LOCAL HEALTH TECHNOLOGY ASSESSMENT IN CANADA: CURRENT STATE AND NEXT STEPS.

OBJECTIVES: Canada has witnessed expansion of the health technology assessment (HTA) infrastructure in the last 25 years. Local HTA entities at the hospital or regional level are emerging to assist decision makers in the acquisition, implementation, maintenance, and disinvestment of healthcare technologies. There is a need to facilitate collaboration and exchange of expertise and knowledge between these entities regarding the role of local HTA in Canada. METHODS: In November 2013, the pan-Canadian Collaborative hosted a symposium, Hospital/Regional HTA: Local Evidence-based Decisions for Health Care Sustainability, bringing together over 60 HTA producers, researchers, stakeholders, and manufacturers involved in local HTA across Canada. The objective was to showcase the diversity of local HTA in Canada, while highlighting common gaps to be addressed. RESULTS: The Symposium focused on current practices in local HTA in Canada to support informed decision making, and opportunities for information sharing and provide equal access to timely evidence-based information to decision makers. The main themes included assessment of evidence for local HTA, contextualization, stakeholder engagement in local HTA, knowledge translation and impact of recommendations, and challenges and opportunities for local HTA. CONCLUSIONS: Local HTA in Canada complements HTAs conducted at the provincial and federal levels to improve the efficient and effective health service delivery in institutions or regions faced with limited resources. Some challenges faced by local HTA producers to influence hospital policies and clinical practice involve the engagement of healthcare professionals and potential lack of training and support necessary for the introduction of a new technology.

Pheromone-Based Monitoring of Spruce Budworm (Lepidoptera: Tortricidae) Larvae in Relation to Trap Position.

The local abundance of male spruce budworm, Choristoneura fumiferana (Clemens) (Lepidoptera: Tortricidae), was evaluated in the province of Quebec at 112 locations between 2002­2012 using pheromone-baited traps deployed on lower branches near the ground level (GL) or in the tree canopy (TC; three traps at GL and TC for each location); in addition, the presence of second instars (L2) was assessed at each location on three balsam fir branches. Numbers of moths captured at GL and TC were highly correlated, and the regression parameters did not vary between years. Consequently, estimates of L2 based on pheromone trap catches are precise independent of trap location, and deploying traps at ground level (rather than in the tree canopy) does not come with a loss of accuracy in L2 assessments. Relationships between moths (x) and L2 (y) exhibited strong nonlinearity and were most adequately described by exponential functions of the form: ln (y+1)=[ß0+ß1×k ln (x)]. A conservative threshold of 100 males per trap at GL (corresponding to one L2 per branch) may be used to guide forest managers in the transition from endemic to epidemic populations. Relationships between L2 and moths are likely influenced by the number of traps per site; hence, the tentative threshold above is only valid for jurisdictions relying on three traps per site. Considering the economic importance and rising populations of spruce budworm, rigorous quality control programs must be implemented promptly to ensure a steady supply of standardized pheromone lures across years.

A population-based study on blood lead levels in blood donors.

BACKGROUND: Recent studies suggested that blood transfusion may represent a significant source of lead exposure in premature infants. Objectives of this study were to determine blood lead levels (BLLs) in a representative sample of blood donors and to identify risk factors associated with BLLs of 0.15 µmol/L or more. STUDY DESIGN AND METHODS: A study was conducted in 2006 to 2007 in 49 drive sites in Quebec. Individuals who qualified for blood donation were eligible to participate. Information was harvested from blood donor file and a standardized self-administered questionnaire. Lead analysis was performed by inductively coupled plasma mass spectrometry. Data on Quebec blood donors from 2003 to 2006 (n = 320,543) were used to establish a reference population. Geometric mean (GM) and 95% confidence interval (CI) were used to describe the results. The project was approved by an ethics committee. RESULTS: Of 6715 eligible individuals, 3490 participated (1392 women and 2098 men). Their mean age was 46.5 years. Results were weighted for region, sex, and age. The GM of BLLs was 0.082 µmol/L (95% CI, 0.027-0.247; range, 0.011-2.90 µmol/L). BLLs of more than 0.15 µmol/L were found in 15.5% of participants. In multivariate analysis, BLLs were mainly explained by age and sex of participants (p < 0.001). A significant association was also found between BLLs and the region of residence, education level, dwelling age, occupational and leisure activities at high risk for lead exposure, smoking, and alcohol intake (p < 0.001). CONCLUSION: BLL in blood donors is strongly explained by sex and age, a fact that can be taken into consideration when transfusing neonates.

