Issues in emerging health technologies
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(1) The NeuRx DPS is a laparoscopically implanted device that provides ventilatory support. (2) This device stimulates the diaphragm muscle, rather than the phrenic nerve, and is intended to lead to less risk of nerve damage than other therapies.(3) This technology provides an alternative to mechanical ventilation, and allows patients to increase day-to-day freedom and minimize the risk of respiratory infection. (4) The NeuRx DPS safety profile is based on clinical testing, which began with clinical trials starting in 2000. It has the potential to reduce costs, but this has not been well established.
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(1) Milnacipran is an antidepressant that is under investigation for the treatment of fibromyalgia (a chronic pain disorder). (2) Preliminary evidence suggests that milnacipran may benefit some patients with fibromyalgia, but adverse effects may limit its use. (3) Complete results of phase 3 trials have not yet been published. Further studies are needed to evaluate the safety and efficacy of milnacipran, determine optimal dosing, confirm if beneficial effects are sustained, and clarify the drug's role relative to, and in conjunction with, other treatments for fibromyalgia.
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(1) Febuxostat is a selective inhibitor of xanthine oxidase. Its use in the management of hyperuricemia and gout is being studied. (2) In a 52-week, phase III randomized clinical trial, febuxostat was superior to allopurinol for lowering uric acid levels. Its efficacy in preventing gout attacks was similar to that of allopurinol. Despite a similar rate of adverse effects, individuals on febuxostat were more likely to stop treatment than those on allopurinol. (3) The most commonly observed adverse effects with febuxostat include liver function test abnormalities, diarrhea, headache, nausea, vomiting, abdominal pain, and dizziness. (4) Given that renal dysfunction is a risk factor for hyperuricemia and gout, the safety and efficacy of febuxostat in this population should be considered, but only limited data are available. (5) The diffusion of febuxostat may be limited by its price relative to that of allopurinol, regardless of whether febuxostat proves to have advantages in specific populations.
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Issues Emerg Health Technol · Aug 2006
Comparative StudyBpTRU(tm) blood pressure monitor for use in a physician's office.
The BpTRU(tm) is an automated device that takes serial blood pressure (BP) measurements in a physician's office. (1) Preliminary data from non-randomized, uncontrolled trials suggest that the average of five BpTRU measurements, taken while the patient is alone, more reliably reflects "resting" BP compared to manual measurements taken with a stethoscope and sphygmomanometer. (2) BpTRU helps reduce the overestimation of BP due to improper measurement technique, or due to a patient's anxiety in a physician's presence ("white coat" effect). (3) The BpTRU device can improve hypertension management by replacing conventional manual BP measurements, which are often poorly performed and inaccurate. (4) BpTRU is more expensive than the manual manometers used in a physician's office. The serial measurement, taken in a private examining room, requires an average of six to 12 minutes, which could increase the duration of a patient's visit.
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(1) Chronic lumbar (lower back) pain, which affects many Canadians, imposes a large economic burden. (2) Symptoms may occur in the vertebral facet joints of 15% to 40% of patients with lower back pain. (3) Medial branch radiofrequency neurotomy is a minimally invasive outpatient procedure that reduces pain by interrupting the nerve supply to painful facet joints. (4) Four systematic reviews of this procedure offer disparate conclusions. (5) One small well designed observational study has shown positive results, but no equally rigorous randomized controlled trial has been conducted.