Post 3
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 Technology Assessments and Appraisals
Acute coronary syndromes - clopidogrel (No. 80): Clarification of recommendation 1.3
Review decision: NICE Technology Appraisal Guidance No.66, olanzapine and valproate semisodium in the treatment of acute mania associated with bipolar I disorder
Review decision: NICE Technology Appraisal Guidance No.58 zanamivir, oseltamivir and amantadine for the treatment of influenza
Review decision: NICE Technology Appraisal Guidance No.41 Routine anti-d prophylaxis in Rh-ve women
Review decision: NICE Technology Appraisal Guidance No.49, ultrasound locating devices for placing central venous catheters
Review decision: NICE Technology Appraisal Guidance No. no.42, use of human growth hormone (somatropin) in children with growth failure
Review decision: NICE Technology Appraisal Guidance No 30: Taxanes for the treatment of breast cancer
Displaced intracapsular hip fractures in fit, older people: a randomised comparison of reduction and fixation, bipolar hemiarthroplasty and total hip arthroplasty (Keating) 82 pages, Volume 9, number 41
Study results provide support for use of total hip replacement in the management of displaced subcapital fracture of the hip in fit, older patients; arthroplasty was more clinically effective and probably less costly over a 2-year period postsurgery.
A randomised controlled trial and cost-effectiveness study of systematic screening (targeted and total population screening) versus routine practice for the detection of atrial fibrillation in people aged 65 and over: The SAFE study (Hobbs) 90 pages, Volume 9, number 40
Trial indicated that in terms of a screening programme for atrial fibrillation in patients aged 65 and over, the only strategy that improved on routine practice was opportunistic screening. Model-based analyses indicated that there was a probability of approximately 60% of annual opportunistic screening being cost-effective.
Displaced intracapsular hip fractures in fit, older people: a randomised comparison of reduction and fixation, bipolar hemiarthroplasty and total hip arthroplasty (Keating) 82 pages, Volume 9, number 41
Study results provide support for use of total hip replacement in the management of displaced subcapital fracture of the hip in fit, older patients; arthroplasty was more clinically effective and probably less costly over a 2-year period postsurgery.
Latest Guidelines
Health Protection Agency Northwest (2005) Guidelines for the Management of Human Bite Injuries: Guidance for healthcare professionals on dealing with injuries where teeth break the skin. Liverpool: HPA NW
The aim of this policy is to ensure that appropriate, prompt advice,
treatment and follow-up is taken by individuals who have been involved in
a human bite.
Health Protection Agency Northwest (2005) Inoculation Injury in the Community Setting: Guidance for healthcare professionals. Liverpool: HPA NW.
This guidance has been produced to provide healthcare professionals with a
framework to assist them in undertaking risk assessments when dealing with
enquiries relating to needle-stick injuries affecting members of the public.
Atrial Fibrillation National Clinical Guideline for the Management of Atrial Fibrillation
NICE has issued a draft clinical guideline on atrial fibrillation for first consultation from 13th October to 10th November 2005.
Latest Reports
What’s the emergency?: A report on the emergency response to stroke
Brings together case studies of stroke survivors and leading voices in stroke care to detail the gold standard of emergency stroke care. It covers the impact of stroke, why stroke needs to be consistently treated as a medical emergency, the current provision of emergency response to stroke, why failures are continually occurring and what is needed to ensure the outcomes of stroke improve. Finally the report calls for experts in all disciplines, including stroke professionals, health managers, policy formulators and parliamentarians, to sign up to a general consensus on the gold standard of emergency stroke care.
Nanny or steward? The role of government in public health
The paper questions whether government intervention in public health issues such as smoking and obesity is an example of ‘nanny statism’ – an unnecessary intrusion into people’s lives - or whether it is a form of ‘stewardship’ – part of government’s responsibility to protect national health. It looks at the options open to governments that want to influence individual and collective behaviour to reduce health risks and also examines historical and contemporary evidence on the impact of state intervention on public health.
The role of complementary and alternative medicine in the NHS
Commissioned by the HRH Prince of Wales, with the objective of taking a fresh and independent look at the contribution which complementary therapies can potentially make to the delivery of healthcare in the UK. The central aim of the investigation was to look at the evidence – both in the literature and in practice in the case studies – in order to assess whether among these therapies treatments were available which could help meet gaps in the current provision of health care by the NHS in cost-effective ways.
