BOOK REVIEW InternationalJournal of Technology Assessment in Health Care. A newjournal edited by Egon Jonnson and Stanley J. Reiser. Quarterly, Cambridge University Press, London. Perhaps no specialty faces more acutely the problem of safely and effectively using new techniques and technologies, and the need to objectively and critically evaluate their performance, than intensive-care medicine. The new International Journal of Technology Assessment in Health Care has as its aims the "generation, evaluation, diffusion, and use of health care technology." The journal is intended for a diverse audience including health-care providers, decision makers in government, industry, health-care organizations, and scholarly disciplines of ethics, economics, law, history, sociology, and engineering. Does this journal have claim to the attention of the busy clinician who cares for critically ill patients ? Each issue is planned to contain a special section focused on a particular topic, general articles, and regular feature sections. The inaugural issue's special topic is technology and health care for the elderly, and this section includes articles on "Intensive Care for the Elderly," "Medical Technology for the Elderly inJapan," "End-stage Renal Failure and the Aged in the United Kingdom," "Orthopedic Technology for the Elderly," "Pacemakers," "Visual Rehabilitation for the Elderly through Improved Surgical Technology," "Neuronal Replacement after Traumatic or Age-dependent Brain Damage," "Audio-visual Programs in the Reality-Orientation Training of Alzheimer's Victims," and "Aspects of Psychological Aging and Technology." Two general essays in this issue are "Medical Technology Assessment: The Evaluation of Coronary Artery Bypass Graft Surgery Using Data Synthesis Techniques," and "Diagnosing Suspected Stroke: A Cost Effectiveness Analysis." The section on technology assessment reports on findings from the United States Office of Technology Assessment, the Clinical Efficacy Assessment Project of the American College of Physicians, the National Institutes of Health's Consensus Development Conference on Fresh Frozen Plasma, and the Swedish Medical Council and Swedish Planning and Rationalization Institute's Consensus Statement on Sight Improving Surgery. The emerging technology section has two articles on extracorporeal shock wave lithotripsy. Issues will contain regular sections on world perspectives, statistics, reviews, short reports, meetings and announcements, and a section entided the sorcerer's apprentice that will consider less formal topics including "parodies, satires, and other humorous items." Permission to reprint a book review printed in this section may be obtained only from the author. Perspectives in Biology and Medicine, 31, 1 ¦ Autumn 1987 \ 151 The article on "Intensive Care for the Elderly" by BryanJennett, M.D., of the University of Glasgow lists five categories of illness that bring adult patients to intensive-care units: myocardial infarction; postoperative care; respiratory, renal , or hepatic failure; coma; and hemorrhage or shock. He reviews studies of the outcome of intensive care and concludes "what such studies of outcome of intensive care indicate is that in patients whose outcome can be influenced, the details of the regimes and technologies matter less than the advantage that accrues from attracting the intensive attention of doctors and nurses." While it may be true that alternative therapeutic regimes can achieve similar outcomes, it is the intensivist's skillful attention to detail that achieves these outcomes. A framework for discussing controversial ethical issues in intensive-care decision making is outlined based on the principles of beneficence, nonmaleficence, patient autonomy, andjustice. The article is followed by two commentaries. David Barnard, Ph.D., of the Institute for Medical Humanities, University of Texas Medical Branch, elaborates on the partial truth of the equivalence of technical and moral excellence in medicine. A second commentary byJohannes O. Vang, M.D., Ph.D., of the Office of Health Technology Assessment of the World Health Organization places the economic cost of intensive care in the context of other technologies for health care and criticizes Dr. Jennett for omitting questions of discomfort, suffering, and dignity in intensive care. The article and commentaries are interesting and thought provoking, but their brevity limits their ability to elucidate the complex issues involved in intensive care. I would prefer longer articles with more attention to the subdeties that physicians face in their use of technologies for individual patients. Future issues will cover advanced technology and health care in the home, nuclear magnetic resonance, prenatal care, use and abuse of routine...
No AccessHealth, Nutrition, and Population1 Feb 2013Better Health Systems for India's PoorFindings, Analysis, and OptionsAuthors/Editors: David H. Peters, Abdo S. Yazbeck, Rashmi R. Sharma, G. N. V. Ramana, Lant H. Pritchett, Adam WagstaffDavid H. Peters, Abdo S. Yazbeck, Rashmi R. Sharma, G. N. V. Ramana, Lant H. Pritchett, Adam Wagstaffhttps://doi.org/10.1596/0-8213-5029-3SectionsAboutPDF (1.3 MB) ToolsAdd to favoritesDownload CitationsTrack Citations ShareFacebookTwitterLinked In Abstract:This report focuses on four areas of the health system in which reforms, and innovations would make the most difference to the future of the Indian health system: oversight, public health service delivery, ambulatory curative care, and inpatient care (together with health insurance). Part 1 of the report contains four chapters that discuss current conditions, and policy options. Part 2 presents the theory, and evidence to support the policy choices. The general reader may be most interested in the overview chapter, and in the highlights found at the beginning of each of the chapters in part 2. These highlights outline the empirical findings, and the main policy challenges discussed in the chapter. The report does not set out to prescribe detailed answers for India ' s future health system. It does however, have a goal: to support informed debate, and consensus building, and to help shape a health system that continually strives to be more effective, equitable, efficient, and accountable to the Indian people, and particularly to the poor. 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No AccessEducationJul 2010Design Thinking for Social InnovationAuthors/Editors: Tim Brown, Jocelyn WyattTim BrownSearch for more papers by this author, Jocelyn WyattSearch for more papers by this authorhttps://doi.org/10.1596/1020-797X_12_1_29SectionsAboutView ChaptersPDF (0.2 MB) ToolsAdd to favoritesDownload CitationsTrack Citations ShareFacebookTwitterLinked In Designers have traditionally focused on enchancing the look and functionality of products. 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Quality Indicators for Assessing Care of Vulnerable Elders16 October 2001Assessing Care of Vulnerable Elders: Methods for Developing Quality IndicatorsFREEPaul G. Shekelle, MD, PhD, Catherine H. MacLean, MD, PhD, Sally C. Morton, PhD, and Neil S. Wenger, MDPaul G. Shekelle, MD, PhDFrom the RAND Health and RAND Statistics Group, Santa Monica, California; and the RAND Statistics Group, Veterans Affairs Greater Los Angeles Healthcare System, and the University of California, Los Angeles, Los Angeles, California., Catherine H. MacLean, MD, PhDFrom the RAND Health and RAND Statistics Group, Santa Monica, California; and the RAND Statistics Group, Veterans Affairs Greater Los Angeles Healthcare System, and the University of California, Los Angeles, Los Angeles, California., Sally C. Morton, PhDFrom the RAND Health and RAND Statistics Group, Santa Monica, California; and the RAND Statistics Group, Veterans Affairs Greater Los Angeles Healthcare System, and the University of California, Los Angeles, Los Angeles, California., and Neil S. Wenger, MDFrom the RAND Health and RAND Statistics Group, Santa Monica, California; and the RAND Statistics Group, Veterans Affairs Greater Los Angeles Healthcare System, and the University of California, Los Angeles, Los Angeles, California.Author, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-135-8_Part_2-200110161-00003 SectionsAboutVisual AbstractPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Quality of care can be measured by using either processes or outcomes. Each method has its strengths and limitations (1). With the concurrence of the Assessing Care of Vulnerable Elders (ACOVE) Policy Advisory Committee [2], we chose to assess the care of vulnerable elders by using processes rather than outcomes. We did so because 1) processes are a more efficient measure of quality; 2) for most conditions there are insufficient information in the medical record and a paucity of validated models to adequately adjust outcomes for differences in case mix between providers; and 3) ultimately, processes of care are amenable to direct action by providers.To be a valid measure of quality, a health care process must be strongly linked to an outcome that is important to patients. Ideally, high-quality published studies would link performance of all such processes to outcomes; however, few health care processes are supported by high-quality evidence (3). Even when a process is supported by strong evidence from randomized clinical trials, the inclusion and exclusion criteria of the clinical trials leave the evidence directly applicable to only a narrow group of patients (4, 5). This is particularly true for vulnerable elders, who are typically excluded from clinical trials (6). Therefore, as we developed the ACOVE quality indicators, we used expert opinion to interpret the available evidence for applicability to vulnerable elders. Our methods entailed a literature review and several levels of expert opinion (Figure), which we explain in detail.Figure. Assessing Care of Vulnerable Elders (ACOVE) method for developing quality indicators for vulnerable elders. Download figure Download PowerPoint MethodsDevelopment of Draft Process IndicatorsFor each ACOVE condition that we selected for quality improvement in vulnerable elders (2), we identified a content expert, who worked as a team with another project member knowledgeable about systematic reviews and quality indicator development. Together, the content expert and project member developed potential quality indicators from existing guidelines, review criteria, and expert opinion.Because practice guidelines and existing quality indicators are seldom referenced in the traditional scientific databases, we used various search strategies to locate these materials. In addition to searching MEDLINE, we searched the following sources: CONQUEST 1.1 (A Computerized Needs-Oriented Quality Measurement Evaluation System) (7); DEMPAQ: A Project to Develop and Evaluate Methods to Promote Ambulatory Care Quality (8); Directory of Clinical Practice Guidelines(9); Guide to Clinical Preventive Services(10); HEDIS 3.0: Health Plan Employer Data and Information Set (11); National Guideline Clearinghouse (12); National Library of Health Care Indicators(13); and The Medical Outcomes & Guidelines Sourcebook(14).We also hand searched the tables of contents of all issues of The Journal of the American Medical Association and Medical Care published April through November 1998 for relevant practice guidelines and quality indicators. Furthermore, we requested practice guidelines and quality indicators from the following agencies and organizations: Administration on Aging (AOA); Agency for Health Care Policy and Research (AHCPR)—now known as Agency for Healthcare Research and Quality (AHRQ); Centers for Disease Control and Prevention (CDC); Department of Health and Human Services (DHHS); Department of Veterans Affairs; Foundation for Accountability (FACCT); Health Care Financing Administration (HCFA); HCFA/Connecticut Peer Review Organization; Joint Commission on Accreditation of Healthcare Organizations (JCAHO); National Committee for Quality Assurance (NCQA); and National Institutes of Health (NIH).By using the quality indicators identified through this process, as well as using expert opinion and existing guidelines, the content expert developed 20 to 30 preliminary quality indicators for further review. Potential indicators were constructed in an IF—THEN—BECAUSE format: IF refers to the clinical characteristics that describe persons eligible for the quality indicator; THEN indicates the actual process that should or should not be performed; and BECAUSE refers to the expected health impact if the indicator is performed. For example, IF a vulnerable elder has heart failure with an ejection fraction of 40% or less, THEN an angiotensin-converting enzyme (ACE) inhibitor should be offered BECAUSE treatment with ACE inhibitors improves longevity.We circulated this initial set of potential quality indicators to other clinical experts for their review. On the basis of reviewers' comments, we narrowed down the initial set to the 10 to 25 most promising indicators for future development.Review of Scientific LiteratureNext, we assessed the published evidence supporting a link between the process specified in each quality indicator and patient outcomes. To do so, we performed a systematic review on each quality indicator by using the essence of the Cochrane Collaboration's methods (15)—except that we used a single reviewer to screen and assess studies.With the assistance of a reference librarian, we electronically searched MEDLINE, EMBASE, The Cochrane Database of Systematic Reviews, HealthSTAR, Ageline, and other specialized databases on a condition-specific basis by using keywords and free-text terms to identify potentially relevant studies. For most conditions, the searches were not restricted by language.The content