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Item does not contain fulltext, OBJECTIVES: The aim of this study was to identify and discuss appropriate approaches to integrate ethical inquiry in health technology assessment (HTA). METHODS: The key question is how ethics can be integrated in HTA. This is addressed in two steps: by investigating what it means to integrate ethics in HTA, and by assessing how suitable the various methods in ethics are to be integrated in HTA according to these meanings of integration. Results : In the first step, we found that integrating ethics can mean that ethics is (a) subsumed under or (b) combined with other parts of the HTA process; that it can be (c) coordinated with other parts; or that (d) ethics actively interacts and changes other parts of the HTA process. For the second step, we found that the various methods in ethics have different merits with respect to the four conceptions of integration in HTA. CONCLUSIONS: Traditional approaches in moral philosophy tend to be most suited to be subsumed or combined, while processual approaches being close to the HTA or implementation process appear to be most suited to coordinated and interactive types of integration. The article provides a guide for choosing the ethics approach that appears most appropriate for the goals and process of a particular HTA.

Contains fulltext : 154875.pdf (publisher's version ) (Closed access), Context and implementation of health interventions have received increasing attention over the past decade, in particular with respect to their influence on the effectiveness and reach of complex interventions. The underlying concepts are both considered partially mature, limiting their operationalization in research and practice. We conducted systematic literature searches and pragmatic utility (PU) concept analyses to provide a state-of-the-art assessment of the concepts of "context" and "implementation" in the health sciences to create a common understanding for their use within systematic reviews and HTA. We performed two separate searches, one for context (EMBASE, MEDLINE) and the other for implementation (Google Scholar) to identify relevant models, theories and frameworks. 17 publications on context and 35 articles on implementation met our inclusion criteria. PU concept analysis comprises three guiding principles: selection of the literature, organization and structuring of the literature, and asking analytic questions of the literature. Both concepts were analyzed according to four features of conceptual maturity, i.e., consensual definitions, clear characteristics, fully described preconditions and outcomes, and delineated boundaries. Context and implementation are highly intertwined, with both concepts influencing and interacting with each other. Context is defined as a set of characteristics and circumstances that surround the implementation effort. Implementation is conceptualized as a planned and deliberately initiated effort with the intention to put an intervention into practice. The concept of implementation presents largely consensual definitions and relatively well-defined boundaries, while distinguishing features, preconditions and outcomes are not yet fully articulated. In contrast, definitions of context vary widely, and boundaries with neighbouring concepts, such as setting and environment, are blurred; characteristics, preconditions and outco

Objectives: The aim of this study was to identify and discuss appropriate approaches to integrate ethical inquiry in health technology assessment (HTA). Methods: The key question is how ethics can be integrated in HTA. This is addressed in two steps: by investigating what it means to integrate ethics in HTA, and by assessing how suitable the various methods in ethics are to be integrated in HTA according to these meanings of integration. Results: In the first step, we found that integrating ethics can mean that ethics is (a) subsumed under or (b) combined with other parts of the HTA process; that it can be (c) coordinated with other parts; or that (d) ethics actively interacts and changes other parts of the HTA process. For the second step, we found that the various methods in ethics have different merits with respect to the four conceptions of integration in HTA. Conclusions: Traditional approaches in moral philosophy tend to be most suited to be subsumed or combined, while processual approaches being close to the HTA or implementation process appear to be most suited to coordinated and interactive types of integration. The article provides a guide for choosing the ethics approach that appears most appropriate for the goals and process of a particular HTA

From the conception of HTA in the 1970s it has been argued that addressing ethical issues is an element of HTA, and many methods for integrating ethics in HTA have become available. However, despite almost 40 years with repeated intentions, only few HTA reports include ethical analysis. Why is this so? How come, ethics is a constituent part of HTA, there are many methods available, but ethics is rarely part of practical HTA work?This is the key question of this article and several reasons why ethics is not a part of HTA are identified. A) Ethicists are professional strangers in HTA. B) A common agreed methodology for integrating ethics is lacking. Ethics methodology appears to be C) deficient, D) insufficient, or E) unsuitable. F) Integrating ethics in HTA is neither efficient nor needed for successful HTA. G) Most moral issues are general, and are not specific to a given technology. H) All relevant ethical issues can be handled within other frameworks, e.g., within economics. I) Ethics can undermine or burst the foundation of HTA.Hence, there are many reasons why ethics is not an integrated part of HTA so many years after identifying ethics as constitutive to HTA. These reasons may all explain why it is so, but on closer scrutiny, they do not work as compelling arguments for not addressing ethical issues in HTA. Hence, the identified reasons may work well as explanations, but not as justifications. In order to move on from a situation of failure we can: Exclude ethics from definitions of HTA, and as a consequence, establish a separate kind of evaluation (Health Technology Evaluation - HTE). Take the existing definition seriously and actually integrate ethics in the performance of HTA practice. Amend, expand or change HTA so that ethics is more genuinely incorporated. Which of these options to choose is open for discussion, but we need to move away from a situation where we have a definition of HTA which does not correspond with HTA practice.

