bluuebunny/crossref_metadata_2025_split huggingface dataset:
PP125 PhotoVoice: Promoting Knowledge Exchange About Patients’ Experiences
Authors: Pego Yolanda Triñanes , Varela Lucía , Mazaira-Castro José , Vallés Maria José Faraldo 
Published: December 2019

IntroductionIn the past decades the community-based participatory research method known as PhotoVoice has gained relevance, but there are few published studies on its application in the field of health technology assessment (HTA) and clinical practice guidelines (CPGs). The aim of this presentation was to describe a PhotoVoice project linked to a CPG on major depression in children and adolescents.MethodsThe design of the study was adapted to the main objective, which was to enhance the understanding of major depression and improve clinical practice with the contributions of clinicians, methodologists, and patients. Seven adolescents and ten of their family members participated in the study through PhotoVoice sessions and focus groups. The audio recordings of all sessions were transcribed verbatim and coded, and a thematic analysis was undertaken.ResultsSix themes emerged: (i) a lack of understanding and information about depression in childhood and adolescence; (ii) the importance of support groups; (iii) the need to favor early care and access to services; (iv) the adaptation of therapeutic strategies tailored to individual needs; (v) the sensitivity of professionals; and (vi) fostering interaction between the health and education systems. Photographic exhibitions were planned to share the main results. These exhibitions were promoted to increase public awareness and reduce stigmatization, and to reach clinicians and policy makers. From a methodological point of view, the use of PhotoVoice in this study helped to effectively incorporate the lived experiences, concerns, and preferences of patients and their relatives into the CPG. The study also confirmed the value of photographs and participatory methods. The main limitations and strengths of the study, as well as suggestions for future research, are also outlined.ConclusionsPhotoVoice is a flexible, effective, and innovative method of obtaining information about patients’ perspectives and experiences, and it offers the added value of being able to reach the main stakeholders, including policymakers and the public.
PP126 Analyses Of User Requirements In The Evaluation Of Medical Equipment
Authors: Cardoso Ricardo Bertoglio , Brust-Renck Priscila G. , Fogliatto Flavio Sanson , Dos Santos Helena Barreto 
Published: December 2019

IntroductionHuman-centered approaches to eliciting requirements for medical equipment selection are recognized as improving healthcare outcomes, safety, and end-user satisfaction. Nevertheless, there are many challenges to conducting rigorous investigations to identify requirements that satisfy different hospital services and types of end users (e.g., patients, healthcare professionals, and clinical engineers). By establishing a systematic method for selecting medical recliners, this study provides detailed technical characteristics and user requirements associated with several hospital areas, as well as a comparison between two end users (health professionals and patients) and their different perceptions of usability.MethodsFirst, clinical engineers and senior nurses from seven hospital services identified and rated the technical characteristics of medical recliners. Ratings were then used to stratify all services in well-defined similar groups using hierarchical and non-hierarchical clustering algorithms. Next, users of hospital recliners (60 patients and 56 healthcare providers) from each group were interviewed to identify their requirements for an ideal medical recliner. Finally, analyses of variance were performed to identify consensus decisions from users across the different hospital contexts as to which technical characteristics were the most relevant.ResultsThe contribution of senior nurses and clinical engineers led to the identification of 41 technical characteristics. The analysis of 116 participant interviews identified 95 different requirements, extracted from 1,052 user suggestions. Correspondence analysis of the most important requirements, combined for each of the three stratified service groups, indicated that two-thirds of all user requirements (14 out of 20) were fulfilled by five out of 32 quantitative technical characteristics, regardless of context.ConclusionsHuman-centered methods can identify similarities between health technology characteristics and decrease the complexity associated with selecting technologies, while simultaneously fulfilling the requirements of multiple users and hospital departments.
PP159 Is Community Paramedicine A Safe/Effective Alternative To Usual Care?
Authors: Guo Bing , Corabian Paula , Yan Charles 
Published: December 2019

