In 2019, the National Evidence-based Healthcare Collaborating Agency (NECA) in Korea established a health technology reassessment (HTR) system to manage the life cycle of health technologies and develop operational measures promoting the efficient use of healthcare resources. The purpose of this study is to introduce the detailed implementation process and practical functional methods of the HTR implemented by NECA.

The HTR is a structured multidisciplinary method for analyzing health technologies currently used in the healthcare system based on the latest information on parameters, such as clinical safety, effectiveness, and cost-effectiveness of optimizing the use of healthcare resources as well as social and ethical issues. All decision-making stages of the HTR are carefully reviewed and transparently managed. The HTR committee makes significant decisions, and the subcommittee decides the details related to the assessment process.

Since the pilot began in 2018, 262 cases have been reassessed, of which, 126 cases (48.1 percent) were health services not covered by the National Health Insurance (NHI). Over the past 5 years, approximately 130 recommendations for the in-use technologies were determined by the HTR committee. In the near future, it will be necessary to officially develop and establish a Korean HTR system and a legal foundation to optimize the NHI system.

Ethiopia has heterogeneous topographic, climatic and socio-ecological systems. Recommendations of agricultural inputs and management practices based on coarse domains such as agro-ecological zones (AEZ) may not lead to accurate targeting, mainly due to large intra-zone variations. The lack of well-targeted recommendations may contribute to the underperformance of promising technologies. Therefore, there is a need to define units where similar environmental and biophysical features prevail, based on which specific recommendations can be made for similar response units (SRUs). We used unsupervised machine learning algorithms to identify areas of high similarity or homogeneous zones called ‘SRUs’ that can guide the targeting of agricultural technologies. SRUs are landscape entities defined by integrating relevant environmental covariates with the intention to identify areas of similar responses. Using environmental spatial data layers such as edaphic and ecological variables for delineation of the SRUs, we applied K- and X-means clustering techniques to generate various granular levels of zonation and define areas of high similarity. The results of the clustering were validated through expert consultation and by comparison with an existing operational AEZ map of Ethiopia. We also augmented validation of the heterogeneity of the SRUs by using field-based crop response to fertiliser application experimental data. The expert consultation highlighted that the SRUs can provide improved clustering of areas of high similarity for targeting interventions. Comparison with the AEZ map indicated that SRUs with the same number of AEZ units captured heterogeneity better with less within-cluster variability of the former. In addition, SRUs show lower within-cluster variability to optimal crop response to fertiliser application compared with AEZs with the same number of classes. This implies that the SRUs can be used for refined agricultural input and technology targeting. The work in this study also developed an operational framework that users can deploy to fetch data from the cloud and generate SRUs for their areas of interest.

Objectives: Contextual data and local expertise are important sources of data that cannot be ignored in hospital-based health technology assessment (HTA) processes. Despite a lack of or unconvincing evidence in the scientific literature, technology can be recommended in a given context. We illustrate this using a case study regarding biplane angiography for vascular neurointervention.

Methods: A systematic literature review was conducted, along with an analysis of the context in our setting. The outcomes of interest were radiation doses, clinical complications, procedure times, purchase cost, impact on teaching program, the confidence of clinicians in the technology, quality of care, accessibility, and the volume of activity. A committee comprising managers, clinical experts, physicians, physicists and HTA experts was created to produce a recommendation regarding biplane technology acquisition to replace a monoplane device.

Results: The systematic literature review yielded nine eligible articles for analysis. Despite a very low level of evidence in the literature, the biplane system appears to reduce ionizing radiation and medical complications, as well as shorten procedure time. Contextual data indicated that the biplane system could improve operator confidence, which could translate into reduced risk, particularly for complex procedures. In addition, the biplane system can support our institution in its advanced procedures teaching program.

Conclusions: Given the advantages provided by the biplane technology in our setting, the committee has recommended its acquisition. Contextual data were of utmost importance in this recommendation. Moreover, this technology should be implemented alongside a responsibility to collect outcome data to optimize clinical protocol in the doses of ionizing delivered.

The project “FArming Tools for external nutrient Inputs and water Management” (FATIMA, H2020-SFS2) is developing satellite-based methodologies and information to support effective and efficient water and nitrogen input recommendations in agricultural production. This paper focuses on nitrogen recommendation for winter cereals in Austria and presents preliminary findings from the 2015/16 crop growing season. The Nitrogen Nutrition Index was applied using an empirical relationship to derive dry mass from Leaf Area Index (LAI) and %Na from a chlorophyll index. Results showed a very high correlation between LAI and above ground dry mass (R2=0.95) but a lower correlation between the chlorophyll index and %Na (R2=0.24). Despite various indices tested, the relationship to estimate %Na remains weak. Additional field data and research are needed to further study this aspect.

