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Featured Review: Interventions to improve the appropriate use of polypharmacy for older people

Tue, 09/11/2018 - 12:05

Taking medicine to treat symptoms of chronic illness and to prevent worsening of disease is common in older people. However, taking too many medicines can cause harm. The Cochrane Review, 'Interventions to improve the appropriate use of polypharmacy for older people' examined studies in which healthcare professionals have taken action to make sure that older people are receiving the most effective and safest medicines for any illness they may have. Actions taken included providing a service, known as pharmaceutical care, which involves promoting the correct use of medicines by identifying, preventing and resolving medicine‐related problems. Another strategy the reviewers were interested in was using computerised decision support, which involves a programme on the doctor’s computer that aids the selection of appropriate treatment(s).

This is an important research area as polypharmacy is the single most commonly identified risk factor associated with potentially inappropriate prescribing in older people.  Potentially inappropriate prescribing has been linked to a range of negative clinical outcomes including hospitalisations.

The review authors found 32 relevant trials from 12 countries that involved 28,672 older people. These studies compared interventions aiming to improve the appropriate use of medicines with usual care. Based on the assessments of the certainty of the evidence, the results of the review showed that:

  •  it is uncertain whether the interventions improved the appropriateness of medicines (based on scores assigned by expert professional judgement)
  •  it is uncertain whether the interventions reduced the number of potentially inappropriate medicines (medicines in which the harms outweigh the benefits)
  • it is uncertain whether the interventions reduced the proportion of patients with one or more potentially inappropriate medications
  • the interventions may slightly decrease the number of potential prescribing omissions
  • it is uncertain whether the interventions reduced the proportion of patients with one or more potential prescribing omissions (cases where a useful medicine has not been prescribed) because the certainty of the evidence is very low
  • the interventions may lead to little or no difference in hospital admissions or quality of life
  • no consistent intervention effect was observed across studies in terms of medication-related problems. 

Review author Audrey Rankin said:

“It is vital that the available evidence is identified and appraised, so that interventions that are effective in ensuring appropriate polypharmacy in older people can be implemented in clinical practice. This review provides an updated and detailed appraisal of current available evidence, the findings of which are relevant to informing future policy, practice and research.

The addition of 20 studies to this updated review, which now includes 32 studies, highlights a notable increase in intervention studies aimed at improving appropriate polypharmacy in older people. However, these additional 20 studies had little impact on the overall findings of the review and the included studies were limited by their small sample sizes and poor certainty of evidence.

Based on the studies included in the review, it is unclear whether interventions to improve appropriate polypharmacy, such as reviews of patients’ prescriptions, resulted in clinically significant improvements. The interventions may be slightly beneficial in terms of reducing the number of potential prescribing omissions; however, this effect estimate is based on only two studies, which had serious limitations in terms of risk bias.”

In advancing future research in this area, it would be important that researchers provide more detailed descriptions of the interventions in terms of how they were developed and delivered. This would help in understanding how the interventions were intended to achieve their desired effects, as well as promoting replication of effective interventions in other settings. It would also be important to ensure greater consistency in terms of the assessment outcomes that are used in evaluating interventions. Members of our research group recently published a core outcome set for interventions aimed at improving appropriate polypharmacy for older people in primary care, which may help in streamlining the outcomes that are routinely measured in trials in this area.

Tuesday, September 11, 2018

Cochrane in the numbers: April - June 2018

Mon, 09/10/2018 - 15:40

We are pleased to announce the publication of our organizational Dashboard looking the second quarter of 2018. This Dashboard, which we publish quarterly, presents our achievements in a series of key metrics, such as publishing output, Cochrane Library usage, and progress on meeting Strategy to 2020 targets. Work on Strategy targets is covered in more detail in the Target Report below.

This initiative is part of Cochrane’s commitment to organizational transparency. For everyone interested in Cochrane and our work, these critical indicators provide an opportunity to monitor our production and dissemination of evidence, and our organizational health.

Highlights from the second quarter include:

  • Global usage of Cochrane.org continues its quarter-by-quarter growth; now exceeding 5.7m sessions in the quarter.
  • 73% of Cochrane.org usage is viewing non-English content. We had 715 new and updated translations published in 15 languages in Q2 2018.
  • Steady growth across all our social media accounts.

For more information:

Monday, September 10, 2018

Featured Review: Interventions for preventing falls in older people in care facilities and hospitals

Fri, 09/07/2018 - 20:17

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How effective are interventions designed to reduce falls in older people in care facilities and hospitals?

Falls by older people in care facilities, such as nursing homes, and hospitals are common events that may cause further loss of independence, injuries, and sometimes death as a result of injury. Effective interventions to prevent falls are therefore important.

Many types of interventions are in use. These include:

  • exercise
  • medication interventions that include vitamin D supplementation
  • medication review of the drugs that people are taking
  • environment or assistive technologies including bed or chair alarms or the use of special (low/low) beds
  • social environment interventions that target staff members and changes in the organisational system, and knowledge interventions

A special type of intervention is the multifactorial intervention, where the selection of single interventions such as exercise and vitamin D supplementation is based on an assessment of a person's risk factors for falling.

A recent Cochrane Review looked at the outcomes of rate of falls (number of falls over time), risk of falling (number of fallers), number of people with fall-related fractures, and adverse events.

This review included 95 randomised controlled trials involving 138,164 participants. Seventy-one trials (40,374 participants) were in care facilities, and 24 (97,790 participants) in hospitals. On average, participants were 84 years old in care facilities and 78 years old in hospitals. In care facilities, 75% were women and in hospitals, 52% were women.

