bluuebunny/crossref_metadata_2025 huggingface dataset:
VP05 Comprehensive Evaluation Of An Evolving Transcatheter Technology
Authors: Lambert Laurie , Azzi Leila , Désy François , Vutcovici Maria , Boothroyd Lucy , Brière Anabèle , Bogaty Peter , de Guise Michèle
Published: January 2018

INTRODUCTION:

Our cardiovascular evaluation unit is mandated to evaluate transcatheter aortic valve implantation (TAVI) in the province of Québec. In 2012, it was recommended that only patients at too high risk for surgery receive TAVI. In partnership with our six hospital TAVI programs, we have measured indicators of structure, process and outcomes since 2013. We are collaborating with multidisciplinary clinical experts to update recommendations for optimal use. Herein, we present the evolving portrait of TAVI in Québec and identify priority issues.

METHODS:

Clinical data were collected and analyzed for all TAVI performed from 1 April 2013 to 31 March 2016. Regular site feedback was provided. A systematic review of recent guidelines and randomized trials facilitated the interpretation of “real world” results and formulation of provincial quality standards.

RESULTS:

Provincial TAVI volume increased from 294 in 2013–14 to 340 in 2014–15, and to 360 in 2015–16. Patient age and sex distribution remained relatively constant over time (median age 83 years; 47 percent female). However, the median predicted risk of operative mortality (STS score) decreased in the latest period [6 percent (Interquartile Range, IQR: 4–9) versus 7 percent (IQR: 4–9) versus 4 percent (IQR: 3–7)], suggesting TAVI is increasingly being performed in lower-risk patients. Clinical documentation and processes of care generally improved. Thirty-day mortality decreased (6.1 percent versus 4.1 percent versus 2.8 percent). The literature review identified two central issues: TAVI futility in patients who are too sick and apparent non-inferiority of TAVI compared with surgical valve replacement in medium-risk patients.

CONCLUSIONS:

Our province-wide TAVI evaluation indicates improving processes and outcomes. Patient selection remains the key in our universal healthcare system, with the need to minimize futile and costly therapy and offer TAVI to those most likely to benefit. Continued monitoring of clinical practice and newly-established quality standards, in close collaboration with clinical teams, remains essential to promote optimal use of this evolving technology.
VP07 Collaboratively Modelling The Impact Of Interventions Retrospectively
Authors: Bache Gordon , Tatla Sukh , Simpson Deborah
Published: January 2018

INTRODUCTION:

A conventional approach to communicating value is to model the budget impact of a medicine and the associated formulations in which it is available to be prescribed. However, such an approach does not demonstrate the actual realization of the proposed impact. This abstract outlines an approach to presenting retrospective data back to healthcare professionals (HCP) that blends assumptions and real-world data. For illustrative purposes, we present the results of an application of the model for subcutaneously delivered trastuzumab in an anonymized trust in Yorkshire and Humber.

METHODS:

The authors developed a model that examined one calendar year (from April 2014) of redistributed sales data for both the intravenous and subcutaneous formulations of trastuzumab for every National Health Service (NHS) trust in England. A series of baseline assumptions (1) were used to model the resource impact of different formulations such as chair time, HCP time, pharmacy preparation time, consumables, wastage, and other considerations. Impacts were estimated at the individual attendance level and scaled to the caseload. These baseline assumptions could then be overwritten by the individual trust using local data.

RESULTS:

The site delivered approximately 985 doses of subcutaneous trastuzumab over a period of 12 months from April 2014, which represented about 76 percent of the total number of doses delivered. Chair time is estimated to have reduced by 22 minutes per attendance, resulting in a total saving of 361hours. HCP administration time is estimated to have reduced by 23 minutes per attendance, resulting in a total saving of 378 hours based on changing 985 IV doses to SC therapy.

CONCLUSIONS:

Blending real data and assumptions to provide a retrospective assessment of actual benefits realized back to HCPs is a powerful tool for demonstrating real-world value at both an individual trust and system level.
VP32 Improving The Efficiency Of Early Awareness For Non-Drugs In Spain
Authors: Gutiérrez-Ibarluzea Iñaki , Varela-Lema Leonor , Baños Elena , Luengo-Matos Setefilla , Llanos Aurora , Polo-Desantos Mar , Prieto Isabel , Ruiz Melquiades , Juarez Celia , Asua José , Molina-Lopez Teresa
Published: January 2018

INTRODUCTION:

Early awareness and alert systems (EAAS) try to anticipate the impact of new technologies in the healthcare systems. Spain, which has a decentralized health system with public provision and universal health coverage, has been a pioneer in establishing EAAS activities. From 2006 a network of regional agencies coordinated EAAS activities. Taking into account the individual agencies scarce resources and in order to improve efficiency, this collaboration decided to distribute tasks when identifying and early assessment of new and emerging health technologies. The aim was to inform the common benefit package of the Spanish public health system.

METHODS:

Four out of eight Spanish Health Technology Assessment (HTA) agencies had EAAS in Spain (AETS-Carlos III Institute; AETSA-Andalusia; Avalia-t-Galicia; Osteba-Basque Country). Each agency has taken care of different sources for the identification of new and emerging non-drug health technologies: industry and innovator contacts, health expert networks, mass media and EAAS databases. Members of the network used the same filtration criteria to reach the final list. The system will run in parallel to a biannual identification process in major databases.

