bluuebunny/crossref_metadata_2025 huggingface dataset:
Maternity Patients' Advocates in the 1990s: Changing Debates and New Debaters
Authors: Shearer Madeleine H.
Published: March 2009

Beginning in the 1960s, the maternity patients' movement in the United States was joined by lay, medical, and political critics who protested the escalating cost, poor and inequitable distribution, and overspecialization of medical care. During the 1970s some goals of the maternity patients' movement were met, including fathers' attendance at birth, care in low intervention birth centers, and keeping the newborn baby with the parents immediately after delivery. At the same time, however, perinatal care became ever more based on new technology, tests, and procedures, some of which were promoted by doctor-developers in continuing education courses and in expert witness testimony at malpractice trials. Primary obstetric units closed while urban and suburban centers advertised new services to people who could pay. In the 1990s the maternity patients' advocates have most of the same complaints as in 1970, as well as many new ones.
Effects and Costs of In-Vitro Fertilization: Again, Let's Be Honest
Authors: Haan Ger
Published: March 2009

The decision whether to enhance diffusion and to reimburse for the fertility treatment in-vitro fertilization (IVF) was postponed in the Netherlands until the results of a cost-effectiveness analysis were known. IVF appeared to be as cost-effective as its most important alternative, tubal surgery. But policy decisions still were not straightforward, obscuring important social and ethical issues.
Randomized Clinical Trials in Surgery
Authors: McPeek Bucknam , Mosteller Frederick , McKneally Martin
Published: March 2009

When it is well conducted, a randomized clinical provides the strongest evidence available for evaluating the comparative effectiveness of the interventions tested. Over the last two generations, we have learned much about various devices for strengthening them and about methods of avoiding between in their design, execution, analysis, and reporting. In a trial, we seek evidence for a causal link between treatment and observed outcomes. Becaues the controlled trial depends on an argument based on exculsion (i.e., no other causes or differences affected the experimental groups), we strengthen its inference by taking steps to exclude any such differences.

This article discusses a number of issues that deserve consideration: problems of multiplicity and generalizability, devices for strengthening trials, issues of power and sample size, the relationship between study design and reported gains, when to undertake a trial, the role of collaborative trials, and ways to make trials more feasible in clinical settings.
Limitations of Nonscience in Surgical Epistemology: The Second-Look Laparotomy
Authors: Baum Michael
Published: March 2009

Decision-making in medicine is a very complex process that demands input both from the doctor and from the client. From the doctor's point of view, the most important component for this decision concerns the quality of evidence available that the recommended intervention is the best available in terms of both cost and benefit. Good quality evidence demands good quality science. The randomized controlled trial is the expression of this scientific process at work within medical practice. This article reviews both the rationale and the ethics of randomized controlled trials in the epistemology of surgery. The ethical dilemma is accentuated because surgery by its very nature is invasive and often irreversible. As an illustration of the scientific and ethical dilemmas arising out of randomized controlled trials in surgery, a description of the CEA directed second-look laparotomy trial in the United Kingdom is provided. This trial may be judged essential because of the clash of attitudes between surgeons in the United States and the United Kingdom. It is unlikely that the truth lies entirely with one or other national groupings of surgeons, and this randomized trial will eventually resolve a conflict of ideas to the ultimate benefit of all patients with operable colorectal cancer.
Adjuvant Radiotherapy in Breast Cancer: Consideration of Cost-Benefits in Relation to the CRC (King's/Cambridge) Trial
Authors: Houghton Joan , Baum Michael
Published: March 2009

The Cancer Research Campaign (CRC) Trial demonstrates a decreased incidence of local recurrence for patients randomized to prophylactic radiotherapy following mastectomy. Irradiated patients alive after 5 years, however, have a small increased risk of dying from causes other than breast cancer. How to estimate the cost-benefit of such therapy is discussed.
Becoming More Efficient at Outcomes Research
Authors: Roos Leslie L. , Sharp Sandra M.
Published: March 2009

This paper discusses several practical problems in research design: Is it worth doing a relatively “quick and dirty” study or is a more thorough study using all available infotmation necessary? All the desired information may either not be available or be time-consuming to collect. What are the likely biases in going ahead and doing the research with the data base “in hand”? Such issues are important because of the limited resources for technology assessment (in terms of money, number of researchers, and research interest) and the great number of unstudies technologies.
Describing Patterns of Recovery as a Basis for Evaluating Progress
Authors: Partridge Cecily J.
Published: March 2009

Collecting descriptive data on patterns of recovery from a disabling condition could provide a baseline for assessing treatment methods and for monitoring the progress of individual patients. An illustrative study of patients recovering from stroke is presented and the strengths and weaknesses of such studies are discussed.
Editorial (Part II) Assessing the Technology of Developing Health Occupations: Obstacles, Risks, and Strategies for Future Work
Authors: Watts Nancy T.
Published: March 2009

