3. Opening of the Austrian Cochrane Branch - Ruth Gilbert

•

2 likes•2,130 views

Professor Ruth Gilbert of University College London presents "Could a systematic review have prevented the epidemic of sudden infant death syndrome?" at the opening of the Austrian Cochrane Branch in Krems, Austria, on December 14th 2010.

"Could a systematic review have
prevented the epidemic of sudden
infant death syndrome?"

Ruth Gilbert
Centre for Evidence-based Child Health
UCL Institute of Child Health, London,
UK

Advice on infant sleeping position
“Avoid prone (front)
sleeping, particularly
at night.” (review of
139 deaths)
–Abramson 1944

1944 1950 1960 1970 1980 1990 2000 2005

Rubber sheet
experiment.
- “suffocation
unlikely”
Woolley 1945

Advice on infant sleeping position

1944 1950 1960 1970 1980 1990 2000 2005

SIDS
Infection/inhalation?
Front sleeping
Scoliosis, rounded heads
Apnoeas, oxygenation
Sleeps better

UK
How did practice change?
Netherlands
Norw ay
Prevalence of prone sleeping
New Zealand
75 Australia
Hong Kong
USA
65

55
USA NTL

45
% prone

35

25

15

5

1955 1960 1965 1970 1975 1980 1985 1990 1995 2000
-5
midpoint date

How did SIDS
incidence
change?

Arch Dis Child
1995;72:478-82.

Clinical studies timeline
Comparative clinical studies
Case control/cohort

1944 1950 1960 1970 1980 1990 2000 2005

???
?

Can we infer causality?
• RCTs feasible in 1970 but not after
• Evidence only from systematic review of
observational studies
• But….
– Strong association
– Not explained by confounders
– Dose effect (side, front vs back)
– SIDS reduced when front sleeping declined

Change in SIDS incidence as front sleeping declined
Postneonatal SIDS: England & Wales

2.5
deaths/1000 live births

2

1.5

1

0.5 Avon
campaign National
campaign
0
74

76

78

80

82

84

86

88

90

92

94

96

98
19

19

19

19

19

19

19

19

19

19

19

19

19
year

Source: Office of National Statistics

SIDS incidence: Europe 1987-1997
Change in 5
Austria E&W NTL Norway Scotland Switz

SIDS 4

rate/1000
3
incidence 2

1

0
1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997

SIDS incidence 1987-1997
Excess death toll Australia NZ USA

due to prone 5

sleeping in 20y 4
rate/1000

3
USA>40,000
2

UK >10,000 1

0
1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997

Lessons

1) Clinical practice requires clinical evidence

2) Delays in systematically reviewing evidence can
cost lives

3) Systematic reviews – can help to explain
conflicting results

"Could a systematic review have
prevented the epidemic of sudden
infant death syndrome?"

Possibly!

Why did it take so long to change advice?

De Jonge (NTL)

1944 1950 1960 1970 1980 1990 2000 2005

SIDS foundation (UK)
Government advice

USA

Acknowledgements
• Georgia Salanti, Sarah See, Melissa Harden
(co-authors), Chris Hiley, Iain Chalmers

Gilbert, Salanti, Harden, See. Int J Epid 2005
r.gilbert@ich.ucl.ac.uk

Similar to 3. Opening of the Austrian Cochrane Branch - Ruth Gilbert

globalisation-pptpavitarsidhu

Riskilaste konverents 2012: Arne Holte: The burden of mental disorderSotsiaalministeerium

Davos bationo full pcGlobal Risk Forum GRFDavos

André Bationo - Agricultural risks linked to soil, water and climate in Sub-S...Global Risk Forum GRFDavos

Cancer projectKhalid Almohdar

Practical considerations in the control of a Rift Valley fever epizootic

marketsblog

Similar to 3. Opening of the Austrian Cochrane Branch - Ruth Gilbert (6)

globalisation-ppt

Riskilaste konverents 2012: Arne Holte: The burden of mental disorder

Davos bationo full pc

André Bationo - Agricultural risks linked to soil, water and climate in Sub-S...

