Canadian Journal of Health Technologies最新文献

{"title":"Inebilizumab (Uplizna)","authors":"Cadth","doi":"10.51731/cjht.2024.864","DOIUrl":"https://doi.org/10.51731/cjht.2024.864","url":null,"abstract":"\u0000CADTH recommends that Uplizna be reimbursed by public drug plans for the treatment of neuromyelitis optica spectrum disorder (NMOSD), if certain conditions are met. \u0000Uplizna should only be covered to treat adult patients who are anti-aquaporin-4 immunoglobulin G (AQP4-IgG) seropositive and who have had at least 1 NMOSD relapse episode (also known as an “attack”) in the 1 year before initiation, or 2 NMOSD relapse episodes in the 2 years before initiation. Patients must have an Expanded Disability Status Scale (EDSS) score of 8 points or less. \u0000Uplizna should only be reimbursed if it is prescribed by neurologists with expertise in treating NMOSD and the cost of Uplizna is reduced to be no greater than the least costly comparator currently reimbursed for the treatment of NMOSD. Uplizna should not be initiated during a NMOSD relapse episode or when used in combination with rituximab, satralizumab, eculizumab, or ravulizumab. \u0000","PeriodicalId":505661,"journal":{"name":"Canadian Journal of Health Technologies","volume":"27 19","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140753342","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sacituzumab Govitecan (Trodelvy)","authors":"Cadth","doi":"10.51731/cjht.2024.835","DOIUrl":"https://doi.org/10.51731/cjht.2024.835","url":null,"abstract":"\u0000CADTH recommends that Trodelvy should be reimbursed by public drug plans for the treatment of adult patients with unresectable locally advanced or metastatic hormone receptor (HR)-positive, human epidermal growth factor receptor 2 (HER2)-negative (IHC 0, IHC 1+, or IHC 2+/ISH–) breast cancer who have received endocrine-based therapy and at least 2 additional systemic therapies in the metastatic setting, if certain conditions are met. \u0000Trodelvy should only be covered to treat adult patients with unresectable locally advanced or metastatic HR-positive, HER2-negative breast cancer who have been previously treated with at least 1 taxane, at least 1 prior anticancer hormonal treatment, and at least 1 cyclin-dependent kinase 4 and 6 (CDK4/6) inhibitor in any setting, have experienced treatment failure after 2 to 4 prior systemic chemotherapy regimens for metastatic disease, and have good performance status. \u0000Trodelvy should only be reimbursed if it is prescribed by clinicians with expertise and experience in treating breast cancer in approved centres, and if the price of Trodelvy is reduced. \u0000","PeriodicalId":505661,"journal":{"name":"Canadian Journal of Health Technologies","volume":"27 3","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139958341","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical and Instrumental Swallowing Assessments for Dysphagia","authors":"Robyn Haas, Sharon Bailey","doi":"10.51731/cjht.2024.833","DOIUrl":"https://doi.org/10.51731/cjht.2024.833","url":null,"abstract":"What Is the Issue? \u0000 \u0000Dysphagia, or swallowing impairment, is a common complication of many health conditions. To assess patients for dysphagia, speech-language pathologists may use instrumental swallowing assessments or clinical assessments. \u0000Instrumental swallowing assessments are more accurate and comprehensive, but they also require more time and resources. \u0000To help inform decisions about whether it is appropriate to increase use of clinical assessments and limit the use of instrumental swallowing assessments, it is important to understand current best practices as well as the comparative clinical utility and diagnostic accuracy. \u0000 \u0000What Did We Do? \u0000 \u0000We searched for literature evaluating the clinical utility and diagnostic accuracy of instrumental swallowing assessments versus clinical assessments for patients with suspected dysphagia. We also searched for evidence-based guidelines that provide recommendations about the use of instrumental and clinical assessments for suspected dysphagia. \u0000An information specialist searched for peer-reviewed and grey literature sources published between January 1, 2019, and November 30, 2023. \u0000 \u0000What Did We Find? \u0000 \u0000Four diagnostic test accuracy studies compared various clinical evaluations to instrumental swallowing exams. The tests ranged in their sensitivity, specificity, positive predictive values, and negative predictive values. Three of the 4 studies concluded that the clinical assessments they examined could be used to identify dysphagia. One of these 3 studies examined multiple clinical evaluations and noted the varying degrees of accuracy among the tests and indicated which of these is most accurate. The fourth study found that further evidence is needed to determine if a clinical feeding evaluation can predict aspiration. We did not find any studies directly evaluating the clinical utility of instrumental swallowing assessments versus clinical evaluation for patients with suspected dysphagia that met the inclusion criteria for this review. \u0000Six evidence-based guidelines made recommendations related to instrumental and clinical swallowing assessments for dysphagia. These recommendations generally indicated that instrumental assessments should be used when resources allow, or that they should take place in addition to clinical swallowing assessments. \u0000 \u0000What Does This Mean? \u0000 \u0000Health care practitioners may wish to conduct an instrumental swallowing assessment, such as a fibreoptic endoscopic evaluation of swallowing or a