bluuebunny/crossref_metadata_2025_split huggingface dataset:
Correlates of Physician Utilization of Physical Therapy
Authors: Anderson Judith , Campbell Suzann K. , Gardner H. Garry 
Published: March 2009

AbstractA survey of 200 physicians explored the relationship between their beliefs in the efficacy of physical therapy (PT) and their use of PT for their patients with cerebral palsy (CP). Results show that utilization of PT is related to physicians' use of PT in general and is inversely related to the percentage of CP in physicians' patient loads, but is not related to their opinions of the value of PT services.
Hospital Care Versus Home Care for Rehabilitation After Hip Replacement
Authors: Möller Gudrun , Goldie Ian , Jonsson Egon 
Published: March 2009

AbstractA pilot study was done to assess the feasibility of reducing the hospital stays of patients with total hip replacement (THR). The length of hospital stay for these patients depends largely on how rehabilitation, mostly physical therapy, is organized. This study shows that not more than a half hour per postoperative day was devoted to care services and rehabilitation activities. It is feasible and less expensive to reduce substantially hospital stay by planned physical therapy in the patient's home. These results have prompted a randomized controlled clinical trial to assess hospital versus home rehabilitation.
Medical Equipment in the People's Republic of China: A Survey of Medical Equipment Procurement, Utilization, and Maintenance in University-Affiliated Hospitals between 1976 and 1987
Authors: Peabody John W. , Schmitt Joseph M. 
Published: March 2009

AbstractWe report results of a survey of medical equipment purchasing, utilization, and maintenance practices in 12 Chinese tertiary-care hospitals. A dramatic increase in expenditures on medical equipment was found to have occurred after 1979, mainly resulting from purchases of imported equipment. Based on survey results and on personal observations, recommendations are given for reducing equipment-related costs through the development of clinical engineering services.
The Potential for Medical Informatics in the Eastern Mediterranean Region
Authors: Al-hashimi Mukhtar S. A. , Pryor T. Allan 
Published: March 2009

AbstractThis article assesses the potential value of an integrated medical/hospital information system (IMIS) for the members of the Eastern Mediterranean Region of the World Health Organization, and describes the preliminary results of a feasibility study questionnaire done in December 1989 at Salmaniya Medical Center (SMC) in the state of Bahrain.
DNA Technology and Vaccines
Authors: Brown Fred 
Published: March 2009

AbstractIt has been 20 years since the concepts that are now embraced in the term recombinant DNA technology were first described. The technology has been used to design new vaccines, and one product — that for hepatitis B — has been in widespread use for almost a decade. Several other engineered vaccines have shown considerable promise in laboratory trials. Nevertheless, the potential of the approach is still to be realized. This article describes the principles that are involved in the design of these new vaccines, focusing on those for hepatitis B and rabies.
The Economic Costs of Acute Myeloid Leukemia in Sweden
Authors: Tennvall Gunnel Ragnarson , Persson Ulf , Nilsson Bo 
Published: March 2009

AbstractThe direct and indirect costs of acute myeloid leukemia were estimated for Sweden in 1989. The calculated total cost was SEK 460 million. Nearly half of the costs, or 1.7 million per patient diagnosed, were indirect costs due to premature mortality. Direct costs of relapses and indirect costs of mortality represent costs due to the absence of completely curable therapy. They also represent potential cost savings that could be ootained after introduction of new treatment options in the future.
Synergism in Technology Assessment
Authors: Tyson Ted R. 
Published: March 2009

In 1899, Charles H. Duell, Commissioner of the U.S. Office of Patents, urged President McKinley to abolish the Patent Office by saying, “Everything that can be invented has been invented.” Fortunately for the health care industry, there have been more significant “medical inventions” in the 89 years following Duell's utterance than in all of recorded history preceding it.There is now a crisis in medical technology, and it has not been caused by a lack of ideas from innovative clinicians, inventors, and scientists. Instead, it is a result of sincere, but often spasmodic, efforts to control health care costs, which in the minds of many observers threaten the national economy, if not the country's survival.
The Rational Use of Medicines
Authors: Werkö Lars 
Published: March 2009

