Health technology assessment最新文献

{"title":"Gait Rehabilitation for Early rheumatoid Arthritis Trial (GREAT): lessons learnt from a mixed-methods feasibility study and internal pilot trial.","authors":"Gordon J Hendry, Lindsay Bearne, Linda Fenocchi, Nadine E Foster, Sally Gates, Emma Godfrey, Samantha Hider, Lisa Jolly, Helen Mason, Alex McConnachie, Iain McInnes, Aimie Patience, Yeliz Prior, Catherine Sackley, Mandeep Sekhon, Bethany Stanley, Jason Vickers, Jim Woodburn, Martijn Pm Steultjens","doi":"10.3310/XBDJ8546","DOIUrl":"10.3310/XBDJ8546","url":null,"abstract":"<p><strong>Background: </strong>People with rheumatoid arthritis experience foot and lower limb pain due to active synovitis, resulting in impaired lower limb function. Earlier intervention may help with prevention of functional decline. The aims of this research were to develop and evaluate a new gait rehabilitation intervention for people with early rheumatoid arthritis, evaluate its feasibility, and to test whether or not gait rehabilitation plus usual care is more clinically and cost-effective than usual care alone.</p><p><strong>Design and methods: </strong>We undertook a single-arm, repeated-measures, pre- and post-intervention, mixed-methods feasibility study with embedded qualitative components. We planned to undertake a pragmatic, two-arm, multicentre, superiority randomised controlled trial, with health economic evaluation, process evaluation and internal pilot.</p><p><strong>Setting and participants: </strong>Participants with early rheumatoid arthritis (< 2 years post diagnosis) were identified from early arthritis and rheumatology outpatient clinics and referred for intervention in either podiatry or physiotherapy clinics.</p><p><strong>Intervention(s): </strong>Participants were randomised to a gait rehabilitation programme (Gait Rehabilitation Early Arthritis Trial Strides) involving a six-task gait circuit. Sessions were underpinned by motivational interviewing to facilitate behaviour change, supported by trained physiotherapists or podiatrists for a minimum of two sessions. Both groups received their normal usual care from the rheumatology multidisciplinary team.</p><p><strong>Main outcome measures: </strong>Outcome measures for the feasibility study were intervention acceptability, adherence using the Exercise Adherence Rating Scale and fidelity using the Motivational Interviewing Treatment Integrity Scale. The main outcome measure for the internal pilot/randomised controlled trial was the Foot Function Index disability subscale. Outcomes were measured at baseline, 3 months, 6 months and 12 months. Other outcomes: intervention acceptability questionnaire, Exercise Adherence Rating Scale, exercise treatment beliefs via the Theory of Planned Behaviour Questionnaire, intervention fidelity (Motivational Interviewing Treatment Integrity Scale), health-related quality of life (EuroQol-5 Dimensions, five-level score).</p><p><strong>Results: </strong>Thirty-five participants were recruited for feasibility and 23 (65.7%) completed 12-week follow-up. Intervention acceptability was excellent: 21/23 were confident that it could help and would recommend it and 22/23 indicated it made sense to them. Adherence was good, with a median (interquartile range) Exercise Adherence Rating Scale score of 17/24 (12.5-22.5). Twelve participants' and nine therapists' interviews confirmed intervention acceptability, identified perceptions of benefit, but highlighted some barriers to completion. Motivational Interviewing Treatment Integrity Scale scores dem","PeriodicalId":12898,"journal":{"name":"Health technology assessment","volume":" ","pages":"255-302"},"PeriodicalIF":3.4,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11973904/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143752298","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The quantity, quality and findings of network meta-analyses evaluating the effectiveness of GLP-1 RAs for weight loss: a scoping review.","authors":"Michael Nunns, Samantha Febrey, Jill Buckland, Rebecca Abbott, Rebecca Whear, Alison Bethel, Kate Boddy, Liz Shaw, Jo Thompson Coon, G J Melendez-Torres","doi":"10.3310/SKHT8119","DOIUrl":"10.3310/SKHT8119","url":null,"abstract":"<p><strong>Background: </strong>Glucagon-like peptide 1 receptor agonists are a class of drug originally developed to treat type 2 diabetes but now increasingly used for weight loss, especially in people living with obesity. Despite an abundance of evidence about the effectiveness and safety of glucagon-like peptide 1 receptor agonists for weight loss, network meta-analyses are inconsistent in their quality and scope, and this is a fast-moving field.