Asthma is a disease of the lungs, symptoms include wheezing, breathlessness, and chest tightness.

Two main features of asthma are underlying inflammation and bronchoconstriction (tightening of the muscles around small tubes in the lungs). The inflammation can be treated with daily steroid inhalers. The bronchoconstriction can be treated with a beta2-agonist to relax the muscles. This opens up the airways and makes it easier to breathe. Beta2-agonists can be used two ways: to provide relief from symptoms of chest tightness ('short-acting beta2-agonists') and to help prevent symptoms from occurring ('long-acting beta2-agonists', or LABAs).

When asthma is not controlled by daily low-dose ICS, many asthma guidelines recommend additional daily LABA, such as formoterol. The author team are confident that LABA improves lung function, quality of life, and worsening symptoms such as shortness of breath, wheezing, coughing and chest tightness. However, there is long-standing controversy about how safe these drugs are for people with asthma. The review authors wanted to explore this by focusing on rare and serious harms. These are defined as events that are life-threatening, require admission to hospital or by making stays in hospital longer, or result in persistent or significant disability/incapacity or a birth defect.

The review author team analysed data from 29 studies in 35,751 adults and 10 studies in 4,035 children aged up to 17 years.

Importantly, almost all trials were sponsored by drug manufacturers.

Thirty deaths were reported in 35,751 adults. Seventeen of these deaths were reported in participants taking formoterol and ICS, and 13 deaths in participants who were taking ICS alone. Three deaths reported in adults taking formoterol and ICS were due to asthma, but there were no asthma-related deaths with ICS alone. No deaths were reported in children up to 17 years age.

The number of people experiencing serious harms of any cause was similar in adults with and without formoterol. Although there was no difference in the risk of serious harms in adults with asthma who were taking regular formoterol in combination with ICS, we could not confirm whether taking formoterol in addition to ICS reduced or increased the risk of events compared to taking ICS alone.

The review authors were moderately certain regarding the data in adults, but less certain about the effects of adding formoterol to ICS in children. Given the low number of deaths that occurred in the studies, they do not yet have enough information to be able to measure accurately the risk of adding formoterol to ICS on number of deaths.

The review authors were not able to state confidently that taking formoterol in addition to ICS carried no risk of increasing the number of deaths in comparison with ICS alone. On the other hand, they found no conclusive evidence of an increase in serious harm. Three asthma-related deaths occurred in a total of 12,777 adults treated with formoterol in combination with ICS. There was no conclusive evidence of risk of non-fatal serious harms attributed to asthma when formoterol was combined with ICS in adults.

• Read the Cochrane Review
• Visit the Cochrane Cochrane Airways website

  

Thursday, September 26, 2019

Stoptober began in 2012 as an event  to encouraging people to quit smoking for good. Since then it has become an annual 28-day mass quitting attempt, offering resources and support for anyone trying to become smoke-free. It's an excellent to put the spotlight on the latest Cochrane evidence on quitting smoking.

In May 2019, the Cochrane Library released a Special Collection which highlights a selection of new or recently updated clinically relevant Cochrane Reviews that address tobacco addiction in the general population. The Cochrane Reviews in this collection are maintained by the Cochrane Tobacco Addiction Group who work to ensure that interventions to treat or prevent tobacco addiction are supported by good-quality evidence that can inform healthcare  decisions and policies.

Featured Evidence:

• Featured Review: Different doses, durations and modes of delivery of nicotine replacement therapy for smoking cessation
• Featured Review: Nicotine replacement therapy versus control for smoking cessation
• Featured Review: Psychosocial interventions to support pregnant women to stop smoking
• Featured Review: Individual, family, and school-level interventions targeting multiple risk behaviours in young people

Additional resources

• View the Special Collection: World No Tobacco Day
• All of the Cochrane Reviews produced on smoking
• Visit the Cochrane Tobacco and Addiction website

Tuesday, October 1, 2019

Specifications: Full Time, permanent
Salary: £72,000
Location: Flexible, though with a preference for London-based
Application Closing Date: 10th October 2019 (12 Midnight GMT)

Cochrane is the world’s most respected producer of high-quality health evidence to inform decision-making by healthcare practitioners, patients and carers, researchers and policymakers. Our global independent network of over 11,000 members and 68,000 supporters analyze and summarize the best evidence from research and publish it in the Cochrane Library (www.cochranelibrary.com). Cochrane is passionate about improving health outcomes for everyone, everywhere by helping them to make informed choices about healthcare issues and we have been doing this for 25 years.

We are looking for someone with exceptional leadership skills and experience to join our Senior Management Team as Head of Finance. This is a newly-created role that reports to the Chief Executive Officer, and we will look to you to:

• Manage and develop the infrastructure, systems and processes for finance, audit and contracts management to support Cochrane’s work;
• Advise the Governing Board as part of its Finance & Investment committee, Remuneration committee and Risk Management & Audit committee;
• Support the work of the trustees of The Cochrane Collaboration (a UK charity and registered company); the Board of Directors of Cochrane Trading Co. Ltd; Cochrane Innovations Ltd. and IKMD Denmark by providing timely and appropriate advice and reports; and ensure statutory filings are made.
• Act as Company Secretary for Cochrane Trading Co. Ltd, Cochrane Innovations Ltd. and IKMD Denmark.
• Lead and support the annual budgeting process (including forecasting future scenarios) for all Cochrane entities.
• Lead and support the Finance team in providing high-quality financial management, including relevant analysis of financial risks and opportunities, for Board consideration
• Lead and manage the contracts management, legal and audit functions; and relationships with its banks, insurers, auditors, solicitors and HM Revenue.
• Ensure that Cochrane’s financial procedures, systems, tools and internal controls protect the organization against fraud and other misuse of funds.
• Manage leasing arrangements and associated management issues connected with Cochrane Offices in London, Denmark and Germany.

