The death of a young child with autism following the improper use of a weighted blanket during school time launched an investigation by the coroner who reported the potential dangers of these blankets and the basic rules that should be applied for their safe use. The Ministère de la Santé et des Services sociaux (MSSS) therefore asked AETMIS to synthesize the evidence on the use of weighted blankets for all potential clients, namely, those with pervasive developmental disorders, mental health disorders, or physical or intellectual disabilities, and frail elderly people. This report also examines the safety and efficacy of weighted vests, given that they appear to be widely used in Québec, especially with children.

Informative note prepared by Jean-Marie Lance. In French only.

Obstructive sleep apnea (OSA) is characterized by recurrent episodes of partial or complete obstruction of the upper airway during sleep, often associated with a reduction in blood oxygen saturation or with micro-arousals. To date, Québec’s Ministère de la Santé et des Services sociaux (MSSS) does not have any management program for these patients, who are growing in number. Applications for assistance from regional domestic help services (services régionaux de soins à domicile – SRSAD) are becoming increasingly frequent. These regional services are responsible for implementing Québec’s home oxygen therapy program (Programme d’oxygénothérapie à domicile – POD).

Obesity is considered a major public health problem by the World Health Organization (WHO) because of its steady and rapid rise in prevalence in many countries, including Canada. According to data, the prevalence of obesity in Québec was approximately 21.4% in 2004. Studies have shown that obesity and overweight are relatively important risk factors for developing chronic diseases, with serious health effects over the medium- to long-term.

The protein-sparing modified fast (PSMF) diet is part of the therapeutic arsenal available in Québec to anyone having an excess of body weight and seeking intentional weight loss, through commercial manufacturers and in medical clinics.

Chronic fatigue syndrome (CFS) is characterized by debilitating fatigue not resulting from exertion, lasting longer than six months and associated with physical and neuropsychological symptoms common to other diseases such as cognitive deficits, impaired sleep, anthralgia, myalgia, headache, gastrointestinal symptoms, and tender lymph nodes.

The 2009-2010 Annual report is now available (in French only).

Informative note prepared by Carole St-Hilaire with the collaboration of Geneviève Martin. In French only.

AETMIS has assessed the suitability and feasibility of a screening program for abdominal aortic aneurysms by ultrasound in Québec by applying the matrix of recognized criteria for screening programs and studied the findings of the scientific literature as well as the organizational, economic, legal and ethical issues associated with implementation of such a program.

Informative note prepared by François Pierre Dussault. In French only.

In Québec, about 6000 women will be diagnosed in 2009 with breast cancer, which is the most frequent cancer site amongst women. Currently, with population screening mammography and improved imaging techniques, breast cancer is diagnosed at earlier stages and with a lower risk of lymph node invasion, the most significant prognostic factor in early-stage breast cancer. Therefore, patients are more often eligible to less invasive surgeries. Among those surgical techniques, there is sentinel lymph node biopsy or sentinel node biopsy. In some breast cancer cases, it can replace axillary dissection, a traditionally used technique that involves the removing of 15 or so lymph nodes from the axilla for anatomical pathology examination. This technique is associated with non-negligible postoperative morbidity, however. Using sentinel node biopsy would in consequence compromise less the quality of life of those affected by breast cancer.

This report was produced at the request of the Direction de la lutte contre le cancer on the recommendation of the Comité de l’évolution des pratiques en oncologie (CEPO). It is a systematic review on the relative efficacy of neoadjuvant chemotherapy, neoadjuvant chemoradiotherapy and chemoradiotherapy without surgery for the curative treatment of cancer of the esophagus and gastro-esophageal junction.

It is well established that mammographic screening helps reduce mortality from breast cancer in women aged 50 to 69 years. Since 1998 Québec’s breast-cancer screening program, the Programme québécois de dépistage du cancer du sein (PQDCS), has offered screening to all women in this age group through a screening test every two years. Recent evidence indicates that annual screening for women aged 40 to 49 years may be effective in reducing mortality from breast cancer, although less so than for women aged 50 to 69 years. In that context, AETMIS was asked to examine the possibility of offering women the opportunity to take part in a systematic mammographic screening program starting at the age of 40.

In Québec, pasteurization is the reference method for high-level thermal disinfection of anesthesia and respiratory devices. Thermal disinfection by water spray in a washer-disinfector is a method that is hardly used, however, and its effectiveness is often questioned.

Esophageal cancer is rare and its prognosis remains poor. Staging esophageal cancer is a key step to determine the feasibility of curative treatment and, if so, to establish an optimal therapy plan.