Efforts to expand technology assessment in developing fields, such as physical therapy, face major obstacles. These impediments include scarcity of assessment tools, weak organizational structure for research, and clinicians' reluctance to assess economic factors. Risks that could accompany future work and strategies for reducing problems are discussed.
Clinical Decision Analysis as a Means of Technology Assessment: The Effectiveness of Intraoperative Cholangiography
Authors: Scott Thomas E. , Jacoby Itzhak
Published: March 2009

Three strategies for timely detection of common duct stones are examined by decision analysis: the use of intraoperative cholangiography (IOC) in ALL, NONE, or in SOME of the cases that are selected by the estimated probability of a common duct stone. Selective use of IOC is the most cost-effective option and offers a slightly lower mortality risk.
Discovery, Transfer, and Diffusion of Technologies for the Detection of Genetic Disorders:Policy Implications
Authors: Holtzman Neil A.
Published: March 2009

Much of the current interest in genetics stems from the Human Genome Project. Although the project will accelerate the identification of disease-related genes, as currently formulated it may retard discovery of gene function and effective treatments, thereby prolonging the stage in which people at risk of genetic diseases can be identified but not treated. This stage is fraught with ethical problems. The project's goal of sequencing the entire human genome could also detract from basic biological research, as could the growing interest of universities in biotechnology transfer to the commercial sector.
The Concept of Cost in the Economic Evaluation of Health Care:A Theoretical Inquiry
Authors: Johannesson Magnus
Published: March 2009

The costs included in economic evaluations of health care vary from study to study. Based on the theory of cost-benefit analysis, the costs that should be included in an economic evaluation are those not already included in the measurement of willingness to pay (net willingness to pay above any treatment costs paid by the individual) in a cost-benefit analysis or in the easurement of effectiveness in a cost-effectiveness analysis. These costs can be defined as the onsumption externality of the treatment (the change in production minus consumption for those included in the treatment program). For a full economic evaluation, the consequences for those included in the treatment program and a caring externality (altruism) should also be added.
The Effect of Allowing Clinical Discretion in Ordering Biochemical Tests: Evaluation by Complementar Methods
Authors: Buckingham Ken , Russell Ian , Ross Iain , Gibson Patrick , Paterson Neil
Published: March 2009

We describe the effects on costs, working patterns, and clinical behavior of installing a DAX “discretionary” biochemistry analyzer. Use of the new analyzer encouraged doctors to be more specific in requesting biochemical tests, which substantially reduced the number of tests requested and slightly reduced overall costs. Doctors preferred being able to order tests in this more specific way.
Individual Perception of Education and Treatment Versus Actual Outcome: A Theoretical Model Exemplified by an Interventional Study on Patients with Insulin-Dependent Diabetes Mellitus
Authors: Furu Margareta , Fischbein Siv , Rosenqvist Urban
Published: March 2009

An educational model is presented that stresses the importance of the interaction between individual characteristics and intentional educational influences on outcome variation. This model is exemplified by an interventional study of patients with insulin-dependent diabetes mellitus who, despite long-term conventional medical treatment, had been unable to achieve satisfactory hemoglobin Aic levels. Treatment modes and their importance for understanding variations in outcomes are discussed from the interactional perspective suggested in the model.
Utilities and Quality-Adjusted Life Years
Authors: Torrance George W. , Feeny David
Published: March 2009

Utilities and quality-adjusted life years (QALYs) are reviewed, with particular focus on their use in technology assessment. This article provides a broad overview and perspective on these two techniques and their interrelationship, with reference to other sources for details of implementation. The historical development, assumptions, strengths/weaknesses, and applications of each are summarized.

Utilities are specifically designed for individual decision-making under uncertainty, but, with additional assumptions, utilities can be aggregated across individuals to provide a group utility function. QALYs are designed to aggregate in a single summary measure the total health improvement for a group of individuals, capturing improvements from impacts on both quantity of life and quality of life– with quality of life broadly defined. Utilities can be used as the quality-adjustment weights for QALYs; they are particularly appropriate for that purpose, and this combination provides a powerful and highly useful variation on cost-effectiveness analysis known as cost-utility analysis.
Genetic Diagnosis: Implications for Medical Practice
Authors: Blumenthal David , Zeckhauser Richard
Published: March 2009

Genetic diagnostic techniques increasingly permit the detection of predisposition to illness long before the onset of the disease process itself. Medicine is on the verge of becoming a predictive science as well as a diagnostic and therapeutic one. Genetic diagnosis could have profound effects on many aspects of our health care system, including the prestige and effectiveness of preventive medicine, the competitive behavior of health care organizations and insurance companies, access to private health insurance, the ability of primary care physicians to serve as gatekeepers, and other matters. This article examines the range of potential effects of the new genetic diagnostics on the organization and financing of health care. For purposes of illustration the authors examine in detail the possible consequences of genetic tests for predisposition to two diseases: Reye's Syndrome and lung cancer in smokers.
Written Patient Information on Prescription Drugs: The Evolution of Government and Voluntary Programs in the United States
Authors: Nightingale Stuart L.
Published: March 2009

