Post 22: 10th March 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
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Latest Technology Assessments and Appraisals
Latest Guidelines
Latest Reports
Evidence from Journals
Latest Questions to the Primary Care Question Answering Service
Latest Technology Assessments and Appraisals
A systematic review of the effectiveness and cost-effectiveness of neuroimaging assessments used to visualise the seizure focus in people with refractory epilepsy being considered for surgery (Whiting) 250 pages, Volume 10, number 4
This review highlighted the inadequacy of existing data for the effectiveness and cost-effectiveness of imaging techniques in patients with refractory epilepsy being considered for surgery. The need for investigative studies was established and suggestions provided for the conduct of future research.
Compariso
n of conference abstracts and presentations with full-text articles in the health technology assessments of rapidly evolving technologies (Dundar) 162 pages, Volume 10, number 5
Systematic review and evaluation of methods of assessing urinary incontinence (Martin) 132 pages, Volume 10, number 6
Study of methods for diagnosing urinary incontinence finds that a large proportion of women with urodynamic stress incontinence can be correctly diagnosed in primary care from clinical history and urinary diaries. However, more research is needed into this area, particularly on urinary incontinence in men, where there is little information.
Latest Guidelines
Management of patients with dementia: A national clinical guideline
Scottish Intercollegiate Guidelines Network
Edinburgh : SIGN, 2006
57p.
(SIGN Guideline No. 86)
The Scottish Intercollegiate Guidelines Network (SIGN) has updated its guideline on interventions for the management of behavioural and psychological aspects of dementia (SIGN 22), which was published in February 1998.
The guideline examines evidence relating to all aspects of diagnosis and management, including the role of complex psychological assessment, drug treatment, techniques such as reality orientation and interventions for behavioural and psychological problems which develop later in the course of the disease.
Final Appraisal Determination on immunosuppressive therapy for renal transplantation in children and adolescents
National Institute for Health and Clinical Excellence
London : NICE, 2006
45p.
NICE has issued a Final Appraisal Determination on immunosuppressive therapy for renal transplantation in children and adolescents. The guidance considers the use of basiliximab, daclizumab, tacrolimus, mycophenolate (mofetil and sodium) and sirolimus in relation to a standard triple therapy regimen of ciclosporin, azathioprine and a corticosteroid.
The following preliminary recommendations have been made:
Tacrolimus is recommended as an alternative option to ciclosporin when a calcineurin inhibitor is indicated as part of an initial or a maintenance immunosuppressive regimen. The initial choice of tacrolimus or ciclosporin should be based on the relative importance of their side-effect profiles for the individual patient
National service guidelines for developing sexual assault referral centres (SARCs)
Department of Health; National Institute for Mental Health in England (NIMHE); Victims of Violence and Abuse Prevention Programme (VVAPP); Home Office
London : DoH, 2005
38p.
Rape and sexual assault are devastating experiences for any victim. Profound feelings of violation, a sense of continuing danger, shock and numbness can affect the person’s ability to function for a long time after the attack. Failure to address the victim’s immediate and ongoing needs can have a considerable and long-term impact on their emotional well-being and health. It can also cause the victim to disengage from the criminal justice process, reducing the opportunity for offenders to be brought to justice.
Sexual Assault Referral Centres are an important example of how agencies working in partnership have the potential to improve both mental and physical health as well as criminal justice outcomes for victims of rape and sexual assault. Crucially, they provide a holistic service to victims of sexual violence, tailored to their needs and under-pinned by principles of dignity and respect.
Latest Reports
Learning from complaints: Summary of responses to the consultation on changes to the social services complaints procedure for adults
Department of Health
London : DoH, 2006
32p.
This document provides a summary of the responses to the consultation on changes to the social services complaints procedure for adults. The consultation asked for views and comments on the proposed regulations and guidance.
Review of research on the impact of violent computer games on young people
Boyle R
Hibberd M
Department for Culture, Media and Sport
London : DCMS, 2005
45p.
This review examines the academic literature on violent video games and violent behaviour. It ensures that all the key studies examining the relationship between playing violent computer games and real-world violence in young people between 1985 and 2004 are covered, and advises on the quality and reliability of that research.
HIV related stigma and discrimination: Action plan
Department of Health
London : DoH, 2005
25p.
The need for action to tackle the stigma associated with HIV was identified in the National Strategy for Sexual Health and HIV in 2001, and a commitment to publish an HIV stigma action plan was made in the strategy's implementation action plan in 2002. The Department of Health welcomes comments on this action plan especially, from people living with or affected by HIV.
State of the English cities: A research study: Volume 1
State of the English cities: A research study: Volume 2
Parkinson M
Champion T; Simmie J; Turok I; Crookston M; Katz B; Park A; Berube A; Coombes M; Dorling D; Evans R; Glass N; Hutchins M; Kearns A; Martin R; Wood P
Office of the Deputy Prime Minister
London : ODPM, 2006
267p.
In its Urban White Paper of 2000, Towards an Urban Renaissance, the Government made a commitment to commission a report on the progress and performance of English cities in the last five years. This State of the Cities report to government by a consortium of research organisations fulfils that commitment.
This is an independent report to ODPM by a group of city experts led by Professor Michael Parkinson. It provides a comprehensive audit of urban performance in England and a review of the impact of government policies upon cities. The main themes are: social cohestion; demographics; economic competitiveness and performance; liveability, and governance and the impact of policy.
This report is based on a series of reports prepared by the team, which contain a much richer mix of evidence, opinions and analysis than can be contained here. The study draws upon many sources – extensive academic and consultancy literature; case studies in 12 cities; interviews with over 250 policy makers; a review of international experience; analysis of public attitudes to cities and a review of demographic trends. It is underpinned by a new, large set of key indicators of urban performance specifically created for the project – the State of the Cities Database.
The report is intended to be an authoritative statement of the state of English cities, the opportunities and challenges they face in an international context and the policy steps that need to be taken to build upon the progress that has been made in recent years.
Points-based System: Making migration work for Britain
Home Office
London : Home Office, 2006
55p.
This document sets out the Government's proposals for a new points-based approach to managing the flow of migrants coming to the UK to work or study.
Employers' use of migrant labour: Summary report
Dench S
Hurstfield J; Hill D; Akroyd K
Home Office
London : Home Office, 2006
21p.
(Home Office Online Report 03/06)
The Institute for Employment Studies was commissioned by the Home Office to conduct research into the recruitment and employment of migrant workers in the UK. This research formed part of the preparation for change from the current economic migration system to the new points-based system. The focus of the study was on economic migrants - people who come to this country primarily to work, rather than asylum seekers or refugees. Data was collected between April and August 2005.
