Health technology assessment reports最新文献

{"title":"Polysomnography and sleep disorder centers.","authors":"","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Sleep disorders are common in our society. It is estimated that there are 50 million people in the United States who suffer to varying degrees from sleep problems. A great deal has been learned about sleep during the past 40 years. Much of this knowledge has been obtained by the use of PSG, which consists of the simultaneous recording of several physiologic parameters from a patient just prior to and during sleep. Much of the technology utilized in PSG are based on individual tests developed many years ago. Current published data permit the conclusion that PSG is useful for the diagnostic evaluation of patients with sleep-related breathing disorders, may be helpful in the evaluation of suspected cases of narcolepsy wherein other findings are inconclusive or contradictory, and may be helpful in cases of parasomnias and/or suspected epilepsy wherein the distinction between seizure activity and other forms of sleep disturbance is uncertain. Current data do not permit a firm conclusion as to the clinical effectiveness of PSG in other symptoms of sleep disturbance such as insomnia. Current, ongoing clinical trials are expected to provide information addressing this point, and several agencies (NINDS, ADAMHA, and NIA) have expressed their intent to encourage the organization of prospective trials to determine the ultimate clinical utility of SDC and PSG techniques. A physician need not be present during PSG in an SDC.</p>","PeriodicalId":77156,"journal":{"name":"Health technology assessment reports","volume":" 4","pages":"1-22"},"PeriodicalIF":0.0,"publicationDate":"1991-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"12985235","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hyperthermia in conjunction with cancer chemotherapy.","authors":"I Green","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":77156,"journal":{"name":"Health technology assessment reports","volume":" 2","pages":"1-16"},"PeriodicalIF":0.0,"publicationDate":"1991-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"12971513","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cardiac rehabilitation programs.","authors":"S S Hotta","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Cardiac rehabilitation programs are safe and effective in improving the functional activities of patients with cardiac disease, but they may be hazardous to those patients whose life might be in jeopardy if subjected to exercise. It is clear that not all cardiac patients require supervised rehabilitation programs to return to normal pre-cardiac-event activities. Many patients who have suffered cardiac events recover from the events without much functional debilitation, usually because they were normally active prior to the cardiac event. Patients who have had heart transplants, percutaneous transluminal coronary angioplasty, or heart valve surgery have no unique characteristics that differentiate them from cardiac patients who have had a myocardial infarction or coronary artery bypass graft or who have stable angina in terms of the necessity for participating in supervised rehabilitation programs. Therefore, patients who have had these surgical procedures might be selected for enrollment in cardiac rehabilitation programs on the basis of their physical and psychological conditions. Those patients who benefit from rehabilitation programs usually accomplish their goals within the 12-week sessions of the usual programs. Patients with stable cardiac conditions who are at high risk and have minimal functional capacities (3-5 METs) appear to benefit most, while patients who are of low risk and have functional capacities of 7-9 METs have minimal need for the program. High-risk patients have been described as including those who develop ventricular arrhythmias or marked ischemia with exercise. Low-risk patients have been described as including those who have functional capacities at 3 weeks postoperation of 8 METs or more, which allows them to resume most of their vocational and recreational activities. Patients with intermediate risk and functional capacities benefit from the programs, but they may not require the full 12 weeks of participation. The latter group may safely exit the programs when they attain the goals of the cardiac rehabilitation programs, e.g., the resumption of pre-cardiac-event activities and return to a relatively normal life. Accordingly, heart transplant patients and patients who have undergone percutaneous transluminal coronary angioplasty or heart valve surgery could benefit from prescribed cardiac rehabilitation programs if they have the need as described. The available information implies that many heart transplant, PTCA, or heart valve surgery patients are in excellent functional status after the surgical intervention and require minimal or no supervised exercise programs. However, a significant number of patients may lack confidence in their capabilities and may benefit from earlier exercise testing that would demonstrate to them their functional capabilities.(ABSTRACT TRUNCATED AT 400 WORDS)</p>","PeriodicalId":77156,"journal":{"name":"Health technology assessment reports","volume":" 3","pages":"1-10"},"PeriodicalIF":0.0,"publicationDate":"1991-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"12833035","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Single and double lung transplantation.","authors":"","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Lung transplantation currently involves the allografting of one or both lungs from a cadaver or brain-dead donor to selected patients with progressive end-stage pulmonary disease for whom there are no other viable treatment options. Expanding experience since 1986 in Canada, the United States, and Europe has demonstrated that both SLT and DLT can provide adequate pulmonary function and palliation for extended periods in some patients with otherwise fatal lung disease. A more rapid expansion of this technology has been constrained by the scarcity of suitable donors and the current limits of organ preservation time. Lung transplantation has evolved as a clinical procedure achieving a favorable risk-benefit ratio and acceptable 1- and 2-year survival rates. Lung transplantation is applied as a therapeutic option for patients with end-stage pulmonary disease. However, the transplant community has not yet reached consensus regarding patient selection criteria or absolute contraindications to LT. Specific selection criteria for the optimal treatment of all LT candidates do not exist as yet and are currently evolving. The majority of candidates have had pulmonary fibrosis, bronchiectasis, emphysema, pulmonary hypertension, or CF. Additional clinical information and experience will be useful in refining evaluation of risk-benefit ratios of SLT and DLT, which may vary for specific subsets of patients.