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4.

Assessment of the learning curve in health technologies. A systematic review.

Ramsay, C R; Grant, A M; Wallace, S A; Garthwaite, P H; Monk, A F; Russell, I T
| Idioma: Inglês
OBJECTIVE: We reviewed and appraised the methods by which the issue of the learning curve has been addressed during health technology assessment in the past. METHOD: We performed a systematic review of papers in clinical databases (BIOSIS, CINAHL, Cochrane Library, EMBASE, HealthSTAR, MEDLINE, Science Citation Index, and Social Science Citation Index) using the search term "learning curve." RESULTS: The clinical search retrieved 4,571 abstracts for assessment, of which 559 (12%) published articles were eligible for review. Of these, 272 were judged to have formally assessed a learning curve. The procedures assessed were minimal access (51%), other surgical (41%), and diagnostic (8%). The majority of the studies were case series (95%). Some 47% of studies addressed only individual oper (mais)
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5.

What should be included in meta-analyses? An exploration of methodological issues using the ISPOT meta-analyses.

Fergusson, D; Laupacis, A; Salmi, L R; McAlister, F A; Huet, C
| Idioma: Inglês
OBJECTIVE: To explore the impact of methodologic issues on the results of meta-analyses. The following issues were examined: the type of literature search strategy used; inclusion or exclusion of non-peer-reviewed studies; the inclusion or exclusion of non-English language publications; the effect of trial quality; and the inclusion or exclusion of non-placebo-controlled studies. METHODS: The International Study of Perioperative Transfusion (ISPOT) meta-analyses were used to evaluate each of the methodologic issues. The 10 meta-analyses consisted of technologies to reduce the need for perioperative red blood cell transfusion. The number of trials for each of the meta-analyses varied from 2 to 45. Both EMBASE and MEDLINE searches were conducted, including the use of systematic search s (mais)
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6.

Can economic evaluation guidelines improve efficiency in resource allocation? The cases of Portugal, The Netherlands, Finland, and the United Kingdom.

Kanavos, P; Trueman, P; Bosilevac, A
| Idioma: Inglês
The use of economic evaluation in decision making appears to have increased over the past few years and economic evaluation is looked upon as another measure to help contain costs and improve efficiency in an evidence-based decision-making environment. Following the examples of Australia and the Canadian Province of Ontario, four European Union (EU) countries (Finland, the Netherlands, Portugal, and the United Kingdom) have recently introduced economic evaluation guidelines. In addition to the Australian and Canadian guidelines, which constitute a hurdle to reimbursement, the paradigm that seems to be evolving in the four EU countries follows a similar route. Finland and the Netherlands seem to be moving toward the notion of a fourth hurdle to reimbursement, whereas the National Insti (mais)
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7.

Socioeconomic costs of rheumatic diseases. Implications for technology assessment.

Jonsson, D; Husberg, M
| Idioma: Inglês
OBJECTIVES: To study the socioeconomic impact of rheumatic illness in Sweden and to discuss the consequences for technology assessment studies. METHODS: A cost-of-illness study based on data from official statistics and treatment studies. RESULTS: The total socioeconomic cost was 52 billion Swedish kronor (SEK) in 1994. The imbalance between direct (10% of total) and indirect costs (90 effectiveness of the healthcare sector, the need for new treatment methods, appropriate information systems, and technology assessment studies as well as the institutional arrangements for rehabilitation and basic medical research. CONCLUSIONS: A discussion of solutions for financial cooperation between county councils and regional social insurance offices should be considered. The new biotechnological (mais)
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8.

The concept of health technology assessment. Views of applicants to funding of HTA projects.

Lange, M; Jørgensen, T; Kristensen, F B; Stilvén, S
| Idioma: Inglês
OBJECTIVE: The purpose of this study is to analyze the perception of the content of health technology assessment (HTA) among health professionals applying for a state grant of DKK 10 million. METHODS: A total of 113 applications were received and analyzed. When conducting the analysis, it was assumed that the applicants' maximum five-page project description would reflect: a) the applicants' perception of what an HTA is; b) how the assessment was to be conducted; and c) what the results were going to be used for. RESULTS: More than 40% of all applications focused on treatment; in 51% only one or two professional groups were to be involved (thus interdisciplinarity was questionable); only 22% of the HTA cases were intended to form the basis for political/administrative decisions; in ge (mais)
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9.

Assessing medical technologies in development. A new paradigm of medical technology assessment.

