Would you like to receive the NCCMT Weekly Round-Up by e-mail? Subscribe today!

National Collaborating Centre for Methods and Tools

November 2015 · Issue 151

In this issue:

Introducing a New Online Learning Module

Evidence-informed Decision Making for Managers

Who is this module for?

Evidence-informed Decision Making for Managers is a free, interactive and self-paced module designed especially for public health managers and directors. While you may not be involved in every step of the evidence-informed decision-making process, you need to know that you can rely on the recommendations made by your staff. 

What will you learn?

This module is designed to help you guide and assess the final evidence-informed process used by public health staff in developing recommendations for program or practice. 

With this module, you will learn to:
  • use a checklist to determine whether your staff is using NCCMT’s seven steps of evidence-informed public health
  • confidently guide and assess your staff’s decision making processes
  • ensure that the programs and interventions recommended by your staff are informed by the best available evidence.
Evidence-Informed Decision Making for Managers uses a realistic public health scenario to support learning. Practise your skills by completing the checklist for the scenario. See how your responses compare to our resolution. 
Log in to the Learning Centre to begin the Evidence-informed Decision Making for Managers module now! http://www.nccmt.ca/learningcentre/index.php

⇧ Back to Top

Did you miss one of our webinars?

Recordings of some of our recent webinars are now available online

We know that our webinars don’t always fit into your schedule. That’s why we are now recording these events. We will be posting the presentations slides in English and in French. Recordings of the full presentations will be available posted on our YouTube channel.

You can catch up on webinars you missed, revisit ones you found particularly interesting, and share the links to these events with your colleagues.

Recently added:

Two-part webinar on the Policy Readiness Tool 

Part 1 – Overview of the Policy Readiness Tool
Part 2 – Using the Policy Readiness Tool

Webinar featuring NCCMT’s Anatomy of a Systematic Review Fact Sheet

Watch for more webinar recordings to be posted in the future: https://www.youtube.com/playlist?list=PL50nkPezdX7mBtoN87KovgYix_2h3lOxr

⇧ Back to Top

New from Public Health+

Corticosteroids for the common cold.

BACKGROUND: The common cold is a frequent illness, which, although benign and self limiting, results in many consultations to primary care and considerable loss of school or work days. Current symptomatic treatments have limited benefit. Corticosteroids are an effective treatment in other upper respiratory tract infections and their anti-inflammatory effects may also be beneficial in the common cold. This updated review has included one additional study. OBJECTIVES: To compare corticosteroids versus usual care for the common cold on measures of symptom resolution and improvement in children and adults. SEARCH METHODS: We searched Cochrane Central Register of Controlled Trials (CENTRAL 2015, Issue 4), which includes the Acute Respiratory Infections (ARI) Group`s Specialised Register, the Database of Reviews of Effects (DARE) (2015, Issue 2), NHS Health Economics Database (2015, Issue 2), MEDLINE (1948 to May week 3, 2015) and EMBASE (January 2010 to May 2015). SELECTION CRITERIA: Randomised, double-blind, controlled trials comparing corticosteroids to placebo or to standard clinical management. DATA COLLECTION AND ANALYSIS: Two review authors independently extracted data and assessed trial quality. We were unable to perform meta-analysis and instead present a narrative description of the available evidence. MAIN RESULTS: We included three trials (353 participants). Two trials compared intranasal corticosteroids to placebo and one trial compared intranasal corticosteroids to usual care; no trials studied oral corticosteroids. In the two placebo-controlled trials, no benefit of intranasal corticosteroids was demonstrated for duration or severity of symptoms. The risk of bias overall was low or unclear in these two trials. In a trial of 54 participants, the mean number of symptomatic days was 10.3 in the placebo group, compared to 10.7 in those using intranasal corticosteroids (P value = 0.72). A second trial of 199 participants reported no significant differences in the duration of symptoms. The single-blind trial in children aged two to 14 years, who were also receiving oral antibiotics, had inadequate reporting of outcome measures regarding symptom resolution. The overall risk of bias was high for this trial. Mean symptom severity scores were significantly lower in the group receiving intranasal steroids in addition to oral amoxicillin. One placebo-controlled trial reported the presence of rhinovirus in nasal aspirates and found no differences. Only one of the three trials reported on adverse events; no differences were found. Two trials reported secondary bacterial infections (one case of sinusitis, one case of acute otitis media; both in the corticosteroid groups). A lack of comparable outcome measures meant that we were unable to combine the data. AUTHORS` CONCLUSIONS: Current evidence does not support the use of intranasal corticosteroids for symptomatic relief from the common cold. However, there were only three trials, one of which was very poor quality, and there was limited statistical power overall. Further large, randomised, double-blind, placebo-controlled trials in adults and children are required to answer this question.

The full text may be available from PubMed

Intermittent oral iron supplementation during pregnancy.

