bluuebunny/crossref_metadata_2025 huggingface dataset:
Screening for Congenital Abnormalities
Authors: Holtzman Neil A.
Published: March 2009

Improvements in nutrition, sanitation, housing, and medical care have been associated with reductions in infectious diseases of infancy, such as diarrhea, and, concomitantly, with a decline in infant mortality. Although deaths from congenital abnormalities have also decreased, the rate of their decline has not kept pace with the overall rate. Thus in the United States they have become the most frequent cause of infant death (58). For abnormalities detected in the newborn period, which comprise 3% of all births, about 8 per cent are due to single gene disorders, 6 to 12% to chromosome abnormalities, and less than 5% to viral infections of the mother (39,69). Little is known about underlying causes in the remainder; polygenic factors, environmental agents, and, probably the most common, genetic-environmental interactions, account for them. Congenital abnormalities also contribute substantially to childhood hospitalizations in several developed countries (17). One chromosome disorder, Down's syndrome, accounts for about 16 to 30% of all severe mental retardation, with other genetic and chromosome disorders contributing another 15 to 20% (58). Although the incidence of congenital abnormalities differs to some extent geographically (39), it seems likely that as any country develops, the proportion of infant mortality and childhood disability due to congenital abnormalities will increase.
Use of Different Systems for Classifying the Population at Risk
Authors: Farnot Ubaldo
Published: March 2009

When a National Health System was established in Cuba and the health services regionalized, three levels of increasing complexity were established for prenatal care. This led to the use throughout the country of a system for the classification of pregnant women according to risk.

The first system used in 1969 was a qualitative system which divided pregnant women into 4 risk groups. This made it possible to establish levels and standards of care, to supervise and control the quality of prenatal care, and to use nurse-midwives for providing prenatal care efficiently. This very expeditious and practical system seemed somewhat inadequate because it gave little attention to biological and social factors, but stressed the complications of pregnancy and concomitant diseases.

Beginning in 1975, another system was used throughout the country to classify pregnant women during prenatal care. In this quantitative risk classification, an arbitrary value was given to each risk factor, and when these values were added up, the final score made it possible to divide pregnant women into 4 risk categories. This new system was also used for the administration of maternal and child health, but its use resulted in too many pregnant women being put into the high-risk category and many protective measures being taken for pregnant women who possibly did not need them. Validation tests such as sensitivity, specificity, and predictive power were used in this system, and it was found that it suffered from problems in discriminating the risk groups.

The need for a system of classifying pregnant women according to risk led to an epidemiological study whose purpose was to give a more appropriate numerical value to each risk factor. It is also emphasized that the objectives of prenatal care include not only the preventive treatment of diseases of women and children, but also the preparation of women for delivery, encouragement of breast feeding, and preparation of couples for assuming their responsibility as parents.
Obstetrical Care by Traditional Birth Attendance in Rural Areas of the State of Ceará, Brazil
Authors: Araújo José Galba
Published: March 2009

Ceará occupies an area of 146,817 km2 in northeastern Brazil, where the climate is tropical and there are only two seasons, rainy and dry. Frequent droughts have serious consequences for subsistence farming, resulting in precarious living conditions for the rural inhabitants. In the absence of any industry to provide employment for labor, low incomes prevail, with 90% of the population receiving incomes below the minimum wage for farm workers (9).
Tissue Groups and Cadaver Kidney Sharing: Socio-Cultural Aspects of a Medical Controversy
Authors: Löwy Ilana
Published: March 2009

The treatment of End-Stage Renal Disease (ESRD) is one of the most widely debated topics in contemporary medicine. The high cost of the most usual treatment, hemodialysis, has been and still is the topic for numerous discussions concerning priorities in health care on the one hand, and various medical, psychological, and ethical problems of life “on the machine” on the other hand. The other treatment of ESRD, kidney transplantation, raises other, no less complicated questions such as the limits of medical experimentation, ownership of one's body, the donation of organs, organ procurement and allocation, and the definition of life and death. As Fox and Swazey put it “The importance of hemodialysis and human organ transplantation lies as much in their social and cultural significance as in their medical and surgical value” (27,376).
Ethical Considerations in the Use of Cancer-Registry Data for Technology Assessment
Authors: Haas J. , Mehnert W. H.
Published: March 2009

It has been suggested that efficacy and safety are the core issues for technology assessment in health care (1). To this must be added the issue of appropriateness (2). Efficacy remains the first issue nonetheless, for surely no one would knowingly evaluate the safety of an ineffective technology.
Development of an Orphan Drug by a Start-Up Company: MetroGel® for Rosacea
Authors: Borgman Robert J.
Published: March 2009

