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Updated: 11 hours 26 min ago

Featured Review: Routine scale and polish for periodontal health in adults

Tue, 01/15/2019 - 10:39

Examining evidence for routine scale and polish treatment – an updated review

The Cochrane Review 'Routine scale and polish for periodontal health in adults' was carried out by authors working with Cochrane Oral Health to assess the effects of routine scale and polish treatments for healthy adults and to establish whether different time intervals between treatments influence these effects. The review had aimed to compare the effectiveness of the treatment when given by a dentist compared to a dental therapist or hygienist, but there were no studies evaluating this comparison.

This review updates the version published in 2013 and includes two studies with a total of 1711 participants. Both studies involved adults without severe periodontitis who were regular attenders at dental appointments in the UK. The studies were conducted in general dental practices, which is the most appropriate setting to evaluate 'routine scale and polish' treatments.

Dr. Thomas Lamont, lead author explains,

“This evidence could help patients and dental professionals make informed decisions about routine scale and polish treatment - which can be also known as ‘prophylaxis’, ‘professional mechanical plaque removal’ and ‘periodontal instrumentation’ - as it questions the effectiveness of the traditional delivery of routine scale and polish treatment in primary dental care.

“The studies found that regular planned scale and polish treatments didn’t reduce the early signs of gum disease more than scale and polish delivered only when the dental professional judged it necessary or it was requested by the patient. The tartar levels were slightly more reduced with scheduled treatments, but it’s uncertain if this small difference would be considered important by patients or their dentists.

“Participants receiving six-monthly and 12-monthly scale and polish treatments reported feeling that their teeth were cleaner than those who were not scheduled to receive treatment, but the evidence is low quality, and the studies didn’t find any difference between the groups in terms of quality of life.

“It should be noticed that neither of the studies measured side effects, such as damage to tooth surfaces and tooth sensitivity, changes in attachment level, tooth loss or bad breath, and available evidence on the costs of the treatments is uncertain.”

Interview with – Dr Thomas Lamont, lead author of this Cochrane review

Please describe yourself and your Cochrane Group?

I graduated in dentistry from Glasgow University in 2008 and went on to complete a PhD at the University of Dundee. I am currently a Clinical Research Fellow and Honorary Specialty Registrar in Restorative Dentistry at the University of Dundee. I am also a clinical editor at Cochrane Oral Health, which was founded in 1994. For over 20 years, Cochrane Oral Health has been producing high-quality, relevant systematic reviews that can improve oral health care and oral health. We currently have 163 active reviews on the Cochrane Library, as well as 35 protocols for reviews currently in progress.

What is the background to this review and the update?

Many adults in high-income countries will be used to having a ‘scale and polish’ when they go to the dentist. It is intended as a supplementary form of plaque removal in addition to oral hygiene undertaken regularly at home by patients, with the aim of reducing the risk of gum disease.

The first Cochrane Review of regular scale and polish treatment was conducted in 2004 and showed that there was very little evidence to go on. In the review’s conclusions, the authors recommended that a trial be conducted to find out whether routinely providing a scale and polish treatment to people who had relatively healthy mouths and tended to visit the dentist regularly actually had an impact on their long-term oral health, and specifically on periodontal disease. NIHR picked up on this, and Professor Jan Clarkson of the University of Dundee collaborated with Professor Craig Ramsay of the University of Aberdeen, together with colleagues from several other universities, to apply for HTA funding to run such a trial. I joined them as the Clinical Research Fellow on the trial, which was known as ‘IQuaD’ in 2011 and subsequently became involved in updating theCochrane Review. IQuaD was completed in 2017, and the findings were published in 2018 (https://www.journalslibrary.nihr.ac.uk/hta/hta22380/#/abstract)

(Improving the Quality of Dentistry (IQuaD): A cluster factorial randomised controlled trial comparing the effectiveness and cost-benefit of oral hygiene advice and/or periodontal instrumentation with routine care for the prevention and management of periodontal disease in dentate adults attending dental primary care. Health Technology Assessment Volume 22, Issue 38, July 2018)

Why is an update of the review important?

As Cochrane’s mission is to promote evidence-informed health decision-making by producing high-quality, accessible systematic reviews and other synthesised research evidence, there is a commitment to ensure Cochrane Reviews are kept up-to-date by identifying and incorporating new evidence. The IQuaD trial reached some strong conclusions that we felt should be combined with the existing evidence and shared widely.

What are the main implications of this research?

This review questions whether it is necessary for scale and polish to be delivered routinely, that is, on a standard schedule of every 6 or 12 months. Many people like the clean feeling that they get from a scale and polish treatment every six months, but it is not clear that there is any real clinical benefit in terms of reducing gum disease. The updated review shows that providing scale and polish treatment when the dentist deems it appropriate or when the patient requests it, does not result in poorer oral health outcomes after 2 to 3 years than providing scale and polish treatments on a predetermined 6- or 12-monthly schedule. 

It is important to point out that the participants in the two trials included in the review had relatively healthy mouths; none of them had severe periodontitis. It is also important to point out the trials were conducted in the UK. In other high-income countries, the treatment may be known as  “prophylaxis”, “professional mechanical plaque removal” or “periodontal instrumentation”, and it is reasonable to assume that the findings would be the same.

Wednesday, January 16, 2019

World Cancer Day

Mon, 01/14/2019 - 17:41

World Cancer Day is an international day marked on February 4 to raise awareness of cancer and to encourage its prevention, detection, and treatment. 2019 marks the launch of the 3-year ‘I Am and I Will’ campaign; an empowering call-to-action urging for personal commitment and represents the power of individual action taken now to impact the future.

Cochrane Cancer supports and coordinates the work across multiple Cochrane Review Groups dealing with the topic of Cancer. These  Cochrane Review Groups provide reliable evidence required to make important decisions on issues concerning cancer and related topics. Cochrane Review Groups facilitate the identification of reports of clinical trials and carry out systematic reviews of available evidence. These are published on the Cochrane Library, and updated periodically as new evidence is identified. This ensures that Cochrane Reviews are relevant, useful, usable, and used.

To mark World Cancer Day, we have collated a selection of  highly view Cochrane Reviews on cancer:

    Monday, February 4, 2019

    Podcast: Cerebrolysin for acute ischaemic stroke

    Thu, 01/10/2019 - 15:39

    When someone has an acute ischemic stroke, urgent and reliable treatments will reduce their risks of disability or dying from their brain tissue damage. The treatments used vary around the world, and a drug called cerebrolysin is widely used in post-Soviet countries, Eastern Europe, Central and Southeast Asia. In April 2017, the latest update of this review was published by researchers from Kazan Federal University in Russia and Chinara Razzakova, a PhD student from the university interviewed one of the authors, Liliya Eugenevna, for this podcast.

    "This Cochrane Review is about a medicine called cerebrolysin, which is used for people who’ve had an acute ischemic stroke. It’s believed to have neuroprotective and neurotropic properties and is widely used here in Russia, countries of the former Soviet Union, China and elsewhere in Asia. We wanted to examine its potential benefits for people with acute ischemic stroke, and whether there are any harms associated with its use.

    One of the reasons for the review was the fact that cerebrolysin is used so often for this type of stroke, but the main issue as we worked on the review was the drug’s use as a potential neuroprotector. In ischemic stroke, the concept of “neuroprotection” includes the suppression of changes that lead to an influx of calcium ions, activation of the reactive oxygen species or free radicals, and cell necrosis. These ideas have stimulated the development of many potentially “neuroprotective” substances, some of which were shown to be effective in animal studies. However, the evidence from clinical trials in patients continues to be problematic. This led us to try to find out whether cerebrolysin effectively protects the brain from damage and has benefits, or harms, for people who have had an acute ischemic stroke.

