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An interview on consumer involvement in research with Simon Denegri, NIHR

Cochrane News - Tue, 09/18/2018 - 08:57

Normal 0 false false false EN-CA X-NONE X-NONE MicrosoftInternetExplorer4 /* Style Definitions */ table.MsoNormalTable {mso-style-name:"Table Normal"; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-priority:99; mso-style-parent:""; mso-padding-alt:0cm 5.4pt 0cm 5.4pt; mso-para-margin:0cm; mso-para-margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:10.0pt; font-family:"Times New Roman",serif;} For this year’s Patients Included Cochrane Colloquium, Richard Morley interviewed Simon Denegri, National Director for Patients, Carers and the Public, UK National Institute of Health Research. Simon talked about patient/consumer involvement in research, co-production, the role of researchers in meaningfully involving stakeholders, and what challenges he might set for Cochrane.

Tuesday, September 18, 2018

Statement from Cochrane's Governing Board

Cochrane News - Mon, 09/17/2018 - 14:48

Dear Cochrane members,

These are extraordinary times and we find ourselves in an extraordinary situation. Your Board is always happy to answer questions about our decisions, and today is no different. We want to explain how we got here today. This wasn’t our original plan because we wanted to behave fairly and with integrity, in a process that respected the privacy of an individual, whilst taking place over a number of days. Days, which unfortunately span this special Colloquium.

This is about the behaviour of one individual. There has been a lengthy investigation into repeated bad behaviour over many years. It is exceptionally unusual for a Board to have to do such an investigation.

Last Thursday, the Board took a decision which divided the Board. Subsequently, four Board members chose to resign and have actively disseminated an incomplete and misleading account of events. At the same time, others contributed to a public and media campaign of misinformation.

We recognize that the last 24 hours have been exceptionally difficult and as a result, we as a Board have decided to share with you information about the decision that was made, the process by which it was made, and where we are now, in order to act in the best interests of Cochrane.

We now want to put before you as much evidence as we can, so you know what is going on. We cannot tell you everything. All of you will understand why individuals have a right to privacy and confidentiality. We ask that you all respect this, because we may not be able to tell you everything, for legal reasons and reasons of privacy.

By way of background, we are a global organization which operates under British law because we were founded as a UK charity. Our mission is to benefit the public. We are governed by our Articles of Association.

As the Board, we are in fact the employers of the Cochrane staff. All our staff, and our members, have the right to do their work without harassment and personal attacks. We are living in a world where behaviours that cause pain and misery to people, are being ‘called out’. This Board wants to be clear that while we are Trustees of this organization, we will have a “zero tolerance” policy for repeated, seriously bad behaviour. There is a critical need for ALL organizations to look after their staff and members; once repeated, seriously bad behaviour had been recognized, doing nothing was NOT an option.

So, here are the facts as we are able to report them. We may be able to tell you more later, we may not. Time will tell.

This Board decision is not about freedom of speech.
It is not about scientific debate.
It is not about tolerance of dissent.
It is not about someone being unable to criticize a Cochrane Review.

It is about a long-term pattern of behaviour that we say is totally, and utterly, at variance with the principles and governance of the Cochrane Collaboration. This is about integrity, accountability and leadership.

In March this year, we received three complaints about an individual. These were not the first complaints that had ever been received. In fact, the earliest recorded goes back to 2003. Many have been dealt with over the years. Many disputes have arisen. Formal letters have been exchanged. Promises have been made. And broken. Some disputes have been resolved, some have not.

It was clear to the Co-Chairs that the Board had to reach a decision about these most recent complaints. The individual then made serious allegations against one of the Senior Management Team and shared those with the Board. We seemed to be in an impossible situation. How could the Board now reach a decision about the complaints in a fair way? How could we fulfil our responsibilities as employers of the Senior Management Team? Or alternatively, act to admonish that member of the Senior Management Team if they had done wrong?

With guidance from a Trustee with extensive experience of complaints, we proposed asking a totally independent person to undertake a review. The report was to be confidential to the Board.

After failing to get agreement from the individual to an independent review, we then sought legal advice on behalf of Cochrane. We asked the lawyers, what should a Charity such as Cochrane do in this situation? We were advised that various legal consequences flowed from the events – the complaints and the accusations - and that Cochrane should take them seriously.

We asked the lawyers to take particular note of Cochrane’s commitment to transparency. They noted that, but also stressed the importance of confidentiality.

They advised that an independent review was both a sensible and proportionate response.

At the Governing Board Teleconference on 13th June 2018, all Board members read the letter from our lawyers. The lawyers stated that given the serious legal concerns about this matter they strongly recommended an independent review by a very senior lawyer. The Board approved a motion to accept the lawyer’s advice and establish the independent review.

