Enhancing equity in access to automated insulin delivery systems in an ethnically and socioeconomically diverse group of children with type 1 diabetes.

INTRODUCTION: Manufacturer-supported didactic teaching programmes offer effective automated insulin delivery (AID) systems onboarding in children and young people (CYP) with type 1 diabetes (T1D). However, this approach has limited flexibility to accommodate the needs of families requiring additional support. RESEARCH DESIGN AND METHODS: Evaluate the efficacy of an inperson manufacturer-supported didactic teaching programme (Group A), in comparison to a flexible flipped learning approach delivered virtually or inperson (Group B). Retrospective analysis of CYP with T1D using continuous glucose monitoring (CGM), who were initiated on AID systems between 2021 and 2023. Compare CGM metrics from baseline to 90 days for both groups A and B. Additionally, compare the two groups for change in CGM metrics over the 90-day period (∆), patient demographics and onboarding time. RESULTS: Group A consisted of 74 CYP (53% male) with median age of 13.9 years and Group B 91 CYP (54% male) with median age of 12.7 years. From baseline to 90 days, Group A lowered mean (±SD) time above range (TAR, >10.0 mmol/L) from 47.6% (±15.0) to 33.2% (±15.0) (p<0.001), increased time in range (TIR, 3.9-10.0 mmol/L) from 50.4% (±14.0) to 64.7% (±10.2) (p<0.001). From baseline to 90 days, Group B lowered TAR from 51.3% (±15.1) to 34.5% (±11.3) (p<0.001) and increased TIR from 46.5% (±14.5) to 63.7% (±11.0) (p<0.001). There was no difference from baseline to 90 days for time below range (TBR, <3.9 mmol/L) for Group A and Group B. ∆ TAR, TIR and TBR for both groups were comparable. Group B consisted of CYP with higher socioeconomic deprivation, greater ethnic diversity and lower carer education achievement (p<0.05). The majority of Group B (n=79, 87%) chose virtual flipped learning, halving diabetes educator time and increasing onboarding cadence by fivefold. CONCLUSIONS: A flexible virtual flipped learning programme increases onboarding cadence and capacity to offer equitable AID system onboarding.

Desenvolvimento e validação de software web de apoio à gestão da assistência pré-natal / Desarrollo y validación de software web de apoyo a la gestión de la atención prenatal / Development and validation of web software to support prenatal care management

Resumo Objetivo Descrever o processo de desenvolvimento e validação de um software web de apoio à gestão da assistência pré-natal. Métodos Pesquisa de produção tecnológica, realizada entre março e agosto de 2022, com base em princípios e técnicas do método Scrum. As funcionalidades do software web, com acesso e funções específicas a três diferentes usuários (Administrador, Gestor e Visitante), foram desenvolvidas de forma colegiada entre desenvolvedores, pesquisadores, gestores e profissionais da saúde, a partir de necessidades práticas relacionadas à gestão da assistência pré-natal. Resultados O software web é uma ferramenta de apoio à gestão da assistência pré-natal, com potencial para gerar infográficos que denotem intercorrências gestacionais e que permitem, de forma ágil e segura, à tomada de decisões estratégicas loco-regionais. Conclusão O processo de desenvolvimento e validação do software web de apoio à gestão da assistência pré-natal deu-se de forma colegiada entre desenvolvedores, pesquisadores, gestores e profissionais da saúde, a partir de necessidades práticas relacionadas à gestão da assistência pré-natal. A ferramenta foi desenvolvida de modo a possibilitar acesso e funções específicas a três diferentes usuários (Administrador, Gestor e Visitante), com vistas à tomada de decisões rápidas e seguras.

Resumen Objetivo Describir el proceso de desarrollo y validación de un software web de apoyo a la gestión de la atención prenatal. Métodos Investigación de producción tecnológica, realizada entre marzo y agosto de 2022, con base en principios y técnicas de la metodología Scrum. Las funcionalidades del software web, con acceso y funciones específicas para tres usuarios (administrador, gestor y visitante), se desarrollaron de forma colegiada entre desarrolladores, investigadores, gestores y profesionales de la salud, a partir de necesidades prácticas relacionadas con la gestión de la atención prenatal. Resultados El software web es una herramienta de apoyo a la gestión de la atención prenatal, con potencial para generar infográficos que indiquen complicaciones gestacionales y que permitan tomar decisiones estratégicas locorregionales de forma ágil y segura. Conclusión El proceso de desarrollo y validación del software web de apoyo a la gestión de la atención prenatal se realizó de forma colegiada entre desarrolladores, investigadores, gestores y profesionales de la salud, a partir de necesidades prácticas relacionadas con la gestión de la atención prenatal. La herramienta se desarrolló a fin de permitir el acceso y funciones específicas para tres diferentes usuarios (administrador, gestor y visitante), con el objetivo de tomar decisiones rápidas y seguras.

Abstract Objective To describe the development and validation process of a web software to support the management of prenatal care. Methods Technological development research, carried out between March and August 2022, based on principles and techniques of the Scrum method. The functionalities of the web software, with access and specific functions for three different users (Administrator, Manager and Visitor), were developed jointly by developers, researchers, managers and health professionals, based on practical needs related to the management of prenatal care. Results The web software is a tool to support the management of prenatal care, with the potential to generate infographics that denote gestational intercurrences and that allow, in an agile and safe way, the making of local-regional strategic decisions. Conclusion The process of development and validation of the web software to support the management of prenatal care was carried out jointly by developers, researchers, managers and health professionals, based on practical needs related to the management of prenatal care. The tool was developed in order to allow access and specific functions to three different users (Administrator, Manager and Visitor), with a view to making quick and safe decisions.

