Objectives: Clear, transparent, and sufficiently detailed abstracts of journal articles and conference abstracts are important because readers often base their assessment of a trial on such information. There are concerns over the reliability and quality of trials published only in the proceedings of scientific meetings. This study aims to assess the reporting quality of abstracts of randomized trials published in Chinese medical conference abstracts.

Methods: Conference abstracts reporting randomized trials included in the China National Knowledge Infrastructure (CNKI) in 2007 were identified. A revised checklist (based on the CONSORT extension for reporting randomized controlled trials in journal and conference abstracts) was used to assess the reporting quality of these conference abstracts.

Results: A total of 567 conference abstracts of randomized trials were identified. Some aspects were well reported, including 94 percent of authors contact details, 83 percent of trial interventions and 78 percent of control interventions, 62 percent of participant eligibility criteria, and 66 percent the number of participants randomized to each group. Other areas were very poorly reported: only 1 percent identified the study as randomized in the abstract title, 2 percent reported the trial design, and only 7 percent reported on blinding. No details of allocation concealment, trial registration, or funding were reported.

Conclusion: The information given for trials in conference proceedings in China is very poor, especially in some aspects of methodological quality, trial registration, and funding source. The quality of conference abstracts for trials should be improved to further facilitate understanding of their conduct and validity.

Objectives: The delay between patient discharge and the completion of the final discharge note have prompted hospitals to consider new information technologies. This study compared the relative cost-effectiveness of an automated medical documentation system to the current system in place at a Canadian hospital. There are significant expenditures associated with the choice of medical documentation system, yet the benefit to the patient population has not been studied.

Methods: A systematic review of the literature was carried out. Cost data for the current documentation system were obtained from the study hospital. The costs of purchasing the automated system were obtained from the manufacturer. Other resource cost implications of the automated system were estimated based on information obtained from the Centre for Applied Health Informatics at the study hospital. The outcome was determined to be the average time (days) between patient discharge and note completion. A cost-effectiveness analysis was conducted. Sensitivity analyses were used to determine the robustness of the results.

Results: The automated documentation system was associated with higher costs but better outcomes than the current system. The incremental cost-effectiveness ratio used for comparing the automated medical documentation system with the traditional system indicated that the incremental daily cost for decreasing a day in average note completion time per discharge note was 0.331 Canadian $/day over the study period (4 years).

Conclusions: Although the automated documentation system was more expensive than the current system, it also provided qualitative benefits that were not considered in the cost-effectiveness analysis.

After 25 years of debate about privacy of automated personal health data, the U.S. Congress has set a deadline of August 1999 for enacting health information privacy legislation. The urgency to establish national policy in the United States re-emerges with implementation of a 1996 law mandating a unique identifier for each participant in the U.S. medical care system and the use of a uniform electronic data set for all health information transmitted in financial and administrative transactions. The impact of electronic data storage and transmittal on privacy, health outcomes, and medical care is unclear. A three-step analytic scheme can clarify the issues in the policy debate and for future assessment. The first step is intended to elicit, for the first time, a precise, accurate, and reproducible description of personal health data transactions and chains of transactions, independent of the policy preferences of any interested party. The second step allows the reader to analyze these transactions according to who benefits first and foremost from each. This scrutiny clarifies the reasons why parties to the debate tend to disagree. The third step characterizes how Congress is likely to perceive the policy process and consider its options before enacting any particular set of compromises. Understanding the policy deliberations and potential effects of evolving information technologies and new national privacy rules should aid assessment of results.

Background: Throughout the world, decision makers face the need to plan on the basis of uncertainty. Prospective updates on future trends of medical technology usage are tools to improve national health status. In Israel, this challenge is met by several steps taken to promote insight into the realm of emerging technologies. Israel's unique horizon strategy refers to three time spans: the immediate to short-term (for the coming year) updating the National List of Health Services (NLHS) and quarterly scanning; the medium-term (3 years to a decade) revitalizing hospital devices and infrastructure; and long-term planning (over a decade), such as the “Health Israel 2020 Project”.

