The average number of general ultrasound examinations performed by a sonographer in an 8-hour workday is not well reported in the literature. Through an informal survey, we estimate that the average general ultrasound examination volume across Canada per 8-hour workday is 11.25, with a range of 9 to 14. Understanding ultrasound examination data volumes provides information to help understand productivity. Decision-makers can also use the examination volume data and factors affecting sonographer examination throughput to create strategies to enhance efficiency in clinic and hospital departments. Factors that may influence the average examination rate include examination time, the age of equipment, resource availability, staffing shortages, and sonographer’s work-related musculoskeletal disorders and stress.
{"title":"General Ultrasound Examination Volumes per Sonographer 8-Hour Workday","authors":"Cmii Service, Report","doi":"10.51731/cjht.2024.841","DOIUrl":"https://doi.org/10.51731/cjht.2024.841","url":null,"abstract":"\u0000The average number of general ultrasound examinations performed by a sonographer in an 8-hour workday is not well reported in the literature. Through an informal survey, we estimate that the average general ultrasound examination volume across Canada per 8-hour workday is 11.25, with a range of 9 to 14. \u0000Understanding ultrasound examination data volumes provides information to help understand productivity. Decision-makers can also use the examination volume data and factors affecting sonographer examination throughput to create strategies to enhance efficiency in clinic and hospital departments. \u0000Factors that may influence the average examination rate include examination time, the age of equipment, resource availability, staffing shortages, and sonographer’s work-related musculoskeletal disorders and stress. \u0000","PeriodicalId":9437,"journal":{"name":"Canadian Journal of Health Technologies","volume":"70 7","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140427004","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Why Is This an Important Area of Interest? CT scanners play an essential role as medical imaging devices for screening, diagnosis, and monitoring of various health conditions. Photon-counting CT (PCCT) is an emerging medical technology that can improve image quality with less radiation exposure. Although Health Canada has licensed certain PCCT scanners for use, it remains unclear whether PCCT currently has a place in care. What Is the Technology? PCCT uses a semiconductor material to directly convert each incident photon into an electrical signal. The detector can quickly read out and “count” each individual photon. By directly detecting each X-ray photon and its energy level, PCCT scans can provide a clearer image. What Is the Potential Impact? PCCT is intended to function like conventional CT (i.e., scanning various anatomical structures for the purpose of screening, diagnosing, and monitoring health conditions). Any person requiring a CT scan could potentially be eligible for a PCCT scan. PCCT requires less time to complete a scan versus a conventional system. This could increase the number of CT scans a health care organization can conduct per day, if there are resources available to operationalize the additional capacity (e.g., health care personnel). We identified evidence that suggests, with a few exceptions, PCCT can provide similar or improved image quality and reduced image noise with often reduced radiation doses compared to conventional CT. It remains unclear whether this results in improvements in key health outcomes. The increased image quality may also increase incidental findings (e.g., incidentalomas), most of which are not clinically relevant. Compared to conventional CT, trends indicate higher or similar diagnostic confidence among clinicians and improved comfort for patients with PCCT. Trends also suggest PCCT may be valuable at improving the ability to diagnose or detect key markers of certain health conditions or diseases, especially for lung conditions. PCCT may offer particular benefits to children, people who require frequent CT scans, and people living with overweight or obesity. What Else Do We Need to Know? PCCT scanners cost 3 to 5 times more than conventional CT scanners. Additional clinical trials to investigate whether the higher resolution and lower radiation doses result in downstream improvements in key health outcomes are imperative to determine if the additional cost of PCCT scanners is justified. To comprehensively assess whether PCCT should be implemented for clinical use in Canada, additional information on certain implementation factors — such as training requirements and implications of dual-machine exposure, user perceptions, accessibility, and its overall place in care — is needed.
