bluuebunny/crossref_metadata_2025_split huggingface dataset:
Cost-effectiveness Analysis of Strategies for Colorectal Cancer Screening in Japan
Authors: Shimbo Takuro , Glick Henry A. , Eisenberg John M. 
Published: March 2009

AbstractTo determine the cost-effectiveness of colorectal cancer screening strategies in Japan and to determine the influence of long-term compliance with screening programs on the selection of strategies, the natural history of a simulated cohort of 40-year-old Japanese of both genders was modeled with and without colorectal cancer screening until age 75 years. Survival, number of complications, and direct medical costs were compared among several combinations of screening examinations. In addition, the age of initiating screening was varied, as was the long-term compliance rate. Strategies using immunoiogical fecal occult blood test were found to be the most cost-effective. Immunological fecal occult blood test followed by colonoscopy, if positive, would save 24.05 (5.88 discounted) days of life and cost 28,420 yen (US $210) per screened person, thus offering a cost-effectiveness ratio of 1.765 million yen (US $13,100) per year of life saved. If long-term compliance is 100%, initiating screening at age 40 years offers more years of life saved and a low incremental cost of screening. However, if more likely dropout rates are considered, initiation at age 40 years is dominated by later initiation of screening.
Health Economic Analysis of the Neonatal Screening Program in Japan
Authors: Hisashige Akinori 
Published: March 2009

AbstractIn Japan, a nationwide mass screening system for neonatal metabolic diseases was established in 1977. This system consisted of screening programs for five main congenital metabolic diseases, including phenylketonuria (PKU). To evaluate the efficiency of the mass screening system, a costbenefit analysis of the screening program for PKU (as a typical case in Japan) was carried out. The costs of the detection and the treatment program were compared with the projected benefit (avoided costs) that results from prevention of the mental retardation associated with the disorders due to PKU. Costs and benefits were discounted at an annual rate of 7%. Assuming that the incidence of PKU was 1/80,500 and the total number of infants screened was 1.2 million, net benefits for the screening program were $283,000, and the cost-benefit ratio was 1:2.5. The sensitivity analysis for the incidence of PKU showed that the cost-benefit ratios exceeded one.
Culture, Conflict, and Cost:Perspectives on Brain Death in Japan
Authors: Feldman Eric A. 
Published: March 2009

AbstractJapanese surgeons have performed only one heart transplant in the quarter century since the procedure was developed. Possessing the requisite training and technology, transplant surgeons have been stymied by several factors that elude professional and political solution. Most critically, the lack of a brain death standard limits the availability of transplantable organs. Mistrust of the medical profession, traditional outlooks on death, and the primacy placed on consensual decision making have fueled debate about brain death and transplantation. Volatile and value laden, these issues have overwhelmed the discussion of health care resources, equal access to high-technology medical procedures, and insurance coverage for transplantation.
National Structures in the Delivery of Rehabilitation Technology Services
Authors: Lorentsen Øivind 
Published: March 2009

AbstarctThe delivery of rehabilitation services requires an infrastructure if service provision is to be given any priority. This article discusses some characteristics of handicaps, technical aids, the service delivery process, and habilitation/rehabilitation, and recommends developments of national structures for service delivery based upon the characteristics of rehabilitation technology, user need, and the country frameworks.
Communication AIDS for the Speech Impaired:Cost and Quality-of-Life Outcomes of Assessment Programs Provided by Speciaiist Communication Aids Centers in the United Kingdom
Authors: Tolley Keith , Leese Brenda , Wright Ken , Hennessy Sue , Rowley Corinne , Stowe Janet , Chamberlain Ann 
Published: March 2009

AbstarctAn evaluation was conducted of the approaches, costs, and quality-of-life outcomes associated with communication aid assessment programs for the speech-impaired provided by specialist Communication Aids Centres (CACs) in the United Kingdom. The average costs of CAC assessment programs was £410 per client, which is not excessive. There was evidence of moderate quality-of-life benefits from clients' use of the recommended aids.
Cost-Utility Analysis of Assistive Technologies in the European Commission's Tide Program
Authors: Brodin Håkan , Persson Jan 
Published: March 2009

