       Document 0321
 DOCN  M9630321
 TI    [What to do in a 60-year-old HIV-positive woman with a cerebral
       arteriovenous malformation? Decision analysis]
 DT    9603
 AU    Dippel DW; Avezaat CJ; van der Ende ME; Habbema JD; Afd. Neurologie,
       Academisch Ziekenhuis Rotterdam-Dijkzigt.
 SO    Ned Tijdschr Geneeskd. 1995 Nov 18;139(46):2362-9. Unique Identifier :
       AIDSLINE MED/96090890
 AB    OBJECTIVE. To illustrate how clinical decision analysis can contribute
       to modern medical practice. DESIGN. Clinical decision analysis. SETTING.
       Academic Hospital Rotterdam-Dijkzigt, Rotterdam, the Netherlands.
       METHOD. Three treatment options (no treatment, neurosurgery and
       radiosurgery) for a 60-year-old HIV-positive woman with a once-ruptured
       cerebral arteriovenous malformation were compared using clinical
       decision analysis, with respect to the discounted quality adjusted life
       expectancy. Estimates of the risk of bleeding and its complications, of
       the efficacy and complications of treatment, and of the risk of
       developing AIDS and its consequences were based on the clinical
       literature. RESULTS. Differences between no treatment and neurosurgery
       or radiosurgery amounted to 0.1 (plausible range: 0.27 to 0.84) and 0.2
       (plausible range: -0.29 to 0.76) discounted quality adjusted life years,
       in favour of no treatment. The limited life expectancy of the patient,
       leading to a relatively low cumulative risk of haemorrhage, did not
       appear to justify the risks of treatment. CONCLUSION. Clinical decision
       consultation may provide a rational, thorough and explicit decision
       procedure which takes into account the complexity of medical care.
 DE    Acquired Immunodeficiency Syndrome/*COMPLICATIONS  *Algorithms  Case
       Report  Cerebral Angiography  Cerebral Arteriovenous
       Malformations/*COMPLICATIONS/DIAGNOSIS/  *THERAPY  Decision Trees
       English Abstract  Female  Human  Life Expectancy  Magnetic Resonance
       Imaging  Middle Age  Risk Factors  Subarachnoid Hemorrhage/ETIOLOGY
       JOURNAL ARTICLE  REVIEW  REVIEW, TUTORIAL

       SOURCE: National Library of Medicine.  NOTICE: This material may be
       protected by Copyright Law (Title 17, U.S.Code).

