<prioritisation

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Prioritised reviews for consumers

Within the project: Prioritisation of Cochrane reviews for consumers and the public in low and high-income countries as a way of promoting evidence-based health care. The areas we are concentrating on are:

Acute respiratory infections

Back pain

Breast cancer

Bone, joint and muscle trauma

Colorectal cancer

Communicating with consumers

Depression and anxiety (and neuroses)

Effective services (practice) and organization of care

Gynaecological cancer

Heart conditions

HIV/AIDS

Metabolic and endocrine diseases

- over weight and obesity

- diabetes

Methodological reviews - clinical trials

Musculoskeletal conditions

- osteoporosis

- fibromyalgia

- shoulder pain

- arthritis

Oral health - dental

Pain, palliative and supportive care - cancer

Pregnancy and childbirth

Skin problems

Tobacco addiction

Links to Cochrane summaries of reviews:

http://www.cochrane.org/reviews/en/topics/

PEARLs (on the Cochrane Primary Health Care website)

www.cochraneprimarycare.org/en/newPage1.html

Acute respiratory infections

Children

Antibiotics for acute otitis media {antibiotics did not alter pain within the first day, slightly reduced pain in the next few days, and did not reduce any deafness (that can last several weeks). They caused unwanted effects such as diarrhoea, stomach pain, and rash, and their use may increase resistance to antibiotics in the community} [PEARLS 49]

Antibiotics for bronchiolitis (hospitalized babies) {antibiotics have little effect on the length of illness; one trial}

Antibiotics for community acquired lower respiratory tract infections secondary to Mycoplasma pneumoniae {no adequate trials to show they are effective}

Antibiotics for community acquired pneumonia (relevant to developing countries) {amoxycillin or procaine penicillin were more effective than co-trimoxazole; if hospitalized, a combined penicillin and gentamycin was more effective than chloramphenicol alone, and oral amoxycillin gave a similar result to injected penicillin}

Humidified air inhalation for treating croup {had no clear benefit for moderate to severe croup}

Advising patients to increase fluid intake for treating acute respiratory infections {no trials}

Bronchodilators for infants with bronchiolitis {a short-term improvement in respiratory scores in some infants treated as outpatients; no clear benefit forinfants hospitalized for bronchiolitis}

Corticosteroids for acute bacterial meningitis (in children and adults) {the corticosteroid dexamethasone reduced hearing loss and deaths, without major adverse effects}

Adults

Antibiotics for acute laryngitis {penicillin and erythromycin were of no benefit} [PEARLS 29, 48]

Antibiotics for acute maxillary sinusitis {antibiotics helped some people a bit, but did not make a major difference to most people}

Antibiotics for community-acquired pneumonia in adult outpatients {not enough community-based trials comparing the different antibiotics}

Antibiotic prophylaxis to reduce respiratory tract infections and deaths in intensive care {a combination of antibiotics applied directly to the part being treated and to the whole body (systemically) reduced infections and deaths}

Elderly

Vaccines for preventing influenza in the elderly (most relevant to those in nursing homes) {prevented about 45% of pneumonia cases, hospital admissions and influenza-related deaths for people in long-term care facilities; less effective for elderly people living in the community. The vaccines appear to be safe}

Back and neck pain

Work programs

Manual material handling advice and assistive devices for prevention and treatment {no clear reduction in reports of back pain, back-related disability or absence from work for the groups who received training on proper lifting techniques and assistive devices – compared with exercise training, back belts or no training}

Work conditioning, work hardening and functional restoration {programs with several features reduced the number of sick days for some workers with chronic back pain – addressed attitudes and behaviours such as fear of movement;, at work or in cooperation with employers; supervised by a physiotherapist or multidisciplinary team}

Back schools for non-specific low-back pain { back schools in an occupational and other settings reduced pain, improve ability to function and return-to-work status}

Multidisciplinary biopsychosocial rehabilitation for subacute low-back pain {some benefit from the rehabilitation program, which could have included workplace visits)

Multidisciplinary biopsychosocial rehabilitation for neck and shoulder pain {not enough evidence from trials to support use}

Treatment for low-back pain

Massage therapy {a trend showing that the greatest benefit came with massage from trained massage therapists who had many years of experience, or licensed massage therapists, for chronic pain. Less clear for acute pain. Acupressure or pressure point massage may provide more relief than classic massage}

Exercise therapy { slight benefit in decreasing pain and improving function, particularly for people visiting a healthcare provider}

Spinal manipulative therapy for low-back pain {effective in reducing pain and improving the ability to perform everyday activities}

Bed rest for acute low-back pain and sciatica {people advised to rest in bed have more pain and are less able to perform every day activities, on average, than those who are advised to stay active – for acute pain. For people with sciatica, there were no important differences in the effects of advice to stay in bed or to stay active}

Behavioural treatment for chronic pain {adding behavioural treatment to usual treatment programs (i.e. physiotherapy, back education, or various forms of medical treatment) did not have any clear benefit}

Muscle relaxants {these medicines are effective for short-term pain relief but also cause drowsiness, dizziness and other side effects; they must be used with caution}

Neuroreflexotherapy {provided in specialized clinics in Spain, appears to reduce pain and disability}

Transcutaneous electrical nerve stimulation (TENS) for chronic pain {conflicting evidence regarding the benefits of TENS alone for management of chronic pain }

Neck pain

Acupuncture {people who received acupuncture reported, on average, better pain relief immediately after treatment and in the short-term than those who received sham treatments}

Electrotherapy for neck disorders {evidence from trials limited or conflicting}

Mechanical neck disorders, for example whiplash

Massage {No conclusions could be drawn on effectiveness}

Exercises {limited evidence of benefit for strengthening, stretching and strengthening or eye-fixation exercises}

Manipulation and mobilization (adjustments and movement imposed onto joints and muscles) {combined care that included exercises plus mobilisation or manipulation gave greater pain reduction, improved ability to perform everyday activities; but not manipulation or mobilisation alone}

Medicinal and injection therapies {corticosteroid injection within 8 hours reduced pain; many other drugs had unclear benefits and can produce side effects; on average, Botulinum toxin A did not lessen pain and disability}

Surgery

Surgical interventions for lumbar disc prolapse {surgical discectomy for selected patients gave faster relief from an acute attack – but long-term effects on disease unclear} [PEARLS 23]

Rehabilitation after lumbar disc surgery {a review from 2002}

Bone, joint and muscle trauma

Check is all adults

Older people

Interventions for preventing falls {shows that falls can be reduced} [PEARLS 40]

Vitamin D and vitamin D analogues for preventing fractures associated with osteoporosis { vitamin D plus calcium did reduce fractures for people living in care (not in their own home or the community); people with some types of kidney disease or disease of the parathyroid glands need to seek medical advice before taking these supplements}

