There is no known recent knowledge in Canada of the average volume of MRI exams performed per hour at the national level. Using data from the national Canadian Medical Imaging Inventory 2019-2020 survey, CADTH calculated an average of 1.80 MRI exams performed per hour across Canada. This average exam rate is adjustable by a wide variety of factors, including (but not limited to): the age of equipment, the number of MRI units on site, and the field strength of the MRI. An understanding of the average exam rate may help individual institutions to establish benchmarks that could help to signal potential operational bottlenecks and initiate strategies to improve workflow and, thereby, patient access to MRI.
{"title":"Average Volume of MRI Exams Conducted per Hour Across Canada","authors":"Cadth","doi":"10.51731/cjht.2024.815","DOIUrl":"https://doi.org/10.51731/cjht.2024.815","url":null,"abstract":"\u0000There is no known recent knowledge in Canada of the average volume of MRI exams performed per hour at the national level. \u0000Using data from the national Canadian Medical Imaging Inventory 2019-2020 survey, CADTH calculated an average of 1.80 MRI exams performed per hour across Canada. \u0000This average exam rate is adjustable by a wide variety of factors, including (but not limited to): the age of equipment, the number of MRI units on site, and the field strength of the MRI. \u0000An understanding of the average exam rate may help individual institutions to establish benchmarks that could help to signal potential operational bottlenecks and initiate strategies to improve workflow and, thereby, patient access to MRI. \u0000","PeriodicalId":9437,"journal":{"name":"Canadian Journal of Health Technologies","volume":" 93","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139619091","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? People with severe emphysema who do not experience relief with non-invasive therapies such as medication, physical activity, and smoking cessation may need advanced treatments. Endobronchial valves are an alternative therapy that may improve exercise capacity and quality of life, and are less invasive compared to lung reduction surgery or transplants. What Did We Do? A 2019 CADTH report summarized clinical effectiveness evidence for valves compared to standard care. CADTH sought to update this evidence with new clinical research and include information on cost-effectiveness, which was not part of the previous report. A research information specialist conducted a literature search of the peer-reviewed and grey literature with a search strategy focused on emphysema and endobronchial valves. The search was limited to English-language documents published since 2018. One reviewer screened articles for inclusion based on predefined criteria, critically appraised the included studies, and narratively summarized the findings. What Did We Find? We did not find systematic reviews or health technology assessments published since 2018 that contained clinical evidence not already captured in the 2019 CADTH report. Two RCTs provide updated clinical evidence for endobronchial valves compared to standard care, and 1 RCT contains evidence on valves compared to lung surgery. The evidence suggests that valves may improve lung function, breathing ability, and physical activity in middle-aged and older adults with emphysema compared to standard care; the effect on quality of life and safety is unclear. The previous CADTH report showed lung function, breathing ability, physical activity, and quality of life were favourable for valve treatment compared to standard care. The previous CADTH report showed that valves resulted in harmful outcomes compared to standard care; however, in the current review, safety was difficult to assess due to poor reporting. When comparing valves to lung surgery, lung surgery may improve quality of life compared to valves; other outcomes did not favour one therapy over another. For cost-effectiveness, valves may be favourable compared to standard medical care, while their cost-effectiveness compared to lung volume reduction surgery is unclear. One study was conducted in Canada, and no studies were conducted in children and younger adults. What Does it Mean? Endobronchial valves are a potential therapy for people with severe emphysema with some favourable clinical and cost outcomes, but the evidence for their safety is unclear. Decision-makers may wish to consider the balance of favourable and harmful effects in existing evidence before more high-quality evidence in Canada, especially for safety, is available.
{"title":"Endobronchial Valves for the Management of Severe Emphysema","authors":"Nazia Darvesh, Qiukui Hao, Jennie Horton","doi":"10.51731/cjht.2024.816","DOIUrl":"https://doi.org/10.51731/cjht.2024.816","url":null,"abstract":"What Is the Issue? \u0000 \u0000People with severe emphysema who do not experience relief with non-invasive therapies such as medication, physical activity, and smoking cessation may need advanced treatments. \u0000Endobronchial valves are an alternative therapy that may improve exercise capacity and quality of life, and are less invasive compared to lung reduction surgery or transplants. \u0000 \u0000What Did We Do? \u0000 \u0000A 2019 CADTH report summarized clinical effectiveness evidence for valves compared to standard care. CADTH sought to update this evidence with new clinical research and include information on cost-effectiveness, which was not part of the previous report. \u0000A research information specialist conducted a literature search of the peer-reviewed and grey literature with a search strategy focused on emphysema and endobronchial valves. The search was limited to English-language documents published since 2018. One reviewer screened articles for inclusion based on predefined criteria, critically appraised the included studies, and narratively summarized the findings. \u0000 \u0000What Did We Find? \u0000 \u0000We did not find systematic reviews or health technology assessments published since 2018 that contained clinical evidence not already captured in the 2019 CADTH report. Two RCTs provide updated clinical evidence for endobronchial valves compared to standard care, and 1 RCT contains evidence on valves compared to lung surgery. \u0000The evidence suggests that valves may improve lung function, breathing ability, and physical activity in middle-aged and older adults with emphysema compared to standard care; the effect on quality of life and safety is unclear. The previous CADTH report showed