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241.
Susan C. Griffin Helen L. A. Weatherly Gerry A. Richardson Mike F. Drummond 《The European journal of health economics》2008,9(2):137-145
This paper outlines methodological challenges encountered in producing an independent economic evaluation for the National Institute for Health and Clinical Excellence (NICE) to inform its technology appraisal process. The analysis used to highlight these challenges is a recent evaluation of pharmacological treatments for attention deficit hyperactivity disorder (ADHD). The NICE reference case for economic evaluation is compared with the methods necessary to complete an evaluation given the evidence base for ADHD. The primary analysis deviated from NICE methods guidelines most noticeably in the time horizon. Identifying appropriate utility data was challenging, and the results were sensitive to the values used. Issues found in this evaluation are common to many technology appraisals. Although challenging to undertake, economic evaluation in disease areas such as ADHD has great potential to add value, making the limitations of the data explicit, combining available evidence in a systematic and transparent framework and identifying future research needs. 相似文献
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A novel ligation forceps can be used as a ligature carrier and knot pusher during laparoscopic surgery 总被引:1,自引:1,他引:0
Asao T Kuwano H Mochiki E Nakamura J Shoji H Shimura T Fujita K 《Surgical endoscopy》2001,15(5):524-527
Background: To extend the usefulness of laparoscopic operations, a secure and easy method for the ligation of large vessels
is needed. Herein we describe a novel ligation forceps that can be used as a ligature carrier and knot pusher. Methods: A
2-0 suture thread with a knot already tied near one end is hooked in the upper jaw of a novel ligation forceps. After the
lower jaw is passed under the vessel or cystic duct, the forceps is closed. When one end of the thread is withdrawn, the knot
is trapped in the indentation built into the lower jaw; the ligature is then passed under the pedicle. An extracorporeal ligation
can then be performed continuously by the same forceps. Results: The origins of large vessels were ligated safely and easily
with this device during 65 laparoscopic procedures (four total colectomies, 12 colectomies, and 49 gastrectomies). Following
temporary hemostasis of accidental bleeding with clamping forceps, ligation hemostasis can also be performed using this instrument.
Conclusion: This novel ligation forceps permits the secure ligation of vessels or a cystic duct without the need for another
device. The proposed method is both easy and inexpensive.
apd: 3 April 2001 相似文献
243.
Objectives
To answer concerns related to implementation of the National Institute for Clinical Excellence (NICE) guideline on the management of head injury by determining the impact on the workload of a district general hospital. Increased computed tomography (CT) was of particular concern (cost, radiation risk, and delivery constraints).Method
Retrospective audit of all patients attending the hospital''s emergency department with a head injury over a three month period. Any reattendees for the same head injury episode were excluded but the need for CT was recorded. Case notes and electronic records were reviewed to determine whether the CT head or skull radiograph (SXR) was indicated in line with the NICE guideline. The workload was compared with an identical audit performed before the implementation of the NICE guideline.Results
Of 17 472 patients attending the ED in 2004, 472 had a head injury. CT scan was indicated in 36, a significant increase from 2003 (p<0.001). No SXR was indicated but two were performed, a significant decrease (p<0.001). The admission rate was unaltered. The positive predictive value of NICE was 17.1% compared with 25% (p = not significant) for the authors'' pre‐NICE departmental guideline.Conclusions
This department has seen an increase in CT head requests since the implementation of the NICE guideline. This costs an extra £15 000 per 100 head injuries annually for this department, with an estimated £51.7 million burden for England and Wales. Further evaluation is required as there were only nine brain injuries in this audit population. 相似文献244.
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246.
H. Lesot S. Kieffer-Combeau J. L. Fausser J. M. Meyer F. Perrin-Schmitt R. Peterková 《Connective tissue research》2013,54(2-3):191-200
Relationships between cell-cell/cell-matrix interactions and enamel organ histomorphogenesis were examined by immunostaining and electron microscopy. During the cap-bell transition in the mouse molar, laminin-5 (LN5) disappeared from the basement membrane (BM) associated with the inner dental epithelium (IDE), and nondividing IDE cells from the enamel knot (EK) underwent a tooth-specific segregation in as many subpopulations as cusps develop. In the incisor, the basement membrane (BM) in contact with EK cells showed strong staining for LN5 and integrin f 6 g 4. LN5 seems to provide stable adhesion, while its proteolytic processing might facilitate cell segregation. In both teeth, immunostaining for antigens associated with desmosomes or adherens junctions was similar for EK cells and neighboring IDE cells. Outside the EK, IDE cell-BM interactions changed locally during the initial molar cusp delimitation and on the labial part of the incisor cervical loop. Conversely, cell-cell junctions stabilized the anterior part of the incisor during completion of morphogenesis. Time and space regulation of cell-matrix and cell-cell interactions might thus play complementary roles in allowing plasticity during tooth morphogenesis and stabilization at later stages of epithelial histogenesis. 相似文献
247.
目的探讨窄带成像(NBI)放大肠镜下NICE分型对结直肠小息肉的诊断价值。方法对肠镜检查发现的264个结直肠小息肉进行窄带成像放大肠镜检查,观察病灶表面的颜色、血管以及腺管开口,根据NICE分型预测息肉的性质,与内镜下切除或外科手术后的病理结果进行对比分析。结果窄带成像放大肠镜下NICE分型判断结直肠肿瘤性小息肉的敏感性、特异性、准确性、阳性预测值和阴性预测值分别为:93.6%(102/109)、96.1%(149/155)、95.1%(251/264)、94.4%(102/108)和95.5%(149/156)。结论 NBI放大肠镜下NICE分型可较好的区分结直肠肿瘤性小息肉和非肿瘤性小息肉,对于"切除丢弃"的治疗策略具有重要的指导价值。 相似文献
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