1,494,825 research outputs found
A decision tool for updating Cochrane reviews
No full textThis report describes the development and validation of an updating tool to help assess the need and likely benefits of updating a Cochrane review. The report is presented in five sections. Section 1 describes the background and rationale for the updating tool, including information about when and how to update. Section 2 describes the development of the updating tool and the resulting decision tree and checklist. Section 3 presents the results of the in-house and ongoing formal pilot of the tool, while Sections 4 and 5 provide information about the dissemination of the tool and our key conclusions. This project was funded by the Cochrane Opportunities Fund in 2007
Ketamine and other NMDA receptor antagonists for chronic pain: protocol
No full textObjectives:
This is a protocol for a Cochrane Review (intervention). The objectives are as follows:
To evaluate the benefits and harms of ketamine and other NDMA receptor antagonists compared to placebo, usual care, or other medicines for adults with chronic non‐cancer pain.National Institute for Health Research (NIHR); Cochrane Infrastructure funding to the Cochrane Pain, Palliative and Supportive Care Review Group (PaPaS)
The use of language methodology for disseminating Cochrane Evidence through Cochrane Corners : Cochrane Rehabilitation experience.
No full textBackground. Health literacy has been recognized for a long time as an important factor both for understanding health information and prediction of health status. There are many efforts to translate health information in different languages, but particular challenge for achieving appropriate health literacy are systematic reviews of health interventions, because they summarize evidence from individual studies to help doctors and patients make informed choices about health treatments. One of these efforts are Cochrane Corners, a knowledge translation tool to disseminate Cochrane Evidence to make sure that all health professionals can make use of the best available evidence in their clinical work.
Objectives. The aim of this work is to highlight the use of qualitative statements, in Cochrane Corners, produced by Cochrane rehabilitation, to communicate the clinical implications of rehabilitation interventions to the clinicians, founded on the certainty of evidence.
Methods. Cochrane Corners have a specific structure: they are authored by one author who is rehabilitation professional to make comments from a rehabilitation perspective, the main section is founded on the summary of Cochrane Review contents and the last section is dedicated to “clinical implication for rehabilitation professionals”. It is founded on the use of qualitative statements, proposed by Cochrane Norway, to communicate the magnitude of rehabilitation intervention effects on specific outcome, based on the certainty of evidence.
Results. We published 8 Cochrane Corners on neurorehabilitation, rheumatology, musculoskeletal diseases and pain conditions. In each Cochrane Corner, it has been provided the clinical implications of each rehabilitation intervention in traumatic brain injury, stroke, fibromyalgia, migraine in adults and in older people living in community.
Conclusion. The use of qualitative statement is a good instrument to improve the applicability of evidence to clinical practice.
Patient or healthcare consumer involvement. Not applicable.
Relevance to diversity. The research addressed to rehabilitation clinicians to use short summary of Cochrane Systematic Reviews in rehabilitation field and to inform clinical and public health decisions on better evidence
Interventions for treating pain and disability in adults with complex regional pain syndrome- an overview of systematic reviews
No full textVersion 3. Overview stabilised in line with the PaPaS Review Group's policy to assess overviews for updating every five years.Differences between protocol and review:
In this updated overview, we made a number of changes compared with the protocol (O'Connell 2011) and the original version of the overview (O'Connell 2013):
• Background: this section has been updated in the current version of the overview to include recent information on CRPS diagnosis, pathophysiology and incidence.
• Searches: in the current version of this overview, we searched Epistemonikos but did not search the Database of Abstracts of Reviews of Effects (DARE), as it is no longer updated.
• Outcomes: in the current version of this overview, we grouped outcomes into post‐intervention, short‐term, medium‐term and long‐term follow‐up periods, reporting only a single effect for each period.
• Assessment of methodological quality of included reviews: in the current version of this overview, we used the revised AMSTAR 2 instead of the original AMSTAR tool to assess the methodological quality of both Cochrane and non‐Cochrane reviews.
• Assessment of the certainty of the evidence in included reviews: where reviews did not use GRADE to assess the certainty in evidence, we conducted these assessments ourselves using updated criteria compared with the previous version of this overview and the protocol (for a full description see Assessment of methodological quality of included reviews). We applied these judgements to all outcomes rather than only the primary outcomes, as done in the previous version of this overview.
• Interpretation of effects: in the current version of this overview, we interpreted minimally important between‐group differences for pain intensity using OMERACT 12 recommendations.Background:
Complex regional pain syndrome (CRPS) is a chronic pain condition that usually occurs in a limb following trauma or surgery. It is characterised by persisting pain that is disproportionate in magnitude or duration to the typical course of pain after similar injury. There is currently no consensus regarding the optimal management of CRPS, although a broad range of interventions have been described and are commonly used. This is the first update of the original Cochrane review published in Issue 4, 2013.
