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Biomedical subjects

J S Pliskin

Publications and source records attributed to J S Pliskin.

At least 19 recordsLinked to original sources
PubMed2001

Reimbursement policies, incentives and disincentives to perform laparoscopic surgery in Israel.

The introduction of laparoscopic surgery was believed to bestow great advantages to patients and health services. Health services and societal costs may also be affected by changes in length of hospital stay, operating room costs and return to normal activity. The aim of this paper is to examine the influence of two different reimbursement methods (per diem and DRG) on the incentives and disincentives given to different role players in the Israeli health-care system regarding two common surgical procedures: appendectomy and inguinal hernia repair. Three different perspectives are discussed: society, the hospitals and the sick funds. From the hospital's perspective, laparoscopic surgery is usually more expensive compared to open procedures, mainly due to higher operating room costs. We suggest that as far as current reimbursement methods are preserved, hospitals have no economic incentive to adopt the laparoscopic technology as benefits occur only to society. In general, sick funds would encourage hospitals to perform laparoscopic appendectomy, where the payment is per diem and would be economically indifferent regarding laparoscopic inguinal hernia repair, where hospitals are compensated on a DRG basis. It has been suggested that economic advantages to society may arise from a faster return to work after laparoscopic appendectomy and laparoscopic inguinal hernia repair. In this case, new payment arrangements should be set to give proper incentives for the adoption of laparoscopic procedures.

Appendectomy↗
PubMed1999

Towards better decision making in growth hormone therapy.

Controlled clinical trials are not always possible or warranted. Other sources of data include observational studies, meta-analyses, expert opinions, subjective judgements, and mathematical/statistical models developed from large databases. Decision analysis is presented as a preferred methodology for analysis in situations of uncertainty, in combination with cost-benefit and cost-effectiveness analyses. Special emphasis is given to quality-of-life considerations in growth hormone (GH) therapy and ways to measure it and express patient preferences.

Body Height↗
PubMed1995

Five-hundred life-saving interventions and their cost-effectiveness.

We gathered information on the cost-effectiveness of life-saving interventions in the United States from publicly available economic analyses. "Life-saving interventions" were defined as any behavioral and/or technological strategy that reduces the probability of premature death among a specified target population. We defined cost-effectiveness as the net resource costs of an intervention per year of life saved. To improve the comparability of cost-effectiveness ratios arrived at with diverse methods, we established fixed definitional goals and revised published estimates, when necessary and feasible, to meet these goals. The 587 interventions identified ranged from those that save more resources than they cost, to those costing more than 10 billion dollars per year of life saved. Overall, the median intervention costs $42,000 per life-year saved. The median medical intervention cost $19,000/life-year; injury reduction $48,000/life-year; and toxin control $2,800,000/life-year. Cost/life-year ratios and bibliographic references for more than 500 life-saving interventions are provided.

Cost-Benefit Analysis↗
PubMed1994

Physician use of a computerized medical record system during the patient encounter: a descriptive study.

The computerized medical record program, CLINIC, specifically designed at Ben-Gurion University of the Negev to be used on-line in a primary care clinic during a patient encounter by healthcare professionals, has been in use for over 6 years in two community clinics. In order to analyse the effectiveness and use of CLINIC, four physicians were video recorded during working sessions before and after the introduction of CLINIC. While using CLINIC did not change the total mean encounter time, the lengths of the encounter components and record use did change. The physicians' work style changed from a 'conversational pattern' (continuous data recording) to a 'blocked pattern' (data entry at intervals).

Attitude of Health Personnel↗
PubMed1992

Computerized algorithms and pediatricians' management of common problems in a community clinic.

In 1987, a microcomputer clinical algorithm (CA) system for constructing and using CAs for patient care was designed and implemented for six common primary care pediatrics problems. Six community clinic pediatricians agreed to use the system for several months. Length of patient's visit, completeness of data collection, antibiotic use, and appropriateness of clinical plan were measured before the computers were introduced (without CAs) and after the computers were introduced (both with and without CAs). All performance measures improved after the introduction of CAs. However, CA implementation had to be discontinued after five weeks because the CAs were too tedious for the physicians to follow during routine care. The authors conclude that CAs cannot be successfully sustained with physicians for common problems, even though their design and use can significantly improve the process of care.

