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Démence / Michel Kroes / Brussels [Belgium] : KCE = Federaal Kenniscentrum voor de Gezondheidszorg = Centre Fédéral d'Expertise des Soins de Santé = Belgian Health Care Knowledge Centre (2011)  

Démence : quelles interventions non pharmacologiques ? [printed text] / Michel Kroes, Author ; Sjokvist Garcia-Stewart, Author ; Felicity Allen, Author ; Marijke Eyssen , Author ; Dominique Paulus , Author . - Brussels [Belgium] : KCE = Federaal Kenniscentrum voor de Gezondheidszorg = Centre Fédéral d'Expertise des Soins de Santé = Belgian Health Care Knowledge Centre, 2011 . - VII, 120 p. : ill. ; A4. - (KCE Reports B. Good Clinical Practice (GCP); 160B) . ISSN : D/2011/10.273/36 : € 0,00 Etude n° 2010-07 Languages : English (eng) French (fre) Descriptors: Indexation 2010-07 ; Caregivers ; Dementia ; Nonpharmacological Treatment ; Pharmacology ; R160 ; Therapeutics Classification WT 155 Senile dementia. Alzheimer's disease Abstract: Les médicaments ne sont pas d’une grande utilité pour la prise en charge de la démence mais y a-t-il des solutions alternatives ? Le Centre fédéral d’expertise des soins de santé (KCE) a analysé trente formes de prise en charge non médicamenteuses. Des données scientifiques montrent l’efficacité de quatre d’entre elles. Le soutien psychologique, social et la formation de l’entourage sont à privilégier à domicile. En institution, la formation du personnel soignant diminue l’usage des moyens de contention. Enfin, l’activité physique et la stimulation des fonctions cognitives exercent un effet positif sur la personne souffrant de démence. Deux conditions pour le succès des ces interventions : un suivi professionnel régulier et un ajustement de l’intervention au patient et à son entourage. Force est de constater que les données scientifiques manquent pour tirer des conclusions relatives aux autres interventions. Contents note: 1 INTRODUCTION 3 -- 1.1 BACKGROUND OF THE STUDY 3 -- 1.2 DEMENTIA 3 -- 1.2.1 A disease with consequences 3 -- 1.2.2 Diagnostic process 3 -- 1.2.3 Prevalence of dementia 4 -- 1.2.4 Types of dementia in Europe 4 -- 1.3 RESEARCH QUESTION 5 -- 2 METHODS 6 -- 2.1 INCLUSION CRITERIA 6 -- 2.2 LITERATURE SEARCH STRATEGY 8 -- 2.2.1 Phase I : systematic reviews 8 -- 2.2.2 Phase II : randomised controlled trials 9 -- 2.3 ASSESSING METHODOLOGICAL QUALITY AND RISK OF BIAS 9 -- 2.3.1 Systematic reviews 9 -- 2.3.2 Randomised controlled trials 10 -- 2.4 DATA EXTRACTION 10 -- 3 RESULTS 11 -- 3.1 METHODOLOGICAL CONSIDERATIONS 11 -- 3.1.1 Systematic reviews 11 -- 3.1.2 Randomised controlled trials 13 -- 3.2 RESULTS BY INTERVENTION 16 -- 3.2.1 Cognition 16 -- 3.2.2 Emotion 19 -- 3.2.3 Sensory enhancement 20 -- 3.2.4 Daily activities 23 -- 3.2.5 Physical activity 23 -- 3.2.6 Communication/interaction/relationship interventions 24 -- 3.2.7 Environmental changes 25 -- 3.2.8 Nutrition 26 -- 3.2.9 Interventions primarily focused on caregivers 26 -- 3.2.10 Interventions for the informal caregivers and patients at home 27 -- 4 SUMMARY OF THE MAIN FINDINGS 31 -- 4.1 QUALITY OF EVIDENCE: SUMMARY TABLE 31 -- 4.2 MODERATE QUALITY OF EVIDENCE FOR SIX GROUPS OF INTERVENTIONS 33 -- 4.2.1 Multicomponent psychoeducation/psychosocial interventions : impact on caregivers -- outcomes and on institutionalisation 33 -- 4.2.2 Physical activity 33 -- 4.2.3 Staff education 33 -- 4.2.4 Cognitive stimulation / training 34 -- 4.3 LOW QUALITY OF EVIDENCE FOR SIXTEEN INTERVENTIONS 34 -- 4.4 NO RCT FOR SIX INTERVENTIONS 34 -- 5 DISCUSSION 35 -- 5.1 STRENGTHS OF THE SYSTEMATIC REVIEW 35 -- 5.2 LIMITATIONS IN THE INTERPRETATION OF RESULTS 35 -- 5.3 LACK OF EVIDENCE: SOME HYPOTHESES 35 -- 5.4 RESULTS: APPLICABLE TO ALL PATIENT SUBGROUPS ? 