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1.
Expert Rev Pharmacoecon Outcomes Res ; 23(10): 1177-1183, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-37755333

RESUMO

INTRODUCTION: Evidence generation for the health technology assessment (HTA) of a new technology is a long and expensive process with no guarantees that the health technology will be adopted and implemented into a health-care system. This would suggest that there is a greater risk of failure for a company developing a high-cost technology and therefore incentives (such as increasing the funding available for research or additional market exclusivity) may be needed to encourage development of such technologies as has been seen with many high-cost orphan drugs. AREAS COVERED: This paper discusses some of the key issues relating to the evaluation of high-cost technologies through the use of existing HTA processes and what the challenges will be going forward. EXPERT OPINION: We propose that while the current HTA process is robust, its evolution into accommodating the incorporation of real-world data and evidence alongside a life-cycle HTA approach should better enable developers to produce the evidence required on effectiveness and cost-effectiveness. This should lead to reduced decision uncertainty for HTA agencies to make adoption decisions in a more timely and efficient manner. Furthermore, budget impact analysis remains important in understanding the actual financial impact on health-care systems and budgets outside of the cost-effectiveness framework used to aid decision-making.


Assuntos
Avaliação da Tecnologia Biomédica , Tecnologia de Alto Custo , Humanos , Incerteza , Tecnologia Biomédica , Produção de Droga sem Interesse Comercial , Análise Custo-Benefício
2.
O.F.I.L ; 32(2)enero 2022. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-205749

RESUMO

Objetivos: Los medicamentos de alto impacto económico (MAIE) constituyen un reto para los servicios de salud públicos de los países europeos. Sin embargo, no existe consenso sobre qué constituye un MAIE. El objetivo del estudio fue configurar una lista de MAIE dispensados por los servicios de farmacia hospitalarios y analizar la situación respecto a estos fármacos en España.Métodos: Se consideraron MAIE aquellos fármacos con un coste >10.000 €/año (MAC) o con un elevado volumen de consumo (MEC). Se estimaron los precios (PVL) por dosis diaria definida o dosis diaria prescrita.Resultados: Un total de 147 principios activos fueron considerados MAC, correspondiendo mayoritariamente con los grupos: L (69,4%), J (10,9%) y A (10,2%). El PVL medio diario de los MAC fue 218,6 € (28,6-2.892,5). El 38,8% de los MAC fueron innovadores, 26,5% huérfanos y 34,0% biológicos. Dieciséis medicamentos tuvieron un coste >10.000 €/envase. Los MEC pertenecieron principalmente al grupo L (45,0%) y J (35,0%). El PVL medio diario de los MEC fue 154,4 € (1,1-1.629,3). El 35,5% fueron innovadores, 5,0% huérfanos y 60,0% biológicos.Conclusiones: Un elevado número de MAIE son dispensados por los servicios de farmacia hospitalarios, principalmente antineoplásicos y antiinfecciosos. Aunque el PVL mínimo diario para considerar un medicamento de alto impacto es 27,4 €, el PVL medio diario de los MAC fue >200 €. Sin embargo, el elevado consumo de algunos fármacos, hace que medicamentos con un coste tan bajo como 1,1 € puedan ser considerados MAIE. Se puede establecer una nueva categoría de MAC para aquellos con un coste >10.000 €/envase. (AU)


