Risk-based Group Research Articles

A comparison of different selective ultrasound screening strategies for developmental dysplasia of the hip.

To analyze whether the addition of risk-based criteria to clinical examination-based selective ultrasound screening would increase the rates of early detected cases of developmental dysplasia of the hip (DDH) and decrease the rate of late detected cases. A systematic review with meta-analysis was performed. The initial search was performed in the PubMed, Scopus, and Web of Science databases in November 2021. The following search terms were used: (hip) AND (ultrasound) AND (luxation or dysplasia) AND (newborn or neonate or congenital). A total of 25 studies were included. In 19 studies, newborns were selected for ultrasound based on both risk factors and clinical examination. In six studies, newborns were selected for ultrasound based on only clinical examination. We did not find evidence indicating that there are differences in the incidence of early- and late-detected DDH, or in the incidence of nonoperatively treated DDH between the risk-based and clinical examination-based groups. The pooled incidence of operatively treated DDH was slightly lower in the risk-based group (0.5 (95% confidence interval (CI) 0.3 to 0.7)) compared with the clinical examination group (0.9 per 1,000 newborns, (95% CI 0.7 to 1.0)). The use of risk factors in conjunction with clinical examination in the selective ultrasound screening of DDH might lead to fewer operatively treated cases of DDH. However, more studies are needed before stronger conclusions can be drawn.

Examining the effectiveness of different dental recall strategies on maintenance of optimum oral health: the INTERVAL dental recalls randomised controlled trial.

Objective To compare the clinical effectiveness of different frequencies of dental recall over a four-year period.Design A multi-centre, parallel-group, randomised controlled trial with blinded clinical outcome assessment. Participants were randomised to receive a dental check-up at six-monthly, 24-monthly or risk-based recall intervals. A two-strata trial design was used, with participants randomised within the 24-month stratum if the recruiting dentist considered them clinically suitable. Participants ineligible for 24-month recall were randomised to a risk-based or six-month recall interval.Setting UK primary dental care.Participants Practices providing NHS care and adults who had received regular dental check-ups.Main outcome measures The percentage of sites with gingival bleeding on probing, oral health-related quality of life (OHRQoL), cost-effectiveness.Results In total, 2,372 participants were recruited from 51 dental practices. Of those, 648 were eligible for the 24-month recall stratum and 1,724 participants were ineligible. There was no evidence of a significant difference in the mean percentage of sites with gingival bleeding on probing between intervention arms in any comparison. For those eligible for 24-month recall stratum: the 24-month versus six-month group had an adjusted mean difference of -0.91%, 95% CI (-5.02%, 3.20%); the 24-month group versus risk-based group had an adjusted mean difference of 0.07%, 95% CI (-3.99%, 4.12%). For the overall sample, the risk-based versus six-month adjusted mean difference was 0.78%, 95% CI (-1.17%, 2.72%). There was no evidence of a difference in OHRQoL (0-56 scale, higher score for poorer OHRQoL) between intervention arms in any comparison. For the overall sample, the risk-based versus six-month effect size was -0.35, 95% CI (-1.02, 0.32). There was no evidence of a clinically meaningful difference between the groups in any comparison in either eligibility stratum for any of the secondary clinical or patient-reported outcomes.Conclusion Over a four-year period, we found no evidence of a difference in oral health for participants allocated to a six-month or a risk-based recall interval, nor between a 24-month, six-month or risk-based recall interval for participants eligible for a 24-month recall. However, patients greatly value and are willing to pay for frequent dental check-ups.Zusatzmaterial online: Zu diesem Beitrag sind unter 10.1038/s41415-021-2612-0 für autorisierte Leser zusätzliche Dateien abrufbar.

Risk-based, 6-monthly and 24-monthly dental check-ups for adults: the INTERVAL three-arm RCT.

