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Search Results: 1 - 10 of 5077 matches for " Eva Grill "
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Graphical modeling of binary data using the LASSO: a simulation study
Ralf Strobl, Eva Grill, Ulrich Mansmann
BMC Medical Research Methodology , 2012, DOI: 10.1186/1471-2288-12-16
Abstract: We analyzed the Bolasso to derive graphical models in comparison with other LASSO based method. Model performance was assessed in a simulation study with random data generated via symmetric local logistic regression models and Gibbs sampling. Main outcome variables were the Structural Hamming Distance and the Youden Index.We applied the results of the simulation study to a real-life data with functioning data of patients having head and neck cancer.Bootstrap aggregating as incorporated in the Bolasso algorithm greatly improved the performance in higher sample sizes. The number of bootstraps did have minimal impact on performance. Bolasso performed reasonable well with a cutpoint of 0.90 and a small penalty term. Optimal prediction for Bolasso leads to very conservative models in comparison with AIC, BIC or cross-validated optimal penalty terms.Bootstrap aggregating may improve variable selection if the underlying selection process is not too unstable due to small sample size and if one is mainly interested in reducing the false discovery rate. We propose using the Bolasso for graphical modeling in large sample sizes.A common problem in contemporary biomedical research is the occurrence of a large number of variables that accompany relatively few observations. Thus, studying associations in high-dimensional data is not straightforward. Including all variables would result in a highly over parameterized model, computational complexity and unstable estimation of the associations [1]. This methodological problem has been solved for the domain of genomic medicine by using graphical modeling. Graphical models were identified as a promising new approach to modeling clinical data [2], and thereby the systems approach to health and disease.A promising approach to describe such complex relationships is graphical modeling. Graphical models [3] provide a probabilistic tool to display, analyze and visualize the net-like dependence structures by drawing a graph describing the con
Patients' functioning as predictor of nursing workload in acute hospital units providing rehabilitation care: a multi-centre cohort study
Martin Mueller, Stefanie Lohmann, Ralf Strobl, Christine Boldt, Eva Grill
BMC Health Services Research , 2010, DOI: 10.1186/1472-6963-10-295
Abstract: Patients' functioning at admission was assessed using the respective Acute ICF Core Set and the Barthel Index, whereas nursing workload data was collected using an established instrument. Associations between dependent and independent variables were modelled using linear regression. Variable selection was carried out using penalized regression.In patients with neurological and cardiopulmonary conditions, selected ICF categories and the Barthel Index Score explained the same variance in nursing workload (44% in neurological conditions, 35% in cardiopulmonary conditions), whereas ICF was slightly superior to Barthel Index Score for musculoskeletal conditions (20% versus 16%).A substantial fraction of the variance in nursing workload in patients with rehabilitation needs in the acute hospital could be predicted by selected categories of the Acute ICF Core Sets, or by the Barthel Index score. Incorporating ICF Core Set-based data in nursing management decisions, particularly staffing decisions, may be beneficial.Nurses play a major role in the acute care hospital by improving or maintaining the health status and functioning of patients, while minimizing their distress and suffering [1]. Since nurse staffing represents a considerable proportion of the total staffing costs in acute care hospitals [2], management decisions regarding quality and quantity of nurse staffing have important consequences for hospital budgets. The task of management is to obtain an optimal solution to the nursing care requirements of particular patient populations within an organizational unit. The cost-benefit analysis implicit in the process is essential because nurse staffing is closely associated with patient outcomes [3-5]. Furthermore, sufficient nurse staffing to avoid excessive workload is an essential requirement for occupational health of caregivers [6].Various criteria are available to determine whether the scale and composition of nurse staffing are adequate to meeting the needs of pa
Functioning and health in patients with cancer on home-parenteral nutrition: a qualitative study
Martin Mueller, Stefanie Lohmann, Paul Thul, Arved Weimann, Eva Grill
Health and Quality of Life Outcomes , 2010, DOI: 10.1186/1477-7525-8-41
Abstract: We conducted a series of qualitative semi-structured interviews. The interviews were analysed to identify categories of the International Classification of Functioning, Disability and Health (ICF) addressed by patients' statements. Patients were consecutively included in the study until an additional patient did not yield any new information.We extracted 94 different ICF-categories from 16 interviews representing patient-relevant aspects of functioning and health (32 categories from the ICF component 'Body Functions', 10 from 'Body Structures', 32 from 'Activities & Participation', 18 from 'Environmental Factors'). About 8% of the concepts derived from the interviews could not be linked to specific ICF categories because they were either too general, disease-specific or pertained to 'Personal Factors'. Patients referred to 22 different aspects of functioning