bluuebunny/crossref_metadata_2025_split huggingface dataset:
Economic Forces and Hospital Technology
Authors: Goddeeris John H. 
Published: March 2009

AbstractThis paper considers economic forces on the organization and use of technology in hospitals from a U.S. perspective. U.S. hospitals are moving from a period of very loose financial constraints to one in which the demand side of the market is likely to exert much greater discipline. Theory and limited evidence suggest some important effects on the adoption and use of technology, leading in general to more emphasis on cost reduction and less emphasis on costly quality improvements. Also discussed are economic influences on the movement of technology out of the hospital and on the development of new technologies. Finally, some peculiarities of very high cost technologies are noted.
Integrating Ancient and Modern Medicine in Chinese Hospitals
Authors: Chen Hao-Hui 
Published: March 2009

AbstractModern industrial society and its industrial processes can sometimes discourage the practice of traditional medicine. The existence and use of traditional Chinese medicine for several thousands of years indicates that it has sound elements. As has been true with features of other ancient, highly developed civilizations, the discipline of traditional Chinese medicine offers a valuable resource in the treatment and prevention of disease. Its scientific aspects and valuable experiences must continue to be developed according to Western scientific methodology. China has initiated a program to utilize modern industrialized technology in the integration of the traditional Chinese and modern Western medical systems. The policy and process aimed at integrating traditional Chinese medicine with Western medicine are presented in this paper.These measures have resulted in considerable utilization and development of the traditional Chinese medicine system, and have had a major impact on the development of public health care, as well as medical technology and science. The positive interactions between these fields of study and existing problems are discussed, and some comments on future expectations are presented.
Reflections on Medical Technology as a Special Type of Capital
Authors: Field Mark G. 
Published: March 2009

AbstractThe classical equation for the production of goods and services, that is, the combination of labor, capital, and knowledge, constrained by the time dimension, may also be used to examine the production of medical and hospital services. However, this is qualified by the special nature of the “capital” used in health care, particularly medical technology. Because of the particular nature of health services, the adoption and the use of technology follows rules that are different from those in the industrial sphere. These differences are examined in some detail as are the implications for the health field in general, and for the hospitals where most of the new (and often costly) technology is located.
Ernest Amory Codman, M.D., and End Results of Medical Care
Authors: Neuhauser Duncan 
Published: March 2009

AbstractErnest Amory Codman, M.D., was one of the most important figures in the history of outcomes research in medicine. While his contemporaries scorned his efforts to create systematic procedures to evaluate the end results of medical care, his work foreshadowed many of today's most pressing issues in technology assessment. This arti traces Codman's career as an innovator and political gadfly at the Massachusetts General Hospital during the first three decades of this century, and examines the development and demise of his end-result system.
Present and Future Value of Dental Composite Materials and Sealants
Authors: Dogon I. Leon 
Published: March 2009

AbstractThis article reviews the development, composition, chemistry, recent technological advances, and extent of use of composite resin restorative materials, adhesives, and pit and fissure sealants. The problems related to the clinical behavior of these materials in the oral environment are dealt with, and methods of minimizing their present deficiencies are suggested. Future directions that might be taken to improve these materials and solve some of the inadequacies that these materials exhibit are also discussed.
Analysis of The National Institutes of Health Medicare Coverage Assessment
Authors: Dubinsky Michael , Ferguson John H. 
Published: March 2009

AbstractThe National Institutes of Health (NIH) is periodically asked to conduct assessments of new medical technologies to assist in coverage decisions made at the Office of Health Technology Assessment (OHTA) for the Health Care Financing Administration coverage policy. Analysis of NIH assessments indicates that even though most NIH assessments rely only on expert opinion, OHTA agreed with NIH recommendaations in over 90%.
Diagnostic Imaging in Small Hospitals
Authors: Racoveanu N. T. , Fresle D. A. 
Published: March 2009

AbstractDiagnostic imaging in small hospitals is discussed. Four key questions are answered: (1) Are diagnostic imaging technologies necessary at this level? (2) Which technologies should be chosen and why? (3) How can they be most rationally and cost effectively used? (4) How can their total impact on health care be assessed? The paper concludes that small hospitals should have diagnostic imaging facilities and that the modalities of choice are diagnostic radiology and ultrasonography. A detailed description is given of the WHO Basic Radiological System and General Purpose Ultrasonographic equipment together with WHO recommendations for the rational use of diagnostic imaging.
The Biological Revolution and Its Cultural Context
Authors: Kaye Howard L. 
Published: March 2009

