Posts Tagged 'Eyes_on_Evidence'

Updates from NICE: Eyes on Evidence

This month in Eyes on Evidence

Acid-suppressive drugs and oesophageal adenocarcinoma in Barrett’s oesophagus
A systematic review and meta-analysis indicates that proton pump inhibitors reduce the risk of oesophageal adenocarcinoma and high-grade dysplasia in people with Barrett’s oesophagus.

Prescriptions for anxiolytics and hypnotics and risk of death
A population-based cohort study in UK primary care suggests that people who are prescribed anxiolytic and hypnotic drugs have a significantly increased risk of death from any cause over a 7-year period.

Assessment and treatment of dementia in older adults
A systematic review finds that brief cognitive assessment tools can adequately detect early dementia, but whether interventions for mild cognitive impairment or early dementia have a clinically significant effect is unclear.

Bedtime schedules and children’s cognition and behaviour
Two analyses of 7-year-olds in the UK Millennium Cohort Study suggest that not having a regular bedtime is associated with impaired cognition in girls and behavioural difficulties in both girls and boys.

Trained glycaemia alert dogs for people with type 1 diabetes

A small UK intervention study suggests that trained glycaemia alert dogs may be able to notify people with type 1 diabetes during blood glucose variations.

NICE opens consultation on the NICE Accreditation Process Manual Update
NICE is inviting comments on its proposals to update the NICE Accreditation Process Manual.

Evidence Updates

NICE has recently published Evidence Updates on:

  • Physical activity and the environment
  • Autism in adults
  • Opioids in palliative care
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Eyes on Evidence: Issue 61; May 2014

Here are the latest topics for this month from NICE – Eyes on Evidence.

Adenotonsillectomy in children with obstructive sleep apnoea
A randomised controlled trial in the USA finds that adenotonsillectomy does not improve cognitive function in children with obstructive sleep apnoea syndrome, although it does have a beneficial effect on symptoms of sleep apnoea.

Ibuprofen compared with indometacin for patent ductus arteriosus
A Cochrane review reports that ibuprofen is as effective as indometacin for closure of patent ductus arteriosus in preterm or low-birthweight babies, and is associated with a lower risk of necrotising enterocolitis, reduced time on assisted ventilation and a lower risk of negative effects on renal function.

Gallbladder removal with or without bile duct imaging
A retrospective cohort study of US data raises caution about interpreting the benefits of using bile duct imaging during gallbladder removal.

Collaborative care for depression
A cluster randomised controlled trial in English general practices suggests that collaborative care delivered by mental health workers acting as care managers is more effective at reducing depression than usual care.

End-of-life preferences of people with terminal illness who live alone
An Australian cohort study finds that around half of people with terminal illness who live alone would prefer to die at home, but only a small proportion manage to do so.

Evidence Updatesnice_logo
NICE has recently published Evidence Updates on:

  • Venous thromboembolic diseases -Interventions to reduce substance misuse among vulnerable young people

Eyes on Evidence helps contextualise important new evidence, highlighting areas that could signal a change in clinical practice. It does not constitute formal NICE guidance. The commentaries
included are the opinions of contributors and do not necessarily reflect the views of NICE.

 

Eyes on Evidence: April edition

This month in Eyes on Evidence

E-cigarette awareness and use to quit smoking
A survey suggests that awareness and use of e-cigarettes has increased over the past few years, but a randomised controlled trial indicates that the products are only modestly effective at helping people to quit smoking.

Beta-2 agonists and exercise-induced asthma
A Cochrane review has assessed the effects of short and long-acting beta-2 agonists for the prevention of exercise-induced asthma in adults and children; the majority of included studies assessed the effect of a single dose of a beta-2 agonist. The Medicines and Healthcare Products Regulatory Agency has previously issued advice recommending that long-acting beta-2 agonists should not be prescribed for the relief of exercise-induced asthma symptoms in the absence of regular inhaled corticosteroids.

