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OP86 Outpatient Initial Management Of New-Onset Diabetes In Children
- Brigitte Larocque, Alice Nourrisat, Marc Rhainds, Martin Coulombe, Isabelle Bouchard
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- Journal:
- International Journal of Technology Assessment in Health Care / Volume 34 / Issue S1 / 2018
- Published online by Cambridge University Press:
- 03 January 2019, p. 31
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Introduction:
Management of new-onset diabetes is important to achieve metabolic stabilization, minimize acute complications, and to provide insulin therapy, diabetes education and psychological support. A health technology assessment (HTA) was conducted to determine if an outpatient setting could be effective and safe for new-onset diabetes in children, and how it can be implemented in our pediatric center.
Methods:A systematic search on initial management (outpatient versus in-hospital) of diabetes in children was performed in multiple databases and grey literature. Practice guidelines (CPGs), systematic reviews (SRs), randomized controlled trials (RCTs) and non-randomized comparative studies (NRCSs) published up to August 2017 were identified. Telephone interviews with key informants from two children's university teaching hospitals were performed to collect information on outpatient initial management models and issues related to their implementation. An interdisciplinary group of experts from our pediatric center collaborated in this project.
Results:According to 5 CPGs, hospitalization would not be required for children without acute complications at time of diagnosis or after initial treatment of ketoacidosis if outpatient care facilities, resources, and education are available. Results from one SR and 7 NRCSs suggested that outpatient initial management is associated with good metabolic control (glycated hemoglobin) and is as safe as the inpatient care model, based on rate of hospital admissions, severe hypoglycemia, and ketoacidosis episode. However, few data regarding treatment adherence, knowledge acquisition, and emotional adaptation were identified. Outpatient education programs can be successfully provided on several consecutive or non-consecutive days after diagnosis as reported by two children's university teaching hospitals.
Conclusions:Although data on effectiveness and safety are scarce and of low-quality, outpatient management of newly diagnosed diabetes, uncomplicated or stabilized, is recommended in children. However, data on children and their families should be collected as part of the implementation evaluation in order to enhance its efficacy and the quality of the patients’ and families’ experiences.
PP100 Rapid Evidence Assessment In Hospital Health Technology Assessment
- Sylvain L'Espérance, Marc Rhainds, Alice Nourrisat, Martin Coulombe, Sylvain Bussières
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- Journal:
- International Journal of Technology Assessment in Health Care / Volume 34 / Issue S1 / 2018
- Published online by Cambridge University Press:
- 03 January 2019, pp. 103-104
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Introduction:
Systematic reviews (SRs) are the most valid and reliable scientific evidence to evaluate the effectiveness of healthcare interventions. However, substantial resources and months are required to conduct such a review. Most hospital-based health technology assessment (HB-HTA) units don't have the time and the academic team to produce SRs. Rapid evidence assessment (REA) may represent, in this local context, an interesting avenue. The aim was to evaluate characteristics of REA and their impacts on healthcare decision making.
Methods:A SR was performed in several databases and grey literature to search data on REA including Mini-HTA and rapid reviews methodologies through March 2017. Data selection, extraction and quality assessment were performed by two independent researchers. Outcomes were about REA's methodology including question, search strategy, inclusion criteria, study selection, data extraction, quality assessment, critical appraisal and impacts on decision making.
Results:Twelve publications on REA have been included. More similarities were found in the methodology between rapid review and SR than with Mini-HTA. Shortcuts in performing rapid reviews included evaluation scope, number of databases, gray literature websites, studies design mainly SR, reviewers number, critical appraisal and production time (3 to 6 months). Study selection and data extraction by two independent reviewers in rapid reviews were seen in thirty-four percent to thirty-eight percent and ten percent to twenty-two percent, respectively. Furthermore, assessment quality was optional. Although it is performed within a short timeframe (2 months), methodology to conduct Mini-HTA is not well defined in the literature. The scope is mainly to support decision making in the introduction of new medical devices. Impacts of REA on local health decision making process are not well documented.
Conclusions:Methodology to conduct REA is quite diverse. According to the data available, rapid review is a more robust methodology for HB-HTA producers than Mini-HTA. Although impacts were not well reported, rapid reviews could be more useful to support health decision making in local context.
VP191 Peripheral Nerve Field Stimulation For Chronic Low Back Pain
- Marc Rhainds, Brigitte Larocque, Sylvain Bussières, Alice Nourrisat, Martin Coulombe, Léo Cantin, Jean-Francois Canuel, Michel Prudhomme
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- Journal:
- International Journal of Technology Assessment in Health Care / Volume 33 / Issue S1 / 2017
- Published online by Cambridge University Press:
- 12 January 2018, p. 238
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INTRODUCTION:
Despite numerous medical, pharmacological and surgical approaches for chronic low back pain (LBP), many patients continue to complain of severe disabling pain. Peripheral nerve field stimulation (PNfS), alone or combined with spinal cord stimulation, is a neuromodulation procedure that have been recently developed and implemented in our hospital. We conducted a Health Technology Assessment (HTA) to determine if PNfS may be considered as a standard of practice in the management of intractable LBP and failed back surgery syndrome (FBSS).
METHODS:An interdisciplinary group of experts was involved in the project. A systematic review (SR) was performed in several databases and grey literature to identify clinical practice guidelines, SR and observational studies published through September 2016. A survey was conducted among other chronic pain centers in Canada to document PNfS use in LBP and FBSS treatment.
RESULTS:Data on effectiveness and safety of PNfS in chronic LBP treatment were scarce. Short-term results (3-12 months) from small sample and low quality studies suggest that PNfS, alone or combined with spinal cord stimulation, is associated with pain intensity and opioid use reductions. Effects on functional status and quality of life remain undetermined. Most frequent adverse events reported with PNfS devices are lead migrations, discomfort or pain and surgical site infections. No other Canadian pain centers were found to use PNfS in chronic LBP or FBSS.
CONCLUSIONS:PNfS is potentially a beneficial treatment option for patients with chronic low back pain or FBSS. However, the value of this innovative treatment remains unknown. Among factors to be clarified are target population (any chronic low back pain or FBSS), use of PNfS alone or combined with spinal cord stimulation, long-term effects, and comparison with conventional medical management. PNfS use in chronic LBP has to be assessed through a rigorous framework before its introduction as a standard medical practice.