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Health Technology Assessment: HTA

Wendy Atkin, Amanda J Cross, Ines Kralj-Hans, Eilidh MacRae, Carolyn Piggott, Sheena Pearson, Kate Wooldrage, Jeremy Brown, Fiona Lucas, Aaron Prendergast, Natalie Marchevsky, Bhavita Patel, Kevin Pack, Rosemary Howe, Hanna Skrobanski, Robert Kerrison, Nicholas Swart, Julia Snowball, Stephen W Duffy, Stephen Morris, Christian von Wagner, Stephen Halloran
BACKGROUND: In the UK, patients with one or two adenomas, of which at least one is ≥ 10 mm in size, or three or four small adenomas, are deemed to be at intermediate risk of colorectal cancer (CRC) and referred for surveillance colonoscopy 3 years post polypectomy. However, colonoscopy is costly, can cause discomfort and carries a small risk of complications. OBJECTIVES: To determine whether or not annual faecal immunochemical tests (FITs) are effective, acceptable and cost saving compared with colonoscopy surveillance for detecting CRC and advanced adenomas (AAs)...
January 2019: Health Technology Assessment: HTA
James Griffiths, Paula Jenkins, Monika Vargova, Ursula Bowler, Edmund Juszczak, Andrew King, Louise Linsell, David Murray, Christopher Partlett, Mehali Patel, Janet Berrington, Nicholas Embleton, Jon Dorling, Paul T Heath, William McGuire, Sam Oddie
BACKGROUND: Infections acquired in hospital are an important cause of morbidity and mortality in very preterm infants. Several small trials have suggested that supplementing the enteral diet of very preterm infants with lactoferrin, an antimicrobial protein processed from cow's milk, prevents infections and associated complications. OBJECTIVE: To determine whether or not enteral supplementation with bovine lactoferrin (The Tatua Cooperative Dairy Company Ltd, Morrinsville, New Zealand) reduces the risk of late-onset infection (acquired > 72 hours after birth) and other morbidity and mortality in very preterm infants...
December 2018: Health Technology Assessment: HTA
Matthew L Costa, Juul Achten, Julie Bruce, Sonia Davis, Susie Hennings, Keith Willett, Stavros Petrou, Steven Jeffery, Damian Griffin, Ben Parker, James Masters, Sarah E Lamb, Elizabeth Tutton, Nick Parsons
BACKGROUND: Open fractures of the lower limb occur when a broken bone penetrates the skin and is exposed to the outside environment. These are life-changing injuries. The risk of deep infection may be as high as 27%. The type of dressing applied after surgical debridement could potentially reduce the risk of infection in the open-fracture wound. OBJECTIVES: To assess the disability, rate of deep infection, quality of life and resource use in patients with severe open fracture of the lower limb treated with negative-pressure wound therapy (NPWT) versus standard wound management after the first surgical debridement of the wound...
December 2018: Health Technology Assessment: HTA
Miriam Brazzelli, Rodolfo Hernández, Pawana Sharma, Clare Robertson, Michal Shimonovich, Graeme MacLennan, Cynthia Fraser, Russell Jamieson, Srinivasa Rao Vallabhaneni
BACKGROUND: Endovascular abdominal aortic aneurysm repair (EVAR) of abdominal aortic aneurysm (AAA) is less invasive than open surgery, but may be associated with important complications. Patients receiving EVAR require long-term surveillance to detect abnormalities and direct treatments. Computed tomography angiography (CTA) has been the most common imaging modality adopted for EVAR surveillance, but it is associated with repeated radiation exposure and the risk of contrast-related nephropathy...
December 2018: Health Technology Assessment: HTA
Kirsi M Kinnunen, Penny Rapaport, Lucy Webster, Julie Barber, Simon D Kyle, Brendan Hallam, Claudia Cooper, Rossana Horsley, James A Pickett, Anastasia Vikhanova, Colin A Espie, Gill Livingston
BACKGROUND: It has been estimated that between 25% and 40% of people living with dementia suffer from sleep disturbances, and there are currently no known effective treatments. Sleep disturbances may be the direct result of dementia or due to other comorbidities, such as pain and limited mobility. If carers' sleep is also disturbed, carers too can become tired and stressed, and this sometimes results in the breakdown of care in the home. OBJECTIVES: To design an evidence-based manualised non-pharmacological therapy for sleep disturbances and test it for feasibility and acceptability...