    We looked for studies in which patients who were receiving a standard treatment regimen for ischemic stroke were randomized to receive either cerebrolysin or a placebo. We then used these studies to investigate the effects on death and adverse events. We found six randomized trials with a total of approximately 1500 participants. Three of the six trials were large multicentre studies, two were small and one did not provide quantitative information to include in the final meta-analyses.

    When we combined the evidence, we found no benefit of cerebrolysin use. There was no obvious effect on deaths and the data from the three multicentre studies, which reported serious adverse events, showed that cerebrolysin more than doubled the number of people with non-fatal serious adverse events.

    Although high-quality large-scale randomized trials are always necessary for getting reliable information about the potential value of drugs used in acute ischemic stroke, our review has shown that the potential benefit of cerebrolysin is not supported by reliable evidence and we would not recommend its routine use in acute ischemic stroke. We’ve also shown that the use of cerebrolysin is unsafe and, so, if it is going to be tested in future research, this needs to take the form of well-designed randomised trials and include assessments of the risks of serious adverse events.

    In summary; myself and my co-authors of this review recommend that cerebrolysin is not the right choice for the treatment of acute ischemic stroke."

    Thursday, January 17, 2019

    Podcast: Intramuscular and intravenous opioid pain relieving drugs in labour

    Thu, 01/10/2019 - 15:26

    The use of pain-relieving drugs during labour is common throughout the world, and an updated Cochrane Review from June 2018 looks at the use of a class of drugs called opioids. Lead author, Lesley Smith from Oxford Brookes University in the UK tells us what they found.

    "For many women in labour, an epidural containing a local anaesthetic has become an increasingly popular choice for pain relief. However, not all women choose this and some give birth in places were an epidural is not available. One of alternatives is the use of an opioid drug, such as pethidine, diamorphine or meptazinol given either intramuscularly or intravenously. These are used less frequently than epidurals but are still widely used in obstetric and midwife-led birth units to relieve pain during labour, and we did this review to satisfy the need for up-to-date information on their effectiveness.

    Opioids are known to provide very effective pain relief for various causes of pain, such as that following surgery, but they can cause side effects like nausea and vomiting, and drowsiness. An additional consideration when used for pregnant women, is that they cross the placenta perhaps leading to unintended effects on the baby.

    Therefore, despite their widespread use it is still unclear just how effective opioids are at relieving pain during labour, which one provides the best pain relief and what the adverse effects are on the mother and baby. We investigated different types and doses of intramuscular and intravenous opiod drugs to evaluate all this.

    We found 61 randomised trials involving more than 8,000 healthy pregnant women. Unfortunately, despite this large body of evidence, few trials had compared the same drug with a control and, instead, we were faced with a total of 34 different drug comparisons. Many comparisons had just a single study providing data, which seriously limited our ability to make firm conclusions. Another problem was that the trials were generally of poor quality, due to relatively small sample sizes, subjective outcome assessment using measures of uncertain validity and reliability, and a lack of blinding of investigators and women.

    Overall, we found that intramuscular or intravenous opioids provided some pain relief and women were moderately satisfied with the pain relief during labour, although up to two thirds of women reported moderate or severe pain or poor pain relief one to two hours after receiving an injection. Some women also experienced nausea, vomiting and drowsiness, but there was no clear evidence of adverse effects on the baby. It also wasn’t possible to establish whether one drug was superior to another, because of the lack of the necessary comparative evidence.

    In summary, our updated review shows that the evidence supporting the choice of intramuscular or intravenous opioids for pain management during labour is poor. We still need research to establish which drug provides the greatest satisfaction to women, with acceptable levels of unintended effects on both them and the newborn."

     

    Thursday, January 10, 2019

    Cochrane’s Colloquium, Santiago 2019 - call for abstracts and workshops now open

    Tue, 01/08/2019 - 17:31

    The 26th Cochrane Colloquium, Santiago 2019 call for abstracts and workshops is now open. 

    This year’s theme is ‘Embracing diversity’, recognizing Cochrane as a truly global independent community, addressing relevant health questions from international stakeholders using a range of diverse methods. 

    We ask that abstract submissions consider the relevance to this theme. In particular, we welcome submissions that address or discuss diversity on reviews from different viewpoints/angles. 

    The deadline for submissions is 12 April 2019.

    All submissions will be notified of their outcome by the first week in June 2019. 

     

    Tuesday, January 8, 2019

    Cochrane Survey: Provide feedback on Cochrane’s Policy on Conflicts of Interest

    Mon, 01/07/2019 - 16:04

    v\:* {behavior:url(#default#VML);} o\:* {behavior:url(#default#VML);} w\:* {behavior:url(#default#VML);} .shape {behavior:url(#default#VML);} Methodological rigour and impartiality are key attributes of Cochrane reviews. In an era where the validity of research is under scrutiny, the impact of conflicts of interest (COI), real and perceived, cannot be underestimated. It is critical, therefore, that Cochrane has a policy in place to minimize this concern and retain the confidence of all its stakeholders.

    To ensure Cochrane’s policy is fit for purpose, we are reviewing the Commercial Sponsorship Policy for Cochrane reviews and Cochrane review groups, which was last updated in October 2014.  We aim to make it easier to identify, prevent and manage COI from initial declarations to published statements in Cochrane reviews. The revised policy will cover both financial and non-financial aspects of COI. By improving clarity and removing ambiguity, we hope that the new policy will deal with issues around perception and transparency.

    In revising the policy, we must consider the unique challenges that arise from Cochrane being both the publisher of the Cochrane Library and an international healthcare research organization which serves multiple stakeholder interests and is powered by a largely volunteer workforce. Like other international organizations, we must ensure that our COI policy is understood and applied in a wide variety of countries and cultural contexts. Information gathered in the survey will be combined with a review of COI policies from other organizations and interviews with key stakeholders and COI experts, to inform the policy update.

    We invite feedback from people who create, use or fund the production of Cochrane Reviews, on how conflict of interest should be defined and managed. Please take 15 minutes to complete this important survey on COI by 17th February.

    If you have any questions about the survey or the COI revision project generally, please contact the team at COISurvey@cochrane.org.

    Monday, January 7, 2019

    Preventing dementia: do vitamin and mineral supplements have a role?

    Mon, 01/07/2019 - 15:09

    In this Evidently Cochrane blog, Sarah Chapman looks at the latest evidence on vitamin and mineral supplements for preventing dementia or at least slowing cognitive decline. Can they really help?

    "I have a clear memory of watching a tv drama with my mum, when I was about fifteen. As we watched a vivid portrayal of a middle-aged woman struggling to cope with her mother, declining with dementia, Mum voiced a fervent hope that she would never be like that. With her own mother enjoying good health in her nineties, the possibility must have seemed as remote to her as middle age did to me. But now I am there, and so is my mum, diagnosed with Alzheimer’s last summer.

    Is there anything my bright, busy mother could have done to reduce her risk of dementia? This woman, who for much of her adult life had a fulfilling career and later voluntary work; was happily busy with friends and family; enjoyed theatre-going, singing in a choir and participating in various special interest groups; read voraciously and had a daily crossword habit. Is there?"

    Despite the many important and positive inroads into our understanding of dementia in recent years, and an increasing shift in emphasis from dementia being something people suffer from to something they can live with, dementia frightens us. Katie Marais from Alzheimer’s Research UK says that “How can I prevent dementia?” is one of the most common questions put to them, and explains here what last year’s Lancet Commission on Dementia found about risk factors. While 65% of the risk for dementia comes from things we can’t change, like our age and our genes, the report lists nine ‘modifiable risk factors’ for dementia, things that we may be able to do something about, including smoking, lack of physical activity and social isolation.

    Preventing dementia: what do we try?

