The document discusses using a consequentialist approach and the GRADE method in health technology assessment (HTA) to evaluate diagnostic tests based on patient outcomes. It provides an example of using this approach to evaluate the appropriateness of FDG-PET in assessing early response to treatment for esophageal cancer. A panel of 60 experts from 7 tumor areas used the RAND/UCLA Appropriateness Method to rate 55 diagnostic questions. For 73% of questions, the panels followed the expected consequentialist approach of the GRADE method in their ratings.
The document discusses shared decision making (SDM) in clinical encounters at Mayo Clinic. It describes the work of the Knowledge and Evaluation Research (KER) Unit, which designs and evaluates decision aids to facilitate SDM between clinicians and patients. Decision aids provide unbiased information on healthcare options and help patients consider what matters most to them. Studies show decision aids improve patient knowledge and involvement without increasing consultation time. The KER Unit has created over 20 decision aids covering various medical topics. Their goal is to create meaningful conversations centered around patient needs and values to improve healthcare outcomes and experience.
This document discusses occupational therapy diagnostic reasoning, which involves assessing patients' occupational problems and creating a clinical image through hypothesis generation and evaluation. The diagnostic reasoning process leads to an occupational therapy diagnosis, which describes patients' occupational deficits and potential causes. The diagnosis serves as the basis for intervention planning. The diagnostic process involves framing the clinical problem, actively problem-solving to define the issue, and refining the clinical image. Various factors like the practice setting and individual therapist can influence this diagnostic reasoning.
The clinical study evaluated peripheral nerve stimulation of the occipital nerves for chronic migraine. 157 patients were randomly assigned to an active or control group in a 2:1 ratio. The primary endpoint of a 10% difference in responders between groups was not met. However, secondary analyses found that the active group experienced significantly greater reductions in headache days, migraine disability, and improvements in quality of life and satisfaction compared to the control group.
This study examines the association between patient perceptions of case manager performance and satisfaction with care, as well as the relationship between perceptions of case managers and primary care providers (PCPs) and subsequent healthcare utilization. The study analyzed survey and claims data from over 2,000 patients receiving primary care from a medical home model with embedded case managers. The results found that higher ratings of both case manager and PCP performance were independently associated with greater patient satisfaction. The study concludes by noting that perceptions of case management may impact health outcomes and behaviors, warranting further analysis of utilization patterns.
Scrambler Therapy May Relieve Chronic Neuropathic Pain More Effectively Than Guideline-Based Drug Management: Results of a Pilot, Randomized, Controlled Trial
White paper 5 things you need to know about patient reported outcome (pro) ...Keith Meadows
1) The document discusses key factors to consider when selecting a patient-reported outcome measure (PROM) for use in a study.
2) It is important to select a PROM that is reliable, valid, and measures the specific outcomes of interest related to the disease and treatment.
3) The document provides guidance on the differences between generic and disease-specific PROMs and when each type may be most appropriate. It also discusses important psychometric properties like reliability and validity that should be considered.
This document summarizes a meta-analysis comparing first-generation and second-generation antipsychotic drugs for schizophrenia. The analysis found that some second-generation drugs were more effective than typical drugs, induced fewer motor side effects, but caused more weight gain and sedation. The meta-analysis provides data to help clinicians individualize treatment based on efficacy, side effects, and cost. However, some studies suggest first-generation mid-potency drugs may be appropriate to avoid motor side effects, sedation, and weight gain.
This document discusses statistical issues related to using patient-reported outcome (PRO) measures in clinical trials. It notes that PROs are often measured on an ordinal scale with skewed distributions and are subject to floor and ceiling effects. Standard analysis methods may not be appropriate. It also discusses challenges like regression to the mean, baseline adjustment, and evaluating change over time without a control group. While a multi-scale PRO like a health-related quality of life instrument can be used as a primary endpoint, its multidimensional nature raises issues around validation and methodology compared to single measures. Regulatory agencies provide guidance on properly using PROs, including multi-scale ones, as primary endpoints.
The document discusses shared decision making (SDM) in clinical encounters at Mayo Clinic. It describes the work of the Knowledge and Evaluation Research (KER) Unit, which designs and evaluates decision aids to facilitate SDM between clinicians and patients. Decision aids provide unbiased information on healthcare options and help patients consider what matters most to them. Studies show decision aids improve patient knowledge and involvement without increasing consultation time. The KER Unit has created over 20 decision aids covering various medical topics. Their goal is to create meaningful conversations centered around patient needs and values to improve healthcare outcomes and experience.
This document discusses occupational therapy diagnostic reasoning, which involves assessing patients' occupational problems and creating a clinical image through hypothesis generation and evaluation. The diagnostic reasoning process leads to an occupational therapy diagnosis, which describes patients' occupational deficits and potential causes. The diagnosis serves as the basis for intervention planning. The diagnostic process involves framing the clinical problem, actively problem-solving to define the issue, and refining the clinical image. Various factors like the practice setting and individual therapist can influence this diagnostic reasoning.
The clinical study evaluated peripheral nerve stimulation of the occipital nerves for chronic migraine. 157 patients were randomly assigned to an active or control group in a 2:1 ratio. The primary endpoint of a 10% difference in responders between groups was not met. However, secondary analyses found that the active group experienced significantly greater reductions in headache days, migraine disability, and improvements in quality of life and satisfaction compared to the control group.
This study examines the association between patient perceptions of case manager performance and satisfaction with care, as well as the relationship between perceptions of case managers and primary care providers (PCPs) and subsequent healthcare utilization. The study analyzed survey and claims data from over 2,000 patients receiving primary care from a medical home model with embedded case managers. The results found that higher ratings of both case manager and PCP performance were independently associated with greater patient satisfaction. The study concludes by noting that perceptions of case management may impact health outcomes and behaviors, warranting further analysis of utilization patterns.
Scrambler Therapy May Relieve Chronic Neuropathic Pain More Effectively Than Guideline-Based Drug Management: Results of a Pilot, Randomized, Controlled Trial
White paper 5 things you need to know about patient reported outcome (pro) ...Keith Meadows
1) The document discusses key factors to consider when selecting a patient-reported outcome measure (PROM) for use in a study.