RESULTS:

In 2016, the network identified and filtered sixty-three technologies: ten by mass media; five by health experts; thirty-five other EAAS and thirteen by direct contact with industry and innovators. Main represented specialties were: endocrinology (seven); gynecology and obstetrics (six); cardiology and cardiac surgery (five); emergency medicine (four); dermatology (three) and pneumology (three). Technologies were grouped by specialty in order to inform the different commissions that discuss inclusion in the Spanish Benefit Package. Specialty monographs will be published to inform stakeholders.

CONCLUSIONS:

The approach is feasible, and increases the capacity of individual agencies to address the needs of the national and regional systems by improving their efficiency. There is a need to previously define the methods and the criteria that will be used for the identification and filtration.
VP61 Patients Views Of Health Technology Assessment At The National Institute Of Health And Care Excellence (NICE): Enhancing Involvement Opportunities
Authors: Thomas Lizzie , Livingstone Heidi , Leng Gillian
Published: January 2018

INTRODUCTION:

The National Institute for Health and Care Excellence (NICE) medicines health technology assessments (HTAs) involve patients throughout (1): scoping the topic, evidence submission, attending committee as ‘patient experts’, consultation and appeal. A 2013 Health Select Committee report stated “It is important for the credibility of NICE and for the decisions that it makes that the patient voice is effectively and openly represented in all its work” (2). We thus wished to build on previous evaluation projects with more formal research into the views of patient organizations and individual patient experts on their involvement. We additionally sought to explore barriers to involvement.

METHODS:

The research was a collaboration between staff from three teams at NICE: public involvement, market research, and HTA committee support. A mix of interviews, focus groups and surveys was used to gather feedback – from patients and organizations who have engaged with NICE, but also those who had not, plus NICE committee chairs and staff. Facilitators and barriers to involvement were investigated, along with attitudes towards process and support. We used qualitative thematic analysis alongside quantitative methods.

RESULTS:

Key findings were that patients and patient organizations mostly:

•

hold favourable opinions of NICE

•

have a good understanding of process and expectations

•

remain unsure of the impact of their inputs.

Improvements identified include clarifying communications, language and roles. Plus increasing transparency of decision making and patient impact.

CONCLUSIONS:

The research findings and action plan, although specific to NICE, hopefully can inform others in the wider HTA ecosystem. Resources developed will be shared with Health Technology Assessment International (HTAi) networks, including updated correspondence templates and new videos explaining decision making in lay language. The research further adds to discussions around appropriate use of patient organizations scarce resources, and how best to feedback to participants and demonstrate impact of patient involvement.
VP63 National Institute For Health And Care Excellence (NICE) Technology Appraisal Patient Expert Feedback: 15 month analysis
Authors: Kastoryano Chloe , Thomas Lizzie , Livingstone Heidi , Leng Gillian
Published: January 2018

INTRODUCTION:

The National Institute for Health and Care Excellence (NICE) has a formal policy stating patients, carers and citizens are involved throughout each Health Technology Assessment (HTA). One key way patient/carer organizations are involved is by nominating patient experts to participate in appraisal committee meetings.

A NICE 2014 report (1) on Patient Experts experiences identified a need to routinely survey Patient Experts. This has been ongoing since October 2015. This study highlights key findings, including new recommendations and whether previous concerns have been addressed.

METHODS:

We refined the 2012 survey to be routinely sent to all patient experts that attended a NICE technology appraisal committee meeting. Between October 2015 and December 2016 this online survey was sent to eighty-eight patient experts. After analysis the findings were compared to the previous report to identify whether concerns have been addressed and whether new recommendations should be considered.

RESULTS:

There was a response rate of 47 percent (n = 41). Quantitative results and qualitative quotes demonstrate that patient experience varies widely. Key findings from the new data revealed that patient experts feel supported by the Public Involvement Programme, however would welcome more opportunities to speak. Notable improvements since 2012 include favourable opinions of support documents and the Chair more regularly introducing themselves to the patient expert before the meeting. Some experts still find the paperwork cumbersome and find the meetings very technical.

CONCLUSIONS:

Progress has been made since 2012, but further improvements could facilitate even more effective patient involvement. We continue to routinely measure experiences to identify and address evolving issues. Some tensions remain between NICE's remit and processes, and patients expectations of these. The findings, although specific to NICE, hopefully can feed into other patient involvement developments in the wider HTA ecosystem.
VP66 Perception Of Decision Makers And Researchers Towards Health Technology Assessment In Ghana
Authors: Addo Rebecca , Hall Jane , Goodall Stephen , Haas Marion
Published: January 2018

INTRODUCTION:

In recent years, the Ghana health system has been faced with the challenge of financial sustainability. New ways of making decisions in a cost-effective manner that ensure efficient use of available resources is being explored. Consequently, Ghana has been pursuing the formal introduction of Health Technology Assessment (HTA) for decision making in the health system.

