The New Zealand Guideline Group (www.nzgg.org.nz)  fund the Cochrane Primary Care Field to produce the P.E.A.R.L.S.

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1. Topical treatments for chronically discharging ears with underlying eardrum perforations (CSOM) are better than systemic antibiotics
2. Nicotine receptor partial agonists help people stop smoking
3. Oral tetracyclines are effective for acne vulgaris
4. Local oestrogen for vaginal atrophy in postmenopausal women
5. Cognitive behavioural therapy (CBT) has a positive effect on some of the qualitative aspects of tinnitus
6. Cardioselective beta blockers do not produce adverse respiratory effects in chronic obstructive pulmonary disease
7. Anticholinergics are effective for overactive bladder syndrome in adults
8. Colchicine is a second line therapy for acute gout
9. Is routine therapeutic monitoring of antiepileptic drugs for epilepsy necessary
10. Oral erythromycin may be effective in treating the symptoms of pityriasis rosea
11. Glue may be better than stitches, staples or adhesive tape for simple cuts
12. There is no evidence supporting the use of Chinese medicinal herbs for the common cold
13. Brief alcohol interventions (BAIs) in primary care populations are effective in reducing alcohol consumption in men
14. Oral steroids are effective short term treatment for adhesive capsulitis
15. Evidence lacking on treatment options for vaginal bleeding irregularities induced by progestin-only contraceptives
16. Organised systems of regular follow-up and review can improve blood pressure control
17. Effectiveness of prolotherapy injections for chronic low-back pain uncertain
18. Bupropion and nortriptyline aid long-term smoking cessation but selective serotonin uptake inhibitors (SSRIs) do not
19. Low molecular weight heparin (LMWH) and non-steroidal  anti-inflammatory drugs (NSAIDs) are the best treatment for superficial thrombophlebitis (ST)
20. Response rates to postal questionnaires can be increased
21. Local corticosteroid injections for carpal tunnel syndrome (cts)
22. Contracts between patients and healthcare practitioners for improving patients' adherence to treatment, prevention and health promotion activities
23. Surgical discectomy can benefit some patients
24. Psychological therapy based on cognitive behavioural therapy (CBT) principles is effective in reducing anxiety symptoms for short-term treatment of generalised anxiety disorder (GAD)
25. Vitamin C supplementation may have preventive effects in populations with a high incidence of pneumonia, and may have therapeutic effects in populations with low plasma vitamin C levels
26. Screening for abdominal aortic aneurysm
27. Proton pump inhibitors (PPPIs)  most effective treatment for oesophagitis
28. School feeding programs may have some small benefits for disadvantaged children
29. Antibiotics appear to have no benefit in treating acute laryngitis in adults
30. Antihistamines and/or decongestants not recommended in children with otitis media with effusion
31. A simple whisper test  is effective for diagnosing hearing impairment
32. Stop using beta-blockers as first-line treatment for hypertension
33. Nasal saline irrigations effective for chronic rhinosinusitis symptoms
34. Prophylactic antibiotics in mammalian bites may prevent wound infection
35. Skin grafting effective for venous leg ulcers
36. Autoinflation for otitis media with effusion helpful in the short term
37. Personalised risk communication may have a small effect on increasing uptake of screening tests
38. Aquatic exercise beneficial in knee and hip osteoarthritis
39. Stimulating the involvement of older patients in their primary care may enhance their health
40. Exercise improves balance in older people
41. Ginkgo biloba is probably not of benefit for cognitive impairment and dementia
42. Insoles do not prevent back pain
43. Antidepressants are effective for neuropathic pain
44. Chinese herbal medicine promising for menstrual pain
45. Topical pimecrolimus is less effective for treating eczema than moderate and potent corticosteroids and tacrolimus
46. Regular inhaled corticosteroids reduce exercise-induced asthma
47. Limited benefits from shared care in chronic disease management
48. Antibiotics of limited use for most people with sore throats 
49. Antibiotics or ‘watch and wait’ for acute otitis media