lung function, breathing ability, physical activity, and quality of life were favourable for valve treatment compared to standard care. \u0000The previous CADTH report showed that valves resulted in harmful outcomes compared to standard care; however, in the current review, safety was difficult to assess due to poor reporting. \u0000When comparing valves to lung surgery, lung surgery may improve quality of life compared to valves; other outcomes did not favour one therapy over another. \u0000For cost-effectiveness, valves may be favourable compared to standard medical care, while their cost-effectiveness compared to lung volume reduction surgery is unclear. \u0000One study was conducted in Canada, and no studies were conducted in children and younger adults. \u0000 \u0000What Does it Mean? \u0000 \u0000Endobronchial valves are a potential therapy for people with severe emphysema with some favourable clinical and cost outcomes, but the evidence for their safety is unclear. \u0000Decision-makers may wish to consider the balance of favourable and harmful effects in existing evidence before more high-quality evidence in Canada, especially for safety, is available. \u0000","PeriodicalId":9437,"journal":{"name":"Canadian Journal of Health Technologies","volume":"38 13","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139528572","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 Polivy in combination with rituximab, cyclophosphamide, doxorubicin, and prednisone (R-CHP) not be reimbursed by public drug plans for the treatment of adult patients with previously untreated large B-cell lymphoma (LBCL), including diffuse large B-cell lymphoma (DLBCL) not otherwise specified (NOS), high-grade B-cell lymphoma, Epstein-Barr virus–positive DLBCL NOS, and T-cell/histiocyte-rich LBCL. Evidence from a clinical trial showed that 6.6% more patients with newly diagnosed moderate- to high-risk LBCL were alive without their disease progressing 2 years after treatment with Polivy in combination with R-CHP compared to those treated with traditional chemoimmunotherapy (rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone [R-CHOP]). However, there is uncertainty whether this difference observed in the clinical trial translates to a meaningful difference in the real world. The evidence from the trial did not show that Polivy combined with R-CHP prolonged survival compared to R-CHOP. It is also unknown if Polivy in combination with R-CHP would reduce disease symptoms or improve functioning compared to R-CHOP because there were no differences between the 2 groups. Patients identified a need for treatments that prolong disease remission, prolong survival, control disease symptoms, normalize blood counts, and improve quality of life. Based on the evidence submitted, it is not clear that Polivy in combination with R-CHP would provide a meaningful benefit in prolonging remission or meet the other important needs in LBCL.
CADTH 建议，Polivy 与利妥昔单抗、环磷酰胺、多柔比星和泼尼松（R-CHP）联合用于治疗既往未经治疗的大 B 细胞淋巴瘤（LBCL）成人患者，公共药品计划不予报销、包括非特异性弥漫大 B 细胞淋巴瘤（DLBCL）、高级别 B 细胞淋巴瘤、Epstein-Barr 病毒阳性 DLBCL NOS 和富含 T 细胞/组织细胞的 LBCL。一项临床试验的证据显示，与接受传统化疗免疫疗法（利妥昔单抗、环磷酰胺、多柔比星、长春新碱和泼尼松 [R-CHOP]）治疗的患者相比，新确诊的中高危 LBCL 患者在接受 Polivy 联合 R-CHP 治疗 2 年后，有 6.6% 的患者存活且病情没有进展。然而，临床试验中观察到的这种差异是否会在现实世界中转化为有意义的差异，还存在不确定性。试验证据并未显示 Polivy 联合 R-CHP 比 R-CHOP 延长了生存期。此外，与R-CHOP相比，Polivy联合R-CHP是否能减轻疾病症状或改善功能也不得而知，因为两组之间没有差异。患者认为需要能够延长疾病缓解期、延长生存期、控制疾病症状、使血细胞计数正常化并改善生活质量的治疗方法。根据所提交的证据，目前尚不清楚Polivy与R-CHP联用是否能在延长缓解期或满足LBCL的其他重要需求方面带来有意义的益处。
{"title":"Polatuzumab Vedotin (Polivy)","authors":"Cadth","doi":"10.51731/cjht.2024.813","DOIUrl":"https://doi.org/10.51731/cjht.2024.813","url":null,"abstract":"\u0000CADTH recommends that Polivy in combination with rituximab, cyclophosphamide, doxorubicin, and prednisone (R-CHP) not be reimbursed by public drug plans for the treatment of adult patients with previously untreated large B-cell lymphoma (LBCL), including diffuse large B-cell lymphoma (DLBCL) not otherwise specified (NOS), high-grade B-cell lymphoma, Epstein-Barr virus–positive DLBCL NOS, and T-cell/histiocyte-rich LBCL. \u0000Evidence from a clinical trial showed that 6.6% more patients with newly diagnosed moderate- to high-risk LBCL were alive without their disease progressing 2 years after treatment with Polivy in combination with R-CHP compared to those treated with traditional chemoimmunotherapy (rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone [R-CHOP]). However, there is uncertainty whether this difference observed in the clinical trial translates to a meaningful difference in the real world. The evidence from the trial did not show that Polivy combined with R-CHP prolonged survival compared to R-CHOP. It is also unknown if Polivy in combination with R-CHP would reduce disease symptoms or improve functioning compared to R-CHOP because there were no differences between the 2 groups. \u0000Patients identified a need for treatments that prolong disease remission, prolong survival, control disease symptoms, normalize blood counts, and improve quality of life. Based on the evidence submitted, it is not clear that Polivy in combination with R-CHP would provide a meaningful benefit in prolonging remission or meet the other important needs in LBCL. \u0000","PeriodicalId":9437,"journal":{"name":"Canadian Journal of Health Technologies","volume":"32 5","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139529723","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? Renal colic is a common problem that is primarily caused by kidney stones. Renal colic, specifically kidney stones, can be a recurrent condition that can negatively impact a person’s quality of life and health system utilization. Ketorolac through IV or intramuscular routes is a common nonsteroidal anti-inflammatory drug (NSAID) used in hospital to treat renal colic. Oral ketorolac for the management of renal colic may reduce patients’ need for opioids after discharge but it is unclear if it is clinically effective when compared to alternative analgesics or whether it is recommended for use in the management of people with renal colic. What Did We Do? To inform decisions about oral ketorolac for the management of outpatients with renal colic, we sought to identify and summarize literature comparing the clinical effectiveness of oral ketorolac and alternative analgesics. We also searched for evidence-based guidelines that provide recommendations about the use of oral ketorolac for the management of people with renal colic. A research information specialist conducted literature searches of peer-reviewed