{"title":"Photon-Counting CT: High Resolution, Less Radiation","authors":"C. Lachance, Jennifer Horton","doi":"10.51731/cjht.2024.843","DOIUrl":"https://doi.org/10.51731/cjht.2024.843","url":null,"abstract":"Why Is This an Important Area of Interest? \u0000 \u0000CT scanners play an essential role as medical imaging devices for screening, diagnosis, and monitoring of various health conditions. Photon-counting CT (PCCT) is an emerging medical technology that can improve image quality with less radiation exposure. \u0000Although Health Canada has licensed certain PCCT scanners for use, it remains unclear whether PCCT currently has a place in care. \u0000 \u0000What Is the Technology? \u0000 \u0000PCCT uses a semiconductor material to directly convert each incident photon into an electrical signal. The detector can quickly read out and “count” each individual photon. By directly detecting each X-ray photon and its energy level, PCCT scans can provide a clearer image. \u0000 \u0000What Is the Potential Impact? \u0000 \u0000PCCT is intended to function like conventional CT (i.e., scanning various anatomical structures for the purpose of screening, diagnosing, and monitoring health conditions). Any person requiring a CT scan could potentially be eligible for a PCCT scan. \u0000PCCT requires less time to complete a scan versus a conventional system. This could increase the number of CT scans a health care organization can conduct per day, if there are resources available to operationalize the additional capacity (e.g., health care personnel). \u0000We identified evidence that suggests, with a few exceptions, PCCT can provide similar or improved image quality and reduced image noise with often reduced radiation doses compared to conventional CT. It remains unclear whether this results in improvements in key health outcomes. The increased image quality may also increase incidental findings (e.g., incidentalomas), most of which are not clinically relevant. \u0000Compared to conventional CT, trends indicate higher or similar diagnostic confidence among clinicians and improved comfort for patients with PCCT. Trends also suggest PCCT may be valuable at improving the ability to diagnose or detect key markers of certain health conditions or diseases, especially for lung conditions. \u0000PCCT may offer particular benefits to children, people who require frequent CT scans, and people living with overweight or obesity. \u0000 \u0000What Else Do We Need to Know? \u0000 \u0000PCCT scanners cost 3 to 5 times more than conventional CT scanners. Additional clinical trials to investigate whether the higher resolution and lower radiation doses result in downstream improvements in key health outcomes are imperative to determine if the additional cost of PCCT scanners is justified. \u0000To comprehensively assess whether PCCT should be implemented for clinical use in Canada, additional information on certain implementation factors — such as training requirements and implications of dual-machine exposure, user perceptions, accessibility, and its overall place in care — is needed. \u0000","PeriodicalId":9437,"journal":{"name":"Canadian Journal of Health Technologies","volume":"34 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140425762","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
What Is the Issue? Gonorrhea is the second most prevalent sexually transmitted infection in Canada. It is caused by Neisseria gonorrhoeae and can be treated with antibiotic therapy. However, gonorrhoeae has developed antibiotic resistance, which may decrease the efficacy of current therapy. Antibiotic therapy can be administered after a positive gonorrhoeae test, but the turnaround time of laboratory testing may result in patients being lost to follow-up (i.e., not returning to the clinic after test results are available). Presumptive or empiric antibiotic therapy can be given before the laboratory confirmation of gonorrhoeae to individuals at high risk of gonorrhea or those with uncertain follow-up; however, such treatment may lead to overtreating those without N. gonorrhoeae, increasing the risk of antibiotic resistance and possible side effects to the individuals. It is important to understand the ideal timing of antibiotic therapy that balances concerns of antibiotic resistance and timely patient care. What Did We Do? To inform decisions about timing of antibiotic therapy for the treatment of adults and adolescents with suspected uncomplicated gonorrhoeae infection, CADTH sought to identify and summarize literature comparing the clinical effectiveness and safety of delaying antibiotic therapy until confirmatory results of testing for N. gonorrhoeae infection are available, versus empiric treatment before test results are available. A research information specialist conducted a literature search of the peer-reviewed and grey literature published since January 1, 2013. What Did We Find? We did not find any studies directly evaluating the clinical effectiveness and safety of delayed antibiotic treatment compared to presumptive treatment for uncomplicated gonorrhoeae infections in adult and adolescent populations. We included 2 nonrandomized studies that compared the rates of accurate treatment and overtreatment in individuals who received presumptive treatment and those who did not. In the 2 studies, gonorrhoeae test positivity rates in the presumptive treatment group were less than 50%, suggesting that less than half of the patients in this group received accurate presumptive treatment. We also found high overtreatment rates, which were up to 90% in the included studies. The certainty of these findings is very low due to methodological limitations of the included studies. We also identified 5 single-arm studies that evaluated these outcomes in individuals who received presumptive therapy. The findings are generally consistent with the 2 included studies. What Does It Mean? Available evidence points to high rates of overtreatment when presumptive antibiotics are given. Results also suggest that there is value in clinical assessment in detecting gonorrhoeae infections. The downstream clinical effectiveness implications of these results for antimicrobial resistance or increasing spread of N. gonorrhoeae are unclear. Co
