International journal of technology assessment in health care
-
Int J Technol Assess Health Care · Jan 1990
Biography Historical ArticleErnest Amory Codman, M.D., and end results of medical care.
Ernest Amory Codman, M. D., was one of the most important figures in the history of outcomes research in medicine. While his contemporaries scorned his efforts to create systematic procedures to evaluate the end results of medical care, his work foreshadowed many of today's most pressing issues in technology assessment. This article traces Codman's career as an innovator and political gadfly at the Massachusetts General Hospital during the first three decades of this century, and examines the development and demise of his end-result system.
-
Int J Technol Assess Health Care · Jan 1989
Test of a noninvasive instrument for measuring hemoglobin concentration.
A colorimetric instrument for the noninvasive quantification of hemoglobin, designed using color shades resembling those observed in the conjunctiva, was tested. The instrument's colors are contrasted against the color of the conjunctiva to measure hemoglobin content. Sensitivity, specificity, negative predictive value, and false-negative value were estimated to test the instrument's accuracy; kappa coefficients were used to estimate inter- and intraobserver variability. ⋯ The interobserver kappa coefficients for three pairs of readers were good to excellent for the same hemoglobin screening value. Statistically significant differences were noted, however, between observers during the reliability test. The instrument can be used by unskilled personnel to improve their decision-making about whom to send for further care or for supplementation with iron.
-
At present there is no definitive test for appendicitis and no clear set of signs and symptoms, so that diagnosis is uncertain and probabilistic. A computer model for analyzing clinical data can improve physician accuracy in diagnosing appendicitis by assessing the outcome probabilities associated with the treatment options. Should a definitive test become available, the computer model will aid clinicians in determining when to test. Once our proposed model has been validated, it will not only improve physician decision-making, but also provide quality assurance feedback, generate reports for documentation, and compile a data base of many cases for study and reference.