The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
Evidence- based periodontology is a bridge from all the available literature to clinical practice. It is a tool which can be used for decision making from available evidence during clinical practice.It should be scientifically sound and patient focussed.
Let's Talk Research Annual Conference - 24th-25th September 2014 (Professor R...NHSNWRD
"Introduction to Evidence Synthesis": Professor Rumona Dickson's presentation provided an overview of evidence synthesis and a platform to refine questions that participants wanted to answer related to their own clinical practice. The workshop also included information detailing how teams of health care professionals might access support for addressing their clinical review questions through the CPD programme of the CLAHRC NWC.
Evidence based dentistry/certified fixed orthodontic courses by Indian dental...Indian dental academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
Indian dental academy provides dental crown & Bridge,rotary endodontics,fixed orthodontics,
Dental implants courses.for details pls visit www.indiandentalacademy.com ,or call
0091-9248678078
What is research, Types of research, Requisites of good research, Concept in epidemiology, Epidemiologic studies , Literature search, Protocol designing, Ethical issues, Dissertation writing , Research paper writing , Reviewing a research paper
Evidence based dentistry strategies for new diagnostic and treatment methodol...devicharan11
If you think that you are facing difficulties covering your course on oral pathology, then it is high time to opt for lectures offered by Professor Dr. Devi Charan Shetty at ITS Dental College. He can help you understand the toughest concepts with his interactive approach.
What is research, Types of research, Requisites of good research, Concept in epidemiology, Epidemiologic studies , Literature search, Protocol designing, Ethical issues, Dissertation writing , Research paper writing , Reviewing a research paper,
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
Evidence- based periodontology is a bridge from all the available literature to clinical practice. It is a tool which can be used for decision making from available evidence during clinical practice.It should be scientifically sound and patient focussed.
Let's Talk Research Annual Conference - 24th-25th September 2014 (Professor R...NHSNWRD
"Introduction to Evidence Synthesis": Professor Rumona Dickson's presentation provided an overview of evidence synthesis and a platform to refine questions that participants wanted to answer related to their own clinical practice. The workshop also included information detailing how teams of health care professionals might access support for addressing their clinical review questions through the CPD programme of the CLAHRC NWC.
Evidence based dentistry/certified fixed orthodontic courses by Indian dental...Indian dental academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
Indian dental academy provides dental crown & Bridge,rotary endodontics,fixed orthodontics,
Dental implants courses.for details pls visit www.indiandentalacademy.com ,or call
0091-9248678078
What is research, Types of research, Requisites of good research, Concept in epidemiology, Epidemiologic studies , Literature search, Protocol designing, Ethical issues, Dissertation writing , Research paper writing , Reviewing a research paper
Evidence based dentistry strategies for new diagnostic and treatment methodol...devicharan11
If you think that you are facing difficulties covering your course on oral pathology, then it is high time to opt for lectures offered by Professor Dr. Devi Charan Shetty at ITS Dental College. He can help you understand the toughest concepts with his interactive approach.
What is research, Types of research, Requisites of good research, Concept in epidemiology, Epidemiologic studies , Literature search, Protocol designing, Ethical issues, Dissertation writing , Research paper writing , Reviewing a research paper,
This workshop is meant to be an introduction to the systematic review process. Further information about systematic reviews was available through a research guide. http://libguides.ucalgary.ca/content.php?pid=593664
Critique Template for a Qualitative StudyCritiquing Qualit.docxtaminklsperaw
Critique Template for a Qualitative Study
Critiquing Qualitative
What is a critique? Simply stated, a critique is a critical analysis undertaken for some purpose. Nurses critique research for three main reasons: to improve their practice, to broaden their understanding, and to provide a base for the conduct of a study.
When the purpose is to improve practice, nurses must give special consideration to questions such as these:
Are the research findings appropriate to my practice setting and situation?
What further research or pilot studies need to be done, if any, before incorporating findings into practice to assure both safety and effectiveness?
How might a proposed change in practice trigger changes in other aspects of practice?
To help you synthesize your learning throughout this course and prepare you to utilize research in your practice, you will be critiquing a qualitative, quantitative, or mixed-methods research study of your choice.
If the article is unavailable in a full-text version through the Walden University Library, you must
e-mail the article as a PDF or Word attachment to your Instructor.