In a recent article in Commentary, American medical sociologist Florence Ruderman observes that the evolution of medical practice and medical attitudes in the United States has been guided largely by the autonomous development of biomedical science and technology. “Science”, she asserts:… is a profoundly unsettling force … it causes endless dislocations and conflicts. Most basically, science is a source of independent values, motives, norms of conduct, and criteria of judgment. It sets its own course, defines its own goals. As for technology, its impact on medicine is even more obvious and direct; again, not just in producing tools or power but in transmitting values and in shaping the field from within. One need only think of the artificial-heart cases now in the news to realize that the physicians involved … are impelled by a technological drive that has its own logic and values, its own momentum—and its own dangers (24,45).
Evolution and Current Status of the Orphan Drug Act
Authors: Asbury Carolyn H. 
Published: March 2009

AbstractThe 1983 Orphan Drug Act was designed in response to market and regulatory disincentives that limited industrial interest in developing drugs needed by people in the United States with rare diseases and conditions. These disincentives evolved from changes in the pharmaceutical industry and in regulatory testing requirements. In the eight years since the Act and subsequent amendments have been in effect, the law has been associated with the new development and approval of 40 marketed drugs and 12 biologicals to treat rare (orphan) diseases. An additional 281 drugs and 141 biologicals have been entered into development and designated as orphans. Finally, the law has mandated exploration of whether the incentives of the Act are necessary and appropriate for stimulating industrial development of orphan medical drugs and devices. Despite this progress, controversies have arisen over three profitable orphan products that have benefited from the law's provisions. This has created the need for continued assessment of the Act's benefits and costs.
Clinical Pet Scanning: A “Short-lived” Orphan
Authors: Coleman R. Edward , Briner William H. , Siegel Barry A. 
Published: March 2009

AbstractPositron emission tomography (PET) is a method of nuclear medicine imaging that uses short-lived radiopharmaceuticals to detect and quantify the metabolic abnormalities of disease processes. PET initially was developed in a research environment as a research tool; data from these research studies resulted in the gradual recognition that PET studies would be useful for various routine clinical applications. The diffusion of PET into clinical practice has been slow in comparison with other new imaging methods (e.g., magnetic resonance imaging). This slow diffusion is attributable to several factors, including the complexity and high cost of PET, the uncertain role of the U.S. Food and Drug Administration in regulating the radiopharmaceuticals that are produced and used on-site for PET studies, and the apparent slow pace at which the Health Care Financing Administration and other third-party payers are developing policies for reimbursing for PET.
Issues in the Cross-National Assessment of Health Technology
Authors: Drummond Michael F. , Bloom Bernard S. , Carrin Guy , Hillman Alan L. , Hutchings H. Christina , Knill-jones Robin P. , De Pouvourville Gerard , Torfs Koen 
Published: March 2009

AbstractWith the growing international literature in economic evaluation and the rapid spread of new health technologies, there is a need to undertake, or at least interpret, economic evaluations on the international level. However, the ways in which cross-national differences affect the cost-effectiveness of health technologies or their evaluations have never been studied. This paper explores these issues by taking advantage of a unique situation in which the same economic evaluation of a new indication for a health technology was conducted simultaneously in four countries using an identical methodology. The study showed that if prior agreement on methods can be reached and local data applied, economic evaluations can be undertaken in a way that facilitates the extrapolation of results from country to country.
Information Dissemination and the Cesarean Birth Rate: The Illinois Experience
Authors: Oleske Denise M. , Glandon Gerald L. , Tancredi Daniel J. , Nassirpour Mehdi , Noak John R. 
Published: March 2009

AbstractA study was initiated to investigate the impact of information dissemination in Illinois upon the projected rise in the cesarean birth rate over the period from 1986 through 1988. The total cesarean birth rate in Illinois had not changed significantly during this period, whereas the rate of vaginal births after cesarean sections (VBAC) increased by 58.4% (p <.001). Information dissemination may have contributed to stemming an increase in the cesarean birth rate in Illinois while promoting VBAC deliveries.
Making Clinical Policy Explicit:Legislative Policy Making and Lessons for Developing Practice Guidelines
Authors: Lomas Jonathan 
Published: March 2009

AbstractPromulgation of practice guidelines in medicine has increased interest in the structure of clinical policy making. It is argued that with a generic efinition of policy as “the rules governing the behavior of individuals or institutions,” clinical policy making is analogous to legislative policy making. Practice guidelines emphasize the advantages of making clinical policy more explicit. The structure of legislative policy making as evolved over many years to meet the challenge of making both the policies and the process of policy making explicit. Processes to promulgate clinical policies may be able to exploit this experience to improve clinical policy making and thereby retain control of the process within medicine. Generic steps are outlined for making decisions with incomplete information; synthesis of facts, vested interests, and values; involvement of stakeholders; and implementation of policy. An illustration of the use of the generic steps to make and implement a clinical policy for cesarean birth follows, with evaluations of its impact on the behavior and satisfaction of clinical stakeholders.
Standardizing Methodologies for Economic Evaluation in Health Care: Practice, Problems, and Potential
Authors: Drummond Michael , Brandt Arno , Luce Bryan , Rovira Joan 
Published: March 2009

