Scanning the Horizon: Recent Developments in Health Innovations and Technologies
July 2008
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.
In this current issue, areas of particular interest are:
- the newly added section for disability services
- inequalities in oral health
- nursing research
- research dissemination.
**In some cases, we have provided links to journal articles for journals to which your organization may or may 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.
Full Contents
IMPROVING IMMUNISATION COVERAGE
Human Papillomavirus Vaccinations (HPV) are becoming increasingly common on the international scene. New Zealand’s HPV Immunisation Programme begins in September of 2008. The following three studies report on HPV programs in the UK, Canada, and Belgium. The Canadian and Belgian reports provide cost analyses, while the UK study looks at the issue of uptake.
IMPROVING ORAL HEALTH
Addressing inequalities across health contexts is a key strategy both nationally and internationally. The following four articles address inequalities in oral health. Of particular interest to the New Zealand context is the study of Pacific children in South Auckland.
CANCER CONTROL AND REDUCING CANCER WAITING TIMES
Comparative Overview Of Cancer Control Strategies In Selected Jurisdictions (www.aetmis.gouv.qc.ca)
“This comparative overview of cancer control strategies (and programs) in selected countries and Canadian provinces is aimed at providing better knowledge of the choices made by different public administrations regarding priorities, governance models, service organization and quality, and the factors of success for implementing change.”
Screening for colorectal cancer the significance of participation rates: A Health Technology Assessment – Summary (PDF)
This 2008 Danish Health Technology Assessment summary reviews participation in colorectal cancer screening according to a number of different factors, including technology, personal, orgainsational, and economic.
Exercise for the management of cancer-related fatigue in adults (Review) (PDF)
These researchers sought to “evaluate the effect of exercise on cancer-related fatigue both during and after cancer treatment, [finding that] exercise can be regarded as beneficial for individuals with cancer-related fatigue during and post cancer therapy. [According to the researchers], further research is required to determine the optimal type, intensity and timing of an exercise intervention.”
See also in Nursing: Specialist breast care nurses for supportive care of women with breast cancer (PDF)
REDUCING AVOIDABLE ADMISSIONS
Incidence, severity and preventability of medication-related visits to the emergency department: a prospective study (PDF)
“Medication-related visits to the emergency department are an important but poorly understood phenomenon. [These researchers] sought to evaluate the frequency, severity and preventability of drug-related visits to the emergency department. [They found that] More than 1 in 9 emergency department visits are due to drug-related adverse events, a potentially preventable problem in [the] health care system.”
See also in Rural Health: Impact of an ultrabroadband emergency department telemedicine system on the care of acutely ill patients and clinicians’ work (www.mja.com.au)
IMPROVING DIABETES SERVICES
Diabetes - Type 2 Update (www.nice.org.uk)
This NICE guidance is about the care and treatment of people with type 2 diabetes in the NHS in England and Wales. It covers the monitoring of glucose, lipid (blood cholesterol and fat) and blood pressure levels, diabetes education programmes, and dietary advice, as well as the use of medications to control blood glucose prevent vascular (blood vessel) disease, reduce blood pressure, improve lipid levels the detection. It also addresses ongoing management (with referral to a specialist if necessary) of eye disease, kidney disease, nerve damage, and nerve pain depression.
The clinical effectiveness of diabetes education models for Type 2 diabetes: a systematic review (www.hta.ac.uk)
The goal of this HTA was to “examine the clinical effectiveness of patient education models for adults with Type 2 diabetes…Based on the evidence, it would seem that education delivered by a team of educators, with some degree of reinforcement of that education made at additional points of contact, may provide the best opportunity for improvements in patient outcomes. Educators need to have time and resources to fulfill the needs of any structured educational programme.”
Efficacy of cholesterol-lowering therapy in 18 686 people with diabetes in 14 randomised trials of statins: a meta-analysis (www.sciencedirect.com)
“Although statin therapy reduces the risk of occlusive vascular events in people with diabetes mellitus, there is uncertainty about the effects on particular outcomes and whether such effects depend on the type of diabetes, lipid profile, or other factors. [The authors] undertook a prospective meta-analysis to help resolve these uncertainties. [Their findings suggest that] statin therapy should be considered for all diabetic individuals who are at sufficiently high risk of vascular events.”IMPROVING MENTAL HEALTH SERVICES
Screening for postnatal depression within the Well Child Tamariki Ora Framework (PDF)
“In comparison with other New Zealand screening programmes and the levels at which PHARMAC might consider funding for a pharmaceutical, the proposed routine screening programme for [postnatal depression] within the Well Child framework appears to be highly cost-effective from a government perspective, when compared with current practice.
However, the economic study conducted herein is only intended to be an exploratory analysis and is based on a number of necessary assumptions, which represent ‘best estimates’ of current practice and the likely costs and benefits associated with the introduction of formalised screening.”
