This is a new Canada's Drug Agency project. Projects listed as “in progress” are at various stages and points of completion. These products have different processes and timelines; therefore, the timing of posting of the final reports varies. The Projects in Progress page on the Canada's Drug Agency website is updated on a seven to eight-day cycle. View other current Projects in Progress.
With delayed tuberculin skin testing (TST) a single TST is performed to screen for tuberculosis (TB) infection 8 weeks after exposure to a known case of TB.
The clinical utility (i.e., clinical benefits and harms of testing) of delayed TST for identifying TB among close contacts with no known risks compared to testing immediately after and at 8 weeks after TB exposure is not known (no evidence was found).
It is not known if delayed TST is a cost-effective approach for identifying TB among close contacts with no known risks compared to testing immediately after and at 8 weeks after TB exposure (no evidence was found).
One evidence-based guideline developed in Canada does not provide specific recommendations regarding delayed TST in close contacts with no known risks of TB. However, the guideline authors discuss that a single TST at 8 weeks after TB exposure could be a practical option for medium-priority contacts (i.e., those with a lower risk to develop active disease). For high-priority contacts (i.e., those with the most exposure and highest risk to develop active disease), the authors propose testing immediately after exposure and a repeat test 8 weeks later.
This review identified 4 relevant systematic reviews, 2 randomized controlled trials and 1 guideline since 2017.
The systematic reviews and trials suggest that guanfacine is more clinically effective than placebo for improving symptoms of attention-deficit/ hyperactive disorder, however it may be associated with increased adverse events such as abdominal pain and fatigue.
There is some suggestion from 2 systematic reviews that guanfacine may be equally effective as other psychostimulants or non-psychostimulants, with the potential for more greater side effects, but the evidence is highly uncertain.
The included guideline has a strong recommendation to offer guanfacine for use in children and adolescents when psychostimulants have failed, or they are not tolerable.
No evidence was identified on the cost-effectiveness of guanfacine relative to psychostimulants, non-psychostimulants or placebo that met the inclusion criteria.
Laboratory tests provide health care professionals with important information to make decisions regarding the prevention, diagnosis, treatment, and management of many diseases. However, overutilization of low-value lab tests can lead to unnecessary interventions or investigations, increased health care spending and resource use, environmental effects of resource waste, and potentially negative patient experiences.
Clinicians may provide people being fitted for a prosthesis with temporary test prosthetic sockets to solicit feedback on their shape and comfort. The feedback can then be incorporated into the final design of the prosthesis, allowing customization based on the individual’s experience.
Limited evidence suggests that providing people with lower limb amputation a test socket before fitting a permanent socket may improve mobility and function, pain while walking, and prosthetic satisfaction, as well as decrease the frequency of admissions.
One guideline recommends the postoperative use of a prosthesis as soon as possible after transtibial amputation and that custom-made prostheses are preferable to prefabricated prostheses.
Additional high-quality evidence is needed to better understand the most appropriate use of multiple prosthetic sockets in people with lower limb amputation.
Injectable diacetylmorphine might provide more benefits and lower costs compared with oral methadone maintenance therapy in patients with severe opioid use disorder.
The Canadian Research Initiative in Substance Misuse guideline recommends that both injectable diacetylmorphine and hydromorphone should be considered as treatment options for individuals with severe, treatment-refractory opioid use disorder and ongoing illicit injection opioid use, and that the injectable opioid agonist treatment should have an end date to transition to an oral opioid agonist treatment.
No recent studies on the clinical effectiveness of diacetylmorphine for injection in comparison with methadone or buprenorphine were identified.
No cost-effectiveness studies of injectable diacetylmorphine compared with buprenorphine were identified.
Testing is an important and evolving factor in the management of the COVID-19 pandemic. For testing to be an effective part of public health strategy, it must be easily and equitably available to all who need it.
Self-testing allows people to test themselves or to test a family member for severe acute respiratory syndrome coronavirus 2, the virus that causes COVID-19, at home, without the supervision of a health care professional.
Understanding barriers to home rapid testing can help shape the availability of more accessible testing for everyone.
This Drug Shortage Implementation Advice synthesizes the evidence on the efficacy and safety of therapeutic alternatives for medullary thyroid cancer and suggests preferred treatment options for use in the event of a supply shortage of vandetanib 100 mg.
Tecovirimat is an oral antiviral therapy approved in Canada for the treatment of human smallpox disease in adult and pediatric patients weighing at least 13 kg. While tecovirimat is only approved for the treatment of smallpox, Canada's Drug Agency conducted a review of the evidence and convened an Implementation Advice Panel to prioritize the patient populations that are most likely to benefit from tecovirimat for the treatment of human monkeypox infection.
The literature search did not identify any studies with relevant evidence on the clinical utility of syphilis screening using risk-based approaches versus population-wide approaches for adolescents and adults.
One overview of systematic reviews of variable methodological quality did not identify any systematic reviews on the clinical utility of syphilis screening comparing risk-based assessment to routine population-based screening in people at low risk of syphilis.