Expert Panel Workshop Research Articles

Health policy and systems research priority-setting exercise in Ethiopia: a collaborative approach

IntroductionHealth policy and systems research (HPSR) is a multi-disciplinary approach of generating health system and policy-level evidence. Setting HPSR agendas is considered as an efficient strategy to map and identify policy and cost-effective research topics, but its practice in developing countries is limited. This paper aimed to conduct a collaborative health policy and system research priority-setting exercise in Ethiopia.MethodThe WHO’s plan, implement, publish, and evaluate (PIPE) framework and the Delphi technique were used to conduct the priority-setting exercise. The PIPE model was used to lead the priority-setting process from planning to evaluation, while the Delphi technique was used to run the rating and ranking exercise with the aim of reaching a consensus. Two rounds of expert panel workshops supplemented with an online survey were used for the HPSR agenda setting, rating and ranking purposes. Groups were formed using the WHO health system building blocks as a base framework to identify and prioritize the HPSR topics.ResultUnder 8 themes, 32 sub-themes and 182 HPSR topics were identified. The identified research themes include leadership management and governance, health policy, health information system, healthcare financing, human resource for health, medical products and supply, service delivery and cross-cutting issues.ConclusionsPriority HPSR topics focussing on national health priority issues were identified. The identified topics were shared with policymakers and academic and research institutions. Evidence generation on the identified priority topics will guide future research endeavours and improve evidence-informed decision-making practice, health system performance and national health goals and targets.

User Requirements in Developing a Novel Dietary Assessment Tool for Children: Mixed Methods Study.

The prevalence of childhood obesity and comorbidities is rising alarmingly, and diet is an important modifiable determinant. Numerous dietary interventions in children have been developed to reduce childhood obesity and overweight rates, but their long-term effects are unsatisfactory. Stakeholders call for more personalized approaches, which require detailed dietary intake data. In the case of primary school children, caregivers are key to providing such dietary information. However, as school-aged children are not under the full supervision of one specific caregiver anymore, data are likely to be biased. Recent technological advancements provide opportunities for the role of children themselves, which would serve the overall quality of the obtained dietary data. This study aims to conduct a child-centered exploratory sequential mixed methods study to identify user requirements for a dietary assessment tool for children aged 5 to 6 years. Formative, nonsystematic narrative literature research was undertaken to delineate initial user requirements and inform prototype ideation in an expert panel workshop (n=11). This yielded 3 prototype dietary assessment tools: FoodBear (tangible piggy bank), myBear (smartphone or tablet app), and FoodCam (physical camera). All 3 prototypes were tested for usability by means of a usability task (video analyses) and user experience (This or That method) among 14 Dutch children aged 5 to 6 years (n=8, 57% boys and n=6, 43% girls). Most children were able to complete FoodBear's (11/14, 79%), myBear's (10/14, 71%), and FoodCam's (9/14, 64%) usability tasks, but all children required assistance (14/14, 100%) and most of the children encountered usability problems (13/14, 93%). Usability issues were related to food group categorization and recognition, frustrations owing to unsatisfactory functioning of (parts) of the prototypes, recall of food products, and the distinction between eating moments. No short-term differences in product preference between the 3 prototypes were observed, but autonomy, challenge, gaming elements, being tablet based, appearance, social elements, and time frame were identified as determinants of liking the product. Our results suggest that children can play a complementary role in dietary data collection to enhance the data collected by their parents. Incorporation of a training program, auditory or visual prompts, reminders and feedback, a user-friendly and intuitive interaction design, child-friendly food groups or icons, and room for children's autonomy were identified as requirements for the future development of a novel and usable dietary assessment tool for children aged 5 to 6 years. Our findings can serve as valuable guidance for ongoing innovations in the field of children's dietary assessment and the provision of personalized dietary support.

MSR23 Health Economic Evaluations Alongside New Clinical Trial Designs – Results of an International Expert Panel Workshop

Cancer research is rapidly evolving with the proliferation of molecular targeted therapies. New types of adaptive, basket, and umbrella trials came to fore to assess innovative treatments tied to the existence of selected biomarkers rather than histological site. There is a lack of sound methodological guidance on conducting health economic evaluations alongside new trial designs. This study aims to investigate 1) how clinical evidence from such trials can be used in economic analyses, and 2) how HTA can respond to the paradigm shift in cancer research and development.

Biomarkers for the prediction of heart failure and cardiovascular events in patients with type 2 diabetes: a position statement from the Heart Failure Association of the European Society of Cardiology.

