Rhenus:structure model
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Structure of the Rhenus model (Yasaman)
This is the structure of the Rhenus Disease Model for the present. Because of the clearness the arrows to the state <death> are not drawn from all states yet.
(Schramm)
Excellent work,
p3 could be neglected. What do you think? The combined state is the aggravation of the single states <Non-proliferative RP> and <Maculopathy>. The combined event most likely is really rare. I suggest we leave it out, unless we find convincing evidence in our literature search. At least all other working groups I know of have made the same decision...
There should be a transition arrow from the combined state <Non-proliferative RP and Maculopathy> to <Blindness>...
We should concentrate the literature search on the combined state <Non-proliferative RP and Maculopathy>. Will we have enough evidence to build a sound model? All other working groups do not use this combined state - may be simply because there is not enough evidence. If so, we could make the model a lot easier (it means five transitions less)!
Best regards Wendelin Schramm
RE: structure of the Rhenus model (Yasaman)
In the pdf-document you can find an article about Maculopathy in patients with diabetes mellitus type 1 and type 2. I have extracted the results of this study in the word-document in order to mark the text passages which may give us an answer concerning the state <non-proliferative retinopathy and diabetic maculopathy>.
This article is also interesting because of the informations about the associations of the risk factors in retinopathy and maculopathy.
RE: structure of the Rhenus model
Super !
I'll have a look at it. Being off until next Wednesday. It will take some time...
Best regards Wendelin
RE: structure of the Rhenus model
Ok,
the study of Zander et al., BMJ, 2000 is nice, but it is a cross-sectional study, which means it provides limited information about the longitudinal development of maculopathy in (the same) persons with diabetes.
They say: "... the prevalence rates are higher than those from the population based studies beacause of patient selection".
I would conclude that we need more information such as from the Wisconsin Epidemiologic Study of Diabetic Retinopathy...
RE: structure of the Rhenus model
After searching the literature for evidence for the Rhenus model presented in this forum before, I did not find evidence for the combined states <non-proliferative retinopathy and diabetic maculopathy> and <proliferative retinopathy and diabetic maculopathy> especially for the progression from one state to the other (p20). Therefore the structure of the Rhenus model has changed as you can see below.
