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261. LQD Spray for treating acute and chronic wounds

or burn wounds). One commentator highlighted that the haemostatic properties of LQD Spray could stop bleeding in highly vascularised areas such as the scalp. Commentators agreed that LQD Spray could change clinical outcomes, and reduce the time associated with patient appointments at GPs, clinics or district nurse home visits. One commentator thought that it may decrease antibiotics because of the antimicrobial properties of the technology. The same commentator thought that clinicians could develop (...) are that it is the only biopolymer wound dressing, and can be used without a secondary dressing (unless it is clinically indicated). Also, it is a natural antimicrobial and it can be used in patient self-management, although there is no published evidence on this use. The intended place in ther place in therap apy y would be instead of or in addition to other primary wound dressing options, such as foam dressings, film dressings or hydrofibre dressings for people with acute and chronic wounds. It could replace

2020 National Institute for Health and Clinical Excellence - Advice

262. NATROX oxygen wound therapy for managing diabetic foot ulcers and complex or chronic non-healing wounds

the depth and position of the ulcer and offload or treat it with compression therapy to promote healing. If a non- healing wound is thought to be infected, healthcare professionals take a microbiological sample NATROX oxygen wound therapy for managing diabetic foot ulcers and complex or chronic non-healing wounds (MIB208) © NICE 2020. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-and- conditions#notice-of-rights). Page 2 of 10and prescribe an antibiotic to treat (...) ://www.nice.org.uk/terms-and- conditions#notice-of-rights). Page 3 of 10according to size: • soft polymer dressing £0.19 to £39.83 • hydrocolloid fibrous dressing £0.97 to £10.37 • antimicrobial dressing £0.18 to £64.13 • PICO negative pressure wound dressings £127.06 to £145.68 • VAC Veraflo treatment £82.06 per wound per day. The average cost of treating a diabetic foot ulcer with an interactive dressing is £2,990 (based on 77 dressing changes), and £3,380 for non-interactive dressings (based on 118 dressing

2020 National Institute for Health and Clinical Excellence - Advice

263. COVID 19 rapid evidence summary: Anakinra for COVID-19 associated secondary haemophagocytic lymphohistiocytosis

effectiveness of anakinra compared with supportive treatment? Supportive care may involve treatment with corticosteroids, IVIG, etoposide, organ support (ventilation, renal replacement therapy, transfusions etc) and antimicrobials. 2. In adults and children with sHLH triggered by SARS-CoV-2 or a similar coronavirus, what is the safety of anakinra compared with supportive treatment? 3. In adults and children with sHLH triggered by SARS-CoV-2 or a similar coronavirus, what is the cost effectiveness

2020 National Institute for Health and Clinical Excellence - Advice

264. MolecuLight i:X for wound imaging

sampling for culture and using systemic or oral antibiotics in line with local protocol, alongside antimicrobial barrier dressings. When prescribing an antimicrobial, microbiological samples should be taken before prescribing and choice of antimicrobial reviewed after antimicrobial results. For non-severe infections, it may be appropriate to withhold antimicrobials until microbiological sample results are back. If a diabetic foot infection is suspected and there is a wound, a soft tissue or bone sample (...) ) and treatment plan modifications guided by fluorescence (73% of study wounds). Antimicrobial stewardship decisions were guided by fluorescence imaging in 47% of cases. Strengths and limitations Strengths and limitations A comparative study helps to compare results with standard care. There is a good range of outcomes, including consideration of antibiotic usage and management decisions. A single-centre observational study gives low-quality evidence. A small sample size limits reliability of results

2020 National Institute for Health and Clinical Excellence - Advice

265. Prontosan for acute and chronic wounds

on product type and quantity. The resource impact resource impact is to replace the cost of standard care, which is saline at £0.25 per 20 ml. The technology The technology Prontosan (B Braun) is available as: • Prontosan Wound Irrigation Solution • Prontosan Wound Gel • Prontosan Wound Gel X. It is indicated for cleansing, decontaminating and moistening acute and chronic wounds and to prevent and remove biofilms. The solution and gels contain 2 active ingredients, an antimicrobial polyhexanide (...) healing and minimise the risk of further complications. Saline or water are usually used to cleanse wounds. If the wound is suspected of being infected, a microbiological sample is usually taken and an antibiotic prescribed to treat the organism causing the infection. The wound is treated with regular cleansing and debridement, and then a dressing is applied. Care staff choose a dressing that promotes healing and Prontosan for acute and chronic wounds (MIB220) © NICE 2020. All rights reserved. Subject

