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(Source: NIH - National Cancer Institute)

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Evidence reviews

Endovascular Therapy for Acute Ischemic Stroke [Internet]

This STE report examines the social and system demographics, technological safety and therapeutic efficacy / effectiveness, cost-effectiveness, and budget impact of endovascular therapy for acute ischemic stroke, contextualized to the Alberta setting.

Insulin Pump Therapy for Type 1 Diabetes [Internet]

This report examines the research evidence on the safety and efficacy of insulin pump therapy, as compared to multiple daily insulin injections, in the treatment of children, adults, and pregnant women diagnosed with type 1 diabetes. The report also analyses the economic impact of introducing the insulin pump therapy in Alberta.

Dialectical Behavioral Therapy (DBT) in Borderline Personality Disorder [Internet]

Conclusions There is limited scientific evidence showing that DBT reduces self-injurious behavior and that the effect remains at 2-year follow-up (limited scientific evidence). Treatment also appears to reduce the need for hospitalization and reduce drug use among people with addictions. Hence, DBT appears to be a promising form of treatment for patients with borderline personality disorder. However, it needs to be tested under Swedish conditions, and it is essential to conduct studies addressing the cost effectiveness of the method.

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Summaries for consumers

Surgery versus non‐surgical interventions (voice therapy, medical treatment) for the resolution of vocal cord nodules

Vocal cord nodules are benign, callous‐like growths on the vocal cords. Symptoms include hoarseness, throat discomfort, pain and an unstable voice when speaking or singing. They can be caused by 'voice abuse' (prolonged shouting or singing above the individual's own range) but may also be caused by infection, allergy or acid reflux.

Recompression therapy and adjunctive drug therapy for decompression illness (the bends)

Decompression illness (DCI) is due to the presence of bubbles in the tissues or blood vessels following the reduction of surrounding pressure (decompression). It is most commonly associated with breathing compressed gas while diving underwater. The effects of DCI may vary from the trivial to life‐threatening and treatment is usually administered urgently. Recompression is applied while breathing 100% oxygen or a mixture of oxygen and helium (heliox), based on the reduction in bubble size with pressure and more rapid elimination of nitrogen from the bubbles when breathing nitrogen poor mixtures. Recovery without recompression can be slow and incomplete and DCI is responsible for significant health problems in geographical areas where recompression is unavailable. Recompression with 100% oxygen has become universally accepted as the appropriate therapy despite the lack of high quality clinical evidence of effectiveness. This review found only two randomized trials enrolling a total of 268 patients. One trial compared standard oxygen recompression to helium and oxygen recompression, while the other compared oxygen recompression alone to recompression and an adjunctive non‐steroidal anti‐inflammatory drug (NSAID). Both trials suggested that these additional interventions may shorten the course of recompression required. For example, the use of an NSAID reduced the median number of recompression sessions required from three to two. We conclude that there is little evidence for using one recompression strategy over another in the treatment of decompression illness and that the addition of an anti‐inflammatory drug may shorten the course of recompression required. More research is needed.

Normal pressure oxygen therapy and hyperbaric oxygen therapy for migraine and cluster headaches

Migraine and cluster headaches are severe and disabling. Hyperbaric oxygen therapy (HBOT, that is the breathing of pure oxygen at pressures greater than one atmosphere in a pressurised chamber) and normal pressure oxygen therapy (NBOT) can be delivered via a mask at home or in a clinic. These treatments may help to end acute attacks and prevent future attacks.

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