AbstractA short description is given of the interplay between the pharmaceutical industry and its critics regarding the rational use of medicines since the 1960s. This was especially vigorous in the developing countries but also had ramifications in the industrialized world. The initiatives taken by the World Health Organization in starting a dialogue between the industry representatives in the International Federation of Pharmaceutical Manufacturers Associations and the critical voices of Health Action International are specially emphasized. The recent developments in the therapy of primary hypertension and peptic ulcer are discussed briefly as examples of the rapid changes in what should be rational in pharmacologic treatment of disease.
Patient Decision Making: The Missing Ingredient in Compliance Research
Authors: Donovan Jenny L. 
Published: March 2009

AbstractMedical noncompliance has been identified as a major public health problem that imposes a considerable financial burden upon modern health care systems. There is a large research record focusing on the understanding, measurement, and resolution of noncompliance, but it is consistently found that between one third and one half of patients fail to comply with medical advice and prescriptions. Critically absent from this research record has been the patient's role in medical decision making. For patients, particularly those with chronic illnesses, compliance is not an issue: they make their own reasoned decisions about treatments based on their own beliefs, personal circumstances, and the information available to them. The traditional concept of compliance is thus outmoded in modern health care systems, where chronic illness and questioning patients predominate.
Pharmacists as Agents of Change for Rational Drug Therapy
Authors: Lipton Helene Levens , Byrns Patricia J. , Soumerai Stephen B. , Chrischilles Elizabeth A. 
Published: March 2009

AbstractWe analyze what is known and unknown about the contribution of the pharmacist as patient educator, physician consultant, and agent to affect patient outcomes in ambulatory settings. The need for pharmacist services is discussed, as are the theoretical underpinnings and quality of the scientific evidence to support their efficacy. The analysis is conducted in the context of a shift in pharmacists' roles from product to patient orientation as well as recent U.S. legislation mandating enhanced pharmacists' roles via drug utilization review for all Medicaid patients. We conclude with a research and action agenda, calling for stronger research designs in evaluating pharmacists' interventions. The shifting paradigm in the pharmacy profession, coupled with the implementation of the Omnibus Budget Reconciliation Act of 1990, provide unique opportunities for rigorous evaluations of pharmacists as agents of change for rational drug therapy.
Cost-Effectiveness Studies of Renal Transplantation
Authors: Karlberg Ingvar , Nyberg Gudrun 
Published: March 2009

AbstractThis study analyzes opportunity costs for the treatment of end-stage renal disease. Kidney transplantation remains the most cost-effective treatment for uremia and is one of the most cost-effective technologies in health care. Improved survival of grafts and increased numbers of transplants have the potential to reduce costs for dialysis programs. To support organ donation activities, the public and concerned health professionals should be informed about the opportunity cost of “unnecessary” dialysis. These resources could be reallocated from dialysis to other programs. Among patients in dialysis, a more common use of chronic ambulatory peritoneal dialysis instead of institution-based hemodialysis would greatly increase cost-utility and further reduce the program costs of renal replacement therapy.
Technology Assessment:Old, New, and Needs-based
Authors: Tugwell Peter , Sitthi-amorn Chitr , O'connor Annette , Hatcher-roberts Janet , Bergevin Yves , Wolfson Michael 
Published: March 2009

AbstractRecent health reports, including the 1993 World Development Report, have emphasized the importance of integrating the needs of the population into technology assessment. This paper reviews previous approaches to technology assessment and identifies the missing link between technology and its impact on the physical, emotional, and social needs of the community, namely needs-based technology assessment. It stresses the key role played by issues of equity and community values in making technology decisions. A number of models for needs-based technology assessment are described.
Case Study: Needs-Based Technology Assessment and Essential National Health Research: Experience in the Philippines
Authors: Tan-Torres Tessa L. 
Published: March 2009

AbstractEssential national health research (ENHR) ensures that health research will be undertaken in priority areas defined by the people and will be used in decision making. Needs-based technology assessment (NBTA) is anchored on the ENHR philosophy. Two case studies are presented, one illustrating a successful application of NBTA and the other a failed approach. Reasons for the difference in success are examined.
Variation in Use of Breast-Conserving Surgery in Lombardia, Italy
Authors: Grilli Roberto , Repetto Francesca 
Published: March 2009

