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•Decentralization of health services and autonomy for hospital managers are important changes.•Hospital planning benefits include improvements in communication and resource management.•Lack of involvement of employees and inappropriate assessment impaired implementation of plans.•Technological, epidemiological and political factors affected management strategies.•Further hospital development will require appropriate resources, planning and management.

An overview of the evolution of Canada's health technology assessment (HTA) program is presented along with suggestions on how Australia can benefit from the Canadian experience.

To evaluate the influence of a health technology assessment (HTA) on pediatric cochlear implantation (CI) in Kazakhstan and to provide a further perspective on the use of the technology in that country. Ideally, children should be implanted as young as possible, have adequate rehabilitation, and be integrated into the regular school system.

SummaryThe Catseye Marble company tests the strength of its marbles by dropping them from various levels of their office tower, to find the highest floor from which a marble will not break. We find the smallest number of drops required and from which floor each drop should be made. We also find out how these answers change if a restriction is placed on the number of marbles allocated for testing. Investigating this puzzle motivates algorithmic thinking, and leads to an interesting recursive solution.

Objective: To review the evidence of benefit from use of telemental health (TMH) in studies that reported clinical or administrative outcomes.Method: Relevant publications were identified through computerized literature searches using several electronic databases. Included for review were scientifically valid articles that described controlled studies, comparing TMH with a non-TMH alternative, and uncontrolled studies that had no fewer than 20 participants. Quality of the evidence was assessed with an approach that considers both study performance and study design. Judgments were made on whether further data were needed to establish each TMH application as suitable for routine clinical use.Results: Included in the review were 72 papers that described 65 clinical studies; 32 (49%) studies were of high or good quality. Quality of evidence was higher for Internet- and telephone-based interventions than for video conferencing approaches. There was evidence of success with TMH in the areas of child psychiatry, depression, dementia, schizophrenia, suicide prevention, posttraumatic stress, panic disorders, substance abuse, eating disorders, and smoking prevention. Evidence of success for general TMH programs and in the management of obsessive–compulsive disorder were less convincing. Further study was judged to be necessary or desirable in 53 (82%) of the studies.Conclusion: Evidence of benefit from TMH applications is encouraging, though still limited. There is a need for more good-quality studies on the use of TMH in routine care. The emerging use of Internet-based applications is an important development that deserves further evaluation.

Background.Although an increasing number of medical devices are labeled “for single use only,” cleaning and reuse of single-use medical devices continues, because of the economic incentive. We conducted a survey of the economic literature to obtain the current evidence available and to assess the costs and benefits of reusing single-use medical devices.Methods.A comprehensive literature search was carried out to identify articles that compared single use and reuse of single-use medical devices and that met specific scientific criteria, including evaluation of economic outcomes. Each selected article was independently reviewed by 2 reviewers to extract cost and clinical outcome data and to assess the quality of the study.Results.Nine published articles met the selection criteria. The savings were about 49% of the direct cost. These savings would be offset by adverse-event costs, but none were detected. However, quality of the studies was generally poor.Conclusions.There is little available evidence of quality in the published literature to assess the practice of reuse of single-use medical devices. Moreover, data on clinical outcomes are missing and, where available, cannot be attributed specifically to the reuse of single-use medical devices.

Objectives: As an initiative of the International Network of Agencies for Health Technology Assessment, an approach to assessment of telemedicine applications was prepared to assist decision makers who are considering introduction and use of this technology. Methods: Review and commentary drawing on published assessment frameworks and reports of primary evaluations of telemedicine, with particular reference to experience in Finland and Canada. Results: Elements of the approach included development of a business case (considering population and services, personnel and consumers, delivery arrangements, specifications and costs); subsequent evaluation of the telemedicine application; and follow-up (covering the domains of technical assessment, effectiveness, user assessment of the technology, costs of telemedicine, trials, economic evaluation methods, and sensitivity analysis). Conclusions: Decision makers should link introduction of new and often costly technology to appraisal of its feasibility, followed by evaluation of the application, including longer term consideration of its sustainability and impact on the healthcare system. As the effectiveness and efficiency of telemedicine applications will often be strongly influenced by local issues, results of assessments may not be generalizable.

Objectives: To compare outcome attributes of three available technologies for stem cell transplantation—bone marrow transplantation (BM), peripheral blood cell transplantation (PB), and cord blood transplantation (CB). To compare the cost per recipient for the three technologies, incorporating all donor and antigen matching functions, as well as the transplantation procedures. Methods: Review of relevant literature using the CancerLit and HealthSTAR databases (plus earlier searches of MEDLINE and Embase) to summarize outcome differences. Estimations of cost per transplant using models drawing on Canadian experience. Results: The literature review indicated that PB may have a modest advantage over BM in terms of outcomes. The literature indicated that CB has longer engraftment times (although this may be due to inadequate controls). Our modeling exercise indicated that costs for PB and BM are similar. CB has a higher cost per recipient, due in large part to the higher testing costs for every donated unit. Conclusions: Current literature is inadequate to provide an outcomes comparison of CB, PB, and BM. Viewed from a system-wide perspective, CB is a higher cost technique. However, PB and CB are emerging as technologies, and so our results should be viewed alongside the notion that there may be a steep learning curve in these technologies.

