A randomized controlled trial assessing the health economics of realtime teledermatology compared with conventional care: an urban versus rural perspective

A randomized controlled trial was carried out to measure the cost-effectiveness of realtime teledermatology compared with conventional outpatient dermatology care for patients from urban and rural areas. One urban and one rural health centre were linked to a regional hospital in Northern Ireland by ISDN at 128 kbit/s. Over two years, 274 patients required a hospital outpatient dermatology referral -126 patients (46%) were randomized to a telemedicine consultation and 148 (54%) to a conventional hospital outpatient consultation. Of those seen by telemedicine, 61% were registered with an urban practice, compared with 71% of those seen conventionally. The clinical outcomes of the two types of consultation were similar - almost half the patients were managed after a single consultation with the dermatologist. The observed marginal cost per patient of the initial realtime teledermatology consultation was f52.85 for those in urban areas and f59.93 per patient for those from rural areas. The observed marginal cost of the initial conventional consultation was f47.13 for urban patients and f48.77 for rural patients. The total observed costs of teledermatology were higher than the costs of conventional care in both urban and rural areas, mainly because of the fixed equipment costs. Sensitivity analysis using a real-world scenario showed that in urban areas the average costs of the telemedicine and conventional consultations were about equal, while in rural areas the average cost of the telemedicine consultation was less than that of the conventional consultation.

Essays in health economics: Volume-Outcome Effect, upcoding behaviour and the evaluation of a short-term intervention program

Evidence in the literature suggests a negative relationship between volume of medical procedures and mortality rates in the health care sector. In general, high-volume hospitals appear to achieve lower mortality rates, although considerable variation exists. However, most studies focus on US hospitals, which face different incentives than hospitals in a National Health Service (NHS). In order to add to the literature, this study aims to understand what happens in a NHS. Results reveal a statistically significant correlation between volume of procedures and better outcomes for the following medical procedures: cerebral infarction, respiratory infections, circulatory disorders with AMI, bowel procedures, cirrhosis, and hip and femur procedures. The effect is explained with the practice-makes-perfect hypothesis through static effects of scale with little evidence of learning-by-doing. The centralization of those medical procedures is recommended given that this policy would save a considerable number of lives (reduction of 12% in deaths for cerebral infarction).

Electroquímica de sustancias de interés en los sistemas agroalimentario y de sanidad animal. Desarrollo de biosensores electroquímicos. Aplicaciones analíticas.Electrochemistry of substances of interest in agroalimentary and animal health systems. Development of electrochemical biosensors. Analytical applications.

Se estudiarán los mecanismos de reacción electroquímica de las micotoxinas (metabolitos tóxicos generados por hongos) citrinina (CIT), patulina (PAT) y moniliformina (MON), de los antioxidantes naturales alfa, beta, gama y delta tocoferoles, de los flavonoides fisetina (FIS), morina (MOR), luteolina (LUT), rutina (RUT), buteina (BUT), naringenina (NAR) y miricetina (MIR) y de las hormonas esteroides estradiol (EDIOL), estrona (EONA) y estriol (ETRIOL). Por otra parte, se implementarán técnicas electroanalíticas para la detección y cuantificación de estos sustratos en muestras de matrices naturales que los contengan. Se realizará el diseño y caracterización de biosensores enzimáticos a partir de peroxidasas y/o fosfatasa alcalina para la determinación de la micotoxina CIT y de los flavonoides y, por otro, de inmunosensores para las micotoxinas ocratoxina A (OTA) y PAT y hormonas. Para el anclaje de enzimas y/o anticuerpos, se estudiarán las propiedades de electrodos modificados por monocapas autoensambladas, nanotubos de carbono y partículas magnéticas. Se usarán las técnicas de voltamperometría cíclica, de onda cuadrada y de redisolución con acumulación adsortiva, espectroscopías de impedancia electroquímica, electrólisis a potencial controlado, uv-vis e IR, microbalanza de cristal de cuarzo y microscopías de alta resolución (SEM, TEM, AFM). La importancia de este proyecto apunta a la obtención de nuevos datos electroquímicos de los sustratos indicados y conocimientos relacionados con la aplicación de electrodos modificados en la preparación de biosensores y en el desarrollo de técnicas alternativas para la determinación de los analitos mencionados precedentemente. Electrochemical reaction mechanisms of mycotoxins (toxic metabolites generated by fungi) citrinin (CIT), Patulin (PAT) and moniliformin (MON), natural antioxidants alpha, beta, gamma and delta tocopherols, flavonoids fisetin (FIS), morin (MOR), luteolin (LUT), rutin (RUT), butein (BUT), naringenin (NAR), miricetin (MIR) and steroid hormones estradiol (EDIOL), estrone (EONA) and estriole (ETRIOL) will be explored. On the other hand, electroanalytical techniques for the detection and quantification of these substrates in samples of natural matrices will be implemented. The design and characterization of enzymatic biosensors from peroxidases and/or from alkaline phosphatase for the determination of CIT and flavonoids, and also of inmunosensors for ochratoxin A (OTA) and PAT and hormones will be performed. For the anchor of enzymes and/or antibody, properties of electrodes modified by self assembled monolayers, carbon nanotubes and magnetic particles will be explored. Cyclic, square wave and adsorptive stripping voltammetries, electrochemical impedance spectroscopy, controlled potential electrolysis, uv-vis and IR, quartz crystal microbalance and high-resolution microcopies (SEM, TEM, AFM) will be used. The importance of this project is aimed at obtaining new electrochemical data for the indicated substrates and knowledge on the application of modified electrodes in preparation of biosensors and in the development of alternative techniques for the determination of the above-mentioned analytes.

