The value of implementation and the value of information: combined and uneven development

In a budget constrained healthcare system the decision to invest in strategies to improve the implementation of cost-effective technologies must be made alongside decisions regarding investment in the technologies themselves and investment in further research. This paper presents a single, unified framework that simultaneously addresses the problem of allocating funds between these separate but linked activities. The framework presents a simple 4 state world where both information and implementation can be either at the current level or ‘perfect’. Through this framework it is possible to determine the maximum return to further research and an upper bound on the value of adopting implementation strategies. The framework is illustrated through case studies of health care technologies selected from those previously considered by the UK National Institute for Health and Clinical Excellence (NICE). Through the case studies, several key factors that influence the expected values of perfect information and perfect implementation are identified. These factors include the maximum acceptable cost-effectiveness ratio, the level of uncertainty surrounding the adoption decision, the expected net benefits associated with the technologies, the current level of implementation and the size of the eligible population. Previous methods for valuing implementation strategies have confused the value of research and the value of implementation. This framework demonstrates that the value of information and the value of implementation can be examined separately but simultaneously in a single framework. This can usefully inform policy decisions about investment in healthcare services, further research and adopting implementation strategies which are likely to differ between technologies.Value of information analysis; value of implementation; healthcare decisionmaking, Bayesian analysis

Improving the efficiency and relevance of health technology assessent: the role of iterative decision analytic modelling

Decision making in health care involves two sets of related decisions: those concerning appropriate service provision on the basis of existing information; and those concerned with whether to fund additional research to reduce the uncertainty relating to the decision. Information acquisition is not costless, and the allocation of funds to the enhancement of the decision makers’ information set, in a budgetconstrained health service, reduces the ‘pot’ of resources available for health service provision. Hence, a framework is necessary to unify these decisions and ensure that HTA is subject to the same evaluation of efficiency as service provision. A framework is presented which addresses these two sets of decisions through the employment of decision analytic models and Bayesian value of information analysis, early and regularly within the health technology assessment process. The model becomes the vehicle of health technology assessment, managing and directing future research effort on an iterative basis over the lifetime of the technology. This ensures consistency in decision making between service provision, research and development priorities and research methods. Fulfilling the aim of the National Health Service HTA programme, that research is “produced in the most economical way” using “cost effective research protocols”. The proposed framework is applied to the decision concerning the appropriate management of female patients with symptoms of urinary tract infection, which was the subject of a recent NHS HTA call for proposals. A probabilistic model is employed to fully characterise and assess the uncertainty surrounding the decision. The expected value of perfect information (EVPI) is then calculated for the full model, for each individual management strategy and for particular model parameters. Research effort can then be focused on those areas where the cost of uncertainty is high and where additional research is potentially cost-effective. The analysis can be used to identify the most appropriate research protocol and to concentrate research upon particular parameters where more precise estimates would be of most value.assessment

The value of implementation and the value of information: combined and uneven development

<i>Aim</i>: In a budget-constrained health care system, the decision to invest in strategies to improve the implementation of cost-effective technologies must be made alongside decisions regarding investment in the technologies themselves and investment in further research. This article presents a single, unified framework that simultaneously addresses the problem of allocating funds between these separate but linked activities. <i>Methods</i>: The framework presents a simple 4-state world where both information and implementation can be either at the current level or "perfect". Through this framework, it is possible to determine the maximum return to further research and an upper bound on the value of adopting implementation strategies. The framework is illustrated through case studies of health care technologies selected from those previously considered by the UK National Institute for Health and Clinical Excellence (NICE). <i>Results</i>: Through the case studies, several key factors that influence the expected values of perfect information and perfect implementation are identified. These factors include the maximum acceptable cost-effectiveness ratio, the level of uncertainty surrounding the adoption decision, the expected net benefits associated with the technologies, the current level of implementation, and the size of the eligible population. <i>Conclusions</i>: Previous methods for valuing implementation strategies have not distinguished the value of efficacy research and the value of strategies to change the level of implementation. This framework demonstrates that the value of information and the value of implementation can be examined separately but simultaneously in a single framework. This can usefully inform policy decisions about investment in health care services, further research, and adopting implementation strategies that are likely to differ between technologies

Originality and the Future of Copyright in an Age of Generative AI

This papers explores the question of human authorship when works are created with generative AI tools.Comment: 3 figure