If you can offer:

• A Master’s degree in finance, business administration (or equivalent experience).
• An internationally recognized chartered accountancy qualification and strong technical accountancy skills.
• Extensive experience in strategic planning and budgeting for organizations with an income of at least £5 million; and the management of financial and supporting infrastructure systems.
• Demonstrable experience of managing finance departments and major financial projects or initiatives, including experience of negotiating agreements and managing vendor relationships.
  then we would like to hear from you.  In return, we can offer you a stimulating, highly collegiate, work environment with plenty of scope to make your own mark.

To apply, please send a detailed CV and a short covering letter to recruitment@cochrane.org setting out your reasons for applying and giving details of your availability.

• For further information, please see the full job description here.
• You will also need to familiarize yourself with our Commercial Sponsorship Policy and Conflict of Interest Policy, here.
• Deadline for applications: 10 October 2019
• Interviews will be held week commencing 14 October 2019
  

Wednesday, September 25, 2019 Category: Jobs

In clinical practice “Doctor, do I have dementia?” is an increasingly common question, but one that is often difficult to answer.  Accurate diagnosis is the first step in managing someone with cognitive concerns. Early diagnosis of a cognitive syndrome, if present, can allow people to make sense of their symptoms, and can help people plan their future, while allowing access to treatments and support.

To mark World Alzheimer's Day on September 21, the Cochrane Dementia and Cognitive Improvement Group have brought together all the completed test accuracy reviews focusing on cognitive screening tests and questionnaires. This Special Collection also includes the supporting materials that they have developed for researchers and reviewers.

• View the Diagnosing Dementia Special Collection
• Visit the Cochrane Dementia and Cognitive Improvement Group website

Thursday, September 19, 2019

The deadline for standard registration for the 2019 Cochrane Colloquium is quickly approaching: it is this Thursday September 26th!

Cochrane’s annual flagship event brings together hundreds of clinicians, health professionals, policy makers, researchers, patients, consumers and others to discuss and learn about the wide usage of Cochrane evidence in health decision-making at all levels.

This year’s Colloquium will take place 22-25 October, with the theme “Embracing diversity”. The full Scientific Program is now posted online!

There is still time to register; September 26 is the deadline for delegates to take advantage of group and regional discounts and the standard registration rate.

Join us in Santiago in October for #CochraneSantiago!

Register here: https://colloquium2019.cochrane.org/registration-fees

See you then!

Monday, September 23, 2019

Specifications: Full Time, permanent
Location: Copenhagen, Denmark (work permit required)
Application Closing Date: 13th October 2019 (12 Midnight GMT)

Are you passionate about software, do you have a quality-focused mind-set and drive to make a difference for health care world-wide? We are a global organization that strives to inform health-care decisions every day. Our development team is located in Copenhagen and supports the process of creating systematic reviews through a web-based application.

“Cochrane summarizes the findings so people making important decisions – you, your doctor, the people who write medical guidelines – can use unbiased information to make difficult choices without having to read every study out there…” Sifting the evidence, The Guardian, 14 September 2016

There are a lot of great things about working here, but by far the greatest benefit is the team. We are a group of motivated, mission-driven people who love learning from each other. Our aim is to work closely with our users, which is interesting and sometimes challenging in a global organization like ours. We take pride in doing great work and collaborate well with each other.

As our new software developer, you'll contribute to the design and development of the web-based software used by thousands of Cochrane authors to produce systematic reviews, including writing, statistical analysis, data management, and integrations with partner tools for study curation, data extraction, and more. Due to the fast-paced nature of our release cycle, the team interact frequently with users and other stakeholders.

Who are we looking for?

• Strong hands-on experience designing and building web applications in an Agile setting;
• Experience with web technologies (e.g. REST), Java EE, AngularJS, etc.;
• Analytical and efficient problem solver that challenges the product and the process around it;
• Result oriented with a high degree of accountability, commitment and responsibility;
• Passionate about working in a cross-functional team and providing constructive feedback for continuous improvement;
• At least 3 years industry experience working as a full-time software developer for web applications;
• Bachelor or Masters Degree in Computer Science (or a related field) OR equivalent work experience;
• Fluent in English.

We consider it beneficial if you have knowledge of Cochrane, evidence-based health care, systematic reviews, and/or the global health sector.

What you'll be doing

• Work with a talented and collaborative agile team that is passionate about delivering a quality product to our users;
• Design, develop, test, and maintain Cochrane systematic review production systems;
• Achieve and maintain a high level of automated test coverage;
• Help drive continuous improvement of product, code, and processes.

How to apply

If you would like to apply for this position, please send a CV along with a supporting statement to recruitment@cochrane.org with “Software Developer” 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: 13th October 2019
• Interviews will be held on: tbc
• For more information, contact recruitment@cochrane.org

Thursday, September 19, 2019 Category: Jobs

Specifications: Full Time, permanent
Location: Copenhagen, Denmark (work permit required)
Application Closing Date: 13th October 2019 (12 Midnight GMT)

Are you passionate about software, do you have a quality-focused mind-set and drive to make a difference for health care world-wide? We are a global organization that strives to inform health-care decisions every day. Our development team is located in Copenhagen and supports the process of creating systematic reviews through a web-based application.

