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  • About
  • The Global ETD Search service is a free service for researchers to find electronic theses and dissertations. This service is provided by the Networked Digital Library of Theses and Dissertations.
    Our metadata is collected from universities around the world. If you manage a university/consortium/country archive and want to be added, details can be found on the NDLTD website.
41

Procedimentos para avaliação tecnológica de equipamentos médico-hospitalares : um estudo aplicado à hemodiálise

Magnago, Patrícia Flores January 2016 (has links)
A Avaliação Tecnológica em Saúde (ATS) é uma sistemática que avalia os impactos clínicos, sociais e econômicos das tecnologias em saúde e tem como finalidade auxiliar os gestores na tomada de decisão quanto ao desenvolvimento, incorporação e descontinuação destas tecnologias. Agências de ATS têm destacado a importância da existência de métodos que visem padronizar e implantar esta sistemática em diferentes contextos. Assim, o objetivo geral desta tese é propor procedimentos para apoiar a avaliação tecnológica de equipamentos médico-hospitalares, por meio de uma pesquisa construtiva (Constructive Research) aplicada à terapia de hemodiálise. Os procedimentos propostos compõem um modelo adaptado do EuroScan, modelo desenvolvido por agências Europeias e indicado como boa prática pelo Ministério da Saúde do Brasil. Também são procedimentos ajustados às necessidades de pesquisadores de centros regionais de avaliação de equipamentos médico-hospitalares. Inicialmente, foi desenvolvida uma coleta de dados sobre os problemas de desenvolvimento e incorporação das tecnologias da saúde por meio de duas fontes: uma revisão sistemática de literatura sobre oportunidades de melhorias do EuroScan no mundo e discussões com pesquisadores no país. A partir destas investigações foi proposto um modelo preliminar de ATS, aplicado para o domínio Operacional e de Inovação na hemodiálise. Finalmente a aplicação foi validada e examinada por especialistas para a geração de um modelo final. Os principais procedimentos resultantes foram: (i) validação da relevância das avaliações para novos desenvolvimentos e incorporações tecnológicas do ponto de vista de diferentes especialistas, integrando diferentes áreas do conhecimento na ATS; (ii) operação de Observatórios Tecnológicos, auxiliando na definição das tecnologias e domínios a serem avaliadas; (iii) definição de técnicas para análise dos domínios de ATS, como o uso de séries temporais e o Technology Roadmap (TRM) para previsões sobre o futuro das inovações e o uso das dimensões da usabilidade e de incidentes críticos de riscos para os aspectos operacionais; e (iv) integração das diretrizes de ATS no Brasil em um único modelo, amparando pesquisadores não relacionados a saúde na compreensão sobre ATS e no desenvolvimento ágil de novos estudos tanto para equipamentos emergentes como em uso. Já a avaliação dos domínios selecionados para a hemodiálise resultou: (i) na identificação de um crescimento médio anual de 7% dos indicadores da terapia; (ii) no diagnóstico de usabilidade de máquinas eficazes, porém com possibilidades de gerarem maior satisfação aos usuários quanto: ao espaço entre elas, a redução dos desperdícios de água e materiais, aos planos de manutenção para evitar temperaturas elevadas, a capacitação visando mais atenção e treinamento para tarefas de apoio e aos aspectos de display (realimentação de dados e visualização); e (iii) na consolidação entre profissionais sobre um futuro promissor, para os próximos 10 anos no Brasil, da assistência homecare com máquinas de hemodiálise portáteis, mais seguras e sustentáveis. / The Health Technology Assessment (HTA) is a systematic evaluation of clinical, social and economic impacts of health technologies aiming to assist managers in the decision making process related to the development, consolidation and discontinuation of these technologies. HTA agencies have been highlighting the importance of methods to standardize and apply this systematic evaluation in different contexts. Thus, the general objective of this thesis is to propose procedures to support the technology assessment of medical-hospital equipment through a constructive research applied to hemodialysis therapy. The proposed procedures compose a EuroScan adapted model, which was developed by European agencies and is recommended as a good practice by the Brazilian Ministry of Health, and also are procedures adjusted to the needs of researchers in regional centers of medical equipment assessment. Initially, a data collection on the problems of developing and incorporating health technologies was carried out using two sources: a systematic review of the literature on opportunities to improve the EuroScan around the world and discussions with Brazilian researchers. Based on these investigations, it was proposed a preliminary HTA model applied to the hemodialysis’ Operational and Innovation domain. The application of the model was reviewed and evaluated by experts to produce a final version. The main resulting procedures were: (i) to validate the importance of assessments for new technological developments and incorporations considering the point of view of different experts from diverse knowledge areas; (ii) to operate Technological Observatories, assisting to define the technologies and domains to be evaluated; (iii) to set techniques for the analysis of HTA domains such as the use of time series and the Technology Roadmap (TRM) to make predictions about the future of innovations and the use of usability dimensions and critical incidents of risks to the operational aspects; and (iv) to integrate HTA Brazilian guidelines in a single model, supporting researchers not related to health in the understanding of HTA and fast development of new studies for both emerging and in use equipment. The assessment of the domains selected for hemodialysis led to: (i) the identification of an annual growth in therapy indicators (7% in average); (ii) the usability diagnosis of efficient machines, however with the potential to generate greater user satisfaction considering: distance between machines, reduction in the waste of water and materials, maintenance plans to avoid high temperatures, training aiming more attention to supporting tasks as well as focus on display aspects (data feedback and visualization); and (iii) the consolidation among professionals of a future, for the next 10 years in Brazil, based on homecare with portable machines, safer and more sustainable.
42

