Disinvestment in healthcare: An overview of HTA agencies and organizations activities at European level

Background: In an era of a growing economic pressure for all health systems, the interest for "disinvestment" in healthcare increased. In this context, evidence based approaches such as Health Technology Assessment (HTA) are needed both to invest and to disinvest in health technologies. In order to investigate the extent of application of HTA in this field, methodological projects/frameworks, case studies, dissemination initiatives on disinvestment released by HTA agencies and organizations located in Europe were searched. Methods: In July 2015, the websites of HTA agencies and organizations belonging to the European network for HTA (EUnetHTA) and the International Network of Agencies for HTA (INAHTA) were accessed and searched through the use of the term "disinvestment". Retrieved deliverables were considered eligible if they reported methodological projects/frameworks, case studies and dissemination initiatives focused on disinvestment in healthcare. Results: 62 HTA agencies/organizations were accessed and eight methodological projects/frameworks, one case study and one dissemination initiative were found starting from 2007. With respect to methodological projects/frameworks, two were delivered in Austria, one in Italy, two in Spain and three in U.K. As for the case study and the dissemination initiative, both came from U.K. The majority of deliverables were aimed at making an overview of existing disinvestment approaches and at identifying challenges in their introduction. Conclusions: Today, in a healthcare context characterized by resource scarcity and increasing service demand, "disinvestment" from low-value services and reinvestment in high-value ones is a key strategy that may be supported by HTA. The lack of evaluation of technologies in use, in particular at the end of their lifecycle, may be due to the scant availability of frameworks and guidelines for identification and assessment of obsolete technologies that was shown by our work. Although several projects were carried out in different countries, most remain constrained to the field of research. Disinvestment is a relatively new concept in HTA that could pose challenges also from a methodological point of view. To tackle these challenges, it is necessary to construct experiences at international level with the aim to develop new methodological approaches to produce and grow evidence on disinvestment policies and practices

Lessons from Sicilian Centenarians for Anti-Ageing Medicine. The Oxi-Inflammatory Status

Population ageing is a great achievement of humanity, but it also represents a challenge that the Western world is currently facing, as ageing is associated with increased susceptibility to age-related inflammatory diseases. Therefore, it is necessary to fully understand the mechanisms of healthy ageing to prevent the harmful aspects of ageing. The study of long living individuals (LLIs) is a great model for trying to achieve this goal. Accordingly, the oxy-inflammatory status of Sicilian LLIs was reviewed in the present paper. Based on the reported data, anti-inflammatory and anti-oxidative stress strategies have been discussed, useful for delaying or avoiding the onset of age-related diseases, thus favouring a healthy ageing process

PP020—Effects of aripiprazole and risperidone on ventricular repolarization in children and adolescents

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Primary carcinoid tumour of the common bile duct

Background Carcinoid tumours of the extrahepatic biliary tree are exceedingly rare. We report a case of primary carcinoid tumour arising in the distal portion of the common bile duct. Case outline A 30-year-old man was admitted with watery diarrhoea and symptoms of biliary obstruction. Abdominal ultrasound scan showed a normal gallbladder without stones, mild dilatation of the intra- and extrahepatic biliary tree and a 2 cm solid lesion in the head of pancreas compressing the distal common bile duct. Computed tomography confirmed these findings and showed that the tumour was hypervascular. Gastrointestinal hormone screening showed an increase in plasma serotonin. The patient underwent a standard pylorus-preserving proximal pancreatoduodenectomy (PPPD). Results Pathological examination showed a neuroendocrine tumour (carcinoid) of the distal bile duct. The postoperative plasma serotonin decreased to normal levels. One year later the patient is well without evidence of disease. Discussion Primary carcinoid tumours of the extrahepatic biliary tree are rare, accounting for 0.2–2% of all digestive carcinoids. This is the fifth report of a tumour arising from the distal common bile duct. Surgical treatment for neoplasms of the distal common bile duct can be problematic because of the site of the lesion and the difficulty in differentiating them from periampullary neoplasms lesions. Pancreatoduodenectomy (PD) is therefore the treatment of choice

Evaluation of acute cardiovascular effects of immediate-release methylphenidate in children and adolescents with attention-deficit hyperactivity disorder

