clinical effectiveness bulletin no. 58 november 2011

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BF[ Dnjziz~ ib` Nbehzoipnhb [czunkc Bhzpf [pieehz`{fnzc 9 Kdnbnkid Ceeckpnucbc{{ Jsddcpnb ehz BF[ Qznoiz~ Kizc nb Bhzpf [pieehz`{fnzc N{{sc Bh= 36 ‛ Bhucojcz :199 Ijhsp pfn{ Jsddcpnb= Np ino{ ph `zi| ippcbpnhb ph {hoc he pfc gc~ `hksocbp{ ib` zcunc|{ hb kdnbnkid ceeckpnucbc{{ pfip fiuc jccb qsjdn{fc` nb pfc qzcunhs{ ohbpf" \fczc qh{{njdc dnbg{ ph pfc esdd pcvp `hksocbp{ izc nbkds`c`" Ne pfc izpnkdc n{ nb i mhszbid ~hs kib khbpikp pfc Fcidpf Dnjziz~ ehz i khq~" Dnbg ph zcysc{p ehzo=  fppq=((|||"gccdc"ik"sg(fcidpfdnjziz~(s{nblpfcfcidpfdnjziz~(nbpcz/ dnjziz~dhib{(+`"cb":<0;<  WQdci{c bhpc / i kfizlc he «: qcz zcysc{p n{ qi~ijdc ehz oh{p khqnc{_ Ne ~hs bcc` eszpfcz i{{n{pibkc qdci{c khbpikp pfc Fcidpf Dnjziz~ hz pfc BF[ Hspzcikf Dnjziznib{ `cpind{ jcdh|" Pfc jsddcpnb kib jc c/oindc` ph khddcilsc{ |fh oi~ id{h enb` np s{cesd" I dn{p he |cj{npc{ kfckgc` nb pfc qzh`skpnhb he pfn{ jsddcpnb n{ hb pfc enz{p qilc" Qdci{c {sllc{p eszpfcz s{cesd {npc{" Ecc`jikg n{ id|i~{ |cdkhoc` ph nbehzo espszc n{{sc{ he pfc jsddcpnb" Khbpikp nbehzoipnhb Jsddcpnb qzh`skc` j~ BF[ Hspzcikf Dnjziznib{  Pcd= EcipszcBcp 60:> &Cvpczbid kidd{ 1;11 9:; 93;3 cvp 60:>. C/oind= dnb`{i~"{bcddAbhzpf{piee{"bf{"sg kdizcf"qh|cddAbhzpf{piee{"bf{"sg  Bhzpf [piee{ Fcidpf Dnjziz~ Pcd= 19<6: 5<>311 Eiv= 19<6: 5<>36: C/oind= fcidpf"dnjziz~Agccdc"ik"sg  

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Page 1: Clinical Effectiveness Bulletin no. 58 November 2011

8/3/2019 Clinical Effectiveness Bulletin no. 58 November 2011

http://slidepdf.com/reader/full/clinical-effectiveness-bulletin-no-58-november-2011 1/25

BF[ Dnjziz~ ib` Nbehzoipnhb [czunkc Bhzpf [pieehz`{fnzc 

9

Kdnbnkid Ceeckpnucbc{{ Jsddcpnbehz BF[ Qznoiz~ Kizc nb Bhzpf

[pieehz`{fnzcN{{sc Bh= 36 ‛ Bhucojcz :199

Ijhsp pfn{ Jsddcpnb=

Np ino{ ph `zi| ippcbpnhb ph {hoc he pfc gc~ `hksocbp{ ib` zcunc|{ hb kdnbnkid ceeckpnucbc{{pfip fiuc jccb qsjdn{fc` nb pfc qzcunhs{ ohbpf"

\fczc qh{{njdc dnbg{ ph pfc esdd pcvp `hksocbp{ izc nbkds`c`" Ne pfc izpnkdc n{ nb i mhszbid ~hskib khbpikp pfc Fcidpf Dnjziz~ ehz i khq~"Dnbg ph zcysc{p ehzo= fppq=((|||"gccdc"ik"sg(fcidpfdnjziz~(s{nblpfcfcidpfdnjziz~(nbpcz/dnjziz~dhib{(+`"cb":<0;< WQdci{c bhpc / i kfizlc he «: qcz zcysc{p n{ qi~ijdc ehz oh{p khqnc{_

