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Endoscopic retrograde cholangiopancreatography (ERCP) is essential in the diagnosis and treatment of pancreaticobiliary pathologies. 1 The procedure time ranges from 30 to 60 minutes, and it is commonly performed in endoscopy suites away from the operating room. 2 ERCP is a minimally invasive technique and has fewer complications, generally shorter hospitalization times, and lower medical costs compared to traditional surgery, particularly in sick and elderly patients suffering from hepatobiliary tract disorders. 1 The procedure may be performed under general anesthesia to keep patients stable 3 or with moderate to deep levels of sedation and analgesia to minimize patient discomfort during the procedure. 2 However, potential complications involving respiratory and cardiovascular conditions, which may be related to the level of sedation, 4 may occur during the operation. Essential factors to consider concerning the level of sedation for ERCP procedure include patient tolerance, the presence of comorbidities, the endoscopist’s comfort and ease of the procedure, staff, equipment, and anesthesia support available in the endoscopy suite. 2 Benzodiazepine, opiates, and propofol in different combinations are commonly administered to provide conscious or deep sedation for patients undergoing ERCP. 5 It has been reported that one-third to one-half of patients undergoing ERCP under conscious sedation experience discomfort and pain. 6 Thus, there is a need for a sedation method or regimen that offers efficacy and has an excellent safety profile regarding sedation-related side effects. This report aims to identify and summarize evidence on the clinical effectiveness of short-acting sedative agents for conscious sedation during ERCP. An additional objective is to synthesize evidence-based guidelines for moderate procedural sedation during ERCP., (Copyright © 2020 Canadian Agency for Drugs and Technologies in Health.)

Nausea is defined as a subjectively unpleasant sensation associated with awareness of the urge to vomit, and vomiting refers to a forceful expulsion of gastric contents from the mouth, or labored, spasmodic, rhythmic contractions of the respiratory muscles without expulsion of gastric contents. 1 The conditions may be caused by multiple factors including organ failure, central nervous system disease, drug therapy, radiation, and gastrointestinal obstruction and pathology. 2 Nausea and vomiting are often associated with other symptoms such as pain, anxiety, depression, shortness of breath, drowsiness, loss of appetite, and tiredness that can negatively influence patients’ activities of daily living and significantly impact their quality of life. 3 , 4 The management of nausea and vomiting involves treatment of the underlying cause(s), supportive care measures, and the use of anti-emetics. 2 , 4 Anti-emetics are medications prescribed for the prevention of nausea and vomiting or use as a rescue treatment once symptoms develop. 5 There are many classes of anti-emetic drugs, including 5-HT3 receptor antagonists, NK-1 receptor antagonists, corticosteroids, butyrophenones, antihistamines, anticholinergics, and phenothiazines. 6 Ondansetron is the most well-studied 5-HT3 receptor antagonist and is considered by some to be the gold standard to which other anti-emetics are compared. 6 Ondansetron is commonly prescribed in the form of standard oral pills or tablets. 7 However, there are patients, including those in the palliative setting, for whom such formulations may not be suitable due to difficulty with swallowing caused by co-morbidities such as dysphagia. 8 This report aims to identify and summarize evidence on the comparative clinical effectiveness of oral versus injectable ondansetron formulations in adult patients requiring medication to control nausea or vomiting. An additional objective is to synthesize evidence on the comparative clinical effectiveness and cost-effectiveness of ondansetron versus other anti-emetic agents for palliative patients, as well as evidence-based guidelines for the use of ondansetron to control nausea or vomiting in that population., (Copyright © 2020 Canadian Agency for Drugs and Technologies in Health.)

