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Influenza vaccine for patients with chronic obstructive pulmonary disease

Despite the almost universal recommendation that people with chronic obstructive pulmonary disease (COPD) should receive an annual influenza vaccination, very few randomised controlled trials have evaluated the effect of influenza vaccination in these patients. This review looks at six studies in COPD patients and a further five in elderly or high risk patients, a proportion of whom had chronic lung disease. It shows that there is now some evidence from randomised trials that inactivated influenza vaccine indeed decreases "flare ups" of COPD, especially those that are related to the influenza virus itself. The inactivated influenza virus vaccine is given intramuscularly and is associated with an increase in local side effects such as pain at the site of injection. This is short‐lived, not serious and is outweighed by the long term benefit of the vaccine. The inactivated virus vaccine does not cause influenza or any significant worsening of COPD.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2010

Vaccines for preventing influenza in healthy children

Children (< 16 years old) and the elderly (above 65 years old) are the two age groups that appear to have the most complications following an influenza infection. Influenza has a viral origin and often results in an acute respiratory illness affecting the lower or upper parts of the respiratory tract, or both. Viruses are mainly of two subtypes (A or B) and spread periodically during the autumn‐winter months. However, many other viruses can also cause respiratory tract illnesses.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2014

Vaccines to prevent influenza in healthy adults

We evaluated the effect of immunisation with influenza vaccines on preventing influenza A or B infections (efficacy), influenza‐like illness (ILI) and its consequences (effectiveness), and determined whether exposure to influenza vaccines is associated with serious or severe harms. The target populations were healthy adults, including pregnant women and newborns.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2015

Efficacy and effectiveness of seasonal and pandemic A (H1N1) 2009 influenza vaccines in low and middle income countries: a systematic review and meta-analysis

PURPOSE: Influenza vaccines have been recommended for populations at risk for severe infection in low and middle income countries (LMICs) although knowledge of the evidence-base for their effectiveness and efficacy is limited in these countries. The aim of this systematic review is to provide an overview of the evidence-base for the effectiveness and efficacy of influenza vaccines in LMICs and to explore critical knowledge gaps.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2013

Safety of Vaccines Used for Routine Immunization in the United States

To conduct a systematic review of the literature on the safety of vaccines recommended for routine immunization of children, adolescents, and adults in the United States as of 2011.

Evidence Reports/Technology Assessments - Agency for Healthcare Research and Quality (US).

Version: July 2014
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Assessing the evidence: live attenuated influenza vaccine in children younger than 2 years. A systematic review

BACKGROUND: Live attenuated influenza vaccine (LAIV) is effective in children but contraindicated in children <2 years of age.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2014

Influenza vaccine in healthy children: a meta-analysis

This review assessed the efficacy of influenza vaccination in healthy children. The authors concluded that the influenza vaccine prevents laboratory-confirmed and clinical influenza, and that inactivated and live-attenuated vaccines have similar overall efficacy. It is difficult to assess the reliability of the authors' conclusions given the limited search for studies, the lack of reporting of review methods, and inadequate assessment of study quality.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2005

Comparing influenza vaccine efficacy against mismatched and matched strains: a systematic review and meta-analysis

BACKGROUND: Influenza vaccines are most effective when the antigens in the vaccine match those of circulating strains. However, antigens contained in the vaccines do not always match circulating strains. In the present work we aimed to examine the vaccine efficacy (VE) afforded by influenza vaccines when they are not well matched to circulating strains.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2013

Meta-analysis of the immunogenicity and tolerability of pandemic influenza A 2009 (H1N1) vaccines

This generally well-conducted review found that 2009 H1N1 vaccines achieved adequate immunogenicity; serious adverse events after vaccination were rare. Oil-in-water adjuvant vaccines gave the highest protection after a single low dose, but they had most frequent mild to moderate adverse events. The authors' conclusions (except those for mild to moderate adverse events) are likely to be reliable.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2011

Prevention of influenza in the general population

This review, which evaluated the effectiveness of influenza vaccine and prophylactic neuraminidase inhibitors in the general population, concluded that there is evidence to suggest moderate effectiveness. This conclusion is weakened by the poor reporting of the review process. In addition, wide variations in efficacy suggest that other factors need consideration when interpreting the evidence.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2004

Vaccines for preventing flu in people with asthma

Asthma is a condition that affects the airways – the small tubes that carry air in and out of the lungs ‐ and the symptoms are generally coughing, wheezing, shortness of breath and chest tightness. The symptoms can be occasional or persistent. When a person with asthma breathes in an asthma trigger (something that irritates their airways), the muscles around the walls of the airways tighten so that the airways become narrower and the lining of the airways becomes inflamed and starts to swell. For many people with asthma, cold and flu viruses trigger their symptoms. Therefore, getting a flu virus makes their asthma worse and having a flu jab (influenza vaccine) may protect people against some of the flu viruses that they will come into contact with in a given winter. However, the effects of a flu jab (vaccination) are not straightforward as there is also the possibility that the flu jab itself could cause a worsening of asthma. Current guidelines in the UK recommend that high‐risk groups such as people with severe asthma should have a flu jab each winter (NHS Choices); however, there is limited evidence for this approach.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2013

