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Resumen: En pandemia, en Argentina y en otros países se observó variabilidad en las políticas públicas implementadas sobre tecnologías sanitarias para prevención y tratamiento de la COVID-19. El objetivo fue analizar cómo se procesaron en Argentina los movimientos de coordinación vs. cooperación, y de autonomía vs. reparto de autoridad entre entidades, explorando asimetrías entre diferentes entidades en la implementación de políticas públicas sobre tecnologías sanitarias en pandemia y las influencias de otros actores. Se realizó una revisión documental del período 2020-2021 (informes técnicos publicados por la Organización Mundial de la Salud, organismos nacionales y sociedades científicas, leyes, fallos judiciales, prensa, encuestas y entrevistas en profundidad a miembros de los Ministerios de Salud de Argentina). Se indagó sobre procesos y resultados de la toma de decisiones en los Ministerios de Salud, mapeando la cobertura y recomendación de cada tecnología y el partido político provincial gobernante. Hubo heterogeneidad en resultados y procesos entre los Ministerios, y disputas en el interior de los mismos. La adherencia a recomendaciones oficiales fue baja, influyendo distintos criterios técnico-políticos (relaciones de poder, presión social, de los medios, académicos, poder Judicial y Legislativo). En algunos casos se observó una fuerte tensión entre oficialismo y oposición al partido gobernante a partir de la discusión sobre tecnologías. Cada provincia argentina definió sus políticas sobre tecnologías sanitarias para COVID-19 con autonomía, y la toma de decisiones en la administración pública en pandemia fue desordenada, compleja y no lineal.

Objetivo: describir el desarrollo de un prototipo de software basado en la Cartilla de Salud de la Persona Mayor, utilizando la Evaluación Heurística para analizar su usabilidad. Método: investigación aplicada de desarrollo tecnológico, utilizando la Evaluación Heurística de Nielsen como medio para realizar el análisis de usabilidad, iniciada en noviembre de 2021 en Juiz de Fora y São João Del Rei. Resultados: el prototipo inicial cuenta con 5 pantallas, que contienen algunos datos relevantes para el cuidado de la salud de las personas mayores, como la edad, las comorbilidades y el historial de alergias. Los ancianos podrán editar sus datos personales, pero sólo los profesionales podrán incluir los datos de salud del paciente, con el objetivo de hacerlo más fiable. Conclusión: El uso de esta aplicación contribuirá a actualizar y avanzar en el uso de las tecnologías destinadas a la atención sanitaria, y aportará beneficios a los sistemas de salud y a los usuarios.

Este informe tiene por objetivo exponer el trabajo realizado sobre el diseño, la publicación y el impacto de las actualizaciones para intervenciones en COVID-19 basadas en la evidencia, para brindar síntesis de evidencia actualizadas a partir de revisiones sistemáticas vivas sobre intervenciones terapéuticas para dar soporte en la toma de decisiones. Para ello, se generó un grupo específico de trabajo en el ámbito de la Comisión Nacional de Evaluación de Tecnologías de Salud (CONETEC) en el Ministerio de Salud de Argentina en colaboración con la Organización Panamericana de la Salud (OPS). Se diseñó una metodología para elaborar y publicar documentos de evaluación orientados a dar apoyo en la toma de decisiones. Estos informes de actualización se respaldaron en la exploración de tres dominios: los efectos en la salud, la factibilidad de la implementación y las recomendaciones basadas en evidencia. Las conclusiones se adaptaron en un esquema semaforizado según el balance entre los beneficios y los aspectos negativos para los distintos escenarios clínicos, a fin de mejorar su interpretación y aplicación. Durante el año 2021 se publicaron 16 informes de síntesis de evidencia (13 originales y 3 actualizaciones completas) que recibieron un destacado número consultas desde la página web de CONETEC y la Base Regional de Informes de Evaluación de Tecnologías en Salud de las Américas (BRISA). Así se hizo visible la necesidad de disponer de resúmenes de evidencia robustos, actualizados y confiables con adaptación al contexto de aplicación en el sistema sanitario del país. El desafío se presenta, además, en la actualización constante de la información, la diseminación apropiada y el sostenimiento en la rigurosidad en el desarrollo de los informes.

