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Choi S.E.,Institute for Technology Assessment | Hur C.,Institute for Technology Assessment | Hur C.,Massachusetts General Hospital | Hur C.,Harvard University
Current Opinion in Gastroenterology | Year: 2012

Purpose of review: Our article discusses the current understanding of screening and surveillance options for Barrett's esophagus and emerging concepts that have the potential to improve the effectiveness and cost-effectiveness of surveillance. Recent findings: Although endoscopic surveillance of patients with Barrett's esophagus is commonly practiced in order to detect high-grade dysplasia and early esophageal adenocarcinoma (EAC), the reported incidence of EAC in Barrett's esophagus patients varies widely. Recent studies found the risk of progression from Barrett's esophagus to EAC to be significantly lower than previously reported, raising concerns regarding the limitations of current surveillance strategies. Advances in imaging techniques and their enhanced diagnostic accuracy may improve the value of endoscopic surveillance. Additionally, various efforts are ongoing to identify biomarkers that identify individuals at higher risk of cancer, possibly allowing for individual risk stratification. Summary: These new data highlight some of the opportunities to revise and improve surveillance in patients with Barrett's esophagus. The incorporation of new advances such as imaging techniques and biomarkers has the potential to improve the effectiveness and cost-effectiveness of new surveillance regimens. © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins. Source


Carlos R.C.,University of Michigan | Buist D.S.M.,Group Health Research Institute | Buist D.S.M.,University of Washington | Wernli K.J.,Group Health Research Institute | And 4 more authors.
Journal of the American College of Radiology | Year: 2012

The Patient-Centered Outcomes Research Institute was created in response to a mandate to conduct comparative effectiveness research in clinical care to inform decision making. The institute will be funded by the Patient-Centered Outcomes Research Trust Fund, through congressional set-asides, and by Medicare and private health insurers, through a per beneficiary fee. The institute is governed by a board with a broad stakeholder constitution. Key committees set the national agenda for patient-centered outcomes research, the agenda for funding priorities, and communication and dissemination of the evidence with the goal of increasing the rate of implementation of the evidence into policy. In imaging, patient-centered outcomes go beyond the traditional metrics of patient satisfaction. Instead, these outcomes need to encompass the benefits and harms, focus on outcomes relevant to patients, and provide information to inform decision making. Therefore, radiologists need to be involved as stakeholders in the design, conduct, and dissemination of this research. © 2012 American College of Radiology. Source


Bose-O'Reilly S.,UMIT University for Health Sciences, Medical Informatics and Technology | Drasch G.,Ludwig Maximilians University of Munich | Beinhoff C.,Gethsemanestr.4 | Tesha A.,University of Dar es Salaam | And 7 more authors.
Science of the Total Environment | Year: 2010

In 2003 UNIDO (United Nations Industrial Development Organization) conducted an environmental and health assessment in a small-scale mining area in Tanzania. BGS (British Geological Survey) performed the environmental assessment. The Institute of Forensic Medicine - University of Munich performed the health assessment. The results of the medical, neurological and neuro-psychological examination of 180 participants from the affected area of Rwamagasa and 31 controls were analyzed. Urine, blood and hair samples were analyzed to detect the level of mercury body burden. Mercury concentrations in the bio-monitors urine, blood and hair were statistically significantly higher in the exposed population from Rwamagasa compared to the control group from Katoro. Only amalgam burners showed mercury levels above the toxicological threshold limits. A speciation of mercury in hair indicated that mainly elemental mercury vapor contributed to the high body burden of the artisanal miners. 104 amalgam-burners, the most exposed population group, were examined. 25 of these workers were found to be intoxicated. Small-scale mining is a serious health hazard for amalgam burners. Reduction of the exposure is essential to prevent further damage. © 2009 Elsevier B.V. All rights reserved. Source


Bose-O'Reilly S.,UMIT University for Health Sciences, Medical Informatics and Technology | Drasch G.,Ludwig Maximilians University of Munich | Beinhoff C.,Gethsemanestr.4 | Rodrigues-Filho S.,University of Brasilia | And 8 more authors.
Science of the Total Environment | Year: 2010

Small scale miners use mercury to extract gold from ore in many countries. An environmental and health assessment was performed in Indonesia in two regions, Galangan in Central Kalimantan and Talawaan in Northern Sulawesi. The environmental assessment showed severe mercury contamination of the sediments, and increased mercury levels in local fish. For the health investigation 281 volunteers were recruited and examined by a standardized questionnaire, a neurological examination and neuro-psychological tests. A medical score was used consisting of significant factors of mercury intoxication. Mercury exposed workers showed typical symptoms of mercury intoxication, such as movement disorders (ataxia, tremor, dysdiadochokinesia, etc.). Blood, urine and hair samples were taken from any participant and analyzed for mercury. The mercury concentration in the biomonitors was high, partly extreme high in the working population, increased in the population living in the same habitat and low in the control group. By a standard protocol which includes a combination of threshold values of mercury in the biomonitors and a medical sum score the diagnosis of chronic mercury intoxication was made for highly burdened workers (amalgam smelters) in 55% in Sulawesi and in 62% in Kalimantan. Less exposed mineral processors and the general population in the mining areas were also intoxicated to a high percentage. © 2009 Elsevier B.V. All rights reserved. Source


Hayes J.H.,Dana-Farber Cancer Institute | Ollendorf D.A.,Institute for Clinical and Economic Review | Pearson S.D.,Institute for Clinical and Economic Review | Barry M.J.,Massachusetts General Hospital | And 3 more authors.
Annals of Internal Medicine | Year: 2013

Background: Observation is underutilized among men with localized, low-risk prostate cancer. Objective: To assess the costs and benefits of observation versus initial treatment. Design: Decision analysis simulating treatment or observation. Data Sources: Medicare schedules, published literature. Target Population: Men aged 65 and 75 years who had newly diagnosed low-risk prostate cancer (prostate-specific antigen level 10<μg/L, stage ≤T2a, Gleason score ≤3+3). Time Horizon: Lifetime. Perspective: Societal. Intervention: Treatment (brachytherapy, intensity-modulated radiation therapy, or radical prostatectomy) or observation (active surveillance [AS] or watchful waiting [WW]). Outcome Measures: Quality-adjusted life expectancy and costs. Results of Base-Case Analysis: Observation was more effective and less costly than initial treatment. Compared with AS, WW provided 2 additional months of quality-adjusted life expectancy (9.02 vs. 8.85 years) at a savings of $15 374 ($24 520 vs. $39 894) in men aged 65 years and 2 additional months (6.14 vs. 5.98 years) at a savings of $11 746 ($18 302 vs. $30 048) in men aged 75 years. Brachytherapy was the most effective and least expensive initial treatment. Results of Sensitivity Analysis: Treatment became more effective than observation when it led to more dramatic reductions in prostate cancer death (hazard ratio, 0.47 vs. WW and 0.64 vs. AS). Active surveillance became as effective as WW in men aged 65 years when the probability of progressing to treatment on AS decreased below 63% or when the quality of life with AS versus WW was 4% higher in men aged 65 years or 1% higher in men aged 75 years. Watchful waiting remained least expensive in all analyses. Limitation: Results depend on outcomes reported in the published literature, which is limited. Conclusion: Among these men, observation is more effective and costs less than initial treatment, and WW is most effective and least expensive under a wide range of clinical scenarios. © 2013 American College of Physicians. Source

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