Asimetrías entre la coordinación nacional y la autonomía de los gobiernos estatales en la adopción de tecnologías sanitarias frente a la COVID-19 en Argentina / Asymmetries between national articulation and the autonomy of state governments in implementing health technologies to fight COVID-19 in Argentina / Assimetrias entre a articulação nacional e a autonomia de governos estaduais na implementação de tecnologias de saúde em combate à COVID-19 na Argentina

Resumen: En pandemia, en Argentina y en otros países se observó variabilidad en las políticas públicas implementadas sobre tecnologías sanitarias para prevención y tratamiento de la COVID-19. El objetivo fue analizar cómo se procesaron en Argentina los movimientos de coordinación vs. cooperación, y de autonomía vs. reparto de autoridad entre entidades, explorando asimetrías entre diferentes entidades en la implementación de políticas públicas sobre tecnologías sanitarias en pandemia y las influencias de otros actores. Se realizó una revisión documental del período 2020-2021 (informes técnicos publicados por la Organización Mundial de la Salud, organismos nacionales y sociedades científicas, leyes, fallos judiciales, prensa, encuestas y entrevistas en profundidad a miembros de los Ministerios de Salud de Argentina). Se indagó sobre procesos y resultados de la toma de decisiones en los Ministerios de Salud, mapeando la cobertura y recomendación de cada tecnología y el partido político provincial gobernante. Hubo heterogeneidad en resultados y procesos entre los Ministerios, y disputas en el interior de los mismos. La adherencia a recomendaciones oficiales fue baja, influyendo distintos criterios técnico-políticos (relaciones de poder, presión social, de los medios, académicos, poder Judicial y Legislativo). En algunos casos se observó una fuerte tensión entre oficialismo y oposición al partido gobernante a partir de la discusión sobre tecnologías. Cada provincia argentina definió sus políticas sobre tecnologías sanitarias para COVID-19 con autonomía, y la toma de decisiones en la administración pública en pandemia fue desordenada, compleja y no lineal.

Abstract: Argentina, as other countries, showed several public policies related to the health technologies implemented to fight and treat the COVID-19 pandemic. This study sought to analyze how articulation vs. cooperation and autonomy vs. division of powers between entities occurred in Argentina, exploring asymmetries between several entities in implementing public policies related to health technologies during the pandemic and the influences of other actors. For this, a documentary research was carried out related to 2020-2021 (technical reports published by the World Health Organization, national agencies and scientific societies, laws, court decisions, press, and research and in-depth interviews with members of the Argentine Ministries of Health). The processes and results of decision-making in the Ministries of Health were analyzed, outlining the coverage and orientations of each technology and the political party in power in the province. This study found heterogeneous results and processes between Ministries and disputes within them. It also observed the poor adherence to official guidelines due to technical-political criteria (power relations, social, media, academic, judiciary, and legislative pressure). Some cases showed a strong tension between the government and its opposition over the discussion of technologies. Each province in Argentina has autonomously defined its policies on health technologies for COVID-19, and decision-making in public administration was disorderly, complex, and non-linear during the pandemic.

Resumo: Na Argentina, assim como em outros países, houve uma variabilidade de políticas públicas relacionadas às tecnologias de saúde implementadas no combate e tratamento da COVID-19 durante a pandemia. Este estudo buscou analisar como ocorreram a articulação vs. cooperação, e a autonomia vs. divisão de poderes entre as entidades na Argentina, explorando assimetrias entre diferentes entidades na implementação de políticas públicas relacionadas a tecnologias de saúde na pandemia, bem como as influências de outros atores. Para tanto, realizou-se uma pesquisa documental para o período de 2020-2021 (relatórios técnicos publicados pela Organização Mundial da Saúde, agências nacionais e sociedades científicas, leis, decisões judiciais, imprensa, pesquisas e entrevistas em profundidade com membros dos Ministérios da Saúde da Argentina). Os processos e os resultados da tomada de decisão nos Ministérios da Saúde foram analisados, traçando a cobertura e orientações de cada tecnologia e o partido político no poder na província. Observou-se uma heterogeneidade nos resultados e processos entre os Ministérios, e disputas em seu interior. Houve uma baixa adesão às orientações oficiais, influenciada por diferentes critérios técnico-políticos (relações de poder, pressão social, midiática, acadêmica, do poder Judiciário e do Legislativo). Em alguns casos, observou-se uma forte tensão entre governo e oposição a partir da discussão das tecnologias. Cada província da Argentina definiu suas políticas sobre tecnologias de saúde para a COVID-19 de forma autônoma, e a tomada de decisões na administração pública foi desordenada, complexa e não linear durante a pandemia.

Assessment of educational technology in lactation physiology by health students / Evaluación de tecnología educativa en fisiología de la lactancia por estudiantes de salud / Avaliação de tecnologia educacional de fisiologia da lactação por estudantes da saúde

ABSTRACT Objectives: to assess the suitability, facilitators, and barriers of using a video clip for teaching lactation physiology to health students. Methods: a cross-sectional study was conducted with online data collection at a higher education institution, using the Assistive Technology Assessment Instrument and open-ended questions. The sample consisted of 88 students. Results: the video clip was deemed suitable in all attributes. Facilitators identified included attractiveness, musicality, and ease of access. Barriers noted were the music's speed and the necessity for prior knowledge. The video clip achieved adequate scores for interactivity (1.71), purpose (1.77), relevance (1.64), and clarity (1.77). The overall average of the attributes was 1.72. Conclusions: the video clip can serve as an effective learning strategy to enhance hybrid education, potentially contributing to the promotion and support of breastfeeding. However, some barriers underscore the importance of prior knowledge for a complete understanding of the content.

RESUMEN Objetivos: evaluar la idoneidad, los facilitadores y las barreras del uso de un videoclip para enseñar fisiologia de la lactancia a estudiantes de salud. Métodos: se realizo un estudio transversal con recopilación de datos en línea en una institución de educación superior, utilizando el Instrumento de Evaluación de Tecnologia Asistiva y preguntas abiertas. La muestra consistió en 88 estudiantes. Resultados: el videoclip fue considerado adecuado en todos los atributos. Los facilitadores identificados incluyeron atractivo, musicalidad y facilidad de acceso. Las barreras señaladas fueron la velocidad de la música y la necesidad de conocimientos previos. El videoclip obtuvo puntuaciones adecuadas en interactividad (1.71), propósito (1.77), relevancia (1.64) y claridad (1.77). El promedio general de los atributos fue de 1.72. Conclusiones: el videoclip puede servir como una estrategia de aprendizaje efectiva para mejorar la educación híbrida, potencialmente contribuyendo a la promoción y el apoyo de la lactancia materna. Sin embargo, algunas barreras subrayan la importancia del conocimiento previo para una comprensión completa del contenido.

