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Featured Review: Barriers and facilitators to the implementation of doctor‐nurse substitution strategies in primary care

Thu, 04/11/2019 - 13:33

What factors influence implementation of doctor-nurse substitution strategies in primary care?

  • Nurses as substitutes for doctors in primary care: evidence from 66 qualitative studies
  • Patients may accept the use of nurses to deliver services that are usually delivered by doctor
  • Implementation prompts have been developed to help programme managers who are considering implementing task-shifting strategies

 Many people do not get the healthcare they need because of a lack of healthcare workers where they live. Governments across the world are trying different solutions to address this problem. One possible solution is to move tasks from more-specialised to less-specialised health workers, for instance, moving certain tasks from doctors to nurses.

In this Cochrane Review of qualitative studies, the review authors working with the Cochrane EPOC (Effective Practice and Organisation of Care) Group explored peoples' views and experiences of moving tasks from doctors to nurses in primary healthcare, it includes 66 studies (69 papers).

This qualitative evidence synthesis links to another Cochrane Review published in 2018 that assesses the effectiveness of moving tasks from doctors to nurses in primary care. Doctor-nurse substitution is a complex intervention. The Cochrane intervention review on doctor-nurse substitution concluded that the effectiveness of doctor-nurse substitution initiatives was promising. However, the level of organisation and support used in these trials may have been higher than in real-life settings. When implementing complex interventions, we need to consider the contextual factors of each setting. This includes a proper understanding of the factors that might influence the intervention’s implementation, success and sustainability. These factors could include the values and preferences of stakeholders and the feasibility and applicability of the intervention for particular settings and health care systems. Our synthesis of qualitative evidence helped to identify factors influencing the success of substitution interventions, including the attitudes and experience of the health workers themselves and also those of other stakeholders.

Lead author of this Cochrane review Elham Shakibazadeh concluded, “Many people do not get the healthcare they need because of a lack of healthcare workers where they live. Governments across the world are trying different solutions to address this problem. One possible solution is to move tasks from more-specialised to less-specialised health workers, for instance, moving certain tasks from doctors to nurses.”

“Patients, doctors and nurses may accept the use of nurses to deliver services that are usually delivered by doctors. But this is likely to depend on the type of services. Nurses taking on extra tasks want respect and collaboration from doctors; as well as proper resources; good referral systems; experienced leaders; clear roles; and adequate incentives, training and supervision. However, these needs are not always met.”

Monday, April 15, 2019

Eleven Cochrane Reviews inform a World Health Organization Guideline on digital healthcare

Thu, 04/11/2019 - 10:20

A new WHO guideline on Digital Interventions for Health System Strengthening published on April 17th, 2019.  The main objective of this new guideline is to provide evidence-informed recommendations to policy makers on key digital health interventions, to inform country investment plans. The guideline also describes potentially important implementation considerations for these interventions. And finally, the guideline identifies evidence gaps to inform member states and streamline future research investments and implementation planning. The guideline includes contributions from eleven Cochrane reviews.

Nine of these reviews were commissioned by the WHO for the guideline. The other two reviews were already in progress but were finalised in collaboration with the WHO.  Two of the reviews are qualitative evidence syntheses and two reviews are mixed methods reviews.

Simon Lewin and Claire Glenton, from Cochrane’s Effective Practice and Organisation of Care (EPOC) Group, have played central roles in the development of the guideline. As part of the technical team, they helped to scope the guideline, commission the reviews, prepare the evidence, and support the decision-making process. They have also been closely involved as editors or co-authors of most of the reviews.  In addition, Cochrane Response – the systematic review unit set up to increase Cochrane’s capacity to respond to the needs of commissioners – has worked on most of the reviews and has played a key part in review production.

In this interview we asked Simon Lewin and Clare Genton from the Cochrane Effective Practice and Organisation of Care Group (EPOC) to tell us more.

Tell us about this guideline…

To give you an overview, the guideline looks at different ways of using digital technology to organise health services, primarily through mobile phones. Some of the recommendations involve service users – for example, people receiving text messages from the health services, or people receiving different types of healthcare services via mobile phone or tablet. However, most of the recommendations focus on health workers using mobile phone technology to improve service delivery, for instance through keeping track of supplies or commodity levels in health facilities, notifying births and deaths, linking with other health workers to receive advice or support on clinical questions, and accessing in-service training.

How/when did your relationship start with WHO on this topic?

This guideline has involved the preparation of eleven Cochrane Reviews, seven of which are from the EPOC Group.

Were some of these reviews specially commissioned by WHO? How were Cochrane Response involved?

Most of the reviews were specially commissioned by WHO. Cochrane EPOC played a key role in shaping the scope of these reviews, providing technical support to the review teams, such as with searching and assessing how much certainty to place in the review findings, and ensuring that the reviews have moved rapidly through the necessary Cochrane editorial processes.

Cochrane Response has also played a central role in getting this large body of work done on time, and the collaboration between WHO, Cochrane Response, Cochrane EPOC and the review author teams has been excellent. Cochrane Response came on board very early on in the process and helped us and the WHO to plan most of the reviews, together with the leads for those reviews. Since then, the Cochrane Response team has worked closely with the lead authors to prepare the reviews and helped to present the results to the WHO Guideline Development Group who were responsible for making the recommendations.  Cochrane Consumers and Communication are also involved through two reviews, and they have also been very supportive.

None of the reviews were published before the guideline was finalised. We relied on preliminary summary of findings tables and evidence profiles for the guideline process. We’re now busy finalising the reviews for final peer review and publication and hope to see all of them published before the end of 2019. 

Can you tell us about the Cochrane Reviews that have contributed to the guideline?

