THE OPTIMAL MANAGEMENT OF CEREBRAL ANEURYSMS

描述（改编自申请人的摘要）： 脑动脉瘤意味着美国有200万到1000万成年人 可能患有颅内动脉瘤。每年有21,000个这样的 个体遭受蛛网膜下腔出血，导致显著的 发病率、死亡率和费用。神经外科医生做出最终决定， 动脉瘤患者的手术干预。虽然有越来越多的 关于脑动脉瘤的自然史、管理和结局的数据， 动脉瘤患者的神经外科决策的组成部分是 不太了解。我的长期目标是建立一个研究事业 旨在改善患者的神经外科决策和结局 患有脑血管疾病我的近期目标是做出一个决定 分析和成本效益的计算机模拟模型，以评估 脑卒中患者的神经外科决策结果 疾病该研究计划包括指导博士马克罗伯茨（一个国家 在决策科学公认的专家），一对一的教程与一组 支持顾问，课程工作，研讨会和指导阅读。具体 本文的目标是：（1）建立一个计算机模拟决策系统 分析模型，以检查患者的最佳神经外科决策 与脑动脉瘤，（2）使用计算机模拟模型， 成本效益分析，以优化社会资源配置， 动脉瘤患者的管理。 研究部分将通过主要收集以下资料来实现这些目标： 患者偏好和经济数据，二次数据分析，以及数学 建模技术该提案将更新并大大扩展我的 包含未破裂和破裂动脉瘤的初步模型，实际 患者对各种结果状态的偏好，疾病严重程度调整， 动脉瘤自然史的最新进展， 以及更详细的经济数据。此外，我将 扩展我在正式决策科学方面的技能和专业知识， 通过辅导课程、具体课程， 研讨会，指导阅读和研究工作。这一建议建立在我的 神经外科和流行病学的培训以及我目前的研究。研究 科研计划要为职业的持续发展奠定基础。 在这个奖项结束时，我将获得的经验和研究 独立调查和改善神经外科决策的技能 脑血管病患者的预后。

DESCRIPTION (Adapted From The Applicant's Abstract): The 1-5% prevalence of cerebral aneurysms implies that 2,000,000 to 10,000,000 adults in the United States may harbor an intracranial aneurysm. Each year 21,000 of these individuals suffer a subarachnoid hemorrhage, resulting in significant morbidity, mortality, and expense. Neurosurgeons make final decisions regarding operative intervention for aneurysm patients. While there is a growing body of data on the natural history, management, and outcomes of cerebral aneurysms, the components of neurosurgical decision-making for aneurysm patients are poorly understood. My long-term objective is to establish a research career targeted at improving neurosurgical decision-making and outcomes in patients with cerebrovascular disease. My immediate goal is to develop a decision analytic and cost-effectiveness computer simulation model to evaluate the outcomes of neurosurgical decisions in patients with cerebral aneurysmsal disease. The study plan includes mentoring by Dr. Mark Roberts (a nationally recognized expert in decision sciences), one-on-one tutorials with a group of supporting advisors, course work, seminars, and directed readings. The specific aims of this proposal are: (1) Construct a computer simulation decision analytic model to examine optimal neurosurgical decision-making in patients with cerebral aneurysms, and (2) Use the computer simulation model to perform a cost effectiveness analysis to optimize societal resource allocation during the management of aneurysm patients. The research component will accomplish these aims via primary collection of patient preference and economic data, secondary data analysis, and mathematical modeling techniques. The proposal will update and greatly expand the my preliminary model to incorporate both unruptured and ruptured aneurysms, actual patient preferences for various outcome states, disease severity-adjustment, recent advances in the understanding of aneurysm natural history, the evolution of treatment technologies, and more detailed economic data. In addition, I will expand my skills and expertise in formal decision sciences and cost-effectiveness analysis through mentored sessions, specific courses, seminars, directed readings, and research work. This proposal builds on my training in neurosurgery and epidemiology and on my current research. The study and research plan should lay the foundation for sustained career development. At the conclusion of this award, I will have gained the experience and research skills to independently investigate and improve neurosurgical decision-making and outcomes in patients with cerebrovascular disease.