expert reviewed the retrieved citations by using a three-step process: First, the titles were reviewed for possibly relevant studies; the abstracts associated with the titles that passed the first round of screening were then reviewed; and, finally, the full articles of abstracts that passed the second round of screening were reviewed. Abstracts and articles were not masked for review. To be accepted, titles and abstracts had to contain information indicating that the full article probably reported evidence on the potential relationship between the process in question and better outcomes in humans. We excluded animal studies, letters, review articles, and other articles that did not report original data.In reviewing full articles, we gave priority to evidence from studies with the strongest designs that were relevant to the potential quality indicator being examined. In general, this meant that we chose randomized clinical trials for questions about the efficacy or effectiveness of interventions and prospective cohort studies to answer questions about risk or prognosis. We considered such evidence to be direct evidence, and we judged direct evidence in elderly persons to be the strongest level of evidence available.In the absence of direct evidence in elderly persons, we performed searches for direct evidence in other groups. Indirect evidence—that from less rigorous designs—in elderly or nonelderly persons was reviewed if the available direct evidence was insufficient. When both direct evidence and indirect evidence were lacking, we included the statements of authoritative bodies (for example, specialty societies, National Institutes of Health consensus development conferences, or Agency for Health Care Policy and Research practice guidelines).After reviewing all of the relevant articles, the content expert prepared a monograph detailing each of the quality indicators and summaries of the evidence supporting them. This monograph was sent to one or more peer reviewers, who were asked to assess the quality of the monograph according to the following guidelines: 1) Is the review complete in terms of both the proposed quality criteria and the evidence? 2) Is the review fair (that is, is the presentation of the evidence unbiased)? The authors subsequently revised the monographs on the basis of reviewers' comments in a manner analogous to the response to a critique of a journal article: Each comment was addressed in turn, and the author provided an appropriate revision or stated the reason why he or she believed that no revision was indicated.Expert PanelsWe convened two multidisciplinary groups, each composed of 12 clinical experts, to interpret the supporting evidence detailed in the monographs and to select quality indicators for further consideration. Each panel of experts considered a separate set of ACOVE conditions. Table 1 lists the members of the panels and the conditions they considered.Table 1. ACOVE Expert Panels To assess the expert opinions of the panelists, we used a modified version of the RAND/UCLA Appropriateness Method (16, 17). In brief, the method entails two rounds of anonymous ratings on a risk–benefit scale ranging from 1 to 9 and a face-to-face group discussion between rounds. Each panelist has equal weight in determining the final ratings. The reproducibility of the RAND/UCLA Appropriateness Method is consistent with that of well-accepted diagnostic tests, such as the interpretation of coronary angiography and screening mammography (18). It also has content, construct, and predictive validity (5, 17, 19, 20).In this application of the method, we sent each panelist the proposed quality indicators and the relevant condition-specific monographs. We asked the panelists to assess the validity of each proposed indicator on a scale of 1 to 9, in which 1 was "definitely not valid" and 9 was "definitely valid." We considered an indicator to be valid if 1) adequate scientific evidence or professional consensus supported a link between the process specified by the indicator and a health benefit to the patient; 2) a physician or health plan with high rates of adherence to the indicator would be considered a higher-quality provider; and 3) the physician or health plan influenced a majority of factors that determine adherence to the indicator (such as smoking cessation).Each panelist was instructed to rate each potential quality indicator for validity and return the ratings to us before the face-to-face meeting. We prepared summaries of these ratings for distribution at the panel meeting. At the face-to-face panel meeting, each quality indicator was discussed in turn; the discussion focused on the evidence (or lack thereof) supporting or refuting the indicator, and the prior rankings of the panelists. Panelists had in front of them the summary of the panel's first-round ratings and a confidential reminder of their own previous rating. Panelists were encouraged to bring any relevant published information that the monographs had omitted, and in the few cases in which panelists did so, the information was discussed in turn. In several cases, the indicators were reworded or otherwise clarified to better fit clinical judgment.After the discussion, each indicator was reranked for validity. Analysis of the final-round rankings was similar to that used in past applications of the RAND/UCLA Appropriateness Method (17, 21). We used the median panel rating and measure of dispersion to categorize the validity of the indicators. We considered disagreement among a panel to occur when at least three members of a panel judged the indicator to be in the highest tertile of validity (the indicator received a rating of 7, 8, or 9) and three members rated the indicator to be in the lowest tertile of validity (rating of 1, 2, or 3) (17). All indicators with panel disagreement were rejected.Review of the Entire ACOVE Indicator SetBecause each expert panel considered only a subset of the ACOVE conditions and necessarily focused on individual indicators within those conditions, we sent the entire set of indicators and conditions for yet another round of review, this time focusing on the set of indicators as a whole. We asked our Clinical Committee (2) to review all of the indicators with a median validity rating of 7 or greater (without disagreement) and to assess whether these indicators should be modified or deleted. We also asked the Clinical Committee to briefly reconsider all of the rejected indicators.The Clinical Committee discussed each indicator in turn at a face-to-face meeting and took explicit yes-or-no votes on any proposed changes to the indicator set. The Clinical Committee made changes to a total of 24 indicators. During the same session, the committee also assessed and ranked the validity of indicators assessing continuity of care; the process for assessing the continuity of care indicators was similar to that used earlier by the two expert panels. (The continuity of care indicators were created at the behest of the ACOVE Policy Advisory Committee after the two expert panel meetings had already taken place.)The final set of indicators therefore resulted from an initial set that was selected by content experts in the field and subjected to a systematic literature review relating the processes specified in the indicators to patient outcomes. One multidisciplinary group of clinical experts subsequently interpreted the evidence from the literature review for relevance to vulnerable elders, and another such group reviewed the final set of indicators for coherence and content validity.ResultsThis process generated 420 potential quality indicators that were presented to two expert panels for validity assessment. The panels and the Clinical Committee accepted 236 of the indicators as valid. Within either panel, members rarely disagreed on the validity of indicators: Panel 1 disagreed on 8 indicators (4.7%), and panel 2 disagreed on 9 indicators (3.8%). Table 2 shows the number of indicators proposed and accepted, according to condition. The number of accepted indicators varied from 6 (for hearing impairment and for falls and mobility disorders) to 17 (for depression).Table 2. Proposed and Accepted Indicators, according to Condition Table 3 shows the number of accepted indicators by the domain of care covered. Domains were defined as screening, prevention, diagnosis, treatment, follow-up, and continuity. Although the majority of accepted indicators were in the diagnosis and treatment domains, each domain had a minimum of 20 accepted indicators.Table 3. Accepted Indicators, according to Domain of Care Table 4 shows the accepted indicators according to medical intervention. The accepted quality indicators cover 14 categories of intervention, ranging from exercise and the use of assistive devices to more commonly assessed categories, such as physical examinations, medication, and surgery.Table 4. Accepted Indicators, according to Medical Intervention Although more than 40% of the proposed indicators were not accepted by the expert panels, this does not imply that these processes do not represent good care. Indicators could be rejected for several reasons, including insufficient evidence linking the proposed indicator with improvements in outcomes; the existence of so many "exceptions to the rule" among vulnerable elders that specifying precisely which patients should or should not be eligible was too difficult; the perception that the data to score the indicator were too difficult to collect; and a desire to keep the number of indicators within manageable limits, meaning some indicators were not included because their expected health benefits were small relative to other accepted indicators.DiscussionWe present here an explicit method for developing process quality indicators for vulnerable elders based on systematic literature reviews and several levels of expert opinion. Indicators developed with this method covered a range of domains and interventions in medical care. 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J Public [PMID: CrossrefMedlineGoogle Scholar In to A Article, and Disclosure the RAND Health and RAND Statistics Group, Santa Monica, California; and the RAND Statistics Group, Veterans Affairs Greater Los Angeles Healthcare System, and the University of California, Los Angeles, Los Angeles, The authors the many RAND prior to the development of the quality assessment in PhD, and the members of the Quality also for developing and the searches for guidelines and quality a from to RAND for this Shekelle is a Research of the Veterans Affairs Health Services Research and G. Shekelle, MD, PhD, Santa Monica, Shekelle, MacLean, and Santa Monica, Department of of Medicine and Health Services University of California, Los Angeles, Los Angeles, Care of Vulnerable Elders: ACOVE Project Neil S. Wenger G. Shekelle and indicators for and a systematic of for the of Disease in During the to Develop and Care Quality Indicators for a for performance assessment of the care in and of for the of Disease in During the of for the of Disease in During the for Quality and of the to Quality in for and quality a systematic and of Evaluation for systematic review and of to in older impact of review with version 2 of and to to criteria in a a the quality of the processes of care and clinical outcomes of to care in for & and 10 for review of clinical practice guidelines for the of patients with and a of for the of quality indicators for and development of an by a method for of of clinical in and of A Systematic Review and of and on and relevance of potentially quality indicators for use in with and the Quality of Care of in on outcome in outcomes and quality from the Association for Care Task on to quality indicators in care of team members about of and to systematic review of for measuring outcomes in within Care of Vulnerable Elders to the of to Healthcare on the Quality of Care for and clinical relevance of of care for with at of and for Elders in The and Association with the Medical the Quality of Health from or A of Methods in for Medical indicators for the care of a systematic of care for and at from characteristics failure to care for 2 Indicators for in the a Systematic of quality indicators for the of care in hospitals in a to quality of the quality of care using health record information in of assessment to improvement of elderly care in practice using to adherence to ACOVE quality indicators: for randomized and Prevention of of Medical on Quality of Ambulatory of Care in of Care in One by ACOVE Process and for developing quality indicators for the care of older in the a method of developing quality indicators for of the Quality indicators for Care Indicators for of a Systematic of care in care hospitals in older for impairment and of health to the quality of care for patients in Quality of Care for and of the Quality Indicator and of Care and of the of Care Indicators for in with Measurement and for on the and for in