2) It is important to select a PROM that is reliable, valid, and measures the specific outcomes of interest related to the disease and treatment.
3) The document provides guidance on the differences between generic and disease-specific PROMs and when each type may be most appropriate. It also discusses important psychometric properties like reliability and validity that should be considered.
This document summarizes a meta-analysis comparing first-generation and second-generation antipsychotic drugs for schizophrenia. The analysis found that some second-generation drugs were more effective than typical drugs, induced fewer motor side effects, but caused more weight gain and sedation. The meta-analysis provides data to help clinicians individualize treatment based on efficacy, side effects, and cost. However, some studies suggest first-generation mid-potency drugs may be appropriate to avoid motor side effects, sedation, and weight gain.
This document discusses statistical issues related to using patient-reported outcome (PRO) measures in clinical trials. It notes that PROs are often measured on an ordinal scale with skewed distributions and are subject to floor and ceiling effects. Standard analysis methods may not be appropriate. It also discusses challenges like regression to the mean, baseline adjustment, and evaluating change over time without a control group. While a multi-scale PRO like a health-related quality of life instrument can be used as a primary endpoint, its multidimensional nature raises issues around validation and methodology compared to single measures. Regulatory agencies provide guidance on properly using PROs, including multi-scale ones, as primary endpoints.
Artigo (acupuntura) - Efeito placebo da acupunturaRenato Almeida
This pilot study aimed to validate the Streitberger placebo needle as a credible placebo for use in acupuncture trials. 37 patients with chronic knee or hip pain were randomized to receive either real acupuncture or placebo needle treatment over two 2-week periods, with a crossover between treatments. Outcomes were measured by questionnaires assessing sensations from the needles and ability to distinguish real from placebo treatment. While most patients could not detect needle penetration, nearly 40% were able to detect a difference between real and placebo treatments. The study was unable to demonstrate clear differences between real and placebo needling. However, the inability of some patients to distinguish treatments raises concerns about using this needle as a standard placebo control. Further research is needed on consistency of technique before
Pregabalin is an effective and safe adjuvant for reducing chronic
post-thoracotomy pain, without significant side effects, in all age
groups and either gender. The pain relief becomes statistically
significant after three weeks of treatment and it continues till six
months. However, larger randomized and placebo-controlled trials
of longer durations are required to further validate these findings.
This randomized, placebo-controlled clinical trial evaluated low-level laser therapy (LLLT) for treating chronic knee pain in 126 patients. Patients received 12 treatments over 4 weeks with a therapeutic laser system or sham laser plus standardized chiropractic techniques. The primary outcome was pain level measured by the visual analog scale (VAS). Results showed significant pain relief and osteoarthritic improvements in the therapeutic laser group compared to the sham laser group, demonstrating LLLT's effectiveness for treating chronic knee pain.
This document discusses achieving and measuring patient satisfaction. It identifies four conceptualizations of patient satisfaction: performance evaluation, disconfirmation of expectations, affect-based assessment, and equity-based assessment. It describes how different pharmacy organizations may address one or more of these conceptualizations when assessing patient satisfaction, depending on their objectives. The document also discusses the ECHO model for evaluating the value and quality of healthcare, which takes an economic, clinical, and humanistic approach.
This document summarizes three studies on the risks and efficacy of opioids for chronic non-cancer pain (CNP). The first study finds that while opioids were associated with small improvements in pain and physical functioning compared to placebo, they also increased the risk of vomiting. Comparisons to other medications found similar benefits to pain and functioning. The second study finds no difference in pain-related function between opioid and non-opioid groups over 12 months, and higher rates of adverse effects and pain intensity in the opioid group. The third study finds limited effectiveness of opioids for CNP, as opioid users did not report improvements in outcomes after 2 years. Regarding risks, higher opioid doses are associated with increased overdose risk across several patient groups in
This document provides information about the 18th annual Pain Therapeutics conference taking place May 21-23, 2018 in London. The conference and two post-conference workshops will explore innovative approaches and novel targets for analgesic medicine. Featured speakers will discuss topics like DNA-based treatments for neuropathic pain, targeting ion channels to reduce pain, and clinical trials in chronic pain. Attendees can learn about drug development challenges and potential solutions for issues like patient recruitment and placebo responses.
The document discusses the interplay between a therapist's personal characteristics and qualities (therapist variables) and a client's theory of change. It argues that the most effective therapy occurs when the therapist is aware of how their variables may influence the therapeutic alliance and adapts their approach to align with the client's theory of change. Case studies are presented to illustrate therapists monitoring client feedback to improve outcomes. Effective therapists recognize when their approach does not match a client's needs and make adjustments to better facilitate the client's process of change.
Medical research relies heavily on statistical inference for generalization of findings, for assessing the uncertainty in applying these findings on new patients. SPSS and similar packages has made complex statistical calculations possible with no or very little understanding of statistical inference. As a consequence, research findings are misunderstood, the presentation of them confusing, and their reliability massively overestimated.
Clinical supervision its influence on client-rated working alliance and clie...Daryl Chow
This study evaluated the impact of clinical supervision on client working alliance and symptom reduction in the brief treatment of major depression. Therapists were randomly assigned to receive either alliance skill-focused or alliance process-focused supervision, or to receive no supervision. Both supervision conditions had a significant positive effect on working alliance, symptom reduction, and treatment retention compared to the no supervision condition. However, there was no significant difference found between the two supervision conditions. The findings provide preliminary evidence that clinical supervision can improve client outcomes, but more research is still needed to separate the effects of different supervision approaches.
The document summarizes a clinical study on the efficacy of Gandharvahasthadi Kwatha in the management of Grudhrasi (sciatica). The study included 100 patients with Grudhrasi who were given Gandharvahasthadi Kwatha for 45 days. Assessments were done before treatment, after treatment, and at follow-ups to analyze the effectiveness of the treatment on symptoms, SLR (straight leg raise) tests, and overall management of Grudhrasi. The results showed that Gandharvahasthadi Kwatha significantly reduced symptoms and improved SLR tests, and provided long-lasting relief even after follow-up periods. The properties and actions of
Clinical reasoning and patient centered care in physiotherapyzualias
This document discusses clinical reasoning and patient-centered care in physiotherapy. It defines clinical reasoning as the process physiotherapists use to collect and evaluate patient data to make judgments about diagnosis and treatment. Patient-centered care actively involves patients in decisions about their care. The document also outlines the components of documentation for patient care, including subjective assessment, objective assessment, analysis, plan, intervention, evaluation and review. Thorough documentation is important for legal protection, communication between healthcare providers, and ensuring quality patient care.