For both hospitals and care facilities, the review is structured by the main categories of interventions evaluated in at least one setting in the review: exercise, medication (medication review; vitamin D supplementation); psychological interventions, environment/assistive technology, social environment, interventions to increase knowledge, other interventions, multiple interventions and multifactorial interventions. There was a lack of evidence on surgery, management of urinary incontinence, or fluid or nutrition therapy in both settings.

Lead author, Ian Cameron, said:

“We found evidence of effectiveness for some fall-prevention interventions in care facilities and hospitals, although in several cases the quality of the evidence was considered low or very low. For all interventions, we are uncertain of their effects on fractures and on adverse events as the quality of the evidence for both outcomes was assessed as very low.”

“A key clinical implication of the findings of the Review is that the use of vitamin D supplements in nursing homes and other care facilities should increase. There are already a number of guidelines recommending this and the findings highlight the evidence to practice gap.”

In care facilities: the review authors were uncertain of the effect of exercise on rate of falls and concluded that it may make little or no difference to the risk of falling. General medication review may make little or no difference to the rate of falls or risk of falling. Vitamin D supplementation probably reduces the rate of falls but not risk of falling. The review team is uncertain of the effect of multifactorial interventions on the rate of falls; they may make little or no difference to the risk of falling.

In hospitals: the review authors are uncertain of the effect of additional physiotherapy on the rate of falls or whether it reduces the risk of falling. The review team is uncertain of the effect of providing bed sensor alarms on the rate of falls or risk of falling. Multifactorial interventions may reduce rate of falls, although subgroup analysis suggests this may apply mostly to a subacute setting; the authors are uncertain of the effect of these interventions on risk of falling.

Friday, September 7, 2018

Pharmacists play vital role in improving patient health shows biggest review of evidence to date

Fri, 09/07/2018 - 15:16

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Pharmacists serving non-hospitalised patients, such as in general practices and community pharmacies, may achieve improvements in patient health outcomes according to the most comprehensive systematic review of the scientific evidence to date.

This press release originally was posted on the University of Bath website.

A team of researchers led by Professor Margaret Watson from the University of Bath, working with Cochrane, NHS Education Scotland, and the Universities of Aberdeen, Brunel, California and Nottingham Trent, reviewed 116 scientific trials involving more than 40,000 patients. They compared pharmacist interventions with the usual care or interventions from other healthcare professionals for a wide range of chronic conditions including diabetes and high blood pressure.

Cochrane reviews assess evidence from as many studies as possible to draw the most reliable conclusions and are internationally recognised as the highest standard in evidence-based health care.

In this review, 111 trials compared pharmacist interventions with usual care. The review authors found that patients in groups that received pharmacist interventions had better outcomes when it came to reducing blood sugar levels and blood pressure, but for others, such as hospital admissions and death rates, the effect was more uncertain although the general direction of effect was positive. 

Blood sugar control is measured using a figure called HbA1c.  Overall, trials involving pharmacist interventions decreased patients’ HbA1C by 0.8% compared with usual care. A 1% rise in HbA1c is associated with a 28% increased risk of premature death.

Patients’ blood pressure was about half as likely to be outside target ranges for individuals receiving pharmacist services, and was on average 5mmHg lower in these patients, a figure associated with a 34% reduction in stroke and a 21% reduction in ischaemic heart disease.

Professor Margaret Watson from the University of Bath, who led the review, said: “What is really important about this review is that it shows pharmacist services can achieve clinically relevant improvements for patients and could lead to benefits for some long term conditions, particularly diabetes and high blood pressure.

We know that these types of long-term conditions are going to increase as the population ages.

There has been huge government investment in placing pharmacists in general practices and elsewhere in the NHS. The results of this review indicate that trials of pharmacist services may produce improvements in patient health. As such, future investment in pharmacist services could be informed by the results of this review.”

However, Professor Watson added: “Pharmacists are not a panacea, but they can increase capability and capacity within the healthcare system and help patients to improve their health.”

“There are some caveats. Due to poor reporting of the details from some trials and overall low quality of evidence, we can’t pinpoint the specific elements of a pharmacist service that is having an effect. So we would like to see much better detailed reporting in future trials.”

Of the five studies that compared services delivered by pharmacists with other health professionals, no studies evaluated the impact of the intervention on the percentage of patients outside blood pressure or glycated haemoglobin target range, hospital attendance and admission, adverse drug effects, or physical functioning.

Professor Watson said: “This indicates that there is no evidence to suggest that interventions delivered by other health professionals, are more or less beneficial than those delivered by pharmacists.”

The Cochrane researchers say that the evidence shows that pharmacists could make vital contributions and help the NHS to improve capability, capacity and most importantly patient health in the face of substantial challenges.

Professor Watson will present the team’s work at the FIP World Congress of Pharmacy and Pharmaceutical Sciences in Glasgow on September 4.

The study was funded by the Chief Scientist Office, Scottish Government, and Professor Watson receives funding from The Health Foundation.

Friday, September 7, 2018

Featured Review: Electromechanical and robot‐assisted arm training for improving activities of daily living, arm function, and arm muscle strength after stroke

Thu, 09/06/2018 - 19:12

Updated review: Electromechanical and robot‐assisted arm training for improving activities of daily living, arm function, and arm muscle strength after stroke

In this updated review authors from Germany came together to re-assess the effects of electromechanical and robot‐assisted arm training for improving arm function in people who have had a stroke. The review was updated from having low/very low quality evidence of benefit to high quality evidence of benefit.