36 -- 5.5 RESULTS APPLICABLE TO ALL SETTINGS ? 36 -- 5.6 INTERVENTIONS TAILORED TO THE PATIENT AND INFORMAL CAREGIVER ARE MORE -- SUCCESSFUL 36 -- 5.7 ADAPTATION TO THE CULTURAL AND HEALTH CARE CONTEXT 37 -- 5.8 PERSPECTIVES 37 -- 5.9 SUGGESTIONS FOR FURTHER RESEARCH 37 -- 6 APPENDICES 38 -- 6.1 APPENDIX 1 MESH TERM : DEMENTIA 38 -- 6.2 APPENDIX 2 SEARCH STRATEGIES SYSTEMATIC REVIEWS 38 -- 6.3 APPENDIX 3. WEBSITES ADDITIONAL HANDSEARCHING 50 -- 6.4 APPENDIX 4 QUALITY APPRAISAL FOR INCLUDED SYSTEMATIC REVIEWS 52 -- 6.5 APPENDIX 5 DATA EXTRACTION TABLE FOR INCLUDED SYSTEMATIC REVIEWS -- (WITH A LOW RISK OF BIAS) 55 -- 6.6 APPENDIX 6 SYSTEMATIC REVIEWS EXCLUDED (HIGH RISK OF BIAS) 65 -- 6.7 APPENDIX 7 RCT SEARCH STRATEGIES 69 -- 6.8 APPENDIX 8 QUALITY APPRAISAL FOR RCTS 77 -- 6.9 APPENDIX 9. DATA EVIDENCE TABLES FOR THE 30 INCLUDED RCTS 95 -- 7 REFERENCES 114 Link for e-copy: https://doi.org/10.57598/R160B Format of e-copy: PDF [Open Access] (780 KB) Record link: https://kce.docressources.info/index.php?lvl=notice_display&id=2625

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Dementia / Michel Kroes / Brussels [Belgium] : KCE = Federaal Kenniscentrum voor de Gezondheidszorg = Centre Fédéral d'Expertise des Soins de Santé = Belgian Health Care Knowledge Centre (2011)  

Dementia : which non-pharmacological interventions? [printed text] / Michel Kroes, Author ; Sjokvist Garcia-Stewart, Author ; Felicity Allen, Author ; Marijke Eyssen , Author ; Dominique Paulus , Author . - Brussels [Belgium] : KCE = Federaal Kenniscentrum voor de Gezondheidszorg = Centre Fédéral d'Expertise des Soins de Santé = Belgian Health Care Knowledge Centre, 2011 . - VI, 120 p. : ill. ; A4. - (KCE Reports. Good Clinical Practice (GCP); 160C) . ISSN : D/2011/10.273/37 : € 0,00 Study nr 2010-07 Languages : English (eng) Descriptors: Indexation 2010-07 ; Caregivers ; Dementia ; Nonpharmacological Treatment ; Pharmacology ; R160 ; Therapeutics Classification WT 155 Senile dementia. Alzheimer's disease Contents note: 1 INTRODUCTION 3 -- 1.1 BACKGROUND OF THE STUDY 3 -- 1.2 DEMENTIA 3 -- 1.2.1 A disease with consequences 3 -- 1.2.2 Diagnostic process 3 -- 1.2.3 Prevalence of dementia 4 -- 1.2.4 Types of dementia in Europe 4 -- 1.3 RESEARCH QUESTION 5 -- 2 METHODS 6 -- 2.1 INCLUSION CRITERIA 6 -- 2.2 LITERATURE SEARCH STRATEGY 8 -- 2.2.1 Phase I : systematic reviews 8 -- 2.2.2 Phase II : randomised controlled trials 9 -- 2.3 ASSESSING METHODOLOGICAL QUALITY AND RISK OF BIAS 9 -- 2.3.1 Systematic reviews 9 -- 2.3.2 Randomised controlled trials 10 -- 2.4 DATA EXTRACTION 10 -- 3 RESULTS 11 -- 3.1 METHODOLOGICAL CONSIDERATIONS 11 -- 3.1.1 Systematic reviews 11 -- 3.1.2 Randomised controlled trials 13 -- 3.2 RESULTS BY INTERVENTION 16 -- 3.2.1 Cognition 16 -- 3.2.2 Emotion 19 -- 3.2.3 Sensory enhancement 20 -- 3.2.4 Daily activities 23 -- 3.2.5 Physical activity 23 -- 3.2.6 Communication/interaction/relationship interventions 24 -- 3.2.7 Environmental changes 25 -- 3.2.8 Nutrition 26 -- 3.2.9 Interventions primarily focused on caregivers 26 -- 3.2.10 Interventions for the informal caregivers and patients at home 27 -- 4 SUMMARY OF THE MAIN FINDINGS 31 -- 4.1 QUALITY OF EVIDENCE: SUMMARY TABLE 31 -- 4.2 MODERATE QUALITY OF EVIDENCE FOR SIX GROUPS