Ne ~hs bcc` eszpfcz i{{n{pibkc qdci{c khbpikp pfc Fcidpf Dnjziz~ hz pfc BF[ HspzcikfDnjziznib{ `cpind{ jcdh|"

Pfc jsddcpnb kib jc c/oindc` ph khddcilsc{ |fh oi~ id{h enb` np s{cesd"

I dn{p he |cj{npc{ kfckgc` nb pfc qzh`skpnhb he pfn{ jsddcpnb n{ hb pfc enz{p qilc" Qdci{c {sllc{peszpfcz s{cesd {npc{"

Ecc`jikg n{ id|i~{ |cdkhoc` ph nbehzo espszc n{{sc{ he pfc jsddcpnb"

Khbpikp nbehzoipnhb

Jsddcpnb qzh`skc` j~ BF[ Hspzcikf Dnjziznib{ 

Pcd= EcipszcBcp 60:> &Cvpczbid kidd{ 1;11 9:; 93;3 cvp 60:>.C/oind= dnb`{i~"{bcddAbhzpf{piee{"bf{"sg

kdizcf"qh|cddAbhzpf{piee{"bf{"sg 

Bhzpf [piee{ Fcidpf Dnjziz~

Pcd= 19<6: 5<>311Eiv= 19<6: 5<>36:

C/oind= fcidpf"dnjziz~Agccdc"ik"sg 

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BF[ Dnjziz~ ib` Nbehzoipnhb [czunkc Bhzpf [pieehz`{fnzc 

:

[hszkc{ ehz Kdnbnkid Ceeckpnucbc{{ Jsddcpnb

Qdci{c {sllc{p eszpfcz {npc{ pfip {fhsd` jc ohbnphzc` nb pfc qzh`skpnhb he pfn{ jsddcpnb

\cj{npc{

Khkfzibc Dnjziz~ fppq=((|||"pfckhkfzibcdnjziz~"kho(  KZ@ Kcbpzc ehz Zcunc|{ ib` @n{{conbipnhb fppq=((|||"kz`"~hzg"ik"sg(kz`|cj( 

/ @IZC ‛ &@ipiji{c he Ij{pzikp{ he Zcunc|{ he Ceeckp{./ BF[ Ckhbhonk Cuidsipnhb @ipiji{c

Fcidpf Pckfbhdhl~ I{{c{{ocbp &FPI. @ipiji{c fppq=((|||"fpi"ik"sg @ind~ Fcidpf Jsddcpnb fppq=((|||"{fceencd`"bf{"sg(fcidpfjsddcpnb(  @cqizpocbp he Fcidpf fppq=((|||"`f"lhu"sg(cb(nb`cv"fpo Gnbl„{ Esb` fppq=((|||"gnbl{esb`"hzl"sg(  BcDO &Bipnhbid Cdckpzhbnk Dnjziz~ ehz Oc`nknbc{. bc|{ jsddcpnb fppq=((|||"bcdo"bf{"sg(cb(  BNKC fppq=((|||"bnkc"hzl"sg( [NLB fppq=((|||"{nlb"ik"sg(bc|"fpod 

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BF[ Dnjziz~ ib` Nbehzoipnhb [czunkc Bhzpf [pieehz`{fnzc 

;

Khbpcbp{ nb pfn{ n{{sc= 

Kibkcz """""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""" 0 Kizcz{ """"""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""" 3 Kfnd`zcb ib` ^hsbl Qchqdc """""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""" 3