Objetivos: Los medicamentos de alto impacto económico (MAIE) constituyen un reto para los servicios de salud públicos de los países europeos. Sin embargo, no existe consenso sobre qué constituye un MAIE. El objetivo del estudio fue configurar una lista de MAIE dispensados por los servicios de farmacia hospitalarios y analizar la situación respecto a estos fármacos en España.Métodos: Se consideraron MAIE aquellos fármacos con un coste >10.000 €/año (MAC) o con un elevado volumen de consumo (MEC). Se estimaron los precios (PVL) por dosis diaria definida o dosis diaria prescrita.Resultados: Un total de 147 principios activos fueron considerados MAC, correspondiendo mayoritariamente con los grupos: L (69,4%), J (10,9%) y A (10,2%). El PVL medio diario de los MAC fue 218,6 € (28,6-2.892,5). El 38,8% de los MAC fueron innovadores, 26,5% huérfanos y 34,0% biológicos. Dieciséis medicamentos tuvieron un coste >10.000 €/envase. Los MEC pertenecieron principalmente al grupo L (45,0%) y J (35,0%). El PVL medio diario de los MEC fue 154,4 € (1,1-1.629,3). El 35,5% fueron innovadores, 5,0% huérfanos y 60,0% biológicos.Conclusiones: Un elevado número de MAIE son dispensados por los servicios de farmacia hospitalarios, principalmente antineoplásicos y antiinfecciosos. Aunque el PVL mínimo diario para considerar un medicamento de alto impacto es 27,4 €, el PVL medio diario de los MAC fue >200 €. Sin embargo, el elevado consumo de algunos fármacos, hace que medicamentos con un coste tan bajo como 1,1 € puedan ser considerados MAIE. Se puede establecer una nueva categoría de MAC para aquellos con un coste >10.000 €/envase. (AU)


Assuntos
Humanos , Farmacoeconomia , Política de Saúde , Tecnologia de Alto Custo , Preparações Farmacêuticas
3.
Nursing (Ed. bras., Impr.) ; 23(264): 3938-3844, maio.2020.
Artigo em Português | LILACS, BDENF - Enfermagem | ID: biblio-1102660

RESUMO

Objetivou-se descrever o papel do enfermeiro auditor nos processos que envolvem Órtese, Prótese e Material Especial (OPME) em ambiente hospitalar público ou privado. Trata-se de um estudo teórico-reflexivo que propõe uma discussão sobre os processos de OPME em território brasileiro, assim como as legislações vigentes, tanto na saúde suplementar quanto no atendimento gratuito e universal praticado pelo Sistema Único de Saúde. Há uma necessidade de profissionais capacitados, com competência técnica e zelo pela segurança, para otimização no controle destes materiais, além de inibir práticas duvidosas e fraudulentas. Contribuindo com o controle e rastreabilidade dos materiais utilizados, garantindo o serviço prestado ao usuário e o monitoramento de qualidade do mesmo. Deste modo, conclui-se que a atuação do Enfermeiro Auditor nos processos de uso de OPME é primordial para que sejam cumpridas e respeitadas, conforme as normatizações e legislações vigentes, todas as etapas do processo, tanto nas instituições públicas ou privadas. Constatou-se também que poucas são as publicações científicas em âmbito nacional a respeito da temática.(AU)


The aim was to describe the role of the nurse auditor in the processes involving OPME in a public or private hospital environment. It is a theoretical-reflective study that proposes a discussion on the OPME processes in Brazilian territory, as well as the current legislation, both in supplementary health and in free and universal care practiced by the Unified Health System. There is a need for professionals trained, with technical competence and zeal for safety, to optimize the control of these materials, in addition to inhibiting doubtful and fraudulent practices. Contributing to the strict control and traceability of these inputs used, guaranteeing the service provided to the user and monitoring its quality. Therefore, it can be concluded that the role of the Nurse Auditor in the processes of use of OPME is essential for all stages of the process to be complied with and respected, in accordance with current regulations and legislation, both in public or private institutions. It was also found that there are few scientific publications nationwide on the subject.(AU)


El objetivo era describir el papel del auditor de enfermería en los procesos que involucran a OPME en un entorno hospitalario público o privado. Es un estudio teórico-reflexivo que propone una discusión sobre los procesos de OPME en el territorio brasileño, así como la legislación actual, tanto en salud complementaria como en atención gratuita y universal practicada por el Sistema Único de Salud. Se necesitan profesionales. capacitados, con competencia técnica y celo por la seguridad, para optimizar el control de estos materiales, además de inhibir prácticas dudosas y fraudulentas. Contribuyendo al estricto control y trazabilidad de estas entradas utilizadas, garantizando el servicio prestado al usuario y monitoreando su calidad. Por lo tanto, se puede concluir que el papel de la Enfermera Auditora en los procesos de uso de OPME es esencial para que se cumplan y respeten todas las etapas del proceso, de acuerdo con las regulaciones y la legislación vigente, tanto en instituciones públicas como privadas. También se descubrió que hay pocas publicaciones científicas en todo el país sobre el tema.(AU)


