bluuebunny/crossref_metadata_2025 huggingface dataset:
Stylistic Variations In National Institutes Of Health Consensus Statements, 1979–1983
Authors: Kahan James P. , Kanouse David E. , Winkler John D.
Published: March 2009

This paper describes a content analysis of the statements of 24 Consensus Development Conferences conducted by the Office of Medical Applications of Research (OMAR) of the National Institutes of Health in the years 1979–1983. The goal was to understand the potential influence of the consensus statements by identifying characteristics that might determine whether and how physicians become aware of their findings and adopt their recommendations. Three characteristics emerged, each suggestive of a different style of consensus statement: discursiveness, didacticism, and scholarliness. Variations in style among consensus statements may affect their acceptance by the medical profession
Biotechnical and Other Factors Affecting Orthognathic Surgery
Authors: Isaacson Robert J. , Strauss Robert A.
Published: March 2009

Orthognathic surgery is a rapidly growing biotechnologic interaction involving alterations of facial form
and dental occlusion. This article describes some of the important and complex psychological, sociological,
ethical, and public policy issues involved. Advances in the latter issues are necessary for advancement
of the field.
Pharmaceutical Innovation in the United States: Factors Affecting Future Performance
Authors: Pollard Michael R.
Published: March 2009

Fueled by high returns on its investments, the pharmaceutical industry in the United States has flourished for the past 50 years. The regulatory strategy of demanding stringent testing then allowing market-based pricing has allowed private companies to fund ambitious research and development activities with the assurance that these investments will be recovered. However, aggressive managed-care cost-containment strategies threaten the companies' ability to recoup research and development expenses and may affect their willingness to invest in future innovative research.
The Development of Contraceptive Technology: Case Studies of Incentives and Disincentives to Innovation
Authors: Gelijns Annetine C. , Pannenborg C. Ok
Published: March 2009

This paper examines the characteristics of the process of innovation as applied to a range of contraceptive technologies. Whereas the understanding of how and why innovation works or does not work has grown in the past few decades in such professional fields as electronics, aviation, and optics, only the first attempts are currently under way in medicine. Borrowing from other fields, this paper proposes a theoretical underpinning to the process of innovation as it would apply to the development of medical technology. Subsequently, it documents this process with regard to contraceptive technology (oral contraceptives, injectables, intrauterine devices, implants, and surgical contraception), providing a framework of first-, second-, and third-generation definitions of development. A number of observations about the importance of certain supply- and demand-side determinants of the direction and rate of medical innovation conclude the essay.
How Important is the Scientific Literature in Guiding Clinical Decisions?: The Case of Magnetic Resonance Imaging
Authors: Ramsey Scott D. , Hillman Alan L. , Renshaw Laura R. , Kimberly John R. , Pauly Mark V. , Schwartz J. Sanford
Published: March 2009

Little is known about how information diffuses to clinicians and influences their purchase and use of new technology. This is especially true about the role of the scientific literature. As a case study, we examined the literature for magnetic resonance imaging (MRI) during the years preceding and the first five years following its clinical introduction. Using a computerized retrieval system, we identified approximately 1,700 citations in which MRI was the major topic. The clinical literature on MRI was heavily concentrated in radiology journals. Less than 28% of articles compared MRI with alternative diagnostic technologies. During the first five years of clinical availability, the diffusion patterns of scientific articles and operational units mirrored the example set by computerized tomography (CT), in that a substantial number of units were purchased in both research and nonresearch settings before studies were available comparing them to alternative diagnostic technologies. These patterns of diffusion, combined with other studies of the MRI literature's content and methodology, suggest that less comprehensive and objective sources of information were important in early purchasing decisions. This study also suggests that the present readership and publication patterns of professional journals may not facilitate effective, rapid information dissemination about innovations to a broad spectrum of clinicians.
Analysis of the Use of Multiple Technologies in Neonatal Care
Authors: Almeida Rosimary T. , Panerai Ronney R. , de Carvalho Manoel , Lopes José Maria A.
Published: March 2009

The use of 53 different technologies was studied in 82 patients in a neonatal intensive care unit. Using a coefficient of similarity based on the utilization pattern of these technologies, it was possible to identify five clusters of patients that can be correlated with the primary diagnostic groups and such other variables as birth weight (BW), gestational age, length of stay (LOS), and weight gain. Four interdependent models were identified by multiple regression analysis. The number of different therapeutic technologies applied to these patients can be explained (r = 0.67) by their Apgar scores, gestational age, and an index of severity of illness based on the diagnostic group. The number of different diagnostic technologies used is directly related to the number of therapies delivered (r = 0.63) and, jointly with BW, determines LOS (r = 0.73). Finally, weight gain is explained by LOS and BW (r = 0.65).
Technology Assessment in the Framingham Heart Study
Authors: Roberts Mark S. , D'agostino Ralph B. , Dillon Maureen , Odell Patricia
Published: March 2009