Electromechanical and robot‐assisted arm training uses specialised machines to assist rehabilitation in supporting shoulder, elbow, or hand movements. However, the role of electromechanical and robot‐assisted arm training for improving arm function after stroke is unclear.

The review authors identified 45 trials (involving 1619 participants) up to January 2018 and included them in the review. The quality of the evidence was high.

Lead author Jan Mehrholz concludes:

“Electromechanical and robot‐assisted arm training improves daily living for people after stroke, and improves function and muscle strength of the affected arm. As adverse events, such as injuries and pain, were seldom described, these devices can be applied with some confidence as a rehabilitation tool, but we still do not know when or how often they should be used. There is still a need for well‐designed, large‐scale, multicentre studies to evaluate benefits and harms of electromechanical‐assisted arm training after stroke.

Perhaps one main difference between electromechanical or robot‐assisted arm training and other interventions could be an improvement in motivation due to the feedback of the device, or the novelty of a robotic device, or both. However, we can only speculate about this.”

Friday, September 7, 2018

Featured Review: Impact of public release of performance data on the behaviour of healthcare consumers and providers

Thu, 09/06/2018 - 11:13

Cochrane Effective Practice and Organisation of Care  wanted to find out if publicly releasing information about the performance of healthcare providers (e.g. hospitals and individual professionals) has a measurable influence on changing the behaviour of consumers, providers, and purchasers of care. The authors also sought to determine whether this affected the performance of healthcare providers, patient outcomes, and staff morale.

 The recently published review found:
  • The available evidence suggests that publishing performance data does not make very much difference to where patients choose to go for treatment. It also appears to make little difference to the behaviour of healthcare providers, i.e. professionals and organisations.
  • There has been little high-quality research in this area and so it is difficult to have a high degree of certainty about the actual impact of publishing data about the performance of healthcare providers. Normal 0 false false false EN-GB JA AR-SA /* Style Definitions */ table.MsoNormalTable {mso-style-name:"Table Normal"; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-priority:99; mso-style-parent:""; mso-padding-alt:0cm 5.4pt 0cm 5.4pt; mso-para-margin:0cm; mso-para-margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:12.0pt; font-family:Cambria; mso-ascii-font-family:Cambria; mso-ascii-theme-font:minor-latin; mso-hansi-font-family:Cambria; mso-hansi-theme-font:minor-latin;}
  • Public release of performance data may improve patient outcomes in some cases. There is however evidence to suggest that this could increase inequality as some patient groups are more likely to act on this information than others.

 “Public release of performance data is becoming increasingly commonplace and is usually assumed to be 'a good thing." says  David Metcalfe, Lead Author. "However, there is a risk of such interventions causing harm, e.g. by misleading patients, encouraging providers to “game” the system or avoid treating high-risk patients, distorting clinical priorities, and/or increasing healthcare inequalities. It is therefore important that we pause to evaluate and understand the effects of such initiatives.

There is room within the “research space” for high quality research aimed at understanding how and when public release of performance data can effect positive change for patients. Future research should aim to examine the impact of public release of performance data on patient outcomes rather than simply healthcare processes.”

The authors searched the literature for studies evaluating the effects of publicly releasing healthcare performance information, and found 12 relevant studies that analysed data from more than 7570 providers, and a further 3,333,386 clinical encounters, e.g. individual patients.

Thursday, September 6, 2018

Cochrane Infectious Diseases seeks part-time Clinical Research Associate in Evidence Synthesis - Liverpool, UK

Wed, 09/05/2018 - 16:19
Contract type: Part-time, Fixed-term appointment at 0.6 FTE for up to 2 years Closing date: 24 September 2018

Founded in 1898 and the oldest of its kind in the world, the Liverpool School of Tropical Medicine (LSTM) is an internationally recognised centre of excellence for teaching and research in tropical diseases. LSTM’s Centre for Evidence Synthesis in Global Health has led developments in systematic reviews in tropical medicine and international health. In the 1990s, staff contributed to setting up Cochrane, and established the Cochrane Infectious Diseases Group (CIDG). This is now recognised as one of Cochrane’s premier groups, with over 150 Cochrane reviews and 600 authors, and is well-linked with the World Health Organization and we are looking to expand the centre.

 As part of this, we are recruiting staff for the six year “Research, Evidence and Development Initiative” (READ-It) programme.  We are in the inception phase and planning a variety of new and exciting reviews with our colleagues, partners, and stakeholders.  You will be part of this process and be part of review teams in the existing and new review portfolio.  Our priorities are developing rapidly and we are seeking to engage the successful applicant in a high-priority area commensurate with their areas of interest. For example, some topics we are mapping out are:

  • Insecticide-residual spraying for malaria control
  • HIV prevention
  • Health of refugees and people living in camps

There are also a variety of methodological projects related to Cochrane review updating, conflicts of interest, statistical reporting, and methods for moving from evidence to policy, and we aim for a mixed portfolio to provide abroad exposure to evidence-informed science.

The successful candidate will have an MBBS and an appropriate postgraduate qualification. Possessing a relevant PhD is desirable. You will have experience and confidence in critically appraising medical literature at postgraduate level. You must demonstrate evidence of a critical insight into priority policy questions in international health in infectious diseases relevant to low- and middle-income countries and have excellent skills in writing in plain English.