RESUMO Objetivos: avaliar a adequação, facilitadores e barreiras para o uso de um videoclipe para aprendizagem da fisiologia da lactação por estudantes da saúde. Métodos: estudo transversal com coleta de dados online em uma instituição de ensino superior, utilizando o Instrumento de Avaliação de Tecnologia Assistiva e questões abertas. A amostra incluiu 88 estudantes. Resultados: o videoclipe foi avaliado como adequado em todos os atributos. Facilitadores identificados incluíram atratividade, musicalidade e praticidade de acesso. Barreiras apontadas foram a velocidade da música e a necessidade de conhecimento prévio. O videoclipe obteve média adequada para interatividade (1,71), objetivo (1,77), relevância (1,64) e clareza (1,77). A média global dos atributos foi 1,72. Conclusões: o videoclipe pode ser utilizado como estratégia de aprendizagem que potencializa o ensino híbrido na formação, com potencial para contribuir com a promoção e apoio ao aleitamento materno. No entanto, algumas barreiras destacam a necessidade de conhecimento prévio para a compreensão total do conteúdo.

Technological advances in obstetric nursing consultations using ultrasound / Avances tecnológicos en consultas de enfermería obstétrica utilizando ultrasonido / Avanço tecnológico na consulta de enfermagem obstétrica com uso de ultrassonografia

ABSTRACT Objective: to understand how ultrasound tools are used in prenatal Nursing consultations from the perspective of obstetric nurses. Method: a descriptive and qualitative study carried out with ten obstetric nurses that use obstetric ultrasound in their Nursing consultations at a maternity hospital in Belo Horizonte, Minas Gerais, Brazil. Individual, semi-structured interviews were conducted between December 1st and 4th, 2021. The Atlas.ti software was employed to process the results using Bardin's thematic content analysis. Results: the obstetric nurses expanded comprehensive care for pregnant women by implementing the use of ultrasound technology during Obstetric Nursing consultations, thus innovating the practices in Brazil. However, they faced countless challenges, which they overcame thanks to the positive results of improving obstetric and fetal care. Conclusion: using ultrasound technology in Obstetric Nursing consultations represents an advance in the Nursing practice, as it enables access and qualification to timely care, free of charge and through the Unified Health System. The support and encouragement of the institutional management strengthened obstetric nurses' professional autonomy, mediating the implementation of innovation. The study focus is added to the technological development employed in the everyday work of Brazilian Nursing, increasing resoluteness of decision-making in health problems.

RESUMEN Objetivo: comprender cómo se utiliza la herramienta de ultrasonido en consultas de Enfermería prenatal, según la opinión de enfermeras especializadas en Obstetricia. Método: estudio descriptivo de enfoque cualitativo, realizado en una maternidad de Belo Horizonte, Minas Gerais, Brasil, con diez enfermeras(os) especializadas(os) en Obstetricia que utilizan ultrasonido obstétrico en consultas de Enfermería. Se llevaron a cabo entrevistas individuales y semiestructuradas entre el 1 y el 4 de diciembre de 2021. Se utilizó el programa de software Atlas.ti para procesar los resultados por medio de análisis temático de contenido según Bardin. Resultados: las enfermeras especializadas en Obstetricia ampliaron la atención integral provista a las embarazadas, implementando el uso de la tecnología de ultrasonido durante las consultas de Enfermería Obstétrica, innovando así las prácticas de la profesión en Brasil. No obstante, enfrentaron innumerables desafíos, que fueron superados gracias a los resultados positivos de calificación de la atención obstétrica y fetal. Conclusión: utilizar la tecnología de ultrasonido en consultas de Enfermería Obstétrica representa un avance en la práctica de Enfermería, puesto que permite acceder y calificar los cuidados en tiempo y forma, de manera gratuita y a través del Sistema Único de Salud. El apoyo e incentivo por parte de la gerencia institucional fortalecieron la autonomía profesional de las enfermeras especializadas en Obstetricia, mediando la implementación de la innovación. El punto central del estudio se suma al desarrollo tecnológico empleado en la rutina de trabajo de los profesionales de Enfermería en Brasil, expandiendo así la capacidad de resolución del proceso de toma de decisiones relacionado con problemas de salud.

RESUMO Objetivo: compreender o uso da ferramenta ultrassonográfica na consulta de enfermagem de pré-natal sob a perspectiva das enfermeiras obstétricas. Método: estudo descritivo, de abordagem qualitativa, realizado em uma maternidade de Belo Horizonte, Minas Gerais, Brasil, com dez enfermeiras(os) obstétricas(os) que utilizam a ultrassonografia obstétrica na consulta de enfermagem. Entrevista individual, semiestruturada, realizada entre 1º e 4 de dezembro de 2021. Utilizou-se o software Atlas.ti para o tratamento dos resultados por meio da análise de conteúdo temática de Bardin. Resultados: as enfermeiras obstétricas ampliaram o cuidado integral às gestantes, implementando a utilização da tecnologia ultrassonográfica durante a consulta de enfermagem obstétrica, inovando as práticas no Brasil. Entretanto, enfrentaram inúmeros desafios, que foram superados graças aos resultados positivos de qualificação do cuidado obstétrico e fetal. Conclusão: a utilização da tecnologia ultrassonográfica na consulta de enfermagem obstétrica significa um avanço na prática de enfermagem, pois possibilita acesso e qualificação ao cuidado em tempo oportuno, gratuitamente, pelo Sistema Único de Saúde. O apoio e o incentivo da gestão institucional fortaleceram a autonomia profissional das enfermeiras obstétricas, mediando a implementação da inovação. O foco do estudo soma-se ao desenvolvimento tecnológico empregado no cotidiano de trabalho da enfermagem brasileira, ampliando a resolubilidade da tomada de decisão aos agravos à saúde.

Dynamic HTA for digital health solutions: opportunities and challenges for patient-centered evaluation.

