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Universal health coverage has been proposed as a strategy to improve health in low- and middle-income countries, but this depends on a good provision of health services. Under-5 mortality (U5M) reflects the quality of health services, and its reduction has been a milestone in modern society, reducing global mortality rates by more than two-thirds between 1990 and 2020. However, despite these impressive achievements, they are still insufficient, and most deaths in children under 5 can be prevented with the provision of timely and high-quality health services. The aim of this paper is to conduct a literature review on amenable (treatable) mortality in children under 5. This indicator is based on the concept that deaths from certain causes should not occur in the presence of timely and effective medical care. A systematic and exhaustive review of available literature on amenable mortality in children under 5 was conducted using MEDLINE/PubMed, Cochrane CENTRAL, OVID medline, Scielo, Epistemonikos, ScienceDirect, and Google Scholar in both English and Spanish. Both primary sources, such as scientific articles, and secondary sources, such as bibliographic indices, websites, and databases, were used. Results: The main cause of amenable mortality in children under 5 was respiratory disease, and the highest proportion of deaths occurred in the perinatal period. Approximately 65% of avoidable deaths in children under 5 were due to amenable mortality, that is, due to insufficient quality in the provision of health services. Most deaths in all countries and around the world are preventable, primarily through effective and timely access to healthcare (amenable mortality) and the management of public health programs focused on mothers and children (preventable mortality). [ABSTRACT FROM AUTHOR]

Intractable, chronic abdominal pain from upper abdominal malignant and benign diseases is a significant challenge for healthcare providers and burden on the healthcare system. While opioid analgesics are commonly used to provide pain relief, the adverse effects of chronic opioid use cannot be overlooked. Celiac plexus neurolysis via chemical or thermal means represents an alternative minimally invasive approach to provide palliative pain relief and increase patients' quality of life. Through the use of computed tomography guidance, celiac plexus neurolysis can be performed by accurately targeting the celiac plexus, while minimizing risks to adjacent structures. Historically, celiac plexus neurolysis was performed via instillation of ethanol or phenol; however, within the past decade cryoablation has gained increasing use with potentially fewer side effects. [ABSTRACT FROM AUTHOR]

The article offers information on the innovation in a learning healthcare system helps to explain position by illuminating the conceptual and practical flaws that follow from drawing a sharp distinction between research and treatment innovation. It mentions both research and innovation are governed by the scientific method; and also mentions moving to implement a learning health care system fosters innovation.

The fundamental criticism of the analyses of relations between the allocated sources into healthcare system and general indicators of health status (represented by mortality) form a concept of avoidable mortality. The concept is a result of a reaction of many specialists in this field. The efficient concept of avoidable mortality that consists of treatable and preventable mortality components should provide prominent information that is not directly absorbed in the metrics of general mortality rate traditionally used for measuring the healthcare systems' outputs. Permanent evaluation of the concept is based on confrontation of actual and relevant facts and supported by significant evidence from analytical outputs. This evaluation may help to form an efficient tool for measuring the amenable mortality with system connections as within health care system so in social policy, long-term health care policy, etc. The aim of this article is an analysis and evaluation of avoidable mortality development at conceptual and evaluative level and a specification of advantages and limitations that result from this concept. The analyses' outputs represent a valuable platform for revision of strategic framework of the Slovak healthcare as well as for formation of targeted policies that focus on increase of healthcare system efficiency. [ABSTRACT FROM AUTHOR]

Black-white mortality disparities remain sizable in the United States. In this study, we use the concept of avoidable/amenable mortality to estimate cause-of-death contributions to the difference in life expectancy between whites and blacks by gender in the United States in 1980, 1993, and 2007. We begin with a review of the concept of 'avoidable mortality' and results of prior studies using this cause-of-death classification. We then present the results of our empirical analyses. We classified causes of death as amenable to medical care, sensitive to public health policies and health behaviors, ischemic heart disease, suicide, HIV/AIDS, and all other causes combined. We used vital statistics data on deaths and Census Bureau population estimates and standard demographic decomposition techniques. In 2007, causes of death amenable to medical care continued to account for close to 2 years of the racial difference in life expectancy among men (2.08) and women (1.85). Causes amenable to public health interventions made a larger contribution to the racial difference in life expectancy among men (1.17 years) than women (0.08 years). The contribution of HIV/AIDS substantially widened the racial difference among both men (1.08 years) and women (0.42 years) in 1993, but its contribution declined over time. Despite progress observed over the time period studied, a substantial portion of black-white disparities in mortality could be reduced given more equitable access to medical care and health interventions. [ABSTRACT FROM AUTHOR]