Our lawyers identified a senior independent lawyer (QC) and he was instructed on 2nd July 2018. As part of the process, he invited written submissions from both individuals concerned. He invited both to be interviewed. The lawyer was asked to work to a deadline of the Board Meeting on Thursday last week, 13th September. And, we did in fact receive his preliminary report in time for that meeting. The report completely exonerated the member of the Senior Management Team but did not exonerate the other individual.

Whilst the review was underway, and as a completely separate matter, a paper was published in the journal BMJ-EBM co-authored by the individual concerned on July 27th 2018. The publication of this paper has proved controversial. As a result, the Board received a number of letters of complaint. Each was sent to the individual to allow a written response. In order to avoid any misunderstanding, the Board want you to be clear that this was a matter that arrived very late in this whole process.

So, at the Board Meeting on Thursday September 13th, the trustees reviewed the lawyer’s report of his independent review, and all the material related to the recently published paper. After they had reviewed and discussed this at length, the Trustees exercised their judgement, and looking across a broad range of behaviours, the Board came to a decision to invoke Article 5.2.1. relating to termination of membership. This was not unanimous.

As a result, Article 5.3 was triggered, and the member has been invited to make a written response within seven days.

At this point in time, this person remains a member of the Cochrane Collaboration. We are waiting for the process to be completed. We will report back to you about the outcome as soon as we are able to.

Let us repeat, this is an extremely rare and unusual thing to do. We hope never to have to do this again.

Cochrane Governing Board
17th September 2018

Monday, September 17, 2018

Beyond the Room Edinburgh Colloquium 2018 Podcasts

Cochrane News - Mon, 09/17/2018 - 14:27

For the first time at a Cochrane Colloquium, we will be taking the conversation #BeyondTheRoom. Beyond the Room is a digital conference service, started in 2016 by André Tomlin from the Mental Elf. Its aim is to increase the reach and impact of health events by live tweeting and podcasting from them, to involve people virtually and facilitate a much more democratic conversation. 

Our Beyond the Room team includes  @SarahChapman30 @TheJackLeahy @Mental_Elf @MightyCasey @DBadenoch @sally_crowe Selena @CochraneUK and  @Laconic_doc They have recorded podcasts with some of the speakers and presenters at the Colloquium - Have a listen!

Monday, September 17, 2018

An Interview with Doug Altman

Cochrane News - Sun, 09/16/2018 - 15:23

Roberto D’Amico from Cochrane Italy shares an interview with Doug Altman. Everyone within the Cochrane community was sad to learn of the death of Professor Doug Altman this year. Doug Altman was a Cochrane leader and pioneer since the Collaboration’s beginning in 1993. He is best known for his work on improving the reliability and reporting of medical research and for highly cited papers on statistical methodology. Doug’s long-serving contributions to Cochrane have been universally acknowledged across the world. He was a long standing co-convenor of Cochrane’s Statistical Methods, and more recently co-convened both the Cochrane Bias and Cochrane Prognosis Methods; he authored over 450 papers in statistical methodology, with 11 being cited more than 1,000 times.

In 1998, I came to the Centre for Statistics in Medicine, which was directed by Doug Altman. For two years I had the privilege of working closely with Doug and his team. That time in Oxford had an important impact on my methodological training and on my way of thinking about clinical research.

In 2013 I was asked to organize a session on state-of-the-art methodology for Cochrane systematic reviews and meta-analyses, at the annual meeting of SISMEC, which is the Italian Society of Medical Statistics and Clinical Epidemiology.

I immediately thought Doug was the person to invite. Unfortunately, he had prior engagements for the dates of the meeting and therefore could not come. I had the idea of interviewing him instead, and when I proposed it to him, he accepted gracefully. We spent half a day together in his office recording the interview. Doug was relaxed and enjoyed answering the questions. I have great memories of that day.

Listening to Doug is always a pleasure. His points of view and his suggestions are exceptionally educational and inspiring. I would like to share his insights with all of you to remember the great person he was and to keep being inspired by him. Doug Altman will always remain an example to follow.

Roberto D’Amico
Professor of Biostatistics
Università di Modena and Reggio Emilia
Azienda Ospedaliero-Universitaria di Modena
Cochrane Italy

 

The interview is in six parts, with Doug responding to these questions:

  1. What are the main changes in methodology of meta-analysis of interventions observed in the last 20 years?
  2. How has the methodology of systematic reviews influenced clinical research?
  3. Where is the methodology of systematic reviews and meta-analyses heading and where should it be heading?
  4. Which skills should young statisticians acquire and what knowledge should they have?
  5. What are the challenges in communicating research findings?
  6. Has the methodological quality of medical research improved in the last 30 years?