improving due to HPN; mainly activities of daily living, mobility, sleep and emotional functions.The ICF proved to be a satisfactory framework to standardize the response of patients with cancer on HPN. For most aspects reported by the patients, a matching concept and ICF category could be found. The development of categories of the component 'Personal Factors' should be promoted to close the existing gap when analyzing interviews using the ICF. The identification and standardization of concepts derived from individual interviews was the first step towards creating new measures based on patients' preferences and experiences which both catch the most relevant aspects of functioning and are sensitive enough to monitor change associated to an intervention such as HPN in a vulnerable population with cancer.Weight loss is a common and serious problem in patients with cancer [1-3]. In patients with cancer in the abdominal cavity weight loss is often caused by symptoms preventing sufficient food intake or digestion, e.g. bowel obstruction, fistulas or short bowel syndrome [4]. More prominently, weight loss in advanced
Identification of aspects of functioning, disability and health relevant to patients experiencing vertigo: a qualitative study using the international classification of functioning, disability and health
Martin Mueller, Edith Schuster, Ralf Strobl, Eva Grill
Health and Quality of Life Outcomes , 2012, DOI: 10.1186/1477-7525-10-75
Abstract: We conducted a series of qualitative semi-structured face-to-face interviews using a descriptive approach. Data was analyzed using the meaning condensation procedure and then linked to categories of the International Classification of Functioning, Disability and Health (ICF).From May to July 2010 12 interviews were carried out until saturation was reached. Four hundred and seventy-one single concepts were extracted which were linked to 142 different ICF categories. 40 of those belonged to the component body functions, 62 to the component activity and participation, and 40 to the component environmental factors. Besides the most prominent aspect “dizziness” most participants reported problems within “Emotional functions (b152), problems related to mobility and carrying out the daily routine. Almost all participants reported “Immediate family (e310)” as a relevant modifying environmental factor.From the patients’ perspective, vertigo has impact on multifaceted aspects of functioning and disability, mainly body functions and activities and participation. Modifying contextual factors have to be taken into account to cover the complex interaction between the health condition of vertigo on the individuals’ daily life. The results of this study will contribute to developing standards for the measurement of functioning, disability and health relevant for patients suffering from vertigo.
Identification of ICF categories relevant for nursing in the situation of acute and early post-acute rehabilitation
Martin Mueller, Christine Boldt, Eva Grill, Ralf Strobl, Gerold Stucki
BMC Nursing , 2008, DOI: 10.1186/1472-6955-7-3
Abstract: First, in a consensus process, "Leistungserfassung in der Pflege" (LEP) nursing interventions relevant for the situation of acute and early post-acute rehabilitation were selected. Second, in an integrated two-step linking process, two nursing experts derived goals of LEP nursing interventions from their practical knowledge and selected corresponding ICF categories most relevant for patients in acute and post-acute rehabilitation (ICF Core Sets).Eighty-seven percent of ICF Core Set categories could be linked to goals of at least one nursing intervention variable of LEP. The ICF categories most frequently linked with LEP nursing interventions were respiration functions, experience of self and time functions and focusing attention. Thirteen percent of ICF Core Set categories could not be linked with LEP nursing interventions. The LEP nursing interventions which were linked with the highest number of different ICF-categories of all were "therapeutic intervention", "patient-nurse communication/information giving" and "mobilising".The ICF Core Sets for the acute hospital and early post-acute rehabilitation facilities are highly relevant for rehabilitation nursing. Linking nursing interventions with ICF Core Set categories is a feasible way to analyse nursing. Using the ICF Core Sets to describe goals of nursing interventions both facilitates inter-professional communication and respects patient's needs. The ICF may thus be a useful framework to set nursing intervention goals.The recovery of patients after an acute episode of illness or injury depends both on adequate medical treatment and on the early identification of needs for rehabilitation care. Acute rehabilitation is carried out by dedicated post-acute rehabilitation facilities, or by specialized wards within acute hospitals. Rehabilitation care in the acute situation is given individually by health professionals, mostly and typically by nurses with the goal to prevent complications and to restore functioning. In t
Economic evaluation of newborn hearing screening: modelling costs and outcomes
Hessel, Franz,Grill, Eva,Schnell-Inderst, Petra,Siebert, Uwe
GMS German Medical Science , 2003,