December 2018: Health Technology Assessment: HTA
Tricia McKeever, Kevin Mortimer, Lucy Bradshaw, Rebecca Haydock, Ian Pavord, Bernard Higgins, Samantha Walker, Andrew Wilson, David Price, Mike Thomas, Graham Devereux, Christopher Brightling, Charlotte Renwick, Steve Parrott, Eleanor Mitchell, Lelia Duley, Tim Harrison
BACKGROUND: Asthma exacerbations affect the quality of life of patients with asthma and have a major effect on the overall costs of asthma care. An asthma self-management plan that advises the temporary quadrupling of inhaled corticosteroid dose may prevent asthma exacerbations, but this needs to be confirmed before being adopted widely. OBJECTIVES: To compare the clinical effectiveness and cost-effectiveness of an asthma self-management plan that advises patients to temporarily quadruple the dose of inhaled corticosteroid when asthma control starts to deteriorate with a standard self-management plan...
December 2018: Health Technology Assessment: HTA
Tristan Snowsill, Huiqin Yang, Ed Griffin, Linda Long, Jo Varley-Campbell, Helen Coelho, Sophie Robinson, Chris Hyde
BACKGROUND: Diagnosis of lung cancer frequently occurs in its later stages. Low-dose computed tomography (LDCT) could detect lung cancer early. OBJECTIVES: To estimate the clinical effectiveness and cost-effectiveness of LDCT lung cancer screening in high-risk populations. DATA SOURCES: Bibliographic sources included MEDLINE, EMBASE, Web of Science and The Cochrane Library. METHODS: Clinical effectiveness - a systematic review of randomised controlled trials (RCTs) comparing LDCT screening programmes with usual care (no screening) or other imaging screening programmes [such as chest X-ray (CXR)] was conducted...
November 2018: Health Technology Assessment: HTA
Alison Avenell, Clare Robertson, Zoë Skea, Elisabet Jacobsen, Dwayne Boyers, David Cooper, Magaly Aceves-Martins, Lise Retat, Cynthia Fraser, Paul Aveyard, Fiona Stewart, Graeme MacLennan, Laura Webber, Emily Corbould, Benshuai Xu, Abbygail Jaccard, Bonnie Boyle, Eilidh Duncan, Michal Shimonovich, Marijn de Bruin
BACKGROUND: Adults with severe obesity [body mass index (BMI) of ≥ 35 kg/m2 ] have an increased risk of comorbidities and psychological, social and economic consequences. OBJECTIVES: Systematically review bariatric surgery, weight-management programmes (WMPs) and orlistat pharmacotherapy for adults with severe obesity, and evaluate the feasibility, acceptability, clinical effectiveness and cost-effectiveness of treatment. DATA SOURCES: Electronic databases including MEDLINE, EMBASE, PsycINFO, the Cochrane Central Register of Controlled Trials and the NHS Economic Evaluation Database were searched (last searched in May 2017)...
November 2018: Health Technology Assessment: HTA
Robert Howard, Elizabeth Cort, Rosie Bradley, Emma Harper, Linda Kelly, Peter Bentham, Craig Ritchie, Suzanne Reeves, Waleed Fawzi, Gill Livingston, Andrew Sommerlad, Sabu Oomman, Ejaz Nazir, Ramin Nilforooshan, Robert Barber, Chris Fox, Ajay Macharouthu, Pranathi Ramachandra, Vivek Pattan, John Sykes, Valerie Curran, Cornelius Katona, Tom Dening, Martin Knapp, Renee Romeo, Richard Gray
BACKGROUND: Very late-onset (aged ≥ 60 years) schizophrenia-like psychosis (VLOSLP) occurs frequently but no placebo-controlled, randomised trials have assessed the efficacy or risks of antipsychotic treatment. Most patients are not prescribed treatment. OBJECTIVES: The study investigated whether or not low-dose amisulpride is superior to placebo in reducing psychosis symptoms over 12 weeks and if any benefit is maintained by continuing treatment thereafter...
November 2018: Health Technology Assessment: HTA
Rachel Archer, Emma Hock, Jean Hamilton, John Stevens, Munira Essat, Edith Poku, Mark Clowes, Abdullah Pandor, Matt Stevenson
BACKGROUND: Rheumatoid arthritis (RA) is a chronic, debilitating disease associated with reduced quality of life and substantial costs. It is unclear which tests and assessment tools allow the best assessment of prognosis in people with early RA and whether or not variables predict the response of patients to different drug treatments. OBJECTIVE: To systematically review evidence on the use of selected tests and assessment tools in patients with early RA (1) in the evaluation of a prognosis (review 1) and (2) as predictive markers of treatment response (review 2)...
