Evidence Based Reports
Omalizumab for the treatment of severe persistent allergic asthma: a systematic review and economic evaluation. (2013) [HTA] NEW
Dehumidifiers for chronic asthma. (2013) [Cochrane Library] NEW
Anticholinergic therapy for acute asthma in children. (2013) [Cochrane Library] NEW
Regular treatment with formoterol for chronic asthma: serious adverse events. (2012) [Cochrane Library] NEW
Combined inhaled anticholinergics and short-acting beta2-agonists for initial treatment of acute asthma in children. (2012) [Cochrane Library] NEW
Monosodium glutamate avoidance for chronic asthma in adults and children. (2012) [Cochrane Library] NEW
Leukotriene receptor antagonists in addition to usual care for acute asthma in adults and children. (2012) [Cochrane Library] NEW
Weight loss interventions for chronic asthma. (2012) [Cochrane Library] NEW
Telehealthcare for asthma. (2012) [Cochrane Library] NEW
Ionisers for chronic asthma. (2012) [Cochrane LIbrary] NEW
Asthma and other recurrent wheezing disorders in children (chronic. (2012) [Clinical Evidence] NEW Subscription required
Asthma and other recurrent wheezing disorders in children (acute. (2012) [Clinicla Evidence] NEW Subscription required
Home-based educational interventions for children with asthma (2011)[Cochrane]
Regular treatment with formoterol and an inhaled corticosteroid versus regular treatment with salmeterol and an inhaled corticosteroid for chronic asthma: serious adverse events (2011)[Cochrane]
Workplace interventions for treatment of occupational asthma (2011)[Cochrane]
Dapsone as an oral corticosteroid sparing agent for asthma (2011)[Cochrane]
Inhaled sodium cromoglycate for asthma in children (2011)[Cochrane]
Continuous versus intermittent beta-agonists for acute asthma (2011)[Cochrane] <
Troleandomycin as an oral corticosteroid sparing agent in stable asthma (2010)[Cochrane]
Oxatomide for stable asthma in adults and children (2010)[Cochrane]
Gold as an oral corticosteroid sparing agent in stable asthma (2010)[Cochrane]
Cyclosporin as an oral corticosteroid sparing agent in stable asthma (2010)[Cochrane]
Pneumococcal vaccine for asthma (2010)[Cochrane]
Fluticasone versus 'extrafine' HFA-beclomethasone dipropionate for chronic asthma in adults and children (2010)[Cochrane]
Indigenous healthcare worker involvement for Indigenous adults and children with asthma (2010)[Cochrane]
Dietary marine fatty acids (fish oil) for asthma in adults and children (2010)[Cochrane]
Alexander technique for chronic asthma (2010)[Cochrane]
Do written asthma action plans reduce hospital admissions? (2009)[BestBETS]
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 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
Brithish Guideline on the Management of Asthma (2012)[SIGN/BTS] updated
Asthma (2011)[CKS]
Care pathway for asthma and/or rhinitis. (2011) [Royal College of Paediatrics and Child Health]
Occupational Asthma (2010)[British Occupational Health Research Foundation]
Recent articles in core journals
Multifaceted allergen avoidance during infancy reduces asthma during childhood with the effect persisting until age 18 years. (2013) [EvidenceUpdate] NEW
The school-based preventive asthma care trial: results of a pilot study. (2013) [EvidenceUpdates] NEW
Safety and tolerability of the novel inhaled corticosteroid fluticasone furoate in combination with the β2 agonist vilanterol administered once daily for 52 weeks in patients >=12 years old with asthma: a randomised trial. (2013) [EvidenceUpdates] NEW
Dose-ranging study of lebrikizumab in asthmatic patients not receiving inhaled steroids. (2013) [EvidenceUpdates] NEW
Microbes and mucosal immune responses in asthma. (2013) [Lancet] NEW
Does BCG vaccination protect against childhood asthma? Final results from the Manchester Community Asthma Study retrospective cohort study and updated systematic review and meta-analysis. (2013) [EvidenceUpdates] NEW
Allergen-specific immunotherapy for pediatric asthma and rhinoconjunctivitis: a systematic review. (2013) [EvidenceUpdates] NEW
Probiotic supplementation during pregnancy or infancy for the prevention of asthma and wheeze: systematic review and meta-analysis. (2013) [BMJ] NEW
Lansoprazole for children with poorly controlled asthma: a randomized controlled trial. (2012) [JAMA] NEW
Association of late-preterm birth with asthma in young children: practice-based study. (2011)[EvidenceUpdates]
Enhancing ventilation in homes of children with asthma: cost-effectiveness study alongside randomised controlled trial. (2011)[EvidenceUpdates]
Enhancing ventilation in homes of children with asthma: pragmatic randomised controlled trial. (2011)[EvidenceUpdates]
Tiotropium is noninferior to salmeterol in maintaining improved lung function in B16-Arg/Arg patients with asthma. (2011)[EvidenceUpdates]
A randomized trial of air cleaners and a health coach to improve indoor air quality for inner-city children with asthma and secondhand smoke exposure. (2011)[EvidenceUpdates]
Lebrikizumab treatment in adults with asthma. (2011)[NEJM]
Effect of bronchoconstriction on airway remodeling in asthma. (2011)[NEJM]
Oral montelukast in acute asthma exacerbations: a randomised, double-blind, placebo-controlled trial. (2011)[EvidenceUpdates]
Characterization of the asthmatic population of St. Vincent and the Grenadines: Asthma severity levels and atopic sensitization. (2010)[Journal of Asthma]
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]
Effects of HEPA Air Cleaners on Unscheduled Asthma Visits and Asthma Symptoms for Children Exposed to Secondhand Tobacco Smoke. (2010)[Pediatrics]
Effect of Obesity on Asthma Phenotype is Dependent upon Asthma Severity. (2010)[Journal of Asthma]
Asthma, asthma medications, and prostate cancer risk. (2010)[Cancer Epidemiology & Biomarkers and Prevention]
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]
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
Exercise Induced Asthma (2013) [eMedicine] updated
Asthma (2011) [eMedicine]
Childhood Asthma (2010) [GP notebook]
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]
Clinical Queries
Are there any contra-indications of Asthmatic patients visiting countries with a high altitude? (2010)[ATTRACT]
Is there any evidence that in patients with asthma, seasonal flu vaccine can trigger an acute exacerbation of asthma? (2010)[ATTRACT]
Is there any evidence for the use of spirometry in children with asthma? (2009)[TRIPAnswers]
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]
Patient Information
Asthma - children (2012)[NHS Choices] updated
Asthma (2012)[NHS Choices] updated
Asthma (2012)[BUPA] updated
Asthma (2009)[MedlinePlus]
Asthma in Children (2009)[MedlinePlus]
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.