Adolescent↗
PubMed1991

The impact of a health education course on maternal knowledge: a comparative study in a low socioeconomic rural region.

A comprehensive health education course was designed for mothers in West Bank villages, a relatively low socioeconomic population. The course focused on nutrition, hygiene, child development, and first aid. It was taught by specially trained local instructors in small classes characterized by an individualized teaching method. To evaluate the contribution of the course, the level of knowledge in topics taught in the course was tested. The test was personally administered by trained interviewers to 241 course participants and to a comparison group of 284 mothers who had not participated. As expected, participants demonstrated higher level of knowledge than nonparticipants, regardless of the time since having taken the course. The course seems to have contributed to all participants, but mostly to women of lower education. In a multiple linear regression the two most significant predictors of knowledge were course participation and level of maternal formal education.

Educational Status↗
PubMed1990

Infant feeding practices: an evaluation of the impact of a health education course.

We assessed the impact of a health education course on infant feeding practices in the West Bank territories by comparing mothers who had attended the course (n = 102) with mothers not exposed to the course (n = 133). After adjustment for child's age, maternal age and education, parity, and birth site, course participants were more likely than non-participants to breastfeed, as well as to start supplementation by semi-solid foods at the recommended time.

Breast Feeding↗
PubMed1986

The frequency of bitewing radiographs.

A model for use in analyzing the implications of different rates of caries incidence and progression for the timing of bitewing radiographs was developed. Estimates of progression rates and incidence patterns were derived from an analysis of serial bitewing radiographs. A time schedule for taking the next radiographs was determined so that carious lesions would be detected before radiolucencies reach the inner half of the dentin. For asymptomatic persons with extensive exposure to fluorides and no unrestored enamel lesions on the last radiographs, bitewing films could be scheduled every 2.5 to 3 years. For persons with little exposure to fluorides or with many early enamel lesions or at least one deep enamel lesion that has not been restored, radiographs should be performed every 6 months to 1 year.

Adolescent↗
PubMed1986

The expected benefits from alternative frequencies of bitewing radiograms.

From an analysis of serial bitewing radiograms, we have developed a mathematical model of the initiation and progression of approximal carious lesions in the permanent teeth. The model is used to estimate the expected number of lesions, per individual, not detected until they reach the inner half of the dentin, as a function of the frequency with which radiograms are taken between the ages of 8 and 20 years. If radiograms are performed every 6 months and lesions not restored until radiolucencies appear in the dentin, under 5% of all lesions developing over the 12-year period will reach the inner half of the dentin before detection. If radiograms are taken every 2 years, about 18% of all lesions will have reached the inner half of the dentin before detection. The sensitivity of these conclusions to different assumptions is examined.

Adolescent↗
PubMed1985

Comparative study of costs and quality of life of chronic ambulatory peritoneal dialysis and hemodialysis patients in Israel.

The more widespread use of chronic ambulatory peritoneal dialysis (CAPD) as an alternative to hemodialysis (HD) has focused attention on costs and quality of life aspects of different dialysis modalities. Costs for hospital HD exceed $23,000 annually, while CAPD annual costs are near $10,500 and home HD about $9,000. There are additional initial costs incurred during the first year of treatment, which range from under $2,000 for hospital-based HD and CAPD to over $11,000 for home HD. Quality of life aspects were compared for CAPD and hospital HD patients. Forty-six CAPD patients and 208 hospital HD patients were interviewed regarding ability to work, performance of physical activity, quality of sleep and sexual activity. The two patient groups were similar demographically (age, sex, origin and level of education). There were no statistically significant differences between the two patient groups for each of the quality of life variables, although CAPD patients showed slightly better results.

Adolescent↗
PubMed1984

Cost effectiveness of epidemiological monitoring.