Immune mediated immunological disorders comprise of a group of common conditions that affects the immunomodulatory pathways resulting in lasting and disabling inflammatory conditions. 1 Rheumatological disorders such as rheumatoid arthritis (RA), psoriatic arthritis (PsA) and ankylosing spondylitis (AS) are chronic inflammatory conditions that affect predominantly the musculoskeletal system leading to pain, disability, functional impairment and lowered health related quality of life (HrQoL). 1 , 2 Treatment of these disorders aim at symptom management and to prevent and control joint and organ damage. 3 They include corticosteroids, non-steroidal anti-inflammatory agents and disease-modifying antirheumatic drugs (DMARDs). Conventional DMARDs (cDMARDs) like methotrexate, sulfasalazine and hydroxychloroquine target the immune pathways, and have been used in early and long-term management of rheumatological disorders. Biologic DMARDs (bDMARDs) and janus kinase inhibitors target the molecules in the inflammatory pathway, thereby suppressing inflammation in RA, PsA and AS among other conditions. 4 The clinical superiority of bDMARDs compared to placebo in rheumatological disorders have been established. 5 , 6 . Among bDMARDs, tumor necrosis factor-alpha (TNF-α) inhibitors like adalimumab (ADA), infliximab (INF), etanercept (ETN), golimumab (GOL), and certolizumab pegol (CTZ) are approved for used in RA, PsA and AS. 7 , 8 In addition, interleukin-6 inhibitors like tocilizumab (TOC) and sarilumab (SAR) and T-cell stimulation blocker, abatacept (ABA) are used for RA, 8 In PsA, secukinumab (SEC) is approved for use, and in AS ixekizumab (IXE) and SEC are also approved. 5 , 7 A janus kinase inhibitor, tofacitinib (TOF), is also approved for use in patients with RA. 7 There is a scarcity of head-to-head trials comparing the clinical effectiveness of bDMARDs with each other. bDMARDs and targeted DMARDs being expensive, long term treatments with these agents will result in increased healthcare expenditure. 9 , 10 Thus, in the absence of comparative evidence, cost is a major determinant factor in the choice of bDMARDs. The objective of this report is to summarize the evidence regarding the comparative efficacy of ADA compared with other bDMARDs and tofacitinib in patients with rheumatological disorders., (Copyright © 2020 Canadian Agency for Drugs and Technologies in Health.)

Psoriasis is an autoimmune and inflammatory disease with genetic predispositions that generally occurs before age 35. 1 The development of the disease is driven by multiple pathways of immune mediators, including tumor necrosis factor-α (TNF-α), interleukin (IL)-23 and IL-17 cytokines. Psoriasis affects about 3% of the population and is associated with systemic diseases including inflammatory bowel disease, metabolic syndrome, and cardiovascular disease. 1 Plaque psoriasis is the most common form of the disease, accounting for about 70% to 90% of all patients with psoriasis. 1 , 2 It is characterized by itchy, red, scaly, raised lesions on the skin, especially on the scalp, elbows, knees, scalp, and back extensor extremities and trunk. 1 Psoriasis significantly impairs patients’ quality of life. 3 Most patients with plaque psoriasis have mild disease that is adequately managed with topical application of corticosteroids, emollients, vitamin D analogs, coal tar products, retinoids and calcineurin inhibitors, or phototherapy. 1 Moderate-to-severe chronic plaque psoriasis symptoms are generally treated with systemic therapies. 2 , 4 They have a significant negative impact on patient quality of life. 1 , 2 and are associated with a considerable economic burden. 4 , 5 Treatment options include conventional agents such as methotrexate and cyclosporine, and relatively newer biologic agents. Biologics approved for patients with moderate-to-severe plaque psoriasis include of TNF-α inhibitors (e.g., as adalimumab and infliximab), IL-17 inhibitors (e.g., ixekizumab, and secukinumab) and IL-23 inhibitors (e.g., risankizumab). 3 , 4 , 6 – 9 Unlike the non-specific conventional immunomodulators, biologic treatments for psoriasis are less likely to cause systematic adverse events because of their specificity for immune targets. 3 , 10 Adalimumab was among the earlier biologic agents that received approval from Health Canada for the treatment of severe plaque psoriasis. 11 Others with similar approved indications include infliximab, ixekizumab, risankizumab, and secukinumab. 11 The variety of biologic agents currently available for the treatment of moderate-to-severe plaque psoriatic presents a challenge to clinicians in making choices that optimize patients’ outcomes. It also creates the need for decision-makers to determine suitable places in therapy for the available treatment options, using evidence-based information. In 2008, CADTH conducted a Common Drug Review (CDR) of adalimumab in patients with plaque psoriasis. 12 However, that review 12 did not cover the comparative effectiveness of adalimumab to other biologics for that indication. The aim of this Rapid Response review is to compare and summarize evidence about the clinical effectiveness of adalimumab versus other biologic drugs indicated for the treatment of in adult patients with plaque psoriasis., (Copyright © 2020 Canadian Agency for Drugs and Technologies in Health.)