Cyberpsychology, Behavior, and Social NetworkingVol. 23, No. 7 EditorialConnecting Through Technology During the Coronavirus Disease 2019 Pandemic: Avoiding “Zoom Fatigue”Brenda K. WiederholdBrenda K. WiederholdBrenda K. Wiederhold, Editor-in-Chief Search for more papers by this authorPublished Online:10 Jul 2020https://doi.org/10.1089/cyber.2020.29188.bkwAboutSectionsView articleView Full TextPDF/EPUB Permissions & CitationsPermissionsDownload CitationsTrack CitationsAdd to favorites Back To Publication ShareShare onFacebookXLinked InRedditEmail View article"Connecting Through Technology During the Coronavirus Disease 2019 Pandemic: Avoiding “Zoom Fatigue”." Cyberpsychology, Behavior, and Social Networking, 23(7), pp. 437–438FiguresReferencesRelatedDetailsCited byQuantitative analysis of communication changes in online medication counseling using the Roter Interaction SystemResearch in Social and Administrative Pharmacy, Vol. 20, No. 1“Who Said That?” Applying the Situation Awareness Global Assessment Technique to Social Telepresence13 December 2023 | ACM Transactions on Human-Robot Interaction, Vol. 12, No. 4The good and bad of an online asynchronous general education course: Students’ perceptions18 December 2023 | Psychology Teaching Review, Vol. 29, No. 2Face-to-face more important than digital communication for mental health during the pandemic17 May 2023 | Scientific Reports, Vol. 13, No. 1Videoconference fatigue from a neurophysiological perspective: experimental evidence based on electroencephalography (EEG) and electrocardiography (ECG)26 October 2023 | Scientific Reports, Vol. 13, No. 1The ‘Zoomification’ of Collaboration: How 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No AccessWorld Development Report1 Feb 2013World Development Report 1990PovertyAuthors/Editors: World BankWorld Bankhttps://doi.org/10.1596/0-1952-0851-XView ChaptersAboutPDF (21.1 MB) ToolsAdd to favoritesDownload CitationsTrack Citations ShareFacebookTwitterLinked In Abstract:This report is the thirteenth in the annual series addressing major development issues. This report is about the poor. It is thus about the fundamental issue in economic development : the eradication of poverty from the world. The report defines poverty in broad terms, to include literacy, nutrition, and health, as well as income. The evidence suggests that rapid and politically sustainable progress on poverty has been achieved by pursuing a strategy with two equally important elements. The first is to promote the efficient use of the poor's most abundant asset : labor. It calls for policies that harness market incentives, social and political institutions, infrastructure and technology. The second element is the provision of basic social services to the poor (e.g. primary health care, family planning, nutrition, and primary education). The report concludes that eliminating poverty altogether is not a realistic goal for the 1990s, but that reducing it greatly is entirely possible. Using plausible assumptions about the global economic environment, and with some policy improvements, the report projects a fall of one third in the number of people in poverty by the year 2000. 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Academia and Clinic18 August 2009Preferred Reporting Items for Systematic Reviews and Meta-Analyses: The PRISMA StatementFREEDavid Moher, PhD, Alessandro Liberati, MD, DrPH, Jennifer Tetzlaff, BSc, and Douglas G. Altman, DSc, the PRISMA Group*David Moher, PhDFrom Ottawa Methods Centre, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada; Università di Modena e Reggio Emilia, Modena, Italy; Centro Cochrane Italiano, Istituto Ricerche Farmacologiche Mario Negri, Milan, Italy; and Centre for Statistics in Medicine, University of Oxford, Oxford, United Kingdom.Search for more papers by this author, Alessandro Liberati, MD, DrPHFrom Ottawa Methods Centre, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada; Università di Modena e Reggio Emilia, Modena, Italy; Centro Cochrane Italiano, Istituto Ricerche Farmacologiche Mario Negri, Milan, Italy; and Centre for Statistics in Medicine, University of Oxford, Oxford, United Kingdom.Search for more papers by this author, Jennifer Tetzlaff, BScFrom Ottawa Methods Centre, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada; Università di Modena e Reggio Emilia, Modena, Italy; Centro Cochrane Italiano, Istituto Ricerche Farmacologiche Mario Negri, Milan, Italy; and Centre for Statistics in Medicine, University of Oxford, Oxford, United Kingdom.Search for more papers by this author, and Douglas G. Altman, DScFrom Ottawa Methods Centre, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada; Università di Modena e Reggio Emilia, Modena, Italy; Centro Cochrane Italiano, Istituto Ricerche Farmacologiche Mario Negri, Milan, Italy; and Centre for Statistics in Medicine, University of Oxford, Oxford, United Kingdom.Search for more papers by this author, the PRISMA Group*Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-151-4-200908180-00135 SectionsSupplemental MaterialAboutVisual AbstractPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Editor's Note: In order to encourage dissemination of the PRISMA Statement, this article is freely accessible on the Annals of Internal Medicine Web site (www.annals.org) and will be also published in PLOS Medicine, BMJ, Journal of Clinical Epidemiology, and Open Medicine. The authors jointly hold the copyright of this article. For details on further use, see the PRISMA Web site (www.prisma-statement.org).Systematic reviews and meta-analyses have become increasingly important in health care. Clinicians read them to keep up to date with their field (1, 2), and they are often used as a starting point for developing clinical practice guidelines. Granting agencies may require a systematic review to ensure there is justification for further research (3), and some health care journals are moving in this direction (4). As with all research, the value of a systematic review depends on what was done, what was found, and the clarity of reporting. As with other publications, the reporting quality of systematic reviews varies, limiting readers' ability to assess the strengths and weaknesses of those reviews.Several early studies evaluated the quality of review reports. In 1987, Mulrow examined 50 review articles published in four leading medical journals in 1985 and 1986 and found that none met all eight explicit scientific criteria, such as a quality assessment of included studies (5). In 1987, Sacks and colleagues (6) evaluated the adequacy of reporting of 83 meta-analyses on 23 characteristics in six domains. Reporting was generally poor; between one and 14 characteristics were adequately reported (mean = 7.7; standard deviation = 2.7). A 1996 update of this study found little improvement (7).In 1996, to address the suboptimal reporting of meta-analyses, an international group developed a guidance called the QUOROM Statement (QUality Of Reporting Of Meta-analyses), which focused on the reporting of meta-analyses of randomized, controlled trials (8). In this article, we summarize a revision of these guidelines, renamed PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses), which have been updated to address several conceptual and practical advances in the science of systematic reviews (Box 1).Box 1. Conceptual Issues in the Evolution From QUOROM to PRISMA Download figure Download PowerPoint TerminologyThe terminology used to describe a systematic review and meta-analysis has evolved over time. One reason for changing the name from QUOROM to PRISMA was the desire to encompass both systematic reviews and meta-analyses. We have adopted the definitions used by the Cochrane Collaboration (9). A systematic review is a review of a clearly formulated question that uses systematic and explicit methods to identify, select, and critically appraise relevant research, and to collect and analyze data from the studies that are included in the review. Statistical methods (meta-analysis) may or may not be used to analyze and summarize the results of the included studies. Meta-analysis refers to the use of statistical techniques in a systematic review to integrate the results of included studies.Developing the PRISMA StatementA three-day meeting was held in Ottawa, Ontario, Canada, in June 2005 with 29 participants, including review authors, methodologists, clinicians, medical editors, and a consumer. The objective of the Ottawa meeting was to revise and expand the QUOROM checklist and flow diagram, as needed.The executive committee completed the following tasks, prior to the meeting: a systematic review of studies examining the quality of reporting of systematic reviews, and a comprehensive literature search to identify methodological and other articles that might inform the meeting, especially in relation to modifying checklist items. An international survey of review authors, consumers, and groups commissioning or using systematic reviews and meta-analyses was completed, including the International Network of Agencies for Health Technology Assessment (INAHTA) and the Guidelines International Network (GIN). The survey aimed to ascertain views of QUOROM, including the merits of the existing checklist items. The results of these activities were presented during the meeting and are summarized on the PRISMA Web site (www.prisma-statement.org).Only items deemed essential were retained or added to the checklist. Some additional items are nevertheless desirable, and review authors should include these, if relevant (10). For example, it is useful to indicate whether the systematic review is an update (11) of a previous review, and to describe any changes in procedures from those described in the original protocol.Shortly after the meeting a draft of the PRISMA checklist was circulated to the group, including those invited to the meeting but unable to attend. A disposition file was created containing comments and revisions from each respondent, and the checklist was subsequently revised 11 times. The group approved the checklist, flow diagram, and this summary paper.Although no direct evidence was found to support retaining or adding some items, evidence from other domains was believed to be relevant. For example, Item 5 asks authors to provide registration information about the systematic review, including a registration number, if available. Although systematic review registration is not yet widely available (12, 13), the participating journals of the International Committee of Medical Journal Editors (ICMJE) (14) now require all clinical trials to be registered in an effort to increase transparency and accountability (15). Those aspects are also likely to benefit systematic reviewers, possibly reducing the risk of an excessive number of reviews addressing the same question (16, 17) and providing greater transparency when updating systematic reviews.The PRISMA StatementThe PRISMA Statement consists of a 27-item checklist (Table 1; see also Table S1, for a downloadable Word template for researchers to re-use) and a four-phase flow diagram (Figure 1; see also Figure S1, for a downloadable Word template for researchers to re-use). The aim of the PRISMA Statement is to help authors improve the reporting of systematic reviews and meta-analyses. We have focused on randomized trials, but PRISMA can also be used as a basis for reporting systematic reviews of other types of research, particularly evaluations of interventions. PRISMA may also be useful for critical appraisal of published systematic reviews. However, the PRISMA checklist is not a quality assessment instrument to gauge the quality of a systematic review.Table 1. Checklist of Items to Include When Reporting a Systematic Review or Meta-AnalysisFigure 1. Flow of information through the different phases of a systematic review. Download figure Download PowerPoint From QUOROM to PRISMAThe new PRISMA checklist differs in several respects from the QUOROM checklist, and the substantive specific changes are highlighted in Table 2. Generally, the PRISMA checklist “decouples” several items present in the QUOROM checklist and, where applicable, several checklist items are linked to improve consistency across the systematic review report.Table 2. Substantive Specific Changes Between the QUOROM Checklist and the PRISMA ChecklistThe flow diagram has also been modified. Before including studies and providing reasons for excluding others, the review team must first search the literature. This search results in records. Once these records have been screened and eligibility criteria applied, a smaller number of articles will remain. The number of included articles might be smaller (or larger) than the number of studies, because articles may report on multiple studies and results from a particular study may be published in several articles. To capture this information, the PRISMA flow diagram now requests information on these phases of the review process.EndorsementThe PRISMA Statement should replace the QUOROM Statement for those journals that have endorsed QUOROM. We hope that other journals will support PRISMA; they can do so by registering on the PRISMA Web site. To underscore to authors, and others, the importance of transparent reporting of systematic reviews, we encourage supporting journals to reference the PRISMA Statement and include the PRISMA Web address in their instructions to authors. We also invite editorial organizations to consider endorsing PRISMA and encourage authors to adhere to its principles.The PRISMA Explanation and Elaboration PaperIn addition to the PRISMA Statement, a supporting Explanation and Elaboration document has been produced (18) following the style used for other reporting guidelines (19–21). The process of completing this document included developing a large database of exemplars to highlight how best to report each checklist item, and identifying a comprehensive evidence base to support the inclusion of each checklist item. The Explanation and Elaboration document was completed after several face-to-face meetings and numerous iterations among several meeting participants, after which it was shared with the whole group for additional revisions and final approval. Finally, the group formed a dissemination subcommittee to help disseminate and implement PRISMA.DiscussionThe quality of reporting of systematic reviews is still not optimal (22–27). In a recent review of 300 systematic reviews, few authors reported assessing possible publication bias (22), even though there is overwhelming evidence both for its existence (28) and its impact on the results of systematic reviews (29). Even