30
40
50
60
70
80
90
100
Variables
Number of patients
1. The study examined levels of anxiety in patients undergoing minor surgery at two primary care surgical units - one led by surgeons and one led by GPs.
2. At the surgeon-led unit, the most common procedures were hand surgeries and skin procedures. The main anxieties for men were pain and success of operation, while for women it was success of operation and pain.
3. At the GP-led unit, the most common procedures were skin operations and joint injections. The main anxieties for men were pain and success of operation,
Artigo (acupuntura) - Acupuntura e seus riscosRenato Almeida
This review analyzed 57 systematic reviews and 95 case reports regarding acupuncture for pain. The systematic reviews showed inconsistent and contradictory results, with only neck pain having unanimously positive conclusions from high quality reviews. Numerous caveats and contradictions emerged from the reviews. Case reports identified 95 cases of severe adverse effects from acupuncture, including 5 deaths, with pneumothorax and infections being most common. The review concluded that the evidence does not convincingly demonstrate acupuncture is effective for pain relief and that serious adverse effects continue to be reported.
This document discusses key aspects of study design, data collection, statistical analysis, and reasoning in biomedical research. It covers observational studies, experiments, data registration and validation, effect estimation and bias evaluation. Statistical analysis includes data description, interpretation of outcomes in light of study limitations, and multiplicity issues. Recent developments in different research areas include longitudinal and multilevel analysis, causality models, and registration guidelines.
El documento discute el concepto de retardo mental leve (RML) y plantea varias preguntas sobre su definición y aplicación. Señala que el RML apareció con la escolarización obligatoria y afecta principalmente el desarrollo del lenguaje, la motricidad y las habilidades simbólicas. También plantea que el éxito o fracaso escolar depende de múltiples factores individuales, sociales y educativos, por lo que la escuela no debe estigmatizar a los estudiantes interpretando la diversidad como
This document is a reference manual for the NETGEAR DM111P ADSL2+ Ethernet Modem. It provides regulatory compliance statements and product details for the DM111P modem, which is intended for home use to connect devices to the internet via an ADSL connection. The manual contains information on the Federal Communications Commission compliance, European Union compliance, and other regulatory notices as well as publication details.
This document provides information about a conference hosted by the National Black Child Development Institute held in Nashville, Tennessee from October 10-11, 2011. The conference's theme was "Essential for the Journey of Our Children: Keep the Cultural Fire Burning." On Monday, October 10th, there was a session titled "Between the Covers: Literature with a Cultural Flavor" featuring four presenters from Oakland University and Marygrove College discussing children's literature. The rest of the document lists over 50 books for children and young adults on cultural and African American themes.
Health Technology Assessment (HTA) Report: Interventions to increase particip...HTAi Bilbao 2012
The document summarizes a Health Technology Assessment report on interventions to increase participation in organized cancer screening programs. It found that mail and phone recalls, as well as having a general practitioner's signature on the invitation letter, consistently increased participation. Fixed appointments also increased participation compared to open invitations. Self-sampling for HPV testing increased participation in non-responders relative to standard recall letters. The report evaluated interventions' efficacy, cost-effectiveness, organizational impact, and social/ethical issues.
Transitional Care for Pediatric Patients with Neuromuscular Diseases: A Healt...HTAi Bilbao 2012
Transitional Care for Pediatric Patients with Neuromuscular Diseases: A Health Technology Assessment
Jackie Tran, MD
University of Medicine and Dentistry of New Jersey, USA
HTAi 9th Annual Meeting, Bilbao
Integrated Care for a Patient Centered System
25 June, 2012
Artigo (acupuntura) - Efeito placebo da acupunturaRenato Almeida
This pilot study aimed to validate the Streitberger placebo needle as a credible placebo for use in acupuncture trials. 37 patients with chronic knee or hip pain were randomized to receive either real acupuncture or placebo needle treatment over two 2-week periods, with a crossover between treatments. Outcomes were measured by questionnaires assessing sensations from the needles and ability to distinguish real from placebo treatment. While most patients could not detect needle penetration, nearly 40% were able to detect a difference between real and placebo treatments. The study was unable to demonstrate clear differences between real and placebo needling. However, the inability of some patients to distinguish treatments raises concerns about using this needle as a standard placebo control. Further research is needed on consistency of technique before
Pregabalin is an effective and safe adjuvant for reducing chronic
post-thoracotomy pain, without significant side effects, in all age
groups and either gender. The pain relief becomes statistically
significant after three weeks of treatment and it continues till six
months. However, larger randomized and placebo-controlled trials
of longer durations are required to further validate these findings.
This randomized, placebo-controlled clinical trial evaluated low-level laser therapy (LLLT) for treating chronic knee pain in 126 patients. Patients received 12 treatments over 4 weeks with a therapeutic laser system or sham laser plus standardized chiropractic techniques. The primary outcome was pain level measured by the visual analog scale (VAS). Results showed significant pain relief and osteoarthritic improvements in the therapeutic laser group compared to the sham laser group, demonstrating LLLT's effectiveness for treating chronic knee pain.
This document discusses achieving and measuring patient satisfaction. It identifies four conceptualizations of patient satisfaction: performance evaluation, disconfirmation of expectations, affect-based assessment, and equity-based assessment. It describes how different pharmacy organizations may address one or more of these conceptualizations when assessing patient satisfaction, depending on their objectives. The document also discusses the ECHO model for evaluating the value and quality of healthcare, which takes an economic, clinical, and humanistic approach.
