OP33 Treatment Of Mitral Insufficiency And Multicriteria Decision-Making

2019 ◽  
Vol 35 (S1) ◽  
pp. 8-8
Author(s):  
François Désy ◽  
Mireille Goetghebeur ◽  
Maria Vutcovici Nicolae ◽  
Laurie Lambert ◽  
Michèle de Guise
Keyword(s):  
Mitral Valve ◽  
Literature Review ◽  
Health System ◽  
Advisory Committee ◽  
Scientific Evidence ◽  
Multicriteria Decision Making ◽  
Clinical Excellence ◽  
Expert Committee ◽  
Mitral Insufficiency ◽  
Health Technologies

IntroductionControversy regarding the efficacy of transcatheter mitral valve repair with a clip (TMVRc) in reducing the mitral regurgitation is related to the lack of solid scientific evidence. Worldwide, refusal or conditional acceptance for implementation of TMVRc, reflect ongoing uncertainty. We sought to apply a systematic multicriteria framework to ensure a fair and reasonable decision regarding the use of TMVRc in Quebec.MethodsThe framework included the following domains: context, quality of evidence concerning safety, efficacy and effectiveness, unmet patient needs, expected volume of patients, and impact on the health system including costs. Each domain within the framework was examined by a review of the literature and through consultations with a scientific advisory committee, a TMVRc clinical expert committee, TMVRc clinical teams, industry representatives and the Institut national d'excellence en santé et en services sociaux (INESSS) clinical excellence committee.ResultsThe literature review indicated that uncertainty about the efficacy and effectiveness of TMVRc persists, particularly in the real world context, and this view was supported by scientific experts. The TMVRc clinical teams provided insight into the burden of mitral insufficiency on patients and the health system and their belief in the promise of TMVRc. They also highlighted the challenges of patient selection and organizational issues related to the introduction of TMVRc within their institutions. The advisory committee stressed the need for further evaluation prior to wide diffusion.ConclusionsUsing a multicriteria framework facilitated a more standardized and transparent approach to our literature review and consultations as well as to the development of the proposed recommendations. This was especially important in the context of an evaluation of a promising new approach to treat mitral valve disease with many important uncertainties. This multi-criteria approach will facilitate a more standardized process for deliberation on how new health technologies should be implemented into the Quebec health system.

PP155 The Impact Of Lawsuits In The Brazilian Public Health System

2017 ◽  
Vol 33 (S1) ◽  
pp. 141-141
Author(s):  
Carla Biella ◽  
Viviane Pereira ◽  
Fabiana Raynal ◽  
Jorge Barreto ◽  
Vania Canuto ◽  
...  
Keyword(s):  
Public Health ◽  
Health Care ◽  
Health System ◽  
Public Health System ◽  
Scientific Evidence ◽  
Health Technology ◽  
Health Technologies ◽  
Access To Health ◽  
The Right ◽  
The Impact

INTRODUCTION:The increase of litigation in Brazil on the right to health, and the Brazilian Public Health System (SUS) targets of litigation, are phenomena that generate discussions both in the judiciary, and among researchers and managers of health. The lawsuits are based on the integrality that includes the right to any health technology. Our aim was to gather information on the use of scientific evidence by judges and other law professionals to support their decisions in lawsuits involving health care in Brazil.METHODS:A narrative review by literature search using key terms of legalization in specific databases was conducted.RESULTS:Twenty-five studies showed litigation matters relating to health care which were focused on legal claims about drugs. In general, law operators used the scientific evidences in a limited way when making decisions, by considering the medical report and medication label indications and disregarding therapeutic alternatives contemplated in the SUS list. The access to health technologies, by litigation, reveals that the gap between scientific knowledge and legal practice are similar to those found between science and decision-making in the formulation and implementation of health policies. The Health Technology Assessment studies have high potential for use by the judiciary as a reference source to support technical and scientific decisions in lawsuits on health care.CONCLUSIONS:For the judiciary to ensure not only access to health technologies, but also the efficacy and safety of technologies to system users, their decisions must be substantiated by scientific evidence. The National Committee for Health Technology Incorporation (CONITEC) in SUS has established actions in conjunction with law operators and society, such as a communication using e-mail, aiding the decision for the injunction and elaboration of technical reports and a policy brief, with the intention that the decisions are taken with the greatest possible knowledge about technologies provided by SUS, and based on scientific evidence.

