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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.

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Useful Resources

 

** 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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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.

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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.

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PT003 - Capsule Endoscopy - Aug 2018

At the July 2018 meeting, the EBPB noted the outcome of screening the Capsule Endoscopy Topic undertaken by SMTL in October 2017, following advice from two expert clinicians from NHS Wales that the technology is being used in three Welsh centres as a last resort intervention with appropriate pre-screening and referral of patients. 
 
The EBPB therefore agreed that no further work was necessary on this specific Topic.
 

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

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PT005 - Offloading Devices - Aug 2018

At the July 2018 meeting, the EBPB noted the Scoping Report produced by SMTL in Nov 2017, and advice from an expert group of Welsh NHS clinicians (Tissue Viability Nurses and Podiatrists) which advised that NHS Wales is already following the advice and guidance from the National Plantar Ulceration Off Loading Pathway (All Wales guidance produced by the National orthotic and Podiatry services in 2016).
 
This advice states that total contact casts or non-removable cast walkers are the appropriate treatment for offloading of diabetic foot ulcers in most clinical cases and should be the first offloading treatment considered.
 
The group therefore advised that no further work was necessary on this specific usage.

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

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Note that Scoping Reports are no longer produced by EBPB.

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  1. PT022 - Laryngoscope Blades - Aug 2018
  2. Hip Prostheses - Recommendation April 2017
  3. Single-use and multiple-use of Medical Devices
  4. Endoscope contamination and rinse water TVCs
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