AbstarctSocioeconomic evaluation is an issue dealt with in the European Commission's research program TIDE. The principles of cost-utility analysis have been examined for usability in the assessment of rehabilitative technologies. A case study, the choice of a type of wheelchair, is described to demonstrate how estimates of utility can be derived and how cost-utility ratios can be used to guide decision making.
A Comparison of the Patient-Borne Costs of Therapy with Gamma Globulin given at the Hospital or at Home
Authors: Gardulf Ann , Möller Gudrun , Jonsson Egon 
Published: March 2009

AbstarctThe major aim of this study was to estimate and compare the patient-borne costs of lifelong subcutaneous gamma globulin therapy at the hospital and at home. Thirty patients were included and the data were collected with a questionnaire. The introduction of self-therapy at home reduced the total yearly costs by approximately 50% and the out-of-pocket expenses for the palients by 85%.
Health Care and Medical Technology in Nigeria: An Appraisal
Authors: Erinosho Olayiwola A. 
Published: March 2009

AbstractThe objective of the study was to ascertain the extent of utilization of medical technologies (defined as equipment) used in various health care institutions in Nigeria. The study also investigated the factors accounting for use of and under- and nonutilization of this equipment. Sixteen major and minor health care institutions were surveyed. The outcomes of the study indicate that not less than a third of the equipment was out of order at the time of the study. A number of factors are responsible for nonutilization of this equipment. They include lack of infrastructural facilities such as piped water, storage, and power supply; poor handling by badly trained staff; and the low priority that is accorded to maintenance. The study leads to the important conclusion that the local culture is unable to sustain the technologies that are procured.
The Canadian Physiotherapy Quality of Care Project: Analysis of a Derailed Project
Authors: Miles-tapping Carole , Rennie G. A. (sandy) 
Published: March 2009

AbstractThe Physiotherapy Quality of Care Project was a project of the Canadian Physiotherapy Association, sponsored by the Canadian government to ensure the quality of physiotherapy. A consensus committee of physiotherapy educators and managers developed and tested an instrument to measure changes in patients' functional status during physiotherapy. Despite scientific development and wide distribution, this technology was not adopted. Alternative methods, which were heavily marketed, gained nationwide use instead.
Analyzing Errors in Practice: A Vehicle for Assessing and Enhancing the Quality of Care
Authors: Deusinger Susan S. 
Published: March 2009

AbstractFailures are inevitable in health care. When failure occurs as a result of practitioner error, quality in patient care may be compromised. This article proposes that analyzing clinical errors may contribute to quality assurance. Examples from physical therapy illustrate how information gained from analyzing errors can enhance patient care.
Development of a Program for the Treatment of Chronic Pain and Anxiety: A Learning Process Leading from Unsound to Sound Assessment
Authors: Torrestad Agneta , Håkanson Margareta , Axelli Tomas 
Published: March 2009

AbstractThe development and assessment, over a 10-year period, of a technology for group treatment of patients with chronic pain and anxiety is described. Positive results, such as a decrease of symptoms and improved self-confidence, have stimulated diffusion of the technology to colleagues and have increased our own involvement in the organization of services.
The Relationship of Technology Assessment and Utilization: Electromyographic Feedback Instrumentation as a Model
Authors: Wolf Steven L. 
Published: March 2009

AbstractBiofeedback instrumentation has been a growing part of physical therapy practice for 20 years, and physical therapists have contributed to researching its efficacy in treating varying conditions. The application of biofeedback to the treatment of stroke was marked by some early difficulties with the quality of the electronics, but sophisticated contemporary equipment can do much more than was originally envisioned. The importance of relating quantified movement-based data to functional measures is projected as a high priority if appropriate reimbursement for physical therapy services with biofeedback is to continue in the future.
Making Information Accessible and Useful to Practicing Clinicians: Problem-Knowledge Coupling
Authors: Zimny Nancy J. 
Published: March 2009