Monday, September 17, 2018

Cochrane Library Editorial - Information specialists: ensuring quality as the basis of evidence synthesis

Cochrane News - Sun, 09/16/2018 - 14:52

The foundations of both Cochrane and the wider evidence synthesis community rest on the involvement of methodologists in the production of high‐quality systematic reviews. Epidemiologists, statisticians, and information specialists have had an enormous impact on the evolution of Cochrane and the advancement of systematic review methodology. Compared with other methodologists, information specialists tend to fly somewhat under the radar despite the fact that they act in a wide variety of roles. Information specialists organize, disseminate, and interpret information; they also preserve knowledge and ensure that it is discoverable in the future.

Read a new Cochrane Library Editorial on how information specialist expertise should be leveraged further to ensure quality and improve the efficiency of evidence synthesis.

Sunday, September 16, 2018

Message from the Governing Board

Cochrane News - Sat, 09/15/2018 - 17:03

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This week at its meeting in Edinburgh, Cochrane’s Governing Board considered, as planned, the findings of an independent review and additional complaints related to the conduct of a Member. The Board’s conclusion was communicated to the individual concerned and is part of an ongoing process. The Co-Chairs of the Board will provide further details once this process is complete.

Following this, four Board members (Gerald Gartlehner, David Hammerstein Mintz, Joerg Meerpohl and Nancy Santesso) decided to resign as Cochrane trustees with immediate effect. This situation required further changes in the composition of the Board in order to comply with Cochrane’s Articles of Association, and as a result Rae Lamb and Catherine Marshall, two appointed trustees, volunteered to step down.

An election for new Board members will take place soon. In the meantime, the Board will continue to govern The Cochrane Collaboration as usual, guided by our principles, Charter and Articles. The Board completed its planned business today and expresses its strong support for the commitment and professionalism of Cochrane’s Central Executive Team.

As the 25th Cochrane Colloquium gets underway in Edinburgh, the Governing Board looks forward to welcoming nearly 1,300 participants from 57 countries to celebrate our theme of ‘Cochrane for all: better evidence for better health decisions’.

Marguerite Koster and Martin Burton
Governing Board Co-Chairs

Saturday, September 15, 2018

Cochrane seeks Methods Implementation Co-ordinator - Flexible location

Cochrane News - Fri, 09/14/2018 - 09:19

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Specifications: Full Time
Salary: Up to £45,000 DOE
Location: Flexible with regular attendance at the London office expected
Application Closing Date: Friday 5th October

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

The Methods Implementation Co-ordinator will provide strategic support to facilitate methods activities in line with Cochrane’s strategic aims. To provide infrastructural support to the Cochrane methods community and its representative groups, including the Methods Executive and Scientific Committee. To support the successful completion of priority projects with a methods component, particularly those aligned with the Content Strategy.  To manage methods-related projects that include strategies, policies and processes to advance and implement methodological developments to improve the quality of Cochrane Reviews.

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

  • Significant experience in medical/healthcare research or relevant PhD.
  • Familiarity with and experience of using Cochrane methods in systematic reviews.
  • Comprehensive problem-solving skills, ability to work independently under general direction, willing and able to work with a small team of staff, self-directed, accountable, and able to provide sound advice to members and other Cochrane staff.
  • Excellent computer skills including expertise with MS Office applications, with the ability to become proficient in information management and other software as required.
  • Excellent writing skills including the ability to produce written material appropriate to a lay audience.
  • Time management skills and ability to work flexible hours as needed.
  • Experience related to all aspects of the planning and organizing of meetings
  • Project and programme management skills.
  • Excellent presentation, interpersonal and communication skills.
  • Credibility to be able to present and contribute to discussions involving high level academics on methodological issues.

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 Methods Implementation Co-ordinator 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.

Deadline for applications: Friday 5th October 2018 (12 midnight GMT)

Interviews to be held on: (TBC)

 

Friday, September 14, 2018 Category: Jobs

Cochrane seeks part-time Information Specialist - Flexible location

Cochrane News - Fri, 09/14/2018 - 08:57

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Specifications: 0.4-0.6 FTE-  Fixed Term for 9 Months
Salary: Competitive
Location: Flexible with regular attendance at the London office expected; frequency to be negotiated.
Application Closing Date: Friday 5th October 2018

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

The successful candidate will provide information specialist advice and services to the Central Executive Team and deliver on key projects for the Editorial & Methods Department.