Knowledge on risk predictors of incident heart failure (HF) in patients with type 2 diabetes (T2D) is crucial given the frequent coexistence of the two conditions and the fact that T2D doubles the risk of incident HF. In addition, HF is increasingly being recognized as an important endpoint in trials in T2D. On the other hand, the diagnostic and prognostic performance of established cardiovascular biomarkers may be modified by the presence of T2D. The present position paper, derived by an expert panel workshop organized by the Heart Failure Association of the European Society of Cardiology, summarizes the current knowledge and gaps in evidence regarding the use of a series of different biomarkers, reflecting various pathogenic pathways, for the prediction of incident HF and cardiovascular events in patients with T2D and in those with established HF and T2D.

Conceptual Development and Content Validation of a Multicultural Instrument to Assess the Normalization of Gender-Based Violence against Women

The normalization of gender-based violence (GBV) consists of all those cultural beliefs and values that sustain, justify, or minimize GBV perpetration. Acknowledging the lack of instruments addressing the normalization of GBV and its constitutive sociocultural dimensions, this article presents the conceptual development and initial validation of the Normalization of gender-based violence against women scale. This 18-item instrument could be used to assess the normalization of violence against women in GBV survivors of various cultural contexts. The scale has been developed through a sizeable mixed-methods study. This paper reports the qualitative portion of the study that allowed the development of the instrument and assessment of its content and face validity. In particular, the method section details the process by which the assessed scale’s domain has been identified through an expert panel workshop, the analysis of GBV survivor’s interviews, and the review of existing scales. The assessment of face and content validity, trough expert judges’ evaluation and Cognitive Interviewing, is presented. This instrument is the first normalization scale developed by a multicultural team for use with violence survivors. The techniques used to construct this scale aimed to capture cultural aspects of normalization that might be shared across women from diverse groups. Therefore, its use could enable social or health care providers worldwide to program or evaluate the effectiveness of interventions to contrast GBV by promoting a clearer understanding of cultural and social norms that sustain the acceptance and normalization of violence.

National Institutes of Health Advancing Multimorbidity Research.

Multimorbidity, the co-occurrence of 2 or more chronic diseases, is more common than having a single chronic disease, especially among persons age 65 years and older. The routine measurement of multimorbidity can facilitate a better understanding of potential causes and interactions and promote more effective treatment and improved outcomes. To present a multimorbidity research framework and identify gaps in the research literature related to multimorbidity. In preparation for an expert panel workshop convened in September 2018, planning committee members reviewed the literature and developed a guiding framework that informed the selection of topics and speakers. The framework, grounded in a patient-centered approach, incorporates the concept of concordant and discordant comorbidity, and includes potential causes, interactions, and outcomes. This work informed workshop presentations and discussion related to identifying and selecting the best available multimorbidity instruments and determining future research needs. Multimorbidity research can be advanced by addressing gaps in study design and target populations, and by increasing attention to universal outcome measurement.

Rebound in Sexually Transmitted Infections Following the Success of Antiretrovirals for HIV/AIDS.

Nearly 1 million people become infected every day with any of the four major curable sexually transmitted infections (STIs), namely trichomoniasis, chlamydia, gonorrhea, and syphilis. Despite huge global incidence, STIs remain as neglected diseases. The success of antiretrovirals for halting progression to AIDS in HIV-infected individuals and for stopping HIV transmission to uninfected contacts, either as pre- or post-exposure -prophylaxis, has to lead to increased risky sexual behaviors through risk compensation. Recent epidemics and outbreaks of STIs among men having sex with men reflect the global loss of fear to HIV/AIDS. The -alarming rising rates of STIs worldwide have been fueled by: (1) rapid spread of drug resistance, that is, for Neisseria gonorrhoeae and Mycoplasma genitalium; (2) unprecedented impact of recreational drugs (chemsex) and internet (apps, websites) for facilitating exposure to multiple sex partners; and (3) growing rates of sexual violence and commercial sex, associated with wars, refugees, migrations, traveling, and sexual tourism. Moreover, there is an increasing appreciation of sexual transmission for other agents, -including human T-lymphotropic virus type 1, hepatitis A and C viruses, Zika, and Ebola. For addressing this new scenario for STIs, an expert panel workshop was arranged in Madrid, Spain in May 2018. This review summarizes the discussions at the meeting.

Education for Sustainability in Western Australian Secondary Schools: Are We Doing It?