Upper extremity pain can significantly reduce an individual’s ability to complete their activities of daily living. 1 Frequently used pharmacological treatments for upper extremity pain include non-steroidal anti-inflammatory drugs, acetaminophen, topical capsaicin, and topical salicylates as well as less conventional drugs such as pregabalin and duloxetine. 2 Interventions involving multidisciplinary teams using a multimodal approach combining splints with other components, such as education or exercise delivered by occupational therapists, have been reported in the literature to be more effective at managing pain than single isolated interventions. 3 , 4 Splint refers to a rigid or flexible appliance for fixation of displaced or movable parts. 5 They are used to stabilize injuries by decreasing movement and providing support, to prevent further damage, as well as to alleviate pain and edema, and promote soft-tissue and bone healing. 6 Splints are frequently applied to immobilize an extremity in advance of a surgical procedure or as a temporary measure while awaiting orthopedic consultation. 6 Although splinting is commonly used in clinical practice with the intent to reduce hand and wrist pain, improve hand function, and reduce or prevent deformity and soft tissue contractures, the evidence of efficacy is unclear. 7 Therefore, the objective of this report is to review and summarize evidence regarding the clinical effectiveness of orthotic bracing and splinting of the upper extremities in patients with chronic, non-cancer pain., (Copyright © 2020 Canadian Agency for Drugs and Technologies in Health.)

Osteoarthritis is caused by the wearing down of cartilage in the joints of the body and thickening of the bones underneath. 1 , 2 The condition causes varying degrees of pain, stiffness and swelling, and may lead to joint damage. Risk factors include age, heredity, obesity, and previous joint injury. 2 Among individuals older than 55 years of age, the prevalence of osteoarthritis is greater in women than men (33.6% for women and 24.3% for men). 1 , 3 However, the prevalence is the same among men and women of younger age, with men being slightly more vulnerable. 1 Although osteoarthritis typically affects hands, feet, knees, spine, and hips, it occurs more frequently at the knee than the other joints. 4 The pain, joint stiffness, instability, and decreased physical function associated with KOA lead to declines in activity and disability that can result in a higher risk of obesity, cardiovascular disease, diminished quality of life, and death among affected patients compared with the general population. 3 Treatments aimed to decrease pain and improve joint mobility include analgesics and anti-inflammatory drugs, exercise, physiotherapy, weight loss or healthy weight programs, and self- management education programs. 2 In severe cases, surgery to replace the entire joint may be recommended. 2 Exercise is generally recommended as a core non-pharmacological therapy to improve symptoms and the general well-being of people with KOA due to its relative safety compared with pharmacological treatments. 5 In 2017, CADTH produced a Rapid Response report summarizing evidence on the clinical effectiveness of exercise for the management of KOA. 6 In 2019, a CADTH Rapid Response Reference List report 7 indicated availability of new and potentially relevant publications on the clinical effectiveness of physical activity on chronic non-cancer pain. Therefore, the objective of this report is to review and summarize any new evidence that may have become available since the 2017., (Copyright © 2020 Canadian Agency for Drugs and Technologies in Health.)