However, the limited use and impact of HTA on health systems has been associated with reasons including, and not restricted to, the knowledge and perception of decision makers towards it (1-3). Therefore as Ghana gears towards using HTA formally, it is important to assess the knowledge and attitude of potential users and producers of HTA. This will provide useful information for the setting up of an HTA agency.

METHODS:

A qualitative research approach using in-depth interviews was utilized. Twenty-three decision makers both at the national and district levels, and four researchers were interviewed. Thematic analysis was conducted using NVivo software.

RESULTS:

Only seven respondents had knowledge about HTA. Respondents perceived HTA differently, and the word ‘technology’, was often misconstrued as a device for communication such as mobile phone. Two main barriers to the use of HTA emerged; lack of resources (human, data, and finance) and politico-cultural issues. To address these barriers respondents recommended that stakeholders be involved in decisions concerning the guidelines for its conduct, composition of the appraisal team, and the focus of HTA. Generating of human, data and financial resources were also indicated.

CONCLUSIONS:

There is paucity of knowledge about HTA in Ghana. For Ghana to successfully introduce HTA for health decision making and realize its expected benefits, there will be a need to address the perceived barriers in a comprehensive manner. Also, to mitigate data and human resource barrier, Ghana will have to examine the available local data and human resource to build on.
VP72 Development Trend Analysis On New Health Technology: Based On Euroscan
Authors: Jiang Chongyang , Zhou Ping , Xia Zhiyuan
Published: January 2018

INTRODUCTION:

Emerging health technologies (EHT) are important to meet the challenges faced by healthcare systems but a major pressure on health systems as well (1). The International Information Network on New and Emerging Health Technologies (EUROSCAN) is a collaborative network to manage the introduction of EHT and share information on the results of early identification and assessment of EHT (2). This article analyzed the early assessment reports of EHT during 2000–2016 published in the EUROSCAN database (3), in order to reflect the 21st century development trend of the EHT.

METHODS:

The EHT report data was downloaded by researchers from the official website of the EUROSCAN and arranged using Excel 2007. A descriptive analysis on the number and growth rate of EHT, distribution of technology type and specialties, developmental trend of the integrated technologies were conducted with SAS 9.3.

RESULTS:

Health technology early assessment reports (3,151) have been published in the past 17 years, of which drugs had the highest proportion (54.3 percent). Most of new and emerging health technologies were adopted in oncology and radiotherapy (32.2 percent). The average growth rate every 4 years of EHT from 2001 to 2016 was 34.6 percent, the fastest-growing period was between 2005 and 2008 (63.8 percent). Rehabilitation & disability was the fastest-growing EHT specialty (184.4 percent) and the integrated technologies was the fastest-growing EHT type (64.6 percent).

CONCLUSIONS:

With the objective needs of effective technologies to deal with cancer and chronic disease, as well as the revolution of science, EHT were in the process of vigorous development, especially oncology & radiotherapy technologies. The integrated technologies and the ones applied in multidisciplinary areas have become a new spotlight. Early identification and timely assessment of new and emerging health technologies has aroused wide public concern. It is suggested to establish an Early Awareness and Alert Systerm in China.
VP88 Transient Ischaemic Attack Referral (TIER) Intervention Development
Authors: Hampton Chelsey , Rees Nigel , Ali Khalid , Dewar Richard , Evans Lyn , Ford Gary , John Roger , Moore Chris , Obiako Mike , Porter Alison , Quinn Tom , Bulger Jenna , Jones Charlene , Seagrove Anne , Snooks Helen
Published: January 2018

INTRODUCTION:

Transient Ischaemic Attack (TIA) is a neurologic event with symptom resolution within 24 hours. Early specialist assessment of TIA reduces risk of stroke and death. National United Kingdom (UK) guidelines recommend patients with TIA are seen in specialist clinics within 24 hours (high risk) or seven days (low risk).

We aimed to develop a complex intervention for patients with low risk TIA presenting to the emergency ambulance service. The intervention is being tested in the TIER feasibility trial, in line with Medical Research Council (MRC) guidance on staged development and evaluation of complex interventions.

METHODS:

We conducted three interrelated activities to produce the TIER intervention:

•

Survey of UK Ambulance Services (n = 13) to gather information about TIA pathways already in use

•

Scoping review of literature describing prehospital care of patients with TIA

•

Synthesis of data and definition of intervention by specialist panel of: paramedics; Emergency Department (ED) and stroke consultants; service users; ambulance service managers.

RESULTS:

The panel used results to define the TIER intervention, to include:

1.

Protocol for paramedics to assess patients presenting with TIA and identify and refer low risk patients for prompt (< 7day) specialist review at TIA clinic

2.

Patient Group Directive and information pack to allow paramedic administration of aspirin to patients left at home with referral to TIA clinic

3.

Referral process via ambulance control room

4.

Training package for paramedics

5.

