bluuebunny/crossref_metadata_2025 huggingface dataset:
Consensus Development Conferences in Sweden: Effects on Health Policy and Administration
Authors: Calltorp Johan
Published: March 2009

Seven consensus development conferences have been held in Sweden since 1982. The conferences, sponsored by the Swedish Medical Research Council and Spri, typically examine social, organizational, and economic aspects of technology, and therefore, generate consensus statements of interest not only to physicians but also to politicians and health administrators.

The study presented here examines the influence of the first five consensus development conferences on politicians and health administrators. Data was obtained via a mail questionnaire and personal interviews with leading individuals in these groups. More than half of the respondents indicated that they had found the statements from one or more conferences to be of practical value as a basis for discussing specific technologies with medical staffs. In some cases the statements directly influenced political decisions.
Update on Assessment Activities: United States Perspective
Authors: Jacoby Itzhak
Published: March 2009

The purpose of this paper is to present an update on biomedical technology assessment activities from a United States perspective. In 1985, I described in detail (a) a primary vehicle for technology assessment—the Consensus Development Program (CDP) of the National Institutes of Health (NIH)— and also discussed, in a second paper, (b) the transfer of consensus-enhanced scientific information and some of its impact on U.S. medical practice. Here, I focus on what has transpired during the past year: the changes in the climate in which U.S. technology assessment efforts are being conducted, the consequences of these changes, and the challenges that they pose for all concerned with the provision of quality health care. The first part of this paper centers on the broader framework within which technology assessment plays a role ir the United States. Later, it addresses the specific technology assessment and transfer activities in which the NIH is engaged.
The Regulation of Drugs: Worlds of Difference
Authors: Dukes M. N. G.
Published: March 2009

It is difficult to determine when drug regulation began. The idea that some kind of control is necessary is very old indeed; it was many centuries ago that apothecaries were first accused of paternalism and secrecy, and it was just as long ago that they found arguments to present their case as guardians of the public interest. It was at least three centuries ago that regulations on the sale of opiates were first devised in order to protect the ignorant, the reckless, and the exploited.
Drug Regulation in the Federal Republic of Germany
Authors: Schnieders Bernhard
Published: March 2009

All drug evaluation and regulation policy in the Federal Republic of Germany is based on the Drug Law of 1976. In accordance with the pharmaceutical directives of the European Community, this law provided that all drug products must be of good pharmaceutic quality, therapeutically effective, and safe according to the current state of knowledge. It is aimed at guaranteeing safety in the use of drugs without hindering the plurality of thought in medical science.
Intensive Care for the Elderly
Authors: Jennett Bryan
Published: March 2009

In 1852 Florence Nightingale wrote, “It is valuable to have one place in the hospital where postoperative and other patients needing close attention can be watched”. Almost 100 years later, an American “anesthesia study commission” concluded that one-third of postoperative deaths in the first 24 hours could have been prevented by better nursing care. Yet it is only in the last 25 years that designated intensive care units have become a feature of acute hospitals in developed countries. In the United States, intensive care beds now comprise 15% of acute beds, and they cost at least two to three times more than ordinary ward beds. Over half the difference between “activity and treatment” in hospitals in the United States and in the United Kingdom is attributed to the much lower provision of intensive care in Britain (1), where such units comprise only 1% of acute hospital beds. Selection for intensive care is therefore more stringent than in the United States, as it is for other high technology procedures (e.g., coronary artery surgery and renal dialysis). However, even in the United States there is now reluctant recognition not only that health care as a whole has to be rationed, but also that unlimited access to high technology medicine is not always in the best interests of patients and their families. In particular the cost-benefit ratio of intensive care for certain types of patients has recently come under scrutiny at an NIH Consensus Development Conference (2) and at the Massachusetts General Hospital (3).
Commentary
Authors: Vang Johannes O.
Published: March 2009

Professor Brian Jennett has written a thoughtful and comprehensive article on Intensive Care for the Elderly, mainly from the British and North American perspective. In my commentary I shall try to look at the issue from a Scandinavian perspective, especially a Swedish one.
Medical Technology for the Elderly in Japan
Authors: Steslicke William E. , Kimura J. D. Rihito
Published: March 2009

Although a relative latecomer in the industrialization process, Japan has managed to catch up with the more advanced nations and become a major competitor in the international marketplace for goods and services. As a result of their excellent economic performance and rapid technological development, the Japanese people enjoy a level of general well-being that is among the highest in the world. This is especially true with respect to health status. In terms of most commonly accepted indicators, Japan compares quite favorably with other industrial nations. Indeed, the life expectancy for males of 74.20 years and that for females of 79.78 years in 1984 were the highest in the world.
Neuronal Replacement After Traumatic or Age-Dependent Brain Damage
Authors: Björklund Anders , Gage Fred H.
Published: March 2009