“Cochrane summarizes the findings so people making important decisions – you, your doctor, the people who write medical guidelines – can use unbiased information to make difficult choices without having to read every study out there…” Sifting the evidence, The Guardian, 14 September 2016

There are a lot of great things about working here, but by far the greatest benefit is the team. We are a group of motivated, mission-driven people who love learning from each other. Our aim is to work closely with our users, which is interesting and sometimes challenging in a global organization like ours. We take pride in doing great work and collaborate well with each other.

As our new test automation engineer, you'll be upgrading and building automated tests for our product. Due to the fast-paced nature of our release cycle, our goal is to maintain product development velocity while having confidence in the quality of our code. You will build out test suites to increase regression test coverage and work cross-functionally to implement quality-minded practices in the product lifecycle process. Our hope is that you can challenge our current way of working and have the experience to pinpoint which tools would fit us best. 

Who are we looking for?

• Strong hands-on test automation experience with BDD and/or TDD methods in an Agile setting;
• Experience of translating acceptance criteria into a robust and integrated test solution;
• Analytical and efficient problem solver that challenges the product and the process around it;
• Result oriented with a high degree of accountability, commitment and responsibility;
• Passionate about working in a cross-functional team and providing constructive feedback for continuous improvement;
• At least 3 years industry experience working as a full-time test automation engineer for web applications;
• Bachelor or Masters Degree in Computer Science (or a related field) OR equivalent work experience;
• Fluent in English

We consider it beneficial if you have knowledge of Cochrane, evidence-based health care, systematic reviews, and/or the global health sector.

What you'll be doing

• Work with a talented and collaborative agile team that is passionate about delivering a quality product to our users;
• Advocate and work cross-team to implement quality-minded practices in the product lifecycle process;
• Identify, implement, and maintain automatic tests to help increase regression coverage for our fast-paced development lifecycle;
• Embrace emerging technologies and solutions to ensure we deliver the quality that our users need;
• Provide 2nd level technical support.

How to apply

If you would like to apply for this position, please send a CV along with a supporting statement to recruitment@cochrane.org with “Test Automation Engineer” 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: 13th October 2019
• Interviews will be held on: tbc
• For more information, contact recruitment@cochrane.org

 

Thursday, September 19, 2019 Category: Jobs

The two days prior to the official 2019 Cochrane Colloquium Scientific Program will see some exciting pre-Colloquium events!

Starting off Colloquium festivities on Sunday, October 20, is the Student Satellite Event. Hosted and sponsored by the University of Valparaíso, this Satellite event will feature a wide range of international speakers, including Dr. Gordon Guyatt as keynote speaker. The event will be held at the Health Campus of the University of Valparaíso in Viña del Mar, approx. 100 km from Santiago and next to the UNESCO World Heritage city of Valparaíso.

Several Pre-Colloquium events will be held on Monday, October 21. The all-day #CochraneTech Santiago Symposium will explore the integration of new technology and tools into the systematic review process. A full-day “train the trainers” workshop is geared toward members of the Cochrane Trainers’ Network. Spanish and English versions of a full-day workshop on the GRADE approach and creating Summary of Findings Tables will be held, as well as the full-day GRADE Working Group Meeting. The Methods Group Co-Convener Meeting will be held in the morning, while the 2019 Methods Symposium, titled “Developing robust review protocols with increasingly diverse evidence” will take place in the afternoon. An invitation-only KT Training Workshop on supporting policymakers in the use of synthesized evidence will take place all-day on Monday, as will a Seminar titled “The Kidnapping of Evidence-Based Medicine”, hosted by Chilean organization Médicos Sin Marca. Plans are also underway for Cochrane Consumer satellite event, which will be confirmed soon.

To learn more about these events, including registration, visit the Pre-Colloquium Satellites page here:
https://colloquium2019.cochrane.org/pre-colloquium-satellites-and-meetings

The full Scientific Program of this year’s Colloquium can be found here:
https://colloquium2019.cochrane.org/signup/d/2019-10-22

Don’t forget, there is still time to register for this year’s Colloquium! Standard registration and discounts end on September 26:
https://colloquium2019.cochrane.org/registration-fees

 

 

Wednesday, September 18, 2019

Hodgkin lymphoma (HL) is one of the most common haematological malignancies in young adults and, with cure rates of 90%, has become curable for the majority of individuals. Positron emission tomography (PET) is an imaging tool used to monitor a tumour’s metabolic activity, stage and progression. Interim PET during chemotherapy has been posited as a prognostic factor in individuals with HL to distinguish between those with a poor prognosis and those with a better prognosis. This distinction is important to inform decision-making on the clinical pathway of individuals with HL.

In this interview with the lead author of this Review we asked Research Associate, Angela Aldin from Cochrane Haematological Malignancies to tell us more about it.

What is (interim) PET and what does the PET scan result indicate?
A positron emission tomography (PET) is an imaging tool that is used for the diagnosis and/or monitoring of a disease. In individuals with Hodgkin lymphoma (HL), a PET scan at diagnosis helps to identify the stage of the disease and aids the treating physician in deciding upon the treatment pathway of the individual. An interim PET scan, however, is conducted during therapy, for instance after the second cycle of chemotherapy, to see whether the individual is responding to the allocated treatment. The Deauville five-point scale is the most commonly used scale for the interpretation of the scans and for assessing the extent of the disease. For example, individuals with a score of four or five are said to have a positive PET scan result, as the PET scan shows a higher uptake and metabolic activity of the cancer cells, and noticeable evidence of disease. Individuals with a score between one and three have a negative PET scan with a lower uptake of the cancer cells.

