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Biomedical subjects

H D Banta

Publications and source records attributed to H D Banta.

At least 37 records · Page 2Linked to original sources
PubMed1993

Diffusion of minimally invasive therapy in Europe.

This paper considers the diffusion of the 10 cases presented in this issue. Most of the cases have diffused relatively slowly. This slow diffusion can be explained by a number of factors, including budgetary restraints, financial incentives, physician conservatism, and lack of appropriate training. A consistent thread in the cases is the argument that evidence of effectiveness is not convincing. The article considers whether further diffusion of each innovation can be justified from existing evidence. This information is important for policy purposes. Policies might be developed to encourage or to discourage any potentially important innovation.

Angioplasty, Balloon, Coronary↗
PubMed1993

The cost-effectiveness of 10 selected applications in minimally invasive therapy.

In this article, evidence of effectiveness and cost-effectiveness of the following procedures is reviewed: (1) laser treatment of bladder tumors; (2) extracorporeal shock-wave lithotripsy and percutaneous nephrolithotomy; (3) laparoscopic treatment of endometriosis; (4) laparoscopic removal of ovarian cysts; (5) laparoscopic cholecystectomy; (6) laparoscopic appendectomy; (7) catheter treatment of coronary artery disease; (8) palliation of colon cancer by endoscopic intervention; (9) treatment of upper gastrointestinal (UGI) bleeding by endoscopic intervention; and (10) arthroscopic knee surgery. Despite considerable potential to be effective and cost-effective, evidence is disappointingly limited in these cases. The lack of evidence hampers decision-making in this new field.

Angioplasty, Balloon, Coronary↗
PubMed1993

Implications of minimally invasive therapy.

The field of minimally invasive therapy (MIT) raises many important issues for the future of health care. It seems inevitable that MIT will replace much conventional surgery. This trend is good for society and good for patients. The health care system, however, may find the change disruptive. The need for hospital beds will shrink. Day surgery and community care will grow. Physicians will have to have special training in doing the new procedures. New organizational forms of care will evolve. Quality assurance procedures will be needed to assure that out-of-hospital care is safe and effective. One negative consequence of MIT is that the indications broaden, so that many 'preventive' procedures may be carried out. Societies are doing little to face up to these changes. The potential of MIT could be enhanced by active policy interventions, including evaluation and attention to the organization and financing of health care.

Ambulatory Surgical Procedures↗
PubMed1993

Implications of minimally invasive therapy.

Minimally invasive therapy (MIT) is a new approach to conditions that previously would have been treated by open surgery. It is made possible by developments in endoscopes, medical imaging and vascular catheters. Minimally invasive therapy has many implications for the health system, as it makes it possible to perform many procedures on an outpatient basis or with a short hospital stay. In addition, surgical training is not always necessary to carry out MIT procedures, which means that other specialties such as internal medicine and radiology have become involved in the field. Minimally invasive therapy has already led to conflicts between different specialties in some countries. It also is giving further stimulus to the reduction in numbers of hospital beds. On the other hand, full implementation of MIT requires attention to the system of out-of-hospital care, which generally is not prepared to monitor patients after discharge or to deal with complications that may arise. Quality of care in the out-of-hospital setting also needs attention.

Ambulatory Surgical Procedures↗
PubMed1992

Quality assurance issues and PACS.

Quality assessment and assurance is a growing concern in all areas of health care. The concern is fueled by a body of evidence that indicates that quality of care is not optimal, and in many instances, is unacceptably low. Although different standards for quality have been proposed, health outcome is the ultimate standard, since improving health is the goal of the health care system. The effects of PACS on health outcome are not known. A PAC system has the potential to improve quality, especially if it makes the diagnostic process more efficient, but evidence that such improvement actually occurs is so far lacking.

Quality Assurance, Health Care↗
PubMed1992

Volume and outcome of organ transplantation.

In general, technically demanding medical procedures are associated with better outcomes when they are carried out in institutions and by physicians with higher volumes of practice. This paper examines the evidence for a volume-outcome relationship in the case of organ transplantation. Although few studies have been done on this subject, existing evidence is consistent with improved outcomes at higher volumes. Therefore, evidence supports policies that regionalize transplantation services.

Health Policy↗
PubMed1990

The case for reassessment of health care technology. Once is not enough.

Assessment of health care technologies should be an iterative process, not a single event. In the United States there are an increasing number of organized attempts at reassessment of technologies by the health industry, professional societies, and national government agencies, such as the Medical Necessity Project of Blue Cross/Blue Shield, the Clinical Efficacy Assessment Project of the American College of Physicians, and the work of the US Preventive Services Task Force. We examine four clinical practices--electronic fetal monitoring, episiotomy, electroencephalography, and hysterectomy--to illustrate the need to continuously reassess existing technologies and to challenge our current inertia in this critical arena of health practice.