Progressive resistance strength training for physical disability {older people who did these exercises became stronger and improved their performance of simple activities such as walking or standing up from a chair more quickly}

Mobilisation strategies after hip fracture surgery {are effective when started soon after surgery – a more intensive programme of physiotherapy did not change recovery and more people were likely to drop out}

Co-ordinated multidisciplinary approaches for inpatient rehabilitation of older patients with hip (proximal femoral) fractures {more older people may recover when cared for by a specialist multidisciplinary team}

Nutritional supplementation for hip fracture aftercare {the evidence from trials is limited for the effectiveness of oral protein and energy feeds}

Pain

Exercise therapy for patellofemoral pain syndrome {whether exercise reduces knee problems during daily activities is unclear}

Orthotic devices for treating patellofemoral pain syndrome {from year 2002, review withdrawn; found that there was not enough information to be able to say if orthotics relieved the pain}

Medications (pharmacotherapy) for patellofemoral pain syndrome {non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen may reduce pain in the short term, but overall pain did not improve after three months. There were conflicting findings on the effect of glycosaminoglycan polysulphate. The anabolic steroid nandrolone may be effective, but associated risks demand extreme caution if used}

Interventions for treating plantar heel pain {treatments that are used to reduce heel pain seem to bring only marginal gains over no treatment and control therapies such as stretching exercises. Steroid injections only seem to be useful in the short term; stretching exercises and heel pads may provide better outcomes than custom made orthoses in people who stand for more than eight hours per day; no evidence to support the effectiveness of ultrasound or insoles with magnetic foil}

Work related

Ergonomic and physiotherapeutic interventions for treating work-related complaints of the arm, neck or shoulder {findings from trials were limited and conflicting because of the different people studied, interventions and outcome measures used}

Biopsychosocial rehabilitation for upper limb repetitive strain injuries in working age adults {year 2000, evidence from trials scarce}

Ligaments and tendons – hand and shoulder

Rehabilitation after surgery for flexor tendon injuries in the hand {no clear indication of a programme that was better than others; limitations in movement caused by adhesion between repaired tendons and surrounding tissues is a common problem}

Interventions for tears of the shoulder (rotator cuff) in adults {no quality trials comparing conservative to surgical treatment; limited information on open versus arthroscopic surgery}

Ligaments and tendons – ankles and knees

Different functional treatment strategies for ankle sprains (acute lateral ankle ligament injuries) in adults {elastic bandages led to few complications than taping, but recovery might have been faster with a semi-rigid ankle or lace-up support}

Interventions for treating long-term (chronic) ankle instability {insufficient evidence from trials to support any specific surgical or conservative intervention over another; however, after surgical reconstruction, early functional rehabilitation was superior to six weeks immobilisation for time to return to work and sports}

Therapeutic ultrasound for acute ankle sprains {ultrasound therapy did not seem to reduce pain and swelling, or to improve the ability to stand on the affected foot and spped recovery}

Exercise for treating isolated anterior cruciate ligament injuries in adults (involved in guiding knee straightening (extension) treated conservatively or with reconstruction surgery) {no strong evidence that one form of rehabilitation exercise program was better than another for return to daily activities, work and sporting activities}

Surgical versus conservative interventions for anterior cruciate ligament ruptures in adults {trials found used old treatment methods}

Exercise for treating anterior cruciate ligament injuries in combination with collateral ligament and meniscal damage of the knee in adults (following conservative treatment and reconstruction surgery) { no evidence to support one form of exercise programme over another looking at return to daily activities, work and sporting activities}

Interventions for treating posterior cruciate ligament injuries of the knee in adults {a lack of high quality evidence (randomized controlled trials) for treatment}

Surgical treatment for meniscal injuries of the knee in adults {review from year 1999, partial meniscectomy seems preferable to the total removal of the meniscus in terms of recovery and overall functional outcome in the short term}

Autologous cartilage implantation for full thickness articular cartilage defects of the knee {promising results from one trial but the evidence on benefits compared with other treatments is lacking; durability and complications of surgery and rehabilitation are important}

Fractures

Hyperbaric oxygen therapy for promoting fracture healing and treating fracture non-union {only one small trial with no clinically important outcomes}

Interventions for treating calcaneal (heel) fractures {from year 1999, withdrawn}

Amputation

Prescription of prosthetic ankle-foot mechanisms after lower limb amputation {In high activity individuals with a transfemoral amputation, there is limited evidence for the superiority of the Flex foot during level walking compared with the solid-ankle cushioned heel foot in terms of energy cost, gait and efficiency}

Breast cancer

Detection and communication (rather than diagnosis)

Screening for breast cancer with mammography {mammography screening has a small effect in reducing mortality; causes increases in overdiagnosis and overtreatment. Not clear whether screening does more harm than good}

Strategies for increasing the participation of women in community breast cancer screening {from year 2001, has a list of possible ways to approach women, not prioritised)

Regular self-examination or clinical examination for early detection of breast cancer {increased breast awareness may have contributed to the decrease in mortality from breast cancer that has been noted in some countries. Women should, therefore, be encouraged to seek medical advice if they detect any change in their breasts that may be breast cancer}

Methods of communicating a primary diagnosis of breast cancer to patients {no trials met standards for inclusion in review}

Early breast cancer

Follow-up strategies for women treated for early breast cancer {from year 2000, programs based on a regular physical exam and yearly mammogram appeared to be as effective as the more intensive approaches - by detection of recurrences of cancers, overall survival and quality of life}

Tamoxifen {review from year 2001 and withdrawn; tamoxifen clearly increased 10-year survival in early ER+ breast cancer}

Radiotherapy {review from year 2002 and withdrawn; radiotherapy reduced recurrences, but had very small effect on overall survival (40 years of trials examined)}

Preoperative chemotherapy for women with operable breast cancer {no difference in overall survival and disease-free survival with either preoperative chemotherapy or with chemotherapy postoperatively}

Metastatic and advanced breast cancer

Psychological interventions for women with metastatic breast cancer (support group sessions) {although psychological interventions were shown to provide some short-term psychological benefits, this benefit was not sustained for longer than a few months}

Chemotherapy alone versus endocrine therapy alone for metastatic breast cancer {while chemotherapy rather than endocrine therapy might be associated with a higher response rate, the two initial treatments had a similar effect on overall survival; there was increased toxicity associated with chemotherapy including nausea, vomiting and hair loss (alopecia)}

Systemic therapy for treating locoregional recurrence in women with breast cancer {insufficient evidence from trials that chemotherapy adds to surgery or radiation}

Aromatase inhibitors for treatment of advanced breast cancer in postmenopausal women {improved survival (hazard ratio 0.9) but overall benefits on progression-free survival, clinical benefit and objective response unclear; side effects included hot flushes and sweating; increased risks of arthritic pain, rash, diarrhoea, nausea and vomiting but less vaginal bleeding and blood clotting events compared with other endocrine therapies}