The Orphan Drug Act of 1983, along with the discovery of a new use for a known drug and an investor willing to assume the necessary risk, brought about the formation of a start-up pharmaceutical company. The primary incentive of the Orphan Drug Act of seven years of marketing exclusivity provided the protection from competition necessary for recovery of the significant research and development and marketing costs. The orphan product, MetroGel®, for the treatment of rosacea, required approximately five years of development before it was approved for marketing by the Food and Drug Administration. MetroGel® has become the number one drug in the United States for the treatment of rosacea. It currently is marketed in other countries through a licensing agreement with a major pharmaceutical company.
Automated Ambulatory Medical Records Systems: An Orphan Technology
Authors: Schoenbaum Stephen C. , Barnett G. Octo
Published: March 2009

Automated ambulatory medical records systems (AAMRSs) have been operational for over 20 years but have not been adopted by more than a small fraction of their potential users. This paper presents a detailed analysis of the uses and benefits of the COSTAR-based AAMRS at the Harvard Community Health Plan and of the factors which have inhibited the dissemination of COSTAR. We conclude that AAMRSs have been an orphan technology and cite trends in health care that favor the future development of AAMRSs.
Health Technologies for the Developing World: Addressing the Unmet Needs
Authors: Free Michael J.
Published: March 2009

This paper provides a critical overview of several strategies and mechanisms that have been employed by the Program for Appropriate Technology in Health over the past decade to address the unmet needs for health technologies in the developing world. Partnerships between public and private-sector organizations are emphasized in order to share risks, encourage efficiency, and ensure the availability of priority products for health care in resource-poor settings. Incentives for the involvement of the commercial sector, the means to protect the interest of the public sector, and the role of bridging organizations are discussed in the light of the shifting goals of the public sector.
The Consensus Development Program: Detecting Changes in Medical Practice Following A Consensus Conference on the Treatment of Prostate Cancer
Authors: Sherman Charles R. , Potosky Arnold L. , Weis Kathleen A. , Ferguson John H.
Published: March 2009

The treatment of prostate cancer was reviewed at a U.S. National Institutes of Health Consensus Development Conference in June 1987. Data from the U.S. National Cancer Institute's Surveillance, Epidemiology, and End Results tumor registries were analyzed and showed that the proportion of eligible prostate cancer patients receiving the recommended therapies did not increase at a faster rate after the conference than before.
Cost-Effectiveness of the Screening and Treatment of Diabetic Retinopathy:What Are the Costs of Underutilization?
Authors: Mark Fendrick A. , Javitt Jonathan C. , Chiang Yen Pin
Published: March 2009

Diabetic retinal disease remains a leading cause of visual disability among those of working age. Controlled trials have demonstrated that timely diagnosis and photocoagulation treatment can reduce significantly the likelihood of visual impairment in affected diabetic patients. Using a prospective simulation model, we show that an annual screening and treatment program saves thousands of years of vision and reduces medical expenditures over the lifetime of a cohort of Swedish Type I diabetic patients.
A Model for Evaluating the Cost-Effectiveness of Cholesterol-Lowering Treatment
Authors: Glick Henry , Heyse Joseph F. , Thompson David , Epstein Robert S. , Smith M. Eugene , Oster Gerry
Published: March 2009

We describe and illustrate the use of a generalizable model for evaluating the cost-effectiveness of alternative cholesterol-lowering treatments. We combine standard incidence-based techniques for measuring the cost of illness with logistic risk functions from the Framingham Heart Study to project, for persons with known coronary risk characteristics, the likelihood of developing coronary heart disease (CHD) over a lifetime as well as a number of related outcomes, including the expected loss of years of life due to CHD, the expected lifetime direct and indirect costs of CHD, and the changes in these outcomes that would result from cholesterol-lowering treatment.
Transplant Policy in the Netherlands
Authors: de Charro Frank , Banta H. David
Published: March 2009

The Netherlands is a small country of about 15 million inhabitants. With 400 inhabitants per square kilometer, it is one of the most densely populated areas of the world (19). Here, government is not seen as negative, but as a tool to solve societal problems. Ordinarily, the public and private sectors work cooperatively together, but the government will step in when needed. (19, 20).
Cost-Effectiveness Analysis of Organ Transplantation
Authors: Scherstén Tore , Brynger Hans , Karlberg Ingvar , Jonsson Egon
Published: March 2009

In 1958 Joseph Murray and associates reported the first successful kidney transplantation between two identical twins at Peter Bent Brigham Hospital in Boston (14). Since then organ transplantation has advanced rapidly. Renal transplantation is now a standard treatment for irreversible renal failure, and liver transplantation is an accepted method for treating end-stage liver disease. A number of patients have survived more than 20 years after renal transplantation and more than 10 years after liver transplantation (20). Very few liver transplantations have been performed in Sweden but this method is expected to become more common in the near future.
Some Reflections on Randomized Controlled Trials
Authors: Scherstén Tore
Published: March 2009

Few would argue that the randomized clinical trial is the most definitive instrument available for measuring the safety and efficacy of a new medical technology, be it drug, device, or procedure. Randomization removes the potential for bias in the allocation of subjects to the intervention group or to the control group. In addition, randomization tends to produce comparable groups which can be further strengthened by stratification and by stratified analyses. The randomized controlled trial guarantees validity of statistical tests, as long as the sample size is large enough to avoid type-II error.
Synthesis: Experience with Diagnosis Related Groups
Authors: Young Donald A.
Published: March 2009

