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306 records – page 1 of 31.

Abdominal aortic aneurysm: endovascular grafts offer a potential alternative to surgery.

https://arctichealth.org/en/permalink/ahliterature191802
Source
Issues Emerg Health Technol. 1998 Jan;(2):1-3
Publication Type
Article
Date
Jan-1998
Source
Issues Emerg Health Technol. 1998 Jan;(2):1-3
Date
Jan-1998
Language
English
Publication Type
Article
Keywords
Aortic Aneurysm, Abdominal - surgery
Blood Vessel Prosthesis Implantation - adverse effects - economics - methods
Canada
Clinical Trials as Topic
Direct Service Costs
Humans
Stents
Surgical Procedures, Minimally Invasive - adverse effects - economics - methods
Technology Assessment, Biomedical
Treatment Outcome
Abstract
Endovascular grafts are a new, experimental surgery for AAAs that alleviates the need for open abdominal surgery. They offer an important alternative for high risk patients who would be at a greater risk with the more invasive surgical procedure. However, this is based on limited evidence, and more randomized controlled trials are needed. The procedure may be cheaper than open surgery, because of the lengthy hospital stay and operating room time with the latter, provided that the costs of the devices are low enough. However, there is insufficient data on the outcomes with endovascular grafts in different patient groups. As with many new or minimally invasive techniques, there is a "learning curve" which will affect costs and outcomes. Endovascular grafting is no exception, and repeated practical applications are needed for competence, expertise and good outcomes. Continued monitoring of this technique is needed. A registry of elective AAA patients now has 10-year follow-up data on about a third of the Canadian patients operated on in 1988. Further development of such registries will provide more accurate information on success rates, costs, and long-term complications.
PubMed ID
11811206 View in PubMed
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Actor-network theory: a tool to support ethical analysis of commercial genetic testing.

https://arctichealth.org/en/permalink/ahliterature180338
Source
New Genet Soc. 2003 Dec;22(3):271-96
Publication Type
Article
Date
Dec-2003
Author
Bryn Williams-Jones
Janice E Graham
Author Affiliation
Centre for Family Research & Homerton College, University of Cambridge, UK.
Source
New Genet Soc. 2003 Dec;22(3):271-96
Date
Dec-2003
Language
English
Publication Type
Article
Keywords
Breast Neoplasms - genetics
Canada
Diffusion of Innovation
Female
Genes, BRCA1
Genes, BRCA2
Genetic Counseling
Genetic Research
Genetic Services - economics - ethics - trends
Genetic Testing - economics - ethics - methods
Health Services Accessibility
Humans
Industry
Internationality
Marketing
Models, organizational
Patents as Topic
Private Sector
Public Policy
Public Sector
Research Support as Topic
Sensitivity and specificity
Technology Assessment, Biomedical
Technology Transfer
Abstract
Social, ethical and policy analysis of the issues arising from gene patenting and commercial genetic testing is enhanced by the application of science and technology studies, and Actor-Network Theory (ANT) in particular. We suggest the potential for transferring ANT's flexible nature to an applied heuristic methodology for gathering empirical information and for analysing the complex networks involved in the development of genetic technologies. Three concepts are explored in this paper--actor-networks, translation, and drift--and applied to the case of Myriad Genetics and their commercial BRACAnalysis genetic susceptibility test for hereditary breast cancer. Treating this test as an active participant in socio-technical networks clarifies the extent to which it interacts with, shapes and is shaped by people, other technologies, and institutions. Such an understanding enables more sophisticated and nuanced technology assessment, academic analysis, as well as public debate about the social, ethical and policy implications of the commercialization of new genetic technologies.
PubMed ID
15115034 View in PubMed
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The Alberta Ambassador Program: delivering Health Technology Assessment results to rural practitioners.

