Cochrane reviews

G. lamblia is treated with 5-nitroimidazole derivates. Paromomycin is a second choice in specific circumstances (e.g. pregnancy). In a Cochrane review, where 34 trials were included and where only one trial was without significant methodological flaws, the authors concluded that a single dose of tinidazole can provide the highest clinical cure rate with relatively few adverse effects. The high recun ence rate of disease after initial diug therapy is a problem. 

Geddes JR, Freemantle N, Mason J, Eccles MP, Boynton J (1999). SSRIs versus alternative antidepressants in depressive disorder (Cochrane Review). In Cochrane Library, Issue 4. Oxford Update Software. 

Finally, a Cochrane review of antiplatelet therapy following CEA found no evidence of a difference in mortality when antiplatelets were compared with placebo. However, treatment with antiplatelet agents following CEA decreased the risk of postoperative stroke (OR 0.58, 95% Cl 0.34-0.98). ... 

Antiplatelet therapy for acute ischemic stroke. The Cochrane review 2003. 

Foundation of the United States. However, a recent Cochrane Review attempting to search for evidence of the benefit of prophylaxis concluded that there were too few trials (only four) to prove benefit.6... 

Cochrane Library. The Cochrane Library [44] includes The Cochrane Database of Systematic Reviews, a collection of regularly updated, systematic reviews of the effects of health care. It is maintained by contributors to the Cochrane Collaboration. Cochrane reviews are reviews mainly of randomized controlled trials. To minimize bias, evidence is included or excluded on the basis of explicit quality criteria. Data are often combined statistically, with meta-analysis, to increase the power of the findings of numerous studies, each too small to produce reliable results individually. Database of Abstracts of Reviews of Effectiveness is also included. It consists of critical assessments and structured abstracts of good systematic reviews published elsewhere. The Cochrane Controlled Trials Register with bibliographic information on controlled trials and other sources of information on the science of reviewing research and evidence-based health care are part of the Cochrane Library. It is commercially available on CD-ROM or the Internet. 

MacLennan A, Lester S, Moore V (2004) Oral oestrogen replacement therapy versus placebo for hot flushes (Cochrane Review). In The Cochrane Library, Issue 1. Wiley, Chichester... 

National Institute of Clinical Excellence (www.nice.org.uk/guidance) Cochrane Reviews Database (www.cochrane.org/reviews)... 

Table 3.3 Some examples of evidence based reviews in the elderly from the Cochrane Review Database...

There are several international and national databases freely available. Most guidance is on the selection of appropriate medications on external evidences (See EBM in Chapter 3). Cochrane Reviews is an international database including EBM evaluation on clinical practices, and NICE is a national source with high impact on practice even outside EnglandAVales. In some countries databases on national guidance are provided. 

In the Cochrane Reviews database 81 protocols and reviews are available (Cochrane Reviews database). This includes continuing education and quality assurance (16 documents), financial interventions (7), organisational interventions (26), and reviews of interventions to improve specific types of practices (28). Several of the documents involve practices with elderly and medications focus. Specific focus can be found in four of the protocols... 

The Cochrane Collaboration prepares Cochrane Reviews and aims to update them regularly with the latest scientific evidence. Members of the organisation (mostly volunteers) work together to provide evidence to help people make decisions about health care. Some people read the healthcare literature to find reports of randomised controlled trials others find such reports by searching electronic databases others prepare and update Cochrane Reviews based on the evidence found in these trials others work to improve the methods used in Cochrane Reviews others provide a vitally important consumer perspective and others support the people doing these tasks. The Cochrane Collaboration website provides information on a variety of ways of registering interest or becoming directly involved www.cochrane.org/docs/involve.htm involve. 

Data from The Cochrane Library in 2004 show that there are more than 11,500 people working within The Cochrane Collaboration in 91 countries, half of whom are authors of Cochrane Reviews. The number of people has increased by about 20% every year for the last five years. The increase in the number of contributors from low, lower-middle and upper-middle income countries has been even greater, to more than 1000 (9.3%) in 2004 - up by 42% since 2003, and by 248% since 2000. See Reference Centres by country (www.cochrane.org/contact/country.htm) and a world map showing the locations of the Cochrane Centres (www.cochrane.org//contact/entities.htm centres). 

Collaborative Review Groups (www.cochrane. org/contact/entities.htm crglist) are made up of people who prepare, maintain and update Cochrane Reviews, and people who support them in this process. Each Group has an editorial base where a small team of people supports the production of Cochrane Reviews. These Groups focus on particular areas of health (for example, Breast Cancer, Infectious Diseases, Multiple Sclerosis, Schizophrenia, Tobacco Addiction). 

Methods Groups are made up of people who develop the methodology of Cochrane Reviews (www.cochrane.org/contact/enti ties.htm mglist). 

The Publication Arbiter helps people to reach a mutually acceptable agreement in areas of dispute between the editorial teams of Collaborative Review Groups (for example, on the appropriate home for a specific Cochrane Review), and between authors of Cochrane Reviews and their editorial team (for example, when authors and editors cannot agree on some aspects of the review). 

