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  1. Article ; Online: Systematic review of patient preference and adherence to the correct use of graduated compression stockings to prevent deep vein thrombosis in surgical patients.

    Wade, Ros / Paton, Fiona / Woolacott, Nerys

    Journal of advanced nursing

    2016  Volume 73, Issue 2, Page(s) 336–348

    Abstract: Aim: The aim of this study was to explore patient preference and adherence to thigh and knee length graduated compression stockings for the prevention of deep vein thrombosis in surgical patients.: Background: Hospitalised patients are at risk of ... ...

    Abstract Aim: The aim of this study was to explore patient preference and adherence to thigh and knee length graduated compression stockings for the prevention of deep vein thrombosis in surgical patients.
    Background: Hospitalised patients are at risk of developing deep vein thrombosis. Mechanical methods of prophylaxis include compression stockings, available as knee or thigh length. Patient adherence to correct stocking use is of critical importance to their effectiveness.
    Design: Systematic review of quantitative evidence.
    Data sources: Eleven databases were searched from inception to 2013 for systematic reviews of compression stockings. Reviews were screened for relevant primary studies and update searches of eight electronic sources were undertaken (2010-2014).
    Review methods: Randomised controlled trials and observational studies of surgical patients using compression stockings were quality assessed and data were extracted on patient adherence and preference. A narrative summary is presented.
    Results: Nine randomised controlled trials and seven observational studies were included in the systematic review. There was substantial variation between studies in terms of patient characteristics, interventions and methods of outcome assessment.
    Conclusion: Patient adherence was generally higher with knee length than thigh length stockings. However, the studies reflect patient adherence in a hospital setting only, where patients are observed by healthcare professionals; it is likely that adherence reduces once patients have been discharged from hospital. Patients preferred knee length stockings over thigh length stockings. In many clinical settings, any difference in efficacy between thigh length and knee length stockings may be rendered irrelevant by patient preference for and likely better adherence to knee length stockings.
    MeSH term(s) Adolescent ; Adult ; Aged ; Aged, 80 and over ; Female ; Humans ; Male ; Middle Aged ; Observational Studies as Topic ; Patient Compliance ; Patient Preference ; Postoperative Care/methods ; Postoperative Complications/prevention & control ; Postoperative Complications/psychology ; Randomized Controlled Trials as Topic ; Stockings, Compression ; Treatment Outcome ; Venous Thrombosis/prevention & control ; Venous Thrombosis/psychology ; Young Adult
    Language English
    Publishing date 2016-10-09
    Publishing country England
    Document type Journal Article ; Review
    ZDB-ID 197634-5
    ISSN 1365-2648 ; 0309-2402
    ISSN (online) 1365-2648
    ISSN 0309-2402
    DOI 10.1111/jan.13148
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  2. Article ; Online: Response to letter to the Editor: comment on Corbett et al. entitled "Acupuncture and other physical treatments for the relief of pain due to osteoarthritis of the knee: network meta-analysis".

    Corbett, M S / Rice, S J C / Madurasinghe, V / Woolacott, N F

    Osteoarthritis and cartilage

    2014  Volume 22, Issue 5, Page(s) 712–713

    MeSH term(s) Acupuncture Analgesia/methods ; Arthralgia/therapy ; Humans ; Osteoarthritis, Knee/therapy ; Physical Therapy Modalities
    Language English
    Publishing date 2014-05
    Publishing country England
    Document type Comment ; Letter ; Research Support, Non-U.S. Gov't
    ZDB-ID 1167809-4
    ISSN 1522-9653 ; 1063-4584
    ISSN (online) 1522-9653
    ISSN 1063-4584
    DOI 10.1016/j.joca.2014.02.005
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  3. Article ; Online: Use of non-randomised evidence alongside randomised trials in a systematic review of endovascular aneurysm repair: strengths and limitations.

    Chambers, D / Fayter, D / Paton, F / Woolacott, N

    European journal of vascular and endovascular surgery : the official journal of the European Society for Vascular Surgery

    2010  Volume 39, Issue 1, Page(s) 26–34

    Abstract: Objective: To assess whether limitations of randomised controlled trials (RCTs) of endovascular aneurysm repair (EVAR) can be addressed by evidence from non-randomised studies.: Design: Analysis of data from a systematic review.: Methods: We ... ...

