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.

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.

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.

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.

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.

The Introduction of New Non-Drug Health Technologies into Canadian Healthcare Institutions: Opportunities and Challenges.

INTRODUCTION: A recent pan-Canadian survey of 48 health organizations concluded that structures, processes, factors and information used to support funding decisions on new non-drug health technologies (NDTs) vary within and across jurisdictions in 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.

Bivariate Pheromone-based Monitoring of Spruce Budworm Larvae (Lepidoptera: Tortricidae).

A bivariate approach to pheromone-based monitoring is developed for the spruce budworm, Choristoneura fumiferana (Clem.) (Lepidoptera: Tortricidae). The approach uses captures of males at pheromone traps for generation t (♂t) as a transitive term between densities of overwintering larvae in consecutive generations (L2t, L2t+1), based on a large data set including >2,000 observations in the province of Quebec (QC) between the interval 1992 and 2010. Although estimates of L2t and ♂t are autocorrelated to some extent, multi-year assessments of larval densities combined with pheromone trapping are justified by the complementarity (statistical significance) of both L2t and ♂t in predicting L2t+1 for 15 of 18 pairs of 2-yr intervals. Bivariate pheromone-based thresholds (number of males corresponding to specific transitions in larval densities between L2t and L2t+1) are reported for each year. As expected, thresholds for stable populations (L2t = L2t+1) were lower than for populations with positive growth rate (L2t < L2t+1). The thresholds derived in this study have limited heuristic value; however, because they vary greatly from year to year.

First Report of Mating Disruption With an Aggregation Pheromone: A Case Study With Tetropium fuscum (Coleoptera: Cerambycidae).

Tetropium fuscum (F.), native to Europe and established in Nova Scotia, Canada, since at least 1990, is considered a low-to-moderate threat to spruce (Picea spp.) forests in North America and regulated as a quarantine pest by the Canadian Food Inspection Agency. We tested broadcast applications of the aggregation pheromone racemic (5E)-6,10-dimethyl-5,9-undecadien-2-ol (fuscumol), formulated at 10% concentration in Hercon Bio-Flakes (Hercon International, Emigsville, PA), for efficacy in disrupting T. fuscum mating and suppressing populations. Two applications of 2.5-2.75 kg Bio-Flakes (250-275 g a.i.) per ha per season significantly reduced trap catches and mating success (2009, 2010, 2012): about 30% of females trapped in treated plots had mated compared with 60% of females trapped in untreated plots. Similar reductions in mating success were observed in 2011 with one or two 4.5 kg/ha applications of Bio-Flakes. Mean densities of T. fuscum colonizing sentinel bait logs or girdled trees were 36% lower in pheromone-treated plots than in untreated plots, but the difference was not statistically significant. Lack of population suppression may have been because mated females immigrated into treated plots or because populations were so high that despite a 50% reduction in mating success, absolute numbers of mated females were sufficient to infest our bait logs or trees. This is the first demonstration of insect mating disruption via broadcast application of an aggregation pheromone. Pheromone-mediated mating disruption has potential to slow the spread of invasive cerambycids by targeting low-density outlier populations near or beyond the leading edge of an infestation.

EVALUATION OF THE SURGICAL TRAY OPENING PROCEDURE IN OPERATING SUITES: SYSTEMATIC REVIEW AND RECOMMENDATIONS.

INTRODUCTION: Optimizing the processes involved in managing operating suite activities is an essential element in obtaining gains in efficiency. The early opening of surgical trays could represent an innovative practice for reducing operating times and wait periods between surgeries as well as for increasing the number of daily surgeries. The purpose of this systematic review is to assess the risks and benefits of introducing this practice in the operating room. METHODOLOGY: A systematic literature review was conducted in various indexed databases as well as in the grey literature in order to identify synthesis studies, clinical guidelines and randomized and non-randomized studies on the impact of opening surgical trays early. The following indicators were sought: time lapse between the patient's entrance and the beginning of surgery, the frequency of surgical tray contamination, and the rate of surgical wound infection. RESULTS: An original study and four practice guides were included after a quality assessment. No studies on efficiency gains associated with the early opening of surgical trays were found. The results of the experimental study suggest that the contamination rate for uncovered surgical trays is low for the first 30 minutes (4%) and increases over time with exposure to the ambient air. Most clinical guidelines recommend preparing the surgical instruments as close to the beginning of surgery as possible without specifying the minimum time interval to be respected as well as whether or not the patient is in the operating room. DISCUSSION: The analysis- of all the available data does not make it possible to determine the optimal moment for opening the surgical trays. Given the uncertainty regarding the risks of infection, and the lack of data on the associated benefits, the decision to opt for a change in practice in the opening of surgical trays should be based on a range of factors. An assessment of the data therefore suggests caution and that a feasibility analysis, including a review of all processes and parameters for managing the risks associated with the early opening of surgical trays, be conducted before initiating any changes in the institutions where a change of practice is being sought.