videofluoroscopic swallowing study for patients for whom there are sufficient resources to do so. \u0000Clinical assessments for dysphagia have the potential to help clinicians diagnose patients with dysphagia without the use of instrumental swallowing assessments, particularly in settings with limited resources. However, this is not the case for all clinical assessments and needs to be determined on a case-by-case basis. \u0000","PeriodicalId":505661,"journal":{"name":"Canadian Journal of Health Technologies","volume":"54 30","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139961159","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Vutrisiran (Amvuttra)","authors":"Cadth","doi":"10.51731/cjht.2024.831","DOIUrl":"https://doi.org/10.51731/cjht.2024.831","url":null,"abstract":"\u0000CADTH recommends that Amvuttra be reimbursed by public drug plans for the treatment of stage 1 or stage 2 polyneuropathy in adult patients with hereditary transthyretin-mediated (hATTR) amyloidosis if certain conditions are met. \u0000Amvuttra should only be covered to treat adults with stage 1 or stage 2 genetically confirmed hATTR amyloidosis with polyneuropathy (hATTR-PN) who are symptomatic with early-stage neuropathy, do not have severe heart failure symptoms, and have not had a liver transplant. A patient’s response to treatment with Amvuttra should be assessed at least every 6 months to determine whether they would benefit from continued treatment. Treatment with Amvuttra should not be continued in patients who are permanently bedridden and dependent on assistance for basic activities of daily living or who are receiving end-of-life care. \u0000Amvuttra should only be reimbursed if the patient is under the care of a specialist with experience in the diagnosis and management of hATTR-PN and should not be reimbursed if it is used in combination with interfering ribonucleic acid drugs or transthyretin stabilizers. The cost of Amvuttra should be reduced so that it does not cost more than other drugs for hATTR amyloidosis. \u0000","PeriodicalId":505661,"journal":{"name":"Canadian Journal of Health Technologies","volume":"23 8","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139963354","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hernia Support Garments for Parastomal Hernia Following Ostomy Procedure","authors":"Robyn Hass, Jennie Horton, Angie Hamson","doi":"10.51731/cjht.2024.810","DOIUrl":"https://doi.org/10.51731/cjht.2024.810","url":null,"abstract":"What Is the Issue? \u0000 \u0000Parastomal hernia is a common complication that can occur following ostomy surgery. They can have a negative impact on a person’s quality of life, affecting them both physically and psychologically. One intervention that may be used to help prevent or manage parastomal hernias are hernia support garments. \u0000To help inform decisions about the most appropriate use for hernia support garments, it is important to understand the current best practices as well as potential benefits and harms of using these garments. \u0000 \u0000What Did We Do? \u0000 \u0000We searched for clinical and cost-effectiveness literature comparing hernia support garments to alternative hernia prevention or management strategies or no intervention. We also searched for evidence-based guidelines that provide recommendations about the use of hernia support garments for the prevention or management of parastomal hernias. \u0000An information specialist searched for peer-reviewed and grey literature sources published between January 1, 2013, and November 1, 2023. \u0000We engaged with an individual who has lived experience of an ostomy and parastomal hernia and who wears a hernia belt regularly. He shared his thoughts on the physical and psychological benefits, impact on quality of life, and challenges of using a hernia belt. This gave CADTH a more nuanced understanding of the literature. \u0000 \u0000What Did We Find? \u0000 \u0000We did not find any studies directly evaluating the clinical or cost-effectiveness of hernia support garments versus alternative hernia prevention or management interventions or no treatment that met the inclusion criteria for this review. \u0000Three evidence-based guidelines made recommendations related to using hernia support garments to prevent and manage parastomal hernia. One guideline recommends that individuals with an ostomy should be assessed to determine the type and level of support required to prevent or manage hernia. Another guideline recommends that health providers provide postoperative education on using support garments. The third guideline recommends that stoma care nurses provide lifestyle advice about support garments to individuals with a stoma. This guideline also recommends that these nurses should be available to advise on non-operative management options for parastomal hernias more generally. \u0000 \u0000What Does This Mean? \u0000 \u0000Decision-makers might wish to consider ways to ensure that individuals who have had or are scheduled to have an ostomy surgery have timely access to parastomal hernia risk assessment, education, and advice on the use of hernia support garments from nurses specialized in wound, ostomy, and continence care. They may also want to consider out-of-pocket costs that may be a barrier to this care. \u0000","PeriodicalId":505661,"journal":{"name":"Canadian Journal of Health Technologies","volume":"15 6","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139383053","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Artificial Intelligence Decision Support Tools for End-of-Life Care Planning Conversations","authors":"Weiyi Xie, Robyn