The Soft Megamachine: Lewis Mumford's Metaphor of Technological Society and Implications for (participatory) Technology Assessment

January 2014 (has links)
abstract: This dissertation explores the megamachine, a prominent metaphor in American humanist and philosopher of technology, Lewis Mumford's Myth of the Machine series. The term refers critically to dynamic, regimented human capacities that drive scientific and technical innovation in society. Mumford's view of the nature of collectives focuses on qualities and patterns that emerge from the behavior of groups, societies, systems, and ecologies. It is my aim to reenergize key concepts about collective capacities drawn from Lewis Mumford's critique of historical and modern sociotechnical arrangements. I investigate the possibility of accessing those capacities through improved design for Technology Assessment (TA), formal practices that engage experts and lay citizens in the evaluation of complex scientific and technical issues. I analyze the components of Mumford's megamachine and align key concerns in two pivotal works that characterize the impact of collective capacities on society: Bruno Latour's Pasteurization of France (1988) and Elias Canetti's Crowds and Power (1962). As I create a model of collective capacities in the sociotechnical according to the parameters of Mumford's megamachine, I rehabilitate two established ideas about the behavior of crowds and about the undue influence of technological systems on human behavior. I depart from Mumford's tactics and those of Canetti and Latour and propose a novel focus for STS on "sociotechnical crowds" as a meaningful unit of social measure. I make clear that Mumford's critique of the sociotechnical status quo still informs the conditions for innovation today. Using mixed mode qualitative methods in two types of empirical field studies, I then investigate how a focus on the characteristics and components of collective human capacities in sociotechnical systems can affect the design and performance of TA. I propose a new model of TA, Emergent Technology Assessment (ETA), which includes greater public participation and recognizes the interrelationship among experience, affect and the material in mediating the innovation process. The resulting model -- the "soft" megamachine --introduces new strategies to build capacity for responsible innovation in society. / Dissertation/Thesis / Doctoral Dissertation Human and Social Dimensions of Science and Technology 2014
43

Procedimentos para avaliação tecnológica de equipamentos médico-hospitalares : um estudo aplicado à hemodiálise

