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1.
Methods Mol Biol ; 2590: 101-125, 2023.
Artículo en Inglés | MEDLINE | ID: mdl-36335495

RESUMEN

In this chapter, we describe single-tube long fragment read (stLFR), a simple preparation method for whole-genome sequencing and physical haplotyping based on the DNA co-barcoding strategy. Similar to LFR, stLFR applies the concept of adding the same barcode to subfragments derived from the same long DNA molecule. However, instead of a 384-well plate, stLFR uses the surface of micron-sized magnetic beads to create millions of virtual compartments in a single reaction tube. This is enabled by a split and pool barcoded bead preparation process capable of generating ~500,000 copies of the same unique barcode, from a library of ~3.6 billion unique barcodes, on each bead. The instruments and devices used in the stLFR process are easily accessible in nearly all standard molecular biology laboratories, and the cost of reagents can be as low as 30 dollars per sample. stLFR libraries can be sequenced by standard second-generation sequencing instruments (e.g., MGI or Illumina devices), and the barcode sharing information enables detection and phasing of all variations, including large structural variations. In addition, stLFR data can be used to scaffold contigs and de novo assemble genomes.


Asunto(s)
Secuenciación de Nucleótidos de Alto Rendimiento , Análisis Costo-Beneficio , Haplotipos , Secuenciación Completa del Genoma , Secuenciación de Nucleótidos de Alto Rendimiento/métodos , Biblioteca de Genes , Análisis de Secuencia de ADN
2.
Rev. bras. med. esporte ; 29(spe1): e2022_0198, 2023. tab, graf
Artículo en Inglés | LILACS | ID: biblio-1394847

RESUMEN

ABSTRACT Introduction Many countries have increased their investments in human resources and technology for the internal development of competitive sports, leading the world sports scene to increasingly fierce competition. Coaches and research assistants must place importance on feedback tools for frequent training of college athletes, and deep learning algorithms are an important resource to consider. Objective To develop and validate a swarm algorithm to examine the fitness of athletes during periods of competition. Methods Based on the swarm intelligence algorithm, the concept, composition, and content of physical exercises were analyzed. Combined with the characteristics of events, the body function files and the comprehensive evaluation system for high-level athletes were established. Results The insight was obtained that the constant mastery of the most advanced techniques and tactics by athletes is an important feature of modern competitive sports. Physical fitness is not only a valuable asset for athletes but also one of the keys to success in competition. Conclusion Fitness has become an increasingly prominent issue in competition, and the scientific training of contemporary competitive sports has been increasingly refined. Level of evidence II; Therapeutic studies - investigation of treatment outcomes.


RESUMO Introdução Muitos países aumentaram seus investimentos em recursos humanos e tecnologia para o desenvolvimento interno de esportes competitivos, levando o cenário esportivo mundial a uma disputa cada vez mais acirrada. Treinadores e assistentes de pesquisa devem dar importância às ferramentas de feedback para o treinamento frequente dos atletas universitários e os algoritmos de aprendizado profundo são um importante recurso a ser levado em consideração. Objetivo Desenvolver e validar um algoritmo de enxame para examinar o condicionamento físico dos atletas em períodos de competição. Métodos Com base no algoritmo de inteligência de enxame, o conceito, composição e conteúdo de exercícios físicos foram analisados. Combinado com as características dos eventos, os arquivos de funções corporais e o sistema abrangente de avaliação de atletas de alto nível foram estabelecidos. Resultados Obteve-se a percepção de que o constante domínio das técnicas e táticas mais avançadas pelos atletas é uma característica importante dos esportes competitivos modernos. A aptidão física não é apenas um ativo valioso para os atletas, mas também uma das chaves para o sucesso nas competições. Conclusão A aptidão física tem se tornado cada vez mais um problema proeminente na competição, sendo o treinamento científico dos esportes competitivos contemporâneos cada vez mais aperfeiçoado. Nível de evidência II; Estudos terapêuticos - investigação dos resultados do tratamento.


RESUMEN Introducción Muchos países han aumentado sus inversiones en recursos humanos y tecnología para el desarrollo interno del deporte de competición, lo que ha llevado al panorama deportivo mundial a una competencia cada vez más feroz. Los entrenadores y asistentes de investigación deben dar importancia a las herramientas de retroalimentación para el entrenamiento frecuente de los atletas universitarios y los algoritmos de aprendizaje profundo son un recurso importante a tener en cuenta. Objetivo Desarrollar y validar un algoritmo de enjambre para examinar el estado físico de los atletas durante los periodos de competición. Métodos A partir del algoritmo de inteligencia de enjambre, se analizó el concepto, la composición y el contenido de los ejercicios físicos. En combinación con las características de los eventos, se establecieron los archivos de funciones corporales y el sistema de evaluación integral de los atletas de alto nivel. Resultados Se obtuvo la conclusión de que el dominio constante de las técnicas y tácticas más avanzadas por parte de los atletas es una característica importante de los deportes de competición modernos. La forma física no sólo es un activo valioso para los deportistas, sino también una de las claves del éxito en las competiciones. Conclusión La aptitud física se ha convertido en una cuestión cada vez más importante en la competición, y el entrenamiento científico de los deportes de competición contemporáneos es cada vez mejor. Nivel de evidencia II; Estudios terapéuticos - investigación de los resultados del tratamiento.