IntroductionDue to an aging population, shortage of healthcare staff, and escalating healthcare costs, there has been a recent shift in the professional roles and responsibilities in acute care settings to help bridge the care gap. Paramedics, whose primary responsibilities have been in emergency/transportation services, are increasingly involved in the management of chronic diseases in the community setting. However, even with additional training, there are concerns about the safety and effectiveness of this expanded role. The objective of this presentation is to highlight some of the key findings from a health technology assessment report on the safety and effectiveness of community paramedicine in assessing and managing conditions/diseases with low acuity.MethodsA systematic review was conducted to identify studies that evaluated the safety and effectiveness of different community paramedicine programs.ResultsFour systematic reviews and 20 primary studies (one randomized controlled trial (RCT) and 19 observational studies) were identified. Of these, two systematic reviews and 14 primary studies focused on the safety and effectiveness of Emergency Care Practitioner (ECP) programs ̶ widely implemented programs whereby a paramedic or nurse undertakes activities traditionally performed by physicians, such as the initial assessment of patients, provision of simple treatment, or referral of patients to other clinical care. Limited evidence showed that ECP programs are promising in reducing repeated emergency calls, emergency department visits, hospital admissions/readmissions, and emergency transport charges. While the majority of included studies did not report any safety outcomes, no significant safety issues were identified from the cluster RCT. Evidence for other types of community paramedicine is limited.ConclusionsEvaluation of the impact of community paramedicine programs remains methodologically challenging. Additional cluster RCTs may help determine the effectiveness of community paramedicine programs; safety outcomes should be a key element of future observational studies.
VP04 The Influence Of Sponsorship On The Treatment Effects Of Trials
Authors: Arienti Chiara , Stefano Negrini , Da costa Bruno , Armijo-Olivo Susan 
Published: December 2019

IntroductionLimited public money is available for funding research and the majority of clinical research undertaken is funded by industry. Mechanisms to regulate conflicts of interest within the research process have been implemented. However, these policies by themselves do not protect against potential sponsorship bias that would affect research results to inform decision makers when using the results of these trials. Therefore, the main aim of this study was to evaluate the influence of sponsorship bias on the treatment effects of RCTs.MethodsThis was a meta-epidemiological study. A random sample of RCTs included in meta-analyses of physical therapy (PT) area were identified. Data extraction including assessments of appropriate influence of funders was conducted independently by two reviewers. To determine the association between biases related to sponsorship biases and effect sizes, a two-level analysis was conducted using a meta-meta-analytic approach.ResultsWe analysed 393 trials included in forty-three meta-analyses. The most common sources of sponsorship for this sample of PT trials were government (n = 205, 52.16 percent) followed by academic (n = 44, 11.2 percent), and industry (n = 39, 10 percent). The funding was not declared in a high percentage of the trials (n = 85, 22 percent). The influence of the trial sponsor was assessed as being appropriate in 246 trials (63 percent) and considered inappropriate/unclear in 147 (37 percent) of them. There was a significant difference in effects estimates between trials with appropriate and inappropriate influence of funders (ES= 0.15; 95% CI -0.03, 0.33;). Trials with inappropriate/unclear influence of funders tended to have on average a larger effect size than those with appropriate influence of fundingConclusionsTreatment effect size estimates were 0.15 larger in trials with lack of appropriate influence of funders. Systematic reviewers should perform sensitivity analyses based on appropriateness of influence of sponsorship in included trials.
VP15 Consumer Willingness To Pay For A Hypothetical Zika Vaccine In Brazil
Authors: Muniz Roberto , Godói Isabella , Reis Edna , Garcia Marina , Guerra Augusto Afonso , Godman Brian , Ruas Cristina 
Published: December 2019