To assess the role of observational data bases in technology assessment, we examined 26 articles from the Framingham Heart Study that evaluated a technology, therapy, or predictive instrument. These assessments were grouped into four categories: (a) the study of a technology voluntarily in use by the cohort, (b) the application of an external technology to members of the cohort, (c) the use of the Framingham results to evaluate an unrelated assessment, and (d) the use of the results to validate predictive instruments from other studies. Factors that contribute to the ability of the study to assess voluntary and external technologies include long-term follow-up, a stable cohort, and storage of such nonnumeric data as cardiograms and blood samples. Framingham results have been used to determine outcome measures in later studies. Although the Framingham Study was not designed to assess a technology, we found that large-scale, observational data bases can and do contribute to technology assessment.
The Development of a Health Technology Assessment Program: The Case of Alberta
Authors: Menon Devidas , Fung Frank , Harstall Christa , O'Connell Petra
Published: March 2009

Canada comprises 10 provinces and 2 territories. The Constitution assigns responsibility for the provision of health services in the provinces to provincial governments. Over the past 5 years, provincial governments have identified technology assessment as a priority. This paper describes an initiative taken by the government of the province of Alberta to develop a health technology assessment program for that province.
The European Community's Research Projects in the Field of Health Services
Authors: Fracchia Giovanni N. , Theofilatou Maria
Published: March 2009

Collaboration within the European Community (EC) over health problems and their possible solutions has progressed significantly during the past decade. The pursuit of appropriate choices among a variety of issues has resulted in a growing demand for comparable health data. EC efforts to coordinate the health services research of the member states in the fourth Medical and Health Research Program (1987–1991) are discussed. Its contribution to the development of information relevant to the EC's health needs as well as financing, policies, and practices is outlined.
Assessing Technologies for Preventing Injuries in Motor Vehicle Crashes
Authors: Chorba Terence L.
Published: March 2009

Motor vehicle crashes are a leading cause of morbidity and mortality. In the Haddon matrix, crashes are divided into three phases and factors affecting each phase. In the context of this matrix, the effectiveness, use, and legislation of safety belts and airbags are discussed, using process, injury, and economic outcome measures.
Assessing Community Interventions to Reduce Smoking
Authors: Mackay Judith , Davis Ronald M.
Published: March 2009

Few major, community-based antismoking programs have undergone specific evaluation in developed countries; the number is even lower in developing countries. Yet not all evaluation need be elaborate, expensive, or overly time-consuming. Data on tobacco trade, import and export, taxation, mortality, and morbidity may already exist within government departments and can be used for evaluation. Published information from the tobacco industry may be obtained easily in trade journals and annual reports. Universities and international and overseas national health agencies may offer information, assistance, and expertise. Indirect evaluation of the importance of any particular antismoking intervention can be measured by how strongly the tobacco industry opposes that measure.
Estimating the Effectiveness of Perinatal Care Technologies by Expert Opinion
Authors: Panerai Ronney B. , Almeida Rosimary T. , Portela Margareth C. , De Carvalho Manoel , Coura-silho Osvaldo , Da Costa Tomas P.
Published: March 2009

The majority of technologies in use in perinatal care were organized into 45 technological functions. Forty-six experts from 19 different regions of Brazil and other Latin American countries then selected a “basic package” (BP) of 15 technological functions. Considering the 12 main causes of perinatal mortality in Brazil, the experts estimated the number of preventable deaths, assuming universal coverage by the BP and the additional reductions that could be obtained by gradually adding other technological functions to the BP. A simulation was performed for the 26 states of Brazil to identify regional priorities for the diffusion of technological functions. For most regions, the BP appears to be the most effective intervention, with the potential of reducing perinatal mortality by 33%, followed by “coordination of services and referral of pregnant women” (14%), and “treatment of respiratory conditions” (11.8%).
Cost-Benefit Analysis of Hepatitis-B Vaccination: A Computerized Decision Model for Spain
Authors: Jönsson Bengt , Horisberger Bruno , Bruguera Miguel , Matter Lukas
Published: March 2009

The availability and efficacy of recombinant deoxyribonucleic acid yeast-derived hepatitis-B vaccine, at a price much lower than the previously available plasma-derived hepatitis-B vaccines against hepatitis-B virus infections, motivate a new cost-benefit analysis of hepatitis-B vaccination. Spanish data were used to calculate direct and indirect costs of hepatitis-B infection and the costs and benefits of different vaccination strategies in defined risk groups of the Spanish population. A vaccination program will reduce direct expenditures for hepatitis B if the attack rate in the target population is higher than 4.9%. If indirect costs are included, the threshold for cost saving is reduced to 0.9%. The results are sensitive to the price of the vaccine, the duration of protection, assumptions about consequences for quality of life, and to indirect costs.
Crisis and Challenges in the Health Care System: A Personal Point of View
Authors: Michaeli Dan
Published: March 2009

Public health care systems in countries all over the world are confronted with increasing difficulties. The problems are mainly economic, but they also reflect difficulties of adaptation to changes both in society as a whole and within the health care services.

