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New Cochrane health evidence challenges belief that omega 3 supplements reduce risk of heart disease, stroke or death

Mon, 07/16/2018 - 13:44

New evidence published today shows there is little or no effect of omega 3 supplements on our risk of experiencing heart disease, stroke or death.

Omega 3 is a type of fat. Small amounts of omega 3 fats are essential for good health, and they can be found in the food that we eat. The main types of omega 3 fatty acids are; alpha­linolenic acid (ALA), eicosapentaenoic acid (EPA), and docosahexaenoic acid (DHA).  ALA is normally found in fats from plant foods, such as nuts and seeds (walnuts and rapeseed are rich sources). EPA and DHA, collectively called long chain omega 3 fats, are naturally found in fatty fish, such as salmon and fish oils including cod liver oil.

Increased consumption of omega 3 fats is widely promoted globally because of a common belief that that it will protect against heart disease. There is more than one possible mechanism for how they might help prevent heart disease, including reducing blood pressure or reducing cholesterol. Omega 3 fats are readily available as over-the-counter supplements and they are widely bought and used.

A new Cochrane systematic review, published today in the Cochrane Library, combines the results of seventy-nine randomised trials involving 112,059 people. These studies assessed effects of consuming additional omega 3 fat, compared to usual or lower omega 3, on diseases of the heart and circulation. Twenty-five studies were assessed as highly trustworthy because they were well designed and conducted.

The studies recruited men and women, some healthy and others with existing illnesses from North America, Europe, Australia and Asia. Participants were randomly assigned to increase their omega 3 fats or to maintain their usual intake of fat for at least a year. Most studies investigated the impact of giving a long-chain omega 3 supplement in a capsule form and compared it to a dummy pill.  Only a few assessed whole fish intake. Most ALA trials added omega 3 fats to foods such as margarine and gave these enriched foods, or naturally ALA-rich foods such as walnuts, to people in the intervention groups, and usual (non-enriched) foods to other participants.

The Cochrane researchers found that increasing long-chain omega 3 provides little if any benefit on most outcomes that they looked at. They found high certainty evidence that long-chain omega 3 fats had little or no meaningful effect on the risk of death from any cause. The risk of death from any cause was 8.8% in people who had increased their intake of omega 3 fats, compared with 9% in people in the control groups.

They also found that taking more long-chain omega 3 fats (including EPA and DHA), primarily through supplements probably makes little or no difference to risk of cardiovascular events, coronary heart deaths, coronary heart disease events, stroke or heart irregularities. Long-chain omega 3 fats probably did reduce some blood fats, triglycerides and HDL cholesterol. Reducing triglycerides is likely to be protective of heart diseases, but reducing HDL has the opposite effect. The researchers collected information on harms from the studies, but information on bleeding and blood clots was very limited. 

The systematic review suggests that eating more ALA through food or supplements probably has little or no effect on cardiovascular deaths or deaths from any cause. However, eating more ALA probably reduces the risk of heart irregularities from 3.3 to 2.6%. The review team found that reductions in cardiovascular events with ALA were so small that about 1000 people would need to increase consumption of ALA for one of them to benefit. Similar results were found for cardiovascular death. They did not find enough data from the studies to be able to measure the risk of bleeding or blood clots from using ALA.

Increasing long-chain omega 3 or ALA probably does not affect body weight or fatness.

Cochrane lead author, Dr. Lee Hooper from the University of East Anglia, UK said: “We can be confident in the findings of this review which go against the popular belief that long-chain omega 3 supplements protect the heart. This large systematic review included information from many thousands of people over long periods.  Despite all this information, we don’t see protective effects.

“The review provides good evidence that taking long-chain omega 3 (fish oil, EPA or DHA) supplements does not benefit heart health or reduce our risk of stroke or death from any cause.  The most trustworthy studies consistently showed little or no effect of long-chain omega 3 fats on cardiovascular health. On the other hand, while oily fish is a healthy food, it is unclear from the small number of trials whether eating more oily fish is protective of our hearts. 

“This systematic review did find moderate evidence that ALA, found in plant oils (such as rapeseed or canola oil) and nuts (particularly walnuts) may be slightly protective of some diseases of the heart and circulation. However, the effect is very small, 143 people would need to increase their ALA intake to prevent one person developing arrhythmia. One thousand people would need to increase their ALA intake to prevent one person dying of coronary heart disease or experiencing a cardiovascular event.  ALA is an essential fatty acid, an important part of a balanced diet, and increasing intakes may be slightly beneficial for prevention or treatment of cardiovascular disease."

Full citation: Abdelhamid AS, Brown TJ, Brainard JS, Biswas P, Thorpe GC, Moore HJ, Deane KHO, AlAbdulghafoor FK, Summerbell CD, Worthington HV, Song F, Hooper L. Omega 3 fatty acids for the primary and secondary prevention of cardiovascular disease. Cochrane Database of Systematic Reviews 2018, Issue 7. Art. No.: CD003177. DOI: 10.1002/14651858.CD003177.pub3.

For further information and media enquiries, please contact,

Katie Abbotts
Media Officer, Cochrane
M +44(0) 7810 504380
kabbotts@cochrane.org or pressoffice@cochrane.org

Dr. Lee Hooper
Norwich Medical School
University of East Anglia
Norwich Research Park
Norwich
Norfolk, UK
E l.hooper@uea.ac.uk

About Cochrane
Cochrane is a global independent network of researchers, professionals, patients, carers and people interested in health.
Cochrane produces reviews which study all of the best available evidence generated through research and make it easier to inform decisions about health. These are called systematic reviews.
Cochrane is a not-for profit organization with collaborators from more than 130 countries working together to produce credible, accessible health information that is free from commercial sponsorship and other conflicts of interest. Our work is recognized as representing an international gold standard for high quality, trusted information.
Follow us on twitter @cochranecollab

If you are a journalist or member of the press and wish to receive news alerts before their online publication or if you wish to arrange an interview with an author, please contact the Cochrane press office: pressoffice@cochrane.org

About UEA
The University of East Anglia (UEA) is a UK Top 15 university. Known for its world-leading research and outstanding student experience, it was awarded Gold in the Teaching Excellence Framework and  is a leading member of Norwich Research Park, one of Europe’s biggest concentrations of researchers in the fields of environment, health and plant science. www.uea.ac.uk.

Wednesday, July 18, 2018

About the 2018 Cochrane Colloquium

Fri, 07/13/2018 - 14:59

Find out more about what we have planned for the 2018 Colloquium  in Edinburgh

Cochrane UK is delighted to be hosting the 25th Cochrane Colloquium, at the Edinburgh International Conference Centre in Scotland, from 16th to 18th September 2018.

We have given the Colloquium the title ‘Cochrane for all – better evidence for better health decisions’.  This is to emphasize that Cochrane welcomes everyone and recognizes that everything Cochrane does is about and for patients and other health consumers.  The Colloquium in 2018 is an event that is co-designed, co-produced and co-presented with healthcare consumers; an event where everyone’s input is valued equally.

We have been asked about this particular focus. We believe passionately that we all share the same goal: better health for patients, healthcare consumers and the world at large.

The Colloquium will be in Edinburgh, the capital city of Scotland, ‘Auld Reekie’ to the Scots.  With its medieval and classic architecture built on the side of an extinct volcano, and its Castle visible from most corners of the city, Edinburgh is best discovered on foot. Wander the narrow passageways and medieval streets winding down from the Castle to join the New Town, and stroll through the gardens that now flourish where once a moat surrounded the Old Town. If walking isn’t for you, there are bus tours of the sights and the city is well served by public buses and trams. With its blend of old and new, three national art galleries and more bars and restaurants per capita than any other city in the UK, Edinburgh is vibrant and diverse, with much to see and do. If you have a Scottish name, you might even be able to find your clan tartan.

