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Horizon scan reports provide brief summaries of information regarding new and emerging health technologies, which are identified through the CADTH Horizon Scanning Service as topics of potential interest to health care decision-makers in Canada. The Actim Pancreatitis test is a rapid point-of-care test that detects acute pancreatitis (including endoscopic retrograde cholangiopancreatography–related pancreatitis). It has the potential to provide a diagnosis of pancreatitis more quickly and with fewer financial and human resources. It may be particularly useful in settings that do not have quick access to laboratory services.

Transanal total mesorectal excision may result in lower rates of conversion to open procedure and a better circumferential resection margin compared with laparoscopic total mesorectal excision in adults with rectal cancer. Transanal total mesorectal excision may be comparable to laparoscopic total mesorectal excision for cancer recurrence, survival, death, and short-term safety outcomes in adults with rectal cancer. Total mesorectal excision may be more cost-effective than laparoscopic and open total mesorectal excision in adults with rectal cancer, but this is uncertain.

Six evidence-based guidelines regarding the use of real-time continuous glucose monitoring in people living with type 1 or type 2 diabetes were included in this report. Three included guidelines were of high quality, while 3 guidelines were of moderate quality due to unclear reporting of methodological details. Four evidence-based guidelines strongly recommended the use of real-time continuous glucose monitoring in adults for the management of type 1 diabetes, based on intermediate- to high-quality evidence. Four guidelines recommended real-time continuous glucose monitoring for adults living with type 2 diabetes, based on low- to high-quality evidence. Three guidelines strongly recommended the use of real-time continuous glucose monitoring in children and young people living with type 1 diabetes, based on intermediate- to high-quality evidence. One guideline recommended real-time continuous glucose monitoring for children and young people with type 2 diabetes, based on expert consensus rather than evidence of clinical effectiveness.

Continuous glucose monitoring (CGM) is a method of glucose testing in which a sensor is inserted into the skin and continuously monitors interstitial glucose concentrations. Real-time continuous glucose monitoring (rtCGM) systems automatically measure glucose and display a recent glucose value. Evidence suggests that rtCGM may improve hemoglobin A1C and time in range in adults and pediatric patients with type 1 diabetes, but this is uncertain. Limited evidence suggests that in people with type 1 diabetes, there is little to no difference between rtCGM and self-monitoring of blood glucose (SMBG) on quality of life, diabetic ketoacidosis, and severe adverse events. Safety evidence suggests that rtCGM may decrease severe hypoglycemia in adults and pediatric patients with type 1 diabetes, but this is uncertain. rtCGM may be more cost-effective in the long term than SMBG in adults with type 1 diabetes.

The literature search did not identify any studies with relevant evidence on the clinical utility of syphilis screening using risk-based approaches versus population-wide approaches for adolescents and adults. One overview of systematic reviews of variable methodological quality did not identify any systematic reviews on the clinical utility of syphilis screening comparing risk-based assessment to routine population-based screening in people at low risk of syphilis.

CADTH included 6 reports describing the potential clinical benefits of 5 stepped care models for chronic pain in this review. The randomized controlled trial of the stepped care model for patients who are overweight or obese with chronic pain due medial tibiofemoral osteoarthritis described the impact on pain remission, pain intensity, and function. The before-after and retrospective cohort study of the Stepped Care Model of Pain Management described the effects on pain, quality of chronic pain care, pharmacotherapy use, and health care utilization in US veterans. The before-after study of the biopsychosocial stepped care model for non-cardiac chest pain described the potential benefits on chest pain, depression, anxiety, quality of life, and health care use. The prospective cohort study of the Stepped Care Strategy compared a cohort of patients who received stepped care strategy-consistent care for hip or knee pain due to osteoarthritis with a cohort who received stepped care strategy-inconsistent care and described the results on pain physical function, self-efficacy, active pain coping, and health care use. The Evaluation of Stepped Care for Chronic Pain randomized controlled trial described the effects on pain, disability, and pharmacotherapy use in US veterans. CADTH included 1 cost-effectiveness analysis that described the cost implications of a stepped care pathway for treating sciatica pain. While all included models used a stepped care approach to chronic pain management, the models were customized, and the evaluation methods were heterogeneous.

