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Cochrane’s Neurological Sciences Field launches 2019 Summer School for young physicians and trainees interested in cerebrovascular diseases

Lun, 06/10/2019 - 17:52

 

Together with support from the Umbria Region Health Authority, Perugia, Italy, Cochrane’s Neurological Sciences Field is organizing a four-day Summer School 10-13 September 2019.

The residential course targeted to young physicians and trainees interested in cerebrovascular diseases, aims to present, discuss and appraise key methodological issues encountered in clinical practice with examples in vascular neurology.


Participants will learn to what extent and how methodology sustains clinical practice and the decisions that can be made accordingly, using cerebrovascular diseases as an example.

Discussions on evidence-based medicine (EBM), elements of statistics, and what is needed to appraise evidence will be conducted so that participants will be encouraged to promote clinical EBM research and systematic reviews in their professional activity to manage uncertainty.

After successful completion of the course, participants will bridge the research-practice gap in a context of evidence-based education through:

  1.  knowing when and how to screen for particular conditions;
  2. having an understanding of how to appraise the evidence from trials and systematic reviews
  3. knowing how to read a Cochrane Summary of Findings Table;
  4. understanding useful elements about statistics;
  5. knowing the current debate on the meaning and role of EBM.

If you are a practitioner, neurologist, healthcare worker, researcher, guideline developer or policy-makers who wants to get more involved in Cochrane methodology and stroke medicine, find out more information and register here: https://neurosciences.cochrane.org/summer-school-2019 or contact Kathryn Mahan, Coordinator, Cochrane Neurological Sciences Field, kmahan@regione.umbria.it

 

Monday, June 10, 2019

Cochrane launches Knowledge Translation mentorship programme

Lun, 06/10/2019 - 17:29

Would you like to develop your skills and experience in knowledge translation? Would you like to become a Cochrane leader and mentor of the future?

Cochrane defines Knowledge Translation (KT) as the process of supporting the use of health evidence from our high quality, trusted Cochrane systematic reviews by those who need it to make health decisions.

In order to develop and build on our existing KT implementation work and to encourage sharing of good practice, we’re excited to announce the launch of our first Knowledge Translation mentorship initiative.

KT mentoring in Cochrane is described as a structured, sustained relationship between two colleagues, in which the person more experienced in a specific area of knowledge translation (mentor) uses their knowledge, experience and understanding to support the development of specific KT practices that will be used in a mentee’s daily Cochrane work.


We are looking for mentees across Cochrane and mentors from Cochrane or beyond who will work collaboratively and confidentially on a 1:1 basis to discuss specifics of a KT activity or project, learning and development needs. A mentor will be paired with a mentee to provide advice and guidance based on their knowledge and experiences in an agreed specific area of KT. They will aim to help to increase the mentee’s awareness of issues involved in delivering KT and to support in exploring solutions to outcomes the mentee wants to achieve. They will also be able to offer the mentee additional tools or resources to support learning.

Thursday, June 13, 2019

Do you want a role in leading Cochrane to 2020 and beyond?

Vie, 06/07/2019 - 14:21

Nominations are now open for Co-Chair of the Cochrane Governing Board – we welcome you to apply!

The deadline for receiving nominations is the end of the day on Sunday 30 June in any time zone.

The Board has two Co-Chairs, to share workload, utilize complementary skills and experience, and permit continuity through the Co-Chairs stepping down at different times. The new Co-Chair will work alongside current Co-Chair Martin Burton and replace Marguerite Koster, who is stepping down as Co-Chair at the end of her current term but will remain on the Board as a member.

The Co-Chairs are accountable to the Board, and to the members of the organization. They are expected to have leadership skills, to be fully consultative, to have vision, to be adept at dealing with people, to be able to solve problems and resolve conflicts effectively, to communicate well, and to be able to represent Cochrane in a variety of different settings.  

Members of the Governing Board have responsibilities both as trustees under UK charity law and as directors under UK company law. All Board members must adhere to the Governing Board Charter and to the Code of Conduct for Trustees.

Eligibility
Anyone who holds, or has held, a leadership position within Cochrane is eligible to apply for the position of Co-Chair. Experience of membership of the Governing Board is advantageous but not essential. Anyone appointed Co-Chair that is not already a Board member becomes a member upon their appointment.

Responsibilities

Co-Chairs agree upon an appropriate division of responsibilities, which include:

  • Chairing Board meetings and various Board sub-committees;
  • Chairing Cochrane’s Annual General Meeting;
  • Facilitating strategic planning by the Board;
  • Advising and guiding the Chief Executive Officer (CEO), the Editor in Chief and the Central Executive Team in working towards delivery of Cochrane’s strategy;
  • Serving as official spokesperson(s) for Cochrane and the Board, with the authority to delegate this responsibility to others;
  • Responding to issues raised by members of the organization, outside the remits of the CEO and the Editor in Chief;
  • Conducting the performance appraisal of the CEO.

Time commitment

There is a need for a minimum of eight hours per week for the Co-Chairs combined, but with an expectation that a combined total of up to 30 hours per week might sometimes be needed (not including the full-time requirements at the times of the two face-to-face Board meetings per year).

This year, the new Co-Chair must be available to travel to Santiago, Chile for the Board’s meeting 19-21 October 2019, and stay on to attend the Colloquium, to at least 23 October 2019.

Term of office

The Co-Chairs hold office for two years. They may continue to hold office for a further two-year term with the approval of the Board. The term of the new Co-Chair will begin on 1 September 2019.

How to nominate

The Board appoints the Co-Chairs. Candidates should be nominated by three Cochrane Members as defined by the Membership Terms & Conditions, including a current member of the Board.

Current Board members may only nominate one candidate each and a serving Co-Chair is not permitted to provide a Letter of Support for a fellow Board member standing for a Co-Chair appointment.