2009-14-05

Radiation therapy is a therapeutic modality that uses ionizing radiation to treat cancer or improve its symptoms. With surgery and chemotherapy, it is part of the standard therapeutic approach for treating cancer. It is delivered through sophisticated technological infrastructures and by specialized human resources working together in multi-disciplinary teams.

This comparative analysis examined the effectiveness and safety of bedpan washers for reusable bedpans with that of macerators for disposable bedpans, as well as organizational, economic and environmental issues.

Home telemonitoring is a telemedicine application in which physiological and biological data are transmitted over a distance for follow-up, interpretation and clinical decision-making purposes. In Québec it is a relatively recent and steadily growing intervention modality, but the outcomes are optimistic. It is a means of making health care and services accessible to vulnerable patients where there is a shortage of resources.

Informative note prepared by Raymonde M.-H. Mayot. In French only.

Report prepared by Geneviève Martin et Lorraine Caron with the collaboration of Alexandra Obadia

The various types of single-use medical devices (SUDs) that have emerged on the market over the last few decades help prevent disease transmission to other patients and device malfunction through wear and tear. However, for economic reasons, some health-care institutions have decided to reuse these devices, some of which are quite expensive.

Report prepared by Jolianne Renaud et Pierre Dagenais

The Québec Newborn Urine Screening Program (Programme québécois de dépistage néonatal urinaire : PQDNU), which operates at the Centre hospitalier de l’Université de Sherbrooke (CHUS), presently screens for more than 25 inborn errors of metabolism.

Monograph prepared by Eric Latimer. In French only.

Technical note prepared by Khalil Moqadem and Gilles Pineau

Telepathology is a specialized field of telemedicine. It is the practice of anatomical pathology at a distance between two or more distant facilities using a microscope (or a slide scanner), a telecommunications medium, and a workstation for the consulting pathologist. The aim of telepathology is to provide pathology services at a distance when there is no on-site pathologist.

Report prepared by Nieves Rodriguez and Brigitte Côté

Of the many eye complications caused by diabetes, diabetic retinopathy is the most severe. Almost all people with diabetes are affected by it at some point in their lives. Diabetic retinopathy (DR), which is the main cause of blindness in the working population in industrialized countries, is often totally asymptomatic until the onset of complications. Vision loss, which may be gradual or sudden, generally appears only in the fi nal stage of the disease.

Informative note prepared by Cathy Gosselin. In French only.

Report prepared by Guylaine Rouleau, Khalil Moqadem and Gilles Pineau.

During the first half of the 20th century, hyperbaric oxygen (HBO) therapy was used to treat decompression sickness. Other indications have been added over the years, with the result that the Hyperbaric Oxygen Therapy Committee of the Undersea and Hyperbaric Medical Society (UHMS) now recommends HBO therapy for the prevention or treatment of 13 conditions.

The 2007-2008 Annual report is now available (in French only).

Report prepared by Sylvie Beauchamp, Alicia Framarin and Jean-Marie R. Lance

Class 3b and Class 4 lasers and intense pulsed light (IPL) can be used for various cosmetic purposes and applications such as skin resurfacing and hair, acne or cellulitis removal. The use of these powerful technologies, that clearly came under activities reserved to physicians in the past, is now falling into the personal care sector. However, the frontier between their use for aesthetic purposes and medical care is not yet defined. In Québec, the cosmetic use of lasers and IPL by non-physician operators without medical supervision is widespread, although no data are available either on the particular types of technologies used or on the cosmetic procedures provided.

The minister of Health and Social services has mandated the Agence d’évaluation des technologies et des modes d’intervention en santé (AETMIS) to prepare a report regarding this issue, addressing more specifically the risks inherent in these technologies and on the
qualifications required to use them.

May, 15  2008 - Report prepared by Cathy Gosselin and Pierre Dagenais

This report is a systematic review of the diagnostic performance of techniques used for HER-2 testing in breast cancer. The conclusions and recommendations may serve as a basis for the CEPO to develop clinical practice guidelines for testing and for the Direction de la lutte contre le cancer to organize services provided by pathology laboratories.

2008-02-27 - In Quebec, it is estimated that 4800 patients are hospitalized each year for acute myocardial infarction with ST-segment elevation (STEMI). The immediate cause of this serious condition is the occlusion of a coronary artery by a thrombus that must be urgently cleared to minimize irreversible damage to the cardiac muscle. There are two treatments that can be used to reopen the occluded artery, fi brinolysis and primary percutaneous coronary intervention (PPCI). Both treatments are recommended in clinical practice guidelines of different countries. According to these guidelines and available evidence, it cannot be affi rmed that one of these methods of reperfusion is superior to the other for all patients in all clinical situations, at all times of the day. In this context, the best treatment for a particular patient will be that which is clinically appropriate and administered in a timely fashion, that is, within recommended delays. Such management is dependant on optimal organization and delivery of care and services.

