bluuebunny/crossref_metadata_2025_split huggingface dataset:
Technology and Disability: Assessment Needs and Potential
Authors: Hutton John , Persson Jan 
Published: March 2009

AbstarctIn 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

AbstarctOrthoses 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

AbstarctThe 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

AbstarctAcquiring 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

AbstarctIn 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

AbstarctThis 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

AbstractThis 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

AbstractBoth 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

AbstractCooperation 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

AbstractMore 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

AbstractThis 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

AbstractControlled 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.
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.
Mass Mammography: The Time for Reappraisal
Authors: Skrabanek Petr 
Published: March 2009

Of the four randomized controlled trials of mass mammography completed to date, the New York HIP trial used obsolete technology and was not designed to assess mammography in the absence of physical examination; the Swedish Two-County trial had serious methodological flaws; the U.K. trial was incompletely documented but showed no significant benefit; and the Malmö trial, which was perfect in design and execution, showed no benefit.Paradoxicially, with each successive trial and an increasing sophistication of mammography, the benefit of screening was becoming not greater but less. This may be summarized by comparing the number of women who would have to be offered mammography for one breast cancer death prevented or postponed in the respective trials: 5,000 in the HIP trial, 13,000 in the Two-County trial, 18,000 in the U.K. trial, and 68,000 in the Malmä trial.The enthusiasts in favor of mass mammography have created an atmosphere of false optimism. They have not informed the public about the very small potential benefit nor about the risks associated with screening, especially the risks of false positive diagnoses and of unnecessary surgical operations. This is an unacceptable situation, and the ethical vacuum in which population screening takes place needs to be filled with guidelines to protect women who are “targeted” for screening.
Consensus Development: An Historical Note
Authors: Perry Seymour 
Published: March 2009

The National Institutes of Health (NIH) has always carefully limited its responsibilities to biomedical research and knowledge development, including clinical trials, dissemination of results of research, and training. Ten years ago, NIH undertook to examine its possible role in the evaluation of medical technologies.In 1976, the U.S. Congress became alarmed over the increase in health care costs: in particular, that a number of expensive technologies, such as coronary artery bypass surgery and electronic fetal monitoring, had entered the delivery system without adequate study of their safety, efficacy, cost, or other implications. At the time, there was no formal structure or forum in either the executive branch of the government or in the private sector for seeking a consensus that a medical innovation was actually safe, beneficial, and ready to be transferred into the health care delivery system. Similarly, there was no structured process through which the parties who comprise the delivery system could meet with representatives of the research community to examine the medical-scientific issues surrounding a given innovation along with cost and cost- effectiveness, ethics, and other societal issues of importance to the system.
Whom to Treat First, and How Much is Enough?: Ethical Dilemmas that Physical Therapists Confront as They Compare Individual Patients' Needs for Treatment
Authors: Purtilo Ruth B. 
Published: March 2009

AbstractWhen there is a scarcity of resources (therapists, modalities), the physical therapist must make decisions about whom to treat and why. This paper discusses ethical dilemmas confronting the therapist and addresses solutions based on approaches of procedural justice and distributive justice.
Translating Technology Assessment Into Policy: Conceptual Issues and Tough Choices
Authors: Deber Raisa B. 
Published: March 2009

AbstractConceptual issues arise in translating the results of technology assessment into policy. A 3 × 3 typology suggests that tough decisions occur when interventions promise increased benefit for increased cost or less benefit for less cost. These decisions are value based; technology assessment alone cannot determine who should receive an intervention and under what circumstances.
Technology Assessment in a User Perspective-Experiences with Drug Technology
Authors: Hansen Ebba Holme 
Published: March 2009

AbstractDrugs have a central place among medical technologies, and medical technology assessment can learn from the established regulation of drug technology. This article outlines how users' experiences are not part of the basis on which decisions are made today, although this knowledge is imperative for identifying the problems that are not uncovered or foreseen by today's drug assessments. Further, users' interests might not be part of assessments that are based on the controlled clinical trial. A framework for drug technology assessments based on a user perspective is suggested.
Reflections on the Cost Consequences of the New Gene Technology for Health Policy
Authors: Rosenau Pauline Vaillancourt 
Published: March 2009