Asunto(s)
Humanos , Adulto , Adulto Joven , Algoritmos , Ejercicio Físico/fisiología , Rendimiento Atlético/fisiología , Aprendizaje Profundo , Traumatismos en Atletas , Deportes/fisiología , Fuerza Muscular , Atletas
3.
s.l; CONETEC; 1 nov. 2022.
No convencional en Español | BRISA/RedTESA, BRISA/RedTESA | ID: biblio-1400075

RESUMEN

INTRODUCCIÓN: La epidermólisis bullosa o ampollosa es un grupo heterogéneo de enfermedades mecanoampollosas genéticas autosómicas, dominantes o recesivas, caracterizadas por diversos grados de fragilidad de la piel y las mucosas causada por mutaciones que afectan las proteínas estructurales de la piel. Se han descripto cuatro tipos principales de epidermólisis bullosa, según el nivel estructural de división del tejido en la piel: epidermólisis bullosa simple, de la unión, distrófica y de Kindler. La gravedad de la enfermedad está determinada por el nivel de ampollas y el tipo de mutación y es muy variable entre los subtipos. La epidermólisis bullosa simple es autosómica dominante de separación intraepidérmica, con ampollas con trauma leve que curan sin dejar cicatriz y suele presentarse al nacer o en la primera infancia y de curso crónico, pero la formación de ampollas tiende a disminuir con la edad. La de la unión es autosómica recesiva de separación intra-lamina lucida, es la variante más grave, con muerte prematura en la infancia debido a la desnutrición o infecciones, y se caracteriza por ampollas y erosiones generalizadas con tejido de granulación que no cicatriza; asociado con uñas ausentes, dientes displásicos, lesiones orales y estenosis pilórica. La distrófica es autosómica recesiva y dominante de separación de láminas sub-basales y suele comenzar al nacer, con ampollas generalizadas que curan con cicatrices extensas que traen un riesgo de presentar secuelas graves y con muerte en la edad adulta temprana por las complicaciones. Finalmente, la Kindler es autosómica recesiva de separación a nivel de los queratinocitos basales o de lámina sub-basal, con ampollas inducidas por traumatismos leves que pueden disminuir con la edad. El manejo de los pacientes con epidermólisis bullosa es principalmente de apoyo e incluye el cuidado de heridas y la prevención y tratamiento de complicaciones (control del dolor, nutrición, cuidado de lesiones extra-cutáneas, etc.) involucrando a un equipo multidisciplinario de profesionales, donde en la actualidad no existe una terapia dirigida para la epidermólisis bullosa. TECNOLOGÍA: Oleogel-S10 (Filsuvez®) es un gel cicatrizante que contiene extracto seco de la corteza de Betulae (corteza de abedul), también conocido como extracto triterpénico. El gel contiene 90% peso/peso de aceite de girasol y 10% peso/peso de extracto seco de corteza de abedul, de los cuales la mayoría es betulina (72 a 88% peso/peso). Las sustancias marcadoras activas adicionales incluyen ácido betulínico, lupeol, ácido oleanólico y eritrodiol. OBJETIVO: El objetivo del presente informe es evaluar rápidamente los parámetros de eficacia, seguridad, costos y recomendaciones disponibles acerca del empleo de Filsuvez® gel (Oleogel-S10) para el tratamiento de la epidermólisis bullosa. MÉTODOS: Se realizó una búsqueda bibliográfica en las principales bases de datos tales como PUBMED, LILACS, BRISA, COCHRANE, SCIELO, EMBASE, TRIPDATABASE como así también en sociedades científicas, agencias reguladoras, financiadores de salud y agencias de evaluación de tecnologías sanitarias. Se priorizó la inclusión de revisiones sistemáticas, ensayos clínicos controlados aleatorizados, evaluación de tecnología sanitaria y guías de práctica clínica de alta calidad metodológica. En PubMed se utilizó la estrategia de búsqueda que se detalla en el Anexo I. La fecha de búsqueda de información fue hasta el 01 de noviembre de 2022. Para la búsqueda en Pubmed se utilizó la siguiente estrategia de búsqueda: ((Filsuvez[tiab] OR Oleogel-S10[tiab] OR birch bark extract[tiab]) AND (Epidermolysis Bullosa[MeSH] OR Acantholysis Bullosa[tiab])). RECOMENDACIONES: No se hallaron guías de práctica clínica actualizadas en Argentina y en el Mundo que mencionen la tecnología en la indicación evaluada. El Instituto Nacional para la Excelencia en Salud y Atención (NICE su sigla del inglés, National Institute for Health and Care Excellence) de Reino Unido y la Agencia Canadiense de Medicamentos y Tecnologías en Salud (CADTH su sigla del inglés, Canadian Agency for Drugs & Technologies in Health) no han evaluado al tratamiento en la indicación evaluada. CONCLUSIONES: La evidencia que sustenta la aprobación de comercialización de Oleogel-S10 (Filsuvez®) para el tratamiento de heridas de espesor parcial asociadas con epidermólisis bullosa en personas a partir de los 6 meses de edad, se basa en un estudio clínico con resultados aún no publicados con control de pares. Este estudio demostraría que en personas sin complicaciones, el OleogelS10 sumado al cuidado estándar aumentaría la proporción de personas con cierre completo de la herida en personas con epidermólisis bullosa distrófica de herencia recesiva frente a placebo al corto plazo. No se observarían beneficios en personas con epidermólisis bullosa de la unión o con distrófica de herencia dominante, como tampoco para otros desenlaces. Los eventos adversos reportados más comunes fueron las complicaciones de heridas, reacciones en el lugar de aplicación, infecciones de heridas, prurito y reacciones de hipersensibilidad. La agencia regulatoria de los Estados Unidos todavía no ha autorizado su comercialización; mientras que la agencia europea la ha autorizado recientemente, junto con la designación de medicamento huérfano, para el tratamiento de heridas de espesor parcial asociadas con epidermólisis bullosa distrófica y de la unión en personas a partir de los 6 meses de edad. No se hallaron guías de práctica clínica actualizadas en Argentina y en el Mundo que mencionen la tecnología en la indicación evaluada. No se hallaron evaluaciones económicas publicadas, como tampoco precios de adquisición de referencia en el Mundo.


