bluuebunny/crossref_metadata_2025_split huggingface dataset:
A Cost-Effectiveness Analysis of Neonatal ECMO Using Existing Evidence
Authors: Howard Sarah , Mugford Miranda , Normand Charles , Elbourne Diana , Grant Adrian , Field David , Johnson Ann 
Published: March 2009

AbstractA cost-effectiveness analysis is part of the U.K. ECMO Trial. In preparation for this analysis, existing evidence on the costs and effectiveness of neonatal ECMO was evaluated. ECMO appears to be more costly but may be more or less effective than conventional treatment. No case can be made for introducing ECMO before trial results are available.
Technology and Staffing in Japanese University Hospitals: Government Versus Private
Authors: Vogt William B. , Bhattacharya Layanta , Kupor Scott , Yoshikawa Aki , Nakahara Toshitaka 
Published: March 2009

AbstractWe examined staffing levels, acquisition of medical technologies, and utilization of those technologies in private and government teaching hospitals in Japan. Adjusting for size and case mix, we found that government hospitals acquire more technology, use that technology less, and employ a more highly skilled staff than do private hospitals.
Bias in the Analysis and Reporting of Randomized Controlled Trials
Authors: Stewart Lesley A. , Parmar Mahesh K. B. 
Published: March 2009

AbstractThe most reliable information on any type of medical intervention is provided by the results of randomized clinical trials (RCTs). In response to increasing pressure to make effective use of limited resources, increasing numbers of health professionals rely on the medical literature, in particular reports of RCTs. However, RCTs may be influenced by a number of factors that introduce bias during the conduct, analysis, and reporting of the trial. Trials may be described as random, when in fact only quasi-random means of treatment allocation have been used; patients may be selectively removed from the analysis; and the report may restrict presentation to or give undue emphasis to only the analyses that yield positive results. The implications of such bias are discussed with particular reference to the effect that they may have on reviews and meta-analyses.
Awareness of Providers' Use of New Medical Technology Among Private Health Care Plans in the United States
Authors: Powe Neil R. , Steiner Claudia A. , Anderson Gerard F. , Das Abhik 
Published: March 2009

AbstractIn a national survey of medical directors at 231 U.S. private health care plans that cover over two thirds of the privately insured population, we studied whether medical directors are aware when a new technology, such as laser therapy, is being used in procedures for which claims are submitted, the factors alerting them to such use, and the factors prompting them to make a specific coverage decision for the technology. We also examined possible associations between health plans' characteristics (HMO versus indemnity, size, profit status, and time in operation) and their medical directors' awareness of the use of technologies, factors alerting medical directors to their use, and factors prompting specific coverage decisions. The majority of plans were generally not aware that laser technology was being used when it was billed under a general billing code, raising the possibility that less effective or less safe technologies could be introduced rapidly into the treatment of insured populations. Nonprofit and older plans were less likely to be aware that lasers were used in some procedures than for-profit and younger plans.
Low-Cost Therapeutic Agents:Uses and Abuses
Authors: Bunker John P. 
Published: March 2009

AbstractThe past quarter century has seen a transformation of the pharmaceutical industry from blind empiricism to the design of drugs to act as agonists or antagonists at specific receptor sites. As truly effective technology, many have led to marked savings in cost. Savings have been achieved when therapeutic drugs, often highly specific, can be substituted for surgery and other invasive procedures and when therapeutic drugs can be used to prevent illness and the need for treatment. Further savings are achieved with the reduced prescription of ineffective drugs. It is estimated that therapeutic drugs and vaccines contribute about half of medicine's contribution to increased life expectancy and improved quality of life in this century at about 7% of national expenditures for medical care in the United States.
The Effect of Dissemination of Recommendations on Use: Preoperative Routines in Sweden, 1989—1991
Authors: Brorsson Bengt , Arvidsson Svante 
Published: March 2009

