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M. Veličković V, Macmillan T, Lones E, Arlouskaya Y, Prieto PA, Webb N, Crompton A, Munro I, Carvalho VF, Attila S, Bárdos D, Lin Y, Chiao H, Probst S. Systematic review and quality assessment of clinical and economic evidence for superabsorbent wound dressings in a population with chronic ulcers. Int Wound J 2024; 21:e14750. [PMID: 38468367 PMCID: PMC10928240 DOI: 10.1111/iwj.14750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Revised: 01/23/2024] [Accepted: 01/23/2024] [Indexed: 03/13/2024] Open
Abstract
Effective exudate management is key for optimal ulcer healing. Superabsorbent dressings are designed to have high fluid handling capacity, reduced risk of exudate leakage, fluid retention under compression, and to sequester harmful exudate components. This study aimed to systematically identify existing evidence for the clinical efficacy and cost-effectiveness of superabsorbent dressings for the treatment of moderate-to-highly exudating chronic ulcers of various etiologies. The aim is focused on examining the 'class' effect of all superabsorbers, not any particular dressing. Clinical and cost effectiveness systematic reviews were conducted, searching Embase, MEDLINE, the Cochrane Library, and the Cumulative Index to Nursing and Allied Health Literature. The Cost Effectiveness Analysis Registry and Econ papers were also searched for the economic review. Outcomes of interest included ulcer closure, dressing properties, hospital- and infection-related outcomes, safety, and economic outcomes. Fourteen studies were included in the clinical systematic review. Eleven were case series, with one randomised controlled trial, one retrospective matched observational study, and one retrospective cohort study. The studies investigated eight superabsorbent dressings and were heterogeneous in their patient population and outcomes. Superabsorbent dressings may result in favourable outcomes, including reductions in frequency of dressing change and pain scores. As most studies were case series, drawing firm conclusions was difficult due to absence of a comparator arm. The economic systematic review identified seven studies, five of which were cost-utility analyses. These suggested superabsorbent dressings are a more cost-effective option for the treatment of chronic ulcers compared with standard dressings. However, the small number and low quality of studies identified in both reviews highlights the need for future research.
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Affiliation(s)
- Vladica M. Veličković
- Evidence Generation DepartmentHARTMANN GROUPHeidenheimGermany
- Institute of Public Health, Medical Decision Making and HTAHall in TirolAustria
| | | | | | - Yana Arlouskaya
- Evidence Generation DepartmentHARTMANN GROUPHeidenheimGermany
| | - Pablo Arija Prieto
- Evidence Generation DepartmentHARTMANN GROUPHeidenheimGermany
- Erasmus Universiteit Rotterdam, Erasmus School of Health Policy&ManagementRotterdamNetherlands
| | | | | | | | - Viviane Fernandes Carvalho
- Nursing DepartmentUniversidade GuarulhosGuarulhosBrazil
- Medical Affair DepartmentHARTMANN GROUPBarueriBrazil
| | - Szijártó Attila
- Department of Surgery, Transplantation and GastroenterologySemmelweis UniversityBudapestHungary
| | - Dávid Bárdos
- Department of Surgery, Transplantation and GastroenterologySemmelweis UniversityBudapestHungary
| | - YunNan Lin
- Division of Plastic Surgery, Department of Surgery, Kaohsiung Medical University HospitalKaohsiung Medical UniversityKaohsiungTaiwan
- School of Post‐Baccalaureate Medicine, College of MedicineKaohsiung Medical UniversityKaohsiungTaiwan
| | - HaoYu Chiao
- Department of Surgery, Plastic and Reconstructive SurgeryTri‐Service General Hospital (Medical Centre), National Defense Medical CenterTaipeiTaiwan
| | - Sebastian Probst
- Geneva School of Health Sciences, HES‐SO University of Applied Sciences and Arts Western Switzerland, Geneva, SwitzerlandUniversity Hospital GenevaGenevaSwitzerland
- College of Medicine Nursing and Health SciencesUniversity of GalwayGalwayIreland
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Veličković VM, Macmillan T, Kottner J, Crompton A, Munro I, Paine A, Savović J, Spelman T, Clark M, Smit HJ, Smola H, Webb N, Steyerberg E. Prognostic models for clinical outcomes in patients with venous leg ulcers: A systematic review. J Vasc Surg Venous Lymphat Disord 2024; 12:101673. [PMID: 37689364 DOI: 10.1016/j.jvsv.2023.06.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 06/02/2023] [Accepted: 06/26/2023] [Indexed: 09/11/2023]
Abstract
OBJECTIVE The purpose of this review was to identify prognostic models for clinical application in patients with venous leg ulcers (VLUs). METHODS Literature searches were conducted in Embase, Medline, Cochrane, and CINAHL databases from inception to December 22, 2021. Eligible studies reported prognostic models aimed at developing, validating, and adjusting multivariable prognostic models that include multiple prognostic factors combined, and that predicted clinical outcomes. Methodological quality was assessed using the CHARMS checklist and PROBAST short form questionnaire. RESULTS Thirteen studies were identified, of which three were validation studies of previously published models, four reported derivation and validation of models, and the remainder reported derivation models only. There was substantial heterogeneity in the model characteristics, including 11 studies focused on wound healing outcomes reporting 91 different predictors. Three studies shared similar predicted outcomes, follow-up timepoint and used a Cox proportional hazards model. However, these models reported different predictor selection methods and different predictors and it was therefore not feasible to summarize performance, such as discriminative ability. CONCLUSIONS There are no standout risk prediction models in the literature with promising clinical application for patients with VLUs. Future research should focus on developing and validating high-performing models in wider VLU populations.