</p><p><strong>Objectives: </strong>We sought to identify the most recent network meta-analyses evaluating the effectiveness of glucagon-like peptide 1 receptor agonists for weight loss; critically appraise included network meta-analyses; provide an overview of the quality and findings of existing network meta-analyses, and identify any pertinent gaps in the evidence; and consider the value of updating the most recent, comprehensive and high-quality network meta-analyses.</p><p><strong>Methods: </strong>On 6 June 2023, we searched MEDLINE, EMBASE, the Cochrane Database of Systematic Reviews and Epistemonikos for systematic reviews with network meta-analyses published since 2020 in adults (18 or above) with body mass index ≥ 25 (or ≥ 23 for Asian populations), including at least one relevant glucagon-like peptide 1 receptor agonist and weight loss outcomes. We screened and selected reviews in duplicate and independently, and appraised reviews using a modified A MeaSurement Tool to Assess systematic Reviews 2 (AMSTAR-2) and a network meta-analysis reliability checklist. The highest-quality reviews were then extracted in depth, and the most relevant network meta-analysis models identified, focusing on weight loss and safety outcomes. A top-up search for trials published since October 2022 was also undertaken to identify relevant trials not included in published network meta-analyses. A further search for new network meta-analyses was conducted on 26 September 2024.</p><p><strong>Results: </strong>Of 22 systematic reviews identified, 14 were prioritised for analysis as the remaining 8 reviews were rated as low or critically low quality. We focused on network meta-analyses of weight loss outcomes measured at 6 months, 12 months, longer than 12 months or over a mix of time points. At 6 months, subcutaneous tirzepatide was the most effective drug associated with 9 kg (at 5 mg) to 12 kg (at 15 mg) of weight loss. However, the largest effects were seen for subcutaneous semaglutide 2.4 mg, which was associated with between 11.5 and 12.5 kg of weight loss, though this came from two network meta-analyses, both informed by six trials, and both merging findings across multiple time points. The relative effectiveness among glucagon-like peptide 1 receptor agonists followed a pattern suggested by their performance against placebo, with tirzepatide and semaglutide standing out as the most effective drugs for weight loss. No network meta-analyses compared tirzepatide and semaglutide 2.4 mg. The drugs associated with th","PeriodicalId":12898,"journal":{"name":"Health technology assessment","volume":" ","pages":"429-502"},"PeriodicalIF":3.4,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12336958/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144527680","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Rapid diagnostic tests to inform clinical decision-making for antifungal stewardship in the ICU: a qualitative study with NHS staff, patients, and their legal representatives.","authors":"Chikomborero Cynthia Mutepfa, Jana Suklan, Jennifer Bell, Mary Guiney, William Jones, John Simpson, Ronan McMullan","doi":"10.3310/GJRM3321","DOIUrl":"10.3310/GJRM3321","url":null,"abstract":"<p><strong>Background: </strong>Invasive candidiasis is a fungal infection of the blood or organs that is associated with high morbidity and mortality in critically ill patients. Current diagnosis is based on blood culture, which typically takes 2 days to confirm the presence of <i>Candida</i>, and longer for differentiating the species and sensitivities to antifungal drugs. Administration of antifungal treatment is time-critical, hence critically ill patients considered 'at-risk' of <i>Candida</i> infection are often started on antifungal treatment pending test results. However, many of these patients may not have empirical treatment stopped when test results become available because of concerns about the sensitivity of blood culture. The Antifungal STewardship Opportunities study is a multisite national diagnostic test accuracy study investigating the use of rapid tests in the intensive care unit that have the potential to influence decision-making.</p><p><strong>Objective(s), study design, settings and participants: </strong>Our aim is to understand patient and physician risk preferences for using the Antifungal STewardship Opportunities testing strategy to discontinue empirical antifungal therapy using semi-structured interviews. An a priori sample size of 30 National Health Service staff and 10 patient interviews was selected to elicit information relating to the aims. Interview schedules were developed, and all interviews were conducted via video or teleconferencing between December 2021 and December 2022 and lasted between 10 and 60 minutes. Interviews were recorded, transcribed and subjected to thematic analysis.