Methodological guidelines and publications of benefit-risk assessment for health technology assessment: a scoping review.

OBJECTIVES: To map the available methodological guidelines and documents for conducting and reporting benefit-risk assessment (BRA) during health technologies' life cycle; and to identify methodological guidelines for BRA that could serve as the basis for the development of a BRA guideline for the context of health technology assessment (HTA) in Brazil. DESIGN: Scoping review. METHODS: Searches were conducted in three main sources up to March 2023: (1) electronic databases; (2) grey literature (48 HTA and regulatory organisations) and (3) manual search and contacting experts. We included methodological guidelines or publications presenting methods for conducting or reporting BRA of any type of health technologies in any context of the technology's life cycle. Selection process and data charting were conducted by independent reviewers. We provided a structured narrative synthesis of the findings. RESULTS: From the 83 eligible documents, six were produced in the HTA context, 30 in the regulatory and 35 involved guidance for BRA throughout the technology's life cycle. We identified 129 methodological approaches for BRA in the documents. The most commonly referred to descriptive frameworks were the Problem, Objectives, Alternatives, Consequences, Trade-offs, Uncertainty, Risk and Linked decisions and the Benefit-Risk Action Team. Multicriteria decision analysis was the most commonly cited quantitative framework. We also identified the most cited metric indices, estimation and utility survey techniques that could be used for BRA. CONCLUSIONS: Methods for BRA in HTA are less established. The findings of this review, however, will support and inform the elaboration of the Brazilian methodological guideline on BRA for HTA. TRIAL REGISTRATION NUMBER: https://doi.org/10.17605/OSF.IO/69T3V.

Wheelchair outcome measurement instruments for children: a scoping review protocol.

Purpose: The proposed scoping review aims to explore and map wheelchair outcome measurement instruments for children in the literature.Method: The proposed scoping review will be conducted in accordance with the Joanna Briggs Institute (JBI) methodology. The review question and eligibility criteria were developed using the PCC (population, concept, context) mnemonic as follows: (P) children manual or motorised wheelchair users (aged ≤ 18 years), (C) wheelchair outcome measurement instruments, (C) primary sources of literature. The search will be conducted in nine relevant electronic databases. including grey literature from Academic Google. Study screening, selection, and data extraction will be performed independently by two authors. A third reviewer will resolve discrepancies between the authors. General characteristics, population, feasibility, interpretability data will be extracted in accordance with the COSMIN methodology (Consensus-based Standards for the selection of health Measurement Instruments). This will encompass data pertaining to the measurement properties of the domains of reliability, validity and responsiveness. A descriptive analysis will be carried out, and the results will be classified into categories and presented in tables accompanied by a descriptive summary.Results: The results can inform future research directions, clinical practice and the development of wheelchair outcome measurement instruments. Furthermore, it will help professionals in rehabilitation and wheelchair services to find the wheelchair outcome measurement instruments according to the target population and cultural context.

IMPLICATIONS FOR REHABILITATIONThis review has the potential to enhance understanding of wheelchair outcome measurement instruments, thereby enabling rehabilitation professionals to assess the impact and progress of wheelchair use within the target population.The findings related to measurement properties may guide future research in the field of wheelchair outcome measurement instruments.Additionally it will assist clinical professionals in identifying appropriate wheelchair outcome measurement instruments based on the target population and cultural context.

A equipe de enfermagem e o atendimento às emergências psiquiátricas: uma revisão integrativa / The nursing team and care for psychiatric emergencies: an integrative review

Analisar o atendimento da equipe de enfermagem nas emergências psiquiátricas. Método: Estudo de revisão integrativa da literatura, considerando como estratégia PICo: (P) Equipe de enfermagem, (I) Atendimento, (Co) Emergências psiquiátricas, os critérios de inclusão são artigos publicados em português, entre 2013 e 2023, disponíveis na Biblioteca Virtual em Saúde. Resultados: Foi elaborado uma tabela para coleta dos dados. Emergiram três categorias: Fragilidades no atendimento de enfermagem às emergências psiquiátricas; Fortalezas no atendimento de enfermagem às emergências psiquiátricas; Educação continuada e permanente como recurso de melhoria da qualidade no atendimento às emergências psiquiátricas. Considerações finais: É evidente a necessidade de ações de educação continuada, a importância dos recursos humanos e físicos adequados para assistência, capacitações profissionais que contemplem a atenção à saúde mental, promoção da desconstrução social, dos estigmas e estereótipos vinculados à loucura e à figura do doente mental.(AU)

To analyze the care provided by the nursing team in psychiatric emergencies. Method: Integrative literature review study, considering the PICo strategy: (P) Nursing team, (I) Care, (Co) Psychiatric emergencies, the inclusion criteria are articles published in Portuguese, between 2013 and 2023, available in the Library Virtual Health. Results: A table was created to collect data. Three categories emerged: Weaknesses in nursing care for psychiatric emergencies; Strengths in nursing care for psychiatric emergencies; Continuing and permanent education as a resource for improving the quality of care for psychiatric emergencies. Final considerations: The need for continuing education actions is evident, the importance of adequate human and physical resources for assistance, professional training that includes mental health care, promotion of social deconstruction, stigmas and stereotypes linked to madness and the figure of brain sick.(AU)