Candidates standing for appointment must submit their nomination by email to Lucie Binder, by the specified deadline below, including:

  1. A completed Co-Chair Candidate Statement which includes a declaration of conflicts of interest (including direct and indirect conflicts, and professional relationships to other members of the Board, and other boards they may sit on).
  2. Letters of Support from three Cochrane members acting as 'nominators' for the candidate, including one current member of the Board, supplying the following information:
    • Name and role in Cochrane of the person writing the Letter of Support.
    • Statement about the capacity in which they know the nominee, why they consider the nominee to be an appropriate candidate in the light of the Co-Chair job description as set out in this policy and the extent to which they think the nominee has the necessary attributes.

For more information, please refer to the Board electoral and appointment procedure on the Cochrane Community website or contact Lucie Binder (lbinder@cochrane.org), Senior Advisor to the CEO (Governance & Management).

Important dates

Nominations openThursday 6 June 2019Deadline for nominationsSunday 30 June 2019Results announcedFrom Thursday 11 July 2019 (following the Governing Board’s decision)

    
    
    

 

 

Friday, June 7, 2019 Category: Jobs

Cochrane seeks Head of Review Production - Editorial and Methods Department

Jue, 06/06/2019 - 15:05

Specifications: Full-time, permanant
Salary: Competitive
Location: London
Application Closing Date: 5th July 2019 (12 Midnight GMT)

Head of Review Production for Cochrane, producer of the Cochrane Library, the world’s pre-eminent collection of high quality evidence to inform healthcare decisions.
 
Cochrane’s new Editor in Chief is seeking to appoint a Head of Review Production to work closely in delivering the objectives and targets of the Cochrane’s Editorial and Methods Department. 
 
The Head of Review Production will support the Editor in Chief by leading our global review production operations and help to implement our goal of offering high-quality, relevant, up-to-date systematic reviews and other synthesized research evidence that informs health decision-making around the world.
 
The successful candidate will support the strategic and editorial development of the Cochrane Library built around the needs of its users, and ensure the Library remains a premier international source of healthcare evidence.
 
The Head of Review Production will also work with the Cochrane Review Groups, and as a member of Cochrane’s Senior Management Team will contribute to organizational management and successful implementation of its Strategy to 2020 and future goals and objectives.
 
The successful candidate will have proven experience of working at a senior leadership level with strong people, project and budget management skills and expertise. Management experience within the healthcare charity sector is not essential.

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 Head of Review Production 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 from here.
Deadline for applications: 5th July 2019 (12 midnight GMT)
Interviews to be held on: (TBC)

Thursday, June 6, 2019

Featured Review: Different ways to reduce consumption of sugary drinks

Jue, 06/06/2019 - 13:34

New Cochrane Review assesses evidence on different ways to reduce consumption of sugary drinks

Consumption of sugary drinks is considered to be a key driver behind the global obesity epidemic, and is linked with tooth decay, diabetes and heart disease. Many public health bodies including the World Health Organization (WHO) have called upon governments, the food and drink industry, educational institutions, places of work and civil society to support healthier beverage choices. This new Cochrane Review summarizes evidence from research studies testing different ways of reducing consumption of sugary drinks at a population level.

A team of researchers from Germany and the UK looked at the results from 58 studies that assessed a range of approaches and strategies aimed at changing the physical or social environment where people consume or buy sugary drinks. The studies were done in a variety of settings, including schools, cafes, restaurants, homes, and retail outlets. The studies assessed a wide range of different approaches to reduce consumption such as labelling and pricing of sugar sweetened drinks and healthy alternatives. They also looked at broader policy initiatives such as community-based campaigns to encourage healthier choices. The studies were conducted in 19 different countries from North and South America, Australasia and Europe and South East Asia.

Within the broad categories of interventions studied, (labelling, nutrition standards, price increases and subsidies, home-based interventions, interventions aimed at the whole food supply, retail and food services, and intersectoral approaches such as food benefit programs and trade and investment policies), the certainty of the evidence for specific measures ranged from very low to moderate.

The review authors identified a number of measures which the available scientific evidence indicates reduces the amount of sugary drinks people drink. These measures included:

  • Labels that are easy to understand, such as ‘traffic-light’ labels, and labels that rate the healthiness of beverages with stars or numbers.
  • Limits to the availability of sugary drinks in schools.
  • Price increases on sugary drinks in restaurants, stores and leisure centres.
  • Children’s menus in chain restaurants which include healthier beverages instead of sugary drinks as the default.
  • Promotion and better placement of healthier beverages in supermarkets.
  • Government food benefits (e.g. food stamps) which cannot be used to purchase sugary drinks.
  • Community campaigns focused on supporting healthy beverage choices.
  • Measures that improve the availability of low-calorie beverages at home, e.g. through home deliveries of bottled water and diet beverages.

The Cochrane authors also found evidence that improved availability of drinking water and diet beverages at home can help people lose weight. There are also other measures which may influence how much sugary drinks people drink, but for these the available evidence is less certain.

Past research has shown that health education and taxation of sugar-sweetened beverages can also help to reduce their consumption, but these approaches were not examined in the current review. Taxation of sugary drinks, unprocessed sugar and sugar-added foods will be examined in two future Cochrane Reviews.

Review author Hans Hauner, Professor of Nutritional Medicine at Technical University Munich, Germany, and a world-leading expert in the field, commented: “Rates of obesity and diabetes are rising globally, and this trend will not be reversed without broad and effective action. Governments and industry in particular must do their part to make the healthy choice the easy choice for consumers. This review highlights key measures that can help to accomplish this.”