OBJECTIVES: Germany's 2019 Digital Healthcare Act (Digitale-Versorgung-Gesetz, or DVG) created a number of opportunities for the digital transformation of the healthcare delivery system. Key among these was the creation of a reimbursement pathway for patient-centered digital health applications (digitale Gesundheitsanwendungen, or DiGA). Worldwide, this is the first structured pathway for "prescribable" health applications at scale. As of October 10, 2023, 49 DiGA were listed in the official directory maintained by Germany's Federal Institute for Drugs and Medical Devices (BfArM); these are prescribable by physicians and psychotherapists and reimbursed by the German statutory health insurance system for all its 73 million beneficiaries. Looking ahead, a major challenge facing DiGA manufacturers will be the generation of the evidence required for ongoing price negotiations and reimbursement. Current health technology assessment (HTA) methods will need to be adapted for DiGA. METHODS: We describe the core issues that distinguish HTA in this setting: (i) explicit allowance for more flexible research designs, (ii) the nature of initial evidence generation, which can be delivered (in its final form) up to one year after becoming reimbursable, and (iii) the dynamic nature of both product development and product evaluation. We present the digital health applications in the German DiGA scheme as a case study and highlight the role of RWE in the successful evaluation of DiGA on an ongoing basis. RESULTS: When a DiGA is likely to be updated and assessed regularly, full-scale RCTs are infeasible; we therefore make the case for using real-world data and real-world evidence (RWE) for dynamic HTAs. CONCLUSIONS: Continous evaluation using RWD is a regulatory innovation that can help improve the quality of DiGAs on the market.

Proposing a health-specific organizational impact framework to evaluate organizational impacts in health technology assessments.

OBJECTIVES: Health technology assessments (HTAs) have traditionally included clinical and cost-effectiveness evaluation of new health technologies (HTs). However, new HTs can generate important organizational impacts (OIs) that influence their overall value. OIs are currently not clearly identified and evaluated in HTA procedures and tools are limited. To address this issue, a comprehensive framework that allows to assess OIs of new HTs in HTAs is proposed. METHODS: A working and methodological group identified the Oslo Manual 2018, 4th edition, OECD/Eurostat, on the objectives and outcomes of commercial innovations as the basis for the OIs framework for HTAs. The Oslo Manual was translated to the healthcare sector and adapted to HTA procedures through a three-step process. RESULTS: The framework is composed of three main parts. Part I tackles the context of the evaluation, Part II the categories of impacts and the specific impacts - in total, 16 OIs were identified - and Part III the stakeholders involved. The central part of the framework is Part II, and consists of three categories of impacts: (i) on the care process, (ii) on the stakeholders' capabilities and skills, and (iii) on society or the community. CONCLUSIONS: This framework provides a comprehensive and structured basis to document OIs of new HTs. It thus contributes to the extension of HTA evaluation criteria to other dimensions than clinical and economic aspects, that is, organizational aspects. Some of its intrinsic limitations and the questions they raise in the field for policy-makers, practitioners, and researchers are discussed.

Enablers and barriers to adopt the locally developed Masi mechanical ventilator amid COVID-19 pandemic in Peru.

Background: Limited supply of resources during the COVID-19 emergency encouraged the local development of the Masi mechanical ventilator (MV). Despite the efforts to promote Masi, adopting this innovation faced multiple obstacles, regardless of its performance. We explored the perceptions among healthcare personnel towards incorporating Masi to provide ventilatory support to COVID-19 patients during the second wave in Peru (January to June 2021). Methods: We conducted twelve in-depth virtual interviews. Topics included experience when handling Masi, the impact of the training received, confidence in the device, barriers perceived, and enablers identified. All participants provided verbal informed consent. Results: Most of the participants were male physicians. Participants belonged to seven hospitals that exhibited a wide range of healthcare capacities. Globally, the adoption of Masi MV was driven by the scarcity of ventilatory devices in the wards and reinforced by appropriate training and prompt technical support. Participants reported that Masi's structural and operational features played both advantages and disadvantages. Hospital infrastructure readiness, availability of commercial MVs, mistrust in its simple appearance, and resistance to change among healthcare personnel were perceived as barriers, while low-cost, prompt technical support and user-friendliness were valuable enablers. The first two enablers were observed in participants regardless of their attitude towards Masi. Despite the small number of participants for this qualitative study, it is important to note that the sample size was sufficient to reach saturation, as the topics discussed with participants became redundant and did not yield new information. Conclusions: The perceptions among healthcare personnel to incorporate Masi as a mechanical ventilator for COVID-19 patients showed that communication, training and experience, and peer encouragement were essential to secure its use and sustainability of the technology. A priori judgments and perceptions unrelated to the performance of the novel device were observed, and its proper management may define its further implementation. Altogether our study suggests that along with strengthening local technological development, strategies to improve their adoption process must be considered as early as possible in medical innovations.

Closing the loop between horizon scanning and health technology assessment - an overview of topics submitted for appraisal in England.

OBJECTIVES: Horizon scanning for health technology appraisal (HTA) in England involves topic notification to the National Institute for Health and Care Excellence (NICE) via technology briefings. This activity is undertaken by the Innovation Observatory with submission timelines designed to ensure that HTA decisions align with regulatory approval time. In this paper, we aimed to track and assess the progression and current status of the topics notified for HTA and provide a descriptive analysis of these topics. METHODS: Technology briefings were mapped from submission to NICE technology appraisal/highly specialized technologies recommendations from April 2017 until October 2021. This was done using a combination of searches on Google and NICE website, searching a downloadable spreadsheet containing NICE topic selection decisions, and querying NICE Topic Selection team. Analysis was undertaken regarding type of indications and interventions of submitted topics and published guidance. RESULTS: Six-hundred and ninety-three topics entered the NICE scoping process, of which 94 percent were prioritized. As of November 2021, approximately 39 percent of prioritized topics were in scoping/in progress, 31 percent were proposed/completed, 20 percent were suspended/terminated, and 4 percent were referred back to Innovation Observatory (IO) for further monitoring. CONCLUSIONS: Our work demonstrates that horizon scanning for HTA is a complex and time-intensive process. Timelines and progress through HTA is challenging due to the growing number of innovative medicines, significant uncertainties, and limited transparency in clinical development and regulatory pathways. A better understanding of clinical trials and regulatory requirements may help eliminate some of this uncertainty and improve timely HTA.

[Interest in disinterestedness in the epidemiology of health systems and services]. / El interés del desinterés en la epidemiología de servicios y sistemas de salud.