This document summarizes three studies on the risks and efficacy of opioids for chronic non-cancer pain (CNP). The first study finds that while opioids were associated with small improvements in pain and physical functioning compared to placebo, they also increased the risk of vomiting. Comparisons to other medications found similar benefits to pain and functioning. The second study finds no difference in pain-related function between opioid and non-opioid groups over 12 months, and higher rates of adverse effects and pain intensity in the opioid group. The third study finds limited effectiveness of opioids for CNP, as opioid users did not report improvements in outcomes after 2 years. Regarding risks, higher opioid doses are associated with increased overdose risk across several patient groups in
This document provides information about the 18th annual Pain Therapeutics conference taking place May 21-23, 2018 in London. The conference and two post-conference workshops will explore innovative approaches and novel targets for analgesic medicine. Featured speakers will discuss topics like DNA-based treatments for neuropathic pain, targeting ion channels to reduce pain, and clinical trials in chronic pain. Attendees can learn about drug development challenges and potential solutions for issues like patient recruitment and placebo responses.
The document discusses the interplay between a therapist's personal characteristics and qualities (therapist variables) and a client's theory of change. It argues that the most effective therapy occurs when the therapist is aware of how their variables may influence the therapeutic alliance and adapts their approach to align with the client's theory of change. Case studies are presented to illustrate therapists monitoring client feedback to improve outcomes. Effective therapists recognize when their approach does not match a client's needs and make adjustments to better facilitate the client's process of change.
Medical research relies heavily on statistical inference for generalization of findings, for assessing the uncertainty in applying these findings on new patients. SPSS and similar packages has made complex statistical calculations possible with no or very little understanding of statistical inference. As a consequence, research findings are misunderstood, the presentation of them confusing, and their reliability massively overestimated.
Clinical supervision its influence on client-rated working alliance and clie...Daryl Chow
This study evaluated the impact of clinical supervision on client working alliance and symptom reduction in the brief treatment of major depression. Therapists were randomly assigned to receive either alliance skill-focused or alliance process-focused supervision, or to receive no supervision. Both supervision conditions had a significant positive effect on working alliance, symptom reduction, and treatment retention compared to the no supervision condition. However, there was no significant difference found between the two supervision conditions. The findings provide preliminary evidence that clinical supervision can improve client outcomes, but more research is still needed to separate the effects of different supervision approaches.
The document summarizes a clinical study on the efficacy of Gandharvahasthadi Kwatha in the management of Grudhrasi (sciatica). The study included 100 patients with Grudhrasi who were given Gandharvahasthadi Kwatha for 45 days. Assessments were done before treatment, after treatment, and at follow-ups to analyze the effectiveness of the treatment on symptoms, SLR (straight leg raise) tests, and overall management of Grudhrasi. The results showed that Gandharvahasthadi Kwatha significantly reduced symptoms and improved SLR tests, and provided long-lasting relief even after follow-up periods. The properties and actions of
Clinical reasoning and patient centered care in physiotherapyzualias
This document discusses clinical reasoning and patient-centered care in physiotherapy. It defines clinical reasoning as the process physiotherapists use to collect and evaluate patient data to make judgments about diagnosis and treatment. Patient-centered care actively involves patients in decisions about their care. The document also outlines the components of documentation for patient care, including subjective assessment, objective assessment, analysis, plan, intervention, evaluation and review. Thorough documentation is important for legal protection, communication between healthcare providers, and ensuring quality patient care.
30
40
50
60
70
80
90
100
Variables
Number of patients
1. The study examined levels of anxiety in patients undergoing minor surgery at two primary care surgical units - one led by surgeons and one led by GPs.
2. At the surgeon-led unit, the most common procedures were hand surgeries and skin procedures. The main anxieties for men were pain and success of operation, while for women it was success of operation and pain.
3. At the GP-led unit, the most common procedures were skin operations and joint injections. The main anxieties for men were pain and success of operation,
Artigo (acupuntura) - Acupuntura e seus riscosRenato Almeida
This review analyzed 57 systematic reviews and 95 case reports regarding acupuncture for pain. The systematic reviews showed inconsistent and contradictory results, with only neck pain having unanimously positive conclusions from high quality reviews. Numerous caveats and contradictions emerged from the reviews. Case reports identified 95 cases of severe adverse effects from acupuncture, including 5 deaths, with pneumothorax and infections being most common. The review concluded that the evidence does not convincingly demonstrate acupuncture is effective for pain relief and that serious adverse effects continue to be reported.
This document discusses key aspects of study design, data collection, statistical analysis, and reasoning in biomedical research. It covers observational studies, experiments, data registration and validation, effect estimation and bias evaluation. Statistical analysis includes data description, interpretation of outcomes in light of study limitations, and multiplicity issues. Recent developments in different research areas include longitudinal and multilevel analysis, causality models, and registration guidelines.
El documento discute el concepto de retardo mental leve (RML) y plantea varias preguntas sobre su definición y aplicación. Señala que el RML apareció con la escolarización obligatoria y afecta principalmente el desarrollo del lenguaje, la motricidad y las habilidades simbólicas. También plantea que el éxito o fracaso escolar depende de múltiples factores individuales, sociales y educativos, por lo que la escuela no debe estigmatizar a los estudiantes interpretando la diversidad como
This document is a reference manual for the NETGEAR DM111P ADSL2+ Ethernet Modem. It provides regulatory compliance statements and product details for the DM111P modem, which is intended for home use to connect devices to the internet via an ADSL connection. The manual contains information on the Federal Communications Commission compliance, European Union compliance, and other regulatory notices as well as publication details.
This document provides information about a conference hosted by the National Black Child Development Institute held in Nashville, Tennessee from October 10-11, 2011. The conference's theme was "Essential for the Journey of Our Children: Keep the Cultural Fire Burning." On Monday, October 10th, there was a session titled "Between the Covers: Literature with a Cultural Flavor" featuring four presenters from Oakland University and Marygrove College discussing children's literature. The rest of the document lists over 50 books for children and young adults on cultural and African American themes.
Health Technology Assessment (HTA) Report: Interventions to increase particip...HTAi Bilbao 2012
The document summarizes a Health Technology Assessment report on interventions to increase participation in organized cancer screening programs. It found that mail and phone recalls, as well as having a general practitioner's signature on the invitation letter, consistently increased participation. Fixed appointments also increased participation compared to open invitations. Self-sampling for HPV testing increased participation in non-responders relative to standard recall letters. The report evaluated interventions' efficacy, cost-effectiveness, organizational impact, and social/ethical issues.