Wednesday, 23 April 2014
Wednesday, 16 April 2014
ATTRACTcme Topics
Postnatal Depression February 2014
Seasonal Affective Disorder January 2014
Depression April 2014
Multiple Sclerosis February 2014
Tennis Elbow January 2014
Smoking Cessation February 2014
Vasectomy February 2014
Statins February 2014
Nocturnal Enuresis February 2014
Helicobacter Pylori February 2014
Hirsutism February 2014
Abdominal Aortic Aneurysm (AAA) February 2014
PCOS February 2014
Osteoarthritis February 2014
Psoriasis February 2014
Schizophrenia February 2014
Acne Vulgaris February 2014
Heart Failure April 2014
Endometriosis February 2014
Bipolar Disorder February 2014
Dyspepsia February 2014
Chlamydia February 2014
Haemorrhoids January 2014
Autism February 2014
Clostridum Difficile March 2014
Alcohol abuse February 2014
Community Acquired Penumonia February 2014
Obesity February 2014
DVT April 2014
Falls February 2014
Hay Fever February 2014
Menopause March 2014
Osteoporosis April 2014
Chronic Fatigue Syndrome February 2014
Epilepsy April 2014
Migraine February 2014
Parkinson's disease February 2014
Alzheimer's disease February 2014
Acute and Chronic Low Back Pain March 2014
Atrial Fibrillation April 2014
Shoulder Pain February 2014
Menorrhagia January 2014
Bell's Palsy February 2014
COPD April 2014
Asthma January 2011
Hypertension April 2014
Anticoagulation April 2014
Seasonal Affective Disorder January 2014
Depression April 2014
Multiple Sclerosis February 2014
Tennis Elbow January 2014
Smoking Cessation February 2014
Vasectomy February 2014
Statins February 2014
Nocturnal Enuresis February 2014
Helicobacter Pylori February 2014
Hirsutism February 2014
Abdominal Aortic Aneurysm (AAA) February 2014
PCOS February 2014
Osteoarthritis February 2014
Psoriasis February 2014
Schizophrenia February 2014
Acne Vulgaris February 2014
Heart Failure April 2014
Endometriosis February 2014
Bipolar Disorder February 2014
Dyspepsia February 2014
Chlamydia February 2014
Haemorrhoids January 2014
Autism February 2014
Clostridum Difficile March 2014
Alcohol abuse February 2014
Community Acquired Penumonia February 2014
Obesity February 2014
DVT April 2014
Falls February 2014
Hay Fever February 2014
Menopause March 2014
Osteoporosis April 2014
Chronic Fatigue Syndrome February 2014
Epilepsy April 2014
Migraine February 2014
Parkinson's disease February 2014
Alzheimer's disease February 2014
Acute and Chronic Low Back Pain March 2014
Atrial Fibrillation April 2014
Shoulder Pain February 2014
Menorrhagia January 2014
Bell's Palsy February 2014
COPD April 2014
Asthma January 2011
Hypertension April 2014
Anticoagulation April 2014
Tuesday, 8 April 2014
Depression
Evidence Based Reports
Lithium or an atypical antipsychotic drug in the management of treatment-resistant depression: a systematic review and economic evaluation. (2013) [HTA] NEW
A cluster randomised controlled trial to determine the clinical effectiveness and cost-effectiveness of classroom-based cognitive–behavioural therapy (CBT) in reducing symptoms of depression in high-risk adolescents. (2013) [HTA] NEW
The effects of qigong on anxiety, depression, and psychological well-being: a systematic review and meta-analysis. (2013) [DARE] NEW
Influence of initial severity of depression on effectiveness of low intensity interventions: meta-analysis of individual patient data. (2013) [DARE] NEW
Second generation antipsychotics in the treatment of bipolar depression: a systematic review and meta-analysis. (2013) [DARE] NEW
Smoking cessation interventions for smokers with current or past depression. (2013) [Cochrane Library] NEW
Tricyclic drugs for depression in children and adolescents. (2013) [Cochrane Library] NEW
Walking for depression or depressive symptoms: a systematic review and meta-analysis. (2012) [DARE] NEW
Fluoxetine versus other types of pharmacotherapy for depression. (2012) [Cochrane Library] NEW
Alprazolam for depression. (2012) [Cochrane Library] NEW
Citalopram versus other anti-depressive agents for depression. (2012) [Cochrane Library] NEW
Psychological and pharmacological interventions for depression in patients with coronary artery disease (2011) [Cochrane Library]
Pharmacologic treatment of depression in multiple sclerosis (2011) [Cochrane Library]
Mirtazapine versus other antidepressive agents for depression (2011) [Cochrane Library]
Psychological and educational interventions for preventing depression in children and adolescents (2011) [Cochrane Library]
Active placebos versus antidepressants for depression (2011) [Cochrane Library]
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]
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]
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]
Clinical Guidelines
Depression. (2013) [CKS] NEW
Depression in children. (2013) [CKS] NEW
Depression overview (2011) [NICE Pathways]
Non-pharmaceutical management of depression in adults (2010)[SIGN]
Depression The treatment and management of depression in adults (2009)[NICE]
Depression in adults with a chronic physical health problem (2009)[NICE]
Recent articles in core journals
Screening for depression in Parkinson's disease: the performance of two screening questions. (2013) [EvidenceUpdates] NEW
Prevention of depression in at-risk adolescents: longer-term effects. (2013) [EvidenceUpdates] NEW
Clinical effectiveness of collaborative care for depression in UK primary care (CADET): cluster randomised controlled trial. (2013) [BMJ] NEW
Treatment in a specialised out-patient mood disorder clinic v. standard out-patient treatment in the early course of bipolar disorder: randomised clinical trial. (2013) [EvidenceUpdates] NEW
A structural multidisciplinary approach to depression management in nursing-home residents: a multicentre, stepped-wedge cluster-randomised trial. (2013) [Lancet] NEW
Cognitive behavioural therapy as an adjunct to pharmacotherapy for primary care based patients with treatment resistant depression: results of the CoBalT randomised controlled trial. (2013) [Lancet] NEW
Effects of music on depression in older people: a randomised controlled trial. (2012) [EvidenceUpdates] NEW
Depression in adolescence. (2012) [Lancet] NEW
Major depressive disorder: new clinical, neurobiological, and treatment perspectives. (2011) [Lancet]
Comparative benefits and harms of second-generation antidepressants for treating major depressive disorder: an updated meta-analysis. (2011) [Ann Intern Med]
Randomized controlled trial of brief cognitive behavioral intervention for depression and anxiety symptoms preoperatively in patients undergoing coronary artery bypass graft surgery. (2011) [EvidenceUpdates]
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]
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]
eTextbooks
Depression in Children and Adolescents (2013)[Mentor] updated
Screening for Depression in Primary Care (2011)[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
Which would be the antidepressant of choice/prescribing guidelines for a patient that has depression predominantly around her menstruation? I recall there is a medication that we can just prescribe for 1 week a month. (2013) [ATTRACT] NEW
What basic tools can be used by any health care professional in primary care for screening of patients with long-term conditions for mental health symptoms (anxiety and depression)? (2012) [ATTRACT] NEW
Is there evidence to suggest that copper-bearing IUDs (Cu-IUD) are associated with depression / anxiety post insertion? (2012) [FRSH] NEW
For a patient who is taking lithium for bipolar disorder are there any restrictions with regards to choice of hormonal contraception? (2011) [FSRH]
What are the issues with longterm (10-20yrs +) treatment of depression with dosulepin 75mg daily? (2011) [ATTRACT]
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
Depression (2013) [RCPsych] updated
Depression in Older Adults (20130 [RCPsych] updated
Alcohol and Depression (2013)[RCPsych] updated
Clinical depression (2012)[NHS Choices]
Depression (2012)[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.
Lithium or an atypical antipsychotic drug in the management of treatment-resistant depression: a systematic review and economic evaluation. (2013) [HTA] NEW
A cluster randomised controlled trial to determine the clinical effectiveness and cost-effectiveness of classroom-based cognitive–behavioural therapy (CBT) in reducing symptoms of depression in high-risk adolescents. (2013) [HTA] NEW
The effects of qigong on anxiety, depression, and psychological well-being: a systematic review and meta-analysis. (2013) [DARE] NEW
Influence of initial severity of depression on effectiveness of low intensity interventions: meta-analysis of individual patient data. (2013) [DARE] NEW
Second generation antipsychotics in the treatment of bipolar depression: a systematic review and meta-analysis. (2013) [DARE] NEW
Smoking cessation interventions for smokers with current or past depression. (2013) [Cochrane Library] NEW
Tricyclic drugs for depression in children and adolescents. (2013) [Cochrane Library] NEW
Walking for depression or depressive symptoms: a systematic review and meta-analysis. (2012) [DARE] NEW
Fluoxetine versus other types of pharmacotherapy for depression. (2012) [Cochrane Library] NEW
Alprazolam for depression. (2012) [Cochrane Library] NEW
Citalopram versus other anti-depressive agents for depression. (2012) [Cochrane Library] NEW
Psychological and pharmacological interventions for depression in patients with coronary artery disease (2011) [Cochrane Library]
Pharmacologic treatment of depression in multiple sclerosis (2011) [Cochrane Library]
Mirtazapine versus other antidepressive agents for depression (2011) [Cochrane Library]
Psychological and educational interventions for preventing depression in children and adolescents (2011) [Cochrane Library]
Active placebos versus antidepressants for depression (2011) [Cochrane Library]
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]
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]
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]
Clinical Guidelines
Depression. (2013) [CKS] NEW
Depression in children. (2013) [CKS] NEW
Depression overview (2011) [NICE Pathways]
Non-pharmaceutical management of depression in adults (2010)[SIGN]
Depression The treatment and management of depression in adults (2009)[NICE]
Depression in adults with a chronic physical health problem (2009)[NICE]
Recent articles in core journals
Screening for depression in Parkinson's disease: the performance of two screening questions. (2013) [EvidenceUpdates] NEW
Prevention of depression in at-risk adolescents: longer-term effects. (2013) [EvidenceUpdates] NEW
Clinical effectiveness of collaborative care for depression in UK primary care (CADET): cluster randomised controlled trial. (2013) [BMJ] NEW
Treatment in a specialised out-patient mood disorder clinic v. standard out-patient treatment in the early course of bipolar disorder: randomised clinical trial. (2013) [EvidenceUpdates] NEW
A structural multidisciplinary approach to depression management in nursing-home residents: a multicentre, stepped-wedge cluster-randomised trial. (2013) [Lancet] NEW
Cognitive behavioural therapy as an adjunct to pharmacotherapy for primary care based patients with treatment resistant depression: results of the CoBalT randomised controlled trial. (2013) [Lancet] NEW
Effects of music on depression in older people: a randomised controlled trial. (2012) [EvidenceUpdates] NEW
Depression in adolescence. (2012) [Lancet] NEW
Major depressive disorder: new clinical, neurobiological, and treatment perspectives. (2011) [Lancet]
Comparative benefits and harms of second-generation antidepressants for treating major depressive disorder: an updated meta-analysis. (2011) [Ann Intern Med]
Randomized controlled trial of brief cognitive behavioral intervention for depression and anxiety symptoms preoperatively in patients undergoing coronary artery bypass graft surgery. (2011) [EvidenceUpdates]
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]
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]
eTextbooks
Depression in Children and Adolescents (2013)[Mentor] updated
Screening for Depression in Primary Care (2011)[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
Which would be the antidepressant of choice/prescribing guidelines for a patient that has depression predominantly around her menstruation? I recall there is a medication that we can just prescribe for 1 week a month. (2013) [ATTRACT] NEW
What basic tools can be used by any health care professional in primary care for screening of patients with long-term conditions for mental health symptoms (anxiety and depression)? (2012) [ATTRACT] NEW
Is there evidence to suggest that copper-bearing IUDs (Cu-IUD) are associated with depression / anxiety post insertion? (2012) [FRSH] NEW
For a patient who is taking lithium for bipolar disorder are there any restrictions with regards to choice of hormonal contraception? (2011) [FSRH]
What are the issues with longterm (10-20yrs +) treatment of depression with dosulepin 75mg daily? (2011) [ATTRACT]
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
Depression (2013) [RCPsych] updated
Depression in Older Adults (20130 [RCPsych] updated
Alcohol and Depression (2013)[RCPsych] updated
Clinical depression (2012)[NHS Choices]
Depression (2012)[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.