and grey literature sources published between January 1, 2013, and December 4, 2023. The search was limited to English-language documents. One reviewer screened articles for inclusion based on predefined criteria. What Did We Find? The tailored search for this rapid review did not find any studies evaluating the clinical effectiveness of oral ketorolac versus alternative analgesics for the management of people with renal colic in outpatient settings that met our criteria for this review. There is therefore no specific evidence available on the efficacy oral ketorolac in the management of renal colic in the community setting in this review. We did not find any eligible evidence-based guidelines concerning the use of oral ketorolac for the management of people with renal colic in outpatient settings. NSAIDs have been generally mentioned as an option for renal colic in the available guidance. Research regarding ketorolac for renal colic published since 2013 has focused on IV or intramuscular administration. Research regarding oral ketorolac focused on indications other than renal colic (e.g., postoperative pain) may be of interest; these are listed in the appendix. These studies suggest the effectiveness of ketorolac for pain management for other indications, such as pain management following endoscopy. What Does It Mean? Without comparative evidence, decision-makers may want to consider how oral ketorolac is used for related indications (e.g., procedures for removing kidney stones, ureteroscopies) to examine how it performed compared with alternative analgesics. Research focused on the management of renal colic is needed to evaluate the clinical effectiveness of oral ketorolac and inform guidance concerning oral ketorolac in outpatient settings.
{"title":"Oral Ketorolac for Renal Colic in Outpatient Settings","authors":"C. Lachance, Quenby Mahood","doi":"10.51731/cjht.2024.814","DOIUrl":"https://doi.org/10.51731/cjht.2024.814","url":null,"abstract":"What Is the Issue? \u0000 \u0000Renal colic is a common problem that is primarily caused by kidney stones. Renal colic, specifically kidney stones, can be a recurrent condition that can negatively impact a person’s quality of life and health system utilization. \u0000Ketorolac through IV or intramuscular routes is a common nonsteroidal anti-inflammatory drug (NSAID) used in hospital to treat renal colic. Oral ketorolac for the management of renal colic may reduce patients’ need for opioids after discharge but it is unclear if it is clinically effective when compared to alternative analgesics or whether it is recommended for use in the management of people with renal colic. \u0000 \u0000What Did We Do? \u0000 \u0000To inform decisions about oral ketorolac for the management of outpatients with renal colic, we sought to identify and summarize literature comparing the clinical effectiveness of oral ketorolac and alternative analgesics. We also searched for evidence-based guidelines that provide recommendations about the use of oral ketorolac for the management of people with renal colic. \u0000A research information specialist conducted literature searches of peer-reviewed and grey literature sources published between January 1, 2013, and December 4, 2023. The search was limited to English-language documents. One reviewer screened articles for inclusion based on predefined criteria. \u0000 \u0000What Did We Find? \u0000 \u0000The tailored search for this rapid review did not find any studies evaluating the clinical effectiveness of oral ketorolac versus alternative analgesics for the management of people with renal colic in outpatient settings that met our criteria for this review. There is therefore no specific evidence available on the efficacy oral ketorolac in the management of renal colic in the community setting in this review. \u0000We did not find any eligible evidence-based guidelines concerning the use of oral ketorolac for the management of people with renal colic in outpatient settings. NSAIDs have been generally mentioned as an option for renal colic in the available guidance. \u0000Research regarding ketorolac for renal colic published since 2013 has focused on IV or intramuscular administration. Research regarding oral ketorolac focused on indications other than renal colic (e.g., postoperative pain) may be of interest; these are listed in the appendix. These studies suggest the effectiveness of ketorolac for pain management for other indications, such as pain management following endoscopy. \u0000 \u0000What Does It Mean? \u0000 \u0000Without comparative evidence, decision-makers may want to consider how oral ketorolac is used for related indications (e.g., procedures for removing kidney stones, ureteroscopies) to examine how it performed compared with alternative analgesics. \u0000Research focused on the management of renal colic is needed to evaluate the clinical effectiveness of oral ketorolac and inform guidance concerning oral ketorolac in outpatient settings. \u0000","PeriodicalId":9437,"journal":{"name":"Canadian Journal of Health Technologies","volume":"10 4","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139529436","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 Vyvgart be reimbursed by public drug plans for the treatment of adult patients with generalized myasthenia gravis (gMG) if certain conditions are met. Vyvgart should only be covered to treat patients who have a diagnosis of class II to IV gMG based on the Myasthenia Gravis Foundation of America (MGFA) system, tested positive for anti–acetylcholine receptor (AChR) antibodies, and have a Myasthenia Gravis Activities of Daily Living (MG-ADL) scale score of at least 5. Vyvgart should only be covered to treat patients if their symptoms persist despite a stable dose of conventional therapy with acetylcholinesterase inhibitors (AChEIs), corticosteroids (CSs), and/or nonsteroidal immunosuppressants (NSISTs). Vyvgart should not be reimbursed when given during a gMG exacerbation (i.e., moment when patient experience weakness in some or all muscles, without needing assistance to breath) or crisis (i.e., moment when respiratory muscles are too weak, limiting air flow in and out of lungs, and as a result, patient is unable to breathe), or within 3 months of thymectomy (i.e., surgical removal of thymus gland). Vyvgart should only be reimbursed if prescribed by or in consultation with a neurologist with expertise in managing patients with gMG, and the cost of Vyvgart is reduced. Vyvgart should not be used concomitantly with rituximab or complement inhibitors.
