Therapeutic Technology Assessment Research Articles

Laparoscopic herniorrhaphy. Diagnostic and therapeutic technology assessment

To provide clinicians with a technology assessment of the safety and effectiveness of laparoscopic herniorrhaphy for the surgical repair of inguinal hernias.A literature review and a Diagnostic and Therapeutic Technology Assessment (DATTA) survey questionnaire were mailed to 75 physicians with expertise in surgical repair of inguinal hernias. These panelists had been nominated to the DATTA panel by the appropriate specialty societies and medical schools. A total of 55 panelists (73%) responded.Assessment was based on the expert opinion of the panelists, as well as on published literature (available as of February 8, 1996). Published studies were identified by a MEDLINE search using the terms laparoscopic surgery, inguinal hernia, and laparoscopic herniorrhaphy and by review of the references cited in these primary sources.The respondents completed a DATTA survey questionnaire; the survey results were tabulated, analyzed, and interpreted by American Medical Association staff.The DATTA panelists rated the use of laparoscopic herniorrhaphy as promising for safety and investigational for effectiveness for two indications: the repair of primary inguinal hernias and the repair of bilateral inguinal hernias. The use of laparoscopic herniorrhaphy to repair recurrent inguinal hernias was rated as investigational for both safety and effectiveness by the panel. This technique was rated as promising for safety and effectiveness as a method for decreasing postoperative tenderness and time until return to full activity.

Laparoscopic Herniorrhaphy

Objective. —To provide clinicians with a technology assessment of the safety and effectiveness of laparoscopic herniorrhaphy for the surgical repair of inguinal hernias. Participants. —A literature review and a Diagnostic and Therapeutic Technology Assessment (DATTA) survey questionnaire were mailed to 75 physicians with expertise in surgical repair of inguinal hernias. These panelists had been nominated to the DATTA panel by the appropriate specialty societies and medical schools. A total of 55 panelists (73%) responded. Evidence. —Assessment was based on the expert opinion of the panelists, as well as on published literature (available as of February 8,1996). Published studies were identified by a MEDLINE search using the terms laparoscopic surgery, inguinal hernia , and laparoscopic herniorrhaphy and by review of the references cited in these primary sources. Consensus Process. —The respondents completed a DATTA survey questionnaire; the survey results were tabulated, analyzed, and interpreted by American Medical Association staff. Conclusions. —The DATTA panelists rated the use of laparoscopic herniorrhaphy as promising for safety and investigational for effectiveness for two indications: the repair of primary inguinal hernias and the repair of bilateral inguinal hernias. The use of laparoscopic herniorrhaphy to repair recurrent inguinal hernias was rated as investigational for both safety and effectiveness by the panel. This technique was rated as promising for safety and effectiveness as a method for decreasing postoperative tenderness and time until return to full activity. ( JAMA . 1996;275:1075-1082)

Diagnostic and therapeutic technology assessment: Peripheral parenteral nutrition MJ GLADE American Medical Association

Diagnostic and therapeutic technology assessment: Peripheral parenteral nutrition MJ GLADE American Medical Association

Continuous ambulatory esophageal pH monitoring in the evaluation of patients with gastroesophageal reflux. Diagnostic and Therapeutic Technology Assessment.

To provide clinicians with a technology assessment of the safety and effectiveness of continuous ambulatory esophageal pH monitoring (CAEpHM) in the diagnosis of pathologic gastroesophageal reflux in adults. A literature review and a Diagnostic and Therapeutic Technology Assessment (DATTA) survey questionnaire were mailed to 118 physicians with special interest in gastroesophageal reflux, esophageal disease, or the use of CAEpHM in the diagnosis of noncardiac chest pain. These panelists had been nominated to the DATTA panel by appropriate specialty societies and medical schools. A total of 93 panelists (79%) responded. Assessment was based on the expert opinion of the panelists, as well as on published scientific and medical literature (available as of June 1, 1994). Published studies were identified by a MEDLINE search using the terms esophagitis, reflux, and gastroesophageal reflux and by review of the references cited in these primary sources. The respondents completed a DATTA survey questionnaire; the survey results were tabulated, analyzed, and interpreted by an American Medical Association medical scientist. The safety of CAEpHM was considered to be established in adults with chronic heartburn, chronic hoarseness, persistent acid reflux refractory to therapy, laryngeal lesions, or noncardiac substernal chest pain. The safety of CAEpHM was considered to be promising in adults with episodes of apnea. The effectiveness of CAEpHM was considered to be established in adult patients with clear primary symptoms that reflect esophageal damage, such as chronic heartburn, persistent acid reflux refractory to therapy, or noncardiac substernal pain; promising in adults with chronic hoarseness; and investigational in adults with episodes of apnea.

