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Podcast: A review of activities to help healthcare professionals share decisions about care with their patients

Thu, 11/29/2018 - 20:42

It is widely recognised that more emphasis needs to be given to the role of the patient in making decisions about their health care. But what are the best ways to make this happen? Some of the answers are in the July 2018 update of a Cochrane Review on shared decision making and we asked the lead author, France Légaré from Université Laval in Québec Canada, to tell us why this is important and what they found.

"I have been practising family medicine since 1990, and training family physicians for many years. I have seen the many difficult decisions that patients face every day about everything from screening to treatment options, and have always suspected that family physicians could do things differently so they could better support their patients in making decisions. Often, the physician makes the decision for the patient, or the patients make it on their own. But this could be different. Physicians could change how they explain the scientific evidence to the patient. They could help patients discover what’s most important to them personally about the pros and cons of the available options. We call this process shared decision making, and I believe not only that physicians can learn to do it better, but that it’s the ethical thing to do. We did this review to find out about the best ways to encourage healthcare professionals to do this, and have several things to suggest.

This is the second update of our review of studies of interventions which include, among other things, training programs, audit and feedback, public campaigns, and patients decision aids. Our first review was published in 2010, when there were just 5 eligible studies. By 2014, 34 more studies were available for our first update, and we’ve now reached 87 studies. The number of studies more than doubled in just five years, probably because of the increased awareness of the importance of shared decision making in medical communities and governments.

It’s also encouraging to see that more than half the studies reported on the patient’s awareness of whether shared decision making occurred, showing that more and more researchers are interested in finding out what matters most to patients from the patients’ perspective. However, only one study took place in a low-income country, suggesting that shared decision making is still seen as something for the privileged one.
Studies had tested a great many different approaches, and many were found to be effective in increasing shared decision making, especially the use of decision aids. However, when applying Cochrane’s very strict rules about evidence quality we found that few studies met the high standards. For example, many didn’t give enough information to properly judge the quality of the evidence they produced. But, we can say that compared to no activity at all, it is clear that some interventions which aim to implement shared decision making in clinical practices slightly improve patients’ quality of life in terms of mental health, but make little difference to their quality of life in terms of physical health.

Having done this update and thinking about its meaning for me as a family physician, I will encourage my patients to use decision aids. And, as an educator, I will encourage health professionals to get training in how to use them. While, as a researcher, I will strongly encourage other researchers to design their studies so that the quality of evidence is better and to agree on a set of measures of shared decision making that would make it easier to compare studies."

Tuesday, December 4, 2018

Routine dental care: does the evidence give us something to smile about?

Thu, 11/29/2018 - 19:52

In this Evidently Cochrane blog, Sarah Chapman looks at the Cochrane evidence for aspects of routine dental care. Something to smile about? Or are there big gaps…?

“Are you afraid to laugh?” Goodall’s Dental Institute, 1912. Wellcome Collection.

My grandmother used to tell the tale of when she was a schoolgirl, back in about 1920, and a school event to which parents were invited. Nan and her friend enjoyed a carefree afternoon without their mothers there, having avoided inviting them – the friend because her mother had white hair, and Nan because her mother had just had all her teeth taken out. There was trouble, she recalled, when they were rumbled by a write-up of the event.

Teenagers haven’t changed much in the hundred years since then, but thankfully the state of the nation’s teeth has. My great-grandmother would not have been unusual in having all her teeth removed, to be replaced by an easier-to-care-for set of dentures, and some women even received this as a 21st birthday present! This changed, thanks, in part, to free dental treatment through the NHS from its beginning in 1948, the fluoridation of toothpaste from 1959, improvements in diet and a new emphasis on good dental hygiene.

Today, we are commonly told we should have a dental check-up every six months, and a visit to the dental surgery often includes getting advice from a hygienist on how to care for our teeth and gums, and perhaps a ‘scale and polish’. This routine dental care is all so familiar we may not question it, but we should! What’s the evidence?  Does it give us, and our dental health professionals, something to smile about?

How often should you have a dental check-up?

As a child, I loved my regular visits to the dentist. As an infant, I delighted in the toy farm in the waiting room with, joy of joys, a ‘real’ well with a bucket you could wind up; while my teenage dental trips were always followed by a visit to the ice cream parlour (oh dear…)! But is there any evidence behind the common recommendation that we should go every six months? No there isn’t! The Cochrane Review addressing this found just one study with 185 people; insufficient evidence to support or refute that six-monthly recall. This is something that has been debated since the 1970s and we still lack evidence to guide practice!

Oral hygiene advice

A newly published Cochrane Review aimed to address uncertainties about the impact of one-to-one oral hygiene advice (OHA), given by a dental care professional in a dental setting, on our oral health, attitudes and behaviour, by bringing together the best available evidence. Although the review includes 19 studies (randomised trials) with over 4000 people, there was so much variation that the team weren’t able to pool the data, and concluded that “there was insufficient high‐quality evidence to recommend any specific one‐to‐one OHA method as being effective in improving oral health or being more effective than any other method.”

That’s disappointing. So what about that ‘scale and polish’? Is the evidence any better?

Routine scale and polish

US dental clinic, circa 1920. Wellcome Collection.

Both hygienists and dentists provide scaling and polishing for their patients at regular intervals, even when those patients are at low risk of gum disease. There is uncertainty about whether this is useful and how often it should be done. Along with a sit-down and a chance to reflect on your guilt about not having flossed when you were told to, the ‘routine scale and polish’ offers you the  removal of deposits of bacteria called plaque, and hardened plaque known as tartar or calculus, which is too hard for removal by toothbrushing by even the most diligent brushers (I’m looking at my husband, bafflingly motivated by the promise of a digital smiley face after two minutes, on a gadget linked to his toothbrush. He is 55…).

A Cochrane Review team looked for the evidence from randomised trials on routine scale and polish in healthy adults without severe gum disease and found surprisingly little – just three studies with 836 people. The authors note that “given the considerable resources involved in providing this treatment for adults in many countries it is disappointing that there is so little good quality, reliable research evidence available to inform clinical practice.”