You will demonstrate experience of working in a multi-disciplinary team with the ability to work collaboratively as well as independently. We want people who have an enthusiastic approach to work and possess excellent attention to detail. You will be responsible for ensuring that effective communication flows within the project team and will need effective communication, time management, and organisational skills. If you have authored a Cochrane review, have experience of using GRADE, or have a track record in published research, it will be an added advantage to your application.

Wednesday, September 5, 2018 Category: Jobs

Cochrane Ireland seeks Senior Research Associate - Programme Manager - Galway, Ireland

Thu, 08/30/2018 - 15:53

Senior Research Associate - Programme Manager

Centre for Health Evaluation Methodology Research & Evidence Synthesis (CHEM-RES)

School of Nursing & Midwifery, NUI Galway.

Applications are invited from suitably qualified candidates for a 3-year fixed term contract position as Programme Manager (Senior Research Associate) for an evidence synthesis capacity building initiative funded by the Health Research Board (HRB) and the Health and Social Care, Research and Development (HSC R&D) Division of the Public Health Agency in Northern Ireland.

On of the principal duties  will be developing a world-class evidence synthesis capacity building centre at NUI Galway, including the re-establishment of Cochrane Ireland.

Thursday, August 30, 2018 Category: Jobs

Cochrane’s Editor in Chief responds to BMJ EBM article criticizing HPV review

Wed, 08/29/2018 - 14:13

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Normal 0 false false false EN-GB JA X-NONE /* Style Definitions */ table.MsoNormalTable {mso-style-name:"Table Normal"; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-priority:99; mso-style-parent:""; mso-padding-alt:0cm 5.4pt 0cm 5.4pt; mso-para-margin-top:0cm; mso-para-margin-right:0cm; mso-para-margin-bottom:10.0pt; mso-para-margin-left:0cm; line-height:115%; mso-pagination:widow-orphan; font-size:11.0pt; font-family:"Source Sans Pro Semibold",sans-serif; mso-ascii-font-family:"Source Sans Pro Semibold"; mso-ascii-theme-font:minor-latin; mso-hansi-font-family:"Source Sans Pro Semibold"; mso-hansi-theme-font:minor-latin; mso-ansi-language:EN-GB; mso-fareast-language:EN-US;} On 27th July 2018, an article was published in the journal BMJ Evidence-Based Medicine relating to the recently published Cochrane Review on prophylactic human papillomavirus (HPV) vaccines. The article is based on analyses undertaken at the Nordic Cochrane Centre, and two of the authors are experienced Cochrane researchers: Professors Peter Gøtzsche and Tom Jefferson. It made several criticisms of the Cochrane Review, most notable of which was that the Cochrane Review was incomplete due to missing "nearly half of the eligible trials".

Cochrane takes all criticisms and feedback seriously, seeing this as one mechanism among many to improve the quality of Cochrane Reviews. The organization has 10 long-standing principles that we hold dear, and they include a commitment to quality and the minimization of bias, transparency, and a recognition of the need for our work to be relevant to the needs of evidence users and decision makers. Cochrane aims to create the best current evidence to guide health decisions.

We initiated an investigation in response to the criticisms, working with the review authors and editors and with independent researchers who had not been involved in the original publication. The key findings of our investigation are that:

  • The Cochrane Review did not miss "nearly half of the eligible trials". A small number of studies were missed due to the primary focus on peer-reviewed reports in scientific journals, but addition of these data makes little or no difference to the results of the review for the main outcome;
  • The trials comparators were unambiguously, transparently, and accurately described;
  • The selection of outcomes for benefits was appropriate and was consistent with World Health Organization guidance;
  • The review included published and unpublished data on serious harms, and the findings on mortality were reported transparently and responsibly;
  • The review was compliant with Cochrane’s current conflict of interest policy;
  • Cochrane’s media coverage was cautious and balanced, but we recognize that there could be improvements in relation to transparency where external experts are quoted;
  • The BMJ Evidence-Based Medicine article substantially overstated its criticisms.

 Read the full response

David Tovey, Editor in Chief, Cochrane
Karla Soares-Weiser, Deputy Editor in Chief, Cochrane

Monday, September 3, 2018

The Recommended Dose podcast: Cochrane co-founder Iain Chalmers

Mon, 08/27/2018 - 14:26

A very special conversation with a maverick British medico who set up a tiny research centre in Oxford and watched it grow into a global collaboration of over 40,000 people across 130 countries. Three decades on, Cochrane  now produces the world's most trusted health evidence that is used by patients, health professionals, researchers and policy makers around the world every day.

Cochrane co-founder Iain Chalmers joins host Dr. Ray Moynihan to look back on the origins of the organisation and the extraordinary life of its namesake, Archie Cochrane. Iain also reflects on his work beyond the collaboration - from working in refugee camps in Gaza to teaching children in Uganda how to detect ‘bullshit’ health claims and more recently, establishing the James Lind Alliance. It's no surprise he's received the BMJ’s most prestigious award for a lifetime of achievement in healthcare, along with a knighthood from the Queen.

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

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

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

Monday, August 27, 2018

Testing Treatments book now available for free in 15 languages

Mon, 08/20/2018 - 16:47

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The book Testing Treatments has been recently translated into Danish, making it available now in a total of 15 languages with more coming soon.

Testing Treatments was written to address a fundamental healthcare question: ‘How do we ensure that research into medical treatments best meets the needs of patients?’  Because research often fails to answer this question, and because many treatments are not based on sound evidence, the authors set out to promote better and more critical public evaluation of the effects of medical treatments.

