Ontario health technology assessment series
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Ont Health Technol Assess Ser · Jan 2015
Review Meta AnalysisPatient Perspectives on Quality of Life With Uncontrolled Type 1 Diabetes Mellitus: A Systematic Review and Qualitative Meta-synthesis.
Patients with uncontrolled type 1 diabetes mellitus may be candidates for pancreatic islet cell transplantation. This report synthesizes qualitative research on how patients with uncontrolled type 1 diabetes perceive their quality of life. ⋯ Uncontrolled type 1 diabetes has significant negative impacts on the quality of life of both people with the disease and their families.
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Ont Health Technol Assess Ser · Jan 2015
ReviewPositional Magnetic Resonance Imaging for People With Ehlers-Danlos Syndrome or Suspected Craniovertebral or Cervical Spine Abnormalities: An Evidence-Based Analysis.
Ehlers-Danlos syndrome (EDS) is an inherited disorder affecting the connective tissue. EDS can manifest with symptoms attributable to the spine or craniovertebral junction (CVJ). In addition to EDS, numerous congenital, developmental, or acquired disorders can increase ligamentous laxity in the CVJ and cervical spine. Resulting abnormalities can lead to morbidity and serious neurologic complications. Appropriate imaging and diagnosis is needed to determine patient management and need for complex surgery. Some spinal abnormalities cause symptoms or are more pronounced while patients sit, stand, or perform specific movements. Positional magnetic resonance imaging (pMRI) allows imaging of the spine or CVJ with patients in upright, weight-bearing positions and can be combined with dynamic maneuvers, such as flexion, extension, or rotation. Imaging in these positions could allow diagnosticians to better detect spinal or CVJ abnormalities than recumbent MRI or even a combination of other available imaging modalities might allow. ⋯ We did not identify any evidence that assessed the diagnostic impact or clinical utility of pMRI for (a) craniovertebral or spinal abnormalities among people with EDS or (b) major craniovertebral or cervical spine abnormalities among symptomatic people relative to currently available diagnostic modalities.
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Ont Health Technol Assess Ser · Jan 2014
ReviewCardiopulmonary Resuscitation in Patients With Terminal Illness: An Evidence-Based Analysis.
Cardiopulmonary resuscitation (CPR) was first introduced in 1960 for people who unexpectedly experience sudden cardiac arrest. Over the years, it became routine practice in all institutions to perform CPR for all patients even though, for some patients with fatal conditions, application of CPR only prolongs the dying process through temporarily restoring cardiac function. ⋯ Survival after CPR depends on the severity of illness, type and number of health conditions, functional dependence, and multiple CPRs.
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Ont Health Technol Assess Ser · Jan 2014
Review Meta AnalysisThe Determinants of Place of Death: An Evidence-Based Analysis.
According to a conceptual model described in this analysis, place of death is determined by an interplay of factors associated with the illness, the individual, and the environment. ⋯ The results obtained were consistent with previously published systematic reviews. The analysis identified several factors that are associated with place of death.
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Ont Health Technol Assess Ser · Jan 2014
ReviewThe appropriate use of neuroimaging in the diagnostic work-up of dementia: an evidence-based analysis.
Diagnosis of dementia is challenging and requires both ruling out potentially treatable underlying causes and ruling in a diagnosis of dementia subtype to manage patients and suitably plan for the future. ⋯ A diagnosis of reversible dementia is rare. Imaging has the most clinical utility in cases where there is potentially mixed dementia or ambiguity as to the type of dementia despite prolonged follow-up (e.g., 2 years or more). Both CT and MRI are useful for detecting a vascular component of dementia.