All posts by dbhcurrentawareness

Cochrane Review: Interventions for autumn exacerbations of asthma in children



Asthma exacerbations in school-aged children peak in autumn, shortly after children return to school following the summer holiday. This might reflect a combination of risk factors, including poor treatment adherence, increased allergen and viral exposure, and altered immune tolerance. Since this peak is predictable, interventions targeting modifiable risk factors might reduce exacerbation-associated morbidity and strain upon health resources. The peak occurs in September in the Northern Hemisphere and in February in the Southern Hemisphere.

Authors’ conclusions

Seasonal omalizumab treatment from four to six weeks before school return might reduce autumn asthma exacerbations. We found no evidence that this strategy is associated with increased adverse effects other than injection site pain, but it is costly. There were no data upon which to judge the effect of this or other seasonal interventions on asthma control, quality of life, or asthma-related death. In future studies definitions of exacerbations should be provided, and standardised where possible. To investigate possible differential effects according to subgroup, participants in future trials should be well characterised with respect to baseline asthma severity and exacerbation history in addition to age and gender.

Full review here


Standard (head-down tilt) versus modified (without head-down tilt) postural drainage in infants and young children with cystic fibrosis – Cochrane Review

This is an update of a review published in 2015.


Postural drainage is used primarily in infants with cystic fibrosis from diagnosis up to the moment when they are mature enough to actively participate in self-administered treatments. However, there is a risk of gastroesophageal reflux associated with this technique.

Authors’ conclusions

The limited evidence regarding the comparison between the two regimens of postural drainage is still weak due to the small number of included studies, the small number of participants assessed, the inability to perform any meta-analyses and some methodological issues with the studies. However, it may be inferred that the use of a postural regimen with a 30° head-up tilt is associated with a lower number of gastroesophageal reflux episodes and fewer respiratory complications in the long term. The 20° head-down postural drainage position was not found to be significantly different from the 20° head-up tilt modified position. Nevertheless, the fact that the majority of reflux episodes reached the upper oesophagus should make physiotherapists carefully consider their treatment strategy. We do not envisage that there will be any new trials undertaken that will affect the conclusions of this review; therefore, we do not plan to update this review.

Full review here

Are we listening? A review of children and young people’s mental health services

Are we listening

The Care Quality Commission, published 8/3/18.

This report describes the findings of an independent review of the system of services that support children and young people’s mental health. It indicates that many children and young people experiencing mental health problems don’t get the kind of care they deserve; the system is complicated, with no easy or clear way to get help or support.

Link to report here

Bringing CAMHS closer to home: Developing community pharmacies to support medication monitoring in children and young people

Image: GoogleImages Free
  • Led by Sussex Partnership NHS Foundation Trust.
  • Aimed to improve care for children and young people (CYP) with attention deficit hyperactivity disorder (ADHD) and related conditions.
  • Trained local community pharmacists to carry out physical monitoring of these patients, providing a more convenient service for families as well as freeing-up child and adolescent mental health services (CAMHS) resources.
  • Project ran from March 2016 to August 2017.

Children and young people (CYP) who are prescribed medication for ADHD and related conditions need regular monitoring of key metrics (height, weight, blood pressure and pulse).

Nationally, child and adolescent mental health services (CAMHS) teams are struggling to meet increasing demands on their services. In addition, service user feedback suggests that families want locally delivered services.

This project used community pharmacies to provide physical monitoring of CYP on ADHD medication, rather than the CAMHS clinic. Consenting families selected a pharmacy to have their key metrics measured at a convenient time. The results were available to the CAMHS team via a secure website.

Previously, some patients were being seen when there was no clinical need, others were unable to get more intensive support, and monitoring targets were being missed. For many families, clinic appointments meant their CYP was missing school unnecessarily and the parent was missing work.

The project has seen increased numbers of patients engaging with medication monitoring, and receiving improved quality of care closer to home. The clinic is also more compliant with NICE guidelines for medication monitoring. Of the 153 CYP eligible, 137 (90%) were actively involved in the project. All audit outcomes relating to medication monitoring and review improved dramatically because of the project.

It is estimated that 40% of the CAMHS team’s resources were released to provide more input to those with greater needs. Important success factors were having a cohesive project team, co-designing with key stakeholders and carrying out a mini-pilot prior to starting the project.

Funding has been secured to maintain this new service at the New Forest CAMHS clinic and it is the Trust’s intention to roll it out across Hampshire and Sussex, pending new funding.

Full article here

NIHR Signal: Group-based interventions may help teenagers stop smoking

Image: Pixabay

Published on 30 January 2018

There is no single clear intervention that helps young people quit smoking in the UK, but this review shows that group counselling is one that may be effective.

Interventions included in this review were diverse, for example, computer or text-based, group or individual counselling. Drug treatments such as nicotine patches were included too. Although the review was large, including 41 trials involving more than 13,000 young people, most interventions were not shown to be effective. In contrast, about a third more of those taking part in group counselling quit smoking compared with controls.

Given the high cost to the NHS attributed to smoking-related illness and the uptake of smoking in teenage years, finding effective interventions for this age group is imperative. This review suggests that using group counselling as one tactic might be effective.

Link to article here