During the last few years evidence has accumulated that fetal neurons, implanted into the depth of the brain in adult rats, can reestablish damaged connections in the host brain and substitute functionally for elements lost or damaged as a result of a preceding lesion. This research work has led to the realization that, contrary to traditional views, the adult mammalian CNS has a potential to incorporate new neuronal elements into already established neuronal circuitry and that such implanted neurons can modify the function and behavior of the recipient. For a long time it was thought that the remarkable regenerative and functional potential of CNS tissue grafts that had been demonstrated in cold-blooded vertebrates reflected a fundamental difference in the regenerative properties of central nervous tissue between cold-blooded vertebrates and mammals. During the last few years it has become evident however, that at least certain types of intracerebral neural grafts can perfoum just as well in developing and mammals as in developing or adult submammalian vertebrates.
Diagnosing Suspected Stroke: A Cost-Effectiveness Analysis
Authors: Britton Mona , Jonsson Egon , Marké Lars-Åke , Murray Veronica
Published: March 2009

Acute cerebrovascular disease (CBVD) has an annual incidence of 100–300 per 100,000 inhabitants in the industrialized countries (1,2). CBVD occurs mainly in the elderly. Acute mortality is around 15%. Disablement and decreased quality of life are common consequences. Institutionalized care will be needed after the acute phase for around one-third of the patients (3). Considering the volume of patients and the growing proportion of elderly persons in most countries, stroke poses a major problem for health care. An effective diagnostic work-up as the base for therapy to improve the situation is, therefore, a matter of great public concern, for humanitarian as well as economic reasons.
Diffusion of Knowledge In Dentistry
Authors: Chapko Michael K.
Published: March 2009

This paper presents data on the diffusion to dentists of information from the May 1981 American Dental Association conference and December 1983 National Institutes of Health (NIH) conference on pit and fissure sealants. A mail survey was sent to 521 (72.2¼ returned) randomly selected dentists in general practice and all 47 (76.6¼ returned) pedodontists in the State of Washington. Approximately 70¼ of the dentists were aware that the conferences had taken place and a little over 50¼ were aware of the conference recommendations. Awareness was related to: being a pedodontist, number of continuing education hours taken, number of refereed journals read, and being an officer in a dental organization
Medical Devices and Biomaterials Parhology
Authors: Kossovsky Nir , Kossowsky Ram
Published: March 2009

Through the postmortem examination, pathologists offer the ultimate clinico-pathologic assessment of the efficacy of medical care. Similarly, pathologists can offer a clinico-pathologic assessment of the efficacy of health care technology. Assessment by pathologists has diagnostic authority because it draws on the resources of the laboratories of surgical and necropsy pathology. In this essay we argue for enhancing the accuracy of medical device and biomaterials technology assessment by systematically collecting pathology-oriented data. We recommend the establishment of a pathology-based medical device registry to assess implantable medical device technology by accumulating reports routinely issued by pathology departments throughout the country. We further suggest the establishment of a university-based, industry-supported Medical Device and Biomaterials Pathology Institute to operate the registry, collect recovered, used health care devices, and generate definitive, pathology-based, primary data for he lth care technology assessment
Oral Radiology: An Expanding Technology in Search of a Direction
Authors: Gröndahl Hans-Göran
Published: March 2009

Oral radiology still seems to be expanding depending upon increasing availability of dental care. It is widely used more or less routinely, although investigations on efficacy, cost-benefit, and cost-effectiveness are sparse. Such studies should be encouraged and decision-making courses included in dental curricula. Decision-making aids and clinical algorithms should be developed to increase efficiency of oral radiology and to help in the abandonment of its routine use.
Demand as a Driving Force in Medical Innovation
Authors: Lotz Peter
Published: March 2009

On the basis of two case histories of medical device innovation, two aspects of demand are identified: (a) the prospect of new markets and (b) information about user needs. Conditions for direct interaction between the user and producer in the innovation process are identified. The article concludes with some normative implications for the publicly designed generation of new medical technology.
Social Process and the Assessment of a New Imaging Technique
Authors: Blume Stuart S.
Published: March 2009

Each group involved in the development of a new medical technology constantly assesses the value of the emergent technique in terms of the group’s own specific goals and conventions. The history of infrared thermography demonstrates the social nature of this assessment process.
Modeling Technology Transfer in Health Information Systems: Learning From the Experience of Chad
Authors: Foltz Anne-Marie
Published: March 2009

Health information systems are complex combinations of methods of organization and computer technologies. They are idiosyncratic to each country. Chad’s design of a national information system followed a process that can serve as a model for sustainable technology transfer—using consensual decision making and reinforcing administrative reforms while providing strong Ministry leadership and using technical assistance.
Development of Information-Based Planning in Niger
Authors: Mock Nancy , Setzer James , Sliney Ian , Hadizatou Gado , Bertrand William
Published: March 2009

