Sustainability of innovations in healthcare: A systematic review and conceptual framework for professional pharmacy services.

BACKGROUND: Implementation science emerged to address the challenges associated with the incorporation of evidence-based innovations into practice. Once the challenge is overcome, the ultimate goal is to achieve the sustainability of innovations to promote their continuity and long-term integration. Assessment tools and measures have been designed to assess the sustainability of innovations in research and practice environments. However, the variability of assessment tools available becomes a challenge for policy makers, researchers and practitioners, particularly when deciding how to evaluate the sustainability of innovations. OBJECTIVES: to identify conceptual approaches and assessment tools for the sustainability of healthcare innovations and to develop a specific discipline-based framework for the sustainability of professional pharmacy services. METHODS: A systematic literature review was conducted in January of 2019 using PubMed, Scopus, and Web of Science. General information regarding the conceptual approaches (based on Nilsen's classification), assessment tools and the factors affecting the sustainability of the healthcare innovations was retrieved. RESULTS: From 3123 articles screened, 132 articles were selected from which 106 conceptual approaches and 26 assessment tools were identified. Several key factors moderating the sustainability of the innovations in healthcare were identified (e.g. funding, adaptation). A framework for the sustainability of professional pharmacy services is proposed based on these factors. It presents three performance domains influencing the service sustainability (i.e. environment, social and economic). CONCLUSIONS: The identified approaches in different healthcare settings have allowed the adaptation and design of a specific framework for pharmacy. The core factors included in the proposed framework are moderators of the sustainability process and should be considered in sustainability studies and evaluations. This framework will guide pharmacy practice researchers and practitioners to measure and achieve the sustainability of professional pharmacy services. Furthermore, the adaptation of this framework will allow its application to other healthcare settings. (Registration number CRD42018092160)

Economic impact of medication non-adherence by disease groups: A systematic review

© Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted. Objective To determine the economic impact of medication non-adherence across multiple disease groups. Design Systematic review. Evidence review A comprehensive literature search was conducted in PubMed and Scopus in September 2017. Studies quantifying the cost of medication non-adherence in relation to economic impact were included. Relevant information was extracted and quality assessed using the Drummond checklist. Results Seventy-nine individual studies assessing the cost of medication non-adherence across 14 disease groups were included. Wide-scoping cost variations were reported, with lower levels of adherence generally associated with higher total costs. The annual adjusted disease-specific economic cost of non-adherence per person ranged from 949 to 44 190 (in 2015 US). Costs attributed to 'all causes' non-adherence ranged from 5271 to 52 341. Medication possession ratio was the metric most used to calculate patient adherence, with varying cut-off points defining non-adherence. The main indicators used to measure the cost of non-adherence were total cost or total healthcare cost (83% of studies), pharmacy costs (70%), inpatient costs (46%), outpatient costs (50%), emergency department visit costs (27%), medical costs (29%) and hospitalisation costs (18%). Drummond quality assessment yielded 10 studies of high quality with all studies performing partial economic evaluations to varying extents. Conclusion Medication non-adherence places a significant cost burden on healthcare systems. Current research assessing the economic impact of medication non-adherence is limited and of varying quality, failing to provide adaptable data to influence health policy. The correlation between increased non-adherence and higher disease prevalence should be used to inform policymakers to help circumvent avoidable costs to the healthcare system. Differences in methods make the comparison among studies challenging and an accurate estimation of true magnitude of the cost impossible. Standardisation of the metric measures used to estimate medication non-adherence and development of a streamlined approach to quantify costs is required. PROSPERO registration number CRD42015027338

Direct-detection 25 Gb/s PON: PROs and CONs of digital signal processing at the transmitter side

We evaluate the performance of direct-detection 25 Gb/s Passive Optical Networks (PON) with adaptive equalization at the receiver side, comparing three transmitter schemes: two including digital signal processing (DSP), namely square-root raised-cosine pulse shaping and pre-emphasis, and the third one without any DSP pre-compensation. We show that DSP at transmitter side can provide a performance advantage only under strong bandwidth limitations and when considering feed-forward equalization (FFE) at the receiver. When including decision-feedback equalization (DFE), the use of pre-compensation at transmitter does not provide any advantage under linear transmission

