ATTRACTcme

Haemorrhoids

2012-01-30T12:00:00.000Z

Evidence Based Reports

Rubber band ligation versus excisional haemorrhoidectomy for haemorrhoids (2011)[Cochrane]NEW

Conventional versus LigaSure hemorrhoidectomy for patients with symptomatic Hemorrhoids (2011)[Cochrane]NEW

Traditional Chinese Medicine herbs for stopping bleeding from haemorrhoids (2010)[Cochrane Library]

Stapled versus conventional surgery for hemorrhoids (2010)[Cochrane Library]

Conservative management of symptomatic and/or complicated haemorrhoids in pregnancy and the puerperium (2010)[Cochrane Library]

Haemorrhoids (2009)[Clinical Evidence]

Conventional versus LigaSure hemorrhoidectomy for patients with symptomatic Hemorrhoids (2009)[Cochrane Library]

Stapled haemorrhoidectomy (haemorrhoidopexy) for the treatment of haemorrhoids: a systematic review and economic evaluation (2009)[DARE]

Stapled haemorrhoidectomy (haemorrhoidopexy) for the treatment of haemorrhoids: a systematic review and economic evaluation (2008)[HTA]

Clinical Guidelines

Haemorrhoids - suspected (2009)[Map of Medicine]

Haemorrhoids (2008)[CKS]

Recent articles in core journals

Residual skin tags following procedure for prolapse and hemorrhoids: differentiation from recurrence.(2010)[EvicenceUpdates]

Randomized clinical trial of symptom control after stapled anopexy or diathermy excision for haemorrhoid prolapse (2010)[EvicenceUpdates]

Randomized prospective study of endoscopic rubber band ligation compared with bipolar coagulation for chronically bleeding internal hemorrhoids.(2009)[EvidenceUpdates]

Randomized clinical trial of botulinum toxin injection for pain relief in patients with thrombosed external haemorrhoids.(2008)[EvidenceUpdates]

eTextbooks

Hemorrhoid Surgery (2011)[eMedicine]NEW

Hemorrhoids (2011)[eMedicine]updated

Haemorrhoids (Piles)(2010)[Mentor]

Clinical Queries

How successful is the haemorrhoidal artery ligation operation? (2010)[ATTRACT]

What is the management of thrombosed haemorrhoids? (2008)[ATTRACT]

What proportion of otherwise well elderly men with visible haemorrhoids on proctoscopy and recurrent fresh rectal bleeding also have a bowel malignancy? (2008)[TRIPAnswers]

Should all patients with rectal bleeding be referred for further investigations even if have strong history and examination consistent with haemorrhoids? (2008)[TRIPAnswers]

Patient Information

Haemorrhoids (Piles)(2011)[Patient UK]

Surgery for piles (haemorrhoidectomy)(2011)[BUPA]updated

Haemorrhoids (piles) (2010)[NHS Choices]

Important

1. If you are a Welsh Primary Care Professional with a clinical query send it to ATTRACT online or email us at questions@attract.wales.nhs.uk or call 01495 332343.
2. If you would like to comment on this CME topic, or suggest a new topic for ATTRACTcme, go to the comments hyperlink below.

Dyspepsia

2012-01-27T13:23:00.001Z

Evidence Based Reports

Meta-analysis: helicobacter pylori 'test and treat' compared with empirical acid suppression for managing dyspepsia (2011)[DARE]NEW

Chinese herbal medicine modified xiaoyao san for functional dyspepsia: meta-analysis of randomized controlled trials (2009)[DARE]

Clinical trial: a randomized trial of early endoscopy, Helicobacter pylori testing and empirical therapy for the management of dyspepsia in primary care (2009)[NHS EED]

Helicobacter pylori test and treat versus proton pump inhibitor in initial management of dyspepsia in primary care: multicentre randomised controlled trial (MRC-CUBE trial)(2009)[NHS EED]

Meta-analysis: Helicobacter pylori 'test and treat' compared with empirical acid suppression for managing dyspepsia (2008)[NHS EED]

Meta-analysis of the effects of prokinetic agents in patients with functional dyspepsia (2008)[DARE]

Cost-effectiveness analysis of two management strategies for dyspepsia (2008)[NHS EED]

Clinical Guidelines

Dyspepsia not requiring investigation (2011)[Map of Medicine]NEW

Non-ulcer dyspepsia (2011)[Map of Medicine]NEW

Dyspepsia (2011)[Map of Medicine]

Dyspepsia - unidentified cause (20080[Prodigy]

Dyspepsia - proven peptic ulcer (20080[Prodigy]

Dyspepsia - proven non-ulcer (2008)[Prodigy]

Dyspepsia - proven gastro-oesophageal reflux disease (2008)[Prodigy]

Dyspepsia - pregnancy-associated (2008)[Prodigy]

Recent articles in core journals

Efficacy of the 5-HT1A agonist tandospirone citrate in improving symptoms of patients with functional dyspepsia: a randomized controlled trial.(2009)[EvidenceUpdates]

Clinical trial: a randomized trial of early endoscopy, Helicobacter pylori testing and empirical therapy for the management of dyspepsia in primary care.(2009)[EvidenceUpdates]

Effect and cost-effectiveness of step-up versus step-down treatment with antacids, H2-receptor antagonists, and proton pump inhibitors in patients with new onset dyspepsia (DIAMOND study): a primary-care-based randomised controlled trial.(2009)[EvidenceUpdates]

Cost-effectiveness of and satisfaction with a Helicobacter pylori "test and treat" strategy compared with prompt endoscopy in young Asians with dyspepsia.(2008)[EvidenceUpdates]

Itopride in functional dyspepsia: results of two phase III multicentre, randomised, double-blind, placebo-controlled trials.(2008)[EvidenceUpdates]

Clinical trial: a randomized controlled cross-over study of flupenthixol + melitracen in functional dyspepsia.(2008)[EvidenceUpdates]

Helicobacter pylori test and treat versus proton pump inhibitor in initial management of dyspepsia in primary care: multicentre randomised controlled trial (MRC-CUBE trial).(2008)[BMJ]

eTextbooks

Dyspepsia (2010)[Mentor]

Clinical Queries

What drugs are considered first line for dyspepsia in a pregnant woman?(2008)[TRIPAnswers]

What investigations are recommended for children with dyspepsia? (2008)[TRIPAnswers]

What is the evidence for using regular gastroprotective proton pump inhibitors in patients having aspirin and diclofenac but with no symptoms of dyspepsia? (2008)[TRIPAnswers]

Patient Information

Dyspepsia (Indigestion)(2011)[PatientUK]updated

Dyspepsia in Pregnancy (2011)[PatientUK]updated

Non-ulcer (Functional) Dyspepsia (2011)[PatientUK]updated

Indigestion (dyspepsia) in pregnancy (2010)[NHS Choice]

Indigestion (2010)[NHS Choice]

Indigestion (2010)[BUPA]

Indigestion medicines (2009)[BUPA]

Important

1. If you are a Welsh Primary Care Professional with a clinical query send it to ATTRACT online or email us at questions@attract.wales.nhs.uk or call 01495 332343.
2. If you would like to comment on this CME topic, or suggest a new topic for ATTRACTcme, go to the comments hyperlink below.

Alzheimer's disease

2012-01-24T16:21:00.002Z

Evidence Based Reports

Donepezil, galantamine, rivastigmine and memantine for the treatment of Alzheimer's disease (2011)[NICE] NEW

NICE reviews its guidance on drug treatment of Alzheimer's disease (2011)[NPC Rapid Reviews]NEW

Assessing the cost-effectiveness of the rivastigmine transdermal patch for Alzheimer's disease in the UK using MMSE- and ADL-based models (2011)[NHS Economic Evalutation Database] NEW

World Alzheimer's Report (2011)[Alzheimer Disease International] NEW

Nicotine for Alzheimer's disease (2010)[Cochrane]

Alzheimer's Disease and Cognitive Decline (2010)[AHRQ]

Preventing Alzheimer's Disease and Cognitive Decline (2010)[NIH]

To treat or not to treat? A meta-analysis of the use of cholinesterase inhibitors in mild cognitive impairment for delaying progression to Alzheimer's disease (2010)[DARE]

Antipsychotics increase mortality in patients with Alzheimer’s disease(2009)[MeRec]

Transcranial direct current stimulation (tDCS) for Alzheimer’s disease (2009)[National Horizon Scanning Centre]

Rivastigmine for Alzheimer's disease (2009)[Cochrane]

Impact of cholinesterase inhibitors on behavioral and psychological symptoms of Alzheimer's disease: a meta-analysis (2009)[DARE]

Dementia (2008)[Clinical Evidence] Athens Log-in required

Metal protein attenuating compounds for the treatment of Alzheimer's disease (2008)[Cochrane]

Physostigmine for dementia due to Alzheimer's disease (2008)[Cochrane]

Metrifonate for Alzheimer's disease (2008) [Cochrane]

Huperzine A for Alzheimer's disease (2008) [Cochrane]

Tarenflurbil (Flurizan)for mild Alzheimer’s disease (2007) [National Horizon Scanning Centre]

Xaliproden (Xalprila) for Alzheimer’s disease (2007) [National Horizon Scanning Centre]

The clinical and cost-effectiveness of donepezil, rivastigmine, galantamine and memantine for Alzheimer’s disease (2006) [HTA]

Donepezil for dementia due to Alzheimer's disease (2006) [Cochrane]

Clioquinol for the treatment of Alzheimer's Disease (2007) [Cochrane]

Atypical antipsychotics for aggression and psychosis in Alzheimer's disease (2006) [Cochrane]

Galantamine for Alzheimer's disease and mild cognitive impairment (2005) [Cochrane]

Positron emission tomography, single photon emission computed tomography, computed tomography, functional magnetic resonance imaging, and magnetic resonance spectroscopy and for the diagnosis and management of Alzheimer's dementia (2005) [AHRQ]

Clinical Guidelines

Recommendations for the diagnosis and management of Alzheimer’s
disease and other disorders associated with dementia (2007) [EFNS]

Dementia: Supporting people with dementia and their carers in health and social care (2006)[NICE]

Recent articles in core journals

A randomized, double-blind, placebo-controlled trial of simvastatin to treat Alzheimer disease (2011)[Neurology] NEW

A phase II trial of huperzine A in mild to moderate Alzheimer disease (2011)[Neurology] NEW

Alzheimer's disease (2011)[Lancet] NEW

Docosahexaenoic acid supplementation and cognitive decline in Alzheimer disease: a randomized trial (2010) [JAMA]

Effectiveness of a specific care plan in patients with Alzheimer's disease: cluster randomised trial (PLASA study)(2010)[BMJ]

Delaying the onset of Alzheimer disease: bilingualism as a form of cognitive reserve (2010)[Neurology]

Acupuncture for Alzheimer's disease: a systematic review (2009)[Int J Clin Pract]

Physical activity, diet, and risk of Alzheimer disease (2009)[JAMA]

Safety and efficacy of galantamine (Reminyl) in severe Alzheimer's disease (the SERAD study): a randomised, placebo-controlled, double-blind trial (2009)[Lancet Neurol]

Effect of dimebon on cognition, activities of daily living, behaviour, and global function in patients with mild-to-moderate Alzheimer's disease: a randomised, double-blind, placebo-controlled study (2008)[Lancet]

Cognitive function over time in the Alzheimer's Disease Anti-inflammatory Prevention Trial (ADAPT): results of a randomized, controlled trial of naproxen and celecoxib (2008)[Arch Neurol]

High-dose B vitamin supplementation and cognitive decline in Alzheimer disease: a randomized controlled trial(2008) [JAMA]

eTextbooks

Alzheimer disease (2011) [Medscape Reference]NEW

Alzheimer's disease: diagnosis and management (2010) [BMJ Learning]

Clinical Queries

Is there a role for statins in the prevention of dementia? (2009)[TRIP Answers]

Is there any evidence to link low testosterone levels with the development of Alzheimers and if so any advice about treating otherwise asymptomatic low levels of testosterone? (2007)[ATTRACT]

In a patient with a very strong history of alzheimers disease are there any screening tests that can be done while the patient is younger and apparently unaffected? (2007) [TRIP Answers]

Patient Information

Alzheimer's disease (2011) [BUPA Health Information] updated

Alzheimer's disease (2010) [NHS Choices]

Important

1. If you are a Welsh Primary Care Professional with a clinical query send it to ATTRACT online or email us at questions@attract.wales.nhs.uk or call 01495 332343.

2. If you would like to comment on this CME topic, or suggest a new topic for ATTRACTcme, go to the comments hyperlink below.

PCOS

2012-01-24T12:43:00.000Z

Evidence Based Reports

Statins for women with polycystic ovary syndrome not actively trying to conceive (2011)[Cochrane]NEW

Acupuncture for polycystic ovarian syndrome (2011)[Cochrane]NEW

In vitro maturation in subfertile women with polycystic ovarian syndrome undergoing assisted reproduction (2011)[Cochrane]NEW

Chinese herbal medicine for subfertile women with polycystic ovarian syndrome (2010)[Cochrane]

PCOS (2009)[Clinical Evidence]

Metformin treatment before and during IVF or ICSI in women with polycystic ovary syndrome (2009)[Cochrane]

Clomiphene citrate, metformin or both as first-step approach in treating anovulatory infertility in patients with polycystic ovary syndrome (PCOS): a systematic review of head-to-head randomized controlled studies and meta-analysis (2009)[DARE]

Effect of preconceptional metformin on abortion risk in polycystic ovary syndrome: a systematic review and meta-analysis of randomized controlled trials (2009)[DARE]

In vitro maturation in sub fertile women with polycystic ovarian syndrome undergoing assisted reproduction (2009)[Cochrane]

Aromatase inhibitors for infertility in polycystic ovary syndrome: the beginning or the end of a new era? (2009)[DARE]

The effects of Diane-35 and metformin in treatment of polycystic ovary syndrome: an updated systematic review (2008)[DARE]

Long versus short course treatment with Metformin and Clomiphene Citrate for ovulation induction in women with PCOS (2008)[Cochrane]

Clinical Guidelines

Polycystic ovary syndrome (PCOS) - suspected (2011)[Map of Medicine]updated

Polycystic ovary syndrome (2009)[CKS]

Metformin therapy for the management of infertility in women with polycystic ovary syndrome (2008)[RCOG]

Recent articles in core journals

Risk of adverse pregnancy outcomes in women with polycystic ovary syndrome: population based cohort study.(2011)[BMJ]NEW

Pregnancy outcomes in women with polycystic ovary syndrome: a metaanalysis.(2011)[EvidenceUpdates]NEW

Laparoscopic ovarian diathermy vs clomiphene citrate plus metformin as second-line strategy for infertile anovulatory patients with polycystic ovary syndrome: a randomized controlled trial (2010)[EvidenceUpdates]

Use of Metformin in Polycystic Ovary Syndrome: A Meta-Analysis (2008)[EvidenceUpdates]

eTextbooks

Polycystic Ovarian Syndrome (2011)[eMedicine]updated

polycystic ovary syndrome (2010)[GPnotebook]

Polycystic Ovarian Syndrome (2010)[Mentor]

Clinical Queries

Do any of the newer diabetic drugs [gliptins etc] have a role in weight reduction in PCOS? Is there any experience of use and are they licensed? (2011)[ATTRACT]NEW

should we continue to moniter lipids/glucose in a woman with PCOS who has had TAH/BSO (2011)[ATTRACT]NEW

Can a woman with polycystic ovarian syndrome and has a liver haemangioma use a combined oral contraceptive (COC)?(2011)[FSRH]NEW

Is there any risk of endometrial cancer associated with use of the desogestrel only pill (Cerazette®) in women with polycystic ovary syndrome who have oligo- or amenorrhoea? (2010)[FSRH]

Is there any evidence that a levonorgestrel-releasing intrauterine system (LNG-IUS) would cause exacerbation of ovarian cysts in a woman with polycystic ovary syndrome (PCOS) and symptomatic ovarian cysts? (2009)[FSRH]

Can women with Polycystic Ovary Syndrome (PCOS) use the etonogestrel implant (Implanon®)? (2009)[FSRH]

How effective is metformin compared to the oral contraceptive pill and thiazolidinediones (glitazones) in women with polycystic ovary syndrome? (2009)[NeLM]

What effect does metformin have on obesity and the cardiovascular problems seen in women with polycystic ovary syndrome? (2009)[NeLM]

What effect does metformin have on hirsutism and acne in women with polycystic ovary syndrome? (2009)[NeLM]

What effect does metformin have on early pregnancy loss in women with polycystic ovary syndrome? (2009)[NeLM]

What effect does metformin have on anovulation, pregnancy and live birth rates in women with polycystic ovary syndrome? (2009)[NeLM]

Should a patient with Polycystic Ovarian Syndrome who wishes to use an intrauterine method use an levnorgestrel releasing intrauterine system rather than a copper bearing intrauterine device in view of its endometrial protective effect?(2009)[FSRH]

What are the contraceptive options for a 23 year old with polycystic ovarian syndrome and a body mass index (BMI) of 56? (2009)[FSRH]

Patient Information

Polycystic ovary syndrome (2011)[NHS Choices]updated

Polycystic ovary syndrome (PCOS0 (2011)[BUPA]updated

Polycystic Ovary Syndrome (2010)[PatientUK]

Important

1. If you are a Welsh Primary Care Professional with a clinical query send it to ATTRACT online or email us at questions@attract.wales.nhs.uk or call 01495 332343.
2. If you would like to comment on this CME topic, or suggest a new topic for ATTRACTcme, go to the comments hyperlink below.

Acne vulgaris

2012-01-24T11:37:00.001Z

Evidence Based Reports

Adapalene with benzoyl peroxide (Epiduo) for severe acne vulgaris (2011)[National Prescribing Service Limited (Australia)]NEW

Adapalene 0.1% of Benzoyl Peroxide (Epiduo Gel) - cutaneous treatment of acne vulgaris when comedones, papules and pustules are present (2011)[Scottish Medicines Consortium]NEW

Acne vulgaris (2010)[Clinical Evidence]

Laser and other light therapies for the treatment of acne vulgaris: systematic review (2010)[DARE]

Combined oral contraceptive pills for treatment of acne (2009)[Cochrane Library]

Spironolactone versus placebo or in combination with steroids for hirsutism and/or acne (2009)[Cochrane Library]

Evidence-based review of lasers, light sources and photodynamic therapy in the treatment of acne vulgaris (2008)[DARE]

Clinical Guidelines

Advice on the safe introduction and continued use of isotretinoin in acne in the U.K.(2010)[British Association of Dermatologists]

Acne (2010)[Map of Medicine]

Acne vulgaris (2009) [CKS]

Recent articles in core journals

Acne vulgaris.(2011)[Lancet]NEW

Association of suicide attempts with acne and treatment with isotretinoin: retrospective Swedish cohort study. (2010)[BMJ]

Hematologic safety of dapsone gel, 5%, for topical treatment of acne vulgaris. (2009)[EvidenceUpdates]

Comparison of a 585-nm pulsed dye laser and a 1064-nm Nd:YAG laser for the treatment of acne scars: A randomized split-face clinical study. (2009)[EvidenceUpdates]

An aqueous gel fixed combination of clindamycin phosphate 1.2% and benzoyl peroxide 2.5% for the once-daily treatment of moderate to severe acne vulgaris: assessment of efficacy and safety in 2813 patients.(2008)[EvidenceUpdates]

Detecting implausible social network effects in acne, height, and headaches: longitudinal analysis.(2008)[BMJ]

eTextbooks

Acne Vulgaris (2011)[eMedicine]updated

Acne Vulgaris (2010)[Mentor]

Clinical Queries

Is it possible to use a copper-bearing intrauterine device (Cu-IUD) or levonorgestrel-releasing intrauterine system (LNG-IUS) in a woman on co-cyprindiol (Dianette®) who wishes to stay on co-cyprindiol for good acne control but fails to take it correctly so would be at risk of pregnancy without an additional contraceptive? (2011)[FSRH]NEW

How common is acne vulgaris? (2008)[TRIPAnswers]

What is the evidence for Nlite(pulsed laser) in acne vulgaris? Sould it be used alone or in combination? (2008)[TRIPAnswers]

For a woman who has been using Dianette for the treatment of acne and for contraception, who has tried other methods of contraception only to have her acne return, how long can she safely use Dianette for? (2008)[FSRH]

I have a 39 year old patient who was started on lymecycline for acne about 18 months ago. Is there a maximum length of time that we can prescribe antibiotics for acne. She has tried several other treatments. (2008)[ATTRACT]

Is there any evidence to suggest that one type of combined oral contraceptive is better than another in reducing acne? (2008)[FSRH]

Patient on oxytetracycline 250mg bd for acne - planned for at least 3/12, also on combined oral contraceptive pill. How long does she need to use condoms for? (2008)[ATTRACT]

In mild acne, what are the best topical alternatives for benzoyl peroxide?(2008)[TRIPAnswers]

Is topical azelaic acid safe for use by pregnant women for the treatment of acne?
(2008)[TRIPAnswers]

Is Zineryt (erythromycin and zinc acetate) safe for use by pregnant women for the treatment of acne? (2008)[TRIPAnswers]

Is there a lower age restriction on commencing dianette for acne in young teenagers? (2008)[TRIPAnswers]

Can an asplenia patient with acne (who cannot tolerate penicillin) take lymecycline? (2008)[TRIPAnswers]

What is the evidence for low dose isotretinoin for acne rather than full dose? In which patients is it most effective? (2008)[TRIPAnswers]

Patient Information

Acne(2010)[British Association Of Dermatologists]

Acne(2010)[BUPA]

Acne(2009)[NHS Choices]

Acne(2009)[PatientUK]

Topical (Rub-On) Treatments For Acne(2009)[PatientUK]

Antibiotic Tablets for Acne(2009)[PatientUK]

Important

1. If you are a Welsh Primary Care Professional with a clinical query send it to ATTRACT online or email us at questions@attract.wales.nhs.uk or call 01495 332343.
2. If you would like to comment on this CME topic, or suggest a new topic for ATTRACTcme, go to the comments hyperlink below.