BACKGROUND: Anaemia is a frequent condition during pregnancy, particularly among women in low- and middle-income countries. Traditionally, gestational anaemia has been prevented with daily iron supplements throughout pregnancy, but adherence to this regimen due to side effects, interrupted supply of the supplements, and concerns about safety among women with an adequate iron intake, have limited the use of this intervention. Intermittent (i.e. two or three times a week on non-consecutive days) supplementation has been proposed as an alternative to daily supplementation. OBJECTIVES: To assess the benefits and harms of intermittent supplementation with iron alone or in combination with folic acid or other vitamins and minerals to pregnant women on neonatal and pregnancy outcomes. SEARCH METHODS: We searched the Cochrane Pregnancy and Childbirth Group`s Trials Register (31 July 2015), the WHO International Clinical Trials Registry Platform (ICTRP) (31 July 2015) and contacted relevant organisations for the identification of ongoing and unpublished studies (31 July 2015). SELECTION CRITERIA: Randomised or quasi-randomised trials. DATA COLLECTION AND ANALYSIS: We assessed the methodological quality of trials using standard Cochrane criteria. Two review authors independently assessed trial eligibility, extracted data and conducted checks for accuracy. MAIN RESULTS: This review includes 27 trials from 15 countries, but only 21 trials (with 5490 women) contributed data to the review. All studies compared daily versus intermittent iron supplementation. The methodological quality of included studies was mixed and most had high levels of attrition.The overall assessment of the quality of the evidence for primary infant outcomes was low and for maternal outcomes very low.Of the 21 trials contributing data, three studies provided intermittent iron alone, 14 intermittent iron + folic acid and four intermittent iron plus multiple vitamins and minerals in comparison with the same composition of supplements provided in a daily regimen.Overall, for women receiving any intermittent iron regimen (with or without other vitamins and minerals) compared with a daily regimen there was no clear evidence of differences between groups for any infant primary outcomes: low birthweight (average risk ratio (RR) 0.82; 95% confidence interval (CI) 0.55 to 1.22; participants = 1898; studies = eight; low quality evidence), infant birthweight (mean difference (MD) 5.13 g; 95% CI -29.46 to 39.72; participants = 1939; studies = nine; low quality evidence), premature birth (average RR 1.03; 95% CI 0.76 to 1.39; participants = 1177; studies = five; low quality evidence), or neonatal death (average RR 0.49; 95% CI 0.04 to 5.42; participants = 795; studies = one; very low quality). None of the studies reported congenital anomalies.For maternal outcomes, there was no clear evidence of differences between groups for anaemia at term (average RR 1.22; 95% CI 0.84 to 1.80; participants = 676; studies = four; I(2) = 10%; very low quality). Women receiving intermittent supplementation had fewer side effects (average RR 0.56; 95% CI 0.37 to 0.84; participants = 1777; studies = 11; I(2) = 87%; very low quality) and were at lower risk of having high haemoglobin (Hb) concentrations (greater than 130 g/L) during the second or third trimester of pregnancy (average RR 0.53; 95% CI 0.38 to 0.74; participants = 2616; studies = 15; I(2) = 52%; (this was not a primary outcome)) compared with women receiving daily supplements. There were no significant differences in iron-deficiency anaemia at term between women receiving intermittent or daily iron + folic acid supplementation (average RR 0.71; 95% CI 0.08 to 6.63; participants = 156; studies = one). There were no maternal deaths (six studies) or women with severe anaemia in pregnancy (six studies). None of the studies reported on iron deficiency at term or infections during pregnancy.Most of the studies included in the review (14/21 contributing data) compared intermittent oral iron + folic acid supplementation compared with daily oral iron + folic acid supplementation (4653 women) and findings for this comparison broadly reflect findings for the main comparison (any intermittent versus any daily regimen).Three studies with 464 women examined supplementation with intermittent oral iron alone compared with daily oral iron alone. There were no clear differences between groups for mean birthweight, preterm birth, maternal anaemia or maternal side effects. Other primary outcomes were not reported.Four studies with a combined sample size of 412 women compared intermittent oral iron + vitamins and minerals supplementation with daily oral iron + vitamins and minerals supplementation. Results were not reported for any of the review`s infant primary outcomes. One study reported fewer maternal side effects in the intermittent iron group, and two studies that more women were anaemic at term compared with those rec

The full text may be available from PubMed

Dried Blood Spots: A Tool to Ensure Broad Access to Hepatitis C Screening, Diagnosis, and Treatment Monitoring.

BACKGROUND: With the advent of highly efficient antiviral therapies for hepatitis C virus (HCV) infection, providing broad access to diagnosis and care is needed. The dried blood spot (DBS) technique can be used to collect, store, and ship whole-blood specimens. Our goal was to assess the performance of standardized HCV diagnostic and monitoring tools in the analysis of DBS. METHODS: Serum specimens and whole-blood specimens collected using the DBS technique from >500 patients were tested for virological markers used to diagnose and monitor HCV infection. RESULTS: Enzyme immunoassay detection of anti-HCV antibodies in specimens from DBS was reliable after establishment of a new signal-to-cutoff ratio. HCV RNA was detected DBS from the vast majority of patients with active replication, but HCV RNA levels were substantially lower than in serum specimens, implying that only the presence or absence of HCV RNA or changes in the HCV RNA level should be taken into consideration for therapy. Detection of HCV core antigen in specimens from DBS was not a sensitive marker of chronic HCV infection. HCV genotype determination was possible in the vast majority of DBS. CONCLUSIONS: This study shows that whole-blood specimens collected using the DBS technique can be confidently used to diagnose and monitor HCV infection. DBS could help improve access to care for HCV infection because they are suitable for use in large-scale screening programs, diagnosis, and therapeutic monitoring.

