bluuebunny/crossref_metadata_2025_split huggingface dataset:
VP102 The Determinants Of Diffusion Of New Technologies Across Life Cycle
Authors: Callea Giuditta , Gautier Lara , Armeni Patrizio , Tarricone Rosanna 
Published: January 2018

INTRODUCTION:The proliferation and uneven diffusion of new medical technologies in recent years has been raising concerns on affordability and equity of care, and inspiring the publication of scientific articles on the determinants of their uptake and adoption (1). Indeed, the knowledge of the determinants spurring the adoption and diffusion of innovative medical technologies is relevant for policymakers because it helps them implementing evidence-based health policies aimed at influencing the use of new technologies, thus reducing inequities in uptake rates across areas and populations.The aims of this study were (i) to identify the empirical literature investigating the determinants of adoption and diffusion of innovative non-pharmaceutical health technologies, and (ii) to discuss the existence of consensus on the direction and significance of the factors that influence their adoption in each phase of technologies life cycle (that is, early adoption, adoption, diffusion).METHODS:We performed a systematic literature review of quantitative empirical literature.RESULTS:We identified a total of thirty-three studies, published between 1977 and 2014. We concluded that early adoption of innovative technologies is positively affected by physician characteristics (for example, experience with new technology by the practitioner or by other physicians in the same hospital) and by the fee-for-service reimbursement scheme. The probability of adoption is mainly driven by provider characteristics (for example, size, importance of being perceived as technology leaders, previous adoption of similar or substitute technologies, strong medical staff involvement in decisions of acquisition), by physician experience with the technology and by the new technology expected impact on hospitals and physicians revenues. Socio-economic determinants (for example, health expenditure), hospitals and physicians reimbursement schemes, market structure (for example, number of providers, number of substitute procedures), provider features (for example, size, quality of care, reputation), and physician characteristics (for example, experience with technology, innovator status of the team) significantly increased the extent of diffusion.CONCLUSIONS:Our results can be used as a guide by policymakers who wish to make evidence-based decisions.
VP113 Reframing “Disinvestment”: Appropriateness And Real-Time Data Capture
Authors: Ronquillo Charlene , Roome Chris , Stein Ken 
Published: January 2018

INTRODUCTION:Disinvestment – stopping the use of health technologies with little or no clinical benefits – can reduce health system costs and change practice towards effective innovations. In England, efforts to support disinvestment have included the National Institute of Health and Care Excellence (NICE's) list of 900+ “Do Not Do (DND) technologies”. However, recent studies show ongoing, varying rates of DND technology, suggesting limited influence. In response, we propose a shift in perspective and reframing of the concept of ‘disinvestment’ to focus on ‘appropriateness’.METHODS:We have developed a two-pronged approach to ‘appropriateness’. The first develops local clinician agreements on specific, appropriate indications for a technology. The "RAND/UCLA Appropriateness Method” is being extended in this stage. This knowledge management process enables incorporation of local knowledge and practice via consensus development amongst local experts alongside scientific evidence. The second, and more novel, element is to specify and routinely collect data on technology use associated with these agreed indications. Shifting from cross-sectional clinical audits to real-time monitoring will highlight variation from the agreed indications, which can inform reimbursement policy and decisions. Evaluating the feasibility and sustainability of this approach will provide important lessons for scaling up.RESULTS:For clinicians, the reframing from disinvestment to appropriateness has important implications. The approach recognizes that there are very few technologies with absolutely no benefit. Framing the management of technology diffusion in terms of appropriateness emphasises benefits and maximises value for public health. Furthermore, combining local agreements on indications with real-time data capture facilitates intelligent, flexible commissioning and informs real-life evaluation.CONCLUSIONS:Shifting the perspective from disinvestment to appropriateness overcomes negative associations of stopping healthcare technologies. Linking clinically driven decisions on technology indications with routine data capture on use can transform clinical audit and healthcare commissioning. The combination of these approaches is, we believe, a novel approach on which more reflection and research will be valuable.
VP126 The Effectiveness And Safety Of Barbed Sutures In Bariatric Surgery
Authors: Lin Yifei , Huang Jin , Du Liang , Zhang Yonggang , Liao Ga 
Published: January 2018

