Screening for prostate cancer.
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Biomedical subjects
Publications and source records attributed to B Stocking.
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Effective Care in Pregnancy and Childbirth (ECPC) is a comprehensive analysis of evidence. The findings are only now beginning to influence practice in the United Kingdom several years after its publication. This article assesses the extent to which policy makers and practitioners are prepared to use evidence and proposes ways to implement the ECPC findings. Such efforts would require leadership from the U.K. Department of Health and the commitment of the leaders of professional and consumer bodies to promote perhaps 10 or 12 key findings rather than try to push forward the whole program at once. A coordinated approach would then be needed to influence managers, professionals, and service users, first through informing them of the findings, and then by devising specific approaches, such as the use of opinion leaders, for each group. Finally, changes in practice should be monitored.
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The introduction of regional secure units into the NHS was studied as one example of the diffusion of patient care innovations. As well as the general history of secure units events in four Regions were studied in detail for the period from 1974 up to mid-1983. It is concluded that secure units became gradually more acceptable over time as (i) the need for such units was recognized, (ii) the climate of opinion changed in psychiatric hospitals from seeing secure units as a retrograde step, following the acceptance of more open door policies, to seeing secure units as a prestige development which might safeguard the future of a particular hospital, (iii) government loosened the definitions of what secure units should be and how they should operate so that there was more room for different regions to assess their own needs. Regions which were able to move relatively fast on secure unit development were those where there was already a 'product champion' present to promote the ideas, usually a forensic psychiatrist, and where there was also managerial support and designated responsibility for secure unit development at local and regional level. It is concluded that while public reaction was a hindrance it did not slow down secure unit development as much as might have been expected.
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During its first year of operation (1988) the Swedish Council on Technology Assessment in Health Care focused on nine areas. Additional activities will be added as need requires and resources permit. Also, preparations for 1989 projects have begun. The nine areas include: identification of technologies needing assessment, including international comparisons; review and synthesis of the value of preoperative routines; review and synthesis of the value of gastroscopy for diagnosing stomach pain; assessment of different treatment methods for back pain; assessment of the value of vascular surgery for vascular spasms in the legs; organization of a strategy conference concerning medical technology assessment in Sweden; creation of a strategy that addresses an international review of medical technology, future technologies in health care, waiting lists for medical care--the importance of medical technology, resource utilization and organizational and educational aspects of introducing new technology in health care, and costs and medical technology; translation of foreign assessment studies, with comments; national and international cooperation. SCTA has discussed the need for assessing specific technology such as bone marrow transplantation and surgical treatment of epilepsy. SCTA's Scientific Advisory Committee has additionally considered the following subjects for future projects: medical, social, and economic consequences of alternative technologies screening for prostate, colorectal, breast, and cervical cancer; costs, indications, and medical benefit of surgery for varicose vains; and modern urology technologies, particularly those related to prostate care.
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This article describes and explains the impact of the National Health Service bureaucracy on the diffusion of medical technology in the United Kingdom. Through case studies of six medical technologies, the author demonstrates how health care authorities may exercise control by using the central financing system to dampen the general diffusion of technology. However, the United Kingdom has less control in specific cases due to the absence of a bureaucratic body to coordinate the evaluation and introduction of new technology.
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Immunoperoxidase staining for carcinoembryonic antigen (CEA) was performed on 192 colorectal carcinomas to determine: whether tissue staining can be substituted for preoperative serum CEA levels, and whether patient survival can be predicted by these parameters. The overall incidence of positive tissue staining was 75 percent, which was similar to the elevated serum level percentage of 73 percent. Both the serum CEA level and the CEA tissue stain correlated with patient survival in Dukes' stage C patients. There was no correlation between tissue CEA stain and tumor differentiation. Positive tissue stain and elevated preoperative serum CEA identified patients with poor prognosis in Dukes' stage D only. This study shows that tissue staining with immunoperoxidase may be substituted for preoperative serum levels for CEA. The combination of these two parameters, however, does not identify patients at greater risk for recurrence than either procedure alone.
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