Soil-transmitted helminth infections

More than a quarter of the world's population is at risk of infection with the soil-transmitted helminths Ascaris lumbricoides, hookworm (Ancylostoma duodenale and Necator americanus), Trichuris trichiura, and Strongyloides stercoralis. Infected children and adults present with a range of medical and surgical conditions, and clinicians should consider the possibility of infection in individuals living in, or returning from, endemic regions. Although safe and effective drugs are donated free to endemic countries, only half of at-risk children received treatment in 2016. This Seminar describes the epidemiology, lifecycles, pathophysiology, clinical diagnosis, management, and public health control of soil-transmitted helminths. Previous work has questioned the effect of population-level deworming; however, it remains beyond doubt that treatment reduces the severe consequences of soil-transmitted helminthiasis. We highlight the need for refined diagnostic tools and effective control options to scale up public health interventions and improve clinical detection and management of these infections

Is primary angioplasty cost effective in the UK? Results of a comprehensive decision analysis

Objective: To assess the cost effectiveness of primary angioplasty, compared with medical management with thrombolytic drugs, to achieve reperfusion after acute myocardial infarction ( AMI) from the perspective of the UK NHS. Design: Bayesian evidence synthesis and decision analytic model. Methods: A systematic review was conducted and Bayesian statistical methods used to synthesise evidence from 22 randomised control trials. Resource utilisation was based on UK registry data, published literature and national databases, with unit costs taken from routine NHS sources and published literature. Main outcome measure: Costs from a health service perspective and outcomes measured as quality-adjusted life years (QALYs). Results: For the base case, the incremental cost-effectiveness ratio of primary angioplasty was pound 9241 for each additional QALY, with a probability of being cost effective of 0.90 for a cost-effectiveness threshold of pound 20 000. Results were sensitive to variations in the additional time required to initiate treatment with primary angioplasty. Conclusions: Primary angioplasty is cost effective for the treatment of AMI on the basis of threshold cost-effectiveness values used in the NHS and subject to a delay of up to about 80 minutes. These findings are mainly explained by the superior mortality benefit and the prevention of non-fatal outcomes associated with primary angioplasty for delays of up to this length

Assessing the effectiveness of primary angioplasty compared with thrombolysis and its relationship to time delay: a Bayesian evidence synthesis

Background: Meta-analyses of trials have shown greater benefits from angioplasty than thrombolysis after an acute myocardial infarction, but the time delay in initiating angioplasty needs to be considered. Objective: To extend earlier meta-analyses by considering 1- and 6-month outcome data for both forms of reperfusion. To use Bayesian statistical methods to quantify the uncertainty associated with the estimated relationships. Methods: A systematic review and meta-analysis published in 2003 was updated. Data on key clinical outcomes and the difference between time-to-balloon and time-to-needle were independently extracted by two researchers. Bayesian statistical methods were used to synthesise evidence despite differences between reported follow-up times and outcomes. Outcomes are presented as absolute probabilities of specific events and odds ratios (ORs; with 95% credible intervals (Crl)) as a function of the additional time delay associated with angioplasty. \ Results: 22 studies were included in the meta-analysis, with 3760 and 3758 patients randomised to primary angioplasty and thrombolysis, respectively. The mean ( SE) angioplasty-related time delay ( over and above time to thrombolysis) was 54.3 (2.2) minutes. For this delay, mean event probabilities were lower for primary angioplasty for all outcomes. Mortality within 1 month was 4.5% after angioplasty and 6.4% after thrombolysis ( OR = 0.68 ( 95% Crl 0.46 to 1.01)). For non-fatal reinfarction, OR = 0.32 ( 95% Crl 0.20 to 0.51); for non-fatal stroke OR = 0.24 ( 95% Crl 0.11 to 0.50). For all outcomes, the benefit of angioplasty decreased with longer delay from initiation. Conclusions: The benefit of primary angioplasty, over thrombolysis, depends on the former's additional time delay. For delays of 30-90 minutes, angioplasty is superior for 1- month fatal and non-fatal outcomes. For delays of around 90 minutes thrombolysis may be the preferred option as assessed by 6-month mortality; there is considerable uncertainty for longer time delays

Integrating law, technology, and design : teaching data protection and privacy law in a digital age