The Medicare prospective payment system (PPS) for inpatient hopital service was enacted in 1983. It uses a classification based on diagnosis-related groups (DRGs) to determine payment for services provided.
Transfer of Technology Assessment to Health Policy Makers
Authors: Blanpain Jan E.
Published: March 2009

The role and the place of technology assessment, in relation to health policy making, are gradually changing. These changes have implications for the transfer of assessment findings to the parties involved in the process of policy making.
The Appropriateness of the Use of Cardiovascular Procedures: British Versus U.S. Perspectives
Authors: Bernstein Steven J. , Kosecoff Jacqueline , Gray David , Hampton John R. , Brook Robert H.
Published: March 2009

To determine whether patients are less likely to receive an inappropriate procedure in countries that devote fewer resources to health care than does the United States, we studied how appropriately coronary angiography and coronary artery bypass surgery were performed in the Trent region of the United Kingdom. The medical records of 320 patients who underwent coronary angiography and 319 who underwent coronary artery bypass surgery in 1987 and 1988 were randomly selected for review. Despite the United Kingdom's more limited use of coronary angiography and coronary artery bypass surgery, a substantial proportion were still performed for less than appropriate reasons, by both U.S. and U.K. criteria. Merely reducing the rate of use of these procedures will not be sufficient to eliminate such inappropriate use.
Diffusion of New Technologies in the Treatment of the Medicare Population: Implications for Patient Access and Program Expenditures
Authors: Boutwell Robert C. , Mitchell Janet B.
Published: March 2009

Patterns of diffusion were analyzed for three pairs of technologies: one of each pair represents a very recent innovation, and the other is more established. Tremendous growth in utilization from 1985–89 was documented, primarily due to more patients obtaining access to the technologies. Nevertheless, disturbing differences in levels of use remain between black and white patients.
Perspectives on Health Technology Assessment in Latin America: The Case of Perinatal Care in the Literature
Authors: Panerai Ronney B. , Almeida Rosimary T. , Freire Sergio M. , Chaim Deise M. V. R. , Miranda Mauro Z. , Madureira Luiz Claudio A. , Aguiar Neto Miguel A. S.
Published: March 2009

The possibility of referring to the medical literature to support technology assessments in perinatal care was studied by examining more than 40,000 references contained in the Index Medicus of Latin America for the period 1984–88. A total of 1,074 references addressed perinatal technologies, but with irregular distribution. Information on effectiveness, safety, costs, and social impact of perinatal technologies was extremely limited. These results led to the conclusion that immediate action needs to be taken to create the necessary conditions for health technology assessment in Latin America.
Assessing the Effectiveness of Ambulatory Cardiac Monitoring for Specific Clinical Indications: Introduction
Authors: Adams Miriam E. , Antczak-Bouckoms Alexia , Frazier Howard S. , Lau Joseph , Chalmers Thomas C. , Mosteller Frederick
Published: March 2009

This introduction and the three essays that follow it examine ambulatory cardiac monitoring for specific clinical indications. They also examine the ways in which evidence from the literature may be synthesized through the framework of decision analysis to guide its appropriate use and identify areas in which more research is needed. The essays discuss ambulatory cardiac monitoring for evaluation of syncope in the elderly; detection of silent ischemia after a myocardial infarction; and selection of antiarrhythmic drugs for malignant ventricular arrhythmias.
Noninvasive Testing of Asymptomatic Patients for the Detection of Silent Ischemia After an Infarction: A Decision Analysis
Authors: Lau Joseph , Adams Miriam E.
Published: March 2009

This decision analysis estimates the overall gain in life expectancy and the relative efficacy of predischarge submaximal exercise electrocardiography, ambulatory cardiac monitoring, and thallium-201 scintigraphy for the identification of silent ischemia in asymptomatic postinfarct patients. A small, virtually equal increase in life expectancy can be obtained from any of the noninvasive tests (as compared to no testing). Large differences in life expectancy may result only when the prevalence of residual coronary artery disease and the probability of left-main and three-vessel lesions are high.
Biomedical Research Councils: Their Role and Function in Transferring Information
Authors: Belaisch Francine
Published: March 2009

Biomedical research plays a great part in promoting not only advances in scientific knowledge but also in the continuous flow of technological innovations in health care. One of the first conditions for the successful transformation of research into an innovation is overcoming the divisions between science and technology, between the researchers and their partners in the innovation process.