This paper describes the evolution of written patient information on prescription drugs, FDA's patient package insert proposal and its revocation before its implementation in the early 1980s, the status of voluntary and government efforts since that time, and a review of current trends in this area. The burgeoning practice of direct-to-consumer advertising of prescription drugs in the lay press is viewed within the context of these efforts. This paper also reviews the current developments in certain FDA regulated consumer products—over-the-counter drug labeling and nutrition labeling. The current state of patient information in the United States is reviewed in light of programs to improve prescription drug counseling, and current research in this area is discussed.
Treating Menorrhagia in Primary Care: An Overview of Drug Trials and a Survey of Prescribing Practice
Authors: Coulter Angela , Kelland Joanne , Peto Viv , Rees Margaret C. P.
Published: March 2009

Menorrhagia can be treated by drug therapy or surgery. General practitioners (GPs) can prescribe drugs to reduce menstrual blood loss as first-line treatment, referring patients for surgical treatment if drug therapy fails. This study examined the efficacy of drugs used to treat menorrhagia and surveyed British GPs to discover the extent to which they prescribed the most effective drugs for this condition. The results suggest that treatment of this condition in primary care falls short of desirable standards. A meta-analysis of randomized trials of drug therapy revealed wide differences in efficacy and side effects. The most effective drug (tranexamic acid) is little used by British GPs, whereas the least effective drug (norethisterone) is the most frequently prescribed.
Outcomes Measurement: The Key to the Appropriate Use of Pharmaceuticals
Authors: Grey Rondi R. , Townsend Raymond J. , Sanders Charles A.
Published: March 2009

Outcomes measurement will be key to the appropriate use of Pharmaceuticals as health care costs continue to rise. The generation of data showing the clinical, economic, and humanistic outcomes of pharmaceutical care will be essential to avoid decision making based solely on cost and to ensure that cost-effective, high-quality health care remains the health care system's top priority.
Health Transition and Needs-Based Technology Planning and Implementation
Authors: Sitthi-Amorn Chitr
Published: March 2009

Investment in health can offer additional benefits to development independent of economic improvement. Many technologies have been useful in improving the health of the people in the past. However, rapid and often unpredictable change has contributed to the inequity, inefficiency, and rising cost of health care. This paper outlines why a needs-based approach to assessing any new technology in the health sector is essential. To respond to changing needs, capacities within the health care system, several of which are described here, must be strengthened. Needs-based technology planning and implementation is affordable and feasible and is crucial in order that both health as a basic human right and good health at low cost can be attained.
Case Study: World Health Organization-International League of Associations for Rheumatology Community-Oriented Programme for the Control of Rheumatic Diseases (WHO-ILAR COPCORD) in Indonesia and Brazil
Authors: Darmawan John , Ferraz Marcos Bosi , Muirden Kenneth D. , Tugwell Peter
Published: March 2009

The three-stage World Health Organization-International League of Associations for Rheumatology Community Oriented Programme for Control of Rheumatic Disease (WHO-ILAR COPCORD) is described. Stage I results from Indonesia and Brazil are presented. This is a needs-based approach that offers efficiency in large-scale survey research that aims to estimate the prevalence of rheumatic diseases. It saves human resources, time, and cost in the collection of epidemiologic data. Awaited with interest are the results of the next two stages of COPCORD, which involve the development of educational programs on rheumatic disease and the evaluation of their impact on the burden of illness.
Models for Determining Cost of Care and Length of Stay in Neonatal Intensive Care Units
Authors: Khoshnood Babak , Lee Kwang-Sun , Corpuz Maria , Koetting Michael , Hsieh Hui-Lung , Kim Beyong Ii
Published: March 2009

New models for determining the cost of care and length of stay in the neonatal intensive care unit (NICU) were developed using financial and clinical data from 588 admissions to our NICU. The model for determining costs explained 71% of the variability in total hospital costs. Models such as the ones developed in this study can be used to compare costs in different institutions, determine temporal trends in costs, and examine the financial impact of using new technologies. Such models can also be useful components of a rational prospective pricing system for the NICU.
The Clinical Effectiveness and Financial Impact of Utilizing Peripheral Blood Progenitor Cells as Rescue Therapy following Autologous Bone Marrow Transplant
Authors: Kucharski Andrew J. , Ghalie Richard , Greenstein Sharon , Matuszewski Karl
Published: March 2009

The use of peripheral blood progenitor cell transplant as rescue therapy after high-dose chemotherapy and autologous bone marrow transplant significantly decreases transfusion, laboratory, room, and total charges. An improvement in clinical indicators also points toward decreased patient morbidity. Additional cost reductions may be realized by greater utilization of outpatient care, thereby further reducing room and total charges.
The ‘Utility’ of the Visual Analog Scale in Medical Decision Making and Technology Assessment: Is It an Alternative to the Time Trade-off?
Authors: Stiggelbout Anne M. , Eijkemans Marinus J. C. , Kiebert Gwendoline M. , Kievit Job , Leer Jan-Willem H. , De Haes Hanneke J. C. J. M.
Published: March 2009