The atmosphere of a crisis results from internal struggles within the health care system and with other welfare and social services that face economical difficulties, while confronting accelerated demographical, social, technological, and cultural changes.

The situation is more acute because of the inability of modern society to provide the public health care system with resources (human and financial) according to the expectations that have developed in the welfare state since the end of World War II.

New welfare policy, adjusted to the changes that occur within the society, is needed. In this struggle, the public health services find themselves in the center of the discussion as one of the whole of public social services and in competition with other public welfare systems.

Economical and organizational problems are the most acute and attract a great deal of interest, and they are amply discussed in many articles and conferences. I shall not deal with them in this article.
Introduction
Authors: Stoeckle John D. , Vuori Hannu , Young Donald A. , Jonsson Egon , Reiser Stanley J.
Published: March 2009

The growing attention paid to the evaluation of health care has focused on hospitalbased techniques. Meanwhile, a variety of diagnostic, therapeutic, and administrative technologies have become important, though inadequately understood, additions to diverse health care settings outside of the hospital – notably ambulatory care centers, physicians' offices, and the home. This special section is devoted to an analysis of the technology used in these settings, particularly in the context of primary care.
Technology and The Work of the Doctor Outside the Hospital
Authors: Lorch Stephen
Published: March 2009

This article examines the ends to which technology are employed in the office practice of medicine. It argues that the types of decisions technology supports are of greater impact on how medicine is practiced over the long view than the actual technologies themselves. The more relevant the technologies are to the effectiveness of diagnosis and treatment, the more they drive the practice of medicine toward a standard endeavor. Similarly, technologies that make existing tests and procedures more efficient often reduce the skill level that is needed to provide care. The results of these forces coupled with the increasing administrative, economic, and regulating pressures lead to a diminished role for physicians unless a conscious effort is made to introduce technologies that enhance their unique and discretionary work with patients.
Medical Diagnostic Tecynology in the Home
Authors: Richter James M. , Goodson John D. , Barry Michael J. , Treadway Katherine K.
Published: March 2009

This article studies the issues surrounding the assessment of several home diagnostic tests. First, the authors review the current data and proper use of fecal occult blood and pregnancy tests. Second, they evaluate the roles of blood and urine glucose monitoring in the management of diabetes mellitus and home pressure monitoring in the management of hypertension. The authors conclude that while home measurement of blood pressure or blood sugar can be recommended to improve compliance with medical programs, home fecal occult blood testing, while helpful, has not been fully investigated.
Technology Assessment and Primary Health Care in Europe: Issues and Problems
Authors: Vang Johannes
Published: March 2009

This article highlights some of th issues ralsed by technology and primary health care (PHC) in the Western lndustrialized world. The author contends that while technology assessment has been focused mostly on hospital-based technology, the wider scope of PHC demands comprehensive assessment projects that would examine virtually every aspect of public health.
The Assessment of Medical Technology: The Case of France
Authors: Weill Caroline , Fagnani Francis , LeFaure Christian
Published: March 2009

The French health system is a complex organization that has developed since 1945 as the result of a subtle combination of two fundamental principles: liberal medicine — the freedom of both the consumers and the producers of care, and solidarity — universal access to health care — embodied in a quasi-generalized system of health insurance (4).

Today, this balance, to which the French are uncontestably dedicated, appears to be precarious. It has gradually become apparent that the financing system—80% of which is based on mandatory deductions and is intended to guarantee the balance between freedom of choice and universal access — is not consistent with the dynamic of health expenditures. The growing costs of care, as witnessed by the increase of health expenses as a percentage of total household expenses from 4.5% in 1950 to 13.3 in 1985, has led to increased state control over the health care system since 1975.
Use of a Home-Care Computer Network by Persons With AIDS
Authors: Brennan Patricia Flatley , Ripich Stefan
Published: March 2009

Computer networks serve as convenient, efficient, and enduring vehicles for delivering nursing services to patients at home. The ComputerLink, a specialized computer network, provided nurse-supervised information, decision support, and communication services to home-dwelling persons living with AIDS (PWAs). During a 26-week randomized field experiment, 26 PWAs accessed the ComputerLink on more than 8,664 occasions. The communications area was used most often; the public communication area functioned like a support group. Multiple behavioral measures of use provide a rich picture of how these PWAs, none of whom had had prior computer experience, adopted and adapted to this innovative nursing care delivery system. Meeting the needs of a rapidly growing and diverse population of home-care clients demands that nurses make effective use of existing technologies such as cable television and telephone triage systems. Computer networks combine the best features of cable television and telephone systems—broadcast distribution and interaction; therefore, computer networks represent an ideal technology for the delivery of certain nursing services to the home.
Women, Health, and Medical Technology
Authors: Stauning Inger
Published: March 2009