This potentially relieves you of guilt if you’re not getting a scale and polish regularly, but it would be very good to have some decent evidence to guide practice, and there is work being done to try to do just this. A randomised trial, mentioned as ongoing in the Cochrane Review, has now been published and you can read about it here. We look forward to seeing this trial incorporated into the next update of the Cochrane Review. They found “no additional benefit from scheduling 6-monthly or 12-monthly PIs [scale and polish] or over not providing this treatment unless desired or recommended, and no difference between OHA delivery for gingival inflammation/bleeding and patient-centred outcomes. However, participants valued, and were willing to pay for, both interventions, with greater financial value placed on PI than on OHA.” This reminds us that patient preference and clinical judgement also play a role and along with evidence these are regarded as the three pillars of evidence-based decision-making.

Flossing?

I have yet to meet a dental hygienist who didn’t advocate flossing, but I really can’t be bothered to do it, and I don’t want to find a reason to add yet another source of plastic to my environmental footprint. Need I feel guilty? There’s a Cochrane Review on flossing too, which includes 12 studies with 582 people, comparing flossing and toothbrushing with toothbrushing alone. All the studies looked at the effects on gum disease and plaque. Once again, there was so much variation between the studies that the data couldn’t be pooled. Whilst there is some evidence that flossing added to toothbrushing may reduce gum disease and plaque compared to just toothbrushing, it is unreliable. For adults, feel free to choose whether or not to floss your teeth, but it’s probably wise to steer clear of this year’s dance trend, or you risk being ridiculed for your flossing, like Jeremy Corbyn at the Pride of Britain Awards.

Check your bathroom shelf

Napoleon Bonaparte’s fancy toothbrush (Wellcome Collection). Would he have been better off with a powered one?

Finally, while good evidence on these elements of routine dental care is lacking, there is evidence to guide us on what we have at home, in those basics of toothbrushes and toothpaste. Something to smile about! A Cochrane Review found moderate-certainty evidence that powered toothbrushes probably reduce plaque compared with manual toothbrushes, in the short- and long-term. (If trialists want to explore the impact of a digital smiley face toothbrushing intervention, I will volunteer my husband.)

Another Cochrane Review has evidence you might want to consider when choosing your toothpaste. It finds that fluoride toothpaste containing triclosan and copolymer leads to a small reduction in tooth decay and is probably more effective at reducing plaque and gingivitis than fluoride toothpaste without those ingredients. As for chlorhexidine mouthwash, you can read all about the Cochrane evidence in this blog by dentist Bosun Hong.

Thursday, December 6, 2018

Featured Review: Piperonyl butoxide (PBO) combined with pyrethroids in insecticide‐treated nets to prevent malaria in Africa

Thu, 11/29/2018 - 19:05

Review confirms that using pyrethroid-PBO treated nets to prevent malaria is more effective at killing mosquitoes in areas where there is a high level of resistance to pyrethroids.

The distribution of nets treated with pyrethroid insecticides has been very effective in reducing malaria transmission during the past two decades in Africa. However, there has been a rise in the number of mosquitoes developing resistance to pyrethroids, which is the only class of insecticides currently used to treat nets.

In a new Cochrane review, an independent team of review authors led by Katherine Gleave and Natalie Lissenden at the Liverpool School of Tropical Medicine (LSTM) assessed the efficacy of insecticide-treated nets (ITNs) with added piperonyl butoxide (PBO). This chemical works by blocking an enzyme in the mosquito that prevents pyrethroids from working, to overcome the problem of insecticide resistance.

LSTM’s Professor Hilary Ranson is senior author on the review. She said: “We have to find a way to maintain the efficacy of ITNs, which have been a cornerstone of vector control. While these nets are more expensive, the evidence shows that in areas where pyrethroid resistance is high, adding PBO to nets killed more mosquitoes, stopping them from feeding on people and probably reducing the levels of disease.”

The review author team looked at results from 15 included studies that compared pyrethroid-PBO nets to standard pyrethroid nets, with one study measuring the impact on malaria infection in humans and the others looking at the impact on the mosquito population. The results show that while there is little or no difference in areas where resistance to pyrethroid is low or moderate, the nets had an impact where resistance was high. One trial carried out in an area at high levels of resistance also showed an important reduction in the number of people developing malaria illness. As ITNs are washed throughout their use, the review team also looked at the impact of washing these pyrethroid-PBO nets. While there was still a decrease in mosquito blood feeding success, the effect on mosquito mortality was not so marked when nets were washed multiple times, which would be important when considering community-level protection.

Professor Ranson continued: “Researchers are working hard to reduce the impact of insecticide resistance, but our review is the first to look at ‘next generation nets’. While there is more research to be undertaken, we think that the results help show the value that these nets represent and supports the WHO’s recommendations for pyrethroid-PBO nets.” Jan Kolaczinski, Coordinator of Entomology and Vector Control at WHO’s Global Malaria Programme, supports this statement noting that “systematic reviews, such as the one on pyrethroid-PBO nets, provide a crucial underpinning of evidence-based WHO recommendations and guidelines. We greatly appreciate the important contribution to WHO’s work made by the Cochrane Infectious Diseases Group in this area.”

This Cochrane Review was co-ordinated by the Cochrane Infectious Diseases Group (CIDG), which has its editorial base at LSTM. The CIDG has been in operation since 1994 and consists of over 600 authors from 52 countries and is supported by UK aid from the UK Government for the benefit of low- and middle-income countries (project number 300342-104).

Gleave K, Lissenden N, Richardson M, Choi L, Ranson H. Piperonyl butoxide (PBO) combined with pyrethroids in insecticide-treated nets to prevent malaria in Africa. Cochrane Database of Systematic Reviews 2018, Issue 11 DOI: 10.1002/14651858.CD012776.pub2

This news article was first published on the LSTM website.

Tuesday, December 4, 2018

Cochrane seeks Knowledge Translation Learning Module Content Developer - Flexible location

Thu, 11/29/2018 - 18:06

Specifications: Secondment/Fixed term contract/consultancy contract for a minimum of 12 weeks starting February 2019 up to three working days a week
Salary: Competitive
Location: Flexible
Application Closing Date: 17th December 2018

Cochrane’s work is recognized as the international gold-standard for high quality, trusted information. We want to be the leading advocate for evidence-informed health care across the world.

