Aanesthetic Agents for Day Surgery - NIHR Health Technology ...

More documents

Recommendations

Info

110 Appendix 2 TABLE 65 contd Summary of adult clinical outcomes studies Study Investigations Outcome Results Authors’ Reviewers’ comments, and subjects measures conclusions grade of evidence McQuay and Propofol vs other PONV: complete Results only None regarding this Results difficult to interpret Moore,1998, 44 anaesthetics for emetic control; presented specific issue or use due to typographical England induction nausea; early graphically errors. Not clear what the vomiting (up comparators were Propofol vs other to 6 h); late < 5 NNT for: anaesthetics for vomiting (up reduction of nausea maintenance TIVA vs other anaesthetics to 48 h) by use of propofol maintenance N 2O vs no N 2O 215 studies (31,801 patients) Sneyd et al., Study included PONV in adults OR = 0.267 (95% Propofol maintenance: MEDLEY database 1998, 45 England inpatient surgery and children CI, 0.220 to 0.325); associated with (proprietary database compared with 3.7-fold reduction low PONV owned by Zeneca). Propofol compared isoflurane, in risk of PONV Method of meta-analysis with inhalational sevoflurane with propofol Induction agent: not reported agents for mainte- no effect nance: 96 studies Effect of opiates and N 2O Choice of inhalational agent: no effect N 2O: no effect Opiate: no effect Tramer et al., Study included PONV: complete Complete emetic Omitting N 2O from MEDLINE only searched 1996, 46 England inpatient surgery emetic control; control: no signifi- general anaesthesia from 1966 to May 1995. nausea; early cant change decreases PONV if Method of meta-analysis Meta-analysis of vomiting (up the baseline risk of not reported PONV and N 2O: to 6 h); late Complete nausea: vomiting is high 24 studies vomiting (up no significant change (2478 patients) to 48 h) Early vomiting: NNT = 11.8 (95% CI, 8.5 to 19.4) Late vomiting: NNT = 13.8 (95% CI, 8.8 to 31.6) Tramer et al., Study included PONV: complete Propofol for Propofol may have a MEDLINE only searched 1997a, 47 England inpatient surgery emetic control; induction: any event, clinically relevant effect from 1966 to December nausea; early NNT = 20.9 on PONV, but only in 1995. Method of meta- Meta-analysis of vomiting (up (95% CI, 8.3 to ∞) the short term, when analysis not reported PONV and propofol to 6 h); late given as a maintenance anaesthesia: vomiting (up Propofol for regimen and the 84 studies to 48 h) maintenance: any baseline PONV rate (3098 patients) event, NNT = 6.2 without prophylaxis (95% CI, 4.7 to 9) is > 20% Tramer et al., Study included PONV: complete NNT (95% CI) Omitting N 2O was as MEDLINE only searched 1997b, 48 England inpatient surgery emetic control; results from Tramer good as using propofol from 1966 to December nausea; early et al. 1996 and for maintenance at 1995. Method of meta- Meta-analysis of vomiting (up 1997b reducing PONV rates analysis not reported PONV and propofol to 6 h); late + N 2O vs propofol vomiting (up with no N 2O to 48 h) FDA, Food and Drugs Administration (USA); NNT, numbers needed to treat; PACU, postanaesthesia care unit
Hierarchy of evidence Grade I: properly randomised controlled trial. Grade II-1a: well-designed controlled trial with pseudo-randomisation.(‘Pseudo-randomisation’ refers to alternate allocation, allocation by birth date or case-note number.) Grade II-1b: well-designed controlled trial without randomisation. Grade II-2a: well-designed cohort prospective study with concurrent controls. Grade II-2b: well-designed cohort prospective study with historical controls. Grade II-2c: well-designed cohort retrospective study with concurrent controls. Grade II-3: well-designed case–control retrospective study. Grade III: large differences from comparisons between time and/or places with and without intervention (in some circumstances these may be equivalent to grade I or II). Grade IV: opinions of respected authorities, based on clinical experience, descriptive studies, or reports of expert committees. Study design checklist for assessing validity RCTs 1. Was the assignment to the treatment groups really random? 