Testing Treatments is widely used as a learning and teaching aid. The book is for anyone who wants to understand better how treatments can be tested fairly, why it is important to do this, and how anyone interested in health and health care can play a part in the process of testing treatments.

You can access the book in all 15 languages for free on the Cochrane Training website

Tuesday, August 21, 2018

Edinburgh Colloquium schedule sign-up and app are now launched

Mon, 08/20/2018 - 15:09
Sign-up for the Colloquium schedule

Sign-up is now available for the full Colloquium schedule. Login to your Colloquium account, and sign-up for the sessions you want to attend.

Workshops

Please note that most workshops have limited capacity, therefore participants are required to sign up for workshops. You can only sign up for one workshop per time slot, but you can be on the waiting list of a preferred workshop while signed up for another one. You will then receive an email when a spot is available.

Restricted meetings

Meetings are open to all delegates unless marked 'Restricted' to a specific target audience.

Social events
  • Register and donate today for the Anne Anderson Fundraising Walk – a city tour on Edinburgh, set-up to raise money for the Anne Anderson Prize.
  • Sign-up for the Ceilidh dance class – and if you like you can show off your new dance skills at the Gala Dinner.
 
Download the Colloquium app

You can now download the Colloquium app for Apple and Android devices. Search ‘Cochrane Colloquium 2018’ in the app stores.
 
Attendees can log into the app using their Colloquium account details to access and edit their sign-up options. Any changes made in the app sign-up will automatically sync with attendee’s website accounts and vice versa*.

Within the app, attendees will be able to:
  • Edit sign-up options for the Colloquium schedule**
  • Edit their app settings
  • View the full schedule
  • View speaker and sponsor profiles
  • Check floor plans
  • and other useful information

*It won't automatically update any exported calendar items.
**Please note: for iOS users, 'My schedule' can't be managed through the app. You will be redirected to your browser.

To find out more about the app, click here.

Monday, August 20, 2018

Cochrane Infectious Diseases Group seeks Clinical Research Associate in Evidence Synthesis - Liverpool, UK

Wed, 08/15/2018 - 17:50
Salary: Starting salary of £32,478 per annumContract type: Full-time, fixed-term for up to 2 yearsClosing date: 11 September 2018

Founded in 1898 and the oldest of its kind in the world, the Liverpool School of Tropical Medicine (LSTM) is an internationally recognised centre of excellence for teaching and research in tropical diseases. LSTM’s Centre for Evidence Synthesis in Global Health has led developments in systematic reviews in tropical medicine and international health. In the 1990s, staff contributed to setting up Cochrane, and established the Cochrane Infectious Diseases Group (CIDG). This is now recognised as one of Cochrane’s premier groups, with over 150 Cochrane reviews and 600 authors, and is well-linked with the World Health Organization and we are looking to expand the centre.

 As part of this, we are recruiting staff for the six year “Research, Evidence and Development Initiative” (READ-It) programme.  We are in the inception phase and planning a variety of new and exciting reviews with our colleagues, partners, and stakeholders.  You will be part of this process and be part of review teams in the existing and new review portfolio.  Our priorities are developing rapidly and we are seeking to engage the successful applicant in a high-priority area commensurate with their areas of interest. For example, some topics we are mapping out are:

  • Insecticide-residual spraying for malaria control
  • HIV prevention
  • Health of refugees and people living in camps

There are also a variety of methodological projects related to Cochrane review updating, conflicts of interest, statistical reporting, and methods for moving from evidence to policy, and we aim for a mixed portfolio to provide abroad exposure to evidence-informed science.

The successful candidate will have an MBBS and an appropriate postgraduate qualification. Possessing a relevant PhD is desirable. You will have experience and confidence in critically appraising medical literature at postgraduate level. You must demonstrate evidence of a critical insight into priority policy questions in international health in infectious diseases relevant to low- and middle-income countries and have excellent skills in writing in plain English.

You will demonstrate experience of working in a multi-disciplinary team with the ability to work collaboratively as well as independently. We want people who have an enthusiastic approach to work and possess excellent attention to detail. You will be responsible for ensuring that effective communication flows within the project team and will need effective communication, time management, and organisational skills. If you have authored a Cochrane review, have experience of using GRADE, or have a track record in published research, it will be an added advantage to your application.

Wednesday, August 15, 2018 Category: Jobs

Cochrane Infectious Diseases Group seeks Research Assistant in Evidence Synthesis - Liverpool, UK

Wed, 08/15/2018 - 17:17
Salary: Starting salary of £28,098 per annumContract type: Full-time, fixed-term for up to 2 yearsClosing date:11 September 2018 

Founded in 1898 and the oldest of its kind in the world, the Liverpool School of Tropical Medicine (LSTM) is an internationally recognised centre of excellence for teaching and research in tropical diseases. 

LSTM'S Centre for Evidence Synthesis in Global Health has led developments in systematic reviews in tropical medicine and international health. In the 1990s, staff contributed to setting up Cochrane and established the Cochrane Infectious Diseases Group (CIDG). This is now recognised as one of Cochrane's premier groups, with over 150 Cochrane reviews and 600 authors, and is well-linked with the World Health Organization and we are looking to expand the centre.