Agreement with TIA clinic service provider including rapid review of referred patients

CONCLUSIONS:

We followed MRC guidance to develop a clinical intervention for assessment and referral of low risk TIA patients attended by emergency ambulance paramedic. We are testing feasibility of implementing and evaluating this intervention in the TIER feasibility trial which may lead to fully powered multicentre randomized controlled trial (RCT) if predefined progression criteria are met.
VP101 Medical Devices For Treatment-resistant Hypertension: Health Technology Assessment Report
Authors: Jefferson Tom , Abraha Iosief , Amicosante Anna Maria Vincenza , Corio Mirella , Migliore Antonio , Cioni Roberto , Taddei Stefano , Cerbo Corrado Vassanelli Marina
Published: January 2018

INTRODUCTION:

While optimal medical therapy (OMT) represents the current standard of care for treatment-resistant hypertension, non-pharmaceutical therapeutic approaches, such as renal denervation and carotid baroreceptor stimulation therapy, have been proposed. The present Health Technology Assessment (HTA) project was aimed at assessing benefits and risk of those approaches versus OMT.

METHODS:

A systematic review of evidence on effectiveness and safety was performed together with a review of economic studies. A contextual analysis of market availability and use of the technology in Italy was also performed.

RESULTS:

In Italy, ninety-nine renal denervation procedures were performed in 2014. Ten studies from six trials were included in the review and meta-analysis. No evidence of dominance or increased harms of renal denervation compared to OMT were found. Four economic evaluations were included and reported dominance of renal denervation. These were based on short-term clinical data and three evaluations used the same Markov model assuming dominance of renal denervation. Estimated average prospective cost of the procedure was EUR6,129.90 (range EUR3,821.15 – EUR9,714.23). We updated the results of an earlier assessment published by an Italian Regional agency on carotid baroreceptor stimulation therapy (1). None of the three studies identified as ongoing in 2015 were completed or had published preliminary results and the technology was not assessed further within the present HTA project.

CONCLUSIONS:

Even if follow-up was limited to 6 months, randomised evidence showed no benefits of the procedure. Economic evaluations were unreliable, based on unrealistic assumptions of effectiveness and contrived therapy regimes. Further investment in renal denervation should await the results of well-designed and adequately followed-up trials assessing the impact of renal denervation on major cardiovascular events compared to OMT. Future economic evaluations should be based on realistic assumptions of cost and effectiveness.
VP115 Practical Issues Of Using Real-World Data In Effectiveness Research
Authors: Makady Amr , Stegenga Heather , Joyeux Alexandre , Lees Michael , Jonsson Pall
Published: January 2018

INTRODUCTION:

The Innovative Medicines Initiative, IMI-GetReal project aimed to explore incorporation of robust methods for real-world data (RWD) collection and synthesis earlier in the medicines development process, both by pharmaceutical companies and healthcare decision makers. The focus was on the potential use of RWD, alone or in combination with randomized controlled trials (RCTs), to demonstrate effectiveness of new interventions. Four case studies were conducted in multiple disease areas to examine methods for predicting drug effectiveness and the perspectives of different stakeholders on these methods. This study aimed to identify practical obstacles in accessing and using RWD and RCT data for effectiveness research conducted as part of these case studies.

METHODS:

Qualitative content analysis was conducted to identify and characterize key issues relating to accessing and analysing study data from external sources, both RWD and RCTs.

RESULTS:

Accessing RWD from registries proved difficult due to multiple reasons, including: complex and non-transparent application procedures, resistance from registry owners to discuss applications and datasets not being research-ready within project timeframes. There were also issues with the RWD eventually accessed, including a lack of individual participant data (IPD) and incomplete data. Where access to IPD from RCTs was obtainable, there were restrictions imposed on how it could be used. For example, it could not be used to target analysis on an individual product, but rather explore methodologies for data synthesis in a product-anonymised setting. This condition encouraged additional data sharing by other stakeholders.

CONCLUSIONS:

Despite the collaborative, multi-stakeholder nature of IMI-GetReal and proper disclosures with data owners, access to data proved challenging. Such barriers to data accessibility can delay effectiveness research, restrict opportunities for the development of methods incorporating RWD and diminish the potential use of RWD in decision making. Where data is intended to be used for this purpose, sufficient attention should be paid to these potential barriers.
VP136 The Impact Of Hospital Costing Methods On Economic Evaluations
Authors: Manetti Stefania , Leal Jose
Published: January 2018

INTRODUCTION:

There are several methods to cost hospital contacts when estimating the cost effectiveness of a new intervention. In England, the National Insitute for Health and Care Excellence (NICE) recommends the use of diagnosis-related group (DRG)-based costs as a valuable way of costing hospital resource use. There are three main sources of unit costs of a DRG: (i) tariffs as used for reimbursement purposes, (ii) benchmarking finished consultant episode (FCE)-level reference costs and (iii) benchmarking spell-level reference costs.

The purpose of this work is to compare the implications of choosing a particular source of DRG-based unit costs when conducting an economic evaluation.

METHODS:

As a case study, we used a cost-utility model developed to compare secondary fracture prevention models of care for hip fracture patients (1). A Markov model was derived from large primary and hospital care administrative datasets in England. Utilities were informed by a meta-regression of thirty-two studies. Hospital resource use (inpatient, outpatient, critical care and emergency care) was valued using the three different 2014–15 DRG-based unit costs and regression-based costing models were derived from 33,000 hip fracture patients to inform the health states of the model (2). For each source of DRG-based costs, we calculated mean life years, Quality-Adjusted Life Years (QALYs) and costs for a representative male and female associated with three models of care: (i) orthogeriatrician (OG)-led, (ii) nurse-led fracture liaison services and (iii) usual care.

