A cost-utility analysis of laparoscopic vs open treatment of colorectal cancer in a public hospital of the Greek National Health System.

PURPOSE: Laparoscopic colectomy has been reported as a safe and oncologically similar operation to open colectomy. A number of expensive surgical instruments are necessary for the procedure which should be applied if it is cost-effective for the patient and the health system in general. The purpose of the current study was the economic evaluation of laparoscopic compared to open colectomy for the treatment of colon cancer in the Greek national health system. METHODS: Fifty patients undergoing open colectomy and 42 undergoing laparoscopic colectomy were enrolled in this case-control study. Length of hospital stay, duration of operation, complication rates, cost of equipment used, total costs and three questionnaires measuring quality of life /QoL (EQ-5D, SF-36 and QLQ-C30) at baseline, 1 and 3 months after the operation were recorded. RESULTS: No statistically significant difference in QoL measured by QALYs between laparoscopic and open colectomy was observed. On the other hand, cost utility analysis revealed that laparoscopic colectomy was more expensive considering the advantages it offers. CONCLUSIONS: Laparoscopic colectomy is not superior to open colectomy on a QoL basis in the Greek public hospital system and is less cost-effective compared to the open procedure. Since the expensive equipment used in laparoscopic colectomy seems to be the causative factor for the high cost of this type of operation, an effort should be made to reduce it either by using reusable instruments or by implementing policies aiming at suppliers cutting down equipment charges.

Validity of the Greek EORTC QLQ-C30 and QLQ-BR23 for measuring health-related quality of life in breast cancer patients.

The aim of this study was to assess construct validity and internal consistency reliability of the Greek EORTC QLQ-C30 and QLQ-BR23 instruments. A sample of female breast cancer patients (n= 105) were self-administered the QLQ-C30, QLQ-BR23 and SF-36 and questions on treatment and socio-demographic status. Hypothesised scale structure, reliability (Cronbach's α) and construct validity (convergent, discriminative, concurrent and known-groups) were assessed. Multitrait scaling confirmed scale structure of the QLQ-C30 and QLQ-BR23 with good item convergence (92% and 85%), and discrimination (87% and 84%) rates. Cronbach's α was >0.70 for all but one scale (cognitive functioning). Strength of Spearman's correlations between the QLQ-C30 and SF-36 scales assessing similar health-related quality of life dimensions ranged from 0.25 to 0.64 (P < 0.01). Construct validity was confirmed with satisfactory results for interscale correlations and known-groups comparisons. QLQ-BR23 scales showed comparatively low (<0.40) correlations with QLQ-C30 functional scales, and higher correlations with conceptually related symptom scales. Most QLQ-C30 and QLQ-BR23 scales discriminated between pre-treatment and current treatment patients. The overall psychometric results for the Greek version of the QLQ-C30 and QLQ-BR23 confirmed it as a reliable and valid questionnaire for assessing breast cancer-specific HRQoL in Greece.

Prescribed-drug utilization and polypharmacy in a general population in Greece: association with sociodemographic, health needs, health-services utilization, and lifestyle factors.

PURPOSE: Our aim was to analyze, in a multivariate framework, how sociodemographic, health-service utilization, health needs, and lifestyle risk factors influence drug utilization and polypharmacy (PP) in a general population in Greece. METHODS: The cross-sectional study took place in 2006. In total 1,005 individuals (> 18 years old) of 1,388 who were approached (response rate 72.4%) were interviewed by trained interviewers. Thirty-seven reported only over-the-counter (OTC) drug use and were excluded. The final sample was 968 individuals. Multivariable logistic regression and multinomial regression analyses were conducted to determine the predictors of drug use and PP at a significance level of p < 0.05. RESULTS: The results revealed a high rate of drug use and PP. Drug use and PP were more common among women and increased with age. Advanced age 65+ [odds ratio (OR) 11.6), university education (OR 2.3), visits to physician (OR 2.2), comorbidity (OR 6.8), or poor physical and mental health were associated with higher likelihood of using drugs. Minor (two to three drugs) and major (four or more drugs) PP depended on comorbidity, physical health, and increased age. Furthermore, visits to physicians (OR 1.1), smoking (OR 3.0), and obesity (OR 3.8) increased the likelihood of major PP. CONCLUSIONS: Overall, drug utilization and PP depended on health needs followed by education, utilization of health services, and age. Social disparities do persist and, after adjustments for health needs and obesity, had a significant influence on PP.

Upgrading undergraduate biomedical engineering laboratory training.

This paper presents the upgrading of biomedical engineering laboratory training at the Department of Medical Instrumentation Technology of the Technological Educational Institution of Athens (TEI-A), taking place in the framework of the "Upgrading of Undergraduate Curricula of TEI-A" project. The educational material of selected specialized laboratory sectors is totally renewed, and new sectors are introduced, so that student-centered learning is promoted utilizing advanced computer-enhanced educational environments. The current implementation status is presented for the laboratories dealing with biosignal acquisition, medical data digital processing and, more extensively, computer networks applications in medicine, where a training application simulating a Radiology Department computer network was developed. Benefits of the use of a balanced training approach, combining hands-on experience with computer simulations, are discussed.

Upgrading the biomedical engineering undergraduate curriculum based on current trends in higher education.

This paper presents the reforming of the curriculum of the Department of Medical Instrumentation Technology at the Technological Educational Institution of Athens (TEI-A), as inspired by current trends in higher education. The reforming is taking place in the framework of the "Upgrading of Undergraduate Curricula of TEI-A" project The project-funded upgrading focuses on a core of eight laboratory sectors, with particular emphasis placed on student-centered learning, taking advantage of computer-enhanced educational environment. The existing and proposed curricula are compared. The student workload in the proposed curriculum is reduced, while maintaining an extensive set of basic and applied knowledge related to biomedical engineering. The overall aim is to provide a curriculum that will help in developing multi-skilled individuals that can relate to the demands of this field within a dynamic social and economical environment.

In-house development of test equipment for quality control and training. Case study: a prototype ECG simulator-tester.

The support services for biomedical technology address a variety of technical and administrative issues, concerning the safe and efficient operation of medical equipment over the period of its intended use and the training of hospital personnel in issues concerning safety and quality. Clinical Engineering Departments undertake the responsibility of developing and operating training programs in medical equipment utilisation apart from the traditional role of training and supervising technicians involved in testing, calibration and preventive/corrective maintenance of electromedical equipment. In view of the above, the Institute of Biomedical Technology and the Centre of Biomedical Engineering collaborated for the design and development of a prototype digital ECG and arrhythmia simulator. In the absence of internationally accepted inspection protocols for ECG simulators, the verification phase of the project involved mainly the inspection of the device's conformity to its initial technical specifications. The results demonstrated that this tester. due to simplicity in construction and easiness of use could be a practical, reliable and economical solution for electrocardiograph and ECG monitor testing and waveform recognition training.