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Given their frontline role in Australia and Aotearoa New Zealand (ANZ) healthcare, trainee medical officers (TMOs) will play a crucial role in the development and use of artificial intelligence (AI) for clinical care, ongoing medical education and research. As 'digital natives', particularly those with technical expertise in AI, TMOs should also be leaders in informing the safe uptake and governance of AI within ANZ healthcare as they have a practical understanding of its associated risks and benefits. However, this is only possible if a culture of broad collaboration is instilled while the use of AI in ANZ is still in its initial phase. [ABSTRACT FROM AUTHOR]

Objectives: This manuscript presents a comprehensive framework for the assessment of the value of real-world evidence (RWE) in healthcare decision-making. While RWE has been proposed to overcome some limitations of traditional, one-off studies, no systematic framework exists to measure if RWE actually lowers the burden. This framework aims to fill that gap by providing conceptual approaches for evaluating the time and cost efficiencies of RWE, thus guiding strategic investments in RWE infrastructure. Methods: The framework consists of four components: (114th Congress. 21st Century Cures Act.; 2015. https://www.congress.gov/114/plaws/publ255/PLAW-114publ255.pdf.) identification of stakeholders using and producing RWE, (National Health Council. Glossary of Patient Engagement Terms. Published 2019. Accessed May 18. 2021. https://nationalhealthcouncil.org/glossary-of-patient-engagement-terms/.) understanding value propositions on how RWE can benefit stakeholders, (Center for Drug Evaluation and Research. CDER Patient-Focused Drug Development. U.S. Food & Drug Administration.) defining key performance indicators (KPIs), and (U.S. Department of Health and Human Services - Food and Drug Administration: Center for Devices and Radiological Health and Center for Biologics Evaluation and Research. Use of Real-World Evidence to Support Regulatory Decision-Making for Medical Devices - Guidance for Industry and Food and Drug Administration Staff. 2017. http://www.fda.gov/BiologicsBloodVaccines/GuidanceComplianceRegulatoryInformation/Guida.) establishing metrics and case studies to assess value. KPIs are categorized as 'better, faster, or cheaper" as an indicator of value: better focusing on high-quality actionable evidence; 'faster,' denoting time-saving in evidence generation, and 'cheaper,' emphasizing cost-efficiency decision compared to methodologies that do not involve data routinely collected in clinical practice. Metrics and relevant case studies are tailored based on stakeholder value propositions and selected KPIs that can be used to assess what value has been created by using RWE compared to traditional evidence-generation approaches and comparing different RWE sources. Results: Operationalized through metrics and case studies drawn from the literature, the value of RWE is documented as improving treatment effect heterogeneity evaluation, expanding medical product labels, and expediting post-market compliance. RWE is also shown to reduce the cost and time required to produce evidence compared to traditional one-off approaches. An original example of a metric that measures the time saved by RWE methods to detect a signal of a product failure was presented based on analysis of the National Cardiovascular Disease Registry. Conclusions: The framework presented in this manuscript offers a comprehensive approach for evaluating the value of RWE, applicable to all stakeholders engaged in leveraging RWE for healthcare decision-making. Through the proposed metrics and illustrated case studies, valuable insights are provided into the heightened efficiency, cost-effectiveness, and improved decision-making within clinical and regulatory domains facilitated by RWE. While this framework is primarily focused on medical devices, it could potentially inform the determination of RWE value in other medical products. By discerning the variations in cost, time, and data utility among various evidence-generation methods, stakeholders are empowered to invest strategically in RWE infrastructure and shape future research endeavors. [ABSTRACT FROM AUTHOR]

Objective To assess how the returns on investment from correcting refractive errors and cataracts in low- and middle- income countries compare with the returns from other global development interventions. Methods We adopted two complementary approaches to estimate benefit-cost ratios from eye health investment. First, we systematically searched PubMed[R] and Web of Science[TM] on 14 August 2023 for studies conducted in low-and-middle-income countries, which have measured welfare impacts associated with correcting refractive errors and cataracts. Using benefit-cost analysis, we compared these impacts to costs. Second, we employed an economic modelling analysis to estimate benefit-cost ratios from eye health investments in India. We compared the returns from eye health to returns in other domains across global health and development. Findings We identified 21 studies from 10 countries. Thirteen outcomes highlighted impacts from refractive error correction for school students. From the systematic