Methods: A description of the Israeli setup of different time spans and tiers.

Results: The matrix of players, loci, interests, population groups, and incentives creates a complex situation and the Ministry of Health has to regulate the different suppliers and tiers of insurance (obligatory, supplementary, and private), balancing need, equity, and cost containment in preparing for future health care. However, preparedness is not a sterile laboratory and is pervaded by numerous dilemmas and the search for adequate evidence for new less mature technologies is an on-going challenge.

Conclusion: Bridging the forecasting chasm for the future requires analyzing needs, reinforcing evidence and seeing “around the corner” when synergizing between all the “actors” in the national arena. Expert consultation and international cooperation with similar horizon organizations can assist in paving the way for more successful planning efforts for future medical technology implementation.

Objectives: The aim of this study was to explore and describe the viewpoints and beliefs with respect to a health technology assessment (HTA) process and its institutionalization in a sample of stakeholder representatives in Chile.

Methods: A qualitative study with a descriptive design, based on the model of discourse analysis, was performed. Eighteen semi-structured interviews were conducted on nineteen Chilean representatives of stakeholders in HTA. The data analysis was based on a process of open coding that allows the contrasting of the interviewees’ visions.

Results: From what the interviewees mentioned, a proposal to institutionalize the process of HTA is presented for Chile. The focus is on three main areas: (i) Principles to guide the HTA, (ii) Institutional Framework for Chile, and (iii) Impacts associated with their implementation process. Transparency and participation were the main principles identified. The idea of an autonomous body for HTA, independent and publicly funded, was widely supported. However, this implementation could face potential resistance from technicians and politicians, who might impose barriers to avoid their loss of decision power.

Conclusions: There is a broad agreement about the importance of creating a national institution for HTA, independent and publicly funded. This study supplies relevant information for other countries that are currently undertaking a similar process.

Objectives: The aim of this study was to assist in the development of a health technology assessment (HTA) program for the Ministry of Health (MOH) of the Republic of Kazakhstan

Methods: Mentoring of an initial HTA program in Kazakhstan was provided by the Canadian Society for International Health (CSIH) by means of a partnership with the Kazakhstan MOH. HTA materials, courses, and one-on-one support for the preparation of a series of initial HTA reports by MOH HTA staff were provided by a seven-member CSIH team over a 2.5-year project.

Results: Guidance documents on HTA and institutional strengthening were prepared in response to an extensive set of deliverables developed by the MOH and the World Bank. Introductory and train-the-trainer workshops in HTA and economic evaluation were provided for MOH staff members, experts from Kazakhstan research institutes and physicians. Five short HTA reports were successfully developed by staff in the Ministry's HTA Unit with assistance from the CSIH team. Challenges that may be relevant to other emerging HTA programs included lack of familiarity with some essential underlying concepts, organization culture, and limited time for MOH staff to do HTA work.

Conclusions: The project helped to define the need for HTA and mentored MOH staff in taking the first steps to establish a program to support health policy decision making in Kazakhstan. This experience offers practical lessons for other emerging HTA programs, although these should be tailored to the specific context.

Objectives: Medical technology is a large and expanding industry. Introducing new medical devices is important but several challenges exist in implementing the optimal method of evaluation. Both objective and subjective measures can be used for evaluation. The former is the mainstay of evaluation, yet subjective assessment is often the basis for the introduction of new medical technology. The aim of this study was to determine the interaction and concordance between objective and subjective assessment of new medical technology.

Methods: This study used both objective performance measures and subjective user perceptions in the evaluation of a new medical device designed to improve the accuracy of gravity-assisted delivery of intravenous fluids, compared with the current, widely used “roller-clamp” device. The concordance of objective and subjective assessments was evaluated using comparative analysis.

