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< Volume 6 - October 2008 >
Chiropractors gain access to The
Cochrane Library
Congratulations to the
Canadian Chiropractic Association! The
Cochrane Library and all it has to offer health professionals
are now available to the 6000 members of the CCA. To access The Cochrane Library to inform your
practice, go to the members only section of www.ccachiro.org/.
Contribute to Cochrane
How? Identify trials for
CENTRAL, the Cochrane trials register. The Canadian Cochrane Centre is
seeking volunteers to handsearch issues of the CMAJ and the Canadian Journal of Nursing Research to
identify controlled trials. Handsearching is an
important means to identify trials for Cochrane reviews. Online training is
available.
Contact: Adrienne
Stevens at astevens doesnotexist@cochrane.org uottawa.ca
2008 Diabetes Guidelines – 14
Cochrane reviews cited
The Canadian Diabetes
Association has just released the latest Clinical
Practice Guidelines for the Prevention and Management of Diabetes in Canada. These
guidelines
represent the most current evidence-based clinical practice data for
healthcare professionals, including the results of 14 Cochrane reviews.
Clinical Pearls from Cochrane
reviews
The 70th issue of the
Therapeutics Letter: "Clinical Pearls from the most popular Cochrane
reviews in 2007" summarizes the top five most accessed Cochrane
reviews in 2007: Interventions for preventing falls in elderly people;
Interventions for treating obesity in children; Beta-blockers for
hypertension; Low glycaemic index or low glycaemic load diets for overweight and obesity;
Nicotine receptor partial agonists for smoking cessation.
Admission avoidance hospital at home
Admission avoidance
hospital at home is a service for patients who would otherwise need acute
care in hospital. Instead they receive care at home for a limited time by
health professionals. This Cochrane review indicates that there is no
significant difference in outcomes between patients treated in hospital and
those treated through admission avoidance hospital at home. In fact, after
6 months follow-up, mortality was significantly reduced with at home care.
Organising health care services for persons with an
intellectual disability
People with intellectual
disabilities often experience health problems, yet have limited access to
the care they need. This review assessed the effect of changes in the
structure or delivery of health care services that may improve the health
outcomes of these people. Limited evidence indicates that multidisciplinary
teams providing intensive services for persons with an intellectual
disability and a mental health problem could improve mental health
outcomes.
Cochrane Library Spotlight - Issue 4, 2008
Hypertension
Blood pressure lowering efficacy of angiotensin converting enzyme (ACE) inhibitors for
primary hypertension
Blood pressure lowering efficacy of angiotensin receptor blockers for primary hypertension
Blood pressure lowering efficacy of renin inhibitors for primary hypertension
ACE, ARB and renin inhibitors are taken for high
blood pressure. Cochrane reviews evaluating the efficacy of these three
classes of drugs found that ACE, ARB and the renin
inhibitor, aliskiren, all had similar modest
effects in lowering blood pressure. There were no clinically meaningful
differences within each class of the ACE and ARB inhibitors examined.
Alternative therapies
Honey as a topical treatment for wounds
A Cochrane review suggests that honey can be an effective treatment for
mild to moderate burns. In comparing studies that examined the effect of
honey on various wounds, reviewers found that it sped up healing time for
burns but could not conclude that it helped with other wounds such as
venous leg ulcers. Honey did not increase healing when used with a bandage
on the wound.
Sanchi for acute ischaemic
stroke
Tongxinluo capsule for acute stroke
Two Chinese traditional medicines for ischaemic
stroke, sanchi and tongxinluo,
have recently been subjects of systematic reviews. In both cases, there
was not enough quality evidence to recommend the use of either medicine for
ischaemic stroke. Sanchi
may be beneficial and safe, but this conclusion is based on poor quality
and short term studies.
Touch therapies for pain relief in adults
Reiki, Therapeutic Touch and Healing Touch are considered “touch therapy”
used to alleviate acute and chronic pain. In a systematic review it was
found that despite few studies and small sample sizes, there was some
evidence to support the benefit of touch therapy. The review suggested that
experienced Reiki practitioners yielded the most positive results for their
patients.
