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OBJECTIVE: In the Brazilian public national healthcare system, botulinum toxin type A has traditionally been the sole treatment option for patients with dystonia. However, as of October 2022, deep brain stimulation (DBS) garnered positive recommendations for the condition. This study aims to assess the cost-effectiveness of DBS in treating adults with generalized and cervical dystonia within the Brazilian healthcare context, considering its recent inclusion. METHODS: A systematic review identified randomized controlled trials assessing DBS efficacy in treating adults with generalized and cervical dystonia. Two cost-utility analyses compared the cost-effectiveness of DBS plus the best clinical practice (BCP) to BCP alone. Markov models, which included 3 health states (no clinical improvement, clinical improvement, and death), employed a 1-year cycle and a lifetime horizon. The study used both 1-way and probabilistic sensitivity analyses. RESULTS: Two randomized controlled trials, one for each condition, revealed superior clinical improvement with DBS when compared to sham simulation. The incremental cost-utility ratio was $ 1121.66 for generalized dystonia and $4556.50 for cervical dystonia. Effectiveness discount rates and age at surgery were identified as influential parameters. In 1000 Monte Carlo simulations, 99.9% of the incremental cost-utility ratio values for generalized dystonia and 74.2% for cervical dystonia fell below the cost-effectiveness threshold in Brazil ($8146.64 per quality-adjusted life year). CONCLUSIONS: From the perspective of the Brazilian public health system, the combination of DBS and BCP appears to be cost-effective for the treatment of both generalized and cervical dystonia when compared to BCP alone.

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BACKGROUND: The economic assessment of health care models in palliative care promotes their global development. The purpose of the study is to assess the cost-effectiveness of a palliative care program (named Contigo) with that of conventional care from the perspective of a health benefit plan administrator company, Sanitas, in Colombia. METHODS: The incremental cost-utility ratio (ICUR) and the incremental net monetary benefit (INMB) were estimated using micro-costing in a retrospective, analytical cross-sectional study on the care of terminally ill patients enrolled in a palliative care program. A 6-month time horizon prior to death was used. The EQ-5D-3 L questionnaire (EQ-5D-3 L) and the McGill Quality of Life Questionnaire (MQOL) were used to measure the quality of life. RESULTS: The study included 43 patients managed within the program and 16 patients who received conventional medical management. The program was less expensive than the conventional practice (difference of 1,924.35 US dollars (USD), P = 0.18). When compared to the last 15 days, there is a higher perception of quality of life, which yielded 0.25 in the EQ-5D-3 L (p < 0.01) and 1.55 in the MQOL (P < 0.01). The ICUR was negative and the INMB was positive. CONCLUSION: Because the Contigo program reduces costs while improving quality of life, it is considered to be net cost-saving and a model with value in health care. Greater availability of palliative care programs, such as Contigo, in Colombia can help reduce existing gaps in access to universal palliative care health coverage, resulting in more cost-effective care.

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INTRODUCTION: Predicting response to inhaled corticosteroids (ICSs) + long-acting ß2-agonist (LABA) by previously detecting the presence of Arg16Gly ADRB2 genotype is a strategy that could reduce and optimize the management of asthmatic patients. There is a need for economic evaluations to facilitate the implementation of such tests. This research aims to evaluate the cost-effectiveness of Arg16Gly ADRB2 screening in children with asthma in Colombia. METHODS: From the perspective of a third-party payer, we conducted a cost-effectiveness analysis to determine the cost and quality-adjusted life-years (QALYs) of genotype-driven asthma prescribing based on the Arg16Gly ADRB2 genotype versus current treatment based on no genetic testing. Using four state-transition models, we estimate cost and QALYs employing micro-simulation modeling with a time horizon of 10 years and a cycle length of 1 week. Cost-effectiveness was assessed at a willingness-to-pay (WTP) value of US$5180. RESULTS: The mean incremental cost of strategy genetic testing versus no genetic testing is US$ -6809. The mean incremental benefit of strategy genetic testing is 16 QALYs. The incremental net monetary benefit of strategic genetic testing versus no genetic testing is US$ 88,893. Genetic testing is the strategy with the highest expected net benefit. The outcomes derived from our primary analysis remained robust when subjected to variations in all underlying assumptions and parameter values. CONCLUSION: Genetic testing of Arg16Gly ADRB2 is a cost-effective strategy to address asthma management in asthmatic children requiring ICS+LABA. This result should encourage the generation of more evidence and the incorporation of such evidence into clinical practice guidelines for pediatric asthma.

