Post 6: 11th November 2005
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
Health Libraries Week Competition
As part of Health Libraries Week 2005, FADE is giving you the opportunity to get your hands on some fab prizes.
What’s on offer?
Everyday there’s a chance to win a £10 Borders voucher.
What do I have to do?
Not much! Just log on to www.fade.nhs.uk/hlw.html from Monday and guess who the baby is! Don’t worry if that seems a bit of a challenge, we have narrowed it down to just members of the FADE team so you’ve got a one in six chance! We’re also including pictures of us in our adult form – it couldn’t be easier!
And that’s not all!
If you take part in the competition you will automatically be entered into a Cheshire and Merseyside wide draw where you could win £50 or even £200 for your department. And if that’s not enough 50 people will have the chance to win one of this season’s must have accessories – a USB memory stick!
NICE (2005) Final Appraisal Determination on statins for the prevention of cardiovascular events. London: NICE.
NICE has issued a Final Appraisal Determination on statins for the prevention of cardiovascular events.
This guidance relates only to the initiation of statin therapy in adults with clinical evidence of cardiovascular disease (CVD) and in adults considered to be at risk of CVD. The guidance does not include specific advice for genetic dyslipidaemias. It makes the following recommendations:
• Statin therapy is recommended for adults with clinical evidence of CVD.
• Statin therapy is recommended as part of the management strategy for the primary prevention of CVD for adults who have a 20% or greater 10-year risk of developing CVD.
• When the decision has been made to prescribe a statin, it is recommended that therapy should usually be initiated with a drug with a low acquisition cost (taking into account required daily dose and product price per dose).
The guidance makes the following estimates of the impact on NHS resources of the recommendation for primary prevention of CVD in adults, based on the assumption that adults with a 30% or greater 10-year CHD risk are already being treated with statin therapy as recommended in the NSF for CHD.
• It is estimated that around 3.3 million adults in England and Wales have between a 15% (approximately equivalent to a 20% 10-year CVD risk) and 30% 10-year CHD risk and would become eligible for the initiation of statin therapy under the proposed guidance.
• It is estimated that the average annual cost per person of statin therapy under the proposed guidance would be £203.36 (based on March BNF).
• If uptake is assumed to be between 50% and 75% of the 3.3 million eligible adults, the estimated additional annual impact on NHS resources in England and Wales of the recommendations would be between £253 million and £380 million. Using the more recent prices from the Drug Tariff (July 2005), this falls to between £55 million and £82 million.
• The cost estimates are based on an assumption that 50% of prescriptions will be for generic simvastatin 20 mg/day and that 50% will be for generic simvastatin 40 mg/day.
NICE (2005) Long acting reversible contraception: the effective and appropriate use of long-acting reversible contraception. London: NICE.
NICE and the National Collaborating Centre for Women and Children's Health have issued a clinical guideline on the effective and appropriate use of long-acting reversible contraception within the NHS in England and Wales. Listed below are the key documents for this guideline, click on the title to link to the relevant document.
Latest Reports
GREAT BRITAIN. Department for Education and Skills.
The children's workforce in England: a review of the evidence.
Great Britain. Department for Education and Skills, London: 2005. 44p.
BOAZ Annete, ASHBY Deborah.
Fit for purpose?: assessing research quality for evidence based policy and practice.ESRC UK Centre for Evidence Based Policy and Practice, London: 2003. 18p.
Patients Association (2005) 100 day challenge. London: Patients Association.
'The 100 day challenge', gives the findings of a survey of NHS trusts regarding their approach towards screening patients for MRSA. The postal questionnaire was sent to every NHS Trust in England, and responses were returned during August 2005. 229 replies were received, representing a response rate of 11%.
The survey reports that only 44% of patients were screened for MRSA upon admission, and only half of patients upon transfer to another hospital. 47% of respondents nationally, but only 31% of respondents in London, said that doctors always used hand gels. Access to cleaning services 24 hours a day, seven days per week reportedly ranged from 76% availability to 36% in other areas.
Only 11% of respondents were able to name the Director of Infection Prevention and Control as the Board Member responsible for the control of infection and cleanliness of the hospital. But 97% of respondents were confident that their Trust is working to improve hospital-acquired infection rates.
