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The latest evidence for practice

Una Adderley
Specialist Nurse
Team Leader

Does pneumococcal vaccination prevent outcomes such as pneumonia?

Many people worldwide become ill or die due to pneumonia caused by streptococcus penumoniae. Preventive action is becoming increasingly important due to increasing drug resistance, which makes treatment difficult. However, the effectiveness of pneumonia vaccination is unclear. This meta-analysis sought to evaluate the effectiveness of pneumonia vaccination for various clinical outcomes.

The review sought studies that compared the effectiveness of pneumonia vaccine compared to placebo, other vaccines or no intervention. It did not include studies that had considered pneumonia vaccination in children or animals. Twenty-two trials met the inclusion criteria. The results found no difference between pneumococcal vaccination and the controls for definitive pneumococcal pneumonia. There was no difference either between the incidence of bacteraemia, bronchitis
or mortality. 

A commentary notes that although meta-analyses can reduce uncertainty, their results can be affected by decisions around inclusion and exclusion criteria. This meta-analysis analysed data according to the methodological quality of the trials but there is controversy as to whether some of the excluded studies should have been excluded. Furthermore, the inaccuracy of diagnostic criteria for pneumonia, bacteraemia and bronchitis further limits the reliability of the findings. It should be noted that having considered all the evidence, including this meta-analysis, the World Health Organization has concluded that pneumococcal polysaccharide vaccination in adults protects against invasive pneumonia in health adults and therefore vaccination should still be considered beneficial. l

Reference
Huss A, Scott P, Stuck AE et al. Efficacy of pneumococcal vaccination in adults: a meta-analysis. CMAJ 2009;180:48-58.
Commentary
Cicutto L. Evid Base Nurs 2009;12(3):74.

Does behavioural counselling reduce the incidence of STIs?

Sexually transmitted infections (STIs) are increasing and solutions are sought to minimise their incidence and prevalence. However, there are concerns that behavioural counselling, may increase rather than decrease risky behaviour.

This meta-analysis sought studies that compared behavioural counselling interventions to prevent STIs that could be delivered in primary care settings with no intervention, a minimal intervention or an attention control conducted in primary care settings or specialty clinics with adults or adolescents. It excluded studies that considered people with HIV, studies in non-industrialised countries and community-based programmes. Fifteen trials were found that met the inclusion criteria.

The studies were not sufficiently similar to carry out statistical analyses but a narrative overview showed that moderate-to-high-intensity behavioural therapy reduces the risk of STI in high-risk adults and sexually active adolescents.  Furthermore, counselling did not increase risky sexual behaviour.

A commentary notes that nurses with good behavioural counselling skills can be effective providers of such risk-reduction interventions. It advises that taking a careful and open sexual history at all primary care visits and using screening STI visits can help identify where moderate-to-high-intensity behavioural therapy might be implemented to help reduce risk.

Reference
Lin JS, Whitlock E, O'Connor E et al. Behavioral counselling to prevent sexually transmitted infections: a systematic review for the US Preventative Services Task Force. Ann Intern Med;2008:497-508.
Commentary
Kaplan C. Evid Base Nurs 2009;12(2):46