QUALITATIVE RESEARCH CRITIQUE
Research Issue and Purpose
What is the research question or issue of the referenced study? What is its purpose? (Sometimes ONLY the purpose is stated clearly and the question must be inferred from the introductory discussion of the purpose.)
Researcher Pre-understandings
Does the article include a discussion of the researcher’s pre-understandings? What does the article disclose about the researcher’s professional and personal perspectives on the research problem?
Literature Review
What is the quality of the literature review? Is the literature review current, relevant? Is there evidence that the author critiqued the literature or merely reported it without critique? Is there an integrated summary of the current knowledge base regarding the research problem, or does the literature review contain opinion or anecdotal articles without any synthesis or summary of the whole? (Sometimes the literature review is incorporated into the introductory section without being explicitly identified.)
Theoretical or Conceptual Framework
Is a theoretical or conceptual framework identified? If so, what is it? Is it a nursing framework or one drawn from another discipline? (Sometimes there is no explicitly identified theoretical or conceptual framework; in addition, many “nursing” research studies draw on a “borrowed” framework, e.g., stress, medical pathology, etc.)
Participants
Who were the participants? Is the setting or study group adequately described? Is the setting appropriate for the research question? What type of sampling strategy was used? Was it appropriate? Was the sample size adequate? Did the researcher stipulate that information redundancy was achieved?
Protection of Human Research Participants
What steps were taken to protect human research subjects?
.
Unpacking Nutrition Research and being an effective Science CommunicatorTim Crowe
Understand what can make nutrition research confusing in the conclusions it reaches and appreciate the key questions to ask when critiquing a research study. Then discover the principles of clear and effective science communication and how to maintain credibility and engage people in different ways on social media,
Presenting a published paper:
"Systematic review or scoping review? Guidance for authors when choosing between a systematic or scoping review
approach"
An Introduction to writing an Systematic review of literature - Scientific re...Pubrica
A systematic review is a type of literature review that uses a systematic method to collect Secondary data in which there is a comprehensive search for relevant studies on a particular topic, and those identified are then evaluated and synthesized according to a predetermined and explicit method.
This framework especially is essential for early career researchers and medical students to enhance their writing knowledge on the systematic review of the literature.
Why Pubrica:
When you order our services, we promise you the following – Plagiarism free, always on Time, outstanding customer support, written to Standard, Unlimited Revisions support and High-quality Subject Matter Experts.
Learn More: https://bit.ly/38jAbCT
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Web: https://pubrica.com/
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WhatsApp : +91 9884350006
United Kingdom : +44-1143520021
How can patients and providers best contribute to the HTA process?EUnetHTA
How can patients and providers best contribute to the HTA process? Anna Nachtnebel, LBI-HTA, Simone Warren, ZIN
Presentation from the 3rd face to face training course for EUnetHTA Stakeholders organised by EUnetHTA JA2 WP2; April 23rd, 2015, Brussels.
How to use the EUnetHTA submission template to support production of core Hea...EUnetHTA
How to use the EUnetHTA submission template to support production of core Health Technology Assessments? Zoe Garrett, NICE
Presentation from the 3rd face to face training course for EUnetHTA Stakeholders organised by EUnetHTA JA2 WP2; April 23rd, 2015, Brussels.
Brief Introduction to the HTA Core Model (r), Anna Nachtnebel, LBI-HTA
Presentation from the 3rd face to face training course for EUnetHTA Stakeholders organised by EUnetHTA JA2 WP2; April 23rd, 2015, Brussels.
How to use HTA for decision-making based on HTA Core InformationEUnetHTA
How to use HTA for decision-making based on HTA Core Information, Anna Nachtnebel, LBI-HTA, Simone Warren, ZIN
Presentation from the 3rd face to face training course for EUnetHTA Stakeholders organised by EUnetHTA JA2 WP2; April 23rd, 2015, Brussels.
Brief introduction to EUnetHTA and its toolsEUnetHTA
Brief introduction to EUnetHTA and its Tools, Marianne Klemp, NOKC
Presentation from the 3rd face to face training course for EUnetHTA Stakeholders organised by EUnetHTA JA2 WP2; April 23rd, 2015, Brussels.