Chief Nursing Officer's review of mental health nursing: Summary of responses to the consultation
Department of Health
London : DoH, 2006
23p.
Summary of responses to the consultation on the Chief Nursing Officer's review of mental health nursing, published by the Department of Health in July 2005, provides an overview of consultation responses on the questions raised. The aim of the consultation was to gain a clearer understanding of views on how mental health nursing should best contribute to the care of service users in the future and to inform final recommendations to be made by the review.
Chief Nursing Officer's review of mental health nursing: consultation document
Supporting women into the mainstream: Commissioning women-only community day services
Newbigging K
Abel K
London : DoH, 2006
38p.
Best practice guidance intended to support commissioners in delivering Section 6.1 of the implementation guidance Mainstream gender and women's mental health on women-only community day services. It relates to the recommendations set out in the Mental health and social exclusion report specific to day services. The purpose of this guide is:
As a practical guide for commissioners: PCTs, local implementation teams and local authorities.
Direct payments for people with mental health problems: A guide to action
National Institute for Mental Health in England
London : DoH, 2006
28p.
This guide sets out good practice in relation to making direct payments more accessible to people with mental health problems. It is intended to support the efforts that all local authorities, primary care trusts, mental health trusts and non-statutory providers of mental health services and support will wish to make to ensure that direct payments become a standard option within mental health services.
From segregation to inclusion: Commissioning guidance on day services for people with mental health problems
National Institute for Mental Health in England; Department of Health, National Inclusion Programme; Care Services Improvement Partnership
London : DoH, 2006
28p.
Abstract: This guidance is designed to assist commissioners of mental health services in the refocusing of day services for working-age adults with mental health problems. It relates to community-based services but does not address acute day hospitals, crisis services or vocational services.
Informing healthier choices: Information and intelligence for healthy populations
Department of Health
London : DoH, 2006
45p.
This consultation invites comments from all interested parties and stakeholders on the public health information and intelligence strategy, devised as part of the delivery plan for the white paper Choosing health: making healthier choices easier. The strategy supports wider health priorities such as action on health inequalities, health protection and effective commissioning of health and wellbeing. It aims to improve the availability and quality of health information and intelligence across England and to increase its use to support population health improvement, health protection and work on care standards and quality. The deadline for responses to this consultation is 5 May 2006.
National Institute for Health and Clinical Excellence (NICE) selection of topics: consultation paper
Department of Health
London : DoH, 2006
19p.
The Department of Health has launched a consultation on proposals for a new streamlined system of selecting topics for review by NICE. The proposed new system is aimed at reducing the time taken to refer topics to NICE by 3-4 months and encouraging wider representation from the NHS and patient groups in the topic selection process. It covers clinical guidelines, technical appraisals and public health programmes. The three-month consultation will run from 6 March 2006 and ends on 9 June 2006.
Cardiovascular disease and air pollution: A report by the Committee on the Medical Effects of Air Pollutants and appendices
Ayres JG
Company: Department of Health, Committee on the Medical Effects of Air Pollutants
London, DoH
215p., 87p.
Abstract: The main findings of the report are that “outdoor air pollutants are likely to be associated with increased deaths and hospital admissions for cardiovascular related disease. This association is not as large as factors such as family history, smoking and hypertension.” The Committe could not identify the exact mechanisms by which air pollution affects the cardiovascular system, but suggests two possible mechanisms:
Changes to primary care trusts: Government response to the Health Committee’s report on changes to primary care trusts
Department of Health
London : TSO, 2006
28p.
(Cm 6760)
This Command Paper sets out the Government’s response to the Health Select Committee’s second report of session 2005–06, Changes to PCTs. It includes discussion on issues surrounding the reconfiguration and sets out in more detail the background to these changes.
HPA weekly national influenza report :Summary of UK surveillance of influenza and other seasonal respiratory illness: 8 March 2006 (Week 10)
Health Protection Agency
London : HPA, 2006
5p.
The Health Protection Agency has issued the weekly national influenza report for week 9, which can be accessed via the link above. It notes that influenza-like illness (ILI) consultation rates continued to decrease from the updated rate of 29.1 per 100,000 in week 08/06 to 24.4 per 100,000 in week 09/06. The rates are below the baseline level of 30 per 100,000 population.
Evidence from Journals
Lee SJ, et al. Development and validation of a prognostic index for 4-year mortality in older adults. JAMA. 2006 Feb 15;295(7):801-8.
CONTEXT: Both comorbid conditions and functional measures predict mortality in older adults, but few prognostic indexes combine both classes of predictors. Combining easily obtained measures into an accurate predictive model could be useful to clinicians advising patients, as well as policy makers and epidemiologists interested in risk adjustment.
OBJECTIVE: To develop and validate a prognostic index for 4-year mortality using information that can be obtained from patient report.
DESIGN, SETTING, AND PARTICIPANTS: Using the 1998 wave of the Health and Retirement Study (HRS), a population-based study of community-dwelling US adults older than 50 years, we developed the prognostic index from 11,701 individuals and validated the index with 8009. Individuals were asked about their demographic characteristics, whether they had specific diseases, and whether they had difficulty with a series of functional measures. We identified variables independently associated with mortality and weighted the variables to create a risk index.
MAIN OUTCOME MEASURE: Death by December 31, 2002.
RESULTS: The overall response rate was 81%. During the 4-year follow-up, there were 1361 deaths (12%) in the development cohort and 1072 deaths (13%) in the validation cohort. Twelve independent predictors of mortality were identified: 2 demographic variables (age: 60-64 years, 1 point; 65-69 years, 2 points; 70-74 years, 3 points; 75-79 years, 4 points; 80-84 years, 5 points, >85 years, 7 points and male sex, 2 points), 6 comorbid conditions (diabetes, 1 point; cancer, 2 points; lung disease, 2 points; heart failure, 2 points; current tobacco use, 2 points; and body mass index <25, style="font-weight: bold;">CONCLUSION: This prognostic index, incorporating age, sex, self-reported comorbid conditions, and functional measures, accurately stratifies community-dwelling older adults into groups at varying risk of mortality.
Winner P, et al. Sumatriptan nasal spray in adolescent migraineurs: a randomized, double-blind, placebo controlled, acute study. Headache. 2006 Feb;46(2):212-22.
Objective.-To compare the efficacy and tolerability of sumatriptan nasal spray (NS) (5, 20 mg) versus placebo in the acute treatment of migraine in adolescent subjects.
