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Updated: 8 hours 49 min ago

PhD Scholarship Opportunity: Implementation Science in Primary Care

Thu, 07/25/2019 - 14:10

Location: Notting Hill, UK
Employment Type: Full-time
Duration: 3 year fixed-term appointment
Remuneration: $27,872 AUD per annum full-time rate (tax-free stipend for 3 years)
Closing Date: 13 Aug 2019

An exciting opportunity exists for an exceptional candidate who is interested in undertaking a PhD project in the field of implementation science, within the Implementing work-related Mental health guidelines in general PRacticE (IMPRovE) NHMRC Partnership Trial.

Located within the Department of General Practice at Monash University, IMPRovE will implement the recently published Clinical practice guidelines for the diagnosis and management of work-related mental health conditions through a pragmatic cluster randomised controlled trial. Our key objectives are to increase the delivery of evidence-based general practice care for patients, assess the cost-effectiveness of our intervention and plan for national scale up. Components of the intervention will include academic detailing, peer-to-peer support and learning through a digital Community of Practice and the provision of resources.

The PhD project attached to this scholarship will focus on using implementation science theory and methods to contribute to a process evaluation of the IMPRovE trial. Supported by a large interdisciplinary team of investigators, and policy and practice partners, the PhD candidate will characterise the aspects of the intervention and our partnership approach that are likely to lead to successful change in GP practice, and to characterise aspects that may hinder success. This will involve initially undertaking a systematic review to identify the elements of a successful digital Community of Practice. Then, the focus will move towards evaluating the successful and unsuccessful components of the intervention as part of the process evaluation of the trial.

Thursday, July 25, 2019 Category: Jobs

Catherine Marshall appointed Co-Chair of the Governing Board

Thu, 07/25/2019 - 12:33

At its teleconference on 10 July, the Governing Board voted unanimously to appoint Catherine Marshall as its new Co-Chair from 1 September 2019. Catherine will work alongside fellow Co-Chair Martin Burton, and replace Marguerite Koster, who is stepping down from the role after one year due to increased commitments in her job at Kaiser Permanente, in Southern California, but will remain on the Board as a member.

Catherine was one of the first two appointed members of the Cochrane Governing Board in 2016. She is also a member of the Board’s Governance Committee, and Finance Audit and Investment Committee, and was elected as Treasurer in September 2018.

Outside Cochrane, Catherine is an Independent Guideline Adviser and Health Sector consultant based in New Zealand. She is currently Co-Chair of the Partnership Advisory Group with the Guidelines International Network (G-I-N) and was previously Vice Chair of its board of trustees. She was also the inaugural Chief Executive of the New Zealand Guidelines Group, where one of her key responsibilities was the development and implementation of evidence-based guidelines and advice – which often relied on evidence from the Cochrane Library. Catherine is also a prominent health consumer advocate, working on the development of health consumer legislation in New Zealand and as a former member of the NZ Stronger Consumer Voices Alliance. In 2018, she helped organize and participate in the consumer programs for the Cochrane Colloquium in Edinburgh.

“Catherine is a recognized leader in the global evidence-based medicine community” says outgoing Co-Chair Marguerite Koster. “Her experience leading non-governmental and charitable organizations will be a significant asset to Cochrane as she assumes the position of Co-Chair of the Governing Board.”
 
Martin Burton adds, “I am delighted that Catherine has been elected to the Co-Chair position. She is passionate about Cochrane and brings a unique set of skills to the role. At the same time, I am sorry to say “goodbye” to Marguerite. She has been a truly outstanding Co-chair and a wonderful colleague to work with. I am very pleased that she is prepared to continue to serve on the Governing Board.”

And of her appointment, Catherine says, “In the last three years as a Governing Board member of Cochrane, I have been deeply impressed by the strength of Cochrane and the talent of the people who contribute to the collaboration. I am strongly committed to expanding our reach around the globe and finding ways Cochrane advice can assist health consumers.”
 
Members of the Governing Board can be contacted at governingboardsecretary@cochrane.org

Thursday, July 25, 2019

Financial conflicts of interest in systematic reviews

Thu, 07/25/2019 - 10:39

The Cochrane Review 'Financial conflicts of interest in systematic reviews: associations with results, conclusions, and methodological quality' has recently published. We talked to author Camilla Hansen to learn what the latest evidence says and why it is important.

Can you please tell us about this Cochrane Review?
"Systematic reviews summarise existing evidence on a specific research question. These summaries sometimes provide a basis for developing clinical guidelines and can have a major impact on how patients are treated. It is therefore essential that findings from systematic reviews are trustworthy. If not, we may end up wasting resources on interventions that don’t actually work, or even harming patients by using interventions that are dangerous, rather than helpful.

There is a lot of debate about the impact of financial conflicts of interest on research findings and their interpretation. This exact issue has been investigated in many methodology studies of financial conflicts of interest in primary research studies, mainly clinical trials; and these studies have shown that financial conflicts of interest do impact on the conclusions drawn from the randomised trials.

In contrast, fewer methodological studies have investigated the impact of financial conflicts of interest in systematic reviews, and we are not aware of any previous attempt to bring these studies together into a methodological systematic review. We decided to fill this gap.

We included ten studies that investigated a total of 1010 systematic reviews. We primarily investigated the potential impact on results (divided into estimated treatment effects and statistically favourable results) and conclusions. We found no clear difference in results between systematic reviews with and without financial conflicts of interest, but our findings are based on very limited data with a high degree of uncertainty. However, the evidence is stronger in relation to the conclusions of systematic reviews and we found that those with financial conflicts of interest more often had favourable conclusions than systematic reviews without financial conflicts of interest. This is based on seven methodology studies that looked at a total of 411 systematic reviews.

We also investigated the potential impact on the quality of the systematic reviews and found a tendency that systematic reviews with financial conflicts of interest had lower methodological quality than those without financial conflicts of interest.

