Post 17: 3rd February 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 Technology Assessments and Appraisals
The clinical effectiveness and cost-effectiveness of computed tomography screening for lung cancer: systematic reviews (Black) 106 pages, Volume 10, number 3
Computed tomography (CT) screening for lung cancer does not currently meet the accepted National Screening Committee criteria, with no randomised controlled trials and no evidence to support its clinical effectiveness or cost-effectiveness.
The clinical and cost-effectiveness of donepezil, rivastigmine, galantamine and memantine for Alzheimer’s disease (Loveman) 176 pages, Volume 10, number 1
To provide an update review of the best quality evidence for the clinical effectiveness and cost-effectiveness of donepezil, rivastigmine and galantamine for mild to moderately severe Alzheimer’s disease (AD) and of memantine for moderately severe to severe AD.
FOOD: a multicentre randomised trial evaluating feeding policies in patients admitted to hospital with a recent stroke (Dennis) 136 pages, Volume 10, number 2
Study findings did not support routine supplementation of hospital diet for unselected stroke patients who are predominantly well nourished on admission nor did they support a policy of early initiation of percutaneous endoscopic gastrostomy (PEG) feeding in dysphagic stroke patients.
Latest Guidelines
NICE (2006) High dose rate brachytherapy for localised prostate cancer - Interventional procedures consultation document. NICE: London.
The consultation period ends on 28/02/2006.
Scottish Intercollegiate Guidelines Network (2005) Management of transitional cell carcinoma of the bladder. Edinburgh: Sign.
Department of Health (2006) Our health, our care, our say: a new direction for community services. London: TSO.
The White Paper, Our health, our care, our say: a new direction for community services aims to provide people with more choice and say over the care they receive in the community, and much closer working and coordination between health and social care. New measures outlined in the White Paper include:
Links are given to online full text resources, all other materials can be obtained via the Fade Library, just mail your request to
Our health, our care, our say: a new direction for community services: A brief guide
Our health, our care, our say: a new direction for community services: Easy Read Version
Change Agent Team (2006)Making Connections, the third and final Annual Report. London: DoH.
This report covers the third year of the health and social care Change Agent Team. It will be their last report as they become part of the new Care Services Improvement Partnership (CSIP). The report reviews the work of the Change Agent Team during 2004/05 and highlights the team's new work areas such as development of Older People's Mental Health Services, Community Hospitals, Telecare and Extra Care Housing
Matrix (2005) Improvement partnership for hospitals: evaluation report. Coventry: NHS Institute for Innovation and Improvement.
This document summarises the lessons learnt from the Improvement Partnership for Hospitals (IPH). It shows that IPH did have an impact, and that people were most likely to adopt clinical systems improvement ideas after training at local and national workshops.
Ofcom (2005) Ofcom own-initiative investigation into the price of making telephone calls to hospital patients:A case closure document issued by the Office of Communications. London: Ofcom.
Ofcom closed its investigation into the price of telephone calls to hospital patients with a recommendation that the Department of Health ('DoH') review all aspects of the installation and operation of bedside telephone and entertainment systems in hospitals
Evidence from Journals
Trials
Latest Questions to the Primary Care Question Answering Service
ASSESSMENT AND DIAGNOSIS
In an otherwise healthy young male who has recurrent haematuria after exercise (jogging for an hour a day) what investigations should be done?
A patient stopped depo 6 months ago and still has no periods, which she wants to initiate, and suggestions?
What is the relative risk for a 14 year old girl travelling on long haul flights of thrombosis if she is on the contraceptive pill?
Are there any significant medical conditions that cause night terrors in a 2 year old child? What advice can I give the mother?
Is there any information on the reliability and validity of wound assessment charts?
Are there any up to date guidelines dealing with burns and scalds?
Can an Indian female vegetarian be suffering fromVitamin D deficiency as a result of her diet?
How high can a testsosterone level be before PCOS is unlikely and more sinister causes should be looked for?
What is the Cockcroft Gault calculation and how is it used?
Is there any guidance on the safety of biopsy of possible squamous cell skin cancer in primary care?
CAUSES, RISKS AND PREVENTION
Is there any evidence that bladder irritants (caffeine, alcohol, nicotine) are directly irritant to the bladder wall or are they deemed irritant by virtue of their diuretic properties? Does avoiding them actually help bladder stability?
Are veterinary workers, and workers at risk of exposure to animal body fluids at risk specifically of hepatitis B? What immunisations should such groups be offered and why?
What harm can result from allowing seizure activity in temporal lobe epilepsy to continue?
When can you start a COC after stopping the most common anti epileptic drugs e.g. Carbamazepine or Lamotrigine?
Are Tampons sterile? Is 'Toxic Shock Syndrom' related to length of time a tampon is left in the vagina or is it completely unrelated and can individuals suffer from this immeditely after a tampon is inserted?
Do pregnant women have to avoid goats as well as sheep?
Parents of a teenager with mumps recently contacted me about having a mumps vaccine. Is there any guidance on vaccinating contacts with mumps cases?
Use of antidepressants in children with depression (ages 5-18)
How suitable are IUDs (non-hormonal) for patients with multiple sclerosis?
Is it safe for a patient with IUDs (non-hormonal) to have a MRI scan?
If someone suffered poliomyelitis as a child, would this render them immune, thus not requiring further immunisation.
Is there any evidence to support not adminstering antipyretics either post vaccination or in fever
CARDIOVASCULAR DISEASE
In the elderly, should statins be started at lower doses e.g. simvastatin 10 or 20mg and titrated upwards?
In patients on multiple lipid lowering agents including a statin a fibrate and ezetimibe is the risk of pancreatitis cumulative with added agents?
