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At least 955 records · Page 53Linked to original sources
PubMed1993

Event related potentials using visual stimulation.

Visual patterns are used to elicit event related potentials. Equipment is available for generating visual geometric patterns such as checkerboards. Slides may be used for patterns which are more complex but preparation is costly and time consuming. A variety of programs exist on PC's for making very elaborate color pictures and in most cases the programs are easy to use making them ideal for generating visual patterns for event related potential experiments. A necessary requirement in event related potential experiments is the ability to control and/or determine precisely when the stimulus is presented to the subject. We have observed that timing is a problem with stimuli generated by the PC as a result of the raster scan and use in many cases of high level system calls in the software. This paper describes a technique which allows for precise control of the time of stimulus presentation using the video control signals to the monitor.

Evoked Potentials, Visual↗
PubMed1995

Natural history of giant intracranial aneurysms and indications for intervention.

Giant intradural aneurysms are associated with an extremely grave natural history, yet remain potentially curable. Those aneurysms located on the intracavernous segment of the internal carotid artery are associated with a more benign natural history but frequently present with intractable cranial neuropathy requiring intervention. Proper current management requires a multidisciplinary approach through which the therapeutic goals are clearly defined. The treatment of giant intracranial aneurysms must be individualized after considering the various therapeutic options available to the multidisciplinary team. The cost of managing these complex lesions can be reduced by minimizing complications. Future advances in our ability to better manage patients with giant intracranial aneurysms will require careful assessment of outcome parameters.

Age Distribution↗
PubMed1997

Single-lead VDD pacing. A case of cross-talk.

The haemodynamic and electrophysiological benefits of dual chamber pacing are well recognized at the cost of a more complex and expensive implant. In selected groups of patients VDD-mode dual chamber pacing offers the advantages of dual chamber pacing with the use of a single catheter and is nowadays gaining increasing popularity. The following report describes an uncommon and potentially harmful pacemaker malfunction secondary to the dislodgement of the catheter.

Aged↗
PubMedDate not supplied

Treatment planning for dental implants: considerations, indications, and contraindications.

During the last 10 years the initial concept of osseointegrated implant dentistry as essentially treatment of the heavily resorbed edentulous mandible in older patients has expanded to encompass almost every combination of prosthetic problem. Many factors must be taken into account when planning treatment to ensure a flexible approach which is necessary given the uncertainty in predicting the outcome of difficult cases. The complex, and therefore inherently costly, nature of implant dentistry will inevitably lead the patient to have very high expectations of treatment. It is extremely important for the operator to determine these expectations at an early stage, and if there is any doubt about being able to satisfy them then he or she may be wiser not to proceed (as in all other areas of dentistry, skillful case selection is the key to success). In any event, the patient must be fully appraised of the complications, the potential risks and the benefits of treatment so that they can proceed on the basis of informed consent.

Contraindications↗
PubMedDate not supplied

[Improving radiographic diagnosis of the sella by means of direct magnification technics and autotomography].

On the basis of personal experiences with 30 cases and a survey of literature the authors discuss the value of radiological diagnostic assessment of sella using a technique of direct magnification and autotomography. The superiority of these techniques over the information obtained from plain films of the skull has been demonstrated. These techniques are easy, not time-consuming, they do not require complex apparatus and their costs approximate those of plain radiograms.

Bone Neoplasms↗
PubMed1998

[Laboratory tests and clinical practice: from diagnosis of an inflammatory syndrome to colon cancer screening].

The general practitioner is continually faced to the greater complexity, number, variety, and costs of available laboratory tests. The challenge is to decide in each topic what is the most important within these vast data. In a deluge of correct but relatively unimportant results, answers to questions might be hidden. This article is meant to guide clinicians to select and interpret useful laboratory tests for the diagnosis of an inflammatory process and the screening of colon cancer.

Clinical Laboratory Techniques↗
PubMed1982

Selective primary health care: is efficient sufficient?

Developing countries are increasingly using economic evaluation methods to assess and plan their health services. Inappropriate application of these methods may lead to serious errors in developing primary health care strategies. In 'Selective Primary Health Care', Julia Walsh and Kenneth Warren present a logical approach to health planning based on cost-effectiveness techniques. Their paper is a timely example of the risks of using simple technical criteria to plan solution to complex public health problems. Cost-effectiveness is not a sufficient criterion for planning primary health care. Related issues are discussed in these comments. As an alternative, a multiple-objective approach is suggested.

Cost-Benefit Analysis↗
PubMed2004

Deep brain stimulation of the subthalamic nucleus reduces antiparkinsonian medication costs.

This study reports a retrospective analysis of 16 patients to determine changes in medication costs associated with deep brain stimulation of the bilateral subthalamic nucleus (DBS B-STN). Antiparkinsonian medication (APMED) costs were evaluated pre- and post-operatively at 1 and 2 years, based on prescribed dosages. After treatment with DBS, patients experienced a 32% reduction in APMED costs after 1 year and a 39% reduction after 2 years. Hypothetical projections of total potential savings are presented, accounting for increasingly complex medication regimens and medication cost inflation. DBS patients may experience a significant long-term reduction in the cost of their pharmacologic treatment.

