Radiofrequency and Microwave Ablation Compared to Systemic Chemotherapy and to Partial Hepatectomy in the Treatment of Colorectal Liver Metastases:A Systematic Review and Meta-Analysis

To assess safety and outcome of radiofrequency ablation (RFA) and microwave ablation (MWA) as compared to systemic chemotherapy and partial hepatectomy (PH) in the treatment of colorectal liver metastases (CRLM). MEDLINE, Embase and the Cochrane Library were searched. Randomized trials and comparative observational studies with multivariate analysis and/or matching were included. Guidelines from National Guideline Clearinghouse and Guidelines International Network were assessed using the AGREE II instrument. The search revealed 3530 records; 328 were selected for full-text review; 48 were included: 8 systematic reviews, 2 randomized studies, 26 comparative observational studies, 2 guideline-articles and 10 case series; in addition 13 guidelines were evaluated. Literature to assess the effectiveness of ablation was limited. RFA + systemic chemotherapy was superior to chemotherapy alone. PH was superior to RFA alone but not to RFA + PH or to MWA. Compared to PH, RFA showed fewer complications, MWA did not. Outcomes were subject to residual confounding since ablation was only employed for unresectable disease. The results from the EORTC-CLOCC trial, the comparable survival for ablation + PH versus PH alone, the potential to induce long-term disease control and the low complication rate argue in favour of ablation over chemotherapy alone. Further randomized comparisons of ablation to current-day chemotherapy alone should therefore be considered unethical. Hence, the highest achievable level of evidence for unresectable CRLM seems reached. The apparent selection bias from previous studies and the superior safety profile mandate the setup of randomized controlled trials comparing ablation to surgery

Cervical and lumbar total disc replacements : Supplement

66 p.ill.,1.HTA CORE MODEL ASSESSMENT ELEMENTS 3 -- 2. CURRENT USE OF TOTAL DISC REPLACEMENT 11 -- 2.1. CERVICAL TOTAL DISC REPLACEMENT 11 -- 2.1.1. INAMI – RIZIV billing codes for cervical surgery 11 -- 2.1.2. Most frequent 3-digit ICD-9-CM codes of principal diagnosis in case of CTDR 11 -- 2.1.3. Five-digit ICD-9-CM codes of principal diagnosis Intervertebral Disc Disorder (722.xx) in case of CTDR 12 -- 2.2. LUMBAR TOTAL DISC REPLACEMENT 12 -- 2.2.1. INAMI – RIZIV billing codes for lumbar TDR 12 -- 2.2.2. Most frequent 3-digits ICD-9-CM codes of principal diagnosis in case of LTDR 13 -- 2.2.3. Five-digits ICD-9-CM codes of principal diagnosis Intervertebral Disc Disorder (722.xx) in case of LTDR 13 -- 3. CLINICAL EFFECTIVENESS AND SAFETY OF TOTAL DISC REPLACEMENT 14 -- 3.1. COMMON SEARCH STRATEGY FOR CERVICAL AND LUMBAR TOTAL DISC REPLACEMENTS 14 -- 3.1.1. Search strategies 14 -- 3.1.2. Study flow of selection of HTAs and SRs for CTDR + LTDR 17 -- 3.1.3. Study flow of selection of RCTs for CTDR and LTDR 17 -- 3.2. RESULTS FOR CERVICAL TOTAL DISC REPLACEMENT 18 -- 3.2.1. Evidence tables of systematic reviews 18 -- 3.2.2. Evidence tables of primary studies 25 -- 3.2.3. AMSTAR Quality appraisal of systematic reviews 33 -- 3.2.4. Quality appraisal of primary studies 34 -- 3.3. RESULTS FOR LUMBAR TOTAL DISC REPLACEMENT 36 -- 3.3.1. Evidence table of systematic review 36 -- 3.3.2. Evidence tables of primary studies 38 -- 3.3.3. AMSTAR Quality appraisal of systematic review 41 -- 3.3.4. Quality appraisal of primary studies 41 -- 4. ECONOMIC EVALUATION OF TOTAL DISC REPLACEMENT 42 -- 4.1. COMMON SEARCH STRATEGY FOR CERVICAL AND LUMBAR TOTAL DISC REPLACEMENTS 42 -- 4.1.1. Search strategies 42 -- 4.1.2. Study flow of selection of economic evaluations 44 -- 4.2. DATA EXTRACTION SHEETS FOR CERVICAL TOTAL DISC REPLACEMENT 45 -- 4.3. DATA EXTRACTION SHEETS FOR LUMBAR TOTAL DISC REPLACEMENT 5