Side effects of treatment

Exercise for women receiving adjuvant therapy for breast cancer {fatigue may be lessened by exercise but insufficient evidence from trials to show this, or of any harms}

Chinese medicinal herbs to treat the side-effects of chemotherapy in breast cancer patients {Chinese herbs in conjunction with chemotherapy or alone may be beneficial in terms of improvement in marrow suppression and Immune sytstem, and may improve quality of life}

Physical therapies for reducing and controlling lymphoedema of the limbs (usually the arms, after surgery) {small trials did not provide sufficient evidence to evaluate self massage and compression sleeves}

Antibiotics, anti-inflammatories for reducing acute inflammatory episodes in lymphoedema of the limbs {too few trials to know the best way of treating infections from lymphedema}

Colorectal cancer

Quality of life after rectal resection for cancer, with or without permanent colostomy {differences in quality of life were not apparent between rectal cancer patients with and without a permanent stoma}

Dietary fibre for the prevention of colorectal adenomas and carcinomas (in industrialised countries) {increasing fibre in a western diet for two to four years did not lower the risk of bowel cancer}

Health professionals Communicating with consumers

At the health system, hospital or health professional level

Communication and decision making

Interventions before consultations for helping patients address their information needs {prompt sheets, coaching in the waiting room immediately before the consultation led to a small increase in patients asking questions, patient satisfaction and consultation length, particularly with written materials. Providing the intervention some time before did not result in changes}

Interventions for improving older patients' involvement in visits to their general physicians (primary care givers) {a pre-visit booklet and face-to-face session (either combined or pre-visit session alone) led to more questioning behaviour and active behaviour in a consultation} [PEARLS 39]

Interventions for providers to promote a patient-centred approach in clinical consultations {training health care providers to be more 'patient centred' may improve communication in consultations and increase people's satisfaction with their providers' manner - not clear if makes a difference to healthcare use or outcomes}

Decision aids for people facing health treatment or screening decisions {improved people's knowledge of their options, created realistic expectations of benefits and harms, improved decision making, and participation in the process; did not saffect satisfaction with decision making or anxiety}

Personalised risk communication for informed decision making about taking screening tests {people given personalised risk information may be more likely to participate in screening, but not clear if they were making more informed decisions} [PEARLS 37]

Contracts between patients and healthcare practitioners for improving patients' adherence to treatment, prevention and health promotion activities {the trials, mainly from the US, reported mixed findings} [PEARLS 22]

Interventions to support the decision-making process for older people facing the possibility of long-term residential care {no trials were found}

Communication systems

Interactive health communication applications for people with chronic disease (computer-based programs that combine health information with online peer support, decision support, or help with behaviour change) {improved users' knowledge, social support, health behaviours and clinical outcomes}

Hospital care and discharge

Written and verbal information versus verbal information only for patients being discharged from acute hospital settings to home {parents' understanding of how to continue care at home is better if they receive both written and verbal information}

Family-centred care for children in hospital {no studies were found that measured the effectiveness although a number described the aspects of care}

Telephone follow-up, initiated by a hospital-based health professional, for postdischarge problems in patients discharged from hospital to home {Some studies found this to be effective but overall there was no clear benefit}

Policy

Methods of consumer involvement in developing healthcare policy and research, clinical practice guidelines and patient information material {information from a small number of studies with very mixed approaches and purposes}

Depression and anxiety (and neuroses)

Children and adolescents

Exercise in prevention and treatment of anxiety and depression among children and young people {may be effective but many of the measures involved healthy students}

Cognitive behavioural therapy for anxiety disorders in children and adolescents {effective in individual, group and family or parent sessions for just over 50% of people}

Psychological and/or educational interventions for the prevention of depression in children and adolescents {psychological prevention programs were effective but very few trials on education}

Interventions for helping people recognise early signs of recurrence in bipolar disorder {improved functioning and added to usual treatment (medication, regular appointments} reduced the recurrence of mania and depression and need for hospitalisation}

Eating disorders

Self-help and guided self-help for eating disorders {may be of assistance for people of all ages}

Self harm

Psychosocial and pharmacological treatments for deliberate self harm {problem-solving therapy, provision of a card to allow emergency contact with services, depot flupenthixol for people with a history, and long-term psychological therapy for female patients with borderline personality disorder and recurrent self-harm all helped, mainly in small trials}

Adults

Non-medication therapies

Meditation therapy for anxiety disorders {too few studies and with many people dropping out}

Psychological therapies for generalised anxiety disorder {can be of benefit for people attending psychological therapy based on cognitive behavioural therapy; those who attended group sessions and older people were more likely to drop out of therapy} [PEARLS 24]

Medications

Antidepressants for generalized anxiety disorder {were of benefit in about one in five people}

Antidepressants plus benzodiazepines for major depression {from 2001, a combination of benzodiazepines and antidepressants decreased people dropping out of treatment and increased short-term response, up to four weeks; benzodiazepines can cause dependence and accident proneness}

Primary Care

Psychosocial interventions by general practitioners {no strong evidence from trials for the effectiveness, or ineffectiveness}

Effectiveness and cost effectiveness of counseling in primary care (the general physician’s surgery) {people who received counselling from a trained counsellor were more likely to feel better immediately after treatment and be more satisfied than those who received care from their general practitioner; in the long term counselling was not any better than the doctor’s care}

Work related EPOC type review topics?

Preventing occupational stress in healthcare workers {person-directed interventions that include a cognitive-behavioural approach such as training in coping skills (possibly combined with relaxation) can reduce burnout, anxiety, stress and general symptoms; as are work-directed interventions that include communication or nursing delivery change}

Other triggers

Psychological treatment of post-traumatic stress disorder {individual trauma focused cognitive-behavioural therapy, eye movement desensitisation and reprocessing, stress management and group sessions were effective ; more so than other non-trauma focused psychological treatments}

Combined psychotherapy plus antidepressants for panic disorder with or without agoraphobia {concluded from trials that either combined therapy or psychotherapy alone may be chosen depending on patient preference}

Effective practice and organization of care

Health system approaches

Effectiveness of shared care across the interface between primary and specialty care in chronic disease management {Shared care had a clear effect on improving prescribing but the pattern of results was mixed for all other outcomes; not clear on role of patient and family or how providers involved} [PEARLS 47, 54}

Guidelines in professions allied to medicine {from 1999, guidelines can improve care and professional roles substituted effectively, for instance a nurse can perform the function of a physician in certain circumstances} The one I just copy edited related to this

Substitution of doctors by nurses in primary care {quality of care was similar but it is not known if the doctor's workload was decreased. Nurses tend to provided more health advice and achieved higher levels of patient satisfaction}