Migraine

2012-01-24T11:19:00.002Z

Evidence Based Reports

Botulinum toxin(Botox®)for chronic migraine (2011)[NHS Regional Drug & Therapeutics Centre] NEW

Steroids (Dexamethasone) for Prevention of Migraine Recurrence (2011)[theNNT] NEW

SpringTMS™ Total Migraine System (2011)[National Horizon Scanning Network] NEW

Acute treatment and prevention of menstrually related migraine headache: evidence-based review (2011)[DARE] NEW

Meta-analysis of the efficacy and safety of naproxen sodium in the acute treatment of migraine (2011)[DARE] NEW

Cochrane review supports the use of paracetamol in acute migraine (2011)[MeReC Rapid Review] NEW

Migraine Headache in children (2010) [Clinical Evidence] Athens log-in required updated

The prophylactic treatment of migraine headaches with Botulinum Toxin Type A did not reduce migraine frequency (2010)[UWO Evidence Based Neurology]

Single dose dexamethasone reduced the recurrence of moderate to severe migraine at up to 72-hours follow-up (2010)[UWO Evidence Based Neurology]

Percutaneous closure of patent foramen ovale for recurrent migraine (2010)[NICE]

Paracetamol (acetaminophen) with or without an antiemetic for acute migraine headaches in adults (2010)[Cochrane]

Ibuprofen with or without an antiemetic for acute migraine headaches in adults (2010)[Cochrane]

Aspirin with or without an antiemetic for acute migraine headaches in adults (2010)[Cochrane]

Meta-analysis of the efficacy and safety of zolmitriptan in the acute treatment of migraine (2009)[DARE]

Are migraineurs at increased risk of adverse drug responses: a meta-analytic comparison of topiramate-related adverse drug reactions in epilepsy and migraine (2009)[DARE]

Acupuncture for migraine prophylaxis (2009)[Cochrane]

Normobaric and hyperbaric oxygen therapy for migraine and cluster headache (2008)[Cochrane]

Parenteral dexamethasone for acute severe migraine headache: meta-analysis of randomised controlled trials for preventing recurrence (2008) [DARE]

Anticonvulsant drugs for migraine prophylaxis (2006) [Cochrane]

Triptans for acute migraine: comparative clinical effectiveness and cost-effectiveness (2005) [HTA]

Selective serotonin re-uptake inhibitors (SSRIs) for preventing migraine and tension-type headaches (2005) [Cochrane]

Propranolol for migraine prophylaxis (2004) [Cochrane]

Clinical Guidelines

Headache-migraine (2011)[Map of Medicine] NEW

Migraine (2010) [CKS] updated

Guidelines for All HealthcareProfessionals in the Diagnosis and Management of Migraine,Tension-Type, Cluster andMedication-Overuse Headache (2010) [BASH] *PDF may be slow to download updated

Recent articles in core journals

Tolerance to the beneficial effects of prophylactic migraine drugs: a systematic review of causes and mechanisms(2011)[Headache] NEW

Tolerance and loss of beneficial effect during migraine prophylaxis: clinical considerations (2011)[Headache] NEW

Migraine with aura and risk of cardiovascular and all cause mortality in men and women: prospective cohort study (2010)[BMJ]

Migraine and risk of haemorrhagic stroke in women: prospective cohort study (2010)[BMJ]

Migraine and cardiovascular disease: systematic review and meta-analysis (2009)[BMJ]

Efficacy of botulinum toxin type A for the prophylaxis of episodic migraine headaches: a meta-analysis of randomized, double-blind, placebo-controlled trials (2009) [Pharmacotherapy]

Migraine, vascular risk, and cardiovascular events in women: prospective cohort study(2008) [BMJ]

Exercise in migraine therapy--is there any evidence for efficacy? A critical review (2008) [Headache]

Effect of early intervention with almotriptan vs placebo on migraine-associated functional disability: results from the AEGIS Trial(2008) [Headache]

eTextbooks

Migraine in children (2011)[Mentor]

Migraine prophylaxis in adults (2011)[Mentor]

Migraine Management (2011)[Mentor]

Migraine: diagnosis and prevention (2010) [BMJ Learning] updated

Clinical Queries

what is the evidence for treating menstrual migraine with oestrogen? any other guidance on management of menstrual headaches (2011)[ATTRACT] NEW

I believe that evidence shows that women with migraine with aura have 2-3 x risk of stroke compared with women with migraine without aura. Is there any evidence that migraine prophylaxis (e.g. with Beta-blockers) reduces this excess risk? (2010)[ATTRACT]

Is it safe for a 46 year old woman to continue taking the combined oral contraceptive pill (COC) Loestrin 20 if she has a history of migraine headaches and well controlled sarcoidosis? (2010)[FSRH]

What is the preferred triptan for the treatment of migraine in breastfeeding mothers? (2010)[NELM]

In a young patient with polycystic ovarian syndrome who has migraines which are made worse by the combined oral contraceptive pill and is amenorroheic on the progestogen only pill, is it safe to use the POP despite amenorrhoea or is there a better alternative? (2009)[FSRH]

Is the use of LNG-IUS restricted in a patient with a history of migraine? (2009)[FSRH]

Is there evidence of benefit of B vitamins for migraine suffers (the patient has migraine without aura). In particular is there evidence of any particular dosage? (2008)[TRIP Answers]

Patient Information

Migraine (2010) [NHS Choices]

Migraine (2011) [BUPA Health Information] updated

Important

1. If you are a Welsh Primary Care Professional with a clinical query send it to ATTRACT online or email us at questions@attract.wales.nhs.uk or call 01495 332343.

2. If you would like to comment on this CME topic, or suggest a new topic for ATTRACTcme, go to the comments hyperlink below.

Helicobacter Pylori

2012-01-24T07:53:00.002Z

Evidence Based Reports

Helicobacter pylori eradication for Parkinson's disease. (2011)[Cochrane]NEW

Usefulness of urea breath test for helicobacter pylori detection (2011)[HTA]NEW

Eradication therapy for peptic ulcer disease in Helicobacter pylori positive patients (2011)[Cochrane]NEW

Does quadruple therapy (QT) result in superior eradication rates of H. pylori over traditional triple therapy (TT)? (2011)[Tools for Practice]NEW

Is there an increased risk of GERD after Helicobacter pylori eradication? A meta-analysis (2010)[DARE]

Empiric quadruple vs triple therapy for primary treatment of Helicobacter pylori infection: systematic review and meta-analysis of efficacy and tolerability (2010)[DARE]

Meta-analysis: four-drug, three-antibiotic, non-bismuth-containing "concomitant therapy" versus triple therapy for Helicobacter pylori eradication (2010)[DARE]

Sequential therapy or triple therapy for Helicobacter pylori infection: systematic review and meta-analysis of randomized controlled trials in adults and children (2009)[DARE]

Meta-analysis: Lactobacillus containing quadruple therapy versus standard triple first-line therapy for Helicobacter pylori eradication (2009)[DARE]

Moxifloxacin-based triple therapy versus clarithromycin-based triple therapy for first-line treatment of Helicobacter pylori infection: a meta-analysis of randomized controlled trials (2009)[DARE]

A systematic review of treating Helicobacter pylori infection with traditional Chinese medicine (2009)[DARE]

Effect of fermented milk-based probiotic preparations on Helicobacter pylori eradication: a systematic review and meta-analysis of randomized-controlled trials (2009)[DARE]

Helicobacter pylori infection (2009)[Clinical Evidence]

Adverse events with bismuth salts for Helicobacter pylori eradication: systematic review and meta-analysis (2008)[DARE]

Clinical Guidelines

Recent articles in core journals

14-day triple, 5-day concomitant, and 10-day sequential therapies for Helicobacter pylori infection in seven Latin American sites: a randomised trial.(2011)[Lancet]NEW

Helicobacter pylori eradication with a capsule containing bismuth subcitrate potassium, metronidazole, and tetracycline given with omeprazole versus clarithromycin-based triple therapy: a randomised, open-label, non-inferiority, phase 3 trial. (2011)[Lancet]NEW

Empirical levofloxacin-containing versus clarithromycin-containing sequential therapy for Helicobacter pylori eradication: a randomised trial.(2011)[EvidenceUpdates]NEW

Comparison of the once-daily levofloxacin-containing triple therapy with the twice-daily standard triple therapy for first-line Helicobacter pylori eradication: a prospective randomised study. (2010)[EvidenceUpdates]

Levofloxacin-based and clarithromycin-based triple therapies as first-line and second-line treatments for Helicobacter pylori infection: a randomised comparative trial with crossover design. (2010)[EvidenceUpdates]

Association between helicobacter pylori and gastrointestinal symptoms in children. (2010)[EvidenceUpdates]

Empiric quadruple vs. triple therapy for primary treatment of Helicobacter pylori infection: Systematic review and meta-analysis of efficacy and tolerability. (2010)[EvidenceUpdates]

Sequential therapy or triple therapy for Helicobacter pylori infection: systematic review and meta-analysis of randomized controlled trials in adults and children. (2010)[EvidenceUpdates]

Meta-analysis: can Helicobacter pylori eradication treatment reduce the risk for gastric cancer? (2009)[Annals of Internal Medicine]

Meta-analysis: efficacy of bovine lactoferrin in Helicobacter pylori eradication. (2009)[EvidenceUpdates]

Duplicate breath testing to confirm eradication of Helicobacter pylori: incremental benefit and cost in 419 patients. (2009)[EvidenceUpdates]

Causal relationship of Helicobacter pylori with iron-deficiency anemia or failure of iron supplementation in children. (2008)[EvidenceUpdates]

Meta-analysis: sequential therapy appears superior to standard therapy for Helicobacter pylori infection in patients naive to treatment. (2008)[Annals of Internal Medicine]

Meta-analysis: high-dose proton pump inhibitors vs. standard dose in triple therapy for Helicobacter pylori eradication. (2008)[EvidenceUpdates]

eTextbooks

Helicobacter Pylori Infection (2011)[eMedicine]updated

Helicobacter Pylori (2010)[Mentor]

quadruple therapy for Helicobacter pylori eradication (2010)[GPnotebook]

Helicobacter pylori(2010)[GPnotebook]

Clinical Queries

Is it possible to pass Helicobacter pylori person-to-person? (2009)[TRIPAnswers]

Is there a relation between H pylori infection and rosacea? Would H pylori eradication help management? (2009)[ATTRACT]

Patient Information

Helicobacter Pylori & Stomach Pain (2011)[PatientUK]

Important

1. If you are a Welsh Primary Care Professional with a clinical query send it to ATTRACT online or email us at questions@attract.wales.nhs.uk or call 01495 332343.
2. If you would like to comment on this CME topic, or suggest a new topic for ATTRACTcme, go to the comments hyperlink below.

Tennis elbow

2012-01-16T09:39:00.002Z

Evidence Based Reports

Surgery for lateral elbow pain (2011)[Cochrane]NEW

Effectiveness of corticosteroid injections compared with physiotherapeutic interventions for lateral epicondylitis: a systematic review (2009)[DARE]

Tennis elbow (2008)[Clinical Evidence]

Effectiveness of corticosteroid injections compared with physiotherapeutic interventions for lateral epicondylitis: a systematic review (2008)[DARE]

A systematic review with procedural assessments and meta-analysis of low level laser therapy in lateral elbow tendinopathy (tennis elbow)(2008)[DARE]

Effectiveness of physical therapy treatments on lateral epicondylitis (2008)[DARE]

Clinical Guidelines

Epicondylitis - suspected (2010) [Map of Medicine]updated

Extracorporeal shockwave therapy for refractory tennis elbow (2009)[NICE]

Tennis elbow (2008)[CKS]

Recent articles in core journals

The management of tennis elbow (2011) [BMJ]NEW

Use of anatomic measurement to guide injection of botulinum toxin for the management of chronic lateral epicondylitis: a randomized controlled trial. (2010)[EvidenceUpdates]

Sensorimotor deficits remain despite resolution of symptoms using conservative treatment in patients with tennis elbow: a randomized controlled trial. (2009)[EvidenceUpdates]

A randomized controlled trial of extracorporeal shock wave therapy for lateral epicondylitis (tennis elbow). (2008)[EvidenceUpates]

An alternative approach to treating lateral epicondylitis. A randomized, placebo-controlled, double-blinded study. (2008)[EvidenceUpates]

eTextbooks

Lateral Epicondylitis (2011) [eMedicine]updated

Lateral Epicondylitis Surgery (2009)[eMedicine]

Epicondylitis - Lateral and Medial (2009)[Mentor]

Injections for Tennis or Golfer's Elbow (2009)[Mentor]

Clinical Queries

Is there any evidence of the efficacy and/ or cost effectiveness of acupuncture as a treatment for tennis elbow? If so, any advice on the points to be used for needling? (2008)[ATTRACT]

Patient Information

Tennis elbow. (2011) [BUPA]updated

Tennis elbow (2010)[NHS Choices]

Tennis elbow. (2009)[Patient UK]

1. If you are a Welsh Primary Care Professional with a clinical query send it to ATTRACT online or email us at questions@attract.wales.nhs.uk or call 01495 332343.
2. If you would like to comment on this CME topic, or suggest a new topic for ATTRACTcme, go to the comments hyperlink below.

Seasonal Affective Disorder

2012-01-16T07:55:00.002Z

Evidence Based Reports

Second-generation antidepressants for seasonal affective disorder (2011) [Cochrane]NEW

Light therapy for seasonal affective disorder (2005)[HTA]

Clinical Guidelines

Recent articles in core journals

A randomized controlled trial of cognitive-behavioral therapy, light therapy, and their combination for seasonal affective disorder. (2007)[EvidenceUpdates]

The Can-SAD study: a randomized controlled trial of the effectiveness of light therapy and fluoxetine in patients with winter seasonal affective disorder. (2006)[EvidenceUpdates]

eTextbooks

seasonal affective disorder (SAD) (2011)[GPnotebook]updated

Seasonal Affective Disorder (2010)[Mentor]

Seasonal Depression (SAD) (2006) [eMedicine]

Clinical Queries

What is the evidence for using Vitamin D supplements in patients with seasonal affective disorder? (2007)[TRIPAnswers]

What are the diagnostic criteria for Seasonal Affective Disorder? (2007)[TRIPAnswers]

What evidence is there for the light boxes being an effective treatment for SAD (seasonal affective disorder)? (2006)[ATTRACT]

Patient Information

Seasonal affective disorder (2010)[NHS Choices]

Seasonal affective disorder (SAD) (2010)[BUPA]

Seasonal Affective Disorder (2009)[Patient UK]

Important

1. If you are a Welsh Primary Care Professional with a clinical query send it to ATTRACT online or email us at questions@attract.wales.nhs.uk or call 01495 332343.
2. If you would like to comment on this CME topic, or suggest a new topic for ATTRACTcme, go to the comments hyperlink below.

Chronic Fatigue Syndrome (CFS)

2012-01-10T11:37:00.002Z

Evidence-Based Reports

State of knowledge workshop report: myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS)research (2011)[NIH] NEW

Chronic Fatigue Syndrome (2010) [Clinical Evidence] updated Athens Log-in required

Traditional Chinese medicinal herbs for the treatment of idiopathic chronic fatigue and chronic fatigue syndrome (2009)[Cochrane]

Efficacy of cognitive behavioral therapy for chronic fatigue syndrome: a meta-analysis (2008)[DARE]

The treatment and management of chronic fatigue syndrome (CFS)/myalgic encephalomyelitis (ME) in adults and children (2007) [HTA]

The treatment and management of chronic fatigue syndrome (CFS)/myalgic encephalomyelitis (ME) in adults and children (2007) [DARE]

A review of the scientific literature for diagnosis and treatment of chronic fatigue syndrome/ myalgic encephalopathy (CFS/ME) (2006) [HTA]

Cognitive behavioural therapy in chronic fatigue syndrome: a randomised controlled trial of an outpatient group programme (2006) [NCCHTA]

The placebo response in the treatment of chronic fatigue syndrome: a systematic review and meta-analysis (2006) [DARE]

Clinical Guidelines

Chronic fatigue syndrome and myalgic encephalopathy (CFS/ME)(2011)[Map of Medicine]updated

Chronic fatigue syndrome / Myalgic encephalomyelitis (CFS/ME) guideline (2007)[NICE]

Evidence Based Guideline for the Management of CFS/ME(Chronic Fatigue Syndrome/Myalgic Encephalopathy)in Children and Young People (2004) [RCPCH]

Chronic Fatigue Syndrome/Myalgic Encephalopathy(CFS/ME) (2004) [Department of Health]

Recent articles in Core Journals

Prevalence of myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) in three regions of England: a repeated cross-sectional study in primary care(2011)[BMC Med] NEW

Nurse led, home based self help treatment for patients in primary care with chronic fatigue syndrome: randomised controlled trial (2010)[BMJ]

Guided self-instructions for people with chronic fatigue syndrome: randomised controlled trial (2008)[Br J Psychiatry]

Cognitive-behavioural therapy v. mirtazapine for chronic fatigue and neurasthenia: randomised placebo-controlled trial (2008)[Br J Psychiatry]

Diagnosis and management of chronic fatigue syndrome or myalgic encephalomyelitis (or encephalopathy): summary of NICE guidance (2007) [BMJ]

Chronic fatigue syndrome (2006) [Lancet]

Does methylphenidate reduce the symptoms of chronic fatigue syndrome? (2006) [Am J Med]

eTextbooks

Chronic Fatigue Syndrome (2011) [eMedicine] updated

Chronic Fatigue Syndrome (2010)[Mentor]

Chronic fatigue syndrome: diagnosis and management (2007) [BMJ Learning]

Clinical Queries

Is there any evidence for the use of xenotropic murine leukemia virus-related virus (XMRV) in diagnosing chronic fatigue syndrome (CFS)? (2010)[ATTRACT]

Is there evidence that melatonin treatment improves symptoms of fatigue in patients with chronic fatigue syndrome? (2009)[TRIPAnswers]

Can ECT be used in the management of chronic fatigue syndrome and if so, is it effective? (2009)[TRIPAnswers]

What are the effects of pregnancy in chronic fatigue syndrome? (2008)[TRIP Answers]

Patient Information

Chronic Fatigue Syndrome (2011)[NHS Choices]reviewed

Chronic Fatigue Syndrome (2010)[BUPA Health Information] updated

Important

1. If you are a Welsh Primary Care Professional with a clinical query send it to ATTRACT online or email us at questions@attract.wales.nhs.uk or call 01495 332343.

2. If you would like to comment on this CME topic, or suggest a new topic for ATTRACTcme, go to the comments hyperlink below.

Hay fever

2012-01-09T08:02:00.003Z

Evidence Based Reports

Sublingual immunotherapy for allergic rhinitis (2010)[Cochrane]

Inferior turbinate surgery for nasal obstruction in allergic rhinitis after failed medical treatment (2010)[Cochrane]

Antihistamines used in addition to topical nasal steroids for intermittent and persistent allergic rhinitis in children (2010)[Cochrane]

Capsaicin for allergic rhinitis in adults (2010)[Cochrane]

Economic evaluation of quality-of-life improvement with second-generation antihistamines and montelukast in patients with allergic rhinitis (2009)[NHS Economic Evaluation Database]

Hay fever in adolescents and adults (2008)[Clinical Evidence]

Clinical Guidelines

Seasonal allergic rhinoconjunctivitis - suspected (2011) [Map of medicine] updated

Allergic rhinitis (2008) [Prodigy]

BSACI guidelines for the management of allergic and non-allergic rhinitis (2008)[National Library of Guidelines (UK)]

Recent articles in core journals

Oxymetazoline adds to the effectiveness of fluticasone furoate in the treatment of perennial allergic rhinitis. (2011) [Evidence Updates] NEW

Combination therapy with azelastine hydrochloride nasal spray and fluticasone propionate nasal spray in the treatment of patients with seasonal allergic rhinitis. (2008)[EvidenceUpdates]

Intranasal noninhaled carbon dioxide for the symptomatic treatment of seasonal allergic rhinitis (2008)[EvidenceUpdates]

Acupuncture in patients with allergic rhinitis: a pragmatic randomized trial (2008)[EvidenceUpdates]

Effect of once-daily fluticasone furoate nasal spray on nasal symptoms in adults and adolescents with perennial allergic rhinitis (2008)[EvidenceUpdates]

Herbal medicines for the treatment of allergic rhinitis: a systematic review. (2008)[EvidenceUpdates]

eTextbooks

Allergic rhinitis (2011)[eMedicine] updated

Pediatric Allergic Rhinitis (2011)[eMedicine] updated

Allergic rhinitis (2008)[Mentor]

Clinical Queries

Which medicines can be used to treat intermittent allergic rhinitis during pregnancy? (2010)[Nelm]

Is there any evidence that phototherapy nasal devices work in allergic rhinitis/ hay fever? (2009)[ATTRACT]

I have a 39 year old patient in the second trimester of her pregnancy. She has terrible hayfever and wants to use a non sedating antihistamine. Is loratadine safe? (2009)[ATTRACT]

How effective is butterbur for hayfever? What dose is recomended? Are there any interactions or side effects? (2009)[TRIPAnswers]

What is the current thinking on the use of the depot Kenalog in moderately severe hay fever not controlled by oral antihistamines and topical therapies? (2008)[ATTRACT]

What is the current clinical guidelines on the use of steroid injections for management of seasonal allergic rhinitis in UK? (2008)[TRIPAnswers]

What evidence is there of immunotherapy in patients with uncontrolled allergic rhinitis? (2008)[TRIPAnswers]

Patient Information

Hay fever (seasonal allergic rhinitis) (2011) [BUPA] updated

Hayfever (2011) [PatientUK] updated

Seasonal allergic rhinits (2009)[NHS Choices]

Important

1. If you are a Welsh Primary Care Professional with a clinical query send it to ATTRACT online or email us at questions@attract.wales.nhs.uk or call 01495 332343.
2. If you would like to comment on this CME topic, or suggest a new topic for ATTRACTcme, go to the comments hyperlink below.

Bell's Palsy

2012-01-05T11:31:00.010Z

Evidence Based Reports

Physical therapy for Bell´s palsy (idiopathic facial paralysis)(2011)[Cochrane] updated

Bell's Palsy (2010) [Clinical Evidence]updated Athens Log-in required

Acupuncture for Bell's palsy (2010) [Cochrane]

Antivirals for Bell's Palsy (2010)[theNNT]

Steroids for Bell's Palsy (2010)[theNNT]

A randomised controlled trial of the use of aciclovir and/or prednisolone for the early treatment of Bell's palsy: the BELLS study (2009)[NCCHTA]

Antiviral treatment for Bell's palsy (idiopathic facial paralysis) (2009)[Cochrane]

The benefits of steroids versus steroids plus antivirals for treatment of Bell's palsy: a meta-analysis (2009)[DARE]

Economic evaluation of early administration of prednisolone and/or aciclovir for the treatment of Bell's palsy (2009)[NHS Economic Evaluation Database]

Combined corticosteroid and antiviral treatment for bell palsy: a systematic review and meta-analysis (2009)[DARE]

Acyclovir Does Not Improve Functional Outcome In Patients with Bell’s Palsy (2007) [Evidence-based paediatrics]

Corticosteroids for Bell's palsy (idiopathic facial paralysis) (2008) [Cochrane]

Do we need to give steroids in children with bell's palsy ? (2005) [BestBETS]

Clinical Guidelines

Bell's Palsy (2008)[CKS]

Recent articles in core journals

The benefits of steroids versus steroids plus antivirals for treatment of Bell's palsy: a meta-analysis (2009) [BMJ]

Combined corticosteroid and antiviral treatment for Bell palsy: a systematic review and meta-analysis (2009)[JAMA]

Economic evaluation of early administration of prednisolone and/or aciclovir for the treatment of Bell`s palsy (2009) [EvidenceUpdates]

Bell's palsy: diagnosis and management (2007) [Am Fam Physician]

Bell's palsy: a review of treatment using antiviral agents (2006) [Ann Pharmacotherapy]

Managing Bell's palsy (2006) [Drug Ther Bull]

eTextbooks

Bell's palsy: diagnosis and treatment (2010) [BMJ Learning]updated

Bell Palsy (2011) [eMedicine] updated

Clinical Queries

What are the chances of a patient presenting in the UK with Ball’s Palsy having Lyme disease? Should anyone presenting with Bell’s Palsy have serology for Lyme disease (2010)[ATTRACT]

Is there any evidence of any therapy to improve a residual facial weakness following Bell's palsy in a 45 yr old woman who was treated with steroids and aciclovir on presentation 6 months ago? (2009) [ATTRACT]

Is aciclovir used in Bell's palsy anymore (2009)[ATTRACT]

Patient Information

Bell's palsy (2010)[NHS Choices]

Bell's Palsy (2010) [BUPA Health Information] updated

Important

1. If you are a Welsh Primary Care Professional with a clinical query send it to ATTRACT online or email us at questions@attract.wales.nhs.uk or call 01495 332343.
2. If you would like to comment on this CME topic, or suggest a new topic for ATTRACTcme, go to the comments hyperlink below.

