Post 14: 13 January 2006
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
Latest Technology Assessments and Appraisals
Towards evidence-based guidelines for the prevention of venous thromboembolism: systematic reviews of mechanical methods, oral anticoagulation, dextran and regional anaesthesia as thromboprophylaxis (Roderick) 94 pages, Volume 9, number 49
This study showed that graduated compression stockings (and other mechanical compression methods) reduced the risk of deep venous thrombosis and pulmonary embolism in a wide range of surgical patients. Oral anticoagulants (such as warfarin) and infusions of dextran were also effective, although they appeared less protective than heparin-based regimens. In operations where regional anaesthesia is feasible, it resulted in a lower risk of venous thromboembolism than general anaesthesia, thus adding to any benefits from mechanical and pharmacologic methods.
The effectiveness and cost-effectiveness of parent training/education programmes for the treatment of conduct disorder, including oppositional defiant disorder, in children (Dretzke) 250 pages, Volume 9, number 50
Clinical and cost-effectiveness of autologous chondrocyte implantation for cartilage defects in knee joints: systematic review and economic evaluation (Clar) 98 pages, Volume 9, number 47
Systematic review of effectiveness of different treatments for childhood retinoblastoma (McDaid) 162 pages, Volume 9, number 48
Latest Guidelines
NICE (2006) Smoking Cessation Programme Draft Scope. London: NICE.
NICE has issued the draft scope for the optimal provision of smoking cessation services, including the provision of nicotine replacement therapy (NRT), for primary care, pharmacies, local authorities and workplaces with particular reference to manual working groups, pregnant smokers and hard to reach communities.
The document is available for consultation between 9 January and 6 February 2006. The final version of the scope will be available on the NICE website in March 2006 and full guidance is expected be published by August 2007.
Latest Reports
House of Commons Health Committee (2006) Changes to Primary Care Trusts: Second Report of Session 2005–06: Report, together with formal minutes, oral and
written evidence. London: TSO.
NHS Primary Care Trusts (PCTs) were created in 2002, and are currently responsible for controlling some 80% of the NHS’s 76 billion annual budget, which they use to
commission health services for their local populations. In addition, they have responsibility for public health, and many PCTs also provide community-based health services, such as district nursing and community hospitals.
Commissioning a Patient-Led NHS was published on 28 July 2005. It set out proposals to dramatically reduce numbers of PCTs in order to achieve cost savings of £250 million and to improve commissioning. The paper also announced plans to contract out community health services currently provided by PCTs to non-NHS providers by the end of 2008. At the same time, the number of Strategic Health Authorities (SHAs) would also be substantially reduced.
These proposals were received with widespread alarm, and were described by
commentators as ‘incoherent’. Those working in the NHS expressed outrage at the
prospect of a further large scale structural reorganisation only three years after PCTs were created in the last round of restructuring, as well as raising serious doubts as to whether the reforms would achieve their stated aims.
Corrigan, P. (2006) Registering Choice: how primary care should change to meet patient needs. London: Social Market Foundation.
Patients have had the right to choose a GP since 1948. Yet for most of us, this right is little more than hypothetical: GP surgeries with closed lists, restrictions regarding where we can register and GP surgeries offering almost identical services means even those of us lucky enough to have a choice of GP find we have very little to choose between.
The report explains why patient demand must be organised more effectively to trigger new and different forms of primary care, and how supply must be better organised to meet this demand. The implications this will have for the future role of the PCT are explored. Explores how, in a system of patient choice, primary care providers might fail and what the Government should do to deal with them. Finally, it discusses the need for more information to help patients make informed choices in primary care; who will provide this information and whether additional guidance, perhaps in the form of Patient Care Advisers, is a justifiable cost to help the hardest to reach groups in society exercise their right to choice.