Early lessons from payment by results
The Audit Commission has published their report on the Payment by Results system. Overall, the report states that whilst the potential benefits of the new approach are recognised, considerable improvements in contracting, information and financial systems are required. In addition in order for the benefits of the system to be realized, the implications need to be more widely understood by clinicians.
At present the report notes that there is a little evidence that the incentives are working, although implementation is still at an early stage.
The report further outlines the following lessons learnt from the first year of implementation (taken directly from report):
Evidence from Journals
Purpose and procedure:
Purpose and procedure
Evid Based Nurs 2005; 8: 98-99.
EBN notebook:
Teaching evidence-based practice on foot
W Scott Richardson and Dawn Dowding
Evid Based Nurs 2005; 8: 100-103.
Treatment:
Clinician advice, an interactive computer program, and motivational counselling during routine medical visits increased reported smoking abstinence among teens
Dawn Kingston (commentator)
Evid Based Nurs 2005; 8: 105.
Review: various devices for delivery of aerosol treatment can be equally efficacious
Sharon D Horner (commentator)
Evid Based Nurs 2005; 8: 106.
Aspirin, 1000 mg, reduced moderate to severe pain in acute migraine headache
Diana E McMillan (commentator)
Evid Based Nurs 2005; 8: 107.
Low dose aspirin lowered stroke risk but not risk of myocardial infarction or cardiovascular death in women
David R Thompson (commentator)
Evid Based Nurs 2005; 8: 108.
Review: good evidence supports use of polyethylene glycol and tegaserod for constipation
Jane P Joy (commentator)
Evid Based Nurs 2005; 8: 109.
Review: non-pharmacological interventions induce or maintain weight loss in adults with prediabetes
Gail D’Eramo Melkus (commentator)
Evid Based Nurs 2005; 8: 110.
Review: group based education in self management strategies improves outcomes in type 2 diabetes mellitus
Arlene Smaldone and Katie Weinger (commentator)
Evid Based Nurs 2005; 8: 111.
Review: self monitoring interventions modestly reduce diastolic blood pressure (BP) but do not improve BP control in hypertension
Ruth Martin Misener (commentator)
Evid Based Nurs 2005; 8: 112.
Review: some evidence suggests that cognitive behaviour therapy may reduce chest pain in the short term in patients with non-specific chest pain and normal coronary anatomy
Michael McGillion (commentator)
Evid Based Nurs 2005; 8: 113.
Review: subglottic secretion drainage reduces ventilator associated pneumonia
Bronagh Blackwood (commentator)
Evid Based Nurs 2005; 8: 114.
Relaxing hip precautions increased patient satisfaction and promoted quicker return to normal activities after total hip arthroplasty
Faith J Forster (commentator)
Evid Based Nurs 2005; 8: 115. doi:10.1136/ebn.8.4.115 [Extract] [Full Text] [PDF]
Protein energy supplementation of usual hospital diet did not improve outcomes in inpatients with recent stroke
Cami D’Uva and Charmaine Martin (commentator)
Evid Based Nurs 2005; 8: 116.
Timing and route of enteral tube feeding did not affect death or combined death or poor outcome in stroke and dysphagia
Robert Lindeboom (commentator)
Evid Based Nurs 2005; 8: 117.
Review: early supported discharge reduces death or dependence after stroke
David Stevenson (commentator)
Evid Based Nurs 2005; 8: 118.
Review: counselling and education may improve outcomes in caregivers of patients with stroke
Nancy Boaro and Karima Velji (commentator)
Evid Based Nurs 2005; 8: 119.
A multifactorial intervention reduced the mean number of falls but not the proportion who fell in older people with recurrent falls
Judith A Lever (commentator)
Evid Based Nurs 2005; 8: 120.
Effects of memantine on behavioural symptoms in Alzheimer's disease patients: an analysis of the Neuropsychiatric Inventory (NPI) data of two randomised, controlled studies.
GAUTHIER S., WIRTH Y., MOBIUS H. J.
International Journal of Geriatric Psychiatry, 20(5), May 2005, pp.459-464.