INTRODUCTION:Knotless barbed sutures can eliminate knot tying during the bariatric surgery (BS) (1). Since effects reported by patients and surgeons are ambiguous, the aim of this study was to establish the safety and efficacy of barbed sutures for intestinal sutures to close the gastrojejunal anastomosis in obese patients undergoing BS.METHODS:PubMed, EMBASE, Cochrane Register of Clinical Studies, and ClinicalTrials.gov were searched for randomized controlled trials (RCTs) and cohort studies comparing barbed sutures with conventional sutures in BS (until 30 June 2016). Quality assessment was conducted using to Cochrane recommendations. Review Manager was applied to analyze the data, and we sequentially omitted each study to perform sensitivity analyses.RESULTS:A total of five cohort studies (low to moderate risk of bias) (n = 859), and no RCTs provided eligible patients. BS includes laparoscopic Roux-en-Y gastric bypass and Laparoscopic sleeve gastrectomy. Comparing to conventional sutures, pooling data showed that suture time (Mean Difference, MD = -5.73, 95 percent Confidence Interval, CI -6.25 to -5.21, P < .01) and operative time (MD = - 7.67, 95 percent CI -10.49 to -4.85, P < .01) decreased significantly in the barbed group. Although the postoperative complications did not suggest significant changes (Odds Ratio, OR = 1.56, 95 percent CI .79 to 3.07, P = .2), the pooling results of hospital stay suggested that a significantly longer duration happened in the barbed groups, despite the fact that there may be only 0.18 day longer. (MD =0.18, 95 percent CI .06 to .29, P = .003).CONCLUSIONS:The barbed suture is an effective and safe surgical technique in BS. More evidence with randomized design, larger sample sizes and longer follow up need to compel validations of this state-of-the-art product in the future (2,3).
VP130 Burden Of Illness For Urothelial Bladder Cancer (UBC) In Italy
Authors: Recchia Alessandra , Gerace Claudio , Era Sara , Doria Simona , Di Ponzio Giuseppe , Teruzzi Cristina 
Published: January 2018

INTRODUCTION:Urothelial Bladder Cancer (UBC) is the ninth worldwide most common cancer. In Italy the prevalence of the disease is about 10 percent, representing the third most prevalent cancer with 180,775 cases in men and 42,757 cases in women. The increase in the incidence requires continuous surveillance and care, resulting in a significant burden on Italian Healthcare System, making any improvement to the strategy for diagnosing and treating this disease important to the medical and scientific community. The aim of this study was to evaluate the burden of UBC in the Italian context, collecting and measuring the total costs of the disease.METHODS:An economic analysis in the National Health Service perspective was carried out, evaluating in six centers direct costs in terms of outpatient, inpatient and emergency care, pharmaceuticals and follow up procedures and indirect costs in terms of productivity losses. Data were collected through aggregated form reports, focusing on patients with an existing diagnosis of UBC who were taken in charge in the last year. Statistical analysis was conducted in order to explore variations between centers.RESULTS:Mean total annual cost per patients was EUR11,310, increasing for disease severity from EUR6,954 for superficial disease to EUR24,896 for metastatic stage. The analysis confirmed a proportional relation between disease severity and disability grade. The total burden of the disease considering all patients, including prevalence and incidence data coming from AIOM guidelines 2015, was EUR2,833,655,822, of which 15 percent is represented by estimated productivity losses.CONCLUSIONS:Our analysis represents the first economic burden study of UBC in the Italian context as well as the first real life evidence of the current therapeutic algorithm. This study opens the possibility for further analysis on the indirect costs components that represent a great burden for the society, especially for the stages of the disease with high disability grade.
VP144 Health Technology Assessment In Hospitals: Determinants Of Performance
Authors: Ferrario Lucrezia , Foglia Emanuela , Pagani Roberta , Lettieri Emanuele , Garagiola Elisabetta , Porazzi Emanuele , Croce Davide 
Published: January 2018