Evidence from Journals
Howard L
Atypical antipsychotic use during the first trimester of pregnancy may not increase major malformations
Evid Based Ment Health 2005, 8(4), 115
Hart S
Comorbid pain related somatisation is common in Latin Americans with major depressive disorder
Evid Based Ment Health 2005, 8(4), 116
Crystal S
Prescription of pharmacotherapy for depression in elderly people varies with age, race, gender, and length of care
Evid Based Ment Health 2005, 8(4), 117
Links PS
Suicide risk peaks in first week of psychiatric hospitalisation and post-discharge
Evid Based Ment Health 2005, 8(4), 114
Cipriani A
Forensic database study suggests selective serotonin reuptake inhibitors do not increase the risk of suicide in people taking antidepressants
Evid Based Ment Health 2005, 8(4), 113
Petry NM
Methadone plus contingency management or performance feedback reduces cocaine and opiate use in people with drug addiction.
Evid Based Ment Health 2005, 8(4), 112
Swinson RP
Pharmacotherapy is an effective treatment option for generalised anxiety disorder.
Evid Based Ment Health 2005, 8(4), 111
Kumar DS
Coordinated care consisting of cognitive behavioural therapy plus medication improves panic disorder.
Evid Based Ment Health 2005, 8(4), 110
Bisson JL
Adding hypnosis to cognitive behavioural therapy may reduce some acute stress disorder symptoms
Evid Based Ment Health 2005, 8(4), 109
Carter FA
Postnatal home visits from healthcare professionals show promise for preventing postnatal depression
Evid Based Ment Health 2005, 8(4), 108
Ernst E
St John's wort is at least as effective as paroxetine in reducing severity of depression and is better tolerated.
Evid Based Ment Health 2005, 8(4), 107
Buist-Bouwman MA
Collaborative care management improves physical functioning in older people with depression
Evid Based Ment Health 2005, 8(4), 106
Conn DK
Collaborative care depression management for older adults: level of comorbidity does not affect outcome
Evid Based Ment Health 2005, 8(4), 105
Herrmann N
Some psychosocial therapies may reduce depression, aggression, or apathy in people with dementia
Evid Based Ment Health 2005, 8(4), 104
Charlesworth G
Cognitive behavioural therapy reduces psychological distress in carers of people with Parkinson's disease.
Evid Based Ment Health 2005, 8(4), 103
Lau MA
Adding cognitive therapy to minimal psychiatric care prevents short term, but not long term, relapse in people with bipolar disorder.
Evid Based Ment Health 2005, 8(4), 102
Carlson GA
Bipolar disorder in young people: divalproex sodium no more effective than lithium for maintenance
Evid Based Ment Health 2005, 8(4), 101
Killeen TK
Long acting injectable naltrexone is effective and safe for treating alcohol dependence
Evid Based Ment Health 2005, 8(4), 100
Lowe B
The sentence completion test for depression can distinguish between people with and without major depressive disorder
Evid Based Ment Health 2005, 8(4), 99
Bonomo Y
Early onset of drinking increases alcohol use in adulthood
Evid Based Ment Health 2005, 8(4), 98
Sakinofsky I
Attendance at accident and emergency for deliberate self harm predicts increased risk of suicide, especially in women
Evid Based Ment Health 2005, 8(4), 97
Haw CM
Lifetime risk of suicide in people with schizophrenia lower than commonly reported
Evid Based Ment Health 2005, 8(4), 96
Bourgeois JA
The incidence of delirium in older people with a mood disorder is similar with lithium and valproate
Evid Based Ment Health 2005, 8(4), 95
Kemper, K.J., Gardiner, P., Gobble, J, Mitra, A. and Woods, C. (2005) Randomized Controlled Trial Comparing Four Strategies for Delivering e-Curriculum to Health Care Professionals. BMC Medical Education 2006, 6:2
Background: Internet education is increasingly provided to health professionals, but little is known about the most effective strategies for delivering the content. The purpose of this study is to compare four strategies for delivering an Internet-based (e-) curriculum on clinicians' knowledge (K), confidence (CONF), and communication (COMM) about herbs and other dietary supplements (HDS).