Asunto(s)
Humanos , Triterpenos/uso terapéutico , Cicatrización de Heridas , Epidermólisis Ampollosa/tratamiento farmacológico , Betula/efectos de los fármacos , Argentina , Eficacia , Análisis Costo-Beneficio
4.
Int J Technol Assess Health Care ; 38(1): e67, 2022 Aug 01.
Artículo en Inglés | MEDLINE | ID: mdl-36317681

RESUMEN

It has been suggested that health economists need to improve their methods in order to meet the challenges of evaluating genomic/genetic tests. In this article, we set out twelve challenges identified from a rapid review of the literature and suggest solutions to the challenges identified. Two challenges were common to all economic evaluations: choice of perspective and time-horizon. Five challenges were relevant for all diagnostic technologies: complexity of analysis; range of costs; under-developed evidence base; behavioral aspects; and choice of outcome metrics. The final five challenges were pertinent for genomic tests and only these may require methodological development: heterogeneity of tests and platforms, increasing stratification, capturing personal utility; incidental findings; and spillover effects. Current methods of economic evaluation are generally able to cope with genomic/genetic tests, although a renewed focus on specific decision-makers' needs and a willingness to move away from cost-utility analysis may be required. Certain analysts may be constrained by reference cases developed primarily for the assessment of pharmaceuticals. The combined impact of multiple challenges may require analysts to be particularly careful in setting the scope of their analysis in order to ensure that feasibility is balanced with usefulness to the decision maker. A key issue is the under-developed evidence-base and it may be necessary to rethink translation processes to ensure sufficient, relevant evidence is available to support economic evaluation and adoption of genomic/genetic tests.


Asunto(s)
Genómica , Evaluación de la Tecnología Biomédica , Análisis Costo-Beneficio
5.
Int J Technol Assess Health Care ; 38(1): e78, 2022 Nov 02.
Artículo en Inglés | MEDLINE | ID: mdl-36321421

RESUMEN

Health technology assessment (HTA) is commonly used to guide evidence-informed decisions to optimize resource use, prioritize policies, and support countries to achieve universal health coverage. Producing HTAs requires time, scientific expertise, and political commitment, but these are not available in all settings - especially in low- and middle-income countries (LMIC) where HTA processes may be less institutionalized. Transferring and adapting existing HTAs to local settings may offer a solution while reducing duplication efforts. This scoping review aims to provide an overview of tools, methods, approaches, and considerations which can aid HTA transfers. We systematically searched (from 2005 to 2020) six databases and, using predefined inclusion criteria, included twenty-two studies. Data extraction followed a structured process, while synthesis was more iterative. We identified a common approach for HTA transfers. It follows the de novo process of undertaking original HTAs, but with additional steps to assess relevance (applicability), quality, and transferability, as well as steps to adapt parameters where necessary. The EUnetHTA Adaptation Toolkit was the only tool that provided guidance for adapting multiple HTA domains. Other tools were specific to systematic reviews (n = 1) or economic evaluations (n = 12), where one provided guidance for systematic reviews of economic evaluations. Eight papers reported transferring an HTA, with only one transferring to an LMIC. Finally, we reported issues that may facilitate or hinder transferability. In conclusion, we identified fourteen transfer approaches in the form of guidance or checklists, but harmonized and pragmatic guidance for HTA transfers to suit settings with limited HTA capacity seems warranted.


Asunto(s)
Lista de Verificación , Evaluación de la Tecnología Biomédica , Revisiones Sistemáticas como Asunto , Evaluación de la Tecnología Biomédica/métodos , Análisis Costo-Beneficio , Tecnología Biomédica
6.
Int J Technol Assess Health Care ; 38(1): e79, 2022 Nov 02.
Artículo en Inglés | MEDLINE | ID: mdl-36321447

RESUMEN

Advances in the digitization of health systems and expedited regulatory approvals of innovative treatments have led to increased potential for the use of real-world data (RWD) to generate real-world evidence (RWE) to complement evidence from clinical trials. However, health technology assessment (HTA) bodies and payers have concerns about the ability to generate RWE of sufficient quality to be pivotal evidence of relative treatment effectiveness. Consequently, there is a growing need for HTA bodies and payers to develop guidance for the industry and other stakeholders about the use of RWD/RWE to support access, reimbursement, and pricing. We therefore sought to (i) understand barriers to the use of RWD/RWE by HTA bodies and payers; (ii) review potential solutions in the form of published guidance; and (iii) review findings with selected HTA/payer bodies. Four themes considered key to shaping the generation of robust RWE for HTA bodies and payers were identified as: (i) data (availability, governance, and quality); (ii) methodology (design and analytics); (iii) trust (transparency and reproducibility); and (iv) policy and partnerships. A range of guidance documents were found from trusted sources that could address these themes. These were discussed with HTA experts. This commentary summarizes the potential guidance solutions available to help resolve issues faced by HTA decision-makers in the adoption of RWD/RWE. It shows that there is alignment among stakeholders about the areas that need improvement in the development of RWE and that the key priority to move forward is better collaboration to make data usable for multiple purposes.