Analizar la atención brindada por el equipo de enfermería en emergencias psiquiátricas. Método: Estudio de revisión integradora de la literatura, considerando la estrategia PICo: (P) Equipo de enfermería, (I) Atención, (Co) Emergencias psiquiátricas, los criterios de inclusión son artículos publicados en portugués, entre 2013 y 2023, disponibles en la Biblioteca Virtual de Salud. Resultados: Se creó una tabla para recolectar datos. Surgieron tres categorías: Debilidades en la atención de enfermería en emergencias psiquiátricas; Fortalezas en la atención de enfermería para emergencias psiquiátricas; La educación continua y permanente como recurso para mejorar la calidad de la atención de las urgencias psiquiátricas. Considerações finais: É evidente a necessidade de ações de educação continuada, a importância dos recursos humanos e físicos adequados para assistência, capacitações profissionais que contemplem a atenção à saúde mental, promoção da desconstrução social, dos estigmas e estereótipos vinculados à loucura e à figura do enfermo mental.(AU)

Methodological guidelines and publications of benefit-risk assessment for health technology assessment: a scoping review protocol.

BACKGROUND: Benefit-risk assessment (BRA) is used in multiple phases along the health technology's life-cycle to evaluate the balance between the benefits and risks, as it is fundamental to all stakeholders. BRA and its methodological approaches have been applied primarily in the context of regulatory agencies. However, BRA's application and extent in the context of health technology assessment (HTA) bodies remain less clear. Our goal is to perform a scoping review to identify and map methodological guidelines and publications on methods of BRA. This will be done considering the different phases of the life-cycle of health technologies to underline both the depth and extent of research concerning BRA, especially in the context of HTA. METHODS AND ANALYSIS: This scoping review protocol was developed following the framework proposed by Arksey and O'Malley, and the updated guidelines by the Joanna Briggs Institute. We will include methodological publications that provide recommendations or guidelines on methods for BRA. We will conduct electronic searches on Medline (PubMed) and EMBASE (Ovid) databases; manual searches on the main websites of HTA bodies and drug regulatory organisations; and contact experts in the field. Systematic extraction forms will be used to screen and assess the identified publications by independent assessors. We will provide a qualitative synthesis using descriptive statistics and visual tools. Results will be summarised in systematic evidence tables and comparative evidence scoping charts. ETHICS AND DISSEMINATION: This review will use data publicly available and does not require ethics approval. The results of this scoping review will contribute to scientific knowledge and act as a basis for methodologists, guideline developers and researchers for the development of BRA to inform regulatory decisions, reimbursement and coverage decision making. The results will be disseminated through peer-reviewed articles, conferences, policy briefs and workshops. TRIAL REGISTRATION NUMBER: Open Science Framework (https://doi.org/10.17605/OSF.IO/69T3V).

Interprofessional collaboration in primary health care from the perspective of implementation science. / A colaboração interprofissional na atenção primária à saúde na perspectiva da ciência da implementação.

The objective was to analyze the perceptions of primary health care (PHC) workers about interprofessional collaboration from the perspective of implementation science. This is a qualitative study that used in-depth interview as a data production technique. Interviews were conducted with 15 workers (three community health agents, one nursing assistant, three nurses, three managers, three physicians, and two nursing technicians) from basic health units in the Municipality of São Bernardo do Campo, São Paulo State, Brazil. The interview plan was based on three domains of the Consolidated Framework for Implementation Research (CFIR). Thematic content analysis was used. In the interprofessional collaboration characteristics domain, respondents highlighted the complexity, and its possible influence, as to the implementation and sustainability of this practice. In the inner setting domain, factors that influence interprofessional collaboration were identified, namely: how the time allocated to formal communication/team meetings is used; social interactions between professionals; and leadership characteristics, such as feedback, autonomy and participation in decisions. In the individuals characteristics domain, participants noted interprofessional collaboration geared to quality of care and the need for integration between knowledge centers. Thus, measures to enhance the quality of communication, collective team building and leadership can contribute to improve interprofessional collaboration in PHC and leverage its impacts on health care.

