Equity in access to MRI equipment: the Portuguese case

Magnetic resonance imaging (MRI) is a method of image diagnose proven to be of undeniable importance when it comes to neuro and cardio related diseases. In fact, these diseases (such as: ischemic heart disease, stroke and acute myocardial infection) have high incidence in Portugal. For these reasons, the allocation of this medical technology should not be considered with light thoughts. In fact, making decision of resource allocation in health care can be a very complex and contested matter. The impacts of new technology allocation, such MRI, can be assessed in a variety of ways. However, a fundamental component should always be present: the use of evidence-based decision-making methods. One of these methods is Technology Assessment (TA). This paper aims to characterize the equity on access of the Portuguese population in general, to a specific medical device such as MRI, under the TA point of view. It is hoped to promote a bridge of scientific knowledge between the gap on research and policy-making through TA that can emerge as a tool to aid decision-makers in the organization of health systems. There are gaps in providing healthcare, due to geographical imbalances, with some areas unable to provide certain specialized services, as hospitals in the countryside do not provide all medical specialties. Portugal has also a large independent private sector that provides diagnostic and therapeutic services to NHS users under contracts called conventions. These medical contracts cover ambulatory health facilities for laboratory tests and examinations such as diagnostic tests and Radiology. However, there is no convention from the NHS when concerning the MRI exam. Therefore, this reality can be considered a limitation in the access of the general population to this kind of clinical exam. TA can play an useful and important role in helping the decision-makers to explore potential gains that might be achieved by introducing a more rational decision making into health care management, namely into the Radiology area, regarding the allocation of MRI equipment.Orientadores: António Brandão Moniz (FCT-UNL) e Michael Decker (ITAS-KIT

Decision-making process in radiology: the magnetic resonance example in the TA context

Based on the report for “Project IV” unit of the PhD programme on Technology Assessment (Doctoral Conference) at Universidade Nova de Lisboa (December 2011). This thesis research has the supervision of António Moniz (FCT-UNL and ITAS-KIT) and Michael Decker (Karlsruhe Institute of Technology-ITAS). Other members of the thesis committee are Carlos Alberto da Silva (University of Évora), José Maria de Albuquerque (Institute of Welding and Quality), Lotte Steuten (University of Twente), Mário Forjaz Secca (FCT-UNL) and Nelson Chibeles Martins (FCT-UNL).In order to understand the decision-making process in a Radiology Department, taking the Magnetic Resonance Equipment as an example, this paper reports a project to be followed. It is a guideline for future work development regarding Technology Assessment in Radiology. The Theoretical Framework is divided is three big issues. The first is “Technology Assessment”. Starting with the definition of some important concepts, the history and development of Technology Assessment will be addressed. The aim of this issue is to give a general main idea concerning TA contextualization. Doing a transposition of this subject to health area, it is also important to understand the particularities of Health Technology Assessment, second issue. Portugal framework on this subject will also be addressed. As so, the Portuguese National Health System is characterized and the decision-making stakeholders identified, has well as the competences for the decision-making process in general. The third issue is Decision-Making and its aim is to give a general elucidation on decision-making matters. To accomplish this, a research methodology was outlined, so that six research questions could be answered and five hypotheses could be accepted or refuted, in the future. With this research methodology, the Portuguese state of the art Magnetic Resonance equipment existence will be studied, using a survey as a resource. In the future, a mapping stakeholder technique will be used to identify the decision making key stakeholders and a survey will be applied to map theirs skills and competences in the process, where a pre-test was already applied. The results of this pre-test are presented

Technology governance in radiology: the example of magnetic resonance imaging

Based on the report for the unit “Project III” of the PhD programme on Technology Assessment in 2011. The unit was supervised by Prof. António B. Moniz (FCT-UNL).This report aims to be the gathering of the main ideas that culminated in the presentation at the 1st Winter School of the PhD Programme on Technology Assessment (FCT-UNL) in December 2010. It is a guideline for future work development regarding Technology Assessment in Radiology, particularly having Magnetic Resonance Imaging, as an example. Therefore, as a background, it is necessary to understand what is “Technology Assessment”, how it developed and what it Europe’s interest in this area. Doing a transposition of this subject to health area, it is also important to understand the particularities of Health Technology Assessment. Portugal framework on this subject will also be addressed. As so, the Portuguese National Health System is characterized and the decision-making stakeholders identified, has well as the competences for the decision-making process in general. More generally, the different stakeholders perception involved in decision making, the mapping skills on technology assessment and decision making, the identification of indicators present in this decision making in Radiology, particularly in Magnetic Resonance area, are subjects to be addressed. To accomplish this, a research methodology was outlined, so that six research questions could be answered and five hypotheses could be accepted or refuted, in the future. With this research methodology, the Portuguese state of the art Magnetic Resonance equipment existence will be studied, using a survey as a resource. In the future, a mapping stakeholder technique will be used to identify the decision making key stakeholders and a survey will be applied to map theirs skills and competences in the process, where a pre-test was already applied

