The Cochrane Library has been introduced previously in this journal. The following synopses highlight some of the key health-care conclusions and their implications for practice as published in The Cochrane Library, 2007, Issue 1. For more information on The Cochrane Collaboration or to obtain a full copy of the reviews, go to the website www.thecochranelibrary.com.

 

Cochrane Column: best evidence from The Cochrane Library

Mona Nasser DDS* **

Coordinator

 

*The Cochrane Developing Countries Network, The Cochrane Collaboration

**Dental Research Center, Tehran University of Medical Sciences, Tehran, Iran.

E-mail: monalisa1n@gmail.com.

 

A recently licensed nicotine receptor stimulant trebles the odds of stopping smoking

The new antismoking drug varenicline is the third antismoking drug to be licensed in the USA for smoking cessation after NRT and bupropion. A group of Cochrane researchers, after evaluating data from six trials involving 4,924 people, compared the effectiveness of varenicline versus placebo and found that varenicline can reduce a person’s need to smoke and may also help them to quit.

In addicts, the nicotine in the smoke stimulates receptors in the nervous system, which causes the feel-good hormone dopamine to be released. Varenicline partially stimulates these nicotine receptors and enables a low-level release of dopamine, which reduces withdrawal symptoms and also partially blocks nicotine from being absorbed by the receptors, making continued smoking less satisfying.

“What we need now are some trials that make direct comparisons between varenicline and nicotine replacement therapy” says Lead Review Author Kate Cahill, who works in the Department of Primary Health Care at Oxford University.

 

Review Title: Cahill K, Stead LF, Lancaster T. Nicotine receptor partial agonists for smoking cessation. Cochrane Database of Systematic Reviews 2007, Issue

1.Art.No.:CD006103.DOI:10.1002/14651858.CD006103.pub2.

 

New evidence boosts the conclusion that some antidepressants can double a smoker’s chance of quitting

Some people may smoke to combat depression and stopping smoking could trigger depressive symptoms in some smokers. Therefore, antidepressants are suggested as an alternative option for quitting smoking.

A Cochrane review first published in 1997 and updated recently in January 2007 has concluded that antidepressants can double smoker’s chance of quitting. The new evidence has shown that the antidepressants bupropion (Zyban) and nortriptyline double a person’s chances of giving up smoking and have few side-effects, but selective serotonin reuptake inhibitors (SSRIs) such as fluoxetine (Prozac) do not.

“Since bupropion and nortriptyline appear to work as well in nondepressed as depressed persons, this suggests they help smokers quit in some way other than as antidepressants,” says John Hughes, Professor in the Department of Psychiatry at the University of Vermont, Burlington, USA.

 

Review Title: Hughes JR, Stead LF, Lancaster T. Antidepressants for smoking cessation. Cochrane Database of Systematic Reviews 2007, Issue 1. Art. No.: CD000031. DOI: 10.1002/14651858.CD000031.pub3.

 

Coaching patients over 65 can help them to take an active role in general practice consultations

A Cochrane review looked at different ways of helping older patients to get more out of their visits to their doctors. They concluded that older patients (over 65 years) who are given previsit information booklets or a previsit coaching session ask more questions when they see a doctor than untrained patients. The trained patients also get more information from their doctors per question asked, and were also in a position to supply the doctor with more information. This added confidence did not, however, cause an increase in the length of appointments.

“The low number of studies is interesting in itself, as it indicates that there has been relatively little effort given to finding ways of helping older people make the most of appointments with their doctors…… It is important to respect patients’ autonomy while at the same time helping to stimulate their active participation in their health-care, and face-to-face coaching sessions, with or without additional written materials, may be the way forward,” says Lead Review Author Raymond Wetzels, who works in the Centre for Quality of Care Research, in Nijmegen, The Netherlands.

 

Review Title: Wetzels R, Harmsen M, van Weel C, Grol R, Wensing M. Interventions for improving older patients' involvement in primary care episodes. Cochrane Database of Systematic Reviews 2007, Issue 1. Art. No.: CD004273. DOI: 10.1002/14651858.CD004273.pub2.