Adoption Decisions for Medical Devices

Decisions to adopt medical devices at the hospital level have consequences for health technology assessment (HTA) on system level and are therefore important to decision makers. Our aim was to investigate the characteristics of organizations and individuals that are more inclined to adopt and utilize cardiovascular devices based on a comprehensive analysis of environmental, organizational, individual, and technological factors and to identify corresponding implications for HTA. Seven random intercept hurdle models were estimated using the data obtained from 1249 surveys completed by members of the European Society of Cardiology. The major findings were that better manufacturer support increased the adoption probability of 'new' devices (i.e. in terms of CE mark approval dates), and that budget pressure increased the adoption probability of 'old' devices. Based on our findings, we suggest investigating the role of manufacturer support in more detail to identify diffusion patterns relevant to HTA on system level, to verify whether it functions as a substitute for medical evidence of new devices, and to receive new insights about its relationship with clinical effectiveness and cost-effectiveness. © 2017 The Authors. Health Economics published by John Wiley & Sons, Ltd

The impact of fuel cell trucks on the long-distance road freight industry in Europe

Heavy-duty vehicles are a major contributor to CO2 emissions in Europe. Today, there are several technological alternatives to decarbonize the industry, one of which is fuel cells. This thesis sought to understand the impact of fuel cell heavy-duty trucks (FC-HDT) on the long-distance road freight industry in Europe in 2031. The results were obtained by conducting expert interviews and analyzing pilot projects, industry reports, press releases, and scientific journals. Compared to heavy-duty trucks with internal combustion engines, the disadvantages of FC-HDTs in areas such as range, infrastructure, and cost outweigh the advantages. However, zero tailpipe emissions can become a decisive advantage if there is stronger regulation of CO2. Therefore, the experts agreed that in the future, only the use of FC-HDTs and battery electric heavy-duty trucks (BE-HDTs) would be a viable option. FC-HDTs, compared with BE-HDTs, currently offer shorter refueling times and longer ranges but are falling behind in terms of costs. A scenario planning approach indicates that FC-HDTs will have moderate adaptation and split the market with BE-HDTs. Scenarios in which FC-HDTs or BE-HDTs became the only prevailing technology were assessed as less likely.Os veículos pesados são um dos principais contribuintes para as emissões de CO2 na Europa. Hoje, existem várias alternativas tecnológicas para descarbonizar a indústria, uma das quais são as células de hidrogénio. Esta tese procura compreender o impacto dos camiões de células de hidrogénio (FC-HDT – Fuel Cell-Heavy Duty Trucks) na indústria de transporte rodoviário de longa distância na Europa em 2031. Os resultados foram obtidos através da realização de entrevistas periciais, bem como da análise de projetos-piloto, relatórios da indústria, comunicados de imprensa e revistas científicas. Em comparação com os veículos pesados de motor de combustão interna, as desvantagens dos FC-HDTs em áreas como a autonomia, infraestruturas e custos superam as vantagens. No entanto, as emissões zero no tubo de escape podem tornar-se uma vantagem decisiva, caso passe a existir uma regulamentação mais significativa quanto às emissões de CO2. Por isso, há consenso entre especialistas de que a única opção viável no futuro será a utilização de FC-HDTs e de veículos pesados a bateria elétrica (BE-HDTs). Os FC-HDTs, em comparação com os BE-HDTs, oferecem atualmente tempos de reabastecimento mais curtos e maior autonomia, mas estão a perder vantagem em termos de custos. Uma abordagem de planeamento de cenários indica que os FC-HDTs terão uma adaptação moderada e dividirão o mercado com os BE-HDTs. Os cenários em que os FC-HDTs ou BE-HDTs se tornaram a única tecnologia prevalecente foram avaliados como menos prováveis