Assuntos
Humanos , Aparelhos Ortopédicos , Próteses e Implantes , Tecnologia de Alto Custo , Auditoria de Enfermagem
4.
Clin. transl. oncol. (Print) ; 20(12): 1493-1501, dic. 2018. tab
Artigo em Inglês | IBECS | ID: ibc-173756

RESUMO

Cancer cases are growing in an exponential way, likewise the prices of new cancer drugs. Continuing in this way, in the near future, it will be impossible to provide optimum care for all cancer patients. Therefore, it is important to establish mechanisms that enable the National Health Systems to provide the best options of treatment, either through the elaboration of decision-binding frameworks or through other initiatives that guarantee the best quality care for all oncology patients to overcome, in the best possible way, this difficult illness. Here, we review current proposals that have been established by different cancer organizations worldwide, their similarities, their differences and whether they are helpful in a real clinical setting. Facing present reality and despite these organizations’ huge efforts, these proposals are not being implemented at all and it does not seem feasible that they will in the short run. In the same way, we support and argue why oncologists should have a crucial and a preponderant role to establish the best way of guaranteeing an equal access to the latest oncology care


No disponible


Assuntos
Humanos , Oncologia/tendências , Tecnologia de Alto Custo , Neoplasias/economia , Equidade no Acesso aos Serviços de Saúde , Acesso aos Serviços de Saúde/tendências , Custos de Cuidados de Saúde/tendências , Papel Profissional
5.
PLoS One ; 13(10): e0204723, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30332422

RESUMO

Each year, evidence-based clinical guidelines gain more space in the health professionals' practice and in services organization. Due to the scarcity of scientific publications focused on diseases of poverty, the development of well-founded clinical guidelines becomes more and more important. In view of that, this paper aims to evaluate the quality of Brazilian guidelines for those diseases. The AGREE II method was used to evaluate 16 guidelines for poverty-related diseases (PRD) and 16 guidelines for global diseases whose treatment require high-cost technologies (HCD), with the ultimate aim of comparing the results. It was found that, in general, the guideline development quality standard is higher for the HCD guidelines than for the PRD guidelines, with emphasis on the "rigour of development" (48% and 7%) and "editorial independence" (43% and 1%) domains, respectively, which had the greatest discrepancies. The HCD guidelines showed results close to or above international averages, whereas the PRD guidelines showed lower results in the 6 domains evaluated. It can be concluded that clinical protocol development priorities need some redirecting in order to qualify the guidelines that define the healthcare organization and the care of vulnerable populations.


Assuntos
Custos de Cuidados de Saúde , Pobreza/economia , Guias de Prática Clínica como Assunto/normas , Brasil , Efeitos Psicossociais da Doença , Prática Clínica Baseada em Evidências/economia , Prática Clínica Baseada em Evidências/normas , Humanos , Programas Nacionais de Saúde/economia , Programas Nacionais de Saúde/normas , Doenças Negligenciadas/economia , Doenças Negligenciadas/terapia , Tecnologia de Alto Custo/economia
6.
Med. intensiva (Madr., Ed. impr.) ; 42(7): 425-443, oct. 2018.
Artigo em Espanhol | IBECS | ID: ibc-178661

RESUMO

El proyecto denominado «Compromiso por la calidad de las sociedades científicas» impulsado desde el año 2013 por el Ministerio de Sanidad, Servicios Sociales e Igualdad tiene como objetivo disminuir las intervenciones sanitarias innecesarias que no han demostrado eficacia, tienen escasa o dudosa efectividad o no son eficientes. El objetivo de este trabajo es elaborar las recomendaciones de «qué no hacer» seleccionadas para el tratamiento de los pacientes críticos. Se designó un panel de expertos de los 13grupos de trabajo (GT) de la Sociedad Española de Medicina Intensiva, Crítica y Unidades Coronarias (SEMICYUC), elegido por su experiencia clínica o científica para la realización de las recomendaciones. Se analizó la literatura publicada entre los años 2000 y 2017 sobre diferentes cuestiones asociadas a los pacientes críticos. En reuniones de cada GT, los expertos debatieron las propuestas y sintetizaron las conclusiones, que fueron finalmente aprobadas por los GT después de un amplio proceso de revisión interna, realizado durante el primer semestre de 2017. Finalmente, se elaboraron un total de 65 recomendaciones, 5 por cada uno de los 13 GT. Estas recomendaciones se basan en la opinión de expertos y en el conocimiento científico, y pretenden reducir aquellos tratamientos o procedimientos que no aporten valor al proceso asistencial, evitar la exposición de los pacientes críticos a potenciales riesgos y mejorar la adecuación de los recursos sanitarios