IntroductionThe Zika virus is a newly emerging infection associated with increasingly large outbreaks especially in countries such as Brazil where an estimated 326,224 cases were confirmed between 2015 and 2018. Common symptoms associated with Zika include headache, conjunctivitis, fever, erythema, myalgia, vomiting, diarrhea, and abdominal pain. However, the symptoms are usually self-limiting and last on average for 4 to 7 days, with patients typically not accessing the public healthcare system (SUS). In severe cases, symptoms include neurological disorders and neonatal malformations. A future Zika vaccine can contribute to decreasing the number of cases and associated complications. However, this has to be balanced against continuing costs to control this and other vector borne diseases. Consequently, information about consumers’ willingness to pay (WTP) for a hypothetical Zika vaccine can help with price setting discussions in Brazil starting with the private market before being considered within SUS.MethodsA cross-sectional study was conducted among residents in one of the main provinces of Brazil (Minas Gerais) regarding their WTP for a hypothetical Zika vaccine with agreed characteristics. This included a mean effective protection of 80 percent, with the possibility of some local and systemic side-effects. The discussed price was USD 56.41 (BRL 180.00) per vaccination as this figure was utilized in a previous WTP study for a dengue vaccine.ResultsFive hundred and seventeen people were interviewed. However, thirty would not be vaccinated even if the vaccine was free. Most of the resultant interviewees (489) were female (58.2 percent), were employed (71.2 percent), had private health insurance (52.7 percent), had household incomes above twice the minimum wage (69.8 percent) and did not have Zika (96.9 percent). The median individual maximum WTP for this hypothetical Zika vaccine was USD 31.34 (BRL 100.00).ConclusionsWTP research can contribute to decision-making about possible prices alongside other economic criteria once a Zika vaccine becomes available in Brazil alongside other programmes to control the virus.
VP21 Economic Burden Of Pertussis Treatment In Brazil, 2014
Authors: Bagattini Ângela , Policena Gabriela , Russell Louise , Toscano Cristiana 
Published: December 2019

IntroductionDespite availability of a cheap, widely accessible vaccine, pertussis remains an important cause of morbidity and mortality in children worldwide. A resurgence of pertussis in Brazil peaked at 8,815 cases in 2014. We estimate the economic burden of pertussis hospitalizations and outpatient cases in Brazil in 2014.MethodsTaking the Brazilian public health system (SUS) perspective we obtained numbers of hospitalizations from the National Hospitalization Information System (SIH) for discharge diagnosis ICD10:A37 and numbers of confirmed outpatient cases from the surveillance information system (SINAN). We estimated costs per case for seven age groups (<1, 1-4, 5-9, 10-19, 20-39, 40-64, and 65+ years). Hospitalization costs were obtained from SIH, which reimburses direct medical (hospital stay, healthcare professional services, and physical therapy) and non-medical costs (parent/caregiver stay accompanying a hospitalized child). Cost of outpatient management was estimated from national guidelines (diagnostic exams, medical visits, and medications) and national pricing lists. Total economic burden was derived by multiplying costs/case by numbers of hospitalized and outpatient cases, respectively, and converted to US Dollars (USD) (December 2014: 1 BRL = USD 0.39).ResultsA total of 8,815 pertussis cases occurred in Brazil in 2014; 55.9 percent were hospitalized. Total cost to the public health care system was USD 2.6 million, 95 percent for hospitalizations. Cost/case was highest at the extremes of age for both hospitalized <1y, BRL 1,378.54 (USD 537); 65y+, BRL 1,875.00 (USD 731) and outpatient cases BRL 41 (USD 16) for <4y and 20y + . Children <4 years accounted for 95.4 percent of hospitalizations, 51.2 percent of outpatient cases, and 95.4 percent of total costs. Children <1 year accounted for 88.1 percent of hospitalizations, 29.1 percent of outpatient cases, and 89.3 percent of total costs.ConclusionsPertussis economic burden in an outbreak year was largely due to hospitalizations in children <1y. Additional prevention strategies are required targeting this population.
VP49 Real-world Evidence For Economic Evaluation Of Medical Devices
Authors: Pongiglione Benedetta , Torbica Aleksandra 
Published: December 2019