https://arctichealth.org/en/permalink/ahliterature169962
Source
BMC Med Educ. 2006;6:21
Publication Type
Article
Date
2006
Author
Saifudin Rashiq
Pamela Barton
Christa Harstall
Donald Schopflocher
Paul Taenzer
Author Affiliation
Division of Pain Medicine, Department of Anesthesiology and Pain Medicine, University of Alberta, Edmonton AB, Canada. srashiq@ualberta.ca
Source
BMC Med Educ. 2006;6:21
Date
2006
Language
English
Publication Type
Article
Keywords
Alberta
Chronic Disease
Decision Making
Education, Medical, Continuing - methods
Evidence-Based Medicine - education
Humans
Pain Management
Physician's Practice Patterns
Program Development
Program Evaluation
Regional Medical Programs
Rural Health Services - standards
Teaching - methods
Teaching Materials
Technology Assessment, Biomedical
Abstract
The purpose of Health Technology Assessment (HTA) is to make the best possible summary of the evidence regarding specific health interventions in order to influence health care and policy decisions. The need for decision makers to find relevant HTA data when it is needed is a barrier to its usefulness. These barriers are highest in rural areas and amongst isolated practitioners.
A multidisciplinary team developed an interactive case-based instructional strategy on the topic of chronic non-cancer pain (CNCP) management using clinical evidence derived by HTA. The evidence for each of 18 CNCP interventions was distilled into single-sheet summaries. Clinicians and HTA specialists ('Ambassadors') conducted 11 two-hour interactive sessions on CNCP in eight of Alberta's nine health regions. Pre- and post-session evaluations were conducted.
The sessions were attended by 130 individuals representing 14 health and administrative disciplines. The ambassador model was well received. The use of content experts as ambassadors was highly rated. The educational strategy was judged to be effective. Awareness of the best evidence in CNCP management was increased. Although some participants reported practice changes as a result of the workshops, the program was not designed to measure changes in patient outcome.
The ambassador program was successful in increasing awareness of the best evidence in CNCP management, and positively influenced treatment decisions. Its teaching methods were felt to be unique and innovative by participants. Its methods could be applied to other clinical content areas in order to increase the uptake of the results of HTA.
Notes
Cites: J Contin Educ Health Prof. 2002 Fall;22(4):214-2112613056
Cites: J Health Soc Policy. 2002;15(3-4):23-3712705462
Cites: BMJ. 1998 Jul 25;317(7153):273-69677226
Cites: J Eval Clin Pract. 2003 Nov;9(4):385-9014758960
Cites: J Contin Educ Health Prof. 2004 Spring;24(2):68-7515279131
Cites: Lancet. 2003 Oct 11;362(9391):1225-3014568747
PubMed ID
16579855 View in PubMed
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Anakinra: interleukin-1 receptor antagonist therapy for rheumatoid arthritis.

https://arctichealth.org/en/permalink/ahliterature192010
Source
Issues Emerg Health Technol. 2001 May;(16):1-4
Publication Type
Article
Date
May-2001
Author
K. Garces
Source
Issues Emerg Health Technol. 2001 May;(16):1-4
Date
May-2001
Language
English
Publication Type
Article
Keywords
Arthritis, Rheumatoid - therapy
Canada
Drug Approval
Drug Costs
Humans
Randomized Controlled Trials as Topic
Receptors, Interleukin-1 - antagonists & inhibitors
Technology Assessment, Biomedical
Treatment Outcome
United States
United States Food and Drug Administration
Abstract
(1) Anakinra is an interleukin-1 receptor antagonist (IL-1ra), which blocks interleukin-1 (IL-1), a protein involved in the inflammation and the joint destruction associated with rheumatoid arthritis (RA). (2) The manufacturer's submission for drug approval is currently under review by Health Canada and the FDA. (3) In randomized controlled trials, patients with severe RA were treated with anakinra. Significant improvement was demonstrated in several clinical, radiologic and health-related quality of life measures in patients treated with anakinra versus placebo. (4) Minimal adverse effects, mainly injection site reactions, were reported.
PubMed ID
11776280 View in PubMed
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Analyzing differences in the costs of treatment across centers within economic evaluations.