AbstractThere has been an exponential growth in the literature on economic evaluation in health care. As the range and quality of analytical work has improved, economic studies are becoming more influential with health care decision makers. The development of standards for economic evaluation methods would help maintain the scientific quality of studies, facilitate the comparison of economic evaluation results for different health care interventions, and assist in the interpretation of results from setting to setting. However, standardization might unnecessarily stifle methodological developments. This paper reviews the arguments for and against standardization, assesses attempts to date, outlines the main areas of agreement and disagreement on methods for economic evaluation, and makes recommendations for further work.
The State of the Art Versus the State of the Science: The Diffusion of New Medical Technologies into Practice
Authors: Greer Ann Lennarson 
Published: March 2009

AbstractThis paper offers a theory to explain the diffusion of new medical technologies into local practice. Based on several hundred interviews with community hospital physicians, it anchors technology decisions in the norms and relationships of local practice. Physician descriptions of their use of different types of assessment information provide insight into the way in which local consenses on appropriate practice are formed, guide behavior, and change. To understand new technology adoption, it is necessary to (a) differentiate “formed” (complete) and “dynamic” (still developing) technologies, and (b) appreciate the extent to which medical practice is locally organized. Concepts from organizational literature, then, become useful in explaining the penetration of these medical communities and the circumstances under which a new modality takes hold in them. Within the framework presented, previously puzzling findings regarding variations in local practice and the poor relationship between practice behavior and the published literature become understandable.
Information Transfer in the Medical Device Industry
Authors: Geuns J. R. van 
Published: March 2009

AbstractThis presentation provides an overview of the process of information transfer in a typical area of the medical device industry, that of medical imaging. The medical device industry must translate technological trends into ideas for new methods for diagnosis and treatment. The feasibility of such ideas has to be evaluated carefully, inasmuch as large amounts of money are sometimes invested in product development. Moreover, the knowhow obtained from research must be protected long enough to enable the industry to complete development and market the product.
The Role of the Universities in Assessing Technology and Disseminating Information
Authors: Jennertt Bryan 
Published: March 2009

AbstractUniversities, especially those with medical schools whose academics engage in clinical research, have a vital role in shaping the way in which medical technology is used. Academic clinicians are a bridge between laboratory research, where new technologies are developed, and clinical practice, where these technologies are applied in treating patients. Academic clinicians are particularly suited to doing clinical assessment of medical technologies, and academic clinical departments should devote more time to the assessment and application of technology on a broad scale.
The Transfer of Medical Information: A Journalist's View
Authors: d'Adler Marie-Ange 
Published: March 2009

AbstractAbstract Despite the quantity of material on medical issues which journalists typically receive, and the tremendous public interest in health news, journalists are only rarely able to provide medical information of any real value to the public. Good news, no matter how tentative, always gets more attention than critical assessment. Deadlines pressure journalists to look only at the surface of the issues that they describe, and few have the expertise necessary to judge the importance of their stories. When accurate, authoritative information is available in a structured format; however, the news media can publicize medical findings rapidly, effecting significant changes in public behavior.
Evluation of The Consensus Conference Program in Sweden: its Impact on Physicians
Authors: Johnsson Monica 
Published: March 2009

AbstractThe impact of consensus conferences on physicians was studied in 1985 for the first four conferences Sweden held in 1982–1985. For each conference a main target group was defined as hospital-based physicians in supervisory positions within relevant clinics. Data were collected through a postal survey of all 1,668 members of the four different target groups. The total response rate was 86%. Reported awareness of a particular consensus conference as well as professed knowledge of a single conference statement was high—roughly 90%—for all four conferences. The consensus statement evoked changes in clinical practice according to 7%–10% of the respondents and changes were proportionally higher for physicians in smaller hospitals. Most of the respondents (61%–83%) reported no change, claiming that the consensus statement reflected clinical practices established prior to the conference. The validity of self-reported data is discussed.
Expert Systems in Medicne:Possible Future Effects
Authors: Potthoff P , Rothemund M. , Schwefel D. , Engelbrecht R. , Eimeren W. van 
Published: March 2009

It should be pointed out that during the interviews most of the experts had positive expectations of ESM. The developers are more generally enthusiastic than the prospective users and affected parties who, especially in respect of the diffusion of ESM into practical application, only show a limited optimism.However, the representatives of the medical profession and the health insurance industry were convinced that ESM might contribute to cost-neutral increases of quality in out-patient and in-patient medicine. But we also understood them to say that they consider other developments in medicine to be overriding, for example, a tendency of general medicine towards a more family-oriented medicine and a reduced emphasis on technology-oriented medicine. In respect of the conception shared by developers as well as potential users that over-enthusiastic expectations should rather be restrained, we consider such a balanced expectation of positive effects of ESM to be adequate to the actual knowledge of the subject.
The Evaluation and Control of Drugs in Norway
Authors: Jøldal Bjørn 
Published: March 2009

