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General health checks in adults for reducing morbidity and mortality from disease

Stephanie Thompson, Marcello Tonelli General health checks in adults for reducing morbidity and mortality from disease

Since the latter half of the 20th century, technological advances in modern medicine and a growing emphasis on preventive care have led to increased enthusiasm for screening in apparently healthy people. In primary care practice, the general health check (also termed periodic health evaluation or routine medical examination) is the usual mechanism used to screen asymptomatic people for disease. Although widely practiced, there is no universally accepted definition of what constitutes a general health check; screening may occur at variable frequencies and include a spectrum of diagnostic maneuvers ranging from physical examination to invasive procedures. Despite this variability, all general health checks share a common goal: to reduce morbidity and mortality by detecting disease or modifiable risk factors at an earlier stage—implicitly assuming that this will improve clinical outcomes compared with waiting until symptoms develop.

Procalcitonin: hope in the fight against antibiotic resistance?

Chris Del Mar, Toby Lasserson Procalcitonin: hope in the fight against antibiotic resistance?

We normally think of calcitonin as a hormone produced by the C-cells of the thyroid, with the role of balancing parathyroid hormone in the conservation of calcium in the body. It's less widely known that calcitonin's precursor, procalcitonin, can be made by many cells, albeit at undetectable levels in healthy people. The discovery that procalcitonin is released into the blood in detectable amounts in response to severe bacterial infection was unexpected. It may be related to the finding that hypocalcaemia is often present in critically ill patients and correlates with severity of illness, although the relationship is complicated. Nevertheless, it opens a number of possibilities. Could procalcitonin be used as a diagnostic marker for serious infection? Any test or decision tool that helps to identify patients who do not need antibiotics could help to target antibiotic therapy more effectively.

Debating the evidence for deworming programmes

John Hilton, David Tovey Debating the evidence for deworming programmes

The July 2012 issue of The Cochrane Library included an update of a Cochrane Review on deworming drugs for soil-transmitted intestinal worms in children. The review hadn't been updated in four years and although a number of new trials had been found, the update didn't radically change the conclusions -- that there is a lack of high-quality evidence that community-based deworming programmes improve outcomes. The updated review also included summary of findings tables that presented the quality of evidence for each of the main outcomes using the GRADE methodology. Given the global investment in deworming programmes it’s not surprising that there was debate and differing opinion on the conduct of the review and its findings.

Health protection and heatwaves: the need for systematic reviews

Sari Kovats, Graham Bickler Health protection and heatwaves: the need for systematic reviews

Following several major heatwaves in Europe and the USA, there has been an increased interest in health protection measures to reduce the impacts of such extreme weather events on human health. Heatwaves are also an issue for mass gatherings and heatwave planning has been incorporated into the preparation for the Olympics this month.

Why should we translate Cochrane Reviews into French? A view from Cameroon

Lawrence Mbuagbaw, Harriet MacLehose Why should we translate Cochrane Reviews into French? A view from Cameroon

The Cochrane Collaboration is a leader in the preparation of high-quality systematic reviews, but they are prepared and available mainly in the English language. This alone greatly undermines the potential of Cochrane Reviews as building blocks for decision-making in many low- and middle-income countries, including those in Africa, where evidence about the benefits and harms of healthcare interventions is needed urgently.

Hospital at home in chronic obstructive pulmonary disease: is it a viable option?

Sasha Shepperd, Christopher Cates Hospital at home in chronic obstructive pulmonary disease: is it a viable option?

Innovative approaches aimed at reducing reliance on acute hospitals are being explored by providers of health systems around the world. These approaches reflect concern about the suitability of the hospital environment for people with complex healthcare problems who are often in need of some form of rehabilitation.

Improving outcomes in gynaecological cancer: the benefits of subspecialisation

Jo Morrison Improving outcomes in gynaecological cancer: the benefits of subspecialisation

Over the past 30 years advances in medicine have resulted in increasingly complex care pathways and individualisation of care. As a result, medicine has become subspecialised in many areas, and there is evidence for improved outcomes for patients treated by multidisciplinary teams, as demonstrated in chronic heart failure, stroke, and colorectal cancer.

