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PP108 Multidimensional Analysis Of Peristeen Plus Medical Device
- Americo Cicchetti, Alessandra Fiore, Filippo Rumi, Maria Giovanna Di Paolo, Agostino Fortunato
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- Journal:
- International Journal of Technology Assessment in Health Care / Volume 38 / Issue S1 / December 2022
- Published online by Cambridge University Press:
- 23 December 2022, p. S75
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Introduction
Neurogenic bowel dysfunction occurs in people with central nervous system disease or injury and causes loss of bowel control and severe constipation. These problems involve a lot of anxiety and discomfort and can reduce the quality of life of those who suffer from them, therefore the management of symptoms is very important. Peristeen Plus is a transanal irrigation (TAI) system for bowel dysfunction management, used to empty the rectum and distal sigmoid colon, to prevent uncontrolled bowel movements or to relieve and prevent constipation.
MethodsA literature review was conducted. A total of 14 records were included to evaluate the benefits in terms of efficacy and safety associated with the adoption of the medical device. To assess the economic impact, two different budget impact models have been implemented. The first aimed at evaluating an incremental diffusion in a short-term time horizon (3 years) of the home distribution of the device compared to the direct and indirect distribution methods in the Italian context. The second model aimed at assessing the impact of the diffusion of the device in the clinical practice.
ResultsOverall, most studies demonstrate improved endpoints related to the severity of fecal incontinence, constipation and intestinal disorders in patients using the device. The economic assessments conducted estimate that the increase in the Italian care setting is associated with a saving of resources in each year under analysis. The diffusion of home distribution of the device would potentially be able to offer a lower absorption of resources compared to other distribution methods. In addition to this, there is an incremental saving correlated to the degree of diffusion of Peristeen Plus.
ConclusionsTAI is considered a safe and more effective method than conventional treatments for reducing fecal incontinence, constipation and improving quality of life. The results of our study confirm the benefits of TAI as a second-line treatment in case of failure of conventional medical therapy in the management of the neurogenic gut.
TOWARD A CONTINGENCY MODEL FOR HOSPITAL-BASED HEALTH TECHNOLOGY ASSESSMENT: EVIDENCE FROM ADHOPHTA PROJECT
- Americo Cicchetti, Valentina Iacopino, Silvia Coretti, Alessandra Fiore, Marco Marchetti, Laura Sampietro-Colom, Kristian Kidholm, Jean-Blaise Wasserfallen, Rabia Kahveci, Esa Halmesmäki, Magdalene Rosenmöller, Claudia Wild, Raul-Allan Kivet
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- Journal:
- International Journal of Technology Assessment in Health Care / Volume 34 / Issue 2 / 2018
- Published online by Cambridge University Press:
- 16 April 2018, pp. 205-211
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Objectives: Hospital-based health technology assessment (HB-HTA) is becoming increasingly relevant because of its role in managing the introduction and withdrawal of health technologies. The organizational arrangement in which HB-HTA activities are conducted depends on several contextual factors, although the dominant models have several similarities. The aims of this study were to explore, describe, interpret, and explain seven cases of the application of HB-HTA logic and to propose a classification for HB-HTA organizational models which may be beneficial for policy makers and HTA professionals.
Methods: The study was part of the AdHopHTA Project, granted under the European 7th Framework Research Programme. A case study methodology was applied to analyze seven HB-HTA initiatives in seven countries, with collection of qualitative and quantitative data. Cross-case analysis was performed within the framework of contingent organizational theory.
Results: Evidence showed that some organizational or “structural” variables, namely the level of procedure formalization/structuration and the level of integration with other HTA bodies at the national, regional, and provincial levels, predominantly shape the HB-HTA approach, determining a contingency model of HB-HTA. Crossing the two variables, four options have emerged: integrated specialized HTA unit, stand-alone HTA unit, integrated-essential HTA, independent group unit.
Conclusions: No one-best-way approach can be used for HTA at the hospital level. Rather, the characteristics of HTA models depend on many contextual factors. Such conceptualization may aid the diffusion of HB-HTA to inform managerial decision making and clinical practice.
12 - A valid person: non-competence as a conversational outcome
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- By Alessandra Fasulo, Professor in Psychology, University of Rome ‘la Sapienza’, Italy, Francesca Fiore, Research Assistant in Psychology, University of Rome ‘la Sapienza’, Italy
- Edited by Alexa Hepburn, Loughborough University, Sally Wiggins, University of Strathclyde
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- Book:
- Discursive Research in Practice
- Published online:
- 04 November 2009
- Print publication:
- 12 July 2007, pp 224-246
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Summary
Putting autism into context
Dealing with a condition such as autism is intimidating if one is not a clinician, especially if the interactions examined are in a therapeutic setting and experts are involved; but we were supported in our research by the significant contributions made in other studies to the understanding of social situations involving people with communicative disabilities, autism-related (see below) or otherwise originated. We shall not attempt an explanation of autism as a syndrome, but will touch upon research that has looked at the social situations which constitute the everyday life of people – especially children – diagnosed with autism.
Existing theories accounting for the most common symptoms of the autistic-spectrum disorder are grounded in extended experimental research (see overviews in Frith, 1989; Baron-Cohen et al., 1993, 1989; Sigman and Capps, 1997) but there is also evidence that changing the nature of the tests, for example by introducing objects familiar to the children, can produce better performance (e.g., in Theory of Mind tests: cf. Astington and Gopnik, 1991). Bushwick (2001) suggested that the unusual behaviour of autistic individuals generates impoverished social experiences leading to insufficient social learning. Some aspects of autistic behaviour, like echoing, eye aversion or repetitive movements, are liable to confound observers' expectations, in particular those related to the interaction order and functioning. Wootton (1999), however, has been able to demonstrate how, even in the case of delayed echoing (the insertion of strings of talk coming from a distal context), echoing turns are respectful of transition relevance places, thus avoiding or minimising overlap, and can run in parallel with non-verbal, cooperative activity.