Earthquakes are a major natural calamity with pervasive effects on human life and nature. Similar effects are mimicked by man-made disasters such as fuel crises and power outages in developing countries. Natural and man-made disasters can cause intangible human suffering and often leave scars of lifelong psychosocial damage. Lessons from these disasters are frequently not implemented. The main objective of this study was to review the effects of the 2015 earthquakes, fuel crisis, and power outages on the health services of Nepal and formulate recommendations for the future. The impacts of earthquakes on health can be divided into immediate, intermediate, and long-term effects. Power outages and fuel crises have health hazards at all stages. It is imperative to understand the temporal effects of earthquakes, because the major needs soon after the earthquake (emergency care) are vastly different from long-term needs such as rehabilitation and psychosocial support. In Nepal, the inadequate and nearly nonexistent specialized health care at the peripheral level claimed many lives during the earthquakes and left many people disproportionately injured. Preemptive strategies such as mobile critical care units at primary health centers, intensive care training for health workers, and alternative plans for emergency care must be prioritized. Similarly, infrastructural damage led to poor sanitation, and alternative plans for temporary settlements (water supply, food, settlements logistics, space for temporary settlements) must be in place where the danger of disease outbreak is imminent. While much of these strategies are implementable and are often set as priorities, long-term effects of earthquakes such as physical and psychosocial supports are often overlooked. The burden of psychosocial stresses, including depression and physical disabilities, needs to be prioritized by facilitating human resources for mental health care and rehabilitation. In addition, inclusion of mental health and rehabilitation facilities in government health care services of Nepal needs to be prioritized. Similarly, power outages and fuel crises affect health care disproportionately. In the current context where permanent solutions may not be possible, mitigating health hazards, especially cold chain maintenance for essential medicines and continuation of life-saving procedures, are mandatory and policies to regulate all health care services must be undertaken. (Disaster Med Public Health Preparedness. 2017;11:625–632)

In accordance with the World Health Assembly Resolution 58.1, the World Health Organization (WHO) convened an Expert Consultation in Geneva, Switzerland from 15–17 February 2006 to discuss and provide recommendations for enhancing emergency preparedness and capacity building at the community, country, regional, and global levels. The consultation included experts and representatives of non-governmental and inter-governmental organizations. Recommendations included a set of operational objectives and strategies for achieving them. It was recognized that emergency preparedness is part of development and that crises occur at the community level. The recommendations, therefore, were focused at the community and country levels and outlined processes by which WHO could assist countries in augmenting their abilities to cope with health emergencies. This document provides a detailed discussion of the issues addressed, the conclusions reached, and recommendations based on the conclusions.

The 10th european ALARA network (EAN) workshop took place in Prague (Czech Republic) in September 2006. This was the 10-year anniversary of the EAN, and unlike the previous workshops that addressed a particular ALARA topic, the aim of this workshop was to consider the implementation of the optimisation principle in all domains of activities (nuclear and conventional industry, medical sector, NORM industry). This principle is fundamental to radiation protection, and the workshop drew together key stakeholders to discuss its past, present and future status. The workshop was asked to consider the practical implementation of ALARA, and how this might be improved in the next 10 years. The objectives of the 10th EAN workshop were to review the past evolution of the ALARA concept, internationally, within the EU, and nationally, in terms of the practical impact on radiation protection; to examine the current status of the implementation of the ALARA principle; and to identify needs for future developments in the concept and implementation of optimisation. As with previous workshops, half the programme time was devoted to invited presentations, and half to working group discussions and report backs. After discussion, the output of these working groups was collated by the EAN co-ordinators, to produce seven formal recommendations to international organizations (IAEA, International Labour Organisation, European Commission), to EAN itself and to national authorities. These recommendations deal with justification of practices, holistic approach, ALARA culture, ALARA training, especially in the medical sector, ALARA focus through inspection and control, and stakeholder involvement. Individual presentations (papers and slides) are available to download from the EAN website (http://www.eu-alara.net).

Objectives: The association between type and amount of clinical evidence and type of National Institute for Health and Clinical Excellence recommendations for interventional procedures was examined.

Methods: The evidence about 736 studies (including 183,729 patients) relating to 130 different interventional procedures and about relevant recommendations was analyzed. Associations were examined between type of recommendation (“normal arrangements” or “cautionary guidance”) and evidence type, total number of treated patients, and mean follow-up length. Evidence type was categorized as (a) randomized, (b) nonrandomized controlled, and (c) case series/reports. The main outcome measures were frequency of evidence type, total number of patients treated, and mean follow-up length, by type of recommendation.

Results: “Normal arrangements” recommendations were made for 70 (54 percent) procedures and “cautionary guidance” was issued for 60 (46 percent) procedures. Procedures supported by at least one randomized study (34 percent, n = 44) were more likely to receive a “normal arrangements” recommendation (relative risk 1.38, p = .063). Overall, there were 85 (12 percent), 135 (18 percent), and 516 (70 percent) studies in categories a–c, respectively. The number of treated patients was significantly larger among procedures with “normal arrangements” (median, 605; range, 26–6,842) than among those with “cautionary guidance” (median, 240; range, 1–3,261; p < .001) recommendation. Mean follow-up length was longer in studies relating to procedures with “normal arrangements” recommendation (median, 16.7; range, 0–84 months) compared with those with “cautionary guidance” (median, 14.6; range, 0–67 months; p = .160).

Conclusions: Procedures supported by randomized studies, and with larger numbers of patients and longer follow-up length, were more likely to receive positive guidance. Future research and development on interventional procedures should aim to produce better and more relevant evidence to optimize the possibility of such procedures being accepted by policy makers.