As part of this, we are recruiting staff for the six year "Research, Evidence and Development Initiative" (READ-It) programme.  We are in the inception phase and planning a variety of new and exciting reviews with our colleagues, partners, and stakeholders.  You will be part of this process and be part of review teams in the existing and new review portfolio.  Our priorities are developing rapidly and we are seeking to engage the successful applicant in a high-priority area commensurate with their areas of interest. For example, some topics we are mapping out are:

  • Insecticide-residual spraying for malaria control
  • HIV prevention
  • Health of refugees and people living in camps

There are also a variety of methodological projects related to Cochrane review updating, conflicts of interest, statistical reporting, and methods for moving from evidence to policy, and we aim for a mixed portfolio to provide abroad exposure to evidence informed science.

The ideal candidate will have a Masters in epidemiology, public health,clinical tropical medicine, or vector biology. You will have experience in biomedical or social science research in low-and middle-income countries and have confidence in critically appraising medical literature at postgraduate level.

You need to have completed a substantive quantitative analysis, either a systematic review or an applied research project.  You need clear evidence of critical insight into priority policy questions in international health relevant to infectious diseases.

Demonstrating initiative, commitment, organisational skills, and the ability to meet deadlines is essential; as is a flexible approach to work withthe ability to work independently or as part of a diverse team.

If you have authored a Cochrane review, have experience of using GRADE, or have a track record in published research, it will be an added advantage to your application.

Wednesday, August 15, 2018 Category: Jobs

The Recommended Dose podcast: Alexandra Barratt on using both medicine and the media to explore and promote the critical role of evidence in healthcare

Thu, 08/09/2018 - 17:15

Episode 12 -Alexandra Barratt
'It's not science or instinct...it's evidence and personal preferences. That's really, to me, the heart of shared decision making.’


This week’s guest has led something of a double life, using both medicine and the media to explore and promote the critical role of evidence in healthcare. Now based at the University of Sydney, Alexandra Barratt's journey from clinician to journalist to global advocate for evidence based medicine and shared decision-making is a fascinating one.

Here she talks with acclaimed journalist and health researcher ,Dr Ray Moynihan, about her varied career and the reasons she's ended up challenging conventional wisdom. She also talks about her research into the pros and cons of breast cancer screening and questions the widely-accepted idea that early detection is always the best medicine.

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

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

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

Thursday, August 9, 2018

Comic highlights Cochrane and World Health Organization collaboration for positive birth experience guideline

Wed, 08/08/2018 - 20:07

Swiss illustrator explains his motivation for creating the comic and what he hopes it shows.

The World Health Organization (WHO) has issued new recommendations to establish global care standards for healthy pregnant women and reduce unnecessary medical interventions. The new WHO guideline includes evidence from 17 Cochrane Reviews and has 56 evidence-based recommendations on what care is needed throughout labour and immediately after for the woman and her baby.

Swiss illustrator, Martin Vuillème from The Science of Cookies (an online French-English comic about the health and social sciences, research, and news) created a comic about the many steps involved in updating the WHO guidelines on the childbirth experience. Here he explains his motivation for creating the comic and what he hopes it illustrates:

“Pregnant women all over the world are keen to make the best decisions for their children and for the future of their families. This may lead them to hear various advice and suggestions from doctors, nurses, midwives, friends and relatives, or even from people they meet on the streets. But where do reliable recommendations come from?  What are they based on? And why should we trust them?

In this illustration I wanted to point out the tremendous work of WHO and the extreme care that was put into formulating trustworthy health recommendations. From the selection of a diversity of unbiased guideline authors, the prioritization of the most important questions and outcomes for pregnant women (such as a “positive childbirth experience”), the search of the most reliable evidence (often coming from Cochrane, an important partner of the WHO) up to the formulation of the final recommendations and their dissemination I hope to have captured the essence of key steps involved in the creation of helpful, informative and reliable international recommendations.

While I may have decided to summarize the guideline making process to a couple pages, care should be taken not to forget that the WHO recommendations and Cochrane review that inspired the creation of this illustration are the culminations of years of efforts invested by dozens of international experts (among which the critically important pregnant women representatives!)...But most importantly, they are the fruit of respectful discussions informed by values and based on research involving thousands of pregnant women, who often volunteered their time and sometimes even risked their lives in the process with no direct rewards. The WHO and Cochrane authors couldn’t have done their work without them.

The care, consideration towards pregnant women and rigor that were shown in the making of those recommendations are the reasons why I put my trust in Cochrane and the WHO...And the reasons why I plan to continue doing so in the future.”

The comic is currently being working on and the input from those involved is welcomed. We will update this page as it progresses.

Thursday, August 9, 2018

Work begins to establish a new Cochrane Network across China

Wed, 08/08/2018 - 19:45

Cochrane is pleased to announce plans to establish a new, open and collaborative Network within China.

A group of interested stakeholders have been invited to a two-day strategic planning meeting to be held on 9-10 October in Beijing (hosted by the Peking University Health Science Center), to discuss the strategic direction and the establishment of a Cochrane China Network. 

The Cochrane China Network primary functions will be around ensuring that Cochrane’s evidence is increasingly used in policy and practice inside China; supporting the Cochrane community of volunteers (authors, methodologists, editors) in China; and promoting and representing Cochrane in the country.

This initiative involves the current Cochrane China Centre in Chengdu, as well as the new leadership of the Cochrane Hong Kong Affiliate. It is expected that a formal launch of Cochrane’s China Network will take place in early 2019.

For more information of Cochrane’s China Network, and sharing suggestions and information that promote Cochrane’s work across China, please contact Sylvia de Haan, Senior Advisor (Centres, Partnerships and Fundraising), Cochrane.

