PubMed · 10438304
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E F Bowen, C F Rayner. 1999. COPD guidelines.. https://doi.org/10.1136/thx.54.7.655
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We compared cost-benefit and cost-effectiveness analyses of hepatitis A prevention with immune serum globulin (ISG) vs inactivated hepatitis A vaccine (iHAV) in the Israel Defence Forces. Personnel were grouped according to conditions and duration of service and analyses were performed based on maximum and minimum hepatitis A projected incidences for each group. For standing army soldiers in field units, iHAV is economically superior compared with ISG. For the five other groups studied, the reverse is true. Expected increases in production costs of ISG and expected decreases in costs of iHAV are likely to make iHAV more economical in the future.
OBJECTIVE: To summarize the recently published US Public Health Service report Treating Tobacco Use and Dependence: A Clinical Practice Guideline, which provides recommendations for brief clinical interventions, intensive clinical interventions, and system changes to promote the treatment of tobacco dependence. PARTICIPANTS: An independent panel of 18 scientists, clinicians, consumers, and methodologists selected by the US Agency for Healthcare Research and Quality. A consortium of 7 governmental and nonprofit organizations sponsored the update. EVIDENCE: Approximately 6000 English-language, peer-reviewed articles and abstracts, published between 1975 and 1999, were reviewed for data that addressed assessment and treatment of tobacco dependence. This literature served as the basis for more than 50 meta-analyses. CONSENSUS PROCESS: One panel meeting and numerous conference calls and staff meetings were held to evaluate meta-analytic and other results, to synthesize the results, and to develop recommendations. The updated guideline was then externally reviewed by more than 70 experts and revised. CONCLUSIONS: This evidence-based, updated guideline provides specific recommendations regarding brief and intensive tobacco cessation interventions as well as system-level changes designed to promote the assessment and treatment of tobacco use. Brief clinical approaches for patients willing and unwilling to quit are described. Major conclusions and recommendations include: (1) Tobacco dependence is a chronic condition that warrants repeated treatment until long-term or permanent abstinence is achieved. (2) Effective treatments for tobacco dependence exist and all tobacco users should be offered those treatments. (3) Clinicians and health care delivery systems must institutionalize the consistent identification, documentation, and treatment of every tobacco user at every visit. (4) Brief tobacco dependence treatment is effective, and every tobacco user should be offered at least brief treatment. (5) There is a strong dose-response relationship between the intensity of tobacco dependence counseling and its effectiveness. (6) Three types of counseling were found to be especially effective-practical counseling, social support as part of treatment, and social support arranged outside of treatment. (7) Five first-line pharmacotherapies for tobacco dependence-sustained-release bupropion hydrochloride, nicotine gum, nicotine inhaler, nicotine nasal spray, and nicotine patch-are effective, and at least 1 of these medications should be prescribed in the absence of contraindications. (8) Tobacco dependence treatments are cost-effective relative to other medical and disease prevention interventions; as such, all health insurance plans should include as a reimbursed benefit the counseling and pharmacotherapeutic treatments identified as effective in the updated guideline. JAMA. 2000;283:3244-3254
In the evaluation of diagnostic tests emphasis is placed on the evaluation of a particular diagnostic test in order to estimate it's sensitivity, specificity, or area under the 'receiver operating characteristic' curve (so called test research). This kind of test research is only useful in situations in which a diagnosis is set by one test (i.e. screening) and in the initial phases of test development for efficiency reasons. But, test research is not suitable to evaluate the clinical or added value of a test. The value of a diagnostic test can be evaluated on its value to discriminate between the presence and absence of a particular disease, to guide therapeutic decisions and to improve the prognosis of the patient. For evaluation of the added value of a diagnostic test within the diagnostic process, the study design should take into account the patient group in which the test will be applied in practice, the target disease of the test and the prior probability (prevalence) of the target disease in that population, the subsequent diagnostic stages and the reference test. In analysing the data it is calculated for each step of the diagnostic process how the test result changes the probability of presence or absence of the target disease.