The project "Commitment to Quality of Scientific Societies", promoted since 2013 by the Spanish Ministry of Health, seeks to reduce unnecessary health interventions that have not proven effective, have little or doubtful effectiveness, or are not cost-effective. The objective is to establish the "do not do" recommendations for the management of critically ill patients. A panel of experts from the 13 working groups (WGs) of the Spanish Society of Intensive and Critical Care Medicine and Coronary Units (SEMICYUC) was selected and nominated by virtue of clinical expertise and/or scientific experience to carry out the recommendations. Available scientific literature in the management of adult critically ill patients from 2000 to 2017 was extracted. The clinical evidence was discussed and summarized by the experts in the course of consensus finding of each WG, and was finally approved by the WGs after an extensive internal review process carried out during the first semester of 2017. A total of 65 recommendations were developed, of which 5 corresponded to each of the 13 WGs. These recommendations are based on the opinion of experts and scientific knowledge, and aim to reduce those treatments or procedures that do not add value to the care process; avoid the exposure of critical patients to potential risks; and improve the adequacy of health resources


Assuntos
Humanos , Cuidados Críticos/normas , Estado Terminal , Análise Custo-Benefício , Cuidados Críticos/métodos , Gerenciamento Clínico , Apoio Nutricional , Cuidados Paliativos/normas , Direitos do Paciente , Tecnologia de Alto Custo , Assistência Terminal/normas , Procedimentos Desnecessários
7.
Health Policy ; 122(12): 1295-1301, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30241797

RESUMO

The Canadian patchwork system of prescription drug coverage and the employer sponsored private health benefits group plans appear vulnerable to cost growth due to insufficient balance of power between fragmented public and private buyers, and pharmaceutical manufacturers. The emergence of "bad" insurance risks caused by new and very expensive treatments featuring high cost specialty medicines - also known as niche buster drugs - exposes this vulnerability. This study fills a gap in knowledge by seeking to better understanding how Canadian private insurers face the arrival of specialty pharmaceuticals. It completes an overview of a body of grey literature composed of publicly available online articles from the employment benefits and group insurance consulting and administration industry; online documents from group benefits sector conferences; and online or on demand materials from Canadian life and health insurers. Claims for high cost specialty drugs generate new bad insurance risks that Canadian health insurers attempt to mitigate through isolated corporate initiatives, industry-wide strategies and calls for universal, public catastrophic coverage. The outcomes of these strategies are limited cost-control measures as well as risk and cost transfers onto plan sponsors, patients and provincial public programs.


Assuntos
Custos de Medicamentos , Planos de Assistência de Saúde para Empregados/economia , Seguradoras/economia , Tecnologia de Alto Custo/economia , Canadá , Controle de Custos , Reforma dos Serviços de Saúde , Humanos , Seguro Saúde/organização & administração , Medição de Risco
9.
Med Intensiva (Engl Ed) ; 42(7): 425-443, 2018 Oct.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-29789183

RESUMO

The project "Commitment to Quality of Scientific Societies", promoted since 2013 by the Spanish Ministry of Health, seeks to reduce unnecessary health interventions that have not proven effective, have little or doubtful effectiveness, or are not cost-effective. The objective is to establish the "do not do" recommendations for the management of critically ill patients. A panel of experts from the 13 working groups (WGs) of the Spanish Society of Intensive and Critical Care Medicine and Coronary Units (SEMICYUC) was selected and nominated by virtue of clinical expertise and/or scientific experience to carry out the recommendations. Available scientific literature in the management of adult critically ill patients from 2000 to 2017 was extracted. The clinical evidence was discussed and summarized by the experts in the course of consensus finding of each WG, and was finally approved by the WGs after an extensive internal review process carried out during the first semester of 2017. A total of 65 recommendations were developed, of which 5 corresponded to each of the 13 WGs. These recommendations are based on the opinion of experts and scientific knowledge, and aim to reduce those treatments or procedures that do not add value to the care process; avoid the exposure of critical patients to potential risks; and improve the adequacy of health resources.


