Subjective measures of hearing aid benefit and satisfaction in the NIDCD/VA follow-up study.

Perceived benefit, satisfaction, and hearing aid use patterns were measured in a follow-up study to a large-scale multi-site clinical trial conducted in 1996-97. Measures included the Hearing Aid Status Questionnaire, the Profile of Hearing Aid Benefit, the Glasgow Hearing Aid Benefit Profile, the Satisfaction with Amplification in Daily Life, and the International Outcome Inventory for Hearing Aids. On the Profile of Hearing Aid Benefit, hearing aid users indicated more unaided difficulty in easy listening situations and less aided benefit in more difficult listening situations compared to the original study.

Promoting patient empowerment in the healthcare system: highlighting the need for patient-centered drug policy.

In recent years the term 'patient empowerment' has increasingly been used among healthcare policy makers; however, discussions have focused on narrow activities that as stand-alone activities would be unlikely to give patients power. This paper presents findings from a systematic review of the medical literature. After offering a new definition of patient empowerment, we review the literature behind the concept, aided by a conceptual model.

Team structure and adverse events in home health care.

Objective: To identify relationships between variations in team structure and risk-adjusted adverse events across 86 teams in a large US home health care organization.

Methods: Patient episode data were collected for two 6-month periods, January-June 2002 (N = 54,732 episodes) and January-June 2003 (N = 51,560 episodes). An adverse event was defined as having 1 or more events defined by the Centers for Medicare and Medicaid Services for home health care episodes.

Comparison of individual and group valuation of health state scenarios across communities in West Africa.

Background: The correct valuation of health state scenarios is important for economic analyses, disease burden assessment and setting clinical guidelines. However, it is unclear whether we should use individual or group valuations. We aimed to compare individual and group valuations of a range of clinically and culturally relevant health state scenarios in a West African population.

Patient-based health technology assessment: a vision of the future.

Background: In conjunction with other important movements in contemporary medicine, including evidence-based medicine (EBM), health technology assessment (HTA) has promoted a culture of critical evaluation. Despite this impact, institutional and methodological challenges are associated with HTA. For example, only in recent years has HTA attempted an open dialogue with patients; however, this is normally done by giving them a "seat" at the HTA decision-making table, rather than by more scientific means.

Functional status decline as a measure of adverse events in home health care: an observational study.

Background: Research that examines the quality of home health care is complex because no gold standard exists for measuring adverse outcomes, and because the patient and clinician populations are highly heterogeneous. The objectives in this study are to develop models to predict functional decline for three indices of functional status as measures of adverse events in home health care and determine which index is most appropriate for risk-adjusting for future quality research.

Methods: Data come from the Outcomes and Assessment Information Set (OASIS) from a large urban home health care agency and other agency data.

Mineralogy and petrology of comet 81P/Wild 2 nucleus samples.

The bulk of the comet 81P/Wild 2 (hereafter Wild 2) samples returned to Earth by the Stardust spacecraft appear to be weakly constructed mixtures of nanometer-scale grains, with occasional much larger (over 1 micrometer) ferromagnesian silicates, Fe-Ni sulfides, Fe-Ni metal, and accessory phases. The very wide range of olivine and low-Ca pyroxene compositions in comet Wild 2 requires a wide range of formation conditions, probably reflecting very different formation locations in the protoplanetary disk. The restricted compositional ranges of Fe-Ni sulfides, the wide range for silicates, and the absence of hydrous phases indicate that comet Wild 2 experienced little or no aqueous alteration.

Elemental compositions of comet 81P/Wild 2 samples collected by Stardust.

We measured the elemental compositions of material from 23 particles in aerogel and from residue in seven craters in aluminum foil that was collected during passage of the Stardust spacecraft through the coma of comet 81P/Wild 2. These particles are chemically heterogeneous at the largest size scale analyzed ( approximately 180 ng). The mean elemental composition of this Wild 2 material is consistent with the CI meteorite composition, which is thought to represent the bulk composition of the solar system, for the elements Mg, Si, Mn, Fe, and Ni to 35%, and for Ca and Ti to 60%.

Impact features on Stardust: implications for comet 81P/Wild 2 dust.

Particles emanating from comet 81P/Wild 2 collided with the Stardust spacecraft at 6.1 kilometers per second, producing hypervelocity impact features on the collector surfaces that were returned to Earth. The morphologies of these surprisingly diverse features were created by particles varying from dense mineral grains to loosely bound, polymineralic aggregates ranging from tens of nanometers to hundreds of micrometers in size.

Patients' preferences for healthcare system reforms in Hungary: a conjoint analysis.

Objectives: To illustrate how conjoint analysis can be used to identify patient preferences for healthcare policies, and to measure preferences for healthcare reforms in Hungary.

Data Source/study Setting: Data was collected via a mail-based survey and a direct survey administered in a rheumatology out-patient centre in Flór Ferenc County Hospital, Budapest, Hungary (n = 86).

Study Design: We designed and administered a conjoint analysis to the study population.

Policy on new workforce roles: a discussion paper.

Addressing workforce issues has increasingly become a central feature of the organisation and management of public sector services internationally. The introduction of new work roles to public services is one approach advocated in response to recruitment and retention difficulties with professional staff and to increasingly complex services. This paper aims to critically examine UK's new roles policy in a health care context and explore its wider relevance by drawing on findings from an action research Ph.

Risk assessment of substances that are both genotoxic and carcinogenic report of an International Conference organized by EFSA and WHO with support of ILSI Europe.

