Alternative perspectives on the biased foundations of medical technology assessment.

Abstract:

:Medical technology assessment seeks to improve the care of individual patients (the conventional unit of clinical practice) through evaluation studies conducted in groups of patients (the conventional unit of clinical investigation). This distinction between individuals and groups has practical relevance to the design, analysis, and clinical applicability of technology assessment studies. We define several biased perspectives about technology assessment that derive from the distinction between individuals and groups: a misguided emphasis on efficacy versus effectiveness, on statistical significance versus clinical importance, and on objective versus subjective outcomes. In each case, we contrast these alternative perspectives and speculate on their implications for health care policy.

journal_name

Ann Intern Med

authors

Diamond GA,Denton TA

doi

10.7326/0003-4819-118-6-199303150-00010

subject

Has Abstract

pub_date

1993-03-15 00:00:00

pages

455-64

issue

6

eissn

0003-4819

issn

1539-3704

journal_volume

118

pub_type

杂志文章,评审
  • Granulomatous hepatitis secondary to carbamazepine.

    abstract::Three cases of carbamazepine-induced granulomatous hepatitis are reported. Each patient had ingested carbamazepine for less than 1 month before presenting with a febrile illness suggestive of biliary tract infection. After withdrawal of carbamazepine, symptoms disappeared rapidly. Histologically, all patients had gran...

    journal_title:Annals of internal medicine

    pub_type: 杂志文章

    doi:10.7326/0003-4819-95-1-64

    authors: Levy M,Goodman MW,Van Dyne BJ,Sumner HW

    更新日期:1981-07-01 00:00:00

  • Physician practices in the prevention of venous thromboembolism.

    abstract:OBJECTIVE:To determine the rate of use of prophylaxis for venous thromboembolism in high-risk hospital patients. DESIGN:A retrospective medical record review. SETTING:A community-wide study in 16 short-stay hospitals in central Massachusetts. PATIENTS:A total of 2017 patients with multiple risk factors for venous th...

    journal_title:Annals of internal medicine

    pub_type: 杂志文章

    doi:10.7326/0003-4819-591

    authors: Anderson FA Jr,Wheeler HB,Goldberg RJ,Hosmer DW,Forcier A,Patwardhan NA

    更新日期:1991-10-15 00:00:00

  • The matrix of ambulatory education.

    abstract::Ambulatory education has become an essential part of all internal medicine residencies. To develop excellent ambulatory education programs, we must thoroughly understand the opportunities available in such a setting, and the leaders in internal medicine must be willing to experiment with nontraditional locations and r...

    journal_title:Annals of internal medicine

    pub_type: 杂志文章

    doi:10.7326/0003-4819-116-12-1076

    authors: Schuster BL

    更新日期:1992-06-15 00:00:00

  • Intentional weight loss and death in overweight and obese U.S. adults 35 years of age and older.

    abstract:BACKGROUND:Although weight loss improves risk factors for cardiovascular and metabolic disease, it is unclear whether intentional weight loss reduces mortality rates. OBJECTIVE:To examine the relationships among intention to lose weight, weight loss, and all-cause mortality. DESIGN:Prospective cohort study using a pr...

    journal_title:Annals of internal medicine

    pub_type: 杂志文章

    doi:10.7326/0003-4819-138-5-200303040-00007

    authors: Gregg EW,Gerzoff RB,Thompson TJ,Williamson DF

    更新日期:2003-03-04 00:00:00

  • Invasive and noninvasive strategies for management of suspected ventilator-associated pneumonia. A randomized trial.

    abstract:BACKGROUND:Optimal management of patients who are clinically suspected of having ventilator-associated pneumonia remains open to debate. OBJECTIVE:To evaluate the effect on clinical outcome and antibiotic use of two strategies to diagnose ventilator-associated pneumonia and select initial treatment for this condition....

    journal_title:Annals of internal medicine

    pub_type: 临床试验,杂志文章,多中心研究,随机对照试验

    doi:10.7326/0003-4819-132-8-200004180-00004

    authors: Fagon JY,Chastre J,Wolff M,Gervais C,Parer-Aubas S,Stéphan F,Similowski T,Mercat A,Diehl JL,Sollet JP,Tenaillon A