AbstractThe purpose of this study was to monitor changes in preoperative routines following recommendations given in 1989 by the Swedish Council on Technology Assessment and by the Swedish Consensus Conference on Preoperative Routines, both suggesting a more individualized utilization of preoperative testing. This was a multicenter, prospective, repetitive study conducted at seven Swedish hospitals providing surgical care. The subjects included all patients presenting at the operating theaters for surgical interventions requiring general or regional anesthesia. The main outcome measures were the frequency of reports of performed preoperative ECG, chest x-ray, and analysis of serum concentration of potassium. Before general recommendations were issued in 1989, 47% of the patients had had a preoperative ECG, 26% had had a chest x-ray, and in 61% serum potassium concentration had been measured. In 1991 these frequencies had been reduced by 5,6, and 9 percentage points, respectively (all figures given standardized for age and sex). Large differences were found between indidividual hospitals. Although recommendations suggesting a more restrictive and individualized utilization of preoperative testing have sparked important revisions in Swedish hospitals, there seems to be substantial potential remaining for further reduction of perfunctory use of preoperative screening.
Economic Evaluation of Diagnostic Technology:Methodological Challenges and Viable Solutions
Authors: Sassi Franco , McKee Martin , Roberts Jennifer A. 
Published: March 2009

AbstractThe principles of economic evaluation are increasingly accepted by clinicians and policy makers as evidence from a significant number of studies becomes available to support their decisions. However, methods of assessment still need to be improved. This paper reports a comprehensive review of methodological challenges in the economic evaluation of diagnostic technology, where such challenges are more evident. This review formed the basis for a prioritized research agenda, with four main areas: modeling techniques for dealing with complexity; measures of the opportunity cost of shared resources; techniques for eliciting decision makers' utility functions for diagnostic tests; and ways of assessing the robustness of decisions. A number of methodoligical solutions are proposed, aimed at capturing elements and relationships that are usually neglected and fully recognizing the presence of an inductive cognitive component in decision-making processes.
The Status of Health Technology Assessment Worldwide: Results of an International Survey
Authors: Perry Seymour , Gardner Eric , Thamer Mae 
Published: March 2009

AbstractHealth technology assessment (HTA) has increasingly become a valuable tool to examine effectiveness, quality of care, patient outcomes, and cost-effectiveness of health care technologies. In 1994 and 1995, a survey was conducted to document the scope of worldwide HTA activities; 103 organizations from 24 countries responded. This paper summarizes the results of this international survey, including a description of each country's program, types of technologies assessed, methodologies used, and dissemination approaches. Results for Canada, the United States, and European and other countries are presented separately.
How Should we Research Unconventional Therapies?A Panel Report from the Conference on Complementary and Alternative Medicine Research Methodology, National Institutes of Health
Authors: Vickers Andrew , Cassileth Barrie , Ernst Edzard , Fisher Peter , Goldman Peter , Jonas Wayne , Kang Sung-Keel , Lewith George , Schulz Ken , Silagy Chris 
Published: March 2009

AbstractResearch in unconventional medicine requires a number of different questions to build up a “mosaic” of evidence. Choice of research design depends on the question being asked and is independent of the therapy under investigation. Despite the doubts of some practitioners, randomized trials are of value for determining certain questions in alternative medicine.
Promoting Consumers' Demand for Evidence-Based Medicine
Authors: Domenighetti Gianfranco , Grilli Roberto , Liberati Alessandro 
Published: March 2009

