bluuebunny/crossref_metadata_2025 huggingface dataset:
VP51 Hospitalizations And Costs In Schizophrenia Patients Initiating Long-acting Injectable Antipsychotics
Authors: Greene Mallik , Yan Tingjian , Chang Eunice , Hartry Ann , Broder Michael
Published: January 2018

INTRODUCTION:

Existing evidence on clinical and economic effectiveness of one long-acting injectable antipsychotic (LAI) versus another in successful management of schizophrenia is scarce. The study was conducted to compare all-cause inpatient healthcare utilization and associated costs among Medicaid patients with schizophrenia who initiated LAIs.

METHODS:

This retrospective cohort analysis used the Truven Health Analytics MarketScan® Medicaid claims database. Schizophrenia patients >18 years with at least one claim for one of the following LAI were identified between 1 January 2013 and 30 June 2014 (identification period): aripiprazole, fluphenazine, haloperidol, paliperidone palmitate, and risperidone. The first day of initiating an LAI was considered the index date. Patients were followed for 1 year from index date. Logistic and general linear regression models were used to estimate risk of inpatient hospitalization and associated costs during follow up.

RESULTS:

Of the identified Medicaid patients with schizophrenia, 1,672 (36.7 percent) initiated an LAI: 44.0 percent received paliperidone, 26.4 percent haloperidol, 13.8 percent risperidone, 9.2 percent aripiprazole, and 6.6 percent fluphenazine. With the aripiprazole cohort as the reference group, the odds of having any inpatient hospitalizations were significantly higher in haloperidol [Odds Ratio, OR (95 percent Confidence Interval, CI): 1.51 (1.05 - 2.16)] and risperidone [OR (95 percent CI): 1.58 (1.07 - 2.33)] cohorts. Fluphenazine and paliperidone palmitate cohorts also had higher risk of having any inpatient hospitalizations compared with aripiprazole, but the differences were not statistically significant (p>.05). Among LAI initiators with any inpatient hospitalizations, the adjusted mean inpatient costs were lowest in the aripiprazole cohort (USD25,616), followed by haloperidol (USD30,811), paliperidone (USD30,833), risperidone (USD31,584), and fluphenazine (USD37,338), although differences were not statistically significant.

CONCLUSIONS:

Our study findings highlight the value of aripiprazole in reducing inpatient hospitalizations and associated costs among patients with schizophrenia. However, our study is limited as our results are reflective of a multi-state Medicaid population. Future studies are warranted to confirm the results in non-Medicaid patient populations.
VP54 Costs And Benefits Of Intensive Inpatient Rehabilitation After Stroke
Authors: Suh Youshin , Ahn Jeonghoon
Published: January 2018

INTRODUCTION:

This study estimated, from the societal perspective, the costs and benefits of the intensive inpatient rehabilitation treatments (IIRT) on patients after stroke using the interim results of a large ongoing registry in Korea, the Korean Stroke Cohort for Functioning and Rehabilitation (KOSCO) (1).

METHODS:

Among others, the benefits were measured by two major cost savings: (i) decrease in government disability subsidy and (ii) caregiver savings. One of the KOSCO study results showed the functional status of the post-stroke patients, measured by the Korean Modified Barthel Index (K-MBI), improved significantly and the disability grades, which the government is using to classify the subsidy amount, reduced as well. Caregiver cost savings were calculated by K-MBI improvements, the average daily compensation of caregivers (USD58.33) and the average period of caregiving. To measure the cost of IIRT on post-stroke patients, the average costs reported by a National Evidence-based Healthcare Collaboration Agency (NECA) Health Technology Assessment report was used (2).

RESULTS:

The disability grade improvements showed savings of government subsidy by USD58.65 to USD478.39 depending on the patient income from the registry. The average caregiving cost decrease was USD6,042 annually. The average cost of IIRT on post-stroke patients was USD926.34 for the first year.

CONCLUSIONS:

This study estimated the cost-benefit of IIRT on post-stroke patients using the KOSCO study interim data. The intensive rehabilitation treatment improves patients functional status significantly enough to save two major cost items, the disability grades which also resulted in a decrease in government subsidy amounts and the caregiver costs which the patient family has to pay in Korea. The results warrant the use of IIRT for the post-stroke patients in Korea from the societal perspective.
VP59 Patients Views On Providing Evidence; Feeding Into The Health Technology Assessment Ecosystem
Authors: Livingstone Heidi , Thomas Lizzie , Leng Gillian , Kastoryano Chloe
Published: January 2018

INTRODUCTION:

Patient evidence is submitted to the National Institute for Health and Care Excellence (NICE) by patient organizations and individual patient experts. Previously NICE developed a new patient organization evidence submissions template, based on the international HTAi patient submission template for medicines (1). The NICE template was reviewed by surveying committee members and also patient organizations who had used the submission template. The findings were presented at HTAi 2016.

The limitation of that review was the low response rate from patient organizations. The key recommendation was to extend the survey to include a larger number of patient organizations. These local findings are an opportunity to contribute to the global Health Technology Assessment (HTA) ecosystem.