Hummel, M J; van Rossum, W; Verkerke, G J; Rakhorst, G
| Idioma: Inglês
OBJECTIVE: Our study aims to provide a practical contribution to the field of medical technology assessment within a new paradigm. This paradigm indicates the need for more comprehensive technology assessments in the development stage of a new technology. METHOD: We introduce a method, based on Saaty's Analytic Hierarchy Process, which quantitatively supports discussions between the various actors that shape the technology's development and diffusion. These discussions focus on technical, medical, social, and economical requirements relevant to the design and diffusion of the new technology. DISCUSSION: In contrast to more traditional technology assessments, our method encompasses the perspectives of the diverse actors in the social context of technology development and diffusion. It (mais)
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10.

The cost of diabetes: time for a different approach?

Dixon, S; Currie, C J; Peters, J R
| Idioma: Inglês
We argue that studies estimating the treatment cost of diabetes and other economic issues have progressed dramatically over recent years. This has undoubtedly improved our understanding of diabetes. However, attention needs to now shift to more detailed studies that require prospective bespoke data collection from epidemiologists as well as economists. This is not to say that investigation of costs using routine data is of no value--such work will continue to provide new data and methods to those evaluating new interventions, as well as by helping to identify important research areas. However, it may be time for a new paradigm to help in our understanding of this challenging disease. Such an approach must be capable of supporting the complex evaluation of new technologies, and subsequently, can not rely solely on routine data.
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11.

The role of economic evaluation in the diagnosis and treatment of Helicobacter pylori infection.

Fendrick, A M
| Idioma: Inglês
The unfolding of the H. pylori story coupled with the high prevalence and economic burden associated with upper gastrointestinal symptoms makes H. pylori-associated disorders an ideal candidate for economic evaluation. As a result of the high quality and quantity of data emerging, H. pylori eradication is cost-effective in individuals with either newly diagnosed or past PUD. The role of eradication in other areas, for example, patients with nonulcer dyspepsia and screening to prevent gastric cancer, may never be worked out to some clinicians' satisfaction. Conflicting reports and the lack of definitive clinical trials have frustrated clinicians. H. pylori diagnosis and treatment have not been integrated into everyday clinical practice. As a result, the enormous potential benefits asso (mais)
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12.

Prospektive multizentrische Erhebungsstudie laparoskopische kolorektale Chirurgie. Qualitätssicherung bei der Einführung neuer Methoden./ [Prospective multicenter study of laparoscopic colorectal surgery. Quality assurance during introduction of new methods].

Schneider, C; Scheidbach, H; Scheuerlein, H; Köckerling, F
| Idioma: Alemão
During the course of development of laparoscopic surgery, the first successful procedures involving the colorectum were reported already in 1991 and 1992. This having demonstrated the principal feasibility of such operations, a study was initiated in German speaking countries in 1995, with the aim of investigating the efficacy and quality of laparoscopic surgery and involving the collection of all the interventions on the colorectum carried out in the departments participating. In an initial step, and when the first 500 patients had been treated, an indication spectrum was identified, which differed from the typical spectra of open colorectal surgery in showing a clear preponderance of benign diseases. In terms of the intra-operative and post-operative complications developing after l (mais)
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14.

Comparison of benefits provided by different hearing aid technologies.

Walden, B E; Surr, R K; Cord, M T; Edwards, B; Olson, L
| Idioma: Inglês
The performance of 40 hearing-impaired adults with the GN ReSound digital BZ5 hearing instrument was compared with performance with linear hearing aids with input compression limiting (AGC-I) or two-channel analog wide dynamic range compression (WDRC) instruments. The BZ5 was evaluated with an omnidirectional microphone, dual-microphone directionality, and a noise reduction circuit in combination with dual-microphone directionality. Participants were experienced hearing aid users who were wearing linear AGC-I or analog WDRC instruments at the time of enrolment. Performance was assessed using the Connected Speech Test (CST) presented at several presentation levels and under various conditions of signal degradation and by the Profile of Hearing Aid Benefit (PHAB). Subjective ratings of (mais)
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15.

Individual or group antenatal education for childbirth/parenthood.

Gagnon, A J
| Idioma: Inglês
BACKGROUND: Structured antenatal education programs for childbirth and/or parenthood are commonly recommended for pregnant women and their partners by health care professionals in many parts of the world. Such programs are usually offered to groups but may be offered to individuals. OBJECTIVES: The objective of this review was to assess the effects of this education on knowledge acquisition, anxiety, sense of control, pain, support, breastfeeding, infant care abilities, and psychological and social adjustment. SEARCH STRATEGY: The Cochrane Pregnancy and Childbirth Group trials register, the Cochrane Controlled Trials Register, and other databases were searched. The date of the last search was December, 1999. SELECTION CRITERIA: Randomized controlled trials of any structured educationa (mais)
Resultados  1-15 de 39.606