THE OPTIMAL MANAGEMENT OF CEREBRAL ANEURYSMS

描述(改编自申请人的摘要)：1-5%的患病率 脑动脉瘤意味着美国有200万至1000万成年人 各州可能存在颅内动脉瘤。每年有21,000个这样的 个人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病史、治疗和结果的数据， 动脉瘤患者的神经外科决策的组成部分包括 人们对此知之甚少。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果 患有脑血管疾病。我的近期目标是制定一项决定 分析和成本效益的计算机模拟模型，以评估 脑动脉瘤患者的神经外科治疗结果 疾病。这项研究计划包括由马克·罗伯茨博士(全国 公认的决策科学专家)，提供一对一教程 辅导员、课程作业、研讨会和指导性阅读。具体的 该方案的目的是：(1)构造一个计算机模拟决策 用于检验患者最优神经外科决策的分析模型 以及(2)使用计算机模拟模型进行 优化社会资源配置的成本效益分析 动脉瘤患者的管理。 研究部分将通过初步收集 患者偏好和经济数据、二次数据分析和数学 建模技术。该提案将更新并大大扩展My 包含未破裂和破裂动脉瘤的初步模型，实际 患者对各种结局状态的偏好，疾病严重程度的调整， 对动脉瘤自然病程、演变过程的研究进展 处理技术和更详细的经济数据。另外，我会 扩展我在正式决策科学方面的技能和专长 通过辅导课程、特定课程、 研讨会、定向阅读和研究工作。这项建议是建立在我的 神经外科和流行病学方面的培训，以及我目前的研究。这项研究 研究计划应该为持续的职业发展奠定基础。 在这个奖项结束时，我将获得经验和研究 独立调查和改进神经外科决策的技能 以及脑血管疾病患者的预后。

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.