Ontario health technology assessment series
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To review the evidence on the effectiveness of hydrophilic catheters for patients requiring intermittent catheterization. ⋯ Patients requiring intermittent catheterization use, on average, 4 to 5 intermittent catheters per day. Patients admitted to hospitals using intermittent catheters typically do not reuse catheters, owing to the potential increased risk of infection in hospital. Patients self-catheterizing at home are more likely to reuse catheters. Standard catheters cost about $1.00 to $1.50/catheter. Hydrophilic catheters cost about $2.00 to $5.00/catheter, depending on the type and whether they have antibiotics inside. All hydrophilic catheters are single-use. At this time there is insufficient evidence to indicate whether hydrophilic catheters are associated with a lower rate of UTIs and improved patient satisfaction among people requiring intermittent catheterization.
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Ont Health Technol Assess Ser · Jan 2006
Ultrasound screening for abdominal aortic aneurysm: an evidence-based analysis.
The aim of this review was to assess the effectiveness of ultrasound screening for asymptomatic abdominal aortic aneurysm (AAA). ⋯ Based on this review, the Medical Advisory Secretariat concluded that there is sufficient evidence to determine that AAA screening using ultrasound is effective and reduces negative health outcomes associated with the condition. Moreover, screening for AAA is cost-effective, comparing favorably for the cost of per life year gained for screening programs for cervical cancer, hypertension, and breast cancer that are in practice in Ontario, with a high degree of compliance, and can be undertaken with a minimal effort at fewer than 10 minutes to screen each patient. Overall, the clinical utility of an invitation to use ultrasound screening to identify AAA in men aged 65 to 74 is effective at reducing AAA-attributable mortality. The benefit of screening women is not yet established. However, Ontario data indicate several areas of concern including population prevalence, detection of AAA in women, and case management of AAA in women in terms of age cutoffs for screening and natural history of disease associated with age of rupture.
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To assess the effectiveness, safety and cost-effectiveness of extracorporeal photophoresis (ECP) for the treatment of refractory erythrodermic cutaneous T cell lymphoma (CTCL) and refractory chronic graft versus host disease (cGvHD). ⋯ The UVAR XTS Photopheresis System is licensed by Health Canada as a Class 3 medical device (license # 7703) for the "palliative treatment of skin manifestations of CTCL." It is not licensed for the treatment of cGvHD. UVADEX (sterile solution methoxsalen) is not licensed by Health Canada, but can be used in Canada via the Special Access Program. (Personal communication, Therakos, February 16, 2006) According to the manufacturer, the UVAR XTS photopheresis system licensed by Health Canada can also be used with oral methoxsalen. (Personal communication, Therakos, February 16, 2006) However, oral methoxsalen is associated with side effects, must be taken by the patient in advance of ECP, and has variable absorption in the gastrointestinal tract. (ABSTRACT TRUNCATED)
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Ont Health Technol Assess Ser · Jan 2006
Ablation for atrial fibrillation: an evidence-based analysis.
To review the effectiveness, safety, and costing of ablation methods to manage atrial fibrillation (AF). The ablation methods reviewed were catheter ablation and surgical ablation. ⋯ Catheter ablation appears to be an effective treatment for patients with drug-refractory AF whose treatment alternatives are limited. Ablation technology is continually evolving with increasing success rates associated with the ablation procedure.
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Ont Health Technol Assess Ser · Jan 2006
Gastric electrical stimulation: an evidence-based analysis.
The objective of this analysis was to assess the effectiveness, safety and cost-effectiveness of gastric electrical stimulation (GES) for the treatment of chronic, symptomatic refractory gastroparesis and morbid obesity. ⋯ "For use in weight reduction for obese adults with a body mass index greater than 35."The GES device that is licensed by Health Canada for treatment of GP, produces high-frequency GES. Most clinical studies examining GES for GP have used high-frequency (4 times the intrinsic slow wave frequency, i.e., 12 cycles per minute), low energy, short duration pulses. This type of stimulation does not alter gastric muscular contraction and has no effect on slow wave dysrhythmias. The mechanism of action is unclear but it is hypothesized that high-frequency GES may act on sensory fibers directed to the CNS. The GES device licensed by Health Canada for treatment of morbid obesity produces low-frequency GES, which is close to or just above the normal/native gastric slow wave cycle (approximately 3 cycles/min.). This pacing uses low-frequency, high-energy, long-duration pulses to induce propagated slow waves that replace the spontaneous ones. Low-frequency pacing does not invoke muscular contractions. Most studies examining the use of GES for the treatment of morbid obesity use low-frequency GES. Under normal circumstances, the gastric slow wave propagates distally and determines the frequency and propagation direction of gastric peristalsis. Low-frequency GES aims to produce abnormal gastric slow waves that can induce gastric dysrhythmia, disrupt regular propagation of slow waves, cause hypomotility of the stomach, delay gastric emptying, reduce food intake, prolong satiety, and produce weight loss. In the United States, the Enterra Therapy System is a Humanitarian Use Device (HUD), meaning it is a medical device designated by the FDA for use in the treatment of medical conditions that affect fewer than 4,000 individuals per year. The Enterra Therapy System is indicated for "the treatment of chronic, drug- refractory nausea and vomiting secondary to GP of diabetes or idiopathic etiology" (not postsurgical etiologies). GES for morbid obesity has not been approved by the FDA and is for investigational use only in the United States. (ABSTRACT TRUNCATED)