The Rand Ucla Appropriateness Method User S Manual

Health systems should function in such a way that the amount of inappropriate care is minimized, while at the same time stinting as little as possible on appropriate and necessary care. The ability to determine and identify which care is overused and which is underused is essential to this functioning. To this end, the "RAND/UCLA Appropriateness Method" was developed in the 1980s. It has been further developed and refined in North America and, increasingly, in Europe. The rationale behind the method is that randomized clinical trials--the "gold standard" for evidence-based medicine--are generally either not available or cannot provide evidence at a level of detail sufficient to apply to the wide range of patients seen in everyday clinical practice. Although robust scientific evidence about the benefits of many procedures is lacking, physicians must nonetheless make decisions every day about when to use them. Consequently, a method was developed that combined the best available scientific evidence with the collective judgment of experts to yield a statement regarding the appropriateness of performing a procedure at the level of patient-specific symptoms, medical history, and test results. This manual presents step-by-step guidelines for conceptualising, designing, and carrying out a study of the appropriateness of medical or surgical procedures (for either diagnosis or treatment) using the RAND/UCLA Appropriateness Method. The manual distills the experience of many researchers in North America and Europe and presents current (as of the year 2000) thinking on the subject. Although the manual is self-contained and complete, the authors do not recommend that those unfamiliar with the RAND/UCLA Appropriateness Method independently conduct an appropriateness study; instead, they suggest "seeing one" before "doing one." To this end, contact information is provided to assist potential users of the method.

The concepts of appropriate and necessary care are fundamental to the creation of an efficient and equitable health-care delivery system. Evidence of inappropriate overuse and underuse of procedures has been documented even in health systems characterised by the absence of global budgets, capitation, utilisation review or the pressure of requiring a second opinion. Health systems should function in such a way that inappropriate care is progressively reduced, while appropriate and especially necessary care are maintained or increased. The ability to determine and identify which care is overused and which is underused is essential to this functioning. To this end, the "RAND/UCLA Appropriateness Method" (here given the acronym RAM) was developed by RAND and UCLA in the 198Os. It has been further developed and refined in North America and, increasingly, in Europe.

Written and edited by world-renowned experts in the field, Benzel’s Spine Surgery: Techniques, Complication Avoidance and Management, 5th Edition, provides expert, step-by-step guidance on the evaluation and management of disorders of the spine. This definitive, two-volume work explores the full spectrum of techniques used in spine surgery, giving you the tools you need to hone your skills and increase your knowledge in this challenging area. Clearly organized and extensively revised throughout, it features contributions from both neurosurgeons and orthopaedic surgeons to present a truly comprehensive approach to spine disease. Offers a thorough overview of the effective management of patients with spinal disorders, including fundamental principles, biomechanics, applied anatomy, instrumentation, pathophysiology of spinal disorders, surgical techniques, motion preservation strategies, non-surgical management, and complication avoidance and management, as well as controversies. Focuses on both pathophysiology and surgical treatment of spine disease, with an increased emphasis on minimally invasive surgery. Contains new features such as key points boxes at the beginning of chapters and algorithms to help streamline the decision making process. Covers today’s hot topics in spine surgery, such as health economics, artificial intelligence, predictive analytics, new less invasive techniques including endoscopic spine surgery, and the future of spine surgery. Provides expert coverage of key topics including biomechanics of motion preservation techniques, spinal injuries in sports, biologics in spine fusion surgery, anterior sub-axial cervical fixation and fusion techniques, complex lumbosacropelvic fixation techniques, and many more. Features more than 1,500 high-quality illustrations, as well as new procedural videos on en bloc spondylectomy, minimally invasive endoscopic posterior cervical foraminotomy, cervical total disc replacement, minimally invasive lumbar decompression of stenosis, and more.

This book is the product of a unique collaboration by experts from leading international, regional and national agencies and professional organizations discussing on the current ‘hot’ issue on the judicious use and safety of radiation in radiology. There have been several cases involving radiation overexposure that have received international attention. Strategies and solutions to guide readers how to maximize the benefits and minimize the risks when using radiation in medicine are covered.

Integrated cardiovascular imaging is the optimal use of multiple imaging modalities to obtain complementary information about cardiac diseases, to aid in diagnosis, determine aetiology and prognosis, with the ultimate objective of effectively guiding clinical decision making. Over the past few decades, advances in technology have contributed to the development of new imaging modalities and refinement of existing ones, leading to major improvements in the accuracy of diagnosing cardiovascular disease. While modality-centric expertise has been the primary driver of improvements in each modality, this has also contributed to imagers working in silos resulting with limited inter-modality coordination and collation of information relevant for patient care. This publication provides comprehensive guidance on the rationale and implementation of integrated cardiovascular imaging for practitioners.

This book is a comprehensive guide to the surgical repair of inguinal and abdominal wall hernias that not only describes all potential approaches, but also places them in the context of the anatomy of the region, the pathology, and the advances in scientific knowledge over the past decade. It documents in detail the individual techniques applicable in each region (inguinal, femoral, and ventral), highlighting tips and tricks and focusing on indications, potential complications, and outcomes. In addition, it presents cases of incisional hernia and examines less frequent and rare cases and complex situations. Written for surgeons from around the globe, it includes procedures used in wealthy, developed countries and those without mesh more commonly employed in developing countries. With a format designed to facilitate use in daily practice, it is invaluable for residents seeking step-by-step guidance on procedures ranging from repair of simple inguinal hernias to complex reconstruction; for general surgeons who frequently perform hernia repairs; and for hernia specialists aiming to achieve optimal results. It also appeals to researchers with an interest in the scientific background to hernia surgery.

This Handbook expertly instructs the reader on how to conduct applied health research across a number of disciplines. Particularly aimed at postgraduate health researchers and students of applied health research, it presents and explains a wide range of research designs and other contemporary issues in applied health research.