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Background: Thrombotic thrombocytopenic purpura (TTP) is a rare, life-threatening thrombotic microangiopathy (TMA), characterized by ADAMTS-13 activity <10%. ADAMTS-13 activity assays are typically performed in reference laboratories with a turnaround time of several days. First-line treatment for TTP, therapeutic plasma exchange (TPE), typically starts while results are pending. The automated, on-demand HemosIL AcuStar ADAMTS-13 Activity assay provides results in under an hour, which could reduce unnecessary TPE use and associated costs. Objectives: To estimate the hospital budget impact in the United States, United Kingdom, and France of using a rapid ADAMTS-13 activity assay. Methods: We compared routine use of a rapid assay in adults with TMA with a scenario in which results take 3 days. Model structure and variables were based on published literature, plus survey and interviews of five clinicians from the three countries. Costs for the ADAMTS-13 activity assays and TPE were included. Results: Model results suggest that if an on-demand, rapid ADAMTS-13 activity assay is used, US, UK, and French hospitals could save $18 million, £1.2 million, and 1.6 million annually, respectively. This equates to $10 788, £3497, and 4700 saved per patient with TMA in the United States, United Kingdom, and France. The model is most sensitive to the exact split of diagnoses of TMA cases, as savings accrue from non-TTP diagnoses. Conclusions: In patients with TMA, use of a rapid, on-demand ADAMTS-13 activity assay such as the HemosIL AcuStar ADAMTS-13 Activity assay has the potential to be cost saving for hospitals.
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The studyHodkinson A, Kontopantelis E, Adeniji C, et al. Accelerometer- and pedometer-based physical activity interventions among adults with cardiometabolic conditions: a systematic review and meta-analysis JAMA Network Open 2019;2:e1912895.This study was funded by the NIHR School for Primary Care Research (project number 390 ESWG Workstream 3).To read the full NIHR Signal, go to: https://discover.dc.nihr.ac.uk/content/signal-000880/pedometers-can-help-people-get-more-active-as-part-of-an-exercise-programme.
Assuntos
Actigrafia/instrumentação , Exercício Físico , Terapia por Exercício , Humanos , Atenção Primária à SaúdeRESUMO
The studyPalmer R, Dimairo M, Cooper C, et al. Self-managed, computerised speech and language therapy for patients with chronic aphasia post-stroke compared with usual care or attention control (Big CACTUS): a multicentre, single-blinded, randomised controlled trial. Lancet Neurol 2019;18:821-33.This project was funded by the NIHR Health Technology Assessment Programme (project number 12/21/01) and the Tavistock Trust for Aphasia.To read the full NIHR Signal, go to: https://discover.dc.nihr.ac.uk/content/signal-000864/after-a-stroke-computerised-speech-and-language-therapy-can-help-people-find-words.
Assuntos
Afasia , Acidente Vascular Cerebral , Atenção , Humanos , Terapia da Linguagem , FalaRESUMO
The studyHewlett S, Almeida C, Ambler N, et al. Reducing arthritis fatigue impact: two-year randomised controlled trial of cognitive behavioural approaches by rheumatology teams (RAFT). Ann Rheum Dis 2019;78:465-72.Hewlett S, Almeida C, Ambler N, et al. Group cognitive behavioural programme to reduce the impact of rheumatoid arthritis fatigue: the RAFT RCT with economic and qualitative evaluations. Health Technol Assess 2019;23:57.This project was funded by the NIHR Health Technology Assessment Programme (project number 11/112/01).To read the full NIHR Signal, go to: https://discover.dc.nihr.ac.uk/content/signal-000860/group-cognitive-behavioural-courses-may-reduce-fatigue-from-rheumatoid-arthritis.
Assuntos
Artrite Reumatoide/complicações , Terapia Cognitivo-Comportamental/métodos , Fadiga/prevenção & controle , Fadiga/terapia , Psicoterapia de Grupo/métodos , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
The studyThe CRASH-3 Trial Collaborators. Effects of tranexamic acid on death, disability, vascular occlusive events and other morbidities in patients with acute traumatic brain injury (CRASH-3): a randomised, placebo-controlled trial. Lancet 2019;394:1713-23.This trial was funded by NIHR Health Technology Assessment Programme (project number 14/190/01), JP Moulton Charitable Trust, Department of Health and Social Care, Department for International Development, Global Challenges Research Fund, Medical Research Council, and the Wellcome Trust (Joint Global Health Trials scheme).To read the full NIHR Signal, go to: https://discover.dc.nihr.ac.uk/content/signal-000870/tranexamic-acid-following-mild-to-moderate-traumatic-brain-injury-is-safe-and-reduces-deaths.