{"title":"Timing of Antibiotic Therapy for Neisseria Gonorrhoeae Infection","authors":"Anusree Subramonian, Weiyi Xie, Sarah C. McGill","doi":"10.51731/cjht.2024.839","DOIUrl":"https://doi.org/10.51731/cjht.2024.839","url":null,"abstract":"What Is the Issue? \u0000 \u0000Gonorrhea is the second most prevalent sexually transmitted infection in Canada. It is caused by Neisseria gonorrhoeae and can be treated with antibiotic therapy. However, gonorrhoeae has developed antibiotic resistance, which may decrease the efficacy of current therapy. \u0000Antibiotic therapy can be administered after a positive gonorrhoeae test, but the turnaround time of laboratory testing may result in patients being lost to follow-up (i.e., not returning to the clinic after test results are available). \u0000Presumptive or empiric antibiotic therapy can be given before the laboratory confirmation of gonorrhoeae to individuals at high risk of gonorrhea or those with uncertain follow-up; however, such treatment may lead to overtreating those without N. gonorrhoeae, increasing the risk of antibiotic resistance and possible side effects to the individuals. \u0000It is important to understand the ideal timing of antibiotic therapy that balances concerns of antibiotic resistance and timely patient care. \u0000 \u0000What Did We Do? \u0000 \u0000To inform decisions about timing of antibiotic therapy for the treatment of adults and adolescents with suspected uncomplicated gonorrhoeae infection, CADTH sought to identify and summarize literature comparing the clinical effectiveness and safety of delaying antibiotic therapy until confirmatory results of testing for N. gonorrhoeae infection are available, versus empiric treatment before test results are available. \u0000A research information specialist conducted a literature search of the peer-reviewed and grey literature published since January 1, 2013. \u0000 \u0000What Did We Find? \u0000 \u0000We did not find any studies directly evaluating the clinical effectiveness and safety of delayed antibiotic treatment compared to presumptive treatment for uncomplicated gonorrhoeae infections in adult and adolescent populations. We included 2 nonrandomized studies that compared the rates of accurate treatment and overtreatment in individuals who received presumptive treatment and those who did not. \u0000In the 2 studies, gonorrhoeae test positivity rates in the presumptive treatment group were less than 50%, suggesting that less than half of the patients in this group received accurate presumptive treatment. We also found high overtreatment rates, which were up to 90% in the included studies. \u0000The certainty of these findings is very low due to methodological limitations of the included studies. \u0000We also identified 5 single-arm studies that evaluated these outcomes in individuals who received presumptive therapy. The findings are generally consistent with the 2 included studies. \u0000 \u0000What Does It Mean? \u0000 \u0000Available evidence points to high rates of overtreatment when presumptive antibiotics are given. Results also suggest that there is value in clinical assessment in detecting gonorrhoeae infections. The downstream clinical effectiveness implications of these results for antimicrobial resistance or increasing spread of N. gonorrhoeae are unclear. \u0000Co","PeriodicalId":9437,"journal":{"name":"Canadian Journal of Health Technologies","volume":"20 2","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140438533","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
CADTH recommends that Opdualag be reimbursed for the treatment of adult and pediatric patients 12 years of age or older with unresectable or metastatic melanoma who have not received prior systemic therapy for unresectable or metastatic melanoma if certain conditions are met. Opdualag should only be covered to treat patients aged 12 years or older who have a histologically confirmed diagnosis of unresectable stage III or stage IV (metastatic) melanoma and have not received prior systemic therapy for advanced melanoma. Patients should be in relatively good health (i.e., have a good performance status, as determined by a specialist). Patients who had prior adjuvant or neoadjuvant anti–programmed death-1 (PD-1) or anti–cytotoxic T-lymphocyte–associated protein 4 (CTLA-4) therapy if the therapy was completed at least 6 months before the date of recurrence are eligible for reimbursement. Opdualag should not be reimbursed in patients with active brain metastases, uveal melanoma, and active autoimmune disease. Opdualag should only be reimbursed if the price of Opdualag is reduced. The feasibility of adoption of Opdualag must also be addressed.
