Plasma Surface Engineering of Natural and Sustainable Polymeric Derivatives and Their Potential Applications

Recently, natural as well as synthetic polymers have been receiving significant attention as candidates to replace non-renewable materials. With the exponential developments in the world each day, the collateral damage to the environment is incessant. Increased demands for reducing pollution and energy consumption are the driving force behind the research related to surface-modified natural fibers (NFs), polymers, and various derivatives of them such as natural-fiber-reinforced polymer composites. Natural fibers have received special attention for industrial applications due to their favorable characteristics, such as low cost, abundance, light weight, and biodegradable nature. Even though NFs offer many potential applications, they still face some challenges in terms of durability, strength, and processing. Many of these have been addressed by various surface modification methodologies and compositing with polymers. Among different surface treatment strategies, low-temperature plasma (LTP) surface treatment has recently received special attention for tailoring surface properties of different materials, including NFs and synthetic polymers, without affecting any of the bulk properties of these materials. Hence, it is very important to get an overview of the latest developments in this field. The present article attempts to give an overview of different materials such as NFs, synthetic polymers, and composites. Special attention was placed on the low-temperature plasma-based surface engineering of these materials for diverse applications, which include but are not limited to environmental remediation, packaging, biomedical devices, and sensor development.

Multi-Sensor Respiratory-Swallow Telecare System for Safe Feeding in Different Trunk Inclinations: System Development and Clinical Application

Proper positioning is especially important to ensure feeding and eating safely. With many nursing facilities restricting visitations and close contact during the coronavirus pandemic, there is an urgent need for remote respiratory-swallow monitoring. This study aimed to develop a semiautomatic feeding telecare system that provides instant feedback and warnings on-site and remotely. It also aimed to analyze the effects of trunk positions on respiratory-swallow coordination. A signal collector with multiple integrated sensors for real-time respiratory-swallow monitoring and warning was developed. A repeated measures design was implemented to evaluate the effects of trunk inclination angles on the swallow-related functions. Significant differences in inclination angles were discovered for swallowing apnea (p = 0.045) and total excursion time of thyroid cartilage (p = 0.037), and pairwise comparisons indicated that these differences were mostly present at 5° to 45°. Alerts were triggered successfully when undesired respiratory patterns or piecemeal occurred. The results indicated that a care recipient can swallow more easily when sitting upright (5°) than when leaning backward (45°). This telecare system provides on-site and remote respiratory-swallow monitoring and alerting for residents in care facilities and can serve as a pipeline for the early screening of swallowing dysfunction.

Green Synthesis of Carbon Nanoparticles (CNPs) from Biomass for Biomedical Applications

In this review, we summarize recent work on the "green synthesis" of carbon nanoparticles (CNPs) and their application with a focus on biomedical applications. Recent developments in the green synthesis of carbon nanoparticles, from renewable precursors and their application for environmental, energy-storage and medicinal applications are discussed. CNPs, especially carbon nanotubes (CNTs), carbon quantum dots (CQDs) and graphene, have demonstrated utility as high-density energy storage media, environmental remediation materials and in biomedical applications. Conventional fabrication of CNPs can entail the use of toxic catalysts; therefore, we discuss low-toxicity manufacturing as well as sustainable and environmentally friendly methodology with a focus on utilizing readily available biomass as the precursor for generating CNPs.

Potential Biomedical Limitations of Graphene Nanomaterials

Graphene-family nanomaterials (GFNs) possess mechanical stiffness, optical properties, and biocompatibility making them promising materials for biomedical applications. However, to realize the potential of graphene in biomedicine, it must overcome several challenges that arise when it enters the body's circulatory system. Current research focuses on the development of tumor-targeting devices using graphene, but GFNs accumulated in different tissues and cells through different pathways, which can cause toxic reactions leading to cell apoptosis and body dysfunction when the accumulated amount exceeds a certain limit. In addition, as a foreign substance, graphene can induce complex inflammatory reactions with immune cells and inflammatory factors, potentially enhancing or impairing the body's immune function. This review discusses the biomedical applications of graphene, the effects of graphene materials on human immune function, and the biotoxicity of graphene materials.

