By Theodore M. Bayless, Anna Mae Diehl M.D.
The most emphasis of this new 5th version of complicated treatment of Gastroenterology and Liver sickness is on sufferer administration. Chapters are devoted to normal themes in gastroenterology and hepatology perform and using diagnostic assessments in scientific decision-making. rules in endoscopy together with sedation and an infection keep an eye on also are tested. each one bankruptcy involves innovations from a professional within the box referring to a truly centred challenge. The authors speak about thoughts for instituting, enhancing, and tracking remedy, together with mixtures of gear and / or healing and diagnostic methods.
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The decision in favor of a COX-2 is followed by two chance events, symbolized by the open circle at the next branching point following the COX-2 decision. The patient may fare well on COX-2 and no other events or costs will ensue, or the patient will fail COX-2 treatment, redevelop his ulcer, and require a switch from COX-2 to PPI treatment added to a regular NSAID, such as naproxen. 1. 0. The NSAID plus PPI outcome is followed by yet another set of two probabilities. 9 probability, or the patient may develop ulcer complications.
Sensitivity analysis of ulcer management. One-way sensitivity is shown in the left and middle panel; Two-way sensitivity analysis is shown in the right panel. COX-2 = cyclooxygenase-2-receptor antagonist; NSAID = nonsteroidal anti-inflammatory drug; PPI = proton pump inhibitor. Decision Analysis in the Management of Digestive Diseases / 11 Each point on the line represents a combination of COX-2 and NSAID plus PPI costs, for which the decision tree yields an identical outcome for the two treatment strategies.
Because the cost of a one-time ABX therapy is much lower than the cost of COX-2 prescribed over 1 or more years, the p value will be very small. 125. The exact costs of ABX or COX-2 become secondary, and the outcome of the threshold analysis can be derived based on comparative estimates and considerations of magnitude alone. In essence, the analysis states that ABXs should be given a trial, because even with low chances of success this one-time strategy will still be much cheaper than long term COX-2 therapy.