Transitional Care for Pediatric Patients with Neuromuscular Diseases: A Healt...HTAi Bilbao 2012
Transitional Care for Pediatric Patients with Neuromuscular Diseases: A Health Technology Assessment
Jackie Tran, MD
University of Medicine and Dentistry of New Jersey, USA
HTAi 9th Annual Meeting, Bilbao
Integrated Care for a Patient Centered System
25 June, 2012
Economic evaluation, reimbursement and context. How to assess personalised me...HTAi Bilbao 2012
Developed a national framework for Australia to assess personalised medicines for reimbursement decisions. The framework provides:
1) Guidelines for evaluating the analytical validity, clinical validity and clinical utility of pharmacogenetic/genomic tests.
2) A methodological framework and 79-item checklist to assess biomarker/test/drug packages based on evidence of treatment effect modification, prognostic impact and cost-effectiveness.
3) A decision framework to inform reimbursement of tests and drugs based on 4 scenarios of cost-effectiveness with and without considering biomarker status.
Using outcome measures in occupational therapy can support evidence-based practice, convince others of the value of OT, and increase accountability. Outcome measures should assess how effective interventions are at achieving intended outcomes. However, it can be difficult to isolate the effects of complex interventions from other factors. OTs should use standardized, valid, and reliable outcome measures that are related to their interventions and objectives. While no single measure can cover all of OT, using a range of appropriate measures can help demonstrate any changes resulting from interventions.
Towards a Continuous Learning Ecosystem: Data Innovations and Collaborations...Vipul Kashyap
A bird's eye view of the healthcare system viewed as a continuous learning ecosystem. This suggests the need for deep collaborations and continuous sharing of insights to enable reduction of costs and improvement in outcomes
QualityMetric and Magellan Presentation at AHIP Conference 2009jponao
The document discusses using patient-reported outcomes to measure the effectiveness of healthcare treatments. It describes a program by Magellan Health Services that uses the SF-12 and SF-BH assessments to measure patients' physical and mental health over time. The results showed that behavioral health interventions significantly improved patients' mental health and well-being based on their responses. There were reductions in depression screening rates, predicted medical expenses, and lost work days post-treatment. Improvements were sustained for three months for some patients. The program aims to promote transparency, prove the value of treatments, and better measure healthcare outcomes.
This study evaluated the outcomes of a pharmacist-provided diabetes medication therapy management program (MTMP) sponsored by an employer for its employees and dependents. The study found:
1) Patients experienced improved clinical outcomes including reductions in A1c, blood pressure, and hospitalizations/ER visits.
2) Economic outcomes improved with reductions in costs of physician visits, hospitalizations, and ER visits.
3) Humanistic outcomes were positive with high patient satisfaction and improved disease knowledge retention over 6 months.
The MTMP resulted in overall improved health, quality of life and cost savings for participants.
Evidence-based medicine has evolved from focusing primarily on randomized controlled trials to incorporating a broader range of evidence, including observational studies and evidence generated from practice settings. It aims to integrate the highest quality external evidence with internal organizational data and stakeholder perspectives to improve health outcomes.
This document discusses the evaluation and regulation of biomarkers from a public health perspective. It makes the following key points:
1. New technologies have led to an unprecedented rate of development of new medical tests and biomarkers, but they require rigorous evaluation of their clinical validity and utility.
2. Existing regulatory frameworks focus mainly on analytical validity and safety, but commissioners need evidence of clinical effectiveness and improved outcomes before reimbursing tests.
3. A new body should be established to systematically evaluate diagnostic tests using frameworks like ACCE (analytical validity, clinical validity, clinical utility, ethical considerations).
4. While assays measure biomarkers, tests interpret those measurements for specific clinical purposes. Each test requires independent evaluation of performance
This document discusses strategies for using measurement to drive quality improvement in clinical practice. It outlines the following key points:
1. Measurement is crucial for both discovery of issues and evaluating actual changes. Tally sheets and Pareto charts can identify root causes, while process measures track baseline data and monitor improvement.
2. The Model for Improvement emphasizes setting aims, measures, and testing changes through small Plan-Do-Study-Act cycles. Measures should be agile, accurate, and accessible.
3. A case study demonstrates using these strategies to address late patient rooming. Baseline data identified room availability as the main issue. Adding a room and optimizing workflow reduced late rooming by 34% over several
The document discusses shared decision making (SDM) in clinical encounters at Mayo Clinic. It describes the work of the Knowledge and Evaluation Research (KER) Unit, which designs and evaluates decision aids to facilitate SDM between clinicians and patients. Decision aids provide unbiased information on healthcare options and help patients consider what matters most to them. Studies show decision aids improve patient knowledge and involvement without increasing consultation time. The KER Unit has created over 20 decision aids covering various medical topics. Their goal is to create meaningful conversations centered around patient needs and values to improve healthcare outcomes and experience.
Karen Sepucha, PhD, describes what a good decision is, how we measure decision quality and how the decision quality instrument might be used.
This presentation was part of a Shared Decision Making Month webinar -- What Makes a Good Medical Decision? Defining and Implementing Decision Quality Measures.
This document describes Bioresonance Analysis of Health (BAH), a new diagnostic and treatment method. BAH uses a drop of a patient's blood to generate a highly accurate individualized treatment protocol in 15-30 minutes. It offers benefits like specificity of treatment, prioritization of therapies, high effectiveness including for chronic illnesses, and time savings. The document discusses how BAH works using resonance phenomena, its application process, achieving strong results even in difficult cases, and registering for a certification course to learn and apply the method.
This document provides an outline of a conference presentation on evaluating moderation and mediation in personalized therapies. The presentation aims to: 1) introduce key concepts of personalized therapy/stratified medicine, causal effects, confounding and RCTs; 2) recap and develop ideas on correct and incorrect approaches to evaluating treatment effect moderation and using interactions to study mediation; and 3) briefly describe the research program evaluating efficacy and mechanisms of complex interventions funded by the MRC Methodology Research Programme.