Objectives:
To summarise the evidence from Cochrane and non‐Cochrane systematic reviews of the efficacy, effectiveness, and safety of any intervention used to reduce pain, disability, or both, in adults with CRPS.
Methods:
We identified Cochrane reviews and non‐Cochrane reviews through a systematic search of Ovid MEDLINE, Ovid Embase, Cochrane Database of Systematic Reviews, CINAHL, PEDro, LILACS and Epistemonikos from inception to October 2022, with no language restrictions. We included systematic reviews of randomised controlled trials that included adults (≥18 years) diagnosed with CRPS, using any diagnostic criteria.
Two overview authors independently assessed eligibility, extracted data, and assessed the quality of the reviews and certainty of the evidence using the AMSTAR 2 and GRADE tools respectively. We extracted data for the primary outcomes pain, disability and adverse events, and the secondary outcomes quality of life, emotional well‐being, and participants' ratings of satisfaction or improvement with treatment.
Main results:
We included six Cochrane and 13 non‐Cochrane systematic reviews in the previous version of this overview and five Cochrane and 12 non‐Cochrane reviews in the current version. Using the AMSTAR 2 tool, we judged Cochrane reviews to have higher methodological quality than non‐Cochrane reviews. The studies in the included reviews were typically small and mostly at high risk of bias or of low methodological quality. We found no high‐certainty evidence for any comparison.
There was low‐certainty evidence that bisphosphonates may reduce pain intensity post‐intervention (standardised mean difference (SMD) ‐2.6, 95% confidence interval (CI) −1.8 to −3.4, P = 0.001; I2 = 81%; 4 trials, n = 181) and moderate‐certainty evidence that they are probably associated with increased adverse events of any nature (risk ratio (RR) 2.10, 95% CI 1.27 to 3.47; number needed to treat for an additional harmful outcome (NNTH) 4.6, 95% CI 2.4 to 168.0; 4 trials, n = 181).
There was moderate‐certainty evidence that lidocaine local anaesthetic sympathetic blockade probably does not reduce pain intensity compared with placebo, and low‐certainty evidence that it may not reduce pain intensity compared with ultrasound of the stellate ganglion. No effect size was reported for either comparison.
There was low‐certainty evidence that topical dimethyl sulfoxide may not reduce pain intensity compared with oral N‐acetylcysteine, but no effect size was reported.
There was low‐certainty evidence that continuous bupivacaine brachial plexus block may reduce pain intensity compared with continuous bupivacaine stellate ganglion block, but no effect size was reported.
For a wide range of other commonly used interventions, the certainty in the evidence was very low and provides insufficient evidence to either support or refute their use. Comparisons with low‐ and very low‐certainty evidence should be treated with substantial caution. We did not identify any RCT evidence for routinely used pharmacological interventions for CRPS such as tricyclic antidepressants or opioids.
Authors' conclusions:
Despite a considerable increase in included evidence compared with the previous version of this overview, we identified no high‐certainty evidence for the effectiveness of any therapy for CRPS. Until larger, high‐quality trials are undertaken, formulating an evidence‐based approach to managing CRPS will remain difficult. Current non‐Cochrane systematic reviews of interventions for CRPS are of low methodological quality and should not be relied upon to provide an accurate and comprehensive summary of the evidence.This project was funded by the National Institute for Health Research (NIHR) via Cochrane Infrastructure funding to the Cochrane Pain, Palliative and Supportive Care Review Group (PaPaS). Brunel University, UK: Salary for NOC; University of Notre Dame, Australia: Salary for BW; University College London, UK: Salary for LM; Neuroscience Research Australia, Australia: Salary for JM; University of South Australia, Australia: Salary for GLM
The rehabilitation definition for scientific research purposes by Cochrane Rehabilitation – first results
No full textBackground. Since its launch in 2016, Cochrane Rehabilitation (CR) has increasingly found the need to better define what rehabilitation is and what is not. We found that currently available definitions of rehabilitation fall short with regard to defining exactly what is needed for research purposes, specifically inclusion and exclusion criteria on an operational level.
Objectives. The aim was to specify a definition of rehabilitation suitable for research purposes that also defines inclusion and exclusion criteria.