Blood pressure control with home telemonitoring and pharmacist management
A US-based cluster randomised trial indicates that home telemonitoring with pharmacist medication management provides better blood pressure control than usual primary care, even once telemonitoring has finished.

Risk factors for congenital abnormalities
A prospective study of a UK multi-ethnic birth cohort suggests that consanguinity is a major risk factor for congenital abnormalities, in particular in children of parents of Pakistani origin.

Antidepressant use late in pregnancy and risk of postpartum haemorrhage
A cohort study of women with low income in the USA suggests that use of antidepressants near delivery is associated with an increased risk of postpartum haemorrhage.

CT scans in childhood or adolescence and risk of cancer
A population-based cohort study in Australia suggests that people who undergo CT scans in childhood or adolescence are at increased risk of developing solid, lymphoid and haematopoietic cancers.

Evidence Updates
NICE has recently published an Evidence Update on:
Alcohol-use disorders: preventing harmful drinking

Eyes on Evidence topics for March

This month from NICE, Eyes on Evidence topics as follows:

Blood oxygen levels in preterm infants
One randomised controlled trial reports that preterm infants with low blood oxygen levels have higher mortality at discharge than infants with high levels. However, a second randomised controlled trial finds no difference in mortality on the basis of blood oxygen level.

Premature mortality in people with epilepsy
A Swedish total population study finds that people with epilepsy are at increased risk of premature death, with the risk even higher among those with psychiatric disorders.

Oral contraceptive pills in preventing ovarian cancer
A meta-analysis reports a lower incidence of ovarian cancer in women who have ever used oral contraceptive pills than in women who have never used oral contraceptives.

Tamsulosin for benign prostatic hyperplasia and risk of severe hypotension
An observational study suggests that tamsulosin for benign prostatic hyperplasia is associated with an increased risk of severe hypotension during the first 8 weeks after both starting and restarting treatment.

Socioeconomic disadvantage and onset of disabling chronic conditions in childhood
A longitudinal study of census data from England and Wales shows a link between socioeconomic disadvantage in early childhood and later development of disabling chronic conditions.

Evidence Updates
NICE has recently published Evidence Updates on:

  • Patient experience in adult NHS services
  • The epilepsies

Eyes on Evidence – October 2013

 

 This month in Eyes on Evidence
A Cochrane review notes that training in patient-centred approaches for healthcare professionals may have positive effects on patients’ experiences of consultation processes.
A Danish case-control study finds that use of glucocorticoids is associated with an increased risk of venous thromboembolism.
A cohort study shows that women who gain large amounts of weight during pregnancy are at increased risk of needing operative delivery.
A prospective population study suggests that, compared with bag-valve-mask ventilation, advanced airway management is associated with lower rates of favourable neurological outcomes after out-of hospital cardiac arrest.
A study suggests that British Pakistani girls may be less active than British white girls during school break times.
We would like your examples of how health and social care staff are helping to improve quality and productivity.
NICE has recently published Evidence Updates on:
  • Obsessive-compulsive disorder

This month’s Eyes on Evidence

Surveillance data from Australia suggests a reduced incidence of genital warts following the introduction of vaccination against human papillomavirus for girls and young women.
A meta-analysis shows that, compared with placebo, pramipexole, ropinirole, rotigotine, gabapentin enacarbil and pregabalin improve symptoms in people with long-term moderate to severe primary restless legs syndrome.
A longitudinal study finds that social isolation and loneliness in older people may be associated with increased all-cause mortality.
An observational study suggests that the risk of thromboembolism after in vitro fertilisation is low but persists into the first trimester of pregnancy.
A meta-analysis notes that COX-2 inhibitors and diclofenac are associated with increased incidence of major vascular events.
A randomised controlled trial suggests that acupuncture for seasonal allergic rhinitis may improve disease-specific quality of life and reduce use of antihistamines.
We highlight a new example from the QIPP collection demonstrating how NHS organisations have implemented new local practices that have both cut costs and improved quality.