Biomedical Research Councils (BMRCs) have an important role in the transfer of information. To improve the chances of successful developments and transfers of scientific breakthroughs, the BMRCs must adopt new, comprehensive strategies for such transfer. They must learn to recognize as early as possible which new opportunities hold promise, at which stage of development information should be transferred to other areas of expertise, and which target groups in which fields should be made partners in the research.
The Role and Function of Professional Journals in the Transfer of Information
Authors: Lundberg George D.
Published: March 2009

Abstract Professional journals are of great importance in the transfer of information about technology, providing most physicians and medical students with the majority of their new information. Professional journals have mission statements and goals and many editorial categories to help achieve their goals. In addition, news media, books, television, and computerized journals are important methods for changing physician knowledge. Physician behavior is changed by many factors of which poor patient outcome is probably the key. Quality of information and activities is best assured by clear definition, goals, proper peer review, and good management. Appropriate use of technology is best approached by separating wants from needs.
Transfer of Information: A Note on the Role of Professional Societies
Authors: Tygstrup Niels
Published: March 2009

Professional societies in general are designed to support and raise the prestige of the professions they represent, and the most overt way in which they do this is by attempting to keep the level of information concerning their profession as high as possible.

Traditionally, the predominant type of transfer of information has been scientific papers presented at meetings for the memebership, and this it still so in many cases. The large amount of information communication in this way, and its significance, is beyoned doubt.
Epilogue: Future Developments in the Transfer of Technology Assessment Information
Authors: Thier Amuel O.
Published: March 2009

Technology assessment in its broadest sense is essential if the highest quality of health care is to be matched to available resources. The results of technology assessment will be meaningful only if they can be transferred in a manner that affects practice as well as policy. Therefore, although we are still far short of an effective system for technology assessment, it is not too early to begin grappling with the problems of transferring the results of such a system when it exists.

In considering future developments in information transfer, it is important to keep several caveats in mind.
When Must a New Approach to Treatment Be Introduced? The Ethics of Technology Assessment
Authors: Tanneberger Stephan
Published: March 2009

Prior to the nationwide diffusion of a new technology, evidence must be assembled to demonstrate that a new technology is, in the terminology of WHO, appropriate. Not everything that is new in health technology is good; not all that is good is needed. It is by no means unethical to demand adequate assessment of new technology before it is diffused. On the contrary, it is unethical to squander resources on hazardous and uneffective treatment. Of the methods available for assessment, the randomized clinical trial is among the most valuable. Randomized clinical trials cannot, however, solve all problems. Speed is a critical element. It is not ethical to permit excessive delay. Balanced, relevant, and informative studies must be conducted as quickly as possible and with a maximum of international collaboration. WHO has a valuable role to play in advising on, coordinating, supporting, and disseminating the findings of such studies.
Europe: Barbara Stocking King's Fund Centre for Health Services Development
Authors: Bloom Bernard S. , Banta H. David , Gross Paul F. , Peña-Mohr Jorge , Sisk Jane E. , Stocking Barbara
Published: March 2009

May and June were busy months in Europe for technology assessors. Following the International Society meeting in Rotterdam, many people went on to the quality assurance meeting at WHO in Copenhagen and the International Hospital Federation Congress in Helsinki. “Modern Technology—How Much and for Whom,” was one of the main themes of the congress; with an attendance of about 400 there was an opportunity to get the ideas about technology assessment across to a large group of health care managers and professionals. For those of us who spoke it was also a chance to meet members of the Finnish Society for Technology Assessment. This may be the only national society for health technology assessment, and with 70 members, it is clearly going to be influential.
Positron Emission Tomography: A Technology Assessment
Authors: Volkow Nora D. , Tancredi Laurence R.
Published: March 2009

Positron emission tomography (PET) is a new nuclear medicine technique that has recently entered the clinical realm of medicine. Although it is a technique that can be utilized for assessment of biochemical and physiological parameters of any organ in the body, it has particular utility in the investigation of the brain. PET poses unique advantages over previous imaging devices. For the first time, it is feasible to investigate directly various biological parameters of the brain in a noninvasive way. PET allows for investigating the functional, biochemical, physiological, and pharmacological characteristics of various areas within the brains of normal and psychiatric or neurological patients. Although it has already started to give promising results, it is too new a technique to obtain an accurate appraisal of its true potentials. This is a problem that seems always to surface when one tries to evaluate the utility of a new technique in a new area of research. The problem is accentuated in the case of PET where there is no other technique available with which to compare results. This paper will discuss the basic principles of PET, its relationship to other existing imaging devices, and the issues to be considered when making a technological assessment of positron emission tomography.
Drug Regulation in the United States
Authors: Hutt Peter Barton
Published: March 2009

Drug regulation in the United States has been the subject of extensive public literature and has been studied more thoroughly than any other aspect of American governmental regulation. Yet it remains mired in criticism and debate that, over the years, have threatened not only the existing regulatory system but also the stability of the American drug industry itself. This article summarizes the history of drug regulation in the United States, discusses the basic structure of the American regulatory system as it exists today, and relates some of the more important controversies that continue to surround this subject.
French Drug Policy
Authors: Steru Lucien , Simon Pierre
Published: March 2009