What are financial conflicts of interest in this context and why are they important?
Financial conflicts of interest can occur when either a company or individuals may benefit financially from how the evidence in a systematic review is interpreted and used, and our focus was on those that relate to connections with drug and device companies. The issue can arise when a systematic review is directly funded by such a company or done by authors employed by such companies. It can also happen when a systematic review is conducted by authors who have financial relationships with drug or device companies, for example when authors have received fees or research grants, or are on advisory boards of drug and device companies. The Cochrane review did not investigate systematic reviews done by authors with a personal financial and professional interest related to certain interventions. For example, surgeons doing specific fee-based procedures in private practice. Similarly, the Cochrane review did not investigate academic conflicts of interest where researchers’ grant applications and academic careers may be influenced by positive studies published in high impact journals.

How did this review come about?
I am doing a PhD on conflicts of interest in clinical research. I realised, together with my supervisors, that no methodological systematic review had been published on this important topic. We therefore decided to do a Cochrane Methodology Review.



What sort of funding can present a conflict of interest? And why?
In medical research, funding can present conflicts of interest in a variety of ways. Sometimes, systematic reviews are primarily funded by non-profit sources (e.g. when reviews are conducted by academic researchers employed at public universities and financed through their salaries), but occasionally industry provides additional indirect funding by contributing with assistance from medical writer or company statisticians. In some cases, systematic reviews are funded by non-profit sources, but conducted by authors with financial ties to the manufacturer of the drug or device they are reviewing. At other times, systematic reviews are solely financed through industry funding (e.g. when drug or device companies provide funding and salary for academic researchers at public institutions to conduct a specific review).  

Common for all types of funding is that it can create ties between the researchers and industry. In some cases, the funding company may influence the design, analysis, or reporting of the study. Since the company has an interest in reaching a specific conclusion, this can impact on decisions made in the way that a study is carried out. In other cases, the conflicts of interest may result in the academic researchers being unduly influenced by the interests of the funder, when interpreting the evidence.

For this review, we focused on funding from drug and device companies only. However, previous studies have also demonstrated that funding from other industries, e.g. tobacco and nutrition companies, impact on research findings and interpretation. Recently, it has been debated whether funding from non-profit organisations or governmental institutions may also create conflicts of interest since they may have an interest in a particular direction of the findings of a study. However, currently little research has been done on the topic.

How does your review build on the work of the previously published review update in 2017 that concluded “sponsorship of drug and device studies by manufacturing company leads to more favourable efficacy results and conclusions than sponsorship by other sources?”
The review from 2017 was led by my colleague Andreas Lundh and focused on funding in primary research studies, mainly clinical trials. Although we deployed similar methods in our review, our focus was on financial conflicts of interest in systematic reviews, rather than the trials in those reviews.

We are also working on a third Cochrane Methodology Review focusing on conflicts of interest in a group of non-research publications, namely clinical guidelines, transcripts from drug and device advisory committee meetings, opinion pieces such as editorials, and narrative reviews.

Therefore, there will soon be three Cochrane Methodology Reviews investigating how conflicts of interest impact on three core types of publications that all influence patient care.

I was interested to read that in contrast to the 2017 review on primary studies, you did not find an association between financial interests and statistically favourable results in systematic reviews. Were you surprised?
You are right that we did not find such an association, but we only found two studies investigating the results sections of systematic reviews, which means that there is not enough data at the moment to determine whether or not there is an association.

You mentioned that you are working on another review: “Conflicts of interest in clinical guidelines, opinion pieces, and narrative reviews”. When is it due? Any preliminary findings you can share?
We are finalising that review right now, and it looks as though the findings from the 2017 review on clinical trials, the new one on systematic reviews, and that third Cochrane Review are quite similar.



What can people who read and use systematic review evidence learn from your review?
Our findings suggest that systematic reviews with financial conflicts of interest should be interpreted carefully. People who read and use systematic review evidence should primarily look for systematic reviews without financial conflicts of interest, for example a Cochrane Review. If that is not available, we suggest that users read the review conclusions with scepticism, are aware of the declarations of interest for the review authors and funding sources, and pay particular attention to their critical appraisal of the review’s methods."

 


Wednesday, August 7, 2019

Fighting bad Science in Austria - BMJ Podcast on Medizin-Transparent

Tue, 07/23/2019 - 17:24

The British Medical Journal 'Talk Medicine' podcast recently featured the work of Medizin-Transparent in the Podcast "Fighting bad science in Austria". Gerald Gartlehner, Director of Cochrane Austria, explains how Medizin-Transparent works.

Medizin-Transparent.at tests the truth of medical statements made in the media in order to support readers, patients, doctors, and decision-makers to critically analyze the information they encounter. This online service is a project of Cochrane Austria and the Department for Evidence-based Medicine and Evaluation.

 

Tuesday, July 23, 2019

Teaching school children about evidence-based medicine: Cochrane UK’s outreach programme

Mon, 07/22/2019 - 20:02

Since 2016 Cochrane UK has been visiting secondary schools in and around Oxford to talk about Evidence-Based Medicine (EBM) and its relevance in our everyday lives. They started with visiting an after-school Science Club and now boost a growing portfolio of schools who welcome them into their classrooms.

  
Cochrane UK  have taught pupils from Years 9 -13 in formal lessons and in extracurricular science and medical clubs. Their talks and workshops aim to bring an awareness of why it is important to question the evidence behind medical claims. They use topical newspaper headlines to illustrate how medical evidence can be misrepresented in the media - how it can sometimes be inaccurate and sometimes just plain wrong. They also illustrate the relevance of EBM on a personal, everyday level by looking at how we choose cold remedies to how we consider medical interventions at national and global levels, using the HPV vaccination programme as an example. They also cover  what constitutes a randomised controlled trial and how a systematic review is produced.