Advisory Committees↗
PubMed1990

The political dimension in health care technology assessment programs.

This article considers technology assessment (TA) to be a comprehensive form of policy research. Technology assessment must then have a relation to policy-making; in the area of health care, TA must relate to such political decisions as resource allocation. Since policies are determined politically, i.e., by factors such as power and influence, technology assessment is, or should be, part of a political process. Technology assessment seems to be developing predominantly as a technical and professional activity, carried out in centers with no relation to the policy-making process. While the impact of technology on health, as well as such broader impacts as those on financial costs, is a key concern, political considerations and political decision-making must always be an important dimension in health care TA.

Communication↗
PubMed1990

The regulation of medical devices and quality of medical care.

Medical devices are now a pervasive part of modern medical care. They are in many cases associated with quality of care. In some cases, the use of devices has certainly improved quality. In other cases, devices can be associated with many problems. The approach to quality of devices has depended largely on regulation. However, regulation of devices in Europe is rather undeveloped, so in many cases the reliability and safety of a device has not been independently established and one cannot assume that a particular device in fact is reliable or safe. In addition, there are many problems in the interface between the machine and the user or the patient that are largely untouched by device regulation, and perhaps should be more often considered in quality assurance programs. As essential as device regulation is, it is not sufficient to assure quality. Education is particularly important in this area. Quality assurance programs need to be familiar with common problems with medical devices and how to approach them.

Contraceptive Devices, Female↗
PubMed1989

Possibilities and problems in the development of home care technology.

Limited resources for health care and increasing health care costs have led to proposals to expand home care services. Presently, home care technology is rather primitive. Its development and use have been largely unplanned. Nonetheless, home care technology is growing in response to obvious needs, and a number of experiments in the Netherlands have begun to demonstrate some potentials in this area. As technological developments accelerate, opportunities for supporting people in their homes will greatly increase. The major problem with the introduction of technology into home care is the lack of an integrated home care system that can select, provide, and assess technology. Without such a system, industrial developments in this area will probably continue to be slow.

Durable Medical Equipment↗
PubMed1989

The Swedish Council on Technology Assessment in Health Care.

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.

Organizational Objectives↗
PubMed1988

Health care technologies in The Netherlands. Assessment and policy.

This article argues that while health care and government authorities in the Netherlands in the last decades have attempted to rationalize the diffusion of medical technology, much work remains to be done. The authors contend that though a mix of direct government regulation and economic incentives will be needed, regulation by incentive is more effective than regulation by directive in achieving cost effective use of technology. Generally, bureaucratic structures provide only limited opportunities for tight control of the diffusion of medical technologies. The article offers possible future strategies for directing the adoption and use of medical technologies and stresses the importance of reliable information culled from comprehensive technology assessments.

Diffusion of Innovation↗
PubMed1987

An inquiry concerning future health care technology: methods and general results.

New and future health care technology has important implications for the delivery and organization of health care. Furthermore, advances in health care technology are increasingly associated with social, ethical, and economic issues. Effective health planning needs to anticipate future health care technology and take into account such implications. This paper concerns an analysis of future health care technology undertaken in the Netherlands. The study involved: (a) the early identification of future developments in health care technology; and (b) prospective assessments of a number of high-priority technologies. The paper concludes that technology forecasting in health care should become an integral part of overall technology assessment activities in industrialized countries.

Forecasting↗
PubMed1986

Medical technology and developing countries: the case of Brazil.

Developing countries, faced with severe resource limitations, are trying to develop modern health care services that deliver sensible medical technologies. Because of their lack of development, these countries must import much technology, while often lacking the expertise to make wise choices. In this article, the case of Brazil is examined. Brazil has shared many of the problems of other developing countries, including inadequate access of the population to health services, maldistribution and excessive use of technology, a relatively weak national industry for production of drugs and medical devices, a weak policy structure for dealing with medical technology, and little tradition of using research or policy analysis as a guide to action. Since the election in 1985 that returned Brazil to democratic rule, the government has taken active steps to address many of these problems. The example of Brazil is important for all of the developing world to examine and follow, where applicable. In addition, North American and European aid programs could play a much more constructive role in helping less developed countries develop their health care services. International organizations such as the World Health Organization must also be active in assisting such countries to improve their decisions concerning medical technology.

Brazil↗