Postgraduate education in Cuba has a determining role in the development of professionals. In this regard, the University of Medical Sciences from Santiago de Cuba has implemented a training model for the management of health technologies assessment, which establishes the interrelation and interconnection of the approach in science, technology and society, as well as the use of context and contextualization in the referents that allow the transformation of postgraduate training process. In the current article, it is exposed how the application of said model has contributed to shaping the training and improving the culture of health science, technology and innovation managers, at the same time that it has favored the quality of postgraduate education from an integral perspective, materialized in the improvement of its management. [ABSTRACT FROM AUTHOR]

Background: Health Technologies (HT) are important to make appropriate decisions in the field of health. The need to standardize TS evaluations is highlighted, since there are currently differences in the methods and recommendations used. In addition, the lack of trained human resources to carry out these evaluations is mentioned, as well as the long times they can take. Therefore, it is essential to prioritize the technologies to be evaluated to maximize available resources. In Latin America, the health technology prioritization process presents various barriers, such as the lack of an explicit and formal prioritization process in most countries. These barriers include fragmentation of health services, disagreement among stakeholders, and fear of reduced discretion in decision-making. Despite these difficulties, prioritization processes have been developed based on different methodological frameworks, which must be transparent, systematic, efficient, explicit and consensual. Therefore, it is necessary to have reference frameworks to evaluate the impact of these technologies on healthcare. The importance of declaring conflicts of interest in the evaluation of health technologies and how industry influence can affect the evaluation process is highlighted. Furthermore, the need to standardize evaluation methodologies and instruments is highlighted to improve the quality and comparability of STDs. [ABSTRACT FROM AUTHOR]

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Objetivo: analizar el costo-efectividad y calcular la relación costoefectividad incremental del tratamiento multicapa compresivo con respecto al inelástico (bota de Unna y estiramiento corto) según la literatura actual. Método: estudio cuantitativo de costo-efectividad a través de un modelo con ayuda del software TreeAge® para la elaboración del árbol de decisión. Los supuestos anunciados se obtuvieron mediante el uso de datos secundarios de la literatura para estimar el costo y la efectividad de los parámetros asumidos. Para ello, se realizó una revisión sistemática de la literatura con metaanálisis. Resultados: el árbol de decisión, después del Roll Back, mostró que la terapia multicapa prevaleció sobre las alternativas en el caso base, presentó un costo intermedio por aplicación, pero obtuvo la mayor efectividad. El gráfico del análisis de costo-efectividad también demostró que había un dominio extendido de la bota de Unna sobre el vendaje de estiramiento corto. El análisis de sensibilidad reveló que el vendaje multicapa sigue siendo la alternativa con mayor costoefectividad, dentro del umbral de disposición a pagar. Conclusión: la alternativa con mayor costo-efectividad fue el vendaje multicapa, considerado estándar de oro en la literatura. La segunda alternativa con mayor costo-efectividad fue la bota de Unna, la terapia más utilizada en Brasil.

Copyright of Cogitare Enfermagem is the property of Cogitare Enfermagem and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Cogitare Enfermagem is the property of Cogitare Enfermagem and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Cogitare Enfermagem is the property of Cogitare Enfermagem and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Cogitare Enfermagem is the property of Cogitare Enfermagem and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Texto & Contexto Enfermagem is the property of Universidade Federal de Santa Catarina, Programa de Pos-Graduacao de Enfermagem and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Introducción: El láser de baja potencia es una técnica utilizada en varias áreas de la salud: fisioterapia, odontología, otorrinolaringología y dermatología, entre otras. Para lograr los efectos terapéuticos la dosificación es fundamental y depende de los niveles de energía emitidos por los equipos. Objetivo: Conocer el estado de calibración y mantenimiento de los equipos de laserterapia de baja potencia, en servicios de fisioterapia u homólogos de instituciones de Montevideo, Uruguay. Método: Se realizó un estudio descriptivo, transversal en servicios de fisioterapia de Montevideo. Se analizaron 20 equipos de láser de baja potencia. Resultados: 7 de los aparatos evaluados se mantuvieron dentro de los límites adecuados de emisión. De los 13 láser fuera de los límites para entregar una emisión adecuada, 6 tenían un desajuste leve, 1 presentaba un desajuste moderado y 6 presentaban un desajuste severo con dosis nulas o que no generaban emisión. Del total de equipos evaluados solo 6 habían realizado una calibración previa y solo 2 de estos se encontraban dentro de los tiempos recomendados. Conclusión: Se observó un gran número de equipos de láser de baja potencia con desajustes en su emisión. En la mayoría de los casos no se lleva un correcto mantenimiento de los aparatos de láser de baja potencia. Se entiende relevante que los equipos sean calibrados para poder ofrecer una terapéutica segura y efectiva a los usuarios.