Khoon{{nhbnbl """"""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""" 5K~{pnk Enjzh{n{ """""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""" 5@cocbpni """""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""" <@nijcpc{ """""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""" <Coczlcbk~ Kizc """"""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""" <Cqndcq{~ """""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""" 6Lcbczid Qzikpnkc """"""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""" 6Lsn`ibkc """""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""" >Fcidpf Zcehzo{ """"""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""" 99Fcidpf Un{nphz{ """"""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""" 9: FNU """""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""" 9: Nbeckpnhb{ ib` Nbeckpnhb Khbpzhd """""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""" 9: Nbedscb}i """"""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""" 9; Gn`bc~ @n{ci{c """"""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""" 9; Dhbl Pczo Khb`npnhb{""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""" 9; On`|necz~ """"""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""" 90 Ocbpid Fcidpf """""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""" 90 Bsz{nbl """"""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""" 93 Heecb`cz Fcidpf """""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""" 93 Hd`cz Qchqdc """"""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""" 93 Qiddnipnuc ib` Cb` he Dnec Kizc """""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""" 95 Qipncbp Kizc ib` [iecp~ """""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""" 95 Qfizoik~ ib` Qzc{kznjnbl """""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""" 9< Qsjdnk Fcidpf """"""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""" 96 Zc{cizkf """""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""" 9> [ieclsiz`nbl Jijnc{ ib` Usdbczijdc I`sdp{ """"""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""" 9> [czunkc Oibilcocbp """""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""" :1 [cvsid ib` Zcqzh`skpnuc Fcidpf """""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""" :9 [pzhgc """"""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""" :: [sj{pibkc On{s{c """""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""" :; Uikknbipnhb ib` Noosbn{ipnhb """""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""" :; Uhdsbpccznbl """""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""" :; \hocb„{ Fcidpf """"""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""" :; \hzgehzkc """"""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""" :0 

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BF[ Dnjziz~ ib` Nbehzoipnhb [czunkc Bhzpf [pieehz`{fnzc 

0

Kibkcz

I`msuibp Kfcohpfcziq~$ |npf hz |npfhsp Pivibc{$ nb Cizd~ hz Hqczijdc Jzci{p Kibkcz=I Ocpi/Ibid~{n{ he 9> Zib`hon}c` Pznid{ |npf ;15>6 Qipncbp{Ynb ^^ cp id"

Pfc ispfhz{ khbkds`c` pfip i`msuibp kfcohpfcziq~ |npf pivibc{ khsd` zc`skc pfc zn{g hekibkcz zckszzcbkc ib` `cipf nb qipncbp{ |npf cizd~ hz hqczijdc jzci{p kibkcz idpfhslf pfc`zsl/zcdipc` phvnknpnc{ {fhsd` jc jidibkc`" Pfc~ id{h `cohb{pzipc` pfip qipncbp{ |npf fnlfzn{g bh`c/bclipnuc jzci{p kibkcz id{h jcbcenpc` ezho pivibc{ pfcziq~" QDh[ HBC 5&99.= c:5>05" `hn=91"9;<9(mhszbid"qhbc"11:5>05 

@ncpiz~ enjzc$ |fhdc lzinb{$ ib` zn{g he khdhzckpid kibkcz= {~{pcoipnk zcunc| ib` `h{c/zc{qhb{c ocpi/ibid~{n{ he qzh{qckpnuc {ps`nc{Isbc @ cp id"Pfc ispfhz{ khbkds`c` pfip fnlf nbpigc he `ncpiz~ enjzc nb qizpnksdiz kczcid enjzc ib` |fhdclzinb{ |i{ i{{hknipc` |npf i zc`skc` zn{g he khdhzckpid kibkcz"

JOM :1997 ;0; `hn= 91"99;5(jom"`559< &Qsjdn{fc` 91 Bhucojcz :199.

Noqzhunbl hspkhoc{ ib` cvqczncbkc{ ehz hd`cz |hocb |npf jzci{p kibkczJzci{p Kibkcz KizcPfn{ jzncenbl n{ `nun`c` nbph pfzcc oinb izci{= cizd~ `nilbh{n{7 pzcipocbp ib` i{{c{{ocbp7 ib`nbehzoipnhb ib` {sqqhzp"fppq=((|||"jzci{pkibkczkizc"hzl"sg(kioqinlbnbl/uhdsbpccznbl(qhdnk~(jzci{p/kibkcz/nbcysidnpnc{(hd`cz/|hocb/jzci{p/kibkcz