What was the objective of this review?
The objective of this review was to determine whether in previously untreated adults with HL (all stages) receiving first-line therapy, interim PET scan results (i.e. a positive or a negative result) can distinguish between those with a poor prognosis and those with a better prognosis, and thereby predict survival in each group.

How many studies were included? What was included and what was excluded?
We included twenty-three studies in total, in this review. In all studies, interim PET was conducted during first-line therapy and after two, three, and/or four cycles of chemotherapy in adults with HL (all stages). We included both retrospective and prospective studies that provided evidence on our prognostic factor of interest (interim PET-scan results) and outcomes of interest (overall survival, progression-free survival and PET-associated adverse events). It was important to include studies in which the treatment regimen of the participants was not adapted according to the interim PET scan results. In other words, irrespective of the interim PET scan result (interim PET-positive or interim PET-negative), participants should continue with the same treatment regimen as specified at the beginning of the study. The reason being that the occurrence of the predicted outcome in each group shall be attributable to the prognostic factor of interest (the interim PET scan result) rather than the modified treatments. Hence, we excluded studies that in their design allowed adaptation of the initially allocated treatment regimen of participants based on their interim PET scan result. In other words, modification of treatment based on the PET results would mask the true impact of the interim-PET as a prognostic factor. Once the significance of the interim-PET results is proven (as this was the aim of the review), then a different type of clinical study would be necessary before recommendations for treatment alterations based on PET results is offered to clinicians.

How certain is the evidence?
We pooled unadjusted effect estimates for overall survival (only nine studies offered relevant data) and progression-free survival (fourteen studies). Our concerns regarding the certainty of the evidence mainly lie with the methodology of the primary studies, particularly the reporting and presentation of the study results. Hence, we could not include all studies in meta-analysis and have very low to moderate certainty in the evidence.

For overall survival, we have moderate-certainty evidence that individuals with HL who have a negative interim PET scan result have better survival compared to those with a positive interim PET scan result.

For progression-free survival, we have very low certainty-evidence that individuals who have a negative interim PET scan result may have longer cancer free periods compared to those with a positive interim PET scan result. For this outcome, we also found some inconsistency as to how the outcome was defined as it is a composite outcome containing different endpoints.

We are not able to comment on PET-associated adverse events as no study measured nor reported these.

Are there different types of prognosis reviews?
This review is a systematic review of prognostic factor studies (type 2 below). However, there are four different types of studies on prognosis:

1. Studies on overall prognosis (i.e. the likely outcome or course of a certain health condition)
2. Prognostic factor studies (i.e. factors that are associated with a certain health outcome)
3. Prognostic model studies (i.e. a combination/set of prognostic factors that together predict a certain health outcome)
4. Stratified medicine research (i.e. using prognostic factors and models to guide the individual treatment path).

Reviews of studies on prognosis fit with the move towards new innovative review types, as the methodology behind the assessment of these studies as well as the pooling and summary of individual study results from studies on prognosis is still new and under development. An accurate and correct prognosis of health-related outcomes lies at the heart of each individual. Therefore, it is important to define and continuously refine the methodology of such reviews in order to be able to provide a good and thorough overview of the evidence on a specific research question related to prognosis.

Why was this topic considered to be high priority and therefore eligible for Cochrane’s Fast- Track initiative, and what was your experience of working with Cochrane Fast-Track?
This project was funded by the German Federal Ministry of Education and Research (01KG1709) as it answers a clinically relevant question that interim PET successfully distinguishes between individuals with a poor prognosis (interim PET-positive) and individuals with a good prognosis (interim PET-negative). This evidence can aid clinical decision-making on the treatment pathway of affected individuals with HL. The treatment pathway of an individual may be adapted based on their interim PET scan result in order to receive the treatment with the greatest efficacy and least toxicity possible. Furthermore, HL is a disease that is most common in young adults.

The evidence that this review provides may also be used in national and international clinical guidelines regarding the treatment pathways of individuals with HL. Further reasons as to why it was considered to be a high priority review and was therefore eligible for the Fast Track is because it is the first Cochrane prognostic factor review with meta-analysis in the Cochrane Library. It was developed through close collaboration with the Cochrane Prognosis Methods Group, as well as the GRADE Prognosis Working Group. The conduct of systematic reviews of prognosis studies is increasingly growing and with our review we try to contribute to the methodological developments and provide a guide for future authors of such reviews. Therefore, the author team applied to the Fast Track team due to the above mentioned reasons and the review met the eligibility criteria and was considered to be an important review for Cochrane. We had a very positive experience with the Cochrane Fast-Track team. We were guided and supported through each step of the editorial and publishing phase, and were continuously updated by the team regarding the status of our review. We received very thorough and detailed feedback from internal and external peer- reviewers who greatly helped in improving this review.

• Read the Cochrane Review
• Visit the Cochrane Haematological Malignancies Website
  

Photo credit: Uniklinik Köln

Wednesday, September 11, 2019

Getting involved in Cochrane’s work means becoming part of a global community. Connect with Cochrane Groups across the world through the Cochrane International Mobility programme!

The Cochrane International Mobility programme builds on previous successful student exchanges involving Cochrane Centres around the world. A broader initiative involving twelve Cochrane Groups has now been launched as a pilot by Cochrane People Services Department.

Successful applicants will complete a placement in a host Group, learning more about the production, use and knowledge translation of Cochrane reviews.

Gain skills and experience

Arrangements are flexible and placements can vary in length, depending on the project plan. Placements are typically self-funded. Participants completing postgraduate study have benefitted from university funding, and some Groups can offer work space or accommodation. Training and mentoring support is offered in different areas, specific to Groups' expertise.

