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Links are given to online full text resources, all other materials can be obtained via the Fade Library, just mail your request to library.services@fade.nhs.uk
Latest Systematic Reviews
CRD Report 29: Diagnostic value of systematic prostate biopsy methods in the investigation for prostate cancer: a systematic review
The diagnostic accuracy of different biopsy schemes used to detect prostate cancer is the subject of the latest publication from CRD.
Conceptual framework and systematic review of the effects of participants' and professionals' preferences in randomised controlled trials (King) 186 pages, Volume 9, number 35
This comprehensive study advances our understanding of how people's preferences affect randomised controlled trials, suggesting that the greatest impact is usually on recruitment of patients and how better information may help improve the external validation of trials.
Latest Technology Assessments and Appraisals
Colorectal cancer (advanced) - irinotecan, oxaliplatin and raltitrexed (review) (No. 93)
The National Institute for Health and Clinical Excellence has published guidance on Irinotecan, oxaliplatin and raltitrexed for the treatment of advanced colorectal cancer.
The clinical effectiveness and cost-effectiveness of implantable cardioverter defibrillators: a systematic review (Bryant) 150 pages, Volume 9, number 36
This review considers the clinical effectiveness and cost-effectiveness of implantable cardioverter defibrillators (ICDs) for arrhythmias.
Latest Guidelines
Evaluating community projects: A practical guide
These guidelines were initially developed as part of the JRF Neighbourhood Programme. This programme is made up of 20 community or voluntary organisations all wanting to exercise a more strategic influence in their neighbourhood. The guidelines were originally written to help these organisations evaluate their work. They provide step-by-step advice on how to evaluate a community project which will be of interest to a wider audience.
Improving outcomes with children and young people with cancer
NICE and the National Collaborating Centre for Cancer have published a guideline for the NHS in England and Wales on improving outcomes with children and young people with cancer.
Latest Reports
Free at the Point of Delivery? Exposing the hidden cost of hospital travel and parking for cancer patients
This report presents the findings of two years' research, both with cancer patients themselves and with staff at the hospitals they attend.
Which? Report into Choice in Healthcare
Examines the Government's current proposals for patient choice. It aims to assess if these proposals go far enough. This research was commissioned as part of the consumer watchdog Which?'s work on choice in key areas affecting consumers.
Evidence from Journals
Modawal A, et al. Hyaluronic acid injections relieve knee pain. J Fam Pract 2005 Sep;54(9):758-67.
OBJECTIVE: To evaluate the efficacy of intra-articular viscosupplementation therapy with hyaluronic acid for pain relief of knee osteoarthritis, we conducted a meta-analysis of randomized, double-blinded, placebo-controlled trials. METHODS: We searched systematically for randomized, double-blinded, placebo-controlled trials of hyaluronic acid (hyaluronan and hylan G-F20) for pain relief of knee osteoarthritis. Studies reporting pain visual analogue scale (VAS) differences were included in the meta-analysis. Changes in pain were measured by VAS for placebo and treatment, and summary estimates of the differences between the 2 arms were calculated at 1 week, 5 to 7 weeks, 8 to 12, and 15 to 22 weeks after the last intra-articular injection. Sources of heterogeneity were assessed using information on quality score, type of viscosupplementation, and VAS change in pain with activity or rest. Heterogeneity across the studies was significant in all analyses (P<.01); therefore a random effect model was used. Pain was measured either on activity or at rest. RESULTS: Eleven trials (9 hyaluronan and 2 hylan G-F 20) allowed calculation of the summary estimate of difference in change of VAS pain at 1 week, 6 of the 11 allowed the estimation between 5 to 7 weeks and 8 to 12 weeks, and only 3 at 15 to 22 weeks. The summary estimates of VAS differences between therapy and placebo injection: at 1 week, 4.4 (95% confidence interval [CI], 1.1-7.2); at 5 to 7 weeks, 17.7 (7.5-28.0); at 8 to 12 weeks, 18.1 (6.3-29.9) and at 15 to 22 weeks, 4.4 (-15.3 to 24.1). CONCLUSION: Intra-articular viscosupplementation was moderately effective in relieving knee pain in patients with osteoarthritis at 5 to 7 and 8 to 10 weeks after the last injection but not at 15 to 22 weeks.
Richards KC, et al. Effect of individualized social activity on sleep in nursing home residents with dementia. J Am Geriatr Soc 2005 Sep;53(9):1510-7.
Objectives: To test the efficacy of an individualized social activity intervention (ISAI) on decreasing daytime sleep, improving nighttime sleep, and lowering the day/night sleep ratio and to determine its cost. Design: Pretest/posttest randomized with an experimental and control group. Setting: Seven nursing homes. Participants: One hundred forty-seven residents with dementia. Intervention: One to 2 hours of individualized social activities for 21 consecutive days. Measurements: Twenty-four-hour sleep/wake patterns using an Actigraph. Results: The ISAI group had significantly less daytime sleep (P=.001) and a lower day/night sleep ratio (P=.03) than the control group, after adjusting for baseline values. Because 40% of the sample slept 7 or more hours at night, a secondary analysis was conducted. When only those residents with a sleep efficiency of less than 50% (n=50) were included, the ISAI group (n=20) had less daytime sleep (P=.005), a lower day/night sleep ratio (P=.02), fell asleep faster (P=.03), and were awake less at night (P=.04) than the control group (n=30), after adjusting for baseline values. The weekly cost of the ISAI was roughly $70 per participant. Initial training and supply costs were $1,944. Conclusion: The ISAI provides an alternative to medications, without side effects.