Anticoagulation
Evidence Based Reports
Newer oral anticoagulants (2013) [WeMeRec] NEW
Rivaroxaban for treating pulmonary embolism and preventing recurrent venous thromboembolism (2013) [NICE] NEW
Warfarin initiation nomograms for venous thromboembolism (2013)[Cochrane] NEW
Once versus twice daily low molecular weight heparin for the initial treatment of venous thromboembolism (2013)[Cochrane] NEW
Antiplatelet and anticoagulation for patients with prosthetic heart valves(2013)[Cochrane] updated
Antiplatelet and Anticoagulant Treatments for Unstable Angina/Non–ST Elevation Myocardial Infarction (2013)[AHRQ][Executive Summary] NEW
Tinzaparin versus Dalteparin or Enoxaparin for the Treatment of Venous Thromboembolism in Adults: Safety and Guidelines (2013)[CADTH] NEW
Rivaroxaban for the treatment of deep vein thrombosis and prevention of recurrent deep vein thrombosis and pulmonary embolism (2012) [NICE] NEW
Apixaban for the prevention of venous thromboembolism after total hip or knee replacement in adults (2012)[NICE] NEW
Antiplatelet and anticoagulant drugs for prevention of restenosis/reocclusion following peripheral endovascular treatment (2012)[Cochrane] NEW
Thrombophilia testing for prevention of recurrent venous thromboembolism(2012)[Cochrane] updated
Comparative effectiveness of warfarin and new oral anticoagulants for the management of atrial fibrillation and venous thromboembolism: a systematic review (2012)[DARE] NEW
Primary prophylaxis for venous thromboembolism in ambulatory cancer patients receiving chemotherapy (2011)[Cochrane] NEW
Vitamin K antagonists versus antiplatelet therapy after transient ischaemic attack or minor ischaemic stroke of presumed arterial origin (2011) [Cochrane] updated
Low molecular weight heparin versus unfractionated heparin for perioperative thromboprophylaxis in patients with cancer (2011) [Cochrane]
Anticoagulation for the long-term treatment of venous thromboembolism in patients with cancer (2011)[Cochrane]
Anticoagulation for the initial treatment of venous thromboembolism in patients with cancer (2011)[Cochrane]
Oral anticoagulation in patients with cancer who have no therapeutic or prophylactic indication for anticoagulation (2010)[Cochrane]
Antiplatelet agents versus control or anticoagulation for heart failure in sinus rhythm (2010)[Cochrane] NEW
Fixed dose subcutaneous low molecular weight heparins versus adjusted dose unfractionated heparin for venous thromboembolism (2010)[Cochrane]
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]
Parenteral anticoagulation for prolonging survival in patients with cancer who have no other indication for anticoagulation (2010) [Cochrane] updated
Systematic review: case-fatality rates of recurrent venous thromboembolism and major bleeding events among patients treated for venous thromboembolism (2010)[DARE]
Dabigatran etexilate (Pradaxa) for secondary prevention of venous thromboembolism (VTE)(2010)[National Horizon Scanning Centre]
Anticoagulation for Venous Thromboembolism (2010)[theNNT]
Oral anticoagulation in patients with cancer who have no therapeutic or prophylactic indication for anticoagulation (2010) [Cochrane]
Rivaroxaban for the prevention of venous thromboembolism after total hip or total knee replacement in adults(2009)[NICE]
Subcutaneous unfractionated heparin for the initial treatment of 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(2008)[Cochrane]
Anticoagulants for preventing recurrence following presumed non-cardioembolic ischaemic stroke or transient ischaemic attack (2008)[Cochrane]
Self-monitoring and self-management of oral anticoagulation (2008)[Cochrane]
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]
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]
Anticoagulants versus non-steroidal anti-inflammatories or placebo for treatment of venous thromboembolism (2008) [Cochrane]
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]
Monitoring anticoagulant therapy in primary care (2007) [WeMeRec]
Oral anticoagulants for preventing stroke in patients with non-valvular atrial fibrillation and no previous history of stroke or transient ischemic attacks (2004) [Cochrane]
Clinical Guidelines
Anticoagulation (2014)[Map of Medicine] updated
Oral anticoagulation (2013)[CKS] updated
Guideline on the investigation, management and prevention of venous thrombosis in children (2011)[BSCH]
Guidelines on oral anticoagulation with warfarin – fourth edition (2011)[BSCH]
Venous Thromboembolism and Hormone Replacement Therapy (2011) [RCOG]
Prevention and management of venous thromboembolism (2010)[SIGN]
Venous thromboembolism:reducing the risk (2010)[NICE]
Guidelines for the management of anticoagulant and antiplatelet therapy in patients undergoing endoscopic procedures (2008)[British Soc Gastroenterology]
eTextbooks
Oral Anticoagulants (2013)[Mentor] updated
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
Dabigatran versus warfarin in patients with mechanical heart valves (2013)[NEJM] NEW
Sustained impact of anticoagulant control achieved in an anticoagulation management service after transfer of management to the primary care physician (2012) [Pharmacotherapy] NEW
Long-term outcome after additional catheter-directed thrombolysis versus standard treatment for acute iliofemoral deep vein thrombosis (the CaVenT study): a randomised controlled trial. (2011)[Lancet]
Duration and magnitude of the postoperative risk of venous thromboembolism in middle aged women: prospective cohort study (2009)[BMJ]
Meta-analysis: travel and risk for venous thromboembolism (2009)[Annals of Internal Medicine]
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
Is there any consensus as to whetherthe dose of warfarin should be adjusted prior to starting a course of antibiotics or is it suffice to check the INR after the course is completed? (2013)[ATTRACT] NEW
Is it safe for a woman with a history of venous thromboembolism (VTE), currently being treated with anticoagulants, to use two desogestrel pills a day to remain amenorrhoeic? (2013) [FSRH] NEW
Is there any consensus as to how antimalarials should be used when patients are on warfarin (2012) [ATTRACT] NEW
How safe is it to perform a 'steroid injection' into a shoulder joint in someone taking Warfarin (2011)[ATTRACT]
Patient Information
Anticoagulant Medicines (2013) [NHS Choices] 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.http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD001100.pub3/abstract
Newer oral anticoagulants (2013) [WeMeRec] NEW
Rivaroxaban for treating pulmonary embolism and preventing recurrent venous thromboembolism (2013) [NICE] NEW
Warfarin initiation nomograms for venous thromboembolism (2013)[Cochrane] NEW
Once versus twice daily low molecular weight heparin for the initial treatment of venous thromboembolism (2013)[Cochrane] NEW
Antiplatelet and anticoagulation for patients with prosthetic heart valves(2013)[Cochrane] updated
Antiplatelet and Anticoagulant Treatments for Unstable Angina/Non–ST Elevation Myocardial Infarction (2013)[AHRQ][Executive Summary] NEW
Tinzaparin versus Dalteparin or Enoxaparin for the Treatment of Venous Thromboembolism in Adults: Safety and Guidelines (2013)[CADTH] NEW
Low Molecular Weight Heparins Versus Unfractionated Heparin for Thromboprophylaxis in Surgery, Cancer and General Medicine: A Review of the Cost-effectiveness and Safety (2013)[CADTH] NEW
Rivaroxaban for the treatment of deep vein thrombosis and prevention of recurrent deep vein thrombosis and pulmonary embolism (2012) [NICE] NEW
Apixaban for the prevention of venous thromboembolism after total hip or knee replacement in adults (2012)[NICE] NEW
Antiplatelet and anticoagulant drugs for prevention of restenosis/reocclusion following peripheral endovascular treatment (2012)[Cochrane] NEW
Thrombophilia testing for prevention of recurrent venous thromboembolism(2012)[Cochrane] updated
Comparative effectiveness of warfarin and new oral anticoagulants for the management of atrial fibrillation and venous thromboembolism: a systematic review (2012)[DARE] NEW
Primary prophylaxis for venous thromboembolism in ambulatory cancer patients receiving chemotherapy (2011)[Cochrane] NEW
Vitamin K antagonists versus antiplatelet therapy after transient ischaemic attack or minor ischaemic stroke of presumed arterial origin (2011) [Cochrane] updated
Low molecular weight heparin versus unfractionated heparin for perioperative thromboprophylaxis in patients with cancer (2011) [Cochrane]
Anticoagulation for the long-term treatment of venous thromboembolism in patients with cancer (2011)[Cochrane]
Anticoagulation for the initial treatment of venous thromboembolism in patients with cancer (2011)[Cochrane]
Oral anticoagulation in patients with cancer who have no therapeutic or prophylactic indication for anticoagulation (2010)[Cochrane]
Antiplatelet agents versus control or anticoagulation for heart failure in sinus rhythm (2010)[Cochrane] NEW
Fixed dose subcutaneous low molecular weight heparins versus adjusted dose unfractionated heparin for venous thromboembolism (2010)[Cochrane]