review, we used 17 out of 33 outcomes for benefit- cost analyses, with the median benefit- cost ratio being 36. The economic modelling approach for India generated benefit-cost ratios ranging from 28 for vision centres to 42 for school eye screening, with an aggregate ratio of 31. Comparing our findings to the typical investment in global development shows that eye health investment returns six times more benefits (median benefit-cost ratio: 36 vs 6). Conclusion Eye health investments provide economic benefits with varying degrees based on the intervention type and location. Our findings underline the importance of incorporating eye health initiatives into broader development strategies for substantial societal returns. Objectif Comparer les retours sur investissement d'une correction des defauts de refraction et des cataractes dans les pays a revenu faible et intermediaire avec ceux d'autres interventions liees au developpement mondial. Methodes Nous avons adopte deux approches complementaires afin d'estimer les rapports couts/avantages d'un investissement dans la sante oculaire. Tout d'abord, nous avons passe au crible PubMed[R] et Web of Science[TM] le 14 aout 2023, a la recherche d'etudes menees dans des pays a revenu faible et intermediaire sur l'impact d'une correction des defauts de refraction et des cataractes, puis nous avons procede a une analyse couts/avantages dans le but de comparer cet impact aux depenses engendrees. Ensuite, nous avons effectue une analyse par modelisation economique afin de determiner les rapports couts/ avantages des investissements dans la sante oculaire en Inde. Enfin, nous avons compare les retours sur investissement dans ce domaine avec ceux d'autres domaines lies a la sante et au developpement a l'echelle mondiale. Resultats Nous avons identifie 21 etudes portant sur 10 pays. Parmi les resultats obtenus, 13 mettaient en evidence l'impact qu'une correction des defauts de refraction representait pour les etudiants. A l'issue de notre revue systematique, nous avons utilise 17 des 33 resultats pour nos analyses couts/avantages, le rapport median s'elevant a 36. Lapproche par modelisation economique pour l'Inde a debouche sur des rapports couts/avantages allant de 28 pour les centres de la vision a 42 pour le depistage des troubles de la vue en milieu scolaire, avec une proportion globale de 31. En comparant nos resultats avec les depenses classiques en matiere de developpement mondial, nous avons constate qu'investir dans la sante oculaire permettait de multiplier les avantages par six (rapport couts/avantages median: 36 contre 6). Conclusion Les investissements dans la sante oculaire s'accompagnent d'avantages economiques a differents niveaux, en fonction du lieu et du type d'intervention. Nos resultats montrent a quel point l'integration d'initiatives de sante oculaire au sein de strategies de developpement plus vastes est importante dans la realisation de benefices considerables pour la societe. Objetivo Evaluar la rentabilidad de la inversion en la correccion de los defectos de refraccion y las cataratas en los paises de ingresos bajos y medios en comparacion con la rentabilidad de otras intervenciones de desarrollo a escala mundial. Metodos Se adoptaron dos enfoques complementarios para estimar la relacion coste-beneficio de la inversion en salud ocular. En primer lugar, se realizo una busqueda sistematica en PubMed[R] y Web of Science[TM] el 14 de agosto de 2023 sobre estudios realizados en paises de ingresos bajos y medios, que han medido los efectos en el bienestar asociados a la correccion de los errores de refraccion y las cataratas. Mediante el analisis beneficio-coste, se compararon estos efectos con los costes. En segundo lugar, se empleo un analisis de modelos economicos para estimar la relacion beneficio-coste de las inversiones en salud ocular en la India. Asimismo, se compararon las rentabilidades de la salud ocular con las de otros sectores de la salud y el desarrollo mundiales. Resultados Se identificaron 21 estudios de 10 paises. Trece resultados destacaron los efectos de la correccion de los defectos de refraccion en estudiantes. A partir de la revision sistematica, se utilizaron 17 de los 33 resultados para los analisis de beneficio-coste, en los que la mediana de esta relacion fue de 36. El enfoque de modelacion economica para la India genero relaciones beneficio-coste que van de 28 para los centros oftalmologicos a 42 para el cribado ocular en las escuelas, con una relacion agregada de 31. Si se comparan los resultados obtenidos con la inversion tipica en desarrollo mundial, se observa que la inversion en salud ocular genera una rentabilidad seis veces mayor (relacion beneficio-coste mediana: 36 frente a 6). Conclusion Las inversiones en salud ocular aportan beneficios economicos de diversa magnitud segun el tipo de intervencion y la ubicacion. Los resultados obtenidos destacan la importancia de incorporar las iniciativas de salud ocular a estrategias de desarrollo mas amplias para obtener una rentabilidad social significativa., Introduction Although vision impairment affects 2.2 billion people, (1) eye health services are underfunded and undervalued in global health policy. Notably, Transforming our world: the 2030 agenda for sustainable development [...]