</p><p><strong>Findings: </strong>Semi-structured interviews were conducted with 21 National Health Service clinicians and seven patients and legal representatives. National Health Service staff were risk-averse to stopping empirical antifungal therapy, especially if the patient was improving, while patients were risk-neutral. Although there is a clear unmet need for new rapid testing strategy, clinical confidence in its accuracy, clinical utility, cost-effectiveness and usability were strong factors for its consideration for use in decision-making and adoption. Patients did not exhibit strong feelings towards stopping empirical antifungal treatment as they expressed reliance on clinical judgement.</p><p><strong>Limitations: </strong>There was a potential for selection bias as interview participants being from participating sites. The target recruitment numbers of patients and their legal representatives was not achieved due to low retention rates.</p><p><strong>Conclusions: </strong>If found to have high accuracy and cost-effectiveness, the potential of the Antifungal STewardship Opportunities diagnostic strategy to aid decision-making on antifungal prescribing could change intensive care unit clinicians practice, as they are risk-averse to stopping empirical antifungal treatment. However, consideration of the resources needed in","PeriodicalId":12898,"journal":{"name":"Health technology assessment","volume":" ","pages":"577-596"},"PeriodicalIF":3.4,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12683465/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145280089","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Removal of small fibroids and polyps in patients with infertility and recurrent miscarriage: The HELP Fertility? RCT.","authors":"Mostafa Metwally, Kirsty McKendrick, Katie Ridsdale, Clare Pye, Stephen Walters, Saad Amer, Amy Barr, Robin Chatters, Ying Cheong, Meenakshi Choudhary, Mary Connor, Lauren Desoysa, Tarek El-Toukhy, Anju Keetharuth, Nick Latimer, Amanda Loban, Lamiya Mohiyiddeen, Mohamed Mostafa, Clair Scaife, Tony Stone, Liz Taylor, Chris Turtle, David White","doi":"10.3310/GJMM1915","DOIUrl":"10.3310/GJMM1915","url":null,"abstract":"<p><strong>Background: </strong>Infertility affects one in six of females globally, with uterine submucous fibroids and endometrial polyps being common findings. The effectiveness of surgical removal to improve fertility remains uncertain. The associated surgical risks and costs highlight the need for more robust research in this area. The HELP Fertility? Study aimed to assess the clinical and cost-effectiveness of hysteroscopic removal of endometrial polyps and submucosal fibroids, compared to no removal, in improving fertility outcomes for participants with infertility or recurrent miscarriage while also evaluating participant experience and longer-term effects. The trial was designed as a multicentre, pragmatic superiority randomised controlled trial with two concurrent trials; one for endometrial polyps and one for submucosal fibroids, with a 9-month feasibility pilot. Participants were randomly assigned 1 : 1 to either receive hysteroscopic resection or no resection. The primary outcome was live birth rate at 15 months. Secondary outcomes included pregnancy rates, procedure details, patient satisfaction and resource use.</p><p><strong>Results: </strong>COVID-19 resulted in significant recruitment challenges, with delays in site set-up and participant enrolment due to pandemic-related healthcare disruptions. The trial was closed early by the National Institute for Health and Care Research-Health Technology Assessment programme following recruitment of 35 participants (19 hysteroscopic resection and 16 no resection) out of a target of 1120. The clinical and cost-effectiveness analyses were severely limited by the small sample size. Clinical pregnancy rates within 15 months of randomisation were 26.5% (5/19) in the hysteroscopic resection group and were 37.5% (6/16) in the no resection group. The live birth rate within 15 months of randomisation (the primary outcome) were 15.8% (3/19) in the hysteroscopic resection group and 18.8% (3/16) in the no resection group: a risk difference of -3.0% (95% confidence intervals -31.1% to 24.2%). No serious adverse events were observed in the follow-up. At the mean, hysteroscopic resection resulted in fewer live births, but increased costs, implying that resection is not cost-effective