A novel policy dialogue to build sustainable and resilient health systems: findings from PHSSR Portugal.

Background: In the aftermath of the COVID-19 pandemic, health policymakers have been reflecting upon sustainability and resilience issues in health systems worldwide. Promoting sustainability and resilience requires policy changes built upon evidence and on the views of health stakeholders and experts. This study aimed to engage health stakeholders in designing and discussing policy recommendations with a high potential to improve sustainability and resilience in the Portuguese healthcare system.

Type 2 inflammation: a Portuguese consensus using Web-Delphi and decision conferencing (INFLAT2-PT).

Objectives: Atopic/allergic diseases impose a growing burden on public health, affecting millions of patients worldwide. The main objective of this study was to develop a national expert consensus on relevant clinical questions related to type 2 inflammation.

Methods: We conducted: a comprehensive literature review with a qualitative analysis to identify the most repeated themes on the overlap of conditions; a modified 3-round Web-Delphi (or e-Delphi); and a final online decision conference.

Economic evaluations of medical devices in paediatrics: a systematic review and a quality appraisal of the literature.

Background: Although economic evaluations (EEs) have been increasingly applied to medical devices, little discussion has been conducted on how the different health realities of specific populations may impact the application of methods and the ensuing results. This is particularly relevant for pediatric populations, as most EEs on devices are conducted in adults, with specific aspects related to the uniqueness of child health often being overlooked. This study provides a review of the published EEs on devices used in paediatrics, assessing the quality of reporting, and summarising methodological challenges.

Unlocking Continuous Improvement in Heart Failure Remote Monitoring: A Participatory Approach to Unveil Value Dimensions and Performance Indicators.

(Access, Clinical aspects, Acceptability, Costs) .

Advancing hospital-based health technology assessment: evaluating genomic panel contracting strategies for blood tumors through a multimethodology.

Introduction: The adoption of genomic technologies in the context of hospital-based health technology assessment presents multiple practical and organizational challenges.

Objective: This study aimed to assist the Instituto Português de Oncologia de Lisboa Francisco Gentil (IPO Lisboa) decision makers in analyzing which acute myeloid leukemia (AML) genomic panel contracting strategies had the highest value-for-money.

Methods: A tailored, three-step approach was developed, which included: mapping clinical pathways of AML patients, building a multicriteria value model using the MACBETH approach to evaluate each genomic testing contracting strategy, and estimating the cost of each strategy through Monte Carlo simulation modeling.

Which value aspects are relevant for the evaluation of medical devices? Exploring stakeholders' views through a Web-Delphi process.

Background: Implementation and uptake of health technology assessment for evaluating medical devices require including aspects that different stakeholders consider relevant, beyond cost and effectiveness. However, the involvement of stakeholders in sharing their views still needs to be improved.

Objective: This article explores the relevance of distinct value aspects for evaluating different types of medical devices according to stakeholders' views.

Telemonitoring in Portugal: where do we stand and which way forward?

Following the pandemic, there is growing pressure in Portugal to adopt new practices that promote more efficient, sustainable, and equitable healthcare. Telemonitoring (TM) has been identified as a valuable solution, particularly for chronically ill, long-term or socially isolated patients. Several initiatives have since emerged.

ANIPHI: An innovative pedagogical platform based on the Delphi method to support animal welfare teaching.

As a teaching subject, animal welfare is challenging for educators and learners, as was recently shown in a recent survey on the evolution of animal welfare teaching in Europe. Among several suggestions to overcome the current resistance to implementing animal welfare education, we highlight two. The first is that animal welfare education should be based on learner-centred approaches; the second is that it should encompass both animal welfare science and ethics and law.

Informing the Design of Data Visualization Tools to Monitor the COVID-19 Pandemic in Portugal: A Web-Delphi Participatory Approach.

Due to the large amount of data generated by new technologies and information systems in the health arena, health dashboards have become increasingly popular as data visualization tools which stimulate visual perception capabilities. Although the importance of involving users is recognized in dashboard design, a limited number of studies have combined participatory methods with visualization options. This study proposes a novel approach to inform the design of data visualization tools in the COVID-19 context.

Setting Requirements for a Dashboard to Inform Portuguese Decision-Makers About Environment Health in an Urban Setting.

Dashboards are being increasingly used in the health field, and literature points out that accurate and efficient dashboards require not only dealing with data issues, but also ensuring that dashboards are user-friendly and that incorporate users' views and needs. The integration of evidence and data into decision aiding tools, such as dashboards, to assess and monitor environmental health (EH) in urban settings requires careful design. Departing from EH evidence and making use of the views of EH stakeholders and experts, this study aimed at defining requirements for a dashboard to help decision-makers analyzing and visualizing EH information in the Lisbon urban context.

Leveraging electronic health record data to inform hospital resource management : A systematic data mining approach.

Early identification of resource needs is instrumental in promoting efficient hospital resource management. Hospital information systems, and electronic health records (EHR) in particular, collect valuable demographic and clinical patient data from the moment patients are admitted, which can help predict expected resource needs in early stages of patient episodes. To this end, this article proposes a data mining methodology to systematically obtain predictions for relevant managerial variables by leveraging structured EHR data.