Masoli M , et al. Moderate dose inhaled corticosteroids plus salmeterol versus higher doses of inhaled corticosteroids in symptomatic asthma. Thorax 2005 Sep;60(9):730-4.
BACKGROUND: There is uncertainty as to the dose of inhaled corticosteroids (ICS) at which to start concomitant long acting beta agonist (LABA) treatment in patients with asthma not adequately controlled by ICS alone. METHODS: A meta-analysis was carried out of randomised, double blind clinical trials that compared the efficacy of adding salmeterol to moderate doses of ICS (fluticasone propionate 200 mug/day or equivalent) with increasing the ICS dose by at least twofold in symptomatic adult patients with asthma. The main outcome measures were the number of subjects withdrawn from the study due to asthma and the number of subjects with at least one moderate or severe exacerbation. RESULTS: Twelve studies with a total of 4576 subjects met the inclusion criteria for the analyses. The number of subjects withdrawn due to asthma and with at least one moderate or severe exacerbation was higher in the high dose ICS group (odds ratios 1.58, 95% CI 1.12 to 2.24 and 1.35, 95% CI 1.10 to 1.66, respectively). For the secondary outcome variables (forced expiratory volume in 1 second, morning and evening peak expiratory flow, and daytime beta agonist use) there was significantly greater benefit in the salmeterol group. CONCLUSIONS: This meta-analysis shows that the addition of salmeterol to moderate doses of ICS (fluticasone 200 mug/day or equivalent) in patients with asthma symptomatic at that dose results in significantly greater clinical benefit than increasing the dose of ICS by twofold or more.
Teaching evidence-based practice on foot
W Scott Richardson
Evid Based Med 2005; 10: 98-101.
Finding the gold in Medline: clinical queries
R Brian Haynes and Nancy Wilczynski
Evid Based Med 2005; 10: 101-102.
Measures of association as used to address therapy, harm, and aetiology questions
Stuart Carney and Helen Doll
Evid Based Med 2005; 10: 102-103.
Evidently...
Richard Lehman
Evid Based Med 2005; 10: 105.
EBM teaching tip: Using a tape measure for intra-observer variability.
Ian Wacogne (commentator)
Evid Based Med 2005; 10: 104.
Rofecoxib for colorectal adenomas increased thrombotic events
David Juurlink (commentator)
Evid Based Med 2005; 10: 106.
Celecoxib for colorectal adenomas increased CV events
David Juurlink (commentator)
Evid Based Med 2005; 10: 107.
Review: a peridischarge multidisciplinary treatment programme reduces readmissions in heart failure
Bertram Pitt (commentator)
Evid Based Med 2005; 10: 108.
An implantable cardioverter defibrillator but not amiodarone reduced risk of death in congestive heart failure
Andrew Corsello (commentator)
Evid Based Med 2005; 10: 109.
Ximelagatran was not inferior to warfarin for preventing stroke and systemic embolism in non-valvular atrial fibrillation
Marcel Levi (commentator)
Evid Based Med 2005; 10: 110.
Clopidogrel was effective in patients who have MI with ST segment elevation receiving aspirin and fibrinolytic therapy
Steven Borzak (commentator)
Evid Based Med 2005; 10: 111.
Aspirin plus esomeprazole reduced recurrent ulcer bleeding more than clopidogrel in high risk patients
Walter L Peterson (commentator)
Evid Based Med 2005; 10: 112.
Review: dipyridamole given with or without aspirin reduces recurrent stroke
Graeme J Hankey (commentator)
Evid Based Med 2005; 10: 113.
Prophylactic coronary artery revascularisation before elective vascular surgery did not improve long term survival
P J Devereaux, Claudio S Cina, and G Malaga Rodriguez (commentator)
Evid Based Med 2005; 10: 114.
Review: antibiotics active against atypical pathogens do not improve community acquired pneumonia more than ß lactam antibiotics
Thomas J Marrie (commentator)
Evid Based Med 2005; 10: 115.
Maintenance plus as needed budesonide plus formoterol was better than fixed dose for severe exacerbations in asthma
P John Rees (commentator)
Evid Based Med 2005; 10: 116.
Review: commonly recommended well-child care interventions are not supported by evidence
Mitch Blair (commentator)
Evid Based Med 2005; 10: 117.
Review: early mobilisation is better than cast immobilisation for injured limbs
Hans J Kreder (commentator)
Evid Based Med 2005; 10: 118.
A functional task exercise programme was better than a resistance exercise programme in elderly women
Jay S Luxenberg (commentator)
Evid Based Med 2005; 10: 119.
Alcohol consumption (in the short-term) in patients with alcohol dependence
Allan W Graham (commentator)
Evid Based Med 2005; 10: 120.