                    

Recently Cochrane UK organised their second half day workshop on EBM. Twenty-five Year 12 students  from local schools took part. Students were introduced to our Citizen Scientist platform Cochrane Crowd, a collaborative volunteer effort to help categorise and summarise healthcare evidence. With the students logged into Cochrane Crowd, they were challenged to screen  as many abstracts as they could within 10 minutes, and they managed an impressive 300+!. You can read more about the first workshop Cochrane UK  ran, in October 2018, here.

 

The schools outreach project now has a momentum and we are getting known in and around Oxfordshire.  We are very keen to extend the programme across the UK and would love to hear from others who might be interested in getting involved. We would be happy to give support and training, and would also share our various slide-sets and resources. Equally, we would be delighted to hear from anyone who has undertaken similar teaching to learn about your experiences.

We can be contacted via Cochrane UK.

Lynda Ware
Senior Fellow in General Practice
Cochrane UK

Selena Ryan-Vig
Communications and Engagement Officer
Cochrane UK

Monday, July 22, 2019

Early Bird Colloquium Registration Deadline: July 25

Mon, 07/22/2019 - 14:47

The Cochrane Colloquium is Cochrane’s flagship annual event that is a great opportunity to meet and network with Cochrane contributors and users globally and to learn more about the wide usage of Cochrane evidence in health decision-making at all levels. This year, the 26th Cochrane Colloquium will take place in the vibrant city of Santiago, Chile, 22-25 October 2019.

The deadline for Early Bird registration for this year’s Colloquium is Thursday, July 25 at midnight Chile time (GMT-4). Registering at the Early Bird rate provides an 18% discount on the standard registration rate. Register now!
 

Monday, July 22, 2019

Video: Cochrane Cancer

Mon, 07/22/2019 - 14:31

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

In this short film we focus on the Cochrane Cancer Network. This film introduces the team, what has happened so far, and the ambition for what is to come.

Monday, July 22, 2019

Cochrane's 30 under 30: Imen Farhat

Mon, 07/22/2019 - 14:12

Cochrane is made up of 11,000 members and over 67,000 supporters come from more than 130 countries, worldwide. Our volunteers and contributors are researchers, health professionals, patients, carers, people passionate about improving health outcomes for everyone, everywhere.

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

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

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

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

The Cochrane 30 Under 30 series is now closed. However, we are keen to hear from early career professionals about their work with Cochrane for future series. If you would like to be added to our waitlist, please conact lparsonson@cochrane.org. Or if you want to know more about Cochrane's work contact membership@cochrane.org where our community support team will be happy to answer your questions.

Name: Imen Farhat (on Twitter: @ImenFarhat2)
Age: 27
Occupation: Research Associate
Program: Masters in Epidemiology at Université Laval, systematic review methodologist at Cochrane Canada Francophone

How did you first hear about Cochrane?
When I was a graduate student, I attended a presentation by Dr Alexis Turgeon, a clinical researcher at Université Laval and the director of Cochrane Canada Francophone. The presentation was on systematic reviews and meta-analyses and the Cochrane methodology. It piqued my curiosity: Why would researchers choose to base a study on already published studies instead of developing an original one? I decided to explore the Cochrane website and was impressed by the methodology and the scientific rigor for published Cochrane studies.

How did you become involved with Cochrane? What is your background?
I have a strong interest in epidemiology, biostatistics, public health and evidence synthesis with the purpose of improving patients’ clinical outcomes and quality of life with evidence-based clinical practice. I have a Bachelor of Science in Mathematics and Biology from McGill University (QC, Canada) and a Master’s of Science in Epidemiology from Université Laval (QC, Canada). During my graduate studies, I joined the Cochrane Crowd and occasionally helped in the Cochrane Canada Francophone team perform meta-analysis. When I graduated with my master’s, I was lucky to get a job working alongside Cochrane Canada Francophone.

What do you do in Cochrane?
I am a systematic review methodologist with Cochrane Canada Francophone. My main role is to train students and researchers interested in performing knowledge synthesis work. I also answer service requests made by systematic reviewers to Cochrane Canada Francophone. Since I am bilingual (French/English), I also help systematic review authors from the French community outside Cochrane Canada Francophone.

What specifically do you enjoy about working for Cochrane and what have you learnt?
I am delighted to be working with multidisciplinary teams that are part of a global network whose focus is to improve patients’ outcomes and evidence-based medicine. I also enjoy the rigour and methodology developed by Cochrane to synthesize evidence. My experience with Cochrane has been very fulfilling as I improved my critical thinking, developed my expertise, and learned how to improve the quality of the systematic reviews. Every day, I have the opportunity to learn new things, improve my medical literacy and share my expertise with others.

What are your future plans?
My future plans are to continue working in clinical research that aims to improve population health and to get more involved with knowledge transfer tools and shared decision making. I look forward to applying to doctoral programs to receive advanced training in epidemiology and health research methodology.

In your personal experience, what one thing could Cochrane do better to improve its global profile?
To improve its global profile, I think Cochrane should embrace technology and social media to disseminate results of systematic reviews to the global population. Although Cochrane is widely known in research and academia, its reach to the public is still far from its potential. I think that working with clinicians to improve evidence-based medicine is crucial in changing practice. However, many individuals outside of academia look for health related answers, either to improve their lifestyle or due to some medical conditions, without ever finding a reliable answer.

I also think that making weekly podcast in widely spoken languages available on popular streaming platforms might allow knowledge seeking individuals to easily access high-quality research that can be understood without prior medical or epidemiological knowledge.

What do you hope for Cochrane for the future?
I hope that Cochrane continues its growth and reaches groups of people that were not reached yet. I think that making the process easier for authors to perform Cochrane reviews will also benefit for the whole community.

How important is it that young people get involved in Cochrane?
I think young people are an important part of the continuous success of any organization. They bring a new dynamic, new ideas and innovation which allows the organization to grow and evolve. They also come with questions and a great appetite for learning and thus, might reflect what other groups, such as the public and non-specialists, think and question.

