Post 9: December 2nd 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
Salpeter S, et al. Cardioselective beta-blockers for chronic obstructive pulmonary disease. Cochrane Database Syst Rev 2005 Oct 19;4:CD003566.
Long term treatment with beta-blocker medication reduces the risk of death in patients with hypertension, heart failure and coronary artery disease, yet patients with COPD in addition to their cardiovascular disease seldom receive these medicines because of fears that they may worsen the airways disease. This review of data from 20 randomised controlled trials on the use of cardioselective beta-blockers in patients with COPD demonstrated no adverse effect on lung function or respiratory symptoms compared to placebo. This finding was consistent whether patients had severe airways chronic airways obstruction or a reversible obstructive component. In conclusion, cardioselective beta-blockers should not be withheld from patients with COPD.
COPD; Medication; Beta-blockers; Chronic Diseases
The effectiveness of the Heidelberg Retina Tomograph and laser diagnostic glaucoma scanning system (GDx) in detecting and monitoring glaucoma (Kwartz) 148 pages, Volume 9, number 46
The findings of the glaucoma imaging study suggest that, although optic nerve head tomography and scanning laser polarimetry provide good-quality digital images, their data may contribute little to a patient's clinical diagnosis but would add significantly to the cost of their assessment.
Glaucoma; Health Technology Assessment
Newborn screening for congenital heart defects: a systematic review and cost-effectiveness analysis (Knowles) 168 pages, Volume 9, number 44
Study findings suggest that the current programme to detect congenital heart defects through newborn screening performs poorly and lacks monitoring of quality assurance, performance management and longer term outcomes. Pulse oximetry is a promising alternative newborn screening strategy and requires further evaluation.
Screening; Health Technology Assessment; Congenital Heart Defects; Pulse Oximetry; Cost Effectiveness;Coronary Diseases and Disorder
The clinical and cost-effectiveness of left ventricular assist devices for end- stage heart failures: a systematic review and economic evaluation (Clegg) 148 pages, Volume 9, number 45
Study found that while left ventricular assist devices appear to be effective in improving the survival of patients with end-stage heart failure, more work is needed on the methodological quality and strength of the evidence to support this.
Screening; Health Technology Assessment; Congenital Heart Defects; Pulse Oximetry; Cost Effectiveness; Coronary Diseases and Disorders
Latest Technology Assessments and Appraisals
Review of NICE Technology Appraisal Guidance No.41 Routine anti-d prophylaxis in Rh-ve women
Anti-D Prophylaxis; Health Technology Assessment; Medication
Review Proposal: NICE Technology Appraisal Guidance No.58 zanamivir, oseltamivir and amantadine for the treatment of influenza: Proposal to move guidance to the static list
Influenza; Health Technology Assessment; Medication
Review of NICE Technology Appraisal Guidance No.47, glycoprotein IIb/IIIa inhibitors in the treatment of acute coronary syndromes
Influenza; Health Technology Assessment; Medication
Latest Guidelines
New UK and international guidelines on CPR
Following our report that the American Heart Association had announced new guidelines for cardiopulmonary resuscitation (CPR), the UK version has been posted and an early release BMJ editorial discusses them. The new guidelines have come from an international initiative that recognises the common core science and differing local needs for CPR guidelines. This initiative arises from global cooperation coordinated by the International Liaison Committee on Resuscitation, and has produced a global consensus statement providing both content and a framework that can be adapted as required to suit local needs and resources. A European version of the guidelines has been developed by the European Resuscitation Council and these have been adopted unchanged by the UK. As previously noted, they include a greater emphasis on chest compression than before, recommending a new ratio of compressions to rescue breaths - 30:2 under most circumstances (previously 15:2). The emphasis is on minimising interruptions to chest compression, and there is new guidance on use of automated defibrillators.
The consensus statement and the European version of the guidelines are available for download from the European Resuscitation Council (see link). The UK version can be found on the Resuscitation Council (UK) website (see link).
Resuscitation; Clinical Guidelines
SIGN (2005) Bronchiolitis in Children: A national clinical guideline. Endinburgh: SIGN.