Abstract: Objectives: The prevalence of newborn hearing disorders is 1-3 per 1,000. Crucial for later outcome are correct diagnosis and effective treatment as soon as possible. With BERA and TEOAE low-risk techniques for early detection are available. Universal screening is recommended but not realised in most European health care systems.Aim of the study was to examine the scientific evidence of newborn hearing screening and a comparison of medical outcome and costs of different programmes, differentiated by type of strategy (risk screening, universal screening, no systematical screening). Methods: In an interdisciplinary health technology assessment project all studies on newborn hearing screening detected in a standardized comprehensive literature search were identified and data on medical outcome, costs, and cost-effectiveness extracted. A Markov model was designed to calculate cost-effectiveness ratios. Results: Economic data were extracted from 20 relevant publications out of 39 publications found. In the model total costs for screening of 100,000 newborns with a time horizon of ten years were calculated: 2.0 Mio.€ for universal screening (U), 1.0 Mio.€ for risk screening (R), and 0.6 Mio.€ for no screening (N). The costs per child detected: 13,395€ (U) respectively 6,715€ (R), and 4,125€ (N). At 6 months of life the following percentages of cases are detected: U 72%, R 43%, N 13%. Conclusions: A remarkable small number of economic publications mainly of low methodological quality was found. In our own model we found reasonable cost-effectiveness ratios also for universal screening. Considering the outcome advantages of higher numbers of detected cases a universal newborn hearing screening is recommended.
Screening of the hearing of newborns - Update
Schnell-Inderst, Petra,Kunze, Silke,Hessel, Franz,Grill, Eva
GMS Health Technology Assessment , 2006,
Abstract: Introduction: Permanent congenital bilateral hearing loss (CHL) of moderate or greater degree (≥40 dB HL) is a rare disease, with a prevalence of about 1 to 3 per 1000 births. However, it is one of the most frequent congenital diseases. Reliance on physician observation and parental recognition has not been successful in the past in detecting significant hearing loss in the first year of life. With this strategy significant hearing losses have been detected in the second year of life. With two objective technologies based on physiologic response to sound, otoacoustic emissions (OAE) and auditory brainstem response (ABR) hearing screening in the first days of life is made possible. Objectives: The objective of this health technology assessment report is to update the evaluation on clinical effectiveness and cost-effectiveness of newborn hearing screening programs. Universal newborn hearing screening (UHNS) (i), selective screening of high risk newborns (ii), and the absence of a systematic screening program are compared for age at identification and age at hearing aid fitting of children with hearing loss. Secondly the potential benefits of early intervention are analysed. Costs and cost-effectiveness of newborn hearing screening programs are determined. This report is intended to make a contribution to the decision making whether and under which conditions a newborn hearing screening program should be reimbursed by the statutory sickness funds in Germany. Methods: This health technology assessment report updates a former health technology assessment (Kunze et al. 2004 [1]). A systematic review of the literature was conducted, based on a documented search and selection of the literature using predefined inclusion and exclusion criteria and a documented extraction and appraisal of the included studies. To assess the cost-effectiveness of the different screening strategies in Germany the decision analytic Markov state model which had been developed in our former health technology assessment report was updated. Results: Universal newborn hearing screening programs are able to substantially reduce the age at identification and the age at intervention of children with CHL to six months of age in the German health care setting. High coverage rates, low fail rates and - if tracking systems are implemented – high follow-up-rates to diagnostic evaluation for test positives were achieved. New publications on potential benefits of early intervention could not be retrieved. For a final assessment of cost-effectiveness of newborn hearing screening evidence based long-
Distribution and determinants of functioning and disability in aged adults - results from the German KORA-Age study
Ralf Strobl, Martin Müller, Rebecca Emeny, Annette Peters, Eva Grill
BMC Public Health , 2013, DOI: 10.1186/1471-2458-13-137
Abstract: The objective of our study is to examine the frequency, distribution and determinants of functioning and disability in aged persons and to assess the contribution of diseases to the prevalence of disability.Data originate from the MONICA/KORA study, a population-based epidemiological cohort. Survivors of the original cohorts who were 65 and older were examined by telephone interview in 2009. Disability was assessed with the Health Assessment Questionnaire Disability Index (HAQ-DI). Minimal disability was defined as HAQ-DI > 0. Logistic regression was used to adjust for potential confounders and additive regression to estimate the contribution of diseases to disability prevalence.We analyzed a total of 4117 persons (51.2% female) with a mean age of 73.6 years (SD = 6.1). Minimal disability was present in 44.7% of all participants. Adjusted for age and diseases, disability was positively associated with female sex, BMI, low income, marital status, physical inactivity and poor nutritional status, but not with smoking and education. Problems with joint functions and eye diseases contributed most to disability prevalence in all age groups.In conclusion, this study could show that there are vulnerable subgroups of aged adults who should receive increased attention, specifically women, those with low income, those over 80, and persons with joint or eye diseases. Physical activity, obesity and malnutrition were identified as modifiable factors for future targeted interventions.