A health technology assessment (HTA) was carried out to critically analyze the evidence on the efficacy and safety of the surgical correction of spinal deformities using the coplanar technique, compared to the conventional derotation techniques, in children, adolescents and adults. A systematic search of the literature was carried out in the PubMed, Cochrane Library and LILACS databases. In addition, a manual search was carried out in the reference lists of the included studies, on Google and on the websites of specialized societies and groups that produce clinical practice guidelines (CPG) and HTA. In addition, we searched ClinicalTrials.gov and the International Clinical Trial Registry Platform (ICTRP) for clinical trial records in progress or not completed. Five documents were selected for evaluation, including two CPG, a randomized clinical trial, and two observational studies. After a critical evaluation of the evidence, it was concluded that both techniques showed a similar efficacy profile in terms of relevant outcomes such as correction of curvatures in the coronal and sagittal planes, quality of life and surgical time. Likewise, the rates of screw malposition, complications and volume of blood loss did not show significant differences between both techniques. However, the profile of opportunity cost of the systems that allow the application of the coplanar technique is not favorable in the context of the evaluation, due to its high cost concerning conventional systems. [ABSTRACT FROM AUTHOR]

Public health systems have the great challenge of meeting the population's health needs with limited financial resources. Thus, to incorporate new health technologies (HT) in their coverage plans, they use tools that allow them to inform their decisions based on scientific evidence, such as health technology assessments (HTAs). These are developed in a multidisciplinary way, under an explicit methodology, which estimates the value of a technology. With this information, the decision-maker can support his decision, anticipate the impact of its implementation, plan actions, and set goals, all of which promote efficient use of resources, transparency of processes, and facilitate accountability. The Peruvian Social Security healthcare system (EsSalud) implemented, through the Instituto de Evaluación de Tecnologías en Salud e Investigación (IETSI), a decisionmaking process based on HTAs to decide on the coverage of new HT. From the creation of the IETSI in December 2014 to December 2021, 407 ETS have been carried out. Of these, 161 were approved, thus extending new treatments for clinical conditions. These incorporations have not translated into a sharp increase in the annual expending of medicines to put EsSalud's financial sustainability at risk, although it has increased patient access to innovative technologies. The average investment per patient treated with these technologies was reduced from S/ 133,270 in 2011 to S/ 47,779 in 2019. [ABSTRACT FROM AUTHOR]

Background: Limitations have been reported to comply with good methodological practices in the development of health technology assessments (HTA). Therefore, the objective of the present study was to describe the methodological characteristics of the HTAs carried out in Peru, between 2019-2021. Methods: Descriptive study. We are looking for Peruvian institutions that prepare HTAs whose reports are accessible to the public. We collected the total number of HTAs produced by these institutions per year, and we collected the characteristics of the HTAs produced during the 2019-2021 period. Results: Three Peruvian institutions developed at least three public HTAs between 2019-2021: The Institute for the Evaluation of Technologies in Health and Research (IETSI) (n=142), the Unit for the Analysis and Generation of Evidence in Public Health (UNAGESP) (n=60), and the National Institute of Neoplastic Diseases (INEN) (n=40). The HTAs of UNAGESP did not reach a decision, while 35.9% of those of IETSI and 70.0% of those of INEN concluded in favor of the evaluated technology. All STDs explained the methodology used and performed systematic searches. However, few presented the risk of bias assessment of the included studies (17.4%), the certainty of the evidence (4.6%), or the benefits and harms per outcome (14.4%). None of the HTAs carried out cost studies or made explicit the methodology used to reach the decision. Conclusions: The HTAs evaluated presented favorable methodological aspects and certain shortcomings (in topics such as the report in the evaluation of risk of bias and certainty of the evidence, presentation of benefits and harms by outcome, and explanation of the methodology used to make decisions). [ABSTRACT FROM AUTHOR]

Health systems in Central America are divided into different sectors, however, each sector has in common the provision of health services, this process links medical care with other actions such as diagnosis and therapy. Therapy as the main tool for disease prevention, healing and health maintenance, has evolved bringing with it innovation, which generally manifests itself with better health outcomes for patients, however, for some years the question has been raised about the value that these health outcomes represent at an individual, collective and health system level. To resolve this problem, health technology assessment has been incorporated into health systems as a tool to reduce uncertainty regarding the benefit to the user and the financing impact of the use of a new technology. [ABSTRACT FROM AUTHOR]