AbstractThis research was commissioned by the (then) Department of Environment and Conservation (DEC) to provide recommendations on how to best support Western Australian (WA) secondary schools to engage in education for sustainability (EfS). The research aims were to identify barriers and benefits to being involved in EfS, the support systems required for schools to participate in EfS at secondary school level, and the difficulties that secondary schools experience when implementing EfS programs. A variety of research methods were utilised: semi-structured interviews with non-teaching stakeholders; online questionnaires for teachers, school administrators and students; focus groups and semi-structured interviews with teachers and school administrators; and an expert panel workshop to discuss data and recommendations prior to completion of a final report. Data were collected from 29 schools, 45 teachers and school administrators, 186 students, and various EfS external providers and stakeholders across metropolitan and regional WA. This article focuses on three issues identified in the data that we consider important and under-represented in discourses of EfS in Australia: lack of understanding about what EfS means among educators; lack of meaningful student involvement in EfS in secondary schools; and differing quality in EfS programs offered by external providers. We conclude this article by offering ways to improve EfS in WA secondary schools.

Assessing scientists for hiring, promotion, and tenure.

Assessment of researchers is necessary for decisions of hiring, promotion, and tenure. A burgeoning number of scientific leaders believe the current system of faculty incentives and rewards is misaligned with the needs of society and disconnected from the evidence about the causes of the reproducibility crisis and suboptimal quality of the scientific publication record. To address this issue, particularly for the clinical and life sciences, we convened a 22-member expert panel workshop in Washington, DC, in January 2017. Twenty-two academic leaders, funders, and scientists participated in the meeting. As background for the meeting, we completed a selective literature review of 22 key documents critiquing the current incentive system. From each document, we extracted how the authors perceived the problems of assessing science and scientists, the unintended consequences of maintaining the status quo for assessing scientists, and details of their proposed solutions. The resulting table was used as a seed for participant discussion. This resulted in six principles for assessing scientists and associated research and policy implications. We hope the content of this paper will serve as a basis for establishing best practices and redesigning the current approaches to assessing scientists by the many players involved in that process.

A Study on the Severity Classification in the KDRG-KM (Korean Diagnosis-Related Groups - Korean Medicine)

Backgrounds Inpatient Classification System for Korean Medicine (KDRG-KM) was developed and has been applied for monitoring the costs of KM hospitals. Yet severity of patients’ condition is not applied in the KDRG-KM. Objectives This study aimed to develop the severity classification methods for KDRG-KM and assessed the explanation powers of severity adjusted KDRG-KM. Methods Clinical experts panel was organized based on the recommendations from 12 clinical societies of Korean Medicine. Two expert panel workshops were held to develop the severity classification options, and the Delphi survey was performed to measure CCL(Complexity and Comorbidity Level) scores. Explanation powers were calculated using the inpatient EDI claim data issued by hospitals and clinics in 2012. Results Two options for severity classification were deduced based on the severity classification principle in the domestic and foreign DRG systems. The option one is to classify severity groups using CCL and PCCL(Patient Clinical Complexity Level) scores, and the option two is to form a severity group with patients who belonged principal diagnosis-secondary diagnosis combinations which prolonged length of stay. All two options enhanced explanation powers less than 1%. For third option, patients who received certain treatments for severe conditions were grouped into severity group. The treatment expense of the severity group was significantly higher than that of other patients groups. Conclusions Applying the severity classifications using principal diagnosis and secondary diagnoses can advance the KDRG-KM for genuine KM hospitalization. More practically, including patients with procedures for severe conditions in a severity group needs to be considered. Keywords: KDRG-KM, Diagnosis-Related Groups, patient classification system, Korean Medicine, severity classification, CCL

Decentralised training for medical students: Towards a South African consensus.

IntroductionHealth professions training institutions are challenged to produce greater numbers of graduates who are more relevantly trained to provide quality healthcare. Decentralised training offers opportunities to address these quantity, quality and relevance factors. We wanted to draw together existing expertise in decentralised training for the benefit of all health professionals to develop a model for decentralised training for health professions students.MethodAn expert panel workshop was held in October 2015 initiating a process to develop a model for decentralised training in South Africa. Presentations on the status quo in decentralised training at all nine medical schools in South Africa were made and 33 delegates engaged in discussing potential models for decentralised training.ResultsFive factors were found to be crucial for the success of decentralised training, namely the availability of information and communication technology, longitudinal continuous rotations, a focus on primary care, the alignment of medical schools’ mission with decentralised training and responsiveness to student needs.ConclusionThe workshop concluded that training institutions should continue to work together towards formulating decentralised training models and that the involvement of all health professions should be ensured. A tripartite approach between the universities, the Department of Health and the relevant local communities is important in decentralised training. Lastly, curricula should place more emphasis on how students learn rather than how they are taught.