AbstractThis article presents a preliminary and necessarily tentative and subjective assessment of the impact of new gene technology on health care costs. In the short term, diagnosis and treatment of genetic disease are likely to increase costs. Treatment with nongene therapy will continue to be far less expensive than gene therapy where it is available. Research developments to monitor as indicators of forthcoming cost reductions in genetic therapy are set forth. Some forms of genetic screening may soon reduce health care costs, and an example is provided. Genetically engineered Pharmaceuticals are described and their impact on costs reviewed. Conditions under which they are likely to reduce health care costs are indicated.
Physicians' Influence on the Decision to Acquire Magnetic Resonance Imagers in Acute Care Hospitals
Authors: Friedman Leonard H. , Jorgensen Jane 
Published: March 2009

AbstractThe influences of four principal types of decision makers on the acquisition of magnetic resonance imagers were measured in hospitals in Southern California, Oregon, and Washington. We propose that of the decision makers assessed, physicians had the most influence on the acquisition of magnetic resonance imagers.
Evaluating Translations of Health Status Questionnaires: Methods From the IQOLA Project
Authors: Ware John E. , Keller Susan D. , Gandek Barbara , Brazier John E. , Sullivan Marianne ,   The IQOLA Project Group
Published: March 2009

AbstractThere is growing demand for translations of health status questionnaires for use in multinational drug therapy studies and for population comparisons of health statistics. The International Quality of Life Assessment (IQOLA) Project is conducting a three-stage research program to determine the feasibility of translating the SF-36 Health Survey, widely used in English-speaking countries, into other languages. In stage 1, the conceptual equivalence and acceptability of translated questionnaires are evaluated and improved using qualitative and quantitative methods. In stage 2, assumptions underlying the construction and scoring of questionnaire scales are tested empirically. In stage 3, the equivalence of the interpretation of questionnaire scores across countries is tested using methods that closely approximate their intended use, and empirical results are compared. Data analyses from Sweden and the United Kingdom, as well as other research cited, support the feasibility of cross-cultural health measurement using the SF-36.
Some Statistical Methods for Combining Experimental Results
Authors: Laird Nan M. , Mosteller Frederick 
Published: March 2009

Advances in science and technology are generally the product of multiple investigations. This article discusses statistical methods for combining empirical results from a series of different experiments or clinical investigations. We delineate the steps an assessor might take in combining data from different studies and provide references for topics not discussed in detail. The article reviews some of the most commonly used statistical techniques for combining results in the medical and social sciences.The expressionmeta-analysisrefers to the practice of using statistical methods to combine the outcomes of a series of different experiments or investigations. The terminology arises because a meta-analysis uses a study as the unit of observation, and, thus, the data point for each study is itself a statistical summary based on an analysis of primary data.
A Consensus Development Conference on the Practice of Platelet Transfusion in the Netherlands
Authors: van Aken W. G. , van der Does J. A. , de Wit C. Dudok , van Everdingen J. J. E. 
Published: March 2009

During the past 5 years, hospitals in several countries have experienced a significant increase in the use of platelet concentrates. In the Netherlands, e.g., the number of donor units of platelet concentrates rose from 59,000 in 1981 to almost 97,000 in 1984 at a cost of 5 million guilders (US $2,800,000) annually. This increased utilization has been attributed to such factors as chemo- and radiotherapy, major surgery, severe trauma, and bone marrow transplantation.However, there was concern that in a significant number of patients, platelet concentrates are administered for no good reason, that the effect of platelet transfusions is often not adequately controlled, that insufficient care is taken to prevent side effects (notably alloimmunization), and that the quality control applied to platelet suspension is not optimal.
Case Study: Assessing Laparoscopic Cholecystectomy:The GVHS Experience
Authors: Juzwishin Donald W. M. 
Published: March 2009

