This paper focuses on research in expert elicitation as a part of the early stage health technology assessment (eHTA). The current state of affairs is analysed and two elicitation approaches are compared-the four fixed intervals method and the histogram method-as applied to an example of early assessment of clinical effectiveness of artificial thymus for patients with DiGeorge syndrome. A survey was carried out consisting of four questions concerning the topic, with the aim to apply the elicitation methods. Eight experts answered the questions using both elicitation methods. Based on their answers, the methods were compared visually and by means of statistical tests. In order to compare the perception of the two elicitation methods, the survey also included questions regarding the experts' subjective preferences. The results of the comparison of the two elicitation approaches did not clearly confirm which method was more beneficial and better; however, it was possible to indicate which of the two methods is better suited for different types of experts. Before selecting an elicitation method as a part of eHTA, it is advisable to effectively consider the technology to be assessed and the type of experts to be invited to share their opinion.
- Publikační typ
- časopisecké články MeSH
BACKGROUND: Cardiovascular surgery is confronted by a lack of suitable materials for patch repair. Acellular animal tissues serve as an abundant source of promising biomaterials. The aim of our study was to explore the bio-integration of decellularized or recellularized pericardial matrices in vivo. METHODS: Porcine (allograft) and ovine (heterograft, xenograft) pericardia were decellularized using 1% sodium dodecyl sulfate ((1) Allo-decel and (2) Xeno-decel). We used two cell types for pressure-stimulated recellularization in a bioreactor: autologous adipose tissue-derived stromal cells (ASCs) isolated from subcutaneous fat of pigs ((3) Allo-ASC and (4) Xeno-ASC) and allogeneic Wharton's jelly mesenchymal stem cells (WJCs) ((5) Allo-WJC and (6) Xeno-WJC). These six experimental patches were implanted in porcine carotid arteries for one month. For comparison, we also implanted six types of control patches, namely, arterial or venous autografts, expanded polytetrafluoroethylene (ePTFE Propaten® Gore®), polyethylene terephthalate (PET Vascutek®), chemically stabilized bovine pericardium (XenoSure®), and detoxified porcine pericardium (BioIntegral® NoReact®). The grafts were evaluated through the use of flowmetry, angiography, and histological examination. RESULTS: All grafts were well-integrated and patent with no signs of thrombosis, stenosis, or aneurysm. A histological analysis revealed that the arterial autograft resembled a native artery. All other control and experimental patches developed neo-adventitial inflammation (NAI) and neo-intimal hyperplasia (NIH), and the endothelial lining was present. NAI and NIH were most prominent on XenoSure® and Xeno-decel and least prominent on NoReact®. In xenografts, the degree of NIH developed in the following order: Xeno-decel > Xeno-ASC > Xeno-WJC. NAI and patch resorption increased in Allo-ASC and Xeno-ASC and decreased in Allo-WJC and Xeno-WJC. CONCLUSIONS: In our setting, pre-implant seeding with ASC or WJC had a modest impact on vascular patch remodeling. However, ASC increased the neo-adventitial inflammatory reaction and patch resorption, suggesting accelerated remodeling. WJC mitigated this response, as well as neo-intimal hyperplasia on xenografts, suggesting immunomodulatory properties.
- MeSH
- allogeneické buňky MeSH
- arteriae carotides MeSH
- cévní protézy MeSH
- hyperplazie MeSH
- lidé MeSH
- ovce MeSH
- perikard MeSH
- prasata MeSH
- remodelace cév * MeSH
- skot MeSH
- tkáňové inženýrství MeSH
- transplantace hematopoetických kmenových buněk * MeSH
- zvířata MeSH
- Check Tag
- lidé MeSH
- skot MeSH
- zvířata MeSH
- Publikační typ
- časopisecké články MeSH
INTRODUCTION: Electrocardiographic Tpeak -Tend interval (Tp-Te) is a promising marker for the prediction of ventricular tachycardia and/or ventricular fibrillation (VT/VF). The study was aimed to compare single-lead vs multilead Tp-Te variables as VT/VF predictors in experimental ischemia/reperfusion model. METHODS AND RESULTS: Computer simulations were done using the ECGSIM model with an ischemic region set in anterior left ventricular apex. In 18 anesthetized cats, myocardial ischemia was induced by 30-minute ligation of left anterior descending coronary artery followed by reperfusion. Body surface ECGs in limb leads and modified precordial leads were recorded. Tp-Te was detected automatically in individual leads with a custom-designed parametric algorithm. Tp-Te dispersion and total Tp-Te were calculated as a difference between the maximal and minimal value of individual Tp-Te(s) and an interval between the earliest Tpeak and the latest Tend throughout all leads, respectively. Simulations showed that the increase of local, but not total, dispersion of repolarization characteristic for ischemic damage led to nonuniform shortening of T-peak times across 12 standard leads, which in turn resulted in the increase of single-lead Tp-Te(s), total Tp-Te and Tp-Te dispersion. Animals experienced VT/VF showed increased Tp-Te dispersion and total Tp-Te during reperfusion. In univariate logistic regression analysis, only the Tp-Te dispersion at the beginning of reperfusion was associated with the VT/VF incidence. According to ROC curve analysis, the optimal cut-off value of the Tp-Te dispersion was 17 ms (sensitivity 0.71, specificity 0.80). CONCLUSIONS: The reperfusion VT/VFs were independently predicted by increased Tp-Te dispersion, which suggests the importance of multi-lead evaluation of Tp-Te intervals.