This guideline provides evidence based recommendations on the prevention, diagnosis, investigation, treatment and management of bronchiolitis in children.
Respiratory Tract Diseases and Disorders; Clinical Guidelines
Proposals for making the guideline development process more efficient
Consultation document
The National Institute for Health and Clinical Excellence (NICE) has published a consultation document which sets out changes that it is proposing to the process and methodology for developing clinical guidelines. The consultation runs until 17 February 2006.
Clinical Guidelines
Latest Reports
Commissioning children and young people’s palliative care services: a practical guide for the NHS Commissioners
The Department of Health has issued a guide to support healthcare organisations in their work with local authorities and other partners to develop children’s palliative care services. It will help commissioners of health services to apply the children’s NSF in their strategic development and delivery of children’s palliative care.
Palliative Care; Commissioning; Paediatrics
Defining a good mental health service
The Sainsbury Centre for Mental Health (SCMH) has set out what mental health services might be like in 2010 if they were to meet all government guidance and targets. Defining a good mental health service shows how much need is known to exist for the range of mental health services the government has pledged to establish. It examines what resources, especially staff, would be required to meet that need. It covers the full range of mental health services for working age adults, from primary care to specialist teams, and from eating disorder services to prison inreach teams. SCMH is inviting comments - email costsconsultation@scmh.org.uk - from all those who use, work in or work with mental health services.
Mental Health
Policy Position: NICE and Herceptin
The recent intervention by Secretary of State for Health Patricia Hewitt in the row over the use of the breast cancer drug Herceptin has once more raised questions about how decisions should be reached about the costs and benefits of new drugs and therapies in the NHS. King's Fund Policy Position.
Cancer; Medication
RCGP view on the White Paper on care outside of hospitals
Writing about the Department of Health’s White Paper on care outside of hospitals due to be published late 2005/early 2006, Dr Lakhani outlines the issues that the RCGP will be bringing to the attention of the Secretary of State in order to influence and shape the White Paper.
Primary Care; NHS Reform
Shaping the future of out-of-hospital care – the NHS Confederation’s response to the consultation
The Confederation entirely agrees with the direction of travel emerging from the public consultation. Working with our members, we have developed a set of principles to help the Government test proposals and support members in developing services. There is no single right answer to how services can be run and solutions must be locally determined.
Primary Care; NHS Reform
Evidence from Journals
Primary care use of antipsychotic drugs: an audit and intervention study
Ann M Mortimer , Charles J Shepherd , Mike Rymer and Alison Burrows
Annals of General Psychiatry 2005, 4:18
Background
Concerns regarding the use of antipsychotic medication in secondary care suggested an examination of primary care prescribing. Aim: To audit and intervene in the suboptimal prescribing of antipsychotic drugs to primary care patients. Design of study: Cross-sectional prevalence: subsequent open treatment intervention. Setting: Seven of the 29 practices in the Eastern Hull Primary Care Trust.
Methods
Criteria for best practice were developed, against which prescribing standards were tested via audit. Patients identified as suboptimally prescribed for were invited to attend an expert review for intervention.
Results
1 in 100 of 53,000 patients was prescribed antipsychotic treatment. Diagnoses indicating this were impossible to ascertain reliably. Half the regimes failed one or more audit criteria, leaving diagnosis aside. Few practices agreed to patients being approached: of 179 invitations sent, only 40 patients attended. Of 32 still taking an antipsychotic drug, 26 required changes. Mean audit criteria failed were 3.4, lack of psychotic disorder diagnosis and problematic side effects being most frequent. Changes were fully implemented in only 16 patients: reasons for complete or partial failure to implement recommendations included the wishes or inaction of patients and professionals, and worsening of symptoms including two cases of antipsychotic withdrawal syndrome.