The authors present their experiences in assisting the government of Niger to develop automated information systems for health care management. They discuss the structure of the health system, the role of donor assistance, the process of initiating automated systems, and the technical requirements and costs of the system. Finally, they draw general conclusions that may be useful for those attempting similar efforts.
On the Oxford Perinatal Care Model and Medical Education
Authors: Bulger Roger J.
Published: March 2009

Medical education in the United States is torn between its allegiance to the Newtonian biomolecular paradigm of medical science that made it so successful in the past and a growing sense, both within academia and without, that medicine needs to become more interdisciplinary and population based. This article explores the potential of the Oxford Perinatal Care model as a useful tool for medical educators to bridge the curricular gap between these two paradigms. The Oxford model is based upon ongoing meta-analysis of all randomized control trials relating to perinatal medicine; interventions and technologies are placed into one of four categories, ranging from “forms of care that reduce negative outcomes” to “forms of care that should be abandoned.” This article proposes a strategy for the inclusion of this information into the U.S. medical school curriculum.
Physicians' Perceptions of Consensus Reports
Authors: Hill Martha N. , Weisman Carol S.
Published: March 2009

In a pretest-posttest panel survey of 595 eligible Maryland physicians practicing family or general medicine, internal medicine, cardiology, or nephrology, perceptions of consensus reports designed to alter medical practice are examined. On a 7-point scale, physicians reported positive or neutral views of descriptors, most favorably rating credible (mean = 2.25) and reliable (mean = 2.41), and least favorably rating biased (mean = 3.79). In a regression analysis of factors influencing changes in practice behavior congruent with consensus recommendations before and 1 year after the release of a consensus report on hypertension (8), these perceptions were not significant determinants. The strongest predictor of congruent practice behavior a year after the report was published was congruent practice behavior just prior to the report's release, and the second strongest predictor was perceived influence of the report's sources/sponsors.
Valuation of the Benefits of Risk-free Blood: Willingness to Pay for Hemoglobin Solutions
Authors: Eastaugh Steven R.
Published: March 2009

The dream of artificial blood has existed since the 1960s. Disease-free hemoglobin solutions will be commercially available in 1991. A willingness-to-pay (WTP) survey was undertaken to assess the tangible and intangible benefits to the public from this new product. The positive results suggest that third-party payers should cover this benefit and assist the diffusion of this new technology. From the perspective of industrial marketing, results suggest that there will be little consumer price resistance for hemoglobin solutions within the suggested price range of $225–300 per unit. Management implications of this new product are discussed.
Operational Evaluation of the Efficacy of Vaccines by the Case Control Method
Authors: Diwan Vinod K.
Published: March 2009

To maintain high efficacy and cost-effectiveness of health interventions, such as immunization programs and health information, systematic and careful evaluation is necessary. This is particularly relevant when health resources are scarce, as in most developing countries. Whereas vaccines used in immunization programs are generally evaluated for efficacy and safety prior to their application in routine health service, very little attention is paid to continuous or operational evaluation.
Introduction: Using Medical Registries and Data Sets for Technology Assessment
Authors: Antczak-bouckoms Alexia , Burdick Elisabeth , Klawansky Sidney , Mosteller Frederick
Published: March 2009

The rising costs of health care and interest in the evaluation of health services and systems have sparked an increased need for technology assessment. A variety of available methods of assessment are described in the Institute of Medicine's book Assessing Medical Technologies (1). Although such methods as the randomized controlled trial (RCT) are widely accepted and used, obtaining information by such methods often takes a considerable amount of time, expense, and sophistication in study design. These costs suggest that a broader range of methods for collecting information about health care technologies should be considered. A vast resource of data collected on patients, ranging from a provider's practice records to national data sets, might be useful for technology assessment if it could be properly appraised.
Economic Evaluation of A Support Program for Caregivers of Demented Elderly
Authors: Drummond Michael F. , Mohide E. Ann , Tew Michelle , Streiner David L. , Pringle Dorothy M. , Gilbert J. Raymond
Published: March 2009

An economic evaluation was undertaken concurrently with a randomized trial comparing a Caregiver Support Program (CSP) with existing conventional community nursing care for those caring for elderly relatives at home. The differences in resource consumption were compared with changes in caregiver quality of life, as measured by the Caregiver Quality of Life Instrument (CQLI). A 20% difference from baseline in the CQLI favored the experimental (CSP) group, although this did not reach conventional levels of statistical significance. A comparison of improvement in quality of life with costs implies an incremental cost per quality-adjusted life year gained of Canadian $20,000 for the CSP, which compares favorably with other health care interventions. Further, larger studies are required to confirm this result.
Cost Comparison of Parenteral Estrogen and Conventional Hormonal Treatment in Patients With Prostatic Cancer
Authors: Henriksson Peter , Stege Reinhard
Published: March 2009