when the possibility of publication bias is assessed, there is no guarantee that systematic reviewers have assessed or interpreted it appropriately (30). Although the absence of reporting such an assessment does not necessarily indicate that it was not done, reporting an assessment of possible publication bias is likely to be a marker of the thoroughness of the conduct of the systematic review.Several approaches have been developed to conduct systematic reviews on a broader array of questions. For example, systematic reviews are now conducted to investigate cost-effectiveness (31), diagnostic (32) or prognostic questions (33), genetic associations (34), and policy making (35). The general concepts and topics covered by PRISMA are all relevant to any systematic review, not just those whose objective is to summarize the benefits and harms of a health care intervention. However, some modifications of the checklist items or flow diagram will be necessary in particular circumstances. For example, assessing the risk of bias is a key concept, but the items used to assess this in a diagnostic review are likely to focus on issues such as the spectrum of patients and the verification of disease status, which differ from reviews of interventions. The flow diagram will also need adjustments when reporting individual patient data meta-analysis (36).We have developed an explanatory document (18) to increase the usefulness of PRISMA. For each checklist item, this document contains an example of good reporting, a rationale for its inclusion, and supporting evidence, including references, whenever possible. We believe this document will also serve as a useful resource for those teaching systematic review methodology. We encourage journals to include reference to the explanatory document in their Instructions to Authors.Like any evidence-based endeavor, PRISMA is a living document. To this end we invite readers to comment on the revised version, particularly the new checklist and flow diagram, through the PRISMA Web site. We will use such information to inform PRISMA's continued development.References1. Oxman AD, Cook DJ, Guyatt GH. Users' guides to the medical literature. VI. How to use an overview. Evidence-Based Medicine Working Group. JAMA. 1994;272:1367-71. [PMID: 7933399] CrossrefMedlineGoogle Scholar2. Swingler GH, Volmink J, Ioannidis JP. Number of published systematic reviews and global burden of disease: database analysis. BMJ. 2003;327:1083-4. [PMID: 14604930] CrossrefMedlineGoogle Scholar3. Canadian Institutes of Health Research. Randomized controlled trials registration/application checklist. December 2006. Accessed at www.cihr-irsc.gc.ca/e/documents/rct_reg_e.pdf on 19 May 2009. Google Scholar4. Young C, Horton R. Putting clinical trials into context. Lancet. 2005;366:107-8. [PMID: 16005318] CrossrefMedlineGoogle Scholar5. Mulrow CD. 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[PMID: CrossrefMedlineGoogle In to A Article, and Disclosure From Ottawa Methods Centre, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada; Università di Modena e Reggio Emilia, Modena, Italy; Centro Cochrane Italiano, Istituto Ricerche Farmacologiche Mario Negri, Milan, Italy; and Centre for Statistics in Medicine, University of Oxford, Oxford, United The following to the PRISMA Altman, DSc, Centre for Statistics in Medicine United PhD, University Hospital MD, Health Research & Health PLoS Medicine United PhD, Hospital of Ontario, A. & Research and PhD, PLoS Medicine the of United PhD, Cochrane Centre United and of and MD, of Medicine, Clinical Epidemiology and University Ontario, PhD, Università di Modena e Reggio and Centro Cochrane Italiano, Istituto Ricerche Farmacologiche Mario J. PhD, University of United MD, PhD, of Medicine, Clinical Epidemiology and University Ontario, PhD, of Health MD, of and Medicine, University of MD, PhD, Medical United MD, The Cochrane Centre PhD, Ottawa Hospital Research Institute Ontario, MD, of Medicine, Clinical Epidemiology and University Ontario, PhD, United MD, University of MD, PhD, Systematic Reviews United and for Health and University of the and Alessandro Liberati, MD, Università di Modena e Reggio and Centro Cochrane Italiano, Istituto Ricerche Farmacologiche Mario MD, Centre for the of the of Health PhD, The United MD, Centro Cochrane Italiano, Istituto Ricerche Farmacologiche Mario Moher, PhD, Ottawa Methods Centre, Ottawa Hospital Research Institute Ontario, MD, Annals of Internal Medicine for Medical MD, Health Research Centre Health and Technology Assessment Ontario, Canada; at the of the first meeting of the group, Ontario, MD, University of Hospital of Ontario, PhD, Health International G. MD, PhD, Evidence-Based Jennifer Tetzlaff, BSc, Ottawa Methods Centre, Ottawa Hospital Research Institute Ontario, The Cochrane Cochrane Collaboration United at the of the first meeting of the group, United and MD, Institute of University of Ottawa Ontario, PRISMA was by the Canadian Institutes of Health Università di Modena e Reggio Emilia, Italy; Research Clinical Evidence The Cochrane Collaboration; and Liberati is in through of the of University and Altman is by Research Moher is by a University of Ottawa Research of the any in the or of the PRISMA no a role in the Moher, PhD, Ottawa Methods Centre, Ottawa Hospital Research Institute, The Ottawa Ottawa, Canada; Moher and Ottawa Methods Centre, Ottawa Hospital Research Institute, The Ottawa Ottawa, Università di Modena e Reggio and Centro Cochrane Italiano, Istituto Ricerche Farmacologiche Mario Negri, Milan, Centre for Statistics in Medicine, University of Oxford, United of the PRISMA is in the PRISMA Statement for Reporting Systematic Reviews and of Studies Health Explanation and Elaboration Alessandro Liberati Douglas G. Altman Jennifer
No AccessDisaster Risk Management1 Feb 2013Natural Disaster HotspotsA Global Risk AnalysisAuthors/Editors: Maxx Dilley, Robert S. Chen, Uwe Deichmann, Arthur L. Lerner-Lam, and Margaret ArnoldMaxx Dilley, Robert S. Chen, Uwe Deichmann, Arthur L. Lerner-Lam, and Margaret Arnoldhttps://doi.org/10.1596/0-8213-5930-4SectionsAboutPDF (29.3 MB) ToolsAdd to favoritesDownload CitationsTrack Citations ShareFacebookTwitterLinked In Abstract:Earthquakes, floods, drought, and other natural hazards cause tens of thousands of deaths, hundreds of thousands of injuries, and billions of dollars in economic losses each year around the world. Many billions of dollars in humanitarian assistance, emergency loans, and development aid are expended annually. Yet efforts to reduce the risks of natural hazards remain largely uncoordinated across different hazard types and do not necessarily focus on areas at highest risk of disaster. Natural Disaster Hotspots presents a global view of major natural disaster risk hotspots – areas at relatively high risk of loss from one or more natural hazards. It summarizes the results of an interdisciplinary analysis of the location and characteristics of hotspots for six natural hazards – earthquakes, volcanoes, landslides, floods, drought, and cyclones. Data on these hazards are combined with state-of-the-art data on the subnational distribution of population and economic output and past disaster losses to identify areas at relatively high risk from one or more hazards. 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Effect: A Case Study of Flood Risk in Vietnam's North of and African Studies, No.812 February new to landslides with a Vol.11, No.16 May of for Energy Production in Vol.8, September Risk Assessment of by Through of Extreme and Case Study of Vol.9, December of disaster and climate analysis of the of and their Change, November climate vulnerability and natural disasters in of Science, Vol.53, November and in Flooding and in and Planning and Space, September we for development and Mapping global and exposure to Environmental Change, the and of and health during floods in Journal of Human in Vol.14, May risk assessment for areas in and Development, Vol.15, October in with climate Science Review, Vol.8, December susceptibility in the and of a Earth Sciences, September to the risk of in to vulnerability and risk in Urban a Hazards, April in with Journal of and May vulnerability and risk using in in Journal of Geosciences, Vol.14, July evaluation of landslide susceptibility and review of Earth Sciences, July analysis of landslide hazard in Earth Sciences, August to urban flooding hotspots and emergency A case study in in Vol.25, August flood by local on a with a performance in drought Journal of and Research, Vol.27, January the impact of on Evidence from and and Planning Urban and City Science, No.610 September in Landslide Extreme for Landslide Susceptibility of Geophysical Research: Earth Surface, July and in to an analysis of of Risk Research, Vol.24, October risk assessment from flooding under climate Research Vol.16, May in and of Vol.34, Resilience the Economic of the and of in an urban A case study in de No.319 March slope model and shallow landslide susceptibility The area climate and change on and April on risks to May 2021The of Human Development Economic and Environmental In Province, AND April vulnerability assessment using a fuzzy in Water Resources Management, February Analysis of in – for Climate Change in Development Journal of Disaster Risk in and from remote & Development, No.36 November analysis on European and natural Hazards, November in Disaster Hazards Review, Vol.22, Method and Its Adaptation in Risk A Case Study in Sri Cities in the Coastal Journal of Environmental Research and Public Health, Vol.18, February Disasters and a and Development Review, Vol.14, June and Strategies in Resilience and of and No.128 August the of adaptation in and Development, Vol.13, February Resilience Through Water Resources Management1 January and Impacts of for and of and November Disaster Risk Reduction and A June Climate Change Adaptation in July Risk Assessment November and for August level of Natural Hazards and Risk, Vol.12, No.13 February urban flood and assessment for disaster risk in West Earth and Environmental Science, January Society of the geological and future of the Geological Society, No.128 December in Environmental Science, on Public from in from a Hazards and Earth System Sciences, Vol.21, April A systematic review and future of flood vulnerability Hazards and Earth System Sciences, Vol.21, May mapping of disasters using the hierarchy process under change and climate change in Hazards and Earth System Sciences, Vol.21, May the future of exposure and vulnerabilities in Modelling of location of urban population with Hazards and Earth System Sciences, Vol.21, No.121 January building exposure for and tsunami risk an case in Hazards and Earth System Sciences, Vol.21, November of the Impacts of the in Using Model in of September for Development of Forest October 2021The of Resilience Interventions to Drought Resilience of in of A Case of the Resilience and Systems in and Journal, of Modeling of to and Journal, the effects of A study of disaster and the Vol.34, January of climate change and area to drought risk for in China over the Journal of Climatology, October on Coastal and Strategies of Global Environmental December Framework for of hazard indices and in disaster risk the case study of and of Maps, Vol.16, January spatial resolution do we to model a local flood testing based on data from River Journal of Geosciences, Vol.13, January analysis of losses in China at the Vol.10, No.130 June Potential Evaluation Using November of drought risk analysis and via a review across and of and development on global flood of Hydrology, and in the of a tsunami in an An experience from the Eastern Science, Risk October
Telemedicine and e-HealthVol. 26, No. 9 OpinionFree AccessTechnology Literacy as a Barrier to Telehealth During COVID-19Austin J. Triana, Roman E. Gusdorf, Kaustav P. Shah, and Sara N. HorstAustin J. TrianaVanderbilt University School of Medicine, Nashville, Tennessee, USA.Search for more papers by this author, Roman E. GusdorfVanderbilt University School of Medicine, Nashville, Tennessee, USA.Search for more papers by this author, Kaustav P. ShahVanderbilt University School of Medicine, Nashville, Tennessee, USA.Search for more papers by this author, and Sara N. HorstAddress correspondence to: Sara N. Horst, MD, MPH, Department of Gastroenterology, Hepatology, and Nutrition, Vanderbilt University Medical Center, 1211 21st Avenue South, Medical Arts Building Suite 220, Nashville, TN 37232, USA E-mail Address: [email protected]Department of Gastroenterology, Hepatology, and Nutrition, Vanderbilt University Medical Center, Nashville, Tennessee, USA.Search for more papers by this authorPublished Online:10 Sep 2020https://doi.org/10.1089/tmj.2020.0155AboutSectionsPDF/EPUB Permissions & CitationsPermissionsDownload CitationsTrack CitationsAdd to favorites Back To Publication ShareShare onFacebookXLinked InRedditEmail During the ongoing COVID-19 pandemic, there have been many fundamental changes to the health care system, one of which has been the rapid adoption of telehealth.1 Despite technological capability for widespread implementation before the pandemic, telehealth remained limited in many areas of the United States due to state regulations and poor insurance reimbursement.2 When these policies changed in March 2020 with national widespread coverage for telemedicine, traditional clinical workflows attempted to rapidly shift to a virtual format to increase social distancing and protect vulnerable patients. At our institution alone, the number of telehealth visits increased from ∼15 per day to >2,000 per day in a matter of weeks.As the health care system rapidly reorganized and trained physicians on how to host videoconference visits, some patients have struggled to keep up. During these changes, providers