Amantadine↗
PubMed1999

Pharmacoeconomic comparison of an albumin-furosemide complex versus sequential therapy for renal insufficiency.

The purpose of this economic analysis was to develop an economic model using intra-institutional cost data for acute, oliguric renal insufficiency treated with either an albumin-furosemide complex or albumin followed by furosemide (sequential therapy). The perspective of this study was from the standpoint of the institution (University Medical Center, a teaching hospital). The decision tree and sensitivity analyses demonstrated that the albumin-furosemide complex would be more effective and less costly than sequential therapy for a range of outcome probabilities. Using effectiveness assumptions from published literature, the complex could avoid dialysis in 27% of patients compared with 8% of patients receiving sequential therapy. The complex would also be less costly ($7778 vs $8748). In terms of cost-effectiveness, the complex is $28,807 per averted dialysis compared with $109,350 for sequential therapy.

Acute Disease↗
PubMed1996

The transmission dynamics of hepatitis B in the UK: a mathematical model for evaluating costs and effectiveness of immunization programmes.

Complex hepatitis B (HBV) epidemiology makes it difficult to evaluate and compare effectiveness of different immunization policies. A method for doing so is presented using a mathematical model of HBV transmission dynamics which can represent universal infant and adolescent vaccination strategies and those targeted at genito-urinary (GU) clinic attenders and infants born to infectious mothers. Model structure, epidemiological underpinning, and parameterization, are described. Data from the UK National Survey of Sexual Attitudes and Lifestyles is used to define patterns of sexual activity and GU clinic attendance; data deficiencies are discussed, in particular that of UK seroprevalence of HBV markers stratified by age, sex, and risk factors. General model predictions of endemic HBV marker prevalence in homosexual and heterosexual populations seem consistent with published UK data. The simulations exhibit non-linearities in the impact of different vaccination strategies. Estimated number of carriers prevented per vaccine dose for each strategy provides a measure of costs and benefits, varying temporally over the course of a programme, and with level of vaccine coverage. Screening before vaccination markedly increases payback per dose in homosexuals but not in heterosexuals; mass infant vaccination gives the poorest effectiveness ratio and vaccination of infants after antenatal screening the best; in general, increasing vaccine coverage yields lower pay-back per dose. The model provides a useful framework for evaluating costs and benefits of immunization programmes, but for precise quantitative comparison more UK epidemiological data is urgently needed.

Adolescent↗
PubMed2002

Balancing the cost and value of medications: the dilemma facing clinicians.

In the current complex healthcare environment, considerations of medication efficacy, risk, cost, reimbursement, and regulation compete to influence the physician's clinical decision making in an atmosphere marked by curtailed physician autonomy, adversarial doctor-patient relationships, and conflict between clinical and managerial goals. Often, pharmaceutical expenditures are managed as if they exist in a universe separate from that occupied by all other aspects of patient care, even when a societally based cost-effectiveness analysis might favour more aggressive use of drug therapy for the long-term benefits it can generate. One response to these conflicting pressures is the creation of institutional resources to help reconcile the inevitable conflicts between such forces. At the author's institution, the Brigham and Women's Hospital, a new clinical Division of Pharmacoepidemiology and Pharmacoeconomics seeks to develop a reservoir of expertise to address the issue of appropriate medication use in a proactive way. Its goal is to help the hospital remain on the cutting edge of therapeutics while containing its drug budget within reasonable bounds. The programme consists of a system of ongoing formulary review, surveillance of current prescribing patterns, the production of educational monographs, a computer-based order entry system, a curriculum on cost effectiveness for interns, residents and medical students, and deployment of hospital-based 'detailers' to discuss problematical prescribing decisions with practitioners. The dissemination of such an approach in multiple sectors of the healthcare system could lead to greater sophistication by payers, prescribers, patients, and policy makers concerning how best to balance benefits, risks, and costs in pharmacotherapy.

Boston↗
PubMed1997

[5 years quality assurance in accordance with the roentgen regulation. Benefits, costs, necessary innovations].

Guidelines and standards supplementing the German "Röntgenverordnung" initiated a complex system of quality control in diagnostic radiology. Cost and profit are analysed for two hospitals of comparable size (Klinikum Buch and Klinikum Nürberg). The considerable expenses that must be incurred for measuring devices, equipment, working time and extra charges on the one hand, are the items that are opposed to achieving a higher image quality and dose reduction on the other. Public quality control enables to demonstrate the quality and to optimise imaging procedures in diagnostic radiology. A critical evaluation of the results of quality control suggests further developments. We should consider larger time intervals for quality tests in some cases, while focussing on techniques with high radiation exposure, e.g. computed tomography, where dose reductions are highly effective.

Adolescent↗
PubMed1989

Cost accounting for blood bank laboratories.