Conclusions
Primary care prescribing of antipsychotic drugs is infrequent, but most is unsatisfactory. Intervention is hampered by pluralistic reluctance: even with expert guidance, rationalisation is not without risk. Use of antipsychotic drugs in primary care patients whose diagnosis does not warrant this should be avoided. How this fits in: This study adds to concerns regarding high levels of off-licence use of potentially harmful medication. It adds evidence of major difficulties in rationalizing suboptimal regimes despite expert input. Relevance to the clinician is that it is better to avoid such regimes in the first place especially if there is no clear 'exit strategy': if in doubt, seek a specialist opinion.
Mental Health; Medication
Mazieres B, et al. Topical ketoprofen patch in the treatment of tendinitis: a randomized, double blind, placebo controlled study. J Rheumatol 2005 Aug;32(8):1563-70.
Objective
To evaluate the efficacy and tolerability of ketoprofen patch in the treatment of tendinitis.
Methods
A multicenter, 14 day, randomized, double blind placebo controlled trial of a once-a-day ketoprofen 100 mg patch in symptomatic tendinitis of recent onset, not requiring orthopedic or surgical treatment. Pain on daily activities scored on a 100 mm visual analog scale was the primary efficacy criterion. Other criteria were spontaneous pain at rest, pain on full passive motion, pain relief, and pain intensity assessed twice daily by the patient (calculation of total pain relief and summed time-weighted pain intensity difference). Statistical analysis was performed on the differences between the 2 groups in the intention-to-treat population.
Results
One hundred seventy-two patients were included. Good compliance was obtained in 98% of patients. Twenty-six patients (15%) discontinued the study mainly because of adverse events, inefficacy, or cure. Decrease in pain after one week of treatment (primary criterion) was -38.4 +/- 25.6 mm (56%) and -25.8 +/- 24.5 mm (37%) in the ketoprofen and placebo groups, respectively (p = 0.0013). The differences of the secondary criteria during the trial between the 2 groups were significant more often than not. Tolerance was considered satisfactory in both groups, most adverse events reported being local reactions: 47 versus 44 were possibly or probably related to treatment in the ketoprofen and placebo groups, respectively. These local skin reactions resolved spontaneously and rarely led to premature termination of treatment.
Conclusion
This trial suggested that a 3-14 day course of treatment by ketoprofen patch is useful in nonarticular rheumatisms, the duration of treatment depending on the results obtained. The safety profile revealed no unexpected adverse events.
Coronary Diseases and Disorders; Medication
Trials
Latest Questions to the Primary Care Question Answering Service
CAUSES, RISKS AND PREVENTION
Are new generation antihistamines like cetirizine loratadine desloratadine safe to use in pregnant women?
Maternal Care; Medication
A child of 3 who had the first MMR in July (delayed because of autism fears) is now due a pre-school booster. Is it too early for MMR be included in this? Is it better to delay the MMR booster or give it now?
MMR; Medication
Balancing potential harms with possible benefits, is there guidance from research about alternating doses of ibuprofen and paracetamol in children as an antipyretic treatment?
Medication
Is there a limit on how long a patient can be be kept on cyproterone acetate for hirsuitism?
MMR; Medication
ASSESSMENT AND DIAGNOSIS
How long does serum and urine HCG stay positive /detectable in pregnany?
Maternal Care; Diagnosis
Are there any statistics available to support the suggestion that there is an increase in numbers of patients diagnosed with allergic rhinitis while asthma rates are falling?
Asthma; Diagnosis
In the diagnosis and/or monitoring of asthma or COPD, should reversibility testing be employed? If so, which short acting beta agonists and anticholinergic drugs should be used and at which dosage?
Asthma; Diagnosis; COPD
Routine smear test on a 28 year old woman with IUCD in situ shows normal cells but the report cites Actinomycoses as a "specific infection", no other details. What is the most appropriate response?
Smear Tests; Diagnosis
Do pigmented lesions on the palms and soles have a higher risk of becoming malignant than equivalent lesions on other parts of the body?
Lesions; Assessment
What advice should women on yasmin be given about its interaction with NSAIDs and when is blood monitoring of U&Es necessary in such cases?