reported that many patients were struggling to access their telemedicine appointments. Patients may have difficulty navigating their devices and entering the health care system virtually. Others simply do not have devices or a stable Wi-Fi to connect with providers from home. Technology literacy and access should be viewed as a major driver of health and needs to be on a large scale.As an example, Ms. P is a 70-year-old woman with diabetes and hypertension who knows she is high risk for complications from COVID-19. Taking extra precautions, she cancelled her in-person appointments and scheduled a telehealth visit with one of her providers. She spent an entire afternoon preparing her technology for the visit, but she could not connect to the virtual appointment. Despite a proactive mindset, she had difficulty downloading the necessary software. Recognizing this barrier to care Ms. P and other patients face, we started a medical student-led volunteer initiative to help patients set up and test devices for their telemedicine appointments. We rapidly created systematic processes for recruitment, volunteer training, clinic coverage, and operational support. A standardized phone script helped students guide patients as they downloaded the proper software and understood what to expect at the time of the visit.Within a month, we have had 135 medical student volunteers commit 1,300 h and assist >5,000 patients in preparing for upcoming telehealth visits. Along the way, we have seen a wide range of patient comfort with technology that has advanced our understanding of technology literacy. One patient, a computer programmer, initially scoffed when asked whether he needed help. However, he still appreciated the tip that he received about which web browser to use to access his visit, avoiding a glitch that kept some patients from connecting. For patients low self-reported technology literacy, our impact can be great. Many patients had never downloaded a smartphone application or used videoconferencing software before their first virtual appointment. Wary of hackers and scammers, another patient was strongly opposed to telehealth and wanted to cancel his visit, but after talking about the safety of the process with a student, he downloaded the software and had a successful telemedicine visit with his provider.If a patient cannot connect to the videoconference, the provider is forced to call the patient to troubleshoot over the phone, reschedule the appointment, or simply proceed without video. Prior work has shown that the video component significantly contributes to quality and satisfaction of the visit.3 In addition to the technology itself, patients need to know what to expect for their telehealth appointments. Ideally, a patient will have a medication list and be in a quiet and private location at the time of the visit. Therefore, it is important to communicate these expectations beforehand to avoid a visit that takes place from the grocery store or in the car.With the ability to see patients in their own environments, we also gain insight into their lives. Using videoconferencing, it is possible to see a patient's home, to contextualize their experiences, and to better utilize the biopsychosocial model of health. One patient was blind but wanted to use videoconferencing so that the provider could see him. A volunteer helped the patient and his able-sighted daughter navigate the telehealth process using accessibility features for blindness. As medical students who grew up immersed in technology, we have been humbled by the complexity of teaching others to navigate smartphones, web browsers, and applications, and we have seen the tremendous technology gaps in various patient populations.Outside the context of direct patient care, widespread adoption of telehealth has the potential to improve quality of life and health outcomes through additional synergies. Although many older adults perceive benefits from technology, common barriers include self-efficacy, cost, and privacy concerns.4 Prior research has shown that technology adoption can be improved through education and increasing perceived self-efficacy.5 If patients can better navigate their web browsers and applications, they may feel empowered to message their providers through the patient portal or look up healthy recipes online.Among the drastic changes in health care, we hope that updated regulations and improved insurance coverage will be permanent, improving access for patients by addressing issues related to distance, mobility, or health concerns. Licensure across state lines remains a big question that could drastically impact access for many patients. In addition, it is imperative to further understand and address how to help our patients access and use technology. The transition to telehealth requires time, patience, and resources—an investment that is crucial for patients who are at risk of being left behind.AcknowledgmentsWe thank Drs. Michelle Griffith and Eiman Jahangir for organizational support of this project as well as reviewing and editing drafts.Disclosure StatementNo competing financial interests exist.Funding InformationNo funding was received for this article.References1. Smith A, Thomas E, Snoswell C, Haydon H, Mehrotra A, Clemensen J, Caffery Lj. Telehealth for global emergencies: Implications for coronavirus disease 2019 (COVID-19). J Telemed Telecare. 2020. Available at: https://doi.org/10.1177/1357633X20916567 (last accessed May 15, 2020). Google Scholar2. Dorsey ER, Topol EJ. State of telehealth. N Engl J Med 2016;375:154–161. Crossref, Medline, Google Scholar3. McLendon SF. Interactive video telehealth models to improve access to diabetes specialty care and education in the rural setting: A systematic review. Diabetes Spectr 2017;30:124–136. Crossref, Medline, Google Scholar4. Scott Kruse C, Karem P, Shifflett K, Vegi L, Ravi K, Brooks M. Evaluating barriers to adopting telemedicine worldwide: A systematic review. J Telemed Telecare 2018;24:4–12. Crossref, Medline, Google Scholar5. Gatti FM, Brivio E, Galimberti C. "The future is ours too": A training process to enable the learning perception and increase self-efficacy in the use of tablets in the elderly. Educ Gerontol 2017;43:209–224. 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Triana, Roman E. Gusdorf, Kaustav P. Shah, and Sara N. Horst.Technology Literacy as a Barrier to Telehealth During COVID-19.Telemedicine and e-Health.Sep 2020.1118-1119.http://doi.org/10.1089/tmj.2020.0155Published in Volume: 26 Issue 9: September 10, 2020Online Ahead of Print:May 19, 2020 TopicsCOVID-19e-health and telehealth careTelehealth devices PDF download
No AccessStand Alone Books1 Feb 2013World Development Indicators 2001Authors/Editors: World BankWorld Bankhttps://doi.org/10.1596/0-8213-4898-1SectionsAboutPDF (4.6 MB) ToolsAdd to favoritesDownload CitationsTrack Citations ShareFacebookTwitterLinked In Abstract:Now in its 5th edition, the World Bank's respected statistical reference publication provides a comprehensive view of the world economy. The print edition contains over 80 tables and 600 indicators for 148 economies and 14 country groups, with basic indicators for a further 59 economies. The book contains new tables on social indicators of poverty and global environmental issues. This year's edition retains the basic thematic presentation with six sections covering World View, People, Environment, Economy, States and Markets, and Global Links.World Development Indicators 2001 contains a wealth of information including:* A special graphical report on progress toward International Development Goals.* The most recent data on poverty, education, health, and the environment from around the world.* New data on gender and development drawn from the World Bank's recent policy research report.* New data on the digital divide and how Information Communication Technology is changing the process of development.* New data on the world economy. 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A case study in GuatemalaHuman impact on bird diversity and community structure in a tropical montane cloud forest in Alta Verapaz, Guatemala, with special reference to the Quetzal (Pharomachrus mocinno)The Economics of Worm ControlUrban development in the global periphery: The consequences of economic and ideological globalization View Published: April 2001ISBN: 978-0-8213-4898-7 Copyright & Permissions Related CountriesChinaRelated TopicsEnvironmentFinance and Financial Sector DevelopmentHealth Nutrition and PopulationPrivate Sector Development KeywordsSTATISTICAL INFORMATIONSTATISTICAL TERMSMORTALITY RATESGENDER DIFFERENCESLABOR FORCE PARTICIPATIONADULT ILLITERACYENROLMENT RATIOGROSS NATIONAL PRODUCTLIFE EXPECTANCY (HUMAN)POPULATION DENSITYEMPLOYMENT STATISTICSUNEMPLOYMENT RATESWAGE STATISTICSGIRLS' EDUCATIONDISEASE PREVENTIONREPRODUCTIVE HEALTHHEALTH RISK ASSESSMENTAGRICULTURAL PRODUCTIVITYDEFORESTATIONENVIRONMENTAL DEGRADATIONENERGY PRODUCTIONENERGY USEURBAN ENVIRONMENTTRANSPORT COSTSEXPORT PERFORMANCEIMPORT STATISTICSPRICESBALANCE OF PAYMENTS STATISTICSTAX POLICYPUBLIC ENTERPRISESGOVERNMENT SPENDING POLICYGLOBAL INTEGRATIONTRADE BARRIERSFINANCIAL FLOWSAID DEPENDENCYTOURISM DEVELOPMENTACQUIRED IMMUNE DEFICIENCY SYNDROMEDEVELOPING COUNTRIESDEVELOPMENT GOALSDISSEMINATIONINFANTINFANT DEATHSINFANT MORTALITYINFANT MORTALITY RATESLEGAL STATUSLIVE BIRTHSPROGRESS PDF DownloadLoading ...
Position Papers1 July 1995Economic Analysis of Health Care Technology: A Report on PrinciplesTask Force on Principles for Economic Analysis of Health Care Technology*Task Force on Principles for Economic Analysis of Health Care Technology*Author, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-123-1-199507010-00011 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail PreambleAlthough economic outcomes research is an evolving field in health services research, there are correct and incorrect ways to conduct and report on economic outcomes studies. Research practices that help to minimize real or perceived bias will increase the quality and usefulness of such studies for those who sponsor, publish, and use them. Because of public concerns about the potential for bias in the design, analysis, and reporting of economic analyses of health care technology, we formed a task force to develop principles to enhance the credibility of these studies. The Task Force on Principles for Economic Analysis of ...References1. Henry D. Economic analysis as an aid to subsidization decisions: the development of Australian guidelines for pharmaceuticals. PharmacoEconomics. 1992; 1:54-67. Google Scholar2. Detsky A. Guidelines for economic analysis of pharmaceutical products: a draft document for Ontario and Canada. PharmacoEconomics. 1993; 3:354-61. Google Scholar3. Udvarhelyi IS, Colditz GA, Rai A, Epstein AM. Cost-effectiveness and cost–benefit analyses in the medical literature. Are the methods being used correctly? Ann Intern Med. 1992; 116:238-44. Google Scholar4. Luce BR, Simpson K. Methods of cost effectiveness analysis: areas of consensus and debate. Clin Ther. 1995; 17:263-80. Google Scholar5. Drummond M, Brandt A, Luce B, Rovira J. Standardizing methodologies for economic evaluation in health care. Practice, problems, and potential. Int J Technol Assess Health Care. 1993; 9:26-36. Google Scholar6. Freedman B. Equipoise and the ethics of clinical research. N Engl J Med. 1987; 317:141-5. Google Scholar7. Uniform requirements for manuscripts submitted to biomedical journals. International Committee of Medical Journal Editors. JAMA. 1993; 269:2282-6. Google Scholar8. Angell M, Relman AS. Ethical imperialism? Fraud in biomedical research: a time for congressional restraint (Editorial). N Engl J Med. 1988; 318:1462-3. Google Scholar9. Engler RL, Covell JW, Friedman PJ, Kitcher PS, Peters RM. Misrepresentation and responsibility in medical research. N Engl J Med. 1987; 317:1383-9. Google Scholar10. Chalmers TC, Frank CS, Reitman D. Minimizing the three stages of publication bias. JAMA. 1990; 263:1392-5. Google Scholar11. Sharp DW. What can and should be done to reduce publication bias? The perspective of an editor. JAMA. 1990; 263:1390-1. Google Scholar12. Dickersin K. The existence of publication bias and risk factors for its occurrence. JAMA. 1990; 263:1385-9. Google Scholar13. Chalmers I. Underreporting research is scientific misconduct. JAMA. 1990; 263:1405-8. Google Scholar14. Schafer A. The ethics of the randomized clinical trial. N Engl J Med. 1982; 307:719-24. Google Scholar15. U.S. Public Health Service Panel on Cost-Effectiveness in Health and Medicine, Washington, D.C.: U.S. Public Health Service 1995. Google Scholar16. American Federation for Clinical Research National Council. American Federation for Clinical Research guidelines for avoiding conflict of interest. Clin Res. 1990; 38:239-40. Google Scholar17. Donaldson MS, Capron AM, eds. Patient Outcomes Research Teams: Managing Conflict of Interest. Washington, D.C.: National Academy Pr; 1991. Google Scholar18. American College of Physicians Ethics Manual. Part II: Research, other ethical issues. Recommended reading. Ad Hoc Committee on Medical Ethics, American College of Physicians. Ann Intern Med. 1984; 101:263-74. Google Scholar19. Institute of Medicine. The Responsible Conduct of Research in the Health Sciences: Report of a Study by a Committee on the Responsible Conduct of Research, Institute of Medicine, Division of Health Sciences Policy. Washington, D.C.: National Academy Pr; 1989. Google Scholar20. Korenman SG, Shipp AC. Teaching the Responsible Conduct of Research through a Case Study Approach: A Handbook for Instructors. Washington, D.C.: Association of American Medical Colleges; 1994; 191-5. Google Scholar21. Association of Academic Health Centers. Conflicts of Interest in Institutional Decision-Making: Task Force on Science Policy. Washington, D.C.: Association of Academic Health Centers; 1994. Google Scholar22. AFCR guidelines for the responsible conduct of research. Clin Res. 1989; 37:510-1. Google Scholar23. Harvard guidelines for investigators in scientific research. Clin Res. 1989; 37:192-3. Google Scholar24. Donaldson MS, Capron AM. Patient Outcome Research Teams: Managing Conflicts of Interest. Washington, D.C.: National Academy Pr; 1991. Google Scholar25. Hillman AL, Eisenberg JM, Pauly MV, Bloom BS, Glick H, Kinosian B, et al. Avoiding bias in the conduct and reporting of cost-effectiveness research sponsored by pharmaceutical companies. N Engl J Med. 1991; 324:1362-5. Google Scholar26. Drummond MF. Economic evaluation of pharmaceuticals: science or marketing? Pharmacoeconomics. 