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PubMedDate not supplied

AAPM/RSNA tutorial on equipment selection: PACS equipment overview: general guidelines for purchasing and acceptance testing of PACS equipment.

A picture archiving and communication system (PACS) is a comprehensive computer system that is responsible for the electronic storage and distribution of medical images in the medical enterprise. The system is highly integrated with digital acquisition and display devices and is often related closely to other medical information systems, such as the radiology information system or hospital information system. In the past few years, there has been continuous growth in clinical implementation of PACS to reduce costs and improve patient care, a trend that is expected to continue. However, a PACS is complex and costly to acquire, replace, maintain, and repair. To select a system that best meets their requirements, purchasers of PACS equipment need to be aware of the key characteristics and differing features of the various products. After the PACS has been installed, the user should perform technical and clinical acceptance testing to ensure that the system meets expectations.

Data Display↗
PubMed1995

Evaluation of VOC emission measurement methods for paint spray booths.

Interest in regulations to control solvent emissions from automotive painting systems is increasing, especially in ozone nonattainment areas. Therefore, an accurate measurement method for VOC emissions from paint spray booths used in the automotive industry is needed to ascertain the efficiency of the spray booth capture and the total emissions. This paper presents the results of a laboratory study evaluating potential VOC sampling and analytical methods used in estimating paint spray booth emissions, and discusses these results relative to other published data. Eight test methods were selected for evaluation. The accuracy of each sampling and analytical method was determined using test atmospheres of known concentration and composition that closely matched the actual exhaust air from paint spray booths. The solvent mixture to generate the test atmospheres contained a large proportion of polar, oxygenated hydrocarbons such as ketones and alcohols. A series of identical tests was performed for each sampling/analytical method with each test atmosphere to assess the precision of the methods. The study identified significant differences among the test methods in terms of accuracy, precision, cost, and complexity.

Air Pollutants↗
PubMed2003

Disease management: a leap of faith to lower-cost, higher-quality health care.

With managed care's promise to reduce costs and improve quality waning, employers and health plans are exploring more targeted ways to control rapidly rising health costs. Disease management programs, which focus on patients with chronic conditions such as asthma and diabetes, are growing in popularity, according to findings from the Center for Studying Health System Change's (HSC) 2002-03 site visits to 12 nationally representative communities. In addition to condition-based disease management programs, some health plans and employers are using intensive case management services to coordinate care for high-risk patients with potentially costly and complex medical conditions. Despite high expectations, evidence of both disease management and case management programs' success in controlling costs and improving quality remains limited.

Case Management↗
PubMed2005

Risks and consequences of gene flow from herbicide-resistant crops: canola (Brassica napus L) as a case study.

Data from the literature and recent experiments with herbicide-resistant (HR) canola (Brassica napus L) repeatedly confirm that genes and transgenes will flow and hybrids will form if certain conditions are met. These include sympatry with a compatible relative (weedy, wild or crop), synchrony of flowering, successful fertilization and viable offspring. The chance of these events occurring is real; however, it is generally low and varies with species and circumstances. Plants of the same species (non-transgenic or with a different HR transgene) in neighbouring fields may inherit the new HR gene, potentially generating plants with single and multiple HR. For canola, seed losses at harvest and secondary dormancy ensures the persistence over time of the HR trait(s) in the seed bank, and the potential presence of crop volunteers in subsequent crops. Although canola has many wild/weedy relatives, the risk of gene flow is quite low for most of these species, except with Brassica rapa L. Introgression of genes and transgenes in B rapa populations occurs with apparently little or no fitness costs. Consequences of HR canola gene flow for the agro-ecosystem include contamination of seed lots, potentially more complex and costly control strategy, and limitations in cropping system design. Consequences for non-agricultural habitats may be minor but appear largely undocumented.

Brassica napus↗
PubMed1990

[Economic aspects of functioning of the occupational health services. Proposed directions of the changes].

In Poland for several years a reform of the health and social care systems has been a subject of discussion. However, more attention has been paid to the problems pertaining to health policy than to modification of economic and financial system. This refers also to occupational health service (OHS), its role and place in industrial plant in general and in the system of social benefits offered by a given economic subject in particular. One of the main issues discussed is effectiveness of OHS functioning. It is particularly important in view of high differentiation of unit costs (e.g. in Occupational Health Care Complexes), The highest cost per one employee covered by the care was six times higher than the lowest noted, whereas the current cost per one consultation in out-patient OHS unit was "only" three times lower--in the most effective in this respect Occupational Health Care Complex-as compared to the highest cost recorded. The similar phenomenon was also observed as regards the costs covered from the budget calculated per one employee covered by the care and per one consultation. The paper presenting a problem of OHS functioning, with particular regard to financing its activities, contributes to the discussion on improvement of economic and financial system of health care in Poland. It also recommends some possible solutions of most effective use of the financial means allocated for OHS activities in new economic situation in our country.

