Evidence Updates Homepage – Public Health Key Documents

The Health Care Team produce a monthly report on evidence updates. The methods used to identify potentially relevant evidence and circulate it each month can be viewed here.

Past months’ updates (plus this months in PDF format) can be accessed at the bottom of the page.

Public Health Key Documents September 2017

NIHR

Clinical and cost-effectiveness of beta interferon and glatiramer acetate for treating multiple sclerosis: systematic review and economic evaluation
There was very little difference between drugs in reducing moderate or severe relapse rates in relapsing–remitting multiple sclerosis (RRMS). All were beneficial compared with best supportive care (BSC). Disease-modifying therapies (DMT) were clinically effective for RRMS and clinically isolated syndrome (CIS) but cost-effective only for CIS.
Health Technology Assessment
Systematic search: Yes
September 2017
https://www.journalslibrary.nihr.ac.uk/hta/hta21520/#/abstract

Molecular testing for Lynch syndrome in people with colorectal cancer: systematic reviews and economic evaluation
Evidence suggests that microsatellite instability (MSI) – and immunohistochemistry (IHC)-based testing can be used to identify Lynch syndrome in colorectal cancer (CRC) patients, although there was heterogeneity in the methods used in the studies identified and the results of the studies. There was no high-quality empirical evidence that screening improves long-term outcomes.
Health Technology Assessment
Systematic search: Yes
September 2017
https://www.journalslibrary.nihr.ac.uk/hta/hta21510/#/abstract

KINGS FUND

Nil

HIS

Evidence note 70: In patients with clinically stable rheumatoid arthritis (clinical remission), can musculoskeletal ultrasound in addition to clinical examination detect or rule out inflammation that predicts subsequent joint damage to inform tapering and discontinuation of therapy?
Evidence suggests that synovitis or inflammation detected on musculoskeletal ultrasound is predictive of relapse or progression of joint damage in rheumatoid arthritis patients in clinical remission.
See also Advice Statement 007/17: http://www.healthcareimprovementscotland.org/our_work/technologies_and_medicines/shtg_advice_statements/advice_statement_007-17.aspx
HIS Evidence Note
Systematic search: Limited
September 2107
http://www.healthcareimprovementscotland.org/our_work/technologies_and_medicines/shtg_-_evidence_notes/evidence_note_70.aspx

Evidence note 71: What is the clinical effectiveness, cost effectiveness and safety of home and mobile health monitoring (HMHM) in addition to usual care compared with usual care for adults with diabetes (Type 1 and Type 2)?
HMHM studies had a wide variation in population, technology, and clinical interventions, preventing firm conclusions being drawn. Evidence was consistent with an improvement in blood glucose control with HMHM use. However, it is unclear whether the reductions in HbA1c are clinically significant, sustainable and independent of other aspects of diabetes care.
See also Advice Statement 008/17: http://www.healthcareimprovementscotland.org/our_work/technologies_and_medicines/shtg_advice_statements/advice_statement_008-17.aspx
HIS Evidence Note
Systematic search: Limited
September 2107
http://www.healthcareimprovementscotland.org/our_work/technologies_and_medicines/shtg_-_evidence_notes/evidence_note_71.aspx

Advice Statement 005/17: What is the evidence for the effectiveness and cost effectiveness of vocational rehabilitation in relation to health outcomes and non- health outcomes for people with inflammatory arthritis?
From the heterogeneous evidence identified it was not possible to reach a firm
conclusion on the clinical or cost effectiveness of vocational rehabilitation for
patients with inflammatory arthritis. A body of qualitative evidence, mainly from people with rheumatoid arthritis, points to the need for tailored interventions to target barriers to work participation. HIS Advice Statement
Systematic search: Limited
September 2107
http://www.healthcareimprovementscotland.org/our_work/technologies_and_medicines/shtg_advice_statements/advice_statement_005-17.aspx

Advice Statement 006/17: In patients with suspected rheumatoid arthritis, does the addition of musculoskeletal ultrasound (MSUS) increase the ability of rheumatologists to confirm or rule out a diagnosis of rheumatoid arthritis at an earlier stage compared to conventional diagnostic assessment alone?
There is evidence to support the addition of MSUS to clinical assessment and laboratory testing to diagnose rheumatoid arthritis at an earlier stage of the disease. Use of ultrasound increased detection of joint inflammation and was more likely to correctly predict progression to inflammatory arthritis in patients with suspected rheumatoid arthritis
HIS Advice Statement
Systematic search: Limited
September 2107
http://www.healthcareimprovementscotland.org/our_work/technologies_and_medicines/shtg_advice_statements/advice_statement_006-17.aspx