    更新日期:2000-04-18 00:00:00

  • Coronary artery spasm.

    abstract::Coronary artery spasm is an important pathogenetic mechanism in some forms of myocardial ischemic disease. Factors that may be important in the genesis of spasm include the autonomic nervous system, prostaglandins, endoperoxides, thromboxanes, and the calcium availability to the contractile apparatus. Spasm results in...

    journal_title:Annals of internal medicine

    pub_type: 杂志文章,评审

    doi:10.7326/0003-4819-91-3-441

    authors: Luchi RJ,Chahine RA,Raizner AE

    更新日期:1979-09-01 00:00:00

  • Profound but reversible myocardial depression in patients with septic shock.

    abstract::To characterize the role of cardiac function in septic shock, serial radionuclide cineangiographic and hemodynamic evaluations were done on 20 patients with documented septic shock. Although all patients had a normal or elevated cardiac index, 10 patients had moderate to severe depression of their ejection fraction wi...

    journal_title:Annals of internal medicine

    pub_type: 杂志文章

    doi:10.7326/0003-4819-100-4-483

    authors: Parker MM,Shelhamer JH,Bacharach SL,Green MV,Natanson C,Frederick TM,Damske BA,Parrillo JE

    更新日期:1984-04-01 00:00:00

  • Guidelines for the care of patients hospitalized with viral hepatitis.

    abstract::For years patients hospitalized with viral hepatitis have been placed in two categories of isolation--enteric precautions and blood precautions. This strategy was based on the inability to differentiate between hepatitis A and B and on the assumption that feces and blood from patients with either type might be infecti...

    journal_title:Annals of internal medicine

    pub_type: 杂志文章

    doi:10.7326/0003-4819-91-6-872

    authors: Favero MS,Maynard JE,Leger RT,Graham DR,Dixon RE

    更新日期:1979-12-01 00:00:00

  • Health System Costs of Treating Latent Tuberculosis Infection With Four Months of Rifampin Versus Nine Months of Isoniazid in Different Settings.

    abstract:BACKGROUND:Four months of rifampin treatment for latent tuberculosis infection is safer, has superior treatment completion rates, and is as effective as 9 months of isoniazid. However, daily medication costs are higher for a 4-month rifampin regimen than a 9-month isoniazid regimen. OBJECTIVE:To compare health care us...

    journal_title:Annals of internal medicine

    pub_type: 杂志文章,随机对照试验

    doi:10.7326/M19-3741

    authors: Bastos ML,Campbell JR,Oxlade O,Adjobimey M,Trajman A,Ruslami R,Kim HJ,Baah JO,Toelle BG,Long R,Hoeppner V,Elwood K,Al-Jahdali H,Apriani L,Benedetti A,Schwartzman K,Menzies D

    更新日期:2020-08-04 00:00:00

  • Acute postoperative confusion and hallucinations in Parkinson disease.

    abstract:STUDY OBJECTIVE:To determine whether patients with Parkinson disease are at an increased risk for postoperative confusion. DESIGN:Retrospective chart review of patients with Parkinson disease who remained in the hospital at least 48 hours after their surgery. Current data were compared with published historical contro...

    journal_title:Annals of internal medicine

    pub_type: 杂志文章

    doi:10.7326/0003-4819-111-3-218

    authors: Golden WE,Lavender RC,Metzer WS

    更新日期:1989-08-01 00:00:00

  • Inhaled or intravenous pentamidine therapy for Pneumocystis carinii pneumonia in AIDS. A randomized trial.

    abstract:OBJECTIVE:To compare inhaled pentamidine with intravenous pentamidine for the treatment of Pneumocystis carinii pneumonia in the acquired immunodeficiency syndrome (AIDS). DESIGN:A randomized trial. SETTING:Community teaching hospital and hospital-based outpatient treatment center. PATIENTS:Twenty-one homosexual men...