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.

Size-Dependent Realized Fecundity in Two Lepidopteran Capital Breeders.

Body size is correlated with potential fecundity in capital breeders, but size-dependent functions of realized fecundity may be impacted by reproductive losses due to mating failure or oviposition time limitations (number of eggs remaining in the abdomen of females at death). Post-mortem assessment of adults collected in the field after natural death represents a sound approach to quantify how body size affects realized fecundity. This approach is used here for two Lepidoptera for which replicated field data are available, the spruce budworm Choristoneura fumiferana Clemens (Tortricidae) and bagworm Metisa plana Walker (Psychidae). Dead female budworms were collected on drop trays placed beneath tree canopies at four locations. Most females had mated during their lifetime (presence of a spermatophore in spermatheca), and body size did not influence mating failure. Oviposition time limitation was the major factor restricting realized fecundity of females, and its incidence was independent of body size at three of the four locations. Both realized and potential fecundity of female budworms increased linearly with body size. Female bagworms are neotenous and reproduce within a bag; hence, parameters related to realized fecundity are unusually tractable. For each of five consecutive generations of bagworms, mating probability increased with body size, so that virgin-dead females were predominantly small, least fecund individuals. The implication of size-dependent reproductive losses are compared for the two organisms in terms of life history theory and population dynamics, with an emphasis on how differential female motility affects the evolutionary and ecological consequences of size-dependent realized fecundity.

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.

[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

Specimen plastic containers used to store expressed breast milk in neonatal care units: a case of precautionary principle.

Breast milk is the only milk that meets both the nutritional and immunitary needs of infants. Since breastfeeding is widely promoted, public health measures to preserve the nutritional qualities of expressed breast milk (EBM) should be applied in hospital care settings. The Health Technology Assessment Unit (HTAU) of the Centre hospitalier universitaire de Québec was requested by the Neonatal Care Unit to assess the acceptability of a plastic specimen container, designed to harvest tissues and body fluids, for storing collected EBM. An evidence-based public health perspective approach was taken to evaluate the safety of the specimen container. The HTAU recommended that plastic specimen containers no longer be used for storing EBM and that other options should be evaluated for neonatal care units. These recommendations are in accordance with the public health precaution principle and with legal considerations.

Omega-3 long-chain polyunsaturated fatty acids for extremely preterm infants: a systematic review.

BACKGROUND AND OBJECTIVE: Omega-3 long chain polyunsaturated fatty acid (LCPUFA) exposure can be associated with reduced neonatal morbidities. We systematically review the evidence for the benefits of omega-3 LCPUFAs for reducing neonatal morbidities in extremely preterm infants. METHODS: Data sources were PubMed, Embase, Center for Reviews and Dissemination, and the Cochrane Register of Controlled Trials. Original studies were selected that included infants born at <29 weeks' gestation, those published until May 2013, and those that evaluated the relationship between omega-3 LCPUFA supplementation and major adverse neonatal outcomes. Data were extracted on study design and outcome. Effect estimates were pooled. RESULTS: Of the 1876 studies identified, 18 randomized controlled trials (RCTs) and 6 observational studies met the defined criteria. No RCT specifically targeted a population of extremely preterm infants. Based on RCTs, omega-3 LCPUFA was not associated with a decreased risk of bronchopulmonary dysplasia in infants overall (pooled risk ratio [RR] 0.97, 95% confidence interval [CI] 0.82-1.13], 12 studies, n = 2809 infants); however, when considering RCTs that include only infants born at ≤32 weeks' gestation, a trend toward a reduction in the risk of bronchopulmonary dysplasia (pooled RR 0.88, 95% CI 0.74-1.05, 7 studies, n = 1156 infants) and a reduction in the risk of necrotizing enterocolitis (pooled RR 0.50, 95% CI 0.23-1.10, 5 studies, n = 900 infants) was observed with LCPUFA. CONCLUSIONS: Large-scale interventional studies are required to determine the clinical benefits of omega-3 LCPUFA, specifically in extremely preterm infants, during the neonatal period.

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.

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.