Evidence for Primary Care: the latest evidence from the Trip Database

British Association of Dermatologists

What are the British Association of Dermatologists' guidelines for managing people with alopecia areata?

Clinical Bottom Line: The British Association of Dermatologists (BAD) has released updated, evidence-based guidelines for the management of alopecia areata (AA). These guidelines provide comprehensive recommendations for clinicians treating adults, children, and young people with AA, aiming to standardize and improve patient care across the UK.

Summary: Alopecia areata is an autoimmune condition characterized by non-scarring hair loss, affecting individuals of all ages. The BAD’s living guideline offers up-to-date, evidence-based recommendations for managing AA in adults (≥18 years), children (0–12 years), and young people (13–17 years). The guideline emphasizes a patient-centered approach, considering disease severity, patient preferences, and psychosocial impact. It covers diagnostic criteria, assessment tools, and therapeutic options, including topical, intralesional, and systemic treatments. The guideline also highlights the importance of multidisciplinary collaboration and the need for further research to address gaps in evidence

The wider evidence base: Search Trip for more evidence on alopecia areata, click here.

UK Health Security Agency

Is vaginal oestrogen effective in preventing primary urinary tract infections in perimenopausal, menopausal, or postmenopausal women?

Clinical Bottom Line: A rapid review conducted by the UK Health Security Agency (UKHSA) found no evidence to determine the effectiveness of vaginal oestrogen in preventing primary urinary tract infections (UTIs) among women experiencing perimenopause, menopause, or postmenopause. Consequently, no conclusions can be drawn regarding its efficacy for this specific purpose.
GOV.UK

Summary: The UKHSA performed a rapid review to assess whether vaginal oestrogen could effectively prevent primary (non-recurrent) UTIs in women undergoing perimenopause, menopause, or postmenopause. The comprehensive search, which included 1,694 records from six databases up to February 26, 2024, did not identify any studies meeting the inclusion criteria. As a result, there is a lack of evidence to support or refute the use of vaginal oestrogen for preventing primary UTIs in this population. Further research is necessary to evaluate the potential benefits and risks of such an intervention.

The wider evidence base: Search Trip for more evidence on UTIs around the menopause, click here.

American Heart Association

What is the impact of smokeless oral nicotine products on cardiovascular disease, and what are the implications for policy, prevention, and treatment?

Clinical Bottom Line: The American Heart Association (AHA) has issued a policy statement highlighting that smokeless oral nicotine products are addictive and may adversely affect certain biomarkers associated with cardiovascular risk. The use of specific smokeless tobacco products has been linked to increased mortality in individuals with ischemic heart or cerebrovascular disease. The AHA emphasizes the need for comprehensive regulatory policies to mitigate the potential health risks associated with these products.

Summary: The AHA’s policy statement addresses the rising use of smokeless oral nicotine products, including nicotine pouches, lozenges, and chewing gums. These products deliver nicotine without combustion, leading to the perception that they are safer alternatives to smoking. However, the statement underscores that these products are addictive and may negatively influence biomarkers related to cardiovascular disease (CVD). Notably, certain smokeless tobacco products have been associated with higher mortality rates among individuals suffering from ischemic heart disease or cerebrovascular conditions. The AHA calls for robust regulatory measures, public education, and further research to fully understand the health implications of these products and to inform policy decisions aimed at protecting public health.

Thorax

Is smartphone application-based pulmonary rehabilitation effective in patients with chronic obstructive pulmonary disease (COPD)?

Clinical Bottom Line: A multicentre randomized controlled trial investigated the efficacy of a smartphone application-based pulmonary rehabilitation program in patients with chronic obstructive pulmonary disease (COPD). The study concluded that the app-based intervention was effective in improving health outcomes for COPD patients, suggesting it as a viable alternative to traditional in-person rehabilitation programs.