AbstractThe widespread implementation of rationing and priority-setting policies in health care opposes the stochastic practice of medicine induced by professional uncertainty and professional vested interests in market-oriented clinical environments. It also clashes with consumers' overly optimistic and “mythical” view of the effectiveness of medicine, which is bound to support a potentially unlimited provision of health services. Thus, for consumers and society at large, it is necessary to create conditions favorable for a more conscious demand of evidence-based health care. In pursuit of this goal, we suggest the adoption of a community-oriented strategy based upon delivery of information to the public in order a) to generate greater awareness (“healthy skepticism”) among consumers, through disclosure of data on the true effectiveness of health care interventions and on the existing variation in their utilization, and b) to provide tools to empower consumers in dealing better with both the uncertainty in their own individual patient-physician relationships and with the health policy issues to be faced in the future. Such a community-oriented strategy could also reinforce and support, through the generation of a “bottom-up” pressure from consumers toward physicians, a wider adoption of evidence-based interventions by health care professionals. This paper, using data from surveys on public opinions and attitudes toward the practice of medicine, focuses on how consumer demand for more evidence-based medical practice can be promoted.
Economic Analysis of Tirilazad Mesylate for Aneurysmal Subarachnoid Hemorrhage:Economic Evaluation of a Phase III Clinical Trial in Europe and Australia
Authors: Glick Henry , Willke Richard , Polsky Daniel , Llana Ted , Alves Wayne M. , Kassell Neal , Schulman Kevin 
Published: March 2009

AbstractThis study used data from a multinational phase III randomized, double-blind, vehicle-controlled trial to evaluate the cost-effectiveness of tirilazad mesylate (Freedox®) in the treatment of aneurysmal subarachnoid hemorrhage. In men, therapy with 6 mg/kg per day of tirilazad mesylate was associated with significantly increased survival, increased cost of care, and ratios of cost per death averted that compare favorably with the ratios of other life and death interventions. In women, it appeared to have no effects on costs or survival. Further clinical studies may provide additional information about the cost-effectiveness of this intervention.
Recommendations for the Application of Bone Density Measurement: What Can You Believe?
Authors: Marshall Deborah A. , Sheldon Trevor A. , Jonsson Egon 
Published: March 2009

AbstractThis study examined the conclusions of published reports that review the literature and make recommendations about appropriate applications of bone density measurement. It is based on a survey of 22 organizations producing such reports between 1986 and Spring 1995. Overall, the application of bone density measurement for the diagnosis of osteoporosis was supported by 65% of reports, by 44% for the monitoring and follow-up of patients with previously diagnosed disease, and by 59% for monitoring and follow-up of patients receiving treatment that may affect their bone density. A smaller proportion of reports from government and public organizations compared with other types of organizations and a smaller proportion of reports using more rigorous methods supported the applications for bone density measurement identified in the survey. A larger proportion of the reports published after 1990 compared with those published between 1986 and 1990 support the applications of bone density measurement, with the exception of population screening. The results of this survey suggest that there is considerable disagreement about the potential applications of bone density measurement. Publicly funded organisations and those using more rigorous methods tended to be more conservative in their conclusions.
Assessment of Surgical Operations for Ductal Carcinoma In Situ of the Breast
Authors: Yin Xi Peng , Li Xiao Qing , Neuhauser Duncan , Evans James T. 
Published: March 2009

AbstractThe choice of surgical procedure for the treatment of ductal carcinoma in situ (DCIS) remains clinically based. A meta-analysis was used to synthesize the results of 24 published clinical studies. Partial breast tissue excision appears to be as efficacious as mastectomy for the treatment of DCIS of the breast.
A History of ISTAHC: A Personal Perspective on Its First 10 Years
Authors: Banta H. David , Perry Seymour 
Published: March 2009

AbstractThis reflection on the history of the International Society of Technology Assessment in Health Care is an effort to describe the creation of the Society and its first 10 years of activity. Without analyzing the forces that spurred the growth of technology assessment internationally or linking events, policies, and changes in the various countries, this essay focuses on the persons and events that surrounded the birth and growth of the Society in the past decade.
Assessing Medical Technology in Less-Developed Countries
Authors: Sideman Samuel , BenDak Joseph D. 
Published: March 2009