Attention-deficit hyperactivity disorder is a frequent condition in children and often extends into adulthood. Use of immediate-release methylphenidate (MPH) has raised concerns about potential cardiovascular adverse effects within a few hours after administration. This study was carried out to investigate acute effects of MPH on electrocardiogram (ECG) in a pediatric population. A total of 54 consecutive patients with attention-deficit hyperactivity disorder (51 males and 3 females; mean age =12.14±2.6 years, range 6–19 years), receiving a new prescription of MPH, underwent a standard ECG 2 hours before and after the administration of MPH 10 mg per os. Basal and posttreatment ECG parameters, including mean QT (QT interval when corrected for heart rate [QTc]), QTc dispersion (QTd) interval duration, T-peak to T-end (TpTe) intervals, and TpTe/QT ratio were compared. Significant modifications of both QTc and QTd values were not found after drug administration. QTd fluctuated slightly from 25.7±9.3 milliseconds to 25.1±8.4 milliseconds; QTc varied from 407.6±12.4 milliseconds to 409.8±12.7 milliseconds. A significant variation in blood pressure (systolic blood pressure 105.4±10.3 vs 109.6±11.5; P<0.05; diastolic blood pressure 59.2±7.1 vs 63.1±7.9; P<0.05) was observed, but all the data were within normal range. Heart rate moved from 80.5±15.5 bpm to 87.7±18.8 bpm. No change in TpTe values was found, but a statistically significant increase in TpTe/QTc intervals was found with respect to basal values (0.207±0.02 milliseconds vs 0.214±0.02 milliseconds; P<0.01). The findings of this study show no significant changes in ECG parameters. TpTe values can be an additional parameter to evaluate borderline cases

A Metabolomic Perspective on Coeliac Disease

Metabolomics is an “omic” science that is now emerging with the purpose of elaborating a comprehensive analysis of the metabolome, which is the complete set of metabolites (i.e., small molecules intermediates) in an organism, tissue, cell, or biofluid. In the past decade, metabolomics has already proved to be useful for the characterization of several pathological conditions and offers promises as a clinical tool. A metabolomics investigation of coeliac disease (CD) revealed that a metabolic fingerprint for CD can be defined, which accounts for three different but complementary components: malabsorption, energy metabolism, and alterations in gut microflora and/or intestinal permeability. In this review, we will discuss the major advancements in metabolomics of CD, in particular with respect to the role of gut microbiome and energy metabolis

The Bright and Dark Sides of High-Redshift starburst galaxies from {\it Herschel} and {\it Subaru} observations

We present rest-frame optical spectra from the FMOS-COSMOS survey of twelve $z \sim 1.6$ \textit{Herschel} starburst galaxies, with Star Formation Rate (SFR) elevated by $\times$8, on average, above the star-forming Main Sequence (MS). Comparing the H$\alpha$ to IR luminosity ratio and the Balmer Decrement we find that the optically-thin regions of the sources contain on average only $\sim 10$ percent of the total SFR whereas $\sim90$ percent comes from an extremely obscured component which is revealed only by far-IR observations and is optically-thick even in H$\alpha$. We measure the [NII]$_{6583}$/H$\alpha$ ratio, suggesting that the less obscured regions have a metal content similar to that of the MS population at the same stellar masses and redshifts. However, our objects appear to be metal-rich outliers from the metallicity-SFR anticorrelation observed at fixed stellar mass for the MS population. The [SII]$_{6732}$/[SII]$_{6717}$ ratio from the average spectrum indicates an electron density $n_{\rm e} \sim 1,100\ \mathrm{cm}^{-3}$, larger than what estimated for MS galaxies but only at the 1.5$\sigma$ level. Our results provide supporting evidence that high-$z$ MS outliers are the analogous of local ULIRGs, and are consistent with a major merger origin for the starburst event.Comment: 6 pages, 4 figures, Accepted for publication in ApJ Letter

Ionized gas kinematics and chemical abundances of low-mass star-forming galaxies at z∼3z\sim 3