We look forward to welcoming you to Edinburgh!

Martin Burton (Director) and Therese Docherty (Business and Programme Manager)
Cochrane UK

Friday, July 13, 2018

About the 2018 Cochrane Colloquium

Fri, 07/13/2018 - 14:59

Find out more about what we have planned for the 2018 Colloquium  in Edinburgh

Cochrane UK is delighted to be hosting the 25th Cochrane Colloquium, at the Edinburgh International Conference Centre in Scotland, from 16th to 18th September 2018.

We have given the Colloquium the title ‘Cochrane for all – better evidence for better health decisions’.  This is to emphasize that Cochrane welcomes everyone and recognizes that everything Cochrane does is about and for patients and other health consumers.  The Colloquium in 2018 is an event that is co-designed, co-produced and co-presented with healthcare consumers; an event where everyone’s input is valued equally.

We have been asked about this particular focus. We believe passionately that we all share the same goal: better health for patients, healthcare consumers and the world at large.

The Colloquium will be in Edinburgh, the capital city of Scotland, ‘Auld Reekie’ to the Scots.  With its medieval and classic architecture built on the side of an extinct volcano, and its Castle visible from most corners of the city, Edinburgh is best discovered on foot. Wander the narrow passageways and medieval streets winding down from the Castle to join the New Town, and stroll through the gardens that now flourish where once a moat surrounded the Old Town. If walking isn’t for you, there are bus tours of the sights and the city is well served by public buses and trams. With its blend of old and new, three national art galleries and more bars and restaurants per capita than any other city in the UK, Edinburgh is vibrant and diverse, with much to see and do. If you have a Scottish name, you might even be able to find your clan tartan.

We look forward to welcoming you to Edinburgh!

Martin Burton (Director) and Therese Docherty (Business and Programme Manager)
Cochrane UK

Friday, July 13, 2018

Featured Review: Nurses as substitutes for doctors in primary care

Thu, 07/12/2018 - 21:01

Delivery of primary healthcare services by nurses instead of doctors probably leads to similar or better patient health and higher patient satisfaction

Current and anticipated problems such as ageing, increased prevalence of chronic conditions and multi-morbidity, increased emphasis on healthy lifestyle and prevention, and efforts to move care from hospitals to communities encourage countries worldwide to develop new models of primary care delivery. Interest in using nurses to expand the capacity of the primary care workforce to address these problems is increasing. The substitution of trained nurses (such as nurse practitioners, practice nurses, and registered nurses) for doctors is one strategy used to improve access, efficiency, and quality of care. Nurse tasks may include diagnostics, treatment, referral to other services, health promotion, management of chronic diseases, or management of acute problems needing same-day consultations. Gains in service efficiency may be achieved if doctors no longer provide the services they have delegated to nurses, enabling doctors to focus on complexity in their caseload and on utilising their role-specific  training and experience.

A team of Cochrane authors based in Netherlands, Thailand, and the United Kingdom worked with Cochrane Effective Practice and Organisation of Care to update the 2005 Cochrane Review that investigated the impact of nurses working as substitutes for primary care doctors on: patient outcomes; processes of care; and utilisation, including volume and cost. Nine randomized trials were added to this update, bringing the total examined to 18. One study was conducted in a middle-income country, and all other studies in high-income countries. The nursing level was often unclear or varied between and even within studies.

Delivery of primary healthcare services by nurses instead of doctors probably leads to similar or better patient health and higher patient satisfaction. Nurses probably also have longer consultations with patients. Using nurses instead of doctors makes little or no difference in the numbers of prescriptions and tests ordered. However, the impacts on the amount of information offered to patients, on the extent to which guidelines are followed and on healthcare costs are uncertain.


“This updated Cochrane Review indicates that nurses can effectively expand the capacity of the primary care workforce, ” says Miranda Laurant, the lead author of the Cochrane Review. “It doesn’t suggest that we can or should eliminate doctors from the primary care level; instead it shows that, in the cases assigned to them, trained nurses can probably provide equal or better quality of care compared to primary care doctors. This is very positive news as doing so may allow doctors to spend more time focusing on more complex cases or cases that utilize their more advanced training. Whether nurse-doctor substitution leads to substantial savings or whether nurse-doctor substitution is cost-effective remains unclear; we hope that future research will examine this.”

Monday, July 16, 2018

The Recommended Dose podcast - JAMA Internal Medicine's Rita Redberg

Thu, 07/12/2018 - 18:51

This week influential Editor-in-Chief of JAMA Internal Medicine Dr Rita Redberg joins host Ray Moynihan on Cochrane Australia's podcast The Recommended Dose to share a wide ranging conversation on all things health. A Professor at the University of California San Francisco and high profile contributor to The Washington Post and New York Times, Rita is also a practising cardiologist who loves to see patients. She says that ‘being a doctor is really a privilege’.

Together, Ray and Rita canvas many topics including shared decision making between doctors and patients, the tricky territory of medical device approvals, the controversy surrounding both statins and CT scans, and the implications of not including enough women in clinical trials. 

Listen to this episode on SoundCloud, iTunes, Stitcher  or wherever you listen to your favourite podcasts. 

Find more details and our show notes our podcast page or follow us on twitter  or facebook.

The Recommended Dose is produced by Cochrane Australia and co-published with The BMJ.

Thursday, July 12, 2018

The Recommended Dose podcast - JAMA Internal Medicine's Rita Redberg

Thu, 07/12/2018 - 18:51

This week influential Editor-in-Chief of JAMA Internal Medicine Dr Rita Redberg joins host Ray Moynihan on Cochrane Australia's podcast The Recommended Dose to share a wide ranging conversation on all things health. A Professor at the University of California San Francisco and high profile contributor to The Washington Post and New York Times, Rita is also a practising cardiologist who loves to see patients. She says that ‘being a doctor is really a privilege’.

Together, Ray and Rita canvas many topics including shared decision making between doctors and patients, the tricky territory of medical device approvals, the controversy surrounding both statins and CT scans, and the implications of not including enough women in clinical trials. 

Listen to this episode on SoundCloud, iTunes, Stitcher  or wherever you listen to your favourite podcasts. 

Find more details and our show notes our podcast page or follow us on twitter  or facebook.

The Recommended Dose is produced by Cochrane Australia and co-published with The BMJ.

Thursday, July 12, 2018

Lead author of ‘Interventions for increasing the use of shared decision making by healthcare professionals’ discusses Cochrane Review

Tue, 07/10/2018 - 15:23

A Q&A with the lead author, France Légaré

Lead author, France Légaré, recently published the Cochrane Effective Practice and Organisation of Care review ‘Interventions for increasing the use of shared decision making by healthcare professionals’ in the Cochrane Library. Shared decision making is a promising approach for preference-sensitive decisions for example initiating hormone replacement therapy for menopausal symptoms or choosing to undergo surgery for knee osteoarthritis. It helps patients and families identify the best options, clarify their values and preferences, and have effective conversations with their healthcare professional thus allowing them to have better control over their treatment plans. However, more work needs to be done to know what are the most promising strategies to put shared decision making into practice.

Please can you describe yourself and your Cochrane Group?

Since 2006 I have held a Canada Research Chair in Shared Decision Making and Knowledge Translation. Our research programme's overarching goal is to provide health professionals and their patients with the necessary skills to promote shared decision-making throughout the healthcare continuum.