INTRODUCTION:While “how to perform” a rigorous Health Technology Assessment (HTA) at the institutional level is well established (1), very little has been experienced for empirically approaching an HTA in hospitals: no scientific evidence is available concerning the correct organizational model, to maximise and to improve the functioning, the performance and the effectiveness of the HTA units (2).This study aims at crystallizing those design options that may positively contribute to the HTA units’ effectiveness (quality) and/or to the efficiency (timely) (3).METHODS:After the collection of qualitative data from ninety-five healthcare professionals by means of ad hoc questionnaires and interviews, a hierarchical sequential linear regression model was conducted to verify the existence of HTA units determinants. Size, multidisciplinary, trust among members, HTA previous skills and organizational support were the variables investigated, determining team performance.RESULTS:A greater size and the presence of different specialities within the working unit positively influenced effectiveness, even if they spent more time to complete the assessment. Trust, previous HTA skills and organizational support played a key role in team performance. Size and previous HTA skills most explained the variance of team effectiveness (R2 = .317; Adjusted R2 = .249). The five investigated variables presented a higher explanatory nature regarding team efficiency (R2 = .246; Adjusted R2 = .165).CONCLUSIONS:The study suggested the creation of multi-dimensional and multi-disciplinary HTA units to increase their effectiveness. HTA units should be monitored by the hospital management board, because an excessive increase in multi-disciplinary and size could determine inefficiency. Trust within members and the attendance of HTA training course improve performance. According to these results, the study gave solutions both to the scholars of HTA and to hospitals strategic management boards, paving the way to the determination of a more efficient and effective HTA units composition.
VP167 Comparison Of Methodology In Mixed Treatment Comparisons Of Treatments For Multiple Sclerosis
Authors: Sormani Maria , Giovannoni Gavin , Wolff Robert , Duffy Steve , Kinter Elizabeth , Wakeford Craig , Hyde Robert , Kleijnen Joseph , Birnie Richard 
Published: January 2018

INTRODUCTION:The expanding range of disease modifying therapies (DMT) for relapsing-remitting multiple sclerosis (RRMS) has led to increased interest in the relative effects of different DMTs. Previous mixed treatment comparisons (MTCs) have used different methods to address similar questions highlighting the need for a consistent approach to the assessment of treatments in RRMS.METHODS:We compared the methodology of six published MTCs of DMTs for RRMS identified by a systematic search of the literature. We assessed sources of evidence, DMTs included, outcomes reported and methods of data synthesis.RESULTS:All six MTCs were based on systematic reviews that included randomized controlled trials (RCTs). MS relapse was reported as the rate ratio based on annualised relapse rates (four MTCs) and as odds ratios or relative risk (one MTC each) based on the proportion with relapse. The analysis of relapse included between sixteen and twenty-seven RCTs and seven to twenty DMTs in different MTCs. One MTC reported both disability progression confirmed after three months (CDP3M) and disability progression confirmed after six months (CDP6M) as hazard ratios. One MTC combined CDP3M and CDP6M as a single outcome. One MTC reported only CDP3M based on hazard ratios. Two MTCs reported only CDP6M as either odds ratios or risk ratios (one MTC each). In one MTC the definition of disability progression was not reported. The analysis of disability included between seven and twenty-six RCTs and between six and nineteen DMTs in different MTCs. All six MTCs fitted a random effects MTC model using either Bayesian (four MTCs) or frequentist (two MTCs) methods.CONCLUSIONS:There is substantial heterogeneity between published MTCs in RRMS with regard to inclusion criteria, outcome definitions, effect measures and statistical methods. There is a clear requirement for a consistent approach to health technology assessment of DMTs for RRMS.
VP191 Peripheral Nerve Field Stimulation For Chronic Low Back Pain
Authors: Rhainds Marc , Larocque Brigitte , Bussières Sylvain , Nourrisat Alice , Coulombe Martin , Cantin Léo , Canuel Jean-Francois , Prudhomme Michel 
Published: January 2018