Traditionally, patients are encouraged to attend dental recall appointments at regular 6-month intervals, irrespective of their risk of developing dental disease. Stakeholders lack evidence of the relative effectiveness and cost-effectiveness of different recall strategies and the optimal recall interval for maintenance of oral health. To test effectiveness and assess the cost-benefit of different dental recall intervals over a 4-year period. Multicentre, parallel-group, randomised controlled trial with blinded clinical outcome assessment at 4 years and a within-trial cost-benefit analysis. NHS and participant perspective costs were combined with benefits estimated from a general population discrete choice experiment. A two-stratum trial design was used, with participants randomised to the 24-month interval if the recruiting dentist considered them clinically suitable. Participants ineligible for 24-month recall were randomised to a risk-based or 6-month recall interval. UK primary care dental practices. Adult, dentate, NHS patients who had visited their dentist in the previous 2 years. Participants were randomised to attend for a dental check-up at one of three dental recall intervals: 6-month, risk-based or 24-month recall. Clinical - gingival bleeding on probing; patient - oral health-related quality of life; economic - three analysis frameworks: (1) incremental cost per quality-adjusted life-year gained, (2) incremental net (societal) benefit and (3) incremental net (dental health) benefit. A total of 2372 participants were recruited from 51 dental practices; 648 participants were eligible for the 24-month recall stratum and 1724 participants were ineligible. There was no evidence of a significant difference in the mean percentage of sites with gingival bleeding between intervention arms in any comparison. For the eligible for 24-month recall stratum: the 24-month (n = 138) versus 6-month group (n = 135) had an adjusted mean difference of -0.91 (95% confidence interval -5.02 to 3.20); the risk-based (n = 143) versus 6-month group had an adjusted mean difference of -0.98 (95% confidence interval -5.05 to 3.09); the 24-month versus risk-based group had an adjusted mean difference of 0.07 (95% confidence interval -3.99 to 4.12). For the overall sample, the risk-based (n = 749) versus 6-month (n = 737) adjusted mean difference was 0.78 (95% confidence interval -1.17 to 2.72). There was no evidence of a difference in oral health-related quality of life between intervention arms in any comparison. For the economic evaluation, under framework 1 (cost per quality-adjusted life-year) the results were highly uncertain, and it was not possible to identify the optimal recall strategy. Under framework 2 (net societal benefit), 6-month recalls were the most efficient strategy with a probability of positive net benefit ranging from 78% to 100% across the eligible and combined strata, with findings driven by the high value placed on more frequent recall services in the discrete choice experiment. Under framework 3 (net dental health benefit), 24-month recalls were the most likely strategy to deliver positive net (dental health) benefit among those eligible for 24-month recall, with a probability of positive net benefit ranging from 65% to 99%. For the combined group, the optimal strategy was less clear. Risk-based recalls were more likely to be the most efficient recall strategy in scenarios where the costing perspective was widened to include participant-incurred costs, and in the Scottish subgroup. Information regarding factors considered by dentists to inform the risk-based interval and the interaction with patients to determine risk and agree the interval were not collected. Over a 4-year period, we found no evidence of a difference in oral health for participants allocated to a 6-month or a risk-based recall interval, nor between a 24-month, 6-month or risk-based recall interval for participants eligible for a 24-month recall. However, people greatly value and are willing to pay for frequent dental check-ups; therefore, the most efficient recall strategy depends on the scope of the cost and benefit valuation that decision-makers wish to consider. Assessment of the impact of risk assessment tools in informing risk-based interval decision-making and techniques for communicating a variable recall interval to patients. Current Controlled Trials ISRCTN95933794. This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme [project numbers 06/35/05 (Phase I) and 06/35/99 (Phase II)] and will be published in full in Health Technology Assessment; Vol. 24, No. 60. See the NIHR Journals Library website for further project information.

Prioritization of non-revenue water reduction scenarios using a risk-based group decision-making approach

This study investigates the effectiveness of the reduction policies of the apparent and real losses of non-revenue water. For this purpose, using technique for order of preference by similarity to ideal solution (TOPSIS) model, a decision matrix is proposed, involving apparent and real losses risk reduction values induced by the implementation of each non-revenue water reduction policy. First, decision criteria, including technical, economic, and social criteria, were selected and introduced. Then, the technical criterion was calculated using a fuzzy Bayesian model. In the following, using group decision-making and analytic hierarchy process method, the criteria were weighted. In the next step, the bests of decision criteria were determined by the TOPSIS method. This method was applied in the water distribution network of district 4 of Tehran, Iran. The results indicated that the most basic non-revenue water reduction policy by risk-based group decision-making is to identify unauthorized connections in the apparent water loss sector and increase the speed and quality of maintenance and repairs in the real water loss sector.

Developing a Risk-Based Consensus-Based Decision-Support System Model for Selection of the Desirable Urban Water Strategy: Kashafroud Watershed Study

In recent years, complexities related to a variety of sustainable development criteria and several preferences of stakeholders have caused a serious challenge for selecting the more desirable urban water strategy within watershed. In addition, stakeholders might have several risk attitudes depending on the number of criteria satisfied by water strategies. Accordingly, a risk-based consensus-based group decision-support system model is proposed for choosing the more desirable water strategy, using the external modified ordered weighted averaging (EMOWA) and internal modified ordered weighted averaging (IMOWA) operators. The operators calculate the scores of strategies in several risk-taking attitudes of group decision-making, considering the sustainable development criteria. Additionally, the consensus-seeking phase is considered using a risk-based weighted Minkowski’s method. This model is successfully implemented for the Kashafroud urban watershed in Iran, for selecting the more desirable urban water strategy in 2040. Accordingly, in the completely risk-averse viewpoint, the stakeholders select the combined supply-demand management strategy satisfying all of the criteria. In contrast, in the completely risk-prone standpoint, the stakeholders choose the demand management strategy satisfying at least one criterion. Developing the risk-based consensus-based group decision-support system model is suggested for integrated urban watershed management for selecting the more desirable strategy, satisfying the sustainable development criteria.