Health Technology Assessment and Decision-Making Processes: The Purchase of Magnetic Resonance Imaging Technology

Medical devices play an essential role in health care. For instance, magnetic resonance imaging (MRI) has revolutionized the way images of the human body are acquired. However, although medical devices improve diagnosis and treatment, they are also one of the causes of increasing health expenditure. Thus, the purchase of new technologies and the determination of how and when they should be used are among the most important decisions made in the health care system in general, and by hospital decisionmakers in particular. Health technology assessment (HTA) studies aim to provide a range of stakeholders with accessible, usable and evidence-based information to guide decisions about the use and diffusion of technology and efficient allocation of resources. For this reason, HTA acts as a bridge between evidence and decision-making by ensuring better synthesis, communication and dissemination of information. However, empirical research on decision processes in the purchase of medical devices is sparse, and a gap on this topic was found in the literature. The present research focuses on the Portuguese health system and sheds light on the characterization of decision-making processes by those involved in MRI purchases, in order to understand the influences of HTA. In terms of research design, two strategies were chosen, aiming at different objectives. To characterize the decision-making process a mixed method was chosen. Data was collected using a questionnaire (40 respondents), and parallel semi-structured interviews (27 participants). Both data sets were analysed and merged. Descriptive statistics were chosen as a data analysis strategy, as well as content analysis (categorical analysis). To assess competences for decision-making a questionnaire retrieving only quantitative data was developed (369 valid respondents), and Exploratory Factorial Analysis was performed, followed by Structural Equation Modelling (Confirmatory Factorial Analysis and Path Analysis). Results show that steps in the decision process are well-defined. Cost and suppliers’ characteristics are seen as the most important indicators to guide decisions. Few studies are performed to support the decision, and these are mostly related to the workload of the Radiology Department. No national or international HTA study was used to support any decisions. The decision process is characterized by a bounded rationality, influenced by intuition and a consultant decision-maker. The decision is a bottomup process where information gathering and consensus building is undertaken by a committee, although external consultancy is also used. The reasoning and justification for selection of committee members is unclear. The process is considered to be bureaucratic, time-consuming and long. Patients are negatively perceived as stakeholders in the process. Their experiences, needs and expectations are not considered. vi Decision-makers in Portugal have limited knowledge and training in areas of decision-making, health informatics, health economics and especially HTA. This may limit their ability to truly understand the future implications of their purchase decisions. Recommendations are made to: (1) deepen the present research in particular regarding the elements that influence the strategies and tactics adopted in the decision-making process for the acquisition of medical devices (2) foster the uptake of HTA by decision-makers with the establishment of an HTA in-house unit, able to carry out TA studies considering the hospital context and aiming to inform managerial local decisions on the uptake or disinvestment of medical devices (3) promote a team comprise by not only TA multidisciplinary researchers but also by professionals from the health institution able to carry out HTA studies (3) foster common languages and values to increase uptake of HTA studies

The impact of artificial intelligence on innovation management: a case study of Aveiro region

In a highly globalized and competitive marketplace, companies have started to bet more on innovation as a source of competitive advantage. Innovation is no longer an isolated and residual agent, but a crucial mindset that should be embedded in all workers and all activities of a company, as innovation has the potential to improve not only an organization's performance but also employees’ well-being and working conditions. Artificial Intelligence is no longer science fiction, but a reality present in the value chain of companies. The purpose of this research is to understand how AI systems are impacting innovation management processes within companies. The analysis methodology is based on a qualitative study supported by interviews directed to a sample of 5 companies based in Aveiro region. The results obtained led to the conclusion that Artificial Intelligence is being progressively included in firms’ activities, changing the way how managers develop solutions and innovation management processes. AI systems are also raising the awareness of improving some of the most important indicators of an innovative economy such as: productivity; qualification; cooperation; entrepreneurial mindset and stakeholder’s satisfaction.No mundo altamente globalizado em que vivemos, as empresas apostam cada vez mais na inovação como uma estratégia para aumentar a competitividade. A Inovação não é mais um agente residual e isolado, mas considerada um mindset que deve ser incutida em todos os trabalhadores e todas as atividades de uma empresa, pois a inovação tem o potencial de melhorar não só a performance da empresa, mas também as condições de trabalho. A Inteligência Artificial já não é ficção científica, mas sim realidade presente na cadeia de valor das empresas. O propósito desta pesquisa é perceber como é que os sistemas de inteligência artificial estão a influenciar os processos de gestão de inovação das empresas. A metodologia de análise baseia-se num estudo de caso qualitativo e está suportada em entrevistas aplicadas a uma amostra de 5 empresas, localizadas na região de Aveiro. Os resultados obtidos permitiram concluir que a Inteligência Artificial está progressivamente a ser incluída nas diversas atividades das empresas, alterando a forma como os gestores desenvolvem soluções e formulam os processos de gestão de inovação. A Inteligência Artificial está também a ter o papel de consciencializar para a necessidade de melhorar alguns dos mais importantes indicadores de uma economia inovadora como a produtividade, a qualificação, a cooperação, forma de pensar inovadora e bem-estar dos trabalhadores e consumidores