Review author Eva Rehfuess, Professor of Public Health and Health Services Research at LMU Munich, Germany, adds: “This review highlights essential building blocks for a comprehensive strategy to support healthy beverage choices for the whole population. However, we need to do more work to understand what works best in specific settings, such as schools and workplaces, for people of different socio-economic and cultural backgrounds, and in countries at different levels of economic development. This would help us to improve existing approaches further. Policy-makers and practioners who implement such measures should therefore cooperate with researchers to allow for high-quality evaluations.”

Review lead author Peter von Philipsborn, Research Associate at LMU Munich, Germany, said: “Sugary drinks are a global problem, and middle-income countries such as South Africa, Mexico and Brazil are particularly affected. The measures highlighted in this review should be considered by policy-makers worldwide.”

This Cochrane Review from Cochrane Public Health was conducted by researchers affiliated with the Institute of Medical Information Processing, Biometry and Epidemiology at the Pettenkofer School of Public Health at the LMU Munich, the Technical University Munich, and University College London.

Full Citation: Von Philipsborn P, Stratil JM, Burns J, Busert LK, Pfadenhauer LM, Polus S, Holzapfel C, Hauner H, Rehfuess E. Environmental interventions to reduce the consumption of sugar-sweetened beverages and their effects on health. Cochrane Database of Systematic Reviews 2019, Issue 6. Art. No.: CD012292. https://doi.org/10.1002/14651858.CD012292.pub2

Wednesday, June 12, 2019

Podcast: Vaccines for preventing rotavirus diarrhoea: vaccines in use

Jue, 06/06/2019 - 13:23

Rotavirus infection is a common cause of diarrhoea and a variety of vaccines are used to try to prevent it. The evidence for these is examined in the fourth update of a Cochrane Review, published in March 2019 and we asked Hanna Bergman one of the authors based in the Cochrane Response team in London UK to tell us about the problem and the latest findings.

"Rotavirus infection is common across the world and although some babies and young children might not develop any symptoms, others might get so ill that they need to go into hospital and some may die. Most of the deaths associated with rotavirus occur in children in low- and middle-income countries, particularly sub-Saharan Africa and the Indian subcontinent. Before children started being vaccinated, rotavirus infection caused almost half a million deaths per year in children under five.

Since 2009, the World Health Organization has recommended that a rotavirus vaccine be included in all national infant and child immunization programmes, and almost 100 countries currently do so. Therefore, we have updated this review in order to examine the latest evidence on both the benefits and the potential side effects of the rotavirus vaccines that have been prequalified by the WHO for preventing diarrhea and deaths in infants and young children. We also looked at whether the effects differ when the vaccines are used in countries with high or low mortality rates.

We included 55 randomized trials in more than 200,000 infants and young children that had compared one of the vaccines against a placebo or no vaccine. Two of the three vaccines tested, Rotarix and RotaTeq, have been studied in several large global clinical trials and are approved for use in many countries, On the other hand, the third vaccine, Rotavac has only been evaluated in India and is only in use there.

Pooling the trial results suggests that the total number of cases of severe rotavirus diarrhoea were reduced by between 35 and 63% after vaccination in high mortality countries and by 82 to 92% after vaccination in low mortality countries, in the couple of years after vaccination. We also found a small reduction in diarrhoea from any cause and a large reduction in rotavirus-related hospitalizations and healthcare encounters as a result of vaccination. We did not detect a reduction in mortality, but unlike the other outcomes mentioned, the evidence for this was of low to very low certainty because there were so few deaths in the trials.

Turning to the side effects, we didn’t find any increased risk of serious adverse events as a result of using the vaccines but we could not exclude the possibility of a small risk of rare serious adverse events. Like with previous rotavirus vaccines, monitoring for these events is ongoing in countries that have introduced rotavirus vaccine and we may have more to say about this in future updates of this review.

To finish and as the take home message, our review shows that Rotarix, RotaTeq and Rotavac do prevent rotavirus diarrhoea and have comparable safety and efficacy profiles."

Thursday, June 6, 2019

Video: Cochrane Mental Health and Neuroscience Network

Mié, 06/05/2019 - 20:32

In this short film we introduce the Cochrane Mental Health and Neuroscience Network.

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

This film introduces the team, what has happened so far and the ambition for what is to come.

 

Monday, June 10, 2019

Cochrane's 30 under 30: Anneliese Arno

Mié, 06/05/2019 - 12:43

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 lparsonson@cochrane.org.  Or if you want to know more about Cochrane’s work contact membership@cochrane.org where our community support team will be happy to answer your questions.

Name: Anneliese Arno
Age: 29
Occupation: PhD/MPhil student, University College London
Program: Community Manager, Covidence.org

How did you first hear about Cochrane?
I first heard about Cochrane through a module in my Masters course in Global Health at Trinity College Dublin.

How did you become involved with Cochrane? What is your background?
I loved the course during my time at Trinity – just loved the whole concept of making better health decisions by drawing on large amounts of data. My MSc thesis ended up being a systematic review – not a Cochrane review, however.

I describe my background as being in Public Health, but really, it’s been a journey. My undergrad degrees were in Biology and Economics, and I figured Public Health would be a good way to combine the two interests. From there I studied Global Health, and then started the job I’m currently in with Covidence after seeing it listed on the Cochrane website. Through working with Covidence and Julian Elliott, I started my PhD researching automation technologies.

What do you do in Cochrane?
I’m not directly associated with Cochrane, but rather with Covidence, the recommended tool for Cochrane reviews. With Covidence, I train users and communicate user needs back into the product development process. With my PhD work, I’m researching the adoption of automation technologies in systematic reviewing.

Through both my PhD and through Covidence, I’ve attended several Cochrane Colloquia and am involved with the Living Systematic Review Network, the Human Behaviour Change Project, and collaborate within Cochrane on my research.