Additional resources:

Wednesday, August 15, 2018

Cochrane Library Special Collections on malnutrition

Thu, 08/02/2018 - 21:16

Free access to all included Cochrane Reviews

Acute malnutrition threatened the lives of 50.5 million children under five years globally (7.5%) in 2017. About 16 million children with acute malnutrition are estimated to have severe acute malnutrition, the most extreme and visible form of undernutrition. 

Two new Cochrane Library Special Collections, which started as part of a joint initiative with Cochrane Nutrition and  Evidence Aid, bring together Cochrane Reviews addressing the prevention of moderate acute malnutrition and severe acute malnutrition and the treatment of acute malnutrition. Access to all Cochrane Reviews included in both Special Collections are free.

Tuesday, August 14, 2018

Editor in Chief discusses the journey to the new Cochrane Library

Thu, 08/02/2018 - 20:31

Editor in Chief of the Cochrane Library, David Tovey, describes the journey of updating the Cochrane Library, which spans being a journal and a knowledge resource, and includes current and archive content, multi-lingual text, and a varied collection of databases.

It all began in April 2012 at Cochrane’s business meeting in Paris: a ‘strategic session’ aimed at agreeing a content strategy for Cochrane and our primary output, the Cochrane Library. My team had prepared well: there was broad approval for moves towards greater diversity in content, and more flexibility in its presentation and delivery to end users (readers). If that moment represents conception, it has been an awfully long gestation.

Readers less familiar with Cochrane may be uncertain about what constitutes the Cochrane Library. Is it a journal? Is it a knowledge database? Therein lies some of the complexity. The Library is a collection of knowledge databases. One of these, the best known and most used, is the Cochrane Database of Systematic Reviews (CDSR). This contains some 7600 systematic reviews, published over the past 25 years, many of which have been updated several times. The CDSR is also a hybrid journal containing some open access content and some available via subscription, which is largely organised on a national, regional or institutional basis. It has monthly issues, an impact factor, and is heavily accessed and cited. The Cochrane Central Register of Controlled Trials (CENTRAL) is a concentrated collection of (predominantly) randomised controlled trials, curated from a variety of sources. It is an essential part of the search for all high quality systematic reviews, whether produced inside Cochrane or not.

The recommendations that emerged from the Paris meeting formed the basis for goals 1 and 2 of the subsequent Strategy to 2020: to produce high quality, relevant reviews that inform health care decision making and to ensure that those reviews are accessed and used. The work to deliver on these goals can be tracked forward to our current Transformation Programme, which has brought together our 52 Cochrane Review Groups into 8 thematic Networks, and the development of our Content and Knowledge Translation strategies. These all reflect an awareness that our content needs to meet increasingly diverse and sophisticated decision maker needs and reflect emerging methods and data sources. We also need to find different ways to communicate review findings, based on a range of different user types (‘personas’ in tech development-speak), and including more diversity in language, presentation (or ‘packaging’) and delivery.

Fast forward from Paris to the café at the Novotel, Hyderabad in September 2014. Around a table in the late afternoon during the Cochrane Colloquium, Todd Toler and Deborah Pentesco-Murphy on behalf of our publishers, John Wiley and Sons laid out their proposals. In essence, after many frustrations, we all recognised that the Wiley Online Library platform, which had hosted the Cochrane Library for many years, was not able to accommodate Cochrane’s plans, without undermining its ability to host all Wiley’s other journals. We agreed that the solution was for Cochrane to be hosted separately, at Wiley’s expense, on a new platform, which would be identified through an RFP (Request for Proposals) process. The discussion energised us all, and it was not difficult to get clearance from our Governing Board to proceed. We had a plan.

A few months later, the venue is a Business School residential centre near London. The largest interview team I have ever experienced – seemingly about 20 people in the room, with more on the phone. Two of us from Cochrane. Four candidate teams over two days. Two clear leaders, and an eventual winner: a software company called Semantico, based in Brighton.

The development was meant to take 12 months. Six or seven months in, we were already behind schedule, when in a blink of an eye Semantico ceased to exist; acquired by Highwire a platform technology company based in Stanford USA with encouraging experience of having hosted major international journals. It may seem churlish now to point out that one of the influences in our choice of development partner was the personal commitment from Semantico’s founder and owner to stay the course. As it turned out not only did Semantico cease to exist but so did its entire Senior Management Team – submerged below the surface without so much as a ripple. The Semantico project manager, then and now viewed widely on all sides as one of the many unstinting heroes of the project, provides the only visible continuity, apart from the developers.

As time went on it became increasingly clear that our deadlines were not being met. The tri-partite development approach originally agreed by Cochrane, Wiley and Highwire was severely tested – we always knew that it was the greatest risk to the project. We got further and further behind schedule despite everyone’s best efforts, which were considerable. Our Governing Board looked over our shoulder, expressed its concern, but permitted us to proceed.

Most of us have had to familiarise ourselves with a new language and new processes. This is a world where ‘waterfall’ is an alternative to ‘agile’. Everyone seemingly agrees that ‘agile’ is the preferred method – leading to show and tell sessions we can attend following every two week ‘sprint’ where we can see the progress that is being made and provide feedback. There are ‘scrum teams’, ‘stand ups’ (brief functional meetings where comedy is not usually a feature), ‘tickets’ and some new acronyms: UX (user experience), UAT (user assessment testing), SMEs (subject matter experts). We talk of ‘SOS’ when we mean ‘Scrum of Scrums’, we document almost every breath in ‘Confluence’, and every task in ‘Jira’. None of the Cochrane editorial team has used these before but by the end of the project several of the team members could choose either as their specialist subject on a quiz show. We talk about ‘Epics’, by which we don’t mean ‘Gone with the Wind’, ‘stories’ (ditto) and ‘features’ (still ditto). You can complete a feature or story without signing off an epic. Or perhaps it is the other way around. Somewhere back in the distant past lies our comfort zone.