The number of opioid overdose cases is increasing in Canada. Although data showing current national-level trends of opioid toxicity-related morbidity and mortality were not identified for this Rapid Response report, the Canadian Institute for Health Information and the Canadian Centre on Substance Abuse have jointly reported that the rate of hospitalizations due to opioid poisoning in Canada increased by more than 30% between 2007–2008 and 2014–2015. 1 Also, data from the Office of the Chief Coroner for Ontario show that the number of opioid overdose-related deaths increased from 206 in 2004 to 624 in 2014. 2 Naloxone, a drug that can temporarily reverse opioid overdose, is a competitive opioid receptor antagonist with a rapid onset and short duration of action. 3 It has been used to reverse the effects of a variety of natural, semisynthetic, and synthetic opioids in both pre-hospital (community) and hospital settings. 4 Some advantages of using naloxone as a reversal agent for opioid overdose include absence of potential for abuse, a wide dose range without a likelihood of overdose, and a lack of pharmacological activity in the absence of opioids or other opioid antagonists. 3 , 5 – 7 Health Canada approved non-prescription use of naloxone for emergency reversal of opioid overdose in pre-hospital settings in March 2016, 8 and authorized the sale for Naloxone Hydrochloride Nasal Spray in Canada on July 5, 2017. 9 Naloxone Hydrochloride Nasal Spray is a needleless device that delivers a fixed intranasal dose of naloxone. 9 Other formulations of naloxone, including injectable for intramuscular, intravenous, or subcutaneous use, are available in Canada. Also, atomizer devices have been used in practice to deliver injectable naloxone solution intranasally. 10 , 11 Both intranasal and intramuscular naloxone formulations are available for pre-hospital use, including by laypersons in the community. In 2017, CADTH produced a Rapid Response report summarizing evidence on the comparative clinical effectiveness, cost effectiveness, and evidence-based recommendations for use of the various formulations and delivery mechanisms of naloxone for the treatment of opioid poisoning in pre-hospital settiongs. The evidence available then for that report was limited in number and quality. Therefore, the objective of this current Rapid Response report is to review any new evidence that may have become available since the 2017 report and update the evidence., (Copyright © 2019 Canadian Agency for Drugs and Technologies in Health.)

Electrosurgical instruments are some of the most often used tools at the surgeon’s disposal. 1 Benefits thought to be associated with these devices range from decreased post-operative pain and intraoperative bleeding, increased surgical speed, and reduced risk of post-surgical hemorrhage. 2 Traditional electrocautery (EC) applies radiofrequency (RF) alternating current to generate high current density at the cutting blade tip and tissue interface resulting in extreme resistive heating of local tissue. that provides effective cutting and coagulation due to instantaneous boiling of fluid and tissue vaporization. 3 , 4 The device operates at temperatures of between 300 ° C–350 ° C and the generated heat provides effective cutting and coagulation due to instantaneous boiling of fluid and tissue vaporization. 3 , 5 It has been reported that the high temperature of the EC procedure is associated with some drawbacks, such as significant thermal damage to incised tissues, reduced surgical precision compared with a scalpel, potential injury to adjacent structures, and delayed wound healing. 4 , 6 The cauterized surface area also increases subsequent inflammation and fluid sequestration into newly created tissue planes, resulting in seroma formation and increased risk of post-operative complications, such as infection. 4 Pulsed-electron avalanche knife (PEAK) PlasmaBlade is a relatively new electrosurgical technology developed to minimize the collateral tissue damage caused by higher-heat instruments such as EC. It uses high-intensity RF pulses to create electrical plasma along the edge of a thin, flat, insulated electrode. 5 , 7 The PEAK PlasmaBlade (PPB) system uses a lower amount of energy translating into operating temperatures of about 40–140 °C, with a corresponding reduction in heat transfer and reduction in depth of thermal damage to adjacent tissues of approximately 50–90%. 5 , 8 The PPB devices are available in several models designed for specific applications and are intended for tissue cutting and coagulation during general surgery. 7 The objective of this report is to summarize the evidence regarding the comparative clinical effectiveness of PPB soft tissue dissection devices versus traditional EC for surgery and the cost-effectiveness of PPB use for surgery., (Copyright © 2019 Canadian Agency for Drugs and Technologies in Health.)