Costs and Cost Analysis↗
PubMed1979

[Heterogeneity of a neuron population with complex receptive fields in the visual cortex of costs].

Visual responses of the striate complex cells to stimuli orientation, direction and velocity of movement were studied in awakening, unanesthetized cats. "Complex" cells were divided into four groups according to the response characteristics which were obtained using a stationary slit, moving light spot and moving oriented stimulus. The first group units response characteristics suggest the presence of the orientation selectivity mechanism in their receptive field organization, the fourth group--the direction selectivity mechanisms, the second and third groups--the presence of both mechanisms. It is supposed that there are two separate mechanisms for coding the orientation and direction of the stimulus movement in the neuronal structures of the visual cortex.

Animals↗
PubMed2000

Financing blood transfusion services in sub-Saharan Africa: a role for user fees?

The provision of a secure and safe blood supply has taken on new importance in sub-Saharan Africa with the onset of the AIDS epidemic. Blood transfusion services capable of providing safe blood are not cheap, however, and there has been some debate on the desirability and sustainability of different financing mechanisms for blood transfusion services. This paper examines patterns of financing blood transfusion in three countries--Côte d'Ivoire, Zimbabwe and Mozambique. It goes on to consider the conceptual options for financing safe blood, and to examine in detail the possible role of user fees for blood transfusion in Africa, developing a simple model of their likely burden to patients based on data from Côte d'Ivoire. The model indicates that, at best, there can only be a limited role for user fees in the financing of safe blood transfusion services, due mainly to the relatively high cost of producing a unit of safe blood. Charging individuals for the blood they receive is likely to be administratively complex and costly, could realistically recover only a fraction of the production costs involved, and is further complicated by the fact that the main recipients of blood transfusion in sub-Saharan Africa are children and pregnant women. If cost-recovery for safe blood is to be attempted, the most viable option appears to be that of charging a collective fee, levied upon all inpatients, not just on those who receive blood. Such a mechanism is not without problems, not least in its failure to offer incentives for more appropriate blood use, and it is still likely to recover only a portion of the costs of producing safe blood. Whether or not cost-recovery is instituted, there will remain an important role for public funding of blood transfusion services, and, by implication, an important role for foreign donor support.

Blood Banks↗
PubMed2000

Economic evaluation of drug resistance genotyping for the adaptation of treatment in HIV-infected patients in the VIRADAPT study.

BACKGROUND: Costs of antiretroviral therapy for HIV-infected patients have increased at a time when most countries are attempting to contain health care costs. Part of this increase results from HIV drug resistance associated with virologic failure and a subsequent shift to more complex and costly therapies. Genotypic guided treatment is associated with better virologic outcome. However, it is not yet known whether it will be cost effective. METHODS: We present here an economic evaluation based on the results from the VIRADAPT study, a prospective, open-label, randomized trial comparing patients assigned to standard of care (n = 43), versus genotypic guided treatment (n = 64) for 6 months. Total follow-up for the extended trial was 1 year. Costs were computed from the viewpoint of the health care system. Hospitalization data were retrieved from the VIRADAPT study case report forms, costs were estimated from the cost of the corresponding diagnosis-related groups derived from the French national cost data base: these were actual costs and not charges. Data on the volume of tests prescribed, drugs, and clinic visits were retrieved from the VIRADAPT study database. The unit costs of tests and clinic visits were determined using the French national Social Security reimbursement price; costing of drugs used were based upon purchase price by either retail pharmacies or hospitals. Genotyping using TruGene HIV-1 assay was estimated at $500 per test from manufacturer's data (all figures in this paper are expressed in U.S. dollars). RESULTS: Total mean (standard deviation) yearly costs per patients were $20,412 (+/-$10, 129) in the standard of care group and $18,484 (+/-$9,652) in the genotyping group (p =.35). Drug costs represented 55% of total costs. There was a trend toward a decrease in drug costs in the genotyping arm (p =.07), the greatest reduction being in the decreased use of protease inhibitors in the genotyping arm. The additional expense of genotyping appeared to be offset by the savings obtained in drug costs. CONCLUSION: In our study, the cost of drug resistance testing is offset by a reduced use of protease inhibitors and their attendant costs. Although not reaching statistical significance, this trend in the reduction of drug costs and drug use presents a great interest for future trials.

Adult↗
PubMed1983

Cardiac pacing in the 1980s: treatment and techniques in transition.

