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The use of Cochrane Reviews
in the development of a first aid guideline
for daily practice
Bert Avau, PhD
Centre for Evide...
Conflict of interest statement
✚ I have no actual or potential conflict of interest in relation to this
presentation.
✚ Al...
The development of a first aid guideline for
Flanders, Belgium
✚ Help! First Aid for Everyone
✚ Targeted at laypeople
• “I...
A first aid guideline according to the principles of
Evidence-Based Practice
27/10/2016 – Belgian Red Cross-Flanders - The...
The best available scientific evidence: Collected via
systematic literature searches
✚ One PICO question per intervention:...
The best available scientific evidence: Collected via
systematic literature searches
✚ One PICO question per intervention:...
319 evidence summaries in 17 first aid categories
27/10/2016 – Belgian Red Cross-Flanders - The use of Cochrane Reviews in...
Aim: How frequently are Cochrane SRs used when
developing first aid guidelines for laypeople?
27/10/2016 – Belgian Red Cro...
Evidence from SRs or primary research was
identified for 191/319 summaries made (60%)
27/10/2016 – Belgian Red Cross-Fland...
Cochrane SRs were available in 20% of the evidence
summaries for which evidence was identified
27/10/2016 – Belgian Red Cr...
The first aid topics best covered by Cochrane SRs are
“pregnancy and delivery”, “chest” and “infections”
27/10/2016 – Belg...
Pregnancy and delivery: Overview of evidence
identified from Cochrane SR
27/10/2016 – Belgian Red Cross-Flanders - The use...
The majority of Cochrane SRs identified were up to
date
27/10/2016 – Belgian Red Cross-Flanders - The use of Cochrane Revi...
Discussion and conclusions
27/10/2016 – Belgian Red Cross-Flanders - The use of Cochrane Reviews in the development of a f...
Questions?
27/10/2016 – Belgian Red Cross-Flanders - The use of Cochrane Reviews in the development of a first aid guideli...
Acknowledgements
27/10/2016 – Belgian Red Cross-Flanders - The use of Cochrane Reviews in the development of a first aid g...
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Cochrane reviews in first aid guidelines

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The use of Cochrane Reviews in the development of a first aid guideline for daily practice

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Cochrane reviews in first aid guidelines