Dementia refers to a set of symptoms and signs associated with a progressive deterioration of cognitive functions that affects daily activities. 1 Symptoms may include memory loss and difficulties with thinking, problem-solving or language, as well as changes in mood, perception, personality, or behaviour. 2 , 3 According to the World Alzheimer Report 2018, about 50 million people worldwide lived with dementia in 2018, with the number projected to increase to 152 million by 2050. 4 In Canada, the estimated number of people living with dementia in 2016 was 564,000, and this is expected to increase to 937,000 by 2031. 5 The total health care system costs and out of pocket costs of caring for people with dementia were $10.4 billion in 2016, and are projected to double by 2031. 5 Alzheimer’s disease is the most common type of dementia, accounting for about two thirds of all dementia. 4 Other types of dementia that occur less frequently include vascular dementia, mixed dementia, Lewy body dementia, frontotemporal dementia, and young-onset dementia. 1 , 3 Neuropsychiatric symptoms (NPS) are common to all dementia types and may manifest as agitation, aggression, wandering, apathy, sleep disorders, depression, anxiety, psychosis, and eating disorders. 3 These behavioral symptoms of dementia present significant risks of injury to the patients and caregivers, reduce quality of life, and may cause distress or depression. The progressive course of dementia cannot be altered since there is no known cure or disease-modifying therapy. 6 However, there are interventions to manage NPS, although they are based on limited and disparate evidence. 3 The first-line treatment of NPS comprises a range of nonpharmacological interventions based on identifying unmet physical and emotional needs, such as inadequately treated pain and unpleasant environmental factors, which may trigger the symptoms. Pharmacological therapies are the second-line treatment in patients for whom nonpharmacological interventions were unsuccessful and who present a potential risk of injury to either themselves or others. Pharmacological interventions commonly involve off-label use of atypical antipsychotics or second-generation antidepressants, usually in combination the nonpharmacological strategies. 3 Given the limited currently available therapeutic options, their side-effect profiles, and inconsistent evidence base, there is a need for alternate therapies in the growing population of dementia patients. 7 – 9 Medical cannabis has been investigated as one the potential alternative treatments for dementia. 10 , 11 Cannabis (also known as marijuana) is a plant that contains over 70 different chemical compounds called cannabinoids. 2 Although their mechanism of action in dementia is not well elucidated, they have been shown to interact with neurotransmitter systems that have been implicated in the manifestations of NPS. 11 Currently, patients living in Canada who have a prescription from an authorized health care professional can legally use cannabis for medical purposes, if they are registered with a licensed producer or Health Canada. 12 , 13 The objective of this report is to summarize the evidence regarding the clinical effectiveness of medical cannabis for the treatment of dementia and the evidence-based guidelines for its use in this condition., (Copyright © 2019 Canadian Agency for Drugs and Technologies in Health.)