The Role of Health Services Research in a Learning Healthcare SystemAcademyHealth
Dr. David Atkins, U.S. Department of Veterans Affairs, presented at AcademyHealth's 2012 Capitol Hill briefing entitled "Health and the Deficit: Using Health Services Research to Reduce Costs and Improve Quality."
This document discusses the differences between efficacy research and effectiveness research. Efficacy research aims to determine if an intervention works under ideal conditions, while effectiveness research examines if an intervention works in real-world practice. Key differences include population characteristics, interventions tested, and outcomes measured. Effectiveness research uses more complex, real-world populations and examines multiple conditions. It also compares combined interventions and models of care. Outcomes focus on overall health rather than single diseases. While effectiveness research is more informative for clinical practice, it sacrifices some internal validity compared to efficacy research.
This document summarizes an evaluation of five programs funded by The Merck Company Foundation to reduce disparities in diabetes care. The programs implemented multicomponent interventions including patient education, clinician cultural competency training, and health system changes. Data was collected from over 1,000 patients and showed significant improvements in clinical measures like HbA1c and blood pressure, as well as patient-reported outcomes regarding diabetes competence, self-management, and self-care. While not randomized trials, the results suggest these types of multilevel interventions can effectively improve outcomes and reduce disparities for those with diabetes.
This document discusses evidence-based practice (EBP) in physiotherapy. It provides several definitions of EBP which emphasize integrating the best research evidence with clinical expertise and patient values. The document notes that clinical practices become outdated if new evidence is not incorporated. It highlights the importance of EBP in improving patient care and outcomes. Examples of research on manual therapy for neck pain, shortwave diathermy for low back pain, and a survey of Malaysian physiotherapists' treatment preferences for low back pain are provided to illustrate EBP. The introduction to research section outlines the importance of clinical research and different types including experimental and non-experimental research.
Four strategies to upgrade clinical trial quality in this computerized world ...Pubrica
• Biostatistics Services is important for collecting, reviewing, presenting, and interpreting data in clinical research.
• Applications of clinical biostatistics services are in different areas, such as epidemiology, clinical trials, population genetics, the biology of structures, and more.
Reference : https://pubrica.com/services/research-services/biostatistics-and-statistical-programming-services/
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Dose response and efficacy of spinal manipulation for care of chronic low bac...Younis I Munshi
This randomized controlled trial studied the dose-response relationship between spinal manipulation therapy (SMT) sessions and chronic low back pain outcomes. 400 participants with chronic low back pain were randomized to receive 0, 6, 12, or 18 SMT sessions over 6 weeks from a chiropractor, with additional non-SMT light massage sessions to control for provider attention. The primary outcomes of pain and disability were evaluated at 12 and 24 weeks. Results showed modest linear dose-response effects, with 12 SMT sessions producing the greatest reduction in pain and disability at 12 weeks and 18 sessions producing the greatest effects at 52 weeks. Overall, SMT produced clinically meaningful improvements in pain and disability that were sustained to 52 weeks, with 12 visits appearing
This document discusses clinical audit, which seeks to improve patient care through systematic review of care against criteria and implementing changes where needed. It defines audit and outlines the audit cycle of selecting a topic, identifying standards, collecting data on performance, implementing changes if needed, and monitoring further to ensure improvement. The document provides examples of what can be audited, such as structure, processes of care, or outcomes. It emphasizes that audit criteria should be evidence-based and measurable. The goal of audit is to continuously improve quality of care.
This document summarizes a study on the impact of quality reporting on consumer choice in healthcare. The study reviewed 24 articles on this topic. It found that 58% of studies showed quality reports significantly influence patient choice, while 26% found no significant impact. The magnitude of impact was between 10-20% of patients responding to quality reports. While quality reporting does seem to impact some consumers, it may not have fully solved the problem of information asymmetry.
Similar to Bringing patients’ outcome at the forefront in HTA of diagnostic tests using the GRADE approach (20)
The use of ‘colloquial evidence’ in HTA: the experience of NICE HTAi Bilbao 2012
The document summarizes a presentation given at the HTAi Annual Meeting about the National Institute for Health and Care Excellence's (NICE) use of "colloquial evidence" in developing clinical guidance. It defines colloquial evidence, explores how NICE utilizes it alongside scientific evidence at different stages of the guidance process, and discusses developing better methods for identifying and critically appraising colloquial evidence. The presentation aims to map NICE's use of colloquial evidence to an existing conceptual framework and identify variations across NICE centers.
Social values international programme: integrating research and policy to ens...HTAi Bilbao 2012
Social values international programme: integrating research and policy to ensure fair allocation of health care resources .
HTAi Conference 2012 Panel Session
Joint chairs
Professor Peter Littlejohns and Professor Albert Weale
Challenges in commissioning research on what works in integrated careHTAi Bilbao 2012
This document discusses challenges in commissioning research on integrated care and how new studies are tackling these challenges. Integrated care research is complex due to the interplay of context, mechanisms and outcomes, and difficulty tracking activity and costs across settings. New studies are using more robust methods like difference-in-difference analysis across multiple sites and person-linked data to better understand costs and impacts. They are also considering generalizability and using mixed methods to understand how micro-level integrated care can be supported at higher levels.
Building a portfolio of research findings for use by healthcare managers and ...HTAi Bilbao 2012
The document summarizes research conducted by the NIHR Health Services and Delivery Research programme on integrated care. It outlines several research projects funded through specific calls on integrated care between 2009-2011, including evaluations of case management initiatives, self-care support, and virtual wards. The research aims to identify healthcare managers' needs and generate evidence to improve services. The programme commissions applied health research to benefit the NHS based on both need and scientific merit.
This document summarizes a study exploring methods for assessing international use of UK-funded health technology assessments (HTAs). The study reviewed literature on impact assessment models and explored bibliometrics, website analytics, and citations in HTA reports. Bibliometric analysis found low international academic impact. Website analytics revealed most non-UK visits were for systematic reviews. Citations in HTA reports provided some evidence of international uptake. The study recommends a multidimensional model and further research using case studies to explore nature of HTA use internationally.
