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A Clinical Conditions ant:] Medical Technologies Consirlere(1 by the Priority-Setting Group The folBowing list of candidate assessment topics was compiled from the sources descnbed in Appendix C. Each candidate topic was classified under the appropriate clinical condition or technology group (noted as the main entry in Tables A.l and A.2~. Suggested technologies that may be used for the prevention, screening, diagnosis, or treatment of a clinical condition are listed under that condition in Table A. 1. Technologies mat may be used for many cI=cal conditions are listed as separate cross- cutt~ng technologies in Table A.2. A total of 496 candidate topics were considered. These are broken down into 73 groups of conical conditions and associated technologies Table A.1) and 36 groups of other technolo- gies (Table A.21. The technologies considered for each clinical condition are neither mutually exclusive nor exhaustive, but represent the topics suggested by the source organizations. The management option of using no technology is understood to be included under each clerical condition. The nomenclature for technologies is as follows: T prey. T T Dx- T - ~Rz. * {} Technology for prevention. Technology for screening. Technology for diagnosis. Technology for treatment. Indicates that the technology is listed under more than one clinical condition. Indicates that the listed clinical states were considered under that clinical condition. 61

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62 NATIONAL ASSESSMENT PR[ORmES TABLE A.1 Candidate Clinical Conditions and Associated Technologies Abdominal pain Te DX T DX T . ADX Adult gastroententis Adult pneumonia Alzheimer's disease Aphasia Bladder cancer T screcJl. Do T ~Dx- T DX Breast cancer T : screen T 5~7CCH, DX T *z T Rx. T Rx. computed tomography [Cl ]* laparoscopy* ultrasound* cystourethroscopy cystoscopy with biopsy urine cytology screening programs mammography hormonal therapy* excision of breast cyst or lesion mastectomy Cardiac arrhythmias {bradycardia' conduction defects, tachycardia} T*x: antiarrhythmic drugs T*x: pacemakers and related procedures TRX catheter ablation techniques T*x: implantable cardiac defibrillatory* Cataracts T RX T RX T RX surgical cataract removal lens laser surgery intraocular lens implant Cerebrovascular accident Cervical cancer T,c,~" screening programs Chronic fever Chronic obstructive pulmonary disease {adult asthma, adult bronchitis } TD~: pulmonary function tests* Table A.] continues

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APPENDIX A TABLE A.1 (Continued 63 T. Rx T R~:- T - ~Rx. Coronary artery disease T: prey T ~ prey. T : Screen T ~crre~l ~ T Ax T Dx. T Dx T ADD. T - ~Dx. T Dx r ~ Dx T Dz- T 1Dz. T Rx- T - ~Rx T Rx. T ~ 1Rz. T - 'Rx. oxygen therapy* ventilator therapy physical therapy {acute myocardial infarction, angina pectorals, chest pain, ischemic heart disease ~ cholesterol-controHing drugs and programs ~ aspirin cholesterol screening* genetic screening* imaging modalities (angio, cine-CI, magnetic resonance imaging [MRIl, positron-emission tomography [PETE* ultrasound modalities (e.g., Doppler echo- cardiography)* stress or exercise tests monoclonal antibodies* other cardiac functional tests cardiac catheterization electrocardiography [EKG]* continuous EKG (Holler monitoring) ombolytic agents and therapy (e.g., :-PA (tissue- plasminogen activator), streptokinase) percutaneous coronary angioplasty percutaneous transluminal atherectomy* coronary artery bypass graft surgery other drug therapy cardiac rehabilitation programs Cystitis Destructive behavior in developmental disabilities Diabetes mellitus {diabetic retinopathy} T ~ be, - a, D~. T ~ secrecy, Dx- T Rx- T Rx- blood glucose tests and monitors* preoperative evaluation of diabetic cardiac surgical patients blood glucose control devices implantable insulin pumps* Table A.] continues