With this goal in mind, we partnered with experts in shared decision making and patient decision aids around the world to identify the most promising strategies to put shared decision making into practice and thus ensure that patients and families have better control over their treatment plans

What was the background to the Review? 

In 2006, the Canada Research Chair in Shared Decision Making and Knowledge Translation team published the first systematic review on barriers and facilitators to implementing shared decision making into practice but then we realised we needed to identify the most promising strategies to put shared decision making into practice that would address these barriers and facilitators.

Why was it important to conduct this Review?

This review is important because: a) patient involvement in decisions about their health is accepted as a right; b) patients in general want more information about their health condition and prefer to take an active role in decisions about their health; c) shared decision making may reduce the overuse of options not clearly associated with benefits for all and increase the use of options clearly associated with benefits for the vast majority of the concerned population; d) shared decision making may reduce unwarranted healthcare practice variations; and e) shared decision making may foster the sustainability of the healthcare system by increasing patient ownership of their own healthcare. Yet in spite of these benefits we can have little confidence as yet in the effectiveness of various methods that have been tried for increasing the use of shared decision by healthcare professionals.

What are the main implications of this research?

There are several gaps in knowledge about the effectiveness of interventions focused on increasing shared decision making among healthcare professionals.

Future studies should:

  • be designed to minimize bias regarding risk of contamination and should have enough power to estimate the effects of active interventions on increased use of shared decision making among healthcare professionals (primary outcome).
  • report their methods and results in enough detail and according to the recommended reporting guidelines to allow extensive assessment of risk of bias.
  • develop better patient-derived measures of shared decision making. Improved methods for measurements might produce consistency between observer-based and patient-reported measures of shared decision making.
  • assess the same intervention across multiple clinical contexts, health professionals and also across diverse jurisdictions (i.e. international collaborations).
  • more clearly determine the cost of interventions to increase the use of shared decision making and the impact of different clinical care payment mechanisms on the use of shared decision making.
What would you like to see happen as a result of publishing this review?  

Better research! And better reporting of research!

Friday, July 20, 2018

Cochrane seeks eight NIHR Network Support Fellows - various locations

Wed, 07/04/2018 - 16:02

Specifications:  Two years fixed-term contract
Salary: Competitive 
Location: Flexible

We are looking for eight Network Support Fellows to work with Cochrane’s global Networks.  The key role of the Network Support Fellow is to support the Networks in prioritization, gap analysis, quality and editorial processes, with a particular focus on ensuring that the Networks are positioned to provide maximum support for the NHS. Each Network Support Fellow will work closely with Cochrane Review Groups, the Network Senior Editor and Associate Editor and will have an individual work plan that includes specific objectives that are customized around the network’s development priorities.  This role would suit a highly motivated individual with experience of conducting high-quality systematic reviews and familiarity with Cochrane Systematic Review processes and methods.  The successful candidate will have an understanding of the research context, a focus on quality and enjoy communicating with a wide range of people, contributing to the global effort to produce reliable, accessible healthcare evidence.

Context

Cochrane has created eight new Network Support Fellow roles to support the efficient and timely production of high-quality systematic reviews, that address the research questions most important to patients and decision makers.  There is one role for each Cochrane Network, covering the review production areas of:

These posts are funded by the National Institute for Health Research (NIHR).  

Recruitment process

This position is open to anyone who meets the requirements outlined in the job description.  All applications will be reviewed by a committee involving the a Co-ordinating Editor, the host institution and the Cochrane Deputy Editor in Chief who will jointly make the appointments.

Applications for this vacancy are to be made online, please follow the link to the vacancy for each network below. As part of the application process you are required to upload your CV and a covering letter

 To apply please see the job postings below, which will be updated as the jobs are posted by the host institution:
  1. Network Support Fellow for Acute and Emergency Care, forthcoming
  2. Network Support Fellow for Brain, Nerves and Mind; forthcoming
  3. Network Support Fellow for Cancer, forthcoming
  4. Network Supprt Fellow for Children and Families, forthcoming
  5. Network Support Fellow for Cochrane Circulation and Breathing Network, London, UK, closing date 29 July.
  6. Network Support Fellow for Long-term Conditions and Ageing 1, Oxford, UK, closing 26 July.
  7. Network Support Fellow for Long-term Conditions and Ageing 2, Oxford, UK, closing 27 July.
  8. Network Support Fellow for Public Health and Health Systems, Oxford, UK, closing 26 July.

 

Wednesday, July 4, 2018 Category: Jobs

Cochrane seeks eight NIHR Network Support Fellows - various locations

Wed, 07/04/2018 - 16:02

Specifications:  Two years fixed-term contract
Salary: Competitive 
Location: Flexible

We are looking for eight Network Support Fellows to work with Cochrane’s global Networks.  The key role of the Network Support Fellow is to support the Networks in prioritization, gap analysis, quality and editorial processes, with a particular focus on ensuring that the Networks are positioned to provide maximum support for the NHS. Each Network Support Fellow will work closely with Cochrane Review Groups, the Network Senior Editor and Associate Editor and will have an individual work plan that includes specific objectives that are customized around the network’s development priorities.  This role would suit a highly motivated individual with experience of conducting high-quality systematic reviews and familiarity with Cochrane Systematic Review processes and methods.  The successful candidate will have an understanding of the research context, a focus on quality and enjoy communicating with a wide range of people, contributing to the global effort to produce reliable, accessible healthcare evidence.

Context

Cochrane has created eight new Network Support Fellow roles to support the efficient and timely production of high-quality systematic reviews, that address the research questions most important to patients and decision makers.  There is one role for each Cochrane Network, covering the review production areas of:

These posts are funded by the National Institute for Health Research (NIHR).  

Recruitment process

This position is open to anyone who meets the requirements outlined in the job description.  All applications will be reviewed by a committee involving the a Co-ordinating Editor, the host institution and the Cochrane Deputy Editor in Chief who will jointly make the appointments.

Applications for this vacancy are to be made online, please follow the link to the vacancy for each network below. As part of the application process you are required to upload your CV and a covering letter

 To apply please see the job postings below, which will be updated as the jobs are posted by the host institution:
  1. Network Support Fellow for Acute and Emergency Care, forthcoming
  2. Network Support Fellow for Brain, Nerves and Mind; forthcoming
  3. Network Support Fellow for Cancer, forthcoming
  4. Network Supprt Fellow for Children and Families, forthcoming
  5. Network Support Fellow for Cochrane Circulation and Breathing Network, London, UK, closing date 29 July
  6. Network Support Fellow for Long-term Conditions and Ageing 1, forthcoming
  7. Network Support Fellow for Long-term Conditions and Ageing 2, forthcoming
  8. Network Support Fellow for Public Health and Health Systems, forthcoming

 

Wednesday, July 4, 2018 Category: Jobs

Featured Review: Saline irrigation for allergic rhinitis

Wed, 07/04/2018 - 13:19

A team of review authors from the UK and Thailand worked with the Cochrane ENT Group to evaluate the benefits of nasal saline irrigation in people with allergic rhinitis.

Allergic rhinitis is inflammation (swelling and/or irritation) of the inside of the nose caused by allergies and is common in both children and adults. Common causes include grass or tree pollen, mould, dust mites or animal dander (tiny flakes of skin). People with allergic rhinitis experience symptoms (nasal obstruction, runny nose, nasal itching and sneezing) that may affect their quality of life.