OF INTERVENTIONS 33 -- 4.2.1 Multicomponent psychoeducation/psychosocial interventions : impact on caregivers -- outcomes and on institutionalisation 33 -- 4.2.2 Physical activity 33 -- 4.2.3 Staff education 33 -- 4.2.4 Cognitive stimulation / training 34 -- 4.3 LOW QUALITY OF EVIDENCE FOR SIXTEEN INTERVENTIONS 34 -- 4.4 NO RCT FOR SIX INTERVENTIONS 34 -- 5 DISCUSSION 35 -- 5.1 STRENGTHS OF THE SYSTEMATIC REVIEW 35 -- 5.2 LIMITATIONS IN THE INTERPRETATION OF RESULTS 35 -- 5.3 LACK OF EVIDENCE: SOME HYPOTHESES 35 -- 5.4 RESULTS: APPLICABLE TO ALL PATIENT SUBGROUPS ? 36 -- 5.5 RESULTS APPLICABLE TO ALL SETTINGS ? 36 -- 5.6 INTERVENTIONS TAILORED TO THE PATIENT AND INFORMAL CAREGIVER ARE MORE -- SUCCESSFUL 36 -- 5.7 ADAPTATION TO THE CULTURAL AND HEALTH CARE CONTEXT 37 -- 5.8 PERSPECTIVES 37 -- 5.9 SUGGESTIONS FOR FURTHER RESEARCH 37 -- 6 APPENDICES 38 -- 6.1 APPENDIX 1 MESH TERM : DEMENTIA 38 -- 6.2 APPENDIX 2 SEARCH STRATEGIES SYSTEMATIC REVIEWS 38 -- 6.3 APPENDIX 3. WEBSITES ADDITIONAL HANDSEARCHING 50 -- 6.4 APPENDIX 4 QUALITY APPRAISAL FOR INCLUDED SYSTEMATIC REVIEWS 52 -- 6.5 APPENDIX 5 DATA EXTRACTION TABLE FOR INCLUDED SYSTEMATIC REVIEWS -- (WITH A LOW RISK OF BIAS) 55 -- 6.6 APPENDIX 6 SYSTEMATIC REVIEWS EXCLUDED (HIGH RISK OF BIAS) 65 -- 6.7 APPENDIX 7 RCT SEARCH STRATEGIES 69 -- 6.8 APPENDIX 8 QUALITY APPRAISAL FOR RCTS 77 -- 6.9 APPENDIX 9. DATA EVIDENCE TABLES FOR THE 30 INCLUDED RCTS 95 -- 7 REFERENCES 114 Link for e-copy: https://doi.org/10.57598/R160C Format of e-copy: PDF [Open Access] (767 KB) Record link: https://kce.docressources.info/index.php?lvl=notice_display&id=2627

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Dementie / Michel Kroes / Brussels [Belgium] : KCE = Federaal Kenniscentrum voor de Gezondheidszorg = Centre Fédéral d'Expertise des Soins de Santé = Belgian Health Care Knowledge Centre (2011)  

Dementie : welke niet-pharmacologische interventies? [printed text] / Michel Kroes, Author ; Sjokvist Garcia-Stewart, Author ; Felicity Allen, Author ; Marijke Eyssen , Author ; Dominique Paulus , Author . - Brussels [Belgium] : KCE = Federaal Kenniscentrum voor de Gezondheidszorg = Centre Fédéral d'Expertise des Soins de Santé = Belgian Health Care Knowledge Centre, 2011 . - VII, 120 p. : ill. ; A4. - (KCE Reports A. Good Clinical Practice (GCP); 160A) . ISSN : D/2011/10.273/35 : € 0,00 Studie nr 2010-07 Languages : English (eng) Dutch (nla) Descriptors: Indexation 2010-07 ; Caregivers ; Dementia ; Nonpharmacological Treatment ; Pharmacology ; R160 ; Therapeutics Classification WT 155 Senile dementia. Alzheimer's disease Abstract: Bij de behandeling van mensen met dementie zijn geneesmiddelen niet echt van groot nut, maar zijn er alternatieve oplossingen? Het Federaal Kenniscentrum voor de Gezondheidszorg (KCE) onderzocht dertig vormen van aanpak zonder geneesmiddelen. Voor vier van hen vonden de onderzoekers voldoende betrouwbare studies die wijzen op werkzaamheid. Vooral het opleiden en psychosociaal ondersteunen van de mantelzorger blijkt doeltreffend te zijn. Aangepaste opleidingen aan zorgverleners verminderen het gebruik van dwangmaatregelen in instellingen. Lichaamsbeweging en stimulering van de cognitieve functies hebben een positief effect op de demente persoon zelf. Voorwaarde is dat deze behandelingen aangepast zijn aan de demente persoon en zijn omgeving en dat ze regelmatig opgevolgd worden door professionele zorgverleners. Voor de andere interventies waren er onvoldoende wetenschappelijke gegevens om