Recently prominent nutrition scientists across the world have opposed continuation of vitamin A supplementation (VAS) programmes and recommended gradual phasing out VAS for pre-school children. A few eminent nutrition scientists in India have echoed this view, arguing that vitamin deficiency (VAD) is no longer a public health problem in India. We review the evidence, highlighting the high rates of VAD among pre-school children in India, (clinical, subclinical, and dietary deficiency) and argue that in India VAD remains an immensely important public health problem and it is crucial to strengthen and continue the existing VAS programme in India, and in other developing countries until such time as their children's dietary consumption of vitamin A is improved adequately and blood vitamin A levels reach optimal levels. [ABSTRACT FROM AUTHOR]

Rationale Evidence-based medicine (EBM) has been acclaimed as a major advance in medical science, but criticized as a proposed alternative model for the practice and teaching of medicine. Ambiguity regarding the proper role of the contributions of EBM within the fabric of medicine and health care has contributed to this discrepancy. Aims and objectives We undertook a critical review of the history of the EBM movement, beginning with its origins in the 1970s and continuing through this century. We drew upon the results of an independent project that rationalized the EBM domain from the perspective of educational evaluation and assessment. We considered the content of EBM in relationship to the propositions and promises embodied in advocacy publications. Results EBM emerged in the context of the explosion of biomedical information in the decade preceding public access to the Internet in the mid-1990s and drew upon the independently derived ‘information literacy’ formula developed by information scientists during the 1980s. The critically important content and achievements of EBM are fully explained within the confines of the information literacy model. The thesis that EBM offers an alternative paradigm for individualized health care, asserted in the advocacy literature, is not supported by published models of evidence-based clinical practice. Conclusion A critical historical review of the origins, content and development of the EBM movement proposes that full integration of the fruits of the movement into routine clinical care remains a conceptual and practical challenge. [ABSTRACT FROM AUTHOR]

The article argues that there are significant reasons for greater occupational therapy commitment to the Cochrane Collaboration at every level of the organization. These reasons are said to range from the value of using Cochrane reviews to inform current clinical practice and program development, to professional development by becoming an advisory board member, editor or systematic reviewer for a Cochrane Review Group. The authors believe that occupational therapist involvement in Cochrane review Groups can influence the choice and priority of clinical interventions subject to systematic review and enhance the utility of Cochrane reviews within professional practice.

The article discusses various reports published within the issue including the evolution and development of the evidence-based healthcare debate and the awards received by the Journal.

Disease management (DM) programmes have long been promoted as a major medical cost-saving mechanism, even though the scant research that exists on the topic has provided conflicting results. In a 2004 literature review, the Congressional Budget Office stated that ‘there is insufficient evidence to conclude that disease management programs can generally reduce the overall cost of health care services’. To address this question more accurately, a meta-analysis was warranted. Meta-analysis is the quantitative technique used to pool the results of many studies on the same topic and summarize them statistically. This method is also quite suitable for individual DM firms to assess whether their programmes are effective at the aggregate level. This paper describes the elements of a rigorous meta-analytic process and discusses potential biases. A hypothetical DM organization is then evaluated with a specific emphasis on medical cost-savings, simulating a case in which different populations are served, evaluation methodologies are employed, and diseases are managed. [ABSTRACT FROM AUTHOR]

The aim of this descriptive, correlational, and cross-sectional survey was to explore uncertainty in patients with atrial fibrillation and to examine the relationships between uncertainty and its antecedents, including education, social support, and perceived seriousness of illness in patients newly diagnosed with atrial fibrillation. The theoretical framework of the study was Mishel's middle-range nursing theory of uncertainty in illness. A convenience sample of 81 participants recruited from two academic medical centers over 10 months was interviewed. Uncertainty was moderately high in patients with atrial fibrillation compared to other clinical populations. Among antecedents of uncertainty, higher education was significantly associated with less uncertainty (β = -.21 to -.25). Except for tangible support, persons with greater social supports perceived less uncertainty(β = -.25 to-.27), and individuals with greater perceived seriousness of illness reported greater uncertainty (β = .30 to .33). [ABSTRACT FROM AUTHOR]