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
Best Ayurvedic medicine for Gas and IndigestionSwastikAyurveda
Here is the updated list of Top Best Ayurvedic medicine for Gas and Indigestion and those are Gas-O-Go Syp for Dyspepsia | Lavizyme Syrup for Acidity | Yumzyme Hepatoprotective Capsules etc
Adv. biopharm. APPLICATION OF PHARMACOKINETICS : TARGETED DRUG DELIVERY SYSTEMSAkankshaAshtankar
MIP 201T & MPH 202T
ADVANCED BIOPHARMACEUTICS & PHARMACOKINETICS : UNIT 5
APPLICATION OF PHARMACOKINETICS : TARGETED DRUG DELIVERY SYSTEMS By - AKANKSHA ASHTANKAR
These lecture slides, by Dr Sidra Arshad, offer a quick overview of the physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
14. Explain the concepts of current of injury, J point, and their significance
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
Muktapishti is a traditional Ayurvedic preparation made from Shoditha Mukta (Purified Pearl), is believed to help regulate thyroid function and reduce symptoms of hyperthyroidism due to its cooling and balancing properties. Clinical evidence on its efficacy remains limited, necessitating further research to validate its therapeutic benefits.
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
The Gram stain is a fundamental technique in microbiology used to classify bacteria based on their cell wall structure. It provides a quick and simple method to distinguish between Gram-positive and Gram-negative bacteria, which have different susceptibilities to antibiotics
EUnetHTA Training course for Stakeholders - Patient involvement (Sophie WERKO)
1. How can patients and providers best
contribute to the HTA process?
Sophie Werko, SBU
werko@sbu.se
HTAi Interest Sub-Group for Patient/Citizen Involvement in HTA
Co-Chair Working Group on Methods and Impact
EUnetHTA Stakeholder Training: 16 January 2014
3. SBU:s process for systematic reviews
Specify questions
Determine inclusion and exclusion criteria
Search the literature
Select articles
Review quality of studies
Tabulate the studies
Summarise the results and grade the quality
of evidence
GRADE
4. SBU strives to minimize the "bias" in the
assessment and synthesis of knowledge
•
•
•
•
•
Systematic process
Broad area of expertise in the project groups
Reproducible and transparent process
Review by independent experts
Meticulous and clear declaration of conflicts of
interests
5. Project process
SBU Board
Selection and prioritization
of projects
Review pair / project group
Writing
External reviewer
Reviewing
Project group
Formulation of questions and
Inclusion/exclusion criteria
Review pair / project group
Synthesis of results and
weighing of evidence
SBU Board
SBU Scientific Advisory Board
Feedback
SBU
Printing
Review pair
Literature search
Review pair / project group
Assessment of quality and
relevance of the studies
SBU / Project group
Dissemination
6. Project process
SBU Board
Selection and prioritization
of projects
Review pair / project group
Writing
External reviewer
Reviewing
Project group
Formulation of questions and
Inclusion/exclusion criteria
Review pair / project group
Synthesis of results and
weighing of evidence
SBU Board
SBU Scientific Advisory Board
Feedback
SBU
Printing
Review pair
Literature search
Review pair / project group
Assessment of quality and
relevance of the studies
SBU / Project group
Dissemination
7. Project group
Formulation of questions
and
Inclusion/exclusion criteria
Population
Intervention
Control
Outcome
Example:
Population: Diabetics type 1 and 2
Intervention: food interventions
Control: diabetes food according to present convention
Outcome: mortality, diabetic complications, quality of
life, side effects…
8. Project process
SBU Board
Selection and prioritization
of projects
Review pair / project group
Writing
External reviewer
Reviewing
Project group
Formulation of questions and
Inclusion/exclusion criteria
Review pair / project group
Synthesis of results and
weighing of evidence
SBU Board
SBU Scientific Advisory Board
Feedback
SBU
Printing
Review pair
Literature search
Review pair / project group
Assessment of quality and
relevance of the studies
SBU / Project group
Dissemination
9. Review pair
Literature search
("diabetes mellitus"[MeSH Terms] OR diabetes[Title/abstract] OR diabetic[Title/abstract] OR
NIDDM[title/abstract] OR IDDM[title/abstract] OR "prediabetic state"[MeSH Terms] OR "hyperglycemia"[MeSH
Terms] OR "prediabetes"[Title/Abstract] OR prediabetic[title/abstract] OR "hyperglycemia"[Title/Abstract] OR
"hyperglycemic"[Title/Abstract] OR "glucose intolerance"[title/abstract] OR "impaired fasting
glucose"[title/abstract] OR "high fasting glucose"[title/abstract] OR "impaired fasting plasma