FRAMEWORK FOR USER INVOLVEMENT IN HEALTH TECHNOLOGY ASSESSMENT AT THE LOCAL LEVEL: VIEWS OF HEALTH MANAGERS, USER REPRESENTATIVES, AND CLINICIANS.

OBJECTIVES: The aim of this study was to explore stakeholders' points of views regarding the applicability and relevance of a framework for user involvement in health technology assessment (HTA) at the local level. We tested this framework in the context of the assessment of alternative measures to restraint and seclusion among hospitalized adults and those living in long-term-care facilities. METHODS: Twenty stakeholders (health managers, user representatives, and clinicians) from seven regions of Quebec participated in a semi-structured interview. A thematic analysis of the transcribed interviews was performed. RESULTS: The findings highlighted the relevance and applicability of the framework to this specific HTA. According to interviewees, direct participation of users in the HTA process allows them to be part of the decision-making process. User consultation makes it possible to consider the views of a wide variety of people, such as marginalized and vulnerable groups, who do not necessarily meet the requirements for participating in HTA committees. However, some user representatives emphasized that user consultation should be integrated into a more holistic and participatory perspective. The most frequent barrier associated with user involvement in HTA was the top-down health system, which takes little account of the user's perspective. CONCLUSIONS: The proposed framework was seen as a reference tool for making practitioners and health managers aware of the different mechanisms of user involvement in HTA and providing a structured way to classify and describe strategies. However, there is a need for more concrete instruments to guide practice and support decision making on specific strategies for user involvement in HTA at the local level.

Use of nonsteroidal anti-inflammatory drugs in colorectal surgery: do the risks cast a shadow on the benefits?

Nonsteroidal anti-inflammatory drug (NSAID) use is recognized as a key component of the Enhanced Recovery After Surgery protocols and is systematically recommended in colorectal surgery to optimize perioperative care. However, a red flag about this practice has been raised because clinical studies have recently pointed out an increased risk of anastomotic leak after colorectal surgery following NSAID administration. Therefore, we used the Bradford Hill criteria to examine this potential relationship and concluded that use of perioperative NSAIDs in colorectal surgery should be evaluated carefully and on an individual basis considering the potentially increased risk of anastomotic leak and its consequences.

Introducing the patient's perspective in hospital health technology assessment (HTA): the views of HTA producers, hospital managers and patients.

BACKGROUND: The recent establishment of health technology assessment (HTA) units in University hospitals in the Province of Quebec (Canada) provides a unique opportunity to foster increased participation of patients in decisions regarding health technologies and interventions at the local level. However, little is known about factors that influence whether the patient's perspective is taken into consideration when such decisions are made. OBJECTIVE: To explore the practices, perceptions and views of the various HTA stakeholders concerning patient involvement in HTA at the local level. METHOD: Data were collected using semi-structured interviews with 24 HTA producers and hospital managers and two focus groups with a total of 13 patient representatives. RESULTS: Patient representatives generally showed considerable interest in being involved in HTA. Our findings support the hypothesis that the patient perspective contributes to a more accurate and contextualized assessment of health technologies and produces HTA reports that are more useful for decision makers. They also suggest that participation throughout the assessment process could empower patients and improve their knowledge. Barriers to patient involvement in HTA at the local level are also discussed as well as potential strategies to overcome them. DISCUSSION AND CONCLUSION: This study contributes to knowledge that could guide interventions in favour of patient participation in HTA activities at the local level. Experimenting with different patient involvement strategies and assessing their impact is needed to provide evidence that will inform future interventions of this kind.