Postnatal depression

2011-04-13T09:09:00.005+01:00

Evidence Based Reports

Oestrogens and progestins for preventing and treating postpartum depression (2010)[Cochrane]

Group cognitive behavioural therapy for postnatal depression: a systematic review of clinical effectiveness, cost-effectiveness and value of information analyses (2010)[HTA]

A pragmatic randomised controlled trial to compare antidepressants with a community-based psychosocial intervention for the treatment of women with postnatal depression: the RESPOND trial. (2010)[HTA]

Postnatal depression (2009)[Clinical Evidence]

Methods to identify postnatal depression in primary care: an integrated evidence synthesis and value of information analysis (2009)[HTA]

A systematic review of home-based interventions to prevent and treat postpartum depression (2009)[DARE]

Clinical Guidelines

antenatal and postnatal mental health (2007)[NICE]

Postnatal Depressionand Puerperal Psychosis (2007)[SIGN]

Recent articles in core journals

Pharmacologic treatment for postpartum depression: a systematic review. (2010)[EvidenceUpdates]

Prenatal and postpartum depression in fathers and its association with maternal depression: a meta-analysis. (2010)[JAMA]

Accuracy of depression screening tools for identifying postpartum depression among urban mothers. (2010)[EvidenceUpdates]

Screening for postnatal depression in primary care: cost effectiveness analysis. (2009)[BMJ]

The effectiveness of exercise in the management of post-natal depression: systematic review and meta-analysis. (2009)[EvidenceUpdates]

Postpartum depression screening at well-child visits: validity of a 2-question screen and the PHQ-9. (2009)[EvidenceUpdates]

Effect of peer support on prevention of postnatal depression among high risk women: multisite randomised controlled trial. (2009)[BMJ]

eTextbooks

Postpartum Depression (2011)[eMedicine]

postnatal depression and lactation (2010)[GPnotebook]

Postnatal Depression (2009)[Mentor]

Clinical Queries

Does progesterone or progestogen supplementation prevent postnatal depression? (2010)[NeLM]

What is the evidence for the use of psychotherapeutics for women with postpartum depression? (2008)[TRIPAnswers]

Is there a role for progestagen pessaries in the postnatal period to prevent postnatal depression? (2008)[TRIPAnswers]

Patient Information

Postnatal depression (2010)[NHS Choices]

Postnatal Depression. (2010)[RCPsych]

Postnatal depression (2009)[BUPA]

Important

1. If you are a Welsh Primary Care Professional with a clinical query send it to ATTRACT online or email us at questions@attract.wales.nhs.uk or call 01495 332343.
2. If you would like to comment on this CME topic, or suggest a new topic for ATTRACTcme, go to the comments hyperlink below.

ATTRACTcme Topics

2011-04-12T10:14:00.000+01:00

Postnatal Depression April 2011
Seasonal Affective Disorder April 2011
Depression April 2011
Multiple Sclerosis April 2011
Tennis Elbow April 2011
Smoking Cessation April 2011
Vasectomy April 2011
Statins April 2011
Nocturnal Enuresis April 2011
Helicobacter Pylori April 2011
Hirsutism April 2011
Abdominal Aortic Aneurysm (AAA) April 2011
PCOS March 2011
Osteoarthritis March 2011
Psoriasis March 2011
Schizophrenia March 2011
Acne Vulgaris March 2011
Heart Failure March 2011
Endometriosis March 2011
Bipolar Disorder March 2011
Dyspepsia March 2011
Chlamydia March 2011
Haemorrhoids March 2011
Autism March 2011
Clostridum Difficile March 2011
Alcohol abuse February 2011
Community Acquired Penumonia February 2011
Obesity February 2011
DVT February 2011
Falls January 2011
Hay Fever January 2011
Menopause January 2011
Osteoporosis January 2011
Chronic Fatigue Syndrome January 2011
Epilepsy January 2011
Migraine January 2011
Parkinson's disease January 2011
Alzheimer's disease January 2011
Acute and Chronic Low Back Pain January 2011
Atrial Fibrillation January 2011
Shoulder Pain January 2011
Menorrhagia January 2011
Bell's Palsy January 2011
COPD January 2011
Asthma January 2011
Hypertension January 2011
Anticoagulation January 2011

Depression

2011-04-08T09:03:00.008+01:00

Evidence Based Reports

Second-generation antipsychotics for major depressive disorder and dysthymia (2010)[Cochrane]

Fluvoxamine versus other anti-depressive agents for depression (2010)[Cochrane]

Antidepressants for depression in physically ill people (2010)[Cochrane]

Reboxetine for acute treatment of major depression: systematic review and meta-analysis of published and unpublished placebo and selective serotonin reuptake inhibitor controlled trials (2010)[DARE]

What is the role of consultation-liaison psychiatry in the management of depression in primary care? A systematic review and meta-analysis (2010)[DARE]

Telemedicine for depression: a systematic review (2010)[DARE]

Effects of befriending on depressive symptoms and distress: systematic review and meta-analysis (2010)[DARE]

Milnacipran versus other antidepressive agents for depression (2009)[Cochrane]

Antidepressants versus placebo for depression in primary care (2009)[Cochrane]

Sertraline versus other antidepressive agents for depression (2009)[Cochrane]

Escitalopram versus other antidepressive agents for depression (2009)[Cochrane]

Efficacy, tolerability and side-effect profile of fluvoxamine for major depression: meta-analysis (2009)[DARE]

Psychological treatment of depression in primary care: a meta-analysis (2009)[DARE]

Vagus nerve stimulation for treatment-resistant depression (2009)[NICE]

Relaxation for depression (2008)[Cochrane]

Exercise for depression (2008)[Cochrane]

Psychostimulants for depression (2008)[Cochrane]

Music therapy for depression (2008)[Cochrane]

Clinical Guidelines

Depression (2010)[CKS]

Non-pharmaceutical management of depression in adults (2010)[SIGN]

Depression - primary care presentation (2010)[Map of Medicine]

Depression The treatment and management of depression in adults (2009)[NICE]

Depression in adults with a chronic physical health problem (2009)[NICE]

Depression in children (2009)[CKS]

Recent articles in core journals

Problem-solving therapy and supportive therapy in older adults with major depression and executive dysfunction. (2010)[EvidenceUpdates]

Reboxetine for acute treatment of major depression: systematic review and meta-analysis of published and unpublished placebo and selective serotonin reuptake inhibitor controlled trials. (2010)[BMJ]

Cost-effectiveness analysis of a rural telemedicine collaborative care intervention for depression. (2010)[EvidenceUpdates]

Combination of antidepressant medications from treatment initiation for major depressive disorder: a double-blind randomized study. (2010)[EvidenceUpdates]

In the clinic. Depression. (2010)[Annals of Internal Medicine]

Effects of befriending on depressive symptoms and distress: systematic review and meta-analysis. (2010)[EvidenceUpdates]

Personality change during depression treatment: a placebo-controlled trial. (2010)[EvidenceUpdates]

Antidepressant drug effects and depression severity: a patient-level meta-analysis. (2010)[JAMA]

Management of depression in UK general practice in relation to scores on depression severity questionnaires: analysis of medical record data. (2009)[BMJ]

Atypical antipsychotic augmentation in major depressive disorder: a meta-analysis of placebo-controlled randomized trials. (2009)[EvidenceUpdates]

Long-term benefits of short-term quality improvement interventions for depressed youths in primary care. (2009)[EvidenceUpdates]

Screening for depression in adult patients in primary care settings: a systematic evidence review. (2009)[Annals of Internal Medicine]

Therapist-delivered Internet psychotherapy for depression in primary care: a randomised controlled trial. (2009)[Lancet]

Relative cost-effectiveness of treatments for adolescent depression: 36-week results from the TADS randomized trial. (2009)[EvidenceUpdates]

Clinical diagnosis of depression in primary care: a meta-analysis. (2009)[Lancet]

A meta-analytic review of depression prevention programs for children and adolescents: factors that predict magnitude of intervention effects. (2009)[EvidenceUpdates]

Prevention of depression in at-risk adolescents: a randomized controlled trial. (2009)[JAMA]

eTextbooks

Screening for Depression in Primary Care (2010)[Mentor]

Depression in Children and Adolescents (2009)[Mentor]

referral criteria from primary care - depression (2008)[GPnotebook]

depression in old age (2008)[GPnotebook]

secondary depression (2008)[GPnotebook]

major depression (2008)[GPnotebook]

recurrent depressive disorder (2008)[GPnotebook]

Clinical Queries

With hospitalised patients over age 80 with newly diagnosed depression, is pharmacotherapy with antidepressants superior to placebo in improving depressive symptoms? (2009)[TRIPAnswers]

What is the most recent evidence with regards St Johns Wort in the treatment of depression?(2009)[ATTRACT]

Is there any evidence to support the use of 5-HTP in the treatment of anxiety and depression? Are there any known contraindications to its use? (2008)[ATTRACT]

Can fish oil help reduce depression and/or first episode psychosis? (Q & A provided by Evidence Direct via the Centre for Evidence Based Practice Australasia)(2008)[TRIPAnswers]

Are there any national self-help groups for patients with depression? (2008)[TRIPAnswers]

Patient Information

Men and Depression (2010)[RCPsych]

Depression in Older Adults (2010)[RCPsych]

Alcohol and Depression (2010)[RCPsych]

Depression (2010)[NHS Choices]

Depression (2010)[BUPA]
Important

1. If you are a Welsh Primary Care Professional with a clinical query send it to ATTRACT online or email us at questions@attract.wales.nhs.uk or call 01495 332343.
2. If you would like to comment on this CME topic, or suggest a new topic for ATTRACTcme, go to the comments hyperlink below.

Multiple Sclerosis

2011-04-05T11:12:00.003+01:00

Evidence Based Reports

Vitamin D for the management of multiple sclerosis (2010)[Cochrane]

Statins for multiple sclerosis (2010)[Cochrane]

Hyperbaric oxygen therapy for multiple sclerosis (2010)[Cochrane]

Glatiramer acetate for multiple sclerosis (2010)[Cochrane]

Carnitine for fatigue in multiple sclerosis (2010)[Cochrane]

Intravenous immunoglobulins for multiple sclerosis (2010)[Cochrane]

Therapeutic interventions in the treatment of people with multiple sclerosis with mobility problems: a literature review (2010)[DARE]

A systematic review on the efficacy of interferon beta in relapsing remitting multiple sclerosis: comparison of different formulations (2010)[DARE]

Treatment of seizures in multiple sclerosis (2009)[Cochrane]

Anticholinergics for urinary symptoms in multiple sclerosis (2009)[Cochrane]

Oral versus Intravenous Steroids for Treatment of Relapses in Multiple Sclerosis
(2009)[Cochrane]

Interferon Beta for Primary Progressive Multiple Sclerosis (2009)[Cochrane]

Effectiveness of vocational rehabilitation intervention on the return to work and employment of persons with multiple sclerosis. (2009)[Cochrane]

Clinical Guidelines

Multiple sclerosis (MS) - suspected (2010)[Map of Medicine]

Natalizumab for the treatment of adults with highly active relapsing–remitting multiple sclerosis (2007)[NICE]

Multiple Sclerosis: national clinical guideline for diagnosis and management (2004)[NICE]

Recent articles in core journals

A phase 3 trial of extended release oral dalfampridine in multiple sclerosis. (2010)[EvidenceUpdates]

Methylprednisolone in combination with interferon beta-1a for relapsing-remitting multiple sclerosis (MECOMBIN study): a multicentre, double-blind, randomised, placebo-controlled, parallel-group trial. (2010)[EvidenceUpdates]

A phase I/II dose-escalation trial of vitamin D3 and calcium in multiple sclerosis.
(2010)[EvidenceUpdates]

Daclizumab in active relapsing multiple sclerosis (CHOICE study): a phase 2, randomised, double-blind, placebo-controlled, add-on trial with interferon beta. (2010)[EvidenceUpdates]

Rituximab in patients with primary progressive multiple sclerosis: results of a randomized double-blind placebo-controlled multicenter trial. (2010)[EvidenceUpdates]

A placebo-controlled trial of oral fingolimod in relapsing multiple sclerosis. (2010)[NEJM]

Resistance training improves muscle strength and functional capacity in multiple sclerosis. (2010)[EvidenceUpdates]

Sustained-release oral fampridine in multiple sclerosis: a randomised, double-blind, controlled trial. (2009)[Lancet]

Effectiveness of rehabilitation intervention in persons with multiple sclerosis: a randomised controlled trial. (2008)[EvidenceUpdates]

eTextbooks

Multiple Sclerosis (2011)[eMedicine]

Multiple Sclerosis (2010)[Mentor]

Brain Imaging in Multiple Sclerosis (2009)[eMedicine]

Multiple Sclerosis (2008)[GPnotebook]

beta interferon in multiple sclerosis (2008)[GPnotebook]

Clinical Queries

I have a patient who has Multiple sclerosis who is travelling to India. He will need to take chloroquine and proguanil as malaria prophylaxis. Are there any reported complications in MS with these medications? (2010)[ATTRACT]

Can the combined oral contraceptive pill be used safely and effectively in a woman with multiple sclerosis who is receiving beta interferon injections? (2009)[FSRH]

What is the evidence for low dose naltrexone for treatment of multiple sclerosis? (2009)[NeLM]

Is there any evidence that atorvastatin alleviates symptoms, maintains remission or is useful in flare-ups of multiple sclerosis? (2009)[ATTRACT]

For women with multiple sclerosis can Depot medroxyprogesterone acetate be safely used? (2008)[FSRH]

Would the etonogestrel implant have any detrimental effects on a patient with multiple sclerosis? (2008)[FSRH]

Is there any evidence for the use of vitamin b12 for the treatment of fatigue in patients with multiple sclerosis? (2008)[TRIPAnswers]

What is the benefit of early diagnosis in Multiple Sclerosis; does early diagnosis and early intervention improve outcome in the longer term? (2008)[TRIPAnswers]

In a patient with multiple sclerosis, does oral treatment with a statin tablet (compared with no treatment) reduce the risk of symptoms, relapses or development of the disease? (2008)[TRIPAnswers]

Patient Information

Multiple Sclerosis (2010)[NHS Choices]

Multiple Sclerosis (MS) (2010)[BUPA]

Multiple sclerosis (2010)[Patient UK]

Important

1. If you are a Welsh Primary Care Professional with a clinical query send it to ATTRACT online or email us at questions@attract.wales.nhs.uk or call 01495 332343.
2. If you would like to comment on this CME topic, or suggest a new topic for ATTRACTcme, go to the comments hyperlink below.

Smoking Cessation

2011-04-05T08:48:00.012+01:00

Evidence Based Reports

Smoking cessation (2009)[WeMeReC]

Cannabinoid type 1 receptor antagonists for smoking cessation (2011)[Cochrane][Cochrane PEARLS]

Mecamylamine (a nicotine antagonist) for smoking cessation (2011)[Cochrane]

Acupuncture and related interventions for smoking cessation (2011)[Cochrane]

Quitting smoking in pregnancy and following childbirth (2010)[NICE]

Nicotine receptor partial agonists for smoking cessation (2010)[Cochrane]

Stage-based interventions for smoking cessation (2010)[Cochrane]

Hypnotherapy for smoking cessation (2010)[Cochrane]

Internet-based interventions for smoking cessation (2010)[Cochrane]

Reduction versus abrupt cessation in smokers who want to quit (2010)[Cochrane]

Motivational interviewing for smoking cessation (2010)[Cochrane]

Mobile phone-based interventions for smoking cessation (2009)[Cochrane]

Nicobrevin for smoking cessation (2009)[Cochrane]

Interventions for preventing weight gain after smoking cessation (2009)[Cochrane][Cochrane PEARLS]

Biomedical risk assessment as an aid for smoking cessation (2009)[Cochrane]

Self-help interventions for smoking cessation (2009)[Cochrane]

Group behaviour therapy programmes for smoking cessation (2009)[Cochrane]

Relapse prevention interventions for smoking cessation (2009)[Cochrane]

Antidepressants for smoking cessation (2009)[Cochrane]

Interventions for promoting smoking cessation during pregnancy (2009)[Cochrane]

Telephone counselling for smoking cessation (2009)[Cochrane]

Opioid antagonists for smoking cessation (2009)[Cochrane]

Lobeline for smoking cessation (2009)[Cochrane]

Silver acetate for smoking cessation (2009)[Cochrane]

Smoking cessation services in primary care, pharmacies, local authorities and workplaces, particularly for manual working groups, pregnant women and hard to reach communities (2008)[NICE]

'Cut down to quit' with nicotine replacement therapies in smoking cessation: a systematic review of effectiveness and economic analysis (2008)[NIHR HTA]

Psychosocial interventions for smoking cessation in patients with coronary heart disease (2008)[Cochrane]

Mass media interventions for smoking cessation in adults (2008)[Cochrane]

Workplace interventions for smoking cessation (2008)[Cochrane]

Competitions and incentives for smoking cessation (2008)[Cochrane]

Individual behavioural counselling for smoking cessation (2008)[Cochrane]

Exercise interventions for smoking cessation (2008)[Cochrane]

Physician advice for smoking cessation (2008)[Cochrane][Cochrane PEARLS]

Clonidine for smoking cessation (2008)[Cochrane]

Enhancing partner support to improve smoking cessation (2008)[Cochrane]

Nicotine replacement therapy for smoking cessation (2008)[Cochrane]

Nursing interventions for smoking cessation (2008)[Cochrane]

Clinical Guidelines

Smoking Cessation (2010)[Map of Medicine]

Smoking Cessation (2010)[CKS]

Recent articles in core journals

Smoking, smoking cessation, and risk for type 2 diabetes mellitus: a cohort study (2011)[Ann Intern Med]

Increasing support for smoking cessation during pregnancy and postpartum: results of a randomized controlled pilot study (2010)[Prev Med]

Cost-effective primary care-based strategies to improve smoking cessation: more value for money(2009)[Arch Intern Med]

eTextbooks

Smoking cessation - in association with NICE (2010)[BMJ Learning]

Managing Smoking Cessation (2010)[Primary Care Respiratory Society]

Smoking cessation (2009)[Mentor]

Clinical Queries

In pregnant women who smoke, how effective are smoking cessation interventions? (2008)[BEST in Mental Health]

Is there any evidence on the effectiveness of smoking cessation advice/facilitation or NRT in children? (2008)[TRIPAnswers]

Patient Information

Smoking (quitting) (2010)[NHS Choices]

Tips To Help You Stop Smoking(2008)[Patient UK]

Important

1. If you are a Welsh Primary Care Professional with a clinical query send it to ATTRACT online or email us at questions@attract.wales.nhs.uk or call 01495 332343.
2. If you would like to comment on this CME topic, or suggest a new topic for ATTRACTcme, go to the comments hyperlink below.

Vasectomy

2011-04-05T08:48:00.009+01:00

Evidence Based Reports

Scalpel versus no-scalpel incision for vasectomy (2009)[Cochrane]

Vasectomy occlusion techniques for male sterilization (2009)[Cochrane]

Clinical Guidelines

Vasectomy (2010)[Map of Medicine]

Recent articles in core journals

Mini-Incision Vasectomy Reversal Using No-scalpel Vasectomy Principles: Efficacy and Postoperative Pain Compared With Traditional Approaches to Vasectomy Reversal (2011)[Urology]

Vasectomy reversal (2008)[Fertility and Sterility]

Vasectomy and the Risk of Prostate Cancer (2008)[Journal of Urology]

eTextbooks

Sterilisation (Female Sterilisation and Vasectomy)(2009)[Mentor]

Mini Topic Review: Vasectomy and Vasectomy Reversal (2010)[NHS Evidence]

Clinical Queries

Are there any guidelines on the need for pre-operative screening for MRSA in men undergoing vasectomy in a community setting? (2009)[FSRH]

Is there any increase risk of testicular or prostate cancer following vasectomy? (2009) [TRIPAnswers]

What are the causes and treatment of post-vasectomy pain? What are the other common complications after vasectomy (apart from bleeding)? (2008)[TRIPAnswers]

Patient Information

Vasectomy (2010)[NHS Choices]

Vasectomy (2010)[BUPA Health Information]

Vasectomy reversal (2010)[BUPA Health Information]

Important

1. If you are a Welsh Primary Care Professional with a clinical query send it to ATTRACT online or email us at questions@attract.wales.nhs.uk or call 01495 332343.
2. If you would like to comment on this CME topic, or suggest a new topic for ATTRACTcme, go to the comments hyperlink below.

Statins

2011-04-05T08:47:00.007+01:00

Evidence Based Reports

Statins for the primary prevention of cardiovascular disease (2011)[Cochrane]

Statins for multiple sclerosis (2010)[Cochrane]

Statins for the treatment of dementia (2010)[Cochrane][Cochrane PEARLS]

Statins for children with familial hypercholesterolemia (2010)[Cochrane]

Statins and all-cause mortality in high-risk primary prevention: a meta-analysis of 11 randomized controlled trials involving 65229 participants (2010)[DARE]

Effect of statins pretreatment on periprocedural myocardial infarction in patients undergoing percutaneous coronary intervention: a meta-analysis (2010)[DARE]

Differing effect of statins on insulin sensitivity in non-diabetics: a systematic review and meta-analysis (2010)[DARE]

HMG CoA reductase inhibitors (statins) for people with chronic kidney disease not requiring dialysis (2009)[Cochrane]

HMG CoA reductase inhibitors (statins) for kidney transplant recipients (2009)[Cochrane]

Statins for age-related macular degeneration (2009) [Cochrane]

Statins for the prevention of dementia (2009)[Cochrane]

Statin prophylaxis and inflammatory mediators following cardiopulmonary bypass: a systematic review (2009)[DARE]

Statin therapy and risk of developing type 2 diabetes: a meta-analysis (2009) [DARE]

Statins for the prevention and treatment of infections: a systematic review and meta-analysis (2009)[DARE]

The benefits of statins in people without established cardiovascular disease but with cardiovascular risk factors: meta-analysis of randomised controlled trials (2009)[DARE]

Statins for secondary prevention in elderly patients: a hierarchical Bayesian meta-analysis (2008)[DARE]

Effects of statins in patients with chronic kidney disease: meta-analysis and meta-regression of randomised controlled trials (2008)[DARE]

The efficacy and safety of intensive statin therapy: a meta-analysis of randomized trials (2008)[DARE]

Statins and cancer: a meta-analysis of case-control studies (2008)[DARE]

Primary prevention of cardiovascular mortality and events with statin treatments: a network meta-analysis involving more than 65,000 patients (2008)[DARE]

Impact of preoperative statin therapy on adverse postoperative outcomes in patients undergoing cardiac surgery: a meta-analysis of over 30 000 patients (2008)[DARE]

Statins for infection and sepsis: a systematic review of the clinical evidence (2008)[DARE]

Statin use and development of atrial fibrillation: a systematic review and meta-analysis of randomized clinical trials and observational studies (2008)[DARE]

Clinical Guidelines

Lipid modification - primary and secondary CVD prevention (2008)[CKS]

Lipid modification (2008)[NICE]

Recent articles in core journals

Statins and risk of incident diabetes: a collaborative meta-analysis of randomised statin trials (2010)[Lancet]

Meta-analysis: Statin Therapy Does Not Alter the Association Between Low Levels of High-Density Lipoprotein Cholesterol and Increased Cardiovascular Risk (2010)[Annals of Internal Medicine]

Statin use and the prevention of venous thromboembolism: a meta-analysis (2010)[Int J Clin Pract]

eTextbooks

Statins (2010)[GP Notebook]

Clinical Queries

Do statins cause amnesia? (2010) [NELM]

Do statins cause alopecia? (2010) [NELM]

Should patients on statins take Coenzyme Q10 supplementation to reduce the risk of myotoxicity? (2010) [NELM]

What is the current guidance on statin treatment for primary prevention in patients with calculated 10-yr CVD risk < 20% but Total cholesterol/HDL ratio > 6.0? (2010)[ATTRACT]

Patient Information

Cholesterol-lowering medicines, statins (2010)[NHS Choices]

Statins and Other Lipid Lowering Drugs (2010)[Patient UK]

Important

1. If you are a Welsh Primary Care Professional with a clinical query send it to ATTRACT online or email us at questions@attract.wales.nhs.uk or call 01495 332343.
2. If you would like to comment on this CME topic, or suggest a new topic for ATTRACTcme, go to the comments hyperlink below.