Methods often used for the valuation of health states are the time trade-off (TTO) and the visual analog scale (VAS). The VAS is easier than the TTO and can be self-administered; however it usually leads to lower scores. In the literature a power transformation of group mean VAS scores to TTO scores has been proposed. We were able to replicate this finding of a power function. We found coefficients that were very similar to those from the literature, for 183 cancer patients. The relationship existed independently of disease state and health status.
Economic Evaluation Alongside Multinational Clinical Trials:Study Considerations for GUSTO iib
Authors: Jönsson Bengt , Weinstein Milton C.
Published: March 2009

Data relevant to economic evaluation are being collected alongside clinical trials with increasing frequency. When these trials involve health outcomes and resource utilization in many different countries, numerous methodologic problems arise. This paper describes and discusses the methodology for economic evaluation that will be used in the Economic Substudy of GUSTO llb, as an example of how to address the problems that arise in economic evaluations linked to international trials.
Identifying New Health Care Technologies in the United Kingdom
Authors: Stevens Andrew , Robert Glenn , Gabbay John
Published: March 2009

We aimed to establish a 1996 baseline of new health care technologies that are predicted to have an impact on the United Kingdom's National Health Service in the next five years. One thousand and ninty-nine health care technologies were identified from a variety of sources. Further work will attempt to determine the most efficient method of identifying and monitoring new health care technologies.
EUR-ASSESS Project Subgroup Report on Dissemination and Impact
Authors: Granados Alicia , Jonsson Egon , Banta H. David , Bero Lisa , Bonair Ann , Cochet Mme. Camille , Freemantle Nick , Grilli Roberto , Grimshaw Jeremy , Harvey Emma , Levi Ragnar , Marshall Deborah , Oxman Andrew , Pasart Lionel , Räisänen Virpi , Rius Elisa , Espinas Josep A.
Published: March 2009

The objective of health technology assessment (HTA) is to support decision making in health care. HTA does not claim to provide a definite solution to a health care problem, but to assist decision makers with evidence-based information about the clinical, ethical, social, and economic implications of the development, diffusion, and use of health care technology.
Laparoscopically Assisted Vaginal Hysterectomy:A Review of Current Issues
Authors: Young Wendy , Cohen Marsha M.
Published: March 2009

A review of 39 articles found no consensus on indication for laparoscopic assisted vaginal hysterectomy (LAVH) compared with traditional approaches. Since only three randomized trials comparing LAVH with traditional methods exist, the scientific basis for surgical choice is lacking. Uncontrolled studies indicated that outcomes following LAVH were not superior to vaginal hysterectomy and costs were significantly higher.
Satisfaction May Not Suffice!: A Commentary on ‘a Patient's Perspective’
Authors: Cleary Paul D.
Published: March 2009

There are inherent limitations in using assessments of patient satisfaction to make inferences about the quality of medical care. Such evaluations tend to be subjective, subject to reporting biases, and difficult to interpret when they are being used to motivate and guide quality improvement efforts. Newer methods of eliciting both reports and ratings from consumers, such as the Consumer Assessment of Health Plans (CAHPS) project, can provide reliable, valid, interpretable, and actionable data about selected aspects of health care. The use of these methods and continued use of new qualitative methods, such as cognitive interviewing, should allow us to continue increasing the prominence of consumer-based information in quality assessment and improvement efforts.
Design of Cost-Effective Packages of Care for Non-Insulin-Dependent Diabetes Mellitus: Defining the Information Needs
Authors: Gulliford Martin C.
Published: March 2009

This review concludes that: a) the global burden of disease from non-insulin-dependent diabetes mellitus (NIDDM) cannot be completely estimated at present; b) evidence for the efficacy of key elements of a package of care is still needed; c) generalizing the results of evaluations of costs or effectiveness across different populations is not straightforward; and d) for this complex intervention, the costs and effectiveness of intervention may be highly dependent on methods of organizing care. Addressing this information deficit represents an important task for researchers and health decision makers.
The Deinstitutionalization Movement in Italy: Ideological Thrust to Cultural Error
Authors: Romanucci-ross Lola
Published: March 2009

The Basaglia movement in Italian psychiatry is described and analyzed in several contexts: the historical, the cultural, and the “practical” in terms of outcomes. Those who began the movement of democratic psychiatry grasped interesting elements of “critical theory”: the definitions of madness, power structures, and medical discourse itself. A backward look at the sea change, however, reveals states and rates of dysfunction that disappoint and indicate that political ideology divorced from cultural awareness can often harden the opposition.
Results of the Economic Evaluation of the FIRST Study:A Multinational Prospective Economic Evaluation
Authors: Schulman Kevin A. , Buxton Martin , Glick Henry , Sculpher Mark , Guzman Gladys , Kong Janet , Backhouse Martin , Mauskopf Jo , Bell Larry , Eisenberg John M.
Published: March 2009