Why is this, do you think?
I think that young people are as much important as experienced ones for Cochrane. Often, young people are not set in their ways which allows them to be more flexible and pursue new ideas. They can adapt rapidly to new technologies, represent the next generation thinking, and are representative of one part (20-30 age category) of the population. Experimenting and incorporating technology is crucial for Cochrane to stay up to date.

As for young people, getting involved in Cochrane can bring them a sense of belonging to a community working together to improve research and evidence-based medicine. This can be very rewarding both at the spiritual level, but also at the intellectual level. Cochrane is one way for young people to develop their critical thinking and sharpen their skills.

What would your message be to other young people who want to get involved with Cochrane’s work but not sure where to start….?
I would suggest they visit the Cochrane website where they can learn more about evidence-based medicine and knowledge synthesis. They can also join the Cochrane Crowd and help summarize and categorize healthcare evidence and get involved by participating in the Cochrane TaskExchange where they can share their skills with others. Students 4 Best Evidence is an interesting initiative from Cochrane where students can learn about evidence-based medicine but also blog about some topics related to research methods and evidence-based knowledge synthesis.

Monday, July 22, 2019

Cochrane launches Cochrane’s Evidence Essentials: An introduction to evidence-based medicine and systematic reviews

Thu, 07/18/2019 - 16:16

New online learning is now freely available to anyone who is interested in an introduction to Evidence Based Medicine, Cochrane evidence and how to use it.

Cochrane is delighted to announce the launch of four, free, online learning modules, Cochrane Evidence Essentials. Written from the perspective of a healthcare consumer and co-created with patients and carers, this learning resource is perfectly pitched to give anyone an introduction to Evidence Based Medicine and Systematic Reviews. It will be especially valuable to the growing community of patients, carers and family members who work alongside researchers to co-create Cochrane evidence.

The journey through the learning is guided by “Eleni” a fictional character, who is looking for reliable evidence to help her make informed choices. By following Eleni’s story, users can explore topics that include Evidence Based Medicine, clinical trials, systematic reviews, and how to find, understand and use Cochrane evidence. The learning is engaging and includes contributions from a wide range of subject matter experts, quizzes, short films, audio, interviews, interactive graphics, and links to further information for people who wish to learn more.

Richard Morley, Cochrane’s Consumer Engagement Officer, said “In my role, I support healthcare consumers every day. I know how hard it can be to find good resources that introduce people to the unfamiliar concepts around Evidence Based Medicine and Systematic Reviews. It was this that led to us providing this highly accessible, new learning that will allow non-experts to learn all about our work and importantly will help more healthcare consumers make informed decisions about their health.

I am especially pleased that we co-produced this learning with healthcare consumers. The result is a learning resource that covers the topics that people need, and in a way that is accessible to all.”


Karen Morley, Cochrane Consumer and co-author of the resources, said “As a consumer, there was so much I wanted to know and understand about Evidence Based Medicine and Cochrane systematic reviews. The information I was seeking was scattered, complex and often challenging. I'm thrilled to see our raw content extensively refined, tested and brought together in this beautiful interactive package. How exciting!”

Chris Champion, Head of Membership, Learning and Support Services added “For Cochrane to achieve its vision, producing high quality reviews isn’t enough, we aspire to a world where all health decisions are informed by that high-quality evidence, and so we need to help people understand evidence and how to use it. This approachable new suite of learning does exactly that by providing high quality, introductory learning about Evidence Based Medicine and systematic reviews, to allow more people to understand the role evidence has in health decisions and to provide them with the understanding to use that evidence. I hope that anyone new to the world of Evidence Based Medicine will find these indispensable.”

The online modules can be accessed with a free Cochrane account at https://training.cochrane.org/essentials

Tuesday, July 23, 2019

Featured Review: Evidence for the benefits and harms of screening for malignant melanoma

Wed, 07/17/2019 - 12:30

 The Cochrane Review 'Screening for reducing morbidity and mortality in malignant melanoma' has been recently updated.  We talked to Cochrane  author  Karsten Juhl Jørgensen to learn what the latest evidence says and why it is important.

Can you tell us about this Cochrane Review?
We reviewed the evidence for the benefits and harms of screening for malignant melanoma (a type of skin cancer) compared with no screening. We included all types of screening (e.g. skin self‐examination, or examination by a health professional) of any person not suspected of having malignant melanoma, i.e. people with no known suspicious mole or lesion, irrespective of age or gender. Studies in people thought to have a high risk of developing malignant melanoma were included, but not those known to previously have had melanoma.

What does the evidence tell us about the current available evidence for screening?
We found two randomised trials that met our inclusion criteria, but no data on any important outcomes where reported. This means that we do not have sufficient evidence to determine the benefits and harms of screening for malignant melanoma. Both international and national health organisations such as WHO and the UK National Screening Committee have outlined specific criteria to implement screening programmes on a population level (UKNSC 2015WHO 2008), underlining the importance of solid evidence for both benefits and harms. Current screening practices for melanoma do not live up to these required evidence standards.

Why is this such an important topic?
Malignant melanoma is a skin tumour, which can cause death by spreading to other parts of the body; the number of malignant melanomas is rising sharply, while the risk of dying from the disease has been virtually stable. Currently, Germany has a national skin cancer screening programme and many interest groups campaign for melanoma screening.

Screening has the potential to reduce deaths from melanoma through earlier detection. However, there are also potential harms from screening people without symptoms of melanoma, such as finding melanomas and other skin lesions that would not have caused symptoms if they had remained undetected (i.e. overdiagnosis), unnecessary surgery, and possible psychological stress. There is also the risk that healthcare resources and finances are not being utilised optimally and could provide greater benefits if allocated to other interventions with a stronger evidence base... It is therefore important to establish the evidence base for both benefits and harms of screening for melanoma.