Interventions to improve hand hygiene compliance in patient care {not enough evidence from trials to know what strategies improve hand hygiene compliance over time}

Mass media interventions for influencing the use of health services {more information from trials is needed on whether mass media coverage brings about appropriate use of services in those patients who can benefit most}

Professional practice and continuing education

Audit and feedback: effects on professional practice and health care outcomes {may be of benefit}

Interprofessional education: effects on professional practice and health care outcomes. {effects are variable so need to evaluate}

Tailored interventions to overcome identified barriers to change: effects on professional practice and healthcare outcomes {with small number of studies, not possible to determine if tailored strategies to overcome organisational barriers were more effective; or that all important barriers were identified and addressed}

Continuing education meetings and workshops: effects on professional practice and health care outcomes (from 2001, interactive workshops could result in moderately large changes in professional practice; lectures or presentations alone were unlikely to change professional practice}

Teaching critical appraisal skills in health care settings {teaching the skills to health professionals improved their knowledge but unclear if led to changes in the process of care or to changes in patient outcomes}

Gynaecological cancer

Communication skills training for health care professionals working with cancer patients, their families and/or carers {not enough trials to inform training} [relevant to effective practice ie broad– using patient awareness ‘to change’]

Intraperitoneal chemotherapy for the initial management of primary epithelial ovarian cancer {improves overall and disease-free survival; catheter associated with risks and adverse effects}

Chemotherapy for advanced ovarian cancer {from year 1999, before paxlitaxel available}

Tamoxifen for relapse of ovarian cancer {no information from randomized controlled trials – and now newer drugs (doxil, abvastin, topotecan, etoposide etc)}

Short versus long duration infusions of paclitaxel for any advanced adenocarcinoma {Short-infusion paclitaxel had fewer adverse effects than 24-hr infusion with no obvious loss of effectiveness}

Oral anticoagulation for prolonging survival in patients with cancer {vitamin K antagonists generally did not improve mortality (except for patients with extensive small cell lung cancer) but reduced risk of venous thromboembolism with a risk of minor and major bleeding

Heart disease or conditions

Prevention

Dietary advice for reducing cardiovascular risk {some evidence of greater effectiveness in people told that they were at risk of heart disease or cancer}

See also: Low glycaemic index diets for coronary heart disease

Interventions for promoting physical activity {professional advice and guidance with continued support can encourage people to be more physically active in the short to mid-term}

Multiple risk factor interventions for primary prevention of coronary heart disease {programmes do result in small reductions in blood pressure, cholesterol, salt intake, weight loss, etc but these lifestyle changes had little or no impact on the risk of heart attack or death} [PEARLS 59, 22]

Omega 3 fatty acids for prevention and treatment of cardiovascular disease {no evidence from quality trials of reduction in deaths or cardiovascular events}

Reduced or modified dietary fat for preventing cardiovascular disease {from 2000, cutting down how much fat we eat or replacing some saturated (animal) fats by plant oils and unsaturated spreads may reduce risk of heart disease}

Interventions for preventing obesity in children { at a population level there is not enough evidence from trials to prove that any one particular programme is effective, although comprehensive strategies to address dietary and physical activity change, together with psycho-social support and environmental change may help}

Stents for heart pain (angina)

Early invasive versus conservative strategies for unstable angina and non-ST-elevation myocardial infarction in the stent era {invasive strategy reduced the incidence of further chest pain or rehospitalization; long term, it may reduce the risk of dying and having another heart attack}

Percutaneous transluminal coronary angioplasty with stents versus coronary artery bypass grafting for people with stable angina or acute coronary syndromes {re-intervention (to alleviate subsequent narrowing) is needed less commonly after surgery than after stenting; risk of death or heart attack following either treatment appeared the same}

Atrial fibrillation

Pharmacological cardioversion for atrial fibrillation and flutter {drugs to create normal heart rhythm offered no benefit over drugs to control the pulse rate; people treated with drugs to control rhythm were more likely to require hospitalisation and to suffer adverse effects}

Heart failure and anticoagulants

Anticoagulation for heart failure in sinus rhythm {from 2000, not enough evidence from trials}

Antiplatelet agents versus control or anticoagulation for heart failure in sinus rhythm {from 2000, not enough evidence from trials}

HIV/AIDS

Prevention

Population based

Population-based interventions for reducing sexually transmitted infections (STIs), including HIV infection { Improved STI treatment services have been shown to reduce HIV incidence}

Mass media interventions for promoting HIV testing {from 2005, mass media campaigns designed to raise awareness of HIV and AIDS have shown immediate and significant effects in the promotion of voluntary counseling and testing}

Individual

Condom effectiveness in reducing heterosexual HIV transmission {condoms, when used consistently, substantially reduced HIV infection but did not totally eliminate the risk of infection}

Male circumcision for prevention of heterosexual acquisition of HIV in men {circumcision in heterosexual men is associated with lower rates of HIV infection; however there are no trials to show whether male circumcision as an intervention reduces HIV infection}

Antiretroviral post-exposure prophylaxis (PEP) for occupational HIV exposure {no evidence from quality trials but due to the success of combination therapies in treating HIV-infected individuals, a combination of drugs should be used}

HIV in pregnancy

Efficacy and safety of cesarean delivery for prevention of mother-to-child transmission {a good intervention for the prevention of transmission for HIV-infected women not taking antiretrovirals or taking only zidovudine, with high HIV viral loads}

Antiretrovirals for reducing the risk of mother-to-child transmission of HIV infection {short courses of certain antiretrovirals are effective in reducing ransmission of HIV, and are not associated with any safety concerns in the short term}

Interventions for reducing the risk of mother-to-child transmission of HIV infection {from 2002, obsolete}

Treatments for people with HIV/AIDS

Stavudine, lamivudine and nevirapine combination therapy for treatment of HIV infection and AIDS in adults [different combinations and dosing schedules had similar outcomes}

Micronutrient supplementation in children and adults {no evidence from trials that affects illness or death for adults; vitamin A may benefit children}

Nutritional interventions for reducing morbidity and mortality {from trials in high-income countries – no evidence of reduction in disease progression or related complications}

Treatment for anemia {no information from trials – using erythropoietin}

Interventions for the prevention and management of oral thrush (oropharyngeal candidiasis) in adults and children {best evidence available with fluconazole at the time of this review, effective in prevention; fluconazole, ketoconazole, itraconazole and clotrimazole all cleared the thrush, fluconazole, gentian violet and ketoconazole were better than nystatin}

Adherence to treatment

Patient support and education for promoting adherence to highly active antiretroviral therapy for HIV/AIDS {complex issues}

HIV – associated (opportunistic) infections

Treatment of latent tuberculosis infection {treatment with isoniazid reduced people’s risk of developing active TB}