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Affiliation(s)
- Vladica M Veličković
- Health Economics and Outcome Research (HEOR) Department, Hartmann Group, Heidenheim, Germany; Institute of Public Health, Medical Decision Making and Health Technology Assessment, UMIT, Hall, Tirol, Austria.
| | | | - Jan Kottner
- Charité-Universitätsmedizin Berlin, Berlin, Germany
| | | | | | - Abby Paine
- Source Health Economics, London, United Kingdom
| | - Jelena Savović
- Bristol Population Health Science Institute, Bristol, United Kingdom
| | - Tim Spelman
- Burnet Institute, Melbourne, Australia, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Michael Clark
- Welsh Wound Innovation Centre, Ynysmaerdy, Pontyclun, United Kingdom
| | | | - Hans Smola
- Health Economics and Outcome Research (HEOR) Department, Hartmann Group, Heidenheim, Germany; Department of Dermatology, University of Cologne, Cologne, Germany
| | - Neil Webb
- Source Health Economics, London, United Kingdom
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Ping Y, Hongmei J, Bellmann C, Inês M, Macmillan T, Webb N, Aram JA, Penack O. A plain language summary on preventing fungal infections with isavuconazole in people with blood-related conditions. Future Microbiol 2023; 18:861-866. [PMID: 37641932 DOI: 10.2217/fmb-2022-0280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/31/2023] Open
Abstract
WHAT IS THIS SUMMARY ABOUT? People with blood-related conditions have a higher chance of getting invasive fungal infections (IFIs). IFIs are severe fungal infections that can lead to death. Only a few medications, known as antifungals, exist that can be used to prevent IFIs, and sometimes they can cause very bad side effects. Isavuconazole is an antifungal which has been approved to treat IFIs, but it has not been approved to prevent IFIs. In this study, we reviewed published studies that looked at how well isavuconazole prevented IFIs in people who have a higher chance of getting IFIs. WHAT WERE THE RESULTS? This review showed that isavuconazole could be effective at preventing IFIs in people with blood-related conditions, as well as being a safe medication. WHAT DO THE RESULTS OF THE STUDY MEAN? Isavuconazole can prevent IFIs in people who have a higher chance of getting IFIs. Guidelines should consider that patients need new antifungals to prevent IFIs, and more research needs to be done to see which medicines work best, and which have fewer side effects. Clinical Trial Registration: Please note that 7 studies included in this review were planned studies (1 prospective, 6 retrospective), 2 were real- world studies, 1 of which was registered as a clinical trial NCT03019939 (ClinicalTrials.gov).