INTRODUCTION:Despite numerous medical, pharmacological and surgical approaches for chronic low back pain (LBP), many patients continue to complain of severe disabling pain. Peripheral nerve field stimulation (PNfS), alone or combined with spinal cord stimulation, is a neuromodulation procedure that have been recently developed and implemented in our hospital. We conducted a Health Technology Assessment (HTA) to determine if PNfS may be considered as a standard of practice in the management of intractable LBP and failed back surgery syndrome (FBSS).METHODS:An interdisciplinary group of experts was involved in the project. A systematic review (SR) was performed in several databases and grey literature to identify clinical practice guidelines, SR and observational studies published through September 2016. A survey was conducted among other chronic pain centers in Canada to document PNfS use in LBP and FBSS treatment.RESULTS:Data on effectiveness and safety of PNfS in chronic LBP treatment were scarce. Short-term results (3-12 months) from small sample and low quality studies suggest that PNfS, alone or combined with spinal cord stimulation, is associated with pain intensity and opioid use reductions. Effects on functional status and quality of life remain undetermined. Most frequent adverse events reported with PNfS devices are lead migrations, discomfort or pain and surgical site infections. No other Canadian pain centers were found to use PNfS in chronic LBP or FBSS.CONCLUSIONS:PNfS is potentially a beneficial treatment option for patients with chronic low back pain or FBSS. However, the value of this innovative treatment remains unknown. Among factors to be clarified are target population (any chronic low back pain or FBSS), use of PNfS alone or combined with spinal cord stimulation, long-term effects, and comparison with conventional medical management. PNfS use in chronic LBP has to be assessed through a rigorous framework before its introduction as a standard medical practice.
VP209 Two-Way Short Message Service (SMS) For Better Engagement And Quality Bio-Surveillance System
Authors: Dang Linh , Wong Jordan , Le Thuy , Phan Ngoc , James Spencer , Katona Peter , Vu Nguyen , Vu Thiem , Katona Lindsay , Rosen Joseph , Nguyen Cuong 
Published: January 2018

INTRODUCTION:Along with the exponential growth of technology, the use of mobile devices in health, or mHealth, has been quickly becoming a viable practice to strengthen health systems, especially in low-resource settings. Nevertheless, the majority of mHealth interventions are pilot efforts which mostly lack robust design and evidence about the use of mHealth in public health. This study assessed the use of a bi-directional Short Message Service (SMS) in disease surveillance in Vietnam and aimed to bring evidence in improving engagement of health staff as well as the quality of reporting.METHODS:Eighty health staff from fourty communes of Hoa Binh and Hung Yen provinces were trained and participated in two 6-month pilots: one with one-way, and one with a bi-directional SMS system for assisting in error screening, and reminder and feedback provision to report two diseases: influenza and diarrhea using cell phones. After each examination and checking-in onto the paper logbook, participants reported the case by texting an SMS to a designated number and made notes of successfully reported cases. A central data repository server was set up to collect SMS reports, and aggregate reported patient data. Engagement of health staff and quality of the reporting work were assessed by the evaluation of the qualitative questionnaires, and the comparison of the texted SMS reports to the patient logbooks.RESULTS:With the use of a two-way versus one-way SMS system, participants were 4.6 times more likely (95 percent Confidence Interval, CI 3.93-5.44, p< .001) to send correctly formatted text reports, and 3.4 times more likely (95 percent CI 2.72-4.33, p< .001) to have precise information in their texted messages. Results also revealed that while their position, age, or gender of participants did not statistically influence the results, ethnicity and management roles did.CONCLUSIONS:The study showed that the use of a bi-directional SMS-based reporting system both significantly improved participants engagement in the reporting protocol, and greatly enhanced their reporting quality. The study demonstrated that robust evidence of a practical utilization of SMS in a disease reporting system to replace the traditional paper-based one has great potential for a scale-up and national-wide implementation.
Resonant plasma excitation by single-cycle THz pulses
Authors: Curcio A. , Marocchino A. , Dolci V. , Lupi S. , Petrarca M. 
Published: January 2018