Neonatal hearing screening: modelling cost and effectiveness of hospital- and community-based screening
Eva Grill, Kai Uus, Franz Hessel, Linda Davies, Rod S Taylor, Juergen Wasem, John Bamford
BMC Health Services Research , 2006, DOI: 10.1186/1472-6963-6-14
Abstract: Design: Clinical effectiveness analysis using a Markov Model. Outcome measure: quality weighted detected child months (QCM).Both hospital and community programmes yielded 794 QCM at the age of 6 months with total costs of £3,690,000 per 100,000 screened children in hospital and £3,340,000 in community. Simulated costs would be lower in hospital in 48% of the trials. Any statistically significant difference between hospital and community in prevalence, test sensitivity, test specificity and costs would result in significant differences in cost-effectiveness between hospital and community.This modelling exercise informs decision makers by a quantitative projection of available data and the explicit and transparent statements about assumptions and the degree of uncertainty. Further evaluation of the cost-effectiveness should focus on the potential differences in test parameters and prevalence in these two settings.Between one and two children per 1000 live births have a moderate or greater bilateral permanent hearing loss [1-3]. Children with congenital hearing impairment benefit from early detection and management of their hearing loss [4,5]. The neurological development of auditory pathways requires acoustic stimulation in the first 18 months of life [6,7]. Communication deficits due to hearing impairment not discovered within the first two years are not easily recovered by later rehabilitation. The consequence may be delayed development of speech and language as well as of other cognitive and social functions. This delay is already measurable in the first 3 years of life [8].These and related considerations led to a comprehensive review of the possible role of newborn hearing screening in the UK [9]. The review recommended the introduction of newborn hearing screening and in 2001 the first phase of a national Newborn Hearing Screening Programme (NHSP) was implemented in England; all areas of the country are expected to be covered by 2005/6.The first implementation p
Health Outcome after Major Trauma: What Are We Measuring?
Karen Hoffman, Elaine Cole, E. Diane Playford, Eva Grill, Helene L. Soberg, Karim Brohi
PLOS ONE , 2014, DOI: 10.1371/journal.pone.0103082
Abstract: Importance Trauma is a global disease and is among the leading causes of disability in the world. The importance of outcome beyond trauma survival has been recognised over the last decade. Despite this there is no internationally agreed approach for assessment of health outcome and rehabilitation of trauma patients. Objective To systematically examine to what extent outcomes measures evaluate health outcomes in patients with major trauma. Data Sources MEDLINE, EMBASE, and CINAHL (from 2006–2012) were searched for studies evaluating health outcome after traumatic injuries. Study selection and data extraction Studies of adult patients with injuries involving at least two body areas or organ systems were included. Information on study design, outcome measures used, sample size and outcomes were extracted. The World Health Organisation International Classification of Function, Disability and Health (ICF) were used to evaluate to what extent outcome measures captured health impacts. Results 34 studies from 755 studies were included in the review. 38 outcome measures were identified. 21 outcome measures were used only once and only five were used in three or more studies. Only 6% of all possible health impacts were captured. Concepts related to activity and participation were the most represented but still only captured 12% of all possible concepts in this domain. Measures performed very poorly in capturing concepts related to body function (5%), functional activities (11%) and environmental factors (2%). Conclusion Outcome measures used in major trauma capture only a small proportion of health impacts. There is no inclusive classification for measuring disability or health outcome following trauma. The ICF may provide a useful framework for the development of a comprehensive health outcome measure for trauma care.
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