The friction cost method: a comment

The friction cost method has been proposed as an alternative to the human-capital approach of estimating indirect costs. We argue that the friction cost method is based on implausible assumptions not supported by neoclassical economic theory. Furthermore consistently applying the friction cost method would mean that the method should also be applied in the estimation of direct costs, which would mean that the costs of health care programmes are substantially decreased. It is concluded that the friction cost method does not seem to be a useful alternative to the human-capital approach in the estimation of indirect costs.     

An introduction to a Bayesian method for meta-analysis: The confidence profile method

The Confidence Profile Method is a new Bayesian method that can be used to assess technologies where the available evidence involves a variety of experimental designs, types of outcomes, and effect measures; a variety of biases; combinations of biases and nested bases; uncertainty about biases; an underlying variability in the parameter of interest; indirect evidence; and technology families. The result of an analysis with the Confidence Profile Method is a posterior distribution for the parameter of interest, posterior distributions for other parameters, and a covariance matrix for all the parameters in the model. The posterior distributions incorporate all the uncertainty the assessor chooses to describe about any of the parameters used in the analysis.     

The benefit method: fitting hearing aids in noise

The most common complaint among individuals with hearing impairment is the inability to follow a conversation when several people are talking simultaneously, a noisy listening situation which is completely different from the quiet surrounding of the conventional pure tone audiometry used as basis for the hearing aid settings. The purpose of this report was to present important characteristics of the BeneFit Method (BFM), a procedure that fits the hearing aid under simulated conditions of competing speech and also a clinical pilot evaluation study comparing the BFM to the NAL-R recommendations and also to the Logic procedure, a GN resound proprietary fitting algorithm representing a modern digital hearing aid fitting procedure. Speech recognition scores in noise (SRSN) using monosyllabic words presented under different background noise levels were evaluated on 21 randomly selected subjects with hearing impairment. The subjects were fitted with the same type of hearing aid Danalogic 163D according to the BFM procedure as well as the logic procedure, the latter developed and recommended by the manufacturer. A comparison of the SRSN when using the subjects' current hearing aid fitted according to the NAL-R procedure was also made. Only the BFM procedure provided a significant SRSN improvement compared to the unaided condition (P< 0.01) in a signal/speech-noise level of 75/65 dB corresponding to a normal cocktail party condition. Moreover, patients performed significantly higher SRSN when fitted according to the BFM, than when fitted according the Logic or NAL-R procedures. The BFM procedure, which is based on individual and functional detection of hearing thresholds in noise levels corresponding to a cocktail party condition, can improve SRSN significantly. Hearing aids should be fitted under conditions similar to those when the hearing disability is perceived the most, i.e, in an environment with background noise.     

The cost of HIV infection: method and results

The project concerned hospital costs: in-patient, out-patient, clinics and home-hospitalisation. It included asymptomatic HIV-infected individuals as well as AIDS patients. The annual cost per patient was calculated according to the various types of disease management described by involved physicians. Standard annual per-patient cost was between 2,470 and 338,000 according to the severity of the disease (four stages of severity have been defined). The standard annual cost per HIV-infected patient with Kaposi's sarcoma was in the range FF 89,000 to FF 131,000. The standard cost of surveillance for an asymptomatic HIV-infected pregnant woman was just over FF 3,400. The standard annual cost per child born to an asymptomatic HIV-infected mother was FF 12,300 for a child enrolled in an epidemiology protocol; it was FF 42,000 or FF 196,000 for a child with AIDS according to the severity of the illness. Furthermore, the study highlights the heterogeneity of medical practice, greater in the earlier stages of the disease, and the incidence of difference forms of disease management upon costs.     

The limited access paradigm: description of one method.

Restricting access to alcohol to a short period daily causes rats, in effect, to drink on command. They usually begin drinking alcohol immediately when it is first made available each day and consume a rather constant amount during each access period. The procedure thus has a variety of useful applications. The specific method reported here in detail provides continual access to food and water, but access to unflavored 10% ethanol solution only 1 h/d, all in the home cage, and produces mean alcohol intakes from 0.5-1.0 g/kg in the access hour.     

The case series method

The case series method was developed by Farrington (1995) to investigate the strength of association between a time-varying exposure and an acute rare potentially recurrent event, using cases only. It can be used when the exposure can only be causally related to the event during a limited period of time. It has been widely used in pharmaco-epidemiology, particularly in the study of vaccine safety. The method is derived from a Poisson model by conditioning on the individual total number of events and its exposure history. As a consequence of this conditioning, the effects of fixed covariates cancel out, so that the method has a particular advantage as compared with cohort and case-control studies.     

The life history interview method: applications to intervention development.

There is an urgent need to develop and test health promotion strategies that both address health disparities and elucidate the full impact of social, cultural, economic, institutional, and political elements on people's lives. Qualitative research methods, such as life history interviewing, are well suited to exploring these factors. Qualitative methods are also helpful for preparing field staff to implement a social contextual approach to health promotion. This article reports results and application of findings of life history interviews conducted as part of intervention planning for the Harvard Cancer Prevention Program Project, "Cancer Prevention in Working-Class, Multi-Ethnic Populations." The salient themes that emerged from interviews with a multi-ethnic, purposive sample are centered on six construct domains: immigration and social status, social support, stress, food, physical activity, and occupational health. Insights gained from thematic analysis of the interviews were integrated throughout intervention and materials development processes.     

