When someone mentions the workplace and health, our first thoughts might be about safety and avoiding accidents, but workplaces also provide an opportunity for interventions to improve the general health of employees. Luke Wolfenden of the University of Newcastle in Callaghan, Australia and colleagues have looked into this and we asked him to tell us what they found for their new Cochrane Review, published in November 2018.

"Several workplace-based interventions are available to improve the diet, physical activity and weight status of employees or to reduce their use of alcohol or tobacco. The implementation of such interventions can reduce the risk of future chronic disease, but their implementation is not routine, and we wanted to find what could be done to improve this. We hoped to identify strategies that might help, in particular with interventions that target employee diet, activity, obesity, tobacco or alcohol use, but were disappointed to find shortcomings with the current evidence.

We searched for studies that had assessed the impact of an implementation strategy, for example, training, audit and feedback or incentives, on the fidelity of implementation of a health-promoting intervention, and were willing to include both randomised and non-randomised studies. Eligible strategies could have targeted policies and practices implemented in the workplace environment, such as changes to what is available in the cafeteria; or workplace‐initiated efforts to encourage the use of external services to promote health behaviour change, such as giving the employees subsidies for gym membership.

After much searching, we were able to include six studies: four from the USA and one each from Brazil and the UK. Four of the studies were randomised trials and all tested multi-strategic implementation strategies. The most common of these were educational meetings, tailored interventions and local consensus processes; and the workplaces included those in the manufacturing, industrial and services‐based sectors. Unfortunately, though, the general quality of this existing evidence was so low that we are not able to draw strong conclusions.

Combining the results of three of the randomised trials in a meta-analysis provided low certainty evidence that there was no benefit of implementation support in improving policy or practice implementation, compared to control. Three trials of the impact of implementation strategies on employee health behaviours provided either very low or low certainty evidence and reported mixed effects for diet and weight status, and no effect for physical activity or tobacco use.

In conclusion, the findings of our review don’t provide the clear evidence needed to know the impact of strategies intended to improve the implementation of workplace-based health-promoting policy and practice interventions. Improving this evidence base will require new studies and these are needed if policies, practices and programs designed to improve employee health are to be applied effectively and efficiently and to yield their intended benefits.

• Read the Cochrane Review
• Listen to more Cochrane Podcasts
• Get Cochrane Podcasts on iTunes
• Visit the Cochrane Cochrane Public Health Group website

Thursday, February 21, 2019

Doctors looking after newborn babies need to be able to detect infections early and accurately if they are to prevent the baby from becoming seriously ill. One of the tests suggested for doing this is to measure their c-reactive protein and this was assessed in a new Cochrane Review in January 2019. We asked the lead author, Jennifer Brown from the Centre for Reviews and Dissemination at the University of York in the UK, to tell us why this review is so important and what it found.

"Getting seriously ill with an infection is one of the biggest risks of death for newborn infants, especially those born preterm or unwell. The focus of our review are babies who are more than three days old and contract a so-called late-onset infection while they are in a neonatal intensive care unit, or NICU, for some other reason. We wanted to see if testing their c-reactive protein, or CRP, could diagnose infection accurately and quickly so that appropriate treatment with antibiotics could be given at the earliest opportunity. This is important because these babies are often already receiving many other treatments and investigations, and antibiotics should not be given to them unless they need them.

The clinical signs of infection in newborn babies are non-specific and might be due to other conditions. Some of these are less serious and some will require other kinds of treatment. Therefore, a test called a blood culture is routinely used to see if the baby does have an infection but it can take 24 to 48 hours to get the result. Because the risks associated with infections in newborns are so high and because they can get sicker very quickly, clinicians will typically prescribe antibiotics when they suspect an infection, rather than waiting for the lab result. This means that some babies will receive several days of antibiotics despite NOT having an infection which puts extra unnecessary stress on their already compromised health and also contributes to the bigger problem of antibiotic resistance.Testing the baby’s serum level of CRP, which rises quickly if they do have an infection, has been proposed as a way that might allow a quicker but similarly accurate diagnosis to the traditional blood culture. In our review, we compared the diagnostic accuracy of these two approaches, using information from more than 1600 infants in 20 studies. Most of the studies were published in the last two decades in a variety of countries in Europe, North America, and Asia. Their overall methodological quality was good and the risk of bias was low but we had some concerns about inconsistency in the results of the studies. On the whole, we considered the quality of the evidence to be moderate.

Most of the studies used a threshold level of 5 to 10 mg/L when deciding if a CRP measurement was "positive" for infection. When we extracted and combined data from the included studies, we found that, on average, CRP correctly identified approximately six in every ten babies who were diagnosed with an infection based on their blood culture. It also incorrectly suggested an infection in about a quarter of the babies who did not have one.

To place this in a broader context, imagine that 40% of these high-risk newborn babies will develop a late-onset infection, which would be in keeping with what was found in the studies in our review. If we use this figure and our findings and imagine a group of 1000 babies, using CRP alone would miss 152 out of the 400 cases of infection and it would wrongly diagnose infection in 156 of the 600 babies without the condition.

This leads us to the conclusion that using the serum level of CRP when an infection is suspected in a newborn is not sufficiently accurate to diagnose infection or decide which babies should or should not be prescribed antibiotics. Tests that speedily and accurately diagnose infection in newborns are still needed and we suggest that future research might focus on other biomarkers, such as procalcitonin, or new technologies, like molecular assays, to fill this gap."

