Leopoldo Trieste

Why Effectiveness of Robot-Mediated Neurorehabilitation Does Not Necessarily Influence Its Adoption

This paper discusses the reasons why evidence of clinical effectiveness is not enough to facilitate adequate adoption of robotic technologies for upper-limb neurorehabilitation. The paper also provides a short review of the state of the art technologies. In particular, the paper highlights the barriers to the adoption of these technologies by the markets in which they are, or should be, deployed. On the other hand, the paper explores how low rates of adoption may depend on communication biases between the producers of the technologies and potential adopters. Finally, it is shown that, although technology-efficacy issues are usually well-documented, barriers to adoption also originate from the lack of solid evidence of the economic implications of the new technologies.

Management and Treatment of Type 1 And 2 Diabetes: State of Art

Background: Diabetes is a hormonal disorder that affects an estimated three hundred million people worldwide. In this review (meta-analysis) of the literature, we carefully analyzed the limits and methods of the management of diabetes in adolescents and adults. Objective: The study focused on the identification of technologies and therapeutic procedures currently used and tried to identify possible factors for future improvement. Methods: The literature review was carried out on search engines like: PubMed, ADA, Google Scholar and Google Patents. According to our search criteria, the selected articles were analyzed regarding evidence and critical issues reported by patients and clinicians. The results were then compared with the recalls of the U.S. Food and Drug Administration (FDA). Results: The currently in use drugs and the insulin infusion systems vary a lot and simultaneous develop of new technology adds to existing chaos. This study revealed possible areas for improvements both from a technological and a medical point of view. For instance: the multiple causes related to the different timing of insulin absorption according to the insertion site, the design of new algorithms focused on simplification of practical activities, and the identification of new methods for training patients and families on the different device’s functions. Moreover, some critical points were emerged related to the current limitations and lack of interchangeability between sensors for monitoring vital parameters. This condition restricts the correct sensor selection according to the patient’s personal preference, age and needs. However, the lack of interchangeability between different devices limits the choice of the most appropriate monitoring software and data storage. Conclusions: The collaboration between medical doctors and biomedical engineers is of great importance when analyzing available medical devices for the purpose, identifies possible weaknesses, technical problems, and areas for improvements. Moreover, multi-specialist collaboration is important to conceive new methods of training for patients and families.

The cost-effectiveness of drug therapies to treat secondary hyperparathyroidism in renal failure: a focus on evidence regarding paricalcitol and cinacalcet.

The present review aims to assess the state-of-the-art regarding cost–effectiveness of therapy for secondary hyperparathyroidism in order to identify the best treatment and review methodological issues. PubMed and the Cochrane Library were searched to identify papers performing comparative analysis of costs and effects of treatment for secondary hyperparathyroidism in adult patients. Among the 66 papers identified, only 10 were included in the analysis. Treatment strategies evaluated in the selected papers were: cinacalcet in addition to vitamin D and phosphate binders versus vitamin D and phosphate binders only (seven papers), paricalcitol versus non-selective vitamin D (two papers), early and late introduction of cinacalcet in addition to vitamin D and phosphate binders (one paper) and paricalcitol versus cinacalcet (one paper). The high degree of heterogeneity among alternative treatments and methodological limits related to cost items considered, resource valuation methods and so on, make it unfeasible to reach a definite conclusion regarding cost–effectiveness but allow for future research opportunities.

On Robots and Insurance

Does a robot producer, owner or user need insurance policy? What kind of risks derive from the use of robots? Are there any differences between insuring a robot and another product? And finally, who should bear the burden of paying the insurance premium? The objective of this article is to provide the reader with an overview on the issue of risk management of robotic applications through insurance contracts. Indeed, insurance products are essential for an effective technology transfer from research to market. As of today, the production, use and diffusion of robots, determines risks that can hardly be identified and assessed both with respect to the probability of their occurrence and to the consequences they might bring about. Thence, innovation causes existing insurance products to be inadequate, and often times, it leaves insurance companies in the complex position of needing to elaborate new solutions in the absence of complete information. This article discusses the reasons for those hindrances and identifies the essential issues that lawyers, economists and engineers need to address in their future research in order to overcome current limitations and ultimately develop efficient and adequate risk management tools.

Approaching 2014: Is Telemedicine Assessed from The Social Perspective? A Brief 2013 Systematic Review

Recent reviews in Telemedicine (TM) detected methodological flaws in economic assessment. Our brief review addresses the perspective adoption problem, investigating to what extent adopting a broader point of view could have an impact on TM economic studies and consequential diffusion. Out of 486 articles found, 15 studies were selected for full-text assessment. Most of them showed an improvement in methodology if compared with the past TM economic evaluations. However, only 4 papers reported data from the social perspective and among them 3 presented productivity loss. Although some positive results in economic evaluation were observed, to date it is not clear to what extent TM is paid for by third parties or has to be paid by the patients. Keywords-economic evaluation perspective; cost-effectiveness; cost-utility; review;

The RaDiCEA Project: cost of illness (COI) analysis applied to Cryopyrin Associated Periodic Syndromes (CAPS)

When a disease affects only a few individuals in each country (ultra-orphan disease), it can be very hard to establish the costs of illness (COI) and the cost-effectiveness (CE) of treatments (ultra-orphan drugs). Conventional methods for COI and CE of drugs for common conditions do not apply, and additional factors need to be considered. As expensive medications (biologicals) show promising results, it becomes crucial to have detailed information on as many patients as possible.

Cost-effectiveness analysis and prevention effects of ultra-orphan drugs for rare diseases: an in silico model applied to Cryopyrin Associated Periodic Syndromes (CAPS)

8th International Congress of Familial Mediterranean Fever and Systemic Autoinflammatory Diseases

The cost–effectiveness of diagnostic cardiac imaging for stable coronary artery disease

Early and accurate diagnosis of stable coronary artery disease (CAD) is crucial to reduce morbidity, mortality and healthcare costs. This critical appraisal of health-economic literature concerning non-invasive diagnostic cardiac imaging aims to summarize current approaches to economic evaluation of diagnostic cardiac imaging and associated procedural risks, inform cardiologists how to use economic analyses for decision-making, highlight areas where new information could strengthen the economic evaluation and shed light on cost-effective approaches to diagnose stable CAD. Economic analysis can support cardiologists’ decision-making. Current economic evidence in the field does not provide sufficient information to guide the choice among different imaging modalities or strategies for each patient. Available economic analyses suggest that computed tomography coronary angiography (CTCA) is a cost-effective approach to rule out CAD prior to invasive coronary angiography in patients with low to intermediate pre-test probability of disease and that stress imaging modalities may be cost-effective at variable pre-test probabilities.

Cost for Tuberculosis Care in Developed Countries: Which Data for an Economic Evaluation?

Tuberculosis (TB) seems to be eradicated in developed countries. However, current migration flows and increasing use of immunosuppressive and biologic drugs for rheumatic diseases are increasing the risk of latent TB and TB onset for citizens of developed countries. Because little is known about the economic burden of TB in developed countries, we set out to describe the order and dimension of the costs of TB care in developed countries. A review of the literature indicated that the cost for anti-TB therapy is about

Natural and Man-Made Disasters: Challenges and International Perspectives for Insurance

2000 US per patient. Costs of drugs associated with standard therapy for active TB [2HRZE/4HR, i.e., 2 months of isoniazid (H), rifampin (R), pyrazinamide (Z), and ethambutol (E), followed by 4 months of HR] are about