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]
Parenteral anticoagulation for prolonging survival in patients with cancer who have no other indication for anticoagulation (2010) [Cochrane] updated
Systematic review: case-fatality rates of recurrent venous thromboembolism and major bleeding events among patients treated for venous thromboembolism (2010)[DARE]
Dabigatran etexilate (Pradaxa) for secondary prevention of venous thromboembolism (VTE)(2010)[National Horizon Scanning Centre]
Anticoagulation for Venous Thromboembolism (2010)[theNNT]
Oral anticoagulation in patients with cancer who have no therapeutic or prophylactic indication for anticoagulation (2010) [Cochrane]
Rivaroxaban for the prevention of venous thromboembolism after total hip or total knee replacement in adults(2009)[NICE]
Subcutaneous unfractionated heparin for the initial treatment of 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(2008)[Cochrane]
Anticoagulants for preventing recurrence following presumed non-cardioembolic ischaemic stroke or transient ischaemic attack (2008)[Cochrane]
Self-monitoring and self-management of oral anticoagulation (2008)[Cochrane]
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]
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]
Anticoagulants versus non-steroidal anti-inflammatories or placebo for treatment of venous thromboembolism (2008) [Cochrane]
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]
Monitoring anticoagulant therapy in primary care (2007) [WeMeRec]
Oral anticoagulants for preventing stroke in patients with non-valvular atrial fibrillation and no previous history of stroke or transient ischemic attacks (2004) [Cochrane]
Clinical Guidelines
Anticoagulation (2014)[Map of Medicine] updated
Oral anticoagulation (2013)[CKS] updated
Venous thromboembolic diseases: the management of venous thromboembolic diseases and the role of thrombophilia testing (2012)[NICE] NEW
Effects on routine coagulation screens and assessment of anticoagulant intensity in patients taking oral dabigatran or rivaroxaban: Guidance from the British Committee for Standards in Haematology (2012) [BSCH] NEW
Guidelines on the diagnosis and management of heparin induced thrombocytopenia: second edition (2012) [BSCH] NEW
Guidelines on the investigation and management of venous thrombosis at unusual sites (2012)[BSCH] NEW
Guidelines on the diagnosis and management of thrombotic thrombocytopenic purpura and other thrombotic microangiopathies (2012)[BSCH] NEW
Guideline on the investigation, management and prevention of venous thrombosis in children (2011)[BSCH]
Guidelines on oral anticoagulation with warfarin – fourth edition (2011)[BSCH]
Venous Thromboembolism and Hormone Replacement Therapy (2011) [RCOG]
Prevention and management of venous thromboembolism (2010)[SIGN]
Venous thromboembolism:reducing the risk (2010)[NICE]
Guidelines for the management of anticoagulant and antiplatelet therapy in patients undergoing endoscopic procedures (2008)[British Soc Gastroenterology]
eTextbooks
Oral Anticoagulants (2013)[Mentor] updated
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
Dabigatran versus warfarin in patients with mechanical heart valves (2013)[NEJM] NEW
Sustained impact of anticoagulant control achieved in an anticoagulation management service after transfer of management to the primary care physician (2012) [Pharmacotherapy] NEW
Long-term outcome after additional catheter-directed thrombolysis versus standard treatment for acute iliofemoral deep vein thrombosis (the CaVenT study): a randomised controlled trial. (2011)[Lancet]
Duration and magnitude of the postoperative risk of venous thromboembolism in middle aged women: prospective cohort study (2009)[BMJ]
Meta-analysis: travel and risk for venous thromboembolism (2009)[Annals of Internal Medicine]
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
Is there any consensus as to whetherthe dose of warfarin should be adjusted prior to starting a course of antibiotics or is it suffice to check the INR after the course is completed? (2013)[ATTRACT] NEW
Is it safe for a woman with a history of venous thromboembolism (VTE), currently being treated with anticoagulants, to use two desogestrel pills a day to remain amenorrhoeic? (2013) [FSRH] NEW
Is there any consensus as to how antimalarials should be used when patients are on warfarin (2012) [ATTRACT] NEW
Can a woman who has a heart valve replacement who is going to need warfarin for life use the progestogen-only implant? (2011)[FSRH]
How safe is it to perform a 'steroid injection' into a shoulder joint in someone taking Warfarin (2011)[ATTRACT]
Patient Information
Anticoagulant Medicines (2013) [NHS Choices] 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.http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD001100.pub3/abstract
Monday, 7 April 2014
COPD
Evidence Based Reports
The effect of complex interventions on depression and anxiety in chronic obstructive pulmonary disease: systematic review and meta-analysis. (20130 [DARE] NEW
Comparative efficacy of aclidinium versus glycopyrronium and tiotropium, as maintenance treatment of moderate to severe COPD patients: a systematic review and network meta-analysis. (2013) [DARE] NEW
Does upper extremity exercise improve dyspnea in patients with COPD? A meta-analysis. (2013) [DARE] NEW
Comparative safety of inhaled medications in patients with chronic obstructive pulmonary disease: systematic review and mixed treatment comparison meta-analysis of randomised controlled trials. (2013) [DARE] NEW
Comparison of three combined pharmacological approaches with tiotropium monotherapy in stable moderate to severe COPD: a systematic review. (2012) [DARE] NEW
Home care by outreach nursing for chronic obstructive pulmonary disease. (2012) [Cochrane Library] NEW
Different durations of corticosteroid therapy for exacerbations of chronic obstructive pulmonary disease. (2012) [Cochrane Library] NEW
Nocturnal non-invasive positive pressure ventilation for stable chronic obstructive pulmonary disease. (2012) [Cochrane Library] NEW
Telehealthcare for chronic obstructive pulmonary disease. (2012) [Cochrane Library] NEW
Airway clearance techniques for chronic obstructive pulmonary disease. (2012) [Cochrane Library] NEW
Mucolytic agents for chronic bronchitis or chronic obstructive pulmonary disease. (2012) [Cochrane Library] NEW
Long-acting beta2-agonist in addition to tiotropium versus either tiotropium or long-acting beta2-agonist alone for chronic obstructive pulmonary disease. (2012) [Cochrane Library] NEW
The effect of adding inhaled corticosteroids to tiotropium and long-acting beta2-agonists for chronic obstructive pulmonary disease (2011)[Cochrane]
Combination inhaled steroid and long-acting beta2-agonist in addition to tiotropium versus tiotropium or combination alone for chronic obstructive pulmonary disease (2011)[Cochrane]
Pharmacological interventions for the treatment of anxiety disorders in chronic obstructive pulmonary disease (2011) [Cochrane]
Optimal intensity and type of leg exercise training for people with chronic obstructive pulmonary disease (2011) [Cochrane]
Pulmonary rehabilitation following exacerbations of chronic obstructive pulmonary disease (2011)[Cochrane]
Carbonic anhydrase inhibitors for hypercapnic ventilatory failure in chronic obstructive pulmonary disease (2010)[Cochrane]
Influenza vaccine for patients with chronic obstructive pulmonary disease (2010)[Cochrane]
Combination inhaled steroid and long-acting beta2-agonist versus tiotropium for chronic obstructive pulmonary disease (2010)[Cochrane]
Action plans with limited patient education only for exacerbations of chronic obstructive pulmonary disease (2010)[Cochrane]
Smoking cessation interventions in COPD: a network meta-analysis of randomised trials (2010)[DARE]
Inspiratory muscle training in patients with chronic obstructive pulmonary disease: the state of the evidence (2010)[DARE]
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]
Clinical Guidelines
COPD (2013)[NICE Pathways] updated
Management of chronic obstructive pulmonary disease in adults in primary and secondary care (partial update)(2010)[NICE]
Chronic obstructive pulmonary disease (2010)[CKS]
Chronic obstructive pulmonary disease: Management of chronic obstructive pulmonary disease in adults in primary and secondary care (2004) [NICE]
Recent articles in core journals
Roflumilast with long-acting β2-agonists for COPD: influence of exacerbation history. (2011)[EvidenceUpdates]
Risk of fractures with inhaled corticosteroids in COPD: systematic review and meta-analysis of randomised controlled trials and observational studies. (2011)[EvidenceUpdates]
Changes in forced expiratory volume in 1 second over time in COPD. (2011)[NEJM]
The future of chronic obstructive pulmonary disease treatment--difficulties of and barriers to drug development. (2011)[Lancet]
Azithromycin for prevention of exacerbations of COPD. (2011)[NEJM]
Tiotropium versus salmeterol for the prevention of exacerbations of COPD. (2011)[NEJM]
