Measuring outcomes in economic evaluations. This economics note is misleading.
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Three alternative cost ratios and the ratio of annual fixed cost for cows to net replacement cost for three populations that differed in genetic (co)variances were investigated. We studied their effect on the value of longevity records to supplement production records to achieve genetic gains for reducing the nonfeed cost of producing a unit of milk. Data files were constructed from stochastically generated production records and culling variant records; the later records represented the relative value for cow survival of all nonproduction traits. The use of one stayability trait instead of none increased gain by 1 to 9% across the populations and cost ratios. Only 2% additional gain occurred with two stayability traits instead of one. Populations that differed in genetic correlation between production and the survival value of nonproduction traits and in survival heritabilities contributed 2 to 5% toward the greater gains. The different cost ratios contributed 1 to 3%. The effect of increasing the length of herd life independent of production is inherently secondary to the effect of increasing the production during lactation. If genetic antagonism between production and the survival of nonproduction traits is found and if the net replacement costs are high, the use of production and longevity records for selection can enhance gain by up to 10%.
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This two-part article outlines a process whereby practices can enhance profitability and reduce malpractice risks. The key is involvement of all parties. First, providers at all levels, including physicians, must understand the factors that promote patient satisfaction. Next, patients must become incorporated into the diagnostic and therapeutic process. That they be allowed to do so requires a shift in providers' attitudes from one of authority figure to co-manager of care. Various methods are described to help staff, providers and patients communicate better. Specific tools to increase patient involvement are outlined.
Lung cancer is a major cause of the premature loss of life and the costs to society of lung cancer are significant. Since smoking is the major cause of lung cancer, the main prevention strategy is to reduce smoking. Interventions to reduce smoking have been shown to be cost effective, from population measures such as tax and advertising restrictions through to individual or group treatments. Different groups of the population may well benefit from different interventions and there could be synergistic effects from a comprehensive programme. Treatment for smokers is an important part of any programme and especially important to prevent longer term smokers contracting lung cancer. However, most health care systems have not been successful in ensuring that smoking cessation interventions have a high priority. It should be an urgent task to ensure that the small additional resources for this work are fully reimbursed and incentives introduced to reap both major health gains and future reductions in health costs.
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