bluuebunny/crossref_metadata_2025_split huggingface dataset:
Abdominal and Vaginal Radical Hysterectomy Among U.S. Women aged 65 Years and Older
Authors: Amini Saeid B. , Weight Steven A. , Yuan Zhong , Rimm Alfred A. 
Published: March 2009

AbstractUnlike most European and Asian countries, radical vaginal hysterectomy (RVH) is not performed often in the United States, especially among older women. To examine the changes in RVH over the years, trends in hospital stay, hospital charges, and patient survival, we studied women aged 65 years and older undergoing RVH and compared them with patients receiving radical abdominal hysterectomy (RAH). During the study period there were a total of 288 RVH surgeries compared with 4,835 RAH surgeries. There were no significant changes in the number or proportion of RVH patients over 8 years (p =.50, trend test). On the average, RVH patients were significantly older and had shorter hospital stays. Among patients without cancer, there were no significant differences in the age, race, or survival of patients having either RVH or RAH. Similar results were obtained for patients with cancer.
Evaluation of the Regular Practice of Breast Cancer Screening in a Health Area
Authors: Cosp Xavier Bonfill , Castillejo Mercé Marzo , Crivillé Melcior Sentís , Mir Ramon Rossell , Cistaré Xavier Gallardo , Masip Ramon Florensa , Ferrer Elena Rivero , Quiroga Coloma Moreno 
Published: March 2009

AbstractBreast cancer screening has proved to be efficacious only in clinical trials or structured programs. However, little is known of its effectiveness as a regular practice. This study is an assessment of breast cancer screening in regular practice in a Spanish area of 350,000 inhabitants through analysis of existing sources of information. It is evident that this screening is insufficient, inefficient, very variable, nonspecific, and probably ineffective, although there is insufficient information to prove it. The immediate implementation of a well structured and accredited screening program is essential to overcome the current limitations.
Priority Classification of Patients According to a Modified ‘Norwegian Model’
Authors: van Assendelft Alexander H. W. 
Published: March 2009

AbstractA priority classification was evaluated according to a modified “Norwegian model.” Many diseases do not belong to any specific priority category based only on the diagnosis. The classification also depends on the condition's type, site, and phase as well as the patient's age and overall condition. Savings cannot be achieved by the model used because 89% of the patients belonged to the priority categories I–III, the care of which can be classified as necessary.
Repeated Testing: An Overview and Analysis
Authors: Sox Harold C. 
Published: March 2009

AbstractPhysicians often obtain the same test over and over again. This article first considers screening tests, such as mammographic screening for breast cancer, and describes several proposals for finding the interval that best balances cost, harms, and benefits. The same principles apply to monitoring a patient for recurrence of a disease, such as bladder cancer. The article closes with a theoretical consideration of the circumstances for repeating a test once to check a surprising value.
Why go see the Doctor?:Care Goes From Office to Home as Technology Divorces Function from Geography
Authors: Stoeckle John D. , Lorch Stephen 
Published: March 2009

AbstractTwo functions of home care, assistance to improve disabled and aged patients' mobility and function, and self-care that includes treatment, screening-monitoring, exercise assistance, and information exchange, are described, as are the technologies used for these functions. Social and economic pressures as well as professional rationales that expand the use of technologies at home are noted, as is their impact on the site of care and on the patient-doctor relationship.
Low-Cost Technologies and Public Policy
Authors: Shine Kenneth I. 
Published: March 2009

AbstractThe evaluation of low-cost technologies is complicated by the difficulty of understanding what is meant by “low” cost. Low unit costs may lead to the widespread use of a technology that results in high aggregate costs. It is often more useful to consider the value than the cost of a technology, recognizing that this value may change, depending upon the group to whom it is applied as well as the factors that are measured. Public policy should attempt not only to control costs but also to obtain the greatest value for expenditures in health care by supporting the development of methodologies to define value, reimbursement strategies that emphasize cost-effectiveness, and clinical guidelines that can reduce variation in practice.
Costs and Effectiveness of Extracorporeal Gallbladder Stone Shock Wave Lithotripsy Versus Laparoscopic Cholecystectomy: A Randomized Clinical Trial
Authors: Barkun Alan N. , Barkun Jeffrey S. , Sampalis John S. , Caro Jaime , Fried Gerald M. , Meakins Johnathan L. , Joseph Lawrence , Goresky Carl A. ,   The McGill Gallstone Treatment Group
Published: March 2009

