newsletter - Cochrane Incontinence

HEALTH SCIENCES BUILDING I FORESTERHILL, ABERDEEN, UK
NEWSLETTER
EDITION 15 I JANUARY 2013
Cochrane Incontinence Review Group
The Cochrane Incontinence Review Group undertakes systematic reviews concentrating on interventions where incontinence
or other aspects of pelvic floor dysfunction are the primary problem. The conditions covered include: urinary and faecal
incontinence; enuresis; day-time wetting in children; encopresis; postprostactectomy incontinence; use of urinary catheters
including catheter-related urinary tract infections (but not other infections); enterocutaneous and enterovesical fistulae;
neurogenic incontinence and retention; postoperative urinary retention; and rectal or vaginal prolapse. We predominantly
use evidence from randomised or quasi-randomised controlled trials for evaluating a range of health care interventions and
investigations for these conditions.
The Cochrane Incontinence Review Group is one of over 50 Collaborative Review Groups (CRGs) of the Cochrane Collaboration
which generate systematic reviews for publication in The Cochrane Library. The Group is made up of researchers, health care
professionals, health care consumers and others from around the world with a shared interest in incontinence and related
problems.
The Group is led by the Co-ordinating Editor with the support of the editorial team. The Group is responsible for
identifying and assembling a Specialised Register with as high a proportion as possible of all the studies relevant
to our declared scope. The Group, drawing on the studies in the Register, takes responsibility for preparing and maintaining reviews.
Did you know?
• The Impact Factor of the Cochrane Database of Systematic Reviews for the year 2011 was 5.912.
• The Cochrane Collaboration is an international network of more than 28,000 dedicated people from over 100 countries.
In this newsletter
Staff Changes at the Editorial Base.......................................3
The Cochrane Library............................................................3
Imran Omar Managing Editor
E-mail: [email protected]
Training and online modules................................................3
Suzanne Macdonald Editorial Assistant
E-mail: [email protected]
RevMan 5.2...........................................................................3
Sheila Wallace Trials Search Co-ordinator
E-mail: [email protected]
Events attended by the Cochrane Incontinence
Review Group........................................................................4
Cathryn Glazener Co-ordinating Editor
E-mail: [email protected]
Events Cochrane Incontinence Review Group
members will be attending in 2013....................................5
Tel: +44 (0)1224 438126 / 438128
Fax: +44 (0)1224 438165
http://www.cochrane.org
http://www.incontinence.cochrane.org
Collaboration with EAU........................................................5
Editors:
Visit by the UK Cochrane Centre Director.............................4
List of new or updated reviews published in 2012.............5
Profile of one of our Editors..................................................6
My experience with the Cochrane Incontinence
Review Group........................................................................6
Abstract of one of our reviews.............................................7
2
Editorial Base Contact Details
How Can You Contribute?.....................................................8
Brian Buckley Galway, Ireland
Jonathan Cook Aberdeen, UK
Nicola Dean York, UK
Mandy Fader Southampton, UK
Jean Hay-Smith Dunedin, New Zealand
Peter Herbison Dunedin, New Zealand
Mela Lapitan Manila, Philippines
Christine Norton Middlesex, UK
Rob Pickard Newcastle upon Tyne, UK
Don Wilson Dunedin, New Zealand
Staff Changes at the Editorial Base
June Cody
After 13 years in the role of Managing Editor, June has now
found another role within the Cochrane Incontinence Review
Group as a Research Fellow with primary responsibility for
conducting and updating some of our reviews. We would
like to acknowledge the major contribution June has made
in her role as Managing Editor and greatly appreciate all the
hard work, commitment and valuable experience she has
contributed both to the development of the Group and the
Cochrane Collaboration.
Suzanne Macdonald
Our new Editorial Assistant Suzanne joined us in January
2012. Suzanne has worked at the University of Aberdeen
since 1998. Please feel free to contact Suzanne who will be
happy to assist you with any queries, help or advice you may
require from the Editorial Base
Euan Fisher
In October 2012 we welcomed Euan to the Group in a parttime administrative support role. Euan is currently a medical
student at the University of Aberdeen.
The Cochrane Library
Imran Omar
Imran was appointed as our new Managing Editor in
October 2011. Imran is medically qualified and has a
Masters in Health Services and Public Health Research
from the University of Aberdeen and a Masters in Medical
Education from the University of Dundee. He has more than
ten years of teaching and research experience in Pakistan,
UK, USA and the Caribbean.