Assuntos
Cuidados Críticos/normas , Estado Terminal , Contraindicações de Medicamentos , Contraindicações de Procedimentos , Análise Custo-Benefício , Cuidados Críticos/métodos , Gerenciamento Clínico , Humanos , Apoio Nutricional , Cuidados Paliativos/normas , Direitos do Paciente , Tecnologia de Alto Custo , Assistência Terminal/normas , Procedimentos Desnecessários
10.
Stem Cells Transl Med ; 6(8): 1723-1729, 2017 08.
Artigo em Inglês | MEDLINE | ID: mdl-28749065

RESUMO

Cellular therapies and other regenerative medicines are emerging as potentially transformative additions to modern medicine, but likely at a staggering financial cost. Public health care systems' budgets are already strained by growing and aging populations, and many private insurer's budgets are equally stretched. The current systems that most payers employ to manage their cash flow are not structured to absorb a sudden onslaught of very expensive prescriptions for a large portion of their covered population. Despite this, developers of new regenerative medicines tend to focus on the demands of regulators, not payers, in order to be compliant throughout the clinical trials phases, and to develop a product that ultimately will be approvable. It is not advisable to assume that an approved product will automatically become a reimbursed product, as examples from current practice in hematopoietic stem cell transplantation in the U.S. demonstrate; similarly, in Europe numerous Advanced-therapy Medicinal Products achieved market authorization but failed to secure reimbursement (e.g., Glybera, Provenge, ChondroCelect, MACI). There are however strategies and approaches that developers can employ throughout clinical development, in order to generate clinical and health economic data which will be necessary to demonstrate the value proposition of the new product and help ensure market access for patients; furthermore, performance based managed entry agreements coupled with post-launch evidence generation can help overcome challenges around product uncertainty at launch and reduce market access delays. Stem Cells Translational Medicine 2017;6:1723-1729.


Assuntos
Análise Custo-Benefício , Transplante de Células-Tronco Hematopoéticas/economia , Tecnologia de Alto Custo/economia , Europa (Continente) , Transplante de Células-Tronco Hematopoéticas/tendências , Humanos , Tecnologia de Alto Custo/tendências , Estados Unidos
11.
Multimedia | Recursos Multimídia | ID: multimedia-2068

RESUMO

Material de alto custo


Assuntos
Tecnologia de Alto Custo
14.
Gac. sanit. (Barc., Ed. impr.) ; 30(2): 110-116, mar.-abr. 2016. ilus, tab
Artigo em Espanhol | IBECS | ID: ibc-151041

RESUMO

Objetivo: Explorar las percepciones sobre el acceso a los medicamentos del Componente Especializado de la Asistencia Farmacéutica (CEAF) del Sistema Único de Salud brasileño (que incluye los medicamentos de alto costo), por parte de los actores involucrados en el ámbito asistencial del CEAF. Métodos: Estudio cualitativo descriptivo. Para la recolección de los datos se realizaron un grupo focal con siete usuarios/as y 11 entrevistas semiestructuradas a profesionales de la salud (medicina y farmacia) del estado de Santa Catarina. Resultados: Según los/las participantes, el acceso a medicamentos del CEAF ha mejorado. Se encontraron también dos percepciones sobre los Protocolos Clínicos y Directrices de Tratamiento del CEAF: las exigencias son burocracia que limita el acceso y los requisitos aumentan la demanda de exámenes y especialistas, superando la capacidad de la red de servicios de salud. A partir de estas percepciones se generan vías alternativas de acceso que evidencian una concepción frágil del derecho a la salud, desinformación y dependencia por parte de los usuarios, las cuales pueden tener consecuencias en la salud de las personas y en el sistema de salud. Según los/las participantes, debido a las dificultades en el acceso de los servicios de salud en general, el pleno acceso a los medicamentos aún es un objetivo por alcanzar. Conclusión: De acuerdo con las percepciones encontradas, aunque el acceso a los medicamentos del CEAF ha mejorado, persisten dificultades para garantizar su oportunidad y su integralidad (AU)