Background: Although value issues are increasingly addressed in health technology assessment (HTA) reports, health technology assessment is still seen as a scientific endeavor and sometimes contrasted with value judgments, which are considered arbitrary and unscientific. This article aims at illustrating how numerous value judgments are at play in the HTA process, and why it is important to acknowledge and address value judgments. 5 6 7 Methods: A panel of experts involved in HTA, including ethicists, scrutinized the HTA process with regard to implicit value judgments. It was analyzed whether these value judgments undermine the accountability of HTA results. The final results were obtained after several rounds of deliberation. 8 9 Results: Value judgments are identified before the assessment when identifying and selecting health technologies to assess, and as part of assessment. They are at play in the selection of studies to include, and in deciding on how to frame, present, summarize or synthesize information in systematic reviews. Also, in economic analysis, value judgments are ubiquitous. Addressing the ethical, legal, and social issues of a given health technology involves moral, legal, and social value judgments by definition. So do the appraisal and the decision-making process. 10 11 12 13 Conclusions: HTA by and large is a process of value judgments. However, the preponderance of value judgments does not render HTA biased or flawed. On the contrary they are basic elements of the HTA process. Acknowledging and explicitly addressing value judgments may improve the accountability of HTA.

Background: Ethics has been identified as a key element in health technology assessment (HTA) since its conception in the 1970s . A wide variety of methods for addressing ethical issues in HTA are available . Some of these are specially developed for use in HTA . Despite the constitutive role of ethics in HTA and the fact that many methods are available, ethics is still rarely addressed explicitly in HTA reports . This has prompted attention to why ethics should be integrated in HTA and less to how ethics can be integrated in HTA in a fruitful manner . Description/Objectives: The panel will demonstrate various ways that ethics can be integrated in HTA and to discuss their merits . The objective is to facilitate HTA agencies’ assessment of how to integrate ethics in their HTA work . An outline of various ways of integrating ethics in HTA will be illustrated by examples from HTA reports and publications . Various kinds of result based and process based integration will be presented and discussed . Checklist approaches will be compared to focus group approaches . Ethics

We have investigated the Ash Shutbah circular structure in central Saudi Arabia (21°37′N 45°39′E) using satellite imagery, field mapping, thin-section petrography, and X-ray diffraction of collected samples. The approximately 2.1 km sized structure located in flat-lying Jurassic Tuwaiq Mountain Limestone has been nearly peneplained by erosional processes. Satellite and structural data show a central area consisting of Dhruma Formation sandstones with steep bedding and tight folds plunging radially outward. Open folding occurs in displaced, younger Tuwaiq Mountain Limestone Formation blocks surrounding the central area, but is absent outside the circular structure. An approximately 60 cm thick, unique folded and disrupted orthoquartzitic sandstone marker bed occurring in the central area of the structure is found 140 m deeper in undisturbed escarpment outcrops located a few hundred meters west of the structure. With exception of a possible concave shatter cone found in the orthoquartzite of the central area, other diagnostic shock features are lacking. Some quartz-rich sandstones from the central area show pervasive fracturing of quartz grains with common concussion fractures. This deformation was followed by an event of quartz dissolution and calcite precipitation consistent with local sea- or groundwater heating. The combination of central stratigraphic uplift of 140 m, concussion features in discolored sandstone, outward-dipping concentric folds in the central area, deformation restricted to the rocks of the ring structure, a complex circular structure of 2.1 km diameter that appears broadly consistent with what one would expect from an impact structure in sedimentary targets, and a possible shatter cone all point to an impact origin of the Ash Shutbah structure. In fact, the Ash Shutbah structure appears to be a textbook example of an eroded, complex impact crater located in flat-lying sedimentary rocks, where the undisturbed stratigraphic section can be studied