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In this editorial, we comment on the article by Zhang et al entitled Development of a machine learning-based model for predicting the risk of early postoperative recurrence of hepatocellular carcinoma. Hepatocellular carcinoma (HCC), which is characterized by high incidence and mortality rates, remains a major global health challenge primarily due to the critical issue of postoperative recurrence. Early recurrence, defined as recurrence that occurs within 2 years posttreatment, is linked to the hidden spread of the primary tumor and significantly impacts patient survival. Traditional predictive factors, including both patient- and treatment-related factors, have limited predictive ability with respect to HCC recurrence. The integration of machine learning algorithms is fueled by the exponential growth of computational power and has revolutionized HCC research. The study by Zhang et al demonstrated the use of a groundbreaking preoperative prediction model for early postoperative HCC recurrence. Chall-enges persist, including sample size constraints, issues with handling data, and the need for further validation and interpretability. This study emphasizes the need for collaborative efforts, multicenter studies and comparative analyses to validate and refine the model. Overcoming these challenges and exploring innovative approaches, such as multi-omics integration, will enhance personalized oncology care. This study marks a significant stride toward precise, effi-cient, and personalized oncology practices, thus offering hope for improved patient outcomes in the field of HCC treatment.

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INTRODUCTION: Recent evidence indicates that Maternal Supplementation with Long-Chain n-3 Fatty Acids During Pregnancy Substantially Mitigates Offspring's Asthma. Adding information regarding its cost-utility will undoubtedly allow its adoption, or not, in clinical practice guidelines. This research aimed to determine the cost-utility of LCPUFA supplementation in the third trimester of pregnancy to reduce the risk of wheezing and asthma in infants in Colombia. METHODS: A Markov model was formulated to estimate the cost and quality-adjusted life-years (QALYs) attributed to individuals with severe asthma in Colombia, with a time horizon of five years and a cycle length of two weeks. Probabilistic sensitivity analysis and a value of information (VOI) analysis were conducted to evaluate the uncertainties in the case base. Cost-utility was assessed at a willingness-to-pay (WTP) value of US$5180. All costs were adjusted to 2021 with a 5% annual discounting rate for cost and QALYs. RESULTS: The mean incremental cost of LCPUFA supplementation versus no supplementation was US-43.65. The mean incremental benefit of LCPUFA supplementation versus no supplementation was 0.074 QALY. The incremental cost-utility ratio was estimated at US$590.68 per QALY. The outcomes derived from our primary analysis remained robust when subjected to variations in all underlying assumptions and parameter values. CONCLUSION: Supplementation strategy supplementation with long-chain n-3 fatty acids during pregnancy is cost-effective in reducing the risk of developing asthma during childhood in Colombia.

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OBJECTIVES: The aim of this study is to conduct a cost-utility analysis of the use of the antiviral nirmatrelvir/ritonavir, applied to a vaccinated Brazilian population against COVID-19, from the perspective of the Brazilian Public Health System (SUS). METHODS: A microsimulation model was created with individual-level data and daily cycles, with a 1-year time horizon, to compare the current scenario of standard care with a scenario in which nirmatrelvir/ritonavir is offered to the population. Adults of any age group that received ≥2 doses of the COVID-19 vaccine formed the investigated population. Direct medical costs of the outpatients and inpatients admitted to the ward or intensive care unit were included. The effectiveness of the model was measured in quality-adjusted life-years (QALYs). RESULTS: In all simulations, the use of nirmatrelvir/ritonavir resulted in incremental costs per patient of US dollar (USD)245.86 and incremental effectiveness of 0.009 QALY, over a year. The incremental cost-utility ratio was USD27 220.70/QALY. The relative risk of the vaccinated population was the factor that affected the outcome most, according to the univariate sensitivity analysis. The probabilistic sensitivity analysis resulted in 100% of the simulations being more costly and effective, but that only 4% of them were below the established cost-effectiveness threshold of USD24 000.00/QALY. In the scenario considering only the population over 60 years old and immunosuppressed (of any age), the incremental cost-utility ratio was USD7589.37/QALY. CONCLUSIONS: The use of nirmatrelvir/ritonavir in the treatment of COVID-19 in a vaccinated population was cost-effective only for immunosuppressed individuals and people over 60 years of age.