2. Was relatively complete follow-up achieved? 3. Were the outcomes of people who withdrew described and included in the analysis? 4. Were those assessing outcomes blind to the treatment allocation? 5. Were the control and treatment groups comparable at entry? 6. Were groups treated identically other than for the named intervention? Cohort studies 1. Are the exposed people representative of the standard users of the intervention? 2. Was the non-exposed cohort selected from the same population as the exposed cohort? 3. What confounding factors may affect the outcome? 4. Were these confounding factors controlled for? © Queen’s Printer and Controller of HMSO 2002. All rights reserved. Appendix 3 Health Technology Assessment 2002; Vol. 6: No. 30 Quality criteria for published studies 5. Was the outcome assessment blind to exposure status? 6. Was an adequate proportion of the cohort followed up? Case–control studies 1. Was the disease state of the cases reliably assessed? 2. Was there a potential for selection bias? 3. Were controls selected from a similar population as the cases? 4. Were hazards and interventions assessed in the same way for cases and controls? 5. Was follow-up long enough? Longitudinal surveys or case series 1. Is the study based on a random sample selected from a suitable sampling frame? 2. Is there any evidence that the sample is representative of standard users of the intervention? 3. Are the inclusion criteria clearly defined? 4. Was follow-up long enough? 5. Were outcomes assessed objectively? Quality assessment of patient-based outcome studies 49 Outcome measures for clinical trials should be chosen by evaluating evidence about instruments in relation to the following eight criteria. • Appropriateness: is the content of the instrument appropriate to the questions which the clinical trial is intended to address? • Reliability: does the instrument produce results that are reproducible and internally consistent? • Validity: does the instrument measure what it claims to measure? • Responsiveness: does the instrument detect changes over time that matter to patients? • Precision: how precise are the scores of the instrument? • Interpretability: how interpretable are the scores of an instrument? • Acceptability: is the instrument acceptable to patients? • Feasibility: is the instrument easy to administer and process? 111
Page 1 and 2:
Which anaesthetic agents are costef
Page 3:
Which anaesthetic agents are costef
Page 6 and 7:
NHS R&D HTA Programme The NHS R&D H
Page 8 and 9:
Contents Appendix 6 Adult patient-b
Page 11 and 12:
Background The aim of the project w
Page 13:
• The incidence of PONV was low d
Page 16 and 17:
2 Introduction dizziness or disorie
Page 18 and 19:
4 Introduction a reduced incidence
Page 20 and 21:
6 Introduction willingness to pay f
Page 22 and 23:
8 Literature review included in the
Page 24 and 25:
10 Literature review TABLE 1 Compar
Page 26 and 27:
12 Literature review intermediate a
Page 28 and 29:
Page 30 and 31:
Page 32 and 33:
18 Literature review Patient-based
Page 34 and 35:
20 Literature review TABLE 5 contd
Page 36 and 37:
22 Literature review No studies fol
Page 38 and 39:
24 Literature review (30%) and meth
Page 40 and 41:
26 Literature review • There are
Page 42 and 43:
28 National survey of anaesthetic p
Page 44 and 45:
Page 46 and 47:
Page 48 and 49:
Page 50 and 51:
36 Economic evaluation methods (inc
Page 52 and 53:
38 Economic evaluation methods The
Page 54 and 55:
40 Economic evaluation methods Tabl
Page 56 and 57:
42 Economic evaluation methods simi
Page 58 and 59:
44 Economic evaluation methods Prob
Page 61 and 62:
Recruitment to the CESA RCT The stu
Page 63 and 64:
Clinical outcome data PONV by anaes
Page 65 and 66:
The findings from the logistic regr
Page 67 and 68:
TABLE 29 The length of stay and pri
Page 69 and 70:
140 120 100 80 60 40 20 0 No. of pa
Page 71 and 72:
250 200 150 100 50 0 No. of patient
Page 73 and 74: TABLE 37 Deterministic sensitivity
Page 75 and 76: 20 15 10 5 0 -5 Difference in varia
Page 77 and 78: Patient admitted for day surgery an
Page 79 and 80: 500 400 300 200 100 0 -100 -200 -30
Page 81 and 82: Recruitment to the CESA RCT The stu
Page 83 and 84: TABLE 49 The occurrence of any PONV
Page 85 and 86: 60 50 40 30 20 10 0 No. of patients
Page 87 and 88: a scale effect for scenario A, but
Page 89 and 90: The mean CVs for avoidance of PONV
Page 91 and 92: 1.80 The new variable cost and tota
Page 93 and 94: 100 90 80 70 60 50 40 30 20 10 0 Su
Page 95 and 96: The structure and content of this d
Page 97 and 98: nurses to have an in-depth knowledg
Page 99 and 100: agent used (see appendix 18). It wa
Page 101 and 102: Furthermore, anaesthetists operate
Page 103 and 104: The CESA project was designed to as
Page 105: practice, such as the use of midazo
Page 109 and 110: 1. Royal College of Surgeons of Eng
Page 111 and 112: 60. Cheng KI, Chu KS, Fang YR, Su K
Page 113 and 114: 112. Raeder J, Gupta A, Pedersen FM
Page 115 and 116: 162. Viitanen H, Baer G, Annila P.
Page 117 and 118: 220. Rosenberg KM, Bridge P, Brown
Page 119 and 120: The range of databases interrogated
Page 121: 24. preferen$.mp. [mp=title, abstra
Page 126 and 127: 112 Appendix 3 Quality assessment o
Page 128 and 129: 114 Appendix 4 TABLE 66 contd Summa
Page 173 and 174: TABLE 69 Summary of paediatric pati
Page 175 and 176:
TABLE 69 contd Summary of paediatri
Page 177 and 178:
TABLE 70 Characteristics of cost or
Page 179 and 180:
TABLE 71 Quality of cost or economi
Page 181 and 182:
TABLE 71 contd Quality of cost or e
Page 183 and 184:
Page 185 and 186:
Page 187 and 188:
Page 189 and 190:
Abbott J, Abbott P. Psychological a
Page 191 and 192:
Hall JE, Stewart JIM, Harmer M. Sin
Page 193:
Struys M, Versichelen L, Thas O, He
Page 196 and 197:
182 Appendix 11
Page 198 and 199:
184 Appendix 11
Page 200 and 201:
186 Appendix 11
Page 202 and 203:
188 Appendix 11
Page 205 and 206:
The aim of this study was to develo
Page 207 and 208:
anaesthetics in day surgery, using
Page 209:
© Queen’s Printer and Controller
Page 213 and 214:
Background The empirical study quan
Page 215 and 216:
Satisfaction with care Nearly all (
Page 217 and 218:
TABLE 76 Reason given for preferenc
Page 219 and 220:
TABLE 79 Comparisons with previous
Page 221 and 222:
TABLE 80 Reason given for preferenc
Page 223 and 224:
TABLE 81 Reason given for willingne
Page 225 and 226:
Background Variable costs account f
Page 227 and 228:
TABLE 85 Unit costs for the purchas
Page 229 and 230:
Background The empirical study requ
Page 231 and 232:
Ethical approval This was covered b
Page 233 and 234:
20 15 10 5 0 -5 -10 -15 True weight
Page 235:
15 10 5 0 -5 -10 True weight - Dion
Page 238 and 239:
224 Appendix 19 • patients aged o
Page 241 and 242:
All staff unit costs were for the y
Page 243:
Background Fixed costs account for
Page 246 and 247:
232 Appendix 22 March, Tuesday 15 A
Page 248 and 249:
234 Appendix 23 TABLE 96 Reasons fo
Page 251 and 252:
Patients were coded using the OPCS
Page 253 and 254:
Q03.4 punch biopsy of cervix Q03.5
Page 255 and 256:
This section displays the associati
Page 257 and 258:
given in Table 103 confirm the age
Page 259:
TABLE 107 Occurrence of PONV by dur
Page 262 and 263:
248 Appendix 27 TABLE 113 Frequency
Page 265 and 266:
This section displays the associati
Page 267 and 268:
The adverse events observed in the
Page 269 and 270:
262 Health Technology Assessment Pr
Page 271:
264 Health Technology Assessment Pr
show all

Aanesthetic Agents for Day Surgery - NIHR Health Technology ...

You also want an ePaper? Increase the reach of your titles

Delete template?

Save as template?