The pacemaker of the 1980s is designed to maintain atrioventricular synchrony through dual-chamber pacing. This pacemaker is multiprogrammable and capable of telemetric transmission of biologic, electronic and electrophysiologic data. Several developments have made this therapeutic modality possible: 1) the cumulative survival rate of many lithium-battery pacemakers exceeds 95% at 5 years; 2) lead and connector problems are rare; 3) atrial and ventricular electrode malfunctions occur in less than 2% of implants; and 4) new introducer techniques have simplified implantation (mortality and major morbidity rates are 0.5 and 0.4%, respectively). With multiprogrammability, pacemaker function can be optimized for the patient's needs, and about 20% of reoperations can be avoided. Ninety-six dual-chamber (DDD) pacemakers, 55 of which have been followed up for more than 3 months, have provided trouble-free performance and have yielded salutary clinical results, particularly when implanted to replace previous ventricular inhibited units. Problems with these pacemakers have included unusual pacing electrocardiograms, pacemaker eccentricities, programmer maintenance, pacing and follow-up complexities and costs. In the 1980s, effort will be required to find a balance between rapidly evolving technology and the clinical need for complex pacing systems. From 1978 to 1981, the rate of pacemaker implantation grew from 309 to 513 implants per million population per year, and there are now approximately 500,000 patients with implanted pacemakers living in the United States. Indications for pacing are ill-defined, because in many cases the assessment of clinical response to pacing is largely subjective, lacking satisfactory quantitative indexes. This decade will be a time of reappraisal of the extent of clinical applicability of new techniques, particularly the multiprogrammable dual-chamber system which, after 3 years of clinical trial, shows promise of being the predominant pacemaker of the immediate future.

Arrhythmias, Cardiac↗
PubMed2002

A comparative analysis of methods to represent uncertainty in estimating the cost of constructing wastewater treatment plants.

Prediction of construction cost of wastewater treatment facilities could be influential for the economic feasibility of various levels of water pollution control programs. However, construction cost estimation is difficult to precisely evaluate in an uncertain environment and measured quantities are always burdened with different types of cost structures. Therefore, an understanding of the previous development of wastewater treatment plants and of the related construction cost structures of those facilities becomes essential for dealing with an effective regional water pollution control program. But deviations between the observed values and the estimated values are supposed to be due to measurement errors only in the conventional regression models. The inherent uncertainties of the underlying cost structure, where the human estimation is influential, are rarely explored. This paper is designed to recast a well-known problem of construction cost estimation for both domestic and industrial wastewater treatment plants via a comparative framework. Comparisons were made for three technologies of regression analyses, including the conventional least squares regression method, the fuzzy linear regression method, and the newly derived fuzzy goal regression method. The case study, incorporating a complete database with 48 domestic wastewater treatment plants and 29 industrial wastewater treatment plants being collected in Taiwan, implements such a cost estimation procedure in an uncertain environment. Given that the fuzzy structure in regression estimation may account for the inherent human complexity in cost estimation, the fuzzy goal regression method does exhibit more robust results in terms of some criteria. Moderate economy of scale exists in constructing both the domestic and industrial wastewater treatment plants. Findings indicate that the optimal size of a domestic wastewater treatment plant is approximately equivalent to 15,000 m3/day (CMD) and higher in Taiwan. Yet the optimal size of an industrial wastewater treatment plant could fall in between 6000 CMD and 20,000 CMD.

Costs and Cost Analysis↗
PubMed1999

The cost-effectiveness of prophylaxis for Mycobacterium avium complex in AIDS.

OBJECTIVE: To develop a simulation model to project costs, life expectancy, and cost-effectiveness in discounted dollars per quality-adjusted life-year (QALY) saved for clinical strategies to prevent Mycobacterium avium complex (MAC) in patients with AIDS. METHODS: We used natural history data from the Multicenter AIDS Cohort Study, efficacy and toxicity data from randomized clinical trials, and cost data from the AIDS Cost and Services Utilization Survey. The model permits timing of prophylaxis to be stratified by CD4 count (201-300, 101-200, 51-100, and < or = 50/mm3), and allows combinations of prophylaxis, crossover to second- and third-line agents for toxicity, and consideration of adherence, resistance, and quality of life. RESULTS: The model projects that the average HIV-infected patient with a beginning CD4 count between 201 and 300/mm3 has total lifetime costs of approximately $43,150 and a quality-adjusted life expectancy of 42.35 months. If azithromycin prophylaxis for M. avium complex is begun after the CD4 declines to 50/mm3, costs and quality-adjusted survival increase to approximately $44,040 and 42.78 months, respectively, for an incremental cost-effectiveness ratio of $25,000/QALY compared with no M. avium complex prophylaxis. Other prophylaxis options (i.e., rifabutin, clarithromycin, and combination therapies) either cost more but offer shorter survival, or have cost-effectiveness ratios above $260,000/QALY. Sensitivity analysis reveals that, for reasonable assumptions about quality of life, risk of infection, prophylaxis cost, adherence, and resistance, azithromycin remains the most cost-effective prophylaxis option. CONCLUSIONS: Azithromycin prophylaxis, begun after the CD4 count has declined to 50/mm3, is the most cost-effective M. avium complex prophylaxis strategy. Consistent with new United States Public Health Service guidelines, it should be the first-line prophylaxis option.