Latest news from Eyes on Evidence

 Issue 51 – July 2013
This month in Eyes on Evidence
General health checks in adults

A Cochrane review suggests that general health checks are not associated with reductions in mortality or morbidity.

Hand eczema in healthcare workers 

A randomised controlled trial indicates that accurate diagnosis of hand eczema and a preventive education intervention in healthcare workers may improve symptoms and quality of life.
A systematic review suggests a lack of clear evidence for a relationship between negative mood and the premenstrual phase in the general population.
Adherence to a warfarin dosing algorithm by clinicians treating people with atrial fibrillation may be associated with improved coagulation control and clinical outcomes.
A retrospective observational study indicates that although short-term trends indicate a decline, longer-term data for 1971 to 2011 show a small increase in new medicine launches.
We highlight 2 new examples from the QIPP collection demonstrating how NHS organisations have implemented new local practices that have both cut costs and improved quality.
NICE has recently published Evidence Updates on:
  • Depression in children and young people
  • Surgical site infection

Eyes on Evidence

Latest news roundup from Eyes on Evidence

A cohort study reports that rates of death from both natural and external causes are higher in people who self-harm than would be expected in the general population.
Probiotics in antibiotic-associated diarrhoea
A systematic review suggests that probiotics can reduce antibiotic-associated diarrhoea.

‘Anti-fat’ bias among doctors
Results of a web-based survey, designed to assess attitudes towards weight, reveal implicit and explicit ‘anti-fat’ bias among doctors.

Domestic violence presenting in primary care
A survey examines knowledge, attitudes and clinical skills related to domestic violence in selected UK general practices.
Small benefits of Z drugs over placebo for insomnia
A meta-analysis has found that Z drugs reduce the time taken to fall asleep by 22 minutes compared with placebo. However, this result may not be clinically significant and any benefit of Z drugs must be balanced against their well-documented risks.
Hormone replacement therapy (HRT): cardiovascular outcomes after recent menopause
Data from long-term follow-up of an open-label randomised controlled trial suggest that HRT reduces cardiovascular endpoints in women if started early after menopause. However, limitations of the analysis make interpretation of the results difficult.
Case studies from the Quality, Improvement, Productivity, and Prevention (QIPP) collection
We highlight 2 new examples from the QIPP collection, demonstrating how NHS organisations have implemented new local practices that have both cut costs and improved quality.

Evidence Updates
NICE has recently published Evidence Updates on:

  • Self-harm: longer term management
  • Autism diagnosis in children and young people

Eyes on Evidence update: Issue 48 – April 2013

Changes at NICE

Since you last received Eyes on Evidence our name has changed to the National Institute for Health and Care Excellence, to reflect our new role and responsibilities. NICE’s role is to improve outcomes for people using the NHS and other public health and social care services.

Infectious diseases among homeless populations

The prevalence of infectious diseases, such as tuberculosis, HIV and hepatitis C, in homeless populations is significantly higher than in the general population. However, figures show much local variation raising questions about the need for a more locally-based response.

Risk of abuse in disabled children A systematic review of studies from across the world suggests that more than a quarter of children with disabilities will experience abuse within their lifetimes and that children with disabilities are 3 to 4 times more likely to be victims of abuse than their peers without disabilities.

Rheumatoid factor and risk of future rheumatoid arthritis A cohort study reports that raised levels of rheumatoid factor are associated with an increased risk of developing rheumatoid arthritis. Although treating pre-rheumatoid is currently of unproven value, this study suggests it might be possible in the future.

Heart failure: effects of aldosterone antagonists and renin-angiotensin antagonists on mortality An observational study in people admitted to hospital with heart failure (HF) with reduced ejection fraction finds that aldosterone antagonists reduce readmissions for HF but have no effect on mortality and increase the risk of admission with hyperkalaemia. Another observational study in people with HF with preserved ejection fraction finds that angiotensin converting enzyme inhibitors or angiotensin receptor blockers reduced all-cause mortality.

