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Taking health systems research syntheses to the next level: overviews of systematic reviews

M Kent Ranson, David B Evans Taking health systems research syntheses to the next level: overviews of systematic reviews

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.

All interventions are complex, but some are more complex than others: using iCAT_SR to assess complexity

Graham F Moore, Rhiannon E Evans, Jemma Hawkins, Hannah J Littlecott, Ruth Turley All interventions are complex, but some are more complex than others: using iCAT_SR to assess complexity

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.

Corticosteroids for preterm deliveries: missing evidence

Newton Opiyo, William Stones Corticosteroids for preterm deliveries: missing evidence

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.

Evidence-based interventions for global mental health: role and mission of a new Cochrane initiative

Corrado Barbui, Marianna Purgato, Rachel Churchill, Clive E Adams, Laura Amato, Geraldine Macdonald, Jenny McCleery, Silvia Minozzi, Rebecca Syed Sheriff Evidence-based interventions for global mental health: role and mission of a new Cochrane initiative

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: we know it works; time to make sure it is in place everywhere

Diamantis Plachouras, Susan Hopkins Antimicrobial stewardship: we know it works; time to make sure it is in place everywhere

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.

A call to action to reshape evidence synthesis and use for nutrition policy

Mark Lawrence, Celeste Naude, Rebecca Armstrong, Lisa Bero, Namukolo Covic, Solange Durao, Davina Ghersi, Geraldine Macdonald, Harriet MacLehose, Barrie Margetts, David Tovey, Jimmy Volmink, Taryn Young A call to action to reshape evidence synthesis and use for nutrition policy

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.

Introducing Cochrane Global Ageing: towards a new era of evidence

Tracey E Howe, Sue Marcus, Vivian Welch Introducing Cochrane Global Ageing: towards a new era of evidence

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 end of the wormwars?

David Tovey, Julia H Littell, Jeremy M Grimshaw The end of the wormwars?

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.

Tailoring asthma therapies using FeNO: can a new objective measure help more people to gain control and reduce over-treatment?

Rebecca Normansell, Christopher Cates Tailoring asthma therapies using FeNO: can a new objective measure help more people to gain control and reduce over-treatment?

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?

Avoiding or stopping steroids in kidney transplant recipients: sounds good but does it work?

David W Mudge Avoiding or stopping steroids in kidney transplant recipients: sounds good but does it work?

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.

High dose, high risk? What updated evidence tells us about chemotherapy dosing in early breast cancer

Annabel Goodwin, Melina Willson, Nicholas Wilcken High dose, high risk? What updated evidence tells us about chemotherapy dosing in early breast cancer

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.

Forward thinking: where next for delirium prevention research?

Terence J Quinn Forward thinking: where next for delirium prevention research?

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.

Finding time to make the right decision: using frozen section to inform intra-operative management of suspicious ovarian masses

Jo Morrison, Toby Lasserson Finding time to make the right decision: using frozen section to inform intra-operative management of suspicious ovarian masses

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.

No implementation without evaluation: the case of mesh in vaginal prolapse surgery

Cindy Farquhar No implementation without evaluation: the case of mesh in vaginal prolapse 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.

This Cochrane Review is closed: deciding what constitutes enough research and where next for pulmonary rehabilitation in COPD

Yves Lacasse, Christopher J Cates, Bernard McCarthy, Emma J Welsh This Cochrane Review is closed: deciding what constitutes enough research and where next for pulmonary rehabilitation in COPD

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.

In defence of reviews of small trials: underpinning the generation of evidence to inform practice

Helen HG Handoll, Peter Langhorne In defence of reviews of small trials: underpinning the generation of evidence to inform practice

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.

Telemedicine: are we advancing the science?

Gabriel Rada Telemedicine: are we advancing the science?

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.

Improving health outcomes for Indigenous peoples: what are the challenges?

Noel Hayman, Papaarangi MJ Reid, Malcolm King Improving health outcomes for Indigenous peoples: what are the challenges?

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.

Can Cochrane Reviews inform decisions to improve Indigenous people’s health?

Vivian Welch, Yvonne Boyer, Catherine Chamberlain Can Cochrane Reviews inform decisions to improve Indigenous people’s health?

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.

Why do we need evidence-based methods in Cochrane?

Joanne E McKenzie, Mike J Clarke, Jackie Chandler Why do we need evidence-based methods in Cochrane?

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.

Making anticoagulation easier and safer in DVT

John Fletcher Making anticoagulation easier and safer in DVT

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.

Farewell and thanks to Dave Sackett, Cochrane’s first pilot

Iain Chalmers, Andrew D Oxman Farewell and thanks to Dave Sackett, Cochrane’s first pilot

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.

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