By James P. Kahan, Marleen Cornelis, Han de Vries, Ineke van Beuskom, Vincent Wietlisbach
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Additional info for Presenting Venous Thromboembolism: Prophylactic Options for Patients at Different Risk Levels
Sample text
The measures of appropriateness were analysed by statistical protocols that include agreement and disagreement within the panel. First of all, the median and standard deviation of all scores were analysed. Then a CART analysis was performed on the data. CART method: For each expert panel (surgical and medical), a classification tree-pruning technique was used to develop a simplified decision algorithm - based on patient characteristics - helping the physician to adopt an appropriate treatment option and to discard those considered as inappropriate or uncertain.
General findings for both the surgical and the medical panel If there really is no risk, then "no treatment" was considered appropriate. And, correspondingly, any other treatment was inappropriate. If there is even a moderate risk, then doing nothing was not considered appropriate, however what to do depends on the seriousness of the risk. The surgical and medical panels differed on their use of stockings. The surgical panel considered that stockings were acceptable, by themselves if the heparin (UFH or LMWH) were not appropriate or useful in combination with the heparin (UFH or LMWH) if the medication was appropriate.
3 ml). Examining the patterns of appropriateness, this disagreement appears to have been concentrated on the benefits and harms of the low dosages in instances when the higher dosages of the same treatments were largely regarded as appropriate. Some surgical panel members believed that the lower dosages as well as the higher dosages could be of benefit, while others believed that only the higher dosages were beneficial for the patient indications rated. Where there was no disagreement, the median score of the panel was used to ascertain the appropriateness of the indication.