International journal of technology assessment in health care
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Int J Technol Assess Health Care · Jan 1993
The pulmonary artery (Swan-Ganz) catheter. Evaluation of a hemodynamic monitoring device in critical care medicine.
The pulmonary artery catheter (PAC) is an invasive hemodynamic monitoring device that is used extensively in critical care units. This technological advance allows the critical care physician and nurse to closely monitor physiological functions at the bedside. ⋯ This has resulted in much editorial comment expressing divergent opinions on the value of the PAC, but there has been no scientific evidence to guide practice and no apparent effect on the use of these devices. The PAC and other medical monitoring devices must be evaluated with respect to their impact on patient care.
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Int J Technol Assess Health Care · Jan 1993
Comparative StudyRevisiting the most informed consumer of surgical services. The physician-patient.
Little is known about the consumption of medical and surgical services by the most informed consumer in the health care market: the physician-patient. Such knowledge should be important for the understanding of the role of information on consumption, supplier-induced demand, the doctor-patient relationship, unnecessary medical services, and the adequacy of professional practices to the renal health needs of the "ordinary patient." We measured by questionnaire the standardized consumption of seven common surgical procedures. Except for appendectomy, the age- and sex-standardized consumption for each of the common surgical procedures was always significantly higher in the general population than for the "gold standard" of physician-patients. The data suggest that (a) contrary to prior research, doctors have much lower rates of surgery than does the general population; and (b) in a fee-for-services health care market without financial barriers to medical care, less-informed patients are greater consumers of common surgical procedures.
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Int J Technol Assess Health Care · Jan 1993
Geographic variation in the treatment of prostate cancer in Connecticut.
In Connecticut there was considerable variation by town of residence in the proportions of patients diagnosed in 1985-1988 receiving transurethral resection only, prostatectomy, and irradiation (without surgery) for local-stage prostate cancer and receiving endocrine surgery for late-stage prostate cancer. Age and socioeconomic variables were examined as predictors of this variation.
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Int J Technol Assess Health Care · Jan 1992
ReviewNeonatal intensive care. When and where is it justified?
There is a wide panorama of disorders in the newborn infant where neonatal intensive care has been proven effective in reducing mortality. Although modern neonatal intensive care can be very costly, short and simple interventions for support and resuscitation still can be highly beneficial. In reviewing the field of neonatal intensive care during the 1980s, it becomes evident that a major challenge for the future will be to apply physiological principles of great and proven value for the newborn baby to more simple devices. Only thereby can the technology of neonatal care defined as a complex of actions-not only equipment and techniques-become justified for future generations.