compared to no resection. However, results were highly uncertain and confidence intervals for incremental costs and the incremental live birth rate spanned zero. At a cost-effectiveness threshold of £20,000 per additional live birth, there is a 10% probability that hysteroscopic resection represents a cost-effective intervention and a 90% probability that no resection is cost-effective. There is a 56% probability that resection is more costly and less effective than no resection. Despite implementing remote training, centralised support and opening 16 National Health Service sites by February 2023, insufficient participants were recruited within planned time frames. The study was ultimately closed as part of the NIHR Research","PeriodicalId":12898,"journal":{"name":"Health technology assessment","volume":" ","pages":"85-120"},"PeriodicalIF":3.4,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12968972/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147344006","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prophylactic antibiotics to prevent chest infections in children with neurological impairment: the PARROT RCT.","authors":"Paul S McNamara, Ashley Paul Jones, Anne Chang, Kieran Crabtree, Kylie Crompton, Sepideh Dehghani, Helen Eccleson, Jo Fothergill, Jonathan Grigg, Paul Gringras, Adrienne Harvey, Michelle Heys, Dyfrig Arwyn Hughes, Gabrielle McCallum, Kim McLennan, Christopher Morris, Amy Nuttall, Jeremy Parr, Yankier Pijeira Perez, Dinah Reddihough, Malcolm Gracie Semple, Hayley Smallman, Mandy Wan, Katrina Williams","doi":"10.3310/GJPM1930","DOIUrl":"10.3310/GJPM1930","url":null,"abstract":"<p><strong>Background: </strong>Improvements in neonatal and paediatric care in recent decades have increased the survival of children with non-progressive neurological impairment. Respiratory disease in children with neurological impairment is common, with symptoms difficult to manage and lower respiratory tract infection occurring frequently. To reduce these, prophylactic antibiotics are being increasingly used, but the type, duration and dose of antibiotics can vary considerably, and there is limited evidence about their effectiveness in children and young people. A joint United Kingdom and Australia multicentre, randomised, double-blind, placebo-controlled trial comparing 52 weeks of azithromycin to placebo in children and young people with neurological impairment at risk of lower respiratory tract infection (PARROT) was planned to address this gap. PARROT was a multicentre, parallel group, blinded, pragmatic randomised controlled trial of 52-week duration with a planned sample size of 500 (250 in each arm) participants with neurological impairment. The primary outcome was the proportion of children and young people hospitalised with lower respiratory tract infection over the 52-week period.</p><p><strong>Results: </strong>In total, 90 children and young people (62 in Australia, 28 in the United Kingdom) aged 3-17 years, with a diagnosed non-progressive, non-neuromuscular neurological impairment, who had persistent respiratory symptoms were randomised (1 : 1) to receive azithromycin or placebo. Baseline demographic and clinical characteristics were relatively well balanced across the two treatment groups and countries. Overall, mean (standard deviation) age was 9.2 (4.4) years, with 64% of participants having cerebral palsy, 67% being non-ambulant and 54% being totally tube-fed. At baseline, mean (standard deviation) numbers of hospital admissions with lower respiratory tract infection in the preceding year were 1.8 (2.0)/year, and general practitioner attendances 3.3 (3.0)/year. The PARROT trial was closed early to recruitment due to challenges arising from the COVID-19 pandemic. Sixty-five (72%) participants (azithromycin <i>n</i> = 30, placebo <i>n</i> = 35) completed 52 weeks of treatment and were not withdrawn early from the trial. Regarding the primary outcome, 11 (36.7%) in the azithromycin group were hospitalised with lower respiratory tract infection and 9 (25.7%) in the placebo group [absolute risk reduction 0.11 (95% confidence interval -0.12 to 0.33), relative risk 1.43 (95% confidence interval 0.68 to 2.97)]. Analysis of secondary outcome data was limited by the number of missing data, but parent-reported quality of life for young person and parent, sleep amount/quality for young person and parent, and respiratory symptoms were similar between groups and countries.