The time trade-off method: Results from a general population study

An important consideration when establishing priorities in health care is the likely effects that alternative allocations of resources will have on health-related quality-of-life (HRQoL). This paper reports on a large-scale national study that elicited the relative valuations attached by the general public to different states of health (defined in HRQoL terms). Health state valuations were derived using the time trade-off (TTO) method. The data from 3395 respondents were highly consistent, suggesting that it is feasible to use the TTO method to elicit valuations from the general public. The paper shows that valuations for severe health states appear to be affected by the age and the sex of the respondent; those aged 18–59 have higher valuations than those aged 60 or over and men have higher valuations than women. These results contradict those reported elsewhere and suggest that the small samples used in other studies may be concealing real differences that exist between population sub-groups. This has important implications for public policy decisions.     

The Socratic method in teaching medical ethics: Potentials and limitations

The Socratic method has a long history in teaching philosophy and mathematics, marked by such names as Karl Weierstrass, Leonard Nelson and Gustav Heckmann. Its basic idea is to encourage the participants of a learning group (of pupils, students, or practitioners) to work on a conceptual, ethical or psychological problem by their own collective intellectual effort, without a textual basis and without substantial help from the teacher whose part it is mainly to enforce the rigid procedural rules designed to ensure a fruitful, diversified, open and consensus-oriented thought process. Several features of the Socratic procedure, especially in the canonical form given to it by Heckmann, are highly attractive for the teaching of medical ethics in small groups: the strategy of starting from relevant singular individual experiences, interpreting and cautiously generalizing them in a process of inter-subjective confrontation and confirmation, the duty of non-directivity on the part of the teacher in regard to the contents of the discussion, the necessity, on the part of the participants, to make explicit both their own thinking and the way they understand the thought of others, the strict separation of content level and meta level discussion and, not least, the wise use made of the emotional and motivational resources developing in the group process. Experience shows, however, that the canonical form of the Socratic group suffers from a number of drawbacks which may be overcome by loosening the rigidity of some of the rules. These concern mainly the injunction against substantial interventions on the part of the teacher and the insistence on consensus formation rooted in Leonard Nelson's Neo-Kantian Apriorism.     

The clinical algorithm nosology: a method for comparing algorithmic guidelines.

Concern regarding the cost and quality of medical care has led to a proliferation of competing clinical practice guidelines. No technique has been described for determining objectively the degree of similarity between alternative guidelines for the same clinical problem. The authors describe the development of the Clinical Algorithm Nosology (CAN), a new method to compare one form of guideline: the clinical algorithm. The CAN measures overall design complexity independent of algorithm content, qualitatively describes the clinical differences between two alternative algorithms, and then scores the degree of similarity between them. CAN algorithm design-complexity scores correlated highly with clinicians' estimates of complexity on an ordinal scale (r = 0.86). Five pairs of clinical algorithms addressing three topics (gallstone lithotripsy, thyroid nodule, and sinusitis) were selected for interrater reliability testing of the CAN clinical-similarity scoring system. Raters categorized the similarity of algorithm pathways in alternative algorithms as "identical," "similar," or "different." Interrater agreement was achieved on 85/109 scores (80%), weighted kappa statistic, k = 0.73. It is concluded that the CAN is a valid method for determining the structural complexity of clinical algorithms, and a reliable method for describing differences and scoring the similarity between algorithms for the same clinical problem. In the future, the CAN may serve to evaluate the reliability of algorithm development programs, and to support providers and purchasers in choosing among alternative clinical guidelines.     

The filter of choice: filtration method preference among injecting drug users

Background

Injection drug use syringe filters (IDUSF) are designed to prevent several complications related to the injection of drugs. Due to their small pore size, their use can reduce the solution's insoluble particle content and thus diminish the prevalence of phlebitis, talcosis.... Their low drug retention discourages from filter reuse and sharing and can thus prevent viral and microbial infections. In France, drug users have access to sterile cotton filters for 15 years and to an IDUSF (the Sterifilt^®) for 5 years. This study was set up to explore the factors influencing filter preference amongst injecting drug users.

Methods

Quantitative and qualitative data were gathered through 241 questionnaires and the participation of 23 people in focus groups.

Results

Factors found to significantly influence filter preference were duration and frequency of injecting drug use, the type of drugs injected and subculture. Furthermore, IDU's rationale for the preference of one type of filter over others was explored. It was found that filter preference depends on perceived health benefits (reduced harms, prevention of vein damage, protection of injection sites), drug retention (low retention: better high, protective mechanism against the reuse of filters; high retention: filter reuse as a protective mechanism against withdrawal), technical and practical issues (filter clogging, ease of use, time needed to prepare an injection) and believes (the conviction that a clear solution contains less active compound).

Conclusion

It was concluded that the factors influencing filter preference are in favour of change; a shift towards the use of more efficient filters can be made through increased availability, information and demonstrations.     

The student diary survey: a method of monitoring hospital-based medical education

A new system of allocating the Service Increment for Teaching (SIFT) has recently been introduced which, by its nature, encourages universities to be more explicit about their teaching requirements. A detailed study of the quantity of teaching received by Leicester clinical medical students was carried out using a student diary. This instrument enables a data base to be constructed which is useful for academic and resource allocation purposes. This information can also be used to estimate the teaching time in the different sites and the source of funding of the teaching staff and thereby provide insights into the 'knock-for-knock' system of informal cost-sharing between universities and the National Health Service.