Fernando Zanghelini

University of East Anglia

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CA Andrade

Hospital Samaritano de São Paulo

MG Pitta

Universidade Federal de Pernambuco

Moacyr Jesus Barreto de Melo Rêgo

Universidade Federal de Pernambuco

MD Oliveira

Universidade Federal de Pernambuco

MC Pereira

Universidade Federal de Pernambuco

Hamed Kord‐Varkaneh

Hamedan University of Medical Sciences

MR Galdino-Pitta

Universidade Federal de Pernambuco

TR Nunes

Universidade Federal de Pernambuco

DC Viana

Universidade Federal de Pernambuco

Richard Fordham

University of East Anglia

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Universidade Federal de Pernambuco

Imperial College London

Fundação Oswaldo Cruz

Shahid Beheshti University of Medical Sciences

Tehran University of Medical Sciences

Hospital das Clínicas da Universidade Federal de Pernambuco

National Nutrition and Food Technology Research Institute

Royal Brompton Hospital

Harefield Hospital

Universidade de Brasília

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Strategies for the implementation of clinical practice guidelines in public health: an overview of systematic reviews

Health Research Policy and Systems (2022)

Viviane Cássia Pereira Sarah Nascimento Silva Viviane Karoline da Silva Carvalho Fernando Zanghelini Jorge Otávio Maia Barreto

As a source of readily available evidence, rigorously synthesized and interpreted by expert clinicians and methodologists, clinical guidelines are part of an evidence-based practice toolkit, which, transformed into practice recommendations, have the potential to improve both the process of care and patient outcomes. In Brazil, the process of development and updating of the clinical guidelines for the Brazilian Unified Health System (Sistema Único de Saúde, SUS) is already well systematized by the Ministry of Health. However, the implementation process of those guidelines has not yet been discussed and well structured. Therefore, the first step of this project and the primary objective of this study was to summarize the evidence on the effectiveness of strategies used to promote clinical practice guideline implementation and dissemination.This overview used systematic review methodology to locate and evaluate published systematic reviews regarding strategies for clinical practice guideline implementation and adhered to the PRISMA guidelines for systematic review (PRISMA).This overview identified 36 systematic reviews regarding 30 strategies targeting healthcare organizations, healthcare providers and patients to promote guideline implementation. The most reported interventions were educational materials, educational meetings, reminders, academic detailing and audit and feedback. Care pathways-single intervention, educational meeting-single intervention, organizational culture, and audit and feedback-both strategies implemented in combination with others-were strategies categorized as generally effective from the systematic reviews. In the meta-analyses, when used alone, organizational culture, educational intervention and reminders proved to be effective in promoting physicians' adherence to the guidelines. When used in conjunction with other strategies, organizational culture also proved to be effective. For patient-related outcomes, education intervention showed effective results for disease target results at a short and long term.This overview provides a broad summary of the best evidence on guideline implementation. Even if the included literature highlights the various limitations related to the lack of standardization, the methodological quality of the studies, and especially the lack of conclusion about the superiority of one strategy over another, the summary of the results provided by this study provides information on strategies that have been most widely studied in the last few years and their effectiveness in the context in which they were applied. Therefore, this panorama can support strategy decision-making adequate for SUS and other health systems, seeking to positively impact on the appropriate use of guidelines, healthcare outcomes and the sustainability of the SUS.

