Ontario health technology assessment series
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Ont Health Technol Assess Ser · Jan 2014
Review Meta AnalysisThe Determinants of Place of Death: An Evidence-Based Analysis.
According to a conceptual model described in this analysis, place of death is determined by an interplay of factors associated with the illness, the individual, and the environment. ⋯ The results obtained were consistent with previously published systematic reviews. The analysis identified several factors that are associated with place of death.
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Ont Health Technol Assess Ser · Jan 2014
ReviewArthroscopic Debridement of the Knee: An Evidence Update.
Patients with knee pain as a result of osteoarthritis or degenerative meniscal injury may seek treatment through arthroscopic surgery. How effective arthroscopic debridement with or without meniscectomy is for relieving pain and improving patients' functional outcomes is uncertain. ⋯ The evidence does not show the superiority of arthroscopic debridement with or without meniscectomy in patients with osteoarthritis of the knee or with meniscal injury from degenerative causes.
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Ont Health Technol Assess Ser · Jan 2014
ReviewArthroscopic Debridement of the Knee: An Evidence Update.
Patients with knee pain as a result of osteoarthritis or degenerative meniscal injury may seek treatment through arthroscopic surgery. How effective arthroscopic debridement with or without meniscectomy is for relieving pain and improving patients' functional outcomes is uncertain. ⋯ The evidence does not show the superiority of arthroscopic debridement with or without meniscectomy in patients with osteoarthritis of the knee or with meniscal injury from degenerative causes.
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Ont Health Technol Assess Ser · Jan 2014
ReviewEnd-of-Life Care Interventions: An Economic Analysis.
The annual cost of providing care for patients in their last year of life is estimated to account for approximately 9% of the Ontario health care budget. Access to integrated, comprehensive support and pain/symptom management appears to be inadequate and inequitable. ⋯ In-home palliative team care was cost-effective, but firm conclusions about the cost-effectiveness of other interventions were not possible.
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Ont Health Technol Assess Ser · Jan 2013
Review Meta AnalysisElectrical stimulation for drug-resistant epilepsy: an evidence-based analysis.
The objective of this analysis was to evaluate the effectiveness of deep brain stimulation (DBS) and vagus nerve stimulation (VNS) for the treatment of drug-resistant epilepsy in adults and children. ⋯ Electrical stimulation of specific areas of the brain is a procedure used to control epileptic seizures when more conventional treatments are not working. Most adults and children with epilepsy are able to control their seizures with medication, but for some patients, drugs are not effective and surgery to remove the part of the brain where the seizures start is not an appropriate option. This study looked at the research available on the effectiveness, safety, and cost of two types of electrical stimulation devices currently licensed for treatment of epilepsy for adults and children in Canada: vagus nerve stimulation (VNS) and deep brain stimulation (DBS). Both approaches appear to be effective at reducing the frequency of seizures in adults. However, the evidence on DBS is limited to a single study with adults; we found no studies of DBS with children. Studies on VNS showed that both adults and children had fewer hospitalizations and emergency department visits after the procedure. Both procedures carry serious risks, but several longer-term studies have found that adverse events appear to be limited. The cost of VNS, including the process of assessing whether or not patients are good candidates for the procedure, is estimated to be about $40,000 per person (and higher for DBS because the device is more expensive and the operating time is longer). Of the 70,000 people in Ontario with epilepsy, about 1,400 (300 children and 1,110 adults) may be candidates for VNS to reduce their seizures.