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Scanning the Horizon: Recent Developments in Health Innovations and Technologies

October 2008
This newsletter provides information, health innovations and emerging new technologies. There is an emphasis on the ten Health Targets. 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.

There are links to:
  • recent horizon scanning reports
  • health technology assessments
  • guidelines
  • research reports.
In this current issue, areas of particular interest are:

IMPROVING ORAL HEALTH


Child Use of Dental Services and Receipt of Dental Care in New Zealand
This report examines children’s’ dental service use and dental care receipt by a range of factors among Maori, Pacific and New Zealand European or Other children in New Zealand…[The results of this study suggest that] “material and behavioural factors all play a role in New Zealand child use of dental services and receipt of dental care”.

Also of interest is an article we highlighted in issue two of this newsletter on the oral health of Pacific Island children in Auckland.

Fluoride Varnish in the Prevention of Dental Caries in Children and Adolescents: A Systematic Review
The purpose of this article is to “to develop a scientifically current and evidence-based protocol for the use of fluoride varnish for the prevention of dental caries among high-risk children and
adolescents”. The report recommends twice yearly applications for children at risk; the use of single dose applications and the ongoing promotion of complementary strategies such as sealants and varnish, as well as toothbrushing and nutritional counselling.


CANCER CONTROL AND REDUCING CANCER WAITING TIMES


Recent Production/Diagnostic Performance of Techniques Used for HER-2 Testing in Breast Cancer
Here, the authors systematically review the techniques used for HER-2 testing with respect to their diagnostic performance, providing a potential basis for the development of clinical guidelines.

What oncologists tell patients about survival benefits of palliative chemotherapy and implications for informed consent
This study examines how much oncologists tell patients about the survival benefit of palliative chemotherapy during consultations at which decisions about treatment are made. The authors conclude that most patients were not given clear information about the survival gain of palliative chemotherapy. They recommend that oncologists sensitively describe the benefits and limitations of this treatment, including survival gain.


IMPROVING DIABETES SERVICES


Problem Solving in Diabetes Self-management and Control
This review assesses both quantitative and qualitative studies on diabetes self management and problem solving. The authors concluded that problem solving is a multidimensional construct encompassing verbal reasoning/rational problem solving, quantitative problem solving, and coping. Most intervention studies reported an improvement in behaviors, most commonly global adherence in children/adolescents and dietary behavior in adults.
Healthy Coping, Negative Emotions, and Diabetes Management: a Systematic Review and Appraisal may also be of interest.

Guidelines for the Management of Diabetic Retinopathy (PDF, 891 KB)
These guidelines were developed by the Australian Diabetes Society and approved by the the National Health & Medical Research Council. The guideline includes literature that has been published up to September 2007. The period since the original Guideines (1997) has witnessed the introduction of newer modalities to investigate patients with diabetic eye disease, such as Optical Coherence Tomography and newer treatments such as intravitreal triamcinolone.


IMPROVING MENTAL HEALTH SERVICES


A review and critical appraisal of measures of therapist-patient interactions in mental health settings
This HTA concludes that “the therapist–patient interaction can be measured using a wide range of instruments of varying value. However, due care should be taken in ensuring that the measure is suitable for the context in which it is to be used’. Following on from this work, it is suggested that specific research networks for the development of therapist–patient measures should be established, that research activity should prioritise investment in increasing the evidence base of existing measures rather than attempting to develop new ones, and that research activity should focus on improving these existing measures in terms of acceptability and feasibility issues.”

A systematic review and economic model of the clinical effectiveness and cost-effectiveness of interventions for preventing relapse in people with bipolar disorder
“Evaluation of bipolar disorder treatments found a number of effective and cost-effective drug therapies. However preferred treatment depends on the specific characteristics of an individual's disorder; psychosocial interventions may be useful adjuncts to drug therapy but need further research.”

Who is identified when screening for depression is undertaken in general practice?
“This method of screening for depressive symptoms in general practice identifies a group of patients with substantial multiple comorbidities — psychiatric, physical and social problems coexist with depressive symptoms, raising challenges for the management of depression in general practice.”


IMPROVING NUTRITION, INCREASING PHYSICAL ACTIVITY, REDUCING OBESITY


Rimonabant for the treatment of overweight and obese patients
According to this guidance from the NHS, “treatment with rimonabant should continue for longer than 6 months only if the person has lost at least 5% of their body weight since starting treatment. If the person returns to their original body weight, rimonabant treatment should be stopped. Treatment should only continue for longer than 2 years after a medical assessment and a discussion of the risks and benefits.”