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Affiliation(s)
- Yang Ping
- Peking University Third Hospital, Beijing, People's Republic of China
| | - Jing Hongmei
- Peking University Third Hospital, Beijing, People's Republic of China
| | | | - Mónica Inês
- Patient Health Impact, Pfizer Inc, Porto Salvo, Portugal
| | | | | | | | - Olaf Penack
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
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Sydnor S, Chatterjee S, Cooney P, Kaur S, Macmillan T, Stewart D, Munro I, Bandeiras C, Paine A, Felizzi F. Efficacy and Safety of Brolucizumab, Aflibercept, and Ranibizumab for the Treatment of Patients with Visual Impairment Due to Diabetic Macular Oedema: A Systematic Review and Network Meta-Analysis. Diabetes Ther 2023:10.1007/s13300-023-01410-8. [PMID: 37198521 DOI: 10.1007/s13300-023-01410-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 04/12/2023] [Indexed: 05/19/2023] Open
Abstract
INTRODUCTION Key clinical guidelines recommend anti-vascular endothelial growth factor (VEGF) therapy as first-line treatment for visual impairment due to diabetic macular oedema (DMO). A systematic literature review (SLR) and network meta-analysis (NMA) were conducted comparing the relative efficacy of the anti-VEGF brolucizumab with a focused network of the most relevant comparator dosing regimens approved in countries other than the USA (aflibercept, ranibizumab). The safety and tolerability of brolucizumab were also assessed. METHODS A broad SLR was conducted to identify randomised controlled trials to ensure all relevant potential comparators were captured. Identified studies were refined to those appropriate for inclusion in the NMA. A Bayesian NMA was conducted comparing brolucizumab 6 mg (every 12 [Q12W]/every 8 weeks [Q8W]) with relevant aflibercept 2 mg and ranibizumab 0.5 mg regimens. RESULTS Fourteen studies were included in the NMA. At 1-year follow-up, the various aflibercept 2 mg and ranibizumab 0.5 mg regimens were mostly comparable with brolucizumab 6 mg Q12W/Q8W across key visual and anatomical outcomes, except brolucizumab 6 mg was favoured over ranibizumab 0.5 mg every 4 weeks (Q4W) for the change from baseline (CFB) in best-corrected visual acuity (BCVA), and BCVA loss/gain of pre-specified numbers of letters, and over ranibizumab 0.5 mg pro re nata for CFB in diabetic retinopathy severity scale, and retinal thickness. At year 2, where data were available, brolucizumab 6 mg showed similar results across efficacy outcomes versus all other anti-VEGFs. In most cases, discontinuation rates (all cause, and due to adverse events [AE]) and serious and overall rates of AEs excluding ocular inflammatory events were similar (in unpooled and pooled-treatment analyses) versus comparators. CONCLUSION Brolucizumab 6 mg Q12W/Q8W was comparable or superior to aflibercept 2 mg and ranibizumab 0.5 mg regimens for various visual and anatomical efficacy outcomes and discontinuation rates.
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Affiliation(s)
- Shelby Sydnor
- Novartis Pharmaceuticals UK Ltd., London, England, UK
| | | | | | - Simarjeet Kaur
- CONEXTS, Novartis Healthcare Pvt. Ltd., Hyderabad, India
| | | | | | | | | | - Abby Paine
- Source Health Economics, Oxford, England, UK
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Ping Y, Hongmei J, Bellmann C, Inês M, Macmillan T, Webb N, Aram JA, Penack O. Effectiveness and safety of isavuconazole prophylaxis for invasive fungal infections in the haematologic setting. Hematology 2022; 27:723-732. [PMID: 35688453 DOI: 10.1080/16078454.2022.2076046] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES Patients with haematologic malignancies are at high risk of developing invasive fungal infections (IFIs). Current guidelines recommend the use of azoles for IFI prophylaxis; however, in many clinical situations, antifungal prophylaxis is used off-label. We conducted a systematic literature review to provide haematologists with the available evidence on the effectiveness and safety of isavuconazole in IFI prophylaxis in interventional and real-world, observational studies. METHODS Embase, MEDLINE and Cochrane Library databases, and relevant conference proceedings and clinical trial registries, were searched for studies on the effectiveness and safety of isavuconazole prophylaxis in adults at high risk of IFIs. Studies were assessed for inclusion and risk of bias. RESULTS Nine studies were eligible for inclusion in the review, eight of which were in haematologic populations (patients undergoing haematopoietic stem cell transplantation or with acute myeloid leukaemia or myelodysplastic syndromes; n = 5) or included haematologic populations (n = 3). Evidence from these studies suggests isavuconazole is effective for IFI prophylaxis in the haematologic setting. However, the studies frequently lacked safety data, most were based on small patient populations from single centres and risk of bias could not be assessed for five studies. DISCUSSION These findings provide evidence for isavuconazole as an alternative azole for prophylaxis in high-risk populations. Limitations include lack of applicability of risk of bias assessment tools, level of filtering applied in the search strategy and focus on English-language publications. CONCLUSION Isavuconazole may be an effective azole for IFI prophylaxis in high-risk haematologic populations, although further studies are needed.