Nasal saline irrigation (also known as nasal douche, wash or lavage) is a procedure that rinses the nasal cavity with saline (salt water) solutions. How saline works is not fully understood but it is probably through making the mucus (snot) thinner, making it easier to remove and also removing some of the allergens from the nose that cause irritation. Nasal saline irrigation can be performed with sprays, pumps or squirt bottles. Although saline irrigation is thought to be safe there have been reports of epistaxis (nosebleeds) and irritation or discomfort in the nose and ears. This therapy is available without prescription and can be used alone or as an add-on to other pharmacological treatment for allergic rhinitis, such as intranasal (in the nose) steroids and oral antihistamines).

Co-author of the review, Anna Schilder said, “The overall quality of evidence from this review was either low or very low because the studies were on the whole very small and measured the same outcome in various ways. Since saline irrigation could provide a cheap, safe and acceptable alternative to intranasal steroids and antihistamines we feel further high-quality studies are needed.”

The review included 14 studies with a total of 747 participants (260 adults; 487 children). With key results as follows:

Nasal saline irrigation compared with no saline irrigation

Nasal saline irrigation may have benefits in both adults and children in relieving the symptoms of allergic rhinitis compared to no saline irrigation and it is unlikely to be associated with adverse effects. It is not possible to tell from this review whether there is a difference between the different volumes and concentrations of saline solution.

Adding nasal saline irrigation onto 'pharmacological' allergic rhinitis treatment

It is uncertain whether adding nasal saline irrigation to pharmacological treatment (intranasal steroids or oral antihistamines) helps to improve the symptoms of allergic rhinitis compared to using pharmacological treatments alone. The use of nasal saline irrigation is unlikely to be associated with adverse effects.

Nasal saline irrigation compared to 'pharmacological' allergic rhinitis treatment

There is not enough evidence to know whether nasal saline irrigation is better, worse or the same as using intranasal steroids. No studies reporting the outcomes we were interested in compared nasal saline irrigation with oral antihistamines.

Dr Martin Burton, joint coordinating editor of the Cochrane ENT Group and an ear nose and throat doctor said in his Evidently Cochrane blog,   “Allergic rhinitis can be seasonal (hay fever) or perennial (year-round allergies to things like house-dust mites); the symptoms can make people miserable.  Many patients use steroid nasal sprays to help with their symptoms.  Although the use of these is widespread, and the chance of having unpleasant side-effects is very low, many people would like to know if there is something a bit more natural that they can use, either instead of the steroids or in addition to them.”

Wednesday, July 4, 2018

Featured Review: Saline irrigation for allergic rhinitis

Wed, 07/04/2018 - 13:19

A team of review authors from the UK and Thailand worked with the Cochrane ENT Group to evaluate the benefits of nasal saline irrigation in people with allergic rhinitis.

Allergic rhinitis is inflammation (swelling and/or irritation) of the inside of the nose caused by allergies and is common in both children and adults. Common causes include grass or tree pollen, mould, dust mites or animal dander (tiny flakes of skin). People with allergic rhinitis experience symptoms (nasal obstruction, runny nose, nasal itching and sneezing) that may affect their quality of life.

Nasal saline irrigation (also known as nasal douche, wash or lavage) is a procedure that rinses the nasal cavity with saline (salt water) solutions. How saline works is not fully understood but it is probably through making the mucus (snot) thinner, making it easier to remove and also removing some of the allergens from the nose that cause irritation. Nasal saline irrigation can be performed with sprays, pumps or squirt bottles. Although saline irrigation is thought to be safe there have been reports of epistaxis (nosebleeds) and irritation or discomfort in the nose and ears. This therapy is available without prescription and can be used alone or as an add-on to other pharmacological treatment for allergic rhinitis, such as intranasal (in the nose) steroids and oral antihistamines).

Co-author of the review, Anna Schilder said, “The overall quality of evidence from this review was either low or very low because the studies were on the whole very small and measured the same outcome in various ways. Since saline irrigation could provide a cheap, safe and acceptable alternative to intranasal steroids and antihistamines we feel further high-quality studies are needed.”

The review included 14 studies with a total of 747 participants (260 adults; 487 children). With key results as follows:

Nasal saline irrigation compared with no saline irrigation

Nasal saline irrigation may have benefits in both adults and children in relieving the symptoms of allergic rhinitis compared to no saline irrigation and it is unlikely to be associated with adverse effects. It is not possible to tell from this review whether there is a difference between the different volumes and concentrations of saline solution.

Adding nasal saline irrigation onto 'pharmacological' allergic rhinitis treatment

It is uncertain whether adding nasal saline irrigation to pharmacological treatment (intranasal steroids or oral antihistamines) helps to improve the symptoms of allergic rhinitis compared to using pharmacological treatments alone. The use of nasal saline irrigation is unlikely to be associated with adverse effects.

Nasal saline irrigation compared to 'pharmacological' allergic rhinitis treatment

There is not enough evidence to know whether nasal saline irrigation is better, worse or the same as using intranasal steroids. No studies reporting the outcomes we were interested in compared nasal saline irrigation with oral antihistamines.

Dr Martin Burton, joint coordinating editor of the Cochrane ENT Group and an ear nose and throat doctor said in his Evidently Cochrane blog,   “Allergic rhinitis can be seasonal (hay fever) or perennial (year-round allergies to things like house-dust mites); the symptoms can make people miserable.  Many patients use steroid nasal sprays to help with their symptoms.  Although the use of these is widespread, and the chance of having unpleasant side-effects is very low, many people would like to know if there is something a bit more natural that they can use, either instead of the steroids or in addition to them.”

Wednesday, July 4, 2018

Announcing the winners of the Rosamund Snow Prize

Tue, 07/03/2018 - 15:37

We are delighted to announce the winners of the Rosamund Snow Prize. This prize will enable two people aged under 30 with experience as health service users to join other healthcare consumers*, researchers and health professionals at Cochrane’s global conference (the Cochrane Colloquium), which takes place on 16th - 18th September 2018 in Edinburgh.

The Rosamund Snow Prize

Rosamund Snow (1971-2017) will be remembered by many for her work to champion patients’ involvement in healthcare. Diagnosed with type 1 diabetes in her teens, Rosamund was later asked to help a consultant at her outpatient clinic investigate its high ‘did not attend’ rate; she explains what she found in this talk. Urging her audience to involve patients in service quality improvement, Rosamund said: “All you have to do is ask us. And we can turn your bag full of question marks into a lightbulb moment.”

At the time of her death, Rosamund’s work included helping to develop patient involvement in curriculum design and teaching communication skills to medical students in Oxford, and championing the increased involvement of patients at the BMJ, where she was Patient Editor. 

Rosamund’s mother, Mary Snow, has established a prize in Rosamund’s name to enable two people aged under 30, with experience as health service users and an interest in evidence-based medical research, to attend the Cochrane Colloquium 2018.

Rosamund was one of the first people involved in consultations about the possibility of involving patients and other healthcare consumers extensively in this conference and suggested that it should be a PatientsIncluded event; co-designed, co-produced and co-presented by healthcare consumers, where everyone’s input is valued equally.  You can read more about that here.

It is with pleasure that we announce the Prize recipients:

Emma Cartwright (@emmacartwrigh1)

"My name is Emma and I am so excited to be one of the recipients of the Rosamund Snow prize. 

At the age of 4 I was diagnosed with Type 1 Diabetes and during the last 24 years of living with the condition I have regularly engaged with many different parts of the health service. As part of my Diabetes management I see a Diabetes consultant at least once a year, have regular contact with Diabetes Specialist Nurses and my GP to help me manage my Diabetes.