Butcher","doi":"10.51731/cjht.2023.802","DOIUrl":"https://doi.org/10.51731/cjht.2023.802","url":null,"abstract":"Why Is This an Issue? End-of-life care provides support for patients and their families during the last stage of life. End-of-life conversations aim to help people better understand their disease prognosis and expected survival, enabling them to make informed decisions regarding end-of-life care. Palliative care focuses on relieving symptoms and improving quality of life for patients with serious or life-threatening diseases. Approximately 89% of patients with life-limiting diseases, such as cancer, can benefit from palliative care. However, not all patients receive it in a timely manner. Due in part to prognostic uncertainty and optimism bias, end-of-life planning conversations and palliative care decisions do not occur early enough to have maximum benefit. Interventions that aim to prompt or help identify those patients who can benefit from palliative and/or end-of-life planning could improve the quality of care. What Is the Technology? An artificial intelligence (AI)–based “nudge” is a decision-making support tool that uses prompts and alerts to aid clinicians in deciding whether and when to discuss end-of-life planning with patients. The nudge sends alerts and/or reminders to clinicians to prompt end-of-life conversations with patients who are at high risk of short-term mortality. These patients are identified by machine learning mortality prediction algorithms incorporated in the electronic health record (EHR) system. Two AI-based nudges designed for patients with cancer were identified. Both tools were developed and internally validated in the US. What Is the Potential Impact? AI-based nudges have the potential to increase the number of end-of-life planning conversations between clinicians and patients as well as the number of referrals to end-of life services. Implementing the nudges into clinical workflows could also help clinicians more easily identify patients with palliative care needs. What Else Do We Need to Know? No AI-based nudges have been approved for use in Canada at the time of this writing nor have there been validation studies using Canadian data. As with many AI algorithms, there is uncertainty about the validity and generalizability of the mortality predictive algorithms used in the nudges. The acceptance of AI-based nudges by clinicians is unclear due to varying clinician attitudes and experiences with nudges and because we did not identify any studies that reported the experience of AI-based nudges from the patient perspective.","PeriodicalId":505661,"journal":{"name":"Canadian Journal of Health Technologies","volume":"348 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139174996","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Emergency Department Overcrowding in Canada","authors":"Cadth","doi":"10.51731/cjht.2023.791","DOIUrl":"https://doi.org/10.51731/cjht.2023.791","url":null,"abstract":"What Is the Issue? Emergency departments (EDs) across Canada are under strain and experiencing overcrowding, a situation that arises when the demand for health services in the ED exceeds the capacity of the health system — which includes the ED, hospital, and community — to provide quality care in a reasonable amount of time. ED overcrowding is contributing to a deteriorating standard of care as health care providers and staff become overworked and burned out, is putting health and lives at risk, and is placing additional strain on an already overwhelmed health care system. What Did We Do? The CADTH Health Technology Expert Review Panel (HTERP) convened to develop objective, impartial, trusted pan-Canadian guidance to inform decisions about which evidence-informed solutions should be considered to help alleviate ED overcrowding in Canada. What Is HTERP’s Position on ED Overcrowding? ED overcrowding is a complex health system issue. EDs operate within hospitals and broader health and social systems, which means that accountability for causes, impacts, and solutions do not lie solely within the ED and its operations. Output factors (e.g., misalignment between acute care bed capacity within the hospital and population needs) and input factors (e.g., misalignment between care available in the community and population needs, including care outside of regular business hours) respectively, are the main contributors to ED overcrowding in Canada. Health system capacity is not aligned with, nor has kept pace with, the growing and changing health care needs of the population, which results in overcrowded EDs. Health systems will observe better results by implementing strategies that improve patient flow and focus on output and input factors relative to throughput factors. What Is HTERP’s Guidance to Help Alleviate ED Overcrowding? Interventions to alleviate overcrowding need to align with the main contributing factors to ED overcrowding in the particular context in which they will be implemented. Understanding the context in which ED overcrowding is occurring, with attention to bottlenecks to patient flow, should be the first step to identify evidence-informed solutions. Transparency and accountability should be key principles in ED, hospital, and health system operations. HTERP recommends identifying and ensuring clear roles, responsibilities, and reporting relationships embedded within an accountability framework for ED overcrowding across health system partners, including a commitment to act on data. Each province and territory should mandate consistent and comprehensive reporting by all hospitals to the Canadian Institute of Health Information’s National Ambulatory Care