Journal ArticleDOI
Economic evaluations in the critical care literature: Do they help us improve the efficiency of our unit?
TLDR
In the critical care literature, very little useful economic information exists to help decision-makers maximize efficiency in their own setting.Abstract:
Objective To determine the extent to which economic evaluations published in the critical care literature provide information that can help us to improve the efficiency of our unit. Data sources We searched computerized bibliographic databases and manually searched key critical care journals to retrieve all economic evaluations. Study selection We included economic evaluations that dealt with clinical problems relevant to the practice of adult critical care and that compared competing healthcare interventions. Data abstraction Included articles were further evaluated using criteria for minimal methodologic soundness, adopted from the literature, and criteria that we developed to assess the generalizability of results to our clinical setting. Data synthesis We screened 4,167 papers manually and > 450 abstracts and titles in our computer search. One hundred fifty-one papers were retrieved for further evaluation; 29 papers met our inclusion criteria. Of these 29 papers, only 14 (48%) adequately described competing healthcare interventions, 17 (59%) provided sufficient evidence of clinical efficacy, six (21%) identified, measured, and valuated costs appropriately, and three (10%) performed a sensitivity analysis. None of the papers met all four of these criteria for a minimum level of methodologic soundness. Four (14%) of 29 studies which adequately dealt with issues of cost and efficacy were evaluated using our generalizability criteria. Different costing methods precluded the application of the results of three of the four studies to our intensive care unit. Conclusions In the critical care literature, very little useful economic information exists to help decision-makers maximize efficiency in their own setting.read more
Citations
More filters
Journal ArticleDOI
A Decision Chart for Assessing and Improving the Transferability of Economic Evaluation Results Between Countries
TL;DR: A transferability decision chart was developed that includes: knock out criteria; a checklist based on the transferability factors; and methods for improving transferability and for assessing the uncertainty of transferred results.
Journal ArticleDOI
Influence of Airway Management on Ventilator-Associated Pneumonia Evidence From Randomized Trials
TL;DR: Some ventilator circuit and secretion management strategies may influence VAP rates in critically ill patients, and whether these strategies are adopted in practice depends on several factors such as the magnitude and precision of estimates of benefit and harm, as well as access, availability, and costs.
Journal ArticleDOI
Mobile phone text messaging interventions for HIV and other chronic diseases: an overview of systematic reviews and framework for evidence transfer.
Lawrence Mbuagbaw,Lawrence Mbuagbaw,Sara Mursleen,Lyubov Lytvyn,Marek Smieja,Marek Smieja,Lisa Dolovich,Lehana Thabane +7 more
TL;DR: Global evidence supports the use of text messaging as a tool to improve adherence to medication and attendance at scheduled appointments and a conceptual framework for transfer of evidence from HIV to other chronic diseases is developed.
Journal ArticleDOI
Sedation in the intensive care unit.
TL;DR: An individualized approach to sedation based on knowledge of drug pharmacology is needed because of confounding variables including concurrent patient illness, depth of sedation, and concomitant use of analgesic agents.
Journal ArticleDOI
American Thoracic Society 100 Years of Advances in the Treatment and Science of Respiratory Diseases; 20-25 May 2005; San Diego, California, USA
TL;DR: This document is an update of the original 1993 statement on community-acquired pneumonia, incorporating new information about bacteriology, patient stratification, diagnostic evaluation, antibiotic therapy, and prevention, as well as evidence-based recommendations for patient management.
References
More filters
Journal ArticleDOI
The Distinction Between Cost and Charges
TL;DR: The literature on economic efficiency in providing hospital services has been growing recently, but instead of measuring cost directly, studies use patient bills (charges) aa a proxy for cost as a measure of cost.
Journal ArticleDOI
Users' guides to the medical literature. ii: how to use an article about therapy or prevention a. are the results of the study valid ?
Gordon H. Guyatt,David L. Sackett,Deborah J. Cook,Gordon Guyatt,Eric B Bass,Patrick Brill-Edwards,George P. Browman,Deborah Cook,Michael E. Farkouh,Hertzel C. Gerstein,Brian Haynes,Robert Hayward,Anne Holbrook,Roman Jaeschke,Elizabeth F. Juniper,Andreas Laupacis,Hui Lee,Mitchell Levine,Virginia Moyer,Jim Nishikawa,Andrew D Oxman,Ameen Patel,John Philbrick,W. Scott Richardson,Stephane Sauve,David L. Sackett,Jack Sinclair,K. S. Trout,Peter Tugwell,Sean Tunis,Stephen D. Walter,John W Williams,Mark Wilson +32 more
TL;DR: An internal medicine resident in a rheumatology rotation and seeing a 19-year-old woman who has had systemic lupus erythematosus diagnosed on the basis of a characteristic skin rash, arthritis, and renal disease is distressed by the rising creatinine level.
Journal ArticleDOI
Users' guides to the medical literature. II. How to use an article about therapy or prevention. A. Are the results of the study valid? Evidence-Based Medicine Working Group.
Journal ArticleDOI
Users' Guides to the Medical Literature: II. How to Use an Article About Therapy or Prevention B. What Were the Results and Will They Help Me in Caring for My Patients?
Gordon H. Guyatt,David L. Sackett,Deborah J. Cook,Gordon Guyatt,Eric Bass,Patrick Brill-Edwards,George P. Browman,Deborah Cook,Michael E. Farkouh,Hertzel C. Gerstein,Brian Haynes,Robert Hayward,Anne Holbrook,Roman Jaeschke,Elizabeth F. Juniper,Andreas Laupacis,Hui Lee,Mitchell Levine,Virginia Moyer,Jim Nishikawa,Andrew D Oxman,Ameen Patel,John Philbrick,W. Scott Richardson,Stephane Sauve,David L. Sackett,Jack Sinclair,K. S. Trout,Peter Tugwell,Sean Tunis,Stephen D. Walter,John W Williams,Mark C. Wilson +32 more
TL;DR: A general internist is asked to see a 65-year-old man with controlled hypertension and a 6-month history of atrial fibrillation resistant to cardioversion, who has no evidence for valvular or coronary heart disease, and who shares concerns about the benefits of long-term anticoagulant therapy.