EVALUATION OF PSYCHOSOCIAL FACTORS INFLUENCING HEALTHCARE PROFESSIONAL ACCEPT...HTAi Bilbao 2012
EVALUATION OF PSYCHOSOCIAL FACTORS INFLUENCING HEALTHCARE PROFESSIONAL ACCEPTANCE OF TELEMONITORING FOR CHRONIC PATIENTS
Estibalitz Orruño1, Marie-Pierre Gagnon2-3, José Asua4, Eva Reviriego1
1 Basque Office for Health Technology Assessment (Osteba), Department of Health and Consumer Affairs, Basque Government, Vitoria-Gasteiz, Spain.
2 Faculty of Nursing Sciences, Université Laval, Québec, Canada.
3 Research Centre of the Centre Hospitalier Universitaire de Québec, Québec, Canada.
4 Direction of Knowledge Management and Evaluation, Department of Health and Consumer Affairs, Basque Government, Vitoria-Gasteiz, Spain.
The document discusses improving opportunities for patient and consumer engagement in health technology assessment (HTA) in Australia. It notes that while mechanisms exist for patient input, the overall HTA process is not well understood, advocacy groups are under-resourced, and the timeline for submissions is short. It proposes the formation of HTA_AUS, a coalition of interested parties including patient groups, government, industry and others, to address this issue and develop practical solutions like supporting patient submissions and extending deadlines. The coalition aims to increase awareness, education and support for patient engagement in HTA.
METHODS, MATHEMATICAL MODELS, DATA QUALITY ASSESSMENT AND RESULT INTERPRETATI...HTAi Bilbao 2012
METHODS, MATHEMATICAL MODELS, DATA QUALITY ASSESSMENT AND RESULT INTERPRETATION: SOLUTIONS DEVELOPED IN THE IFEDH FRAMEWORK
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How to promote the prescription of evidence-based non-pharmacological treatme...HTAi Bilbao 2012
How to promote the prescription of evidence-based non-pharmacological treatments in France?
HTAi 2012, Bilbao
Clémence Thébaut, Olivier Scemama, Françoise Hamers, Catherine Rumeau-Pichon
Department of economic and public health evaluation
The application of Health Technology Assessment in the field of biologics: an...HTAi Bilbao 2012
This document provides a health technology assessment of etanercept for treating rheumatoid arthritis. It includes 7 chapters that evaluate the epidemiology and burden of RA, biologic drugs for RA including etanercept, the economic impacts, organizational implications, and ethical considerations of using etanercept. The assessment finds that etanercept improves quality of life when combined with methotrexate compared to methotrexate alone, and has a cost-effectiveness ratio of €25,130 per quality-adjusted life year gained, making it a reasonable treatment option.
Hospital-based HTA: does it impact on medical technologies’ expenditure and c...HTAi Bilbao 2012
This document summarizes a study on hospital-based health technology assessment (HB HTA) in Italy. The study aimed to assess the diffusion of HB HTA, its impact on hospital decisions, and potential factors influencing its effectiveness. A survey found that almost half of hospitals have an HTA commission. While few clear impacts were identified, some relationships were found between HTA characteristics and resource use. Future research should evaluate additional outcomes to better understand HB HTA's effects and inform its adoption.
Measuring the Gap between Demand and Access in the Brazilian Public Health Ca...HTAi Bilbao 2012
This document reviews the gap between demand and access to medicines in Brazil's public health care system. It finds that while over 70% of medical consultations are publicly funded, around 70% of medicines are privately purchased due to high prices and limited availability in public pharmacies. This shifts the financial burden to users and disproportionately harms those who cannot afford treatment, increasing inequality. The document calls for improvements in budget forecasting, health planning, and data collection to better measure and address variations in access to medicines across regions and types of treatments.
MAST: a model for HTA-based assessment of telemedicine applicationsHTAi Bilbao 2012
This document describes MAST (Model for Assessment of Telemedicine), a multidisciplinary framework for assessing telemedicine applications. It was developed through a comprehensive process and aims to describe effectiveness and quality of care impacts of telemedicine. MAST consists of 3 stages: setting context, multidisciplinary assessment across clinical, economic, organizational and social domains, and assessing transferability. It is being empirically tested through large European projects and has supported over 25 trials. While time-consuming, MAST provides a standardized approach and ensures comparability. Feedback has been positive and several regions are adopting it, with revisions planned based on empirical results to establish MAST as a widely accepted methodology.
Decision making in management for large medical equipmentHTAi Bilbao 2012
This document discusses decision making for purchasing large medical equipment like MRI machines. It presents data showing differences in MRI availability between countries. There are challenges in decision making due to varying supplier policies, objectives of health facilities, and heterogeneous information. A methodology is proposed to help with rational choice involving developing a system for equipment selection and procurement. Experts would be evaluated and their competence indexed based on both objective and subjective criteria. Analytical hierarchy process (AHP) techniques could be applied to determine priority weights for MRI machine characteristics through pairwise comparisons. Predictions could also be made on how weights may change. This would help create a ranked list of recommended MRI machine options.
- Video recording of this lecture in English language: https://youtu.be/Pt1nA32sdHQ
- Video recording of this lecture in Arabic language: https://youtu.be/uFdc9F0rlP0
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Local Advanced Lung Cancer: Artificial Intelligence, Synergetics, Complex Sys...Oleg Kshivets
Overall life span (LS) was 1671.7±1721.6 days and cumulative 5YS reached 62.4%, 10 years – 50.4%, 20 years – 44.6%. 94 LCP lived more than 5 years without cancer (LS=2958.6±1723.6 days), 22 – more than 10 years (LS=5571±1841.8 days). 67 LCP died because of LC (LS=471.9±344 days). AT significantly improved 5YS (68% vs. 53.7%) (P=0.028 by log-rank test). Cox modeling displayed that 5YS of LCP significantly depended on: N0-N12, T3-4, blood cell circuit, cell ratio factors (ratio between cancer cells-CC and blood cells subpopulations), LC cell dynamics, recalcification time, heparin tolerance, prothrombin index, protein, AT, procedure type (P=0.000-0.031). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and N0-12 (rank=1), thrombocytes/CC (rank=2), segmented neutrophils/CC (3), eosinophils/CC (4), erythrocytes/CC (5), healthy cells/CC (6), lymphocytes/CC (7), stick neutrophils/CC (8), leucocytes/CC (9), monocytes/CC (10). Correct prediction of 5YS was 100% by neural networks computing (error=0.000; area under ROC curve=1.0).