Asunto(s)
Evaluación de la Tecnología Biomédica , Confianza , Evaluación de la Tecnología Biomédica/métodos , Reproducibilidad de los Resultados
7.
Int J Technol Assess Health Care ; 38(1): e80, 2022 Nov 02.
Artículo en Inglés | MEDLINE | ID: mdl-36321449

RESUMEN

OBJECTIVE: The French health technology assessment (HTA) agency initiated a research between 2018 and 2019 with the aim of determining whether other HTA organizations (agencies, bodies, institutes, and expert networks) and researchers had developed an evaluation framework of organizational impacts (OIs). METHODS: Three types of investigation were carried out: (i) an analysis of documents published by selected HTA organizations, (ii) a rapid review on the OI issues, (iii) a questionnaire survey to experts of the International Network of Agencies for Health Technology Assessment. RESULTS: The analyses highlight six key points: (i) there is no explicit conceptual definition of OIs; (ii) OIs are often not included in a specific dimension of the evaluation or in the same dimensions; (iii) three recurring categories emerge from the assessment of OIs: processes, structure, and culture; (iv) despite its limitations, the European Network for Health Technology Assessment framework (Core Model) is the most mature assessment model to date; (v) the question of the scope of OIs to be considered is unresolved (micro-meso-macro); and (vi) the delineation between OI assessment and economic assessment must be addressed. CONCLUSIONS: Although the issue of considering OI in HTA has been raised for many years, it remains largely unresolved. Defining the concept of OI is a prerequisite for taking the next step toward an evaluation framework. As the question of the impact of innovation goes beyond the health sector, extensive research on how to define and take into account these OIs may be relevant.


Asunto(s)
Evaluación de la Tecnología Biomédica
8.
Int J Technol Assess Health Care ; 38(1): e82, 2022 Nov 14.
Artículo en Inglés | MEDLINE | ID: mdl-36373501

RESUMEN

OBJECTIVES: Treatment seeking for gender dysphoria (GD) has increased manifold in western countries. This has led to increased interest on evidence-base of treatments, but also discussions related to human rights, identity politics, gender-related structures, and medicalization. Combining these discourses into coherent health policy is difficult. Health technology assessment (HTA) is the golden standard for assessing whether a medical intervention should be included in a health system. A comprehensive HTA should include medical, safety, and cost-utility perspectives, but often also ethical, societal, organizational, and legal concerns. Still, ethics is often omitted in practice. This paper aims to demonstrate how integrated ethical analysis influenced a HTA of complex and controversial topics like GD. METHODS: A HTA of medical treatments of GD was conducted using integrated ethical analysis based on the EUnetHTA-model. This integrates ethical thinking into the whole HTA, explicitly analyses ethical topics, and balances arguments using several ethical theories. RESULTS: Integrating ethics had a significant impact on the HTA process and recommendations. It influenced how the HTA was planned and executed, emphasized autonomy and justice when creating the recommendations, and helped the workgroup to understand the complexity of combining different stakeholders' discourses. Tensions between scientific evidence, expectations, and values became explicit. CONCLUSIONS: Comprehensive HTA provides an important, integrative approach to considering complex and controversial topics in health systems. HTA emphasizes multidisciplinary and multi-stakeholder approach but simultaneously forces a pragmatic, results-oriented, and evidence-based approach on all argumentation. Ethical analysis can facilitate interactions between stakeholders, bridge different discourses, and help formulate widely acceptable guidelines and policy decisions.


Asunto(s)
Disforia de Género , Evaluación de la Tecnología Biomédica , Humanos , Disforia de Género/tratamiento farmacológico , Análisis Ético , Política de Salud , Principios Morales
9.
Health Technol Assess ; 26(43): 1-58, 2022 10.
Artículo en Inglés | MEDLINE | ID: mdl-36321501