The World Health Organization has developed target product profiles containing minimum and optimum targets for key characteristics for tests for tuberculosis treatment monitoring and optimization. Tuberculosis treatment optimization refers to initiating or switching to an effective tuberculosis treatment regimen that results in a high likelihood of a good treatment outcome. The target product profiles also cover tests of cure conducted at the end of treatment. The development of the target product profiles was informed by a stakeholder survey, a cost-effectiveness analysis and a patient-care pathway analysis. Additional feedback from stakeholders was obtained by means of a Delphi-like process, a technical consultation and a call for public comment on a draft document. A scientific development group agreed on the final targets in a consensus meeting. For characteristics rated of highest importance, the document lists: (i) high diagnostic accuracy (sensitivity and specificity); (ii) time to result of optimally [less than or equal to] 2 hours and no more than 1 day; (iii) required sample type to be minimally invasive, easily obtainable, such as urine, breath, or capillary blood, or a respiratory sample that goes beyond sputum; (iv) ideally the test could be placed at a peripheral-level health facility without a laboratory; and (v) the test should be affordable to low- and middle-income countries, and allow wide and equitable access and scale-up. Use of these target product profiles should facilitate the development of new tuberculosis treatment monitoring and optimization tests that are accurate and accessible for all people being treated for tuberculosis. L'Organisation mondiale de la sante a elabore des profils de produits cibles contenant des cibles minimales et optimales pour les caracteristiques principales des essais destines au suivi et a l'optimisation du traitement de la tuberculose. L'optimisation du traitement de la tuberculose fait reference a l'instauration d'un regime de traitement efficace de la tuberculose ou a l'adoption d'un tel regime, avec une probabilite elevee d'obtenir de bons resultats therapeutiques. Les profils de produits cibles couvrent egalement les essais de guerison effectues a l'issue du traitement. Les profils de produits cibles ont ete elabores sur la base d'un sondage aupres des parties prenantes, d'une analyse cout-efficacite et d'une analyse du parcours de soins du patient. Des retours supplementaires des parties prenantes ont ete obtenus au moyen d'un processus cree selon la methode Delphi, d'une consultation technique et d'un appel a commentaires publics sur un projet de document. Un groupe d'elaboration scientifique s'est mis d'accord sur les objectifs finaux lors d'une reunion de concertation. En ce qui concerne les caracteristiques jugees les plus importantes, le document enumere ce qui suit: (i) une grande precision diagnostique (sensibilite et specificite); (ii) un delai ideal d'obtention des resultats [less than or equal to] 2 heures et au maximum de 1 jour; (iii) le type d'echantillon requis doit etre peu invasif et facile a obtenir, comme l'urine, l'haleine ou le sang capillaire, ou bien un echantillon respiratoire au-dela des expectorations; (iv) idealement, l'essai pourrait avoir lieu dans un etablissement de sante peripherique sans laboratoire ; et (v) l'essai devrait etre abordable pour les pays a revenu faible et intermediaire et permettre un acces large et equitable ainsi qu'une mise a l'echelle. L'utilisation de ces profils de produits cibles devrait faciliter la mise au point de nouveaux essais de surveillance et d'optimisation du traitement de la tuberculose qui soient precis et accessibles a toutes les personnes suivant un traitement pour la tuberculose. La Organizacion Mundial de la Salud ha elaborado perfiles de productos objetivo que contienen objetivos minimos y optimos para las caracteristicas principales de las pruebas de seguimiento y optimizacion del tratamiento de la tuberculosis. La optimizacion del tratamiento de la tuberculosis consiste en iniciar o cambiar a un regimen eficaz de tratamiento de la tuberculosis que ofrezca una alta probabilidad de un buen resultado terapeutico. Los perfiles de productos objetivo tambien abarcan las pruebas de curacion realizadas al final del tratamiento. La elaboracion de los perfiles de los productos objetivo se baso en una encuesta a las partes interesadas, un analisis de rentabilidad y un analisis de la via de atencion al paciente. Se obtuvo informacion adicional de las partes interesadas mediante un proceso tipo Delphi, una consulta tecnica y una convocatoria de