Challenges and opportunities in the use of low‐energy sugar replacers

Challenges and opportunities in the use of low‐energy sugar replacers

U.S. Transportation and Health Tool: Data for action.

Transportation investments have the potential to improve health, but readily available data to guide transportation decisions that could promote health are limited. In October 2015, the U.S. Department of Transportation (USDOT) and the Centers for Disease Control and Prevention (CDC) released the Transportation and Health Tool (THT). The tool is a resource to help transportation professionals in states and metropolitan areas access data about transportation and health in their jurisdictions and stimulate discussions on how to improve public health through transportation planning and policy. To develop the tool, a multidisciplinary team identified 190 possible data indicators. Using input from expert panel workshops and criteria that addressed data availability, geographic scale, timeliness, feasibility, validity, and topic area, the team selected 14 transportation and health indicators that covered the four priority topic areas of safety, active transportation, air quality, and connectivity. The THT contains the raw values for each indicator and a standardized score to enable comparisons. Additionally, the THT contains 25 evidence-based strategies that can help practitioners in states and metropolitan areas take action to improve health outcomes.

OP19 Unlocking The Potential Of Established Products: Need For Incentives

INTRODUCTION:Re-purposing of established products (EPs) – defined as marketed for 8 years or more – may represent a high value for patients and society. It has been recognized by the European Commission as an important factor contributing to greater access to new therapies. Due to a lower development cost, it could also represent a cost-effective alternative and help to reduce pressure on healthcare budgets. However, it is perceived that no financial incentives exist for the pharmaceutical industry to invest in new indications for EPs. The objective of this research was to review current European regulations and propose strategies stimulating development in this field.METHODS:We performed a targeted literature review and held two international expert panel workshops to discuss current policies and their implications, and issue recommendations for changes.RESULTS:Within the current regulatory framework EPs face price cuts due to generic competition, reference pricing (RP), price re-negotiations or systematic price cuts, after a period of marketing presence. Extension of indications does not permit to increase or maintain the price. Generic substitution regardless of indication poses another challenge. Limited incentives in the form of an additional year of market protection exists only for new indication(s) registered within the first 8 years following initial approval. The expert panel proposed several strategies to stimulate development in this field, including: (i) extending the period in which registering a new indication results in additional market protection beyond 8 years and extending the duration of additional market protection; (ii) delaying inclusion in RP for EPs with a new value adding indication; (iii) establishing a differential pricing by indication; (iv) preventing temporarily generic substitution when an EP is prescribed for a new indication.CONCLUSIONS:Current regulations represent a serious disincentive to develop new indications for EPs. Regulatory and pricing policy changes are needed to stimulate development in this important field.

Distributed manufacturing: scope, challenges and opportunities

This discussion paper aims to set out the key challenges and opportunities emerging from distributed manufacturing (DM). We begin by describing the concept, available definitions and consider its evolution where recent production technology developments (such as additive and continuous production process technologies), digitisation together with infrastructural developments (in terms of IoT and big data) provide new opportunities. To further explore the evolving nature of DM, the authors, each of whom are involved in specific applications of DM research, examine through an expert panel workshop environment emerging DM applications involving new production and supporting infrastructural technologies. This paper presents these generalisable findings on DM challenges and opportunities in terms of products, enabling production technologies and the impact on the wider production and industrial system. Industry structure and location of activities are examined in terms of the democratising impact on participating network actors. The paper concludes with a discussion on the changing nature of manufacturing as a result of DM, from the traditional centralised, large-scale, long lead-time forecast-driven production operations to a new DM paradigm where manufacturing is a decentralised, autonomous near end user-driven activity. A forward research agenda is proposed that considers the impact of DM on the industrial and urban landscape.

Meeting the public health challenge of protecting private wells: Proceedings and recommendations from an expert panel workshop

Private wells serving fewer than 25 people are federally unregulated, and their users may be exposed to naturally occurring agents of concern such as arsenic and radionuclides, as well as anthropogenic contaminants. The Centers for Disease Control and Prevention's Clean Water for Health Program works to protect private wells and prevent adverse health outcomes for the roughly 15% of Americans who rely on them. To understand current and emerging challenges to the private drinking water supply, an interdisciplinary expert panel workshop on “Future and Emerging Issues for Private Wells” was organized to inform strategic planning for the Clean Water for Health Program. The panel assessed current conditions of ground water as a source for private wells, identified emerging threats, critical gaps in knowledge, and public health needs, and recommended strategies to guide future activities to ensure the safety of private drinking water wells. These strategies addressed topics of broad interest to the environmental public health community including: development of new methods to support citizen science; addressing contaminant mixtures; expanding capacity for well testing; evaluating treatment technologies; building an evidence base on best practices on well owner outreach and stewardship; and research and data needs.

