bluuebunny/crossref_metadata_2025 huggingface dataset:
Issues in the Cross-National Assessment of Health Technology
Authors: Drummond Michael F. , Bloom Bernard S. , Carrin Guy , Hillman Alan L. , Hutchings H. Christina , Knill-jones Robin P. , De Pouvourville Gerard , Torfs Koen
Published: March 2009

With the growing international literature in economic evaluation and the rapid spread of new health technologies, there is a need to undertake, or at least interpret, economic evaluations on the international level. However, the ways in which cross-national differences affect the cost-effectiveness of health technologies or their evaluations have never been studied. This paper explores these issues by taking advantage of a unique situation in which the same economic evaluation of a new indication for a health technology was conducted simultaneously in four countries using an identical methodology. The study showed that if prior agreement on methods can be reached and local data applied, economic evaluations can be undertaken in a way that facilitates the extrapolation of results from country to country.
Information Dissemination and the Cesarean Birth Rate: The Illinois Experience
Authors: Oleske Denise M. , Glandon Gerald L. , Tancredi Daniel J. , Nassirpour Mehdi , Noak John R.
Published: March 2009

A study was initiated to investigate the impact of information dissemination in Illinois upon the projected rise in the cesarean birth rate over the period from 1986 through 1988. The total cesarean birth rate in Illinois had not changed significantly during this period, whereas the rate of vaginal births after cesarean sections (VBAC) increased by 58.4% (p <.001). Information dissemination may have contributed to stemming an increase in the cesarean birth rate in Illinois while promoting VBAC deliveries.
Implants, Transplants and Artificial Organs: Technical Feasibility versus Social Desirability
Authors: Jennett Bryan
Published: March 2009

Substitution of lost anatomical structure or physiological function by various devices was one of the earliest technologies in medicine. The wooden leg, the spectacle lens, and the ear trumpet were antecedents of today's powered limb prostheses, pacemakers, valves, vessels, and hearts. Transplantation of tissues or organs from humans and animals represents a further step along the same path. The replacement of deficient organic chemicals such as insulin and coagulation factors might be considered as part of the same continuum. Such substitutes may be wholly external. These include the extension of extremities foreshortened by congenital or acquired abnormality and various communication aids that allow the transmission or reception of information. Replacing the chemical activity of the kidney by dialysis is another external device.
Coverage and Reimbursement for Heart Transplantation
Authors: Evans Roger W.
Published: March 2009

From the perspectives of coverage and reimbursement, heart transplantation has been a serious concern of policymakers in the U.S. since 1980, the year it was decided that a comprehensive study was required before the Health Care Financing Administration (HCFA), the federal agency responsible for the administration of the Medicare program, would be able to decide the status of the procedure (14;15;30;35). It was well acknowledged that the issues surrounding this decision were complex and that initial attempts to resolve the underlying coverage issue seemed to be too narrowly construed. It was at this time that the late Patricia Roberts Harris, then Secretary of the Department of Health and Human Services (DHHS), declared that DHHS would require new technologies to pass muster on the basis of their “social consequences” before “financing their wide distribution” (30). In a very special sense, although not appreciated at the time, a new era of health care technology assessment was ushered in, as Harris proclaimed that the then-conceived study of heart transplantation should serve as the “prototype” of technology assessment.
Liver Transplantation in Europe—Present Status
Authors: Höckerstedt Krister , Kankaanpää Jari
Published: March 2009

Liver transplantation is an exciting new therapeutic procedure that over the past few years has shown signs of increasing interest among physicians and health care providers (26;36). The history of liver transplantation dates back to the immediate post-World War II years when early experiments showed the technical feasibility of transplanting a functioning liver into a recipient, either heterotopically as an accessory organ or orthotopically, i.e., by complete replacement of the original organ (29).
Pancreatic Transplantation
Authors: Tydén G. , Groth C. G.
Published: March 2009

Insulin dependent diabetes mellitus ranks as one of the major disease entities in the world. It is widespread in industrialized countries as well as in developing countries. In spite of the considerable improvements in conventional diabetes therapy during the past few years, severe secondary complications still develop in most patients. The National Commission on Diabetes in the United States has reported that patients with insulin dependent diabetes are 25 times more prone to blindness, 17 times more prone to kidney disease, 5 times more often afflicted with gangrene and twice as often afflicted with heart disease than are non-diabetic individuals. In Sweden diabetes is now the second most common cause of uremia and it is the most common cause of blindness in adults. The life expectancy for the diabetic patient is approximately one-third less than that of the general population. Since the metabolic abnormalities that prevail in diabetes mellitus are due to abolished beta-cell function, it would seem logical to treat this disease by the transplantation of normally functioning islets of Langerhans. This operation should correct the metabolic abnormalities and presumably prevent or delay the severe secondary complications. There are two ways of transplanting the endocrine pancreas, either by means of a vascularized graft or by providing free, isolated islets. Unfortunately it has not been possible, so far, to correct diabetes in humans with islet transplantation. However, during the last years there has been substantial progress in the field of vascularized pancreatic transplantation and the results now begin to approach those obtained with other organs such as the kidney, heart, and liver.
Strategies for Technology Assessment and Implementation in Some European Countries
Authors: Stocking Barbara
Published: March 2009