comentarios publicos sobre un borrador del documento. Un grupo de desarrollo cientifico acordo los objetivos finales en una reunion de consenso. Para las caracteristicas clasificadas de mayor importancia, el documento enumera: (i) alta precision diagnostica (sensibilidad y especificidad); (ii) tiempo hasta el resultado de optimamente [less than or equal to] 2 horas y no mas de 1 dia; (iii) el tipo de muestra requerida debe ser minimamente invasiva, facil de obtener, como orina, aliento o sangre capilar, o una muestra respiratoria que vaya mas alla del esputo; (iv) idealmente la prueba podria realizarse en un centro sanitario periferico sin laboratorio; y (v) la prueba debe ser asequible para los paises de ingresos bajos y medios y permitir un acceso amplio y equitativo y su expansion. El uso de estos perfiles de producto objetivo deberia facilitar el desarrollo de pruebas nuevas de seguimiento y optimizacion del tratamiento de la tuberculosis que sean precisas y accesibles para todas las personas que reciben tratamiento antituberculoso. [phrase omitted], Introduction Tuberculosis continues to be a major cause of morbidity and mortality globally, despite being curable and preventable. In 2021, an estimated 10.6 million people had tuberculosis disease and 1.6 [...]

Objective: This research aimed to determine how a 12-week PRECEDE-PROCEED model-based intervention affected fatigue in patients with coronary heart disease. Methods: This cluster randomized controlled trial recruited participants diagnosed with coronary heart disease at 2 community health centers in China. Participants in the control group (n = 36) received routine health education, whereas those in the intervention group (n = 38) were given a 12-week PRECEDE-PROCEED model-based intervention and routine health education. The intervention consisted of 6 training sessions on coronary heart disease, fatigue, fatigue management, self-management skills and social support. A primary outcome (fatigue) and 4 secondary outcomes (knowledge of fatigue, self-management, quality of life and body mass index) were assessed using the Fatigue Scale-14, Fatigue Cognitive Questionnaire for Patients with Coronary Heart Disease, Coronary Artery Disease Self-Management Scale, Chinese Cardiovascular Questionnaire of Quality of Life, and electronic weighing scale, respectively. Data were collected 3 times over 12 weeks. Results: Compared with the control group, the intervention group showed a statistically significant improvement in the level of fatigue (8.72 vs 7.06, P <.001), knowledge of fatigue (P <.001), self-management skills (P <.001), and quality of life (P <.001). However, there was no significant difference in body mass index between the 2 groups (P =.504). Conclusions: The findings suggest that a well-designed intervention based on the PRECEDE-PROCEED model could alleviate fatigue symptoms and increase knowledge of fatigue, self-management skills and quality of life in patients with coronary heart disease. [ABSTRACT FROM AUTHOR]

Aims: The aim of this study was to explore factors that influence family caregiver readiness to adopt health smart home technology for their care‐dependent older adult family member. Health smart homes are designed to remotely monitor the health and wellness of community‐dwelling older adults supporting independent living for as long as possible. Accordingly, if the health smart home is deployed into the home of a care‐depended older adult, it can potentially support family caregivers by facilitating workforce participation and give piece of mind to the family caregiver who may not live close to the older adult. However, wider adoption of health smart home technologies into the homes of community‐older adults is low, and little is known about the factors that influence the readiness of family caregivers to adopt smart home technologies for their care‐dependent older adults. Design: A qualitative Descriptive study design was utilized. Methods: Qualitative data were collected between 2019 and 2020 via semi‐structured interviews. Thematic analysis of interviews was completed, and data were organized into themes. Results: Study findings show that caregiver readiness (N = 10) to adopt smart home technology to monitor older adult family members were influenced by five primary themes including a 'big brother effect', 'framing for acceptance', 'data privacy', 'burden' and 'cost.' Conclusion: Family caregivers were open to adopting smart home technology to support the independent living of their older adult family members. However, the readiness of family caregivers was inextricably linked to the older adults' readiness for smart home adoption. The family caregiver's primary concern was on how they could frame the idea of the smart home to overcome what they viewed as hesitancy to adopt in the older adult. The findings suggest that family caregivers endeavour to balance the hesitancy in their older adult family members with the potential benefits of smart home technology. Impact: Family caregivers could benefit if their care‐dependent older adults adopt smart home technology. Recognizing the role of caregivers and their perspectives on using smart home technologies with their care‐dependents is critical to the meaningful design, use and adoption. [ABSTRACT FROM AUTHOR]