METHODS:

A project group was convened consisting of NICE staff, a committee lay member and a patient organization representative. Together we reassessed the suitability of the previous feedback survey. This was then sent out to patient groups who had completed the submission template from July 2014 to November 2016. Additionally, public involvement staff telephoned selected patient organizations to increase the feedback response rate and gain greater understanding. The anonymized results were shared with patients involved in NICE who helped interpret the results from a patient organization's perspective.

RESULTS:

Key findings are that patient organizations find:

•

the template clear

•

it was easiest to provide information about living with the condition

•

it was hardest to give information on equality issues and research evidence.

They would also like a submission guide, and to receive feedback on their submissions.

CONCLUSIONS:

Although it was difficult to obtain feedback from the patient organizations on the submission template, the depth of information provided by them was fundamental to updating the template and producing a supporting guide.

This feedback on the local English needs can be used when evaluating the international submission template to form a greater part of the HTA ecosystem.
VP70 Structuring The Process Of Innovation Uptake In Tunisia
Authors: Jameleddine Mouna , Brahem Asma Ben , Grati Hela , Ouertatani Hella , Allouche Wafa , Zghal Khaled , Asua José , Gutiérrez-Ibarluzea Iñaki
Published: January 2018

INTRODUCTION:

Tunisia recently implemented a Health Technology Assessment (HTA) agency (INASanté) to inform decisions around health technologies and to improve clinical practice by means of the elaboration of Clinical Practice Guidelines (CPG). However many decisions on new and emerging technologies, their implementation and coverage in the health care system are still taken at the hospital level without any structured process that informs the decisions. The aim of this project was to improve the methods and flow-chart of decision-making processes on innovation uptake in the Tunisia Healthcare System.

METHODS:

By means of the toolkit of EuroScan for the implementation of an early awareness and alert system (EAAS), and its checklist, it was discussed specifically within INASanté the characteristics of the Tunisia Healthcare System and its specificities regarding decisions on drugs and medical devices. The analysis included the process of innovation uptake at the hospital level and its specific flow-chart. In depth interviews and a devoted workshop were performed with personal in INASanté: two physicians (one involved in CPG elaboration and the second in accreditation), three pharmacists (HTA), one nutritionist (HTA), two librarians and other stakeholders, including the Directorate of Hospitals.

RESULTS:

The uptake of innovations in Tunisia does not follow a structured process. In fact, there is no central purchase of medical devices in Tunisia and most medical devices are purchased by hospitals within a tender process in accordance with the Tunisian public procurement law. The main pitfalls are: lack of awareness around innovations that could impact the system, non-structured process of information sharing among the different decision-makers that promotes inequity in access to technologies and services, and lack of explicit criteria that determine decisions around health technologies.

CONCLUSIONS:

Tunisia requires a structured and informed process on decisions around innovation uptake in the healthcare system. The principles that should govern this system are: anticipation of the impact of new health technologies, establishing priorities and criteria for decision making in all places of decision. The decisions should be recorded and publicly shared to avoid inequities in the access to technologies.
VP96 Information Flow As Base For Planning Biomedical Technologies In Italy
Authors: Medici Mario Fregonara , Bellelli Stefania , Pepe Michela
Published: January 2018

INTRODUCTION:

An effective installed medical equipment base management requires an information flow of Biomedical Technologies (BT) providing a common and standardized methodology for data collection and inventories management, representing the knowledge base for the BT assessment and procurement planning.

METHODS:

In a North Region of Italy a standardized methodology for BT regional codification has been defined to univocally identify BT, by classifying health fields and specialities, technological classes, models and manufacturers. Since 2012, an information flow of BT, named FITeB, allows to monitor and follow-up large medical equipment (LME), innovative equipment (IE) and widespread technologies (WT) set up in public settings, through biannual equipment census (1,2). Data about classification, identification, location, age, operating status, way of acquisition, economic value and maintenance have been analytically collected for LME and IE. LME data have been integrated with the information flow for public funding management allocated to regional healthcare buildings through other procedure. The number and economic value of WT have been collected. FITeB data have been used for the Regional planning procedure for medical equipment procurement (3).

RESULTS:

The distribution of BT, their age profile, technological burden and innovative components as well as the overall economic value, have been estimated with FITeB. In 2016, information about 341 LME was collected; LME mean age was 7.4 years with a value of EUR248,353,000. The 293 IE were set up with mean age of 5.9 years and an overall economic value of EUR20,167,000. The WT amounted to 45,263 equipment with a value of EUR843,353,000. Over the years 2014 and 2015, the Public Hospitals and Local Health Authorities (ASRs) submitted 491 BT requests, of which 87 percent were replacement/new acquisition/upgrade, 9 percent innovative acquisition and 4 percent donations.