1992; 1:8-13. Google Scholar27. Freeman R. Health economics and strategic planning in pharmaceutical companies. Journal of Research in Pharmaceutical Economics. 1992; (In press). Google Scholar28. The Zitter Group. The HMO Outcomes Study. San Francisco: Center for Outcomes Information; 1991. Google Scholar29. Asch D. Opportunity and motive: conflicts of interest in industry-sponsored research. LDI Health Policy and Research Quarterly. 1981; 1:3. Google Scholar30. Kassirer JP, Angell M. The journal's policy on cost-effectiveness analyses (Editorial). N Engl J Med. 1994; 331:669-70. Google Scholar31. Hillman AL, Kim M. Decision-making in health care: discounting of life years revisited. PharmacoEconomics. 1994; 1995; 7:198-205. Google Scholar Author, Article, and Disclosure InformationAffiliations: Disclosure: The public announcement (at the time of a presentation or publication) of the evaluation and interpretation of the results of a study. Disclosure includes discussion of sources of possible bias, potential conflict of interest, relevant constraints imposed on investigators in their conduct or reporting of the study, the nature and amount of support received by the investigators, and other pertinent information necessary for full evaluation of the report.Corresponding Author: Alan L. Hillman, MD, MBA, Leonard Davis Institute of Health Economics, Center for Health Policy, University of Pennsylvania, 3641 Locust Walk, Philadelphia, PA 19104-6218.Disclaimer: Some of the views expressed in this report do not necessarily reflect those of all individual members of the Task Force or their affiliated organizations. Individual members did not officially represent the affiliated organizations. 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During the past few months, mental health has received public and media attention in an unprecedented manner. This was related to the release of the report of the National Mental Health Survey (NMHS).[1] Media referred to the findings of the report as follows: “India needs to talk about mental illness;”[2] “Every sixth Indian needs mental health help;”[3] “8% of people in Karnataka have mental illness;”[4] “Mental problems more in 30–49 age group or over 60; low income linked to occurrence of mental disorders;”[5] and “urban areas to be most affected”[2] were some of the headlines in the mass media. The NMHS[1] will be a milestone in understanding the epidemiology of mental disorders in the country. It is against this importance of the survey, the current commentary places the survey in the historical context, describes the methodology of the survey, salient findings and discusses the implications of the survey. Psychiatric epidemiology has been an area of great interest among all the leading psychiatrists. The other similar area of interest is the psychiatric classifications. In both these fields, there are more “failures” than successes in the past 60 years. There have been great times and not so great times in the Indian psychiatric epidemiology. It has been well reviewed.[67] One of the first studies, a massive plan by Govindaswamy as quoted by[67] in the 1st year of the All India Institute of Mental Health, Bengaluru, was so ambitious in identifying the causative factors that it did not get off the planning stage. The next major, a milestone, was the Agra study.[8] This study is significant for the size of the studied population (nearly 30,000 in one study center, as compared to 30,000 + in the National Mental Health survey (NMHS), which is in the focus of the current review) and the identification of factors contributing to mental disorders (rural–urban differences, migrancy, etc.). There were a number of small size studies in the 1960s and 1970s. The most important of these was the “The Great Universe of Kota”[9] considered later. There was a recognition for the need for a large-scale multicentered epidemiological study in 1976 and the Indian Council of Medical Research Department of Science and Technology (DST) project came up.[7] This was a four-centered epidemiological project in Bengaluru, Baroda, Calcutta, and Patiala. Initially, the study aimed to “estimate the prevalence of psychiatric morbidity at different selected centers and investigate the sociodemographic correlates.” However, midway in the project, the objective was shifted to an interventional study, “develop and evaluate methods designed to reach, and offer services to the sick population.”[7] There was a lull in general population, psychiatric epidemiological studies till the early 2000. The next major multicentered study using the World Mental Health Survey (WMHS) occurred in the beginning of the current century. It has had challenges is clear from the fact that it is being published only after 12 years of completion of the study (published in the current issue).[10] The background is important to understand as the NMHS is the most expensive (around Rs. 5 crores), and most ambitious general population epidemiological study undertaken in the country to date. For this reason, it is important to understand the findings in detail and draw lessons for the future. As a scientific discipline, epidemiology has an important place in health sciences. It was Morris who described the seven purposes of epidemiology. These are: (i) understanding the magnitude of the mental disorders; (ii) the causative factors; (iii) calculating the morbid risk; (iv) monitoring the historical trends; (v) completion of clinical picture; (vi) identification of new syndromes; and (vii) treatment utilization in the community.[11] NATIONAL MENTAL HEALTH SURVEY METHODOLOGY The NMHS was undertaken in 12 states across six regions of India (North [Punjab and Uttar Pradesh]; South [Tamil Nadu and Kerala]; East [Jharkhand and West Bengal]; West [Rajasthan and Gujarat]; Central [Madhya Pradesh and Chhattisgarh]; and North-East [Assam and Manipur]). In each state, the dedicated team of investigators included mental health and public health professionals. A uniform and standardized methodology was adopted for the NMHS. A pilot study was undertaken in the district of Kolar, the Public Health Observatory of National Institute of Mental Health and Neuro Sciences (NIMHANS). The Master Protocol for the study was drafted based on the results from the pilot study and finalized after deliberations with the National Technical Advisory Group and the National Expert Panel and discussions with the state teams. A detailed operational guidelines document was developed to conduct the survey. The report provides detailed account of the methodology adopted for the study (pages 7–83) and results (pages 84–132) and presents recommendations (pages 138–144). The methodology adopted was multistage, stratified, random cluster sampling technique, with random selection based on probability proportionate to size at each stage; all individuals 18 years and above in the selected households were interviewed. A subsample was included in four states to examine feasibility of methodology for understanding mental morbidity among adolescents (13–17 years). The total sample is 34,802 with about 3000 (range: 2479–3508) in each of the states. The NMHS 2015–2016 interviewed 39,532 individuals across 720 clusters from eighty taluks in 43 districts of the 12 selected states. The response rate was 91.9% at household level and 88.0% at individual level. Across the states, the population interviewed were similar to the state population characteristics and also representative of the country as per Census 2011. Both quantitative and qualitative methods were employed. A set of ten instruments including Mini International Neuropsychiatric Interview (M.I.N.I 6.0) was utilized to identify the cases, household information, sociodemographic details, tobacco use, screening for epilepsy, screening for intellectual disability (ID), screening for autism spectrum disorder, disability assessment, health-care utilization, and socioeconomic impact of illness. After a rigorous 8-week training and microplanning effort, field data collectors undertook door-to-door interviews. The training was participatory and the different methods included classroom sessions, training in the hospital (observation and demonstration of interviews), and training in the community (both supervised and independent) and hands-on training in data collection on tablets. Information was captured on handheld devices, and strict protocols were established for data transfer and management with access controlled mechanisms. To ensure quality apart from rigorous training, weekly and fortnightly review and problem-solving meeting were held both locally and with the NIMHANS team. Data received from all states were examined for errors periodically and regularly and feedback provided to the state team during fortnightly e-reviews. More than 200 such e-meetings were held during the survey period. The weighted estimates for the lifetime prevalence and current prevalence were derived for conditions included in the International Classification of Disease, Tenth Revision, Diagnostic Criteria for Research. RESULTS Of the large amount of findings, three of them are vital for understanding of the prevalence, pattern of mental disorders, and the treatment utilization. First of this is the lifetime and current prevalence for the different states [Table 1].Table 1: Crude prevalence rates of mental disorders, tobacco use and suicidal risk (Adapted from Table 13 (p.79) from NMHS[1])The overall weighted prevalence for any mental morbidity was 13.7% lifetime and 10.6% current mental morbidity. What is striking is the differing prevalence rates across the centers. The lowest lifetime prevalence of 8.1% in Assam and the highest lifetime prevalence of 19.9% in Manipur have been reported, though they share common background. Similar is the striking 2-fold difference in the lifetime prevalence between Punjab and Uttar Pradesh (18.1% and 8.7%). The same 2-fold difference is seen in the current prevalence rates. Another significant finding is the vast difference in tobacco use (5.4%–39.6%). Furthermore, significant finding are the differences in the reported suicidal risk (2.2%–12.2%). A number of tables provide the sociodemographic factors and prevalence rates. Currently, only aggregated data are available and not center-specific data. It is interesting to see wide variation in the prevalence rates of different disorders across the states. Explanation for these differences is not currently available [Table 2].Table 2: Distribution of mental morbidity across the states, from NMHS, Table 22, Page 121[1]The age group between 40 and 49 years was predominantly affected (psychotic disorders, bipolar affective disorders [BPADs]), depressive disorders, and neurotic and stress-related disorders. The prevalence of substance use disorders was highest in the 50–59 years age group (29.4%). The gender prevalence of psychotic disorders was near similar (lifetime: male: 1.5%; female: 1.3%; current: male: 0.5%; female: 0.4%). While there was a male predominance in alcohol use disorders (9.1% vs. 0.5%) and for BPAD (0.6% vs. 0.4%), a female predominance was observed for depressive disorders (both current [female: 3.0%; male: 2.4%] and lifetime [female: 5.7%; male: 4.8%]) for neurotic and stress-related disorders. Residents from urban metro had a greater prevalence across the different disorders. Persons from lower income quintiles were observed to have a greater prevalence of one or more mental disorders. An individual's risk of suicide in the past 1 month was observed to be 0.9% (high risk) and 0.7% (moderate risk); it was highest in the 40–49 years age group, greater among females, and those from urban metros. The most striking findings calling for greater analysis is the wide variations in the rates of specific disorders across the states. For example, under “neurotic and stress disorders,” there is a near 10-fold difference between Assam and Jharkhand and Manipur and Rajasthan. It is not clear whether this is a reflection of the social differences, cultural factors, or other variables. A detailed analysis can only give the answers. ID screener positivity rate was 0.6%; it was greater among the younger age group, among males, and those from urban metro areas. The prevalence of morbidity among adolescents was 7.3% with a similar distribution between males and females (male: 7.5%; female: 7.1%) but was higher in urban metro areas. The current prevalence of anxiety disorders was 3.6%, and depressive disorders was 0.8%. The third important finding relates to treatment gap. This has serious implications for the organization of services [Table 3].Table 3: Treatment patterns and care characteristics (Adapted from Table 36 (Page 126) from NAMS[1]Treatment gap for mental disorders ranged between 70% and 92% for different disorders: common mental disorder - 85.0%; severe mental disorder - 73.6%; psychosis - 75.5%; BPAD - 70.4%; alcohol use disorder - 86.3%; and tobacco use - 91.8%. The median duration for seeking care from the time