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64 TABLE A.1 (Continued NAT70NAL ASSESSMENT PRIORITIES Disseminated neoplastic disease TRX chemotherapy* TRY: bone marrow transplantation* Diverticular disease Encephalopathy T *.r T Rat T . TRY Epilepsy T ~ ~Rx. T - ~ R.~. {coma} Fecal incontinence T Ret Gallbladder disease {gallstones, cholelithiasis, cholecystitis3 T ADA T 1Dz T ADA T Rx- T Ret T Rx. T Rx- T Rx. T Rx- standard life support drug therapy hypothermia surgery dmg therapy surgical procedures . Gastrointestinal bleeding T sconce T~creca T arts T ADA T Dot oral cholecystogram nuclear radioisotope scan imaging technologies (e.g., ultrasound)* cholecystectomy and other hepatobilia~y procedures (e.g., cholangiography) li~otnpsy* stone dissolution Snags and agents endoscopic interventions (e.g., papillotomy) laser ablation* other drug therapy {bleeding peptic ulcers*, colorectal cancer' diverticulosis, esophageal cancer, hemorrhoids, upper gastrointestinal bleeding, rectal bleeding, stomach cancers colorectal cancer screening (e.g., fecal occult blood testing) colonoscopy upper gastrointestinal (GI) endoscopy colonoscopy win biopsy upper GI endoscopy with biopsy - Table A.] continues

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APPENDIX TABLE A.1 (Conanue~ 65 T D~ T . ~ *~. T RS T Rx. T ~ ~Rs. Glaucoma T Rx Headache Head injur T ADX Hearing loss T DS T Rx- T - 'Rs. Heart fa~lure T Rx. T T Rx. Hemoptysis sigmoi do s copy ~ennal cautery (e.g., laser endoscopic elec~o- coaguladon)* sclerosing agents colonoscopy with polypectomy colectomy laser trabeculoplasty* imaging modalities (e.g., CI~, MRI)* audiometry tests (e.g., tympanometry) cochlear implants* bone conduction hearing devices heart transplantation* ardficial hearts* cardiopulmona~y resuscitation {lung cancer, pulmonary embolus} TD~ bronchoscopy T D~ T . AD~ T DS T DS Hern~as TRS SUrg1C~j1 inguinal repa~r Human immunodeficiency v~rus (HIV) infection {acquired immune deficiency syndrome [AIDS] Tp~: infecdous control programs for AIDS T~D~ H]tiVv~ drugs (e g., zidovudine [AZr]) spu~n cytology imag~ng modalities (e.g., chest cr, MRI)* mediastinoscopy wi~ node biopsy ~oracotomy wi~ node biopsy Hypertension Table A.] con~inues

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66 TABLE A.1 (Continued NATIONAL ASSESSMENT PRIORITIES Impotence TRX penile prosthesis Incontinence TDS urodynamic studies Tic: incontinence devices TRX artificial urinary sphincter Infectious disease diagnosis Infertility T . 'DX- T Rx T 'Rx laparoscopy* in vitro fertilization procedures vaginal probe-directed egg retrieval Joint disease & injury arthritis, degenerative joint disease, health impact of jog- ging, knee problems, rheumatoid arthritis, sports injures) T : blood level of keratan sulfate in osteoarthritis C,CA T : genetic markers for rheumatoid arthritis 5C'CCA TDX arthroscopy TED: imaging modalities (e.g., x ray, CI, MRI)* TRX orthopedic prostheses* (e.g., total knee and/or hip- replacements) T Rx T - ~Rx. T RX T Rx Kidney stones T Rx. Leukemia Low back pain viscoelastic joint fluid replacement radiation synovectomy for rheumatoid arthritis meniscectomy other joint surgery lithotnpsy* {chronic medical back problems, medical back problems, herniated lumbar disks, low backache ~ TDX imaging modalities (x ray, CI, MRI)* TRX rest andlor exercise TRX percutaneous lumbar diskectomy TRX chemical degradation of herniated disks (e.g., win chymopapain) T*x: musculoskeleta] manipulations Table A.] continues