O lagostim-de-patas-brancas do rio Angueira: a mim lembra-se-me que...

No Nordeste Transmontano os sentidos são vigorosos, puros, primitivos. Estranhamente naturais. Estranhamente humanos. Ao cinzento opõem-se a cor, ao frio o calor, às pedras os aromas, às plantas os animais, aos animais as pessoas, às pessoas de cá as pessoas de fora, ao homem a mulher... Ao real o simbólico. O protagonista desta comunicação é o lagostim-de-patas-brancas (Austrapotamobius pallipes), também conhecido por lagostim do rio Angueira, ou cangrejo. Em um século de história, espaço temporal da sua existência conhecida naquele rio, o cangrejo impregnou o quotidiano das populações ribeirinhas e vizinhas: como actividade económica, em tempo de privação; como símbolo de identidade local e nacional; como elemento de laços de amizade e pertença; como objecto de descoberta e identidade sexual. O lagostim não é sujeito único, real ou simbólico, a desempenhar este papel por terras transmontanas, mas é rara a rapidez e intensidade com que o protagonizou. Ainda hoje se sente aquilo que podemos designar como a “febre do lagostim”, tal o entusiasmo e disponibilidade dos nossos interlocutores. Graças a ela obtivemos entrevistas (com pescadores portugueses e espanhóis) para o minuto seguinte, participamos em debates de rua espontâneos, fomos conduzidos aos locais “sagrados” da pesca, trilhamos os caminhos do contrabando, ouvimos relatos longos, acedemos a arquivos com rara facilidade, fizeram-nos desenhos e objectos e repetiram-nos gestos de pesca. E, no fim, quase todos perguntavam com o coração a rebentar de saudade: E então o cangrejo vai voltar ao rio? Estabelecendo uma ordem cronológica aos acontecimentos pudemos clarificar muitos aspectos do desaparecimento do lagostim no Angueira. Todavia, encontramos uma, e uma só, conclusão inequívoca e incontornável: o Homem, não interessa se português se espanhol, se criança se adulto, se anónimo se figura conhecida, se técnico se político, não foi capaz de gerir racionalmente o recurso natural - lagostim. Esta comunicação tem por objectivo principal lançar um alerta contra a delapidação de recursos naturais nacionais e transmontanos, em particular. Pretende-se que a comunidade científica, técnica e política, e a sociedade em geral, se mobilize no sentido de que os cogumelos, os espargos bravios (Asparagus acutifolius), as merujas (Montia fontana), entre outros, não tenham a mesma “morte anunciada”. A trama desta história é longa e variada e será contada num livro que aguarda publicação. Neste encontro centramo-nos nas seis hipóteses de causa de extinção, as quais alimentaram discussões inúteis, se não patéticas, que entretiveram, pescadores, políticos, técnicos e académicos, enquanto o lagostim agonizava. Porém, no ponto quatro, descreveremos com algum pormenor os aspectos relacionados com a importância económica e sociocultural do lagostim, para que se tenha a noção de que não se perdeu apenas uma espécie animal, mas também um “modo de vida”

Do Concreto para o Abstrato pelo Uso dos Sentidos e de Sensores: Um Estudo de Caso sobre o Ecossistema Poças de Maré