CADTH 建议，在满足特定条件的情况下，Opdualag 可用于治疗 12 岁或以上患有不可切除或转移性黑色素瘤且既往未接受过不可切除或转移性黑色素瘤系统治疗的成人和儿童患者。Opdualag 只能用于治疗经组织学确诊为不可切除的 III 期或 IV 期（转移性）黑色素瘤且既往未接受过晚期黑色素瘤系统治疗的 12 岁或以上患者。患者的健康状况应相对良好（即由专科医生确定的良好表现状态）。既往接受过抗程序性死亡-1（PD-1）或抗细胞毒性T淋巴细胞相关蛋白4（CTLA-4）辅助治疗或新辅助治疗的患者，如果治疗在复发日期前至少6个月完成，则符合报销条件。对于患有活动性脑转移、葡萄膜黑色素瘤和活动性自身免疫性疾病的患者，Opdualag 不应报销。只有在 Opdualag 降价的情况下，Opdualag 才能获得报销。此外，还必须解决采用 Opdualag 的可行性问题。
{"title":"Nivolumab and Relatlimab (Opdualag)","authors":"Cadth","doi":"10.51731/cjht.2024.836","DOIUrl":"https://doi.org/10.51731/cjht.2024.836","url":null,"abstract":"\u0000CADTH recommends that Opdualag be reimbursed for the treatment of adult and pediatric patients 12 years of age or older with unresectable or metastatic melanoma who have not received prior systemic therapy for unresectable or metastatic melanoma if certain conditions are met. \u0000Opdualag should only be covered to treat patients aged 12 years or older who have a histologically confirmed diagnosis of unresectable stage III or stage IV (metastatic) melanoma and have not received prior systemic therapy for advanced melanoma. Patients should be in relatively good health (i.e., have a good performance status, as determined by a specialist). \u0000Patients who had prior adjuvant or neoadjuvant anti–programmed death-1 (PD-1) or anti–cytotoxic T-lymphocyte–associated protein 4 (CTLA-4) therapy if the therapy was completed at least 6 months before the date of recurrence are eligible for reimbursement. Opdualag should not be reimbursed in patients with active brain metastases, uveal melanoma, and active autoimmune disease. Opdualag should only be reimbursed if the price of Opdualag is reduced. The feasibility of adoption of Opdualag must also be addressed. \u0000","PeriodicalId":9437,"journal":{"name":"Canadian Journal of Health Technologies","volume":"16 S1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140443118","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
CADTH recommends that Columvi be reimbursed by public drug plans for the treatment of adult patients with relapsed or refractory (R/R) diffuse large B-cell lymphoma (DLBCL) not otherwise specified, DLBCL arising from follicular lymphoma (trFL), or primary mediastinal B-cell lymphoma (PMBCL), who have received 2 or more lines of systemic therapy and are ineligible to receive or cannot receive CAR-T cell therapy or have previously received CAR-T cell therapy if certain conditions are met. Columvi should only be covered to treat adult patients who have DLBCL not otherwise specified, trFL, or PMBCL that has come back or that did not respond to 2 or more previous treatments for their cancer, and who have also previously received CAR-T cell therapy, declined CAR-T cell therapy, or cannot receive CAR-T cell therapy. Columvi should only be reimbursed for a maximum of 12 treatment cycles, after a single dose of obinutuzumab to reduce the risk of cytokine release syndrome (CRS) and should not be given in combination with other anticancer drugs. Reimbursement of Columvi should be discontinued if a patient’s cancer grows or spreads or if treatment is unacceptably toxic to the patient. Columvi should only be reimbursed when prescribed by specialists with experience managing DLBCL, and if its cost is reduced.
