Cochrane Collaboration

About: Cochrane Collaboration is a nonprofit organization based out in Oxford, United Kingdom. It is known for research contribution in the topics: Systematic review & Randomized controlled trial. The organization has 1995 authors who have published 3928 publications receiving 382695 citations.

Systematic review of the treatment of functional dysphonia and prevention of voice disorders

Abstract: Objective To evaluate the effectiveness of interventions for treating functional dysphonia or preventing voice disorders in adults. Data Sources We searched MEDLINE (1950 to 2006), EMBASE (1974 to 2006), CENTRAL (Issue 2 2006), CINAHL (1983 to 2006), PsychINFO (1967 to 2006), Science Citation Index (1986 to 2006), and the Occupational Health databases OSH-ROM (February 2006). Review Methods Systematic review and meta-analysis of randomized controlled trials. Included studies evaluated the effectiveness of interventions for 1) treating functional/nonorganic dysphonia or 2) preventing voice disorders. We identified six randomized controlled trials about treatment and two about prevention. Two authors independently extracted data and assessed trial quality. Results A combination of direct and indirect voice therapy, compared with no intervention, improves self-reported (standardized mean difference −1.07; 95% CI −1.94 to −0.19), observer-rated (weighted mean difference [WMD] −13.00; 95% CI −17.92 to −8.08), and instrumentally assessed vocal functioning (WMD −1.20; 95% CI −2.37 to −0.03) in adults with functional dysphonia. Effects are reported to remain for at least 14 weeks. Effects are similar in patients and in teachers and student teachers screened for voice problems. We found two studies that did not show voice training, compared with no intervention, to have a preventive effective in improving self-reported vocal functioning. Assessment of publication bias showed that the real effect sizes are probably smaller. Conclusion Comprehensive voice therapy is effective in improving vocal performance in adults with functional dysphonia. There is no evidence of effectiveness of voice training in preventing voice disorders.

Experience, knowledge and attitudes of mental health staff regarding clients with a borderline personality disorder.

Abstract: A survey of mental health staff experience, knowledge and attitudes regarding the management of clients with a diagnosis of borderline personality disorder (BPD) aimed to obtain baseline data to provide direction for developing planned education and determining staff willingness to participate in such training. A 23-item questionnaire was developed and posted to mental health staff in a public Area Mental Health Service in New South Wales (n = 516). A total of 229 staff completed the questionnaire. Most staff (85%) reported having contact with clients who have a diagnosis of BPD at least once a month or more frequently, with 32% of respondents reporting daily contact. Eighty per cent of respondents found dealing with clients who have a BPD to be moderate to very difficult; 84% of staff felt that dealing with this client group was more difficult than dealing with other client groups. Most staff (82%) believed that, as mental health professionals, they had a role in the assessment, management and referral of clients with BPD, as well as in educating and providing information. Staff readily identified resources which would be helpful to them when working with such clients. It was encouraging to see that the majority of staff (95%) indicated their willingness to gain further education and training in the management of these clients. Although many staff believed they were knowledgeable about and confident in managing these clients, most staff also indicated difficulties posed by these clients and perceived a need for further education and training in this area.

Polyunsaturated fatty acid supplementation for schizophrenia

Abstract: Background Limited evidence supports a hypothesis suggesting that the symptoms of schizophrenia may be the result of altered neuronal membrane structure and metabolism. The structure and metabolism is dependent on blood plasma levels of certain essential fatty acids and their metabolites. Objectives To assess the effects of polyunsaturated fatty acids for people with schizophrenia. Search methods We have updated the initial searches of 1998, 2002 and 2005 with a search of the Cochrane Schizophrenia Group's Register, November 2008, which is based on regular searches of CINAHL, EMBASE, MEDLINE and PsycINFO. Where necessary, we contacted authors and relevant pharmaceutical companies for additional information. Selection criteria We included all randomised controlled trials of polyunsaturated fatty acid treatment for schizophrenia. Data collection and analysis Working independently, we selected studies for quality assessment and extracted relevant data. We analysed on an intention-to-treat basis. Where possible and appropriate we calculated the Relative Risk (RR) and their 95% confidence intervals (CI) and estimated the number needed to treat (NNT). For continuous data we calculated weighted mean differences (WMD) and their 95% confidence intervals. We also inspected the data for heterogeneity. Main results Eight studies are now included in this review. When any dose omega-3 (E-EPA or EPA) is compared with placebo, small short trials suggest that the need for neuroleptics appears to be reduced for people allocated omega-3 supplementation (n=30, 1 RCT, RR 0.73 CI 0.54 to 1.00) and mental state may improve (n=30, 1 RCT, RR not gaining 25% change in PANSS scores 0.54 CI 0.30 to 0.96, NNT 3 CI 2 to 29). There are no differences in the number of people leaving the study early (n=595, 6 RCTs, RR 0.86 CI 0.50 to 1.48). There are few data on the comparison of any dose omega-6 (GLA) with placebo. For movement disorder outcomes, the one small study we found does not show any difference for average short-term endpoint AIMS score (n=16, 1 RCT, WMD 1.30 CI -1.96 to 4.56). When any dose omega-3 (E-EPA or EPA) is compared with any dose omega-3 (DHA) there is no significant difference for mental state outcome of not gaining 25% change in PANSS scores (n=31, 1 RCT, RR 0.66 CI 0.39 to 1.11). When different doses of omega-3 (E-EPA) are compared with placebo there are no differences in measures of global and mental state between the studies. For the outcome of 'experiencing at least one adverse effect' no differences between groups are found for any dose (1 g/day E-EPA vs placebo n=63, 1 RCT, RR 0.97 CI 0.60 to 1.56; 2 g/day E-EPA vs placebo n=63, 1 RCT, RR 0.67 CI 0.37 to 1.20; 4 g/day E-EPA vs placebo n=58, 1 RCT, RR 1.15 CI 0.72 to 1.82). Authors' conclusions Three updates of this review have resulted in more included studies and more people randomised but still relatively little useful additional data. The results remain inconclusive. The new trials all compare the omega-3 polyunsaturated fatty acids, in particular eicosapentaenoic acid and its ester, ethyl-eicosapentaenoic acid. The use of omega-3 polyunsaturated fatty acids for schizophrenia still remains experimental and this review highlights the need for large, well designed, conducted and reported studies.