Involving patient in the early stages of health technology assessment (HTA): a study protocol.

BACKGROUND: Public and patient involvement in the different stages of the health technology assessment (HTA) process is increasingly encouraged. The selection of topics for assessment, which includes identifying and prioritizing HTA questions, is a constant challenge for HTA agencies because the number of technologies requiring an assessment exceeds the resources available. Public and patient involvement in these early stages of HTA could make assessments more relevant and acceptable to them. Involving them in the development of the assessment plan is also crucial to optimize their influence and impact on HTA research. The project objectives are: 1) setting up interventions to promote patient participation in three stages of the HTA process: identification of HTA topics, prioritization, and development of the assessment plan of the topic prioritized; and 2) assessing the impact of patient participation on the relevance of the topics suggested, the prioritization process, and the assessment plan from the point of view of patients and other groups involved in HTA. METHODS: Patients and their representatives living in the catchment area of the HTA Roundtable of Université Laval's Integrated University Health Network (covering six health regions of the Province of Quebec, Canada) will be involved in the following HTA activities: 1) identification of potential HTA topics in the field of cancer; 2) revision of vignettes developed to inform the prioritization of topics; 3) participation in deliberation sessions for prioritizing HTA topics; and 4) development of the assessment plan of the topic prioritized. The research team will coordinate the implementation of these activities and will evaluate the process and outcomes of patient involvement through semi-structured interviews with representatives of the different stakeholder groups, structured observations, and document analysis, mainly involving the comparison of votes and topics suggested by various stakeholder groups. DISCUSSION: This project is designed as an integrated approach to knowledge translation and will be conducted through a close collaboration between researchers and knowledge users at all stages of the project. In response to the needs expressed by HTA producers, the knowledge produced will be directly useful in guiding practices regarding patient involvement in the early phases of HTA.

[Patient participation in the assessment of alternatives to restraint and seclusion]. / La participation des patients à ;'évaluation des mesures alternatives à la contention et à l'isolement.

AIM: To explore the perceptions of members of a working group of caregivers, health technology assessment (HTA) units members, healthcare facilities managers and patients representatives regarding the participation of the latter in the assessment of alternatives to restraint and seclusion among adults in short-term psychiatric wards and in long-term care facilities for the elderly, in Quebec. METHODS: A descriptive design was used for this research based on fifteen semi-structured interviews with caregivers, healthcare managers, patient representatives and HTA unit members. The direct observation of two meetings of the working group and informal discussions with participants at these meetings was also performed. Data analysis was based on a framework developed to assess patients' involvement in HTA. RESULTS: Information resources and human resources were mobilized to support the participation of patients' representatives. Nevertheless, this participation was uneven between patients' representatives due to their personal characteristics, the understanding of their role in this working group and expectations of the committee. The presence of patient representatives led caregivers and managers to focus the assessment on patients' concerns and to adjust the language used during the meeting. Moreover, organizational and political context has been identified as a facilitator for this participation. CONCLUSION: Involving patients' representatives in HTA activities is thus possible. However, some resources must be mobilized to equip patients' representatives who participate in these activities and personal characteristics should be considered when selecting them to favour their involvement

Mass Trapping Lepidopteran Pests with Light Traps, with Focus on Tortricid Forest Pests: What If?

