Post 10: December 9th 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
Latest Systematic Reviews
Community pharmacy services to optimise the use of medications for mental illness: a systematic review. Simon Bell , Andrew J McLachlan , Parisa Aslani , Paula Whitehead and Timothy F Chen. Australia and New Zealand Health Policy 2005, 2:29
The objective of this systematic review was to evaluate the impact of pharmacist delivered community-based services to optimise the use of medications for mental illness. Twenty-two controlled (randomised and non-randomised) studies of pharmacists' interventions community and residential aged care settings identified in international scientific literature were included for review. Papers were assessed for study design, service recipient, country of origin, intervention type, number of participating pharmacists, methodological quality and outcome measurement. Three studies showed that pharmacists' medication counselling and treatment monitoring can improve adherence to antidepressant medications among those commencing treatment when calculated using an intention-to-treat analysis. Four trials demonstrated that pharmacist conducted medication reviews may reduce the number of potentially inappropriate medications prescribed to those at high risk of medication misadventure. The results of this review provide some evidence that pharmacists can contribute to optimising the use of medications for mental illness in the community setting. However, more well designed studies are needed to assess the impact of pharmacists as members of community mental health teams and as providers of comprehensive medicines information to people with schizophrenia and bipolar disorder.
Mental Health; Medication; Schizophrenia; Bipolar Disorder; Pharmacists
Latest Guidelines
Consultation on obesity care pathway and resources for primary care
Tackling obesity is a priority for the Government and primary care has a key role to play in the prevention and management of obesity. A comprehensive guidance on prevention and management of obesity is currently under preparation by the National Institute of Clinical Excellence (NICE) and is expected in early 2007. Pending the NICE guidance, the public health White Paper, Choosing Health, is committed to developing an obesity care pathway and a weight loss guide to support weight management in primary care.
Obesity; Primary Care; Care Pathways
Latest Reports
Healthcare Commission (2005) Variations in the experiences of patients in England: analysis of the Healthcare Commission’s 2003/2004. London: Healthcare Commission.
This report includes an analysis that examines national variations in the experiences of patients, using a range of variables (for example, age, gender, ethnicity) based on the survey of patients undertaken during 2003/2004.
Survey Methods; Quality; Patient Satisfaction
London Resilience Team and Regional Public Health Group (2005) London flu pandemic contingency plan prompt document. London:LRT.
As part of the Government's UK-wide Influenza Pandemic Contingency Plan programme of preparation, Regional Resilience Forums (RRF) have been tasked with ensuring that key agencies and organisations in their regions have the effective contingency plans in place to respond to a flu pandemic should one occur, supporting the role of the Department of Health. The London RRF has commissioned the London Resilience Team (LRT) and Regional Public Health Group (RPHG) to work with agencies to ensure that their business continuity arrangements are robust against the likely impact of a flu pandemic and would enable them to maintain essential services. Working together, RPHG and LRT have developed a London Flu Pandemic Contingency Plan Prompt Document.
Influenza; Pandemic; Emergency Planning
Information for the palliative care sector: Healthcare Resource Groups; Payment by Results; HM Treasury’s Cross Cutting Review (full cost recovery)
An information paper has been produced on behalf of the National Partnership Group for Palliative Care.It sets out the situation regarding Healthcare Resource Groups and Payment by Results and the understanding of how these will operate in the specialist palliative care field. Although prepared primarily for the specialist palliative care voluntary sector, the paper will also be of interest to the statutory sector, including commissioners and NHS specialist palliative care service providers.
Palliative Care; Commissioning; Purchasing; Voluntary Sector; Payment by Results
Audit Commission (2005) World class financial management. London: Audit Commission.
Providers of public services are being challenged to consider what they can learn from international examples of world class financial management, in a discussion paper published the Audit Commission. World class financial management examines global excellence in all the key areas of financial management including governance, planning and reporting.