Report prepared for AETMIS by Carole St-Hilaire.

Point-of-care testing (POCT) refers to analytical tests performed by qualified health professionals outside recognized and accredited public or private laboratories and outside health and social services institutions (as defined by law). This area of activity is not
currently regulated.  Faced with the growing reliance on POCT and the need to ensure that these tests are of high quality, safe and technically effective, the Ministère de la Santé et des Services sociaux (MSSS) decided to review the legislation and regulations applicable to POCT and to assess the need for governance oversight in this area. In that context, the MSSS asked AETMIS to support this review process by performing an exhaustive
literature review that would help provide an appropriate defi nition for POCT, draw up a list of Canada approved kits and instruments, flag the major issues associated with POCT, and identify the quality-control and quality-assurance measures proposed in Canada and around the world.

Report prepared for AETMIS by Khalil Moqadem and Gilles Pineau. 

Since the first hyperbaric chambers were built more than two centuries ago, the therapeutic use of hyperbaric oxygen (HBO) therapy has gradually expanded to several diseases and conditions. 

Report prepared for AETMIS by Brigitte Côté et Nieves Rodriguez.

In recent years, the emergence of new diagnostic techniques for detecting this disease has again raised the issue of the advisability of implementing a population screening program. In this context, the Agency considered it appropriate to produce an update on this issue.

Information Brief prepared for AETMIS by Laurie Lambert, Peter Bogaty, James Brophy and Lucy J. Boothroyd.

Percutaneous coronary intervention (PCI) is a technique for opening up or dilating coronary arteries narrowed or occluded by atherothrombotic lesions. It is generally performed in catheterization laboratories in facilities that have on-site cardiac surgery to deal with certain serious, albeit rare, complications that can occur. However, over the past several years, there have been pressures worldwide to perform PCI at facilities without on-site cardiac surgical support. Québec already has five such centres (more than in the rest of Canada combined), but the Ministère de la Santé et des Services sociaux continues to receive requests for opening new catheterization laboratories in hospitals without on-site cardiac surgery. Despite the advantages of this practice in terms of patient access, its advisability and safety are still debated.

Report prepared for AETMIS by Lorraine Caron, with the collaboration of Mirella De Civita, Susan Law and Isabelle Brault.

This comparative overview of cancer control strategies (and programs) in selected countries and Canadian provinces is aimed at a better knowledge of the choices made by different public administrations regarding priorities, governance models, service organization and quality, and the factors of success for implementing change.

The PDF version of the Annual management report 2006-2007 (in French only under the title Rapport annuel de gestion 2006-2007) is now available.

Report prepared for AETMIS by Cathy Gosselin.

In September 2005, at a forum on colon and rectal cancer organized by the Direction de la lutte contre le cancer, specialists observed that Québec lags behind the rest of Canada with regard to colon and rectal cancer mortality. Several strategies for improving patient management were discussed. One of the many solutions proposed was to improve access to medical imaging for better rectal cancer staging and better candidate selection for preoperative treatments in particular. During the course of the forum the specialist had, in fact, also discussed problems with access to endorectal ultrasonography and magnetic resonance imaging in Québec.

Report prepared for AETMIS by Pierre Dagenais and Alicia Framarin.

Osteoarthritis of the knee is a degenerative disease that frequently results in the need for total knee replacement. This disease has been absorbing an ever-growing share of the human and financial resources of Québec's health-care system.

Considered by some to  be an alternative to surgery, viscosupplementation involves draining the affected knee then injecting it with hyaluronic acid. The clinical effectiveness of this procedure, which is intended to relieve pain and improve joint mobility, remains controversial.

Initial report prepared for AETMIS by Michèle Monette with the subsequent contribution of Imen Khelia.

The ministry wanted to know under what circumstances it would be preferable to allocate three- and four-wheel scooters rather than electric-powered wheelchairs (EPWs) and whether transferring its program to the Régie de l'assurance maladie du Québec would make for easier management of all mobility devices. The findings show that a scooter is of greater benefit than a motorized wheelchair when it meets the user's mobility needs and the user has the ability to operate it. Scooters actually seem to support social integration, mainly because they have a less stigmatizing appearance. Moreover, since their average cost is half that of EPWs, their allocation could represent savings. However, scooters do not necessarily represent an alternative to powered wheelchairs.

