Explaining spatial accessibility to high-quality nursing home care in the US using machine learning.

In this study we measure and map the system-wide spatial accessibility to good quality nursing home care for all counties in the contiguous United States, and use an 'imputed post-lasso' machine learning technique to systematically examine this accessibility measure's associations with a broad range of county-level socio-demographic variables. Both steps were carried out using publicly available datasets. Analyses found clear evidence of spatial patterning in accessibility, particularly by population density, state and the populations of specific racial minorities.

Developing composite indices of geographical access and need for nursing home care in Ireland using multiple criteria decision analysis.

Spatial accessibility has consistently been shown to influence utilisation of care and health outcomes, compared against local population needs. We sought to identify how appropriately nursing homes (NHs) are distributed in Ireland, as its NH market lacks central planning. We used multiple criteria decision analysis (MCDA) approaches to develop composite indices of both access (incorporating measures of availability, choice, quality and affordability) and local NH need for over 65s (relating to the proportion living alone, with cognitive disabilities or with low self-rated health, estimated scores for activities of daily living and instrumental activities of daily living, the average number of disabilities per person and the average age of this group).

Data linkage in medical science using the resource description framework: the AVERT model.

There is an ongoing challenge as to how best manage and understand 'big data' in precision medicine settings. This paper describes the potential for a Linked Data approach, using a Resource Description Framework (RDF) model, to combine multiple datasets with temporal and spatial elements of varying dimensionality. This "AVERT model" provides a framework for converting multiple standalone files of various formats, from both clinical and environmental settings, into a single data source.

Using the Analytic Hierarchy Process to Derive Health State Utilities from Ordinal Preference Data.

Background: The EuroQol five-dimensional questionnaire is a standardized instrument used in the economic evaluation of health care to measure health state preferences across disease groups. A time trade-off (TTO) approach is commonly used to elicit preferences from the public. However, there are issues regarding how best to measure worse-than-dead states; at present, extreme valuations are rounded up to more acceptable values.

An operational research approach to identify cardiac surgery patients at risk of severe post-operative bleeding.

Severe post-operative bleeding can lead to adverse outcomes for cardiac surgery patients and is a relatively common complication of cardiac surgery. One of the most effective drugs to prevent such bleeding, aprotinin, has been withdrawn from the market due to concerns over its safety. Alternative prophylactic drugs which can be given to patients to prevent bleeding can result in significant side effects and are expensive.

The Papworth Bleeding Risk Score: a stratification scheme for identifying cardiac surgery patients at risk of excessive early postoperative bleeding.

Objective: We have developed a risk stratification score to identify cardiac surgical patients at higher risk of severe postoperative bleeding to aid a decision of whether to use a specific intervention preoperatively.

Methods: We prospectively created a database of 11592 consecutive patients, who underwent cardiac surgery with cardiopulmonary bypass. An adverse outcome was formally defined as a mean blood loss exceeding 2 ml kg(-1)h(-1) measured between arrival in the intensive care unit (ICU) and the earliest of the elapse of 3h; the start of transfusion of any one of fresh-frozen plasma, platelets or cryoprecipitate; return to theatre or death.

Posterolateral versus interbody fusion in isthmic spondylolisthesis: functional results in 52 cases with a minimum follow-up of 6 years.

Posterolateral fusion has long been considered the "gold standard" technique for surgical treatment of adult spondylolisthesis. Superior results have subsequently been reported with interbody fusion with cages and posterior instrumentation. The goal of this prospective study was to compare the two techniques regarding their clinical outcomes and fusion rates.

Endoscopic anterior cervical foraminotomy for unilateral radiculopathy: anatomical morphometric analysis and preliminary clinical experience.

Object: Cervical radiculopathy is typically caused by posterolateral disc herniation or spondylotic foraminal stenosis, either of which may compress the ventral aspect of the nerve root. The authors undertook a study to establish the feasibility of performing an endoscopic approach for anterior cervical foraminotomy (ACFor) in a clinical setting.

Methods: Application of this method on cadavers was conducted to verify the practicability of this technique.

Recurrent angiofibroma invading the skull base--case report.

A 16-year-old male presented with a massive nasopharyngeal angiofibroma arising in the nasopharynx, nasal cavity, pterygopalatine fossa, and infratemporal fossa, and eroding the pterygoid process of the sphenoid bone. Neuroimaging showed the tumor had infiltrated the parasellar region from the middle cranial fossa and reached the cavernous sinus. The tumor was almost completely removed macroscopically by a modified transbasal approach.

Traumatic arteriovenous fistula of the vertebral artery.

A 22-year-old woman sustained a stab wound injury of the right vertebral artery. Initial treatment with endovascular embolization using platinum coils in a local hospital could not stop the bleeding. The patient was transferred to our department in hypovolemic shock.