• Read the Cochrane Review
• Listen to more Cochrane Podcasts
• Get Cochrane Podcasts on iTunes
• Visit the Cochrane Cochrane Neonatal Group website

Monday, February 18, 2019

After leading Cochrane Finland for 22 years, Cochrane expresses thanks to Marjukka Mäkelä, for her outstanding contributions to Cochrane.

Marjukka founded Cochrane Finland in 1996 and during her long service to Cochrane, she has become highly respected in the field of evidence-based medicine. Marjukka was the first Editor in Chief of the Finnish national clinical practice guidelines in1994. She describes the early days of Cochrane Finland as: ‘Sitting in the dusty national medical library in mid-1990s to track down all Finnish-language RCTs and CCTs from the 1950s on. A classic one was a study on the effect of using DDT to protect milk from being infected by flies, outcome: number of diarrheos in infants’.
 
A substantial amount of Marjukka’s work evolved around the development of Current Care Guidelines. These are national guidelines that cover important issues related to Finnish health, medical treatment as well as prevention of diseases. The work included training of librarians in all medical libraries in Finland to do systematic literature searches for guideline groups; obtaining state budget for the development of Current Care Guidelines; and, ensuring the publishing of conflict of interest statements of all guideline authors on the Current Care website (with Finnish language medical journals following suite).
 
Current Care is now becoming a household name. A journalist recently complained in a blog about his wife being a “walking Current Care guideline”! The 100th Current Care Guideline was published in 2011. All this work on guidelines has been supported by the increasing number of high-quality Cochrane reviews that were used to support guideline development.
 
Jorma Komulainen has taken over the leadership of Cochrane Finland, and will focus the activities on (1) diffusion of Cochrane work in Finland, (2) implementing Cochrane evidence in national clinical practice guidelines, and (3) networking with the Finnish people who participate in various Cochrane groups. Marjukka will continue to support Jorma in this new role.
 
The formal announcement of the leadership change at Cochrane Finland has recently taken place at a national doctor’s training event in January – for more information, listen to this Duodecim Blues, asking all to join Cochrane!
 

The musicians are (from left to right): Marjukka Mäkelä, vocals; Jorma Komulainen, guitar and vocals; Janne Rapola, ukulele; Pasi Kojola, bass.
 
Text of the Duodecim Blues:
Finnish:
Sijaan suosituksen telepaattisen
tahdon tehdä ohjeen systemaattisen,
Archie mukaan siis
ja Cochranea lisää käyttöön please.
 
Kaikki mukaan tukemaan tätä Cochrane juttua,
se on lääketiedettä, ei tyhjää huttua,
populaarisuus
niin syntyy tämä Duodecim-blues.
 
English:
Instead of recommendations telepathic
I wish to make a guideline systematic
Follow Archie’s views
and apply more Cochrane reviews.
 
All aboard to support this Cochrane thing,
it’s real medicine, not a useless fling,
join the guideline crews
to sing along this Duodecim blues.

Friday, February 15, 2019

Cochrane is made up of 13,000 members and over 50,000 supporters come from more than 130 countries, worldwide. Our volunteers and contributors are researchers, health professionals, patients, carers, people passionate about improving health outcomes for everyone, everywhere.

Cochrane is an incredible community of people who all play their part in improving health and healthcare globally. We believe that by putting trusted evidence at the heart of health decisions we can achieve a world of improved health for all. 

Many of our contributors are young people working with Cochrane as researchers, citizen scientists, medical students, and volunteer language translators and we want to recognize the work of this generation of contributors as part of this series called, Cochrane’s “30 under 30." 

In this series, we will interview 30 young people, 30 years old or younger who are contributing to Cochrane activities in a range of ways, all promoting evidence-informed health decision making across the world. 

We will be hearing from them in a series of interviewees published over the coming months.

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

Name: Carlo Frassetto (on Twitter at @CarloFrassetto)
Age: 27
Occupation: Emergency Registered Nurse – Member of the European Health Parliament (Committee of Disease prevention and Management) - President of Italian Nursing Students association.
Program: Graduate student at Universita’ Cattolica del Sacro Cuore (Rome, Italy) and Master degree in Nursing Management and Public Health.

How did you first hear about Cochrane?
I first heard about Cochrane as a Bachelor Nursing Student during my last year. During that time, I read about Cochrane’s history and the importance of Cochrane systematic. I was impressed at risk of bias approach of the Collaboration and its impact on health politics.

I chose to get involved with Cochrane because of the opportunities available to learn more about evidence synthesis and the process by which high quality information is made accessible to consumers. I look forward to future opportunities to stay engaged with the organization.

How did you become involved with Cochrane? What is your background?
I have a strong interest in Nursing, Emergency medicine, Public health, Health Politics, epidemiology, and evidence synthesis with a specific aim of improving evidence-based health care for patients through policy making and education. I am developing a Healthcare App about diet and healthy living at the Millenianl Startapp camp in Budapest. I first became involved with Cochrane after I submitted my application for Cochrane’s UK elective. I was selected for a 4 weeks program in Oxford UK. The aim of the Elective was to spread evidence-based practice and disseminate worldwide.

What do you do in Cochrane?
I am a Cochrane Supporter, member of Students for Best Evidence, I was intern at Cochrane UK collaborating for Evidence Blogs and Social media dissemination.