Thiolated Polymeric Hydrogels for Biomedical Applications: A Review

Hydrogels are a three-dimensional (3D) network of hydrophilic polymers. The physical and chemical crosslinking of polymeric chains maintains the structure of the hydrogels even when they are swollen in water. They can be modified with thiol by thiol epoxy, thiol-ene, thiol-disulfide, or thiol-one reactions. Their application as a matrix for protein and drug delivery, cellular immobilization, regenerative medicine, and scaffolds for tissue engineering was initiated in the early 21st century. This review focuses on the ingredients, classification techniques, and applications of hydrogels, types of thiolation by different thiol-reducing agents, along with their mechanisms. In this study, different applications for polymers used in thiolated hydrogels, including dextran, gelatin, polyethylene glycol (PEG), cyclodextrins, chitosan, hyaluronic acid, alginate, poloxamer, polygalacturonic acid, pectin, carrageenan gum, arabinoxylan, carboxymethyl cellulose (CMC), gellan gum, and polyvinyl alcohol (PVA) are reviewed.

Surface decorated quantum dots: Synthesis, properties and role in herbal therapy

Quantum dots are the serendipitous outcome of materials research. It is the tiny carbonaceous nanoparticles with diameters ranging from 1 to 10 nm. This review is a brief discussion of the synthesis, properties, and biomedical applicability of quantum dots, especially in herbal therapy. As quantum dots are highly polar, they can be surface decorated with several kinds of polar functionalities, such as polymeric molecules, small functional molecules, and so on. The review also consists of the basic physical and optical properties of quantum dots and their excitation-dependent properties in the application section. We focus on therapeutics, where quantum dots are used as drugs or imaging probes. Nanoprobes for several diagnostics are quite new in the biomedical research domain. Quantum dot-based nanoprobes are in high demand due to their excellent fluorescence, non-bleaching nature, biocompatibility, anchoring feasibility for several analytes, and fast point-of-care sensibility. Lastly, we also included a discussion on quantum dot-based drug delivery as phytomedicine.

Wearable Polarization Conversion Metasurface MIMO Antenna for Biomedical Applications in 5 GHz WBAN

This paper presents a wearable metasurface multiple-input multiple-output (MIMO) antenna for biomedical applications in a 5 GHz wireless body area network (WBAN) with broadband, circular polarization (CP), and high gain. The physical properties of the MIMO antenna element and the principles of polarization conversion are analyzed in-depth using characteristic mode analysis. For the proposed MIMO antenna, the measured -10 dB impedance bandwidth is 34.87% (4.76-6.77 GHz), and the 3 dB axial ratio bandwidth is 22.94% (4.9-6.17 GHz). By adding an isolation strip, the measured isolation of the two antenna elements is greater than 19.85 dB. The overall size of the MIMO antenna is 1.67λ₀ × 0.81λ₀ × 0.07λ₀ at 5.6 GHz, and the maximum gain is 7.95 dBic. The envelope correlation coefficient (ECC) is less than 0.007, with the maximum diversity gain greater than 9.98 dB, and the channel capacity loss is less than 0.29 b/s/Hz. The specific absorption rate (SAR) of the wearable MIMO antenna is simulated by the human tissue model, which proves that the proposed antenna conforms to international standards and is harmless to humans. The proposed wearable metasurface MIMO antenna has CP, broadband, high gain, low ECC, and low SAR, which can be used in wearable devices for biomedical applications.

Study of solid waste (municipal and medical) management during the COVID-19 pandemic: a review study

The COVID-19 pandemic has resulted in a global emergency crisis and created waste management challenges worldwide. Such a critical point has changed solid waste (municipal and medical) management prospects and posed fact challenges to the health decision-makers and policy-makers to make decisions to ensure sustainable management of the environment. One of the most negative prospects of COVID-19 pandemic is the increased waste generation, especially plastic waste in developing and developed countries. This study systematically reviews the potential influences of the COVID-19 pandemic on medical and municipal waste, and discusses the corresponding measures and policies of solid waste management in several countries. The results show that the highest and lowest quality of final disposal is observed in Finland with 75% recycling and in India with 90% open dumping, respectively. In many countries, the medical waste showed an increase by 350-500%.The pandemic has brought particular problems to the disposal capacity of municipal waste and medical waste across the world. We think that this point of view study provides valuable data for scientists, policy makers, health decision-makers, consultants, medical staff, medical supplies, those working in public health sector, and field engineers responsible for solid waste management.