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INTRODUCTION: The use of comprehensive genomic profiling (CGP) and target therapies is associated with substantial improvements in clinical outcomes among patients with non-small cell lung cancer (NSCLC). However, the costs of CGP may increase the financial pressures of NSCLC on health systems worldwide, especially in low- and middle-income countries. This study aimed to estimate the cost-effectiveness of CGP compared with current genomic tests in patients with NSCLC from the perspective of the Colombian Health System. METHODS: To estimate the costs and benefits of CGP and its comparators, we developed a 2-stage cohort model with a lifetime horizon. In the first stage, we made up a decision tree that calculated the probability of receiving each therapy as result of identifying a specific, actionable target. In the second stage, we developed a partitioned survival model that estimated the time spent at each health state. Incremental cost-effectiveness ratios were calculated for life-years (LYs) and quality-adjusted LYs gained. All costs were expressed in 2019 international dollars (INT$). RESULTS: CGP is associated with gains of 0.06 LYs and 0.04 quality-adjusted LYs compared with current genomic tests. Incremental cost-effectiveness ratios for CGP ranged from INT$861 to INT$7848, depending on the outcome and the comparator. Sensitivity analyses show that the cost-effectiveness decision was sensitive to prices of CGP above INT$7170 per test. These results are robust to most deterministic and probabilistic sensitivity analyses. CONCLUSIONS: CGP may be cost-effective in patients with NSCLC from the perspective of the Colombian Health System (societal willingness-to-pay threshold of INT$15 630 to INT$46 890).

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Objetivo: Comparar o implante transcateter de valva aórtica (TAVI) ao tratamento conservador em pacientes inoperáveis ou à cirurgia de troca valvar (SAVR) em pacientes com risco cirúrgico alto ou intermediário conforme a Society of Thoracic Surgeons (STS), por meio de uma revisão sistemática de avaliações econômicas completas. Avaliar a variabilidade de modelos econômicos, parâmetros, pressupostos e sua influência nos resultados finais. Métodos: Foi realizada uma busca da literatura nas bases Medline, EMBASE, Cochrane Library, Web of Science, SciELO e International HTA Base e busca manual. Foram incluídas análises econômicas completas baseadas em modelos econômicos publicadas entre 2011 e 2022, em português, inglês e espanhol. A qualidade dos estudos foi avaliada usando o instrumento QHES (Quality of Health Economic Studies). Resultados: Foram incluídos 36 estudos, majoritariamente análises de custo-utilidade (64%), da Europa (41%), utilizando dados de eficácia dos estudos PARTNER. O modelo de Markov (61%) foi predominante. O custo da prótese do TAVI foi um parâmetro de impacto na análise de sensibilidade nos três grupos. Os estudos alcançaram uma boa qualidade no instrumento QHES. Conclusão: O TAVI tendeu a ser custo-efetivo em relação aos comparadores. Os modelos não foram homogêneos nos parâmetros, horizontes temporais e taxa de desconto, podendo impactar a custo-efetividade do TAVI e dificultar a comparação dos resultados entre diferentes países e perspectivas.

ABSTRACT Objective: To compare transcatheter aortic valve implantation (TAVI) to conservative treatment in inoperable patients or to valve replacement surgery (SAVR) in patients at high or intermediate surgical risk according to the Society of Thoracic Surgeons (STS), through a systematic review of comprehensive economic evaluations. Evaluate the variability of economic models, parameters, assumptions and their influence on final results. Methods: A literature search was performed in Medline, EMBASE, Cochrane Library, Web of Science, SciELO and International HTA Base and manual search. Complete economic analyzes based on economic models published between 2011 and 2022 in Portuguese, English and Spanish were included. The quality of the studies was evaluated using the QHES (Quality of Health Economic Studies) instrument. Results: Thirty-six studies were included, mostly cost-utility analyses (64%), from Europe (41%), and using efficacy data from the PARTNER studies. The Markov model (61%) was predominant. The cost of the TAVI prosthesis was the most important parameter in the sensitivity analysis in the three groups. The studies achieved a good quality in QHES instrument. Conclusion: TAVI tended to be cost-effective relative to comparators. The models were not homogeneous in parameters, time horizons and discount rate, which may have an impact on the cost-effectiveness of TAVI, making it difficult to compare the results between different countries and perspectives.

