Featured Articles
PT025 - DACC (dialkylcarbamoyl chloride) coated dressings
The Evidence Based Procurement Board’s (EBPB) Evidence Research Group (ERG) conducted a review of evidence for dialkylcarbamoyl chloride (DACC) coated wound dressings.
Due to the mixed results reported in the review and the few well designed studies published to date, the EBPB agreed that the evidence is currently inadequate to make a positive recommendation for the use of DACC coated wound dressings.
The board would reconsider its recommendations if better quality evidence became available. This would include studies with:
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A comparator dressing included in the study design (for example a standard, uncoated dressing).
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Longer duration and useful endpoints (for example, time taken until healing).
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Larger patient groups.
- Randomisation of patients with blinding where possible.
The ERG has issued an Evidence Review (available as a PDF download) and the EBPB have issued an Advice Statement (available as a PDF download).
If substantial new evidence becomes available, the EBPB will ask the ERG to consider the new evidence.
NOTE: The Medical Technologies Guidance by NICE on Leukomed Sorbact (MTG55, published February 2021) does not alter the conclusions drawn from the Evidence Review.
Downloads
- EBPB Advice Statement - "DACC coated dressings", Jan 2023 [PDF].
- EBPB Evidence Review - "DACC coated dressings ", Sep 2022 [PDF].
- Details
DACC (dialkylcarbamoyl chloride) coated dressings - new advice from EBPB (Jan 2023)
The EBPB have issued advice and an evidence review for the use of DACC (dialkylcarbamoyl chloride) coated dressings.
Due to the mixed results reported in the review and the few well designed studies published to date, the EBPB agreed that the evidence is currently inadequate to make a positive recommendation for the use of DACC coated wound dressings.
The full statement and evidence review are available on the EBPB pages.
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PT031 - Atraumatic diagnostic lumbar puncture
The EBPB were asked to look at the evidence for the use of atraumatic needles in diagnostic lumbar puncture (DLP).
The EBPB noted a clear clinical benefit to using atraumatic needles for DLP, through a reduction of post-dural puncture headache (PDPH). Economic analysis suggests that
despite the increased cost of atraumatic needles, cost savings could be achieved through PDPH reduction. The EBPB agreed that even without the potential for cost savings,
patients would still benefit from this change in needle design.
The EBPB therefore make the following recommendations:
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Welsh Health Boards and Trusts should switch to using atraumatic needles (e.g. pencil-point) instead of conventional needles (e.g. Quincke) to carry out DLP.
The EBPB Evidence Review Group (ERG) 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 - "Atraumatic Diagnostic Lumbar Puncture", Dec 2020 [PDF].
- EBPB Evidence Review - "Atraumatic Diagnostic Lumbar Puncture", Feb 2020 [PDF].
- Details
PT028 - Farco-fill Protect - Aug 2019
The EBPB were asked to look at the evidence for the use of Farco-fill Protect, a sterile solution containing 0.3% triclosan that is used for the inflation of indwelling urinary catheters in an effort to reduce bacterial colonisation of the catheter
Following consideration of the published evidence, the EBPB consider that there is currently insufficient evidence to support its use in the Welsh NHS.
The EBPB therefore make the following recommendations:
- Welsh Health Boards and Trusts should refrain from using Farco-fill Protect until better quality evidence is available on the clinical efficacy, preferably through randomised controlled trials or sufficiently powered comparative studies with appropriate length of follow-up.
- The EBPB notes concerns from NHS personnel about the lack of data on the safety of triclosan, and whilst not addressed specifically in the Evidence Review, EBPB recommend that manufacturers address the safety concerns about the use of medical devices before they are considered for further use in the Welsh NHS.
The EBPB Evidence Review Group (ERG) 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 - "Farco-fill protect", June 2019 [PDF].
- EBPB Evidence Review - "PT028 - Farco-fill Protect", March 2019 [PDF].
- Details
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:
- LIPUS should not be used to promote the healing of fresh fractures at low risk of non-healing.
- 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).
- 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")
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