Bisphosphonate drugs are one of the most commonly prescribed therapies for postmenopausal osteoporosis. However, a systematic review by Woodis (Woodis, C. B. Pharmacother. 2008;42) suggests that once-yearly intravenous zoledronic acid may be a more attractive option for some patients.

The review, highlighted in the annual evidence update for osteoporosis and fragility fractures, included five randomised controlled studies. It reported that once-yearly zoledronic acid decreased bone turnover markers such as serum C-telopeptide by 49-52 per cent. The treatment also decreased the vertebral fracture rate by approximately 70 per cent, and increased bone mineral density at total hip, femoral neck, and lumbar spine by 6.02 per cent, 5.06 per cent, and 6.71 per cent, respectively.

Recent NICE guidance on primary and secondary prevention (Oct 2008) sets out treatment options for osteoporosis. Once-yearly intravenous zoledronate therapy is not included because, at the time of consideration, the drug was not licensed. NICE is considering it for the forthcoming osteoporosis clinical guideline.

The review concluded that additional studies investigating zoledronic acid against oral bisphosphonates, specifically looking at rates and types of fractures, are needed to fully determine its place in postmenopausal osteoporosis treatment.

Clinical lead for NHS Evidence - Musculoskeletal and consultant rheumatologist, Dr Ray Armstrong recognises the need for more research in this area but suggests: "Given the well-known difficulties with patient adherence with bisphosphonate therapy, this treatment option appears to provide greater reassurance that treatment objectives will be achieved, especially in those patients who are unable to take bisphonates orally."

An estimated 250,000 adults in the UK suffer from blindness due to age related macular degeneration (AMD), making it the most common cause of severe visual impairment in older adults.

The term AMD is used to cover both wet and dry forms of AMD.
Management of the condition is a fast changing field with strong epidemiological and clinical reasons to issue new guidance. The annual evidence update for AMD highlights new NICE guidance on intervention, recommending Ranibizumab for people with wet AMD under certain conditions.

Parul Desai, clinical lead for NHS Evidence – eyes and vision explains:  "Currently there is no treatment that can restore vision from AMD, so there is a great deal of interest in its prevention."

A Cochrane systematic review (Evans JR, Henshaw KS, 2008, Issue 1) investigated the effects of vitamin E and beta-carotene supplementation in preventing the development of AMD, identifying three large, high quality randomised controlled trials based in Australia, Finland and USA. The review concludes that there is no evidence to suggest taking antioxidant vitamin or mineral supplements delay the onset of AMD. The results of ongoing trials are awaited.

Dr Desai adds: "While the hypothesis that antioxidant micronutrients may protect against the disease is a reasonable one, to date there is no evidence from randomised trials that healthy people should take antioxidant vitamin and mineral supplements to prevent or delay the onset of AMD and further research is needed on both their effectiveness and safety."

The Health Action Planning and Health Facilitation for people with learning disabilities: good practice guidance, published this year, aims to reduce health inequalities experienced by people with learning disabilities.

The annual evidence update for learning disability health needs references this report, as well as recent research into key health issues, such as, cancer, challenging behavior, coronary heart disease, epilepsy and respiratory illness.

It highlights difficulties people with learning disabilities can face in seeking out support from the health care system, resulting in many health issues remaining undiagnosed or untreated. In terms of cancer screening services, e.g. breast cancer screening, take up is lower than in the general population (Willis DS, et al. British Journal of Learning Disabilities 2008; 36).

Policy and research reports have highlighted a need for more accessible cancer information (O'Regan P, Drummond E. European Journal of Oncology Nursing 2008; 12(2)). There are two recent published examples of accessible patient information: An Easy Guide to Bowel Cancer Screening and An Easy Guide to Having a Colonoscopy. 

John Northfield, clinical lead for NHS Evidence - learning disabilities comments: "For people with learning disabilities the incidence of cancer is increasing. A lack of appropriate cancer information is presenting clear obstacles that impact on diagnosis, management and overall survival rates.

"Healthcare professionals in primary care have infrequent contact with people with learning disabilities and few have had specific training, although Health Action Planning should improve outcomes."

When NHS Evidence launched in April the internet was already a universal tool for healthcare professionals. Before going live NHS Evidence commissioned a baseline survey of health professionals, to determine how and to what extent the internet was being used to inform clinical decision making, learning and research.

Of the 2,752 responses 69 per cent were from clinical staff, 12 per cent management and 19 per cent non-clinical (researchers, librarians and lecturers).

• 99 per cent used the internet for work purposes.
• 84 per cent of those were accessing information to support clinical decision making
• 81 per cent were looking for educational materials for professional development
• 69 per cent used it for guidance when making management decisions in policy or planning
• 72 per cent reported frequently using the internet to access best practice information for training purposes and 67 per cent when updating care pathways

• 20 per cent use it as a reference before a consultation
• 22 per cent use it with a patient present
• 41 per cent use it to access information following a consultation with a patient

The NHS Evidence accreditation scheme has attracted a lot of questions this month, many about the decision making process.

The accreditation process begins when a guidance producer provides an online application in response to key criteria. In this application the guidance producer must demonstrate its policies and processes for producing guidance and evidence that these are being implemented.

The submission is assessed by the accreditation team who prepare a briefing document which is then both subject to an independent external review and sent to the guidance producer for feedback. The overview, external advisors' input and guidance producer feedback is submitted to the accreditation advisory committee for a draft accreditation decision.

After a draft accreditation decision has been made, the report is put out to public consultation for 20 working days. Any comments are reviewed before a final decision is made.

There is a resolution process should there be any dispute about the process used to reach the accreditation decision. Any guidance producers who do not meet the standard required will be supported and offered advice on how to improve their processes. Guidance producers who do not meet the standard can resubmit an application after a year.

As NHS Evidence is a new and developing service you may have questions about how it works and the plans to enhance the portal's functionality.

The service is here to make your job easier so if there is anything you would like clarifying let us know.

Search topics

Question: The search terms that appear in your top ten - are they single word searches or part of a more complex search?

Answer: The statistics are based on single word searches entered into the portal's home-page.

Accreditation timing

Question: How long does it take for guidance producers to be accredited?

Answer: We are currently in the process of making the first accreditation decisions and estimate that, from submission to the final response, will take about six months. (See above for details)

Using Athens

We are getting lots of questions about how to use Athens for more specialist searches of subscription journals via NHS Evidence. The most frequently asked are:

Question: Do I need an Athens password to use NHS Evidence?

Answer: Access to NHS Evidence is free to all without the need for any registration or password. However, if you want to access subscription only journals via the portal you will need an Athens account.

Question: How do I register for an Athens account?

Answer: You can register for an NHS Athens account on the NHS Evidence portal. On the home-page click 'Conduct a Specialist Search' and on the drop down menu you will see 'Register for Athens'. To find out if you're eligible for an account click here.

Question: I've forgotten my password. What do I do?

A time saver for study

Dear Eyes on Evidence,

As a second year nursing student I'd just like to say what a bonus I think a service like NHS Evidence will be for my studies. I hadn't heard about the site until I visited your stand at the NHS Innovation EXPO. I'd just finished a project and one of your staff showed me how to search for the information I'd used for my work via NHS Evidence. Details I'd spent hours looking for were there straight away. I was kicking myself because had I known about it a week earlier I could have saved myself so much time. Now I know about it I will definitely be using it to research future assignments – and saving some time!

EL, student

Whatever your views on NHS Evidence or on the latest evidence in your field we want to hear from you.