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BACKGROUND: In Colombia, the best strategy to establish indication for adjuvant chemotherapy in early breast cancer (EBC) remains unknown. This study aimed to identify the cost-utility of Oncotype DX™ (ODX) or Mammaprint™ (MMP) tests to establish the necessity of adjuvant chemotherapy. METHODS: This study used an adapted decision-analytic model to compare cost and outcomes of care between ODX or MMP tests and routine care without ODX or MMP tests (adjuvant chemotherapy for all patients) over a 5-year time horizon from the perspective of the Colombian National Health System (NHS; payer). Inputs were obtained from national unit cost tariffs, published literature, and clinical trial database. The study population comprised women with hormone-receptor-positive (HR +), HER2-negative, lymph-node-negative (LN0) EBC with high-risk clinical criteria for recurrence. The outcome measures were discounted incremental cost-utility ratio (ICUR; 2021 United States dollar per quality-adjusted life-year [QALY] gained) and net monetary benefit (NMB). Probabilistic (PSA) and deterministic sensitivity analysis (DSA) were performed. RESULTS: ODX increases QALYs by 0.05 and MMP by 0.03 with savings of $2374 and $554 compared with the standard strategy, respectively, and were cost-saving in cost-utility plane. NMB for ODX was $2203 and for MMP was $416. Both tests dominate the standard strategy. Sensitivity analysis revealed that with a threshold of 1 gross domestic product per capita, ODX will be cost-effective in 95.5% of the cases compared with 70.2% cases involving MMP.DSA showed that the variable with significant influence was the monthly cost of adjuvant chemotherapy. PSA revealed that ODX was a consistently superior strategy. CONCLUSIONS: Genomic profiling using ODX or MMP tests to define the need of adjuvant chemotherapy treatment in patients with HR + and HER2 -EBC is a cost-effective strategy that allows Colombian NHS to maintain budget.

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Resumen El opio y sus derivados, y recientemente los opioides, han acompañado a la humanidad desde las civilizaciones más antiguas hasta la actualidad. Sus efectos analgésicos, hipnóticos y placenteros no pasaron desapercibidos para los antiguos, los consideraron de utilidad médica y beneficiosa para el estado de ánimo. Hoy en día no existe otro tipo de medicamentos que puedan tratar el dolor más intenso tan eficientemente como estos potentes analgésicos. Sin embargo, el uso médico y recreativo de los opiáceos y los opioides conlleva riesgos para la salud, como la tolerancia, la hiperalgesia y la adicción. Actualmente, además de ser indiscutiblemente el tratamiento médico más poderoso para mitigar el sufrimiento ocasionado por el dolor, se ha convertido también en un problema de salud pública debido a la alta cantidad de personas con trastorno por uso de opioides y por las muertes ocasionadas por sobredosis. En esta revisión se hará mención de las bondades de los opiáceos y opioides, y también de los efectos no deseados que estos producen.

Abstract Opium and its derivatives, and recently the opioids have accompanied the humankind since the ancient civilizations to the present day. Its analgesic, hypnotic and pleasant effects did not go unnoticed by ancient people, which considered most of these effects of medical utility and noticed that they had remarkable mood benefits. Currently, there are no other kind of drugs that can palliate intense pain as efficiently as these powerful analgesics. However, the medical and recreational use of opiates and opioids may carry health risks such as tolerance, hyperalgesia, and addiction. Nowadays, in addition to being indisputably the most powerful medical treatment to alleviate the suffering caused by pain, it has also become a public health problem due to the high number of people with opioid use disorder that have facilitated deaths caused by opioids overdose. In this review we will discuss the medical benefits of opiates and opioids, as much as the unwanted effects they produce.

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BACKGROUND: The clinical activities developed by pharmacists in a hospital environment can improve health outcomes and generate savings for hospitals. However, to determine whether pharmaceutical interventions are cost effective, it is essential to define a method according to which cost-effectiveness is intended to be measured. In addition, the quality of economic assessments and the amount of information present in systematic reviews in the literature make it difficult to analyze the effects of this intervention. OBJECTIVE: This paper aims to provide an overview of systematic reviews on the pharmacoeconomic impact of the performance of pharmaceutical care in hospitals. METHODS: A systematic search of the Cochrane Library databases, PubMed or MEDLINE, LILACS, Scopus, Web of Science, Google Scholar, and Open Thesis will be performed using the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement. The search will involve the use of keywords determined using the Medical Subject Headings database to define the search terms and include the following terms: "pharmacoeconomics," "pharmaceutical care," and "hospital." The study designs to be included will be systematic reviews of good quality. Studies will be included that address pharmacoeconomics; studies that evaluated pharmaceutical care in hospitals; and studies published in Portuguese, English, or Spanish. The primary outcome sought in the systematic reviews will be the cost ratio in monetary units and the outcomes in monetary or natural units. The secondary economic outcomes considered will be determined based on factors associated with the drugs and translated into benefit, efficacy, or utility. RESULTS: It is intended to start this overview in January 2023. Thus far, only previous searches have been carried out to contextualize the theme and build the protocol. CONCLUSIONS: This overview will determine the pharmacoeconomic impact of pharmaceutical care interventions in the hospital environment. In addition, this study will point out which clinical outcomes in natural units are impacted by the performance of pharmaceutical care and the strengths and limitations of each approach. It will also identify gaps in the literature and areas for future work. TRIAL REGISTRATION: PROSPERO CRD42019140665; https://tinyurl.com/bddwnz43.

