Evidence Update (June 2015)

Evidence Update (June 2015)

For abstracts of the reviews below please click on the titles. There may be a link to the full text in the top right hand corner of the webpage. You may have to log in using your NHS Athens username and password, if you don’t have one go to Register for Athens and register for free.

If full text is not available then please email us to request a copy, directly quoting the number(s) of the articles you would like.


1) Violence and aggression: short-term management in mental health, health and community settings (NG10)

Additional link: NICE press release

2) Challenging behaviour and learning disabilities: prevention and interventions for people with learning disabilities whose behaviour challenges (NG11)

Additional link: NICE press release

3) Bronchiolitis in children


4) Rhythm control in atrial fibrillation

Updated 2015 May 15 02:37:00 PM: amiodarone may reduce risk for atrial fibrillation recurrence compared to dronedarone, sotalol, and class I antiarrhythmic drugs (Cochrane Database Syst Rev 2015 Mar 28)


5) Sweet tasting solutions for reduction of needle-related procedural pain in children aged one to 16 years

Authors’ conclusions: Based on the eight studies included in this systematic review update, two of which were subgroups of small numbers of eligible toddlers from larger studies, and three of which were pilot RCTs with small numbers of participants, there is insufficient evidence of the analgesic effects of sweet tasting solutions or substances during acutely painful procedures in young children between one and four years of age. Further rigorously conducted, adequately powered RCTs are warranted in this population. Based on the two studies by the same author, there was no evidence of analgesic effects of sweet taste in school-aged children. As there are other effective evidence-based strategies available to use in this age group, further trials are not warranted.

Despite the addition of four studies in this review, conclusions have not changed since the last version of the review.

6) Transfusion of fresher versus older red blood cells for all conditions

Authors’ conclusions:  Several factors precluded firm conclusions about the clinical outcomes of transfusing red blood cell units that have been stored for different periods of time before transfusion, including differences in clinical population and setting, diversity in the interventions used, methodological limitations and differences in how outcomes were measured and reported.

No clear differences in the primary outcome - death - were noted between 'fresher' and 'older' or 'standard practice' red blood cells in trials that reported this outcome. Findings of a large number of ongoing trials will be incorporated into this review when they are published.

Updates of this review will explore the degree of overlap in trials between 'fresher', 'older' and 'standard practice' storage ages of red blood cells and will consider whether the size of any observed effects is dependent on recipient factors such as clinical background, patient age or clinical presentation.

7) Antibiotics for acute laryngitis in adults

Authors’ conclusions: Antibiotics do not appear to be effective in treating acute laryngitis when assessing objective outcomes. They appear to be beneficial for some subjective outcomes. Erythromycin could reduce voice disturbance at one week and cough at two weeks when measured subjectively. Fusafungine could increase the cure rate at day five. The included RCTs had important methodological problems and these modest benefits from antibiotics may not outweigh their cost, adverse effects or negative consequences for antibiotic resistance patterns.

8) Computed tomography versus magnetic resonance imaging versus bone scintigraphy for clinically suspected scaphoid fractures in patients with negative plain radiographs

Authors’ conclusions: Although quality of the included studies is moderate to good, findings are based on only 11 studies and the confidence intervals for the summary estimates are wide for all three tests. Well-designed direct comparison studies including CT, MRI and BS could give valuable additional information.

Bone scintigraphy is statistically the best diagnostic modality to establish a definitive diagnosis in clinically suspected fractures when radiographs appear normal. However, physicians must keep in mind that BS is more invasive than the other modalities, with safety issues due to level of radiation exposure, as well as diagnostic delay of at least 72 hours. The number of overtreated patients is substantially lower with CT and MRI.

Prior to performing comparative studies, there is a need to raise the initially detected prevalence of true fractures in order to reduce the effect of the relatively low specificity in daily practice. This can be achieved by improving clinical evaluation and initial radiographic assessment.


9) Trial of Short-Course Antimicrobial Therapy for Intraabdominal Infection

10) Therapeutic Hypothermia after Out-of-Hospital Cardiac Arrest in Children

11) Acute Appendicitis — Appendectomy or the “Antibiotics First” Strategy

12) Treatment of Hematoma of the Nasal Septum

13) Clinical problem-solving. Sick as a dog

14) Case records of the Massachusetts General Hospital. Case 16-2015. A 9-year-old girl with loss of consciousness and seizures

15) Case records of the Massachusetts General Hospital. Case 15-2015. A 27-year-old man with a nail in the eye

16) Antibiotics for Abdominal Sepsis

17) Reduction in Ephedra Poisonings after FDA Ban


18) Using apps in clinical practice

The Royal College of Physicians has published Using apps in clinical practice, this guidance aims to provide clinicians and medical app developers with important information about the use of apps in clinical practice.

19) Emergency department bulletin

20) Urgent Care and A&E from the patient perspective

The Royal College of Emergency Medicine and the Patient’s Association have jointly published Time to Act - urgent care and A&E: the patient perspective. This report highlights new research exploring the choices, decisions and experiences of patients who accessed A&E services for urgent healthcare needs.  The survey results show that patients are aware of alternatives to A&E however, many still attend A&E because they are unable to access timely help elsewhere.

Additional link: RCGP press release

21) Local alcohol profiles for England: 2015 annual data update

Public Health England has published the Local Alcohol Profiles for England (LAPE) data update for June 2015 in a new interactive tool. The tool presents data for 19 alcohol-related indicators and allows users to view and analyse data in a user-friendly format. The LAPE website also provides links to further supporting and relevant information to aid understanding of alcohol-related harm in a local population. This update includes: more recent data for all indicators; new indicators relating to reason for hospital admission and benefit claims and additional gender breakdowns for mortality and hospital admission indicators.

Additional link: PHE press release

22) Statistics

23) Guidance on overseas visitors hospital charging regulations updated

The Department of Health has added an ordinary residence tool for overseas visitors to its suite of documents relating to overseas visitors hospital charging regulations.  The tool is aims to help managers when there are doubts about a patient’s entitlement to free NHS hospital treatment and when their ordinary residence or status is not immediately clear.


24) Academic Emergency Medicine

25) Annals of Emergency Medicine

26) Emergency Medicine Journal

27) European Journal of Emergency Medicine

28) Journal of Emergency Nursing

29) The Lancet

30) BMJ

31) New England Journal of Medicine

32) Pediatrics

33) Archives of Disease in Childhood

New Doctors Day

New Doctors Day

Evidence Update (May 2015)

Evidence Update (May 2015)