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Health Technology Assessment: HTA

David J Cottrell, Alex Wright-Hughes, Michelle Collinson, Paula Boston, Ivan Eisler, Sarah Fortune, Elizabeth H Graham, Jonathan Green, Allan O House, Michael Kerfoot, David W Owens, Eirini-Christina Saloniki, Mima Simic, Sandy Tubeuf, Amanda J Farrin
BACKGROUND: Self-harm in adolescents is common and repetition rates high. There is limited evidence of the effectiveness of interventions to reduce self-harm. OBJECTIVES: To assess the clinical effectiveness and cost-effectiveness of family therapy (FT) compared with treatment as usual (TAU). DESIGN: A pragmatic, multicentre, individually randomised controlled trial of FT compared with TAU. Participants and therapists were aware of treatment allocation; researchers were blind to allocation...
March 2018: Health Technology Assessment: HTA
Matthew Cox, Catherine O'Connor, Katie Biggs, Daniel Hind, Oscar Bortolami, Matthew Franklin, Barbara Collins, Stephen Walters, Allan Wailoo, Julie Channell, Paul Albert, Ursula Freeman, Stephen Bourke, Michael Steiner, Jon Miles, Tom O'Brien, David McWilliams, Terry Schofield, John O'Reilly, Rodney Hughes
BACKGROUND: Chronic obstructive pulmonary disease (COPD) affects > 3 million people in the UK. Acute exacerbations of COPD (AECOPD) are the second most common reason for emergency hospital admission in the UK. Pulmonary rehabilitation is usual care for stable COPD but there is little evidence for early pulmonary rehabilitation (EPR) following AECOPD, either in hospital or immediately post discharge. OBJECTIVE: To assess the feasibility of recruiting patients, collecting data and delivering EPR to patients with AECOPD to evaluate EPR compared with usual care...
March 2018: Health Technology Assessment: HTA
Rhona Johnston, Olalekan Uthman, Ewen Cummins, Christine Clar, Pamela Royle, Jill Colquitt, Bee Kang Tan, Andrew Clegg, Saran Shantikumar, Rachel Court, J Paul O'Hare, David McGrane, Tim Holt, Norman Waugh
No abstract text is available yet for this article.
February 2018: Health Technology Assessment: HTA
Howard Ring, James Howlett, Mark Pennington, Christopher Smith, Marcus Redley, Caroline Murphy, Roxanne Hook, Adam Platt, Nakita Gilbert, Elizabeth Jones, Joanna Kelly, Angela Pullen, Adrian Mander, Cam Donaldson, Simon Rowe, James Wason, Fiona Irvine
BACKGROUND: People with an intellectual (learning) disability (ID) and epilepsy have an increased seizure frequency, higher frequencies of multiple antiepileptic drug (AED) use and side effects, higher treatment costs, higher mortality rates and more behavioural problems than the rest of the population with epilepsy. The introduction of nurse-led care may lead to improvements in outcome for those with an ID and epilepsy; however, this has not been tested in a definitive clinical trial...
February 2018: Health Technology Assessment: HTA
Peter Brocklehurst, David Field, Keith Greene, Edmund Juszczak, Sara Kenyon, Louise Linsell, Chris Mabey, Mary Newburn, Rachel Plachcinski, Maria Quigley, Philip Steer, Liz Schroeder, Oliver Rivero-Arias
BACKGROUND: Continuous electronic fetal monitoring (EFM) in labour is widely used and computerised interpretation has the potential to increase its utility. OBJECTIVES: This trial aimed to find out whether or not the addition of decision support software to assist in the interpretation of the cardiotocograph (CTG) reduced the number of poor neonatal outcomes, and whether or not it was cost-effective. DESIGN: Two-arm individually randomised controlled trial...