New medical technologies are often developed and diffused in health care without societal assessments or setting of priorities. This article discusses the driving forces behind the development of new technologies and asks how women as users and providers of health services can gain influence on the process. Technologies used in pregnancy and childbirth are discussed to reveal different interests in their development and use and to discuss the role of industry in the development of new medical technologies in general.
Technology Assessment Applied to Liver Transplantation in Adults
Authors: Foster Willis R. , Burton Benjamin T.
Published: March 2009

This article is a review of liver transplantation in adults, in the context of ongoing technology assessments of the National Institutes of Health (NIH). Liver transplantation in adults has become an accepted therapeutic procedure for end-stage liver disease, as it is practiced in established programs of a number of experienced institutions. The number of medical centers instituting programs of liver transplantation has greatly increased since the 1983 NIH Consensus Conference on this subject, and this article traces the clear relationship between the experience level of the institution and the end result of adult transplantation. Five determinants of the survival rate, safety, and efficacy of liver transplantation are discussed: the supply of donor organs, the selection criteria for transplantation candidates, surgical technique, the support system and support staff available, and adequate suppression of the immunological response. Medical diagnoses most likely to produce successful results are enumerated.
The Imperative Character of Medical Technology and the Meaning of “Anticipated Decision Regret”
Authors: Tymstra Tjeerd
Published: March 2009

Medical-technical possibilities are often experienced as being strongly compelling. This imperative character of medical technology not only applies to the medical profession, but also to patients who frequently find it very difficult to refuse medical examinations or treatments. This article discusses the technological imperative with regard to patients. It attempts to discover relationships with decision theory, particularly concerning “anticipated decision regret:” The fact that prevention of regret plays an important role in the use of medical technology is illustrated through a number of examples: liver transplantation, prenatal diagnosis, screening, and in vitro fertilization.
Innovation and Diffusion of Health-Related Technologies: A Conceptual Framework
Authors: Battista Renaldo N.
Published: March 2009

The development and diffusion of health-related technologies constitute an extremely complex process. This article examines the phenomenon of technological innovation; discusses the factors determining the diffusion of high, medium, and low technologies; and suggests strategies for controlling the diffusion of these technologies. A research program is also proposed that should improve our understanding of the process of development and diffusion of health-related technologies.
A Comparison of International Health Outcomes and Health Care Spending
Authors: Babazono Akira , Hillman Alan L.
Published: March 2009

Does increased spending improve health outcomes? We analyzed 1988 data from OECD countries to determine how key health care indexes correlate with health care outcomes. Total health care spending per capita and outpatient and inpatient utilization are not related to health outcomes. How our resources are allocated seems to be more important than how much money is actually spent.
Management of Acute Otitis Media:Assessment of Therapeutic Strategy in Japan Today
Authors: Ikeda Shunya , Tsuchihashi Nobuaki , Kawashiro Nobuko , Kanzaki Jin
Published: March 2009

Currently, myringotomy is widely used in the routine initial treatment of acute otitis media in Japan. In an attempt to evaluate the validity of this strategy, a number of issues that demand reassessment or clarification have been identified. These issues and factors contributing to the persisting uncertainty about myringotomy are examined.
Some Factors to Consider when Using the Results of Economic Evaluation Studies at the Population Level
Authors: Leidl Reiner M.
Published: March 2009

The cost-effectiveness of a medical intervention at the population level may deviate from that reported for evaluations at the patient level. It is important for researchers and decision makers to know about the relevance of externalities, phasing-in effects, treatment effectiveness in the community, capacity issues, and different time perspectives in the evaluation of an intervention.
Diffusion of In-Vitro Fertilization in the Netherlands and England: An Exploratory Study
Authors: de Wit Ardine , Banta David
Published: March 2009

In-vitro fertilization (IVF) is a relatively recent approach to overcoming human fertility problems. This study explored factors in the diffusion of IVF in England and in the Netherlands. Many factors were common to the two countries. Governments in both countries have been passive, apparently wishing to avoid entering a controversial field. Technology assessment has played little part in the diffusion process in these two countries.
Economic Evaluation of Trends in Cancer Therapy: Marginal or Average Costs?
Authors: Goddard Maria , Hutton John
Published: March 2009