Lesions; Medication; Blood Monitoring
NEUROLOGICAL DISEASE
I have been asked by a 56 year old MS sufferer about Sativex(cannaboid derivative) for muscle spasms I saw a recent press release related to its availability on license how can I prescribe it and where can I get guidance on prescribing recommendations?
Neurological Diseases and Disorders; Medication
What is the role of oestrogen supplements in menstrual migraine?
Neurological Diseases and Disorders; Medication
MENTAL HEALTH
Is there any evidence for oral testosterone decanoate in improving mood?
Mental Health; Medication
GENITOURINARY - MALE
What is the reported incidence of significant side effects arising from use of trimethoprim in the elderly / those with renal compromise. What is the best alternative?
Genitourinary Diseases and Disorders; Medication; Renal Diseases and Disorders
SKIN CONDITIONS
In female patients with hair secondary to drugs (methotrexate) is there any evidence for the use of minoxidil ?
Dermatological Diseases and Disorders; Medication
COMPLEMENTARY MEDICINE
Is there any evidence that cerasomal-cis-9-cetylmyristoleate is beneficial for arthritis?
Complementary Medicine; Arthritis
MUSCULOSKELETAL DISEASE
How should a woman of 37 on regular depot provera who has osteopaenia on her DEXA scan be managed?
Muskuloskeletal Diseases and Disorders; Medication
CARDIOVASCULAR DISEASES
Is there any evidence that I should prescribe ACE Inhibitors like perindopril or ramipril routinely to my angina patients who have never had an MI or stroke?
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
Salpeter S, et al. Cardioselective beta-blockers for chronic obstructive pulmonary disease. Cochrane Database Syst Rev 2005 Oct 19;4:CD003566.
Long term treatment with beta-blocker medication reduces the risk of death in patients with hypertension, heart failure and coronary artery disease, yet patients with COPD in addition to their cardiovascular disease seldom receive these medicines because of fears that they may worsen the airways disease. This review of data from 20 randomised controlled trials on the use of cardioselective beta-blockers in patients with COPD demonstrated no adverse effect on lung function or respiratory symptoms compared to placebo. This finding was consistent whether patients had severe airways chronic airways obstruction or a reversible obstructive component. In conclusion, cardioselective beta-blockers should not be withheld from patients with COPD.
COPD; Medication; Beta-blockers; Chronic Diseases
The effectiveness of the Heidelberg Retina Tomograph and laser diagnostic glaucoma scanning system (GDx) in detecting and monitoring glaucoma (Kwartz) 148 pages, Volume 9, number 46
The findings of the glaucoma imaging study suggest that, although optic nerve head tomography and scanning laser polarimetry provide good-quality digital images, their data may contribute little to a patient's clinical diagnosis but would add significantly to the cost of their assessment.
Glaucoma; Health Technology Assessment
Newborn screening for congenital heart defects: a systematic review and cost-effectiveness analysis (Knowles) 168 pages, Volume 9, number 44
Study findings suggest that the current programme to detect congenital heart defects through newborn screening performs poorly and lacks monitoring of quality assurance, performance management and longer term outcomes. Pulse oximetry is a promising alternative newborn screening strategy and requires further evaluation.
Screening; Health Technology Assessment; Congenital Heart Defects; Pulse Oximetry; Cost Effectiveness;Coronary Diseases and Disorder
The clinical and cost-effectiveness of left ventricular assist devices for end- stage heart failures: a systematic review and economic evaluation (Clegg) 148 pages, Volume 9, number 45
Study found that while left ventricular assist devices appear to be effective in improving the survival of patients with end-stage heart failure, more work is needed on the methodological quality and strength of the evidence to support this.