Assuntos
Antifibrinolíticos , Lesões Encefálicas Traumáticas , Doenças Vasculares , Humanos , Avaliação da Tecnologia Biomédica , Ácido TranexâmicoRESUMO
The studyDambha-Miller H, Day AJ, Strelitz J, et al. Behaviour change, weight loss and remission of Type 2 diabetes: a community-based prospective cohort study. Diabet Med 2019. doi:10.1111/dme.14122This project was funded by the NIHR Health Technology Assessment Programme (project number 08/116/300) as well as the Wellcome Trust (grant number: G061895), the Epidemiology Unit programme (MC_UU_12015/4), and the National Health Service R&D support funding.To read the full NIHR Signal, go to: https://discover.dc.nihr.ac.uk/content/signal-000841/weight-loss-after-type-2-diabetes-diagnosis-boosts-chance-of-remission.
Assuntos
Diabetes Mellitus Tipo 2 , Redução de Peso , Peso Corporal , Humanos , Estudos Prospectivos , Medicina EstatalRESUMO
The studyCleland LC, McComb L, Kee F, et al. Effects of 20 mph interventions on a range of public health outcomes: a meta-narrative evidence synthesis. J Transp Health 2019. doi:10.1016/j.jth.2019.100633This project was funded by the NIHR Policy Research Programme (project number 17/149/19).To read the full NIHR Signal, go to: https://discover.dc.nihr.ac.uk/content/signal-000853/twenty-mph-speed-zones-reduce-the-danger-to-pedestrians-and-cyclists.
Assuntos
Acidentes de Trânsito/prevenção & controle , Condução de Veículo/legislação & jurisprudência , Ciclismo/lesões , Pedestres , Ferimentos e Lesões/prevenção & controle , Ciclismo/legislação & jurisprudência , Humanos , Reino UnidoRESUMO
Treatment adherence in adults with cystic fibrosis (CF) is poor. One of the reasons identified for lack of adherence to nebulised treatments is that patients may not experience any immediate relief in their symptoms or notice changes as a result of taking their treatment, thus many report that they do not perceive there to be consequences of non adherence. The aim of the study was to investigate the temporal relationships between symptoms and adherence to nebulised treatments in adults with CF using an N-of-1 observational design. Six participants were recruited for a six-week period during which time they completed a daily online respiratory symptom questionnaire. Adherence to treatment was measured throughout the duration of the study using an eTrack® nebuliser that logged date and time of treatments taken. Data generated from each participant was analysed separately. There were significant relationships between pain and adherence for three participants, tiredness and adherence for one participant and cough and adherence for one participant. For all of these findings, the symptom and adherence were experienced on the same day. Extending the monitoring period beyond six weeks may provide increased insight into the complex relationship between symptoms and adherence in CF.
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BACKGROUND: Inaccessible services and poor communication are barriers to successful transitions between adolescent and adult mental health services, for which digital communications (DC) offer a possible solution. AIMS: To investigate the role of DC, including smartphone apps, email and text, given the known barriers and facilitators of mental health service transitions reported in the literature. METHODS: Use of Neale's (2016) iterative categorisation technique to undertake a secondary analysis of qualitative data collected for the Long-term conditions Young people Networked Communication (LYNC) study. RESULTS: DC were used successfully by young people and staff in ways that ameliorated known barriers to service transitions. They engendered responsibility in young people, promoted service access and contributed to client safety, particularly in times of crisis. DC risks included over-familiarity between young people and staff, and the possibility that messages could go unread. CONCLUSIONS: DC have the potential to facilitate trust and familiarity during and after transition to adult mental health services. They can strengthen young people's perceptions of adult services as supportive, empowering and available. DC can be used for frequent 'check-ins' and remote digital support for social and personal problems. They provide an additional safety net for at-risk individuals, but require careful boundary setting.