AbstractThirty-five patients were randomized to extracorporeal shock-wave lithotripsy (ESWL) and 25 to laparoscopic cholecystectomy (LC). Stone disappearance occurred in only 12 of 32 ESWL patients [38% (95% Cl: 21–56%)] during a 15-month follow-up. Greater incremental gains in quality of life after 6 months were observed among LC patients (p <.01). Total duration of disability was 6.8 ± 8.5 days for ESWL, and 22.7 ± 16.6 days for LC (p <.01). Nine (28%) patients crossed over electively to the LC group, but only 44% of these underwent LC within the next 3 years. ESWL cost Can $58.9/ day of disability saved. ESWL is limited by its selective applicability and modest stone disappearance rate. Its cost-effectiveness is largely dependent on patient acceptance of recurrent episodes of biliary colic due to the persistence of stone fragments.
The Cost-Effectiveness of Magnetic Resonance Imaging for Patients with Equivocal Neurological Symptoms
Authors: Mushlin Alvin I. , Mooney Cathleen , Holloway Robert G. , Detsky Allan S. , Mattson David H. , Phelps Charles E. 
Published: March 2009

AbstractObjective: To determine the incremental cost-effectiveness of magnetic resonance imaging (MRI) and computed tomography (CT) in young adults presenting with equivocal neurological signs and symptoms. Designs and methods: A decision analysis of long-term survival using accuracy data from a diagnostic technology assessment of MRI and CT in patients with suspected multiple sclerosis, information from the medical literature, and clinical assumptions. Main results: In the baseline analysis, at 30% likelihood of an underlying neurologic disease, MRI use has an incremental cost of $101,670 for each additional quality-adjusted life-year saved compared with $20,290 for CT use. As the probability of disease increases, further MRI use becomes a cost-effective alternative costing $30,000 for each quality-adjusted life-year saved. If a negative MRI result provides reassurance, the incremental costs of immediate MRI use decreases and falls below $25,000 for each quality-adjusted life-year saved no matter the likelihood of disease. Conclusions: For most individuals with neurological symptoms or signs, CT imaging is cost-effective while MR imaging is not. The cost-effectiveness of MRI use, however, improves as the likelihood of an underlying neurological disease increases. For selected patients who highly value diagnostic information, MRI is a reasonable and cost-effective use of medical resources when even the likelihood of disease is quite low (5%).
Selecting the Best Renal Function Tests:A Meta-analysis of Diagnostic Studies
Authors: Campens Dirk , Buntinx Frank 
Published: March 2009

AbstractA literature review compared the results of different kidney function tests using the inulin clearance or similar methods as a gold standard. The methodological strength of the available studies was weak. For the time being, the calculated creatinine clearance using formula, is a first choice, especially in general practice.
Evaluating the Impact of Health Care Information Systems
Authors: Anderson James G. , Aydin Carolyn E. 
Published: March 2009

AbstractEvaluating the impact of computer-based medical information systems requires not only an understanding of computer technology but also an understanding of complex social and behavioral processes. This essay discusses the need for evaluation of health care information systems, a set of evaluation questions based on assumptions about the impact of technology on organizations, and recommendations for reducing barriers to the implementation of health care information systems.
A Model for Estimating the Cost-Utility of Clinical Audit: The Example of Thrombolysis for Suspected Acute Myocardial Infarction
Authors: Robinson Michael B. , Thompson Elizabeth , Black Nick A. 
Published: March 2009

