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Biomedical subjects

D Hailey

Publications and source records attributed to D Hailey.

At least 19 recordsLinked to original sources
PubMed2006

Health technology assessment.

Health technology assessment (HTA) involves the systematic evaluation of healthcare technologies and the dissemination of assessment findings. Its main purpose is to provide objective information to support healthcare decisions and policy-making. This article provides a brief overview of HTA, covering availability of assessment reports, approaches used, relevance and reliability of assessments and the influence of HTA. HTA reports vary greatly in their scope and complexity, because of the range of questions considered and the needs of those who request advice on health technologies. A key to the reliability of an HTA report is its transparency. Explicit information should be provided on the question that is addressed, data used, approach to analysis, and any assumptions that are made. Effectiveness of HTA--the extent to which it influences decisions--will be highly dependent on how well assessment findings are disseminated.

Biomedical Technology↗
PubMed2006

Radiofrequency ablation in the treatment of kidney cancer.

(1) The standard approach for the treatment of kidney (renal) cancer is radical or partial nephrectomy (removal of the kidney). (2) Radiofrequency ablation (RFA), a less invasive approach, is an option for the treatment of small tumours, and in cases where surgery is contraindicated. (3) Its safety and efficacy compare favourably with those of other approaches. (4) The persistence of residual tumour is a disadvantage of earlier versions of the technology. The use of more powerful radiofrequency (RF) generators may reduce such persistence, but definitive evidence is unavailable. (5) Experience with this application of the technology is limited. Longer follow-up of patients is required to provide an adequate comparison with nephrectomy.

Canada↗
PubMed2006

Digital mammography: an update.

(1) Digital mammography can improve breast-image quality and storage through the digital capture of x-ray images. (2) Large comparative studies indicate that the overall accuracy of full-field digital mammography (FFDM) is similar to that of conventional filmscreen mammography (FSM). (3) Recent evidence suggests that FFDM is more accurate than FSM for diagnosing cancer in women younger than 50 years, those with dense breasts, and pre- or peri-menopausal women. (4) The costs of FFDM are higher than those for FSM. (5) The quality control of FFDM systems offers advantages compared to that of FSM, but it is more complex, and it is associated with a long learning curve.

Breast Neoplasms↗
PubMed2006

Open magnetic resonance imaging (MRI) scanners.

(1) In most MRI scanners, the patient examination table fits inside a long cylindrical tube. Large patients cannot be accommodated, and some persons experience claustrophobic reactions. Open MRI systems, in which the patient is placed between two plates, overcome these disadvantages. (2) Open MRI scanners are widely used in health care. High-field closed MRI systems are preferred for many examinations. (3) Early versions of open MRI scanners had low magnetic field strength, gave poorer image quality than most closed systems, and required longer examination times. Newer open scanners include machines with higher magnetic field strengths and improved image quality. (4) Closed high magnetic field scanners with short magnets and wide bore tubes offer improved comfort to patients, and may be an alternative to open scanners. (5) There is interest in using open systems for intra-operative and image-guided interventions.

Canada↗
PubMed2005

Achievements and challenges on policies for allied health professionals who use telehealth in the Canadian Arctic.

We formulated policies and procedures for allied health professionals (AHPs) who provide services using telehealth in Nunavut, Canada's newest Arctic territory. These are a supplement to the clinical policies and procedures already established for Nunavut physicians and nurses. The services were in the areas of audiology, dietetics/nutrition, midwifery, occupational therapy, ophthalmic services, pharmacy, physiotherapy, psychology, respiratory therapy, social work and speech therapy. Documents specific to each of the services were developed, drawing on information from Government of Nunavut data, Nunavut healthcare providers and links made through the Internet. Topics included the scope and limitations of telehealth services, staff responsibilities, training and reporting, professional standards and cultural considerations. We also considered generic policies covering common issues such as jurisdiction, licensing and liability. The policies and procedures for AHPs will enhance and expand the successes already achieved with telehealth in Nunavut. The challenges are to balance the preferred approaches to service provision with the realities of health care and communications in an Arctic setting.