Four reports describing the potential clinical benefits of hub-and-spoke models of care for chronic pain were included in this report: The single arm pre- and post- study of the Manage Your Pain Program described its impact on pain, depression, anxiety, and health-related quality of life. The retrospective cohort study of the Army and Navy Extension of Community Healthcare Outcomes Pain described pharmacotherapy use. The single-arm pre- and post-study of the Extension of Community Healthcare Outcomes Pain in the University Health Network described pain, depression, and pharmacotherapy and health care use. The comparative pre- and post-study of the Extension of Community Healthcare Outcomes Pain in community health care centres described pharmacotherapy and health care use. While all of the referenced models included central specialized care by hubs and core services by spokes, and the use of videoconferencing to provide chronic care education, the models were tailored, and the evaluation methods were heterogeneous. No reports were identified that described the potential harms or the potential cost implications of hub-and-spoke models for the delivery of care for chronic pain.

One systematic review (that summarized 9 relevant studies) provided evidence on the use of mattresses for treating chronic low back pain. Medium-firm mattresses may lead to less back pain and better sleep quality compared with firmer mattresses. Mattresses with an air overlay may also improve pain and sleep quality in those with chronic low back pain. Several limitations of the data informing this report were identified, which limits the certainty of the evidence.

There were no statistically significant differences between custom-made foot orthotics and prefabricated foot orthotics for plantar heal pain in adults. There is limited evidence for short-term pain relief and improved quality of life with custom-made orthotics compared to placebo or no intervention in adults with plantar fasciitis. Custom-made foot orthotics are less cost-effective than other interventions (placebo, prefabricated orthotics, usual care) in the short and medium term. Two evidence-based guidelines recommended the use of custom-made foot orthotics in patients with diabetes for prevention and treatment of foot ulceration.

In adults with rheumatoid arthritis, prefabricated orthopedic footwear may reduce foot pain and improve physical functioning, but not affect health-related quality of life. However, this is based on evidence of variable quality from within-group designs, comparing outcomes pre- and postintervention. Due to conflicting results, evidence of variable quality from comparatives studies regarding the effectiveness of prefabricated orthopedic footwear for foot pain and foot function in people with inflammation of the soles of the feet (plantar fasciitis) or gout was inconclusive. Evidence of variable quality from 2 systematic reviews suggested that prefabricated orthopedic footwear after a healed diabetic foot ulcer (DFU) may prevent the recurrence of the condition better than conventional shoes at 1 year but not at 2 years. No economic evaluations were identified that evaluated the cost-effectiveness of prefabricated orthopedic footwear for treating people with lower-limb conditions. Two evidence-based guidelines recommended against using orthopedic footwear for treatment in patients with DFUs and 2 recommended using orthopedic footwears for adults with healed DFUs to prevent a recurrence. One guideline recommended using orthopedic footwear by adults with rheumatoid arthritis.

Evidence of variable quality from 6 diagnostic test accuracy studies indicates that the Pan-Canadian Early Detection of Lung Cancer (PanCan) model may perform better at determining which lung nodules identified by low-dose CT are cancerous compared to the Lung Imaging Reporting and Data System. However, evidence from 3 other studies, also of variable quality, suggests that the risk calculators have similar diagnostic test accuracy. No studies were identified that compared the clinical utility of PanCan versus the Lung Imaging Reporting and Data System. Results from 2 economic evaluations were inconsistent about the cost-effectiveness of the 2 lung cancer risk models. However, each study applied the models to different types of lung nodules. One evidence-based guideline recommended that PanCan be used in the UK for initial risk assessment and for the management of lung nodules.