Reviews

Integrated disease management interventions for patients with chronic obstructive pulmonary disease
In these COPD participants, IDM not only improved disease-specific QoL and exercise capacity, but also reduced hospital admissions and hospital days per person. Evidence Updates

Addition of anti-leukotriene agents to inhaled corticosteroids in children with persistent asthma
The addition of anti-leukotrienes to ICS is not associated with a statistically significant reduction in the need for rescue oral corticosteroids or hospital admission compared to the same or an increased dose of ICS in children and adolescents with mild to moderate asthma. Although anti-leukotrienes have been licensed for use in children for over 10 years, the paucity of paediatric trials, the absence of data on preschoolers, and the variability in the reporting of relevant clinical outcomes considerably limit firm conclusions. At present, there is no firm evidence to support the efficacy and safety of anti-leukotrienes as add-on therapy to ICS as a step-3 option in the therapeutic arsenal for children with uncontrolled asthma symptoms on low-dose ICS. Evidence Updates

Screening and management of depression for adults with chronic diseases: an evidence-based analysis
There was no evidence to suggest that a screen-and-treat strategy for depression among adults with chronic diseases resulted in improved chronic disease outcomes. Health Quality Ontario. Ont Health Technol Assess Ser. 2013 Sep 1;13(8):1-45. PMID: 24133570

Adult Patients With Nosocomial Pneumonia: Epidemiology, Diagnosis, and Treatment
The new guideline's recommendations are intended to encourage rational use of antibiotics, so that antimicrobial treatment will be highly effective while the unnecessary selection of multi-drug-resistant organisms will be avoided. Dalhoff K, Ewig S; on behalf of the Gideline Development Group*. Dtsch Arztebl Int. 2013 Sep;110(38):634-640. Epub 2013 Sep 20. Review. PMID: 24133545

Negative pressure wound therapy for treating foot wounds in people with diabetes mellitus
There is some evidence to suggest that negative pressure wound therapy is more effective in healing post-operative foot wounds and ulcers of the foot in people with DM compared with moist wound dressings. However, these findings are uncertain due to the possible risk of bias in the original studies. The limitations in current RCT evidence suggests that further trials are required to reduce uncertainty around decision making regarding the use of NPWT to treat foot wounds in people with DM. Dumville JC, Hinchliffe RJ, Cullum N, Game F, Stubbs N, Sweeting M, Peinemann F. Cochrane Database Syst Rev. 2013 Oct 17;10:CD010318. [Epub ahead of print] PMID: 24132761

Valproic acid, valproate and divalproex in the maintenance treatment of bipolar disorder
Limited evidence supports the efficacy of valproate in the long-term treatment of bipolar disorder. Clinicians and patients should consider acceptability and tolerability profile when choosing between lithium and valproate-their combination or other agents-as long-term treatment for bipolar disorder. Cipriani A, Reid K, Young AH, Macritchie K, Geddes J. Cochrane Database Syst Rev. 2013 Oct 17;10:CD003196. [Epub ahead of print] PMID: 24132760

Surgical interventions for the early management of Bell's palsy
There is only very low quality evidence from randomised controlled trials and this is insufficient to decide whether surgical intervention is beneficial or harmful in the management of Bell's palsy.Further research into the role of surgical intervention is unlikely to be performed because spontaneous recovery occurs in most cases. McAllister K, Walker D, Donnan PT, Swan I. Cochrane Database Syst Rev. 2013 Oct 16;10:CD007468. [Epub ahead of print] PMID: 24132718

The difficult airway with recommendations for management - Part 1 - Difficult tracheal intubation encountered in an unconscious/induced patient
The clinician must be aware of the potential for harm to the patient that can occur with multiple attempts at tracheal intubation. This likelihood can be minimized by moving early from an unsuccessful primary intubation technique to an alternative "Plan B" technique if oxygenation by face mask or ventilation using a supraglottic device is non-problematic. Irrespective of the technique(s) used, failure to achieve successful tracheal intubation in a maximum of three attempts defines failed tracheal intubation and signals the need to engage an exit strategy. Failure to oxygenate by face mask or supraglottic device ventilation occurring in conjunction with failed tracheal intubation defines a failed oxygenation, "cannot intubate, cannot oxygenate" situation. Cricothyrotomy must then be undertaken without delay, although if not already tried, an expedited and concurrent attempt can be made to place a supraglottic device. Law JA, Broemling N, Cooper RM, Drolet P, Duggan LV, Griesdale DE, Hung OR, Jones PM, Kovacs G, Massey S, Morris IR, Mullen T, Murphy MF, Preston R, Naik VN, Scott J, Stacey S, Turkstra TP, Wong DT; for the Canadian Airway Focus Group. Can J Anaesth. 2013 Oct 17. [Epub ahead of print] PMID: 24132407

Inhaled Nitric Oxide Does Not Reduce Mortality in Patients With Acute Respiratory Distress Syndrome Regardless of Severity: Systematic Review and Meta-Analysis
Nitric oxide does not reduce mortality in adults or children with acute respiratory distress syndrome, regardless of the degree of hypoxemia. Given the lack of related ongoing or recently completed randomized trials, new data addressing the effectiveness of nitric oxide in patients with acute respiratory distress syndrome and severe hypoxemia will not be available for the foreseeable future. Adhikari NK, Dellinger RP, Lundin S, Payen D, Vallet B, Gerlach H, Joo Park K, Mehta S, Slutsky AS, Friedrich JO. Crit Care Med. 2013 Oct 15. [Epub ahead of print] PMID: 24132038