What does this tell us about screening programmes in current use?
We do not know whether current screening initiatives for malignant melanoma results in any benefits, or whether such potential benefits are outweighed by the potential harms, or if it is reasonable in relation to the resources used. We do know that current screening programmes and campaigns do not fulfil established general criteria for screening.

What is needed to determine the benefits and harms of screening?
To determine the benefits and harms of screening for malignant melanoma, a rigorously conducted randomised trial is needed. As malignant melanoma is a comparatively uncommon cause of death, such a trial would need to be quite large to provide useful answers.

Since opportunistic screening is already widespread in many countries, a challenge to any trial would be to make sure that the control group is not subject to such screening (i.e. to avoid contamination of the control group), since this may dilute both potential benefits and potential harms of screening estimated from the trial. Apart from a potential effect on mortality from melanoma, other important outcomes to consider in future trials include less aggressive treatment, overdiagnosis, psychosocial consequences, and resource use.

Why is this important?
This review shows that adult general population screening for malignant melanoma is not supported or refuted by current evidence from randomised controlled trials and therefore does not fulfil well-established screening criteria. Yet screening for malignant melanoma is currently practised in many countries in a more or less organised form. This is problematic since data from randomised trials demonstrating that benefits outweigh harms is considered mandatory before the introduction of screening programmes for cancer (UKNSC 2015WHO 2008). The case of screening for malignant melanoma reinforces the importance of this requirement. First, non‐randomised studies of the effects of screening may lead to seriously misleading results. Second, screening has important harms, such as overdiagnosis and overtreatment of malignant melanomas, and robust trials would need to be performed to quantify them and enable us to weigh them against the benefit. Third, the majority of people who take part in the screening programmes cannot benefit from screening as they will never develop the disease. Fourth, screening programmes have a high potential for opportunity costs (Harris 2014). Fifth, when offering screening, healthcare systems invite asymptomatic people to an intervention that they have not asked for, which leads to ethical considerations that differ from those in regular health care (Sackett 2002).

Friday, July 19, 2019

Featured Review: Electric fans during heatwaves

Wed, 07/17/2019 - 11:06

The Cochrane Review 'Electric fans for reducing adverse health impacts in heatwaves' is being turned to for advice on dealing with recent heatwaves. We talked to lead author, Mike Clarke, to learn if the evidence says that the use of electric fans contribute to or impede heat loss during a heatwave.

Why is this Cochrane Review so important? Isn’t it obvious that electric fans are useful when the weather gets hot?
Although it‘s clear that fans make us feel cooler when the temperature is in the high 20s and 30s °C, and the speed with which they leave the shop shelves as temperatures rise shows this; what’s much less clear is what they do to health generally and, at the extreme, whether they increase or reduce the chances of people surviving a heatwave. We did the review to look into this and the studies we identified suggest a need for caution, especially as the temperature rises beyond 35°C.

 What did you find?
After searching through thousands of articles in multiple languages, we were disappointed that there were no high quality comparative trials that would allow us to reliably determine the effects of fans on major health outcomes or survival. However, we did find several other studies that had looked at this during heatwaves, such as the one that led to an additional 30,000 deaths in Europe in the summer of 2003. These studies had mixed results, and the important message is that some of them suggested that using an electric fan might increase the chances of dying during the heatwave.

 How could that be?
One of the main ways that fans make us feel better is that they cool us by speeding up the evaporation of our sweat. The downside of this is that our bodies are losing water more quickly. If we don’t replace this by drinking more, we will dehydrate, which is dangerous. Another issue is that a fan might actually heat us up. This is because it‘s blowing hot air on to us, especially when the temperatures gets above 35°C, and that’s like what happens when switching an electric oven from its regular setting to the fan setting in order to cook our food faster.

Who might this be most relevant to and what should people do?
If fans are harmful, it’s going to be a particular problem when they are used for people who aren’t able to let us know if they’re feeling particularly unwell or becoming dehydrated, such as the very young or old, and those who have difficulty communicating, such as people with dementia or other types of cognitive impairment. Everyone needs to be aware of the potential harms from using fans, especially those who are looking after these vulnerable groups.

People should heed the advice from Public Health England, which was released with their national heatwave plan for England. They recommend that electric fans be used if the temperature is below 35°C, but not aimed directly at the body and that those using them should stay hydrated with regular drinks.

How did this review come about?
The review was done in the run up to the London Olympics in 2012, when it was important to gather evidence that might be needed if a heatwave struck when thousands of athletes and tens of thousands of extra visitors arrived for the Games. We assembled an international team, with researchers from Canada, Hong Kong, India and the UK looking for and checking the existing research. We were from a variety of organisations, including the Climate Change and Health Office of Health Canada; Queen’s University Belfast in the UK; the Chinese University of Hong Kong-Oxford University Centre in Hong Kong; what is now Public Health England; and Evidence Aid, which is an international organisation dedicated to improving access to evidence relevant to disasters and humanitarian emergencies, such as heatwaves. The Centre for Public Health in Queen’s University Belfast provided methodological support for the team, and working with the Cochrane Gynaecological Cancer Group in Bath (UK), we were able to get the review done in about nine months.

If the review was done in 2012, are the findings still valid?
Yes. We’re not aware of any studies that would change our conclusions that the benefits and harms on major health outcomes of using electric fans during heatwaves are uncertain, and that there is a risk that using fans might increase the number of deaths.

What type of study would provide the information to clear this up?
What I'd really like to see is a large trial in which one group of people go without fans and another group use them during a heatwave. Given the uncertainty about benefits and harms, it would be reasonable to decide these groups using a random process and it might be particularly relevant for, for example, older people living in care homes whose health should be closely monitored during the heatwave. Ideally, a national or international funder of health research should arrange for such a study to be in place, ready to take “off the shelf” and activate the next time a heatwave strikes.