Academic detailing

Guideline

Evidence-Based Practice

Health Services Research

Health administration

Systematic process

Implementation research

10.1186/s12961-022-00815-4

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Citations (127)

A systematic review and meta-analysis on the accuracy of rapid immunochromatographic tests for dengue diagnosis

European Journal of Clinical Microbiology & Infectious Diseases (2022)

Jéssica V. L. Macêdo Isaac A.M. Frías Maria D.L. Oliveira Fernando Zanghelini César A.S. Andrade

Grading (engineering)

Forest plot

10.1007/s10096-022-04485-6

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Citations (9)

P005 The economic burden of delayed diagnosis in axial spondyloarthritis in the UK

Lara D. Veeken (2024)

Fernando Zanghelini Georgios Xydopoulos Stephanie Howard Wilsher Oyewumi Afolabi Dale Webb

Abstract Introduction Timely diagnosis of axial spondyloarthritis (axSpA) remains challenging and delays result in harmful consequences. Few studies have evaluated the cost of delayed axSpA diagnosis. This study aims to develop an economic analysis to determine the annual cost of delaying the axSpA diagnosis, adopting both NHS (UK) and societal perspectives. Methods We developed a Markov economic model to estimate the costs of delayed axSpA diagnosis in the UK. The cohort of patients assessed comprised a mixed population (cohort size: 1,000 patients, 64% males), mean age of symptom onset 26 years. The model captured the resources used and costs related to diagnosing and managing axSpA symptoms until the disease was diagnosed. Results Results are summarised in Table 1. Our economic analysis results show the cost of delayed axSpA diagnosis is substantial and falls mainly on the individuals concerned in the form of productivity losses, out of pocket medical expenses, non-prescribed drug expenses, and travel costs to healthcare services. These costs are higher in younger patients but remain substantial in older groups. With a symptom onset at the age of 26 and an average time to diagnosis of 8.5 years, we estimate that the cumulative cost of delayed diagnosis per person living with axial SpA is £193,512 (CI95%: £108,769 - £306,789). The total annual cost that accrues to delay before the diagnosis of axSpA in the UK was £3.1 billion and £12.4 billion, based on a prevalence of 0.3% and 1.2%, respectively (Table 1). Our results corroborate findings from other studies, showing that patients with a late diagnosis of axSpA had higher costs, reduced incapacity for work, and worse clinical outcomes1,2. P005 Table 1.Nationwide total cost of delaying the axSpA diagnosis based on axSpA prevalence.Prevalence of 0.3%Prevalence of 1.2%ResultsTotal cost - ModelledTotal cost – NASS pop*Total cost – UK adult pop**Total cost – UK adult pop**DSA£23,104.17£4,236,794,775£3,115,805,703£12,463,222,813PSA£24,025.06£4,431,645,007£3,259,101,637£13,036,406,54995% LCI£14,568.52£2,703,455,437£1,988,163,769£7,952,655,07995% UCI£36,950.02£6,595,614,347£4,850,518,822£19,402,075,288Note: 83.4% remaining undiagnosed per year*NASS estimate population: 220,000 patients.**UK adult population (2022): 53,930,490.DSA: deterministic sensitivity analysis, LCI: low confidence interval, pop: population, PSA: probabilistic sensitivity analysis: UCI: upper confidence interval. Conclusion To our knowledge, this is the first UK-specific study and the first internationally to develop an economic analysis to determine the annual cost of delay in diagnosing axSpA, adopting both NHS and societal perspectives. Earlier diagnosis is essential in order to reduce healthcare needs, resource utilisation, and enhance the quality of life for people living with axSpA References 1. Kobelt G, et al. Value Health. 2008 May;11(3):408–15. 2. Grigg SE, et al. ACRARHP Sci Meet 2011. 2011;63(abstract 1308).

Axial spondyloarthritis

10.1093/rheumatology/keae590.008

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Digital breast tomosynthesis added to synthetic mammography (DBT + s2D) in women with partially fatty or heterogeneously dense breasts (patterns 2 and 3 ACR BI-RADS): Systematic review, metaanalysis, and clinical outcomes in brazilian breast cancer screening

Mastology (2023)

Henrique Lima Couto Fernando Zanghelini Ludmila Peres Gargano Bertha Andrade Coelho Vilmar Marques de Oliveira