Epidemiological monitoring (EPM) is emerging as a frequent counterpart to environmental monitoring (ENM). EPM and ENM are not alternatives to each other but rather complement each other. Each cannot be evaluated on its own merit but rather on its contributory effects in conjunction with the other. The effectiveness of EPM depends primarily on the types of action which it is designed to trigger. The benefits may be evaluated in terms of the prevention of adverse health outcomes on the one hand, and from costs saved due to avoidance of unnecessary controls on the other. Nothing definitive can be said about the cost-effectiveness of EPM in general. Every context and setting require a separate analysis. The attractiveness of introducing EPM, perhaps in conjunction with ENM, is its more immediate linkage to action and protective measures.

Carcinogens, Environmental↗
PubMed1984

A longitudinal analysis from bite-wing radiographs of the rate of progression of approximal carious lesions through human dental enamel.

Four to ten years of serial bite-wing radiographs from over 700 children from five groups, three in Sweden and two in the U.S., were interpreted. By analysing changes in the depth of unfilled lesions over time, the mean time and probability distribution for the time a lesion remains in both the outer half and inner half of the enamel were estimated. The procedure incorporated information on filled lesions and non-progressing lesions and thus minimized bias that results in overestimation of the progression rate. In primary teeth, in both the U.S. and Swedish groups, it took on average 12 months for a lesion to progress through the outer half of the enamel and on average 10-12 months for a lesion to progress through the inner half. In newly-erupted first permanent molars, it took 21-23 months for a lesion to progress through the outer half of the enamel and between 19 (U.S. data) and 28 months (Swedish data) for progression through the inner half. In older adolescents in the two Swedish groups, progression was slower: 38-41 months through the outer-half and 47-56 months through the inner-half. In older U.S. adolescents, progression appeared to be more rapid: 16 months through the outer half of the enamel and 27 months through the inner half. The duration of time a lesion remains in different halves of the enamel could be approximated by a piecewise exponential or exponential probability distribution, which exhibits extreme variability. Assuming duration in each half of the enamel follows an exponential distribution with a mean of 2 yr, about 10 per cent of new lesions will progress through the enamel in one year and 25 per cent in two years. However, over 40 per cent of the lesions will not have progressed in 4 yr. There were no consistent differences in the rate of progression by sex, between upper and lower dentitions, for premolars versus molars, or between high and low-risk individuals.

Adolescent↗
PubMed1984

Balancing the failure modes in the electronic circuit of a cardiac pacemaker: a decision analysis.

Cardiac pacemaker malfunctions are of continuous concern to the medical profession as well as to the electronics industry. Certain failures in cardiac pacemaker performance are critical and can result in patient deaths. Cardiac pacemakers are vulnerable to certain malfunctions in the electrode, batteries and the electronic circuit. This paper focuses on failures and reliability of the electronic circuit and how they affect its choice and design. The paper discusses the issues of balancing the various failure modes by considering both failure rates and failure outcomes. As the choice of an appropriate pacemaker is a decision problem under conditions of uncertainty, we employ decision analysis as the analytical and conceptual framework. Use of utility theory enables a systematic quantitative evaluation of such seeming intangibles as the various failure outcomes. Probabilities are assessed using specific engineering and reliability literature. The method is demonstrated on a choice problem between two specific electronic circuit designs. The methodology can be useful in designing the electronic circuit to meet certain reliability specifications, deciding whether or not to introduce redundancy, decisions affecting components and technology, and establishing minimal reliability standards, with regard not only to cardiac pacemakers but to other electronics as well.

Electronics, Medical↗
PubMed1984

Use of the Kaplan-Meier estimate to reduce biases in estimating the rate of caries progression.

An important determinant of how often to perform dental radiography is how rapidly dental caries progress. Estimates of the rate of progression of dental caries have been biased by the elimination of filled lesions and non-progressing lesions (i.e. censored data) from the analysis. We illustrate the use of the Kaplan-Meier estimate to incorporate information from these cases and demonstrate the effect of using this information on estimates of the rate of progression of approximal caries.

Adolescent↗