A burn is an injury to the skin or other organic tissue primarily caused by heat or due to radiation, radioactivity, electricity, friction, or contact with chemicals.1 The World Health organization has stated that every year burns cause an estimated 180,000 deaths, and non-fatal burn injuries are a leading cause of morbidity.1 According to the Canadian Skin Patient Alliance, more than 3,200 people were admitted to Canadian hospitals for burns in 2005 to 2006, when the latest statistics are available.2 Based on data from the Canadian Hospitals Injury Reporting and Prevention Program, the Public Health Agency of Canada identified 1,682 cases of thermal burns and scalds, representing 1.2% of injuries reported in 2013. The report did not include burns from friction, chemical or caustic agents, or direct contact with lightning, which were considered to present unique circumstances. For survivors with severe scars, significantly diminished quality of life often persists despite traditional scar management, due to disfigurement, pain, itchiness, and contractures restraining the motion of body and joints. 3 Thus, trauma from burn injuries may continue to bother patients long after their wounds have healed and their hospital stay is over. 4 Treatment may be associated with substantial financial costs for modern health-care systems. For example, the direct costs for care of children with burns in the United States of America exceeded US$211 million in 2000, and the costs for hospital burn management in Norway exceeded €10.5 million in 2007. 1 The cost burden of burn-related treatment to the Canadian health system was not immediately available, at the time of compiling this report. For contracted scars, surgery is the primary therapeutic approach to relieve tension and ultimately improve the range of motion of the affected areas. However, the efficacy of surgical treatment is limited to the surgical site, and the procedure is associated with considerable morbidity and high recurrence rates. 3 Non-surgical interventions that are often used in clinical practice to improve burn scar management include silicone gel preparations, the use of pressure garments, physical therapy, compression, onion extract-based products, local medical therapy, and different types of laser treatments. 3 , 4 The three main groups of lasers that can be used to improve scars include pulsed dye lasers and devices that use similar technology, Q-switched neodymium-doped yttrium aluminum garnet (Nd:YAG) lasers, and ablative and non-ablative fractional lasers (e.g., fractionated CO2 laser). 5 The objective of this report is to summarize the evidence regarding the clinical effectiveness of fractionated CO2 laser for burn scar improvement and the cost-effectiveness of its use for this condition., (Copyright © 2019 Canadian Agency for Drugs and Technologies in Health.)

Lipedema is a disorder characterized by large amount of subcutaneous fat in the upper and lower legs due to both hyperplasia and hypertrophy. 1 It occurs almost exclusively in females, although a few cases in men have been reported. 1 , 2 The condition is relatively rare and often seen in patients with a family history of the disease. 1 , 2 Lipedema does not yet have a registered diagnosis in the International Classification of Diseases (ICD-10) of the World Health Organization (WHO), making it difficult to establish its prevalence. 2 However, lipedema is believed to affect nearly 11% of adult women, 3 with noted significant differences in prevalence worldwide. 2 , 4 , 5 The literature search for this report did not find epidemiological data for lipedema in Canada. The cause of lipedema is unknown, and it is likely that the condition is frequently misdiagnosed or wrongly diagnosed as lifestyle-induced obesity or lymphedema (i.e., localized fluid retention and tissue swelling). 2 , 6 However, although lipedema and obesity can co-occur, unlike obesity, lipedema usually targets the legs and thighs, without affecting the feet or hands, and the adipose tissue in lipedema is painful. 1 , 4 , 7 – 9 The lymphatic system remains unimpaired in the initial stages and can keep up with the increased amount of interstitial fluid. 1 , 7 However, patients with lipedema may develop secondary lymphedema (lipolymphoedema) if the fatty deposits compromise the lymphatic system. 8 Lipedema targets both legs (and sometimes, also both hands) to the same extent and has a bilateral, nearly symmetrical presentation. 2 – 5 The excessive fat deposits are typically unresponsive to traditional weight loss interventions such as physical activity or dietary measures. 1 , 6 , 9 Symptoms of the condition include pain in the lower extremities, particularly with pressure, loss of strength, easy bruising, and deterioration in daily activity levels that can greatly impact the health and quality of life of the individual with lipedema. 1 , 2 , 6 Untreated lipedema may result in secondary problems including osteoarthritis, reduced mobility, psychological impairment, and lowered self-esteem. 