Chris Champion, Head of People Services, Cochrane Central Executive, said “This is an exciting opportunity to pilot ways to support community learning and development that makes the most of Cochrane’s network of members across the globe. The programme offers opportunities for people involved in Cochrane - particularly at an early stage in their careers - to benefit from experiences in other contexts. It also encourages networking and skills development across Groups both for those who are visiting and for those supporting them.”

Learn from each other

Cochrane International Mobility offers opportunities for learning and training not only for participants but also for host staff. Cochrane Croatia welcomed a student intern this summer as part of the fledgling programme.

“I’m very grateful to Cochrane Croatia for hosting me and for this wonderful experience, and I’m sure I’ll be using all the skills I learned as I continue on in my academic career,” said Sarah Tanveer, Cochrane International Mobility participant, summer 2019.

Tina Poklepović Peričić, Co-director, Cochrane Croatia added, “This was an encouraging experience for us all, and spending time with Sarah, exchanging experiences, teaching and working with her was a true refreshment to our Centre.”

Apply now

Find out more about the programme on Cochrane Training or search for opportunities on Cochrane TaskExchange.

Monday, September 16, 2019

One of the earliest Cochrane Reviews on high blood pressure was first published in 1998, investigating treatments for the elderly. It was substantively updated for a second time in June 2019 and we asked the lead author, Vijaya Musini, from the University of British Columbia in Vancouver Canada to tell us about the evidence.

High blood pressure or hypertension, which is defined as systolic blood pressure of 140 mm of mercury or more, or diastolic blood pressure of 90 mm of mercury or more, increases with age, particularly in those over 60. It raises the risk of heart attack and stroke, with systolic hypertension, which is more common in older people, being more strongly associated with cardiovascular disease than diastolic hypertension.

Our focus, therefore, is on the benefits and harms of using blood pressure-lowering drugs, rather than no treatment or a placebo in people aged 60 to 79 and over 80.

We looked for randomized trials that had treated and followed patients for at least a year and identified 16 studies that had recruited nearly 27,000 people aged 60 or more from western industrialised countries who had moderate to severe systolic or diastolic hypertension, or both. The mean age of patients was 73 years and their average systolic blood pressure was 182 mmHg and diastolic blood pressure was 95 mmHg. Most studies evaluated first‐line thiazide diuretic therapy for a mean duration of nearly four years.

In patients 60 years or older, we found that antihypertensive drug treatment reduced the proportion of people who died from any cause during their trial from 11% in the control group to 10% with treatment. This reduction was due mostly to benefits in the subgroup aged 60 to 79 years. Overall, cardiovascular morbidity and mortality was reduced from 13.6% with control to 9.8% with treatment, primarily due to a 1.8% reduction in fatal and non-fatal strokes. The three trials restricted to people with isolated systolic hypertension showed similar benefits.

Patients given the drug treatment were much more likely to withdraw because of adverse effects, with 15.7% of the treatment group withdrawing for this reason, compared to 5.4% in the control group.

In summary, giving antihypertensive therapy to healthy adults aged 60 or older with moderate to severe systolic or diastolic hypertension, or both, reduces all‐cause mortality, strokes, heart attacks and heart failure. The largest amount of evidence of benefit relates to those people who have not had a previous cardiovascular event and who use a thiazide as first‐line treatment.

• Read the Cochrane Review
• Listen to more Cochrane Podcasts
• Get Cochrane Podcasts on iTunes
• Visit the Cochrane Hypertension Group Website

Wednesday, September 18, 2019

We encounter Evidence Syntheses on an almost day-to-day basis, but do we know what it is and why we need it?

Cochrane Ireland and Evidence Synthesis Ireland aims to build knowledge, awareness, and capacity in the methods used to gather and build evidence (known as evidence synthesis) and using it effectively to inform health and healthcare decisions in Ireland. Policy makers, healthcare institutions, clinicians, researchers and the public will stand to benefit.

Evidence synthesis, also sometimes called “systematic reviews”, is a way of combining information from multiple studies that have investigated the same thing, to come to an overall understanding of what they found. This helps determine how effective a certain treatment or drug is, or how people have experienced a particular health condition or treatment.

• Search Cochrane's Plain Language Summaries of health evidence
• Visit the Cochrane Ireland website
• Visit the Evidence Synthesis website
• Save the date - Cochrane UK and Cochrane Ireland Symposium in Dublin, 21-22 April 2020

Friday, September 13, 2019

Among the dozens of Cochrane Reviews of various treatments for people with HIV or AIDS, are some that look more at how the treatments should be used, rather than the treatments themselves. One of these examines the timing of the start of treatment, and it was published in June 2019. Lead author, Alberto Mateo from the Liverpool School of Tropical Medicine in the UK, tells us about the evidence base and the findings for this important question.

"When people are diagnosed with HIV, they normally have to attend several clinic visits before they are offered treatment. This is to make sure that they are ready and that it is safe to start the medication. However, attending many clinic visits may be a barrier for people, particularly in low- and middle-income countries, which means that many of them stop being engaged with health services and never actually start the treatment. This makes them at risk of dying sooner than people on the therapy.

One proposed solution is to offer the antiretroviral therapy, or ART, on the same day that the person is diagnosed, or within a few days, what is known as “rapid ART”. We wanted to investigate if doing this could reduce mortality and improve other outcomes, and our review has found that rapid ART probably does increase the number of people initiating the therapy and the number of people with no detectable level of virus in the blood 12 months after diagnosis. We also found that rapid ART may increase the number of people in contact with healthcare services.

