Background: Opioid use disorder (OUD) and its consequences have strained the resources of health, social, and criminal justice services in the Cincinnati region. However, understanding of the potential number of people suffering from OUD is limited. Little robust and reliable information quantifies the prevalence and there is often great variation between individual estimates of prevalence. In other fields such as meteorology, finance, sports, and politics, model averaging is commonly employed to improve estimates and forecasts. The objective of this study was to apply a model averaging approach to estimate the number of individuals with OUD in the Cincinnati region. Methods: Three individual probabilistic simulation models were developed to estimate the number of OUD individuals in the Cincinnati Core Based Statistical Area (CBSA). The models used counts of overdose deaths, non-fatal overdoses, and treatment admissions as benchmark data. A systematic literature review was performed to obtain the multiplier data for each model. The three models were averaged to generate single estimate and confidence band of the prevalence of OUD. Results: This study estimated 15 067 (SE 1556) individuals with OUD in the Cincinnati CBSA (2 165 139 total population). Based on these results, we estimate the prevalence of OUD to be between 13 507 (0.62% of population) and 16 620 (0.77% of population). Conclusions: The method proposed herein has been shown in diverse fields to mitigate some of the uncertainty associated with reliance on a single model. Further, the simplicity of the method described is easily replicable by community health centers, first-responders, and social services to estimate capacity needs supported by OUD estimates for the region they serve.
Background: Opioid use disorder (OUD) and its consequences have strained the resources of health, social, and criminal justice services in the Cincinnati region. However, understanding of the potential number of people suffering from OUD is limited. Little robust and reliable information quantifies the prevalence and there is often great variation between individual estimates of prevalence. In other fields such as meteorology, finance, sports, and politics, model averaging is commonly employed to improve estimates and forecasts. The objective of this study was to apply a model averaging approach to estimate the number of individuals with OUD in the Cincinnati region. Methods: Three individual probabilistic simulation models were developed to estimate the number of OUD individuals in the Cincinnati Core Based Statistical Area (CBSA). The models used counts of overdose deaths, non-fatal overdoses, and treatment admissions as benchmark data. A systematic literature review was performed to obtain the multiplier data for each model. The three models were averaged to generate single estimate and confidence band of the prevalence of OUD. Results: This study estimated 15 067 (SE 1556) individuals with OUD in the Cincinnati CBSA (2 165 139 total population). Based on these results, we estimate the prevalence of OUD to be between 13 507 (0.62% of population) and 16 620 (0.77% of population). Conclusions: The method proposed herein has been shown in diverse fields to mitigate some of the uncertainty associated with reliance on a single model. Further, the simplicity of the method described is easily replicable by community health centers, first-responders, and social services to estimate capacity needs supported by OUD estimates for the region they serve.
Background: Bifurcation lesions represent 15-20% of all patients undergoing a percutaneous coronary intervention (PCI) for coronary artery disease. The provisional 1-stent stenting strategy is the preferred strategy to treat bifurcation lesions. Other strategies used to treat bifurcation lesions include 2-stent complex stenting strategies and the Tryton Side Branch Stent® (TSB)—a dedicated side-branch stent for bifurcation lesions, which gained FDA approval in March 2017. Objectives: To conduct a systematic literature review of the safety and effectiveness of three stenting strategies (provisional, complex, and Tryton Side Branch Stent®) for bifurcation lesions with a side-branch diameter ≥2.25 mm, undergoing PCI. Methods: Literature searches in Medline, Cochrane Library, Web of Science and Embase were conducted to identify prospective clinical trials from January 2007-July 2017. Results: 602 articles were identified. Nine articles (6275 patients) met all inclusion criteria. Seven studies (5282 patients) compared provisional to complex stenting strategies. Two studies (993 patients) compared provisional to the TSB. Outcomes of interest reported were target vessel failure in 2 studies, major adverse cardiac event (MACE) (cardiac death, all myocardial infarction, ischemic driven target legion revascularization TLR) in 5 studies. For target vessel failure, the provisional strategy ranged from 5.6% to 15.6 %; complex at 7.2% (one study); and TSB from 11.3% to 17.4%. For MACE, provisional strategy ranged from 8%-13.2%; complex from 11.9%-15.2%; and TSB from 8.2%-18.6%. Conclusions: To our knowledge, this is the first review comparing three bifurcation lesion stenting strategies. Significant heterogeneity in the study design of the nine studies reviewed prevented a meta-analysis. A clinical trial comparing the TSB to both the provisional and complex strategies would provide better inference on the safety and effectiveness when comparing strategies.
Background: Bifurcation lesions represent 15-20% of all patients undergoing a percutaneous coronary intervention (PCI) for coronary artery disease. The provisional 1-stent stenting strategy is the preferred strategy to treat bifurcation lesions. Other strategies used to treat bifurcation lesions include 2-stent complex stenting strategies and the Tryton Side Branch Stent® (TSB)—a dedicated side-branch stent for bifurcation lesions, which gained FDA approval in March 2017. Objectives: To conduct a systematic literature review of the safety and effectiveness of three stenting strategies (provisional, complex, and Tryton Side Branch Stent®) for bifurcation lesions with a side-branch diameter ≥2.25 mm, undergoing PCI. Methods: Literature searches in Medline, Cochrane Library, Web of Science and Embase were conducted to identify prospective clinical trials from January 2007-July 2017. Results: 602 articles were identified. Nine articles (6275 patients) met all inclusion criteria. Seven studies (5282 patients) compared provisional to complex stenting strategies. Two studies (993 patients) compared provisional to the TSB. Outcomes of interest reported were target vessel failure in 2 studies, major adverse cardiac event (MACE) (cardiac death, all myocardial infarction, ischemic driven target legion revascularization TLR) in 5 studies. For target vessel failure, the provisional strategy ranged from 5.6% to 15.6 %; complex at 7.2% (one study); and TSB from 11.3% to 17.4%. For MACE, provisional strategy ranged from 8%-13.2%; complex from 11.9%-15.2%; and TSB from 8.2%-18.6%. Conclusions: To our knowledge, this is the first review comparing three bifurcation lesion stenting strategies. Significant heterogeneity in the study design of the nine studies reviewed prevented a meta-analysis. A clinical trial comparing the TSB to both the provisional and complex strategies would provide better inference on the safety and effectiveness when comparing strategies.
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