Achievement↗
PubMed2004

Policy implications associated with the socioeconomic and health system impact of telehealth: a case study from Canada.

This research was undertaken to inform future telehealth policy directions regarding the socioeconomic impact of telehealth. Fifty-seven sources were identified and analyzed through a comprehensive literature search of electronic databases, the Internet, journals, conference proceedings, as well as personal communication with consultants in the field. The review revealed a focus on certain socioeconomic indicators such as cost, access, and satisfaction. It also identified areas of opportunity for further research and policy analysis and development (e.g., social isolation, life stress, poverty), along with various barriers and challenges to the advancement of telehealth. These included confidentiality, reimbursement, and legal and ethical considerations. To become fully integrated into the health care system, telehealth must be viewed as more than an add-on service. This paper offers 19 general and 20 subject-specific telehealth recommendations, as well as seven policy strategies.

Alberta↗
PubMed2004

Successes and challenges in a field-based, multi-method study of home telehealth.

We are conducting a three-year study of telehealth in 11 home care offices that serve rural clients in Alberta. Three hundred and twenty palliative home care clients are being recruited to participate in a randomized controlled trial (RCT) to answer three questions about the use of video-phones and their effect on symptom management, quality of life and cost, as well as readiness to use the technology. Both successes and challenges have been identified in three main areas: technology, people/organizational issues and study design. Maintaining study integrity has been the key factor in decision making, as adjustments from the original proposal are made. It is already clear that field-based RCTs are feasible, but require commitment and flexibility on the part of researchers and community partners to work through the study implementation.

Adult↗
PubMed2003

The socio-economic impact of telehealth: a systematic review.

We reviewed the socio-economic impact of telehealth, focusing on nine main areas: paediatrics, geriatrics, First Nations (i.e. indigenous peoples), home care, mental health, radiology, renal dialysis, rural/remote health services and rehabilitation. A systematic search led to the identification of 4646 citations or abstracts; from these, 306 sources were analysed. A central finding was that telehealth studies to date have not used socio-economic indicators consistently. However, specific telehealth applications have been shown to offer significant socio-economic benefit, to patients and families, health-care providers and the health-care system. The main benefits identified were: increased access to health services, cost-effectiveness, enhanced educational opportunities, improved health outcomes, better quality of care, better quality of life and enhanced social support. Although the review found a number of areas of socio-economic benefit, there is the continuing problem of limited generalizability.

Bias↗
PubMed2001

Assessing telemedicine: a systematic review of the literature.

BACKGROUND: To clarify the current status of telemedicine, we carried out a systematic review of the literature. We identified controlled assessment studies of telemedicine that reported patient outcomes, administrative changes or economic assessments and assessed the quality of that literature. METHODS: We carried out a systematic electronic search for articles published from 1966 to early 2000 using the MEDLINE (1966-April 2000), HEALTHSTAR (1975-January 2000), EMBASE (1988-February 2000) and CINALH (1982-January 2000) databases. In addition, the HSTAT database (Health Services/Technology Assessment Text, US National Library of Medicine), the Database of Abstracts of Reviews of Effectiveness (DARE, NHS Centre for Reviews and Dissemination, United Kingdom), the NHS Economic Evaluation Database and the Cochrane Controlled Trials Register were searched. We consulted experts in the field and did a manual search of the reference lists of review articles. RESULTS: A total of 1124 studies were identified. Based on a review of the abstracts, 133 full-text articles were obtained for closer inspection. Of these, 50 were deemed to represent assessment studies fulfilling the inclusion criteria of the review. Thirty-four of the articles assessed at least some clinical outcomes; the remaining 16 were mainly economic analyses. Most of the available literature referred only to pilot projects and short-term outcomes, and most of the studies were of low quality. Relatively convincing evidence of effectiveness was found only for teleradiology, teleneurosurgery, telepsychiatry, transmission of echocardiographic images, and the use of electronic referrals enabling e-mail consultations and video conferencing between primary and secondary health care providers. Economic analyses suggested that teleradiology, especially transmission of CT images, can be cost-saving. INTERPRETATION: Evidence regarding the effectiveness or cost-effectiveness of telemedicine is still limited. Based on current scientific evidence, only a few telemedicine applications can be recommended for broader use.