CONCLUSIONS:

Critical issues can be identified from FITeB indicators representing the basis for BT procurements assessment and definition of strategies of replacement, introduction or relocation of medical equipments in the Region. An integrated information flow, as the case of FITeB, is an useful knowledge tool for appropriate governance, planning and management of BT.
VP111 Referral Center For Multiple Myeloma Patient Care
Authors: Saccilotto Indara , Bittencourt Rosane , Fischer Camila , Quevedo Amanda , Hirakata Vania , Picon Paulo
Published: January 2018

INTRODUCTION:

Within the Brazilian Health System, Referral Centers (RCs) are care facilities that provide specialized services. The objective of this study was to evaluate the efficacy of care provided to patients with multiple myeloma (MM) at a specialized Referral Centers (Hospital de Clínicas de Porto Alegre Referral Center for Multiple Myeloma, CRMM-HCPA) and to compare quality of life between patients with MM treated at CRMM-HCPA and those treated at non-RC facilities.

METHODS:

A 6-month cohort study was conducted in patients with MM receiving thalidomide from the State Health Department and treated at CRMM-HCPA, and patients receiving treatment at other non-RC facilities. Thirty-two patients were included in the study, nineteen from CRMM-HCPA and thirteen from other institutions. To analyze the efficacy of care provided at CRMM-HCPA, the main outcome measure was the time from diagnosis to referral for autologous hematopoietic stem cell transplantation.This outcome measure was assessed using questionnaires specifically designed for this study. Quality of life was also assessed, using the Short-Form 36 Item Health Survey (SF-36) questionnaire.

RESULTS:

Time from MM diagnosis to referral for autologous hematopoietic stem cell transplantation in each group was measured only in patients aged 65 years (n = 25); of these, 15 were recruited from CRMM-HCPA and 10 from other institutions. In this analysis, there was a significant difference (p = .036) in time elapsed between diagnosis and referral for autologous hematopoietic stem cell transplantation, which was significantly shorter for patients treated at CRMM-HCPA (median, 9 months; Interquartile Range, IQR, 8.5–14.5) than for those treated elsewhere (median, 24 months; IQR, 16–24). On quality of life analysis, there was a significant difference in the Social Functioning, which relates to performance of social activities (p = .02).

CONCLUSIONS:

The Referral Centers model provided seems to be a more efficient treatment strategy as compared with other health care facilities, as it enabled a reduction in time to transplantation. Patients treated at CRMM-HCPA demonstrated greater ease in performing social activities, with less interference from physical or emotional problems.
VP133 Patient-Reported Health State Utilities In Neuroendocrine Tumours
Authors: Meng Yang , McCarthy Grant , Berthon Anthony , Dinet Jerome
Published: January 2018

INTRODUCTION:

Gastroenteropancreatic neuroendocrine tumours (GEP-NETs) are rare cancers most often found in the gastrointestinal system or the pancreas. However, patient-reported health state utilities based on clinical trials have not been previously reported in this disease area.

METHODS:

The CLARINET study collected the European Organization for Research and Treatment of Cancer (EORTC) QLQ-C30 data from patients in both stable and progressive disease states, although data for the latter were only available during the early stage of progression due to trial design. Using published algorithms, data were mapped to EQ-5D utility values. Random-effects generalized least squares models were used to investigate the impacts of progression status, tumour site and other patient characteristics on mapped utility values.

RESULTS:

In total, 1,053 observations from 204 patients were mapped to EuroQol (EQ-5D) utilities using the McKenzie mapping algorithm. The final random-effects model included age, gender, baseline utility and progression status as covariates; it was not feasible to investigate time-to-death utility due to a limited number of death in the CLARINET study. Tumour location (midgut versus pancreas) does not seem to affect utility. However, the difference in utilities based on progression status is statistically significant (p<.05) in the base case analysis, and the estimated utilities for stable and progressive disease are .776 and .726, respectively. Furthermore, scenario analyses showed that utility for progressive disease is numerically lower than for stable disease, but this may not be statistically significant in some scenarios.

CONCLUSIONS:

Patients with GEP-NETs experience worse utility values in the progressive disease state compared to the stable disease state, based on patient-reported health-related quality of life (HRQL) data from the CLARINET study. The decline of utility in the progressive disease state may be underestimated because progressive HRQL data were only collected shortly after the progression event in the trial. The estimated trial-based utilities can be used in future economic evaluations for GEP-NET treatments and to provide more insights to physicians on patient-reported quality of life outcomes in GEP-NETs.
VP137 Why We Should Not Meet Unmet Needs!
Authors: Sandman Lars
Published: January 2018

INTRODUCTION:

In formulating criteria for Health Technology Assessment (HTA) and priority setting a number of such criteria have been suggested and are used, for example in multi-criteria decision making. Besides taking central aspects like severity of disease, effectiveness, cost-effectiveness and patient safety into account, we also find references to criteria like unmet needs, and lack of alternative treatment. Often these criteria are treated as on par with each other, only given different weights in decision making. However, it seems like there is a conceptual overlap between some of these criteria and if that remains unnoticed, there is a risk of taking the same criteria into account twice. One such example is the relationship between severity of disease and unmet need. The aim of this presentation is to present a tentative analysis of the relationship between severity of disease and unmet need.

METHODS:

The presentation is based on a conceptual and normative analysis.