What specifically do you enjoy about working for Cochrane and what have you learnt?
It has been incredible to work with such prepared and wonderful team at the Cochrane UK centre. Every day it is a challenge to find the best evidence and make it simple to understand for everybody.  I am constantly working hard to influence health politics using evidence-based research, especially Cochrane reviews.

What are your future plans?
My future plans are to continue to work in the field of Nursing and Public health while combining my passion for evidence-based medicine. I look forward to applying to PhD in public health because I think Nurses need to get more active about his topic as per they are Number one healthcare workforce worldwide.

In your personal experience, what one thing could Cochrane do better to improve its global profile?
If I could change one thing about Cochrane, it would be to increase Cochrane’s voice on social media. Moreover, increase opportunities and professional development activities Nationwide involving Professionals and Patients associations.

What do you hope for Cochrane for the future?
I hope that Cochrane continues to expand its network worldwide by approaching policy makers, local leaders, and associations. Moreover, I am looking forward to writing EHP policy on disease prevention using Cochrane Evidence to inspire young health professionals.

How important is it that young people get involved in Cochrane?
I think it is essential for young people to get involved with Cochrane because the future of health care lies in our hand and we need to improve it by embracing evidence.

Why is this, do you think?
If we want to provide a good future for health care and guarantee UN global health goals, we absolutely need to engage evidence-based practice and Cochrane is the voice we need to hear.

What would your message be to other young people who want to get involved with Cochrane’s work but not sure where to start….?
Be passionate and driven.  You can make a difference. Don’t be afraid to approach such a huge NGO. People are open and ready to hear and support. Get involved! Don’t be scared!

Friday, February 22, 2019

Cochrane is made up of 13,000 members and over 50,000 supporters come from more than 130 countries, worldwide. Our volunteers and contributors are researchers, health professionals, patients, carers, people passionate about improving health outcomes for everyone, everywhere.

Cochrane is an incredible community of people who all play their part in improving health and healthcare globally. We believe that by putting trusted evidence at the heart of health decisions we can achieve a world of improved health for all. 

Many of our contributors are young people working with Cochrane as researchers, citizen scientists, medical students, and volunteer language translators and we want to recognize the work of this generation of contributors as part of this series called, Cochrane’s “30 under 30." 

In this series, we will interview 30 young people, 30 years old or younger who are contributing to Cochrane activities in a range of ways, all promoting evidence-informed health decision making across the world. 

We will be hearing from them in a series of interviewees published over the coming months.

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

Name: Shalini Suresh (On Twitter at @shalini_suresh)
Age: 24
Occupation: Director of Compliance and Data Analytics
Program: Master of Public Health in Epidemiology & Global Health, Columbia University Mailman School of Public Health

How did you first hear about Cochrane?
I first heard about Cochrane during my junior year of college while looking for an undergraduate Honors project. I was determined to pursue research from an evidence-based lens, and was certain I did not want to follow the conventional path of lab-based research. While I scanned several different options, I came across the Cochrane group at my university and started learning more about Cochrane systematic reviews and the important influence of Cochrane on evidence-based medicine.

How did you become involved with Cochrane? What is your background?
After finding out about Cochrane, I reached out to the University of Ottawa Centre for Global Health and met with Vivian Welch and Jordi Pardo Pardo, two Cochrane experts and wonderful mentors. They introduced me to the world of Cochrane systematic reviews and gave me the opportunity to conduct a systematic review for my Honors project in the senior year of my B.Sc degree in Biomedical Science.

What do you do in Cochrane?
I am a Cochrane systematic review author with the Cochrane Musculoskeletal Group, and I co-authored an update to a systematic review on Thermotherapy for Rheumatoid Arthritis, which is currently going through the editorial process. I’ve also been an advocate of Cochrane internationally, and while living in Nepal last year, I supported the Nepal Health Research Council in capacity building for evidence-based research, specifically with systematic reviews. I helped outline a training agenda to equip interested researchers with the technical skills required to conduct Cochrane systematic reviews.

What specifically do you enjoy about working for Cochrane and what have you learnt?
Cochrane exposed me very early on to the value of robust research methodology in informing high quality conclusions. The Cochrane author training that I received cultivated my critical thinking skills, a foundational element of research, that has helped me through multiple projects in subsequent work positions and graduate school. I realized the true value of my Cochrane training when I transitioned into conducting primary data research, and I was already aware of the challenges and nuances I would need to overcome to ensure that my results provide high quality evidence.

I also value the global influence of Cochrane and its holistic systems approach that is essentially “from everyone, for everyone”. The diverse group of contributors that make up the Cochrane community bring a range of skill sets and perspectives, validating the integrity of the research and its ability to inform global guidelines.

What are your future plans?
I’m currently working in global program implementation, data analysis, and research at an impactful NGO. I plan to eventually pursue a doctoral degree to apply my passion for robust research methods to generate high quality evidence in sectors that have wide data gaps, specifically within global development. Having just completed my Masters, I feel the need to spend some time in the real world to clearly identify a topic that has a high research need and overlaps with my interests, before going back to school!

In your personal experience, what one thing could Cochrane do better to improve its global profile?
From my personal experience engaging with the group in Nepal, I noticed a gap in the tools and resources they were able to access to deepen their involvement with the Cochrane community. They reported challenges in obtaining the training and guidance needed to participate in Cochrane projects so one suggestion I would have would be to increase access to materials and tools for training. Geographic barriers can play a role in limiting the accessibility to resources, so an intentional initiative to support and increase engagement of interested researchers could be explored. One possible way to foster global connections could be by perhaps having virtual mentorship sessions between Cochrane experts and newcomers.