AbstractThe extent of variation in the use of breast-conserving surgery was analyzed using the 1990 and 1991 hospital discharge data of Lombardia, Italy. The proportion of patients undergoing breast-conserving surgery for unilateral breast cancer was estimated for each of the 10 geographic areas (9 provinces plus metropolitan Milano) in which the region is divided. Overall, the rate of use was 41% of 3,225 patients in 1990, and 45% of 3,736 patients in 1991. In both study years, patient age was strongly correlated with the likelihood of undergoing conservative surgery, with younger women more frequently treated with this approach. In each province, patients treated at centers located in the main city had a greater probability (OR, 1.54; 95% Cl, 1.37–1.69) of having conservative surgery. This procedure was also more often used in private hospitals (OR, 1.59; 95% Cl, 1.20–2.08) where care is paid at the point of consumption by patients, directly or through their private insurance. The observed variation in the use of the conservative procedure across the 10 regional areas was greater than that expected by chance alone (p <.0001), with rates ranging from 29% to 60%. This pattern persisted even after adjusting for the relevant patient and hospital characteristics. Despite the relatively large body of scientific evidence, it appears that the surgical management of breast cancer is more dependent on physicians' attitudes in each geographic area than on individual patients' characteristics.
Perioperative Use of Total Parenteral Nutrition: Variations in Guidelines and Practice in Three Norwegian Hospitals
Authors: Mjaaland Marianne , Revhaug Arthur , Førde Olav Helge 
Published: March 2009

AbstractIn a cross-sectional, retrospective study of 604 cases, variations among three Norwegian hospitals in use of perioperative parenteral nutrition (TPN) after gastrointestinal surgery was determined. Postoperative TPN rates were 25%, 34% (p =.05) and 56% (p <.0001). respectively. However, a substantial part of the variation was explained by differences in patient characteristics.
Assisted Conception Techniques: On What Basis Do Health Technologies Become Routinely Available When They Have Been Assessed As Effective?
Authors: Freemantle Nick , Watt Ian 
Published: March 2009

AbstractThe possibility of restoring fertility among some infertile couples through assisted reproductive technology has led to questions about the terms under which such treatments should be made available. Although there is now evidence on their effectiveness, there is considerable variation in the availability of these treatments under the U.K. National Health Service.
The Tension Between Cost Containment and the Underutilization of Effective Health Services
Authors: Bloom Bernard S. , Mark Fendrick A. 
Published: March 2009

AbstractOne of the common ingredients in all attempts to slow escalating health care costs is to control the utilization of services that provide little or uncertain benefit. To reform existing delivery systems, the organization, provision, and financing of health care need to be evaluated critically. Successful reform requires that more rational methods be used to determine which services to provide. The preferences of physicians, patients, and payers of care do not appear optimal from a societal perspective in choosing health care services. While reducing the use of interventions of little or unknown benefit should save money, a policy to restrict the use of medical services may lead to an unwanted result: the underutilization of interventions of proven clinical benefit. Through the determination of the value—by rigorous assessment of both costs and benefits of available alternatives—in a context sensitive to the unique cultural, political, and economic characteristics of individual nations, the health of the population should be improved and growth of health expenditures constrained. This is the first step in health care reform.
A Cost-Utility Analysis of Laser-Assisted Angioplasty for Peripheral Arterial Occlusions
Authors: Sculpher Mark , Michaels Jonathan , Mckenna Mike , Minor Julia 
Published: March 2009

AbstractDespite the perception of many people that lasers represent the cutting edge of high-technology medicine, this form of medical technology has been subject to relatively little rigorous evaluation. This dearth of research relates particularly to economic evaluation, where there have been few attempts to justify the high cost of laser equipment. This paper details an economic evaluation of the use of laser technology as a secondary adjunct to angioplasty to treat peripheral arterial occlusions. Using data from a range of sources, including a published randomized trial, a cost-utility model is developed to estimate the costs and benefits of the laser, relative to standard angioplasty. The best available data indicate a cost-effective role for the laser, but important areas of uncertainty exist, including the laser's secondary recanalization rate, which has been estimated on the basis of limited numbers of patients. This uncertainty suggests that further research is required before widespread diffusion of the laser for use in this clinical context.
A Risk Assessment and Control Model for the Failing Björk-Shiley Convexo-Concave Heart Valve
Authors: Koornneef Floor , van Gaalen Geerda L. , de Mol Bas A. J. M. 
Published: March 2009