IntroductionRandomized controlled trials (RCTs) are considered the gold standard in the hierarchy of research designs for evaluating the efficacy and safety of a treatment intervention. The low external validity of RCTs and the general shortage of clinical evidence available to support the use of many medical devices have emphasized the necessity for exploring the use of real-world data (RWD) as a complementary source to RCTs data for establishing a more robust evidence base on the effectiveness of medical devices. The aim of the present project is to assess in a comprehensive way the existing sources of real world data on medical devices in Europe.MethodsThe guidelines to the mapping exercise have been outlined in a research protocol. First, all national relevant sources (e.g. website of Ministry of Health, national institutions, research bodies) are screened, both in local language and English. Second, we perform a systematic search on PubMed using a set of key words for each case study, adapted to each country setting. Finally, we seek advice from key actors in the field of the device and clinical conditions, such as manufacturers or clinicians.ResultsInformation on existing sources of RWD for each case studies are provided in a template including details on the key features of the source (e.g. data producer, data collection period, sample size, study design, geographical coverage) and the main content of the dataset, distinguishing socio-demographic information, clinical and epidemiological data, data on resource use and health outcomes. The data mapping includes all countries of the project participants, i.e. Italy, UK, Netherlands, Switzerland, Germany, Hungary, and we enlarge the scope of our mapping including other countries: Spain, France, Denmark, Finland, Sweden, Poland and Hungary as well as international databases at pan-EU level. The number of available sources of RWD and their quality vary depending on case study and across countries. For example, in the case of orthopaedics, many countries have a national registry and administrative data, such as hospital discharge, contain useful information, although not as detailed. When a registry is not available, it is often the case that more observational studies are available; this occurs for example in France.ConclusionsIn this work we shows the importance of RWE and map in an accurate and comprehensive way which source of RWD are currently available and to what extent they are known and used in medical, epidemiological and economic research.
VP65 HTA Beyond 2020: Need For “Professionalization”?
Authors: Nyamadzawo Evidence 
Published: December 2019

IntroductionHealth Technology Assessment (HTA) should continue evolving in order to effectively meet stakeholder expectations in the next decade. There is need for strengthening current expertise while developing new capabilities to keep up with rapid innovations in health care. Institutionalizing knowledge and skill through professionalization of HTA is a critical factor for successful “smart capability building” and the practice of HTA beyond 2020.MethodsProfessionalism is understood to mean different things by different people. This paper does not primarily focus on whether HTA is or should be a “profession” but on the development of institutions, structures, and attitudes that are characteristic of a profession and the impact they could have on the practice of knowledge and skill in HTA. “Professionalization” is used in this case to refer to the status of institutions, structures and attitudes and the process of establishing them. Professional standards include both ethical standards and standards of (technical) competence. Ethics applies to standards of competence, because stakeholders expect professionals to adhere to standards of competence and ethical standards. I will argue for the institutionalization of the practice of HTA knowledge and skill for mutual benefit and the prevention of exploitative and unjust use of HTA capabilities and processes. Is expertise necessary in HTA? Yes, conducting HTA requires specialized skills and knowledge. Effective decision-support requires multidisciplinary and efficient HTA teams. Core competencies and smart capabilities must be clearly defined and institutionalized for the production of effective HTA in the coming decade. Credentialism also becomes necessary for protecting the public from the consequences of bad evidence and bad choices. It will also protect the integrity of HTA practitioners and bolster professional autonomy.ResultsProfessionalization is instrumental in the development of ethical standards and standards of technical competence necessary for successful HTA practice.ConclusionsHTAi should professionalize HTA to facilitate and guide “smart capability building”.
VP67 Caring For Children With Neurodevelopmental Disorders
Authors: Andrade Aurélio , Girardi Juliana , de Mello Nicole , Köptcke Luciana , Elias Flávia 
Published: December 2019

