Decision Analysis Model for Facial Composite Tissue Allotransplantation
Notice bibliographique
Résumé
Facial composite tissue allotransplantation (CTA) has been proposed as a potential reconstructive option in severe facial disfigurement, in view of the reported success of hand allotransplantation. In the absence of clinical data, the decision to proceed with facial allotransplantation is dependent on the value or expected utility of the resultant status. Utility is measured by various means, including quality adjusted life years (QALYs). The QALY was developed as an attempt to integrate length of life in a particular health state and quality of life in that state into a single index measure. The change in utility value effected by an intervention multiplied by the duration of the treatment effect provides the number of QALYs gained. Utilities expressed as QALYs can then be fitted into a decision analytic model. Decision analysis enables surgeons to compare the expected consequences of pursuing different strategies (e.g., facial CTA vs. severe facial disfigurement). The purpose of this study was to assist surgeons with the decision of whether to proceed with CTA of the face. The principal complications associated with facial allotransplantation were identified by a comprehensive review of kidney transplant and hand allotransplant literature. Based on the latter, the probabilities associated with the occurrence of each complication were derived, and fitted into a decision analytic “tree.” The decision analytic tree was constructed illustrating possible health states (pathways) for facial allotransplantation. The QALYs gained with transplantation were obtained from a sample of convenience (n = 60) that included various health care professionals. Utilities were computed from values obtained with the “feeling thermometer” (FG), standard gamble (SG), and time trade-off (TTO) measures. Quality adjusted life years for severe facial deformity was 11.2, 16.0, and 17.5 with the FT, SG, and TTO measures, respectively. Following facial allotransplantation, QALYs were 37.4, 32.6, and 31.1 with the above listed measures. The current debate within the medical community surrounding facial CTA has centered on the issue of inducing a state of immunocompromise in a physically healthy individual for a non-life-saving procedure. However, the latter must be weighed against the potential social and psychological benefit transplantation would confer. As demonstrated by a mean gain of 33.7 QALYs, participants' valuation of quality of life is notably greater for facial transplantation and the side effects of immunosuppression than for a state of uncompromised physical health with severe facial disfigurement.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,006 | 0,010 |
| Méta-épidémiologie (sens strict) | 0,002 | 0,001 |
| Méta-épidémiologie (sens large) | 0,003 | 0,002 |
| Bibliométrie | 0,002 | 0,001 |
| Études des sciences et des technologies | 0,001 | 0,001 |
| Communication savante | 0,004 | 0,001 |
| Science ouverte | 0,003 | 0,002 |
| Intégrité de la recherche | 0,004 | 0,004 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,018 | 0,002 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».