No European country (as far as the author knows) has a comprehensive strategy for technology assessment and implementation. Many countries undertake some aspects of such a strategy, but none cover all of them. Such a strategy would need to include the technical, clinical, economic and social evaluation of technologies, and the use of this information to set policies and to ensure that they are implemented. Despite the considerable differences in health systems financing and organization there is a surprising degree of similarity in the way we approach technology assessment; more variability exists in the mechanisms used to regulate and control the introduction and use of medical technologies.
Technology Assessment—Impact on Medical Practice
Authors: Gutzwiller Felix , Chrzanowski Richard
Published: March 2009

“Technology assessment” is still a relatively new concept, and its application to the field of medicine is even more recent. This results not only from an important effort to develop the scientific basis for health care, but also as a consequence of the growing concern about medical care costs (19). The term refers basically to the evaluation of the costs and effects of a medical technology. The most important methodological approach in this area has been, and still is, the traditional clinical trial, defined by Bradford Hill as “A carefully and ethically designed experiment with the aim of answering some precisely framed question,” including random allocation of the subjects in the trial (4).
Making Clinical Policy Explicit:Legislative Policy Making and Lessons for Developing Practice Guidelines
Authors: Lomas Jonathan
Published: March 2009

Promulgation of practice guidelines in medicine has increased interest in the structure of clinical policy making. It is argued that with a generic efinition of policy as “the rules governing the behavior of individuals or institutions,” clinical policy making is analogous to legislative policy making. Practice guidelines emphasize the advantages of making clinical policy more explicit. The structure of legislative policy making as evolved over many years to meet the challenge of making both the policies and the process of policy making explicit. Processes to promulgate clinical policies may be able to exploit this experience to improve clinical policy making and thereby retain control of the process within medicine. Generic steps are outlined for making decisions with incomplete information; synthesis of facts, vested interests, and values; involvement of stakeholders; and implementation of policy. An illustration of the use of the generic steps to make and implement a clinical policy for cesarean birth follows, with evaluations of its impact on the behavior and satisfaction of clinical stakeholders.
Standardizing Methodologies for Economic Evaluation in Health Care: Practice, Problems, and Potential
Authors: Drummond Michael , Brandt Arno , Luce Bryan , Rovira Joan
Published: March 2009

There has been an exponential growth in the literature on economic evaluation in health care. As the range and quality of analytical work has improved, economic studies are becoming more influential with health care decision makers. The development of standards for economic evaluation methods would help maintain the scientific quality of studies, facilitate the comparison of economic evaluation results for different health care interventions, and assist in the interpretation of results from setting to setting. However, standardization might unnecessarily stifle methodological developments. This paper reviews the arguments for and against standardization, assesses attempts to date, outlines the main areas of agreement and disagreement on methods for economic evaluation, and makes recommendations for further work.
The Diagnosis of Syncope in the Elderly
Authors: Frazier Howard S.
Published: March 2009

Given a group of individuals presenting with syncope, the use of the standard diagnostic maneuvers will yield a diagnosis for approximately half. Promising new diagnostic tests offer the prospect of more efficient diagnostic pathways and treatments and demonstrate the need for better clinical trials before they are adopted.
The State of the Art Versus the State of the Science: The Diffusion of New Medical Technologies into Practice
Authors: Greer Ann Lennarson
Published: March 2009

This paper offers a theory to explain the diffusion of new medical technologies into local practice. Based on several hundred interviews with community hospital physicians, it anchors technology decisions in the norms and relationships of local practice. Physician descriptions of their use of different types of assessment information provide insight into the way in which local consenses on appropriate practice are formed, guide behavior, and change. To understand new technology adoption, it is necessary to (a) differentiate “formed” (complete) and “dynamic” (still developing) technologies, and (b) appreciate the extent to which medical practice is locally organized. Concepts from organizational literature, then, become useful in explaining the penetration of these medical communities and the circumstances under which a new modality takes hold in them. Within the framework presented, previously puzzling findings regarding variations in local practice and the poor relationship between practice behavior and the published literature become understandable.
Information Transfer in the Medical Device Industry
Authors: Geuns J. R. van
Published: March 2009