Magnago, Patrícia Flores January 2016 (has links)
A Avaliação Tecnológica em Saúde (ATS) é uma sistemática que avalia os impactos clínicos, sociais e econômicos das tecnologias em saúde e tem como finalidade auxiliar os gestores na tomada de decisão quanto ao desenvolvimento, incorporação e descontinuação destas tecnologias. Agências de ATS têm destacado a importância da existência de métodos que visem padronizar e implantar esta sistemática em diferentes contextos. Assim, o objetivo geral desta tese é propor procedimentos para apoiar a avaliação tecnológica de equipamentos médico-hospitalares, por meio de uma pesquisa construtiva (Constructive Research) aplicada à terapia de hemodiálise. Os procedimentos propostos compõem um modelo adaptado do EuroScan, modelo desenvolvido por agências Europeias e indicado como boa prática pelo Ministério da Saúde do Brasil. Também são procedimentos ajustados às necessidades de pesquisadores de centros regionais de avaliação de equipamentos médico-hospitalares. Inicialmente, foi desenvolvida uma coleta de dados sobre os problemas de desenvolvimento e incorporação das tecnologias da saúde por meio de duas fontes: uma revisão sistemática de literatura sobre oportunidades de melhorias do EuroScan no mundo e discussões com pesquisadores no país. A partir destas investigações foi proposto um modelo preliminar de ATS, aplicado para o domínio Operacional e de Inovação na hemodiálise. Finalmente a aplicação foi validada e examinada por especialistas para a geração de um modelo final. Os principais procedimentos resultantes foram: (i) validação da relevância das avaliações para novos desenvolvimentos e incorporações tecnológicas do ponto de vista de diferentes especialistas, integrando diferentes áreas do conhecimento na ATS; (ii) operação de Observatórios Tecnológicos, auxiliando na definição das tecnologias e domínios a serem avaliadas; (iii) definição de técnicas para análise dos domínios de ATS, como o uso de séries temporais e o Technology Roadmap (TRM) para previsões sobre o futuro das inovações e o uso das dimensões da usabilidade e de incidentes críticos de riscos para os aspectos operacionais; e (iv) integração das diretrizes de ATS no Brasil em um único modelo, amparando pesquisadores não relacionados a saúde na compreensão sobre ATS e no desenvolvimento ágil de novos estudos tanto para equipamentos emergentes como em uso. Já a avaliação dos domínios selecionados para a hemodiálise resultou: (i) na identificação de um crescimento médio anual de 7% dos indicadores da terapia; (ii) no diagnóstico de usabilidade de máquinas eficazes, porém com possibilidades de gerarem maior satisfação aos usuários quanto: ao espaço entre elas, a redução dos desperdícios de água e materiais, aos planos de manutenção para evitar temperaturas elevadas, a capacitação visando mais atenção e treinamento para tarefas de apoio e aos aspectos de display (realimentação de dados e visualização); e (iii) na consolidação entre profissionais sobre um futuro promissor, para os próximos 10 anos no Brasil, da assistência homecare com máquinas de hemodiálise portáteis, mais seguras e sustentáveis. / The Health Technology Assessment (HTA) is a systematic evaluation of clinical, social and economic impacts of health technologies aiming to assist managers in the decision making process related to the development, consolidation and discontinuation of these technologies. HTA agencies have been highlighting the importance of methods to standardize and apply this systematic evaluation in different contexts. Thus, the general objective of this thesis is to propose procedures to support the technology assessment of medical-hospital equipment through a constructive research applied to hemodialysis therapy. The proposed procedures compose a EuroScan adapted model, which was developed by European agencies and is recommended as a good practice by the Brazilian Ministry of Health, and also are procedures adjusted to the needs of researchers in regional centers of medical equipment assessment. Initially, a data collection on the problems of developing and incorporating health technologies was carried out using two sources: a systematic review of the literature on opportunities to improve the EuroScan around the world and discussions with Brazilian researchers. Based on these investigations, it was proposed a preliminary HTA model applied to the hemodialysis’ Operational and Innovation domain. The application of the model was reviewed and evaluated by experts to produce a final version. The main resulting procedures were: (i) to validate the importance of assessments for new technological developments and incorporations considering the point of view of different experts from diverse knowledge areas; (ii) to operate Technological Observatories, assisting to define the technologies and domains to be evaluated; (iii) to set techniques for the analysis of HTA domains such as the use of time series and the Technology Roadmap (TRM) to make predictions about the future of innovations and the use of usability dimensions and critical incidents of risks to the operational aspects; and (iv) to integrate HTA Brazilian guidelines in a single model, supporting researchers not related to health in the understanding of HTA and fast development of new studies for both emerging and in use equipment. The assessment of the domains selected for hemodialysis led to: (i) the identification of an annual growth in therapy indicators (7% in average); (ii) the usability diagnosis of efficient machines, however with the potential to generate greater user satisfaction considering: distance between machines, reduction in the waste of water and materials, maintenance plans to avoid high temperatures, training aiming more attention to supporting tasks as well as focus on display aspects (data feedback and visualization); and (iii) the consolidation among professionals of a future, for the next 10 years in Brazil, based on homecare with portable machines, safer and more sustainable.
44