Bronwyn Davidson
Our Editorial Assistant Bronwyn left the Group in January
2012. Bronwyn was expecting her second baby and as
a family were relocating to live in South Africa. We are
delighted to announce Bronwyn had a baby boy, Tristan,
and together with her husband and eldest son Anakin, are
happily enjoying their new life in South Africa. We would
like to thank Bronwyn for the major contribution she made
to the Group during her time with us as Editorial Assistant.
James N’Dow
James has stepped down as Joint Co-ordinating Editor of
the Group. We thank James for his major contribution to
the Group. James took over as the Joint Co-ordinating Editor
with Cathryn Glazener in 2008 and before that he was an
Editor in the Group for almost four years. James has made
a major contribution in raising the profile of the Cochrane
Incontinence Review Group.
The systematic reviews are published in The Cochrane
Library, an electronic publication, updated monthly (online)
and quarterly (on DVD-Rom), on an annual subscription
basis. Access and/or subscribe to The Cochrane Library at:
http://www.thecochranelibrary.com/view/0/index.html.
Some countries have free national provision for low-income
countries, e.g. through HINARI and BIREME – to find out
more go to: ‘Access’ on The Cochrane Library website.
Training and online modules
The Cochrane Collaboration has developed a number of
training modules for both new and experienced review
authors. These modules are freely available for registered
Archie users at http://training.cochrane.org/.
The following modules are currently available:
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•
•
•
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Systematic reviews - an introduction
Writing a Cochrane Protocol
Searching for studies for a Cochrane intervention review
Collecting data for a review
Meta-analysis - an introduction
Heterogeneity - an introduction
RevMan 5.2
3
Farewell dinner for James N’Dow
RevMan 5 is constantly being improved and updated
by its creators. You can take advantage of these
improvements and bug fixes by updating the latest
version. To download the latest updates of RevMan 5.2 http://ims.cochrane.org/revman/download/updates
Events attended by the Cochrane
Incontinence Review Group
International Continence Society, 2011
The 41st Annual Meeting of the International Continence
Society took place in Glasgow, Scotland, from 29th August to
2nd September 2011. It was attended by Cathryn Glazener,
James N’Dow, June Cody, Imran Omar, Sheila Wallace and
a number of editors. The Group conducted a successful
workshop on “Producing reliable summaries of incontinence
research: a ‘hands-on’ workshop on how to conduct a
Cochrane systematic review” and had an exhibition stand at
which to meet review authors and recruit new ones.
http://www2.kenes.com/ics2011/Pages/Home.aspx
UK & Ireland Cochrane Collaboration Meeting, 2012
17th Annual Meeting of UK and Ireland-based Contributors
to The Cochrane Collaboration took place in Loughborough
on 20th to 21st March 2012 and was attended by Imran
Omar, June Cody and Sheila Wallace.
http://asp.artegis.com/lp/2012Registration/7114-1560000?1=1
Cochrane Colloquium, 2012
Imran Omar, Sheila Wallace, Jean Hay-Smith and Peter
Herbison attended the 20th Cochrane Colloquium held in
Auckland, New Zealand from 30th September to 3rd October
2012. They were joined by Madeleine Jacobs, an Aberdeen
medical student who helped to update one of our reviews
during a summer placement.
http://2012.colloquium.cochrane.org/
European Association of Urology, 2012
The 27th annual European Association of Urology Congress
was held in Paris on 24th to 28th February 2012 and was
attended by James N’Dow, Cathryn Glazener, Imran Omar
and June Cody. The Group had an exhibition stand at
the Congress.
http://www.eauparis2012.org/
L-R Imran Omar, Cathryn Glazener, June Cody
4
L-R Imran Omar, Sheila Wallace, Madeleine Jacobs, Peter Herbison, Jean Hay-Smith
Visit by the UK Cochrane Centre Director
In July 2012, the Cochrane Incontinence Review Group were
pleased to receive a visit in Aberdeen from Martin Burton the
Director of the UK Cochrane Centre. Martin shared his vision
for the UK Cochrane Centre with the Group.