Adjunctive corticosteroids for Pneumocystis jiroveci pneumonia (advanced with low blood oxygen levels (hypoxaemia) {trial results suggest beneficial}

Antifungal interventions for the primary prevention of cryptococcal disease in adults (causes meningitis and pneumonia, potentially lethal) {itraconazole and fluconazole were both effective in preventing fungal cryptococcal disease; but not in decreasing the overall death rates from HIV}

Cotrimoxazole prophylaxis for opportunistic infections in children {a clear reduction in deaths when taking cotrimoxazole; using cotrimoxazole in HIV-infected children waiting for antiretroviral treatment, or not yet requiring it, may increase survival and decrease number of days in hospital}

Cotrimoxazole prophylaxis for opportunistic infections in adults from 2003. cotrimoxazole improved survival in some areas of Africa, and outcomes, but adverse effects and possible drug resistance were unclear}

Metabolic and endocrine diseases - being overweight, diabetes

Over weight and obesity

Low glycaemic index or low glycaemic load diets (Need to explain the diets) {overweight and obese people lost more weight on low glycaemic index diets than on high glycaemic index or other weight reduction diets and their cardiovascular risks improved}

Exercise {exercise had a positive effect on body weight and cardiovascular disease risk factors particularly when combined with diet; it improved health even if no weight was lost}

Advice on low-fat diets for obesity {review withdrawn}

Diabetes – type 2 diabetes mellitus

Dietary advice for treatment in adults {the addition of exercise to dietary advice showed improvement of metabolic control after 6 and 12 months follow up; no information on the effects on vascular diabetic complications, deaths or quality of life}

Exercise {exercise improved blood sugar control even without weight loss (or changes in blood cholesterol or blood pressure; no information on the effects on diabetic complications}

Fish oil {not enough evidence from quality trials on any benefits of taking omega-3 fats}

Management of type 2 diabetes mellitus

Group based training for self-management strategies (adults who have participated in programmes improved their diabetes control (fasting blood glucose and glycated haemoglobin) and knowledge of diabetes, and had a reduced need for diabetes medication}

Interventions for improving adherence to treatment recommendations {nurse-led interventions, home aids, diabetes education and pharmacy-led interventions showed a very small effect on some outcomes including metabolic control; no information from trials on illness, deaths or quality of life}

Self-monitoring of blood glucose in patients not using insulin {self-monitoring of blood glucose only might be effective in improving glucose control – if used to adjust diet and exercise; insufficient information on quality of life, well-being, patient satisfaction}

Systems for routine surveillance for people with diabetes mellitus {from 1998, unstructured care in the community was associated with poorer follow up, more deaths and worse glycaemic control than hospital care} with EPOC reviews – can be considered together?

Inhaled insulin in diabetes {review withdrawn}

Methodological reviews - clinical trials

Participation in trials

Outcomes of patients who participate in randomised controlled trials compared to similar patients receiving similar interventions who do not participate {on average, the outcomes of patients participating and not participating in the trials were similar}

Randomisation to protect against selection bias in healthcare trials {the unpredictability of random allocation is the best protection against the unpredictability of the extent to which non-randomised trials may be biased}

Strategies to improve recruitment to research studies {trials of methods aimed at participants were easily generalizable; no trials on methods aimed at researcher collaborators or ethics committees}

Incentives and disincentives to participation by clinicians in randomised controlled trials {healthcare professionals inviting patients to take part in a randomised controlled trial in which they provide at least one of the interventions only invite a small proportion of the people who are eligible for trials to take part}

Peer review and publication

Editorial peer review for improving the quality of reports of biomedical studies {few studies of reasonable quality and mostly concerned with the effects of blinding reviewers and authors to each others' identity}

Full publication of results initially presented in abstracts (for conferences) {positive results are subsequently published as full-length journal articles more often than studies with negative results - less than half of all studies and about 60% of randomized or controlled clinical trials}

Peer review for improving the quality of grant applications {unable to find comparative studies assessing the actual (positive and negative) effects of peer review procedures on the quality of the research funded}

Musculoskeletal conditions

-osteoporosis, fibromyalgia, shoulder pain, arthritis

Osteoporosis

Vitamin D and vitamin D analogues for preventing fractures {vitamin D plus calcium does reduce fractures for people living in care – not in their home or the community; some people, particularly with some types of kidney disease or disease of the parathyroid glands, should seek medical advice before taking these supplements}

Calcium and vitamin D for corticosteroid-induced osteoporosis {from 1998, a clinically and statistically significant prevention of bone loss at the lumbar spine and forearm with vitamin D and calcium}

Exercise for preventing and treating osteoporosis in postmenopausal women {from 2002, appears to be effective on bone density; little information from trials on fractures}

Fibromyalgia

Exercise for treating fibromyalgia syndrome {different exercise programs were studied (such as aerobic training, strength training) which some people with fibromyalgia may not be able to undertake; it is not known whether exercise training for more than 12 weeks improves other symptoms such as fatigue, stiffness or poor sleep or if flexibility training, programs combining types of exercise, and programs combining exercise with non-exercise strategies improve symptoms from the trials in this review} [PEARLS 55]

Multidisciplinary rehabilitation for fibromyalgia and musculoskeletal pain in working age adults {from 1999 and too old to show any measurable benefit}

Shoulder pain

Acupuncture {the little evidence from quality trials indicates acupuncture may improve pain and function over 2 to 4 weeks}

Corticosteroid injections for rotator cuff disease, adhesive capsulitis or frozen shoulder {subacromial (bursa on the ligament) corticosteroid injection for rotator cuff disease may have small short-lived benefits but be no better than non-steroidal anti-inflammatory drugs; intra-articular steroid injection into the joint may be of limited, short-term benefit for adhesive capsulitis}

Physiotherapy interventions {use of the different techniques, including mobilisation, exercise, laser therapy, was supported by some evidence from trials and may be effective for specific disorders}
[PEARLS 75 surgery] check 14

Osteoarthritis

Exercise for the knee {land-based exercise resulted in a modest reduction in pain and a modest improvement in physical function} [PEARLS 38 water based]

Intensity of exercise for treatment {both low and high intensity aerobic exercise improves functional status, pain, gait, and fitness}

Braces and moulded inner soles for shoes (orthoses) for treating osteoarthritis of the knee {wearing a knee brace: improves the distance people can walk, foot or ankle orthoses reduce pain over time}

Glucosamine therapy {improves pain and function but inconsistent results from the different studies}

Therapeutic ultrasound for osteoarthritis of the knee {no benefit on pain, range of movement or ability to function}

Thermotherapy {a few studies using cold or hot packs to reduce pain and swelling}

Joint replacement

Pre-operative education for hip or knee replacement {although important to know what to expect, people with or without education before surgery had about the same amount of anxiety}

