Efficacy and Safety of Inhaled Corticosteroids in Patients With COPD: A Systematic Review and Meta-Analysis of Health Outcomes

PURPOSE We wanted to review systematically the efficacy, effectiveness, and safety of inhaled corticosteroids with respect to health outcomes in patients with chronic obstructive pulmonary disease (COPD)

Activities to support the implementation of complex interventions as part of routine care: a review of the quality of reporting in cluster randomised controlled trials

Objective: To review a sample of cluster randomised controlled trials and explore the quality of reporting of (1) enabling or support activities provided to the staff during the trial, (2) strategies used to monitor fidelity throughout the trial and (3) the extent to which the intervention being tested was delivered as planned. Design: A descriptive review. Data sources and study selection: We searched MEDLINE for trial reports published between 2008 and 2014 with combinations of the search terms 'randomised', 'cluster', 'trial', 'study', 'intervention' and 'implement∗'. We included trials in which healthcare professionals (HCPs) implemented the intervention being tested as part of routine practice. We excluded trials (1) conducted in non-health services settings, (2) where the intervention explicitly aimed to change the behaviours of the HCPs and (3) where the trials were ongoing or for which only trial protocols were available. Data collection: We developed a data extraction form using the Template for Intervention Description and Replication (TIDieR checklist). Review authors independently extracted data from the included trials and assessed quality of reporting for individual items. Results: We included 70 publications (45 results publications, 25 related publications). 89% of trials reported using enabling or support activities. How these activities were provided (75.6%, n=34) and how much was provided (73.3%, n=33) were the most frequently reported items. Less than 20% (n=8) of the included trials reported that competency checking occurred prior to implementation and data collection. 64% (n=29) of trials reported collecting measures of implementation. 44% (n=20) of trials reported data from these measures. Conclusions: Although enabling and support activities are reported in trials, important gaps exist when assessed using an established checklist. Better reporting of the supports provided in effectiveness trials will allow for informed decisions to be made about financial and resource implications for wide scale implementation of effective interventions

The Impact of Inclusion Criteria in Health Economic Assessments

The article of record as published may be found at https://doi.org/10.2165/11590150-000000000-00000This study aims to present complex network models which analyze professional swimmers of 50-m freestyle Olympic competitions, comparing characteristics and variables that are considered performance determinants. This comparative research includes Olympic medalists’ versus non-medalists’ behavior. Using data from 40 athletes with a mean age, weight and height of 26 ± 2.9 years, 87 ± 5.59 kg, 193 ± 3.85 cm, respectively, at the Olympics of 2000, 2004, 2008, 2012, and 2016 (16-year interval), we built two types of complex networks (graphs) for each edition, using mathematical correlations, metrics and the spectral decomposition analysis. It is possible to show that complex metrics behave differently between medalists and non-medalists. The spectral radius (SR) proved to be an important form of evaluation since in all 5 editions it was higher among medalists (SR results: 3.75, 3.5, 3.39, 2.91, and 3.66) compared to non- medalists (2.18, 2.51, 2.23, 2.07, and 2.04), with significantly differences between. This study introduces a remarkable tool in the evaluation of the performance of groups of swimming athletes by complex networks, and is relevant to athletes, coaches, and even amateurs, regarding how individual variables relate to competition results and are reflected in the SR for the best performance. In addition, this is a general method and may, in the future, be developed in the analysis of other competitive sports

How effective are common medications: a perspective based on meta-analyses of major drugs

Study protocol. (PDF 161 kb

Evidence-Based Medicine Breaking the Borders - The European Union as a Paradigm

Evidence-based medicine has instigated a shift in medical paradigms over the last decade. Systematic reviews and meta-analyses in particular have a strong impact on the way we practice medicine today. Although evidence-based medicine focuses on results at an individual patient level, the assumption that an increase in the practicing of evidence-based medicine will lead to health improvements of the general population seems to be a causal chain. The influence of evidence-based medicine is continually extending beyond clinical decision- making to act as a foundation for health policy decisions. The European Union has realized the potential benefits of evidence-based health care. Under the umbrella of thee-Health initiative, the European Union plans to implement a telematic (telecommunication and informatics) health network by the end of 2004. The objective of this network is to facilitate information exchange and to provide databases of the best evidence available in health care. Health care providers and the general public will be able to access these databases through the internet free of charge. Evaluations of the network will have to focus on the extent and depth health care decision makers accept, use and apply not only the databases but clinical guidelines as well. The only substantial official publication of the EU regarding this program is a report by the European Commission on evidence-based health care. The document mentions three components to improve evidence-based health care in the European Union: (1) Evidence-based medicine; (2) Clinical practice guidelines and; (3) Health technology assessment. However, no official information about the structure of a telematic health network has become available yet. The challenge though is unique - to link 15 different health systems with 11 different languages. This paper first gives some background information about the practice of evidence-based medicine - a description of the status quo; a review of its development; and a critical appraisal of its usage - including benefits and risks of evidence-based medicine and a detailed look at its influence on health policy in general. Next, the paper provides an overview of the health systems of the European Union and the political and theoretical framework of a telematic health network. Based on these premises, a hypothetical structure of evidence-based databases is proposed. This concept takes the heterogeneity of the European Union into consideration and examines factors that will be crucial for the acceptance of evidence-based databases and clinical practice guidelines by health care decision makers. It discusses lessons that could be learned from existing databases on national and internationill levels. It also describes the necessity of a parallel evaluation program and outlines methods of evaluation that could be successfully used to assess the impact and effectiveness of the program and provide a base for cybernetic decision - making.Master of Public Healt