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APPENDIX A TABLE A.1 (Continued 67 T'r: laminectomy TRX traction T RX T Ri. pain therapies (e.g., epidural and intraligamentous injections) other medical and drug therapy (both outpatient and inpatient) Lyme disease Obesity Oral complications of cancer treatment Osteoporosis t hip fracture} T . prep T ~ ~ . T : screc`I Parkinson's disease Pediatnc ear infection hormonal therapy* blood test for level of interieukin ~ bone densitometry (e.g., dual-photon abso~ptiometry)* TRX: middle ear tube drainage TR.X antibiotic therapy Pediatnc gastroententis Pediatnc hyperactivity Pediatnc respiratory disease Pediatric asthma, pediatric bronchitis, pediatric pneumonias, respiratory distress syndrome] Peptic ulcer disease* T : antiuicer drugs pack Penpheral vascular disease {aortic aneurysms; stenosis/occlusion of precerebral, renal, femoral artenes; deep vein ~mbophlebitis; pulmonary embolus) TDX digital subtraction angiography TED: Doppler ultrasound (e.g., carotid and other peripheral vessels)* extracranial vascular procedures percutaneous ~nsluminal angioplasty * percutaneous transluminal atherectomy* laser atherectomy* T Rz- T . ~R,- T *x T RX - Table A.] continues

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68 TABLE A.1 (Continued NATIONAL ASSESSMENT PRIORITIES T *x T Rx Pregnancy T: prey T prey T : 5c,J! T Dx. T ~Dx. T Dx T 'Dx- T Dx. T ~Dx. T Rs T firs T firs T Rs T ARM Prostatism Psoriasis Psychiatric Disorders T. T - 'R.~- T Rs surgical ~}omboendarterectomy (e.g., carotid vertebral, aortic) surgical aneurysm repair {uncomplicated pregnancy, high-nsk pregnancy, low-birthweight infants) prenatal care and education programs prenatal genetic counseling prenatal laboratory testing and screening (e.g., alpha- fetoprotein testing) ultrasound* chononic vilBus sampling amniocentesis fetal monitoring in utero genetic evaluation* flow cytometry natural vaginal delivery electronically monitored vaginal delivers, forceps vaginal delivery cesarean section neonatal intensive care* {prostatic hype~plasia~ypertrophy} open prostatectomy transurethral prostatectomy "watchful waiting" {anxiety states, depressive neurosis, depressive states disorders, eating disorders (e.g., anorexia, bulimia), psychosis, schizophrenia, sleep disorders in the elderly} psychotropic drugs psychotherapy psychosurger, Table A.] continues

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APPENDIX A TABLE A.1 (Continued 69 Pyelonephritis Renal failure TRX hemodialysis TRX e~h~poietin* Respiratory failure Scoliosis TRX surgery and fixation TRX bracing TRX electromagnetic shmulation Skin effects of sunlight and ultraviolet radiation Spinal cord injuries TRX long-tenn rehabilitation programs Stroke {cerebrovascular accident) Substance abuse ~ alcohol and drug abuse] Tprev: public education and prevention programs Sudden infant death syndrome Tprc,: sleep apnea mo~tonng Surgical blood loss TRX autotransfusion TRX homologous transfusion TRX hemodilution Surgical infection T pace T - ARX . preoperative antibiotic therapy postoperative antibiotic therapy Throat infection TD3[ thmat culture* TR,` antibiotics Tonsillitis/Adenoiditis TRX antibiotic therapy TRX surgery (e.g., tonsillectomy) Table A.] continues

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70 TABLE A.1 (Continued NATIONAL ASSESSMJENTPRlORlTlES . . Transient ischemic attack Utenne bleeding {uterine cancer) TDX pe .VlsCOpy TDX hysteroscopy TRX laser ablation of endometnal tissue* TRY: hysterectomy TRY honnonal therapy* TRY: dilatation and curettage Valvular heart disease TRX valvuloplasty and other surgical cardiac valve procedures TRX percutaneous balloon valvuloplasty Weight loss