The management of Lepidopteran pests with light traps (LTs) is often achieved by luring adults to death at light sources (light trap-based mass trapping, or LTmt). Large-scale LTmt programs against agricultural pests initiated in the late 1920s in the United States were phased out in the 1970s, coinciding with the rise of pheromone-based management research. The interest in LTmt has surged in recent years with the advent of light emitting diodes, solar power sources, and intelligent design. The first step in implementing LTmt is to identify a trapping design that maximizes the capture of target pests and minimizes the capture of non-target beneficial insects-with a cautionary note that high captures in LTs are not equivalent to the feasibility of mass trapping: the ultimate objective of LTmt is to protect crop plants from pest damage, not to trap adults. The captures of egg-carrying females in light traps have a greater impact on the efficiency of LTmt than the captures of males. When LTmt is defined as a harvesting procedure, the biomass of females in LTs may be viewed as the best estimator of the mass trapping yield; biomass proxy has universal application in LTmt as every living organism can be defined on a per weight basis. While research has largely focused on agricultural pests, an attempt is made here to conceptualize LTmt as a pest management strategy in forest ecosystems, using spruce budworm as a case study. The mass trapping of female budworms is impossible to achieve in endemic populations due to the large spatial scale of forest landscapes (implying the deployment of a prohibitively large number of LTs); in addition, ovipositing female budworms do not respond to light sources at a low density of conspecifics. The light-based mass trapping of female budworms may provide a realistic management option for geographically isolated forest stands heavily infested with budworms, as a tool to prevent tree mortality. Somehow unexpectedly, however, one factor obscuring the feasibility of LTmt is as follows: the complex ('unknowable') economic valuation of forest stands as opposed to agricultural landscapes.

Assessment of the economic relevance of the use of single-use digital flexible ureteroscopes: A systematic review.

INTRODUCTION: Breakages and repairs related to flexible digital reusable ureteroscopes (flURS) are expensive. Thus, we aimed to assess the cost-effectiveness of single-use flexible digital ureteroscopes (SUDFU). METHODS: We conducted a literature review on MEDLINE and EMBASE until September 19, 2018. Systematic reviews and guidelines were assessed for methodologic quality by using standardized grids (R-AMSTAR and AGREE-II). Original studies were analyzed according to local customized grids. The CAPS (Critical Appraisal Skills Program) tool enabled the assessment of the economic aspects in the literature. We also collected local data over a year in 2017-2018 and conducted an economic evaluation by cost minimization, comparing SUDFU and flURS in our center. By generating different flURS breakage reduction scenarios, we aimed to demonstrate the budgetary impact that would have SUFDU introduction in our center. RESULTS: Five economic studies were included. Data on flURS showed breakage rates between 6.4% and 13.2%, and mean numbers of interventions before breakage between 7.5 and 14.4. Four of the five economic analyses suggested a higher cost per intervention with SUDFU. Our local data demonstrated similar results (6.4% and 11.8 cases) and enabled us to estimate the annual number of ureteroscopies for which SUDFU would become profitable: 11-26 (depending on the chosen device). Furthermore, we illustrated how selective use of SUFDU can reduce annual costs by avoiding breakages in different scenarios. CONCLUSIONS: The mean cost per intervention with SUDFU is usually higher than with flURS in high-volume centers and exclusive use becomes unprofitable from a small number of cases.

Involving patients in HTA activities at local level: a study protocol based on the collaboration between researchers and knowledge users.

BACKGROUND: The literature recognizes a need for greater patient involvement in health technology assessment (HTA), but few studies have been reported, especially at the local level. Following the decentralisation of HTA in Quebec, Canada, the last few years have seen the creation of HTA units in many Quebec university hospital centres. These units represent a unique opportunity for increased patient involvement in HTA at the local level. Our project will engage patients in an assessment being carried out by a local HTA team to assess alternatives to isolation and restraint for hospitalized or institutionalized adults. Our objectives are to: 1) validate a reference framework for exploring the relevance and applicability of various models of patient involvement in HTA, 2) implement strategies that involve patients (including close relatives and representatives) at different stages of the HTA process, 3) evaluate intervention processes, and 4) explore the impact of these interventions on a) the applicability and acceptability of recommendations arising from the assessment, b) patient satisfaction, and c) the sustainability of this approach in HTA. METHODS: For Objective 1, we will conduct individual interviews with various stakeholders affected by the use of alternatives to isolation and restraint for hospitalized or institutionalized adults. For Objective 2, we will implement three specific strategies for patient involvement in HTA: a) direct participation in the HTA process, b) consultation of patients or their close relatives through data collection, and c) patient involvement in the dissemination of HTA results. For Objectives 3 and 4, we will evaluate the intervention processes and the impact of patient involvement strategies on the recommendations arising from the HTA and the understanding of the ethical and social implications of the HTA. DISCUSSION: This project is likely to influence future HTA practices because it directly targets knowledge users' need for strategies that increase patient involvement in HTA. By documenting the processes and outcomes of these involvement strategies, the project will contribute to the knowledge base related to patient involvement in HTA.