of the onset of symptoms varied from 2.5 months for depressive disorder. Of all the findings, the most important from public health point is the long duration of illness of severe mental disorders. In majority of the cases, a government facility was the most common source of care. At least half of those with a mental disorder reported disability in all three domains of work, social, and family life and was relatively less among alcohol use disorder. Greater disability was reported among persons with epilepsy, depression, and BPAD. These data are the most important for planning of services. However, as the twelve states where the survey was conducted varied widely in terms of the mental health resources (Kerala and Madhya Pradesh are at two extremes), it would have been valuable to see the treatment gap in the different states and across specific mental disorders. It is important to know the contribution of the following factors to the treatment gap, namely, level of mental health infrastructure, the distance (people have to travel to treatment centers, the integration of mental health care in general health care in the study area, the level of stigma attached to mental disorders, the availability of alternative sources of help, and income level of the nonusers of services). COMMENTARY In preparation for the current book review, I had communicated with Prof. G. Gururaj and Prof. Mathew Verghese, of the NMHS team, for clarifications on a number of areas of the report. I am thankful for their prompt response. The summary of the response to the same is as follows: “All states are working on state-specific reports in their specific context to bring out state prevalence data along with current status of mental health services. These are in progress and likely to be released in the next few months;” “data from NMHS is available only on different sources for care and has to be analysed.” “Information on how long the person utilised each source is specifically unavailable as various care sources got combined. This will be analysed later for different diagnostic categories;” “being a descriptive study, we have been able to show the associations between different sociodemographic and illness-related variables. Risk factor assessments and quantifications were not part of the study;” “broad conclusions (about literacy) have been drawn on this issue and future analysis will provide more details.” Regarding the 2-fold difference, in the current morbidity, (6.6%–13.4%) across the participating states, “this needs to be analysed further.” We look forward to the detailed analysis to understand the full implications of the survey. It is relevant to recall the historic and milestone epidemiological study (The Great Universe of Kota)[9] carried out nearly 45 years back, to understand the approaches used and the findings of the various parameters relating mental disorders/psychiatric symptoms. This study of 1233 adults in one center examined the relationships between “case rate” and sex, education, income, marital status, caste, and social change. Further, it presented psychiatric symptom distribution in relation to sexes, castes, and the occurrence of somatic symptoms and possession states. The study also gave information about the ability to cope, social functioning, consultation pattern, role of social stress, and the need for treatment. This report could provide a framework for the analysis of state level data and reporting of findings. With such an analysis, there would be greater possibility of understanding the associations of sociodemographic and other factors and prevalence rates and treatment utilization rates across the states. This type of analysis is awaited, as noted by the NMHS team and state centers. The NMHS is important for the following reasons: First, this survey in 12 centers provides an important reference point about mental disorders in the community. Taking the earlier WMHS (reported in this issue of the journal)[11] covering ten states, we have a rich baseline to plan services at the level of prevention, promotion, and treatment of mental disorders. Second, the methodology and the use of information technology used for the survey is a major methodological advance in psychiatric epidemiology in the country. Third, it has provided insights into the prevalence of different mental disorders in 12 centers and some sociodemographic associations of these disorders. Fourth, the current level of treatment utilization and the large treatment gap among all the disorders is a cause of concern. This is especially so, as India completes 35 years of the National Mental Health Programme, formulated in August 1982. There is much cause for concern, for the relative failure to educate the population, decrease stigma, and empower the primary health-care personnel to initiate care at their level to reach the population in need of services. It is not sufficient to call for more of the same measures implemented during the past few decades. To that extent, the survey provides a wake-up call to redesign mental health care in the country. The issues relating the mental health systems have been covered in the second part of the NMHS as well as by the National Human Rights Report of 2016. These will be covered in the next issue of IJP. There are some areas of concern, arising from the survey. The limited scope of the NMHS[1] and the WMHS[11] calls for comment. Traditionally, the purpose of epidemiology is to address seven aspects of understanding health and illness conditions [Box 1].Box 1: Recent epidemiological studies in IndiaIt is significant that only two of the seven purposes of an epidemiological survey have been fulfilled. Of these two aspects also, there is limited information. The NMHS was possibly not powered to address severe mental disorders and both the surveys for the understanding of the biosocial variables related to mental disorders. Currently, the treatment-seeking information is available to the total sample and not for the individual disorders at each of the centers. With widely varying levels of mental health-care infrastructure, it would have added much value to know the impact of the differing levels of mental health care in the community and the treatment gaps. The identification of etiological factors has occurred at a very limited level. The study being conducted in a large number of sites with wide variations in potential etiological factors such as level of poverty, literacy, status of the two sexes, the cultural beliefs and practices relating to distress, disease and help-seeking behavior, and comorbidities has been lost. There are many reasons for this failure of the survey. The sample sizes chosen for the individual centers were small to bring out the differential contribution of these factors. The more than two fold difference between the twelve states surveyed (prevalence rate has not been broken down across the diagnostic groups and participating centers), to see the possible correlation with the prevalence rates of the syndromes and the etiological factors in the different study centers. This limitation of the NMHS and WMNH survey is especially important as preventive, promotive efforts can only come from such an identification etiological associations and possible causation. The lack of reference to objectives relating to the syndromal description and identification new syndromes suggests that the survey was not geared to look for this aspect of distribution of mental disorders. It seems to have decided on what to find and found them (the much talked about “suitcase syndrome” - you find what you have put into the suitcase). CONCLUSION In India, psychiatric epidemiology remains a challenge. This was noted succinctly in 1976 by Carstairs and Kapur[9] as follows: “Cross-cultural comparisons for determining the relative significance of environmental factors in the development of mental disorder. However, researchers engaged in such comparisons face two major problems: that of establishing comparable definitions of psychiatric symptoms across cultures and the lack of suitable techniques for the relevant also share with psychiatric in general the of and methods of a in a population and of those in greater need of attention from the It was against this background that the study was The NMHS team - NIMHANS and state centers are to be for of this massive There is need for analysis of the state reports and to these aspects in future studies in the sample and This survey be in and by all mental health and public health of the country.
HomeCirculationVol. 83, No. 1An updated coronary risk profile. A statement for health professionals. Free AccessAbstractPDF/EPUBAboutView PDFSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toFree AccessAbstractPDF/EPUBAn updated coronary risk profile. A statement for health professionals. K M Anderson, P W Wilson, P M Odell and W B Kannel K M AndersonK M Anderson Office of Scientific Affairs, American Heart Association, Dallas, TX 75231. , P W WilsonP W Wilson Office of Scientific Affairs, American Heart Association, Dallas, TX 75231. , P M OdellP M Odell Office of Scientific Affairs, American Heart Association, Dallas, TX 75231. and W B KannelW B Kannel Office of Scientific Affairs, American Heart Association, Dallas, TX 75231. Originally published1 Jan 1991https://doi.org/10.1161/01.CIR.83.1.356Circulation. 1991;83:356–362 Previous Back to top Next FiguresReferencesRelatedDetailsCited By Hespe C, Giskes K, Harris M and Peiris D (2022) Findings and lessons learnt implementing a cardiovascular disease quality improvement program in Australian primary care: a mixed method evaluation, BMC Health Services Research, 10.1186/s12913-021-07310-6, 22:1, Online publication date: 1-Dec-2022. Lemke E, Vetter V, Berger N, Banszerus V, König M and Demuth I (2022) Cardiovascular health is associated with the epigenetic clock in the Berlin Aging Study II (BASE-II), Mechanisms of Ageing and Development, 10.1016/j.mad.2021.111616, 201, (111616), Online publication date: 1-Jan-2022. 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No AccessWorld Development Report1 Feb 2013World Development Report 1986The Hesitant Recovery and Prospects for Sustained Growth; Trade and Pricing Policies in World Agriculture; World Development IndicatorsAuthors/Editors: World BankWorld Bankhttps://doi.org/10.1596/0-1952-0518-9AboutView ChaptersPDF (20.1 MB) ToolsAdd to favoritesDownload CitationsTrack Citations ShareFacebookTwitterLinked In Abstract:This is the ninth in an annual series assessing development issues. The world economy is entering its fourth year of growth since the recession of 1982. Yet the recovery is hesitant with many developing countries facing serious problems of adjustment. The recent decline in oil prices, interest rates, and inflation will provide a stimulus to developed and developing countries alike. But many debtor countries, particularly oil exporters, will find it hard to maintain growth in the near term. The effects of the recovery have been much weaker for many low-income Sub-Saharan countries. Part I of the report explores the policies required to restore growth in the developing world. It stresses the importance of developed countries maintaining the policies that have both reduced inflation and moderated distortions in their markets. Of concern however is the increase in international trade restrictions, if countries are to attain sustainable growth, the reform of domestic institutions must be accompanied by an effort towards international freer trade. Part 2 suggests that the gradual liberalization of trade should be a high priority for international action in agriculture. An examination of the policy options in developing countries suggests that economic stability and growth could be greatly enhanced by focusing on improved pricing and trade policies. Previous bookNext book FiguresreferencesRecommendeddetailsCited byDeng Xiaoping's Use of Positive Economic Statecraft: The Importance of Securing Long-Term Partnerships with Major International Financial Organizations (IFOs)11 May 2022Bibliography26 November 2019Paradigm and nexus: neoclassical economics and the growth imperative in the World Bank, 1948–2000Review of International Political Economy, Vol.26, No.116 January 2019Between the Engine and the Fifth Wheel: An Analytical Survey of the Shifting Roles of Agriculture in Development Theory7 February 2018Estimating Trade, Welfare, and Poverty Effects of Trade Policy Reforms30 November 2016Prospective Effects of (or Requiem for?) 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der Tropen und die Auswirkung auf das KlimaForstwissenschaftliches Centralblatt, Vol.106, No.11 December 1987The Internationalization of Canadian AgricultureCanadian Journal of Agricultural Economics/Revue canadienne d'agroeconomie, Vol.35, No.4THE COMMON AGRICULTURAL POLICY: THE IMPLICATIONS FOR ITALIAN AGRICULTUREJournal of Agricultural Economics, Vol.38, No.3"The Africans:" Myth or Reality?A Current Bibliography on African Affairs, Vol.20, No.11 September 1987Food Insecurity and Adjustment Policies in sub-Saharan Africa: A Review of the EvidenceDevelopment Policy Review, Vol.5, No.2South Africa: Assistance and aid programmesThird World Quarterly, Vol.9, No.215 November 2007Trade, Technology and Security: Implications for East Asia and the West: Part IIThe African food crisis of 1982-1986*Disasters, Vol.10, No.418 December 2007 View Published: July 1986ISBN: 978-0-19-520518-3 Copyright & Permissions Related TopicsFinance and Financial Sector DevelopmentIndustryMacroeconomics and Economic GrowthPrivate Sector Development KeywordsDEVELOPING COUNTRIESECONOMIC DEVELOPMENTFOREIGN CAPITALFOREIGN DEBTINCENTIVE STRUCTUREINDUSTRIAL COUNTRIESINTEREST RATESINTERNATIONAL TRADEWORLD DEVELOPMENT INDICATORSWORLD ECONOMY PDF DownloadLoading ...