This article intends to critique of the cultural authority of the medical sciences, opening up a discussion on its publicization from a political standpoint. At the same time, from a more technical standpoint, it proposes the implementation of an epidemiology of health systems and services. Based on Pierre Bourdieu's concept of interest in disinterestedness and Joseph Gusfield's notion of the cultural authority of public problems, it analyzes why epidemiological information is so rarely used in the evaluation and monitoring of clinical, population, institutional, and territorial practices. That is, why does the dominant culture of decision making eschew epidemiological information? Within this conceptual framework, a body of documental evidence is analyzed that sheds light on the weak scientific basis that upholds or that has underpinned certain practices in the health field at different historical moments. The discussion is organized around three major themes: assistentialist professional practice, medication, and biomedical technologies.

Este trabajo se propone problematizar, discutir y publicizar la autoridad cultural de la medicina científica, desde una dimensión política, y la implementación de la epidemiología de los servicios y sistemas de salud, desde una dimensión técnica. A partir de los conceptos de interés del desinterés, de Pierre Bourdieu, y de autoridad cultural de los problemas públicos de Joseph Gusfield se analiza ¿por qué la información epidemiológica es tan poco utilizada para la evaluación y monitoreo de las prácticas clínicas, poblacionales, institucionales y territoriales?, ¿por qué domina una cultura de toma de decisiones sin información epidemiológica? Desde este marco conceptual, se aborda un cuerpo documental que permite recuperar la débil cientificidad que sustentaron o sustentan algunas prácticas del campo de la salud en diferentes momentos históricos, organizado en tres ejes temáticos: la práctica profesional asistencial, los medicamentos y las tecnologías biomédicas.

Ciencia, tecnología y sociedad en el modelo formativo para la gestión de la evaluación de tecnologías sanitarias / Science, technology and society in the training model for the management of health technology assessment i: en

La educación de posgrado en Cuba tiene una función determinante en el desarrollo de los profesionales. Al respecto, en la Universidad de Ciencias Médicas de Santiago de Cuba se ha implementado un modelo formativo para la gestión de la evaluación de las tecnologías sanitarias, en el cual se establece la interrelación e interconexión del enfoque en ciencia, tecnología y sociedad, así como el empleo del contexto y la contextualización en los referentes que permiten la transformación del proceso de formación de posgrado. En el actual artículo se expone cómo la aplicación de dicho modelo ha contribuido a moldear la preparación e incrementar la cultura de los gestores de ciencia, tecnología e innovación en salud, a la vez que ha favorecido la calidad de la educación de posgrado desde una perspectiva integral, materializada en la mejora de su gestión.

Postgraduate education in Cuba has a determining role in the development of professionals. In this regard, the University of Medical Sciences from Santiago de Cuba has implemented a training model for the management of health technologies assessment, which establishes the interrelation and interconnection of the approach in science, technology and society, as well as the use of context and contextualization in the referents that allow the transformation of postgraduate training process. In the current article, it is exposed how the application of said model has contributed to shaping the training and improving the culture of health science, technology and innovation managers, at the same time that it has favored the quality of postgraduate education from an integral perspective, materialized in the improvement of its management.

La importancia de la evaluación de tecnologías sanitarias: estado del arte / The importance of health technology assessment: state of the art / A importância da avaliação da tecnologia em saúde: o estado da arte

En un contexto de atención médica en constante evolución, la evaluación de tecnologías sanitarias se ha vuelto esencial. Este proceso evalúa la efectividad, seguridad y costo-efectividad de las tecnologías médicas, desde medicamentos hasta dispositivos. La evaluación respalda decisiones clínicas informadas, reduciendo la variabilidad en la práctica y mejorando la atención al paciente. Además, desempeña un papel crucial en las políticas de salud al guiar la asignación eficiente de recursos y promover el acceso equitativo a las tecnologías sanitarias. Como conclusión se puede decir que la evaluación de tecnologías sanitarias es esencial para garantizar sistemas de salud sostenibles y una atención de calidad.

In an ever-evolving healthcare environment, health technology assessment has become essential. This process evaluates the effectiveness, safety and cost-effectiveness of medical technologies, from drugs to devices. The assessment supports informed clinical decisions, reducing practice variability and improving patient care. It also plays a crucial role in health policy by guiding the efficient allocation of resources and promoting equitable access to health technologies. In conclusion, health technology assessment is essential to ensure sustainable health systems and quality care.

Em um contexto de saúde em constante evolução, a avaliação da tecnologia da saúde tornou-se essencial. Esse processo avalia a eficácia, a segurança e a relação custo-benefício das tecnologias médicas, de medicamentos a dispositivos. A avaliação apóia decisões clínicas fundamentadas, reduzindo a variabilidade na prática e melhorando o atendimento ao paciente. Ela também desempenha um papel fundamental na política de saúde, orientando a alocação eficiente de recursos e promovendo o acesso equitativo às tecnologias de saúde. Em conclusão, a avaliação da tecnologia em saúde é essencial para garantir sistemas de saúde sustentáveis e atendimento de qualidade.

Bioinspired Approaches to Engineer Antithrombogenic Medical Devices for Vascular Intervention.

Medical devices form a critical component of health care systems for treating and maintaining patient health. However, devices exposed to blood are prone to blood clotting (thrombosis) and bleeding complications leading to device occlusion, device failure, embolism and stroke, and increased morbidity and mortality. Over the years, developments in innovative material design strategies have been made to help reduce the occurrence of thrombotic events on medical devices, but complications persist. Here, we review material and surface coating technologies that have taken bioinspiration from the endothelium to reduce medical device thrombosis, either by mimicking aspects of the glycocalyx to prevent adhesion of proteins and cells to the material surface or mimicking the bioactive function of the endothelium through immobilized or released bioactive molecules to actively inhibit thrombosis. We highlight newer strategies that take inspiration from multiple aspects of the endothelium or are stimuli responsive, only releasing antithrombotic biomolecules when thrombosis is triggered. Emerging areas of innovation target inflammation to decrease thrombosis without increasing bleeding, and interesting results are coming from underexplored aspects of material properties, such as material interfacial mobility and stiffness, which show that increased mobility and decreased stiffness are less thrombogenic. These exciting new strategies require further research and development before clinical translation, including consideration of longevity, cost, and sterilization, but show capacity for the development of more sophisticated antithrombotic medical device materials.

Health technology assessment for oral health in the past decade: a scoping review.