In the framework of the project implementation associated with the Program "Training methodology for the administration of the health technologies evaluation process" in Santiago de Cuba province, an exploratory study of empiric character was carried out to value the feasibility of this methodology implementation as for the appropriation, updating and deepening of knowledge and abilities in the science, technology and health innovation agents when evaluating health technologies. In this work the results obtained taking the methodology implementation as a starting point are exposed, which evidence that it is pertinent and possible, because it contributes to transform the administration of the health technologies evaluation process.

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The Instituto de Evaluación de Tecnologías en Salud e Investigación (IETSI) of the Seguro Social de Salud (EsSalud) has completed seven brief reports by means of rapid reviews of evidence regarding the potentially effective therapies against SARS-CoV-2 in order to provide current and relevant information for decision makers, clinicians, researchers and the academic community in Peru. The therapeutic agents evaluated were chloroquine/hydroxychloroquine, lopinavir/ritonavir, tocilizumab, oseltamivir, interferon, atazanavir and anti SARS-CoV-2 serum. Evidence identification included the review of PubMed and Cochrane Library electronic databases. Additionally, manual search was carried out on websites from groups dedicated to research and education on health, as well as in the main specialized societies or institutions, such as, the World Health Organization (WHO) and Centers for Disease Control and Prevention (CDC). Furthermore, in order to reduce publication bias, the websites: www.clinicaltrials.gov and http://apps.who.int/trialsearch were searched to identify in-progress or unpublished clinical trials. Finally, a “snowball” strategy was performed by reviewing the reference lists of the systematic reviews, primary studies and selected narrative reviews to identify relevant information. The latest review (March 27, 2020) showed that there is no evidence to recommend any medication for patients´ treatment with COVID-19. More evidence, preferably high-quality randomized clinical trials, is needed for decision-making against SARS-CoV-2.

When determining its suitability for health uses, should Artificial Intelligence(AI)-based health technology be evaluated differently from other technologies? Although the evaluation of technological developments is strongly oriented to the process (design) and market impact, the evaluation of health technologies is strongly oriented towards the consequences, both positive and negative, on the health of individuals and the health of the population. The evaluation of health technologies must continue evolving to adapt to the defiance posed by AI in health, and thus respond to the growing expectations, the new social, legal, and ethical challenges, and the new evaluative restrictions that different authors have highlighted as challenges in the implementation of IA technologies. We require new professional and social consensus around this issue that is already being implemented and developed (even by itself) with dizzying speed. This paper presents some personal reflections on the subject from the fundamental principles of evaluation and bioethics considerations. [ABSTRACT FROM AUTHOR]

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In the framework of the project implementation associated with the Program "Training methodology for the administration of the health technologies evaluation process" in Santiago de Cuba province, an exploratory study of empiric character was carried out to value the feasibility of this methodology implementation as for the appropriation, updating and deepening of knowledge and abilities in the science, technology and health innovation agents when evaluating health technologies. In this work the results obtained taking the methodology implementation as a starting point are exposed, which evidence that it is pertinent and possible, because it contributes to transform the administration of the health technologies evaluation process. [ABSTRACT FROM AUTHOR]

Copyright of Cadernos de Saude Publica is the property of Escola Nacional de Saude Publica Sergio Arouca and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Introducción: La correcta determinación de la longitud de trabajo es uno de los principales factores determinantes para el éxito de los tratamientos endodónticos. Objetivo: valorar si es precisa la determinación de la longitud de trabajo de un localizador de ápice electrónico en dientes monorradiculares. Métodos: se realizó un estudio experimental exploratorio in vivo, donde se determinó la longitud de trabajo en 141 conductos monorradiculares en pacientes con indicación de exodoncia. Se determinó la longitud de trabajo con un localizador de ápice electrónico iPex II(NSK). Cuando el localizador marcó que la lima se encontraba en el ápice, sin retirar el instrumento del conducto se procedió a fijarla. Se realizó la extracción con precaución y, posteriormente, se desgastó una pared proximal del tercio apical hasta que se pudo observar la lima en el interior del conducto, con auxilio de una lupa. La longitud de trabajo fue aceptable cuando el localizador determinó que estaba entre 0,5-1,5 mm del límite cemento-dentina-conducto; corto cuando estaba a más de 1,5 mm y largo cuando se observó que sobrepasaba el límite cemento-dentina-conducto. Resultados: fue aceptable la precisión en 135 (95,7 %) mediciones y solo 13 (9,2 %) conductos tuvieron inestabilidad, con una relación existente entre la precisión y la inestabilidad de las mediciones. Se observó que 88 (62,4 %) conductos con secreciones obtuvieron un aceptable en la determinación de la longitud de trabajo, mientras que solo 3 (2,1 %) conductos con secreciones tuvieron mediciones cortas. La presencia de secreciones no fue significativa para evaluar la precisión. Conclusiones: Las mediciones de las longitudes de trabajo empleando el localizador estudiado fueron mayormente de precisión aceptable y no inestables. Del mismo modo, la presencia de secreciones en el interior de los conductos radiculares no afectó significativamente la precisión del localizador en cuestión. Palabras clave: endodoncia; ápice del diente; medicina de precisión; evaluación de la tecnología biomédica; estudios de evaluación.

