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< Volume 20 – June 2012>
Cochrane Canada
In the News
Symposium 2012
Minister Aglukkaq announces new appointment of Dr Terry
Klassen to the Governing Council of the Canadian Institutes of
Health Research
University of Manitoba Dean of Medicine Dr Brian Postl congratulates the Faculty of Medicine’s Dr Terry Klassen on his appointment to the Governing Council of the CIHR. The Honourable Leona Aglukkaq, Minister of Health announced 4 June the appointment of Dr Terry Klassen, to the Governing Council of the Canadian Institutes of Health Research (CIHR) for a three-year

to read more.

CCC Welcomes New Advisory Board Chair
The Canadian Cochrane Centre (CCC) is pleased to welcome Krista Connell,
CEO of the Nova Scotia Health Research Foundation (NSHRF), as the new
Chair of our Advisory Board. The Advisory Board provides a balance of high-
level, strategic perspectives from across the Canadian healthcare landscape
and has the capacity to strengthen the development of CCC activities,
linkages and funding stability in Canada with their strategic advice and strong
capacity for an advocacy role.
Krista began her involvement with the Canadian Cochrane Centre in 2007,
when she participated in the new Board Structure. She has been a member
at large and also participated on the CCC’s Funding Committee from 2008-
2010. The NSHRF also hosted the 7th Annual Canadian Cochrane
Symposium in 2009.

Welcome Krista!
Where’s the Evidence? A Top Ten List of Cochrane Reviews
Presented by the Canadian Cochrane Centre and the Canadian Institutes of
Health Research
Every day new health research studies are covered in the media worldwide.
One day you may read that coffee is bad for your health; the next day you’ll
hear that the same cup of java reduces your risk of disease. How can you
sort through the complex and often conflicting world of scientific research to
make sound health decisions? And where can you find accurate and reliable
information written in plain language? Try
In honour of the 10th Annual which took
place in Winnipeg last month, the Canadian Cochrane Centre and the
Canadian Institutes of Health Research are pleased to present a top ten list
of Cochrane Reviews that have helped clarify health questions that concern
many of us.
Visit outo view the full list.
Rx for Change has been updated
The Rx for Change database is a first in class tool for promoting optimal
therapy. It provides a unique source of evidence summaries specific to
interventions geared towards changing health practitioner or consumer
behaviours around drug prescribing and use.
Professional Section – literature up to September 2011 Consumer Section – literature up to September 2011 Cochrane for Practice
Position in the second stage of labour for women without epidural
There are several different positions that women use to deliver a baby, such
as being upright (sitting, squatting, kneeling) or lying down. This review aims
to assess the benefits and risks of the different birthing positions for women
who are not using an epidural. This review included 22 trials with a total of
7280 women. There was no significant impact on the duration of labour for
any of the positions. However, women who sat in an upright position during
the second stage of labour experienced a reduction in episiotomies (surgical
cut in the perineum), fewer abnormal fetal heart patterns and fewer assisted
deliveries than the women lying down. Women lying down during labour
experienced less blood loss. Authors recommend that results be interpreted
with caution, as the methodological quality of the studies is questionable.
More research is needed.

Cochrane for Policy
Centralization of care may prolong survival in women with ovarian
cancer, and possibly more generally, gynaecological cancer
Gynaecological cancers, such as ovarian, uterine or cervical, are the second
most common cancers among women (breast cancer is the first). It has been
suggested that centralized care improves outcomes in gynaelogical cancer,
and this review aims to examine its effectiveness. Three studies involving
9000 women were analyzed, and it was found that institutions with onsite
gynaecological oncologists may prolong survival in women with ovarian
cancer compared to general hospitals. A meta-analysis of three other studies
involving over 50,000 women found that teaching or regional cancer centres
may prolong survival of women with any gynaecological cancer compared to
hospitals. The largest out of those three studies included all gynaecological
malignancies and involved 48,981 women, so findings extend beyond just
ovarian cancer. Further studies are needed to assess the quality of life
associated with the centralization of gynaecological care, as well as its
effectiveness on outcomes of other gynaecological cancers besides ovarian.
Cochrane Library Spotlight – Issues 3, 4 & 5 2012
Physical training for asthma
People who suffer from asthma tend to refrain from physical activity due to
fear of their symptoms worsening, medical advice or family influence. This
can result in reduced physical fitness, neuromuscular co-ordination and self-
confidence. There have been conflicting studies in the past on the effect
physical training has on the respiratory system and people with asthma, and
this review aims to get a better understanding. The authors included 19
studies with a total of 695 participants. Six studies found physical training
improved cardiopulmonary fitness by increasing participants’ maximum
oxygen uptake, and four studies found an increase in maximum expiratory
ventilation. This review found clinically and statistically significant data that
shows exercise can improve cardiopulmonary fitness. People with asthma
should be encouraged to participate in regular fitness activities without fear of
worsening their symptoms.