An Emerging Technology Assessment of Factory-Grown Food

January 2014 (has links)
abstract: In vitro, or cultured, meat refers to edible skeletal muscle and fat tissue grown from animal stem cells in a laboratory or factory. It is essentially meat that does not require an animal to be killed. Although it is still in the research phase of development, claims of its potential benefits range from reducing the environmental impacts of food production to improving human health. However, technologies powerful enough to address such significant challenges often come with unintended consequences and a host of costs and benefits that seldom accrue to the same actors. In extreme cases, they can even be destabilizing to social, institutional, economic, and cultural systems. This investigation explores the sustainability implications of cultured meat before commercial facilities are established, unintended consequences are realized, and undesirable effects become reified and locked in. The study utilizes expert focus groups to explore the social implications, life cycle analysis to project the environmental implications, and economic input-output assessment to explore tradeoffs between conventionally-produced meat and factory-grown food products. The results suggest that, should cultured meat be widely adopted by consumers, food is likely to be increasingly a product of human design, perhaps becoming integrated into existing human institutions such as health care delivery and education. Environmentally, cultured meat could require smaller quantities of agricultural inputs and land than livestock. However, those avoided costs could come at the expense of more intensive energy use as biological processes are replaced with industrial systems. Finally, the research found that, since livestock production is a driver of significant economic activity, shifting away from traditional meat production in favor of cultured meat production could result in a net economic contraction. / Dissertation/Thesis / Ph.D. Civil and Environmental Engineering 2014
45

Knowledge Translation of Economic Evaluations and Network Meta-Analyses

Sullivan, Shannon January 2015 (has links)
Economic evaluations and network meta-analyses (NMAs) are complex methodologies. Increasing their transparency and accessibility could enhance confidence in the legitimacy of policy decisions informed by these analyses. Four systematic reviews were conducted to understand policymakers’ informational needs and to determine what guidance researchers have on how to present economic evaluations and NMAs. Qualitative interviews were conducted with Canadian policymakers, i.e., knowledge users, to understand barriers and facilitators to using and communicating economic evaluations and NMAs and with individuals in international health technology assessment organizations, i.e. knowledge producers, to explore current approaches to communicating economic evaluations and NMAs. A toolkit for NMAs and economic evaluations was proposed based on an integrated review of these findings and guided by the Knowledge-to-Action framework. Examples of tools were developed and applied to an economic evaluation and NMA of osteoporosis therapies. Systematic reviews and qualitative interviews found that communication approaches that provide robust content, identify contextual factors relevant to policy decisions and enhance clarity were valued. Twelve tools were proposed that enhance communication, education and access to resources for policymakers. Two of these tools were developed: Economic Guidance for Researchers and NMA Guidance for Researchers.
46

Deliberative Democracy and Expertise: New Directions for 21st Century Technology Assessment

Caron, Brandiff Robert 26 July 2012 (has links)
This dissertation presents the case for a normative vision of the relationship between technical experts and other non-expert members of a democratic citizenry. This vision is grounded in two key insights that have emerged from the field of science and technology studies. First, is the "third wave" science studies movement that identifies problems of expertise as the "pressing intellectual problem of the age." Characterized by the problems of legitimacy and extension, Collins and Evans build the case for the extension of the category of expertise to include those who have the relevant experience but lack relevant accreditation. Alongside this extension of the category of expertise is the extension of those who participate in the framing of techno-scientific issues. This dissertation builds a case for the inclusion of all democratic citizens in the problem framing process. What we are left with from the current "third wave" literature is a multi-tiered prescription for the role of non-experts in public decision-making about science and technology. On the ground floor, when the issue is being framed there is a need to include non-expert stakeholders (in theory, any concerned democratic citizen). Once a framing of the problem has been constructed, there is a need to recognize a larger category of people who count as "expert." Together, these constitute the two most powerful prescriptive elements of expertise developed in the recent science studies literature. The dissertation then explores claims that it is specifically "deliberative" theories of democracy that are best suited to make sense out of this democratization of expertise. After presenting a typology of deliberative theories of democracy that clears up a serious problem of equivocation found in appeals to deliberative democracy in current STS literature, this dissertation argues that only a specific set of deliberative theories of democracy, "discursive" deliberative theories of democracy, are capable of fulfilling the role theories of deliberative democracy are assigned in current STS literature. The dissertation then goes on to suggest how these new insights into the democratization of expertise might affect future instantiations of technology assessment mechanisms (such as the office of Technology Assessment) in the U.S. / Ph. D.
47