Knowledge Translation (KT) is defined in Cochrane as the process of supporting the use of health evidence from our high quality, trusted Cochrane systematic reviews by those who need it to make health decisions. Knowledge Translation is essential in achieving Cochrane’s vision and maximizes the benefit of the work of our global contributors and members. The Cochrane Knowledge Translation Framework (KT Framework) provides more details on Strategy to 2020’s commitment to the dissemination, use and impact of Cochrane evidence.  For many working in Cochrane, the focus on KT is a different way of thinking and uses concepts and terminology that may be unfamiliar.

This exciting role provides you with the opportunity to take the lead on the development and implementation of an introductory ‘What is Knowledge Translation in Cochrane?’ online learning module for people working across Cochrane’s Groups and global community.

The successful candidate will be responsible for developing the content of the module, supporting the creation and testing of the e-learning module and for launching the module in the Cochrane community. You will be working with Cochrane’s central KT Department, members of Cochrane’s KT Working Groups with expertise in KT, Cochrane Membership and Learning Services Department, and external contractors, to ensure a smooth delivery of the project.

We are looking for a self-motivated and highly organised individual who is able to work effectively and collaboratively with a diverse range of contacts across the world.  The successful candidate will also have

  • Experience of developing and delivering educational training materials.
  • Experience of delivering Knowledge Translation projects.
  • Good understanding of the Cochrane Knowledge Translation Framework and terminology.
  • Understanding of the structure and function of Cochrane groups (Review Groups, Networks, Fields and Geographically Orientated Groups).
  •  Ability to work alongside varied teams in different cultural and linguistic settings.
  • Good IT skills, including PowerPoint and Excel.
  • Proven experience of quickly building productive working relationships, both internally and externally, in a geographically dispersed environment.
  • Strong written and verbal communication skills.
  • Willingness to work flexibly including outside normal working hours for occasional out-of-hours telephone conferences.
  • Commitment to Cochrane’s mission and values.

Cochrane is a global, independent network of health practitioners, researchers, patient advocates and others, responding to the challenge of making vast amounts of research evidence useful for informing decisions about health. We do this by synthesizing research findings to produce the best available evidence on what can work, what might harm and where more research is needed. Our work is recognised as the international gold standard for high quality, trusted information.

If you would like to apply for this position, please send a CV along with a supporting statement to recruitment@cochrane.org with Knowledge Translation Learning Module Content Developer in the subject line.  The supporting statement should indicate why you are applying for the post, and how far you meet the requirements for the post outlined in the job description using specific examples.  List your experience, achievements, knowledge, personal qualities, and skills which you feel are relevant to the post.

For further information, please review the full job description.

Deadline for applications: 17 December 2018 (12 midnight GMT)

Interviews to be held on: (TBC)

Thursday, November 29, 2018 Category: Jobs

Governing Board elections November 2018: Interviews with the candidates

Wed, 11/28/2018 - 17:03

Dear Cochrane Members,

If you haven’t voted yet in the current Governing Board elections, you’re still able to do so until 10 December 2018 at 12:00 GMT.

With 18 candidates standing for election this year, there’s a lot of information available for you to review before casting your votes. To support your choices, we’ve interviewed the candidates about their motivation to stand for election and their views on Cochrane’s key opportunities and challenges.

Visit elections.cochrane.org to read these interviews, view the full Candidate Statements, and cast your votes.

All members as defined by the Membership Terms & Conditions are entitled to vote in this election. To check your membership status, please see https://join.cochrane.org/your-membership. If you know of fellow members who aren’t receiving these emails but want to, you can ask them to check their communications preferences in their Cochrane Account. The Community Support Team will also be happy to assist you by email at support@cochrane.org.

Questions about any aspects of the elections process can be raised with Lucie Binder, Senior Advisor to the CEO (Governance & Management) and Electoral Officer for this election.

Wednesday, November 28, 2018

Podcast: Talking therapy for the management of mental health in low- and middle-income countries affected by mass human tragedy

Tue, 11/27/2018 - 20:40

Evidence Aid, an organisation dedicated to improving the use of evidence in humanitarian crises, highlights information from Cochrane and other systematic reviews of particular relevance to those involved in humanitarian assistance and, in July 2018, these were added to by a report on psychological therapies for the treatment of mental disorders in low- and middle-income countries. We asked one of the authors, Marianna Purgato from the University of Verona in Italy, to tell us about this new Cochrane Review.

"Whether a humanitarian crisis is triggered by natural hazards or other events, people affected by it in low- and middle-income countries are exposed to many stressors that make them more vulnerable to mental disorders, including post-traumatic stress disorder, major depression and anxiety. They are also more at risk of other negative psychological outcomes. 

Various types of psychological therapy are available to try to manage these conditions, including different forms of cognitive-behavioural therapy, or CBT, including CBT with a trauma focus, Brief Behavioural Activation, narrative exposure therapy, the common elements treatment approach and several others. It’s important, therefore, to know how effective and acceptable these therapies are and we did our review to investigate this for people with mental disorders who are living in humanitarian crises in low- and middle-income countries.

We included 33 randomised trials, involving more than 3500 participants.  The studies are from sub-Saharan Africa, the Middle East and North Africa, and Asia, and were implemented during armed conflicts and disasters triggered by natural hazards, as well as in other types of humanitarian crises. Together, the 33 studies assessed the effects of eight different psychological treatments, each of which was compared against a control group.
Most of the studies were limited to adults, but three included both older children and adults, and four just recruited children and adolescents between 5 and 18 years of age. 

In adults, we found that psychological therapies may substantially reduce post-traumatic stress disorder symptoms by the end of the therapy, but the effect is smaller over the subsequent one to four months and at six months follow-up. There were similar findings for the effects of the therapies on depression, and we found that they may moderately reduce anxiety at the end of the therapy and at one to four months' follow-up.
The evidence was much less clear for children and adolescents. We found very low quality evidence for lower post-traumatic stress disorder symptoms scores after CBT compared to control conditions, and there was no randomised evidence on major depression or anxiety in children.

