Are we over-estimating the value of further research? A review of methods used to estimate uptake in population expected value of information analyses

Background: There is a lack of guidance on how population estimates should be obtained for expected value of information (EVI) analysis. We argue that disregarding uptake may lead to over-estimation of the population EVI (PEVI). Aims: To investigate how population estimates for PEVI analyses were obtained, whether they were adjusted by uptake and what methods were employed to obtain the uptake estimates. Methods: A literature search and review was conducted using the NHS Economic Evaluation Database (EED) and prior knowledge of relevant publications. Publications were excluded when they did not report PEVI estimates or were duplicates. Results: Out of 43 records resulting from the CRD search and 3 relevant publications that were known to us prior to this study, 29 studies were included. Out of these, 27 had not adjusted their population estimate by uptake levels. The remaining 2 studies had obtained their uptake estimates from uptake levels reported in trials and based on assumption. Only 5 studies acknowledged uncertainty associated with the population estimate used. Conclusion: Based on the result that very few PEVI studies had adjusted their population estimate by uptake and taking into account the large downward effect that uptake adjustments could have on the value of PEVI estimates, there is a need for discussion and further research around uptake adjustments in PEVI analyses

When future change matters: modelling future price and diffusion in health technology assessments of medical devices

Objectives: Whilst health technology assessments (HTAs) that take account of future price change have been examined in the literature, the important issue of price reductions that are generated by the reimbursement decision has been ignored. Our objective is to explore the impact of future price reductions caused by increasing uptake on HTAs and decision making for medical devices. Methods: We demonstrate the use of a two-stage modelling approach to derive estimates of technology price as a consequence of changes in technology uptake over future periods based on existing theory and supported by empirical studies. We explore the impact on cost-effectiveness and expected value of information analysis in an illustrative example based on a technology used in pre-term birth screening that is in development. Results: The application of our approach to the case study technology generates smaller incremental cost-effectiveness ratios (ICERs) compared to the commonly used single cohort approach. The extent of this reduction of the ICER depends on the magnitude of the modelled price reduction, the speed of diffusion and the length of the assumed technology-life horizon. Results of value of information analysis are affected through changes in the expected net benefit calculation, the addition of uncertain parameters and the diffusion-adjusted estimate of the affected patient population. Conclusions: Since modelling future changes in price and uptake has the potential to affect HTA outcomes, modelling techniques that can address such changes should be considered for medical devices that may otherwise be rejected

Assessing the expected value of research resolving uncertainty and improving implementation

Background: With low implementation of cost-effective health technologies being a problem in many health systems, it may be worth considering the potential effect of research on implementation at the time of technology appraisal. Objective: To demonstrate methods for assessing the value of research in terms of both reduction of uncertainty and improvement in implementation, considering the dynamic nature of implementation. Methods: We extend an existing framework to assess the values of information and implementation to account for the relationship between information and implementation and to reflect implementation dynamics. The resulting framework is applied to a genuine technology in the area of pre-term birth screening and results obtained from static and dynamic analyses are compared. The data to inform the effect of research evidence on implementation dynamics was obtained through a previous elicitation of expert opinion on quantities that informed the parameterisation of a dynamic implementation curve based on diffusion theory. Results: Incorporating the relationship between information and implementation in the assessment of research led to an expected value of research much larger than the one based on reduction of uncertainty alone in the exemplar case study. Considering the dynamics of implementation makes a significant difference to the expected value of research and accounting for the time when research reports may do so as well, both making existing analyses more realistic. However, such analyses require additional data and therefore resources. Conclusions: Assessing the expected value of research in terms of both, the reduction in uncertainty and improvements in implementation dynamics, has the potential to complement currently used analyses in health technology assessments, especially in Recommendation with Research decision

Estimating future health technology diffusion using expert beliefs calibrated to an established diffusion model

