Key Message

Three systematic reviews and six randomized controlled trials were identified regarding the clinical evidence for provision of direct observational therapy (DOT) for the treatment of tuberculosis. The evidence suggested that DOT provided by a family member was as effective as DOT provided by non-family members. Evidence regarding the location for the provision of DOT suggested that alternative locations such as at home, at work, or in the community, can be more or similarly effective as DOT provided in health care facilities. The provision of video observational therapy was found to be equally or more effective than DOT. The body of evidence was limited by its heterogeneity and was largely low to moderate in quality Six evidence-based guidelines were identified regarding the use of DOT for the treatment of tuberculosis. Two guidelines provide strong and conditional recommendations, based on low-quality evidence, that DOT should be administered by people trained specifically to provide DOT. One guideline provides a conditional recommendation, based on moderate-quality evidence, to administer DOT in a community setting or at home rather than a health care facility. For the general population, and members of vulnerable or hard-to-reach populations, two guidelines recommend video observational therapy as an alternative to DOT, based on weak evidence.

Key Message

One moderate quality randomized controlled trial (two publications) regarding the clinical effectiveness of trastuzumab combined with carboplatin and paclitaxel compared with carboplatin and paclitaxel alone in patients with HER2 positive uterine serous carcinoma was identified. The trial showed that trastuzumab combined with carboplatin and paclitaxel significantly improved progression-free survival and improved overall survival in patients with advanced and recurrent HER2 positive uterine serous carcinoma compared with carboplatin and paclitaxel alone. High-grade adverse events during and following treatment were not significantly different between the treatment groups. Objective response rate did not differ between groups. No clinical evidence regarding trastuzumab monotherapy or other types of trastuzumab combination therapies (e.g., trastuzumab in combination with cisplatin and paclitaxel or docetaxel), patients with non-serous uterine cancer, other comparators (e.g., docetaxel), or data on quality of life were identified. No studies were identified regarding the cost-effectiveness of trastuzumab.

Key Message

Prostate-specific membrane antigen (PSMA) positron emission tomography (PET) imaging for patients with biochemical recurrence of prostate cancer was evaluated as a cost-effective alternative to usual care imaging in one well-conducted economic analysis. The applicability of this study to the Canadian healthcare setting was not clear and the study was limited by the sources of clinical and cost data inputs. Evidence identified on the diagnostic accuracy of PSMA PET imaging consisted of 197 relevant primary studies compiled in 16 systematic reviews included in this report. This large body of evidence was evaluated by 11 of the included systematic reviews as having significant risk of bias, most commonly associated with the diagnostic reference standard. Additionally, four systematic reviews found evidence of possible publication bias in favour of positive results within the primary study evidence. Despite high heterogeneity and a lack of consistent diagnostic performance outcomes between primary studies, a consensus that PSMA PET provided useful diagnostic performance for recurrent prostate cancer was reported by the systematic reviews. Evidence was also identified from four systematic reviews that suggested that PSMA PET provided greater diagnostic accuracy than radiolabeled choline-based PET. There was also consensus that PSMA PET diagnostic accuracy decreased with decreasing prostate-specific antigen (PSA) levels in biochemical recurrence, as observed with other PET radiolabeled tracers. One meta-analysis also reported statistically superior disease detection of PSMA PET as compared to radiolabeled choline PET imaging in patients with lower PSA levels. The authors of the majority of systematic reviews concluded that larger prospective comparative trials with a suitable and consistent reference standard are required to accurately determine diagnostic accuracy of PSMA PET and thereby its optimal role in diagnosing patients with recurrence of prostate cancer. One set of guidelines from the US had a relevant recommendation, based on expert opinion, that PET/CT including PSMA PET imaging may be used for patients with biochemical recurrence of prostate cancer as an alternative to conventional imaging.

Key Message

This rapid qualitative evidence synthesis included 12 primary qualitative studies on the perspectives and experiences of people living with BPD and people involved in their lives on accessing and undergoing therapy for BPD including DBT.