We present the prospective economic evaluation that served as a secondary endpoint for the FIRST study, a randomized international multicenter trial of patients with severe congestive heart failure. Although the clinical results of this study were disappointing, we demonstrated the feasibility of incorporating prospective economic evaluation in phase III clinical trials.
Can Resource Use be Extracted from Randomized Controlled Trials to Calculate Costs?: A Review of Smoking Cessation Interventions in General Practice
Authors: Rigby Kathryn , Silagy Christopher , Crockett Alan
Published: March 2009

The ability to extract information on resource use from randomized controlled trials can provide the groundwork for systematically compiling health economic reviews of health interventions. A review of the brief smoking interventions in general practice demonstrates that not all the necessary information can be extrapolated from these trials, and cost data will have to be supplemented from other sources.
The Diffusion of Magnetic Resonance Imaging Scanners in a Changing U.S. Health Care Environment
Authors: Hillman Bruce J. , Neu C.R. , Winkler John D. , Aroesty Jerome , Rettig Richard A. , Williams Albert P.
Published: March 2009

Technological aspects and early clinical experiences are arousing great enthusiasm over magnetic resonance imaging (MRI). However, influences such as regulation, reimbursement, and increasing competition also are playing important roles in determining the diffusion of this new technology. Of these considerations, competition among providers seems the most important. Competition related to MRI is manifested as direct competition over MRI services, using MRI to improve a provider's strategic position and competition among specialties. In making decisions concerning MRI acquisition and operation, providers are drawing upon their experiences with computed tomography (CT) to help them determine when would be the best time for acquisition, how to decide whether acquisition is appropriate, and how best to acquire, operate, and market the technology.
The New Medicine: Something Different
Authors: Thomas Lewis
Published: March 2009

To read the newspapers, the whole practice of medicine suddenly has been transformed from the learned profession it used to be into a high technology, beset on all sides by scientific hubris. And complaints about this perceived change are heard everywhere. There is too much science, it is claimed. Doctors are unable to deal at first hand with their patients, it is said, because of the sheer mass of machinery required for medical care. There is, it is asserted, such a high technology needed for health care that no society can cope with the cost. If it continues, medicine will be done in by its own scientific success.
Teaching the Ethics/Technology Interface
Authors: Jonsen Albert R.
Published: March 2009

The problem that I will discuss in this essay is marvellously illustrated in the title given to me by the editors. The word “interface” is itself part of the jargon of technology, the technospeak needed by those who develop, use, and discuss functions, things, and relationships that had not existed previously in the human world. They must make up new words to describe new realities (and, unfortunately, allow new and ugly words to obscure old ones). An “interface” presumably describes the way in which one electronic system contacts another so that the first energizes the second. In the old world of human experience, an “interface” is impossible. The face of one human being is visible to another; two faces, smiling or frowning at each other, communicate. The mind behind one face can interpret the movements of another. Never does one human face interpenetrate or merge with another.
Resource Allocation: Education for the Rationing of Care
Authors: Lister John
Published: March 2009

In considering the allocation of resources for health it is necessary to make a distinction between the provision of public and environmental health services and the provision of medical care by physicians and surgeons for those patients who seek treatment.
Early Warning in the Light of Theories of Technological Change
Authors: Blume Stuart
Published: March 2009

Current interest in early warning can be understood as a natural response to the regularity with which health service planners have been overwhelmed by new technology. Planning the rational introduction of a new technology should be facilitated by advance warning of its imminent arrival on the market. Current approaches to early warning tend to rely on the insights and expectations of scientific and clinical experts in the field in question. In this paper it is argued that such an approach fails to recognize important changes that have occurred both in the innovation process itself, and in theoretical understanding of it. With the more complex roles that governments now play, and with the increasingly articulate demands of consumers, the innovation process has become more complex. At the same time, it is now clear that the innovation process embodies a multitude of choices. Approaches to early warning must be compatible with these new perspectives.
Basis for Decisions on Emerging Health Technology: A Danish Feasibility Study
Authors: Jørgensen Torben , Larsen Lars Grupe
Published: March 2009

The objectives of the feasibility study were to evaluate sources of information for an eventual Danish system for early identification and assessment of emerging health technology, to identify potential users of the system, and to clarify their specific need for information concerning emerging health technology. The methods used were questionnaires to informants within and outside the health services and to decision makers on different levels in the health services, and follow-up telephone interviews. Our study reveals a strong, and to some extent unsatisfied, need among policy makers, planners, and managers in the Danish health services for information concerning emerging health technology. The requested information should in particular concern indication for use, number of patients affected, clinical effectiveness and side effects, running cost, and investments. The time horizon most relevant to the decision makers seems to be only zero to 2 years. Furthermore, we found that numerous sources are available that frequently display information on emerging technology important to the health services. The challenges seem to be to select information of sufficient importance and quality, and to combine information, since very few, if any, single primary sources cover all the requested information. In conclusion, we recommend the establishment of a Danish national system for early identification and assessment of emerging health technology, consisting of a small secretariat that collaborates nationally and internationally, the latter in particular on identification of technology and on development of methods for early assessment.
The Measurement of Indirect Costs in the Health Economics Evaluation Literature:A Review
Authors: Jacobs Philip , Fassbender Konrad
Published: March 2009

