Systematic reviews addressing a wide range of healthcare questions, and drawing on a range of different study designs, are increasingly available in the literature. The Cochrane Database of Systematic Reviews currently considers Cochrane Reviews on the effectiveness of health interventions and the accuracy of screening and diagnostic tests, as well as overviews of reviews and methodology reviews. November 2013 marks an important milestone for The Cochrane Collaboration with the publication of a review of qualitative studies. This synthesis of qualitative evidence addresses barriers and facilitators to the implementation of lay health worker (LHW) programmes.
Capacity building is a widely used phrase with a simple underyling concept: investment that leads to individuals or institutions becoming self-sufficient rather than dependent. The Cochrane Collaboration provides a brilliant vehicle for this development, conducting systematic reviews, promoting the use of research evidence, and enhancing research capacity through sustainable networks. Mutual support and strong networks are what makes Cochrane powerful, so let's use them even more in fulfilling what the development specialists like to call 'capacity building'.
Archie Cochrane's seminal work was titled "Effectiveness and efficiency: random reflections on health services", reflecting his belief that healthcare interventions should not only do more good than harm, but should also represent a good use of resources. Since its inception, The Cochrane Collaboration has produced over 5000 systematic reviews of the effectiveness of interventions, but these have largely ignored the challenge to provide information on efficiency. Is this a problem and, if so, what can be done about it?
In 1996, a team at the World Health Organization (WHO), with the help of many outside partners, embarked on a project to improve the accessibility of Cochrane Reviews among healthcare professionals in low- and middle-income countries (LMICs), in the area of sexual and reproductive health. These efforts culminated in the launch of The WHO Reproductive Health Library (RHL), a free-of-charge electronic journal based on Cochrane Reviews and endorsed by The Cochrane Collaboration. This ground-breaking, long-standing collaborative partnership has benefitted not only the two organisations but also scores of healthcare professionals and their patients.
In order to fully realise Cochrane's vision of a world where this can lead to better health for everyone, proactive strategic alliances are needed to ensure wider dissemination of Cochrane evidence. Wikipedia, the web-based, multilingual, free-content encyclopaedia, is the sixth most visited site, and the most used medical resource, on the Internet, so the potential for Cochrane to reach previously unreached audiences by forging a strategic partnership with Wikipedia is enormous.
Disabling shoulder pain is a common reason to seek medical care and may be caused by tears in the rotator cuff, a group of tendons and muscles that surrounds the shoulder. A recently published Cochrane diagnostic test accuracy review evaluates magnetic resonance imaging, magnetic resonance arthrography and ultrasonography for assessing rotator cuff tears in people with shoulder pain.
Few topics in medicine stimulate the same level of controversy and emotionally charged debate as questions related to screening for cancer. At the same time, questions of screening are among the most complex to fully comprehend, requiring decision-makers to have a solid understanding of methodological issues relating to common validity threats to clinical trials as well as an understanding of baseline risks and downstream harms through additional diagnostic testing and subsequent treatments. As the Collaboration celebrates its 20th Anniversary, it's an opportunity to recall how the Cochrane Prostatic Diseases and Urologic Cancers Group has been a loud and clear voice in the debate over the benefits and harms of prostate-specific antigen (PSA)-based prostate cancer screening.
Authored by Tusting and colleagues, a new Cochrane review published in the August 2013 issue of the Cochrane Database of Systematic Reviews, looks at the effectiveness of larval source management for malaria control. The publication of this review is timely, but it is disappointing to learn that there continues to be a lack of robust evidence on the impact of larval source management on parasite prevalence and malaria incidence. Until there is more compelling evidence, larval control should continue to be viewed as a supplementary measure for malaria control in carefully selected settings. Promoting the widespread use of larval source management in rural areas of sub-Saharan Africa would be premature.
Most patients with acute coronary syndromes receive oxygen therapy as part of their emergency treatment, initiated by paramedics during transfer and before their first contact with a physician. Cabello et al report a systematic review which assesses the routine use of inhaled oxygen in acute myocardial infarction. The authors conclude that this systematic review challenges the status quo predicated by international guidelines on the treatment of acute coronary syndromes and highlights the need for large scale trials.
Drugs that inhibit the coagulation factors Xa or IIa (thrombin) form a class called new oral anticoagulants, which offer an alternative to vitamin K antagonists in the prevention of stroke and systematic embolism in patients with atrial fibrillation. A new meta-analysis includes 10 trials comparing factor Xa inhibitors with vitamin K antagonists in patients with atrial fibrillation. The positive results of included trials have prompted several guideline groups to incorporate the use of new oral anticoagulants in their recommendations. However, issues surrounding implementing these drugs into clinical practice remain.
A recently updated Cochrane Review found strong evidence for the benefit of low-dose folic acid or folinic acid supplementation for reducing side effects of methotrexate (MTX) in patients with rheumatoid arthritis. Considering the low cost of folic acid supplementation and its overwhelming benefits without any evidence of reduction of MTX efficacy, its use should be considered in all rheumatoid arthritis patients taking or starting MTX. But questions remain.
Administration of intravenous immunoglobulin (IVIG) to very-low-birthweight infants has been extensively studied as a way of preventing or treating nosocomial (hospital-acquired) infections in preterm infants. But two recently updated Cochrane Reviews show little benefit for routine IVIG treatment and indicate that there is no need for further studies.
