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Biomedical subjects

T G Ganiats

Publications and source records attributed to T G Ganiats.

At least 19 recordsLinked to original sources
PubMed1995

Cost-effectiveness analysis.

Cost-effectiveness analysis is increasingly recognized as an important element for health policy formation. Family physicians will be affected by these analyses because they will influence the manner and type of care that physicians offer. The principles of cost-effectiveness research are straightforward and offer primary care clinicians the opportunity to become more involved in the policies that affect their practice.

Cost-Benefit Analysis↗
PubMed1995

A glossary of medical decision-making terms.

Many of the terms used in medical decision making are foreign to clinicians. This problem creates a barrier that can prevent physicians from acquiring these new clinical tools. This glossary contains definitions of the most common terms as well as examples of their usage by using Down syndrome as the illustrative condition.

Decision Support Techniques↗
PubMed1995

Comparing the quality-adjusted life-year output of two treatment arms in a randomized trial.

The quality-adjusted life year (QALY) is an outcome measure with two dimensions: wellness and time. It is difficult to compare the QALY output of two groups when subjects are observed for varying time periods, because both elements of the two-dimensional outcome measure vary in all subjects. This paper evaluates the strengths and weaknesses of five approaches for making these comparisons. These approaches are: a subject-based approach, the elimination of time, calculation of the mean of available data, use of quality-adjusted survival analysis, and calculation of a maximum likelihood estimation. It is concluded that the maximum likelihood estimation offers significant advantages over the other methods.

Female↗
PubMed1994

Incremental cost-effectiveness of incorporating oestriol evaluation in Down syndrome screening programmes.

As screening for Down syndrome becomes increasingly sophisticated, it is important to evaluate the newer technologies in terms of their cost-effectiveness. One recent addition to Down syndrome screening programmes is maternal serum unconjugated oestriol (uE3), especially when used in conjunction with maternal serum alpha-fetoprotein and human chorionic gonadotropin. Using assumptions used in a California proposal to justify an expanded screening programme for Down syndrome, we calculated both the average and the incremental cost-effectiveness of adding uE3. Using the base case assumptions, including an $8 fee for the uE3, the incremental cost-effectiveness of adding uE3 to the proposed California programme is $119,100 per case detected, a value that compares favourably with other Down syndrome screening programmes. The sensitivity analysis supports this conclusion over a wide range of assumptions. However, because of the uncertainty with some key data, it is still too early to fully support the inclusion of uE3 in Down syndrome screening programmes.

Adult↗
PubMed1991

Factors associated with paradoxical survival at higher blood pressures in the very old.

Paradoxically greater survival for persons aged 85 years and older with higher blood pressures has been reported in a Finnish population study (Br Med J 1988;296:887-9). In a previous report, the authors demonstrated improved 10-year survival with increasing diastolic blood pressure in men (but not in women) aged 75 years and older in the Rancho Bernardo Chronic Disease Study (Br Med J 1989;298:1356-7). However, few of the covariates which could potentially explain this effect were obtained at the visit used in that analysis. In an effort to confirm these reports of paradoxical survival and to explore possible reasons for them, the authors analyzed all-cause and cardiovascular mortality in 795 men and women aged 75-96 years (mean, 80.6), evaluated in 1984-1987 and followed prospectively for an average of 3 years after that comprehensive examination. Of 63 deaths, 48 (76%) were in men; 43 (68%) of all deaths were cardiovascular. Kaplan-Meier survival analyses showed a significant trend for improved survival with increasing diastolic pressure in men aged 80 years and older versus all-cause mortality (chi 2 p less than or equal to 0.01), and cardiovascular mortality (chi 2 p less than or equal to 0.00). These trends were not evident in men aged less than 80 years or in women in either age group. Results were not explained by differences in the use of antihypertensive medication, pulse pressure, history of hypertension, history of coronary heart disease, isolated systolic hypertension, interval change in diastolic pressure (over an average of 12 years), or by cholesterol, triglycerides, fasting plasma glucose, smoking, or body mass index. Thus, the paradoxical relation of improved all-cause and cardiovascular survival in men aged 80 years or older with higher diastolic pressure is not explained by a wide range of biologic and historical factors.

Age Factors↗
PubMed1991

Evaluation of cost-effectiveness research: a survey of recent publications.

Because of interest in cost containment, a series of basic guidelines for performing cost-effectiveness research has evolved in the past decade. These guidelines advise that the perspective of the cost study be clarified, that all applicable costs, benefits, and health outcomes be included, and that discounting and sensitivity analyses be performed where appropriate. A survey of 47 recent cost-effectiveness publications selected via MEDLINE and manual searches confirms our hypothesis that many studies do not adhere to these guidelines. Since such short-comings can lead to misleading or ill-founded conclusions, attention must be paid to the principles of cost-effectiveness research to avoid making major, inappropriate health policy decisions.

Bibliometrics↗
PubMed1990

Effect of normal MSAFP screening on maternal age for genetic amniocentesis.

Routine maternal serum alpha-fetoprotein (MSAFP) screening for neural tube defects is considered by many to be standard obstetrical care, and recently many have encouraged this test to screen for Trisomy-21 (Down's syndrome). We questioned whether, after a normal MSAFP screen, the risk of Trisomy-21 decreases enough to warrant modifying the recommended age for genetic amniocentesis for Down's syndrome. A logistic regression was developed which, using reported values for sensitivity and specificity for MSAFP detection of Trisomy-21 and assuming a constant threshold risk in opting for amniocentesis, indicates that genetic amniocentesis for Trisomy-21 may be deferred in some women who have a normal MSAFP screening. Sensitivity analysis of varying thresholds for a normal MSAFP demonstrates that a 37 year old woman with a median MSAFP level has the same risk for Trisomy-21 as an unscreened women who is 4.5 years younger. An abnormal MSAFP is useful in screening for neural tube defects and possibly for Trisomy-21. A normal MSAFP may allow for delaying the potentially risky amniocentesis in otherwise low-risk pregnancies.

Adult↗
PubMed1990

Clustering of atherogenic behaviors in coffee drinkers.

We studied the clustering of coffee consumption and selected atherogenic behaviors in older adults living in a southern California community. Men were somewhat more likely to drink caffeinated coffee while women were more likely to drink decaffeinated coffee. In men, but not women, caffeinated coffee drinking decreased with age and decaffeinated coffee drinking increased. Caffeinated coffee drinkers drank more alcohol, consumed more dietary saturated fats and cholesterol, were more likely to be current smokers and less likely to be current exercisers than were non-coffee drinkers. Smoking and exercise also showed a dose-response relationship to the amount of caffeinated coffee consumed. Risk factor levels among drinkers of decaffeinated coffee were more like those of caffeinated coffee than non-drinkers. These data illustrate the clustering of atherogenic behaviors with coffee drinking and highlight their potential importance in interpreting the growing body of literature about coffee and health.

Age Factors↗