AbstractFor risk assessment and control of the failing Björk-Shiley convexo-concave heart valve, we present a life cycle-based complex system model and a risk intensity assessment model, allowing consistent analysis of this complex medical problem and identification of all pertinent aspects of product-related risks to patients.
The Measurement of Utility in Multiphase Health States
Authors: Richardson Jeffrey , Hall Jane , Salkeld Glen 
Published: March 2009

AbstractTo examine the validity of the additive quality-adjusted lite year model used to evaluate a multiphase health state, data from a pilot study of mammography were used to determine whether the values assigned to a multiphase postmastectomy health state could be estimated from a combination of the independently rated constituent health state values. The results suggest that they cannot.
Making Choices in Hospital Resources Allocation: The Use of an Assessment Tool to Decide Which New Projects Are Financed
Authors: Durand-Zaleski Isabelle , Leclerq Roland , Bagot Martine , Lemaire François , Revuz Jean , Spetebroodt Yvon , Zafrani Elie-Serge , Rochant Henri 
Published: March 2009

AbstractWe designed a scoring system to rank acute care hospital projects and allocate resources between them. The evaluation tool assessed projects on an ordinal scale; the criteria scored were medical interest, feasibility, interest for teaching and research, and compatibility with the hospital's strategy. Clinical and technical projects were ranked separately. In 1994, 25 new projects, representing a total cost of $1.4 million, were reviewed by two independent reviewers. The scores ranged from 30 to 18 over 36. Projects presented by clinical departments scored higher than projects presented by medicotechnical departments.
Beware of Surrogate Outcome Measures
Authors: Gøtzsche Peter C. , Liberati Alessandro , Torri Valter , Rossetti Luca 
Published: March 2009

AbstractSurrogate outcome measures may speed up clinical research if they can be measured earlier in a study than the primary outcome of interest. We review the justification for their use and conclude that reliance on them may be harmful. Results obtained with surrogates should therefore be regarded as preliminary. Large, definitive trials with clinically relevant outcomes should always be performed before new interventions are accepted.
Transcutaneous Electrical Nerve Stimulation (TENS): A Technology Assessment
Authors: Reeve Janis , Menon Devidas , Corabian Paula 
Published: March 2009

AbstractThe scientific evidence for clinical effectiveness of transcutaneous electrical nerve stimulation (TENS) for treatment of acute, chronic, and labor and delivery pain is assessed in this paper, and it is concluded that there is little evidence for other than a limited use of TENS. The utilization of TENS in Canadian hospitals and payments for TENS services are addressed. Some practicalities regarding the use and assessment of health technologies are discussed.
Hospital-and Patient-Related Characteristics Determining Length of Hospital Stay for Hip and Knee Replacements
Authors: Rissanen Pekka , Aro Seppo , Paavolainen Pekka 
Published: March 2009

AbstractTotal hip arthroplasty (THA) and total knee arthroplasty (TKA) are among the most prestigious health care technologies. Their popularity has grown rapidly, and an increasing proportion of health care resources is allocated to them. We studied patient- and hospital-related factors that cause variation in a major determinant of hospital costs, the length of hospital stay (LOS) for THA and TKA. We gathered data on 10,288 hip and 5,173 knee patients with primary or secondary arthrosis from the Finnish Arthroplasty Register, which we linked with the Finnish Hospital Discharge Register. Patientand hospital-related variations in LOS were explained using regression models. Of the patient-related factors, complications caused the greatest prolongation of hospital stay, but patient's age, gender, and charge category also influenced LOS. Hospital-related factors were major causes of LOS variation. In the hospitals the average case-mix-adjusted LOS ranged from less than a week to 3 weeks. The number of arthroplasties performed in hospital was inversely related to LOS. The within-hospital LOS figures for THA and TKA were strikingly similar and persistent.
Economic Evaluation of HIV Testing Among Intravenous Drug Users: An Analytic Framework and Its Application to Italy
Authors: Villari Paolo , Fattore Giovanni , Siegel Joanna E. , Paltiel A. David , Weinstein Milton C. 
Published: March 2009

