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

Report on the call for feedback about The Scope of the European guidelines for breast cancer screening and diagnosis: European Commission Initiative on Breast Cancer

In 2015, the European Commission Initiative on Breast Cancer (ECIBC) started the development of the European guidelines for breast cancer screening and diagnosis (henceforth the European Breast Guidelines) under the auspices of the Directorate-General for Health and Food Safety (DG SANTE) and the technical and scientific coordination of the Directorate-General Joint Research Centre (JRC). To support the JRC in this task, a Guidelines Development Group (GDG), consisting of independent experts and individuals, was established. The European Breast Guidelines’ scope (The Scope) represented the first output of the development process of the European Breast Guidelines. Via a public call for feedback, stakeholders and individual citizens were invited to provide their feedback on The Scope. The call for feedback was open from 18 December 2015 to 17 January 2016 and an online questionnaire was made available on the ECIBC web hub via the EU Survey platform. The JRC received a total of 82 valid responses, from 40 individuals from 18 different countries and from 42 organisations from 20 different countries. During a meeting held in Varese (Italy) in March 2016, the GDG discussed the new version of The Scope which was prepared taking into account the results of the call for feedback. The Scope was finalised and approved by the GDG after some minor editing on 6 September 2016 and was later made publicly available together with this report.JRC.F.1-Health in Societ

Patología Física en la Esquizofrenia. Revisión Sistémica y Análisis de Registros Hospitalarios

El presente estudio se ha desarrollado en el marco de una línea de investigación de la Agencia de Evaluación de Tecnologías Sanitarias iniciada bajo convenio suscrito con Laboratorios BMS y continuada posteriormente al amparo del Plan Nacional de I+D+I (Proyecto nº PI06/90571OBJETIVOS: Analizar de manera sistemática la evidencia científica que sustenta el concepto de una mayor morbilidad y mortalidad por causas físicas en pacientes con Esquizofrenia frente a la población general, conjugando revisión de la literatura y análisis de registros hospitalarios

The ECIBC (European Commission Initiative on Breast Cancer) web hub concept and feasibility study

In December 2012, the Joint Research Centre (JRC) was assigned by the Directorate-General for Health and Consumers (now the Directorate-General for Health and Food Safety - DG SANTE) with the task of coordinating the European Commission Initiative on Breast Cancer henceforth shortened to ECIBC. ECIBC main tasks as defined in the DG SANTE published document are: • To develop a new version of the European guidelines for breast cancer screening and diagnosis based on new knowledge and evidence. • To develop a voluntary European quality assurance (QA) scheme for breast cancer services covering all care processes based on the EU legislative framework on accreditation and underpinned by the evidence provided by the guidelines With regards to guidelines covering processes other than screening and diagnosis (treatment, rehabilitation and follow-up, and all relevant horizontal aspects), a platform for breast cancer guidelines is envisaged to host existing evidence-based, high-quality guidelines. The ECIBC project also includes the definition of a concept for training of professionals in breast cancer screening and the development of a dedicated web hub, to which this report refers. The ECIBC web hub will be the communication interface with stakeholders and the main tool presenting and making available project deliverables (and their updates) over the long-term. The present report is a summary of the process of developing the concept for the ECIBC web hub and of the feasibility study activities: • It provides a list of user requirements along with some sketched ECIBC web hub pages, crafted out of a series of meetings and analysing relevant cancer-related web portals. • It describes the technical platform evaluation process that led to the selection of Liferay Portal. • It presents a high-level initial plan to provide ECIBC web hub functionality needed by the upcoming ECIBC project steps, with a pilot in the second part of 2015 and a fully functional web hub at the end of 2017. In order to develop the ECIBC web hub, the JRC carried out a specific feasibility study with three main objectives: • Analyse user requirements. • Select a technical platform. • Make an initial time and effort estimation.JRC.I.2-Public Health Policy Suppor

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

Projeto e validação de um questionário de saúde oral para avaliação pré‐anestésica no pré‐operatório

BACKGROUND AND OBJECTIVES: Dental injuries incurred during endotracheal intubation are more frequent in patients with previous oral pathology. The study objectives were to develop an oral health questionnaire for preanaesthesia evaluation, easy to apply for personnel without special dental training; and establish a cut-off value for detecting persons with poor oral health. METHODS: Validation study of a self-administered questionnaire, designed according to a literature review and an expert group's recommendations. The questionnaire was applied to a sample of patients evaluated in a preanaesthesia consultation. Rasch analysis of the questionnaire psychometric properties included viability, acceptability, content validity and reliability of the scale. RESULTS: The sample included 115 individuals, 50.4% of men, with a median age of 58 years (range: 38-71). The final analysis of 11 items presented a Person Separation Index of 0.861 and good adjustment of data to the Rasch model. The scale was unidimensional and its items were not biased by sex, age or nationality. The oral health linear measure presented good construct validity. The cut-off value was set at 52 points. CONCLUSIONS: The questionnaire showed sufficient psychometric properties to be considered a reliable tool, valid for measuring the state of oral health in preoperative anaesthetic evaluations.S

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