AbstractAssessments of health care technology will lead to improvements in patient services only if this information is actually used by clinicians. Traditional methods of planning treatment that rely solely on memory limit the clinician's access to and use of the full available body of knowledge in the field. An alternative approach using a computer-assisted methodology is presented as a way to overcome traditional limitations and promote the development and diffusion of knowledge.
Treatment of Symptomatic Cholelithiasis in France: A Decision Analysis Comparing Cholecystectomy and Biliary Lithotripsy
Authors: Fendrick A. Mark , De Pouvourville Gérard , Bitker Caterine , Pelletier Gilles 
Published: March 2009

AbstractTo determine the potential role of extracorporeal shock wave lithotripsy (ESWL) in the treatment of symptomatic gallstone patients in France, a simulation model evaluated the health and economic effects of three different treatment strategies. Decision analysis of conventional cholecystectomy alone and either of two strategies using a combination of biliary lithotripsy and conventional cholecystectomy reveals that a strategy employing biliary ESWL results in a significant number of successfully treated patients, thus avoiding the risks and costs of abdominal surgery. Moreover, cost analysis shows that expanding the use of lithotripsy to all patients for whom the procedure is indicated increases the average cost per successfully treated patient, but, more importantly, decreases the overall costs incurred by the cohort. From a societal viewpoint, a policy using biliary ESWL in appropriate patients is superior to one of cholecystectomy alone, from both clinical and economic perspectives.
Genetic Technology in Health Care: A Global View
Authors: Galjaard Hans 
Published: March 2009

AbstractClinical genetics services have become an integrated part of health care in nearly all European countries. The emphasis has been on postnatal cytogenetic, biochemical, and DNA diagnosis of congenital disorders, carrier detection, genetic counseling, and prenatal diagnosis. Use has been satisfactory, and very few ethical problems have arisen, apart from moral objections against abortion by minority groups. The progress of human gene mapping is associated with new perspectives in clinical genetics and will enable the identification of people at risk of major adult diseases. This prospect has caused some concern about psychosocial and ethical issues that are being dealt with in different ways in various postindustrial societies. In future decades, however, 95% of the world's population increase will occur in developing countries. In most of these countries, a low per capita income, female illiteracy, low rates of contraceptive use, teenage pregnancy, and religious and traditional cultural factors are major complications of implementing genetic services at a global level. There are, however, some exceptions, which are discussed.
Assessing Genetic Technologies: Two Ethical Issues
Authors: Murray Thomas H. 
Published: March 2009

AbstractAssessment of the impact of genetic technologies requires an understanding of the ethical issues that such technologies raise, which in turn requires an understanding of the social context of genetics. This article discusses 10 factors that characterize the social context of contemporary genetics, and considers two presumptions that usually are unquestioned—first, that more choice is always better; second, that what can be improved should be improved. Recent experience with genetic screening and testing to increase reproductive choice indicates that it is sometimes an ambiguous good. Prenatal testing, which has been guided by an ideology of nondirective counseling, will become increasingly problematic as the menu of possible genetic tests grows longer, because nondirectiveness offers no way to distinguish between significant disease and parental whim. In the realm of reproduction, more choice may also come to mean increasing parental responsibility to have genetically “healthy” offspring. Technologies intended to improve health outcomes may also be used for non-health-related goals—such as to increase athletic performance or to capitalize on social prejudices. Genetic technologies increasingly will challenge the troubled distinction between therapy and enhancement.
Techniques in Current Use in Prenatal Diagnosis
Authors: Chitty Lyn S. , Bobrow Martin 
Published: March 2009

AbstractPrenatal diagnosis is now offered to the majority of pregnant women in Europe and the United States. Advances in obstetric and laboratory techniques mean that increasing numbers of conditions can be diagnosed prenatally; indeed, gene carriers can be identified before pregnancy in some cases. Current obstetric and laboratory techniques for prenatal screening and diagnosis of genetic disorders are discussed.
DNA Diagnosis in Oncology
Authors: Rowley Janet D. 
Published: March 2009