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OBJECTIVES: This study aimed to determine the cost-utility of ocrelizumab versus rituximab in patients with RRMS, from the perspective of the Colombian healthcare system. METHODOLOGY: Cost-utility study based on a Markov model, with a 50-year horizon and payer perspective. The currency was the US dollar for the year 2019, with a cost-effectiveness threshold of $5180 defined for Colombian health system. The model used annual cycles according to the health status determined by the disability scale. Direct costs were considered, and the incremental cost-effectiveness ratio per 1 quality-adjusted life-year (QALY) gained was used as the outcome measure. A discount rate of 5% was applied to costs and outcomes. Multiple one-way deterministic sensitivity analyses and 10 000 Monte Carlo simulation were conducted. RESULTS: For the treatment of patients with RRMS, ocrelizumab versus rituximab had an incremental cost-effectiveness ratio of $73 652 for each QALY gained. After 50 years, 1 subject treated with ocrelizumab earns 4.8 QALYs >1 subject treated with rituximab, but at a higher cost of $521 759 versus $168 752, respectively. Ocrelizumab becomes a cost-effective therapy if its price is discounted > 86% or if there is a high willingness to pay. CONCLUSIONS: Ocrelizumab was not a cost-effective drug as compared with rituximab in treating patients with RRMS in Colombia.

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INTRODUCTION: Chronic rhinosinusitis with nasal polyps (CRSwNP) compromises respiratory function, sleep, concentration, work capacity, and quality of life, generating high costs for patients and health systems. The aim of the study was to analyze the cost utility of Dupilumab compared to endoscopic sinus surgery for patients with CRSwNP. RESEARCH DESIGN AND METHODS: We developed a model-based cost-utility analysis from the perspective of the Colombian health system to compare Dupilumab vs. endoscopic nasal surgery in patients with difficult-to-treat CRSwNP. Transition probabilities were extracted from the published literature about CRSwNP, and costing was based on local tariffs. We performed probabilistic sensitivity analysis for outcomes, probabilities, and costs (10.000 Monte Carlo simulations). RESULTS: The cost of dupilumab ($ 142.919) was 7.8 times higher than nasal endoscopic sinus surgery ($ 18.347). In terms of quality-adjusted life years (QALYs), surgery generates better results than Dupilumab: 11.78 vs. 9.05 QALYs. CONCLUSIONS: From the perspective of the health system, endoscopic sinus surgery for the management of CRSwNP is a dominant alternative in all the analyzed scenarios compared to the use of Dupilumab. From a cost-utility point of view, the use of dupilumab should be considered when the patient requires multiple surgeries or when there is a contraindication for surgery performance.

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Pesquisa transversal com objetivo de analisar a associação entre qualidade de vida e comportamentos desenvolvidos por indivíduos hipertensos durante o período de isolamento social, devido à pandemia da COVID-19. O estudo foi realizado através de ligações telefônicas e avaliou adultos cadastrados na atenção primária de saúde. A prática de atividade física foi avaliada pelo Questionário Internacional de Atividade Física, sendo somadas a duração e a frequência das atividades e o tempo total sentado durante a semana e fim de semana. A qualidade de vida foi analisada através do Sistema Descritivo ­ EQ-5D, considerando o score utilidade e o estado geral de saúde. Presença de doenças e comportamentos durante o isolamento social, assim como aspecto emocional e ambiente para realização de atividades físicas foram analisados. Foram utilizados os testes t de Studant e ANOVA one way para comparação de grupos e ANCOVA para comparações entre os grupos ajustadas. A significância estatística foi pré-fixada em valores inferiores a 5%. Foram entrevistados 659 hipertensos, com idade entre 41 e 93 anos. Observou-se maior qualidade de vida naqueles que praticaram exercício físico (p = 0,015), que não relataram ter a saúde emocional afetada pela pandemia (p = 0,001) e que responderam ter ambiente favorável em casa para prática de atividade física, (p = 0,001). Em conclusão, a qualidade de vida associou-se aos comportamentos positivos dos participantes durante a pandemia, como a prática de atividade física, contudo é necessário que os órgãos públicos se atentem aos baixos níveis de atividade física da população provocados pela pandemia