Cancer project

Practical considerations in the control of a Rift Valley fever epizootic

Recently uploaded

Effective-Soaps-for-Fungal-Skin-Infections.pptx

SwisschemDerma

basicmodesofventilation2022-220313203758.pdf

aljamhori teaching hospital

Non-respiratory Functions of the Lungs.pdf

MedicoseAcademics

These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract. Learning objectives: 1. Enlist the non-respiratory functions of the respiratory tract 2. Briefly explain how these functions are carried out 3. Discuss the significance of dead space 4. Differentiate between minute ventilation and alveolar ventilation 5. Describe the cough and sneeze reflexes Study Resources: 1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition 2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition 3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition 4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874

New Drug Discovery and Development .....

NEHA GUPTA

The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.

How to Give Better Lectures: Some Tips for Doctors

LanceCatedral

KDIGO 2024 guidelines for diabetologists

د.محمود نجيب

Novas diretrizes da OMS para os cuidados perinatais de mais qualidade

Prof. Marcus Renato de Carvalho

Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva. Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade. Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal. Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural. Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis. É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais. O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada. Recomendamos muito. Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos. Esta publicação só está disponível em inglês até o momento. Prof. Marcus Renato de Carvalho www.agostodourado.com

Sex determination from mandible pelvis and skull

ShashankRoodkee

Maxilla, Mandible & Hyoid Bone & Clinical Correlations by Dr. RIG.pptx

Dr. Rabia Inam Gandapore

NVBDCP.pptx Nation vector borne disease control program

Sapna Thakur

Physiology of Special Chemical Sensation of Taste

MedicoseAcademics

Title: Sense of Taste Presenter: Dr. Faiza, Assistant Professor of Physiology Qualifications: MBBS (Best Graduate, AIMC Lahore) FCPS Physiology ICMT, CHPE, DHPE (STMU) MPH (GC University, Faisalabad) MBA (Virtual University of Pakistan) Learning Objectives: Describe the structure and function of taste buds. Describe the relationship between the taste threshold and taste index of common substances. Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation. Recognize different abnormalities of taste perception and their causes. Key Topics: Significance of Taste Sensation: Differentiation between pleasant and harmful food Influence on behavior Selection of food based on metabolic needs Receptors of Taste: Taste buds on the tongue Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper) Primary and Secondary Taste Sensations: Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami Chemical basis and signal transduction mechanisms for each taste Taste Threshold and Index: Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine) Taste index relationship: Inversely proportional to taste threshold Taste Blindness: Inability to taste certain substances, particularly thiourea compounds Example: Phenylthiocarbamide Structure and Function of Taste Buds: Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers Location of Taste Buds: Found in papillae of the tongue (Fungiform, Circumvallate, Foliate) Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus Mechanism of Taste Stimulation: Interaction of taste substances with receptors on microvilli Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes Taste Sensitivity and Adaptation: Decrease in sensitivity with age Rapid adaptation of taste sensation Role of Saliva in Taste: Dissolution of tastants to reach receptors Washing away the stimulus Taste Preferences and Aversions: Mechanisms behind taste preference and aversion Influence of receptors and neural pathways Impact of Sensory Nerve Damage: Degeneration of taste buds if the sensory nerve fiber is cut Abnormalities of Taste Detection: Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia) Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels Neurotransmitters and Taste Threshold: Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity Supertasters: 25% of the population with heightened sensitivity to taste, especially bitterness Increased number of fungiform papillae

Light House Retreats: Plant Medicine Retreat Europe

Lighthouse Retreat

heat stroke and heat exhaustion in children

SumeraAhmad5

Knee anatomy and clinical tests 2024.pdf

vimalpl1234

Pharma Pcd Franchise in Jharkhand - Yodley Lifesciences

Yodley Lifesciences

TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...

kevinkariuki227

Ocular injury ppt Upendra pal optometrist upums saifai etawah

pal078100

Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...

Oleg Kshivets

RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0). CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.

Are There Any Natural Remedies To Treat Syphilis.pdf

Little Cross Family Clinic

Triangles of Neck and Clinical Correlation by Dr. RIG.pptx

Dr. Rabia Inam Gandapore

Recently uploaded (20)

Effective-Soaps-for-Fungal-Skin-Infections.pptx

basicmodesofventilation2022-220313203758.pdf

Non-respiratory Functions of the Lungs.pdf

New Drug Discovery and Development .....