Vitamin D deficiency as a risk factor for dementia: a systematic review and meta-analysis

Abstract Background Sunlight exposure and high vitamin D status have been hypothesised to reduce the risk of developing dementia. The objective of our research was to determine whether lack of sunlight and hypovitaminosis D over time are associated with dementia. Methods We systematically searched MEDLINE (via PubMed), Cochrane Library, EMBASE, SCOPUS, Web of Science, ICONDA, and reference lists of pertinent review articles from 1990 to October 2015. We conducted random effects meta-analyses of published and unpublished data to evaluate the influence of sunlight exposure or vitamin D as a surrogate marker on dementia risk. Results We could not identify a single study investigating the association between sunlight exposure and dementia risk. Six cohort studies provided data on the effect of serum vitamin D concentration on dementia risk. A meta-analysis of five studies showed a higher risk for persons with serious vitamin D deficiency (<25\ua0nmol/L or 7\u201328\ua0nmol/L) compared to persons with sufficient vitamin D supply (\u226550\ua0nmol/L or 54\u2013159\ua0nmol/L) (point estimate 1.54; 95% CI 1.19\u20131.99, I 2 \u2009=\u200920%). The strength of evidence that serious vitamin D deficiency increases the risk of developing dementia, however, is very low due to the observational nature of included studies and their lack of adjustment for residual or important confounders (e.g. ApoE \u3b54 genotype), as well as the indirect relationship between Vitamin D concentrations as a surrogate for sunlight exposure and dementia risk. Conclusions The results of this systematic review show that low vitamin D levels might contribute to the development of dementia. Further research examining the direct and indirect relationship between sunlight exposure and dementia risk is needed. Such research should involve large-scale cohort studies with homogeneous and repeated assessment of vitamin D concentrations or sunlight exposure and dementia outcomes

Stakeholder involvement in systematic reviews: a protocol for a systematic review of methods, outcomes and effects

Background There is an expectation for stakeholders (including patients, the public, health professionals, and others) to be involved in research. Researchers are increasingly recognising that it is good practice to involve stakeholders in systematic reviews. There is currently a lack of evidence about (A) how to do this and (B) the effects, or impact, of such involvement. We aim to create a map of the evidence relating to stakeholder involvement in systematic reviews, and use this evidence to address the two points above. Methods We will complete a mixed-method synthesis of the evidence, first completing a scoping review to create a broad map of evidence relating to stakeholder involvement in systematic reviews, and secondly completing two contingent syntheses. We will use a stepwise approach to searching; the initial step will include comprehensive searches of electronic databases, including CENTRAL, AMED, Embase, Medline, Cinahl and other databases, supplemented with pre-defined hand-searching and contacting authors. Two reviewers will undertake each review task (i.e., screening, data extraction) using standard systematic review processes. For the scoping review, we will include any paper, regardless of publication status or study design, which investigates, reports or discusses involvement in a systematic review. Included papers will be summarised within structured tables. Criteria for judging the focus and comprehensiveness of the description of methods of involvement will be applied, informing which papers are included within the two contingent syntheses. Synthesis A will detail the methods that have been used to involve stakeholders in systematic reviews. Papers from the scoping review that are judged to provide an adequate description of methods or approaches will be included. Details of the methods of involvement will be extracted from included papers using pre-defined headings, presented in tables and described narratively. Synthesis B will include studies that explore the effect of stakeholder involvement on the quality, relevance or impact of a systematic review, as identified from the scoping review. Study quality will be appraised, data extracted and synthesised within tables. Discussion This review should help researchers select, improve and evaluate methods of involving stakeholders in systematic reviews. Review findings will contribute to Cochrane training resources

Efficacy and safety of donepezil, galantamine, and rivastigmine for the treatment of Alzheimer’s disease: A systematic review and meta-analysis

Pharmacologic treatments for Alzheimer’s disease include the cholinesterase inhibitors donepezil, galantamine, and rivastigmine. We reviewed their evidence by searching MEDLINE®, Embase, The Cochrane Library, and the International Pharmaceutical Abstracts from 1980 through 2007 (July) for placebo-controlled and comparative trials assessing cognition, function, behavior, global change, and safety. Thirty-three articles on 26 studies were included in the review. Meta-analyses of placebo-controlled data support the drugs’ modest overall benefits for stabilizing or slowing decline in cognition, function, behavior, and clinical global change. Three open-label trials and one double-blind randomized trial directly compared donepezil with galantamine and rivastigmine. Results are conflicting; two studies suggest no differences in efficacy between compared drugs, while one study found donepezil to be more efficacious than galantamine, and one study found rivastigmine to be more efficacious than donepezil. Adjusted indirect comparison of placebo-controlled data did not find statistically significant differences among drugs with regard to cognition, but found the relative risk of global response to be better with donepezil and rivastigmine compared with galantamine (relative risk = 1.63 and 1.42, respectively). Indirect comparisons also favored donepezil over galantamine with regard to behavior. Across trials, the incidence of adverse events was generally lowest for donepezil and highest for rivastigmine