BACKGROUND: Health technology assessment (HTA) is the systematic evaluation of various properties and effects of a health technology. HTA can serve as a bridge between the world of knowledge and that of decision making, offering decision makers the best summary of scientific evidence. Scoping HTA reports in the context of dentistry can help researchers identify grey areas; help practitioners make evidence-based decisions and further initiate better policy making. AIM: To provide an overview on HTAs pertaining to oral health and dentistry in the past decade, map the extension and scope of the methodological practices, key findings, and limitations. METHODOLOGY: A scoping review was conducted using the Joanna Briggs Institute framework. A comprehensive search for HTA reports was done through the International Network of Agencies for Health Technology Assessment Database from January 2010 to December 2020. Consecutively, electronic databases (PubMed and Google Scholar) were searched. Finally, thirty-six reports were included in this review and analyzed. RESULTS: A total of 709 articles were initially identified, of which thirty-six met the inclusion criteria. Reviewed HTAs focused on various specialties of dentistry worldwide. Maximum number of reports (N = 5) were related to "prosthodontics and dental implants" and technologies related to preventive dentistry were most commonly assessed (N = 4). CONCLUSION: Functional, appropriate, and evidence-based information provided through HTA pertaining to oral health on a regular basis will enable decision makers to have enough data to make decisions on the future use of new technology, modify existing policies, accelerate its translation into practice, and ensure provision of robust dental healthcare services.

End-User Assessment of an Innovative Clothing-Based Sensor Developed for Pressure Injury Prevention: A Mixed-Method Study.

This study aimed to evaluate a clothing prototype that incorporates sensors for the evaluation of pressure, temperature, and humidity for the prevention of pressure injuries, namely regarding physical and comfort requirements. A mixed-method approach was used with concurrent quantitative and qualitative data triangulation. A structured questionnaire was applied before a focus group of experts to evaluate the sensor prototypes. Data were analyzed using descriptive and inferential statistics and the discourse of the collective subject, followed by method integration and meta-inferences. Nine nurses, experts in this topic, aged 32.66 ± 6.28 years and with a time of profession of 10.88 ± 6.19 years, participated in the study. Prototype A presented low evaluation in stiffness (1.56 ± 1.01) and roughness (2.11 ± 1.17). Prototype B showed smaller values in dimension (2.77 ± 0.83) and stiffness (3.00 ± 1.22). Embroidery was assessed as inadequate in terms of stiffness (1.88 ± 1.05) and roughness (2.44 ± 1.01). The results from the questionnaires and focus groups' show low adequacy as to stiffness, roughness, and comfort. The participants highlighted the need for improvements regarding stiffness and comfort, suggesting new proposals for the development of sensors for clothing. The main conclusions are that Prototype A presented the lowest average scores relative to rigidity (1.56 ± 1.01), considered inadequate. This dimension of Prototype B was evaluated as slightly adequate (2.77 ± 0.83). The rigidity (1.88 ± 1.05) of Prototype A + B + embroidery was evaluated as inadequate. The prototype revealed clothing sensors with low adequacy regarding the physical requirements, such as stiffness or roughness. Improvements are needed regarding the stiffness and roughness for the safety and comfort characteristics of the device evaluated.

Análise situacional da incorporação de tecnologias em hospitais públicos federais no Brasil / Situational analysis of the technology incorporation in the brazilian federal university hospitals / Análisis situacional de la incorporación de tecnologías en hospitalares públicos federales de Brasil

Objetivo: identificar o processo de incorporação de tecnologias na Empresa Brasileira de Serviços Hospitalares, com especial atenção às Comissões de Padronização de Produtos para a Saúde. Métodos: estudo transversal, descritivo, com pesquisa exploratória de campo e análise quanti-qualitativa para um diagnóstico situacional, realizado por meio de questionário eletrônico encaminhado às 36 filiais da Empresa, em todas as regiões do Brasil, de novembro de 2019 a agosto de 2020. Empregou-se a análise quantitativa por meio de estatística descritiva e a qualitativa a partir da análise de conteúdo e de Strengths, Weakness, Opportunities, Threats. Resultados: 44,4% dos hospitais possuem Núcleos de Avaliação de Tecnologias em Saúde, enquanto 91,7% deles dispõem de Comissão de Padronização de Produtos para a Saúde formalmente constituída. As variáveis observadas com maior frequência: ausência de processos documentados, fluxos não definidos e falta de infraestrutura. Conclusão: o processo de incorporação de tecnologias ocorre de maneira desigual. Os dados podem contribuir para que a Empresa Brasileira de Serviços Hospitalares (re)defina estratégias e implemente ações, no sentido de apoiar suas filiais na constituição e implantação dessas instâncias, fundamentais no processo de incorporação de tecnologias em âmbito hospitalar. (AU)

Objective: to identify the process of incorporating technologies at the Brazilian Hospital Services Company, specially to the Commission for the Standardization of Health Products. Methods: this is a cross-sectional and exploratory study, under a descriptive approach with quantitative and qualitative analysis, which sought to perform a situational diagnosis through an electronic research questionnaire sent to the 36 branches, in all regions of Brazil, from November 2019 to August 2020. Using quantitative analysis through of descriptive statistics and qualitative analysis based on content analysis and Strengths, Weakness, Opportunities, Threats. Results: 44.4% of hospitals have Health Technology Assessment Centers, while 91.7% of them have formally constituted a Commission for the Standardization of Health Products. The most frequently observed variables: absence of documented processes, undefined flows and lack of infrastructure. Conclusion: the process of incorporating technologies occurs unevenly. The data can contribute to the Brazilian Hospital Services Company defining strategies and implementing actions, in order to support its branches in the constitution and implantation of these instances, which are fundamental in the process of incorporating technologies in the hospital environment. (AU)

Objectivo: identificar el proceso de incorporación de tecnologias en la Empresa Brasileña de Servicios Hospitalarios, con especial atención a las comisiones de estandarización de productos de salud. Métodos: estudio descriptivo transversal, con investigación de campo exploratoria y análisis cuantitativo y cualitativo para um diagnóstico situacional realizado mediante um cuestionario electrónico enviado a las 36 filiales, em todas las regiones de Brasil, de noviembre de 2019 a agosto de 2020. Usado análisis cuantitativo utilizando estadística descriptiva y la análisis cualitativo basado en análisis de contenido y de la Fortalezas, Debilidades, Oportunidades, Amenazas. Resultados: el 44,4% de los hospitales cuenta con Centros de Evaluación de Tecnologías Sanitarias, mientras que el 91,7% de ellos tiene una Comisión de Estandarización de Productos de Salud formalmente constituída. Las variables observadas con mayor frecuencia: ausencia de procesos documentados, flujos indefinidos y falta de infraestructura. Conclusión: el proceso de incorporación de tecnologías ocurre de manera desigual. Los datos pueden contribuir a que la Empresa Brasileña de Servicios Hospitalarios reinicia estrategias e implemente acciones, a fin de apoyar a sus filiales en la constitución e implantación de estas instancias, fundamentales en el proceso de incorporación de tecnologías en el ámbito hospitalario. (AU)