glucose"[title/abstract] OR "high fasting plasma glucose"[title/abstract] OR "impaired fasting blood
glucose"[title/abstract] OR "high fasting blood glucose"[title/abstract] OR "impaired glucose
tolerance"[title/abstract] OR "igt"[title/abstract] OR "ifg"[title/abstract]) AND ("diet, carbohydrate
restricted"[MeSH Terms] OR "carbohydrate restricted"[Title/Abstract] OR "low carbohydrate"[Title/Abstract] OR
"low carb"[Title/Abstract] OR "south beach"[Title/Abstract] OR "atkins diet"[Title/Abstract] OR "high fat
diet"[Title/Abstract] OR "high protein diet"[Title/Abstract] OR "lchf"[Title/Abstract] OR "lchp"[Title/Abstract] OR
"lckd"[title/abstract] OR "ketogenic diet"[Title/Abstract] OR "dietary carbohydrates"[MeSH Terms] OR (("dietary
fats"[MeSH Terms] OR "dietary proteins"[MeSH Terms]) AND (carbohydrate[title/abstract] OR
carbohydrates[title/abstract] OR carb[title] OR carbs[title] OR carbohydrates[MeSH Terms]))) AND ("randomized
controlled trial"[Publication Type] OR randomized[title/abstract] OR random[title/abstract] OR
randomly[title/abstract] OR multicenter[title/abstract] OR controlled[title] OR "controlled clinical
trial"[publication type] OR "multicenter study"[publication type] OR (review[publication type] AND
"systematic"[title/abstract]) OR "meta analysis"[publication type] OR "cohort studies"[MeSH Terms] OR
"cohort"[Title] OR "prospective"[Title] OR "long term"[Title] OR "observational"[title] OR "secondary
prevention"[Title/Abstract] OR "case control"[Title/Abstract] OR "case control studies"[MeSH Terms] OR
"risk"[title] OR "incidence"[title] OR "incident"[title] OR "risk factors"[MeSH Terms]) NOT ("animals"[MeSH
Terms] NOT "humans"[MeSH Terms])
10. Project process
SBU Board
Selection and prioritization
of projects
Review pair / project group
Writing
External reviewer
Reviewing
Project group
Formulation of questions and
Inclusion/exclusion criteria
Review pair / project group
Synthesis of results and
weighing of evidence
SBU Board
SBU Scientific Advisory Board
Feedback
SBU
Printing
Review pair
Literature search
Review pair / project group
Assessment of quality and
relevance of the studies
SBU / Project group
Dissemination
11. Review of the literature – flow chart
Literature search
Reviewer 1
Title and abstract
inclusion and exclusion
A
A
B
Reviewer 2
Individual review of abstracts
Include or exclude?
A
B
B
If A and B say include = order fulltext
If A or B says include = order fulltext
If A and B say exclude = exclusion
Ordering of articles in fulltext
Fulltext
inclusion and exclusion
A
General individual review of articles
Include or exclude?
A
Fulltext
reviewing and exclusion
A
B
B
If A and B say include = review
If A or B says include = review
If A and B say exclude = exclusion, to list of excluded studies
Reivew articles with quality assessment tool
A
A
B
B
B
Discussion about how the studies have been validated, consensus.
If A and B say exclude = exclusion, to list of excluded studies
Tabellation of results for furthur discussion in the project group
12. Review pair / project group
Assessment of relevance and quality of the studies
13. Project process
SBU Board
Selection and prioritization
of projects
Review pair / project group
Writing
External reviewer
Reviewing
Project group
Formulation of questions and
Inclusion/exclusion criteria
Review pair / project group
Synthesis of results and
weighing of evidence
SBU Board
SBU Scientific Advisory Board
Feedback
SBU
Printing
Review pair
Literature search
Review pair / project group
Assessment of quality and
relevance of the studies
SBU / Project group
Dissemination
14. Review pair / project group
Synthesis of results and
weighing of evidence
Evidence table
Wound infections associated with surgical treatment of jaw fractures,
antibiotic prophylaxis compared to placebo
Studies
Patients
Design
Quality
3
461
RCT
⊕⊕⊕⊕
-1 *
Consistency
0
GR
AD
E
Directness
Imprecise
results
Publication
bias
Effect
size
Dose
response
Confounding
0**
-1***
0
0
0
0
*Lack of blinding
**Different antibiotics
***Few outcomes, together with ** -1
15. 15
Project process
SBU Board
Selection and prioritization
of projects
Review pair / project group
Writing
External reviewer
Reviewing
Project group
Formulation of questions and
Inclusion/exclusion criteria
Review pair / project group
Synthesis of results and
weighing of evidence
SBU Board
SBU Scientific Advisory Board
Feedback
SBU
Printing
Review pair
Literature search
Review pair / project group
Assessment of quality and
relevance of the studies
SBU / Project group
Dissemination
17. Patients’ and carers’ experiences
• Living with an illness
– ‘No one knows better what it is like to live with an
illness day in, day out, than those who are doing this –
the patients and their family and friends who care for
them.’