{"title":"Efgartigimod Alfa (Vyvgart)","authors":"Cadth","doi":"10.51731/cjht.2024.811","DOIUrl":"https://doi.org/10.51731/cjht.2024.811","url":null,"abstract":"\u0000CADTH recommends that Vyvgart be reimbursed by public drug plans for the treatment of adult patients with generalized myasthenia gravis (gMG) if certain conditions are met. \u0000Vyvgart should only be covered to treat patients who have a diagnosis of class II to IV gMG based on the Myasthenia Gravis Foundation of America (MGFA) system, tested positive for anti–acetylcholine receptor (AChR) antibodies, and have a Myasthenia Gravis Activities of Daily Living (MG-ADL) scale score of at least 5. Vyvgart should only be covered to treat patients if their symptoms persist despite a stable dose of conventional therapy with acetylcholinesterase inhibitors (AChEIs), corticosteroids (CSs), and/or nonsteroidal immunosuppressants (NSISTs). \u0000Vyvgart should not be reimbursed when given during a gMG exacerbation (i.e., moment when patient experience weakness in some or all muscles, without needing assistance to breath) or crisis (i.e., moment when respiratory muscles are too weak, limiting air flow in and out of lungs, and as a result, patient is unable to breathe), or within 3 months of thymectomy (i.e., surgical removal of thymus gland). Vyvgart should only be reimbursed if prescribed by or in consultation with a neurologist with expertise in managing patients with gMG, and the cost of Vyvgart is reduced. Vyvgart should not be used concomitantly with rituximab or complement inhibitors. \u0000","PeriodicalId":9437,"journal":{"name":"Canadian Journal of Health Technologies","volume":"97 8","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139444484","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 Ondexxya should not be reimbursed by public drug plans for adult patients treated with factor Xa (FXa) inhibitors (rivaroxaban or apixaban) when rapid reversal of anticoagulation is needed due to life-threatening or uncontrolled bleeding. Evidence from a clinical trial (ANNEXA-4) demonstrated that Ondexxya treatment could reduce the activity of FXa inhibitors in the blood and improve imaging and laboratory markers of bleeding; however, without a control group, there is uncertainty in how much the observed benefits were due to Ondexxya treatment rather than chance. Clinical outcomes such as neurologic status and mortality were also uncertain. No evidence was submitted at the time of the review that directly compared Ondexxya to usual care for managing bleeding related to an FXa inhibitor. Observational evidence comparing Ondexxya and prothrombin complex concentrate, which is part of the usual care, was uncertain due to limitations of study design and analysis. Based on the evidence reviewed, the CADTH Canadian Plasma Protein Product Expert Committee (CPEC) was not convinced that treatment with Ondexxya would achieve outcomes that are clinically important to patients or meet needs not already addressed by other available treatments.