Financial Management; Commissioning; Purchasing>; Public Sector
How Should we Deal with Hospital Failure? Facing the challenges of the new NHS market
One in four NHS trusts in England ended 2004 in deficit. The impact of current NHS reforms will be to magnify financial imbalances at a significant number of trusts, with the risk that some of them will fail. But there is no real plan for dealing with failure in the NHS. This paper outlines proposals for dealing with financial instability by heading off failure before it happens and introducing a regime to manage those failures that cannot be averted. It emphasises the need for mechanisms that not only restore financial viability, but also protect the quality of patient care.
Financial Management; Commissioning; Purchasing>; Public Sector
Monitor(2005) Developing effective commissioning in the NHS. London: Monitor.
In The NHS Plan (2000), the government laid out a vision for system reform aimed at
transforming England’s healthcare system. Many of the conditions needed for reform
have been put in place, including the introduction of NHS foundation trusts and
independent sector provision. The challenge now is embedding these reforms and
ensuring desired outcomes are achieved.
This paper on commissioning is second in a series of publications focusing on areas
of policy critical to the delivery of system reform.
Financial Management; Commissioning; Purchasing>; Public Sector
Evidence from Journals
Ray JG, et al. Cardiovascular health after maternal placental syndromes (CHAMPS): population-based retrospective cohort study. Lancet 2005 Nov 19;366(9499):1797-803.
BACKGROUND
Maternal placental syndromes, including the hypertensive disorders of pregnancy and abruption or infarction of the placenta, probably originate from diseased placental vessels. The syndromes arise most often in women who have metabolic risk factors for cardiovascular disease, including obesity, pre-pregnancy hypertension, diabetes mellitus, and dyslipidaemia. Our aim was to assess the risk of premature vascular disease in women who had had a pregnancy affected by maternal placental syndromes. METHODS: We did a population-based retrospective cohort study in Ontario, Canada, of 1.03 million women who were free from cardiovascular disease before their first documented delivery. We defined the following as maternal placental syndromes: pre-eclampsia, gestational hypertension, placental abruption, and placental infarction. Our primary endpoint was a composite of cardiovascular disease, defined as hospital admission or revascularisation for coronary artery, cerebrovascular, or peripheral artery disease at least 90 days after the delivery discharge date.
FINDINGS
The mean (SD) age of participants was 28.2 (5.5) years at the index delivery, and 75 380 (7%) women were diagnosed with a maternal placental syndrome. The incidence of cardiovascular disease was 500 per million person-years in women who had had a maternal placental syndrome compared with 200 per million in women who had not (adjusted hazard ratio [HR] 2.0, 95 CI 1.7-2.2). This risk was higher in the combined presence of a maternal placental syndrome and poor fetal growth (3.1, 2.2-4.5) or a maternal placental syndrome and intrauterine fetal death (4.4, 2.4-7.9), relative to neither.
INTERPRETATION
The risk of premature cardiovascular disease is higher after a maternal placental syndrome, especially in the presence of fetal compromise. Affected women should have their blood pressure and weight assessed about 6 months postpartum, and a healthy lifestyle should be emphasised.
Maternal Care; Hypertension; Cardiovascular Diseases and Disorders
Uchida H, et al. Combined Treatment With Sulpiride and Paroxetine for Accelerated Response in Patients With Major Depressive Disorder. J Clin Psychopharmacol 2005 Dec;25(6):545-551.
Although serotonin reuptake inhibitors are recommended as first-line agents for major depressive disorder, delayed onset of action is problematic, and faster effective treatment is needed. Sulpiride, a dopamine-mediated agent, has been reported to show faster antidepressant efficacy, and we examined the efficacy of adjunctive sulpiride in combination with paroxetine (PAX), compared with PAX alone, to clarify whether the combined treatment exerts faster effect. Forty-one major depressive disorder patients were enrolled in this 12-week open-label trial and were randomly assigned to a PAX (10-40 mg/d) or a PAX (10-40 mg/d) plus sulpiride (100 mg/d) group. Assessments included the Montgomery-Asberg Depression Rating Scale, the 17-item Hamilton Rating Scale for Depression, and the Zung Self-rating Depression Scale on an intent-to-treat basis, and safety was also monitored. Thirty-three patients completed the study. Both PAX + sulpiride and PAX treatments showed a mean reduction in the total Montgomery-Asberg Depression Rating Scale score of 34.4 to 5.6 and 32.2 to 10.4, respectively (P
Mental Health; Medication; Depression
Prognosis:
The incidence of delirium in older people with a mood disorder is similar with lithium and valproate
James A Bourgeois (commentator)
Evid Based Ment Health 2005; 8: 95.