This presentation provides an overview of the process of information transfer in a typical area of the medical device industry, that of medical imaging. The medical device industry must translate technological trends into ideas for new methods for diagnosis and treatment. The feasibility of such ideas has to be evaluated carefully, inasmuch as large amounts of money are sometimes invested in product development. Moreover, the knowhow obtained from research must be protected long enough to enable the industry to complete development and market the product.
The Role of the Universities in Assessing Technology and Disseminating Information
Authors: Jennertt Bryan
Published: March 2009

Universities, especially those with medical schools whose academics engage in clinical research, have a vital role in shaping the way in which medical technology is used. Academic clinicians are a bridge between laboratory research, where new technologies are developed, and clinical practice, where these technologies are applied in treating patients. Academic clinicians are particularly suited to doing clinical assessment of medical technologies, and academic clinical departments should devote more time to the assessment and application of technology on a broad scale.
The Transfer of Medical Information: A Journalist's View
Authors: d'Adler Marie-Ange
Published: March 2009

Abstract Despite the quantity of material on medical issues which journalists typically receive, and the tremendous public interest in health news, journalists are only rarely able to provide medical information of any real value to the public. Good news, no matter how tentative, always gets more attention than critical assessment. Deadlines pressure journalists to look only at the surface of the issues that they describe, and few have the expertise necessary to judge the importance of their stories. When accurate, authoritative information is available in a structured format; however, the news media can publicize medical findings rapidly, effecting significant changes in public behavior.
Evluation of The Consensus Conference Program in Sweden: its Impact on Physicians
Authors: Johnsson Monica
Published: March 2009

The impact of consensus conferences on physicians was studied in 1985 for the first four conferences Sweden held in 1982–1985. For each conference a main target group was defined as hospital-based physicians in supervisory positions within relevant clinics. Data were collected through a postal survey of all 1,668 members of the four different target groups. The total response rate was 86%. Reported awareness of a particular consensus conference as well as professed knowledge of a single conference statement was high—roughly 90%—for all four conferences. The consensus statement evoked changes in clinical practice according to 7%–10% of the respondents and changes were proportionally higher for physicians in smaller hospitals. Most of the respondents (61%–83%) reported no change, claiming that the consensus statement reflected clinical practices established prior to the conference. The validity of self-reported data is discussed.
Expert Systems in Medicne:Possible Future Effects
Authors: Potthoff P , Rothemund M. , Schwefel D. , Engelbrecht R. , Eimeren W. van
Published: March 2009

It should be pointed out that during the interviews most of the experts had positive expectations of ESM. The developers are more generally enthusiastic than the prospective users and affected parties who, especially in respect of the diffusion of ESM into practical application, only show a limited optimism.

However, the representatives of the medical profession and the health insurance industry were convinced that ESM might contribute to cost-neutral increases of quality in out-patient and in-patient medicine. But we also understood them to say that they consider other developments in medicine to be overriding, for example, a tendency of general medicine towards a more family-oriented medicine and a reduced emphasis on technology-oriented medicine. In respect of the conception shared by developers as well as potential users that over-enthusiastic expectations should rather be restrained, we consider such a balanced expectation of positive effects of ESM to be adequate to the actual knowledge of the subject.
The Need for Asylum in Society for the Mentally Ill or Infirm: The Third King's Fund Forum Consensus Statement
Authors: Perry Seymour , Blanpain Jan , Hanft Ruth , Hutton John , Tanneberger Stephan
Published: March 2009

The third King's Fund Forum was held in London from 8 to 10 April 1987. A panel of 12 from a range of backgrounds listened to evidence from experts in public sessions attended by 200 people, including representatives from many consumer and voluntary organizations as well as health care and social service professionals. After closed sessions the panel discussed its report with the audience; the agreed consensus statement was then presented at a press conference.
International Differences in Drug Regulation Philosophy
Authors: Lasagna Louis , Werkö Lars
Published: March 2009

The articles in this issue of the International Journal of Technology Assessment in Health Care are intended to give the reader a bird's-eye view of the ways that different countries approach the regulation of pharmaceuticals.
The Evaluation and Control of Drugs in Norway
Authors: Jøldal Bjørn
Published: March 2009

The basic aim of a drug policy is to ensure that effective and safe drugs of good quality are available to cover the health needs of a country. A national drug policy should be considered an integral part of any comprehensive health-care policy. The formulation of national drug policies varies even between similar countries because of conflicting interests and different political, economic, and social pressures. It is influenced by such factors as:

the health situation of the country;

the medical care system;

the education and training of health personnel;

the social security and health-insurance schemes;

drug research and development possibilities;

the domestic production of drugs;

the determination of the demand for drugs;

the system of drug distribution;

the possibilities for evaluation and control of drugs; and

international policies on medicinal products.
Internationalization of the Japanese Pharmaceutical Regulations and Environment
Authors: Kran Klaus
Published: March 2009