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APPENDIX A TABLE A.2 Other Candidate Technologies 71 Acupuncture Acyclovir Biofeedback Blood donor screening programs Chelation therapy Dermatological technologies Drug: topical cor~costeroids Procedure: skin biopsy Procedure: Procedure: Procedure: acne surgery excision of cyst destruction of skin lesion Diagnostic and therapeutic immuno/genetic technologies Drug: monoclonal antibodies* Drug: antitumor vaccines Drug: immune agents (e.g., interleukin, interferon) Procedure: viral infection screening tests Procedure: Procedure: Procedure: Procedure: Procedure: Procedure: Procedure: Procedure: Procedure: Procedure: genetic tests & probes DNA recombinant techniques in utero genetic evaluation* genetic screening in adults (e.g., Huntington's chores, coronary artery disease*) immunocytochemistry tests other genetic engineering technologies human gene therapy plasmapheresis allergy testing & therapy other immunotherapy Diagnostic imaging technologies Drug: low osmolality and other imaging contrast agents Drug: radiopharmaceuticals Device/procedure: x ray (including dental x rays)* Device/procedure: CI and related technologies (e.g., cine-CI)* Device/procedure: MR] and related technologies (e.g., gating devices)* Device/procedure: PHIL* Device/procedure: single photon emission CT [SPECr] Table A.2 continues

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72 TABLE A.2 (Continued NYLONS MS=SM~PHOR=ES Device/procedure: ultrasound (e.g., endovaginal, transrectal, endoscopic)* Device/procedure: echocardiography (e.g., heart, carotid artenes)* Device/procedure: dual-photon abso~tiometry* Device/procedure: Oceanography Device/procedure: microwave tomography Support system: picture archiving and communication systems Support system: teleradiology systems Diagnostic laboratory testing Device: automated clinical analyzers Device: diagnostic kits. Procedure: blood lipoprotein evaluation Procedure: other blood tests* Procedure: Procedure: Procedure: Procedure: Drug delivery systems Device: Device: urinalysis throat culture* human papillomavirus testing other laboratory tests* vascular access device infusion pumps (e.g., implantable insulin pumps)* Procedure: patient~ontrolled analgesia Procedure: parenteral nutntion* Procedure: home intravenous therapy* Erythropoiedn Growth hormone Home health care technologies Drug: metabolic and nutrient agents (e.g., parenteral nutntion)* Device: Device: Device: Device: Device: Procedure: beds (e.g., electric, flotation) home diagnostic kits* device to prevent pressure sores home monitoring equipment (e.g., EKG, fetal monitors and pediatric apnea monitors) home alarm systems home respiratory therapy (e.g., oxygen*, ventilator therapy*) Table A.2 continues

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APPENDIX ~ TABLE A.2 (Continued 73 home intravenous therapy* Procedure: hoplantable devices Device: Device: Device: Device: implantable bone growth stimulators* Device: implantable cardiac defibriBators* Intensive care units DCU) Support system: medical ICU Support system: surgical ICU Support system: coronary ICU Support system: neonatal ICU* Laser technologies Device: Device: Procedure: Procedure: Procedure: Procedure: Procedure: Procedure: Procedure: Procedure: Procedure: Procedure: cochIear implants* implantable infusion pumps (e.g., insulin)* pacemakers* endoscopic lasers* dye lasers palliative treaunent of recap cancer gallstone, kidney stone ablation* bone fracture repair peripheral nerve microsurgery ablation of endometnal tissue* nenre ablation for menstrual pain neurosurgery applications photocoagulation of the retina* laser atherectomy* laser trabeculoplasty* Neonatal circumcision Neonatal extraco~poreal membrane oxygenation Neoplastic technologies Drug: tumor markers Procedure: chemotherapy* Procedure: radiation and photoradiation therapy P~oce~iure: tumor~irected therapy Procedure: hypenhem~ia Neurological technologies Procetlure: electroencephalogram [EEG] monitonng* Procedure: nerve conduction studies P~cedure: peripheral nerve ultrasound P~dure: elec~s~dmulabon of salivary production Table A.2 continues

