Meta-analysis of percutaneous radiofrequency ablation versus ethanol injection in hepatocellular carcinoma

BACKGROUND: Percutaneous radiofrequency ablation (RFA) has gained popularity in the treatment of hepatocellular carcinoma (HCC). However, its role versus other conventional minimally invasive therapies is still a matter of debate. The purpose of this work is to analyse the efficacy and safety of RFA versus that of ethanol injection (PEI), the percutaneous standard approach to treat nonsurgical HCC. METHODS: Systematic review and meta-analysis of randomised or quasi-randomised controlled trials published up to August 2008 in PubMed, ISI Web of Science and The Cochrane Library. Overall survival, local recurrence rate and adverse effects were considered as primary outcomes. Studies were critically appraised and estimates of effect were calculated according to the random-effects model. Inconsistency across studies was evaluated using the I2 statistic. Sensitivity analyses were conducted to explore statistical heterogeneity. RESULTS: Six studies were eligible. The studies reported data on 396 patients treated by RFA and 391 treated by PEI. In general, subjects were in Child-Pugh class A (74%) and had unresectable HCC (mean size 2.5 cm). Mean follow-up was 25 +/- 11 months. The survival rate showed a significant benefit for RFA over PEI at one, two, three and four years. The advantage in survival increased with time with Relative Risk values of: 1.28 (95%CI:1.12-1.45) and 1.24 (95%CI:1.05-1.48) for RFA versus PEI at 3- and 4-years respectively. Likewise, RFA achieved significantly lower rates of local recurrence (RR: 0.37, 95%CI: 0.23-0.59). The overall rate of adverse events was higher with RFA (RR:2.55, 95%CI: 1.8-3.6) yet no significant differences were found concerning major complications (RR:1.85, 95%CI: 0.68-5.01). There was not enough evidence supporting a better cost-effectiveness ratio for RFA compared to PEI. CONCLUSION: Available evidence from adequate quality controlled studies support the superiority of RFA versus PEI, in terms of better survival and local control of the disease, for the treatment of patients with relatively preserved liver function and early-stage non-surgical HCC. However, the higher rate of adverse events displayed is something that will have to be tested with appropriate weighting of the possible benefits in each individual case. Overall cost-effectiveness of RFA needs further evaluation.This study was commissioned by the Health Technology Assessment Programme on behalf of the Ministry of Health & Consumer Affairs and was partially funded by the Spanish National I+D Program Ministry of Science & Technology (to C Bouza, Z Saz and JM Amate, grant SEC 2001-0138 and PI08/90612). The funding body had no further role in study design; in the collection, analysis and interpretation of data; in the writing of the report; and in the decision to submit the paper for publication.S

European Commission Initiative on Breast Cancer (ECIBC): Plenary 2016

The European Commission Initiative on Breast Cancer (ECIBC) Plenaries are an opportunity to inform representatives from the 28 EU Member States and 7 other countries participating in the ECIBC, as well as patients and other stakeholders, policymakers, and the scientific and health policy communities, about the aims, activities and achievements of the ECIBC. They also provide a platform for the exchange of ideas, feedback and input into the ECIBC. The 2016 ECIBC Plenary, entitled “When science and policy collaborate for health”, took place on 24-25 November in Varese, Italy. Its main focus was the implementation of both the voluntary European Quality Assurance scheme for Breast Cancer Services (European QA scheme) and the European guidelines for breast cancer screening and diagnosis (European Breast Guidelines). In this context, the first concrete results were presented, with the launch of the first four European Breast Guidelines recommendations on screening. The first day of the Plenary was dedicated to the JRC informing the audience about the various tools that ECIBC is developing. The second day instead, gave the floor to the audience, who informed the JRC of their views in terms of the challenges and opportunities related to implementing the ECIBC in the respective European countries. The event opened with welcome speeches from the European Commission’s Joint Research Centre (JRC), a moving presentation from a breast cancer survivor and reflections on how to ensure science makes its way into policy. The JRC and ECIBC working group members then brought the audience up to date with progress on the European QA scheme, the European Breast Guidelines, as well as the Guidelines Platform, the template for training on digital mammography, as well as about how ECIBC plans to monitor its impact. Participants also received in-depth explanations of the accreditation framework selected for the European QA scheme, as well as two countries’ experiences of using the ISO 15189 standard for accreditation, which is foreseen for the European QA scheme. The second day saw a focus on the individual countries represented at the Plenary. Presentations assessed how the European QA scheme could potentially fit into three different health systems (Scotland, the Netherlands, Romania), while a special breakout session gave national representatives from the 27 countries present (out of the 35 countries participating in the ECIBC) the chance to discuss implementation of the European Breast Guidelines and the European QA scheme themselves. The results, collected through questionnaires, fed into a roundtable debate on what needs to be done at European and national level to ensure ECIBC implementation. The meeting was closed by Member of the European Parliament and President of MEPs Against Cancer (MACs), Alojz Peterle. An evaluation of the event revealed that the third ECIBC Plenary met its aims to inform stakeholders: all responding participants felt that the event succeeded in providing a comprehensive overview of how the ECIBC is progressing, and what the challenges are. Discussions also provided the JRC with valuable information and feedback. The fourth ECIBC Plenary will take place once the results from piloting the European QA scheme are available.JRC.F.1-Health in Societ