Models in the delivery of depression care: A systematic review of randomised and controlled intervention trials (PDF)
“This paper aims to determine the effective components of depression care in primary care through a systematic examination of both general practice and community based intervention trials… Components which were found to significantly predict improvement were the revision of professional roles, the provision of a case manager who provided direct feedback and delivered a psychological therapy, and an intervention that incorporated patient preferences into care. Nurse, psychologist and psychiatrist delivered care were effective, but pharmacist delivery was not. Training directed to general practitioners was significantly less successful than interventions that did not have training as the most important intervention. Community interventions were effective.”
See also in Improving Nutrition, Increasing Physical Activity, and Reducing Obesity: Obesity and mental disorders in the general population: results from the world mental health surveys (PDF)
IMPROVING NUTRITION, INCREASING PHYSICAL ACTIVITY, REDUCING OBESITY
Getting patients to exercise more: a systematic review of underserved populations: brief counseling and a written plan increase exercise rates in the underserved (www.findarticles.com)
The authors report that “physical activity interventions need to be replicated in underserved populations before their results [can be seen as] generalizable. Though characteristics of existing studies show promise, [the authors report that] future research on physical activity in underserved populations should assess the effect of practice-based systems on reducing barriers and promoting physical activity, the dose-response effect of clinician counseling on physical activity outcomes, and the effect of the physician-patient relationship and continuity of care on physical activity outcomes.”
Physical fitness in childhood and adolescence: a powerful marker of health (PDF)
“This review aims to summarize the latest developments with regard to physical fitness and several health outcomes in young people. The literature reviewed suggests that (1) cardiorespiratory fitness levels are associated with total and abdominal adiposity; (2) both cardiorespiratory and muscular fitness are shown to be associated with established and emerging cardiovascular disease risk factors; (3) improvements in muscular fitness and speed/agility, rather than cardiorespiratory fitness, seem to have a positive effect on skeletal health; (4) both cardiorespiratory and muscular fitness enhancements are recommended in pediatric cancer patients/survivors in order to attenuate fatigue and improve their quality of life; and (5) improvements in cardiorespiratory fitness have positive effects on depression, anxiety, mood status and self-esteem, and seem also to be associated with a higher academic performance.”
Obesity and mental disorders in the general population: results from the world mental health surveys (PDF)
The goals of this research project were twofold: “(1) To investigate whether there is an association between obesity and mental disorders in the general populations of diverse countries, and (2) to establish whether demographic variables (sex, age, education) moderate any associations observed. [Findings indicate] a modest relationship between obesity (particularly severe obesity) and emotional disorders among women in the general population. The study is limited by the self-report of BMI and cannot clarify the direction or nature of the relationship observed, but it may indicate a need for a research and clinical focus on the psychological heterogeneity of the obese population.”
ELECTIVE SURGERIES AND IMPROVING ELECTIVE SERVICES
Elective surgery in Australia: new measures of access (www.aihw.gov.au)
“Access to elective surgery in public hospitals is of interest to health providers, policy makers and the general public. This report presents a detailed picture of access to elective surgery services in Australia using combined admitted patient and elective surgery waiting times data.”
See also in Screening for colorectal cancer the significance of participation rates: A Health Technology Assessment – Summary (PDF)
REDUCING THE HARM CAUSED BY TOBACCO
New Zealand smoking cessation guidelines (PDF)
“These guidelines will assist healthcare professionals in providing evidence-based smoking cessation support to people who smoke. To be effective, the ABC model needs to be integrated into routine practice. ABC prompts healthcare professionals to ask about smoking status; give brief advice to stop smoking to all smokers; and provide evidence-based Cessation support for those who wish to stop smoking.”
Preventing the uptake of smoking by children and young people: consultation on the evidence (www.nice.org.uk)
“This review examines the effectiveness of: (a) mass media interventions designed to prevent the uptake of smoking in children and young people and (b) interventions that are designed to prevent the illegal sale of tobacco to children and young people.”
Nursing Interventions for Smoking Cessation (PDF)
The authors of this systematic review sought to determine the effectiveness of nursing-delivered smoking cessation interventions. “The results indicate the potential benefits of smoking cessation advice and/or counselling given by nurses to patients, with reasonable evidence that intervention is effective. The evidence of an effect is weaker when interventions are brief and are provided by nurses whose main role is not health promotion or smoking cessation”.
DISABILITY SERVICES
The role of hyperbaric oxygen therapy in the management of autism (www.aetmis.gouv.qc.ca)
In this summary, the AETMIS reviewers conclude that “there is insufficient evidence to build a strong case for the efficacy of hyperbaric oxygen therapy in the management of autistic disorders. In these circumstances, a literature watch should be conducted to evaluate the results of the current and future studies. In short, for the management of autism, hyperbaric oxygen therapy should, for now, be considered an experimental treatment modality. Consequently, this treatment should be limited to formal research projects.”
