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Introduction: Assessing medical technologies for Alzheimer's disease (AD) creates challenges for current methods of value assessment. New value assessment approaches for AD are also needed. Methods: We adapted concepts from health economics to help guide decision makers to more informed decisions about AD therapies and diagnostics. Results: We propose a value framework based on five categories: perspective, value elements, analysis, reporting, and decision making. AD value assessments should include the perspective of the patient–caregiver dyad. We propose a broader array of value elements than currently used. Analytics and decision methods can synthesize evidence for all elements of value. Decisions should use a "deliberative appraisal" approach informed by the composite evidence and be transparently reported. Discussion: Using the proposed framework, the value of forthcoming innovations for AD may be more thoroughly assessed for and by all stakeholders. It can guide decision makers to carefully consider all relevant elements of value contributing to more holistic and transparent decision making. Research Highlights: Alzheimer's disease challenges common methods of evaluating medical technology.Using current methods, new AD innovations might not be appropriately valued.Poor value assessments will adversely affect patient access to AD innovations.A full AD value framework expands perspective, elements, analysis, decision‐making, reporting. [ABSTRACT FROM AUTHOR]

Confronting Alzheimer's disease (AD) involves patients, healthcare professionals, supportive services, caregivers, and government agencies interacting along a continuum from initial awareness to diagnosis, treatment, support, and care. This complex scope presents a challenge for health system transformation supporting individuals at risk for, or diagnosed with, AD. The AD systems preparedness framework was developed to help health systems identify specific opportunities to implement and evaluate focused improvement programs. The framework is purposely flexible to permit local adaptation across different health systems and countries. Health systems can develop solutions tailored to system‐specific priorities considered within the context of the overall framework. Example metric concepts and initiatives are provided for each of ten areas of focus. Examples of funded projects focusing on screening and early detection are provided. It is our hope that stakeholders utilize the common framework to generate and share additional implementation evidence to benefit individuals with AD. [ABSTRACT FROM AUTHOR]

Both the medical care and public health systems have invested considerable resources to define, measure, and improve quality and health outcomes. A movement toward accountability has generated performance indicators from the medical arena and 'leading health indicators' from the public health arena. The focus on specific conditions by the medical care system has been at odds with public health's emphasis on improving population health and has perpetuated a bifurcated system. Aligning the goals of medical care with those of public health will require reformulation of performance measurement and accountability into a common language that is valued by both systems. Such a creation would amount to a whole that is stronger than the sum of the component parts. (Am J Public Health. 2003;93:406-411)

Gottschalk, Jack A., et at. Jolly Roger with an Uzi: The Rise and Threat of Modern Piracy. Annapolis, Md.: Naval Institute Press, 2000. 170pp. $26.95 Jolly Roger with an Uzi [...]

The diagnosis of neurotic disturbance in children and adolescents can be an exceedingly complex decision given the impact of developmental and situational factors on aspects of personality organization and personality style. The potential for rapid regression, rapid development, and incomplete structuralization of personality organization and style complicates our understanding of the meaning of particular symptoms or behavior. The Rorschach offers help in sorting through these issues because it can uniquely assess aspects of personality organization, personality style, and the impact of developmental or situational factors. [ABSTRACT FROM AUTHOR]

Much of the research on the use of the Rorschach to diagnose borderline disturbance has sought to discover a specific borderline pattern or Rorschach configuration. Given our increased understanding of borderline functioning representing a level of personality organization (or personality structure), this single pattern approach is excessively simplistic. It fails to consider the complex interaction between personality structure, personality style, and situational variables. An approach to the Rorschach assessment of borderline functioning is presented using a clinical example. The patient was tested at the onset of psychotherapy and then some 4 years into treatment. Results from the two testings were compared using Weiner and Exner's (1991) Rorschach variable clusters for assessing change in psychotherapy. [ABSTRACT FROM AUTHOR]

Much Rorschach research on case material focuses on the utility of a single scoring system, set of variables, or scale in isolation from other systems, scales, or perspectives. This approach fails to acknowledge the complexity of the Rorschach and to reflect the manner in which sophisticated clinicians select and synthesize various perspectives during the clinical inference and decision-making process. A case of a psychotic child is presented to illustrate the utility of a synthetic approach to the Rorschach. The strengths and weaknesses of various Rorschach perspectives in addressing specific diagnostic issues is explored through the case material. [ABSTRACT FROM AUTHOR]

It was hypothesized that male transsexuals manifest a character structure consistent with WP's criteria for borderline personality organization. Exploring this hypothesis, 's criteria for borderline personality organization were operationalized using Rorschach measures. The following variables were examined: aggression (Holt System Aggressive Content Section), object relations (Urist's Mutuality of Autonomy Scale), reality testing (Exner System X+%), and self/object differentiation (Exner System Special Scorings). A group of male college students, a group of male borderlines, and a group of male transsexuals were compared on the above variables. Compared to the normals, the transsexuals and borderlines displayed significantly more intense levels of aggression, a lower level of object relations, poorer reality testing, and impaired boundary differentiation. The transsexuals and borderlines did not differ significantly. The results were taken as suggesting that male gender dysphorics may be a sub-group of the wider borderline diagnostic category. [ABSTRACT FROM AUTHOR]