Health technology assessment : HTA
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Health Technol Assess · Nov 2021
Randomized Controlled TrialUnicompartmental compared with total knee replacement for patients with multimorbidities: a cohort study using propensity score stratification and inverse probability weighting.
Although routine NHS data potentially include all patients, confounding limits their use for causal inference. Methods to minimise confounding in observational studies of implantable devices are required to enable the evaluation of patients with severe systemic morbidity who are excluded from many randomised controlled trials. ⋯ Further research is required to understand the performance of propensity score methods for evaluating surgical innovations and implantable devices.
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Health Technol Assess · Jul 2021
Randomized Controlled TrialVenous access devices for the delivery of long-term chemotherapy: the CAVA three-arm RCT.
Venous access devices are used for patients receiving long-term chemotherapy. These include centrally inserted tunnelled catheters or Hickman-type devices (Hickman), peripherally inserted central catheters (PICCs) and centrally inserted totally implantable venous access devices (PORTs). ⋯ The deliverability of a PORTs service merits further study to understand the barriers to and methods of improving the service.
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Health Technol Assess · Jun 2021
Randomized Controlled Trial Multicenter StudyCognitive-behavioural therapy compared with standardised medical care for adults with dissociative non-epileptic seizures: the CODES RCT.
Dissociative (non-epileptic) seizures are potentially treatable by psychotherapeutic interventions; however, the evidence for this is limited. ⋯ Examination of moderators and mediators of outcome.
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Health Technol Assess · May 2021
Randomized Controlled Trial Multicenter StudyPalliative radiotherapy combined with stent insertion to reduce recurrent dysphagia in oesophageal cancer patients: the ROCS RCT.
Most patients with oesophageal cancer present with incurable disease. For those with advanced disease, the mean survival is 3-5 months. Treatment emphasis is therefore on effective palliation, with the majority of patients requiring intervention for dysphagia. Insertion of a self-expanding metal stent provides rapid relief but dysphagia may recur within 3 months owing to tumour progression. Evidence reviews have called for trials of interventions combined with stenting to better maintain the ability to swallow. ⋯ Further studies are required to identify interventions that improve stent efficacy and to address the multidimensional challenges of eating and nutrition in this patient population.
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Health Technol Assess · Apr 2021
Randomized Controlled Trial Multicenter StudyMicrodiscectomy compared with transforaminal epidural steroid injection for persistent radicular pain caused by prolapsed intervertebral disc: the NERVES RCT.
Sciatica is a common condition reported to affect > 3% of the UK population at any time and is most often caused by a prolapsed intervertebral disc. Currently, there is no uniformly adopted treatment strategy. Invasive treatments, such as surgery (i.e. microdiscectomy) and transforaminal epidural steroid injection, are often reserved for failed conservative treatment. ⋯ These results will lead to further studies in the streamlining and earlier management of discogenic sciatica.