Ground walk training improves functional exercise capacity more than cycle training in people with chronic obstructive pulmonary disease (COPD): a randomised trial (2010)[EvidenceUpdates]
Disease management program for chronic obstructive pulmonary disease: a randomized controlled trial (2010)[EvidenceUpdates]
Susceptibility to exacerbation in chronic obstructive pulmonary disease (2010)[NEJM]
Once-daily bronchodilators for chronic obstructive pulmonary disease: indacaterol versus tiotropium (2010)[EvidenceUpdates]
Efficacy of a new once-daily long-acting inhaled beta2-agonist indacaterol versus twice-daily formoterol in COPD (2010)[EvidenceUpdates]
Association of corticosteroid dose and route of administration with risk of treatment failure in acute exacerbation of chronic obstructive pulmonary disease (2010)[JAMA]
Oral immunotherapy with inactivated nontypeable Haemophilus influenzae reduces severity of acute exacerbations in severe COPD (2010)[EvidenceUpdates]
Cardiovascular safety of tiotropium in patients with COPD (2010)[EvidenceUpdates]
A multicenter, randomized trial of noninvasive ventilation with helium-oxygen mixture in exacerbations of chronic obstructive lung disease (2010)[EvidenceUpdates]
Antibiotics in addition to systemic corticosteroids for acute exacerbations of chronic obstructive pulmonary disease (2010)[EvidenceUpdates]
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 (2011) [eMedicine]
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]
Clinical Queries
Are you aware of an association between longterm Seretide Treatment(in doses recommended for COPD) and joint pains / arthropathy? (2011)[ATTRACT]
There appears to be a high prevalence of osteopenia/osteoporosis in patients with COPD which is multifactorial. Are there any firm recommendations on DEXA Scanning +/- starting biphosphonate treatments in this group of individuals? (2011)[ATTRACT]
Are there any trials - in COPD - of patients being started directly on dual therapy (as opposed to monotherapy and stepping up when COPD progresses)..? (2011)[ATTRACT]
What evidence is there that beta blockers should be used with caution in COPD? (2011)[ATTRACT]
what should the first line antibiotic be for patients with COPD? (2010)[ATTRACT]
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. (2012) [NHS Choices] NEW
Chronic obstructive pulmonary disease (COPD) (2011)[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.
The effect of complex interventions on depression and anxiety in chronic obstructive pulmonary disease: systematic review and meta-analysis. (20130 [DARE] NEW
Comparative efficacy of aclidinium versus glycopyrronium and tiotropium, as maintenance treatment of moderate to severe COPD patients: a systematic review and network meta-analysis. (2013) [DARE] NEW
Does upper extremity exercise improve dyspnea in patients with COPD? A meta-analysis. (2013) [DARE] NEW
Comparative safety of inhaled medications in patients with chronic obstructive pulmonary disease: systematic review and mixed treatment comparison meta-analysis of randomised controlled trials. (2013) [DARE] NEW
Comparison of three combined pharmacological approaches with tiotropium monotherapy in stable moderate to severe COPD: a systematic review. (2012) [DARE] NEW
Home care by outreach nursing for chronic obstructive pulmonary disease. (2012) [Cochrane Library] NEW
Different durations of corticosteroid therapy for exacerbations of chronic obstructive pulmonary disease. (2012) [Cochrane Library] NEW
Nocturnal non-invasive positive pressure ventilation for stable chronic obstructive pulmonary disease. (2012) [Cochrane Library] NEW
Telehealthcare for chronic obstructive pulmonary disease. (2012) [Cochrane Library] NEW
Airway clearance techniques for chronic obstructive pulmonary disease. (2012) [Cochrane Library] NEW
Mucolytic agents for chronic bronchitis or chronic obstructive pulmonary disease. (2012) [Cochrane Library] NEW
Long-acting beta2-agonist in addition to tiotropium versus either tiotropium or long-acting beta2-agonist alone for chronic obstructive pulmonary disease. (2012) [Cochrane Library] NEW
The effect of adding inhaled corticosteroids to tiotropium and long-acting beta2-agonists for chronic obstructive pulmonary disease (2011)[Cochrane]
Combination inhaled steroid and long-acting beta2-agonist in addition to tiotropium versus tiotropium or combination alone for chronic obstructive pulmonary disease (2011)[Cochrane]
Pharmacological interventions for the treatment of anxiety disorders in chronic obstructive pulmonary disease (2011) [Cochrane]
Optimal intensity and type of leg exercise training for people with chronic obstructive pulmonary disease (2011) [Cochrane]
Pulmonary rehabilitation following exacerbations of chronic obstructive pulmonary disease (2011)[Cochrane]
Carbonic anhydrase inhibitors for hypercapnic ventilatory failure in chronic obstructive pulmonary disease (2010)[Cochrane]
Influenza vaccine for patients with chronic obstructive pulmonary disease (2010)[Cochrane]
Combination inhaled steroid and long-acting beta2-agonist versus tiotropium for chronic obstructive pulmonary disease (2010)[Cochrane]
Action plans with limited patient education only for exacerbations of chronic obstructive pulmonary disease (2010)[Cochrane]
Smoking cessation interventions in COPD: a network meta-analysis of randomised trials (2010)[DARE]
Inspiratory muscle training in patients with chronic obstructive pulmonary disease: the state of the evidence (2010)[DARE]
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]
Clinical Guidelines
COPD (2013)[NICE Pathways] updated
Management of chronic obstructive pulmonary disease in adults in primary and secondary care (partial update)(2010)[NICE]
Chronic obstructive pulmonary disease (2010)[CKS]
Chronic obstructive pulmonary disease: Management of chronic obstructive pulmonary disease in adults in primary and secondary care (2004) [NICE]
Recent articles in core journals
Roflumilast with long-acting β2-agonists for COPD: influence of exacerbation history. (2011)[EvidenceUpdates]
Risk of fractures with inhaled corticosteroids in COPD: systematic review and meta-analysis of randomised controlled trials and observational studies. (2011)[EvidenceUpdates]
Changes in forced expiratory volume in 1 second over time in COPD. (2011)[NEJM]
The future of chronic obstructive pulmonary disease treatment--difficulties of and barriers to drug development. (2011)[Lancet]
Azithromycin for prevention of exacerbations of COPD. (2011)[NEJM]
Tiotropium versus salmeterol for the prevention of exacerbations of COPD. (2011)[NEJM]
Ground walk training improves functional exercise capacity more than cycle training in people with chronic obstructive pulmonary disease (COPD): a randomised trial (2010)[EvidenceUpdates]
Disease management program for chronic obstructive pulmonary disease: a randomized controlled trial (2010)[EvidenceUpdates]
Susceptibility to exacerbation in chronic obstructive pulmonary disease (2010)[NEJM]
Once-daily bronchodilators for chronic obstructive pulmonary disease: indacaterol versus tiotropium (2010)[EvidenceUpdates]
Efficacy of a new once-daily long-acting inhaled beta2-agonist indacaterol versus twice-daily formoterol in COPD (2010)[EvidenceUpdates]
Association of corticosteroid dose and route of administration with risk of treatment failure in acute exacerbation of chronic obstructive pulmonary disease (2010)[JAMA]
Oral immunotherapy with inactivated nontypeable Haemophilus influenzae reduces severity of acute exacerbations in severe COPD (2010)[EvidenceUpdates]
Cardiovascular safety of tiotropium in patients with COPD (2010)[EvidenceUpdates]
A multicenter, randomized trial of noninvasive ventilation with helium-oxygen mixture in exacerbations of chronic obstructive lung disease (2010)[EvidenceUpdates]
Antibiotics in addition to systemic corticosteroids for acute exacerbations of chronic obstructive pulmonary disease (2010)[EvidenceUpdates]
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 (2011) [eMedicine]
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]
Clinical Queries
Are you aware of an association between longterm Seretide Treatment(in doses recommended for COPD) and joint pains / arthropathy? (2011)[ATTRACT]
There appears to be a high prevalence of osteopenia/osteoporosis in patients with COPD which is multifactorial. Are there any firm recommendations on DEXA Scanning +/- starting biphosphonate treatments in this group of individuals? (2011)[ATTRACT]
Are there any trials - in COPD - of patients being started directly on dual therapy (as opposed to monotherapy and stepping up when COPD progresses)..? (2011)[ATTRACT]
What evidence is there that beta blockers should be used with caution in COPD? (2011)[ATTRACT]
what should the first line antibiotic be for patients with COPD? (2010)[ATTRACT]
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. (2012) [NHS Choices] NEW
Chronic obstructive pulmonary disease (COPD) (2011)[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.