{"title":"Glofitamab (Columvi)","authors":"Cadth","doi":"10.51731/cjht.2024.837","DOIUrl":"https://doi.org/10.51731/cjht.2024.837","url":null,"abstract":"\u0000CADTH recommends that Columvi be reimbursed by public drug plans for the treatment of adult patients with relapsed or refractory (R/R) diffuse large B-cell lymphoma (DLBCL) not otherwise specified, DLBCL arising from follicular lymphoma (trFL), or primary mediastinal B-cell lymphoma (PMBCL), who have received 2 or more lines of systemic therapy and are ineligible to receive or cannot receive CAR-T cell therapy or have previously received CAR-T cell therapy if certain conditions are met. \u0000Columvi should only be covered to treat adult patients who have DLBCL not otherwise specified, trFL, or PMBCL that has come back or that did not respond to 2 or more previous treatments for their cancer, and who have also previously received CAR-T cell therapy, declined CAR-T cell therapy, or cannot receive CAR-T cell therapy. \u0000Columvi should only be reimbursed for a maximum of 12 treatment cycles, after a single dose of obinutuzumab to reduce the risk of cytokine release syndrome (CRS) and should not be given in combination with other anticancer drugs. Reimbursement of Columvi should be discontinued if a patient’s cancer grows or spreads or if treatment is unacceptably toxic to the patient. Columvi should only be reimbursed when prescribed by specialists with experience managing DLBCL, and if its cost is reduced. \u0000","PeriodicalId":9437,"journal":{"name":"Canadian Journal of Health Technologies","volume":"145 2","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140443852","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
CADTH recommends that Akeega be reimbursed by public drug plans for the first-line treatment of metastatic castration-resistant prostate cancer (mCRPC) if certain conditions are met. Akeega should only be covered to treat patients with mCRPC who have BRCA mutations, have not been treated with an androgen receptor pathway inhibitor (ARPi) for earlier stages of prostate cancer, and have not received treatments that affect the entire body for mCRPC (except for treatments of less than 4 months with abiraterone acetate and prednisone) or a poly-(ADP-ribose) polymerase inhibitor (PARPi) for mCRPC. Moreover, patients should be in relatively good health. Akeega should only be reimbursed if it is prescribed by a clinician with expertise in treating prostate cancer with systemic anticancer therapy and if the cost of Akeega is reduced. Akeega should not be reimbursed when used in combination with other anticancer drugs.
{"title":"Niraparib and Abiraterone Acetate (Akeega)","authors":"Cadth","doi":"10.51731/cjht.2024.834","DOIUrl":"https://doi.org/10.51731/cjht.2024.834","url":null,"abstract":"\u0000CADTH recommends that Akeega be reimbursed by public drug plans for the first-line treatment of metastatic castration-resistant prostate cancer (mCRPC) if certain conditions are met. \u0000Akeega should only be covered to treat patients with mCRPC who have BRCA mutations, have not been treated with an androgen receptor pathway inhibitor (ARPi) for earlier stages of prostate cancer, and have not received treatments that affect the entire body for mCRPC (except for treatments of less than 4 months with abiraterone acetate and prednisone) or a poly-(ADP-ribose) polymerase inhibitor (PARPi) for mCRPC. Moreover, patients should be in relatively good health. \u0000Akeega should only be reimbursed if it is prescribed by a clinician with expertise in treating prostate cancer with systemic anticancer therapy and if the cost of Akeega is reduced. Akeega should not be reimbursed when used in combination with other anticancer drugs. \u0000","PeriodicalId":9437,"journal":{"name":"Canadian Journal of Health Technologies","volume":"69 4","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140448360","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
CADTH recommends that Evkeeza be reimbursed by public drug plans as an adjunct to diet and other low-density lipoprotein cholesterol (LDL-C)–lowering therapies for the treatment of adult and pediatric patients aged 5 years and older with homozygous familial hypercholesterolemia (HoFH) if certain conditions are met. Evkeeza should only be covered to treat patients aged 5 years and older with a diagnosis of HoFH and extremely high levels of LDL-C (sometimes referred to as bad cholesterol) despite receiving other cholesterol-lowering treatments. Evkeeza should only be reimbursed if prescribed by specialists with experience in managing HoFH and if the cost of Evkeeza is reduced. Evkeeza may only be prescribed for 24 weeks the first time it is used. To continue treatment with Evkeeza longer than 6 months, the treating physician must provide proof that the patient is responding to treatment, defined as reduction in LDL-C levels.