O objetivo foi analisar as percepções de trabalhadores da atenção primária à saúde (APS) sobre a colaboração interprofissional na perspectiva da ciência de implementação. Trata-se de estudo qualitativo que utilizou a entrevista em profundidade como técnica de produção de dados. Foram entrevistados 15 trabalhadores (três agentes comunitários de saúde, um auxiliar de enfermagem, três enfermeiros, três gerentes, três médicos e dois técnicos de enfermagem) de unidades básicas de saúde no Município de São Bernardo do Campo, São Paulo, Brasil. O roteiro da entrevista baseou-se em três dimensões do Quadro Conceitual Consolidado para Pesquisa de Implementação (CFIR; Consolidated Framework for Implementation Research). Foi realizada análise de conteúdo temática. Na dimensão características da colaboração interprofissional, os entrevistados destacaram a complexidade, e sua possível influência, na implementação e sustentabilidade dessa prática. Na dimensão cenário interno, foram identificados fatores que influenciam a colaboração interprofissional: como se utiliza o tempo destinado a comunicação formal/reuniões de equipe; interações sociais entre os profissionais; e características da liderança, como feedback, autonomia e participação nas decisões. Na dimensão características dos indivíduos, os participantes destacaram a colaboração interprofissional direcionada para a qualidade do cuidado e a necessidade de integração entre os núcleos de saberes. Assim, ações para aperfeiçoar a qualidade da comunicação, a construção coletiva em equipe e o aprimoramento da liderança podem contribuir para melhorar a colaboração interprofissional na APS e potencializar seus impactos na atenção à saúde.

El objetivo fue analizar las percepciones de los trabajadores de atención primaria de salud (APS) sobre la colaboración interprofesional desde la perspectiva de la ciencia de implementación. Se trata de un estudio cualitativo que utilizó la entrevista en profundidad como técnica de producción de datos. Fueron entrevistados 15 trabajadores (tres agentes comunitarios de salud, un auxiliar de enfermería, tres enfermeros, tres gerentes, tres médicos y dos técnicos de enfermería) de unidades básicas de salud en el Municipio de São Bernardo do Campo, São Paulo, Brasil. La guía de la entrevista se basó en tres dimensiones del Marco Consolidado para la Investigación sobre la Implementación (CFIR; Consolidated Framework for Implementation Research). Se realizó un análisis de contenido temático. En la dimensión característica de la colaboración interprofesional, los entrevistados destacaron la complejidad y la posible influencia en su implantación y sostenibilidad. En la dimensión escenario interno, fueron identificados factores que influencian en la colaboración interprofesional: cómo se utiliza el tiempo destinado a la comunicación formal/reuniones de equipo; las interacciones sociales entre los profesionales, y las características del liderazgo, como feedback, la autonomía y la participación en las decisiones. En la dimensión de las características de los individuos, los participantes destacaron la colaboración interprofesional orientada a la calidad de la atención y la necesidad de integración entre los núcleos de saberes. Así, las acciones para mejorar la calidad de la comunicación, la construcción colectiva en equipo y la mejora del liderazgo pueden contribuir para mejorar la colaboración interprofesional en la APS y mejorar sus impactos en la atención a la salud.

Impact of switching between reference biologics and biosimilars of tumour necrosis factor inhibitors for rheumatoid arthritis: a systematic review and network meta-analysis.

What is the impact of switching between biologics and biosimilars of adalimumab, etanercept, and infliximab on efficacy and safety for rheumatoid arthritis? A systematic review and network meta-analysis were performed to compare switching and non-switching groups of treatments. Pooled Risk Relative (RR) or standardised mean differences (SMD) with 95% credible intervals (95% CrIs) were obtained. Seventeen randomized trials with a switching phase involving 6,562 patients were included. Results showed that a single switch from biologics to biosimilars compared to continuing biologics had comparable effects for primary and co-primary outcomes, the American College of Rheumatology criteria with 20% response (ACR20) (7 trials, 1,926 patients, RR 0.98, 95% CrIs 0.93 to 1.03) and the Health Assessment Questionnaire-Disability Index (HAQ-DI) (5 trials, 1,609 patients, SMD - 0.07, 95% CrIs - 0.23 to 0.1), and within the equivalence margins: ACR20 [RR 0.94, 1.06] and HAQ-DI [SMD - 0.22, 0.22]. The risk of treatment-emergent adverse events, discontinuation, and positive anti-drug antibodies were comparable after switching. Safety results were imprecise, and the follow-up period might not be sufficient to evaluate long-term effects, especially malignancies. Overall, the practice of single switching between approved biologics and biosimilars of Tumour Necrosis Factor inhibitors is efficacious and safe for rheumatoid arthritis.

Does patient and public involvement impact public health decision-making? A 10 year retrospective analysis of public consultation in Brazil.

BACKGROUND:  The aim of this work is to characterize the processes associated with patient and public involvement (PPI) in the form of public consultations (PC) during the first 10 years of operation of the National Committee for Health Technology Incorporation in the Unified Health System (Conitec) of Brazil, and to identify factors associated with changes in Conitec's recommendations following these PC. METHODS:  This cross-sectional study analysed all processes related to the adoption of technologies that took place in Brazil between 2012 and 2021 based on technical reports and self-reported information collected from PC participants. A multiple logistic regression model identified factors associated with changes in Conitec's recommendations following PC. RESULTS:  A total of 479 technical reports were published, of which 83% (n = 400) were submitted to PC. Demands were made mainly by applicants from the government (n = 262; 55%), regarding the adoption of medicines (n = 366; 76%), in which context neoplasms and infectious diseases were the most frequent indications (n = 66; 14% for each). A total of 264 (55%) processes resulted in a final recommendation in favour of introducing the technology. Over the period of 10 years, 196 483 contributions were received in response to PC. The largest volume of contributions was made by patients and their families or representatives (n = 99 082; 50%), females (122 895; 67%), white individuals (129 165; 71%) and individuals between the ages of 25 and 59 years (145 364; 80%). Alteration of the preliminary recommendation occurred in 13% (n = 53) of the PC, with a higher proportion of recommendations being altered from 2017 onwards. Increased participation by patients had a significant impact on the alteration of the preliminary recommendation (odds ratio 3.87, 95% CI 1.33-13.35, p = 0.02). CONCLUSIONS: Increased engagement of patients and their families and caregivers in PC was associated with changing the preliminary recommendation of Conitec about the adoption of technologies into the public health system in Brazil.