I have always had an interest in understanding why we behave in the way we do especially in regards to our health. This interest has led me into health behaviours research and I am currently working as a Research Assistant at the University of Oxford. I have also been involved in setting up peer support projects to help young people with Diabetes manage and live with the condition.

I am really pleased to be a recipient of the Rosamund Snow prize as I am excited to have the opportunity to meet with healthcare professionals and researchers to better understand how they decide what areas to focus on in their research and how their research questions are developed. I am keen to explore with them how patients can be involved in these decisions and also in supporting to conduct and implement research. I am also interested in investigating how research can be communicated in a way that patients can engage with and learn from.

I hope that by attending this colloquium, I can advise healthcare professionals and researchers of ways in which a wider group of patients can be involved in research and health service design using social media, support groups and charity events. I also hope to be able to share the work presented at the conference with patient groups and start the conversation on how patients, who are not currently involved in supporting research/service re-design, can become involved to ensure their voices are also heard."

 Jess Rees (@jessrees_)

"I’m Jess, a nursing student at the University of Birmingham. I will be attending the Cochrane Colloquium in Edinburgh as a grateful recipient of the Rosamund Snow Prize. As a health service user, personally I have been receiving long term primary healthcare for minor conditions. In my experience, evidence for and against my treatment decisions aren’t often discussed explicitly in consultations. I would like to see more patients feeling empowered to ask questions about their care in line with current evidence and to be made aware of research opportunities. From my nursing placements, patients are often willing to partake in research but they are unsure of their subsequent contribution in the creation of improved best evidence. Cochrane have worked hard to promote ‘Patients Included’ and I feel very passionate about supporting this initiative. The Colloquium is a brilliant networking event and I am so pleased to be attending for the educational benefit I can obtain and share with my peers.  

I have more experience in the health service as a relative of a user. My grandparents have complex medical histories and I have supported them throughout their care. Their experience has involved chronic issues being misdiagnosed or incorrectly treated which has been challenging for them in the face of limited evidence. I’m interested in research in a personal and professional capacity as a service user, student and a future nurse. I aim to use this opportunity to discuss research with a wider community and make it more accessible to all. I have seen first-hand the work of research nurses in hospitals throughout the West Midlands and I have taken part in research myself when practising on my clinical placements. I know how valuable and innovative research can be to healthcare when utilised effectively and by all.  I am active on Twitter (@jessrees_) and I hope to use this platform to help share key messages from the Colloquium."

We very much look forward to welcoming Emma and Jess to Edinburgh in September. We have invited them to participate in the Colloquium as Citizen Reporters. This could involve them reporting in whatever formats appeal – social media, blogs, interviews, photos or film, drawings – or maybe something else. Over the coming weeks, we will work with Emma and Jess  to find something that suits their skills and interests. In the meantime, join in the conversation on Twitter ahead of the event using #CochraneForAll

*Cochrane uses the term ‘consumer’ to include patients (or people with personal experience of a health condition), health and social care service users, care-givers and family members who are involved with someone with a health condition, and people who represent (or advocate for) patients and carers. You might be interested in this Evidently Cochrane blog on the language used to talk about patients/consumers.

Tuesday, July 3, 2018

Announcing the winners of the Rosamund Snow Prize

Tue, 07/03/2018 - 15:37

We are delighted to announce the winners of the Rosamund Snow Prize. This prize will enable two people aged under 30 with experience as health service users to join other healthcare consumers*, researchers and health professionals at Cochrane’s global conference (the Cochrane Colloquium), which takes place on 16th - 18th September 2018 in Edinburgh.

The Rosamund Snow Prize

Rosamund Snow (1971-2017) will be remembered by many for her work to champion patients’ involvement in healthcare. Diagnosed with type 1 diabetes in her teens, Rosamund was later asked to help a consultant at her outpatient clinic investigate its high ‘did not attend’ rate; she explains what she found in this talk. Urging her audience to involve patients in service quality improvement, Rosamund said: “All you have to do is ask us. And we can turn your bag full of question marks into a lightbulb moment.”

At the time of her death, Rosamund’s work included helping to develop patient involvement in curriculum design and teaching communication skills to medical students in Oxford, and championing the increased involvement of patients at the BMJ, where she was Patient Editor. 

Rosamund’s mother, Mary Snow, has established a prize in Rosamund’s name to enable two people aged under 30, with experience as health service users and an interest in evidence-based medical research, to attend the Cochrane Colloquium 2018.

Rosamund was one of the first people involved in consultations about the possibility of involving patients and other healthcare consumers extensively in this conference and suggested that it should be a PatientsIncluded event; co-designed, co-produced and co-presented by healthcare consumers, where everyone’s input is valued equally.  You can read more about that here.

It is with pleasure that we announce the Prize recipients:

Emma Cartwright (@emmacartwrigh1)

"My name is Emma and I am so excited to be one of the recipients of the Rosamund Snow prize. 

At the age of 4 I was diagnosed with Type 1 Diabetes and during the last 24 years of living with the condition I have regularly engaged with many different parts of the health service. As part of my Diabetes management I see a Diabetes consultant at least once a year, have regular contact with Diabetes Specialist Nurses and my GP to help me manage my Diabetes.

I have always had an interest in understanding why we behave in the way we do especially in regards to our health. This interest has led me into health behaviours research and I am currently working as a Research Assistant at the University of Oxford. I have also been involved in setting up peer support projects to help young people with Diabetes manage and live with the condition.

I am really pleased to be a recipient of the Rosamund Snow prize as I am excited to have the opportunity to meet with healthcare professionals and researchers to better understand how they decide what areas to focus on in their research and how their research questions are developed. I am keen to explore with them how patients can be involved in these decisions and also in supporting to conduct and implement research. I am also interested in investigating how research can be communicated in a way that patients can engage with and learn from.

I hope that by attending this colloquium, I can advise healthcare professionals and researchers of ways in which a wider group of patients can be involved in research and health service design using social media, support groups and charity events. I also hope to be able to share the work presented at the conference with patient groups and start the conversation on how patients, who are not currently involved in supporting research/service re-design, can become involved to ensure their voices are also heard."

 Jess Rees (@jessrees_)

"I’m Jess, a nursing student at the University of Birmingham. I will be attending the Cochrane Colloquium in Edinburgh as a grateful recipient of the Rosamund Snow Prize. As a health service user, personally I have been receiving long term primary healthcare for minor conditions. In my experience, evidence for and against my treatment decisions aren’t often discussed explicitly in consultations. I would like to see more patients feeling empowered to ask questions about their care in line with current evidence and to be made aware of research opportunities. From my nursing placements, patients are often willing to partake in research but they are unsure of their subsequent contribution in the creation of improved best evidence. Cochrane have worked hard to promote ‘Patients Included’ and I feel very passionate about supporting this initiative. The Colloquium is a brilliant networking event and I am so pleased to be attending for the educational benefit I can obtain and share with my peers.  

I have more experience in the health service as a relative of a user. My grandparents have complex medical histories and I have supported them throughout their care. Their experience has involved chronic issues being misdiagnosed or incorrectly treated which has been challenging for them in the face of limited evidence. I’m interested in research in a personal and professional capacity as a service user, student and a future nurse. I aim to use this opportunity to discuss research with a wider community and make it more accessible to all. I have seen first-hand the work of research nurses in hospitals throughout the West Midlands and I have taken part in research myself when practising on my clinical placements. I know how valuable and innovative research can be to healthcare when utilised effectively and by all.  I am active on Twitter (@jessrees_) and I hope to use this platform to help share key messages from the Colloquium."

