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Using a decision-analytic model, we evaluated the effectiveness and cost-effectiveness of surveillance for hepatocellular carcinoma (HCC) in individuals with cirrhosis. Separate cohorts with cirrhosis due to alcoholic liver disease, hepatitis B and hepatitis C were simulated. Results were also combined to approximate a mixed aetiology population. Comparisons were made between a variety of surveillance algorithms using a-foetoprotein (AFP) assay and/or ultrasound at 6-and 12-monthly intervals. Parameter estimates were obtained from comprehensive literature reviews. Uncertainty was explored using one-way and probabilistic sensitivity analyses. In the mixed aetiology cohort, 6-monthly AFP þ ultrasound was predicted to be the most effective strategy. The model estimates that, compared with no surveillance, this strategy may triple the number of people with operable tumours at diagnosis and almost halve the number of people who die from HCC. The cheapest strategy employed triage with annual AFP (incremental cost-effectiveness ratio (ICER): d20 700 per quality-adjusted life-year (QALY) gained). At a willingness-to-pay threshold of d30 000 per QALY the most cost-effective strategy used triage with 6-monthly AFP (ICER: d27 600 per QALY gained). The addition of ultrasound to this strategy increased the ICER to d60 100 per QALY gained. Surveillance appears most cost-effective in individuals with hepatitis B-related cirrhosis, potentially due to younger age at diagnosis of cirrhosis. Our results suggest that, in a UK NHS context, surveillance of individuals with cirrhosis for HCC should be considered effective and cost-effective. The economic efficiency of different surveillance strategies is predicted to vary markedly according to cirrhosis aetiology.

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This paper investigated decision pattern analysis (DPA) as a general and standard framework for studying individuals' consistent decision making behavior within and between contexts. DPA classifies decisions on the basis of judgement accuracy and the goal orientation of the decided-upon action. Over repeated decisions, patterns of individuals' decision behavior are described by five variables: competence, optimality, recklessness, hesitancy and decisiveness. A fictitious medical decision making test and three standard cognitive ability tests (extended with confidence ratings and a 'submit answer for marking' decision) were used to investigate the psychometric properties of these DPA variables. Internal consistency of the decision patterns ranged from good to excellent. Convergent validity was assessed via cognitive abilities, metacognitive confidence and a control criterion imposed on confidence that determines the decision to be made: the point of sufficient certainty. Personality variables were included to assess discriminant validity. As hypothesised, cognitive abilities showed positive correlations with competence and optimality. High confidence, low points of sufficient certainty and a greater discrepancy between them were associated with higher decisiveness and recklessness, and lower hesitancy. Personality measures showed mixed and generally weak correlations with the DPA variables. These convergent and discriminant results also held after controlling for all variables in regression. The results provide preliminary psychometric support for DPA as a general framework of behavioral decision making. DPA has the potential to be exploited in many contexts for uses that, to date, have been unachievable in a psychometrically valid manner.

Decision making is the process by which actions are constructed and initiated. Across many research streams, this can be explained in terms of three broad cognitive processes: cognitive abilities that construct judgements and potential courses of action, and interacting monitoring and control processes that determine when to initiate them as behaviour. The aim of this research was to investigate the generality of individual differences in these processes, and their power to predict patterns of decision behaviour identified in our previous research. Undergraduate participants (N = 364) completed nine tests assessing cognitive abilities, monitoring confidence, control thresholds and various patterns of decision behaviour. The tests differed in their cognitive ability requirements and the nature of the payoffs associated with decisions. Cognitive abilities were a strong predictor of individuals' decision competence and optimality, while monitoring confidence and control thresholds were strong and unique predictors of their overall decisiveness, and reckless and hesitant errors. These results were strongest when the measures of cognitive abilities and monitoring confidence were derived from tests with the same cognitive requirements as the tests used to derive the decision behaviours and when the control threshold measure was derived from tests with the same decision payoffs as the test used to derive the decision behaviours. This effect was particularly pronounced for control thresholds, highlighting the domain‐specific nature of cognitive control processes. These findings demonstrate how cognitive abilities, monitoring output and control thresholds interact with cognitive requirements and context‐specific payoffs to drive individual differences in decision‐making behaviour. Copyright © 2016 John Wiley & Sons, Ltd.

AimThe aim was to compare postoperative quality of life (QOL) between patients undergoing pelvic exenteration (PE) and pelvic exenteration with sacrectomy (PES), and to investigate the influence of high (L5-S2) vs low (≤ S3) sacrectomy on QOL and functional outcomes.Method Patients undergoing en bloc sacrectomy as part of a PE and PE alone from 2008 to 2015 were identified from a prospectively maintained database. ResultsOf the 344 patients identified, data were available for 116 patients who underwent PE alone and 140 patients who underwent PES. PES patients had significantly poorer physical component scores (P < 0.001) but not mental component scores (P = 0.17). Of the 140 PES patients, 55 were eligible and were invited to participate in a second functional survey, with 30 patients returning the study questionnaire. High sacrectomy patients, compared with low sacrectomy, had significantly worse lower limb motor function (P = 0.03) and poorer physical (P = 0.001) and mental health component scores (P = 0.02). No differences were found in sexual, bladder and bowel function between high and low sacrectomy patients.Conclusions Patients undergoing PES had worse physical component scores compared with PE alone, whereas high sacrectomy patients had significantly worse lower limb motor function and physical and mental component scores but comparable bowel, bladder and sexual functional outcomes compared with low sacrectomy patients.

Background: Transcatheter aortic valve implantation (TAVI) can cause profound haemodynamic