Objective: To explore perceptions on access to medication supplied by the Specialized Component of Pharmaceutical Assistance (CEAF) within the Brazilian Unified Health System (which includes high-cost drugs) by the actors involved in the healthcare services of this component. Method: A descriptive, qualitative study was carried out by using a focal group with 7 users and 11 semi-structured interviews with health professionals (physicians and pharmacist) in the state of Santa Catarina. Results: According to the participants, access to medicines had improved. Two main perceptions of the CEAF Clinical Guidelines were identified: the requirements constitute a bureaucracy that limits access, and the requisites increase the demand for tests and specialized healthcare services, exceeding the capacity of the healthcare services network. These assumptions generated the search for other means of access that revealed a lack of information and understanding of the right to health among the users. In addition, according to the participants, because of the difficulties of accessing services as a whole, full access to CEAF medicines is a goal that remains to be achieved. Conclusion: Although access to CEAF medicines has improved, there are still some difficulties in guaranteeing treatment access and comprehensiveness (AU)


Assuntos
Humanos , Preço de Medicamento , Serviço de Farmácia Hospitalar/organização & administração , Medicamentos Essenciais/economia , Equidade no Acesso aos Serviços de Saúde , Guias de Prática Clínica como Assunto , Tecnologia de Alto Custo/organização & administração , Brasil
17.
Circulation ; 132(21): 2012-27, 2015 Nov 24.
Artigo em Inglês | MEDLINE | ID: mdl-26596977

RESUMO

We examined evidence on whether mobile health (mHealth) tools, including interactive voice response calls, short message service, or text messaging, and smartphones, can improve lifestyle behaviors and management related to cardiovascular diseases throughout the world. We conducted a state-of-the-art review and literature synthesis of peer-reviewed and gray literature published since 2004. The review prioritized randomized trials and studies focused on cardiovascular diseases and risk factors, but included other reports when they represented the best available evidence. The search emphasized reports on the potential benefits of mHealth interventions implemented in low- and middle-income countries. Interactive voice response and short message service interventions can improve cardiovascular preventive care in developed countries by addressing risk factors including weight, smoking, and physical activity. Interactive voice response and short message service-based interventions for cardiovascular disease management also have shown benefits with respect to hypertension management, hospital readmissions, and diabetic glycemic control. Multimodal interventions including Web-based communication with clinicians and mHealth-enabled clinical monitoring with feedback also have shown benefits. The evidence regarding the potential benefits of interventions using smartphones and social media is still developing. Studies of mHealth interventions have been conducted in >30 low- and middle-income countries, and evidence to date suggests that programs are feasible and may improve medication adherence and disease outcomes. Emerging evidence suggests that mHealth interventions may improve cardiovascular-related lifestyle behaviors and disease management. Next-generation mHealth programs developed worldwide should be based on evidence-based behavioral theories and incorporate advances in artificial intelligence for adapting systems automatically to patients' unique and changing needs.


Assuntos
Doenças Cardiovasculares/terapia , Telefone Celular , Gerenciamento Clínico , Comportamento de Redução do Risco , Telemedicina/instrumentação , Adulto , Tecnologia Biomédica/economia , Doenças Cardiovasculares/economia , Doenças Cardiovasculares/prevenção & controle , Países em Desenvolvimento , Complicações do Diabetes/sangue , Complicações do Diabetes/prevenção & controle , Comportamentos Relacionados com a Saúde , Gastos em Saúde/estatística & dados numéricos , Promoção da Saúde/economia , Promoção da Saúde/métodos , Mão de Obra em Saúde/economia , Mão de Obra em Saúde/estatística & dados numéricos , Humanos , Internet , Pobreza , Autocuidado , Transferência de Tecnologia , Tecnologia de Alto Custo/economia , Telemedicina/economia , Telemedicina/estatística & dados numéricos
19.
J Am Acad Dermatol ; 72(4): 577-86; quiz 587-8, 2015 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-25773408