Evaluating the use of resources as well as outcomes in cancer therapy is increasingly becoming recognized by both clinicians and others as a legitimate and indeed even desirable activity. While this trend is to be welcomed if it facilitates the efficient use of resources for cancer care, there are dangers in applying estimates of unit costs, in particular average costs to the evaluation of trends in practice in cancer therapies. This article examines the use of appropriate measures of average and marginal cost in the economic evaluation of developments in cancer therapy, taking illustrations from radiotherapy and chemotherapy.
Costs of Breast Cancer and the Cost-Effectiveness of Breast Cancer Screening
Authors: Elixhauser Anne
Published: March 2009

Breast cancer is the second leading cause of death by cancer among women in the United States. The total cost of illness for breast cancer has been estimated to be $3.8 billion, of which $1.8 billion represents medical care costs. It has been estimated that breast cancer detected early is considerably less expensive than when the tumor is discovered at a later stage. Mass screening using mammography can improve early detection by as much as 15–35%. Cost-effectiveness studies have estimated that the costs of breast cancer screening range between $13,200 and $28,000 per year of life saved. The cost-effectiveness of breast cancer screening in the 40–49-year-old age group is controversial. Mass screening for breast cancer will probably increase total health care costs, but when all economic costs are included, screening appears to be more cost-effective than not screening.
Pragmatic Versus Explanatory Trials
Authors: MacRae Kenneth D.
Published: March 2009

This article considers the distinction between “explanatory” and “pragmatic” aims in clinical trials—the distinction between testing a biological hypothesis and providing evidence to permit a choice between alternative treatment policies. The choice of treatments to compare, the selection of patients for the trial, the study size, and how the treatment comparison should be made are among the matters discussed. In general, where explanatory and pragmatic aims conflict, the pragmatic aim will often take priority.
Treatment Outcomes and Quality of Life
Authors: Ebbs Stephen R. , Fallowfield Lesley J. , Fraser Simon C. A. , Baum Michael
Published: March 2009

Physicians through the ages have practiced their trade with more or less regard to the effects of their treatment on their patients' sense of well-being, if not as much as on the disease itself.

Until recently, however, little attempt has been made to measure the effect of disease upon quality of life and how this quality is or is not improved by the treatment. Several means have now evolved and in areas of medicine where the treatment may profoundly affect the patient's sense of well-being, effort is being made to gauge these consequences.
The Assessment of Technology and Quality: A Comparative Study of Certainties and Ambiguities
Authors: Donabedian Avedis
Published: March 2009

Though technology assessment and quality assessment have much in common, they differ significantly in emphasis. Technology assessment judges technology itself; quality assessment examines the extent to which a technology is used well in its various settings. This article explores the nature of quality assessment–including the performance of individual practitioners as they care for individual patients and the care received by communities–and examines its interrelationship with technology assessment.
The Use of Combined Estrogen-Progestin Replacement Therapy: An Example of the Dissemination of New Indications for an Old Technology
Authors: Hemminki Elina
Published: March 2009

The evaluation of innovations which use old technology poses different problems than does the evaluation of new technologies. The main necessity is the targeting of its use rather than the technology itself. The need to evaluate the extent of use and its problems is illustrated by the example of progestin use among menopausal and postmenopausal women in the United States. There progestins are not of ficially approved for use in menopause, even though they have been on the market for a long time with other indications. Estrogen-replacement therapy was widely used from the early 1960s until 1975, when the claim that estrogens cause endometrial cancer notably decreased their use. The use of estrogens increased again in the early 1980s, and one reason for this revival was the claim that progestins offered protection against endometrial cancer. When recommendations for combined estrogen-progestin therapy have been made, other health effects have been ignored. Two consensus conferences as well as the drug control authority have recommended against combined estrogen-progestin therapy until further research is completed. Absence of good research, specialization in medicine, and advantages for prescribers and the drug industry may have contributed to the wide use of this unassessed treatment. Possible solutions for prevention of the diffusion of these kinds of innovations are discussed.
Decision-Making and the Health Sector in Argentina CEA and the Use of Nitrous Oxide in Anesthesia
Authors: Tieffenberg Jacob A. , Wood Irene , Pino Hernan Del , Berbeglia Alberto , Marké Lars A.
Published: March 2009

We analyze Argentina's demographic and socioeconomic data as the context for understanding its health sector. Health expenditures and the number of physicians are high in Argentina. Health coverage is extensive, but covers only about 50% of the per capita expenditures. The high expenditures in health do not correlate with improvements of indicators such as infant and general mortality. Evaluations of the way health care is provided are insufficient. Argentina's “medical-intensive” model of health is responsible for the expansion of the “small-ticket technology”, which accounts for a significant proportion of the increase in health expenditures. With this picture, we believe that health decision-makers could benefit from cost-effectiveness analysis (CEA), because this technique stresses the relationship between expenditures and appropriately defined goals. As a demonstration project, we look at the way that technology is used in Argentina using CEA to assess anesthesia procedures. The results of our study show that increasing the use of N2O would save us $670,000 per year, and 10,300 years of life to surgical patients of all ages.
Crucial Questions for Physiotherapy in Finland
Authors: Paatero Heidi , Holma Tuula , Leisti Seppo
Published: March 2009