Introducción: Las decisiones de inclusión de medicamentos en planes de beneficios deben estar basadas en Evaluaciones de Tecnología –ET– en metodologías transparentes, robustas y válidas, deben considerar los precios comparados a los que se compran los medicamentos, su estatus de competencia y deben considerar la información de decisiones de cobertura en otros países y las estrategias de uso racional que permitan modular los impactos de las decisiones sobre el consumo. Objetivo: Describir cómo se diseñó y puso en marcha un bien público regional consistente en una plataforma web basada en la gestión del conocimiento de países de Latinoamérica y el Caribe como respuesta a la presión impuesta por los fabricantes globales de medicamentos y tecnologías médicas sobre los presupuestos públicos del sector salud. Metodología: Se describen los antecedentes que motivaron la creación de una plataforma web de información sobre medicamentos de alto impacto financiero, la metodología para su desarrollo y los resultados y productos diseñados gracias a una comunidad de expertos de organismos gubernamentales y universidades de distintos países de América Latina, para facilitar la trasferencia del conocimiento a los tomadores de decisiones en la región. Resultados: Los tomadores de decisiones farmacéuticas de la región cuentan con información comparada de precios, competencia, decisiones de cobertura, uso racional de medicamentos para 35 medicamentos. Se realizaron acciones de capacitación local en ET en los países participantes. En la actualidad se dispone de 25 informes de evaluación de tecnología regionales y modelos metodológicos para su desarrollo. La región latinoamericana y del Caribe cuenta con un importante grupo de investigadores con capacidad de trabajar en equipo para realizar actividades de transferencia del conocimiento. Conclusiones: Es posible desarrollar estrategias de transferencia y gestión del conocimiento a nivel regional, con el fin de lograr una mejor gestión en medicamentos y tecnologías en beneficio de la salud de la población de la región.

Los sistemas de salud se enfrentan al reto de decidir cuáles de las nuevas tecnologías disponibles deben ser utilizadas y estar disponibles con carácter prioritario a través de la cobertura estatal. De esta manera la Organización Mundial de la Salud (OMS) ratifica la importancia de la Evaluación de la Tecnologías Sanitarias (ETS), con el objetivo de fortalecer los sistemas de información y la capacidad de investigación en salud. El proceso de la preparación de un informe de ETS, requiere una búsqueda exhaustiva de la evidencia disponible; para su posterior síntesis y presentación a los interesados. Este es un paso crucial para que una tecnología sea considerada para su introducción en un sistema de salud; convirtiéndose en la cuarta y última barrera (Calidad, Seguridad, Eficacia y Costo-Efectividad); para la implementación de nuevas intervenciones en salud. Sin embargo, para determinar mejor el impacto presupuestario de las intervenciones, la ETS se basa en las herramientas proporcionadas por las Evaluaciones Económicas en Salud (EES), que pueden analizar los costos y las consecuencias clínicas del uso de una determinada tecnología particular para un problema de salud particular en un contexto particular. Esta información resulta vital cuando se consideran principios como la equidad o el costo de oportunidad (lo que se gasta en una intervención no se puede utilizar en otra), y, en última instancia, el limitado presupuesto de salud de los sistemas de salud.

