This paper describes the development and testing of a European version of the Appropriateness Evaulation Protocol (AEP). It stemmed from the original U.S. version and the multiple adaptations and modifications made previously and separately by researchers in European countries. The group was particularly concerned with developing a common list of reasons for inappropriate admissions and days of stay, since the principal goal was to enable an understanding of inappropriate hospital use and potential solutions within local health and social care systems. Developing a common EU-AEP included several steps. First, each national instrument was translated from the national language to English. These back translations were compared with each other and with the US-AEP. A working group analyzed the content of the lists of reasons published in the literature and proposed a novel conceptual approach. On the basis of workshop discussions, a draft of a common European version was circulated to each participant for agreement. In the EU-AEP, the clinical criteria for the appropriateness of admission include 10 related to patient condition and five to clinical services. The criteria for the appropriateness of days of care include 10 covering medical services, six for life support/nursing services, and eight related to patient condition. The proposed core list of reasons of inappropriateness distinguish clearly between two concepts: a) the level of care required by the patient; and b) the reason why this level of care was not used. The first list would thus refer to the nature of resources and facilities required, while the second would focus more on the efficient organization of those resources. A validated European tool to assess inappropriate hospital admissions and hospital days of stay and their causes might be used to assess the need for resources for inpatient care as well as for outpatient care. Assessing the reasons for inadequacies might lead also to the examination of organizational questions. Finally, a common tool allows comparisons between countries concerning the frequency of inappropriate admissions and days of stay and their reasons in relation to the different organizations of health care across Europe.

A medical consensus conference on depression was held in Copenhagen, Denmark, on March 1–3, 1999. The consensus panel addressed the following questions: a) When does dejection constitute depression? b) What do we know about the causes of depression? c) How frequent is depression among different sections of the population? d) Which forms of treatment are available? e) Can several forms of treatment be combined with advantageous results? f) What happens if treatment is not received? g) Should the present organization of efforts be changed? h) What are the costs of depression and treatment of depression? i) Are there areas of research that should be enhanced?

This paper analyzes the cost-effectiveness of screening and treating diabetic retinopathy (DR) by simulating the disease progress continuously with existing data. A new computer simulation based on Monte Carlo techniques and logistic transformation follows cohorts from diabetes onset until death in five care scenarios. For younger-onset patients, ophthalmic care reduces the prevalence of blindness by 52% or greater while savings in disability facilities and production losses surpass direct costs. For older-onset patients, less favorable results appear. Financial benefits surpass costs for juvenile-onset patients. For other patients, the net costs of ophthalmic care seem lower than in other health care programs.

Several new topical agents have been introduced recently and it can be expected that the treatment of glaucoma will change, depending on how effectively these agents control intraocular pressure (IOP). IOP is considered the major risk factor in the development of glaucomatous damage. In order to estimate the impact of these new agents on the cost of treating glaucoma, a simulation model was created to estimate the cost of treating patients with a recent diagnosis of primary open-angle glaucoma or ocular hypertension in different countries. The Markov model is based on retrospective chart reviews in different countries and calculates only cost, not outcome. Results are presented for France and the United Kingdom, where current treatment appeared to be comparable. Average one-year costs per patient with current treatment were FF2,389 (US $389) and £380 (US $627), respectively. Costs with the new treatments were lower than with current therapy.

Purpose of assessment: To assess the usefulness and convenience of including ultrasonography as a diagnostic tool in primary health care services provided by the Spanish National Institute of Health.

Xenotransplantation research, as a part of biomedical research, investigates the question of whether it is possible to take living organs, tissues, or cells from animals and transplant them into humans. It is hoped that the xenotransplantation of organs will close the widening gap between the growing demand for organs and the limited supply of donor organs; cellular xenotransplantation aims at providing first or improved therapies for a variety of diseases.

The results of a field study of three sites that used video to link primary care medical centers to hospitals are reported. The analysis was concerned with identifying the people involved, the tasks carried out in collaboration at each end of the link, and how the different communications facilities helped or hindered. The results are summarized as six task characteristics and their design implications for this model of telemedical consultation are discussed.