Bisphosphonates in multiple myeloma
Multiple Myeloma is cancer of the plasma cells in bone marrow that grows
inside and outside of bones. This can lead to fractures in long bones and the
spine and can be treated with a family of drugs called bisphosphonates. The
purpose of this review (an update of a review from 2002, and again in 2010)
was to investigate if bisphosphonates can improve overall survival,
progression-free survival and the number of fractures in people with multiple
myeloma. Twenty studies were included with a total of 6692 patients. Of
those studies, 16 compared bisphosphonates with a placebo or no treatment,
and four compared one kind of bisphosphonates with another. Two studies
(2464 patients) were added that were not included in the 2010 update. It was
found that the use of bisphosphonates reduces vertebral fractures, skeletal-
related events and pain. No significant adverse effects were identified, and no
evidence suggested that one kind of drug is better than the other. However,
zoledronate appears to be superior to placebo and etidronate in improving
overall survival.

Child Health
Non-pharmacological interventions for acute pain in infants
Infancy is a stage of ongoing development and it is not uncommon for
children ages three years and under to experience pain throughout that
period after an acutely painful procedure such as needles. However, if the
pain is left untreated it can cause distress and have lasting implications
throughout their lifetime. This review investigates the effects of non-
pharmacological interventions for managing acute pain in infants, not
including breast milk, sucrose and music. The authors analyzed 51 studies
with a total of 3396 participants. Twenty-nine studies looked at heel sticks, a
minimally invasive way of taking blood samples from infants, and 10 studies
looked at needles. The studies show that the most effective interventions for
pain-regulation and pain reactivity were non-nutritive sucking-related
interventions, kangaroo care, swaddling and rocking/holding. Though there is
evidence to suggest that these non-pharmacological interventions can be
used to manage acute pain in infants, there were significant differences in
each study regarding the level of effectiveness of the interventions.
Therefore, results should be interpreted with caution.

Mental Health
Atypical Antipsychotics benefit people with dementia but the risks of
adverse events may outweigh the benefits, particularly with long term

People suffering from dementia often experience periods of aggression,
agitation and psychosis. Atypical antipsychotics have become the drug of
choice for treatment of such symptoms, and this systematic review aims to
evaluate their effectiveness. Nine studies were included in the meta-analysis,
five of which have been published in peer-reviewed journals. Most studies
involved risperidone or olanzapine treatments compared to a placebo. The
authors found that both drugs significantly improved symptoms of aggression,
and there was a significant improvement in psychosis among risperidone
treated patients. There was not enough data to measure the effects on
cognitive function. Serious adverse cerebrovascular effects, such as stroke,
were noted in the controlled groups of both drugs, the drop-out rate was
higher, and there was an increased risk of mortality. In view of these safety
concerns, atypical antipsychotics such as risperidone and olanzapine should
not be routinely used unless there is severe risk of distress or physical harm
to those living with or caring for the patient.

Public Health
Cutting down or changing the fat we eat may reduce our risk of heart

Reducing and modifying the fat we eat has different effects on cardiovascular
risk factors, but it is unclear on how it effects other important health
outcomes. This review is an update from a 2010 Cochrane Review and looks
at the effects that reducing/modifying dietary fat intake can have on total
mortality, cardiovascular mortality and cardiovascular morbidity. This update
looked at 24 comparisons involving 65,508 participants. It was found that
reducing saturated fat intake lowered the risk of cardiovascular disease, such
as heart attacks, angina, strokes and the need for heart surgery, by 14 per
cent. This outcome was seen in studies of fat modification (not reduction)
over a period of two years in studies of men. No results were found on the
effect on total mortality or cardiovascular mortality. The findings only suggest
a small reduction in the risk of heart and vascular disease. However, this
update concludes that modifying, not reducing, the fat in our food by
replacing saturated fats with unsaturated fats for the duration of at least two
years would be beneficial for all people.