Nocturnal Enuresis

2011-04-05T08:46:00.002+01:00

Evidence Based Reports

Nocturnal enuresis(2010)[Clinical Evidence]

Complex behavioural and educational interventions for nocturnal enuresis in children (2008)[Cochrane]

Alarm interventions for nocturnal enuresis in children (2007)[Cochrane]

Drugs for nocturnal enuresis in children (other than desmopressin and tricyclics)(2007)[Cochrane]

Tricyclic and related drugs for nocturnal enuresis in children (2007)[Cochrane]

Complementary and miscellaneous interventions for nocturnal enuresis in children (2006)[Cochrane]

Desmopressin for nocturnal enuresis in children (2006)[Cochrane]

Simple behavioural and physical interventions for nocturnal enuresis in children (2005)[Cochrane]

Clinical Guidelines

The management of bedwetting and nocturnal enuresis in children and young people (2010)[NICE]

Bed-wetting (enuresis) (2010)[CKS]

Enuresis-suspected (2011)[Map of Medicine]

Recent articles in core journals

Nocturnal Enuresis in Children: Prevalence, Correlates, and Relationship with Obstructive Sleep Apnea (2011)[Journal of Pediatrics]

The Efficacy of Enuresis Alarm Treatment in Pharmacotherapy-Resistant Nocturnal Enuresis (2010)[Urology]

eTextbooks

Nocturnal Enuresis (2010)[GP notebook]

Nocturnal Enuresis in Children (2009)[Mentor]

Clinical Queries

Patient Information

Bedwetting (2010)[NHS Choices]

Important

1. If you are a Welsh Primary Care Professional with a clinical query send it to ATTRACT online or email us at questions@attract.wales.nhs.uk or call 01495 332343.
2. If you would like to comment on this CME topic, or suggest a new topic for ATTRACTcme, go to the comments hyperlink below.

Hirsutism

2011-04-01T10:54:00.007+01:00

Evidence Based Reports

Spironolactone versus placebo or in combination with steroids for hirsutism and/or acne (2009)[Cochrane]

Antiandrogens for the treatment of hirsutism: a systematic review and metaanalyses of randomized controlled trials (2009)[DARE]

Insulin sensitizers for the treatment of hirsutism: a systematic review and metaanalyses of randomized controlled trials (2008)[DARE]

Clinical Guidelines

Hirsutism (2010)[CKS]

Hirsutism (2010)[Map of Medicine]

Recent articles in core journals

Cyproterone acetate or drospirenone containing combined oral contraceptives plus spironolactone or cyproterone acetate for hirsutism: Randomized comparison of three regimens (2011) [Journal of Dermatological Treatment]

Hair Removal in Hirsute Women with Normal Testosterone Levels: A Randomized Controlled Trial of Long-Pulsed Diode Laser versus Intense Pulsed Light (2010) [British Journal of Dermatology]

eTextbooks

Hirsutism and Virilism (2009)[Mentor]

Clinical Queries

In a young woman who has developed significant hirsutism and has normal blood tests, could this be related to her use of the progestogen-only implant? (2009)[FSRH]

What effect does metformin have on hirsutism and acne in women with polycystic ovary syndrome? (2009)[NeLM]

Is there any evidence that Eflornithine (Vaniqa) is effective for localised areas of non-facial hirsutism in women e.g. on the lower abdomen? (2009)[ATTRACT]

Is there any evidence to suggest a causal link between the development of hirsutism and the use of the combined hormonal patch (EVRA)? (2008)[FSRH]

Patient Information

Hirsutism (2010)[NHS Choices]

Hirsutism (2010)[BAD]

Important

1. If you are a Welsh Primary Care Professional with a clinical query send it to ATTRACT online or email us at questions@attract.wales.nhs.uk or call 01495 332343.
2. If you would like to comment on this CME topic, or suggest a new topic for ATTRACTcme, go to the comments hyperlink below.

Abdominal aortic aneurysm (AAA)

2011-04-01T10:52:00.002+01:00

Evidence Based Reports

Endovascular stents for abdominal aortic aneurysms: a systematic review and economic model (2009)[NIHR HTA]

Endovascular stent - grafts for the treatment of abdominal aortic aneurysms (2009)[NICE]

Surgery for small asymptomatic abdominal aortic aneurysms (2008)[Cochrane]

Outcome after endografting in small and large abdominal aortic aneurysms: a metanalysis (2008)[DARE]

Clinical Guidelines

Abdominal aortic aneurysm screening (2010)[Map of Medicine]

The UK NSC policy on Abdominal Aortic Aneurysm screening in men over 65 (2009)[UK NSC]

Abdominal aortic aneurysm (2010)[Map of Medicine]

Recent articles in core journals

Evaluation of the diagnostic and prognostic value of plasma D-dimer for abdominal aortic aneurysm (2011)[Eur Heart J]

Long-term outcome of open or endovascular repair of abdominal aortic aneurysm (2010)[NEJM]

Screening men for abdominal aortic aneurysm: 10 year mortality and cost effectiveness results from the randomised Multicentre Aneurysm Screening Study (2009)[BMJ]

eTextbooks

Abdominal aortic Aneurysms (2009)[Mentor]

Clinical Queries

A 62 year old male patient with a strong family history of abdominal aortic aneurysm (AAA) (father and uncles) asked if he should undergo screening for AAA. What is the current advice and evidence for screening for AAA? (2010)[ATTRACT]

Fenestrated Endovascular Stents (EVAR)/Abdominal Aortic Aneurysms (2009)[ARIF]

Can the combined oral contraceptive pill be used by a 30 year-old woman who suffered a dissecting aortic aneurysm type A at the age of 29 years (no apparent underlying cause and no other cardiovascular risk factors)? (2008)[FSRH]

Patient Information

Repair of abdominal aortic aneurysm (2009)[NHS Choices]

Abdominal Aortic Aneurysm (2010)[BUPA]

Important

1. If you are a Welsh Primary Care Professional with a clinical query send it to ATTRACT online or email us at questions@attract.wales.nhs.uk or call 01495 332343.
2. If you would like to comment on this CME topic, or suggest a new topic for ATTRACTcme, go to the comments hyperlink below.

Osteoarthritis

2011-03-09T00:26:00.009Z

Evidence Based Reports

Oral calcitonin - Osteoarthritis of knee (2011)[NHSC]

Surgery for shoulder osteoarthritis (2010) [Cochrane]

Interventions for treating osteoarthritis of the big toe joint (2010) [Cochrane]

Joint lavage for osteoarthritis of the knee (2010)[Cochrane]

Effectiveness and cost-effectiveness of arthroscopic lavage in the treatment of osteoarthritis of the knee: a mixed methods study of the feasibility of conducting a surgical placebo-controlled trial (the KORAL study) (2010)[NIHR HTA]

Effects of glucosamine, chondroitin, or placebo in patients with osteoarthritis of hip or knee: network meta-analysis (2010)[DARE]

Therapeutic trajectory of hyaluronic acid versus corticosteroids in the treatment of knee osteoarthritis: a systematic review and meta-analysis (2010)[DARE]

Individually magnetic resonance imaging-designed unicompartmental interpositional implant insertion for osteoarthritis of the knee (2009)[NICE]

Osteoarthritis of the hip (2009)[Clinical Evidence]

S-Adenosylmethionine for osteoarthritis of the knee or hip (2009) [Cochrane]

Oral or transdermal opioids for osteoarthritis of the knee or hip (2009) [Cochrane]

Doxycycline for osteoarthritis of the knee or hip (2009) [Cochrane]

Exercise for osteoarthritis of the hip (2009) [Cochrane]

Surgery for thumb (trapeziometacarpal joint) osteoarthritis (2009) [Cochrane]

Glucosamine therapy for treating osteoarthritis (2009) [Cochrane]

Transcutaneous electrostimulation for osteoarthritis of the knee (2009) [Cochrane]

Three Treatments for Osteoarthritis of the Knee: Evidence Shows Lack of Benefit (2009)[AHRQ]

The clinical effectiveness of glucosamine and chondroitin supplements in slowing or arresting progression of osteoarthritis of the knee: a systematic review and economic evaluation (2009) [NIHR HTA]

Cyclooxygenase-2 selective non-steroidal anti-inflammatory drugs (etodolac, meloxicam, celecoxib, rofecoxib, etoricoxib, valdecoxib and lumiracoxib) for osteoarthritis and rheumatoid arthritis: a systematic review and economic evaluation
(2009)[NIHR HTA][DARE]

Evidence of effectiveness of herbal medicinal products in the treatment of arthritis. Part 1: Osteoarthritis (2009)[DARE]

A systematic review of ultrasonography in osteoarthritis (2009)[DARE]

Arthroscopic debridement for knee osteoarthritis (2008)[Cochrane]

Exercise for osteoarthritis of the knee (2008)[Cochrane]

Balneotherapy may be beneficial for osteoarthritis (2008)[Cochrane PEARLS]

Systematic review of the nutritional supplements dimethyl sulfoxide (DMSO) and methylsulfonylmethane (MSM) in the treatment of osteoarthritis (2008)[DARE]

Unicompartmental knee arthroplasty for the treatment of unicompartmental osteoarthritis: a systematic study (2008)[DARE]

Osteoarthritis of the knee (2007)[Clinical Evidence]

Clinical Guidelines

The care and management of osteoarthritis in adults (2008)[NICE]

Osteoarthritis (2008) [CKS]

Osteoarthritis (2008)[Map of Medicine]

OARSI recommendations for the management of hip and knee osteoarthritis: part III: Changes in evidence following systematic cumulative update of research published through January 2009 (2010)[OARSI]

OARSI recommendations for the management of hip and knee osteoarthritis Part II - OARSI evidence-based expert consensus guidelines (2008)[OARSI]

Recent articles in core journals

Tai Chi is effective in treating knee osteoarthritis: a randomized controlled trial (2009)[Arthritis Rheum]

Association between radiographic features of knee osteoarthritis and pain: results from two cohort studies (2009) [BMJ]

eTextbooks

Osteoarthritis (2010)[Mentor]

Clinical Queries

Is there any evidence for the use of rosehip powder for osteoarthritis? (2008)[ATTRACT]

What evidence exists for the use of glucosamine in the prevention and treatment of osteoarthritis? (2008)[TRIPAnswers]

Patient Information

Osteoarthritis (2010)[NHS Choices]

Osteoarthritis (2009)[BUPA]

Osteoarthritis (2010)[Patient UK]

Osteoarthritis (2010)[ARC]

Important

1. If you are a Welsh Primary Care Professional with a clinical query send it to ATTRACT online or email us at questions@attract.wales.nhs.uk or call 01495 332343.
2. If you would like to comment on this CME topic, or suggest a new topic for ATTRACTcme, go to the comments hyperlink below.

psoriasis

2011-03-08T11:28:00.005Z

Evidence Based Reports

Ustekinumab for the treatment of adults with moderate to severe psoriasis (2009)[NICE]

Etanercept and efalizumab for the treatment of adults with psoriasis 92009)[NICE]

Topical treatments for chronic plaque psoriasis (2009)[Cochrane Library]

A cost-utility analysis of etanercept for the treatment of moderate-to-severe psoriasis in Italy (2009)[NHS EED]

Economic evaluation of systemic therapies for moderate to severe psoriasis (2009)[NHS EED]

Cost-effectiveness of biologic treatments for psoriasis based on subjective and objective efficacy measures assessed over a 12-week treatment period (2009)[NHS EED]

Infliximab for the treatment of adults with psoriasis (2009)[NICE]

Adalimumab for the treatment of adults with psoriasis (2009)[NICE]

Safety and efficacy of alefacept, efalizumab, etanercept and infliximab in treating moderate to severe plaque psoriasis: a meta-analysis of randomized controlled trials (2008)[DARE]

Efficacy and tolerability of biologic and nonbiologic systemic treatments for moderate-to-severe psoriasis: meta-analysis of randomized controlled trials (2008)[DARE]

Cost-effectiveness of the two-compound formulation calcipotriol and betamethasone dipropionate compared with commonly used topical treatments in the management of moderately severe plaque psoriasis in Scotland (2008)[NHS EED]

Psoriasis (chronic plaque)(2007)[Clinical Evidence]

Clinical Guidelines

Psoriasis(2010)[CKS]

Diagnosis and management of psoriasis and psoriatic arthritis in adults(2010)[SIGN]

British Association of Dermatologists’ guidelines for biologic interventions for psoriasis(2009)[British Association of Dermatologists]

Recent articles in core journals

Cost effectiveness of home ultraviolet B phototherapy for psoriasis: economic evaluation of a randomised controlled trial (PLUTO study). (2010)[BMJ]

Comparison of two etanercept regimens for treatment of psoriasis and psoriatic arthritis: PRESTA randomised double blind multicentre trial. (2010)[BMJ]

Comparison of ustekinumab and etanercept for moderate-to-severe psoriasis. (2010)[NEJM]

Efficacy and safety of combination Acitretin and Pioglitazone therapy in patients with moderate to severe chronic plaque-type psoriasis: a randomized, double-blind, placebo-controlled clinical trial. (2009)[EvidenceUpdates]

Incidence and clinical predictors of psoriatic arthritis in patients with psoriasis: a population-based study.(2009)[EvidenceUpdates]

Clinical assessment of patients with recalcitrant psoriasis in a randomized, observer-blind, vehicle-controlled trial using indigo naturalis.(2009)[EvidenceUpdates]

A new scalp formulation of calcipotriene plus betamethasone compared with its active ingredients and the vehicle in the treatment of scalp psoriasis: a randomized, double-blind, controlled trial. (2008)[EvidenceUpdates]

Etanercept treatment for children and adolescents with plaque psoriasis. (2008)[EvidenceUpdates]

eTextbooks

Psoriasis (2010)[eMedicine]

Plaque Psoriasis (2010)[eMedicine]

Psoriasis, Pustular (2009)[eMedicine]

Psoriasis of Hands and Feet (2009)[Mentor]

Guttate Psoriasis (2009)[Mentor]

Generalised Pustular Psoriasis (2009)[Mentor]

Erythrodermic Psoriasis (2009)[mentor]

Chronic Plaque Psoriasis (2009)[Mentor]

Clinical Queries

what is the evidence for neem oil in scalp psoriasis? (2010)[ATTRACT]

Fumaderm®: what is the evidence for its efficacy and safety in psoriasis? (2009)[NeLM]

Is there any evidence as to the efficacy of the use of oregan grape root extract in the management of psoriasis? (2009)[TRIPAnswers]

Is there any known link between the mirena IUS and psoriasis? I have a pt who has noticed a significant flare in her psoraisis within 4 weeks of IUS insertion. (2008)[TRIPAnswers]

Is there any evidence that propranolol makes psoriasis worse? (2008)[ATTRACT]

What is the clinical evidence for psoriasis being an inflammatory state that increases the risk of cardiovascular disease? (2008)[TRIPAnswers]

Patient Information

Psoriasis (2010)[Patient UK]

Coal Tar for Psoriasis (2010)[Patient UK]

Vitamin D Analogues for Psoriasis (2010)[Patient UK]

Psoriasis (2010)[BUPA]

Treatments for Moderate or Severe Psoriasis (2010)[British Association of Dermatologists]

Topical Treatments for Psoriasis (2010)[British Association of Dermatologists]

Psoriasis – an Overview (2009)[British Association of Dermatologists]

Psoriasis (2009)[NHS Choices]

Important

1. If you are a Welsh Primary Care Professional with a clinical query send it to ATTRACT online or email us at questions@attract.wales.nhs.uk or call 01495 332343.
2. If you would like to comment on this CME topic, or suggest a new topic for ATTRACTcme, go to the comments hyperlink below.

Schizophrenia

2011-03-08T10:55:00.006Z

Evidence Based Reports

Aripiprazole for schizophrenia in people aged 15 to 17 years (2011) [NICE]

Risperidone versus other atypical antipsychotics for schizophrenia (2011)[Cochrane]

Antipsychotic switching for people with schizophrenia who have neuroleptic-induced weight or metabolic problems (2010)[Cochrane]

Family intervention for schizophrenia (2010)[Cochrane]

Clozapine versus other atypical antipsychotics for schizophrenia (2010)[Cochrane]

Levomepromazine for schizophrenia (2010)[Cochrane]

Beta-blocker supplementation of standard drug treatment for schizophrenia (2010)[Cochrane]

Exercise therapy for schizophrenia (2010)[Cochrane]

Individual psychodynamic psychotherapy and psychoanalysis for schizophrenia and severe mental illness (2010)[Cochrane]

Olanzapine versus other atypical antipsychotics for schizophrenia (2010)[Cochrane]

Zotepine versus other atypical antipsychotics for schizophrenia (2010)[Cochrane]

Sulpiride augmentation for schizophrenia (2010)[Cochrane]

Risperidone versus placebo for schizophrenia (2010)[Cochrane]

Quetiapine versus other atypical antipsychotics for schizophrenia (2010)[Cochrane]

Amisulpride versus other atypical antipsychotics for schizophrenia (2010)[Cochrane]

Asenapine (Sycrest) Schizophrenia - acute and maintenance, first or second line (2010)[NHSC]

Loxapine inhalation (Staccato Loxapine) - Agitation associated with schizophrenia or bipolar-1 disorder (2010)[NHSC]

Ziprasidone versus other atypical antipsychotics for schizophrenia (2009)[Cochrane]

Risperidone dose for schizophrenia (2009)[Cochrane]

Monetary incentives for schizophrenia (2009)[Cochrane]

Aripiprazole versus other atypical antipsychotics for schizophrenia(2009)[Cochrane]

Clozapine combined with different antipsychotic drugs for treatment resistant schizophrenia (2009)[Cochrane]

Twenty-four hour care for schizophrenia (2009)[Cochrane]

Sulpiride versus placebo for schizophrenia (2009)[Cochrane]

Sertindole versus other atypical antipsychotics for schizophrenia (2009)[Cochrane]

Chlorpromazine dose for people with schizophrenia (2009)[Cochrane]

Dance therapy for schizophrenia (2009)[Cochrane]

Oral paliperidone for schizophrenia (2009)[Cochrane]

Morita therapy for schizophrenia (2009)[Cochrane]

Polyunsaturated fatty acid supplementation for schizophrenia (2009)[Cochrane]

Individual psychodynamic psychotherapy and psychoanalysis for schizophrenia and severe mental illness (2009)[Cochrane]

Day hospital versus outpatient care for people with schizophrenia (2009)[Cochrane]

Clozapine versus typical neuroleptic medication for schizophrenia (2009)[Cochrane]

Schizophrenia (maintenance treatment) (2009)[Clinical Evidence]

Antipsychotics increase mortality in elderly patients with dementia, NICE updates schizophrenia guideline (2009)[MeReC]

Benzodiazepines for catatonia in people with schizophrenia and other serious mental illnesses (2008)[Cochrane]

Cannabis and schizophrenia (2008)[Cochrane]

Haloperidol versus chlorpromazine for schizophrenia (2008)[Cochrane]

Aripiprazole versus typical antipsychotic drugs for schizophrenia (2008)[Cochrane]

Atypical antipsychotics for people with both schizophrenia and depression (2008)[Cochrane]

Valproate for schizophrenia (2008)[Cochrane]

Aripiprazole (Abilify) Schizophrenia in children (2008)[NHSC]

Clinical Guidelines

Schizophrenia (2010) [Map of Medicine]

Chronic schizophrenia (2010) [Map of Medicine]

Core interventions in the treatment and management of schizophrenia in primary and secondary care (update) (2009) [NICE]

Schizophrenia (2009)[CKS]

Recent articles in core journals

Acupuncture for schizophrenia: a systematic review and meta-analysis (2009)[Int J Clin Pract]

eTextbooks

Schizophrenia (2009)[Mentor]

Schizophrenia: diagnosis and initial management (2007)[BMJ Learning]

Schizophrenia: long term management and follow up (2007)[BMJ Learning]

Clinical Queries

What is the best practice (and/or guidance) on the treatment for patients suffering depression and schizophrenia? (2008) [TRIPAnswers]

Patient Information

Schizophrenia (2010) [NHS Choices]

Schizophrenia (2010)[Royal College of Psychiatrists]

Schizophrenia (2010)[BUPA]

Important

1. If you are a Welsh Primary Care Professional with a clinical query send it to ATTRACT online or email us at questions@attract.wales.nhs.uk or call 01495 332343.
2. If you would like to comment on this CME topic, or suggest a new topic for ATTRACTcme, go to the comments hyperlink below.

Heart Failure

2011-03-04T14:49:00.006Z

Evidence Based Reports

Heart failure (2010)[Clinical Evidence]Athens Log-in required

Erythropoiesis-stimulating agents for anaemia in chronic heart failure patients (2010)[Cochrane]

Exercise based rehabilitation for heart failure (2010)[Cochrane]

Structured telephone support or telemonitoring programmes for patients with chronic heart failure (2010)[Cochrane]

A systematic review and economic evaluation of the clinical effectiveness and cost-effectiveness of aldosterone antagonists for postmyocardial infarction heart failure (2010)[NIHR HTA]

Ivabradine (Procoralan) Chronic heart failure (2010)[National Horizon Scanning Centre]

Levosimendan for the treatment of acute severe heart failure: a meta-analysis of randomised controlled trials (2010)[DARE]

Beta-blockers for congestive heart failure in children (2009)[Cochrane]

Diuretics for heart failure (2009)[Cochrane]

Digitalis for treatment of congestive heart failure in patients in sinus rhythm (2009)[Cochrane]

Enhanced external counterpulsation for stable angina or heart failure: a systematic review and economic evaluation (2009)[NIHR HTA])[DARE]

Systematic review and individual patient data meta-analysis of diagnosis of heart failure, with modelling of implications of different diagnostic strategies in primary care (2009)[NIHR HTA]

Meta-analysis: beta-blocker dose, heart rate reduction, and death in patients with heart failure (2009)[DARE]

The accuracy of plasma natriuretic peptide levels for diagnosis of cardiac dysfunction and chronic heart failure in community-dwelling elderly: a systematic review (2009)[DARE]

Treatment of Chronic Heart Failure (2009)[WeMRec]

Effects of neuromuscular electrical stimulation of muscles of ambulation in patients with chronic heart failure or COPD: a systematic review of the English-language literature (2009)[DARE]

Chronic heart failure: overview of diagnosis and drug treatment in primary care (2008)[MeRec]

Hawthorn extract for treating chronic heart failure (2009)[Cochrane]

Hawthorn extract may have benefit as an adjunctive treatment for chronic heart failure (2008)[Cochrane PEARLS]

Non-Pharmacological Interventions for Post-Discharge Care in Heart Failure (2008)[AHRQ]

Rolofylline (MK-7418) - Heart failure – acute, hospitalised (2008)[National Horizon Scanning Centre]

Irbesartan (Aprovel) - Heart failure – preserved systolic function, adjunctive therapy (2008)[National Horizon Scanning Centre]

Congestive heart failure and cardiovascular death in patients with prediabetes and type 2 diabetes given thiazolidinediones: a meta-analysis of randomised clinical trials (2008)[DARE]

Benefits and harms of antidiabetic agents in patients with diabetes and heart failure: systematic review (2008)[DARE]

Clinical Guidelines

Chronic heart failure: management of chronic heart failure in adults in primary and secondary care (2010)[NICE]

Heart failure - chronic (2009)[CKS]

Heart failure (2008)[Map of Medicine]

ESC guidelines for the diagnosis and treatment of acute and chronic heart failure (2008) [ESC]

Management of chronic heart failure (2007)[SIGN]

Recent articles in core journals

Management of chronic heart failure guided by individual N-terminal pro-B-type natriuretic peptide targets: results of the PRIMA study (2010)[J Am Coll Cardiol]

Heart rate as a risk factor in chronic heart failure (SHIFT): the association between heart rate and outcomes in a randomised placebo-controlled trial (2010)[Lancet]

Preventing heart failure and improving survival(2010)[NEJM]

Randomized Trial of Warfarin, Aspirin, and Clopidogrel in Patients With Chronic Heart Failure: The Warfarin and Antiplatelet Therapy in Chronic Heart Failure (WATCH) Trial (2009) [Circulation]

eTextbooks

Heart Failure Diagnosis and Investigation (2011)[ Mentor]

Heart Failure Management (2011)[Mentor]

Palliative Care of Heart Failure (2011)[Mentor]

Heart failure: an update on management (2007)[BMJ Learning]

Clinical Queries

proBNP is used to diagnose heart failure. Can and should it be used to monitor response to heart failure treatment (2010)[ATTRACT]

What is the rationale and evidence for combining angiotensin converting enzyme inhibitors with angiotensin II receptor antagonists in heart failure? (2010)[NELM]

Are there any recommendations regarding how best to change patients with heart failure from the more “traditional” beta-blockers to those licensed for use in heart failure. Can they simply be switched from one to another and if so what are the equivalent doses? (2009)[ATTRACT]

Patient Information

Heart failure (2010)[NHS Choices]

Heart Failure (2010)[Patient UK]

Heart Failure (2009)[BUPA]

Important

1. If you are a Welsh Primary Care Professional with a clinical query send it to ATTRACT online or email us at questions@attract.wales.nhs.uk or call 01495 332343.
2. If you would like to comment on this CME topic, or suggest a new topic for ATTRACTcme, go to the comments hyperlink below.