{"title":"Andexanet Alfa (Ondexxya)","authors":"Cadth","doi":"10.51731/cjht.2023.806","DOIUrl":"https://doi.org/10.51731/cjht.2023.806","url":null,"abstract":"CADTH recommends that Ondexxya should not be reimbursed by public drug plans for adult patients treated with factor Xa (FXa) inhibitors (rivaroxaban or apixaban) when rapid reversal of anticoagulation is needed due to life-threatening or uncontrolled bleeding. \u0000 \u0000Evidence from a clinical trial (ANNEXA-4) demonstrated that Ondexxya treatment could reduce the activity of FXa inhibitors in the blood and improve imaging and laboratory markers of bleeding; however, without a control group, there is uncertainty in how much the observed benefits were due to Ondexxya treatment rather than chance. Clinical outcomes such as neurologic status and mortality were also uncertain. \u0000No evidence was submitted at the time of the review that directly compared Ondexxya to usual care for managing bleeding related to an FXa inhibitor. Observational evidence comparing Ondexxya and prothrombin complex concentrate, which is part of the usual care, was uncertain due to limitations of study design and analysis. \u0000Based on the evidence reviewed, the CADTH Canadian Plasma Protein Product Expert Committee (CPEC) was not convinced that treatment with Ondexxya would achieve outcomes that are clinically important to patients or meet needs not already addressed by other available treatments. \u0000","PeriodicalId":9437,"journal":{"name":"Canadian Journal of Health Technologies","volume":"41 8","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138951775","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}
This review focused on the perspectives and experiences of adults with end-stage renal disease (referred to as “patients”), their families, and their health care providers regarding accessing, offering, deciding about, undergoing, performing, and recovering from procedures to create arteriovenous fistulas (AVFs) for hemodialysis. AVFs are connections between an artery and vein used for vascular access, a process that allows a hemodialysis machine to access a patient’s blood. A total of 8 qualitative studies were synthesized. Patients and health care providers mostly valued shared decision-making (SDM) when deciding to undergo procedures to create AVFs. The perceived benefits of SDM include patients’ increased knowledge of their condition, satisfaction, greater sense of control, and improved coping abilities. Yet, some health care providers continue to practice traditional prescriptive approaches to decision-making. Contextual factors influenced decision-making approaches and patients’ agency to access or refuse procedures to create AVFs. These factors included values, beliefs, and attitudes; the timing of decision-making; and human, structural, financial, and informational resources. People who are racialized and those experiencing poverty, houselessness, or language barriers may disproportionately experience difficulties engaging in timely and informed SDM; as a result, they may make uninformed decisions or experience traumatic unplanned dialysis initiation using a form of vascular access they did not choose. Decision-makers may consider promoting SDM practices by integrating SDM criteria in health care performance measures and SDM reimbursement models. They may also consider providing decision aids and SDM coaching to health care providers. They may also consider tailored interventions based on unique social, financial, and language-related needs to promote equitable access to procedures to create AVFs. During decision-making, patients weigh factors such as trust in their health care providers, past experiences, the invasive nature of procedures to create AVFs, and the anticipated outcomes of these procedures. Patients’ fears of being “cut” or experiencing pain and complications could hinder their engagement in these procedures. Patients’ concerns about an AVF being dysfunctional or hard to maintain and the anticipated pain of needles could also prevent them from wanting AVFs. Additional concerns included the risk of bleeding and an AVF’s impact on physical appearance. The included literature provided limited insights into the perspectives and experiences of undergoing, performing, and recovering from procedures to create AVFs. However, some patients and their families experienced financial and emotional burdens while accessing these procedures in Canada. This can be exacerbated by prolonged surgical wait times and rescheduling. People in rural communities, who often had to travel long distances for care, experienced these burdens more tha
{"title":"Perspectives and Experiences Regarding the Creation of Arteriovenous Fistulas for Hemodialysis Access: A Rapid Qualitative Review","authors":"Jamie Anne Bentz, Sharon Bailey","doi":"10.51731/cjht.2023.807","DOIUrl":"https://doi.org/10.51731/cjht.2023.807","url":null,"abstract":"\u0000This review focused on the perspectives and experiences of adults with end-stage renal disease (referred to as “patients”), their families, and their health care providers regarding accessing, offering, deciding about, undergoing, performing, and recovering from procedures to create arteriovenous fistulas (AVFs) for hemodialysis. AVFs are connections between an artery and vein used for vascular access, a process that allows a hemodialysis machine to access a patient’s blood. A total of 8 qualitative studies were synthesized. \u0000Patients and health care providers mostly valued shared decision-making (SDM) when deciding to undergo procedures to create AVFs. The perceived benefits of SDM include patients’ increased knowledge of their condition, satisfaction, greater sense of control, and improved coping abilities. Yet, some health care providers continue to practice traditional prescriptive approaches to decision-making. Contextual factors influenced decision-making approaches and patients’ agency to access or refuse procedures to create AVFs. These factors included values, beliefs, and attitudes; the timing of decision-making; and human, structural, financial, and informational resources. People who are racialized and those experiencing poverty, houselessness, or language barriers may disproportionately experience difficulties engaging in timely and informed SDM; as a result, they may make uninformed decisions or experience traumatic unplanned dialysis initiation using a form of vascular access they did not choose. \u0000Decision-makers may consider promoting SDM practices by integrating SDM criteria in health care performance measures and SDM reimbursement models. They may also consider providing decision