RESULTS:

First it will be argued that we have reason to clarify what is meant by unmet needs, whether it is a need which is not met to any degree or if it is a need for which there is no treatment with curative intent or for which there is only palliative treatment, for example. Second, analyzing unmet needs in relation to severity, a number of different scenarios will be examined, showing that unmet needs can be captured in terms of severity of disease (to some extent dependent upon how we operationalize severity of disease).

CONCLUSIONS:

The general conclusion of the study is that we have reason to carefully analyze criteria used for decision making in HTA from a conceptual and normative perspective in order to uncover logical relationships and avoid overlapping criteria. In relation to the specific question of unmet needs versus severity of disease, the conclusion is that in most cases unmet need will be redudant in relation to severity and we should be careful using both of them in decision making unless we can provide reasons for why it is an exceptional case.
VP148 Health Technology Assessment Of Femtosecond Laser: A New Frontier In Cataract Surgery
Authors: Faggiano Francesco , Andellini Martina , Sabusco Francesca , Derrico Pietro , Ritrovato Matteo
Published: January 2018

INTRODUCTION:

Cataract surgery is one of the most frequent ophthalmological surgical procedures performed in children. However, clinical outcomes in younger patients are generally unpredictable. Currently, cataract surgery can be performed through the traditional phacoemulsification ultrasound probe or Femtosecond Laser (1). The aim of this study is to describe the application of Decision-oriented Health Technology Assessment (HTA) (DoHTA) to assess the femtosecond laser-assisted cataract surgery (FLACS) compared to conventional cataract surgery (CCS).

METHODS:

To evaluate safety, costs, organizational aspects, effectiveness and technical characteristics of FLACS compared with CCS, a DoHTA method was applied (2). DoHTA is a new implementation of the European Network For HTA (EUnetHTA) Core Model®, which integrates the Multi-Criteria Decision Analysis (MCDA) using the Analytic Hierarchy Process (AHP). All the relevant assessment aspects of FLACS are summarized in a hierarchical decision tree by means of Key Performance Indicators (KPI), subsequently weighted through pairwise comparisons. Lastly, FLACS and CCS were ranked against lowest indicators of decision tree.

RESULTS:

The multidisciplinary assessment took into consideration all the aspects and recommendations about the benefits and disadvantages of FLACS compared to CCS. DoHTA results showed that FLACS surgery is safe and effective for pediatric patients. Furthermore, FLACS seems to overcome CCS with several important developments such as increased precision of anterior capsulotomy, reduced ultrasound power requirement during phacoemulsification, decreased collateral tissue damage, increased accuracy and consistency in surgical results as well as better visual outcomes. Notwithstanding such clinical improvements, FLACS is more expensive than its comparator.

CONCLUSIONS:

The DoHTA results integrated the evidence from the scientific literature (which is still limited) with experts judgments. Indeed, although FLACS had the highest purchase price, DoHTA results showed that FL improves the quality of cataract surgery. Based on our results and taking into consideration the positive safety and clinical effectiveness features, we conclude that FLACS may be a good alternative to CCS.
VP155 Synchronization Of Regulatory Approval And Health Technology Assessment Recommendation Timing
Authors: McAuslane Neil , Wang Tina , Liberti Lawrence
Published: January 2018

INTRODUCTION:

Minimizing the delay between regulatory approval and Health Technology Assessment (HTA) recommendation is critical to ensure patients access to medicines of therapeutic value. The aim of this study was to evaluate the level of synchronization between the regulatory decision and HTA recommendation.

METHODS:

Data were collected from the public domain for new active substances that were first appraised by the HTA agency in Scotland (SMC - Scottish Medicines Consortium), France (HAS - Haute Autorité de Santé), Germany (IQWIG - Institut für Qualität und Wirtschaftlichkeit im Gesundheitswesen), Australia (PBAC - Pharmaceutical Benefits Advisory Committee) and Canada (CADTH - Canadian Agency for Drugs and Technologies), and that reached an outcome in 2014 and 2015. The year the product was approved by the European Medicines Agency (EMA), Australian Therapeutic Goods Administration (TGA) and Health Canada were also assessed.

RESULTS:

In 2014 and 2015, fifty-one products with HTA recommendations were identified for SMC and IQWIG, forty-two for HAS, forty for PBAC and thirty-eight for CADTH.

Of the HTA agencies studied, CADTH had the lowest percentage of HTA recommendations occurring the same year as jurisdictional regulatory approval. Of the products with CADTH recommendations in 2014, only 7 percent were approved by Health Canada in the same year. By comparison, all of the products with PBAC recommendations in 2015 were approved by TGA in the same year.

For 2014 and 2015, comparing the percentage of HTA recommendations with the jurisdictional regulatory agency approval the same year showed 7 percent (2014) versus 29 percent (2015) for CADTH: 35 percent versus 37 percent for SMC: 35 percent versus 44 percent for HAS; 56 percent versus 57 percent for IQWIG; and 91 percent versus 100 percent for PBAC.

