The vision of universal health coverage is that all people obtain the health services they need, while not being pushed into poverty by paying out-of-pocket costs for health care. To achieve this, health systems must be strengthened, based on the best available information. Four new Cochrane Overviews summarize evidence from systematic reviews about the effects of delivery, financial, and governance arrangements, and implementation strategies for health systems.
The term 'complex intervention' is commonly used by health researchers, but what makes an intervention complex remains contested. The intervention Complexity Assessment Tool for Systematic Reviewers (iCAT_SR) provides systematic review authors with a structure for locating interventions on a continuum according to a number of dimensions of complexity. The iCAT-SR tool may assist in anticipating and planning for implementation challenges, and designing evaluations that are proportionate to the uncertainties posed by an intervention and that focus upon core elements of complexity.
Preterm birth is a major cause of death and morbidity in babies worldwide. Antenatal corticosteroid administration to pregnant women at high risk of preterm delivery is a proven hospital-based intervention to reduce adverse effects associated with preterm birth. In high-resource settings, the safety and effectiveness of corticosteroid therapy for reducing preterm-associated adverse effects is unequivocal, and the priority is scale-up to address remaining gaps in coverage. However, whether similar benefits are replicable in low-resource settings remains to be demonstrated.
There are striking disparities in the provision of mental health care between rich and poor countries. In low- and middle-income countries more than 75% of people with serious mental health conditions receive inadequate care, despite substantial disability and functional impairment. A new Cochrane partnership, Cochrane Global Mental Health, will support the production, dissemination, access, and use of systematic reviews in mental health globally.
Antimicrobial stewardship programmes were introduced in hospitals more than 30 years ago to address inappropriate antibiotic prescribing and increasing antibiotic resistance. Since then a large body of evidence on the effectiveness and safety of this approach has accumulated, and a new Cochrane Review updates the evidence on interventions and delivery methods to improve antibiotic prescribing.
Dietary risk factors are among the leading contributors to the global burden of disease. Recognizing the need for nutrition policies and interventions to tackle such risk factors, 2016 to 2025 is the UN Decade of Action on Nutrition. Cochrane has a strong track record of producing systematic reviews of the evidence supporting nutrition policies and interventions. This call to action focuses on how Cochrane could reshape evidence synthesis and use for nutrition policy. The recent establishment of a Cochrane Nutrition Field provides an opportunity to progress this call to action.
Cochrane Global Ageing aims to promote the quality, dissemination, accessibility, applicability and impact of Cochrane Reviews towards optimizing the health and wellbeing of older people everywhere. Our mission is to connect people within and outside Cochrane and facilitate sharing of knowledge and experiences related to global ageing and health that are relevant and accessible to consumers, review editors, authors, specialists, policy makers, educators, commissioners, and funders.
The Cochrane Review of deworming populations in endemic areas, first published in 1998 and updated most recently in 2015 has attracted increasingly vociferous opposition to its findings. A new systematic review and network meta-analysis of deworming strategies by researchers working within the Campbell Collaboration supports the Cochrane Review findings. There is no dispute that treating children infected with worms is worthwhile, but the findings of the two systematic reviews together provide a strong case against the current population-wide programmes.
Despite being one of the most common long-term diseases worldwide, asthma is notoriously difficult to get under control for many people with the condition. There is growing interest in objective measures to guide both diagnosis and management. One strategy involves measuring fractional exhaled nitric oxide (FeNO), a marker of airway inflammation caused by eosinophils and associated with allergy. Does FeNO offer an advantage over using symptoms and measures such as peak flow to tailor asthma treatment?
Receiving a kidney transplant is transformative for a patient who is on dialysis. Transplantation means a major operation, short-term and long-term monitoring, and multiple drugs to prevent rejection of the new organ, but it also brings the promise of a more normal life. Corticosteroids have been one of the mainstays for preventing rejection since the inception of solid organ transplantation, but reducing the risk of rejection needs to be carefully balanced against the harms of corticosteroids. An updated Cochrane Review provides more information on this important topic.