Copyright of Saúde Coletiva is the property of MPM Comunicacao and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

El síndrome del túnel del carpo (STC) es la neuropatía por atrapamiento más frecuente y, a su vez, la que más afecta a la población trabajadora, cuyo tratamiento implica una carga económica para el sistema de salud . El objetivo de esta investigación fue evaluar el costo-efectividad del tratamiento quirúrgico convencional y la infiltración local de corticoides, para el síndrome del túnel del carpo, en población trabajadora colombiana . Teniendo en cuenta que es una de las enfermedades de origen laboral más prevalentes en el país, se realizó un estudio de costo efectividad, desde la perspectiva del tercer pagador (Empresas Promotoras de Salud y Aseguradoras de Riesgos Laborales), en que se compararon alternativas de tratamiento quirúrgica y médica, para esta patología, para lo cual, se elaboró un árbol de decisión en el escenario clínico de un trabajador con un síndrome del túnel del carpo severo, para un horizonte temporal de un año, en el que se incluyeron los costos directos e indirectos asociados . Los resultados para el escenario y horizonte temporal propuesto en relación con esta patología es que ninguna de las alternativas resultó ser claramente dominante, dentro del plano de costo-efectividad . La razón de costo-efectividad incremental de la cirugía en comparación con la aplicación de corticoides fue de $1 .974 .945,68, por 0,6 casos de mejoría . En el análisis de sensibilidad de Montecarlo, la aplicación lo- cal de corticoides fue costo-efectiva en el 100% de los casos, de acuerdo con el umbral propuesto.

Objective: To evaluate the functional performance and the technical quality of the Electronic Documentation System of the Nursing Process of the Teaching Hospital of the University of São Paulo. Method: exploratory-descriptive study. The Quality Model of regulatory standard 25010 and the Evaluation Process defined under regulatory standard 25040, both of the International Organization for Standardization/International Electrotechnical Commission. The quality characteristics evaluated were: functional suitability, reliability, usability, performance efficiency, compatibility, security, maintainability and portability. The sample was made up of 37 evaluators. Results: in the evaluation of the specialists in information technology, only the characteristic of usability obtained a rate of positive responses of less than 70%. For the nurse lecturers, all the quality characteristics obtained a rate of positive responses of over 70%. The staff nurses of the medical and surgical clinics with experience in using the system) and staff nurses from other units of the hospital and from other health institutions (without experience in using the system) obtained rates of positive responses of more than 70% referent to the functional suitability, usability, and security. However, performance efficiency, reliability and compatibility all obtained rates below the parameter established. Conclusion: the software achieved rates of positive responses of over 70% for the majority of the quality characteristics evaluated.

Objective. To analyze the value judgments behind cost--benefit tradeoffs made by health stakeholders in deciding whether or not to incorporate new health technologies and how they should be financed and allocated in limited-resource settings in Brazil. Method. From June 2009 to January 2010, a sample of stakeholders in the public and private health sector was identified and invited to complete an online survey consisting of two questionnaires: one collecting socio-demographic/professional information and one capturing resource allocation preferences in four hypothetical scenarios for the incorporation of new health technologies. Results. A total of 193 respondents completed the survey; more than half were male (53.9%) and the most common age group was 31--40 years (36.8%). Scenario 1 (incorporation of a new drug treatment for chronic disease, by reducing/eliminating resources for existing programs) was rejected by 49.2% of the survey sample, who preferred to maintain the status quo for existing programs. Scenario 2 (incorporation of the same new treatment, but financed by a new tax) was rejected by 58.0%. Scenario 3 (incorporation of a new treatment for a highly lethal disease, by age group--20--75 years versus 75+ years--by reducing/eliminating resources for existing programs), was rejected by 42.0%, while 20.7% supported allocations for both groups, 34.2% supported allocations exclusively for the 20--75-year age group, and 3.1% supported allocations exclusively for the 75+ year age group. For Scenario 4, which consisted of five different resource allocations for prevention and treatment programs for another highly lethal disease, the most preferred option (chosen by 50.8% of respondents) was 75%:25% ( prevention versus treatment). Conclusions. When incorporating a new health technology requires reducing/eliminating other health programs, financing it through a tax, or having to choose certain age groups (e.g., younger, working people versus older people), respondents are likely to reject it. When offered the choice of limiting the scope of the program (e.g., prevention versus treatment), respondents are likely to favor prevention. This was the first study in Brazil to capture value judgments that affect stakeholder decision-making on various resource allocations for different scenarios for health technology introduction in limited-resource settings. Future research should investigate the perspective of society as a whole to determine the best approach for decision-making based on common values and consensus within a particular health care system. [ABSTRACT FROM AUTHOR]

