bluuebunny/crossref_metadata_2025_split huggingface dataset:
DNA Diagnosis in Monogenic Diseases
Authors: Alford Raye Lynn , Rossiter Belinda J. F. , Caskey C. Thomas 
Published: March 2009

AbstractSeveral 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.
The Prescription as Final Common Pathway
Authors: Avorn Jerry 
Published: March 2009

AbstractThere 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

AbstractThis 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

AbstractThere 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

AbstractThe 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

AbstractA 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.
Investing in Health Wisely: The Role of Needs-based Technology Assessment
Authors: Jamison Dean T. , Saxenian Helen , Bergevin Yves 
Published: March 2009

AbstractCountries 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.
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

AbstractIn 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

AbstractEconomic 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

AbstractAgreement 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.
Competing or Complementary?:Ethical Considerations and the Quality of Randomized Trials
Authors: Lumley Judith , Bastian Hilda 
Published: March 2009

AbstractThe 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

AbstractA 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

AbstractProliferation 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

AbstractFacing 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.
Assessing the Impact of Health Technology Assessment
Authors: Jacob Robert , Mcgregor Maurice 
Published: March 2009

AbstractMethodology for evaluation of impact of health technology assessments (HTAs) is outlined and its use illustrated by applying it to 21 HTAs produced by CETS. Impact on policies and technology diffusion was identified in documents, through interviews, questionnaires, and use of data banks. There was evidence that all but three reports influenced policy and that cost-minimization studies caused savings of between $16 million and $27 million annually. Precise estimates of impact will seldom be possible, but systematic documentation of effects is feasible.
The Paradox of Decreasing Prices and Increasing Costs for Diagnostic Tests, Imaging, and Drugs in Japan
Authors: Ikegami Naoki , Ikeda Shunya 
Published: March 2009

AbstractAnalysis of the 1987–1991 national outpatient claims data shows that the percentage of patients undergoing sophisticated diagnostic tests tended to increase and was greater if the hospital was larger, in the public sector, or affiliated with an university. For imaging, the percentage that had CAT scans performed increased, while the percentage undergoing x-rays using contrast medium and other tomography decreased. However, for drugs, newer and more expensive ones tended to be preferred irrespective of the providers' characteristics. Although costs arising from the shift to more expensive and sophisticated technologies have been largely contained by reducing their prices in the fee schedule, this cost-containment strategy faces structural problems. We advocate the establishment of an infrastructure that offers incentives for providers to conduct technology assessment and to use the results.
Developing Information Materials to Present the Findings of Technology Assessments to Consumers: The Experience of the NHS Centre for Reviews and Dissemination
Authors: Entwistle Vikki A. , Watt Ian S. , Davis Hilary , Dickson Rumona , Pickard Diane , Rosser Jilly 
Published: March 2009

AbstractWe discuss some of the issues that have arisen during the development and introduction into practice of information materials for health professionals and patients that aim to promote clinical effectiveness and informed patient participation in clinical decision making.
The Role of Media and Communication in Improving the Use of Drugs and Other Technologies
Authors: Sitthi-amorn Chitr , Ngamvithayapongse Jintana 
Published: March 2009

AbstractPolicy makers, health care providers, and the general public need valid information about the benefits and harmful effects of drugs and technologies to be able to make rational choices in their acquisition, distribution, and use. Effective communication is important for quality choices of drugs and other technologies. In effective communication, the choice of messages and media must correspond to the culture and beliefs of the target groups to make them comprehend and adopt the conclusions. Messages must be presented on a regular basis. Most regulatory agencies do not have enough resources to mount effective communication programs. Private advertising agencies and other stakeholders have definite roles. Valid knowledge must be the basis of dialogues to reduce emotional disputes among various benefit groups in society.
The Science and Politics of Dental Amalgam
Authors: Gelband Hellen 
Published: March 2009

AbstractDental amalgam—a mixture of elemental mercury and a silver-dominated metal alloy—has been the most widely used dental filling material for well over a century. Alternative materials exist but are not well suited for some important applications, and all are more expensive than amalgam. The toxic effects of occupational mercury exposure have long been known, but it was not until about 1980 that serious consideration was given to the possibility that mercury vapor escaping from amalgam fillings might be affecting health, specifically producing subtle effects on the central nervous system. Such effects have been reported among dentists and other dental personnel, whose exposures are well below industrial levels but above those from fillings alone. No large studies have been completed that examine the effects of mercury exposure from dental amalgam fillings. In the face of inadequate evidence on the possible risks of dental amalgam, countries have reacted disparately. Sweden is phasing out amalgam entirely, possibly by the end of 1997. Germany has produced guidelines for limiting its use, other countries have signaled their intention to reduce it, and others—the United States and Canada—have studied the matter but taken no action. Policy differences within Europe have made dental amalgam a test case for the European Community's new medical device regulations. Relatively little epidemiologic research has been initiated to try to answer the question of dental amalgam's possible health effects. An international effort to define and carry out a research agenda to guide public policy is called for.
Trials and Tribulations:Emerging Issues in Designing Economic Evaluations Alongside Clinical Trials
Authors: Coyle Douglas , Davies Linda , Drummond Michael F. 
Published: March 2009