The need for better communication and collaboration between health technology assessment agencies led to the formation of an International Network of Agencies for Health Technology Assessment (INAHTA). The network now comprises 27 agencies and has been successful in improving exchange of information and in undertaking joint health technology assessment projects. Issues for the future include possible changes to criteria for membership and identification of resources for more extensive programs.

The evolution of clinical technologies presents potential adopters with considerations in planning for clinical program development that include the stage and the rate of a technology's evolution. This paper presents a conceptual framework for these considerations and applies the framework to orthopedic technologies. Eight orthopedic surgeons were asked to assess 14 orthopedic technologies and position each of them along a spectrum of research, clinical, and adopted technologies. The distribution of responses for each technology–year combination is presented, and estimates of central tendency, dispersion, and variances provide measures of the change in the distribution of responses over time for each technology and the change in the degree of rater consensus over time for each technology. While orthopedic trauma was chosen to illustrate the technology spectrum model, the model and assessment methodology is applicable to other medical specialties as well. Adoption of this framework in a hospital setting should enable more systematic and effective clinical program development.

This paper considers standard effective treatments for non-Hodgkin's lymphoma and early breast cancer in premenopausal women. The literature assesses the treatments' effectiveness, and expected charges for different treatments in the context of the Belgian Health Insurance System are compared. Ovariectomy in breast cancer (770 ECU) and conventional chemotherapy in non-Hodgkin (2,745 lymphoma ECU) prove equally effective and are less costly in comparison with chemotherapy (1,904 ECU) in breast cancer or chemotherapy and autologous bone marrow transplantation (19,262 ECU) in non-Hodgkin's lymphoma. Further unbiased insights in competitive treatments' costs and outcome could save money and enhance developments in cancer care.

The Health Council of the Netherlands (Gezondheidsraad) is the scientific advisory body on health and health care to the Dutch government. Its recommendations cover fields that relate to the health of the population, such as clinical medicine, public health, environmental protection, food and nutrition, and occupational hygiene. Independent multidisciplinary committees draw up the Council's advisory reports. The Council's 1997 Executive Summaries booklet is now available. The reports are:

This assessment was undertaken at the request of a Regional Health Authority to provide input into a funding decision on a computerized dynamic posturography (CDP) system for use by a rehabilitation department.

In Catalonia, ultrasonographic control of pregnancies is carried out in hospitals and in certain primary care centers within the women's care program. There is no scientific evidence on its efficacy in the improvement of the fetal viability at this level of care; therefore, the question of whether obstetric ultrasonography is efficacious and safe in primary care cannot be answered properly to recommend its application. However, it may be assessed whether routine ultrasonography, the one expected to be carried away in primary care centers, is more effective than selective ultrasonography, i.e., the one carried away in the referential gynecology and obstetrics service due to risk conditions during the pregnancy.

Heparin-induced thrombocytopenia (HIT) is an idiosyncratic drug reaction first reported in the literature in the 1940's. Two different types of HIT have been identified. Type I, also known as benign, early-onset thrombocytopenia, occurs in as many as 20% of patients receiving heparin and is characterized by up to a 30% reduction in baseline platelet counts during the first few days of therapy. Despite reductions in platelet count, most patients with this type of HIT have platelet values above 100 × 109 cells/L, and this condition usually resolves in a few days without further adverse sequelae.

The Department of Epidemiology and Social Medicine at the Medizinische Hochschule Hannover is one of the leading university-based public health departments in Germany. It is divided into units for health system analysis, epidemiology, prevention, and health economics. The department offers a postgraduate master's degree program in public health. The staff number is approximately 25, two-thirds of whom are researchers. The German Federal Ministries of Health and of Education, Science, Research, and Technology are the major providers of research grants. The department is the managerial focus of the North German Center for Public Health Research. Internationally, the department is an active member of the International Society of Technology Assessment in Health Care (ISTAHC), the European Healthcare Management Association (EHMA), and the International Society for Quality Assurance (ISQua). The department has been involved in several European-wide studies and collaborates with the World Health Organization (WHO).