AbstractWe performed an economic evaluation of HIV testing among intravenous drug users (IVDUs) in Italy using the analytical framework of cost-effectiveness analysis. A semi-Markov model was developed to calculate costs and life expectancy of a cohort of IVDUs with and without an annual HIV testing program. We also investigated the incremental cost-effectiveness of a hypothetical early treatment to prolong the life expectancy of HIV-infected asymptomatic subjects by 1 year. The testing program is cost saving in the low prevalence scenario (0.05), and costs L 14,000,000 (US $8,400) and L 55,800,000 (US $33,500) per year of life saved in areas of medium (0.3) and high (0.6) prevalence, respectively. The incremental cost-effectiveness of the hypothetical early treatment may compare favorably with other health care interventions. The program may be considered a cost-effective procedure in low and medium prevalence areas. Where prevalence is high, more evidence about the magnitude of the behavior change is needed. In these areas, the availability of an effective early treatment may become the economic rationale for implementing such a program.
Low-Cost Diagnostic Technologies and Clinical Outcomes:The Impact of Inappropriate Utilization
Authors: Lewis Steven , Foreman Jeanette 
Published: March 2009

AbstractCommodification of low-cost diagnostic technologies (LCDTs) carries the risk of an unintended and potentially worrisome shift in how we conceive of health assessment. Optimizing practice requires a balanced understanding of both the beneficial and harmful impact of the use of LCDTs and the development of system incentives for appropriate use.
Medical and Surgical Supply Costs: Case Study of a Costly Low-Cost Technology
Authors: Thamer Mae , Fitzpatrick Kevin J. , Perry Seymour 
Published: March 2009

AbstractThere is a paucity of research regarding the contribution of “low-cost” technologies to the escalation of medical costs in the United States. We examined total charges for medical and surgical supplies (MSS) among all hospitalized Medicare beneficiaries in 1994; a total of US $16.8 billion was spent on MSS, or $1,397 per hospitalization. For selected surgical procedures, both the proportion of total hospital charges attributed to MSS and the mean charge per hospitalization were considerably higher. Concerns regarding excessive payments for MSS and the lack of accountability by the Medicare program are discussed. Itemization of MSS supplies may serve to eliminate wasteful use and lead to decreased costs.
Costs and Cost-Effectiveness in Hip and Knee Replacements:A Prospective Study
Authors: Rissanen Pekka , Aro Seppo , Sintonen Harri , Asikainen Kimmo , Slätis Pär , Paavolainen Pekka 
Published: March 2009

AbstractThe extensive benefits of the total hip (THA) and knee (TKA) replacements are well documented, but surprisingly little is known about their economics. We assessed costs, cost-effectiveness (C/E), and patient-related C/E variances in THA and TKA from data on 276 THA and 176 TKA patients. Patients with primary arthrosis, primary operation, and total joint replacement were recruited from seven hospitals between March 1991 and June 1992. Their use of health and other welfare services together with health-related quality of life (HRQoL) were measured before the surgery and at 6, 12, and 24 months postoperatively. HRQoL was assessed by the 15D, a 15-dimensional HRQoL instrument, and the Nottingham Health Profile. Costs were assessed from questionnaire responses, the Finnish Hospital Discharge Register, and Finnish Arthroplasty Register. Total hospital costs per patient were 45,000 FIM (US $10,500) for THA and 49,600 FIM (US $11,500) for TKA. Prosthesis costs comprised 21 % of these costs in THA and 24% in TKA. On average, hip patients gained more in terms of HRQoL, and the operations were more cost-effective. The C/E ratio for younger (« 60 years) knee patients did not differ from those in all age groups of hip patients, whereas TKAs in those over 60 years had a worse C/E ratio compared with all other patient subgroups. It was concluded that allocation efficiency can be improved by considering not only the intervention but also patient characteristics such as age. Indeed, the C/E ratio varied more across age groups of knee patients than between average THA and TKA patients.