Scanning the Horizon, February 09 - Newsletter - Service Planning and New health Intervention Assessment (SPNIA)

Scanning the Horizon: Recent Developments in Health Innovations and Technologies

February 2009

This newsletter provides links to systematic reviews and important research on health innovations and emerging new technologies. It is aimed to help District Health Boards and health care providers keep up to date with information to help them improve performance around the Ministry of Health's ten Health Targets and other relevant topics. The back issues can be found at http://www.moh.govt.nz/moh.nsf/indexmh/nstr-horizonscanning

In each issue, there are links to:

Recent Horizon Scanning Reports	Health Technology Assessments
Guidelines	Research reports.

In this current issue, areas of particular interest are:

Health Targets	Ageing in Place	Maternity
Cardiac Services	Surgical Site Infections	Complementary & Alternative Medicine.
Disability Services	Managing Long-Term Condtions

In some cases, we have provided links to journal articles for journals to which your organization might not subscribe. If you can not link directly to the full article and you want to order it, you can coordinate an interloan through your local library

If you come across a useful report that you think could be shared please let Stephen_Lungley@moh.govt.nz or Kristie_Saumure@moh.govt.nz know and we will consider it for a subsequent edition.

REDUCING AVOIDABLE ADMISSIONS
The effectiveness of interventions for reducing ambulatory sensitive hospitalisations (www.healthsac.net)
This systematic review [from the Health Services Assessment Collaboration] summarises evidence on the effectiveness of different therapeutic interventions, specific patterns of clinical practice, and models of health services delivery, for the reduction of ambulatory sensitive hospitalizations (ASH). ASH were defined as defined as hospital admissions due to those medical conditions that could be avoided by provision of outpatient-based primary care. Overall, five care processes emerged as particularly beneficial in reducing ASH.

Interventions found to be effective were:

comprehensive, multidisciplinary, team based, collaborative, and patient-centric programmes
education based comprehensive care programmes,
interventions that aimed at increasing access, or providing a wider coverage of healthcare delivery services for all patients in the system, in particular for children, the poor and underserved
observation units for diseases that are amenable to home based pharmacological management, and
telemedicine and computer based programmes where patients and health care providers interacted with each other.

A summary of the report is available (www.healthsac.net)

See also:
What works in management of chronic care: heart failure as an example (www.commonwealthfund.org)
Can home visits help reduce hospital readmissions? Randomized controlled trial (www.ncbi.nlm.nih.gov)
Telehome monitoring in patients with cardiac disease who are at high risk of readmission (www.ncbi.nlm.nih.gov)

REDUCING THE HARM CAUSED BY TOBACCO
Pharmacotherapies for smoking cessation: a meta-analysis of randomized controlled Trials (www.ncbi.nlm.nih.gov)
“Many placebo-controlled trials have demonstrated the efficacy of individual pharmacotherapies approved for smoking cessation. However, few direct or indirect comparisons of such interventions have been conducted. [The researchers] performed a meta-analysis to compare the treatment effects of 7 approved pharmacologic interventions for smoking cessation. Varenicline, bupropion and the 5 nicotine replacement therapies were all more efficacious than placebo at promoting smoking abstinence at 6 and 12 months.”

The RealU online cessation intervention for college smokers: a randomized controlled trial (www.ncbi.nlm.nih.gov)
The goal of this study was “to determine the efficacy of providing online cessation intervention for college smokers…[The researchers found that] providing personalized smoking cessation messages as part of a general interest online college life magazine increased 30-day abstinence by the end of this two semester intervention.”

Smoking cessation intervention for female prisoners: addressing an urgent public health need (www.ncbi.nlm.nih.gov)
The researchers “tested the efficacy of a combined pharmacologic and behavioral smoking cessation intervention among women in a state prison in the southern United States. [Their findings reveal that] female prisoners are interested in smoking cessation interventions and achieved point-prevalence quit rates similar to community samples. Augmenting tobacco control policies in prison with smoking cessation interventions has the potential to address a significant public health need.”

IMPROVING ORAL HEALTH
Preventive Oral Health Intervention for Pediatricians (www.pediatrics.aappublications.org)
“This American Academy of Pediatrics policy--[Oral Health Interventions for Pediatricians]--is a compilation of current concepts and scientific evidence required to understand and implement practice-based preventive oral health programs designed to improve oral health outcomes for all children and especially children at significant risk of dental decay. In addition, it reviews cariology [study of dental caries] and caries risk assessment and defines, through available evidence, appropriate recommendations for preventive oral health intervention by primary care pediatric practitioners.”