    journal_title:Annals of internal medicine

    pub_type: 临床试验,杂志文章,随机对照试验

    doi:10.7326/0003-4819-113-3-195

    authors: Soo Hoo GW,Mohsenifar Z,Meyer RD

    更新日期:1990-08-01 00:00:00

  • The role of intravenous amiodarone in the management of cardiac arrhythmias.

    abstract:PURPOSE:To review the electropharmacology, clinical applications, side effects, and hemodynamic profile of intravenous amiodarone. DATA SOURCES:The MEDLINE database was searched for English-language material, including reports of clinical trials and in vivo studies, review articles, and abstracts presented at national...

    journal_title:Annals of internal medicine

    pub_type: 杂志文章,评审

    doi:10.7326/0003-4819-127-4-199708150-00007

    authors: Desai AD,Chun S,Sung RJ

    更新日期:1997-08-15 00:00:00

  • Descriptive epidemiology of body weight and weight change in U.S. adults.

    abstract::Data on body weight and weight change collected from nationally representative samples of U.S. adults are reviewed. The body mass index (weight [kg]/height [m2]) has a low correlation with height and is used to compare body weights between persons of differing heights. The BMI varies to a greater degree in women than ...

    journal_title:Annals of internal medicine

    pub_type: 杂志文章,评审

    doi:10.7326/0003-4819-119-7_part_2-199310011-00004

    authors: Williamson DF

    更新日期:1993-10-01 00:00:00

  • Human immunodeficiency virus (HIV) antigenemia (p24) in the acquired immunodeficiency syndrome (AIDS) and the effect of treatment with zidovudine (AZT).

    abstract::Infection with human immunodeficiency virus (HIV) may cause viral antigenemia, detected primarily as p24 viral core protein. Among 16 patients with the acquired immunodeficiency syndrome (AIDS) or AIDS-related complex studied serially, 12 had or developed antigenemia ranging from 16 to 3006 pg/mL in plasma. The level ...

    journal_title:Annals of internal medicine

    pub_type: 临床试验,杂志文章,随机对照试验

    doi:10.7326/0003-4819-108-2-175

    authors: Jackson GG,Paul DA,Falk LA,Rubenis M,Despotes JC,Mack D,Knigge M,Emeson EE

    更新日期:1988-02-01 00:00:00

  • Preoperative screening: value of previous tests.

    abstract:OBJECTIVE:To determine the frequency of tests done in the year before elective surgery that might substitute for preoperative screening tests and to determine the frequency of test results that change from a normal value to a value likely to alter perioperative management. DESIGN:Retrospective cohort analysis of compu...

    journal_title:Annals of internal medicine

    pub_type: 杂志文章

    doi:10.7326/0003-4819-113-12-969

    authors: Macpherson DS,Snow R,Lofgren RP

    更新日期:1990-12-15 00:00:00

  • Systematic review: cardiac resynchronization in patients with symptomatic heart failure.

    abstract:BACKGROUND:Even with optimal pharmacotherapy, symptomatic heart failure is associated with substantial morbidity and mortality. PURPOSE:To determine the efficacy and safety of cardiac resynchronization therapy in adults with advanced systolic heart failure. DATA SOURCES:The Cochrane Central Register of Controlled Tri...

    journal_title:Annals of internal medicine

    pub_type: 杂志文章,meta分析,评审

    doi:10.7326/0003-4819-141-5-200409070-00101

    authors: McAlister FA,Ezekowitz JA,Wiebe N,Rowe B,Spooner C,Crumley E,Hartling L,Klassen T,Abraham W

    更新日期:2004-09-07 00:00:00

  • Reporting and Implementing Interventions Involving Machine Learning and Artificial Intelligence.

    abstract::Increasingly, interventions aimed at improving care are likely to use such technologies as machine learning and artificial intelligence. However, health care has been relatively late to adopt them. This article provides clinical examples in which machine learning and artificial intelligence are already in use in healt...

    journal_title:Annals of internal medicine

    pub_type: 杂志文章,评审

    doi:10.7326/M19-0872

    authors: Bates DW,Auerbach A,Schulam P,Wright A,Saria S

    更新日期:2020-06-02 00:00:00

  • New federal initiatives to enhance the medical treatment of opioid dependence.