L-R James N’Dow, Cathryn Glazener, Martin Burton, June Cody, Imran Omar, Suzanne Macdonald
Events Cochrane Incontinence Review
Group members will be attending in 2013
List of new or updated reviews published
in 2012
We currently have 71 reviews and 13 protocols. Please
contact us for a complete list of our published reviews and
protocols. These reviews and protocols are also accessible
online at http://incontinence.cochrane.org/our-reviews
European Association of Urology, 2013
Imran Omar and June Cody will be attending the 28th
Annual European Association of Urology Congress to be
held in Milan on 15th to 19th March 2013. The Group has
planned to set up an exhibition stand during the Congress
and look forward to seeing you there.
http://www.eaumilan2013.org/
UK & Ireland Cochrane Collaboration Symposium, 2013
The Cochrane Incontinence Review Group editorial base
staff are all attending the Cochrane UK and Ireland 21st
Anniversary Symposium to be held in Oxford on 20th to 21st
March 2013. The Cochrane Collaboration is celebrating the
21st birthday of the UK Cochrane Centre and the symposium
is looking forward to the challenges ahead and how
Cochrane can address them.
http://oxford2013.cochrane.org/
• Anticholinergic drugs versus non-drug active therapies
for non-neurogenic overactive bladder syndrome in
adults.
• Biofeedback and/or sphincter exercises for the
treatment of faecal incontinence in adults
• Conservative management for post-prostatectomy
urinary incontinence
• Drugs for nocturnal enuresis in children (other than
desmopressin and tricyclics).
• Oestrogen therapy for urinary incontinence in postmenopausal women
• Open retropubic colposuspension for urinary
incontinence in women
• Pelvic floor muscle training for prevention and
treatment of urinary and faecal incontinence in
antenatal and postnatal women
• Plugs for containing faecal incontinence Types of
indwelling urinary catheters for long-term bladder
drainage in adults
Cochrane Colloquium, 2013
The 21st Cochrane Colloquium will be held in Québec City,
Canada from 19th to 23rd September 2013 and the focus
of this Colloquium will be: Better Knowledge for Better
Health - on how evidence informs health care decisions at
every level from patient to practitioner, to institutional or
government policy-maker. Imran Omar and Sheila Wallace
from the Editorial Base will be attending.
http://colloquium.cochrane.org/colloquium-2013
Collaboration with EAU
The Cochrane Incontinence Review Group is working in
conjunction with the European Association of Urology
(EAU) guideline panel. This partnership facilitates both the
updating of relevant reviews and their direct incorporation
of some of the most influential international guidelines
on urinary incontinence. June Cody has taken the lead on
updating and conducting reviews prioritised by the Panel.
5
• Prophylactic antibiotics to reduce the risk of urinary
tract infections after urodynamic studies
• Simple urethral dilatation, endoscopic urethrotomy,
and urethroplasty for urethral stricture disease in adult
men
• Urethral injection therapy for urinary incontinence in
women
• Urinary catheter policies for long-term bladder
drainage
• Urinary diversion and bladder reconstruction/
replacement using intestinal segments for intractable
incontinence or following cystectomy
• Urodynamic studies for management of urinary
incontinence in children and adults
• Which anticholinergic drug for overactive bladder
symptoms in adults
Profile of one of our Editors
Imran Omar
Cameron Edwin Alexander
My journey to become a health care professional has been a
long and challenging one. My desire to become a medical
doctor began at an early age when my grandmother was
hospitalized after developing lung cancer. I was amazed by
the tremendous impact that medical science and health care
professionals can have on the lives of people, and this event
had a great influence on my life.
My experience with the Cochrane Incontinence Review
Group first began in 2010, as a 2nd year medical student,
when I was awarded an Aberdeen Summer Research
Studentship. Since that time, I have maintained close ties
with the Group, and have benefited massively from the close
mentorship and support that I have received from dedicated
research staff members working within the Group.
During my undergraduate medical education, I had a very
keen interest in the clinical aspects of my training and
started to become aware of the importance of evidencebased medicine. After graduation, I initially planned to
work in America and became certified there. Later on I
passed the Professional and Linguistic Assessments Board
exams and registered with the General Medical Council, UK.
Subsequently, I have completed a Masters degree in Health
Services and Public Health Research at the University of
Aberdeen and, more recently, a Masters in Medical Education
from the University of Dundee.
The teaching provided to students on systematic review
methodology and evidence-based medicine is of the
highest quality, and it inspired me to pursue further
research experience as part of an intercalated degree, which
I have undertaken this year. Working with the Cochrane
Incontinence Review Group has equipped me with research
skills that will be invaluable as I progress through the rest
of my time in undergraduate medical education, but also as
I move on to practice clinical medicine as a doctor. It has
been a privilege to work as a co-author recently on a review
of the drugs for faecal incontinence; this condition causes
a great deal of distress for patients and it is rewarding to
know that the high quality research produced by Cochrane
Collaboration can have a positive effect on the care for such
patients. Moreover, my time with Cochrane has allowed me
to develop as an individual and has strengthened my desire
to maintain close links with the academic world as I progress
through my career in medicine.