The intensity with which the United States and the European Community (EC) are reviewing their trade difficulties with Japan makes examination of the Japanese pharmaceutical regulatory environment particularly appropriate at this time. One of the four topics identified for focused discussion between the U.S. and Japanese governments in last year's Market Oriented Sector Selective (MOSS) talks was pharmaceuticals, a $13 billion industry (at 1985 exchange rates), in which Japan is the world's second largest market for pharmaceuticals.
The Clinical Efficacy Assessment Project of the American Collegeof Physicians
Authors: White Linda Johnson , Ball John R.
Published: March 2009

Throughout the history of the development and use of medical technologies (phar-maceuticals, laboratory tests, invasive and noninvasive procedures, and medical devices), physicians and their patients have been the primary assessors of a technology's worth. If a drug, test, or procedure produces consistent beneficial effects, with little or no risk, then such a technology is commonly added to the clinician's arsenal of weapons against illness and disease. Academic researchers, however, with their keen desires to find new and better ways to diagnose, treat, and cure, are relied upon to produce evidence documenting a technology's efficacy. Others engaged in technology assessment activities—from their own perspectives—include manufacturers, who produce data showing the value of the products they hope to sell; hospitals that wish to make cost-effective purchases; and government agencies, with mandates to protect the public and to spend public dollars wisely. Still, it is the practicing physician who ultimately judges a technology's value based upon its use in individual clinical situations. Until very recently, with the apparent adequacy of these evaluative methods, medical professional societies were not required to enter the technology assessment arena.
Medical Technology in the United Kingdom
Authors: Stocking Barbara
Published: March 2009

This article describes and explains the impact of the National Health Service bureaucracy on the diffusion of medical technology in the United Kingdom. Through case studies of six medical technologies, the author demonstrates how health care authorities may exercise significant control by using the central financing system to dampen the general diffusion of technology. However, the United Kingdom has less control in specific cases due to the absence of a bureaucratic body to coordinate the evaluation and introduction of new technology.
Emerging Policies For Controlling Medical Technology In Italy
Authors: France George
Published: March 2009

This article begins by sketching out the constitutional arrangements in Italy for the distribution of powers among different levels of government. The more important characteristics of the health system are then examined in some detail, the aim being to provide a sufficient basis for understanding the analysis of technology policy which follows later. The mechanisms used for funding medical technology are next described, after which data available on the diffusion of medical equipment are illustrated. Medical technology policies at the national and regional level are examined and an attempt made to appraise their effectiveness. The article concludes with a brief analysis of the possible role played by private medicine in the diffusion of medical technology in ltaly.
Health Technology Development in Japan
Authors: lkegami Naoki
Published: March 2009

This article provides a comprehensive analysis of the social, cultural and economic factors which have led to the present pattern of technology utilization in Japan. It is divided into five sections. The first provides the historical framework; the second, an overview of the health care delivery context and its economic incentive structure; the third, an analysis of the various contenders involved in the process of resource allocation; the fourth, a description of the technology areas which have been emphasized in Japan; and the fifth, an examination of future issues.
Medical Technology in The United States: The Last Decade
Authors: Russell Louise B. , Sisk Jane E.
Published: March 2009

This paper reviews the evolution of U.S. policy toward medical technology in areas such as cost containment, regulation of devices and drugs, and third party reimbursement. In addition the authors chronicle the diffusion of major medical technologies, procedures, and organizational innovations in the United States. Finally, the article provides tentative observations on the effect of recent policy changes and concludes with some recommendations for the future.
Dental Implants: State of the Art, State of the Science
Authors: Schnitman Paul A.
Published: March 2009

Analysis of epidemiologic studies reveals that even with advances in preventive dentistry, edentulism continues to be a pressing problem especially in a rapidly expanding senior population. As an alternative to traditional removable dentures, dental implants can provide fixed support for crowns and bridges. A recent National Institutes of Health Consensus Development Conference revealed significant growth in implant technology and established that, although a complex treatment alternative, implants can function for 10 years or more. Continued development in basic and clinical research, federal regulations, professional education, public awareness, insurance, and marketing will shape the future of the field.
Dental Radiology: Present Limitations and Future Prospects
Authors: Webber Richard L.
Published: March 2009

Abstract The diagnostic process is likely to be limited by one or more of the following factors: (a) ambiguous signal definition, (b) inappropriate data sampling strategy, (c) inadequate signal strength, and (d) misinterpretation of data. Controlled tests suggest that the first two factors largely control performances of common dental diagnostic tasks.
Nonsurgical Treatment of Cholelithiasis: An Analysis of Clinical Opportunity
Authors: Weinstein Debra F. , Brink James A. , Richter James M.
Published: March 2009

