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< Volume 8 - May 2009 >
National license for The Cochrane Library launched!
All
Canadians with access to the Internet now have full access to The Cochrane Library!
The Canadian Cochrane Network and Centre, in partnership with the Canadian
Health Libraries Association, has successfully secured a national license
to The Cochrane Library.
Everybody is one click away from the best available evidence on the
effectiveness of treatment procedures, including which ones may be harmful.
For more
information see http://www.ccnc.cochrane.org/en/index.html
Building Cochrane Collaboration Activities in Nova Scotia
Thanks to
the Nova Scotia Health Research Foundation (www.nshrf.ca),
the following activities in Nova Scotia are being funded to help build capacity
to conduct and use Cochrane Reviews.
1.
The
Cochrane Prognosis Methodology Resource Group, a new subgroup of the
Prognosis Methods Group
2.
The
Dalhousie University Cochrane Network Site
3.
A new Nova
Scotia Cochrane Resource and Training Group
For more
information contact Dr. Jill Hayden, Dalhousie University (jhayden@dal.ca).
PPD database – Rising Star Award
Congratulations
to Michael Wilson for receiving the 2008-2009 CIHR-IHSPR Rising
Star Award for his work on the PPD/CCNC
database of systematic reviews. This database helps healthcare managers
and policymakers find and use systematic reviews efficiently. It was
produced by McMaster University’s Program in Policy Decision-Making in
partnership with the Canadian Cochrane Network and Centre.
Cochrane Child Health – new partnership
Martin
Offringa and Terry Klassen, Editors-in-Chief of the Child Health Field
journal, Evidence-Based
Child Health: A Cochrane Review Journal, are delighted to
announce a new partnership with the European Paediatric Association. EBCH
will now be an official journal for the Association. The journal
specializes in overviews of reviews related to peadiatrics. www.evidence-basedchildhealth.com.
Continuing education meetings and workshops: effects
on professional practice and health care outcomes
This
updated review, with 49 new trials, confirms that educational meetings can
improve professional practice and patient outcomes, although the effect is
small. Educational meetings with a mixture of interactive and didactic
components were more effective than either alone. Educational meetings are
unlikely to change complex behaviours in health professionals.
Alternatives to inpatient mental health care for
children and young people
For
several reasons, it may be preferable to offer mental health services for children
and young people outside the hospital environment. Minimal evidence found
on four types of mental health services showed that some behaviour in
children improved with therapists providing family-centred therapy in the
home or an intensive home-based crisis intervention. Intensive home
treatment or specialist outpatient services did not improve children’s
outcomes as compared to control interventions.
Workplace interventions for preventing work
disability
Long term
absence due to sickness is costly to society, employers and the individuals
concerned. Changes at the workplace may reduce barriers to people returning
to work. Based on moderate-quality evidence, the results of this review
show that workplace interventions can reduce absence due sickness among
workers with musculoskeletal disorders when compared to usual care.
Cochrane Library Spotlight - Issue 2, 2009
Alternative therapies
Homeopathic
medicines for adverse effects of cancer treatments
Drugs and radiotherapy used to treat cancer often cause unpleasant side
effects such as nausea, vomiting and mouth sores. Patients commonly use
alternative medicines to reduce these effects. This review found
preliminary data that calendula ointment may reduce skin irritation caused
by radiotherapy. There was no convincing evidence to support the use of
homeopathic medicines for other adverse effects of cancer treatments.
Podcast
Asthma
Regular
treatment with formoterol and inhaled steroids for chronic asthma: serious
adverse events
There has been debate about the safety of beta2-agonists when used alone or
with inhaled corticosteroids to treat asthma. In this review, four deaths,
including one related to asthma, were reported in over 6,000 adults using
regular formoterol with inhaled corticosteroids. No deaths occurred with
regular inhaled corticosteroids used alone. Clinical decisions should
consider the benefits with the potential harmful effects of formoterol.
Combination
formoterol and budesonide as maintenance and reliever therapy versus
inhaled steroid maintenance for chronic asthma in adults and children
Different inhalers are used to prevent asthma attacks and provide relief of
asthma symptoms. A combination therapy of formoteral and budesonide would
provide both these functions in a single inhaler. This review found that
single inhaler therapy did not reduce the time to a severe asthma attack in
adults as compared to current best practice for uncontrolled asthma
(regular long-acting beta2-agonist used with inhaled corticosteroids). The
mean total daily dose of inhaled corticosteroids was reduced with single
inhaler therapy. Five trials studying single inhaler therapy are currently
ongoing.
Podcast
Interventions
for educating children who are at risk of asthma-related emergency
department attendance
Asthma is a leading cause for paediatric admission to hospital, resulting
in substantial costs. This updated review shows that educational programs
delivered to children, their parents or both, helped to reduce the risk of
future emergency department visits and unscheduled doctor visits.
Senior’s health
Submacular
surgery for choroidal neovascularisation secondary to age-related macular
degeneration
This review examined whether surgery to remove tissue that damages the
centre of the retina preserves or improves vision in patients with
neovascular age-related macular degeneration. One year after surgery, there
was no benefit for preventing loss of vision or chance of gaining vision.