Rehabilitation therapies
Rehabilitation after lumbar disc surgery
Following herniated disk surgery, patients can choose rehabilitation
treatments that vary in intensities. This updated review found a slight
decrease in pain and disability for patients following an exercise program
4-6 weeks post-surgery. A high intensity exercise program provided faster
relief than a low intensity program. There is little benefit to supervised
programs over at-home programs.
Surgical versus non-surgical treatment for carpal
tunnel syndrome
Surgery, splinting and steroid injections are used to treat the numbness
and tingling felt by sufferers of carpal tunnel syndrome. This updated
review indicates that surgery is more effective than splinting. Additional
studies are required to know if surgery is preferable to injections, and
what is best for mild symptoms.
Asthma
Regular treatment with formoterol
for chronic asthma: serious adverse events
Formoterol is a long-acting beta2-agonist used to
treat chronic asthma. This Cochrane review found an increased risk of
non-fatal serious adverse effects for patients using formoterol
as compared to placebo, particularly for children. However, the rate of
fatal or non-fatal events was no different than those reported for patients
using regular salbutamol or terbutaline.
Senior’s health
Combined intermittent pneumatic leg compression
and pharmacological prophylaxis for prevention of venous thromboembolism in high-risk patients
People who have undergone surgery or trauma can run an increased risk for
deep vein thrombosis (DVT) and pulmonary embolism (PE). Compression and
medications such as blood-thinners, can prevent
such complications. A recent review indicates that a combination of the two
treatments is more effective at preventing DVT than either method alone.
There was insufficient data to determine their implications for PE.
Low molecular weight heparin for prevention of
venous thromboembolism in patients with lower-leg
immobilization
Adults who wear a plaster cast or a brace on the lower leg face an
increased risk of deep vein thrombosis (DVT). This review investigated
whether low molecular weight heparin (LMWH), an anti-coagulant, might be
used to prevent DVT in patients with immobilized legs from different types
of injuries. The results show that LMWH was significantly better at
reducing the incidence of venous thromboembolism
than no treatment or placebo, with few adverse side effects.
Women’s health
Midwife-led versus other models of care for
childbearing women
A recent Cochrane review supports midwife-led care for pregnant women. The
data show that benefits of midwife-led care over physician-led care
included fewer spontaneous abortions prior to 24 weeks, fewer episiotomies,
more vaginal births and less use of instruments
and pain management medication. Women in midwife-led care were also more
likely to start breast-feeding.
Mental health
Exercise for depression
Relaxation for depression
Exercise and relaxation both have potential in treating depression. A
systematic review found that relaxation techniques reduced depressive
symptoms reported by patients, but not as well as psychological therapy.
However, relaxation may be an alternative therapy for first-time sufferers
who prefer a simple, non-medicated approach. Exercise also seems to improve
the symptoms of depression and its effect is not significantly different
from psychotherapy.
Public Health
Mupirocin ointment for preventing Staphylococcus aureus infections in nasal carriers
The spread of Staphylococcus aureus infection in
hospitals occurs between patients, but infections actually begin inside the
patient’s nose and spreads from there. In order to reduce infection, a
Cochrane review recommends the use of mupirocin
as a topical ointment in nasal carriers of Staphylococcus aureus.
Oral Health
Mouthrinses
for the treatment of halitosis
Halitosis, or bad breath, can be serious enough to be personally
embarrassing. Over the counter mouthrinses are
often used to neutralize or mask the odour. This
review shows some evidence that mouthrinses
containing antibacterial agents or those containing chlorine dioxide and
zinc can reduce the unpleasant odour. However, mouthrinses containing chlorhexidine
caused temporary staining of the tongue and teeth.
14th International Congress on
Circumpolar Health
July 11-16, 2009
Yellowknife,
NWT
www.icch2009.com/
Call for abstracts open, deadline January 31, 2009.
Attend a Cochrane workshop!
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