Selecting Indicators to Monitor and Assess Environmental Health in a Portuguese Urban Setting: A Participatory Approach.

Environmental health (EH) is influenced by complex interactions between health and the built and natural environments, there being little research on its specificities in urban settings. The use of suitable indicators to monitor and assess EH is fundamental in informing evidence-based interventions at the local level. A participatory approach to selecting indicators to inform the monitoring and assessment of EH in Lisbon is herein considered.

Environmental determinants of population health in urban settings. A systematic review.

Background: Population health is influenced by interactions between environmental determinants, which are captured by dimensions and indicators. This study aims to systematically review key environmental determinants and respective dimensions and indicators, relevant to evaluate population health in urban settings, and to understand their potential implications into policies.

Methods: A search of literature published between 2008 and 2018 was conducted in PubMed, Web of Science, Scopus and SciELO Portugal databases, on studies with evidence on association between an environmental determinant and a health outcome in urban contexts.

Can structured EHR data support clinical coding? A data mining approach.

Structured data formats are gaining momentum in electronic health records and can be leveraged for decision support and research. Nevertheless, such structured data formats have not been explored for clinical coding, which is an essential process requiring significant manual workload in health organisations. This article explores the extent to which fully structured clinical data can support assignment of clinical codes to inpatient episodes, through a methodology that tackles high dimensionality issues, addresses the multi-label nature of coding and optimises model parameters.

Scenarios for population health inequalities in 2030 in Europe: the EURO-HEALTHY project experience.

Background: Health inequalities have been consistently reported across and within European countries and continue to pose major challenges to policy-making. The development of scenarios regarding what could affect population health (PH) inequalities across Europe in the future is considered critical. Scenarios can help policy-makers prepare and better cope with fast evolving challenges.

Multi-criteria decision analysis for health technology assessment: addressing methodological challenges to improve the state of the art.

Background: Multi-criteria decision analysis (MCDA) concepts, models and tools have been used increasingly in health technology assessment (HTA), with several studies pointing out practical and theoretical issues related to its use. This study provides a critical review of published studies on MCDA in the context of HTA by assessing their methodological quality and summarising methodological challenges.

Methods: A systematic review was conducted to identify studies discussing, developing or reviewing the use of MCDA in HTA using aggregation approaches.

Valuing health states: is the MACBETH approach useful for valuing EQ-5D-3L health states?

Background: Quality Adjusted Life Years (QALYs) are a key outcome measure widely used within health technology assessment and health service research studies. QALYs combine quantity and quality of life, with quality of life calculations relying on the value of distinct health states. Such health states' values capture the preferences of a population and have been typically built through numerical elicitation methods.

Indicators for evaluating European population health: a Delphi selection process.

Background: Indicators are essential instruments for monitoring and evaluating population health. The selection of a multidimensional set of indicators should not only reflect the scientific evidence on health outcomes and health determinants, but also the views of health experts and stakeholders. The aim of this study is to describe the Delphi selection process designed to promote agreement on indicators considered relevant to evaluate population health at the European regional level.

Preprocessing structured clinical data for predictive modeling and decision support. A roadmap to tackle the challenges.

Background: EHR systems have high potential to improve healthcare delivery and management. Although structured EHR data generates information in machine-readable formats, their use for decision support still poses technical challenges for researchers due to the need to preprocess and convert data into a matrix format. During our research, we observed that clinical informatics literature does not provide guidance for researchers on how to build this matrix while avoiding potential pitfalls.

Detection of sweet potato virus C, sweet potato virus 2 and sweet potato feathery mottle virus in Portugal.

Field sweet potato plants showing virus-like symptoms, as stunting, leaf distortion, mosaic and chlorosis, were collected in southwest Portugal and tested for the presence of four potyviruses, sweet potato virus C (SPVC), sweet potato virus 2 (SPV2), sweet potato feathery mottle virus (SPFMV), sweet potato virus G (SPVG), and the crinivirus sweet potato chlorotic stunt virus (SPCSV). DsRNA fractions were extracted from symptomatic leaves and used as templates in single and multiplex RT-PCR assays using previously described specific primers for each analyzed virus. The amplified reaction products for SPVC, SPV2 and SPFMV were of expected size, and direct sequencing of PCR products revealed that they correspond to the coat protein gene (CP) and showed 98%, 99% and 99% identity, respectively, to those viruses.

Modeling the demand for long-term care services under uncertain information.

Developing a network of long-term care (LTC) services is currently a health policy priority in many countries, in particular in countries with a health system based on a National Health Service (NHS) structure. Developing such a network requires proper planning and basic information on future demand and utilization of LTC services. Unfortunately, this information is often not available and the development of methods to properly predict demand is therefore essential.

Using discrete event simulation to compare the performance of family health unit and primary health care centre organizational models in Portugal.

Background: Recent reforms in Portugal aimed at strengthening the role of the primary care system, in order to improve the quality of the health care system. Since 2006 new policies aiming to change the organization, incentive structures and funding of the primary health care sector were designed, promoting the evolution of traditional primary health care centres (PHCCs) into a new type of organizational unit--family health units (FHUs). This study aimed to compare performances of PHCC and FHU organizational models and to assess the potential gains from converting PHCCs into FHUs.