An Ethics Framework for Evaluating Ownership Practices in Biomedical Citizen Science

The collaborative nature of citizen science raises important questions about managing ownership of its research outputs. Potential citizen science research outputs include data sets, findings, publications, and discoveries of new ideas, methods, products, and technologies. Unlike citizen science projects conducted in other disciplines, biomedical citizen science projects often include features, such as contribution of personal health data, that might heighten citizen scientists' expectations that they will be able to access, control, or share in the benefits of project outputs. Here, we refer to moral claims of access, control, and benefit as ownership claims, and a project's management of ownership claims as its ownership practices. Ethical management of ownership is widely recognized as an important consideration for citizen science projects, and practitioners and scholars have described helpful recommendations for preempting issues and engaging stakeholders on practices. Building on this literature, we propose a framework to help biomedical citizen science projects systematically evaluate the ethical soundness of their ownership practices based on four considerations: reciprocal treatment, relative treatment, risk-benefit assessment, and reasonable expectations.

Incorporating environmental and sustainability considerations into health technology assessment and clinical and public health guidelines: a scoping review

Healthcare systems account for a substantial proportion of global carbon emissions and contribute to wider environmental degradation. This scoping review aimed to summarize the evidence currently available on incorporation of environmental and sustainability considerations into health technology assessments (HTAs) and guidelines to support the National In stitute for Health and Care Excellence and analogous bodies in other jurisdictions developing theirown methods and processes. Overall, 7,653 articles were identified, of which 24 were included in this review and split into three key areas - HTA (10 studies), healthcare guidelines (4 studies), and food and dietary guidelines (10 studies). Methodological reviews discussed the pros and cons of different approaches to integrate environmental considerations into HTAs, including adjustments to conventional cost-utility analysis (CUA), cost-benefit analysis, and multicriteria decision analysis. The case studies illustrated the challenges of putting this into practice, such as lack of disaggregated data to evaluate the impact of single technologies and difficulty in conducting thorough life cycle assessments that consider the full environmental effects. Evidence was scant on the incorporation of environmental impacts in clinical practice and public health guidelines. Food and dietary guidelines used adapted CUA based on life cycle assessments, simulation modeling, and qualitative judgments made by expert panels. There is uncertainty on how HTA and guideline committees will handle trade-offs between health and environment, especially when balancing environmental harms that fall largely on society with health benefits for individuals. Further research is warranted to enable integration of environmental considerations into HTA and clinical and public health guidelines.

Underrepresentation of Respiratory Therapists as Experts in Delphi Studies on Respiratory Practices and Research Priorities

Delphi survey techniques are a common consensus method used to collect feedback from an expert panel to inform practices, establish guidelines, and identify research priorities. Collecting respiratory therapists' (RT) expertise and experiences as part of consensus-building methodologies is one way to ensure that they align with RT practices and to better influence respiratory care practice. This narrative review aimed to report the RT representation in expert panels of Delphi studies focused on respiratory therapy practices and research priorities. The research question that guided this review is: to what extent are RTs included as expert participants among published Delphi studies relate to respiratory therapy and research topics? We conducted a structured search of the literature and identified 23 papers that reported Delphi studies related to respiratory care practices and 15 that reported on respiratory-related research priorities. Delphi studies that focused on reporting consensus on respiratory care practices included the following: (1) mechanical ventilation, (2) high-flow nasal cannula therapy, (3) COVID-19 respiratory management, (4) home oxygen therapy, (5) cardiopulmonary monitoring, and (6) disease-specific guidelines. Delphi studies that focused on establishing respiratory research priorities included the following: (1) theory and practice-orientated knowledge gaps, and (2) priority research topics for empirical investigation. The results of this review suggest that RTs were rarely included as expert participants and, when involved, were minimally represented (5% to 33%). Given RTs' diverse and relevant experience in respiratory care, incorporating their perspectives to inform future education, respiratory care practices, and research priorities would allow evidence to better align with knowledge gaps deemed important for the respiratory therapy profession.