IntroductionProfessionals dealing with children with Neurodevelopmental Disorders (NDDs) need to be constantly trained because of the numerous challenges posed by the particularities arising from the multiple conditions that pervade child development. The aim of this study is to describe the training processes of education, health and social care professionals who care for children aged 0 to 12 years with neurodevelopmental disorders.MethodsThe revision overview was registered in the PROSPERO platform CRD42018100715 that followed the parameters of the PRISMA protocol and aimed to identify the existing multi-professional training processes, aimed at health professionals, education and social assistance aimed at promoting skills for care with children and families with TND. The research question was structured according to the acronym PICO. The search was performed in PubMed, Embase, Cochrane Library, CRD, Web of Science, Campbell Library, Health System Evidence, Epistemonikos and Joanna Briggs databases in May 2018.ResultsWe selected 23 articles. Of these, 21 (91 percent) were health professionals, 22 (96 percent) referred to intellectual disability, 16 (71 percent) were in the American continent and 15 (65 percent) used in-service training as educational resource. The outcomes showed that the structuring of teaching-learning in the practice of health, education and social care professionals determines a more inclusive proposal in the treatment of children with NDD.ConclusionsThe health professional is the most trained to attend children with NDD, however, training and development policies are lacking for professionals from other areas who act as a gateway to diagnostic services. Establishing in-service training initiatives strengthens the support and structuring of intersectoral programs that would facilitate multi-professional participation in the prognosis and treatment directed at children with NDD. Therefore, associating the use of assistive technologies allows new opportunities to access tools and electronic devices that allow the formation of professionals.
VP99 Study On The Responsiveness Of Primary Medical Institution In ZJ & QH
Authors: Wei Jingming , Dong Hengjin 
Published: December 2019

IntroductionThe health system responsiveness, defined as non-medical aspect of treatment relating to the protection of the patients’ legitimate rights, is the intrinsic goal of the WHO strategy for 21st century, and is an important index to measure the service ability of medical institutions.MethodsThe data were collected in 2016-2017 and consists of the first visits for patients of grass-roots medical institutions. SPSS21.0 was used to complete statistical description and tests including multiple linear regression model analysis and structural equation analysis.ResultsThere are differences in perceived responsiveness of primary medical institutions in Qinghai and Zhejiang. Zhejiang residents believe that the primary medical institutions have better medical environment, medical staff have better attitudes to explain problems, treatment plan explanation is more clear, and the attitude toward listening to patient condition is more serious. However, Qinghai residents think that the waiting time of the basic medical institutions is shorter and the degree of trust in the medical staff is higher. There are differences in health system responsiveness among different groups. According to the standard of ɑ=0.05, factors such as ethnicity, household registration type, the medical insurance type, the occupational type, the marital status, the educational level have a significant impact on the perceived responsiveness of primary medical institutions.ConclusionsHealth system responsiveness exists in the region, which may be related to the differences in the economic development level, the state of health service and the management and investment in health services among different regions. On the other hand, residents living in the same area are more similar in terms of living environment, socio-economic status, ideology and culture, and health beliefs than those from different regions. This may be one of the reasons the results of health system responsiveness assessment are closer than for residents in different regions.
Common envelope evolution of massive stars
Authors: Ricker Paul M. , Timmes Frank X. , Taam Ronald E. , Webbink Ronald F. 
Published: December 2019

AbstractThe discovery via gravitational waves of binary black hole systems with total masses greater than 60Mʘ has raised interesting questions for stellar evolution theory. Among the most promising formation channels for these systems is one involving a common envelope binary containing a low metallicity, core helium burning star with mass ⁓30 – 40Mʘ and a black hole with mass ⁓30 – 40Mʘ. For this channel to be viable, the common envelope binary must eject more than half the giant star’s mass and reduce its orbital separation by as much as a factor of 80. We discuss issues faced in numerically simulating the common envelope evolution of such systems and present a 3D AMR simulation of the dynamical inspiral of a low-metallicity red supergiant with a massive black hole companion.