This article examines the potential impact of recently developed nonsurgical treatments for gallstones on patient care and resource utilization. Using epidemiological and efficacy data from the literature and current patient selection criteria, the authors evaluate UDCA, extracorporeal shock-wave lithotripsy, and direct instillation of methyltertbutyl ether in terms of short-term clinical results, health policy, and economic implications.
Quality Assurance Procedures in Radiotherapy: Economic Criteria to Support Decision Making
Authors: Kesteloot Katrien , Dutreix André , van der Schueren Emmanuel
Published: March 2009

This paper details the costs of two types of quality assurance activities in radiotherapy: in vivo dosimetry, intended to check the delivered dose, and portal imaging to check the treated volume. For both activities, either on-line or off-line techniques may be used. Describing the costs allows the calculation of which techniques are most COSt-efficient for different radiotherapy departments.
Geographic Variation in the Treatment of Prostate Cancer in Connecticut
Authors: Polednak Anthony P.
Published: March 2009

In Connecticut there was considerable variation by town of residence in the proportions of patients diagnosed in 1985–1988 receiving transurethral resection only, prostatectomy, and irradiation (without surgery) for local-stage prostate cancer and receiving endocrine surgery for late-stage prostate cancer. Age and socioeconomic variables were examined as predictors of this variation.
Cross-design Synthesis:A New Form of Meta-analysis for Combining Results from Randomized Clinical Trials and Medical-practice Databases
Authors: Droitcour Judith , Silberman George , Chelimsky Eleanor
Published: March 2009

Cross-design synthesis is a new (and still evolving) strategy for providing quantitative results that capture the strengths and minimize the weaknesses of different kinds of research. The strategy, which is being developed to answer questions about the effects of treatment in medical practice, includes (a) identifying complementary research designs and studies conducted according to those designs; (b) completing an in-depth assessment of each study with respect to the chief potential bias(es) that are associated with its design; (c) making “secondary adjustments” of study results to correct known biases; and (d) developing synthesis frameworks and models that will minimize the impact of hidden biases.
Medical Technology Transfer in Major Chinese Hospitals
Authors: Hu Teh-wei
Published: March 2009

The objective of this article is to describe and analyze the decision-making process and its consequences for medical technology transfer in China. Data were obtained in 1987 from 35 elite teaching hospitals affiliated with 13 medical universities, directly supervised by the Ministry of Health in the People's Republic of China. This article focuses on three kinds of diagnostic equipment: computerized tomographs, ultrasonic diagnostic units, and high-power x-ray diagnostic apparatuses. Decision-making on the transfer of medical technology in China is decentralized. Most hospitals rely on foreign medical sales representatives and medical exhibits, and their decisions on the acquisition of equipment rely more on the services available than on the price of the product. Chinese hospitals also encounter serious infrastructure problems when buying medical equipment. A number of alternatives are suggested for improving the efficiency of medical technology transfer in China.
On the (Near) Equivalence of Cost-Effectiveness and Cost-Benefit Analyses
Authors: Phelps Charles E. , Mushlin Alvin I.
Published: March 2009

Many people believe that cost-effectiveness (CE) and cost-benefit (CB) analyses require different assumptions. However, when CE analysis supports decisions to use medical resources, it makes the same assumptions that CB analysis requires. They are mathematically equivalent. Differences between CE and CB hinge more on reporting style than on fundamental assumptions.
Technological Innovation and the Winning-Combination Phenomenon: The Case of the Extracorporeal Lithotriptor
Authors: Poulin Diane
Published: March 2009

There are situations where, for many reasons, an innovation considered revolutionary in several respects is widely accepted by those whose ways of doing things are transformed by it. The innovation represents a “winning combination” in that it combines such attractive elements that each party, for its own reasons, will desire its adoption and work toward that common goal. In France, and particularly in the Assistance Publique de Paris and in the Hospices Civils de Lyon, such has been the case with the German-made Dornier extracorporeal lithotriptor, an innovation that makes it possible to destroy kidney stones without surgery.
Technology Assessment in the Connecticut Tumor Registry
Authors: Wyshak Grace , Burdick Elisabeth , Mosteller Frederick
Published: March 2009

A search of literature using the Connecticut Tumor Registry (CTR) for technology assessment produced eight articles. These articles represent a small but apparently increasing percentage (2%) of total CTR publications. By keeping pace with the development and dissemination of medical technologies, the population-based CTR has been useful for assessing them, especially their adverse effects.
Technology Assessment in the Normative Aging Study
Authors: Antczak-bouckoms Alexia , Tulloch J. F. Camilla , Klawansky Sidney
Published: March 2009

This review of publications based on data from the Veterans Affairs Normative Aging Study identified four articles that were considered assessments of health care technologies. Three evaluated methods for research on body composition, the fourth studied ventricular size in patients with presenile dementia. Several additional articles are discussed that provided data on baseline values or risk factors for disease that might be useful in generating hypotheses to be tested in later assessments of technologies.
Use of A Clinical Data Registry to Evaluate Medical Technologies: Experience from the International Bone Marrow Transplant Registry
Authors: Rimm Alfred A. , Barr Judith T. , Horowitz Mary M. , Bortin Mortimer M.
Published: March 2009