Screening; Health Technology Assessment; Congenital Heart Defects; Pulse Oximetry; Cost Effectiveness; Coronary Diseases and Disorders
Latest Technology Assessments and Appraisals
Review of NICE Technology Appraisal Guidance No.41 Routine anti-d prophylaxis in Rh-ve women
Anti-D Prophylaxis; Health Technology Assessment; Medication
Review Proposal: NICE Technology Appraisal Guidance No.58 zanamivir, oseltamivir and amantadine for the treatment of influenza: Proposal to move guidance to the static list
Influenza; Health Technology Assessment; Medication
Review of NICE Technology Appraisal Guidance No.47, glycoprotein IIb/IIIa inhibitors in the treatment of acute coronary syndromes
Influenza; Health Technology Assessment; Medication
Latest Guidelines
Latest Reports
Evidence from Journals
Primary care use of antipsychotic drugs: an audit and intervention study
Ann M Mortimer , Charles J Shepherd , Mike Rymer and Alison Burrows
Annals of General Psychiatry 2005, 4:18
Background
Concerns regarding the use of antipsychotic medication in secondary care suggested an examination of primary care prescribing. Aim: To audit and intervene in the suboptimal prescribing of antipsychotic drugs to primary care patients. Design of study: Cross-sectional prevalence: subsequent open treatment intervention. Setting: Seven of the 29 practices in the Eastern Hull Primary Care Trust.
Methods
Criteria for best practice were developed, against which prescribing standards were tested via audit. Patients identified as suboptimally prescribed for were invited to attend an expert review for intervention.
Results
1 in 100 of 53,000 patients was prescribed antipsychotic treatment. Diagnoses indicating this were impossible to ascertain reliably. Half the regimes failed one or more audit criteria, leaving diagnosis aside. Few practices agreed to patients being approached: of 179 invitations sent, only 40 patients attended. Of 32 still taking an antipsychotic drug, 26 required changes. Mean audit criteria failed were 3.4, lack of psychotic disorder diagnosis and problematic side effects being most frequent. Changes were fully implemented in only 16 patients: reasons for complete or partial failure to implement recommendations included the wishes or inaction of patients and professionals, and worsening of symptoms including two cases of antipsychotic withdrawal syndrome.
Conclusions
Primary care prescribing of antipsychotic drugs is infrequent, but most is unsatisfactory. Intervention is hampered by pluralistic reluctance: even with expert guidance, rationalisation is not without risk. Use of antipsychotic drugs in primary care patients whose diagnosis does not warrant this should be avoided. How this fits in: This study adds to concerns regarding high levels of off-licence use of potentially harmful medication. It adds evidence of major difficulties in rationalizing suboptimal regimes despite expert input. Relevance to the clinician is that it is better to avoid such regimes in the first place especially if there is no clear 'exit strategy': if in doubt, seek a specialist opinion
Mazieres B, et al. Topical ketoprofen patch in the treatment of tendinitis: a randomized, double blind, placebo controlled study. J Rheumatol 2005 Aug;32(8):1563-70.
Objective
To evaluate the efficacy and tolerability of ketoprofen patch in the treatment of tendinitis.
Methods
A multicenter, 14 day, randomized, double blind placebo controlled trial of a once-a-day ketoprofen 100 mg patch in symptomatic tendinitis of recent onset, not requiring orthopedic or surgical treatment. Pain on daily activities scored on a 100 mm visual analog scale was the primary efficacy criterion. Other criteria were spontaneous pain at rest, pain on full passive motion, pain relief, and pain intensity assessed twice daily by the patient (calculation of total pain relief and summed time-weighted pain intensity difference). Statistical analysis was performed on the differences between the 2 groups in the intention-to-treat population.
Results
One hundred seventy-two patients were included. Good compliance was obtained in 98% of patients. Twenty-six patients (15%) discontinued the study mainly because of adverse events, inefficacy, or cure. Decrease in pain after one week of treatment (primary criterion) was -38.4 +/- 25.6 mm (56%) and -25.8 +/- 24.5 mm (37%) in the ketoprofen and placebo groups, respectively (p = 0.0013). The differences of the secondary criteria during the trial between the 2 groups were significant more often than not. Tolerance was considered satisfactory in both groups, most adverse events reported being local reactions: 47 versus 44 were possibly or probably related to treatment in the ketoprofen and placebo groups, respectively. These local skin reactions resolved spontaneously and rarely led to premature termination of treatment.