Therapeutic Equivalence of Biosimilar and Reference Biologic Drugs in Rheumatoid Arthritis: A Systematic Review and Meta-analysis.

Importance: Biosimilar drugs are potentially lower-cost versions of biologics that may improve access to therapy. However, there is a lack of adequate systematic reviews demonstrating equivalence between these drugs for the treatment of rheumatoid arthritis (RA). Objectives: To assess the efficacy, safety, and immunogenicity associated with biosimilars of adalimumab, etanercept, and infliximab compared with their reference biologics in patients with RA. Data Sources: MEDLINE via PubMed, Embase, Cochrane Central Register of Controlled Trials, and LILACS databases were searched from inception to September 2021. Study Selection: Head-to-head randomized clinical trials (RCTs) of biosimilars of adalimumab, etanercept, and infliximab and their biologic reference drugs for RA were assessed. Data Extraction and Synthesis: Two authors independently abstracted all data. Meta-analysis was conducted with bayesian random effects using relative risks (RRs) for binary outcomes and standardized mean differences (SMDs) for continuous outcomes, with 95% credible intervals (CrIs) and trial sequential analysis. Specific domains were assessed for the risk of bias in equivalence and noninferiority trials. This study was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guideline. Main Outcomes and Measures: Equivalence was tested using prespecified margins for the American College of Rheumatology criteria, with at least 20% improvement in the core set measures (ACR20) (ie, RR, 0.94 to 1.06), and for the Health Assessment Questionnaire-Disability Index (HAQ-DI) (ie, SMD, -0.22 to 0.22). Secondary outcomes included 14 items measuring safety and immunogenicity. Results: A total of 25 head-to-head trials provided data on 10 642 randomized patients with moderate to severe RA. Biosimilars met equivalence with reference biologics in terms of ACR20 response (24 RCTs with 10 259 patients; RR, 1.01; 95% CrI, 0.98 to 1.04; τ2 = 0.000) and change of HAQ-DI scores (14 RCTs with 5579 patients; SMD, -0.04; 95% CrI, -0.11 to 0.02; τ2 = 0.002) considering prespecified margins of equivalence. Trial sequential analysis found evidence for equivalence for ACR20 since 2017 and HAQ-DI since 2016. Overall, biosimilars were associated with similar safety and immunogenicity profiles compared with reference biologics. Conclusion and Relevance: In this systematic review and meta-analysis, biosimilars of adalimumab, infliximab, and etanercept were associated with clinically equivalent treatment effects compared with their reference biologics for the treatment of RA.

Economic evaluations of colorectal cancer screening: A systematic review and quality assessment.

Colorectal Cancer (CRC) is the third most common type of cancer worldwide and ranks second in mortality. Screening programs for early detection and treatment have been implemented in several countries. Economic evaluations are an important tool to support decision-making about reimbursement and coverage decisions in health systems and, therefore, to support efficient resource allocation. The article aims to review the up-to-date evidence on economic evaluations of CRC screening strategies. MEDLINE, EMBASE, Web of Science, SCOPUS, SciELO, Lilacs, CRD databases, and lists of references were reviewed to identify relevant literature regarding full economic evaluations of CRC screening in asymptomatic average-risk individuals over 40 years old. Searches were conducted with no restriction to language, setting, or date. Qualitative syntheses described CRC screening strategies and comparators (baseline context), study designs, key parameter inputs and incremental cost-effectiveness ratios. Seventy-nine articles were included. Most of the studies were from high-income countries and a third-party payer perspective. Markov models were predominantly used, although microsimulation has been increasingly adopted in the last 15 years. The authors found 88 different screening strategies for CRC, which differed in the type of technique, the interval of screening, and the strategy, i.e., isolated or combined. The annual fecal immunochemical test was the most predominant screening strategy. All studies reported cost-effective results in their scenarios compared to no screening scenarios. One-quarter of the publications reported cost-saving results. It is still necessary to develop future economic evaluations in Low- and Middle-Income Countries (LMICs), which account for the high burden of disease.

The methodological quality of economic evaluations of measles outbreaks: A systematic review of cost-of-illness studies.

