Systematic review of economic evaluations and cost analyses of guideline implementation strategies

Objectives To appraise the quality of economic studies undertaken as part of evaluations of guideline implementation strategies; determine their resources use; and recommend methods to improve future studies. Methods Systematic review of economic studies undertaken alongside robust study designs of clinical guideline implementation strategies published (1966-1998). Studies assessed against the BMJ economic evaluations guidelines for each stage of the guideline process (guideline development, implementation and treatment). Results 235 studies were identified, 63 reported some information on cost. Only 3 studies provided evidence that their guideline was effective and efficient. 38 reported the treatment costs only, 12 implementation and treatment costs, 11 implementation costs alone, and two guideline development, implementation and treatment costs. No study gave reasonably complete information on costs. Conclusions Very few satisfactory economic evaluations of guideline implementation strategies have been performed. Current evaluations have numerous methodological defects and rarely consider all relevant costs and benefits. Future evaluations should focus on evaluating the implementation of evidence based guidelines. Keywords: Cost-effectiveness analysis, physician (or health care professional) behaviour, practice guidelines, quality improvement, systematic review.Peer reviewedAuthor versio

The Value of IgM Memory B-Cells in the Assessment of Splenic Function in Childhood Cancer Survivors at Risk for Splenic Dysfunction:A DCCSS-LATER Study

Background: Childhood cancer survivors (CCS) who received radiotherapy involving the spleen or total body irradiation (TBI) might be at risk for splenic dysfunction. A comprehensive screening test for examining splenic dysfunction is lacking. Objective: We investigated whether IgM memory B-cells could be used to assess splenic dysfunction in CCS who received a splenectomy, radiotherapy involving the spleen, or TBI. Methods: All CCS were enrolled from the DCCSS-LATER cohort. We analyzed differences in IgM memory B-cells and Howell-Jolly bodies (HJB) in CCS who had a splenectomy (n = 9), received radiotherapy involving the spleen (n = 36), or TBI (n = 15). IgM memory B-cells &lt; 9 cells/µL was defined as abnormal. Results: We observed a higher median number of IgM memory B-cells in CCS who received radiotherapy involving the spleen (31 cells/µL, p=0.06) or TBI (55 cells/µL, p = 0.03) compared to CCS who received splenectomy (20 cells/µL). However, only two CCS had IgM memory B-cells below the lower limit of normal. No difference in IgM memory B-cells was observed between CCS with HJB present and absent (35 cells/µL vs. 44 cells/µL). Conclusion: Although the number of IgM memory B-cells differed between splenectomized CCS and CCS who received radiotherapy involving the spleen or TBI, only two CCS showed abnormal values. Therefore, this assessment cannot be used to screen for splenic dysfunction.</p

Beton: Niet stuk te krijgen, of toch?

Civil Engineering and Geoscience

Mechanisms of shear transfer in cracks in concrete: A survey of literature

The aim of the project is to develop computer programs based on the finite element method which are able to analyse arbitrary plane structures of reinforced or prestressed concrete with any type of loading untill failure. Besides all, the shear behaviour of structures should receive the main attention.Design & ConstructionCivil Engineering and Geoscience

Experiments on shear transfer in cracks in concrete. Part II: Analysis of results

Design & ConstructionCivil Engineering and Geoscience

Aggregate interlock: A theoretical and experimental analysis

Civil EngineeringCivil Engineering and Geoscience

Synthesized intervention method to prolong service life of reinforced concrete structures: ICCP-SS

Concrete Structure

High performance fiber reinforced concrete: Progress in knowledge and design codes

High performance fiber reinforced concrete is developing quickly to a modern structural material with a high potential. As for instance testified by the recent symposium on HPFRC in Kassel, Germany (April 2008) the number of structural applications increases. At this moment studies are carried out with the aim to come to an international recommendation for the design of structures with HPFRC. Research projects are being carried out in order to supply missing information in relevant areas. Some examples of recent research at TU Delft are given. For the preparation of an internationally acceptable design recommendation for HPFRC a number of principles should be respected. The code should as much as possible be in harmony with the code for conventional fiber concrete. Moreover it should be consistent with existing design recommendations for structural concrete. Second thoughts on the introduction of such a new code are given.Department Design and ConstructionCivil Engineering and Geoscience