Christopher Ray. "A comparison of geocoding baselayers for electronic medical record data analysis." Thesis, 2014. http://hdl.handle.net/1805/3841.
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Indiana University-Purdue University Indianapolis (IUPUI)Identifying spatial and temporal patterns of disease occurrence by mapping the residential locations of affected people can provide information that informs response by public health practitioners and improves understanding in epidemiological research. A common method of locating patients at the individual level is geocoding residential addresses stored in electronic medical records (EMRs) using address matching procedures in a geographic information system (GIS). While the process of geocoding is becoming more common in public health studies, few researchers take the time to examine the effects of using different address databases on match rate and positional accuracy of the geocoded results. This research examined and compared accuracy and match rate resulting from four commonly-used geocoding databases applied to sample of 59,341 subjects residing in and around Marion County/ Indianapolis, IN. The results are intended to inform researchers on the benefits and downsides to their selection of a database to geocode patient addresses in EMRs.
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Han, Baoguang. "Statistical analysis of clinical trial data using Monte Carlo methods." Thesis, 2014. http://hdl.handle.net/1805/4650.
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Indiana University-Purdue University Indianapolis (IUPUI)In medical research, data analysis often requires complex statistical methods where no closed-form solutions are available. Under such circumstances, Monte Carlo (MC) methods have found many applications. In this dissertation, we proposed several novel statistical models where MC methods are utilized. For the first part, we focused on semicompeting risks data in which a non-terminal event was subject to dependent censoring by a terminal event. Based on an illness-death multistate survival model, we proposed flexible random effects models. Further, we extended our model to the setting of joint modeling where both semicompeting risks data and repeated marker data are simultaneously analyzed. Since the proposed methods involve high-dimensional integrations, Bayesian Monte Carlo Markov Chain (MCMC) methods were utilized for estimation. The use of Bayesian methods also facilitates the prediction of individual patient outcomes. The proposed methods were demonstrated in both simulation and case studies. For the second part, we focused on re-randomization test, which is a nonparametric method that makes inferences solely based on the randomization procedure used in clinical trials. With this type of inference, Monte Carlo method is often used for generating null distributions on the treatment difference. However, an issue was recently discovered when subjects in a clinical trial were randomized with unbalanced treatment allocation to two treatments according to the minimization algorithm, a randomization procedure frequently used in practice. The null distribution of the re-randomization test statistics was found not to be centered at zero, which comprised power of the test. In this dissertation, we investigated the property of the re-randomization test and proposed a weighted re-randomization method to overcome this issue. The proposed method was demonstrated through extensive simulation studies.
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Zhan, Jia. "New statistical methods for the evaluation of effectivenss and safety of a medical intervention in using observational data." Diss., 2016. http://hdl.handle.net/1805/12305.
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Indiana University-Purdue University Indianapolis (IUPUI)Observational studies offer unique advantages over randomized clinical trials (RCTs) in many situations where RCTs are not feasible or suffer from major limitations such as insufficient sample sizes and narrowly focused populations. Because observational data are relatively easy and inexpensive to access, and contain rich and comprehensive demographic and medical information on large and representative populations, they have played a major role in the assessment of the effectiveness and safety of medical interventions. However, observational data also have the challenges of higher rates of missing data and the confounding effect. My proposal is on the development of three statistical methods to address these challenges. The first method is on the refinement and extension of a multiply robust (MR) estimation procedure that simultaneously accounts for the confounding effect and missing covariate process, where we derived the asymptotic variance estimator and extended the method to the scenario where the missing covariate is continuous. The second method focuses on the improvement of estimation precision in an RCT by a historical control cohort. This was achieved through augmenting the conventional effect estimator with an extra mean zero (approximately) term correlated with the conventional effect estimator. In the third method, we calibrated the hidden database bias of an electronic medical records database and utilized an empirical Bayes method to improve the accuracy of the estimation of the risk of acute myocardial infarction associated with a drug by borrowing information from other drugs.
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蕭雅慧. "Evaluating medical image quality of JPEG compression and wavelet compression at low compression ratio by using statistic methods." Thesis, 2002. http://ndltd.ncl.edu.tw/handle/54471831482680289199.
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碩士國立清華大學
原子科學系
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With the widely applications of digital images, the lossy compression will gradually become the mainstream of compression methods. Because this method might cause the lost of important information, only compression with low ratio are considered on medical images. The goal that we are pursuing is to maximize compression ratio while keeping image quality unchanged. Therefore image quality assessment plays an important role for it. ROC (Receiver Operating Characteristic) is a well-known method for evaluating wavelet compression and JPEG (Joint Photographic Experts Group) compression. Human eyes are difficult to differentiate the nuances of compressed images at low compression ratio. Our research focuses on evaluating image quality by using statistic methods. We develop some image quality indexes using Moran’s I test, kurtosis, etc to evaluate the image quality of wavelet and JPEG compression at low compression ratio (about < 25 times). The results indicate that JPEG compression is better than wavelet compression when the ratio is below 10 times and the reverse is true at compression ratio from 10 to 25 times.
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Carney, Timothy Jay. "An Organizational Informatics Analysis of Colorectal, Breast, and Cervical Cancer Screening Clinical Decision Support and Information Systems within Community Health Centers." Thesis, 2013. http://hdl.handle.net/1805/3243.
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Indiana University-Purdue University Indianapolis (IUPUI)A study design has been developed that employs a dual modeling approach to identify factors associated with facility-level cancer screening improvement and how this is mediated by the use of clinical decision support. This dual modeling approach combines principles of (1) Health Informatics, (2) Cancer Prevention and Control, (3) Health Services Research, and (4) Organizational Change/Theory. The study design builds upon the constructs of a conceptual framework developed by Jane Zapka, namely, (1) organizational and/or practice settings, (2) provider characteristics, and (3) patient population characteristics. These constructs have been operationalized as measures in a 2005 HRSA/NCI Health Disparities Cancer Collaborative inventory of 44 community health centers. The first, statistical models will use: sequential, multivariable regression models to test for the organizational determinants that may account for the presence and intensity-of-use of clinical decision support (CDS) and information systems (IS) within community health centers for use in colorectal, breast, and cervical cancer screening. A subsequent test will assess the impact of CDS/IS on provider reported cancer screening improvement rates. The second, computational models will use a multi-agent model of network evolution called CONSTRUCT® to identify the agents, tasks, knowledge, groups, and beliefs associated with cancer screening practices and CDS/IS use to inform both CDS/IS implementation and cancer screening intervention strategies. This virtual experiment will facilitate hypothesis-generation through computer simulation exercises. The outcome of this research will be to identify barriers and facilitators to improving community health center facility-level cancer screening performance using CDS/IS as an agent of change. Stakeholders for this work include both national and local community health center IT leadership, as well as clinical managers deploying IT strategies to improve cancer screening among vulnerable patient populations.