February 2018: Health Technology Assessment: HTA
Peymane Adab, Timothy Barrett, Raj Bhopal, Janet E Cade, Alastair Canaway, Kar Keung Cheng, Joanne Clarke, Amanda Daley, Jonathan Deeks, Joan Duda, Ulf Ekelund, Emma Frew, Paramjit Gill, Tania Griffin, Karla Hemming, Kiya Hurley, Emma R Lancashire, James Martin, Eleanor McGee, Miranda J Pallan, Jayne Parry, Sandra Passmore
BACKGROUND: Systematic reviews suggest that school-based interventions can be effective in preventing childhood obesity, but better-designed trials are needed that consider costs, process, equity, potential harms and longer-term outcomes. OBJECTIVE: To assess the clinical effectiveness and cost-effectiveness of the WAVES (West Midlands ActiVe lifestyle and healthy Eating in School children) study intervention, compared with usual practice, in preventing obesity among primary school children...
February 2018: Health Technology Assessment: HTA
Paula Ghaneh, Robert Hanson, Andrew Titman, Gill Lancaster, Catrin Plumpton, Huw Lloyd-Williams, Seow Tien Yeo, Rhiannon Tudor Edwards, Colin Johnson, Mohammed Abu Hilal, Antony P Higginson, Tom Armstrong, Andrew Smith, Andrew Scarsbrook, Colin McKay, Ross Carter, Robert P Sutcliffe, Simon Bramhall, Hemant M Kocher, David Cunningham, Stephen P Pereira, Brian Davidson, David Chang, Saboor Khan, Ian Zealley, Debashis Sarker, Bilal Al Sarireh, Richard Charnley, Dileep Lobo, Marianne Nicolson, Christopher Halloran, Michael Raraty, Robert Sutton, Sobhan Vinjamuri, Jonathan Evans, Fiona Campbell, Jon Deeks, Bal Sanghera, Wai-Lup Wong, John P Neoptolemos
BACKGROUND: Pancreatic cancer diagnosis and staging can be difficult in 10-20% of patients. Positron emission tomography (PET)/computed tomography (CT) adds precise anatomical localisation to functional data. The use of PET/CT may add further value to the diagnosis and staging of pancreatic cancer. OBJECTIVE: To determine the incremental diagnostic accuracy and impact of PET/CT in addition to standard diagnostic work-up in patients with suspected pancreatic cancer...
February 2018: Health Technology Assessment: HTA
Steve J Edwards, Victoria Wakefield, Peter Cain, Charlotta Karner, Kayleigh Kew, Mariana Bacelar, Natalie Masento, Fatima Salih
BACKGROUND: Several therapies have recently been approved for use in the NHS for pretreated advanced or metastatic renal cell carcinoma (amRCC), but there is a lack of comparative evidence to guide decisions between them. OBJECTIVE: To evaluate the clinical effectiveness and cost-effectiveness of axitinib (Inlyta®, Pfizer Inc., NY, USA), cabozantinib (Cabometyx®, Ipsen, Slough, UK), everolimus (Afinitor®, Novartis, Basel, Switzerland), nivolumab (Opdivo®, Bristol-Myers Squibb, NY, USA), sunitinib (Sutent®, Pfizer, Inc...
January 2018: Health Technology Assessment: HTA
Rajesh Patel, Janet T Powell, Michael J Sweeting, David M Epstein, Jessica K Barrett, Roger M Greenhalgh
BACKGROUND: Short-term survival benefits of endovascular aneurysm repair (EVAR) compared with open repair (OR) of intact abdominal aortic aneurysms have been shown in randomised trials, but this early survival benefit is soon lost. Survival benefit of EVAR was unclear at follow-up to 10 years. OBJECTIVE: To assess the long-term efficacy of EVAR against OR in patients deemed fit and suitable for both procedures (EVAR trial 1; EVAR-1); and against no intervention in patients unfit for OR (EVAR trial 2; EVAR-2)...
January 2018: Health Technology Assessment: HTA
David F Garway-Heath, Haogang Zhu, Qian Cheng, Katy Morgan, Chris Frost, David P Crabb, Tuan-Anh Ho, Yannis Agiomyrgiannakis
BACKGROUND: Progressive optic nerve damage in glaucoma results in vision loss, quantifiable with visual field (VF) testing. VF measurements are, however, highly variable, making identification of worsening vision ('progression') challenging. Glaucomatous optic nerve damage can also be measured with imaging techniques such as optical coherence tomography (OCT). OBJECTIVE: To compare statistical methods that combine VF and OCT data with VF-only methods to establish whether or not these allow (1) more rapid identification of glaucoma progression and (2) shorter or smaller clinical trials...