    There are many things that people do in the hope of staving off cognitive decline, from dietary modifications to daily sudoku solving. I think we may travel more in hope than expectation, but sometimes we can find evidence to see if our efforts might actually reduce our risk, and whether we could be doing ourselves any harm by trying.

    Two Cochrane Reviews bring together the best available evidence on the safety and effectiveness of vitamin and mineral supplements for maintaining cognitive function and preventing dementia. In theory, these could help, as vitamins and minerals have many functions in our central nervous systems which may help keep the brain healthy and our minds working well. But is there robust evidence to inform our choices? Let’s see.


    Vitamin and mineral supplements for cognitively healthy people

    This new Cochrane Review concerns the effects of vitamin and mineral supplements on cognitive function in people with no cognitive problems when they started taking part in the research studies. Although the review authors looked for studies involving people aged 40 and over, there are few data on people taking supplements under the age of 60. Despite being able to include 28 studies involving more than 83,000 people, there are limitations of the evidence which mean that confident conclusions can’t be drawn. Here’s what they found.
    B vitamin supplements

    Taking B vitamin supplements probably has little or no effect on overall cognitive function at any time point up to five years and may have no effect at five to ten years. There are very few data on harms or on the incidence of cognitive impairment or dementia.

    Antioxidant vitamins: ß‐carotene, vitamin C or vitamin E

    The results are mixed, but the review authors say that long-term supplementation with antioxidant vitamins may be the most promising area for future research. There is low-certainty evidence of benefit in overall cognitive function with long-term supplementation with ß‐carotene (after a mean of 18 years of treatment) and with vitamin C (after 5 to 10 years), but an antioxidant vitamin combination or vitamin E, alone or with selenium, may have no effect.

    Selenium

    Selenium alone, taken for around five years, may have no effect on the incidence of dementia.

    Zinc and copper supplementation

    Moderate-certainty evidence suggests that this has little or no effect on overall cognitive function, or the incidence of cognitive impairment, after five to ten years.

    Complex supplements

    Combinations of B vitamins, antioxidant vitamins, and minerals may have little or no effect on cognitive function, after around 8.5 years of taking them. The authors’ bottom line is:

    “We did not find evidence that any vitamin or mineral supplementation strategy for cognitively healthy adults in mid or late life has a meaningful effect on cognitive decline or dementia, although the evidence does not permit definitive conclusions.”

    Omega 3-PUFA (fish oils)

    An older Cochrane Review looks at the effect of omega-3 fatty acid supplementation (in gel capsules or margarine) compared with placebo (olive oil capsules or omega-free margarine) in cognitively healthy older people.  There is no direct evidence of the effect of omega-3 supplements on the number of people being diagnosed with dementia, while three high quality randomised trials show no benefit for cognitive function, measured by the Mini Mental State Examination (MMSE) score at 24 or 40 months. Some people taking omega-3 supplements experienced mild gastrointestinal problems.

    Vitamin and mineral supplements for people with mild cognitive impairment

    The authors of this Cochrane Review on the effects of vitamin and mineral supplementation on cognitive function in people with mild cognitive impairment (MCI) have found that the evidence is very limited. Only B vitamins have been assessed in more than one clinical trial. Taking B vitamins for six months to two years probably results in little or no difference in memory, thinking skills or quality of life, and the evidence doesn’t tell us whether or not there are any harms from taking them.

    They conclude:

    “At the moment, it is not possible to identify any supplements which can reduce the risk of people with MCI developing dementia or which can effectively treat their symptoms.”

    Where does this leave us?

    So many things that we try in the hope of maintaining our health are costly in terms of money, time, effort and the hopes we pin on them. Preventive strategies, like taking dietary supplements, are often pushed hard by those with a commercial interest in their uptake. Whether it is NHS budgets or individuals’ purses that take the financial hit, knowing whether there is evidence to guide these choices, and what that evidence tells us, is so important. These Cochrane Reviews show us what the state of the evidence is to date and when more evidence becomes available it can be assessed for inclusion in an update of the reviews. Meanwhile, we are anticipating three new Cochrane Reviews on another popular preventive strategy, computerised cognitive training or ‘brain training’, which we’ll be  blogging about here.

    Wednesday, January 9, 2019

    Cochrane Nigeria works with national guideline developers to help them develop and adapt evidence-based guidelines

    Thu, 12/27/2018 - 16:13

    We recognize the work of Cochrane Nigeria who are supporting national guideline development groups in using Cochrane evidence to develop evidence-based guidelines and to be able to adapt existing guidelines to the Nigerian context. Cochrane Nigeria has been developing skills in how to appraise and adapt existing guidelines using the AGREE II tool, and how to use evidence, including Cochrane evidence, in the guideline development process.

    Thursday, December 27, 2018

    Cochrane's 30 under 30: Heidi Gardner

    Mon, 12/24/2018 - 12:28

    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 a new 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: Heidi Gardner (on Twitter at @heidirgardner)
    Age: 27
    Occupation: Research Fellow in Clinical Trials Methodology
    Program: Cochrane Methods Group

    How did you first hear about Cochrane?
    I first heard about Cochrane towards the end of my undergraduate degree in Pharmacology at the University of Aberdeen. I was looking at PhD programmes and was doing some research on potential projects and supervisors. Both of the PhD supervisors that I wanted to work with were involved in Cochrane systematic reviews (Prof Shaun Treweek and Dr Katie Gillies), so I read those as interview prep. I’d never heard of a systematic review until that point so the idea of using rigorous methods to find all of the available evidence to answer a question was new and exciting and I knew I wanted to get involved further throughout my career. 

    How did you become involved with Cochrane? What is your background?
    My background is laboratory science – my undergraduate degree was in Pharmacology and I did lab-based research involving protein profiling of human brain tissue to detect Alzheimer’s disease. During that degree I was given the opportunity to convert my BSc to an MSci (an undergraduate masters) by taking a year away from formal teaching and going out to work. That year-long placement saw me work in staffing and recruitment – I was working with global clinical research organisations to help them to source staff such as Research Nurses, PIs, Clinical Research Associates etc to support trials from phase I to III. My patch covered the UK, Germany and South Africa, and I consistently found that the staff that I was hiring on a contract basis were being turned away from work because there were no patients for them to do trial data collection with. I was frustrated because I was finding really talented members of staff, but they weren’t able to do their job because of a shortage of patients. After doing a few google searches and eventually coming across Shaun’s Cochrane recruitment review, I realised I wasn’t the only one feeling frustrated so I figured a PhD would be a good way to get started on solving the problem of poor participant recruitment in trials!

    What do you do in Cochrane?
    I first got involved with Cochrane through Students 4 Best Evidence – within the first few months of starting my PhD I wrote a blog introducing Trial Forge, which is an initiative that aims to improve the efficiency of randomised controlled trials through generation of evidence to support trial processes (that blog post is here). After that I did a regular blog post slot debunking health claims reported in the media, and then my PhD took over and I got too busy! I then got involved with a Cochrane review update that my PhD supervisor (Prof Shaun Treweek) was leading (now published here), which was a brilliant way to learn about the hands on process of doing a systematic review (abstract screening, full text screening, data extraction etc) whilst I was planning a systematic review as part of my PhD. That also led me to being involved in a qualitative evidence synthesis that looks at factors that impact on recruitment to trials (the protocol is published here), and I’ve now been asked to contribute to another recruitment-related qualitative evidence synthesis, which I’m really excited about.