In this paper we develop a framework to categorize the concepts used to estimate indirect costs in economic evaluation. We apply this framework in a literature review of economic evaluation studies. We searched all English language literature from 1994–1996. Following the application of a search algorithm, which yielded 25 articles, we abstracted information from these articles to determine the methods used to identify the relative contribution of indirect costs to the cost-effectiveness ratio, the time horizon selected by the authors, the identification of those activities that were foregone, the time given up by these activities, and the valuation placed on this time. These methods were then assessed. Indirect costs, as they have been measured, significantly influence efficiency ratios. A wide variation exists among studies in how they incorporate each of the components of indirect costs. All of the four components that were identified will affect the measurement of indirect cost. Future guidelines in this area should address the entire measurement process.
Cost-Effectiveness of Cardiovascular Prevention Programs in Spain
Authors: Plans-rubió Pedro
Published: March 2009

Individual programs for prevention of cardiovascular disease include dietary and drug treatment of hypercholesterolemia, hypertension treatment, and smoking cessation therapies. In this study, the cost-effectiveness of available cardiovascular prevention programs was assessed in Spain in terms of net cost per life-year gained (LYG). Cost-effectiveness ratios ranged from US $2,600 to $80,000 per LYG in men and from $4,500 to $230,000 per LYG in women. In men aged 40–59 years, the ranking of increasing cost-effectiveness was: smoking cessation ($2,608–3,738 per LYG); treatment of moderate and severe hypertension ($8,564–38,678 per LYG); treatment of mild hypertension ($11,906–59,840 per LYG); dietary treatment ($16,143–20,158 per LYG); and drug treatment of hypercholesterolemia ($33,850–81,010 per LYG). In women, the ranking list was: smoking cessation ($4,482–5,756 per LYG), treatment of moderate and severe hypertension ($9,585–57,983 per LYG), treatment of mild hypertension ($15,248–86,075 per LYG), dietary treatment ($57,175–62,154 per LYG); and drug treatment of hypercholesterolemia ($104,100–259,150 per LYG).
Technology Assessment of the Dutch Lung Transplantation Program
Authors: Van Enckevort Petra J. , Tenvergert Elisabeth M. , Bonsel Gouke J. , Geertsma Albert , Van Der Bij Wim , De Boer Wim J. , Koopmanschap Marc A. , Al Maiwenn J. , Ruttten Frans F.h.
Published: March 2009

The costs, effects, and cost-effectiveness of the Dutch Lung Transplantation program were assessed. The results show that lung transplantation is a very costly intervention that improves survival and quality of life. Costs per life-year and per QALY gained were, respectively, US $90,000 and US $71,000.
Preterm Factors Influencing Surfactant Deficiency
Authors: Jobe Alan H.
Published: March 2009

Surfactant deficiency has come to be understood as equivalent clinically to lung immaturity, except in situations of extreme prematurity or lung hypoplasia. Thus, surfactant deficiency and the diagnosis respiratory distress syndrome (RDS) have been applied quite uniformly to preterm infants with respiratory distress who have no other identifiable problems. While the diagnosis can be made more specific by assay of surfactant phospholipid composition (12), such measurements are seldom made in clinical practice. Perinatal discussions of the premature with respiratory distress also have been focused toward surfactant by the availability of multiple tests of “lung maturation” based on the assay of surfactant components in amniotic fluid (19). While surfactant is necessary for normal lung function, adequate surfactant is not sufficient to assure normal gas exchange in the preterm. There are no simple ways to separate surfactant deficiency states clearly from other aspects of lung development, such as airway development, alveolarization, and the development of the pulmonary vasculature in the preterm infant. The anatomic data of Hislop et al. (13) and Langston et al. (22) indicate a considerable variability in the number of alveoli in the preterm infant at each gestational age, resulting in large differences in potential gas exchange surfaces in different infants. Airway development also differs between infants of comparable gestational ages, as is evident clinically by susceptibility to the development of pulmonary interstitial emphysema. Assuming that surfactant treatments for RDS fully correct the surfactant deficiency, a realistic expectation based on animal studies (16), surfactant treatments should be useful in the near future to eliminate the surfactant deficiency component of lung immaturity syndromes. Any residual lung disease can then be better characterized.
Neonatal Surfactant Deficiency and Surfactant Replacement Therapy
Authors: Hallman Mikko , Pohjavuori Maija , Bry Kristiina , Merritt T. Allen
Published: March 2009

For the past 25 years, attempts have been made to treat respiratory distress syndrome (RDS) by administration of surfactant into the airways. This practice is not yet an accepted form of therapy. Lack of generally available surfactant during the present era of prospective studies will hopefully decrease the therapeutic misuse of this novel medicine.
CPAP and Mechanical Ventilation
Authors: Sedin Gunnar
Published: March 2009