Cross-sectional research with the objective of analyzing the association between quality of life and behaviors developed by hypertensive individuals during the period of social isolation, due to the COVID-19 pandemic. The study was carried out through telephone calls and evaluated adults registered in primary health care. The practice of physical activity was assessed by the International Physical Activity Questionnaire, adding the duration and frequency of activities and the total time sitting during the week and weekend. Quality of life was analyzed using the Descriptive System ­ EQ-5D, considering the utility score and general health status. Presence of diseases and behaviors during social isolation, as well as the emotional aspect and environment for carrying out physical activities were analyzed. Student's t-test and one-way ANOVA were used for group comparisons and ANCOVA for adjusted between-group comparisons. Statistical significance was pre-set at values below 5%. 659 hypertensive adults aged between 41 and 93 years were interviewed. A better quality of life was observed in hypertensive individuals who practiced physical exercise (p = 0.015), who did not report having their emotional health affected by the pandemic (p = 0.001) and who responded that they had a favorable environment at home for the practice of physical activity, (p = 0.001). In conclusion, QoL was associated with the positive behaviors of the participants during the pandemic, such as the practice of physical activity, however, it is necessary for public agencies to pay attention to the low levels of PA in the population caused by the pandemic

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Introducción: La patente es un título de propiedad industrial otorgado por el Estado al inventor de un nuevo producto o tecnología, susceptible de ser comercializado para obtener ganancias de forma exclusiva a un plazo de tiempo determinado. Objetivo: Determinar el número de patentes otorgadas a las universidades peruanas en el campo biomédico de 2010 a 2020, en comparación con la producción de otros inventores. Material y método: Este estudio descriptivo, observacional, retrospectivo y transversal analizó 73 patentes provenientes de un universo de 759, obtenidas de la base de datos del Instituto Nacional de Defensa de la Competencia y de la Protección de la Propiedad Intelectual en el Perú, de 2010 a 2020. Para comparar el número de patentes otorgadas a las universidades respecto a otros inventores, se aplicó la prueba del Chi Cuadrado de Pearson con la corrección de continuidad de Yates. Resultados: En el Perú, durante 2010 a 2020 se han otorgado 759 patentes, de las cuales 73 pertenecen al campo biomédico (9,61 por ciento), de los cuales las universidades han generado 24,66 por ciento; es decir 2,47 por ciento del total. Además, las universidades presentaron diferencias significativas de producción de patentes (p = 0,019) en comparación a otros autores. Conclusiones: En el campo biomédico, la producción de patentes en las universidades peruanas ha sido muy limitadas desde 2010 a 2020. Además, las universidades presentaron significativamente menor producción de patentes en comparación a otros inventores, observándose que desde 2016, no se les ha otorgado ninguna patente de invención en el campo biomédico(AU)

Introduction: A patent is an industrial property title granted by the State to the inventor of a new product or technology, susceptible of being marketed for profit on an exclusive basis for a determined period of time. Objective: To determine the number of patents granted to Peruvian universities in the biomedical field from 2010 to 2020, in comparison with the production of other inventors. Material and Methods: This descriptive, observational, retrospective and cross-sectional study analyzed 73 patents from a universe of 759 patents obtained from the database of the National Institute for the Defense of Competition and Protection of Intellectual Property in Peru, from 2010 to 2020. To compare the number of patents granted to universities with respect to other inventors, Pearson's chi-square test with Yates' continuity correction was applied. Results: In Peru, during the years 2010 to 2020, 759 patents have been granted, of which 73 belong to the biomedical field (9.61 percent), of which universities have generated 24.66 percent, i.e. 2.47 percent of the total. Furthermore, universities showed significant differences in patent production (p = 0.019) compared to other authors. Conclusions: In the biomedical field, patent production in Peruvian universities has been very limited from 2010 to 2020. In addition, universities presented significantly lower patent production compared to other inventors, noting that since 2016, they have not been granted any invention patents in the biomedical field(AU)

