• MeSH
• Humans MeSH
• Linear Models MeSH
• Probability MeSH
• Problem Solving MeSH
• Decision Theory MeSH
• Decision Making MeSH
• Check Tag
• Humans MeSH

Child behavior and school performance is influenced by many genetic and environmental factors including prenatal exposure to chemical neurotoxins contained in cigarette smoke. The European Longitudinal Study of Pregnancy and Childhood (ELSPAC) prospective study which in the Czech Republic incorporates a cohort of children born in the years 1991/2 in Brno city and the Znojmo district also allows to analyze the relationships between prenatal cigarette smoke exposure and the occurrence of behavior and learning disorders. METHODS: Using questionnaires repeatedly filled in by teachers and investigation protocols performed by research team workers data for the Brno sample of children was collected on the occurrence of signs indicating more serious problems with school assignment fulfilling and behavior disorders in the childrens' 8, 11 and 13 years of age. According to mothers' statements about their smoking behavior during pregnancy, the children were divided into two groups: prenatally exposed and non-exposed. The frequency differences of individual traits were evaluated in the SPSS statistical program (Pearson's chi2 test and linear associations, probability relations). RESULTS: In the ELSPAC study set the occurrence of inferior schoolwork performance evaluated based on term-report grades was more frequent in children prenatally exposed to mothers' smoking, along with more frequently diagnosed disorders which to significant extent implicate these inferior results and also special care needs occurred more frequently when compared to their peers born to non-smoking mothers. In the prenatally exposed subset also more frequent occurrence of various signs characterizing behavior disorders including attention disorders, hyperactivity, aggressiveness and signs of delinquency behavior were recorded. CONCLUSIONS: The Czech ELSPAC cohort confirmed the results of other studies; within it was documented that children born to smoking mothers have more frequent behavioral problems and problems with fulfilling their school assignments in the school age period.

• MeSH
• Child MeSH
• Adult MeSH
• Smoking epidemiology   adverse effects   MeSH
• Humans MeSH
• Linear Models MeSH
• Longitudinal Studies MeSH
• Mothers MeSH
• Adolescent MeSH
• Attention Deficit and Disruptive Behavior Disorders epidemiology   MeSH
• Prospective Studies MeSH
• Surveys and Questionnaires MeSH
• Chi-Square Distribution MeSH
• Pregnancy MeSH
• Educational Measurement MeSH
• Prenatal Exposure Delayed Effects MeSH
• Check Tag
• Child MeSH
• Adult MeSH
• Humans MeSH
• Adolescent MeSH
• Pregnancy MeSH
• Female MeSH
• Geographicals
• Czech Republic MeSH

Východiska: Analyzovali jsme dostupná data o vykázané péči za účelem návrhu nového modelu úhrady radioterapie postaveného na prospektivním principu. Cílem bylo otestovat vysvětlující faktory (prediktory), které by dokázaly nejlépe roztřídit hospitalizační případy do nákladově homogenních skupin. Testovány byly čtyři potenciální prediktory – počet frakcí radioterapie, skupina techniky radioterapie, dia­gnostické skupiny a stadium onemocnění. Cílem naopak nebyl samotný návrh úhradového modelu jako takového. Metody: Analyzováno bylo celkem 7 440 hospitalizačních případů onkologicky nemocných pacientů z let 2007–2011 ve třech vybraných zdravotnických zařízeních. Zdrojem dat byla především databáze I‑COP vyvinutá Institutem bio­statistiky a analýz Masarykovy univerzity ve spolupráci s komplexními onkologickými centry ČR, která na úrovni jednotlivých zdravotnických zařízení propojuje data z Národního onkologického registru s daty o vykázané péči zdravotnických zařízení zdravotním pojišťovnám. Výsledky: Při srovnání čtyř potenciálních prediktorů jsme vyhodnotili jako nejsilnější z nich počet aplikovaných frakcí radioterapie a použitou techniku radioterapie. Stadium onemocnění neprokázalo v tomto srovnání dostatečnou rozlišovací schopnost. Mezi dia­gnostickými skupinami byly identifikovány významné rozdíly v průměrných nákladech, ty však souvisely převážně s rozdílným spektrem použitých technik radioterapie a rozdílným počtem frakcí v jednotlivých skupinách. Uvnitř dia­gnostických skupin tak byly z hlediska vykázaných nákladů příliš velké rozdíly, které nejsou v případném úhradovém modelu žádoucí. Závěr: Pro potřeby prospektivního úhradového systému pro oblast radioterapie může být využita kombinace dvou prediktorů – počet aplikovaných frakcí radioterapie a technika radioterapie. Pro návrh úhradového modelu by byly vhodné další analýzy testující prediktivní schopnost záměru aplikované radioterapie. V současnosti však v ČR neexistují potřebné datové zdroje pro takovéto analýzy.