The present study compares the cost of antitumor therapy and adverse cardiovascular effects during the first year of treatment with oral estrogens, nonoral estrogens, or surgical castration in patients with prostatic cancer. We found a much higher cost for patients treated with orchidectomy and oral estrogens than for patients treated with nonoral estrogens. Twenty-five percent of the patients treated with oral estrogen suffered cardiovascular complications, compared to none of the patients treated by orchidectomy or nonoral estrogens. The initial cost of orchidectomy as compared to nonoral estrogen treatment was shown not to be balanced within the expected survival time of patients with advanced prostatic cancer. Furthermore, surgical castration causes psychological trauma to the patient. We recommend parenteral estrogen therapy as a low-cost therapeutic regimen in patients with prostatic cancer.
A Brief Introduction to Influence Diagnostics in Regression
Authors: Hoaglin David C.
Published: March 2009

Statistical analyses that involve regression methods often encounter data in which some observations have substantial influence. This article presents a nontechnical discussion of influence and of two techniques, based on leaving out each individual observation in turn, for diagnosing influential data. An example illustrates the techniques in an analysis of recurrence rates in endoscopic treatment of bleeding peptic ulcers.
A Cost-Outcome Description of the Septic Work-Up for Bacterial Infection in Neonates in a Tertiary Care Hospital
Authors: Thomas Roger E. , Baker Philip
Published: March 2009

Analysis of the septic work-up of 194 neonates at Women's College Hospital, Toronto, showed that the only antepartum condition predicting neonatal sepsis was the mother being on antibiotics. The only postnatal condition predicting sepsis was a maternal postpartum white blood cell count over 11,000. The average cost for tests for a septic work-up in these 194 mother-neonate pairs was $71.48 (Canadian dollars), and the average cost of tests to find a septic case was $1,066.77.
Screening for Colorectal Cancer: What are the Costs?
Authors: Weller David , Moss John , Hiller Janet , Thomas David , Edwards John
Published: March 2009

We examined a screening program for colorectal cancer in South Australia in terms of its overall direct costs to society and costs to participants. The best estimate of the cost per cancer detected was $18,924 (Australian dollars). Potential improvements in health outcome through screening are discussed in light of these costs.
The Ranking Properties of Healthy-Years Equivalents and Quality-Adjusted Life-Years Under Certainty and Uncertainty
Authors: Johannesson Magnus
Published: March 2009

This paper investigates the theoretical properties of healthy-years equivalents (HYEs) and quality-adjusted life-years (QALYs). A distinction is made between ex ante HYEs (EA-HYEs) and expected HYEs (EXP-HYEs) and between risk-neutral quality-adjusted life-years (RN-QALYs) and risk-adjusted quality adjusted life-years (RA-QALYs). In the case of certainty, HYEs always rank health profiles according to individual preferences, whereas QALYs only rank health profiles according to individual preferences if constant proportional trade-off holds for all health states and if additive independence of quality in different periods holds. In the case of uncertainty, EA-HYEs always rank risky health profiles the same way as expected utility. The assumptions needed for the other measures to rank risky health profiles the same way as expected utility are: risk neutrality with respect to healthy time for EXP-HYEs; risk neutrality with respect to time in all health states and additive independence of quality in different periods for RN-HYEs; and constant proportional risk posture with respect to time in all health states and additive independence of quality in different periods for RA-QALYs.
Cost-Utility Analysis of Group Living in Dementia Care
Authors: Wimo Anders , Mattson Bengt , Krakau Ingvar , Eriksson Tua , Nelvig Anders , Karlsson Goran
Published: March 2009

A cost-utility analysis (CUA) was applied to group living for dementia patients. A Markov-model of an expected life-length of 8 years was used. Forty-six patients in group living were compared to 39 patients living at home by inclusion and 23 institutionalized patients. When the cost per gained quality-adjusted life-year (QALY) was calculated, the group living alternative was the most favorable for the patients, giving a cost per paired QALY of US dollars > 0. In the extensive sensitivity analysis the main result was consistent but methodological problems were indicated.
The Use of Technology Assessment by Hospitals, Health Maintenance Organizations, and Third-Party Payers in the United States
Authors: Luce Bryan R. , Brown Ruth E.
Published: March 2009

A case study design was used to determine the reliance on technology assessment of decisionmakers in hospitals, health maintenance organizations (HMOs), and third-party payers. Thirty different organizations were contacted and semistructured interviews conducted. The study found that hospitals, HMOs, and insurers are conducting technology assessments, but the form and sophistication of these analyses range widely. Hospitals are particularly focused on traditional financial analyses (“prudent purchasing”) with the exception of pharmacy committees, which generally conduct more sophisticated socio-economic analyses. HMOs and insurers conduct outcome assessments for coverage of expensive or controversial technologies but exclude economics. Technology assessment will become increasingly important in resource allocation decision making and it is in the interest of technology providers to foster better information, a more comprehensive assessment process, and a more efficient assessment system.
Assessment of Screening Tests for Transfusion-Associated Non-A Non-B Hepatitis
Authors: Fleurette Frederic , Durieux Pierre , Battista Renaldo N. , Benhamou Jean-Pierre , Degos Françoise , Brechot Christian , Courouce Anne-Marie , Janot Christian , Trepo Christian
Published: March 2009