• The technology
– Their needs and preferences, and benefits and
unwanted effects
Understanding HTA. Health Equality Europe. 2008
(Available in several languages). http://www.htai.org/index.php?id=744
18. HTA and decision making
• HTA can be considered as a bridge between
scientific evidence and decision making
• Patient perspectives’ can
illuminate the bridge by
identifying appropriate research
questions, helping translate
efficacy into effectiveness,
clarifying the determination of
value, helping us write clear
recommendations.
19. How can patients get involved in
HTA?
• A patient’s view is an individual’s subjective
experience
- Is it representative?
- Is it biased by industry influence?
• How can patients’ and carers’/care-givers’
perspectives be combined with evidence from
controlled clinical trials or complicated
economic models of cost and benefit?
20. ‘Patients’ perspectives in HTA: a route to
robust evidence and fair deliberation’
(Int. J. Tech Assess Health Care, 2010, 334-340)
Karen Facey,
Scotland
Javier Gracia,
Spain
Helle Ploug Hansen,
Denmark
Alessandra Lo Scalzo, Italy
Jean Mossman,
Health Equality Europe
Antoine Boivin,
Canada
Ann Single,
Australia
21. Effective patient participation in HTA
• Patients’ views and preferences contributing to
HTA:
o In the form of robust evidence
o Through engagement in the process
22. Patient Evidence
Describing burden of illness
• Nature of illness (chronic, common, rare, life
threatening, etc)
• Impact of illness daily life (home, work,
social activities,…)
• Psychological and social issues (stigma,
exclusion, mental wellbeing,…)
• The most difficult aspects of the illness
Understanding HTA. Health Equality Europe. 2008
23. Patient Evidence
Impacts of Technology
• How current treatments are taken and
issues arising – side effects, alteration
of dosing,…
• How easily technology fits into daily life
• Outcomes from a treatment that would
be most valued by patients, e.g.
– relief of symptoms to allow return to work,
ability to dress;
– fewer visits to hospital
Understanding HTA. Health Equality Europe. 2008
24. Patient evidence
•
•
•
•
Concise and balanced
Presents a range of patients perspectives
Variations in clinical practice
Personal experience with existing and new
technologies
• Expectations from new technology
• Views on who should be treated and for how
long
• Evidence and facts, not emotion
25. 1. PARTICIPATION in the HTA process
At every stage:
•
•
•
•
•
•
•
•
•
•
•
•
Study design to produce evidence
HTA topic selection
Scoping
Submission of evidence
Presentation of patient experience to expert committee
Sitting on an HTA decision-making committee
Providing consultation comments on draft HTA report
Patient friendly summaries
Dissemination/communication
Designing & reviewing patient engagement processes
Use HTA to inform charity investments
Contributing to governmental review of HTA
26. Scoping
• Population
– What patients will benefit?
• Intervention
• Comparators
– What treatments are currently given?
• Outcome
– What matters to patients?
27. Important Outcome (NICE example)
• Skin condition
• Clinical data focussed on overall body
• Patients’ priority was to reduce coverage
on hands and face, and then overall body
Delloite, Eli Lilly – Enhancing Consumer Involvement in Medicines HTA - 2009
28. Patient evidence
• Patient evidence can identify limitations in
published research
– In particular the failure to capture the true
concerns of individual patients related to
quality of life
• Committee is looking for a concise and
balanced overview that reflects the range
of patients perspectives
Briefing paper for the update to Methods Guide - 2012
29. Draft Patient Submission Template
• Consultation until 28 February 2014 on form for
patients to submit information when medicines
being assessed
http://www.htai.org/index.php?id=776
• Please give us your comments!
• Amended form piloted by HTA organisations in
May 2014
• Consultation in Spring 2014 on form for patients
to submit information when health technologies,
other than medicines, are being assessed
30. Commitment in the draft template
• All members of HTA Committee will have access
to all patient submissions.