Objective: The objectives of this study were to compare DBT + s2D to digital mammography (DM) in breast cancer screening of women with breast patterns 2 and 3 ACR BI-RADS and evaluate the clinical outcomes in Brazil. Methodology: This is a systematic review and meta-analysis (PRISMA) comparing DBT+s2D with DM in women between 40 and 69 years old with breast patterns B and C of ACR BI-RADS 5th Edition eligible for biennial breast cancer screening. The Medline, PubMed, Embase, and Cochrane databases were searched on September 06, 2022 for the descriptors: digital breast tomosynthesis, DM, and breast cancer combined to Boolean AND or OR. To estimate outcomes between the screening strategies, a hybrid decision analytic tree with a Markov transitional model was built. Results: A total of 18 publications from 11 studies were included, two randomized clinical trials and the others, prospective or retrospective observational studies. The detection cancer rate of DBT+s2D was 1.35 (RR, p <0.001) , the detection invasive cancer rate was 1.48 (RR, p <0.001), the recall rate (RR) was 0.81 (RR, p=0.028), the biopsy rate was (BR) 0.89 (RR, p=0.303), and the positive predictive value for recall (PPV1) was 1.64 (RR; p <0.001) when compared with DM. For every 10,000 screening exams, 49 biopsies and 69 recalls would be avoided with DBT+s2D. DBT+s2D would have a lower rate of interval cancer (0.13% for DBT+s2D and 0.19% for DM), while it would detect more patients in the early stage of breast cancer (TNM 1) 0.74% for DBT+s2D and 0.45% for DM). DBT+s2D would present superior results regarding the number of false positives and true negatives. For every 10,000 screens, 79 false positives would be avoided, and 80 more true negatives would be identified when compared with DM. Conclusion: DBT + s2D breast cancer screening for women with breast patterns B and C BI-RADS would improve Brazilian screening outcomes when compared with mammography.

Overdiagnosis

Digital Breast Tomosynthesis

10.29289/259453942023v33s1006

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Cost-Effectiveness of GaitSmart and an Artificial Intelligence Solution for Rehabilitation of Patients Undergoing Total Hip Arthroplasty (THA) and Total Knee Arthroplasty (TKA) in Older Population in the United Kingdom

Geriatrics (2024)

Fernando Zanghelini Aisling Ponzo Georgios Xydopoulos Richard Fordham Saval Khanal

Background: GaitSmart (GS) is a sensor-based digital medical device that can be used with the integrated app vGym to provide a personalised rehabilitation programme for older people undergoing total hip arthroplasty (THA) or total knee arthroplasty (TKA). This study aimed to determine whether the GS intervention used in the rehabilitation of older people undergoing THA or TKA is potentially cost-effective compared to the current standard of care (SoC). Methods: Decision-analytic modelling was conducted to estimate the cost-effectiveness over a seventeen-week time horizon from an NHS perspective. UK clinical and cost data from the GaitSmart randomised clinical trial was used to obtain the input parameters, and a sensitivity analysis was performed to address uncertainties. Results: Over a seventeen-week time horizon, GS incurred cost savings of GBP 450.56 and a 0.02 gain in quality-adjusted life years (QALYs) compared to the SoC. These results indicate that GS is the dominant intervention because the device demonstrated greater effectiveness and lower costs. Probabilistic sensitivity analyses confirm the robustness of our results. Conclusions: GS appears to offer short-term efficiency benefits and demonstrates cost-effectiveness for the improvement in gait in people undergoing THA or TKA, compared to the SoC.

10.3390/geriatrics9050129

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Biosensing breast cancer cells based on a three-dimensional TIO2 nanomembrane transducer

Biosensors and Bioelectronics (2016)

Fernando Zanghelini Isaac A.M. Frías Moacyr Jesus Barreto de Melo Rêgo Maíra Galdino da Rocha Pitta Marco Sacilloti

10.1016/j.bios.2016.11.006

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Citations (37)

The effects of tocotrienols intake on obesity, blood pressure, inflammation, liver and glucose biomarkers: a meta-analysis of randomized controlled trials

Critical Reviews in Food Science and Nutrition (2021)

Fengxiang Li Biao Xu Samira Soltanieh Fernando Zanghelini Ahmed Abu‐Zaid

(2021). The effects of tocotrienols intake on obesity, blood pressure, inflammation, liver and glucose biomarkers: a meta-analysis of randomized controlled trials. Critical Reviews in Food Science and Nutrition. Ahead of Print.