RESULTS:

Using the benchmarking FCE-level DRG-based costs, the OG-led model was estimated to be the most effective model of care (1.77 QALYs, 95 percent Confidence Interval, CI 1.56-1.98) at a threshold of GBP30,000/QALY. However, it also resulted in the highest costs per patient. We will report the cost-effectiveness results using the two remaining DRG-based costs.

CONCLUSIONS:

Choosing a particular hospital costing method may have an impact on economic evaluations. We will reflect on the implications for the estimated hospital costs, decision uncertainty and adoption of models of care.
VP140 Methods For Ethical Analysis In The Health Technology Assessment
Authors: Martins Raysa , Barreto Jorge , Elias Flavia
Published: January 2018

INTRODUCTION:

This paper is based on a narrative review to identify and describe approaches to incorporate ethical aspects in Health Technology Assessment (HTA). On the first decade HTA was being established as a new area of research, the social and ethical dimensions seemed to play an essential role. This perspective, centered on the social impact of technology contrasts with the current definition, which focuses on the technical conditions of technology, especially properties and effects. Some authors have discussed the obstacles to include the ethical dimension into this area to a large extent. Those authors were motivated by the perception that there are few sections explicitly dedicated to these dimensions in the evaluation reports.

METHODS:

We searched these scientific databases: Pubmed, Cochrane Library, Centre for Review and Dissemination (CRD), PDQ - Evidence and Virtual Health Library (VHL), and selected studies that presented procedures and methodologies for the inclusion of ethical analysis in HTA.

RESULTS:

A total of 308 articles were retrieved, nine of them were included. The identified methods were classified into four groups according to the parameters and procedures: (i) normative-based evaluation, (ii) case comparison-based evaluation; (iii) predefined questionnaire application-based evaluation and iv) debate and deliberation-based evaluation.

The result showed a great diversity of approaches (1 - 3) for the inclusion of the ethical dimension in the evaluation studies of health technologies, which can even be used together. It is suggested that its use considers the characteristics and needs of each different application contexts.

CONCLUSIONS:

This work presented as methodological base of approaches for the integration of the ethical dimension in the HTA field. Nonetheless, the proposed approaches to the incorporation of philosophical field of ethics into the systematization and objectivity field of the HTA reveal a considerable approach diversity that is applied productively. Since it has been agreed that technology evaluation is contextual, different approaches would help to meet the needs for possible adjustment.
VP149 Sustained Low Efficiency Dialysis (SLED): A Rapid Review
Authors: Aung Khin Chaw Yu , Chow Wai Leng , Tong Shao Chuen
Published: January 2018

INTRODUCTION:

This rapid review aimed to determine the effectiveness of Sustained Low Efficiency Dialysis (SLED) when compared to Continuous Renal Replacement Therapy (CRRT) and Continuous Veno-Venous Hemofiltration (CVVH) in the treatment of acute renal failure (ARF) with a view to implementing SLED in a tertiary hospital in 2014.

METHODS:

A rapid review was performed on the effect of SLED for patients with ARF compared with CRRT or CVVH. The outcomes of interest were mortality, hemodynamic stability, reduced utilization of intensive care unit (ICU) and cost-effectiveness. The search terms ("sustained low-efficiency dialysis[MESH]”) were used to search PubMed, the Cochrane Library, UK NHS Centre for Reviews and Dissemination databases and the US National Guidelines Clearinghouse for relevant articles until 2014.

RESULTS:

Four observational and two randomized controlled trial (RCT) studies were found. The results showed that 90-day mortality, was similar between groups (SLED: 49.6 percent versus CVVH: 55.6 percent, p = .43). Hemodynamic stability did not differ between SLED and CVVH and between SLED and CRRT. Patients in the SLED group had significantly fewer days of mechanical ventilation (17.7 ± 19.4 versus 20.9 ± 19.8, p = .047) and fewer days in the ICU (19.6 ± 20.1 versus 23.7 ± 21.9, p = .04). Patients treated with SLED needed fewer blood transfusions (1,375 ± 2,573 ml versus 1,976 ± 3,316 ml, p = .02) and had a substantial reduction in nursing time (p < .001). The hospital weekly costs were CAD1,431 for SLED, CAD2,607 for CRRT with heparin, and CAD 3,089 for CRRT with citrate. Dialysis using SLED was associated with higher first post-dialysis mean arterial pressure (p = .003) than those treated with CVVH, which led to lower mortality.

CONCLUSIONS:

The evidence suggests that SLED can be used as an alternative to CRRT, as the outcomes were similar. SLED provides solute removal equivalent to CRRT at significantly lower cost.
VP163 Patient Involvement In The Development Of Multi-Criteria Decision Tool
Authors: Gagnon Marie-Pierre , L'Espérance Sylvain , Lindsay Carmen , Rhainds Marc , Coulombe Martin , Rousseau François
Published: January 2018

INTRODUCTION:

Healthcare organizations should assess the relevance of both existing and new practices. Involving patients in decisions regarding which health technologies and interventions should be prioritized could favor a better fit between strategic choices and patients needs.