Most of the reviews were intervention reviews and focused on the effectiveness of these digital health interventions included in the guideline. However, two of the intervention reviews also included other types of data that could tell us something about how people are using these digital systems in practice and what influences their use. And two of the reviews were qualitative evidence syntheses. We used these qualitative evidence syntheses to answer questions about the acceptability of the interventions to different stakeholders, including service users and health care providers, as well as the feasibility of implementing these interventions and their impacts on equity and human rights. These qualitative evidence syntheses add to the growing body of such reviews within the Cochrane Public Health and Health Systems Network.

The guideline uses the GRADE Evidence to Decision Framework, why do you think this is important?

The GRADE Evidence-to-Decision framework is a key tool for helping decision makers with the process of moving from the best available evidence to a decision or recommendation. It helps decision makers, such as Guideline Development Groups, consider all important factors in a systematic and balanced way and makes the decision process more transparent to others, such as users at the country level. The framework presents in a condensed format the best available evidence for pros and cons of each option or intervention, including evidence on effectiveness and on the acceptability and feasibility of interventions. WHO has used the GRADE Evidence-to-Decision framework in this guideline – this means that there is a call for different types of evidence in addition to evidence of effectiveness.

How valuable do you think the Cochrane reviews have been in terms of their contribution to the guideline?

Despite widespread enthusiasm in many settings around the use of digital interventions delivered via mobile phones, the reviews showed a number of evidence gaps, and the evidence we did find was often of low or very low certainty. There was some evidence of impacts on health outcomes, but in many other cases, the available evidence suggests that these types of interventions may make little or no difference to the outcomes that were measured. The qualitative evidence can perhaps explain some of these results – it pointed to quite a few problems with the feasibility of these types of programmes, particularly in settings with weak health systems. The qualitative evidence also showed a number of acceptability issues, for instance tied to the privacy and confidentiality of information, as well as equity issues.

Although most of the digital interventions have been recommended by the WHO, the guideline made some recommendations conditional in response to some of the feasibility and acceptability issues identified. The WHO also highlighted acceptability, feasibility and equity issues – drawing on evidence from Cochrane qualitative evidence syntheses – when presenting implementation considerations to its end users. As all interventions have benefits and harms, use resources and need to be accepted by those to whom they are directed, it is important that recommendations are not simply based on enthusiasm and assumptions about benefits that may not be valid. The Cochrane reviews helped ensure that the recommendations were informed by the best available global evidence. Based on the findings of these reviews and the deliberations of the Guideline Development Group, the guideline also describes important research gaps to inform future studies in this field.

 

Wednesday, April 17, 2019

Featured Review: Home use of devices for cleaning between the teeth

Wed, 04/10/2019 - 07:57

This review asked the question, “How effective are home-use interdental cleaning devices, used in conjunction with toothbrushing, compared with toothbrushing only or another device, for preventing and controlling gum diseases, tooth decay and plaque?”

Tooth decay and periodontal diseases (gum diseases called gingivitis and periodontitis) affect the majority of people. These conditions can cause pain, difficulties with eating and speaking, low self-esteem, and, in extreme cases, may lead to tooth loss and the need for surgery. The cost to health services of treating these diseases is very high.

As dental plaque is the root cause, it is important to remove plaque from teeth on a regular basis. While many people routinely brush their teeth to remove plaque up to the gum line, it is difficult for toothbrushes to reach into areas between teeth ('interdental'), so this type of cleaning is often recommended as an extra step in personal oral hygiene routines. 


Different tools can be used to clean interdentally, such as dental floss, interdental brushes, tooth cleaning sticks, and water pressure devices known as oral irrigators.

Review authors working with Cochrane Oral Health identified 35 studies including 3929 adult participants; notably participants knew that they were in an experiment, which might have affected their teeth cleaning or eating behaviour. 

Lead author of the review, Dr Helen Worthington concluded: “Using floss or interdental brushes in addition to toothbrushing may reduce gingivitis or plaque, or both, more than toothbrushing alone and interdental brushes may be more effective than floss."



"However, overall, there is considerable uncertainty in the evidence, and we don’t know if the effects observed are important or lead to improvements in periodontal health long term. We hope that any future trials will clearly report participant periodontal status according to the new periodontal diseases classification, and last long enough to measure interproximal caries and periodontitis.”

Thursday, April 11, 2019

Cochrane Clinical Answers

Tue, 04/09/2019 - 19:32

Readable, clinically-focused, actionable answers to inform point-of-care decision-making for health professionals. 

Cochrane Clinical Answers (CCAs) provide a readable, digestible, clinically-focused entry point to rigorous research from Cochrane Reviews. They are designed to be actionable and to inform point-of-care decision-making. Each CCA contains a clinical question, a short answer, and data for the outcomes from the Cochrane Review deemed most relevant to practising healthcare professionals. The evidence is displayed in a user-friendly tabulated format that includes narratives, data, and links to graphics.

CCAs are available with a Cochrane subscription or national license. The following CCAs will be free until the 31 May:

Get involved: The clinical answer is written either by a practicing clinician or by a CCA Editor, with the answer being peer-reviewed by a practicing clinician. If you would like to join the Clinical Answers authoring team, please contact the team at clinicalanswers@cochrane.org. We are specifically looking for clinicians in the following areas: Respiratory medicine, Care of the elderly, Cardiovascular medicine, Pregnancy and childbirth, Neurology - especially epilepsy, Infectious disease, Paediatrics, Rheumatology, ENT, and Urology.