{"title":"Evinacumab (Evkeeza)","authors":"Cadth","doi":"10.51731/cjht.2024.823","DOIUrl":"https://doi.org/10.51731/cjht.2024.823","url":null,"abstract":"\u0000CADTH recommends that Evkeeza be reimbursed by public drug plans as an adjunct to diet and other low-density lipoprotein cholesterol (LDL-C)–lowering therapies for the treatment of adult and pediatric patients aged 5 years and older with homozygous familial hypercholesterolemia (HoFH) if certain conditions are met. \u0000Evkeeza should only be covered to treat patients aged 5 years and older with a diagnosis of HoFH and extremely high levels of LDL-C (sometimes referred to as bad cholesterol) despite receiving other cholesterol-lowering treatments. \u0000Evkeeza should only be reimbursed if prescribed by specialists with experience in managing HoFH and if the cost of Evkeeza is reduced. Evkeeza may only be prescribed for 24 weeks the first time it is used. To continue treatment with Evkeeza longer than 6 months, the treating physician must provide proof that the patient is responding to treatment, defined as reduction in LDL-C levels. \u0000","PeriodicalId":9437,"journal":{"name":"Canadian Journal of Health Technologies","volume":"244 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140472738","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Why Is This an Issue? Artificial intelligence (AI) is increasingly being used in health care settings. Chatbots geared toward patient use are becoming more widely available, but the clinical evidence of their effectiveness remains limited. What Is the Technology? AI-based chatbots are computer programs or software applications that have been designed to engage in simulated conversation with humans using humanlike language. Chatbots can help humans save time and allow them to focus on more high-level creative or strategic thinking by taking over more routine or repetitive tasks, such as automated customer service chats, appointments, or staff scheduling. What Is the Potential Impact? Anyone with access to an internet-enabled computer or a smartphone could use these chatbots to access health information. Chatbots can provide patients with 24/7 access to health information, such as symptom assessment, supportive information, medication reminders, or appointment scheduling, allowing access to information when health care providers are unavailable. There appear to be trends toward efficacy and user satisfaction, but the evidence to support the clinical effectiveness of chatbots in health care is still being established. Existing health care chatbots are mostly free for patients to access, although some developers and health care providers charge fees to access additional features or content. Some apps may be prescribed to patients by providers. These could be covered by insurance or licensed to health care providers by the developer. What Else Do We Need to Know? Ethical and data privacy issues remain top of mind when considering the widespread implementation of chatbots for patient use in health care settings. ChatGPT and other AI tools that were not developed specifically for health care do not necessarily provide the level of data privacy that is required of health care information. They are also trained on historical datasets and do not provide responses based on the most current clinical recommendations or health data. The development of AI-specific ethical frameworks could facilitate safer and more consistent development of AI tools in health care by preventing the misuse of AI technologies and minimizing the spread of misinformation. AI tools still require human oversight in terms of moderation and troubleshooting.
{"title":"Chatbots in Health Care: Connecting Patients to Information","authors":"Michelle Clark, Sharon Bailey","doi":"10.51731/cjht.2024.818","DOIUrl":"https://doi.org/10.51731/cjht.2024.818","url":null,"abstract":"Why Is This an Issue? \u0000 \u0000Artificial intelligence (AI) is increasingly being used in health care settings. Chatbots geared toward patient use are becoming more widely available, but the clinical evidence of their effectiveness remains limited. \u0000 \u0000What Is the Technology? \u0000 \u0000AI-based chatbots are computer programs or software applications that have been designed to engage in simulated conversation with humans using humanlike language. \u0000Chatbots can help humans save time and allow them to focus on more high-level creative or strategic thinking by taking over more routine or repetitive tasks, such as automated customer service chats, appointments, or staff scheduling. \u0000 \u0000What Is the Potential Impact? \u0000 \u0000Anyone with access to an internet-enabled computer or a smartphone could use these chatbots to access health information. \u0000Chatbots can provide patients with 24/7 access to health information, such as symptom assessment, supportive information, medication reminders, or appointment scheduling, allowing access to information when health care providers are unavailable. There