OBJECTIVES: To identify the main cost components included in the economic evaluations of measles outbreaks, their items and cost drivers, and evaluate the quality of costing methodology, analyzing the key features that may affect the validity of these studies in countries with different income levels. METHODS: We systematically searched multiple databases EMBASE, MEDLINE (via PubMed), Biblioteca Virtual em Saúde do Ministério da Saúde (BVS MS), NHS Economic Evaluation Database (NHS EED) and NHS Health Technology Assessment (NHS HTA) (via The Centre for Reviews and Dissemination Library - CRD), and EconLit, SCOPUS, and Web of Science, selecting cost analysis and cost of illness studies (COI) of measles outbreaks. Two independent reviewers screened articles for relevance and extracted the data. The quality of costing methods was assessed using a guide to critical evaluation of COI studies. We performed a qualitative narrative synthesis. RESULTS: Twenty-two studies were reviewed. Most studies evaluated outbreaks that occurred from 2011 to 2013 and 2017 to 2019. Total costs varied from $40,147 to $39.3 million. Per case cost varied from $168 to $49,439. The main drivers of measles outbreak costs were outbreak response, personnel, and productivity losses. Most studies (20/22) did not report the costing methodology adopted, the degree of disaggregation used in the identification and measurement of resource and costs components and the method for the valuation of resource and cost components. CONCLUSIONS: The quality of the costing methodology, its transparency and accuracy are essential to the validity of these studies results and their potential use to allocate public health resources in the most efficient manner and to inform measles outbreak control strategies, with rapid and effective response.

Systematic review of economic evaluations on stereotactic ablative radiotherapy (SABR) compared to other radiotherapy techniques or surgical procedures for early-stage non-small cell lung cancer.

BACKGROUND: Stereotactic ablative radiotherapy (SABR) is recommended as first-choice treatment to inoperable early-stage non-small cell lung cancer (NSCLC). However, it is not widely adopted in developing countries, and its cost-effectiveness is unclear. We aimed to perform a systematic review of full economic evaluations (EE) that compared SABR with other radiotherapy or surgical procedures to assess the results and methodological approach. METHODS: The protocol was registered on PROSPERO (CRD42021241640). We included full EE studies with early-stage NSCLC in which one group was submitted to SABR. Studies that were partial EE, included advanced NSCLC or other neoplasm were excluded. We performed the last search on June 2021 in Medline, EMBASE and other databases. The reporting quality were assessed by CHEERS checklist. The main characteristics of each study were tabulated, and the results were presented by a narrative synthesis. RESULTS: We included nine studies. Three compared radiotherapy techniques, in which SABR was found to be dominant or cost-effective. Six compared SABR with surgery, and in this group, there was not a unanimous decision. All included only direct healthcare costs but varied about categories included. The parameters used in the model-based studies were highly heterogeneous using mixed data from various sources. The items properly reported varied from 29 to 67%. CONCLUSIONS: The studies were all from developed countries and lacked in reporting quality. We recommend that developing countries produce their own studies. More strict alignment to reporting guidelines and use of robust evidence as model parameters are also advised.

A colaboração interprofissional na atenção primária à saúde na perspectiva da ciência da implementação / La colaboración interprofesional en la atención primaria de salud desde la perspectiva de la ciencia de la implementación / Interprofessional collaboration in primary health care from the perspective of implementation science

O objetivo foi analisar as percepções de trabalhadores da atenção primária à saúde (APS) sobre a colaboração interprofissional na perspectiva da ciência de implementação. Trata-se de estudo qualitativo que utilizou a entrevista em profundidade como técnica de produção de dados. Foram entrevistados 15 trabalhadores (três agentes comunitários de saúde, um auxiliar de enfermagem, três enfermeiros, três gerentes, três médicos e dois técnicos de enfermagem) de unidades básicas de saúde no Município de São Bernardo do Campo, São Paulo, Brasil. O roteiro da entrevista baseou-se em três dimensões do Quadro Conceitual Consolidado para Pesquisa de Implementação (CFIR; Consolidated Framework for Implementation Research). Foi realizada análise de conteúdo temática. Na dimensão características da colaboração interprofissional, os entrevistados destacaram a complexidade, e sua possível influência, na implementação e sustentabilidade dessa prática. Na dimensão cenário interno, foram identificados fatores que influenciam a colaboração interprofissional: como se utiliza o tempo destinado a comunicação formal/reuniões de equipe; interações sociais entre os profissionais; e características da liderança, como feedback, autonomia e participação nas decisões. Na dimensão características dos indivíduos, os participantes destacaram a colaboração interprofissional direcionada para a qualidade do cuidado e a necessidade de integração entre os núcleos de saberes. Assim, ações para aperfeiçoar a qualidade da comunicação, a construção coletiva em equipe e o aprimoramento da liderança podem contribuir para melhorar a colaboração interprofissional na APS e potencializar seus impactos na atenção à saúde.