    Abstract Objective: To assess whether limitations of randomised controlled trials (RCTs) of endovascular aneurysm repair (EVAR) can be addressed by evidence from non-randomised studies.
    Design: Analysis of data from a systematic review.
    Methods: We conducted a review of EVAR versus open repair or non-surgical management of abdominal aortic aneurysms. In addition to RCTs, we included pre-specified registries of EVAR and open repair.
    Results: The six included RCTs randomised patients in 2003 and earlier. Of the three registries included, one contributed data on a large (>8000) sample of patients treated with newer generation EVAR devices and followed up for up to 8 years. However, treatment dates of these patients overlapped with those of the RCTs. The other registries were of limited usefulness. A large (>45,000) controlled observational study published while the review was in progress broadly supported the findings of RCTs comparing EVAR with open surgery. A comparison of outcomes across all studies did not support the hypothesis that the findings of the RCTs are no longer representative of clinical practice.
    Conclusions: Both randomised and non-randomised sources of evidence have strengths and weaknesses for assessing the effectiveness of EVAR. Further research should explore the optimum use of registry data, including patient-level analyses.
    MeSH term(s) Aortic Aneurysm, Abdominal/mortality ; Aortic Aneurysm, Abdominal/surgery ; Blood Vessel Prosthesis Implantation/adverse effects ; Blood Vessel Prosthesis Implantation/mortality ; Evidence-Based Medicine ; Humans ; Minimally Invasive Surgical Procedures ; Randomized Controlled Trials as Topic ; Registries ; Risk Assessment ; Treatment Outcome ; Vascular Surgical Procedures/adverse effects ; Vascular Surgical Procedures/mortality
    Language English
    Publishing date 2010-01
    Publishing country England
    Document type Journal Article ; Meta-Analysis ; Research Support, Non-U.S. Gov't ; Review
    ZDB-ID 1225869-6
    ISSN 1532-2165 ; 1078-5884
    ISSN (online) 1532-2165
    ISSN 1078-5884
    DOI 10.1016/j.ejvs.2009.09.010
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  4. Book: Systematic review of the clinical effectiveness of self care support networks in health and social care

    Woolacott, N. F

    (Report ; 34)

    2006  

    Institution University of York. / NHS Centre for Reviews & Dissemination
    Author's details Nerys Woolacott ... [et al.]
    Series title Report ; 34
    MeSH term(s) Self Care ; Community Networks ; Treatment Outcome ; Social Support
    Keywords Great Britain
    Language English
    Size xviii, 291 p. ;, 30 cm.
    Publisher University of York, Centre for Reviews and Dissemination
    Publishing place York
    Document type Book
    Note "September 2006."
    ISBN 9781900640411 ; 1900640414
    Database Catalogue of the US National Library of Medicine (NLM)

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  5. Book: Systematic review of the clinical and cost effectiveness of ultrasound in screening for developmental dysplasia of the hip in newborns

    Woolacott, N. F

    (Report ; 28)

    2005  

    Institution University of York. / NHS Centre for Reviews & Dissemination.
    Switzerland. / Bundesamt für Sozialversicherung
    Author's details Nerys Woolacott ... [et al.]
    Series title Report ; 28
    MeSH term(s) Hip Dislocation, Congenital/diagnostic imaging ; Ultrasonography ; Cost-Benefit Analysis ; Infant, Newborn, Diseases/diagnostic imaging ; Neonatal Screening/economics
    Keywords United Kingdom
    Language English
    Size x, 96 p. :, ill.
    Publisher Centre for Reviews and Dissemination, University of York
    Publishing place York
    Document type Book
    Note "Report commissioned by Bundesamt fur Sozialversicherungen (Swiss Federal Office for Social Security)." ; "August 2005."
    ISBN 9781900640350 ; 190064035X
    Database Catalogue of the US National Library of Medicine (NLM)

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  6. Article ; Online: Retigabine for the adjunctive treatment of adults with partial-onset seizures in epilepsy with and without secondary generalization : a NICE single technology appraisal.

    Craig, Dawn / Rice, Stephen / Paton, Fiona / Fox, David / Woolacott, Nerys

    PharmacoEconomics

    2013  Volume 31, Issue 2, Page(s) 101–110

    Abstract: The National Institute for Health and Clinical Excellence (NICE) invited the manufacturer of retigabine (GlaxoSmithKline) to submit evidence for the clinical and cost effectiveness of this drug for the treatment of adults with partial-onset seizures in ... ...