CONCLUSIONS:

This study shows that the parallel submission mechanism to enable synchronizing HTA and regulatory decision making is effective in Australia, whilst there remains a synchronization disconnect in other countries; although this may be improving. The extent of decision timing disconnect, influence of company strategy and type of HTA outcome were also studied. This initial analysis suggests gaps between the timing of regulatory approval and HTA recommendation for HTA agencies outside of Australia.
VP159 Strengthening Primary Health Care In Nigeria By Patient Involvement
Authors: Adeyemi Sylvester , Ekpenyong Aniekan
Published: January 2018

INTRODUCTION:

The Health system in Nigeria is structured into three tiers which include tertiary health care, secondary health care and primary health care (PHC). The latter forms the grassroots system of delivering basic health services to communities in both rural and urban centers. However PHC in Nigeria have been affected by poor service delivery. This has resulted in underuse of PHC due to the acceptance and utilization of health services delivered through this system. This research seek to bridge the gap of inequality, reaffirm that implementing PHC is a human right/duty and fosters patient and consumer involvement for economic, social and environmental sustainability of PHC.

METHODS:

A qualitative method of research was adopted using a participatory research model. The relative data was sourced secondarily from recent findings (July 2015) carried out in seventy-three primary health centers across Anambra State, Benue State, Kaduna State, Plateau State and Federal Capital Territory (FCT) of Nigeria. Issues that were examined included: client perspective and community involvement, status of available services, utilization and service delivery, and infrastructure and human resource capacities. The respondent of 294 client/service user population from interview were recorded and analyzed.

RESULTS:

The assessment showed client dissatisfaction to services being provided. In most centers, National Primary Health Care Development Agency (NPHCDA) requirements like availability of basic functional equipment, well trained health workers, patient record system, and access to water and sanitation were not met. Most of the facilities visited reported to be disconnected from the health system due to supportive supervision.

CONCLUSIONS:

Conclusively, the interest of the underserved Nigerian could be advocated for through local committees of consumer organizations. Their involvement will have an impact in PHC evaluation, policy making, and implementation of action plans aimed at improving PHC services.
VP168 Assessment Of Plasmapheresis For Alzheimer's Disease Systematic Review
Authors: Luengo-Matos Setefilla , Polo-Desantos Mar , Sanchez-Gomez Luis Maria , Orrego Juan Pablo Chalco
Published: January 2018

INTRODUCTION:

Alzheimer's disease (AD) is the most common type of dementia. Plasmapheresis is a procedure consisting of removing the plasma, or specific elements which are considered to be involved in pathological processes. Plasmapheresis could reduce the A beta peptides load in the brain. The objective is to study the safety and efficacy of plasmapheresis for AD.

METHODS:

Systematic review, with all studies published before April 2016 reviewed. Selected studies included patients with AD treated with plasmapheresis. GRADE was used to assess quality. Efficacy outcomes include: (i) Cognitive, functional and behavior status, through Mini Mental State Examination, and Alzheimer Disease Assessment Scale-Cognitive test; (ii) Plasma and cerebrospinal fluid A beta levels; (iii) Brain-imaging and functional neuroimaging studies. Safety outcomes included side effects related to the treatment.

RESULTS:

Two papers reporting results from three studies were selected: (i) pilot study (n = 10), (ii) its extended study (12 months more of follow-up) (n = 7), and (iii) clinical trial (n = 39). The quality of evidence was very low. About efficacy, the studies didn't report quantitative results and were inconclusive. The pilot study and its extended study reported (1): a tendency towards stabilization in cognitive status; the plasma levels of A beta peptides didn't show a clear pattern; and the brain-imaging assessment suggested a progressive volume increase in the hippocampus. The clinical trial reported in the experimental group vs control (2): a better score for the cognitive status; an increase of plasma A beta peptides; and did not find significant differences between groups for cerebrospinal fluid A beta peptides. The brain-imaging assessment showed a progressive loss of hippocampus volume in both groups. Regarding safety, the studies didn't report quantitative data. We didn't find economic evaluation studies.

CONCLUSIONS:

The included studies had very high risk of bias and very low quality. We found no evidence on efficacy and safety of plasmapheresis treating AD. Plasmapheresis isn't a priority line in research of AD treatment.
VP174 Atlases Of Quality: Assessing Integrated Care In Chronic Diseases
Authors: Robles Noemi , Ortiz Laura Muñoz , Espallargues Mireia
Published: January 2018

INTRODUCTION:

The Comprehensive Public Healthcare System of Catalonia (SISCAT) Atlases of Quality aim to evaluate the quality of care in relation to specific diseases or procedures in the Catalan territory with a focus on outcomes of care in order to promote best practices. The first Atlas of Quality aimed to assess the quality of integrated care for chronic patients.

METHODS:

Methodology was articulated in four stages:(i) Establishment of a conceptual framework of reference specific for each intervention/technology being assessed, (ii) Definition and consensus of the assessment indicators, and (iii) Implementation of indicators using the Basic Health Areas (ABS) of Catalonia as a unit of analysis, comparing ABS with vs without the intervention (such as integrated care for chronicity). Indicators were obtained from the SISCAT databases and implemented through risk adjustment models. For performance assessment, we calculated the observed and expected indicator rates for each ABS, and for the benchmarking analysis, these ratios were represented in funnel plots (Confidence Interval, CI 95 percent and 99.8 percent for exclusion zones). (iv) Evaluation of the intervention and identification of specific success factors.