AbstractDecisions relating to designing and implementing economic evaluations alongside clinical trials are dependent on a number of issues. Initial consideration should focus on whether an economic evaluation is appropriate, whether a randomized controlled trial (RCT) is a suitable vehicle, and whether the design of the specific RCT is appropriate for integration of economic evaluation. If an economic evaluation is appropriate, decisions are required on how economic data are to be collected and analyzed. This paper discusses these and other issues and, where appropriate, provides recommendations for future studies.
Schizophrenia and Antipsychotic Somatic Treatment
Authors: Lindström Leif H. , Wieselgren Ing-Marie 
Published: March 2009

AbstractSchizophrenia typically affects individuals in early life and leads to long-term suffering at high cost to both the individual and the community. Structural, functional, and biochemical factors may play a role in the pathogenesis, and perhaps the course, of schizophrenia. Although early research into the treatment of schizophrenia was not fruitful, the results of recent research, particularly the use of narcoleptics combined with new clinical appreciation of psychosocial factors in chronic psychotic disorders, give reason for hope and optimism.
Technologies for the Delivery of Mental Health Care
Authors: Mechanic David 
Published: March 2009

AbstractMental health services depend both on efficacious drug and interpersonal interventions and strategies for financing, organizing, and delivering these services. In recent years, much attention has been devoted to approaches that seek to coordinate needed care and to provide it in the most cost-effective ways. Cost constraints encourage the substitution of alternative community treatments for expensive inpatient care and the identification of appropriate ways to link effectively the varying care components. The mechanism most commonly advocated is case management, but the concept is applied in diverse ways and has little agreed upon meaning and disparate outcomes. This paper discusses and evaluates concepts of case management and a variety of other systems interventions designed to reduce fragmentation. It also reviews approaches to managed care, including mental health capitation and utilization management. New organizational technologies are likely to change dramatically professional practices and standards and the future provision of mental health care.
Using Research Synthesis in Medical Technology Assessment
Authors: Wortman Paul M. , Yeaton William H. 
Published: March 2009

AbstractThis article describes the use of research synthesis procedures (e.g., meta-analysis) in evaluating medical technologies. The synthesis process involves retrieval, extraction, and analysis of pertinent information from a set of research studies. There are several advantages of research synthesis: determining overall effectiveness, explaining seemingly contradictory findings, providing a standard measure of effect, and increasing statistical power. In addition, such syntheses provide timely results that can assist various policy decisions such as initiating clinical trials at NIH, reimbursement at HCFA, and answering NIH consensus conference questions. The authors' synthesis of the research literature on coronary artery bypass graft surgery (CABGS) illustrates how this method can address the various elements of a technology assessment such as safety, efficacy, and cost-effectiveness. The paper concludes by noting how research synthesis can be particularly advantageous in assessing technologies that are rapidly evolving (e.g., lytic agents for acute myocardial infarction).
A Note on Confidence Intervals in Cost-Effectiveness Analysis
Authors: Tambour Magnus , Zethraeus Niklas , Johannesson Magnus 
Published: March 2009

AbstractHow to obtain confidence intervals for cost-effectiveness ratios is complicated by the statistical problems of obtaining a confidence interval for a ratio of random variables. Different approaches have been suggested in the literature, but no consensus has been reached. We propose an alternative simple solution to this problem. By multiplying the effectiveness units by the price per effectiveness unit, both costs and benefits can be expressed in monetary terms and standard statistical techniques can be used to estimate a confidence interval for net benefits. This approach avoids the ratio estimation problem and explicitly recognizes that the price per effectiveness unit has to be known to provide cost-effectiveness analysis with a useful decision rule.
Physicians' Patterns of Using a Computerized Collection of Guidelines for Primary Care
Authors: Jousimaa Jukkapekka , Kunnamo Ilkka , Mäkelä Marjukka 
Published: March 2009

AbstractPhysician's Desk Reference and Database is a Finnish collection of computerized primary care guidelines. The program has been in clinical use since 1989. For this study, a function producing a log file of all searches was added to the program. Two hundred twenty-seven users returned log files that contained 15,267 searches. The users made 3.12 (range 1–10.4) searches per day. The average time needed to find and read an article was 4.9 minutes. Sufficient facts were found in 71% of the searches. Dermatology was the most popular field of interest, followed by infectious diseases and cardiology.