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LA CENA DI NATALE LUCA BIANCHINI PDF

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To assist in the initial estimates, the panel members were provided with the rates of hospitalization and outpatient physician visits in the United States for treatment of fractures of the hip, spine, forearm, and all other sites combined in by age, race, and gender.

Each panelist had an opportunity to review the modal probabilities, the range of probabilities, and the underlying assumptions. At this point, published data on fracture incidence by age, gender, and ethnic group, as well as the excess of fractures in each group over and above the rates seen in young individuals i.

The latter data were only available for fractures among elderly white women. Upon completion of this discussion, each member of the expert panel developed a new set of attribution probabilities by again completing the Osteoporosis Attribution Probability Response Form. Another discussion ensued regarding the areas where most disagreement on the probabilities remained. To complete Round III, each panelist assigned a final probability value for the 72 different categories.

The median attribution probabilities from this final stage were calculated and redistributed to panel members who in turn ranked each of the final 72 probabilities according to the numeric validity scale described above. Panel assumptions Panelists were given an opportunity to list the major assumptions they used to estimate the attribution probabilities for each subpopulation and fracture type of interest.

The assumptions were used in two important ways: first, to assist each panel member in estimating the probabilities in as systematic a manner as possible and, second, to provide an organized approach for discussing disagreements between members in order to reduce the discrepancy in probability estimates at each stage.

The various assumptions that were recorded, organized by general topic area, are presented in Table 1. It must be noted that, although the assumptions were shared by the majority of the panel, not all members agreed with every assumption. Panelists generally assumed that women have more fractures than men after age 45 and that a greater proportion of them are osteoporotic in nature.

The last set of assumptions made by the panel addressed issues related to fracture type. Table Table 1.

However, there was less certainty in the estimate for men compared with women in this age group validity score 1.

Much smaller proportions of forearm fractures and all other fracture types combined were considered to be related to osteoporosis. Regardless of fracture type or race or gender, the panel members agreed that attribution probabilities generally increase with age.

Table Table 2. Even when the degree of trauma is considerable, 53 fractures generally occur in a setting of low bone density, and detailed investigation indicates that bone density is an important determinant of risk.

In the absence of empirical data, we attempted to address this issue by using the Delphi method to estimate the probability that fractures of a given type are related to osteoporosis. As noted above, the Delphi approach is a widely used and validated method to make such estimations. Our estimates for spine fractures were also greater than those from the previous panel of 0. Their estimates for distal forearm fractures 0. Moreover, validity scores were not used by the earlier expert panel, which further hinders direct comparison with our results.

The issues to be addressed by the panel and the Response Form to be completed were presented in each round.

Round I initial estimate of osteoporosis attribution probabilities was completed independently by each panel member by mail, as is typically done with this approach.

The six clinicians on the expert panel then met for a day in Washington, DC, to review results from the first round and to hear a presentation of relevant data.

A detailed description of these three stages is presented below. To determine the degree of confidence with which the panel estimated each of the 72 attribution probabilities, each panelist was also asked to associate a validity score with each final probability estimate. The group validity scores are important in using the attribution probabilities in future health services research applications.

Selection of the expert panel The size and composition of a Delphi panel are crucial to its success since the results are based on the combined expert knowledge of its members. The panel must reflect relevant perspectives on an issue while permitting a complete and free exchange of views among all concerned in a relatively short period of time. The final panel, listed at the end of the report, was composed of clinicians in the fields of internal medicine, endocrinology, rheumatology, orthopedic surgery, and nuclear medicine.

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Round I—Initial estimation of osteoporosis attribution probabilities: The first round was conducted by mail prior to the Delphi Committee meeting. These attribution probabilities were recorded in the appropriate boxes on an Osteoporosis Attribution Probability Response Form in increments of 0. In addition, participants outlined the key assumptions underlying their attribution probabilities on a separate form.

To assist in the initial estimates, the panel members were provided with the rates of hospitalization and outpatient physician visits in the United States for treatment of fractures of the hip, spine, forearm, and all other sites combined in by age, race, and gender. Each panelist had an opportunity to review the modal probabilities, the range of probabilities, and the underlying assumptions.

Terroni and Polentoni: An Open Debate

At this point, published data on fracture incidence by age, gender, and ethnic group, as well as the excess of fractures in each group over and above the rates seen in young individuals i.

The latter data were only available for fractures among elderly white women. Upon completion of this discussion, each member of the expert panel developed a new set of attribution probabilities by again completing the Osteoporosis Attribution Probability Response Form.

Another discussion ensued regarding the areas where most disagreement on the probabilities remained. To complete Round III, each panelist assigned a final probability value for the 72 different categories. The median attribution probabilities from this final stage were calculated and redistributed to panel members who in turn ranked each of the final 72 probabilities according to the numeric validity scale described above.

Panel assumptions Panelists were given an opportunity to list the major assumptions they used to estimate the attribution probabilities for each subpopulation and fracture type of interest.

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The assumptions were used in two important ways: first, to assist each panel member in estimating the probabilities in as systematic a manner as possible and, second, to provide an organized approach for discussing disagreements between members in order to reduce the discrepancy in probability estimates at each stage. The various assumptions that were recorded, organized by general topic area, are presented in Table 1. It must be noted that, although the assumptions were shared by the majority of the panel, not all members agreed with every assumption.

Panelists generally assumed that women have more fractures than men after age 45 and that a greater proportion of them are osteoporotic in nature.Selection of the expert panel The size and composition of a Delphi panel are crucial to its success since the results are based on the combined expert knowledge of its members.

In the absence of a gold standard, it is not possible to rigorously validate any of these osteoporosis attribution probabilities.

The movie ranked number 1 the day of screening. This is not possible for osteoporosis, which is rarely listed in conjunction with its associated fractures. The Osteoporosis Delphi process comprised three iterative rounds based on the observation that more than three rounds leads to diminishing returns.

The final panel, listed at the end of the report, was composed of clinicians in the fields of internal medicine, endocrinology, rheumatology, orthopedic surgery, and nuclear medicine.