< Volume 9 - July 2009 >

Cochrane in Canada: Reporting Back

A big thank you to those who participated in our survey for the Canadian Cochrane Impact and Usage Project 2009! Your testimonials showed us that Cochrane reviews are powerful enablers for policy or program change, confidence makers for professionals and empowering tools for consumers. Your input is invaluable - please continue to tell us how you use The Cochrane Library. To share your story or read others’ stories please click here.

Why studying ‘what works’ makes sense

Sharon Begley, a Newsweek journalist, clarifies the value of comparative-effectiveness research and profiles The Cochrane Collaboration in a recent article.

http://www.newsweek.com/id/205616

Citations to Cochrane reviews are on the increase

More people are citing Cochrane reviews! The impact factor of the Cochrane Database of Systematic Reviews is 5.182 for 2008, an increase over last year by 11%. More details.

Involving patients

What are the best ways to communicate with patients about screening tests, taking their medication or about their cancer? These are some of the topics explored at the new Centre for Health Communication and Participation at La Trobe University, Australia. The Centre springs from the work of the Cochrane Consumers and Communication Review Group, which is one of the three 'arms' of the new Centre. Their mission is to improve communication with, and participation by, consumers and carers through evidence-informed policy and decision making.

Do decision aids work?

Decision aids for people facing health treatment or screening decisions
Decision aids, such as pamphlets and videos, are used explain the options about treatments or screening tests to help people make health decisions. Using decision aids increases people’s involvement in their decisions, improves their knowledge of the options, and improves their perceptions of the benefits and harms. See the Cochrane review for details.

The effects of on-screen, point of care computer reminders on processes and outcomes of care

Computer alerts could remind physicians about important information while they make decisions. This review found that computer reminders that prompt doctors at the point of care can improve physicians’ prescribing behaviours and remind them about vaccinations or to order tests. Patient outcomes also benefited in some of the studies, mainly blood pressure levels.

Interprofessional collaboration: effects of practice-based interventions on professional practice and healthcare outcomes

The extent to which different healthcare professionals work well together can affect the quality of the health care that they provide. There is limited evidence that interventions such as interprofessional rounds or meetings and an externally facilitated interprofessional audit can improve patient care, such as drug use, length of hospital stay and total hospital charges.

Hypertension

Treatment blood pressure targets for hypertension
New guidelines are recommending lower blood pressure targets than the standard ≤140-160/ 90-100 mmHg. Data from seven trials in over 22,000 people provide no evidence to support aiming for a blood pressure target lower than 140/90 mmHg in any hypertensive patient. Using more drugs in the lower target groups did modestly lower blood pressures, but did not prolong survival or reduce stroke, heart attack, heart failure or kidney failure.

Interventions in the management of serum lipids for preventing stroke recurrence
This updated review includes three additional studies. The authors conclude there is now evidence that patients with a history of ischaemic stroke or transient ischaemic attack who are treated with statins are less likely to experience subsequent serious vascular events.

Asthma

Mono and multifaceted inhalant and/or food allergen reduction interventions for preventing asthma in children at high risk of developing asthma
It is thought that reducing children’s exposure to allergens alters their risk of developing asthma. An indirect comparison of interventions shows that strategies that reduce the exposure of children to both inhaled and dietary allergens may be better at preventing the likelihood of a diagnosis of asthma as compared to reducing their exposure to a single type of allergen.

Diabetes

Granulocyte-colony stimulating factors as adjunctive therapy for diabetic foot infections
Foot infections in people with diabetes can be difficult to treat, and unresolved infection may lead to amputation. The limited evidence available suggests that granulocyte-colony stimulating factor (G-CSF) does not improve the healing of foot ulcers, but it does appear to reduce the need for surgery, especially amputations, and reduces the number of days in hospital.

Senior’s health

Progressive resistance strength training for improving physical function in older adults
Muscle strength reduces as people age, leaving older people more susceptible to falls. This updated review incorporates the results of 55 new trials. The results demonstrate that older people who do resistance exercises become stronger. They are better able to perform simple activities such as climbing steps or standing up from a chair quickly, as well as complex daily activities.

Exercise for osteoarthritis of the hip
Symptomatic hip osteoarthritis is associated with joint pain and physical disability and is the most common reason for total hip replacement surgery. Land-based exercise, such as gym or Tai Chi classes, may reduce pain slightly but may not improve physical function.

Child health

Addition of long-acting beta-agonists to inhaled corticosteroids for chronic asthma in children
Most consensus statements recommend the use of long-acting ß2-agonists (LABA) as adjunct therapy to inhaled corticosteroids for poorly controlled asthma in adults. The direction is less clear for children. Based on the pediatric trials in this review, adding LABA did not reduce the risk of asthma events requiring rescue systemic steroids. However, the addition of LABA did improve lung function compared to ongoing treatment with a similar dose of inhaled corticosteroids.

Cancer

Erythropoietin or Darbepoetin for patients with cancer - meta-analysis based on individual patient data
Erythropoiesis-stimulating agents (ESAs) are used to reduce anemia in cancer patients, but recently there has been concern about their potential harm. Individual patient data from 53 trials of nearly 14,000 people given ESAs during or after cancer treatment were examined. Consistent results showed that ESA treatment in cancer patients increased mortality and shortened overall survival.

Workplace health

Interventions to prevent occupational noise induced hearing loss
Millions of workers are at risk for hearing loss from exposure to high levels of noise at work. There is low quality evidence that legislation can reduce noise levels in workplaces. The effectiveness of hearing protection devices depends on their proper use. The effectiveness of hearing loss prevention programmes is not clear.

Cochrane Library webinars

Remember, all Canadians have full access to The Cochrane Library for 2009! Need an orientation to the Library? See webinars being offered for Canadians.

17th Cochrane Colloquium

11-14 October 2009; Singapore
Check plenaries and workshops online.

Innovation at Work

An invitation for request for proposals from WorkSafe BC. These grants are intended to support the development of new knowledge and/or practical problem-solving at the workplace level.
Notice of intent deadline: 17 August 2009
Application deadline: 14 September 2009.

Save the date!

8th Canadian Cochrane Symposium
19-20 May 2010, Ottawa
Pre-symposium workshops: 17-18 May 2010

Pass it on! Click here to forward to a friend or colleague.