However, the evidence currently available does not allow us to say whether rapid ART reduces mortality. Some authors have previously suggested that giving ART so quickly after diagnosis could increase the number of drug adverse effects, and we did not have enough data to analyse this either.

It is important to note that in all the studies included in our review, rapid ART was delivered alongside several other interventions which needed to be in place to make rapid ART possible. These interventions allowed healthcare services to diagnose and assess the physical and psychological health of people with HIV to see if they were ready to start ART.

Looking forward, we hope that future studies will help to consolidate these promising findings, as well as determining which interventions help best to deliver rapid ART.”

• Read the Cochrane Review
• Listen to more Cochrane Podcasts
• Get Cochrane Podcasts on iTunes
• Visit the Cochrane Infectious Diseases Group Website

Friday, September 13, 2019

Cochrane Chile is thrilled to present highlights of this year’s Scientific Program! Cochrane’s annual flagship event brings together hundreds of clinicians, health professionals, policy makers, researchers, patients, consumers and others to discuss and learn about the wide usage of Cochrane evidence in health decision-making at all levels. This year’s Colloquium will take place 22-25 October, with the theme “Embracing diversity”. Pre-Colloquium activities start October 20.

The Full Schedule of the Scientific Program is now published!

Three Plenary Sessions will discuss the importance of evidence for Health Equity, its use by Diverse Stakeholders, and the importance of embracing Methodological Diversity.

The Cochrane Lecture will be given by Andy Oxman, and will explore the diversity of options for the future of the Cochrane Collaboration.

Nine Special Sessions, two presented in Spanish, will highlight innovative and interesting topics, varying from advances in the new Cochrane Handbook to multiple sessions on aspects of linguistic diversity in Cochrane; from engaging healthcare consumers in evidence, to technological innovation integrated with the evidence ecosystem.  

Concurrent sessions will offer 63 workshops ranging across 18 topic categories. For the first time, 8 workshops will be presented in Spanish!

Fifty one oral presentation sessions will include 241 presentations and three poster sessions will comprise 242 posters, covering topics from 17 different categories. Posters and orals are presented by delegates from all over the world.

We are so excited to welcome you to Santiago! There is still time to register before the Standard Registration deadline.

See you soon!

Wednesday, September 11, 2019

A recent study comparing low back pain systematic reviews abstracts to their full text was published in the Journal of Orthopaedic & Sports Physical Therapy. Looking at 66 systematic reviews reserchers found that 80% of abstracts presented spin and inconsistencies when compared to their full text. 9 of the systematic reviews investigated were Cochrane Reviews and it was found that  "Cochrane review abstracts had substantial to almost perfect agreement with the full text."

Lower back pain reviews are overseen by Cochrane Back and Neck (CBN). CBN coordinates the publication of literature reviews of diagnosis, primary and secondary prevention and treatment of neck and back pain and other spinal disorders, excluding inflammatory diseases and fractures. CBN is hosted by the Institute for Work & Health (IWH) in Toronto, Canada. IWH is an independent, not-for-profit organization. Its mission is to conduct and share research that protects and improves the health of working people and is valued by policy-makers, workers, workplaces, clinicians, and health & safety professionals.

• Visit the Cochrane Back and Neck website
• Read Cochrane evidence on low back pain
• Read 'Eight Out of Every Ten Abstracts of Low Back Pain Systematic Reviews Presented Spin and Inconsistencies With the Full Text: An Analysis of 66 Systematic Review'

 

 

Tuesday, September 10, 2019

 

Cochrane, JBI, Campbell Collaboration and Guidelines International Network are excited to announce the host of the Global Evidence Summit (GES) 2021 is the Czech National Centre for Evidence-Based Healthcare and Knowledge Translation (CEBHCKT).

The Cochrane geographic Centre is a leading national umbrella institution for evidence-based healthcare and guideline development, inclusive of a JBI Centre of Excellence, a Guidelines International Network member and the Masaryk University GRADE Centre.

The Centre was selected after a competitive application process that saw organizations from around the world contest to host the Global Evidence Summit in 2021. Professor Andrea Pokorná, Deputy Director of the Czech National Centre for Evidence-Based Healthcare and Knowledge Translation, is delighted that the Centre will host the Summit:

“Winning the bid to host is a great achievement that will influence the provision of healthcare in Central Europe, particularly in the Czech Republic. I am very proud that Masaryk University and its Centre for Evidence-based Healthcare and Knowledge Translation will be host to the Summit in 2021.”

The Global Evidence Summit 2021 will be held in October at O2 Universum, the brand new Multifunctional Cultural and Congress Centre in beautiful historic Prague and is easily accessible from every city quarter.  Prague is home to one of the most complete ensembles of Renaissance, Gothic and Baroque architecture in Europe.

Director of Cochrane Czech Republic and the Czech National Centre for Evidence-Based Healthcare and Knowledge Translation, Dr Miloslav Klugar, said that by partnering to deliver the Global Evidence Summit the four organizing partners send a message that co-operation and knowledge sharing must be embraced to improve health and the quality of life for people globally: “The Global Evidence Summit 2021 is an exciting opportunity for us here in the Czech Republic, Central Europe and everyone around the world to create synergies and to benefit from knowledge sharing in the global evidence community.”

Deputy Director, Dr Jitka Klugarová, added, “We are very proud that the Global Evidence Summit 2021 will take place in the Czech Republic. It is an amazing opportunity for global stakeholders in healthcare, research, social justice and education to participate in a global discussion about evidence-based practice.”