    What specifically do you enjoy about working for Cochrane and what have you learnt?
    It has been a hugely rewarding process so far; from beginning with short blog posts that I used to help me improve my communication skills (S4BE), right through to being an author on a Cochrane review, I have learned so much. I’ve learned that each review requires a significant amount of work – no matter whether it contains 1 study or 100 – and that the work involved is full of what feels like hundreds of steps at the time, but each of those steps is crucial in producing a systematic review that provides readers with all the information that they could possibly want or need on a specific area of research. I’ve met a lot of experienced researchers whilst working on various Cochrane reviews, and the kindness and generosity of those researchers will stay with me throughout my career. Despite the fact that I was at a very early stage of my career, these collaborators gave me their time and insight to ensure that I was learning and able to contribute effectively to each of the reviews I’ve been involved in. Hopefully in the future I’ll be able to lead my own Cochrane review and offer that opportunity to early career researchers like I was.


    What are your future plans?
    Over the next few months I will be working across various trials methodology projects going on at the Health Services Research Unit at the University of Aberdeen, and then after Christmas I’ll leave the Unit for a few months as I’ve been awarded a Winston Churchill Memorial Trust Fellowship that involves a lot of travel. I’ll be travelling to the USA, Canada, Singapore and Hong Kong over a period of 2 months, to learn from expert science communicators, digital teams and artists – I’ll be using my learnings to help to support UK-based science communicators in their online communication practices when I get back. Then in March I will return to HSRU to begin a new role as Research Fellow, which will see me lead my first independent research project. The project focusses on outcome collection in trials, specifically how much time and energy is being used to collect primary and secondary outcomes, and how we can work to improve efficiencies within these processes. I plan to continue building a career in trials methodology from there.

    In your personal experience, what one thing could Cochrane do better to improve its global profile?
    I would like to see more people knowing and using Cochrane systematic reviews; researchers in the way they design and create research projects, patients in the way they make decisions about the healthcare they want to receive, and the media in the way that they report health-related stories for the public. I did a qualitative study as part of my PhD where I talked to trial staff about the way they planned participant recruitment strategies, and the way that they used evidence to inform their decision making; the majority of participants did not reference the Cochrane recruitment review and when prompted explained that they ‘hadn’t had time to read it’. Often, Cochrane reviews end up in big chunky documents that immediately make people hesitate when looking at them.

    What do you hope for Cochrane for the future?
    I’d like to see Cochrane work on adding a step to the process of doing a systematic review; effectively disseminating their findings in easy and quick to view ways. It’s important that the main review is available for those that need it, but we could be doing a lot more to make the ‘golden nuggets’ of information within reviews easy to access. 

    How important is it that young people get involved in Cochrane?
    I think it’s incredibly important not only for young people, but people at the early stage of their research career, to get involved in Cochrane. It offers a fantastic network of hugely talented researchers that can teach us so much! It’s important to learn good research habits at the beginning of our careers so that we can produce high quality, rigorous research right from the off; Cochrane’s guidance and my learning of the methods used and endorsed by Cochrane have definitely stood me in good stead for a research career where I hope to focus on producing high quality work that is relevant to patients and can improve practice in the future.

    I also think early career researchers can do a lot to get the work of Cochrane out into the public through things like public engagement activities, social media and research communication focused at new audiences that are not necessarily leaning on Cochrane reviews to support the work that they are doing currently.

    What would your message be to other young people who want to get involved with Cochrane’s work but not sure where to start….?
    Get in touch with the Students 4 Best Evidence team! They’re a very friendly and welcoming group of people, and you’ll learn a lot by blogging (e.g. about recently published or updated Cochrane reviews) before you jump into doing systematic reviews of your own.

    Friday, February 15, 2019

    Cochrane's 30 under 30: Ammar Sabouni

    Mon, 12/24/2018 - 11:34

    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: Ammar Sabouni (on Twitter at @amosabo)
    Age: 26
    Occupation: Academic Clinical Trainee and Students 4 Best Evidence PioneerProgram: Academic Foundation Year 1 Doctor at Hull and East Yorkshire Hospitals NHS trust

    How did you first hear about Cochrane?
    I started medical school in Syria, a year before the start of the uprising. Towards the end of my first year I became interested in the activities of the Cochrane Schizophrenia group through one of my Psychiatry professors, Prof. Adib Essali. During my first two years at university I attended my first Cochrane Standard Author training in Damascus, by Prof. Clive Adams, head of the Cochrane Schizophrenia Group and I also had the chance to meet Sir Iain Chalmers and listen to his talk when he visited Damascus.

    How did you become involved with Cochrane? What is your background?
    Still in my basic science years at University studying to become a doctor I struggled to grasp the clinical contexts of the Cochrane reviews we were doing at first. Though my first systematic review was not a Cochrane one, later and with time I completed my first update of a Cochrane systematic review with the Cochrane Heart group. During this time, I became involved with Cochrane’s student initiative, Students 4 Best Evidence through which I was invited to come to Oxford for a placement within Cochrane UK.

    What do you do in Cochrane?
    I have since completed a number of consultancies for Cochrane UK including work on Cochrane review impact on Guidelines, early stages of the Cochrane-Wikipedia work, and Arabic translation work for Cochrane Bahrain, and become a Students 4 Best Evidence pioneer, authoring many blogs for the network. I have also continued to author Cochrane reviews for the Heart Group, Bone Muscle Joint Trauma group and am currently working on advancing Cochrane Arabic translation through a blogshot translation project.

    What specifically do you enjoy about working for Cochrane and what have you learnt?
    I know it may sound cheesy – but Cochrane is very much a huge family. Most people you will work with are there because they really believe in the work. I remember asking Sir Iain Chalmers if I could be involved in any research work while I was in Oxford and him telling me that in his opinion currently carrying out almost any primary research was unethical; that we should all be working on Cochrane systematic reviews, period. That is something you will really live and feel when working with people in Cochrane. It is a huge, multi-cultural, truly global collaboration of people who have come together because they really believe in the need for this work.



    What are your future plans?
    I received a bursary to attend the Global Evidence Summit in Cape Town but unfortunately was unable to attend because of the birth of my little baby girl, Maria. The ethos behind the Global Evidence Summit though I did not attend carries a lot of meaning for me. The fact that we need evidence-based policy not simply in health, in this day and age, is essential.

    When many are keen to blur the lines between fact and fiction our best response is to produce, disseminate and advocate for the use of the best evidence and critical thinking for policy in all aspects of life. I am still searching for what truly interests me and where I can do the most good. Be that as it may rest my belief in the importance of the work that Cochrane does, best evidence and critical thinking, will go with me wherever I go.

    In your personal experience, what one thing could Cochrane do better to improve its global profile?
    I think there has been a lot of work to engage with much wider audiences. There is still much left for us to do to engage with younger generations. The nature of the work that Cochrane does makes this no easy task. I believe we can though create places where young authors work to create draft reviews and get instant feedback in a learning environment that is streamlined and friendly. In a way that will give people the opportunity to get stuck right into the work. In addition to helping with translations, dissemination and other tasks.

    What do you hope for Cochrane for the future?
    I hope Cochrane will continue to involve patient and wider communities into the synthesis and application of the amazing work that happens. I am ambitious that the evidence we produce we will keep finding new and innovative ways to translate directly into practice. I am especially excited about the Cochrane – Wikipedia work and hope that it will continue to bear fruit and help people get access to the best evidence.


    How important is it that young people get involved in Cochrane? Why is this, do you think?
    I think you may have gathered from above that I feel young people are essential for Cochrane. Context is key; with a collaboration of this magnitude and with how critical it is for the evidence we produce to be utilised. Eventually we will no longer understand the contexts that we work in as well as the younger generations. To make the work Cochrane does sustainable then we need to actively engage the younger generations.

    What would your message be to other young people who want to get involved with Cochrane’s work but not sure where to start….?
    With tens of thousands of volunteers from around the world Cochrane is a very large organisation. Start small and find any opportunity to help. Translations, task exchange, social media, and training courses are very good places to start. Students 4 Best Evidence are a great community and always welcome new people. It will take some time until you create your network of Cochranites but with a little perseverance you will find yourself a member of this big family. 