AbstractEconomic evaluation of quality assurance programs is often called for but rarely reported. A study was designed to estimate the cost-utility of audit of thrombolysis in four U.K. district general hospitals, using the quality-adjusted life year. Although the results obtained were imprecise, the model used could be applied in future evaluations.
Costing Methods in the Canadian Literature on the Economic Evaluation of Health Care: A Survey and Assessment
Authors: Jacobs Philip , Bachynsky John 
Published: March 2009

AbstractWe reviewed the Canadian literature on cost-effectiveness from 1980–1995 with regard to costing methodologies. We abstracted each study using a list of data elements that describe costing methodology, and evaluated costing methodologies in the light of biases in costing methods, site, and case-mix selection.
The Diffusion and Use of Diagnostic Imaging Equipment in France
Authors: Fagnani F. , Moatti J. P. , Weill C. 
Published: March 2009

AbstractThe paper presents a French national survey on diagnostic imaging equipment and activity showing that conventional x-ray radiology still dominates and that the rate of diffusion of technological innovations has been very different, being slower than in other industrialized countries for such technologies as CT scanners, nuclear medicine, and magnetic resonance imaging, but on the other hand, very quick for ultrasound and digital angiography.The variety of regulations for this equipment, although it plays an important role, is not sufficient to explain these differences in the rate of diffusion. The paper shows that other explanatory variables must be taken into account, at least in the French context: the situation of the domestic biomedicai industry, the relations between private and public sectors of health care delivery, and even the “technical” culture and tradition of French radiologists.
What Determines the Choice of Procedure in Stress Incontinence Surgery?: The Use of Multilevel Modeling
Authors: Griffiths Joanne M. , Black Nicholas A. , Pope Catherine , Stanley Jenny , Bowling Ann , Abel Paul D. 
Published: March 2009

AbstractThe purpose of this study was to identify the determinants of choice of surgical procedure (anterior colporrhaphy, colposuspension, or needle suspension) to treat stress incontinence in women. We used multilevel modeling of data on 271 patients in 18 hospitals in England in 1993–94. Patient-related factors included sociodemographic details, anatomical diagnosis, symptom severity, symptom impact, previous treatment, parity, comorbidity, and general health status. Surgeon-related factors were specialty, grade, and annual volume of procedures undertaken. Hospital teaching status was considered. Some patient-related factors were associated with choice of procedure: women with a concomitant genital prolapse, with a history of high parity, and with no previous nonsurgical treatment were more likely to undergo an anterior colporrhaphy than a colposuspension or needle suspension (although this finding could be confounded by surgical specialty). In addition, women were more likely to be treated by colposuspension if their surgeon specialized in incontinence surgery (measured by annual volume of cases). Finally, being treated by needle suspension depended on there being a consultant surgeon familiar with the procedure at the hospital attended. While choice of surgical procedure depends partly on the patient's anatomical diagnosis, it is also dependent on the specialty of the surgeon whom she consults and the hospital that she attends. This variability, in turn, could have implications for the patient (as the relative effectiveness of the different procedures is unknown) and for the purchasers of care (as the relative cost-effectiveness of procedures is also unknown).
An Economic Evaluation of Energy-Absorbing Flooring to Prevent Hip Fractures
Authors: Zacker Christopher , Shea Dennis 
Published: March 2009

AbstractAn economic evaluation of energy-absorbing flooring designed to prevent hip fractures revealed a payback period of 10½ years if only direct costs avoided were evaluated and just over 11 months when direct and indirect costs were included. Cost-effectiveness ratios of less than $0 per hip fracture prevented and life year saved were also estimated.
An Assessment of Picture Archiving and Communication Systems (PACS): The Case Study of the SMZO Project
Authors: Wild Claudia , Peissl Walter , Tellioglu Hilda 
Published: March 2009