Cost-Benefit Analysis↗
PubMed2001

Providing information on emerging health technologies to provincial decision makers: a pilot project.

A pilot project to provide advice on new and emerging medical technologies to decision makers in a provincial health care system was undertaken by a health technology assessment (HTA) program. Briefs were prepared on technologies which were not yet available in the province and which might have a significant impact on health care. These were sent to the ministry of health and regional health authorities and made available through the agency's website. Reaction to the briefs was sought from decision makers. Decision makers in the health ministry and health authorities found the briefs helpful, and wished to continue receiving them. They had made limited use of them for planning purposes, but the briefs provided useful input to further consideration of technologies in several cases. Within the HTA program, the briefs and the process that produced them were valuable in increasing awareness of new health technologies that might require assessment in future. This pilot project demonstrated the feasibility of providing timely advice on emerging health technologies within a provincial health system. However, while decision makers found the information provided to be useful, this had not yet been integrated with provincial health care planning. Necessary machinery within policy areas and communication with the HTA process appear to be in need of development.

Canada↗
PubMed2001

Elements for assessment of telemedicine applications.

OBJECTIVES: As an initiative of the International Network of Agencies for Health Technology Assessment, an approach to assessment of telemedicine applications was prepared to assist decision makers who are considering introduction and use of this technology. METHODS: Review and commentary drawing on published assessment frameworks and reports of primary evaluations of telemedicine, with particular reference to experience in Finland and Canada. RESULTS: Elements of the approach included development of a business case (considering population and services, personnel and consumers, delivery arrangements, specifications and costs); subsequent evaluation of the telemedicine application; and follow-up (covering the domains of technical assessment, effectiveness, user assessment of the technology, costs of telemedicine, trials, economic evaluation methods, and sensitivity analysis). CONCLUSIONS: Decision makers should link introduction of new and often costly technology to appraisal of its feasibility, followed by evaluation of the application, including longer term consideration of its sustainability and impact on the healthcare system. As the effectiveness and efficiency of telemedicine applications will often be strongly influenced by local issues, results of assessments may not be generalizable.

Canada↗
PubMed2001

Evaluation of a routine telepsychiatry service.

An assessment was undertaken of a routine telepsychiatry service in rural areas of a Canadian province as a follow-up to a pilot telepsychiatry project. Over two years, there were 546 consultations at the five participating general hospitals, although the level of use varied considerably between them. Health professionals expressed high satisfaction with the service. While there were equipment problems in 17% of all consultations in the second year, they did not seem to affect acceptance of the technique. A cost analysis comparing consultations provided by a visiting psychiatrist and telepsychiatry found a break-even point of 348 consultations a year. However, when use of the videoconferencing network for administrative meetings was considered, the break-even point was 224 consultations a year, substantially below the actual utilization of telepsychiatry. Telepsychiatry appeared to result in increased access to community mental health services, suggesting future increased demand for these. From the perspective of health authorities and health professionals, telepsychiatry proved to be a useful and sustainable addition to existing mental health services.

Adult↗
PubMed2001

Telepsychiatry as a routine service--the perspective of the patient.