Summary: The trial assessed the impact of a smartphone application designed to deliver pulmonary rehabilitation to COPD patients. Participants were randomly assigned to either the app-based rehabilitation group or a control group receiving standard care. Outcomes measured included exercise capacity, quality of life, and symptom management. Results demonstrated significant improvements in the app-based group compared to the control group, indicating that smartphone application-based pulmonary rehabilitation can be an effective tool for managing COPD, especially for patients who may have limited access to traditional rehabilitation services.

The wider evidence base: Click here to search Trip for more evidence on the use of smartphones in COPD rehabilitation.

NICE

What are the NICE guidelines for antimicrobial prescribing in recurrent urinary tract infections?

Clinical Bottom Line: NICE guidelines provide strategies for preventing and managing recurrent UTIs, focusing on antimicrobial stewardship, non-antibiotic measures, and personalized treatment plans.

Summary: NICE recommends behavioral measures, vaginal estrogen for menopausal women, and methenamine hippurate as alternatives to daily antibiotics for recurrent UTIs. Antibiotic prophylaxis may be considered when other measures fail, with regular treatment reviews to ensure effective care. Shared decision-making and specialist input are emphasized for complex cases.

Health Technology Wales

Are digital platforms effective for personalized diabetes management, education, and support in adults?

Clinical Bottom Line: The MyWay Diabetes platform is recommended for managing type 2 diabetes in non-insulin users, improving glycemic control and offering cost-effective care. Evidence for other digital platforms and for type 1 diabetes is insufficient.

Summary: Health Technology Wales reviewed digital platforms for diabetes management. MyWay Diabetes demonstrated improved glycemic control and cost-effectiveness in type 2 diabetes (non-insulin users). Evidence is lacking for other platforms or for type 1 diabetes, warranting further research.

The wider evidence base: Click here to search Trip for more evidence on digital platforms and diabetes.

INESSS

What are the optimal practices for diagnosing and treating Helicobacter pylori infection?

Clinical Bottom Line: The Institut national d’excellence en santé et en services sociaux (INESSS) has published a new Optimal Use Guide to assist healthcare professionals in diagnosing and treating Helicobacter pylori infection. This guide aims to standardize practices, promote judicious use of diagnostic tests, and ensure optimal antibiotic use, thereby preventing complications such as peptic ulcers and gastric cancer.
INESSS

Summary: Helicobacter pylori is a bacterium that causes gastric inflammation and is implicated in dyspepsia, peptic ulcer disease, and gastric cancer. Although the overall prevalence in Quebec is approximately 13%, higher rates are observed among Indigenous communities and individuals born in South America, Africa, and Asia. The INESSS guide provides evidence-based recommendations for the appropriate use of invasive and non-invasive diagnostic tests, including the urea breath test, stool antigen test, and serology. It also outlines optimal therapeutic strategies and follow-up protocols to enhance patient outcomes and minimize antibiotic resistance.

Diabetes Obes Metab.

Do GLP-1 receptor agonists exhibit anti-diabetic effects in obese and overweight patients regardless of diabetes status, administration routes, treatment duration, and baseline characteristics?

Clinical Bottom Line: Glucagon-like peptide-1 (GLP-1) receptor agonists are effective in reducing blood glucose levels and promoting weight loss in overweight and obese individuals, irrespective of their diabetes status. These benefits are observed across various administration routes, treatment durations, and patient baseline characteristics. Clinicians should consider GLP-1 receptor agonists as a therapeutic option for managing hyperglycemia and obesity in this population.

Summary: A systematic review published in Diabetes, Obesity and Metabolism on December 26, 2024, evaluated the anti-diabetic effects of GLP-1 receptor agonists in overweight and obese patients. The study analyzed outcomes across different diabetes statuses, administration routes, treatment durations, and baseline characteristics. Findings indicate that GLP-1 receptor agonists consistently improve glycemic control and facilitate weight loss in this demographic, regardless of the variables assessed. These results support the broad utility of GLP-1 receptor agonists in managing hyperglycemia and obesity among overweight and obese individuals.