Tuesday, April 9, 2019

Cochrane in the Workplace - High School

Fri, 04/05/2019 - 17:28

Cochrane does not make clinical recommendations, instead it provides unbiased and high-quality health evidence so that health decisions, policies, and clinical guidelines can be informed by the best available evidence. ‘Cochrane in the workplace’ series collects stories about how Cochrane evidence is being 'put to work' in non-clinical settings - by teachers, by guideline makers, and by policy makers.

High School teacher, Ray Gowlett's story of using Cochrane evidence:

Ray Gowlett
Physical Education High School Teacher
Central Algoma Secondary School
Algoma District School Board
@raygowlett

"I'm a physical education teacher at a high school outside of my small hometown of Richards Landing, Ontario, Canada.  When teaching about nutrition, many students would make claims of ‘research says this’, and ‘research says that’.  I had to teach my students how to analyze the primary research that lead to the recommendations in the first place. My students had to be taught to think critically and evaluate evidence for themselves.  They needed to learn the concepts and terminology required to provide an accurate rationale for ignoring click bait editors who misinterpret results and sensationalize headlines.

In order to learn about how to read and understand evidence, I had to go outside of the world of education.  As luck would have it, I ran into a retired emergency medicine doctor, Dr. Roedde, who had taught evidence based medicine using the principles of Cochrane.  We quickly hit it off, and he committed to helping me through this process which is now going into year three.  Since then, it has been an absolute whirlwind of reading, analyzing, presenting, and defending what I have come to understand about the Cochrane principles. 

I was amazed that in a relatively short period of time students had gone from reading “Buzzfeed” articles for advice, to formulating clinical questions addressing outcomes of interest, finding systematic reviews of randomized control trials, differentiating between statistical significance and real world relevance, and were forming reasonable conclusions.  I would leave classes exhausted, but impressed. 

After my experiences of using the principles of Cochrane to improve my own subject specific knowledge and pedagogical practices, I believe that it is my professional obligation to become as proficient as I can with this skillset and to teach it to as many of my colleagues who would like to do the same.  I believe it is my responsibility to teach the principles of Cochrane to students, so they too, will have the ability to ‘Debunk Anything That I Teach Them’."

Would you  like to add your story of using Cochrane evidence? Please contact mumoquit@cochrane.org to share your story. 

Friday, April 5, 2019

Cochrane's 30 under 30: Meisser Madera

Wed, 04/03/2019 - 10:25

Cochrane is made up of 13,000 members and over 50,000 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.

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

Name: Meisser Madera (on Twitter @resiem1209)
Age: 30
Occupation: Professor at Faculty of Dentistry, University of Cartagena, Cartagena, Colombia; and member of Iberoamerican Cochrane Center, Barcelona, Spain
Program: PhD candidate in Methodology of Biomedical Research and Public Health at the Autonomous University of Barcelona, Spain

How did you first hear about Cochrane?
I first heard about Cochrane Collaboration when I was a Masters student. My classmates and I had to read some Cochrane systematic reviews and discuss the importance of Evidence-Based Medicine.  

How did you become involved with Cochrane? What is your background?
I have been involved in medical research since I was an Undergraduate student in Dental School at the University of Cartagena, Colombia. After my dentistry bachelor’s degree, I worked as a Research Assistant in the Research Department at that same University. There, I worked in several projects focusing on dental public health. Afterwards, I attended two Master degrees: one on Clinical Epidemiology, and the second one on Biochemistry. Currently, I am enrolled in the Methodology of Biomedical Research and Public Health doctorate program at the Autonomous University of Barcelona, Spain. So, my involvement with Cochrane began when I started to develop my PhD thesis in collaboration with the Iberoamerican Cochrane Centre in Barcelona. The main focus of my thesis is on quality assessment of available evidence about diagnosis and treatment for oral cavity cancer.

What do you do in Cochrane?
Besides my PhD thesis project, I have been collaborating in some projects concerning evidence-based medicine. They are mainly focused on quality assessment of clinical practice guidelines, evidence mapping methodology and systematic reviews.  I also belong to Students 4 Best Evidence and Oral Health Evidence Ecosystem initiative.

Fortunately, I also had the opportunity to attend the Edinburgh Colloquium and the Cochrane UK student elective program in Oxford, last year. It was fabulous and I had a different perspective about the Cochrane's work and its importance in research all over the world.


What specifically do you enjoy about working for Cochrane and what have you learnt?
I love the spirit of openness of its members, all the availability of all researchers and the spirit of sharing information, and the discussion around important themes. It is an organization where you can work with people from across the world, be involved in different ways and tasks, with the main goal to contribute on the improvement of evidence-based health care practice. In this sense, I have learnt so much about critical appraisal of evidence, as well as different ways to translate the best available evidence into practice.

What are your plans?
I am planning to finish my PhD program and to continue to be involved in Cochrane's work as much as possible before I go back to Colombia. I will continue to work as a professor at University of Cartagena, where I hope to share all my knowledge on Evidence-Based Medicine with my students and colleagues with the main goal of spreading everything I learnt and indirectly improve the quality of dental practice performed in my country. However, I think that I will keep on developing research because if you do not investigate, science wont go further…

In your personal experience, what one thing could Cochrane do better to improve its global profile?
In my opinion, Cochrane’s work is wonderful. However, I think that Cochrane should increase the participation of stakeholders such as clinicians, health care students, patients and their families, etc. into its process.  Although Cochrane has been doing a great work on evidence dissemination, it should be more accessible, especially in developing countries.

What do you hope for Cochrane for the future?
I hope that Cochrane continues to be an independent leader organization, which impacts on public health policies globally. I also wish that Cochrane’s work will be of knowledge and recognized in all regions where currently is unknown. It would be a great help on the improvement of health care practice and decision-making process in those areas.   