In summary, our review supports the approach of providing psychological therapies to populations affected by humanitarian crises, although none of the included studies looked at the effectiveness or acceptability of these therapies for depressive and anxiety symptoms beyond six months, and most of the data comes from research in adults. Only a small number of the trials studied children and adolescents, and these provided very low-quality evidence of benefit from the psychological treatments."

 

Tuesday, November 27, 2018

2018 Colloquium Gala Dinner Raises £9,880 for Social Bite, a charity dedicated to tackling homelessness in Scotland

Tue, 11/27/2018 - 18:04

The Colloquium is Cochrane's annual flagship event, bringing people together from around the world to discuss research into important global health questions and to promote evidence-informed health care. This year, the Colloquium took place in Edinburgh, UK, in September and was hosted by Cochrane UK. Almost 1300 people from 57 countries attended. The theme was ‘Cochrane for all - better evidence for better health decisions.’  It was a Patients Included event, co-designed, co-produced and co-presented by healthcare consumers.

This year’s Colloquium gala dinner was held at the National Museum of Scotland. Guests enjoyed their meal in the Grand Gallery, followed by traditional Scottish music, a ceilidh and a disco.

In order to guarantee their place at the dinner, guests were asked to make a charitable donation at the time of registration. These donations were promised to Social Bite, a national Social Enterprise in Scotland dedicated to tackling homelessness. We are delighted to have raised £9,880 for this cause.

Social Bite invite their homeless customers into their chain of sandwich shops to enjoy homemade food and hot drinks throughout the day. Among other ventures, they also hold a series of ‘social supporter’ events in the evenings, including nights for refugees and ‘women’s only’ nights for homeless women. Social Bite have also secured 800 homes for their first Housing Initiative. This plans to take a minimum of 800 people out of homelessness and into a proper home with fully funded support over the next 18 months.

After learning of the donation raised from the gala dinner, Jamie Boyd, Head of Event Fundraising at Social Bite passed on this message: 

“Your gift will make such a difference to the lives of the many homeless people we support.  Thanks to the generosity of our supporters, like yourselves, we are able to distribute over 100,000 items of food and hot drinks every year to Scotland’s most vulnerable people… Support such as yours gives the small team at Social Bite great hope that together we can end homelessness and we thank you once again”.

 To learn more about Social Bite watch this short video:  

Tuesday, November 27, 2018

Featured Review: Very early versus delayed mobilisation after stroke

Mon, 11/26/2018 - 15:14

Does very early and active mobilisation improve recovery after stroke?

Care in a stroke unit is recommended for people soon after a stroke, and results in an improved chance of surviving, returning home, and regaining independence. Very early mobilisation (helping people to get up out of bed very early, and more often after the onset of stroke symptoms) is performed in some stroke units, and is recommended in many acute stroke clinical guidelines. However, the impact of very early mobilisation on recovery after stroke is not clear.

This review identified nine trials (2958 participants), although one trial (2104 participants) provided most of the information. On average, very early mobilisation participants started mobilisation 18.5 hours after their stroke, compared with 33.3 hours in the usual care group.

Review author Prof. Julie Bernhardt said: 

“Very early mobilisation did not increase the number of people who survived or made a good recovery after their stroke but there was a suggestion that very early mobilisation may reduce the length of stay in hospital by about one day. 

“However the results raised the concern that starting intensive mobilisation within 24 hours of stroke may carry some increased risk, at least for some people with stroke and this potential risk needs to be clarified.”

 

Monday, November 26, 2018

2018 Cochrane Governing Board election: Voting now open

Thu, 11/22/2018 - 20:22

Dear Cochrane Members,
 
Voting is now open for the current Governing Board election.

Visit elections.cochrane.org to view the candidates standing, read their Candidate Statements, and cast your votes.

We’ll be sending a series of reminders before voting closes on 10 December 2018 at 12:00 GMT. Next week on the Cochrane Community website, we’ll be interviewing the candidates about their motivation to stand for election, providing you with another opportunity to get to know candidates before voting.

All members as defined by the Membership Terms & Conditions are entitled to vote in this election. To check your membership status, please see https://join.cochrane.org/your-membership. If you have questions about your status, you can email membership@cochrane.org.

Questions about any aspects of the elections process can be raised with Lucie Binder, Senior Advisor to the CEO (Governance & Management) and Electoral Officer for this election.

Friday, November 23, 2018

Cochrane Review Group Networks launch their two-year strategic plans

Thu, 11/22/2018 - 18:44

Engaging professionals, patients and policy makers with Cochrane reviews for greater impact.

Cochrane’s primary role is to produce and publish ‘high-quality, relevant, up-to-date systematic reviews and other synthesized research evidence’ to support inform healthcare decisions. This is possible through the sheer dedication and hard work of the Cochrane community, including the author teams and the editorial support and guidance given to them by Cochrane Review Groups (CRGs).

During the last 12 months, Cochrane has created eight new Networks of Cochrane Review Groups, responsible for the efficient and timely production of high-quality systematic reviews that address the most important research questions for decision makers.

The CRG Networks within Cochrane, each have a Network team comprising of a Senior Editor, Associate Editor, and a Network Support Fellow.

Now, following comprehensive consultation and finalization with their CRG community at Cochrane’s Edinburgh Colloquium in September, the Network’s Senior and Associate Editors are delighted to announce their strategic plans that will guide their work over the next two years:

The CRG Network’s Strategic Plans are based on five key objectives:

  1. Supporting review production and capacity
  2. Evaluating Network scope and prioritisation of topic
  3. Fostering collaboration within the Network and with the wider Cochrane community
  4. Supporting knowledge translation to increase the impact of Cochrane review
  5. Ensuring accountability and sustainability of the Network

This is an exciting new development for Cochrane, working collectively to improve review production and editorial processes, which in turn aim to improve the quality of Cochrane reviews. These strategic plans also mean that the review questions chosen are the right ones for professionals, patients and policymakers, and are prioritized through interaction with relevant stakeholders, leading to higher impact in adoption in health guidelines and policies in the future.