Conclusion
This trial suggested that a 3-14 day course of treatment by ketoprofen patch is useful in nonarticular rheumatisms, the duration of treatment depending on the results obtained. The safety profile revealed no unexpected adverse events.
Trials
Latest Questions to the Primary Care Question Answering Service
CAUSES, RISKS AND PREVENTION
Are new generation antihistamines like cetirizine loratadine desloratadine safe to use in pregnant women?
Maternal Care; Medication
A child of 3 who had the first MMR in July (delayed because of autism fears) is now due a pre-school booster. Is it too early for MMR be included in this? Is it better to delay the MMR booster or give it now?
MMR; Medication
Balancing potential harms with possible benefits, is there guidance from research about alternating doses of ibuprofen and paracetamol in children as an antipyretic treatment?
Medication
Is there a limit on how long a patient can be be kept on cyproterone acetate for hirsuitism?
MMR; Medication
ASSESSMENT AND DIAGNOSIS
How long does serum and urine HCG stay positive /detectable in pregnany?
Maternal Care; Diagnosis
Are there any statistics available to support the suggestion that there is an increase in numbers of patients diagnosed with allergic rhinitis while asthma rates are falling?
Asthma; Diagnosis
In the diagnosis and/or monitoring of asthma or COPD, should reversibility testing be employed? If so, which short acting beta agonists and anticholinergic drugs should be used and at which dosage?
Asthma; Diagnosis; COPD
Routine smear test on a 28 year old woman with IUCD in situ shows normal cells but the report cites Actinomycoses as a "specific infection", no other details. What is the most appropriate response?
Smear Tests; Diagnosis
Do pigmented lesions on the palms and soles have a higher risk of becoming malignant than equivalent lesions on other parts of the body?
Lesions; Assessment
What advice should women on yasmin be given about its interaction with NSAIDs and when is blood monitoring of U&Es necessary in such cases?
Lesions; Medication; Blood Monitoring
NEUROLOGICAL DISEASE
I have been asked by a 56 year old MS sufferer about Sativex(cannaboid derivative) for muscle spasms I saw a recent press release related to its availability on license how can I prescribe it and where can I get guidance on prescribing recommendations?
Neurological Diseases and Disorders; Medication
What is the role of oestrogen supplements in menstrual migraine?
Neurological Diseases and Disorders; Medication
MENTAL HEALTH
Is there any evidence for oral testosterone decanoate in improving mood?
Mental Health; Medication
GENITOURINARY - MALE
What is the reported incidence of significant side effects arising from use of trimethoprim in the elderly / those with renal compromise. What is the best alternative?
Genitourinary Diseases and Disorders; Medication; Renal Diseases and Disorders
SKIN CONDITIONS
In female patients with hair secondary to drugs (methotrexate) is there any evidence for the use of minoxidil ?
Dermatological Diseases and Disorders; Medication
COMPLEMENTARY MEDICINE
Is there any evidence that cerasomal-cis-9-cetylmyristoleate is beneficial for arthritis?
Complementary Medicine; Arthritis
MUSCULOSKELETAL DISEASE
How should a woman of 37 on regular depot provera who has osteopaenia on her DEXA scan be managed?
Coronary Diseases and Disorders; Medication
In patients who are diagnosed as HIV positive on antiretroviral medication who are also found to have essential hypertension, are there any contra-indications to the use of anti-hypertensives?
HIV; Hypertension; Medication
Does a middle-aged patient with a history of childhood rheumatic fever who is clinically well and has no murmur on auscultation, require echocardiography and/or prophylaxis for dental procedures?
Dental Health Services; Medication
Hitting the Headlines - Evidence Behind the Press Stories
Surgery for headache
Surgery has been successfully used to treat tension headaches, reported the Daily Mail (29 November 2005). The report accurately summarised a small study of 12 people, noting the need for further research and that surgery is likely to be a treatment of last resort for most people with frequent headaches.
Surgery has been successfully used to treat tension headaches, reported the Daily Mail (29 November 2005). The report accurately summarised a small study of 12 people, noting the need for further research and that surgery is likely to be a treatment of last resort for most people with frequent headaches.