Self management of oral anticoagulation: randomised trial
Objective To determine the clinical effectiveness of self management compared with routine care in patients on long term oral anticoagulants. Design Multicentre open randomised controlled trial. Setting Midlands region of the UK. Participants 617 patients aged over 18 and receiving warfarin randomised to intervention (n = 337) and routine care (n = 280) from 2470 invited; 193/337 (57%) completed the 12 month intervention. Intervention Intervention patients used a point of care device to measure international normalised ratio twice a week and a simple dosing chart to interpret their dose of warfarin. Main outcome measure Percentage of time spent within the therapeutic range of international normalised ratio. Results No significant differences were found in percentage of time in the therapeutic range between self managment and routine care (70% v 68%). Self managed patients with poor control before the study showed an improvement in control that was not seen in the routine care group. Nine patients
(2.8/100 patient years) had serious adverse events in the self managed group, compared with seven (2.7/100 patient years) in the routine care arm (2(df = 1) = 0.02, P = 0.89). Conclusion With appropriate training, self management is safe and reliable for a sizeable proportion of patients receiving oral anticoagulation treatment. It may improve the time spent within
the therapeutic range for patients with initially poor control. Trial registration ISRCTN 19313375.
Assessment (screening or diagnosis):
Review: fever and cough are the most accurate single tests for diagnosing influenza
Judith Carrier (commentator)
Evid Based Nurs 2005; 8: 121.
The Center for Epidemiologic Studies Depression Scale in older Chinese: thresholds for long and short forms.
CHENG Sheung-Tak, CHAN Alfred C. M.
International Journal of Geriatric Psychiatry, 20(5), May 2005, pp.465-470.
Gleason score predicted mortality rate to 20 years for untreated early prostate...Barry
Evid Based Med.2005; 10: 151
BNP and amino terminal proBNP assays did not differ for detecting congestive heart...Doust
Evid Based Med.2005; 10: 148
Low dose aspirin lowered stroke risk but not risks of MI or cardiovascular deaths...Eikelboom
Evid Based Med.2005; 10: 137
Effect of educational outreach to nurses on tuberculosis case detection and primary care of respiratory illness: pragmatic cluster randomised controlled trial. Fairall LR, Zwarenstein M, Bateman ED, Bachmann M, Lombard C, Majara BP, Joubert G, English RG, Bheekie A, van Rensburg D, Myers P, Peters AC, Chapman RD. BMJ. 2005 Oct 1;331(7519):750-4.
Objectives To develop and implement an educational outreach programme for the integrated case management of priority respiratory diseases (practical approach to lung health in South Africa PALSA) and to evaluate its effects on respiratory care and detection of tuberculosis among adults attending primary care clinics. Design Pragmatic cluster randomised controlled trial, with clinics as the unit of randomisation. Setting 40 primary care clinics, staffed by nurse practitioners, in the Free State province, South Africa. Participants 1999 patients aged 15 or over with cough or difficult breathing (1000 in intervention clinics, 999 in control clinics). Intervention Between two and six educational outreach sessions delivered to nurse practitioners by usual trainers from the health department. The emphasis was on key messages drawn from the customised clinical practice guideline for the outreach programme, with illustrative support materials. Main outcome measures Sputum screening for tuberculosis, tuberculosis case detection, inhaled corticosteroid prescriptions for obstructive lung disease, and antibiotic prescriptions for respiratory tract infections. Results All clinics and almost all patients (92.8%, 1856/1999) completed the trial. Although sputum testing for tuberculosis was similar between the groups (22.6% in outreach group v 19.3% in control group; odds ratio 1.22, 95% confidence interval 0.83 to 1.80), the case detection of tuberculosis was higher in the outreach group (6.4% v 3.8%; 1.72, 1.04 to 2.85). Prescriptions for inhaled corticosteroids were also higher (13.7% v 7.7%; 1.90, 1.14 to 3.18) but the number of antibiotic prescriptions was similar (39.7% v 39.4%; 1.01, 0.74 to 1.38). Conclusions Combining educational outreach with integrated case management provides a promising model for improving quality of care and control of priority respiratory diseases, without extra staff, in resource poor settings. Trial registration Current controlled trials ISRCTN13438073.
Quality improvement:
An educational programme for primary healthcare providers improved functional ability in older people living in the community
Dorothy A Forbes (commentator)
Evid Based Nurs 2005; 8: 122.
Qualitative:
Mothers of children at risk described engaging with home visitors in terms of limiting family vulnerability
Karen I Chalmers (commentator)
Evid Based Nurs 2005; 8: 123.