AbstractIn this paper, an alternative perspective for the generation of millimetric high-gradient resonant plasma waves is discussed. This method is based on the plasma-wave excitation by energetic single-cycle THz pulses whose temporal length is comparable to the plasma wavelength. The excitation regime discussed in this paper is the quasi-nonlinear regime that can be achieved when the normalized vector potential of the driving THz pulse is on the order of unity. To investigate this regime and determine the strength of the excited electric fields, a Particle-In-Cell (PIC) code has been used. It has been found that by exploiting THz pulses with characteristics currently available in laboratory, longitudinal electron plasma waves with electric gradients up to hundreds MV/m can be obtained. The mm-size nature of the resonant plasma wave can be of great utility for an acceleration scheme in which high-brightness electron bunches are injected into the wave to undergo a strong acceleration. The long-size nature of the acceleration bucket with respect to the short length of the electron bunches can be handled in a more robust manner in comparison with the case when micrometric waves are employed.
Epigallocatechin gallate (EGCG) reduces the intensity of pancreatic amyloid fibrils in human islet amyloid polypeptide (hIAPP) transgenic mice
Authors: Franko Andras , Rodriguez Camargo Diana C. , Böddrich Annett , Garg Divita , Rodriguez Camargo Andres , Rathkolb Birgit , Janik Dirk , Aichler Michaela , Feuchtinger Annette , Neff Frauke , Fuchs Helmut , Wanker Erich E. , Reif Bernd , Häring Hans-Ulrich , Peter Andreas , Hrabě de Angelis Martin 
Published: January 2018

AbstractThe formation of amyloid fibrils by human islet amyloid polypeptide protein (hIAPP) has been implicated in pancreas dysfunction and diabetes. However, efficient treatment options to reduce amyloid fibrils in vivo are still lacking. Therefore, we tested the effect of epigallocatechin gallate (EGCG) on fibril formation in vitro and in vivo. To determine the binding of hIAPP and EGCG, in vitro interaction studies were performed. To inhibit amyloid plaque formation in vivo, homozygous (tg/tg), hemizygous (wt/tg), and control mice (wt/wt) were treated with EGCG. EGCG bound to hIAPP in vitro and induced formation of amorphous aggregates instead of amyloid fibrils. Amyloid fibrils were detected in the pancreatic islets of tg/tg mice, which was associated with disrupted islet structure and diabetes. Although pancreatic amyloid fibrils could be detected in wt/tg mice, these animals were non-diabetic. EGCG application decreased amyloid fibril intensity in wt/tg mice, however it was ineffective in tg/tg animals. Our data indicate that EGCG inhibits amyloid fibril formation in vitro and reduces fibril intensity in non-diabetic wt/tg mice. These results demonstrate a possible in vivo effectiveness of EGCG on amyloid formation and suggest an early therapeutical application.
Prime-boost vaccination with recombinant protein and adenovirus-vector expressing Plasmodium vivax circumsporozoite protein (CSP) partially protects mice against Pb/Pv sporozoite challenge
Authors: de Camargo Tarsila Mendes , de Freitas Elisângela Oliveira , Gimenez Alba Marina , Lima Luciana Chagas , de Almeida Caramico Karina , Françoso Kátia Sanches , Bruna-Romero Oscar , Andolina Chiara , Nosten François , Rénia Laurent , Ertl Hildegund C. J. , Nussenzweig Ruth S. , Nussenzweig Victor , Rodrigues Mauricio M. , Reyes-Sandoval Arturo , Soares Irene S. 
Published: January 2018

AbstractVaccine development against Plasmodium vivax malaria lags behind that for Plasmodium falciparum. To narrow this gap, we administered recombinant antigens based on P. vivax circumsporozoite protein (CSP) to mice. We expressed in Pichia pastoris two chimeric proteins by merging the three central repeat regions of different CSP alleles (VK210, VK247, and P. vivax-like). The first construct (yPvCSP-AllFL) contained the fused repeat regions flanked by N- and C-terminal regions. The second construct (yPvCSP-AllCT) contained the fused repeat regions and the C-terminal domain, plus RI region. Mice were vaccinated with three doses of yPvCSP in adjuvants Poly (I:C) or Montanide ISA720. We also used replication-defective adenovirus vectors expressing CSP of human serotype 5 (AdHu5) and chimpanzee serotype 68 (AdC68) for priming mice which were subsequently boosted twice with yPvCSP proteins in Poly (I:C) adjuvant. Regardless of the regime used, immunized mice generated high IgG titres specific to all CSP alleles. After challenge with P. berghei ANKA transgenic parasites expressing Pb/PvVK210 or Pb/PvVK247 sporozoites, significant time delays for parasitemia were observed in all vaccinated mice. These vaccine formulations should be clinically tried for their potential as protective universal vaccine against P. vivax malaria.