The European Food Safety Authority (EFSA) and the World Health Organization (WHO), with the support of the International Life Sciences Institute, European Branch (ILSI Europe), organized an international conference on 16-18 November 2005 to discuss how regulatory and advisory bodies evaluate the potential risks of the presence in food of substances that are both genotoxic and carcinogenic. The objectives of the conference were to discuss the possible approaches for risk assessment of such substances, how the approaches may be interpreted and whether they meet the needs of risk managers. ALARA (as low as reasonably achievable) provides advice based solely on hazard identification and does not take into account either potency or human exposure.

Globalization and healthcare: understanding health and medical tourism.

Faced with long waiting lists, the high cost of elective treatment and fewer barriers to travel, the idea of availing healthcare in another country is gaining greater appeal to many. The objective of this review is to perform a literature review of health and medical tourism, to define health and medical tourism based on the medical literature and to estimate the size of trade in healthcare. The Medline database was used for our literature review.

Survey of surgical experience during training in obstetrics and gynaecology in the UK.

The 2002 RCOG survey of training reported that the percentage of obstetric and gynaecology trainees who class their operative training as good or very good has declined from 45% in 1995, to 39% in 2002; reduction in years of training and number of working hours may have further impact on the surgical experience. In this study, we have attempted to assess the level of surgical confidence reported by senior and recently accredited trainees in obstetrics and gynaecology in the UK via an anonymised postal questionnaire. A total of 103 replies were received from 202 questionnaires.

Accounting for tastes: a German perspective on the inclusion of patient preferences in healthcare.

Internationally, there has been a movement in medicine to better involve patients in decision making, whether it be at the individual or aggregate level. However, the German health sector has been slow to understand and accommodate the preferences of patients. This paper discusses the reasons why and attempts to highlight some of the consequences of not involving patients in healthcare decision making within the German context.

Librarians in the Woods Hole Biomedical Informatics course.

What has come to be known as the "Woods Hole course", Biomedical Informatics, is a week-long course sponsored by the National Library of Medicine which has been offered since 1992. Its participants include librarians, clinicians, educators, and administrators. This article discusses the content of the course and its applicability to medical librarians.

Adaptation and increased susceptibility to infection associated with constitutive expression of misfolded SP-C.

Mutations in the gene encoding SP-C (surfactant protein C; SFTPC) have been linked to interstitial lung disease (ILD) in children and adults. Expression of the index mutation, SP-C(Deltaexon4), in transiently transfected cells and type II cells of transgenic mice resulted in misfolding of the proprotein, activation of endoplasmic reticulum (ER) stress pathways, and cytotoxicity. In this study, we show that stably transfected cells adapted to chronic ER stress imposed by the constitutive expression of SP-C(Deltaexon4) via an NF-kappaB-dependent pathway.

What can economics add to health technology assessment? Please not just another cost-effectiveness analysis!

Evidence based medicine is not only important for clinical practice, but national governments have embraced it through health technology assessment (HTA). HTA combines data from randomized controlled trials (RCT) and observational studies with an economic component (among other issues). HTA, however, is not taking full advantage of economics.

Routine computerized tomography scanning, groin ultrasound with or without fine needle aspiration cytology in the surgical management of primary squamous cell carcinoma of the vulva.

We set out to study whether computerized tomography (CT) scanning of the vulva and the groin and groin ultrasound scanning (USS) alone or with fine needle aspiration cytology (FNAC) (USS/FNAC) influenced or could influence the surgical management of primary squamous cell carcinoma of the vulva (SCCaV). Forty-four patients underwent surgery for primary SCCaV following radiologic imaging by one or more modalities. Patient details included the clinical assessment of the carcinoma, radiologic findings, the operation performed, and whether the decision regarding the type and extent of surgery for the vulval carcinoma and, in particular, for the groin node dissection was or could be influenced by the radiologic findings.

Overcoming bias in estimating the volume-outcome relationship.

Objective: To examine the effect of hospital volume on 30-day mortality for patients with congestive heart failure (CHF) using administrative and clinical data in conventional regression and instrumental variables (IV) estimation models.

Data Sources: The primary data consisted of longitudinal information on comorbid conditions, vital signs, clinical status, and laboratory test results for 21,555 Medicare-insured patients aged 65 years and older hospitalized for CHF in northeast Ohio in 1991-1997.

Study Design: The patient was the primary unit of analysis.

Toxicological comments to the discussion about REACH.

It is the ultimate goal of the intended REACH process (Registration, Evaluation and Authorization of Chemicals) of the European Union to identify substances of hazardous properties and to evaluate the risks of human and environmental exposure. During the last few months there has been a controversial discussion as to what extent in vitro studies and consideration of structure activity relationship provide sufficient information to waive repeated exposure studies. Industry as well as certain regulatory agencies or NGOs support this approach and propose that repeated dose studies may only be required beyond 100 t/a.

Use of transgenic mice to study lung morphogenesis and function.

Successful transition to air breathing at birth depends on perinatal maturation of the gas exchange surface, resorption of fluid from the air spaces, and synthesis and secretion of pulmonary surfactant. Genetic mutations that alter lung development and/or cellular differentiation in the prenatal period, lung function in the perinatal period, or lung homeostasis in the postnatal period can lead to neonatal lethality or chronic lung disease. Current knowledge of the molecular pathways that regulate key prenatal, perinatal, and postnatal morphogenetic events has been shaped largely by remarkable advances in transgenic technologies.