AbstractThis article describes the experience at the Greater Victoria Hospital Society of assessing the appropriateness of introducing laparoscopic cholecystectomy (lap chole) within the framework of an established technology assessment process. Lap chole promised to deliver cost savings; however, these could only be realized by capitalizing on the reduced length of stay by removing the surgical beds from service. A cautionary note is raised as to whether the increased use of lap chole in the population is appropriate.
Case Study: Practical Tools for Improving Needs-Based Health Management and Technology Assessment: The PHC MAP Series
Authors: Wilson Ronald G. 
Published: March 2009

AbstractThis paper outlines the need for and development of a practical set of tools to improve needs-based health management and technology assessment. International reports have documented the lack of adequate information for the managerial process in primary health care. The components of the Primary Health Care Management Advancement Program (PHC MAP) Series, designed for both manual and computer applications, are described. The series has been widely pretested and is currently being implemented by many government health services and nongovernmental organizations worldwide. Information is included indicating how the PHC MAP materials may be obtained.
Is there a Relationship between the Volume of Work Carried Out in Intensive Care and its Outcome?
Authors: Jones Jeremy , Rowan Kathy 
Published: March 2009

AbstractThis paper reports the results of a study of the association between volume of activity and patient outcome in 26 intensive care units in the United Kingdom. Hospital fatality rates showed a statistically significant (p =.016) negative association with volume. However, mean APACHE II scores, as a measure of the severity of case mix, were also negatively associated with volume (p =.021). Thus, one explanation of the lower death rates at higher volumes is that larger units admit less severely ill patients. For patients admitted immediately after surgery, the correlation between severity standardized mortality ratios and volume (while not significant, p <.1) suggests there may be a volume-output effect unexplained by severity.
The Evolution of Laparoscopic Surgery in Routine Health Care
Authors: Hirsch Naarilla , Hailey David 
Published: March 2009

AbstractWhile laparoscopic cholecystectomy is now widely used, diffusion of other laparoscopic surgical methods has been more modest. Uptake of most laparoscopic methods has been influenced by considerations of effectiveness compared with open surgery, competing minimally invasive therapies, and the inconvenience and cost of technical change.
The Role of Perspective in Defining Economic Measures for the Evaluation of Medical Technology
Authors: Davidoff Amy J. , Powe Neil R. 
Published: March 2009

AbstractPerspectives in an economic analysis of medical technology reflect who makes decisions about the use of or payment for medical resources. Commonly used perspectives include those of providers, insurers, the individual, and society. Perspective is a critical determinant of study design, affecting the time horizon, types of resources considered, and economic cost measures assigned to those resources. Individuals involved in technology assessment for either research or policy-making purposes should be aware of the complexities of defining costs from different perspectives.
The Internationalization of Health Technology Assessment
Authors: Menon Devidas , Marshall Deborah 
Published: March 2009

AbstractHealth technology assessment as a formalized set of activities has a relatively short history. At its current stage of development, it is clear that it has global dimensions and impact. In this paper we review the history of health technology assessment, its development as a form of health services research, and its “institutionalization.” We then identify the reasons for its internationalization, review current international initiatives, and propose actions to be taken to improve cooperation among countries.
Predicting Nursing Home Length of Stay and Outcome with a Resource-Based Classification System
Authors: Ljunggren Gunnar , Brandt Lena 
Published: March 2009

AbstractThe anticipated demographic changes with an increasing number of elderly force us to plan and use health care resources more efficiently. In this study we have used the components of a case-mix measure for nursing homes; the Resource Utilization Groups (RUG-II), to predict length of stay (LOS) and outcome in geriatric institutions. We have shown that the RUG categories and an activities of daily living (ADL) index differ significantly in both respects, but that other variables might be of more clinical value when establishing a prospective payment system, based on LOS in geriatric institutions.