Endometriosis

2011-03-04T11:05:00.004Z

Evidence Based Reports

Pre and post-operative medical therapy for endometriosis surgery (2011)[Cochrane Library]

Gonadotrophin-releasing hormone analogues for pain associated with endometriosis (2010)[Cochrane Library]

Interventions for women with endometrioma prior to assisted reproductive technology (2010)[Cochrane Library]

Anti-TNF-α treatment for pelvic pain associated with endometriosis (2010)[Cochrane Library]

Pentoxifylline versus medical therapies for subfertile women with endometriosis (2009)[Cochrane Library]

Chinese herbal medicine for endometriosis (2009)[Cochrane Library]

Hormone therapy for endometriosis and surgical menopause (2009)[Cochrane Library]

Levonorgestrel-releasing intrauterine device (LNG-IUD) for symptomatic endometriosis following surgery (2009)[Cochrane Library]

Ovulation suppression for endometriosis for women with subfertility (2009)[Cochrane Library]

Laparoscopic surgery for pelvic pain associated with endometriosis (2009)[Cochrane Library]

Medical treatment for rectovaginal endometriosis: what is the evidence?(2009)[DARE]

The effect of second-line surgery on reproductive performance of women with recurrent endometriosis: a systematic review (2009)[DARE]

Diagnostic accuracy of transvaginal sonography for the diagnosis of adenomyosis: systematic review and metaanalysis (2009)[DARE]

The effect of surgical treatment for endometrioma on in vitro fertilization outcomes: a systematic review and meta-analysis (2009)[DARE]

Laparoscopic management of endometriosis: comprehensive review of best evidence (2009)[DARE]

Endometriosis (2009)[Clinical Evidence]

Systematic review of the effects of aromatase inhibitors on pain associated with endometriosis (2008)[DARE]

Clinical Guidelines

Endometriosis (2009)[CKS]

Endometriosis - suspected (2009)[Map of Medicine]

Recent articles in core journals

Endometriosis and infertility: pathophysiology and management.(2010)[Lancet]

Randomized trial of laparoscopically assisted versus open colorectal resection for endometriosis: morbidity, symptoms, quality of life, and fertility.(2010)[EvidenceUpdates]

Diagnostic accuracy of transvaginal sonography for the diagnosis of adenomyosis: systematic review and metaanalysis.(2009)[EvidenceUpdates]

Systematic review of the effects of aromatase inhibitors on pain associated with endometriosis.(2008)[EvidenceUpdates]

eTextbooks

Endometriosis in Emergency Medicine(2010)[eMedicine]

Pediatric Endometriosis Surgery(2010)[eMedicine]

Endometriosis(2009)[eMedicine]

Endometriosis (2009)[Mentor]

Clinical Queries

What are the contraceptive options for a woman taking danazol for endometriosis, menorrhagia and dysmenorrhoea? (2010)[FSRH]

Is there any evidence that one form of contraception is superior to another with regards to treating dysmenorrhoea secondary to endometriosis and is there any evidence that one combined oral contraception or type of progestogen is more effective than another in treating dysmenorrhoea or pelvic pain secondary to endometriosis?(2010)[FSRH]

Which contraceptive methods are suitable for a 37 year old with endometriosis and a history of transient ischaemic attack (TIA) who had surgical treatment of carotid artery disease 3 years ago?(2009)[FSRH]

Is there any evidence that a young nulliparous woman who is currently using the progestogen-only implant and has recently been diagnosed with endometriosis would be better switching to the levonorgestrel-releasing intrauterine system (LNG-IUS)? (2009)[FSRH]

Is HRT recommended for a patient on goserelin for endometriosis experiencing menopausal symptoms?(2009)[ATTRACT]

What evidence is there to support that Depo can help women with endometriosis?(2009)[ATTRACT]

In a lady who has had a hysterectomy/bilateral oopherectomy for severe endometriosis with new onset back pain would recurring endometriosis be considered as part of a differential diagnosis?(2008)[ATTRACT]

Does a woman receiving Zoladex implants for endometriosis need to continue her oral contraceptive.(2008)[ATTRACT]

Which regimen of HRT (combined or oestrogen-only) should be prescribed for a patient who recently had an abdominal hysterectomy bilateral salpingo-oophorectomy and who has endometriosis?(2008)[TRIPAnswers]

In a young woman with endometriosis wanting to use depo provera for symptom control and contraception long term is there a way of minimising/negating bone loss?(2008)[TRIPAnswers]

Is there any evidence for the use of mirena coil in treatment of endometriosis?(2008)[TRIPAnswers]

After a woman has had a six month course of GnRH analogues for endometriosis, on average how long will it take for her periods to restart?(2008)[ATTRACT]

Patient Information

Endometriosis(2011)[BUPA]

Endometriosis(2010)[NHS Choices]

Endometriosis(2009)[Patient UK]

Important

1. If you are a Welsh Primary Care Professional with a clinical query send it to ATTRACT online or email us at questions@attract.wales.nhs.uk or call 01495 332343.
2. If you would like to comment on this CME topic, or suggest a new topic for ATTRACTcme, go to the comments hyperlink below.

Bipolar Disorder

2011-03-04T09:12:00.006Z

Evidence Based Reports

Asenapine (Saphris) for manic episodes associated with bipolar 1 disorder (2010) [National Horizon Scanning Centre]

Tolerability of atypical antipsychotics in the treatment of adults with schizophrenia or bipolar disorder: a mixed treatment comparison of randomized controlled trials (2010)[DARE]

Comparison of carbamazepine and lithium in treatment of bipolar disorder: a systematic review of randomized controlled trials (2010)[DARE]

Olanzapine in long-term treatment for bipolar disorder (2009)[Cochrane]

Limited evidence for effectiveness of olanzapine in long term treatment of bipolar disorder (2009)[Cochrane PEARLS]

Risperidone (Risperdal Consta) injection - Bipolar 1 disorder – prevention of recurrent mania (2009)[National Horizon Scanning Centre]

Aripiprazole (Abilify) Bipolar I disorder in children, acute mania (2009)[National Horizon Scanning Centre]

Omega-3 fatty acids for bipolar disorder (2008)[Cochrane]

Oxcarbazepine in the maintenance treatment of bipolar disorder (2008)[Cochrane]

Bipolar Disorder (2006)[Clinical Evidence]Athens Log-in required

Clinical Guidelines

Bipolar Disorder (2009)[CKS]

Evidence-based guidelines for treating bipolar disorder: revised second edition - recommendations from the British Association for Psychopharmacology (2009)[BAP]

Bipolar Disorder (2008)[Map of Medicine]

The management of bipolar disorder in adults, children and adolescents, in primary and secondary care (2006)[NICE]

Recent articles in core journals

Efficacy and acceptability of mood stabilisers in the treatment of acute bipolar depression: systematic review (2010)[Br J Psychiatry]

Child bipolar I disorder: prospective continuity with adult bipolar I disorder; characteristics of second and third episodes; predictors of 8-year outcome (2008)[Arch Gen Psychiatry]

eTextbooks

Bipolar Disorder and Manic Depression (2008)[Mentor]

Managing patients with bipolar disorder in primary care Interactive case history (2007)[BMJ Learning]

Clinical Queries

How should a patient taking lithium for bipolar disorder with serum creatinine levels outside the normal range and a gradually decreasing eGFR be managed? (2008)[TRIPAnswers]

Is ECT used very much these days, in bipolar syndrome, and if so, with what results?
(2008)[TRIPAnswers]

Patient Information

Bipolar disorder (2009)[NHS Choices]

Bipolar Disorder (manic depression)(2006)[RCPsych]

Important

1. If you are a Welsh Primary Care Professional with a clinical query send it to ATTRACT online or email us at questions@attract.wales.nhs.uk or call 01495 332343.
2. If you would like to comment on this CME topic, or suggest a new topic for ATTRACTcme, go to the comments hyperlink below.

Chlamydia

2011-03-03T12:23:00.005Z

Evidence Based Reports

Chlamydia (uncomplicated, genital) (2010)[Clinical Evidence]Athens Log-in required

Systematic review of the clinical effectiveness and cost-effectiveness of rapid point-of-care tests for the detection of genital chlamydia infection in women and men (2010)[NIHR HTA]

Testing for Chlamydia trachomatis in Primary Care using self-taken swabs (2009)[MaDOx]

Clinical Guidelines

Chlamydia trachomatis: UK Testing Guidelines (2010)[BASHH]

Chlamydia - uncomplicated genital (2009)[CKS]

Management of genital Chlamydia trachomatis infection (2009)[SIGN]

Chlamydia (2008)[Map of Medicine]

BASHH CEG statement on Chlamydia window period (2008)[BASHH]

Recent articles in core journals

Randomised controlled trial of screening for Chlamydia trachomatis to prevent pelvic inflammatory disease: the POPI (prevention of pelvic infection) trial (2010)[BMJ]

Expedited partner therapy for Chlamydia trachomatis at the community pharmacy (2010)[NELM]

eTextbooks

Chlamydial Genital Infection (2008)[Mentor]

Chlamydia infection: diagnosis and management Interactive case history (2007)[BMJ Learning]

Clinical Queries

If someone requires treatment for positive Chlamydia with azithromycin within their pill free week, is there a requirement to offer emergency contraception if there has been sexual intercourse without a condom in the pill free week? (2010)[FSRH]

How long before inserting an intrauterine method should a swab for Chlamydia be taken? (2009)[FSRH]

Should an IUD be removed in a woman with current Chlamydia infection because of the risk of ascending infection? (2008)[FSRH]

Patient Information

Chlamydia (2010) [BUPA]

Chlamydia (2009)[NHS Choices]

Important

1. If you are a Welsh Primary Care Professional with a clinical query send it to ATTRACT online or email us at questions@attract.wales.nhs.uk or call 01495 332343.
2. If you would like to comment on this CME topic, or suggest a new topic for ATTRACTcme, go to the comments hyperlink below.

Autism

2011-03-03T10:30:00.005Z

Evidence Based Reports

Gluten-free and casein-free diets in the treatment of autism spectrum disorders: a systematic review (2011)[DARE]

Autism (2010)[Clinical Evidence]Athens Log-in required

Selective serotonin reuptake inhibitors (SSRIs) for autism spectrum disorders (ASD)(2010)[Cochrane]

Selective serotonin reuptake inhibitors (SSRIs) for autism spectrum disorders (2010)[QIPP]

Comprehensive synthesis of early intensive behavioral interventions for young children with autism based on the UCLA young autism project model (2010)[DARE]

The use of weighted vests with children with autism spectrum disorders and other disabilities (2009)[DARE]

Gluten- and casein-free diets for autistic spectrum disorder (2008)[Cochrane]

Parent implemented early intervention for young children with autism spectrum disorder: a systematic review (2008)[DARE]

Risperidone for autism spectrum disorder (2007)[Cochrane]

Clinical Guidelines

Fulfilling and rewarding lives - the strategy for adults with autism in England 2010 (2010) [DoH]

Supporting people with autism through adulthood (2009)[National Audit Office]

Services for adults with autistic spectrum conditions (ASC): good practice advice for primary care trust and local authority commissioners (2009)[DoH]

Assessment, diagnosis and clinical interventions for children and young people with autism spectrum disorders (2007)[SIGN]

Recent articles in core journals

Mitochondrial dysfunction in autism (2010)[JAMA]

Autism (2009)[Lancet]

Prenatal risk factors for autism: comprehensive meta-analysis (2009)[Br J Psychiatry]

eTextbooks

Autism (2009)[Mentor]

Autism: diagnosis in primary care (2007)[BMJ Learning]

Clinical Queries

What is the best way of picking up autism in pre-school children? (2009)[CLEAR- NHS Scotland]

For women with autism, are there any specific recommendations for the choice of contraception? (2008)[FSRH]

What is the evidence for the use of secretin for autism? (2007)[NELM]

Patient Information

Autism (2009)[MedlinePlus]

Autistic spectrum disorder (2009)[NHS Choices]

The National Autistic Society

Important

1. If you are a Welsh Primary Care Professional with a clinical query send it to ATTRACT online or email us at questions@attract.wales.nhs.uk or call 01495 332343.
2. If you would like to comment on this CME topic, or suggest a new topic for ATTRACTcme, go to the comments hyperlink below.

Clostridium difficile

2011-03-03T10:26:00.005Z

Evidence Based Reports

Prevention of Clostridium difficile infection with Saccharomyces boulardii: a systematic review (2009)[DARE]

Diagnosis of Clostridium difficile infection by toxin detection kits: a systematic review (2008)[DARE]

Clinical Guidelines

Clostridium difficile infection - how to deal with the problem (2009)[DoH]

Recent articles in core journals

Prevention of endemic healthcare-associated Clostridium difficile infection: reviewing the evidence.(2010)[EvidenceUpdates]

Clostridium difficile infection in Europe: a hospital-based survey. (2010)[Lancet]

In the clinic. Clostridium difficile Infection. (2010)[Annals of Internal Medicine]

Reducing Clostridium difficile infection in acute care by using an improvement collaborative. (2010)[BMJ]

Proton pump inhibitors and risk for recurrent Clostridium difficile infection. (2010)[EvidenceUpdates]

Treatment with monoclonal antibodies against Clostridium difficile toxins. (2010)[NEJM]

Does my patient have Clostridium difficile infection? (2009)[Annals of Internal Medicine]

Prospective derivation and validation of a clinical prediction rule for recurrent Clostridium difficile infection.(2009)[EvidenceUpdates]

A 76-year-old man with recurrent Clostridium difficile-associated diarrhea: review of C. difficile infection. (2009)[JAMA]

eTextbooks

Clostridium Difficile Colitis (2011)[eMedicine]

Clinical Queries

Clostridium difficile infection – are acid suppressant medicines a risk factor? (2008)[NeLM]

Clostridium difficile infection – is there an academic detail aid to promote appropriate antimicrobial prescribing? (2008)[NeLM]

Clostridium difficile infection – are probiotics useful? (2008)[NeLM]

Clostridium difficile infection – which antimicrobials are implicated? (2008)[NeLM]

Patient Information

Clostridium difficile (2010)[NHS Choices]

Clostridium difficile (2010)[BUPA]

Clostridium Difficile (2009)[Patient UK]

Important

1. If you are a Welsh Primary Care Professional with a clinical query send it to ATTRACT online or email us at questions@attract.wales.nhs.uk or call 01495 332343.
2. If you would like to comment on this CME topic, or suggest a new topic for ATTRACTcme, go to the comments hyperlink below.

Alcohol abuse

2011-02-18T11:16:00.007Z

Evidence Based Reports

Alcohol misuse (2009)[Clinical Evidence]

Opioid antagonists for alcohol dependence (2010)[Cochrane Library]

Benzodiazepines for alcohol withdrawal (2010)[Cochrane Library]

Acamprosate for alcohol dependence (2010)[Cochrane Library]

Anticonvulsants for alcohol withdrawal (2010)[Cochrane Library]

Gamma-hydroxybutyrate (GHB) for treatment of alcohol withdrawal and prevention of relapses (2010)[Cochrane Library]

Pharmacologic Interventions for Pregnant Women Enrolled in Alcohol Treatment (2010)[Cochrane Library]

Acupuncture for alcohol dependence: a systematic review (2010)[DARE]

Interventions for reducing adolescent alcohol abuse: a meta-analytic review (2010) [DARE]

Cost-effectiveness of screening for unhealthy alcohol use with %carbohydrate deficient transferrin: results from a literature-based decision analytic computer model (2010)[NHS EED]

The cost effectiveness of naltrexone added to cognitive-behavioral therapy in the treatment of alcohol dependence (2010)[NHS EED]

Clinical Guidelines

Alcohol - problem drinking (2010)[CKS]

Alcohol use disorders: Diagnosis and clinical management of alcohol-related physical complications (2010)[NICE]

Alcohol-use disorders: preventing the development of hazardous and harmful drinking (2010)[NICE]

Alcohol and pregnancy (2010) [RCM]

Guidance on the consumption of alcohol by children and young people (2009)[DoH]

The management of harmful drinking and alcohol dependence in primary care (2009)[SIGN]

Recent articles in core journals

The spread of alcohol consumption behavior in a large social network. (2009)[Annals of Internal Medicine]

Effectiveness and cost-effectiveness of a stepped care intervention for alcohol use disorders in primary care: pilot study (2010)[EvidenceUpdates]

Effects of a brief intervention for reducing violence and alcohol misuse among adolescents: a randomized controlled trial. (2010)[JAMA]

A double-blind, placebo-controlled trial combining sertraline and naltrexone for treating co-occurring depression and alcohol dependence (2010)[EvidenceUpdates]

Interventions for reducing adolescent alcohol abuse: a meta-analytic review (2010)[EvidenceUpdates]

Alcohol use and alcohol-related problems before and after military combat deployment.
(2008)[JAMA]

eTextbooks

Alcohol and Substance Abuse Evaluation (2010)[eMedicine]

Fetal Alcohol Syndrome (2010)[eMedicine]

Fetal Alcohol Syndrome (2010)[Mentor]

Alcoholism and Alcohol Abuse - Management (2009) [Mentor]

Alcohol Related Problems (2009)[Mentor]

Clinical Queries

With patients with alcohol dependence, does acamprosate plus usual care compared to usual care (ITT analysis) reduce alcohol dependence, mortality or hospitalisation rates? (2009)[TRIPAnswers]

Are there any contraindications to the progestogen-only implant (Implanon)in a patient with recurrent acute pancreatitis (secondary to alcohol abuse), impaired glucose tolerance and normal liver function and clotting? (2009)[FRSHC]

How useful is carbohydrate deficient transferrin (CDT) as a marker for alcohol abuse? what are its limitations? (2009)[TRIPAnswers]

is it safe to prescribe oral antifungals for a fungal nail infection, to a gentleman who drinks excessive alcohol with a raised GGT( 107), but normal LFTs? (2008)[TRIPAnswers]

Patient Information

Pregnancy and Alcohol (2010)[Patient UK]

Alcohol Detoxification (2010)[Patient UK]

Alcohol misuse (2009)[NHS Choices]

Important

1. If you are a Welsh Primary Care Professional with a clinical query send it to ATTRACT online or email us at questions@attract.wales.nhs.uk or call 01495 332343.
2. If you would like to comment on this CME topic, or suggest a new topic for ATTRACTcme, go to the comments hyperlink below.

Community Acquired Pneumonia

2011-02-17T11:51:00.009Z

Evidence Based Reports

Community-acquired pneumonia (2010)[Clinical Evidence]Athens Log-in required

Antibiotics for community-acquired pneumonia in children (2010) [Cochrane]

Chest physiotherapy for pneumonia in adults (2010)[Cochrane]

Antibiotics for treating community acquired pneumonia in people with sickle cell disease (2009)[Cochrane]

Antibiotics for community acquired pneumonia in adult outpatients (2009)[Cochrane]

Blood cultures for community-acquired pneumonia: are they worthy of two quality measures: a systematic review (2009)[DARE]

The role of corticosteroids in severe community-acquired pneumonia: a systematic review (2009)[DARE]

Short-course versus long-course antibiotic therapy for non-severe community-acquired pneumonia in children aged 2 months to 59 months (2008) [Cochrane]

Empiric antibiotic coverage of atypical pathogens for community-acquired pneumonia in hospitalized adults (2008)[Cochrane]

The role of corticosteroids in severe community-acquired pneumonia: a systematic review (2008)[DARE]

Clinical Guidelines

British Thoracic Society Guidelines for the Management of Community Acquired Pneumonia in Children (2011)[BTS] draft document

Guidelines for the management of community acquired pneumonia in adults (2009)[BTS]

Community-acquired pneumonia (2008)[Map of Medicine]

Cough - acute with chest signs in children: Community-acquired pneumonia (2007)[CKS]

Chest infections - adult: Community-acquired pneumonia (2007)[CKS]

Recent articles in core journals

Association of community-acquired pneumonia with antipsychotic drug use in elderly patients: a nested case-control study (2010)[Annals Intern Med]

Antibiotics for community-acquired pneumonia (2009)[NeLM]

Statin use and risk of community acquired pneumonia in older people: population based case-control study (2009)[BMJ]

Delayed administration of antibiotics and mortality in patients with community-acquired pneumonia (2009)[NELM]

Local guidelines for management of adult community acquired pneumonia: a survey of UK hospitals (2009)[NELM]

Influenza vaccination and risk of community-acquired pneumonia in immunocompetent elderly people: a population-based, nested case-control study (2008)[Lancet]

Identifying barriers to the rapid administration of appropriate antibiotics in community-acquired pneumonia (2008)[NELM]

eTextbooks

Diagnosis and Treatment of Community-Acquired Pneumonia(2006)[American Family Physician]

Clinical Queries

Can the use of proton pump inhibitors increase the risk of community acquired pneumonia infection? (2010)[NELM]

In community acquired pneumonia, what is the first and second choice antibiotic? (2008) [TRIPAnswers]

When should a person with community acquired pneumonia be admitted to hospital?
(2008)[TRIPAnswers]

Patient Information

Pneumonia (2010)[NHS Choices]

Important

1. If you are a Welsh Primary Care Professional with a clinical query send it to ATTRACT online or email us at questions@attract.wales.nhs.uk or call 01495 332343.
2. If you would like to comment on this CME topic, or suggest a new topic for ATTRACTcme, go to the comments hyperlink below.