Thursday, July 18, 2019

Featured Review: Incentives for smoking cessation

Wed, 07/17/2019 - 10:38

Evidence published in the Cochrane Library provides strong evidence that financial incentives helped people to stop smoking and stay stopped long term.

The team investigated whether rewards such as cash payments, vouchers, or the return of money deposited by those taking part, worked. The review summarizes the results from 33 randomised controlled trials involving more than 21,600 people from eight countries. They included ten trials that focused on pregnant smokers who were rewarded with vouchers for quitting and staying smoke free.

The review was led by University of East Anglia (UK) and involved researchers from the University of Oxford and the University of Stirling. Lead author Dr Caitlin Notley, from UEA’s Norwich Medical School, said: “Smoking is the leading cause of disease and death worldwide. Most smokers want to quit, but stopping smoking can be really challenging.

We found that six months or more after the beginning of the trials, people receiving rewards were approximately 50 per cent more likely to have stopped smoking than those in the control groups.  In people not receiving incentives, approximately 7% had successfully quit for six months or longer, compared to approximately 10.5% of those receiving incentives. This is an important increase when we consider the enormous harms of smoking, and benefits of quitting, and suggests that incentives can be a useful part of a comprehensive approach to help people quit smoking. Another really important thing is that success rates continued beyond when the incentives had ended."

Wednesday, July 17, 2019

Cochrane seeks new Co-ordinating Editor – flexible location

Tue, 07/16/2019 - 15:07

Specifications: Hours tbc
Location: Flexible
Application Closing Date: 1 September 2019 (12 Midnight GMT)

The Cochrane IBD Group is looking to appoint one or more new Co-ordinating Editors to provide leadership of the Group. The IBD Group is part of the Cochrane Abdomen & Endocrine Network. This is an important opportunity to lead and shape the future development of a strategically important area of Cochrane’s healthcare evidence coverage. The IBD Group portfolio of reviews includes 90 active reviews and 45 protocols.

We invite applications from individuals based anywhere in the world, from existing Cochrane Groups and from outside Cochrane, and also those interested in a job share arrangement. Applicants should be aware of the following requirements:

1.    The Co-ordinating Editor(s) must have:

  • Experience of authoring Cochrane or alternative high quality systematic reviews
  • Clinical expertise and standing in the field of inflammatory bowel disease
  • Methodology expertise in the field of evidence synthesis, including risk of bias and GRADE assessments


2.    The following attributes are highly desirable

  • Experience of editing Cochrane reviews or alternative high quality systematic reviews
  • Advanced methodological skills and knowledge

3.    The new Co-ordinating Editor(s) must work within the terms of the Collaboration Agreement that defines the responsibilities of Cochrane and the Cochrane Review Group. 

4.    The new Co-ordinating Editor(s) must actively engage with the Abdomen & Endocrine Network and adhere to the Network’s strategic plan.

For further information, please see the full role description, which sets out all of the responsibilities of the role.
Potential applicants should familiarise themselves with Cochrane’s commercial sponsorship and conflict of interest policy.

Individuals who are interested in exploring this opportunity are welcome to contact Karla Soares-Weiser, Editor-in-Chief (ksoares-weiser@cochrane.org) or Cindy Farquhar, Senior Editor, Abdomen & Endocrine Network (c.farquhar@auckland.ac.nz).

To apply, please send a cover letter detailing the responses to the numbered bullet points above, and a short Curriculum Vitae to recruitment@cochrane.org.

Deadline for applications: September 1, 2019 (12 midnight GMT)

Details of interviews will be provided in the due course

Tuesday, July 16, 2019 Category: Jobs

Video: Cochrane Musculoskeletal, Oral, Skin and Sensory Network

Mon, 07/15/2019 - 17:43

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

In this short film we focus on the Cochrane Musculoskeletal, Oral, Skin and Sensory Network. This film introduces the team, what has happened so far, and the ambition for what is to come.

 

Monday, July 15, 2019

Cochrane's 30 under 30: Jenna Patterson

Mon, 07/15/2019 - 15:21

Cochrane is made up of 11,000 members and over 67,000 supporters come from more than 130 countries, worldwide. Our volunteers and contributors are researchers, health professionals, patients, carers, people passionate about improving health outcomes for everyone, everywhere.

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

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

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

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

The Cochrane 30 Under 30 series is now closed. However, we are keen to hear from early career professionals about their work with Cochrane for future series. If you would like to be added to our waitlist, please conact lparsonson@cochrane.org. Or if you want to know more about Cochrane's work contact membership@cochrane.org where our community support team will be happy to answer your questions.

Name: Jenna Patterson
Age: 26
Occupation: PhD Student
Program: Vaccines for Africa Initiative, University of Cape Town

How did you first hear about Cochrane?
I first came across Cochrane whilst writing an assignment for my nursing degree having been introduced to the organisation in the theory taught. My ‘evidence-based practice’ module also covered the principles behind Cochrane reviews and how they are the gold standard for systematic reviews.

How did you become involved with Cochrane? What is your background?
I am trained as an epidemiologist and am currently completing my PhD project considering evidence-informed vaccinology in South Africa. I decided to include a Cochrane review as one chapter of my PhD as it is the gold standard of synthesizing available evidence. I became involved with Cochrane on a consulting bases through connections made and the African Evidence Network Conference in 2018 conference and African Cochrane Indaba in 2019.

What do you do in Cochrane?
I am the first author of an ongoing Cochrane Hepato-Biliary Group review entitled “Hepatitis A immunisation in persons not previously exposed to hepatitis A” and also consult as a research assistant for the Cochrane Center South Africa.

What specifically do you enjoy about working for Cochrane and what have you learnt?
I really enjoy working under the Cochrane method. Completing reviews using Covidence and RevMan greatly empowers global collaboration and has allowed me to make many professional connections around the world.