What specifically do you enjoy about working for Cochrane and what have you learnt?
Getting to connect with people all over the world is a huge plus for me – I’ve always wanted travel and exploration to be part of my life, so it’s great to combine that with my work.

In terms of the biggest lessons I’ve learnt: first, to be adaptable. Even the most well-planned projects hit road bumps and have to be continually re-evaluated, and that is okay. I think early career researchers (myself absolutely included) can get very discouraged when this occurs and feel like we’re incapable of the research we’ve undertaken, when the truth is that the whole process is fairly normal. Second, that it’s always worth it to take a moment to ask the bigger questions about the research you’re doing. Keeping your sights on your mission and ‘zooming out’ of what you’re doing helps to make the tougher periods easier to get through.

What are your future plans?
Finishing my PhD! After that, I’m hoping to continue with the same sort of research – how do we maximise efficiency and quality in health research? I’d love to also get back to my Global Health background and contribute to technological capacity building in LMIC settings.

In your personal experience, what one thing could Cochrane do better to improve its global profile?
Cochrane is still very English-speaking world focused, in my observation. There’s been improvements in this, but I think there’s a long way to go!

What do you hope for Cochrane for the future?
I hope that Cochrane continues to focus on its overall mission of creating better evidence for better health and makes sure to frame all organisational endeavours through that lens. Given the following question, I also hope that Cochrane communicates to new graduates that their input is desired and valued.

How important is it that young people get involved in Cochrane? Why is this, do you think?
Extremely! Every organisation can always improve, and new, fresh ideas are often the best way to do that.

What would your message be to other young people who want to get involved with Cochrane’s work but not sure where to start….?
Check out Task Exchange to see if you can get some bits of experience here and there. It can be hard to face the wall of job descriptions requiring seemingly huge amounts of experience, but you can get that experience in creative ways if you’re willing to jump on a few volunteer research projects. Also try to be active in discussion forums like Twitter and LinkedIn – with a bit of regular academia-minded input, people will learn your name and help you with further connections.

Wednesday, June 5, 2019

Podcast: Immunosuppressive treatment for people with proliferative lupus nephritis

Jue, 05/30/2019 - 10:53

Systemic lupus erythematosus, or SLE, is an autoimmune disease that can affect any part of the body. About half the people with it develop lupus nephritis. In the June 2018 update of their Cochrane Review, David Tunnicliffe from the Centre for Kidney Research in the Children’s Hospital at Westmead and the University of Sydney’s School of Public Health in Australia and colleagues brought together the studies that have tested a range of treatments.

"Lupus nephritis is a serious condition, leading to end-stage kidney disease in 15% of patients after 10 years. It mainly affects women of child-bearing age, and is more common in some groups, such as those of Hispanic and Asian ethnicity, who also experience more aggressive disease. In the 1950s, most patients survived less than five years, but newer treatments mean that more than 90% of patients will now live a normal lifespan. Cyclophosphamide-containing regimens became established as first line therapy for inducing remission in the 1970s and 1980s, but the drug has a high incidence of adverse events, such as serious infection, hair-loss, and infertility. Furthermore, response to treatment is often slow, and even if remission is achieved, the risk or relapse or flare remains considerable.

In the past ten years, mycophenolate mofetil (MMF) emerged as a less toxic alternative to cyclophosphamide but there is uncertainty about which agent is more effectie. Over recent years, randomized trials have been done to compare these drugs and to test other therapies such as the combination of low-dose MMF and tacrolimus and newer biologic agents.

Our updated Cochrane Review evaluates the relative effects of these various drugs, looking at all available trials of immunosuppressive therapies for the induction and maintenance treatment of proliferative lupus nephritis, the most serious form of the disease.

We have now identified 74 randomized trials, involving more than 5000 participants but these trials differ in many ways and only relatively small numbers are available for the various comparisons.

For the induction of disease, eight trials, with a total of about 800 patients, compared MMF with intravenous cyclophosphamide and two trials, with 402 patients, compared low dose MMF and tacrolimus against intravenous cyclophosphamide. Our analyses show that patients receiving short term treatment of up to six months with MMF or intravenous cyclophosphamide may have similar rates of complete remission. There was less leucopenia and alopecia with MMF, but an increased risk of diarrhoea. The addition of data from some recent trials shows that the effect on ovarian failure is unclear, because of the fragility in the effect estimates. This contrasts with the general medical consensus and observational data suggesting a risk of ovarian failure from repeated cyclophosphamide doses. When tacrolimus and low-dose MMF are used together, this may increase complete remission, but the safety of this therapy is uncertain, and the generalizability of these findings is unclear because they come from just two trials, both done in China.

There are only a small number of trials evaluating the safety and efficacy of biological therapy in patients with lupus nephritis. For example, four trials, including 452 patients, have compared MMF with azathioprine for maintenance therapy and these showed a significantly lower risk of renal relapse with MMF than with azathioprine.

The best duration of therapy remains unclear and longer-term outcome data are sparse, with patients followed up for an average of 12 months in the induction therapy trials and 30 months for maintenance therapy. This is not long enough to examine critical and important outcomes, such as death and end-stage kidney disease. So, the power of the existing studies to detect significant differences among interventions is limited, even when their findings are combined in meta-analyses.

In summary, the main messages from this review are that there are similar effects for induction of remission with MMF and cyclophosphamide, but with fewer toxic effects for MMF. This supports MMF over cyclophosphamide as induction therapy for lupus nephritis. Combining low-dose MMF with tacrolimus may increase complete remission but we are cautious about this because the findings comes from few trials, restricted to patients of Asian ethnicity. Despite the small amount of data on maintenance therapy, MMF appears more effective than azathioprine at preventing renal relapse with less leucopenia and doubling of serum creatinine.

