Herpes viruses are responsible for a wide spectrum of infections ranging from cold sores, genital herpes, and chicken pox to disseminated herpes infections in normal and more commonly in immunocompromised patients. Symptoms range from mildly distressing and uncomfortable to severe and life-threatening. The sophistication of virological methods is increasing. Specific types, classes, and subclasses of antibodies to viruses can now be determined, as well as the reactivity of T-lymphocytes. It is possible to detect herpes virus type-specific antibodies (to HSV-l or HSV-2) in a blood sample using the simple and inexpensive enzyme-linked immunosorbent assay (ELISA). The virus is usually type-determined rapidly and currently susceptibility or resistance to antiviral compounds can be defined in vitro. Such assays of antiviral resistance have been shown to be quick and effective. Effective antiviral therapies have been developed against a number of viral diseases. The concomitant need for isolation and evaluation of resistance patterns of herpes virus against different antiviral compounds appears to be of considerable importance. Pure clinical observations are no longer sufficient to distinguish the types, since HSV-l may be present in the genital region and HSV-2 at upper parts of the body–contrary to common belief.

This presentation provides an overview of the process of information transfer in a typical area of the medical device industry, that of medical imaging. The medical device industry must translate technological trends into ideas for new methods for diagnosis and treatment. The feasibility of such ideas has to be evaluated carefully, inasmuch as large amounts of money are sometimes invested in product development. Moreover, the knowhow obtained from research must be protected long enough to enable the industry to complete development and market the product.

The rapidly changing health care system is still largely organized according to old, and increasingly outdated models. The contemporary demands of patient care and residency training call for an experimental ward, which can develop and test new techniques in hospital organization and the delivery of care in a comprehensive way.

The Physiotherapy Quality of Care Project was a project of the Canadian Physiotherapy Association, sponsored by the Canadian government to ensure the quality of physiotherapy. A consensus committee of physiotherapy educators and managers developed and tested an instrument to measure changes in patients' functional status during physiotherapy. Despite scientific development and wide distribution, this technology was not adopted. Alternative methods, which were heavily marketed, gained nationwide use instead.

This decision analysis estimates the overall gain in life expectancy and the relative efficacy of predischarge submaximal exercise electrocardiography, ambulatory cardiac monitoring, and thallium-201 scintigraphy for the identification of silent ischemia in asymptomatic postinfarct patients. A small, virtually equal increase in life expectancy can be obtained from any of the noninvasive tests (as compared to no testing). Large differences in life expectancy may result only when the prevalence of residual coronary artery disease and the probability of left-main and three-vessel lesions are high.

An economic evaluation of a health care program seeks to investigate the relative costs and consequences of alternative strategies in health care by examining the values of the resources used and weighing them against the values of the outcomes. Because resources are finite, there are choices to be made about how best to use them. Thus, the concept of the value of resources that is applied in an economic evaluation is that of opportunity cost: since resources are finite, deploying them in one way means that a benefit is foregone in not having them available to pursue the best alternative. An economic evaluation of a health care program fundamentally is an exercise about choices, not simply about money.

We describe the effects on costs, working patterns, and clinical behavior of installing a DAX “discretionary” biochemistry analyzer. Use of the new analyzer encouraged doctors to be more specific in requesting biochemical tests, which substantially reduced the number of tests requested and slightly reduced overall costs. Doctors preferred being able to order tests in this more specific way.

Given a group of individuals presenting with syncope, the use of the standard diagnostic maneuvers will yield a diagnosis for approximately half. Promising new diagnostic tests offer the prospect of more efficient diagnostic pathways and treatments and demonstrate the need for better clinical trials before they are adopted.

This paper presents a discussion of the historical development of deinstitutionalization in the United States, including the political, ideological, and social origins of that policy. The outcomes of deinstitutionalization are considered, including the impact of the policy on the quality of life of people with severe mental disorders. The authors also provide a brief review of the literature on the efficacy and cost-effectiveness of hospitalization versus outpatient (community) care. Recent developments in the use of involuntary hospitalization are discussed, along with a number of important trends in the delivery and financing of services for persons with severe mental disorders.