RESUMEN

BACKGROUND: People with avascular necrosis of the hip have very limited treatment options currently available to stop the progression of this disease; this often results in the need for a hip replacement. There is some weak evidence that a class of drugs called bisphosphonates may delay the course of the disease, and this trial was commissioned and set up to provide robust evidence regarding the use of bisphosphonates in adults aged ≥ 18 years with this condition. OBJECTIVES: The aim of the Managing Avascular Necrosis Treatments: an Interventional Study ( MANTIS ) trial was to evaluate the clinical effectiveness and cost-effectiveness of a 12-month course of alendronate in the treatment of avascular necrosis. DESIGN: This was a 66-month, definitive, multisite, two-arm, parallel-group, placebo-controlled, double-blind, randomised controlled trial, with an internal pilot phase. SETTING: Eight secondary care NHS hospitals across the UK. PARTICIPANTS: Planned trial size - 280 adult patients with avascular necrosis. INTERVENTION: Participants in the intervention group received 70 mg of alendronate (an oral bisphosphonate) weekly for 12 months. MAIN OUTCOMES: The main outcomes were Oxford Hip Score at 12 months (short-term outcome) and the time to decision that a hip replacement is required at 36 months (long-term outcome). RESULTS: Twenty-one patients were recruited and randomised to receive either the intervention drug, alendronate, or a placebo-matched tablet. LIMITATIONS: This trial was principally limited by low disease prevalence. Other limitations included the late disease stage at which participants were identified and the rapid progression of the disease. FUTURE WORK: This trial was limited by a low recruitment rate. Avascular necrosis of the hip should be treated as a rare disease. Future trials would need to recruit many more sites and recruit over a longer time period, and, for this reason, a registry may provide a more effective means of collecting data pertaining to this disease. CONCLUSIONS: The MANTIS trial was terminated at the end of the pilot phase, because it did not meet its go/no-go criteria. The main issue was a poor recruitment rate, owing to a lower than expected disease prevalence and difficulties in identifying the condition at a sufficiently early stage. Those patients who were identified and screened either were too advanced in their disease progression or were already taking medication. We would not recommend that a short-term interventional study is conducted on this condition until its prevalence, geographic foci and natural history and better understood. The difficulty of acquiring this understanding is likely to be a barrier in most health-care markets. One means of developing this understanding would be the introduction of a database/registry for patients suffering from avascular necrosis of the hip. TRIAL REGISTRATION: The trial is registered as ISRCTN14015902. FUNDING: This project was funded by the National Institute for Health and Care Research ( NIHR ) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 26, No. 43. See the NIHR Journals Library website for further project information.


WHAT WAS THE QUESTION?: The Managing Avascular Necrosis Treatments: an Interventional Study ( MANTIS ) trial was designed to compare ways of treating patients with avascular necrosis who are seeking to slow down the deterioration of their condition. Alendronate is a drug routinely available across the NHS in both tablet and injection form, and doctors and scientists believe that it might prevent ongoing hip deterioration and result in fewer patients requiring a total hip replacement. WHAT DID WE DO?: This trial attempted to compare alendronate taken as a tablet with an identical-looking tablet that did not contain any of the drug (a placebo) to find out if alendronate reduced the number of patients requiring a hip replacement and having pain (compared with patients who did not get alendronate). WHAT DID WE FIND?: Patients were willing to participate in the trial but we were able to recruit only a small number to the study. The main reason for this was difficulty in identifying potentially suitable patients and approaching them at the right point in their medical care. This was more challenging than anticipated, particularly because the NHS sites and professionals that patients with this condition seek out are extremely variable in the UK. It was also difficult to locate and identify patients with the condition at an early enough stage, and before they had already started taking the drug. WHAT DOES THIS MEAN?: More information on patients with this rare condition, such as NHS referral pathways, and an understanding of how the condition progresses may help to improve our understanding of this patient group. This information could also help us determine whether or not there is scope to carry out the study in a different way that might enable these patients to be more easily identified.


Asunto(s)
Alendronato , Evaluación de la Tecnología Biomédica , Adulto , Humanos , Análisis Costo-Beneficio , Resultado del Tratamiento , Necrosis
10.
BMC Health Serv Res ; 22(1): 1343, 2022 Nov 14.
Artículo en Inglés | MEDLINE | ID: mdl-36376868

RESUMEN

The 'Cost of Health Services in India (CHSI)' is the first large scale multi-site facility costing study to incorporate evidence from a national sample of both private and public sectors at different levels of the health system in India. This paper provides an overview of the extent of heterogeneity in costs caused by various supply-side factors.A total of 38 public (11 tertiary care and 27 secondary care) and 16 private hospitals were sampled from 11 states of India. From the sampled facilities, a total of 327 specialties were included, with 48, 79 and 200 specialties covered in tertiary, private and district hospitals respectively. A mixed methodology consisting of both bottom-up and top-down costing was used for data collection. Unit costs per service output were calculated at the cost centre level (outpatient, inpatient, operating theatre, and ICU) and compared across provider type and geographical location.The unadjusted cost per admission was highest for tertiary facilities (₹ 5690, 75 USD) followed by private facilities (₹ 4839, 64 USD) and district hospitals (₹ 3447, 45 USD). Differences in unit costs were found across types of providers, resulting from both variations in capacity utilisation, length of stay and the scale of activity. In addition, significant differences in costs were found associated with geographical location (city classification).The reliance on cost information from single sites or small samples ignores the issue of heterogeneity driven by both demand and supply-side factors. The CHSI cost data set provides a unique insight into cost variability across different types of providers in India. The present analysis shows that both geographical location and the scale of activity are important determinants for deriving the cost of a health service and should be accounted for in healthcare decision making from budgeting to economic evaluation and price-setting.