How important is it that young people get involved in Cochrane, why is this, do you think?
I believe that the involvement of young people in Cochrane is essential to guarantee the continuous in the evolution in research and the pursuing of its principles in the future.  

Why is this, do you think?
Since one of Cochrane's aims is to build an effective and sustainable organization. In my opinion, the young people’s work is crucial to achieve this goal. Young investigators can contribute in different areas and tasks in many ways. We also have the chance to recognize the importance of use of high-quality evidence into clinical practice. Therefore, it is likely that all young people involved in Cochrane Collaboration will apply that knowledge in their careers. 



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 felt very cherished when I came to Cochrane; there is hope for everyone in Cochrane!

Please do not be afraid. My first suggestion is, that they look for information about Cochrane on its website and follow Cochrane on social media. In those sites there is useful information that will help them to apply and decide in which field or task they want to get involved. The second suggestion is for them to contact Cochrane Center or Network that they are interested in. They will get an answer as soon as possible.   


Monday, April 8, 2019

Cochrane's 30 under 30: Tahira Devji

Tue, 04/02/2019 - 10:53

Cochrane is made up of 13,000 members and over 50,000 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.

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

Name: Tahira Devji (on Twitter @TahiraDevji)
Age: 28
Occupation: PhD Candidate, Health Research Methodology Program
Program: Department of Health Research Methods (formerly Clinical Epidemiology & Biostatistics), Evidence and Impact, McMaster University

How did you first hear about Cochrane?
I first heard about Cochrane in a course I took on systematic review methods while completing my Masters training in the Health Research Methodology program at McMaster University. The course covered fundamentals of rigorous review methods based on the guidance offered in the Cochrane Handbook for Systematic Reviews of Interventions, and the Grading of Recommendations, Assessment, Development and Evaluation framework for evaluating certainty of estimates, and presenting and interpreting evidence.

How did you become involved with Cochrane? What is your background?
Early in my doctoral studies at McMaster University under the supervision of distinguished Professor, and leader in evidence-based medicine, Dr. Gordon Guyatt, I took a keen interest in the use, analysis and presentation of patient-reported outcome (PROs) – specifically, questionnaires addressing patients’ health status (e.g. quality of life, symptoms, functional abilities) – in clinical research. Despite the increased use of PROs in the evaluation of health care interventions in clinical trials and systematic reviews, interpretation of their results remains challenging. My doctoral research aims to improve methods for enhancing the interpretation of PROs, with a focus on the concept of the minimal important difference (MID) – the smallest change in an outcome, either positive or negative, that patients perceive as important – which has proved invaluable in facilitating the interpretation of PRO results.

Given my research interests and Dr. Guyatt’s role as the co-chair of the Cochrane PRO methods group, I was encouraged to join the PRO methods group to broaden my research network, share my research interests and ideas with other members, and potentially collaborate on projects that contribute to the objectives and efforts of the group.

What do you do in Cochrane?
The Cochrane PRO methods group offers a workshop at the annual Cochrane Colloquium addressing issues in using, interpreting and presenting PROs in Cochrane reviews. I first attended the PRO workshop in Seoul, South Korea in 2016 as an attendee, and have since helped facilitate the workshop at the last two Colloquia (Cape Town, SA and Edinburgh, UK).

Together with my colleagues from McMaster University, we are leading an emerging program of research on MID methods. Based on this work, at the last two Cochrane Colloquia, we created and offered a second workshop that focuses on the methods for evaluating credibility of MID estimates and their application in meta-analysis to make PRO results more interpretable in systematic reviews and guidelines.

I have also co-authored the new PROs chapter for version 6 of the Cochrane Handbook. This chapter illustrates key risk of bias issues that systematic reviewers should consider when including results from PROs in meta-analysis and provides guidance on approaches to meta-analysis that will improve the interpretability of PROs to enhance decision-making.


What specifically do you enjoy about working for Cochrane and what have you learnt?
Cochrane remains a world leader in promoting evidence-informed health decision-making by producing trustworthy, relevant and up-to-date synthesized research evidence. What is most impressive is the collaborative culture instilled in Cochrane’s ethic, evidenced by a network of 37,000 contributors from more than 130 countries, united through a common vision to produce credible evidence and improve health outcomes. I have experienced first-hand, the diversity, inclusivity and openness in the Cochrane community, which, for me, has led to important collaborations on innovative projects.

What are your plans?
In the immediate future, I plan to continue my work in MIDs and PROs during my post-doctoral fellowship with Dr. Guyatt. In response to a continually expanding field, both in terms of the number of published studies estimating MIDs and the increasing uptake of these estimates for PROs interpretation in clinical trials and systematic reviews, our research group has developed resources for facilitating identification and appraisal of MID estimates. We have created a comprehensive inventory of all published MIDs for PROs and created a novel instrument to evaluate the credibility of these estimates. Future work will focus on maintaining updated records of latest evidence and making this inventory of MID estimates easily available to users, such as Cochrane reviewers and guideline developers, through implementation in authoring platforms, such as RevMan Web, GRADE Pro and MAGIC app.

In your personal experience, what one thing could Cochrane do better to improve its global profile?
I believe there is an opportunity for Cochrane to bolster engagement with practitioners, consumers and the public, as well as researchers, funding agencies, and policy-makers to improve mechanisms for identifying critical research gaps, prioritizing health care questions, co-producing Cochrane reviews, and co-developing knowledge translation (KT) plans.