conclusies te kunnen trekken. Contents note: 1 INTRODUCTION 3 -- 1.1 BACKGROUND OF THE STUDY 3 -- 1.2 DEMENTIA 3 -- 1.2.1 A disease with consequences 3 -- 1.2.2 Diagnostic process 3 -- 1.2.3 Prevalence of dementia 4 -- 1.2.4 Types of dementia in Europe 4 -- 1.3 RESEARCH QUESTION 5 -- 2 METHODS 6 -- 2.1 INCLUSION CRITERIA 6 -- 2.2 LITERATURE SEARCH STRATEGY 8 -- 2.2.1 Phase I : systematic reviews 8 -- 2.2.2 Phase II : randomised controlled trials 9 -- 2.3 ASSESSING METHODOLOGICAL QUALITY AND RISK OF BIAS 9 -- 2.3.1 Systematic reviews 9 -- 2.3.2 Randomised controlled trials 10 -- 2.4 DATA EXTRACTION 10 -- 3 RESULTS 11 -- 3.1 METHODOLOGICAL CONSIDERATIONS 11 -- 3.1.1 Systematic reviews 11 -- 3.1.2 Randomised controlled trials 13 -- 3.2 RESULTS BY INTERVENTION 16 -- 3.2.1 Cognition 16 -- 3.2.2 Emotion 19 -- 3.2.3 Sensory enhancement 20 -- 3.2.4 Daily activities 23 -- 3.2.5 Physical activity 23 -- 3.2.6 Communication/interaction/relationship interventions 24 -- 3.2.7 Environmental changes 25 -- 3.2.8 Nutrition 26 -- 3.2.9 Interventions primarily focused on caregivers 26 -- 3.2.10 Interventions for the informal caregivers and patients at home 27 -- 4 SUMMARY OF THE MAIN FINDINGS 31 -- 4.1 QUALITY OF EVIDENCE: SUMMARY TABLE 31 -- 4.2 MODERATE QUALITY OF EVIDENCE FOR SIX GROUPS OF INTERVENTIONS 33 -- 4.2.1 Multicomponent psychoeducation/psychosocial interventions : impact on caregivers -- outcomes and on institutionalisation 33 -- 4.2.2 Physical activity 33 -- 4.2.3 Staff education 33 -- 4.2.4 Cognitive stimulation / training 34 -- 4.3 LOW QUALITY OF EVIDENCE FOR SIXTEEN INTERVENTIONS 34 -- 4.4 NO RCT FOR SIX INTERVENTIONS 34 -- 5 DISCUSSION 35 -- 5.1 STRENGTHS OF THE SYSTEMATIC REVIEW 35 -- 5.2 LIMITATIONS IN THE INTERPRETATION OF RESULTS 35 -- 5.3 LACK OF EVIDENCE: SOME HYPOTHESES 35 -- 5.4 RESULTS: APPLICABLE TO ALL PATIENT SUBGROUPS ? 36 -- 5.5 RESULTS APPLICABLE TO ALL SETTINGS ? 36 -- 5.6 INTERVENTIONS TAILORED TO THE PATIENT AND INFORMAL CAREGIVER ARE MORE -- SUCCESSFUL 36 -- 5.7 ADAPTATION TO THE CULTURAL AND HEALTH CARE CONTEXT 37 -- 5.8 PERSPECTIVES 37 -- 5.9 SUGGESTIONS FOR FURTHER RESEARCH 37 -- 6 APPENDICES 38 -- 6.1 APPENDIX 1 MESH TERM : DEMENTIA 38 -- 6.2 APPENDIX 2 SEARCH STRATEGIES SYSTEMATIC REVIEWS 38 -- 6.3 APPENDIX 3. WEBSITES ADDITIONAL HANDSEARCHING 50 -- 6.4 APPENDIX 4 QUALITY APPRAISAL FOR INCLUDED SYSTEMATIC REVIEWS 52 -- 6.5 APPENDIX 5 DATA EXTRACTION TABLE FOR INCLUDED SYSTEMATIC REVIEWS -- (WITH A LOW RISK OF BIAS) 55 -- 6.6 APPENDIX 6 SYSTEMATIC REVIEWS EXCLUDED (HIGH RISK OF BIAS) 65 -- 6.7 APPENDIX 7 RCT SEARCH STRATEGIES 69 -- 6.8 APPENDIX 8 QUALITY APPRAISAL FOR RCTS 77 -- 6.9 APPENDIX 9. DATA EVIDENCE TABLES FOR THE 30 INCLUDED RCTS 95 -- 7 REFERENCES 114 Link for e-copy: https://doi.org/10.57598/R160A Format of e-copy: PDF [Open Access] (785 KB) Record link: https://kce.docressources.info/index.php?lvl=notice_display&id=2626

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Diagnose en behandeling van spataders in de benen / Felicity Allen / Brussels [Belgium] : KCE = Federaal Kenniscentrum voor de Gezondheidszorg = Centre Fédéral d'Expertise des Soins de Santé = Belgian Health Care Knowledge Centre (2011)  

