PT001 - The use of low-intensity pulsed ultrasound (LIPUS) therapy in fracture healing - November 2018

The EBPB were asked to look at the evidence for the use of low-intensity pulsed ultrasound (LIPUS) therapy in fracture healing.

During the period when the review took place, the National Institute for Health and Care Excellence (NICE) announced that they were reviewing their guidance, and in July 2018 issued interventional procedures guidance (IPG) on LIPUS. The EBPB Evidence Review was then updated to reflect this IPG.

Following consideration of recent published evidence and IPG issued by NICE, the EBPB advise that:

1. LIPUS should not be used to promote the healing of fresh fractures at low risk of non-healing.
2. LIPUS should not be used to promote the healing of fresh fractures at high risk of non-healing unless it is done so within the context of research, preferably through randomised controlled trials (see Appendix A of the Advice Statement).
3. LIPUS should not be used to promote the healing of delayed-union and non-union fractures unless it is done so with special arrangements for clinical governance, consent and audit or research (see Appendix B of the Advice Statement).

The EBPB also draw attention to a BMJ clinical practice guideline, which recommends against the use of LIPUS for bone fracture healing, and which stated that "Further research is unlikely to alter the evidence".

The EBPB Evidence Review Group have issued an Evidence Review (available as a PDF download)  and the EBPB have issued an Advice Statement (available as a PDF download).

If you become aware of a substantial change in the evidence base or circumstances related to this published advice, This email address is being protected from spambots. You need JavaScript enabled to view it. who will then consider whether a further review is necessary.

Downloads

• EBPB Advice Statement - "Low-intensity pulsed ultrasound (LIPUS) to promote fracture healing", December 2018 [PDF](**).
• EBPB Evidence Review - "PT001 - The use of low-intensity pulsed ultrasound (LIPUS) therapy in fracture healing", November 2018 [PDF].

Useful Resources

• Low-intensity pulsed ultrasound to promote healing of fresh fractures at low risk of non-healing (NICE interventional procedures guidance 621, 2018)
• Low-intensity pulsed ultrasound to promote healing of fresh fractures at high risk of non-healing (NICE interventional procedures guidance 622, 2018)
• Low-intensity pulsed ultrasound to promote healing of delayed-union and non-union fractures (NICE interventional procedures guidance 623, 2018)
• Low intensity pulsed ultrasound (LIPUS) for bone healing: a clinical practice guideline (BMJ Clinical Practice Guideline, BMJ 2017)

** The December 2018 Advice Statement replaces the November 2018 Advice Statement which had a typographical error in Appendix B (which referred to "fresh fractures" in the first sentence rather than "delayed-union and non-union fractures")

Details

Published: 12 November 2018

PT011 - Antimicrobial Wound dressings - October 2018

The EBPB were asked to look at the evidence for the use of Antimicrobial Wound dressings (AWDs).

Following advice from the EBPB expert group on AWDs, which relied substantially on the SHTG Health Technology Assessment from Scotland, the EBPB advise that:

1. Antimicrobial dressings should not routinely be used on non-infected acute and chronic wounds;
2. Antimicrobial dressings should be considered only when there are clinical signs or symptoms of localised infection, or where localised infection is suspected as a cause of non-healing. They should not be used to treat MDRO (multi drug resistant organism) colonised wounds which do not fall into this category;
3. Antimicrobial dressings should only be recommended/prescribed by specialist staff (for example tissue viability nurses or specialist podiatrists) as designated by the Health Board or Trust. Their use requires regular review of the requirement for AWDs by the clinician;
4. To ensure appropriate control and use of antimicrobial dressings, the EBPB AWD Recommendations and Algorithm (page 3 and onwards of the full Advice and Recommendation document) should be adopted by Welsh NHS organisations.

The expert group have issued clinical advice and recommendations in support of the Advice Statement.  The Advice Statement and the Recommendations and Algorithm are all available in a single PDF download.

If you become aware of substantial change in the evidence base or circumstances related to this published advice, This email address is being protected from spambots. You need JavaScript enabled to view it. who will then consider whether a further review is necessary.

Downloads

• Advice and Recommendations on Antimicrobial Wound Dressings – Oct 2018 [PDF]

Details

Published: 24 October 2018

PT027 - SepsisBox - October 2018

The EBPB were asked to look at evidence for the SepsisBox, produced by Rocialle. The EBPB Evidence Review Group (ERG) performed a review of the evidence but found no published evidence for the SepsisBox. Rocialle have subsequently ceased its production and it is no longer available.  The review is available as a PDF.

As there was no evidence and subsequently no actual product on the market for the EBPB to make recommendations on, no further actions were possible. However, the importance of implementing the Sepsis 6 care bundle was noted.

If you become aware of substantial change in the evidence base or circumstances related to this published advice, This email address is being protected from spambots. You need JavaScript enabled to view it. who will then consider whether a further review is necessary.

Downloads

• Evidence Review for the EBPB - SepsisBox for Sepsis 6 care bundle implementation

Details

Published: 18 October 2018

PT003 - Capsule Endoscopy - Aug 2018

Downloads

• The October 2017 screening form is available as a PDF.

Details

Published: 22 August 2018