SGHD

Nil

SIGN

Nil

HEALTH SCOTLAND

Nil

NICE

CG28 Depression in children and young people: identification and management
This guideline covers identifying and managing depression in children and young people aged between 5 and 18 years. Based on the stepped care model, it aims to improve recognition and assessment and promote effective treatments for mild, moderate and severe depression.
NICE Guidance
Systematic search: Yes
September 2017
https://www.nice.org.uk/guidance/cg28

CG54 Urinary tract infection in under 16s: diagnosis and management
This guideline covers diagnosing and managing first or recurrent upper or lower urinary tract infections in infants, children and young people. It aims to achieve more consistent clinical practice, based on accurate diagnosis and effective management.
NICE Guidance
Systematic search: Yes
September 2017
https://www.nice.org.uk/guidance/cg54

CG153 Psoriasis: assessment and management
This guideline covers assessing and managing psoriasis in adults, young people and children. It aims to improve long-term disease control and quality of life for people with psoriasis.
NICE Guidance
Systematic search: Yes
September 2017
https://www.nice.org.uk/guidance/cg153

CG156 Fertility problems: assessment and treatment
This guideline covers diagnosing and treating fertility problems. It aims to reduce variation in practice and improve the way fertility problems are investigated and managed. See also NG73 Endometriosis: diagnosis and management (below).
NICE Guidance
Systematic search: Yes
September 2017
https://www.nice.org.uk/guidance/cg156

NG51 Sepsis: recognition, diagnosis and early management
This guideline covers the recognition, diagnosis and early management of sepsis for all populations. The guideline committee identified that the key issues to be included were: recognition and early assessment, diagnostic and prognostic value of blood markers for sepsis, initial treatment, escalating care, identifying the source of infection, early monitoring, information and support for patients and carers, and training and education.
NICE Guidance
Systematic search: Yes
September 2017
https://www.nice.org.uk/guidance/ng51

NG73 Endometriosis: diagnosis and management
This guideline covers diagnosing and managing endometriosis. It aims to raise awareness of the symptoms of endometriosis, and to provide clear advice on what action to take when women with signs and symptoms first present in healthcare settings. It also provides advice on the range of treatments available.
NICE Guidance
Systematic search: Yes
September 2017
https://www.nice.org.uk/guidance/ng73

NG74 Intermediate care including reablement
This guideline covers referral and assessment for intermediate care and how to deliver the service. Intermediate care is a multidisciplinary service that helps people to be as independent as possible. It provides support and rehabilitation to people at risk of hospital admission or who have been in hospital. It aims to ensure people transfer from hospital to the community in a timely way, and to prevent unnecessary admissions to hospitals and residential care.
NICE Guidance
Systematic search: Yes
September 2017
https://www.nice.org.uk/guidance/ng74

NG75 Faltering growth: recognition and management of faltering growth in children
This guideline covers recognition, assessment and monitoring of faltering growth in infants and children. It includes a definition of growth thresholds for concern and identifying the risk factors for, and possible causes of, faltering growth. It also covers interventions, when to refer, service design, and information and support.
NICE Guidance
Systematic search: Yes
September 2017
https://www.nice.org.uk/guidance/ng75

PH21 Immunisations: reducing differences in uptake in under 19s
This guideline covers increasing immunisation uptake among children and young people aged under 19 years in groups and settings where immunisation coverage is low. It aims to improve access to immunisation services and increase timely immunisation of children and young people. It also aims to ensure babies born to mothers infected with hepatitis B are immunised.
NICE Guidance
Systematic search: Yes
September 2017
https://www.nice.org.uk/guidance/ph21

PH38 Type 2 diabetes: prevention in people at high risk
This guideline covers how to identify adults at high risk of type 2 diabetes. It aims to remind practitioners that age is no barrier to being at high risk of, or developing, the condition. It also aims to help them provide those at high risk with an effective and appropriate intensive lifestyle-change programme to prevent or delay the onset of type 2 diabetes.
NICE Guidance
Systematic search: Yes
September 2017
https://www.nice.org.uk/guidance/ph38

TA357 Pembrolizumab for treating advanced melanoma after disease progression with ipilimumab
Pembrolizumab is recommended as an option for treating advanced (unresectable or metastatic) melanoma in adults only after the disease has progressed with ipilimumab and, for BRAF V600 mutation‑positive disease, a BRAF or MEK inhibitor.
NICE Technology Appraisal
Systematic search: Yes
September 2017
https://www.nice.org.uk/guidance/ta357

TA366 Pembrolizumab for advanced melanoma not previously treated with ipilimumab
Pembrolizumab is recommended as an option for treating advanced (unresectable or metastatic) melanoma that has not been previously treated with ipilimumab, in adults.
NICE Technology Appraisal
Systematic search: Yes
September 2017
https://www.nice.org.uk/guidance/ta366