Background.-Currently, no triptan is approved in the United States for the treatment of migraine in adolescent subjects (12 to 17 years). In a previous randomized, placebo-controlled study of 510 adolescent subjects, sumatriptan NS at 5, 10, and 20 mg doses was well tolerated. However, the primary efficacy analysis for headache relief with 20 mg at 2 hours did not demonstrate statistical significance (P= .059). A second study was initiated to evaluate the efficacy of sumatriptan NS in this population. Methods.-This was a randomized (1:1:1), placebo-controlled, double-blind, parallel-group study. Overall, 738 adolescent subjects (mean age: 14 years) with >/=6-month history of migraine (with or without aura) self-treated a single attack of moderate or severe migraine. The primary endpoints were headache relief at 1 hour and sustained relief from 1 to 24 hours. Pain-free rates, presence/absence of associated symptoms, headache recurrence, and use of rescue medications were also assessed. Tolerability was based on adverse events (AEs) and vital signs.
Results.-Sumatriptan NS 20 mg provided greater headache relief than placebo at 30 minutes (42% vs. 33%, respectively; P= .046) and 2 hours (68% vs. 58%; P= .025) postdose, but did not reach statistical significance at 1 hour (61% vs. 52%; P= .087) or for sustained headache relief from 1 to 24 hours (P= .061). Significant differences (P < .05) in favor of sumatriptan NS 20 mg over placebo were observed for several secondary efficacy endpoints including sustained relief from 2 to 24 hours. In general, sumatriptan NS 5 mg percentages were slightly higher than placebo but the differences did not reach statistical significance. Both doses of sumatriptan NS were well tolerated. No AEs were serious or led to study withdrawal. The most common event was taste disturbance (2%, placebo; 19%, sumatriptan NS 5 mg; 25%, sumatriptan NS 20 mg). Conclusions.-This study suggests that sumatriptan may be beneficial to some adolescents and is generally well tolerated in the acute treatment of migraine in this population.
Holtmann G, et al. A placebo-controlled trial of itopride in functional dyspepsia. N Engl J Med. 2006 Feb 23;354(8):832-40.
BACKGROUND: The treatment of patients with functional dyspepsia remains unsatisfactory. We assessed the efficacy of itopride, a dopamine D2 antagonist with acetylcholinesterase effects, in patients with functional dyspepsia.
METHODS: Patients with functional dyspepsia were randomly assigned to receive either itopride (50, 100, or 200 mg three times daily) or placebo. After eight weeks of treatment, three primary efficacy end points were analyzed: the change from baseline in the severity of symptoms of functional dyspepsia (as assessed by the Leeds Dyspepsia Questionnaire), patients' global assessment of efficacy (the proportion of patients without symptoms or with marked improvement), and the severity of pain or fullness as rated on a five-grade scale.
RESULTS: We randomly assigned 554 patients; 523 had outcome data and could be included in the analyses. After eight weeks, 41 percent of the patients receiving placebo were symptom-free or had marked improvement, as compared with 57 percent, 59 percent, and 64 percent receiving itopride at a dose of 50, 100, or 200 mg three times daily, respectively (P<0.05 p="0.05)." p="0.04)." style="font-weight: bold;">CONCLUSIONS: Itopride significantly improves symptoms in patients with functional dyspepsia
Kimerling R, et al. Brief report: Utility of a short screening scale for DSM-IV PTSD in primary care. J Gen Intern Med. 2006 Jan;21(1):65-7.
OBJECTIVE: To evaluate Breslau's 7-item screen for posttraumatic stress disorder (PTSD) for use in primary care.
DESIGN: One hundred and thirty-four patients were recruited from primary care clinics at a large medical center. Participants completed the self-administered 7-item PTSD screen. Later, psychologists blinded to the results of the screen-interviewed patients using the Clinician Administered PTSD Scale (CAPS). Sensitivity, specificity, and likelihood ratios (LR) were calculated using the CAPS as the criterion for PTSD.
RESULTS: The screen appears to have test-retest reliability (r=.84), and LRs range from 0.04 to 13.4.
CONCLUSIONS: Screening for PTSD in primary care is time efficient and has the potential to increase the detection of previously unrecognized PTSD.
Jackson RD, et al. Calcium plus vitamin D supplementation and the risk of fractures. N Engl J Med. 2006 Feb 16;354(7):669-83.
BACKGROUND: The efficacy of calcium with vitamin D supplementation for preventing hip and other fractures in healthy postmenopausal women remains equivocal.
METHODS: We recruited 36,282 postmenopausal women, 50 to 79 years of age, who were already enrolled in a Women's Health Initiative (WHI) clinical trial. We randomly assigned participants to receive 1000 mg of elemental calcium as calcium carbonate with 400 IU of vitamin D3 daily or placebo. Fractures were ascertained for an average follow-up period of 7.0 years. Bone density was measured at three WHI centers.
RESULTS: Hip bone density was 1.06 percent higher in the calcium plus vitamin D group than in the placebo group (P<0.01). style="font-weight: bold;">CONCLUSIONS: Among healthy postmenopausal women, calcium with vitamin D supplementation resulted in a small but significant improvement in hip bone density, did not significantly reduce hip fracture, and increased the risk of kidney stones.
Scaccianoce G, et al. Helicobacter pylori eradication with either 7-day or 10-day triple therapies, and with a 10-day sequential regimen. Can J Gastroenterol. 2006 Feb;20(2):113-7.
BACKGROUND: Helicobacter pylori eradication rates achieved by standard seven-day triple therapies are decreasing in several countries, while a novel 10-day sequential regimen has achieved a very high success rate. A longer 10-day triple therapy, similar to the sequential regimen, was tested to see whether it could achieve a better infection cure rate.
METHODS: Patients with nonulcer dyspepsia and H pylori infection were randomly assigned to one of the following three therapies: esomeprazole 20 mg, clarithromycin 500 mg and amoxycillin 1 g for seven days or 10 days, or a 10-day sequential regimen including esomeprazole 20 mg plus amoxycillin 1 g for five days and esomeprazole 20 mg, clarithromycin 500 mg and tinidazole 500 mg for the remaining five days. All drugs were given twice daily. H pylori eradication was checked four to six weeks after treatment by using a 13C-urea breath test. RESULTS: Overall, 213 patients were enrolled. H pylori eradication was achieved in 75.7% and 77.9%, in 81.7% and 84.1%, and in 94.4% and 97.1% of patients following seven-day or 10-day triple therapy and the 10-day sequential regimen, at intention-to-treat and per protocol analyses, respectively. The eradication rate following the sequential regimen was higher than either seven-day (P=0.002) or 10-day triple therapy (P=0.02), while no significant difference emerged between the latter two regimens (P=0.6).
