Intrarectal quinine for treating Plasmodium falciparum malaria: a systematic review

BACKGROUND: In children with malaria caused by Plasmodium falciparum, quinine administered rectally may be easier to use and less painful than intramuscular or intravenous administration. The objective of this review was to compare the effectiveness of intrarectal with intravenous or intramuscular quinine for treating falciparum malaria. METHODS: All randomized and quasi-randomized controlled trials comparing intrarectal with intramuscular or intravenous quinine for treating people with falciparum malaria located through the following sources were included: Cochrane Infectious Diseases Group Specialized Register, CENTRAL, MEDLINE, EMBASE, LILACS and CINAHL. Trial quality was assessed and data, including adverse event data, were extracted. Dichotomous data were analysed using odds ratios and continuous data using weighted mean difference. RESULTS: Eight randomized controlled trials (1,247 children) fulfilled the inclusion criteria. The same principal investigator led seven of the trials. Five compared intrarectal with intravenous quinine, and six compared intrarectal with intramuscular treatment. No statistically significant difference was detected for death, parasite clearance by 48 hours and seven days, parasite and fever clearance time, coma recovery time, duration of hospitalization and time before drinking began. One trial (898 children) reported that intrarectal was less painful than intramuscular administration. CONCLUSION: No difference in the effect on parasites and clinical illness was detected for the use of intrarectal quinine compared with other routes, but most trials were small. Pain during application may be less with intrarectal quinine. Further larger trials, in patients with severe malaria and in adults, are required before the intrarectal route could be recommended

Translating Cochrane Reviews to Ensure that Healthcare Decision-Making is Informed by High-Quality Research Evidence

Erik von Elm and colleagues discuss plans to increase access and global reach of Cochrane Reviews through translations into other languages. Please see later in the article for the Editors' Summar

A scoping review of competencies for scientific editors of biomedical journals

Background Biomedical journals are the main route for disseminating the results of health-related research. Despite this, their editors operate largely without formal training or certification. To our knowledge, no body of literature systematically identifying core competencies for scientific editors of biomedical journals exists. Therefore, we aimed to conduct a scoping review to determine what is known on the competency requirements for scientific editors of biomedical journals. Methods We searched the MEDLINE®, Cochrane Library, Embase®, CINAHL, PsycINFO, and ERIC databases (from inception to November 2014) and conducted a grey literature search for research and non-research articles with competency-related statements (i.e. competencies, knowledge, skills, behaviors, and tasks) pertaining to the role of scientific editors of peer-reviewed health-related journals. We also conducted an environmental scan, searched the results of a previous environmental scan, and searched the websites of existing networks, major biomedical journal publishers, and organizations that offer resources for editors. Results A total of 225 full-text publications were included, 25 of which were research articles. We extracted a total of 1,566 statements possibly related to core competencies for scientific editors of biomedical journals from these publications. We then collated overlapping or duplicate statements which produced a list of 203 unique statements. Finally, we grouped these statements into seven emergent themes: (1) dealing with authors, (2) dealing with peer reviewers, (3) journal publishing, (4) journal promotion, (5) editing, (6) ethics and integrity, and (7) qualities and characteristics of editors. Discussion To our knowledge, this scoping review is the first attempt to systematically identify possible competencies of editors. Limitations are that (1) we may not have captured all aspects of a biomedical editor’s work in our searches, (2) removing redundant and overlapping items may have led to the elimination of some nuances between items, (3) restricting to certain databases, and only French and English publications, may have excluded relevant publications, and (4) some statements may not necessarily be competencies. Conclusion This scoping review is the first step of a program to develop a minimum set of core competencies for scientific editors of biomedical journals which will be followed by a training needs assessment, a Delphi exercise, and a consensus meeting

When and how to update systematic reviews: consensus and checklist.

Updating of systematic reviews is generally more efficient than starting all over again when new evidence emerges, but to date there has been no clear guidance on how to do this. This guidance helps authors of systematic reviews, commissioners, and editors decide when to update a systematic review, and then how to go about updating the review.This is the final version of the article. It first appeared from the BMJ Publishing Group via http://dx.doi.org/10.1136/bmj.i350

Cochrane for Cam providers: Evidence for action

Extracts of the leaves of the maidenhair tree, Ginkgo biloba, have long been used in china as a traditional medicine for various disorders of health. A standardized extracts is widely prescribed in Germany and France for the treatment of a range of conditions, including memory and concentration problems, confusion, depression, anxiety, dizziness, tinnitus, and headache. The mechanisms of action are thought to reflect the action of several components of the extract and include increasing blood supply by dilating blood vessels, reducing blood viscosity, modification of neurotransmitter systems, and reducing the density of oxygen free radicals. Here, Liu and MacLehose assess the efficacy and safety of Ginkgo biloba for the treatment of patient with dementia or cognitive decline

Community animal health services for improving household wealth and health status of low-income farmers