Diagnose en behandeling van spataders in de benen [printed text] / Felicity Allen, Author ; Michel Kroes, Author ; Stephen Mitchell, Author ; Françoise Mambourg , Author ; Dominique Paulus , Author . - Brussels [Belgium] : KCE = Federaal Kenniscentrum voor de Gezondheidszorg = Centre Fédéral d'Expertise des Soins de Santé = Belgian Health Care Knowledge Centre, 2011 . - IX, 111 p. : ill. ; A4. - (KCE Reports A. Good Clinical Practice (GCP); 164A) . ISSN : D/2011/10.273/50 : € 0,00 Languages : English (eng) Dutch (nla) Descriptors: Indexation 2010-01 ; Diagnosis ; R164 ; Therapeutics ; Varicose Veins Classification WG 620 Varicose veins Abstract: Spataders in de benen kunnen worden verwijderd door een klassieke operatie, de zogenaamde ‘stripping’. Er bestaan vandaag ook nieuwere, mindere invasieve methoden. De ader wordt daarbij via een katheter met laser of radiofrequentie van binnenuit dichtgeschroeid, of verschrompelt na de inspuiting van een vloeistof of schuim (sclerotherapie). Het Federaal Kenniscentrum voor de Gezondheidszorg (KCE) bekeek de doeltreffendheid en de veiligheid van deze technieken. Ze blijken niet minder doeltreffend te zijn dan de klassieke ingreep en beter te zijn voor de levenskwaliteit van de patiënt. Over de neveneffecten bestaan er wel nog weinig wetenschappelijke studies, vooral dan voor de inspuitingen met schuim. Er zijn ook nog twijfels over de resultaten op lange termijn. Het KCE raadt daarom aan deze ingrepen terug te betalen met een registratie van de patiënten om zo de lange termijn effecten van deze nieuwe behandelingen op te kunnen volgen. Over het nut van steunkousen bestaan weinig gegevens. Geneesmiddelen worden niet aanbevolen voor de behandeling van spataders. Contents note: Table of contents -- ABBREVIATIONS 4 -- 1 INTRODUCTION 5 -- 1.1 BACKGROUND OF THE STUDY 5 -- 1.1.1 Necessary update of billing codes 5 -- 1.1.2 Use of obsolete diagnostic techniques 5 -- 1.2 CLINICAL BACKGROUND: VARICOSE VEINS 6 -- 1.2.1 Definition 6 -- 1.2.2 Prevalence 6 -- 1.2.3 Aetiology and risk factors 6 -- 1.2.4 Disease severity: CEAP Classification 6 -- 1.3 RESEARCH QUESTIONS 7 -- 1.3.1 First research question: diagnostic procedures 7 -- 1.3.2 Second research question: effectiveness and safety of treatments 8 -- 1.3.3 Third research question: type of anaesthetic for each intervention 8 -- 1.4 DIAGNOSIS OF VARICOSE VEINS 8 -- 1.5 TREATMENT OPTIONS FOR VARICOSE VEINS 9 -- 1.5.1 Traditional surgical procedures 9 -- 1.5.2 Endovenous Laser Therapy 10 -- 1.5.3 Radiofrequency Ablation 10 -- 1.5.4 Sclerotherapy 10 -- 1.5.5 Mixed treatments 10 -- 2 METHODS 11 -- 2.1 SEARCH STRATEGIES 11 -- 2.1.1 Diagnostic techniques for varicose veins 11 -- 2.1.2 Treatment of varicose veins 11 -- 2.2 ASSESSING METHODOLOGICAL QUALITY AND RISK OF BIAS 12 -- 2.2.1 Diagnostic studies 12 -- 2.2.2 Systematic reviews 12 -- 2.2.3 Randomised controlled trials 12 -- 2.3 DATA EXTRACTION 12 -- 2.3.1 Diagnostic studies 12 -- 2.3.2 Systematic reviews 13 -- 2.3.3 Randomised controlled trials 13 -- 3 RESULTS: DIAGNOSTIC PROCEDURES FOR VARICOSE VEINS 14 -- 3.1 IDENTIFIED STUDIES AND QUALITY APPRAISAL 14 -- 3.1.1 Selection of two diagnostic studies 14 -- 3.1.2 Quality appraisal of diagnostic studies 16 -- 3.2 OVERVIEW OF INCLUDED DIAGNOSTIC STUDIES 16 -- 3.3 PRE-OPERATIVE DUPLEX ULTRASOUND COMPARED WITH NO SCAN 16 -- 3.4 COMPUTED TOMOGRAPHY VERSUS DUPLEX 17 -- 4 RESULTS: INTERVENTIONS FOR THE TREATMENT OF VARICOSE VEINS .. 