CONCLUSIONS: The 10-day sequential regimen was significantly more effective than both triple regimens, while 10-day triple therapy failed to significantly increase the H pylori eradication rate achieved by the standard seven-day regimen.
Latest Questions to the Primary Care Question Answering Service
Assessment and Diagnosis
What are the current thoughts regarding dipstick testing for UTI in children?
Does an incidental finding of positive parietal antibodies in a patient with a normal full blood count require further investigation.
If CRP is raised in infection and inflamation, would it be usefull to distinguish if the cause of breathlessness in a patient with co-morbidities such as asthma, COPD or heart failure, was due to infection or not?
In the past every child with a first febrile convulsion was admitted but now paediatricians seem less keen to admit. Are there any guidelines or protocols on when to admit? Is it age related?
Do you have any evidence based guidelines for the management of otitis media in primary care? what are the indications for antibiotics?
Do you have any evidence based guidelines for the management of conjunctivitis in primary care?
How useful is carbohydrate deficient transferrin (CDT) as a marker for alcohol abuse? what are its limitations?
What causes a raised ESR and normal CRP?
What evidence is there that too big a cuff will produce erroneous bp readings?
Is unilateral breast enlargement in an otherwise healthy and normally developed 18/12 old child simply a variant of normal or should it be investigated further?
Cancer
What stage is the HPV vaccine at in development, and is it currently available?
Does a patient of 45 years who has a FH of breast cancer in her maternal grandmother in her 40's and her maternal great grandmother need screening early?
1. What is the evidence of increased risk of breast cancer for a 15 year old girl prescribed combined oral contraceptive for svere dysmenorrhoea who has a FH of breast cancer in her mother aged 40? The breast cancer was hormone sensitive.
Which treatment gives the best prognosis: the clearance of axillary lymph nodes or node sampling in a 46 year old with discrete lobular breast cancer 15 mm lower inner quadrant? There is no tumour spread detectable clinically or with ultrasound or mammography. Also, is the treatment of choice lumpectomy (followed by radiotherapy) or mastectomy?
Cardiovascular disease
What are the recommendations for Vit b12 blood level monitoring in those patients receiving long term hydroxcobalamin three monthly?
Where would I find a comprehensive list of drug interactions with warfarin, and warfarin interactions with herbal remedies
For diabetic patients who have had a stroke or MI, is clopidogrel more effective than aspirin at reducing further espisodes of atherothrombotic events?
Can statins or fibrates cause gynaecomastia?
In using beta-blockers for treating hypertension is any particular beta-blocker preferred?
Causes Risks and Prevention
In addition to scheduled immunisations, what is the recommended immunisation/s for a child (aged one year) due to have cochlear implants please?
What evidence is there about the use of one way valve mouth pieces to prevent the spread of infection when used with tools such as peak flow meters and spirometers? Also, how often to change air inlet and outlet filters in nebilisers?
Can you tell me what is known about flushing in elderly men and what options have been tried to treat this? Is there any evidence to support the use of oestrogens for this problem?
Are there any proven interventionsthat improve access to teenage sexual health services, and most importantly reduce adverse events?
What are the criteria for BCG now? I have a family with three children living in an affluent area. They have no UK risks but visit Lebanon twice a year and have grandparents in Ghana, should they have BCG?
Is there any evidence about the longterm effects of omega 3 and 5 supplementation in children (recommended by some for learning difficulties/ADHD/dyspraxia) indeed, is there good evidence for their use with children? If not, is there a view about their likely safety?
32 year old patient complaining of unilateral headache on waking up on most days for 3 years which gets better within 1-2 hrs of waking up. What are the possible causes ? Can it be rebound headache ?
Is there any evidence that vitamin E reduces the incidence of cataracts?
Is it ok to give Depo Provera in the buttock in obese women?
Can saw palmetto be causing a man of 76 to develop abnormal LFTs, and if so how common/likely is this?
Can a 57 year old lady with OA and type 2 DM take glucosamine - are there any contraindications?
Child health
Who can do baby clinics and 6w checks? And as a qualified GP who does not have a paeds exam how can I gain a certificate in CHS if this is necessary.
I recently heard a weaning talk to a group of young parents and wondered what evidence there is for the following: A baby should not be weaned before six month as its gastric juices cannot break down the food adequately.
Complementary medicine
What is the standard daily dose of St john's wort which should be recommended for a patient with mild depression and for how long would it need to be taken before an improvement could be expected?
What is the evidence for magnet therapy in osteoarthritis and how would you 'prescribe' magnet therapy if it was at all appropriate?
Ear nose and throat
A patient has recently read that melatonin can be used for treating his tinnitus - any evidence?
Health informatics
Are you aware of any tools to review web sites (our aim is to review web sites that are specifically for teenagers and would like a tool to support this)
Health management
What is the future role of district nurses in diabetes management changes that will be needed.
Infectious disease
What is current UK stockpile of Tamiflu, if we were to be asked by a member of the public?
What evidence is there that cimetidine helps cure verrucas?
What evidence is there that 5 days antibiotic treatment for chest infections is superior to 3 days.
Learning disabilities
Is there any evidence to support the use of "brain gym" techniques in dyspraxia & related conditions?
Mental health
In anorexics are anti-depressants useful?
Musculoskeletal disease
How often should someone take Folic Acid if on Methotrexate or is it dependent on blood folate levels?
Renal & urogenital
What is the evidence for using allopurinol for hyperuracaemia but without any history of gout?
Respiratory
Patients with > 400 mls salbutamol spirometry reversibility, but who do not reverse to normal lung function - should they be on the asthma or COPD register or both?
Latest Technology Assessments and Appraisals
Latest Guidelines
Latest Reports
Evidence from Journals
Latest Questions to the Primary Care Question Answering Service
Latest Technology Assessments and Appraisals
A systematic review of the effectiveness and cost-effectiveness of neuroimaging assessments used to visualise the seizure focus in people with refractory epilepsy being considered for surgery (Whiting) 250 pages, Volume 10, number 4
This review highlighted the inadequacy of existing data for the effectiveness and cost-effectiveness of imaging techniques in patients with refractory epilepsy being considered for surgery. The need for investigative studies was established and suggestions provided for the conduct of future research.