Strategic review of The Cochrane Library

David Tovey Strategic review of The Cochrane Library

Every now and again any publication needs to review its progress. This provides an opportunity to reach out to those who read or use the publication, as well as those who contribute material, provide editorial support or help with production. As The Cochrane Collaboration heads for its third decade, stepping into adulthood perhaps, this is a good time to undertake a strategic review of The Cochrane Library.

Neuraminidase inhibitors for influenza: methods change, principles don’t

Toby Lasserson, David Tovey Neuraminidase inhibitors for influenza: methods change, principles don’t

Systematic reviews seek to identify and summarise all the relevant research evidence relating to the clinical or health policy decision under consideration. This rationale can be fatally undermined if the review only includes a proportion of the research conducted, due to the restricted availability of some studies or their data. The recognition of reporting bias and its potential to confound the results of evidence synthesis is not new, and there is now ample methodological research demonstrating that studies with 'positive' results are more likely to be published and published sooner, than those with 'negative' results. If systematic reviews fail to address reporting biases they are at risk of generating misleading results. We should, therefore, pay particular attention to reviews that either identify strong evidence of a risk of reporting bias or adopt innovative methods to overcome it.

Need to re-align patient-oriented and commercial and academic research

Alessandro Liberati Need to re-align patient-oriented and commercial and academic research

People facing life threatening illness have a right to expect that research into their illness will address the uncertainties that matter most to them. Unfortunately, this is not always the case, as Alessandro Liberati (1954-2012)†describes in this editorial, first published in The Lancet, building on his own experience as a patient.

Implications for research: getting the most out of Cochrane Reviews

Urbà González, Hywel Williams Implications for research: getting the most out of Cochrane Reviews

Cochrane Reviews are essential tools for accurately summarising the evidence of the effects of healthcare interventions in a way that minimises bias. In addition to occasionally providing clear clinical answers, when several smaller apparently conflicting studies are brought together, such reviews are a rich resource for people planning to fund or undertake future healthcare research.

Helping people make well-informed decisions before, during and after disasters: the Evidence Aid initiative

Mike Clarke, Claire Allen, Bonnix Kayabu Helping people make well-informed decisions before, during and after disasters: the Evidence Aid initiative

Evidence Aid, a global initiative that arose within The Cochrane Collaboration, aims to promote the scientific output from systematic reviews to improve the outcomes of people affected by natural disasters and other humanitarian emergencies. Special Collections of short summaries of Cochrane Reviews are available on The Cochrane Library, and the whole content of The Cochrane Library has been made freely accessible to some of the areas affected by disasters.

We need access to all data from all clinical trials

Peter C Gøtzsche We need access to all data from all clinical trials

A variety of international organisations, funders, and others have made calls for sharing research data. These calls have mostly been restricted to publicly funded research, but if the over-riding objective of healthcare research is to improve patient care and health policy, the distinction between publicly funded research and industry-funded research is artificial and irrelevant. It is pretty clear that if commercial concerns lead to the withholding of data that are important for rational decision-making by doctors and patients, there is something fundamentally wrong.

Centralised access to evidence-informed nutrition actions

Hannah Neufeld, Francesco Branca Centralised access to evidence-informed nutrition actions

On 10 August 2011, the Department of Nutrition for Health and Development of the World Health Organization (WHO), in collaboration with other departments, launched a new web-based resource tool designed to assist key players worldwide in making informed decisions on the most effective actions in response to the different forms of malnutrition and for improving the health and nutrition of populations globally.

Post-operative pain management

Christopher Eccleston Post-operative pain management

This month sees the landmark publication of an authoritative Cochrane overview of systematic reviews of oral analgesics for acute post-operative pain in adults. The lead author, Professor Andrew Moore describes this study in this month’s podcasts.

The use of Cochrane Reviews in NICE clinical guidelines

Phil Alderson, Toni Tan The use of Cochrane Reviews in NICE clinical guidelines

The National Institute for Health and Clinical Excellence (NICE) produces clinical guidelines for the National Health Service (NHS) in England and Wales. These guidelines are developed by groups that combine people with expertise in conducting systematic reviews and health economic analyses, with those with expertise in the clinical area (from healthcare professionals and patients).