However, in conclusion, despite identifying 74 trials for our review, there are still lots of unanswered questions about the treatment of lupus nephritis. Many interventions, including rituximab and other biologics, and tacrolimus and cyclosporin, have only been tested in small studies with inconsistent outcome reporting and we see two main implications for future research: the need to make better use of existing data, and to plan new studies in a strategic way. Multi-centre collaboration and trials of longer follow-up and in a wider range of ethnic groups are needed. This research would also benefit from registry-based randomized studies, which use efficient data linkage between hospital records, and national registries, to clarify the potential benefits and harms of therapies for this uncommon disease.”

Friday, May 31, 2019

Podcast: Interventions for improving outcomes in pregnancies that follow stillbirth

Jue, 05/30/2019 - 10:39

The Cochrane Pregnancy and Childbirth Group has produced several hundred reviews on the effects of interventions for women who are pregnant, giving birth or with a newborn baby. They also assess the evidence on how to help after pregnancy loss, and one of their new reviews from December 2018 looks at care during pregnancies following a stillbirth. Lead author, Aleena Wojcieszek from the Mater Research Institute in the University of Queensland in Brisbane, Australia, tells us what they found.

"Women who have had a stillborn baby are up to five times more likely to have a stillbirth in their subsequent pregnancies. They are also at higher risk of other complications, such as preterm birth and growth problems for the baby. On top of this, women and their families often experience high anxiety in pregnancies after stillbirth, which can be particularly intense at significant pregnancy milestones and in the lead up to, and during, antenatal care visits. However, although these women and their families clearly have increased medical and psychosocial needs, there is currently little evidence to guide clinical practice and provide optimal care.

We did this broad systematic review to bring the existing evidence together, aiming to capture any interventions or models of care that might be provided before and during pregnancies following stillbirth. These could include medical interventions, as well as psychosocial support targeting anxiety, depression or complicated grief. We focussed on interventions for mothers or their partners whose previous stillbirth occurred 20 weeks or more into the pregnancy.

The lack of research is highlighted by the fact that we were able to include just 10 trials, with data from only 222 women and their babies. All these trials assessed drug therapies and presented us with nine different comparisons, including looking at the effects of low dose aspirin, low molecular weight heparin, third‐party leukocyte immunisation, intravenous immunoglobulin G, and progestogen.

With so few participants, such a small number of trials, and so many comparisons, this relatively small amount of evidence means that it is uncertain whether any of the interventions had an effect on most of the outcomes we looked at. Although there was some suggestion that low dose aspirin and third‐party leukocyte immunisation may increase the birthweight of babies, even these findings were unstable due to the very small sample sizes.

One of our greatest challenges was when assessing the articles for eligibility. There was a lot of inconsistency in the terminology used to describe pregnancy loss, and reports often did not define words like ‘miscarriage’, ‘abortion’, or ‘stillbirth’ by gestational age. We often had to contact the original researchers to determine if a trial was eligible, and we also found that in many cases women whose previous pregnancy loss occurred 20 or more weeks into their pregnancy were recruited alongside women who had earlier pregnancy losses. This lead to the further complication of needing the researchers to split up their data, so that we could use only data from the former women in our analyses. We are very grateful to the researchers who did this and provided data, but it’s also important to note that not all trials in the review necessarily targeted the pathophysiology of stillbirth specifically, and we had to leave out some potentially eligible trials because researchers did not respond to our queries or for other reasons.

In summary, we were not able to capture sufficient evidence to inform clinical practice for care in subsequent pregnancies following stillbirth. Carefully-designed trials are urgently needed, and these trials should specifically address the prevention of recurrent stillbirth, and be large enough to detect differences in rare, but vitally important outcomes such as stillbirth and death of the newborn baby. We would also like to see the prioritisation of trials of psychosocial support interventions, which are currently lacking from our review."

Thursday, May 30, 2019

Cochrane Sweden hosts one week 'Introduction to Cochrane Methodology' course

Mié, 05/29/2019 - 20:56

Cochrane Sweden recently hosted a 1-week course on Cochrane Methodology at the Lund University. The course was mainly aimed at PhD students from the Faculty of Medicine but was open for everyone. 

This 40-hour course  used Cochrane Interactive Learning modules, lectures, and discussion to cover the following topics: 

  • Introduction to conducting systematic reviews
  • Writing the review protocol
  • Searching for studies
  • Selecting studies and collecting data
  • Introduction to study quality and risk of bias
  • Analysing the data
  • Interpreting the findings
  • Reporting the review

Wednesday, May 29, 2019

WHO cognitive decline and dementia guideline cites three Cochrane Reviews

Mié, 05/29/2019 - 14:19

 The World Health Organization's latest guideline on risk reduction of cognitive decline and dementia has been published. This guideline provides global, evidence-informed recommendations on how to reduce the risk of cognitive decline and dementia.

It features evidence from reviews of the Cochrane Dementia and Cognitive Improvement group in 3 of the guideline’s  evidence profiles - Physical activity interventions, Management of diabetes and Management of dyslipidaemia. The featured reviews are:

Cochrane Dementia and Cognitive Improvement remit includes producing systematic reviews of both global cognitive impairment and focal cognitive impairments occurring in the context of brain disease. We are pleased to see Cochrane evidence being highlighted in this important guideline.

 

Wednesday, May 29, 2019

Farewell Message from David Tovey

Mié, 05/29/2019 - 13:42

 This Friday (31st May, 2019) will mark my final day as your Editor in Chief. I want to express my gratitude to you all for your forbearance, support, challenge and friendship over these past 10 years. Believe me when I say that having the privilege of serving you all has been the highlight of my working life. Life has never been easy, but I have learned such a great deal from you, had experiences I couldn’t have imagined, and found myself stretched (in a good way) every day.