Objectives: Estimates of future health technology diffusion, or future uptake over time, are a requirement for different analyses performed within health technology assessments. Methods for obtaining such estimates include constant uptake estimates based on expert opinion or analogous technologies, and extrapolation from initial data points using parametric curves – but remain divorced from established diffusion theory and modelling. We propose an approach to obtaining diffusion estimates using experts’ beliefs calibrated to an established diffusion model to address this methodological gap. Methods: We performed an elicitation of experts’ beliefs on future diffusion of a new preterm birth screening illustrative case study technology. The elicited quantities were chosen such that they could be calibrated to yield the parameters of the Bass model of new product growth, which was chosen based on a review of the diffusion literature. Results: With the elicitation of only three quantities per diffusion curve, our approach enabled us to quantify uncertainty about diffusion of the new technology in different scenarios. Pooled results showed that the attainable number of adoptions was predicted to be relatively low compared with what was thought possible. Further research evidence improved the attainable number of adoptions only slightly but resulted in greater speed of diffusion. Conclusions: The proposed approach of eliciting experts’ beliefs about diffusion and informing the Bass model has the potential to fill the methodological gap evident in value of implementation and research, as well as budget impact and some cost-effectiveness analyses

Educational Needs of Community Health Nursing Supervisors

Recent legislative trends toward early hospital dismissal and cost containment have shifted the setting for health care from the hospital to the home. Consequently, community health nursing supervisors are becoming increasingly responsible both for coordinating care for sicker clients with fewer available resources, and for guiding staff nurses who provide high-tech nursing skills in the home. This has resulted in new educational needs for these supervisors. To determine their educational needs and the barriers to implementing their roles, 160 community health nursing supervisors employed by community health nursing agencies in Michigan were surveyed. They reported educational needs related to labor relations, reimbursement procedures, fiscal management, marketing, and computer systems. Several types of educational experiences were found to influence their abilities to handle supervisory responsibilities, including enrollment in an educational program, highest level of education, and selected content areas taught in their formal educational programs. Nursing implications include using the research results to develop educational programs to meet the needs of community health nursing supervisors. Those who are adequately prepared educationally will be better able to provide effective supervision of staff nurses and ultimately, coordinate high-level client home care.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/74660/1/j.1525-1446.1989.tb00565.x.pd

Psychological impact of lymphoma on adolescents and young adults:Not a matter of black or white

Contains fulltext : 171302.pdf (publisher's version ) (Open Access)PURPOSE: The purpose of the study is to examine differences in perceived impact of cancer (IOC) between adolescents and young adults (AYAs; 18-35 years at cancer diagnosis), adults (36-64 years) and elderly (65-84 years) with a history of (non-)Hodgkin lymphoma. Furthermore, to investigate the association of socio-demographic, clinical and psychological characteristics with IOC; and the association between IOC and health-related quality of life (HRQoL) among AYAs only. METHODS: This study is part of a population-based PROFILES registry survey among lymphoma patients diagnosed between 1999 and 2009. Patients (n = 1.281) were invited to complete the IOCv1 and EORTC-QLQ-C30 questionnaires. Response rate was 67 % (n = 861). RESULTS: AYA lymphoma survivors scored higher on the positive IOC summary scale, compared to adult and elderly patients (p < 0.001), while no significant differences were observed for negative IOC. Among AYAs, females, survivors with a partner, and survivors with elevated psychological distress levels scored significantly higher on the negative IOC summary scale. The negative IOC summary scale was negatively associated with all EORTC QLQ-C30 functioning scales (beta ranging from -0.39 to -0.063; p < 0.05). The positive IOC summary scale was negatively associated with the EORTC QLQ-C30 subscale 'Emotional functioning' (beta = -0.24; p < 0.05). CONCLUSION: AYA, adult and elderly with a history of (non-)Hodgkin lymphoma experienced different types of IOC in terms of positive and negative aspects. IMPLICATIONS FOR CANCER SURVIVORS: Although AYAs experience a more positive IOC compared to older survivors, some AYAs experience more negative IOC and may require developmentally appropriate interventions to address their specific concerns

A comparative analysis of two land reform models : Mashishimale Farm Management Model (FMM) and Nkumbuleni Strategic Partnership Model (SPM), South Africa