- MeSH
- akční potenciály * MeSH
- časové faktory MeSH
- elektrokardiografie * MeSH
- fibrilace komor diagnóza etiologie patofyziologie MeSH
- kočky MeSH
- komorová tachykardie diagnóza etiologie patofyziologie MeSH
- modely kardiovaskulární MeSH
- modely nemocí na zvířatech MeSH
- počítačová simulace MeSH
- prediktivní hodnota testů MeSH
- reperfuzní poškození myokardu diagnóza etiologie patofyziologie MeSH
- rizikové faktory MeSH
- srdeční frekvence * MeSH
- zvířata MeSH
- Check Tag
- kočky MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- zvířata MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
- srovnávací studie MeSH
OBJECTIVES: Faulty wound healing is a global healthcare problem. Chronic wounds are generally characterized by a reduction in availability of growth factors. New strategies are being developed to deliver growth factors more effectively. METHODS: In this study, we introduced electrospun scaffolds composed of polycaprolactone (PCL) nanofibers functionalized with adhered platelets, as a source of numerous growth factors. Three concentrations of platelets were immobilized to nanofibrous scaffolds by simple adhesion, and their influence on adhesion, proliferation and metabolic activity of seeded cells (murine fibroblasts, keratinocytes and melanocytes) was investigated. RESULTS: The data obtained indicated that presence of platelets significantly promoted cell spreading, proliferation and metabolic activity in all the skin-associated cell types. There were no significant differences among tested concentrations of platelets, thus even the lowest concentration sufficiently promoted proliferation of the seeded cells. CONCLUSIONS: Such complex stimulation is needed for improved healing of chronic wounds. However, the nanofibrous system can be used not only as a skin cover, but also in broader applications in regenerative medicine.
- MeSH
- buněčná adheze MeSH
- buněčné linie MeSH
- fibroblasty cytologie metabolismus MeSH
- hojení ran MeSH
- keratinocyty cytologie metabolismus MeSH
- melanocyty cytologie metabolismus MeSH
- myši MeSH
- nanovlákna chemie ultrastruktura MeSH
- polyestery chemie MeSH
- proliferace buněk * MeSH
- tkáňové inženýrství MeSH
- tkáňové podpůrné struktury chemie MeSH
- trombocyty cytologie MeSH
- zvířata MeSH
- Check Tag
- myši MeSH
- zvířata MeSH
- Publikační typ
- časopisecké články MeSH
Aims of the study were to compare the development of electrocardiographic responses of the ischemia-induced heterogeneities of activation and repolarization in the ventricular myocardium of normal and diabetic animals. Body surface ECGs and unipolar electrograms in 64 epicardial leads were recorded before and during 20 min after the ligation of the left anterior descending artery in diabetic (alloxan model, 4 weeks, n=8) and control (n=8) rabbits. Activation times (ATs), end of repolarization times (RTs) and repolarization durations (activation-recovery intervals, ARIs) were determined in ischemic and periischemic zones. In contrast to the controls, the diabetic rabbits demonstrated the significant prolongation of ATs and shortening of ARIs (P<0.05) during ischemia in the affected region resulting in the development and progressive increase of the ARI and RT gradients across the ischemic zone boundary. The alterations of global and local dispersions of the RTs in diabetics correlated with the T(peak)-T(end) interval changes in the limb leads ECGs. In the ischemic conditions, the diabetic animals differed from the controls by the activation delay, significant repolarization duration shortening, and the increase of local repolarization dispersion; the latter could be assessed by the T(peak)-T(end) interval measurements in the body surface ECGs.
- MeSH
- elektrokardiografie MeSH
- epikardiální mapování MeSH
- experimentální diabetes mellitus patofyziologie MeSH
- ischemická choroba srdeční patofyziologie MeSH
- králíci MeSH
- převodní systém srdeční patofyziologie MeSH
- srdeční komory patofyziologie MeSH
- zvířata MeSH
- Check Tag
- králíci MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- zvířata MeSH
- Publikační typ
- časopisecké články MeSH
- srovnávací studie MeSH
Závěrečná zpráva o řešení grantu Interní grantové agentury MZ ČR
1 svazek : ilustrace, tabulky ; 30 cm
Writing algorithms for transfer and pre-processing of data on medical devices in hospitals and clinics and their purchases from hospital information systems. Creation of a data base of purchased and operated devices. Writing algorithms for data analysisusing statistical methods. Creation of a methodology for provided data analysis using data mining methods. Creation of algorithms for automated generating of analytical reports. Creation of IS modules incl. user interface and access control module.