I wish you all, and Cochrane, every success in the coming years, and hope to continue to contribute in different ways. I leave you in the excellent hands of Karla Soares-Weiser who has been a fantastic deputy and will be an even better leader. She will be fully supported by the other members of the Editorial and Methods team, who have all at various times provided me with inspiration, rescued me from danger and have simply been a joy to lead.

I have been lucky to have had the support of some wise and inspiring Co-Chairs, Steering Groups and the Governing Board. I owe particular thanks to Cochrane’s Chief Executive Officers, Nick Royale and Mark Wilson, my colleagues on the Senior Management Team, and the wider Central Executive Teams. I have enjoyed working with the various representative groups across the Editorial and Methods communities, and the new Editorial Board and Scientific Committee. The members of the Cochrane Library Oversight Committee have quietly provided guidance and wise counsel.

I want to finish by repeating my debt to all those of you who toil at Cochrane’s coalface as authors, editors, peer reviewers, information specialists and so on. If Cochrane handed out 200 Chris Silagy prizes every year, it would still not be possible to reward all of those who have earned it. You are the true heart of Cochrane, and I will join your number now with pride.

David Tovey

 

Thursday, May 30, 2019

Cochrane's 30 under 30: Stephen Surace

Mar, 05/28/2019 - 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 lparsonson@cochrane.org.  Or if you want to know more about Cochrane’s work contact membership@cochrane.org where our community support team will be happy to answer your questions.

Name: Stephen Surace
Age: 27
Occupation: Doctor
Program: Cochrane Musculoskeletal

How did you first hear about Cochrane?
From very early on in medical school you start hearing the words “Cochrane review” used with a fair amount of reverence. If they aren’t appearing as a reference in a lecture note or your tutors aren’t talking about a new publication, they are used as the real-life example of the pinnacle of the evidence pyramid.

How did you become involved with Cochrane? What is your background?
I am a doctor, but I first became involved as a medical student. I was looking to use my epidemiology and research methods classes for a practical purpose, and after asking around my hospital I was given the name of someone to speak to who was involved in “some research”. I was just incredibly lucky that my rotations at the time brought me into contact with people who worked with Cochrane.

What do you do in Cochrane?
I have helped with data collection and synthesis on two published reviews and am a primary author on a third.

What specifically do you enjoy about working for Cochrane and what have you learnt?
Working with Cochrane has taught me an incredible amount about research. There are the obvious lessons, such as how to critically appraise trials, a better understanding of different biases and their consequences, and an appreciation of just how much work goes into each and every review. However, there were also unexpected lessons. Examining bias and trial method actually taught me a lot about how to construct trials and investigating evidence and data quality allowed me to realise how there are many ways not only to interpret, but also to present and modulate results. This has real and continuing implications for my work as a doctor, and my experience with Cochrane eventually lead me to undertaking a research degree in addition to my medical studies. Beyond the review, working with Cochrane is also a great opportunity to work with and learn from a group of experienced research mentors.

What are your future plans?
I’d love to keep working with Cochrane and keep working on reviews. I’d especially like to come back when I’m further through my training, so that I can provide analysis and commentary not just from the point of view of an enthusiastic researcher, but also from the view of a specialist in my field.



In your personal experience, what one thing could Cochrane do better to improve its global profile?
I think more people should know how they could get involved with Cochrane.  The first question from so many of my colleagues when I said I was helping to write a Cochrane review was to ask me how in the world I managed to arrange that.

What do you hope for Cochrane for the future?
I hope that they can find the time and expertise to expand their number of reviews. If I have to answer a question in medicine, I can always breathe a sigh of relief if there is a recent Cochrane review to guide me.

How important is it that young people get involved in Cochrane? Why is this, do you think?
There is no better time to get involved than right now. The earlier you start, the more opportunities you have to implement the skills you learn from working with Cochrane, whether they relate to research methods or the lessons you learn from your supervisors and mentors. As for the organisation, young people are always a source of new ideas and fresh perspectives, so it’s really a win-win situation.  

What would your message be to other young people who want to get involved with Cochrane’s work but not sure where to start….?
As I said, it’s never too early to get involved, but it’s also never too late. I thought for sure when I was looking around in medical school that I had left it too late to ever find any research to help out with. Yet it was really only just the beginning. Think of a field of interest, even if that is just a broad type of research you want to become familiar with and start looking up contact details. Google the relevant Cochrane group page, email the contact person, phone around. You can even try the old-fashioned way and knock on their office door like I did when I first started. The Cochrane people are happy to provide help and are also always looking for help. If you have the enthusiasm and drive to volunteer your time, then you have something invaluable to offer.

Tuesday, May 28, 2019

Belgian Red Cross’ First Aid Guidelines for Sub-Saharan Africa feature 13 Cochrane reviews

Lun, 05/27/2019 - 18:15

 

The Belgian Red Cross specializes in the development of evidence-based first aid guidelines and materials. After the update of its basic first aid manual for Sub-Saharan Africa in 2016 (freely downloadable following registration), a brand new manual with advanced first aid techniques, contextualized to Sub-Saharan Africa, is currently being developed. The manual will be used during first responder training programs of several African Red Cross societies, including those of Malawi, South-Africa and Zimbabwe. First responders are laypeople who are trained to be the first line of support within their community when disaster strikes. The guideline features evidence from 13 Cochrane Reviews of 8 different Cochrane groups:  Cochrane Acute Respiratory Infections (1); Cochrane Airways (2); Cochrane Back and Neck (1); Cochrane Eyes and Vision (1); Cochrane Injuries (3); Cochrane Vascular (1); Cochrane Work (2) and Cochrane Wounds (2).