Parents of children with diabetes described the transition to the insulin pump in terms of enhanced freedom and quality of life for all family members
Lesley Lowes (commentator)
Evid Based Nurs 2005; 8: 124.
Parents of young people with mental health problems experienced a deskilling and had to learn to reskill themselves
Jeannette LeGris (commentator)
Evid Based Nurs 2005; 8: 125.
The media contributed to the knowledge and decision making of patients throughout their cancer experiences
Helen Roberts (commentator)
Evid Based Nurs 2005; 8: 126.
Community living older adults described using medical, collaborative, and self agency models for asthma self management
Carol Jillings (commentator)
Evid Based Nurs 2005; 8: 127.
"Multiple margins" (being older, a woman, or a visible minority) constrained older women’s access to Canadian health care
Diane Pirner (commentator)
Evid Based Nurs 2005; 8: 128.
A pilot study examining the effectiveness of maintenance Cognitive Stimulation Therapy (MCST) for people with dementia.
PRRELL Martin., et al.
International Journal of Geriatric Psychiatry, 20(5), May 2005, pp.446-451.
Hitting the Headlines - Evidence Behind the Press Stories
'Vaccine for cervical cancer'
shown 100% efficacy against cervical cancer reported nine newspapers (7 October 2005). The newspapers gave generally accurate summaries of a press release describing what appear to be interim results of a clinical trial. It is not possible to evaluate the research because full details are not available.
Nine newspapers (1-9) reported the results of a trial of a vaccine. The newspapers reported that the vaccine demonstrated 100% efficacy against cervical cancer. All reported that the vaccine was designed to protect against two strains of a virus called human papillomavirus (HPV) which is believed to be a main cause of cervical cancer.
The reports appear to be based on a press release (10) describing interim results of a randomised controlled trial which is part of an ongoing programme of trials by the manufacturers of the vaccine; Merck. The results are due to be presented at the Infectious Diseases Society of America annual meeting in October 2005 (11). A licensing application for the vaccine is planned by the end of the year.
The trial involved 12,167 women from 13 countries. Half of the women received three doses of the vaccine Gardasil over six months and the other half received placebo injections. The main results that were reported were based on women that had received all three injections and had been followed up for an average of 17 months. No cases of cervical pre-cancers or non-invasive cancers were observed in the women that received all three injections of the vaccine (n=5301), compared to 21 cases in the group that received three placebo injections (n=5258).
The newspaper reports were generally accurate summaries of the results described in the press release. Most newspapers reported about the age that the vaccine would be administered in practice and two newspapers (1, 3) optimistically reported that the vaccine could end the need for smear tests.
'Stem cells can help repair the liver'
Damaged livers have been repaired using bone marrow stem cells from patients' own blood reported the Daily Mail (6 October 2005)(1). The newspaper article accurately reported on a news item in New Scientist about five patients who had received the treatment. Approval for further research to refine the technique is being sought.
Damaged livers have been repaired using bone marrow stem cells extracted from the patients' own blood reported the Daily Mail on 6 October 2005(1).The treatment involved injecting the stem cells into the blood vessels leading to the liver of the patient. The stem cells then appeared to regenerate tissue in the liver.
The newspaper article was based on a study reported in the news section of the New Scientist (2). The researcher stated that three out of the five patients that received the treatment experienced significant improvements in liver function and general health within two months. The remaining two patients without health improvements experienced no ill effects as a result of the treatment.
The newspaper article accurately outlined the report in New Scientist. There were however insufficient details in the New Scientist report for an assessment of the quality of the research to be carried out. The newspaper article appropriately stated that the treatment needs to be proven to work. Approval for a follow-up trial is being sought by the researchers.
Document of the Week from the National Library for Health
Special issue contains important articles on health IT
The latest issue of "Health Affairs" contains highly relevant articles about the economics of health information technology. Topics covered include electronic patient records, e-prescribing, physician adoption of IT, and collaborative networks. NHS Athens passwords are required to access this resource, and can be obtained from the National Library for Health.
Eyes and Vision Specialist Library launched October 13th.
The purpose of the library is to find, organise, and facilitate access to the best currently available evidence on eye health in order to support and inform clinical care in NHS England. Clearly knowledge gaps exist - the conditions covered at launch represent those eye conditions that are sufficiently common to have had guidance procured by the NHS or prepared by professional bodies.
0 Comments:
Post a Comment
<< Home