</p>","PeriodicalId":77156,"journal":{"name":"Health technology assessment reports","volume":" 5","pages":"1-15"},"PeriodicalIF":0.0,"publicationDate":"1991-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"12984415","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Intermittent positive pressure breathing (IPPB) therapy.","authors":"H Handelsman","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>IPPB uses a mechanical respirator to deliver a controlled pressure of a gas to assist in ventilation or expansion of the lungs, thereby providing an increased tidal volume for patients with a variety of pulmonary conditions. IPPB machines are also used for the delivery of aerosol medications. The early widespread application of IPPB has dramatically diminished in response to published reports of more recent clinical trials that either question its utility or document its futility in the prophylaxis or treatment of the numerous conditions for which it was commonly prescribed. The effects of IPPB are short-lived, lasting approximately 1 hour, and the long-term consequences have not been adequately evaluated. In no study has IPPB been shown to have unequivocal clinical effectiveness, in terms of morbidity, mortality, or lung function, when used either alone or in combination with other modalities. In general, IPPB is not thought to offer any advantage over simpler therapies in the treatment of COPD or asthma or in preventing or treating postoperative atelectasis. However, IPPB may be useful in the following circumstances: 1) in patients at risk of respiratory failure because of decreased respiratory function secondary to kyphoscoliosis or neuromuscular disorders; 2) in patients with acute severe bronchospasm or exacerbated COPD, who fail to respond to other standard therapy; and 3) in the management of atelectasis that has not improved with simpler therapy (e.g., IS, postural drainage, aerosol therapy).</p>","PeriodicalId":77156,"journal":{"name":"Health technology assessment reports","volume":" 1","pages":"1-9"},"PeriodicalIF":0.0,"publicationDate":"1991-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"12971512","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Diagnosis and treatment of impotence.","authors":"H Handelsman","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Among the common procedures used in the diagnosis of impotence, neither nocturnal penile tumescence testing nor inhome monitoring devices designed to measure tumescence or rigidity is regarded as reliable for evaluating impotence. Plethysmography as a nonspecific test of vascular competence is increasingly being supplanted by Doppler ultrasound as a safe and effective diagnostic modality. Arteriography, cavernosography, and cavernosometry are established techniques for evaluating penile vasculature. Intracavernosal injection of smooth muscle relaxing drugs, endocrine assays, and electrophysiological testing are widely used for the diagnosis of impotence. Excluding implanted devices, and intracavernosal injections. Aortoiliac reconstruction, endarterectomy, or arterial dilatations are regarded as safe and effective for the treatment of proximal occlusive lesions, and venous leakage surgery is regarded as investigational. Intracavernosal injections are widely employed in clinical environments and for self-injection at home. However, this currently represents the use of FDA-approved drugs for an unlabeled indication. The use of external vacuum devices has achieved widespread use and is regarded as being safe and effective for the treatment of impotence.</p>","PeriodicalId":77156,"journal":{"name":"Health technology assessment reports","volume":" 2","pages":"1-23"},"PeriodicalIF":0.0,"publicationDate":"1990-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"13375511","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Surface/specialty coil devices and gating techniques in magnetic resonance imaging.","authors":"M Erlichman","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Surface and other specialty coil devices and gating techniques are used in conjunction with MRI procedures to enhance image quality. Surface coils improve image quality by virtue of the improved signal-to-noise ratio, which results in better anatomic detail and tissue contrast. These coils may be advantageous for many kinds of imaging procedures, particularly for small structures that require greater spatial resolution. Although safety is not considered an issue, certain precautions must be taken to avoid skin burns. Gating techniques have been used to eliminate movement artifacts and associated image blurring. Cardiac-gated imaging has enabled the acquisition of high resolution diagnostic quality cardiac images with conventional MRI. Studies of gated cardiac imaging have demonstrated the technical capacity of MR scanning for evaluating ischemic heart disease, cardiomyopathy, pericardial diseases, intracardiac and paracardiac masses, thoracic-aortic diseases, and congenital heart disease. Cardiac imaging also has been found valuable in reducing motion artifacts in MRI of the chest, brain, spine, and liver. Gated imaging studies demonstrated that MRI respiratory gating improves thoracic and abdominal imaging; however, inherent time delays limit its usefulness. No patient-related risks appear to be involved when gating procedures are used appropriately. The use of gating techniques may add substantial time to the imaging procedure. Surface coil and gated MRI techniques have been found to be better than the conventional MRI studies when they improve the quality of the exam and its diagnostic capabilities.