Mental Health; Old People; Medication
Lifetime risk of suicide in people with schizophrenia lower than commonly reported
Camilla M Haw (commentator)
Evid Based Ment Health 2005; 8: 96.
Mental Health; Suicide
Attendance at accident and emergency for deliberate self harm predicts increased risk of suicide, especially in women
Isaac Sakinofsky (commentator)
Evid Based Ment Health 2005; 8: 97.
Mental Health; Self Harm
Early onset of drinking increases alcohol use in adulthood
Yvonne Bonomo (commentator)
Evid Based Ment Health 2005; 8: 98.
Mental Health; Alcohol Use
Diagnosis:
Third and fourth heart sounds had low sensitivity but moderate to high specificity for predicting left ventricular dysfunction.
Adrian F Hernandez (commentator)
Evid Based Med 2005; 10: 182.
Diagnosis; Coronary Diseases and Disorders
Neurological examination identified 61% of patients with focal cerebral hemisphere lesions but without obvious focal signs
Robert G Holloway (commentator)
Evid Based Med 2005; 10: 183.
Neurological Diseases and Disorders; Diagnosis
The sentence completion test for depression can distinguish between people with and without major depressive disorder
Bernd Löwe (commentator)
Evid Based Ment Health 2005; 8: 99.
Mental Health; Depression; Diagnosis
Therapeutics:
Radical prostatectomy reduced death and progression more than watchful waiting in early prostate cancer
Alastair J Munro (commentator)
Evid Based Med 2005; 10: 168.
Surgery; Prostate Cancer; Cancer
Review: chemotherapy and hormonal therapy reduce recurrence and mortality at 15 years in early breast cancer
Thomas J Smith and James Khatcheressian (commentator)
Evid Based Med 2005; 10: 169.
Surgery; Breast Cancer; Cancer; Chemotherapy
Amlodipine or lisinopril was not better than chlorthalidone for reducing CVD risk in hypertensive black or non-black patients
Mark Rosenberg and Meera Jain (commentator)
Evid Based Med 2005; 10: 170.
Medication; Cardiovascular Diseases and Disorders; Hypertension; Ethnicity
Screening and active management reduced perinatal complications more than routine care in gestational diabetes
Joel G Ray (commentator)
Evid Based Med 2005; 10: 171.
Diabetes; Maternal Care; Screening
A lifestyle intervention or metformin prevented or delayed the onset of metabolic syndrome in persons at risk
Ronald J Sigal (commentator)
Evid Based Med 2005; 10: 172.
Metabolic Syndrome; Medication
Review: group-based education in self management strategies improves outcomes in type 2 diabetes mellitus
Susan S Bjornsen and Steven A Smith (commentator)
Evid Based Med 2005; 10: 173.
Metabolic Syndrome; Medication
Review: {alpha} glucosidase inhibitors improve glycaemic control but have uncertain effects on patient-important outcomes in type 2 diabetes
William L Isley (commentator)
Evid Based Med 2005; 10: 174.
Diabetes; Medication
Review: treatment with ventilation tubes has little effect in children with otitis media with effusion
James Y Paton (commentator)
Evid Based Med 2005; 10: 175.
Otitis+Media
Review: tiotropium reduces exacerbations and hospital admissions in COPD and improves quality of life
Matthew B Stanbrook (commentator)
Evid Based Med 2005; 10: 176.
Chronic Diseases; Medication; COPD
A varicella-zoster virus vaccine reduced the burden of illness of herpes zoster in older adults
Thomas Fekete (commentator)
Evid Based Med 2005; 10: 177.