January 2018: Health Technology Assessment: HTA
Bryony Beresford, Susan Clarke, Jane Maddison
BACKGROUND: Therapy interventions emerged four times in the top 10 research priorities in a James Lind Alliance research prioritisation exercise for children with neurodisabilities (Morris C, Simkiss D, Busk M, Morris M, Allard A, Denness J, et al. Setting research priorities to improve the health of children and young people with neurodisability: a British Academy of Childhood Disability-James Lind Alliance Research Priority Setting Partnership. BMJ Open 2015;5:e006233). The National Institute for Health Research (NIHR) commissioned this study as part of an information-gathering exercise in response to this...
January 2018: Health Technology Assessment: HTA
Khalid S Khan, Philip Moore, Matthew Wilson, Richard Hooper, Shubha Allard, Ian Wrench, Tracy Roberts, Carol McLoughlin, Lee Beresford, James Geoghegan, Jane Daniels, Sue Catling, Vicki A Clark, Paul Ayuk, Stephen Robson, Fang Gao-Smith, Matthew Hogg, Louise Jackson, Doris Lanz, Julie Dodds
BACKGROUND: Caesarean section is associated with blood loss and maternal morbidity. Excessive blood loss requires transfusion of donor (allogeneic) blood, which is a finite resource. Cell salvage returns blood lost during surgery to the mother. It may avoid the need for donor blood transfusion, but reliable evidence of its effects is lacking. OBJECTIVES: To determine if routine use of cell salvage during caesarean section in mothers at risk of haemorrhage reduces the rates of blood transfusion and postpartum maternal morbidity, and is cost-effective, in comparison with standard practice without routine salvage use...
January 2018: Health Technology Assessment: HTA
Graham Scotland, Moira Cruickshank, Elisabet Jacobsen, David Cooper, Cynthia Fraser, Michal Shimonovich, Angharad Marks, Miriam Brazzelli
BACKGROUND: Chronic kidney disease (CKD) is a long-term condition requiring treatment such as conservative management, kidney transplantation or dialysis. To optimise the volume of fluid removed during dialysis (to avoid underhydration or overhydration), people are assigned a 'target weight', which is commonly assessed using clinical methods, such as weight gain between dialysis sessions, pre- and post-dialysis blood pressure and patient-reported symptoms. However, these methods are not precise, and measurement devices based on bioimpedance technology are increasingly used in dialysis centres...
January 2018: Health Technology Assessment: HTA
Naeem Soomro, Jan Lecouturier, Deborah D Stocken, Jing Shen, Ann Marie Hynes, Holly F Ainsworth, David Breen, Grenville Oades, David Rix, Michael Aitchison
BACKGROUND: There is uncertainty around the appropriate management of small renal tumours. Treatments include partial nephrectomy, ablation and active surveillance. OBJECTIVES: To explore the feasibility of a randomised trial of ablation versus active surveillance. DESIGN: Two-stage feasibility study: stage 1 - clinician survey and co-design work; and stage 2 - randomised feasibility study with qualitative and economic components. METHODS: Stage 1 - survey of radiologists and urologists, and development of patient information materials...
December 2017: Health Technology Assessment: HTA
Ros Wade, Stephen Rice, Alexis Llewellyn, Eoin Moloney, Julie Jones-Diette, Julija Stoniute, Kath Wright, Alison M Layton, Nick J Levell, Gerard Stansby, Dawn Craig, Nerys Woolacott
BACKGROUND: Hyperhidrosis is uncontrollable excessive sweating that occurs at rest, regardless of temperature. The symptoms of hyperhidrosis can significantly affect quality of life. The management of hyperhidrosis is uncertain and variable. OBJECTIVE: To establish the expected value of undertaking additional research to determine the most effective interventions for the management of refractory primary hyperhidrosis in secondary care. METHODS: A systematic review and economic model, including a value-of-information (VOI) analysis...