What do you hope for Cochrane for the future?
I already see Cochrane as the global leader in evidence generation methods and the highest standard in evidence-based research. I hope that more international agencies and government bodies are able to recognize the value that Cochrane provides to the scientific community and supports its growth and expansion in the future.

How important is it that young people get involved in Cochrane? Why is this, do you think?
There’s an imperative need for young people to get involved in Cochrane, both from the perspective of what Cochrane provides to young people and how young people can contribute to Cochrane. Cochrane provides a unique platform for young individuals to learn about real-world, evidence-based research, which is unfortunately not given enough focus during college education. Academia tends to be centrered around courses and more traditional forms of scientific thinking that has its benefits, but often misses out on teaching students about research from an implicational lens. Cochrane provides a valuable learning opportunity to bridge this gap. On the flip side, young people bring a fresh perspective to Cochrane with new ideas and an eagerness to learn. By imparting Cochrane’s valuable research methods to young individuals, we are creating a new generation of critical thinkers and empowered researchers, equipping them with the ability to contribute meaningfully to the scientific community throughout their careers.

What would your message be to other young people who want to get involved with Cochrane’s work but not sure where to start….?
Cochrane has its presence in over 100 countries and has established groups at numerous universities, making it quite accessible globally. There are so many incredible opportunities for young individuals to get involved and all it takes is doing some outreach, sending some emails, putting effort into connecting with the network, and committing to stay involved. Being involved with Cochrane at a young age shaped my research abilities, provided me with valuable experience to build on early in my career, and contributed to my education as much, if not more, than the courses I took at college. In short, my message to students is to reach out to anyone from the Cochrane community that interests you, or to inquire more about any Cochrane project that interests you. It will be more than worth the effort!

Monday, February 25, 2019

The aim of this study was to examine the effect of adding iodine to foods, beverages, condiments, or seasonings, other than salt, on iodine nutrition status and health‐related outcomes in all populations.

Many people around the world do not consume enough iodine. This is a problem because iodine is important for normal childhood growth and brain development, and for ensuring a healthy adult population. Inadequate intake of iodine can lead to health problems, such as intellectual disability and goitre (enlargement of the thyroid gland). Currently, the main strategy to increase the amount of iodine consumed in populations recommended by the World Health Organization is adding iodine to salt. However, in some areas where salt is not the major condiment, adding iodine to other foods has also been explored.

Eleven studies captured data on 4317 participants. The type of foods used as vehicle to deliver iodine differed between the studies, and included biscuits, milk, fish sauce, drinking water, yoghurt, fruit drinks, seasoning powder, and infant formula milk.

Lead author Dr Jacqui Webster, from the University of New South Wales, Australia explains; overall, the findings suggest that iodine fortification of foods other than salt is effective in terms of increasing urinary iodine concentration. However, there was insufficient evidence to demonstrate the effects of the intervention on goitre prevalence, physical development measures, or any adverse effects. Whilst the review suggests that other foods could potentially be used as a vehicle for fortification, additional adequately powered, high quality studies on the effects of iodine fortification of foods on important outcomes, would be useful.

Read the review here
Learn more about Cochrane Public Health
Image credit: iStock Weekend Images Inc.

Thursday, February 14, 2019

Salary: £150,000 - £170,000
Location: Flexible
Application Closing Date: 28th February 2019

Dr David Tovey, Cochrane’s first Editor in Chief, is stepping down at the end of May after 10 years in the role.

His successor - as both the external face of Cochrane’s content and the internal lead for the editorial production of Cochrane evidence - will play a key role in taking the organization forward beyond our existing Strategy to 2020.

You can find further information on the role, including details about how to apply and closing date for applications, here.

The new Editor in Chief can be located anywhere in the world although there is a preference for London, UK.

Wednesday, February 13, 2019

New member is sought from a low- or middle-income country, and/ or from a geographical region that is different from that of the current Trustees.

Cochrane is looking for an experienced person with a strong interest in the work of Cochrane, a belief in its power to improve healthcare decision making worldwide, and the ability to provide strategic input into the work of the organization to serve as an Appointed Member of the Governing Board.
 
Cochrane is an international and diverse organization committed to informing healthcare decisions with synthesised evidence from research. Organisationally, we are a registered charity in the UK. The members of the Governing Board hence are from from around the world with diverse skills and experience, and are also Trustees of the charity. The Trustees carry ultimate responsibility for Cochrane and this is a critically important role.
 
The Board works as a team, including members with complementary skills and backgrounds. Members of the Board are a mix of elected members (who must be Cochrane Members) and appointed members who aim to bring an external perspective to the Board. Appointed members can be anyone with the relevant skills and experience and will normally not be Cochrane Members.
 
On this occasion, the Board wishes to broaden our geographic and language diversity and so is seeking to appoint an individual from a low- or middle-income country, and/ or from a geographical region that is different from that of the current Trustees. The current Trustees are from Australia, New Zealand, Spain, Mexico, Denmark, Canada, the United States and the United Kingdom. The Board is especially seeking candidates who have one or more of the following areas of expertise, in order to complement those of existing Board members:

• Publishing
• Fundraising and Development
• Advocating for Evidence
• Organizational Finance and Resource Management
• Organizational Development
• Charity Governance (in any charitable organization around the world)

This is an exciting opportunity to join the team providing strategic oversight to Cochrane, making sure the organization’s work is effective and innovative, and that it delivers on its mission to promote evidence-informed health decision making by producing high-quality, relevant, accessible systematic reviews and other synthesized research evidence.
 