November 2018: Health Technology Assessment: HTA
Richard Ig Holt, Daniel Hind, Rebecca Gossage-Worrall, Michael J Bradburn, David Saxon, Paul McCrone, Tiyi A Morris, Angela Etherington, David Shiers, Katharine Barnard, Lizzie Swaby, Charlotte Edwardson, Marian E Carey, Melanie J Davies, Christopher M Dickens, Yvonne Doherty, Paul French, Kathryn E Greenwood, Sridevi Kalidindi, Kamlesh Khunti, Richard Laugharne, John Pendlebury, Shanaya Rathod, Najma Siddiqi, Stephen Wright, Glenn Waller, Fiona Gaughran, Janette Barnett, Alison Northern
BACKGROUND: Obesity is twice as common in people with schizophrenia as in the general population. The National Institute for Health and Care Excellence guidance recommends that people with psychosis or schizophrenia, especially those taking antipsychotics, be offered a healthy eating and physical activity programme by their mental health care provider. There is insufficient evidence to inform how these lifestyle services should be commissioned. OBJECTIVES: To develop a lifestyle intervention for people with first episode psychosis or schizophrenia and to evaluate its clinical effectiveness, cost-effectiveness, delivery and acceptability...
November 2018: Health Technology Assessment: HTA
David J Keene, Michael M Schlüssel, Jacqueline Thompson, Daryl A Hagan, Mark A Williams, Christopher Byrne, Steve Goodacre, Matthew Cooke, Stephen Gwilym, Philip Hormbrey, Jennifer Bostock, Kirstie Haywood, David Wilson, Gary S Collins, Sarah E Lamb
BACKGROUND: Ankle sprains are very common injuries. Although recovery can occur within weeks, around one-third of patients have longer-term problems. OBJECTIVES: To develop and externally validate a prognostic model for identifying people at increased risk of poor outcome after an acute ankle sprain. DESIGN: Development of a prognostic model in a clinical trial cohort data set and external validation in a prospective cohort study. SETTING: Emergency departments (EDs) in the UK...
November 2018: Health Technology Assessment: HTA
David Kessler, Alison Burns, Debbie Tallon, Glyn Lewis, Stephanie MacNeill, Jeff Round, William Hollingworth, Carolyn Chew-Graham, Ian Anderson, John Campbell, Chris Dickens, Una Macleod, Simon Gilbody, Simon Davies, Tim J Peters, Nicola Wiles
BACKGROUND: Depression is usually managed in primary care and antidepressants are often the first-line treatment, but only half of those treated respond to a single antidepressant. OBJECTIVES: To investigate whether or not combining mirtazapine with serotonin-noradrenaline reuptake inhibitor (SNRI) or selective serotonin reuptake inhibitor (SSRI) antidepressants results in better patient outcomes and more efficient NHS care than SNRI or SSRI therapy alone in treatment-resistant depression (TRD)...
November 2018: Health Technology Assessment: HTA
Mark Corbett, Emily South, Melissa Harden, Sam Eldabe, Erlick Pereira, Imad Sedki, Neil Hall, Nerys Woolacott
BACKGROUND: Although many treatments exist for phantom limb pain (PLP), the evidence supporting them is limited and there are no guidelines for PLP management. Brain and spinal cord neurostimulation therapies are targeted at patients with chronic PLP but have yet to be systematically reviewed. OBJECTIVE: To determine which types of brain and spinal stimulation therapy appear to be the best for treating chronic PLP. DESIGN: Systematic reviews of effectiveness and epidemiology studies, and a survey of NHS practice...
November 2018: Health Technology Assessment: HTA
Nick A Francis, Cherry-Ann Waldron, Rebecca Cannings-John, Emma Thomas-Jones, Thomas Winfield, Victoria Shepherd, Debbie Harris, Kerenza Hood, Deborah Fitzsimmons, Amanda Roberts, Colin Ve Powell, Micaela Gal, Sarah Jones, Christopher C Butler
BACKGROUND: Children with hearing loss associated with otitis media with effusion (OME) are commonly managed through surgical intervention, hearing aids or watchful waiting. A safe, inexpensive, effective medical treatment would enhance treatment options. Small, poorly conducted trials have found a short-term benefit from oral steroids. OBJECTIVE: To determine the clinical effectiveness and cost-effectiveness of a 7-day course of oral steroids in improving hearing at 5 weeks in children with persistent OME symptoms and current bilateral OME and hearing loss demonstrated by audiometry...
November 2018: Health Technology Assessment: HTA
Bryony Beresford, Catriona McDaid, Adwoa Parker, Arabella Scantlebury, Gemma Spiers, Caroline Fairhurst, Catherine Hewitt, Kath Wright, Vicki Dawson, Heather Elphick, Megan Thomas
BACKGROUND: There is uncertainty about the most appropriate ways to manage non-respiratory sleep disturbances in children with neurodisabilities (NDs). OBJECTIVE: To assess the clinical effectiveness and safety of NHS-relevant pharmacological and non-pharmacological interventions to manage sleep disturbance in children and young people with NDs, who have non-respiratory sleep disturbance. DATA SOURCES: Sixteen databases, including The Cochrane Central Register of Controlled Trials, EMBASE and MEDLINE, were searched up to February 2017, and grey literature searches and hand-searches were conducted...