18 -- 4.1 IDENTIFIED STUDIES AND QUALITY APPRAISAL 18 -- 4.1.1 Systematic reviews 18 -- 4.1.2 Randomised controlled trials 20 -- 4.2 OVERVIEW OF INCLUDED SYSTEMATIC REVIEWS 22 -- 4.2.1 Systematic reviews on multiple treatments 22 -- 4.2.2 Endovenous laser therapy 23 -- 4.2.3 Radiofrequency ablation 23 -- 4.2.4 Sclerotherapy 23 -- 4.2.5 Surgery 23 -- 4.2.6 Compression hosiery 23 -- 4.2.7 Drugs 23 -- 4.3 OVERVIEW OF INCLUDED RCTS 23 -- 5 RESULTS BY INTERVENTION 25 -- 5.1 ENDOVENOUS LASER THERAPY 25 -- 5.1.1 Results from systematic reviews 25 -- 5.1.2 Results from randomised controlled trials 25 -- 5.1.3 Summary: Endovenous Laser Therapy 27 -- 5.2 RADIOFREQUENCY ABLATION 27 -- 5.2.1 Results from systematic reviews 27 -- 5.2.2 Results from randomised controlled trials 27 -- 5.2.3 Summary: Radiofrequency ablation 29 -- 5.3 SCLEROTHERAPY 29 -- 5.3.1 Results from systematic reviews 29 -- 5.3.2 Results from randomised controlled trials 29 -- 5.3.3 Summary: Sclerotherapy 30 -- 5.4 SURGERY 31 -- 5.5 COMPRESSION HOSIERY 31 -- 5.6 DRUGS 32 -- 5.6.1 One Cochrane review on the effect of phlebotonics for chronic venous insufficiency .. 32 -- 5.6.2 Lack of evidence in one RCT 32 -- 5.7 OTHER CONSERVATIVE TREATMENTS 32 -- 6 SAFETY CONSIDERATIONS 33 -- 6.1 ENDOVENOUS LASER THERAPY 33 -- 6.2 RADIOFREQUENCY ABLATION 33 -- 6.3 SCLEROTHERAPY 34 -- 6.4 SURGERY 34 -- 6.5 SUMMARY: SAFETY 35 -- 7 ANAESTHESIA 36 -- 7.1 DESCRIPTION OF ANAESTHESIA IN THE INCLUDED RCTS 36 -- 7.2 ANAESTHESIA SUMMARY 36 -- 8 SUMMARY OF FINDINGS AND DISCUSSION 38 -- 8.1 SUMMARY OF FINDINGS 38 -- 8.1.1 Diagnostic: duplex ultrasound is the standard procedure 38 -- 8.1.2 Treatment options: comparable efficacy and complications 38 -- 8.1.3 Heterogenous anaesthetic procedures 38 -- 8.1.4 Coherence of the results with other recent publications 39 -- 8.2 TRANSFERABILITY OF RESULTS TO THE BELGIAN HEALTH CARE SETTING ? 39 -- 8.3 STRENGTHS AND LIMITATIONS OF THIS SYSTEMATIC REVIEW 39 -- 8.3.1 Strengths of this review 39 -- 8.3.2 Methodological limitations of the included studies 39 -- 8.4 SUGGESTIONS FOR FURTHER RESEARCH 40 -- 8.5 KEY POINTS OF THE REPORT 41 -- 9 APPENDICES 42 -- 9.1 ADDITIONAL HANDSEARCHING 42 -- 9.2 DIAGNOSTIC STUDIES: QUALITY APPRAISAL AND DETAILED RESULTS ABOUT THE -- USE OF HAND-HELD DOPPLER 44 -- 9.2.1 Quality items derived from QUADAS tool 44 -- 9.2.2 Quality appraisal of varicose vein diagnostic studies 45 -- 9.2.3 Data extraction table for Diagnostic studies (including hand-held Doppler) 46 -- 9.2.4 Overview of included diagnostic studies for hand-held Doppler 57 -- 9.2.5 Clinical Consequences of the findings: hand-held Doppler versus Colour duplex -- ultrasound 60 -- 9.3 QUALITY APPRAISAL FOR INCLUDED SYSTEMATIC REVIEWS 62 -- 9.4 DATA EXTRACTION TABLE FOR INCLUDED SYSTEMATIC REVIEWS 66 -- 9.4.1 Reviews evaluating multiple treatments 66 -- 9.4.2 Reviews evaluating EVLT 69 -- 9.4.3 EVLT RCTs from the review of Rees et al., 2009 29 70 -- 9.4.4 Reviews evaluating RFA 71 -- 9.4.5 RFA RCTs from Rees et al., 2009 29 72 -- 9.4.6 Reviews evaluating sclerotherapy 73 -- 9.4.7 Sclerotherapy RCTs from Rees et al., 2009 29 75 -- 9.4.8 Reviews focused on surgery evaluation, 77 -- 9.4.9 Reviews evaluating hosiery 77 -- 9.4.10 Reviews evaluating drugs 77 -- 9.5 QUALITY APPRAISAL FOR INCLUDED PRIMARY STUDIES 78 -- 9.5.1 Quality appraisal tool 78 -- 9.5.2 Quality appraisal of treatment RCTs: results 79 -- 9.6 DATA EXTRACTION TABLES OF INCLUDED RCTS 88 -- 9.6.1 Included RCTs evaluating EVLT 88 -- 9.6.2 Included RCTs evaluating RFA 91 -- 9.6.3 Included RCTs evaluating sclerotherapy 95 -- 9.6.4 Included RCT evaluating compression hosiery 98 -- 9.6.5 Included RCT evaluating drugs 99 -- 9.7 STUDIES EVALUATING THE SAFETY OF VARICOSE VEIN TREATMENTS 100 -- 10 REFERENCES 104 Link for e-copy: https://doi.org/10.57598/R164A Format of e-copy: PDF [Open Access] (906 Kb) Record link: https://kce.docressources.info/index.php?lvl=notice_display&id=2768