Menstrual cups are considered a sustainable solution for menstrual health and hygiene management, as they are cost-effective, environment-friendly, reusable and offer health benefits over traditional menstrual hygiene products such as pads and tampons. However, in lower middle income countries (LMICs), menstrual cup use is limited. Recently, India's current menstrual hygiene program has included menstrual cups as an option for menstrual health and hygiene management. However, the menstrual cup has not been promoted widely in the Indian context. Even if the use of menstrual cups among female healthcare providers in India is minimal, the manuscript identified the crucial challenges in menstrual health and hygiene management, the role of menstrual cups as a solution and the essential strategies to increase menstrual cup use. Programmatic success requires endorsement from healthcare providers as they are trusted sources of information related to healthcare. Good experiences and leading examples from healthcare providers about using menstrual cups is a welcoming step in the path of the dream of a "pad-free country" for India. [ABSTRACT FROM AUTHOR]

: Introduction: In 2018, the Mozambique Ministry of Health launched guidelines for implementing differentiated service delivery models (DSDMs) to optimize HIV service delivery, improve retention in care, and ultimately reduce HIV‐associated mortality. The models were fast‐track, 3‐month antiretrovirals dispensing, community antiretroviral therapy groups, adherence clubs, family approach and three one‐stop shop models: adolescent‐friendly health services, maternal and child health, and tuberculosis. We conducted a cost‐effectiveness analysis and budget impact analysis to compare these models to conventional services. Methods: We constructed a decision tree model based on the percentage of enrolment in each model and the probability of the outcome (12‐month retention in treatment) for each year of the study period—three for the cost‐effectiveness analysis (2019–2021) and three for the budget impact analysis (2022–2024). Costs for these analyses were primarily estimated per client‐year from the health system perspective. A secondary cost‐effectiveness analysis was conducted from the societal perspective. Budget impact analysis costs included antiretrovirals, laboratory tests and service provision interactions. Cost‐effectiveness analysis additionally included start‐up, training and clients’ opportunity costs. Effectiveness was estimated using an uncontrolled interrupted time series analysis comparing the outcome before and after the implementation of the differentiated models. A one‐way sensitivity analysis was conducted to identify drivers of uncertainty. Results: After implementation of the DSDMs, there was a mean increase of 14.9 percentage points (95% CI: 12.2, 17.8) in 12‐month retention, from 47.6% (95% CI, 44.9–50.2) to 62.5% (95% CI, 60.9–64.1). The mean cost difference comparing DSDMs and conventional care was US$ –6 million (173,391,277 vs. 179,461,668) and –32.5 million (394,705,618 vs. 433,232,289) from the health system and the societal perspective, respectively. Therefore, DSDMs dominated conventional care. Results were most sensitive to conventional care interaction costs in the one‐way sensitivity analysis. For a population of 1.5 million, the base‐case 3‐year financial costs associated with the DSDMs was US$550 million, compared with US$564 million for conventional care. Conclusions: DSDMs were less expensive and more effective in retaining clients 12 months after antiretroviral therapy initiation and were estimated to save approximately US$14 million for the health system from 2022 to 2024., INTRODUCTION In November 2018, Mozambique's Ministry of Health (MISAU) launched guidelines for the nationwide implementation of eight differentiated service delivery models (DSDMs) to increase efficiency and reduce HIV‐associated mortality. The [...]

