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Comparative effectiveness research on patients with acute ischemic stroke using Markov decision processes

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      Abstract

      Background

      Several methodological issues with non-randomized comparative clinical studies have been raised, one of which is whether the methods used can adequately identify uncertainties that evolve dynamically with time in real-world systems. The objective of this study is to compare the effectiveness of different combinations of Traditional Chinese Medicine (TCM) treatments and combinations of TCM and Western medicine interventions in patients with acute ischemic stroke (AIS) by using Markov decision process (MDP) theory. MDP theory appears to be a promising new method for use in comparative effectiveness research.

      Methods

      The electronic health records (EHR) of patients with AIS hospitalized at the 2 nd Affiliated Hospital of Guangzhou University of Chinese Medicine between May 2005 and July 2008 were collected. Each record was portioned into two " state- action- reward" stages divided by three time points: the first, third, and last day of hospital stay. We used the well-developed optimality technique in MDP theory with the finite horizon criterion to make the dynamic comparison of different treatment combinations.

      Results

      A total of 1504 records with a primary diagnosis of AIS were identified. Only states with more than 10 (including 10) patients' information were included, which gave 960 records to be enrolled in the MDP model. Optimal combinations were obtained for 30 types of patient condition.

      Conclusion

      MDP theory makes it possible to dynamically compare the effectiveness of different combinations of treatments. However, the optimal interventions obtained by the MDP theory here require further validation in clinical practice. Further exploratory studies with MDP theory in other areas in which complex interventions are common would be worthwhile.

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      Most cited references 37

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      Framework for design and evaluation of complex interventions to improve health.

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        Framework for design and evaluation of complex interventions to improve health

         M M Campbell (2000)
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          Guidelines for the early management of adults with ischemic stroke: a guideline from the American Heart Association/American Stroke Association Stroke Council, Clinical Cardiology Council, Cardiovascular Radiology and Intervention Council, and the Atherosclerotic Peripheral Vascular Disease and Quality of Care Outcomes in Research Interdisciplinary Working Groups: the American Academy of Neurology affirms the value of this guideline as an educational tool for neurologists.

          Our goal is to provide an overview of the current evidence about components of the evaluation and treatment of adults with acute ischemic stroke. The intended audience is physicians and other emergency healthcare providers who treat patients within the first 48 hours after stroke. In addition, information for healthcare policy makers is included. Members of the panel were appointed by the American Heart Association Stroke Council's Scientific Statement Oversight Committee and represented different areas of expertise. The panel reviewed the relevant literature with an emphasis on reports published since 2003 and used the American Heart Association Stroke Council's Levels of Evidence grading algorithm to rate the evidence and to make recommendations. After approval of the statement by the panel, it underwent peer review and approval by the American Heart Association Science Advisory and Coordinating Committee. It is intended that this guideline be fully updated in 3 years. Management of patients with acute ischemic stroke remains multifaceted and includes several aspects of care that have not been tested in clinical trials. This statement includes recommendations for management from the first contact by emergency medical services personnel through initial admission to the hospital. Intravenous administration of recombinant tissue plasminogen activator remains the most beneficial proven intervention for emergency treatment of stroke. Several interventions, including intra-arterial administration of thrombolytic agents and mechanical interventions, show promise. Because many of the recommendations are based on limited data, additional research on treatment of acute ischemic stroke is needed.
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            Author and article information

            Affiliations
            [1 ]The 2nd Clinical Medical College of Guangzhou University of Chinese Medicine, the 2nd Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
            [2 ]Guangdong Provincial Academy of Chinese Medical Sciences, Guangzhou, China
            [3 ]South China Normal University, Guangzhou, China
            [4 ]Sun Yat-Sen University, Guangzhou, China
            [5 ]School of Mathematics and Computational Science, Sun Yat-Sen University, 135, Xingangxi Road, Haizhu District, Guangzhou, Guangdong, China
            Contributors
            Journal
            BMC Med Res Methodol
            BMC Med Res Methodol
            BMC Medical Research Methodology
            BioMed Central
            1471-2288
            2012
            9 March 2012
            : 12
            : 23
            3348070
            1471-2288-12-23
            22400712
            10.1186/1471-2288-12-23
            Copyright ©2012 Wu et al; licensee BioMed Central Ltd.

            This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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            Research Article

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