Copyright of Journal of Nursing UFPE / Revista de Enfermagem UFPE is the property of Revista de Enfermagem UFPE and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Revista de Pesquisa: Cuidado é Fundamental is the property of Revista de Pesquisa: Cuidado e Fundamental Online and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

A análise de decisão multicritérios (ADMC) é uma ferramenta emergente que permite a integração de fatores relevantes para os processos de avaliação de tecnologias em saúde (ATS). O objetivo deste estudo é apresentar uma síntese dos aspectos metodológicos da ADMC: definições, abordagens, aplicações e etapas de implementação. Realizou-se um estudo de caso no Instituto do Câncer do Estado de São Paulo (ICESP) com a intenção de compreender as perspectivas de tomadores de decisão no processo de elaboração de uma recomendação de incorporação de tecnologia no âmbito do Sistema Único de Saúde (SUS), por um relatório da Comissão Nacional de Incorporação de Tecnologias no SUS (CONITEC). A lógica paraconsistente anotada evidencial Eτ foi a abordagem metodológica escolhida por ser capaz de ser uma lógica subjacente para construtos capazes de sintetizar informações objetivas (provenientes da literatura científica) e subjetivas (provenientes de valores e preferências de especialistas na área de conhecimento); além de permitir a incorporação de informações conflitantes (contradições), vagas e mesmo incompletas no processo de valoração, resultantes da imperfeição das evidências científicas disponíveis. Foram identificadas como vantagens do método: permitir considerar de modo explícito os critérios que influenciaram a decisão; facilitar o acompanhamento e visualização das etapas do processo; permitir avaliar a contribuição de cada critério de modo isolado e agregado para o resultado da decisão; facilitar a discussão de perspectivas divergentes dos grupos de interesse e aumentar a compreensão das recomendações elaboradas. O emprego de uma abordagem explícita de ADMC poderá facilitar a mediação de conflitos e otimizar a participação de diferentes grupos de interesse.

Objetivos: Más allá de la actual crisis económica, el Sistema Nacional de Salud (SNS) tiene un problema de sostenibilidad a largo plazo derivado de los cambios en los patrones de morbilidad con la irrupción de la cronicidad y la aceleración del cambio tecnológico con la rápida incorporación de nuevas tecnologías de elevado precio. El objetivo de este artículo es explorar el papel de la desinversión de tecnologías de bajo valor como estrategia para la sostenibilidad del SNS. Material y método: Revisión narrativa y discusión de las características relevantes de las estrategias de desinversión en varios países. Resultados: La desinversión es un proceso explícito mediante el cual dejan de financiarse de forma parcial o completa medicamentos, dispositivos, aparatos o procedimientos con bajo o dudoso valor clínico. Sistemas sanitarios muy dispares -como los de Australia, Nueva Zelanda, Reino Unido o Estados Unidos- han puesto en marcha estrategias de desinversión diferenciadas adaptadas a su contexto, mientras que en España se mantienen las reticencias a incorporar mecanismos explícitos para la toma de decisiones sobre la incorporación o desinversión de tecnologías sanitarias al SNS. Discusión: Desinvertir en tecnologías de bajo valor es complejo. Muchas tecnologías son sólo candidatas a desinversión parcial o su valor es objeto de controversia y, adicionalmente, existen barreras psicológicas y sociológicas a la desinversión. La implantación de estas estrategias requiere el compromiso de profesionales y administraciones sanitarias y la complicidad de pacientes y ciudadanos, compromiso que debe ser gestionado.

Objective. Learn how the Ministry of Public Health (MSP, the Spanish acronym) of Ecuador uses health technology assessment (HTA) in decision-making on the purchase of drugs that are not on the National List of Essential Medicines (NLEM). Methods. Information from databases of the Health Intelligence Directorate (DIS, the Spanish acronym) and the National Directorate of Drugs and Medical Devices (DNMDM, the Spanish acronym), was used to compare decisions made by both entities, to learn about the use and consistency of HTA reports in decisions on purchasing drugs not included in the NLEM. Results. From 2012 to 2015, 227 reports were issued, of which 87 cover drugs; 36, devices; 29: medical procedures; 34: health programs; and 41: other medical technologies. The DNMDM requested 59 of the reports on drugs. There was 80% agreement in decisions made by the two directorates that participate in the process. Conclusions. The MSP, through the DIS, began using HTA in 2012. Given that the majority of reports evaluate drugs, it is essential that reports be prepared for other types of medical technologies and that they be prepared and used as widely as possible. Despite a high level of agreement in decisions, it is important to continue to improve the reports' scope and quality, and to monitor adoption and dissemination of authorized and funded technologies to learn the effectiveness and impact of HTA in Ecuador. [ABSTRACT FROM AUTHOR]

