This was a study to determine whether a pharmacist can effectively review repeat prescriptions through consultations with elderly patients in general practice.It was a randomised controlled trial comparing clinical medication review by a pharmacist against normal general practice review in four general practices

1188 patients aged 65 or over who were receiving at least one repeat prescription and living in the community took part.

Patients were invited to a consultation at which the pharmacist reviewed their medical conditions and current treatment. The number of changes to repeat prescriptions over one year, drug costs, and use of healthcare services were measured.

590 (97%) patients in the intervention group were reviewed compared with 233 (44%) in the control group. Patients seen by the pharmacist were more likely to have changes made to their repeat prescriptions (mean number of changes per patient 2.2 v 1.9; difference = 0.31, 95% confidence interval 0.06 to 0.57; P = 0.02).

Monthly drug costs rose in both groups over the year, but the rise was less in the intervention group (mean difference £4.72 per 28 days, - £7.04 to £2.41); equivalent to £61 per patient a year. Intervention patients had a smaller rise in the number of drugs prescribed (0.2 v 0.4; mean difference – 0.2, - 0.4 to – 0.1.) There was no evidence that review of treatment by the pharmacist affected practice consultation rates, outpatient consultations, hospital admissions, or death rate.

This study showed that a clinical pharmacist can conduct effective consultations with elderly patients in general practice to review their drugs. Such review results in significant changes in patients’ drugs and saves more than the cost of the intervention without affecting the workload of general practitioners.

Ref: (web)

Summary of recommendations:

Acupuncture involves the stimulation of specific points (acupoints) on the skin, usually by the insertion of needles. It is widely used in both private and NHS settings.

It has been estimated that one million acupuncture treatments are given on the NHS and two million in the private sector in England each year.

In the West, acupuncture is most commonly used for the treatment of chronic pain, particularly musculoskeletal complaints. Whilst there are many RCTs evaluating the effectiveness of acupuncture, the majority are of poor quality, and provide conflicting evidence.

chemotherapy-related nausea and vomiting and for postoperative dental pain.

Current evidence suggests that acupuncture is unlikely to be of benefit for obesity, smoking cessation and tinnitus.

For most other conditions, the available evidence is insufficient to guide clinical decisions. Acupuncture appears a relatively safe treatment in the hands of suitably qualified practitioners, with serious adverse events being extremely rare.

Ref: to main effective healthcare bulletin site

One of the fundamental skills required for practising EBM is the asking of well-built clinical questions. To benefit patients and clinicians, such questions need to be both directly relevant to patients' problems and phrased in ways that direct your search to relevant and precise answers. In practice, well-built clinical questions usually contain four elements, summarised below.

Starting with your patient ask “How would I describe a group of patients similar to mine?” Balance your precision with brevity

Eg in patients with heart failure from dilated cardiomyopathy who are in sinus rhythm...

Ask “Which main intervention am I considering?” Be specific

Eg … would adding anticoagulation with warfarin to standard heart failure therapy …

Ask “What is the main alternative to compare with the intervention?” Again, be specific.

Eg … when compared with standard therapy alone….

Ask “What can I hope to accomplish?” or “What could this therapy really effect?” Again be specific.

Eg. … lead to lower mortality or morbidity from thromboembolism. Is this enough to be worth the increased risk of bleeding?

The benefits of breast feeding are well known but controversy continues about how long mothers should wait before introducing their baby to other foods. Should she do so when the baby is four or five months old, or should she wait for six months?

A new Cochrane review, which has been prepared following the production of a systematic review for WHO. The searching found 38 citations, reporting 20 separate studies. Nine of these had been done in developing countries and 11 in developed countries. Among these, there were only two studies which used an experimental design to address the duration of exclusive breast feeding. Both of these were done in Honduras.

The reviewers found that babies who were exclusively breast fed for six months had less infectious illness than those who were given other foods from three or four months onwards. The reviewers also found no convincing evidence that the growth of babies in either developing or developed countries was impaired if they were exclusively breast fed for six months or longer.

They conclude that there is no evidence to oppose a general policy of exclusive breast feeding until a baby is six months old. This is true for both developing and developed countries. However It would be nice to have some large, randomised trials.

Ref: (web)