Reporting System (NACRS) database. HTERP’s guidance includes an Evidence Navigation Guide to support identification of evidence-informed interventions to help alleviate ED overcrowding.","PeriodicalId":505661,"journal":{"name":"Canadian Journal of Health Technologies","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-11-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139242272","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Tremelimumab (Imjudo) in Combination With Durvalumab (Imfinzi)","authors":"Cadth","doi":"10.51731/cjht.2023.788","DOIUrl":"https://doi.org/10.51731/cjht.2023.788","url":null,"abstract":"CADTH recommends that tremelimumab (Imjudo) in combination with durvalumab (Imfinzi) should be reimbursed by public drug plans for the treatment of patients with unresectable hepatocellular carcinoma (HCC) if certain conditions are met. Imjudo in combination with Imfinzi should only be covered to treat adult patients who have confirmed liver cancer that cannot be removed by surgery, are classified as Child-Pugh score class A, and require systemic therapy. Patients should be in relatively good health (i.e., have a good performance status, as determined by a specialist). Imjudo in combination with Imfinzi should only be reimbursed as first-line treatment and should not be given in combination with other systemic anticancer drugs. Imjudo in combination with Imfinzi should be prescribed by clinicians with expertise and experience in treating unresectable HCC. In addition, the price for Imjudo in combination with Imfinzi should be reduced.","PeriodicalId":505661,"journal":{"name":"Canadian Journal of Health Technologies","volume":"7 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-11-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139250408","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Implications of ChatGPT on Radiology Workflow","authors":"Cadth","doi":"10.51731/cjht.2023.789","DOIUrl":"https://doi.org/10.51731/cjht.2023.789","url":null,"abstract":"The demand for medical imaging in Canada has risen due to factors, including an aging population, increased patient volumes, advancements in procedures and treatments, and shifts in standard of care. Notably, there has been a substantial increase in CT and MRI examinations. Radiologists in Canada often have large patient volumes, work extended overtime, and manage prolonged wait-lists, all of which contribute to burnout. This burnout has an impact on productivity and staff turnover and may jeopardize patient safety. Burnout may also lead to radiologists reducing their work hours, seeking new employers, or leaving clinical practice. ChatGPT could play a role in supporting radiologists in a variety of ways, including generating radiology reports, providing structured report templates, assisting with clinical history sections of radiology reports, and facilitating patient communication. ChatGPT may also aid clinical decision support by assisting in final diagnoses and cancer screening decisions, and optimizing clinical decision support. ChatGPT’s limitations in radiology workflow include dependence on training data, potential inaccuracies in responses, ethical concerns about patient data privacy, and difficulties in handling complex radiology tasks. While ChatGPT holds promise in enhancing radiology workflow and patient care, careful consideration is needed for its limitations and potential risks. Responsible implementation and ongoing research and development are vital to leveraging its benefits while upholding patient safety and ethical standards.","PeriodicalId":505661,"journal":{"name":"Canadian Journal of Health Technologies","volume":"74 1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-11-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139250140","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ibrutinib (Imbruvica)","authors":"Cadth","doi":"10.51731/cjht.2023.785","DOIUrl":"https://doi.org/10.51731/cjht.2023.785","url":null,"abstract":"CADTH recommends that ibrutinib, in combination with venetoclax, should be reimbursed by public drug plans for the treatment of adult patients with previously untreated chronic lymphocytic leukemia (CLL), including those with 17p deletion only if certain conditions are met. In combination with venetoclax, Ibrutinib should only be covered to treat adult (≥ 18 years) patients with previously untreated CLL, including those with 17p deletion. Patients receiving Imbruvica should be in relatively good health (i.e., have a good performance status, as determined by a specialist). Patients with major surgery within 4 weeks of the first dose of study treatment, bleeding disorder, central nervous system involvement, Richter syndrome, or uncontrolled autoimmune hemolytic anemia or thrombocytopenia should not be eligible for coverage. Imbruvica in combination with venetoclax should only be reimbursed if prescribed by hematologists or oncologists with expertise and experience in the treatment of CLL and monitoring of therapy and if the drug program cost of Imbruvica in combination with venetoclax does not exceed the drug program cost of treatment with the least costly comparator that is reimbursed for the treatment of CLL. Patients who experience disease progression while taking Imbruvica in combination with venetoclax or who cannot tolerate the drug would not be eligible for continued coverage.","PeriodicalId":505661,"journal":{"name":"Canadian Journal of Health Technologies","volume":"79 11","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-11-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139248095","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}