Hormone therapy increased incidence and severity of urinary incontinence in healthy postmenopausal women
David Atkins (commentator)
Evid Based Med 2005; 10: 121.
Review: delayed pushing reduces rotational or mid pelvic instrumental deliveries but increases duration of the second stage of labour in women having epidural analgesia
Gavin Young (commentator)
Evid Based Med 2005; 10: 122.
Review: no single physical examination sign rules in or out osteoporosis or spinal fracture
Olof Johnell (commentator)
Evid Based Med 2005; 10: 123.
Colonoscopy detected colon polyps better than air contrast barium enema or computed tomographic colonography
Virender K Sharma and Cuong C Nguyen (commentator)
Evid Based Med 2005; 10: 124.
A clinical prediction rule predicted outcome in patients with low back pain having spinal manipulation and exercise treatment
Martin Underwood (commentator)
Evid Based Med 2005; 10: 125.
Trials
A trial of problem-solving by community mental health nurses for anxiety, depression and life difficulties among general practice patients. The CPN_GP study (Kendrick) 104 pages, Volume 9, number 37
The study found that specialist mental health nurse support is no better than support from GPs for most patients with anxiety, depression and reactions to life difficulties, although there may be other roles in primary care that community mental health nurses could play effectively.
The British Rheumatoid Outcome Study Group (BROSG) randomised controlled trial to compare the effectiveness and cost-effectiveness of aggressive versus symptomatic therapy in established rheumatoid arthritis (Symmons) 94 pages, Volume 9, number 34
This trial showed no additional benefit of aggressive treatment in patients with stable established rheumatoid arthritis (RA). Approximately one-third of current clinic attenders with stable RA could be managed in a shared care setting with an annual review by a rheumatologist and regular contact with a rheumatologist nurse.
Latest Questions to the NLH Primary Care Question Answering Service
What are the long term side effects or consequences of methotrexate treatment in children with arthritis (JCA)?
Do you have a list of drugs that have been associated with gynaecomastia as a side-effect?
What are the appropriate management guidelines for gross haematuria in pregnancy?
In non-anaemic patients, but with low iron, is there an effect on memory?
What is the percentage of serum cholesterol lipid lowering effect of ezetimibe as sole therapy?
Is there any special medical considerations a GP should take into account for muslim patients during rhamadan - the fasting month?
What are the effects of methadone on the developing foetus? What abnormalities can be expected? what abnormalities around the anus occur?
Which research underpins the use of the Edinburgh Post-natal Depression Scale and is it all qualitative or is there quantitative research in this area also ?
Are you aware of any references other than the nice guidelines as to why orlistat patients must lose 5% in 3 months to give better outcomes and is there any evidence that this is a better predictor of satisfactory outcome than 2.5kg loss prior to treatment.
Is there any evidence that "brittle" asthma is familial?
Diabetes UK state that 20-30% of cases of diabetes will be missed if a fasting plasma glucose alone is used to screen for diabetes (without an oral glucose tolerance test). What is the evidence to support this?
Do you have have any information on foreskin reconstruction in adults, the patient having had circumcision as a child?
What evidence is there for glucosamine being effective at a) alleviating the symptoms of, and b) the prevention of osteoarthritis?
What is the evidence that lowering the levels of homocysteine is beneficial? If beneficial what is the best way to lower the blood levels?
What is the evidence that raised levels of homocystine is a risk factor for vascular and any other disease?
In the secondary prevention of CVD what evidence is there that aspirin low dose still works in patients taking NSAIDs?
For esomeprazole are there equivalent doses for omeprazole? Is esomeprazole double the strength of omeprazole?
In an elderly patient with stroke is there any evidence that adding dipyridamole to warfarin reduces the risk of further stroke, if he experiences further TIAs? How about adding aspirin instead?
Has anyone produced a good quality statin patient information leaflet?
In patients who have been diagnosed with dementia, what is the evidence that strict control of cardiovascular risk factors is of benefit in reducing cognitive decline?
Hitting the Headlines - Evidence Behind the Press Stories
'Stuttering best treated before school age'
Stuttering is best treated before school age, reported The Guardian (23 September 2005). The newspaper reported the results of a trial showing beneficial effects of a behavioural treatment for children aged under six. The trial was too small to reliably detect a significant treatment effect; the results should be viewed with caution.
National Library for Health - Focus On
Fixed dose combinations and adherence
A systematic review published by the WHO is examined.
Weight loss for knee arthritis
A recent RCT on the positive effects of weight loss on knee osteoarthritis discussed.
Document of the Week from the National Library for Health
Early clinical experience has a positive effect on medical education
The British Medical Journal reports on a systematic review on the affect of early experience in clinical and community settings on medical education, and finds that it makes the learning process easier, and benefits all involved, patients, teachers and students.
What's New from the National Library for Health
BNF for Children Launched
BNF for Children has been developed to meet the clinical requirements of GPs, paediatricians, pharmacists, nurses, students and all healthcare professionals involved in the prescribing, dispensing, monitoring and administration of medicines to children. This new paediatric resource provides reliable advice on the use of medicines in children of all ages.