The First Aid for First Responders Manual will be available by the end of 2019. The evidence included will be available through the evidence summary database of the Belgian Red Cross’ Centre for Evidence-Based Practice (CEBaP). CEBaP recently also launched Cochrane First Aid and will further advocate for the inclusion of Cochrane reviews in first aid guidelines.

Monday, May 27, 2019

Join the Rapid, Rapid, Rapid study and help answer an important methodological question!

Lun, 05/27/2019 - 14:25

The Cochrane Rapid Review Methods Group is leading an important piece of methodological research and need your help.

Does it make a difference whether abstracts are screened by one or two people to find relevant studies for a systematic review? How many relevant studies will be missed when abstracts are reviewed by only one person? Can the Cochrane RCT-classifier, a machine-learning tool for classifying RCTs and the Cochrane Crowd, do this accurately? The Cochrane Rapid Review Methods Group and the Cochrane Crowd Team have developed a study to try to answer these questions.

The study is made up of three ‘arms’ – three different groups that participants to the study could be assigned to. If you already have experience screening search results for a review, you will be randomly assigned to review a set of 100 abstracts and classify them as "Relevant" or "Not Relevant" to a particular research question from a search for either a pharmacological review or for a public health review. If you have no experience screening for reviews, you will be assigned to the "Crowd" arm where you can screen as many records as you like for the pharmacological review.

More details about the study can be found here.

We are looking for participants:

  • with and without experience of screening search results for a review
  • willing to spend around 2 to 3 hours screening 100 abstracts over the next three weeks
  • over 18 years of age

To join, just follow these 4 steps:

  1. If you don't have a Cochrane Crowd account yet, register here first and continue with step 2. If you already have a Cochrane Crowd account, you can go straight to step 2:
  2. Click on this link that will launch the brief participant questionnaire
  3. Once you have completed the questionnaire, log in to Cochrane Crowd as usual
  4. Near the top of your task dashboard you will see the task called Rapid, Rapid, Rapid. This is the task you will have been randomly assigned to. Complete the training and get screening your 100 records!

You don’t have to screen all 100 records in one go. We will keep the study running until Friday 14th June so there should be plenty of time for you to chip away at your 100 records.

If you are able to take part, you will be named on a conference poster about the study at the Cochrane Colloquium, receive a certificate of participation, and enter a prize draw for one of five gift vouchers worth $100.

Happy citation screening!

Monday, May 27, 2019

Launch of Cochrane US Network

Jue, 05/23/2019 - 20:34

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Cochrane launches a new network of US institutions to promote evidence-based health care and public health  

The Cochrane US Network made up of some of the country’s leading institutions in the research and practice of evidence-based medicine, and they join Cochrane’s 70 existing geographic Groups around the world. The Cochrane US Network will promote evidence-informed decision making in health care in the US by supporting and training systematic review authors and users of Cochrane Reviews, as well as working with clinicians, professional associations, policymakers, patients, healthcare provider organizations and the media to encourage the dissemination and use of Cochrane evidence.

The Cochrane US Network is initially made up of the existing Cochrane US West Associate Center based at Oregon Health & Science University; three Cochrane Review Groups producing systematic reviews in neonatal health, fertility regulation and urological conditions; three US satellites of Cochrane Review Groups focusing on eyes and vision, pregnancy and childbirth and musculoskeletal disease; one Field specializing in complementary medicine; and 11 new Affiliate institutions, including:

  • AcademyHealth
  • American College of Physicians
  • Central Michigan University
  • Cornell University
  • Mayo Clinic Evidence-based Practice Center
  • Penn Medicine Center for Evidence-based Practice
  • RTI International – University of North Carolina Evidence-based Practice Center
  • Texas Christian University
  • University of Chicago Medicine
  • University of Colorado Anschutz Medical Campus; and
  • University of Maryland School of Medicine

Mark Wilson, Cochrane CEO, said: “I am delighted to see such a prestigious and committed group of US institutions and leaders in evidence-informed health care join Cochrane’s global family of collaborators.

Many of these researchers and clinicians are leaders in the field, and I am excited by the expertise, innovation and knowledge they will bring to our mission of delivering trusted evidence into health policy and clinical decision-making. The US health system is the largest and most sophisticated in the world, yet suffers from huge inequalities in health outcomes and tremendous wastefulness. We believe a vibrant Cochrane Network promoting greater use of evidence showing what health interventions work and what don’t can make a real difference to this; and I hope that this new – already extensive – Network will grow further and welcome many more partners in the years to come.”

These new Cochrane Affiliates each have their own specific areas of expertise and focus. Collectively, the Network will focus on producing high quality evidence on priority topics for the US; providing training to systematic review authors and health care practitioners, policymakers and others in the interpretation of Cochrane Reviews; as well as raising general awareness of the Cochrane evidence available to make well-informed health and health care decisions.  The new Network will build on the work of the former US Cochrane Center based at Johns Hopkins University, Baltimore.


Marguerite Koster, co-chair of the Cochrane Governing Board adds: “The establishment of the US Network is an important development for Cochrane as well as the health care community in the US. Coordination and collaboration are core values of the Network because we strongly believe we can add value by working  together as a consortium. I very much look forward to the start of the Network and to seeing it develop and grow as a platform for anyone interested in evidence-informed health and health care in the US.”

A formal launch of the new ‘Cochrane US Network’ was held onJune 4, at the Marriott Marquis Washington DC, immediately after AcademyHealth’s 2019 Annual Research Meeting at the same location.

During the launch meeting Cochrane CEO, Mark Wilson, and Governing Board co-chair, Marguerite Koster, introduced the US Network. Additionally, representatives from the Network introduced their institutions and planned work, and spoke to the value of being part of the Network.