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:

  • Undergraduate Degree
  • Qualification in librarianship or information science (postgraduate or undergraduate)
  • Experience of designing, executing and reporting search strategies in collaboration with systematic review authors, using appropriate biomedical databases
  • Experience developing or commenting on the trial identification and reference sections of Cochrane reviews and protocols as part of the authorship/editorial process
  • Extensive experience of searching biomedical databases including (but not limited to) MEDLINE, Embase, CINAHL, LILACS, PsycINFO, CT.gov, etc
  • Experience of Cochrane and using the Cochrane Library
  • Experience of using reference management platforms such an Mendeley, RefWorks, Reference Manager, Endnote, etc
  • Knowledge of the role and importance of clinical trials registries and experience in searching them
  • Excellent communication and interpersonal skills
  • Drive and Enthusiasm
  • Commitment to Continuing Professional Development (CPD).

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 “Information Specialist” 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.

Deadline for applications: Friday 5th October 2018 (12 midnight GMT)

Interviews to be held on: (TBC)

Friday, September 14, 2018 Category: Jobs

Cochrane Switzerland seeks Coordinator - Lausanne, Switzerland

Cochrane News - Tue, 09/11/2018 - 16:44

The Institute of Social and Preventive Medicine (IUMSP), University Hospital of Lausanne (CHUV) and the Faculty of Biology and Medicine, University of Lausanne (UNIL) offers a position of 

Coordinator, Cochrane Switzerland, 50%

Description:

Cochrane (www.cochrane.org) is an international independent network of health practitioners, researchers, patient advocates and others, responding to the challenge of making the vast amounts of evidence generated through research accessible for those who need to make decisions about health. 

Cochrane is a not-for-profit organisation with about 11’000 members and 35’000 supporters from over 130 countries working together to produce credible and accessible health information (in particular, systematic reviews) that is free from commercial sponsorship and other conflicts of interest. Cochrane Switzerland is one of its geographic groups and active in all three Swiss language regions (www.swiss.cochrane.org).

Your tasks:

  • Contribute to the development of Cochrane Switzerland together with its leadership; 
  • Coordinate day-to-day organisational tasks with support by secretariat;
  • Develop and maintain communication activities with external stakeholders and within   Cochrane;
  • Organise and promote training activities.

Your skills and experience:

  • Bachelor degree or equivalent in life/health sciences, administration, project management, communication, social marketing, or related area;
  • Prior experience in an area related to the post: min. 2 years; 
  • Interest in and knowledge of evidence-based health care would be an asset; 
  • Excellent spoken & written skills in at least two languages (French / German / English) and intermediate knowledge of the third;
  • Good command of IT and electronic tools;
  • Good communication skills;
  • Ability to work independently;
  • Team player who likes working in an international environment.

Starting date:  1.11.2018, to be agreed

Salaries: Wage grids from Canton of Vaud 

Enquiries: Further information on the position can be obtained from Dr Erik von Elm, Director, Cochrane Suisse, erik.vonelm@chuv.ch, +41 21 314 6723 

Deadline for submission:  21 September 2018 

Application:Interested candidates are invited to send their electronic application via the CHUV internet site

Tuesday, September 11, 2018

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

Cochrane News - Tue, 09/11/2018 - 12:05

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

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

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

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

Review author Audrey Rankin said:

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

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

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

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

Tuesday, September 11, 2018

Cochrane in the numbers: April - June 2018

Cochrane News - Mon, 09/10/2018 - 15:40

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

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

Highlights from the second quarter include:

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

For more information:

Monday, September 10, 2018

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

Cochrane News - Fri, 09/07/2018 - 20:17

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

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

Many types of interventions are in use. These include:

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

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

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

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

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

Lead author, Ian Cameron, said:

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

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

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

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

Friday, September 7, 2018

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

Cochrane News - Fri, 09/07/2018 - 15:16

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Friday, September 7, 2018

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

Cochrane News - Thu, 09/06/2018 - 19:12

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

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

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

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

Lead author Jan Mehrholz concludes:

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

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

Friday, September 7, 2018

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

Cochrane News - Thu, 09/06/2018 - 11:13

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

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

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

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

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

Thursday, September 6, 2018

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

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

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

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

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

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

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

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

Wednesday, September 5, 2018 Category: Jobs

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

Cochrane News - Thu, 08/30/2018 - 15:53

Senior Research Associate - Programme Manager

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

School of Nursing & Midwifery, NUI Galway.

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

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

Thursday, August 30, 2018 Category: Jobs

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

Cochrane News - Wed, 08/29/2018 - 14:13

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

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

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

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

 Read the full response

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

Monday, September 3, 2018

The Recommended Dose podcast: Cochrane co-founder Iain Chalmers

Cochrane News - Mon, 08/27/2018 - 14:26

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

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

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

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

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

Monday, August 27, 2018

Testing Treatments book now available for free in 15 languages

Cochrane News - Mon, 08/20/2018 - 16:47

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

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

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

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

Tuesday, August 21, 2018

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