We selected 35 low-mass SFGs (7.9<log(M$_*$/M$_{\odot}$)<10.3) from deep spectroscopic surveys based on their CIII]1908 emission. We used follow-up NIR observations to examine their rest-optical emission lines and identify ionized outflow signatures through broad emission wings detected after Gaussian modeling of [OIII]4959,5007 profiles. We characterized the galaxies' gas-phase metallicity and carbon-to-oxygen (C/O) abundance using a Te-based method via the OIII]1666/[OIII]5007 ratio and photoionization models. We find line ratios and rest-frame EWs characteristic of high-ionization conditions powered by massive stars. Our sample displays mean rest-frame EW([OIII]5007)~560\r{A} while 15% of them show EW([OIII]4959,5007)>1000\r{A} and EW(CIII])>5\r{A}, closely resembling those now seen in EoR galaxies with JWST. We find low gas-phase metallicities 12+log(O/H)~7.5-8.5 and C/O abundances from 23%-128% solar, with no apparent increasing trend with metallicity. From our [OIII]4959,5007 profile modeling, we find that 65% of our sample shows an outflow component, which is shifted relative to the ionized gas systemic velocity, with mean $v_{max}$~280 km/s which correlates with the $\Sigma_{SFR}$. We find that the mass-loading factor $\mu$ of our sample is typically lower than in more massive galaxies from literature but higher than in typical local dwarf galaxies. In the stellar mass range covered, we find that $\mu$ increases with $\Sigma_{SFR}$ thus suggesting that for a given stellar mass, denser starbursts in low-mass galaxies produce stronger outflows. Our results complement the picture drawn by similar studies at lower redshift, suggesting that the removal of ionized gas in low-mass SFGs driven by stellar feedback is regulated by their stellar mass and by the strength and concentration of their star formation, i.e. $\Sigma_{\rm SFR}$.Comment: Accepted for publication in A&A. We updated the manuscript following referee's suggestions. We updated the estimations of C/O by not including CIV flux since it is not detected in most of our sample. No major changes in our results compared with previous versio

Alcohol Septal Ablation for Hypertrophic Obstructive Cardiomyopathy: A Contemporary Reappraisal

Percutaneous alcohol septal ablation (ASA) is an effective and minimally invasive therapeutic strategy to resolve left ventricular outflow tract obstruction (LVOTO) in patients with hypertrophic cardiomyopathy who remain symptomatic on maximally tolerated medical therapy. First performed by Sigwart in 1994, the procedure consists in determining an iatrogenic infarction of the basal interventricular septum to reduce LVOTO and alleviate symptoms. Since its first description, numerous studies have demonstrated its efficacy and safety, proposing ASA as a valid and attractive alternative to surgical septal myectomy. The success rate of the intervention is profoundly affected by patient selection and centre experience. In this review, we sought to summarise current evidence on ASA, describing the procedure and proposing a cardiomyopathy team-based approach to resolve clinical disputes in clinical practice

The VANDELS survey: A strong correlation between Lyα\alpha equivalent width and stellar metallicity at 3≤z≤5\mathbf{3\leq z \leq 5}

We present the results of a new study investigating the relationship between observed Ly$\alpha$ equivalent width ($W_{\lambda}$(Ly$\alpha$)) and the metallicity of the ionizing stellar population ($Z_{\star}$) for a sample of $768$ star-forming galaxies at $3 \leq z \leq 5$ drawn from the VANDELS survey. Dividing our sample into quartiles of rest-frame $W_{\lambda}$(Ly$\alpha$) across the range -58 \unicode{xC5} \lesssim $W_{\lambda}$(Ly$\alpha$) \lesssim 110 \unicode{xC5} we determine $Z_{\star}$ from full spectral fitting of composite far-ultraviolet (FUV) spectra and find a clear anti-correlation between $W_{\lambda}$(Ly$\alpha$) and $Z_{\star}$. Our results indicate that $Z_{\star}$ decreases by a factor $\gtrsim 3$ between the lowest $W_{\lambda}$(Ly$\alpha$) quartile ($\langle$$W_{\lambda}$(Ly$\alpha$)\rangle=-18\unicode{xC5}) and the highest $W_{\lambda}$(Ly$\alpha$) quartile ($\langle$$W_{\lambda}$(Ly$\alpha$)\rangle=24\unicode{xC5}). Similarly, galaxies typically defined as Lyman Alpha Emitters (LAEs; $W_{\lambda}$(Ly$\alpha$) >20\unicode{xC5}) are, on average, metal poor with respect to the non-LAE galaxy population ($W_{\lambda}$(Ly$\alpha$) \leq20\unicode{xC5}) with $Z_{\star}$$_{\rm{non-LAE}}\gtrsim 2 \times$ $Z_{\star}$$_{\rm{LAE}}$. Finally, based on the best-fitting stellar models, we estimate that the increasing strength of the stellar ionizing spectrum towards lower $Z_{\star}$ is responsible for $\simeq 15-25\%$ of the observed variation in $W_{\lambda}$(Ly$\alpha$) across our sample, with the remaining contribution ($\simeq 75-85\%$) being due to a decrease in the HI/dust covering fractions in low $Z_{\star}$ galaxies.Comment: 10 pages, 6 figures, MNRAS accepte