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Diagnosis and treatment of varicose veins in the legs / Felicity Allen / Brussels [Belgium] : KCE = Federaal Kenniscentrum voor de Gezondheidszorg = Centre Fédéral d'Expertise des Soins de Santé = Belgian Health Care Knowledge Centre (2011)  

Diagnosis and treatment of varicose veins in the legs [printed text] / Felicity Allen, Author ; Michel Kroes, Author ; Stephen Mitchell, Author ; Françoise Mambourg , Author ; Dominique Paulus , Author . - Brussels [Belgium] : KCE = Federaal Kenniscentrum voor de Gezondheidszorg = Centre Fédéral d'Expertise des Soins de Santé = Belgian Health Care Knowledge Centre, 2011 . - IX, 111 p. : ill. ; A4. - (KCE Reports. Good Clinical Practice (GCP); 164C) . ISSN : D/2011/10.273/52 : € 0,00 Languages : English (eng) Descriptors: Indexation 2010-01 ; Diagnosis ; R164 ; Therapeutics ; Varicose Veins Classification WG 620 Varicose veins Contents note: 1 INTRODUCTION 5 -- 1.1 BACKGROUND OF THE STUDY 5 -- 1.1.1 Necessary update of billing codes 5 -- 1.1.2 Use of obsolete diagnostic techniques 5 -- 1.2 CLINICAL BACKGROUND: VARICOSE VEINS 6 -- 1.2.1 Definition 6 -- 1.2.2 Prevalence 6 -- 1.2.3 Aetiology and risk factors 6 -- 1.2.4 Disease severity: CEAP Classification 6 -- 1.3 RESEARCH QUESTIONS 7 -- 1.3.1 First research question: diagnostic procedures 7 -- 1.3.2 Second research question: effectiveness and safety of treatments 8 -- 1.3.3 Third research question: type of anaesthetic for each intervention 8 -- 1.4 DIAGNOSIS OF VARICOSE VEINS 8 -- 1.5 TREATMENT OPTIONS FOR VARICOSE VEINS 9 -- 1.5.1 Traditional surgical procedures 9 -- 1.5.2 Endovenous Laser Therapy 10 -- 1.5.3 Radiofrequency Ablation 10 -- 1.5.4 Sclerotherapy 10 -- 1.5.5 Mixed treatments 10 -- 2 METHODS 11 -- 2.1 SEARCH STRATEGIES 11 -- 2.1.1 Diagnostic techniques for varicose veins 11 -- 2.1.2 Treatment of varicose veins 11 -- 2.2 ASSESSING METHODOLOGICAL QUALITY AND RISK OF BIAS 12 -- 2.2.1 Diagnostic studies 12 -- 2.2.2 Systematic reviews 12 -- 2.2.3 Randomised controlled trials 12 -- 2.3 DATA EXTRACTION 12 -- 2.3.1 Diagnostic studies 12 -- 2.3.2 Systematic reviews 13 -- 2.3.3 Randomised controlled trials 13 -- 3 RESULTS: DIAGNOSTIC PROCEDURES FOR VARICOSE VEINS 14 -- 3.1 IDENTIFIED STUDIES AND QUALITY APPRAISAL 14 -- 3.1.1 Selection of two diagnostic studies 14 -- 3.1.2 Quality appraisal of diagnostic studies 16 -- 3.2 OVERVIEW OF INCLUDED DIAGNOSTIC STUDIES 16 -- 3.3 PRE-OPERATIVE DUPLEX ULTRASOUND COMPARED WITH NO SCAN 16 -- 3.4 COMPUTED TOMOGRAPHY VERSUS DUPLEX 17 -- 4 RESULTS: INTERVENTIONS FOR THE TREATMENT OF VARICOSE VEINS .. 18 -- 4.1 IDENTIFIED STUDIES AND QUALITY APPRAISAL 18 -- 4.1.1 Systematic reviews 18 -- 4.1.2 Randomised controlled trials 20 -- 4.2 OVERVIEW OF INCLUDED SYSTEMATIC REVIEWS 22 -- 4.2.1 Systematic reviews on multiple treatments 22 -- 4.2.2 Endovenous laser therapy 23 -- 4.2.3 Radiofrequency ablation 23 -- 4.2.4 Sclerotherapy 23 -- 4.2.5 Surgery 23 -- 4.2.6 Compression hosiery 23 -- 4.3 OVERVIEW OF INCLUDED RCTS 23 -- 5 RESULTS BY INTERVENTION 25 -- 5.1 ENDOVENOUS LASER THERAPY 25 -- 5.1.1 Results from systematic reviews 25 -- 5.1.2 Results from randomised controlled trials 25 -- 5.1.3 Summary: Endovenous Laser Therapy 27 -- 5.2 RADIOFREQUENCY ABLATION 27 -- 5.2.1 Results from systematic reviews 27 -- 5.2.2 Results from randomised controlled trials 27 -- 5.2.3 Summary: Radiofrequency ablation 29 -- 5.3 SCLEROTHERAPY 29 -- 5.3.1 Results from systematic reviews 29 -- 5.3.2 Results from randomised controlled trials 29 -- 5.3.3 Summary: Sclerotherapy 30 -- 5.4 SURGERY 31 -- 5.5 COMPRESSION HOSIERY 31 -- 5.6 DRUGS 32 -- 5.6.1 One Cochrane review on the effect of phlebotonics for chronic venous insufficiency .. 