Non-A non-B hepatitis is the most common serious sequela of blood transfusion, and its screening has become an essential goal of blood transfusion centers. Before 1989, two surrogate screening tests (for alanine aminotransferase and for antibody to hepatitis B core antigen) were used; in 1989, a direct test for the antibody to hepatitis C virus (the main agent of this hepatitis) was developed. The French National Agency for the Development of Medical Evaluation undertook an investigation to determine the optimal prevention strategy for posttransfusion non-A and non-B hepatitis (PTH). A detailed literature review was performed, complemented by expert group opinion. The performance of each test was derived indirectly by calculating the number of cases of PTH averted by each test. Hepatitis C virus testing is probably the most promising strategy, but different policies can be developed given the uncertainties of scientific data. Cost considerations should be taken into account in identifying the best screening strategy.
Revisiting the Most Informed Consumer of Surgical Services: The Physician-Patient
Authors: Domenighetti Gianfranco , Casabianca Antoine , Gutzwiller Felix , Martinoli Sebastiano
Published: March 2009

Little is known about the consumption of medical and surgical services by the most informed consumer in the health care market: the physician-patient. Such knowledge should be important for the understanding of the role of information on consumption, supplier-induced demand, the doctor-patient relationship, unnecessary medical services, and the adequacy of professional practices to the real health needs of the “ordinary patient.” We measured by questionnaire the standardized consumption of seven common surgical procedures. Except for appendectomy, the age- and sex-standardized consumption for each of the common surgical procedures was always significantly higher in the general population than for the “gold standard” of physician-patients. The data suggest that (a) contrary to prior research, doctors have much lower rates of surgery than does the general population; and (b) in a fee-for-services health care market without financial barriers to medical care, less-informed patients are greater consumers of common surgical procedures.
The Influence of Health Technology Assessment on the Diffusion of MRI in Australia
Authors: Hailey David M. , Crowe Bernard L.
Published: March 2009

A major assessment of magnetic resonance imaging (MRI) in Australia influenced the early use of this technology and informed policy decisions on future MRI services. However, the impact of the assessment, and of government policy, on the subsequent diffusion of MRI has been more modest, reflecting the limitations of the evaluation process in a complex health care system.
Assessing Technology Assessment: Early Results of the Quebec Experience
Authors: Jacob Robert , Battista Renaldo N.
Published: March 2009

The Quebec Council on Health Care Technology Assessment was created in 1988. Its functions are to promote, support, and produce health care technology assessments and to advise the Minister of Health. An independent review of the council’s first four years of operation was commissioned. The evaluation team concluded that the council showed very good results in terms of the scope, quality, and impact of its production and succeeded in establishing its credibility. However, the evaluation team suggested that the council adopt a more active strategy toward the promotion and diffusion of its reports. Some critical determinants of success of the Quebec experience in technology assessment are discussed.
Appropriate Technology in Primary Health Care: Evolution and Meaning of WHO's Concept
Authors: Cohen J.
Published: March 2009

This article examines the meaning of appropriate technology in the World Health Organization's comprehensive definition of primary care. The author concludes that broad-ranging aspects of health maintenance, such as public health, personal lifestyles, and scientific research, as well as traditional diagnostic and therapeutic practices, need to be subjected to clear and careful scrutiny. It is vital that the results of these technology assessment studies be disseminated as widely as possible to both health care professionals and the public.
Evaluation of Assistive Devices after a Course in Joint Protection
Authors: Nordenskiöld Ulla
Published: March 2009

This study assessed a joint protection education program and investigated the costs and effects of assistive devices. Fifty-three women with seropositive rheumatoid arthritis, whose ages ranged from 29 to 65 years, attended a standardized joint protection course (13 hours). A self-report questionnaire was constructed listing the most common devices, and the subjects were asked to check which devices they had received, which ones they used and did not use, and why. Pain during activities of daily living and when using assistive devices was measured using the visual analogue scale. Results show that the subjects reported great benefits from the joint protection course, assistive devices, and wrist orthosis. The women had tried 663 devices, 91 % of which were still being used. Pain decreased significantly (p < .001) when using assistive devices. The utility of 11 devices at a cost of SEK 1,683 per person can be described as increased capacity and ability to work at home, work outside the home, and perform leisure activities with less pain.
Are People Willing to Pay for a Community-Based Preventive Program
Authors: Lindholm Lars , Rosén Måns , Hellsten Gideon
Published: March 2009

This pilot study is the first known attempt to test the willingness-to-pay or willingness-to-accept (WTP/WTA) method of assessment on a community-based primary prevention program against cardiovas cular disease. The results indicate that the population's perceived WTA outweighs the program's costs by at least three to one. However, the methodological problems of using the WTP/WTA method in community-based programs are far from solved, and further research in this area is required.
Long-Term Technology Assessment: Mortality, Hospitalization, and Work Loss Due to Peptic Ulcer and Gastritis/Duodenitis in the Federal Republic of Germany
Authors: Bloom Bernard S. , Gessner Urs
Published: March 2009

Once the effects of short-term data analysis of new medical technology appear clear, additional or long-term analyses are infrequently performed on subsequent information. This often leads to incomplete understanding of the technology's full medical, social, and economic effects.