Results: Objective assessment of the accuracy of intravenous fluid delivery revealed no difference between the two devices (p = .636). Subjective assessment revealed that the new device was perceived to be significantly more accurate (p = .001). This lack of concordance can be partially explained by both device and demand characteristics.

Conclusions: This case study reveals a significant discordance between the objective and subjective assessments. It provides some explanation for why new medical devices are adopted without objective evidence of benefit. This phenomenon has been termed “persuasive design” and its influence should be controlled for in the evaluation, purchase and introduction of new medical devices. This should help reduce the risk and associated cost of premature introduction.

Objectives: The impact of health technology assessment (HTA) in the judicialization of the right of health has not been deeply studied in Latin American countries. The purpose of this study is to review the process of judicialization of the access to high cost drugs in Uruguay and assess the impact HTAs have had on this process.

Methods: The methodology used for this study included a comprehensive literature search in electronic databases, local journals, internal documents developed in the Ministry of Health, as well as conducting interviews with key informants.

Results: Judicialization of the access of high cost drugs has been increasing since 2010. The strategy of the Ministry of Health of Uruguay to decrease this problem included the organization of roundtables with judges and other stakeholders on the basis of HTA, the training of defense lawyers in the use and interpretation of HTA, and the participation of a professional who develops HTA in the preparation of the defense arguments. A year after the implementation of this strategy, 25 percent of writs of protection were won by the Ministry of Health.

Conclusions: Even though the strategy implemented was effective in reducing the loss of litigations, it was not effective in reducing the growing number of writs of protection. It is essential to address this problem in a broad debate and to promote understanding between the parties.

This mini-theme contains six stories of health technology assessment (HTA) impact from member agencies of The International Network of Agencies for Health Technology Assessment (INAHTA), which were originally shared at the 2015 and 2016 INAHTA Congresses. The INAHTA impact story sharing is an innovative network activity where member agency representatives share experiences of HTA impact in a loosely structured story format. Through this process, members gain insights from other agencies on new ways of thinking about and approaching HTA impact assessment. A guide is provided to members to prepare their story, and the best story receives the David Hailey Award for Best Impact Story. This mini-theme contains stories of HTA impact from six member agencies in different parts of the world: the Health Assessment Division of the Ministry of Public Health (Uruguay), the Institute of Quality and Efficiency in Health Care (Germany), the Health Information and Quality Authority (Ireland), the Finnish Office for Health Technology Assessment (Finland), the Australian Safety and Efficacy Register of New Interventional Procedures-Surgical (Australia), and the Institut national d'excellence en santé et en services sociaux (Canada). Across the papers, common themes emerge about the importance of appropriate engagement of stakeholders and the broadening scope of HTA beyond reimbursement decision making.

The ability to extract information on resource use from randomized controlled trials can provide the groundwork for systematically compiling health economic reviews of health interventions. A review of the brief smoking interventions in general practice demonstrates that not all the necessary information can be extrapolated from these trials, and cost data will have to be supplemented from other sources.

Fifty-three deaf patients were screened psychologically and medically for suitability to receive an intracochlear implant. After initial screening for psychological normalcy, candidates were assessed again 1 year postimplant. Isolated deleterious psychological effects were found, and certain aspects of psychological functioning were enhanced. Overall evidence suggests that the implant is not psychologically damaging.

In order to explore the diffusion of the selected technologies in one Canadian province (British Columbia), two administrative data sets were analyzed. The data included over 40 million payment records for each fiscal year on medical services provided to British Columbia residents (2,968,769 in 1988) and information on physical facilities, services, and personnel from 138 hospitals in the province. Three specific time periods were examined in each data set, starting with 1979–80 and ending with the most current data available at the time. The detailed retrospective analysis of laboratory and imaging technologies provides historical data in three areas of interest: (a) patterns of diffusion and volume of utilization, (b) institutional profile, and (c) provider profile. The framework for the analysis focused, where possible, on the examination of determinants of diffusion that may be amenable to policy influence.