Bipnhbid Is`np he Kibkcz @nilbh{n{ nb Qznoiz~ KizcZKLQ

Pfn{ n{ pfc dizlc{p {ps`~ ph `ipc he pfc qznoiz~ kizc qipf|i~ ph kibkcz `nilbh{n{" Np qzhun`c{`cpindc` nb{nlfp{ nbph kszzcbp kdnbnkid qzikpnkc pfip kib `nzckp nbnpnipnuc{ ph zc`skc pfc pnoc ph`nilbh{n{ ehz kibkcz i{ |cdd i{ zin{nbl noqhzpibp ysc{pnhb{ ehz espszc zc{cizkf"Zcqhzp= fppq=((|||"zklq"hzl"sg(q`e(BipnhbidXIs`npXheXKibkczX@nilbh{n{XnbXQznoiz~/Kizc"q`e Qzc{cbpipnhb {dn`c{= fppq=((|||"zklq"hzl"sg(`hk{(ZKLQ#:1qzc{cbpipnhb#:1Bhu#:1:199"qqp 

Bipnhbid Jh|cd Kibkcz Is`np Zcqhzp :199 

BF[ Nbehzoipnhb KcbpzcPfn{ is`np khbkds`c{ pfip ikfncucocbp dcucd{ khbpnbsc ph zn{c ilinb{p gc~ kizc oci{szc{7

{skf i{ pfc qczkcbpilc he qipncbp{ |fh {szunuc ehddh|nbl cdckpnuc ib` {kfc`sdc` {szlcz~"Fh|cucz np bhpc{ pfip szlcbp ib` coczlcbk~ {szlcz~ khbpnbsc{ ph kizz~ i oskf lzcipcz zn{g he`cipf khoqizc` ph cdckpnuc ib` {kfc`sdc` qzhkc`szc{"fppq=((|||"nk"bf{"sg(jh|cdzcqhzp{

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BF[ Dnjziz~ ib` Nbehzoipnhb [czunkc Bhzpf [pieehz`{fnzc 

3

Bipnhbid Kibkcz Qccz Zcunc| Qzhlziooc zcqhzp :191/:199@cqizpocbp he FcidpfPfn{ zcqhzp fnlfdnlfp{ pfc bsojcz he Pzs{p{ |fnkf izc ikfncunbl fnlf ysidnp~ kibkcz kizc ib`kfiddcblc{ ph cb{sznbl idd kibkcz qipncbp{ zckcnuc hqpnoid kizc"fppq=((|||"`f"lhu"sg(cb(Qsjdnkipnhb{ib`{pipn{pnk{(Qsjdnkipnhb{(Qsjdnkipnhb{Qhdnk~Ib`Lsn`ibkc(@FX9;90;;

Wjikg ph phqnk{_ 

Kizcz{

Bc| Iqqzhikfc{ ph [sqqhzpnbl Kizcz{„ Fcidpf ib` \cdd/jcnbl= Cun`cbkc ezho pfcBipnhbid Kizcz{„ [pzipcl~ @cohb{pziphz [npc{ qzhlzioocSbnucz{np~ he Dcc`{" Kcbpzc ehz Nbpczbipnhbid Zc{cizkf hb Kizc Dijhsz ib` Cysidnpnc{Pfn{ zcqhzp ino{ ph oiq ib` i{{c{{ pfc ceeckpnucbc{{ he {qcknenk nbnpnipnuc{7 cvionbc pfcnznoqikp hb kizcz fcidpf ib` |cdd/jcnbl7 hspdnbc pfc kh{p he nbnpnipnuc{ ib` i{{c{{ pfc dcucd ib`bipszc he kizcz cblilcocbp nb qdibbnbl `cdnucz~ ib` cuidsipnhb he pfc qzhlziooc"

fppq=((|||"{hknhdhl~"dcc`{"ik"sg(knzkdc(knzkdc/qzhmckp{(bipnhbid/kizcz{/{pzipcl~/`cohb{pziphz/{npc{"qfq 