scholarly journals Mitral Valve Endocarditis with Perforation from a Urinary Source: An Unusual Case and Literature Review

2019 ◽  
Vol 2019 ◽  
pp. 1-7
Author(s):  
Fernando Figueroa Rodriguez ◽  
Antonio Faieta Lasarcina ◽  
Francisco Davila Grijalva
Keyword(s):  
Mitral Valve ◽  
Literature Review ◽  
Unusual Case ◽  
High Yield ◽  
Mitral Insufficiency ◽  
Beta Lactams ◽  
Elderly Males ◽  
Aerococcus Urinae ◽  
Tract Infections ◽  
The Impact

Aerococcus urinae (AU) is a rare pathogen, identified as gram-positive, catalase-negative coccus that grows in pairs and clusters which has been reported to mainly cause urinary tract infections (UTI), especially in elderly males. Treatment for this microorganism is usually with beta-lactams although cultures with antibiotic susceptibility testing are imperative. We present a case of AU endocarditis initially treated with IV antibiotics; nevertheless, the patient required emergent mitral valve replacement due to severe mitral insufficiency and perforation. We also present an analysis with high-yield points summarizing epidemiology, risk factors, microbiology, clinical features, diagnostic workup, and management of AU in general and AU endocarditis. Finally, we post a literature review of relevant cases and the impact of different variables associated with it.

PD59 Formulation and Disclosure Of Information On Technologies In Health

2018 ◽  
Vol 34 (S1) ◽  
pp. 150-151
Author(s):  
Lays Marra ◽  
Sarah Silva ◽  
Roberta Rabelo ◽  
Camila Chacarolli ◽  
Nayara Brito ◽  
...  
Keyword(s):  
Health System ◽  
Scientific Evidence ◽  
National Committee ◽  
Policy Makers ◽  
Health Technologies ◽  
Professional Health ◽  
The Government ◽  
The Right ◽  
Health Registry ◽  
Therapeutic Alternatives

Introduction:The Brazilian public health system (SUS) provides technologies based on the best available scientific evidence. However, there is a large number of lawsuits against the government for access to non-standard technologies, a phenomenon called “judicialization of the right to health”, which disrupts the system's operating logic. The aspect of judicialization that most impacts the health system involves unregistered technologies without scientific evidence of superiority being comparing to the alternatives already offered in the country. The aim of this study is to report experience of the National Committee for Health Technology Incorporation in the Brazilian Health System (CONITEC) to mitigate the effects of the judiciary, with the elaboration of informative documents about technologies directed towards policy-makers, patient, users of system health, professional health and other stakeholders.Methods:The main judicialized technologies in the country were identified and then a meeting with experts was realized to discuss a more appropriate format for these documents. After defining the format, a review of the literature was carried out to identify the best available evidence of those health technologies.Results:A question-and-answer (QA) format document was drawn. The QA addressed information on the use of the technology for a specific clinical condition. Health registry and price in Brazil, if it has already been evaluated by CONITEC and its respective recommendation, as well as strategies of care and therapeutic alternatives available in the SUS were included. Their content has been adapted to a lay language and all of the documents were made available on the CONITEC website in the “Law and Health Section”.Conclusions:The availability of QA represents a strong link between evidence and actions in health. For, they enable broad access to quality information by the lay public and stakeholders who seek information to support evidence-based decision-making.

US health system is not meeting patients' needs at end of life, says expert committee

BMJ ◽  
2014 ◽  
Vol 349 (sep18 7) ◽  
pp. g5739-g5739 ◽  
Author(s):  
M. McCarthy
Keyword(s):  
Health System ◽  
End Of Life ◽  
Expert Committee

scholarly journals Health Priority Setting in Iran: Evaluating Against the Social Values Framework

2016 ◽  
Vol 8 (10) ◽  
pp. 212
Author(s):  
Hakimeh Mostafavi ◽  
Arash Rashidian ◽  
Mohammad Arab ◽  
Mohammad R. V. Mahdavi ◽  
Kioomars Ashtarian
Keyword(s):  
Health Care ◽  
Health System ◽  
Priority Setting ◽  
Social Values ◽  
City Council ◽  
Decision Makers ◽  
The Public ◽  
Health Technologies ◽  
Health Priority ◽  
The Social