    Abstract The National Institute for Health and Clinical Excellence (NICE) invited the manufacturer of retigabine (GlaxoSmithKline) to submit evidence for the clinical and cost effectiveness of this drug for the treatment of adults with partial-onset seizures in epilepsy, with and without secondary generalization, as part of the Institute's single technology appraisal (STA) process. The Centre for Reviews and Dissemination was commissioned to act as the Evidence Review Group (ERG). The ERG undertakes a critical review of the clinical and cost-effectiveness evidence of the technology based upon the manufacturer's submission to NICE. The ERG also independently searches for relevant evidence and evaluates modifications to the manufacturer's decision-analytic model. This paper provides a description of the company submission, the ERG review and NICE's subsequent decisions. The clinical effectiveness data were derived from three placebo-controlled randomized controlled trials (RCTs). A meta-analysis pooling across all doses of retigabine found beneficial effects of retigabine in terms of responder rate (odds ratio [OR] 2.79; 95 % CI 2.08, 3.76) and rate of seizure freedom (OR 2.54; 95 % CI 0.92, 6.98) [both double-blind phase analyses]. When compared in a network meta-analysis with the selected comparator antiepileptic drugs (AEDs) [eslicarbazepine acetate, lacosamide, pregabalin, tiagabine and zonisamide], retigabine offered broadly similar efficacy in terms of responder rate and freedom from seizure. The de novo decision-analytic model presented within the submission evaluated the cost effectiveness of retigabine compared with these AEDs and no treatment (i.e. maintenance therapy). After numerous additional analyses, the ERG considered the use of retigabine to be not cost effective for NICE at thresholds below £43,000 if no treatment was considered a relevant comparator. The NICE Appraisal Committee decided that an appropriate comparator was an active treatment. The Committee recommended that retigabine is offered as an option for the adjunctive treatment of partial-onset seizures with or without secondary generalization in adults aged 18 years and older with epilepsy, only when previous treatment with carbamazepine, clobazam, gabapentin, lamotrigine, levetiracetam, oxcarbazepine, sodium valproate and topiramate has not provided an adequate response, or has not been tolerated.
    MeSH term(s) Adolescent ; Adult ; Anticonvulsants/economics ; Anticonvulsants/therapeutic use ; Carbamates/economics ; Carbamates/therapeutic use ; Cost-Benefit Analysis ; Decision Support Techniques ; Drug Industry ; Epilepsies, Partial/drug therapy ; Epilepsies, Partial/economics ; Epilepsies, Partial/physiopathology ; Humans ; Models, Theoretical ; Phenylenediamines/economics ; Phenylenediamines/therapeutic use ; Randomized Controlled Trials as Topic ; Seizures/drug therapy ; Seizures/economics ; Seizures/physiopathology ; Young Adult
    Chemical Substances Anticonvulsants ; Carbamates ; Phenylenediamines ; ezogabine (12G01I6BBU)
    Language English
    Publishing date 2013-01-23
    Publishing country New Zealand
    Document type Journal Article ; Meta-Analysis ; Research Support, Non-U.S. Gov't ; Review
    ZDB-ID 1100273-6
    ISSN 1179-2027 ; 1170-7690
    ISSN (online) 1179-2027
    ISSN 1170-7690
    DOI 10.1007/s40273-012-0018-1
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  7. Article ; Online: Thigh length versus knee length antiembolism stockings for the prevention of deep vein thrombosis in postoperative surgical patients; a systematic review and network meta-analysis.

    Wade, Ros / Paton, Fiona / Rice, Stephen / Stansby, Gerard / Millner, Peter / Flavell, Hayley / Fox, Dave / Woolacott, Nerys

    BMJ open

    2016  Volume 6, Issue 2, Page(s) e009456

    Abstract: Objectives: To assess the clinical effectiveness of thigh length versus knee length antiembolism stockings for the prevention of deep vein thrombosis (DVT) in surgical patients.: Design: Systematic review and meta-analysis using direct methods and ... ...