aids and SDM coaching to health care providers. They may also consider tailored interventions based on unique social, financial, and language-related needs to promote equitable access to procedures to create AVFs. \u0000During decision-making, patients weigh factors such as trust in their health care providers, past experiences, the invasive nature of procedures to create AVFs, and the anticipated outcomes of these procedures. Patients’ fears of being “cut” or experiencing pain and complications could hinder their engagement in these procedures. Patients’ concerns about an AVF being dysfunctional or hard to maintain and the anticipated pain of needles could also prevent them from wanting AVFs. Additional concerns included the risk of bleeding and an AVF’s impact on physical appearance. \u0000The included literature provided limited insights into the perspectives and experiences of undergoing, performing, and recovering from procedures to create AVFs. However, some patients and their families experienced financial and emotional burdens while accessing these procedures in Canada. This can be exacerbated by prolonged surgical wait times and rescheduling. People in rural communities, who often had to travel long distances for care, experienced these burdens more tha","PeriodicalId":9437,"journal":{"name":"Canadian Journal of Health Technologies","volume":"69 8","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138957052","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? Since 2008, the shortage of leucovorin has had a significant impact on fluorouracil-based chemotherapy. Many institutions worldwide provided possible options to relieve the leucovorin shortage, including using treatment without leucovorin, lowering the standard leucovorin dose, or using alternative drugs. If lowering the body surface area-adjusted standard dose of leucovorin does not affect efficacy and safety, then implementation of a low flat-dose protocol may prevent mistakes that result during dose calculation and save pharmacy compounding time and costs. Decision-makers want to know if any clinical evidence supports a low flat-dose protocol for leucovorin. What Did We Do? To inform decisions about using flat-dose leucovorin in conjunction with fluorouracil-based chemotherapy, CADTH sought to identify and summarize literature comparing the clinical effectiveness of flat dosing versus weight-based leucovorin dosing. We also attempted to identify evidence-based recommendations for leucovorin dosing for colorectal or upper gastrointestinal cancer. A research information specialist conducted a literature search of the peer-reviewed and grey literature with a search strategy focused on leucovorin, dosing, and colorectal or gastrointestinal cancers. The search was limited to English-language documents published since 2013. One reviewer screened articles for inclusion based on predefined criteria, critically appraised the included studies, and narratively summarized the findings. What Did We Find? We found 1 small retrospective cohort study (58 patients) comparing low flat-dose 50 mg leucovorin with body surface area-adjusted to high dose 200 mg/m2 to 500 mg/m2 leucovorin in patients with colorectal cancer. The study found no statistically significant differences between the 2 doses in survival or complication rates. We found no evidence-based guidelines regarding leucovorin dosing for colorectal or upper gastrointestinal cancer. However, we found several guidelines with unclear methodology reporting leucovorin doses used in different fluorouracil-based regimens. What Does it Mean? Limited evidence from this review suggests that the standard weight-based dosing of leucovorin may be reduced to a low flat-dose. However, we require a larger and well conducted trial to confirm the findings of that study. Decision-makers may wish to consider that reducing the dose of leucovorin may conserve the supply, reduce pharmacy compounding time and control acquisition costs.
{"title":"Leucovorin Dosing for Gastrointestinal Cancer","authors":"Khai Tran, Melissa Walter","doi":"10.51731/cjht.2023.805","DOIUrl":"https://doi.org/10.51731/cjht.2023.805","url":null,"abstract":"What Is the Issue? \u0000 \u0000Since 2008, the shortage of leucovorin has had a significant impact on fluorouracil-based chemotherapy. Many institutions worldwide provided possible options to relieve the leucovorin shortage, including using treatment without leucovorin, lowering the standard leucovorin dose, or using alternative drugs. \u0000If lowering the body surface area-adjusted standard dose of leucovorin does not affect efficacy and safety, then implementation of a low flat-dose protocol may prevent mistakes that result during dose calculation and save pharmacy compounding time and costs. \u0000Decision-makers want to know if any clinical evidence supports a low flat-dose protocol for leucovorin. \u0000 \u0000What Did We Do? \u0000 \u0000To inform decisions about using flat-dose leucovorin in conjunction with fluorouracil-based chemotherapy, CADTH sought to identify and summarize literature comparing the clinical effectiveness of flat dosing versus weight-based leucovorin dosing. We also attempted to identify evidence-based recommendations for leucovorin dosing for colorectal or upper gastrointestinal cancer. \u0000A research information specialist conducted a literature search of the peer-reviewed and grey literature with a search strategy focused on leucovorin, dosing, and colorectal or gastrointestinal cancers. The search was limited to English-language documents published since 2013. One reviewer screened articles for inclusion based on predefined criteria, critically appraised the included studies, and narratively summarized the findings. \u0000 \u0000What Did We Find? \u0000 \u0000We found 1 small retrospective cohort study (58 patients) comparing low flat-dose 50 mg leucovorin with body surface area-adjusted to high dose 200 mg/m2 to 500 mg/m2 leucovorin in patients with colorectal cancer. The study found no statistically significant differences between the 2 doses in survival or complication rates. \u0000We found no evidence-based guidelines regarding leucovorin dosing for colorectal or upper gastrointestinal cancer. However, we found several guidelines with unclear methodology reporting leucovorin doses used in different fluorouracil-based regimens. \u0000 \u0000What Does it Mean? \u0000 \u0000Limited evidence from this review suggests that the standard weight-based dosing of leucovorin may be reduced to a low flat-dose. However, we require a larger and well conducted trial to confirm the findings of that study. \u0000Decision-makers may wish