Cervical and lumbar total disc replacements

84 p.ill.,LIST OF FIGURES .2 -- LIST OF TABLES .3 -- LIST OF ABBREVIATIONS .4 -- SCIENTIFIC REPORT 7 -- 1 INTRODUCTION 7 -- 1.1 BACKGROUND 7 -- 1.2 SCOPE AND OBJECTIVES .8 -- 2 CERVICAL TOTAL DISC REPLACEMENT 9 -- 2.1 HEALTH PROBLEMS 9 -- 2.1.1 Population and condition 9 -- 2.1.2 Existing treatments .9 -- 2.2 DESCRIPTION AND TECHNICAL CHARACTERISTICS 9 -- 2.3 CURRENT USE 14 -- 2.3.1 Methods 14 -- 2.3.2 Results .15 -- 2.4 CLINICAL EFFECTIVENESS AND SAFETY .19 -- 2.4.1 Methods 19 -- 2.4.2 Results on Clinical Effectiveness .23 -- 2.4.3 Results on Safety .35 -- 2.4.4 Discussion 42 -- 2.5 ECONOMIC EVALUATION 42 -- 2.5.1 Introduction 42 -- 2.5.2 Methods 43 -- 2.5.3 Characteristics of the economic evaluations 44 -- 2.5.4 Results of the economic evaluations .48 -- 2.5.5 Discussion 50 -- 3 LUMBAR TOTAL DISC REPLACEMENT .51 -- 3.1 HEALTH PROBLEMS 51 -- 3.1.1 Population and condition 51 -- 3.1.2 Existing treatments .51 -- 3.2 DESCRIPTION AND TECHNICAL CHARACTERISTICS 51 -- 3.3 CURRENT USE 56 -- 3.3.1 Methods 56 -- 3.3.2 Results .56 -- 3.4 CLINICAL EFFECTIVENESS AND SAFETY .60 -- 3.4.1 Methods 60 -- 3.4.2 Results on Clinical Effectiveness .62 -- 3.4.3 Results on Safety .67 -- 3.4.4 Discussion 69 -- 3.5 ECONOMIC EVALUATION 70 -- 3.5.1 Introduction 70 -- 3.5.2 Methods 70 -- 3.5.3 Characteristics of the economic evaluations 72 -- 3.5.4 Results of the economic evaluations .75 -- 3.5.5 Discussion 77 -- REFERENCES .7

Remplacement total de disque cervical ou lombaire : Synthèse

19 p.ill.,Les maux de dos dans leur ensemble comptent parmi les problèmes de santé les plus fréquents. Quand ils persistent un certain temps, la chirurgie est parfois proposée, avec l’espoir qu’elle apporte la guérison. Le Centre fédéral d’Expertise des Soins de Santé (KCE) a examiné deux types d’interventions portant sur les vertèbres, l’une destinée à traiter les fractures ou « tassements » douloureux, l’autre à remplacer les disques intervertébraux abîmés. Aucune des deux techniques n’est pleinement à la hauteur des espoirs placés en elle

Volledige vervanging van cervicale of lumbale tussenwervelschijven : Synthese

19 p.ill.,Rugklachten behoren tot de vaakst voorkomende gezondheidsproblemen. Wanneer de pijn een tijd aansleept, wordt er soms een rugoperatie voorgesteld, met de hoop dat dit genezing zal brengen. Het Federaal Kenniscentrum voor de Gezondheidszorg (KCE) onderzocht twee soorten ingrepen aan de ruggenwervels. Bij de ene worden pijnlijke breuken behandeld, bij de andere worden beschadigde tussenwervelschijven vervangen. Geen van beide technieken beantwoordt volledig aan de verwachtingen

Cervical and lumbar total disc replacements : Synthesis

13 p.ill.

Evaluating fracture risk in acute ankle sprains: any news since the Ottawa Ankle Rules?: a systematic review

Background: Ankle sprain is frequently encountered, both in primary care and in emergency departments. Since 1992, the Ottawa ankle rules (OAR) can assist clinicians in determining whether an X-ray should be performed to exclude a fracture. Several guidelines recommend the use of OAR based on a systematic review from 2003. Ten years later, one can wonder if this recommendation should be changed. Objective: To review systematically the current evidence on the most accurate method to assess the fracture risk after an ankle sprain in adults. Methods: A methodical search for systematic reviews, meta-analyses and primary studies was carried out in Medline, Cochrane Database of systematic reviews, Embase, Pedro, CINAHL, Medion and specific guideline search engines. At least two independent researchers performed selection, quality appraisal (with validated checklists) and data extraction. Results: One systematic review and 21 primary studies were selected. Sensitivity and specificity of the OAR range from 92-100% and from 16-51%, respectively. To improve the OAR specificity, other tools are proposed such as the Bernese ankle rules. Vibrating tuning fork test and ultrasound could be useful in patient with OAR positive to decrease the need for radiographs. No evidence was found in favour of the use of magnetic resonance imaging (MRI) or computed tomography (CT) in the acute phase of ankle sprain. Conclusion: The findings confirm the value of the OAR at ruling out fractures after an ankle sprain and propose other or additional tools to decrease the need for X-rays