Cost Effectiveness of Treatment With New Agents in Advanced Non-Small-Cell Lung Cancer: A Systematic Review

In past decades, studies focusing on new chemotherapeutic agents for patients with inoperable non-small-cell lung cancer have reported only modest gains in survival. These health gains are achieved at considerable cost, but economic evidence is lacking on superiority of one agent in terms of cost effectiveness. The objective of this systematic review was to assess fully published cost-effectiveness studies comparing the new agents docetaxel, paclitaxel, vinorelbine, gemcitabine and pemetrexed, and the targeted therapies erlotinib and gefitinib with one another.We performed systematic searches in the bibliographic databases PubMed, EMBASE and Health Economic Evaluations (HEED) via the Cochrane Library for fully published studies from the past 10 years. Studies were screened by two independent reviewers according to a priori inclusion criteria. The methodological quality of the included studies was evaluated by two independent reviewers using standardized assessment tools.A total of 222 potential studies were identified; 11 studies and six reviews were included. The methodological quality of the full economic evaluations was fairly good. Transparency in costs and resource use, details on statistical tests and sensitivity analysis were points for improvement. In first-line treatment, gemcitabinecisplatin was cost effective compared with other platinum-based regimens (paclitaxel, docetaxel and vinorelbine). In one study, pemetrexedcisplatin was cost effective compared with gemcitabinecisplatin in patients with non-squamous-cell carcinoma. In second-line treatment, docetaxel was cost effective compared with best supportive care; erlotinib was cost effective compared with placebo; and docetaxel and pemetrexed were dominated by erlotinib.We found indications of superiority in terms of cost effectiveness for gemcitabinecisplatin in a first-line setting, and for erlotinib in a second-line setting. © 2012 Adis Data Information BV. All rights reserved

Instruments Measuring Externalizing Mental Health Problems in Immigrant Ethnic Minority Youths: A Systematic Review of Measurement Properties

Background:Little is known about reliability and validity of instruments measuring externalizing mental health problems in immigrant ethnic minority youths.Aims:To provide an overview of studies on measurement properties of instruments measuring these problems in immigrant ethnic minority youths, their methodological quality and results.Methods:A systematic review of the literature in MEDLINE, EMbase, PsycINFO and Cochrane Library was performed. Evaluation of methodological quality of studies found was done by using the 'COSMIN-checklist'. Full text, original articles, published in English after 1990 were included. Articles had to concern the development or evaluation of the measurement properties of self-reported, parent-reported and/or teacher- or clinician-reported questionnaires assessing or screening externalizing mental health problems in immigrant ethnic minority youths. Specific results of analyses on (an) immigrant ethnic minority group had to be given.Results:Twenty-nine studies evaluating 18 instruments met our criteria. Most studies concerned instruments with known validity in Western populations, tested mainly in African Americans. Considering methodological quality, inequivalences between ethnicities were found, self-reports seemed to perform better, and administration of an instrument influenced reliability and validity.Conclusion:It seems that the majority of instruments for assessing externalizing problems in immigrant ethnic minority youths is currently not sufficiently validated. Further evaluating existing instruments is crucial to accurately assess and interpreted externalizing problems in immigrant ethnic minority youths. © 2013 Paalman et al

Evidence-based treatments for children with trauma-related psychopathology as a result of childhood maltreatment: a systematic review

This is a systematic review of evidence-based treatments for children exposed to childhood maltreatment. Because exposure to childhood maltreatment has been associated with a broad range of trauma-related psychopathology (e.g., PTSD, anxiety, suicidal ideation, substance abuse) and with aggressive and violent behavior, this review describes psychotherapeutic treatments which focus on former broad range of psychopathological outcomes. A total of 26 randomized controlled clinical trials and seven non-randomized controlled clinical trials published between 2000 and 2012 satisfied the inclusionary criteria and were included. These studies dealt with various kinds of samples, from sexually abused and maltreated children in child psychiatric outpatient clinics or in foster care to traumatized incarcerated boys. A total of 27 studies evaluated psychotherapeutic treatments which used trauma-focused cognitive, behavioral or cognitive-behavioral techniques; only two studies evaluated trauma-specific treatments for children and adolescents with comorbid aggressive or violent behavior; and four studies evaluated psychotherapeutic treatments that predominantly focused on other mental health problems than PTSD and used non-trauma focused cognitive, behavioral or cognitive-behavioral techniques. The results of this review suggest that trauma-focused cognitive-behavioral therapy (TF-CBT) is the best-supported treatment for children following childhood maltreatment. However, in line with increased interest in the diagnosis of complex PTSD and given the likely relationship between childhood maltreatment and aggressive and violent behavior, the authors suggest that clinical practice should address a phase-oriented approach. This review concludes with a discussion of future research directions and limitation