Vytvoření algoritmů pro přenos a předběžné zpracování údajů o přístrojovém vybavení zdravotnických zařízení a jejich nákupech z informačních systémů zdravotnických zařízení. Vytvoření databáze nakoupených a provozovaných přístrojů. Vytvoření algoritmu pro analýzu dat pomocí statistických metod. Vytvoření metodiky analýzy poskytovaných dat na základě metod data miningu. Vytvoření algoritmů pro automatické generováni analytických zpráv. Vytvoření modulů informačního systému, včetně uživatelského rozhranía modulu řízení přístupu.
- MeSH
- algoritmy MeSH
- data mining MeSH
- informační systémy MeSH
- ukládání a vyhledávání informací MeSH
- uživatelské rozhraní počítače MeSH
- veřejné zdravotnictví - informatika MeSH
- výhodné společné nákupy MeSH
- zabezpečení počítačových systémů MeSH
- zdravotnické prostředky MeSH
- Konspekt
- Informační věda
- NLK Obory
- technika lékařská, zdravotnický materiál a protetika
- lékařská informatika
- NLK Publikační typ
- závěrečné zprávy o řešení grantu IGA MZ ČR
Tento článek prezentuje p řístupy použité ke sledování nákupů zdravotnických přístrojů v České republice. Vytvo řený systém umožňuje sledování a hodnocení efektivity nákupů a poskytuje objektivní informace všem osobám zainteresovaným v plánování nákupů zdravotnických přístrojů. Byl navržen a otestován proces sběru dat. Byly vytvořeny reporty, které jsou založené na multikriteriálním porovnání v rámci komplexního datového modelu. Tento model formalizuje data o nákupech a umožňuje formulovat hypotézy o efektivitě nákupů. Multikriteriální přístup je založen na hodnocení nákupů zdravotnických přístrojů na základě sady kritérií specifikovaných uživatelem. Mezi tato kritéria patří smluvní podmínky nákupu, cena zdravotnického přístroje a technické parametry. Navržený systém umožňuje uživatelům porovnávat kupní smlouvy, identifikovat jejich slabiny a plánovat nákupy zdravotnické techniky.
This article presents the approaches used for tracking purchases of medical equipment in the Czech Republic. Developed tracking system allows monitoring and evaluation of the procurement effectiveness and provides objective information to all parties involved in planning of medical equipment acquisition. The data collection process was designed and tested. Reports were designed and created based on multi-criteria comparisons within a complex data model. This model is based on formalization of procurement information and is designed to formulate hypotheses about the procurement effectiveness. Multi-criteria approach is based on the evaluation of medical devices purchases based on a set of criteria specified by the user. These criteria include the terms and conditions of purchase, the price of medical equipment and technical parameters. Designed system allows users to compare the purchase orders, identify their weaknesses and use this information to plan further acquisitions of medical equipment.
- Klíčová slova
- zdravotnické přístroje, sledování nákupů, report,
- MeSH
- data mining MeSH
- metody pro podporu rozhodování MeSH
- sběr dat MeSH
- ukládání a vyhledávání informací MeSH
- výhodné společné nákupy MeSH
- zdravotnické prostředky ekonomika klasifikace normy statistika a číselné údaje zásobování a distribuce MeSH
- Publikační typ
- práce podpořená grantem MeSH
Druhé, upravené vydání 140 stran : ilustrace ; 25 cm
- MeSH
- biomedicínské inženýrství MeSH
- lékařská elektronika MeSH
- lékařská počítačová informatika MeSH
- náklady a analýza nákladů MeSH
- veřejné zdravotnické služby MeSH
- zdravotnické prostředky MeSH
- Publikační typ
- sborníky MeSH
- Konspekt
- Veřejné zdraví a hygiena
- NLK Obory
- veřejné zdravotnictví
- biomedicínské inženýrství
- Klíčová slova
- provozování MRI, řízení zdravotnického vybavení, řízení univerzitní nemocnice, racionální řízení,
- MeSH
- efektivita organizační statistika a číselné údaje MeSH
- lidé MeSH
- magnetická rezonanční tomografie * ekonomika přístrojové vybavení využití MeSH
- nemocnice - náklady * MeSH
- nemocnice univerzitní ekonomika MeSH
- prospektivní studie MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- práce podpořená grantem MeSH
- tabulky MeSH
Health Technology Assessment (HTA) methods have become a standard part of decision-making processes in healthcare service. Although it is routinely applied in drugs and surgery, HTA in medical devices is still quite challenging. The reason is that the main objective of HTA studies for devices is not optimization of the cost-effectiveness ratio, but rather decisions about procurement and/or incorporation of the device. The clinical benefit is not expressed in terms of quality of life, but in the rate of diagnostic yield, and in the extent to which the technology makes the therapy shorter and/or more patient-friendly. Utilization of multiple-criteria decision-making methods for evaluation of the aggregated clinical, technical and user´s effect (outcome) is recommended as the input to cost-effectiveness analyses. Different methods are derived for strategic and/or operational assessment of new technology. Other studied problems are identification of requirements for medical device selection and purchase, composition of expert panels, and assessment of medical device maintenance demandingness.
