bluuebunny/crossref_metadata_2025_split huggingface dataset:
Impact of Extracorporeal Lithotripsy on Patient Management
Authors: Carlsson Per , Jönsson Bengt , Tiselius Hans-Göran 
Published: March 2009

AbstractSweden's first, and so far only, ESWL unit for kidney stone treatment became operational on April 1, 1985. This paper presents some intermediate results from an integrated medical, economic, and technical evaluation of the new technology. Seventy-eight percent of 477 patients were defined as successfully treated, totally stone free or fragments less than 4 mm in size, after a follow-up of four weeks. After six months, the share of successfully treated patients had increased to 82%. Successes were closely related to the stone situation; the smaller the stone, the greater success of treatment. Patients' experiences with treatment were also studied and showed that less than 5% of the patients perceived the treatment as unpleasant, frightening, and/or time consuming. Epidemiological data reveal that one unit can replace all open surgical operations on the kidney.
Toward Quality Assurance in QALY Calculations
Authors: Nord Erik 
Published: March 2009

AbstractThe utility weights that are used in published scientific articles for assessing benefits in terms of quality adjusted life-years gained often have a weak theoretical and empirical basis. To a large extent, the weights seem to be used without critical thought and sensible discussion. In a majority of cases, the sensitivity of the results to the weights that have been chosen is not demonstrated, and readers are not provided with information in a way that facilitates independent calculations. This paper calls for a standard for future publications.
Defusing Technology:Technology Diffusion in British Columbia
Authors: Kazanjian Arminée , Friesen Kathryn 
Published: March 2009

AbstractIn order to explore the diffusion of the selected technologies in one Canadian province (British Columbia), two administrative data sets were analyzed. The data included over 40 million payment records for each fiscal year on medical services provided to British Columbia residents (2,968,769 in 1988) and information on physical facilities, services, and personnel from 138 hospitals in the province. Three specific time periods were examined in each data set, starting with 1979–80 and ending with the most current data available at the time. The detailed retrospective analysis of laboratory and imaging technologies provides historical data in three areas of interest: (a) patterns of diffusion and volume of utilization, (b) institutional profile, and (c) provider profile. The framework for the analysis focused, where possible, on the examination of determinants of diffusion that may be amenable to policy influence.
Biotechnical and Other Factors Affecting Orthognathic Surgery
Authors: Isaacson Robert J. , Strauss Robert A. 
Published: March 2009

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

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

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

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

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

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

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

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

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

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

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

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

Public health care systems in countries all over the world are confronted with increasing difficulties. The problems are mainly economic, but they also reflect difficulties of adaptation to changes both in society as a whole and within the health care services.The atmosphere of a crisis results from internal struggles within the health care system and with other welfare and social services that face economical difficulties, while confronting accelerated demographical, social, technological, and cultural changes.The situation is more acute because of the inability of modern society to provide the public health care system with resources (human and financial) according to the expectations that have developed in the welfare state since the end of World War II.New welfare policy, adjusted to the changes that occur within the society, is needed. In this struggle, the public health services find themselves in the center of the discussion as one of the whole of public social services and in competition with other public welfare systems.Economical and organizational problems are the most acute and attract a great deal of interest, and they are amply discussed in many articles and conferences. I shall not deal with them in this article.
The Assessment of Medical Technology: The Case of France
Authors: Weill Caroline , Fagnani Francis , LeFaure Christian 
Published: March 2009

The French health system is a complex organization that has developed since 1945 as the result of a subtle combination of two fundamental principles: liberal medicine — the freedom of both the consumers and the producers of care, and solidarity — universal access to health care — embodied in a quasi-generalized system of health insurance (4).Today, this balance, to which the French are uncontestably dedicated, appears to be precarious. It has gradually become apparent that the financing system—80% of which is based on mandatory deductions and is intended to guarantee the balance between freedom of choice and universal access — is not consistent with the dynamic of health expenditures. The growing costs of care, as witnessed by the increase of health expenses as a percentage of total household expenses from 4.5% in 1950 to 13.3 in 1985, has led to increased state control over the health care system since 1975.
Use of a Home-Care Computer Network by Persons With AIDS
Authors: Brennan Patricia Flatley , Ripich Stefan 
Published: March 2009

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

AbstractNew medical technologies are often developed and diffused in health care without societal assessments or setting of priorities. This article discusses the driving forces behind the development of new technologies and asks how women as users and providers of health services can gain influence on the process. Technologies used in pregnancy and childbirth are discussed to reveal different interests in their development and use and to discuss the role of industry in the development of new medical technologies in general.
A Comparison of International Health Outcomes and Health Care Spending
Authors: Babazono Akira , Hillman Alan L. 
Published: March 2009

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

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

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

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

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

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

Physicians through the ages have practiced their trade with more or less regard to the effects of their treatment on their patients' sense of well-being, if not as much as on the disease itself.Until recently, however, little attempt has been made to measure the effect of disease upon quality of life and how this quality is or is not improved by the treatment. Several means have now evolved and in areas of medicine where the treatment may profoundly affect the patient's sense of well-being, effort is being made to gauge these consequences.
Crucial Questions for Physiotherapy in Finland
Authors: Paatero Heidi , Holma Tuula , Leisti Seppo 
Published: March 2009

AbstractWhen planning for health services, questions of production and distribution as well as cost and quality are key issues for health planners and decision makers. The lack of available objective data often makes this work difficult. This paper presents recent efforts in Finland to improve the collection of information needed for planning in the field of physiotherapy.
Perspectives in Genetic Screening: Principles and Implications
Authors: Kaback Michael M. 
Published: March 2009

AbstractRecent advances in genetic identification and characterization of a number or hereditary disorders have led to increased possibilities for genetic testing and screening. The context and methods of screening are important given that identification of otherwise healthy persons as being presymptomatic or at increased risk for genetic diseases may have serious consequences for their future lifestyle, employment, and insurability. This article examines general principles for genetic screening, including goals, delivery issues, and professional and lay responses to screening and counseling, and recommends areas in which social psychological research on screening is needed.