Lipid Profile

10.1080/10408398.2021.1911926

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Citations (6)

A IMPORTÂNCIA ECONÔMICA DA COMPRA CENTRALIZADA DOS INIBIDORES DO FATOR DE NECROSE TUMORAL-ALFA EM PERNAMBUCO

Revista Eletrônica de Farmácia (2014)

Fernando Zanghelini André Santos da Silva José de Arimatea Rocha Filho

Analisou-se o impacto nos custos da aquisição centralizada de medicamentos de alta complexidade para o tratamento da artrite reumatoide (AR) na Secretaria de Saúde de Pernambuco. Realizou-se um estudo transversal, comparativo de custo, com medicamentos adquiridos em licitações de 2010 (compra descentralizada) e 2012 (compra centralizada). O custo anual atualizado, com a compra descentralizada dos inibidores de Fator de Necrose Tumoral-Alfa (TNF-?) chegaria ao estimado de R$ 29.640.229,68, frente a R$ 15.339.978,00 da compra centralizada, perfazendo uma economia de 48,2%. Este resultado demonstrou que a compra centralizada pelo Ministério da Saúde possibilitou economia de recursos, sugerindo uma importante ferramenta para a melhoria da gestão da Assistência Farmacêutica nos estados.

10.5216/ref.v11i2.29273

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Citations (1)

Effectiveness evaluation of public policy incentive R&D in technological innovation in Brazil: a focus on law of the well

DOAJ (DOAJ: Directory of Open Access Journals) (2015)

Fernando Zanghelini César A.S. Andrade

The present paper will address pharmaceutical industries that carry out research, development and innovation (RDI and legal framework destined for supporting research, both provided by Ministry of Science, Technology and Innovation of Brazil. During the studied period, an increase of 800% of the participating companies of the ‘Law of the Well’ was observed, demonstrating a need to invest in RD e o arcabouco legal de amparo a pesquisa, ambos fornecidos pelo Ministerio de Ciencia, Tecnologia e Inovacao do Brasil. Durante o periodo estudado, observou-se um aumento de 800% das empresas participantes do Lei do Bem, demonstrando a necessidade de investir em P & D. A soma das despesas com custeio para efeito do calculo dos incentivos as empresas que operaram em regime de lucro real e que optaram por usufruir dos incentivos fiscais da Lei do Bem atingiram o valor de R$ 40,52 bilhoes. Embora um dos propositos da Lei do Bem seja subsidiar a fixacao de pesquisadores nas empresas, os valores totais das despesas capitais nao ultrapassam a 4% do valor total investido em atividades de P&D. Semelhantemente observa-se que os percentuais de incentivo ao desenvolvimento e registro de patentes tambem nao ultrapassam a 1%. Embora a Lei do Bem se apresente como um aparato institucional que contribui para as empresas se tornarem eficientes e competitivas para enfrentar o acirrado mercado globalizado, indicadores recentes sobre os gastos com P&D no Brasil demonstram certa estagnacao nos investimentos nos diversos setores. Palavras-chave: Lei do Bem. Politicas publicas. Complexo farmaceutico. Inovacao tecnologica.

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Indicação Do Medicamento Talidomida Para O Tratamento De Mieloma Múltiplo: Uma Avaliação Para Atualização Da Rename

Value in Health (2015)

MC Pereira MG Pitta Moacyr Jesus Barreto de Melo Rêgo PS Oliveira Fernando Zanghelini

10.1016/j.jval.2015.09.238

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