Key Message

There was evidence indicating that in the treatment of opioid use disorder, injectable hydromorphone or injectable methadone provided more benefit at less cost compared with injectable diacetylmorphine over a six-month time horizon.

Evidence suggests that in the treatment of opioid use disorder, both injectable hydromorphone and injectable diacetylmorphine are likely to provide more benefit at less cost than methadone maintenance treatment. Treatment with injectable hydromorphone was more cost-effective than injectable diacetylmorphine in opioid use disorder patients who do not respond to or relapse from drug treatments.

The evidence is limited because observed data was collected during a short-term follow-up, and long-term cost-effectiveness outcomes were based on extrapolations beyond data from the actual studies.

One guideline provided a weak recommendation, supported by low-quality evidence, for using slow-release oral morphine in older adults with adequate renal function in whom buprenorphine and methadone maintenance have been ineffective to treat opioid use disorder or could not be tolerated. Another guideline recommends using injectable hydromorphone or injectable diacetylmorphine for individuals with severe opioid use disorders who relapsed previous treatments failed.

No relevant cost-effectiveness evidence or guidelines with recommendations regarding the use of oral hydromorphone, fentanyl patches, or fentanyl buccal tablets for OUD treatment were identified; therefore, no summary can be provided.

Key Message

High-functioning acute care hospitals enable efficient patient flow from admission to discharge with the right care from the right providers at the right time.

Barriers to patient flow can result in cascading events and contribute to patient harm and caregiver burnout.

Quality improvement endeavours in the UK, Switzerland, Finland, and the US have shown success through addressing workplace culture, utilizing management and process theories, altering roles and responsibilities, and taking advantage of technologies.

Successful and sustainable improvements tend to involve substantial planning along with engagement of stakeholders in the design and implementation of a tailored approach.

Key Message

No relevant evidence was identified comparing the safety of frequent obstetrical ultrasounds compared to the routine use of obstetrical ultrasound during pregnancy. This review identified 10 evidence-based guidelines that provided recommendations regarding various indications for obstetrical ultrasound, as well as the frequency of obstetrical ultrasound; however, the methodological rigour of these guidelines is limited and recommendations should be interpreted with caution. One guideline recommended against obstetrical ultrasound for non-medical purposes and recommended that ultrasound exposure be as low as reasonably possible during pregnancy. These recommendations were based on moderate-quality evidence and expert opinion, and should be interpreted with caution. The guidelines made recommendations for specific patient populations for whom more frequent obstetrical ultrasound examinations may be required. These populations included pregnancies affected by certain congenital infections, people pregnant with twins, pregnant adolescents, and pregnant people at high risk for fetal anomalies or for whom mid-trimester transabdominal ultrasound would be challenging.

Key Message

Limited evidence from 2 randomized controlled trials suggested that floatation with restricted environmental stimulation therapy may provide some potential benefits in reducing anxiety and improving many of the symptoms associated with anxiety, including muscle tension, blood pressure, difficulties in emotion regulation, sleep difficulties, and depression, in individuals with anxiety disorders.

Both trials reported no serious adverse events or negative side effects associated with the floatation therapy.

No evidence was found on the cost-effectiveness of floatation therapy for the treatment of mental health conditions.

No evidence-based guidelines with recommendations regarding the use of floatation therapy for the treatment of mental health conditions were identified.

Key Message

Evidence of variable quality from 6 diagnostic test accuracy studies indicates that the Pan-Canadian Early Detection of Lung Cancer (PanCan) model may perform better at determining which lung nodules identified by low-dose CT are cancerous compared to the Lung Imaging Reporting and Data System. However, evidence from 3 other studies, also of variable quality, suggests that the risk calculators have similar diagnostic test accuracy.

No studies were identified that compared the clinical utility of PanCan versus the Lung Imaging Reporting and Data System.

Results from 2 economic evaluations were inconsistent about the cost-effectiveness of the 2 lung cancer risk models. However, each study applied the models to different types of lung nodules.

One evidence-based guideline recommended that PanCan be used in the UK for initial risk assessment and for the management of lung nodules.

Key Message

The applicability of the identified findings and the potential impact on patient outcomes for any individual diagnostic setting was unclear. In the majority of the identified studies, the authors reported diagnostic accuracy and clinical utility outcomes that supported digital pathology systems as a valuable diagnostic modality, comparable to conventional microscopy. These studies lacked statistical power calculations, making the accuracy of these statements unclear. One systematic review and 1 diagnostic study reported clinical utility outcomes of digital pathology. This evidence supported digital pathology using primary case sign-out for accurate prognosis of patient outcomes; however, the clinical utility compared to conventional microscopy was unclear in the identified evidence. One systematic review and 13 diagnostic cohort studies reported on the diagnostic accuracy of whole slide image (WSI). The identified outcomes indicated that WSI is a valuable diagnostic modality; however, a large range of diagnostic accuracy in different settings, and a lack of clear statistical power in all studies make comparator conclusions to conventional microscopy unclear. One systematic review and 4 diagnostic cohort studies reported diagnostic areas that can present challenges for a digital pathology implementation, the most common being the interpretation and grading of dysplasia. One identified systematic review stressed the importance of whole-system validation to identify strengths and weaknesses of specific digital pathology implementations. The range of diagnostic accuracy across studies also indicated that implementation of digital pathology primary case sign-out systems is associated with unclear diagnostic accuracy until appropriately validated. No relevant cost-effectiveness evidence for digital pathology using primary case sign-out was identified.

Key Message

No relevant literature was identified regarding the comparative clinical effectiveness of cardiac monitoring devices for adolescents with eating disorders in inpatient settings. No evidence-based guidelines were identified regarding cardiac monitoring for adolescents with eating disorders in inpatient settings.

Key Message

Among residents with dementia, positive effects of small-scale homelike models of care on social interaction were observed in 1 non-randomized study, whereas the evidence from relevant primary studies captured in 1 systematic review was mixed. Residents with dementia living in small-scale homelike care facility compared with a traditional nursing home may spend more time in a positive mood or engagement, based on findings from 1 non-randomized study. Evidence captured in 1 systematic review suggested lower use of restraints and psychotropic drugs in small-scale homelike settings compared with traditional nursing homes; however, a non-randomized study published in 2020 found no differences in psychotropic drug use. Associations between homelike models of care and safety outcomes (e.g., COVID-19 infection, fall injuries) suggested a benefit of small-scale homelike long-term care settings over traditional large-scale settings.

Key Message

Two systematic reviews that met the inclusion criteria of this report were identified. Within these reviews, the clinical effectiveness of nabilone for the treatment of adult patients with post-traumatic stress disorder (PTSD) was evaluated in 1 relevant primary study. This single-arm, open-label study found that most patients with PTSD experienced total cessation or reduction of nightmares following treatment with nabilone. This study lacked a control group, limiting the certainty of these findings.No evidence-based guidelines regarding the use of nabilone for the treatment of adult patients with PTSD were identified.

Key Message

Data from 2 randomized controlled trials indicated a statistically significant benefit in progression-free survival and overall survival for patients with follicular lymphoma who received R2 as compared to patients who received rituximab plus placebo or R-CHOP.

The frequency of all types of adverse events in patients receiving R2 as compared to rituximab plus placebo or R-CHOP was comparable, but patients receiving R2 experienced more severe adverse events.

Two economic analyses concluded that R2 was cost-effective for the treatment of patients with follicular lymphoma as compared to rituximab plus placebo (UK and Dutch contexts).

Evidence identified in this review was mostly limited to that describing patients with follicular lymphoma.

Most evidence identified in this review was generated with support and/or funding from a private industry pharmaceutical manufacturer.