    Abstract Objectives: To assess the clinical effectiveness of thigh length versus knee length antiembolism stockings for the prevention of deep vein thrombosis (DVT) in surgical patients.
    Design: Systematic review and meta-analysis using direct methods and network meta-analysis.
    Methods: Previous systematic reviews and electronic databases were searched to February 2014 for randomised controlled trials (RCTs) of thigh length or knee length antiembolism stockings in surgical patients. Study quality was assessed using the Cochrane Risk of Bias Tool. The primary outcome was incidence of DVT. Analysis of the DVT data was performed using ORs along with 95% CIs. The I(2) statistic was used to quantify statistical heterogeneity.
    Results: 23 RCTs were included; there was substantial variation between the trials and many were poorly reported with an unclear risk of bias. Five RCTs directly comparing thigh length versus knee length stockings were pooled and the summary estimate of effect favouring thigh length stockings was not statistically significant (OR 1.48, 95% CI 0.80 to 2.73). 13 RCTs were included in the network meta-analysis; thigh length stockings with pharmacological prophylaxis were more effective than knee length stockings with pharmacological prophylaxis, but again results were not statistically significant (OR 1.76, 95% credible intervals 0.82 to 3.53).
    Conclusions: Thigh length stockings may be more effective than knee length stockings, but results did not reach statistical significance and the evidence base is weak. Further research to confirm this finding is unlikely to be worthwhile. While thigh length stockings appear to have superior efficacy, practical issues such as patient acceptability may prevent their wide use in clinical practice.
    Systematic review registration number: CRD42014007202.
    MeSH term(s) Equipment Design ; Fibrinolytic Agents/adverse effects ; Fibrinolytic Agents/therapeutic use ; Humans ; Knee ; Postoperative Complications/prevention & control ; Pulmonary Embolism/etiology ; Stockings, Compression/adverse effects ; Thigh ; Venous Thrombosis/complications ; Venous Thrombosis/prevention & control
    Chemical Substances Fibrinolytic Agents
    Language English
    Publishing date 2016-02-16
    Publishing country England
    Document type Journal Article ; Meta-Analysis ; Review ; Systematic Review
    ZDB-ID 2747269-3
    ISSN 2044-6055 ; 2044-6055 ; 2053-3624
    ISSN (online) 2044-6055
    ISSN 2044-6055 ; 2053-3624
    DOI 10.1136/bmjopen-2015-009456
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  8. Article ; Online: Graduated compression stockings for the prevention of deep-vein thrombosis in postoperative surgical patients: a systematic review and economic model with a value of information analysis.

    Wade, Ros / Sideris, Eleftherios / Paton, Fiona / Rice, Stephen / Palmer, Stephen / Fox, Dave / Woolacott, Nerys / Spackman, Eldon

    Health technology assessment (Winchester, England)

    2015  Volume 19, Issue 98, Page(s) 1–220

    Abstract: Background: Deep-vein thrombosis (DVT) can occur in surgical patients. Routine prophylaxis can be pharmacological and/or mechanical [e.g. graduated compression stockings (GCSs)]. GCSs are available in knee length or thigh length.: Objective: To ... ...

    Abstract Background: Deep-vein thrombosis (DVT) can occur in surgical patients. Routine prophylaxis can be pharmacological and/or mechanical [e.g. graduated compression stockings (GCSs)]. GCSs are available in knee length or thigh length.
    Objective: To establish the expected value of undertaking additional research addressing the relative effectiveness of thigh-length GCSs versus knee-length GCSs, in addition to pharmacoprophylaxis, for prevention of DVT in surgical patients.
    Design: Systematic review and economic model, including value of information (VOI) analysis.
    Review methods: Randomised controlled trials (RCTs) assessing thigh- or knee-length GCSs in surgical patients were eligible for inclusion. The primary outcome was incidence of DVT. DVT complications and GCSs adverse events were assessed. Random-effects meta-analysis was performed. To draw on a wider evidence base, a random-effects network meta-analysis (NMA) was undertaken for the outcome DVT. A review of trials and observational studies of patient adherence was also conducted. A decision-analytic model was developed to assess the cost-effectiveness of thigh- and knee-length GCSs and the VOI.
    Results: Twenty-three RCTs were included in the review of effectiveness. There was substantial variation between trials in terms of the patient characteristics, interventions and methods of outcome assessment. Five trials comparing knee-length with thigh-length GCSs with or without pharmacoprophylaxis were pooled; the summary estimate of effect indicated a non-significant trend favouring thigh-length GCSs [odds ratio (OR) 1.48, 95% confidence interval (CI) 0.80 to 2.73]. Thirteen trials were included in the NMA. In the base-case analysis, thigh-length GCSs with pharmacoprophylaxis were more effective than knee-length GCSs with pharmacoprophylaxis (knee vs. thigh OR 1.76, 95% credible interval 0.82 to 3.53). Overall, thigh-length stockings with pharmacoprophylaxis was the most effective treatment, with a 0.73 probability of being the most effective treatment in a new trial of all the treatments. Patient adherence was generally higher with knee-length GCSs, and patients preferred knee-length GCSs. Thigh-length GCSs were found to be cost-effective in all but the subgroup with the lowest baseline risk, although the absolute differences in costs and effects were relatively small. The expected value of perfect information ranged from £0.2M to £178.0M depending on the scenario and subgroup. The relative effect parameters had the highest expected value of partial perfect information and ranged from £2.0M to £39.4M. The value of further research was most evident in the high-risk subgroups.
    Limitations: There was substantial variation across the included trials in terms of patient and intervention characteristics. Many of the included trials were old and poorly reported, which reduces the reliability of the results of the review.
    Conclusions: Given that the results from both the standard meta-analysis and the NMA lacked precision (CIs were wide) owing to the heterogeneous evidence base, a new definitive trial in high-risk patients may be warranted. However, the efficiency of any further research (i.e. whether this represents value for money) is dependent on several factors, including the acquisition price of GCSs, expected compliance with thigh-length GCSs wear, and whether or not uncertainty can be resolved around possible effect modifiers, as well as the feasibility and actual cost of undertaking the proposed research.
    Study registration: This study is registered as PROSPERO CRD42014007202.
    Funding: The National Institute for Health Research Health Technology Assessment programme.
    MeSH term(s) Cost-Benefit Analysis ; Humans ; Models, Economic ; Patient Compliance/psychology ; Postoperative Period ; Randomized Controlled Trials as Topic ; Stockings, Compression/adverse effects ; Stockings, Compression/economics ; Treatment Outcome ; Venous Thrombosis/drug therapy ; Venous Thrombosis/prevention & control
    Language English
    Publishing date 2015-11
    Publishing country England
    Document type Journal Article ; Research Support, Non-U.S. Gov't ; Review
    ZDB-ID 2006765-3
    ISSN 2046-4924 ; 1366-5278
    ISSN (online) 2046-4924
    ISSN 1366-5278
    DOI 10.3310/hta19980
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  9. Article ; Online: Dilemmas in the interpretation of diagnostic accuracy studies on presurgical workup for epilepsy surgery.