The role of health-related behaviors in the socioeconomic disparities in oral health (www.ncbi.nlm.nih.gov)
“This study aimed to examine the socioeconomic disparities in health-related behaviors and to assess if behaviors eliminate socioeconomic disparities in oral health in a nationally representative sample of adult Americans… The results showed clear socioeconomic disparities in all behaviors. These findings imply that improvement in health-related behaviors may lessen, but not eliminate socioeconomic disparities in oral health, and suggest the presence of more complex determinants of these disparities which should be addressed by oral health preventive policies.”

CARDIAC SERVICES
Incremental prognostic value of the exercise electrocardiogram in the initial assessment of patients with suspected angina: cohort study (www.bmj.com)
This multicentre cohort study was intended to determine whether resting and exercise electrocardiograms (ECGs) provide prognostic value that is incremental to that obtained from the clinical history in ambulatory patients with suspected angina attending chest pain clinics. The researchers found that in ambulatory patients with suspected angina, basic clinical assessment encompasses nearly all the prognostic value of resting ECGs and most of the prognostic value of exercise ECGs. ‘The limited incremental value of these widely applied tests emphasises the need for more effective methods of risk stratification in this group of patients.’

Cost effective methods of investigation of suspected angina (www.nice.org)
Exercise electrocardiography (ECG) is widely available and comparatively cheap but has more limited diagnostic power and its incremental prognostic power over clinical assessment is poor compared with myocardial perfusion scintigraphy . Recent NICE guidance has found scintigraphy to be both effective and cost effective in assessing patients presenting with possible stable angina. Clinical and modelling studies have shown that a strategy that omits exercise ECG and goes straight to myocardial perfusion scintigraphy is cost effective, particularly in the intermediate likelihood group of patients who are commonly seen in rapid access chest pain clinics. Similarly, in the lower likelihood group, cost effective practice is to follow initial exercise ECG with myocardial perfusion scintigraphy if further investigation is required.

Remote monitoring systems for patients with implanted cardiac devices (www.msac.gov.au - PDF, 2.8 MB)
This MSAC study evaluated the safety, effectiveness and cost-effectiveness of remote monitoring systems for patients with pacemakers, implantable cardioverter defibrillators (ICD) and cardiac resynchronisation therapy (CRT) devices. It concluded there appeared to be no direct safety issues associated with remote monitoring but that clinical effectiveness is not demonstrated in the studies reviewed.

See also:
Telehome monitoring in patients with cardiac disease who are at high risk of readmission (www.ncbi.nlm.nih.gov)
What works in management of chronic care: heart failure as an example (www.commonwealthfund.org)

DISABILITY SERVICES
The effectiveness of digital hearing aids and assistive listening devices for adults with hearing loss: A systematic review of the literature (www.healthsac.net)
“This systematic review [from the Health Services Assessment Collaboration] provides a summary of the recent evidence pertaining to the effectiveness of various types and styles of digital hearing aids and assistive listening devices in the management of adults with various degrees of hearing loss. The review [compares] the use of digital hearing aids to the no use/ or to the use of other styles of digital hearing aids. The report did not include the use of analogue hearing aids (as an intervention or a comparator).”

Hearing aids in Belgium: Health technology assessment (www.kce.fgov.be)
“The purpose of this Health Technology Assessment on hearing aids is to examine the evidence for the efficacy and cost-effectiveness of various hearing aid characteristics; to describe the hearing aid market in Belgium and in other countries, to describe the reimbursement criteria and rules in several countries, and finally to assess hearing aid use, reimbursement and budgetary implications in Belgium, both today and in the foreseeable future.”

Comparing performance of manual wheelchair skills using new and conventional rear anti-tip devices: randomized controlled trial (www.ncbi.nlm.nih.gov)
These researchers sought “to test the hypotheses that, compared with participants using manual wheelchairs equipped with conventional rear anti-tip devices (C-RADs), those using a new RAD design that deploys through an arc (Arc-RAD) perform RAD-relevant wheelchair skills better and as safely. [They concluded that] ‘the new RAD design allows much better performance on relevant wheelchair skills than the conventional design without compromising safety.”