Friday, 4 April 2014
DVT
Evidence Based Reports
Use of Compression Therapy Following Diagnosis of Deep Vein Thrombosis: Guidelines (2012) [CADTH] NEW
Graduated Compression Stockings for Prevention of Deep Vein Thrombosis in Stroke Patients (2012) [the NNT] NEW
Rivaroxaban for treatment and prevention of DVT (2012)[MTRAC] NEW
Home versus in-patient treatment for deep vien thrombosis (2011) [Cochrane]
Elastic compression stockings for prevention of deep vein thrombosis(2010)[Cochrane]
Anticoagulant therapy for deep vein thrombosis (DVT) in pregnancy (2010) [Cochrane]
Risk of deep vein thrombosis following a single negative whole-leg compression ultrasound: a systematic review and meta-analysis (2010)[DARE]
The D-Dimer Test for ruling out Deep Vein Thrombosis in Primary Care (2009)[MaDOX]
Physical methods for preventing deep vein thrombosis in stroke (2009)[Cochrane]
Interventions for preventing venous thromboembolism following abdominal aortic surgery (2009)[Cochrane]
Anticoagulant prophylaxis to prevent asymptomatic deep vein thrombosis in hospitalized medical patients: a systematic review and meta-analysis (2009)[DARE]
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 (2006)[Cochrane]
Clinical Guidelines
Deep vein thrombosis (2013)[CKS] updated
Deep vein thrombosis - prevention for travellers (2013)[CKS] updated
Reducing the risk of venous thromboembolism (deep vein thrombosis and pulmonary embolism) in patients admitted to hospital (2010)[NICE]
Prevention and management of venous thromboembolism (2010)[SIGN]
Guidelines on travel-related venous thrombosis (2010) [BCSH]
Venous thromboembolism and hormonal contraception (2010)[RCOG]
Recent articles in core journals
Effectiveness of intermittent pneumatic compression in reduction of risk of deep vein thrombosis in patients who have had a stroke (CLOTS 3): a multicentre randomised controlled trial (2013)[Lancet] NEW
Comparing the diagnostic performance of 2 clinical decision rules to rule out deep vein thrombosis in primary care patients (2011)[Am Fam Med]
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 (2012)[Mentor] updated
Prevention of Venous Thromboembolism (2010)[Mentor]
Deep vein thrombosis: diagnosis and treatment Interactive case history (2007)[BMJ Learning]
Clinical Queries
Certain progesterones in the third generation OCP increase risk of DVT. Desogestrel is one of those. Does Cerazette/ Cerelle have the same effect? (2014) [ATTRACT] NEW
I am looking after a 44yr old woman with recurrent DVT and who is on life-long Warfarin. She is menopausal with debilitating hot flushes. What is the evidence with regards to use of HRT or antidepressant therapy respectively in such a patient? (2013) [ATTRACT] NEW
Patient Information
Deep vein thrombosis (2014)[NHS Choices] updated
Deep vein thrombosis (DVT) (2013) [BUPA] 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.
Prophylaxis for venous thromboembolic disease in pregnancy and the early postnatal period (2013)[Cochrane] updated
Thrombophilia testing for prevention of recurrent venous thromboembolism
(2012)[Cochrane] updated
Knee length versus thigh length graduated compression stockings for prevention of deep vein thrombosis in postoperative surgical patients (2012) [Cochrane] NEW
Rivaroxaban for the treatment of deep vein thrombosis and prevention of recurrent deep vein thrombosis and pulmonary embolism (2012)[NICE] NEW
Thrombophilia testing for prevention of recurrent venous thromboembolism
(2012)[Cochrane] updated
Knee length versus thigh length graduated compression stockings for prevention of deep vein thrombosis in postoperative surgical patients (2012) [Cochrane] NEW
Rivaroxaban for the treatment of deep vein thrombosis and prevention of recurrent deep vein thrombosis and pulmonary embolism (2012)[NICE] NEW
Use of Compression Therapy Following Diagnosis of Deep Vein Thrombosis: Guidelines (2012) [CADTH] NEW
Graduated Compression Stockings for Prevention of Deep Vein Thrombosis in Stroke Patients (2012) [the NNT] NEW
Rivaroxaban for treatment and prevention of DVT (2012)[MTRAC] NEW
Home versus in-patient treatment for deep vien thrombosis (2011) [Cochrane]
Elastic compression stockings for prevention of deep vein thrombosis(2010)[Cochrane]
Anticoagulant therapy for deep vein thrombosis (DVT) in pregnancy (2010) [Cochrane]
Risk of deep vein thrombosis following a single negative whole-leg compression ultrasound: a systematic review and meta-analysis (2010)[DARE]
The D-Dimer Test for ruling out Deep Vein Thrombosis in Primary Care (2009)[MaDOX]
Physical methods for preventing deep vein thrombosis in stroke (2009)[Cochrane]
Interventions for preventing venous thromboembolism following abdominal aortic surgery (2009)[Cochrane]
Anticoagulant prophylaxis to prevent asymptomatic deep vein thrombosis in hospitalized medical patients: a systematic review and meta-analysis (2009)[DARE]
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 (2006)[Cochrane]
Clinical Guidelines
Deep vein thrombosis (2013)[CKS] updated
Deep vein thrombosis - prevention for travellers (2013)[CKS] updated
Reducing the risk of venous thromboembolism (deep vein thrombosis and pulmonary embolism) in patients admitted to hospital (2010)[NICE]
Prevention and management of venous thromboembolism (2010)[SIGN]
Guidelines on travel-related venous thrombosis (2010) [BCSH]
Venous thromboembolism and hormonal contraception (2010)[RCOG]
Recent articles in core journals
Effectiveness of intermittent pneumatic compression in reduction of risk of deep vein thrombosis in patients who have had a stroke (CLOTS 3): a multicentre randomised controlled trial (2013)[Lancet] NEW
Comparing the diagnostic performance of 2 clinical decision rules to rule out deep vein thrombosis in primary care patients (2011)[Am Fam Med]
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 (2012)[Mentor] updated
Prevention of Venous Thromboembolism (2010)[Mentor]
Deep vein thrombosis: diagnosis and treatment Interactive case history (2007)[BMJ Learning]
Clinical Queries
Certain progesterones in the third generation OCP increase risk of DVT. Desogestrel is one of those. Does Cerazette/ Cerelle have the same effect? (2014) [ATTRACT] NEW
I am looking after a 44yr old woman with recurrent DVT and who is on life-long Warfarin. She is menopausal with debilitating hot flushes. What is the evidence with regards to use of HRT or antidepressant therapy respectively in such a patient? (2013) [ATTRACT] NEW
Patient Information
Deep vein thrombosis (2014)[NHS Choices] updated
Deep vein thrombosis (DVT) (2013) [BUPA] 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.
