Silver, napkins and some choice morsels of Cochrane evidence

Last week I gave you jellyfish, so don’t let it be said that I only go for the big health issues here! There’s a feast of new evidence in The Cochrane Library and this week, from an extensive menu, I’ve picked out a few tidbits on some more common health problems, plus some great dementia resources and a beautiful project that I want to highlight.
Thomas Henry Huxley

It was the opinion of that bewhiskered Victorian biologist, Thomas Henry Huxley, that “perhaps the most valuable result of all education is the ability to make yourself do the thing you have to do, whether you like it or not”. I’ll leave you to ponder that, but I think he’d share my disappointment that a new review on self-management education programmes for people with osteoarthritis suggests that such programmes result in no or minimal benefit. These are designed to help people take an active role in managing their chronic health condition, such as osteoarthritis, through education and behaviour change strategies. The evidence isn’t brilliant but the reviewers say that further studies investigating these programmes, as delivered in the trials included in the review, are unlikely to change their conclusions much.

Educational, supportive and behavioural interventions to help people with obstructive sleep apnoea (OSA) improve their use of continuous positive airway pressure (CPAP) machines have been evaluated in a review which has just been updated, with new studies added. Most of the patients were new to CPAP. All three types of intervention were found to improve machine use over a limited time, with behavioural interventions having the greatest impact. However, the evidence is only low to moderate quality; optimal timing, duration and long-term effectiveness of interventions is uncertain and the impact of increased machine use on symptoms remains unclear. It’s also not known which type of intervention would be best for individual patients. So only a crumb of comfort for Thomas Huxley and, more relevantly, for people with OSA.

silver Silver has long been used for its germicidal properties and in the care of chronic wounds for the last 400 years or so. Trials of silver- and honey-based products have been added to a review on antibiotics and antiseptics for treating venous leg ulcers.  Current evidence does not support the routine use of honey- or silver-based products, nor of systemic antibiotics, to aid leg ulcer healing. The effectiveness of a number of other topical agents agents such as povidone-iodine remains unclear. Most of the trials were small, and most of the evidence was of high or unclear risk of bias. More and better research needed please.

Time for something for that apparently works. A review of antidepressants for smoking cessation has been updated, adding 24 new studies and more information about serious adverse events (side effects). There’s high quality evidence from 44 trials that bupropion is effective as a single treatment to help people quit smoking long term and moderate evidence from fewer trials that this is so for nortriptyline too. These drugs seem to be comparable to nicotine replacement therapy (NRT) in terms of effectiveness and there was no clear evidence that adding either drug to NRT offers any additional benefit. Whilst these, as other, antidepressant medicines have the potential for serious side effects, the reviewers conclude that adverse events with either medicine appear rarely to be serious or to lead to people stopping taking it.

Elderly lady stretching
Photo by Claire Bazeley

Many people of all ages, from the very fittest to those with chronic health conditions, find they feel better for exercise, but what do we know about whether it might be helpful for people with dementia? Clearly there’s research being done in this area, as 12 trials were found to add to the original four in the latest version of the Cochrane review looking at this. Combined results from eight trials suggested that exercise might significantly improve cognitive functioning, but the trials were very different from each other and when one outlier trial was removed then it didn’t look like exercise made much difference. The review also found that exercise might improve the ability of people with dementia to perform activities of daily living, but again the evidence is problematic. You can read more in this helpful blog by the Mental Elf.

When I wander don’t tell me
to come and sit down.
Wander with me. 

So begins Maybe, a poem about dementia by an unknown voice. Sometimes, it’s the simple things that make a difference. Two wonderful leaflets, How Would I Know What I Can Do? and Difficult Conversations, from the National Council for Palliative Care, highlight some simple things you can do to help someone with dementia who is in pain or distress and offer guidance on talking to people with dementia about the end of life. Do read them, if you are involved in any way in caring for someone with dementia.

All rights reserved by The Napkin Projec
All rights reserved by The Napkin Project

The leaflet about recognising and relieving pain reminds us of the importance of ‘life story’ information to help with understanding the person and who they are. A beautiful thread to connect people with dementia and those caring for them and to access past memories is at the heart of The Napkin Project. No, it’s not part of a trial or a systematic review. It’s just a beautiful, compassionate thing. Many people have been involved in embroidering napkins with motifs on the theme of ‘home’, which have been given to a dementia care home in Bristol, where they have become triggers for reminiscence. The napkin shown here and at the top of the blog are two from over 120 created for the project. You can read more here. The use of various arts as therapy is, of course, subject to investigation in trials and I will be looking at some Cochrane evidence on music in various health settings later on. Meanwhile, if you missed my blog on the art, as well as the evidence, of migraine, you can catch up with it here.