National CJD Surveillance Unit (2004) The Thirteenth Annual Report of the National Creutzfeldt-Jakob Disease Surveillance Unit. Edinburgh: National CJD Surveillance Unit.
Looks back over the period from May 1990 when the Unit was set up to 31 December 2004. The report outlines the Unit’s work in the clinical surveillance of sporadic, variant (vCJD) and iatrogenic CJD.
Also included in the report are details of a study on the potential risk factors for variant and sporadic CJD and the work of the National Care Team in arranging care and advice to the families of CJD patients.
Department of Health (2005) Competence and curriculum framework for the medical care practitioner. London: DOH.
Lays out proposals for a new role, Medical Care Practitioners (MCPs), to help doctors and nurses to treat patients in both primary care and hospital settings, as Physician Assistants do in the US.
The government’s intention is that MCPs will be a new type of health professional performing similar duties to junior doctors under consultant supervision. It is anticipated that there will be up to 100 MCPs per Strategic Health Authority when the system is fully working, alongside many more staff working in extended roles within extended scope of practice arrangements.
National Audit Office (2005) A safer place for patients: learning to improve patient safety. London: NAO.
Half of incidents in which NHS hospital patients are unintentionally harmed could have been avoided, if lessons from previous incidents had been learned. The report goes on to say that overall, there remains a clear need to improve evaluation and sharing of lessons and solutions by the large number of organisations with a stake in patient safety. It also says there is a need for a clear system for monitoring that lessons are learned.
NHS Employers (2005) Workplace stress in the NHS. London: NHS Employers.
Aims to help both NHS employers and their staff recognise stress and deal with it effectively. The report states that over 60 per cent of NHS organisations believe up to half their staff may be suffering from workplace stress, according to a new report published today. The report follows a survey carried out during the NHS Confederation annual conference in June 2005.
Health and Safety Executive (2005) Management standards for work-related stress. London: HSE.
Work-related stress is a major cause of occupational ill health. That means sickness absence, high staff turnover and poor performance in your organisation. HSE’s Management Standards will help you, your employees and their representatives manage the issue sensibly and minimise the impact of work-related stress on your business. In fact, it might help you improve organisational performance.
Department of Health (2005) Alcohol Needs Assessment Research Project (ANARP) The 2004 national alcohol needs assessment for England. London: DoH.
Describes the methodology and results of the first ever English needs assessment. It presents information at national and regional level to highlight the range of alcohol use disorders in the population and the range of services currently available to offer treatment for alcohol problems. The report identifies gaps in services and the regional variations in access to current treatment.
Evidence from Journals
Shulman KI, Sykora K, Gill S, et al.
Incidence of delirium in older adults newly prescribed lithium or valproate: a population-based cohort study.
J Clin Psychiatry 2005;66:424–7
Palmer BA, Pankratz VS, Bostwick JM.
The lifetime risk of suicide in schizophrenia: a reexamination.
Arch Gen Psychiatry 2005;62:247–53.
Cooper J, Kapur N, Webb R, et al.
Suicide after deliberate self-harm: a 4-year cohort study.
Am J Psychiatry 2005;162:297–303
Pitkanen T, Lyyra AL, Pulkkinen L.
Age of onset of drinking and the use of alcohol in adulthood: a follow-up study from age 8–42 for females and males.
Addiction 2005;100:652–61.
Barton S, Morley S, Bloxham G, et al.
Sentence completion test for depression (SCD): an idiographic measure of depressive thinking.
Br J Clin Psychol 2005;44:29–46
Garbutt JC, Kranzler HR, O’Malley SS, et al.
Efficacy and tolerability of long-acting injectable naltrexone for alcohol dependence: a randomized controlled trial.
JAMA 2005;293:1617–25.
Findling RL, McNamara NK, Youngstrom EA, et al.
Double-blind 18-month trial of lithium versus divalproex maintenance treatment in pediatric bipolar disorder.
J Am Acad Child Adolesc Psychiatry 2005;44:409–17.
Lam DH, Hayward P, Watkins ER, et al.
Relapse prevention in patients with bipolar disorder: cognitive therapy outcome after 2 years.
Am J Psychiatry 2005;162:324–9
Secker DL, Brown RG.
Cognitive behavioural therapy for carers of patients with Parkinson’s disease: a preliminary randomised controlled trial.
J Neurol Neurosurg Psychiatry 2005;76:491–7
Secker DL, Brown RG.