2020 National Institute for Health and Clinical Excellence - Advice

266. FebriDx for C-reactive protein and myxovirus resistance protein A testing

measurement of MxA and CRP in people with acute febrile respiratory infections is designed to help differentiate between viral and bacterial infections. This can then guide appropriate use of antibiotics. T ests that improve clinical decision making in antibiotic prescription at the point of care could support antimicrobial stewardship. FebriDx is a self-contained, portable, all-in-one test device, which both collects and analyses the blood sample. It consists of a single strip test card, a buffer (...) . The 2018 English surveillance programme for antimicrobial utilisation and resistance (ESPAUR), reported that 81% of all antibiotics prescribed in England in 2017 were from a primary care setting. This was equal to about 654 prescriptions for every 1,000 people. A recent study on antibiotic prescribing in English primary care suggested that approximately 9% to 23% of antibiotics used in secondary care were inappropriate (Smieszek et al. 2018). Point-of-care testing should be considered in primary care

2020 National Institute for Health and Clinical Excellence - Advice

267. MR-proADM test for use with clinical deterioration scores in cases of suspected infection

. This was compared with a subgroup of a cohort from a previous study done in the Netherlands. This second cohort was used to validate the results measured prospectively. This method of comparison is subject to bias because the 2 cohorts of data were collected under different conditions. The authors published further analysis in a letter to the journal indicating that delayed antibiotics for patients with low MR-proADM concentrations might result in fewer adverse effects, potentially allowing for a more detailed (...) at high risk must have antibiotics within 1 hour (medium risk within 3 hours and patients at low risk may not need antibiotics). One specialist commentator noted that the Kryptor platform is semi-automated (rather than fully automated) and does not fit with current workflows in most NHS labs that use high-throughput automated platforms. Two specialists stated that the Kryptor platform is not widely available in the NHS. General comments One specialist commentator noted that MR-proADM is a non-specific

2019 National Institute for Health and Clinical Excellence - Advice

268. The V.A.C. Veraflo Therapy system for infected wounds

-of-rights). Page 2 of 12minimising risk of further complications. If infection of the wound is suspected, a microbiological sample is taken and an antibiotic prescribed to treat the causative organisms. The wound is treated with regular cleansing and debridement followed by the application of a dressing. Hospital staff choose a dressing that will promote healing and manage exudate on a case-by-case basis. Some wounds are treated with topical negative pressure therapy. Chronic non-healing wounds (...) and 25.40±6.57, respectively; p<0.001) and until the wound closed (13.20±6.75 and 29.60±6.54 respectively; p<0.001). Strengths and limitations There was no significant between-group variance in patient demographic information and wound characteristics. The study compared the technology with standard care and outcome measures addressed clinical effectiveness. The study is limited by the retrospective cohort comparison. The use of silver nitrate antimicrobial solution in the V.A.C. Veraflo Therapy system

2019 National Institute for Health and Clinical Excellence - Advice

269. UroShield for preventing catheter-associated urinary tract infections

by commentators as the potential benefits to patients from using UroShield. A reduced need for antibiotics and reduced risk of antimicrobial resistance was also identified by 1 of the commentators. People with indwelling urethral catheters who have blockages and recurrent CAUTIs despite current management, and patients with autoimmune suppressive conditions such as multiple sclerosis were identified by commentators as people who would particularly benefit from UroShield. One commentator said the technology (...) to address CAUTI usually involve coating the surface of the catheter or adapting the catheter material (such as antibiotic- coated, silver-coated and antiseptic-impregnated catheters). The company claim that UroShield may have the potential to reduce antibiotic use, by reducing the patient's dose or shortening their treatment course. By minimising the exposure of bacteria to antibiotics, the technology has the potential to help reduce antibiotic resistance. Current care pathway According to NICE's