appear to be trends toward efficacy and user satisfaction, but the evidence to support the clinical effectiveness of chatbots in health care is still being established. \u0000Existing health care chatbots are mostly free for patients to access, although some developers and health care providers charge fees to access additional features or content. Some apps may be prescribed to patients by providers. These could be covered by insurance or licensed to health care providers by the developer. \u0000 \u0000What Else Do We Need to Know? \u0000 \u0000Ethical and data privacy issues remain top of mind when considering the widespread implementation of chatbots for patient use in health care settings. \u0000ChatGPT and other AI tools that were not developed specifically for health care do not necessarily provide the level of data privacy that is required of health care information. They are also trained on historical datasets and do not provide responses based on the most current clinical recommendations or health data. \u0000The development of AI-specific ethical frameworks could facilitate safer and more consistent development of AI tools in health care by preventing the misuse of AI technologies and minimizing the spread of misinformation. \u0000AI tools still require human oversight in terms of moderation and troubleshooting. \u0000","PeriodicalId":9437,"journal":{"name":"Canadian Journal of Health Technologies","volume":"14 5","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139607814","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
CADTH recommends that Asparlas be reimbursed by public drug plans as a component of a multiagent chemotherapeutic (MAC) regimen for the treatment of acute lymphoblastic leukemia (ALL) in pediatric and young adult patients age 1 to 21 years if certain conditions are met. Asparlas should only be covered to treat children and young adults with ALL. Asparlas should only be reimbursed as part of a MAC regimen. Asparlas should be prescribed by clinicians with expertise in the management of ALL, and the cost of Asparlas should not exceed the drug program cost of treatment with pegaspargase.
CADTH 建议，在满足特定条件的情况下，Asparlas 可作为治疗 1 至 21 岁儿童和年轻成人急性淋巴细胞白血病 (ALL) 的多药化疗 (MAC) 方案的组成部分，获得公共药品计划的报销。Asparlas 只能用于治疗儿童和年轻成人 ALL 患者。Asparlas 只能作为 MAC 方案的一部分获得报销。Asparlas应由具有ALL治疗专业知识的临床医生处方，且Asparlas的费用不应超过使用pegaspargase治疗的药物计划费用。
{"title":"Calaspargase Pegol (Asparlas)","authors":"Cadth","doi":"10.51731/cjht.2024.820","DOIUrl":"https://doi.org/10.51731/cjht.2024.820","url":null,"abstract":"\u0000CADTH recommends that Asparlas be reimbursed by public drug plans as a component of a multiagent chemotherapeutic (MAC) regimen for the treatment of acute lymphoblastic leukemia (ALL) in pediatric and young adult patients age 1 to 21 years if certain conditions are met. \u0000Asparlas should only be covered to treat children and young adults with ALL. \u0000Asparlas should only be reimbursed as part of a MAC regimen. Asparlas should be prescribed by clinicians with expertise in the management of ALL, and the cost of Asparlas should not exceed the drug program cost of treatment with pegaspargase. \u0000","PeriodicalId":9437,"journal":{"name":"Canadian Journal of Health Technologies","volume":"7 6","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139609262","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Angela M. Barbara, Weiyi Xie, Quenby Mahood, Angie Hamson
What Is the Issue? Many drug treatments are available for depression, but 22% of people in Canada with the condition have treatment-resistant depression (TRD). For people with TRD, standard drug treatments do not improve their symptoms or do not work for long, and their depression persists. Posttraumatic stress disorder (PTSD) is a disabling mental health condition that affects about 9% of people in Canada in their lifetime. Few drugs are available for treating PTSD, none of which are considered effective. Ketamine is a hallucinogenic drug used primarily for anesthesia. Ketamine has also been explored for other indications, such as TRD and PTSD, generating questions about whether it could be a treatment option for these conditions. What Did We Do? We conducted a review of the clinical effectiveness, cost-effectiveness, and evidence-based guidelines on the use of ketamine in adults with TRD or PTSD, to help guide decisions on the use of ketamine for managing these conditions. An information specialist conducted a search of peer-reviewed and grey literature sources published in March 2022 or later. One reviewer screened citations and selected and critically appraised the included studies. CADTH engaged a patient with lived experience of TRD who shared their experiences and perspectives on ketamine-assisted psychotherapy. These perspectives helped us to contextualize the literature and appreciate nuances of the experience. What Did We Find? Ketamine could lead to an immediate improvement in depressive symptoms and suicidal ideation compared to placebo or midazolam in