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The latest evidence for practice

Choice picks from the research journals,
with some choice comment …

Una Adderley
Community Tissue
Viability Prescribing
Nurse

Does the HPV vaccine protect young women from cervical cancer precursors?

The new public health immunisation programme that is being rolled out across the UK is aimed at reducing the incidence of cervical cancer in the next generation of young women. As with any new public health initiative, it is important that health workers understand the clinical background in order to help parents and young women understand the risks and benefits of immunisation. 

This systematic review examined the evidence for the effectiveness of prophylactic human papillomavirus (HPV) vaccination in preventing persistent HPV infection and precancerous cervical changes in young women. The review sought randomised controlled trials that had compared a vaccine against one or more cancer-related types of HPV with a placebo or no HPV vaccination. Six high-quality randomised trials were found and evaluated. The review found that HPV vaccines reduced the risk of high-grade cervical lesions, any grade cervical lesions, persistent HPV infection, external genital lesions, and adverse events. It concluded that vaccines against human papillomavirus in young women prevent persistent infection and precancerous cervical disease associated with HPV. 

A commentary notes that although it is not yet known how effective such vaccines will be in the long term in reducing cervical cancer incidence and mortality, it is evident that these vaccines offer many benefits. However, patients must be made aware that the vaccines do not protect against all strains of HPV and it is not yet known for how long they will be effective. Patients need to be aware that safer sex practices and continued cervical screening continue to be important in protecting against sexually transmitted disease.

Reference
Rambout L, Hopkins L, Hutton B, et al, Prophylactic vaccination against human papillomavirus infection and disease in women: a systematic review of randomized controlled trials.
CMAJ 2007;177:469-79.

Commentary
Muresan J. Evid Based Nurs 2008;11:11.

Does magnet therapy reduce pain?
Magnet therapy is a heavily promoted therapy for a number of clinical conditions, including pain. It is popular with patients possibly because there is apparently little risk of adverse side-effects. However, its effectiveness is unclear.

This British systematic review sought randomised controlled trials that compared static (permanent) magnets with placebo or a device with a weak magnetic field strength for treatment of any pain related to any condition. Twenty-five trials were of sufficient quality to be included within the systematic review, but when the results were combined the evidence showed that the use of static magnets is not effective for reducing pain. However, more evidence is required to establish whether magnet therapy is effective in reducing joint pain related to osteomyelitis.

A commentary noted that although this systematic review had a robust methodology, none of the included trials were flawless. Despite this, the results of this review were sufficient to conclude that it is not appropriate to recommend magnet treatment for pain in general. Although the evidence for pain relief for peripheral joint osteomyelitis is inconclusive, any possible benefits are likely to be small. Therefore although magnet therapy is unlikely to be harmful, clinicians should advise patients to avoid wasting money on such devices.

Reference
Pittler MH, Brown EM, Ernst E. Static magnets for reducing pain: systematic review and meta-analysis of randomized trials. CMAJ 2007:177;736-42.

Commentary
Parsons G. Evid Based Nurs 2008;11:49.