We will regularly monitor and evaluate the implementation of these strategic plans and will publish our results with the Cochrane community every three months.

 

Thursday, November 22, 2018

International Day of Persons with Disabilities

Mon, 11/19/2018 - 19:00

Join us December 3 to increase awareness of diverse abilities, promote inclusion for those with disabilities, and highlight Cochrane evidence around this subject.

The United Nations recognizes International Day of Persons with Disabilities (IDPD) each year on December 3. This day increases awareness of diverse abilities and promotes inclusion for those  with disabilities, and is an opportunity to highlight the latest Cochrane evidence around this subject.

Rehabilitation is a health strategy aimed at enabling people with disabilities to reach and maintain their optimal physical, sensory, intellectual, psychological and social functional levels. Rehabilitation provides disabled people with the tools they need to attain independence and self-determination. The Cochrane Rehabilitation Field was established in 2016 and serves as a bridge between all the stakeholders in Rehabilitation and Cochrane. Cochrane Rehabilitation will on one side drive evidence and methods developed by Cochrane to the world of Rehabilitation and on the other convey priorities, needs and specificities of Rehabilitation to Cochrane.

Monday, December 3, 2018

Governing Board elections November 2018: Announcing the candidates standing

Thu, 11/15/2018 - 16:28

Following a period of nominations, we’re very pleased that 19 candidates are standing for election to the Governing Board in this election. They are listed on elections.cochrane.org and here you can read more about the them, why they’re standing for election, and what they plan to do for Cochrane if elected.

There are four (4) positions available on the Board for this election, which is open to Cochrane Members. Candidates do not have to be a leader of a Cochrane Group and the Board is looking for a diverse and international range of candidates. Voting will open on 22 November 2018 and close on 10 December 2018 (12:00 GMT).

All members as defined by the Membership Terms & Conditions will be entitled to vote in the election. To check your membership status, please see https://join.cochrane.org/your-membership. If you have questions about your status, you can email membership@cochrane.org. Instructions on how to vote will be sent to you on 22 November 2018.

Cochrane places high regard on minimizing bias, promoting access, and enabling wide participation. For these reasons, canvassing for specific candidates is prohibited. It should be noted that:

  • Any Cochrane individual, Group or committee may encourage members to participate in elections without endorsing specific candidates;
  • Cochrane leaders or leadership committees (such as Executives) should not publicly endorse specific candidates.

Questions about any aspects of the elections process, or concerns about a candidate’s eligibility, can be raised with Lucie Binder, Senior Advisor to the CEO (Governance & Management) and Electoral Officer for this election.

Best wishes to all candidates standing!

Thursday, November 15, 2018

Podcast: How accurate are diagnostic tools for autism spectrum disorder in preschool children?

Wed, 11/14/2018 - 20:04

There are more than 20 Cochrane Reviews of interventions that might be used in the care of children with autism spectrum disorder. In July 2018, these were added to with an assessment of the accuracy of tests for this condition. Senior author, Katrina Williams from the Department of Paediatrics at the University of Melbourne in Australia, tells us what they found in this podcast.

"Doing our review, we wanted to answer the question: How accurate are tools for diagnosing autism spectrum disorder, which I’ll refer to as autism, in preschool children? And we’ve reached the conclusion that they are not accurate enough. This is important because we need to diagnose autism correctly so that children with autism can access timely support and education and children who don’t have autism avoid unnecessary investigations and treatments.

We found relevant evidence for three diagnostic tools: the Autism Diagnostic Inventory, which is a carer interview and is known as the ADI-R; the Autism Diagnostic Observation Scale, known as the ADOS, which is based on observing the child while they do structured tasks and the Childhood Autism Rating Scale, or CARS, which combines an interview with un-structured observation. 

The 13 relevant studies were mainly from high income countries and included preschool children with language difficulties, developmental delay, intellectual disability, or a mental health problem, presenting to a clinical service or enrolling in a research study. The studies varied in quality and it’s likely that they appear to be more accurate in making diagnoses in these research studies than they would be in routine practice, which means we need to be cautious about the findings.

The largest amount of evidence was for ADOS, with 12 analyses and a total of more than 1600 children. We found it to be the best for identifying children who have autism, but it was similar to CARS and ADI-R in falsely diagnosing autism. To put this into numbers, the pooled analyses for ADOS gave a summary sensitivity of 0.94, meaning that it identified autism in 94 of every 100 children with it, and a summary specificity of 0.80, meaning that it would diagnose autism in 20 children out of 100 without it. This means that if we used ADOS to examine 100 children, 74 of who truly had autism, it would detect autism correctly in 70 but would also suggest that five of the children without autism actually had it. This makes it especially important to think about two specific settings in which these tools might be used. These are services that assess many children who do not have autism and those looking after children with intellectual disability, because a higher proportion of these children are likely to receive an incorrect diagnosis. 

In thinking about the implications of our findings, it’s important to note that autism tools that are currently considered 'diagnostic' were not designed to make an autism diagnosis and are not sufficient for that. A diagnosis involves consideration of several factors, such as whether behaviours are in keeping with the child’s communication ability and intelligence, and the exclusion of causes that require genetic testing and a detailed understanding of the child’s environment. Also, families need more than diagnoses relating to autism to understand their child’s strengths and challenges and to work with professionals to access the supports and interventions they need. That’s why child health specialists are urging a more dimensional neurodevelopmental approach than the tools we found evidence for when young children are being assessed, and we would encourage such approaches."

 

Monday, November 19, 2018

New research finds omega-3 fatty acids reduce the risk of premature birth

Wed, 11/14/2018 - 17:16

A new Cochrane Review published today has found that increasing the intake of omega-3 long-chain polyunsaturated fatty acids (LCPUFA) during pregnancy reduces the risk of premature births.

Premature birth is the leading cause of death for children under 5 years old worldwide, accounting for close to one million deaths annually. Premature babies are at higher risk of a range of long-term conditions including visual impairment, developmental delay and learning difficulties.

