Paul Little, Nick A Francis, Beth Stuart, Gilly O'Reilly, Natalie Thompson, Taeko Becque, Alastair D Hay, Kay Wang, Michael Sharland, Anthony Harnden, Guiqing Yao, James Raftery, Shihua Zhu, Joseph Little, Charlotte Hookham, Kate Rowley, Joanne Euden, Kim Harman, Samuel Coenen, Robert C Read, Catherine Woods, Christopher C Butler, Saul N Faust, Geraldine Leydon, Mandy Wan, Kerenza Hood, Jane Whitehurst, Samantha Richards-Hall, Peter Smith, Michael Thomas, Michael Moore, Theo Verheij
BACKGROUND: Antimicrobial resistance is a global health threat. Antibiotics are commonly prescribed for children with uncomplicated lower respiratory tract infections, but there is little randomised evidence to support the effectiveness of antibiotics in treating these infections, either overall or relating to key clinical subgroups in which antibiotic prescribing is common (chest signs; fever; physician rating of unwell; sputum/rattly chest; shortness of breath). OBJECTIVES: To estimate the clinical effectiveness and cost-effectiveness of amoxicillin for uncomplicated lower respiratory tract infections in children both overall and in clinical subgroups...
June 2023: Health Technology Assessment: HTA
Usha Menon, Aleksandra Gentry-Maharaj, Matthew Burnell, Andy Ryan, Jatinderpal K Kalsi, Naveena Singh, Anne Dawnay, Lesley Fallowfield, Alistair J McGuire, Stuart Campbell, Steven J Skates, Mahesh Parmar, Ian J Jacobs
BACKGROUND: Ovarian and tubal cancers are lethal gynaecological cancers, with over 50% of the patients diagnosed at advanced stage. TRIAL DESIGN: Randomised controlled trial involving 27 primary care trusts adjacent to 13 trial centres based at NHS Trusts in England, Wales and Northern Ireland. METHODS: Postmenopausal average-risk women, aged 50-74, with intact ovaries and no previous ovarian or current non-ovarian cancer. INTERVENTIONS: One of two annual screening strategies: (1) multimodal screening (MMS) using a longitudinal CA125 algorithm with repeat CA125 testing and transvaginal scan (TVS) as second line test (2) ultrasound screening (USS) using TVS alone with repeat scan to confirm any abnormality...
May 11, 2023: Health Technology Assessment: HTA
Jessica Harris, Koen B Pouwels, Thomas Johnson, Jonathan Sterne, Christalla Pithara, Kalaivani Mahadevan, Barney Reeves, Umberto Benedetto, Yoon Loke, Daniel Lasserson, Brett Doble, Noreen Hopewell-Kelly, Sabi Redwood, Sarah Wordsworth, Andrew Mumford, Chris Rogers, Maria Pufulete
BACKGROUND: Bleeding among populations undergoing percutaneous coronary intervention or coronary artery bypass grafting and among conservatively managed patients with acute coronary syndrome exposed to different dual antiplatelet therapy and triple therapy (i.e. dual antiplatelet therapy plus an anticoagulant) has not been previously quantified. OBJECTIVES: The objectives were to estimate hazard ratios for bleeding for different antiplatelet and triple therapy regimens, estimate resources and the associated costs of treating bleeding events, and to extend existing economic models of the cost-effectiveness of dual antiplatelet therapy...
May 2023: Health Technology Assessment: HTA
Fiona Beyer, Stephen Rice, Giovany Orozco-Leal, Madeleine Still, Hannah O'Keefe, Nicole O'Connor, Akvile Stoniute, Dawn Craig, Stephen Pereira, Louise Carr, John Leeds
BACKGROUND: Early evidence suggests that using radiofrequency ablation as an adjunct to standard care (i.e. endoscopic retrograde cholangiopancreatography with stenting) may improve outcomes in patients with malignant biliary obstruction. OBJECTIVES: To assess the clinical effectiveness, cost-effectiveness and potential risks of endoscopic bipolar radiofrequency ablation for malignant biliary obstruction, and the value of future research. DATA SOURCES: Seven bibliographic databases, three websites and seven trials registers were searched from 2008 until 21 January 2021...
May 2023: Health Technology Assessment: HTA
Adrian H Taylor, Tom P Thompson, Adam Streeter, Jade Chynoweth, Tristan Snowsill, Wendy Ingram, Michael Ussher, Paul Aveyard, Rachael L Murray, Tess Harris, Colin Green, Jane Horrell, Lynne Callaghan, Colin J Greaves, Lisa Price, Lucy Cartwright, Jonny Wilks, Sarah Campbell, Dan Preece, Siobhan Creanor
BACKGROUND: Physical activity can support smoking cessation for smokers wanting to quit, but there have been no studies on supporting smokers wanting only to reduce. More broadly, the effect of motivational support for such smokers is unclear. OBJECTIVES: The objectives were to determine if motivational support to increase physical activity and reduce smoking for smokers not wanting to immediately quit helps reduce smoking and increase abstinence and physical activity, and to determine if this intervention is cost-effective...