RESULTS:

For the assessment of integrated care interventions for chronicity, the defined framework in stage 1 was base on the Kaiser Pyramid (population distribution), and the Porter and the Donabedian's approaches (structure, processes, outcomes) (1). In stage 2 more than 500 experts, using several qualitative techniques, considered 18 indicators as relevants and feasibles for the assessment (2). Ten of them were implemented in stage 3 for congestive heart failure and pulmonary obstructive chronic disease. Significant values were found both in ABS with and without chronicity care programms (phase 3).

CONCLUSIONS:

The subsequent analysis (phase 4) will allow identification of practices of each ABS that best explain these results. Some limitations must be considered such as the availability of the consensued indicators in the SISCAT databases.
VP176 Effectiveness Of Anti-Tumor Necrosis Factor In Patients With Psoriatic Arthritis
Authors: da Silva Michael , dos Santos Jéssica , Almeida Alessandra , Alvares Juliana , Guerra Augusto , Oliveira Haliton , Rodrigues Flávia , Bennie Marion , Godman Brian , Acurcio Francisco
Published: January 2018

INTRODUCTION:

Anti-tumor necrosis factor drugs (anti-TNF) are the last line of treatment for psoriatic arthritis (PsA) in the guideline of Brazilian Public Health System (SUS). Data of effectiveness of these drugs are scarce in the Latin American population. This study evaluated the effectiveness of the anti-TNF on a cohort of patients with PA in the SUS.

METHODS:

PsA patients treated with anti-TNF, were included in an open prospective cohort study. The Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) and Clinical Disease Activity Index (CDAI) were used to assess the effectiveness at six months of follow-up. The anti-TNF was considered effective when the patient achieves scores of four or less measured for BASDAI or scores of ten or less for CDAI. Frequency distributions were compiled for the sociodemographic variables and mean and standard deviation (SD) was used for clinical variables. The paired Student t-test was established to evaluate the differences between baseline and 6 months evaluated for BASDAI and CDAI.

RESULTS:

Fifty-four patients with PsA completed six months of follow-up. The mean age of patients was 54.03 years (10.44) and the mean disease duration was 8.00 years (7.49). Furthermore, 50 percent of the patients were female, 61.1 percent white and 59.6 percent married. The most used anti-TNF was adalimumab (63.0 percent), followed by etanercept (20.4 percent) and infliximab (16.7 percent). The anti-TNF reduced disease activity measured by BASDAI and CDAI at six months of follow-up (p<.001). The percentage of patients achieving the effectiveness with anti-TNF was 61.1 percent measured by BASDAI and 53.7 percent by CDAI.

CONCLUSIONS:

Anti-TNF drugs demonstrated to be effective in more than half of patients at six months. This result highlighted the importance of the treatment with the anti-TNF drugs in the Brazilian population. Long-term data are needed to confirm these results.
VP198 Efficient Retrieval Of Trial Protocols: An Empirical Study
Authors: Sutton Anthea , de la Cruz Maria del Carmen Galvan , Booth Andrew , Leaviss Joanna
Published: January 2018

INTRODUCTION:

Registration of trial protocols has become increasingly important in recent years. In the context of systematic reviews, published trial protocols facilitate the identification of studies. Data recorded in trials registers requires standardization to assist with ease of identification, and availability of the most current protocol version. Searching sources of trial protocols, for example trials registers, has issues relating to currency, coverage, functionality and indexing. An empirical study was conducted in the context of a funded systematic review, to establish; the proportion of trial protocols retrievable, the most effective retrieval methods, barriers to retrieving protocols, and whether the most easily retrieved protocol copy remains the document of record.

METHODS:

In a systematic review of primary care interventions for medically unexplained symptoms, seventy-four trials were identified as potential included studies. To search for the seventy-four trial protocols, multiple sources and methods were utilized to identify the the differential coverage of sources and the relative efficiency of retrieval methods. Retrieval methods included searching trials registers and bibliographic databases, internet searching, checking journal websites and contacting authors.

RESULTS:

Results included; (i) number of trial protocols that were referenced in the corresponding study publication(s), (ii) percentage of protocols indexed in each checked source, including MEDLINE and various trials registers, (iii) number of authors that responded to email contact, (iv) number of authors that provided a reference to, or copy of, the protocol. Information on when the trial protocol was published, funding sources, and trial registration, was also recorded.

CONCLUSIONS:

Conclusions are made regarding the coverage of different sources of trial protocols. This will enable Information Specialists to prioritize retrieval methods for identifying trial protocols to inform future search methods guidance. The main barriers to retrieving protocols are discussed together with recommendations for future empirical studies.
VP214 Criteria That Influence The Brazilian Public Decision-Making
Authors: de Souza Andrea Brígida , Santos Marisa
Published: January 2018

INTRODUCTION:

In Brazil, the National Committee for Health Technology Incorporation in the public health system (CONITEC) advises the Ministry of Health about incorporation, exclusion and alteration of health technologies in Brazilian public health system (SUS). Decision making considers multiple criteria, included or not in legislation. This analysis was the first step for a multiple-criteria decision analysis (MCDA) building. This study aims to identify criteria that influence Health Technology Assessment (HTA) for SUS.