Seasonal influenza vaccine efficacy and its determinants in children and non-elderly adults: a systematic review with meta-analyses of controlled trials

Authors concluded that influenza vaccines were efficacious for the prevention of influenza but efficacy depended on variables such as type of vaccine. Reporting of the review process was somewhat limited. The authors’ conclusions broadly reflected the large evidence base although evidence of efficacy was restricted to non-elderly populations. The authors' recommendations for cautious interpretation of several analyses appear appropriate.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2012

Influenza vaccination in cancer patients undergoing systemic therapy

BACKGROUND: Cancer patients often experience preventable infections, including influenza A and B. These infections can be a cause of significant morbidity and mortality. The increased risk of infection may be because of either cancer itself or treatment-induced immunosuppression.1 Influenza immunization has been shown to decrease the risk of influenza infection in patients with intact immunity.2 In cancer patients, active immunization has been shown to confer protective immunity against several infections at similar rates to healthy individuals, which has translated into decreased duration and severity of infection and potentially improved morbidity and mortality.3.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2014

Rural vs. Urban Ambulatory Health Care: A Systematic Review [Internet]

Approximately 3 million veterans, slightly more than one-third of all veterans enrolled in the Department of Veterans Affairs (VA) health care system, live in rural areas. This pattern is likely to continue, as a comparable proportion of Operation Enduring Freedom/Operation Iraqi Freedom (OEF/OIF) veterans are from rural areas. The Rural Veterans Care Act of 2006 was signed into law to improve care for rural veterans. Ensuring that the health care needs of rural veterans are met has become a top priority for VA, resulting in a considerable expansion of community based outpatient clinics (CBOCs), inclusion of rural health/access as a research priority, and creation of the VA Office of Rural Health (ORH) in 2006.

Evidence-based Synthesis Program - Department of Veterans Affairs (US).

Version: May 2011

Lactose Intolerance and Health

We systematically reviewed evidence to determine lactose intolerance (LI) prevalence, bone health after dairy-exclusion diets, tolerable dose of lactose in subjects with diagnosed LI, and management.

Evidence Reports/Technology Assessments - Agency for Healthcare Research and Quality (US).

Version: February 2010
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Nutrition Support for Adults: Oral Nutrition Support, Enteral Tube Feeding and Parenteral Nutrition

These guidelines cover most aspects of nutrition support in adult patients (>18 years) who are either malnourished or are at ‘risk’ of malnutrition. In some cases specific guidance related to patients in specific care settings or with specific diseases has been provided but in general the guidance is applicable to patients whatever their setting (hospital or community) or disease. The guideline therefore includes: information on the prevalence of malnutrition and the benefits of good nutrition; guidance on the appropriate forums for the organisation of nutrition support in all settings; guidance on who should be screened for malnutrition and when, along with the criteria for consideration when assessing patients’ nutritional status; the general indications for nutrition support together with ethical and legal considerations that may arise; guidance on the process and special considerations required to prescribe nutrition support and details information on the important parameters to monitor for patients receiving nutrition support; detailed guidance on the administration of oral, enteral and parenteral nutrition including; the appropriate types of access for enteral and parenteral nutrition and the optimum mode of delivering these; specific guidance on the management of providing nutrition support to patients with dysphagia; issues to consider for patients receiving enteral and parenteral nutrition support in the community; issues arising for patients and their carers.

NICE Clinical Guidelines - National Collaborating Centre for Acute Care (UK).

Version: February 2006

Chronic Obstructive Pulmonary Disease: Management of Chronic Obstructive Pulmonary Disease in Adults in Primary and Secondary Care [Internet]

This guideline offers best practice advice on the identification and care of patients with chronic obstructive pulmonary disease (COPD). It aims to define the symptoms, signs and investigations required to establish a diagnosis of COPD. It also aims to define the factors that are necessary to assess its severity, provide prognostic information and guide best management. It gives guidance on the pharmacological and non-pharmacological treatment of patients with stable COPD, and on the management of exacerbations. The interface with surgery and intensive therapy units (ITU) are also discussed.

NICE Clinical Guidelines - National Clinical Guideline Centre (UK).

Version: June 2010
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Childhood Hematopoietic Cell Transplantation (PDQ®): Health Professional Version

Expert-reviewed information summary about the use of hematopoietic cell transplantation in treating childhood cancer.

PDQ Cancer Information Summaries [Internet] - National Cancer Institute (US).

Version: May 14, 2015

Late Effects of Treatment for Childhood Cancer (PDQ®): Health Professional Version

Expert-reviewed information summary about the health problems that continue or appear after cancer treatment has ended.

PDQ Cancer Information Summaries [Internet] - National Cancer Institute (US).

Version: April 21, 2015

Developing a Protocol for Observational Comparative Effectiveness Research: A User's Guide

The Observational CER User's Guide serves as a resource for investigators and stakeholders when designing observational comparative effectiveness research (CER) studies, particularly those with findings that are intended to translate into decisions or actions. The User's Guide provides principles for designing research that will inform health care decisions of patients and other stakeholders. Furthermore, it serves as a reference for increasing the transparency of the methods used in a study and standardizing the review of protocols through checklists provided in every chapter.

Agency for Healthcare Research and Quality (US).

Version: January 2013
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