A risk-based emergency group decision method for haze disaster weather based on cumulative prospect theory

The frequent occurrence of extreme haze episodes currently in China has caused widespread public concern. The Chinese Government has developed and implemented a series of long-term measures to mitigate the serious situation. Nevertheless, some emergency response measures are also needed in the short-term. Hence, a risk-based emergency group decision method for haze disaster weather based on cumulative prospect theory (CPT) with linguistic evaluation information is proposed. This method obtains and expresses group decision-makers' (DMs') evaluation information based on additional linguistic evaluation scale and its extended scale, calculates the comprehensive prospect value matrix of each haze emergency response alternative based on CPT, after that, calculates the final decision results with DMs' weights. On these bases, the best haze disaster emergency response alternative can be selected. Finally, an application case of HD city in North China is presented to illustrate the usefulness and effectiveness of the proposed method.

Risk-based group decision making regarding renewable energy schemes using a stochastic graphical matrix model

Improvements to sustainability are generally measurable based on their environmental, economic, and socio-cultural effects. This study applied this concept by developing and empirically testing a risk-based method for assessing renewable energy policy. An integrated theoretical framework is proposed for analyzing group decision-making regarding renewable energy (RE) policy selection. The proposed graphical matrix approach combined with Monte Carlo simulation compares alternative RE schemes by identifying and measuring critical performance indicators with acceptable reliability. The mathematical model reliably prioritizes alternatives using majority voting to address uncertainty in multi-criteria decision making process. A case study using historical data from previous RE development projects to confirm the feasibility of this approach. Compared to the conventional deterministic method, the stochastic graphical matrix approach provides more reliable estimation accuracy, decision quality, and efficiency in selection of sustainable renewable energy. The systematic approach provides policy makers information for use in evaluation by synthesizing the judgments of a panel of experts.

Risk-based early prevention in comparison with routine prevention of dental caries: a 7-year follow-up of a controlled clinical trial; clinical and economic aspects

BackgroundThe results in an earlier study with 2–5-year-old children indicated that, in comparison with conventional prevention, a risk-based prevention programme was effective in reducing dental caries in a low-caries community. The aim of the present study was to examine the clinical and economic findings seven years after the cessation of the targeted programme, from the perspective of public health care.MethodsThe present material was collected from the dental records of the public health care centres, and included all dental visits after the 5-year examination until the 12-year examination. The groups were compared in relation to clinically detected caries at the age of 12 years, the number of dental visits needed from 5 to 12 years of age, and the estimation of running costs during these years. Statistical analyses included univariate analysis of variance, and calculation of absolute risk reduction and number needed to treat (NNT) values.ResultsAt the age of 12 years, DMF was significantly related to the risk category determined ten years earlier, in both study groups. In the risk-based group, the absolute risk reduction for caries in permanent dentition was 0.13 (95% confidence interval 0.06 – 0.21), and the associated NNT value was 8 (95% confidence interval 5 – 17). The total number of preventive, as well as restorative visits was lower in the risk-based than in the routine prevention group. The findings indicate that early risk-based prevention can be correctly targeted, clinically effective, and economically profitable also from the long-term point of view.ConclusionEarly prevention of dental caries also has long-term benefits in a 7-year follow-up perspective. This seems to hold true as regards targeting, as well as clinical and economic effectiveness. Success in risk-based prevention enables successful work division, and consequently, economic effectiveness.

Economic evaluation of a risk-based caries prevention program in preschool children

We have previously reported that, in young children, a risk-based caries prevention program compared with conventional prevention has a good caries-preventive effect. The present study aimed to assess the economic aspects of this program. We used the presence of mutans streptococci in plaque (Dentocult-SM) and/or the presence of incipient carious lesions at 2 years of age for risk assessment, and measured the outcome of caries (yes/no) at the age of 5 years. Dental assistants carried out the screening and preventive work. The economic analysis included the actual running costs of the program during the 3-year follow-up based on the time spent on dental visits. The costs per child per 3 years were significantly lower in the risk-based group (54 €) than in the conventional prevention group (69 €) (Student's t test, P = 0.004). If a dentist with an assistant had done all the work, the costs would have been twice as high. Compared to conventional prevention, the results suggest that risk-based prevention can be effective in reducing both costs and dental caries in preschool children, provided that the screening and preventive measures are delegated to preventive dental assistants.