To meet the challenges of present-day blood banking, laboratory managers and supervisors must acquire and use skills in financial management. One such skill is cost analysis. Cost analyses vary from simple to complex and are used to determine the basic elements contributing to a test cost. Cost analysis can be used to identify costs, justify updating laboratory test prices, monitor general supply and reagent costs, help in the decision to lease or buy an instrument, modify existing test procedures to cut costs, determine staffing needs, and assure accurate reimbursement for laboratory services.

Journal Article↗
PubMed2001

Intensive care--a cost effective option for developing countries?

The estimation of cost-effectiveness of pediatric critical care services is an extremely relevant issue for both developing and industrialized nations. Pediatric critical care is expensive and the long outcomes are still relatively unclear. From the perspective of patients who receive the benefits of these services, there may be little controversy regarding cost-effectiveness. However, the issue becomes very complex when attempts are made to identify which patients will benefit most. This also needs to be considered while developing public policy when decisions for allocation of limited resources need to be made within health care systems, and choices need to be made between the provision of health care and other public services. This article addresses the complex issue of economic evaluations and describes various type of cost analyses. The difference between charges and costs is defined, and a discussion of the measurement of costs and benefits, and their relationship to outcomes research is provided. Although there is not a unique answer to the issue of cost-effectiveness for pediatric critical care services, the available literature particularly from the United States is summarized, and the ethical implications explored.

Child↗
PubMed1994

Survey of health planning proposals.

It is important that physicians participate in the debate and planning process that will ultimately guide how we reform the way health care is financed and delivered in the United States. Herein is offered a perspective on the problem, one which is not necessarily appreciated by health planners. While we deliver the best quality of care in the world to most of our population, our system has been severely criticized because we fail to provide for access to a substantial minority of our population. Additionally, the cost of the product is considerably greater than that in comparable countries. Attempts to control costs without diminishing quality have introduced expensive complexities into our system without any real success in cutting costs. Several proposals have been advanced to address the issues of cost and access. One of these is a single payer system, common in Europe and Canada, whereby a single agent or group of agents finances all health care through universal rules and means. A system operating in Hawaii is a simple employer mandate to provide health insurance. A uniquely American plan is the Jackson Hole Plan or Managed Competition (now called "Managed Cooperation"). This system is currently popular among national health planners, and involves a defined minimum managed health plan offered by various groups of providers to employees and individuals through health plan purchasing cooperatives. This plan is interesting, but has not been implemented in any jurisdiction, and it is not certain it would accomplish its goals in practice since it is difficult to predict behavior of all parties to such a system.

Health Care Costs↗
PubMed1997

Reduced risk of complex response: an invisible outcome.

Reduced risk of complex response is proposed as a category of outcomes sensitive to the effects of advanced practice nursing. Processes of risk assessment and risk management are described. The goals are to identify complex responses whose occurrence is high in human and/or economic costs, to assess factors associated with these complex responses, to provide good information to support interventions that reflect the values of the discipline, and to make the effectiveness of advance practice registered nurses visible.

Humans↗
PubMed1990

Current trends in Canadian health care: myths and misconceptions in health economics.

This paper is concerned with the economic aspects of the trends in Canadian health care. Various myths and misconceptions abound regarding the applicability of economics to behaviour in the health care industry as well as to the interpretation of recent trends. Both issues are examined in this paper. While most discussions regarding health care trends begin with the share of health expenditures in Gross National Product, I propose an alternative share that adjusts for cyclical variations in both unemployment and labour force participation. Using this measure, I show that the "real" growth of resources devoted to the health care industry is much larger than that obtained with conventional measures, and that the difference in growth rates between Canada and the U.S. is narrowed considerably. The paper outlines and disputes the validity of three public health policy propositions. First, it is not empirically valid to say that the introduction of universal medical insurance in Canada successfully contained the growth in the share of society's resources devoted to the health care industry. Second, it is not correct to argue that the change in the federal funding for hospital and medical care in 1977 was a "fiscal non-event". And finally, the proposed "equity" funding formula for Ontario hospitals is unlikely to contain costs and will potentially skew hospitals towards the provision of complex forms of care instead of cost-effective community-based alternatives.

Canada↗
PubMed1987

Structural analysis of tree trunks and branches: tapered cantilever beams subject to large deflections under complex loading.

The dimensions, deflections and support costs of tree trunks and branches can be deduced using the structural theory for cantilever beams. However, elementary theory applies only as long as deflections are small, and complex analytical solutions are required to account for complex taper and patterns of loading. This paper describes a method that copes with large deflections, any patterns of taper, and any patterns of distributed loading, point loading or externally applied bending moments. A beam is considered to be composed of a series of short segments, such that each has only a small deflection, and each can have specified dimensions, Young's modulus and loading. The transport matrix method of structural analysis is used to determine the end conditions of each segment and of the whole beam. The method is verified by comparing predicted deflections with deflections (a) calculated using an analytical solution by Bisshopp and Drucker (1945), (b) calculated and measured for sapling tree trunks by Leiser and Kemper (1968), and (c) measured on tapered and untapered plastic rods.

Journal Article↗