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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
Helen Tilbrook, Laura Clark, Liz Cook, Martin Bland, Hannah Buckley, Ian Chetter, Jo Dumville, Chris Fenner, Rachael Forsythe, Rhian Gabe, Keith Harding, Alison Layton, Ellie Lindsay, Catriona McDaid, Christine Moffatt, Debbie Rolfe, Illary Sbizzera, Gerard Stansby, David Torgerson, Peter Vowden, Laurie Williams, Robert Hinchliffe
BACKGROUND: Venous leg ulcers (VLUs) are the most common cause of leg ulceration, affecting 1 in 100 adults. VLUs may take many months to heal (25% fail to heal). Estimated prevalence is between 1% and 3% of the elderly population. Compression is the mainstay of treatment and few additional therapies exist to improve healing. Two previous trials have indicated that low-dose aspirin, as an adjunct to standard care, may improve healing time, but these trials were insufficiently robust. Aspirin is an inexpensive, widely used medication but its safety and efficacy in the treatment of VLUs remains to be established...
October 2018: Health Technology Assessment: HTA
Mathilde Peron, Alexis Llewellyn, Thirimon Moe-Byrne, Simon Walker, Matthew Walton, Melissa Harden, Stephen Palmer, Mark Simmonds
BACKGROUND: Dynamic Spectral Imaging System (DySIS)map (DySIS Medical Ltd, Edinburgh, UK) and ZedScan (Zilico Limited, Manchester, UK) can be used adjunctively with conventional colposcopy, which may improve the detection of cervical intraepithelial neoplasia (CIN) and cancer. OBJECTIVES: To systematically review the evidence on the diagnostic accuracy, clinical effectiveness and implementation of DySISmap and ZedScan as adjuncts to standard colposcopy, and to develop a cost-effectiveness model...
September 2018: Health Technology Assessment: HTA
Andrew Jahoda, Richard Hastings, Chris Hatton, Sally-Ann Cooper, Nicola McMeekin, Dave Dagnan, Kim Appleton, Katie Scott, Lauren Fulton, Robert Jones, Alex McConnachie, Rachel Zhang, Rosie Knight, Dawn Knowles, Christopher Williams, Andy Briggs, Craig Melville
BACKGROUND: Depression is the most prevalent mental health problem among people with learning disabilities. OBJECTIVE: The trial investigated the clinical effectiveness and cost-effectiveness of behavioural activation for depression experienced by people with mild to moderate learning disabilities. The intervention was compared with a guided self-help intervention. DESIGN: A multicentre, single-blind, randomised controlled trial, with follow-up at 4, 8 and 12 months post randomisation...
September 2018: Health Technology Assessment: HTA
Freddie C Hamdy, Daisy Elliott, Steffi le Conte, Lucy C Davies, Richéal M Burns, Claire Thomson, Richard Gray, Jane Wolstenholme, Jenny L Donovan, Ray Fitzpatrick, Clare Verrill, Fergus Gleeson, Surjeet Singh, Derek Rosario, James Wf Catto, Simon Brewster, Tim Dudderidge, Richard Hindley, Amr Emara, Prasanna Sooriakumaran, Hashim U Ahmed, Tom A Leslie
BACKGROUND: Prostate cancer (PCa) is the most common cancer in men in the UK. Patients with intermediate-risk, clinically localised disease are offered radical treatments such as surgery or radiotherapy, which can result in severe side effects. A number of alternative partial ablation (PA) technologies that may reduce treatment burden are available; however the comparative effectiveness of these techniques has never been evaluated in a randomised controlled trial (RCT). OBJECTIVES: To assess the feasibility of a RCT of PA using high-intensity focused ultrasound (HIFU) versus radical prostatectomy (RP) for intermediate-risk PCa and to test and optimise methods of data capture...
September 2018: Health Technology Assessment: HTA
David Inwald, Ruth R Canter, Kerry Woolfall, Caitlin B O'Hara, Paul R Mouncey, Zohra Zenasni, Nicholas Hudson, Steven Saunders, Anjali Carter, Nicola Jones, Mark D Lyttle, Simon Nadel, Mark J Peters, David A Harrison, Kathryn M Rowan
BACKGROUND: There has been no randomised controlled trial (RCT) of fluid bolus therapy in paediatric sepsis in the developed world despite evidence that excess fluid may be associated with harm. OBJECTIVES: To determine the feasibility of the Fluids in Shock (FiSh) trial - a RCT comparing restricted fluid bolus (10 ml/kg) with current practice (20 ml/kg) in children with septic shock in the UK. DESIGN: (1) Qualitative feasibility study exploring parents' views about the pilot RCT...
September 2018: Health Technology Assessment: HTA
Jane Goodwin, Jan Lecouturier, Anna Basu, Allan Colver, Sarah Crombie, Johanna Smith, Denise Howel, Elaine McColl, Jeremy R Parr, Niina Kolehmainen, Andrew Roberts, Keith Miller, Jill Cadwgan
BACKGROUND: Standing frames are recommended as part of postural management for young people with cerebral palsy (CP) Gross Motor Function Classification System (GMFCS) level IV or V. They may have a variety of benefits, including improving bone mineral density, gastrointestinal function and social participation. The NHS needs to know if these benefits are real, given the cost implications of use and the reported negative effects (e.g. pain). The lack of evidence for the clinical effectiveness of standing frames demonstrates the need for evaluative research...