French drug policy is closely controlled by the government to achieve two main purposes: to ensure therapeutic efficacy and safety, and to control pricing. Manufacturers usually price new drugs at the amount the French Sécurité Sociale (Social Security) agrees to reimburse the consumer. The specific steps a new ethical drug must go through in order to be released on the French market, and the process of negotiation between the government and the manufacturer are discussed in this paper.
How Are Drugs Made Available in Australia?
Authors: Hodge Robert L.
Published: March 2009

The release of prescription drugs in Australia for use by the medical profession is complicated because in practice there is a two-tier system determining availability. The first tier, for new drugs, involves evaluation for safety and efficacy prior to marketing. The final decision is made by the Australian Drug Evaluation Committee (ADEC) serviced by the Department of Health. In the second, much more unusual step, a decision is made by a different committee on whether the now-approved drug is to be included on the government-subsidized drug list (Pharmaceutical Benefits Scheme—PBS). Because the PBS list is unusually extensive for a country without a nationalized health service (1,184 items, including all forms and strengths of over 600 drugs) and because a large proportion of prescriptions are written for drugs on the PBS, the PBS Committee making the listing decisions has a major influence on prescribing patterns. In addition, the government is able to exert considerable pressure on drug prices.
Pharmaceutical Problems in Developing Countries
Authors: Törnqvist Gunnar
Published: March 2009

The circumstances and conditions bounding the use of drugs in developing countries are not, as many commentators on this subject assume, similar to those in industrialized countries. Appropriate solutions to the issues of quality control, price, and distribution present major quandaries (1). But they can be addressed if governments exhibit adequate political will and set realistic policy objectives.
End-Stage Renal Failure and the Aged in the United Kingdom
Authors: Halper Thomas
Published: March 2009

The kidneys are the body's main organs of excretion. They are, however, subject to serious, progressive, and irreversible deterioration, and as a result, to a decreased ability to extract poisonous wastes and excess fluids from the blood. Almost invariably, this condition proceeds to the point where it is termed end-stage renal failure (ESRF). As the name suggests, ESRF is fatal.
Commentary
Authors: Wing A. J.
Published: March 2009

Tom Halper is not the only American who has been looking at the rationing of renal replacement therapy in the United Kingdom. All are appalled at the denial of effective lifesaving therapy to elderly and high-risk patients, such as diabetics, with end stage renal failure (1). Some realize that the rationing practiced in the United Kingdom today may have to be applied in other countries tomorrow (2). Medical resources are not unlimited (3).
Pacemakers
Authors: Moss Arthur J.
Published: March 2009

The association between a slow pulse and fainting episodes dates back to Mor-gagni's original description in 1761, when he discussed two elderly men whose pulses were very slow and who suffered from epileptic seizures. Subsequent reports by Adams in 1827 and Stokes in 1846 substantiated that the slow heart rate was caused by degenerative changes in the heart and not by a disorder of the brain.
The Elderly and the Pacemaker: A Note from Sweden
Authors: Edhag K. O.
Published: March 2009

When first introduced in the early 1950s, the pacemaker was driven by a battery-powered impulse generator that was large and cumbersome (Figure 1). The introduction of transistors later in the 1950s made it possible to build a generator small enough for implantation beneath the skin (Figure 2), allowing patients to walk about freely.
Visual Rehabilitation for the Elderly Through Improved Surgical Technology
Authors: Philipson Bo
Published: March 2009

During the last decade, microsurgical improvements have developed extremely rapidly in eye surgery. The use of operating microscopes has opened this field to a wide range of technical innovations such as finger suture materials, more sophisticated instruments, and new implants. The result has been better rehabilitation of patients, whose vision was impaired by opacities in the refracting media of the eye. The most frequent cause of poor vision in the elderly is cataract, which is an opacification of the lens in the eye. Most people older than 70 years will have some cataract, with about 30% having opacities that markedly reduce visual acuity and often produce glare phenomena in at least one eye (see Figure 1). There is at present no medical treatment for cataract.
Audiovisual Programs in the Reality-Orientation Training of Alzheimer's Victims: Prospects for Research and Practice
Authors: Baro F.
Published: March 2009

Of all the diseases afflicting the elderly, the degenerative brain disorder, known as Alzheimer's disease, may be the crudest because it kills its victims twice. The mind dies first. The patients display decreased knowledge of recent events, both about their own personal lives and the world around them. Decreased performance is manifested in demanding situations at work, traveling, and managing personal finances. These symptoms are commonly accompanied by anxiety, denial, social withdrawal, and loss of initiative. The patients' performances on psychometric tests are well below average, yet they may be able to function safely in a limited familiar environment with familiar routines.
Aspects of Psychological Aging and Technology
Authors: Berg Stig
Published: March 2009