Report prepared for AETMIS by Gilles Pineau and Khalil Moqadem.

According to AETMIS, it is necessary to dispel the scientific uncertainty surrounding the efficacy of hyperbaric oxygen therapy in the management of cerebral palsy.

Report prepared for AETMIS by Imen Khelia, Myrlande Martin and Stéphanie Adam, with the collaboration of François Pierre Dussault.

Information brief prepared by Jean-Marie R. Lance, Raouf Hassen-Kodja and Alicia Framarin.

This briefing note begins by examining the nature of autologous blood donation (ABD) programs and the risks associated with allogeneic transfusions, which this specific blood-transfusion method is designed to reduce. Then, based on the state of current scientific evidence, the study describes the clinical value of ABD programs by identifying their advantages and drawbacks. Examination of different clinical guidelines developed in various countries provides specific details regarding the main surgical indications for autologous blood donation. This briefing note also summarizes the different studies that have addressed the cost issue and, more rarely, the cost-effectiveness of this transfusion method.

Report prepared for AETMIS by Héla Makni, Carole St-Hilaire, Laura Robb, Kathy Larouche and Ingeborg Blancquaert.

This report was prepared at the request of the Ministry of Health, in the context of scientific debates and pressure in favour of adopting tandem mass spectrometry (MS/MS) for neonatal blood screening of inborn errors of metabolism.

Report prepared for AETMIS by Valérie Martin.

Should night vision aids (NVA) be included in the Visual Devices Program administered by Québec’s public health insurance plan? According to the assessment carried by AETMIS, night vision devices, such as wide-angle mobility lights (WAML) and night vision aids (NVA), can, despite certain limitations, effectively help certain individuals with night blindness.

Report prepared for AETMIS by Guylaine Rouleau and Lonny James Erickson.

The purpose of this assessment was to consider the medical context for the use of this product and to analyze published scientific studies on its effectiveness with respect to pain relief, reduction of infection, and healing.

Full report in French as well as summaries in French and in English are now available.

Technical note prepared for AETMIS by Wilber Deck.

This technical note assesses the scientific evidence on the diagnostic performance of the VAB in relation to that of conventional core needle biopsy (CNB). It also examines the economic aspects and the quality-assurance measures required to guarantee that core needle biopsies yield maximum benefits while avoiding errors and complications.

Summary (English and French) and full report in French are now available.

Report prepared for AETMIS by François Bergeron.

Bone-anchored hearing aids (BAHA) operate on the principle of bone-conducted auditory stimulation. BAHA involves surgically implanting a titanium fixture into the mastoid portion of the bone. An external vibration transducer is attached to the fixture through a percutaneous titanium abutment. This vibration transducer is designed to directly stimulate the cochlea embedded temporal bone. According to the AETMIS assessment, which is, however, based on limited evidence, bone-hearing aids yield audiometric benefits, chiefly including a subjective post-implantation quality of-life improvement. These benefits emerge especially for users of bone-conduction hearing but also for those who wear conventional hearing aids and who suffer from chronic middle- infections.

Summary (English and French) and full report in French are now available.

Report prepared for AETMIS Julie Tranchemontagne, Lucy Boothroyd and Ingeborg Blancquaert.

The document summarizes a monograph which is the result of the analysis undertaken at AETMIS on
1) prevalence and penetrance of BRCA1/2 mutations;
2) risk assessment models and testing indications;
3) clinical validity of molecular tests; and
4) the impact of molecular testing on risk assessment and genetic counselling.

Summary Report (English and French) and Monograph now available.

Report prepared for AETMIS by Gilles Pineau, Khalil Moqadem, Carole St-Hilaire, Robert Perreault, Éric Levac, Bruno Hamel with the collaboration of A. Obadia and L. Caron

 English Summary, French Report and French Summary now available.

Report prepared for AETMIS by Lonny Erickson.
English Report, English Summary, French Report and French Summary now available. 

Report prepared for AETMIS by Raouf Hassen-Kodja and Jean-Marie R. Lance.

Here are the links to the PDF version of the Summary and the French report.

Report prepared for AETMIS by Wilber Deck with the collaboration of Ritzuko Kakuma

For more information, here are the links to the PDF version of the French summary and the French report.

Report prepared for AETMIS by Reiner Banken.

English report and summary as well as French summary and French report are now available.

Report prepared for AETMIS by Reiner Banken, Brigitte Côté, François de Champlain and André Lavoie

For more information, here are the links to the PDF version of the English Summary. The French report and French summary are also available.