A Health Economics Model. The cost benefits of the Physical Activity Strategy for Northern Ireland - a summary of key findings

This summary report follows on from the publication of the Northern Ireland physical activity strategy in 1996 and the subsequent publication of the strategy action plan in 1998. Within this strategy action plan a recommendation was made for the health sector, that research should be carried out to evaluate and compare the cost of investing in physical activity programmes against the cost of treating preventable illness. To help in the development of this key area, the Department of Health, Social Services and Public Safety's Economics Branch agreed to develop a model that would seek to establish the extent of avoidable deaths from physical inactivity and, as a consequence, the avoidable economic and healthcare costs for Northern Ireland.

An Introduction to Health Economics & Economic Evaluations

- Overview of Economic Evaluation - Stages in Economic Evaluation  

Introduction to Evaluation and Health Economics

A video summary by Orla Doyle

Building synergies in development research: The application of the mosaic model to animal health research

Development research has responded to a number of charges over the past few decades. For example, when traditional research was accused of being 'top-down', the response was participatory research, linking the 'receptors' to the generators of research. As participatory processes were recognised as producing limited outcomes, the demand-led agenda was born. In response to the alleged failure of research to deliver its products, the 'joined-up' model, which links research with the private sector, has become popular. However, using examples from animal-health research, this article demonstrates that all the aforementioned approaches are seriously limited in their attempts to generate outputs to address the multi-faceted problems facing the poor. The article outlines a new approach to research: the Mosaic Model. By combining different knowledge forms, and focusing on existing gaps, the model aims to bridge basic and applied findings to enhance the efficiency and value of research, past, present, and future.

Animal health and welfare in organic livestock production in Europe: Current state and future challenges

Existing data on animal health and welfare in organic livestock production systems in the European Community countries are reviewed in the light of the demands and challenges of the recently implemented EU regulation on organic livestock production. The main conclusions and recommendations of a three-year networking project on organic livestock production are summarised and the future challenges to organic livestock production in terms of welfare and health management are discussed. The authors conclude that, whilst the available data are limited and the implementation of the EC regulation is relatively recent, there is little evidence to suggest that organic livestock management causes major threats to animal health and welfare in comparison with conventional systems. There are, however, some well-identified areas, like parasite control and balanced ration formulation, where efforts are needed to find solutions that meet with organic standard requirements and guarantee high levels of health and welfare. It is suggested that, whilst organic standards offer an implicit framework for animal health and welfare management, there is a need to solve apparent conflicts between the organic farming objectives in regard to environment, public health, farmer income and animal health and welfare. The key challenges for the future of organic livestock production in Europe are related to the feasibility of implementing improved husbandry inputs and the development of evidence-based decision support systems for health and feeding management.