What do you hope for Cochrane for the future?
With the mounting body of research evidence in the published medical literature, an enormous pressure exists for decision-makers to remain informed of best current evidence. The most important facilitator for the uptake of Cochrane evidence is effective knowledge translation to consumers. Cochrane has recognized this as a priority and is developing a KT strategy/implementation plan for 2019.

For the future, it is critical that evidence produced by Cochrane responds to the needs of key stakeholders and is presented in a format that decision-makers can easily digestible. Optimal presentation of evidence will require creative efforts that extend beyond traditional forms of publishing (i.e. stagnant journal publications), such as the development of interactive and dynamic electronic resources to facilitate rapid access to evidence summaries of systematic reviews, as well as implementation of these summaries in health care systems at the point of primary care. Certainly, as an advocate and producer of high-quality and up-to-date evidence syntheses, Cochrane has a unique and important opportunity to act as a key player within the vision for a Digital and Trustworthy Evidence Ecosystem.

How important is it that young people get involved in Cochrane, why is this, do you think?
Young people, in particular graduate trainees and those early in their independent research career, should certainly seek opportunities to get involved in Cochrane, as both the organization and such individuals are very likely to benefit. Cochrane’s global reach and diverse network of researchers and health professionals provides a nurturing environment for international and interdisciplinary research, professional development and training. Young people may benefit from access to global networks to broaden their own collaborative network and opportunities to work with renowned experts in evidence-based care. It is important young people think about not only what they have to benefit from their involvement in Cochrane, but also what they have to offer. Even if one is considered a novice on a particular topic, they may offer different or fresh perspectives and identify important research issues and questions that may not have previously considered. Given we are living in a digital age, young people who tend to be more tech savvy, may be able to harness technology to drive innovation in Cochrane.



What would your message be to other young people who want to get involved with Cochrane’s work but not sure where to start….?
The Cochrane community is remarkably diverse, inclusive and open, and young aspiring researchers should take full advantage of this culture. Some tips that worked for me and others may find useful: 1) become a Cochrane member, 2) join a Review, Geographic or Methods group; 3) attend and network at the Cochrane Colloquium (present your research, sign-up and attend workshops and open business meetings for groups of interest).


Tuesday, April 2, 2019

Podcast: Which talking therapies work for people who use drugs and also have alcohol problems?

Mon, 04/01/2019 - 13:49

The Cochrane Drugs and Alcohol Group studies interventions to help people who have problems with alcohol or who use illicit drugs. In December 2018, these came together in an updated review on psychosocial interventions for people who use drugs and also have alcohol problems. Jan Klimas, from the British Columbia Centre on Substance Use in Vancouver, Canada tells us about the latest evidence in this podcast.

For people generally, drinking alcohol above the low‐risk drinking limits can lead to serious alcohol related problems or disorders. But it’s even worse for those who also have problems with other drugs, leading to a large impact on their physical and mental health.

One class of psychosocial interventions, called talking therapies, aim to help people identify an alcohol problem and then boost their motivation to do something about it. Talking therapies can be given by trained doctors, nurses, counsellors, psychologists, etc. They may help reduce alcohol use and we wanted to find out if they can help people who also have problems with other drugs, such as opioids and stimulants. Our main aim was to see whether these therapies reduce drinking in adults who use illicit drugs and whether one type of therapy is more effective than another.

We found seven randomised trials that examined five talking therapies among 825 people with drug problems. Overall, we found that the therapies led to little or no differences for the outcomes assessed in the trials, which included abstinence, reduced drinking, and substance use. However, to give you a little more detail, I’ll work through our findings for each type of therapy.

There were several studies based around motivational interviewing, which helps people to explore and resolve doubts about changing their behaviour. It can be delivered in group, individual and intensive formats. There is also a shorter form, called brief motivational interviewing that takes 45 minutes to three hours, and even briefer forms take only five to 30 minutes and are often delivered by a non‐specialist.

One study found that intensive motivational interviewing may be somewhat better than a standard form at reducing the severity of alcohol use disorder among women, but not among men and it did not show differences for other outcomes. Another study found that brief motivational interviewing is probably better at reducing alcohol use than usual treatment, which was needle exchange in this case, but did not detect differences in other outcomes.

However, things were even less promising for other comparisons. The findings from three studies of motivational interviewing compared with usual treatment or education alone suggest that there may be no difference between these approaches. And the evidence from three studies comparing brief intervention and usual treatment leads to a similar conclusion.

Finally, the single study that compared cognitive‐behavioural coping skills training with a twelve‐step programme, based on theories from Alcoholics Anonymous, also failed to show a difference between these two talking therapies.

Where this leaves us, after this second update of our review that was first published in 2012 is that we remain uncertain about whether talking therapies reduce alcohol and drug use in people who also have problems with other drugs. There are no high‐quality studies and these are much needed to help with this major problem for individuals, families and society.

Monday, April 1, 2019

Cochrane in Practice - Nursing

Thu, 03/28/2019 - 18:41

Cochrane does not make clinical recommendations, instead it provides unbiased and high-quality health evidence so that health decisions, policies, and clinical guidelines can be informed by the best available evidence. ‘Cochrane Evidence in Practice’ series collects stories about clinical professionals using Cochrane evidence - the everyday healthcare professional making sure their patients and clients are getting the best care!

Nurse Nafas Sarah Hemati's story:

 Nafas Sarah Hemati
Care Coordinator at Central West Local Health Integration Network, Brampton, Canada

I got my Masters of Arts degree in Health Policy as I’ve always had a special interest in population health and the role of the patient in policy making. It was through this work that I became aware of Cochrane health evidence and was particularly impressed with Cochrane’s commitment to involving patients and carers in their review production. After working in academia and clinical research, I became a Registered Nurse (RN), the decision to become an RN was because I felt as though I could make more of a difference in patient care if I combined my knowledge of health policy with clinical practice. During my nursing degree at the University of Toronto I utilized Cochrane evidence for research and papers, but more importantly, moving forward I use it often to inform my practice. I am thankful that Cochrane is a user-friendly resource that enables important decision making without hours of research. 