Análisis comparativo de la Encuesta Nacional de Salud. Año 1997

El objetivo del presente informe es iniciar el estudio de los factores que influyen en la SP de los españoles utilizando los datos de la Encuesta Nacional de Salud (ENS) realizada en 1997, que es la más reciente hasta la fecha. Las variables cuya relación con la SP se pretende analizar incluyen información sobre morbilidad, utilización de asistencia sanitaria, estilos de vida y características sociodemográficas. Se pretende también estudiar las posibles diferencias en la salud percibida (SP) debidas a la edad y al sexo.Resumen,Conclusiones,INAHTA Structured Abstract, Introducción, Consideraciones sobre la Salud Percibida, Teorías sobre la Salud Percibida, Hipótesis de la esponja, Hipótesis de la trayectoria Hipótesis de la intervención, Hipótesis de los recursos, Estudios sin planteamiento teórico predefinido, Evidencias generadas por los resultados disponibles hasta ahora, Estudios internacionales en la población general, Estudios internacionales en personas de 65 años en adelante, Estudios sobre salud percibida en españoles, Aspectos metodológicos, Material y método, Material, Método, Análisis de los datos, Resultados, Análisis descriptivo, Análisis univariable, Análisis multivariable, Discusión, Conclusiones, Referencias, Anexo: Preguntas del cuestionario de la Encuesta Nacional de Salud de 1997

Efectividad de las Bombas de Infusión de Insulina: Impacto sobre la calidad de vida de determinados pacientes

El objetivo del presente informe es evaluar la eficacia de las bombas de infusión de insulina conforme a la evidencia científica disponible, prestando especial atención a su impacto sobre la calidad de vida de los pacientes.Resumen, INAHTA Structured Abstract, Introducción, Método, Resultados, Efectividad de las bombas de infusión de insulina, Bombas externas, Bombas implantables, Uso de las bombas en poblaciones específicas, Embarazadas, Adolescentes, Características de los pacientes, Calidad de vida relacionada con la salud, Consideraciones económicas, Población diana, Discusión, Conclusiones, Bibliografí

European Commission Initiative on Breast Cancer: Concept document

The European Commission Initiative on Breast Cancer (ECIBC) is aimed at ensuring and harmonising breast cancer services quality across European countries. It is coordinated by Commission’s Joint Research Centre, under the supervision of the Directorate-General Health and Food Safety. This document describes the background of the initiative, its general goals and objectives, and its foreseen outcomes.JRC.F.1-Health in Societ

Systematic review on women's values and preferences concerning breast cancer screening and diagnostic services

Background: There is still lack of consensus on the benefit‐harm balance of breast cancer screening. In this scenario, women's values and preferences are crucial for developing health‐related recommendations. In the context of the European Commission Initiative on Breast Cancer, we conducted a systematic review to inform the European Breast Guidelines. Methods: We searched Medline and included primary studies assessing women's values and preferences regarding breast cancer screening and diagnosis decision making. We used a thematic approach to synthesise relevant data. The quality of evidence was determined with GRADE, including GRADE CERQual for qualitative research. Results: We included 22 individual studies. Women were willing to accept the psychological and physical burden of breast cancer screening and a significant risk of overdiagnosis and false‐positive mammography findings, in return for the benefit of earlier diagnosis. The anxiety engendered by the delay in getting results of diagnostic tests was highlighted as a significant burden, emphasising the need for rapid and efficient screening services, and clear and efficient communication. The confidence in the findings was low to moderate for screening and moderate for diagnosis, predominantly because of methodological limitations, lack of adequate understanding of the outcomes by participants, and indirectness. Conclusions: Women value more the possibility of an earlier diagnosis over the risks of a false‐positive result or overdiagnosis. Concerns remain that women may not understand the concept of overdiagnosis. Women highly value time efficient screening processes and rapid result delivery and will accept some discomfort for the peace of mind screening may provide

ECICC: European Commission Initiative on Colorectal Cancer

This leaflet describes the European Commission Initiative on Colorectal Cancer (ECICC), a person-centred initiative to improve colorectal cancer care in Europe. The ECICC will develop evidence-based guidelines and a quality assurance scheme for healthcare services involved in the colorectal cancer care pathway.JRC.F.1-Health in Societ