Abstract Routine childhood vaccinations are among the most cost-effective child health interventions. In recent years, the broader benefits of vaccines, which include improved cognitive and schooling outcomes, have also been established. This paper evaluates the long-term economic benefits of India's national program of childhood vaccinations, known as the Universal Immunization Programme (UIP). We combine individual-level data from the 68th round of the National Sample Survey of India (2011–12) with district-wise data on the rollout of UIP from 1985 to 1990. We employ age-district fixed-effects regression models to compare the earnings and per capita household consumer spending of 21- to 26-year-old adults who were born in UIP-covered districts vis-à-vis non-UIP districts between 1985 and 1990. We find that exposure to UIP in infancy increases weekly wages by 13.8 percent (95 percent CI: 7.6–20.3 percent, p < 0.01) and monthly per capita household consumption expenditure by 2.9 percent (95 percent CI: 0.7–5.0 percent, p < 0.01). Program exposure also reduces the probability that an individual's household relies on agriculture as the main source of income by 1.9 percent (95 percent CI: 0.0–3.5 percent, p < 0.01). The findings are robust to several specifications including varying study duration and accounting for potential migration. The effects vary by sex, location, and caste group. [ABSTRACT FROM AUTHOR]

In Ethiopia, post-harvest losses caused by insects are a major challenge in crop production systems. Dried maize is particularly susceptible to insects during storage. Storage loss affects the livelihoods of small-scale farmers leading to food insecurity and loss of income. Therefore, the objective of this study was to assess the cost-benefit analysis of Purdue Improved Crop Storage (PICS) bags on maize storage in Northwest Ethiopia. Cross-sectional data was collected from 392 randomly selected households from both users and non-users of PICS bags, using stratified sampling technique. A structured questionnaire, key informant interviews, focus group discussions, individual in-depth interviews, and field observations were used to gather the data. A cost-benefit analysis was computed to evaluate the viability of PICS bags for maize storage. The binary logistic regression model was used to identify factors that affect the use of PICS bags. Descriptive statistics (percentage, mean, and standard deviation) and inferential statistics (t-test and chisquare test) were employed to analyze the data. The benefit-to-cost ratios (BCRs) of insecticide with both ordinary and PICS bags were greater than one, but PICS bags resulted in more than two-fold higher values as compared to insecticide with ordinary bags. The net present value (NPV) at 15% discount rate in 2018 was 20.73 USD and 25.35 USD per 100 kilograms of stored maize when insecticide was applied to ordinary and PICS bags, respectively. Sensitivity analysis with a 10% cost increment and up to 50% price discount showed that both technologies would still be viable for maize storage. However, PICS bags had higher NPV and BCR; making the technology more viable than insecticide with ordinary bags. The results of binary logit model indicated that educational level, gender, awareness, training, accessibility of the technology, perception of the technology, involvement in leadership activities in the community, and total income of the household positively influenced farmers' decisions to use PICS bags, whereas price negatively affected the use of the PICS bags. PICS bags had clear economic advantage over insecticide with ordinary bags for maize storage in Northwest Ethiopia. Efforts should be made to disseminate and improve access to PICS bags for strengthening food security and increasing incomes of maize farmers in Northwest Ethiopia. Key words: Hermetic bag, smallholder farmers, profitability, post-harvest management, food security, INTRODUCTION In Ethiopia, post-harvest losses caused by insects are a major challenge in crop production systems. Stored maize is highly susceptible to pests, particularly insects [1]. Reducing food losses increases [...]