The basic aim of a drug policy is to ensure that effective and safe drugs of good quality are available to cover the health needs of a country. A national drug policy should be considered an integral part of any comprehensive health-care policy. The formulation of national drug policies varies even between similar countries because of conflicting interests and different political, economic, and social pressures. It is influenced by such factors as:the health situation of the country;the medical care system;the education and training of health personnel;the social security and health-insurance schemes;drug research and development possibilities;the domestic production of drugs;the determination of the demand for drugs;the system of drug distribution;the possibilities for evaluation and control of drugs; andinternational policies on medicinal products.
Health Technology Development in Japan
Authors: lkegami Naoki 
Published: March 2009

AbstractThis article provides a comprehensive analysis of the social, cultural and economic factors which have led to the present pattern of technology utilization in Japan. It is divided into five sections. The first provides the historical framework; the second, an overview of the health care delivery context and its economic incentive structure; the third, an analysis of the various contenders involved in the process of resource allocation; the fourth, a description of the technology areas which have been emphasized in Japan; and the fifth, an examination of future issues.
Medical Technology in The United States: The Last Decade
Authors: Russell Louise B. , Sisk Jane E. 
Published: March 2009

AbstractThis paper reviews the evolution of U.S. policy toward medical technology in areas such as cost containment, regulation of devices and drugs, and third party reimbursement. In addition the authors chronicle the diffusion of major medical technologies, procedures, and organizational innovations in the United States. Finally, the article provides tentative observations on the effect of recent policy changes and concludes with some recommendations for the future.
Dental Implants: State of the Art, State of the Science
Authors: Schnitman Paul A. 
Published: March 2009

AbstractAnalysis of epidemiologic studies reveals that even with advances in preventive dentistry, edentulism continues to be a pressing problem especially in a rapidly expanding senior population. As an alternative to traditional removable dentures, dental implants can provide fixed support for crowns and bridges. A recent National Institutes of Health Consensus Development Conference revealed significant growth in implant technology and established that, although a complex treatment alternative, implants can function for 10 years or more. Continued development in basic and clinical research, federal regulations, professional education, public awareness, insurance, and marketing will shape the future of the field.
Nonsurgical Treatment of Cholelithiasis: An Analysis of Clinical Opportunity
Authors: Weinstein Debra F. , Brink James A. , Richter James M. 
Published: March 2009

AbstractThis article examines the potential impact of recently developed nonsurgical treatments for gallstones on patient care and resource utilization. Using epidemiological and efficacy data from the literature and current patient selection criteria, the authors evaluate UDCA, extracorporeal shock-wave lithotripsy, and direct instillation of methyltertbutyl ether in terms of short-term clinical results, health policy, and economic implications.
Quality Assurance Procedures in Radiotherapy: Economic Criteria to Support Decision Making
Authors: Kesteloot Katrien , Dutreix André , van der Schueren Emmanuel 
Published: March 2009

AbstractThis paper details the costs of two types of quality assurance activities in radiotherapy: in vivo dosimetry, intended to check the delivered dose, and portal imaging to check the treated volume. For both activities, either on-line or off-line techniques may be used. Describing the costs allows the calculation of which techniques are most COSt-efficient for different radiotherapy departments.
Geographic Variation in the Treatment of Prostate Cancer in Connecticut
Authors: Polednak Anthony P. 
Published: March 2009

AbstractIn Connecticut there was considerable variation by town of residence in the proportions of patients diagnosed in 1985–1988 receiving transurethral resection only, prostatectomy, and irradiation (without surgery) for local-stage prostate cancer and receiving endocrine surgery for late-stage prostate cancer. Age and socioeconomic variables were examined as predictors of this variation.
Cross-design Synthesis:A New Form of Meta-analysis for Combining Results from Randomized Clinical Trials and Medical-practice Databases
Authors: Droitcour Judith , Silberman George , Chelimsky Eleanor 
Published: March 2009

AbstractCross-design synthesis is a new (and still evolving) strategy for providing quantitative results that capture the strengths and minimize the weaknesses of different kinds of research. The strategy, which is being developed to answer questions about the effects of treatment in medical practice, includes (a) identifying complementary research designs and studies conducted according to those designs; (b) completing an in-depth assessment of each study with respect to the chief potential bias(es) that are associated with its design; (c) making “secondary adjustments” of study results to correct known biases; and (d) developing synthesis frameworks and models that will minimize the impact of hidden biases.