to consider that reducing the dose of leucovorin may conserve the supply, reduce pharmacy compounding time and control acquisition costs. \u0000","PeriodicalId":9437,"journal":{"name":"Canadian Journal of Health Technologies","volume":"65 21","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138956934","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? Doctors use ketamine to induce loss of consciousness as general anesthesia during surgery. At low doses that do not produce dissociation, practitioners use ketamine to relieve acute or chronic pain. The previous CADTH report published in 2020 found that IV ketamine, compared to placebo, could only provide short-term pain relief in patients with chronic non-cancer pain, with increased risks of nausea, vomiting, and psychomimetic effects. The included guidelines did not provide definitive recommendations due to insufficient evidence. Decision-makers want to know if there is any new evidence to support the use of ketamine for treating of chronic non-cancer pain in adults. What Did We Do? To inform decisions about the use of ketamine for treating of chronic non-cancer pain, CADTH sought to update the previous report by identifying and summarizing literature comparing the clinical effectiveness and cost-effectiveness of ketamine with placebo or other pharmacological therapies for chronic non-cancer pain. We also attempted to identify evidence-based recommendations from most recent guidelines for the use of ketamine for chronic non-cancer pain. A research information specialist conducted a literature search of the peer-reviewed and grey literature with a search strategy focused on ketamine, chronic non-cancer pain, and adults. The search was limited to English-language documents published since 2020 up to November 06, 2023. One reviewer screened articles for inclusion based on predefined criteria, critically appraised the included studies, and narratively summarized the findings. What Did We Find? We found 3 SRs and 1 randomized controlled trial on the use of ketamine for the treatment of patients with neuropathic pain, complex regional pain syndrome, fibromyalgia, and other chronic pain conditions. Collective evidence from the included studies suggests that ketamine treatment was associated with short-term pain reduction in patients with chronic non-cancer pain. However, the long-term efficacy of ketamine in pain relief remains unclear. Adverse events (AEs) associated with ketamine treatment were with psychedelic effects, discomfort, dizziness, fatigue, headache, and nausea; all of those events appeared to be short-lasting. There were mixed results regarding the effect of ketamine on quality of life and functional improvement. We did not find any studies on the cost-effectiveness of ketamine or new evidence-based guidelines on the use of ketamine for treating chronic non-cancer pain. What Does It Mean? The findings in this review are consistent with the previous CADTH report published in 2020. Well-controlled studies with larger populations and longer follow-ups are needed to determine the optimal treatment protocol of ketamine for each specific type of chronic pain. Given that ketamine is a dissociative drug that could be associated with the development of a substance use disorder, decision-makers may w
{"title":"Ketamine for Chronic Non-Cancer Pain: A 2023 Update","authors":"Khai Tran, Daniel W. MacDougall","doi":"10.51731/cjht.2023.809","DOIUrl":"https://doi.org/10.51731/cjht.2023.809","url":null,"abstract":"What Is the Issue? \u0000 \u0000Doctors use ketamine to induce loss of consciousness as general anesthesia during surgery. At low doses that do not produce dissociation, practitioners use ketamine to relieve acute or chronic pain. \u0000The previous CADTH report published in 2020 found that IV ketamine, compared to placebo, could only provide short-term pain relief in patients with chronic non-cancer pain, with increased risks of nausea, vomiting, and psychomimetic effects. The included guidelines did not provide definitive recommendations due to insufficient evidence. \u0000Decision-makers want to know if there is any new evidence to support the use of ketamine for treating of chronic non-cancer pain in adults. \u0000 \u0000What Did We Do? \u0000 \u0000To inform decisions about the use of ketamine for treating of chronic non-cancer pain, CADTH sought to update the previous report by identifying and summarizing literature comparing the clinical effectiveness and cost-effectiveness of ketamine with placebo or other pharmacological therapies for chronic non-cancer pain. We also attempted to identify evidence-based recommendations from most recent guidelines for the use of ketamine for chronic non-cancer pain. \u0000A research information specialist conducted a literature search of the peer-reviewed and grey literature with a search strategy focused on ketamine, chronic non-cancer pain, and adults. The search was limited to English-language documents published since 2020 up to November 06, 2023. One reviewer screened articles for inclusion based on predefined criteria, critically appraised the included studies, and narratively summarized the findings. \u0000 \u0000What Did We Find? \u0000 \u0000We found 3 SRs and 1 randomized controlled trial on the use of ketamine for the treatment of patients with neuropathic pain, complex regional pain syndrome, fibromyalgia, and other chronic pain conditions. Collective evidence from the included studies suggests that ketamine treatment was associated with short-term pain reduction in patients with chronic non-cancer pain. However, the long-term efficacy of ketamine in pain relief remains unclear. \u0000Adverse events (AEs) associated with ketamine treatment were with psychedelic effects, discomfort, dizziness, fatigue, headache, and nausea; all of those events appeared to be short-lasting. \u0000There were mixed results regarding the effect of ketamine on quality of life and functional improvement. \u0000We did not find any studies on the cost-effectiveness of ketamine or new evidence-based guidelines on the use of ketamine for treating chronic non-cancer pain. \u0000 \u0000What Does It Mean? \u0000 \u0000The findings in this review are consistent with the previous CADTH report published in 2020. \u0000Well-controlled studies with larger populations and longer follow-ups are needed to determine the optimal treatment protocol of ketamine for each specific type of chronic pain. \u0000Given that ketamine is a dissociative drug that could be associated with the development of a substance use disorder, decision-makers may w","PeriodicalId":9437,"journal":{"name":"Canadian Journal of Health