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Affiliation(s)
- Yang Ping
- Peking University Third Hospital, Beijing, People's Republic of China
| | - Jing Hongmei
- Peking University Third Hospital, Beijing, People's Republic of China
| | | | - Mónica Inês
- Patient Health Impact, Pfizer Inc, Porto Salvo, Portugal
| | | | | | | | - Olaf Penack
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
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Macmillan T, Pennington M, Summers JA, Goddard K, Zala D, Herz N, Peacock JL, Keevil S, Chalkidou A. SecurAcath for Securing Peripherally Inserted Central Catheters: A NICE Medical Technology Guidance. Appl Health Econ Health Policy 2018; 16:779-791. [PMID: 30123950 PMCID: PMC6244619 DOI: 10.1007/s40258-018-0427-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Central venous catheters are commonly used to deliver therapies and to monitor patients, and require securing at the point of percutaneous entry to avoid dislodgement. SecurAcath is a catheter securement device designed for central venous catheters. The National Institute for Health and Care Excellence, as a part of its Medical Technologies Evaluation Programme, selected this device for evaluation and invited the manufacturer, Interrad Medical, to submit clinical and economic evidence. The King's Technology Evaluation Centre, an External Assessment Centre commissioned by the National Institute for Health and Care Excellence, independently critiqued the manufacturer's submissions. The External Assessment Centre found a lack of evidence comparing SecurAcath with alternative approaches to securement (StatLock, suturing, tape securement), with one unpublished randomised controlled trial providing the strongest evidence. The External Assessment Centre conducted a new systematic review and meta-analysis and concluded that there is some evidence indicating the non-inferiority of SecurAcath compared to StatLock. The External Assessment Centre considered the manufacturer's economic model to be appropriate but made revisions to some parameters and noted significant heterogeneity in the included studies. The revised model indicated that StatLock was more cost effective than SecurAcath for catheter indwell times of up to 5 days; however, for medium- and long-term indwell times, SecurAcath was the most cost-effective option. The National Institute for Health and Care Excellence Medical Technologies Guidance MTG 34, issued in June 2017, recommended the adoption of SecurAcath for securing peripherally inserted central catheters within the National Health Service in England.
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Affiliation(s)
- Tom Macmillan
- King's Technology Evaluation Centre, School of Biomedical Engineering and Imaging Sciences, King's College London, 5th Floor, Becket House, 1 Lambeth Palace Road, London, SE1 7EU, UK.
| | - Mark Pennington
- King's Health Economics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Jennifer A Summers
- School of Population Health and Environmental Sciences, King's College London, London, UK
| | - Kate Goddard
- King's Technology Evaluation Centre, School of Biomedical Engineering and Imaging Sciences, King's College London, 5th Floor, Becket House, 1 Lambeth Palace Road, London, SE1 7EU, UK
| | - Darshan Zala
- King's Health Economics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Naomi Herz
- King's Technology Evaluation Centre, School of Biomedical Engineering and Imaging Sciences, King's College London, 5th Floor, Becket House, 1 Lambeth Palace Road, London, SE1 7EU, UK
| | - Janet L Peacock
- School of Population Health and Environmental Sciences, King's College London, London, UK
| | - Stephen Keevil
- King's Technology Evaluation Centre, School of Biomedical Engineering and Imaging Sciences, King's College London, 5th Floor, Becket House, 1 Lambeth Palace Road, London, SE1 7EU, UK
| | - Anastasia Chalkidou
- King's Technology Evaluation Centre, School of Biomedical Engineering and Imaging Sciences, King's College London, 5th Floor, Becket House, 1 Lambeth Palace Road, London, SE1 7EU, UK
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Abstract
Nine boys with Duchenne muscular dystrophy, chairbound but without scoliosis, were fitted with a recently developed brace of metal and moulded medium-density polyethylene, the modified Calot brace. Each was also fitted with a wrap-around, moulded leather jacket. Each brace held the relaxed lumbar spine in an angle of lordosis similar to that achieved by a brief active effort to sit erect without a brace. Over-all, they proved equally acceptable to patients and carers. The modified Calot brace caused substantially less restriction of pulmonary function and so may be preferable to the moulded leather jacket.
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