Vocational rehabilitation services for people with hearing difficulties: A systematic review of the literature

Objective: The goal of this review was to list and summarize work-related health programs for employees with hearing difficulties and to summarize the statistical evidence of the effectiveness of these programs. Methods: A systematic review was performed by searching the PubMed, EMBASE, PsycINFO, CINAHL, and The Cochrane Library databases for relevant citations. From 2313 unique citations retrieved from the search strategy, we included nine programs that met all inclusion criteria. The authors assessed the methodological quality of studies which evaluated the program's effectiveness, using the Downs and Black checklist. Results: Nine vocational rehabilitation programs for people with hearing difficulties were described. The programs differed in procedure, duration, setting, and content. In four studies, the effectiveness of the program was explored statistically. Measurements showed an improvement in general health (SF-36), communication strategies, and the degree of work readiness, but none of these studies included a control group, a power calculation, nor adjusted for confounding. Hence, the methodological quality to provide evidence of effectiveness was assessed as poor. Discussion: Existing vocational programs for employees with hearing difficulties provide relevant information to demonstrate how to implement the appropriate content of the programs. Future research is required to improve the strength of evidence of the effectiveness of vocational rehabilitation for workers with hearing difficulties. © 2013 - IOS Press and the authors. All rights reserved

Can pharmacological and psychological treatment change brain structure and function in PTSD? A systematic review

While there is evidence of clinical improvement of posttraumatic stress disorder (PTSD) with treatment, its neural underpinnings are insufficiently clear. Moreover, it is unknown whether similar neurophysiological changes occur in PTSD specifically after child abuse, given its enduring nature and the developmental vulnerability of the brain during childhood.We systematically reviewed PTSD treatment effect studies on structural and functional brain changes from PubMed, EMBASE, PsycINFO, PILOTS and the Cochrane Library. We included studies on adults with (partial) PTSD in Randomized Controlled Trials (RCT) or pre-post designs (excluding case studies) on pharmacotherapy and psychotherapy. Risk of bias was evaluated independently by two raters. Brain coordinates and effect sizes were standardized for comparability.We included 15 studies (6 RCTs, 9 pre-post), four of which were on child abuse. Results showed that pharmacotherapy improved structural abnormalities (i.e., increased hippocampus volume) in both adult-trauma and child abuse related PTSD (3 pre-post studies). Functional changes were found to distinguish between groups. Adult-trauma PTSD patients showed decreased amygdala and increased dorsolateral prefrontal activations post-treatment (4 RCTs, 5 pre-post studies). In one RCT, child abuse patients showed no changes in the amygdala, but decreased dorsolateral prefrontal, dorsal anterior cingulate and insula activation post-treatment.In conclusion, pharmacotherapy may reduce structural abnormalities in PTSD, while psychotherapy may decrease amygdala activity and increase prefrontal, dorsal anterior cingulate and hippocampus activations, that may relate to extinction learning and re-appraisal. There is some evidence for a distinct activation pattern in child abuse patients, which clearly awaits further empirical testing. © 2013 Elsevier Ltd

Complications of mandibular distraction osteogenesis for developmental deformities: a systematic review of the literature

A systematic review of English and non-English articles on the complications of mandibular distraction osteogenesis (MDO) for patients with developmental deformities was performed, in accordance with the PRISMA statement. Search terms expressing distraction osteogenesis were used in ‘AND’ combination with search terms comprising ‘mandible’ and terms for complication, failure, and morbidity. A search using PubMed (National Library of Medicine, NCBI), EMBASE, and Cochrane Controlled Trials Register yielded 644 articles published between 1966 and mid October 2013. Clinical articles that reported complications related to MDO in developmental deformities were included. Two hundred and fifty articles were eligible and were screened in detail. A total of 32 articles reporting the cases of 565 patients were finally included. Patients underwent mandibular lengthening and transverse widening. A total of 211 complications were reported (37.4%); these were classified according to an index that indicates the clinical impact. Inferior alveolar nerve (IAN) neurosensory disturbances, minor infection, device failure, anterior open bite, permanent dental damage, and skeletal relapse were most represented. Complications that resolved spontaneously (type I) were seen in 11.0%, medically or technically manageable complications, without hospitalization, were seen in 10.8% (type II), and permanent complications (type VI) were seen in 9.6%