Aging is generally regarded as a reduction of physical, psychological, and social resources. This reduction is due to two processes that operate simultaneously during the life of an individual. One of these processes is the basic biological changes which take place within the individual and are probably programmed by genetic factors. The other is change due to environmental factors, such as air pollution, noise, poor working conditions, and eating habits, social and psychological factors such as attitudes and norms, and technological factors which can enhance adaptation or cause a decline in social or psychological resources. According to present knowledge, biological age changes are irreversible. However, it should be possible to reverse the environmental changes either through short-term interventions among individuals and the community, or by long-term interventions in the society.
Medical Technology Assessment
Authors: Yeaton William H. , Wortman Paul M.
Published: March 2009

Coronary artery bypass graft surgery (CABGS) has become an important procedure for the treatment of coronary heart disease. Over 100,000 of these surgical procedures are performed each year (1) at an aggregate cost of about $2 billion (2). Despite its current widespread acceptance, this major surgical innovation has generated considerable controversy concerning its effectiveness (3), and there still remains substantial confusion in assessing its overall impact (4).
Development of medical Care Technology: The Case of Israel
Authors: Ellencweig Avi Y.
Published: March 2009

This article presents a survey of the public and private agencies and institutions providing health care in Israel and examines the degree and nature of the control that these bodies exercise over medical technology. The author demonstrates that while the Israeli government is highly centralized, the Ministry of Health is able to exercise only limited practical influence and is neutralized because of its circumscribed control of government funds. In addition, the Ministry of Health lacks standardized procedures for the assessment of prospective or existing technologies. The author notes that there has been a clear move toward a system to oversee the rational diffusion of technology and outlines several proposals for the future.
Consensus Conferences in Different Countries
Authors: Andreasen Buch
Published: March 2009

The different models of consensus development conferences (CDC5) are analyzed in relation to democratic technology assessment. In some countries CDCs are mainly concerned with influencing the quality of clinical practice and thus are dominated by medical experts. In other countries, CDCs are directed towards the public and the decision makers on the political and administrative level. The Danish experience demonstrates that CDCs may be a forceful social technology with a strong potential to influence decisions about medical as well as non-medical technology
Cost-Effectiveness Study of the Extracorporeal Shock-Wave Lithotriptor
Authors: Hatziandreu Evi E. , Carlson Karen , Mulley Albert G. , Weinstein Milton C.
Published: March 2009

We performed a cost-effectiveness analysis to examine the relative efficacy and costs of percutaneous ultrasonic lithotripsy (PUL), extracorporeal shock-wave lithotripsy (ESWL), and surgery for the treatment of upper urinary tract stones. We developed a Markov model with 35 states, cycles of 3 months, and a time frame of 5 years. Probability estimates were derived from a meta-analysis of the published literature. For stones less than or equal to 2 cm, ESWL is preferred to PUL, since it prevents 2 additional days of morbidity and saves $440. For larger stones, PUL is preferable to ESWL, avoiding 4 more days of morbidity, and saving $722. Both ESWL and PUL were superior to surgery. Sensitivity analysis showed that the results are sensitive to ESWL efficacy rates, the stone recurrence rate, and the hospital component of the ESWL cost. Our analysis suggests that although ESWL is preferable, relatively small changes in the efficacy and cost can shift the preferred strategy; in addition, these findings underscore the need for more reliable data.
The Pulmonary Artery (Swan-Ganz) Catheter: Evaluation of A Hemodynamic Monitoring Device in Critical Care Medicine
Authors: Pagliarello Giuseppe
Published: March 2009

The pulmonary artery catheter (PAC) is an invasive hemodynamic monitoring device that is used extensively in critical care units. This technological advance allows the critical care physician and nurse to closely monitor physiological functions at the bedside. There have been no formal evaluations of the impact of this device on patient care. Reviews and observational studies have yielded different conclusions regarding risks and benefits to patients. This has resulted in much editorial comment expressing divergent opinions on the value of the PAC, but there has been no scientific evidence to guide practice and no apparent effect on the use of these devices. The PAC and other medical monitoring devices must be evaluated with respect to their impact on patient care.
Technology Transfer to Developing Countries: Lessons from Colombia
Authors: Serpa-Flórez Fernando
Published: March 2009

Medical technology will contribute to improving the health status of people in developing countries only when it is carefully implemented after proper planning. Providers, users, health ministry employees, and industry all share responsibility for proper planning and careful implementation.
Methodology of OTA's Report on Drug Labeling in Developing Countries
Authors: Gelband Hellen , Corrigan Jackie , McDonough Robert
Published: March 2009

This article discusses the methodology of the OTA Project onDrug Labeling in Developing Countries. This report describes (a) the process of the project; (b) observations from a field visit to Thailand; (c) the development of the multinational pharmaceutical industry; and (d) influences on multinational pharmaceutical companies from their home countries, host countries, international organizations, selfregulation, and public interest groups. The results of the assessment will appear in the final report to Congress.
Economic Assessment of Magnetic Resonance Imaging for Inpatients: Is It Still Too Early?
Authors: Durand-zaleski Isabelle , Reizine Daniel , Puzin Daniel , Merland Jean-Jacques , Blum-Boisgard Claudine
Published: March 2009