In clinical trials, parallel group designs, such as placebo-controlled trials or activecontrolled trials, are commonly used. The study design in comparative clinical trials to address the intended objective is vital to the interpretation of the trial results. If inappropriate study design are employed, they not only cannot answer the intended clinical hypothesis, but they can also impose adverse effects on the collection of efficacy and safety data that may further be compounded by observable and unobservable baseline data. Documentation and interpretation of the outcomes need to be carefully considered. It is well known that various sources of biases can arise during the course of the trial, for instance, design bias, operational bias, analytical bias, methodological bias, interpretation bias, and documentation bias. As a result of such biases, the accuracy and precision of the treatment effect estimate may be severely compromised, depending on the design considered. In this article, commonly used study designs for comparative clinical trials are described. Statistical considerations with various designs, the concept of robustness of statistical findings, and statistical evidence will be discussed in light of the blinding, potential unblinding, and open-label designs. [ABSTRACT FROM AUTHOR]

Psychologists in academic health systems are in a unique position to impact the dynamic interplay among research, clinical practice, and policy domains. In addition to their specialty expertise in psychopathology, particular types of physical illness and disease, and health promotion, psychologists have substantial knowledge of human behavior, refined scientific skills, knowledge and experience in the effective delivery of clinical services, strengths in written expression, and a collaborative orientation. This combination of strengths makes psychologists extremely well-suited for (a) interdisciplinary efforts to develop and implement evidence-based assessment and intervention strategies with biological, psychological, behavioral, and social components, and (b) leadership and advocacy efforts that impact the quality and availability of health care services. [ABSTRACT FROM AUTHOR]

Discusses the possibility of reconciling sham surgery with genuine standards of care. Justification of burdens associated with an invasive surgical procedure; Conditions for the ethical acceptability of clinical research; Kinds of utility in clinical research.

The paper develops methods for the comparison of randomized rules of the biased coin type for the sequential allocation of treatments in a clinical trial. One important characteristic is the loss, which measures the increase in the variance of parameter estimates due to the imbalance caused by randomization. The other important characteristic is the selection bias measuring the probability of correctly guessing which treatment is to be allocated next. The combination of these two measures leads to the elucidation of admissible designs. Simulations provide clear plots of the behaviour of the designs and make it possible to distinguish good designs from those which are less good. [ABSTRACT FROM AUTHOR]

This study compares access to primary care, utilization, and costs among enrollees in four forms of managed care and an indemnity plan. We use 1996 data from a commercial insurer. Most managed care enrollees had better access to primary care services than indemnity enrollees. This access was associated with a generally lower rate of preventable hospitalization. Per Capita inpatient costs were notably lower in managed care plans than in the indemnity plan. We describe how health care managers can use readily available administrative data and straightforward statistical techniques to enhance routine monitoring for quality and costs. Policy makers can use this approach to identity health services trends, and to evaluate access to health services for individuals enrolled in various benefit plan types. [ABSTRACT FROM AUTHOR]