Experiences of Using Cochrane Systematic Reviews by Local HTA Units.

This study evaluated the use of Cochrane systematic reviews (CSRs) by Quebec's local health technology assessment (HTA) units to promote efficiency in hospital decision-making. An online survey was conducted to examine: Characteristics of the HTA units; Knowledge about works and services from the Cochrane Collaboration; Level of satisfaction about the use of CSRs; Facilitating factors and barriers to the implementation of CSRs evidence in a local context; Suggestions to improve the use of CSRs. Data accuracy was checked by 2 independent evaluators. Ten HTA units participated. From their implementation a total of 321 HTA reports were published (49.8% included a SR). Works and services provided by the Cochrane collaboration were very well-known and HTA units were highly satisfied with CSRs (80%-100%). As regards to applicability in HTA and use of CSRs, major strengths were as follow: Useful as resource for search terms and background material; May reduce the workload (eg, brief review instead of full SR); Use to update a current review. Major weaknesses were: Limited use since no CSRs were available for many HTA projects; Difficulty to apply findings to local context; Focused only on efficacy and innocuity; Cannot be used as a substitute to a full HTA report. This study provided a unique context of assessment with a familiar group of producers, users and disseminators of CSRs in hospital setting. Since they generally used other articles from the literature or produce an original SR in complement with CSRs, this led to suggestions to improve their use of CSRs. However, the main limit for the use of CRS in local HTA will remain its lack of contextualisation. As such, this study reinforces the need to consider the notion of complementarity of experimental data informing us about causality and contextual data, allowing decision-making adapted to local issues.

Introducing patients' and the public's perspectives to health technology assessment: A systematic review of international experiences.

OBJECTIVES: The aim of this study was to review international experiences of patient or public involvement in the field of health technology assessment (HTA). METHODS: A systematic review of the scientific literature was conducted. A literature search was performed across nine databases. Other literature was identified through citation tracking, government websites (HTA agencies), and Internet search engines. Characteristics of the studies, description of the activities related to patient or public involvement, impact of these activities on the HTA process, and factors facilitating or limiting involvement were abstracted independently by two reviewers. RESULTS: A total of 1,441 potentially relevant papers were identified by the main search strategy. Among these, seventeen papers met the inclusion criteria; other search strategies identified seven additional documents. The findings reveal that patient or public involvement in HTA activities was reported in two domains, research and HTA process. In the research domain, patients are consulted to gather evidence about their perspectives, experiences, or preferences about a health technology. These perspectives could add key dimensions to the evaluation of health technologies that might otherwise be overlooked. In the domain of the HTA process, patients or public representatives participate in different stages of this process: prioritization, evidence assessment, or dissemination of findings. CONCLUSIONS: There are few published examples of experiences involving patients and the public in HTA. These examples show that patients' or the public's perspectives could add important dimensions to the evaluation of health technologies. However, there is a need to develop more systematic approaches to considering patients' and the public's perspectives in HTA.

Evidence for limited spatial spread in an exotic longhorn beetle, Tetropium fuscum (Coleoptera: Cerambycidae).