Vaccination; Old People
A multidimensional non-drug intervention reduced daytime sleep in nursing home residents with sleep problems
Claudia Beghe (commentator)
Evid Based Med 2005; 10: 178.
Sleep Disorders; Old People
Safety of a D-dimer based strategy and repeated ultrasonography did not differ in DVT and normal proximal vein ultrasonography
Scott M Stevens and C Gregory Elliott (commentator)
Evid Based Med 2005; 10: 179.
DVT; Ultrasound
Epidermal lidocaine safely reduced pain in children having venipuncture at the antecubital fossa
Cleo K Hardin (commentator)
Evid Based Med 2005; 10: 180.
Pain; Medication; Venipuncture
Fatty acid supplements did not improve motor function but improved literacy levels in developmental coordination disorder
Alyson Hall (commentator)
Evid Based Med 2005; 10: 181.
Developmental Disorders; Nutritional Supplements
Long acting injectable naltrexone is effective and safe for treating alcohol dependence
Therese K Killeen (commentator)
Evid Based Ment Health 2005; 8: 100.
Mental Health; Medication; Alcohol Use
Bipolar disorder in young people: divalproex sodium no more effective than lithium for maintenance
Gabrielle A Carlson (commentator)
Evid Based Ment Health 2005; 8: 101.
Mental Health; Medication; Bipolar Disorder
Adding cognitive therapy to minimal psychiatric care prevents short term, but not long term, relapse in people with bipolar disorder
Mark A Lau (commentator)
Evid Based Ment Health 2005; 8: 102.
Mental Health; Cognitive Therapy; Bipolar Disorder
Cognitive behavioural therapy reduces psychological distress in carers of people with Parkinson’s disease
Georgina Charlesworth (commentator)
Evid Based Ment Health 2005; 8: 103.
Mental Health; Cognitive Therapy; Parkinson's Disease
Some psychosocial therapies may reduce depression, aggression, or apathy in people with dementia
Nathan Herrmann (commentator)
Evid Based Ment Health 2005; 8: 104.
Mental Health; Psychosocial Therapies; Depression; Apathy; Aggression
Collaborative care depression management for older adults: level of comorbidity does not affect outcome
David K Conn (commentator)
Evid Based Ment Health 2005; 8: 105.
Mental Health; Old People; Depression
Collaborative care management improves physical functioning in older people with depression
Martine A Buist-Bouwman (commentator)
Evid Based Ment Health 2005; 8: 106.
Mental Health; Old People; Depression
St John’s wort is at least as effective as paroxetine in reducing severity of depression and is better tolerated
Professor Edzard Ernst (commentator)
Evid Based Ment Health 2005; 8: 107.
Mental Health; Depression
Postnatal home visits from healthcare professionals show promise for preventing postnatal depression
Frances A Carter (commentator)
Evid Based Ment Health 2005; 8: 108.
Mental Health; Postnatal Depression; Maternal Care
Adding hypnosis to cognitive behavioural therapy may reduce some acute stress disorder symptoms
Dr Jonathan I Bisson (commentator)
Evid Based Ment Health 2005; 8: 109.
Mental Health; Cognitive Therapy; Stress; Hypnosis
Coordinated care consisting of cognitive behavioural therapy plus medication improves panic disorder
Dr Shailesh Kumar (commentator)
Evid Based Ment Health 2005; 8: 110.
Mental Health; Cognitive Therapy; Stress
Pharmacotherapy is an effective treatment option for generalised anxiety disorder
Richard P Swinson (commentator)
Evid Based Ment Health 2005; 8: 111.
Mental Health; Medication; Anxiety
Methadone plus contingency management or performance feedback reduces cocaine and opiate use in people with drug addiction
Nancy M Petry (commentator)
Evid Based Ment Health 2005; 8: 112.
Mental Health; Medication; Drug Use
Aetiology:
Perinatal environmental factors and parental psychopathology were associated with risk of autism in Danish children
Joachim Hallmayer (commentator)
Evid Based Med 2005; 10: 184.