Defining Soft Tissue: Bitmap Printing of Soft Tissue for Surgical Planning

Nearly all applications of 3D printing for surgical planning have been limited to bony structures and simple morphological descriptions of complex organs due to the fundamental limitations in accuracy, quality, and efficiency of the current modeling paradigms and technologies. Current approaches have largely ignored the constitution of soft tissue critical to most surgical specialties where multiple high-resolution variations transition gradually across the interior of the volume. Differences in the scales of organization related to unique organs require special attention to capture fine features critical to surgical procedures. We present a six-material bitmap printing technique for creating 3D models directly from medical images, which are superior in spatial and contrast resolution to current 3D modeling methods, and contain previously unachievable spatial fidelity for soft tissue differentiation. A retrospective exempt IRB was obtained for all data through the Colorado Multiple Institution Review Board #21-3128.

Review on Biocompatibility and Prospect Biomedical Applications of Novel Functional Metallic Glasses

The continuous development of novel materials for biomedical applications is resulting in an increasingly better prognosis for patients. The application of more advanced materials relates to fewer complications and a desirable higher percentage of successful treatments. New, innovative materials being considered for biomedical applications are metallic alloys with an amorphous internal structure called metallic glasses. They are currently in a dynamic phase of development both in terms of formulating new chemical compositions and testing their properties in terms of intended biocompatibility. This review article intends to synthesize the latest research results in the field of biocompatible metallic glasses to create a more coherent picture of these materials. It summarizes and discusses the most recent findings in the areas of mechanical properties, corrosion resistance, in vitro cellular studies, antibacterial properties, and in vivo animal studies. Results are collected mainly for the most popular metallic glasses manufactured as thin films, coatings, and in bulk form. Considered materials include alloys based on zirconium and titanium, as well as new promising ones based on magnesium, tantalum, and palladium. From the properties of the examined metallic glasses, possible areas of application and further research directions to fill existing gaps are proposed.

Pineapple Agro-Industrial Biomass to Produce Biomedical Applications in a Circular Economy Context in Costa Rica

Pineapple is a highly demanded fruit in international markets due to its unique appearance and flavor, high fiber content, vitamins, folic acid, and minerals. It makes pineapple production and processing a significant source of income for producing countries, such as Costa Rica. This review collects bibliographic information dating back to the beginnings of pineapple production in Costa Rica to the state of the market today. It details the impacts of its production chain and proposes a biorefinery as a solution to environmental problems. Besides the potentiality of new sustainable markets to contribute to the post-COVID-19 economy in Costa Rica is highlighted. The general characteristics of pineapple by-products -cellulose, hemicellulose, lignin, and other high-value products like bromelain y saponin- are described, as well as the primary processes for their ex-traction via biorefinery and main applications in the medical field. Finally, a brief description of the main works in the literature involving modeling and simulation studies of pineapple by-products properties is included.

Design and Manufacturing of Antibacterial Electrospun Polysulfone Membranes Functionalized by Ag Nanocoating via Magnetron Sputtering

Antibacterial properties of engineered materials are important in the transition to a circular economy and societal security, as they are central to many key industrial areas, such as health, food, and water treatment/reclaiming. Nanocoating and electrospinning are two versatile, simple, and low-cost technologies that can be combined into new advanced manufacturing approaches to achieve controlled production of innovative micro- and nano-structured non-woven membranes with antifouling and antibacterial properties. The present study investigates a rational approach to design and manufacture electrospun membranes of polysulfone (PSU) with mechanical properties optimized via combinatorial testing from factorial design of experiments (DOE) and endowed with antimicrobial silver (Ag) nanocoating. Despite the very low amount of Ag deposited as a conformal percolating nanocoating web on the polymer fibers, the antimicrobial resistance assessed against the Gram-negative bacteria E. coli proved to be extremely effective, almost completely inhibiting the microbial proliferation with respect to the reference uncoated PSU membrane. The results are relevant, for example, to improve antifouling behavior in ultrafiltration and reverse osmosis in water treatment.