Available data for the Federal Republic of Germany on mortality, hospitalization, and work loss due to gastric and duodenal ulcer and gastritis/duodenitis allowed long-term analysis of direct and indirect impacts on the population from 1975 through 1984. Mortality rates declined for all ages (ρ ≤ 0.01) except for those age 75 and older, and nearly equally for all study diagnoses. Hospital discharge rates for all diagnoses rose slowly and steadily, while those for persons diagnosed with gastric ulcer, duodenal ulcer or gastritis/duodenitis declined sharply (ρ = 0.04). Declines of hospital discharges were greater for men than for women. The ongoing decline in rates of mortality and hospital discharges increased after 1977. Rates of work loss per 10,000 population-at-risk for study diagnoses were either stable or increasing until 1979, after which there was a marked decline (ρ = 0.03 for gastric ulcer, ρ = 0.02 for duodenal ulcer, ρ = 0.008 for gastritis/duodenitis). Work loss due to study diseases declined as a percentage of work loss for all diseases during the later study years. Only by examining many years' data could the accelerating declines be discerned, not only for mortality and hospitalizations, which have been examined before, but also for work loss, an infrequently analyzed effect of disease.
Population-Based study of Echocardiography: Time Trends in Utilization and Diagonistic Profile of an Evolving Technology, 1975–1987
Authors: Ballard David J. , Khandheria Bijoy K. , Tajik A. Tamil , Seward James B. , Weber Vernon P. , Melton L. Joseph
Published: March 2009

We evaluated trends in the use of echocardiography among residents of Olmsted County, Minnesota, from January 1, 1975, through June 30, 1987. Annual examinations per 100,000 population among Olmsted County residents increased 6-fold from 264 in 1975 to 1,644 in 1986. Given the pattern of echo use in Olmsted County, these population-based data project a potential annual utilization of 4 million echo exams in the United States. Marked increases over time in labeling of patients with regurgitant valvular heart disease were noted following the introduction of Doppler echocardiography. The diagnostic labeling associated with this evolving technology and the resultant apparent epidemic of valvular regurgitation present a significant clinical technology assessment dilemma.
The Introduction and Evaluation of MRI in Japan
Authors: Hisashige Akinori
Published: March 2009

Not only is the number of computed tomography (CT) units relative to population in Japan the highest in the world, that of magnetic resonance imaging (MRI) units is second only to the United States. This study examines the diffusion pattern of MRI in Japan, as well as the factors that influence it. The number of MRI units has increased sharply, closely following CT, as has been the case in the United States. This pattern of diffusion in Japan was determined mainly by the following factors: the technological attributes of MRI; the market situation of the medical engineering industry; the reimbursement system of health insurance; and Japan's sociocultural background. However, the introduction of MRI in Japan was not linked to any formal assessment of its efficacy or effectiveness.
An Economic Evaluation of the Introduction of Vaccination Against Hepatitis a in a Peacekeeping Operation: The Case of the United Nations Protection Force in Yugoslavia
Authors: Jefferson Tom , Demicheli Vittorio , Wright David
Published: March 2009

The costs and benefits of vaccinating troops on United Nations tours in Yugoslavia against hepatitis A were compared. The marginal cost of one case of hepatitis A avoided by vaccination was calculated and compared with the marginal cost of achieving the same outcome by passive immunization. The cost-benefit ratio (medium estimate) for troops at low risk of contracting hepatitis A was 0.01 and for those at high risk was 0.03.

Vaccinating troops against hepatitis A for a single deployment appears to be an inefficient procedure, especially in troops at low risk. However, in professional troops from countries of low hepatitis A endemicity who are likely to be involved in several operational deployments, vaccination becomes more efficient the more times the same troops are deployed.
Use of the Swedish Microcomputer Alarm System in Care for the Elderly and Disabled: Policy and Practice
Authors: Wallengren Brita , Lindgren Bjön , Ranstam Jonas , Samuelsson Sven-Mårten , Jendteg Stefan
Published: March 2009

This study describes the operation of an in-home alarm system in seven Swedish municipalities. Statistics on the diffusion of this technology, its costs, and the characteristics of its use are reported. Alarms were triggered by 60% of the users. Mean annual costs per recipient varied from SEK 1,985 to SEK 8,215, mainly reflecting different patterns of use.
Technology and Disability: Assessment Needs and Potential
Authors: Hutton John , Persson Jan
Published: March 2009

