Economic evaluation of different screening alternatives for patients with clinically suspected acute deep vein thrombosis

Introduction:

We examined the cost-effectiveness of the three different D-dimer measurements in the screening of DVT in models with and without calculation of pre-test probability (PTP) score. Moreover, we calculated the minimal cost in DVT detection.

Material and methods:

In the group of 192 patients with clinically suspected acute DVT, we examined the three different D-dimer measurements (Innovance D-dimer, Hemosil D-dimer HS and Vidas D-dimer Exclusion II) in combination with and without PTP assessment.

Results:

The diagnostic alternative employing Vidas D-dimer Exclusion II assay without and with PTP calculation gave lower incremental cost-effectiveness ratio (ICER) than the alternative employing Hemosil D-dimer HS assay (0.187 Euros vs. 0.998 Euros per one additional DVT positive patient selected for CUS in model without PTP assessment and 0.450 vs. 0.753 Euros per one DVT positive patient selected for CUS in model with PTP assessment). According to sensitivity analysis, the Hemosil D-dimer HS assay was the most cost effective alternative when one patient was admitted to the vascular ambulance per day. Vidas D-dimer Exclusion II assay was the most cost effective alternative when more than one patient were admitted to the vascular ambulance per day. Cost minimisation analysis indicated that selection of patients according to PTP score followed by D-dimer analysis decreases the cost of DVT diagnosis.

Conclusions:

ICER analysis enables laboratories to choose optimal laboratory tests according to number of patients admitted to laboratory. Results support the feasibility of using PTP scoring and D-dimer measurement before CUS examination in DVT screening.     

Using real data for statistics education in an open‐source learning environment

The tutor‐web is an open‐source learning environment designed to be used for teaching mathematics and statistics. The system offers thousands of exercises at high school and university level, and has been used for a decade to teach introductory statistics courses with good results. A new component has recently been added to the tutor‐web so that students can enter their own data or get real data from several data sources for practicing and learning new concepts.     

Perceived distributed effort in team ball sports

Abstract

In this study, we explored the multifaceted concept of perceived mental and physical effort in team sport contexts where athletes must invest individual and shared efforts to reach a common goal. Semi-structured interviews were conducted with a convenience sample of 15 Catalan professional coaches (3 women and 12 men, 3 each from the following sports: volleyball, basketball, handball, soccer, and water polo) to gain their views of three perceived effort-related dimensions: physical, psychological, and tactical. From a theoretical thematic analysis, it was found that the perception of effort is closely related to how effort is distributed within the team. Moreover, coaches viewed physical effort in relation to the frequency and intensity of the players’ involvement in the game. They identified psychological effort in situations where players pay attention to proper cues, and manage emotions under difficult circumstances. Tactical effort addressed the decision-making process of players and how they fulfilled their roles while taking into account the actions of their teammates and opponents. Based on these findings, a model of perceived distributed effort was developed, which delineates the elements that compose each of the aforementioned dimensions. Implications of perceived distributed effort in team coordination and shared mental models are discussed.