METHODS:

Following a systematic review of existing multi-criteria decision support tools and a consultation with hospital clinicians and managers, a set of potentially relevant criteria was identified. A three-round modified Delphi study was then conducted among four groups (hospital managers, heads of department, clinicians, and patient representatives) in order to reach consensus on criteria that should be considered in the tool.

RESULTS:

In total, seventy-four participants completed the third round of the Delphi study. Consensus was obtained on twelve criteria. There were some significant differences between groups in priority scores given to criteria. Patient representatives differed significantly from other groups on two criteria. Their ranking of the accessibility criteria was higher, and their ranking of the organizational aspect criteria was lower than for the other groups.

CONCLUSIONS:

Patient representatives can be involved in the development of a multi-criteria decision support tool to identify, evaluate and prioritize high value-added health technologies and interventions in order to enhancing clinical appropriateness The fact that accessibility aspects were more important for patient representatives calls for specific attention to these criteria when prioritizing health technologies or interventions. Furthermore, we need to ensure that the decisions made regarding the relevance of these technologies and interventions also reflect patients’ preferences.
VP169 Grouping Treat-to-Target Studies In Systematic Reviews
Authors: Martyn-St James Marrissa , Hock Emma , Wong Ruth , Stevenson Matt , Wailoo Allan
Published: January 2018

INTRODUCTION:

A Health Technology Assessment (HTA) systematic review was undertaken in rheumatoid arthritis (RA) of treat-to-target (TTT) studies (n = 16) in which studies were grouped according to: TTT versus usual care, trials comparing different targets, or trials comparing different treatment protocols. To our knowledge, this was the first RA TTT review where studies were grouped in this way. We wanted to compare if our approach had been adopted in reviews of hypertension, hyperlipidemia or diabetes.

METHODS:

We searched MEDLINE for systematic reviews (SRs) of TTT studies in hypertension, hyperlipidaemia or diabetes.

RESULTS:

Eleven SRs were included; eight were in diabetes, and four were in hypertension, while none were in hyperlipidaemia. The diabetes SRs evaluated different insulin regimens (n = 3), non-insulin medications (n = 1), any antidiabetic treatment (n = 2), metformin monotherapy versus combination therapy (n = 1), and tight versus conventional glucose control (n = 1). The metformin review grouped studies by outcome whereas all other diabetes SRs grouped studies by treatment. Two hypertension SRs evaluated the effects of any treatment on two blood pressure targets, whereas one evaluated two different treatment regimen effects on the same blood pressure target. No SR in hypertension or diabetes included a mix of TTT versus usual care, and/or same treatment protocol different targets, and/or different treatment protocols same target study designs.

CONCLUSIONS:

In RA TTT does not refer to a single concept but a range of different approaches to the treatment of patients and the evidence reflects this. Whilst our approach to grouping RA TTT studies in a review was novel, this made it complex for us to synthesize evidence and draw general conclusions. We did not identify any TTT reviews in hypertension or diabetes including a mix of the TTT approaches we identified in RA. At present, a comparison of the strengths and limitations of our TTT review study grouping with reviews of hypertension, hyperlipidemia or diabetes cannot be made.
VP192 Importance Of Contextual Data In Producing Health Technology Assessment Recommendations
Authors: Poder Thomas , Bellemare Christian
Published: January 2018

INTRODUCTION:

Available data in the scientific literature is not always sufficient to make a clear Health Technology Assessment (HTA) recommendation without any other source of data. Contextual data and local expertize are an important source of data that cannot be ignored in HTA process. Despite a lack of evidence in the scientific literature, a technology can be recommended in a given context. We illustrate this by a case study about biplane angiography for vascular neurointervention.

METHODS:

A systematic review was conducted. The level of evidence was assessed by the grid of Downs and Black. An analysis of the context in our setting was also conducted. The main outcomes were: radiation doses, clinical complications, procedure times, purchase cost, impact on teaching programs, confidence of clinicians in the technology, quality of care, and volume of activity. A committee constituted of managers, clinical experts, physicians, physicists and HTA experts was created to produce a recommendation about biplane technology acquisition.

RESULTS:

A list of 257 citations was obtained yielding 9 eligible articles for analysis. Despite the lack of evidence found in the literature (median of Downs and Black: 3/32), the biplane system appears to reduce ionizing radiation and medical complications as well as shorten procedure time. Contextual data indicated that biplane system could improve operator's confidence, which could translate into reduced risk, especially for complex procedures. We estimate that a minimum of 50 cases can be done in our context (University hospital center covering a population of 306,322 people) with a higher level of patient safety. In addition, the biplane system can support our institution in advanced procedures teaching program.