AIDS-Related Opportunistic Infections↗
PubMed1999

The ECAT ART Scanner for Positron Emission Tomography. 1. Improvements in Performance Characteristics.

The widespread use of positron emission tomography (PET) has been to some extent limited by the cost and complexity of PET instrumentation. Recognition of the wider applicability of clinical PET imaging is reflected in the ECAT ART design, a low cost PET scanner targeted for clinical applications, particularly in oncology. The ART comprises two asymmetrically opposed arrays of BGO block detectors. Each array consists of 88 (transaxial) by 24 (axial) crystals, and the arrays rotate continuously at 30 rpm to acquire a full 3D projection data set. Sensitivity and count rate limitations are key performance parameters for any imaging device. This paper reports on improved performance characteristics of the ART, achieved by operating the scanner with a decreased block integration time, reduced coincidence time window, and collimated singles transmission sources. Compared to the standard ART configuration, these modifications result in both improved count rate performance and higher quality transmission scans.

Journal Article↗
PubMed1990

[The cost of a campaign against malaria. General considerations].

Malaria is yet one of the major tropical problems and the technical evolution of the malaria campaigns since 90 years is a witness of its complexity. The cost of a programme against malaria, including house spraying, case finding with chemotherapy and chemoprophylaxis for pregnant women, must allow a long-term (10 years) mobilization of resources. In Mayotte island (Comoro archipelago), the cost of the malaria campaign was, in 1987, about 6 US $ by inhabitant. Without man power cost, the house spraying needed 3 US $ by inhabitant, 0.2 US $ for Entomology and Parasitology Laboratories, 0.1 US $ for chemoprophylaxis, case finding and treatment. Apart from the frequency of house spraying which depends on epidemiological features (whole year or seasonal transmission), the integration of activities looks to be the major argument for the optimization of this cost.

Animals↗
PubMedDate not supplied

Atopic dermatitis in Italian children: evaluation of its economic impact.

INTRODUCTION: The aim of our study was to evaluate the economic impact of atopic dermatitis (AD) on the family of young children affected by the disease in Italy. METHODS: Thirty-three families of young children affected by AD were asked to fill in a questionnaire about financial costs associated with providing health care during the past year for their child affected by AD. For each child AD severity was evaluated by using the SCORAD index. RESULTS: By analyzing the questionnaire, an annual average cost of 1254euro (about U.S. $1540) for each family was determined. Main expenses concern the use of moisturizing therapies, particular detergent, and private specialist consultations. Annual family average cost was lower for children with mild AD compared with those with moderate to severe AD. DISCUSSION: AD has a deep impact on the family budget, with an increasing cost in proportion to the increasing severity of the disease. These data support previous reports suggesting that the management of AD in children is complex and costly, altering the quality of life of children and their families.

Attitude to Health↗
PubMed2001

The benefits of using customized procedure packs.

Discrete item purchasing is the traditional approach for hospitals to obtain consumable supplies for theatre procedures. Although most items are relatively low cost, the management and co-ordination of the supply chain, raising orders, controlling stock, picking and delivering to each operating theatre can be complex and costly. Customized procedure packs provide a solution.

Cost-Benefit Analysis↗
PubMed1984

The 33rd John Stanley Coulter memorial lecture. The goals of rehabilitation.

The present system of service provision to people with disability is very complex, fragmented, and costly. The large number of disabilities receiving separate consideration contributes to the complexity and cost. Major costs to society associated with disability are institutional care and income support programs. An action plan is proposed based upon two national goals--reduction in the need for institutional care by 30% and reduction in the level of unemployment among employable disabled people to the national average by 1990. Basic considerations for implementing an action plan are outlined, including the need for morbidity indices to measure progress towards goal attainment.

Canada↗
PubMed1994

Health care reform: identifying some cost culprits.

In terms of both total cost and fraction of the gross national product, the cost of health care in the United States is considerably greater than anywhere else in the world. The reasons for the excessively high cost are complex and include issues of administration, issues of quality, and issues peculiar to American culture. Some contributing factors are the demographics of the population, the cost of defensive medicine and litigation, costly regulation, extensive application of technology in response to public demand and expectations, and finally, waste and abuse of the system. Control of costs cannot realistically be achieved by simply changing the way we finance health care, but will require changing the economic incentives for both providers and patients. Reforming the system will necessarily include compromising some of our expectations about health care, changing unhealthy lifestyles, and more realistically analyzing the costs of litigation and regulations.

Defensive Medicine↗