Compariso
n of conference abstracts and presentations with full-text articles in the health technology assessments of rapidly evolving technologies (Dundar) 162 pages, Volume 10, number 5
Systematic review and evaluation of methods of assessing urinary incontinence (Martin) 132 pages, Volume 10, number 6
Study of methods for diagnosing urinary incontinence finds that a large proportion of women with urodynamic stress incontinence can be correctly diagnosed in primary care from clinical history and urinary diaries. However, more research is needed into this area, particularly on urinary incontinence in men, where there is little information.
Latest Guidelines
Management of patients with dementia: A national clinical guideline
Scottish Intercollegiate Guidelines Network
Edinburgh : SIGN, 2006
57p.
(SIGN Guideline No. 86)
The Scottish Intercollegiate Guidelines Network (SIGN) has updated its guideline on interventions for the management of behavioural and psychological aspects of dementia (SIGN 22), which was published in February 1998.
The guideline examines evidence relating to all aspects of diagnosis and management, including the role of complex psychological assessment, drug treatment, techniques such as reality orientation and interventions for behavioural and psychological problems which develop later in the course of the disease.
Final Appraisal Determination on immunosuppressive therapy for renal transplantation in children and adolescents
National Institute for Health and Clinical Excellence
London : NICE, 2006
45p.
NICE has issued a Final Appraisal Determination on immunosuppressive therapy for renal transplantation in children and adolescents. The guidance considers the use of basiliximab, daclizumab, tacrolimus, mycophenolate (mofetil and sodium) and sirolimus in relation to a standard triple therapy regimen of ciclosporin, azathioprine and a corticosteroid.
The following preliminary recommendations have been made:
- Basiliximab or daclizumab, used as part of a ciclosporin-based immunosuppressive regimen, are recommended as options for induction therapy in the prophylaxis of acute organ rejection, irrespective of immunological risk. The induction therapy with the lowest acquisition cost should be used, unless it is contraindicated.
Tacrolimus is recommended as an alternative option to ciclosporin when a calcineurin inhibitor is indicated as part of an initial or a maintenance immunosuppressive regimen. The initial choice of tacrolimus or ciclosporin should be based on the relative importance of their side-effect profiles for the individual patient
- Mycophenolate mofetil (MMF) is recommended as an option as part of an immunosuppressive regimen only when:
- there is proven intolerance to calcineurin inhibitors, particularly nephrotoxicity which could lead to risk of chronic allograft dysfunction, OR
- there is a very high risk of nephrotoxicity necessitating the minimisation or avoidance of a calcineurin inhibitor until the period of high risk has passed.
- The use of MMF in corticosteroid reduction or withdrawal strategies is recommended only within the context of RCTs.
- Mycophenolate sodium (MPS) is currently not recommended for use as part of an immunosuppressive regimen.
- Sirolimus is not recommended unless there is proven intolerance to calcineurin inhibitors (including nephrotoxicity) which necessitates the complete withdrawal of these treatments.
National service guidelines for developing sexual assault referral centres (SARCs)
Department of Health; National Institute for Mental Health in England (NIMHE); Victims of Violence and Abuse Prevention Programme (VVAPP); Home Office
London : DoH, 2005
38p.
Rape and sexual assault are devastating experiences for any victim. Profound feelings of violation, a sense of continuing danger, shock and numbness can affect the person’s ability to function for a long time after the attack. Failure to address the victim’s immediate and ongoing needs can have a considerable and long-term impact on their emotional well-being and health. It can also cause the victim to disengage from the criminal justice process, reducing the opportunity for offenders to be brought to justice.
Sexual Assault Referral Centres are an important example of how agencies working in partnership have the potential to improve both mental and physical health as well as criminal justice outcomes for victims of rape and sexual assault. Crucially, they provide a holistic service to victims of sexual violence, tailored to their needs and under-pinned by principles of dignity and respect.
Latest Reports
Learning from complaints: Summary of responses to the consultation on changes to the social services complaints procedure for adults
Department of Health
London : DoH, 2006
32p.
This document provides a summary of the responses to the consultation on changes to the social services complaints procedure for adults. The consultation asked for views and comments on the proposed regulations and guidance.
Review of research on the impact of violent computer games on young people
Boyle R
Hibberd M
Department for Culture, Media and Sport
London : DCMS, 2005
45p.
This review examines the academic literature on violent video games and violent behaviour. It ensures that all the key studies examining the relationship between playing violent computer games and real-world violence in young people between 1985 and 2004 are covered, and advises on the quality and reliability of that research.
HIV related stigma and discrimination: Action plan
Department of Health
London : DoH, 2005
25p.
The need for action to tackle the stigma associated with HIV was identified in the National Strategy for Sexual Health and HIV in 2001, and a commitment to publish an HIV stigma action plan was made in the strategy's implementation action plan in 2002. The Department of Health welcomes comments on this action plan especially, from people living with or affected by HIV.
State of the English cities: A research study: Volume 1
State of the English cities: A research study: Volume 2
Parkinson M
Champion T; Simmie J; Turok I; Crookston M; Katz B; Park A; Berube A; Coombes M; Dorling D; Evans R; Glass N; Hutchins M; Kearns A; Martin R; Wood P
Office of the Deputy Prime Minister
London : ODPM, 2006
267p.
In its Urban White Paper of 2000, Towards an Urban Renaissance, the Government made a commitment to commission a report on the progress and performance of English cities in the last five years. This State of the Cities report to government by a consortium of research organisations fulfils that commitment.
This is an independent report to ODPM by a group of city experts led by Professor Michael Parkinson. It provides a comprehensive audit of urban performance in England and a review of the impact of government policies upon cities. The main themes are: social cohestion; demographics; economic competitiveness and performance; liveability, and governance and the impact of policy.
This report is based on a series of reports prepared by the team, which contain a much richer mix of evidence, opinions and analysis than can be contained here. The study draws upon many sources – extensive academic and consultancy literature; case studies in 12 cities; interviews with over 250 policy makers; a review of international experience; analysis of public attitudes to cities and a review of demographic trends. It is underpinned by a new, large set of key indicators of urban performance specifically created for the project – the State of the Cities Database.
The report is intended to be an authoritative statement of the state of English cities, the opportunities and challenges they face in an international context and the policy steps that need to be taken to build upon the progress that has been made in recent years.
Points-based System: Making migration work for Britain
Home Office
London : Home Office, 2006
55p.
This document sets out the Government's proposals for a new points-based approach to managing the flow of migrants coming to the UK to work or study.
Employers' use of migrant labour: Summary report
Dench S
Hurstfield J; Hill D; Akroyd K
Home Office
London : Home Office, 2006
21p.