Brans-Dicke-type theories and avoidance of the cosmological singularity

We tudy flat Friedmann-Robertson-Walker cosmology in Brans-Dicke-type theories of gravitation with minimal coupling between the scalar field and the matter fields in the Einstein frame (general relativity with an extra scalar field) for arbitrary values of the Brans-Dicke parameter $\omega>-{3/2}$. It is shown that the cosmological singularity occuring in the Einstein frame formulation of this theory is removed in the Jordan frame in the range $-{3/2}<\omega<\leq-{4/3}$. This result is interpreted in the ligth of a viewpoint (first presented in reference gr-qc/9905071) asserting that both Jordan frame and Einstein frame formulations of general relativity are physically equivalent. The implications of the obtained result for string theory are outlined.Comment: 9 pages, LaTeX, no figures. Improved version accepted for publication in PR

Quinstant Dark Energy Predictions for Structure Formation

We explore the predictions of a class of dark energy models, quinstant dark energy, concerning the structure formation in the Universe, both in the linear and non-linear regimes. Quinstant dark energy is considered to be formed by quintessence and a negative cosmological constant. We conclude that these models give good predictions for structure formation in the linear regime, but fail to do so in the non-linear one, for redshifts larger than one.Comment: 9 pages, 14 figures, "Accepted for publication in Astrophysics & Space Science

Prevalencia del virus de la diarrea viral bovina y de animales portadores del virus en bovinos en la provincia de Espinar, Cusco.

The prevalence of bovine viral diarrhea virus (BVDV) in 406 cattle was evaluated of both sexes and older than 6 months. Animals belonged to 114 small farmers from three rural communities of the province of Espinar, Cusco, Peru. Blood samples were collected according to three age groups Ɩ-12, 13-23, \u3e24 months old). Serum samples were tested for antibodies against BVDV using the viral neutralization test. The 56.2 ± 4.8% 鴤/406) of samples had antibodies against BVDV. Persistently infected animals were not detected. Antibodies were present in the three age groups, but the highest prevalence ࿡.4%) was detected in animals older than 24 months of age. The 51.3% ྴ/39) of young and adult bulls had antibodies against BVDV. Antibodies titers varied from 2 to \u3e256, and high titers 鳀 to \u3e256) were detected in 42.1% of animals of 13 to \u3e24 months of age. The 86.8% ဃ/114) of the small farmers had at least one animal seropositive to BVDV

PANIC: the new panoramic NIR camera for Calar Alto

PANIC is a wide-field NIR camera, which is currently under development for the Calar Alto observatory (CAHA) in Spain. It uses a mosaic of four Hawaii-2RG detectors and covers the spectral range from 0.8-2.5 micron(z to K-band). The field-of-view is 30x30 arcmin. This instrument can be used at the 2.2m telescope (0.45arcsec/pixel, 0.5x0.5 degree FOV) and at the 3.5m telescope (0.23arcsec/pixel, 0.25x0.25 degree FOV). The operating temperature is about 77K, achieved by liquid Nitrogen cooling. The cryogenic optics has three flat folding mirrors with diameters up to 282 mm and nine lenses with diameters between 130 mm and 255 mm. A compact filter unit can carry up to 19 filters distributed over four filter wheels. Narrow band (1%) filters can be used. The instrument has a diameter of 1.1 m and it is about 1 m long. The weight limit of 400 kg at the 2.2m telescope requires a light-weight cryostat design. The aluminium vacuum vessel and radiation shield have wall thicknesses of only 6 mm and 3 mm respectively.Comment: This paper has been presented in the SPIE of Astronomical Telescopes and Instrumentation 2008 in Marseille (France

Coupling parameters and the form of the potential via Noether symmetry

We explore the conditions for the existence of Noether symmetries in the dynamics of FRW metric, non minimally coupled with a scalar field, in the most general situation, and with nonzero spatial curvature. When such symmetries are present we find general exact solution for the Einstein equations. We also show that non Noether symmetries can be found. Finally,we present an extension of the procedure to the Kantowski- Sachs metric which is particularly interesting in the case of degenerate Lagrangian.Comment: 13 pages, no figure