AbstractOur understanding of the genetic changes that transform normal cells into malignant cells is increasing at a remarkable pace. Some of the changes involve detectable cytogenetic aberrations, whereas others are identifiable only at the molecular level. Many of the structural cytogenetic changes have also been defined molecularly because the genes involved have been cloned. Thus, we are approaching the stage in which the DNA obtained from tumor tissue can be analyzed to detect the presence of a series of chromosomal and molecular alterations. These studies provide important information regarding the precise diagnosis of the tumor type as well as prognostic information about the likely response to therapy and survival.
Pharmaceutical Prescriptions in Italy
Authors: Garattini Silvio 
Published: March 2009

AbstractPharmaceutical prescriptions are quite different in four European countries: Italy, France, Germany, and the United Kingdom. In particular, in 1992, among the 50 most sold products by value, only seven active principles are common to these four countries. In Italy, in 1994, there has been a substantial change in pharmaceutical prescriptions, since, for the first time, drugs have been reimbursed by the National Health System (NHS) on the basis of efficacy. As a result of this new policy, the 50 most-sold products by value have changed dramatically in the first five months of 1994. The pharmacologic and economic implications of this change are discussed.
The Distribution of “Big Ticket” Medical Technologies in OECD Countries
Authors: Lázaro Pablo , Fitch Kathryn 
Published: March 2009

AbstractFive “big ticket” medical technologies (BTTs) in 1990 were compared in the 24 OECD countries in relation to population, the number of physicians, gross domestic product (GDP), and health care expenditures (HCE). Wide variations were observed between and within countries for all measures. Regression analysis revealed that HCE explains part of the variation in the distribution of computed tomography scanners (excluding Japan), magnetic resonance imaging units, and radiation therapy units (R2 between 0.40 and 0.69), but not extracorporeal shock wave lithotripters. To a lesser extent, GDP was also found to correlate with the distribution of these technologies, but no correlation was found with number of physicians. Other factors affecting the diffusion of these technologies are proposed for study.
A Comparison of the Investment in Hospital-Based Obstetrical Ultrasound in Wales and Washington State
Authors: Rosenblatt Roger A. , Dawson Andrew J. , Larson Eric H. , Tressler Carolyn J. , Jones Anthony , Hart L. Gary , Nesbitt Thomas S. 
Published: March 2009

AbstractThe purpose of this study was to examine differences in the way Britain and the United States invest in and deploy a new medical technology. We used structured interviews to obtain information on the technical sophistication and approximate replacement value of all hospital-based obstetrical ultrasound machines in every maternity hospital in Washington state and Wales. The supply of hospital-based ultrasound machines—approximately two machines per 1,000 births—was similar in both countries. Wales had fewer advanced ultrasound machines than Washington state, and they were based exclusively in high-volume district general hospitals; there were no obstetric ultrasound machines in the private sector. In Washington state, the majority of advanced machines were in small and medium-sized hospitals, and many private offices had ultrasound machines. The approximate replacement value of hospital-based machines was three times as high per birth in Washington state as in Wales. In the case of obstetrical ultrasound, centralization of facilities, a relatively small private sector, and global budgeting lead to lower expenditures per patient within the National Health Service without compromising access to care.
Cost-Effectiveness of Laser Ablation of the Prostate:Premature Evaluation
Authors: Jackson Terri , Street Andrew , Costello Anthony , Crowe Helen 
Published: March 2009

AbstractA cost-effectiveness study compared visual laser ablation of the prostate (VLAP) with transurethral resection (TURP). Achieving equivalent outcomes, VLAP was more expensive than TURP. The result was sensitive to various assumptions, suggesting that VLAP might prove to be the preferred technology. Problems inherent in economic evaluation of emerging technologies are discussed.
International Variation in Intervention Rates: What Are the Implications for Patient Selection?
Authors: Black Nick , Glickman Mark E. , Ding Jiao , Flood Ann Barry 
Published: March 2009