Cognitive behavioural therapy for carers of patients with Parkinson’s disease: a preliminary randomised controlled trial.
J Neurol Neurosurg Psychiatry 2005;76:491–7
Harpole LH, Williams JW, Olsen MK, et al.
Improving depression outcomes in older adults with comorbid medical illness.
Gen Hosp Psychiatry 2005;27:4–12
Callahan CM, Kroenke K, Counsell SR, et al.
IMPACT Investigators. Treatment of depression improves physical functioning in older adults.
J Am Geriatr Soc 2005;53:367–73.
Szegedi A, Kohnen R, Dienel A, et al.
Acute treatment of moderate to severe depression with hypericum extract WS 5570 (St John’s wort): randomised controlled double blind non-inferiority trial versus paroxetine.
BMJ 2005;330:503
Dennis CL.
Psychosocial and psychological interventions for prevention of postnatal depression: systematic review.
BMJ 2005;331:1–8.
Bryant RA, Moulds ML, Guthrie RM, et al.
The additive benefit of hypnosis and cognitive-behavioral therapy in treating acute stress disorder.
J Consult Clin Psychol 2005;73:334–40
Roy-Byrne PP, Craske MG, Stein MB, et al.
A Randomized effectiveness trial of cognitive-behavioral therapy and medication for primary care panic disorder.
Arch Gen Psychiatry 2005;62:290–8.
Mitte K, Noack P, Steil R, et al.
A meta-analytic review of the efficacy of drug treatment in generalized anxiety disorder.
J Clin Psychopharmacol 2005;25:141–50
Schottenfeld RS, Chawarski MC, Pakes JR, et al.
Methadone versus buprenorphine with contingency management or performance feedback for cocaine and opioid dependence.
Am J Pyschiatry 2005;162:340–8.
Isacsson G, Holmgren P, Ahlner J.
Selective serotonin reuptake inhibitor antidepressants and the risk of suicide: a controlled forensic database study of 14,857 suicides.
Acta Psychiatr Scand 2005;111:286–90
Qin P, Nordentoft M.
Suicide risk in relation to psychiatric hospitalization: evidence based on longitudinal registers.
Arch Gen Psychiatry 2005;62:427–32
McKenna K, Koren G, Tetelbaum M, et al.
Pregnancy outcome of women using atypical antipsychotic drugs: A prospective comparative study.
J Clin Psychiatry 2005;66:444–9.
Munoz RA, McBride ME, Brnabic AJM, et al.
Major depressive disorder in Latin America: the relationship between depression severity, painful somatic symptoms, and quality of life.
J Affect Disord 2005;86:93–8
Strothers HS, Rust G, Minor P, et al.
Disparities in antidepressant treatment in Medicaid elderly diagnosed with depression.
J Am Geriatr Soc 2005;53:456–61
Folsom DP, Hawthorne W, Lindamer L, et al.
Prevalence and risk factors for homelessness and utilization of mental health services among 10,340 patients with serious mental illness in a large public mental health system.
Am J Psychiatry 2005;162:370–6
GAUTHIER S., WIRTH Y., MOBIUS H. J.
Effects of memantine on behavioural symptoms in Alzheimer's disease patients: an analysis of the Neuropsychiatric Inventory (NPI) data of two randomised, controlled studies.
International Journal of Geriatric Psychiatry, 20(5), May 2005, pp.459-464.
PRRELL Martin., et al.
A pilot study examining the effectiveness of maintenance Cognitive Stimulation Therapy (MCST) for people with dementia.
International Journal of Geriatric Psychiatry, 20(5), May 2005, pp.446-451.
Piccart-Gebhart MJ , et al. Trastuzumab after adjuvant chemotherapy in HER2-positive breast cancer. N Engl J Med 2005 Oct 20;353(16):1659-72.
Latest Questions to the Primary Care Question Answering Service
For resistant childood constipation in an 18 month old is there an evidence base supporting the use of Paediatric Movicol ?
Is there any evidence for an extract of white kidney beans used for weight control? Also any evidence that Hoodia gordonii can be used for weight control?
Does porridge for breakfast lower the cholesterol?. If so by how much?
Should I be testing clotting in a young woman who wants to start the combined oral contraceptive pill who has a mother who had a DVT while on COC.?