Background: As a part of the development of a new prospective payment model for radiotherapy we analyzed data on costs of care provided by three comprehensive cancer centers in the Czech Republic. Our aim was to find a combination of variables (predictors) which could be used to sort hospitalization cases into groups according to their costs, with each group having the same reimbursement rate. We tested four variables as possible predictors – number of fractions, stage of disease, radiotherapy technique and dia­gnostic group. Methods: We analyzed 7,440 hospitalization cases treated in three comprehensive cancer centers from 2007 to 2011. We acquired data from the I‑COP database developed by Institute of Biostatistics and Analyses of Masaryk University in cooperation with oncology centers that contains records from the National Oncological Registry along with data supplied by healthcare providers to insurance companies for the purpose of retrospective reimbursement. Results: When comparing the four variables mentioned above we found that number of fractions and radiotherapy technique were much stronger predictors than the other two variables. Stage of disease did not prove to be a relevant indicator of cost distinction. There were significant differences in costs among dia­gnostic groups but these were mostly driven by the technique of radiotherapy and the number of fractions. Within the dia­gnostic groups, the distribution of costs was too heterogeneous for the purpose of the new payment model. Conclusion: The combination of number of fractions and radiotherapy technique appears to be the most appropriate cost predictors to be involved in the prospective payment model proposal. Further analysis is planned to test the predictive value of intention of radiotherapy in order to determine differences in costs between palliative and curative treatment. Key words: health care costs – radiotherapy – radiation oncology – prospective payment system – reimbursement mechanisms – diagnosis-related groups This study was supported by Institutional Resources for Supporting the Research Organization provided by the Ministry of Health of the Czech Republic to Masaryk Memorial Cancer Institute and from European Social Fund, project „Educational and informative platform for comprehensive cancer centers for support and modernization of education in medical and allied domains“ CZ.1.07/2.4.00/31.0020. The authors declare they have no potential conflicts of interest concerning drugs, products, or services used in the study. The Editorial Board declares that the manuscript met the ICMJE “uniform requirements” for biomedical papers. Submitted: 15. 12. 2013 Accepted: 5. 1. 2014

• Keywords
• I-COP,
• MeSH
• Dose Fractionation, Radiation MeSH
• Hospitalization * economics   MeSH
• Diagnosis-Related Groups MeSH
• Humans MeSH
• Linear Models MeSH
• International Classification of Diseases MeSH
• Neoplasms * diagnosis   radiotherapy   MeSH
• Costs and Cost Analysis * MeSH
• Prospective Payment System * MeSH
• Radiation Oncology economics   standards   MeSH
• Radiotherapy * economics   methods   MeSH
• Registries MeSH
• Neoplasm Staging MeSH
• Statistics as Topic MeSH
• Medicare Assignment MeSH
• Check Tag
• Humans MeSH
• Publication type
• Research Support, Non-U.S. Gov't MeSH
• Geographicals
• Czech Republic MeSH

Complex decision making tasks of different natures, e.g. economics, safety engineering, ecology and biology, are based on vague, sparse, partially inconsistent and subjective knowledge. Moreover, decision making economists / engineers are usually not willing to invest too much time into study of complex formal theories. They require such decisions which can be (re)checked by human like common sense reasoning. One important problem related to realistic decision making tasks are incomplete data sets required by the chosen decision making algorithm. This paper presents a relatively simple algorithm how some missing III (input information items) can be generated using mainly decision tree topologies and integrated into incomplete data sets. The algorithm is based on an easy to understand heuristics, e.g. a longer decision tree sub-path is less probable. This heuristic can solve decision problems under total ignorance, i.e. the decision tree topology is the only information available. But in a practice, isolated information items e.g. some vaguely known probabilities (e.g. fuzzy probabilities) are usually available. It means that a realistic problem is analysed under partial ignorance. The proposed algorithm reconciles topology related heuristics and additional fuzzy sets using fuzzy linear programming. The case study, represented by a tree with six lotteries and one fuzzy probability, is presented in details.