Development of a Safety Management Web Tool for Horse Stables.

Simple SummaryA new web tool for equine activities, InnoHorse, was developed to support horse stable managers in business, safety, pasture and manure management. The aim of the safety section of the web tool was to raise awareness of safety issues in daily horse stable activities. This section contains a safety checklist, stable safety map and good practices to support human health and horse welfare and to prevent injuries in horse-related activities. Reviews of the literature and statistics, empirical horse stable case studies, expert panel workshops and stakeholder interviews were utilized in designing the web tool.Managing a horse stable involves risks, which can have serious consequences for the stable, employees, clients, visitors and horses. Existing industrial or farm production risk management tools are not directly applicable to horse stables and they need to be adapted for use by managers of different types of stables. As a part of the InnoEquine project, an innovative web tool, InnoHorse, was developed to support horse stable managers in business, safety, pasture and manure management. A literature review, empirical horse stable case studies, expert panel workshops and stakeholder interviews were carried out to support the design. The InnoHorse web tool includes a safety section containing a horse stable safety map, stable safety checklists, and examples of good practices in stable safety, horse handling and rescue planning. This new horse stable safety management tool can also help in organizing work processes in horse stables in general.

Standards as catalyst for national innovation and performance – a capability assessment framework for latecomer countries

This paper develops a framework for assessing national standards capability. The framework draws on total quality management (TQM) models as its theoretical basis and was developed through an expert group panel, interviews, and focus group workshops. To verify the framework, pilot implementation was conducted in four countries. The results show that the proposed framework is useful for measuring the strengths and weaknesses of overall capability per pillar and category in a national standards system. The paper contributes to the expansion of the TQM model in assessing national level capability by more effective evaluation and systematic development of national standards systems for developing countries.

DOUBLE PROTECTION: Reaching Accord on the Ethical Conduct of Child Observational Research

From Bernardino Ramazzini’s visits to seventeenth-century craftsmen’s worksites—where he made observations that earned him the title of “father of occupational medicine”—to modern-day research leading to bans on public smoking, observational studies have improved and enhanced environmental health. Such studies involve observing people’s everyday lives, defining the characteristics of their environments, and determining whether any risks arise from activities within the context of those environments. Modern environmental observational studies, including the recently launched National Children’s Study, also measure environmental compounds and their metabolites in people’s bodies while assessing sources and routes of exposure so that the appropriate agencies can initiate reduction strategies if high exposures are seen. Generally, an observational study is conducted without the observer intervening with research subjects to avoid undermining research goals. However, strict adherence to this practice could create significant ethical concerns, particularly when a vulnerable subject such as a child is at risk for harm. Misunderstandings and disagreements about how those concerns should be addressed in children’s observational exposure studies have forced researchers and policy makers to more precisely—and now possibly successfully—define what constitutes a scientifically rigorous and ethical study.

Introduction to the Proceedings of a Centers for Disease Control and Prevention Expert Panel Workshop: Developing a Comprehensive Public Health Strategy for Preventing the Development, Progression, and Complications of CKD

Chronic kidney disease (CKD) is now recognized as a major public health problem that imposes an enormous societal burden for the United States. The prevalence of kidney failure treated by means of dialysis and transplantation, as well as earlier stages of CKD, is increasing and will continue to increase in the future despite the inclusion of a summary of strategies for public health action on CKD published by the Centers for Disease Prevention and Control (CDC) in Healthy People 2010. 1 US Department of Health and Humans ServicesChronic Kidney Disease. Healthy People 2010: Understanding and Improving Health and Objectives for Improving Health (ed 2), vol 2. US Government Printing Office, Washington, DCNovember 2000http://www.healthypeople.gov/Document/pdf/Volume1/04CKD.pdf Google Scholar CKD is now the ninth leading cause of death in males and females in the United States, reflecting this growing impact on the health and well-being of the US population. In March 2007, seven years after the release of Healthy People 2010, the CDC convened a 2-day conference titled Developing a Comprehensive Public Health Strategy for Preventing the Development, Progression, and Complications of CKD to examine responses to this public health threat and develop new strategies for preventing and slowing the progression of CKD.