• All submissions from patients will be summarised
in HTA advice with indication of how the
information was considered in the development of
conclusions or recommendations.
• Will provide feedback about usefulness of your
submission in our deliberation
• Will share some submissions on website as
examples (with permission)
31. Evidence on patient’s perspectives
• Literature searching
•
•
•
•
•
•
Surveys (QOL, resource use, experience)
Interviews, focus groups – qualitative research
Review of members’ helpline enquiries
Patient stories
Discussion fora
Social networking
32. Evaluation and synthesis of studies using
qualitative methods of analysis (SBU, 2012)
When the aim of a study is to achieve a
deeper understanding of a person’s
subjective perception of – for example –
quality of life, a person’s individual
perceptions, experiences, impressions and
actions, then qualitative research methods
may be more relevant. Such methods offer
an understanding of associations from the
individual’s perspective.
http://www.sbu.se/en/Assessment-and-Evidence/SBUs-Handbook/
(C) Karen Facey 2009
33. NICE
Briefing paper for update to Methods Guide 2012
Views from expert patients can inform the debate
about:
•Variations in clinical practice
•Personal perspectives about benefits and
difficulties with the technology
•Views on rules for starting and stopping treatment
34. Public partner on HTA Committee
• Equal member of committee
– Participation in discussion
– Presentation of information from patient
organisations
– Voting
– Conflicts of Interest
• Requirements
– Clear description of role and timely reimbursement
of expenses
– Understandable, accessible information
– Support to contribute (training, one-to-ones with
researchers, understanding of Chairman)
35. Tips for writing your consultation response
(NICE-IPP)
• (Evaluation of efficacy and safety - not costs)
• Doesn’t need to be lengthy or comment on
everything
• Short, focussed response
• Be specific about the procedure
• Balanced - positive and negative
• No local issues
36. Patient Decision Aids (O’Connor, 2005)
• Interventions designed to help patients discuss
treatment options with their clinicians
and make specific, informed choices
(as an adjunct to ‘counselling’)
• Examples for HTAs in breast cancer treatment
(Spain) and breast cancer screening (Finland)
37. Patient Decision Aids (PtDAs)
Essential elements
• Facts on condition, options, outcomes
• Risk communication (probability of outcomes
and uncertainty)
• Values clarification (to help patient determine
which benefits, harms and uncertainties
matter most to them)
• Structured guidance in deliberating and
communicating with clinician
• Balanced display of positive and negative
features of options
38. Improving HTA patient engagement
processes
• Strategic group of public
partners/patient representatives
• Materials and training to explain the
process for patient engagement
that are developed by patients
• Publish a policy for patient
engagement
• Publish an annual report on patient
engagement, highlight successes
and priority areas for development
(C) Karen Facey 2009
39. DRAFT Values for
patient involvement in HTA
Unique knowledge
Patients provide perspectives and experiences that can
inform HTA value judgements and decision-making.
Mutual respect
Contributions from all participants in HTA are respected and
valued.
Equity
Patient involvement in HTA addresses issues of equity by
ensuring that fair processes are used to understand the
needs of those with one particular medical condition in the
context of a health system that must provide care for all.
Legitimacy
Patient involvement is important for an HTA organisation’s
accountability for decision-making; ensuring openness and
transparency.
40. DRAFT Standards
Overarching issues
•Those working in HTA have a policy for patient
involvement in HTA that includes a commitment to
patient involvement across key organisational
functions.
•HTA organisations assign a budget and resources
for patient involvement.
•HTA organisations identify a named contact whose
role is to ensure that patients can contribute
effectively to HTA.
•HTA contributors (patients, HTA committees,
researchers, staff etc) receive appropriate education
and training about HTA and patient involvement.
41. DRAFT Standards
HTA process
•Communications between parties involved in HTA use
plain language (simple, accessible, no jargon).
•The HTA process provides advance notice of patient
involvement deadlines so that input from a range of
st
patients can be obtained.
•Patients are given access to appropriate information to
enable them to fully contribute to HTA.
•Processes for patient involvement, and how patients’
perspectives have affected HTA outputs, are clearly
reported.
•Feedback is given to individual contributors about the
value of their input to an HTA.
•HTA outputs are presented in a form that can be
communicated to patients and understood by them.