    abstract::Opioid dependence is a chronic relapsing medical condition with substantial health and societal complications. Recent federal initiatives are designed to enhance the medical treatment of patients with opioid dependence and will expand the role of internists in the care of these patients. These initiatives include a pr...

    journal_title:Annals of internal medicine

    pub_type: 杂志文章

    doi:10.7326/0003-4819-137-8-200210150-00014

    authors: Fiellin DA,O'Connor PG

    更新日期:2002-10-15 00:00:00

  • Care of the aged: the barriers of traditions.

    abstract::The growing population of older persons in our society will require increased attention. It is contended that the current pattern of third-party reimbursement for hospitalization and technical procedures focuses upon acute care and cure. The philosophy underlying medical education and practice is a barrier to the prov...

    journal_title:Annals of internal medicine

    pub_type: 杂志文章

    doi:10.7326/0003-4819-94-2-256

    authors: Eisdorfer C

    更新日期:1981-02-01 00:00:00

  • Polycythemia vera: the natural history of 1213 patients followed for 20 years. Gruppo Italiano Studio Policitemia.

    abstract:OBJECTIVE:To reassess the natural history of polycythemia vera and to obtain reliable estimates of both incidence of thrombosis and survival for use in defining the sample size for therapeutic clinical trials. STUDY DESIGN:Retrospective cohort study of patients with polycythemia who had been followed for 20 years. SE...

    journal_title:Annals of internal medicine

    pub_type: 杂志文章

    doi:10.7326/0003-4819-123-9-199511010-00003

    authors:

    更新日期:1995-11-01 00:00:00

  • Prevention of cytomegalovirus infection by cytomegalovirus immune globulin after marrow transplantation.

    abstract::In an effort to prevent cytomegalovirus infection among seronegative patients having marrow transplants, a globulin with high antibody levels against cytomegalovirus was given before and for 11 weeks after transplantation in a randomized trial. Among 36 patients who received no prophylactic granulocyte transfusions, g...

    journal_title:Annals of internal medicine

    pub_type: 临床试验,杂志文章,随机对照试验

    doi:10.7326/0003-4819-98-4-442

    authors: Meyers JD,Leszczynski J,Zaia JA,Flournoy N,Newton B,Snydman DR,Wright GG,Levin MJ,Thomas ED

    更新日期:1983-04-01 00:00:00

  • Aspirin hepatotoxicity and disseminated intravascular coagulation.

    abstract::A 17-year-old girl with a clinical diagnosis of adult-type juvenile rheumatoid arthritis developed a severe hepatotoxic reaction to 3.6 g of aspirin per day. This was associated with a microangiopathic anemia and transient congestive cardiac failure. She responded well to steroids, and when all laboratory test finding...

    journal_title:Annals of internal medicine

    pub_type: 杂志文章

    doi:10.7326/0003-4819-86-2-183

    authors: Sbarbaro JA,Bennett RM

    更新日期:1977-02-01 00:00:00

  • Better access to information about clinical trials.

    abstract::Access to information about clinical trials is important to researchers, health care professionals, and patients. Many have argued for the establishment of clinical trials registries, citing their substantial benefits. Although some registries do exist, it has been difficult to create comprehensive, easily accessible ...

    journal_title:Annals of internal medicine

    pub_type: 杂志文章

    doi:10.7326/0003-4819-133-8-200010170-00013

    authors: McCray AT

    更新日期:2000-10-17 00:00:00

  • Bullets, lead poisoning and thyrotoxicosis.

    abstract::A patient with a retained bullet developed lead poisoning in association with thyrotoxicosis. The clinical and laboratory data suggest that lead was mobilized from an increased mobile bone pool during the hypermetabolic period with resultant poisoning. The findings give factual support to earlier concepts that lead po...

    journal_title:Annals of internal medicine

    pub_type: 杂志文章

    doi:10.7326/0003-4819-89-4-509

    authors: Cagin CR,Diloy-Puray M,Westerman MP

    更新日期:1978-10-01 00:00:00

  • Adenosine for paroxysmal supraventricular tachycardia: dose ranging and comparison with verapamil. Assessment in placebo-controlled, multicenter trials. The Adenosine for PSVT Study Group.

