The impact of cumulative medications with anticholinergic effects on future adverse clinical outcomes in people with dementia
How systematic reviewers can bring attention to fraudulent studies, writes Lisa Bero in The Conversation US
While medical research is the best source of information on which to guide treatment of health issues, fraudulent studies are an issue. Such research can skew the evidence base and even lead to harm, as well as damage trust in the scientific process.
Our Senior Research Integrity Editor, Lisa Bero, has recently written about this phenomenon in The Conversation US. In the article, she describes how systematic reviewers can be part of the solution and help to find such problematic studies. She also discusses research which she, Stephanie Boughton of the Cochrane Research Integrity team, and others have carried out about this.
“Cochrane is actively involved in research and advocacy to promote independence, transparency, and integrity in healthcare research. While most research follows rigorous standards, studies with fake or fatally flawed findings are sometimes published. Cochrane and other systematic reviewers are in a unique position to be able to find and draw attention to these types of studies.”
What is Cochrane doing about this issue?
Cochrane has a policy in place that helps our reviewers spot problematic studies and decide what research to include and what to exclude in new reviews. When problems with medical research are so serious that the studies have to be withdrawn from publication, Cochrane also encourages our reviewers to go and back and mark where these studies have been included in reviews and, where necessary, update, amend or even withdrawn the review.
The World Health Organization has a target of reducing global population salt intake by 30% by 2025. This has made Cochrane’s new systematic review on the efficacy and safety of low sodium salt substitutes (LSSS) timely. The Cochrane systematic review and meta-analysis examines the evidence regarding the use of LSSS on cardiovascular health in adults and children and included blood pressure as a primary outcome.
Rachael McLean, from the Department of Preventive and Social Medicine, University of Otago, New Zealand, discusses the latest Cochrane evidence and how it can support policymakers in their efforts to reduce sodium intake and how applicable the evidence may be in different settings and populations.
Rachael McLean explains:
“In some countries, more than 50% of the salt intake comes from salt used in the home. Cochrane’s review of the evidence on low sodium salt substitutes is valuable for policy makers looking to make substantial impacts for cardiovascular health and in directing researchers where further studies are urgently needed.”
Thursday, August 18, 2022
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Women around the world should be able to access the best medical treatments that help to delay preterm births and improve neonatal outcomes, updated Cochrane network meta-analysis suggests.
Cochrane is a global, independent network of health practitioners, researchers, patient advocates and others, responding to the challenge of making vast amounts of research evidence useful for informing decisions about health. We do this by synthesizing research findings to produce the best available evidence on what can work, what might harm, and where more research is needed. Our work is recognised as the international gold standard for high quality, trusted information.
A new Cochrane Pregnancy and Childbirth paper published in the Cochrane Library looked at data from 122 clinical trials to create a league table of drugs that delay birth, called tocolytics, about their effectiveness and side effects. Researchers from the University of Birmingham and World Health Organization reviewed 122 randomised trials, published between 1966 and 2021, involving 13,697 women and conducted in 39 countries including high, middle and low-income states.
Women benefitted from all preterm delay treatments included in the meta-analysis of studies, although the research team noted that the effectiveness of different drugs was less clear in some of the studies considered. The team also looked at the side effects of different drugs and combinations, including the likelihood of having to stop treatment.
The team have bought together the evidence on the benefits as well as the harms of these treatments (compared to no treatment or placebo), to arm clinicians and policy makers around the world with the information to decide upon the best treatment for the women in their care in their specific setting.
Dr Amie Wilson, Research Fellow Global Maternal Health at the University of Birmingham said:
The findings show that the benefits of these drugs outweigh any risks associated with unwanted side effects. These treatments are leading to a significant reduction in the number of deadly preterm births, and we now need to further understand the effectiveness of tocolytics for specific groups depending on pregnancy length.
Our previous research has led to the improvement of guidelines for use of tocolysis drug use to delay preterm birth in the UK. Knowing that this paper helped to inform the forthcoming recommendations of the World Health Organization on the use of tocolytics, we hope that many more women around the globe will have access to these drugs, and have healthier births.
Dr Victoria Hodgetts Morton, NIHR Clinical Lecturer in Obstetrics at the University of Birmingham and co-author of the paper said:
Preterm birth is the most common reason why a newborn baby may die, and the leading cause of death in children under five years of age.
Tocolytics aim to delay preterm birth and allow time for the women to receive medicines that can help with baby's breathing and feeding if born preterm, and medicines that lower the chance of cerebral palsy of the infant. Crucially, a short delay in preterm birth can enable women to reach specialist care.
Full citation: Wilson A, Hodgetts-Morton VA, Marson EJ, Markland AD, Larkai E, Papadopoulou A, Coomarasamy A, Tobias A, Chou D, Oladapo OT, Price MJ, Morris K, Gallos ID. Tocolytics for delaying preterm birth: a network meta-analysis (0924). Cochrane Database of Systematic Reviews 2022, Issue 8. Art. No.: CD014978. DOI: 10.1002/14651858.CD014978.pub2
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Special Collection: Achieving sustainable healthcare through deprescribing of unnecessary medications
A new Cochrane Library Special Collection provides an overview of Cochrane Reviews that summarize the potential benefits and harms of deprescribing specific medications and help to inform how to implement deprescribing across different settings and populations.
This collection of reviews highlight that deprescribing is likely feasible and safe and can lead to benefits in prescribing and clinical outcomes. However, they also highlight significant gaps in the literature and methodological challenges to both conducting deprescribing studies and systematic reviews of deprescribing.
Catherine joins Cochrane from The Seafarers’ Charity where she held the position of CEO.
Governing Board Co-Chairs, Tracey Howe and Catherine Marshall said: "We are delighted to welcome Catherine to Cochrane. Catherine is a proven Chief Executive with an exceptional record leading non-profit organisations. She brings expertise in strategic planning, change management, and communications under pinned by a global perspective. Catherine is well positioned to partner with the Editor-in-Chief, Karla Soares-Weiser, to lead Cochrane as we drive an exciting programme of delivering trusted evidence, promoting informed decisions, and better health.”
Prior to her role at The Seafarers’ Charity, Catherine was acting Chief Operating Officer and Director of Communications and Change Management at international public health research organisation, icddrb, in Dhaka, Bangladesh. Between 2008-2015 Catherine held various senior management roles at the Army Families Federation, including three years as Chief Executive.
Catherine Spencer said, “Like all organisations post-Covid, we have challenges to deal with, but I see so much opportunity for Cochrane in the future. I look forward to what will inevitably be stimulating conversations with the Cochrane Community about what a thriving future Cochrane looks like and what we need to do to achieve that as we build a long-term strategy together.
I spent three and a half years working at icddr,b, in Dhaka, Bangladesh - a large public health research organisation, that at the time was facing enormous financial and structural challenge. Working as part of the Senior Leadership Team, and very closely with the Executive Director and Board, the organization was rejuvenated, meaning its essential public health research could continue. Thus, I come to Cochrane familiar with an organisation managing change and I look forward to working with you, collaboratively to steer Cochrane to success.”
Catherine will meet with the Cochrane Community in two introductory webinars to accommodate different time zones. Invites will be sent directly to Community Members via email.
Tuesday, July 12, 2022