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< Volume 7 - February 2009 >
Cochrane is growing in Quebec!
The
Centre de recherche du Centre hospitalier universitaire de Québec (CRCHUQ)
and Université Laval’s Cochrane network site is expanding its
activities! By supporting a part-time Research Coordinator, Martine Magnan,
MSc, MBA, CRCHUQ can allow researchers to carry out systematic reviews in
the fields of knowledge translation and exchange, shared decision making,
health policies and e-health. Moreover, they are happy to report new
funding from the CIHR knowledge synthesis competition for two reviews on
patient and public involvement in clinical practice guidelines and
electronic health records.
Recently,
two successful standard author trainings (in French) were organized with
local trainers Marie-Pierre Gagnon, Karine Gravel and Merlin Njoya.
Cochrane consumer recognized
M. Jean
Légaré received a doctorate honoris causa from Université Laval for his
dedication as a volunteer arthritis advocate and his leadership in many
patient organizations. M. Légaré has been very involved as a consumer
representative with the Cochrane Musculoskeletal Review Group. He strongly
believes in the power of patients to make things happen.
Dr. Peter Tugwell named Canadian Health Researcher of
the Year
Dr. Peter
Tugwell of the University of Ottawa (Professor, Faculty of Medicine) and
Co-editor of the Cochrane Musculoskeletal Review Group and Co-convenor of
the Cochrane Health Equity Field, was named Canada's 2008 Health Researcher
of the Year for Health Services and Systems and Population Health Research.
Dr. Tugwell receives the prestigious Canadian Institutes of Health Research
(CIHR) Michael Smith Prize.
Canadian Prehospital Cochrane Corner - A
new evidence resource for paramedics
The
Canadian Prehospital Evidence Based Protocols project has joined forces
with the Canadian Cochrane Network and Centre in an effort to improve the
evidence available to support the care delivered by paramedics in Canada.
The Canadian Prehospital Cochrane Corner lists Cochrane reviews related to
emergency medical services, which are added to the Protocol project’s
database.
Find out
more about the Protocols project at the upcoming Canadian Cochrane
Symposium, where translating evidence to paramedic practice will be
discussed. For more information, email jljensen@dal.ca.
New tutorial walks users through Rx for Change
CADTH has
launched an online
tutorial to help users navigate the Rx
for Change database - a unique interventions database that
summarizes current research evidence about the effects of strategies to
improve drug prescribing and use.
The tutorial
outlines how the database is organized, the interventions that are
available, and provides tips and case studies that demonstrate how to use
the database in the real world.
Interventions for increasing the proportion of health
professionals practising in rural and other underserved areas
The
inequitable distribution of health care professionals is a concern and many
educational, financial and regulatory interventions have been used to
address this imbalance. However, the authors of this review were not able
to find any studies in which bias and confounding are minimized in the
design, to support or refute these approaches.
Interventions for promoting information and
communication technologies adoption in healthcare professionals
Many
healthcare professionals have yet to take advantage of information and
communication technologies (ICT) in their practice. This review found
limited evidence for the effectiveness of interventions promoting the
adoption of ICT in the practice of healthcare professionals. These
interventions included educational meetings, distribution of educational
materials, and educational outreach visits teaching the use of electronic
databases and digital libraries.
Cochrane Library Spotlight - Issue 1, 2009
Anakinra
for rheumatoid arthritis
Rheumatoid arthritis reduces a person’s mobility paired with joint
stiffness and pain and can be debilitating for those affected. Anakinra, a
biologic, was found to be modestly effective in treating the symptoms of
rheumatoid arthritis as compared to placebo and relatively safe. Although
no head-to-head trials are available, when compared to the results of other
biologic therapies, the absolute treatment benefit compared to placebo is
less with anakinra.
Robot
assistant for laparoscopic cholecystectomy
Using a robotic assistant to remove a patient’s gallbladder by key-hole
surgery (laparoscopic cholecystectomy) is as safe as working with a human
assistant, this review concludes. Comparisons between robot- and
human-assisted surgery showed that there were no differences in terms of
morbidity, the need to switch to open surgery, total operating time, or
length of stay in hospital.
Alternative therapies
Acupuncture
for migraine prophylaxis
Currently, those suffering from migraine headaches may take medicine to
avoid the migraine. There is now consistent evidence to indicate the
prophylactic effect of acupuncture. This updated review with 12 additional
trials shows that acupuncture prevents migraines when added to basic care
and has fewer side effects than prophylactic drug treatment. However, in
other trials, sham acupuncture was also effective in reducing the migraine
frequency, suggesting that needle placement is less critical than thought.
Diabetes
Individual
patient education for people with type 2 diabetes mellitus
Patient education is an integral component of diabetes care; however, there
is uncertainty as to the effectiveness of different educational approaches.