Respiratory insufficiency has previously been a frequent cause of neonatal death, especially in preterm infants. As late as in 1967, Silverman and associates (66) found that in infants with hyaline membrane disease (HMD), mechanical ventilation with a body-enclosing negative pressure respirator did not improve survival. Before 1970, the mortality among infants who required respiratory therapy was high (20;46;70). At the end of the 1960s and the beginning of the 1970s, several new methods were introduced to improve ventilation of newborn infants. Kirby and coworkers (41) introduced intermittent mandatory ventilation as a way of weaning from mechanical ventilation. In a series of studies, Reynolds and coworkers evaluated the effects of different peak airway pressures, respiratory frequencies, and inspiratory:expiratory ratios on arterial blood gases and right to left shunts (32;58;59;60).
Respiratory Control and Stimulation of Spontaneous Breathing
Authors: Lagercrantz Hugo
Published: March 2009

Respiratory movements are controlled by two pairs of neuronal groups in the brain stem: nucl. tractus solitarius and nucl. paraambigualis. These neuronal pools receive drive inputs from the forebrain and hypothalamus, and from central and peripheral chemoreceptors (9). Whether there is endogenous spontaneous respiratory rhythmic activity has been a matter of controversy, but this has recently been discovered in brainstem preparations of the neonatal rat in studies by Onimaru and Homma (27).
Bronchopulmonary Dysplasia:Pharmacologic Treatments and Prediction of Outcome
Authors: Truog William E.
Published: March 2009

Bronchopulmonary dysplasia (BPD) is a progressive disorder of the lungs of newborn infants initially involving distal airways, but followed in weeks by the development of abnormalities in all parts of the lung architecture. BPD develops primarily but not exclusively in premature infants. The incidence in the general population has never been assessed accurately in a prospective manner. One retrospectively calculated incidence figure is 1.2 infants per 1,000 total live births per year in the United States (17). With approximately 4 million births annually in North America, there are about 5,000 babies each year who develop BPD. The additional weeks, months, and, in some cases, years of hospitalization, the frequent rehospitalizations, and the mortality of 20–50% beyond 1 month of age (17) underscore the disproportionate financial and emotional toll of BPD not only on patients and families but caregivers as well. The glacial rates of improvement in the illness, the frequent setbacks, and the profound disruption to family life all support the contention that BPD is a major public health problem.
Water and Heat Balance
Authors: Hammarlund Karen
Published: March 2009

As those involved in neonatal intensive care are well aware, water and heat balance play a very important role in the well-being of the newborn infant. While some aspects of water and heat balance have been studied extensively, others have been less elucidated. Recent studies have demonstrated that both insensible and sensible water loss depend on the maturity of the infant and that both environmental factors and the activity of the infant can have dramatic effects on both these modes of water loss. As heat loss is affected by the insensible and sensible water loss from the infant, the same factors also have implications for heat loss, but heat loss is also influenced by other factors. The aim of this article is to review some of the knowledge relevant to the fields of water and heat balance in the neonatal period.
Etiology and Pathophysiology of Postasphyxial Brain Damage
Authors: Kjellmer Ingemar
Published: March 2009

In spite of major developments in prenatal supervision, perinatal asphyxia remains an important reason for the development of brain damage (18). Epidemiological investigations suggest that perinatal asphyxia actually represents a factor of increasing frequency as a cause of severe cerebral injury (9).
Outcome after Asphyxial and Circulatory Disturbances in the Brain
Authors: Levene Malcolm I.
Published: March 2009

The first consideration must be an agreed-upon definition ofasphyxia. We cannot determine outcome of a condition if some observers are referring to apples and others to pears. Asphyxia is a pathophysiological event comprising both hypoperfusion and hypoxia, and these events result in compromise at a cellular level with the production of metabolic acids. This can be due to a wide number of insults, but a complication of the birth process is the most important cause. Asphyxia is not like intraventricular hemorrhage (IVH) or periventricular leukomalacia (PVL), as these are conditions that can be diagnosed with a reasonable degree of precision with imaging techniques.
New Noninvasive Techniques for Assessing Brain Oxygenation and Hemodynamics
Authors: Reynolds E. Osmund R.
Published: March 2009

Infants who require intensive care are at considerable risk of death or long-term neurodevelopmental disability. Therefore, noninvasive methods have been sought for assessing the structure and function of the brain in the immediate newborn period. The major aims are to investigate the prevalence and mechanisms of brain-damaging lesions, to test preventive strategies and treatment, and to assign the prognosis of the infants. Several methods have proved their worth, e.g., ultrasound imaging, electroencephalography, including the testing of evoked potentials, and Doppler ultrasonography for measuring flow velocity in intracerebral vessels.
Economic Evaluation of Neonatal Intensive Care:Which Variables Have to Be Known?
Authors: Sinclair John C.
Published: March 2009