AbstractLess developed countries (LDCs) are limited in medical resources. Medical technology and the management talent required to handle it play a particularly major role in their national health care and has significant economic, political, and ethical ramifications. This study of the assessment process of medical technology in the LDCs proposes a limited framework for the analysis of the major parameters involved, i.e., stakeholders, boundaries and constraints, goals and objectives, criteria to be met, performance measures, and measurement of performance. The importance of the intangible factors is elucidated.
Depressive Illness and the Possibilities of Somatic Antidepressant Treatment
Authors: Mårtensson Björn 
Published: March 2009

AbstractDepression constitutes a considerable mental health problem. Depression is too often unrecognized or unproperly treated, which causes distress, social impairment, and increased risk of mortality for the individual, and large costs for society. However, several efficient treatment modalities and strategies exist. Different somatic antidepressant treatments for short- and long-term therapy and their respective quality-of-life and economic aspects will be presented and discussed.
Assessing Psychiatric Care Settings:Hospitalization Versus Outpatient Care
Authors: Durham Mary L. , La Fond John Q. 
Published: March 2009

AbstractThis paper presents a discussion of the historical development of deinstitutionalization in the United States, including the political, ideological, and social origins of that policy. The outcomes of deinstitutionalization are considered, including the impact of the policy on the quality of life of people with severe mental disorders. The authors also provide a brief review of the literature on the efficacy and cost-effectiveness of hospitalization versus outpatient (community) care. Recent developments in the use of involuntary hospitalization are discussed, along with a number of important trends in the delivery and financing of services for persons with severe mental disorders.
Consumerism for Neurobiological Disorders:An Assessment
Authors: Peschel Richard E. , Peschel Enid 
Published: March 2009

AbstractConsumerism is a growing phenomenon in U.S. health care, yet its exercise is still inhibited by powerful forces within the medical community. Despite the neuroscientific framework that stresses the commonalities between mental and physical illness, consumerism is even more problematic and difficult in mental health care than in other areas of health care. People with severe mental illness and their advocates must contend with limited public understanding of neurobiological disorders, poor definitions of effective treatment, and a paucity of outcome data, especially from prospective randomized and long-term studies. The only clear way for consumerism to grow in mental health care is for its advocates to align themselves with the neuroscientific revolution and to demand that effective and equitable treatment programs be created based on the documented evidence of the physical nature of neurobiological disorders.
The Public's Role in the Evaluation of Health Care Technology: The Conflict Over ECT
Authors: Heitman Elizabeth 
Published: March 2009

AbstractThe use of electroconvulsive therapy (ECT), controversial since its inception, offers an instructive case study on the challenge of addressing patients' perspectives in the evaluation of health care technology. Despite widespread professional acceptance of ECT, groups of former psychiatric patients have worked through the U.S. legal system to restrict and even ban ECT in the treatment of mental illness. This unusual lay participation in the regulation of health care illustrates how differing conceptions of evidence can affect the evaluation of technology. ECT provides a powerful example of the value of a more complex definition of the significant outcomes of treatment and the growing practice of outcomes assessment, especially as such research is used to shape health policy.
Use of Microbiological Diagnostics and Antibiotics in Danish General Practice
Authors: Sørensen Henrik Toft , Steffensen Flemming Hald , Schønheyder Henrik C. , Grøn Poul , Sabroe Svend 
Published: March 2009

AbstractThis article analyzes the use of antibiotics in Danish general practice. We observed considerable variation in the prescription of antibiotics among general practitioners (GPs). Internationally, Denmark has a low consumption of antibiotics. The use of antibiotics was closely associated with GPs' use of drugs, other than antibiotics, and to some extent with use of microbiological diagnostic tests. These findings provide evidence for the assumption that the consumption of antibiotics can be decreased further, which stresses the need for a restrictive policy concerning antibiotics.
The Growing Dependency in Health Care: Recent Changes in Medical Technology Imports and Exports in Turkey
Authors: Şemin Semih , Güldal Dilek 
Published: March 2009

