A review of clopidogrel resistance in lower extremity arterial disease.

Objective: Lower extremity arterial disease (LEAD) is a prevalent condition that produces a significant burden on health care systems. Patients with LEAD have an increased risk of major adverse cardiovascular events as well as major adverse limb events. Despite significant variation in guidance on antiplatelet therapy for LEAD worldwide, many governing bodies recommend clopidogrel as the preferred single anti-platelet agent.

Development and Validation of a Rapid Point-of-Care CYP2C19 Genotyping Platform.

Pharmacogenetic-guided prescribing can lead to more accurate medicine selection and dosing, improving patient outcomes and leading to better use of health care budgets. Loss-of-function variants in CYP2C19 influence an individual's ability to metabolize clopidogrel, increasing the risk of secondary vascular events following ischemic stroke and percutaneous coronary intervention. In acute clinical contexts, centralized laboratory-based testing is too slow to inform timely clinical decision-making.

A structured process for the validation of a decision-analytic model: application to a cost-effectiveness model for risk-stratified national breast screening.

Background: Decision-makers require knowledge of the strengths and weaknesses of decision-analytic models used to evaluate healthcare interventions to be able to confidently use the results of such models to inform policy. A number of aspects of model validity have previously been described, but no systematic approach to assessing the validity of a model has been proposed. This study aimed to consolidate the different aspects of model validity into a step-by-step approach to assessing the strengths and weaknesses of a decision-analytic model.

Understanding the Impact of Different Modes of Information Provision on Preferences for a Newborn Bloodspot Screening Program in the United Kingdom.

Unlabelled: This study aimed to understand the impact of alternative modes of information provision on the stated preferences of a sample of the public for attributes of newborn bloodspot screening (NBS) in the United Kingdom. An online discrete choice experiment survey was designed using 4 attributes to describe NBS (effect of treatment on the condition, time to receive results, whether the bloodspot is stored, false-positive rate). Survey respondents were randomized to 1 of 2 survey versions presenting the background training materials using text from a leaflet (leaflet version) or an animation (animation version).

Estimating the Cost of 3 Risk Prediction Strategies for Potential Use in the United Kingdom National Breast Screening Program.

Background: Economic evaluations have suggested that risk-stratified breast cancer screening may be cost-effective but have used assumptions to estimate the cost of risk prediction. The aim of this study was to identify and quantify the resource use and associated costs required to introduce a breast cancer risk-stratification approach into the English national breast screening program.

Methods: A micro-costing study, conducted alongside a cohort-based prospective trial (BC-PREDICT), identified the resource use and cost per individual (£; 2021 price year) of providing a risk-stratification strategy at a woman's first mammography.

Quantifying the effects of risk-stratified breast cancer screening when delivered in real time as routine practice versus usual screening: the BC-Predict non-randomised controlled study (NCT04359420).

Background: Risk stratification as a routine part of the NHS Breast Screening Programme (NHSBSP) could provide a better balance of benefits and harms. We developed BC-Predict, to offer women when invited to the NHSBSP, which collects standard risk factor information; mammographic density; and in a sub-sample, a Polygenic Risk Score (PRS).

Methods: Risk prediction was estimated primarily from self-reported questionnaires and mammographic density using the Tyrer-Cuzick risk model.

Capturing the Impact of Constraints on the Cost-Effectiveness of Cell and Gene Therapies: A Systematic Review.

Objective: Decision-makers need to resolve constraints on delivering cell and gene therapies to patients as these treatments move into routine care. This study aimed to investigate if, and how, constraints that affect the expected cost and health consequences of cell and gene therapies have been included in published examples of cost-effectiveness analyses (CEAs).

Method: A systematic review identified CEAs of cell and gene therapies.

How do women want to receive information about non-invasive prenatal testing? Evidence from a discrete choice experiment.

Objective: Non-invasive prenatal testing (NIPT) identifies the risk of abnormalities in pregnancy, potentially reducing the risk of miscarriage associated with invasive tests. This study aimed to understand the preferences of current and future mothers about the content, format and timing of information provision about NIPT.

Methods: An online discrete choice experiment was designed comprising four attributes: when in the pregnancy information is provided (4 levels); degree of detail (2 levels); information format (6 levels); cost to women for gathering information (5 levels).

Quantifying the Impact of Capacity Constraints in Economic Evaluations: An Application in Precision Medicine.

Background: Examples of precision medicine are complex interventions featuring both testing and treatment components. Because of this complexity, there are often barriers to the introduction of such interventions. Few economic evaluations attempt to determine the impact of these barriers on the cost-effectiveness of the intervention.

Implementing Interventions with Varying Marginal Cost-Effectiveness: An Application in Precision Medicine.

. A range of barriers may constrain the effective implementation of strategies to deliver precision medicine. If the marginal costs and consequences of precision medicine vary at different levels of implementation, then such variation will have an impact on relative cost-effectiveness.

Prostate cancer survivors' preferences on the delivery of diet and lifestyle advice: a pilot best-worst discrete choice experiment.

Background: Lifestyle factors, including diet and physical activity, are associated with prostate cancer progression and mortality. However, it is unclear how men would like lifestyle information to be delivered following primary treatment. This study aimed to identify men's preferences for receiving lifestyle information.