2019 National Institute for Health and Clinical Excellence - Advice

270. InterDry for intertrigo

to target all 3 factors associated with intertrigo: moisture, bacteria or fungi and friction from skin-to-skin contact. The intended place in ther place in therap apy y would be as an alternative to other treatment options used in managing intertrigo. This may include topical or systemic antimicrobial agents and corticosteroids, and absorptive materials such as gauze. The main points from the e main points from the evidence vidence summarised in this briefing are from 1 prospective single- arm (...) /terms-and- conditions#notice-of-rights). Page 1 of 12overall treatment time and associated costs. There is no published evidence to support these claims. The technology The technology InterDry (Coloplast Limited) for treating intertrigo is made of a non-sterile, polyester fabric that wicks away moisture from the skin and allows it to evaporate. It has a polyurethane coating that is designed to reduce skin-to-skin friction and silver within the fabric to provide antibacterial action. The company

2019 National Institute for Health and Clinical Excellence - Advice

271. HemaClear for bloodless surgical field during limb surgery

, staying within the safe limit of tourniquet pressure, not exceeding maximum duration of use and providing adequate analgesia. NICE's guideline on surgical site infections recommends earlier intravenous antibiotic prophylaxis HemaClear for bloodless surgical field during limb surgery (MIB187) © NICE 2019. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-and- conditions#notice-of-rights). Page 2 of 15(before starting anaesthesia) in cases when a tourniquet has been used

2019 National Institute for Health and Clinical Excellence - Advice

272. Endo-SPONGE for colorectal anastomotic leakage

, antibiotics and oxygen, with close clinical observation. However, for people showing signs of sepsis, steps must be taken to remove the source of the leak within 3 to 18 hours, depending on the underlying condition and severity of infection. In less severe cases of sepsis associated with extraperitoneal rectal anastomotic leakage, proximal Endo-SPONGE for colorectal anastomotic leakage (MIB188) © NICE 2019. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-and- conditions

2019 National Institute for Health and Clinical Excellence - Advice

273. Danis stent for acute oesophageal variceal bleeds

happen in people with underlying liver disease. Current standard care for people with acute variceal bleeding involves a combination of basic resuscitation, vasoactive drugs, prophylactic antibiotics and endoscopic techniques. NICE's guideline on acute upper gastrointestinal bleeding in over 16s recommends offering terlipressin to people with suspected variceal bleeding at presentation. Band ligation is the recommended primary therapy for people with upper gastrointestinal bleeding from oesophageal

2019 National Institute for Health and Clinical Excellence - Advice

274. Peezy Midstream for urine collection

taken using standard collection. Inclusion criteria: pregnancies booked before 12 weeks gestation and continued their care, ending in delivery at study hospital. 100 most recent deliveries from 8 September 2019. Variables examined: MSU samples sent in total, positive MSU samples, antibiotics administered to protocol, contamination rate. A service evaluation study on Peezy (n=40) for MSU collection. UK. Peezy Midstream for urine collection (MIB183) © NICE 2019. All rights reserved. Subject to Notice (...) for people with poor balance or manual dexterity, because they may find it difficult to control their urinary stream. Potential system impact Peezy Midstream has the potential to improve clinical outcomes and reduce system costs because it reduces the number of samples sent for laboratory testing and unnecessary use of prophylactic antibiotics. Peezy Midstream for urine collection (MIB183) © NICE 2019. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-and- conditions#notice

2019 National Institute for Health and Clinical Excellence - Advice

275. SEM Scanner for pressure ulcer prevention

and incontinence- associated dermatitis. All specialists agreed that initial and acquisition costs of SEM Scanner will be higher than current standard care. However, 2 specialists noted the potential for substantial downstream savings for the NHS. One specialist had done research that showed SEM Scanner can reduce costs because of released nursing time in hospital and community settings, reduced dressings and antibiotic costs, improved revenue loss in secondary care settings from lost bed days, reduced

2019 National Institute for Health and Clinical Excellence - Advice

276. IQoro for stroke-related dysphagia

are greater with IQoro, this could result in potential cost savings because of shorter lengths of stay in hospital and fewer medical complications and interventions (such as enteral feeding or antibiotic use). One commentator explained that IQoro could potentially be used to help reduce time needed for speech and language therapy in the community, which is helpful if there are shortages in this service. Another highlighted that IQoro can be used in inpatient, outpatient, and community settings, so

