Strategic Medical Equipment Incorporation Process: A Proposed Model to be used by the Lebanese Healthcare Organizations

Background: The Improvement in healthcare as provided by new modern equipment is associated with the rise in healthcare cost. Lebanon’s economy and its public healthcare sector might be struggling with a crisis stimulated by the absence of any legal limit for the sophisticated medical equipment number per population density. Purpose: to assess the current methodology for health technology incorporation used by the Lebanese hospitals, and to propose an incorporation model guiding them in medical devices acquisition. Methodology: combination of quantitative and qualitative approaches were used in addition to a proposed incorporation models with an applied case study on it. Questionnaires were distributed among 34 hospitals, with a response rate of 82.35%, and interviews were conducted with five biomedical managers. Results: The study shows that only 7% of mangers know what Health Technology Assessment (HTA) means, and none of these hospitals use HTA reports. Additionally, 71% of hospitals don’t monitor their incorporation process and only 4% evaluate the purchased devices’ utilization. Based on the qualitative analysis, the lack of proper need assessment, market study, and poor supplier evaluation were the main reasons behind poor incorporation processes. Conclusion: We found that hospitals lack a proper incorporation process as evident in their poor methodology, hence recommendations were to follow a formalized process for medical device incorporation. However when it comes to the Ministry of Public Health, the recommendations were to formalize and apply new laws and regulations for the certificate of needs.

Highly Conserved Regions of Influenza A Virus Polymerase Gene Segments Are Critical for Efficient Viral RNA Packaging

ABSTRACT The genome of the influenza A virus is composed of eight different segments of negative-sense RNA. These eight segments are incorporated into budding virions in an equimolar ratio through a mechanism that is not fully understood. Two different models have been proposed for packaging the viral ribonucleoproteins into newly assembling virus particles: the random-incorporation model and the selective-incorporation model. In the last few years, increasing evidence from many different laboratories that supports the selective-incorporation model has been accumulated. In particular, different groups have shown that some large viral RNA regions within the coding sequences at both the 5′ and 3′ ends of almost every segment are sufficient for packaging foreign RNA sequences. If the packaging regions are crucial for the viability of the virus, we would expect them to be conserved. Using large-scale analysis of influenza A virus sequences, we developed a method of identifying conserved RNA regions whose conservation cannot be explained by population structure or amino acid conservation. Interestingly, the conserved sequences are located within the regions identified as important for efficient packaging. By utilizing influenza virus reverse genetics, we have rescued mutant viruses containing synonymous mutations within these highly conserved regions. Packaging of viral RNAs in these viruses was analyzed by reverse transcription using a universal primer and quantitative PCR for individual segments. Employing this approach, we have identified regions in the polymerase gene segments that, if mutated, result in reductions of more than 90% in the packaging of that particular polymerase viral RNA. Reductions in the level of packaging of a polymerase viral RNA frequently resulted in reductions of other viral RNAs as well, and the results form a pattern of hierarchy of segment interactions. This work provides further evidence for a selective packaging mechanism for influenza A viruses, demonstrating that these highly conserved regions are important for efficient packaging.