(Home Office Online Report 03/06)
The Institute for Employment Studies was commissioned by the Home Office to conduct research into the recruitment and employment of migrant workers in the UK. This research formed part of the preparation for change from the current economic migration system to the new points-based system. The focus of the study was on economic migrants - people who come to this country primarily to work, rather than asylum seekers or refugees. Data was collected between April and August 2005.
Chief Nursing Officer's review of mental health nursing: Summary of responses to the consultation
Department of Health
London : DoH, 2006
23p.
Summary of responses to the consultation on the Chief Nursing Officer's review of mental health nursing, published by the Department of Health in July 2005, provides an overview of consultation responses on the questions raised. The aim of the consultation was to gain a clearer understanding of views on how mental health nursing should best contribute to the care of service users in the future and to inform final recommendations to be made by the review.
Chief Nursing Officer's review of mental health nursing: consultation document
Supporting women into the mainstream: Commissioning women-only community day services
Newbigging K
Abel K
London : DoH, 2006
38p.
Best practice guidance intended to support commissioners in delivering Section 6.1 of the implementation guidance Mainstream gender and women's mental health on women-only community day services. It relates to the recommendations set out in the Mental health and social exclusion report specific to day services. The purpose of this guide is:
As a practical guide for commissioners: PCTs, local implementation teams and local authorities.
- To support local commissioners to review and develop women-only community day services which promote inclusion and access to mainstream opportunities for women with mental health problems.
- To provide further information and support to the previously published "Mainstreaming gender and women’s mental health: implementation guidance"
- For local women and other stakeholders who want to get involved in the development of local provision for women.
Direct payments for people with mental health problems: A guide to action
National Institute for Mental Health in England
London : DoH, 2006
28p.
This guide sets out good practice in relation to making direct payments more accessible to people with mental health problems. It is intended to support the efforts that all local authorities, primary care trusts, mental health trusts and non-statutory providers of mental health services and support will wish to make to ensure that direct payments become a standard option within mental health services.
From segregation to inclusion: Commissioning guidance on day services for people with mental health problems
National Institute for Mental Health in England; Department of Health, National Inclusion Programme; Care Services Improvement Partnership
London : DoH, 2006
28p.
Abstract: This guidance is designed to assist commissioners of mental health services in the refocusing of day services for working-age adults with mental health problems. It relates to community-based services but does not address acute day hospitals, crisis services or vocational services.
Informing healthier choices: Information and intelligence for healthy populations
Department of Health
London : DoH, 2006
45p.
This consultation invites comments from all interested parties and stakeholders on the public health information and intelligence strategy, devised as part of the delivery plan for the white paper Choosing health: making healthier choices easier. The strategy supports wider health priorities such as action on health inequalities, health protection and effective commissioning of health and wellbeing. It aims to improve the availability and quality of health information and intelligence across England and to increase its use to support population health improvement, health protection and work on care standards and quality. The deadline for responses to this consultation is 5 May 2006.
National Institute for Health and Clinical Excellence (NICE) selection of topics: consultation paper
Department of Health
London : DoH, 2006
19p.
The Department of Health has launched a consultation on proposals for a new streamlined system of selecting topics for review by NICE. The proposed new system is aimed at reducing the time taken to refer topics to NICE by 3-4 months and encouraging wider representation from the NHS and patient groups in the topic selection process. It covers clinical guidelines, technical appraisals and public health programmes. The three-month consultation will run from 6 March 2006 and ends on 9 June 2006.
Cardiovascular disease and air pollution: A report by the Committee on the Medical Effects of Air Pollutants and appendices
Ayres JG
Company: Department of Health, Committee on the Medical Effects of Air Pollutants
London, DoH
215p., 87p.
Abstract: The main findings of the report are that “outdoor air pollutants are likely to be associated with increased deaths and hospital admissions for cardiovascular related disease. This association is not as large as factors such as family history, smoking and hypertension.” The Committe could not identify the exact mechanisms by which air pollution affects the cardiovascular system, but suggests two possible mechanisms:
- Inhalation of particles in the air causes chemical reactions in the body which increase the likelihood of blood to clot and/or atheromatous plaque to rupture, leading to heart attack.
- Particles subtly affect the control of heart rhythm.
Changes to primary care trusts: Government response to the Health Committee’s report on changes to primary care trusts
Department of Health
London : TSO, 2006
28p.
(Cm 6760)
This Command Paper sets out the Government’s response to the Health Select Committee’s second report of session 2005–06, Changes to PCTs. It includes discussion on issues surrounding the reconfiguration and sets out in more detail the background to these changes.
HPA weekly national influenza report :Summary of UK surveillance of influenza and other seasonal respiratory illness: 8 March 2006 (Week 10)
Health Protection Agency
London : HPA, 2006
5p.
The Health Protection Agency has issued the weekly national influenza report for week 9, which can be accessed via the link above. It notes that influenza-like illness (ILI) consultation rates continued to decrease from the updated rate of 29.1 per 100,000 in week 08/06 to 24.4 per 100,000 in week 09/06. The rates are below the baseline level of 30 per 100,000 population.
Evidence from Journals
Lee SJ, et al. Development and validation of a prognostic index for 4-year mortality in older adults. JAMA. 2006 Feb 15;295(7):801-8.
CONTEXT: Both comorbid conditions and functional measures predict mortality in older adults, but few prognostic indexes combine both classes of predictors. Combining easily obtained measures into an accurate predictive model could be useful to clinicians advising patients, as well as policy makers and epidemiologists interested in risk adjustment.
OBJECTIVE: To develop and validate a prognostic index for 4-year mortality using information that can be obtained from patient report.
DESIGN, SETTING, AND PARTICIPANTS: Using the 1998 wave of the Health and Retirement Study (HRS), a population-based study of community-dwelling US adults older than 50 years, we developed the prognostic index from 11,701 individuals and validated the index with 8009. Individuals were asked about their demographic characteristics, whether they had specific diseases, and whether they had difficulty with a series of functional measures. We identified variables independently associated with mortality and weighted the variables to create a risk index.
MAIN OUTCOME MEASURE: Death by December 31, 2002.
RESULTS: The overall response rate was 81%. During the 4-year follow-up, there were 1361 deaths (12%) in the development cohort and 1072 deaths (13%) in the validation cohort. Twelve independent predictors of mortality were identified: 2 demographic variables (age: 60-64 years, 1 point; 65-69 years, 2 points; 70-74 years, 3 points; 75-79 years, 4 points; 80-84 years, 5 points, >85 years, 7 points and male sex, 2 points), 6 comorbid conditions (diabetes, 1 point; cancer, 2 points; lung disease, 2 points; heart failure, 2 points; current tobacco use, 2 points; and body mass index <25, style="font-weight: bold;">CONCLUSION: This prognostic index, incorporating age, sex, self-reported comorbid conditions, and functional measures, accurately stratifies community-dwelling older adults into groups at varying risk of mortality.