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The studyEveritt H, Landau G, Little P. Therapist telephone-delivered CBT and web-based CBT compared with treatment as usual in refractory irritable bowel syndrome: the ACTIB three-arm RCT. Health Technol Assess 2019;23:1-154.This project was funded by the NIHR Health Technology Assessment Programme (project number 11/69/02).To read the full NIHR Signal, go to https://discover.dc.nihr.ac.uk/content/signal-000784/irritable-bowel-syndrome-helped-by-telephone-or-internet-cbt.
Assuntos
Síndrome do Intestino Irritável , Humanos , Internet , Fonoterapia , Avaliação da Tecnologia Biomédica , TelefoneRESUMO
The studyGilbert R, Brown M, Rainford N et al. Antimicrobial-impregnated central venous catheters for prevention of neonatal bloodstream infection (PREVAIL): an open-label, parallel-group, pragmatic, randomised controlled trial. Lancet Child Adolesc Health 2019;3:381-90.The study was funded by the NIHR Health Technology Assessment programme (project number 12/167/02).To read the full NIHR Signal, go to https://discover.dc.nihr.ac.uk/content/signal-000782/antimicrobial-central-venous-catheters-for-pre-term-babies-do-not-reduce-infections.
Assuntos
Anti-Infecciosos , Bacteriemia , Cateteres Venosos Centrais , Antibacterianos , Criança , Humanos , Lactente , Recém-Nascido , Avaliação da Tecnologia BiomédicaRESUMO
The studyLyttle MD, Rainford NEA, Gamble C, et al. Levetiracetam versus phenytoin for second-line treatment of paediatric convulsive status epilepticus (EcLiPSE): a multicentre, open-label, randomised trial. Lancet 2019;393:2125-34.This trial was funded by the NIHR Health Technology Assessment Programme (project number 12/127/134).To read the full NIHR Signal, go to https://discover.dc.nihr.ac.uk/content/signal-000790/levetiracetam-vs-phenytoin-in-stopping-childrens-prolonged-epileptic-seizures.
Assuntos
Epilepsia , Estado Epiléptico , Criança , Humanos , Levetiracetam , Fenitoína , ConvulsõesRESUMO
The studyPeden CJ, Stephens T, Martin G et al. Effectiveness of a national quality improvement programme to improve survival after emergency abdominal surgery (EPOCH): a stepped-wedge cluster-randomised trial. Lancet 2019;393:2213-21.This project was funded by the NIHR Health Services and Delivery Research Programme (project number 12/5005/10).To read the full NIHR Signal, go to https://discover.dc.nihr.ac.uk/content/signal-000789/national-quality-improvement-programmes-need-time-and-resources-to-have-impact.
Assuntos
Dor Abdominal/cirurgia , Procedimentos Cirúrgicos do Sistema Digestório , Tratamento de Emergência , Melhoria de Qualidade/organização & administração , Doença Aguda , Análise por Conglomerados , Procedimentos Clínicos , Procedimentos Cirúrgicos do Sistema Digestório/normas , Tratamento de Emergência/normas , Humanos , Avaliação de Programas e Projetos de Saúde , Melhoria de Qualidade/normasRESUMO
The studyTaylor RS, Walker S, Ciani O, et al. Exercise-based cardiac rehabilitation for chronic heart failure: the EXTRAMATCH II individual participant data meta-analysis. Health Technol Assess 2019;23:1-98.This project was funded by the NIHR Health Technology Assessment Programme (project number 15/80/30).To read the full NIHR Signal, go to https://discover.dc.nihr.ac.uk/content/signal-000803/cardiac-rehabilitation-for-heart-failure-can-improve-quality-of-life-and-fitness.
Assuntos
Reabilitação Cardíaca , Insuficiência Cardíaca , Exercício Físico , Terapia por Exercício , Humanos , Qualidade de VidaRESUMO
The studyTaylor S, Mallett S, Beare S et al. Diagnostic accuracy of whole-body MRI versus standard imaging pathways for metastatic disease in newly diagnosed colorectal cancer: the prospective Streamline C trial. Lancet Gastroenterol Hepatol 2019;4:529-37.This project was funded by the NIHR Health Technology Assessment Programme (project number 10/68/01).To read the full NIHR Signal, go to https://discover.dc.nihr.ac.uk/content/signal-000797/identifying-metastatic-disease-in-colorectal-cancer-with-whole-body-mri.