Key Points The data protection lawyer of the future will be a key intermediary of innovation—or ‘transaction engineer’—who facilitates and coordinates new forms of business and other social relationships in rapidly evolving multi-disciplinary settings. The effective performance of this function requires legal professionals to develop a different mindset, along with new skills and capacities, specifically a better understanding of the underlying technologies and the value and techniques of legal design, as well as a knowledge of relevant data protection law. Transferable principles for teaching data protection law and privacy law in a digital age are identified. The article proposes a task-oriented, gamified, and sandbox approach to data protection education that delivers a more relevant student experience that cultivates meaningful capacities and skills that are more closely aligned with the needs and values of a digital age.©The Author(s) 2022. Published by Oxford University Press. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited.fi=vertaisarvioitu|en=peerReviewed

Peran Keterlibatan Ayah dalam Pengasuhan Sebagai Moderator dalam Hubungan Persahabatan dengan Harga Diri Remaja Akhir di Universitas Sebelas Maret Surakarta

Memiliki penghargaan diri yang baik terhadap diri sendiri merupakan hal yang penting bagi remaja. Harga diri menjadi penting karena menyangkut bagaimana kita memandang diri kita sendiri dan hal tersebut yang akan menentukan bagaimana kita berinteraksi dengan lingkungan. Mahasiswa tingkat awal yang masih termasuk remaja, perlu untuk memiliki penghargaan diri yang positif. Salah satu faktor yang berperan penting ialah lingkungan sosial, baik lingkungan pertemanan ataupun keluarga. Memiliki ikatan emosional yang dalam dengan teman sebaya, akan memunculkan penghargaan diri yang lebih positif pada individu. Adanya keterlibatan ayah dalam pengasuhan diketahui memiliki peran yang positif bagi perkembangan kompetensi sosial seseorang, dengan begitu hubungan terbentuknya harga diri melalui proses persahabatan pada remaja juga akan meningkat. Penelitian ini bertujuan untuk mengetahui hubungan persahabatan dengan harga diri yang dimoderasi oleh keterlibatan ayah dalam pengasuhan. Teknik pengambilan sampel yang digunakan adalah purposive sampling. Subjek penelitian berjumlah 175 orang. Populasi dalam penelitian ini adalah angkatan 2015 di UNS. Pengumpulan data menggunakan skala harga diri, skala persahabatan dan skala keterlibatan ayah. Analisis data menggunakan PROCESS Procedure for SPSS by Andrew F. Hayes – Regression Based Analysis. Hasil penelitian menunjukkan terdapat hubungan yang signifikan antara persahabatan dengan harga diri dengan nilai F = 7,9375 (> F tabel) dan p = 0,0001 ( t tabel, dengan nilai 1,96), serta p = 0,01 ( F tabel, yaitu 3,91), dan nilai p sebesar 0,0113 (< 0,05)

Illness Cognitions and Coping Self-Efficacy in Depression Among Persons With Low Vision.

PURPOSE: To investigate the mediating role of coping self-efficacy (CSE) between two types of illness cognitions (i.e., acceptance and helplessness) and depressive symptoms in persons with low vision. METHODS: This was a single-group, cross-sectional study. Patients with visual acuity \u3c 6/12 in the better eye and at least minimal depressive symptoms (≥5 on the Patient Health Questionnaire-9 [PHQ-9]) were recruited from vision rehabilitation services and participated in telephone-administered structured interviews at one time point. Measures were the PHQ-9, CSE Scale, and Illness Cognition Questionnaire. Structural equation modeling (SEM) devised the causal flow of illness cognitions and their observed indirect effects on depressive symptoms via the CSE mediators: problem focused, emotion focused, and social support. RESULTS: The study comprised 163 patients (mean age 62 years; 61% female), most with age-related macular degeneration (26%) and moderate vision impairment (44%, \u3c6/18-6/60). Structural equation modeling indices indicated a perfect fit (χ2 \u3c 0.001, P = 1.00), accounting for 55% of the variance in depressive symptoms. Lower levels of acceptance and higher levels of helplessness illness cognitions were associated with lower self-efficacy in problem-focused coping (β = 0.38, P \u3c 0.001, β = -0.28, P \u3c 0.01, respectively), which in turn was associated with greater depressive symptom severity (β = -0.54, P \u3c 0.001). CONCLUSIONS: Lack of acceptance and greater helplessness relating to low vision led to a lack of perceived capability to engage in problem-focused coping, which in turn promoted depressive symptoms. Third-wave cognitive-behavioral treatments that focus on acceptance may be efficacious in this population