If your idea of a present is a new or updated Cochrane review then it’s now Christmas every day with the arrival of Publish When Ready here in Cochraneland. In a huge change to the system for publishing reviews and protocols in the Cochrane Library, new arrivals appear daily, throughout the day, instead of once a month. In the time it takes me to make a cup of tea, a new review may have popped into the Library, ready for my consumption. It’s all rather exciting! It’s also rather alarming, as I have the distinct feeling that with such a rapid flow of evidence I may miss things and fail to shout about stuff that you might like to know about. It may calm down (or I may speed up!) but with the sudden arrival of a very large amount of new evidence I thought I’d give you a bit of a round-up. So here are my picks of the week on surgery, drugs and rock’n’roll, with some talking treatment thrown in.
Burn wound infection is a serious problem, delaying healing and accounting for 75% of deaths from burns after initial resuscitation. Antibiotics may be given as a preventive measure, but there is a lack of evidence about the effectiveness and safety of this approach, along with the usual concerns about antibiotics use, such as their contribution to the emergence of resistant strains of micro-organisms. A new review has looked at antibiotics for preventing burn wound infection and disappointingly found that there is only a little, poor quality evidence on this topic. A meta-analysis of the 11 randomized controlled trials (645 people) evaluating silver sulfadiazine found a significant increase in burn wound infection and longer hospital stay associated with its use compared with dressings/skin substitute, but it should be noted that these trials were at high or unclear risk of bias.
Still on the subject of antibiotics, a review on antibiotics for community-acquired pneumonia in children has been updated, with the addition of two trials and new evidence that children with severe pneumonia without hypoxaemia, who are up and about, can be treated with oral amoxycillin, while for those who are hospitalized penicillin/ampicillin plus gentamycin is better than chloramphenicol.
Cognitive behavioural therapy (CBT) is a ‘talking treatment’ which has been shown to help with a range of problems, including anxiety disorders. A review on CBT for children and young people which found CBT to be effective has been updated and finds from moderate quality evidence that CBT is significantly more effective for reducing anxiety than doing nothing but no more effective than other ‘active therapies’ such as self-help books. There were too few studies to compare CBT with medicines and it’s not clear whether one way of delivering CBT (in a group, individually or with parents) is better than another, or whether the improvement lasts long-term.
Many people who would prefer to die at home die in hospital, so it’s really good to see a new review on home palliative care services for adults which finds that home palliative care can more than double a person’s chance of dying at home and also reduce the symptoms experienced in advanced illness. This review also looked at cost-effectiveness and has data which service planners and policy makers may find useful to consider when looking at the needs of their localities. I will be writing a blog on this important review later this month. There’s also a new review on medicines to help relieve treatment-associated itching in adults receiving palliative care. It’s disappointing that the evidence was insufficient to provide clear guidance about how this can best be managed and more, good quality, studies are needed in this area.
Hard on the heels of the overview of reviews on drugs to help people stop smoking, which I blogged here last month, the review looking at opioid antagonists for smoking cessation has been updated. These are drugs such as naltrexone, which might help reduce nicotine addiction by blocking some of the rewarding effects of nicotine. Four new trials with long-term outcomes have been added and the reviewers say that further research is unlikely to change the finding that the clinical use of naltrexone or other opioid antagonists is of no benefit for smoking cessation.
Music might be more effective than drugs at quelling people’s anxiety when they’re about to have surgery, finds another new review, though methodological weaknesses in the included studies means we have to be a bit cautious about the results. This joins two other reviews which also suggest a beneficial effect of music for patients in medical settings and I shall be looking at these and other Cochrane reviews on music interventions in a future blog. Music instead of medicines is certainly an appealing approach.