The Sustainable Restitution Support – South Africa (SRS-SA) program aimed at the development of a post-settlement support model that could be used to support beneficiaries of land reform in South Africa, especially those who received the land through restitution. The two land restitution claims were identified namely Mashishimale in the Limpopo Province and Nkumbuleni in KwaZulu Natal Province in South Africa. The main objective of the study is to determine the essential elements of two post-settlement support models to successfully implement and manage land reform projects in a sustainable manner namely: Mashishimale Farm Management Model (FMM) and Nkumbuleni Strategic Partnership Model (SPM). The data was collected through meetings and interviews with different stakeholders or role players. The study reveals that the following actions are essential for the successful post-settlement to restitution farms: The execution of baseline study (survey) to determine the socio-economic situation in a community (beneficiaries). The appointment of an independent project facilitator/coordinator to ensure effective and efficient communication. A well-defined management structure and the appointment of a knowledgeable, skilful and experienced farm manager(s) or strategic partner. The development of a business plan for the farm with the support of professional agriculturist. The identification of qualified professional extension advisor to provide advice and guidance to the manager(s) or strategic partner. Appointment of a mentor to guide advice and train the manager(s) or strategic partner. Financial support to manage the farm (Grants; Comprehensive Agricultural Support Program; financial institutions and specifically the Land Bank).http://www.journals.co.za/ej/ejour_agri.htmlhb201

Infant mental health home visiting therapists- reflective supervision self- efficacy in community practice settings

In recent years, there has been an increase in the research on reflective supervision, including the development of tools designed to measure reflective practice in the context of reflective supervision. The Reflective Supervision Self- Efficacy Scale for Supervisees (RSSESS) is a self- report measure that has been used in previous evaluations and is designed to assess perceived reflective practice self- efficacy for Infant Mental Health- Home Visiting (IMH- HV) therapists. Properties of the RSSESS including factor structure and reliability are explored in a first study that lays the foundation for the use of the RSSESS in an IMH- HV evaluation in the State of Michigan. IMH- HV therapists completed the RSSESS at 4 time points over a 12- month period and also completed a Clinician Profile Form that included questions about their IMH background and their work experience, including job satisfaction and burnout. Results indicated that the RSSESS is a reliable tool to measure change in reflective practice skills. IMH- HV therapists demonstrated growth in their use of reflective practice skills with families and their observational skills over the 12- month period. In addition, results indicated correlations between reflective supervision self- efficacy and job satisfaction as well as burnout.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/154909/1/imhj21834.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/154909/2/imhj21834_am.pd

Propagating user interests in ontology-based user model

In this paper we address the problem of propagating user interests in ontology-based user models. Our ontology-based user model (OBUM) is devised as an overlay over the domain ontology. Using ontologies as the basis of the user profile allows the initial user behavior to be matched with existing concepts in the domain ontology. Such ontological approach to user profiling has been proven successful in addressing the cold-start problem in recommender systems, since it allows for propagation from a small number of initial concepts to other related domain concepts by exploiting the ontological structure of the domain. The main contribution of the paper is the novel algorithm for propagation of user interests which takes into account i) the ontological structure of the domain and, in particular, the level at which each domain item is found in the ontology; ii) the type of feedback provided by the user, and iii) the amount of past feedback provided for a certain domain object

Carnitine Acetyltransferase Mitigates Metabolic Inertia and Muscle Fatigue during Exercise

SummaryAcylcarnitine metabolites have gained attention as biomarkers of nutrient stress, but their physiological relevance and metabolic purpose remain poorly understood. Short-chain carnitine conjugates, including acetylcarnitine, derive from their corresponding acyl-CoA precursors via the action of carnitine acetyltransferase (CrAT), a bidirectional mitochondrial matrix enzyme. We show here that contractile activity reverses acetylcarnitine flux in muscle, from net production and efflux at rest to net uptake and consumption during exercise. Disruption of this switch in mice with muscle-specific CrAT deficiency resulted in acetyl-CoA deficit, perturbed energy charge, and diminished exercise tolerance, whereas acetylcarnitine supplementation produced opposite outcomes in a CrAT-dependent manner. Likewise, in exercise-trained compared to untrained humans, post-exercise phosphocreatine recovery rates were positively associated with CrAT activity and coincided with dramatic shifts in muscle acetylcarnitine dynamics. These findings show acetylcarnitine serves as a critical acetyl buffer for working muscles and provide insight into potential therapeutic strategies for combatting exercise intolerance