Health Technology Assessment

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Evaluation of droplet dispersion during non-invasive ventilation, oxygen therapy, nebuliser treatment and chest physiotherapy in clinical practice: implications for management of pandemic influenza and other airborne infections
Health Technology Assessment - Tập 14 Số 46
AK Simonds, A. Hanak, Michelle Chatwin, MJ Morrell, Aron J. Hall, K. H. Parker, JH Siggers, RJ Dickinson
EVALUATE hysterectomy trial: a multicentre randomised trial comparing abdominal, vaginal and laparoscopic methods of hysterectomy
Health Technology Assessment - Tập 8 Số 26
R Garry, J Fountain, Julia Brown, Andrea Manca, Suzanne Mason, Mark Sculpher, Vicky Napp, Stephen Bridgman, J. Gray, Richard Lilford
Consensus development methods, and their use in clinical guideline development.
Health Technology Assessment - Tập 2 Số 3 - 1998
Murphy Murphy, Black, Lamping, Martin McKee, Sanderson, Askham, Marteau
Eliciting public preferences for healthcare: a systematic review of techniques
Health Technology Assessment - Tập 5 Số 5
Mandy Ryan, David A. Scott, Catherine Reeves, Angela Bate, Edwin van Teijlingen, Elizabeth M. Russell, Moira Joan Napper, C. Robb
A novel peer-support intervention using motivational interviewing for breastfeeding maintenance: a UK feasibility study
Health Technology Assessment - Tập 21 Số 77 - Trang 1-138
Shantini Paranjothy, Lauren Copeland, Laura Merrett, Aimee Grant, Rhiannon Phillips, Nina Gobat, Julia Sanders, Deborah Fitzsimmons, Billie Hunter, Sian Regan, Rebecca Playle, Amy Brown, Sally Tedstone, Heather Trickey, Michael Robling
Background

In total, 81% of women in the UK start breastfeeding, but fewer than half continue beyond 6 weeks. Peer support in the early postnatal period may encourage women to breastfeed for longer.

Objective

To develop a breastfeeding peer-support intervention based on motivational interviewing (MI) for breastfeeding maintenance and to test the feasibility of delivering it to mothers in areas with high levels of social deprivation.

Design

Intervention development and a non-randomised multisite feasibility study.

Setting

Community maternity services in three areas with high levels of social deprivation and low breastfeeding initiation rates in England and Wales.

Participants

Pregnant women considering breastfeeding. Women who did not plan to breastfeed, who had a clinical reason that precluded breastfeeding continuation or who were unable to consent were excluded.

Intervention

The intervention Mam-Kind was informed by a survey of infant feeding co-ordinators, rapid literature review, focus groups with service users and peer supporters and interviews with health-care professionals and a Stakeholder Advisory Group. It consisted of face-to-face contact at 48 hours after birth and proactive one-to-one peer support from the Mam-Kind buddy for 2 weeks, followed by mother-led contact for a further 2–6 weeks.

Main outcome measures

Recruitment and retention of Mam-Kind buddies, uptake of Mam-Kind by participants, feasibility of delivering Mam-Kind as specified and of data collection methods, and acceptability of Mam-Kind to mothers, buddies and health-care professionals.

Results

Nine buddies were recruited to deliver Mam-Kind to 70 participants (61% of eligible women who expressed an interest in taking part in the study). Participants were aged between 19 and 41 years and 94% of participants were white. Intervention uptake was 75% and did not vary according to age or parity. Most contacts (79%) were initiated by the buddy, demonstrating the intended proactive nature of the intervention and 73% (n = 51) of participants received a contact within 48 hours. Follow-up data were available for 78% of participants at 10 days and 64% at 8 weeks. Data collection methods were judged feasible and acceptable. Data completeness was > 80% for almost all variables. Interviews with participants, buddies and health service professionals showed that the intervention was acceptable. Buddies delivered the intervention content with fidelity (93% of intervention objectives were met), and, in some cases, developed certain MI skills to a competency level. However, they reported difficulties in changing from an information-giving role to a collaborative approach. These findings were used to refine the training and intervention specification to emphasise the focus of the intervention on providing mother-centric support. Health-care professionals were satisfied that the intervention could be integrated with existing services.

Conclusions

The Mam-Kind intervention was acceptable and feasible to deliver within NHS maternity services and should be tested for effectiveness in a multicentre randomised controlled trial. The feasibility study highlighted the need to strengthen strategies for birth notification and retention of participants, and provided some insights on how this could be achieved in a full trial.

Limitations

The response rate to the survey of infant feeding co-ordinators was low (19.5%). In addition, the women who were recruited may not be representative of the study sites.

Funding

The National Institute for Health Research Health Technology Assessment programme.