October 2018: Health Technology Assessment: HTA
Guy E Thwaites, Matthew Scarborough, Alexander Szubert, Pedro Saramago Goncalves, Marta Soares, Jennifer Bostock, Emmanuel Nsutebu, Robert Tilley, Richard Cunningham, Julia Greig, Sarah A Wyllie, Peter Wilson, Cressida Auckland, Janet Cairns, Denise Ward, Pankaj Lal, Achyut Guleri, Neil Jenkins, Julian Sutton, Martin Wiselka, Gonzalez-Ruiz Armando, Clive Graham, Paul R Chadwick, Gavin Barlow, N Claire Gordon, Bernadette Young, Sarah Meisner, Paul McWhinney, David A Price, David Harvey, Deepa Nayar, Dakshika Jeyaratnam, Timothy Planche, Jane Minton, Fleur Hudson, Susan Hopkins, John Williams, M Estee Török, Martin J Llewelyn, Jonathan D Edgeworth, A Sarah Walker
BACKGROUND: Staphylococcus aureus bacteraemia is a common and frequently fatal infection. Adjunctive rifampicin may enhance early S. aureus killing, sterilise infected foci and blood faster, and thereby reduce the risk of dissemination, metastatic infection and death. OBJECTIVES: To determine whether or not adjunctive rifampicin reduces bacteriological (microbiologically confirmed) failure/recurrence or death through 12 weeks from randomisation. Secondary objectives included evaluating the impact of rifampicin on all-cause mortality, clinically defined failure/recurrence or death, toxicity, resistance emergence, and duration of bacteraemia; and assessing the cost-effectiveness of rifampicin...
October 2018: Health Technology Assessment: HTA
Doreen McClurg, Fiona Harris, Kirsteen Goodman, Selina Doran, Suzanne Hagen, Shaun Treweek, Christine Norton, Maureen Coggrave, John Norrie, Petra Rauchhaus, Peter Donnan, Anton Emmanuel, Sarkis Manoukian, Helen Mason
BACKGROUND: Between 50% and 80% of people with multiple sclerosis (PwMS) experience neurogenic bowel dysfunction (NBD) (i.e. constipation and faecal incontinence) that affects quality of life and can lead to hospitalisation. OBJECTIVES: To determine the clinical effectiveness and cost-effectiveness of abdominal massage plus advice on bowel symptoms on PwMS compared with advice only. A process evaluation investigated the factors that affected the clinical effectiveness and possible implementation of the different treatments...
October 2018: Health Technology Assessment: HTA
Miriam Santer, Kate Rumsby, Matthew J Ridd, Nick A Francis, Beth Stuart, Maria Chorozoglou, Amanda Roberts, Lyn Liddiard, Claire Nollett, Julie Hooper, Martina Prude, Wendy Wood, Emma Thomas-Jones, Taeko Becque, Kim S Thomas, Hywel C Williams, Paul Little
BACKGROUND: Childhood eczema is very common. Treatment often includes emollient bath additives, despite there being little evidence of their effectiveness. OBJECTIVES: To determine the clinical effectiveness and cost-effectiveness of emollient bath additives in the management of childhood eczema. DESIGN: Pragmatic, randomised, open-label, multicentre superiority trial with two parallel groups. SETTING: Ninety-six general practices in Wales, the west of England and southern England...
October 2018: Health Technology Assessment: HTA
Ibrahim Abubakar, Ajit Lalvani, Jo Southern, Alice Sitch, Charlotte Jackson, Oluchukwu Onyimadu, Marc Lipman, Jonathan J Deeks, Chris Griffiths, Graham Bothamley, Onn Min Kon, Andrew Hayward, Joanne Lord, Francis Drobniewski
BACKGROUND: Despite a recent decline in the annual incidence of tuberculosis (TB) in the UK, rates remain higher than in most Western European countries. The detection and treatment of latent TB infection (LTBI) is an essential component of the UK TB control programme. OBJECTIVES: To assess the prognostic value and cost-effectiveness of the current two interferon gamma release assays (IGRAs) compared with the standard tuberculin skin test (TST) for predicting active TB among untreated individuals at increased risk of TB: (1) contacts of active TB cases and (2) new entrants to the UK from high-TB-burden countries...
October 2018: Health Technology Assessment: HTA
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