  1. 1. The use of Cochrane Reviews in the development of a first aid guideline for daily practice Bert Avau, PhD Centre for Evidence-Based Practice (CEBaP) 27/10/2016 – Belgian Red Cross-Flanders - The use of Cochrane Reviews in the development of a first aid guideline for daily practice
  2. 2. Conflict of interest statement ✚ I have no actual or potential conflict of interest in relation to this presentation. ✚ All authors contributing to this work are employees of the Belgian Red Cross-Flanders 27/10/2016 – Belgian Red Cross-Flanders - The use of Cochrane Reviews in the development of a first aid guideline for daily practice
  3. 3. The development of a first aid guideline for Flanders, Belgium ✚ Help! First Aid for Everyone ✚ Targeted at laypeople • “Immediate help provided to a sick and injured person until professional help arrives. It is concerned not only with physical injury or illness but also with other initial care, including psychosocial support for people suffering emotional distress from experiencing or witnessing a traumatic event. First aid interventions seek to preserve life, alleviate suffering, prevent further illness or injury and promote recovery” (International Federation of Red Cross/Red Crescent societies) ✚ Updated every 5 years ✚ New release: September 2016 ✚ Evidence-Based 27/10/2016 – Belgian Red Cross-Flanders - The use of Cochrane Reviews in the development of a first aid guideline for daily practice
  4. 4. A first aid guideline according to the principles of Evidence-Based Practice 27/10/2016 – Belgian Red Cross-Flanders - The use of Cochrane Reviews in the development of a first aid guideline for daily practice The best available scientific evidence: SRs, guidelines, primary research Opinion of a panel of experts, the medical commision of the Belgian Red Cross- Flanders Preferences of the target audience, i.e. laypeople practicing first aid 319 Evidence Summaries
  5. 5. The best available scientific evidence: Collected via systematic literature searches ✚ One PICO question per intervention: • P: Patient • I: Intervention • C: Comparison • O: Outcome ✚ Example: Breathing in a paper bag when hyperventilating • P: People hyperventilating, healthy volunteers with induced symptoms • I: Breathing in a paper or plastic bag or other closed breathing circuit • C: Not breathing in a paper or plastic bag or other closed breathing circuit • O: Symptoms of hyperventilation 27/10/2016 – Belgian Red Cross-Flanders - The use of Cochrane Reviews in the development of a first aid guideline for daily practice
  6. 6. The best available scientific evidence: Collected via systematic literature searches ✚ One PICO question per intervention: • P: Patient • I: Intervention • C: Comparison • O: Outcome ✚ Development of a search strategy, based on PICO ✚ Systematic search in 3 literature databases: • The Cochrane Library • MEDLINE (via the PubMed interface) • Embase (via Embase.com) ✚ Summarizing the evidence in an ‘evidence summary’ ✚ Grading the evidence according to AGREE II 27/10/2016 – Belgian Red Cross-Flanders - The use of Cochrane Reviews in the development of a first aid guideline for daily practice
  7. 7. 319 evidence summaries in 17 first aid categories 27/10/2016 – Belgian Red Cross-Flanders - The use of Cochrane Reviews in the development of a first aid guideline for daily practice
  8. 8. Aim: How frequently are Cochrane SRs used when developing first aid guidelines for laypeople? 27/10/2016 – Belgian Red Cross-Flanders - The use of Cochrane Reviews in the development of a first aid guideline for daily practice ?
  9. 9. Evidence from SRs or primary research was identified for 191/319 summaries made (60%) 27/10/2016 – Belgian Red Cross-Flanders - The use of Cochrane Reviews in the development of a first aid guideline for daily practice 0 10 20 30 40 50 60 #Summaries First Aid topic # Evidence summaries per topic # Summaries for which evidence was identified
  10. 10. Cochrane SRs were available in 20% of the evidence summaries for which evidence was identified 27/10/2016 – Belgian Red Cross-Flanders - The use of Cochrane Reviews in the development of a first aid guideline for daily practice 319 191 71 41 0 50 100 150 200 250 300 350 # Evidence summaries # Summaries with evidence # Summaries based on a SR # Summaries with evidence from a Cochrane SR
  11. 11. The first aid topics best covered by Cochrane SRs are “pregnancy and delivery”, “chest” and “infections” 27/10/2016 – Belgian Red Cross-Flanders - The use of Cochrane Reviews in the development of a first aid guideline for daily practice 0% 5% 10% 15% 20% 25% 30% 35% Burns Electricity and lightning Heat and cold Poisoning Resuscitation Allergy Other Bleeding Travel medicine Head and neck Bites and stings Drowning Stomach and back Limbs Infections Chest Pregnancy and delivery % summaries with evidence, covered by Cochrane SRs
  12. 12. Pregnancy and delivery: Overview of evidence identified from Cochrane SR 27/10/2016 – Belgian Red Cross-Flanders - The use of Cochrane Reviews in the development of a first aid guideline for daily practice Intervention Cochrane SR used Optimal position during labour • Position in the second stage of labour for women without epidural anaesthesia. Gupta, 2012 • Maternal positions and mobility during first stage labour. Lawrence, 2013 Early skin-to-skin contact • Early skin-to-skin contact for mothers and their healthy newborn infants. Moore, 2012 Intake of food/drinks during labour • Restricting oral fluid and food intake during labour. Singata, 2013 Massage during labour • Massage, reflexology and other manual methods for pain management in labour. Smith, 2012 Relaxation techniques during labour • Relaxation techniques for pain management in labour. Smith, 2011 Using warm compresses during labour • Perineal techniques during the second stage of labour for reducing perineal trauma. Aasheim, 2011 Use of antiseptics for cord care • Umbilical cord antiseptics for preventing sepsis and death among newborns. Imdad, 2013 • Chlorhexidine skin or cord care for prevention of mortality and infections in neonates. Sinha, 2015 • Topical umbilical cord care at birth. Zupan, 2004 Timing of cutting the umbilical cord • Effect of timing of umbilical cord clamping of term infants on maternal and neonatal outcomes. McDonald, 2013
  13. 13. The majority of Cochrane SRs identified were up to date 27/10/2016 – Belgian Red Cross-Flanders - The use of Cochrane Reviews in the development of a first aid guideline for daily practice 41 Cochrane SRs identified 31 Cochrane SRs up to date or considered ‘stable’ 10 Cochrane SRs outdated (> 5y) 5 Cochrane SRs: No additional evidence identified 5 Cochrane SRs: Additional evidence identified
  14. 14. Discussion and conclusions 27/10/2016 – Belgian Red Cross-Flanders - The use of Cochrane Reviews in the development of a first aid guideline for daily practice ✚ Cochrane SRs: Relevant for the healthcare professional but to a lesser degree for the layman ✚ Implications for Cochrane authors: Important first aid topics, e.g. poisoning, not covered by Cochrane SRs, gaps waiting to be filled in ✚ The identified Cochrane SRs were largely up to date, but a closer collaboration between Cochrane groups and guideline developers for prioritizing updates might be warranted ✚ Statements about the ‘stability’ of Cochrane SRs are relevant for guideline developers ✚ Peer-reviewed publication: Borra V, Van Remoortel H, Vande Veegaete A, De Buck E, Vandekerckhove P (2016). Development of Evidence-Based First Aid Guidelines for Laypeople in Flanders, Belgium. J Epidemiol Public Health Rev 1(4)
  15. 15. Questions? 27/10/2016 – Belgian Red Cross-Flanders - The use of Cochrane Reviews in the development of a first aid guideline for daily practice
  16. 16. Acknowledgements 27/10/2016 – Belgian Red Cross-Flanders - The use of Cochrane Reviews in the development of a first aid guideline for daily practice ✚ Prof. Dr. Philippe Vandekerckhove ✚ Prof. Dr. Emmy De Buck ✚ Axel Vande Veegaete ✚ Hans Van Remoortel ✚ Vere Borra ✚ Véronique Huygelen

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