How to Give Better Lectures: Some Tips for Doctors

KDIGO 2024 guidelines for diabetologists

Novas diretrizes da OMS para os cuidados perinatais de mais qualidade

Sex determination from mandible pelvis and skull

Maxilla, Mandible & Hyoid Bone & Clinical Correlations by Dr. RIG.pptx

NVBDCP.pptx Nation vector borne disease control program

Physiology of Special Chemical Sensation of Taste

Light House Retreats: Plant Medicine Retreat Europe

heat stroke and heat exhaustion in children

Knee anatomy and clinical tests 2024.pdf

Pharma Pcd Franchise in Jharkhand - Yodley Lifesciences

TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...

Ocular injury ppt Upendra pal optometrist upums saifai etawah

Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...

Are There Any Natural Remedies To Treat Syphilis.pdf

Triangles of Neck and Clinical Correlation by Dr. RIG.pptx

3. Opening of the Austrian Cochrane Branch - Ruth Gilbert

1. "Could a systematic review have prevented the epidemic of sudden infant death syndrome?" Ruth Gilbert Centre for Evidence-based Child Health UCL Institute of Child Health, London, UK

2. 1947 – book on parent craft

3. Advice on infant sleeping position “Avoid prone (front) sleeping, particularly at night.” (review of 139 deaths) –Abramson 1944 1944 1950 1960 1970 1980 1990 2000 2005 Rubber sheet experiment. - “suffocation unlikely” Woolley 1945

4. Advice on infant sleeping position 1944 1950 1960 1970 1980 1990 2000 2005 SIDS Infection/inhalation? Front sleeping Scoliosis, rounded heads Apnoeas, oxygenation Sleeps better

5. UK How did practice change? Netherlands Norw ay Prevalence of prone sleeping New Zealand 75 Australia Hong Kong USA 65 55 USA NTL 45 % prone 35 25 15 5 1955 1960 1965 1970 1975 1980 1985 1990 1995 2000 -5 midpoint date

6. How did SIDS incidence change? Arch Dis Child 1995;72:478-82.

7. Clinical studies timeline Comparative clinical studies Case control/cohort 1944 1950 1960 1970 1980 1990 2000 2005 ??? ?

8. Front vs back

9. Front vs other positions

10. Can we infer causality? • RCTs feasible in 1970 but not after • Evidence only from systematic review of observational studies • But…. – Strong association – Not explained by confounders – Dose effect (side, front vs back) – SIDS reduced when front sleeping declined

11. Change in SIDS incidence as front sleeping declined Postneonatal SIDS: England & Wales 2.5 deaths/1000 live births 2 1.5 1 0.5 Avon campaign National campaign 0 74 76 78 80 82 84 86 88 90 92 94 96 98 19 19 19 19 19 19 19 19 19 19 19 19 19 year Source: Office of National Statistics

12. SIDS incidence: Europe 1987-1997 Change in 5 Austria E&W NTL Norway Scotland Switz SIDS 4 rate/1000 3 incidence 2 1 0 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 SIDS incidence 1987-1997 Excess death toll Australia NZ USA due to prone 5 sleeping in 20y 4 rate/1000 3 USA>40,000 2 UK >10,000 1 0 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997

13. Lessons 1) Clinical practice requires clinical evidence 2) Delays in systematically reviewing evidence can cost lives 3) Systematic reviews – can help to explain conflicting results

14. "Could a systematic review have prevented the epidemic of sudden infant death syndrome?" Possibly!

15. Why did it take so long to change advice? De Jonge (NTL) 1944 1950 1960 1970 1980 1990 2000 2005 SIDS foundation (UK) Government advice USA

16. Acknowledgements • Georgia Salanti, Sarah See, Melissa Harden (co-authors), Chris Hiley, Iain Chalmers Gilbert, Salanti, Harden, See. Int J Epid 2005 r.gilbert@ich.ucl.ac.uk

3. Opening of the Austrian Cochrane Branch - Ruth Gilbert

Recommended

Recommended

More Related Content

Similar to 3. Opening of the Austrian Cochrane Branch - Ruth Gilbert

Similar to 3. Opening of the Austrian Cochrane Branch - Ruth Gilbert (6)

More from Cochrane.Collaboration

More from Cochrane.Collaboration (20)

Recently uploaded

Recently uploaded (20)

3. Opening of the Austrian Cochrane Branch - Ruth Gilbert