AbstractIn order to make rational decisions for further implementation of picture archiving and communication systems (PACS) in Viennese community hospitals, an assessment of the Sozialmedizinisches Zentrum Ost (SMZO) project was launched by the Viennese community hospital financing body. The aim of the technology assessment was to look at the experiences of day-to-day practice, organizational aspects of, and obstacles to developing the full potential of the PACS installation. The study analyzes the conditions for employment of digital radiology, gathers the experiences of national and international projects, and presents a view on critical points, from which options for further implementation can be derived. In the center of interest stood work organization, handling and user attitudes, perceptions of radiologists and clinicians, realism of expectations regarding economic efficiency, technical aspects, and influence of quality of medical care.
An Early System for the Identification and Assessment of Future Health Care Technology: The Dutch STG Project
Authors: David Banta H. , Gelijns Annetine 
Published: March 2009

AbstractThis article is based on the report, Anticipating and Assessing Health Care Technology, written in the Netherlands between 1985–1988. The project was carried out because of increasing concern in the Dutch Ministry of Health (STG, then WVC) about the costs and benefits of new technologies for health care. At that time, there were no established models for early identification, so the project was not only the most extensive such effort to that date, but had to develop its own methods. Overseen by a special commission, the project staff identified many future and emerging technologies in health care and assessed selected technologies. Although the actual information produced was quickly dated and the project was discontinued in 1988, it did stimulate the Ministry of Health to ask the Dutch Health Council (Gezondheidsraad) to continuously identify important new technologies. The reports also demonstrated the potential usefulness of such an effort to Dutch policy makers, and probably to those in other countries as well.
Implementing Early Warning Messages on Emerging Health Technologies
Authors: Mowatt Graham , Thomson Mary Ann , Grimshaw Jeremy , Grant Adrian 
Published: March 2009

AbstractThe purpose of this study was to determine how horizon-scanning organizations can encourage the implementation of recommendations contained in their early warning messages about emerging health technologies. We reviewed the conclusions of the EUR-ASSESS Project Subgroup report on dissemination and impact, an overview of systematic reviews of interventions to promote implementation of research findings by health care professionals, and various Cochrane Effective Practice and Organisation of Care Group protocols and reviews. The evidence on the effectiveness of different implementation strategies aimed at distinct target groups is of variable quality. There is some evidence from rigorous study designs on the effectiveness of strategies designed to influence the behavior of health care professionals; the quality of the evidence relating to policy makers and the general public is more limited. Horizon-scanning organizations can improve the likelihood of their recommendations being acted upon by developing active implementation strategies based on the best available evidence, establishing links with key groups, and directing early warning messages at specific target audiences. Given the relative lack of good quality evidence, it is important that implementation strategies be rigorously evaluated to determine their effectiveness.
The Identification of New Health Care Technologies by the Health Council of the Netherlands
Authors: ten Velden Gabriël H. M. 
Published: March 2009

AbstractThe article gives a global overview of the 14 years of signposting experience of the Health Council of the Netherlands. The Council signals new health care technologies and emerging health care problems in briefs, comprehensive reports, and bulletins. Its main purpose is to provide the government with timely information to support rational policy decision making.
Early Warning of New Health Care Technologies in the United Kingdom
Authors: Stevens Andrew , Packer Claire , Robert Glenn 
Published: March 2009

AbstractIn this paper we describe the present range of organizations that have a role in the early warning of new and emerging health care technologies in the United Kingdom. We discuss in more detail the processes and prioritization criteria used by the U.K. horizon-scanning project for the NHS Health Technology Assessment Programme, and the principal methods of technology identification for the horizon-scanning project are outlined. The United Kingdom plans to develop an integrated system for the identification of technologies for commercial planning, health service research prioritization, financial planning, and provision of information to policy makers, purchasers, and providers of health care.
How well do Investigators Estimate Results in Advance?: A Methodological Study from a Multinational Epidemiological Survey on Hip Fracture Risks
Authors: Allander Erik 
Published: March 2009

