Cadth 2015 v breakfast 1 quick and snappy breakfast session
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CADTH 2015 Symposium
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Cadth 2015 v breakfast 1 quick and snappy breakfast session
- 3. Presenters from CADTH • Ann Vosilla, BC Liaison Officer, KMLO • Sheila Tucker, NL Liaison Officer, KMLO • Kathleen Kulyk, SK Liaison Officer, KMLO • Stephanie Smith, NB Liaison Officer, KMLO • Dawn Priestley, Yukon & NWT Liaison Officer, KMLO • Jeannette Smith, Federal Programs & Nunavut Liaison Officer, KMLO
- 4. …about clothing for hospitalized psychiatric patients? (BC)
- 5. …about lab tests in Newfoundland and Labrador?
- 6. Background CADTH Rapid Response Service in Newfoundland and Labrador • Customers are Department of Health and Community Services and regional health authorities. • Service model is highly valued. • Customers report that Rapid Response fills a unique need, especially in areas with limited access to evidence providers. “We truly appreciate the level of expertise and professionalism evident at CADTH.” Kelli O’Brien, Vice-President – Long Term Care and Rural Health Western Health, Newfoundland
- 7. Delivering the Evidence on Lab Tests in Newfoundland and Labrador Stool Antigen Tests for Helicobacter pylori Infection: A Review of Clinical and Cost-Effectiveness and Guidelines (January 2015) • Summary with critical appraisal • RESEARCH QUESTIONS 1. What is the diagnostic accuracy and clinical effectiveness of stool antigen tests in patients with suspected H. pylori infections? 2. What is the cost-effectiveness of stool antigen tests in patients with suspected H. pylori infections? 3. What are the evidence-based guidelines associated with stool antigen tests in patients with suspected H. pylori infections?
- 8. What the Evidence Says Key Findings • Diagnostic Accuracy • Certain commercially available stool antigen tests with high test performance provide reliable results in diagnosing H. Pylori. • Cost-Effectiveness • A stool antigen test-and-treat strategy was cost-effective. • Evidence-Based Guidelines • Guidelines recommend a laboratory-based validated monoclonal stool test for test-and-treat strategies and for follow-up testing after eradication therapy.
- 9. Observations on the Report Relevance • Provided evidence to help address a local issue where uncertainty existed. Timeliness • Negotiated with the customer and delivered to fit with their decision horizon. Significance • Implications for clinical practice, patient access, and cost.
- 10. Going Forward Increasing awareness and use. Transferability / leveraging of existing reports. CADTH ‘Lab Test’ event webinars have garnered local interest. Potential for implementation support: • Knowledge exchange sessions • Clinical practice tools • Other interventions developed in partnership with laboratory medicine professionals
- 11. …about surgical masks in operating rooms? (SK)
- 13. Research Questions 1. What is the clinical evidence regarding the effectiveness of wearing surgical masks in the operating room to reduce bacterial transmission from staff to patients? 2. What are the clinical practice guidelines for the wearing of surgical masks in the operating room? 13
- 14. Results Key Messages: • No evidence was found to support the use of surgical face masks to reduce the frequency of surgical site infections • No evidence was found on the effectiveness of wearing surgical face masks to protect staff from infectious material in the operating room • Guidelines recommend the use of surgical face masks by staff in the operating room to protect both operating room staff and patients (despite lack of evidence 14
- 15. Conclusion The rapid response report “What is the clinical evidence regarding the effectiveness of wearing surgical masks in the operating room?” is my favorite to date because it helped me to examine my nursing practice, understand the evidence available and guided me towards best practice 15
- 16. …about islet cell transplantation for patients with unstable diabetes? (NB)
- 17. Meet the Customer Dr. Zeljko Bolesnikov Medical Consultant Medicare Eligibility and Claims NB Department of Health 17
- 18. Requests for Out of Province Coverage 18
- 19. The Issue: Evidence Needed Islet Cell Transplantation in Patients with Unstable Diabetes… ?? 19
- 20. The Rapid Response 20 …In conclusion, limited evidence suggests that islet transplantation is effective in maintaining insulin independence and is associated with improved clinical outcomes for unstable type 1 diabetes. There is a trend of increasing insulin independence and decreasing risks of adverse events related to this evolving technology. The cost-effectiveness of islet transplantation relative to the current treatment standards is undetermined based on the limited evidence.