In line with the usual requirements for UK charity Trustees, these are voluntary, unpaid roles. Each year you will need to commit to attending at least three and up to four face-to-face meetings at different locations internationally, and at least two teleconferences. You will be expected to be a member of one or more Board Sub-Committees. Your expenses will be paid to attend meetings. The term of appointment is three years, from March 2019 to March 2022. In 2019, you should ideally be available to travel to Krakow, Poland, 1-5 April, 2019; and definitely be available for the meeting in Santiago, Chile, 22-25 October 2019.
 
The deadline for nominations is Tuesday 12 March. To find out how to stand for appointment, please visit elections.cochrane.org. Questions can be submitted at any time to Lucie Binder, Senior Advisor to the CEO (Governance & Management) at elections@cochrane.org

Wednesday, February 13, 2019

Do general health checks reduce illness and death?

The authors of this updated Cochrane Review set out to find if general health checks reduce illness and deaths.

General health checks involve multiple tests in a person who does not feel ill. The purpose is to find disease early, prevent disease from developing, or provide reassurance. Health checks are a common element of health care in some countries. Experience from screening programmes for individual diseases have shown that the benefits may be smaller than expected and the harms greater. The review authors identified and analysed all randomised trials that compared invitations for one or more health checks for the general public with no invitations. They analysed the effect on illness and the risk of death, as well as other outcomes that reflect illness, for example, hospitalisation and absence from work.

The authors found fifteen trials reported results and included 251,891 participants. Eleven of these trials had studied the risk of death and included 233,298 participants and assessed 21,535 deaths.
 

Lead author of this Cochrane Review, Lasse T Krogsbøll said;

"One reason for the apparent lack of effect may be that primary care physicians already identify and intervene when they suspect a patient is at high risk of developing disease when they see them for other reasons. Also, those at high risk of developing disease may not attend general health checks when invited or may not follow suggested tests and treatments.

But the conclusions do not imply that physicians should stop clinically motivated testing and preventive activities, as such activities may be an important reason why an effect of general health checks has not been shown.

This update addresses a criticism of the previous version of the review, that the included trials were old and were not done when statins were available. The evidence base has also substantially strengthened, as the previous review had data from 150,000 patients, we now have data from 230,000.

In the future we suggest research focus is shifted to the effects of structural interventions to reduce disease, for example, higher taxes on tobacco and alcohol, or restricting corporate advertising for harmful products."

• Read this Cochrane Review
• Learn more about the Cochrane Effective Practice and Organisation of Care Group

Wednesday, February 20, 2019

Wrist fractures are the most common bone injury in children, causing much pain, distress and life impact for them and their families. In a comprehensive Cochrane Review from December 2018, Joanne Elliott, Managing Editor of the Cochrane Bone, Joint and Muscle Trauma Group based at the University of Manchester in the UK and colleagues, also based in the UK, look at a variety of interventions that are used for these fractures and she outlines the findings in this podcast.

Most wrist fractures in children are buckle fractures, also called torus fractures, where the bone surface bulges out. These minor fractures heal well, often with the child needing to wear a wrist splint or a below-elbow plaster cast for two or three weeks. More serious fractures will generally result in bits of the bone being displaced. A process called reduction might then be used to manipulate the pieces of bone back into place and the wrist and, often the elbow, would then be immobilised in an above-elbow cast. When surgery is considered, it generally involves putting pins through the skin and into the repositioned bone, again followed by cast immobilisation.

Our review assesses the evidence on the effects of interventions for treating children with all types of wrist fracture. We reviewed information on nearly 3000 children in 30 randomised or quasi-randomised trials, which had included a total of 14 different comparisons. The average ages of the children in these trials ranged between 8 and 10 years. However, most of these comparisons were made in one trial only, making it difficult for us to be confident in the findings.

Instead, we focused on five key comparisons that we had specified at the start of our work but, unfortunately, we were still faced with evidence of low or very low quality or certainty.

Three of the comparisons involved children with buckle fractures; with six trials comparing a removable splint with a below-elbow cast; four trials comparing a soft or elasticated bandage with a below-elbow cast; and two trials comparing cast removal at home by parents versus at a hospital fracture clinic by clinicians, in which the home casts could be removed without a special cast saw.

Our other two comparisons involved children with displaced fractures. Four trials compared below versus above-elbow casts, and five trials compared pinning and above-elbow cast immobilisation versus above-elbow cast immobilisation alone.

We wanted to focus on the impact on physical function, treatment failure, adverse events, recovery time, wrist pain and child or parent satisfaction, but the small amount of data and the lack of certainty in the studies means, disappointingly, that our overall conclusion is that "There is not enough evidence to determine the best ways of treating different types of wrist fractures in children".

There are some important positives, though. We found reassuring evidence of a full return to previous function with no serious adverse events, including subsequent breaks of the wrist, for correctly-diagnosed buckle fractures, whatever treatment was used. This supports the move away from cast immobilisation for these non-serious injuries. And, when considering the implications for future research, we are encouraged that some priority topics, such as the comparison of bandage versus removable splints for buckle fractures, are already being tested in large multicentre trials.

