Search

Objectives: Early awareness and alert (EAA) activities are increasingly recognized to be an important component of the health technology assessment (HTA) process. Sharing information on methods used in this discipline is vital to ensure the development of sustainable systems. The objectives of this study is to outline the approach taken to share the different methods that members of the EuroScan International Network use by producing a methods toolkit; and to provide an overview of the similarities and differences in methods adopted by EAA systems.Methods: A Delphi technique was used to develop the methods toolkit. Structured questionnaires were used to identify the sources used in the identification of emerging technologies and to determine the methods used by agencies to carry out EAA activities.Results: A methods toolkit incorporating guidance on all of the stages described by EuroScan members was produced. The toolkit and an accompanying checklist presents users with different methods that can be adopted to suit their needs. The comparative analysis demonstrates that different methods are being used by EAA systems dependent on resources available and customer requirements. Differences in identification, filtration, prioritization, and assessment are apparent along with the role of collaborators in these processes.Conclusions: The methods used by EAA systems are not homogeneous resulting in a toolkit constructed on the basis of “one size doesn't fit all.” Methods in this discipline are developing continually to accommodate changes in health systems and the HTA world. Differences between agencies and the sharing of ideas and experiences enable EAA agencies to adapt to these developments.

BackgroundUncertainty exists about benefits and harms of a planned vaginal birth after caesarean (VBAC) compared with elective repeat caesarean (ERC). We conducted a prospective restricted cohort study consisting of a patient preference cohort study, and a small nested randomised trial to compare benefits and risks of a planned ERC with planned VBAC.Methods and findings2,345 women with one prior caesarean, eligible for VBAC at term, were recruited from 14 Australian maternity hospitals. Women were assigned by patient preference (n = 2,323) or randomisation (n = 22) to planned VBAC (1,225 patient preference, 12 randomised) or planned ERC (1,098 patient preference, ten randomised). The primary outcome was risk of fetal death or death of liveborn infant before discharge or serious infant outcome. Data were analysed for the 2,345 women (100%) and infants enrolled. The risk of fetal death or liveborn infant death prior to discharge or serious infant outcome was significantly lower for infants born in the planned ERC group compared with infants in the planned VBAC group (0.9% versus 2.4%; relative risk [RR] 0.39; 95% CI 0.19-0.80; number needed to treat to benefit 66; 95% CI 40-200). Fewer women in the planned ERC group compared with women in the planned VBAC had a major haemorrhage (blood loss ≥ 1,500 ml and/or blood transfusion), (0.8% [9/1,108] versus 2.3% [29/1,237]; RR 0.37; 95% CI 0.17-0.80).ConclusionsAmong women with one prior caesarean, planned ERC compared with planned VBAC was associated with a lower risk of fetal and infant death or serious infant outcome. The risk of major maternal haemorrhage was reduced with no increase in maternal or perinatal complications to time of hospital discharge. Women, clinicians, and policy makers can use this information to develop health advice and make decisions about care for women who have had a previous caesarean.Trial registrationCurrent Controlled Trials ISRCTN53974531

To the Editor: Dr Baker and colleagues reported that only 40% of US Internet users search for health information online yearly and that only 9% search for this information on a monthly basis. Industry market research studies, however, report results that differ greatly from the findings of Baker et al. Using random-digit dialing telephone methods, Cybercitizen Health found that 53% of all Internet users visited online health information sites in 2001 and that 65% did so in 2002. In addition, Cybercitizen Health found that 56% of such users accessed these sites monthly in 2001 and that 59% did so in 2002. In contrast, Baker et al found that only 22% of such users visited monthly in 2002. The Cybercitizen Health data also indicated that 30% of all Internet health information users are monthly users of the WebMD Network alone, a percentage in excess of the 22% overall that Baker et al reported. Similarly, according to published WebMD Business Intelligence figures, the WebMD network alone had 15.9 million average monthly visitors in the first quarter of 2002, again far exceeding the 12.1 million that Baker et al estimated for all Internet health sites. We believe that the methods of Baker et al were flawed due to the manner in which the information was collected. The study sample was based on an Internet panel that was given the incentive of a free WebTV offer. Less than 10% of the Internet population uses WebTV, thus making such a panel unlikely to be representative of either the online population or the population as a whole.