Breastfeeding promotion for infants in neonatal units: a systematic review and economic analysis
Health Technology Assessment - Tập 13 Số 40
Mary J. Renfrew, Dawn Craig, Lisa Dyson, Felicia McCormick, Stephen Rice, Sarah King, Kate Misso, Elizabeth Stenhouse, A F Williams
The measurement of satisfaction with healthcare: implications for practice from a systematic review of the literature
Health Technology Assessment - Tập 6 Số 32
Rosemary Crow, Heather Gage, S Hampson, Jo Hart, Alan Kimber, Les Storey, Hayley Thomas
Methods of prediction and prevention of pre-eclampsia: systematic reviews of accuracy and effectiveness literature with economic modelling
Health Technology Assessment - Tập 12 Số 6
Catherine Meads, Jeltsje S. Cnossen, Shireen Meher, A. Juarez-Garcia, Gerben ter Riet, Lelia Duley, Tracy Roberts, Ben W. Mol, Joris van der Post, Mariska Leeflang, Pelham Barton, Christopher Hyde, Janesh Gupta, Khalid S. Khan
The effectiveness and cost-effectiveness of carmustine implants and temozolomide for the treatment of newly diagnosed high-grade glioma: a systematic review and economic evaluation
Health Technology Assessment - Tập 11 Số 45
Ruth Garside, Martin Pitt, Rob Anderson, G Rogers, Matthew Dyer, Stuart Mealing, Matthew C. Somerville, Anita P. Price, Ken Stein
Viscoelastic point-of-care testing to assist with the diagnosis, management and monitoring of haemostasis: a systematic review and cost-effectiveness analysis
Health Technology Assessment - Tập 19 Số 58 - Trang 1-228
Penny Whiting, Maiwenn Al, Marie Westwood, Isaac Corro Ramos, Steve Ryder, Nigel Armstrong, Kate Misso, Janine Ross, Johan L. Severens, Jos Kleijnen
Background

Patients with substantive bleeding usually require transfusion and/or (re-)operation. Red blood cell (RBC) transfusion is independently associated with a greater risk of infection, morbidity, increased hospital stay and mortality. ROTEM (ROTEM®Delta, TEM International GmbH, Munich, Germany;www.rotem.de), TEG (TEG®5000 analyser, Haemonetics Corporation, Niles, IL, USA;www.haemonetics.com) and Sonoclot (Sonoclot®coagulation and platelet function analyser, Sienco Inc., Arvada, CO) are point-of-care viscoelastic (VE) devices that use thromboelastometry to test for haemostasis in whole blood. They have a number of proposed advantages over standard laboratory tests (SLTs): they provide a result much quicker, are able to identify what part of the clotting process is disrupted, and provide information on clot formation over time and fibrinolysis.

Objectives

This assessment aimed to assess the clinical effectiveness and cost-effectiveness of VE devices to assist with the diagnosis, management and monitoring of haemostasis disorders during and after cardiac surgery, trauma-induced coagulopathy and post-partum haemorrhage (PPH).

Methods

Sixteen databases were searched to December 2013: MEDLINE (OvidSP), MEDLINE In-Process and Other Non-Indexed Citations and Daily Update (OvidSP), EMBASE (OvidSP), BIOSIS Previews (Web of Knowledge), Science Citation Index (SCI) (Web of Science), Conference Proceedings Citation Index (CPCI-S) (Web of Science), Cochrane Database of Systematic Reviews (CDSR), Cochrane Central Register of Controlled Trials (CENTRAL), Database of Abstracts of Reviews of Effects (DARE), Health Technology Assessment (HTA) database, Latin American and Caribbean Health Sciences Literature (LILACS), International Network of Agencies for Health Technology Assessment (INAHTA), National Institute for Health Research (NIHR) HTA programme, Aggressive Research Intelligence Facility (ARIF), Medion, and the International Prospective Register of Systematic Reviews (PROSPERO). Randomised controlled trials (RCTs) were assessed for quality using the Cochrane Risk of Bias tool. Prediction studies were assessed using QUADAS-2. For RCTs, summary relative risks (RRs) were estimated using random-effects models. Continuous data were summarised narratively. For prediction studies, the odds ratio (OR) was selected as the primary effect estimate. The health-economic analysis considered the costs and quality-adjusted life-years of ROTEM, TEG and Sonoclot compared with SLTs in cardiac surgery and trauma patients. A decision tree was used to take into account short-term complications and longer-term side effects from transfusion. The model assumed a 1-year time horizon.

Results

Thirty-one studies (39 publications) were included in the clinical effectiveness review. Eleven RCTs (n = 1089) assessed VE devices in patients undergoing cardiac surgery; six assessed thromboelastography (TEG) and five assessed ROTEM. There was a significant reduction in RBC transfusion [RR 0.88, 95% confidence interval (CI) 0.80 to 0.96; six studies], platelet transfusion (RR 0.72, 95% CI 0.58 to 0.89; six studies) and fresh frozen plasma to transfusion (RR 0.47, 95% CI 0.35 to 0.65; five studies) in VE testing groups compared with control. There were no significant differences between groups in terms of other blood products transfused. Continuous data on blood product use supported these findings. Clinical outcomes did not differ significantly between groups. There were no apparent differences between ROTEM or TEG; none of the RCTs evaluated Sonoclot. There were no data on the clinical effectiveness of VE devices in trauma patients or women with PPH. VE testing was cost-saving and more effective than SLTs. For the cardiac surgery model, the cost-saving was £43 for ROTEM, £79 for TEG and £132 for Sonoclot. For the trauma population, the cost-savings owing to VE testing were more substantial, amounting to per-patient savings of £688 for ROTEM compared with SLTs, £721 for TEG, and £818 for Sonoclot. This finding was entirely dependent on material costs, which are slightly higher for ROTEM. VE testing remained cost-saving following various scenario analyses.

Conclusions

VE testing is cost-saving and more effective than SLTs, in both patients undergoing cardiac surgery and trauma patients. However, there were no data on the clinical effectiveness of Sonoclot or of VE devices in trauma patients.

Study registration

This study is registered as PROSPERO CRD42013005623.

Funding

The NIHR Health Technology Assessment programme.

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