Subcutaneous immunoglobulin (SCIG) is a new therapeutic procedure for patients with primary immunodeficiency (PI). This research is a systematic review of studies on the efficacy and safety of intravenous immunoglobulin (IVIG) and SCIG in adult patients with PI. This study includes a systematic review of cohorts and randomized clinical trials (24 articles) from 5 databases with no time limits. Random effects meta-analysis was performed for outcomes such as efficacy and safety. Standard mean difference (SMD) of serum immunoglobulin level was equal to 0.336 (P <0.01; 0.205-0.467) and the odds ratio (OR) of side effects was 0.497 (P=0.1; 0.180-1.371). The results indicate that SCIG leads to a higher level of immunoglobulin and a reduction in side effects but shows the same infection rate as IVIG. Our analysis shows that shifting from IVIG to SCIG therapy can have clinical benefits for PI patients.
Background: Assessing individual and organisational capacity for evidence use is essential for developing evidence-based strategies.<br />Aims and objectives: This study aimed to assess the psychometric and practical properties of existing tools to assess the capacity to use evidence at the individual and organisational levels of health policy and identify the best instruments.<br />Methods: A systematic review of the databases of ISI Web of Science, Embase, Scopus, and PubMed was conducted up to 6 June 2018. Search engines, websites of key organisations, and the reference lists of selected articles were also used to find relevant studies. The search strategy for each database was written individually. Psychometric properties were assessed using the Standards for Educational and Psychological Testing (SEPT) and pragmatic properties were assessed using the protocol proposed by Lewis et al (2018). Simple statistics were used to describe the psychometric and pragmatic properties of the identified instruments.<br />Results: Overall, 16 instruments were identified. SEER had the highest validity score. Reliability was estimated for 38% of the instruments. Responsiveness was assessed in only 19% of the studies. The results showed that internal consistency was reported for 40% of the articles using statistical analysis. Pragmatic properties of the studied instruments were verified; 75% usefulness, 56% actionability, 50% sensitive to change and 56% user-friendly, 19% compatible, 38% feasibility.<br />Discussion and conclusions: There are few instruments with strong psychometric evidence, and without high-quality instruments, it would be difficult to determine the factors that affect implementation. Therefore, special attention is needed for the systematic development of instruments and their reporting standards.<br /><br />Key messages:<br /><ol><li>Sixteen instruments were identified for assessing the capacity to use evidence in health sectorpolicy making.</li><br /><li>SEER and Rodríguez’s instruments were identified as a good basis for assessing the capacityto use evidence.</li><br /><li>Without high-quality instruments from both psychometric and pragmatic levels, it would bedifficult to determine the factors that affect implementation.</li></ol><br />
Allopurinol and febuxostat are urate-lowering drugs used for the long-term treatment of gout through reducing the uric acid levels. More studies have indicated cost-effectiveness of febuxostat in reducing serum urate concentration and showed that it alleviates gout flares better than allopurinol. However, related studies have reported conflicting results about the cost-effectiveness of these drugs.
→What this article adds:Febuxostat is more cost-effective than allopurinol in all treatment sequences in studies which have used uric acid level as the measure of effectiveness. In addition, febuxostat has been shown to be more costeffective as the second-line treatment in studies with the quality of life as the measure of effectiveness.
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