A new Cochrane Review looks at the evidence for surgical fixation of middle-third clavicle (collarbone) fractures. Clavicle fractures account for up to 4% of all fractures and typically occur in young males engaged in sporting activities, such as cycling and skiing. Around 80% of these fractures occur in the middle-third section of the clavicle. This new review, which includes eight small and flawed trials, concludes that there is insufficient evidence to determine whether surgery gives better outcomes that matter to patients than conservative (non-surgical) treatment.
As The Cochrane Collaboration celebrates its 20th anniversary, we recall the Cochrane Pain, Palliative and Supportive Care (PaPaS) Review Group's first published review, which looked at treating any acute or chronic pain with any antiepileptic drug, at any dose.
A Cochrane Review was recently stated to have "uncritically included" data under suspicion. We write to correct some misunderstandings about the writing and editing of this review, and we also challenge The Cochrane Collaboration to authorise a working group to develop and implement a methodology that estimates data integrity and standards for the inclusion or non-inclusion of studies under suspicion but not yet retracted.
Randomised clinical trials are often inadequately reported and may be inadequately conducted. Any associated biases could impact seriously on the findings and conclusion of a systematic review. Authors of systematic reviews thus need to assess the risk of bias in included randomised clinical trials. In this 20th Anniversary editorial, we look at the evolution of guidance on appraising studies included in Cochrane Reviews.
The Cochrane Collaboration has become a lead partner in the AllTrials initiative (AllTrials.net), a campaign to ensure that all clinical trials are registered and the results reported, for all treatments in current use. Cochrane joins Sense About Science, Bad Science, the BMJ, the James Lind Initiative, and the Centre for Evidence Based Medicine in leading this international campaign, which has already signed up over 200 research bodies, regulators, and patient groups, and nearly 50,000 individuals. This, though, is just a beginning.
There have been improvements in many occupational safety and health (OSH) statistics, such as injury rates and exposures to chemical agents, but there are also OSH problems for which the statistics have not shown a decline. Occupational hearing loss is still reported among the most frequent occupational diseases in many countries. Around the world, workers and employers struggle with problems such as disability related to back pain and other musculoskeletal problems. And in health care, we still cannot fully protect workers from the risks of contracting infectious diseases from their work.
In 2013 The Cochrane Collaboration celebrates 20 years of outstanding work supporting decision makers by providing reviews synthesising the best available knowledge. With a strong focus on randomised controlled trials (RCTs), The Cochrane Collaboration has become the world's largest producer of systematic reviews of healthcare interventions. One of the ten key principles of the Collaboration is striving for relevance "by promoting the assessment of healthcare interventions using outcomes that matter to people making choices in health care"
The leishmaniases are a group of diseases caused by infection with protozoan parasites of the genus Leishmania. They affect the poorest of the poor and are associated with malnutrition, wars, displacement, poor housing, illiteracy, gender discrimination, lack of resources, and environmental changes. The infection is transmitted by bites from sandﬂies infected with the parasite. The World Health Organization (WHO) considers leishmaniasis to be one of the most serious parasitic diseases, and the World Health Assembly has advocated that authorities should address the major factors underlying the failure to control the disease.
Blame the champagne! At the 2012 Cochrane Colloquium’s welcome reception in Auckland, New Zealand, David Tovey (Editor in Chief of The Cochrane Library) suggested I write an editorial about why I did the Cochrane Review on the prevention of falls, its impact on my life, and its impact on practice and policy. So this editorial is about a personal journey lasting 18 years.
On 14 September last year regular users of The Cochrane Library discovered that the search interface they had become accustomed to over the past eight years had radically changed. A subsequent launch on 15 December saw another round of important changes. Over a period of 16 months the Cochrane Search Testing Group has been working with colleagues at Wiley to develop these new search features. The project began as a problem-solving exercise...
Accurate diagnosis of disease remains one of the biggest obstacles to global tuberculosis (TB) control. Inadequate diagnosis results in poor patient outcomes and contributes to sustained TB transmission. The majority of national TB control programmes, particularly in low- and middle-income countries, still rely predominantly on sputum microscopy for diagnosis. This is notoriously insensitive, particularly in HIV co-infected patients. Moreover, rapid and accurate diagnosis of drug resistance is required to control multidrug-resistant (MDR-TB) and extensively drug-resistant TB (XDR-TB). An accurate, quick, and accessible test for the diagnosis of TB and determination of drug resistance is therefore a global priority.
Twenty years ago this October, 77 people from nine countries gathered in Oxford, England, to launch The Cochrane Collaboration, under the leadership of Iain Chalmers. The meeting was the culmination of shared ideas and discussions among people with a collective vision to identify randomised controlled trials and to use the findings to prepare systematic reviews to inform healthcare practice and decision-making. Participants in this meeting share their reflections on this landmark event in the first of a series of videos (available at anniversary.cochrane.org) commissioned by the Collaboration on the ideas, achievements, and people that have contributed to its growth since 1993.
Lipitor (atorvastatin) is one of the best-selling pharmaceutical drugs of all time. This month's issue of the Cochrane Database of Systematic Reviews includes a new review by Wright, Adams, and Tsang concerning the effects of this statin. The review is big, and it is not like most of the others in the database.