When planning for health services, questions of production and distribution as well as cost and quality are key issues for health planners and decision makers. The lack of available objective data often makes this work difficult. This paper presents recent efforts in Finland to improve the collection of information needed for planning in the field of physiotherapy.
Outcome Assessment in Cardiac Rehabilitation
Authors: Michel Theresa Hoskins
Published: March 2009

Cardiac rehabilitation outcome assessment has reflected the isolated concerns of different professionals, each addressing different factors of the problems of patients. Physical, medical, psychosocial, and epidemiological approaches have been taken. Discrepancies in findings may relate more to problems with assessment than to the technology itself, and can undermine the usefulness of the intervention.
Perspectives in Genetic Screening: Principles and Implications
Authors: Kaback Michael M.
Published: March 2009

Recent advances in genetic identification and characterization of a number or hereditary disorders have led to increased possibilities for genetic testing and screening. The context and methods of screening are important given that identification of otherwise healthy persons as being presymptomatic or at increased risk for genetic diseases may have serious consequences for their future lifestyle, employment, and insurability. This article examines general principles for genetic screening, including goals, delivery issues, and professional and lay responses to screening and counseling, and recommends areas in which social psychological research on screening is needed.
DNA Diagnosis in Monogenic Diseases
Authors: Alford Raye Lynn , Rossiter Belinda J. F. , Caskey C. Thomas
Published: March 2009

Several routine procedures are available for diagnosis of diseases caused by an alteration in a single gene. These techniques include Southern analysis, the polymerase chain reaction, allele-specific oligonucleotide screening, automated DNA nucleotide sequencing, and linkage analysis. DNA testing procedures can be used for diagnosis of disease, determination of carrier status in affected families, or general screening of the population. Some of the more commonly used techniques and their applications are described in this article.
Giving, Receiving, Repaying: Gamete Donors and Donor Policies in Reproductive Medicine
Authors: Novaes Simone B.
Published: March 2009

Current practices of donor recruitment for medical fertilization procedures are analyzed in the light of Marcel Mauss' essay on the gift in primitive societies. In this perspective, donor policies seem primarily designed to spare infertile recipients the obligation to recognize the donor's contribution to these procedures, thus avoiding the kinship issues that they raise. Questions of meaning concerning donation, social recognition of the donor's role, and clarification of the relational issues underlying fertilization procedures are nevertheless essential elements in establishing their social legitimacy.
The Prescription as Final Common Pathway
Authors: Avorn Jerry
Published: March 2009

There is an informational void about Pharmaceuticals in the training of most doctors, despite the importance of the prescription in medical care. The writing of the prescription is the final common pathway in therapeutic decision making, which involves such diverse forces and disciplines as anthropology, decision science, health economics, ethics, and politics, as well as pharmacology and clinical medicine. Programs to improve the precision and cost-effectiveness of doctors' prescribing must consider all of these factors if pharmacotherapeutics are to be used optimally.
Information on Marketed Drugs for Doctors and Patients: Experience in Six European Countries
Authors: Brown Philip , Charlish Peter , Brazier Helen , Butterfield Michael
Published: March 2009

This article describes a project that looked at the availability of information on marketed pharmaceutical products to doctors and patients in six European countries. It examines the legal status of the drug compendia published in each country and reports on the Implementation of EC Directive 92/27/EEC on labeling and packaging. A small survey showed that it is hard to compare patient information because it is difficult to obtain copies of pack inserts available in each country. However, a limited analysis revealed some differences in the content and presentation of data for doctors and patients.
Rational Prescribing and Interpractitioner Variation:A Multilevel Approach
Authors: Davis Peter , Gribben Barry
Published: March 2009

There are marked geographical variations in rates of medical and surgical intervention at every level of aggregation and in every aspect of medical practice. These data raise a range of important theoretical, methodological, and policy issues. Much the same pattern of variation characterizes the prescription and consumption of therapeutic drugs. Data from a survey of general practice in New Zealand confirm the existence of extensive variability in prescribing. Multilevel techniques are deployed to isolate the specific interpractitioner element in this variability. Controlling for patient, diagnostic, and practitioner variables improves the predictive power of the model but does not reduce the extent of interpractitioner variability in prescribing rates. The existence of such variability raises questions about the role of clinical uncertainty and professional autonomy in the promotion of rational therapeutics in medical practice.
The Rational Use of Therapeutic Drugs in the 21st Century:Important Lessons from Cumulative Meta-analyses of Randomized Control Trials
Authors: Lau Joseph , Chalmers Thomas C.
Published: March 2009