Carpal Tunnel Syndrome (CTS) is a very common problem and carpal tunnel release is one of the most common surgical procedures in the USA. A new review looking at rehabilitation following carpal tunnel release found only limited and low quality evidence for a range of rehabilitation interventions, such that the reviewers say decisions on rehabilitation approaches are down to clinician’s expertise and patients preferences and that patients should be informed that there is limited evidence on effectiveness and safety. CTS can also be treated without surgery and last year a review on splinting for CTS found only weak evidence, showing a small effect of splinting for CTS. You can read more about that here in a blog from Tracey Howe, Professor of Rehabilitation Sciences at Glasgow Caledonian University, who is an editor and author for the Cochrane Bone, Joint and Muscle Trauma Group.
My last pick of the week is a review which looked at two surgical approaches for another fairly common problem, thought to result from changes in the jelly inside the eye (the vitreous), full-thickness macular hole. The new review compared these surgical procedures for FTMH: vitrectomy with internal limiting membrane (ILM) peeling versus vitrectomy with no peeling and found that people who had received ILM peeling had better vision after three months, more holes were closed and fewer needed another operation, making this likely to be a cost-effective approach. Complications were similar with both types of surgery.
That’s it for now but there are other new and updated reviews that may interest you, and while I’ve been writing no doubt more have appeared in the Cochrane Library. I may add these round-ups on a regular basis. Meanwhile, you might like to go to the Cochrane Library and check out what’s new, or to Cochrane Summaries, where there are links to the full review, the relevant Review Group and often a podcast.
Barajas-Nava LA, López-Alcalde J, Roqué i Figuls M, Solà I, Bonfill Cosp X. Antibiotic prophylaxis for preventing burn wound infection. Cochrane Database of Systematic Reviews 2013, Issue 6. Art. No.: CD008738. DOI: 10.1002/14651858.CD008738.pub2.
Lodha R, Kabra SK, Pandey RM. Antibiotics for community-acquired pneumonia in children. Cochrane Database of Systematic Reviews 2013, Issue 6. Art. No.: CD004874. DOI: 10.1002/14651858.CD004874.pub4.
James AC, James G, Cowdrey FA, Soler A, Choke A. Cognitive behavioural therapy for anxiety disorders in children and adolescents. Cochrane Database of Systematic Reviews 2013, Issue 6. Art. No.: CD004690. DOI: 10.1002/14651858.CD004690.pub3.
Gomes B, Calanzani N, Curiale V, McCrone P, Higginson IJ. Effectiveness and cost-effectiveness of home palliative care services for adults with advanced illness and their caregivers. Cochrane Database of Systematic Reviews 2013, Issue 6. Art. No.: CD007760. DOI: 10.1002/14651858.CD007760.pub2.
Xander C, Meerpohl JJ, Galandi D, Buroh S, Schwarzer G, Antes G, Becker G. Pharmacological interventions for pruritus in adult palliative care patients. Cochrane Database of Systematic Reviews 2013, Issue 6. Art. No.: CD008320. DOI: 10.1002/14651858.CD008320.pub2
Bradt J, Dileo C, Shim M. Music interventions for preoperative anxiety. Cochrane Database of Systematic Reviews 2013, Issue 6. Art. No.: CD006908. DOI: 10.1002/14651858.CD006908.pub2
David SP, Lancaster T, Stead LF, Evins AE, Prochaska JJ. Opioid antagonists for smoking cessation. Cochrane Database of Systematic Reviews 2013, Issue 6. Art. No.: CD003086. DOI: 10.1002/14651858.CD003086.pub3.
Peters S, Page MJ, Coppieters MW, Ross M, Johnston V. Rehabilitation following carpal tunnel release. Cochrane Database of Systematic Reviews 2013, Issue 6. Art. No.: CD004158. DOI: 10.1002/14651858.CD004158.pub2.
Spiteri Cornish K, Lois N, Scott N, Burr J, Cook J, Boachie C, Tadayoni R, la Cour M, Christensen U, Kwok A. Vitrectomy with internal limiting membrane (ILM) peeling versus vitrectomy with no peeling for idiopathic full-thickness macular hole (FTMH). Cochrane Database of Systematic Reviews 2013, Issue 6. Art. No.: CD009306. DOI: 10.1002/14651858.CD009306.pub2.