Accessing treatment started with accessing a diagnosis of BPD. People living with BPD found receiving a diagnosis offered them a sense relief and a way forward to treatment. When accessing care for their BPD through non-BPD specialist services, they described facing stigma.

Due to the volatile nature of BPD, people living with the condition identified the need to be able to access services when they were in crisis (i.e., at all hours of the day). People reported facing long wait lists and a lack of specialists when trying to access treatment for their BPD.

For many living with BPD, recovery was seen as a long, hard road with many ups and downs. Recovery was framed not as a return to self but as a shift to another way of being, of being able to cope with emotional distress and symptom reduction in ways that allowed them to engage positively in life, interpersonal relationships and activities such as work and school.

Engaging with DBT was largely described as a positive experience by participants with BPD. Negative views, particularly of group skills training, tended to relate to the content and the way it was delivered. Participants of DBT valued the ability to learn skills from each other through group skills training, and the sense of community that shared learning offered. Individual psychotherapy and telephone support provided additional support for people living with BPD to feel secure and to learn and practice applying their skills.

The recovery process required that people with BPD continually practice applying the skills they acquired through DBT. Once these skills became second nature, they felt that they were making headway towards recovery. People engaging in DBT for BPD appreciated the opportunity for their family and partners to receive information on and training in DBT.

People living with BPD and another mental health condition or substance use found it difficult to find and access appropriate treatment for their conditions. Some described the financial barriers as limiting their ability to access treatment. People living in rural areas who sought care for their BPD described having limited access.

Key Message

One non-randomized single-arm study was identified regarding the safety of intravenous propofol and remifentanil administered by independent target-controlled infusions pumps for patients undergoing moderate sedation for bronchoscopy. No relevant economic evaluations or evidence-based guidelines were identified regarding the cost-effectiveness or use of intravenous propofol and remifentanil administered by independent target-controlled infusion pumps for patients undergoing moderate procedural sedation in medicine and dentistry. Overall, the body of evidence was limited in quantity and quality.Favourable visual analogue scale scores for dyspnea, pain, cough, and anxiety were reported by patients who received intravenous propofol and remifentanil administered by independent target-controlled infusion pumps operated by specialist sedation nurses. Additionally, favourable visual analogue scale scores for dyspnea, pain, cough, and discomfort were reported by bronchoscopists. Desaturation and hypotension occurred in four and two of 32 procedures, respectively, with no occurrence of serious adverse events.

The included study had several methodological limitations. The small sample size (N = 13) and lack of comparison to other sedation strategies should be considered when interpreting the findings of this report. Without comparator groups, it is unclear if these favourable safety outcomes are related to target-controlled infusions of propofol and remifentanil. Furthermore, statistical tests were not performed to evaluate changes from baseline for relevant outcomes.

Key Message

Three relevant systematic reviews and one relevant economic evaluation were identified.

Generally, rates of complication, readmission, and reoperation were not statistically different or appeared numerically comparable between the outpatient and inpatient total hip arthroplasty (THA) groups. Mortality rates were low and appeared to be numerically comparable between the outpatient and inpatient THA groups.

Generally, rates of complication, readmission, and reoperation were not statistically different or appeared numerically comparable between the outpatient and inpatient total knee arthroplasty (TKA) groups. There were inconsistencies with respect to mortality rates in the outpatient and inpatient TKA groups; this finding was based on two studies included in one systematic review.

Inpatient THA was considered not to be cost-effective compared to outpatient THA at a willingness to pay threshold of US$50,000 as the incremental cost effectiveness ratio (ICER) for inpatient THA was US$81,116 per quality adjusted life year (QALY) for Medicare and US$140,917 per QALY for private payer insurance.

Findings need to be interpreted in the light of limitations such as evidence of limited quantity and low quality; and lack of long-term data.

No evidence was identified regarding the cost effectiveness of outpatient or short stay TKA.

No evidence-based guidelines regarding the outpatient or short stay THA or TKA were identified.