Ontario health technology assessment series
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Ont Health Technol Assess Ser · Jan 2006
Midurethral slings for women with stress urinary incontinence: an evidence-based analysis.
The objective of the current review was to evaluate the safety, efficacy, and cost-effectiveness of midurethral slings compared with traditional surgery. ⋯ Quality of life was not consistently reported in all of the randomized controlled trials. In the studies that reported quality of life there does not appear to be a significant difference in quality of life scores between the sling procedures.
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Ont Health Technol Assess Ser · Jan 2006
Optimum methadone compliance testing: an evidence-based analysis.
The objective of this analysis was to determine the diagnostic utility of oral fluid testing collected with the Intercept oral fluid collection device. ⋯ A total of 854 potential citations were retrieved. After reviewing titles and abstracts, 2 met the inclusion and exclusion criteria. Two other relevant studies were found after corresponding with the author of the 2 studies retrieved from the literature search. Therefore a total of 4 published studies are included in this analysis. All 4 studies carried out by the same investigator meet the definition of Medical Advisory Secretariat level III (not a-randomized controlled trial with contemporaneous controls) study design. In each of the studies, paired urine and oral fluid specimens where obtained from drug users. Urine collection was not observed in the studies however, laboratory tests for pH and creatinine were used to determine the reliability of the specimen. Urine specimens thought to be diluted and unreliable were removed from the evaluation. Urinalysis was used as the criterion measurement for which to determine the sensitivity and specificity of oral fluid testing by the Intercept oral fluid device for opiates, benzodiazepines, cocaine and marijuana. Alcohol was not tested in any of the 4 studies. From these 4 studies, the following conclusions were drawn: The evidence indicates that oral fluid testing with the Intercept oral fluid device has better specificity than sensitivity for opiates, benzodiazepines, cocaine and marijuana.THE SENSITIVITY OF ORAL FLUIDS TESTING WITH THE INTERCEPT ORAL FLUID DEVICE SEEMS TO BE FROM BEST TO WORST: cocaine > benzodiazepines >opiates> marijuana.The sensitivity and specificity for opiates of the Intercept oral fluid device ranges from 75 to 90% and 97- 100% respectively.The consequences of opiate false-negatives by oral fluid testing with the Intercept oral fluid device need to be weighed against the disadvantages of urine testing, including invasion of privacy issues and adulteration and substitution of the urine specimen.The window of detection is narrower for oral fluid drug testing than urinalysis and because of this oral fluid testing may best be applied in situations where there is suspected frequent drug use. When drug use is thought to be less frequent or remote, urinalysis may offer a wider (24-48 hours more than oral fluids) window of detection.The narrow window of detection for oral fluid testing may mean more frequent testing is needed compared to urinalysis. This may increase the expense for drug testing in general.POC oral fluid testing is not yet available and may limit the practical utility of this drug testing methodology. POC urinalysis by immunoassay is available.The possible applications of oral fluid testing may include:Because of its narrow window of detection compared to urinalysis oral fluid testing may best be used during periods of suspected frequent or recent drug use (within 24 hours of drug testing). This is not to say that oral fluid testing is superior to urinalysis during these time periods.In situations where an observed urine specimen is difficult to obtain. This may include persons with "shy bladder syndrome" or with other urinary conditions limiting their ability to provide an observed urine specimen.When the health of the patient would make urine testing unreliable (e,g., renal disease)As an alternative drug testing method when urine specimen tampering practices are suspected to be affecting the reliability of the urinalysis test.Possible limiting Factors to Diffusion of Oral Fluid Technology No oral fluid POC test equivalent to onsite urine dips or POC analyzer reducing immediacy of results for patient care.Currently, physicians get reimbursed directly for POC urinalysis. (ABSTRACT TRUNCATED)
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Ont Health Technol Assess Ser · Jan 2006
Utilization of DXA Bone Mineral Densitometry in Ontario: An Evidence-Based Analysis.
Systematic reviews and analyses of administrative data were performed to determine the appropriate use of bone mineral density (BMD) assessments using dual energy x-ray absorptiometry (DXA), and the associated trends in wrist and hip fractures in Ontario. ⋯ A review of 3 published pooled analyses of observational studies and 12 prospective population-based observational studies showed that the presence of any prevalent fracture increases the relative risk for future fractures by approximately 2-fold or more. (ABSTRACT TRUNCATED)
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Ont Health Technol Assess Ser · Jan 2006
Routine eye examinations for persons 20-64 years of age: an evidence-based analysis.
The objective of this analysis was to determine the strength of association between age, gender, ethnicity, family history of disease and refractive error and the risk of developing glaucoma or ARM? ⋯ The total cost of a major eye examination by a physician is $42. (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.