    Remember that Cochrane produces one of the most rigorous methodological outputs in biomedical research. You will be able to play your part with some patience! Output will be well worth the wait. I attended Cochrane Colloquium Edinburgh and I met people I had not seen for years and it still felt like it was only yesterday!

    Friday, February 15, 2019

    Cochrane's 30 under 30: Emma Cartwright

    Mon, 12/24/2018 - 11:16

    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: Emma Cartwright (on Twitter at @EmmaCartwrigh1)
    Age: 29
    Occupation: PhD student and Patient Editor
    Program: Rosamund Snow Award

    How did you first hear about Cochrane?
    I first heard about Cochrane when I saw a Tweet about the colloquium in Edinburgh and how it was a patient included event which made me click on the link. It was then that I started to explore Cochrane and learn more about all of the work that happens at Cochrane.

    How did you become involved with Cochrane? What is your background?
    I became involved with Cochrane as the recipient of the Rosamund Snow Award. The award was for young health service users to attend the colloquium to find out more about Cochrane and how young people could become more involved in the work Cochrane does. My background is in Health Psychology, which I am currently studying a PhD in and I am also a person with Type 1 Diabetes, for which I do a lot of advocacy and peer support work. I am also a patient editor for the BMJ.

    What do you do in Cochrane?
    As part of the Rosamund Snow award I attended the colloquium in Edinburgh to learn about Cochrane and explore how patients could be further involved in the work Cochrane does. During the colloquium I, with the other prize winner, held a stand where we ask attendees of the colloquium (researchers, healthcare professionals and patients) how they had or hoped to involved patients in research. We collected the responses on a board so any attending the conference that wanted to involve patients more in their work could take some inspiration. I also supported the delivery of a workshop at the colloquium about how to involve patients in research with my colleagues from the BMJ. During this workshop we shared and explored how patients could sign up to become patient reviewers.

    What specifically do you enjoy about working for Cochrane and what have you learnt?
    My experience working with Cochrane so far has been very positive as I have found everyone to be very open to exploring new ways to better involve patients, and members of the public in research. I enjoy working with people from all over the world to bring together ideas and new ways of working which I think is a great strength of Cochrane being an international collaboration.

    Since winning the Rosamund Snow award I have learnt who Cochrane are and what they do. Particularly around how they bring research studies together to create a review and how this can give more confidence when asking a question about health (e.g. is this medication effective). I have also learnt that researchers really want to help patients like me and how important it is for patients to be involved in research from the very beginning of research projects to ensure this happens.


    What are your future plans?
    Within the next few years, during my PhD, I hope to bring together my knowledge as a researcher in Health Psychology with being a patient to find new and better ways of involving young patients in research. I hope to be able to show researchers, and clinicians, the unique skills and knowledge that patients can bring to research projects. I also hope to empower patients to become more involved within the research process, ensuring their voices are heard when identifying areas of research, questions to be addressed, outcomes measured, research design and in the communication of findings. I would also like to continue working with Cochrane to explore how they can involve wider groups of patients (and the public) in the work they do and continue to involve patients in the colloquiums.

    In your personal experience, what one thing could Cochrane do better to improve its global profile?
    One thing I think Cochrane could do to better improve its global profile is to explore new ways of informing patients of its role and the information they can offer. I think Cochrane needs to become much more engaging, outside of the research community, by reaching out to groups who would not normally hear of Cochrane. In order to do this, I think Cochrane must work closely with clinicians who are seeing patients every day and can recommend Cochrane as a place for patients to find information about their condition. I would also suggest that Cochrane works with patient advocates or patient groups to also help share their work to the relevant patients and establish itself as the go to resource of information for patients.

    I also think Cochrane needs to rethink its ways of communicating research to patients and the public. I personally find lay summaries difficult to engage with (e.g. lots of acronyms) and are still largely written in an academic format (e.g. number of studies included, number of participants). As a patient all I want to know is what does the evidence tell us and how does/could this affect me. You also have to know what a lay summary is and where to find it in order to engage with it which is not always easy. One way Cochrane could improve on this is through developing engaging videos, podcasts, short summaries (one paragraph) or infographics to communicate research findings in a much more accessible way. 

    What do you hope for Cochrane for the future?
    I hope that Cochrane continues to further patient involvement in research and that they involve patients in how best to carry this out. I think the colloquium in Edinburgh was a great step in really involving patients within the Cochrane community and attempting to try and involve different groups of patients (e.g. The Rosamund Snow award, Beyond the Room team with tweets and podcasts of the event). However, I would like to see patient involvement to continue to be a large focus of the colloquium by ensuring that patients are not only involved in the planning of the colloquium but also there at future events as well. I also hope that Cochrane takes on the feedback from patients to better improve patient involvement in events and research.
    Finally, I hope that Cochrane can raise its profile as a credible, reliable and accessible resource for patients looking for information on their health.

    How important is it that young people get involved in Cochrane?
    I think it is incredibly important for young people to get involved in Cochrane as we can bring new, innovate and engaging ideas to shape the future direction.

    Why is this, do you think?
    Research and patient involvement are areas which are moving fast and constantly changing with many organisations trying to determine the best way to bring both of these together. Involving young people in Cochrane, especially patients, is important in ensuring that Cochrane’s direction is in line with the needs and wants of future contributors and users. Many organisations continue to do things because that is always how they have been. Sometimes a new, fresh pair of eyes looking at how things work and asking ‘why?’ can spark a change in moving things forward.

    What would your message be to other young people who want to get involved with Cochrane’s work but not sure where to start….?
    First of all I would say check out the Cochrane website. It is full of information and videos about what Cochrane is and what they do, from the very beginning including all of the basics is really helpful as a patient or young researcher. I would also say sign up to the Cochrane task exchange. You will be amazed at the number of skills you have that researchers are looking for and it is a great way to get involved with Cochrane with no or little prior knowledge of research.

    Tuesday, February 12, 2019

    Cochrane's 30 under 30: Robin Vernooij

    Mon, 12/24/2018 - 11:03

    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: Robin Vernooij
    Age: 29
    Occupation: Post-doctoral researcher at the Netherlands Comprehensive Cancer Organisation and post-doctoral fellow at the Dalhousie University in the Nutritional Recommendations and Accessible Evidence Summaries Composed of Systematic Reviews (NutriRECS) group
    Program: Netherlands Comprehensive Cancer Organisation

    How did you first hear about Cochrane?
    I became aware of Cochrane in 2011 while working on my Master's degree in Epidemiology and Biostatistics at the VU University in Amsterdam. One of my courses focused on the methodology and statistics of systematic reviews and meta-analyses. The Cochrane Handbook was a “suggested reading” and not surprisingly turned out to be an invaluable learning resource.

    How did you become involved with Cochrane? What is your background?
    My medical career started in 2006 at the HAN University of Applied Sciences in Nijmegen, the Netherlands where I obtained his Bachelor's degree in nursing in 2010. Afterwards, as part of my Master's degree, I completed a one-year placement at the Iberoamerican Cochrane Centre in Barcelona. Subsequently I was fortunate to continue to work at the centre for two more years. It was with the same centre, affiliated with Autonomous University of Barcelona, that I completed my PhD thesis in the Methodology of Biomedical Research and Public Health (2013 to 2018).

    What do you do in Cochrane?
    Apart from being employed by the Iberoamerican Cochrane Center for almost three years, I have been involved in the Cochrane community by collaborating with several Cochrane groups. In this capacity, I have helped author teams in completing their systematic reviews, including authors and editors of the Anaesthesia, Critical, and Emergency Care group; Dementia and Cognitive Improvement group; Urology group; and the Vascular group. Additionally, I serve as a contact editor for the Cochrane Urology group and as a regular peer-reviewer for the Cochrane Screening and Diagnostic Tests Methods Group.