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OBJECTIVES: To determine performance of C-reactive protein (CRP) in the diagnosis of early-onset sepsis, and to assess patient outcomes with and without routine use of CRP. STUDY DESIGN: This was a retrospective cohort study of infants admitted to 2 neonatal intensive care units. CRP was used routinely in early-onset sepsis evaluations during 2009-2014; this period was used to determine CRP performance at a cut-off of ≥10 mg/L in diagnosis of culture-confirmed early-onset sepsis. Routine CRP use was discontinued during 2018-2020; outcomes among infants admitted during this period were compared with those in 2012-2014. RESULTS: From 2009 to 2014, 10 134 infants were admitted; 9103 (89.8%) had CRP and 7549 (74.5%) had blood culture obtained within 3 days of birth. CRP obtained ±4 hours from blood culture had a sensitivity of 41.7%, specificity 89.9%, and positive likelihood ratio 4.12 in diagnosis of early-onset sepsis. When obtained 24-72 hours after blood culture, sensitivity of CRP increased (89.5%), but specificity (55.7%) and positive likelihood ratio (2.02) decreased. Comparing the periods with (n = 4977) and without (n = 5135) routine use of CRP, we observed lower rates of early-onset sepsis evaluation (74.5% vs 50.5%), antibiotic initiation (65.0% vs 50.8%), and antibiotic prolongation in the absence of early-onset sepsis (17.3% vs 7.2%) in the later period. Rate and timing of early-onset sepsis detection, transfer to a greater level of care, and in-hospital mortality were not different between periods. CONCLUSIONS: CRP diagnostic performance was not sufficient to guide decision-making in early-onset sepsis. Discontinuation of routine CRP use was not associated with differences in patient outcomes despite lower rates of antibiotic administration.

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OBJECTIVES: This study aims to synthesize health state utility values (HSUVs) of type 2 diabetes mellitus (T2DM) and its related complications published in the literature, conducting a meta-analysis of the data when possible. METHODS: We conducted a systematic search in MEDLINE and School of Health and Related Research Health Utilities Database repository. Studies focused on T2DM and its complications reporting utility values elicited using direct and indirect methods were selected. We categorized the results according to the instrument to describe health and meta-analyzed them accordingly. Data included in the analysis were pooled in a fixed-effect model by the inverse of variance mean and random-effects DerSimonian-Laird method. Two approaches on sensitivity analysis were performed: leave-one-out method and including data of HSUVs obtained by foreign population value sets. RESULTS: We identified 70 studies for the meta-analysis from a total of 467 studies. Sufficient data to pool T2DM HSUVs from EQ-5D instrument, hypoglycemia, and stroke were obtained. HSUVs varied from 0.7 to 0.92 in direct valuations, and the pooled mean of 3-level version of EQ-5D studies was 0.772 (95% confidence interval 0.763-0.78) and of 5-level version of EQ-5D 0.815 (95% confidence interval 0.808-0.823). HSUVs of complications varied from 0.739 to 0.843, or reductions of HSUVs between -0.014 and -0.094. In general, HSUVs obtained from 3-level version of EQ-5D and Health Utility Index 3 instruments were lower than those directly elicited. A considerable amount of heterogeneity was observed. Some complications remained unable to be pooled due to scarce of original articles. CONCLUSIONS: T2DM and its complications have a considerable impact on health-related quality of life. 5-level version of EQ-5D estimates seems comparable with direct elicited HSUVs.

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ABSTRACT Objective: To study the feasibility of time trade-off (TTO) method in quantifying health utility ratings in different types of malocclusion. Material and Methods: In this cross-sectional study, 70 orthodontic patients aged 18 years or above, reporting for treatment/consultation, were included and interviewed. Malocclusion-related health utilities were assessed through the TTO method, and oral health-related quality of life was measured with the help of Orthognathic Quality of Life Questionnaire (OQLQ). Angle's classification of malocclusion was recorded. Bivariate analyses and multivariate Poisson's regression were done to find out an association between the oral health utility values, OQLQ and demographic and clinical characteristics. Results: Patients with skeletal Class III malocclusion had lower health utility values than those with Class I and Class II malocclusions (p=0.013). Poisson's regression showed that Angle's Class II division 1 (0.90, CI 0.84 to 0.97), Class III (0.68, CI 0.59 to 0.95) and Skeletal malocclusion (0.79, CI 0.71 to 0.87) and OQLQ scores (1.0, CI 1 to 1.003) were found to be significant predictors of TTO utility scores. Conclusions: TTO utilities were found to be valid and well correlated with clinical findings. Health utilities could serve as useful and reliable markers of health-related quality of life (HRQL) among individuals or communities and help cost-effective preventive or intervention programs planning.