The GES is a quadrennial event that brings together some of the world’s leading organizations in evidence-based practice in a shared mission to provide a platform to discuss critical issues across different sectors, including health, education, social justice, the environment and climate change. The GES is intended as a multi-disciplinary and cross-cultural event to exchange ideas about how we best produce, summarize and disseminate evidence to inform policy and practice, and using that evidence to improve people’s lives across the world.

Together with the host, the Czech National Centre for Evidence-Based Healthcare and Knowledge Translation, Cochrane, JBI, Campbell Collaboration, and Guidelines International Network intend the second Global Evidence Summit to build on the successes of the 2017 Summit in Cape Town to advance the use of reliable research evidence in addressing some of the world’s most serious health and social challenges.

 

Wednesday, September 11, 2019

In 2015 Cochrane published a review on this topic, which has now been updated to include six new trials, additional data from included trials, and addresses comments and criticisms.

Global Advocacy organisations claim routine deworming of all school children at regular intervals with deworming drugs in areas where helminth infection is common has substantive health and societal effects beyond the removal of worms.

This interview with David Taylor Robinson, Professor of Public Health and Policy, Honorary Consultant in Child Public Health at The University of Liverpool, tells us a little more about this review.

What is deworming and why is it important?
Soil-transmitted worms, including roundworms, hookworms, and whipworms, are common in tropical and subtropical areas, and particularly affect children living in poverty where there is inadequate sanitation. The World Health Organization (WHO) currently recommends that school children in many areas are regularly treated with drugs which kill these worms. Some advocates claim such programmes improve child growth, haemoglobin, cognition, school attendance, school performance, physical fitness, and survival.

What is the history of this Cochrane Review?
A summary is given here in this Cochrane editorial which gives some of the background to this debated area.  Advocates believe strongly in population wide treatment programmes but the Cochrane review finds quite substantial evidence of no benefit in terms of haemoglobin, cognition, school performance, and mortality.

How widely is periodic deworming for children living in endemic areas advocated?
Periodic deworming for children living in endemic areas has been advocated by organizations as influential as the World Health Organization, the World Bank, and the Bill & Melinda Gates Foundation, and it has been considered to be a fundamental solution to the problems associated with endemic soil‐transmitted helminth infections.

What did this update aim to do?
To summarize the effects of public health programmes to regularly treat all children with deworming drugs on child growth, haemoglobin, cognition, school attendance, school performance, physical fitness, and mortality.

The evidence of no effect presented in the 2015 Cochrane Review was firm. Is this still the case with the 2019 review?
Yes, the overall conclusions are the same. We have included data from six additional trials in the update and have addressed comments and criticisms following the 2015 version – as with the 2015 version we see substantial evidence of no benefit for haemoglobin, cognition, school performance, and mortality. For weight studies conducted in two settings over 20 years ago showed large effects on weight, but this hasn’t been shown in more recent larger studies. 

Tell us more about how this update was conducted?
Cochrane researchers examined the effects of deworming children in areas where intestinal worm infection is common. After searching for relevant trials up to 19 September 2018, we included 50 trials with a total of 84,336 participants, and an additional trial of one million children.

It includes randomised controlled trials (RCTs) and quasi-RCTs that compared deworming drugs for soil-transmitted helminths (STH) with placebo or no treatment in children aged 16 years or less, reporting on weight, height, haemoglobin, and formal tests of cognition. We also sought data on other measures of growth, school attendance, school performance, physical fitness, and mortality.

What does the 2019 Cochrane Review tell us?
In populations of children living in endemic areas, the effect of the first, single dose of deworming drugs on weight is unclear. There was little or no effect in most studies, except for a large effect detected from one study area in Kenya, reported in two trials carried out over 30 years ago in a school where children were heavily infected with worms. This causes uncertainty which means we do not know if a first dose or single dose of deworming impacts on weight. For height, most studies showed little or no effect, with the exception of the site in Kenya. A single dose of deworming medicine probably has no effect on haemoglobin and cognition. There is insufficient data to know if there is an effect on school attendance, school performance, or physical fitness or mortality.

In studies where children were regularly treated with deworming medicine there was little or no effect on weight in all but two trials, irrespective of whether children were heavily infected with worms or not. The two trials with large average weight gains included the Kenya study carried out over 30 years ago, and one study from India carried out over 20 years ago in a low worm burden area where later studies in the same area did not show an effect. In trials from 2000 onwards, which are more relevant given the global reduction in worm burden, there is little or no effect. This causes uncertainty and means we do not know if regularly treating children with deworming medicine improves their weight. Regularly deworming children probably has no effect on height, haemoglobin, cognition, and mortality. We do not know if there is an impact on school attendance, since the evidence is inconsistent and at high risk of bias. There is insufficient data to know if there is an effect on physical fitness.

What criticism or comments does it address?
We addressed some detailed comments from deworming advocates which were helpful, and we included some new studies as a result of this. Also, previous criticisms concerned splitting the analysis between people known to be infected and community studies where whole populations are treated. In this update we conducted a fresh analysis considering all the data together, stratified on the basis of worm burden. We also repeated the analysis for different worm types.

What message does this review have for policy makers and those delivering public health programmes?
For public health programmes to regularly treat all children in endemic areas with deworming drugs, there is quite substantial evidence of no benefit in terms of haemoglobin, cognition, school performance, and mortality. For weight, contemporary studies do not show an effect, but unusually large effects were seen in studies over 20 years ago. We would caution against selecting only the evidence from these older studies as a rationale for contemporary mass treatment programmes.