Technologies","volume":"122 17","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138953824","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? Incidence of colorectal cancer in individuals younger than 50 years in Canada is rising, despite existing recommendations in Canada advising that colorectal cancer screening be initiated at 50 years. In response to the also increasing incidence of colorectal cancer observed in other jurisdictions, screening for colorectal cancer in individuals of average risk younger than 50 years has been recommended. These factors have prompted reconsideration of current Canadian guidelines regarding the age at which colorectal cancer screening should be initiated. What Did We Do? To inform considerations about the age at which colorectal cancer screening should best be initiated, CADTH identified and summarized studies comparing colorectal cancer screening in individuals of average risk younger than 50 years with either no screening or screening in individuals of average risk aged 50 years and older. An information specialist conducted a search of peer-reviewed and grey literature sources. Recommendations from evidence-based guidelines for screening individuals of average risk younger than 50 years were also sought and summarized. What Did We Find? Data from 1 retrospective cohort study in the US conducted in a large sample across 13 years suggested there is higher incidence of colorectal cancer among individuals between the ages of 45 and 49 years who underwent screening colonoscopy than in those between the ages of 50 and 54 years. Data from a retrospective cohort study conducted in Greece with a limited sample size across 1 year of observation demonstrated no difference in the cumulative incidence of colorectal cancer in individuals of average risk younger than 50 years or 50 years and older. Estimates from 4 modelling studies (1 of which was Canadian) that investigated screening in individuals younger than 50 years indicate that life-years may be gained, colorectal cancer cases and deaths may be reduced, but that numbers of lifetime colonoscopies and complications from screening would likely increase. One economic evaluation conducted in Portugal concluded that there is no cost-utility for colorectal cancer screening in individuals of average risk younger than 50 years at a willingness-to-pay threshold of €39,760, given current estimates of incidence in this age cohort. Seven evidence-based guidelines identified recommend that colorectal cancer screening be initiated in individuals of average risk at age 45 years, whereas 1 guideline recommends against screening in individuals of average risk beginning at 45 years and 1 guideline recommends against screening beginning at age 40 years. Most evidence-based guidelines highlight the lack of empirical evidence describing clinical effectiveness and cost-effectiveness as limitations when developing recommendations. What Does It Mean? Empirical data describing the effectiveness of colorectal cancer screening in individuals of average risk younger than 50 years remain
{"title":"Screening for Colorectal Cancer in Individuals Younger Than 50 Years","authors":"Sara D. Khangura, Carolyn Spry","doi":"10.51731/cjht.2023.808","DOIUrl":"https://doi.org/10.51731/cjht.2023.808","url":null,"abstract":"What Is the Issue? \u0000 \u0000Incidence of colorectal cancer in individuals younger than 50 years in Canada is rising, despite existing recommendations in Canada advising that colorectal cancer screening be initiated at 50 years. \u0000In response to the also increasing incidence of colorectal cancer observed in other jurisdictions, screening for colorectal cancer in individuals of average risk younger than 50 years has been recommended. \u0000These factors have prompted reconsideration of current Canadian guidelines regarding the age at which colorectal cancer screening should be initiated. \u0000 \u0000What Did We Do? \u0000 \u0000To inform considerations about the age at which colorectal cancer screening should best be initiated, CADTH identified and summarized studies comparing colorectal cancer screening in individuals of average risk younger than 50 years with either no screening or screening in individuals of average risk aged 50 years and older. \u0000An information specialist conducted a search of peer-reviewed and grey literature sources. Recommendations from evidence-based guidelines for screening individuals of average risk younger than 50 years were also sought and summarized. \u0000 \u0000What Did We Find? \u0000 \u0000Data from 1 retrospective cohort study in the US conducted in a large sample across 13 years suggested there is higher incidence of colorectal cancer among individuals between the ages of 45 and 49 years who underwent screening colonoscopy than in those between the ages of 50 and 54 years. \u0000Data from a retrospective cohort study conducted in Greece with a limited sample size across 1 year of observation demonstrated no difference in the cumulative incidence of colorectal cancer in individuals of average risk younger than 50 years or 50 years and older. \u0000Estimates from 4 modelling studies (1 of which was Canadian) that investigated screening in individuals younger than 50 years indicate that life-years may be gained, colorectal cancer cases and deaths may be reduced, but that numbers of lifetime colonoscopies and complications from screening would likely increase. \u0000One economic evaluation conducted in Portugal concluded that there is no cost-utility for colorectal cancer screening in individuals of average risk younger than 50 years at a willingness-to-pay threshold of €39,760, given current estimates of incidence in this age cohort. \u0000Seven evidence-based guidelines identified recommend that colorectal cancer screening be initiated in individuals of average risk at age 45 years, whereas 1 guideline recommends against screening in individuals of average risk beginning at 45 years and 1 guideline recommends against screening beginning at age 40 years. Most evidence-based guidelines highlight the lack of empirical evidence describing clinical effectiveness and cost-effectiveness as limitations when developing recommendations. \u0000 \u0000What Does It Mean? \u0000 \u0000Empirical data describing the effectiveness of colorectal cancer screening in individuals of average risk younger than 50 years remain ","PeriodicalId":9437,"journal":{"name":"Canadian Journal of Health Technologies","volume":"108 20","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138958700","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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