• Read the Cochrane Review
• Listen to more Cochrane Podcasts
• Get Cochrane Podcasts on iTunes
• Visit the Cochrane Bone, Joint and Muscle Trauma Group website

Monday, February 11, 2019

Specifications: Full Time
Salary: £28,000
Location: London
Application Closing Date: 22nd February 2019

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

The Office Administrator will provide effective and efficient administrative support to the EA to the CEO, to ensure smooth running of the London office and administrative functions for the Central Executive Team (CET).

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:

Essential:

• Previous experience of providing administrative support to a team
• Intermediate level IT skills, including Word, Excel and PowerPoint
  
• Strong organization and prioritization skills
  
• Excellent written and verbal communication skills
  
• Excellent interpersonal skills
  
• Professional telephone manner
  
• Ability to work methodically and accurately
  
• A flexible approach with the ability to respond quickly to issues as they arise
  
• A pro-active approach to problem-solving
  
• Awareness of handling confidential and sensitive information
  

Preferred:

• Experience of healthcare charity sector
  
• Previous experience of providing PA support
   

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 Office Administrator 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: 22nd February 2019 (12 midnight GMT)
 
Interviews to be held on: (TBC)
Monday, February 11, 2019 Category: Jobs

The Cochrane Pain, Palliative and Supportive Care Group is producing a series of reviews on drugs for the treatment of people with neuropathic pain. One of these, published in March 2018, examines the effects of cannabis-based medicines and we asked one of the authors, Martin Mücke from the University Hospital of Bonn in Germany, to outline the findings in this podcast.

Neuropathic pain comes from damaged nerves and several products based on the cannabis plant have been suggested as possible treatments. These include inhaled herbal cannabis, and various sprays or tablets that contain ingredients either obtained directly from the plant or made synthetically. Some people with neuropathic pain have said that cannabis-based products are effective for them, and you have probably heard stories about this in the media.

Therefore, one of the reasons for doing this Cochrane Review was to address this “cannabis hype“ in the media by using research evidence to clarify the benefits and harms of cannabis-based medicines for adults with chronic neuropathic pain.

We searched for randomised trials and found 16 separate studies, with a total of just 1650 patients, and judged the quality of the evidence to be very low to moderate. The studies lasted from 2 to 26 weeks, with ten comparing a mouth spray with a plant-derived combination of tetrahydrocannabinol (THC) and cannabidiol (CBD), two investigating a synthetic cannabinoid called nabilone that mimicks THC, two that tested inhaled herbal cannabis (two studies) and another two of the plant-derived THC, dronabinol.  One of the 16 studies compared the cannbis-based medicine with an analgesic, dihydrocodeine, while the other 15 were all comparisons against placebo, a dummy medication made to look and taste like the cannabis-based one.
Overall, we found no difference between people allocated to take cannabis-based medicines or placebo when we looked at the impact on the clinically relevant outcome of an improvement in pain relief of 50% or greater. Those who took cannabis-based medicines did report more frequently than those taking placebo that the global impression of their health was much or very much improved and that they had pain relief of 30% or greater. On the other hand, the cannabis-based medicines group had more dropouts due to side effects, more adverse events of the nervous system and more psychiatric disorders.

In summary, we concluded that the potential benefits of cannabis-based medicines in chronic neuropathic pain were outweighed by their potential harms, although a minority of people with cannabis-based medicines do experience substantial symptom relief without clinically relevant adverse events.

• Read the Cochrane Review
• Listen to more Cochrane Podcasts
• Get Cochrane Podcasts on iTunes
• Visit the Cochrane Pain, Palliative and Supportive Care Group website

Wednesday, February 6, 2019

Register before 25 July 2019 to receive discounted rate.

This year the 26th Cochrane Colloquium will take place at CasaPiedra in the vibrant city of Santiago, Chile, 22-25 October 2019.

The theme of the Colloquium is 'Embracing diversity', recognizing Cochrane as a truly global independent community, addressing relevant health questions from international stakeholders using a range of diverse methods. 

• Register today by clicking here (Cochrane account required)
• Registration fee information
• Registration guidelines and policies

Stipend applications open 20 March 2019

Further information:

• Website: colloquium2019.cochrane.org
• Twitter:  @CochraneChile and #CochraneSantiago

Tuesday, February 12, 2019

Specifications: Full Time - 1-year Fixed Term Contract
Salary: up to £30,000 DOE
Location: London
Application Closing Date: 15th February 2019

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

The Project Coordinator will provide effective and efficient co-ordination, administrative and project support to projects within the Central Executive Team focusing in 2019 on Publishing.

Publishing Management Support:

• Co-ordinate meetings and support for Publishing Management and Cochrane Library Roadmap planning meetings including: production and dissemination of agendas and supporting papers; minutes and action items follow up to agreed timelines.

Project Support:

• Scheduling and booking project meetings
• Supporting meetings as required including co-ordinating agendas, taking minutes, recording action items and circulating paperwork.
  
• Managing project folders and documentation in Dropbox and Confluence.
  
• Assisting in monitoring and reporting of project tasks and following up action items to ensure they are completed to agreed timelines.
  
• To liaise effectively with project team members and external stakeholders as required
  
• Provide back up support to the admin team within the CET
• Undertake any other duties considered appropriate to the role

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:

• Previous experience within project / programme environment or equivalent
  
• Understanding of principles and methods for coordination of multiple projects
  
• Ability and confidence to problem solve and use initiative in a complex project environment
  
• IT literate - for a variety of tasks including Excel, word, power point
  
• Proven ability to deliver in a timely and professional manner
  
• Excellent communication skills; verbal, written and presentation
  
• Ability to prioritise and manage own workload amid conflicting demands and during busy work periods
  
• Excellent interpersonal skills
  
• Ability to communicate confidently with a range of diverse contacts at all levels
  
• Proven ability to work under pressure and to tight deadlines
  
• Ability to exercise discretion and diplomacy in dealing with confidential or sensitive matters
  
• Attention to detail/accuracy
• Adaptability

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

For further information, please download the full job description.