The objective was to analyze the perceptions of primary health care (PHC) workers about interprofessional collaboration from the perspective of implementation science. This is a qualitative study that used in-depth interview as a data production technique. Interviews were conducted with 15 workers (three community health agents, one nursing assistant, three nurses, three managers, three physicians, and two nursing technicians) from basic health units in the Municipality of São Bernardo do Campo, São Paulo State, Brazil. The interview plan was based on three domains of the Consolidated Framework for Implementation Research (CFIR). Thematic content analysis was used. In the interprofessional collaboration characteristics domain, respondents highlighted the complexity, and its possible influence, as to the implementation and sustainability of this practice. In the inner setting domain, factors that influence interprofessional collaboration were identified, namely: how the time allocated to formal communication/team meetings is used; social interactions between professionals; and leadership characteristics, such as feedback, autonomy and participation in decisions. In the individuals characteristics domain, participants noted interprofessional collaboration geared to quality of care and the need for integration between knowledge centers. Thus, measures to enhance the quality of communication, collective team building and leadership can contribute to improve interprofessional collaboration in PHC and leverage its impacts on health care.

El objetivo fue analizar las percepciones de los trabajadores de atención primaria de salud (APS) sobre la colaboración interprofesional desde la perspectiva de la ciencia de implementación. Se trata de un estudio cualitativo que utilizó la entrevista en profundidad como técnica de producción de datos. Fueron entrevistados 15 trabajadores (tres agentes comunitarios de salud, un auxiliar de enfermería, tres enfermeros, tres gerentes, tres médicos y dos técnicos de enfermería) de unidades básicas de salud en el Municipio de São Bernardo do Campo, São Paulo, Brasil. La guía de la entrevista se basó en tres dimensiones del Marco Consolidado para la Investigación sobre la Implementación (CFIR; Consolidated Framework for Implementation Research). Se realizó un análisis de contenido temático. En la dimensión característica de la colaboración interprofesional, los entrevistados destacaron la complejidad y la posible influencia en su implantación y sostenibilidad. En la dimensión escenario interno, fueron identificados factores que influencian en la colaboración interprofesional: cómo se utiliza el tiempo destinado a la comunicación formal/reuniones de equipo; las interacciones sociales entre los profesionales, y las características del liderazgo, como feedback, la autonomía y la participación en las decisiones. En la dimensión de las características de los individuos, los participantes destacaron la colaboración interprofesional orientada a la calidad de la atención y la necesidad de integración entre los núcleos de saberes. Así, las acciones para mejorar la calidad de la comunicación, la construcción colectiva en equipo y la mejora del liderazgo pueden contribuir para mejorar la colaboración interprofesional en la APS y mejorar sus impactos en la atención a la salud.

Economic evaluations of colorectal cancer screening: A systematic review and quality assessment

Abstract Colorectal Cancer (CRC) is the third most common type of cancer worldwide and ranks second in mortality. Screening programs for early detection and treatment have been implemented in several countries. Economic evaluations are an important tool to support decision-making about reimbursement and coverage decisions in health systems and, therefore, to support efficient resource allocation. The article aims to review the up-to-date evidence on economic evaluations of CRC screening strategies. MEDLINE, EMBASE, Web of Science, SCOPUS, SciELO, Lilacs, CRD databases, and lists of references were reviewed to identify relevant literature regarding full economic evaluations of CRC screening in asymptomatic average-risk individuals over 40 years old. Searches were conducted with no restriction to language, setting, or date. Qualitative syntheses described CRC screening strategies and comparators (baseline context), study designs, key parameter inputs and incremental cost-effectiveness ratios. Seventy-nine articles were included. Most of the studies were from high-income countries and a third-party payer perspective. Markov models were predominantly used, although microsimulation has been increasingly adopted in the last 15 years. The authors found 88 different screening strategies for CRC, which differed in the type of technique, the interval of screening, and the strategy, i.e., isolated or combined. The annual fecal immunochemical test was the most predominant screening strategy. All studies reported cost-effective results in their scenarios compared to no screening scenarios. One-quarter of the publications reported cost-saving results. It is still necessary to develop future economic evaluations in Low- and Middle-Income Countries (LMICs), which account for the high burden of disease.

Conceptual mapping proposed to comprehend the effect of wheelchair mobility on social participation and quality of life: a systematic review.

PURPOSE: To identify and synthesise the available evidence on the effect of mobility on social participation and quality of life (QoL) of wheelchairs (WC) on adults who use WC as their primary means of mobility. MATERIALS AND METHODS: Systematic review undertaken in accordance with the Centre for Reviews and Dissemination Guidelines and registered in the PROSPERO International Prospective Register of Systematic reviews. Nine electronic databases (MEDLINE via PubMed, EMBASE, Cochrane Library, LILACS, CINAHL, PEDro, SCOPUS, Web of Science, and BVS ECOS) were searched with the following PICO eligibility criteria: (P) Population was individuals with mobility limitations that live in their community, aged 18 or older; (I) Intervention was mobility devices, such as manual and powered wheelchairs; (C) Comparators, not applied; (O) Outcome was factors that can be influenced by wheelchair use, such as: social participation, health-related quality of life and QOL. Critical appraisal of methodological quality of studies were undertaken. RESULTS: A total of 18 studies were included. The proportion of studies evaluating the effects of mobility on participation was higher than to mobility on QoL. WC quality, device benefit (ease of repairs and maintenance), confidence using a WC and WC skills were key factors determining participation. The provision of WC according to the eight steps service proposed by the Word Health Organisation contributed to higher levels of physical health, WC satisfaction, hours using the WC and QoL enhancement. CONCLUSION: Attention should be given to enhance WC service provision (with continuous service support) as well as professional continuing education.IMPLICATIONS FOR REHABILITATIONWheelchair technology is a key element in rehabilitation. Significant effort should be made to provide and maintain the wheelchair as a facilitator to participation. A great attention should be done to enhance wheelchair services as well as professional continuous education.Wheelchair skills are associated with participation and may be targeted in clinical intervention.