The longhorn beetle Tetropium fuscum F. (Coleoptera: Cerambycidae) has become established in Nova Scotia, Canada, where it coexists with Tetropium cinnamopterum Kirby. The two Tetropium species share a similar ecological niche and use the same volatile cues for mate attraction. Exotic T. fuscum was introduced near Halifax, Nova Scotia, in approximately 1990, but the rate of its spread 20 yr later has not been documented. We report a large-scale, 3-yr study that investigates the distribution of T. fuscum relative to its site of introduction. Traps baited with male-produced pheromone and host volatiles were used to estimate the relative abundance of the two Tetropium species. Adult T. fuscum emerged 1-2 wk earlier than T. cinnamopterum each year between 2008 and 2010. The spatial distribution of T. fuscum was characterized by a sharp decline in abundance in relation to its point of introduction, up to a threshold distance of approximately 80 km beyond which T. fuscum is rare in comparison with native T. cinnamopterum. The restricted range of T. fuscum 20 yr after its introduction may be attributed to limited dispersal of adults or reproductive failures of low-density populations. The distribution of T. fuscum seemed stable between 2008 and 2010. In 1 of 3 yr, the abundance of T. cinnamopterum increased with the distance to the site of introduction of T. fuscum, which suggests competitive interactions between the two Tetropium species.

Derivation of Pheromone-Based Larval Thresholds in Spruce Budworm Accounting for Distance to Defoliated Forest Stands.

Spruce budworm, Choristoneura fumiferana Clem. (Lepidoptera: Tortricidae), is the most severe defoliator of Pinaceae in Nearctic boreal forests. Three tools widely used to guide large-scale management decisions (year-to-year defoliation maps; density of overwintering second instars [L2]; number of males at pheromone traps) were integrated to derive pheromone-based thresholds corresponding to specific intergenerational transitions in larval densities (L2i → L2i+1), taking into account the novel finding that threshold estimates decline with distance to defoliated forest stands (DIST). Estimates of thresholds were highly variable between years, both numerically and in terms of interactive effects of L2i and DIST, which limit their heuristic value. In the context of early intervention strategy (L2i+1 > 6.5 individuals per branch), however, thresholds fluctuated within relatively narrow intervals across wide ranges of L2i and DIST, and values of 40-200 males per trap may thus be used as general guideline.

Potential of suction traps as a monitoring tool for Aphis glycines (Hemiptera: Aphididae) in soybean fields.

The current study evaluated the potential of using counts of winged adults captured in suction traps to forecast the local abundance of soybean aphid, Aphis glycines Matsumura (Hemiptera: Aphididae), in soybean, Glycine max (L.) Merr., fields. The abundance of aphids was evaluated weekly by sampling plants in four to 11 soybean fields and recording the number of aphids in suction traps between 2006 and 2008 in four counties in Indiana and Illinois. Fields in each county were located within 10 km of their respective suction trap, which allowed us to evaluate the relation between aphid abundance on soybean plants and in suction traps at the county level. Migrant soybean aphids caught in suction traps exhibited distinct seasonal trends each year: in 2006, trapped migrants consisted predominantly of individuals dispersing from soybean to buckthorn (Rhamnus sp.); in 2007, in contrast, the majority of trapped migrants were apparently individuals dispersing among soybean fields. The cumulative number of aphids captured in suction traps was positively related to aphid densities on soybean plants. However, the utility of suction traps as a monitoring tool may be limited by the variation in temporal patterns observed in suction traps and on soybean plants each year, and the spatial variation in aphid abundance among soybean fields within a county.

Variation in Wing Load of Female Spruce Budworms (Lepidoptera: Tortricidae) During the Course of an Outbreak: Evidence for Phenotypic Response to Habitat Deterioration in Collapsing Populations.

Reproduction in female spruce budworms, Choristoneura fumiferana, entails sedentary oviposition early in life (gravid females with their heavy abdomen full of eggs are unable to sustain flight), followed by short- and long-range dispersal by females that have laid a portion of their eggs. Body size measurements (wing surface area and dry weight) of gravid females, spent females at death (after all eggs are laid), and inflight females captured at light traps were collected at one location (forest stands near Fredericton in New Brunswick) over multiple years, from the outbreak stage (1976-1979: peak budworm abundance) to late declining phase with collapsing populations (1988-1989, following near two-fold magnitude of decline in adult density after 1987). For both demographic phases, females rarely flew until having laid at least 40% of their eggs, in contradiction to the hypothesis that females in defoliated forest stands can fly upon emergence due to their light-weight abdomen. As expected, the weight and fecundity of females in 1988-1989 was significantly lower than early on; in terms of body size (wing surface area), however, females were larger in late outbreak phase. These trends suggest that females have evolved morphological adaptation to further dispersal from deteriorated habitats.