Este artigo apresenta um estudo de caso exploratório, desenvolvido no contexto do Projeto Sondar e Sentir o Ambiente para Desenvolver o Pensamento Abstrato (SOS Abstrato), que visa estudar as potencialidades da utilização conjunta e sinérgica dos sentidos humanos e de sensores eletrónicos para desenvolver o pensamento abstrato nas crianças. O estudo de caso foi desenvolvido com uma turma do 4.º ano de escolaridade e centrado no ecossistema Poças de Maré de uma praia no Norte de Portugal. A utilização dos sentidos e sensores em atividades experimentais produziu evidências de desenvolvimento da abstração no estudo da biodiversidade e da temperatura.This paper presents an exploratory case study, developed in the context of the Using Sensors and Sensing in the Environment to Develop Abstract Thinking Project (SOS Abstract), which goal is to study the potential of the joint and synergic use of electronic sensors and human senses to develop children’s abstract thinking. The case study was developed with a 4th year class and is centred on the Tide Pools of a beach in the North of Portugal. The use of senses and sensors in experimental activities produced evidences of the development of abstract thinking, while studying biodiversity and temperature

Improving access to prosthetic limbs in Germany: An explorative review

Background: Meeting the needs of users when it comes to accessing prosthetic limbs is an important factor in the acceptance and use of a prosthesis; the cost of such prosthetics also constitutes a potential financial challenge. Objectives: The aim of this study was to investigate potential hurdles to accessing limb prosthetics in the German health care system, including organizational, social, economic, and regulatory issues, and to provide food for thought about ethical implications. Methods: Sixteen German users of limb prosthetics with upper-limb and/or lower-limb amputation were recruited by means of purposive sampling. Semistructured interviews were performed, with the guiding question being as follows: “What were your experiences with the German prosthetic care and reimbursement system?” Ten stakeholders (insurance representatives, prosthetic technicians, medical service representatives, a law expert, and a lawyer) were asked about the issues they encounter in their work related to prosthetic care and reimbursement, and about ways to ameliorate these issues. A qualitative content analysis method was used to analyze the data. Results: Half of the interviewed service users experienced hurdles to gaining a suitable prosthetic device, such as waiting times and pressure to negotiate their need for a certain prosthesis. Some of the views expressed about the issues relating to prosthetic reimbursement in Germany were common to all stakeholders, whereas some conflicted with the views of others

Innovation scoring no sector de serviços de saúde: um estudo de caso

Baseado no relatório avaliado na disciplina de Economia e Gestão da Inovação (Prof. Maria Luísa Lopes), no programa doutoral de Avaliação de Tecnologia, na Faculdade de Ciências e Tecnologia - Universidade Nova de Lisboa em Janeiro de 2011Na actualidade, a inovação deve ser entendida como uma estratégia global adoptada por uma empresa, para que esta se mantenha adaptada, flexível e com capacidade de resposta ao mercado em constante mutação, onde a empresa está inserida e opera. Para que uma empresa seja bem sucedida no processo de inovação deve ter presente a sua posição quanto a este factor. Existem vários sistemas de dinamização, controlo e gestão da inovação. Um desses sistemas é o Innovation Scoring, da COTEC Portugal – Associação Empresarial para a Inovação. O Innovation Scoring é um instrumento de apoio às organizações nacionais que visa estimular as empresas a desenvolverem inovação de uma forma mais sistemática, eficiente e eficaz, contribuindo para a reflexão estratégica da empresa, sobre os seus processos de inovação. Permite desta forma que se conheça, de modo mais aprofundado, as diferentes dimensões que sustentam os processos de inovação, permitindo identificar áreas de potencial melhoria. Com o objectivo de fazer uma análise e o diagnóstico das competências inovadoras de uma organização real, recorreu-se à aplicação do Innovation Scoring. Um Hospital Central da área da Grande Lisboa (Entidade Pública Empresarial) foi a organização em estudo, mais especificamente, o Serviço de Imagiologia. O Sistema Innovation Scoring é um questionário de auto-diagnóstico e por isso de auto-preenchimento, no entanto, para tornar os resultados mais fidedignos e isentos de viés, optou-se por alterar a metodologia de aplicação deste instrumento. Assim, recorreu-se à realização de uma entrevista, cujas respostas serviram para preencher posteriormente o questionário. Na etapa seguinte, procedeu-se à interpretação dos resultados, fazendo-se uma análise, sob o ponto de vista da inovação, ao Serviço em estudo. Como resultado final, o Serviço de Imagiologia obteve uma ponderação de 224 em 1000, relativamente ao Índice de Inovação, o que significa que o Serviço tem ainda muito que desenvolver e trabalhar, no que concerne a está temática. Os resultados deverão servir de base de motivação e reflexão estratégica do Serviço de Imagiologia face aos seus processos de inovação. Este trabalho está estruturado em 7 capítulos. No primeiro, pretende-se fazer uma pequena introdução ao sistema Innovation Scoring. Segue-se a caracterização da empresa em estudo e a metodologia adoptada. No capítulo 4, são apresentados, analisados e discutidos os resultados. Segue-se a conclusão da análise efectuada e posteriormente uma reflexão crítica.António B. Moni