In addition, the risk of developing cataract and detachment of the retina
increased.
Interventions
for preventing falls in older people living in the community
This review found that exercise programmes such as Tai Chi that target
strength, balance, flexibility or endurance, may help to prevent falls
among the elderly living in the community. There is less evidence for the
effectiveness of home safety improvements and vitamin D supplements to
prevent falls. There is no evidence to support exercise interventions in
people with severe visual impairment or mobility problems after a stroke, Parkinson's
disease, or a hip fracture.
Routine
preoperative medical testing for cataract surgery
The volume of cataract surgery and its associated costs are increasing and
there is question whether routine preoperative medical testing is
necessary. This review of over 21,000 cataract surgeries found that routine
preoperative medical testing did not reduce the risk of medical adverse
events during or after cataract surgery compared to selective or no
testing. The authors conclude that preoperative testing does not increase
the safety of cataract surgery.
Rivastigmine
for Alzheimer's disease
Alzheimer's disease is the most common cause of dementia affecting older
people. The drug therapy rivastigmine, administered in doses of 6-12 mg
daily, was shown to slow the decline in cognitive function, activities of
daily living and the severity of dementia. Adverse effects were consistent
with the cholinergic actions of the drug.
Child health
The
Cochrane Library and recurrent abdominal pain in children: an overview of
reviews
Many children have abdominal pains and do not need significant treatment.
For children who need further treatment, this overview of reviews concludes
that dietary changes are not effective for consistently relieving recurrent
abdominal pain. In addition, pharmacotherapy of any sort did not help
children with IBS or functional abdominal pain. However, early treatment
using cognitive behavioural therapy may be helpful as well as discussion of
the issues with the patient and his/her family.
Extraction
of primary (baby) teeth for unerupted palatally displaced permanent canine
teeth in children
Sometimes the permanent canine tooth in the upper jaw does not erupt into
the mouth correctly. It has been suggested that if the baby canine is
removed at the right time this palatal eruption might be avoided. However,
there is currently no trial to support or dispute the practice of
extracting baby canine teeth to make way for adult canines that are
erupting in the wrong place.
Podcast
Influenza
vaccination in children being treated with chemotherapy for cancer
In national guidelines it is recommended to vaccinate children being
treated for cancer against influenza. Clinical evidence from randomized
controlled studies to support this recommendation is lacking. In the trials
included in this review the children are able to generate immune response
to influenza vaccine, although poorer than healthy children. It remains
unclear whether this immune response protects them from influenza infection
or its complications. Influenza vaccination appears to be safe in these
children.
Public health
Vaccines
for preventing anthrax
Anthrax is a bacterial zoonosis that occasionally causes human disease and
is potentially fatal. One cluster-RCT provides limited evidence that a
live-attenuated vaccine is able to prevent cutaneous anthrax. More recent
types of vaccines tested in the smaller trials, also based on inactivated
components of the anthrax bacterium, appear to have few adverse events and
to stimulate a good immune response. Several trials testing these newer
vaccines are in progress.
Women’s Health
Transcutaneous
electrical nerve stimulation (TENS) for pain relief in labour
Transcutaneous nerve stimulation (TENS) has been proposed as a means of
reducing pain in labour, although the physiological mechanisms whereby TENS
relieves pain are uncertain. A review of 19 studies found no consistent
evidence that TENS reduced pain during labour or had any impact on outcomes
for mothers or babies.
Chronic disease
Psychological
therapies for the management of chronic pain (excluding headache) in adults
A review of the effectiveness of psychological therapies on pain,
disability, and mood found that cognitive behavioural therapy and
behavioural therapy have weak effects in improving pain not related to
headaches or cancer. These therapies are effective in altering depression
and anxiety, and there is some evidence that these changes are maintained
at six months.
HMG
CoA reductase inhibitors (statins) for people with chronic kidney disease
not requiring dialysis
Patients with chronic kidney disease (CKD) are at very high risk of heart
disease. Statins are used to reduce cholesterol levels and mortality
in the general population. This review concludes that statins also
significantly reduced the risk of all-cause and cardiovascular mortality in
CKD patients who are not receiving renal replacement therapy. They do not
affect the decline in renal function as measured by creatinine clearance,
but may reduce protein excretion in urine. Two large ongoing studies will
provide more clarification.
Surgery
for obesity
Bariatric (weight loss) surgery for obesity is considered when other
treatments have failed. This updated review concludes that surgery for
obesity results in greater weight loss than conventional treatment, and
that the results are maintained for at least up to ten years. Weight loss
is associated with reductions in associated conditions such as diabetes and
hypertension, and medication use. However, this surgery is associated with
complications, adverse effects and some deaths.
Podcast
National Eating Disorders Information Centre Annual Body
Image and Self-esteem: Shades of Grey Conference
May 22,
2009
Workshop: What
should you believe? Using research to be informed www.nedic.ca/2009ConferenceIntro.shtml
Canadian Association of Occupational Therapists
Conference 2009
Engaging in Healthy
Occupation: Partners for Change
June 2,
2009
Pre-conference workshop: Tapping
into Cochrane: How can an evidence-based approach support your practice?
www.caot.ca/default.asp?pageid=1457
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