Force-Sensorless Identification and Classification of Tissue Biomechanical Parameters for Robot-Assisted Palpation

The implementation of robotic systems for minimally invasive surgery and medical procedures is an active topic of research in recent years. One of the most common procedures is the palpation of soft tissues to identify their mechanical characteristics. In particular, it is very useful to identify the tissue's stiffness or equivalently its elasticity coefficient. However, this identification relies on the existence of a force sensor or a tactile sensor mounted at the tip of the robot, as well as on measuring the robot velocity. For some applications it would be desirable to identify the biomechanical characteristics of soft tissues without the need for a force/tactile nor velocity sensors. An estimation of such quantities can be obtained by a model-based state observer for which the inputs are only the robot joint positions and its commanded joint torques. The estimated velocities and forces can then be employed for closed-loop force control, force reflection, and mechanical parameters estimation. In this work, a closed-loop force control is proposed based on the estimated contact forces to avoid any tissue damage. Then, the information from the estimated forces and velocities is used in a least squares estimator of the mechanical parameters. Moreover, the estimated biomechanical parameters are employed in a Bayesian classifier to provide further help for the physician to make a diagnosis. We have found that a combination of the parameters of both linear and nonlinear viscoelastic models provide better classification results: 0% misclassifications against 50% when using a linear model, and 3.12% when using only a nonlinear model, for the case in which the samples have very similar mechanical properties.

Preparation and Characterization of Alginate Hydrogel Fibers Reinforced by Cotton for Biomedical Applications

In this study, cotton-reinforced alginate hydrogel fibers were successfully synthesized using the wet spinning technique to improve hydrogel fibers' mechanical strength and durability. Structural, chemical, and mechanical properties of the prepared fibers were characterized using scanning electron microscopy, Fourier transform infrared spectroscopy, X-ray Diffraction, differential scanning calorimeter, and single fiber strength tester. Based on the results obtained from fourier transform infrared spectroscopy and x-ray Diffraction, cotton fibers have been successfully incorporated into the structure of the hydrogel fibers. It was seen from the differential scanning calorimeter results that the incorporation of fibers in the structure even enhanced the thermal stability of the fiber and is viable to be implanted in the human body. Cotton reinforcement in alginate hydrogel fibers increases the modulus up to 56.45 MPa providing significant stiffness and toughness for the hydrogel composite fiber. The tenacity of the fibers increased by increasing the concentration of alginate from 2.1 cN/Tex (1% w/v) to 8.16 cN/Tex (1.5% w/v). Fiber strength increased by 26.75% and water absorbance increased by 120% by incorporating (10% w/w) cotton fibers into the fibrous structure. It was concluded that these cotton-reinforced alginate hydrogel fibers have improved mechanical properties and liquid absorption properties suitable for use in various biomedical applications.

Physicochemical Properties of Cellulose-Based Hydrogel for Biomedical Applications

Hydrogels are three-dimensional network structures of hydrophilic polymers, which have the capacity to take up an enormous amount of fluid/water. Carboxymethyl cellulose (CMC) is a commercially available cellulose derivative that can be used for biomedical applications due to its biocompatibility. It has been used as a major component to fabricate hydrogels because of its superabsorbent nature. In this study, we developed carboxylic acid crosslinked carboxymethyl cellulose hydrogels for biomedical applications. The physicochemical, morphological, and thermal properties were analyzed to confirm the crosslinking of carboxymethyl cellulose. Fourier-transform infrared spectra confirmed the crosslinking of carboxymethyl cellulose with the presence of peaks due to an esterification reaction. The distinct peak at 1718 cm-1 in hydrogel samples is due to the carbonyl group vibrations of the ester bond from the crosslinking reaction. The total carboxyl content of the sample was measured with crosslinker immersion time. The swelling of crosslinked hydrogels showed an excellent swelling capacity for CG02 that is much higher than CG01 in water and PBS. Morphological analysis of the hydrogel showed it has a rough surface. The thermal degradation of hydrogel showed stability with respect to temperature. However, the mechanical analysis showed that CG01 has a higher compressive strength than CG01. The optimum swelling ratio and higher compressive strength of CG01 hydrogels could give them the ability to be used in load-bearing tissue regeneration. These results inferred that the carboxylic acid crosslinked CMC hydrogels could be a suitable matrix for biomedical or tissue-engineering applications with improved stability.