Assessing rapid diagnostic tests for malaria

Hasifa Bukirwa Assessing rapid diagnostic tests for malaria

Malaria remains a major cause of illness and death in Africa and other endemic, and often resource-limited, settings. Most cases of malaria are uncomplicated but can quickly turn into severe, often fatal, episodes in vulnerable individuals if not promptly diagnosed and effectively treated.

Viewpoint: Randomised controlled trials using invasive control interventions should be included in Cochrane Reviews

David F Kallmes, Rachelle Buchbinder, Franklin G Miller Viewpoint: Randomised controlled trials using invasive control interventions should be included in Cochrane Reviews

To listen to a podcast of this editorial, please click here. We find it fascinating that both Cyna et al. and ourselves begin at the exact same point – that is, patient protection is paramount – yet we end up at diametrically opposing views regarding the use of invasive ‘placebos’ in randomised controlled trials (RCTs).

Viewpoint: Randomised controlled trials using invasive ‘placebo’ controls are unethical and should be excluded from Cochrane Reviews

Allan M Cyna, David Costi, Philippa Middleton Viewpoint: Randomised controlled trials using invasive ‘placebo’ controls are unethical and should be excluded from Cochrane Reviews

Placebo controls are frequently used to ‘blind’ participants, trial personnel and outcome assessors to intervention and control in clinical trials. Effective blinding of treatment reduces the risk of performance bias (differences between groups in the care provided apart from the intervention being evaluated) and detection bias (differences between groups in how outcomes are ascertained, diagnosed or verified). A placebo has traditionally been defined as an “inert or innocuous substance”, such as a ‘sugar pill’.

Phosphodiesterase 4 inhibitors for chronic obstructive pulmonary disease

Milo Puhan Phosphodiesterase 4 inhibitors for chronic obstructive pulmonary disease

The pharmaceutical industry is currently investing vast resources to develop drugs that provide benefits to patients with chronic obstructive pulmonary disease (COPD). Phosphodiesterase 4 (PDE4) inhibitors are among the drugs that raise hopes that two important goals of the COPD management, symptom relief and risk reduction of exacerbations, can be targeted more effectively than it is currently possible. Over the last ten years, industry-sponsored phase II and III randomised trials have been conducted to explore the efficacy and safety of the PDE4 inhibitors cilomilast and roflumilast in COPD patients. Are PDE4 inhibitors the long-needed magic pill for COPD patients?

Incentives for promoting smoking cessation: what we still do not know

Paul Aveyard, Linda Bauld Incentives for promoting smoking cessation: what we still do not know

In a newly updated Cochrane Review, Cahill and Perera summarise the effectiveness of incentives for smoking cessation. Their disappointing conclusion is that while there is some evidence that incentives work in the short term, the effects generally dissipate, and there is still insufficient evidence to recommend their adoption into routine practice. Much therefore remains to be discovered, but what are the particular questions that this review highlights?

Cochrane: spreading the message of research to students and juniors

Vikas Sud, Kiran Ejaz, Zbys Fedorowicz, Manu Mathew, Akshay Sharma Cochrane: spreading the message of research to students and juniors

At the 2009 meeting of INFORMER (www.informer.org.in), the forum for Indian medical students' research, Professor Prathap Tharyan, director of the South Asian Cochrane Centre (www.cochrane-sacn.org), gave a workshop on evidence-based medicine (EBM). As a consequence, INFORMER became associated with the Cochrane Centre, based at Christian Medical College, Vellore, India.

If there are no randomised controlled trials, do we always need more research?

Karianne Thune Hammerstrøm, Arild Bjørndal If there are no randomised controlled trials, do we always need more research?

We have recently come across Cochrane Reviews in which evaluative research other than randomised controlled trials, as well as logic and basic science, seem to have been largely ignored. Hence, the review questions cannot be answered in the manner that the authors set out to do, the implication being that more research is needed.

Rehabilitation of older people after hip (proximal femoral) fracture

David J Stott, Helen H Handoll Rehabilitation of older people after hip (proximal femoral) fracture

Proximal femoral, or 'hip', fracture is a major health problem in older age. It is a common condition, with a lifetime risk of around 17.5% for white women and 6% for white men. It occurs predominantly in older people, and is strongly associated with comorbidity, including under-nutrition, frailty, and impaired physical and cognitive function.