March 2023: Health Technology Assessment: HTA
Andrew J Goldberg, Kashfia Chowdhury, Ekaterina Bordea, James Blackstone, Deirdre Brooking, Elizabeth L Deane, Iva Hauptmannova, Paul Cooke, Marion Cumbers, Simon S Skene, Caroline J Doré
BACKGROUND: We aimed to compare the clinical effectiveness, cost-effectiveness and complication rates of total ankle replacement with those of arthrodesis (i.e. ankle fusion) in the treatment of end-stage ankle osteoarthritis. METHODS: This was a pragmatic, multicentre, parallel-group, non-blinded randomised controlled trial. Patients with end-stage ankle osteoarthritis who were aged 50-85 years and were suitable for both procedures were recruited from 17 UK hospitals and randomised using minimisation...
March 2023: Health Technology Assessment: HTA
Kate F Walker, Eleanor J Mitchell, Susan Ayers, Nia W Jones, Reuben Ogollah, Natalie Wakefield, Jon Dorling, Phoebe Pallotti, Arani Pillai, Nicola Tempest, Rachel Plachcinski, Lucy Bradshaw, Marian Knight, Jim G Thornton
BACKGROUND: Second-stage caesarean sections, of which there are around 34,000 per year in the UK, have greater maternal and perinatal morbidity than those in the first stage. The fetal head is often deeply impacted in the maternal pelvis, and extraction can be difficult. Numerous techniques are reported, but the superiority of one over another is contentious and there is no national guidance. OBJECTIVE: To determine the feasibility of a randomised trial of different techniques for managing an impacted fetal head during emergency caesarean...
March 2023: Health Technology Assessment: HTA
Laura Jones, Emma Danks, Benjamin Costello, Kate Jolly, Fiona Cross-Sudworth, Pallavi Latthe, Meg Fassam-Wright, Joanne Clarke, Alison Byrne, Julie Taylor
BACKGROUND: Female genital mutilation is an important UK health-care challenge. There are no health benefits of female genital mutilation, and it is associated with lifelong physical, psychological and sexual impacts. The annual cost to the NHS to care for survivors is £100M. Deinfibulation may improve the health and well-being of some women, but there is no consensus on the optimal timing of surgery for type 3 survivors. UK care provision is reportedly suboptimal. OBJECTIVES: We aimed to explore the views of survivors, men and health-care professionals on the timing of deinfibulation surgery and NHS service provision...
March 2023: Health Technology Assessment: HTA
Barry Wright, Pasco Fearon, Megan Garside, Eleni Tsappis, Elaine Amoah, Danya Glaser, Victoria Allgar, Helen Minnis, Matthew Woolgar, Rachel Churchill, Dean McMillan, Peter Fonagy, Alison O'Sullivan, Michelle McHale
BACKGROUND: Attachment refers to an infant's innate tendency to seek comfort from their caregiver. Research shows that attachment is important in promoting healthy social and emotional development. Many parenting interventions have been developed to improve attachment outcomes for children. However, numerous interventions used in routine practice have a limited evidence base, meaning that we cannot be sure if they are helpful or harmful. OBJECTIVES: This research aimed to conduct a large-scale survey to identify what interventions are being used in UK services to improve child attachment; conduct a systematic review to evaluate the evidence for parenting attachment interventions; and develop recommendations for future research and practice...
February 2023: Health Technology Assessment: HTA
Susan Channon, Elinor Coulman, Rebecca Cannings-John, Josie Henley, Mandy Lau, Fiona Lugg-Widger, Heather Strange, Freya Davies, Julia Sanders, Caroline Scherf, Zoë Couzens, Leah Morantz
BACKGROUND: Women with overweight (a body mass index of ≥ 25 kg/m2 ) or obesity (a body mass index of ≥ 30 kg/m2 ) are at greater risk of experiencing complications during pregnancy and labour than women with a healthy weight. Women who remove their long-acting reversible contraception (i.e. coils or implants) are one of the few groups of people who contact services as part of their preparation for conception, creating an opportunity to offer a weight loss intervention...
January 2023: Health Technology Assessment: HTA
Hema Mistry, Jodie Enderby, Rachel Court, Lena Al-Khudairy, Chidozie Nduka, G J Melendez-Torres, Sian Taylor-Phillips, Aileen Clarke, Olalekan A Uthman
BACKGROUND: Cardiovascular diseases are the leading cause of morbidity and mortality worldwide. The aim of the study was to guide researchers and commissioners of cardiovascular disease preventative services towards possible cost-effective interventions by reviewing published economic analyses of interventions for the primary prevention of cardiovascular disease, conducted for or within the UK NHS. METHODS: In January 2021, electronic searches of MEDLINE and Embase were carried out to find economic evaluations of cardiovascular disease preventative services...