No AccessWorld Development Report1 Feb 2013World Development Report 1982International Development Trends; Agriculture and Economic Development; World Development IndicatorsAuthors/Editors: World BankWorld Bankhttps://doi.org/10.1596/0-1950-3225-XView ChaptersAboutPDF (20.5 MB) ToolsAdd to favoritesDownload CitationsTrack Citations ShareFacebookTwitterLinked In Abstract:This report reviews development prospects in the international economy and supplements the extensive discussion of adjustment issues in the 1981 World Development Report. It finds that, although international prospects have worsened over the past year, during the remainder of the decade the middle-income countries should be able to continue narrowing the income gap between themselves and the industrial countries. The prospects for many of the low-income countries, however, remain a matter of grave concern. The report concentrates on agriculture, which remains the chief source of income for close to two-thirds of the population in developing countries and for the vast majority of the world's poor. Informing the discussion is the experience gained by the World Bank in helping to finance some 800 agricultural and rural development projects in more than 70 countries - experience supported by its broad, intensive programs of economic, scientific, and social research. Numerous tables and multicolor maps and graphics supplement the main body of the report; case studies are interspersed to provide analyses directly related to the substance of the text. The final portion of the report comprises world development indicators, 25 two-page tables containing economic and social profiles of more than 120 countries. Previous bookNext book FiguresreferencesRecommendeddetailsCited byDeng Xiaoping's Use of Positive Economic Statecraft: The Importance of Securing Long-Term Partnerships with Major International Financial Organizations (IFOs)11 May 2022Extreme Poverty: Definitions and Concepts25 May 2021Extreme Poverty: Definitions and Concepts1 September 2020Introduction4 December 2020The social construction of "shared growth": Zambia Sugar and the uneven terrain of social benefitJournal of Agrarian Change, Vol.19, No.117 May 2018Technical Assistance Components21 August 2017Between the Engine and the Fifth Wheel: An Analytical Survey of the Shifting Roles of Agriculture in Development Theory7 February 2018Policy-Making for Sustainable Agricultural Development11 April 2018Poverty15 February 2018IntroductionStructural ChangeDevelopment and Change, Vol.46, No.419 June 2015World Vision, Organizational Identity and the Evolution of Child SponsorshipThe Role of Agriculture and Surplus Labour for IndustrializationDevelopment and urbanization: a revisit of Chenery–Syrquin's patterns of developmentThe Annals of Regional Science, Vol.43, No.416 May 2008Challenges Facing World Agriculture: A Political Economy PerspectiveDevelopment and Change, Vol.40, No.615 December 2009The World Development Report 2008 : inconsistencies, silences, and the myth of ?win-win? scenariosThe Journal of Peasant Studies, Vol.36, No.330 October 2009The World Bank on ?agriculture for development?: a failure of imagination or the power of ideology?The Journal of Peasant Studies, Vol.36, No.222 July 2009Book ReviewsThe Journal of Peasant Studies, Vol.36, No.222 July 2009(Re)imagining Agrarian Relations? The World Development Report 2008: Agriculture for DevelopmentDevelopment and Change, Vol.39, No.631 December 2008Poverty14 March 2017The Japanese Political Economy Since 1945Overview6 July 2018Back Matter6 July 2018Reducing Distortions to Agricultural Incentives: Progress, Pitfalls, and ProspectsAmerican Journal of Agricultural Economics, Vol.88, No.51 December 2006Is agriculture the engine of growth?Agricultural Economics, Vol.35, No.1China: The New Global GiantOptions for Viable Economic Development through Tourism among the Non-Oil Arab Countries: The Egyptian CaseTourism Economics, Vol.10, No.415 September 2016Financial Sector Competition, Services Trade, and GrowthSSRN Electronic JournalThe Reorganization of Production on a World Scale: States, Markets and Networks in the Apparel and Electronics Commodity ChainsAn exploration of relationships between urbanization and per capita income: United States and countries of the worldPapers in Regional Science, Vol.75, No.2Political regime type and variation in economic growth ratesConstitutional Political Economy, Vol.7, No.3Policy-induced Innovation in Sub-Saharan African Agriculture: A Multilateral Malmquist Productivity Index ApproachDevelopment Policy Review, Vol.13, No.4Future Prospects for Cassava Root Yield in Sub-Saharan AfricaOutlook on Agriculture, Vol.24, No.13 August 2016Determinants of agriculture's relative decline: ThailandAgricultural Economics, Vol.11, No.2-31 December 1994MOVING FROM `THE STATUS OF WOMEN' TO `GENDER INEQUALITY': CONCEPTUALISATION, SOCIAL INDICATORS AND AN EMPIRICAL APPLICATIONInternational Sociology, Vol.9, No.129 June 2016Policy Analysis Priorities in Poorer Countries: Basic Needs and the Barefoot EvaluatorReview of Policy Research, Vol.11, No.3-4Economic Growth Strategy and Urbanization Policies in China, 1949-1982International Journal of Urban and Regional Research, Vol.16, No.2The International System, Labor-Force Structure, and the Growth and Distribution of National Income, 1950?1980Sociological Perspectives, Vol.35, No.22 August 2016The relevance of basic needs for political and economic developmentStudies In Comparative International Development, Vol.25, No.3Socialist Institutions and Family Wealth Flows ReversalJournal of Family History, Vol.15, No.225 July 2016Fiscal variables and growth: A cross-sectional analysisPublic Choice, Vol.64, No.3SOCIALIST INSTITUTIONS AND FAMILY WEALTH FLOWS REVERSAL: An Assessment of Post-Revolutionary Chinese Rural FertilityJournal of Family History, Vol.15, No.125 July 2016PRICISM v. 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LESSONS FROM THE TWO OIL SHOCKSSingapore Journal of Tropical Geography, Vol.4, No.2EditorialsEnvironment and Planning A, Vol.15, No.121 December 1983THE PRODUCTION STRUCTURE OF WORLD AGRICULTURE: AN INTERCOUNTRY CROSS-SECTION ANALYSISThe Developing Economies, Vol.21, No.36 March 2007National independence and reciprocal advantages: The political economy of Romanian?South relationsSoviet Studies, Vol.35, No.36 November 2007Global Financiers, Consultants and Contractors in the Southwest Pacific Since 1970Pacific Viewpoint, Vol.24, No.21 May 1983The IMF and Africa in the 1980sCanadian Journal of African Studies / Revue canadienne des études africaines, Vol.17, No.110 March 2014 View Published: January 1982ISBN: 978-0-19-503225-3 Copyright & Permissions Related TopicsEnvironmentFinance and Financial Sector DevelopmentMacroeconomics and Economic GrowthPrivate Sector Development KeywordsAGRICULTUREDEBTECONOMIC GROWTHINCOMEINTEREST RATESINTERNATIONAL TRADEPER CAPITA INCOMEPRODUCTIVITYRECESSIONUNEMPLOYMENT PDF downloadLoading ...
The objective of this study is to evaluate the feasibility of implementing Hospital-Based Health Technology Assessment (HB-HTA) within Ukraine's healthcare system, focusing on its potential to strengthen evidence-based decision-making regarding clinical effectiveness, safety, cost-efficiency, and organizational and strategic impact of health technologies (HTs) in healthcare facilities (HCFs). We collected and synthesized key initiatives implemented between 2021 and 2025, outlining the main steps involved in introducing HB-HTA in Ukraine. The article describes the landscape of the Ukrainian healthcare system and shares the experience of the initial steps of HB-HTA introduction amid tight budgets and increasing demands. Drawing on international models and adapting them to the national context, we outline key implementation strategies, the development of scientific and methodological approaches for HB-HTA, and the integration of a pilot HB-HTA project within a leading national HCF known for its high-level diagnostic and operational capabilities. The conducted pilot laid the groundwork for integrating HB-HTA into Ukraine's healthcare system and demonstrated its role in empowering HCFs to guide smarter budget allocation and procurement decisions, especially in the context of decentralization. With continued investment in expertise, legal integration, and streamlined methodology, HB-HTA can become a cornerstone of transparent, cost-effective decision-making across the HCFs of the National healthcare system. The experience gained in Ukraine provides valuable insights that can support other countries in effectively adopting and utilizing HTs at the hospital level.
This study aims to systematically identify and summarize the key characteristics of Mini-Health Technology Assessment (Mini-HTA) and assess the completeness of its basic reporting information, providing a theoretical foundation for developing future reporting guidelines.. A comprehensive search for Mini-HTAs was performed using CNKI, Wanfang Data, VIP, CBM, PubMed, Embase, Web of Science, HTA database, and major HTA-related websites from inception until February 2024. The completeness of basic information reporting in Mini-HTAs was assessed using the INAHTA checklist. The key characteristics of the included Mini-HTAs were summarized descriptively. Microsoft Excel 2019 was used to analyze and visually present the data. A total of 21 Mini-HTA reports were included, with the highest number published in 2021 (5 reports, 23.8 percent). China contributed the most reports (18 reports, 85.7 percent). The most common assessment purpose was technology comparison (15 reports, 71.4 percent), with general hospitals being the predominant assessment setting (17 reports, 80.9 percent), and drugs being the most frequently assessed technology type (14 reports, 66.7 percent). The INAHTA checklist evaluation identified notable deficiencies in reporting key methodological aspects, including participant roles, conflict of interest statements, data sources, literature search strategies, and methods for data assessment and analysis. Mini-HTAs have significantly increased in China since 2020, mainly in technology comparison, drug evaluation, and general hospitals. However, gaps remain in reporting key aspects, such as participant roles, conflict of interest, and data sources. Future efforts should focus on refining reporting guidelines to improve consistency and address these reporting deficiencies in Mini-HTA.
Despite omics technologies gaining traction in clinical settings, particularly in oncology, challenges persist in their widespread adoption due to the pre-requisite robust evidence supporting efficacy and cost-effectiveness. This study aims to explore the experiences of organizations working in the health technology assessment (HTA) field in evaluating omics technologies, with a particular focus on the adoption and application of specific assessment frameworks. We conducted a global survey to gather insights into current practices and frameworks used in HTA evaluations of omics technologies. We gathered responses from thirty-nine participants representing organizations across twenty-nine countries and five continents. Among them, 51 percent (n = 20) reported experience in evaluating omics technologies, including multi-omics tests for early disease detection, biomarker-based cancer diagnostics, and advanced genomic sequencing techniques. Only three organizations employed specific assessment frameworks: the Adelaide Health Technology Assessment Agency in Australia, the Netherlands Cancer Institute, and the Andalusian HTA Agency in Spain. These frameworks address key evaluation aspects such as analytical and clinical validity, clinical and personal utility, organizational impact, and ethical, legal, and social implications of omics technologies. Despite their relevance, the limited adoption of tailored frameworks highlights the need for more structured and context-specific approaches to facilitate the integration of omics technologies into healthcare systems. Collaborative efforts among stakeholders, including patients, healthcare providers, policymakers, and industry representatives, are crucial for devising robust evaluation strategies addressing the complexities of omics technologies comprehensively.
Since the introduction of health technology assessment (HTA) in Ukraine, the international technical assistance project "Safe, Affordable, and Effective Medicines for Ukrainians" with financial contributions of the United States Agency for International Development has supported capacity building activities. In 2020, the main HTA stakeholders expressed interest in a comprehensive training program for HTA doers, users, and trainers. To inform the design of a training program, the needs of forty HTA doers, users, and potential trainers were assessed using validated surveys. Identified knowledge gaps included comparative effectiveness, health economics, qualitative evidence synthesis, patient and public involvement, and ethical issues. Based on these results a tailored training program consisting of five modules was developed, including an introduction to HTA, as well as a train-the-trainers program. During January-July 2023, seventy-five persons participated in the training program, while twelve HTA professionals followed the train-the-trainer program. We evaluated participants' self-reported knowledge and skill gains by asking about their confidence level in each learning objective at the beginning and end of each training module. For each module, a learning effect was observed among participants. Furthermore, the majority of trainers felt confident to provide the introductory module on HTA, while for the other modules only one or two trainers felt completely confident to teach the content. Establishing a training program based on the needs of HTA doers, users, and trainers as developed for Ukraine can serve as inspiration for other countries that wish to attain sustainable HTA capacity.
Health Technology Assessment (HTA) guides healthcare decision-making, while Implementation Research (IR) addresses challenges in operationalizing these decisions. The SAVING (Sustainable Access and Delivery of New Vaccines in Ghana) Consortium aims to enhance health intervention delivery in Ghana, focusing on HTA evidence. This study identifies barriers to the application of HTA-related evidence (cost analysis) in coronavirus disease 2019 (COVID-19) vaccine deployment in Ghana. This qualitative exploratory study purposively selected 12 key stakeholders with high interest and power relating to COVID-19 vaccine deployment in Ghana. Through in-depth interviews, seven stakeholders from diverse sectors contributed insights into barriers to the application of HTA-related evidence. Thematic analysis was conducted with narrative reporting supported by direct quotes for substantiation. Six main barriers were identified: (1) timing and access to HTA reports, (2) technical complexities, (3) relevance of content, (4) political considerations and power dynamics, (5) health system fragmentation, and (6) poor responsiveness of decision-makers to research. Proposed solutions include engaging political decision-makers continuously, simplifying technical reports, aligning report content with policymakers' needs, reducing political considerations, enhancing capacity building, fostering health system cohesion, and improving responsiveness to research. HTA is vital for informed healthcare decisions. However, technical complexity, relevance of content, inappropriate timing, and lack of access to HTA reports, among other barriers, prevent the uptake of HTA findings. Continuous and improved engagement between HTA producers and policymakers, along with rapid production of HTA, has the potential to improve the uptake of HTA findings, even during public health emergencies.