NO CLEAR BENEFIT FROM ACTIVE CHEST COMPRESSION-DECOMPRESSION COMPARED WITH STANDARD MANUAL CPR

5 April 2014 PEARLS 409,October 2013,written by Brian R McAvoy Clinical question:How effective is active chest compression-decompression cardiopulmonary resuscitation(ACDR CPR)in adults with cardiac arrest?Bottom line:There is no clear evidence of a benefit from the use of ACDR CPR compared with standard manual CPR in people with cardiac arrest occurring in different settings and different emergency medical systems.

SMALL BENEFIT FROM COGNITIVE BEHAVIORAL THERAPIES FOR FIBROMYALGIA

8 April 2014 PEARLS 412,November 2013,written by Brian R McAvoy Clinical question:How effective are cognitive behavioral therapies(CBTs)for treating fibromyalgia?Bottom line:CBTs were superior to controls in reducing pain at the end of treatment by 0.5 points on a scale of 0-10 and by 0.6 points at the time of long-term follow-up(median=6 months).CBTs reduced negative mood at end of treatment by 0.7 points and 1.3 points at long-term follow up.

ENHANCED CARE MAY HELP PEOPLE WITH FUNCTIONAL SOMATIC SYMPTOMS

Clinical question:How effective are enhanced care interventions for adults with functional symptoms in primary care?Bottom line:Trials aimed to teach general practitioners(GPs)a variety of interventions,including opportunistic approaches,individual consultations,and more structured management(e.g.,patient diaries and planned follow-up).While statistical heterogeneity in some comparisons precluded meta-analyses,other comparisons were conducive to meta-analyses.Effect sizes for both physical and mental health were small and without clinical significance at both short-and long-term follow-up.Patient satisfaction with care appeared to be greater in the intervention group in all three studies that evaluated this treatment approach,although the results were not statistically significant.The effects on healthcare use were inconclusive with respect to GP visits;the effects on overall healthcare costs could not be estimated.Attrition was slightly higher in the intervention group.

LIMITED BENEFIT FROM TELEPHONE SUPPORT FOR PREGNANT WOMEN

May 2014 PEARLS 422,February 2014,written by Brian R McAvoy Clinical question:Compared with routine care,how effective is telephone support during pregnancy and the first 6 weeks postpartum?Bottom line:Despite some encouraging findings,there is insufficient evi-dence to recommend routine telephone support for women accessing maternity services,as the evidence is neither strong nor consistent.

SIMPLE TREATMENTS EFFECTIVE FOR BEDWETTING IN CHILDREN

Clinical question:How effective are simple behavioral interventions(rewarding dry nights with star charts,lifting and waking,and bladder training)for nocturnal enuresis in children(≤16 years of age)?Bottom line:Based on single small trials,rewards,lifting and waking,and bladder training were each associated with significantly fewer wet nights,higher full response rates,and lower relapse rates compared with controls.Simple behavioral interventions appeared to be less effective when compared with other known effective interventions,such as enuresis alarm therapy and drug ther-apy with imipramine and amitriptyline;however,the effect of drug therapies was not sustained at follow-up after completion of treatment.When one simple behavioral therapy was compared with another behavioral therapy,there did not appear to be one behavioral therapy that was more effective.Simple treatments have no side effects or safety concerns.

INTERVENTIONS TO PROMOTE PRE-OP INFORMED CONSENT EFFECTIVE

Clinical question:How effective are interventions to promote informed con-sent for patients undergoing surgical and other invasive healthcare treatments and procedures?Bottom line:Most interventions to pro-mote informed consent included the use of written or audiovisual aids.Interventions improved knowledge of the planned pro-cedure immediately(≤24 h),in the short-term(1-14 days)and long-term(>14 days).Satisfaction with decision-making was increased,decisional conflict was reduced,and the length of consultation was slightly increased.There were no differences between the intervention and control groups regarding outcomes involving generalized anxiety,and anxiety or satisfaction associated with the consent process.

SELF-HELP THERAPIES OF SOME BENEFIT IN ANXIETY DISORDERS

Clinical question:How effective are media-delivered cognitive behavioral therapy and behavioral therapy(self-help therapy)for anxiety disorders in adults?Bottom line:Self-help therapies may be superior to no intervention for people with anxiety.There are reports of positive effects arising from self-help therapy on symptoms of anxiety and depression,response and recovery from illness,disability,and quality of life.Face-to-face interventions may be superior to media-delivered interventions.There are differences favoring face-to-face treatment for symptoms of anxiety,but no significant differences in response and recovery from illness,disability,and quality of life;however,few studies included follow-up after 6 months.The therapeutic effects were maintained after cessation of treatment.