December 9, 2022: Health Technology Assessment: HTA
Katie Thomson, Stephen Rice, Oluwatomi Arisa, Eugenie Johnson, Louise Tanner, Christopher Marshall, Tumi Sotire, Catherine Richmond, Hannah O'Keefe, Wael Mohammed, Margot Gosney, Anne Raffle, Barbara Hanratty, Claire T McEvoy, Dawn Craig, Sheena E Ramsay
BACKGROUND: Malnutrition worsens the health of frail older adults. Current treatments for malnutrition may include prescribed oral nutritional supplements, which are multinutrient products containing macronutrients and micronutrients. OBJECTIVE: To assess the effectiveness and cost-effectiveness of oral nutritional supplements (with or without other dietary interventions) in frail older people who are malnourished or at risk of malnutrition. DATA SOURCES: MEDLINE, EMBASE, Cochrane Library, Scopus, CINAHL (Cumulative Index to Nursing and Allied Health Literature) and grey literature were searched from inception to 13 September 2021...
December 2022: Health Technology Assessment: HTA
Noemi Lois, Christina Campbell, Norman Waugh, Augusto Azuara-Blanco, Mandy Maredza, Hema Mistry, Danny McAuley, Nachiketa Acharya, Tariq M Aslam, Clare Bailey, Victor Chong, Louise Downey, Haralabos Eleftheriadis, Samia Fatum, Sheena George, Faruque Ghanchi, Markus Groppe, Robin Hamilton, Geeta Menon, Ahmed Saad, Sobha Sivaprasad, Marianne Shiew, David H Steel, James Stephen Talks, Paul Doherty, Clíona McDowell, Mike Clarke
BACKGROUND: The National Institute for Health and Care Excellence recommends macular laser to treat diabetic macular oedema with a central retinal subfield thickness of < 400 µm on optical coherence tomography. The DIAMONDS (DIAbetic Macular Oedema aNd Diode Subthreshold micropulse laser) trial compared standard threshold macular laser with subthreshold micropulse laser to treat diabetic macular oedema suitable for macular laser. OBJECTIVES: Determining the clinical effectiveness, safety and cost-effectiveness of subthreshold micropulse laser compared with standard threshold macular laser to treat diabetic macular oedema with a central retinal subfield thickness of < 400 µm...
December 2022: Health Technology Assessment: HTA
Ana Duarte, Mark Corbett, Hollie Melton, Melissa Harden, Stephen Palmer, Marta Soares, Mark Simmonds
BACKGROUND: EarlyCDT Lung (Oncimmune Holdings plc, Nottingham, UK) is a blood test to assess malignancy risk in people with solid pulmonary nodules. It measures the presence of seven lung cancer-associated autoantibodies. Elevated levels of these autoantibodies may indicate malignant disease. The results of the test might be used to modify the risk of malignancy estimated by existing risk calculators, including the Brock and Herder models. OBJECTIVES: The objectives were to determine the diagnostic accuracy, clinical effectiveness and cost-effectiveness of EarlyCDT Lung; and to develop a conceptual model and identify evidence requirements for a robust cost-effectiveness analysis...
December 2022: Health Technology Assessment: HTA
Eric Lim, Rosie A Harris, Holly E McKeon, Timothy Jp Batchelor, Joel Dunning, Michael Shackcloth, Vladimir Anikin, Babu Naidu, Elizabeth Belcher, Mahmoud Loubani, Vipin Zamvar, Lucy Dabner, Timothy Brush, Elizabeth A Stokes, Sarah Wordsworth, Sangeetha Paramasivan, Alba Realpe, Daisy Elliott, Jane Blazeby, Chris A Rogers
BACKGROUND: Lung cancer is the leading cause of cancer death. Surgery remains the main method of managing early-stage disease. Minimal-access video-assisted thoracoscopic surgery results in less tissue trauma than open surgery; however, it is not known if it improves patient outcomes. OBJECTIVE: To compare the clinical effectiveness and cost-effectiveness of video-assisted thoracoscopic surgery lobectomy with open surgery for the treatment of lung cancer. DESIGN, SETTING AND PARTICIPANTS: A multicentre, superiority, parallel-group, randomised controlled trial with blinding of participants (until hospital discharge) and outcome assessors conducted in nine NHS hospitals...
