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Background and aims: Tobacco and cannabis are commonly co‐used, and evidence for the influence of co‐use on quit outcomes for either substance is mixed. We sought to determine the efficacy of tobacco and/or cannabis use interventions delivered to co‐users on cannabis and tobacco use outcomes. Method: Systematic review with meta‐analysis and narrative review, using five databases and author requests for co‐use data. Controlled and uncontrolled intervention studies focusing on treatment of tobacco and/or cannabis use assessing use of both pre‐ and post‐intervention were included. Prevention interventions were excluded. Bayesian meta‐analysis was used across four outcome measures: risk ratio for tobacco and cannabis cessation post‐intervention separately; standardized mean change for tobacco and cannabis reduction post‐intervention separately. Narrative reporting of the same outcome measures in non‐randomized clinical trials (non‐RCTs) and quality assessment of all included studies were conducted. Results: Twenty studies (12 RCTs and eight uncontrolled) were included. Bayesian meta‐analysis with informative priors based on existing data of 11 RCTs (six single‐substance, five multi‐substance interventions) delivered to co‐users (n = up to 1117) showed weak evidence for an effect on cannabis cessation [risk ratio (RR) = 1.48, credibility interval (CrI) = 0.92, 2.49, eight studies] and no clear effect on tobacco cessation (RR = 1.10, CrI = 0.68, 1.87, nine studies). Subgroup analysis suggested that multi‐substance interventions might be more effective than cannabis‐targeted interventions on cannabis cessation (RR = 2.19, CrI = 1.10, 4.36 versus RR = 1.39, CrI = 0.75, 2.74). A significant intervention effect was observed on cannabis reduction (RR = 0.25, CrI = 0.03, 0.45, nine studies) but not on tobacco reduction (RR = 0.06, CrI = −0.11, 0.23, nine studies). Quality of evidence was moderate, although measurement of co‐use and cannabis use requires standardization. Uncontrolled studies targeting both cannabis and tobacco use indicated feasibility and acceptability. Conclusions: Single and multi‐substance interventions addressing tobacco and/or cannabis have not shown a clear effect on either tobacco or cannabis cessation and reduction among co‐users. However, dual substance interventions targeting tobacco and cannabis appear feasible. [ABSTRACT FROM AUTHOR]

Rationale and aim Clear and logical eligibility criteria are fundamental to the design and conduct of a systematic review. This methodological review examined the quality of reporting and application of eligibility criteria in systematic reviews published in three leading medical journals. Methods All systematic reviews in the BMJ, JAMA and T he L ancet in the years 2013 and 2014 were extracted. These were assessed using a refined version of a checklist previously designed by the authors. Results A total of 113 papers were eligible, of which 65 were in BMJ, 17 in T he L ancet and 31 in JAMA. Although a generally high level of reporting was found, eligibility criteria were often problematic. In 67% of papers, eligibility was specified after the search sources or terms. Unjustified time restrictions were used in 21% of reviews, and unpublished or unspecified data in 27%. Inconsistency between journals was apparent in the requirements for systematic reviews. Conclusions The quality of reviews in these leading medical journals was high; however, there were issues that reduce the clarity and replicability of the review process. As well as providing a useful checklist, this methodological review informs the continued development of standards for systematic reviews. [ABSTRACT FROM AUTHOR]

Aims To assess the association between doctors' smoking status and the use of the '5 As' of smoking cessation. Methods A systematic search of 11 databases covering English and Spanish language publications since 1996 was undertaken. Studies were included if they reported doctors' smoking status (current, former or never smoker) and rates of practising any of the 5 As of smoking cessation ( Ask; Advise; Assess; Assist; and Arrange). Frequencies and proportions were extracted from individual papers and risk ratios ( RR) were calculated. A random-effects meta-analysis model was used to assess the effect of the doctor's personal smoking history. Covariate effects were explored using meta-regression for three pre-specified study characteristics: doctors' role, smoking prevalence of the sample and study quality. Results Twenty studies were included in this systematic review. The RR of always asking patients about their smoking was not associated significantly with doctors' smoking status [ RR = 0.98; 95% confidence interval ( CI) = 0.94-1.02; P = 0.378; I2 = 0.00%; 10 studies]. Meta-analysis suggested that doctors who were current smokers had a 17% increased risk of not advising their patients to quit compared with never-smokers ( RR = 0.83; 95% CI = 0.77-0.90; P < 0.000; I2 = 82.14%; 14 studies). However, high levels of heterogeneity were found that were not explained by the meta-regression. Regarding assisting patients to quit, never smokers were more likely to counsel than current smokers ( RR = 0.92; 95% CI = 0.85-0.99; P = 0.036; I2 = 0.00%; three studies) but less likely to make a referral ( RR = 1.40; 95% CI = 1.09-1.79; P = 0.009; I2 = 0.00%; five studies). No statistically significant differences were found in arranging future contact by smoking status ( RR = 0.80; 95% CI = 0.52-1.23; P = 0.315; I2 = 47.03%; four studies). Conclusions Smoking status of doctors may affect their delivery of smoking cessation treatments to patients, with smokers being less likely than non-smokers or ex-smokers to advise and counsel their patients to quit but more likely to refer them to smoking cessation programmes. [ABSTRACT FROM AUTHOR]

• Nosocomial infection is potentially a major problem in paediatric wards. However, there are methological difficulties which hinder researchers in identifying the true extent of nosocomial infection. • Respiratory infections pose the greatest challenge, with the respiratory syncytical virus (RSV) being particularly problematic. However, RSV can be contained by strict implementation of isolation procedures. • Other major pathogens such as bacteria and viruses can similarly be controlled through vigorous attention to hand-washing and isolation. • Health-care staff are implicated in the nosocomial spread of many other infectious agents, and should pay particular care to personal practice. [ABSTRACT FROM AUTHOR]

The author reflects on a study which makes contribution to the debate about the use of different methods of clinical thermometry. The study has led to a very general statement on the use of tympanic thermometers, which is not supported by data and is not generalized to other clinical settings. He pointed that the problems with the conclusion are twofold, which include the relationship between different thermometry sites and the ability of various techniques to inform clinical decision making.

The authors discuss the study by L. J. Sahm et al. within the issue, which analysis the knowledge, attitudes and beliefs about fever by Danish parents. They remark that the findings of the study are in line with other observational studies, but with the difference on the reluctance of parents to use medicine to treat fever. They are critical on the need for more efforts by health care practitioner to provide guidance to parents on fever management and the use of antipyretic drugs.

Editorial. Focuses on the importance of age in determining the capability of children to give informed consent to medical treatment in Great Britain. Arguments against the involvement of children in decisions about their care; Concerns on prejudices of many health care staff; Ability of children to take part in decisions regarding terminal care.

A response by Edward Purssell to a reader's comment about his article on the uses of antibiotics is presented.