</p><p><strong>Limitations: </strong>As PARROT was stopped early and was consequently underpowered, it is not possible to say whether azithromycin prophylaxis is any mo","PeriodicalId":12898,"journal":{"name":"Health technology assessment","volume":" ","pages":"597-616"},"PeriodicalIF":3.4,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12989902/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147377175","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Surgery versus non-surgical splint treatment for proximal phalanx shaft finger fractures in adults: the POINT Randomised Controlled Trial.","authors":"Alexia Karantana, Jennifer White, Lucy Bradshaw, Tim R Davis, Maureen Godfrey, Marilyn James, Hugh Jarrett, Christina Jerosch-Herold, Reuben Ogollah, Cristina Roadevin, Jeremy Rodrigues, Kirsty Sprange, Ryan W Trickett, Matthew L Costa, Alan Montgomery","doi":"10.3310/GJAK6715","DOIUrl":"10.3310/GJAK6715","url":null,"abstract":"<p><strong>Background: </strong>Proximal phalanx finger shaft fractures are common and can impair hand function. There is controversy, but no high-quality evidence, on how they are best treated. We compared the clinical and cost-effectiveness of surgery versus non-surgical splint treatment.</p><p><strong>Objective: </strong>The primary objective was to compare hand function following surgical fixation with hand function following non-surgical splint treatment using the Hand Health Profile of the Patient Evaluation Measure at 6 months post randomisation.</p><p><strong>Design: </strong>Pragmatic multicentre, parallel superiority randomised (1 : 1) trial.</p><p><strong>Setting: </strong>Twenty-four acute hospitals in the United Kingdom National Health Service.</p><p><strong>Participants: </strong>Patients ≥ 16 years with one or more proximal phalanx shaft fracture(s), which can be treated via either surgery or non-surgical splint treatment. Patients with intra-articular, base-metaphyseal, neck, open proximal phalanx fractures, injury ≥ 14 days or unable to adhere to trial procedures/complete questionnaires were excluded.</p><p><strong>Interventions: </strong>Surgery was any mode of surgical fixation that was considered as appropriate by the treating specialist. Non-surgical splint treatment consisted of any technique/material used in routine care, which may involve manipulation of the fracture with analgesia or local anaesthetic, and subsequent bracing through an externally applied support, usually performed in a clinic or therapy room environment.</p><p><strong>Main outcome measures: </strong>The primary outcome measure was the Hand Health Profile of the Patient Evaluation Measure (possible range 11-77, higher scores indicate worst function). Measurements were collected at 6 weeks, 3, 6 and 12 months; 6 months was the primary outcome time point. The primary health outcome for economic evaluation was quality-adjusted life-years in accordance with National Institute for Health and Care Excellence guidelines.</p><p><strong>Results: </strong>Between 9 November 2020 and 2 February 2023, 113 participants were randomised to surgery (<i>n</i> = 56) or non-surgical treatment (<i>n</i> = 55); 2 were excluded. Participants were 60% male, with mean age of 38 years. Treatment arms were balanced. Fifty-three participants in the surgical and 46 in the non-surgical group were included in the primary analysis. At 6 months, the mean Patient Evaluation Measure was 27.1 (standard deviation = 13.6, <i>n</i> = 48) in the surgical group and 25 (standard deviation 12.4, <i>n</i> = 41) in the non-surgical group, with no clinically important difference between groups (adjusted difference in means for surgery vs. non-surgical groups 3, 95% confidence interval -1.6 to 7.7). There were no differences at 6 weeks and 3 months. There were more complications in the surgery group. Surgery was more expensive, resulting in an incremental cost-effectiveness ratio of £39,686 per qualit","PeriodicalId":12898,"journal":{"name":"Health technology assessment","volume":" ","pages":"43-84"},"PeriodicalIF":3.4,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12994879/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147377268","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A network approach to addressing the needs of patients with incurable head and neck cancer and their families.","authors":"Joanne M Patterson, Catriona R Mayland, Peter Bath, Michelle Lawton, Valerie Bryant, David Hamilton, Madina Hasan, Tony Stone, Richard Campbell, Annabel Crum, Linda Sharp","doi":"10.3310/TKLD6486","DOIUrl":"10.3310/TKLD6486","url":null,"abstract":"<p><strong>Background: </strong>Patients with incurable head and neck cancer have considerable unmet needs and complex symptom burden, with evidence of substantial geographical and/or socioeconomic inequalities. Accurate information on healthcare needs, resource utilisation and service provision in the last year of life is lacking. This places limits on service delivery planning and the development and testing of interventions to better meet needs. Our partnership spans three regions, which nationally have some of the highest rates of incurable head and neck cancer.