Electrospun nanofibers with antibacterial properties for wound dressings

The antibacterial nanofibers have been proposed as an interesting material for wound healing management, since the majority of traditional wound dressings exhibit issues and complications such as infection, pain, discomfort, and poor adhesive proprieties. It allows the organism's passage through the dressing and delay the wound healing progression. Electrospun nanofibers have been intensively investigated for wound dressings in tissue engineering applications due to their distinctive features and structural similarities to the extracellular matrix including the various available methods to load the antibacterial compounds onto the nanofiber webs. To construct an effective electrospun wound dressing, various efforts have been made to design different strategies to develop advanced polymers, such as employing synthetic and/or natural materials, modifying fiber orientation, and incorporating chemicals and metallic nanoparticles (NPs) as intriguing materials for antibacterial bandages. Thus, this review summarizes the relevant recent studies on the production of electrospun antibacterial nanofibers from a wide variety of polymers used in biomedical applications for wound dressings.

Effective and Efficient Delivery of Genome-Based Testing-What Conditions Are Necessary for Health System Readiness?

Health systems internationally must prepare for a future of genetic/genomic testing to inform healthcare decision-making while creating research opportunities. High functioning testing services will require additional considerations and health system conditions beyond traditional diagnostic testing. Based on a literature review of good practices, key informant interviews, and expert discussion, this article attempts to synthesize what conditions are necessary, and what good practice may look like. It is intended to aid policymakers and others designing future systems of genome-based care and care prevention. These conditions include creating communities of practice and healthcare system networks; resource planning; across-region informatics; having a clear entry/exit point for innovation; evaluative function(s); concentrated or coordinated service models; mechanisms for awareness and care navigation; integrating innovation and healthcare delivery functions; and revisiting approaches to financing, education and training, regulation, and data privacy and security. The list of conditions we propose was developed with an emphasis on describing conditions that would be applicable to any healthcare system, regardless of capacity, organizational structure, financing, population characteristics, standardization of care processes, or underlying culture.

Actuators for Implantable Devices: A Broad View

The choice of actuators dictates how an implantable biomedical device moves. Specifically, the concept of implantable robots consists of the three pillars: actuators, sensors, and powering. Robotic devices that require active motion are driven by a biocompatible actuator. Depending on the actuating mechanism, different types of actuators vary remarkably in strain/stress output, frequency, power consumption, and durability. Most reviews to date focus on specific type of actuating mechanism (electric, photonic, electrothermal, etc.) for biomedical applications. With a rapidly expanding library of novel actuators, however, the granular boundaries between subcategories turns the selection of actuators a laborious task, which can be particularly time-consuming to those unfamiliar with actuation. To offer a broad view, this study (1) showcases the recent advances in various types of actuating technologies that can be potentially implemented in vivo, (2) outlines technical advantages and the limitations of each type, and (3) provides use-specific suggestions on actuator choice for applications such as drug delivery, cardiovascular, and endoscopy implants.

