ABSTRACT
La progresivas preocupación de los países para optimizar el acceso, la eficiencia y la calidad de la salud, han impulsado la utilización más apropiada de las intervenciones en salud. Por ende, el interés tanto de profesionales sanitarios como de tomadores de decisiones en salud, ha sido orientado hacia la medicina basada en la evidencia, la eficacia comparativa y la Evaluación de Tecnologías Sanitarias (ETESA). Aunque los conceptos anteriormente señalados son convergentes en sus características, no son sinónimos. Sin embargo, todos estos, se basan en la orientación sistemática de pruebas y el enfoque en resultados relevantes para el paciente entre otras. Como consecuencia de todo esto, el interés no sólo implica los conceptos de eficacia, efectividad y eficiencia; sino que también en práctica clínica, costes y transparencia. En este artículo se resumen los conceptos de economía de la salud, evaluación económica, tecnología sanitaria (TS) y ETESA. Luego, se comenta el ciclo de vida de una TS, razones para implementar un programa de ETESA; para finalizar con algunos ejemplos de TS emergentes, comentarios respecto de la evidencia científica en la ETESA; y algunos ejemplos de estudios de ETESA en la práctica clínica cotidiana.
The progressive concern of countries to optimize access, efficiency and quality of health have led to the most appropriate use of health interventions. Therefore, the interest of both health professionals and health decision makers has been oriented towards evidence-based policy, comparative efficacy and Health Technologies Assessment (HTA). Although the aforementioned concepts are converging in their characteristics, they are not synonymous. However, all these are based on systematic testing orientation and focus on relevant patient outcomes among others. As a consequence of all this, interest does not only imply the concepts of effectiveness, effectiveness and efficiency, but also in clinical practice, costs and transparency.This manuscript summarizes concepts of health economics, economic evaluation, health technology and HTA. Then, the life cycle of a health technology and the reasons for implementing an HTA program are discussed. Concluding with some examples of emerging health technologies, comments on the scientific evidence in HTA, and some examples of HTA studies in daily clinical practice.
Subject(s)
Technology Assessment, Biomedical , Health Care Economics and Organizations , Evidence-Based Medicine , Quality of Health Care , Effectiveness , Chile , Efficacy , Cost-Benefit Analysis , EfficiencyABSTRACT
Aims: To evaluate Iranian physicians’ perspectives on shared decision making by validating and translating the physician version of a shared decision making questionnaire (SDM-Q-DOC). Place and Duration: Iranian Evidence-Based Medicine Center of Excellence, Tabriz University of Medical Sciences, Tabriz, Iran, from June 2012 to July 2013. Methods: The physician version of a shared decision making questionnaire (SDM-QDOC) was translated and validated through a pilot study among urologists in one of the hospitals of Tabriz University of Medical Sciences. A validated questionnaire was handed out among Iranian physicians in three main hospitals of Urmia. The results were analyzed using factorial analysis SPSS 16 software. To assess reliability, Cronbach’s alpha coefficient was calculated. Pearson correlation coefficient was used to assess testretest value. Results: The Persian version of the questionnaire showed an acceptable level of reliability (Cronbach alpha=0.901). In the implementation phase, Iranian physicians were generally in favor of the SDM process ( mean score=74.4%) but their perspective on different phases of SDM were different, with 93% answering questions evaluating physicians’ clinical explanations to their patients and only 68% agreeing with questions evaluating physicians’ attitudes regarding involving patients in the last treatment option. Conclusion: The physician version of SDM-Q-DOC is a valid and reliable questionnaire assessing physicians’ attitudes toward the SDM process. In this study, Iranian physicians showed a positive view to SDM.
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Aims: To evaluate relationship between patient age, location and their preference toward partnership in clinical decision making Place and Duration: A university-based clinic, Tabriz University of medical sciences, Tabriz, Iran from March to September Methods: In a cross-sectional study, 200 patients were randomly selected for the study. Patients’ demographic indicators and attitude toward partnership with their doctor was assessed by the use of an author-developed questionnaire containing 12 questions. Validity of this questionnaire was previously confirmed. The data was finally collected and analyzed. Results: Fifty three percent (53%) of patients were male and 47% was female. Mean age was 33.88 (SD=11.35). Of the 200 patients, 66% had tendency toward shared decision making (SDM). There was a positive correlation between higher level of education and SDM in Iranian patients. Conclusion: We found a trend toward shared decision making among patients. We conclude that raising literacy could change the culture of patient-physician relationship within the country.
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Progress in multi-disciplinary therapy for primary liver cancer (PLC) increases the 5-year survival rate from 2.6％ to 20.6％.However,the overall survival rate failed to increase significantly in the past twenty years because of lack of standardization in treatment of PLC.It is important to establish clinical guidelines which are based on randomized controlled trials,meta analysis,or systematic reviews.This review summarizes the pertinent clinical trials on PLC therapies published before October 2010.The articles were selected by a comprehensive literature search using the terms ‘liver neoplasms',‘ hepatectomy',‘ liver transplantation',‘ transarterial chemoembolization',‘ radiofrequency ablation',‘ percutaneous ethanol injection',‘ radiotherapy',‘ biological therapy',‘ chemotherapy',or ‘ Chinese herbs’.
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OBJECTIVE:To provide reference for the improvement of Metaanalysis. METHODS:13 repots about Meta-analysis of randomized controlled trials(RCTs)on antivirus traditional Chinese medicine(TCM)injections for respiratory tract infections were collected and analyzed. Their qualities were evaluated using QUOROM statement,CONSORT statement,Jadad scale and the quality evaluation method for Metaanalysis posed by Sacks,etc. Disagreements were resolved by consensus. RESULTS:The obtained average mark of 13 studies was(64?10.13)with the highest mark of 84 and the lowest of 52. Quality evaluations of reports were conducted from 5 aspects including 25 items. 5 aspects were all considered in 13 studies. 60% of the 25 items were in- volved in 13 reports at least and 88% at most. CONCLUSION:Meta- analysis methods are improved significantly in China. It should be still standardized to make sure correctness and reliability of results of meta-analysis. Meta-analysis method should be stan-dardized to obtain correct and reliable results.
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Standardized patient(SP)is used to simulate clinical practice for examining medical students so as to train clinical skills and promote practicality and sociality in evidence-based education,through which important information of individual patient can be gained.It is the foundation and precondition for searching the best clinical evidences and accumulating abundant clinical experiences.Evidence-based medicine emphasizes the teaching model which centers on patients.Different patients should receive distinct strategy of treatment while making evidence-based decision.