    Burch, Jane / Marson, Anthony / Beyer, Fiona / Soares, Marta / Hinde, Sebastian / Wieshmann, Udo / Woolacott, Nerys

    Epilepsia

    2012  Volume 53, Issue 8, Page(s) 1294–1302

    Abstract: We conducted a systematic review to determine which noninvasive technologies should be used in the workup for epilepsy surgery to identify structural or functional abnormalities to help locate the site of seizure onset. The review focused on patients ... ...

    Abstract We conducted a systematic review to determine which noninvasive technologies should be used in the workup for epilepsy surgery to identify structural or functional abnormalities to help locate the site of seizure onset. The review focused on patients where there was insufficient confidence, in either the decision to go to surgery or the site at which surgery should be conducted, after the initial clinical examination. The majority of the studies identified were single-gate diagnostic accuracy studies; none were randomized controlled trials, and only one reported the effect of the test results on the decision making process. It became apparent that the data derived from diagnostic accuracy studies could not be used to answer the review question. This article focuses on the methods used to extract data from the diagnostic accuracy studies, the difficulties interpreting the resulting data, why such studies are not an appropriate study design in this setting, and how the evidence-base can be improved.
    MeSH term(s) Brain/pathology ; Brain/physiopathology ; Electroencephalography ; Epilepsy/diagnosis ; Epilepsy/pathology ; Epilepsy/physiopathology ; Epilepsy/surgery ; Humans ; Magnetic Resonance Imaging ; Magnetic Resonance Spectroscopy ; Magnetoencephalography ; Neuroimaging ; Positron-Emission Tomography ; Tomography, Emission-Computed, Single-Photon ; Treatment Outcome
    Language English
    Publishing date 2012-08
    Publishing country United States
    Document type Journal Article ; Research Support, Non-U.S. Gov't ; Review
    ZDB-ID 216382-2
    ISSN 1528-1167 ; 0013-9580
    ISSN (online) 1528-1167
    ISSN 0013-9580
    DOI 10.1111/j.1528-1167.2012.03534.x
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  10. Article ; Online: The clinical effectiveness and cost-effectiveness of technologies used to visualise the seizure focus in people with refractory epilepsy being considered for surgery: a systematic review and decision-analytical model.