Patient perspectives were examined as part of an assessment of a routine telepsychiatry service in rural Alberta. Information was gathered through self-report questionnaires and telephone interviews. Of 379 questionnaires distributed to patients, 230 (61%) were returned. Of the patients who completed questionnaires, 89% reported being satisfied with the service and 96-99% were satisfied with the equipment and the room. Twenty-nine of 31 patients who were interviewed by telephone preferred telepsychiatry to waiting for a consultation, were willing to use the service again and would recommend telepsychiatry to a friend. While 25 of these 31 patients preferred telepsychiatry to travelling to a consultation, 15 indicated that they would prefer a face-to-face interview to telepsychiatry and a further seven were unsure. Twenty-three of the 31 patients interviewed would have had to miss time from work or pay for child care in order to travel to a conventional psychiatric consultation. The availability of telepsychiatry led to an estimated cost saving of $210 per consultation for patients who would otherwise have had to travel. From the patient's perspective, telepsychiatry was an acceptable technique in the management of mental health difficulties that both increased access to services and produced cost savings.

Adolescent↗
PubMed2001

Some successes and limitations with telehealth in Canada.

Canada has taken important steps towards establishing telehealth within its health-care system. However, in many areas telehealth in Canada has yet to progress beyond the stage of testing feasibility. A recent survey of eight Canadian telehealth programmes that are using videoconferencing indicated that there is little evidence of either clinical or economic benefits compared with conventional care. There are examples of sustainable, routine telehealth services in Canada. However, overall, the number of patients seen by telehealth is still very small in comparison with the number of face-to-face visits. 'People-related' factors seem dominant in determining the degree of success of telehealth applications.

Canada↗
PubMed2001

Oxygen carriers ("blood substitutes").

(1) A number of oxygen carriers, or "blood substitutes", are undergoing clinical trials. One product (Hemopure(R)) was recently licensed for use in South Africa. Another, (Hemolink(tm) may soon be approved for marketing in Canada. (2) Most trials of oxygen carriers have focused on their use in surgery, primarily as a way to minimize the need for allogeneic blood transfusion. (3) The benefits of these products in comparison with other blood conservation technologies and with allogeneic blood transfusion must be determined. (4) The safety and cost-effectiveness of these products, and the patient populations that would benefit most from their use require further study.

Blood Substitutes↗
PubMed2001

Non-penetrating glaucoma surgery using AquaFlow(TM)collagen implants.

AquaFlow TM is an absorbable collagen implant for use in non-penetrating surgery for primary open angle glaucoma. Its purpose is to facilitate drainage of fluid from the eye, thereby reducing intraocular pressure. AquaFlow TM is approved for use in Canada in medically refractory cases of primary open angle glaucoma. Non-penetrating glaucoma surgery with the AquaFlow TM implant appears to be a relatively safe procedure. However, there is a steep learning curve for the surgeon and it is initially associated with a high rate of conversion to conventional surgery during the operation. Limited evidence from small non-randomized trials suggests that the AquaFlow TM implant may offer benefits over conventional surgical approaches in terms of reduced complication rates, reduced medication use, an earlier return of improved vision and sustained control of intraocular pressure. However, the efficacy and cost-effectiveness of this approach have not been established. January, 2001 for use in patients with uncontrolled

Canada↗
PubMed2000

An assessment of gait analysis in the rehabilitation of children with walking difficulties.

PURPOSE: To assess the current status of computerized gait analysis techniques in the management of children with cerebral palsy or spina bifida who have significant walking disorders. METHOD: Synthesis of available data from a review of the literature, drawing on MEDLINE, EMBASE, PRE-MEDLINE, HealthStar and PsychInfo. Other information was obtained from persons with expertise in computerized gait analysis. Cost data were obtained from Canadian rehabilitation centres and the provincial health ministry. RESULTS: This technology seems helpful in detecting gait changes. However, available evidence is insufficient to draw conclusions about the influence of computerized gait analysis on treatment outcomes. Part of the rationale for use of the technology is that costs of gait analysis (of the order of $ CAN 2,000 per examination) would be offset by a decrease in follow-up surgical procedures and associated hospital care. There could also be a major influence on children's independence and quality of life. However, there are as yet no convincing data to support these propositions. CONCLUSIONS: Computerized gait analysis is a potentially useful technology in the management of children with walking disabilities, but its efficacy is not established. It should be regarded as a developing technology and its clinical application linked to systematic collection and assessment of outcomes data.

Cerebral Palsy↗