I have been involved in a wide range of research projects
that have adopted quantitative, qualitative or mixed
methodology. However, I have particularly enjoyed the
re-analysis of secondary data and conducting systematic
reviews. I am a firm believer that patient management
should be evidence based and strongly believe in the ethos
of the Cochrane Collaboration that “healthcare decisionmaking throughout the world should be informed by highquality, timely research evidence.”
6
My experience with the Cochrane
Incontinence Review Group
On a personal note, I am married with a five-year old
daughter. In our free time we love to explore the scenic
beauty of Scotland and spend time with our daughter. I
consider myself extremely fortunate that I have a lovely
family and have been able to work in a field of research that
I am extremely passionate about.
http://www.cochrane.org
Abstract of one of our reviews
Which anticholinergic drug for overactive bladder
symptoms in adults. Priya Madhuvrata, June D Cody,
Gaye Ellis, G Peter Herbison, E. Jean C Hay-Smith
Background
Around 16% to 45% of adults have overactive bladder
symptoms, urgency with frequency or urgency urinary
incontinence, or both, termed ‘overactive bladder syndrome’.
Anticholinergic drugs are common treatments.
Objectives
To compare the effects of different anticholinergic drugs for
overactive bladder symptoms.
Search methods
We searched the Cochrane Incontinence Group Specialised
Trials Register (searched 8 March 2011) and reference lists
of relevant articles.
Selection criteria
Randomised trials in adults with overactive bladder
symptoms or detrusor overactivity that compared
one anticholinergic drug with another, or two doses of the
same drug.
Data collection and analysis
Two authors independently assessed eligibility, trial quality
and extracted data. Data were processed as described in the
Cochrane Handbook for Systematic Reviews of Interventions.
Main results
Eighty-six trials, 70 parallel and 16 cross-over design,
were included (involving 31,249 adults). Most trials
were described as double-blind but were variable in other
aspects of quality. Cross-over studies did not present data in
a way that could be included in the meta-analyses. Twentynine collected quality of life data (the primary outcome
measure) using validated measures, but only 15 reported
useable data.
Tolterodine versus oxybutynin: there were no statistically
significant differences for quality of life, patient reported cure
or improvement, leakage episodes or voids in 24 hours, but
fewer withdrawals due to adverse events with tolterodine
(risk ratio (RR) 0.52, 95% confidence interval (CI) 0.40 to
0.66, data from eight trials) and less risk of dry mouth (RR
0.65, 95% CI 0.60 to 0.71, data from 10 trials).
7
Solifenacin versus tolterodine: there were statistically
significant differences for quality of life (standardised mean
difference (SMD) -0.12, 95% CI -0.23 to -0.01, data from
three trials), patient reported cure or improvement (RR
1.25, 95% CI 1.13 to 1.39, data from two trials), leakage
episodes in 24 hours (weighted mean difference (WMD)
-0.30, 95% CI -0.53 to -0.08, data from four studies) and
urgency episodes in 24 hours (WMD -0.43, 95% CI -0.74 to
-0.13, data from four trials), all favouring solifenacin. There
was no difference in withdrawals due to adverse events and
dry mouth but after sensitivity analysis dry mouth rates (RR
0.69, 95% CI 0.51 to 0.94) were statistically significantly
lower with solifenacin when compared to immediate
release (IR) tolterodine.
Fesoterodine versus extended release tolterodine: three trials
contributed to the meta analyses. There were statistically
significant differences for quality of life (SMD -0.20, 95% CI
-0.27 to -0.14), patient reported cure or improvement (RR
1.11, 95% CI 1.06 to 1.16), leakage episodes (WMD -0.19,
95% CI -0.30 to -0.09), frequency (WMD -0.27, 95% CI
-0.47 to -0.06) and urgency episodes (WMD -0.44, 95%
CI -0.72 to -0.16) in 24 hours, all favouring fesoterodine.
Those taking fesoterodine had a higher risk of withdrawal
due to adverse events (RR 1.45, 95% CI 1.07 to 1.98) and
higher risk of dry mouth (RR 1.80, 95% CI 1.58 to 2.05) at
12 weeks.
Different doses of tolterodine: the standard recommended
starting dose (2 mg twice daily) was compared with two
lower doses (0.5 mg and 1 mg twice daily) and one higher
dose (4 mg twice daily).
The effects of 1 mg, 2 mg and 4 mg doses were
similar for leakage episodes and micturitions in 24
hours, with a greater risk of dry mouth with the 2 and
4 mg doses at two to 12 weeks.