Computed tomography of the thorax of calves from birth to the age of 105 days

The present study was undertaken to provide computed tomographic (CT) reference values for structures in the thorax of the calf. Six clinically healthy Holstein-Friesian calves were anaesthetized. Transverse pre- and postcontrast images with a reconstructed 1.5-mm slice thickness were obtained using a multislice-CT scanner at 6 different time points from birth to 105 days of age. Absolute and relative measurements of the trachea, heart, cranial and caudal vena cava, thoracic aorta, right and left principal bronchi, right and left caudal lobar bronchi and the accompanying branches of the right and left pulmonary artery and vein, thoracic lymph nodes and lung density were taken for every time point. All animals were euthanized after the last CT scan, and 4 calves were frozen to generate an atlas comparing gross anatomy with CT. During the study, 4 animals temporarily showed coughing and mucopurulent nasal discharge, and mild to moderate bronchopneumonia and pleuritis were diagnosed using CT. Animals recovered with treatment; however, mild to moderate CT changes remained throughout the study. Even in the 2 clinically normal animals, mild bronchopneumonia was diagnosed on CT

Health technology assessment of medical devices: a survey of non-European union agencies

The aim of this study was to review and compare current health technology assessment (HTA) activities for medical devices across non-European Union HTA agencies

Health technology assessment of medical devices: a survey of non-European union agencies

OBJECTIVES The aim of this study was to review and compare current health technology assessment (HTA) activities for medical devices across non-European Union HTA agencies. METHODS HTA activities for medical devices were evaluated from three perspectives: organizational structure, processes, and methods. Agencies were primarily selected upon membership of existing HTA networks. The data collection was performed in two stages: stage 1-agency Web-site assessment using a standardized questionnaire, followed by review and validation of the collected data by a representative of the agency; and stage 2-semi-structured telephone interviews with key informants of a sub-sample of agencies. RESULTS In total, thirty-six HTA agencies across twenty non-EU countries assessing medical devices were included. Twenty-seven of thirty-six (75 percent) agencies were judged at stage 1 to have adopted HTA-specific approaches for medical devices (MD-specific agencies) that were largely organizational or procedural. There appeared to be few differences in the organization, process and methods between MD-specific and non-MD-specific agencies. Although the majority (69 percent) of both categories of agency had specific methods guidance or policy for evidence submission, only one MD-specific agency had developed methodological guidelines specific to medical devices. In stage 2, many MD-specific agencies cited insufficient resources (budget, skilled employees), lack of coordination (between regulator and reimbursement bodies), and the inability to generalize findings from evidence synthesis to be key challenges in the HTA of medical devices. CONCLUSIONS The lack of evidence for differentiation in scientific methods for HTA of devices raises the question of whether HTA needs to develop new methods for medical devices but rather adapt existing methodological approaches. In contrast, organizational and/or procedural adaptation of existing HTA agency frameworks to accommodate medical devices appear relatively commonplace

Influence of dental status on outcome after lung transplantation

Introduction Poor oral hygiene can cause infections and inflammatory diseases. Data on its impact on outcome after lung transplantation (LuTX) is scarce. Most transplant centers have individual standards regarding dental care as there is no clinical guideline. This study's objective was to assess LuTX-listed patient's dental status and determine its effect on postoperative outcome. Methods Two hundred patients having undergone LuTX from 2014 to 2019 were selected. Collected data comprised LuTX-indication, periodontal status, and number of carious teeth/fillings. A preoperative panoramic dental X-ray and a dentist's consultative clarification were mandatory. Results 63.5% had carious dental status, differing significantly regarding TX-indication (p < 0.001; ILD: 41.7% vs. CF: 3.1% of all patients with carious teeth). Mean age at the time of LuTX differed significantly within these groups. Neither preoperative carious dental status nor periodontitis or bone loss deteriorated post-LuTX survival significantly. No evidence was found that either resulted in a greater number of deaths related to an infectious etiology. Conclusion This study shows that carious dental status, periodontitis, and bone loss do not affect post-TX survival. However, literature indicates that they can cause systemic/pulmonary infections that deteriorate post-LuTX survival. Regarding the absence of standardized guidelines regarding dental care and LuTX, we strongly recommend emphasizing research in this field