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The cost-effectiveness of molecular pathology testing is highly context dependent. The field is fast-moving, and national health technology assessment may not be relevant or timely for local decision makers. This study illustrates a method of context-specific economic evaluation that can be carried out in a limited timescale without extensive resources.
Methods
We established a multi-disciplinary group including an oncologist, pathologists and a health economist. We set out diagnostic and treatment pathways and costs using registry data, health technology assessments, guidelines, audit data, and estimates from the group. Sensitivity analysis varied input parameters across plausible ranges. The evaluation setting was the West of Scotland and UK NHS perspective was adopted. The evaluation was assessed against the AdHopHTA checklist for hospital-based health technology assessment.
Results
A context-specific economic evaluation could be carried out on a timely basis using limited resources. The evaluation met all relevant criteria in the AdHopHTA checklist. Health outcomes were expected to be at least equal to the current strategy. Annual cost savings of £637,000 were estimated resulting primarily from a reduction in the proportion of patients receiving intravenous infusional chemotherapy regimens. The result was not sensitive to any parameter. The data driving the main cost saving came from a small clinical audit. We recommended this finding was confirmed in a larger population.
Conclusions
The method could be used to evaluate testing changes elsewhere. The results of the case study may be transferable to other jurisdictions where the organization of cancer services is fragmented.
The decades around 1900 were crucial in the evolution of modern medical and social sciences, and in the formation of various national health services systems. The modern fields of psychiatry and mental health care are located at the intersection of these spheres. There emerged concepts, practices, and institutions that marked responses to challenges posed by urbanization, industrialization, and the formation of the nation-state. These psychiatric responses were locally distinctive, and yet at the same time established influential models with an international impact. In spite of rising nationalism in Europe, the intellectual, institutional, and material resources that emerged in the various local and national contexts were rapidly observed to have had an impact beyond any national boundaries. In numerous ways, innovations were adopted and refashioned for the needs and purposes of new national and local systems. 'International Relations in Psychiatry: Britain, Germany, and the United States to World War II' brings together hitherto separate approaches from the social, political, and cultural history of medicine and health care and argues that modern psychiatry developed in a constant, though not always continuous, transfer of ideas, perceptions, and experts across national borders. Contributors: John C. Burnham, Eric J. Engstrom, Rhodri Hayward, Mark Jackson, Pamela Michael, Hans Pols, Volker Roelcke, Heinz-Peter Schmiedebach, Mathew Thomson, Paul J. Weindling, Louise Westwood. Volker Roelcke is professor and director at the Institute for the History of Medicine, Giessen University, Germany. Paul J. Weindling is professor in the history of medicine, Oxford Brookes University, UK. Louise Westwood is honorary research reader, University of Sussex, UK.
The decades around 1900 were a crucial period in the making of the various national systems of health services, as well as the formation of the modern medical and social sciences. The field of psychiatry and mental health care can be understood as located at the intersection of these spheres. Here, concepts, practices, and institutions emerged that marked responses to the challenges posed by urbanization, industrialization, and the formation of the nation-state. Psychiatry had a considerable impact on the modes of perception and evaluation, and on the patterns of action toward contemporary social concerns and political issues. These psychiatric responses were locally distinctive, and yet at the same time they established, in part, influential models with an international impact.
This volume addresses two important topics of late nineteenth- and early twentieth-century history. The essays deal with the transformation of psychiatry into one of the most contested and influential modern sciences; and they link this focus to broader issues of international relations and transfers of concepts, practices, personnel, as well as funds in a context of rising internationalism and nationalism.
For instance, an orientation toward new career opportunities in the United States by European physicians in the context of innovative and flexible institutional structures and systems of funding may be documented for the 1920s; yet this orientation has found almost no attention in the historiography of psychiatry.
The evolution of the microstructure of GaN grown by molecular beam epitaxy on {001} and {111} oriented GaAs substrates has been followed using transmission electron microscopy and reflection high energy electron diffraction. A thin layer of GaN has been shown to form during the nitridation of the GaAs surface prior to growth. Growth of GaN then proceeds by an island mechanism. Faulting on the four {111} planes of the cubic zinc-blende phase which grows on the {001 } surface occurs at an early stage as a consequence of misfit strain. The distribution of the {111} microtwins is initially isotropic, but growth of one pair of {111} twins proceeds much faster than that of the other pair, leading to a final microstructure which has an anisotropic distribution of microtwins. Doping of GaN with Si hinders the growth of the zinc-blende phase, leading to a textured, columnar (0001) wurtzite microstructure. Evidence is presented to show that addition of Mg as a dopant may reduce the stacking fault energy of wurtzite GaN.
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