As someone with practical clinical experience, a background in research, and in policy, it is sometimes disheartening to see people spread false information on social media. It’s important to look at the source of the information you are basing decisions on and the quality of that information. When I see that Cochrane evidence is backing our hospital practices and polices, I know that I am giving patients the best possible care.

Would you  like to add your story of using Cochrane evidence? Please contact mumoquit@cochrane.org to share your story. 

 

Thursday, March 28, 2019

We are now accepting proposals for Spanish workshops

Thu, 03/28/2019 - 14:24

To fully embrace linguistic diversity, the 2019 Cochrane Colloquium will accept proposals for workshops to be given in Spanish.

Embracing the native language of this year’s Colloquium host country and region, proposals for Spanish-language workshops are being accepted. While the proposals themselves should be written in English for fairness in the review process, accepted workshops be can given in Spanish.

With this decision to incorporate Spanish into the scientific program, we aim to be inclusive to Cochrane's Spanish-speaking participants from Chile and the entire Cochrane Iberoamerican Network, which comprises members from across the Americas and the Iberian Peninsula.

The deadline for submitting workshop proposals is Friday 12 April 2019, and accepted proposals will be notified in June.

For more details, see the Call for Workshops. 

Thursday, March 28, 2019

Cochrane Pregnancy and Childbirth establishes Satellite Group in the United States

Wed, 03/27/2019 - 13:54

We are delighted to announce that Cochrane Pregnancy and Childbirth has established a US Satellite.

The main purpose of the Satellite is to disseminate Cochrane Reviews and to promote Cochrane and its work in the United States, while supporting and developing the US-based community of Cochrane members.

This newly-established US Satellite is currently funded by CMU School of Health Sciences , and is currently seeking external funding. They are based at the Central Michigan University (CMU) School of Health Sciences and Indiana University School of Medicine’s Department of Obstetrics and Gynecology. the satellite also has collaborative partners across the US.

Wednesday, March 27, 2019

Cochrane in the Workplace - Research

Tue, 03/26/2019 - 21:22

Cochrane does not make clinical recommendations, instead it provides unbiased and high-quality health evidence so that health decisions, policies, and clinical guidelines can be informed by the best available evidence. ‘Cochrane in the workplace’ series collects stories about how Cochrane evidence is being used in non-clinical settings - in universities, by researchers, by guideline makers, and by policy makers.

User story:

Name: Ellen Koo
Position: Research Coordinator
Location: Toronto, Canada

"I completed my Masters of Science, Physiology at the University of Toronto.  I have over 6 years of experience working in healthcare research, using both qualitative and quantitative analytic skills.  I have worked on everything from helping to conduct systematic reviews to collecting patient data for clinical studies. My passion for improving patient and caregiver experience has always been an important focus in my work.

I was first exposed to Cochrane Reviews in my graduate training.  Reading a Cochrane Review is helpful to get an overview of the all the available research on one research question and it’s so helpful that the quality of that evidence is clearly graded.  Later as a Research Assistant helping with a systematic review, I learned the important processes that goes into developing a systematic review.  In my current role as a research coordinator, I have access to the Cochrane Library at my host institution.  I look to Cochrane Reviews for identifying research gaps for possible grant proposals and for using it in reports to summarize available evidence.  For me, Cochrane Reviews have always been a trusted source of health evidence.”

Would you  like to add your story of using Cochrane evidence? Please contact mumoquit@cochrane.org to share your story. 

 

Tuesday, March 26, 2019

Cochrane in Practice - Clinicians

Mon, 03/25/2019 - 18:33

Cochrane does not make clinical recommendations, instead it provides unbiased and high-quality health evidence so that health decisions, policies, and clinical guidelines can be informed by the best available evidence. ‘Cochrane Evidence in Practice’ series collects stories about clinical professionals using Cochrane evidence - the everyday healthcare professional making sure their patients and clients are getting the best care!

User story:

Name: Dr. Karla Duque
Location: Ecuador
"I am an Ecuadorian Medical Doctor with a Masters in Public Health. Cochrane has been with me in every step of my education. I went to university in Ecuador and used problem based learning since the first semester; this is were students learn about a subject through the experience of solving an open-ended problem. The Cochrane Library was the go-to-database for every class; from basic anatomy to different diagnosis and treatment. In Ecuador, I found that health research was pretty sparse, especially out side of the English language. It is great that many of the plain language summaries of Cochrane Reviews are also translated into Spanish.  As I continued my studies in the UK, Cochrane was the main tool for my dissertation, as I tackled my own systematic review.

I am now a full time medical doctor in Ecuador and am happy to have the Cochrane Library as a resource to support me. I strongly believe that Cochrane is one of the most useful places for reliable information. Cochrane has helped me develop my own research skills and helped put me in contact with researchers worldwide."

 

Would you  like to add your story of using Cochrane evidence? Please contact mumoquit@cochrane.org to share your story. 

 

Monday, March 25, 2019

Cochrane seeks Clinical Research Associate - Liverpool, UK

Mon, 03/25/2019 - 16:41
 Liverpool school of Tropical Medicine'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.

We are looking to expand the centre. As part of this, we are recruiting staff for the "Research, Evidence and Development Initiative" (READ-It) programme that is just starting, a collaborative five-year programme with partners in South Africa, Zambia, Sri Lanka, India and Nepal. Our priorities are entirely derived from LMIC priorities and develop rapidly. We are seeking to engage the successful applicant in a high-priority area commensurate with their areas of interest and to work with colleagues in partner countries.