50. Influenza vaccines may not prevent time off from influenza in healthy adults
51. Customised foot orthoses effective for pain due to pes cavus
52. Case management for people with substance abuse disorders can improve linkage with relevant services
53. Psychosocial and psychological interventions effective for postpartum depression
54. Lay-led self-management education programmes can be effective
55. Exercise beneficial in fibromyalgia syndrome
56. Hand washing is very effective in preventing diarrhoea
57. Oral antibiotics are as effective as parenteral therapy in severe urinary tract infection
58. No evidence supporting the use of antidepressants for non-specific low-back pain
59. Multiple risk factor interventions for primary prevention of coronary heart disease have limited utility
60. Electromechanical assisted training improves walking after stroke
61. Stretching does not prevent or reduce delayed-onset muscle soreness
62. Cannabinoid type 1 receptor antagonists assist smoking cessation
63. Non-steroidal anti-inflammatory drugs have a small short-term effect on low-back pain
64. Hawthorn extract may have benefit as an adjunctive treatment for chronic heart failure
65. Taxane containing chemotherapy is effective for women with operable early breast cancer
66. No good evidence for effectiveness of over-the-counter medications for acute cough
67. Music therapy for depression may improve mood
68. Bromocriptine is effective in early Parkinson’s disease
69. Mass media interventions are effective in changing smoking behaviour
70. Alendronate prevents osteoporotic fractures in at risk postmenopausal women
71. Drug therapy effective for cancer related fatigue
72. Balance of risks and benefits unclear for dopamine agonist therapy in early Parkinson’s disease
73. Cognitive behavioural therapy a possible treatment option for some children with recurrent abdominal pain
74. Limited role for antibiotics post-tonsillectomy
75. Surgery for rotator cuff disease is no more effective than active non-surgical treatment
76. Chinese herbal medicine may be of benefit for angina
77. Individual patient education is effective for acute or subacute low-back pain
78. Antioxidant supplements do not reduce mortality
79. Homemade spacers are effective in delivering bronchodilator therapy to children with acute wheezing or asthma
80. House dust mite control measures do not reduce asthma symptoms
81. Physician advice alone has a small effect on smoking cessation
82. Insufficient data on clinical effects of low level laser therapy for low-back pain
83. Low dose aspirin is effective for secondary prevention of thrombosis in patients with polycythemia vera
84. No evidence for antiepileptic drugs preventing seizures in people with brain tumours
85. Aerobic physical activity improves cognitive function in older people
86. Short-course antibiotic therapy appears effective for community-acquired pneumonia in young children
87. Five-alpha-reductase inhibitors reduce the risk of prostate cancer
88. Little evidence of blood pressure benefits from relaxation therapies for hypertension
89. Heparins reduce the number of heart attacks after acute coronary syndromes
90. Insufficient evidence on bone scaffolding for distal radial fractures in adults
91. Antihistamines not recommended for prolonged non-specific cough in children
92. Culture-specific programmes for minority groups who have asthma improve some outcomes
93. No evidence of effective treatments for alopecia
94. Exercise can help reduce cancer-related fatigue
95. Culturally appropriate health education for type 2 diabetes is effective in the short-term
96. Intranasal cortocsteroids may improve nasal obstruction
97. Low molecular weight heparin is more effective than vitamin K
98. Limited evidence to support removable splintage
99. Occlusion and refractive correction are more effective than refractive correction alone in strabismic amblyopia
100. Combined inhalers are more effective for chronic obstructive pulmonary disease but increase the risk of pneumonia
101. Open mesh repair is more effective than open suture repair for incisional hernia.
102. Custom-made insoles can reduce foot pain
103. Lack of evidence to support treatment decisions for subclinical hypothyroidism
104. Balneotherapy may be beneficial for osteoarthritis