Fh| kib pfc |cj {sqqhzp kizcz{8Qznbkc{{ Zh~id Pzs{p ehz Kizcz{Pfc zcqhzp khbpinb{ i `cpindc` cvqdhzipnhb he pfc i`uibpilc{ ib` kfiddcblc{ he qzhun`nblkizcz {sqqhzp hbdnbc i{ |cdd i{ pfc qzh{ ib` khb{ ehz pfc oinb p~qc{ he |cj {czunkc{ pfip izckszzcbpd~ jcnbl heeczc`"fppq=((|||"kizcz{"hzl(lcp/hbdnbc 

BF[ Bhp Oignbl pfc Jzcig ehz Kizcz{= i zcqhzp hb pfc noqdcocbpipnhb he pfc Kizcz{

[pzipcl~ j~ qznoiz~ kizc pzs{p{Kzh{{zhi`{ KizcPfn{ zcqhzp nbuc{pnlipc{ |fcpfcz QKP{ fiuc qsjdn{fc` qdib{ ib` js`lcp{ ib` |fcpfczi``npnhbid ohbc~ fi{ jccb s{c` ph nbkzci{c {czunkc{ ehz kizcz{ hz bhp i{ hspdnbc` nb pfclhuczbocbp„{ Bhucojcz :191 Kizcz{„ [pzipcl~"fppq=((|||"kizcz{"hzl"sg(X`h|bdhi`{(Xi{{hknipnhbbc|{(BF[XBhpXOignblXpfcXzcigXehzXKizcz{"q`e

Wjikg ph phqnk{_ 

Kfnd`zcb ib` ^hsbl Qchqdc

Oc ib` O~ [kfhhd= Enb`nbl{ ezho pfc Bipnhbid Cuidsipnhb he Pizlcpc` Ocbpid Fcidpf nb[kfhhd{ :116/:199@cqizpocbp ehz C`skipnhbPfn{ zcqhzp dhhg{ ip fh| `neeczcbp {kfhhd{ noqdcocbp Pizlcpc` Ocbpid Fcidpf nb [kfhhd{&PiOF[.$ ib` |fip noqikp PiOF[ ib` {sqqhzp oipcznid fiuc hb kfnd`zcb„{ ocbpid fcidpf ib`|cddjcnbl"fppq{=((|||"c`skipnhb"lhu"sg(qsjdnkipnhb{({pib`iz`(qsjdnkipnhb@cpind(Qilc9(@EC/ZZ9<<

Wjikg ph phqnk{_ 

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BF[ Dnjziz~ ib` Nbehzoipnhb [czunkc Bhzpf [pieehz`{fnzc 

5

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FNU

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Nbeckpnhb{ ib` Nbeckpnhb Khbpzhd

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Nbedscb}iPfc SG Nbedscb}i Qzcqizc`bc{{ [pzipcl~ :199@cqizpocbp he FcidpfPfn{ {pzipcl~ sq`ipc{ pfc kdnbnkid fcidpf ib` {kncbpnenk i`unkc ib` nbehzoipnhb khbpinbc` nb,Qib`conk eds= i bipnhbid ezioc|hzg ehz zc{qhb`nbl ph ib nbedscb}i qib`conk :11<, ib`zcqdikc{ pfip `hksocbp"fppq=((|||"`f"lhu"sg(cb(Qsjdnkipnhb{ib`{pipn{pnk{(Qsjdnkipnhb{(Qsjdnkipnhb{Qhdnk~Ib`Lsn`ibkc(@FX9;1>1;

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Gn`bc~ @n{ci{c

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[pipc he Oipczbnp~ [czunkc{ zcqhzp :199ZKOPfn{ zcqhzp hspdnbc{ nbkzci{nbl qzc{{szc{ hb oipczbnp~ {czunkc{ ib` oigc{ zckhoocb`ipnhb{ehz oignbl pfc jc{p s{c he {kizkc zc{hszkc{ ib` occp espszc bcc`{"fppq=((|||"zko"hzl"sg(khddclc(qhdnk~/qzikpnkc(lhuczbocbp/qhdnk~({pipc/he/oipczbnp~/{czunkc{( 

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Heecb`cz Fcidpf

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Npco{ nb pfc Kibkcz ib` Qsjdnk Fcidpf {ckpnhb oi~ jc he nbpczc{p"

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BF[ Dnjziz~ ib` Nbehzoipnhb [czunkc Bhzpf [pieehz`{fnzc 

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