December 2022: Health Technology Assessment: HTA
Mohamed Abdel-Fattah, David Cooper, Tracey Davidson, Mary Kilonzo, Dwayne Boyers, Kiron Bhal, Alison McDonald, Judith Wardle, James N'Dow, Graeme MacLennan, John Norrie
BACKGROUND: Stress urinary incontinence is the most common type of urinary incontinence in premenopausal women. Until recently, synthetic mid-urethral slings (mesh/tape) were the standard surgical treatment, if conservative management failed. Adjustable anchored single-incision mini-slings are newer, use less mesh and may reduce perioperative morbidity, but it is unclear how their success rates and safety compare with those of standard tension-free mid-urethral slings. OBJECTIVE: The objective was to compare tension-free standard mid-urethral slings with adjustable anchored single-incision mini-slings among women with stress urinary incontinence requiring surgical intervention, in terms of patient-reported effectiveness, health-related quality of life, safety and cost-effectiveness...
December 2022: Health Technology Assessment: HTA
Michael Nugent, Valerie Bryant, Chrissie Butcher, Holly Fisher, Sean Gill, Rebecca Goranova, Shaun Hiu, Lyndsay Lindley, James O'Hara, Yemi Oluboyede, Joanne Patterson, Tim Rapley, Tomos Robinson, Nikki Rousseau, Vicky Ryan, Ramkumar Shanmugasundaram, Linda Sharp, Ruby Smith Whelan, Deborah D Stocken, Laura Ternent, Janet Wilson, Jenn Walker
BACKGROUND: Oral mucositis is a debilitating and painful complication of head and neck cancer irradiation that is characterised by inflammation of the mucous membranes, erythema and ulceration. Oral mucositis affects 6000 head and neck cancer patients per year in England and Wales. Current treatments have not proven to be effective. International studies suggest that low-level laser therapy may be an effective treatment. OBJECTIVES: To assess the clinical effectiveness and cost-effectiveness of low-level laser therapy in the management of oral mucositis in head and neck cancer irradiation...
December 2022: Health Technology Assessment: HTA
Olalekan A Uthman, Rachel Court, Jodie Enderby, Lena Al-Khudairy, Chidozie Nduka, Hema Mistry, G J Melendez-Torres, Sian Taylor-Phillips, Aileen Clarke
BACKGROUND: As part of our ongoing systematic review of complex interventions for the primary prevention of cardiovascular diseases, we have developed and evaluated automated machine-learning classifiers for title and abstract screening. The aim was to develop a high-performing algorithm comparable to human screening. METHODS: We followed a three-phase process to develop and test an automated machine learning-based classifier for screening potential studies on interventions for primary prevention of cardiovascular disease...
November 30, 2022: Health Technology Assessment: HTA
Lucy C Chappell, Peter Brocklehurst, Marcus Green, Pollyanna Hardy, Rachael Hunter, Alice Beardmore-Gray, Ursula Bowler, Anna Brockbank, Virginia Chiocchia, Alice Cox, Kate Duhig, Jessica Fleminger, Carolyn Gill, Melanie Greenland, Eleanor Hendy, Ann Kennedy, Paul Leeson, Louise Linsell, Fergus P McCarthy, Jamie O'Driscoll, Anna Placzek, Lucilla Poston, Stephen Robson, Pauline Rushby, Jane Sandall, Laura Scholtz, Paul T Seed, Jenie Sparkes, Kayleigh Stanbury, Sue Tohill, Basky Thilaganathan, John Townend, Edmund Juszczak, Neil Marlow, Andrew Shennan
BACKGROUND: In women with late preterm pre-eclampsia (i.e. at 34+0 to 36+6 weeks' gestation), the optimal delivery time is unclear because limitation of maternal-fetal disease progression needs to be balanced against infant complications. The aim of this trial was to determine whether or not planned earlier initiation of delivery reduces maternal adverse outcomes without substantial worsening of perinatal or infant outcomes, compared with expectant management, in women with late preterm pre-eclampsia...
November 30, 2022: Health Technology Assessment: HTA
Martha Mc Elwenspoek, Howard Thom, Athena L Sheppard, Edna Keeney, Rachel O'Donnell, Joni Jackson, Cristina Roadevin, Sarah Dawson, Deborah Lane, Jo Stubbs, Hazel Everitt, Jessica C Watson, Alastair D Hay, Peter Gillett, Gerry Robins, Hayley E Jones, Sue Mallett, Penny F Whiting
BACKGROUND: Coeliac disease is an autoimmune disorder triggered by ingesting gluten. It affects approximately 1% of the UK population, but only one in three people is thought to have a diagnosis. Untreated coeliac disease may lead to malnutrition, anaemia, osteoporosis and lymphoma. OBJECTIVES: The objectives were to define at-risk groups and determine the cost-effectiveness of active case-finding strategies in primary care. DESIGN: (1) Systematic review of the accuracy of potential diagnostic indicators for coeliac disease...
October 2022: Health Technology Assessment: HTA
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