Methods. The methodology was developed based on discussions during the CR Executive and Methodology Committees Meetings and with the Advisory Board of CR, which includes all relevant rehabilitation stakeholders, during its meeting in Kobe in June 2019. The methodology was then refined to include: (1) a survey involving a) the Advisory and b) the Executive Committee members and c) the participants invited to the consensus meeting here reported to collect the current definitions promoted by CR stakeholders, (2) a consensus meeting (CM) held in Milan (Italy) in February 2020, and (3) a Delphi procedure to reach a final definition.
The CM was organized in three parts. Part 1: presentation and discussion of current definitions and related problems. Part 2: work in smaller groups to prepare a proposal of the new operational definition of rehabilitation for research purposes. Part 3: discussion and voting procedures on the proposal to be submitted to the Delphi procedure. The first round of the Delphi procedure will be conducted among the Meeting participants and the second round among the CR Advisory Board members. The results of the two rounds will be reviewed and synthesized, and a third Delphi round will be held again among the participants to the Meeting.
Results. During the Meeting it was decided that the proposed definition should contain all the essential key words that constitute the inclusion and exclusion criteria for research purposes, following the PICO (Population, Intervention, Control, Outcome) model as much as possible.
The current definition to be proposed for the Delphi Rounds is: In a health care context rehabilitation is: “a multimodal person-centered process, including functioning interventions targeting (1) body functions, and/or (2) activities and participation, and/or (3) the interaction with the environment” (Intervention), with the goal of “optimizing functioning” (Outcome) for “(1) persons with health conditions (a) experiencing disability or (b) likely to experience disability and/or (2) persons with disability” (Population).
This definition is currently provisional, and it should not be used until the final results of the Delphi are published.
Conclusions. These results will inform all the future work of CR and could also serve the scientific rehabilitation community.
Patient or healthcare consumer involvement. Representative of healthcare consumers are present in the Advisory Board of CR and contributed at all stages of the project when the Advisory Board was involved
Topical anti-inflammatory treatments for eczema: network meta-analysis
No full textBackgroundEczema (atopic dermatitis) is the most burdensome skin condition worldwide and cannot currently be prevented or cured. Topical anti-inflammatory treatments are used to control eczema symptoms, but there is uncertainty about the relative effectiveness and safety of different topical anti-inflammatory treatments.ObjectivesTo compare and rank the efficacy and safety of topical anti-inflammatory treatments for people with eczema using a network meta-analysis.Search methodsWe searched the Cochrane Skin Specialised Register, CENTRAL, MEDLINE, Embase and trial registries on 29 June 2023, and checked the reference lists of included studies.Selection criteriaWe included within-participant or between-participant randomised controlled trials (RCTs) in people of any age with eczema of any severity, but excluded trials in clinically infected eczema, seborrhoeic eczema, contact eczema, or hand eczema. We included topical anti-inflammatory treatments used for at least one week, compared with another anti-inflammatory treatment, no treatment, or vehicle/placebo. Vehicle is a 'carrier system' for an active pharmaceutical substance, which may also be used on its own as an emollient for dry skin. We excluded trials of topical antibiotics used alone, complementary therapies, emollients used alone, phototherapy, wet wraps, and systemic treatments.Data collection and analysisWe used standard Cochrane methods. Primary outcomes were patient-reported eczema symptoms, clinician-reported eczema signs and investigator global assessment. Secondary outcomes were health-related quality of life, long-term control of eczema, withdrawal from treatment/study, and local adverse effects (application-site reactions, pigmentation changes and skin thinning/atrophy were identified as important concerns through patient and public involvement). We used CINeMA to quantify our confidence in the evidence for each outcome.Main resultsWe included 291 studies involving 45,846 participants with the full spectrum of eczema severity, mainly conducted in high-income countries in secondary care settings. Most studies included adults, with only 31 studies limited to children aged Authors' conclusionsPotent TCS, JAK inhibitors and tacrolimus 0.1% were consistently ranked as amongst the most effective topical anti-inflammatory treatments for eczema and PDE-4 inhibitors as amongst the least effective. Mild TCS and tapinarof 1% were ranked amongst the least effective treatments in three of five efficacy networks. TCI and crisaborole 2% were ranked most likely to cause local application-site reactions and TCS least likely. We found no evidence for increased skin thinning with short-term TCS but an increase with longer-term TCS
User involvement in a Cochrane systematic review: using structured methods to enhance the clinical relevance, usefulness and usability of a systematic review update