Obesity

2011-02-16T13:00:00.009Z

Evidence Based Reports

Interventions to change the behaviour of health professionals and the organisation of care to promote weight reduction in overweight and obese people (2010)[Cochrane]

Surgery for obesity (2010)[Cochrane]

Interventions for treating obesity in children (2010)[Cochrane]

Schemes to promote healthy weight among obese and overweight children in England (2009) [EPPI Centre]

Liraglutide for the treatment of obesity (2010)[NPC]

Acupuncture for obesity: a systematic review and meta-analysis (2009)[DARE]

Lorcaserin (APD-356) - Obesity or overweight - with co-morbidity (2009)[National Horizon Scanning Centre]

Obesity in adults (2009)[Clinical Evidence]Athens Log-in required

The drug management of obesity (2008)[MeReC]

Taranabant (MK-0364) Obesity (2008)[National Horizon Scanning Centre]

Chitosan for overweight or obesity (2008)[Cochrane]

Prevention and early treatment of overweight and obesity in young children: a critical review and appraisal of the evidence (2008) [DARE]

Obesity in children (2006)[Clinical Evidence] Athens Log-in required

Clinical Guidelines

Management of obesity (2010) [SIGN]

Dietary interventions and physical activity interventions for weight management before, during and after pregnancy (2010) [NICE]

Guidelines on management of adult obesity and overweight in primary care (2010)[National Obesity Forum]

Management of women with obesity in pregnancy (2010)[RCOG]

Obesity in children (2010)[Map of Medicine]

Obesity in adults (2010)[Map of Medicine]

Obesity (2007)[CKS]

Obesity: the prevention, identification, assessment and management of overweight and obesity in adults and children (2006)[NICE]

Recent articles in core journals

Attitudes towards obesity treatment in GP training practices: a focus group study(2011)[Family Practice]

Overweight adults may have the lowest mortality--do they have the best health? (2011)[Am J Epidemiol]

Pharmaceutical interventions for obesity: a public health perspective (2010) [Diabetes Obes Metab]

Childhood obesity (2010)[Lancet]

eTextbooks

Obesity: a multidisciplinary approach (part 1)(2010) [BMJ Learning]

Obesity: a multidisciplinary approach (part 2)(2010) [BMJ Learning]

Childhood obesity: a guide to diagnosis, management, and prevention (2009) [BMJ Learning]

Obesity: a guide to prevention and management - in association with NICE (2009)[BMJ Learning]

Obesity in Children (2008)[Mentor]

Obesity in Adults (2008)[Mentor]

GP Fact File to managing obesity in primary care (2010)[Healthcare Republic]

Clinical Queries

Is there any evidence that Depo-Provera is unreliable in a very obese woman, and any for giving a double dose to those with high BMI? (2009) [ATTRACT]

What is the best evidence based practice to treat chilhood obesity for under 5's?
(2009)[TRIPAnswers]

What is the evidence that orlistat helps obese patients to lose weight? (2008)[ATTRACT]

Patient Information

Obesity (2010)[NHS Choices]

Obesity (2010)[BMJ Best Health]

Obesity and Overweight in Adults (2010) [Patient UK]

Important

1. If you are a Welsh Primary Care Professional with a clinical query send it to ATTRACT online or email us at questions@attract.wales.nhs.uk or call 01495 332343.
2. If you would like to comment on this CME topic, or suggest a new topic for ATTRACTcme, go to the comments hyperlink below.

DVT

2011-02-10T10:24:00.014Z

Evidence Based Reports

The D-Dimer Test for ruling out Deep Vein Thrombosis in Primary Care (2009)[Monitoring & Diagnosis in Oxford]

Physical methods for preventing deep vein thrombosis in stroke (2010)[Cochrane]

Elastic compression stockings for prevention of deep vein thrombosis(2010)[Cochrane]

Anticoagulant therapy for deep vein thrombosis (DVT) in pregnancy (2010) [Cochrane]

Prophylaxis for venous thromboembolic disease in pregnancy and the early postnatal period (2010)[Cochrane]

Risk of deep vein thrombosis following a single negative whole-leg compression ultrasound: a systematic review and meta-analysis (2010)[DARE]

Physical activity in patients with deep venous thrombosis: a systematic review
(2009)[DARE]

Thrombophilia testing for prevention of recurrent venous thromboembolism
(2009)[Cochrane]

A meta-analysis of bed rest versus early ambulation in the management of pulmonary embolism, deep vein thrombosis, or both (2009)[DARE]

Anticoagulant prophylaxis to prevent asymptomatic deep vein thrombosis in hospitalized medical patients: a systematic review and meta-analysis (2009)[DARE]

Trellis-8 Peripheral Infusion System (Bacchus Vascular Inc.) for deep vein thrombosis (2009)[HTA]

Pharmacological venous thromboembolism prophylaxis in hospitalized medical patients: a meta-analysis of randomized controlled trials (2008)[DARE]

Low molecular weight heparin for prevention of venous thromboembolism in patients with lower-leg immobilization (2008)[Cochrane]

Combined intermittent pneumatic leg compression and pharmacological prophylaxis for prevention of venous thromboembolism in high-risk patients (2008)[Cochrane]

Interventions for preventing venous thromboembolism in adults undergoing knee arthroscopy (2008)[Cochrane]

The accuracy of MRI in diagnosis of suspected deep vein thrombosis: systematic review and meta-analysis (2008)[DARE]

Home versus in-patient treatment for deep vein thrombosis (2007)[Cochrane]

Interventions for preventing venous thromboembolism following abdominal aortic surgery (2008)[Cochrane]

Clinical Guidelines

Reducing the risk of venous thromboembolism (deep vein thrombosis and pulmonary embolism) in patients admitted to hospital (2010)[NICE]

Deep vein thrombosis - prevention for travellers (2010)[CKS]

Deep vein thrombosis (2010)[CKS]

Prevention and management of venous thromboembolism (2010)[SIGN]

Guidelines on travel-related venous thrombosis (2010) [BCSH]

Venous thromboembolism and hormonal contraception (2010)[RCOG]

Suspected deep vein thrombosis (DVT) (2008)[Map of Medicine]

Recent articles in core journals

Clinical inquiries. Does hypercoagulopathy testing benefit patients with DVT? (2010)[Journal of Family Practice]

Should patients with acute DVT limit activity? (2010)[Journal of Family Practice]

Silent pulmonary embolism in patients with deep venous thrombosis: a systematic review. (2010)[American Journal of Medicine]

Predicting deep venous thrombosis in pregnancy: out in "LEFt" field? (2009)[Annals of Internal Medicine]

Safely ruling out deep venous thrombosis in primary care (2009)[Annals of Internal Medicine]

eTextbooks

Deep Vein Thrombosis (2008)[Mentor]

Prevention of Deep Vein Thrombosis (2008)[Mentor]

Deep vein thrombosis: diagnosis and treatment Interactive case history (2007)[BMJ Learning]

Clinical Queries

Can a woman who is now 8 weeks postpartum (not breastfeeding) and is on warfarin following a DVT in pregnancy use the levonorgestrel-releasing intrauterine system (LNG-IUS) or Implanon? (2009) [FSRH]

In a man with a DVT 6 months ago, plans on flying 3-4 hours, what DVT prophylaxis is indicated? (2008) [TRIPanswers]

In elderly patients who are bed bound, is there any evidence that they are at increased risk of a DVT and if so would prophylaxis help? (2008) [TRIPanswers]

Patient Information

Deep vein thrombosis (2010)[NHS Choices]

Deep Vein Thrombosis - Prevention When Travelling (2010)[Patient UK]

Deep vein thrombosis (DVT) (2009)[BUPA]

Important

1. If you are a Welsh Primary Care Professional with a clinical query send it to ATTRACT online or email us at questions@attract.wales.nhs.uk or call 01495 332343.
2. If you would like to comment on this CME topic, or suggest a new topic for ATTRACTcme, go to the comments hyperlink below.

Acute and Chronic Low Back Pain

2011-01-17T16:23:00.002Z

Evidence Based Reports

Complementary and Alternative Therapies for Back Pain II (2010)[Agency for Healthcare Research and Quality]NEW

A multicentred randomised controlled trial of a primary-care based cognitive behavioural programme for low back pain. The Back Skills Training (BeST) trial (2010)[NIHR HTA]NEW

Effectiveness of exercise on work disability in patients with non-acute non-specific low back pain: systematic review and meta-analysis of randomized controlled trials (2010)[DARE]NEW

Systematic review of the effectiveness of thermal annular procedures in treating discogenic low back pain (2010)[DARE]NEW

Percutaneous intradiscal electrothermal therapy for low back pain (2009) [National Institute for Health and Clinical Excellence - Interventional Procedures]

Antidepressants for non-specific low back pain (2009)[Cochrane]

Exercise for the primary, secondary and tertiary prevention of low back pain in the workplace: a systematic review (2009)[DARE]

Individual patient education for low back pain (2008) [Cochrane]

Back pain, acute low back (2008)[Clinical Evidence]Athens Log-in required

Back pain, chronic low back (2008)[Clinical Evidence]Athens Log-in required

Non-steroidal anti-inflammatory drugs for low back pain (2008) [Cochrane]

Lumbar supports for prevention and treatment of low back pain (2008) [Cochrane]

Antidepressants for non-specific low back pain (2008) [Cochrane]

Traction for low-back pain with or without sciatica (2007) [Cochrane]

Opioids for chronic low-back pain (2007) [Cochrane]

Clinical Guidelines

Non-rigid stabilisation techniques for the treatment of low back pain (2010)[ National Institute for Health and Clinical Excellence - Interventional Procedures]NEW

Low back pain - initial assessment (2010) [Map of Medicine]NEW

Low back pain: Early management of persistent non-specific low back pain (2009)[NICE]

Back pain - low (without radiculopathy) (2009)[CKS]

Recent articles in core journals

Multicenter randomized controlled trial to evaluate the effect of home-based exercise on patients with chronic low back pain: the Japan low back pain exercise therapy study (2010)[EvidenceUpdates]NEW

Four-year follow-up of surgical versus non-surgical therapy for chronic low back pain (2010)[EvidenceUpdates]NEW

Graded activity and graded exposure for persistent nonspecific low back pain: a systematic review (2010)[EvidenceUpdates]NEW

Role of physical exercise in low back pain rehabilitation: a randomized controlled trial of a three-month exercise program in patients who have completed multidisciplinary rehabilitation (2010)[EvidenceUpdates]NEW

Effect of glucosamine on pain-related disability in patients with chronic low back pain and degenerative lumbar osteoarthritis: a randomized controlled trial (2010[JAMA]NEW

Causal assessment of awkward occupational postures and low back pain: results of a systematic review (2010)[EvidenceUpdates]NEW

Causal assessment of occupational bending or twisting and low back pain: results of a systematic review (2010)[EvidenceUpdates]NEW

New criteria for inflammatory back pain in patients with chronic back pain: a real patient exercise by experts from the Assessment of SpondyloArthritis international Society (ASAS) (2009)[EvidenceUpdates]

Prognosis for patients with chronic low back pain: inception cohort study.(2009)[BMJ]

Evaluation of the effectiveness and efficacy of iyengar yoga therapy on chronic low back pain (2009)[EvidenceUpdates]

Efficacy of microcurrent therapy in the treatment of chronic nonspecific back pain: a pilot study (2009)[EvidenceUpdates]

A randomized trial comparing acupuncture, simulated acupuncture, and usual care for chronic low back pain (2009)[EvidenceUpdates]

Comparison of isokinetic exercise versus standard exercise training in patients with chronic low back pain: a randomized controlled study (2009)[EvidenceUpdates]

A randomised controlled trial of spinal manipulative therapy in acute low back pain (2009)[EvidenceUpdates]

L2 spinal nerve-block effects on acute low back pain from osteoporotic vertebral fracture (2009)[EvidenceUpdates]

Intramuscular oxygen-ozone therapy in the treatment of acute back pain with lumbar disc herniation: a multicenter, randomized, double-blind, clinical trial of active and simulated lumbar paravertebral injection (2009)[EvidenceUpdates]

Early physiotherapy intervention in an Accident and Emergency Department reduces pain and improves satisfaction for patients with acute low back pain: a randomised trial (2009)[EvidenceUpdates]

Evidence-informed management of chronic low back pain with lumbar extensor strengthening exercises(2008) [EvidenceUpdates]

Evidence-informed management of chronic low back pain with lumbar stabilization exercises (2008)[EvidenceUpdates]

Evidence-informed management of chronic low back pain with herbal, vitamin, mineral, and homeopathic supplements (2008)[EvidenceUpdates]

Evidence-informed management of chronic low back pain with needle acupuncture (2008) [EvidenceUpdates]

Evidence-informed management of chronic low back pain with massage (2008)[EvidenceUpdates]

Evidence-informed management of chronic low back pain with physical activity, smoking cessation, and weight loss (2008) [EvidenceUpdates]

Evidence-informed management of chronic low back pain with traction therapy (2008) [EvidenceUpdates]

Evidence-informed management of chronic low back pain with spinal manipulation and mobilization (2008) [EvidenceUpdates]

Evidence-informed management of chronic low back pain with transcutaneous electrical nerve stimulation, interferential current, electrical muscle stimulation, ultrasound, and thermotherapy (2008) [EvidenceUpdates]

Evidence-informed management of chronic low back pain with prolotherapy (2008) [EvidenceUpdates]

eTextbooks

Low Back Pain and Sciatica (2009)[Mentor]updated

Mechanical back pain (2006) [eMedicine]

GP Notebook (2009) [GP Notebook]

Clinical Queries

A patient is claiming sildenafil (Viagra) helps relief back pain. Is there any evidence to support this? (2010)[ATTRACT]NEW

Is there any evidence for chiropractic advice and treatment for simple back pain? I am interested in all aspects of the intervention and not just manipulations. (2010)[ATTRACT] NEW

What level of evidence do we have for the effectiveness or absence of effectiveness, for non-specific, acute low back pain and non-specific chronic low back pain? (2009)[TRIPAnswers]

Is there any evidence for the use of benzodiazepines in acute back pain? (2007)[ATTRACT]

Is there any evidence for physiotherapy, osteopathy or chiropractic manipulation in the treatment of chronic non-specific back pain? (2007) [TRIP answers]

How does acupuncture performed in a primary care setting for mechanical low back pain compare with outcomes from standard physiotherapy treatment? (2007)[TRIP answers]

What is the evidence that core stability exercises reduce low back pain? (2006) [TRIP answers]

Is chiropractic care, for the treatment of mechanical low back pain, safe during pregnancy? (2006) [TRIP answers]

Do you have any information on the management of back pain during pregnancy? (2006) [TRIP answers]

Patient Information

Back Pain (2010)[NHS Choices]updated

Back pain (2010)[MedlinePlus]updated

Back Pain (2010) [BUPA Health Information]updated

Important

1. If you are a Welsh Primary Care Professional with a clinical query send it to ATTRACT online or email us at questions@attract.wales.nhs.uk or call 01495 332343.

2. If you would like to comment on this CME topic, or suggest a new topic for ATTRACTcme, go to the comments hyperlink below.

Parkinson's disease

2011-01-17T14:51:00.000Z

Evidence Based Reports

Evaluation of the efficacy and safety of adjuvant treatment to levodopa therapy in Parkinson´s disease patients with motor complications (2010)[Cochrane]NEW

Treadmill training for patients with Parkinson’s disease (2010)[Cochrane] NEW

Dopamine agonists in the treatment of early Parkinson's disease: a meta-analysis
(2010)[DARE] NEW

Anti-inflammatory drugs and risk of Parkinson disease: a meta-analysis (20100 [DARE]NEW

Monoamine oxidase B inhibitors versus other dopaminergic agents in early Parkinson's disease (2009)[Cochrane]

Levodopa / carbidopa - Parkinson's disease (2009)[Canadian Agency for Drugs and Technologies in Health]

Dopamine agonist therapy in early Parkinson's disease (2008)[Cochrane]

Carbidopa, levodopa and entacapone - Parkinson's Disease (2008) [Canadian Agency for Drugs and Technology in Health]

Bromocriptine versus levodopa in early Parkinson's disease (2007) [Cochrane]

Bromocriptine/levodopa combined versus levodopa alone for early Parkinson's disease (2007) [Cochrane]

Occupational therapy for patients with Parkinson's disease (2007) [Cochrane]

Parkinson's disease (2007) [BMJ Clinical Evidence] Athens Log-in required

Clinical Guidelines

Diagnosis and pharmacological management of Parkinson’s disease (2010)[SIGN] NEW

Parkinson's disease (2009) [CKS]

Parkinson's disease (2009) [Map of Medicine]

Parkinson's disease: diagnosis and management in primary and secondary care (2007) [NICE]

Essence of Care. Continence Care for People with Parkinson’s Disease (2006) [RCN]

Recent articles in core journals

Reproducibility and diagnostic accuracy of substantia nigra sonography for the diagnosis of Parkinson`s disease (2010)[EvidenceUpdates] NEW

Transcranial direct current stimulation for the treatment of Parkinson`s disease (2010)[Evidenceupdates]NEW

Deep-brain stimulation for Parkinson's disease (2010)[NEJM]NEW

Pramipexole for the treatment of depressive symptoms in patients with Parkinson`s disease: a randomised, double-blind, placebo-controlled trial (2010)[Lancet]NEW

Bilateral deep brain stimulation vs best medical therapy for patients with advanced Parkinson disease: a randomized controlled trial (2009) [JAMA]

Diabetes in patients with idiopathic Parkinson's disease (2008) [EvidenceUpdates]

Valvular heart disease and the use of dopamine agonist for Parkinson's disease (2007)[NEJM]

The specificity and sensitivity of transcranial ultrasound in the differential diagnosis of Parkinson's disease: a prospective blinded study (2008) [EvidenceUpdates]

Transdermal rotigotine: double-blind, placebo-controlled trial in Parkinson disease (2007) [Arch Neurol]

Randomized, double-blind, placebo-controlled trial on symptomatic effects of coenzyme Q(10) in Parkinson disease (2007) [Arch Neurol]

eTextbooks

Parkinson's disease (2010) [eMedicine]updated

Parkinsonism and Parkinson's Disease (2009)[Mentor]

Parkinson's disease (2006) [Merck Manual]

Parkinson's disease (2003) [GPNotebook]

Clinical Queries

A patient with Parkinsons on stalevo and ropinarole was given viagra for ED and felt it worsened his Parkinsons. Is this likely and is there evidence of a possible mechanism-eg drug interaction? (2010)[ATTRACT]NEW

Is there evidence to support the use of nicotine patches for Parkinsons patients? (2008)[TRIPAnswers]

What is the evidence for statins causing Parkinsons disease? (2007)[TRIP answers]

I have a female patient both of whose parents have developed Parkinson's Disease in their 60's. What is the likelihood of her or her children developing parkinson's. Is there a genetic component? (2006) [TRIP answers]

I have a patient with early parkinsons disease and debilitating sialorrhoea. What is the best treatment for him? (2006)[TRIP answers]

Patient Information

Parkinson's Disease (2010) [Patient UK]NEW

Parkinson's disease (2010)[NHS Choices]updated

Parkinson's disease (2009) [BUPA Health Information]updated

Important

1. If you are a Welsh Primary Care Professional with a clinical query send it to ATTRACT online or email us at questions@attract.wales.nhs.uk or call 01495 332343.

2. If you would like to comment on this CME topic, or suggest a new topic for ATTRACTcme, go to the comments hyperlink below.

COPD

2011-01-17T14:10:00.000Z

Evidence Based Reports

Carbonic anhydrase inhibitors for hypercapnic ventilatory failure in chronic obstructive pulmonary disease (2010)[Cochrane]NEW

Pulmonary rehabilitation following exacerbations of chronic obstructive pulmonary disease (2010)[Cochrane]NEW

Influenza vaccine for patients with chronic obstructive pulmonary disease (2010)[Cochrane]NEW

Combination inhaled steroid and long-acting beta2-agonist versus tiotropium for chronic obstructive pulmonary disease (2010)[Cochrane]NEW

Action plans with limited patient education only for exacerbations of chronic obstructive pulmonary disease (2010)[Cochrane]NEW

Mucolytic agents for chronic bronchitis or chronic obstructive pulmonary disease (2010)[Cochrane]NEW

Smoking cessation interventions in COPD: a network meta-analysis of randomised trials (2010)[DARE]NEW

Inspiratory muscle training in patients with chronic obstructive pulmonary disease: the state of the evidence (2010)[DARE]NEW

Two new studies in COPD: 1. Combined LABA/ICS versus LABA alone in COPD - few clinical benefits but increased serious adverse effects (2010)[MeReC]NEW

Triple therapy with LABA/ICS plus tiotropium in COPD (2010)[MeRec]NEW

Budesonide and risk of pneumonia in patients with COPD (2010)[MeReC]NEW

Recent safety issues with inhaled treatments for COPD (2009)[MeRec]

Roflumilast (Daxas) for chronic obstructive pulmonary disease (2009)[NHSC]

Indacaterol (Onbrez Breezhaler) for chronic obstructive pulmonary disease (2009)[NHSC]

Bronchoscopic lung volume reduction with airway valves for advanced emphysema (2009)[NICE]

Pulmonary rehabilitation following exacerbations of chronic obstructive pulmonary disease (2009)[Cochrane]

Screening for chronic obstructive pulmonary disease using spirometry: summary of the evidence for the U.S. preventive services task force (2009)[DARE]

Short-course antibiotic treatment in acute exacerbations of chronic bronchitis and COPD: a meta-analysis of double-blind studies (2009)[DARE]

Benefits and risks of adjunctive inhaled corticosteroids in chronic obstructive pulmonary disease: a meta-analysis (2009)[DARE]

Long-term use of inhaled corticosteroids and the risk of pneumonia in chronic obstructive pulmonary disease: a meta-analysis (2009)[DARE]

Inhaled corticosteroids in patients with stable chronic obstructive pulmonary disease: a systematic review and meta-analysis (2009) [DARE]

Contemporary management of acute exacerbations of COPD: a systematic review and metaanalysis (2009) [DARE]

Oxygen therapy in the pre-hospital setting for acute exacerbations of chronic obstructive pulmonary disease (2009) [Cochrane]

Oxygen therapy during exercise training in chronic obstructive pulmonary disease (2009) [Cochrane]

Chronic Obstructive pulmonary disease (2008)[WeMeRec]

Inhaled anticholinergics and risk of major adverse cardiovascular events in patients with chronic obstructive pulmonary disease: a systematic review and meta-analysis
(2008)[DARE]

Safety of long-acting beta-agonists in stable COPD: a systematic review (2008)[DARE]

Exacerbations of chronic obstructive pulmonary disease: when are antibiotics indicated? A systematic review (2008)[DARE]

Screening for Chronic Obstructive Pulmonary Disease Using Spirometry (2008) [AHRQ]

Mucolytic agents for chronic bronchitis or chronic obstructive pulmonary disease (2008) [Cochrane]

Ipratropium bromide versus long-acting beta-2 agonists for stable chronic obstructive pulmonary disease (2008) [Cochrane]

Ipratropium bromide versus short acting beta-2 agonists for stable chronic obstructive pulmonary disease (2006) [Cochrane]

Chronic Obstructive Pulmonary Disease (2007) [BMJ Clinical Evidence] Athens Log-in required

Combined corticosteroid and long-acting beta-agonist in one inhaler versus long-acting beta-agonists for chronic obstructive pulmonary disease (2007) [Cochrane]

Inhaled corticosteroids for stable chronic obstructive pulmonary disease (2007) [Cochrane]

Clinical Guidelines

Management of chronic obstructive pulmonary disease in adults in primary and secondary care (partial update)(2010)[NICE] updated

Chronic obstructive pulmonary disease (2010)[CKS]updated

Global Strategy for Diagnosis, Management, and Prevention of COPD (2009)[GOLD]

Chronic obstructive pulmonary disease (COPD) (2008)[NHS Choices]

Non-invasive ventilation in chronic obstructive pulmonary disease: management of acute type 2 respiratory failure (2008)[RCP] NEW

Practice Guidance on the Care of People with Asthma and Chronic Obstructive Pulmonary Disease (2006) [Royal Pharmaceutical Society]

Diagnosis and management of chronic obstructive pulmonary disease in primary care: A guide for those working in primary care (2005) [GPIAG]

Chronic obstructive pulmonary disease: Management of chronic obstructive pulmonary disease in adults in primary and secondary care (2004) [NICE]

Recent articles in core journals

Ground walk training improves functional exercise capacity more than cycle training in people with chronic obstructive pulmonary disease (COPD): a randomised trial (2010)[EvidenceUpdates]NEW

Disease management program for chronic obstructive pulmonary disease: a randomized controlled trial (2010)[EvidenceUpdates]NEW

Susceptibility to exacerbation in chronic obstructive pulmonary disease (2010)[NEJM]NEW

Once-daily bronchodilators for chronic obstructive pulmonary disease: indacaterol versus tiotropium (2010)[EvidenceUpdates]NEW

Efficacy of a new once-daily long-acting inhaled beta2-agonist indacaterol versus twice-daily formoterol in COPD (2010)[EvidenceUpdates]NEW

Association of corticosteroid dose and route of administration with risk of treatment failure in acute exacerbation of chronic obstructive pulmonary disease (2010)[JAMA]NEW

Oral immunotherapy with inactivated nontypeable Haemophilus influenzae reduces severity of acute exacerbations in severe COPD (2010)[EvidenceUpdates]NEW

Cardiovascular safety of tiotropium in patients with COPD (2010)[EvidenceUpdates]NEW

A multicenter, randomized trial of noninvasive ventilation with helium-oxygen mixture in exacerbations of chronic obstructive lung disease (2010)[EvidenceUpdates]NEW

Antibiotics in addition to systemic corticosteroids for acute exacerbations of chronic obstructive pulmonary disease (2010)[EvidenceUpdates]NEW

Mortality in the 4-year trial of tiotropium (UPLIFT) in patients with chronic obstructive pulmonary disease (2009)[Evidence Updates]

Statins in COPD: a systematic review(2009)[Evidence Updates]

Pharmacologic treatments for chronic obstructive pulmonary disease: a mixed-treatment comparison meta-analysis (2009) [Evidence Updates]

Expansion of the prognostic assessment of patients with chronic obstructive pulmonary disease: the updated BODE index and the ADO index(2009)[Lancet]

Screening for and early detection of chronic obstructive pulmonary disease (2009)[Lancet]

eTextbooks

Chronic Obstructive Pulmonary Disease (2008)[Mentor]

Diagnosing COPD (2008)[Mentor]

Management of Stable COPD (2008)[Mentor]

Chronic obstructive pulmonary disease: diagnosis (2007) [BMJ Learning]

Chronic obstructive pulmonary disease: treatment (2007) [BMJ Learning]

Chronic Obstructive Pulmonary Disease (2006) [eMedicine]

Clinical Queries

what should the first line antibiotic be for patients with COPD? (2010)[ATTRACT]NEW

With patients with COAD and PaO2 less than 55-60 mmHg, does home oxygen in addition to 'medical management' compared with medical management alone reduce mortality by 12 months? (2009)[TRIPanswers]

When should a patient on high dose inhaled steroids for COPD have a DXA scan? (2009)[TRIPAnswers]

What is the evidence for long term benefit of long acting beta agonists, inhaled steroid and long acting anticholinergic agents in COPD at 2 years and 5 years? (2008) [TRIP answers]

Are there any studies comparing tiotropium with long-acting beta agonists (e.g. salmeterol and formoterol) in the treatment of COPD? (2008) [TRIP answers]

Patient Information

Chronic obstructive pulmonary disease (COPD) (2009)[BUPA]

COPD (2009)[MedlinePlus]

Inhalers for Chronic Obstructive Pulmonary Disease (2009)[Patient UK]

Important

1. If you are a Welsh Primary Care Professional with a clinical query send it to ATTRACT online or email us at questions@attract.wales.nhs.uk or call 01495 332343.
2. If you would like to comment on this CME topic, or suggest a new topic for ATTRACTcme, go to the comments hyperlink below.