Continuous passive motion following total knee arthroplasty {benefits in short-term rehabilitation but inconvenience, costs and any long-term benefits not looked at}

Rheumatoid arthritis

Patient education for adults {had small benefit at first follow up, but not later, on physical, psychological measures and depression}

Splints and moulded inner soles for shoes (orthoses) {from 2001, one study showed that wearing extra-depth shoes for two months reduced pain when walking and climbing stairs climbing, semi-rigid insoles as well provided better pain relief; splints did not appear to be effective but people preferred to wear them}

Occupational therapy for rheumatoid arthritis {can help people do daily chores but less clear about helping pain}

Low level laser therapy (Classes I, II and III) {decreases pain and morning stiffness in the short term}

Acupuncture and electroacupuncture {one trial for each: electroacupuncture to the knee seemed to be effective}

Tai chi {could improve range of movement of ankle, knee and hip joints}

Thermotherapy {heat and ice packs do not change disease activity but paraffin wax baths help pain and hand function after 4 weeks of treatment}

Moderate-term, low-dose corticosteroids {from 1998, prednisone treatment was better than placebo and comparable to treatment with aspirin}

Folic acid and folinic acid for reducing side effects in patients receiving methotrexate {from 1999, effective in reducing mucosal and gastrointestinal side effects}

Psoriatic arthritis

Interventions for treating psoriatic arthritis {from year 2000, injected methotrexate and sulfasalazine resulted in important benefit in over half the patients}

Oral health - dental

Fluoride for preventing dental caries – children and adolescents

Fluoride toothpastes {using to brush with at least once a day reduced decay}

Fluoride mouthrinses {regular supervised use reduced decay}

Topical fluoride (toothpastes, mouthrinses, gels or varnishes) {reduced decay, missing teeth; increased benefit with supervision; chewing and eating the products a problem}

Fluoride gels {reduced decay when used a few times a year} Where have done?

Fluoride varnishes {substantially reduce decay when applied professionally 2 to 4 times a year}

One topical fluoride (toothpastes, or mouthrinses, or gels, or varnishes) versus another {topical fluorides do not appear to be more effective than toothpaste}

Sealants for preventing dental decay – children and adolescents

Pit and fissure sealants for permanent teeth {children who have their molar teeth covered by a sealant are less likely to have dental decay in their molar teeth than children without sealant}

Pit and fissure sealants versus fluoride varnishes {reduced decay more than fluoride varnishes}

General dental care

Manual versus powered toothbrushing for oral health {only rotation oscillation power toothbrushes better than manual toothbrushes in removing plaque and reducing gum inflammation – no more likely to injure gums}

Tongue scraping for treating halitosis {scrapers slightly more effective than toothbrushes; short duration of effect, can cause some tongue trauma}

See also: Mouthrinses for halitosis

Routine scale and polish for periodontal health in adults {trials of poor quality and could not inform on any benefit}

Recall intervals for oral health in primary care patients {only one trial so no good evidence on the 6-monthly checks commonly used}

Interventions for treating asymptomatic impacted wisdom teeth in adolescents and adults {some reliable evidence that cannot be justified in adolescents; no trials in adults}

Complete or ultraconservative removal of decayed tissue in unfilled teeth {no detriment to patient not removing all decay and reduced risk of pulpal exposure}

Interventions for dental implants – replacing missing teeth

Maintaining health around dental implants {antibacterial mouthrinses may reduce plaque and bleeding; no evidence that electric tooth brushes were better}

Treatment of perimplantitis {no clear advantages of complex, expensive therapies over deep mechanical cleaning}

Preprosthetic surgery versus dental implants {some evidence that people may prefer implants to stabilize a denture compared with conventional surgery}

Cancer

Interventions for treating oral mucositis for patients with cancer receiving treatment {weak, unreliable evidence that allopurinol mouthwash, granulocyte macrophage-colony stimulating factors, immunoglobulin, human placental extract relieve or cure the ulcers}

Screening programmes for the early detection and prevention of oral cancer {more evidence needed to find out if visual inspection could provide earlier detection and reduce death rate}

Interventions for treating oral leukoplakia (to prevent from becoming cancerous) {no evidence from trials on drugs and supplements}

Pain, palliative and supportive care - cancer

General pain relief

Music for pain relief {music reduced pain, increased the number of patients who reported at least 50% pain relief, and reduced requirements for morphine-type analgesics}

New, Touch therapies for pain relief in adults

Transcutaneous electrical nerve stimulation (TENS) for chronic pain {insufficient information from trials to draw conclusions on effectiveness; usually not used alone}

Opioids – strong addictive pain killers (analgesics)

Patient controlled opioid analgesia versus conventional opioid analgesia for postoperative pain { provided slightly better pain control and increased patient satisfaction when compared with conventional methods; patients tended to use higher doses and suffered a higher occurrence of itching}

Opioids for neuropathic pain (caused by nerve damage) {mixed results on short-term use of opioids; intermediate-term trials demonstrated that opioids were effective for the subtypes of neuropathic pain tested - side effects such as nausea, dizziness, and drowsiness were common}

Cancer

Acupuncture-point stimulation for chemotherapy-induced nausea or vomiting (used in combination with antivomiting drugs) {electroacupuncture reduced first-day vomiting but manual acupuncture did not; acupressure also reduced first-day nausea but was not effective on later days and showed no benefit for vomiting}

Aromatherapy and massage for symptom relief in patients with cancer {review withdrawn, massage alone and massage with aromatherapy oils can reduce anxiety in the short term; and may also have a beneficial effect on physical symptoms of cancer}

Selenium for alleviating the side effects of chemotherapy, radiotherapy and surgery in cancer patients {no clear evidence from trials of an improvemen in side effects; no adverse effects but evidence of (unintentional) overdosing}

Cancer pain

NSAIDS or paracetamol, alone or combined with opioids {no large clinical difference when combining an opioid with a non-steroidal anti-inflammatory drug (NSAID) versus either medication alone}

Oral morphine {good relief of pain but with some unwanted effects, mainly constipation and nausea and vomiting}

Hydromorphone for acute and chronic pain {from 2002, a potent analgesic – no clinically significant difference between hydromorphone and other strong opioids such as morphine on pain efficacy and tolerability}

Opioids for the management of breakthrough (episodic) pain {oral transmucosal fentanyl citrate is an opioid and is effective in the management of breakthrough pain, with similar side effects as other opioids}

Opioid switching to improve pain relief and drug tolerability {no randomised trials met the inclusion criteria for this review}

Ketamine as an adjuvant to opioids for cancer pain (additional treatment) {2 small trials suggested that ketamine given with morphine may help to control cancer pain}

Comparative efficacy of epidural, subarachnoid, and intracerebroventricular opioids in patients with pain due to cancer {evidence from uncontrolled studies showed that giving opioids intracerebroventricularly was more effective for pain relief than either epidural or subarachnoid (into cerebrospinal fluid) administration; adverse effects and complications were reported for all three procedures}

