No abstract

The rapid development and updates of mobile medical resource applications (apps) highlight the need for an evaluation tool to assess the content of these resources. The purpose of the study was to develop and test a new evaluation rubric for medical resource apps. The evaluation rubric was designed using existing literature and through a collaborative effort between a hospital and an academic librarian. Testing found scores ranging from 23% to 88% for the apps. The evaluation rubric proved able to distinguish levels of quality within each content component of the apps, demonstrating potential for standardization of medical resource app evaluations.

Four systematic reviews, 1 randomized controlled trial (RCT), 1 economic evaluation, and 2 evidence-based guidelines were identified. Four systematic reviews (2 that included moderate- to high-quality evidence and 2 that did not report the quality of the evidence) and 1 RCT (that provided high-quality evidence) reported on the clinical effectiveness of rituximab (RTX) for the treatment of neuromyelitis optica spectrum disorder (NMOSD). Overall, RTX treatment appeared to reduce the relapse rate and disability level compared with pre-treatment or placebo. In terms of reduction in relapse rate and disability, RTX was either better or not different from azathioprine (AZA). For relapse rates, disability levels, and incidence of adverse events, network meta-analyses showed that no treatment was favoured for comparisons between RTX, mycophenolate mofetil (MMF), and cyclophosphamide (CYP). One economic evaluation (of moderate quality) showed that, for patients with NMOSD, in the context of the Thai health care system, RTX biosimilar with CD27+ memory B cell monitoring regimen had the highest probability (48%) of being cost-effective, followed by AZA (30%), MMF (13%), RTX with CD27+ memory B cell monitoring regimen (9%), RTX biosimilar (0%), and RTX (0%) at a willingness-to-pay threshold of 160,000 Thai bhat (equivalent to US$5,289 in 2019 values) per quality-adjusted life-year gained. The 2 guidelines recommended immunosuppressants (RTX, AZA, and MMF) for prevention of NMOSD attacks. In addition, 1 guideline mentioned that tocilizumab, eculizumab, inebilizumab, and satralizumab can be used in NMOSD leave it up to patients who have no response to other immunosuppressants. The quality of the evidence that informed the guidelines and the strength of the recommendations were not reported. Findings need to be interpreted with caution given the limited quantity of evidence on comparative efficacy and safety between various immunosuppressants, that many of the included primary studies were retrospective studies, the heterogeneity among the studies included in the systematic reviews, and the lack of clarity with respect to the strength of the recommendations.

Evidence was summarized to determine the effect of alteplase in adult stroke patients. There is substantial uncertainty concerning the evidence due to the risk of bias in the available studies and imprecision in how the magnitude of the treatment effects were estimated. The identified research suggests that alteplase administered within 3 hours of a stroke might result in: fewer deaths after 18 months and little-to-no difference in death after 7 days, 3 months, 6 months, or 3 years increased brain bleeds after 7 days but no difference after 36 hours or after 3 months improvements in functioning and independence after 7 days and after 6 months; at 3 months, some studies showed no difference in independence and another study showed higher functioning. The identified research suggests that alteplase administered between 3 hours and 4.5 hours after a stroke might result in: little-to-no difference in deaths after 3 months; at 7 days, some evidence showed little-to-no difference in death while other evidence suggested more deaths little-to-no differences in brain bleeds after 36 hours; at 7 days, some evidence showed no effect on brain bleeds, while other evidence showed more brain bleeds no differences in functioning and independence after 6 months; at 3 months, some evidence showed no effect on functioning, while other evidence reported improved functioning.

This custom rapid report provides insight into some challenges of equitable access to and inclusion in specialized eating disorder care for racialized, LGBTQ2S+, and male adolescents living with distress related to body image, eating, and food. To do this work, the author of this custom report engaged with empirical and conceptual literature around adolescent eating disorders and investigates how access and inclusion have been conceptualized in that literature. Equitable access to specialized and inclusive eating disorder care for racialized, LGBTQ2S+, and male adolescents can be hampered by reductive understandings of these adolescents’ needs and experiences of distress around eating and body image. Similarly, diagnostic categories, diagnostic assessment tools, and treatments designed with and for the archetype of the young, white, cisgender woman living with an eating disorder, reduce the understanding of adolescents not fitting this archetype. Cultural competency training and practising cultural humility were both described as supportive elements in working toward providing equitable access to inclusive eating disorder care. A series of sensitizing questions are provided at the end of this report and are meant to support the CADTH team in remaining attentive to considerations of equity of access and inclusivity as they assess early intervention programs for adolescents living with eating disorders in an upcoming health technology assessment.