Antenatal risk factors in combination with symphysis-fundus distance can identify pregnancies with small infants, who can be divided in genetically small, malformed, and malnourished infants. Only the last category benefit from fetal surveillance. Maternal diseases, pregnancy complications (hypertension), and environmental factors (smoking) are connected to malnourished small infants.

Abstract Professional journals are of great importance in the transfer of information about technology, providing most physicians and medical students with the majority of their new information. Professional journals have mission statements and goals and many editorial categories to help achieve their goals. In addition, news media, books, television, and computerized journals are important methods for changing physician knowledge. Physician behavior is changed by many factors of which poor patient outcome is probably the key. Quality of information and activities is best assured by clear definition, goals, proper peer review, and good management. Appropriate use of technology is best approached by separating wants from needs.

It has been repeated ad nauseam in recent years that health care is changing rapidly. Today even the pattern of change itself is in flux: modifications seem to be accelerating and shifts are of a more profound nature. Moreover, the prevailing changes are highly interactive and send ripples through a health care arena which presents all the symptoms of turmoil.

Deapite the importance of understanding factors related to physician adoption and use of diagnostiv technologies, relatively few studies have been published. Results of a two-year study of the adoption of magnetiv resonance imaging (MRI) and its substitution for computed tomography scanning (CT) are presented. The literature on physician adoption and use of technologu is used to provide a frame-work for this study. Differences in adoption and substitution among medical specialties, early versus late adopters, and high versus low users of MRI are examined. Results show that neuerologists and internists more rapidly adopt MRI and substitute it for CT than do orthopedists and other surgical specialists. Referral of higher number of patients is the best predictor of more rapid substitution. Physicians who were late adopters more quickly substituted MRI for CT. The cost and social implications of empirical versus “ideal” substitution rates are discussed along with various regulatory, technology assessment, and finicial strategies influence substitution. The role of individual physicians, radiologists, and specialty societies in determining substitution rates is also discussed.

A common criticism of high technology is that therapeutic objectives are sometimes secured at too high a price in loss of quality of life. Certainly some interventions serve only to prolong life that is already of unacceptable quality to the patient (some rescues in intensive care and salvage surgery for cancer). Others leave the patient with less good quality of life than he enjoyed before treatment, either because the crisis that called for rescue had lasting effects (incomplete recovery from severe head injury) or because the intervention itself had inevitable adverse effects (mastectomy, laryngectomy, colostomy). Yet some life-extending technologies can improve dramatically the quality of a patient's life (renal and heart transplantation), while others are directed primarily at improving quality of life (hip replacement and coronary bypass surgery). When the ultimate result of technological intervention is improved quality of life or a reasonable extension of life of quality, then some temporary impairment of life's quality may be justifiable. The problem is to discover in which clinical circumstances the benefits expected from high technology are both great enough, and are also likely enough to be realized, to justify the resources that have to be expended by society and the inevitable burdens that have to be borne by the patient (11).

Large registries have been used by the National Heart, Lung, and Blood Institute to evaluate a number of medical procedures. Two of these, the Coronary Artery Surgery Study (CASS) and the Balloon Valvuloplasty Registry (BVR), are described to illustrate potential problems in using registry data to compare medical procedures.

A breast cancer screening program mainly aims at reducing mortality. However, it also has an effect, often not assessed, on the utilization of health care resources that is relevant to health care policy making. Using a simulation model, this paper forecasts the impact of introducing a breast cancer screening program on the utilization of resources for the primary therapy of breast cancer. The most important consequences from a health care point of view will be an increased use of breast-conserving therapy and an increased need for postoperative radiotherapy; there will also be a higher number of women diagnosed with noninvasive breast cancer. The results of this study could provide support for health care decision making by showing the consequences of policy decisions on the introduction of screening programs for health care utilization.