Asunto(s)
Costos de la Atención en Salud , Evaluación de la Tecnología Biomédica , Humanos , Análisis Costo-Beneficio , Servicios de Salud , Hospitales Privados , India
11.
Farm. hosp ; 46(Suplemento 1): 86-91, noviembre 2022. tab
Artículo en Español | IBECS | ID: ibc-JHG-1225

RESUMEN

La tecnología surgida de la transformación digital ha traído consigo cambios en la asistencia sanitaria. En los próximos años, la Telefarmaciaprevisiblemente se convertirá en uno de los aspectos más importantes dela Telemedicina, ya que ofrece a los pacientes un acceso más inmediato ala atención farmacéutica, supone una reducción de costes tanto para lospacientes como para los sistemas sanitarios, y deriva en una mayor satisfacción, experiencia y comodidad de los pacientes, mejorando así losresultados clínicos. Debido en gran medida a la pandemia de COVID-19,la Telefarmacia ha adquirido gran importancia en el ámbito de la atención farmacéutica, ya que esta crisis ha provocado una enorme presiónsobre los sistemas sanitarios de todo el mundo. Se pueden encontrar multitud de experiencias publicadas en la literatura científica sobre modelos deTelefarmacia en diferentes países del mundo. Existen algunos modelosinnovadores de servicios de Telefarmacia orientados a optimizar y mejorar el acceso a la atención farmacéutica, lo que se traduce en una mejorade la seguridad y los resultados de los pacientes. Entre las ventajas dela Telefarmacia se incluye el aumento del valor para las farmacias y losfarmacéuticos y la adaptación a las necesidades de los pacientes, lamejora de la atención interprofesional, el aumento de la eficiencia de los sistemas sanitarios y la mayor prestación de servicios centrados enel paciente, entre otras. Sin embargo, a pesar de presentar múltiplesventajas, siguen existiendo importantes barreras para la implantación dela Telefarmacia, como la confidencialidad del paciente y la privacidadde la información clínica. Estas barreras para la implantación de la Telefarmacia pueden dividirse en cuatro ámbitos: tecnológico, organizativo,humano y económico. La prestación de atención y servicios farmacéuticosa través de medios digitales es una prioridad clave de la FederaciónInternacional Farmacéutica. (AU)


Digital transformation impacts health care through technology. Telepharmacy is set to become one of the most important aspects of Telemedicinein the years to come with its ability to provide patients with increased andmore timely access to pharmaceutical care, reduced costs for individualsand health systems, improved patient satisfaction, experience and convenience, and better health outcomes. Telepharmacy has gained increasingimportance in the delivery of pharmaceutical care, largely due to theCOVID-19 pandemic which has placed enormous pressures on healthcaresystems globally. There is a significant amount of published literature fromdifferent countries around the world that provide examples of Telepharmacy. There are some innovative models of Telepharmacy services aimedat optimizing and improving access to pharmaceutical care, resulting inimproved patient safety and outcomes. The benefits of Telepharmacyinclude increased value for pharmacies and pharmacists and adaptingto patients´ needs, enhanced interprofessional care and increased efficiency of health systems and increased provision of patient-centred services, among others. However, despite these benefits, major barriers forimplementation of Telepharmacy remain such as patient confidentialityand privacy of health information. These barriers to the implementation of Telepharmacy have been identified and can be divided into four differentenvironments: technological, organizational, human and economic. Delivering pharmaceutical care and services through digital media is identified as a key priority for the International Pharmaceutical Federation. (AU)


Asunto(s)
Humanos , Farmacia , Seguridad del Paciente , Virus del SRAS , Telemedicina , Satisfacción del Paciente , Tecnología
12.
J Gerontol Nurs ; 48(12): 17-24, 2022 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-36441065

RESUMEN

One of the greatest challenges for older, homebound patients receiving health care is accessibility, particularly following a hospitalization. The current study evaluates the effects of using voice-activated technology in the homes of recently discharged patients and its effects on health care outcomes. Voice-based software was embedded in a smart device, which allowed patients to ask questions and receive answers about their own specific care plan. A pre-post study design was used. Forty-eight patients completed the pre and post survey. There was a 63% reduction in emergency department visits and a 26% reduction in physician calls. There was no change in the number of patients requiring hospitalization. More than one half of patients used the smart device daily for their health care needs. More than 70% of patients believed the device was helpful for their general health care needs and assisted in the achievement of care goals. This is the first study of its kind to evaluate patient engagement and outcomes after the use of a smart device with embedded health care directions. [Journal of Gerontological Nursing, 48(12), 17-24.].


Asunto(s)
Enfermería Geriátrica , Servicios de Atención de Salud a Domicilio , Voz , Humanos , Anciano , Tecnología , Evaluación del Resultado de la Atención al Paciente
13.
Proc Natl Acad Sci U S A ; 119(49): e2207754119, 2022 Dec 06.
Artículo en Inglés | MEDLINE | ID: mdl-36442126

RESUMEN

Millions of people across the world live off-grid not by choice but because they live in rural areas, have low income, and have no political clout. Delivering sustainable energy solutions to such a substantial amount of the world's population requires more than a technological fix; it requires leveraging the knowledge of underserved populations working together with a transdisciplinary team to find holistically derived solutions. Our original research has resulted in an innovative Convergence Framework integrating the fields of engineering, social sciences, and communication, and is based on working together with communities and other stakeholders to address the challenges posed by delivering clean energy solutions. In this paper, we discuss the evolution of this Framework and illustrate how this Framework is being operationalized in our on-going research project, cocreating hybrid renewable energy systems for off-grid communities in the Brazilian Amazon. The research shows how this Framework can address clean energy transitions, strengthen emerging industries at local level, and foster Global North-South scholarly collaborations. We do so by the integration of social science and engineering and by focusing on community engagement, energy justice, and governance for underserved communities. Further, this solution-driven Framework leads to the emergence of unique approaches that advance scientific knowledge, while at the same time addressing community needs.


