Family Medicine and Community Health COCHRANE UPDATES & NICE GUIDELINES

399 MulTIMEDIA EDuCATIONAl INTERVENTIONS REgARDINg PRESCRIBED AND OVER-THE-COuNTER MEDICATIONS THAT ARE EFFECTIVE FOR CONSuMERS

28 September 2013

PEARLS 399, August 2013, written by Brian R McAvoy

Clinical question: How effective are multimedia patient educational interventions regarding prescribed and over-thecounter medications for people of all ages, including children and carers?

Bottom line: Multimedia education regarding medications is more effective than usual care (non-standardised education provided by health professionals as part of usual clinical care), or no education, in improving both knowledge and skill acquisition, but not adherence to taking medications. Multimedia education was at least equivalent to other forms of education, including written education and education provided by a health professional.

Caveat: There was significant heterogeneity in the comparators used and the outcomes measured, which limited the ability to pool data. It was not possible to determine the effect of multimedia education on other outcomes, including patient satisfaction, self-efficacy, and health outcomes, due to an inadequate number of studies from which to draw conclusions. Many of the studies did not report sufficient information in their methods to allow judgment of the risk of bias.

Context: Consumers need detailed information about medications to enable them to use their medications safely and effectively. For information to be useful, the information needs to be presented in a format that can be easily understood by consumers. There is evidence that methods, such as spoken communication between the health provider and consumer and written materials, are not meeting consumers’ needs. Multimedia education programmes use more than 1 format to provide information. This could include using written words, diagrams, and pictures with the use of audio, animation, or video. The information can be provided using different technologies, such as DVDs and CD-ROMs, or can be accessed over the internet.

Cochrane Systematic Review: Ciciriello S et al. Multimedia educational interventions for consumers about prescribed and over-the-counter medications. Cochrane Reviews, 2013, Issue 4. Art. No.: CD008416.DOI: 10.1002/14651858. CD008416.pub2. This review contains 24 studies involving 8112 participants.

402 HOW EFFECTIVE ARE TOPICAl HERBAl THERAPIES FOR TREATINg OSTEOARTHRITIS?

31 October 2013

PEARLS 402, September 2013, written by Brian R McAvoy

Clinical Question: How effective are topical herbal therapies for treating osteoarthritis?

Bottom Line: Arnica gel likely improves symptoms as effectively as a gel containing non-steroidal anti-inflammatory drugs, but without a better (and possibly worse) adverse event profile. Comfrey extract gel likely improves pain, and capsicum extract gel would likely not improve pain or function at the doses examined in this review. Patches containing the Chinese herbal mixtures, Fufang Nanxing Zhitong gao (FNZg) and Shangshi Jietong gao (SJg), slightly improves pain and function more than placebo; however, there is uncertainty in the clinical applicability of these results because these interventions were tested over 7 days only.

Caveat: This review was compromised by some poorly designed clinical trials that were underpowered and inadequately blinded. The quality and/or quantity of current scientific evidence of effectiveness were insufficient for all of the products. generally, a high tolerance of the herbal medicinal products wasdemonstrated; however, caution is warranted in interpreting safety due to the small sample size in some of the studies.

Context: Before extraction and synthetic chemistry were invented, musculoskeletal complaints were treated with preparations from medicinal plants. The preparations were administered orally or topically. In contrast to the oral medicinal plant products, topical agents act in part as counterirritants or are toxic when given orally.

Cochrane Systematic Review: Cameron M and Chrubasik S. Topical herbal therapies for treating osteoarthritis. Cochrane Reviews, 2013, Issue 5. Art. No.: CD010538.DOI: 10.1002/14651858. CD010538. This review contains 7 studies involving 785 participants.

MANAgINg OVERWEIgHT AND OBESITY AMONg CHIlDREN AND YOuNg PEOPlE: lIFESTYlE WEIgHT MANAgEMENT SERVICES

NICE guidelines [PH47] Published date: October 2013http://www.nice.org.uk/guidance/PH47

This guidance makes recommendations on lifestyle weight management (sometimes called tier 2) services for overweight and obese children and young people < 18 years of age. These services are just one part of a comprehensive approach for the prevention and treatment of obesity.

The recommendations are for commissioners in local authorities and the NHS, and providers of community-based services that take a ‘lifestyle’ approach to helping overweight or obese children and young people manage their weight. The recommendations are also for health professionals and people working with children and young people, as well as members of the public.

The recommendations cover the following:

? planning services

? commissioning programmes

? core components of lifestyle weight management programmes

? developing a tailored programme plan to meet individual needs

? encouraging adherence

? raising awareness of programmes

? formal referrals to programmes

? providing ongoing support

? programme staff (training, knowledge, and skills)

? training how to make programme referrals

? supporting programme staff and those making programme referrals

? monitoring and evaluating programmes.

SMOKINg CESSATION IN SECONDARY CARE: ACuTE, MATERNITY, AND MENTAl HEAlTH SERVICES

NICE guidelines [PH48] Published date: November 2013

http://www.nice.org.uk/guidance/PH48

This guidance partially updates and replaces NICe public health guidance 10 (published in February 2008).

Stopping smoking at any time has considerable health benefits, and for people using secondary care services, there are additional advantages, including shorter hospital stays and fewer complications. Secondary care providers have a duty of care to protect the health of, and promote healthy behaviour among, people who use or work in their services.

This guidance aims to support smoking cessation, temporary abstinence from smoking, and smoke-free policies in all secondary care settings. The guidance recommends the following:

? Strong leadership and management to ensure premises remain smoke-free

? All hospitals have an on-site smoking cessation service

? Identifying people who smoke, offering advice and support for smoking cessation

? Providing intensive behavioural support and pharmacotherapy as anintegral component of secondary care

? Integrating smoking cessation support in secondary care with support provided by community-based services

? ensuring staff are trained to support people to stop smoking, while using secondary care services

? Supporting staff to stop smoking or to abstain while at work

? ensuring there are no designated smoking areas or staff-facilitated smoking breaks for anyone using secondary care services.