Senior’s Health
A review of the ways that healthcare professionals can improve the use
of suitable medicines for older people

Taking multiple medications for a chronic illness is very common amongst
seniors for the purpose of treating symptoms and preventing the illness from
advancing. However, sometimes taking multiple medications, known as
polypharmacy, can be harmful. This review investigates the interventions that
healthcare professionals use when prescribing medications to determine
which are most effective for improving the use of polypharmacy and reducing
medical-related problems in seniors. The authors examined 139 studies and
included 10 in the review. One study looked at computer decision support
and nine looked at pharmaceutical care such as identifying, preventing and
resolving medication-related problems, promoting the correct use of
medications and encouraging health promotion and education. The review
found that the interventions demonstrated an average reduction of -6.78 in
inappropriate medication use, using the Medication Appropriateness Index. It
is unclear if this translates into a clinically significant improvement. However,
it was found that these interventions do help in terms of reducing
inappropriate prescribing and reducing medicine-related issues.

Smoking Cessation
Can training health professionals to ask people if they smoke increase
offers of advice and help patients quit?
There is evidence to suggest that more people are likely to quit smoking if
they receive advice and support from their doctor. Providing skills training to
healthcare professionals can lead them to have greater success in stopping
their patients from smoking. This review examines the effectiveness of skills
training programs in the delivery of smoking cessation interventions.
Seventeen studies were included, and a meta-analysis of 14 studies found
that training programs produced statistically and clinically significant results in
favour of smoking cessation. The studies also found an increased rate of
continuous abstinence after the intervention has taken place. The evidence
shows that training programs help healthcare professionals identify smokers
and increase the number of people who quit smoking. However, the
intervention showed no difference in the provision of nicotine gum and other
replacement therapies.

Women’s Health
Treatments for female pattern hair loss
Many women experience hair loss or thinning of the hair at the top or front of
the head. This is known as female pattern hair loss or androgenic alopecia,
most commonly occurring in postmenopausal women. The purpose of this
review is to determine the most effective treatment for androgenic alopecia.
Twenty trials were included involving 2349 participants. Ten trials
investigated the effects of different concentrations of minoxidil, a drug that
increases hair growth. Data from four studies suggested that nearly twice as
many women treated with minxodil reported a moderate increase in hair
growth compared to women given a placebo. Seven studies reported an
increase of 13.28 in total hair count per cm2 in the minoxidil group. There
were no adverse effects reported in either group, besides additional hair
growth on areas other than the scalp when taking minoxidil (five per cent)
twice daily. This review found that minoxidil is more effective than a placebo
for the treatment of female pattern hair loss, though the majority of the
studies were assessed as high risk of bias. More studies are needed to
determine the sustainability of the effects after stopping the treatment.

What’s Ahead
Cochrane Canada Live – 2012

Review Manager 5 for New Authors
30 October 2012, 1200 EST (1 hour)

Learn from John MacDonald, Managing Editor, Cochrane Inflammatory
Bowel Disease and Functional Bowel Disorders Review Group, on how to
use Review Manager for your Cochrane Review. We'll cover the basics, from
opening and saving your files to uploading additional figures, tracking
changes to conducting meta-analysis.
to register!
Reporting Guidelines for Equity-Focused Systematic Reviews - Equity-
Extension of the PRISMA Statement
11 December 2012, 1200 EST (1 hour)
Join presenters from the Equity Methods Group – Peter Tugwell, Vivian
Welch, and Jennifer O’Neill – to learn about new reporting guidelines for
systematic reviews with an equity focus: those with interventions that target
disadvantaged populations, are aimed at reducing social gradients across
populations, or are likely to have important effects on equity. You’ll learn
about using the equity-extension checklist for your systematic review and
you’ll be asked to provide ideas and feedback regarding dissemination and
KT strategies.
to register!
For more webinar details and to register:
The Canadian Cochrane Centre is one of 14 independent, not-for-profit Cochrane Centres worldwide. Over 2,795 people in Canada contribute to The Cochrane Collaboration The CCC is funded by the Canadian Institutes of Health Research. Relay Cochrane! is published quarterly Canadian Cochrane Centre
Ottawa Hospital Research Institute (OHRI) Centre for Practice-Changing Research (CPCR)



Bluthochdruck und Herz-Kreislauf-ErkrankungenDas Angebot von Boehringer Ingelheim umfasst diverse Medikamente, die Ärzte bei der Behandlung des Bluthochdrucks unterstützen und einen Schutz über die reine Blutdruckkontrolle hinaus erzielen. Bluthochdruck Diverse Optionen zur Behandlung des Bluthochdrucks sich die Anzahl der einzunehmenden Tabletten verringern lässt,

Self-directed feeding program

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