Abstarct

In assessing technologies for disabled people, the aims of habilitative or rehabilitative interventions, the concepts of disability and handicap, and the potential of existing and emerging technologies in various social arenas, as well as the structure of service delivery systems, are of importance. A discussion of these issues in the light of previous work on cost and effectiveness in the field is given.
Orthoses and Prostheses
Authors: Hailey David M.
Published: March 2009

Abstarct

Orthoses and prostheses include a wide range of devices and strategies for correcting and alleviating dysfunction and disability. Features in these areas of technology include continuing evolution of new devices, further development of well-established approaches, a need for critical assessment, requirements for support from technical and health care workers, and the need to identify funding to achieve efficient programs.
Outcome Measurement in Medical Rehabilitation
Authors: Granger Carl V. , Brownscheidle Carol M.
Published: March 2009

Abstarct

The Uniform Data System for Medical Rehabilitation (UDSmr) provides a method for uniform assessment of the severity of patient disability and the outcomes of medical rehabilitative care. The effectiveness and efficiency of medical rehabilitation services may be analyzed using the Functional Independence Measure (FIM), the functional assessment component of the UDS, and other data. Program evaluation models based on the UDSMR and the FIM are useful for measuring resource cost of disability.
Deciding to Buy Expensive Technology:The Case of Biliary Lithotripsy
Authors: Weingart Saul N.
Published: March 2009

Abstarct

Acquiring expensive, new medical technology requires an evaluation of the efficacy and effectiveness, safety, profitability, feasibility, and risk of a project in the context of the hospital's social responsibility and institutional strategy. A case study of the decision to bring biliary lithotripsy to Strong Memorial Hospital illustrates how these criteria offer managers a coherent approach to difficult and consequential decisions about acquiring medical technology.
Physicians' Opinions and Use of Controversial Technologies: The Case of Mammographic Screening in Norway
Authors: Kristiansen Ivar Sønbø , Natvig Nils Lauritz , Sager Eli Marie
Published: March 2009

Abstarct

In a survey of 196 Norwegian radiologists and 37 breast imaging centers, physicians' preferences were found to be likely to influence the use of mammography. In their decision making, the radiologists appear to be influenced by income motives and by perceptions of the risk of misdiagnosing breast cancer. Despite opinions favorable to mammographic screening, most radiologists would prefer a CT scanner or a magnetic resonance imaging unit to a mammographic unit if the x-ray department were in a position to acquire capital equipment.
Potential Inconsistencies Between Cost-Effectiveness and Cost-Utility Analyses: An Upstairs/Downstairs Socioeconomic Distinction
Authors: Rittenhouse Brian E.
Published: March 2009

Abstarct

This paper indicates that certain economic evaluation methods (cost-effectiveness and cost-utility analyses) may yield inconsistent results. Along with the lack of formal grounding of these methods in economic “first principles,” this finding suggests the possible benefit of greater reliance on the more formally developed method of cost-benefit analysis.
The Work of the National Perinatal Epidemiology Unit: One Example of Technology Assessment in Perinatal Care
Authors: Chalmers Lain
Published: March 2009

This article describes one approach to assessing the effects of perinatal care–that adopted by the National Perinatal Epidemiology Unit in Oxford, England. The unit's research has been based primarily on a combination of simple, descriptive analyses of observational data and statistically robust analyses of evidence derived from randomized controlled trials.
Support in Pregnancy
Authors: Bryce Robert L.
Published: March 2009

Both observational studies and nonrandomized controlled trials have found the presence of support during pregnancy to be associated with superior outcomes in terms of preventing abortion, extending the length of gestation, and reducing interventions in labor. However, randomized controlled trials of supportive interventions in pregnancy have not demonstrated any physical benefits from the interventions. It is also unlikely there are any significant adverse effects. Psychological benefits do appear to result from supportive interventions, including better enjoyment of the pregnancy and better postnatal status.
Assessment of Midwifery Routines: Toward a North/South Collaborative Effort
Authors: Sterky Göran , Ransjö-arvidson Anna-Berit
Published: March 2009

Cooperation in midwifery research between Zambia and Sweden is ongoing. Joint studies on gastric suctioning and maternity routines are used as examples, and breastfeeding is discussed from a global perspective. The midwife, who also interprets responses from mothers, is an important member of an assessment team. Cooperation over cultural boundaries is feasible and mutually rewarding.
Prenatal Diagnosis, Prenatal Screening, and the Rise of the Tentative Pregnancy
Authors: Tymstra Tjeerd
Published: March 2009

More and more medical technologies are becoming available for the early detection of congenital abnormalities, such as amniocentesis, chorionic villus sampling, and ultrasound scanning. Recent research has shown that maternal serum can provide a wealth of information on the unborn fetus and that the testing method lends itself to mass screening. Although screening will prevent a great deal of grief, such developments also lead to extreme medicalization of pregnancy. However, owing to the fact that people show a strong desire to avert every possible approaching calamity, the “tentative pregnancy” seems to be unavoidable.
Medical Technology Transfer in Major Chinese Medical Schools
Authors: Hu Teh-wei , Meng Ying-ying
Published: March 2009