What exactly is Myofascial syndrome, who do we refer to and what is the best treatment?
Could you advise regarding any up-to-date advice that can be given to Muslim parents who are concerned about the use of pork in the manufacture of MMR vaccines.
Is there any evidence that Depo Provera causes breast enlargement?
Is there any evidence for the use of a very expensive product called VegEPA in treating chronic or post viral fatigue syndrome?
What are the latest guidelines on antibiotics and vaccinations for post-splenectomy patients?
What are the currently preferred treatments for migraine prophyaxis?
What are the currently preferred treatments for acute attacks in migraine?
What should I be advising contact lens wearers who develop conjunctivitis on when they can start wearing their lenses again?
In a patient aged 70 or above with a previous history of thromboembolism, what is the risk of DVT, PE or death with a hip or knee replacement operation
Can Suprax cause kidney damage/failure?
In a patient with congenital adrenal hyperplasia taking 500mcg dexamethasone, how long should they remain on this treatment?
What is the evidence in favour of surgical repair of an asymptomatic thoracic aortic aneurysm of 5.5cm a 77 yr old woman. What is the operative mortality?
What is the evidence that betablockers increase the risk of stroke in hypertension?
What is the latest evidence on colon cancer screening
In the primary prevention on CHD at what level of cholesterol do you need to instigate treatment?
What is the evidence that hip protectors prevent falls in elderly people?
Is there anything to counteract the intermittent sweating caused as a side effect of zoladex injection. The man is 64 well, on 3 monthly 10.8mg zoladex. He has no other medication
In splenectomised patients who cannot take penicillin or erythromycin what are the alternatives?
Please could you inform me of the evidence base for the use of progesterone pessaries in treating Premenstrual Syndrome
I would like a list of the dose of common drugs which might be lethal or severely toxic in overdose?
As a percentage, roughly, what proportion of patients taking long term oral steroids are at risk of osteoporosis or GI complications? Has any research been done into this?
Is there any evidence for the use of anticoagulants (such as low molecular weight heparin) in the treatment of superficial thrombophlebitis?
Can you recommend any evidence-based measures/screening tools (e.g. their validity, sensitivity and items) for Anxiety in Primary Care. In particular, the Beck Anxiety Inventory for Primary Care.
What is current evidence on cardiac risk of taking strenuous exercise with a low BMI ? I am thinking in the 16-17 range...
Is there any evidence that beta blockers reduce the risk of myocardial infarction in hypertensive patients?
Do steroids injections for inflamatory joint disease affect the immune response and hence effectiveness of the flu vaccine, if given at approximately the same time?
What is the latest evidence regarding Brugada syndrome and cardiac defibrillator?
Hitting the Headlines - Evidence Behind the Press Stories
Xolair for treating asthma
A new drug cuts asthma attacks, reported eight newspapers (7 November 2005). The articles were based on a meta-analysis of trials from Novartis' clinical database, which found that Xolair reduced emergency visits by 47% in people with severe asthma; lack of detail makes it difficult to assess the robustness of the findings.
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Six newspaper articles (1-6) reported that Xolair reduces hospital admissions by 47% in people with severe asthma. A further two newspaper articles (7-8) reported that the drug almost halves emergency visits. Most of the articles also reported a 55% reduction in attacks with Xolair.
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The newspaper articles are based on a meta-analysis of seven trials (9) which found that, compared with control, Xolair (omalizumab) reduced all emergency visits by 47%, and hospital admissions by 52%, in people aged 12 years and over with severe asthma. Asthma exacerbations were reduced by 38% compared with controls.
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Apart from a small discrepancy, the newspapers reported the study accurately. The meta-analysis was limited to trials in Novartis' clinical database. It appears to have been quite thorough but, from the information available, it was difficult to assess the robustness of the study. The 55% reduction in exacerbations, reported in seven newspaper articles, appears to relate to an earlier meta-analysis of three trials (10) and is not summarised here.
Evaluation of the evidence base for the effect of treatment with omalizumab on asthma exacerbations and emergency medical visits in patients with severe persistent asthma
Where does the evidence come from?
The research was conducted by J Bousquet of Hôpital Arnaud de Villeneuve, Montpellier France and colleagues from a number of centres including Novartis Horsham Research Centre.
What were the authors' objectives?