</p><p><strong>Aims: </strong>The overall aims were to (1) establish a palliative head and neck cancer partnership, (2) identify and evaluate routine incurable head and neck cancer data sources and utilise these to develop and address research priorities.</p><p><strong>Objectives: </strong>O1. Develop a palliative head and neck cancer network within the North of England, representing a geographical area with high incidence of incurable head and neck cancer and palliative care needs. O2. Develop and refine research questions and priorities. O3. Engage with data providers to identify relevant data sets and specific data fields to understand the potential quality and utility of these to inform research priorities.</p><p><strong>Methods: </strong>There were three interconnected work packages: WP1: A 'snowballing' approach to establish a network of clinicians, researchers, patient and public representatives, data architects and key stakeholders with an interest in head and neck cancer palliative care. WP2: A Delphi consensus process to develop and refine research questions and priorities, based on national guidance and systematic reviews of evidence gaps. WP3: Identification of national and local data sets and exploration of the potential data quality and utility, and associated information governance processes for access.</p><p><strong>Results: </strong>WP1: A diverse network was established, encompassing members from a wide range of professions and patient/carer groups. WP2: The Delphi consisted of two rounds involving up to 66 participants. Consensus was reached on 12 research questions representing 4 key areas of prioritisation: service provision, symptom management, psychosocial support and information provision and communication. WP3: A range of national and local data sources were identified as having the potential to address the research priorities. A directory of data sources was developed. Working in an iterative way, data sets and relevant data fields were mapped to the 12 potential research priority areas to assess the applicability of using routine data to address these priorities.</p><p><strong>Limitations: </strong>Approximately, one-third of participants in the Delphi process dropped out in round 2. Despite attempts to be flexible in our approach, retaining participants, particularly for patients and their families on a palliative care pathway, is challenging.</p><p><strong>","PeriodicalId":12898,"journal":{"name":"Health technology assessment","volume":" ","pages":"655-684"},"PeriodicalIF":3.4,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12067161/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144008744","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effectiveness and cost-effectiveness of targeted and population screening for osteoporosis in women: scoping review.","authors":"Kieran Becker, Morgan Weiland, Samantha Febrey, Michael Nunns, Jill Buckland, Rebecca Abbott, Rebecca Whear, Alison Bethel, Elizabeth Shaw, Kate Boddy, G J Melendez-Torres, Joanna Thompson Coon","doi":"10.3310/GJJT0804","DOIUrl":"10.3310/GJJT0804","url":null,"abstract":"<p><strong>Background: </strong>Osteoporosis is a systemic skeletal disorder characterised by bone tissue deterioration, leading to reduced bone density and increased susceptibility to fractures. Osteoporosis screening is the process of identifying people with an increased risk of osteoporosis by using risk assessment tools or medical imaging. The National Institute for Health and Care Excellence recommends opportunistic risk assessment in women over 65 years or under 65 years with risk factors, though this guideline was last updated in 2017. Regular surveillance of the available evidence is warranted to gauge the volume and type of evidence published on key issues relating to population-based and targeted screening for osteoporosis.</p><p><strong>Objectives: </strong>To identify and review the volume and type of evidence on effectiveness and cost-effectiveness of population-based and targeted osteoporosis screening in women and to explore the consideration of health equity in the evidence base.