The full text may be available from PubMed

Independent Evaluation of Middle School-Based Drug Prevention Curricula: A Systematic Review.

Importance: Lack of robust program evaluation has hindered the effectiveness of school-based drug abuse prevention curricula overall. Independently evaluated randomized controlled trials (RCTs) of universal, middle school-based drug abuse prevention curricula are the most useful indicators of whether such programs are effective or ineffective. Objective: To conduct a systematic review identifying independently evaluated RCTs of universal, middle school-based drug abuse prevention curricula; extract data on study quality and substance use outcomes; and assess evidence of program effectiveness. Evidence Review: PsycInfo, Educational Resources Information Center, Science Citation Index, Social Science Citation Index, Cumulative Index to Nursing and Allied Health Literature, MEDLINE, EMBASE, and the Cochrane Database of Systematic Reviews were searched between January 1, 1984, and March 15, 2015. Search terms included variations of drug, alcohol, tobacco, and marijuanause, as well as school, prevention, and effectiveness. Studies included in the review were RCTs carried out by independent evaluators of universal school-based drug prevention curricula available for dissemination in the United States that reported alcohol, tobacco, marijuana, or other drug use outcomes. Two researchers extracted data on study quality and outcomes independently using a data extraction form and met to resolve disagreements. Findings: A total of 5071 publications were reviewed, with 13 articles meeting final inclusion criteria. Of the 13 articles, 6 RCTs of 4 distinct school-based curricula were identified for inclusion. Outcomes were reported for 42 single-drug measures in the independent RCTs, with just 3 presenting statistically significant (P < .05) differences between the intervention group and the control group. One program revealed statistically significant positive effects at final follow-up (Lions-Quest Skills for Adolescence). Conclusions and Relevance: The results of our review demonstrate the dearth of independent research that appropriately evaluates the effectiveness of universal, middle school-based drug prevention curricula. Independent evaluations show little evidence of effectiveness for widely used programs. New methods may be necessary to approach school-based adolescent drug prevention.

The full text may be available from PubMed

⇧ Back to Top

Register now for our next Spotlight on Methods and Tools webinars

These events will be presented in English. Audio recordings will be available following the event. The presentation slides will be posted online in English and French following the event.
Webinar featuring The Consolidated Framework for Implementation Research (CFIR)

November 12, 2015
1:00 pm – 2:30 pm (EST)

The Consolidated Framework for Implementation Research can help you identify barriers and facilitators to implementation, monitor progress toward implementation goals and evaluate the outcome or impact of an intervention.

Join us to learn more about the CFIR tool: http://ow.ly/T7WHR

To see the summary statement of this tool developed by NCCMT, click here: http://www.nccmt.ca/registry/view/eng/210.html
Webinar featuring NCCMT’s Applicability and Transferability of Evidence Tool (A&T Tool)

December 9, 2015
1:00 pm – 2:30 pm (EST)

This tool helps you decide whether an intervention that worked in one setting will get similar results if implemented in another. Presenters from the Sudbury & District Health Unit describe how they use this tool in practice.

Click here to register: http://ow.ly/T7WUe

To see the summary statement of this tool developed by NCCMT, click here: http://www.nccmt.ca/registry/view/eng/24.html

⇧ Back to Top

Upcoming webinar from HealthEvidence.org

A monthly series from health Evidence TM featuring review authors presenting their findings
Food supplementation programmes for improving the health of socio-economically disadvantaged children: What's the evidence?

November 23, 2015
1:00 pm – 2:30 pm (EST)

Join Dr. Elizabeth Kristjansson, Professor, School of Psychology, University of Ottawa, for an overview of findings from her latest Cochrane review examining the effectiveness of food supplementation programmes for improving the physical and psychosocial health of socio-economically disadvantaged children:

Kristjansson E., Francis D.K., Liberato S., Benkhalti J.M., Welch V., Batal M., et al. (2015). Food supplementation for improving the physical and psychosocial health of socio-economically disadvantaged children aged three months to five years. Cochrane Database of Systematic Reviews,2015(2), Art. No.: CD009924

Click here to register: http://ow.ly/Sif54

⇧ Back to Top

Past issues of the Round-up are available online: Weekly Digest Archive
NCCMT is funded by the Public Health Agency of Canada and affiliated with McMaster University.
Production of this newsletter has been made possible through a financial contribution from the Public Health Agency of Canada.
The views expressed herein do not necessarily represent the views of the Public Health Agency of Canada.
Contact us at nccmt@mcmaster.ca or www.nccmt.ca.