Community animal health services (CAHS) have been promoted since the 1970s by aid organizations in low-income countries to improve the health of animals. they are also thought to improve directly the wealth and health or livelihood of their owners. We have systematically searched for observational studies of basic preventive and curative animal health services provided by a community animal health worker in communities in low-income countries. The objective was to summarize the available research on the effects of CAHS on indicators for household wealth and health. Studies for inclusion were assessed independently according to predefined eligibility criteria, the methodological quality of the studies examined, and data extracted. Fourteen studies of varying methodological quality met the inclusion criteria. The results were unclear in four studies, and in the remaining studies it was difficult to summarize the results because they reported different outcomes. However, the studies report that CAHS has a considerable potential for improving human health and wealth as well as animal health and productivity. Given the amount of money and time invested in this area, these observations need to be conformed in the context of a well-designed study using standard pragmatic outcomes

Biofilms, homoserine lactones and biocide susceptibility

Aims: To investigate the susceptibility, to a range of different biocides, of Pseudomonas aeruginosa strains variously deficient in N-acyl homoserine lactone systems, grown either as planktonic or biofilm populations. Methods and results: Biocide susceptibility data were generated for strains of P. aeruginosa deficient in N-acyl homoserine lactone production, grown planktonically or as biofilm populations using a poloxamer hydrogel construct. Component cells from the biofilm constructs were also tested for their susceptibility. Significant differences in susceptibility were noted between the wild-type strain, a mutant defective in the long chain (C-12) homoserine lactone and a mutant defective in the short chain (C-4) homoserine lactone which could not be related to the biofilm mode of growth. Moreover, differences in susceptibility appeared to be dependent upon the nature of the homoserine lactone deletion and type of biocide rather than the mode of growth. Conclusions: No general trend exists between homoserine lactone deficiency and biocide susceptibility regardless of mode of growth

Systematic reviews in malaria: global policies need global reviews

This article highlights systematic reviews of malaria research and what has been learned about applying methods of research synthesis in this particular infectious disease over the last 15 years. It illustrates how systematic reviews have been used to guide policy, shows what has been learned about synthesizing research in this area, and reflects on how best to maximize their uptake in policy and practice

Vaccines for preventing rotavirus diarrhoea: vaccines in use (Review)

