Health technology assessment : HTA
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Health Technol Assess · Oct 2010
ReviewIntensity-modulated radiotherapy for the treatment of prostate cancer: a systematic review and economic evaluation.
Prostate cancer (PC) is the most common cancer in men in the UK. Radiotherapy (RT) is a recognised treatment for PC and high-dose conformal radiotherapy (CRT) is the recommended standard of care for localised or locally advanced tumours. Intensity-modulated radiotherapy (IMRT) allows better dose distributions in RT. ⋯ The comparative data of IMRT versus 3DCRT seem to support the theory that higher doses, up to 81 Gy, can improve biochemical survival for patients with localised PC, concurring with data on CRT. The data also suggest that toxicity can be reduced by increasing conformality of treatment, particularly with regard to GI toxicity, which can be more easily achieved with IMRT than 3DCRT. Whether differences in GI toxicity between IMRT and 3DCRT are sufficient for IMRT to be cost-effective is uncertain, depending on the difference in incidence of GI toxicity, its duration and the cost difference between IMRT and 3DCRT.
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Health Technol Assess · Oct 2010
ReviewSystematic review of the links between human resource management practices and performance.
In recent years human resource management (HRM) has been seen as an important factor in the successful realisation of organisational change programmes. The UK NHS is undergoing substantial organisational change and there is a need to establish which human resource (HR) initiatives may be most effective. ⋯ Some potentially effective practices for both health and non-health areas were identified, and HRM methods could be used to support change processes within the NHS; the findings relating to work organisation are particularly promising with regard to changes in methods of service delivery. Using training to support the implementation of change is highlighted. However, future multilevel studies that embrace the individual, team and organisational level are needed. Studies should look into interventions aimed at improving HR outcomes and performance, and allow for pre- and post-intervention measurement of practices and outcomes.
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Health Technol Assess · Oct 2010
Evaluation of triage methods used to select patients with suspected pandemic influenza for hospital admission: cohort study.
Triage methods are necessary in emergency departments to provide clinicians with a reliable method for determining each patient's risk of adverse outcome. Prior to the 2009 H1N1 influenza pandemic the CURB-65 (a risk prediction score for pneumonia, based on confusion, urea level, respiratory rate, blood pressure and age over 65 years) pneumonia score and the Pandemic Modified Early Warning Score (PMEWS) were used to assess adults. In response to the emergence of the pandemic, national guidance produced a new swine flu hospital pathway for use adults and children. However, none of these methods had been widely validated or tested in the setting of pandemic influenza. ⋯ Potential concerns were raised about the use of existing triage methods for patients with suspected pandemic influenza, as these methods may fail to discriminate between patients who will have an adverse outcome and those with a benign course. Clinicians in the study did not generally appear to admit or discharge on the basis of these methods, despite their recommended use. Further research is required to evaluate existing triage methods and develop new triage tools for suspected pandemic influenza.
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Health Technol Assess · Oct 2010
Virus shedding and environmental deposition of novel A (H1N1) pandemic influenza virus: interim findings.
The relative importance of different routes of influenza transmission, including the role of bioaerosols, and ability of masks and/or hand hygiene to prevent transmission, remains poorly understood. Current evidence suggests that infectious virus is not typically released from adults after 5 days of illness, however, little is known about the extent to which virus is deposited by infected individuals into the environment and whether deposited virus has the ability to infect new hosts. Further information about the deposition of viable influenza virus in the immediate vicinity of patients with pandemic influenza is fundamental to our understanding of the routes and mechanisms of transmission. ⋯ The finding that over 30% of infected individuals have infectious virus in their noses for 5 days or more has infection control implications. The data suggest that contact transmission of pandemic influenza via fomites may be less important than previously thought, but transmission via bioaerosols at short range may be possible, meaning that high-level personal protective equipment may be needed by health-care workers when attending patients with pandemic influenza. Further work is being undertaken to consolidate these findings, as they have important potential implications for the protection of health-care workers and the formulation of advice to households, nationally and internationally.
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Health Technol Assess · Sep 2010
Randomized Controlled TrialA pragmatic randomised controlled trial to compare antidepressants with a community-based psychosocial intervention for the treatment of women with postnatal depression: the RESPOND trial.
To evaluate clinical effectiveness at 4 weeks of antidepressant therapy for mothers with postnatal depression (PND) compared with general supportive care; to compare outcome at 18 weeks of those randomised to antidepressant therapy with those randomised to listening visits as the first intervention (both groups were to be allowed to receive the alternative intervention after 4 weeks if the woman or her doctor so decided); and to assess acceptability of antidepressants and listening visits to users and health professionals. ⋯ At 4 weeks, antidepressants were significantly superior to general supportive care. Trial design meant that by 18 weeks many of the women initially randomised to listening visits were also receiving antidepressants, and more vice versa. The lack of evidence for differences at 18 weeks is likely to reflect a combination of reduced power and the considerable degree of switching across the two interventions. Qualitative study revealed that women found both antidepressants and listening visits effective depending on their circumstances and preferences. The trial indicates that early treatment with antidepressants leads to clinical benefit for women with PND.