Method: This national randomized 2 X 2 factorial trial included physicians, pharmacists, nurses, nutritionists and trainees in these fields. Participants were randomly assigned to one of four curriculum delivery strategies for 40 brief modules about HDS: a) delivering four (4) modules weekly over ten (10) weeks by email (drip-push); b) modules accessible on web site with 4 reminders weekly for 10 weeks (drip-pull); c) 40 modules delivered within 4 days by email (bolus-push); and d) 40 modules available on the Internet with one email informing participants of availability (bolus-pull).
Results: Of the 1,267 enrollees, 25% were male; the average age was 40 years. The completion rate was 62%, without significant differences between delivery groups. There were statistically significant improvements in K, CONF and COMM scores after the course (P<0.001 style="font-weight: bold;">Conclusion: All delivery strategies tested similarly improved K, CONF, COMM scores about HDS. Educators can use the strategy that is most convenient without diminishing effectiveness. Additional curricula may be necessary to make substantial changes in clinicians' communication practices.
Helping practitioners understand the contribution of qualitative research to evidence-based practice
Mark Newman, Carl Thompson, and Anthony P Roberts
Evid Based Nurs 2006; 9: 4-7.
Reflections on "Helping practitioners understand the contribution of qualitative research to evidence-based practice"
Sally Thorne
Evid Based Nurs 2006; 9: 7-8.
The WHO technique for intramuscular thigh vaccination in infants and toddlers had fewer adverse reactions than 2 other techniques
Linda Diggle (commentator)
Evid Based Nurs 2006; 9: 9.
Liposomal lidocaine improved intravenous cannulation success rates in children
Jeanette Robertson (commentator)
Evid Based Nurs 2006; 9: 10.
Review: children permitted clear fluids <=120 minutes before surgery have similar gastric volumes and pH values as those on standard fasts
Andrew Jull (commentator)
Evid Based Nurs 2006; 9: 11.
Topical chloramphenicol was not effective for acute infective conjunctivitis in children
Gene Elizabeth Harkless (commentator)
Evid Based Nurs 2006; 9: 12.
Nurse home visits did not differ from standard care for prevention of recurrent child abuse
Wendy E Peterson (commentator)
Evid Based Nurs 2006; 9: 13.
Multisystemic therapy improved adherence to blood glucose testing in adolescents with type 1 diabetes
Barbara L Paterson (commentator)
Evid Based Nurs 2006; 9: 14.
A weight maintenance diet reduced bulimic symptoms in adolescent girls
Janet D Allan (commentator)
Evid Based Nurs 2006; 9: 15.
After 3 months, low dose oral contraceptives reduced pain in adolescent girls with moderate to severe dysmenorrhoea
Marjorie MacDonald (commentator)
Evid Based Nurs 2006; 9: 16.
Trimethoprim reduced dysuria in women with symptoms of urinary tract infection but negative urine dipstick test results
M Kay Libbus (commentator)
Evid Based Nurs 2006; 9: 17.
Review: wearing graduated compression stockings during air travel reduces the risk of deep venous thromboembolism
Susan Campbell (commentator)
Evid Based Nurs 2006; 9: 18.
A home based, physical activity intervention increased physical activity, fitness, and vigour and reduced fatigue in sedentary women with early stage breast cancer
Carolyn Ingram (commentator)
Evid Based Nurs 2006; 9: 19.
Glargine dose titration by patients and by physicians were equally effective for preventing severe hypoglycaemia
Randa Fakhry (commentator)
Evid Based Nurs 2006; 9: 20.
Web based care management improved glucose control in patients with poorly controlled diabetes
Anne Phillips (commentator)
Evid Based Nurs 2006; 9: 21.
An educational booklet did not improve adherence or symptoms in patients prescribed thyroxine for primary hypothyroidism
Barbara A Given (commentator)
Evid Based Nurs 2006; 9: 22.