After all these tribulations, we have finally reached the first summit. Cochrane has a brand new Cochrane Library. It looks superficially similar to its predecessor so as not to alarm our frequent users, but with some important enhancements.  Our multi-lingual content is easier to find and better presented. This is important. In the past three years we have seen a tripling of the number of people accessing the summaries on Cochrane.org, our own website. This has been almost entirely driven by the increases in use in Francophone and Spanish speaking countries. It is true that if you provide content that is easy to find and in people’s own languages, they will come. The new Cochrane Library incorporates more links between related pieces of content, internally and between the Library and external sites. This includes more links between the bibliographic records in CENTRAL and the reviews in CDSR, and more links from reviews to relevant guidelines. The Cochrane Library now includes content aimed at practising health professionals – Cochrane Clinical Answers - and a federated search of the Epistemonikos platform to identify non-Cochrane systematic reviews. There are other features and functionality available now, including some aimed at ensuring that the Cochrane Library meets the needs of, and links with other developments in the scientific publishing landscape such as Crossref, ORCID, Altmetric, Read Cube and others. Most importantly, there is the promise of many more to follow, including the potential to search by PICO parameters (Population, Intervention, Comparators, Outcomes), and the ability to publish different content types, such as methodological articles, rapid reviews and more varied forms of systematic review, and to package them in different ways customised around the needs of evidence users.

There is no denying that the journey has been harder than we all imagined in 2012. Perhaps that is the underlying message. There is a reason why project management language is now dominated by its technology influences. Nothing is simple when you are building a product that spans being a journal and a knowledge resource, includes current and archive content, multi-lingual text, and a varied collection of databases. If you are planning such a large technology project, my advice is to take 10 deep breaths and ask yourself: do you know everything you need to know? Are you sufficiently clear on your requirements and have you communicated them effectively? What will the implementation effort be, and how much will this distract you from everything else you want to achieve? Study it as hard and in as much detail as you can, and then consider whether to add a nought on to every calculation.

Nonetheless, across the three organisations, committed, skilled groups of people have worked tirelessly to deliver the new Cochrane Library. I am extraordinarily proud of the contributions all of our teams have made, whilst recognising the costs, the sacrifices and pain that the project has incurred. Throughout a long and arduous process, the relationships within and across our organisations have remained positive, cordial and collegiate. We are all pleased with what we have delivered and excited about the next steps. Please visit the Cochrane Library, and send me your feedback. We hope that it will become the ‘home of evidence’ that our ‘Strategy to 2020’ envisaged.

David Tovey
Editor in Chief
Cochrane Library

Thursday, August 2, 2018

Cochrane seeks Medical Terminology Manager - flexible location

Thu, 08/02/2018 - 15:55

Specifications: Part Time (0.6 FTE) 12 Months Fixed Term Contract
Salary: Competitive
Location: Flexible
Application Closing Date: 31/08/2018

This role is an exciting opportunity to use your experience as a Medical Terminology Manager to make a difference in the field of health care research. 

As part of the Cochrane Linked Data team you will have a lead role in developing and maintaining the Cochrane Vocabulary, which includes managing and implementing policies regarding purpose, scope, requirements, concept models, hierarchies and terms for the Cochrane Vocabulary.

You will manage and deliver the quality validation process used in the maintenance of the Cochrane PICO Vocabulary and Ontology.

You will quality check the PICO (Population, Intervention, Comparator, Outcome) meta-data for biomedical research information, coded using controlled vocabularies and terminology sets, including SNOMED CT, RxNorm, MedDRA and WHO ATC. Research information includes systematic reviews, clinical trial reports and randomised control trials.

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:

  • Significant theoretical and practical experience in information science, medical informatics, or closely-related discipline
  • Minimum 3 years experience with the practical application of clinical coding systems (SNOMED CT, RxNorm, MedDRA, WHO ATC)  to a diverse range of content
  • Experience with evidence-based medicine, systematic reviews, trial design, and methodologies
  • Demonstrated experience with taxonomies, thesauri, ontologies, and other hierarchical schema
  • Experience with the maintenance and governance of metadata and the processes around curation, versioning, and management of controlled terminology sets
  • Broad topic experience across all health domains
  • Experience or knowledge of techniques of information retrieval and understanding of users’ needs - search, browse, faceted browse, user interfaces, and federated querying.
  • Strong communication skills (both written and verbal), good collaboration skills, and the ability to work effectively across teams and organizations in a global (mostly virtual) work environment.
  • Results-oriented and the ability to deliver on a schedule
  • Strong analytical and judgment skills including ability to make decisions and manage risk.
  • Attention to detail

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. An understanding of Cochrane’s work and health research more generally is an advantage, but not essential.

If you would like to apply for this position, please send a CV along with a supporting statement, including salary expectations, to recruitment@cochrane.org with Medical Terminology Manager 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 role outlined in the job description using specific examples.  Please list your experience, achievements, knowledge, personal qualities, and skills which you feel are relevant to the post.

For further information, please download the full job description.

Deadline for applications: 31st August 2018 (12 midnight GMT)

Interviews to be held on: (TBC)

Thursday, August 2, 2018 Category: Jobs

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