Objectives: To consider the impact of rapid health technology assessments undertaken as part of a program in a provincial healthcare system in response to urgent requests for advice. Methods: Review of the development and preparation of 20 rapid assessment reports, communication with decision makers within the healthcare system, and appraisal of data subsequent to preparation of the reports. Results: Fourteen of the assessments were judged to have had an influence on policy and other decisions, as judged by responses from those who had requested advice. Another four were considered to have provided guidance, while having less immediate influence on decisions, and two others had no apparent impact. Quality of the assessments was considered acceptable, on the basis of literature that subsequently became available and from comments received. Conclusions: These brief reports are considered to be a useful component of a health technology assessment program. However, they should be regarded as provisional appraisals and followed up with more detailed evaluation where possible.

•Electronic health records (EHR) support health centre programs for HIV/AIDS.•Differences in documentation between EHR and paper records increase workload.•There are challenges to consistently operating and managing the EHR system.•The EHR system cannot communicate with other health or government facilities.•EHR use should be integrated with all health structures and processes.

Objectives: To examine the economic efficiency of current cochlear implant technology under Australian conditions in profoundly deaf adults, partially deafened adults, and children Methods:> Cost—utility study, with weights based on judgments from persons experienced with the technology, and cost data from Australian sources. Results: Quality—of— improvements due to functional consequences of hearing improvement were greater than those due to amelioration of hearing disability. Costs in Australian dollars per QALY (15—year assessment) ranged from $5,070—$11,100 for children, $11,790—$38,150 for profoundly deaf adults, and $14,410—$41,000 for partially deaf adults. Conclusions: Results suggest cochlear implantation is acceptable value for money when compared with other health programs to which resources are committed in Australia.

The need for better communication and collaboration between health technology assessment agencies led to the formation of an International Network of Agencies for Health Technology Assessment (INAHTA). The network now comprises 27 agencies and has been successful in improving exchange of information and in undertaking joint health technology assessment projects. Issues for the future include possible changes to criteria for membership and identification of resources for more extensive programs.

This paper examines the current status of in vitro fertilization and embryo transfer (IVF-ET) as a treatment for various types of infertility. We reviewed studies on the efficacy and safety of IVF-ET and intracytoplasmic sperm injection (ICSI) plus IVF-ET, compared with conventional treatment or no treatment for various infertility diagnoses. Material retrieved included English language publications between 1992 and January 1997 that reported the results of prospective controlled clinical trials, cohort studies, and retrospective comparative studies with large series, and reviews presenting risks, complications, and longer-term health consequences associated with IVF-ET and ICSI. No adequate prospective comparative studies of sufficient power on the use of IVF-ET for specific infertility diagnoses have been reported to date. Most of the published reports concerning results with IVF-ET as a treatment of infertility have been based upon small, uncontrolled studies, with various methodological weaknesses. Reported results are not directly comparable. There are few follow-up data on outcomes after pregnancy is established or on long-term health consequences of the use of IVF-ET on mothers and their babies. IVF-ET has diffused widely without comprehensive assessment of its efficacy and safety. The available evidence supports its use only for severe bilateral tubal occlusion. For other diagnoses of infertility the evidence is limited and does not establish whether IVF-ET is effective. Long-term, well-designed, prospective clinical trials are required to determine when and for what indications IVF-ET is effective and what its health effects are on both mothers and their babies.

Preliminary results from 2723 examinations to June 30,1987, at the first two installations that are participating in a broadly‐based prospective trial of the utilization and diagnostic value of magnetic resonance imaging are presented. Compliance by the investigators with the trial protocol was excellent. The head (60% of cases) and spine (31% of cases) were the most common regions that were examined, and such examinations were completed mostly in one hour. Active, mobile outpatients were predominant among those who were examined. Further reports will be directed to particular disease groups, cost studies and patient outcomes.

This article claims that it is possible to teach both rhetorical frameworks and technical skills effectively if we select appropriate topics and design appropriate classes. It examines the nature of the help file document as a heuristic capable of reinforcing intensive writing instruction while adding powerful software skills to student resumes. More specifically, this article examines the extent to which the citation of help files demands rhetorical skill, the structure of a class that effectively teaches the rhetoric of help, and the nature of the teacher and teaching environment for such a class.

Evaluation of: Henderson C, Knapp M, Fernández J-L et al.Cost effectiveness of telehealth for patients with long term conditions (Whole Systems Demonstrator telehealth questionnaire study): nested economic evaluation in a pragmatic, cluster randomised controlled trial. BMJ346, f1035 (2013).Telehealth has the potential to improve the management of chronic health conditions but there are still limited data on its effectiveness and cost–effectiveness in routine practice. A questionnaire study nested within a pragmatic randomized controlled trial estimated costs and outcomes for management of patients in England who had heart failure, chronic obstructive pulmonary disease, or diabetes. Patients received telehealth support and usual care or usual care only. The study perspective was that of the health system. Incremental cost per quality-adjusted life year of telehealth when added to usual care was £79,000. In this setting, telehealth had a low probability of being a cost-effective addition to standard care for patients with the chronic conditions.