Assuntos
Neoplasias Colorretais , Segunda Neoplasia Primária , Humanos , Imageamento por Ressonância Magnética , Estudos Prospectivos , Avaliação da Tecnologia BiomédicaRESUMO
The studyStory A, Aldridge R, Smith C, et al. Smartphone-enabled video-observed versus directly observed treatment for tuberculosis: a multicentre, analyst-blinded, randomised, controlled superiority trial. Lancet 2019;393:1216-24.The study was funded by the NIHR Programme Grants for Applied Research programme (project number RP-PG-0407-10340).To read the full NIHR Signal, go to https://discover.dc.nihr.ac.uk/content/signal-000777/smartphones-for-tb-treatment-observation.
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Smartphone , Tuberculose , HumanosRESUMO
The studyFeatherstone K, Northcott A, Harden J, et al. Refusal and resistance to care by people living with dementia being cared for within acute hospital wards: an ethnographic study. Health Serv Deliv Res 2019;7.This study was funded by the National Institute for Health Research Health Services and Delivery Research Programme (project number 13/10/80).To read the full NIHR Signal, go to https://discover.dc.nihr.ac.uk/content/signal-000779/understanding-dementia-care-in-hospitals.
Assuntos
Demência/enfermagem , Demência/psicologia , Hospitalização , Cooperação do Paciente , Inglaterra , Humanos , Relações Profissional-Paciente , Medicina Estatal/normas , País de GalesRESUMO
The studyA Rodger, V Cambiano, T Bruun, et al. Risk of HIV transmission through condomless sex in serodifferent gay couples with the HIV-positive partner taking suppressive antiretroviral therapy (PARTNER): final results of a multicentre, prospective, observational study. Lancet 2019;393:2428-38.This project was funded by the NIHR Research for Patient Benefit Programme (project number PB-PG-1013-32069).To read the full NIHR Signal, go to https://discover.dc.nihr.ac.uk/content/signal-000785/antiretroviral-treatment-can-reduce-the-risk-of-hiv-transmission-between-male-partners-to-zero.
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Infecções por HIV , Minorias Sexuais e de Gênero , HIV , Humanos , Masculino , Estudos Prospectivos , Parceiros SexuaisRESUMO
The studyFawsitt C, Thom H, Hunt L. Choice of prosthetic implant combinations in total hip replacement: cost-effectiveness analysis using UK and Swedish hip joint registries data. Value Health 2019;22:303-12.This study was funded by the NIHR Research for Patient Benefit Programme (project number PB-PG-0613-31032).To read the full NIHR Signal, go to https://discover.dc.nihr.ac.uk/content/signal-000771/a-traditional-hip-implant-is-as-effective-as-more-expensive-newer-types-for-older-people.
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Artroplastia de Quadril , Desenho de Equipamento , Prótese de Quadril , Complicações Pós-Operatórias , Reoperação , Idoso , Artroplastia de Quadril/efeitos adversos , Artroplastia de Quadril/instrumentação , Artroplastia de Quadril/métodos , Cerâmica/uso terapêutico , Análise Custo-Benefício , Desenho de Equipamento/métodos , Desenho de Equipamento/normas , Feminino , Prótese de Quadril/classificação , Prótese de Quadril/normas , Humanos , Masculino , Próteses Articulares Metal-Metal , Osteoartrite do Quadril/cirurgia , Avaliação de Resultados em Cuidados de Saúde , Polietileno/uso terapêutico , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/cirurgia , Falha de Prótese/efeitos adversos , Reoperação/métodos , Reoperação/estatística & dados numéricos , Reino UnidoRESUMO
The studyGazzard G, Konstantakopoulou G, Garway-Heath E, et al. Selective laser trabeculoplasty versus eye drops for first-line treatment of ocular hypertension and glaucoma (LiGHT): a multicentre randomised controlled trial. Lancet 2019; doi:10.1016/S0140-6736(18)32213-XThis project was funded by the NIHR Health Technology Assessment Programme (project number 09/104/40) and was sponsored by the Moorfields Eye Hospital NHS Foundation Trust.To read the full NIHR Signal, go to https://discover.dc.nihr.ac.uk/content/signal-000774/early-glaucoma-laser-eye-treatment-trabeculoplasty.