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14 TABLE A.2 (Continued NA TI ONAL ASSESSMENT PRI ORI TIES Operating room and other Wonton technologies Device: _ _ _ = _ _ _ _ c~ _ oxygen analyzers Device/procedure: cardiac output monitoring (e.g., electrical bioimpedance) Device/procedure: blood pressure monitoring Device/procedure: apnea monitoring* Device/procedure: carbon dioxide monitoring Device/procedure: EKG monitonng* Device/procedure: mass spectroscopy Device/procedure: BEG monitonng* (e.g., continuous, video) Device/procedure: pulse oximet~ Device/procedure: ventilator alann systems Organ transplantation and replacement Device/procedure: orthopedic prostheses* Device/procedure: heart (e.g., transplantation, artificial)* Device/procedure: kidney (e.g., transplantation, dialysis) Device/procedure: ligaments (e.g., transplantation, artificial) Device/procedure: pancreas (e.g., transplantation, artificial) Procedure: bone graft surgery Procedure: bone marrow transplantation* Procedure: liver transplantation Procedure: lung transplantation Procedure: intestine transplantation Procedure: other tissue transplantation (e.g., brain, fetal, endocnne) Organizational systems for health care Org. system: improved health status measures for quality of care improved medical criteria for preadmission Org. system: review and discharge planning Org. system: strategies for changing physician behavior Org. system: third-party coverage of Drugs (e.g., nordabeled uses, investigational new drugs) Org. system: risk adjustment and quality assurance Org. system: ergonomic research in industrial accident prevention Table A.2 continues

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APPE:[JDIX A TABLE A.2 (Continued 75 Other gastrointestinal technologies Device: gastroesophageal device Device: gastric bubble Procedure: percutaneous gastrostomy Procedure: colonic irrigation Other musculoskeletal technologies Drug: heterotropic bone factor Drug: hydroxyapatite and other bone substitutes Device: bone growth stimulators* (e.g., for spinal surgery) Other ophthalmologic technologies Procedure: glare testing and contrast sensitivity Procedure: Procedure: Other surgical technologies Procedure: Procedure: Procedure: Procedure: refractive keratoplasty laser photocoagulation of the retina* back and neck surgery fetal surgery liposuction surged temporomandibular surgery Procedure: tissue expansion surged Patient care information systems Device: Device: Support system: Support system: Support system: Support system: Support system: Pediatric urethral dilatation Periodic health exam~nabon Physical therapy Procedure: Procedure: Preoperative evaluation Device: bedside computer tennis bar code readers (e.g., medical record, x ray retrieval) data input and storage electronic image transmission and storage computer techniques in medical diagnosis and management automated patient record systems expert systems in medical diagnosis kinetic therapy medical therapy automatic preoperative test selection device other modes of preoperative evaluation Table A.2 continues

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76 TABLE A.2 (Continued NATIONAL ASSESSMENT PRIORITIES Respiratory Technologies Device: ventilators Procedure: pulmonary function tests* Procedure: bronchospasm evaluation Procedure: spirometry Procedure: respiratory therapy* (e.g., intermittent positive pressure) oxygen therapy* (e.g., hyperbaric) Ribavirin Technologies for the handicapped Device: low-vision aids Device: other communication aids Device: robotic aids Device: walking aids Device: wheelchairs Device: other mechanized vehicles Therapeutic radiologic procedures Procedure: Procedure: abscess drainage Procedure: cyst puncture Procedure: percutaneous transluminal angioplasty* Procedure: litho~ipsy (renal, biliary)*