Atrial Fibrillation
Evidence Based Reports
Micra™ Transcatheter Pacing System for atrial fibrillation and bradycardia (2014)[National Horizon Scanning Centre] NEW
Nanostim Leadless Pacemaker for atrial fibrillation and bradycardia (2014)[National Horizon Scanning Centre] NEW
Diagnostic Technology: Hand-held ECG monitors for the detection of atrial fibrillation (AF) in primary care (2013) [MaDOX] NEW
Echocardiography in newly diagnosed atrial fibrillation patients: a systematic review and economic evaluation (2013) [NIHR HTA] NEW
Dabigatran texilate - for stroke prevention in patients with atrial fibrillation (2012)[MTRAC] NEW
Rivaroxaban for the prevention of stroke and systemic embolism in people with atrial fibrillation(2012)[NICE] NEW
Rivaroxaban (Xarelto) - for stroke prevention in patients with non-valvular atrial fibrillation (2012)[MTRAC] NEW
Thoracoscopic exclusion of the left atrial appendage (with or without surgical ablation) for non-valvular atrial fibrillation for the prevention of thromboembolism (2011)[NICE]
Percutaneous endoscopic catheter laser balloon pulmonary vein isolation for atrial fibrillation (2011)[NICE]
Effect of statins on atrial fibrillation: collaborative meta-analysis of published and unpublished evidence from randomised controlled trials (2011)[DARE]
Dronedarone increases the risk of heart failure, stroke and death compared to placebo in people with permanent AF (2011)[MeReC Rapid Review]
Modelling study finds no net benefit from aspirin plus clopidogrel versus aspirin alone in people with AF unable to take warfarin (2011)[MeReC Rapid Review]
Dronedarone for the treatment of atrial fibrillation (2011)[MTRAC]
Atrial fibrillation (chronic)(2011)[Clinical Evidence]Athens Log-in required
Atrial fibrillation (acute onset) (2010) [Clinical Evidence] Athens Log-in required
Atrial fibrillation (2010)[WeMeReC]
Percutaneous occlusion of the left atrial appendage in non-valvular atrial fibrillation for the prevention of thromboembolism (2010)[NICE]
Dronedarone for the treatment of non-permanent atrial fibrillation (2010)[NICE]
Antiarrhythmics for maintaining sinus rhythm after cardioversion of atrial fibrillation (2010) [Cochrane]
Systematic review and cost effectiveness evaluation of 'pill-in-the-pocket' strategy for paroxysmal atrial fibrillation compared to episodic in-hospital treatment or continuous antiarrhythmic drug therapy (2010)[NIHR HTA]
Statins for prevention of atrial fibrillation after cardiac surgery: a systematic literature review (2010)[DARE]
Warfarin vs. Aspirin For Atrial Fibrillation Stroke Prevention (2010)[theNNT]
Warfarin for Atrial Fibrillation Stroke Prevention (2010)[theNNT]
Percutaneous (non-thoracoscopic)epicardial catheter radiofrequency ablation for atrial fibrillation (2009)[NICE]
Catheter ablation for paroxysmal and persistent atrial fibrillation (2009)[Cochrane] NEW
Thoracoscopic epicardial radiofrequency ablation for atrial fibrillation (2009)[NICE]
Comparative effectiveness of radiofrequency catheter ablation for atrial fibrillation(2009)[DARE]
A systematic review of randomized trials comparing radiofrequency ablation with antiarrhythmic medications in patients with atrial fibrillation (2009)[DARE]
Intravenous magnesium sulphate and sotalol for prevention of atrial fibrillation after coronary artery bypass surgery: a systematic review and economic evaluation (2008) [NCCHTA]
Curative catheter ablation in atrial fibrillation and typical atrial flutter: systematic review and economic evaluation (2008)[NCCHTA]
Catheter ablation vs antiarrhythmic drug therapy for atrial fibrillation: a systematic review (2008)[DARE]
Is pulse palpation helpful in detecting atrial fibrillation: a systematic review (2006) [DARE]
Percutaneous radiofrequency ablation for atrial fibrillation (2006) [NICE]
Percutaneous occlusion of the left atrial appendage for atrial fibrillation (2006) [NICE]
High-intensity focused ultrasound for atrial fibrillation in association with other cardiac surgery (2006) [NICE]
Radiofrequency ablation for atrial fibrillation in association with other cardiac surgery (2005) [NICE]
Microwave ablation for atrial fibrillation in association with other cardiac surgery (2005) [NICE]
Cryoablation for atrial fibrillation in association with other cardiac surgery (2005) [NICE]
Pharmacological cardioversion for atrial fibrillation and flutter (2005) [Cochrane]
Electrical cardioversion for atrial fibrillation and flutter (2005) [Cochrane]
Antiplatelet therapy for preventing stroke in patients with non-valvular atrial fibrillation and no previous history of stroke or transient ischemic attacks (2005) [Cochrane]
Anticoagulants versus antiplatelet therapy for preventing stroke in patients with nonrheumatic atrial fibrillation and a history of stroke or transient ischemic attack (2004) [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 for preventing stroke in patients with nonrheumatic atrial fibrillation and a history of stroke or transient ischaemic attack (2003) [Cochrane]
Clinical Guidelines
Atrial Fibrillation (AF)(2013) [Map of Medicine] updated
Guidelines for the management of atrial fibrillation (2010) [ESC]
Atrial Fibrillation (2009) [CKS]
Atrial Fibrillation: The management of Atrial fibrillation (2006) [NICE] update expected in 2014
Recent articles in core journals
Outcomes of apixaban vs. warfarin by type and duration of atrial fibrillation: results from the ARISTOTLE trial (2013) [Eur Heart Journal] NEW
Cryoballoon ablation of pulmonary veins for paroxysmal atrial fibrillation: first results of the North American Arctic Front (STOP AF) pivotal trial (2013) [J Am Coll Cardiol] NEW
Effect of weight reduction and cardiometabolic risk factor management on symptom burden and severity in patients with atrial fibrillation: a randomized clinical trial (2013) [JAMA] NEW
Subclinical atrial fibrillation and the risk of stroke (2012)[NEJM] NEW
Atrial fibrillation (2012)[Lancet] NEW
In the clinic. Atrial fibrillation (2010)[Ann Intern Med]
Effect of age on stroke prevention therapy in patients with atrial fibrillation: the atrial fibrillation investigators (2009) [Evidence Updates]
Development of a risk score for atrial fibrillation (Framingham Heart Study): a community-based cohort study (2009) [Lancet]
eTextbooks
Atrial fibrillation: diagnosis and management (2011)[BMJ Learning]
Clinical Queries
A patient has a history of coronary artery disease and bypass graft and is taking an antiplatelet in the form of clopidogrel. Has recently been diagnosed with atrial fibrillation and warfarin has been initiated. Is there evidence/guideline to suggest whether he should continue clopidogrel for its antiplatelet effect, or should this be discontinued once warfarin treatment is established? I note a previous Attract answer to a similar query in 2009 - any more recent guidance? (2012) [ATTRACT]NEW
Would the levonorgestrel releasing intrauterine system be a suitable method for a woman who has had surgery for removal of four atrial myxomas, has atrial fibrillation and is taking aspirin and if so does she require antibiotic prophylaxis? (2011) )[FSRH]
What is the incidence of Atrial fibrillation (AF) in children under 15. Can AF be familial? (2009)[ATTRACT]
What is the evidence for an alternative anticoagulation e.g. dipyridamole in a patient with AF, who is allergic to aspirin and that warfarin is contra-indicated? (2008) [TRIP Answers]
Is there any evidence or guidance available on the most appropriate way to initiate Warfarin in patients newly diagnosed with chronic AF in the community? (2008)[ATTRACT]
Patient Information
Atrial Fibrillation (2013) [NHS Choices] updated
Atrial Fibrillation (2012) [Patient UK] updated
Atrial fibrillation (2012) [BUPA] NEW
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.