Cochrane Reviews are systematic assessments of evidence of the effects of healthcare interventions, intended to help people to make informed decisions about health care, their own or someone else s. Cochrane Reviews are needed to help ensure that healthcare decisions throughout the world can be informed by high quality, timely research evidence. This is described in Systematic reviews and The Cochrane Collaboration (www.cochrane. org/docs/whycc.htm). Cochrane Reviews are published in full in The Cochrane Database of Systematic Reviews, one of several databases in The Cochrane Library (www.thecochranelibrary.com). 

The main output of The Cochrane Collaboration, the Cochrane Reviews, has had a real and significant impact on practice, policy decisions and research around the world. Many examples are given in The Dissemination of Cochrane Evidence (www.cochrane.org/reviews/impact). 

Specialist subsets of Cochrane Reviews Cochrane Reviews are listed by Collaborative Review Group on the website (www.cochrane.org/ cochrane/revabstr/crgindex.htm). Several subsets of Cochrane Reviews published in The Cochrane Library are also published separately, namely The WHO Reproductive Health Library (available in both English and Spanish) (www. update-software.com/RHL/) The Cancer Library (www.update-software.com/cancer/) The Mental... 

Versions of Cochrane Reviews in languages other than English The Cochrane Library is available in Spanish La Cochrane Library Plus en es-panol (www.update-software.com/clibplus/). For information on translations of reviews and their abstracts into other languages, contact the Collaboration s publishers, John Wiley and Sons (mcouat wiley.co.uk). 

Cochrane methodology reviews As well as Cochrane Reviews of the effects of healthcare interventions, there are also Cochrane methodology reviews of the ways in which health care can be evaluated and, from 2006, there will be Cochrane Reviews of the accuracy of diagnostic tests. 

The Cochrane Collaboration has special software for processing Cochrane Reviews called RevMan (Review Manager), managed by the Information Management System (IMS) team at the Nordic Cochrane Centre (www.cc-ims.net/IMSG). 

Information on how to prepare a Cochrane Review is contained in the Cochrane Reviewers Handbook (www.cochrane.org/resources/handbook). Preparing a Cochrane Review requires skills that may be new to the author. The Cochrane Collaboration s Open Learning Material (www.cochrane.org/resources/ openlearning), together with the Cochrane Reviewers Handbook, helps people to prepare a Cochrane Review, and the Cochrane Centres and some Collaborative Review Groups provide or facilitate training through workshops (www.cochrane.org/news/ workshops.htm). 

For editorial teams of Collaborative Review Groups (www.cochrane.org/crgprocedures). This password-protected material contains many procedural resources, including examples of checklists, forms, etc. In addition, the Cochrane Style Guide (www.liv.ac.uk/lstm/ehcap/CSR/home. html) provides guidance to enable people to copy edit Cochrane Reviews and other documents produced within The Cochrane Collaboration in a consistent manner. 

A recent Cochrane review failed to demonstrate the advantage of oxytocin receptor antagonists for women with preterm labour as a form of tocolytic therapy. Possible side effects are nausea, vomiting and headache in the mother. Oxytocin receptor antagonists for preterm labour do not improve infant outcomes more than placebo or other tocolytics. 

Amyotrophic lateral sclerosis (ALS) is a progressive, usually fatal, neurodegenerative disease caused by the degeneration of motor neurons in the central nervous system. No cure has yet been found for ALS. The U.S. Food and Drug Administration (FDA) has approved riluzole as the first drug treatment for the disease. It delays the onset of ventilator-dependence or tracheostomy in selected patients. A Cochrane review states a 9% gain in the probability of surviving one year (see Miller et ah, 2007). 

The anthelmintic agent levamisole increases delayed hypersensitivity and T-cell mediated immunity. It has been used as adjuvant therapy for colorectal cancer. A recent Cochrane review concluded that... 

Britton A, Russell R. Multidisciplinary team interventions for delirium in patients with chronic cognitive impairment (Cochrane review). In The Cochrane library. Issue 4. Oxford Update Software 1999. 

A Cochrane Review of 20 randomised controlled trials involving 280 participants, showed that 4 mg, of nedocromil sodium inhaled 15-60 minutes prior to exercise significantly reduces the severity and duration of exercise-induced bronchus constriction in both adults and children, when compared to placebo. This effect appears to be more pronounced in people with severe exercise-induced bronchoconstriction. 

A Cochrane Review of 7 studies concludes that a short course of corticosteroids following assessment... 

An other Cochrane review of nine trials representing 1049 randomized patients concludes Top-iramate has efficacy as an add-on treatment in patients with drug resistant partial epilepsy. However, trials reviewed were of relatively short duration, and provide no evidence for the long term efficacy of top-iramate. Results cannot be extrapolated to monotherapy or patients with other epilepsy types . 

With regard to hormone use for epithelial ovarian cancer a Cochrane review concluded that there... 

Neo-adjuvant chemotherapy for muscle invasive and locally advanced bladder cancer has been assessed in a number of randomized studies. Most studies have been relatively small and therefore underpowered. More recently the larger INT 0080 trial from the United States and the MRC/FORTC study from Europe reported survival advantages for neoadjuvant MVAC and CMV but these differences did not quite reach statistical significance. A Cochrane Review (see Advanced Bladder Cancer Overview, 2004) concluded that cisplatin based neo-adjuvant chemotherapy provided a 5% 5-year survival benefit. 

---