CONCLUSIONS:

Given on the advantages provided by the biplane technology in our setting, the committee has recommended its acquisition. However, this technology should be implemented with a responsibility in collecting outcome data to optimize clinical protocol in doses of ionizing delivered.
VP205 Implementing Electronic Records In Ambulances
Authors: Porter Alison , Black Sarah , Dale Jeremy , Fitzpatrick David , Harris-Mayes Robert , Lawrenson Robin , Lyons Ronan , Mason Suzanne , Morrison Zoe , Mountain Pauline , Potts Henry , Siriwardena Niro , Rees Nigel , Snooks Helen , Williams Victoria
Published: January 2018

INTRODUCTION:

Increasingly, ambulance services offer alternatives to transfer to the emergency department (ED), when this is better for patients. The introduction of electronic health records (EHR) in ambulance services is encouraged by national policy across the United Kingdom (UK) but roll-out has been variable and complex.

Electronic Records in Ambulances (ERA) is a two-year study which aims to investigate and describe the opportunities and challenges of implementing EHR and associated technology in ambulances to support a safe and effective shift to out of hospital care, including the implications for workforce in terms of training, role and clinical decision-making skills.

METHODS:

Our study includes a scoping review of relevant issues and a baseline assessment of progress in all UK ambulance services in implementing EHR. These will inform four in-depth case studies of services at different stages of implementation, assessing current usage, and examining context.

RESULTS:

The scoping review identified themes including: there are many perceived potential benefits of EHR, such as improved safety and remote diagnostics, but as yet little evidence of them; technical challenges to implementation may inhibit uptake and lead to increased workload in the short term; staff implementing EHR may do so selectively or devise workarounds; and EHR may be perceived as a tool of staff surveillance.

CONCLUSIONS:

Our scoping review identified some complex issues around the implementation of EHR and the relevant challenges, opportunities and workforce implications. These will help to inform our fieldwork and subsequent data analysis in the case study sites, to begin early in 2017. Lessons learned from the experience of implementing EHR so far should inform future development of information technology in ambulance services, and help service providers to understand how best to maximize the opportunities offered by EHR to redesign care.
CHC Model According to Weiss
Authors: Pezzuti Lina , Lang Margherita , Rossetti Serena , Michelotti Clara
Published: January 2018

Abstract. The Italian version of the Wechsler Adult Intelligence Scale – Fourth Edition (WAIS-IV) – was standardized using a sample of 2,174 participants, aged between 16 and 90 years. The WAIS-IV consists of 10 core subtests and 5 supplemental subtests. While the 70–90 yr group is usually excluded from three of the five supplemental subtests (Letter-Number Sequencing, Figure Weights, and Cancellation), we administered all 15 subtests both to adults and elderly people. The aim of the present study was to investigate the factorial invariance of the Weiss and colleagues’ hierarchical five-factor CHC (Cattell-Horn-Carroll) model in Italian adults and elders. The overall results of this study generally support both the configural and factorial invariance of the WAIS-IV, and hence the five-factor CHC model of Weiss is equivalent in adults and elderly people. However, for the elderly sample we found higher loadings of WAIS-IV subtests on the second-order g factor.
Rotator side chains trigger cooperative transition for shape and function memory effect in organic semiconductors
Authors: Chung Hyunjoong , Dudenko Dmytro , Zhang Fengjiao , D’Avino Gabriele , Ruzié Christian , Richard Audrey , Schweicher Guillaume , Cornil Jérôme , Beljonne David , Geerts Yves , Diao Ying
Published: January 2018

Martensitic transition is a solid-state phase transition involving cooperative movement of atoms, mostly studied in metallurgy. The main characteristics are low transition barrier, ultrafast kinetics, and structural reversibility. They are rarely observed in molecular crystals, and hence the origin and mechanism are largely unexplored. Here we report the discovery of martensitic transition in single crystals of two different organic semiconductors. In situ microscopy, single-crystal X-ray diffraction, Raman and nuclear magnetic resonance spectroscopy, and molecular simulations combined indicate that the rotating bulky side chains trigger cooperative transition. Cooperativity enables shape memory effect in single crystals and function memory effect in thin film transistors. We establish a molecular design rule to trigger martensitic transition in organic semiconductors, showing promise for designing next-generation smart multifunctional materials.
Radionuclides transform chemotherapeutics into phototherapeutics for precise treatment of disseminated cancer
Authors: Kotagiri Nalinikanth , Cooper Matthew L. , Rettig Michael , Egbulefu Christopher , Prior Julie , Cui Grace , Karmakar Partha , Zhou Mingzhou , Yang Xiaoxia , Sudlow Gail , Marsala Lynne , Chanswangphuwana Chantiya , Lu Lan , Habimana-Griffin LeMoyne , Shokeen Monica , Xu Xinming , Weilbaecher Katherine , Tomasson Michael , Lanza Gregory , DiPersio John F. , Achilefu Samuel
Published: January 2018