AbstractWhile international variations in intervention rates are well recognized, little is known about their implications for patient selection. This paper describes an exploratory study in which the probability of undergoing an elective intervention (surgery for benign prostatic hyperplasia) in an area in the United Kingdom was compared with an area in the United States. It found that the area with high intervention rates was associated with higher levels of surgery in men with low levels of need who are unlikely to gain much benefit.
Prostheses for Primary Total Hip Replacement:A Critical Appraisal of the Literature
Authors: Cowley Delma E. 
Published: March 2009

AbstractEighty-one published papers on the performance of prostheses in total hip replacement were appraised. Sound methodology was demonstrated in 1 of 8 randomized controlled trials and 4 of 17 nonrandomized comparative studies. Of 56 case series without controls, 32 met the appraisal criteria, but these are intrinsically less useful. The published literature does not provide solid evidence for the superiority of cement-free or hybrid prostheses over modern cemented types.
Assessment of Waiting Time and Priority Setting by Means of a National Register
Authors: Lundström Mats , Stenevi Ulf , Thorburn William 
Published: March 2009

AbstractTo increase access to care for cataract patients in Sweden, it was decided, starting in 1992, that all cataract patients listed for surgery and with priority should have their cataract extraction performed within three months. To evaluate the effect of this waiting time guarantee, a National Cataract Register (NCR) was initiated in late 1991. In 1992, 81% of all cataract extractions performed in Sweden were reported to the NCR; in 1993 this figure was 92%. Reasons for this high participation ratio are discussed. In 1993, 74.4% (range between different clinics, 40–99%) of the patients with priority had their operation performed within three months. Great variation in visual acuity and age was found in patients with priority among the different surgical units.
Cost-Effectiveness of Breast Cancer Screening in Spain
Authors: Plans Pedro , Casademont Laura , Salleras Luis 
Published: March 2009

AbstractIn the last several years, the development of an effective breast cancer screening procedure has increased the possibility of the early detection of this cancer. We investigated the cost-effectiveness of a breast cancer screening program to screen 100,000 women 50–64 years of age in Catalonia (Spain). The cost-effectiveness ratio was measured in terms of the cost per cancer detected comparing program costs to the estimated number of cancers detected. We assumed a participation rate, sensitivity, and specificity of 70%, 92%, and 94%, respectively, and that 0.36 breast cancers could be detected per 100 women screened. We estimated a total cost of $2.1 million with $1.4 million for the mammographic stage and $0.7 million for the detection of the true positive mammographic results. The cost per woman screened was $30. We estimated that 252 cases of breast cancer could be detected with the program. The cost-effectiveness ratio obtained in this study was $8,424 per cancer detected. Sensitivity analysis has shown that cost-effectiveness results are sensitive to the variations in the following variables: specificity, cancer detection rate, and screening costs. In planning preventive programs, breast cancer screening should be considered one of the priorities.
Assessing the Quality of Randomized Controlled Trials:Current Issues and Future Directions
Authors: Moher David , Jadad Alejandro R. , Tugwell Peter 
Published: March 2009

AbstractAssessing the quality of randomized controlled trials is a relatively new and important development. Three approaches have been developed: component, checklist, and scale assessment. Component approaches evaluate selected aspects of trials, such as masking. Checklists and scales involve lists of items thought to be integral to study quality. Scales, unlike the other methods, provide a summary numeric score of quality, which can be formally incorporated into a systematic review. Most scales to date have not been developed with sufficient rigor, however. Empirical evidence indicates that differences in scale development can lead to important differences in quality assessment. Several methods for including quality scores in systematic reviews have been proposed, but since little empirical evidence supports any given method, results must be interpreted cautiously. Future efforts may be best focused on gathering more empirical evidence to identify trial characteristics directly related to bias in the estimates of intervention effects and on improving the way in which trials are reported.