What are your future plans?
I would like to continue working in the evidence-based health care space. My professional goal is to contribute to work that attempts to close the “know-do” gap in public health policy and to increase the uptake of evidence in health care decision-making.

In your personal experience, what one thing could Cochrane do better to improve its global profile?
In order to improve its global profile, I believe that Cochrane should invest in training policy and/or decision makers in the art of conducting systematic reviews and meta-analyses.

What do you hope for Cochrane for the future?
My hope is that Cochrane continues to foster relationships with stakeholders in public health to increase the translation of findings into policy.

How important is it that young people get involved in Cochrane?
It is incredibly important that young people get involved with Cochrane and learn systematic review and meta-analyses methodologies.

Why is this, do you think?
In the future where “Big Data” rules, it will become more and more important for us to synthesize research findings in order to create evidence-based health policies.

What would your message be to other young people who want to get involved with Cochrane’s work but not sure where to start….?
My best piece of advice would be for young professionals to consult the Cochrane interactive learning resources and to join in on Cochrane Webinars. These are incredibly helpful resources and can enable researchers to learn about the Cochrane method.

Monday, July 15, 2019

Podcast: Constraint-induced movement therapy in the treatment of the upper limb in children with unilateral cerebral palsy

Mon, 07/15/2019 - 14:33

Cerebral palsy is the most common form of childhood disability, and there are several Cochrane Reviews of therapies that might help the children and their families. These include a review on constraint-induced movement therapy, which was updated in April 2019. We asked lead author Brian Hoare from Monash Children’s Hospital in Australia to tell us about this treatment, and the evidence on its effects.

A large proportion of children with cerebral palsy, or CP, have unilateral CP, which is also known as hemiplegic CP. This affects muscle control and function on one side of the body and is the focus of our review. Children with unilateral CP find it difficult to use their hands together and will often disregard the more affected arm. Constraint-induced movement therapy, or CIMT, aims to increase use of this arm and improve how children with unilateral CP use their two hands together to perform daily tasks. It’s based on two principles: restraining the use of the less affected arm (for example, using a splint, mitt or sling) and intensive therapeutic practice of the more affected arm.

In our Cochrane review, we look at direct comparisons of CIMT and comparisons against other interventions, which we analyzed in groups depending on the relative dosage of those other interventions. Among a range of outcomes, we were particularly interested in evaluating the effect of CIMT on how children with unilateral CP use their two hands together, which goes by the technical term: bimanual performance.

We found 36 randomised trials from 19 countries, making CIMT the most highly studied intervention in children with CP. There was enormous diversity among the trials including a broad range of constraint devices, models and dosage of therapy; outcome measures; settings; and comparison interventions. The average age of children in the studies was 6 years, with the youngest being just 3 months old and the oldest, 19. While the average duration of the CIMT provided was about 130 hours, there was significant variation; ranging from 20 hours to just over 500 hours; and the duration of daily intervention sessions also varied widely, from 30 minutes to 8 hours. The average length of programs was 5 weeks.



When assessments were done immediately following intervention, we found low-quality evidence that CIMT is more effective than a low dose comparison for improving bimanual performance. However, it was not more effective for improving bimanual performance when compared with a high dose or dose-matched intervention. A small number of children were unable to tolerate CIMT due to frustration and lack of acceptance of the constraint device, with nine children out of nearly 500 in the trials being unable to continue CIMT. However, overall, CIMT appears to be a safe intervention for children with unilateral CP.

In summary, CIMT may work better than other arm therapy carried out at low intensity for improving children’s ability to use both hands together, but it appears no more effective than other therapies carried out at a high dose or equal dose. The specific mode of CIMT is a lesser issue than implementation of a carefully-targeted and well-supported therapy program. Families should feel confident that, on average, active engagement in a well-defined, intensive program of CIMT or bimanual therapy at an intensity greater than "usual care" can lead to improvements in their child’s hand performance. The challenge now is for clinicians to identify potential barriers and enablers for implementation of these approaches and to bring them into their clinical practice.

Monday, July 15, 2019

Cochrane seeks Managing Editor / Researcher for Cochrane Work - Amsterdam

Thu, 07/11/2019 - 18:52

Job type: Fixed Term Contract
Working hours: Part-time
Application deadline: 9 Aug 2019
Location: Amsterdam

A Managing Editor is required to ensure the efficient and effective operation of the Amsterdam Satellite of Cochrane Work in collaboration with the editorial base in Kuopio (https://work.cochrane.org/). The candidate will be responsible for managing the editorial processes for systematic review preparation and publication. This involves providing specialized editorial and methodological support to systematic review authors, managing the process of peer review, maintaining communication between the editorial team members, submitting reviews and protocols to the publisher, maintaining the website, and representing Cochrane Work to all relevant individuals and agencies.

The satellite’s editorial base location will be at the Coronel Institute of Occupational Health at Amsterdam UMC, Academic Medical Center (AMC), University of Amsterdam, Amsterdam, the Netherlands. The Coronel Institute of Occupational Health is the Netherlands’ largest university department in the field of Occupational Health. Subjects of research include the prevention, etiology, assessment and treatment or supervision of diseases that are related to work and work ability. The Coronel Institute collaborates with various university departments in and outside the Netherlands that conduct research in the field of Occupational Health and Insurance Medicine.

The position is for 14.4 hours a week (2 days a week).

Thursday, July 11, 2019 Category: Jobs

Cochrane 2018 Annual Review now available

Wed, 07/10/2019 - 19:25

Find out more about Cochrane’s key achievements during 2018 and the strides being made on our major Strategy to 2020 initiatives.