Benefits and harms of annual, biennial, or triennial breast cancer mammography screening for women at average risk of breast cancer : a systematic review for the European Commission Initiative on Breast Cancer (ECIBC)

Background: Although mammography screening is recommended in most European countries, the balance between the benefits and harms of different screening intervals is still a matter of debate. This review informed the European Commission Initiative on Breast Cancer (BC) recommendations. Methods: We searched PubMed, EMBASE, and the Cochrane Library to identify RCTs, observational or modelling studies, comparing desirable (BC deaths averted, QALYs, BC stage, interval cancer) and undesirable (overdiagnosis, false positive related, radiation related) effects from annual, biennial, or triennial mammography screening in women of average risk for BC. We assessed the certainty of the evidence using the GRADE approach. Results: We included one RCT, 13 observational, and 11 modelling studies. In women 50-69, annual compared to biennial screening may have small additional benefits but an important increase in false positive results; triennial compared to biennial screening may have smaller benefits while avoiding some harms. In younger women (aged 45-49), annual compared to biennial screening had a smaller gain in benefits and larger harms, showing a less favourable balance in this age group than in women 50-69. In women 70-74, there were fewer additional harms and similar benefits with shorter screening intervals. The overall certainty of the evidence for each of these comparisons was very low. Conclusions: In women of average BC risk, screening intervals have different trade-offs for each age group. The balance probably favours biennial screening in women 50-69. In younger women, annual screening may have a less favourable balance, while in women aged 70-74 years longer screening intervals may be more favourable

Characteristics and impact of interventions to support healthcare providers’ compliance with guideline recommendations for breast cancer: a systematic literature review

BackgroundBreast cancer clinical practice guidelines (CPGs) offer evidence-based recommendations to improve quality of healthcare for patients. Suboptimal compliance with breast cancer guideline recommendations remains frequent, and has been associated with a decreased survival. The aim of this systematic review was to characterize and determine the impact of available interventions to support healthcare providers' compliance with CPGs recommendations in breast cancer healthcare.MethodsWe searched for systematic reviews and primary studies in PubMed and Embase (from inception to May 2021). We included experimental and observational studies reporting on the use of interventions to support compliance with breast cancer CPGs. Eligibility assessment, data extraction and critical appraisal was conducted by one reviewer, and cross-checked by a second reviewer. Using the same approach, we synthesized the characteristics and the effects of the interventions by type of intervention (according to the EPOC taxonomy), and applied the GRADE framework to assess the certainty of evidence.ResultsWe identified 35 primary studies reporting on 24 different interventions. Most frequently described interventions consisted in computerized decision support systems (12 studies); educational interventions (seven), audit and feedback (two), and multifaceted interventions (nine). There is low quality evidence that educational interventions targeted to healthcare professionals may improve compliance with recommendations concerning breast cancer screening, diagnosis and treatment. There is moderate quality evidence that reminder systems for healthcare professionals improve compliance with recommendations concerning breast cancer screening. There is low quality evidence that multifaceted interventions may improve compliance with recommendations concerning breast cancer screening. The effectiveness of the remaining types of interventions identified have not been evaluated with appropriate study designs for such purpose. There is very limited data on the costs of implementing these interventions.ConclusionsDifferent types of interventions to support compliance with breast cancer CPGs recommendations are available, and most of them show positive effects. More robust trials are needed to strengthen the available evidence base concerning their efficacy. Gathering data on the costs of implementing the proposed interventions is needed to inform decisions about their widespread implementation

Systematic review on women's values and preferences concerning breast cancer screening and diagnostic services

Background: There is still lack of consensus on the benefit‐harm balance of breast cancer screening. In this scenario, women's values and preferences are crucial for developing health‐related recommendations. In the context of the European Commission Initiative on Breast Cancer, we conducted a systematic review to inform the European Breast Guidelines. Methods: We searched Medline and included primary studies assessing women's values and preferences regarding breast cancer screening and diagnosis decision making. We used a thematic approach to synthesise relevant data. The quality of evidence was determined with GRADE, including GRADE CERQual for qualitative research.Results: We included 22 individual studies. Women were willing to accept the psychological and physical burden of breast cancer screening and a significant risk of overdiagnosis and false‐positive mammography findings, in return for the benefit of earlier diagnosis. The anxiety engendered by the delay in getting results of diagnostic tests was highlighted as a significant burden, emphasising the need for rapid and efficient screening services, and clear and efficient communication. The confidence in the findings was low to moderate for screening and moderate for diagnosis, predominantly because of methodological limitations, lack of adequate understanding of the outcomes by participants, and indirectness.Conclusions: Women value more the possibility of an earlier diagnosis over the risks of a false‐positive result or overdiagnosis. Concerns remain that women may not understand the concept of overdiagnosis. Women highly value time efficient screening processes and rapid result delivery and will accept some discomfort for the peace of mind screening may provide.</p