    What specifically do you enjoy about working for Cochrane and what have you learnt?
    Working for Cochrane on a systematic review includes commonly a multidisciplinary collaboration between methodologists, statisticians, clinicians, and policy-makers. This collaboration allows me to learn more about the practices of the other involved disciplines. Secondly, I welcome any opportunity to learn more about the quality standards and emerging methods in conducting systematic reviews or meta-analyses. Being involved in the Cochrane collaboration allows me to remain up-to-date with the “gold standard” of systematic reviews and meta-analyses. Finally, contributing to the most comprehensive up-to-date evidence summaries on a given topic is very motivating.



    What are your future plans?
    Apart from my enthusiasm about systematic reviews, I am also keen on the development and updating of guidelines. Obviously, they go hand in hand since guidelines should be informed by the best summaries of the latest evidence available. My future plans are to collaborate on making an evidence ecosystem in which guidelines (informed by high-quality systematic reviews) are used to implement quality indicators in clinical practice. These quality indicators, based on the recommendations of the guidelines, should be used by healthcare professionals to treat their patients accordingly. Ideally, adherence to these quality indicators should be measured by registry data, allowing real-time feedback of the healthcare professionals performance.

    In your personal experience, what one thing could Cochrane do better to improve its global profile?
    Cochrane has grown a lot in the last five years and has many demands and priorities, particularly with respect to emerging methods including network-meta-analyses and living systematic reviews. I think that Cochrane should emphasise the need for living systematic reviews based on new practice-changing trials. If, at least, 75 new trials are published every day, it becomes very difficult to keep all available Cochrane reviews up-to-date. Methods and software development for identifying new trials, prioritising evidence that may be practice-changing, and conducting updates would be an asset to the organisation.

    What do you hope for Cochrane for the future?
    “It is surely a great criticism of our profession that we have not organised a critical summary, by specialty or subspecialty, adapted periodically, of all relevant randomised controlled trials” (Cochrane 1979).

    Although we have, over the last 40 years, came a long way, in my modest experience, there is still much room for improvement in the original aim. And now we are facing additional challenges, such as: how are we going to keep our systematic reviews and guidelines up-to-date? How do we prioritise practice-changing new evidence? And how do we use new technologies to facilitate systematic review development? I hope we can collectively work together to answer these questions.

    How important is it that young people get involved in Cochrane?
    As with most successful medical and public health organisations that are non-for-profit, research volunteers are crucial and it is important that a substantial proportion have healthcare and research training. It is important that trainees recognise the role of systematic reviews for evidence-informed health care decision-making. Crucial to learning about systematic reviews is the opportunity to have hands-on-experience.

    Why is this, do you think?
    For most of the young people, building both an academic and clinical network is crucial for the success of their career. Those pursuing a PhD project in the field of medicine or public health should consider –in my opinion – conducting or supporting a Cochrane review. This allows collecting all available evidence, understanding risk of bias issues, summarising the certainty of evidence to generate conclusions, and, identifying gaps in the current knowledge. The identified gaps could be used as inspiration on follow-up studies in a PhD project and beyond.

    What would your message be to other young people who want to get involved with Cochrane’s work but not sure where to start….?
    I would suggest reaching out to authors and editors that may be in need of a helping hand. For instance, Cochrane often posts on its website, reviews in need of update help, particularly priority reviews. Additionally, they can start browsing Cochrane’s TaskExchange for opportunities such as translation, data-extraction, or risk of bias assessment, as well as Cochrane Crowd, which allows gaining experience in literature screening. To get started, there are often simple tasks (e.g. literature screening, data-extraction) available on these websites that can be of great help to those leading the systematic review process, tasks that perhaps lead to co-authorship!

    Tuesday, January 15, 2019

    Cochrane's 30 under 30: Emma Persad

    Mon, 12/24/2018 - 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: Emma Persad
    Age: 26
    Occupation: Part-time student researcher at the Department of Evidence-based Medicine and Clinical Epidemiology at Danube University Krems and Cochrane Austria
    Program: Bachelor of Science Honours in Molecular Biology (Canada), Medicine (Austria)

    How did you first hear about Cochrane?
    Cochrane Austria is fortunately located on campus at the Department of Evidence-based Medicine and Clinical Epidemiology at Danube University Krems. Due to the convenience of having the Centre so close and the importance of teaching evidence-based medicine to medical students, Cochrane’s methods, work, and strict standards have been taught extensively since the first year of the program.

    How did you become involved with Cochrane? What is your background?
    My background is more in molecular biology and laboratory research, but after starting my medicine program I got introduced to Cochrane’s work and was lucky enough to get a job working alongside Cochrane Austria. I have always been passionate about public health and international affairs, so working for an international organization like Cochrane really fits my profile.

    What do you do in Cochrane?
    I’ve been involved in a variety of Cochrane reviews, with research and outreach for the Rapid Reviews Methods Group, and am currently leading an update of a Cochrane Review alongside my thesis.

    What specifically do you enjoy about working for Cochrane and what have you learnt?
    I really enjoy working for such a tight-knit community that is so determined to reach out with the best available evidence to both professionals and the general public. A great example of this is the plain language summaries of reviews to make the major points understood by lay people. As a future doctor, I have personally learned the importance of evidence-based medicine in my future career, and I can now appreciate that most people, especially doctors, don’t have time to read and synthesize all of the studies that are published. Thus, it is reassuring to have a set place to find the most trustworthy, all-inclusive, and up-to-date evidence.



    What are your future plans?
    I hope to work in the medical field while combing my passion for evidence-based medicine and public health into my career. I would like to stay involved in Cochrane’s work as much as possible and continue to be involved in reviews, when presented with the opportunity. I would eventually like to work with the WHO, and I’m sure my background with Cochrane will be a great asset for me there.

    In your personal experience, what one thing could Cochrane do better to improve its global profile?
    I think Cochrane could do a better job with student outreach and involvement. My university is lucky to have Cochrane so close and so involved in the curriculum, but I think many students in science and research-related disciplines unfortunately graduate without knowing what Cochrane even is. If Cochrane can be more present in universities, then people worldwide will know Cochrane’s work and take that knowledge into their careers with them. This could be made possible by country Centres offering internships to interested students or by holding lectures on Cochrane and how to get involved in relevant faculties at universities, for example.

    What do you hope for Cochrane for the future?
    I hope that the country Centres will continue to grow and expand so that Cochrane’s high-quality research can be done around the world and influence the public health and medical practices in each country. 

    How important is it that young people get involved in Cochrane?
    Very important!

    Why is this, do you think?
    I believe that youth involvement is needed to continue Cochrane’s work in the future and that people planning to work in this field should be exposed to Cochrane as early as possible. This way, proper recognition and respect for evidence-based medicine can be taught, passed-on, and used throughout their whole 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….?
    First of all, check out Cochrane’s website to find out the ways that you can get involved. Translating Cochrane reviews or becoming a Cochrane citizen scientist are good ways to start. You can also contact your country Cochrane Centre to see if you can do an internship or get involved in their work. 

    Friday, January 4, 2019

    Featured review: Uterotonic agents for preventing postpartum haemorrhage

    Thu, 12/20/2018 - 10:59

    Which drug is best for reducing excessive blood loss after birth?

    The aim of this Cochrane Review was to find out which drug is most effective in preventing excessive blood loss at childbirth and has the least side effects. The authors collected and analysed all the relevant studies to answer this question.

    The review’s lead author Dr Ioannis Gallos from the University of Birmingham explains, “Bleeding after birth is the most common reason why mothers die in childbirth worldwide. Although most women will have moderate bleeding at birth, others may bleed excessively, and this can pose a serious risk to their health and life. To reduce excessive bleeding blood loss at childbirth, the routine administration of a drug to contract the uterus (uterotonic) has become standard practice across the world. The aim of this research was to identify which drug is most effective in preventing excessive bleeding after childbirth and has the least side-effects.