adults with TRD. The longest follow-up was 90 days, and the longest lasting effect after a dose was 28 days. Serious side effects of ketamine — such as dissociation — were rare and short-lived, lasting hours, in adults with TRD. It is uncertain if ketamine is an effective and safe treatment for symptoms of PTSD, due to little to no evidence suggesting its effectiveness or safety against placebo, midazolam, or opioids. Most studies evaluated ketamine given intravenously, and we found limited evidence on intramuscular (IM), subcutaneous, and intranasal routes of administration. We found no studies on oral or sublingual administration of ketamine and no studies comparing the different ways that ketamine can be given for TRD or PTSD. An economic evaluation found that IV ketamine was likely to be cost-effective compared to intranasal esketamine in adults with TRD from a health care perspective in the US. However, from a patient perspective, IV ketamine was unlikely to be cost-effective compared to esketamine, due to comparable levels of clinical effectiveness and lower costs of esketamine attributable to commercial insurance coverage and manufacturer assistance programs. A US guideline on TRD suggests ketamine as augmentation to antidepressants. A US guideline on PTSD does not suggest the use of ketamine as therapy. The patient contributor CADTH engaged for this revie
{"title":"Ketamine for Adults With Treatment-Resistant Depression or Posttraumatic Stress Disorder: A 2023 Update","authors":"Angela M. Barbara, Weiyi Xie, Quenby Mahood, Angie Hamson","doi":"10.51731/cjht.2024.817","DOIUrl":"https://doi.org/10.51731/cjht.2024.817","url":null,"abstract":"What Is the Issue? \u0000 \u0000Many drug treatments are available for depression, but 22% of people in Canada with the condition have treatment-resistant depression (TRD). For people with TRD, standard drug treatments do not improve their symptoms or do not work for long, and their depression persists. \u0000Posttraumatic stress disorder (PTSD) is a disabling mental health condition that affects about 9% of people in Canada in their lifetime. Few drugs are available for treating PTSD, none of which are considered effective. \u0000Ketamine is a hallucinogenic drug used primarily for anesthesia. Ketamine has also been explored for other indications, such as TRD and PTSD, generating questions about whether it could be a treatment option for these conditions. \u0000 \u0000What Did We Do? \u0000 \u0000We conducted a review of the clinical effectiveness, cost-effectiveness, and evidence-based guidelines on the use of ketamine in adults with TRD or PTSD, to help guide decisions on the use of ketamine for managing these conditions. \u0000An information specialist conducted a search of peer-reviewed and grey literature sources published in March 2022 or later. One reviewer screened citations and selected and critically appraised the included studies. \u0000CADTH engaged a patient with lived experience of TRD who shared their experiences and perspectives on ketamine-assisted psychotherapy. These perspectives helped us to contextualize the literature and appreciate nuances of the experience. \u0000 \u0000What Did We Find? \u0000 \u0000Ketamine could lead to an immediate improvement in depressive symptoms and suicidal ideation compared to placebo or midazolam in adults with TRD. The longest follow-up was 90 days, and the longest lasting effect after a dose was 28 days. Serious side effects of ketamine — such as dissociation — were rare and short-lived, lasting hours, in adults with TRD. \u0000It is uncertain if ketamine is an effective and safe treatment for symptoms of PTSD, due to little to no evidence suggesting its effectiveness or safety against placebo, midazolam, or opioids. \u0000Most studies evaluated ketamine given intravenously, and we found limited evidence on intramuscular (IM), subcutaneous, and intranasal routes of administration. We found no studies on oral or sublingual administration of ketamine and no studies comparing the different ways that ketamine can be given for TRD or PTSD. \u0000An economic evaluation found that IV ketamine was likely to be cost-effective compared to intranasal esketamine in adults with TRD from a health care perspective in the US. However, from a patient perspective, IV ketamine was unlikely to be cost-effective compared to esketamine, due to comparable levels of clinical effectiveness and lower costs of esketamine attributable to commercial insurance coverage and manufacturer assistance programs. \u0000A US guideline on TRD suggests ketamine as augmentation to antidepressants. A US guideline on PTSD does not suggest the use of ketamine as therapy. \u0000The patient contributor CADTH engaged for this revie","PeriodicalId":9437,"journal":{"name":"Canadian Journal of Health Technologies","volume":"7 12","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139616691","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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