Winner P, et al. Sumatriptan nasal spray in adolescent migraineurs: a randomized, double-blind, placebo controlled, acute study. Headache. 2006 Feb;46(2):212-22.
Objective.-To compare the efficacy and tolerability of sumatriptan nasal spray (NS) (5, 20 mg) versus placebo in the acute treatment of migraine in adolescent subjects.
Background.-Currently, no triptan is approved in the United States for the treatment of migraine in adolescent subjects (12 to 17 years). In a previous randomized, placebo-controlled study of 510 adolescent subjects, sumatriptan NS at 5, 10, and 20 mg doses was well tolerated. However, the primary efficacy analysis for headache relief with 20 mg at 2 hours did not demonstrate statistical significance (P= .059). A second study was initiated to evaluate the efficacy of sumatriptan NS in this population. Methods.-This was a randomized (1:1:1), placebo-controlled, double-blind, parallel-group study. Overall, 738 adolescent subjects (mean age: 14 years) with >/=6-month history of migraine (with or without aura) self-treated a single attack of moderate or severe migraine. The primary endpoints were headache relief at 1 hour and sustained relief from 1 to 24 hours. Pain-free rates, presence/absence of associated symptoms, headache recurrence, and use of rescue medications were also assessed. Tolerability was based on adverse events (AEs) and vital signs.
Results.-Sumatriptan NS 20 mg provided greater headache relief than placebo at 30 minutes (42% vs. 33%, respectively; P= .046) and 2 hours (68% vs. 58%; P= .025) postdose, but did not reach statistical significance at 1 hour (61% vs. 52%; P= .087) or for sustained headache relief from 1 to 24 hours (P= .061). Significant differences (P < .05) in favor of sumatriptan NS 20 mg over placebo were observed for several secondary efficacy endpoints including sustained relief from 2 to 24 hours. In general, sumatriptan NS 5 mg percentages were slightly higher than placebo but the differences did not reach statistical significance. Both doses of sumatriptan NS were well tolerated. No AEs were serious or led to study withdrawal. The most common event was taste disturbance (2%, placebo; 19%, sumatriptan NS 5 mg; 25%, sumatriptan NS 20 mg). Conclusions.-This study suggests that sumatriptan may be beneficial to some adolescents and is generally well tolerated in the acute treatment of migraine in this population.
Holtmann G, et al. A placebo-controlled trial of itopride in functional dyspepsia. N Engl J Med. 2006 Feb 23;354(8):832-40.
BACKGROUND: The treatment of patients with functional dyspepsia remains unsatisfactory. We assessed the efficacy of itopride, a dopamine D2 antagonist with acetylcholinesterase effects, in patients with functional dyspepsia.
METHODS: Patients with functional dyspepsia were randomly assigned to receive either itopride (50, 100, or 200 mg three times daily) or placebo. After eight weeks of treatment, three primary efficacy end points were analyzed: the change from baseline in the severity of symptoms of functional dyspepsia (as assessed by the Leeds Dyspepsia Questionnaire), patients' global assessment of efficacy (the proportion of patients without symptoms or with marked improvement), and the severity of pain or fullness as rated on a five-grade scale.
RESULTS: We randomly assigned 554 patients; 523 had outcome data and could be included in the analyses. After eight weeks, 41 percent of the patients receiving placebo were symptom-free or had marked improvement, as compared with 57 percent, 59 percent, and 64 percent receiving itopride at a dose of 50, 100, or 200 mg three times daily, respectively (P<0.05 p="0.05)." p="0.04)." style="font-weight: bold;">CONCLUSIONS: Itopride significantly improves symptoms in patients with functional dyspepsia
Kimerling R, et al. Brief report: Utility of a short screening scale for DSM-IV PTSD in primary care. J Gen Intern Med. 2006 Jan;21(1):65-7.
OBJECTIVE: To evaluate Breslau's 7-item screen for posttraumatic stress disorder (PTSD) for use in primary care.
DESIGN: One hundred and thirty-four patients were recruited from primary care clinics at a large medical center. Participants completed the self-administered 7-item PTSD screen. Later, psychologists blinded to the results of the screen-interviewed patients using the Clinician Administered PTSD Scale (CAPS). Sensitivity, specificity, and likelihood ratios (LR) were calculated using the CAPS as the criterion for PTSD.
RESULTS: The screen appears to have test-retest reliability (r=.84), and LRs range from 0.04 to 13.4.
CONCLUSIONS: Screening for PTSD in primary care is time efficient and has the potential to increase the detection of previously unrecognized PTSD.
Jackson RD, et al. Calcium plus vitamin D supplementation and the risk of fractures. N Engl J Med. 2006 Feb 16;354(7):669-83.
BACKGROUND: The efficacy of calcium with vitamin D supplementation for preventing hip and other fractures in healthy postmenopausal women remains equivocal.
METHODS: We recruited 36,282 postmenopausal women, 50 to 79 years of age, who were already enrolled in a Women's Health Initiative (WHI) clinical trial. We randomly assigned participants to receive 1000 mg of elemental calcium as calcium carbonate with 400 IU of vitamin D3 daily or placebo. Fractures were ascertained for an average follow-up period of 7.0 years. Bone density was measured at three WHI centers.
RESULTS: Hip bone density was 1.06 percent higher in the calcium plus vitamin D group than in the placebo group (P<0.01). style="font-weight: bold;">CONCLUSIONS: Among healthy postmenopausal women, calcium with vitamin D supplementation resulted in a small but significant improvement in hip bone density, did not significantly reduce hip fracture, and increased the risk of kidney stones.
Scaccianoce G, et al. Helicobacter pylori eradication with either 7-day or 10-day triple therapies, and with a 10-day sequential regimen. Can J Gastroenterol. 2006 Feb;20(2):113-7.
BACKGROUND: Helicobacter pylori eradication rates achieved by standard seven-day triple therapies are decreasing in several countries, while a novel 10-day sequential regimen has achieved a very high success rate. A longer 10-day triple therapy, similar to the sequential regimen, was tested to see whether it could achieve a better infection cure rate.