Physical fitness in childhood and adolescence: a powerful marker of health
“Schools may play an important role by identifying children with low physical fitness and by promoting positive health behaviors such as encouraging children to be active, with special emphasis on the intensity of the activity.”


REDUCING THE HARM CAUSED BY TOBACCO


NICE has issued new guidance on preventing the uptake of smoking by children and young people, which is based on the review described below.
http://www.nice.org.uk/Guidance/PH14

Interventions to Prevent the Uptake of Smoking in Children and Young People (PDF, 1MB)
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. The review considers specific sub-questions related to the factors that might influence effectiveness, any differential effects for different audiences, and barriers and facilitators to implementation.


DISABILITY SERVICES


The following articles describe developments in technology for disability services.

Evaluation of cognitively accessible software to increase independent access to cellphone technology for people with intellectual disability
Developments in smart phone technology and PDA-based cellphones provide an opportunity to make the social and safety benefits of cellphones more independently accessible to this population. The authors found promising evidence of the feasibility of implementing universal design and other specialised software development methodologies for increasing independent access to the benefits of cellphone technologies.

Trends and issues in wheelchair technologies
The authors believe that there is an overwhelming need for wheelchairs and the research and development required to make them safer, more effective, and widely available. The identify practitioner credentials, accreditation, device evaluation, device user training, patient education, clinical prescribing criteria, national contracts, and access to new technology as of particular importance. They note that some of the trends in wheelchairs are going to require new service delivery mechanisms, changes to public policy, and certainly greater coordination between consumers, policy makers, manufacturers, researchers, and service providers.

Add-on power devices for manual wheelchairs (PDF, 1.2 MB)
Many wheelchairs are manual but there is scope for some users to benefit from add-on power devices. This English report reviews a range of these including technical, operational and economic considerations.

Tooth-click control of a hands-free computer interface
People with severe upper limb paralysis use devices that monitor head movements to control computer cursors. The authors tested a new method in which small tooth-clicks were detected by an accelerometer contacting the side of the head. They found that tooth-click/head-mouse control was much faster than dwell-time control and not quite as fast as sip-and-puff control, but were more reliable and less cumbersome than the latter

A systematic review of repetitive functional task practice with modelling of resource use, costs and effectiveness
This “study suggests that some form of repetitive functional task practice can be effective in improving lower limb function at any time after stroke, but that the duration of intervention effect is unclear and further good-quality evidence is required”.


HIGHLIGHTED ISSUE: SCREENING


Regular self-examination or clinical examination for early detection of breast cancer
Breast self examination has long been advocated as a screening method to diagnose breast cancer at an early stage. The authors of this Cochrane report created a sample of 388,535 women from well designed trials to compare breast self examination with no intervention. They found that women who were randomised to breast self-examination were almost twice as likely to undergo a biopsy of the breast. The review of data from these trials did not find a beneficial effect of screening in terms of improvement in breast cancer mortality. They recommend that the lack of evidence to support breast self examination be discussed with women.

Recent production/Diagnostic Performance of Techniques Used for HER-2 Testing in Breast Cancer
“This report is a systematic review of the diagnostic performance of techniques used for HER-2 testing in breast cancer. The conclusions and recommendations may serve as a basis for the CEPO to develop clinical practice guidelines for testing and for the Direction de la lutte contre le cancer to organize services provided by pathology laboratories.”



HIGHLIGHTED ISSUE: MANAGEMENT OF OTITIS MEDIA


Surgical management of Otitis Media with effusion in children (PDF, 161 KB)
NICE has recently released guidelines on the evidence related to surgical management of OME in children younger than 12 years, and to advise on best and safest practice. It shows the need to balance benefits against potential risks, reflecting the fact that the degree of benefit usually depends upon the severity and persistence of the condition.

The Management of Otitis Media with Early Routine Insertion of Grommets in Children with Cleft Palate - A Systematic Review
According to the authors, “there is currently insufficient evidence on which to base the clinical practice of early routine grommet placement in children with cleft palate.”

Grommets (ventilation tubes) for hearing loss associated with otitis media with effusion in children
“This review found that the beneficial effect of grommets on hearing diminished during the first year. Most grommets come out over this time. The review did not find any evidence that grommets help speech and language development. Watchful waiting would appear to be an appropriate management strategy for most children with glue ear.”