TA428 Pembrolizumab for treating PD-L1-positive non-small-cell lung cancer after chemotherapy
Pembrolizumab is recommended as an option for treating locally advanced or metastatic PD‑L1-positive non-small-cell lung cancer in adults who have had at least one chemotherapy (and targeted treatment if they have an epidermal growth factor receptor [EGFR]- or anaplastic lymphoma kinase [ALK]‑positive tumour).
NICE Technology Appraisal
Systematic search: Yes
September 2017
https://www.nice.org.uk/guidance/ta428

TA439 Cetuximab and panitumumab for previously untreated metastatic colorectal cancer
Cetuximab and Panitumumab are recommended as options for previously untreated epidermal growth factor receptor (EGFR)-expressing, RAS wild-type metastatic colorectal cancer in adults, in combination with FOLFOX or FOLFIRI.
NICE Technology Appraisal
Systematic search: Yes
September 2017
https://www.nice.org.uk/guidance/ta439

TA474 Sorafenib for treating advanced hepatocellular carcinoma
Sorafenib is recommended as an option for treating advanced hepatocellular carcinoma only for people with Child-Pugh grade A liver impairment.
NICE Technology Appraisal
Systematic search: Yes
September 2017
https://www.nice.org.uk/guidance/ta474

TA475 Dimethyl fumarate for treating moderate to severe plaque psoriasis
Dimethyl fumarate is recommended as an option for treating plaque psoriasis in adults, only if the disease is severe (PASI > 10 or DLQI > 10) and has not responded to other systemic therapies, including, ciclosporin, methotrexate and PUVA (psoralen and long-wave ultraviolet A radiation), or these options are contraindicated or not tolerated.
NICE Technology Appraisal
Systematic search: Yes
September 2017
https://www.nice.org.uk/guidance/ta475

TA476 Paclitaxel as albumin-bound nanoparticles with gemcitabine for untreated metastatic pancreatic cancer
Paclitaxel as albumin-bound nanoparticles (nab‑paclitaxel) with gemcitabine is recommended as an option for untreated metastatic adenocarcinoma of the pancreas in adults, only if other combination chemotherapies are unsuitable and they would otherwise have gemcitabine monotherapy
NICE Technology Appraisal
Systematic search: Yes
September 2017
https://www.nice.org.uk/guidance/ta476

EPPI Centre

Nil

AHRQ (Agency for Healthcare Research and Quality – USA)

Nil

Health Foundation

Nil

Canadian Agency for Drugs and Technologies in Health (CADTH)

Imiquimod for the Treatment of Genital Warts: A Review of Clinical Effectiveness and Cost-Effectiveness
Low quality evidence suggests that treatment with Imiquimod is associated with greater clearance of anogenital warts but greater adverse effects when compared with placebo. It appears there is no difference in clearance or adverse effects when compared with podophyllin, podophyllotoxin, cryotherapy, or Mycobacterium w vaccine.
CADTH Rapid Response Report
Systematic search: Limited
September 2017
https://www.cadth.ca/imiquimod-treatment-genital-warts-review-clinical-effectiveness-and-cost-effectiveness

Pimecrolimus for the Treatment of Adults with Atopic Dermatitis, Seborrheic Dermatitis, or Psoriasis: A Review of Clinical and Cost-Effectiveness
In atopic dermatitis, pimecrolimus is superior to vehicle (placebo) in decreasing the severity of the symptoms of the disease. There is some evidence maintenance therapy with pimecrolimus was not statistically significantly different than placebo. Evidence when comparing pimecrolimus to corticosteroid treatment is conflicting.
CADTH Rapid Response Report
Systematic search: Limited
September 2017
https://www.cadth.ca/pimecrolimus-treatment-adults-atopic-dermatitis-seborrheic-dermatitis-or-psoriasis-review-clinical-0

Management and Treatment of Cervicitis: A Review of Clinical Effectiveness and Guidelines
Limited evidence regarding the comparative clinical effectiveness of doxycycline versus azithromycin for the treatment of non-pregnant women with cervicitis caused by Neisseria gonorrhoeae, Chlamydia trachomatis, and Mycoplasma genitalium suggested that azithromycin was more effective at achieving both microbiological and clinical cure. Limited evidence favours using a test-and-wait approach over presumptive treatment in non-pregnant women with cervicitis of unknown etiology.
CADTH Rapid Response Report
Systematic search: Limited
September 2017
https://www.cadth.ca/management-and-treatment-cervicitis-review-clinical-effectiveness-and-guidelines