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These lecture slides, by Dr Sidra Arshad, offer a simplified look into the mechanisms involved in the regulation of respiration:
Learning objectives:
1. Describe the organisation of respiratory center
2. Describe the nervous control of inspiration and respiratory rhythm
3. Describe the functions of the dorsal and respiratory groups of neurons
4. Describe the influences of the Pneumotaxic and Apneustic centers
5. Explain the role of Hering-Breur inflation reflex in regulation of inspiration
6. Explain the role of central chemoreceptors in regulation of respiration
7. Explain the role of peripheral chemoreceptors in regulation of respiration
8. Explain the regulation of respiration during exercise
9. Integrate the respiratory regulatory mechanisms
10. Describe the Cheyne-Stokes breathing
Study Resources:
1. Chapter 42, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 36, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 13, Human Physiology by Lauralee Sherwood, 9th edition
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One health condition that is becoming more common day by day is diabetes.
According to research conducted by the National Family Health Survey of India, diabetic cases show a projection which might increase to 10.4% by 2030.
Bringing patients’ outcome at the forefront in HTA of diagnostic tests using the GRADE approach
1. Agenzia sanitaria e sociale regionale
Methods in HTA – Health outcomes
Bringing patients’ outcome at the forefront in HTA of
diagnostic tests using the GRADE approach
Luciana Ballini
Luca Vignatelli, Susanna Maltoni, Antonella Negro, Fabio Trimaglio, Roberto Grilli
Bilbao 26th June 2012
http://asr.regione.emilia-romagna.it
2. Appropriateness of
Agenzia sanitaria e sociale regionale
FDG-PET in oncology: 3rd update
Since 2001 a permanent research activity
alongside the development and diffusion
of the technology
An obsession ?
… or an opportunity
• To reason on diagnostic-therapeutic strategies, rather than simply on
diagnostic test
• To address research gaps (clinical effectiveness)
• To test a new methods for working groups developing diagnostic
recommendations
3. Appropriateness of a diagnostic test
Agenzia sanitaria e sociale regionale
The value of any medical test is ultimately measured by whether the
information it provides affects patient-relevant outcomes (Bossuyt 2010)
• Initial diagnostic assessment with subsequent
therapeutic approach
• The potential of the new test to modify initial diagnostic Rationale
assessment (e.g. stage of disease)
• The change in management following change of
diagnostic assessment
• The diagnostic accuracy of the new test Available evidence
• The resulting improvement in patients’
outcome due to change in therapeutic ?
approach induced by new test’s results
Schunemann et al BMJ 2008;336:1106-1110.
4. Agenzia sanitaria e sociale regionale Consequentialist Approach
NOT MODIFIABLE MODIFIABLE
Initial diagnostic
assessment
Treatment options
Change in Management effectiveness
SIGNIFICANT NEGLIGIBLE CURATIVE PALLIATIVE
Diagnostic Impact on
accuracy patients’
outcomes
Diagnostic Outcomes
efficacy trade off
TEST POSITION harms versus benefits
APPROPRIATENESS
CRITERIA
5. Agenzia sanitaria e sociale regionale
The
consequentialist
approach at work :
information
provided to the
panel
6. NOT MODIFIABLE MODIFIABLE
Initial diagnostic
assessment
Agenzia sanitaria e sociale regionale
Change in Management Treatment options
effectiveness
SIGNIFICANT NEGLIGIBLE CURATIVE PALLIATIVE
CLINICAL QUESTION:
Role of FDG-PET in early response to pre-operative chemoradiation of
patients treated for locally advanced esophageal cancer
Treatment effectiveness : Preoperative chemo/radio therapy improves 2
year survival by 13% (absolute difference) compared to surgical treatment
only (Gebski Lancet Oncology 2007)
Rationale: Preoperative chemo/radio therapy reduces tumour mass but increases risk
of post-operative mortality (ESMO 2010). Early identification of non responders could
avoid futile treatment and unnecessary risks
RESEARCH QUESTION: FDG-PET as replacement
Is FDG-PET accurate in evaluating early response to pre-operative chemoradiation
of patients treated for locally advanced esophageal cancer ?
7. Diagnostic
Outcomes
accuracy
importance
Agenzia sanitaria e sociale regionale
LEVEL OF EVIDENCE
PATIENT IMPORTANT OUTCOMES
Schunemann et al BMJ 2008;336:1106-1110.
8. Diagnostic Outcomes
efficacy trade off
harms versus benefits
TEST POSITION
Agenzia sanitaria e sociale regionale
APPROPRIATENESS
CRITERIA
Median scores
of importance
7
8
7
5
Not good enough
INAPPROPRIATE
9. RAND/UCLA Appropriateness Method: Results
Agenzia sanitaria e sociale regionale
7 panels (60 experts) – 7 tumours Lung
Breast
Head & Neck
55 Esophageal
questions
Colo-rectal
H Lymphoma
12
11 4
indeterminate
13
inappropriate
27
inappropriate NH Lymphoma
appropriate Disagreement
No rationale
5 9 11
appropriate inappropriate 2 uncertain
disagreement
28/55 (50.9%) resolved at first voting round 9 light
Disagreement
16/55 (29.1%) resolved at second voting round
11/55 (20%) persistent disagreement
2 Strong
Disagreement
10. Was the approach followed by the panels ?
Agenzia sanitaria e sociale regionale
21
20
18
N° of questions 16
14 YES (40 questions)
14
12 NO (4 questions)
10
8
6 4
4 2 1
2 1
1
0
in
te
ria
de
in
p in
te
pr o rta
ap
rm
e te
un
ap nc ri a
pr
in
u
ce
p te
op
pro
ap
ina
at
rt
ria
e
ap
pr
ai
Observed (RAND) in rm
et e
te
n
op
ind
ria
Expected(GRADE)
te
Yes in 73% of questions
(considering also the 11 unresolved questions)
11. Agenzia sanitaria e sociale regionale
The panelists
Thank you
luballini@regione.emilia-romagna.it http://asr.regione.emilia-romagna.it