RESUMO

Telemedicine is the use of telecommunications technology to support health care at a distance. Dermatology relies on visual cues that are easily captured by imaging technologies, making it ideally suited for this care model. Advances in telecommunications technology have made it possible to deliver high-quality skin care when patient and provider are separated by both time and space. Most recently, mobile devices that connect users through cellular data networks have enabled teledermatologists to instantly communicate with primary care providers throughout the world. The availability of teledermoscopy provides an additional layer of visual information to enhance the quality of teleconsultations. Teledermatopathology has become increasingly feasible because of advances in digitization of entire microscopic slides and robot-assisted microscopy. Barriers to additional expansion of these services include underdeveloped infrastructure in remote regions, fragmented electronic medical records, and varying degrees of reimbursement. Teleconsultants also confront special legal and ethical challenges as they work toward building a global network of practicing physicians.


Assuntos
Tecnologia Biomédica/tendências , Dermatologia/métodos , Telemedicina/tendências , Tecnologia Biomédica/economia , Telefone Celular , Dermatologia/organização & administração , Dermatologia/tendências , Dermoscopia/métodos , Diagnóstico por Imagem , Acesso aos Serviços de Saúde , Humanos , Consentimento Livre e Esclarecido , Mecanismo de Reembolso , Dermatopatias/diagnóstico , Dermatopatias/epidemiologia , Dermatopatias/terapia , Tecnologia de Alto Custo , Telemedicina/instrumentação , Telemedicina/organização & administração
20.
Cancer Radiother ; 18(5-6): 369-78, 2014 Oct.
Artigo em Francês | MEDLINE | ID: mdl-25199865

RESUMO

The identification of the optimal radiation technique in prostate cancer is based on the results of dosimetric and clinical studies, although there are almost no randomized studies comparing different radiation techniques. The feasibility of the techniques depends also on the technical and human resources of the radiation department, on the cost of the treatment from the points of view of the society, the patient and the radiation oncologist, and finally on the choice of the patient. The slow evolution of prostate cancer leads to consider the biochemical failure as the main judgment criteria in the majority of the studies. A proper urinary radio-induced toxicity evaluation implies a long follow-up. Intensity-modulated radiotherapy (IMRT) combined with image-guided radiotherapy (IGRT) is recommended in case of high dose (≥76Gy) to the prostate, pelvic lymph nodes irradiation and hypofractionation schedules. For low-risk tumors, the aim of the treatment is to preserve quality of life, while limiting costs. Stereotactic body radiotherapy shows promising results, although the follow-up is still limited and phase III trials are ongoing. Focal radiation techniques are in the step of feasibility. For intermediate and high-risk tumors, the objective of the treatment is to increase the locoregional control, while limiting the toxicity. IMRT combined with IGRT leads to either a well-validated dose escalation strategy for intermediate risk tumors, or to a strategy of moderate hypofractionated schedules, which cannot be yet considered as a standard treatment. These combined radiation techniques allow finally large lymph node target volume irradiation and dose escalation potentially in the dominant intraprostatic lesion. The feasibility of simultaneous integrated boost approaches is demonstrated.


Assuntos
Adenocarcinoma/radioterapia , Neoplasias da Próstata/radioterapia , Adenocarcinoma/secundário , Adenocarcinoma/terapia , Terapia Combinada , Fracionamento da Dose de Radiação , Acesso aos Serviços de Saúde/economia , Humanos , Irradiação Linfática/ética , Irradiação Linfática/métodos , Metástase Linfática/radioterapia , Masculino , Órgãos em Risco , Seleção de Pacientes , Guias de Prática Clínica como Assunto , Antígeno Prostático Específico/sangue , Neoplasias da Próstata/terapia , Qualidade de Vida , Lesões por Radiação/etiologia , Lesões por Radiação/prevenção & controle , Radiocirurgia/efeitos adversos , Radiocirurgia/economia , Radiocirurgia/ética , Radiocirurgia/métodos , Dosagem Radioterapêutica , Radioterapia Conformacional/efeitos adversos , Radioterapia Conformacional/economia , Radioterapia Conformacional/ética , Radioterapia Conformacional/métodos , Radioterapia Guiada por Imagem/ética , Radioterapia Guiada por Imagem/métodos , Ensaios Clínicos Controlados Aleatórios como Assunto , Risco , Tecnologia de Alto Custo/ética
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