Micra™ Transcatheter Pacing System for atrial fibrillation and bradycardia (2014)[National Horizon Scanning Centre] NEW
Nanostim Leadless Pacemaker for atrial fibrillation and bradycardia (2014)[National Horizon Scanning Centre] NEW
Diagnostic Technology: Hand-held ECG monitors for the detection of atrial fibrillation (AF) in primary care (2013) [MaDOX] NEW
WatchBP Home A for opportunistically detecting atrial fibrillation during diagnosis and monitoring of hypertension (2013)[NICE] NEW
Apixaban for preventing stroke and systemic embolism in people with nonvalvular atrial fibrillation (2013)[NICE] NEW
Percutaneous balloon cryoablation for pulmonary vein isolation in atrial fibrillation (2013)[NICE] NEW
Stroke Prevention in Atrial Fibrillation (2013)[AHRQ] [Executive Summary] NEW
Treatment of Atrial Fibrillation (2013)[AHRQ][Executive Summary] NEWStroke Prevention in Atrial Fibrillation (2013)[AHRQ] [Executive Summary] NEW
Combined anticoagulation and antiplatelet therapy for high-risk patients with atrial fibrillation: a systematic review (2013) [NIHR HTA] NEW
Echocardiography in newly diagnosed atrial fibrillation patients: a systematic review and economic evaluation (2013) [NIHR HTA] NEW
Factor Xa inhibitors versus vitamin K antagonists for preventing cerebral or systemic embolism in patients with atrial fibrillation (2013) [Cochrane] NEW
Fish oil and atrial fibrillation after cardiac surgery: a meta-analysis of randomized controlled trials (2013)[DARE] NEW
Comparison of the efficacy and safety of new oral anticoagulants with warfarin in patients with atrial fibrillation: a meta-analysis of randomised trials (2013)[DARE] NEW
Novel oral anticoagulants in atrial fibrillation: a meta-analysis of large, randomized, controlled trials vs warfarin (2013)[DARE] NEW
Dabigatran in Atrial Fibrillation Question and Answers document to inform commissioners (2013)[West Midlands Clinical Support Unit] NEW
Dabigatran etexilate for the prevention of stroke and systemic embolism in atrial fibrillation (2012)[NICE] NEW
Comparison of the efficacy and safety of new oral anticoagulants with warfarin in patients with atrial fibrillation: a meta-analysis of randomised trials (2013)[DARE] NEW
Novel oral anticoagulants in atrial fibrillation: a meta-analysis of large, randomized, controlled trials vs warfarin (2013)[DARE] NEW
Dabigatran in Atrial Fibrillation Question and Answers document to inform commissioners (2013)[West Midlands Clinical Support Unit] NEW
Dabigatran etexilate for the prevention of stroke and systemic embolism in atrial fibrillation (2012)[NICE] NEW
Dabigatran texilate - for stroke prevention in patients with atrial fibrillation (2012)[MTRAC] NEW
Rivaroxaban for the prevention of stroke and systemic embolism in people with atrial fibrillation(2012)[NICE] NEW
Rivaroxaban (Xarelto) - for stroke prevention in patients with non-valvular atrial fibrillation (2012)[MTRAC] NEW
Dabigatran for Stroke Prevention in Atrial Fibrillation: A Review of the Evidence on Safety (2012)[CADTH] NEW
Comparative effectiveness of warfarin and new oral anticoagulants for the management of atrial fibrillation and venous thromboembolism: a systematic review (2012)[DARE] NEW
Percutaneous endoscopic catheter laser balloon pulmonary vein isolation for atrial fibrillation (2011)[NICE]
Effect of statins on atrial fibrillation: collaborative meta-analysis of published and unpublished evidence from randomised controlled trials (2011)[DARE]
Dronedarone increases the risk of heart failure, stroke and death compared to placebo in people with permanent AF (2011)[MeReC Rapid Review]
Modelling study finds no net benefit from aspirin plus clopidogrel versus aspirin alone in people with AF unable to take warfarin (2011)[MeReC Rapid Review]
Dronedarone for the treatment of atrial fibrillation (2011)[MTRAC]
Atrial fibrillation (chronic)(2011)[Clinical Evidence]Athens Log-in required
Atrial fibrillation (acute onset) (2010) [Clinical Evidence] Athens Log-in required
Atrial fibrillation (2010)[WeMeReC]
Percutaneous occlusion of the left atrial appendage in non-valvular atrial fibrillation for the prevention of thromboembolism (2010)[NICE]
Dronedarone for the treatment of non-permanent atrial fibrillation (2010)[NICE]
Antiarrhythmics for maintaining sinus rhythm after cardioversion of atrial fibrillation (2010) [Cochrane]
Systematic review and cost effectiveness evaluation of 'pill-in-the-pocket' strategy for paroxysmal atrial fibrillation compared to episodic in-hospital treatment or continuous antiarrhythmic drug therapy (2010)[NIHR HTA]
Statins for prevention of atrial fibrillation after cardiac surgery: a systematic literature review (2010)[DARE]
Warfarin vs. Aspirin For Atrial Fibrillation Stroke Prevention (2010)[theNNT]
Warfarin for Atrial Fibrillation Stroke Prevention (2010)[theNNT]
Percutaneous (non-thoracoscopic)epicardial catheter radiofrequency ablation for atrial fibrillation (2009)[NICE]
Catheter ablation for paroxysmal and persistent atrial fibrillation (2009)[Cochrane] NEW
Thoracoscopic epicardial radiofrequency ablation for atrial fibrillation (2009)[NICE]
Comparative effectiveness of radiofrequency catheter ablation for atrial fibrillation(2009)[DARE]
A systematic review of randomized trials comparing radiofrequency ablation with antiarrhythmic medications in patients with atrial fibrillation (2009)[DARE]
Intravenous magnesium sulphate and sotalol for prevention of atrial fibrillation after coronary artery bypass surgery: a systematic review and economic evaluation (2008) [NCCHTA]
Curative catheter ablation in atrial fibrillation and typical atrial flutter: systematic review and economic evaluation (2008)[NCCHTA]
Catheter ablation vs antiarrhythmic drug therapy for atrial fibrillation: a systematic review (2008)[DARE]
Is pulse palpation helpful in detecting atrial fibrillation: a systematic review (2006) [DARE]
Percutaneous radiofrequency ablation for atrial fibrillation (2006) [NICE]
Percutaneous occlusion of the left atrial appendage for atrial fibrillation (2006) [NICE]
High-intensity focused ultrasound for atrial fibrillation in association with other cardiac surgery (2006) [NICE]
Radiofrequency ablation for atrial fibrillation in association with other cardiac surgery (2005) [NICE]
Microwave ablation for atrial fibrillation in association with other cardiac surgery (2005) [NICE]
Cryoablation for atrial fibrillation in association with other cardiac surgery (2005) [NICE]
Pharmacological cardioversion for atrial fibrillation and flutter (2005) [Cochrane]
Electrical cardioversion for atrial fibrillation and flutter (2005) [Cochrane]
Antiplatelet therapy for preventing stroke in patients with non-valvular atrial fibrillation and no previous history of stroke or transient ischemic attacks (2005) [Cochrane]
Anticoagulants versus antiplatelet therapy for preventing stroke in patients with nonrheumatic atrial fibrillation and a history of stroke or transient ischemic attack (2004) [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 for preventing stroke in patients with nonrheumatic atrial fibrillation and a history of stroke or transient ischaemic attack (2003) [Cochrane]
Clinical Guidelines
Atrial Fibrillation (AF)(2013) [Map of Medicine] updated
Guidelines for the management of atrial fibrillation (2010) [ESC]
Atrial Fibrillation (2009) [CKS]
Atrial Fibrillation: The management of Atrial fibrillation (2006) [NICE] update expected in 2014
Recent articles in core journals
Outcomes of apixaban vs. warfarin by type and duration of atrial fibrillation: results from the ARISTOTLE trial (2013) [Eur Heart Journal] NEW
Cryoballoon ablation of pulmonary veins for paroxysmal atrial fibrillation: first results of the North American Arctic Front (STOP AF) pivotal trial (2013) [J Am Coll Cardiol] NEW
Effect of weight reduction and cardiometabolic risk factor management on symptom burden and severity in patients with atrial fibrillation: a randomized clinical trial (2013) [JAMA] NEW
Subclinical atrial fibrillation and the risk of stroke (2012)[NEJM] NEW
Atrial fibrillation (2012)[Lancet] NEW
In the clinic. Atrial fibrillation (2010)[Ann Intern Med]
Effect of age on stroke prevention therapy in patients with atrial fibrillation: the atrial fibrillation investigators (2009) [Evidence Updates]
Development of a risk score for atrial fibrillation (Framingham Heart Study): a community-based cohort study (2009) [Lancet]
eTextbooks
Atrial fibrillation: diagnosis and management (2011)[BMJ Learning]
Clinical Queries
A patient has a history of coronary artery disease and bypass graft and is taking an antiplatelet in the form of clopidogrel. Has recently been diagnosed with atrial fibrillation and warfarin has been initiated. Is there evidence/guideline to suggest whether he should continue clopidogrel for its antiplatelet effect, or should this be discontinued once warfarin treatment is established? I note a previous Attract answer to a similar query in 2009 - any more recent guidance? (2012) [ATTRACT]NEW
Would the levonorgestrel releasing intrauterine system be a suitable method for a woman who has had surgery for removal of four atrial myxomas, has atrial fibrillation and is taking aspirin and if so does she require antibiotic prophylaxis? (2011) )[FSRH]
What is the incidence of Atrial fibrillation (AF) in children under 15. Can AF be familial? (2009)[ATTRACT]
What is the evidence for an alternative anticoagulation e.g. dipyridamole in a patient with AF, who is allergic to aspirin and that warfarin is contra-indicated? (2008) [TRIP Answers]
Is there any evidence or guidance available on the most appropriate way to initiate Warfarin in patients newly diagnosed with chronic AF in the community? (2008)[ATTRACT]
Patient Information
Atrial Fibrillation (2013) [NHS Choices] updated
Atrial Fibrillation (2012) [Patient UK] updated
Atrial fibrillation (2012) [BUPA] NEW
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.
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