Mechanical efficiency and propulsion technique after 7 weeks of low-intensity wheelchair training(www.ncbi.nlm.nih.gov)
This study “evaluate[d] the effect of a 7-week low-intensity hand rim wheelchair training on the submaximal metabolic cost, mechanical efficiency and propulsion technique in able-bodied participants. [The researchers found that] a low-intensity, 7-week training protocol has a beneficial effect on the mechanical efficiency and metabolic cost of wheelchair propulsion in able-bodied participants. The improved mechanical efficiency seems to be the result of changes in propulsion technique.”

HIGHLIGHTED ISSUE: AGEING IN PLACE
Telehome monitoring in patients with cardiac disease who are at high risk of readmission (www.ncbi.nlm.nih.gov)
“A randomized control trial tested the impact of 3 months of telehome monitoring on hospital readmission, quality of life, and functional status in patients with heart failure or angina [and found that] telehome monitoring significantly reduced the number of hospital readmissions and days spent in the hospital for patients with angina and improved quality of life and functional status in patients with heart failure or angina. Patients found the technology easy to use and expressed high levels of satisfaction.”

Complex interventions to improve physical function and maintain independent living in elderly people: a systematic review and meta-analysis (www.thelancet.com)
“In old age, reduction in physical function leads to loss of independence, the need for hospital and long-term nursing-home care, and premature death. [These researchers] undertook a systematic review to assess the effectiveness of community-based complex interventions in preservation of physical function and independence in elderly people. Complex interventions can help elderly people to live safely and independently, and could be tailored to meet individuals' needs and preferences.”

Can home visits help reduce hospital readmissions? Randomized controlled trial (www.ncbi.nlm.nih.gov)
“This paper is a report of a study to determine whether home visits can reduce hospital readmissions. The phenomenon of hospital readmission raises concerns about the quality of care and appropriate use of resources. Home visits after hospital discharge have been introduced to help reduce hospital readmission rates, but the results have not been conclusive. The research found that preventive home visits were not effective in reducing hospital readmissions, but satisfaction with care was enhanced. Subjective well-being is a key variable that warrants attention in the planning and evaluation of post-discharge home care.”

Characteristics and quality of life of patients who choose home care at the end of life (www.ncbi.nlm.nih.gov)
The research aimed to determine appropriate forms of support for patients with advanced cancer and short-survival expectancy. A sample of advanced cancer patients were given hospital-based advanced home care (AHC) or conventional care (CC), according to their preference and to determine whether there were differences between the AHC and the CC patients that may help explain their choice of care. The AHC group showed significantly poorer functioning and an overall higher symptom burden than the CC patients. Fewer of the AHC patients were receiving cancer treatment and had lived longer with their cancer diagnosis, had a significantly shorter survival after study enrolment, and a significantly poorer performance status. The major differences between the two groups seemed to be related to being at different stages in their disease when they entered the research. The results indicate that patients are reluctant to accept home care until absolutely necessary due to severity of functioning impairments and symptom burden. Those planning palliative care could consider these findings.

HIGHLIGHTED ISSUE: SURGICAL SITE INFECTIONS
Prevention and treatment of surgical site infection (www.nice.org.uk)
“Surgical site infections cause up to 20% of all healthcare-associated infections, affecting at least 5% of patients undergoing a surgical procedure. Surgical site infections can have a significant effect on [mortality and] quality of life for the patient and have a considerable financial burden to healthcare providers… The National Institute for Health and Clinical Excellence (NICE) and the National Collaborating Centre for Women and Children’s Health have released a guideline on the prevention and treatment of surgical site infections. This covers advice for patients; use of antibiotic prophylaxis; preparation of patients skin and post operation treatment.”

Methods for identifying surgical wound infection after discharge from hospital: a systematic review (www.ncbi.nlm.nih.gov)
Existing research has not identified a valid and reliable method to prevent surgical wound infection. This review explored ways to establish robust methods of surveillance for those surgical site infections that occur post discharge and to develop a method of case ascertainment that is valid and reliable post discharge. At a local level, the method used to ascertain post discharge SSI will depend upon the purpose of the surveillance, the nature of available routine data and the resources available.”

Healing by primary closure versus open healing after surgery for pilonidal sinus: systematic review and meta-analysis (www.bmj.com)
The review found that wounds heal more quickly after primary closure than after open healing but at the expense of increased risk of recurrence. Benefits were clearly shown with off-midline closure compared with midline closure. [The authors concluded] that off-midline closure should become standard management for pilonidal sinus when closure is the desired surgical option.”

