The practice of medicine is intrinsically a cooperative activity, involving not only a number of individuals but requiring access to a wide variety of types of data, produced and maintained by different people. Achieving seamless, integrated access to these data requires a new infrastructure of information systems that supports the construction of applications designed to incorporate and use external information resources. The term groupware may be used to connote this collective set of information resources and tools for access to them. Groupware will generate a variety of new kinds of products and services with implications for medical libraries, electronic publishing, and academic and professional collaboration.

Each group involved in the development of a new medical technology constantly assesses the value of the emergent technique in terms of the group’s own specific goals and conventions. The history of infrared thermography demonstrates the social nature of this assessment process.

Health information systems are complex combinations of methods of organization and computer technologies. They are idiosyncratic to each country. Chad’s design of a national information system followed a process that can serve as a model for sustainable technology transfer—using consensual decision making and reinforcing administrative reforms while providing strong Ministry leadership and using technical assistance.

The authors present their experiences in assisting the government of Niger to develop automated information systems for health care management. They discuss the structure of the health system, the role of donor assistance, the process of initiating automated systems, and the technical requirements and costs of the system. Finally, they draw general conclusions that may be useful for those attempting similar efforts.

National concern about escalating health care costs and inefficiencies in delivery systems has created demand for informatics technology such as decision-support systems. This paper discusses the pressing need for better cost information in health care and how decision-support technology meets this need. Future directions for the technology also are discussed.

To reduce their dependency on donors or the international currency costs of essential health care products, developing countries are building or improving capability for local manufacturing or competitive international procurement. Through long-term strategic planning, public/private partnerships, collaboration with firms in industrialized nations, and farsighted donor policies, the capacity for alternative supply can be increased in stages from importation through local processing and packaging to full production and multiproduct enterprises.

Pakistan has produced essential vaccines as part of an Expanded Program on Immunization. The program has been successful in achieving high rates of immunization in pregnant women and children under two years of age. This paper focuses on key events in the development of Pakistan's capacity to produce vaccines.

Medical education in the United States is torn between its allegiance to the Newtonian biomolecular paradigm of medical science that made it so successful in the past and a growing sense, both within academia and without, that medicine needs to become more interdisciplinary and population based. This article explores the potential of the Oxford Perinatal Care model as a useful tool for medical educators to bridge the curricular gap between these two paradigms. The Oxford model is based upon ongoing meta-analysis of all randomized control trials relating to perinatal medicine; interventions and technologies are placed into one of four categories, ranging from “forms of care that reduce negative outcomes” to “forms of care that should be abandoned.” This article proposes a strategy for the inclusion of this information into the U.S. medical school curriculum.

The use of upper gastrointestinal (Gl) fiberoptic endoscopy has spread at different times and rates in Japan than in the United States. Factors that explain this disparity and its effects on patient outcomes are reported. This essay outlines Japanese data in gastroenterology, giving an account of the resources and time that were spent on the development of upper Gl endoscopy in Japan. It also draws implications for the assessment of endoscopy for populations at high risk for gastric cancer.

During 1984–1985, laminectomy rates in Massachusetts demonstrated a 2.2-fold variation among districts. Thirty-five percent of laminectomies occurred in 7 of the 108 hospitals studied. Approximately 81% of laminectomies were performed by neurosurgeons. Rates of laminectomy decline with increasing age after 65, while rates of hospitalization for lower-back pain rise.

Cross-design synthesis is a new (and still evolving) strategy for providing quantitative results that capture the strengths and minimize the weaknesses of different kinds of research. The strategy, which is being developed to answer questions about the effects of treatment in medical practice, includes (a) identifying complementary research designs and studies conducted according to those designs; (b) completing an in-depth assessment of each study with respect to the chief potential bias(es) that are associated with its design; (c) making “secondary adjustments” of study results to correct known biases; and (d) developing synthesis frameworks and models that will minimize the impact of hidden biases.

Bernstein, S. J., Kosecoff, J., Gray, D., Hampton, J. R., & Brook, R. H. (1993). The appropriateness of the use of cardiovascular procedures: British versus U.S. perspectives. International Journal of Technology Assessment in Health Care 9, 3–10.

Page 3: David Gray's affiliation was incorrectly listed. His correct affiliation is University Hospital, Nottingham, U.K.