Falls

2011-01-17T12:27:00.004Z

Evidence Based Reports

Interventions for preventing falls in older people in nursing care facilities and hospitals (2010)[Cochrane]

Vision improvement and reduction in falls after expedited cataract surgery: systematic review and metaanalysis (2010)[DARE]

Evaluating the cost-effectiveness of fall prevention programs that reduce fall-related hip fractures in older adults (2010)[NHS EED]

Systematic review of accuracy of screening instruments for predicting fall risk among independently living older adults (2010)[DARE]

Cost-effectiveness analysis of screening for risk of in-hospital falls using physiotherapist clinical judgement (2010)[NHS EED]

Interventions for preventing falls in older people living in the community (2009)[Cochrane]

NSAIDs and the risk of accidental falls in the elderly: a systematic review (2009)[DARE]

Quality of life as an outcome of fall prevention interventions among the aged: a systematic review (2009)[DARE]

Clinical Guidelines

Falls (2010)[Map of Medicine]

Falls in elderly people (2010)[Map of Medicine]

Falls − specialist care assessment for non-specific or multifactorial causes (2010)[Map of Medicine]

Falls - risk assessment (2009)[CKS]

Clinical practice guideline for the assessment and prevention of falls in older people (2007)[NICE]

Recent articles in core journals

The effects of Tai Chi on fall prevention, fear of falling and balance in older people: a meta-analysis (2010)[EvidenceUpdates]

Community falls prevention for people who call an emergency ambulance after a fall: randomised controlled trial. (2010)[EvidenceUpdates]

Multifactorial intervention to reduce falls in older people at high risk of recurrent falls: a randomized controlled trial (2010)[EvidenceUpdates]

Fear of falling after hip fracture: a systematic review of measurement instruments, prevalence, interventions, and related factors (2010)[EvidenceUpdates]

What works in falls prevention after stroke?: a systematic review and meta-analysis (2010)[EvidenceUpdates]

Vitamin D treatment for the prevention of falls in older adults: systematic review and meta-analysis (2010)[EvidenceUpdates]

Evaluating the cost-effectiveness of fall prevention programs that reduce fall-related hip fractures in older adults (2010)[EvidenceUpdates]

The Winchester falls project: a randomised controlled trial of secondary prevention of falls in older people (2010)[EvidenceUpdates]

Chronic musculoskeletal pain and the occurrence of falls in an older population. (2010)[EvidenceUpdates]

Reducing risk of falling in older people discharged from hospital: a randomized controlled trial comparing seated exercises, weight-bearing exercises, and social visits (2009)[EvidenceUpdates]

A meta-analysis of fear of falling treatment programs for the elderly (2009)[EvidenceUpdates]

eTextbooks

Recurrent fall (2010)[Mentor]

Prevention of falls in the elderly (2010)[Mentor]

Clinical Queries

NICE have recently recommended Vitamin D supplement to reduce falls in the elderly. Does this guidance apply only to those in Nursing homes or to an age group? What is the evidence for this intervention? What is the NNT to prevent 1 adverse outcome? (2009)[ATTRACT]

With older patients with a history of falls and diagnosed with Benign Paroxysmal Positional Vertigo, what is the success rate of Epley Manoeuvre (also known as Canalith Repositioning Technique)? (CEBPA) (2008)[TRIPAnswers]

What is the incidence of vestibular deficit resulting in falls within the elderly and what evidence is there to support vestibular rehabilitation against pharmaceutical management? (2008)[TRIPAnswers]

Patient Information

Falls (2010)[Physiopedia]

Preventing falls in older people (2010)[Informed Health Online]

Falls (2009)[NHS Choices]

Important

1. If you are a Welsh Primary Care Professional with a clinical query send it to ATTRACT online or email us at questions@attract.wales.nhs.uk or call 01495 332343.
2. If you would like to comment on this CME topic, or suggest a new topic for ATTRACTcme, go to the comments hyperlink below.

Asthma

2011-01-17T12:12:00.000Z

Evidence Based Reports

Omalizumab for the treatment of severe persistent allergic asthma in children aged 6-11 (2010)[National Institute for Health and Clinical Excellence - Technology Appraisal]NEW

Troleandomycin as an oral corticosteroid sparing agent in stable asthma (2010)[Cochrane]NEW

Oxatomide for stable asthma in adults and children (2010)[Cochrane]NEW

Gold as an oral corticosteroid sparing agent in stable asthma (2010)[Cochrane]NEW

Cyclosporin as an oral corticosteroid sparing agent in stable asthma (2010)[Cochrane]NEW

Telehealthcare for asthma (2010)[Cochrane] NEW

Pneumococcal vaccine for asthma (2010)[Cochrane]NEW

Fluticasone versus 'extrafine' HFA-beclomethasone dipropionate for chronic asthma in adults and children (2010)[Cochrane]NEW

Indigenous healthcare worker involvement for Indigenous adults and children with asthma (2010)[Cochrane]NEW

Dietary marine fatty acids (fish oil) for asthma in adults and children (2010)[Cochrane]NEW

Alexander technique for chronic asthma (2010)[Cochrane]NEW

Do written asthma action plans reduce hospital admissions? (2009)[BestBETS] NEW

Feather versus non-feather bedding for asthma (2009)[Cochrane]

Inhaled versus oral steroids for adults with chronic asthma (2009)[Cochrane]

Culture-specific programs for children and adults from minority groups who have asthma (2009)[Cochrane]

Regular treatment with formoterol and inhaled steroids for chronic asthma: serious adverse events (2009)[Cochrane]

Regular treatment with formoterol versus regular treatment with salmeterol for chronic asthma: serious adverse events (2009)[Cochrane]

Regular treatment with salmeterol and inhaled steroids for chronic asthma: serious adverse events (2009)[Cochrane]

Regular treatment with formoterol and inhaled steroids for chronic asthma: serious adverse events (2009)[Cochrane]

Holding chambers versus nebulisers for inhaled steroids in
chronic asthma (2008) [Cochrane]

Herbal interventions for chronic asthma in adults and children (2008) [Cochrane]

Fluticasone versus placebo for chronic asthma in adults and
children (2008) [Cochrane]

House dust mite control measures for asthma (2008) [Cochrane]

Fluticasone at different doses for chronic asthma in adults and
children (2008) [Cochrane]

Acupuncture for chronic asthma (2008) [Cochrane]

Clinical Guidelines

Occupational Asthma (2010)[British Occupational Health Research Foundation]NEW

2008 British Guideline on the Management of Asthma (2009)[British Thoracic Society]

Global strategy for asthma management and prevention. (2009)[Global Initiative for Asthma]

Asthma in Children (2008) [Map of Medicine]

Acute Asthma (2008) [Map of Medicine]

Chronic Asthma (2008) [Map of Medicine]

Asthma (2007) [CKS]

Asthma (2008 updates) [BTS/SIGN]

Recent articles in core journals

Characterization of the asthmatic population of St. Vincent and the Grenadines: Asthma severity levels and atopic sensitization. (2010)[Journal of Asthma]NEW

Subacute lack of asthma control and acute asthma exacerbation history as predictors of subsequent acute asthma exacerbations: evidence from managed care data. (2010)[Journal of Asthma]NEW

Effects of HEPA Air Cleaners on Unscheduled Asthma Visits and Asthma Symptoms for Children Exposed to Secondhand Tobacco Smoke. (2010)[Pediatrics]NEW

Effect of Obesity on Asthma Phenotype is Dependent upon Asthma Severity. (2010)[Journal of Asthma]NEW

Asthma, asthma medications, and prostate cancer risk. (2010)[Cancer Epidemiology & Biomarkers and Prevention]NEW

Individualized asthma self-management improves medication adherence and markers of asthma control (2009)[EvidenceUpdates]

Do school-based asthma education programs improve self-management and health outcomes? (2009)[EvidenceUpdates]

Small-group, interactive education and the effect on asthma control by children and their families (2009)[EvidencUpdates]

Internet-based self-management plus education compared with usual care in asthma: a randomized trial. (2009)[EvidenceUpdates]

Inhaled corticosteroids and asthma control in children: assessing impairment and risk (2009)[EvidenceUpdates]

Acetaminophen use and the risk of asthma in children and adults: a systematic review and metaanalysis (2009)[EvidenceUpdates]

A comparison of budesonide/formoterol maintenance and reliever therapy vs. conventional best practice in asthma management (2009)[EvidenceUpdates]

A randomized controlled evaluation of the effect of community health workers on hospitalization for asthma: the asthma coach (2009)[EvidenceUpdates]

Adherence feedback to improve asthma outcomes among inner-city children: a randomized trial (2009)[EvidenceUpdates]

Beliefs and barriers to follow-up after an emergency department asthma visit: a randomized trial (2009)[EvidenceUpdates]NEW

Daily versus as-needed inhaled corticosteroid for mild persistent asthma (The Helsinki early intervention childhood asthma study) (2008) [EvidenceUpdates]

Daclizumab improves asthma control in patients with moderate to severe persistent asthma: a randomized, controlled trial (2008) [EvidenceUpdates]

eTextbooks

Asthma in adults: management (2007) [BMJ Learning]

Asthma in adults: diagnosis (2007) [BMJ Learning]

Childhood asthma: diagnosis and treatment (2007) [BMJ Learning]

Running an asthma clinic (2007) [BMJ Learning]

Childhood asthma (2003) [GP Notebook]

Asthma (2006) [eMedicine]

Clinical Queries

Are there any contra-indications of Asthmatic patients visiting countries with a high altitude? (2010)[ATTRACT]NEW

Is there any evidence that in patients with asthma, seasonal flu vaccine can trigger an acute exacerbation of asthma? (2010)[ATTRACT]NEW

What contraceptives are suitable for a 20 year old nulliparous woman with cystic fibrosis, who has had a liver transplant, is experiencing heavy mentstrual bleeding and uses tacrolimus, mycophenolate, Creon, asthma inhalers and nebulised colomycin? (2010)[FRSH]NEW

Should growth be monitored in asthmatic children on inhaled steroids? (2009)[ATTRACT]

Is there any evidence for the use of spirometry in children with asthma? (2009)[ATTRACT]

In a patient with Type 2 Diabetes and acute excacerbation of Asthma, is a short course of predinslone (30 mg for 3-5days) contraindicated? (2009)[TRIPAnswers]

If a patient on a steroid inhaler for asthma is discovered to have COPD, is it harmful to stop the steroid and use a bronchodilator? (2008) [TRIPAnswers]

Is there any evidence for the use of tiotropium in asthma? (2008) [TRIPAnswers]

I'm trying to find statistics that suggest a link between asthma and eczema in children - and is there any greater susceptability to contracting other skin conditions? (2008) [TRIPAnswers]

Can calcium channel blockers be used to treat panic symptoms in patients with asthma? If not, what are the alternatives? (2008) [TRIPAnswers]

What is the optimum dose and duration of treatment with oral steroids for an acute exacerbation of asthma in an otherwise healthy adult / child? (2007) [NHL Q&A]

The SIGN guidelines for the diagnosis of asthma refer to ">20% diurnal variation...on PEF diary"; is this 20% of the higher (peak) or lower (trough) reading? (2007) [NLH Q&A]

In well controlled asthmatics, what is the best way for them to 'step down' from inhaled long acting beta agonists? (2007) [NLH Q&A]

Patient Information

Asthma (2009)[MedlinePlus]

Asthma in Children (2009)[MedlinePlus]

Asthma - children (2007)[NHS Choices]

Asthma (2007)[NHS Choices]

Asthma - children (2007) [Prodigy]

Asthma in children (2005) [BUPA Health Information]

Important

1. If you are a Welsh Primary Care Professional with a clinical query send it to ATTRACT online or email us at questions@attract.wales.nhs.uk or call 01495 332343.

2. If you would like to comment on this CME topic, or suggest a new topic for ATTRACTcme, go to the comments hyperlink below.

Shoulder Pain

2011-01-17T11:26:00.001Z

Evidence Based Reports

Botulinum toxin for shoulder pain (2010)[Cochrane]NEW

Interventions for hemiplegic shoulder pain: systematic review of randomised controlled trials (2010)[DARE]NEW

Shoulder Pain (2009) [Clinical Evidence]updated

Extracorporeal shock wave treatment for chronic rotator cuff tendonitis (shoulder pain) (2007) [DARE]

Oral steroids for adhesive capsulitis (2006) [Cochrane]

Ergonomic and physiotherapeutic interventions for treating work-related complaints of the arm, neck or shoulder in adults (2006) [Cochrane]

Conservative management following closed reduction of traumatic anterior dislocation of the shoulder (2006) [Cochrane]

Acupuncture for shoulder pain (2006) [Cochrane]

Diagnostic evaluation of shoulder pain: a systematic review on the accuracy of signs and symptoms related to rotator cuff disorders (2004) [DARE]

Supportive devices for preventing and treating subluxation of the shoulder after stroke (2004) [Cochrane]

Interventions for tears of the rotator cuff in adults (2003) [Cochrane]

Surgical versus non-surgical treatment for acute anterior shoulder dislocation (2003) [Cochrane]

Physiotherapy interventions for shoulder pain (2003) [Cochrane]

Multidisciplinary biopsychosocial rehabilitation for neck and shoulder pain among working age adults (2003) [Cochrane]

Corticosteroid injections for shoulder pain (2002) [Cochrane]

Clinical Guidelines

Shoulder pain (2008)[CKS]

Shoulder pain (2009)[Map of Medicine] updated

Recent articles in core journals

German Randomized Acupuncture Trial for chronic shoulder pain (GRASP) - a pragmatic, controlled, patient-blinded, multi-centre trial in an outpatient care environment (2010)[EvidenceUpdates]NEW

Exercise therapy after corticosteroid injection for moderate to severe shoulder pain: large pragmatic randomised trial (2010)[EvidenceUpdates]NEW

A comparison of the effectiveness of landmark-guided injections and ultrasonography guided injections for shoulder pain (2010)[EvidenceUpdates]

Bracing in external rotation for traumatic anterior dislocation of the shoulder (2009)[EvidenceUpdates]

Efficacy of surgical preparation solutions in shoulder surgery (2009)[EvidenceUpdates]

Effectiveness of interventions of specific complaints of the arm, neck, or shoulder (CANS): musculoskeletal disorders of the hand (2009)[EvidenceUpdates]

Passive mobilisation of shoulder region joints plus advice and exercise does not reduce pain and disability more than advice and exercise alone: a randomised trial (2009)[EvidenceUpdates]

Shoulder pain and external rotation in spastic hemiplegia do not improve by injection of botulinum toxin A into the subscapular muscle (2008) [EvidenceUpdates]

A simple clinical maneuver to reduce laparoscopy-induced shoulder pain: a randomized controlled trial(2008) [EvidenceUpdates]

Gabapentin does not reduce post-thoracotomy shoulder pain: a randomized, double-blind placebo-controlled study (2008) [EvidenceUpdates]

Correlation between clinical diagnosis and arthroscopic findings of the shoulder (2005)[Postgrad Med J]

Shoulder pain: diagnosis and management in primary care (2005) [BMJ]

Diagnosis and treatment of chronic painful shoulder: review of nonsurgical interventions (2005) [Arthroscopy]

eTextbooks

Shoulder pain(2010)[Mentor] updated

Frozen shoulder (adhesive capsulitis) (2007) [BMJ Learning]

Clinical Queries

Is there any guidance or instructions on how to inject steroids in shoulder joint for pain relief? (2008) [TRIP Answers]

What is the evidence that steroid injections for soft tissue shoulder problems improve outcomes? (2007)[TRIP answers]

Is there any evidence for benefit of injectable NSAIDs locally in terms of localised muscular (not joint) problems? A local chiropracter has asked if I would inject voltarol locally into a gluteal trigger point. (2007)[TRIP answers]

What are the best treatments for "frozen shoulder" Is doing "nothing" safer and as effective? Is the Niel-Asher technique effective, has it been independantly assessed? (2006)[TRIP answers]

Is there any evidence of benefit for injections of hyaluronic acid into the shoulder joint of a 50 year old professional climber who has had rotator cuff repair but also has an arthritic joint? (2006) [TRIP answers]

In shoulder joint adhesive capsulitis what is the evidence for giving mutiple intra-articular injections of long acting corticosteroids? (2005) [NLH Q&A]

Patient Information

Shoulder pain (2007)[NHS Choices]

Frozen shoulder (2007)[NHS Choices]

The Painful Shoulder (2004) [The Arthritis Research Campaign]

Important

1. If you are a Welsh Primary Care Professional with a clinical query send it to ATTRACT online or email us at questions@attract.wales.nhs.uk or call 01495 332343.

2. If you would like to comment on this CME topic, or suggest a new topic for ATTRACTcme, go to the comments hyperlink below.

Epilepsy

2011-01-17T10:21:00.000Z

Evidence Based Reports

Lamotrigine adjunctive therapy for refractory generalized tonic-clonic seizures (2010)[Cochrane]NEW

Care delivery and self-management strategies for children with epilepsy (2010)[Cochrane]NEW

Tiagabine add-on for drug-resistant partial epilepsy (2010)[Cochrane]NEW

Vagus nerve stimulation for partial seizures (2010)[Cochrane]NEW

Early versus late antiepileptic drug withdrawal for people with epilepsy in remission (2010)[Cochrane] NEW

Therapeutic monitoring of antiepileptic drugs for epilepsy (2010)[Cochrane]NEW

Lamotrigine add-on for drug-resistant partial epilepsy (2010)[Cochrane]NEW

Ethosuximide, sodium valproate or lamotrigine for absence seizures in children and adolescents (2010)[Cochrane]NEW

Carbamazepine versus phenytoin monotherapy for epilepsy (2010)[Cochrane]NEW

Antiepileptic drugs for the primary and secondary prevention of seizures after intracranial venous thrombosis (2010)[Cochrane]NEW

Immediate-release versus controlled-release carbamazepine in the treatment of epilepsy (2010)[Cochrane]NEW

Antiepileptic drugs for the primary and secondary prevention of seizures after stroke (2010)[Cochrane]NEW

Should a child with ADHD and epilepsy be given Ritalin? (2010)[BestBETS]NEW

Oxcarbazepine versus carbamazepine monotherapy for partial onset seizures (2009) [Cochrane]

treatment of seizures in multiple sclerosis (2009) [Cochrane]

Traditional Chinese medicine for epilepsy (2009) [Cochrane]

Levetircetam - for the treatment of partial-onset seizures (2009)[Midlands Theraputics Review and Advisory Committee]

Epilepsy (partial)(2009)[Clinical Evidence]

Epilepsy (generalised)(2009)[Clinical Evidence]

Epilepsy: Absence seizures in children (2009)[Clinical Evidence]

Drug management for acute tonic-clonic convulsions
including convulsive status epilepticus in children (2008)[Cochrane]

Psychological treatments for epilepsy (2008)[Cochrane]

Acupuncture for epilepsy (2008) [Cochrane]

Care delivery and self-management strategies for adults with
epilepsy (2008) [Cochrane]

Interventions for psychotic symptoms concomitant with
epilepsy (2008) [Cochrane]

Preconception counselling for women with epilepsy to reduce
adverse pregnancy outcome (2008) [Cochrane]

Antiepileptic drugs for preventing seizures in people with
brain tumors (2008) [Cochrane]

Epilepsy Annual Evidence Update (2007) [NLH]

Pharmacological interventions for epilepsy in people with intellectual disabilities (2007) [Cochrane]

Non-pharmacological interventions for epilepsy in people with intellectual disabilities (2007) [Cochrane]

Clinical Guidelines

Epilepsy (2009)[CKS]

Epilepsy (2008)[Map of Medicine]

The epilepsies: the diagnosis and management of the epilepsies in adults and children in primary and secondary care (2004) [NICE]

Recent articles in core journals

Risk of recurrence after a first seizure and implications for driving: further analysis of the Multicentre study of early Epilepsy and Single Seizures (2010)[EvidenceUpdates]NEW

Intranasal midazolam vs rectal diazepam for the home treatment of acute seizures in pediatric patients with epilepsy (2010)[EvidenceUpdates]NEW

Polytherapy increases the risk of infertility in women with epilepsy (2010)[EvidenceUpdates]NEW

Adjunctive brivaracetam for refractory partial-onset seizures: a randomized, controlled trial (2010)[EvidenceUpdates]NEW

Cognitive-behavioral therapy for psychogenic nonepileptic seizures: a pilot RCT(2010)[EvidenceUpdates]NEW

Randomized trial of adjunctive topiramate therapy in infants with refractory partial seizures (2010)[EvidenceUpdates]NEW

Ethosuximide, Valproic Acid, and Lamotrigine in Childhood Absence Epilepsy (2010)[EvidenceUpdates]NEW

A self-administered screening instrument for psychogenic nonepileptic seizures (2009)[EvidenceUpdates]

Practice parameter update: management issues for women with epilepsy--focus on pregnancy (an evidence-based review): obstetrical complications and change in seizure frequency (2009)[EvidenceUpdates]

Clinical Neonatal Seizures are Independently Associated with Outcome in Infants at Risk for Hypoxic-Ischemic Brain Injury (2009) [EvidenceUpdates]

Juvenile myoclonic epilepsy 25 years after seizure onset: a population-based study (2009)[EvidencdeUpdates]

Long-term risk of epilepsy after traumatic brain injury in children and young adults: a population-based cohort study (2009)[Lancet]

Levetiracetam for the treatment of idiopathic generalized epilepsy with myoclonic seizures (2008)[Neurology]

Outcomes of epilepsy surgery in adults and children (2008)[Lancet Neurology]

eTextbooks

Seizures and Epilepsy: Overview and Classification (2010) [eMedicine]updated

Epilepsy: an update on treatment (2007) [BMJ Learning Module]

Epilepsy (2003) [GPNotebook]

Clinical Queries

In someone who has been seizure free for 25 years but has experienced a grand mal seizure two weeks after insertion of a levonorgestrel releasing intrauterine system (LNG-IUS), is there any evidence that the levonorgestrel-releasing intrauterine system could be responsible? (2010)[FRSH Q&A]NEW

What are the best contraception options for a 35 year old epileptic woman on lamotrigine (2009)[FRSH Q&A]

Are there any suitable contraceptive alternatives for a woman with learning difficulties who is epileptic and on carbamazepine, and who appears to have mood disturbance and behavioural problems while using depot medroxyprogesterone acetate (DMPA)? (2009)[FRSH Q&A]

In the past every child with a first febrile convulsion was admitted but now paediatricians semm less keen to admit. Are there any guidelines or protocols on when to admit? Is it age related? (2009) [TRIPAnswers]

What is the optimal management of partial epilepsy uncontrolled by a first choice anticonvulsant? (2009)[TripAnswers]

In patients who have epilepsy, is there a quantifiable seizure risk (i.e. how likely are they to have another one because they take an SSRI) in taking an SSRI as new treatment? (2008) [TripAnswers]

Patient Information

Epilepsy (2010) [MedlinePlus]updated

Epilepsy (2010)[NHS Choices]updated

Epilepsy [BUPA Health Information]

Important

1. If you are a Welsh Primary Care Professional with a clinical query send it to ATTRACT online or email us at questions@attract.wales.nhs.uk or call 01495 332343.