Deadline for applications: 15th February 2019 (12 midnight GMT)
 
Interviews to be held on: (TBC)

Friday, February 1, 2019 Category: Jobs

Specifications: Full Time
Salary: Competitive
Location: London
Application Closing Date: 1st March 2019

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

The Human Resources Manager will lead and manage a high quality, responsive, efficient and effective Human Resources function for Cochrane and its subsidiaries.

Key areas:

• Recruitment and on-boarding
• Talent attraction and management
• Employee Relations
• People Relations for secondment and consultancy contracts
• Learning and Development
• Monitoring and managing HR data
• Reviewing and implementing policies across the organisation
• Reviewing and overseeing the HR appraisals process
• Maintain effective and supportive relationships throughout the organisation
• Promote equality and diversity as part of the culture of the organisation

Stakeholder Management and Support - External

• Develop and maintain effective relationships with business advisers including overseas HR/payroll support in Denmark and Germany; UK payroll bureau; out-sourced training providers
• Maintain and manage relationships with pension provider Royal London; childcare voucher and cycle to work scheme providers
  
• Build and manage relationships with host institutions for secondment contracts

Stakeholder Management and Support – Internal

• Ensure high levels of service to staff, consultants and other Cochrane employees are maintained across the Central Executive Team
• Provide and review monthly HR dashboard with Heads of Department
  
• Ensure people-related contracts are regularly monitored and reviewed
  
• Provide proactive HR guidance and support across the organisation, (including Cochrane Groups) as required.

Other

• Lead in the roll out of any new HR processes or other organisational infrastructure change and revise reporting to include this new data or support the changes to workflows
  
• Support the development of the HR function, implementing standard operating procedures alongside improvements to controls making full use of IT and automation of processes wherever possible.
  
• Assist the Finance team/budget holders with any people-related information required for monthly reporting, annual plan and budget or annual audit
  
• Ensure all HR policies and procedures comply with legal requirements and best practice and written up in easy to follow accessible formats, providing training and guidance where necessary
  
• To conduct and advise on training needs analysis for individual staff and teams
  
• To design and deliver workshops and training as required
  
• Mentor, manage and support the HR Business Partner and HR Assistant
  
• Undertake any other duties considered appropriate    

Essential

• CIPD qualification equivalent to Level 7
  
• Demonstrable experience of leading a fully operational HR service comprising generalist advice, payroll, benefits, learning & development and change management
  
• Experience of scoping and implementing HRIS systems
  
• Ability to work in a dynamic, fast-paced environment, adapting quickly to rapidly changing situations
  
• Up to date working knowledge of employment legislation.
  
• Experience of coaching and supporting managers
  
• Experience of designing and managing training and development programmes
  
• Self-confidence, personal credibility and the ability to support and challenge others appropriately
  
• Good understanding of and the ability to apply the principles of confidentiality
  
• Intermediate level IT skills, including Word, Excel, PowerPoint and Outlook.
  
• Ability to prioritise and manage own workload.
  
• Proven ability to work both independently and productively as part of a team
  
• Excellent interpersonal skills.
  
• Excellent communication skills, both verbal and written.
  
• Good understanding and application of the principles of Equal Opportunities in a HR context
  
• Excellent attention to detail
  
• Pragmatism and problem-solving skills and the ability to think creatively when faced with new problems
  
• Commitment to Cochrane’s mission and values.

Desirable

• Up to date working knowledge of employment legislation in Denmark and/or Germany
  Overseas payroll /contract experience
  
• Experience of HR support in an International context supporting remote working
  
• Experience of healthcare charity sector.

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 “Human Resources 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.

Deadline for applications: 1st March 2019 (12 midnight GMT)
 
Interviews to be held on: (TBC)

Friday, February 1, 2019 Category: Jobs

In North America and elsewhere, February is  marked as 'Heart Month' - a time to bring attention to the importance of cardiovascular health, and what we can to reduce our risk of cardiovascular disease.

The Cochrane Heart Group was established in 1998. Its  aim is to prepare, maintain and promote the access of systematic reviews of the effect of interventions for treating ischaemic and all other heart diseases and preventing cardiovascular diseases. They have over 30 editors and nearly 1,000 authors. Their wide membership includes clinicians, researchers, and healthcare consumers who share an interest in generating reliable, up-to-date evidence relevant to the prevention, treatment and rehabilitation of particular heart problems.

To celebrate Heart Month, we have collated a selection of some recent featured Cochrane Reviews:

• New Cochrane health evidence challenges belief that omega 3 supplements reduce risk of heart disease, stroke or death.
• Adrenaline and vasopressin for cardiac arrest.
• Promoting patient utilisation of cardiac rehabilitation

The Cochrane Consumer Network describes the importance of including people who access health services in the work that Cochrane does.  As someone with experience of heart disease, Cochrane Heart would welcome your perspective and input at all stages of the review process.