Surgical hand antisepsis to reduce surgical site infection (www.cochrane.org)
“Members of the surgical team routinely use antiseptic solutions as either scrubs or hand rubs with the aim of reducing the chance of the patient developing an infection following surgery. The research aimed to determine the effects of surgical hand antisepsis on the number of surgical site infections (SSIs) in patients and the effects of surgical hand antisepsis on the numbers of colony forming units (CFUs) of bacteria on the hands of the surgical team. Ten trials were included in the research. The authors concluded alcohol rubs used in preparation for surgery by the scrub team are as effective as aqueous scrubbing in preventing SSIs, though noted that this evidence comes from only one, equivalence, cluster trial which did not appear to adjust for clustering. Other studies suggested that alcohol rubs are at least as, if not more, effective than aqueous scrubs."

HIGHLIGHTED ISSUE: MANAGING LONG-TERM CONDITIONS
New Zealand, along with most advanced health systems, is experiencing a shift from acute and episodic illness as the dominant drivers of demand to long-term conditions such as diabetes, heart disease, stroke, Alzheimer’s, disease and cancer. These conditions are the leading causes of illness and early death. They account for around 80% of early deaths, and 70% of health costs.

Managing chronic conditions: Experience in eight countries (www.euro.who.int)
The book (available on-line) contains 8 articles and an overview on different countries’ experience in managing chronic conditions. The publication uses a SWOT [strengths, weaknesses, opportunities, threats] analysis for each country allowing the editors to bring out “lessons learnt” and to show some best practices. The editors found the Swedish system largely led by nurses the most interesting one. They concluded that patients and their families need to be part of the solution, the value of team work in addressing these issues and that innovation should be encouraged.

What works in management of chronic care: heart failure as an example (www.content.healthaffairs.org)
This study looks at the ability of chronic care management programmes to reduce hospital readmission and the number of readmission days. Data from 10 clinical trials in the United States, Australia, the United Kingdom and the Netherlands was re-analysed. Key findings included fewer readmissions for patients in programmes than those receiving routine care; that in-person communication greatly increased the outcomes of programmes using a single heart failure expert and for patients in programmes that used a multidisciplinary team approach. The authors concluded that programmes that used multidisciplinary teams and in-person communication lead to fewer readmissions for heart failure patients.

The experience of patients with complex health needs (www.content.healthaffairs.org)
Each year the Commonwealth Fund conducts a survey on a specific health issue in a number of countries including New Zealand. The focus of the 2008 survey was patients with chronic illness. The report addresses issues such as the impact of cost on access to treatment, same day access to doctors when sick, medical errors, coordination of care, use of emergency departments and perception of room for improvement in care. Comparison tables between all countries can be accessed on the Commonwealth Fund site.

The impact of not having a primary care physician among people with chronic conditions(www.ices.on.ca)
Primary care plays a pivotal role in the treatment of people with long term conditions. People (with long term conditions) without access to a regular GP experience adverse outcomes. This Canadian research explored the impact of long term condition on such people. They found that people without a regular GP, those with less than three GP visits over a two year period or who had low continuity of care were more likely to visit an emergency department and to have non-elective hospital admissions. The excess otherwise avoidable visits for such groups have an economic cost. The authors believe that improving access to primary health care will reduce this demand and improve outcomes for these groups.

HIGHLIGHTED ISSUE: MATERNITY CARE
Towards better births: A review of maternity services in England (www.healthcarecommission.org.uk)
“On 10 July 2008, the Healthcare Commission published a report (Towards better births: a review of maternity services in England) of maternity services. This urged the NHS to increase its efforts to improve maternity services by enhancing the quality of clinical care and the experiences of women.”

Brief intervention for reducing alcohol use by pregnant women (www.ajph.org)
The researchers “examined the efficacy of brief intervention as a technique to help pregnant women achieve abstinence from alcohol. Brief intervention consisted of 10- to 15-minute sessions of counseling by a nutritionist, who used a scripted manual to guide the intervention. Women in the brief intervention condition were 5 times more likely to report abstinence after intervention compared with women in the assessment-only condition. Newborns whose mothers received brief intervention had higher birthweights and birth lengths, and fetal mortality rates were 3 times lower (0.9%) compared with newborns in the assessment-only (2.9%) condition.”

Research investigates tests and interventions for pre-eclampsia (www.hta.ac.uk)
“The research team found that none of the current tests available to help predict pre-eclampsia are accurate enough to be recommended for use. They concluded that offering low-dose aspirin to women at risk of pre-eclampsia could be effective and calcium supplementation could be considered for those with low dietary calcium intake.”