Acesso a um serviço de saúde público especializado: experiência no centro de referência de doença trofoblástica gestacional do Hospital São Paulo / Accessing a specialized public health service: the São Paulo Hospital reference center for gestational trophoblastic diseases

Objetivo: Analisar a trajetória das mulheres com doença trofoblástica gestacional (DTG) até o Centro de Referência de Doença Trofoblástica Gestacional do Hospital São Paulo (CRDTG-HSP), identificando as portas de entrada ao serviço e as dificuldades que elas enfrentaram desde o diagnóstico. Métodos: Estudo de caso transversal exploratório, descritivo-analítico, com abordagem quali-quantitativa, que incluiu pacientes atendidas no período de 2015 a 2018. A coleta dos dados se deu por meio de um questionário on-line e de uma entrevista com roteiro semiestruturado. Resultados: Entre 96 pacientes, 40,63% (n = 39) tiveram acesso ao CRDTG-HSP por encaminhamento entre médicos, 31,25% (n = 30), pela página do Facebook da Associação Brasileira de Doença Trofoblástica Gestacional e 10,42% (n = 10), por meio da central de regulação de vagas do estado de São Paulo (CROSS), das quais 28,2%, 73% e 30%, respectivamente, possuíam assistência privada, na qual receberam tratamento inicial. As 12 entrevistadas relataram dificuldades, tais como a percepção da falta de preparo médico no manejo e comunicação da doença, o desconhecimento da sua situação de saúde mesmo após procedimentos cirúrgicos, a exposição a conversas inapropriadas entre médicos sobre o seu caso e o recebimento de encaminhamento sem explicação esclarecedora sobre seu quadro clínico. Por fim, as pacientes avaliaram positivamente a utilização de e-mail e WhatsApp como facilitadores no atendimento no CRDTG-HSP. Conclusão: O acesso ao CRDTG-HSP ocorreu minoritariamente pela CROSS e, mesmo tendo assistência privada, pacientes migraram para atendimento no centro especializado. Além disso, as pacientes tiveram percepção de falta de preparo médico no atendimento da DTG fora do CRDTG.(AU)

Objective: To understand and elaborate the trajectories of women with gestational trophoblastic disease from the initial entry to the healthcare system to follow-up at a public tertiary reference center. Methods: This exploratory, descriptive-analytical, cross-sectional case study included patients from 2015 to 2018. The data collected through online questionnaires and semi-structured interviews were analyzed via quantitative and qualitative approaches. Statistical analysis was performed using Pearson's chi-square test at 5% significance using software R version 4.0.2. The test power for the sample was calculated using G*power software version 3.1.9.6. Results: Overall, 96 patients completed the questionnaire. Only 10(10.42%) patients reached the reference center through the official channel, Sao Paulo State Vacancy Regulation Center, while 39(40.63%) patients through referral from physicians, and 30(31.25%) patients through the Brazilian Association of Gestational Trophoblastic Disease's Facebook fan page. Overall, 36 patients (37.5%) had private insurance and 73% of patients who reached the reference center via Facebook had private insurance. Twelve participants were interviewed and reported barriers, such as difficulties in understanding their health issues prior to arrival at the reference center, lack of professional knowledge about the disease, poor communication, and exposure to inappropriate conversations. They positively evaluated the reference center, the interaction was facilitated using email and WhatsApp. Conclusion: Although appropriate public care for these women exists, the flow from the diagnosis to specialized treatment remains unclear for both professionals and patients. The participants perceived that communication and physicians' expertise were inadequate.(AU)

Preliminary evaluation of an automated robotic transfer assist device in the home setting.

PURPOSE: The purpose of this study was to examine the effects of six weeks of routine use of a novel robotic transfer device, the AgileLife Patient Transfer System, on mobility-related health outcomes, task demand, and satisfaction relative to previous transfer methods. MATERIALS AND METHODS: Six end users and five caregivers used the system in their homes for six weeks. Participants completed several surveys examining perceived demands related to preparing and performing a transfer and mobility-related health outcomes pre and post intervention. Participants were also asked about their satisfaction with using the technology compared to previous transfer methods. RESULTS: Both end users and caregivers reported reduction in perceived physical demand (p = 0.007) and work (p ≤ 0.038) when preparing for and performing a transfer. End users indicated that the device intervention had a positive impact, indicating some improvements to health-related quality of life as well as improved competence, adaptability, and self-esteem post-intervention. All participants were highly likely to recommend the technology to others. CONCLUSION: The AgileLife Patient Transfer System is a promising new form of transfer technology that may improve the mobility and mobility-related health of individuals with disabilities and their caregivers in home settings.Implications for rehabilitationRobotic transfer assistance reduced physical demand and work among end users and caregivers.The robotic device had a positive impact on some quality of life outcomes after 6 weeks of use.Users were highly likely to recommend the robotic transfer device to others.

Fidelização e impacto de tecnologias sociais em saúde centradas no usuário: nova proposta de desenvolvimento / Reliability and impact of user-centered social technologies in health: a new development proposal / Reliability and impact of user-centered social technologies in health: a new development proposal / Fidelización e impacto de tecnologías sociales en salud centradas en el usuario: nueva propuesta de desarrollo

Resumo Objetivo Descrever metodologia para o desenvolvimento de tecnologias sociais em enfermagem/saúde centradas no usuário Métodos Estudo de desenvolvimento tecnológico que apresenta proposição metodológica para a expansão de tecnologias sociais, com foco na solução de problemas oriundos de demandas dos usuários de saúde. Resultados A metodologia de aplicação tecnológica foi concebida e sistematizada em cinco fases sequenciais, quais sejam: Diagnóstico situacional, Idealização e prototipagem, Validação, Implementação, Fidelização e impacto social da aplicação. Conclusão Pretende-se, com essa nova proposta de desenvolvimento tecnológico, contribuir para a fidelização e o impacto das tecnologias sociais centradas nas necessidades dos usuários de saúde, a partir de abordagens como o Design Thinking e o Design Centrado no Usuário.