Autism; Environment
Forensic database study suggests selective serotonin reuptake inhibitors do not increase the risk of suicide in people taking antidepressants
Andrea Cipriani (commentator)
Evid Based Ment Health 2005; 8: 113.
Mental Health; Medication; Suicide
Suicide risk peaks in first week of psychiatric hospitalisation and post-discharge
Paul S Links (commentator)
Evid Based Ment Health 2005; 8: 114.
Mental Health; Medication; Maternal Care
Atypical antipsychotic use during the first trimester of pregnancy may not increase major malformations
Louise M Howard (commentator)
Evid Based Ment Health 2005; 8: 115.
Mental Health; Medication; Maternal+Care
Economics:
Review: prompt endoscopy is not a cost effective strategy for initial management of dyspepsia
Nicholas J Talley (commentator)
Evid Based Med 2005; 10: 185
Cost Effectiveness; Endoscopy; Dyspepsia
Prevalence
Comorbid pain related somatisation is common in Latin Americans with major depressive disorder
Stacey Hart (commentator)
Evid Based Ment Health 2005; 8: 116.
Mental Health; Pain; Depression
Prescription of pharmacotherapy for depression in elderly people varies with age, race, gender, and length of care
Stephen Crystal (commentator)
Evid Based Ment Health 2005; 8: 117.
Mental Health; Old People; Medication; Ethnicity; Gender
Fifteen per cent of people treated for mental health disorders are homeless
Stephen W Hwang (commentator)
Evid Based Ment Health 2005; 8: 118.
Mental Health; Homelessness
Clinical Prediction Guide:
A web-based clinical prediction tool predicted 10 year survival in breast cancer
Chris Williams (commentator)
Evid Based Med 2005; 10: 186.
Breast Cancer
An algorithm comprising 7 baseline variables predicted the 2 year work disability status in non-specific back pain
Arthur T Evans and Nortin M Hadler (commentator)
Evid Based Med 2005; 10: 187.
Back Pain; Disability
Hitting the Headlines - Evidence Behind the Press Stories
Asthma inhalers 'can lead to attacks'
Inhalers used for short-term asthma relief can increase the risk of attacks if used regularly, reported the Daily Telegraph (5 December 2005). The research was accurately summarised; however lack of details in the study report means that it is difficult to assess the significance and robustness of the findings.
- On 5 December 2005, the Daily Telegraph (1) reported that regular use of short-acting inhalers such as salbutamol (albuterol) can increase the risk of severe asthma attacks within the next month. They report that similar use of long-acting inhalers can decrease the risk.
- The newspaper article was based on a study published in Nature (2). The study analysed data on 80 asthma sufferers that were part of a well-conducted randomised controlled trial (RCT) involving 165 people (3). Participants were all non-smokers with stable mild to moderate asthma who received regular short-acting albuterol, regular long-acting salmeterol and placebo separately for six months each. The analysis showed that regular short-acting albuterol increased the risk of moderate and severe asthma attacks within one month compared to salmeterol and placebo.
- The newspaper report was a generally accurate summary of the analysis study. However no details about the characteristics of the participants included in the analysis and some significance values were not reported. It is unclear the extent to which these results are clinically significant and how applicable the results may be to other people suffering from asthma.
Evaluation of the evidence base for predicting the risk of severe asthma from fluctuation analysis of airway function.
Where does the evidence come from?
The research was conducted by Urs Frey of the University Hospital of Berne, Switzerland and colleagues from a number of international centres.
What were the authors' objectives?
The objective of this study was to introduce an approach to predict the risk of worsening airflow function using peak expiratory flow (PEF) measures over time.
What was the nature of the evidence?
This was a time series analysis using data from a previously published, randomised, placebo-controlled double-blind crossover study (n=165). Participants included in the trial were all non-smoking individuals with stable mild to moderate bronchial asthma. The analysis was based on a small subset of participants (80 out of 165) for whom sufficient data were recorded in the RCT (those with less than 3% of their values missing). The outcomes analysed in this study are 300 consecutive, twice-daily PEF measurements together with daily asthma symptom scores.
What interventions were examined in the research?