Evidence-Based Maternity Care: What It Is and What It Can Achieve (www.milbank.org)
“A large, growing body of systematic reviews is available to help clarify effects of maternity practices, yet these valuable resources are grossly underutilized in policy, practice, education, and research [in the United States]. Practices that are disproved or appropriate for mothers and babies in limited circumstances are in wide use, and beneficial practices are underused. This report points the way to achieving these gains for the large population of childbearing women and newborns and for those who pay for their care.”

HIGHLIGHTED ISSUE: COMPLEMENTARY AND ALTERNATIVE MEDICINE
Abdominal acupuncture for insomnia in women: a randomized controlled clinical trial (www.ncbi.nlm.nih.gov)
“A randomized single-blind trial was conducted to evaluate the efficacy of short-term abdominal acupuncture as a novel treatment for insomnia in Chinese women… Results indicate that short-term abdominal acupuncture is more effective than pharmacological treatment for relieving insomnia in adult women and has few adverse effects.”

Acupuncture and related techniques for postoperative pain: a systematic review of randomized controlled trials(bja.oxfordjournals.org)
“Postoperative pain management remains a significant challenge for all healthcare providers. The objective of this systematic review was to quantitatively evaluate the efficacy of acupuncture and related techniques as adjunct analgesics for acute postoperative pain management. [The results indicate that] perioperative acupuncture may be a useful adjunct for acute postoperative pain management.”

Acupressure and meridian massage: combined effects on increasing body weight in premature infants(www.ncbi.nlm.nih.gov)
“The purpose of this study was to assess the body weight gain of combined acupressure and meridian massage in premature infants… An experimental trial established the effects of using acupressure and meridian massage on increasing body weight in premature infants. Acupressure and meridian massage have a significant effect on weight gain in premature infants. Nurses could be trained in acupressure and meridian massage techniques to provide more effective level of clinical care for premature infants.”

Single-point acupuncture and physiotherapy for the treatment of painful shoulder: a multicentre randomized controlled trial (rheumatology.oxfordjournals.org)
These researchers “Evaluate[d] the efficacy of acupuncture associated with physiotherapy for patients with painful shoulder. [They found that] single-point acupuncture in association with physiotherapy improves shoulder function and alleviates pain, compared with physiotherapy as the sole treatment. This improvement is accompanied by a reduction in the consumption of analgesic medicaments.”

HIGHLIGHTED WEBSITE
Centre for Reviews and Dissemination (www.york.ac.uk)
“The Centre for Reviews and Dissemination is a department of the University of York and is part of the National Institute for Health Research. CRD undertakes high quality systematic reviews that evaluate the effects of health and social care interventions and the delivery and organisation of health care.” Included on this site is the DARE database, which “contains 15,000 abstracts of systematic reviews including over 6,000 quality assessed reviews and details of all Cochrane reviews and protocols”.

HEALTH SERVICES ASSESSMENT COLLABORATION
Health Services Assessment Collaboration (HSAC) is funded by the Ministry of Health. Projects recently completed or being undertaken at present are noted below.

RECENT PUBLICATIONS

CURRENT PROJECTS

ABC smoking cessation [systematic review]
Borderline personality disorder [review of evidence-based Practice Guidelines]
Magnetic Resonance Spectroscopy for the initial diagnosis and staging of prostate, brain, breast and other cancers [horizon scan]
Microvolt T-wave Alternans [horizon scan]

LINKS TO HEALTH TECHNOLOGY NEWSLETTERS
This newsletter highlights “new health technologies identified through the Australia and New Zealand Horizon Scanning Network (ANZHSN)”.

ANZHSN Bulletin: Issue 8 – October 2008 (www.horizonscanning.gov.au)
Areas of particular interest in issue 8 include non invasive prenatal testing for Down’s Syndrome, HeartMate II® left ventricular assist device, targeted screening for abdominal aortic aneurysm, Autopulse® automated compression device for CPR, and breast tomosynthesis: a breast cancer screening tool.

ANZHSN Bulletin: Issue 9 – January 2009 (www.horizonscanning.gov.au)
Key areas of interesting in issue 9 include percutaneous endoscopic colostomy, FloWatch-PAB pulmonary artery banding for congenital heart defects, and narrow band imaging.

The information available on or through this website is intended to provide general information to the health sector and the public, and is not intended to address specific circumstances of any particular individual or entity. All reasonable measures have been taken to ensure the quality and accuracy of the information available on this website. If you find any information on this website that you believe may be inaccurate, please send an email to webmaster@moh.govt.nz