The Cochrane US Network is part of Cochrane,  global independent network of researchers, professionals, patients, carers and people interested in health. Cochrane produces reviews which study all of the best available evidence generated through research and make it easier to inform decisions about health. Cochrane is a not-for profit organization with over 65,000 members and supporters from more than 130 countries working together to produce credible, accessible health information that is free from commercial sponsorship and other conflicts of interest. Cochrane’s work is recognized as representing an international gold standard for high quality, trusted information.

Tuesday, June 4, 2019

Inaugural Editor in Chief of Cochrane Clinical Answers announced

Jue, 05/23/2019 - 17:43

We are delighted to announce that Dr Christopher Bunt, MD, FAAFP has been appointed as the inaugural Editor in Chief of Cochrane Clinical Answers (CCAs), reporting to Karla Soares-Weiser, Editor in Chief of Cochrane. Chris has been a practicing Family Medicine physician in the US since 2004 and has recently added Medical Acupuncture to his clinical duties. Chris has also been a Clinician-Educator since 2007, focusing on teaching and designing evidence-based medicine curricula for interprofessional students, residents and faculty colleagues. Chris has worked with the CCA team as an Associate Editor since 2012, writing 56 CCAs. He also has extensive editorial experience as a Contributing Editor for American Family Physician, the largest primary care journal in the US, since 2016.

CCAs form a key strand of Cochrane’s Knowledge Translation strategy, providing concise, evidence-based answers to Patient, Intervention, Comparison, Outcome (PICO) clinical questions based on Cochrane Reviews. The product was developed in partnership between Cochrane and Wiley and in 2018 became part of the suite of databases available to all Cochrane Library subscribers. The Editor in Chief of CCAs is a new honorary role that has been created to oversee the development and implementation of editorial policies for CCAs, guide editorial strategy decisions and ensure the quality of CCA content.

We are thrilled to welcome Chris to the team; we are convinced that he will be a great asset to Cochrane and will be instrumental in the development and future strategy of CCAs. Karla also welcomes Chris’ appointment: “We are excited to welcome Chris into this new post. We look forward to working with him to further develop CCAs and reach out to clinical communities around the world to promote the use of this important Cochrane resource”. And Chris highlights: “CCAs are the ‘point-of-care home’ for busy clinicians. I am thrilled to continue to work with the CCA team as we further evidence-based medicine practice around the world.”   

Chris is currently the Associate Dean for Student Affairs in the College of Medicine at the Medical University of South Carolina in Charleston, South Carolina. He will be contributing two days a month as Editor in Chief of Cochrane Clinical Answers. He can be reached at cbunt@cochrane.org.

Friday, May 24, 2019

The First Cochrane Hong Kong Symposium

Jue, 05/23/2019 - 15:37

Cochrane Hong Kong is celebrating it's first Symposium on 23-24 May, with workshops following on 27-28 May. The theme of the Cochrane Hong Kong Symposium is ‘Paving the Way for and Achieving Excellence in Evidence-informed Health Care in the Belt and Road Regions’. The symposium aims to provide an international multidisciplinary platform for discussion and debate among health care providers, policy makers, academics, and researchers on contemporary strategies and issues in evidence-informed health care and policy formulation.

Co-Directors of Cochrane Hong Kong, Professor Wai Tong Chien and Professor Professor Pak Chun Janita Chau were joined by Mark Wilson, Chief Executive Officer to open the Symposium. Professor Martin Burton, Co-Chair of the Cochrane Governing Board, gave the Keynote Address

Professor Sek Ying Chair, Director and Professor at The Nethersole School of Nursing, Faculty of Medicine, the Chinese University of Hong Kong said: "Over the past two decades, Cochrane has significantly contributed to the promotion of evidence-informed health care decision-making through producing high quality and accessible systematic reviews and other synthesised research evidence. Cochrane evidence is internationally regarded as a powerful tool to enhance health care knowledge and practice. With the establishment of Cochrane Hong Kong, our School is committed to working hand in hand with other Cochrane centres around the world especially those in Asia and the Belt and Road regions towards a shared vision for better health."

Thursday, May 23, 2019

Cochrane seeks Systematic Review Methodology Editor - Flexible location

Mié, 05/22/2019 - 13:55

Specifications: Full-time, initially as a one year fixed-term contract. Secondments considered.
Salary: £40,000 to £45,000
Location: Flexible
Application Closing Date: 12th June 2019 (12 Midnight GMT)

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

As Systematic Review Methodology Editor, you will provide support, general systematic review methods advice and methods peer review as requested by Network Editorial Teams (Network Senior Editor, Associate Editor or Network Support Fellow) or field queries from the Community Support Team as needed. The role will require an understanding of methods such as the assessment of risk of bias, application of GRADE and interpretation of findings in the review. An understanding of statistical meta-analysis methods is advantageous in the role, although specialist statistical editors in the unit will be able to provide this advice.

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:

  • Familiarity with Cochrane guidance and standards on the design, conduct and reporting of systematic reviews (MECIR), including GRADE methods.
  • Familiarity with systematic review methods relevant to the synthesis of non-randomised evidence
  • An understanding of the importance of systematic reviews to clinical decision making
  • Intermediate level IT skills, including Word, Excel and PowerPoint
  • Computing experience with a statistical software (such as Stata, R, SAS)
  • Knowledge and skills relevant to the systematic review process
  • An ability to develop and maintain working relationships with key stakeholders
  • Strong organization and prioritization skills
  • Attention to detail
  • Excellent written and verbal communication skills
  • Ability to work methodically and accurately
  • A pro-active approach to problem-solving

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 “Systematic Review Methodology Editor” 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 from here.

Deadline for applications: 12th June 2019 (12 midnight GMT)
 
Interviews to be held on: (TBC)


Wednesday, May 22, 2019 Category: Jobs

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