Other

Nutrition support for bone marrow transplant patients {limited information from trials indicated that patients with an inadequate food intake, unable to tolerate oral or tube feeding, were likely to go home earlier if they receive parenteral nutrition with additional glutamine}

Palliative care

Laxatives for the management of constipation in palliative care patients { All laxatives used ineffective for a significant number of patients – relative lack of treatments}

Benzodiazepines and related drugs for insomnia in palliative care {from 2001, no guidelines on their use – and no trials found}

Opioids for the palliation of breathlessness in terminal illness {small but positive effect with oral and subcutaneous, but not inhaled, opioids; a lack of consistent evidence in support of the use of opioids to improve exercise tolerance}

Drug therapy for anxiety in palliative care {no trials were found}

Drug therapy for delirium in terminally ill patients {only one study, no results given}

Radiotherapy for the palliation of painful bone metastases {from 1999}

Pleurodesis for malignant pleural effusions (a collection of fluid in the space between the lung and chest wall that causes breathing problems and requires hospital treatment. After the fluid has been removed, chemicals called sclerosants are introduced into the cavity to prevent the fluid from accumulating again) {talc was more effective than other sclerosants; and thoracoscopic removal of fluid (pleurodesis)}

Surgery for the resolution of symptoms in malignant bowel obstruction in advanced gynaecological and gastrointestinal cancer {from 2000, lack of quality trials and appropriate, validated outcome criteria appropriate for these patients}

Pregnancy and childbirth

During pregnancy (antenatal)

Individual or group antenatal education for childbirth or parenthood, or both (decision making about and during labour, skills for labour, pain relief, infant and postnatal care, breastfeeding and parenting skills ) {benefits unclear because of insufficient information from trials, different interventions and outcomes}

Giving women their own case notes to carry during pregnancy {improves their sense of control and satisfaction; not enough evidence on effects on health behaviours such as smoking, breastfeeding and clinical outcomes}

Interventions for nausea and vomiting in early pregnancy {acupressure and ginger may work with no side effects; antihistamines work well but cause drowsiness}

Interventions for promoting smoking cessation during pregnancy {there are effective strategies to help and support women to stop smoking that lead to fewer premature babies and better birthweights for babies}

Interventions for preventing and treating pelvic and back pain in pregnancy {specifically tailored strengthening exercise, sitting pelvic tilt exercise programs, and water gymnastics all had beneficial effects; acupuncture seemed more effective than physiotherapy; adverse effects when reported were minor and transient}

Psychosocial and psychological interventions for treating antenatal depression {only one trial from the US}

Antenatal day care units versus hospital admission for women with complicated pregnancy {from year 2001, some evidence that inpatient stay and the rate of induced labour was reduced by admission to day care units}

Ultrasound for fetal assessment in early pregnancy {from 1998, routine ultrasound enabled better gestational age assessment, earlier detection of multiple pregnancies and earlier detection of clinically unsuspected fetal malformation at a time when termination of pregnancy was possible}

External cephalic version for breech presentation at term {from 1996, after about 36 weeks of pregnancy, it reduced the chance that the baby present as breech at the time of birth, and reduced the chance of caesarean birth}

External cephalic version for breech presentation before term {done very early in the third trimester (32 to 34 weeks) it did not affect how the baby was lying at full term nor was there any change in the number of babies born by caesarean delivery}

Antenatal education for self-diagnosis of the onset of active labour at term {from year 1998, not enough evidence to show whether specific criteria were more beneficial than general guidelines in helping women determine their stage of labour}

Antenatal perineal massage for reducing perineal trauma (for as little as once or twice a week from 35 weeks on) {undertaken by the woman or her partner, massage reduced the likelihood of perineal trauma (mainly episiotomies) and ongoing perineal pain; particularly for women who had not given birth vaginally before}

Supporting childbirth

Continuity of caregivers for care during pregnancy and childbirth {from 2000, trial withdrawn - women who had continuity of care by a team of midwives were more likely to discuss antenatal and postnatal concerns, attend prenatal classes, give birth without painkillers, feel well prepared and supported during labour, and feel prepared for child care; their babies less often required resuscitation}

Continuous support for women during childbirth {increased the chance of a spontaneous vaginal birth, had no identified adverse effects and women were more satisfied, less likely to use pain medications, and had slightly shorter labours; appeared to be more effective when provided by women who were not part of the hospital staff and commenced early in labour}

Traditional birth attendant training for improving health behaviours and pregnancy outcomes {the potential of trainingin decreasing newborn deaths was promising when combined with improved health services}

Home-like versus conventional institutional settings for birth {modest benefits including decreased medical intervention and higher rates of spontaneous vaginal birth, breastfeeding, and maternal satisfaction; may be an added risk of perinatal deaths}

Home versus hospital birth {from year 1998, only one small trial}

Immersion in water in pregnancy, labour and birth {from year 2002, immersion during the first stage of labour clearly reduced maternal pain and the need for epidural or spinal analgesia without adversely affecting labour duration, operative delivery rates, or wellbeing of the newborn; during the second stage of labour it increased women's reported satisfaction with pushing}

Acupuncture for induction of labour {small trials suggested that women receiving acupuncture received fewer methods of induction when compared to standard obstetric care}

Labour assessment programs to delay admission to labour wards {from year 2001, women assessed by a hospital program had shorter labour ward stays, felt more in control and needed fewer drugs to progress labour or give pain relief}

Management of labor

Position in the second stage of labour for women without epidural anaesthesia {when women gave birth on their backs it was more painful for the mother, caused more problems with the baby's heartbeat, more women needed help from doctors using forceps and cuts to the birth outlet; but blood loss was less}

Epidural versus non-epidural or no analgesia in labour {epidurals relieved pain better than other types of pain medication but led to more use of instruments to assist with the birth; no difference in caesarean delivery rates, long-term backache, or effects on the baby soon after birth. However, women who used epidurals were more likely to have a longer second stage of labour, need their labour contractions stimulated, experience very low blood pressure, be unable to move for a period of time after the birth, have problems passing urine, and have a fever}

Complementary and alternative therapies for pain management in labour {acupuncture and hypnosis could help relieve pain during labour; insufficient evidence from trials about the benefits of music, massage, relaxation, white noise, acupressure, aromatherapy}

Early versus delayed umbilical cord clamping in preterm infants {delaying clamping for just a very short time helped the babies to adjust to their new surroundings, helping the flow of blood to the baby's lungs}

Episiotomy for vaginal birth {from 1999, restrictive episiotomy policies had a number of benefits compared to routinely doing episiotomies including less posterior perineal trauma, suturing or complications; an increased risk of anterior perineal trauma with restrictive episiotomy}