    abstract:OBJECTIVE:To assess the safety and efficacy of intravenous adenosine in terminating acute episodes of paroxysmal supraventricular tachycardia. DESIGN:Two prospective, double-blind, randomized, placebo-controlled trials to evaluate dose response in patients receiving adenosine and to compare the effects of adenosine wi...

    journal_title:Annals of internal medicine

    pub_type: 临床试验,杂志文章,多中心研究,随机对照试验

    doi:10.7326/0003-4819-113-2-104

    authors: DiMarco JP,Miles W,Akhtar M,Milstein S,Sharma AD,Platia E,McGovern B,Scheinman MM,Govier WC

    更新日期:1990-07-15 00:00:00

  • D-dimer for the exclusion of acute venous thrombosis and pulmonary embolism: a systematic review.

    abstract:BACKGROUND:Despite extensive literature, the diagnostic role of d-dimer for deep venous thrombosis (DVT) or pulmonary embolism (PE) remains unclear, reflecting multiple d-dimer assays and concerns about differing sensitivities and variability. PURPOSE:To systematically review trials that assessed sensitivity, specific...

    journal_title:Annals of internal medicine

    pub_type: 杂志文章,meta分析,评审

    doi:10.7326/0003-4819-140-8-200404200-00005

    authors: Stein PD,Hull RD,Patel KC,Olson RE,Ghali WA,Brant R,Biel RK,Bharadia V,Kalra NK

    更新日期:2004-04-20 00:00:00

  • The lessons of SARS.

    abstract::Given the low mortality and morbidity of the severe acute respiratory syndrome (SARS) compared with other public health scourges, is the attention devoted to it misdirected? The SARS experience has provided at least 4 enduring lessons. First, by providing a test of the capacity of each part of the public health system...

    journal_title:Annals of internal medicine

    pub_type: 杂志文章

    doi:10.7326/0003-4819-139-7-200310070-00011

    authors: Emanuel EJ

    更新日期:2003-10-07 00:00:00

  • Homocyst(e)ine and cardiovascular disease: a critical review of the epidemiologic evidence.

    abstract:PURPOSE:To review epidemiologic studies on the association between homocyst(e)ine level and risk for cardiovascular disease and the potential benefits of homocysteine-decreasing therapies. DATA SOURCES:Computerized and manual searches of the literature on total homocysteine levels and cardiovascular disease. STUDY SE...

    journal_title:Annals of internal medicine

    pub_type: 杂志文章,评审

    doi:10.7326/0003-4819-131-5-199909070-00008

    authors: Eikelboom JW,Lonn E,Genest J Jr,Hankey G,Yusuf S

    更新日期:1999-09-07 00:00:00

  • Discussing hidden bias in observational studies.

    abstract::In observational studies or nonrandomized experiments, treated and control groups may differ in their outcomes even if the treatment has no effect; this may happen if the groups were not comparable before the start of treatment. The groups may fail to be comparable in either of two ways: They may differ with respect t...

    journal_title:Annals of internal medicine

    pub_type: 杂志文章

    doi:10.7326/0003-4819-115-11-901

    authors: Rosenbaum PR

    更新日期:1991-12-01 00:00:00

  • Pathologic findings in guinea pigs inoculated intraperitoneally with the Legionnaires' disease bacterium.

    abstract::Tissues from guinea pigs inoculated intraperitoneally with the Legionnaires' disease (LD) bacterium were studied with light, immunofluorescent, and electron microscopy. The principal gross lesion was diffuse peritonitis of varying severity. Microscopically, the peritonitis of covered by a mixed inflammatory infiltrate...

    journal_title:Annals of internal medicine

    pub_type: 杂志文章

    doi:10.7326/0003-4819-90-4-671

    authors: Chandler FW,McDade JE,Hicklin MD,Blackmon JA,Thomason BM,Ewing EP Jr

    更新日期:1979-04-01 00:00:00