Echocardiography and the general physician.
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Doctors from many medical specialties request echocardiography as part of their assessment of patients with a wide range of pathology. Recent advances in the technology and techniques of echocardiography are discussed. The role of echocardiography in acute medicine is reviewed and its place in general medicine is also discussed. (+info)
Challenges and opportunities in diabetes care: improving outcomes with education, disease management, and new technologies.
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In summary, point-of-care testing of beta-hydroxybutyrate concentrations, whether in the home or the physician's office, augments blood glucose monitoring and serves as an important tool for the routine management of diabetes. Through the timely use of beta-hydroxybutyrate monitoring, patients may be able to avert episodes of DKA, preventing significant morbidity and potential mortality. Furthermore, health care systems can be spared the substantial expense of hospital treatment of DKA and its consequences. The challenge for diabetes professionals comes with the need to establish blood ketone monitoring a routine part of diabetes care, similar in importance to blood glucose monitoring for patients with insulin-treated diabetes. (+info)
Cancer therapy: reimbursement of new therapeutic technologies.
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New drugs and technologies for cancer treatment are being developed at a rate that has created a reimbursement crisis. This article discusses third-party concerns about this problem and describes generic criteria that have proven to be useful in assessing any new technology. It is equally important to discontinue funding of ineffective and obsolete therapies as it is to devise a strategy for identifying and encouraging the development of new therapy that will be both clinically useful and cost-effective. Examples are provided to show that these are not necessarily mutually exclusive goals. Off-label application of standard therapy as well as the funding of new cancer therapy are considered. High-dose chemotherapy with autologous stem-cell support for treatment of a variety of neoplasms has become a major reimbursement challenge. Other technologies such as autolymphocyte therapy and use of colony-stimulating factors are considered in detail. Finally, a process for deciding how to fund new cancer therapy is described. (+info)
Technology and the boundaries of the hospital: three emerging technologies.
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U.S. hospitals have proved remarkably adept at altering their service offerings to incorporate new technologies. New technologies threatened to undercut hospitals' central role in health care delivery in the 1980s. An array of new technologies promise yet again to alter the boundaries of hospitals' franchise. These technologies will not only continue the shift away from acute, inpatient care that we have seen for the past thirty years but will also challenge hospitals to collaborate more effectively with physicians and technology developers. How hospitals and policymakers respond to these emerging technologies will help determine whether hospitals remain at the center of the U.S. health system. (+info)
Comparing estimates of cost effectiveness submitted to the National Institute for Clinical Excellence (NICE) by different organisations: retrospective study.
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OBJECTIVE: To assess the association between different types of organisation and the results from economic evaluations. DESIGN: Retrospective pairwise comparison of evidence submitted to the technology appraisal programme of the National Institute for Clinical Excellence (NICE) by manufacturers of the relevant healthcare technologies and by contracted university based assessment groups. DATA SOURCES: Data from the first 62 appraisals. MAIN OUTCOME MEASURE: Incremental cost effectiveness ratios. RESULTS: Data from 27 of the 62 appraisals could be compared. The analysis of 54 pairwise comparisons showed that manufacturers' estimates of incremental cost effectiveness ratios were lower (suggesting a more cost effective use of resources) than those produced by the assessment groups (25 were lower, 29 were the same, none were higher, P < 0.01). Restriction of this dataset to include only one pairwise comparison per appraisal (27 pairs) produced a similar result (21 were lower, two were the same, four were higher, P < 0.001). CONCLUSIONS: The estimated incremental cost effectiveness ratios submitted by manufacturers were on average significantly lower than those submitted by the assessment groups. These results show that an important role of NICE's appraisal committee, and of decision makers in general, is to determine which economic evaluations, or parts of evaluations, should be given more credence. (+info)
Evidence, politics, and technological change.
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In few fields of public policy are the use and cost of services so powerfully driven by technological change as they are in medicine. To manage technology, policy-makers have expanded their investment in evaluative research. This paper addresses three underexamined challenges in using evidence: those inherent in the dynamics of technological change itself; those inherent in the analytical enterprise; and the ways in which political factors shape the translation of evidence into policy decisions. The design of institutional arrangements and processes that seek to blend evidence with politics merit closer attention, and existing cross-national arrangements deserve careful study. (+info)
Economic evaluation of medical technologies.
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Innovation in medical science is progressing at a rapid pace. As a result, new medical technologies that offer to improve upon or completely replace existing alternatives are continually appearing. These technologies--which include pharmaceuticals, devices, equipment, supplies, medical and surgical procedures, and administrative and support systems--are changing the way medicine can be practiced and delivered, forcing healthcare providers and policymakers to consistently evaluate and adapt to new treatment options. Meanwhile, society is becoming more demanding of new medical technologies. Emerging medical technology, however, has been viewed as a significant factor in increasing the cost of healthcare. The abundance of new medical alternatives, combined with scarcity of resources, has led to priority setting, rationing and the need for more technology management and assessment. Economic evaluation of medical technologies is a system of analysis used to formally compare the costs and consequences of alternative healthcare interventions. EEMT can be used by many healthcare entities, including national policymakers, manufacturers, payers and providers, as a tool to aid in resource allocation decisions. This paper discusses the four current popular methodologies for EEMT (cost-minimization, cost-benefit, cost-effectiveness and cost-utility), and describes the industry environment that has shaped their development. (+info)
Classical medicine v alternative medical practices.
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Classical medicine operates in a climate of rational discourse, scientific knowledge accretion and the acceptance of ethical standards that regulate its activities. Criticism has centred on the excessive technological emphasis of modern medicine and on its social strategy aimed at defending exclusiveness and the privileges of professional status. Alternative therapeutic approaches have taken advantage of the eroded public image of medicine, offering treatments based on holistic philosophies that stress the non-rational, non-technical and non-scientific approach to the unwell, disregarding traditional diagnostic categories and concentrating on enhancing subjective comfort and well-being, but remaining oblivious to the organic substrate of disease. This leads to questionable ethics in terms of false hopes and lost opportunities for effective therapy. (+info)