Medical Cannabis for the Treatment of Drug-Resistant Epilepsy in Children: A Health Technology Assessment

Elliott, Jesse 07 May 2020 (has links)
Interest in the use of medical cannabis for the treatment of drug-resistant epilepsy in children has grown over the last decade; however, little is known about its potential benefits and harms, cost-effectiveness, or the perspectives of key stakeholders. In this thesis, a health technology assessment approach was adopted to assess the intended and unintended consequences of medical cannabis use in the treatment of pediatric drug-resistant epilepsy. This thesis comprises three main sections: (1) a living systematic review of the benefits and harms of medical cannabis for the treatment of pediatric epilepsy, including drug-resistant forms; (2) an economic evaluation of the cost-effectiveness of medical cannabis for the treatment of pediatric drug-resistant epilepsy, and (3) qualitative exploration of the perspectives of neurologists and parents of children with drug-resistant epilepsy about the use of medical cannabis in this population. While neurologists generally perceived medical cannabis as a viable treatment option for drug-resistant epilepsy in children, particularly after other treatments have failed, they identified several gaps in the evidence base, including a lack of long-term studies and a lack of evidence related to cannabinoids other than cannabidiol. This is in keeping with the findings of the living systematic review, which support a beneficial role for medical cannabis in reducing seizures associated with drug-resistant epilepsy, although the certainty of the evidence was moderate at best. Parents described experiencing many barriers to accessing medical cannabis for their children, primarily related to finding a health care provider to authorize its use, the high cost of cannabis-based treatments, and a lack of reimbursement through public or private insurance programs. However, cannabinoid oil may be a more cost-effective treatment for some types of pediatric drug-resistant epilepsy compared with antiepileptic drugs currently reimbursed by some provincial insurance programs. These findings suggest that medical cannabis is a potentially effective and cost-effective treatment for drug-resistant epilepsy that may addresses an unmet need. However, additional studies are needed to address uncertainty related to the long-term benefits and harms of cannabis-based products, particularly with respect to products available in Canada.
48

An Investigation of the Attractiveness and Feasibility of Introducing Temocillin to the Swedish or Scandinavian Market

Hultqvist, Lovisa, Jonsson, Cajsa, Kani, Sufyan, Regnell, Julia, Weiden, Lovisa January 2023 (has links)
Antibiotic resistance is a global health concern. Its increasing development is seemingly due to the irresponsible use of antibiotics and their availability. To ensure the correct treatment of patients and avoid unnecessary strain on the individual and society as a whole, it is vital to ensure access to both new and old antibiotics where there is a distinct need. Temocillin is an antibiotic used in the treatment of febrile UTIs. It is currently unavailable in Sweden, although being well-established and proven effective in other European countries. Hence, this report aims to investigate the introduction of temocillin to the Swedish or Scandinavian market in regards to the economic, technical, medical, and regulatory possibilities and barriers. The research is based on literature, internet, and database reviews and empirical data collection through interviews with people of expertise within the fields of antibiotic resistance and concerned aspects. This study emphasizes the great potential of introducing temocillin to Sweden. The evident conclusion drawn is that a production of the antibiotic is not possible in Sweden in the near future. Despite this, an identified supply chain in Europe can enable a role for Sweden as a distribution country. Through a performed break-even analysis, the calculated break-even point and profit margins indicated a low risk of financial loss for a MAH acting as the supplier of temocillin, such as the company Eumedica S.A.. Only 1 % of the Swedish market would have to be covered to break even, and regardless of the estimated volumes of usage upon introduction being either 50 % or 25 % of the total medical need, a profit is likely. In addition, temocillin holds a great medical and social value. However, the obvious obstacle observed is its out-dated documentation. The dossier is of the wrong format, which complicates the regulatory procedure. Thus, this needs to be taken into consideration for an introduction to be possible.
49