METHODS: Patients with nonulcer dyspepsia and H pylori infection were randomly assigned to one of the following three therapies: esomeprazole 20 mg, clarithromycin 500 mg and amoxycillin 1 g for seven days or 10 days, or a 10-day sequential regimen including esomeprazole 20 mg plus amoxycillin 1 g for five days and esomeprazole 20 mg, clarithromycin 500 mg and tinidazole 500 mg for the remaining five days. All drugs were given twice daily. H pylori eradication was checked four to six weeks after treatment by using a 13C-urea breath test. RESULTS: Overall, 213 patients were enrolled. H pylori eradication was achieved in 75.7% and 77.9%, in 81.7% and 84.1%, and in 94.4% and 97.1% of patients following seven-day or 10-day triple therapy and the 10-day sequential regimen, at intention-to-treat and per protocol analyses, respectively. The eradication rate following the sequential regimen was higher than either seven-day (P=0.002) or 10-day triple therapy (P=0.02), while no significant difference emerged between the latter two regimens (P=0.6).
CONCLUSIONS: The 10-day sequential regimen was significantly more effective than both triple regimens, while 10-day triple therapy failed to significantly increase the H pylori eradication rate achieved by the standard seven-day regimen.
Latest Questions to the Primary Care Question Answering Service
Assessment and Diagnosis
What are the current thoughts regarding dipstick testing for UTI in children?
Does an incidental finding of positive parietal antibodies in a patient with a normal full blood count require further investigation.
If CRP is raised in infection and inflamation, would it be usefull to distinguish if the cause of breathlessness in a patient with co-morbidities such as asthma, COPD or heart failure, was due to infection or not?
In the past every child with a first febrile convulsion was admitted but now paediatricians seem less keen to admit. Are there any guidelines or protocols on when to admit? Is it age related?
Do you have any evidence based guidelines for the management of otitis media in primary care? what are the indications for antibiotics?
Do you have any evidence based guidelines for the management of conjunctivitis in primary care?
How useful is carbohydrate deficient transferrin (CDT) as a marker for alcohol abuse? what are its limitations?
What causes a raised ESR and normal CRP?
What evidence is there that too big a cuff will produce erroneous bp readings?
Is unilateral breast enlargement in an otherwise healthy and normally developed 18/12 old child simply a variant of normal or should it be investigated further?
Cancer
What stage is the HPV vaccine at in development, and is it currently available?
Does a patient of 45 years who has a FH of breast cancer in her maternal grandmother in her 40's and her maternal great grandmother need screening early?
1. What is the evidence of increased risk of breast cancer for a 15 year old girl prescribed combined oral contraceptive for svere dysmenorrhoea who has a FH of breast cancer in her mother aged 40? The breast cancer was hormone sensitive.
Which treatment gives the best prognosis: the clearance of axillary lymph nodes or node sampling in a 46 year old with discrete lobular breast cancer 15 mm lower inner quadrant? There is no tumour spread detectable clinically or with ultrasound or mammography. Also, is the treatment of choice lumpectomy (followed by radiotherapy) or mastectomy?
Cardiovascular disease
What are the recommendations for Vit b12 blood level monitoring in those patients receiving long term hydroxcobalamin three monthly?
Where would I find a comprehensive list of drug interactions with warfarin, and warfarin interactions with herbal remedies
For diabetic patients who have had a stroke or MI, is clopidogrel more effective than aspirin at reducing further espisodes of atherothrombotic events?
Can statins or fibrates cause gynaecomastia?
In using beta-blockers for treating hypertension is any particular beta-blocker preferred?
Causes Risks and Prevention
In addition to scheduled immunisations, what is the recommended immunisation/s for a child (aged one year) due to have cochlear implants please?
What evidence is there about the use of one way valve mouth pieces to prevent the spread of infection when used with tools such as peak flow meters and spirometers? Also, how often to change air inlet and outlet filters in nebilisers?
Can you tell me what is known about flushing in elderly men and what options have been tried to treat this? Is there any evidence to support the use of oestrogens for this problem?
Are there any proven interventionsthat improve access to teenage sexual health services, and most importantly reduce adverse events?
What are the criteria for BCG now? I have a family with three children living in an affluent area. They have no UK risks but visit Lebanon twice a year and have grandparents in Ghana, should they have BCG?
Is there any evidence about the longterm effects of omega 3 and 5 supplementation in children (recommended by some for learning difficulties/ADHD/dyspraxia) indeed, is there good evidence for their use with children? If not, is there a view about their likely safety?
32 year old patient complaining of unilateral headache on waking up on most days for 3 years which gets better within 1-2 hrs of waking up. What are the possible causes ? Can it be rebound headache ?
Is there any evidence that vitamin E reduces the incidence of cataracts?
Is it ok to give Depo Provera in the buttock in obese women?
Can saw palmetto be causing a man of 76 to develop abnormal LFTs, and if so how common/likely is this?
Can a 57 year old lady with OA and type 2 DM take glucosamine - are there any contraindications?
Child health
Who can do baby clinics and 6w checks? And as a qualified GP who does not have a paeds exam how can I gain a certificate in CHS if this is necessary.
I recently heard a weaning talk to a group of young parents and wondered what evidence there is for the following: A baby should not be weaned before six month as its gastric juices cannot break down the food adequately.
Complementary medicine
What is the standard daily dose of St john's wort which should be recommended for a patient with mild depression and for how long would it need to be taken before an improvement could be expected?
What is the evidence for magnet therapy in osteoarthritis and how would you 'prescribe' magnet therapy if it was at all appropriate?
Ear nose and throat
A patient has recently read that melatonin can be used for treating his tinnitus - any evidence?
Health informatics
Are you aware of any tools to review web sites (our aim is to review web sites that are specifically for teenagers and would like a tool to support this)
Health management
What is the future role of district nurses in diabetes management changes that will be needed.
Infectious disease
What is current UK stockpile of Tamiflu, if we were to be asked by a member of the public?
What evidence is there that cimetidine helps cure verrucas?
What evidence is there that 5 days antibiotic treatment for chest infections is superior to 3 days.
Learning disabilities
Is there any evidence to support the use of "brain gym" techniques in dyspraxia & related conditions?
Mental health
In anorexics are anti-depressants useful?
Musculoskeletal disease
How often should someone take Folic Acid if on Methotrexate or is it dependent on blood folate levels?
Renal & urogenital
What is the evidence for using allopurinol for hyperuracaemia but without any history of gout?
Respiratory
Patients with > 400 mls salbutamol spirometry reversibility, but who do not reverse to normal lung function - should they be on the asthma or COPD register or both?
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