Kroon FPB, van der Burg LRA, Buchbinder R, Osborne RH, Johnston RV, Pitt V. Self-management education programmes for osteoarthritis. Cochrane Database of Systematic Reviews 2014, Issue 1. Art. No.: CD008963. DOI: 10.1002/14651858.CD008963.pub2.

Cochrane summary

Wozniak DR, Lasserson TJ, Smith I. Educational, supportive and behavioural interventions to improve usage of continuous positive airway pressure machines in adults with obstructive sleep apnoea. Cochrane Database of Systematic Reviews 2014, Issue 1. Art. No.: CD007736. DOI: 10.1002/14651858.CD007736.pub2.

Cochrane summary

O’Meara S, Al-Kurdi D, Ologun Y, Ovington LG, Martyn-St James M, Richardson R. Antibiotics and antiseptics for venous leg ulcers. Cochrane Database of Systematic Reviews 2014, Issue 1. Art. No.: CD003557. DOI: 10.1002/14651858.CD003557.pub5.

Cochrane summary

Hughes JR, Stead LF, Hartmann-Boyce J, Cahill K, Lancaster T. Antidepressants for smoking cessation. Cochrane Database of Systematic Reviews 2014, Issue 1. Art. No.: CD000031. DOI: 10.1002/14651858.CD000031.pub4.

Cochrane summary

Forbes D, Thiessen EJ, Blake CM, Forbes SC, Forbes S. Exercise programs for people with dementia. Cochrane Database of Systematic Reviews 2013, Issue 12. Art. No.: CD006489. DOI: 10.1002/14651858.CD006489.pub3.

Cochrane summary

Tomlin A. Exercise may help older people with dementia, but more research is needed. The Mental Elf [blog]. 4 December 2013. Available at:

Black J, The National Council for Palliative Care. Difficult conversations: making it easier to talk to people with dementia about the end of life. (Dying Matters: Let’s talk about it). London: The National Council for Palliative Care; 2011. Available at:

The National Council for Palliative Care. How would I know? What can I do? How to help someone with dementia who is in pain or distress. London: The National Council for Palliative Care; 2012. Available at:

Taylor G. How creativity and craft are tackling dementia… one stitch at a time. Guardian Professional [blog]. 29 November 2013. Available at:

Silver, napkins and some choice morsels of Cochrane evidence by Sarah Chapman

is licensed under a Creative Commons Attribution-NoDerivatives 4.0 International

5 Comments on this post

  1. Thanks for your blog, always interesting and entertaining! I think we need to clarify on the self-management review. Self-management is a really powerful tool, and those patients who are good at self-management have better results. What the review shows is that we are not really good on speeding up this self-management with programmes: people improve (or not) on their self-management independently of being on a programme. I think that’s an important decision, as the problem is not on the self-management, but on how we can improve self-management. Newer approaches, probably coming from a better understanding on what improves self-management is needed. I think it is also interesting the identified need to learn more on how this programmes might affect different population groups, as this might bring a better idea of how can benefit the most.
    Apologies if I’m being too picky: it is really hard to condense what the review says in few words and you are doing an excellent work, I hope my comment helps to get a better picture of the review!

    Jordi / Reply
    • Thanks for taking the time to comment and for explaining a bit more about this review – it’s helpful! Yes it is worth noting that the reviewers do highlight some fruitful areas for further research, looking at different approaches. For interested readers, here’s a bit from the review’s Implications for research section on this:
      “It is possible that other models of self-management education programmes that differ in mode of delivery, type of audience, duration and frequency of sessions, personnel used to teach self-management skills, etc., may enhance self-management of OA. Further trials of different self-management education programmes, particularly those that are tailored to the individual, may therefore be warranted.”

      sarahkchapman / (in reply to Jordi) Reply
  2. St Mary’s Hospital in the Isle of Wight has a wonderful piece of art, not unlike the napkin project: a patchwork of embroidered scenes from the island, outside one of the wards for elderly people. There are usually patients and visitors clustered around it reminiscing, identifying places, and enjoying it. It’s worth hours of examination. That hospital had a budget for art when it was built, and the architects and artist in charge put a lot of thought into integrating it.

    Dr Amanda C de C Williams / Reply
    • Thanks for sharing this – how lovely! I see from the hospital website that there’s a long-standing programme of enhancing the hospital environment through visual artworks. On a related theme, I’ll soon be blogging about Cochrane evidence on the therapeutic effects of music in various health settings.

      sarahkchapman / (in reply to Dr Amanda C de C Williams) Reply

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