We very much look forward to welcoming Emma and Jess to Edinburgh in September. We have invited them to participate in the Colloquium as Citizen Reporters. This could involve them reporting in whatever formats appeal – social media, blogs, interviews, photos or film, drawings – or maybe something else. Over the coming weeks, we will work with Emma and Jess  to find something that suits their skills and interests. In the meantime, join in the conversation on Twitter ahead of the event using #CochraneForAll

*Cochrane uses the term ‘consumer’ to include patients (or people with personal experience of a health condition), health and social care service users, care-givers and family members who are involved with someone with a health condition, and people who represent (or advocate for) patients and carers. You might be interested in this Evidently Cochrane blog on the language used to talk about patients/consumers.

Tuesday, July 3, 2018

2017 Journal Impact Factor for Cochrane Database of Systematic Reviews rises to 6.754

Wed, 06/27/2018 - 15:42

The 2017 Journal Citation Report (JCR) has been released by Clarivate Analytics, and we are delighted to announce that Cochrane Database of Systematic Reviews (CDSR) Journal Impact Factor is now 6.754.

This is a significant increase on the 2016 Journal Impact Factor, which was 6.264.

The CDSR Journal Impact Factor is calculated by taking the total number of citations in a given year to all Cochrane Reviews published in the past two years, and dividing that number by the total number of Reviews published in the past 2 years. It is a useful metric for measuring the strength of a journal by how often its publications are cited in scholarly articles.

Some highlights of the CDSR 2017 Journal Impact Factor include:

  • The CDSR is ranked 12 of the 154 journals in the Medicine, General & Internal category
  • The CDSR received 62,332 cites in the 2017 Journal Impact Factor period, compared with 57,740 in 2016
  • The five-year Journal Impact Factor is 7.669 compared to 7.084 in 2016.

Cochrane’s Editor in Chief, David Tovey, commented: “I am delighted to see a further rise in Impact Factor for the Cochrane Database of Systematic Reviews. There is also a pleasing increase in total citations, and the five year impact factor is strong. All of these data demonstrate the usage and impact of our reviews, and reflect enormous credit on our contributors and groups.”

More information is available here on how the CDSR Journal Impact Factor is calculated.

Wednesday, June 27, 2018

2017 Journal Impact Factor for Cochrane Database of Systematic Reviews rises to 6.754

Wed, 06/27/2018 - 15:42

The 2017 Journal Citation Report (JCR) has been released by Clarivate Analytics, and we are delighted to announce that Cochrane Database of Systematic Reviews (CDSR) Journal Impact Factor is now 6.754.

This is a significant increase on the 2016 Journal Impact Factor, which was 6.264.

The CDSR Journal Impact Factor is calculated by taking the total number of citations in a given year to all Cochrane Reviews published in the past two years, and dividing that number by the total number of Reviews published in the past 2 years. It is a useful metric for measuring the strength of a journal by how often it its publications are cited in scholarly articles.

Some highlights of the CDSR 2017 Journal Impact Factor include:

  • The CDSR is ranked 12 of the 154 journals in the Medicine, General & Internal category
  • The CDSR received 62,332 cites in the 2017 Journal Impact Factor period, compared with 57,740 in 2016
  • The five-year Journal Impact Factor is 7.669 compared to 7.084 in 2016.

Cochrane’s Editor in Chief, David Tovey, commented: “I am delighted to see a further rise in Impact Factor for the Cochrane Database of Systematic Reviews. There is also a pleasing increase in total citations, and the five year impact factor is strong. All of these data demonstrate the usage and impact of our reviews, and reflect enormous credit on our contributors and groups.”

More information is available here on how the CDSR Journal Impact Factor is calculated.

Wednesday, June 27, 2018

Cochrane takes its mission of promoting evidence-informed health decision-making to the UK Parliament

Wed, 06/27/2018 - 15:29

This week Cochrane was given the opportunity to speak as part of the UK’s first ever Evidence Week at the Houses of Parliament in London, UK.

The initiative, led by Sense About Science, bought together MPs, peers, parliamentarians and others interested in science and health to talk about why health evidence is important and matters to global decision-makers.  It aimed to highlight the role of the House of Commons Library and share insights into the work of Parliament in seeking and scrutinizing the value of evidence for making better healthcare decisions. 

Cochrane joined Sense about Science, the House of Commons Library, the Parliamentary Office of Science and Technology and House of Commons Science and Technology Committee as well as partners SAGE Publishing in arranging a week of events and briefings.

As part of the week of briefings, Dr Lynda Ware, Senior Fellow in General Practice at Cochrane UK, presented to wide-ranging delegates on how Cochrane uses high-quality, relevant, synthesized research evidence to help make informed decisions about health care. 

Dr Lynda Ware commented: “We are bombarded by health claims and it is difficult to make sense of them all. It is hard to filter out the fake and misleading from those that are true and evidence-based. As a global organization providing the very best analysis of research evidence available, Cochrane can help us find our way through this information to make informed decisions about health care.”

Attendees to Dr Ware’s talk came from government departments, independent fact checking organizations, press officers working in science communications as well as researchers looking at how evidence can help tackle some of the big social problems of our time  - homelessness and an aging population. 

Wednesday, June 27, 2018

My OCD story: evidence-based medicine to the rescue!

Wed, 06/27/2018 - 14:55

Karen Morley blogs about her experience of seeking help for her Obsessive-Compulsive Disorder (OCD) and how finding and using Cochrane evidence was a turning point. This blog post was originally published on Evidently Cochrane.

Without knowing what it was, I had experienced episodes of Obsessive-Compulsive Disorder (OCD) since I was an adolescent, usually when I was particularly stressed. But it was when I was caring full time for my mother, who had multiple conditions including dementia, that I had an unusually distressing episode of contamination-related OCD. When I took to the internet I was amazed to discover that the obsessive checking, washing and acute, abnormal anxiety were symptoms of an illness with a name – and to recognize other symptoms from my past that I now realised were related to it.

I read everything I could find…

I read everything I could find. I knew I should be careful about my sources, but I read fairly indiscriminately from forums, charity websites and a variety of health websites – some sensible, others less so – and that was a mistake.

I had a vague sense of stigma about mental illness and particularly about medication, so I was interested in talking therapies, especially Cognitive Behavioural Therapy (CBT) with Exposure and Response Prevention (ERP). What could I expect if I tried it? Unfortunately there were some out-of-date posts in which people described nightmare experiences: someone who had allegedly to sit for two hours with his hands in a toilet; a specialist who made his patients ‘contaminate’ everything in their house including their bedsheets; a popular self-help book with an example of an ERP goal of touching the toilet bowl without washing your hands, then all the ‘clean’ areas in your house, and then preparing a meal! The mere thought of this made my anxiety soar.

Seeking help for OCD

Nevertheless, since the OCD and anxiety were becoming increasingly hard to tolerate and making my carer’s role difficult, with the ongoing and patient support of my brother I made a ten minute appointment with my GP. I told her I thought my OCD was situational and that I understood it was usual to try a talking therapy before medication. I don’t recall that we had much discussion about this, though we did talk about respite care, something I knew my mother would hate. The GP gave me the contact details of the local Increasing Access to Psychological Therapies (IAPT) service and told me to refer myself.

It was a difficult telephone conversation that I had to arrange at a time my mother would not overhear. I described my situation, my symptoms, my feelings, my fears of CBT/ERP, I cried and I felt ashamed. The call handler talked to her supervisor and we agreed that I should try counseling first. The waiting list would be shorter at my GP’s surgery, she said; she would write a letter and I should contact them. They told me that it would take at least six months to get an appointment.