‘We know premature birth is a critical global health issue, with an estimated 15 million babies born too early each year,’ explains Cochrane Pregnancy and Childbirth lead author Associate Professor Philippa Middleton.

‘While the length of most pregnancies is between 38 and 42 weeks, premature babies are those born before the 37 week mark – and the earlier a baby is born, the greater the risk of death or poor health.’

The author team took a close look at long-chain omega-3 fats and their role in reducing the risk of premature births – particularly docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA) found in fatty fish and fish oil supplements. They looked at 70 randomised trials and found that for pregnant women, increasing the daily intake of long-chain omega-3s:

  • lowers the risk of having a premature baby (less than 37 weeks) by 11% (from 134 per 1000 to 119 per 1000 births
  • lowers the risk of having an early premature baby (less than 34 weeks) by 42% (from 46 per 1000 to 27 per 1000 births)
  • reduces the risk of having a small baby (less than 2500g) by 10%

‘There are not many options for preventing premature birth, so these findings are very important for pregnant women, babies and the health professionals who care for them,’ Philippa says. ‘We don’t yet fully understand the causes of premature labour, so predicting and preventing early birth has always been a challenge. This is one of the reasons omega-3 supplementation in pregnancy is of such great interest to researchers around the world.’

The Cochrane review published today was first undertaken back in 2006, and concluded there wasn’t enough evidence to support the routine use of omega-3 fatty acid supplements during pregnancy. Over a decade on, this updated review concludes that there’s high quality evidence for omega-3 supplementation being an effective strategy for preventing preterm birth.

‘Many pregnant women around the world are already taking omega-3 supplements by personal choice rather than as a result of advice from health professionals,’ Philippa says. ‘It’s worth noting though that many supplements currently on the market don’t contain the optimal dose or type of omega-3 for preventing premature birth. Our review found the optimum dose was a daily supplement containing between 500 and 1000 milligrams (mg) of long-chain omega-3 fats (containing at least 500mg of DHA) starting at 12 weeks of pregnancy.’

‘Ultimately we hope this review will make a real contribution to the evidence base we need to reduce premature births, which continue to be one of the most pressing and intractable maternal and child health problems in every country around the world.’

A team from SAHMRI, including Cochrane researchers from the omega-3 review, have used the findings from this review to develop resources and information about omega-3 fatty acids for pregnant women and health professionals that can be accessed online at www.sahmriresearch.org/omega3.

Citation: Middleton P, Gomersall JC, Gould JF, Shepherd E, Olsen SF, Makrides M. Omega-3 fatty acid addition during pregnancy. Cochrane Database of Systematic Reviews 2018, Issue 11 . Art. No.: CD003402. DOI: 10.1002/14651858.CD003402.pub3

Media contacts:

Shauna Hurley
Communications and Media Manager
Cochrane Australia
Email: shauna.hurley@monash.edu
Phone: 0400 018 570

Katie Abbotts
External Communications and Media Officer
Cochrane 
Email: kabbotts@cochrane.org or pressoffice@cochrane.org
Phone: 44 7810 504380

 

Thursday, November 15, 2018

TaskExchange: a new hub for Cochrane Consumers

Wed, 11/14/2018 - 16:54

Are you interested in volunteering for Cochrane? TaskExchange is Cochrane’s new hub to help you find ways in which you can contribute. Would you be interested in finding out more? We are holding two webinars for consumers and patients, carers and other non-scientists who may be interested in being involved in producing Cochrane evidence.

The webinars have been co-organised on behalf of the Cochrane Consumer Network by members of Cochrane's Membership, Learning and Support team, and the team behind Cochrane’s TaskExchange platform.

Dr Emily Steele, the TaskExchange Community Engagement and Partnerships Manager, will introduce TaskExchange and show potential consumer volunteers how to use the platform to find projects that suit their interests and skills. The session will include a live demonstration and Q & A, and will be hosted by Cochrane’s Consumer Engagement Officer, Richard Morley.

This webinar will be held on two separate dates to cover global time zones.

Monday 3rd December 21:00 UTC [check the time in your time zone]
Wednesday 5th December 09:00 UTC [check the time in your time zone]

Find out more and sign up here.

You can also sign up and start using TaskExchange right now!

Wednesday, November 14, 2018

Four major policy issues for Cochrane: recent correspondence with the Governing Board

Wed, 11/14/2018 - 15:32

A group of Cochrane members recently submitted a letter to the Board detailing “four major policy issues for Cochrane”.

You’re invited to read their letter and the Board’s response.

To learn more about the Cochrane Council, the organization’s representative body for Cochrane members, please visit the resources on Cochrane Community: https://community.cochrane.org/organizational-info/people/cochrane-council

Wednesday, November 14, 2018

Podcast: Bedside examination tests to detect beforehand adults who are likely to be difficult to intubate

Tue, 11/13/2018 - 20:18

Patients who require general anaesthesia or ventilation to help them breathe while in intensive care, need a clear airway. This is usually achieved by inserting a tube to help air reach their lungs and a new Cochrane Review from May 2018 examines the evidence for different tests to help doctors assess how difficult this might be for patients with no immediately obvious problems with their breathing. We asked one of the authors, Jasmin Arrich from the Medical University of Vienna in Austria, to tell us what they found.

"Placing a tube into the patient’s airway, or tracheal intubation, is the best way to ensure that their airway stays clear and that air can get into their lungs during general anaesthesia, or when they need ventilation or oxygenation for other reasons. Before intubation, it’s common practice to determine if the patient has a difficult airway, which is a potentially life-threatening situation because they will not be able to breathe, and will quickly die.

There are several bedside airway examination tests to help doctors to anticipate possible difficulties before intubation and such tests are used every day by clinicians all across the world. However, there is little information about which test is most useful and we have investigated this further by reviewing the validity of different tests for detecting a difficult airway in patients with no apparent airway abnormalities.

We found no less than 133 eligible studies involving more than 840,000 patients on four continents. Most of the studies included patients undergoing elective surgery, and, overall, the evidence was of moderate to high quality. All studies focused on the assessment of predictors that would indicate if a patient was likely to have difficult face mask ventilation, laryngoscopy or intubation. 