</p>","PeriodicalId":77156,"journal":{"name":"Health technology assessment reports","volume":" 3","pages":"1-23"},"PeriodicalIF":0.0,"publicationDate":"1990-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"13510597","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reassessment of external insulin infusion pumps.","authors":"S S Hotta,&nbsp;D Adams","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Continuous subcutaneous insulin infusion (CSII) therapy using external infusion pumps provides an alternative to multiple daily injections (MDI) for insulin-dependent diabetics who require intensive insulin therapy. CSII allows for the delivery of regular insulin continuously at preset basal rates and at bolus doses, which can be varied in response to insulin needs of the patient. Intensive insulin therapy by CSII or MDI was administered to diabetics to improve control of their blood glucose levels and to assess its effects on the development of complications such as retinopathy and nephropathy. CSII appeared to be as effective as MDI in attaining near-normoglycemia and improving metabolic control in patients with insulin-dependent diabetes mellitus who required intensive insulin therapy. It was not clear, however, whether the improved control of the blood glucose levels resulted in the prevention or progression of the diabetic complications. The risks of having adverse effects, such as diabetic ketoacidosis or hypoglycemia, were higher with CSII as compared with MDI; both methods having higher risks of these complications in comparison to conventional insulin therapy. CSII may be beneficial for patients requiring intensive insulin therapy who may need greater lifestyle flexibility with regard to meal timing, work, and recreational scheduling.</p>","PeriodicalId":77156,"journal":{"name":"Health technology assessment reports","volume":" 9","pages":"1-9"},"PeriodicalIF":0.0,"publicationDate":"1990-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"13283906","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Carotid endarterectomy.","authors":"H Handelsman","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Carotid endarterectomy is a surgical procedure to remove atherosclerotic occlusions from the carotid artery. The surgery is usually performed in patients with transient ischemic attacks (TIAs), asymptomatic stenosis, or stroke in order to reduce stroke risk and increase cerebral blood flow. Complication rates vary widely among surgeons and hospitals, and numerous studies testing the efficacy of carotid endarterectomy and documenting its associated morbidity and mortality have produced conflicting or inconclusive results. No properly designed prospective clinical trial has convincingly demonstrated this surgery to be superior or inferior to nonoperative management for any subset of patients with carotid artery disease. There has been no definitive study concluding that patients with TIA benefit from carotid endarterectomy. The benefits for asymptomatic patients are even less clear. Among the alternative surgical and medical treatments advocated for occlusive carotid disease, none has clearly demonstrated superior therapeutic results. It is generally agreed that current ongoing prospective, randomized, controlled clinical trials are likely to provide the data required for determination of optimal therapy and better identify subsets of patients who are most likely to benefit from carotid endarterectomy. Until the results of these clinical trials become available, the proposed benefits of carotid endarterectomy must be regarded as indeterminate.</p>","PeriodicalId":77156,"journal":{"name":"Health technology assessment reports","volume":" 5","pages":"1-15"},"PeriodicalIF":0.0,"publicationDate":"1990-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"13259231","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Protein A columns for the treatment of patients with idiopathic thrombocytopenic purpura and other indications.","authors":"H Handelsman","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>ECI using protein A columns has been designed to selectively remove circulating CICs and IgG from the plasma of patients in whom these substances are associated with their disease. The use of protein A columns appears to be a reasonable alternative to plasmapheresis in many autoimmune disorders for which plasma exchange is indicated. Although preliminary evidence suggests efficacy of plasma exchange, there is a paucity of data indicating that ECI would indeed provide comparable efficacious results. Although the role of ECI using protein A columns for the treatment of ITP continues to be poorly defined, its use in urgent and life-threatening situations in both ITP and HUS appears reasonable. The results of any treatment for chronic refractory ITP continue to be unsatisfactory. However, favorable responses have been achieved using protein A columns, suggesting the need for further investigation. The role of ECI in the treatment of other disorders, including AIDS, TTP, and the treatment of malignancies, where clinical effects are transient, continues to be investigational. The true clinical response rates and duration of responses to ECI using protein A in treating any disorder requires definition in studies involving a larger number of patients with longer followup. The demonstration of the ultimate clinical value of this therapy will require clinical trials comparing its efficacy to other therapies. Although more serious reactions have been reported, toxicities associated with the use of protein A columns are generally transient and mild.</p>","PeriodicalId":77156,"journal":{"name":"Health technology assessment reports","volume":" 7","pages":"1-8"},"PeriodicalIF":0.0,"publicationDate":"1990-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"12542616","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}