2019 National Institute for Health and Clinical Excellence - Advice

277. Prevena incision management system for closed surgical incisions

(MIB173) © NICE 2019. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-and- conditions#notice-of-rights). Page 2 of 12infections, which is currently being updated, patients should have post-surgical care that involves: applying wound dressings using aseptic techniques wound cleaning with sterile saline for up to 48 hours and cleaning with tap water afterwards antibiotics, if a surgical site infection is suspected debridement (which may involve surgery) to remove the dead (...) that using Prevena is likely to lead to cost savings because of reduced incidence of surgical site infections and other complications. This in turn could lead to reduced readmissions, reoperations, length of stay and antibiotic use. The company provides staff training through online resources and employs clinical advisers to provide advice and training in hospitals. Prevena incision management system for closed surgical incisions (MIB173) © NICE 2019. All rights reserved. Subject to Notice of rights

2019 National Institute for Health and Clinical Excellence - Advice

278. Leukomed Sorbact for preventing surgical site infection

and postoperative measures to prevent SSI. It also suggests offering prophylactic antibiotics before a clean surgery involving the placement of an implant or before a clean-contaminated surgery. The guideline recommends covering surgical incisions with an appropriate interactive dressing at the end of the operation and that dressings should be changed or removed using aseptic non-touch technique. The guideline does not specify which interactive dressings to use. NICE has recommended PICO negative pressure wound (...) =0.005, OR=0.09 95%, CI 0.01 to 0.072, p=0.005). In the other patients at risk there was no significant difference in SSI at 30 days after surgery. The patient with SSI in the study arm needed intravenous antibiotics, whereas 2 patients with SSI in the control arm needed intravenous antibiotics. The other 8 had oral antibiotics. At postoperative day 30 readmission rates because of SSI in both groups were not significantly different (7/99 and 9/90, p=0.470). Regression analysis showed

2019 National Institute for Health and Clinical Excellence - Advice

279. Ivacaftor (cystic fibrosis, 6 years and older, with G551D mutation) - Addendum to Commission A19-65

in the addendum ? Kirsten Janke ? Lars Beckmann ? Katharina Biester ? Cornelia Rüdig Keywords: Ivacaftor, Cystic Fibrosis, Child, Adolescent, Adult, Benefit Assessment, NCT00909532, NCT00909727 Addendum A20-04 Version 1.0 Ivacaftor – Addendum to Commission A19-65 30 January 2020 Institute for Quality and Efficiency in Health Care (IQWiG) - iii - Table of contents Page List of tables iv List of abbreviations v 1 Background 1 2 Assessment 2 2.1 Antibiotic treatment in the studies VX08-770-102 and VX08-770-103 2 (...) 2.2 Summary 4 3 References 5 Addendum A20-04 Version 1.0 Ivacaftor – Addendum to Commission A19-65 30 January 2020 Institute for Quality and Efficiency in Health Care (IQWiG) - iv - List of tables Page Table 1: Additional information subsequently submitted by the company on the switch in antibiotic treatment in the framework of the basic therapy before the first administration of the study medication (baseline) and in the course of the study – RCT, direct comparison: ivacaftor + BSC vs. placebo

2020 Institute for Quality and Efficiency in Healthcare (IQWiG)

280. Ivacaftor (combination with tezacaftor/ivacaftor, cystic fibrosis, 12 years and older, with F508del mutation, heterozygous) - Addendum to Commission A19-71

with intravenous antibiotics As a result of the analyses on the event rates of the company, the time from entry into treatment period 2 of the VX-14-661-108 study plus 96 weeks of the extension study was included in the analysis for analysis group 1, and the time from entry into the extension study was included in the analysis for analysis group 2. The analyses of the VX-14-661-110 study subsequently submitted by the company in the comments were incomplete for several reasons: ? As already described (...) ] N = 68 13.8 [10.3 ; 17.2] Number of patients with at least one pulmonary exacerbation c Event rate/year [95% CI] N = 81 40 (49.4) 0.44 [0.29 ; 0.66] N = 78 28 (35.9) 0.22 [0.14 ; 0.35] Number of patients with at least one pulmonary exacerbation requiring hospitalization c Event rate/year [95% CI] n = 81 12 (14.8) 0.07 [0.03 ; 0.18] n = 78 9 (11.5) 0.05 [0.02 ; 0.13] Number of patients with at least one pulmonary exacerbation requiring administration of IV antibiotics c : Event rate/year [95% CI

2020 Institute for Quality and Efficiency in Healthcare (IQWiG)

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