The wider evidence base: Click here to search Trip for more evidence on the anti-diabetic effects of GLP-1 receptor agnosits.

Diabet Med .

Does glucocorticoid treatment lead to new-onset hyperglycaemia and diabetes in individuals with chronic obstructive pulmonary disease?

Clinical Bottom Line: A systematic review and meta-analysis investigated the association between glucocorticoid therapy and the development of new-onset hyperglycaemia and diabetes in patients with chronic obstructive pulmonary disease (COPD). The study concluded that glucocorticoid treatment is linked to an increased risk of these conditions in individuals with COPD. Clinicians should be vigilant in monitoring blood glucose levels in this patient population during and after glucocorticoid therapy.

Summary: This systematic review and meta-analysis aimed to evaluate the risk of new-onset hyperglycaemia and diabetes associated with glucocorticoid use in people living with chronic obstructive pulmonary disease (COPD). The study synthesized data from multiple sources and found a significant association between glucocorticoid treatment and the onset of hyperglycaemia and diabetes in COPD patients. These findings underscore the importance of regular glucose monitoring and proactive management strategies to mitigate the risk of glucocorticoid-induced hyperglycaemia and diabetes in this vulnerable population.

NIHR

Is first contact physiotherapy clinically and cost-effective for managing musculoskeletal disorders in primary care?

Clinical Bottom Line: The FRONTIER study indicates that first contact physiotherapy (FCP) services are as clinically effective as general practitioner (GP)-led care for patients with musculoskeletal disorders in primary care settings. Moreover, FCP services are more cost-effective, with GP-led models incurring higher median total costs. Implementing FCP can enhance patient outcomes and reduce healthcare costs.

Summary: The FRONTIER study, a mixed-method realist evaluation, assessed the clinical and cost-effectiveness of first contact physiotherapists compared to GP-led care for musculoskeletal disorders in UK primary care. Conducted across 46 general practices, the study involved 426 patients and included interviews with 80 staff and patients. Findings revealed no significant differences in clinical outcomes between FCP and GP-led models. However, the GP-led model was significantly more expensive, with a median total cost of £105.50, compared to £41.00 for standard FCP provision and £44.00 for FCPs with additional qualifications. The study recommends raising awareness of the FCP role, maintaining extended appointment times, and providing professional support to FCPs for effective implementation.

Age Ageing

What are the adverse events associated with cannabinoid use in middle-aged and older adults across all indications?

Clinical Bottom Line: A meta-analysis published in Age and Ageing (2024) investigated the adverse events associated with cannabinoid use in middle-aged and older adults. The study found that while cannabinoids are increasingly used for various medical conditions in this population, there is a significant incidence of adverse events. Clinicians should carefully weigh the potential benefits against the risks when considering cannabinoid therapies for middle-aged and older patients.

Summary: The study titled “Adverse events caused by cannabinoids in middle aged and older adults for all indications: a meta-analysis of incidence rate difference” aimed to quantify the adverse events associated with cannabinoid use in individuals aged 50 and above. The researchers conducted a comprehensive meta-analysis, pooling data from multiple clinical trials and observational studies. The findings indicated a higher incidence of adverse events, including dizziness, dry mouth, and cognitive disturbances, among cannabinoid users compared to non-users. The authors recommend that healthcare providers exercise caution and conduct thorough assessments before prescribing cannabinoids to middle-aged and older adults, considering the balance between therapeutic benefits and potential harms.

Diabetes Obes Metab

Do SGLT2 inhibitors reduce epicardial adipose tissue more effectively than GLP-1 agonists or exercise interventions in patients with type 2 diabetes mellitus and/or obesity?

Clinical Bottom Line: A systematic review and network meta-analysis published in Diabetes, Obesity and Metabolism suggests that SGLT2 inhibitors are more effective in reducing epicardial adipose tissue (EAT) volume compared to GLP-1 receptor agonists or exercise interventions in patients with type 2 diabetes mellitus and/or obesity. This finding highlights the potential of SGLT2 inhibitors in managing cardiovascular risk factors associated with increased EAT in this patient population.

