Objectives: This review aims to assess the state of the science around the potential impact of certain patient characteristics on the safety and effectiveness of in vitro fertilization (IVF).

Methods: Following Cochrane Collaboration guidelines and the PRISMA statement, a comprehensive systematic review of reviews and recent primary studies examining the impact of paternal age and maternal age, smoking, and body mass index (BMI) on the safety and effectiveness of IVF was performed. Papers, published between January 2007 and June 2014, were independently reviewed and critically appraised by two researchers using published quality assessment tools for reviews and primary studies. Due to heterogeneity across papers (different study designs and patient selection criteria), a qualitative analysis of extracted information was performed.

Results: Seventeen papers (ten systematic reviews and seven primary studies) were included. They comprised evidence from retrospective observational studies in which maternal age, BMI, and smoking status were explored as part of secondary analyses of larger studies. The majority of papers found that the likelihood of achieving a pregnancy was lower among women who were >40 years, had a BMI ≥ 25 and smoked. Advanced maternal age and BMI were also associated with higher rates of preterm birth and low birth weight.

Conclusions: Based on available evidence, it may be appropriate to consider “maternal age” and “morbid obesity” in public funding policies that aim to maximize the effectiveness of IVF. However, given inconsistencies in the effect of smoking across different pregnancy-related outcomes, support for incorporating it into funding conditions appears weak.

A new method for continuous monitoring of the concentration of 131I-labelled iodoantipy rine during an autoradiographic local cerebral blood flow (LCBF) experiment is described. During infusion of iodoantipy rine, radioactivity in an external femoral arteriovenous loop is monitored by a scintillation detector. Data is collected with a variable time base, and the arterial activity curve displayed visually in its entirety. The main advantage of this method is that there is no blood loss. It will therefore be of particular importance in dual-label autoradiography. This method can also be used for other gamma-emitting blood flow tracers, e.g. 123I-iodoantipyrine.

Seventy six regional cerebral blood flow (rCBF) studies were conducted on 32 patients who had a total of 39 aneurysms. Twenty three of these patients were studied pre- and post-operatively. Normal values were obtained from a control group of 33 subjects, each of whom underwent one rCBF study. Flow was reduced following subarachnoid hemorrhage (SAH); it increased significantly postoperatively. Lower flows were associated with poorer clinical grades. There was a greater variation in regional distribution of flow immediately following SAH than in normals or in patients who had recovered from the acute phase. rCBF studies correlated with CT scans demonstrated that a progressive increase in ventricular size was accompanied by a progressive reduction in flow. In addition, intraventricular hemorrhage (IVH) was associated with a significant reduction in cerebral blood flow (CBF). No significant correlation between CBF and spasm was demonstrable.

Using the Xel33 inhalation technique, measurements of the blood flow to the left and right parietal and temporal regions of the cerebrum were obtained in 5 healthy individuals while simultaneously recording their EEGs. Up to 3 measurements were obtained from each of the subjects the first while they were mentally at rest and the others while they were engaged in prescribed forms of mental activity. Relationships between the measured blood flow through grey matter, initial slope index, relative grey weight, percent grey flow and power in the delta, delta-theta, alpha, beta and gamma rhythms of the EEG were examined. The results showed that for the subject group as a whole there was a strong correlation between the power present in the low frequency components of EEG and the grey flow and relative grey weight parameters of blood flow. On an individual basis, the observed relationships were highly variable particularly at high flow rates and at low relative grey weights, but became much more definitive at low flows and high weights. The results as they relate to previous work of this kind are discussed.

Fifteen regional cerebral blood flow studies (rCBF) were conducted on 14 patients with arteriovenous malformations (AVM). Only one patient was studied at the time of a hemorrhage. None of the patients were operated upon. All patients had angiographically demonstrated lesions. All the CT scans performed demonstrated the lesions. rCBF was increased in the involved hemisphere compared to the non-involved hemisphere and the difference was greater when the malformations were superficial. There was a higher incidence of high flow regions in the involved hemisphere of patients with AVMs compared to our normal control group and patients with subarachnoid hemorrhage (SAH) from aneurysms. Flow rales within the involved hemisphere demonstrated abnormal distributions and greater variability than normals. Some peaks previously demonstrated in the intraarterial flow studies are not apparent using the inhalation method. This noninvasive technique has a potential to provide additional useful information on the natural history of this disorder.

The authors report on a patient with a ruptured anterior communicating aneurysm treated surgically on the day following her subarachnoid hemorrhage (SAH). Repeated measurements of cerebral blood flow (rCBF) were carried out using the inhalational Xenon 133 method. Dramatic acute increases in rCBF occurred, coincident with clinical improvement, following mannitol, CSF drainage and dopamine. Later, further elevation to normal levels occurred following ventriculo-peritoneal shunting.

The volumetric and qualitative analysis of the food of Gadus minutus has been discussed. The post-larvae feed entirely on copepods, mostly Pseudocalanus elongatus. The O-group feeds on copepods, small decapods, amphipods, polychaetes and isopods. The adolescent and adult groups feed on larger decapods like Processa canaliculata, Galathea spp. and Portunus spp., fish, polychaetes and amphipods.

The age and rate of growth of G. minutus have been computed from a study of the supra-occipital crest. These age determinations have been correlated with the age determined by scales, otoliths and size-analysis. Back-calculations have been made by graphical method and by using the Lea-Dahl formula. The differences between the back-calculated lengths and actual observed lengths are negligible.

The scientific evidence for clinical effectiveness of transcutaneous electrical nerve stimulation (TENS) for treatment of acute, chronic, and labor and delivery pain is assessed in this paper, and it is concluded that there is little evidence for other than a limited use of TENS. The utilization of TENS in Canadian hospitals and payments for TENS services are addressed. Some practicalities regarding the use and assessment of health technologies are discussed.