Continuous ambulatory esophageal pH monitoring in the evaluation of patients with gastroesophageal reflux. Diagnostic and Therapeutic Technology Assessment

Continuous ambulatory esophageal pH monitoring in the evaluation of patients with gastroesophageal reflux. Diagnostic and Therapeutic Technology Assessment

Diagnostic and therapeutic technology assessment. Transjugular intrahepatic portosystemic shunt (TIPS)

To provide clinicians with a technology assessment of the safety and effectiveness of the use of a transjugular intrahepatic portosystemic shunt (TIPS) for reducing portal hypertension and its associated complications of esophageal varices and ascites. A literature review and a Diagnostic and Therapeutic Technology Assessment (DATTA) survey questionnaire were mailed to 72 physicians with expertise in gastrointestinal or abdominal surgery or interventional radiology and a special interest in liver disease or esophageal varices. These panelists had been nominated to the DATTA panel by appropriate specialty societies and medical schools. A total of 54 panelists (75%) responded. Assessment was based on the expert opinion of the panelists, as well as on published scientific literature (available as of January 2, 1995). Published studies were identified by a MEDLINE search using the terms transjugular intrahepatic portosystemic shunt, TIPS, and transjugular and by review of the references cited in these primary sources. The respondents completed a DATTA survey questionnaire; the survey results were tabulated, analyzed, and interpreted by an American Medical Association staff physician. The safety of TIPS was considered to be established in the acute control of bleeding from esophageal varices in patients who had failed sclerotherapy. The safety of TIPS was considered to be promising for long-term control of bleeding from esophageal varices. In patients with end-stage liver disease and esophageal varices who are liver transplant candidates, the use of TIPS was considered to be an established therapy. The effectiveness of TIPS was considered to be (1) established in the acute control of bleeding in patients who failed sclerotherapy; (2) promising for long-term control of bleeding from esophageal varices; and (3) established in patients with end-stage liver disease and esophageal varices who are candidates for liver transplants.

Transjugular Intrahepatic Portosystemic Shunt (TIPS)

Objective. —To provide clinicians with a technology assessment of the safety and effectiveness of the use of a transjugular intrahepatic portosystemic shunt (TIPS) for reducing portal hypertension and its associated complications of esophageal varices and ascites. Participants. —A literature review and a Diagnostic and Therapeutic Technology Assessment (DATTA) survey questionnaire were mailed to 72 physicians with expertise in gastrointestinal or abdominal surgery or interventional radiology and a special interest in liver disease or esophageal varices. These panelists had been nominated to the DATTA panel by appropriate specialty societies and medical schools. A total of 54 panelists (75%) responded. Evidence. —Assessment was based on the expert opinion of the panelists, as well as on published scientific literature (available as of January 2, 1995). Published studies were identified by a MEDLINE search using the terms transjugular intrahepatic portosystemic shunt, TIPS , and transjugular and by review of the references cited in these primary sources. Consensus Process. —The respondents completed a DATTA survey questionnaire; the survey results were tabulated, analyzed, and interpreted by an American Medical Association staff physician. Conclusions. —The safety of TIPS was considered to be established in the acute control of bleeding from esophageal varices in patients who had failed sclerotherapy. The safety of TIPS was considered to be promising for long-term control of bleeding from esophageal varices. In patients with end-stage liver disease and esophageal varices who are liver transplant candidates, the use of TIPS was considered to be an established therapy. The effectiveness of TIPS was considered to be (1) established in the acute control of bleeding in patients who failed sclerotherapy; (2) promising for long-term control of bleeding from esophageal varices; and (3) established in patients with end-stage liver disease and esophageal varices who are candidates for liver transplants. ( JAMA . 1995;273:1824-1830)