https://arctichealth.org/en/permalink/ahliterature194089
Source
Int J Technol Assess Health Care. 2001;17(2):155-63
Publication Type
Article
Date
2001
Author
D. Coyle
M F Drummond
Author Affiliation
Ottawa Hospital Research Institute, University of Ottawa.
Source
Int J Technol Assess Health Care. 2001;17(2):155-63
Date
2001
Language
English
Publication Type
Article
Keywords
Bronchial Neoplasms - radiotherapy
Canada
Clinical Trials as Topic - economics
Head and Neck Neoplasms - radiotherapy
Health Care Costs - statistics & numerical data
Humans
Multicenter Studies as Topic
Technology Assessment, Biomedical - economics
Abstract
Assessments of health technologies increasingly include economic evaluations conducted alongside clinical trials. One particular concern with economic evaluations conducted alongside clinical trials is the generalizability of results from one setting to another. Much of the focus relating to this topic has been on the generalizability of results between countries. However, the characteristics of clinical trial design require further consideration of the generalizability of cost data between centers within a single country, which could be important in decisions about adoption of the new technology.
We used data from a multicenter clinical trial conducted in the United Kingdom to assess the degree of variation in costs between patients and between treatment centers and the determinants of the degree of such variation.
The variation between patients was statistically significant for both the experimental and conventional treatments. However, the degree of variation between centers was only statistically significant for the experimental treatment. Such variation appeared to be a result of hospital practice, such as payment mechanisms for staff and provision of hostel accommodation, rather than variations in physical resource use or substantive differences in cost structure.
Multicenter economic evaluations are necessary for determining the variations in hospital practice and characteristics that can in turn determine the generalizability of study results to other settings. Such analyses can identify issues that may be important in adopting a new health technology. Analysis is required of similar large multicenter trials to confirm these conclusions.
PubMed ID
11446127 View in PubMed
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An equity framework for health technology assessments.

https://arctichealth.org/en/permalink/ahliterature129832
Source
Med Decis Making. 2012 May-Jun;32(3):428-41
Publication Type
Article
Author
Anthony J Culyer
Yvonne Bombard
Author Affiliation
Department of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada. tony.culyer@utoronto.ca
Source
Med Decis Making. 2012 May-Jun;32(3):428-41
Language
English
Publication Type
Article
Keywords
Bias (epidemiology)
Biomedical Technology - economics - organization & administration
Casuistry
Checklist
Cost-Benefit Analysis
Decision Making
Delivery of Health Care - economics - organization & administration
Health Status Disparities
Humans
Models, organizational
Ontario
Social Justice - economics
Technology Assessment, Biomedical - economics - methods - organization & administration
Abstract
Despite the inclusion of equity in the design of many health care systems, pragmatic tools for considering equity systematically, alongside the efficiency categories of cost-effectiveness in health technology assessment (HTA), remain underdeveloped. This article develops a framework to help decision makers supplement the standard efficiency criteria of HTA and avoid building inequities, explicit or implicit, into their methods. The framework is intended as a first step toward creating a checklist for alerting decision makers to a wide range of equity considerations for HTA. This framework is intended be used as part of the process through which advisory bodies receive their terms of reference; scope the agenda prior to the selection of a candidate intervention and its comparators for HTA; prepare background briefing for decision makers; and help to structure the discussion and composition of professional and lay advisory groups during the assessment process. The framework is offered as only a beginning of an ongoing process of deliberation and consultation, through which the matters covered can be expected to become more comprehensive and the record of past decisions and their contexts in any jurisdiction adopting the tool can serve to guide subsequent evidence gathering and decisions. In these ways, it may be hoped that equity will be more systematically and fully considered and implemented in both the procedures and decisions of HTA.
PubMed ID
22065143 View in PubMed
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Animal spare parts? A Canadian public consultation on xenotransplantation.

https://arctichealth.org/en/permalink/ahliterature187235
Source
Sci Eng Ethics. 2002 Oct;8(4):579-91
Publication Type
Article
Date
Oct-2002
Author
Edna F Einsiedel
Heather Ross
Author Affiliation
Communication Studies Program, Faculty of Communication and Culture, University of Calgary, Calgary, Alberta T2N 1N4, Canada. einsiede@ucalgary.ca
Source
Sci Eng Ethics. 2002 Oct;8(4):579-91
Date
Oct-2002
Language
English
Publication Type
Article
Keywords
Animal Rights
Animals
Attitude to Health
Bioethics
Canada
Clinical Trials as Topic
Consumer Participation
Ethics, Research
Health Policy
Humans
National Health Programs - ethics
Technology Assessment, Biomedical - ethics
Transplantation, Heterologous - ethics - psychology
Abstract
Xenotransplantation, or the use of animal cells, tissues and organs for humans, has been promoted as an important solution to the worldwide shortage of organs. While scientific studies continue to be done to address problems of rejection and the possibility of animal-to-human virus transfer, socio-ethical and legal questions have also been raised around informed consent, life-long monitoring, animal welfare and animal rights, and appropriate regulatory practices. Many calls have also been made to consult publics before policy decisions are made. This paper describes the Canadian public consultation process on xenotransplantation carried out by the Canadian Public Health Association in an arm's length process from Health Canada, the ministry overseeing government health policy and regulation. Focusing on six citizen for a conducted around the country patterned after the citizen jury deliberative approach, the paper describes the citizen panelists' recommendations to hold off on proceeding with clinical trials and the rationales behind this recommendation. The consultation process is discussed in the context of constructive technology assessment, a framework which argues for broader input into earlier stages of technology innovation, particularly at the technology design stage.
PubMed ID
12501726 View in PubMed
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An introduction to utility measurement in health care.