We reviewed the 18 disease-specific evaluations that used the data base of the International Bone Marrow Transplant Registry to determine the effectiveness of alternative strategies for bone marrow transplant. We identify 17 treatment variables that physicians can control and report the associations between these variables and five clinical endpoints: stable engraftment, graft-versus-host disease, development of interstitial pneumonia, relapse, and disease-free survival. We also suggest policies to promote active participation in establishing and operating a registry.
Social Evaluation of Health Care Versus Personal Evaluation of Health States:Evidence on the Validity of Four Health-state Scaling Instruments Using Norwegian and Australian Surveys
Authors: Nord Erik , Richardson Jeff , Macarounas-Kirchmann Kelly
Published: March 2009

In most of the cost-utility literature, quality-adjusted life-year (QALY) gains are interpreted as a measure of social value. Given this interpretation, the validity of different multi-attribute health-state scaling instruments may be tested by comparing the values they provide on the 0–1 QALY scale with directly elicited preferences for person trade-offs between different treatments (equivalence of numbers of different patients treated). Norwegian and Australian public preferences as measured by the person trade-off suggest that the EuroQol Instrument assigns excessively low values to health states. This seems to be even more true of the McMaster Health Classification System. The Quality of Well-being Scale appears to compress states toward the middle of the 0–1 scale. By contrast, the Rosser/Kind index fits reasonably well with directly measured person trade-off data.
Benefits and Costs of Recombinant Human Erythropoietin for End-Stage Renal Failure: A Review: Benefits and Costs of Erythropoietin
Authors: McNamee Paul , van Doorslaer Eddy , Segaar Rob
Published: March 2009

Recombinant human erythropoietin is an efficacious therapy in treatment of the anemia of end-stage renal failure. However, the scale of impact on quality of life and medical care resources remains uncertain. By reviewing the literature we evaluate cost-effectiveness of recombinant human erythropoietin and show how previous studies may have implicitly overestimated cost-effectiveness.
Acquiring Advanced Technology: Decision-making Strategies at Twelve Medical Centers
Authors: Weingart Saul N.
Published: March 2009

This study describes decision making regarding the acquisition of technology in 12 major medical centers. The financial impact of a project was the most widely cited criterion of decision, but financial considerations were less important than either the impact of a technology on the quality of clinical care or its contribution to teaching and research. Rarely were criteria set out explicitly or in advance. Although exemplary models exist, the technology assessment process at most institutions is described as “political,” “informal,” or “ad hoc.”
Survival from Localized Breast Cancer: Variability Across Trials and Registries
Authors: Klawansky Sidney , Berkey Catherine , Shah Nirav , Mosteller Frederick , Chalmers Thomas C.
Published: March 2009

Age-specific (<50, 50–69 years) 10-year survival proportions in four European trials for node-negative, Stage I and II breast cancer patients differ significantly. These patients, identified as having the same stage as localized-breast cancer patients in the End Results Registry of the U.S. National Cancer Institute, had pooled survival proportions for the two age groups (0.713, 0.579) close to those of the registry (0.713, 0.607).
The Usefulness of Four Methods of Assessing the Benefits of Electrically Adjustable Beds in Relation to their Costs
Authors: Söderback Ingrid , Lassfolk Anita
Published: March 2009

Ten picture cards, interviews, time logs, and the Klein-Bell ADL scale were useful in assessing the benefits of electrically adjustable beds to patients but not to caregivers. The mean cost per bed per year of US $346 seems, in relation to the benefits, to be a worthwhile investment for increasing patients' quality of life.
Cost Savings through Technological Change in the Administration of Antibiotics
Authors: Liaropoulos Lycurgus L.
Published: March 2009

Once-daily antibiotics (ODAs) represent a technological change in hospital processes that can lead to substantial savings of scarce resources. In a three-hospital prospective study, five antibiotics were administered to 58 patients suffering from infections classified by major body system. Savings ranged from 10.9% to 38%, depending on hospital organization, method of delivery, and daily dose. Per-unit price proved a poor indicator of hospital cost, as variable delivery costs for labor and materials ranged from 11.6% to 39.5% of total costs.
Assessment of Screening for Cancer
Authors: Vecchia Carlo La , Levi Fabio , Franceschi Silvia , Boyle Peter
Published: March 2009