METHODS:

Five real cases of controversial recommendations of technology incorporation made by CONITEC were reviewed by listening to the plenary recordings and reviewing committee minutes. The choice was guided by convenience, with prioritization according to CONITEC's members, using a pre-defined standardized form. Weight in decision making was also raised and identified. Selected technologies judgments were: Trastuzumab for metastatic/advanced Breast Cancer; Fingolimod for Multiple Sclerosis; Clozapine, Lamotrigine, Olanzapine, Quetiapine and Risperidone for Bipolar Affective Disorder; Hematopoietic stem cell transplantation for Sickle Cell Disease; and Positron Emission Computed Tomography (PET-CT) for Lung Cancer and for hepatic metastasis from Colorectal Cancer.

RESULTS:

The choice of different technologies allowed verifying specific criteria used for the incorporation of each type of technology, as well as the similar criteria discussed and used by all these technology types. In addition, some identified criteria were specific to the Brazilian reality, such as: “Incorporation by other countries”, “Potential technologies without registration in Brazil” and “Off-label use”. These criteria were not previously identified in studies conducted in other countries. Some criteria have been identified in all decisions, such as: efficacy, disease severity, quality and confidence in the evidences, logistic challenges for implementation, unmet needs, budget impact and treatment costs. Relative impact of cost-effectiveness was considered low.

CONCLUSIONS:

CONITEC's recordings are an important source to understand the Brazilian decision-making process. To identify the important criteria can help to standardize and improve the HTA process.
From Classroom to Public Space: Creating a New Theatrical Public Sphere in Early Independent India
Authors: MUKHERJEE MANJARI
Published: January 2018

Though India declared itself a sovereign nation only in 1947, after two hundred years of British rule, its people had unleashed the processes of ‘Indianization’ well before independence. While addressing the transition from colonial subjecthood to independent citizenship is intricately linked to efforts of decolonization, the role of English-medium education in the creation of a new emergent class of independent Indian citizens often gets overlooked. This essay analyses the immediate impact of independence (1947–50), and locates the educational spaces where Indians (predominantly elite Bengalis) were struggling to unlink citizenship from nationalism and exploring inter-community relationships such as those between the Bengali elite and the micro-minority Jews, Parsis, Armenians and Anglo-Indians. I show how theatre activities by the students of St Xavier's Collegiate School and College, their new roles as potential public intellectuals and citizens of post-independent India and their theatre constituted an important intervention in the new democratic processes. I examine the duality of a Bengali elite who acquired an English-medium education and performed English-style Shakespeare while trying to construct a political dramaturgy as an ensemble or collective.
Results of balloon pulmonary valvoplasty in children with Noonan’s syndrome
Authors: Holzmann Jonathon , Tibby Shane M. , Rosenthal Eric , Qureshi Shakeel , Morgan Gareth , Krasemann Thomas
Published: January 2018

Pulmonary valve stenosis is common in patients with Noonan’s syndrome. The response to balloon valvoplasty varies.

We assessed the correlation between re-intervention rate, immediate response, and the progress of the valve gradient over time after intervention.

Methods

This is a retrospective study conducted from 1995 to 2014.

Results

Of 14 patients identified, seven had re-intervention 28±54 months (range 3–149, median 3.3) after valvoplasty. These patients did not have a significant decrease in gradient after intervention. Their gradient subsequently decreased during follow-up and then became static before increasing years after intervention. In contrast, the gradient of patients not requiring further intervention continually reduced over time. Demographics did not differ between these groups.

Conclusion

We could not identify predisposing factors for long-term success of pulmonary valvoplasty in Noonan’s patients, but the trajectory of gradients differs significantly between patients needing re-intervention from those who remain free from re-intervention.
Metamaterial inspired DNG superstrate for performance improvement of microstrip patch antenna array
Authors: Arora Chirag , Pattnaik Shyam S. , Baral Rudra Narayan
Published: January 2018

To utilize the manipulation of wave properties by metamaterials, in this paper, a microstrip-fed patch antenna array, loaded with metamaterial superstrate, has been proposed. Under unloaded conditions, the conventional patch antenna array resonates at IEEE 802.16a 5.8 GHz Wi-MAX band with gain of 4.31 dBi and bandwidth of 425 MHz, whereas when each patch of this array is loaded with a metamaterial superstrate, composed with the pair of circular split ring resonators and wire strips, gain and bandwidth approaches to 11.9 dBi and 685 MHz, respectively, which corresponds to gain improvement by 7.6 dBi and bandwidth enhancement of 260 MHz. The proposed antenna is fabricated and tested to compare simulated and measured results. A good compliance is observed between these two results. Equivalent circuit model of the composite structure has been developed and analyzed.
The Self-Access Form
Authors: Quirin Markus , Kuhl Julius
Published: January 2018