AbstractThis study investigates recent changes related to the import and export of medical technology and their results in Turkey. Between 1980 and 1993 the number of medical technology imports in Turkey rose, and there was a parallel rise in its ratio to total imports and health expenditures. In contrast the ratio of medical technology exports to total exports decreased significantly in the same period. The liberalization of foreign trade and the changes of health services toward free market policy has caused growing import of medical technology in Turkey.
The Method of Information Synthesis and Its Use in the Assessment of Health Care Technology
Authors: Marcus Susan H. , Grover Prakash L. , Revicki Dennis A. 
Published: March 2009

AbstractThis paper compares information synthesis to literature review and meta-analysis as tools for the researcher trying to summarize published information and identify information gaps on emerging technologies. Because information synthesis is narrowly focused and addresses the question of what isnotknown, as well as whatisknown, it is a good precursor to a full-scale technology assessment. An example of information synthesis is given, comparing cost-effectiveness of extracorporeal shock wave lithotripsy to two other treatments for kidney stones.
Cost-Effectiveness Comparison of Estrogen Therapy and Orchidectomy in Patients With Prostatic Cancer
Authors: Henriksson Peter , Edhag Olaf 
Published: March 2009

AbstractThis study compares the cost of antitumor therapy and adverse cardiovascular effects during the first year of treatment with either exogenous estrogens or orchidectomy of patients with prostatic cancer. We found that the higher costs for the orchidectomy patients were partially outweighed by the costs of treating cardiovascular complications in the estrogen-treated patients; the net overcost of orchidectomy is balanced after two and a half years by the ongoing costs of estrogen treatment. The fact that 25% of the patients treated with estrogen suffered cardiovascular complications, but no difference in mortality rates between the two groups was observed, speaks in favor of orchidectomy as the preferred treatment for prostatic carcinoma.
Intensive Home Health Care in the United States
Authors: Fox Daniel M. , Andersen Kathleen S. , Benjamin A. E. , Dunatov Linda J. 
Published: March 2009

AbstractThis paper assesses the impact of mechanisms for financing intensive home health care services in the United States on their utilization. As lengths of stay have decreased in response to prospective payment methods for hospitals, demand has increased for intensive and complex services provided to patients in the home. Third-party payers, however, are willing to satisfy only some of this potential demand that their reimbursement policies have generated. It is the policies of payers rather than the safety and effectiveness of devices and procedures that are the major constraints on the expansion of intensive home health care. We describe the effects of these policies on who receives intensive home health care services, who provides them, what services are provided, how their quality is monitored, and what they cost.
Empirical Criteria for the Selection of Quality-of-Life Instruments for the Evaluation of Peripheral Blood Progenitor Cell Transplantation
Authors: Glick Henry A. , Shpall Elizabeth J. , LeMaistre C. F. , McCarron Thomas J. , Lu Z. John , Erder M. Haim , Glaspy John A. 
Published: March 2009

AbstractWe propose a method for selecting quality-of-life instruments for use in phase III trials using the convergent validity of patient responses collected in phase I and II clinical trials.Two generic and two disease-specific instruments were administered to patients with breast cancer undergoing peripheral blood progenitor cell mobilization and transplantation. They included the visual analog scale from the EuroQoL EQ5D instrument, the SF-36, the European Organization for Research and Treatment of Cancer (EORTC)-QLQ-C30, and the Functional Assessment of Cancer Therapy instrument. No single instrument was found to have superior convergent validity in all domains, but the EORTC-QLQ-C30 seemed to perform better than the SF-36.
The Effect of a Redistribution System for Health Care for the Elderly on the Financial Performance of Health Insurance Societies in Japan
Authors: Babazono Akira , Weiner Janet , Tsuda Toshihide , Mino Yoshio , Hillman Alan L. 
Published: March 2009

AbstractHealth care for the elderly in Japan is financed through a pool to which all insurers contribute. We analyzed insurers' financial data to evaluate this redistribution system. Cost sharing affected financial performance substantially. The current formula for cost-sharing redistributes elderly health care costs unequally and should be changed.