- 21. The Outcome / Decision 21
- 22. …about Tranexamic Acid in Pre- hospital (ambulance) settings? (Yukon)
- 23. Meet Gerard… 23
- 24. When bad things happen to good tourists 24 Photos: www.travelyukon.com and www.facebook.com/YukonEMS
- 25. Control excessive bleeding in trauma patients? 25 Photo source: http://www.hexal- elements.de/sandoz_ca/2/index-fr.php?cat=p
- 26. Getting to work… 26 Photo credit: Yukon EMS
- 28. …about therapy dogs and horses for mental health? (Federal)
- 30. Seriously? 30
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- 33. 33 news.nationalpost.com/2014/11/25/michael-den-tandt-canadian-veterans-deserve-better-than-the-conservative-party/ THE CANADIAN PRESS/Adrian Wyld
- 34. 34 www.ottawacitizen.com/news/ottawa/Ottawa+Citizen+week+photos/9298122/story.html Photo credit, Bruno Schlumberger
- 35. 35 @CADTH_ACMTS linkedin.com/company/cadth slideshare.net/CADTH-ACMTS youtube.com/CADTHACMTS cadth.ca/photoblog requests@cadth.ca Connect With Us
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Editor's Notes
- Now let me explain the importance of surgical masks in the operating room. Anyone working in an OR or who enters the OR, must wear a surgical mask. The rationale behind this is to help protect the sterility of the surgical field, and protect the staff from surgical spray. I cannot underscore the importance of wearing a mask and the culture surrounding this. If you enter an OR and are not wearing a mask, you will get a dirty look and be shamed out of the room..
- These were the research questions of the report. Now the title of this report and the research questions peaked my interest for a couple of reasons. Firstly, I had heard colleagues mention over the years how they had heard of ORs in Europe and other far-flung and technologically advanced locations who did not wear masks in the operating room (besides the staff who are scrubbed). We always said how crazy this sounded but secretly wondered why they were so special. Secondly, the main reason my interest was peaked, is realistically I had never really thought about it. As a staff nurse, I instantly and habitually always put on a mask when entering the OR and felt naked if I wasn’t wearing one, which is part of the culture I was talking about. Over the course of a day, I could easily use 5 masks at minimum, but likely a lot more than this, depending how many surgical cases there are. This report helped me to examine my practice in a different way that I normally would not have done and forced me to ask questions I might have been a little bit uncomfortable asking because it goes against the norm.
- I was very excited to get to the results and find out if I would radically change my practice, but in this instance I am not quite there yet. No evidence was found to support the use of surgical face masks to reduce the frequency of surgical site infections, There was a consensus of the guidelines which recommended surgical face mask use by staff. These recommendations acknowledged a lack of evidence and instead are based on expert opinion. Bottom line: no clinical practice change yet for me. Although the results are inconclusive, it still helps me to demonstrate one of the aspects of the rapid response program I appreciate the most. The report caused me to question and examine my practice as a registered nurse in the operating room and wonder whether I was doing what was actually best for the patient and cost-effective for the system. I habitually put on a surgical mask without even thinking about it. As clinicians, we always strive to do what is best but it can get very easy to fall into routine or do what everyone else is doing for the sake that this is the way it is. It is important to continually be incorporating evidence into practice and most clinicians are great at doing this, but sometimes even the best of us needs a bit of a nudge and a reminder. This brings to another reason the rapid response service is so beneficial to me as a registered nurse, is that it is usable and reachable for clinicians. It often answers the questions being asked on the front lines of healthcare, be it surgical masks or dressing materials or IV pumps, all of these topics are clinically relevant to practitioners and are presented in a format which is easy to read and use.
- In conclusion, the RR report “What is the clinical evidence regarding the effectiveness of wearing surgical masks in the operating room” is my favorite rapid response report to date and helped me to question my practice, understand the evidence available and help me to make a decision about always having best practice.
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- House of Commons Standing Committee on National Defence National Post: http://news.nationalpost.com/2014/11/25/michael-den-tandt-canadian-veterans-deserve-better-than-the-conservative-party/
- Col Scott McLeod Col Rakesh Jetly Deputy Surgeon General Hugh McKay Photo credit, Bruno Schlumberger