THE ARTICULATION OF PUBLIC VALUES IN HEALTH TECHNOLOGY ASSESSMENT: THE USE OF DELIBERATIVE DISCOURSE

Simeonov, Dorina 10 1900 (has links)
Objectives: The use of interactive public engagement methods to elicit public values is becoming routine practice in health system planning, policy and evaluation; however, little systematic attention has been given to the analysis of how these values are articulated. This process will be examined with the use of deliberative discourse methods in the context of health technologies. Approach: The deliberations of a 14-person Citizens’ Reference Panel on Health Technologies were audiotaped and transcribed. The panel provided input to the Ontario Health Technology Advisory Committee in developing its recommendations. Discussion transcripts were analyzed using Gee’s (2005) ‘building tasks’ framework with a focus on identities, relationships, and politics. In depth language-context analysis was then used to study ‘situated meanings’ of social and ethical citizen values. Both levels of discourse analysis were then used to elicit the meso-level dynamics within the citizen panel deliberations. Results: Panel members used the provided materials, personal experience and other sources of information to express their values toward the technologies under review. In the group, members used their occupational, personal and cultural identities and adopted in-group citizen panel roles that involved summarizing small group discussions, challenging other members, providing information, providing expertise, interpreting information and facilitating. These individual roles were similar across meetings and members began to form relationships with their fellow citizens and make connections between the values involved in similar technologies. Conclusion: Discourse analysis methods can be used to draw in-depth insights from public engagement deliberations which contribute important new knowledge to the field of public deliberation and health policy. Further use and refinement of deliberative discourse methods will allow public values to be better understood and more adequately portrayed in the health technology assessment process. / Master of Science (MSc)
50

The Politics of Child Health Technologies: Social Values and Public Policy on Drug Funding for Children in Canada / The Politics of Child Health Technologies

Denburg, Avram Ezra January 2018 (has links)
Health technology assessment (HTA) frameworks appraise the value of technologies – be they drugs, devices, procedures or services – to inform policy decision-making and resource allocation amongst alternatives within publicly funded health systems. The prevailing principles and metrics by which HTA is conducted were designed with adult health conditions and treatments in mind. The evidentiary and normative dimensions of HTA frameworks may have unique repercussions for drug policy and coverage decisions in children, but their relevance to child health has received almost no critical scrutiny in either academic or policy circles. Approaches to paediatric drug coverage approval and access currently lack child-specific data on social values and priorities, a core component of HTA in most countries with public drug funding programs, including Canada. This thesis presents a mixed methods study of social values relevant to child HTA and drug policymaking in publicly funded health systems, comprised of three original scientific contributions. The first of these is a critical interpretive synthesis (CIS) of the academic literature on the moral dimensions of child health and social policymaking across a range of disciplines and policy domains. The second is a grounded theory analysis of qualitative interviews with diverse health system stakeholders on the social values and health system factors relevant to child HTA and drug funding policy in Canada. The third is a stated preference survey of the general public that assesses societal preferences for health resource allocation to children as compared to adults, to generate evidence for priority setting on health technologies within Canada’s publicly funded health system. Together, these studies yield specific knowledge about the policy landscape for child health technologies in Canada, broad conceptual insights into the normative and methodological dimensions of child HTA, and a foundational understanding of the social values relevant to drug policy decisions for children. / Thesis / Doctor of Philosophy (PhD) / Drug research, development and policy have historically excluded children. One area of persistent neglect is public policy on funding for paediatric medicines. In most publicly funded health systems, including Canada’s, decisions about which drugs to cover are made through a formal process called health technology assessment (HTA). This dissertation examines the role and challenges of HTA as applied to child health technologies, with a focus on the social values that inform drug policy for children. It addresses existing gaps in knowledge through the integration of insights from: 1) a comprehensive review of the academic literature on the moral dimensions of child health and social policymaking; 2) in-depth qualitative analysis of the HTA and drug policy environments for children in Canada, employing Ontario as a case study; and 3) a survey of the Canadian public on health system resource allocation for children. Together, these studies generate a detailed picture of the Canadian policy landscape for child health technologies, insights into the fit of current HTA approaches to the realities of child health and illness, and a foundational understanding of the social values relevant to drug policy decisions for children.

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