What do you hope might happen as a result of this evidence update?
We suggest that the current evidence does not support large public health programmes of deworming in low and middle- income countries. Countries implementing such programmes should consider the findings of our updated review and make their own minds up. People developing global guidelines should be clear on what basis deworming programmes are being promoted.

• Read the review here
• Learn more about Cochrane Infectious Diseases Group
  
   

Wednesday, September 11, 2019

Specifications: Full time, permanent 
Salary: Competitive
Location: London
Application Closing Date: 2nd October 2019 (12 midnight GMT)

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

The Publishing Technology Manager will join Cochrane’s product team to oversee the management and development of the external publishing technology systems and vendors, including the editorial management system and production system.

The Publishing Technology Manager will work with the technology vendors, the Product Lead, Head of Review Production and Senior Editor (Publishing Operations) to ensure that Cochrane content is processed on time and to the desired specifications, and that any necessary development work or dependencies for new content types or workflows are captured and resolved.

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:

• Educated to degree-level (or equivalent experience).
• Experience of production systems, typesetters and paginators within scientific publishing.
• Experience with web-based submission systems.
• Fluent in English (written and spoken).
• Excellent written and verbal communication skills.
• Proven ability to establish and maintain positive relationships with people and teams from a range of
• functional, professional, linguistic and cultural backgrounds.
• Demonstrable experience of holding people to account.
• Exceptional organisation skills and the ability to manage multiple projects at once.
• Theoretical and practical experience of change management.
• An understanding of how technology is affecting innovation within STM journal production and operations.

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 “Publishing Technology Manager” in the subject line.  The supporting statement should indicate why you are applying for the post, and how far you meet the requirements for the post outlined in the job description using specific examples.  List your experience, achievements, knowledge, personal qualities, and skills which you feel are relevant to the post.

• For further information, please download the full job description from here.
• Deadline for applications: 2nd October 2019 (12 midnight GMT)
• Interviews to be held on: (TBC)

Monday, September 9, 2019

Specifications: Part time (0.6) permanent 
Salary: Competitive
Location: London
Application Closing Date: 30th September 2019 (12 midnight GMT)

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

The Senior Editorial Officer will support the Editor in Chief of Cochrane in achieving the strategic aims and delivering the objectives of the Cochrane Editorial and Methods Department (EMD). 

The Senior Editorial Officer will lead and oversee strategic projects, including:

• Working with the Editorial and Communications Officer on strategic projects or programmes of works relevant to the strategic vision for Cochrane’s content and review production.
• Supporting effective and timely communications between the Editorial and Methods Department and other departments of the Cochrane Executive Team.
• Lead the development of editorial projects and plans for making Cochrane reviews more accessible (in liaison with the KT Department and IRD).
• Working with the Peoples Services Department on projects aiming to improve authors’ experiences. This includes the delivery of Editorial and Author Charters describing agreed expectations between Networks, authors and CRGs to assure the equity and consistently high quality of the review process.
• Implementing the agreed quality-assurance process for high-profile reviews.
• Supporting the Head of Review Production on operational projects relevant to the Cochrane Review Group (CRG) Networks including:
  
  • The implementation of the new Editorial Management System;
  • The development of Centralised Editorial Services;
  • The introduction of a new journal submission process; and
  • Editorial policy and process implementation.

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:

• An understanding of the importance of systematic reviews to clinical decision-making.
• An ability to work alongside varied teams in different cultural and linguistic settings.
• Strong organization and prioritization skills
• Attention to detail
• Excellent written and verbal communication skills
• Impressive interpersonal skills both in person and by telephone and Skype.
• An ability to accomplish projects with little supervision.
• Intermediate-level IT skills, including proficiency in Word, Excel and PowerPoint.
• An ability to develop and maintain good working relationships with key stakeholders.
• Knowledge of and commitment to Cochrane’s mission and values and good understanding of Cochrane’s Strategy 2020 goals and targets.

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 “Senior Editorial Officer” 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: 30th September 2019 (12 midnight GMT)
• Interviews to be held on: (TBC)
  
  
  

Wednesday, September 4, 2019 Category: Jobs

September is  Polycystic Ovary Syndrome Awareness Month and is an excellent time to focus on the latest Cochrane evidence.

Polycystic ovary syndrome (PCOS) is a very common condition affecting 8% to 13% of women. Being overweight worsens all clinical features of PCOS. These clinical features include reproductive issues such as reduced frequency of ovulation and irregular menstrual cycles, reduced fertility, polycystic ovaries on ultrasound and high levels of male hormones such as testosterone, which can cause unwanted facial or body hair growth and acne. PCOS is also associated with metabolic features, with risk factors for diabetes and cardiovascular disease including high levels of insulin or insulin resistance and abnormal cholesterol levels. PCOS affects quality of life and can worsen anxiety and depression either due to its symptoms or due to the diagnosis of a chronic disease.

The Cochrane Gynaecology and Fertility Group (CGF)  is concerned with the systematic evaluation of the management and treatment of menstrual disorders and subfertility. The CGF carries out extensive searches for all relevant randomised controlled trials (RCTs) both published and unpublished; scrutinises each trial for its relevance and quality; critically appraises trials; draws conclusions based on pooling data about how their net result should be applied in healthcare; and produces structured reports (systematic reviews) for widespread dissemination to health care providers and planners, and to consumers.

Here is a curated list of some PCOS related Cochrane systematic reviews:

• Insulin‐sensitising drugs (metformin, rosiglitazone, pioglitazone, D‐chiro‐inositol) for women with polycystic ovary syndrome, oligo amenorrhoea and subfertility
• The effect of a healthy lifestyle for women with polycystic ovary syndrome

Tuesday, September 3, 2019