An economic evaluation of a health care program seeks to investigate the relative costs and consequences of alternative strategies in health care by examining the values of the resources used and weighing them against the values of the outcomes. Because resources are finite, there are choices to be made about how best to use them. Thus, the concept of the value of resources that is applied in an economic evaluation is that of opportunity cost: since resources are finite, deploying them in one way means that a benefit is foregone in not having them available to pursue the best alternative. An economic evaluation of a health care program fundamentally is an exercise about choices, not simply about money.
Staff Competence and Program Compliance: Scotland
Authors: Hall Marion H.
Published: March 2009

In Britain, antenatal care is performed by specialist obstetricians, general practitioners (GPs), and midwives, often in combination. Because most women are delivered in specialist hospitals, obstetricians are involved in booking for place of delivery, and usually in delivery of specialized investigations such as ultrasonic scanning. General practitioners may independently book women for confinement under their care in Cottage Hospitals or (rarely) at home, and may provide all the medical care for those women, in addition to sharing in the antenatal care of women to be delivered at specialist units, and in fact doing most of the care for these women, unless they are very high risk or complicated.
Blood Pressure, Growth Retardation, and Preterm Delivery
Authors: Goldenberg Robert L. , Cliver Suzanne P. , Cutter Gary R. , Davis Richard O. , Hoffman Howard J. , Wen Shi Wu
Published: March 2009

The effect of various levels of both diastolic and systolic blood pressure at various times during pregnancy on the rates of intrauterine growth retardation (IUGR) and preterm delivery (PTD) were determined. Low systolic and diastolic pressures were associated with both IUGR and PTD, as were high pressures. Low pressures tended to be associated with spontaneous preterm deliveries, whereas high pressures were associated with more indicated preterm deliveries.
Smoking During Pregnancy:Possibilities of Prevention in Antenatal Care
Authors: Svanberg Bernhard
Published: March 2009

Prevention of smoking in pregnancy is a mission of utmost importance since the fetal outcome is improved when the mother quits smoking. Methods to prevent smoking have to consider maternal attitudes and characteristics and be based on pedagogical and behavioral principles. A well-motivated staff, a self-help manual accepted by most women, and special support to those who want it are minimal requirements.
Prevalence and Significance of Social and Psychological Risk Factors During Pregnancy
Authors: Sydsjö Gunilla
Published: March 2009

Moderate psychosocial problems identified during early pregnancy in 78 women were found to predispose for various “complications” during gestation, but not for prematurity or obstetrical complications during delivery. However, from a normal postnatal status the children of these mothers demonstrated a significantly unfavorable somatic, as well as psychomotoric development, until the age of 4. Pregnant women with certain psychosocial problems must be early identified and property attended to in order to preclude an adverse child development.
Measuring the Effectiveness of Psychosocial Interventions in Pregnancy
Authors: Oakley Ann
Published: March 2009

Questions about the effectiveness of psychosocial interventions in pregnancy are important in any overall evaluation of antenatal care. This article reviews the evidence as to the positive benefit on a range of pregnancy outcomes provided by 35 published and unpublished randomized controlled trials of psychosocial interventions.
Small-for-Gestational-Age (SGA) Definitions and Associated Risks
Authors: Bakketeig Leiv S. , Magnus Per
Published: March 2009

Samples and methods vary in constructing birthweight charts. Introduction of ultrasound dating affects the distribution of gestation, increases the proportion of preterm births, and reduces postterm and small-for-gestational-age (SGA) births. The need for standardized charts is emphasized. Preferably such charts ought to be sex- and parity-specific, also taking into account the mother's previous pregnancy outcome in terms of birthweight. The risks associated with being bom SGA involve various morbidity as well as short- and long-term survival.
Antenatal Screening and Risk Factors for Intrauterine Growth Retardation
Authors: Wennergren Margareta
Published: March 2009

Antenatal risk factors in combination with symphysis-fundus distance can identify pregnancies with small infants, who can be divided in genetically small, malformed, and malnourished infants. Only the last category benefit from fetal surveillance. Maternal diseases, pregnancy complications (hypertension), and environmental factors (smoking) are connected to malnourished small infants.
An Exact Discrete Analog to a Closed Linear First-Order Continuous-Time System with Mixed Sample
Authors: Agbeyegbe Terence D.
Published: March 2009

This article deals with the derivation of the exact discrete model that corresponds to a closed linear first-order continuous-time system with mixed stock and flow data. This exact discrete model is (under appropriate additional conditions) a stationary autoregressive moving average time series model and may allow one to obtain asymptotically efficient estimators of the parameters describing the continuous-time system.
Adaptive Rules for Seminonparametric Estimators That Achieve Asymptotic Normality
Authors: Eastwood Brian J. , Gallant A. Ronald
Published: March 2009

In econometrics, seminonparametric (SNP) estimators originated in the consumer demand literature. The Fourier flexible form is a well-known example. The idea is to replace the consumer's indirect utility function with a truncated series expansion and then use a parametric procedure, such as nonlinear multivariate regression, to set a confidence interval on an elasticity. More recently, SNP estimators have been used in nonlinear time series analysis. A truncated Hermite expansion with an ARCH leading term is used as the conditional density of the process. The method of maximum likelihood is used to fit it to data.