https://arctichealth.org/en/permalink/ahliterature215489
Source
Infect Control Hosp Epidemiol. 1995 Apr;16(4):240-7
Publication Type
Article
Date
Apr-1995
Author
B M Ferguson
P A Keown
Author Affiliation
British Columbia Transplant Society, Vancouver Hospital, Vancouver, Canada.
Source
Infect Control Hosp Epidemiol. 1995 Apr;16(4):240-7
Date
Apr-1995
Language
English
Publication Type
Article
Keywords
Canada
Costs and Cost Analysis
Decision Theory
Efficiency, Organizational
Health status
Humans
Program Evaluation - economics
Technology Assessment, Biomedical - methods
Therapeutics
Abstract
Key decisions regarding the introduction and optimal use of health technologies often are made on an ad hoc basis. Quantitative information on effectiveness, if incorporated into the decision-making process, would establish a reasoned and defensible basis for the introduction and optimal use of therapeutic technologies. Utility measures provide a single summary score of effectiveness which, when combined with cost information, permits the calculation of cost-utility ratios for alternative technologies. A number of techniques have been developed to elicit utilities, including standard gamble, time trade-off, rating scales, the Quality of Well-Being Scale, and the Health Utility Index. No single method has been accepted yet as the gold standard. Selection therefore must be guided by the specific objectives of the assessment.
PubMed ID
7636174 View in PubMed
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The appropriateness of performing coronary angiography and coronary artery revascularization in a Swedish population.

https://arctichealth.org/en/permalink/ahliterature54902
Source
JAMA. 1994 Apr 27;271(16):1260-5
Publication Type
Article
Date
Apr-27-1994
Author
A. Bengtson
J. Herlitz
T. Karlsson
G. Brandrup-Wognsen
A. Hjalmarson
Author Affiliation
Division of Cardiology, Wallenberg Laboratory, University of Göteborg, Sweden.
Source
JAMA. 1994 Apr 27;271(16):1260-5
Date
Apr-27-1994
Language
English
Publication Type
Article
Keywords
Adult
Aged
Aged, 80 and over
Angina Pectoris - radiography - surgery
Chronic Disease
Comparative Study
Coronary Angiography - statistics & numerical data - utilization
Female
Humans
Male
Middle Aged
Myocardial Revascularization - statistics & numerical data - utilization
New York
Prospective Studies
Quality Assurance, Health Care
Regional Health Planning
Sweden
Technology Assessment, Biomedical
Utilization Review
Abstract
OBJECTIVE--To evaluate the appropriateness of performing coronary angiography and revascularization in a Swedish population. DESIGN--Prospective population study of questionnaires and medical records. SETTING--All the hospitals in southwestern Sweden that perform coronary angiography and revascularization. PATIENTS--Random sample of 831 patients (with chronic stable angina) on the waiting list for coronary angiography or revascularization in southwestern Sweden in September 1990. MAIN OUTCOME MEASURE--Percentage of patients referred for coronary angiography or revascularization for appropriate, uncertain, or inappropriate indications. RESULTS--Of the patients referred for angiography, 89% were classified as appropriate, 9% as uncertain, and 2% as inappropriate. The percentages are similar for patients referred for coronary artery bypass graft surgery and for angioplasty (91% and 86%, respectively, classified as appropriate). The majority of patients had chest pain rated as Canadian Cardiovascular Society classes II through IV (93%), despite maximum anti-ischemic therapy in 90% of these patients. CONCLUSIONS--Few patients were referred for coronary angiography or revascularization for inappropriate or uncertain indications. The percentage of these patients who are from southwestern Sweden is similar to the percentage recently reported from New York State.
Notes
Comment In: JAMA. 1994 Oct 26;272(16):1254-57933367
PubMed ID
8151901 View in PubMed
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306 records – page 1 of 31.