32 -- 5.6.2 Lack of evidence in one RCT 32 -- 5.7 OTHER CONSERVATIVE TREATMENTS 32 -- 6 SAFETY CONSIDERATIONS 33 -- 6.1 ENDOVENOUS LASER THERAPY 33 -- 6.2 RADIOFREQUENCY ABLATION 33 -- 6.3 SCLEROTHERAPY 34 -- 6.4 SURGERY 34 -- 6.5 SUMMARY: SAFETY 35 -- 7 ANAESTHESIA 36 -- 7.1 DESCRIPTION OF ANAESTHESIA IN THE INCLUDED RCTS 36 -- 7.2 ANAESTHESIA SUMMARY 36 -- 8 SUMMARY OF FINDINGS AND DISCUSSION 38 -- 8.1 SUMMARY OF FINDINGS 38 -- 8.1.1 Diagnostic: duplex ultrasound is the standard procedure 38 -- 8.1.2 Treatment options: comparable efficacy and complications 38 -- 8.1.3 Heterogenous anaesthetic procedures 38 -- 8.1.4 Coherence of the results with other recent publications 39 -- 8.2 TRANSFERABILITY OF RESULTS TO THE BELGIAN HEALTH CARE SETTING ? 39 -- 8.3 STRENGTHS AND LIMITATIONS OF THIS SYSTEMATIC REVIEW 39 -- 8.3.1 Strengths of this review 39 -- 8.3.2 Methodological limitations of the included studies 39 -- 8.4 SUGGESTIONS FOR FURTHER RESEARCH 40 -- 8.5 KEY POINTS OF THE REPORT 41 -- 9 APPENDICES 42 -- 9.1 ADDITIONAL HANDSEARCHING 42 -- 9.2 DIAGNOSTIC STUDIES: QUALITY APPRAISAL AND DETAILED RESULTS ABOUT THE -- USE OF HAND-HELD DOPPLER 44 -- 9.2.1 Quality items derived from QUADAS tool 44 -- 9.2.2 Quality appraisal of varicose vein diagnostic studies 45 -- 9.2.3 Data extraction table for Diagnostic studies (including hand-held Doppler) 46 -- 9.2.4 Overview of included diagnostic studies for hand-held Doppler 57 -- 9.2.5 Clinical Consequences of the findings: hand-held Doppler versus Colour duplex -- ultrasound 60 -- 9.3 QUALITY APPRAISAL FOR INCLUDED SYSTEMATIC REVIEWS 62 -- 9.4 DATA EXTRACTION TABLE FOR INCLUDED SYSTEMATIC REVIEWS 66 -- 9.4.1 Reviews evaluating multiple treatments 66 -- 9.4.2 Reviews evaluating EVLT 69 -- 9.4.3 EVLT RCTs from the review of Rees et al., 2009 29 70 -- 9.4.4 Reviews evaluating RFA 71 -- 9.4.5 RFA RCTs from Rees et al., 2009 29 72 -- 9.4.6 Reviews evaluating sclerotherapy 73 -- 9.4.7 Sclerotherapy RCTs from Rees et al., 2009 29 75 -- 9.4.8 Reviews focused on surgery evaluation, 77 -- 9.4.9 Reviews evaluating hosiery 77 -- 9.4.10 Reviews evaluating drugs 77 -- 9.5 QUALITY APPRAISAL FOR INCLUDED PRIMARY STUDIES 78 -- 9.5.1 Quality appraisal tool 78 -- 9.5.2 Quality appraisal of treatment RCTs: results 79 -- 9.6 DATA EXTRACTION TABLES OF INCLUDED RCTS 88 -- 9.6.1 Included RCTs evaluating EVLT 88 -- 9.6.2 Included RCTs evaluating RFA 91 -- 9.6.3 Included RCTs evaluating sclerotherapy 95 -- 9.6.4 Included RCT evaluating compression hosiery 98 -- 9.6.5 Included RCT evaluating drugs 99 -- 9.7 STUDIES EVALUATING THE SAFETY OF VARICOSE VEIN TREATMENTS 100 -- 10 REFERENCES 104 -- Link for e-copy: https://doi.org/10.57598/R164C Format of e-copy: PDF [Open Access] (9010 Kb) Record link: https://kce.docressources.info/index.php?lvl=notice_display&id=2767

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Diagnostic et traitement des varices des membres inférieurs / Felicity Allen / Brussels [Belgium] : KCE = Federaal Kenniscentrum voor de Gezondheidszorg = Centre Fédéral d'Expertise des Soins de Santé = Belgian Health Care Knowledge Centre (2011)  

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