Different doses of solifenacin: the standard recommended
starting dose of 5 mg once daily was compared to 10 mg.
While frequency and urgency were less (better) with 10 mg
compared to 5 mg, there was a higher risk of dry mouth with
10 mg solifenacin at four to 12 weeks.
Different doses of fesoterodine: the recommended starting
dose of 4 mg once daily was compared to 8 mg and 12
mg. The clinical efficacy (patient reported cure, leakage
episodes, micturition per 24 hours) of 8 mg was better than
4 mg fesoterodine but with a higher risk of dry mouth with
the 8 mg dose.
There was no statistically significant difference between
4 mg and 12 mg in efficacy but the dry mouth was
significantly higher with 12 mg at eight to 12 weeks.
Extended versus immediate release preparations of
oxybutynin or tolterodine, or both: there were no statistically
significant differences for cure or improvement, leakage
episodes or micturitions in 24 hours or withdrawals due to
adverse events, but there were few data. Overall, extended
release preparations had less risk of dry mouth at two to
12 weeks.
One extended release preparation versus another: there
was less risk of dry mouth with oral extended release
tolterodine than oxybutynin (RR 0.75, 95% CI 0.59 to 0.95)
but no difference between transdermal oxybutynin and
oral extended release tolterodine, although some people
withdrew due to a skin reaction at the transdermal patch
site at 12 weeks.
Authors’ conclusions
Where the prescribing choice is between oral immediate
release oxybutynin or tolterodine, tolterodine might be
preferred for reduced risk of dry mouth. With tolterodine, 2
mg twice daily is the usual starting dose but a 1 mg twice
daily dose might be equally effective, with less risk of dry
mouth. If extended release preparations of oxybutynin
or tolterodine are available, these might be preferred to
immediate release preparations because there is less risk of
dry mouth.
Between solifenacin and immediate release tolterodine,
solifenacin might be preferred for better efficacy and less
risk of dry mouth. Solifenacin 5 mg once daily is the usual
starting dose, which could be increased to 10 mg once daily
for better efficacy but with increased risk of dry mouth.
Between fesoterodine and extended release tolterodine,
fesoterodine might be preferred for superior efficacy but has
a higher risk of withdrawal due to adverse events and higher
risk of dry mouth. There is little or no evidence available
about quality of life, costs, or long-term outcomes in these
studies. There were insufficient data from trials of other
anticholinergic drugs to draw any conclusions.
8
Imran Omar Managing Editor
E-mail: [email protected]
Tel: +44 (0)1224 438126 / 438128
Fax: +44 (0)1224 438165
http://www.cochrane.org
http://www.incontinence.cochrane.org
How Can You Contribute?
You can contribute to the Incontinence Group in many
ways by:
• Searching a journal for randomised controlled studies
– particularly those not listed in MEDLINE and/or
published in languages other than English.
• Searching abstracts books and conference proceedings
for randomised controlled studies.
• Notifying us of ongoing or unpublished randomised
controlled studies.
• Preparing or assisting with the preparation of a
systematic review.
• Peer refereeing a protocol (outline of a proposed
systematic review) and/or a completed review.
• Providing feedback on completed reviews.
• Offering technical or other support.
The Cochrane Incontinence reviews predominantly use
evidence from randomised or quasi-randomised controlled
trials for evaluating a range of relevant health care
interventions. Our scope includes:
Chemical: drug; homeopathy; diet; hormone
Physical: vaginal cones, pelvic floor muscle training; electrical
stimulation; acupuncture; chiropractic; biofeedback
Surgery: perineal/vaginal/rectal; injections; abdominal;
laparoscopic; urinary/faecal diversion; postsurgical
management
Psychological/behavioural training: psychotherapy; bladder
drill/training; toilet training; alarms; motivation; reward
schemes
Lifestyle: changes in fluid intake; change in type of fluid (eg
caffeine reduction); weight loss; postural changes; smoking
cessation; treatment of constipation; treatment of chronic
respiratory conditions; changes to physical work
Mechanical devices: vaginal pessaries; anal tampons;
urethral plugs; pad and bed sheets; catheters; bags; artificial
sphincters; sheaths
Rehabilitation: alternative types of nursing care; skin care;
nursing home care
Investigations: pad tests; diaries; x-rays; urodynamics;
assessment teams; ultrasound; ambulatory monitoring
Education: of clinical staff (e.g. CME, guidelines); of other lay
carers; of patients