Diagnostic and Therapeutic Technology Assessment. Hyperthermia as adjuvant treatment for recurrent breast cancer and primary malignant glioma

Diagnostic and Therapeutic Technology Assessment. Hyperthermia as adjuvant treatment for recurrent breast cancer and primary malignant glioma

Diagnostic and therapeutic technology assessment. Human papillomavirus DNA testing in the management of cervical neoplasia

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Diagnostic and Therapeutic Technology Assessment (DATTA)

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Climbing 'The Learning Curve'

First performed in France in 1987 and in the United States in 1988, laparoscopic cholecystectomy rapidly became the prevailing treatment of symptomatic gallstones. The National Institutes of Health estimated that as of September 1992 approximately 15000 surgeons in this country have received some training in the procedure and that 80% of gallbladder removals are now done with this technique. 1 It is notable that no large randomized trials comparing laparoscopic techniques with the established open cholecystectomy procedure have been done or are being planned. Patient demand for the most advanced technology—and its promise of less postoperative pain and shorter recovery time—drove implementation of the modality faster than prospective research could be done. 2 The data that have emerged indicate that complications occur infrequently, prompting the majority of an American Medical Association Diagnostic and Therapeutic Technology Assessment (DATTA) panel 3 and a National Institutes of Health consensus conference 1 to characterize

Diagnostic and therapeutic technology assessment. Use of Teflon preparations for urinary incontinence and vesicoureteral reflux

Diagnostic and therapeutic technology assessment. Use of Teflon preparations for urinary incontinence and vesicoureteral reflux

Diagnostic and Therapeutic Technology Assessment (DATTA)

Diagnostic and Therapeutic Technology Assessment (DATTA)

Diagnostic and therapeutic technology assessment. Lung transplantation

Diagnostic and therapeutic technology assessment. Lung transplantation

Diagnostic and therapeutic technology assessment. Distraction/compression osteosynthesis with the Ilizarov device

Although the Ilizarov device (and technique) to treat problematic fractures and bone deformities has been used since the 1950s in the former Soviet Union, the technique was not introduced to the United States until 1984. Since that time, the technique has become increasingly popular because, in comparison with the alternatives, the Ilizarov technique involves only one surgical procedure and it appears to have fewer complications. In addition, the Ilizarov technique was designed to correct multiple deformities simultaneously. The DATTA panelists thought that the technique was established in terms of safety and effectiveness as a treatment of limb length deformity, bone defects, and angular/rotational deformity of the long bones. The panelists thought that it was promising in terms of safety and effectiveness as a treatment of pseudarthrosis. However, this overall endorsement of the technique was tempered by comments that the technique was associated with a lengthy learning curve, was very labor intensive, and required a large degree of patient cooperation.

Diagnostic and Therapeutic Technology Assessment (DATTA)

Diagnostic and Therapeutic Technology Assessment (DATTA)

Diagnostic and therapeutic technology assessment. Radiofrequency catheter ablation of aberrant conducting pathways of the heart

Radiofrequency catheter ablation has very quickly generated considerable enthusiasm among electrophysiologists because it offers a less invasive alternative to an open surgical procedure and potentially offers an alternative to lifelong drug therapy. Early literature on RF catheter ablation focused on the technical aspects of the procedure. In contrast, the literature of the past several years is dominated by very favorable reports of large series of patients and the experience of individual institutions. The larger series have focused on the treatment of accessory pathways as opposed to AV nodal reentry pathways. The opinions of the DATTA panelists parallel the literature. The panelists considered the technology to be established in terms of its safety and effectiveness as a curative treatment of accessory pathways, and promising in terms of its safety and between promising and established in terms of its effectiveness as a treatment of AV nodal reentrant tachycardias.

Diagnostic and Therapeutic Technology Assessment (DATTA)

Diagnostic and Therapeutic Technology Assessment (DATTA)

Diagnostic and therapeutic technology assessment. Surrogate markers of progressive HIV disease

Diagnostic and therapeutic technology assessment. Surrogate markers of progressive HIV disease

Diagnostic and therapeutic technology assessment. Endoscopic balloon dilation of the prostate

Diagnostic and therapeutic technology assessment. Endoscopic balloon dilation of the prostate