Participatory design in the development of the wheelchair convoy system (PDF)
“The Wheelchair Convoy System (WCS) is being developed to allow a single caregiver to move multiple individuals without removing them from their wheelchairs. The WCS will consist of a processor, and a flexible cord linking each wheelchair to the wheelchair in front of it. A Participatory Design approach – in which several iterations of design, fabrication and evaluation are used to elicit feedback from users – was used. An iterative cycle of development and evaluation was followed through five prototypes of the device. The third and fourth prototypes were evaluated in unmanned field trials at J. Iverson Riddle Development Center. The prototypes were used to form a convoy of three wheelchairs that successfully completed a series of navigation tasks.”
Tilted seat position for non-ambulant individuals with neurological and neuromuscular impairment: a systematic review (PDF)
The objective of this study was to “to determine the effects of tilt-in-space seating on outcomes for people with neurological or neuromuscular impairment who cannot walk. Posterior tilt can reduce pressures at the interface under the pelvis”.
HIGHLIGHTED ISSUE: NURSING
On 28 April of 2008, the Ministry of Health sponsored a day bringing together research on nursing commissioned by the Ministry, which centered on the implementation of nursing research into practice. The summary of this can be found at:
http://www.moh.govt.nz/moh.nsf/indexmh/nursing-initiatives-researchday
A number of key, recent review articles have recently been published about nursing. The following articles take a range of directions including workforce pressures, examinations of breast care nurses, staffing models and nursing education.
See also in Reducing the Harm Caused by Tobacco: Nursing Interventions for Smoking Cessation (PDF)
See also in Research Use: Patterns of Research Utilization on Patient Care Units (PDF)
HIGHLIGHTED ISSUE: RESEARCH USE
These articles reflect how research is being used in health. Some describe techniques for moving research into practice. Others examine the effectiveness of a range of health research initiatives.
HIGHLIGHTED ISSUE: RURAL HEALTH
New Zealand (and in particular, the West Coast DHB) is set to pilot Cisco’s HealthPresence, which will use telemedicine technology to provide services that replicate face-to-face medical interactions, despite geographical distance. The following evaluative study reports on a similar technology used in Australia.
Impact of an ultrabroadband emergency department telemedicine system on the care of acutely ill patients and clinicians’ work (www.mja.com.au)
This study evaluated “the Virtual Critical Care Unit (ViCCU), which uses an ultrabroadband connection allowing real-time audiovisual communication between clinicians at distant sites. Semi-structured interviews were conducted with medical and nursing staff at the end of the study…[according to the authors] the ViCCU appears most effective for moderate trauma patients, with associated reductions in admissions and transfers. Large-scale trials of telemedicine systems that include measurements of both patient care and impact on clinicians’ work are required.”
HIGHLIGHTED ISSUE: LONG-TERM CONDITIONS
Systematic Review of the Chronic Care Model in Chronic Obstructive Pulmonary Disease Prevention and Management (archinte.ama-assn.org)
“Limited published data exist evaluating the efficacy of CCM components in chronic obstructive pulmonary disease management. However, pooled data demonstrated that patients with chronic obstructive pulmonary disease who received interventions with 2 or more CCM components had lower rates of hospitalizations and emergency/unscheduled visits and a shorter length of stay compared with control groups.”
HIGHLIGHTED ISSUE: LOWER BACK PAIN
Individual patient education for low back pain (PDF)
“People with low-back pain who were given an additional individual two and a half-hour education session with a trained specialist on top of their usual care did better than those given normal care alone.”
ACC – THE EVIDENCE-BASED HEALTHCARE GROUP
The Evidence-Based Healthcare Group “produces several different kinds of report for ACC”, including evidence-based reviews, brief reports, and clinical guidelines. Evidence-based reviews are based upon the systematic literature review methodology, while brief reports offer concise information about a particular health intervention. Clinical guidelines offer advice for health professionals, funders, and patients based upon research evidence. Recent ACC publications include:
Evidence-Based Reviews
Brief Reports
Clinical Guidelines
Guidelines and Other Publications in Progress (www.acc.co.nz)
HEALTH SERVICES ASSESSMENT COLLABORATION
The Health Services Assessment Collaboration (HSAC) has recently launched their new website, from which their publications can be accessed. The most recent publications are:
Work in progress:
- The effectiveness of digital hearing aids and assistive listening devices for adults with hearing loss - A systematic review
- Effectiveness of different interventions on ambulatory sensitive hospitalizations - A systematic review
- Foetal Alcohol Spectrum Disorders - A systematic review.
LINKS TO HEALTH TECHNOLOGY NEWSLETTERS
ANZHSN Bulletin - Issue 7 Apr 2008 (PDF, 930 KB)
This newsletter highlights “new health technologies identified through the Australia and New Zealand Horizon Scanning Network (ANZHSN)”. Areas of particular interest in issue 7 include discussions of a kidney transplantation using incompatible blood group donors, as well as a mini-cardio pulmonary bypass system.
OTHER USEFUL LINKS
Medical Services Advisory Committee (www.msac.gov.au)
Canadian Agency for Drugs and Technologies in Health (www.cadth.ca)
INAHTA (International Network of Agencies for Health Technology Assessment - www.inahta.org)
EuroScan (www.euroscan.bham.ac.uk)
The Canadian Partnership against Cancer (www.partnershipagainstcancer.ca)