Things didn’t improve

Unsurprisingly, things didn’t improve. My Carer Support Worker arranged for some funding for private counselling: I had to find someone from an online approved register. The support of this kind, sympathetic woman was only of limited relevance, largely because my OCD was quite severe. Unfortunately she didn’t challenge my fear of psychological treatment, saying she felt CBT/ERP seemed ‘cruel’ and when I talked about medication, told me an anecdote about her sister who hadn’t tolerated it well. After ten sessions I called it off. I talked again with my brother and with a friend who had taken fluoxetine and was currently on citalopram. At the time there were confusing debates in the press and social media about the effectiveness of these anti-depressants, some of which denied their effectiveness and suggested tackling the perceived causes of depression and anxiety.

I wanted to see the evidence and know how good it was

And then I searched in the Cochrane Library. I knew what I found there would be evidence based, free from vested interest, recent and reliable.

That was what I needed. I wanted to see the evidence and know how good it was. I wanted to escape the confusion, the emotion (my own included), the forum postings and anecdotes.

I found two Cochrane Reviews:

Selective serotonin re-uptake inhibitors (SSRIs) versus placebo for obsessive compulsive disorder (OCD)

Psychological treatments versus treatment as usual for obsessive compulsive disorder (OCD)

They told me all the SSRIs in the study were known to be more effective than placebo in reducing symptoms in the short term. So they did work. The effect was described as modest but any improvement would be welcome. There might be unpleasant side effects, which was a worry, but the risk of common side effects for fluoxetine was close to placebo.

Psychological treatments derived from Cognitive/Behavioural models were more effective than ‘treatment as usual’. So they worked, too, although a subgroup analysis suggested that people with more severe symptoms might not benefit as much. Antidepressants, not psychological therapies, were usually the first line of treatment. That was a relief: I had somehow come to think I had a moral duty to slog through a psychological therapy and that taking antidepressants was a sign of weakness, but clearly that was nonsense. ERP was collaborative and the treatment was negotiated with the patient – so no-one was going to make me prepare food after touching the toilet if I didn’t want to – and really, who would?

The second review also referred to this one:

Behavioural and cognitive behavioural therapy for obsessive compulsive disorder in children and adolescents.

I knew I should be wary of this because my eighteenth birthday has long gone. But the study said OCD was similar in children and adults. I was interested in the finding that neither medication nor BT/CBT was superior but there was evidence that medication and BT/CBT combined produced better outcomes than medication alone. It looked as if I was going to have to tackle the Exposure and Response Prevention.

It gave me a feeling of control

I made up my mind to be pro-active, grasp the nettle and discuss treatment with my GP. It gave me a feeling of control I hadn’t had before.

Unable to get a quick appointment with my GP, I asked for the duty doctor to phone me and advise me. I was lucky: psychiatry was his specialism and he was extremely sympathetic, bypassing reception and making me an appointment at his clinic. He asked me what I already knew about OCD and its treatment. ‘I’ve read a couple of Cochrane Reviews,’ I said, casually. I was unprepared for the response. He perked up instantly and looked twice as energetic. It might have been a coincidence – he was an excellent doctor – but for the first time ever I experienced shared decision-making. It was tremendous. I felt like a partner in the consultation. He showed me where I could find information online. We discussed the potential benefits and risks of medication – it was customary to begin with fluoxetine – the dosage, the side effects, what we would do if I couldn’t tolerate the treatment. He turned his computer screen towards me so I could share the information and talked me through things as he looked them up. We discussed my circumstances, too, and what positive steps could be taken to help my mother and me.

Cochrane was a turning point for me

Then he asked me, ‘Do you think you’re depressed?’ I was surprised. I knew I was anxious. But as I went through a list of depressive symptoms, I realised I was. He already thought so, of course, but he didn’t tell me: he asked me. He was listening to me. I felt valued; I could be active and exercise control, which I found particularly encouraging in my situation. This persisted through subsequent appointments when we discussed whether and when to increase the dosage. I made another call to IAPT to ask for CBT/ERP and (after several months) had some therapy via telephone: I felt much braver once the medication had begun to take effect. And yes, the whole process was negotiated and graded.

If I hadn’t taken this route – if I had carried on with counseling – I am sure I would have had to give up my caring role, and I wouldn’t be recovering now. Cochrane was a turning point for me, and I am utterly convinced of the value of evidence based medicine.

But you don’t have to take my word for it. Try it for yourself.

Join in the conversation on Twitter with @CochraneUK or leave a comment on the Evidently Cochrane blog post for Karen.

References can be found here.

Tuesday, July 3, 2018 Category: The difference we make

My OCD story: evidence-based medicine to the rescue!

Wed, 06/27/2018 - 14:55

Karen Morley blogs about her experience of seeking help for her Obsessive-Compulsive Disorder (OCD) and how finding and using Cochrane evidence was a turning point. This blog post was originally published on Evidently Cochrane.

Without knowing what it was, I had experienced episodes of Obsessive-Compulsive Disorder (OCD) since I was an adolescent, usually when I was particularly stressed. But it was when I was caring full time for my mother, who had multiple conditions including dementia, that I had an unusually distressing episode of contamination-related OCD. When I took to the internet I was amazed to discover that the obsessive checking, washing and acute, abnormal anxiety were symptoms of an illness with a name – and to recognize other symptoms from my past that I now realised were related to it.

I read everything I could find…

I read everything I could find. I knew I should be careful about my sources, but I read fairly indiscriminately from forums, charity websites and a variety of health websites – some sensible, others less so – and that was a mistake.

I had a vague sense of stigma about mental illness and particularly about medication, so I was interested in talking therapies, especially Cognitive Behavioural Therapy (CBT) with Exposure and Response Prevention (ERP). What could I expect if I tried it? Unfortunately there were some out-of-date posts in which people described nightmare experiences: someone who had allegedly to sit for two hours with his hands in a toilet; a specialist who made his patients ‘contaminate’ everything in their house including their bedsheets; a popular self-help book with an example of an ERP goal of touching the toilet bowl without washing your hands, then all the ‘clean’ areas in your house, and then preparing a meal! The mere thought of this made my anxiety soar.

Seeking help for OCD

Nevertheless, since the OCD and anxiety were becoming increasingly hard to tolerate and making my carer’s role difficult, with the ongoing and patient support of my brother I made a ten minute appointment with my GP. I told her I thought my OCD was situational and that I understood it was usual to try a talking therapy before medication. I don’t recall that we had much discussion about this, though we did talk about respite care, something I knew my mother would hate. The GP gave me the contact details of the local Increasing Access to Psychological Therapies (IAPT) service and told me to refer myself.

It was a difficult telephone conversation that I had to arrange at a time my mother would not overhear. I described my situation, my symptoms, my feelings, my fears of CBT/ERP, I cried and I felt ashamed. The call handler talked to her supervisor and we agreed that I should try counseling first. The waiting list would be shorter at my GP’s surgery, she said; she would write a letter and I should contact them. They told me that it would take at least six months to get an appointment.

Things didn’t improve

Unsurprisingly, things didn’t improve. My Carer Support Worker arranged for some funding for private counselling: I had to find someone from an online approved register. The support of this kind, sympathetic woman was only of limited relevance, largely because my OCD was quite severe. Unfortunately she didn’t challenge my fear of psychological treatment, saying she felt CBT/ERP seemed ‘cruel’ and when I talked about medication, told me an anecdote about her sister who hadn’t tolerated it well. After ten sessions I called it off. I talked again with my brother and with a friend who had taken fluoxetine and was currently on citalopram. At the time there were confusing debates in the press and social media about the effectiveness of these anti-depressants, some of which denied their effectiveness and suggested tackling the perceived causes of depression and anxiety.