To illustrate the range of topics, some systematic review topics in the in-tray include:

  • Public health programmes in preventing anaemia, micronutrient supplementation, filariasis
  • Detection and treatment of TB
  • Diagnostic test accuracy reviews in histoplasmosis, HIV, G6PD deficiency
  • Community health workers and mental health promotion and delivery

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. We aim for a mixed portfolio to provide a broad exposure to evidence-informed science.

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

The post holder 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. Strong communication, time and organisational skills are pivotal as you will be responsible for ensuring effective communication flow within the project team. If you have authored a Cochrane review, have experience of using GRADE, have a track record in published research or possess a PhD in a relevant field, it will be an added advantage to your application. You will also contribute to the postgraduate teaching programme in critical appraisal and evidence synthesis.

You need to be able to travel overseas.

Monday, March 25, 2019 Category: Jobs

Endometriosis Awareness Month

Fri, 03/22/2019 - 20:11

March is Endometriosis Awareness Month. Endometriosis is a painful condition where endometrial tissue grows outside the uterus. It is estimated that up to 10% of women have endometriosis (Ozkan 2008).  Endometriosis can cause infertility and for women with subfertility the prevalence rate ranges from 25% to 40% (Ozkan 2008). Endometriosis frequently presents with the symptom of pain (Barlow 1993) including dysmenorrhoea (painful periods), dyspareunia (pain during sexual intercourse), and pelvic or abdominal pain. 

We invited Edgardo Somigliana, MD-PhD (Dept Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy) to share his clinical view on endometriosis:

“Endometriosis is an enigmatic but curable disease. Significant improvements have been reached over the last two decades and most women can now be effectively cured. Indeed, when properly combined, surgery, hormonal medical therapy and assisted reproductive techniques can overcome endometriosis-related symptoms in the vast majority of cases. These results have not be obtained with revolutionary new therapies but, conversely, through a wiser use of the available tools (Vercellini 2015). Several challenges remain. Of utmost relevance is still disentangling the origin and pathogenesis of the disease. This unsolved issue is crucial and only progresses in this area could open new avenues or research that can ultimately lead to significant steps forwards, including prevention and early diagnosis.”

Cochrane Gynaecology and Fertility group has published over 20 intervention reviews and protocols investigating the effectiveness and safety of treatments for the management of endometriosis. In addition, we have published five diagnostic test accuracy reviews assessing the effectiveness of various tests in the diagnosis of endometriosis. We are joining #EndometriosisAwarenessMonth by sharing a collection of our reviews on endometriosis that focus on pain-related outcomes and fertility outcomes. The treatments include pharmacological interventions (hormonal therapy, immune-modulators, anti‐inflammatory drugs), surgery, and alternative medicine.

Friday, March 22, 2019

Cochrane in the Workplace - Round Up

Fri, 03/22/2019 - 15:53

Cochrane does not make clinical recommendations, instead it provides unbiased and high-quality health evidence so that health decisions, policies, and clinical guidelines can be informed by the best available evidence. ‘Cochrane in the workplace’ series collects stories about how Cochrane evidence is being used in non-clinical settings - in universities, by researcher, by guideline makers, and by policy makers. Each piece in the series collects stories around how Cochrane Reviews are being used in one type of workplace or area of work.

Would you like to add your story about using Cochrane evidence in your workplace? Please contact mumoquit@cochrane.org to share your story!

Cochrane in High School stories coming soon - contact us to add your story!

Cochrane in University stories coming soon- contact us to add your story!

Cochrane in research stories coming soon - contact us to add your story!

Cochrane in clinical research coming soon - contact us to add your story!

Cochrane in quality improvement coming soon - contact us to add your story!

Cochrane in guideline development coming soon - contact us to add your story!

 

Friday, March 22, 2019

Cochrane in Practice - Round Up

Fri, 03/22/2019 - 15:15

Cochrane does not make clinical recommendations, instead it provides unbiased and high-quality health evidence so that health decisions, policies, and clinical guidelines can be informed by the best available evidence. ‘Cochrane Evidence in Practice’ series collects stories about clinical professionals using Cochrane evidence - the everyday healthcare professional making sure their patients and clients are getting the best care! Each piece in the series collects stories around the impact that Cochrane Review has made for a specific clinical area or clinical profession.

Would you like to add your story about using Cochrane evidence in your practice? Please contact mumoquit@cochrane.org to share your story!

Click on the images below to read stories of how Cochrane Evidence is being used in different clinical professions:

Nursing stories coming soon - contact us to add your story!

Optometry stories coming soon - contact us to share your story!

Dentistry stories coming soon - contact us to add your story

Midwifery stories coming soon - contact us to add your story

Friday, March 22, 2019

Podcast: Colloids or crystalloids for fluid replacement in critically ill people

Wed, 03/20/2019 - 13:34

The care of critically ill patients is highly complex, requiring treatments for their underlying conditions and for the consequences of those conditions, such as the loss of bodily fluids. A wide range of these treatments are assessed in Cochrane Reviews and one of these was updated in August 2018, looking at the effects of giving patients extra fluids. Lead author, Sharon Lewis from the Royal Lancaster Infirmary in the UK, tells us about the latest findings in this podcast.