4 Over time, the weight of the excessive fat build-up can cause the knees to knock inward or droop to the side of the leg, and impair the inability to walk. 10 As mentioned, in the later stages, secondary lymphedema can occur due to imbalance in the amount of fluid produced and drained by the lymphatic system. 1 – 3 , 6 , 7 , 10 Lipedema poses a significant psychosocial burden for most patients, and associated effects often limit capacity for exercise. In severe cases, lipedema may lead to absence from work or occupational disability. 1 There is no known curative therapy for lipedema. The primarily focus of treatment is to reduce its related lower extremity symptoms, disability, and functional limitations to improve patients’ quality of life, as well as preventing disease progression. 1 – 3 , 6 , 11 Treatment is divided into conservative therapy and surgical interventions. The conservative therapy includes promotion of individually adjusted healthy lifestyle, combined decongestive therapy (CDT), and other supportive measures, such as psychosocial therapy and orthopedic counseling. 2 Conservative therapy can alleviate some lipedema symptoms such as heaviness, pain, and secondary swelling. 12 However, these benefits are short-lived, usually requiring repeat treatment within days. 9 Liposuction is the main surgical interventions for lipedema. 5 Commonly used liposuction methods for lipedema are tumescent anesthesia (TA) liposuction, and water assisted liposuction (WAL). 2 In TA liposuction, tumescent is infused in the subcutaneous tissues to cause the fat cells to swell and vessels to constrict; then blunt micro-cannulas are used to suction the fat. 3 , 13 , 14 Water assisted liposuction uses a pressure spray of tumescent fluid to dislodge the fat from the connective tissue, rather than utilizing a cannula. 10 Unlike traditional liposuction, both TA and WAL rely on the local anesthetics in the tumescent fluid and do not require general anesthesia. The objective of this report is to summarize the evidence regarding the clinical effectiveness of liposuction for the treatment of lipedema and the recommendations of evidence-based clinical guidelines regarding its use for this condition., (Copyright © 2019 Canadian Agency for Drugs and Technologies in Health.)

Cystic fibrosis (CF) is a rare chronic genetic disease that affects multiple systems in the body including the respiratory tract, pancreas, gastro-intestinal tract and liver. 1 , 2 The disorder is caused by mutations of the CF transmembrane conductance regulator (CFTR) gene. Approximately, one in 25 Canadians carries an abnormal CFTR gene, and CF occurs in children who inherit two abnormal genes, one from each parent. 3 It is estimated that one in every 3,600 children born in Canada has CF, with more than 4,300 Canadian children, adolescents, and adults with CF attending specialized CF clinics. 3 The disease has no cure at present, and it is the most common fatal genetic disease affecting Canadian children and young adults 3 Lung disease is the most prominent manifestation of CF, and it is reported to account for nearly 85% of deaths. 4 Respiratory tract abnormalities in CF patients cause mucus plugging of the airways, bronchial wall thickening due to inflammation, increased susceptibility to respiratory tract infection, and airway destruction. 1 , 2 Much of the pulmonary damage begins with lung inflammation. 5 Although a normal inflammatory response is beneficial to host defence mechanisms, and helps to prevent the spread of infection, the excessive inflammation seen in CF patients is harmful as it contributes to the disease and associated death. 1 One of the goals in the treatment of cystic fibrosis is to reduce lung inflammation. 4 Corticosteroids are potent anti-inflammatory drugs which have been widely used in the treatment of a variety of diseases with underlying inflammation including asthma and chronic obstructive pulmonary disease (COPD). 1 , 4 They exert direct inhibitory effects on many inflammatory cells, and regular use of inhaled corticosteroids (ICS) has been reported to reduce the number of mast cells within the airways, decrease airway microvascular leakage, and lessen mucus production. 4 Although benefit of its use in CF has not been proven, ICS has been widely prescribed as anti-inflammatory agents to treat children and adults with CF empirically. 1 , 4 , 5 The objective of this report is to summarize the evidence regarding the clinical effectiveness of ICS for the treatment of CF., (Copyright © 2019 Canadian Agency for Drugs and Technologies in Health.)

The objective of this health technology assessment (HTA) is to assess the optimal diagnostic strategy for acute pulmonary embolism (PE) in urban, rural, and remote settings through an assessment of the diagnostic test accuracy, clinical utility, safety, cost-effectiveness, patients’ perspectives and experience, implementation issues, and the environmental impact of strategies for the diagnosis of adults with suspected PE., (Copyright © 2018 Canadian Agency for Drugs and Technologies in Health.)