Chemical typicity of tropical tannat red wines from sub-middle São Francisco Valley, Brazil.

Tannat is a Vitis vinifera cultivar with typically high phenolic compound contents, showing intense coloration, well-bodied, and great aging potential. However, even with this great potential, this variety is still commercially underexplored in the Sub-middle São Francisco Valley (SSFV). This work aimed to characterize the typicity of Tannat red wines from Sub-middle São Francisco Valley (SSFV), Brazil. In addition, the present work represents the first study featuring phenolic compounds quantification and antioxidant activity of Tannat in tropical climate wine-producing regions. Considering the condition of a short-applied maceration time during the winemaking, the tropical Tannat wine showed significant antioxidant activity and high phenolic contents. Trans-caftaric, malvidin-3-O-glucoside, and procyanidin B1 stood out among the phenolic compounds quantified, presenting Tannat with the potential to be an important grape variety to tropical wine-producing regions in Brazil, containing high contents of bioactive compounds. Previously results to compounds (-)-epigallocatechin gallate, procyanidin B2, quercetin-3-ß-D-glucoside, pelargonidin-3-O-glucoside, chlorogenic acid, and piceatannol were not found in Tannat wines. Further studies are necessary to make the Tannat grape's adaptation better in tropical climate conditions, including investigating the phenolic profile and antioxidant activity of Tannat red wines with longer maceration times during the winemaking.

Logical model of telenursing program of a high complexity oncology care center.

OBJECTIVE: To develop the logical model of the Alô Enfermeiro program aiming at elucidating the existing structure, activities carried out, and expected results, allowing the program implementation systematic evaluation. METHOD: This is an evaluative study with a qualitative approach. The development of the logical model was based on systematic methodologies, constituted from the analysis of institutional documents, literature review, search for essential elements that supported the implementation of the program, and the participation of stakeholders for discussion and validation of the data obtained. RESULTS: It was possible to define the macro problem that gave rise to the program, establish the definition of the Program Alô Enfermeiro, target audience, general and specific objectives, as well as to structure the necessary components, such as inputs and activities, indicating the expected results in the short, medium, and long term. The logical model allowed the identification of the Alô Enfermeiro Program evaluation question, directed to the evaluation of results. CONCLUSION: The logical model developed allowed the comprehension of the program structure, the interaction among the activities carried out and the expected results of the "Alô Enfermeiro".

Decision criteria for resource allocation: an analysis of CONITEC oncology reports. / Critérios de decisão para a alocação de recursos: uma análise de relatórios da CONITEC na área de oncologia.

In health technology assessment (HTA), decision criteria are considered relevant to support the complex deliberative process that requires simultaneous consideration of multiple factors. The aim was to identify and analyze the decision criteria that have been used by the National Health Technology Assessment Commission (CONITEC) when recommending the incorporation of technologies for the treatment of cancer. Descriptive study, based on reports from CONITEC, between 2012 and 2018, on oncology technologies. The data were collected in a specific extraction form and analyzed using descriptive statistics. 39 reports were analyzed, 15 of them did not present any explicit decision criteria. Medicines were the most frequently evaluated type of technology. The most frequent types of cancers were: breast cancer, head and neck cancer, colorectal cancer, non-Hodgkin's lymphoma and lung cancer. The most frequently considered criteria were: financial impact and effectiveness. The study identified the decision criteria that have been most used in the area of ​​oncology, however, the lack of transparency in relation to the weight of these criteria makes it difficult to understand their influence on the result of the decisions taken.

Nos processos de avaliação de tecnologias em saúde (ATS), critérios de decisão são considerados relevantes para apoiar o complexo processo deliberativo que requer consideração simultânea de múltiplos fatores. Objetivou-se identificar e analisar os critérios de decisão que têm sido utilizados pela Comissão Nacional de Avaliação de Tecnologias em Saúde (CONITEC) na recomendação de incorporação de tecnologias para o tratamento do câncer. Trata-se de um estudo descritivo, baseado em relatórios da CONITEC, entre 2012 e 2018, sobre tecnologias em oncologia. Os dados foram coletados em formulário de extração específico e analisados por meio de estatísticas descritivas. Foram analisados 39 relatórios, 15 deles não apresentavam nenhum critério de decisão explícito. Os medicamentos constituíram o tipo de tecnologia mais frequentemente avaliado. Os tipos de cânceres mais frequentes foram: de mama, de cabeça e pescoço, colorretal, linfoma não Hodgkin e de pulmão. Os critérios considerados com mais frequência foram: impacto financeiro e efetividade. O estudo identificou os critérios de decisão que têm sido mais utilizados na área de oncologia, entretanto, a falta de transparência em relação ao peso desses critérios torna difícil compreender a influência deles no resultado das decisões tomadas.