Testing for changes in biomass dynamics in large-scale forest datasets.

Tropical forest responses to climate and atmospheric change are critical to the future of the global carbon budget. Recent studies have reported increases in estimated above-ground biomass (EAGB) stocks, productivity, and mortality in old-growth tropical forests. These increases could reflect a shift in forest functioning due to global change and/or long-lasting recovery from past disturbance.

The role of information provision in economic evaluations of non-invasive prenatal testing: a systematic review.

Background: Technological progress has led to changes in the antenatal screening programmes, most significantly the introduction of non-invasive prenatal testing (NIPT). The availability of a new type of testing changes the type of information that the parent(s) require before, during and after screening to mitigate anxiety about the testing process and results.

Objectives: To identify the extent to which economic evaluations of NIPT have accounted for the need to provide information alongside testing and the associated costs and health outcomes of information provision.

Effects of neighborhood trait composition on tree survival differ between drought and postdrought periods.

Although direct tree demographic responses to drought are widely recognized, studies of drought-mediated changes in tree interactions are rare. We hypothesize that drought exacerbates soil-water limitation and intensifies competition for water, but reduces light limitation and competition for light. We predict that competition would be stronger for trees (1) consuming more water or more susceptible to water deficits during drought and (2) intercepting more light or more susceptible to shade during postdrought periods.

Accounting for Capacity Constraints in Economic Evaluations of Precision Medicine: A Systematic Review.

Background And Objective: Precision (stratified or personalised) medicine is underpinned by the premise that it is feasible to identify known heterogeneity using a specific test or algorithm in patient populations and to use this information to guide patient care to improve health and well-being. This study aimed to understand if, and how, previous economic evaluations of precision medicine had taken account of the impact of capacity constraints.

Methods: A meta-review was conducted of published systematic reviews of economic evaluations of precision medicine (test-treat interventions) and individual studies included in these reviews.

Understanding Midwives' Preferences for Providing Information About Newborn Bloodspot Screening.

Understanding preferences for information provision in the context of health care service provision is challenging because of the number of potential attributes that may influence preferences. This study aimed to identify midwives' preferences for the process and outcomes of information provision in an expanded national newborn bloodspot screening program. A sample of practicing midwives completed a hybrid-stated preference survey including a conjoint analysis (CA) and discrete choice experiment to quantify preferences for the types of, and way in which, information should be provided in a newborn bloodspot screening program.

Accounting for Scale Heterogeneity in Healthcare-Related Discrete Choice Experiments when Comparing Stated Preferences: A Systematic Review.

Background: Scale heterogeneity, or differences in the error variance of choices, may account for a significant amount of the observed variation in the results of discrete choice experiments (DCEs) when comparing preferences between different groups of respondents.

Objective: The aim of this study was to identify if, and how, scale heterogeneity has been addressed in healthcare DCEs that compare the preferences of different groups.

Methods: A systematic review identified all healthcare DCEs published between 1990 and February 2016.

Cost-effectiveness analyses of genetic and genomic diagnostic tests.

Developments in next-generation sequencing technologies have driven the clinical application of diagnostic tests that interrogate the whole genome, which offer the chance to diagnose rare inherited diseases or inform the targeting of therapies. New genomic diagnostic tests compete with traditional approaches to diagnosis, including the genetic testing of single genes and other clinical strategies, for finite health-care budgets. In this context, decision analytic model-based cost-effectiveness analysis is a useful method to help evaluate the costs versus consequences of introducing new health-care interventions.

What are colorectal cancer survivors' preferences for dietary advice? A best-worst discrete choice experiment.

Purpose: Studies on healthy lifestyle interventions in survivors of colorectal cancer have been disappointing, demonstrating only modest changes. This study aims to quantify people's preferences for different aspects of dietary intervention.

Method: A best-worst discrete choice experiment was designed and incorporated into a questionnaire including participants' characteristics and a self-assessment of lifestyle.

Eliciting Preferences for Information Provision in Newborn Bloodspot Screening Programs.

Background: The national newborn bloodspot screening programs (NBSPs) are continually expanding to screen for more conditions.

Objectives: To quantify parents' preferences for information and the way in which this is provided in example NBSPs.

Methods: A hybrid choice experiment, combining a conjoint analysis and a discrete choice experiment, was designed.

Relating belowground microbial composition to the taxonomic, phylogenetic, and functional trait distributions of trees in a tropical forest.

The complexities of the relationships between plant and soil microbial communities remain unresolved. We determined the associations between plant aboveground and belowground (root) distributions and the communities of soil fungi and bacteria found across a diverse tropical forest plot. Soil microbial community composition was correlated with the taxonomic and phylogenetic structure of the aboveground plant assemblages even after controlling for differences in soil characteristics, but these relationships were stronger for fungi than for bacteria.

The Role of Information Provision in Economic Evaluations of Newborn Bloodspot Screening: A Systematic Review.

Background: The extent to which economic evaluations have included the healthcare resource and outcome-related implications of information provision in national newborn bloodspot screening programmes (NBSPs) is not currently known.

Objectives: To identify if, and how, information provision has been incorporated into published economic evaluations of NBSPs.

Methods: A systematic review of economic evaluations of NBSPs (up to November 2014) was conducted.