December 2017: Health Technology Assessment: HTA
Joanna Picot, Micah Rose, Keith Cooper, Karen Pickett, Joanne Lord, Petra Harris, Sophie Whyte, Dankmar Böhning, Jonathan Shepherd
BACKGROUND: Current clinical practice is to remove a colorectal polyp detected during colonoscopy and determine whether it is an adenoma or hyperplastic by histopathology. Identifying adenomas is important because they may eventually become cancerous if untreated, whereas hyperplastic polyps do not usually develop into cancer, and a surveillance interval is set based on the number and size of adenomas found. Virtual chromoendoscopy (VCE) (an electronic endoscopic imaging technique) could be used by the endoscopist under strictly controlled conditions for real-time optical diagnosis of diminutive (≤ 5 mm) colorectal polyps to replace histopathological diagnosis...
December 2017: Health Technology Assessment: HTA
Céline Miani, Adam Martin, Josephine Exley, Brett Doble, Ed Wilson, Rupert Payne, Anthony Avery, Catherine Meads, Anne Kirtley, Molly Morgan Jones, Sarah King
BACKGROUND: To reduce expenditure on, and wastage of, drugs, some commissioners have encouraged general practitioners to issue shorter prescriptions, typically 28 days in length; however, the evidence base for this recommendation is uncertain. OBJECTIVE: To evaluate the evidence of the clinical effectiveness and cost-effectiveness of shorter versus longer prescriptions for people with stable chronic conditions treated in primary care. DESIGN/DATA SOURCES: The design of the study comprised three elements...
December 2017: Health Technology Assessment: HTA
Shantini Paranjothy, Lauren Copeland, Laura Merrett, Aimee Grant, Rhiannon Phillips, Nina Gobat, Julia Sanders, Deborah Fitzsimmons, Billie Hunter, Sian Regan, Rebecca Playle, Amy Brown, Sally Tedstone, Heather Trickey, Mike Robling
BACKGROUND: In total, 81% of women in the UK start breastfeeding, but fewer than half continue beyond 6 weeks. Peer support in the early postnatal period may encourage women to breastfeed for longer. OBJECTIVE: To develop a breastfeeding peer-support intervention based on motivational interviewing (MI) for breastfeeding maintenance and to test the feasibility of delivering it to mothers in areas with high levels of social deprivation. DESIGN: Intervention development and a non-randomised multisite feasibility study...
December 2017: Health Technology Assessment: HTA
Michael I Bennett, Matthew R Mulvey, Natasha Campling, Sue Latter, Alison Richardson, Hilary Bekker, Alison Blenkinsopp, Paul Carder, Jose Closs, Amanda Farrin, Kate Flemming, Jean Gallagher, David Meads, Stephen Morley, John O'Dwyer, Alexandra Wright-Hughes, Suzanne Hartley
BACKGROUND: Pain affects most people approaching the end of life and can be severe for some. Opioid analgesia is effective, but evidence is needed about how best to support patients in managing these medicines. OBJECTIVES: To develop a self-management support toolkit (SMST) and delivery strategy and to test the feasibility of evaluating this intervention in a future definitive trial. DESIGN: Phase I - evidence synthesis and qualitative interviews with patients and carers...
December 2017: Health Technology Assessment: HTA
Frances Bunn, Claire Goodman, Peter Reece Jones, Bridget Russell, Daksha Trivedi, Alan Sinclair, Antony Bayer, Greta Rait, Jo Rycroft-Malone, Chris Burton
BACKGROUND: Dementia and diabetes mellitus are common long-term conditions that coexist in a large number of older people. People living with dementia and diabetes may be at increased risk of complications such as hypoglycaemic episodes because they are less able to manage their diabetes. OBJECTIVES: To identify the key features or mechanisms of programmes that aim to improve the management of diabetes in people with dementia and to identify areas needing further research...
December 2017: Health Technology Assessment: HTA
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