Background Rotavirus results in more diarrhoea-related deaths in children less than five years of age than any other single agent in countries with high childhood mortality. It is also a common cause of diarrhoea-related hospital admissions in countries with low childhood mortality. Currently licensed rotavirus vaccines include a monovalent rotavirus vaccine (RV1; Rotarix, GlaxoSmithKline Biologicals) and a pentavalent rotavirus vaccine (RV5; RotaTeq, Merck & Co., Inc.). Lanzhou lamb rotavirus vaccine (LLR; Lanzhou Institute of Biomedical Products) is used in China only. Objectives To evaluate rotavirus vaccines approved for use (RV1, RV5, and LLR) for preventing rotavirus diarrhoea. Search methods We searched MEDLINE (via PubMed) (1966 to May 2012), the Cochrane Infectious Diseases Group Specialized Register (10 May 2012), CENTRAL (published in The Cochrane Library 2012, Issue 5), EMBASE (1974 to 10 May 2012), LILACS (1982 to 10 May 2012), and BIOSIS (1926 to 10 May 2012). We also searched the ICTRP (10 May 2012), www.ClinicalTrials.gov (28 May 2012) and checked reference lists of identified studies. Selection criteria We selected randomized controlled trials (RCTs) in children comparing rotavirus vaccines approved for use with placebo, no intervention, or another vaccine. Data collection and analysis Two authors independently assessed trial eligibility, extracted data, and assessed risk of bias. We combined dichotomous data using the risk ratio (RR) and 95% confidence intervals (CI). We stratified the analysis by child mortality, and used GRADE to evaluate evidence quality. Main results Forty-one trials met the inclusion criteria and enrolled a total of 186,263 participants. Twenty-nine trials (101,671 participants) assessed RV1, and 12 trials (84,592 participants) evaluated RV5. We did not find any trials assessing LLR. RV1 Children aged less than one year: In countries with low-mortality rates, RV1 prevents 86% of severe rotavirus diarrhoea cases (RR 0.14, 95% CI 0.07 to 0.26; 40,631 participants, six trials; high-quality evidence), and, based on one large multicentre trial in Latin America and Finland, probably prevents 40% of severe all-cause diarrhoea episodes (rate ratio 0.60, 95% CI 0.50 to 0.72; 17,867 participants, one trial; moderate-quality evidence). In countries with high-mortality rates, RV1 probably prevents 63% of severe rotavirus diarrhoea cases (RR 0.37, 95% CI 0.18 to 0.75; 5414 participants, two trials; moderate-quality evidence), and, based on one trial in Malawi and South Africa, 34% of severe all-cause diarrhoea cases (RR 0.66, 95% CI 0.44 to 0.98; 4939 participants, one trial; moderate-quality evidence). Children aged up to two years: In countries with low-mortality rates, RV1 prevents 85% of severe rotavirus diarrhoea cases (RR 0.15, 95% CI 0.12 to 0.20; 32,854 participants, eight trials; high-quality evidence), and probably 37% of severe all-cause diarrhoea episodes (rate ratio 0.63, 95% CI 0.56 to 0.71; 39,091 participants, two trials; moderate-quality evidence). In countries with high-mortality rates, based on one trial in Malawi and South Africa, RV1 probably prevents 42% of severe rotavirus diarrhoea cases (RR 0.58, 95% CI 0.42 to 0.79; 2764 participants, one trial; moderate-quality evidence), and 18% of severe all-cause diarrhoea cases (RR 0.82, 95% CI 0.71 to 0.95; 2764 participants, one trial; moderate-quality evidence). RV5 Children aged less than one year: In countries with low-mortality rates, RV5 probably prevents 87% of severe rotavirus diarrhoea cases (RR 0.13, 95% CI 0.04 to 0.45; 2344 participants, three trials; moderate-quality evidence), and, based on one trial in Finland, may prevent 72% of severe all-cause diarrhoea cases (RR 0.28, 95% CI 0.16 to 0.48; 1029 participants, one trial; low-quality evidence). In countries with high-mortality rates, RV5 prevents 57% of severe rotavirus diarrhoea (RR 0.43, 95% CI 0.29 to 0.62; 5916 participants, two trials; high-quality evidence), but there was insufficient data to assess the effect on severe all-cause diarrhoea. Children aged up to two years: Four studies provided data for severe rotavirus and all-cause diarrhoea in countries with low-mortality rates. Three trials reported on severe rotavirus diarrhoea cases and found that RV5 probably prevents 82% (RR 0.18, 95% CI 0.07 to 0.50; 3190 participants, three trials; moderate-quality evidence), and another trial in Finland reported on severe all-cause diarrhoea cases and found that RV5 may prevent 96% (RR 0.04, 95% CI 0.00 to 0.70; 1029 participants, one trial; low-quality evidence). In high-mortality countries, RV5 prevents 41% of severe rotavirus diarrhoea cases (RR 0.59, 95% CI 0.43 to 0.82; 5885 participants, two trials; high-quality evidence), and 15% of severe all-cause diarrhoea cases (RR 0.85, 95% CI 0.75 to 0.98; 5977 participants, two trials; high-quality evidence). There was no evidence of a vaccine effect on mortality (181,009 participants, 34 trials; low-quality evidence), although the trials were not powered to detect an effect on this end point. Serious adverse events were reported in 4565 out of 99,438 children vaccinated with RV1 and in 1884 out of 78,226 children vaccinated with RV5. Fifty-eight cases of intussusception were reported in 97,246 children after RV1 vaccination, and 34 cases in 81,459 children after RV5 vaccination. No significant difference was found between children receiving RV1 or RV5 and placebo in the number of serious adverse events, and intussusception in particular. Authors' conclusions RV1 and RV5 prevent episodes of rotavirus diarrhoea. The vaccine efficacy is lower in high-mortality countries; however, due to the higher burden of disease, the absolute benefit is higher in these settings. No increased risk of serious adverse events including intussusception was detected, but post-introduction surveillance studies are required to detect rare events associated with vaccination

Developing a policy on peer review for Cochrane Reviews

Presentation given at the 24th Cochrane Colloquium, 23-27 October 2016, Seoul, South Korea. Abstract http://abstracts.cochrane.org/2016-seoul/developing-policy-peer-review-cochrane-reviews Background: Peer review is a core part of the editorial workflow for Cochrane Reviews, representing an opportunity for scrutiny of methodology, interpretation and context before publication. All Cochrane Reviews are peer-reviewed, and Cochrane Review Groups manage the peer review process for their reviews. Development of an overarching peer review policy is part of Cochrane's integrated quality strategy. Objectives: To describe the development and implementation of new peer review policy for Cochrane Reviews, aiming to clarify when to peer review (including for updates) and who to use for peer review. The policy is for the use of editorial teams, authors, peer reviewers, and readers and other users of Cochrane Reviews. Methods: Following an exploratory workshop at the 2015 Cochrane Colloquium, an outline of the policy and supporting guidance was developed by the Cochrane Editorial Unit. We recruited a working group representing Cochrane Review Groups, authors, consumers, and Wiley, and the policy was developed further in collaboration with the group. We identified many different aspects that could be covered by the policy and/or supporting guidance, and in each case we considered whether policy should allow for diversity or set new standards. The policy will be distributed for consultation, finalised, agreed, and published in the Cochrane Editorial and Publishing Policy Resource. We will establish what guidance is needed to support implementation. Results: We identified the need for policy in a number of areas, including: anonymous or open peer review; number and expertise of peer reviewers; declarations of interest for peer reviewers; acknowledgement and credit; peer review turnaround time; communication with peer reviewers; peer review criteria and conduct; and peer review fraud. Conclusions: We identified the need for an overarching policy for the peer review of Cochrane Reviews, and we are developing a policy that meets the needs of diverse Cochrane editorial teams, review authors, peer reviewers, and users of Cochrane Reviews