Asunto(s)
Sistemas de Computación , Energía Renovable , Humanos , Ingeniería , Tecnología , Altruismo
14.
Artículo en Ruso | MEDLINE | ID: mdl-36385058

RESUMEN

BACKGROUND: Research on the development and implementation of new principles and methods applicable in the evaluation of medical devices (MD) will allow to accumulate new, as well as the most effective long-used and proven approaches to the clinical and economic evaluation of such an important and extensive class of medical technologies. AIMS: The aim of the study is to identify and analyze developed, approved recommendations for the assessment of MD in the world and domestic practice of assessing health technologies, as well as to find and summarize the current principles, optimal proven and innovative methods for assessing MD for the draft modern recommendations for MD assessment in Moscow. MATERIALS AND METHODS: The sources of the study were scientific articles on the topic of MD assessment and recommendations published over the past five years. RESULTS: A review of publications revealed disunity in the approaches to assessing MD according to international sources, as well as the lack of unified agreed recommendations in Russia. A number of problems and aspects that need to be taken into account when formulating uniform recommendations are clearly defined. CONCLUSION: It is obvious that there is a need to formulate and adopt clear recommendations on the assessment of medical technologies (HTA) of MD, taking into account positive international experience.


Asunto(s)
Evaluación de la Tecnología Biomédica , Evaluación de la Tecnología Biomédica/métodos , Análisis Costo-Beneficio , Moscú , Federación de Rusia
16.
Front Public Health ; 10: 1010702, 2022.
Artículo en Inglés | MEDLINE | ID: mdl-36388387

RESUMEN

Health technology assessment (HTA) offers a set of analytical tools to support health systems' decisions about resource allocation. Although there is increasing interest in these tools across the world, including in some middle-income countries, they remain rarely used in low-income countries (LICs). In general, the focus of HTA is narrow, mostly limited to assessments of efficacy and cost-effectiveness. However, the principles of HTA can be used to support a broader series of decisions regarding new health technologies. We examine the potential for this broad use of HTA in LICs, with a focus on Malawi. We develop a framework to classify the main decisions on health technologies within health systems. The framework covers decisions on identifying and prioritizing technologies for detailed assessment, deciding whether to adopt an intervention, assessing alternative investments for implementation and scale-up, and undertaking further research activities. We consider the relevance of the framework to policymakers in Malawi and we use two health technologies as examples to investigate the main barriers and enablers to the use of HTA methods. Although the scarcity of local data, expertise, and other resources could risk limiting the operationalisation of HTA in LICs, we argue that even in highly resource constrained health systems, such as in Malawi, the use of HTA to support a broad range of decisions is feasible and desirable.


Asunto(s)
Asignación de Recursos , Evaluación de la Tecnología Biomédica , Malaui , Pobreza , Análisis Costo-Beneficio
17.
Artículo en Inglés | MEDLINE | ID: mdl-36360894

RESUMEN

BACKGROUND: Telemedicine is an effective, widely used strategy in the field of cystic fibrosis management. The objective of this scoping review is to summarize and analyze the scientific literature with the special focus on the tools and the strategies used in patients with a chronic disease, such as cystic fibrosis. METHODS: This scoping review will be performed in accordance with the Joanna Briggs Institute methodology. In this context, the planned scoping review is a research synthesis that will map the literature on the applications of telemedicine and telemonitoring to the management of cystic fibrosis, with the aim to identify key concepts in the research and work to be conducted that may impact clinical practice. Studies will be included if they meet the following population, concept, and context criteria: all patients with cystic fibrosis receiving treatment with the tools of telemedicine and telemonitoring. No study design, publication type, or data restrictions will be applied. MEDLINE, Scopus, CINHAL, Pedro, Embase, Web of Science, ACM Digital Library, Health Technology Assessment Database (HTA), and Cochrane Central will be searched up to September 2022. DISCUSSION: To the best of our knowledge, this will be the first scoping review to provide a comprehensive overview of the topic. The results could add meaningful information for future research and, especially, for clinical practice, when implementing telerehabilitation in cystic fibrosis treatment. Furthermore, we expect that our work may identify possible knowledge gaps on the topic. The results of this research will be published in a peer-reviewed journal and will be presented at relevant international scientific events, such as in congress or meetings.


Asunto(s)
Fibrosis Quística , Telemedicina , Telerrehabilitación , Humanos , Fibrosis Quística/terapia , Proyectos de Investigación , Evaluación de la Tecnología Biomédica , Literatura de Revisión como Asunto
18.
JAMA Netw Open ; 5(11): e2239874, 2022 Nov 01.
Artículo en Inglés | MEDLINE | ID: mdl-36326765