Health technology assessment as a formalized set of activities has a relatively short history. At its current stage of development, it is clear that it has global dimensions and impact. In this paper we review the history of health technology assessment, its development as a form of health services research, and its “institutionalization.” We then identify the reasons for its internationalization, review current international initiatives, and propose actions to be taken to improve cooperation among countries.

Patterns of the diffusion of laparoscopic cholecystectomy in Canadian hospitals were determined by a telephone survey of 153 randomly selected hospitals over two years. Results were analyzed by region, hospital size, and type of hospital. Laparoscopic cholecystectomy has diffused very quickly compared with other technologies, before any comprehensive evaluation to consider its potential impact could take place.

Canada comprises 10 provinces and 2 territories. The Constitution assigns responsibility for the provision of health services in the provinces to provincial governments. Over the past 5 years, provincial governments have identified technology assessment as a priority. This paper describes an initiative taken by the government of the province of Alberta to develop a health technology assessment program for that province.

Objectives: This study sought to examine the safety, efficacy, and economic implications of the use of cerebral protection devices during carotid artery angioplasty and stenting (CAS) in high-risk patients with severe carotid artery disease (CAD).

Methods: A comprehensive search for peer- and non–peer-reviewed studies that compared carotid endarterectomy (CEA) or CAS without cerebral protection to CAS with cerebral protection and appeared in the English language literature between January 1990 and January 2005 was completed. Information from studies identified was extracted using a common data abstraction form and then critically appraised against published quality assessment criteria.

Results: Of the eight studies found, six provided information on technical or procedural success rates, with values ranging from 95.6 percent to 100 percent. Three of the four studies comparing groups of patients who received CAS with cerebral protection with those who received only CAS reported a non-statistically significantly higher 30-day incidence of death and stroke (major or minor) in the latter group. None of the three studies comparing CAS with cerebral protection to CEA demonstrated a statistically significant difference in the 30-day incidence of death, major stroke, or myocardial infarction between treatment groups. No economic analyses were found.

Conclusions: In high-risk patients with severe CAD, the evidence suggests that CAS with cerebral protection may offer a safe and efficacious alternative to CEA, reducing the risk of embolic peri-procedural complications associated with CAS to acceptable levels.

Objectives: Since 1988, four government-funded health technologyassessment (HTA) agencies have been established in Canada. This paperis a descriptive review of reports issued by these organizationsduring the period from 1988 to 1998.

Methods: Publications from the national and three provincial HTAagencies in Canada were obtained and reviewed. Only the 117assessment reports that were reported to have undergone externalreview were included in this analysis. Each report was classified ona standard abstraction form according to criteria such as technologytype(s), assessment focus, whether a specific policy question wasclearly stated and relevant decision maker(s) identified, descriptionof search strategy and selection criteria, sources of data andassessment methods used, whether recommendations or conclusions weremade, and duplication or overlap of reports. The trends in thesequalities over the 10-year period were also examined.

Results: Therapeutic technologies have received the most attentionfrom all four agencies, although the focus on devices, drugs, andprocedures varied between agencies. The policy question underinvestigation was clearly identified in 82% of reports, and 71% clearly identified the decision maker toward whom the assessment wastargeted. Efficacy or effectiveness was examined in 81% of reports,and costs were assessed in 65% of studies. These were the two mostfrequently examined aspects. Almost all assessments were descriptiveliterature reviews; 9% included meta-analyses and 32% had costanalyses or economic evaluations. Forty-four percent of reports had aclear description of the literature search strategy, and selectioncriteria were clearly specified in 38% of studies, but there wasconsiderable variation among agencies in the level of descriptionof these methods. Conclusions were clearly stated in 83% of the assessments' conclusions, and 13% had recommendations. When analyzedlongitudinally, it is apparent that the quality of reports hasimproved markedly during the past decade. This was determined byexamining the clarity of specifying the policy question(s) underinvestigation, the identification of the target audience of decisionmakers for the information, and by evaluating the thoroughness of thedescription of the methods used in the assessment.

Conclusions: Canadian government agencies have contributed aconsiderable quantity of health technology assessments. There hasbeen very little duplication of technologies evaluated, and thequality of the assessment reports has markedly improved during thepast decade.

Biomedical databases are an important source of information for health technology assessment. However, there is considerable variation in the costs of accessing commercial databases. We sought to measure the quality, amount of overlap, and costs of information retrieved from two of the main database sources — MEDLINE and EMBASE. Librarians at two health technology assessment agencies ran a total of eight literature searches on various medical technologies, using both databases. All search results were independently reviewed by two researchers. The researchers were asked to identify relevant references and to rank each of these according to a level of evidence scale. The results were tabulated to show the number of references identified by each database, the number of relevant references ranked by level of evidence, and the number of these references that were unique to one or the other database. The cost of retrieving references from each source was also calculated. Each database contained relevant references not available in the other. Because of the longer time lag for indexing in MEDLINE, many of the references that originally appeared to be unique to EMBASE were subsequently available in MEDLINE as well. Since our study was conducted, MEDLINE has been made available worldwide, free of charge, via the Internet. Hence, the cost difference between the databases is now even greater. However, notwithstanding the costs, it appears that literature searches that rely on only one or the other database will inevitably miss pertinent information.

The need for better communication and collaboration between health technology assessment agencies led to the formation of an International Network of Agencies for Health Technology Assessment (INAHTA).The network now comprises 27 agencies and has been successful in improving exchange of information and in undertaking joint health technology assessment projects.Issues for the future include possible changes to criteria for membership and identification of resources for more extensive programs.