PEARLS in newsletter NHCF in 2010

105. Repetitive task training can improve functional ability after stroke

106. Interventions to promote walking are effective in the short term

107. Educational outreach visits can influence prescribing

108. Antibiotics have a small treatment effect in acute sinusitis

109. No evidence that antenatal breast examination promotes breastfeeding

110. Interferon beta is effective for delaying progression to multiple sclerosis

111. Buprenorphine is effective maintenance treatment for heroin dependence

112. Exercise and diet are effective in preventing type 2 diabetes

113. Placental delivery with cord traction is more effective than manual removal at caesarean section

114. No clear evidence of benefit for antimicrobial interventions in atopic eczema

115. Evidence lacking on effectiveness of life skills programmes for chronic mental illness

116. Lack of evidence for antiviral therapy in Ramsay Hunt syndrome

117. Unclear role for lumbar supports in low back pain

118. Antipsychotics useful as add-on therapy for acute and chronic pain

119.Strategies for enhancing medication adherence not very effective

120. Some evidence that acyclovir is effective for treating primary herpetic gingivostomatitis

121. Renin inhibitors are effective in lowering blood pressure

122. Calcium antagonists are of no benefit in Duchenne muscular dystrophy

123. ACE inhibitors have a modest blood pressure lowering effect

124. No evidence on effectiveness of smart home technologies

125. Relaxation techniques have some benefit in depression

126. Probiotics not effective for eczema

127. Beta-blockers can be used with caution in peripheral arterial disease

128. Mupirocin reduces infections in Staphylococcus aureus carriers

129. Selective serotonin re-uptake inhibitors are effective for obsessive compulsive disorder

130. Psychosocial interventions do promote smoking abstinence in people with coronary heart disease

131. Cranberries can prevent recurrent urinary tract infections in women

132. Early laparoscopic cholecystectomy beneficial for biliary colic

133. Acupuncture effective for migraine prophylaxis

134. Systemic antibiotics do not improve healing of venous leg ulcers

135. Limited evidence for honey in topical treatment of wounds

136. Increased police patrols may prevent alcohol-impaired driving

137. Ventilation tubes (Grommets) effective for recurrent acute otitis media

138. Limited evidence for the effectiveness of burn wound dressings

139. Exercise may improve depression

140. No evidence for benefit of procaine in prevention or treatment of dementia

141. Tonsillectomy or adeno-tonsillectomy effective for chronic and recurrent acute tonsillitis

142. Touch therapies may have a modest effect in pain relief

143. Limited evidence for effectiveness of electromechanical and robot-assisted arm training after stroke

144. Nebulised hypertonic saline effective for acute bronchiolitis in infants

145. Active management of labour is associated with a small reduction in caesarean section rate

146. Mechanical pumps are effective for expressing milk

147. St John’s wort is effective for depression

148. Combined leg compression and anticoagulants effective in preventing venous thromboembolism

149. Low molecular weight heparin effective for prevention of venous thromboembolism in patients with lower-leg immobilisation

150. Anakinra effective in rheumatoid arthritis

151. Anticholinergics ineffective for urinary symptoms in multiple sclerosis

152. Insufficient evidence on effectiveness of interventions for preventing weight gain after smoking cessation

153. Insufficient evidence on effectiveness of antibiotics for lactational mastitis

154. Limited evidence for effectiveness of olanzapine in long term treatment of bipolar disorder

155. Anticholinergics ineffective for urinary symptoms in multiple sclerosis

156. Psychological treatments may be effective for managing irritable bowel syndrome

157. Low glycaemic index and low glycaemic load diets effective for diabetes mellitus

158. Aciclovir effective in prevention and treatment of herpes simplex virus in patients being treated for cancer

159. Insufficient evidence for vision screening of older drivers preventing road traffic injuries and fatalities

160. Short course of antibiotics as effective as standard duration for streptococcal pharyngitis in children

161. School-based physical activity programmes have positive effects

162. Corticosteroid injections effective for trigger finger

163. Rehabilitation interventions effective for older people in long term care

164. Clinical trials subject to publication bias

165. Insufficient evidence for benefits of very early mobilisation after stroke