Screening has a relevant role in and is likely to become an increasingly important instrument for cancer control in the near future. This overview summarizes some of the available evidence on the issue. Some of the opinions are well established. The apparent absence of consensus on other issues should be critically evaluated, too, because the evidence on some procedures is substantially more convincing than that on others. High costs, low compliance, poor curability, and substantial false positive rates, in a disease as relatively rare as cancer, often counterbalance in practice the theoretical benefits of diagnostic anticipation. In screening as well as in treatment for cancer, it is unlikely that major technical breakthroughs will occur in the near future. The evaluation of whether the benefits likely to be achieved by the screening program outweigh its disadvantages by a sufficient margin, therefore, should rely on large and carefully planned controlled studies.
Evaluation of Immunization Policies for PeaceKeeping Missions
Authors: Steffen Robert , Woodall Jack P. , Nagel Jörg , Desaules Madeleine
Published: March 2009

This article first examines data bases available to assess the risk of vaccine-preventable diseases (VPD). In the second part, immunization recommendations and practices are briefly evaluated in view of the risk of exposure to VPD and of the efficacy and safety of available vaccines.
Issues in Cochlear Prosthetics From an International Survey of Opinions
Authors: De Foa J. Lance , Loeb Gerald E.
Published: March 2009

Cochlear prostheses are beginning to be implanted regularly to restore hearing in profoundly deaf patients, but there is little agreement on the relative merits of the many different designs and rehabilitative procedures. We report on the responses to a technology assessment questionnaire that was sent to 120 researchers and clinicians worldwide who have been at the forefront of research in this field.
Technology and Primary Care in the United States: A Challenge for Technology Assessment
Authors: Young Donald A. , Roe Wayne I. , Strauss Michael J.
Published: March 2009

This article examines technology in primary care and its implications for technology assessment. Following an overview of the primary care setting and the importance of medical technology to primary care providers, the article identifies the new decisionmakers in medicine who both direct and respond to technological change in primary care, focusing, in particular, on their needs for information on primary care technologies. Furthermore, new methodologic issues for technology assessors are posed and examined. Finally, the authors offer conclusions about the need for changes in technology assessment and speculate about its future in primary care.
Use of Slowscan Technology in the North Slope Borough Telehealth Project
Authors: Hoyle M. Frances , Jamieson Lisa N.
Published: March 2009

The North Slope Borough (NSB) Telehealth Project involves the use of slowscan (freeze-frame video) and telephone communications between 7 small villages, a central 14-bed hospital, and a large urban hospital over 700 air miles away. The project is intended to improve the quality of health care in this remote rural area in northernmost Alaska. This article describes the initial testing stages of the project and discusses applications for use of this technology. It focuses on the technological potentials for bridging cultural and linguistic differences between health care provider and client and from provider to provider for enhanced primary health care.
The Impact of New Technologies in Primary Health Care
Authors: Sjöell Göran
Published: March 2009

This article surveys the gradual diffusion of diagnostic technologies into homes in Sweden. The author speculates on the advantages and prospective problems of home care. In addition, the article proposes some general guides to assure that new technologies provide genuine benefits for the patient.
Requirements for Technology: As Seen by Providers of Primary Health Care
Authors: Horder John , Metcalfe David
Published: March 2009

This article is concerned with principles that might help to ensure that procedures and tools used in primary care are appropriate to people's needs and expectations. It urges attention, not first to technology, but to the broad range of purposes served by primary care and to the relevance of procedures to them. Other criteria for ensuring appropriateness are also proposed.
Technology Assessment in Health Care in Australia
Authors: Gross Paul F.
Published: March 2009

In 1977, in the middle of a protracted debate on the costs and methods of paying for health care, the federal minister for health established a Committee on Applications and Costs of Modern Technology in Medical Practice. In 1978, the committee produced its report, which reviewed a number of cost containment strategies, including the reduction or regulation of fees paid to medical practitioners for specific procedures. It recommended that a national panel be established to collect information on medical technology and advise on its introduction in Australia.

In 1982, the National Health Technology Advisory Panel (NHTAP) was created to identify and examine existing and emerging medical technology, to determine methods and priorities for assessment, and to make recommendations to the minister for health with respect to assessment and funding of new technology.
Innovations in Human Service Technologies: Strengthening Health Care Delivery Systems
Authors: Taft Susan Hoefflinger , Seitz Pauline
Published: March 2009

The authors report on innovative approaches to the organization of health services and the delivery of patient care in 19 U.S. hospitals and hospital networks. Strengthening patient care is the focus of this initiative. Hospital-wide interdisciplinary planning and the subsequent trial of new human service technologies are explored.
Translating Traditional Principles of System Development into a Process for Designing Clinical Information Systems
Authors: Gillis Pamela A. , Booth Holly , Graves Judith R. , Fehlauer Charles Steven , Soller Jerome
Published: March 2009

Traditional software development methodologies enhanced by a clinical component result in information systems that support the practice of nursing. This paper describes the clinical informatics model used to develop and evaluate a mobile computer assessment tool. Data entry of atomic-level elements, with storage in a relational database, allows the synthesis and analysis by multiple disciplines to aid in real-time decision making. The system is designed to improve the recording and accessibility of patient data and nursing observations on a geriatric unit at the Salt Lake VA Medical Center.
Diffusion of Laparoscopic Cholecystectomy in Canada
Authors: Menon Devidas , Marshall Deborah
Published: March 2009