Grapefruit–drug interactions A review article details the evidence for a pharmacokinetic interaction between grapefruit and certain drugs, and the potential clinical consequences of this.

Case studies from the Quality Improvement Productivity and Prevention (QIPP) Collection

The QIPP Collection highlights examples of local best practice, demonstrating how NHS organisations have implemented new practices that have both cut costs and improved quality. We highlight 2 new examples:

Evidence Updates
NICE has recently published Evidence Updates on:

  • Diabetic foot problems
  • Hip fracture
  • Caesarean section
  • Anaphylaxis

 

Eyes on Evidence for March

This month’s topics in NHS Eyes on Evidence:

Analysis of data from a large randomised controlled trial suggests that intensive glucose control in critically ill patients is associated with moderate to severe hypoglycaemia, and a higher risk of death.

A large scale trial examines the benefits and effectiveness of telehealth and telecare services in helping patients avoid the need for emergency hospital care.
 
A cross-sectional study investigating a possible link between harsh physical punishment and mental health disorders reports that reducing physical punishment may help to reduce the prevalence of mental health disorders in the general population. It suggests giving parents information about alternative discipline strategies, such as positive reinforcement.
The QIPP Collection highlights examples of local best practice, demonstrating how NHS organisations have implemented new practices that have both cut costs and improved quality. We highlight a new example:
Chair of the British HIV Association Guidelines Subcommittee, Martin Fisher, talks about the organisation’s experience of the NICE accreditation process.
Accreditation news  
At its January meeting the NICE Accreditation Advisory Committee accredited 2 guidance programmes.

Evidence Updates 
NICE recently published Evidence Updates on:

  • Strategies to prevent unintentional injuries among children and young people aged under 15
  • Hyperglycaemia in acute coronary syndromes
  • Common mental health disorders
  • Hypertension.

Eyes on Evidence newsletter: Issue 45, January 2013

NHS Evidence produces Eyes on Evidence – you can sign up to receive regular emails.

 
A retrospective case record review shows the number of preventable deaths in English NHS hospitals is unacceptably high, but not as high as previously estimated.
 
An analysis of the impact of New York City policy to restrict the use of trans fat for human consumption shows a significant fall in the trans fat content of fast food purchases, without a commensurate rise in the level of saturated fat. 
 
A systematic review and meta-analysis show that the molecular detection of tumour cells in regional lymph nodes is associated with an increased risk of disease recurrence and poor survival in patients with node-negative colorectal cancer.
 
Results of a randomised controlled trial show that offering either additional free nicotine replacement therapy or higher intensity proactive telephone counselling to people who rang a national helpline for support to stop smoking, did not increase quit rates over and above those obtained using standard helpline support. 
A Cochrane review concludes that antihypertensive drugs have not been shown to reduce mortality or morbidity in adults with mild hypertension and no previous cardiovascular events. Significantly more people taking antihypertensive treatment discontinued treatment due to adverse effects, compared with placebo. However, the review has some significant limitations. 
 
The QIPP Collection highlights examples of local best practice, demonstrating how NHS organisations have implemented new practices which have both cut costs and improved quality. 

Eyes on Evidence: Issue 38, June 2012

 People who are admitted to hospital with a psychotic disorder may have their illness misclassified. Diagnosis should be reassessed periodically to ensure that the most appropriate interventions are being used.

There may be differences in mortality risk between individual antipsychotic agents used to treat people with dementia. Patients should be monitored for adverse events in the acute treatment period, and periodic attempts to discontinue medication should be made.

Caution is urged over the long-term use of antiplatelets in people with chronic kidney disease. Treating 1000 patients with oral antiplatelet therapy for a year may prevent nine heart attacks, but this needs to be balanced against an increased risk of bleeding.
Pregnant women may experience some benefit from using relaxation techniques during labour, in relation to reduced pain, increased satisfaction and improved clinical outcomes. However, the available evidence is insufficient to make clinical recommendations.