When we pooled the results, we found high variability among the tests. The upper lip bite test for diagnosing difficult laryngoscopy provided a summary sensitivity of 67%, which was higher than any of the other tests. However, this suggests that even this, the most sensitive test in the studies we reviewed, correctly identifies the presence of a problem only two-thirds of the time. The modified Mallampati test had the highest sensitivity for detecting difficult tracheal intubation, but its summary sensitivity of 51% means that it fails to identify the problem in nearly half the patients for whom it will be difficult to insert the tube.

In summary, bedside airway examination tests for detecting a difficult airway are intended as screening tests and are expected to miss only very few patients with a potential problem. They are recommended in airway management guidelines around the world, but we have found that they often fail to meet their goal and that most are little better than simply flipping a coin to decide if the patient has a difficult airway. On the other hand, the tests were consistently better at showing that a patient did not have a difficult airway when there really did not have one, but this is of little relevance in this context. In conclusion, therefore, standard bedside airway examination tests for difficult airways in patients with no apparent airway abnormalities do not appear to be good screening tests, and we urge great caution in their use and interpretation."

Tuesday, November 13, 2018

Cochrane's 30 under 30: Lara A Kahale

Tue, 11/13/2018 - 11:53

Cochrane is made up of 11,000 members and over 35,000 supporters come from more than 130 countries, worldwide. Our volunteers and contributors are researchers, health professionals, patients, carers, people passionate about improving health outcomes for everyone, everywhere.

Cochrane is an incredible community of people who all play their part in improving health and healthcare globally. We believe that by putting trusted evidence at the heart of health decisions we can achieve a world of improved health for all. 

Many of our contributors are young people working with Cochrane as researchers, citizen scientists, medical students, and volunteer language translators and we want to recognize the work of this generation of contributors as part of a new series called, Cochrane’s “30 under 30." 

In this series, we will interview 30 young people, 30 years old or younger who are contributing to Cochrane activities in a range of ways, all promoting evidence-informed health decision making across the world. 

We will be hearing from them in a series of interviewees published over the coming months.

 We're keen to hear from you. Would you like to take part in this series? Do you know someone you'd like to see interviewed? Contact kabbotts@cochrane.org.  Or if you want to know more about Cochrane’s work contact membership@cochrane.org where our community support team will be happy to answer your questions.

Name: Lara A Kahale
Age: 28
Occupation: AUB GRADE center coordinator at the American University of Beirut Medical Center, Beirut, Lebanon
Program: PhD candidate in Epidemiology at Utrecht University, Utrecht, the Netherlands

How did you first hear about Cochrane? 
I was first introduced to Cochrane as a research assistant at the Clinical Research Institute at the American University of Beirut Medical Center (AUBMC) in 2012. The concept of systematic reviews was still very novel at AUBMC and in Lebanon. During my time there, I undertook Cochrane training modules on how to conduct systematic reviews and meta-analyses. I was very impressed with the rigorous methods described in these modules. 

How did you become involved with Cochrane? What is your background? 
As a registered nurse, I was trained to make clinical decisions based on evidence. Instead of just searching or reading the evidence, Cochrane paved the way for me to contribute to evidence synthesis. My first experience as an author with Cochrane was gained through the process of  leading updates of six Cochrane systematic reviews on “anticoagulation with patients with cancer” with the Gynaecological, Neuro-oncology and Orphan Cancer Group (GNOC). This project allowed me to apply what I had learned in the modules as well as increase my knowledge and update my skills. It also allowed me to forge a very positive and beneficial relationship with the GNOC editorial team.  

What do you do in Cochrane? 
I am a Cochrane author on six systematic reviews with the GNOC Group and one review with the Cochrane Neonatal Group. 

I was one of two lead authors, who in conjunction with the GNOC Group and the Project Transform Team, successfully participated in the Living Systematic Review Evidence pilot project. This process enables reviews to be continually updated, incorporating relevant new evidence as it becomes available. The concept of living evidence synthesis are of increasing interest to Cochrane’s stakeholders and are intended to provide a means seamless way to connect evidence and practice. This approach has only recently been possible due developments in linked data and machine learning. Our initial goal was to produce one living systematic review but due to the incredible commitment of the author team and support from the GNOC Group and Project Transform Team, we currently have three LSRs published on the Cochrane Library. 

What specifically do you enjoy about working for Cochrane and what have you learnt? 
Cochrane facilitates reaching out to and learning from experts in the field of evidence-based research. In particular, attending the annual Cochrane Colloquia is hugely motivating on a personal level and hugely beneficial for my continued learning. Through networking, I can easily follow-up and learn innovative and impactful work. Since the very first Colloquium I attended in 2014, I have felt like a “Cochranite”.  

What are your future plans? 
My future plans are to continue contributing to evidence synthesis and guideline development and adaptation. Also, I look forward to teaching evidence-based medicine after I complete my PhD studies. 

In your personal experience, what one thing could Cochrane do better to improve its global profile? 
One thing that I think Cochrane could do better is to increase funding opportunities to the members to undertake short-term visits to peer members to further their research experience and learn new techniques. This scheme would build research links and develop ongoing scientific collaboration. 

What do you hope for Cochrane for the future? 
I hope that Cochrane continues on providing this familial atmosphere for members as this is one of its major strengths. Also, I hope that Cochrane branch is established in the Middle East, a region in need for high-quality evidence that could serve its numerous health-related challenges.  I would be very happy to be involved in any future discussions around this goal.  

How important is it that young people get involved in Cochrane? 
With the exponential growth of seeking medical information via the internet, it is tremendously important for young people to benefit from the concept of evidence-based practice. Cochrane very well facilitates this, especially with the availability of excellent learning packages.   

Cochrane can help young people differentiate between trust-worthy and unreliable information. 