<p><strong>Background:</strong> Health systems, as part of the social system, consider public values. This study was conducted to examine the role of social values in the health priority setting in the Iranian health system.</p><p><strong>Methods:</strong> In this qualitative case study, three main data sources were used: literature, national documents, and key informants who were purposefully selected from health care organizations and other related institutions. Data was analyzed and interpreted using the Clark-Weale Framework.</p><p><strong>Results:</strong> According to our results, the public indirectly participates in decision-making. The public representatives participate in the meetings of the health priority setting as parliament members, representatives of some unions, members of the city council, and donors. The transparency of the decisions and the accountability of the decision makers are low. Decision makers only respond to complaints of the Audit Court and the Inspection Organization. Individual choice, although respected in hospitals and clinics, is limited in health care networks because of the referral system. Clinical effectiveness is considered in insurance companies and some hospitals. There are no technical abilities to determine the cost-effectiveness of health technologies; however, some international experiences are employed. Equity and solidarity are considered in different levels of the health system.</p><p><strong>Conclusion:</strong> Social values are considered in the health priority decisions in limited ways. It seems that the lack of an appropriate value-based framework for priority setting and also the lack of public participation are the major defects of the health system. It is recommended that health policymakers invite different groups of people and stakeholders for active involvement in health priority decisions. </p>

scholarly journals Skin tear treatment and prevention by nurses: an integrative literature review

2014 ◽  
Vol 35 (2) ◽  
pp. 142-149
Author(s):  
Érick Igor dos Santos
Keyword(s):  
Health Education ◽  
Literature Review ◽  
Scientific Evidence ◽  
Skin Flap ◽  
Exclusion Criteria ◽  
Safe Environment ◽  
Best Management ◽  
Treatment And Prevention ◽  
Skin Tears ◽  
Work And Health

The objective of the present study was to identify scientific evidence in the literature regarding management and prevention of skin tears by nurses over the last ten years. This is an integrative review of articles found in the LILACS, SciELO, BDENF, MEDLINE, Scopus, ScienceDirect and PubMed databases, identified with the Portuguese, English and Spanish descriptors for "skin," "friction," or with the keyword "skin tears". After inclusion and exclusion criteria were applied, fifteen texts were selected. Scientific evidence demonstrated that the best management results are obtained by covering the tear with the skin flap itself, using octylcyanoacrylate or silicone-based products. Prevention consists of promoting a safe environment, through multidisciplinary work and health education. We conclude that it is the nursing staff's responsibility to avoid infection, trauma of any intensity, pain and bleeding.

scholarly journals Nursing care in the anesthetic procedure: an integrative review

2016 ◽  
Vol 50 (1) ◽  
pp. 154-162 ◽  
Author(s):  
Cassiane de Santana Lemos ◽  
Aparecida de Cassia Giani Peniche
Keyword(s):  
United States ◽  
Health System ◽  
Patient Care ◽  
Nursing Care ◽  
Scientific Evidence ◽  
The United States ◽  
Nurse Anesthetists ◽  
Integrative Review ◽  
Nursing Professional

Abstract OBJECTIVE To search for the scientific evidence available on nursing professional actions during the anesthetic procedure. METHOD An integrative review of articles in Portuguese, English and Spanish, indexed in MEDLINE/PubMed, CINAHL, LILACS, National Cochrane, SciELO databases and the VHL portal. RESULTS Seven studies were analyzed, showing nurse anesthetists' work in countries such as the United States and parts of Europe, with the formulation of a plan for anesthesia and patient care regarding the verification of materials and intraoperative controls. The barriers to their performance involved working in conjunction with or supervised by anesthesiologists, the lack of government guidelines and policies for the legal exercise of the profession, and the conflict between nursing and the health system for maintenance of the performance in places with legislation and defined protocols for the specialty. Conclusion Despite the methodological weaknesses found, the studies indicated a wide diversity of nursing work. Furthermore, in countries absent of the specialty, like Brazil, the need to develop guidelines for care during the anesthetic procedure was observed.

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