Informed healthcare online

Informed Health Online is produced by the Health Research and Education Foundation Ltd. The Foundation is a not-for-profit health promotion organisation based in Melbourne, Australia. The Foundation is based on these principles:

·                 Good health care information should be available free, in major community languages.

·                 Evidence on the effects of health care is essential for informed self-care and professional health care.

·                 Communities have a right of access to information that is essential to improving and maintaining their health and wellbeing.

·                 Health professionals have a right of access to information that is essential to offering the best advice and care.

The Foundation aims to provide information and resource tools that enable people to keep up-to-date with reliable, evidence-based information. The Foundation promotes research literacy, and individual and community use of high quality research.

A key goal is to promote the accessibility of health information from the Cochrane Collaboration, and based on Cochrane reviews and other reliable research on the effects of health care.

All the information produced by the Informed Health Online for this web site and for the Collaboration aims to uphold both the high scientific standards of the Cochrane Collaboration, and high quality in communicating in plain language.

If you want to know if something is really worth trying, you need good evidence about the treatment’s effects – ideally from high quality trials. Trials are a powerful way of testing, as fairly and as objectively as possible, what the impacts are of health care treatments and other activities. You can learn more about fair tests of health care interventions, and reducing the influence of bias and chance, at The James Lind Initiative.

While trials offer a strong and reliable method to test health care interventions and activities, a single trial is rarely enough. What's more, even if all the good quality trials show the same results, new evidence can emerge that shifts the balance of evidence and changes the bigger picture.

Looking at a single trial can be very misleading - perhaps there are 10 other trials that found the opposite. Or perhaps only the trials that showed a treatment was effective were published and reached the light of the day .

Ref: Web

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Glucosamine and chondroitin for knee OA

This piece, in the latest Bandolier, showed that as many as 1 in 5 patients with knee arthritis will benefit from using oral glucosamine at 1,500 mg daily. The number needed to treat for response was 4.9. Glucosamine reduced joint space narrowing by 2.7 mm over three years compared with placebo.

The systematic review they report had an exhaustive search strategy up to March 2002, For inclusion trials had to be randomised, double blind and placebo controlled, had to assess structural or symptomatic efficacy of oral glucosamine or chondroitin, have a treatment period of at least four weeks, use sensible outcomes, and be valid biological assays.

Fifteen studies were included, with data on 1,775 patients (1,020 glucosamine and 755 chondroitin). Quality scores were high, and were higher for glucosamine trials (all scored 4 or 5 out of 5) than chondroitin trials (all scored 3, 4 or 5 out of 5, except one with insufficient details for scoring). Most studies used intention to treat analyses.

Glucosamine significantly reduced joint space narrowing by about 0.27 mm compared with placebo over three years with 1,500 mg daily. Glucosamine and chondroitin improved continuous outcomes measured using the Lequesne index, the WOMAC index, and pain and mobility.

This excellent systematic review calculated a number needed to treat (NNT) for a responder as 4.9 on the basis of global outcomes, rather similar to the value of 5.0 calculated in the original Bandolier review (Bandolier 46).

As many as 1 in 5 patients with knee arthritis will benefit from using oral glucosamine at 1,500 mg daily.

Ref: Web

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Best Bets—tap water OK for sterilising small wounds

I make no apology for mentioning this most useful site again. Physicians need rapid access to the best current evidence on a wide range of clinical topics. But where to find it? Textbooks are frequently out-of-date, and we don't have the time to perform literature reviews while the patient is waiting.

BETs were developed in the Emergency Department of Manchester Royal Infirmary, UK, to provide rapid evidence-based answers to real-life clinical questions, using a systematic approach to reviewing the literature. BETs take into account the shortcomings of much current evidence, allowing physicians to make the best of what there is. Although BETs initially had an emergency medicine focus, there are a significant number of BETs covering cardiothoracics, nursing, primary care and paediatrics.

BETs bring the evidence one step closer to the bedside, by providing answers to very specific clinical problems, using the best available evidence. Each Topic answers a carefully worded 3-part question, using a structured approach to finding and reviewing the literature. BETs are designed specifically for Emergency Medicine. The BET method allows the use of lower quality research, and lists the shortcomings of the evidence used. As with other forms of EBM topic review, each BET has a clinical "bottom line" for the busy physician.

The clinical scenario is: A patient presents to the Emergency Department with a laceration to the right forearm. The wound will need cleaning and then closing. There appear to be many different cleaning solutions available - you wonder which is best.

397 papers on the subject were found. One citation was a Cochrane review of tap water use. There are no individual published after the Cochrane review. 4 other papers not included in the Cochrane review of water are also included.

It is striking that the infection rate remained 5 - 10% whatever the intervention. In this case the cheapest and most easily obtained solution should be used. The meta-analysis shows that tap water may have a beneficial effect.

Clearly the quality of water should be good (at least potable). The clinical bottom line is that tap water is a safe and effective solution for cleaning recent wounds requiring closure and is the treatment of choice.

Ref: Web

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