Health technology assessment : HTA
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Health Technol Assess · Nov 2018
Randomized Controlled Trial Multicenter StudyCombining mirtazapine with SSRIs or SNRIs for treatment-resistant depression: the MIR RCT.
Depression is usually managed in primary care and antidepressants are often the first-line treatment, but only half of those treated respond to a single antidepressant. ⋯ Treatment-resistant depression remains an area of important, unmet need, with limited evidence of effective treatments. Promising interventions include augmentation with atypical antipsychotics and treatment using transcranial magnetic stimulation.
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Health Technol Assess · Oct 2018
Randomized Controlled Trial Multicenter StudyAdding emollient bath additives to standard eczema management for children with eczema: the BATHE RCT.
Childhood eczema is very common. Treatment often includes emollient bath additives, despite there being little evidence of their effectiveness. ⋯ Further research is required on optimal regimens of leave-on emollients and the use of emollients as soap substitutes.
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Health Technol Assess · Oct 2018
Randomized Controlled Trial Multicenter StudyAdjunctive rifampicin to reduce early mortality from Staphylococcus aureus bacteraemia: the ARREST RCT.
Staphylococcus aureus bacteraemia is a common and frequently fatal infection. Adjunctive rifampicin may enhance early S. aureus killing, sterilise infected foci and blood faster, and thereby reduce the risk of dissemination, metastatic infection and death. ⋯ Given the substantial mortality, other antibiotic combinations or improved source management should be investigated.
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Health Technol Assess · Sep 2018
Randomized Controlled Trial Multicenter StudyRestricted fluid bolus versus current practice in children with septic shock: the FiSh feasibility study and pilot RCT.
There has been no randomised controlled trial (RCT) of fluid bolus therapy in paediatric sepsis in the developed world despite evidence that excess fluid may be associated with harm. ⋯ Further observational work is required to determine the epidemiology of severe childhood infection in the UK in the postvaccine era.
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Health Technol Assess · Aug 2018
Randomized Controlled Trial Multicenter StudyNicotine preloading for smoking cessation: the Preloading RCT.
Nicotine preloading means using nicotine replacement therapy prior to a quit date while smoking normally. The aim is to reduce the drive to smoke, thereby reducing cravings for smoking after quit day, which are the main cause of early relapse. A prior systematic review showed inconclusive and heterogeneous evidence that preloading was effective and little evidence of the mechanism of action, with no cost-effectiveness data. ⋯ Use of nicotine-patch preloading for 4 weeks prior to attempting to stop smoking can increase the proportion of people who stop successfully, but its benefit is undermined because it reduces the use of varenicline after preloading. If this latter effect could be overcome, then nicotine preloading appears to improve health and reduce health-service costs in the long term. Future work should determine how to ensure that people using nicotine preloading opt to use varenicline as cessation medication.