-
On 29 November 2005, the Daily Mail (1) reported that surgeons in the USA have for the first time used surgery to treat patients with frequent tension headaches.
-
The report was based on a small study (2) of patients undergoing surgery to the brow for cosmetic reasons. Twelve patients who suffered frequent tension and/or migraine headaches were asked to complete a questionnaire before and after surgery. All 12 patients had less frequent headaches after surgery and 11 reported less intense headaches. Four of the seven patients, who suffered from tension headaches only, reported complete relief of their headaches.
-
The newspaper's report was a generally accurate summary of this small uncontrolled study. However, the use of 'cures' in the headline was inappropriate as it overstated the success of the treatment. The report included a comment from the Migraine Action Association noting that more research is needed and that surgery would be a last resort for most patients with headaches.
Evaluation of the evidence base for surgery for tension headaches
Where does the evidence come from?
The research was conducted by Dr William H. Bearden and Dr Richard L. Anderson at the Center for Facial Appearances in Salt Lake City, USA.
What were the authors' objectives?
To investigate the effect of excision of the corrugator superciliaris muscles (the muscles above the eye that move the eyebrow) on patients with frequent tension and/or migraine headaches originating from or localised in the glabellar (brow) or frontal regions.
What was the nature of the evidence?
The research study included 12 people already scheduled to undergo surgery for cosmetic reasons. Before surgery, each participant completed a questionnaire regarding onset, frequency, severity, duration and location of headaches. All the participants reported experiencing tension headaches at least twice weekly or migraine at least monthly or both conditions. All had been diagnosed with migraine or tension headache by a primary care physician or neurologist. After recovering from the surgery they were followed up by questionnaires and interviews to identify changes in frequency and severity of headache and any adverse effects from the surgery.
What interventions were examined in the research?
Participants underwent excision of the corrugator superciliaris muscles above each eye together with blepharoplasty (eyelid surgery). Patients were followed up for 6 to 19 months.
What were the findings?
All 12 participants reported a reduced frequency of headaches after surgery and all except 1 reported reduced headache intensity. Four out of seven participants with tension headache reported complete resolution of their symptoms, as did two out of three participants with both tension and migraine headache and one out of two with migraine headache only. All participants stated that with hindsight they would be prepared to go through the procedure again for headache management.
All 4 participants followed up for 13 months or more had regained normal sensation in the forehead, compared with 4 out of 8 followed up for 6 to 8 months.
What were the authors' conclusions?
Excision of the corrugator superciliaris muscles provides significant relief for headaches emanating from or localised in the glabellar and frontal regions.
How reliable are the conclusions?
This was a small study and there was no control group, so larger controlled studies will be required to validate the findings. The excision was done in conjunction with another procedure (blepharoplasty) which could have affected the results. As the authors point out, longer follow-up would be required to determine whether the relief obtained following surgery is permanent. The participants involved in the study were not typical of people with headache in that they were already scheduled to undergo surgery for cosmetic reasons. The results may not be applicable to people requiring the relief of headache symptoms only, for whom other effective treatments are available.
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 were no related systematic reviews identified on the Cochrane Database of Systematic Reviews (CDSR) or on the Database of Abstracts of Reviews of Effects (DARE).
References and resources
1. Snip to your forehead that cures headaches. Daily Mail 29 November 2005, p.42.
Consumer information
Document of the Week from the National Library for Health
Clinicians should be wary of the results of trials, which have been stopped prematurely
The early completion of randomized controlled trials is occurring more frequently, according to the Journal of the American Medical Association.
Often the reasons for stopping the trial earlier than planned are not made clear in the published research, and clinicians must be aware of this, as the results may not be as reliable as trials which have run their full course. NHS Athens passwords are required to access this resource, and can be obtained from http://www.nelh.nhs.uk/home_use.asp
Randomized Controlled Trials; Evidence Based Practice
posted by skif at 8:20 am
0 Comments:
Post a Comment
<< Home