What are the side-effects of statins?
Should patients on oral steroids be screened for aortic aneurysm? Is there an association between oral steroids and large blood vessel abnormalities?
INFECTIOUS DISEASES
Is there evidence that melatonin treatment improves symptoms of fatigue in patients with chronic fatigue syndrome?
NEUROLOGICAL DISEASES
Is there any evidence for use of oxygen therapy in the treatment of migraine. If so how should the oxygen be used ?flow rate
HEALTH MANAGEMENT
Do you know what the criteria is for chronic renal disease in the new contract? Will it be based on GFR and if so what is the cut off value.
GASTROENTEROLOGY
1)How long should a patient with ulcerative colitis continue to take oral mesalazine/5' ASA be continued to prevent relapse? 2) How should an acute exacerbation while on oral 5'ASA treatment be managed?
Hitting the Headlines - Evidence Behind the Press Stories
Possible new bird flu vaccine
A new vaccine against bird flu has been developed, reported six newspapers (2nd Feb 2006)(1-6). The reports were based on laboratory studies where a new vaccine had provided protection in mice. Two newspaper articles omitted to mention that it may be several years before a vaccine is available for human use (1,2).
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Hope that a new bird flu vaccine had been developed was reported in six newspapers (1-6). Four reported that unlike conventional vaccines, this one could be stockpiled (3-6).
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The newspaper reports were based on a series of experimental studies which tested a vaccine genetically engineered from the common cold virus (7). The studies were carried out on mice and investigated the ability of the vaccine to protect the mice from three variations of the H5N1 type of avian influenza infection, isolated from people. The researchers also looked at the method of delivery of the vaccine and its ability to produce T cells which fight infections.
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The researchers' findings appear to follow from the results of the experiments. However, as stated in four of the newspapers, further development work and eventually trials in human volunteers are required before such a vaccine is made generally available.
Evaluation of the evidence base for adenoviral-vector-based influenza vaccine against H5N1 strains in mice
Where does the evidence come from?
The research was conducted by Mary A Hoelscher and colleagues at the Influenza Branch, Division of Rickettsial and Viral Diseases, Centers for Disease Control and Prevention, Atlanta USA, and the Department of Veterinary Pathobiology, Purdue University, USA.
What were the authors' objectives?
To develop an influenza vaccine and to assess the immunogenicity and efficacy of the vaccine to confer protection in BALB/c mice.
What was the nature of the evidence?
The researchers developed a vaccine by genetically engineering a common cold virus to produce the protein haemugglutinin subtype 5(H5HA), a component of the H5N1 avian influenza virus. Controlled trials of the vaccine were then carried out on mice in a laboratory.
What interventions were examined in the research?
In a series of laboratory experiments, groups of mice were vaccinated with HAd-H5HA, HAd-deltaE1E3, or rH5HA either in the presence or absence of 1% alum adjuvant. The control groups of mice received phosphate-buffered saline. Two doses of vaccine were given four weeks apart. Four weeks later all the mice were infected with a lethal for mice dose of the H5N1 HK/483/97 virus. The mice were monitored for clinical signs and bodyweight changes for 14 days. Further similar experiments were conducted to test more recent strains of the H5N1 virus isolated from people (eg HK/213/03) and investigate the route of immunisation (intramuscular or intranasal). The researchers used a further trial to determine whether the vaccine induced functional CD 8 T cells in mice, as these cells have been shown to contribute to viral clearance.
What were the findings?
HAd-H5HA and rH5HA plus alum produced better protective effect than the interventions used in the other groups against HK/156/97 virus. However, HAd-H5HA was the most effective against the two other virus strains tested. Overall, intramuscular delivery of HAd-H5HA vaccine induced consistently higher responses than intranasal delivery. Mice that received the HAd-H5HA vaccine had a three to eight fold higher frequency of CD8 T cells compared to the other groups.
What were the authors' conclusions?
That BALB/c mice immunised with HAd-H5HA vaccine were effectively protected from H5N1 disease. The authors also said the findings highlight the potential of an Ad-vector-based delivery system which offers stockpiling options for the development of a pandemic influenza vaccine.
How reliable are the conclusions?
As the studies are laboratory studies no formal assessment of the reliability of the authors' conclusions has been made. However, they would appear to be reasonable, given that the authors word their discussion in terms of what the research could 'potentially' lead to. Clearly further development work and eventually trials in human volunteers are required before such a vaccine becomes widely 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. GM vaccine raises hopes of beating bird flu. The Guardian, 2 February 2006, p7.
2. Common cold cure for bird flu. Daily Mirror, 2 February 2006, p11.
3. New bird flu vaccine may be key to preventing pandemic. The Times, 2 February 2006, p8.
4. Cold virus link for bird flu vaccine. The Daily Telegraph, 2 February 2006, p13.
5. Vaccine hope on bird flu. The Sun, 2 February 2006, p27.
6. Scientists create a new bird flu vaccine. Daily Mail, 2 February 2006, p35.
Consumer information
Health Protection Agency - Influenza
Science and development network - Bird flu: the facts
Previous Hitting the Headlines summaries on this topic
Antiviral treatment for avian flu. Hitting the Headlines archive, 19 January 2006.
'New drug promises to hit flu where it hurts'. Hitting the Headlines archive, 23 January 2003.
Drug stops flu's spread through families. Hitting the Headlines archive, 14 February 2001.
Aricept for dementia
Document of the Week from the National Library for Health
Junghans, C., Feder, G., Hemingway, H., Timmis, A. and Jones, M. (2005) Recruiting patients to medical research: double blind randomised trial of "opt-in" versus "opt-out" strategies. BMJ 331:940.
What's New from the National Library for Health
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