No full textBackground: This paper describes the structured methods used to involve patients, carers and health professionals in an update of a Cochrane systematic review relating to physiotherapy after stroke and explores the perceived impact of involvement.Methods: We sought funding and ethical approval for our user involvement. We recruited a stakeholder group comprising stroke survivors, carers, physiotherapists and educators and held three pre-planned meetings during the course of updating a Cochrane systematic review. Within these meetings, we used formal group consensus methods, based on nominal group techniques, to reach consensus decisions on key issues relating to the structure and methods of the review.Results: The stakeholder group comprised 13 people, including stroke survivors, carers and physiotherapists with a range of different experience, and either 12 or 13 participated in each meeting. At meeting 1, there was consensus that methods of categorising interventions that were used in the original Cochrane review were no longer appropriate or clinically relevant (11/13 participants disagreed or strongly disagreed with previous categories) and that international trials (which had not fitted into the original method of categorisation) ought to be included within the review (12/12 participants agreed or strongly agreed these should be included). At meeting 2, the group members reached consensus over 27 clearly defined treatment components, which were to be used to categorise interventions within the review (12/12 agreed or strongly agreed), and at meeting 3, they agreed on the key messages emerging from the completed review. All participants strongly agreed that the views of the group impacted on the review update, that the review benefited from the involvement of the stakeholder group, and that they believed other Cochrane reviews would benefit from the involvement of similar stakeholder groups.Conclusions: We involved a stakeholder group in the update of a Cochrane systematic review, using clearly described structured methods to reach consensus decisions. The involvement of stakeholders impacted substantially on the review, with the inclusion of international studies, and changes to classification of treatments, comparisons and subgroup comparisons explored within the meta-analysis. We argue that the structured approach which we adopted has implications for other systematic reviews.</p
Identifying Cochrane and non-Cochrane reviews relevant to your review topic
No full textBefore submitting the Review Proposal Form to EPOC, we ask authors to conduct searches for both Cochrane and non-Cochrane reviews on the proposed topic. The purpose is two-fold:
1. To prevent duplication of topics within the Cochrane Database of Systematic Reviews (CDSR).
2. To identify the existing evidence-base in a topic area so that the proposed review topic builds on, but does not replicate published research.https://epoc.cochrane.or
Episode 89: Sentientist Politics with Alasdair Cochrane
No full textIn this episode Knowing Animals I am joined by Dr. Alasdair Cochrane. Alasdair is Senior Lecturer in Political Theory at the University of Sheffield. We will discuss his latest book ‘Sentientist Politics: A Theory of Global Inter-Species Justice’. It was published by Oxford University Press in 2018
Disseminating Cochrane evidence to the public health workforce via author-led webinars
No full text<b>Title</b>\ud
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- Disseminating Cochrane evidence to the public health workforce via author-led webinars\ud
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<b>Background</b> \ud
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- <u><a href="http://www.healthevidence.org/">Health Evidence™</a></u> is a free searchable repository, of 4,500+ quality-appraised public health relevant reviews, including nearly 700 Cochrane reviews. Author-led webinars is one knowledge translation strategy to disseminate the findings of Cochrane reviews.\ud
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<b>Objectives</b>\ud
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- (i) Disseminate the findings of Cochrane reviews via webinars\ud
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- (ii) Evaluate the impact of Cochrane author-led webinars \ud
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<b>Methods</b>\ud
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- Webinars are 60-90 minutes in length and include: an overview of the principles of evidence-informed decision making (15mins), a presentation of the findings by the review author (30mins), and a Q&A period (30mins). Webconferencing software monitors participant registration, attendance, engagement, poll responses, and questions. Standard polling questions are asked throughout each session to assess familiarity with and use of systematic reviews, as well as familiarity and agreement with session-specific review findings.\ud
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<b>Results</b>\ud
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- Since January 2015 Health Evidence™ has hosted six Cochrane author-led webinars. Webinar participants include: nurses, health promoters, physicians, dietitians, and knowledge brokers. On average, participants in each session were attentive and engaged 68.8% of the time. Google Analytics reflect an average 572% increase in users accessing the Cochrane review featured in each webinar on the day of the session compared to average daily access the month prior. On average, each session attracted 177 registrants, of which approximately half joined on the session date. Poll response data reveal 59.6% attendees use systematic reviews to inform their practice. Data collected pre/post on participant’s knowledge of the effectiveness of an intervention, suggest that webinars are an effective way to influence participant’s knowledge about intervention effectiveness (participant knowledge improved 10-31.8%, measured via pre/post poll questions). During the Q&A period, attendees submitted 5-12 questions per session.\ud
Conclusion: Webinars are an interactive and effective mechanism for promoting public health relevant Cochrane evidence to decision makers. Data from webinars highlight a high level of interest and engagement with Cochrane author-led sessions
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