Early skin-to-skin contact for mothers and their healthy newborn infants {early contact at birth reduced crying, improved mother-baby interaction, kept the baby warmer, and helped women breastfeed}

Induction of labour for improving birth outcomes for women at or beyond term {fewer baby deaths when a labour induction policy was implemented for women after 41 completed weeks, however, such deaths were rare with either policy; women's experiences and opinions about these choices were not adequately evaluated}

Active versus expectant management in the third stage of labour to deliver the placenta after the baby has been born (active management includes drug administration, early cord clamping and controlled cord traction) {from year 2000, active management was effective, important as uterine muscles then contract to stop blood loss) but some of the drugs can cause side effects of nausea and vomiting}
Expedited versus conservative approaches for vaginal delivery in breech presentation {from 1996, no trials}

Caesarians and interventions

Caesarean section for non-medical reasons at term {from 2000, no trials assessing the risks and benefits of caesarean section when undertaken without a conventional medical indication}

Regional versus general anaesthesia for caesarean section {some differences favoured general anaesthesia, for example, less nausea and vomiting; differences favouring regional anaesthesia included less blood loss or shivering. None of the trials addressed important issues for women like recovery times, effects on breastfeeding and the mother-child relationship, and length of time before mother feels well enough to care for her baby.

Planned caesarean section for term breech delivery {was safer for the singleton breech baby at term than planned vaginal birth, however, mothers suffered more short-term complications and there was limited information about the potential for problems with future pregnancies}

Elective repeat caesarean section versus induction of labour for women with a previous caesarean birth {from year 2000, no trials}

Planned elective repeat caesarean section versus planned vaginal birth for women with a previous caesarean birth {from 2004, no trials}

After giving birth (postnatal)

Early postnatal discharge from hospital for healthy mothers and term infants {from year 2002, inconclusive findings but early discharge did not appear to have harmful effects}

Psychosocial and psychological interventions for preventing postpartum depression {appeared to be of more benefit when delivered to individuals rather than groups and initiated in the postnatal period without an antenatal component}

Breastfeeding

Interventions for promoting the initiation of breastfeeding {5 US programs showed overall success at increasing the number of poorer women who started to breastfeed their baby; peer support and needs-based sessions by a trained breastfeeding professional or peer counselor also effective}

Interventions in the workplace to support breastfeeding for women in employment {no trials were found}

Support for breastfeeding mothers {both professional and lay support were effective, also when given together, in areas where initiation and continuation of breastfeeding was not high}

Optimal duration of exclusive breastfeeding {from 2002, exclusive breastfeeding for six months (versus three to four months) reduced gastrointestinal infection, did not slow growth, and helped the mother lose weight; reduced level of iron has been observed in developing-country settings}

Support for mothers, fathers and families after perinatal death {no quality trials were found]

Skin problems

Fungal infections

Topical treatments for fungal infections of the skin and nails of the foot {fungal skin infections of the skin of the feet (athlete's foot or tinea pedis) are effectively managed by over-the-counter topical antifungal creams, lotions and gels}

Oral treatments for fungal infections of the skin of the foot from year 2002, effective against athlete's foot (tinea pedis) but they cause stomach upsets and can be quite expensive}

Skin conditions

Eczema

Psychological and educational interventions for atopic eczema in children {education decreased the severity of the eczema; education improved quality of life for the parents; relaxation methods reduced the severity of the eczema in a psychological study. The education was led by a nurse or a team of health professionals – needs to include education and support by patient support groups}

Chinese herbal medicine for atopic eczema (from 2004, the herbal preparation tested is no longer available}

Impetigo

Interventions for impetigo {two antibiotic creams were at least as effective as taking antibiotics by mouth for limited disease (penicillin is not effective); little evidence that using disinfectant solutions improves impetigo}

Cancers

Interventions for basal cell carcinoma of the skin {surgery and radiotherapy were the most effective treatments); photodynamic therapy (to avoid scarring) and cryotherapy also effective; imiquimod cream was promising for superficial cancers}

Statins and fibrates for preventing melanoma {no evidence from trials that reduce risk of melanomas}

Tobacco addiction

Prevention and community based

Young people

Community interventions for preventing smoking in young people {some evidence that coordinated programs made up of a number of parts (multicomponent) could reduce smoking, more effectively than single strategies alone}

Family and carer smoking control programmes for reducing children's exposure to environmental tobacco smoke {several interventions including parental education and counselling programs have been used to try to reduce parental smoking; the review was unable to determine that one intervention was more effectively than another but intensive counselling in a clinical setting was effective}

School-based programmes for preventing smoking {little evidence that providing information or education alone was effective}

Adults

Community interventions for reducing smoking among adults {from 2002, increased knowledge and awareness but rarely led to higher quit rates}

Smoking cessation

Young people

Tobacco cessation interventions for young people {complex programmes, including those tailored to the young person's preparation for quitting, and behavioural therapy programmes showed some promise; nicotine replacement and bupropion were not sufficiently tested in adolescents}

Adults

Nicotine replacement therapy {all forms of replacement therapy make success in stopping smoking more likely}

Self-help interventions {advice and behavioural counselling could help smokers to quit; giving the same type of support using written materials or other media was not very helpful; tailoring materials to provide individualized support was more effective}

Exercise interventions {helped smokers to quit in some of the studies}

Antidepressants {the two medications bupropion (Zyban) and nortriptyline helped smokers quit but had side effects including dry mouth and nausea}

Workplace interventions {proven stopping smoking methods like group therapy, individual counselling and nicotine replacement therapy were equally effective when offered in the workplace; evidence less clear for self-help methods; bans and restrictions can reduce smoking at work; social and environmental support, competitions and incentives, and comprehensive programmes do not show a clear benefit in helping smokers to quit at work}

Interventions for smokeless tobacco use cessation {snuff, chewing tobacco (US only), nicotine patches, gum, bupropion did not help to stop}

Providing assistance

Enhancing partner support to improve smoking cessation {made smokers were more likely to quit – but programs intended to improve the support not shown to increase long-term quit rates}

Group behaviour therapy programmes {more effective for helping people to stop smoking than being given self-help materials without face-to-face instruction and group support, chances of quitting more than doubled; not clear if groups are better than individual counselling or other advice}

In hospital

Interventions for preoperative smoking cessation {short-term quitting and reduction could be achieved but unclear what effect it had on complication rates from surgery}

Interventions for smoking cessation in hospitalised patients {programs to stop smoking that began during a hospital stay and included follow-up support for at least one month after discharge were effective}

Nursing interventions for smoking cessation {advice and support from nurses could increase quitting, particularly in hospital}

General practice or primary care

Training health professionals in smoking cessation {not strong evidence from trials that training doctors to ask if people smoked and then offer advice increases the number who quit}