Abstract. Different lines of research suggest that individuals differ in accessing self-referential information, that is, to know who they are, what they think, want, need, or feel, and that this construct is positively associated with emotion regulation, adaptive functioning, well-being, and meaning in life. We developed a brief scale of five items, the Self-Access Form (SAF) and conducted four studies to approve its validity with respect to markers of adaptive personality functioning and health. Study 1 shows a clear, unidimensional factor structure for the SAF. Self-access correlates positively with adaptive self- and emotion regulation, as well as with psychological and physical health, but does not correlate with private self-consciousness (Study 2). Additionally, self-access is positively related to self-complexity and self-integration as two markers of adaptive self-development (Study 3). It is also inversely related to self-infiltration, that is, the misconception of other individuals’ expectations as own goals (Study 4). We conclude that self-access can validly be measured by a brief scale and positively relates to adaptive functioning and health.
Rethinking How Water Circulates Between the Oceans and Land
Authors: Cook Terri
Published: January 2018

A reexamination of the global water cycle shows that tropical coastlines exert a profound influence on atmospheric water circulation by wringing water vapor from the atmosphere.
Direct characterization of a nonlinear photonic circuit’s wave function with laser light
Authors: Lenzini Francesco , Poddubny Alexander N , Titchener James , Fisher Paul , Boes Andreas , Kasture Sachin , Haylock Ben , Villa Matteo , Mitchell Arnan , Solntsev Alexander S , Sukhorukov Andrey A , Lobino Mirko
Published: January 2018

Integrated photonics is a leading platform for quantum technologies including nonclassical state generation1, 2, 3, 4, demonstration of quantum computational complexity5 and secure quantum communications6. As photonic circuits grow in complexity, full quantum tomography becomes impractical, and therefore an efficient method for their characterization7, 8 is essential. Here we propose and demonstrate a fast, reliable method for reconstructing the two-photon state produced by an arbitrary quadratically nonlinear optical circuit. By establishing a rigorous correspondence between the generated quantum state and classical sum-frequency generation measurements from laser light, we overcome the limitations of previous approaches for lossy multi-mode devices9, 10. We applied this protocol to a multi-channel nonlinear waveguide network and measured a 99.28±0.31% fidelity between classical and quantum characterization. This technique enables fast and precise evaluation of nonlinear quantum photonic networks, a crucial step towards complex, large-scale, device production.
Phosphate insensitive aminophosphonate mineralisation within oceanic nutrient cycles
Authors: Chin Jason P , Quinn John P , McGrath John W
Published: January 2018

Many areas of the ocean are nutrient-poor yet support large microbial populations, leading to intense competition for and recycling of nutrients. Organic phosphonates are frequently found in marine waters, but require specialist enzymes for catabolism. Previous studies have shown that the genes that encode these enzymes in marine systems are under Pho regulon control and so are repressed by inorganic phosphate. This has led to the conclusion that phosphonates are recalcitrant in much of the ocean, where phosphorus is not limiting despite the degradative genes being common throughout the marine environment. Here we challenge this paradigm and show, for the first time, that bacteria isolated from marine samples have the ability to mineralise 2-aminoethylphosphonate, the most common biogenic marine aminophosphonate, via substrate-inducible gene regulation rather than via Pho-regulated metabolism. Substrate-inducible, Pho-independent 2-aminoethylphosphonate catabolism therefore represents a previously unrecognised component of the oceanic carbon, nitrogen and phosphorus cycles.
Corallivory and the microbial debacle in two branching scleractinians
Authors: Bettarel Yvan , Halary Sébastien , Auguet Jean-Christophe , Mai Thanh Chi , Van Bui Ngoc , Bouvier Thierry , Got Patrice , Bouvier Corinne , Monteil-Bouchard Sonia , Christelle Desnues
Published: January 2018

The grazing activity by specific marine organisms represents a growing threat to the survival of many scleractinian species. For example, the recent proliferation of the corallivorous gastropod Drupella now constitutes a critical case in all South-East Asian waters. If the damaging effects caused by this marine snail on coral polyps are relatively well known, the indirect incidence of predation on coral microbial associates is still obscure and might also potentially impair coral health. In this study, we compared the main ecological traits of coral-associated bacterial and viral communities living in the mucus layer of Acropora formosa and Acropora millepora, of healthy and predated individuals (i.e., colonized by Drupella rugosa), in the Bay of Van Phong (Vietnam). Our results show a substantial impact of the gastropod on a variety of microbiological markers. Colonized corals harbored much more abundant and active epibiotic bacteria whose community composition shifted toward more pathogenic taxa (belonging to the Vibrionales, Clostridiales, Campylobacterales, and Alteromonadales orders), together with their specific phages. Viral epibionts were also greatly influenced by Drupella corallivory with spectacular modifications in their concentrations, life strategies, genotype richness, and diversity. Novel and abundant circular Rep-encoding ssDNA viruses (CRESS-DNA viruses) were detected and characterized in grazed corals and we propose that their occurrence may serve as indicator of the coral health status. Finally, our results reveal that corallivory can cause severe dysbiosis by altering virus–bacteria interactions in the mucus layer, and ultimately favoring the development of local opportunistic infections.