The use of randomized control trials to assess the usefulness of therapeutic drugs over the last half century has brought significant benefits to patient care. The full potential benefits, however, have been only partially fulfilled because available data are frequently poorly used. Meta-analysis has emerged as an important tool for combining clinical evidence. Several examples are presented that compared the results of cumulative meta-analysis of randomized control trials with clinical expert recommendations. These comparisons demonstrated that clinical expert recommendations are often not synchronized with accumulating evidence, and this lack of recognition often resulted in delays in the acceptance of effective drugs and the slow abandonment of possibly harmful therapeutic practices. The problems of inappropriate therapeutic drug use will only intensify as new drugs are introduced and new uses for established drugs are proposed. The rational use of therapeutic drugs can be achieved only through the routine use of meta-analysis on high-quality clinical data. Some suggestions are made to improve the quality of the original research and the ways of assembling meta-analyses and disseminating their results.
Medical Device Education among Australian Registered Nurses:A Comparison of Agency and Hospital Nurses
Authors: McConnell Edwina A. , Fletcher Jan , Nissen Jutta H.
Published: March 2009

A cross-sectional survey was used to compare the medical device education of 142 agency- and 443 hospital-employed Australian registered nurses. The two groups differed significantly on descriptive characteristics and on what they had learned about medical devices. Potential negative aspects of device use were nurse stress and patient harm, with a significantly larger proportion of hospital nurses indicating their use of any medical device had made them feel stress. Fear of harming the patient and being unsure of how to use the device caused stress in the majority of nurses. The incidence of patient harm was approximately 10% for each group.
The Political Dimension in Health Care Technology Assessment Programs
Authors: Banta H. David , Andreasen Per Buch
Published: March 2009

This article considers technology assessment (TA) to be a comprehensive form of policy research. Technology assessment must then have a relation to policy-making; in the area of health care, TA must relate to such political decisions as resource allocation. Since policies are determined politically, i.e., by factors such as power and influence, technology assessment is, or should be, part of a political process. Technology assessment seems to be developing predominantly as a technical and professional activity, carried out in centers with no relation to the policy-making process. While the impact of technology on health, as well as such broader impacts as those on financial costs, is a key concern, political considerations and political decision-making must always be an important dimension in health care TA.
Investing in Health Wisely: The Role of Needs-based Technology Assessment
Authors: Jamison Dean T. , Saxenian Helen , Bergevin Yves
Published: March 2009

Countries worldwide spend huge sums on health—about $1,700 billion a year, or roughly 8% of global income. But the World Development Report 1993: Investing in Health shows that these monies could be spent much more wisely, in the process doing a great deal to help the world's 1 billion poor. Essential national public health and clinical packages are proposed based on assessment of the burden of disease (measured in disability adjusted life years) and the cost-effectiveness of interventions. Governments can play a central role in improving the health of their citizens: they can foster an environment that enables households to improve health and they can also improve their own spending on health, targeting it to support universal access to essential national public health and clinical packages based on the above methods. This is a good example of the concept of needs-based technology assessment, combining the disciplines of epidemiology, economics, and policy formulation. When applied, it should lead to improved effectiveness, efficiency, and equity.
Pharmacoeconomic Studies: Pitfalls and Problems
Authors: De Graeve Diana , Nonneman Walter
Published: March 2009

The literature on economic evaluation of Pharmaceuticals is growing rapidly. Although there have been substantial methodologic advances, there remain serious problems and pitfalls. This presentation focuses on three aspects, i.e., use (and abuse) of evaluation studies, methodologic problems, and the quality of published studies.
Health Status Index Models for Use in Resource Allocation Decisions:A Critical Review in the Light of Observed Preferences for Social Choice
Authors: Nord Erik
Published: March 2009

In the last two decades a number of health status index models have been developed for assessing the value of health outcomes in terms of quality-adjusted life years. The models can be tested by comparing their implications with direct observations of how societies think resources should be distributed across patient groups. This paper reviews empirical evidence of this kind from various countries and summarizes the evidence in three rules of thumb for selecting values for health states. Nine different models are judged relative to these rules of thumb. Eight of the models underestimate the strength of social preferences for treating the severely ill before the less severely ill. The ninth has a strong bias against states associated with emotional distress. As a consequence, none of the models can be seen as sufficient stand-alone instruments for valuing health outcomes. Instead, the models may be seen as complementary and adjustable parts of a tool kit that should also include the rules of thumb suggested in this paper.
A Multinational Economic Evaluation of rhDNase in the Treatment of Cystic Fibrosis
Authors: Menzin Joseph , Oster Gerry , Davies Linda , Drummond Michael F. , Greiner Wolfgang , Lucioni Carlo , Merot Jean-Louis , Rossi Franco , Schulenburg J. Graf , Souêtre Eric
Published: March 2009