I wanted to see the evidence and know how good it was

And then I searched in the Cochrane Library. I knew what I found there would be evidence based, free from vested interest, recent and reliable.

That was what I needed. I wanted to see the evidence and know how good it was. I wanted to escape the confusion, the emotion (my own included), the forum postings and anecdotes.

I found two Cochrane Reviews:

Selective serotonin re-uptake inhibitors (SSRIs) versus placebo for obsessive compulsive disorder (OCD)

Psychological treatments versus treatment as usual for obsessive compulsive disorder (OCD)

They told me all the SSRIs in the study were known to be more effective than placebo in reducing symptoms in the short term. So they did work. The effect was described as modest but any improvement would be welcome. There might be unpleasant side effects, which was a worry, but the risk of common side effects for fluoxetine was close to placebo.

Psychological treatments derived from Cognitive/Behavioural models were more effective than ‘treatment as usual’. So they worked, too, although a subgroup analysis suggested that people with more severe symptoms might not benefit as much. Antidepressants, not psychological therapies, were usually the first line of treatment. That was a relief: I had somehow come to think I had a moral duty to slog through a psychological therapy and that taking antidepressants was a sign of weakness, but clearly that was nonsense. ERP was collaborative and the treatment was negotiated with the patient – so no-one was going to make me prepare food after touching the toilet if I didn’t want to – and really, who would?

The second review also referred to this one:

Behavioural and cognitive behavioural therapy for obsessive compulsive disorder in children and adolescents.

I knew I should be wary of this because my eighteenth birthday has long gone. But the study said OCD was similar in children and adults. I was interested in the finding that neither medication nor BT/CBT was superior but there was evidence that medication and BT/CBT combined produced better outcomes than medication alone. It looked as if I was going to have to tackle the Exposure and Response Prevention.

It gave me a feeling of control

I made up my mind to be pro-active, grasp the nettle and discuss treatment with my GP. It gave me a feeling of control I hadn’t had before.

Unable to get a quick appointment with my GP, I asked for the duty doctor to phone me and advise me. I was lucky: psychiatry was his specialism and he was extremely sympathetic, bypassing reception and making me an appointment at his clinic. He asked me what I already knew about OCD and its treatment. ‘I’ve read a couple of Cochrane Reviews,’ I said, casually. I was unprepared for the response. He perked up instantly and looked twice as energetic. It might have been a coincidence – he was an excellent doctor – but for the first time ever I experienced shared decision-making. It was tremendous. I felt like a partner in the consultation. He showed me where I could find information online. We discussed the potential benefits and risks of medication – it was customary to begin with fluoxetine – the dosage, the side effects, what we would do if I couldn’t tolerate the treatment. He turned his computer screen towards me so I could share the information and talked me through things as he looked them up. We discussed my circumstances, too, and what positive steps could be taken to help my mother and me.

Cochrane was a turning point for me

Then he asked me, ‘Do you think you’re depressed?’ I was surprised. I knew I was anxious. But as I went through a list of depressive symptoms, I realised I was. He already thought so, of course, but he didn’t tell me: he asked me. He was listening to me. I felt valued; I could be active and exercise control, which I found particularly encouraging in my situation. This persisted through subsequent appointments when we discussed whether and when to increase the dosage. I made another call to IAPT to ask for CBT/ERP and (after several months) had some therapy via telephone: I felt much braver once the medication had begun to take effect. And yes, the whole process was negotiated and graded.

If I hadn’t taken this route – if I had carried on with counseling – I am sure I would have had to give up my caring role, and I wouldn’t be recovering now. Cochrane was a turning point for me, and I am utterly convinced of the value of evidence based medicine.

But you don’t have to take my word for it. Try it for yourself.

Join in the conversation on Twitter with @CochraneUK or leave a comment on the Evidently Cochrane blog postfor Karen.

References can be found here.

Tuesday, July 3, 2018 Category: The difference we make

The Recommended Dose with Ray Moynihan – series 2 podcast kicks off this week with one of the most influential scientists on the planet

Wed, 06/27/2018 - 13:50

Series two of The Recommended Dose kicks off this week with polymath and poet, Dr John Ioannidis. Recognised by The Atlantic as one the most influential scientists alive today, he’s a global authority on genetics, medical research and the nature of scientific inquiry itself – among many other things.

A professor at Stanford University, John has authored close to 1,000 academic papers and served on the editorial boards of 30 of the world's top journals. He is best known for seriously challenging the status quo. His trailblazing 2005 paper Why Most Published Research Findings Are False has been viewed over 2.5 million times and is the most cited article in the history of PLoS Medicine. In it, he argues that much medical research is biased, overblown or simply wrong. Here, he talks to Ray about the far-reaching implications of these findings for people both inside and outside the world of health.

While most closely associated with exploring cutting-edge conundrums across science, genomics and even economics, John is also something of a humanist. He’d be right at home with the philosophers of ancient Greece, seeking as he does to find answers to the big questions of the day in science and medicine, as well as in nature and narratives. 

A voracious reader himself, John has a lifelong love of ‘swimming in books’ and has penned seven literary works of his own in Greek – two of which have been nominated for prestigious literary prizes. And fittingly, he finds inspiration for his myriad of multi-disciplinary pursuits on Antipaxi, one of Greece’s most beautiful and secluded islands. 

He shares some of his distinctive logic, reason - and even a little of his poetry - on this very special episode of The Recommended Dose.

You’ll find the episode on SoundCloud, iTunes, Stitcher or wherever you listen to your favourite podcasts.

Visit australia.cochrane.org/trd for our show notes and a full transcript of the show, or follow us on twitter or facebook.

Thursday, June 28, 2018

The Recommended Dose with Ray Moynihan – series 2 podcast kicks off this week with one of the most influential scientists on the planet

Wed, 06/27/2018 - 13:50

Series two of The Recommended Dose kicks off this week with polymath and poet, Dr John Ioannidis. Recognised by The Atlantic as one the most influential scientists alive today, he’s a global authority on genetics, medical research and the nature of scientific inquiry itself – among many other things.

A professor at Stanford University, John has authored close to 1,000 academic papers and served on the editorial boards of 30 of the world's top journals. He is best known for seriously challenging the status quo. His trailblazing 2005 paper Why Most Published Research Findings Are False has been viewed over 2.5 million times and is the most cited article in the history of PLoS Medicine. In it, he argues that much medical research is biased, overblown or simply wrong. Here, he talks to Ray about the far-reaching implications of these findings for people both inside and outside the world of health.

While most closely associated with exploring cutting-edge conundrums across science, genomics and even economics, John is also something of a humanist. He’d be right at home with the philosophers of ancient Greece, seeking as he does to find answers to the big questions of the day in science and medicine, as well as in nature and narratives. 

A voracious reader himself, John has a lifelong love of ‘swimming in books’ and has penned seven literary works of his own in Greek – two of which have been nominated for prestigious literary prizes. And fittingly, he finds inspiration for his myriad of multi-disciplinary pursuits on Antipaxi, one of Greece’s most beautiful and secluded islands. 

He shares some of his distinctive logic, reason - and even a little of his poetry - on this very special episode of The Recommended Dose.

You’ll find the episode on SoundCloud, iTunes, Stitcher or wherever you listen to your favourite podcasts.

Visit australia.cochrane.org/trd for our show notes and a full transcript of the show, or follow us on twitter or facebook.

Thursday, June 28, 2018

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