    The different drugs oxytocin, misoprostol, ergometrine, carbetocin, and combinations of these drugs, each have different effectiveness and side-effects. Some of the side effects identified include: vomiting, high blood pressure and fever. We analysed all the available evidence to compare all of these drugs and calculated a ranking among them providing robust effectiveness and side-effect profiles for each drug.

    We found all drugs were generally effective for preventing excessive bleeding when compared with no uterotonic drug treatment. Ergometrine plus oxytocin combination, carbetocin, and misoprostol plus oxytocin combination may have some additional benefits compared with the current standard oxytocin. The two combination drugs, however, are associated with significant side effects that women might find disturbing compared with oxytocin. Carbetocin may have some additional benefits compared with oxytocin and appears to be without an increase in side effects.”

    This updated review includes 196 studies involving 135,559 women. Studies were conducted across 53 countries. In most studies women were giving birth normally and in a hospital.

    Thursday, December 20, 2018

    Interview with Dr Ioannis Gallos lead author of the updated Uterotonic agents for preventing postpartum haemorrhage: a network meta‐analysis

    Thu, 12/20/2018 - 10:47

    The aim of this Cochrane Review was to find out which drug is most effective in preventing excessive blood loss at childbirth and has the least side effects. The authors collected and analysed all the relevant studies to answer this question.

    The lead author of this review is Dr Ioannis Gallos. He is a Clinician Scientist in University of Birmingham and Honorary Consultant in Obstetrics & Gynaecology for Birmingham Women’s Hospital. Ioannis obtained his Degree in Medicine and Surgery (DMS) cum laude from the University of Rome, Italy. He subsequently trained in Obstetrics & Gynaecology in the UK and sub-specialised in Reproductive Medicine & Surgery before joining University of Birmingham.

    Ioannis’ research is focussed on reproduction, early pregnancy and maternal health. Ioannis has carried out evidence synthesis including the first network meta-analysis in O&G within Cochrane with cost-effectiveness analysis for identifying the most effective and cost-effective uterotonic agents for preventing postpartum haemorrhage in collaboration with the World Health Organisation. He is the National Clinical Co-ordinator for the “Letrozole or Clomifene, with or without metformin, for ovulation induction in women with polycystic ovary syndrome: a 2x2 factorial design randomised trial (The LOCI trial)” funded by the NIHR HTA programme and is expected to roll out in 50 hospitals across the UK. Ioannis is a consultant for the Tommy's National Centre for Miscarriage Research based at Birmingham Women’s Hospital. He is also the principal investigator for Tommy’s Net, a platform that will help us to collect and store information from many different centres. By sharing information, hospitals will be able to work together to carry out more effective research.  

    We asked the review’s lead author, Dr Ioannis Gallos  a few questions about this important Cochrane Review.

    What is the history behind this updated review (what came before?)
    This review was originally published in April 2018. It has been updated so soon to incorporate results from a large WHO trial and other recent large trials. We have added 56 new trials (46,612 women), and the update now includes a total of 196 trials (135,559 women). 

    Why was it important to conduct this review?
    The individual uterotonics described in the review have been compared in existing Cochrane Reviews and all comparisons are based on trials that directly compared one uterotonic against another uterotonic agent in head-to-head trials. In the absence of a single randomised controlled trial comparing all available uterotonic agents, uncertainty remains over their relative effectiveness and ranking. When multiple interventions are available, a network meta-analysis is better placed for synthesising and interpreting the wider picture of the evidence and to understand the relative effects of all available interventions. Network meta-analysis has advantages over conventional pairwise meta-analysis, as the technique uses both direct and indirect evidence in a single coherent analysis to improve certainty about all possible treatment comparisons. Indirect evidence is obtained when the relative effectiveness of two competing interventions is inferred through a common comparator, even though this pair may not have been compared directly. WHO wished to update their recommendations on prevention of postpartum haemorrhage for the first time using a Cochrane network meta-analysis.

    Can you give a brief summary of results?
    All agents were generally effective for preventing excessive bleeding when compared with no uterotonic drug treatment. Ergometrine plus oxytocin combination, carbetocin, and misoprostol plus oxytocin combination may have some additional benefits compared with the current standard oxytocin. The two combination drugs, however, are associated with significant side effects that women might find disturbing compared with oxytocin. Carbetocin may have some additional benefits compared with oxytocin and appears to be without an increase in side effects.

     How did you co-ordinate with WHO to have this review integrated into the guideline?
    Together with Cochrane Pregnancy and Childbirth and WHO we ran, in parallel, the updated evidence synthesis for the effectiveness and safety of the uterotonic agents. Results of the synthesis were integrated to the guideline and presented to the WHO guideline development group as forthcoming evidence to help them reach a decision about which uterotonic to recommend.

    What does the review mean in terms of influencing policy and/or practice?
    The results of this work are already integrated in the recent WHO recommendations and we hope they are helpful to other policy-makers and practising clinicians. You can view this here.

     

    Thursday, December 20, 2018

    Featured Review: Interventions for treating wrist fractures (broken wrists) in children

    Wed, 12/19/2018 - 16:03

    The recently published Cochrane Review from the Bone, Joint and Muscle Trauma Group assessed the best-quality evidence for different treatments of wrist fractures in children.

     Wrist fractures are the most common bone injury in children. Most are buckle (or torus) fractures, where the bone surface bulges out. These minor fractures heal well. They are often treated with a wrist splint or a below-elbow plaster cast.

    More serious fractures are where the bone breaks, generally resulting in displacement of the bone parts. Usually the bone is manipulated back into place ('reduction'), followed by cast immobilisation, often with an above-elbow cast including the elbow. When considered, surgery generally involves placing wires through the skin and into the bone (percutaneous wiring).

    The review includes 30 studies with 2930 children. Most of the 14 comparisons made by the studies were tested in one study only. The review focussed on five key comparisons. The three comparisons involving children with buckle fractures compared a removable splint with a below-elbow cast (6 studies); a soft or elasticated bandage with a below-elbow cast (4 studies); and cast removal at home by parents versus at the hospital fracture clinic by clinicians (2 studies). The other two comparisons, which involved children with displaced fractures, compared below-elbow versus above-elbow casts (4 studies) and percutaneous wiring and above-elbow cast immobilisation versus above-elbow cast immobilisation alone (5 studies).

    Lead author Helen Handoll concluded, “There is not enough evidence to determine the best ways of treating different types of wrist fractures in children. However, the review findings are consistent with the treatment trend away from cast immobilisation for buckle fractures.”

     

    Wednesday, December 19, 2018

    Podcast: Lamotrigine versus carbamazepine monotherapy (single medication treatment) for epilepsy

    Tue, 12/18/2018 - 20:41

    Up to 70 million people worldwide have epilepsy and there are many Cochrane Reviews of ways to treat it. These include reviews that work with the original researchers to gather data on everyone who was in their studies, to perform individual participant data meta-analyses. In June 2018, Sarah Nevitt and colleagues from the University of Liverpool in the UK updated one of these reviews, comparing two commonly used drugs, lamotrigine and carbamazepine.

    "Carbamazepine and lamotrigine are both recommended as first-line treatments for people with newly diagnosed focal onset epileptic seizures and as second-line treatments for those with newly diagnosed generalised onset seizures, if first-line treatment with sodium valproate is considered unsuitable. Therefore, in order to help choose between them, we have brought together the evidence from randomised trials, increasing the precision of results relating to efficacy and tolerability of the two drugs. 