This economic assessment of the implementation of magnetic resonance imaging (MRI) in a French hospital examines data on the diagnostic resources used in neurology and neurosurgery before and after MRI was available. Given a similar patient population and case mix, there was no change in the resources used other than the addition of MRI. So far, MRI appears to be a complement to, and not a substitute for, other imaging techniques used in neuroradiology. The focus of this work is purely economic; its conclusions do not challenge the major scientific contributions of MRI.
Technology Transfer in Medical Information Systems: The Potential for “groupware” and its Implications
Authors: Greenes Robert A.
Published: March 2009

The practice of medicine is intrinsically a cooperative activity, involving not only a number of individuals but requiring access to a wide variety of types of data, produced and maintained by different people. Achieving seamless, integrated access to these data requires a new infrastructure of information systems that supports the construction of applications designed to incorporate and use external information resources. The term groupware may be used to connote this collective set of information resources and tools for access to them. Groupware will generate a variety of new kinds of products and services with implications for medical libraries, electronic publishing, and academic and professional collaboration.
Decision-Support Systems in Health Care: Factors Influencing the Development and Transfer of Technology
Authors: Vian Taryn , Verjee Shabira , Siegrist Richard B.
Published: March 2009

National concern about escalating health care costs and inefficiencies in delivery systems has created demand for informatics technology such as decision-support systems. This paper discusses the pressing need for better cost information in health care and how decision-support technology meets this need. Future directions for the technology also are discussed.
Laminectomy and the Treatment of Lower-Back Pain in Massachusetts
Authors: Milamed Debra R. , Warfield Carol A. , Hedley-whyte John , Mosteller Frederick
Published: March 2009

During 1984–1985, laminectomy rates in Massachusetts demonstrated a 2.2-fold variation among districts. Thirty-five percent of laminectomies occurred in 7 of the 108 hospitals studied. Approximately 81% of laminectomies were performed by neurosurgeons. Rates of laminectomy decline with increasing age after 65, while rates of hospitalization for lower-back pain rise.
Use of the Seer Cancer Registry for Technology Assessment
Authors: Klawansky Sidney , Burdick Elisabeth , Adams Miriam , Bollini Paola , Orza Michele , Falotico-taylor Jennifer
Published: March 2009

The Surveillance, Epidemiology, and End Results (SEER) cancer registry contributed to technology assessment by providing population-based samples for detailed case-control studies, by serving as the control group in comparisons with various experimental groups, by allowing an assessment of selection bias in clinical trials, and by facilitating evaluations of classification and coding systems.
Technology Assessment in the Veterans Administration Dental Longitudinal Study
Authors: Antczak-bouckoms Alexia , Tulloch J. F. Camilla , Chauncey Howard H.
Published: March 2009

Of the 52 studies emanating from the Veterans Affairs Dental Longitudinal Study, 6 were identified as technology assessments. Three of these studies evaluated dental radiographs used for the diagnosis of oral lesions. Two studies compared alternative technologies for the replacement of missing teeth, and one reported the effects of NSAIDs on alveolar bone loss. Four additional articles are discussed that provide data that will be useful in future assessments of dental technologies.
Technology Assessment in the Coronary Artery Surgery Study
Authors: Burdick Elisabeth , Falotico-Taylor Jennifer , Young James M.
Published: March 2009

The majority of the 26 technology assessment articles from the Coronary Artery Surgery Study (CASS) follow the original purpose of the registry and evaluate the therapeutic capabilities of coronary artery bypass graft surgery. However, these registry data have also been used to identify risk factors for cardiovascular disease, to test diagnostic technologies, and to evaluate technological processes. Consideration of quality of life issues and the availability of cost data provide valuable additions to the continued use of the CASS for technology assessment.
Using Medical Registries and Data Sets for Technology Assessment: An Overview of Seven Case Studies
Authors: Klawansky Sidney , Antczak-Bouckoms Alexia , Barr Judith , Burdick Elisabeth , Roberts Mark S. , Wyshak Grace , Mosteller Frederick
Published: March 2009

In this concluding article, we summarize the major ways that seven registries and data sets have been used for technology assessment in the published literature. The registries fell into three groups according to the original purpose of the registry. Within each group, we note the types of contributions that researchers using the registries made to technology assessment.
Using Administrative Data Bases for Technology Assessment in Health Care: Results of an International Survey
Authors: Blais Régis
Published: March 2009

This study assesses the nature, use, and quality of large administrative data bases available in different countries for technology assessment in health care. Using postal questionnaires, data were collected describing 91 data bases from 15 countries. Current uses are promising, but more efforts are needed if the full potential of administrative data files is to be tapped.
Management of Early Prostatic Cancer in the Nordic Countries:Variations in Clinical Policies and Physicians' Attitudes Toward Radical Treatment Options
Authors: Jonsson Pia M. , Danneskiold-Samsøe Bent , Heggestad Torhild , Iversen Peter , Leisti Seppo
Published: March 2009

