During the last decade, microsurgical improvements have developed extremely rapidly in eye surgery. The use of operating microscopes has opened this field to a wide range of technical innovations such as finger suture materials, more sophisticated instruments, and new implants. The result has been better rehabilitation of patients, whose vision was impaired by opacities in the refracting media of the eye. The most frequent cause of poor vision in the elderly is cataract, which is an opacification of the lens in the eye. Most people older than 70 years will have some cataract, with about 30% having opacities that markedly reduce visual acuity and often produce glare phenomena in at least one eye (see Figure 1). There is at present no medical treatment for cataract.

The literature on economic evaluation of Pharmaceuticals is growing rapidly. Although there have been substantial methodologic advances, there remain serious problems and pitfalls. This presentation focuses on three aspects, i.e., use (and abuse) of evaluation studies, methodologic problems, and the quality of published studies.

Objectives: The purpose of this study was to identify the Evidence-Based Practice Center (EPC) network participants' perceptions of the characteristics of the EPC process and the relationship of the process to the success of EPC reports.

Methods: Semistructured interviews were conducted with the three groups involved in the EPC: EPC staff, Agency for Healthcare Research and Quality (AHRQ) staff, and representatives of partner organizations.

Results: The analysis of the coded transcripts revealed three related major themes, which form the conceptual basis for the interpretation presented here: the definition of a successful report, the determinants of a successful report, and the role of AHRQ in the process.

Conclusions: A successful report is a report that is used. The ultimate success of the core health technology assessment objective, moving from research to policy, depends on balancing two values: excellence and relevance. Our findings are consistent with the “two communities thesis,” which postulates the existence of two camps that confer different values to excellence and relevance, with resulting tension. A promising model for approaching this tension is integration or collaboration, which requires linking researchers and policy makers, promoting productive dialogues about the formulation and timing of analysis, and early consideration of how the resulting analysis will be used. This effort suggests that actively blurring the frontiers between these two groups will enhance their interaction. Furthermore, enhancing the role of the AHRQ as scientific broker will maximize the potential of the EPC network.

Technology assessment in health care seeks to evaluate intended and unintended consequences of the use of technology across a broad range that includes health, economic, legal, ethical, and other social implications. In conducting such evaluations, analysts draw on methods and information from an equally broad range of disciplines. The field of technology assessment thus itself conforms to the definition of a technology, that is, the application of knowledge to a purpose.

Percutaneous lithotripsy has achieved widespread diffusion throughout the medical community and is described by many authors as the manipulative treatment of choice in an increasing number of patients with renal stones. Appropriate use of percutaneous lithotripsy is not an isolated event of patient management but is considered to be one episode in the medical#surgical management of nephrolithiasis. Medical management must be initiated at the first determination of the presence of the stone or at the time of the diagnosis of one of the underlying conditions which predispose to stone formation. In spite of the fact that no randomized prospective trial studies are available, the overall preponderance of the available information is that percutaneous lithotripsy for the treatment of kidney stones is a safe and efficacious procedure. In addition, it has achieved widespread acceptance and is generally employed throughout the country. Cooperation between the physician responsible for medical management of the patient, the urologist, and the radiologist appears to be an essential ingredient for successful management. Long-term studies are indicated to determine the true incidence of complications and the long-range effects of the procedures employed by the percutaneous route.

The Cancer Research Campaign (CRC) Trial demonstrates a decreased incidence of local recurrence for patients randomized to prophylactic radiotherapy following mastectomy. Irradiated patients alive after 5 years, however, have a small increased risk of dying from causes other than breast cancer. How to estimate the cost-benefit of such therapy is discussed.

As a new global strategy for improving public health, the Children's Vaccine Initiative implicitly raises, once again, the question of the role of science in developing countries. If there are to be new and improved vaccines, better delivery systems, and simplified immunization schedules, there must be substantial analysis, laboratory activity, and fieldwork to ensure that the new products are ready for effective use. In the context of these requirements, this paper reviews the possibilities for vaccine research and development in middle-income countries and the benefits in terms of fostering socioeconomic development through integrated scientific health research.

This study assessed the diagnostic utility of two technologies for evaluating respiratory abnormalities in sleep. We compared conventional polysomnography with a new, ambulatory microprocessor technology. Two key features of the comparison involved: (a) the use of multiple, skilled interpreters of each system; and (b) inter-rater agreement within the systems as a crucial test for the diagnostic utility of each. Results indicated that general categories of respiratory abnormalities could be judged more reliably than more specific categories, regardless of technology. For certain categories of respiratory abnormalities, however, inter-rater agreement with the newer technology was extremely low (e.g., reliability coefficients of.12,.09, and –.06). Factors contributing to these low diagnostic reliabilities are discussed. Our data indicate that any assessment of new technology cannot be made apart from the clinical judgments to be rendered with that new technology. This approach may be generalizable to the assessment of other diagnostic technologies.

This article presents a survey of the public and private agencies and institutions providing health care in Israel and examines the degree and nature of the control that these bodies exercise over medical technology. The author demonstrates that while the Israeli government is highly centralized, the Ministry of Health is able to exercise only limited practical influence and is neutralized because of its circumscribed control of government funds. In addition, the Ministry of Health lacks standardized procedures for the assessment of prospective or existing technologies. The author notes that there has been a clear move toward a system to oversee the rational diffusion of technology and outlines several proposals for the future.

Molecular biology and, in particular, knowledge of the immune response at the molecular level provide the research community with the opportunity to design vaccines that will elicit the appropriate responses for many diseases. The critical issue is to identify the immune response that correlates with protection. It is remarkable how well the empirical approach has worked; it is essential, therefore, not to ignore the lessons to be learned from these successes. It is particularly essential that each disease and the immune response that affords protection be studied individually so that the appropriate responses can be induced.

The generation of diversity of T and B cells begins early in gestation. Selective restrictions in expression of V genes occur in fetal life, but insufficient clonal diversity is not likely to limit newborn immune capabilities. The functional immaturity of neonatal T and B cells is beginning to be defined. Virgin T cells lack the capacity to produce diverse lymphokines, whereas neonatal B cells are less responsive to the lymphokines that promote terminal differentiation to plasma cells.

Objectives: The aim of this study was to assess the status of translating research findings into practice at a major academic healthcare system in Central Texas.

Methods: We conducted a cross-sectional survey addressing knowledge of and participation in translational research of physicians, residents, nurses and third- and fourth-year medical students in a major academic healthcare system in Central Texas.

Results: Out of 508 respondents, 428 (84.3 percent) completed all questions. A total of 68.9 percent of faculty reported having sufficient education and training to conduct research versus 44.4 percent of residents and 35.6 percent of nurses. Fifty-eight percent of faculty, 53 percent of residents and 9 percent of nurses reported current involvement in research activity. A total of 55.6 percent of residents reported that their departments provide them with protected time for research versus 18.4 percent of faculty and 10.3 percent of nurses. In addition, 33.9 percent of nurses reported interest in participating in research but do not know how to start. There were 86.4 percent of faculty, 77.8 percent of residents, and 58 percent of nurses who indicated they were familiar with translational research. However, only 42.7 percent of faculty, 46.7 percent of residents and 35.6 percent of nurses indicated they were aware of any changes in the delivery of care that resulted from research projects.

Conclusions: The study results suggested failure to leverage members of the healthcare team in a systematic process to ensure translation of research findings into practice. Results highlighted the need to merge culture of safety and quality improvement with research while dealing with the daily pressures of patient care.