Resumen Objetivo Describir metodología para el desarrollo de tecnologías sociales en enfermería/salud centradas en el usuario Métodos Estudio de desarrollo tecnológico que presenta una proposición metodológica para la expansión de tecnologías sociales, con enfoque en la solución de problemas originarios de demandas de los usuarios de salud. Resultados La metodología de aplicación tecnológica fue formulada y sistematizada en cinco etapas secuenciales, a saber: Diagnóstico situacional, Idealización y creación de prototipo, Validación, Implementación, Fidelización e impacto social de la aplicación. Conclusión Con esta nueva propuesta de desarrollo tecnológico se pretende contribuir para la fidelización y para el impacto de las tecnologías sociales centradas en las necesidades de los usuarios de salud, a partir de intervenciones como el Design Thinking y el Design Centrado en el Usuario.

Abstract Objective To describe the methodology for developing user-centered social technologies in nursing/health Methods A technological development study that presents a methodological proposal for the expansion of social technologies, with a focus on solving problems arising from the demands of healthcare users. Results The technological application methodology was conceived and systematized in five sequential steps, namely: Situational diagnosis, Ideation and prototyping, Validation, Implementation, Reliability, and social impact of the application. Conclusion With this new technological development proposal, we intend to contribute to the reliability and impact of social technologies centered on health users' needs, based on approaches such as Design Thinking and User-Centered Design.

Video clip for learning the physiology of lactation: evaluation by the family support network for breastfeeding women / Videoclip para aprender la fisiología de la lactancia: evaluación realizada por la red de apoyo familiar para mujeres en lactancia / Videoclipe para aprendizagem da fisiologia da lactação: avaliação pela rede de apoio familiar às lactantes

ABSTRACT Objective: to evaluate the adequacy of using a care-educational technology with video clips for learning the physiology of lactation by the family support network for breastfeeding women. Method: a methodological study guided by the Knowledge Translation in Action Model. The collection procedure was carried out from July to September 2022 in the city of Santa Cruz do Sul, state of Rio Grande do Sul, Brazil. After the childcare consultation, each puerperal woman indicated one or more members of her support network to participate in the research. In face-to-face interviews, 52 participants answered the following instruments: Assistive Technology Assessment and Face Validation of Educational Technologies in Health. Normality of the variables was verified using the Kolmogorov-Smirnov test. The quantitative variables with normal distribution were described by mean and standard deviation. Face Validity Index and Cronbach's Alpha were calculated. Results: the video clip was evaluated as adequate (1.75) in all attributes: Interactivity (1.75), Objectivity (2.00), Relevance and efficacy (2.00) and Clarity (2.00). Face validity was excellent (0.969). Both instruments obtained Cronbach's Alpha values of 0.883 and 0.852, respectively, indicating reliability in this population. Conclusion: the video clip for learning the physiology of lactation is suitable for use by the family support network for breastfeeding mothers.

RESUMEN Objetivo: evaluar lo adecuado de utilizar una tecnología de atención-educativa del tipo videoclip para aprender la fisiología de la lactancia con la red de apoyo familiar para mujeres en lactancia. Método: estudio metodológico guiado por el Modelo de Traducción del Conocimiento en Acción. Los datos se recolectaron entre julio y septiembre de 2022 en la ciudad de Santa Cruz do Sul, estado do Río Grande do Sul, Brasil. Después de la consulta de puericultura, cada puérpera indicó al menos un integrante de su red de apoyo para que participara de la investigación. En sendas entrevistas presenciales, 52 participantes respondieron los siguientes instrumentos: Evaluación de Tecnología de Asistencia y Validación de la Apariencia de Tecnologías Educativas en Salud. La normalidad de las variables se verificó con la prueba de Kolmogorov-Smirnov. Las variables cuantitativas con distribución normal se describieron con valores medios y desviaciones estándar. Se calcularon el Índice de Validez de la Apariencia y el coeficiente Alpha de Cronbach. Resultados: el videoclip fue evaluado como adecuado (1,75) en todos los atributos: Interactividad (1,75), Objetividad (2,00), Relevancia y eficacia (2,00) y Claridad (2,00). La validez de la apariencia fue excelente (0,969). Ambos instrumentos obtuvieron coeficientes Alpha de Cronbach de 0,883 y 0,852 respectivamente, indicando confiabilidad en esta población. Conclusión: el videoclip para aprender la fisiología de la lactancia es adecuado para ser usado por la red de apoyo familiar para mujeres en lactancia.

RESUMO Objetivo: Avaliar a adequação do uso da tecnologia cuidativo-educacional, do tipo videoclipe, para aprendizagem da fisiologia da lactação pela rede de apoio familiar às lactantes. Método: Estudo metodológico, guiado pelo Modelo de Tradução do Conhecimento em Ação. A coleta foi desenvolvida na cidade de Santa Cruz do Sul, no Estado do Rio Grande do Sul, Brasil, no período de julho a setembro de 2022. Após a consulta de puericultura, a puérpera indicou um ou mais membros de sua rede de apoio para participar da pesquisa. Em entrevista presencial, 52 participantes responderam os instrumentos: Avaliação de Tecnologia Assistiva e Validação de Aparência de Tecnologias Educacionais em Saúde. A normalidade das variáveis foi verificada com o teste de Kolmogorov Smirnov. As variáveis quantitativas com distribuição normal foram descritas pela média e o desvio padrão. Foram calculados o Índice de Validade de Aparência e o Alpha de Cronbach. Resultados: O videoclipe foi avaliado como adequado (1,75) em todos os atributos interatividade (1,75), objetividade (2,00), relevância e eficácia (2,00) e clareza (2,00). A validade de aparência foi excelente (0,969). Ambos os instrumentos obtiveram Alpha de Cronbach, 0,883 e 0,852 respectivamente, apontando a confiabilidade nesta população. Conclusão: O videoclipe para aprendizagem da fisiologia da lactação está adequado ao uso pela rede de apoio familiar às lactantes.