    Burch, J / Hinde, S / Palmer, S / Beyer, F / Minton, J / Marson, A / Wieshmann, U / Woolacott, N / Soares, M

    Health technology assessment (Winchester, England)

    2012  Volume 16, Issue 34, Page(s) 1–157, iii–iv

    Abstract: Background: For patients who continue to have seizures despite ongoing treatment, surgical resection of the epileptic focus may be considered, and can result in seizure-freedom. Currently, non-invasive tests provide information to inform the scope and ... ...

    Abstract Background: For patients who continue to have seizures despite ongoing treatment, surgical resection of the epileptic focus may be considered, and can result in seizure-freedom. Currently, non-invasive tests provide information to inform the scope and positioning of invasive electroencephalography (EEG) electrodes. However, these technologies could replace intracranial EEG in at least some patients if their ability to accurately locate a seizure focus could be established. In order to inform clinical practice, studies need to investigate the clinical value of a test, and the impact of the results of that test on the decision-making process and subsequently on clinical outcomes.
    Objectives: The aims of this systematic review were to determine the diagnostic accuracy of non-invasive technologies, how these technologies impact on the decision-making process, associations with surgical outcome, and the gaps in the current evidence base. In addition, a decision-analytical model was designed to consider the potential use of existing data to determine the cost-effectiveness of options for presurgical work-up.
    Data sources: Eighteen electronic databases were searched without language restrictions [including MEDLINE, EMBASE, BIOSIS Previews, PASCAL, ClinicalTrials.gov, Cochrane Database of Systematic Reviews (CDSR), Cochrane Central Register of Controlled Trials (CENTRAL) and the Cochrane Register of Diagnostic Studies] from 2003 to July 2010. A prior, wider-ranging HTA review in this area conducted by the Centre for Reviews and Dissemination was used as the source for studies prior to 2003. Reference lists of included studies and relevant reviews were also searched, and a citation search of key papers undertaken.
    Review methods: Systematic reviews of the diagnostic accuracy, clinical utility and cost-effectiveness of non-invasive technologies used to define the seizure focus in patients with refractory epilepsy being considered for surgery were undertaken according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Thirteen diagnostic accuracy studies, seven outcome prediction studies and one study reporting the impact of test results on the decision-making process ('decision study') were included. The decision study was used to aid the development of a decision-analytical model to illustrate how data from appropriately designed clinical studies can be utilised.
    Results: Data from the diagnostic accuracy studies could not determine the contribution of the tests to the decision-making process. The number of index tests that could not be classified as correctly, non- or wrongly localising as indicated by a surgical outcome was high, up to 53%. The decision study reported fluorodeoxyglucose positron emission tomography influencing the decision for or against surgery in 78 of the 110 patients. The constructed decision-analytical model provided provisional cost-effectiveness results from the included diagnostic strategies. It demonstrated the feasibility of extending such analysis to all diagnostic strategies if suitable data were to become available.
    Limitations: There were a number of limitations of the available evidence, and overall, the quality of the available evidence was poor; only one study met the inclusion criteria that evaluated the use an index test on the decision-making process. Most of the available data was from the diagnostic accuracy studies; those currently available did not provide information on either the diagnostic accuracy or clinical utility of the tests being evaluated. Further limitations were the generally small study sizes, patient selection bias and the substantial clinical heterogeneity across the studies.
    Conclusions: The current evidence base is abundant but not adequately informative; there is no acceptable reference standard, reporting of clinical outcomes tends to be only following surgery, and decision level and clinical effectiveness studies are lacking. The additional value of diagnostic technologies for the localisation of epileptic foci is related to the impact on treatment decisions and the value of the treatments themselves; this needs to be considered fully in informing cost-effectiveness. Appropriately designed studies are needed to determine the added value of diagnostic regimens. Ultimately, how research informs the actual decision problem(s) faced by clinicians and the NHS needs to be considered; decision modelling is central to this issue.
    Funding: The National Institute for Health Research Health Technology Assessment programme.
    MeSH term(s) Cost-Benefit Analysis ; Decision Support Techniques ; Epilepsy/diagnosis ; Epilepsy/economics ; Epilepsy/therapy ; Humans ; Prognosis ; Seizures/diagnosis ; Seizures/economics ; Seizures/therapy ; Treatment Failure ; United Kingdom
    Language English
    Publishing date 2012
    Publishing country England
    Document type Journal Article ; Research Support, Non-U.S. Gov't ; Review
    ZDB-ID 2006765-3
    ISSN 2046-4924 ; 1366-5278
    ISSN (online) 2046-4924
    ISSN 1366-5278
    DOI 10.3310/hta16340
    Database MEDical Literature Analysis and Retrieval System OnLINE

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