</p><p><strong>Design and methods: </strong>Two information specialists developed the search strategy in MEDLINE (via Ovid) and translated it to 10 other databases. The title and abstract then full text of each record were screened by two independent reviewers. Disagreements were resolved through discussion. Records found through supplementary searches were single-screened as were reference lists of relevant guidelines identified. One reviewer completed data extraction of included studies, with a second reviewer checking the accuracy.</p><p><strong>Setting and participants: </strong>Included studies were required to be experimental designs, systematic reviews or cost-effectiveness studies with a standard care comparator. Populations of interest were women over 65 years and women below 65 years with osteoporosis risk factors.</p><p><strong>Interventions: </strong>Any population or targeted screening intervention involving any combination of risk assessment and dual energy X-ray absorptiometry scan designed to identify women with, or at risk for, osteoporosis.</p><p><strong>Main outcome measures: </strong>Outcomes related to osteoporosis prevention (osteoporotic fractures, all-cause fractures and mortality), possible screening harms and cost-effectiveness.</p><p><strong>Data sources: </strong>Searches were conducted in 11 databases and were supplemented by forward and backward citation searching.</p><p><strong>Review methods: </strong>Study characteristics and equity considerations were tabulated and narratively described.</p><p><strong>Results: </strong>The 19 included studies consisted of 3 randomised controlled trials with 9 sibling papers, 1 non-concurrent cohort study and 6 reviews. The primary studies generally included women 65 years old and older, with interventions involving several risk assessment and screening methods. Most reviews investigated the general population and included either bone mineral density measurement or clinical risk assessment ","PeriodicalId":12898,"journal":{"name":"Health technology assessment","volume":" ","pages":"269-296"},"PeriodicalIF":3.4,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13051324/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147581303","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Implementation of eye screening programmes for patients with diabetes: a systematic map of evidence from five countries.","authors":"Alison O'Mara-Eves, Silvy Mathew, Rachael C Edwards, Katy Sutcliffe, Claire Stansfield, Hossein Dehdarirad, Sara-Jane McAteer, Sarah Markham, Dylan Kneale","doi":"10.3310/GJAO0707","DOIUrl":"10.3310/GJAO0707","url":null,"abstract":"<p><strong>Background: </strong>Diabetic retinopathy is a severe diabetes complication that can cause blindness. The United Kingdom's pioneering diabetic eye screening programme has decreased blindness by early detection and treatment. Enhancing diabetic eye screening uptake requires a deeper understanding of the programme implementation.</p><p><strong>Objectives: </strong>This study aimed to develop a logic model depicting diabetic eye screening programme implementation and to systematically map evidence on the implementation of diabetic eye screening in the United Kingdom and countries with similar health systems: Australia, Canada, Ireland and New Zealand.</p><p><strong>Methods: </strong>A logic model was coproduced with UK National Screening Committee members and public coproducers with living experience of diabetic eye screening, informed by existing models and group knowledge. We searched 14 discipline-focused bibliographic databases, 3 academic search engines (Google Scholar, Bielefeld Academic Search Engine and OpenAlex) and targeted websites that covered the time frame up to December 2023. Eligible studies, from 2003 onwards, involved diabetic eye programme implementation in the target countries, covering a range of outcomes. Data extracted were publication year, study location (country), aim of study, study evaluation design, reported data (effectiveness outcomes, implementation outcomes, views/experiences data, observational data or data on resources required), study population, screening stage, intervention strategies and health inequality considerations. Findings are displayed as an interactive evidence map and searchable database.