Patterns of the diffusion of laparoscopic cholecystectomy in Canadian hospitals were determined by a telephone survey of 153 randomly selected hospitals over two years. Results were analyzed by region, hospital size, and type of hospital. Laparoscopic cholecystectomy has diffused very quickly compared with other technologies, before any comprehensive evaluation to consider its potential impact could take place.
Toward a Model for Quality Assessment in Heart Transplantation
Authors: Larsson A. , Möller Anders , Karlsson Ingela , Stolz-löfgren Marie , Pettersson Gösta , William-Olsson Eva Berglin , Shapiro Peter A.
Published: March 2009

A model for quality assessment of heart transplantation that combines a scientific method for studying the recipients' quality of life and a basis for a method of clinical work by nurses and other health care professionals is discussed. Besides its use as a research method, this model also may serve as an instrument for documenting patients' biopsychosocial status, including coping capacity, and for evaluating nursing interventions.
A Critical Review of Cancer Screening Programs in Japan
Authors: Oshima Akira
Published: March 2009

In Japan, screening programs for various cancers have been eagerly conducted as part of public health policy. However, these programs have not always produced the results that were originally expected. To improve the ill-planned and unscientific state of the current programs in Japan, two proposals are made.
The Acceptability of Prenatal Diagnosis in Japan
Authors: Kitai Hirokatsu , Watanabe Hisako , Sayama Mitsuko , Kanemune Miyuki , Nishiyama Mayumi , Nishino Ruriko , Itoh Kimihiko
Published: March 2009

Prenatal diagnosis has been performed more frequently in Japan recently, but is still less popular than in the United States or Europe. Legal arrangements, insufficient economic support, and insufficient medical information provided to future parents may explain this difference. The acceptability of prenatal diagnosis, based on the concept of the cost of side effects and elective abortion, was found to be similar when examined through decision analysis and direct survey. Amniocentesis was considered useful for more than half of couples in Japan when the incidence of chromosomal abnormality is more than 0.5% and proper information about the decision to undergo this examination is provided to the pregnant woman and her family.
The Diffusion of Obstetric Technology into Rural U.S. Hospitals
Authors: Rosenblatt Roger A. , Saunders Gregory R. , Tressler Carolyn J. , Larson Eric H. , Nesbitt Thomas S. , Hart L. Gary
Published: March 2009

We determined the distribution and sophistication of obstetric technologies in all 80 maternity hospitals in the state of Washington and examined the effect of rural or urban location, birth volume, and physician staffing on technological intensity. Although smaller and more rural hospitals refer most premature and low-birth-weight infants to regional referral centers, sophisticated prenatal and intrapartum technologies are available in the majority of even the smallest and most remote rural units. Rural hospitals have slightly lower obstetrical intervention rates than do their urban counterparts, but the differences are not great.
Accrual of Patients to Randomized Clinical Trials: Factors Affecting Cancer Prevention and Control Research
Authors: Kaluzny Arnold D. , Lacey Linda M. , Warnecke Richard , Morrissey Joseph P. , Sondik Edward J. , Ford Leslie
Published: March 2009

Clinical judgment is increasingly being challenged by the need for randomized clinical trials. The 1987 National Cancer Institute mandate—that the Community Clinical Oncology Program (CCOP) accrue patients to cancer control protocols—provided an opportunity to examine the factors that affect accrual performance. An analysis of 52 CCOPs and their research bases participating in the program found that the availability of protocols, involvement with research base activities, a demonstrated link to community physicians (particularly those physicians, such as surgeons, who had access to patients), and the use of personal contacts to inform non-CCOP physicians about CCOP activities were important facilitating factors for accruing patients to cancer prevention and control trials.
On the General Concepts of Action and Ability: A Philosophical Introduction to the Theory of Handicaps
Authors: Nordenfelt Lennart
Published: March 2009

Abstarct

The main task of this paper is to contribute to the theory of disabilities and handicaps, in particular their characterization and classification. It presents an analysis of the conditions for the successful performance of actions. By this procedure a list of reasons for failure of action, i.e., for disability and handicap, is obtained. This list can be used for a detailed classification of disabilities and handicaps. Some theories in modern philosophical action theory serve as platforms for the analysis.
The Potential of Technological Innovations for the Disabled
Authors: Milner Morris
Published: March 2009

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Technical innovations have enormous potential for enhancing the lives of people with disabilities, often providing means for substantial independence and contributing to their dignity. This paper uses a framework related to the personal needs of individuals throughout the hours of waking and rest. Examples of various potentialities are provided and discussed.