Delphi 1 stage consultation
process runs until
26 January 2014
42. Available in English, Spanish, Italian, Polish, Mandarin, Greek
www.htai.org/index.php?id=545
43. HTAi consumer and patient glossary
A beginner’s guide to words used in
health technology assessment
Compiled by Ann Single and Biotext Pty Ltd
with contributions from Eleanor Ahern,
Tony Culyer, Helena Dahlgren, Karen Facey,
Karen MacPherson, Margaret Reid,
Karen Ritchie, Tania Stafinski,
Durhane Wong-Rieger
Version: 1
October 2009
www.htai.org/fileadmin/HTAi_Files/ISG/PatientInvolvement/Glossary/
HTAiPatientAndConsumerGlossaryOctober2009_01.pdf
44. • HTAi promotes development and use of HTA, with over
1,000 members in 50 countries – from all stakeholders
• Interest Group on Patient/Citizen Involvement in HTA
• Working Groups:
Involvement and Education
Methods and Impact
Citizen and Community perspectives
• Travel grants to HTAi Annual Meeting
• Reduced subscription
45. Interest-Sub Group on
Patient/Citizen Involvement in HTA
• Quarterly ebulletin and email list
• Contributions to annual HTAi conference
• Website of resources
www.htai.org/index.php?id=545
HEE Guide to HTA in 5 languages
Glossary for HTA and clinical research
Free Access themed edition of HTA journal
Organisational reports
Information on HTA Agency approaches to
patient/public involvement
Links to training courses
47. Making HTA more patient-centered
• Engage with those doing research to ensure clinical
studies include outcomes that are important to patients
• Work with academics to do qualitative research
• Work with HTA Agencies to develop their processes for
engaging patients so that patients can help
demonstrate the value of a new technology
• Engage with politicians to ensure that robust HTA
systems lead to rational and consistent decisions by
healthcare payers
• Encourage collaboration among stakeholders to
ensure rapid access to technologies that demonstrate
value
48. HTA and You!
• HTA is used to help health systems make investment
decisions
• Patients and carers have important perspectives that
can contribute to HTA
• Patient evidence should include clear facts about
experience and views
• Patients and carers may be included in the HTA
process at all stages
• Find out what happens in your local HTA process.
Ask how you can be involved!
http://www.htai.org/index.php?id=545
49. SBU's conference on collaboration with healthcare users
SBU – Kunskapscentrum för hälso- och sjukvården I Swedish Council on Health Technology Assessment
www.sbu.se
50. Multiple Sclerosis Research Trust
• Questionnaire issued by MSRT
• To people with multiple sclerosis (MS) and
their carers with whom they had contact in
previous 6 years who volunteered to provide
personal details
• Characteristics of form of MS (type of
disease, number and frequency of relapses,
disability score, cognition), treatment,
quality-of-life using the EQ-5D instrument
51. MSRT input to NICE appraisal
• 1555 respondents covering forms of disease
• 152 had relapsing remitting or secondary
progressive MS and were receiving
treatment with one of the products
considered by NICE appraisal at the time of
the questionnaire
• Utilities from these 152 were used in the
revised NICE model to replace UK values
provided by leading Swedish economist
52. Prevention of relapse in alcohol
dependence (NHS QIS HTA3)
• 4 effective psychosocial therapies and 2 medicines found
to be cost saving to the NHS over 20 years
• Even in controlled conditions, more than half the patients
relapsed at the end of the (short) study period
• 45 patients interviewed in 3 hospitals – felt they were
failures, didn’t know about alternatives, put to the bottom
of the list for future treatment
• HTA recommended that a choice of treatments should be
available, for initial choice and after failure
53. Communicating to a committee
• Understand your audience and how you are
allowed to participate (responding to questions
and posing questions)
• Identify what other experts will be involved and
seek to provide unique knowledge
• Be prepared with written evidence to refer to
• Know how long you have to speak - top 3
messages
• Facts, not emotion
54. Communicating benefit that changes a
committee decision (Scotland)
• Combination product
• More expensive, limited clinical evidence
of benefit
• Patient organisations explained that a key
symptom of disease is dry mouth, making
swallowing pills difficult
Delloite, Eli Lilly – Enhancing Consumer Involvement in Medicines HTA - 2009
Editor's Notes
CMS – not real partnership!
SMC example – patients say that to manage diarrhoea they split the tablet into 3 and take it morning, lunchtime and evening. But that sometimes they forget to take the final part.