"We’re a knowledge organization built on the capabilities and passion of our collaborators; and the good news is that people from around the world are flocking to contribute and support our work."
Mark Wilson
Cochrane Chief Executive Officer

View or download the 2018 Annual Review

Wednesday, July 10, 2019

Cochrane supports European regulators as they urge clinical trial sponsors to share their results

Wed, 07/10/2019 - 14:32

Cochrane’s Editor in Chief supports an open letter recently co-authored by the European Commission (EC), the European Medicines Agency (EMA) and the Heads of Medicines Agencies (HMA), reminding clinical trial sponsors of their obligation to make their results public.

Cochrane has long recognised that clinical trials are key to improvements in patient care and disease prevention and that access to information from these trials is essential for patients, practitioners, policy makers and other stakeholders to be able to make well-informed decisions about healthcare and medical research. Yet an unacceptable number of sponsors allow their trials to go unreported, despite their legal obligations.

Karla Soares-Weiser, Cochrane’s Editor in Chief, responded to the EC-EMA-HMA letter, saying: “Cochrane strongly supports the reporting of results from all clinical trials. Failure to report findings and the selective sharing of results stop us from getting a full view of the evidence for our systematic reviews – so the benefits of an intervention could be exaggerated, or the harms underestimated. This severely undermines the ability to make truly evidence-informed decisions about healthcare.

We welcome this effort from these key European stakeholders to push trial sponsors to meet their ethical obligations by submitting their protocols and results in a timely manner. While regulations already exist in this area, action needs to be taken to ensure compliance. We urge the sponsors of these studies – the pharmaceutical companies and particularly the academic institutions – to do better.”

The EC-EMA-HMA letter reminds sponsors to follow legislation by submitting trial protocols and results to the EU Clinical Trials Database (EudraCT).

Under EU rules, which came into force in July 2014, trial sponsors must post summary results within one year of a study ending, or six months for paediatric trials. However, the letter reports that, as of April 2019, 31.8% (5,855) of studies due for results are missing findings.

Non-commercial sponsors, such as academic institutions, have drastically lower rates of reporting than the pharmaceutical industry. According to the letter, just 23.6% of studies from non-commercial sponsors had posted results, compared to 77.2% of those with commercial sponsors.

Cochrane’s support of trial transparency
Cochrane has supported the AllTrials initiative since it started in 2013. AllTrials calls for all past and present clinical trials to be registered and their full methods and summary results reported.

In 2017, Cochrane co-published a report with Transparimed, Transparency International and the Collaboration for Research Integrity and Transparency, Clinical Trial Transparency – A Guide for Policy Makers, highlighting the dangers of inadequate reporting of clinical trials and making recommendations to improve the situation. These include ensuring that publicly-funded trials are transparent; effectively enforcing existing rules; and strengthening laws and regulation.

Wednesday, July 10, 2019

Cochrane seeks Interim Human Resources Manager - London, UK

Tue, 07/09/2019 - 18:14

Specifications: Full Time 4 Months Fixed term contract
Salary: Competitive
Location: London Office based
Application Closing Date: Immediate start required

This role is an exciting opportunity to use your experience in HR Management to make a difference in the field of health care research. 

The Human Resources Manager will lead and manage a high quality, responsive, efficient and effective Human Resources function for Cochrane and its subsidiaries.

Key areas

  • Recruitment and on-boarding
  • Talent attraction and management
  • Employee Relations
  • People Relations for secondment and consultancy contracts
  • Learning and Development
  • Monitoring and managing HR data
  • Reviewing and implementing policies across the organisation
  • Reviewing and overseeing the HR appraisals process
  • Maintain effective and supportive relationships throughout the organisation
  • Promote equality and diversity as part of the culture of the organisation

Stakeholder Management and Support - External

  • Develop and maintain effective relationships with business advisers including overseas HR/payroll support in Denmark and Germany; UK payroll bureau; out-sourced training providers
  • Maintain and manage relationships with pension provider Royal London; childcare voucher and cycle to work scheme providers
  • Build and manage relationships with host institutions for secondment contracts

Stakeholder Management and Support – Internal

  • Ensure high levels of service to staff, consultants and other Cochrane employees are maintained across the Central Executive Team
  • Provide and review monthly HR dashboard with Heads of Department
  • Ensure people-related contracts are regularly monitored and reviewed
  • Provide proactive HR guidance and support across the organisation, (including Cochrane Groups) as required.
  • Undertake any other duties considered appropriate.                                                                                                                                                                                 

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:

Essential

  • CIPD qualification equivalent to Level 7
  • Demonstrable experience of leading a fully operational HR service comprising generalist advice, payroll, benefits, learning & development and change management
  • Experience of scoping and implementing HRIS systems (PeopleHR)
  • Ability to work in a dynamic, fast-paced environment, adapting quickly to rapidly changing situations
  • Up to date working knowledge of employment legislation
  • Experience of coaching and supporting managers
  • Experience of designing and managing training and development programmes
  • Self-confidence, personal credibility and the ability to support and challenge others appropriately
  • Good understanding of and the ability to apply the principles of confidentiality
  • Intermediate level IT skills, including Word, Excel, Powerpoint and Outlook
  • Ability to prioritise and manage own workload
  • Proven ability to work both independently and productively as part of a team
  • Excellent interpersonal skills
  • Excellent communication skills, both verbal and written
  • Good understanding and application of the principles of Equal Opportunities in a HR context
  • Excellent attention to detail
  • Pragmatism and problem-solving skills and the ability to think creatively when faced with new problems
  • Commitment to Cochrane’s mission and values

Desirable

  • Up to date working knowledge of employment legislation in Denmark and/or GermanyOverseas payroll /contract experience
  • Experience of HR support in an International context supporting remote working
  • Experience of healthcare charity sector

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

If you would like to apply for this position, please send a CV along with a supporting statement to recruitment@cochrane.org with “Human Resources 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 post outlined in the job description using specific examples.  List your experience, achievements, knowledge, personal qualities, and skills which you feel are relevant to the post.

For further information, please download the full job description.

Interviews to be held on: (TBC)

 

Tuesday, July 9, 2019 Category: Jobs

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