September 2018: Health Technology Assessment: HTA
Ruben Mujica-Mota, Jo Varley-Campbell, Irina Tikhonova, Chris Cooper, Ed Griffin, Marcela Haasova, Jaime Peters, Stefano Lucherini, Juan Talens-Bou, Linda Long, David Sherriff, Mark Napier, John Ramage, Martin Hoyle
BACKGROUND: Neuroendocrine tumours (NETs) are a group of heterogeneous cancers that develop in cells in the diffuse neuroendocrine system. OBJECTIVES: To estimate the clinical effectiveness of three interventions [everolimus (Afinitor® ; Novartis International AG, Basel, Switzerland), lutetium-177 DOTATATE (177Lu-DOTATATE) (Lutathera® ; Imaging Equipment Ltd, Radstock, UK) and sunitinib (Sutent® ; Pfizer Inc., New York, NY, USA)] for treating unresectable or metastatic NETs with disease progression and establish the cost-effectiveness of these interventions...
September 2018: Health Technology Assessment: HTA
Philip M Bath, Lisa J Woodhouse, Jason P Appleton, Maia Beridze, Hanne Christensen, Robert A Dineen, Katie Flaherty, Lelia Duley, Timothy J England, Diane Havard, Stan Heptinstall, Marilyn James, Chibeka Kasonde, Kailash Krishnan, Hugh S Markus, Alan A Montgomery, Stuart Pocock, Marc Randall, Annamarei Ranta, Thompson G Robinson, Polly Scutt, Graham S Venables, Nikola Sprigg
BACKGROUND: Two antiplatelet agents are better than one for preventing recurrent stroke after acute ischaemic stroke or transient ischaemic attack (TIA). Therefore, intensive treatment with three agents might be better still, providing it does not cause undue bleeding. OBJECTIVE: To compare the safety and efficacy of intensive therapy with guideline antiplatelet therapy for acute ischaemic stroke and TIA. DESIGN: International prospective randomised open-label blinded end-point parallel-group superiority clinical trial...
August 2018: Health Technology Assessment: HTA
Steve Goodacre, Kimberley Horspool, Neil Shephard, Daniel Pollard, Beverley J Hunt, Gordon Fuller, Catherine Nelson-Piercy, Marian Knight, Steven Thomas, Fiona Lecky, Judith Cohen
BACKGROUND: Pulmonary embolism (PE) is a leading cause of death in pregnancy and post partum, but the symptoms of PE are common in normal pregnancy. Simple diagnostic tests are needed to select women for diagnostic imaging. OBJECTIVE: To estimate the accuracy, effectiveness and cost-effectiveness of clinical features, decision rules and biomarkers for selecting pregnant or postpartum women with a suspected PE for imaging. DESIGN: An expert consensus study to develop new clinical decision rules, a case-control study of women with a diagnosed PE or a suspected PE, a biomarker study of women with a suspected PE or diagnosed deep-vein thrombosis (DVT) and decision-analysis modelling...
August 2018: Health Technology Assessment: HTA
Mark Corbett, David Marshall, Melissa Harden, Sam Oddie, Robert Phillips, William McGuire
BACKGROUND: Extravasation injuries are caused by unintended leakages of fluids or medicines from intravenous lines, but there is no consensus on the best treatment approaches. OBJECTIVES: To identify which treatments may be best for treating extravasation injuries in infants and young children. DESIGN: Scoping review and survey of practice. POPULATION: Children aged < 18 years with extravasation injuries and NHS staff who treat children with extravasation injuries...
August 2018: Health Technology Assessment: HTA
Peter Jd Andrews, H Louise Sinclair, Aryelly Rodríguez, Bridget Harris, Jonathan Rhodes, Hannah Watson, Gordon Murray
BACKGROUND: Traumatic brain injury (TBI) is a major cause of disability and death in young adults worldwide. It results in around 1 million hospital admissions annually in the European Union (EU), causes a majority of the 50,000 deaths from road traffic accidents and leaves a further ≈10,000 people severely disabled. OBJECTIVE: The Eurotherm3235 Trial was a pragmatic trial examining the effectiveness of hypothermia (32-35 °C) to reduce raised intracranial pressure (ICP) following severe TBI and reduce morbidity and mortality 6 months after TBI...
August 2018: Health Technology Assessment: HTA
Marie Westwood, Bram Ramaekers, Shona Lang, Sabine Grimm, Sohan Deshpande, Shelley de Kock, Nigel Armstrong, Manuela Joore, Jos Kleijnen
BACKGROUND: Ovarian cancer is the sixth most common cancer in UK women and can be difficult to diagnose, particularly in the early stages. Risk-scoring can help to guide referral to specialist centres. OBJECTIVES: To assess the clinical and cost-effectiveness of risk scores to guide referral decisions for women with suspected ovarian cancer in secondary care. METHODS: Twenty-one databases, including MEDLINE and EMBASE, were searched from inception to November 2016...
August 2018: Health Technology Assessment: HTA
Simon G Thompson, Matthew J Bown, Matthew J Glover, Edmund Jones, Katya L Masconi, Jonathan A Michaels, Janet T Powell, Pinar Ulug, Michael J Sweeting
BACKGROUND: Abdominal aortic aneurysm (AAA) screening programmes have been established for men in the UK to reduce deaths from AAA rupture. Whether or not screening should be extended to women is uncertain. OBJECTIVE: To evaluate the cost-effectiveness of population screening for AAAs in women and compare a range of screening options. DESIGN: A discrete event simulation (DES) model was developed to provide a clinically realistic model of screening, surveillance, and elective and emergency AAA repair operations...
August 2018: Health Technology Assessment: HTA
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