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< Volume 6 - October 2008 >
In the News
Chiropractors gain access to The Cochrane Library
Congratulations to the Canadian Chiropractic Association! The Cochrane Library and all it has to offer health professionals are now available to the 6000 members of the CCA. To access The Cochrane Library to inform your practice, go to the members only section of www.ccachiro.org/.
Contribute to Cochrane
How? Identify trials for CENTRAL, the Cochrane trials register. The Canadian Cochrane Centre is seeking volunteers to handsearch issues of the CMAJ and the Canadian Journal of Nursing Research to identify controlled trials. Handsearching is an important means to identify trials for Cochrane reviews. Online training is available.
Contact: Adrienne Stevens at astevens@uottawa.ca
Cochrane for Practice
2008 Diabetes Guidelines – 14 Cochrane reviews cited
The Canadian Diabetes Association has just released the latest Clinical Practice Guidelines for the Prevention and Management of Diabetes in Canada. These guidelines represent the most current evidence-based clinical practice data for healthcare professionals, including the results of 14 Cochrane reviews.
Clinical Pearls from Cochrane reviews
The 70th issue of the Therapeutics Letter: "Clinical Pearls from the most popular Cochrane reviews in 2007" summarizes the top five most accessed Cochrane reviews in 2007: Interventions for preventing falls in elderly people; Interventions for treating obesity in children; Beta-blockers for hypertension; Low glycaemic index or low glycaemic load diets for overweight and obesity; Nicotine receptor partial agonists for smoking cessation.
Cochrane for Policy
Admission avoidance hospital at home is a service for patients who would otherwise need acute care in hospital. Instead they receive care at home for a limited time by health professionals. This Cochrane review indicates that there is no significant difference in outcomes between patients treated in hospital and those treated through admission avoidance hospital at home. In fact, after 6 months follow-up, mortality was significantly reduced with at home care.
People with intellectual disabilities often experience health problems, yet have limited access to the care they need. This review assessed the effect of changes in the structure or delivery of health care services that may improve the health outcomes of these people. Limited evidence indicates that multidisciplinary teams providing intensive services for persons with an intellectual disability and a mental health problem could improve mental health outcomes.
Cochrane Library Spotlight - Issue 4, 2008
Hypertension
Blood pressure lowering efficacy of angiotensin converting enzyme (ACE) inhibitors for primary hypertension
Blood pressure lowering efficacy of angiotensin receptor blockers for primary hypertension
Blood pressure lowering efficacy of renin inhibitors for primary hypertension
ACE, ARB and renin inhibitors are taken for high blood pressure. Cochrane reviews evaluating the efficacy of these three classes of drugs found that ACE, ARB and the renin inhibitor, aliskiren, all had similar modest effects in lowering blood pressure. There were no clinically meaningful differences within each class of the ACE and ARB inhibitors examined.
Alternative therapies
Honey as a topical treatment for wounds
A Cochrane review suggests that honey can be an effective treatment for mild to moderate burns. In comparing studies that examined the effect of honey on various wounds, reviewers found that it sped up healing time for burns but could not conclude that it helped with other wounds such as venous leg ulcers. Honey did not increase healing when used with a bandage on the wound.
Sanchi for acute ischaemic stroke
Tongxinluo capsule for acute stroke
Two Chinese traditional medicines for ischaemic stroke, sanchi and tongxinluo, have recently been subjects of systematic reviews. In both cases, there was not enough quality evidence to recommend the use of either medicine for ischaemic stroke. Sanchi may be beneficial and safe, but this conclusion is based on poor quality and short term studies.
Touch therapies for pain relief in adults
Reiki, Therapeutic Touch and Healing Touch are considered “touch therapy” used to alleviate acute and chronic pain. In a systematic review it was found that despite few studies and small sample sizes, there was some evidence to support the benefit of touch therapy. The review suggested that experienced Reiki practitioners yielded the most positive results for their patients.
Rehabilitation therapies
Rehabilitation after lumbar disc surgery
Following herniated disk surgery, patients can choose rehabilitation treatments that vary in intensities. This updated review found a slight decrease in pain and disability for patients following an exercise program 4-6 weeks post-surgery. A high intensity exercise program provided faster relief than a low intensity program. There is little benefit to supervised programs over at-home programs.
Surgical versus non-surgical treatment for carpal tunnel syndrome
Surgery, splinting and steroid injections are used to treat the numbness and tingling felt by sufferers of carpal tunnel syndrome. This updated review indicates that surgery is more effective than splinting. Additional studies are required to know if surgery is preferable to injections, and what is best for mild symptoms.
Asthma
Regular treatment with formoterol for chronic asthma: serious adverse events
Formoterol is a long-acting beta2-agonist used to treat chronic asthma. This Cochrane review found an increased risk of non-fatal serious adverse effects for patients using formoterol as compared to placebo, particularly for children. However, the rate of fatal or non-fatal events was no different than those reported for patients using regular salbutamol or terbutaline.
Senior’s health
Combined intermittent pneumatic leg compression and pharmacological prophylaxis for prevention of venous thromboembolism in high-risk patients
People who have undergone surgery or trauma can run an increased risk for deep vein thrombosis (DVT) and pulmonary embolism (PE). Compression and medications such as blood-thinners, can prevent such complications. A recent review indicates that a combination of the two treatments is more effective at preventing DVT than either method alone. There was insufficient data to determine their implications for PE.
Low molecular weight heparin for prevention of venous thromboembolism in patients with lower-leg immobilization
Adults who wear a plaster cast or a brace on the lower leg face an increased risk of deep vein thrombosis (DVT). This review investigated whether low molecular weight heparin (LMWH), an anti-coagulant, might be used to prevent DVT in patients with immobilized legs from different types of injuries. The results show that LMWH was significantly better at reducing the incidence of venous thromboembolism than no treatment or placebo, with few adverse side effects.
Women’s health
Midwife-led versus other models of care for childbearing women
A recent Cochrane review supports midwife-led care for pregnant women. The data show that benefits of midwife-led care over physician-led care included fewer spontaneous abortions prior to 24 weeks, fewer episiotomies, more vaginal births and less use of instruments and pain management medication. Women in midwife-led care were also more likely to start breast-feeding.
Mental health
Exercise for depression
Relaxation for depression
Exercise and relaxation both have potential in treating depression. A systematic review found that relaxation techniques reduced depressive symptoms reported by patients, but not as well as psychological therapy. However, relaxation may be an alternative therapy for first-time sufferers who prefer a simple, non-medicated approach. Exercise also seems to improve the symptoms of depression and its effect is not significantly different from psychotherapy.
Public Health
Mupirocin ointment for preventing Staphylococcus aureus infections in nasal carriers
The spread of Staphylococcus aureus infection in hospitals occurs between patients, but infections actually begin inside the patient’s nose and spreads from there. In order to reduce infection, a Cochrane review recommends the use of mupirocin as a topical ointment in nasal carriers of Staphylococcus aureus.
Oral Health
Mouthrinses for the treatment of halitosis
Halitosis, or bad breath, can be serious enough to be personally embarrassing. Over the counter mouthrinses are often used to neutralize or mask the odour. This review shows some evidence that mouthrinses containing antibacterial agents or those containing chlorine dioxide and zinc can reduce the unpleasant odour. However, mouthrinses containing chlorhexidine caused temporary staining of the tongue and teeth.
What’s Ahead
14th International Congress on Circumpolar Health
July 11-16, 2009
Yellowknife, NWT
www.icch2009.com/
Call for abstracts open, deadline January 31, 2009.
Attend a Cochrane workshop!
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