What would your message be to other young people who want to get involved with Cochrane’s work but not sure where to start….? 
Cochrane has provided several platforms for encouraging young people to get engaged like Cochrane crowd, task exchange, etc. Also, thanks to the spirit of openness, one can easily contact managing editors of any Cochrane group or network and receive answers on how to get involved. Last but not least, attending Colloquia is the most impactful method to see things in action and sign-up to any activity or project that advances one’s professional development. 

Monday, December 10, 2018

Cochrane's 30 under 30: Andres Viteri Garcia

Tue, 11/13/2018 - 11:19

Cochrane is made up of 11,000 members and over 35,000 supporters come from more than 130 countries, worldwide. Our volunteers and contributors are researchers, health professionals, patients, carers, people passionate about improving health outcomes for everyone, everywhere.

Cochrane is an incredible community of people who all play their part in improving health and healthcare globally. We believe that by putting trusted evidence at the heart of health decisions we can achieve a world of improved health for all. 

Many of our contributors are young people working with Cochrane as researchers, citizen scientists, medical students, and volunteer language translators and we want to recognize the work of this generation of contributors as part of a new series called, Cochrane’s “30 under 30." 

In this series, we will interview 30 young people, 30 years old or younger who are contributing to Cochrane activities in a range of ways, all promoting evidence-informed health decision making across the world. 

We will be hearing from them in a series of interviewees published over the coming months.

 We're keen to hear from you. Would you like to take part in this series? Do you know someone you'd like to see interviewed? Contact kabbotts@cochrane.org.  Or if you want to know more about Cochrane’s work contact membership@cochrane.org where our community support team will be happy to answer your questions.Name: Andres Viteri Garcia
Age: 25
Program: Associate Researcher at Cochrane Ecuador - Iberoamerican Network and Lecturer of Biostatistics and Evidence-based  practice at UTE University.

How did you first hear about Cochrane? 
It was 2016, I was doing a social service year in the Ecuadorian Amazon Jungle and my former mentor at the University told me about a research conference that was going to be held in Quito (Ecuador’s capital). It was the XV Annual Meeting of the Iberoamerican Cochrane Network at UTE University, after attending the conference and some workshops I confirmed that besides practicing dentistry I wanted to become a researcher. 

How did you become involved with Cochrane? What is your background? 
After attending the conference of the Iberoamerican Network and showing my interest in systematic reviews and the methods involved in them I was offered a position as a junior researcher at the Ecuadorian Cochrane Centre in 2017. 

I am a first graduated dentist from Universidad Central del Ecuador, and a Master of Clinical Research Applied to Health Sciences at Autonomous University of Barcelona. I have been working in dentistry research since I was an undergrad and in methodology research for about two years. Further more, I had the chance to work as a research intern at the Iberoamerican Cochrane Centre (Barcelona-Spain) for one year and also doing a student elective at Cochrane UK (Oxford-UK) last summer. Currently I work as a lecturer of Evidence-Based Dentistry and Biostatistics at UTE University and as an associate researcher at the Ecuadorian Cochrane Centre (Quito-Ecuador) 

What do you do in Cochrane? 
My main role is to undertake systematic reviews; however, I am also involved in dissemination of evidence through the Wikipedia-Cochrane project, Students for Best Evidence initiative, and a new network of Iberoamerican’s dentists interested in help to develop the “Oral Health Evidence Ecosystem” within the Cochrane Oral Health Group. 


What specifically do you enjoy about working for Cochrane and what have you learnt? 

What I love the most about Cochrane is the collaborative spirit of its members. I can’t think in any other research initiative where you can literally e-mail the leaders of your field, present yourself, propose projects and actually get a response and a lot of feedback. 
 
What are your future plans? 
I am planning to continue doing clinical research and also starting my PhD studies within the next year. 

In your personal experience, what one thing could Cochrane do better to improve its global profile? 
In my point of view, Cochrane could make more efforts to be known in the Universities that offer health related degrees, especially in developing countries. 

What do you hope for Cochrane for the future? 
I believe that even when Cochrane is doing a great job, we should be working better to translate evidence into clinical practice among all areas of knowledge, especially in the countries where Cochrane is not yet well known. 

How important is it that young people get involved in Cochrane 
It’s crucial! Young people, even when inexperienced, can contribute a lot to the organization. Also, if we manage to attract more people in the early stages of their carriers its more likely that they will be willing to assess and apply the best evidence into their clinical practice. 

What would your message be to other young people who want to get involved with Cochrane’s work but not sure where to start? 
You are welcome to join us! There is not “too little” contribution. Please think about your skills and look out for some tasks that fit your interests and skills in Cochrane Crowd  or Cochrane TaskExchange and if you are interested in further contributions you can contact your local Cochrane Centre.

Tuesday, November 20, 2018

Featured Review: Improving the implementation of health-promoting policies and practices in workplaces

Tue, 11/13/2018 - 09:44

Implementation strategies are meant to improve the adoption and integration of evidence-based health interventions into routine policies and practices within specific settings. 

This review examined whether using these strategies improved the implementation of policies and practices in the workplace promoting:

  • Healthy eating
  • Physical activity
  • Weight control
  • Tobacco cessation
  • Prevention of risky alcohol consumption

The review authors also wanted to know if these strategies changed employees' health behaviours, caused any unintended effects, and were good value for money.

Workplaces are a good setting for programmes that aim to improve health-related behaviours like diet, physical activity and tobacco use, as adults spend a long time at work each day. However, these kinds of workplace-based interventions are often poorly implemented, limiting their potential impact on employee health. Identifying strategies that are effective in improving the implementation of workplace-based interventions has the potential to increase their impact on chronic disease prevention. Examples may include a workplace healthy catering policy, employee gym membership subsidies, or tobacco control policies.

The review authors found six eligible studies, mostly in the USA with workplaces focused in the manufacturing, industrial, and services-based sectors. 

Lead author Professor Luke Wolfenden said,

“The findings of the review do not provide clear evidence regarding the impact of implementation strategies on workplace health-promoting policy and practice implementation or on employee health behaviours. Further research is required to meet the need to develop the implementation evidence base, ensuring policies, practices and programs designed to improve employee health are applied and can yield their intended benefits.”

Wednesday, November 14, 2018

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