Summary: The study conducted a systematic review and network meta-analysis to compare the effects of SGLT2 inhibitors, GLP-1 receptor agonists, and exercise interventions on epicardial adipose tissue (EAT) volume in individuals with type 2 diabetes mellitus and/or obesity. The results indicated that SGLT2 inhibitors led to a more significant reduction in EAT volume than either GLP-1 receptor agonists or exercise interventions. Given the association between increased EAT and cardiovascular risk, these findings suggest that SGLT2 inhibitors may offer additional cardiovascular benefits beyond glycemic control in this patient group.

The wider evidence base: Click here to search Trip for more evidence on SGLT2 inhibitors adiposity and diabetes.

Perinatal Services British Columbia

How should mental health be managed during pregnancy?

Clinical Bottom Line: Perinatal Services BC emphasizes the importance of a non-judgmental, trauma-informed approach when addressing mental health during pregnancy. Healthcare providers should be aware of biopsychosocial risk factors and collaborate with pregnant individuals to develop personalized mental health care plans for both the pregnancy and postpartum periods.

Summary: Pregnancy is a critical period for mental health, requiring sensitive and informed care. Perinatal Services BC emphasizes a non-stigmatizing, culturally safe, and trauma-informed approach to discussions about mental health. Healthcare providers should assess risk factors, such as personal or family history of mental illness, financial stress, and inadequate support systems, while providing education on the commonality of perinatal depression and anxiety. Universal screening for depression and anxiety is recommended early in pregnancy and again between 28–32 weeks gestation to promote healthier outcomes for both mother and child.

The wider evidence base: Click here to search Trip for more evidence on mental health in pregnancy.

Neurology

What Early Improvements Are Seen With Atogepant for Preventive Migraine Treatment According to Results From 3 Randomized Phase 3 Trials?

Clinical Bottom Line: Atogepant, an oral calcitonin gene-related peptide (CGRP) receptor antagonist, has demonstrated early and significant reductions in monthly migraine days (MMDs) within the first four weeks of treatment. This efficacy was observed across three randomized, double-blind, placebo-controlled Phase 3 trials involving adults with episodic or chronic migraine. The treatment was well-tolerated, with a safety profile comparable to placebo. These findings support atogepant as an effective and rapid-onset preventive therapy for migraine.

Summary: This analysis pooled data from three Phase 3 clinical trials to evaluate the early efficacy and safety of atogepant in preventing migraines. Participants received varying doses of atogepant or placebo. Results indicated that atogepant led to a significant reduction in MMDs as early as the first week of treatment, with continued improvement over the four-week period. The most common adverse events were mild to moderate and included constipation and nausea. The study concludes that atogepant offers a rapid and well-tolerated preventive treatment option for individuals suffering from migraines.

The wider evidence base: Click here to search Trip for more evidence on Atogepant in Migraine.

Diabetes Obes Metab.

Does metformin use reduce the risk of dementia in patients with type 2 diabetes?

Clinical Bottom Line: A systematic review and meta-analysis published in Diabetes, Obesity and Metabolism suggests that metformin use is associated with a reduced risk of dementia in individuals with type 2 diabetes. These findings support the potential cognitive benefits of metformin in this patient population.

Summary: Researchers conducted a systematic review and meta-analysis to evaluate the association between metformin use and the risk of developing dementia among patients with type 2 diabetes. The study, published in Diabetes, Obesity and Metabolism, analyzed data from multiple studies and found that metformin use was linked to a decreased risk of dementia in this population. These results highlight the potential neuroprotective effects of metformin, suggesting it may offer cognitive benefits beyond its primary role in glycemic control. Further research is warranted to confirm these findings and elucidate the underlying mechanisms.

The wider evidence base: Click here to search Trip for more evidence on metformin, dementia and diabetes.