Chemotherapy is established as an effective therapy for early breast cancer, reducing recurrence rates and improving survival. It was postulated that higher doses of treatment might be more effective. An updated Cochrane Review includes data from extended follow-up from existing trials, and we now have high-quality evidence that high-dose chemotherapy does not improve survival in breast cancer.
Two new and very different Cochrane Reviews illustrate some key pragmatic decisions taken to enhance the relevance of review findings to clinical practice. Both reviews shifted away from the more exacting inclusion criteria initially implied in their scopes to reflect clinical reality, and thus increase the applicability of the findings.
Cochrane Review authors should avoid overemphasis on whether or not a meta-analysis result is statistically significant. The clinical significance and positive or negative implication of an effect estimate should only be emphasised if the statistical assessment is conclusive beyond reasonable doubt.
Delirium is recognized as clinically important and yet has seen relatively little original research. Guidance from professional bodies and government policy in many countries highlights improving delirium as a priority. An updated Cochrane Review provides a nice summary of what we know and gives some pointers as to where we need to go with delirium prevention research.
Ovarian cancer is the seventh most common cancer in women worldwide. Women who present with a suspicious ovarian mass usually require surgery for diagnosis and staging. Surgical removal of the mass is the only way to obtain a definitive result by histological examination. A new Cochrane Review provides crucial evidence on the accuracy of frozen section analysis, a rapid diagnostic test that can inform management decisions of during surgery.
A new Cochrane Review focuses on the use of transvaginal mesh for surgery in women with vaginal prolapse. The findings are of concern for operating gynaecologists and for women who are considering surgery for prolapse. The evidence underlines the need to balance the potential harms against the potential benefits of surgery. New interventions should always be subject to rigorous evaluation through randomized controlled trials, and adoption of new interventions must be accompanied by specific training in their use.
The conclusions of the recent update of the Cochrane Review of pulmonary rehabilitation in chronic obstructive pulmonary disease (COPD) agree with prior versions, supporting the benefit of pulmonary rehabilitation for improving quality of life. Additional randomised controlled trials are no longer warranted. Cochrane Airways made the unusual decision that this review is now closed and won't be updated.
The value of systematic reviews of small trials has recently been questioned. This editorial illustrates why Cochrane Reviews of small trials are of value and how they can act as important grounds and platforms for trials that are large and robust enough to inform practice. We look at recently updated Cochrane Reviews on the treatment of a common fracture and a common impairment after stroke.
Delivering health care at a distance is a practical and moral imperative in a world where underserved populations are the rule rather than the exception. Telemedicine epitomises the potential of technology to reshape health care delivery. But for interactive telemedicine – real-time distant interaction between a health professional and a patient – implementation has stalled.
The International Day of the World’s Indigenous Peoples is commemorated on 9 August each year. This year’s theme, “Post 2015 agenda: Ensuring Indigenous peoples’ health and well-being”, is important for us all. Internationally, the health of Indigenous peoples continues to be inequitable.
Cochrane Reviews can provide valuable evidence to support an accountable decision-making process to improve Indigenous people’s health. Such a process needs to consider community values, preferences, local needs, and resource use, as well as provide opportunities for feedback and debate.
If systematic reviews are to provide the information that people need when making decisions about health and social care, we need to be confident that the methods used to plan, conduct, and report these reviews result in valid, reliable evidence. The 2015 Cochrane Methods Symposium will focus on why the methods used to produce reviews for evidence-based care should themselves be evidence-based.
Urinary incontinence is common in women. Women with stress urinary incontinence normally try pelvic floor exercises in the first instance. If this fails, more women than ever before are seeking a surgical cure. A newly updated Cochrane Review compares surgical approaches and materials.
Venous thromboembolism is an important thromboembolic disorder with an incidence of just over 1 per 1000 population. Its two inter-related components of deep vein thrombosis (DVT) and pulmonary embolism are associated with significant morbidity and mortality. A new Cochrane Review of studies of new oral anticoagulants in the management of DVT is most welcome and timely, as these treatments may be an effective and safe alternative to conventional anticoagulation treatment.
David Sackett, the first chair of the Cochrane Collaboration’s steering group, died on 13 May 2015. Dave influenced and inspired people around the world, developing what he first called clinical epidemiology and what is now called evidence-based medicine.