Computational Design, Synthesis, and Pharmacological Evaluation of Naproxen-Guaiacol Chimera for Gastro-Sparing Anti-Inflammatory Response by Selective COX2 Inhibition

The 4-allyl guaiacol is a natural phenolic molecule that has been widely studied for its antioxidant capacity against reactive-oxygen-species-mediated cellular damage. Therefore, we hypothesized that concomitant use of an antioxidant and NSAID may decrease the risk of gastrointestinal toxicity and make the therapy safer. To address the gastrointestinal toxicity of conventional NSAIDs, a new S-naproxen-4-allyl guaiacol chimera (MAS-1696) was computationally developed, chemically synthesized, and tested for anti-inflammatory effectiveness and gastrointestinal safety. The inhibitory potency of MAS-1696 tested against cyclooxygenase-2 (COX2), 15-lipoxygenase-2 (15-LOX2), and lipoxygenase-5 (5-LOX) in vitro revealed a stronger inhibition of COX2. Furthermore, the MAS-1696 chimera increased the COX selectivity index by 23% as compared to the parent compound naproxen, implying higher efficacy and gastric safety. In vivo data showed that MAS-1696 was less likely to cause gastrointestinal harm than naproxen while also exerting anti-inflammatory and analgesic effects equivalent to or superior to naproxen. In conclusion, MAS-1696 is orally active, bio-labile, and crystalline, making it a medication that may be administered orally.

A systematic review of the early dialogue frameworks used within health technology assessment and their actual adoption from HTA agencies

Introduction

Early advice in the process of developing health technologies allows manufacturers to plan their production and transfer to health care systems more accurately. This review aims to describe frameworks used within HTA and their current use by HTA Agencies.

Material and methods

We carried out a systematic literature review in Pubmed, Embase, Scopus, and WoS, including all references published in Spanish and English. This was last updated in March 2022. We extracted all available information regarding the organizations involved, services offered, types of technology, collaborators involved, fees, output and impact. Websites of several HTA organizations and Google were also searched in order to update and complete the information obtained from this generic search.

Results

Five-hundred and forty one articles were identified and screened, of which 26 met the eligibility criteria and were selected. Seven of them were non-systematic reviews that described two or more HTA organizations. Ten studies were focused on the advice offered by individual organizations, and eight described the EMA and EUnetHTA parallel or joint advice. We found variations in the technology assessed, services offered, stage of development and costs for advisory services.

Conclusions

Early and scientific advice would help manufacturers focus their product development on what is needed for the management of specific diseases. Most of the examples or services found refer to drugs as well as to some medical devices and diagnostics. A common definition of the type of advice that could be offered for different health technologies by HTA bodies to ascertain health care systems and manufacturers' needs, in addition to the timeline in which that advice needs to be given, would help HTA bodies provide the right support at the right time.

Systematic review registration

https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020219401, PROSPERO CRD42020219401.

Competence-Based Assessment of Biomedical Equipment Management and Maintenance System (e-Upkaran) Using Benefit Evaluation Framework

Introduction To establish a centralized inventory management system for the efficient functioning of all healthcare facilities, e-Upkaran (equipment management and maintenance system) was launched in 2015 in the state of Rajasthan. This study is conducted to assess the functioning of e-Upkaran in Rajasthan. Methods The assessment of the e-Upkaran system for primary and secondary healthcare centers was carried out using a systematic review of the literature and a multi-indicator stakeholder questionnaire. The benefits evaluation framework focused on the system quality, information and service quality, use and user satisfaction, and net benefits utilized for the assessment. A review of the literature was done to highlight the importance of computerized medical equipment management and maintenance systems and appraise the challenges and benefits associated with such systems as compared to the traditional pen-paper register. Information was gathered based on available documents, field observation, and data obtained from specific hospital staff, including the bioengineers and other users of e-Upkaran. Results The finding of this study suggests that e-Upkaran efficiently improves documentation, reporting, maintenance, and management of medical equipment. It is more efficient than the traditional paper-pen system. It is designed to minimize downtime and maintain equipment in good operating condition and has potential benefits in terms of improving information quality, use, and net benefit. The cost of service ratio is within the benchmark value. This system has also considerably reduced out-of-pocket expenditure. Computer proficiency and the workload of other e-health programs pose a challenge in the implementation of this program. Conclusion The e-Upkaran system is competent in terms of improving information quality, use, and net benefit. Other Indian states could also adopt this system to improve their biomedical equipment management and maintenance system.