A national survey investigated the current practices of reprocessing and reusing single-use medical devices in Canadian acute-care hospitals. Our response rate was 72% (413 responses), and 28% of hospitals reprocess single-use devices. The results showed that Canadian hospital practices have not changed much in the past decade.

No Abstract

BACKGROUND: Lung cancer is the leading cause of cancer morbidity and mortality. In addition, lung cancer has a significant economic impact on society.OBJECTIVE: To present an economic analysis of the actual care costs of lung cancer which will allow comparison with, and verification of, cost estimates that were developed through modelling and opinion.METHODS: A chart review was conducted of incident cases (circa 1998) of primary bronchogenic lung cancer. Cases were censored at two years from the date of diagnosis. Relevant clinical and health utilization data were collected. Health utilization data included hospital and institutional outpatient (ie, ambulatory clinic) costs. Cost estimates were derived for over 200 specific health services. The present analysis was performed from the economic perspective of the health care institution.RESULTS: A total of 13,389 health service events were captured with an estimated total cost of $8.4 million. Laboratory tests, diagnostic imaging and ambulatory visits constituted 86% of the service events while patient admissions and therapy constituted 76% of the costs. The vast majority of overall costs occurred just before, or within, three months of diagnosis. The median nonsmall cell lung cancer and small cell lung cancer case costs were $10,928 (range $9,234 to $11,047) and $15,350 (range $13,033 to $21,436), respectively.CONCLUSION: The results agree with the literature that the majority of lung cancer case costs are realized around the date of diagnosis (ie, early phase). The present study illustrates Canadian health care system lung cancer case costs based on actual care received versus hypothetical care algorithms.

BACKGROUND: Autotitrating continuous positive airway pressure (APAP) devices have the potential to address some of the disadvantages of titration and treatment with conventional continuous positive airway pressure (CPAP). Information on the performance of APAP in clinical use is still comparatively limited.OBJECTIVE: To assess the status of APAP devices in the management of obstructive sleep apnea (OSA) by reviewing evidence of their efficacy, effectiveness and costs.METHODS: A systematic search of electronic databases and a review of selected comparative studies on the use of APAP in the diagnosis, titration and treatment of OSA was undertaken. Cost analysis using data applicable to the management of OSA in Edmonton, Alberta was performed.RESULTS: Thirty-three studies met the selection criteria: three on the use of APAP in diagnosing OSA; six on APAP for titration; 14 that considered short-term treatment outcomes; and 10 that addressed longer-term treatment of OSA. In most studies, patients suffering from cardiac, pulmonary and other medical conditions were excluded. Available data suggested some potential for the use of APAP in the diagnosis of OSA, but further validation is needed. In titration, estimated treatment pressures tended to be lower with APAP than with the manual titration of CPAP. Although lower treatment pressures were achieved with APAP, there was no significant difference in clinical outcome measures between APAP and CPAP. Estimates of costs suggested that APAP may provide savings in some scenarios.CONCLUSIONS: APAP shows promise in the management of OSA; however, given the exclusion of some categories of patients from trials of this technology, caution is still required in its use.

BACKGROUND: Lung cancer contributes significantly to cancer morbidity and mortality. Although case fatality rates have not changed significantly over the past few decades, there have been advances in the diagnosis, staging and management of lung cancer.OBJECTIVE: To describe the epidemiology of primary lung cancer in an Alberta cohort with an analysis of factors contributing to survival to two years.PATIENTS AND METHODS: Six hundred eleven Albertans diagnosed with primary lung cancer in 1998 were identified through the Alberta Cancer Registry. Through a chart review, demographic and clinical data were collected for a period of up to two years from the date of diagnosis.RESULTS: The mean age at diagnosis was 66.5 years. The majority of cases (92%) were smokers. Adenocarcinoma, followed by squamous cell carcinoma, were the most frequent nonsmall cell lung cancer histologies. Adenocarcinoma was more frequent in women, and squamous cell carcinoma was more frequent in men. The overall two- year survival rates for nonsmall cell, small cell and other lung cancers were 24%, 10% and 13%, respectively. In multivariate analysis, stage, thoracic surgery and chemotherapy were significantly associated with survival to two years in nonsmall cell carcinoma; only stage and chemotherapy were significant in small cell carcinoma.CONCLUSIONS: This study provides a Canadian epidemiological perspective, which generally concurs with the North American literature. Continued monitoring of the epidemiology of lung cancer is essential to evaluate the impact of advances in the diagnosis, staging and management of lung cancer. Further clinical and economic analysis, based on data collected on this cohort, is planned.