RESUMO Objetivo: Estudar a viabilidade do método Time trade-off (TTO) para quantificar escores de valoração da saúde em diferentes tipos de má oclusão. Material e Métodos: Neste estudo transversal, foram incluídos e entrevistados 70 pacientes ortodônticos com idade igual ou superior a 18 anos, que compareceram para tratamento/consulta. A valoração da saúde em relação à má oclusão foi avaliada por meio do método TTO e a qualidade de vida relacionada à saúde bucal foi medida com a ajuda do Questionário de Qualidade de Vida Ortognática (Orthognathic Quality of Life Questionnaire, OQLQ). A classificação da má oclusão segundo Angle foi registrada, e análises bivariadas e regressão multivariada de Poisson foram feitas para verificar qualquer associação entre os escores de valoração da saúde bucal, OQLQ e características demográficas e clínicas. Resultados: Os pacientes com má oclusão esquelética de Classe III apresentaram escores de valoração da saúde mais baixos do que aqueles com má oclusão de Classe I e Classe II (p=0,013). A regressão de Poisson mostrou que a Classe II de Angle divisão 1 (0,90, IC 0,84 a 0,97), Classe III (0,68, IC 0,59 a 0,95), má oclusão esquelética (0,79, IC 0,71 a 0,87) e os escores do OQLQ (1,0, IC 1 a 1,003) foram considerados preditores significativos dos escores de valoração pelo método TTO. Conclusões: Os escores do TTO foram considerados válidos e bem correlacionados com os achados clínicos, e podem servir como marcadores úteis e confiáveis da qualidade de vida relacionada à saúde (health-related quality of life, HRQL) entre indivíduos ou comunidades, e ajudar no planejamento de programas de prevenção ou de intervenção, com uma boa relação custo-benefício.

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Objective: To assess the feasibility of an adjustable, subischial transfemoral prosthesis by comparing self-reported outcome measures regarding socket comfort, fit and utility relative to a persons' conventionally made socket. Assessing limb compressibility was another aim of this study. Design: A single-group pre-post intervention design. Setting: Physical medicine and rehabilitation biomechanics laboratory. Participants: All 18 enrolled participants (N = 18) completed the feasibility trial. There were 16 men and 2 women with an average age of 59.4 (±7) years. Most of the participants (61.1%) had worn a socket for 1 to 10 years before the trial, 22.2% of the participants had worn one for less than a year, and 16.7% of the participants had worn a prosthesis for more than 10 years. Intervention: Participants were fit with the study prosthesis and used it for a 2-week home trial. Main Outcome Measures: A Prosthetic Comfort and Utility Questionnaire was completed on the participant's conventional prosthetic device and the subischial socket system after the trial. Results: The adjustable subischial prostheses were rated superior overall to the participant's conventional sockets (40.9 ± 7.2 vs 32.8 ± 10.8; P=.004). Six of the 10 parameters measured (adjustability, overall fit, prosthesis weight, sitting comfort, standing comfort, and standing stability) were rated higher for the adjustable prostheses compared to the conventional sockets. Compression of the soft tissues of the thigh ranged from 5.6 ± 4.2 cm at the distal end to 7.3 ± 3.6 cm at the proximal site. There were no falls, skin breakdown, or limb ischemia. At the 2-month telephone follow-up, 61% of subjects had transitioned to using the adjustable subischial socket most of the time. Conclusions: The adjustable, immediate fit, subischial prosthesis provided safe, comfortable, and functional ambulation for persons with transfemoral limb loss in this short-term feasibility study. This study supports the consideration of a new paradigm in transfemoral prosthetics-adjustable subischial sockets. These devices should be tested in a larger multi-center study.

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Telehealth strategies have become essential for responding to the sanitary emergency due to the COVID-19 pandemic. In this context, developing online psychological interventions (OPIs) that can treat and prevent psychological difficulties is gaining more relevance. This article describes an acceptance and commitment therapy (ACT) based OPI focused on repetitive negative thinking (RNT). This OPI is called Disentangled, Aware, and Committed (DAC) and represents an attempt to adapt previous RNT-focused ACT protocols to this format type. Study 1 evaluated content validity through the assessment of four experts in ACT regarding clarity, utility, pertinence, conceptual adjustment, and therapeutic goal fulfillment for each component of the DAC program. In Study 2, forty-one undergraduate clinical psychology trainees rated the components of the DAC program according to its clarity and perceived utility. These participants were enrolled in a randomized controlled trial that analyzed the efficacy of the DAC to prevent the usually observed increase in emotional symptoms and RNT among this population. Expert reviewers in Study 1 rated all DAC components as clear and useful for potential users, following a logical order, theoretically coherent with the ACT model, and successfully fulfilling its stated goals. In Study 2, the participants also rated the DAC components as clear and potentially useful for their lives. In conclusion, the DAC appears to be a feasible transdiagnostic OPI for treating and preventing emotional symptoms, which warrants further studies analyzing its efficacy.