The authors' objectives were to examine the effect of omalizumab (which was designed to treat allergic asthma) on exacerbations in people with severe persistent asthma.
What was the nature of the evidence?
This was a meta-analysis of trials of omalizumab from Novartis' clinical database. Seven trials of 4,308 participants aged 12 to 79 years with severe or uncontrolled asthma were included. The length of studies ranged from 24 to 52 weeks.
What interventions were examined in the research?
All participants received omalizumab, given as an injection every two or four weeks, as an add-on therapy to current asthma treatment. This was compared with placebo plus current asthma treatment in five trials and current asthma treatment alone in two trials.
What were the findings?
When the individual studies were combined, the exacerbation rate was 38% lower in participants receiving omalizumab than control and this was statistically significant. This result held true for all subgroups of gender, asthma severity (predicted FEV1), serum total immunoglobulin E, and dosing schedule. However, those in the 65 years and older age category did not experience the benefit, although this may have been due to the small size of the subgroup.
There was also a reduction in the rate of hospitalisations and other unscheduled visits in the omalizumab group compared with control; the annualised incidence of hospital admissions was reduced by 52%, emergency room visits by 61%, unscheduled doctor visits by 43% and total emergency visits by 47%. These differences all reached statistical significance.
What were the authors' conclusions?
The authors concluded that omalizumab may fulfil an important need in people with persistent asthma, many of whom are not adequately controlled in current therapy.
How reliable are the conclusions?
The authors' conclusions seem reasonable, but the study had some limitations that made it difficult to assess the robustness of the findings. Although the study includes both published and unpublished evidence on omalizumab, it was unclear from the description of the study whether all available relevant data had been included. Additionally, the quality of individual studies was not assessed or taken into consideration. No information on safety or quality of life was reported. There was evidence that the studies were not statistically similar enough to combine and possible sources of between study differences could have been more thoroughly investigated. Only limited details of the individual studies were provided making it difficult to assess how clinically similar the studies were.
Systematic reviews
Information staff at CRD searched for systematic reviews relevant to this topic. Systematic reviews are valuable sources of evidence as they locate, appraise and synthesize all available evidence on a particular topic.
There was one related systematic review identified on the Cochrane Database of Systematic Reviews (CDSR) (11) and one on the Database of Abstracts of Reviews of Effects (DARE) (12).
References and resources
1. Hope for sufferers. Daily Star, 7 November 2005, p24.
2. Asthma Jab hope. Daily Mirror, 7 November 2005, p16.
3. Jab KOs asthma. The Sun, 7 November 2005, p30.
4. The £250 jab that halves the risk of an asthma attack. Daily Mail, 7 November 2005, p19
5. New drug attacks causes of asthma. The Independent, 7 November 2005, p19.
6. New asthma drug could halve attacks. The Times, 7 November 2005, p16.
7. Asthma jab could save lives and cut hospital admissions. The Guardian, 7 November 2005, p6.
8. Jab that gives hope to asthma sufferers. Daily Express, 7 November 2005, p15.
12. Davis L A. Omalizumab: a novel therapy for allergic asthma. Annals of Pharmacotherapy 2004; 38(7-8): 1236-1242.
Consumer information
Document of the Week from the National Library for Health
Frequency, type and clinical importance of medication history errors at admission to hospital: a systematic review
Closer collaboration between caregivers, could reduce medication errors.
Closer collaboration between caregivers, could reduce medication errors. The background of this article suggests that more than 25% of hospital prescribing errors occur because the medication histories taken on admission are incomplete. This systematic review shows that the frequency of these errors can be reduced through training, access to community pharmacy databases and "closer teamwork between patients, physicians and pharmacists." NHS Athens passwords are required, and can be obtained from the following link: http://www.nelh.nhs.uk/home_use.asp
What's New from the National Library for Health
Health Libraries Week 14th - 18th November
November 14th – 18th this year sees the 2nd annual Health Libraries Week, co-ordinated by the National Library for Health (NLH) (hyperlink). The aim of the week is to raise the profile of health library services, and increase awareness of the range of library and information services and resources available to those working in healthcare in
Did you know that health library services offer help and advice from skilled staff, journal and book collections – electronic as well as paper, study space and internet access, training courses and current awareness services, search services and document delivery – all designed to help busy healthcare staff find the best available evidence about healthcare matters as quickly as possible.
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