AbstractThe aim of the present study was to compare the factual results with the perception of results by the expert investigators involved in a major epidemiological study on risk factors for hip fracture, the Mediterranean Osteoporosis Study (MEDOS), and to do so before the actual results were known. A selection of 30 questions were used from the original MEDOS questionnaire to obtain estimates of selected key risk factors from the 14 participating experts. Ten investigators participated, six of whom filled out the questionnaire completely; these six questionnaires were used for the analysis. The population was estimated to be younger, to have better functional capacity, and to be more subjected to preventive activities than the actual survey data showed. Several methodological problems are explored.
Outcome of Total Hip Replacement in Japan and England:Comparison of Two Retrospective Cohorts
Authors: Imamura Kyoko , Black Nick 
Published: March 2009

AbstractTwo retrospective cohorts of patients who had undergone a primary total hip replacement (THR) were studied in Japan and England. We analyzed information from hospital case notes and self-administered questionnaires. THR was highly effective in both countries, with significant improvements in morbidity and health status. There were, however, important differences in clinical management and outcome. Japanese patients were more likely to be treated under regional anesthesia by means of an anterior/anterolateral incision, to be transfused, to have a prosthesis implanted without cement, and to stay longer in the hospital. A higher rate of serious in-hospital complications occurred in England, mostly due to the high frequency of hypotension. The incidences of minor complications were consistent with known differences in risks between the two countries. The persistent postoperative perception of limping reported by the English patients was unexpected.
The Effectiveness of Bone Density Measurement and Associated Treatments for Prevention of Fractures:An International Collaborative Review
Authors: Hailey David , Sampietro-colom Laura , Marshall Deborah , Rico Rosa , Granados Alicia , Asua José 
Published: March 2009

AbstractThis review assesses the evidence regarding the effectiveness of bone density measurement (BDM) screening and related interventions—hormone replacement therapy (HRT) and intranasal salmon calcitonin (SCT[N])—in menopausal women to prevent fractures in later life. Data sources included systematic reviews of evidence and relevant primary studies identified through literature searches on MEDLINE and EMBASE. Study selection included trials of BDM screening programs, prospective studies exam-ining the predictive value of BDM, randomized controlled trials, cohort studies, and case-controlstudies of HRT and SCT(N). The evidence was evaluated using a classification system incorporatingstudy design and quality. Outcomes were measured in terms of relative risk of fracture for a 1 SDdecrease in bone mineral density below the age-adjusted mean, relative risks or odds ratios forfractures associated with treatments, and proportion of hip fractures potentially prevented by BDMscreening linked to treatments. Fair evidence from prospective cohort studies suggests that BDMcan predict the risk of fractures, but not with high accuracy. Fair evidence from low-quality randomizedcontrolled trials and observational studies suggests that HRT and SCT(N) are efficacious in preventingfractures. Good evidence supports the efficacy of these treatments in preserving bone mass, butthere is fair evidence that the effect wears off after cessation of therapy. There is little evidence onthe impact of screening menopausal women with BDM in association with HRT or SCT(N) treatment.Estimates based on combining existing evidence regarding the predictive value of BDM and efficacyof HRT suggests that 1–7% of hip fractures might be prevented.
Anticipating the Consequences for the Primary Therapy of Breast Cancer after Introducing Screening: A More Global Picture for Health Care Policy Making
Authors: Borràs Josep M. , Espinas Josep A. , Beemsterboer Petra M. M. , Granados Alicia , Koning Harry J. De 
Published: March 2009

AbstractA breast cancer screening program mainly aims at reducing mortality. However, it also has an effect, often not assessed, on the utilization of health care resources that is relevant to health care policy making. Using a simulation model, this paper forecasts the impact of introducing a breast cancer screening program on the utilization of resources for the primary therapy of breast cancer. The most important consequences from a health care point of view will be an increased use of breast-conserving therapy and an increased need for postoperative radiotherapy; there will also be a higher number of women diagnosed with noninvasive breast cancer. The results of this study could provide support for health care decision making by showing the consequences of policy decisions on the introduction of screening programs for health care utilization.