Antimuscarinic drugs for urinary incontinence in women 

There is no strong evidence of a clinically important difference in efficacy between antimuscarinic drugs. The choice of antimuscarinic drug for an individual woman is likely to depend on tolerability, patient preference, and cost.

Details of a new resource available via NHS Evidence search.

Cochrane quality and productivity topics

Potential disinvestment opportunities highlighted this month are:
  • Aminosalicylates for induction of remission or response in Crohn’s disease.
  • Oral budesonide for induction of remission in ulcerative colitis.

Evidence Updates

This month NHS Evidence has published three Evidence Updates.
  • Improving outcomes in head and neck cancers.
  • Familial breast cancer.
  • Sedation in children and young people.

New risk prediction tool for venous thromboembolism

Venous thromboembolism (VTE) is a condition in which a blood clot (a thrombus) forms in a vein. Embolism occurs when the thrombus dislodges from its site of origin and travels in the blood.

VTE is an important and preventable cause of morbitity and mortality, with almost a third of survivors experiencing long term effects. To improve survival and prevent complications, the occurence of VTE needs to be reduced.

Current advice: NICE guidance on reducing the risk of VTE in patients admitted to hospital, highlights the need for new research to develop and validate risk prediction models for use by primary care research databases.

Although there are currently no validated algorithms to predict risk for VTE designed for use in primary care, computerised clinical decision support could improve appropriate use of thromboprophylaxis in a hospital setting.

Extended VTE prophylaxis is a research recommendation in the current NICE guidance and features in the VTE NICE Quality Standard.

NICE has guidance in development on the management of venous thromboembolic diseases and the role of thrombophilia testing.

See New Evidence

Continue reading ‘New risk prediction tool for venous thromboembolism’

Health checks for people with learning disabilities

Overview: People with learning disabilities have poorer health than their non-disabled peers and evidence suggests that this is partly because of barriers associated with identifying ill health and ensuring timely access to healthcare services (Michael 2008).

Current advice: The Department of Health recommends that primary care services provide comprehensive annual health checks for people with learning disabilities using local or directly enhanced schemes. Local authorities should help to identify individuals who would benefit from, and would be eligible for, enhanced services.

Continue reading ‘Health checks for people with learning disabilities’

Eyes on Evidence: Biologic drugs for the treatment of psoriasis

Overview: Psoriasis is a skin condition in which skin cells reproduce too quickly, causing red, flaky, crusty patches with silvery scales. It affects about 2% of the UK population and is a chronic condition that often goes through cycles and can return at any time. There are several clinical variants of psoriasis, including plaque, guttate, erythrodermic and pustular. Plaque type is the most common form, accounting for 80% of cases. Psoriasis runs in families, although the exact role of genetics in the condition is unclear. The inflammatory processes of psoriasis are not fully understood but it is known that levels of tumour necrosis factor-alpha (TNF-alpha) are elevated in the skin of people with the condition.

See the NHS Evidence topic page on psoriasis for a general overview of the condition.

NICE recommends the use of biologic drugs infliximab, adalimumab and etanercept when psoriasis is severe and has failed to respond to standard systemic therapies such as methotrexate. Continue reading ‘Eyes on Evidence: Biologic drugs for the treatment of psoriasis’

Eyes on Evidence: Meningitis

The Meningitis Trust

NHS Evidence provides access to more than 300,000 reliable resources from 1,300 sources. The number of evidence providers we receive information from is increasing every month.

Fact sheets from the Meningitis Trust are a recent addition to the search. The resources are primarily patient support information and cover a range of issues including developmental difficulties following meningitis, recovering after leaving hospital, entitlement to statutory benefits, and coping with bereavement. There are also fact sheets written specifically for child carers, teachers and pupils, employers, colleges and universities, and health professionals. 

The Meningitis Trust was one of the first charities to become a certified member of The Information Standard.


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