• MeSH
• Algorithms MeSH
• Fuzzy Logic * MeSH
• Heuristics physiology   MeSH
• Humans MeSH
• Decision Support Techniques MeSH
• Probability MeSH
• Decision Trees * MeSH
• Decision Making physiology   MeSH
• Models, Theoretical MeSH
• Check Tag
• Humans MeSH
• Publication type
• Journal Article MeSH
• Research Support, Non-U.S. Gov't MeSH

• MeSH
• Nursing MeSH
• Research MeSH

• Conspectus
• Patologie. Klinická medicína
• NML Fields
• ošetřovatelství

BACKGROUND: Carotid endarterectomy (CEA) is a beneficial procedure for selected patients with an internal carotid artery (ICA) stenosis. Surgical risk of CEA varies from between 2 and 15%. The aim of the study is to demonstrate the safety and effectiveness of sonolysis (continual transcranial Doppler monitoring, TCD) using a 2-MHz diagnostic probe with maximal diagnostic energy on the reduction of the incidence of stroke, transient ischemic attack (TIA) and brain infarction detected using magnetic resonance imaging (MRI) by the activation of the endogenous fibrinolytic system during CEA. METHODS/DESIGN: Design: a multicenter, randomized, double-blind, sham-controlled trial. SCOPE: international, multicenter trial for patients with at least 70% symptomatic or asymptomatic ICA stenosis undergoing CEA. INCLUSION CRITERIA: patients with symptomatic or asymptomatic ICA stenosis of at least 70% are candidates for CEA; a sufficient temporal bone window for TCD; aged 40-85 years, functionally independent; provision of signed informed consent. Randomization: consecutive patients will be assigned to the sonolysis or control (sham procedure) group by computer-generated 1:1 randomization. Prestudy calculations showed that a minimum of 704 patients in each group is needed to reach a significant difference with an alpha value of 0.05 (two-tailed) and a beta value of 0.8 assuming that 10% would be lost to follow-up or refuse to participate in the study (estimated 39 endpoints). ENDPOINTS: the primary endpoint is the incidence of stroke or TIA during 30 days after CEA and the incidence of new ischemic lesions on brain MRI performed 24 h after CEA in the sonolysis and control groups. Secondary endpoints are occurrence of death, any stroke, or myocardial infarction within 30 days, changes in cognitive functions 1 year post procedure related to pretreatment scores, and number of new lesions and occurrence of new lesions ≥0.5 mL on post-procedural brain MRI. ANALYSIS: descriptive statistics and linear/logistic multiple regression models will be performed. Clinical relevance will be measured as relative risk reduction, absolute risk reduction and the number needed to treat. DISCUSSION: Reduction of the periprocedural complications of CEA using sonolysis as a widely available and cheap method may significantly increase the safety of CEA and extend the indication criteria for CEA. TRIAL REGISTRATION: ClinicalTrials.gov, NCT02398734 . Registered on 20 March 2015.

• MeSH
• Carotid Artery, Internal diagnostic imaging   surgery   MeSH
• Time Factors MeSH
• Cerebral Infarction diagnostic imaging   etiology   prevention & control   MeSH
• Adult MeSH
• Double-Blind Method MeSH
• Fibrinolysis * MeSH
• Endarterectomy, Carotid * adverse effects   MeSH
• Clinical Protocols MeSH
• Middle Aged MeSH
• Humans MeSH
• Magnetic Resonance Imaging MeSH
• Predictive Value of Tests MeSH
• Risk Factors MeSH
• Aged, 80 and over MeSH
• Aged MeSH
• Carotid Stenosis blood   complications   diagnostic imaging   surgery   MeSH
• Ultrasonography, Doppler, Transcranial * MeSH
• Ultrasonic Therapy methods   MeSH
• Treatment Outcome MeSH
• Research Design MeSH
• Check Tag
• Adult MeSH
• Middle Aged MeSH
• Humans MeSH
• Male MeSH
• Aged, 80 and over MeSH
• Aged MeSH
• Female MeSH
• Publication type
• Journal Article MeSH
• Multicenter Study MeSH
• Research Support, Non-U.S. Gov't MeSH
• Randomized Controlled Trial MeSH
• Geographicals
• Czech Republic MeSH

• MeSH
• Genetics MeSH

• Conspectus
• Obecná genetika. Obecná cytogenetika. Evoluce
• NML Fields
• genetika, lékařská genetika

• MeSH
• Cell Biology MeSH
• Genetic Predisposition to Disease MeSH
• Molecular Biology MeSH
• Neoplastic Processes MeSH
• Neoplasms MeSH

• Conspectus
• Patologie. Klinická medicína
• NML Publication type
• monografie