2. If you would like to comment on this CME topic, or suggest a new topic for ATTRACTcme, go to the comments hyperlink below.

Menorrhagia

2011-01-17T10:12:00.002Z

Evidence Based Reports

Surgery versus medical therapy for heavy menstrual bleeding (2010)[Cochrane] NEW

Hysterectomy, endometrial destruction, and levonorgestrel releasing intrauterine system (Mirena) for heavy menstrual bleeding: systematic review and meta-analysis of data from individual patients (2010) [Dare] NEW

Endometrial resection / ablation techniques for heavy menstrual bleeding (2009)[Cochrane]

Endometrial resection and ablation versus hysterectomy for heavy menstrual bleeding (2009)[Cochrane]

Oral contraceptive pill for heavy menstrual bleeding (2009)[Cochrane]

Cyclical progestogens for heavy menstrual bleeding (2008) [Cochrane]

Heavy Menstrual Bleeding-Introducation (2007)[NLH National Knowledge Weeks 2007]

Heavy Menstrual Bleeding-History taking (2007)[NLH National Knowledge Weeks 2007]

Heavy Menstrual Bleeding-Examination and investigations (2007)[NLH National Knowledge Weeks 2007]

Heavy Menstrual Bleeding-Treatment: surgical and non-surgical (2007)[NLH National Knowledge Weeks 2007]

Danazol for heavy menstrual bleeding (2007) [Cochrane]

Nonsteroidal anti-inflammatory drugs for heavy menstrual bleeding (2007) [Cochrane]

Heavy menstrual bleeding (2007) [NLH National Knowledge weeks]

Menorrhagia (2008) [BMJ Clinical Evidence] Athens Log-in required

Clinical Guidelines

Heavy menstrual bleeding (2007) [NICE]

Menorrhagia (2007) [CKS]

Recent articles in core journals

Levonorgestrel-releasing intrauterine system or medroxyprogesterone for heavy menstrual bleeding: a randomized controlled trial. (2010)[EvidenceUpdates] NEW

Clinical outcomes from a randomised comparison of Microwave Endometrial Ablation with Thermal Balloon endometrial ablation for the treatment of heavy menstrual bleeding (2009)[EvidenceUpdates]

Levonorgestrel-releasing intrauterine system and endometrial ablation in heavy menstrual bleeding: a systematic review and meta-analysis (2009)[EvidenceUpdates]

A 41-year-old woman with menorrhagia, anemia, and fibroids: review of treatment of uterine fibroids (2009)[JAMA]

The effect of hysterectomy or levonorgestrel-releasing intrauterine system on sexual functioning among women with menorrhagia: a 5-year randomised controlled trial (2007) [BJOG]

A randomised trial comparing the levonorgestrel intrauterine system and thermal balloon ablation for heavy menstrual bleeding (2006) [BJOG]

Randomised comparative trial of the levonorgestrel intrauterine system and mefenamic acid for the treatment of idiopathic menorrhagia: a multiple analysis using total menstrual fluid loss, menstrual blood loss and pictorial blood loss assessment charts (2006) [BJOG]

A randomised controlled trial of microwave endometrial ablation without endometrial preparation in the outpatient setting: patient acceptability, treatment outcome and costs (2005) [BJOG]

A randomised comparison of microwave endometrial ablation with transcervical resection of the endometrium; follow up at a minimum of five years (2005) [BJOG]

eTextbooks

Periods, heavy (2010)[NHS Choices]NEW

Treatment of Menorrhagia (2007)[AAFP]

Menorrhagia (2007)[eMedicine]

Menorrhagia (2007) [GPNotebook]

Clinical Queries

Is there any evidence about the effectiveness of the progestogen-only implant for the treatment of menorrhagia or dysmenorrhoea? (2010)[FSRH] NEW

Can a woman who has von Hippel-Lindau syndrome use the levonorgestrel-releasing intrauterine system for contraception and heavy menstrual bleeding? (2010)[FRSH]NEW

In a woman who has rheumatoid arthritis and requires hormone replacement therapy (HRT) and treatment for heavy menstrual bleeding and anaemia requiring blood transfusion, is being on infliximab and prednisolone a contraindication to fitting a levonorgestrel-releasing intrauterine system? (2010)[FRSH]NEW

Can the combined oral contraceptive be used for treatment of heavy menstrual bleeding in someone who was diagnosed with wenckeback phenomenon during early pregnancy and was advised to use a pacemaker but refused and is currently on no medication? (2010)[FRSH]NEW

Is there any evidence about the effectiveness of the progestogen-only implant for the treatment of menorrhagia or dysmenorrhoea? (2010)[FRSH]NEW

Is there any reason to avoid a levonorgestrel-releasing intrauterine system (LNG-IUS) in a woman with a history of benign breast disease (fibroadenomas), no family history of breast cancer and suffering from menorrhagia? (2009)[FSRH]

Is tranexamic acid better than or as effective as mefenamic acid in managing menorrhagia? (2008)[ATTRACT]

Is there an increased risk of a DVT using tranexamic acid for menorrhagia, especially on long haul flights? (2008) [TRIPAnswers]

Is there any evidence concerning expulsion rates of intrauterine contraception if it is inserted on days of heavy menstrual bleeding versus days of lighter menstrual bleeding? (2008) [FSRH]

Patient Information

Heavy periods (Menorrhagia) (2007) [Patient UK]

Important

1. If you are a Welsh Primary Care Professional with a clinical query send it to ATTRACT online or email us at questions@attract.wales.nhs.uk or call 01495 332343.
2. If you would like to comment on this CME topic, or suggest a new topic for ATTRACTcme, go to the comments hyperlink below.

Menopause

2011-01-16T10:40:00.000Z

Evidence Based Reports

Exercise for vasomotor menopausal symptoms (2010)[Cochrane]

Menopausal hormone therapy and risk of lung cancer: systematic review and meta-analysis (2010)[DARE]

Efficacy of black cohosh-containing preparations on menopausal symptoms: a meta-analysis (2010)[DARE]

Hormone therapy for endometriosis and surgical menopause (2009)[Cochrane]

Cost-effectiveness of hormone replacement therapy for menopausal symptoms in the UK (2009)[NHS Economic Evaluation Database]

Acupuncture for treating menopausal hot flushes: a systematic review (2009)[DARE]

Menopausal symptoms (2009)[Clinical Evidence]

Trifolium pratense isoflavones in the treatment of menopausal hot flushes: a systematic review and meta-analysis (2008)[DARE]

Clinical Guidelines

Menopause (2010)[Map of Medicine]

Menopause (2008)[CKS]

Recent articles in core journals

Benefits and risks of postmenopausal hormone therapy when it is initiated soon after menopause (2009)[EvidenceUpdates]

Desvenlafaxine for the treatment of vasomotor symptoms associated with menopause: a double-blind, randomized, placebo-controlled trial of efficacy and safety (2009)[EvidenceUpdates]

Revisiting the duration of vasomotor symptoms of menopause: a meta-analysis (2009)[EvidenceUpdates]

Increased risk of parkinsonism in women who underwent oophorectomy before menopause. (2008)[EvidenceUpdates]

Menopause. (2008)[Lancet]

eTextbooks

Menopause and Mood Disorders (2011)[eMedicine]

Menopause (2011)[eMedicine]

Menopause and its Management (2009)[Mentor]

Clinical Queries

What non-hormonal alternatives to antidepressants are available for the management of menopausal hot flushes? (2010)[NeLM]

What evidence is available for the use of antidepressants for the management of menopausal hot flushes? (2010)[NeLM]

Should a 38 year women who has had a hysterectomy continue with HRT until normal menopause age (50) or stop sooner than this? No family history of breast cancer etc. (2010)[ATTRACT]

Can a 46 year old woman who is due to have her Levonorgestrel releasing system changed in 2011 when she will be 49 retain the device until the menopause? (2009)[FSRHC]

Can follicle-stimulating hormone (FSH) and luteinising hormone (LH) levels be measured to check for signs of the menopause and interpreted accurately while a 45 year old woman is on the progestogen-only injectable depot medroxyprogesterone acetate (DMPA)?(2009)[FSRHC]

What are the contraceptive options for a 37 year old with premature menopause who is on continuous combined hormone replacement therapy (HRT) and the desogestrel pill (Cerazette)? (2009)[FSRHC]

Is HRT recommended for a patient on goserelin for endometriosis experiencing menopausal symptoms? (2009)[ATTRACT]

What is an normal endometrial thickness and is it different during the menopause?
(2009)[TRIPAnswers]

Patient Information

Menopause (2010)[NHS Choices]

Menopause and HRT(2010)[Patient UK]

Menopause (inc HRT) (2009)[BUPA]

Important

1. If you are a Welsh Primary Care Professional with a clinical query send it to ATTRACT online or email us at questions@attract.wales.nhs.uk or call 01495 332343.
2. If you would like to comment on this CME topic, or suggest a new topic for ATTRACTcme, go to the comments hyperlink below.

Hypertension

2011-01-14T14:56:00.002Z

Evidence Based Reports

Spironolactone for hypertension (2010)[Cochrane]NEW

Calcium channel blockers versus other classes of drugs for hypertension(2010) [Cochrane]NEW

Interventions used to improve control of blood pressure in patients with hypertension (2010) [Cochrane]NEW

Roselle for hypertension in adults (2010) [Cochrane]NEW

Blood pressure lowering efficacy of potassium-sparing diuretics (that block the epithelial sodium channel) for primary hypertension(2010) [Cochrane]NEW

Blood pressure lowering efficacy of beta-blockers as second-line therapy for primary hypertension (2010)[Cochrane]NEW

Nurse led interventions to improve control of blood pressure in people with hypertension: systematic review and meta-analysis(2010) [DARE]NEW

The effectiveness of Hibiscus sabdariffa in the treatment of hypertension: a systematic review (2010)[DARE] NEW

Primary prevention of CVD: treating hypertension (2010) [ Clinical Evidence]NEWAthens Log-in required

Clevidipine (Cleviprex) for acute hypertension (2009)[National Horizon Scanning Centre]

Darusentan as an add-on in treatment-resistant hypertension (2009)[On the Horizon rapid review NPC]

What blood pressure target in hypertension, and which drug to try first? (2009)[MeRec Rapid Review]

The effects of biofeedback for the treatment of essential hypertension: a systematic review (2009) [NCCHTA]

Methyldopa for primary hypertension (2009)[Cochrane]

Blood pressure lowering efficacy of reserpine for primary hypertension(2009)[Cochrane]

Blood pressure lowering efficacy of loop diuretics for primary hypertension(2009)[Cochrane]

Blood pressure lowering efficacy of diuretics as second-line therapy for primary hypertension(2009)[Cochrane]

Blood pressure lowering efficacy of coenzyme Q10 for primary hypertension(2009)[Cochrane]

Blood pressure lowering efficacy of alpha blockers for primary hypertension(2009)[Cochrane]

Treatment blood pressure targets for hypertension(2009)[Cochrane]

Long-term effects of weight-reducing drugs in hypertensive patients(2009)[Cochrane]

First-line drugs for hypertension(2009)[Cochrane]

Prevention and treatment of postpartum hypertension(2009)[Cochrane]

Treatment of hypertension in peripheral arterial disease(2009)[Cochrane]

Pharmacological interventions for hypertensive emergencies (2008)[Cochrane]

Long-term effects of weight-reducing interventions in hypertensive patients: systematic review and meta-analysis (2008)[DARE]

Blood pressure lowering efficacy of angiotensin converting enzyme (ACE) inhibitors for primary hypertension (2008)[Cochrane]

Blood pressure lowering efficacy of angiotensin receptor blockers for primary hypertension (2008)[Cochrane]

Blood pressure lowering efficacy of renin inhibitors for primary hypertension (2008) [Cochrane]

Relaxation therapies for the management of primary hypertension in adults (2008) [Cochrane]

Systematic review: comparative effectiveness of angiotensin-converting enzyme inhibitors and angiotensin II receptor blockers for treating essential hypertension(2008)[DARE]

Beta-blockers for hypertension (2007) [Cochrane]

Closing the quality gap: a critical analysis of quality improvement strategies. Volume 3 - hypertension care (2005) [HTA] [AHRQ]

Clinical Guidelines

Hypertension (2010)[Map of Medicine] updated

Hypertension in people who do not have diabetes mellitus(2009) [CKS]updated

Hypertension: Management of hypertension in adults in primary care (2006) [NICE]

Guidelines for management of hypertension: report of the fourth working party of the British Hypertension Society (2004) [BHS]

Recent articles in core journals

Comparison of continuous positive airway pressure and valsartan in hypertensive patients with sleep apnea (2010)[Am J Respir Crit Care Med]NEW

Continuous positive airway pressure as treatment for systemic hypertension in people with obstructive sleep apnoea: randomised controlled trial (2010)[BMJ]NEW

Renal sympathetic denervation in patients with treatment-resistant hypertension (The Symplicity HTN-2 Trial): a randomised controlled trial (2010) [Lancet]NEW

Diet and lifestyle risk factors associated with incident hypertension in women(2009)[JAMA]

Progression of kidney disease in moderately hypercholesterolemic, hypertensive patients randomized to pravastatin versus usual care: a report from the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT)(2008)[Am J Kidney Dis]

Prevalence of primary hyperaldosteronism in resistant hypertension: a retrospective observational study (2008) [Lancet]

eTextbooks

Management of Hypertension (2010)[Mentor] updated

Hypertension (2010) [Mentor] updated

Prescribing antihypertensives: what the patient is thinking (2007)[BMJ Learning]

Hypertension: Background, diagnosis and treatment aims (2007)[NPC Podcasts]

Hypertension:Issues about measuring blood pressure (2007)[NPC Podcast]

Hypertension: Lifestyle contributions to management of hypertension
(2007)[NPC Podcast]

Hypertension: The evidence base for drug treatment of hypertension (2007)[NPC Podcast]

Hypertension: Drug treatment of hypertension - from evidence to practice (2007)[NPC Podcast]

Clinical Queries

What is the rationale and evidence for combining angiotensin converting enzyme inhibitors with angiotensin II receptor antagonists in vascular diseases and hypertension? (2010)[NeLM Q&A] NEW

am or pm what is the optimal time to take once a day antihypertensives? I am particularly interested in ACE inhibitors and calcium channel blockers (2010)[ATTRACT]NEW

What is the most recent evidence with regards to the use of aspirin in hypertensive women and at what age should aspirin therapy be considered? (2009)[ATTRACT]

Patient Information

High blood pressure (hypertension) (2009)[Patient UK]

Medication for High Blood Pressure (2009)[Patient UK]

High blood pressure (2010) [BUPA Health Information]

Blood pressure (high) (2010) [NHS Choices Online]

Important

1. If you are a Welsh Primary Care Professional with a clinical query send it to ATTRACT online or email us at questions@attract.wales.nhs.uk or call 01495 332343.

2. If you would like to comment on this CME topic, or suggest a new topic for ATTRACTcme, go to the comments hyperlink below.

Anticoagulation

2011-01-14T14:21:00.007Z

Evidence Based Reports

Fixed dose subcutaneous low molecular weight heparins versus adjusted dose unfractionated heparin for venous thromboembolism (2010)[Cochrane]NEW

Antiplatelet and anticoagulation for patients with prosthetic heart valves(2010)[Cochrane] NEW

Self-monitoring and self-management of oral anticoagulation (2010)[Cochrane]NEW

Direct thrombin inhibitors versus vitamin K antagonists or low molecular weight heparins for prevention of venous thromboembolism following total hip or knee replacement (2010)[Cochrane]NEW

Systematic review: case-fatality rates of recurrent venous thromboembolism and major bleeding events among patients treated for venous thromboembolism (2010)[DARE]NEW

Dabigatran etexilate (Pradaxa) for secondary prevention of venous thromboembolism (VTE)(2010)[National Horizon Scanning Centre]NEW

Anticoagulation for Venous Thromboembolism (2010)[theNNT]NEW

Rivaroxaban (Xarelto) for prevention of venous thromboembolism in medically ill patients (2010)[National Horizon Scanning Centre] NEW

Rivaroxaban (Xarelto) for venous thromboembolism (2010)[National Horizon Scanning Centre] NEW

Thromboembolism (2010)[Clinical Evidence] NEW Athens Log-in required

Idrabiotaparinux for the treatment of DVT and/or PE and secondary prevention of venous thromboembolism (2008)[National Horizon Scanning Centre]

Dabigatran etexilate (Pradaxa) for acute symptomatic venous thromboembolism (2008)[National Horizon Scanning Centre]

AVE-5026 for the prevention of venous thromboembolism in patients at risk (2008)[National Horizon Scanning Centre]

Apixaban for prevention of venous thromboembolism after joint replacement or with acute medical illness (2008)[ National Horizon Scanning Centre]

Subcutaneous unfractionated heparin for the initial treatment of venous thromboembolism(2009)[Cochrane]

Thrombophilia testing for prevention of recurrent venous thromboembolism(2009)[Cochrane]

Interventions for preventing venous thromboembolism following abdominal aortic surgery(2009)[Cochrane]

Aspirin or anticoagulants for treating recurrent miscarriage in women without antiphospholipid syndrome(2009)[Cochrane]

Anticoagulants for preventing recurrence following presumed non-cardioembolic ischaemic stroke or transient ischaemic attack (2009)[Cochrane]

Rivaroxaban for the prevention of venous thromboembolism after total hip or total knee replacement in adults(2009)[NICE]

Anticoagulants for preventing recurrence following presumed non-cardioembolic ischaemic stroke or transient ischaemic attack (2008)[Cochrane]

Aspirin or anticoagulants for treating recurrent miscarriage in women without antiphospholipid syndrome (2008)[Cochrane]

Anticoagulation for the long term treatment of venous thromboembolism in patients with cancer (2008)[Cochrane]

Anticoagulation for the initial treatment of venous thromboembolism in patients with cancer (2008)[Cochrane]

Anticoagulants for acute ischaemic stroke (2008)[Cochrane]

Anticoagulants versus non-steroidal anti-inflammatories or placebo for treatment of venous thromboembolism (2008)[Cochrane]

Low-molecular-weight heparins or heparinoids versus standard unfractionated heparin for acute ischaemic stroke (2008)[Cochrane]

Low molecular weight heparin for prevention of venous thromboembolism in patients with lower-leg immobilization (2008)[Cochrane]

Oral anticoagulation in patients with cancer who have no therapeutic or prophylactic indication for anticoagulation(2010) [Cochrane]NEW

Anticoagulation for thrombosis prophylaxis in cancer patients with central venous catheters (2007) [Cochrane]

Combined aspirin-oral anticoagulant therapy compared with oral anticoagulant therapy alone among patients at risk for cardivascular disease: a meta-analysis of randomized trials (2007) [DARE]

Oral anticoagulants versus antiplatelet therapy for preventing stroke in patients with non-valvular atrial fibrillation and no history of stroke or transient ischemic attacks (2006) [Cochrane]

Parenteral anticoagulation for prolonging survival in patients with cancer who have no other indication for anticoagulation (2007) [Cochrane]

Monitoring anticoagulant therapy in primary care (2007) [WeMeRec]

Oral anticoagulants versus antiplatelet therapy for preventing further vascular events after transient ischaemic attack or minor stroke of presumed arterial origin (2005) [Cochrane]

Oral anticoagulants for preventing stroke in patients with non-valvular atrial fibrillation and no previous history of stroke or transient ischemic attacks (2004) [Cochrane]

Anticoagulants versus non-steroidal anti-inflammatories or placebo for treatment of venous thromboembolism (2008) [Cochrane]

Clinical Guidelines

Prevention and management of venous thromboembolism (2010)[SIGN] NEW

Venous thromboembolism:reducing the risk (2010)[NICE] NEW

Anticoagulation (2010)[Map of Medicine]

Oral anticoagulation (2009)[CKS]

Guidelines for the management of anticoagulant and antiplatelet therapy in patients undergoing endoscopic procedures (2008)[British Soc Gastroenterology]

Guidelines on oral anticoagulation (warfarin): third edition (2005) [BCSH]

eTextbooks

Oral Anticoagulants (2010)[Mentor]NEW

Starting patients on anticoagulants: how to do it (2007) [BMJ Learning]

Maintaining patients on anticoagulants: how to do it (2007) [BMJ Learning]

Recent articles in core journals

Duration and magnitude of the postoperative risk of venous thromboembolism in middle aged women: prospective cohort study (2009)[BMJ] NEW

Meta-analysis: travel and risk for venous thromboembolism (2009)[Annals of Internal Medicine] NEW

Risks and benefits of oral anticoagulation compared with clopidogrel plus aspirin in patients with atrial fibrillation according to stroke risk: the atrial fibrillation clopidogrel trial with irbesartan for prevention of vascular events (ACTIVE-W).(2008)[Stroke]

Combined aspirin-oral anticoagulant therapy compared with oral anticoagulant therapy alone among patients at risk for cardiovascular disease: a meta-analysis of randomized trials(2008)[Arch Intern Med]

Oral anticoagulant and antiplatelet therapy and peripheral arterial disease (2007)[NEJM]

Clinical Queries

What doses of thromboprophylaxis are appropriate for adult patients at extremes of body weight? (2010)[NELM]NEW

Are low molecular weight heparins preferred to unfractionated heparin in people with renal impairment being treated for venous thromboembolism and myocardial infarction? (2010)[NELM]]NEW

What would be the contraception of choice for a woman with a venous Thromboembolism (VTE) currently on anticoagulants? (2009)[FSRH]

What are the relative and absolute risks of venous thromboembolism associated with different types of combined hormonal contraception? 2009)[FSRH]

For women using Warfarin can she restart hormone replacement therapy? (2008)[FFPRHC]

Patient Information

Anticoagulant Medicines (2009) [NHS Choices]

Important

1. If you are a Welsh Primary Care Professional with a clinical query send it to ATTRACT online or email us at questions@attract.wales.nhs.uk or call 01495 332343.
2. If you would like to comment on this CME topic, or suggest a new topic for ATTRACTcme, go to the comments hyperlink below.