Objective. Identify the most relevant, applicable, and priority good practice principles in health technology assessment (HTA) in Latin America, and potential barriers to implementing them in the region. Methods. HTA good practice principles postulated worldwide were identified and then explored through a deliberative process in a forum of evaluators, funders, and technology producers. Results. Forty-two representatives from ten Latin American countries participated in the forum. The good practice principles postulated at the international level were considered valid and potentially applicable in Latin America. Five principles were identified as priorities and as having greater potential to be expanded at this time: transparency in carrying out HTA; involvement of stakeholders in the HTA process; existence of mechanisms to appeal decisions; existence of clear mechanisms for HTA priority-setting; and existence of a clear link between assessment and decision-making. The main challenge identified was to find a balance between application of these principles and available resources, to prevent the planned improvements from jeopardizing report production times and failing to meet decision-makers' needs. Conclusions. The main recommendation was to gradually advance in improving HTA and its link to decision-making by developing appropriate processes for each country, without attempting to impose, in the short term, standards taken from examples at the international level without adequate adaptation to the local context. [ABSTRACT FROM AUTHOR]

Objectives. To describe, analyze, and compare the opinions of decisionmakers involved in the health technology assessment (HTA) process in Brazil in 2011. Methods. A cross-sectional study was conducted using a structured questionnaire to evaluate the opinions of a convenience sample of health care professionals from both the public and private health care systems (HCS). The survey collected demographic data for each respondent along with their input on national regulations. Data analysis included descriptive statistics, including chi-square tests to compare groups. Results. Of the 200 completed questionnaires, 65% of the respondents were 31-50 years of age; 36% were HCS managers, 49.3% from the public and 50.7% from the private system. The majority of respondents (85%) considered the time permitted for submission of new technology to be inadequate; 88% also stated that the composition of the evaluation committee needed improvement. Respondents from the private health system more frequently stated that submission times were inappropriate (P = 0.019) and that the deadline for a decision by the committee should be defined (P = 0.021), with a maximum of no more than 180 days / 6 months (P < 0.001). Conclusions. Respondents indicated that the HTA process should be improved to meet their expectations. Given that new legislation has been enacted to continuously accept submissions, to make decisions within 180 days, and to expand the committee to represent more stakeholders, most of the respondents concerns have been addressed. This study is valuable as an historical analysis of HTA process improvement. Further surveys are needed to track the new HTA process, its application, and its contribution to health care needs in Brazil. [ABSTRACT FROM AUTHOR]

Objective. Health technology assessment (HTA) has been adopted by countries in order to improve allocative efficiency in their health systems. This study aimed to describe and analyze the HTA decision-making process in the Region of the Americas. Methods. A literature review was done to better understand the HTA situation in the Region. Also, in 2014 and 2015, individuals responsible for conducting HTA in countries of the Americas were identified and received a questionnaire on HTA and the decision-making process. Results. A total of 46 questionnaire responses were obtained, from 30 countries. The respondents were similar in terms of their institutions, main funding sources, and technology types assessed. Of the 46 respondents, 23 (50%) work for their respective ministry of health. Also, 36 (78%) undertake and/or coordinate HTA through coverage and reimbursement/pricing decisions and other HTA-related activities, while 24 (52%) use HTA for emerging technologies. While some countries in the Region have created formal HTA units, there is a weak link between the HTA process and decision-making. Most of the countries with recognized HTA institutions are members of the Health Technology Assessment Network of the Americas (RedETSA). Despite the advances in the Region overall, most countries in Central America and the Caribbean are still at the early stages of implementing HTA to support decision-making. Conclusions. Many countries in the Americas have benefited from the exchange and capacity-building opportunities within RedETSA. However, there are still many challenges to overcome in the Region in terms of the discussion and creation of HTA-related policies. [ABSTRACT FROM AUTHOR]

Copyright of Cadernos de Saude Publica is the property of Escola Nacional de Saude Publica Sergio Arouca and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)