Individual face-to-face patient education for type 2 diabetes over a 6-12
month period benefited patients with a baseline HbA1c greater than 8%. In
other studies, there was no difference in the impact of individual vs group
education on HbA1c levels.
Senior’s health
Orthotic
devices after stroke and other non-progressive brain lesions
A recent systematic review found that a foot-drop splint can help people
walk and maintain balance after stroke or non-progressive brain lesions in
the short term. This therapy does not help with activities like climbing
stairs. There is insufficient evidence to make conclusions about the
benefits of upper limb orthosis in these patients.
Rehabilitation therapies
Rehabilitation
for older people in long-term care
This review of 49 trials concludes that many different types of physical
rehabilitation benefit physical and mental health and are safe for older
people in long term care. Since a variety of interventions was studied, the
size and duration of the effects of physical rehabilitation approaches is
unclear.
Pulmonary
rehabilitation following exacerbations of chronic obstructive pulmonary
disease (COPD)
In patients with unstable COPD who have suffered from an exacerbation
recently, the effects of pulmonary rehabilitation are not established. This
review concludes that pulmonary rehabilitation appears to be a highly
effective and safe intervention in these patients. It is likely to reduce
the risk for future hospital admissions and mortality compared with no
rehabilitation. Quality of life was also substantially improved.
Child Health
The
Cochrane Library and long-acting beta-agonist treatment for childhood
asthma: An overview of reviews
One treatment option used to control asthma symptoms is the class of
medications known as the long acting  2-agonists
(LABA) and they are often used in combination with inhaled corticosteroids
(ICS). The use of LABA in children has been widely debated in the
literature. This overview of reviews from The Cochrane Library found no clear
benefit to LABA in preventing asthma exacerbations in children. Currently,
ICS should remain the controller therapy of choice. The addition of LABA to
ICS may result in some improvements, however there is a greater risk of
adverse events as compared to ICS alone or with placebo.
Kinship
care for the safety, permanency, and well-being of children removed from
the home for maltreatment
Children who have suffered abuse or neglect are vulnerable and typically
placed in care out of the home. A recent review of 62 studies found that
kinship care- placing children with relatives - resulted in fewer
behavioural and mental health problems and more stable placements than
placing children in foster care. Children in traditional foster care were
more likely to use mental health resources and to be adopted.
Obesity
Interventions
for treating obesity in children
Obese children run a greater risk of poor health as adults. Additional
studies in this updated review identifies family-based changes in a child’s
diet and encouraging more physical activity can result in weight loss
compared to standard care or self help approaches. Drug therapy can be used
in combination with lifestyle changes, but the drugs, orlistat and
sibutramine, were associated with negative side effects.
School-based
physical activity programs for promoting physical activity and fitness in
children and adolescents aged 6-18
Increased activity during school has been one approach to reduce the
growing number of obese young people in western countries. This review
shows a positive impact of school-based activity programs on reducing blood
cholesterol and the amount of time students watch television. However,
other outcomes such as physical activity during leisure time, blood pressure
or body mass index were not affected.
Public health
Interventions
for preventing weight gain after smoking cessation
A low calorie diet and cognitive behavioural therapy (CBT) were most
effective in long-term smoking cessation and preventing weight gain, but
longer-term CBT was more effective in maintaining weight-loss. There is not
enough evidence about low calorie diets to make the same claim. Replacement
therapies, naltrexone and varenicline also were effective in preventing
weight gain but it is unknown if weight is maintained after ending therapy.
Finally, more research is needed to draw a firm conclusion on the effects
of exercise.
Understanding systematic and literature reviews
March 31,
2009; 9:30 – 11:00 EST
Host: CCNC and Seniors Health Research Transfer Network
Location: Webinar, Registration
Contact: Cheryl Arratoon (carratoo@uottawa.ca)
or Nancy Roberts (NRoberts@bruyere.org);
Systematic reviews and meta-analyses of diagnostic reviews
workshop
May
25-26, 2009
Host: Respiratory Epidemiology and Clinical Research Unit, Montreal Chest
Institute and Cochrane Infectious Diseases Group
Location: McGill University Health Centre, Montreal
Contact: Dr. Madhukar Pai: madhukar.pai@mcgill.ca
or Danielle Bastien: danielle.bastien@mcgill.ca
14th International Congress on Circumpolar Health
July
11-16, 2009
Yellowknife, NT
Funding
Evidence
on Tap-Expedited Knowledge Synthesis – apply now!
This
competition awards teams of researchers up to $110,000 to produce a knowledge
synthesis on a Ministry-identified health system priority within six months
and to host a KT end-of-synthesis workshop to assist decision makers in the
interpretation and contextualization of the findings.
Deadline: March 16, 2009.
funding
opportunity guidelines
Contact: McMahon (meghan.mcmahon@utoronto.ca or
416-978-5172)
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