While some aspects of addiction can be studied in laboratory or controlled settings, the study of long-term recovery management and the health services that support it requires going out into the community and dealing with populations and systems that are much more diverse and less under our control. This in turn raises many methodological challenges for the health service researchers studying alcohol and other drug abuse treatment. This paper identifies some of these challenges related to the design, measurement, implementation and effectiveness of health services research. It then recommends 25 strategies (and key primers) for addressing them: (1) identifying in advance all stakeholders and issues; (2) developing conceptual models of intervention and context; (3) identifying the population to whom the conclusions will be generalized; (4) matching the research design to the question; (5) conducting randomized experiments only when appropriate and necessary; (6) balancing methodological and treatment concerns; (7) prioritizing analysis plans and increasing design sensitivity, (8) combining qualitative and quantitative methods; (9) identifying the four basic types of measures needed; (10) identifying and using standardized measures; (11) carefully balancing measurement selection and modification; (12) developing and evaluating modified and new measures when necessary; (13) identifying and tracking major clinical subgroups; (14) measuring and analyzing the actual pattern of services received; (15) incorporating implementation checks into the design; (16) incorporating baseline measures into the intervention; (17) monitoring implementation and dosage as a form of quality assurance; (18) developing procedures early to facilitate tracking and follow-up of study participants; (19) using more appropriate representations of the actual experiment; (20) using appropriate and sensitive standard deviation terms; (21) partialing out variance due to design or known sources prior to estimating experimental effect sizes; (22) using dimensional, interval and ratio measures to increase sensitivity to change; (23) using path or structural equation models; (24) integrating qualitative and quantitative analysis into reporting; and (25) using quasi-experiments, economic or organizational studies to answer other likely policy questions. Most of these strategies have been tried and tested in this and other areas, but are not widely used. Improving the state of the art of health services research and bridging the gap between research and practice do not depend upon using the most advanced methods, but rather upon using the most appropriate methods. [ABSTRACT FROM AUTHOR]

The discussion of evidence-based policy and practice has continued apace since the last Public Money & Management issue on this theme in January 1999. It was the topic of this year's annual Public Management and Policy Association conference held in June 2000 in Brighton and the views represented there, which ranged from optimistic enthusiasm to weary skepticism, seem fairly representative of the debate more broadly. Whereas the January 1999 issue of the journal provided a cross-sector overview of the role of evidence in public sector policy and practice, and in particular considered the crucial question of what constitutes evidence, this issue focuses on the challenge of getting such evidence to impact on practice. There is a growing body of research evidence on what works across the public sector, although some areas such as health care are still better served than others like social care. A number of initiatives have been launched to consolidate, review and disseminate the findings to emerge from this existing evidence base.

The article focuses on evidence-based medicine (EBM) in the National Health Service of Great Britain. In EBM, clinical decisions concerning the care of individual patients were to be made in the light of the best available evidence of effectiveness and ineffectiveness. EBM has attracted particular attention in the U.S. because of essentially economic factors. It offers opportunities for controlling the escalating costs of health care. The rapid growth of health maintenance organizations and similar agencies has reinvigorated competition in U.S. health care.

The prevalence of Hepatitis B surface antigen (HBsAg) and antibody (anti-HBs) seropositivity and the association of seropositivity with demographic, personal health, and professional experiences were studied in a cohort of Army Medical Department officer personnel. Serologic evidence of Hepatitis B infection was found in 5.0 per cent of personnel and was associated with age, sex, place of birth, history of hepatitis, history of blood transfusion, and previous overseas assignments. Seropositivity rates were higher for patient care oriented officer personnel, especially for those in surgical specialties, and rose with increasing professional experience. These data present a composite of risk factors operative in the acquisition of Hepatitis B seropositivity and identify a cohort for prospective study. [ABSTRACT FROM AUTHOR]

Examines the sentinel health event as the basis for physician recognition and public health surveillance in the United States. Improvement in the quality of medical care; Impetus for epidemiologic or industrial studies; Development of national system for occupational health surveillance.

Health care practitioners (especially doctors) have always given assurances that what they do is efficacious. But in the past 50 years justification of the effectiveness of health care interventions has attained a new prominence. Evidence, at least notionally, now lies at the heart of health care policy and practice. This article provides an overview of the generation and use of evidence on effectiveness in health care. It explains why rigorous methodologies have taken hold and describes the major preoccupation with trying to ensure that research evidence has an impact on clinical practice. The strengths and weaknesses of evidence-based health care are explored to identify the opportunities for profitable transfer of experience across the public sector. [ABSTRACT FROM AUTHOR]

This article considers the nature of risk in health care and the use the National Health Service (NHS) makes of risk management. It explores how the concept of risk has been challenged by the rise of 'evidence-based' health care, accompanied and accelerated by a decline in professional prestige, status and mystique and much greater use of external measurement and controls as part of the New Public Management. The nature of evidence-based health care is outlined and the implications of the use of guidelines and other practice aids are explored. Finally, the article discusses how evidence-based health care is affecting our views of clinical risk. [ABSTRACT FROM AUTHOR]