"People who are critically ill may lose large amounts of fluid because of trauma, burns, infections, such as sepsis, or other serious conditions. They are often given additional fluids, usually intravenously, to try to counter this and two of the common types are crystalloids and colloids. Crystalloids are salt solutions, which are cheap, easy to use, and provide immediate resuscitation – but the small molecules in these solutions mean that they pass through the cells quickly and can cause oedema, or swelling. Colloids have larger molecules and may be more efficient at increasing fluid volume in the blood. They include starches, dextrans, gelatins, and naturally-occurring colloids, such as albumin or fresh frozen plasma or FFP. However, they are more expensive and there are concerns about side effects, including kidney failure, blood clotting disorders, and allergic reactions.

Therefore, we updated and extended the Cochrane Review of colloids versus crystalloids in critically ill people, to provide up-to-date evidence on effects on death, blood transfusion or renal replacement therapy, and adverse events, in particular, allergic reactions, itching, or rashes.

We focused on critically ill people who needed fluid volume replacement in hospital or in an emergency out-of-hospital setting, but didn’t include studies of new born babies, women who had caesarean sections, or people scheduled for any type of surgery.

We found 65 randomised and 4 quasi-randomised trials, with a total of just over 30,000 participants. Four types of colloids had been tested against crystalloids: starches in 28 studies, dextrans in 20, gelatins in 7, and albumin or FFP in the other 22.

Evaluating each of these colloids, we found little or no difference between starches and crystalloids on deaths within 30 or 90 days, or by the final time point reported in each study. However, starches probably slightly increase the need for blood transfusion and for renal replacement therapy. Fewer participants given crystalloids reported itching or rashes but too few studies reported whether starches caused adverse events for us to be confident about which is better or worse.

We judged the evidence on starches to be of moderate certainty and felt the same about the evidence for dextrans, and albumin or FFP. These colloids also probably make little or no difference to mortality compared to crystalloids and the finding was similar for gelatins versus crystalloids, but, because we had fewer studies for this comparison, we judged the evidence to be of low certainty. We also cannot be certain about whether there are any differences between these types of colloid and crystalloids on the need for a blood transfusion or renal replacement therapy, or on adverse events.

This is the sixth update of this review, and there remains some hope that the certainty of the evidence will increase in future updates, because we found some studies that could not be included at the moment and there are at least three ongoing studies, which should become available in the coming years.

Friday, March 22, 2019

We are now accepting applications for 2019 Cochrane Colloquium stipends

Wed, 03/20/2019 - 11:04

A number of stipends and bursaries are available to help consumers and other attendees based in developing countries to attend Cochrane Colloquium Santiago 2019. This is our 26th annual flagship event and this year it will take place at CasaPiedra in the vibrant city of Santiago, Chile, 22-25 October 2019.

Stipends and bursaries represent funding you can apply for if you are eligible that is intended to help cover registration and other expenses associated with attending the 2019 Colloquium.

Cochrane is providing stipends for:
1.    Cochrane Consumers
2.    individuals living in low-lower-middle, (LMIC) and upper-middle-income countries (UMIC)

The deadline for applying is Monday 10 June 2019 and winners will be notified in July

Find out whether you are eligible and how to apply

Wednesday, March 20, 2019

Cochrane expresses thanks to Professor Philippe Ravaud for leadership of Cochrane France

Mon, 03/18/2019 - 17:32

After leading Cochrane France for nine years, Professor Philippe Ravaud is stepping down as Director.   

Philippe has led Cochrane France since 2010. His team and Epidemiology unit, based at Paris Descartes University, is an extremely productive and innovative group that has been at the forefront in developing innovative approaches for disseminating Cochrane evidence in France particularly through language translation and training.

Philippe’s primary research focus is methodological research to assess treatments in chronic diseases. His research activities are structured around non-pharmacological treatments, innovative design of trials, evidence synthesis, burden of treatment, as well as research on research (and especially interventional research on research). He works on meta-analyses, network meta-analyses, and on living network meta-analyses and is interested in questioning the methods used at all the steps of a systematic review.  He also conducts research on new methods of meta analyses. Philippe is among the few scientists with strong experience in performing randomized trials and systematic reviews of interventions to change physician practices.

Philippe’s groundbreaking approaches for evidence synthesis through living network meta-analysis have made, and continue to make, an enormous contribution to Cochrane’s methods development.

David Tovey, Editor in Chief, Cochrane said: "Philippe is a highly skilled and forward thinking methodologist. I have had the pleasure to work with and learn from Philippe, and we all continue to benefit from his contributions through the Cochrane Scientific Committee which Philippe co-chairs."

In addition to his methodological contributions, Philippe also contributed to building projects and capacity with and through the wider, international Cochrane collaboration:

Jeremy Grimshaw, Professor, University of Ottawa says: "Philippe has made a major contribution to Cochrane in France and globally. His tireless efforts led to the re-establishment of Cochrane France. He led an initiative (with Cochrane Canada) to translate Cochrane plain language summaries and abstracts into French which had over 1 million accesses in the first 12 months."

Joerg Meerpohl, Director Cochrane Germany says: "He is a very generous, extremely friendly, and hugely supportive person; who is willing to share his brilliant ideas thereby stimulating people to pursue and enjoy rigorous research. Without his support and offer to host me for a year in his group in Paris, I would not be in the position I am today as Director of Cochrane Germany."

Cochrane’s Chief Executive Officer, Mark Wilson, said: "I would sincerely like to thank Philippe for his outstanding contributions to Cochrane’s work. I am very pleased that Philippe will remain closely involved with Cochrane’s work as the co-chair of the scientific committee, and Cochrane will thus continue to benefit from Philippe’s expertise in evidence synthesis methods."

Cochrane France will be led under the new Directorship of Professor, Isabelle Boutron. Isabelle has been Deputy-Director of Cochrane France June 2017.

Monday, March 18, 2019

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