Review: multidisciplinary interventions reduce hospital admission and all cause mortality in heart failure
Simon Stewart (commentator)
Evid Based Nurs 2006; 9: 23.
Review: multivitamins and mineral supplements do not reduce infections in elderly people
Catherine Ford Thomas (commentator)
Evid Based Nurs 2006; 9: 24.
Multivitamin and multimineral supplements did not reduce reported infection days or related use of healthcare services in elderly people
Veronica L Conners (commentator)
Evid Based Nurs 2006; 9: 25.
A simple risk score predicted 7 day stroke risk after transient ischaemic attack
Sandra Ireland (commentator)
Evid Based Nurs 2006; 9: 26.
Mothers’ decisions about MMR vaccination were framed by their children’s vulnerabilities and wider social trends
Francine M Cheater (commentator)
Evid Based Nurs 2006; 9: 27.
UK and US adolescents perceived internet health information to be salient but of questionable credibility
Deborah Finfgeld-Connett (commentator)
Evid Based Nurs 2006; 9: 28.
Young women described the benefits of having advance supplies of emergency contraception but emphasised its use as a "last resort" rather than an alternative form of contraception
Cicely Marston (commentator)
Evid Based Nurs 2006; 9: 29.
Marginalised HIV positive drug users felt that an HIV diagnosis created benefits as well as losses
Irene Goldstone (commentator)
Evid Based Nurs 2006; 9: 30.
Perceived barriers and benefits were factors in decision making about colorectal screening
John Oliffe (commentator)
Evid Based Nurs 2006; 9: 31.
UK palliative care professionals identified service infrastructure, patient and carer attitudes and characteristics, and practice culture as influencing place of death of patients with cancer
Lucille Taylor (commentator)
Evid Based Nurs 2006; 9: 32.
Trials
Latest Questions to the Primary Care Question Answering Service
CAUSES, RISKS AND PREVENTION
How long can alcohol stay in blood?
Once a young man has developed mumps parotitis is there anything we can do to stop him developing orchitis, and if he does is there anything we can do to stop him becoming sterile
Can inhaled steroids in recommended doses stunt growth in asthmatic children?
Should prophylactic antibiotics be prescribed routinely following ingrown toe nail surgery?
Is there any evidence to suggest that bleach or other hair dyes should not be used in pregnancy?
Is tonsillectomy recommended for teenagers presenting with regular episodes of tonsillitis?
ASSESSMENT AND DIAGNOSIS
Is it acceptable to prescribe antibiotics over the telephone for suspected otitis media in a 6 month old?
1) I use 400mcgs salbutamol via spacer for reversibility testing for copd, but was originally taught either 10 puffs or to nebulise, is there evidence that i am adminiistering enough? 2) I also do steroid reversibility if still not sure if Asthma, is there evidence that should do this always?
What is the prevalence of a history of splenectomy?
Barretts' oesophagus and PPIs. What dose PPI should we use and how often should we re-scope. Is there any evidence for or against H pylori eradication?
How should I manage a second UTI in an otherwise well 8yr old?
Who is the most appropriate person to refer to for a patient with McArdle's disease in view of weight loss and diet problems aged 35?
If a patient has a positive chlamydia swab, could you advise what is the max length of time that she may have previously been infected?
Is there any data available on the prevelance of a false diagnosis of an antibiotic "allergy" being recorded on a patients medical record? (If you could be specific for Penicillin this would be ideal)
CARDIOVASCULAR DISEASES
What was the myocardial infarct rate prior to 1910? How did this compare to 1930, 1950 and 1970?
Please can you tell me after a blood transfusion, how long it it is before the body regenerates the bodies blood?
What is the evidence for changing patients from atorvastatin to simvastatin ? Is one better than the other?
What drugs are recommended for the treatment of diastolic dysfunction?