</p><p><strong>Results: </strong>The coproduced logic model depicted factors that could be mapped: screening stage, intervention strategy and evidence type as well as 'black box' factors that would require an in-depth synthesis to address: points for improvement and mechanisms of action. One hundred and thirty-three records were included the interactive map. The largest subset of studies provided information relevant to the entire screening pathway or multiple parts of this system (<i>n</i> = 85), followed by interventions relating to delivery of the eye screening appointment (<i>n </i>= 36), while the fewest studies focused specifically on processes for identifying people eligible for screening. Few studies used experimental designs to evaluate the intervention effectiveness, and there were relatively few studies assessing how well interventions were implemented. Of the studies that reported the evaluation of some form of intervention, the most common type was environmental restructuring of the social and/or physical context (<i>n </i>= 40). The most common data types were observational (e.g. audit studies; <i>n = </i>69) and views or experiences (<i>n </i>= 51). Most studies provided data that can contribute to tackling health inequalities (<i>n</i> = 91).</p><p><strong>Limitations: </strong>We identified","PeriodicalId":12898,"journal":{"name":"Health technology assessment","volume":" ","pages":"39-72"},"PeriodicalIF":3.4,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12989905/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147377109","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Diagnostic accuracy of point-of-care tests for acute respiratory infection: a systematic review of reviews.","authors":"Katie E Webster, Tom Parkhouse, Sarah Dawson, Hayley E Jones, Emily L Brown, Alastair D Hay, Penny Whiting, Christie Cabral, Deborah M Caldwell, Julian Pt Higgins","doi":"10.3310/JLCP4570","DOIUrl":"10.3310/JLCP4570","url":null,"abstract":"<p><strong>Background: </strong>Acute respiratory infections are a common reason for consultation with primary and emergency healthcare services. Identifying individuals with a bacterial infection is crucial to ensure appropriate treatment. However, it is also important to avoid overprescription of antibiotics, to prevent unnecessary side effects and antimicrobial resistance. We conducted a systematic review to summarise evidence on the diagnostic accuracy of symptoms, signs and point-of-care tests to diagnose bacterial respiratory tract infection in adults, and to diagnose two common respiratory viruses, influenza and respiratory syncytial virus.</p><p><strong>Methods: </strong>The primary approach was an overview of existing systematic reviews. We conducted literature searches (22 May 2023) to identify systematic reviews of the diagnostic accuracy of point-of-care tests. Where multiple reviews were identified, we selected the most recent and comprehensive review, with the greatest overlap in scope with our review question. Methodological quality was assessed using the Risk of Bias in Systematic Reviews tool. Summary estimates of diagnostic accuracy (sensitivity, specificity or area under the curve) were extracted. Where no systematic review was identified, we searched for primary studies. We extracted sufficient data to construct a 2 × 2 table of diagnostic accuracy, to calculate sensitivity and specificity. Methodological quality was assessed using the Quality Assessment of Diagnostic Accuracy Studies version 2 tool. Where possible, meta-analyses were conducted. We used GRADE to assess the certainty of the evidence from existing reviews and new analyses.</p><p><strong>Results: </strong>We identified 23 reviews which addressed our review question; 6 were selected as the most comprehensive and similar in scope to our review protocol. These systematic reviews considered the following tests for bacterial respiratory infection: individual symptoms and signs; combinations of symptoms and signs (in clinical prediction models); clinical prediction models incorporating C-reactive protein; and biological markers related to infection (including C-reactive protein, procalcitonin and others). We also identified systematic reviews that reported the accuracy of specific tests for influenza and respiratory syncytial virus. No reviews were found that assessed the diagnostic accuracy of white cell count for bacterial respiratory infection, or multiplex tests for influenza and respiratory syncytial virus. We therefore conducted searches for primary studies, and carried out meta-analyses for these index tests. Overall, we found that symptoms and signs have poor diagnostic accuracy for bacterial respiratory infection (sensitivity ranging from 9.6% to 89.1%; specificity ranging from 13.4% to 95%). Accuracy of biomarkers was slightly better, particularly when combinations of biomarkers were used (sensitivity 80-90%, specificity 82-93%). The sensitivity and specifici","PeriodicalId":12898,"journal":{"name":"Health technology assessment","volume":" ","pages":"503-578"},"PeriodicalIF":3.4,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13591369/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142365067","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}