Participants in the trial were randomised to receive each of three treatments: salmeterol 50µg twice daily (long-acting period); albuterol 400µg four times per day (short-acting period) or placebo. Participants all received similar mean daily doses of corticosteroids throughout the trial. There was a four-week run-in period and each treatment was administered for 24 weeks and was followed by a four-week 'washout' period using only placebo.
What were the findings?
The daily asthma symptom scores for each treatment group were averaged and normalised. The scores were statistically significantly lower for those receiving salmeterol compared to those receiving albuterol or placebo - indicating better asthma control was obtained during the long-acting period.
The time series analyses showed that the mean PEF values were statistically significantly higher for those in the long-acting period compared to the short-acting period and the placebo period. The variability within each of the series was statistically significantly higher during the short-acting period compared to either the long-acting or placebo period. This implies that better improved airway control is obtained with salmeterol and that albuterol is associated with increased instability of airway function.
Conditional probabilities that assessed the risk of significant deterioration in airway obstruction were calculated. The probabilities were designed to predict the chance of deterioration, defined as PEF<80%>
What were the authors' conclusions?
The authors conclude that the model used to predict the risk of asthma exacerbations in patients based on PEF values can have practical benefits for patient management. Using this model in this analysis showed that regular use of short-acting bronchodilators may increase the risk of asthma episodes, whereas regular long-acting bronchodilators are more effective at stabilising airway function over extended periods.
How reliable are the conclusions?
The authors' conclusions seem reasonable, but the study had some limitations that make it difficult to assess the robustness of the findings.
The data used in this study were obtained from a well-conducted RCT. However this study was based on the analysis of a small subset of participants for whom sufficient data were recorded in the trial. No details about the characteristics of these participants are reported in this study; therefore it is unclear whether this subset differs from the other trial participants, which could affect the reliability of the results.
It is unclear whether the reported p-values of the conditional probabilities relate to moderate or severe deterioration in airway function. It is not reported whether any corrections were made to account for the multiple comparisons that were undertaken. No p-values were reported relating to the apparent increased risk of moderate or severe deterioration associated with regular use of short-acting albuterol. Therefore, it is not clear whether this finding is statistically or, more importantly, clinically significant.
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 reviews identified on the Cochrane Database of Systematic Reviews (CDSR) (4). There were no related reviews on the Database of Abstracts of Reviews of Effects (DARE).
References and resources
1. Asthma inhalers 'can lead to attacks'. Daily Telegraph, 5 December 2005, p8.
2. Frey U, Brodbeck T, Majumdar A, Taylor DR, Town GI, Silverman M, Suki B. Risk of severe asthma episodes predicted from fluctuation analysis of airway function. Nature 2005;439:667-670.
3. Taylor DR, Town GI, Herbison GP et al. Asthma control during long term treatment with regular inhaled salbutamol and salmeterol. Thorax 1998;53:744-752.
4. Ram FSF, Brocklebank DM, White J, Wright JP, Jones PW. Pressurised metered dose inhalers versus all other hand-held inhaler devices to deliver beta-2 agonist bronchodilators for non-acute asthma. The Cochrane Database of Systematic Reviews 2002, Issue 2. Art. No.: CD002158. DOI: 10.1002/14651858.CD002158
5. NHS Centre for Reviews and Dissemination. Inhaler devices for the management of asthma and COPD. Effective Health Care 2003;8(1).
Consumer information
Asthma UK
NHS Direct: Asthma
British Thoracic Society
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Respirator; Hypertension; Cardiovascular Diseases and Disorders
Document of the Week from the National Library for Health
Ten commandments for effective clinical decision support
The authors of this article, published in the Journal of the American Medical Informatics Association, have spent the last eight years looking at the impact of decision support in a variety of situations, to find the important elements of success.
Informatics; Decision Support
What's New from the National Library for Health
Migration of DLNet Content to NLH
As part of the migration from NeLH to NLH, the DLNet pages will no longer be updated. Up to date content will begin appearing on the 'For Librarians' pages of NLH shortly.
Librarianship
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