In patients on ACE inhibitors or AR2 blockers, BNF recommends monitoring U+E before and during treatment, is there any evidence that confirms this or suggests any other time frame? Or is it just tradition?
Can I safely prescribe bupropion with someone taking cannabis with no previous history of fits or depression?
1) What is the significance of raised protein C and S levels in relation to venous or arterial thrombosis? 2) Do raised protein C and S levels affect the decision to prescribe statins?
NUTRITION AND METABOLIC DISEASES
An overweight patient with polycystic ovary syndrome is having difficulty losing weight despite serious long term efforts. Is it acceptable to use metformin to aid weight loss?
INFECTIOUS DISEASES
What is the dose of pencillin V in post splenectomy patients?
CANCER
What is the evidence that dairy products have a causative role in the development of malignant and/or benign breast disease?
TREATMENT AND DISEASES MANAGEMENT
Has anyone got any PGD [Patient Group Directions] on reversibility testing for asthma/copd. Drugs include salbutamol, atrovent, combivent. we are still reversing for copd due to qaf points.
What is the evidence for metformin in restoring fertility in women with PCOS?
In patients using depo provera contraception, what should be done if they are late for their next injection in order to ensure safe contraception?
Hitting the Headlines - Evidence Behind the Press Stories
"Prostate cancer test may not cut death rate"
Screening for prostate cancer with the prostate-specific antigen (PSA) test does not reduce the risk of death, reported two newspapers (10 January 2006). The newspapers reflected the overall conclusion of a case-control study, however, this was based on an analysis of 1002 men, only 135 of whom were screened.
-
On 10th January 2006, two newspapers (1,2) reported that having a PSA test to screen for prostate cancer may not reduce the risk of death in men.
-
The research(3), was a well-conducted case-control study involving 501 men (cases) aged over 50 who had been diagnosed with and had died of prostate cancer, and 501 living men (controls) aged over 50, and with or without cancer. The study found no significant difference in all-cause mortality, or mortality due to prostate cancer, between men screened and not screened, whether adjusted for age and co-morbidity (the presence of coexisting or additional diseases/conditions).
-
Although the newspaper reports generally provided an accurate overview of the results of the study, The Guardian (1) incorrectly stated that all the men in the control group had prostate cancer. This type of study cannot provide a definitive answer on the PSA test, and The Times (2) highlights that randomised controlled trials assessing the effectiveness of screening with the PSA test are currently underway in the USA and Europe.
Evaluation of the evidence base for prostate cancer screening not reducing death rate in men
Where does the evidence come from?
The multi-centre study was carried out in the United States, led by Dr Concato from the Department of Veterans Affairs Connecticut Healthcare System, West Haven. Funding was provided by the Department of Veterans Affairs.
What were the authors' objectives?
To evaluate the effectiveness of the PSA test, with or without digital rectal examination (DRE), in reducing mortality.
What was the nature of the evidence?
The study was a multi-centre case-control study, involving a cohort of 71,661 men over the age of 50 who had not been diagnosed with prostate cancer when the study commenced (1991). From this cohort, 501 men who were diagnosed as having prostate cancer in the years 1991 to 1995 and had died by the end of 1999 were identified as cases. The 501 controls were men randomly selected from the same cohort, with or without cancer, who were alive at the time the corresponding case patient had died. Medical records of cases and controls were reviewed to determine whether patients had received screening with PSA or DRE. Researchers abstracting these data were blinded to case or control status. Controls were matched for each case patient based on Veteran Affairs facility and age. Cases included a statistically significant greater number of people who were black and/or had more severe co-morbidity.
How did participants differ on their levels of exposure to the factor of interest?
The factor of interest was whether PSA testing or DRE was performed for screening prior to the diagnosis of prostate cancer among cases. Screening occurred in 70 cases (14%) and 65 controls (13%). There were 54 pairs of men where the cases were screened and the controls were not, and 49 pairs where the controls were screened and the cases were not.