    Our primary outcome for the analyses was the time between a patient starting the drug and being withdrawn from it, which reflects both how effective the drugs are for seizure control and the tolerability of the drugs in terms of side effects. We also examined secondary efficacy outcomes, including time to first seizure and remission of seizures, as well as the types and frequency of side effects. 

    We found fourteen relevant trials for this updated review, involving nearly 3800 people, and were able to obtain individual participant data for more than 2500 people from nine of the trials, representing nearly 70 percent of all the data. 

    Our main results from the meta-analyses of these data suggest that people are more likely to withdraw earlier from carbamazepine than from lamotrigine treatment, with the most common reason for withdrawal being side effects, followed by seizure recurrence. The results also suggest that recurrence of seizures after starting treatment with lamotrigine may happen earlier than with carbamazepine and that people will achieve a period of six months without a seizure quicker on carbamazepine than lamotrigine. Adverse events occurred with a similar frequency for both drugs. The most common ones were dizziness, fatigue, gastrointestinal disturbances, headache and skin problems.

    In summary, the evidence from the randomised trials shows that both carbamazepine and lamotrigine are effective treatments for people with focal onset seizures. Carbamazepine may be superior in terms of seizure control, while lamotrigine therapy is less likely to be withdrawn than carbamazepine therapy. This means that a choice between these first-line treatments should be made with careful consideration, taking personal circumstances of individuals into account, and using the information in our updated review as a guide to what might happen to patients on either drug."

    Tuesday, December 18, 2018

    Cochrane Library Editorial: Treatment for Buruli ulcer

    Mon, 12/17/2018 - 19:02

    Buruli ulcer is a neglected tropical disease caused by Mycobacterium ulcerans. It predominantly affects children below age 15 in sub‐Saharan Africa and people of any age in Australia. The infection manifests as a skin nodule, oedematous lesion, plaque, or ulcer. Transmission of Buruli ulcer is not entirely understood, with aquatic insects and mosquitoes being linked to disease transmission in some settings. It is clear, however, that disease is caused by the puncturing injury and introduction of the environmental pathogen into the skin and subcutaneous tissues. Whether the bacteria are thriving within a vector before they are transmitted (biological transmission) or merely transported and injected (mechanical transmission) is yet to be elucidated. Another hypothesis is that M ulcerans on the host skin is introduced following an insect bite or minor trauma.

    A new Cochrane Infectious Diseases Review by included and discussed five randomized controlled trials and 13 prospective observational studies on drug treatment of Buruli ulcer - the first of its kind to formally assess the available evidence for drug treatment. This Cochrane Library Editorial discusses the latest findings, what we know, and what questions are still left unanswered.

    Monday, December 17, 2018

    Cochrane Crowd, Cochrane’s citizen science platform, breaks records in Mexico

    Mon, 12/17/2018 - 18:19

    Cochrane Crowd, Cochrane’s citizen science platform, is a global community of volunteers who are helping to classify the research needed to support informed decision-making about health care.

    The job of the Cochrane Crowd community is to review descriptions of research studies to identify and classify randomized controlled trials (RCTs), a type of study that is considered the gold standard for clinical trials. Reports of RCTs are then fed into Cochrane’s Central Register of Controlled Trials, helping Cochrane authors and other systematic reviewers around the world quickly find the evidence they need to determine whether a treatment works, or whether a diagnostic test is accurate.

    A challenge held in partnership with the Cochrane Associated Centre at Sinaloa’s Pediatric Hospital (Mexico) and the Autonomous University of Sinaloa (Mexico) recently broke all previously held challenge records. 

    Giordano Perez-Gaxiola, director of Cochrane Mexico and key challenge organiser said; "I had run a couple of small challenges through Cochrane Classmate with my students in the past year. I thought it was a simple way to motivate them to learn what Cochrane is, what a clinical trial is, and how an easy-to-use platform like Cochrane Crowd could help them learn. A couple of months ago I had a meeting with the dean of the medical faculty of the Autonomous University of Sinaloa (Universidad Autónoma de Sinaloa, UAS), Dr. Gerardo Alapizco, to discuss how the university and our Cochrane Associated Centre at Sinaloa’s Pediatric Hospital (Hospital Pediátrico de Sinaloa, HPS) could collaborate. I proposed setting up a university-wide challenge in order to engage a large number of students. This would introduce them to Cochrane and hopefully pique their interest, potentially leading to further engagement with Cochrane. This proposal was then discussed and approved by the medical faculty’s governing committee. We agreed that all students at UAS would be invited to take part."

    Over three days from Dec 5-8, 738 people signed up, 455 participated and 319,643 individual assessments were made equating to 89,692 records being screened. 90 people screened at least 1000 records during the challenge and as a result were invited to become Cochrane members. And finally, almost 10,000 RCTs were identified for Cochrane’s CENTRAL register of controlled trials, where they can be accessed by systematic reviewers around the world.

    Perez-Gaxiola added; "In my opinion, a Cochrane Crowd challenge is a simple way to engage students, to help them learn about Cochrane and about clinical trials. It is very easy to set up (takes about 10 minutes) and easy for the students to participate. It can be a useful teaching tool, too. And if you make it a competition, it can be fun."

    Monday, December 17, 2018

    Featured Review: Adverse events in people taking macrolide antibiotics versus placebo for any indication

    Mon, 12/17/2018 - 09:45

    The review 'Adverse events in people taking macrolide antibiotics'  asked, “Will people taking a macrolide antibiotic experience more adverse events than those treated with placebo?”

    Macrolide antibiotics are one of many types of antibiotic. They are commonly used to treat both acute and chronic infections. The four most commonly used macrolides are azithromycin, clarithromycin, erythromycin, and roxithromycin. People taking macrolide antibiotics are at risk of experiencing adverse events such as nausea, diarrhoea or rashes.

    Lead author of the review Malene Plejdrup Hansen explains, “This review was undertaken to quantify adverse events in patients using macrolide antibiotics, independently of the indication or effects of the treatments. The intent is to support clinicians and patients in evaluating harms as well as benefits in the choice of management when antibiotics are considered.”

    The review includes 183 studies with 252,886 participants. Most studies were conducted in hospitals. Azithromycin and erythromycin were more commonly studied than clarithromycin and roxithromycin. Most studies (89%) reported some adverse events or at least stated that no adverse events were observed. 

    • People treated with a macrolide antibiotic experienced gastrointestinal adverse events, such as nausea, vomiting, abdominal pain, and diarrhoea more often than those treated with placebo.
    • Taste disturbances were more often reported by people taking macrolides than those taking a placebo. However, very few studies reported on these adverse events, and results should be interpreted with caution.
    • Hearing loss was more often reported by people taking macrolide antibiotics; however, only four studies reported this outcome.
    • Macrolides caused less cough and less respiratory tract infections than placebo.
    • We did not find any evidence that macrolides caused more cardiac disorders, liver disorders, blood infections, skin and soft tissue infections, changes in liver enzymes, appetite loss, dizziness, headache, respiratory symptoms, itching, or rashes than placebo.
    • We did not find more deaths in people treated with macrolides than in those treated with placebo.
    • Very limited information was available to assess if people taking a macrolide antibiotic were at greater risk of developing resistant bacteria than those treated with placebo. However, bacteria that did not respond to macrolide antibiotics were more commonly identified immediately after treatment in people taking a macrolide than in those treated with placebo, but differences in resistance thereafter were inconsistent.

    The quality of evidence ranged from very low (cardiac disorders, change in liver enzymes, liver disorders), to low (abdominal pain, death, diarrhoea, dizziness, hearing loss, skin and soft tissue infections, taste disturbance, wheeze), to moderate (appetite loss, blood infection, cough, fever, headache, itching, nausea, rash, respiratory symptoms, respiratory tract infections, vomiting) according to GRADE assessment.

     

    Monday, January 21, 2019

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