This paper examines how the decision-making process and its consequences affect medical technology transfer in major Chinese medical schools. Data are from a 1987 survey of 13 key medical universities, directly supervised by the Ministry of Public Health in the People's Republic of China. This paper limits itself to four types of laboratory equipment — electron microscopes, UV/VIS spectrophotometers, high-performance liquid chromatographs, and polygraphs. Decisions on the transfer of medical technology have been more decentralized in China since the economic reform in 1978. The major reason for schools to import these four types of equipment is their dissatisfaction with the quality of domestic products. Chinese medical schools depend heavily on the information provided at medical equipment exhibits and their neighboring schools. Their decisions to acquire the equipment are based more on the quality and service available than on the prices. Chinese medical schools face serious infrastructure problems in acquiring and maintaining these pieces of equipment. A number of suggestions are made for improving the efficiency of medical technology transfer in China.
Economic Analysis Alongside Clinical Trials: Revisiting the Methodological Issues
Authors: Drummond Michael F. , Davies Linda
Published: March 2009

Controlled clinical trials are recognized as the best source of data on the efficacy of health care interventions and technologies. Because economic evaluation is dependent on the quality of the underlying medical evidence, clinical trials have increasingly been viewed as a natural vehicle for economic analysis. However, the closer integration of economic and clinical research raises many methodological issues. This paper discusses these issues in trial design, collection of resource use data, collection of outcome data, and interpretation and extrapolation of results. Some guidelines are suggested for economic analysts wishing to undertake evaluations alongside clinical trials.
Assessment, Ethics, and the Randomized Controlled Trial
Authors: Baum Michael
Published: March 2009

Decision-making in surgical practice is a highly complex interaction between the client (patient) and his or her professional advisor (surgeon). The client approaches the professional advisor full of expectations and fears. The expectations may be realistic or unrealistic, and, in the same way, the fears may be justified or unjustified. Furthermore, the client may have a variety of priorities not immediately apparent to the surgeon and may wish to express different degrees of autonomy. For example, some patients may demand the final say in determining the balance between length and quality of survival, whereas others would be happy to allow complete abrogation of their responsibilities to the surgeon, who is invited to make the difficult decisions concerning the patient's utilities. From the viewpoint of the surgeon, the transaction is equally complex, and his or her decisions may be constrained by resource allocation and time available. However, in the final analysis, assuming a beneficent doctor, the most appropriate decision will be determined by the weight of evidence that can be adduced in favor of any intervention.
Nonexperimental Data Systems in Surgery
Authors: Roos Leslie L.
Published: March 2009

This article reviews nonexperimental data bases, emphasizing the present uses and future opportunities of routinely collected information. Data bases are discussed in terms of appropriate research designs. Possibilities for expanding available information through new data collection and through record linkage are stressed. The relationship of nonexperimental data systems to randomized trials and to clinical decision-making is examined.
Microrisks for Medical Decision Analysis
Authors: Howard Ronald A.
Published: March 2009

Many would agree on the need to inform patients about the risks of medical conditions or treatments and to consider those risks in making medical decisions. The question is how to describe the risks and how to balance them with other factors in arriving at a decision. In this article, we present the thesis that part of the answer lies in defining an appropriate scale for risks that are often quite small. We propose that a convenient unit in which to measure most medical risks is the microprobability, a probability of 1 in 1 million. When the risk consequence is death, we can define a micromort as one microprobability of death. Medical risks can be placed in perspective by noting that we live in a society where people face about 270 micromorts per year from interactions with motor vehicles.

Continuing risks or hazards, such as are posed by following unhealthful practices or by the side-effects of drugs, can be described in the same micromort framework. If the consequence is not death, but some other serious consequence like blindness or amputation, the microrisk structure can be used to characterize the probability of disability.

Once the risks are described in the microrisk form, they can be evaluated in terms of the patient's willingness-to-pay to avoid them. The suggested procedure is illustrated in the case of a woman facing a cranial arteriogram of a suspected arterio-venous malformation. Generic curves allow such analyses to be performed approximately in terms of the patient's sex, age, and economic situation. More detailed analyses can be performed if desired.

Microrisk analysis is based on the proposition that precision in language permits the soundness of thought that produces clarity of action and peace of mind.
Appendicitis: The Computer as a Diagnostic Tool
Authors: Clarke John R.
Published: March 2009

At present there is no definitive test for appendicitis and no clear set of signs and symptoms, so that diagnosis is uncertain and probabilistic. A computer model for analyzing clinical data can improve physician accuracy in diagnosing appendicitis by assessing the outcome probabilities associated with the treatment options. Should a definitive test become available, the computer model will aid clinicians in determining when to test. Once our proposed model has been validated, it will not only improve physician decision-making, but also provide quality assurance feedback, generate reports for documentation, and compile a data base of many cases for study and reference.