RESUMEN

Importance: The external validity of survival outcomes derived from clinical practice data from US patients with advanced non-small cell lung cancer (NSCLC) is not known and is of potential importance because it may be used to support regulatory decision-making and health technology assessment outside of the US. Objective: To evaluate whether overall survival (OS) estimates for a selected group of patients with advanced NSCLC from a large US clinical practice database are transportable to Canadian patients receiving the same systemic therapies. Design, Setting, and Participants: This retrospective multicenter cohort study used transportability analysis to assess whether adjustment for pretreatment characteristics of eligible patient cohorts could reliably approximate OS estimated from US-based samples to Canadian populations. A total of 17 432 eligible adult patients who were diagnosed de novo with advanced NSCLC on or after January 1, 2011, were included in the analysis and followed up until September 30, 2020. Because data on race and ethnicity were available in the US database but not the Canadian database and because racial and ethnic distribution was likely to be similar between US and Canadian patients, these characteristics were not analyzed. Exposures: Initiation of platinum-doublet chemotherapy or pembrolizumab monotherapy as first-line systemic treatment for advanced NSCLC. Main Outcomes and Measures: OS measured from the time of initiation of the respective treatment regimen. Results: Among 17 432 eligible patients, 15 669 patients from the US and 1763 patients from Canada were included in the analysis. Of those, 11 863 patients (sample size-weighted estimates of mean [SD] age, 68.0 [9.3] years; 6606 [55.7%] male; 10 100 from the US and 1763 from Canada) were included in the subset of patients with complete data for baseline covariates. A total of 13 532 US patients received first-line chemotherapy, and 2137 received first-line pembrolizumab monotherapy. Of those, 8447 patients (62.4%) in the first-line chemotherapy group and 1653 patients (77.3%) in the first-line pembrolizumab group had complete data on baseline covariates for outcome model estimation. A total of 1476 Canadian patients who received first-line chemotherapy and 287 patients who received first-line pembrolizumab monotherapy were identified from the target population. After standardization to baseline patient covariates in the Canadian cohorts, transported OS estimates revealed a less than 5% mean absolute difference from the observed OS in the target population (0.56% over 60 months of follow-up in the first-line chemotherapy group and 4.54% over 30 months of follow-up in the first-line pembrolizumab group). Negative control analysis using a mismatched outcome model revealed a 6.64% discrepancy and an incompatible survival curve shape. The results were robust to assumptions of random missingness for baseline covariates, to unadjusted differences in baseline metastases and comorbidities, and to differences in the standard of care between the US and Canada related to administration of second-line anti-programmed cell death 1 ligand 1 immunotherapy for patients who initiated first-line chemotherapy. Conclusions and Relevance: The results of this cohort study suggest that, under specific circumstances, OS estimates from US clinical practice data can be adjusted using baseline clinical characteristics to closely approximate OS in selected groups of Canadian patients with advanced NSCLC. These results may have implications for regulatory decision-making and health technology assessment in target populations outside of the US.


Asunto(s)
Carcinoma de Pulmón de Células no Pequeñas , Neoplasias Pulmonares , Adulto , Humanos , Masculino , Anciano , Femenino , Carcinoma de Pulmón de Células no Pequeñas/patología , Neoplasias Pulmonares/patología , Evaluación de la Tecnología Biomédica , Estudios de Cohortes , Canadá/epidemiología
19.
Sensors (Basel) ; 22(22)2022 Nov 09.
Artículo en Inglés | MEDLINE | ID: mdl-36433223

RESUMEN

A smart grid is a next-generation intelligent power grid that can maximize energy efficiency by monitoring power information in real time and by controlling the flow of power by introducing IT communication technology to the existing power grid. In order to apply a wireless communication network to a smart grid, it is necessary to be able to efficiently process large amounts of power-related data while enabling a high level of reliability and quality of service (QoS) support. In addition, international standards-based design is essential considering compatibility and scalability. The IEEE 802.15.4 standard is considered to be the most powerful communication method for processing data through the smart grid AMI. To reduce the energy consumption, as the duty cycle of the superframe increases, the probability of the congestion increases. However, this binary exponential algorithm in IEEE 802.15.4 standard does not account for the application of traffic characteristics that essentially negatively affect the smart grid network performances in terms of packet delivery ratio and time delay. Therefore, in this paper, we propose a new transmission scheme to reduce performance degradation by excessive collisions in the content access period (CAP), when data transmission is performed in IEEE 802.15.4 applied to smart grids. In addition, we investigated the main research topics required when applying wireless networking technology to smart grids and suggested improvement measures. Simulation results showed that the proposed scheme increased the data delivery rate and reduced the latency, and it was confirmed that reliability was improved.


Asunto(s)
Sistemas de Computación , Proyectos de Investigación , Reproducibilidad de los Resultados , Probabilidad , Tecnología de la Información
20.
Health Res Policy Syst ; 20(1): 124, 2022 Nov 04.
Artículo en Inglés | MEDLINE | ID: mdl-36333759

RESUMEN

Public health emergencies (PHEs), such as the COVID-19 crisis, are threats to global health and public order. We recommend that countries bolster their PHE responses by investing in health technology assessment (HTA), defined as a systematic process of gathering pertinent information on and evaluating health technologies from a medical, economic, social and ethical standpoint. We present examples of how HTA organizations in low- and middle-income countries have adapted to supporting PHE-related decisions during COVID-19 and describe the ways HTA can help the response to a PHE. In turn, we advocate for HTA capacity to be further developed globally and for increased institutional acceptance of these methods as a building block for preparedness and response to future PHEs. Finally, the long-term potential of HTA in strengthening health systems and embedding confidence and transparency into scientific policy should be recognized.


Asunto(s)
COVID-19 , Evaluación de la Tecnología Biomédica , Humanos , Salud Pública , Política de Salud , Urgencias Médicas
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