Choice picks from the research journals, with some choice comment...
Q. What are the most effective interventions for preventing occupational irritant hand dermatitis?
Occupational irritant hand dermatitis (OIHD) is an inflammatory skin reaction related to contact with water, chemicals, detergents or other possible irritants that are encountered as part of normal working practice. Amongst those at increased risk are those with contact allergy or atopic eczema, those who do ‘wet work,’ and women. Therefore, health care workers are particularly at risk due to the need for frequent hand washing and hand cleansing as an essential part of good clinical practice.
This Cochrane systematic review sought randomised controlled trials which had studied the effectiveness of interventions aimed at preventing OIHD. The interventions included barrier creams, gloves, moisturisers and complex education interventions. A commentary notes that out of total of 21 possible trials, only 4 randomised controlled trials were of sufficient relevance and quality to be included in the systematic review. However, two of the studies lacked sufficient quantitative data to enable further analysis. The trials also varied too much in terms of the participants’ occupation, gender and age to enable the studies to be combined for further analysis. Overall, all four studies had methodological flaws which made it difficult to draw reliable conclusions although the authors of the systematic review do note that all trials were carried out in the actual field which can be challenging
However, the review did find evidence which suggested that barrier creams, moisturisers, creams applied after work and complex education interventions might protect against the primary prevention of OIHD in the short and long term. There was no evidence to suggest whether or not the use of protective gloves might be effective. The authors of the review noted that larger RCTs which collected data over longer time periods were needed. However, in the meantime, this review does suggest that the use of barrier creams, moisturisers and the provision of education to encourage their use, is likely to contribute to the prevention of OIHD.
Bauer A, Schmitt J, Bennett C, et al. Interventions for preventing occupational irritant hand dermatitis. Cochrane Database Syst Rev 2010;6:CD004414.
Peters J. Insufficient evidence to determine the effectiveness of measures to prevent occupational irritant hand dermatitis. Evid Based Nurs 2011;14(1):21-22.
Q. Is hypnotherapy an effective treatment for smoking cessation?
Hypnotherapy is a very popular choice of treatment amongst smokers who wish to give up smoking but it is unclear whether it is an effective treatment. In the past, there have been claims for its effectiveness derived from a number of studies. However, it has been difficult to make sense of this data since the studies varied widely in terms of their methodology, the participants, and the frequency and manner in which the hypnotherapy was delivered. This Cochrane systematic review sought randomised controlled trials which compared hypnotherapy with other different forms of smoking cessation interventions.
A search found 11 studies which met the inclusion criteria. These studies compared hypnotherapy to 18 other forms of smoking cessation intervention. The main outcome measure was abstinence from smoking after at least six months. Abstinence was defined not only by patient reporting but more rigorous methods such as biochemical validation. The studies were too varied to combine them to carry out new statistical analyses. However, the authors concluded that there was no evidence to suggest that hypnotherapy was more effective than other interventions or as effective as counselling for smoking cessation.
A commentary notes that the systematic review was conducted to a high standard and that the researchers’ conclusions are an accurate reflection of the results. However, the results of this review do not change the conclusions of previous studies and further research is still needed to explore the effectiveness of this intervention.
At present, although there is a high level of public interest in hypnotherapy for smoking cessation, relatively few health professionals are certified to provide this intervention. In the absence of evidence of effectiveness, there is unlikely to be a drive for healthcare organisations to train its employees to deliver this intervention. However, in order to meet public interest, nursing professionals may wish to be aware of local practitioners who are able to offer this intervention.
Barnes J, Dong CY, McRobbie H, et al. Hypnotherapy for smoking cessation. Cochrane Database Syst Rev 2010;10:CD001008.
Carmody TP. No clear evidence that hypnotherapy for smoking cessation is more effective in the long term than no treatment or other interventions. Evid Based Nurs 2011;14(2):48-49.
PhD DN RGN
Lecturer in Community Nursing
School of Healthcare, University of Leeds
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