Fuelling the debate on e-cigarettes

E-cigarettes continue to divide opinion (resulting in some strange bedfellows), but there is emerging evidence that they are a beneficial aid to stopping smoking and reducing consumption. The first version of what is likely to be a frequently updated review included two randomised trials involving 662 smokers that compared e-cigarettes with and without nicotine. About 9% of smokers who used nicotine e-cigarettes had stopped smoking for at least 6 months, compared with 4% of those using nicotine-free e-cigarettes. Nicotine e-cigarettes were also more effective than placebo e-cigarettes in enabling participants to halve cigarette consumption rates (doi: 10.1002/14651858.CD010216.pub2). There is not yet sufficient evidence to properly compare e-cigarettes with other quitting aids.

A recent review of point-of-care biomarker testing sounds a cautiously optimistic note in the fight against antibiotic resistance. Six trials involving over 3200 mostly adult patients with acute respiratory infections were reviewed. All investigated the use of C-reactive protein tests to guide antibiotic prescribing in primary care. Encouragingly, doctors who test for the presence of bacterial infections were likely to prescribe fewer antibiotics, and no difference was found between the two groups in terms of how long patients took to recover (doi: 10.1002/14651858.CD010130.pub2).

Getting back to work after the summer break can test even the most eager among us, but what of depressed workers for whom absenteeism is commonplace? A recent review of clinical and work-related interventions to reduce the number of days of sick leave taken included 23 studies involving about 6000 participants. The review found that adding a work-directed intervention, such as modifying the type of work, to usual care reduced sick leave, as did enhancing primary or occupational care with cognitive behaviour therapy (doi: 10.1002/14651858.CD006237.pub3).

Parents of children suffering from gastro-oesophageal reflux might reasonably ask whether medicines would make a difference. Although 24 studies contributed data to a new review, concerns over industry influence, diverse study populations and a lack of common end points limit the usefulness of the evidence. Most parents of young babies would probably nod resignedly on hearing there is “little evidence to suggest that medicines for babies younger than one year work”. In older children, proton pump inhibitors and histamine antagonists appear to work, but the evidence does not provide a guide to their relative efficacy (doi: 10.1002/14651858.CD008550.pub2).

For more on these and other reviews, check out www.thecochranelibrary.com.