Behaviour Modification for the Treatment of Urinary Incontinence Resulting from Neurogenic Bladder: A Review of Clinical Effectiveness and Guidelines
There was no evidence that directly compared behavioural modification to pharmacologic treatment such as anticholinergics for the treatment of adults with urinary continence from neurogenic bladder. Earlier evidence suggested that pelvic floor muscle training (PFMT) lead to better control of stress urinary incontinence (SUI) in women as compared to no treatment or inactive control treatments.
CADTH Rapid Response Report
Systematic search: Limited
September 2017
https://www.cadth.ca/behaviour-modification-treatment-urinary-incontinence-resulting-neurogenic-bladder-review-clinical-0

Imiquimod for the Treatment of Actinic Keratosis: A Review of Clinical and Cost-Effectiveness
Good evidence showed that in patients with actinic keratosis (AK), treatment with imiquimod (IMQ) appeared to be better than placebo with respect to complete clearance. There was insufficient evidence to support conclusions regarding IMQ versus other active treatments for AK.
CADTH Rapid Response Report
Systematic search: Limited
September 2017
https://www.cadth.ca/imiquimod-treatment-actinic-keratosis-review-clinical-and-cost-effectiveness-0

Intensive Day Treatment Programs for Mental Health Treatment: A Review of Clinical Effectiveness, Cost-Effectiveness, and Guidelines
The available evidence suggests that intensive day treatment (such as day hospital treatment) is effective in treating various mental health disorders; however, there is limited data comparing the effectiveness of intensive day treatment to other psychological treatment modalities. The limited data available suggests there may be no difference between intensive day treatment and other treatment approaches such as inpatient treatment or standard weekly outpatient treatment.
CADTH Rapid Response Report
Systematic search: Limited
September 2017
https://www.cadth.ca/intensive-day-treatment-programs-mental-health-treatment-review-clinical-effectiveness-cost

Imiquimod for the Treatment of Basal Cell or Squamous Cell Carcinoma: A Review of Clinical Effectiveness and Cost-Effectiveness
For basal cell carcinoma, squamous cell carcinoma, and Bowen’s disease (in situ SCC), good evidence suggests that surgical excision was the most favorable treatment for complete lesion clearance, followed in order by imiquimod, cryotherapy, photodynamic therapy, fluorouracil, and placebo.
CADTH Rapid Response Report
Systematic search: Limited
September 2017
https://www.cadth.ca/imiquimod-treatment-basal-cell-or-squamous-cell-carcinoma-review-clinical-effectiveness-and-cost

Thromboelastography or Rotational Thromboelastography for Trauma: A Review of the Clinical and Cost-Effectiveness and Guidelines
The clinical effectiveness of TEG or ROTEG to guide transfusion requirements in trauma patients is unclear, due to lack of high quality studies. Evidence-based guidelines found that evidence was insufficient to recommend the use of TEG and ROTEG in trauma patients.
CADTH Rapid Response Report
Systematic search: Limited
September 2017
https://www.cadth.ca/thromboelastography-or-rotational-thromboelastography-trauma-review-clinical-and-cost-0

Soft Toothbrushes versus Foam Swabs for Oral Care: A Review of the Comparative Clinical Effectiveness, Cost-Effectiveness, and Guidelines
Weak evidence provided mixed findings for the efficacy of soft toothbrushes compared to oral swabs for oral care in patients at hospitals or long-term care facilities. One moderate-quality guideline for the oral care of adult patients with head and neck cancer recommends the use of twice daily brushing with a soft toothbrush and only recommends the use of oral sponges if the use of a toothbrush is painful.
CADTH Rapid Response Report
Systematic search: Limited
September 2017
https://www.cadth.ca/soft-toothbrushes-versus-foam-swabs-oral-care-review-comparative-clinical-effectiveness-cost

McGill University Health Centre (Canada)

Nil

Health Information & Quality Authority (Ireland)

Nil

Campbell Collaboration

Nil

Glasgow Centre for Population Health

Nil

NICE FORWARD PLANNING – Publications due October 2017

Asthma (eosinophilic) – reslizumab (after inhaled corticosteroids)
Single Technology Appraisal

Brentuximab vedotin for treating relapsed or refractory systemic anaplastic large cell lymphoma
Single Technology Appraisal

Knee cartilage defects – autologous chondrocyte implantation
Single Technology Appraisal

Child abuse and neglect
Social Care

Kidney transplantation (adults) – immunosuppressive therapy
Single Technology Appraisal

Kidney transplantation (children, adolescents) – immunosuppressive regimens
Single Technology Appraisal

Familial hypercholesterolaemia
Clinical Guideline

Cataracts in adults: management
Clinical Guideline

Cystic fibrosis: diagnosis and management
Clinical Guideline

Asthma management
Clinical Guideline

Asthma – diagnosis and monitoring
Clinical Guideline

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