Most cancer patients succumb to disseminated disease because conventional systemic therapies lack spatiotemporal control of their toxic effects in vivo, particularly in a complicated milieu such as bone marrow where progenitor stem cells reside. Here, we demonstrate the treatment of disseminated cancer by photoactivatable drugs using radiopharmaceuticals. An orthogonal-targeting strategy and a contact-facilitated nanomicelle technology enabled highly selective delivery and co-localization of titanocene and radiolabelled fluorodeoxyglucose in disseminated multiple myeloma cells. Selective ablation of the cancer cells was achieved without significant off-target toxicity to the resident stem cells. Genomic, proteomic and multimodal imaging analyses revealed that the downregulation of CD49d, one of the dimeric protein targets of the nanomicelles, caused therapy resistance in small clusters of cancer cells. Similar treatment of a highly metastatic breast cancer model using human serum albumin-titanocene formulation significantly inhibited cancer growth. This strategy expands the use of phototherapy for treating previously inaccessible metastatic disease.
Universal type/subtype-specific antibodies for quantitative analyses of neuraminidase in trivalent influenza vaccines
Authors: Xu Kangwei , Li Changgui , Gravel Caroline , Jiang Zheng , Jaentschke Bozena , Van Domselaar Gary , Li Xuguang , Wang Junzhi
Published: January 2018

Both influenza viral hemagglutinin and neuraminidase can induce protective immune responses in humans. Although the viral hemagglutinin antigens have been quantified in influenza vaccines, the amounts of neuraminidase remain undetermined. Using comprehensive bioinformatics analyses of all neuraminidase sequences, we identified highly conserved and subtype-specific peptide epitopes within each of N1, N2 and type B neuraminidase groups. Mono-specific antibodies generated against these peptides bound to their respective subtype/type only while demonstrating remarkable specificity against the viral neuraminidase sequences without any cross-reactivity with allantoic and cellular proteins. Moreover, the subtype/type-specific antibodies were found not to interfere with one another when a mixture of vaccine samples was analysed. Importantly, immunoassay based on these antibodies can quantitatively determine neuraminidase in commercial trivalent vaccine samples. Analyses of vaccines from eight manufacturers using the same vaccine seeds revealed significant differences in neuraminidase levels. Specifically, while the ratio between neuraminidase and hemagglutinin in some products are found to be close 1/5, other products have a ratio of approximately 1/100, a level which is far below the theoretical ratio between neuraminidase and hemagglutinin in a virus. The antibody-based assays reported here could be of great value for better quality control of both monovalent and trivalent vaccines.
Variation at position 350 in the Chikungunya virus 6K-E1 protein determines the sensitivity of detection in a rapid E1-antigen test
Authors: Tuekprakhon Aekkachai , Nakayama Emi E. , Bartholomeeusen Koen , Puiprom Orapim , Sasaki Tadahiro , Huits Ralph , Luplertlop Natthanej , Kosoltanapiwat Nathamon , Maneekan Pannamas , Ariën Kevin K. , Shioda Tatsuo , Leaungwutiwong Pornsawan
Published: January 2018

Chikungunya virus (CHIKV), a mosquito-borne pathogen, consists of three genotypes: East/Central/South African (ECSA), West African (WA), and Asian. Although a current rapid immunochromatographic (IC) test detecting CHIKV E1-antigen showed high sensitivity to ECSA-genotype viruses, it showed poor performance against the Asian-genotype virus that is spreading in the American continents. To understand the basis for the low performance of this IC test against Asian-genotype virus, we re-examined the anti-CHIKV monoclonal antibodies (mAbs) used in the assay for their interaction with E1-antigen of the three CHIKV genotypes. We found that the reactivity of one mAb for Asian-genotype virus was lower than that for ECSA virus. Comparison of E1 amino acid sequences revealed that the ECSA virus used to generate these mAbs possesses glutamic acid (E) at position 350, in contrast to WA and Asian, which possess aspartic acid (D) at this position. Site-directed mutagenesis confirmed that the mutation altered mAb reactivity, since E-to-D substitution at position 350 in ECSA reduced recognition by the mAb, while D-to-E substitution at this position in Asian and WA increased affinity for the mAb. Taken together, these results indicate that residue 350 of the CHIKV 6K-E1 is a key element affecting the performance of this IC assay.
Diurnal cycle and seasonal variation of cloud cover over the Tibetan Plateau as determined from Himawari-8 new-generation geostationary satellite data
Authors: Shang Huazhe , Letu Husi , Nakajima Takashi Y. , Wang Ziming , Ma Run , Wang Tianxing , Lei Yonghui , Ji Dabin , Li Shenshen , Shi Jiancheng
Published: January 2018

Analysis of cloud cover and its diurnal variation over the Tibetan Plateau (TP) is highly reliant on satellite data; however, the accuracy of cloud detection from both polar-orbiting and geostationary satellites over this area remains unclear. The new-generation geostationary Himawari-8 satellites provide high-resolution spatial and temporal information about clouds over the Tibetan Plateau. In this study, the cloud detection of MODIS and AHI is investigated and validated against CALIPSO measurements. For AHI and MODIS, the false alarm rate of AHI and MODIS in cloud identification over the TP was 7.51% and 1.94%, respectively, and the cloud hit rate was 73.55% and 80.15%, respectively. Using hourly cloud-cover data from the Himawari-8 satellites, we found that at the monthly scale, the diurnal cycle in cloud cover over the TP tends to increase throughout the day, with the minimum and maximum cloud fractions occurring at 10:00 a.m. and 18:00 p.m. local time. Due to the limited time resolution of polar-orbiting satellites, the underestimation of MODIS daytime average cloud cover is approximately 4.00% at the annual scale, with larger biases during the spring (5.40%) and winter (5.90%).