Multiple Criteria Decision Analysis (MCDA) for evaluating cancer treatments in hospital-based health technology assessment: The Paraconsistent Value Framework.

BACKGROUND: In recent years, the potential of multi-criteria decision analysis (MCDA) in the health field has been discussed widely. However, most MCDA methodologies have given little attention to the aggregation of different stakeholder individual perspectives. OBJECTIVE: To illustrate how a paraconsistent theory-based MCDA reusable framework, designed to aid hospital-based Health Technology Assessment (HTA), could be used to aggregate individual expert perspectives when valuing cancer treatments. METHODS: An MCDA methodological process was adopted based on paraconsistent theory and following ISPOR recommended steps in conducting an MCDA study. A proof-of-concept exercise focusing on identifying and assessing the global value of first-line treatments for metastatic colorectal cancer (mCRC) was conducted to foster the development of the MCDA framework. RESULTS: On consultation with hospital-based HTA committee members, 11 perspectives were considered in an expert panel: medical oncology, oncologic surgery, radiotherapy, palliative care, pharmacist, health economist, epidemiologist, public health expert, health media expert, pharmaceutical industry, and patient advocate. The highest weights were assigned to the criteria "overall survival" (mean 0.22), "burden of disease" (mean 0.21) and "adverse events" (mean 0.20), and the lowest weights were given to "progression-free survival" and "cost of treatment" (mean 0.18 for both). FOLFIRI and mFlox scored the highest global value score of 0.75, followed by mFOLFOX6 with a global value score of 0.71. mIFL was ranked last with a global value score of 0.62. The paraconsistent analysis (para-analysis) of 6 first-line treatments for mCRC indicated that FOLFIRI and mFlox were the appropriate options for reimbursement in the context of this study. CONCLUSION: The Paraconsistent Value Framework is proposed as a step beyond the current MCDA practices, in order to improve means of dealing with individual expert perspectives in hospital-based HTA of cancer treatments.

Palliative cancer care: costs in a Brazilian quaternary hospital.

Palliative care (PC) improves the quality of life of patients with diseases such as cancer, and several studies have shown a reduction in costs among patients who use PC services when compared with those receiving standard oncological treatments. Most studies on PC costs are carried out in high-income countries. There is a lack of these types of studies in middle-income and low-income countries and of better evidence about this intervention. OBJECTIVE: To describe resource utilisation and costs among patients with cancer in a Brazilian quaternary hospital by cancer localisation and per month of treatment before death. METHODS: This study is a description of retrospective costs to estimate the costs of formal healthcare sector associated with PCs, from the perspective of a public quaternary cancer hospital. Unit costs were estimated using microcosting and macrocosting approaches. SETTING/PARTICIPANTS: Patients older than 18 years old who died from 2010 to 2013 and who had at least two visits in PC and/or made use of hospice care. RESULTS: Among the 2985 patients included in the study, the average cost per patient was US$12 335, ranging from US$8269 for patients with pancreatic cancer to US$19 395 for patients with brain cancer. The main costing item was hospital admission (47.6% of the total cost), followed by hospice care (29.5%) and medical and other supplies (11.1%). CONCLUSIONS: The study clarified the direct medical costs and the profile and use of resources of patients with cancer who need PC, and can help in the planning and allocation of resources in cancer care.

Multicriteria decision analysis in health care decision in oncology: a systematic review.

INTRODUCTION: Multicriteria decision analysis (MCDA) has been used to inform health decisions in health technology assessments (HTA) processes. This is particularly important to complex treatment decisions in oncology. AREAS COVERED: Five databases (PubMed, EMBASE, LILACS, Web of Science and CRD's NHS Economic Evaluation Database) were searched for studies comparing health technologies in oncology, involving the concept MCDA. The ISPOR MCDA Good Practices Guidelines were used to assess the reporting quality. Study selection, appraisal, and data extraction were performed by two reviewers. Fifteen studies were included. The main decision problem was related to health technology assessment of cancer treatments. Clinicians and public health experts were the most frequent stakeholders. The most frequently included criteria comprised therapeutic benefit, and socio-economic impact. Value measurement approach, direct rating techniques, and additive model for aggregation were used in most studies. Uncertainty analysis revealed the impact of posology and costs on the studies' results. All studies showed some level of overlapping decision criteria. EXPERT OPINION: There is considerable diversity of methods in MCDA for healthcare decision-making in oncology. The evidence presented can serve as a resource when considering which stakeholders, criteria, and techniques to include in future MCDA studies in oncology.