HIGHLIGHTED ISSUE: ALMA-ATA DECLARATION


September 2008 is the 30th anniversary of the signing of the Alma-Ata Declaration (PDF, 12 KB). “The Declaration of Alma-Ata articulated primary health care as a set of guiding values for health development, a set of principles for the organization of health services, and a range of approaches for addressing priority health needs and the fundamental determinants of health.”

The Lancet has published a comprehensive suite of articles on primary health care and Alma-Ata. Other articles also published to recognize this event include:


HIGHLIGHTED ISSUE: PRIMARY CARE


The Ministry of Health has developed a work plan implementation programme for primary care that runs from 2006-2010. Reducing inequalities is described as a core goal within this work plan. .


HIGHLIGHTED ISSUE: STROKES & CORONARY HEART DISEASE


Toward a More Effective Approach to Stroke: Canadian Best Practice Recommendations for Stroke Care
The Canadian Best Practice Recommendations for Stroke Care consist of 24 recommendations based on the strongest evidence and address topics that span the full continuum of stroke care.

Meta-analysis: Subclinical Thyroid Dysfunction and the Risk for Coronary Heart Disease and Mortality (PDF, 300 KB)
In this meta-analysis, the authors “summarize prospective evidence about the relationship between subclinical thyroid dysfunction and CHD and mortality, finding that subclinical hypothyroidism and hyperthyroidism may be associated with a modest increased risk for CHD and mortality, with lower risk estimates when pooling higher-quality studies and larger CIs for subclinical hyperthyroidism.”


HIGHLIGHTED ISSUE: SINGLE USE AND REUSABLE DEVICES


Reprocessing Single-Use Medical Devices in Canada
“CADTH’s two-part health technology assessment report series on reprocessing of Single-Use Devices (SUDs) addresses concerns about possible risks to patients of infection or other complications, legal liability issues, and uncertainties regarding cost-effectiveness. The first report summarizes findings from a Canadian survey of acute-care hospitals on SUD reprocessing practices. The second report examines clinical and cost-effectiveness of reprocessing SUDs, as well as legal, ethical and psychosocial issues.”

In this vein, a 2004 report by the NZHTA also looks at the issue of single-use devices:
What is the evidence on the safety and effectiveness of the reuse of medical devices labelled as single-use only? (PDF, 1MB)

Buyer’s Guide: Reusable Insulin Pens (PDF, 636 KB)
“This buyer’s guide was commissioned in order to help inform purchasing decisions. It draws together the current evidence on [reusable] insulin pens, including the results from a survey of insulin pen users and usability evaluations of available pens.”


HIGHLIGHTED WEBSITE


Centre for Evidence-Based Purchasing
“CEP underpins purchasing decisions by providing objective evidence to support the uptake of useful, safe, innovative products and related procedures in health and social care. We cover:
  • all medical devices
  • patient safety technology
  • products on market or near market (post-CE marking)
  • all products used in health and social care.”

HEALTH SERVICES ASSESSMENT COLLABORATION


The Health Services Assessment Collaboration (HSAC) is working on a number of projects at present and those are noted below. A list of upcoming projects is also provided.
New Publications:

Current projects:
  • HSAC06 Effectiveness of different interventions on ambulatory sensitive hospitalisations – Systematic Review
  • HSAC06A Summary Report - Effectiveness of different interventions on ambulatory sensitive hospitalisations
  • HSAC07 Foetal Alcohol Spectrum Disorders – Systematic Review

Upcoming projects:
  • HSAC09 Comparative cost-effectiveness of revascularisation of coronary artery disease – SR update & economic analysis
  • HSAC10 Smoking cessation – Tech Brief
  • HSAC11 Borderline personality disorder – Tech Brief

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 (PDF, 1,17 MB)
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 7 – June 2008 (PDF, 1MB)
Areas of particular interest in issue 7 include kidney transplantation using incompatible blood group donors, as well as a mini-cardio pulmonary bypass system.


OTHER USEFUL LINKS


Medical Services Advisory Committee (MSAC)
Canadian Agency for Drugs and Technologies in Health (CADTH)
INAHTA (International Network of Agencies for Health Technology Assessment)
The Canadian Partnership against Cancer
ACC – The Evidence Based Healthcare Group


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