Introducing patient perspective in health technology assessment at the local level.

BACKGROUND: Recognizing the importance of increased patient participation in healthcare decisions leads decision makers to consider effective ways to incorporate patient perspectives in Health Technology Assessment (HTA) processes. The implementation of local health HTA units in university hospitals in Quebec provides a unique opportunity to foster an increased participation of patients in decisions regarding health technologies and clinical interventions. This project explores strategies that could be effective in involving patients in HTA activities at the local level. To do so, three objectives are pursued: 1) To synthesise international knowledge and experiences on patient and public involvement in HTA activities; 2) To explore the perceptions of stakeholders (administrators, clinical managers, healthcare professionals, HTA producers, and patients) regarding strategies for involving patients in various HTA activities; and 3) To produce a consensual strategic framework that could guide interventions for involving patients in HTA activities at the local level. METHODS: A systematic review of the literature will be conducted to synthesise international knowledge and experiments regarding the implication of patients and public in HTA. Then, focus groups will be carried out with representatives of various stakeholder groups in order to explore their perceptions regarding patient participation in HTA. Based on findings from the systematic review and the focus groups, a framework to support patient participation in HTA activities will be proposed. It will then be validated during a deliberative meeting with the research team, composed of scientists and decision makers, and representatives from different groups involved in HTA in Quebec. This deliberative meeting will aim at identifying the type and the degree of participation as well as the adequate timing for involving patients in local HTA activities. DISCUSSION: Given the actual state of evidence, integrating patient perspective in HTA activities has the potential to improve the quality of healthcare services. This study provides an opportunity to bridge the gap between HTA producers and its ultimate end-user: the patient. It will provide guidance to support local HTA units in Quebec and elsewhere in their decisions regarding patient participation. The framework developed could be applied to design and implement strategies for involving patients in HTA activities.

Control of bagworms (Lepidoptera: Psychidae) using contact and soil-applied systemic insecticides.

The current study evaluated the effect of different classes of insecticides against bagworms (Lepidoptera: Psychidae) on arborvitae by using a laboratory bioassay that allowed us to simultaneously evaluate the feeding rate, growth, and mortality of larvae. Soil application of the systemic insecticides dinotefuran and (to a lesser extent) chlothianidin increased larval mortality and reduced the feeding rate and growth of larvae, up to 50 d posttreatment. The effectiveness of systemic insecticides against bagworms makes them well suited to control bagworms on tall trees heavily infested in the upper canopy. Chlorantranilipole and indoxacarb were as effective in controlling bagworms as other contact insecticides commercially available (spinosad and bifenthrin). Chlorantraniliprole had a residual effect 10 d posttreatment and may therefore provide an effective tool to protect the foliage of arborvitae against bagworms over a sustained period.

Decision-Making on New Non-Drug Health Technologies by Hospitals and Health Authorities in Canada.

INTRODUCTION: Unlike those for publicly funded drugs in Canada, coverage decision-making processes for non-drug health technologies (NDTs) are not well understood. OBJECTIVES: This paper aims to describe existing NDT decision-making processes in different healthcare organizations across Canada. METHODS: A self-administered survey was used to determine demographic and financial characteristics of organizations, followed by in-depth interviews with senior leadership of consenting organizations to understand the processes for making funding decisions on NDTs. RESULTS: Seventy-three and 48 organizations completed self-administered surveys and telephone interviews, respectively (with 45 participating in both ways). Fifty-five different processes were identified, the majority of which addressed capital equipment. Most involved multidisciplinary committees (with medical and non-medical representation), but the types of information used to inform deliberations varied. Across all processes, decision-making criteria included local considerations such as alignment with organizational priorities. CONCLUSIONS: NDT decision-making processes vary in complexity, depending on characteristics of the healthcare organization and context.