To explore the treatment of patients with early localized prostatic carcinoma, we surveyed the departments of urology and general surgery in Denmark, Finland, Norway, and Sweden. Clinical policies and physicians' attitudes toward the radical treatment options varied widely between the countries. A correlation seems to exist between practice patterns and national attitudes toward special technologies.
Evaluation of the Canadian Coordinating Office for Health Technology Assessment
Authors: Battista Renaldo N. , Feeny David H. , Hodge Matthew J.
Published: March 2009

The Canadian Coordinating Office for Health Technology Assessment (CCOHTA) was recently evaluated. We summarize the evaluation process, report, and 17 recommendations for enhancing CCOHTA's effectiveness. This paper may be useful for evaluators of agencies for technology assessment.
Hospital Utilization Reviews Under Field Conditions: Potential and Improvements
Authors: Santos-Eggimann Brigitte
Published: March 2009

Hospital reviews based on an adaptation of Gertman and Restuccia's Appropriateness Evaluation Protocol were performed by acute care hospitals and the canton of Vaud (Switzerland) public health department in three settings during a six-month period in 1990–1991. Interrater agreement between hospital and public health department reviewers was measured on 1,847 days of consecutively admitted patients during the last weeks of the reviews.
Cost-Effectiveness of Hepatitis-B Vaccine in Greece: A Country of Intermediate HBV Endemicity
Authors: Hatziandreu Evi J. , Hatzakis Angelos , Hatziyannis Stefanos , Kane Mark A. , Weinstein Milton C.
Published: March 2009

We evaluated the cost-effectiveness of (a) a vaccination program for the prevention of hepatitis B; and (b) the two commercially available vaccines (Merck Sharp and Dohme; Pasteur Institute) in Greece, a country of intermediate endemicity. We examined cases of hepatitis-B infection prevented and the expected medical costs among the high-risk groups of medical and nursing students, hospital personnel, and the general population. Employing a vaccination program reduces considerably the risk of infection, especially in the high-risk groups, while it increases the total cost. The vaccines are very comparable in terms of both health and economic outcomes. Sensitivity analysis indicated that vaccine cost, incidence of hepatitis B, and compliance were the key factors for the choice of (a) whether to undertake an extensive program to prevent hepatitis-B infection and its chronic sequelae; and (b) which vaccine to administer.
Screening for Human Immunodeficiency Virus
Authors: Rosenbrock Rolf D.
Published: March 2009

Screening for human immunodeficiency virus (HIV) antibodies as a means of preventing both the progress and spread of acquired immunodeficiency syndrome (AIDS) is problematic in terms of efficacy, effectiveness, and ethics. The few desired effects are mostly offset by greater and more certain undesirable effects on individuals and society.
Assessing Population-Based Programs to Reduce Blood Cholesterol Level and Saturated Fats
Authors: Vartiainen Erkki , Heath Gregory , Ford Earl
Published: March 2009

This article reviews seven community-based programs for prevention of cardiovascular disease and their effects on blood cholesterol levels and saturated fat intake. In two programs, cholesterol levels were reduced more in the intervention area than in the reference area. In two other programs, cholesterol increased less in the intervention area than in the reference area. In one program, cholesterol levels initially fell in the intervention group and increased in the reference group; after the first 4 years, the levels also started to increase in the intervention group. The final two programs reduced cholesterol equally in both groups. Only two programs reported on the intake of saturated fats; in both, intake of saturated fat was reduced more in the intervention area than in the reference populations. In one program area, total intake of fat was reduced more than in the reference area. Published data do not allow us to draw conclusions regarding which components of the programs were most important. These studies show that the average blood cholesterol level can be affected in a general population.
Oral Disease Prevention Technologies for Community Use
Authors: Corbin Stephen B.
Published: March 2009

Dentistry is perhaps the most prevention oriented of the many disciplines in health care. This article examines technologies for the prevention of caries (including the use of fluoride, oral hygiene and prophylaxis, sealants, and dietary modifications), periodontal disease, and soft-tissue lesions that can be used in community-oriented programs.
Some Observations on the Assessment of Preventive Technologies
Authors: Koplan Jeffrey P. , Gutzwiller Felix F.
Published: March 2009

The articles in this issue of the International Journal of Technology Assessment in Health Care (IJTAHC) have explored the assessment of preventive health technologies. When considered together, these technologies provide an interesting contrast with the health care technologies that are usually evaluated on these pages. Disease prevention and its twin, health promotion, are usually practiced on a well population. Thus, many persons have the technology applied to them but only a fraction of these would have acquired the condition being prevented. Often the intervention is applied to populations rather than to individuals. The unit cost for preventive technologies is usually far less than that of diagnostic or therapeutic technologies. However, when multiplied by the larger population to be involved in the prevention program, the total costs can be considerable. In concluding this section on prevention, we would like to examine some of the larger areas of difference between preventive and other health technologies illustrated by the papers assembled here.