Fossati N, Willemse P-PM, Van den Broeck T, van den Bergh RCN, Yuan CY, Briers E, Bellmunt J, Bolla M, Cornford P, De Santis M, MacPepple Ekelechi, Henry AM, Mason MD, Matveev BV, van der Poelp HG, van der Kwast TH, Rouvière O, Schoots IG, Wiegel T, Lam TB, Mottet N, Joniau S (2017) The Benefits and Harms of Different Extents of Lymph Node Dissection During Radical Prostatectomy for Prostate Cancer: A Systematic Review,European Urology 72 (1) pp. 84-109
Context There is controversy regarding the therapeutic role of pelvic lymph node dissection (PLND) in patients undergoing radical prostatectomy for prostate cancer (PCa). Objective To systematically review the relevant literature assessing the relative benefits and harms of PLND for oncological and non-oncological outcomes in patients undergoing radical prostatectomy for PCa. Evidence acquisition MEDLINE, MEDLINE In-Process, Embase, and the Cochrane Central Register of Controlled Trials were searched up to December 2015. Comparative studies evaluating no PLND, limited, standard, and (super)-extended PLND that reported oncological and non-oncological outcomes were included. Risk-of-bias and confounding assessments were performed. A narrative synthesis was undertaken. Evidence synthesis Overall, 66 studies recruiting a total of 275,269 patients were included (44 full-text articles and 22 conference abstracts). Oncological outcomes were addressed by 29 studies, one of which was a randomized clinical trial (RCT). Non-oncological outcomes were addressed by 43 studies, three of which were RCTs. There were high risks of bias and confounding in most studies. Conflicting results emerged when comparing biochemical and clinical recurrence, while no significant differences were observed among groups for survival. Conversely, the majority of studies showed that the more extensive the PLND, the greater the adverse outcomes in terms of operating time, blood loss, length of stay, and postoperative complications. No significant differences were observed in terms of urinary continence and erectile function recovery. Conclusions Although representing the most accurate staging procedure, PLND and its extension are associated with worse intraoperative and perioperative outcomes, whereas a direct therapeutic effect is still not evident from the current literature. The current poor quality of evidence indicates the need for robust and adequately powered clinical trials. Patient summary Based on a comprehensive review of the literature, this article summarizes the benefits and harms of removing lymph nodes during surgery to remove the prostate because of PCa. Although the quality of the data from the studies was poor, the review suggests that lymph node removal may not have any direct benefit on cancer outcomes and may instead result in more complications. Nevertheless, the procedure remains justified because it enables accurate assessment of cancer spread.
Paying for performance is a strategy to meet the unmet need for family planning in low and middle income countries; however, rigorous evidence on effectiveness is lacking. Scientific databases and grey literature were searched from 1994 to May 2016. Thirteen studies were included. Payments were linked to units of targeted services, usually modified by quality indicators. Ancillary components and payment indicators differed between studies. Results were mixed for family planning outcome measures. Paying for performance was associated with improved modern family planning use in one study, and increased user and coverage rates in two more. Paying for performance with conditional cash transfers increased family planning use in another. One study found increased use in the upper wealth group only. However, eight studies reported no impact on modern family planning use or prevalence. Secondary outcomes of equity, financial risk protection, satisfaction, quality, and service organization were mixed. Available evidence is inconclusive and limited by the scarcity of studies and by variation in intervention, study design, and outcome measures. Further studies are warranted.
Blair Mitch, Gage Heather, MacPepple Ekelechi, Michaud Pierre-André, Hilliard Carol, Clancy Anne, Hollywood Eleanor, Brenner Maria, Al-Yassin Amina, Nitsche Catharina (2019) Workforce and Professional Education,In: Blair Mitch, Rigby Michael, Alexander Denise (eds.), Issues and Opportunities in Primary Health Care for Children in Europe: The Final Summarised Results of the Models of Child Health Appraised (MOCHA) Project pp. 247-282
Emerald Publishing Limited
Rigby Michael, Deshpande Shalmali, Luzi Daniela, Pecoraro Fabrizio, Tamburis Oscar, Rocco Ilaria, Corso Barbara, Mimnicuci Nadia, Liyanage Harshana, Hoang Uy, Ferreira Filipa, de Lusignan Simon, MacPepple Ekelechi, Gage Heather (2019) The Invisibility of Children in Data systems,In: Blair Mitch, Rigby Michael, Alexander Denise (eds.), Issues and Opportunities in Primary Health Care for Children in Europe: The Final Summarised Results of the Models of Child Health Appraised (MOCHA) Project pp. 129-158
Emerald Publishing Limited
Background/aims: Direct-acting antivirals (DAAs) provide an unprecedented opportunity
for a ?find-and-treat strategy.? We aimed to report real-world clinical, patient
reported and health economic outcomes of community-based hepatitis C virus (HCV)
screening/treatment in people who use drugs (PWUDs).
Methods: Project ITTREAT (2013-2021), established at a drug and alcohol treatment
centre, offered a comprehensive service. Generic (SF-12v2 and EQ-5D-5L) and liverspecific
(SFLDQoL) health-related quality of life (HRQoL) were assessed before and
after HCV treatment. Costs/case detected and cured were calculated. Primary outcome
measure was sustained virological response (SVR) (intention to treat).
Results: Till March 2018, 573 individuals recruited, 462 (81%) males, mean age
40.5 ± 10.0 years. Of the 125 treated, 115 (92%) had past/current history of injecting
drug use, 88 (70%) were receiving opioid agonist treatment and 50 (40%) were homeless.
Twenty-six per cent received interferon-based and 74% DAA-only regimens.
SVR (ITT) was 87% (90% with DAAs). Service uptake/HCV treatment completion
rates were >95%, HCV reinfection being 2.63/100 person years (95% CI 0.67-10.33).
HRQoL improved significantly at end of treatment (EOT) in those with SVR: SFLDQoL
(symptoms, memory, distress, loneliness, hopelessness, sleep and stigma) (P = .011);
SF-12 v2 physical and mental health domains (P
score (P = .009) and visual analogue scale, P
case detected was £171; mean cost per cure (excluding medication) was £702 ± 188.
Conclusions: Excellent real-world SVRs in PWUDs with significant improvement in
HRQoL can be achieved at modest costs. Project ITTREAT endorses communitybased
integrated services to help achieve HCV elimination.