What were the findings?
Results showed no statistically significant difference in all-cause mortality, or mortality due to prostate cancer, between men screened and not screened, whether adjusted for age and co-morbidity or not.
In addition, there were no statistically significant differences in mortality with PSA screening when men with symptoms of benign prostatic hyperplasia were included in the screening, when PSA screening was conducted more frequently, in the subset of men with no or mild co-morbidity, or when the subset of patients aged 72.5 years or younger were analysed.
Black race and co-morbidity were significant predictors of all-cause mortality and mortality from prostate cancer.
What were the authors' conclusions?
The authors concluded that the results do not suggest that screening with PSA is effective in reducing mortality.
How reliable are the conclusions?
On the whole, this was a well-conducted case-control study, with cases and controls sourced from then same population, and information obtained from medical records by researchers blind to case or control status. The imbalance in race, and more particularly co-morbidity, between the cases and controls may have impacted on the observed mortality of these groups, however, the authors performed analyses with and without adjusting for these confounding factors, and the results were similar in both. The authors' conclusions appear valid, but were based on the analysis of 501 matched pairs of which only 135 were screened. This is a small sample size when considering the number and the diversity of men involved in screening programmes, and it is unclear whether results of this sample would be representative of the wider population of men being screened for prostate cancer. However, the authors had performed a calculation to determine the sample size required, which was exceeded in the study.
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), although there is one review which is currently being completed and will be available in the future (5). Three related systematic reviews were identified on the Database of Abstracts of Reviews of Effects (DARE) (6-8).
References and resources
1. Prostate cancer test may not cut death rate. The Guardian, 10 January 2006, p7.
2. Prostate cancer test may leave men even worse off. The Times, 10 January 2006, p11.
4. Barry MJ. The PSA conundrum [editorial]. Archives of Internal Medicine 2006;166:7-8.
6. Selley S, Donovan J, Faulkner A, Coast J, Gillatt D. Diagnosis, management and screening of early localised prostate cancer. Health Technology Assessment 1997;1(2):1-96. [DARE Abstract]
7. Hoogendam A, Buntinx F, de Vet H C. The diagnostic value of digital rectal examination in primary care screening for prostate cancer: a meta-analysis. Family Practice 1999;16(6):621-626. [DARE Abstract]
8. Hoffman R M, Clanon D L, Littenberg B, Frank J J, Peirce J C. Using the free-to-total prostate-specific antigen ratio to detect prostate cancer in men with nonspecific elevations of prostate-specific antigen levels. Journal of General Internal Medicine 2000;15(10):739-748. [DARE Abstract]
Consumer information
NHS Direct – Cancer of the prostate
Previous Hitting the Headlines summaries on this topic
Men's cancer test fails 82% of time. Hitting the Headlines archive, 24 July 2003.
Special journal supplement contains key articles on challenges of summarising better health.
The North American Evidence-Based Practice Centers (EPCs) make up a network set up by the Agency for Healthcare Research and Quality (AHRQ) in 1997. By 2004, they had produced more than 100 evidence reports and had learned much from the experience. This experience of methodological challenges that they encompassed, is written up in this special supplement, produced by the Annals of Internal Medicine.
Click on each heading to view the articles. NHS Athens passwords are required to access this resource, and can be obtained from the National Library for Health here
Challenges in Systematic Reviews of Complementary and Alternative Medicine Topics
Challenges in Systematic Reviews of Diagnostic Technologies
Challenges in Systematic Reviews of Economic Analyses
Challenges in Systematic Reviews of Educational Intervention Studies
Challenges in Systematic Reviews of Therapeutic Devices and Procedures
Challenges in Systematic Reviews That Assess Treatment Harms
Challenges in Systematic Reviews That Evaluate Drug Efficacy or Effectiveness
Challenges in Using Nonrandomized Studies in Systematic Reviews of Treatment Interventions
0 Comments:
Post a Comment
<< Home