We designed a scoring system to rank acute care hospital projects and allocate resources between them. The evaluation tool assessed projects on an ordinal scale; the criteria scored were medical interest, feasibility, interest for teaching and research, and compatibility with the hospital's strategy. Clinical and technical projects were ranked separately. In 1994, 25 new projects, representing a total cost of $1.4 million, were reviewed by two independent reviewers. The scores ranged from 30 to 18 over 36. Projects presented by clinical departments scored higher than projects presented by medicotechnical departments.

Objectives: A systematic review was performed to examine the effects of cholesterol, breast cancer, and cervical cancer screening on actual or intended health-promoting behaviors and health-related beliefs.

The first (known) national consensus conference on matters of health care ever held in an east European country was conducted in Latvia in September of 2002. This conference marks one of the steps in the government's efforts to establish a sustainable mechanism for health technology assessment (HTA). The conference was organized by the agency now given the responsibility to develop HTA in Latvia.

Objectives: Semiautomated external defibrillators (AEDs) should be considered as a means to facilitate in-hospital early defibrillation (IHED) in areas where advanced life support rescuers are not readily available. In this study, we aimed to develop a checklist and a measurement protocol to evaluate and compare AEDs by assessing factors that may affect IHED.

Methods: A clinical and technical comparison of six AEDs was performed. Technical specifications were analyzed, while an emergency team evaluated ergonomics and appropriateness for IHED at Bambino Gesù Children's Hospital. A measurement protocol was implemented, which aimed to assess the ability of defibrillators to recognize shockable and nonshockable rhythms, accuracy of delivered energy, and charging time.

Results: Designs of AEDs differed in several features which influence their appropriateness for IHED. Some units showed poor ergonomics and instructions/feedback for cardiopulmonary resuscitation. Differences between defibrillators in recognizing shockable and nonshockable rhythms emerged for polymorphic ventricular tachycardia waveforms and when the frequency and amplitude of input signals varied. Tests for accuracy revealed poor performances at low and high impedance levels for most AEDs. Notably, differences greater than 20 seconds were found in the time from power-on to “ready for discharge.”

Conclusions: The approach we used to assess AEDs allowed us to evaluate their appropriateness with respect to the organizational context, to measure their parameters, and to compare models. Results showed that ergonomics and/or performances (timing and accuracy) could be improved in each device.

In Health Technology Assessment (HTA), clinical and economic evidence are assessed in the regulatory and reimbursement environments, with community input considered as complementary to this. Stakeholders are calling for more meaningful community engagement, but this will not be reached without a significant shift. The Centre for Community-Driven Research (CCDR) is a nonprofit organization bringing much needed change to the way we think about community engagement in health. This article is based on CCDR's experience and outlines three system changes needed to advance community engagement in decisions about health and HTA. This paper comes from the perspective of engaging everyday people in the process as opposed to representation on panels and committees. The three key areas of change that are discussed include building holistic evidence, creating supportive environments, and infrastructure for community engagement, with the term community referring to people affected by disease or health conditions and their carers/families.

Recent developments in health technology assessment (HTA), including the promotion of a new and internationally accepted definition of HTA, have highlighted the need to go beyond clinical and cost-effectiveness to fully understand the potential value of health technologies. Multidisciplinary efforts to generate patient-focused evidence relevant to HTA, using both quantitative and qualitative approaches, are needed. Although it has been more than 20 years since opportunities for qualitative methods to inform HTA were first discussed, their use remains infrequent. The goal of this article is to resurrect the debate about the value of qualitative research in HTA. Drawing on examples from published literature, we propose five key areas where qualitative methods can contribute to HTA, complementary to studies of clinical and cost-effectiveness: (i) assessing acceptability and subjective value; (ii) understanding perspectives and providing context; (iii) reaching the groups other methods cannot reach; (iv) laying the groundwork for subsequent quantitative exercises; and (v) contributing to economic model development.