Economic evaluations of Pharmaceuticals are increasingly being conducted in conjunction with randomized phase III clinical trials to meet the demand for pharmacoeconomic data when new products are launched. While the need for such data is often global, the trials in which relevant information may be collected are often conducted in only one or a limited number of countries. A critical issue is how data from pivotal clinical trials in one setting can serve as the basis for pharmacoeconomic evaluations in others. We address this issue and report on four economic evaluations that we undertook in conjunction with a recent U.S. phase III clinical trial of recombinant human deoxyribonuclease (rhDNase), which is used to improve pulmonary function in patients with cystic fibrosis (CF). The objective of these evaluations was to estimate the potential impact of rhDNase therapy in France, Germany, Italy, and the United Kingdom on the direct costs of medical care for the treatment of respiratory tract infections (RTIs) in patients with CF. Analyses of economic impact were undertaken
Assessing Health Benefit from Hospitalization: Agreement Between Expert Panels
Authors: Eriksen Bjørn O. , Almdahl Sven M. , Hensrud Anne , Jæger Steinar , Kristiansen Ivar S. , Mürer Fred A. , Nord Erik , Pape Jan Fr. , Robertsen Reidar , Thorsen Glen
Published: March 2009

Agreement between two expert panels in assessing gain in life expectancy and quality of life from unselected stays in a department of internal medicine was investigated. Weighted kappa statistics of 0.45 for gain in life expectancy and 0.63 for gain in quality of life were found.
Generations of Misplaced Confidence: A Personal View
Authors: Stolley Paul D.
Published: March 2009

A humorous look at one family's experience with the milestones of medical achievement illustrates the need for continued research on the efficacy of treatment. Skepticism about the benefits of new treatments and careful examination of even standard procedures should be encouraged within the medical profession.
Competing or Complementary?:Ethical Considerations and the Quality of Randomized Trials
Authors: Lumley Judith , Bastian Hilda
Published: March 2009

The ethical principles of beneficence (doing the best for one's patients and clients), nonmaleficence (doing no harm), autonomy, justice, and equity, are positively associated with the quality of a trial rather than being opposed to it. Ethical considerations involve such important questions as appropriate design and documentation, participation rates, withdrawals or losses to follow-up, careful monitoring of safety and efficacy, timely completion, generalizability, and publication and dissemination of findings. When conflicts between ethical considerations and the trial's scientific quality do occur, the ethical considerations must be paramount.
Collecting the Evidence Systematically:Ensuring That It Is Complete and Up-to-Date
Authors: Enkin Murray , Hetherington Jini
Published: March 2009

A complete and comprehensive search of the relevant evidence is an essential step in the preparation of a scientific systematic review. The Cochrane Pregnancy and Childbirth Database consists of some 600 systematic reviews, based on almost 6,000 randomized or quasi-randomized trials of care during pregnancy and childbirth. As ascertainment from electronic search of the National Library of Medicine MEDLINE database was not complete, the mainstay of our search strategy was a systematic hand search of some 60 journals, beginning with volumes published in 1950. Additional references were obtained from the list of references in primary research reports and conference reports. A major effort was made to identify unpublished trials and to obtain unpublished data from published trials.
The Impact of the Technological Care Environment on the Nursing Role
Authors: Pelletier Dianne , Duffield Christine , Adams Anne , Crisp Jackie , Nagy Sue , Murphy Jillian
Published: March 2009

Proliferation of acute health care technology creates problems and benefits for nurses and patients. In this paper the impact of technology on the nursing work role is reviewed through the international literature. The thrust of the nursing literature has, not surprisingly, matured over time as the use of technology has become well established in the acute care environment, and three themes can be identified. The implications for acute care nurse specialists, including their educational needs, are set in context of the Australian health care system, with particular reference to the cardiac care environments.
Can Information on Cost Improve Clinicians' Behavior?: Lessons from Health Care Trials and Management
Authors: Lowet Peter F. , Eisenberg John M.
Published: March 2009

Facing intense price competition and societal pressures, health care provider organizations have focused increasingly on the cost-effectiveness of medical services. In instances when there is insufficient evidence that a more expensive treatment course generates improved outcomes, the lower cost option is often encouraged. Yet, with resource utilization still determined principally by individual physicians, large practice variations often persist. This paper reviews the literature and explores the impact of sharing cost information on physicians' practice patterns utilizing management theory concepts. More research should be conducted to determine long-term benefits of educational interventions, physicians' fundamental views on the relationship between cost and quality and its effect on their responsiveness to cost information, and the role of leadership in changing clinical behavior.