Perhaps you could help select new topics for reviews, or check that review protocols contain outcomes of relevance to patients and their families?  All Cochrane reviews have Plain Language Summaries for a wider audience, and your input here would be really valuable in helping to get the review’s message across to everyone.

If this sounds like something you’d like to get involved with, please visit the Cochrane Heart website and contact cochrane.heart@ucl.ac.uk for further information.

Friday, February 1, 2019

‘Cochrane exists so that healthcare decisions get better.’ That is the first sentence of our Strategy to 2020. We want individuals around the world to enjoy ‘Better Health’ because high-quality, relevant, accessible Cochrane evidence is changing decision making and improving health outcomes. Every Cochrane collaborator volunteering their time and expertise, every Cochrane Group and Central Executive Team staff member devoting part or all of their working lives, are energised and devoted to this mission: it is the fuel that drives us, the motivation that sustains and binds us together.

It’s worth reminding ourselves of the power of this shared mission given the criticism of Cochrane in recent months, from both inside and outside the organization, to ask at the beginning of a new year: ‘If that’s what we’re for, how are we doing?’ The answer - despite what you may have been hearing – is that we are meeting this mission in an extraordinary way.

We’re a knowledge organization built on the capabilities and passion of our collaborators; and the good news is that people from around the world are flocking to contribute and support our work. Last year 20,000 new members and supporters signed up to ‘Join Cochrane’! Our new membership scheme is an important driver of this growth, but Cochrane Crowd, Task Exchange and other ways for new collaborators to contribute to our work are helping to generate it. Just before Strategy to 2020 began 31,800 collaborators were registered on our Archie database, but a significant proportion of them had not been involved in the organization for many years. At the beginning of 2019 Cochrane has over 13,000 members and an additional 52,000 supporters who have actively signed up to help or support us. The new series highlighting ’30 under 30’ Cochrane researchers and contributors shows just a few of the dynamic, brilliant young people newly involved in our work. And they come from all over the world, with our geographic network now spanning 43 countries, with 17 more Centres, Associate Centres and Affiliates established since 2013 (and many more to come with the development this year of new Cochrane Networks in the US and China).

Even more importantly, the number of people accessing and using Cochrane evidence through the Cochrane Library and our Cochrane.org website is rising spectacularly. In 2013 there were 4.2 million-page views of Cochrane Review Summaries on Cochrane.org; by 2018 this had increased to 37 million page-views and nearly 28 million visits to our website. Twenty million of those page views (54%) were by people using non-English language browsers (compared to only 6% in 2013). This is a reflection of the outstanding work of Cochrane’s translation teams over the last five years, and we now offer nearly 26,000 abstracts and Plain-Language Summaries of Cochrane Reviews in 15 languages. The increase in visits to Cochrane.org has also accelerated dramatically in recent years (up 85% in 2018 from the year before) as we become easier to find through Google and other searches, and easier to use through improvements to the website.

In 2017 there were 12.5 million full text downloads of Cochrane Reviews from the Cochrane Library (compared with 7.4 million downloads in 2013). The launch in August 2018 of an enhanced Cochrane Library that now integrates Biblioteca Cochrane Plus (BCP) and therefore includes a full Spanish-language capability (with the chance to add other languages in future) means we expect Review access and download figures to rise significantly in the coming year – beyond the old total of the Library plus BCP users.

This growth in usage is principally because people are finding and trusting the Cochrane evidence that we produce. Although the number of new Cochrane Reviews published in 2018 was down (from 406 in 2017 to 341) the mean number of included studies in each Review went up from 13.1 to 16.9 between 2016 and 2018; 95% of Reviews now contain Summary of Findings tables; annual citations of Cochrane Reviews rose 56% between 2013 (39,856) and 2017 (62,332); and the Cochrane Library’s Impact Factor increased 13.7% between 2013 and 2017 to 6.74: proxy indicators showing that the quality of our Reviews is rising.

Every new Cochrane Review Group Network now has its own strategic and prioritization plan to ensure that Cochrane increasingly answers the questions key audiences (clinicians, policymakers, patients and researchers) want us to address. Every year, between 70-80% of all guidelines published by the WHO cite Cochrane evidence; and it has just been announced that the Cochrane Database of Systematic Reviews is the most cited health-related journal in Wikipedia, where more people get their health information from than anywhere else. Our Knowledge Translation efforts are now being organized so that collectively we take Cochrane evidence into health decision making ‘moments’ on a scope and scale that we have never achieved before.

More people around the world also have free access to Cochrane Reviews (including 3.66 billion people who can access the whole Cochrane Library in low- and middle-income countries), and 60% of all Cochrane Reviews in the Library are now available to everyone, everywhere as a result of our Strategy to 2020 Open Access policy (0.6% in 2013). More people and institutions are also buying the Cochrane Library because of its value to them: sales have increased from £6.35 million in 2012 to a record £10.68 million in 2018, with Cochrane’s annual income rising from £3 million to a projected £8.3 million in that time. That means Cochrane can continue to afford the large investments required to achieve Strategy to 2020’s ambitious objectives; whilst at the same time having built up our financial reserves (from £3 million in 2013 to approximately £6.9 million at the end of 2018) to protect us against the uncertainties of the coming years.

In responding to the recent criticism of Cochrane, its strategy and leadership, David Tovey, Cochrane’s Editor in Chief, pointed out: ‘by all objective measures, Cochrane is thriving’. As the evidence above shows: it is! Over the last five years Cochrane has delivered quite remarkable increases in the quality and reach of our evidence, and in our organizational growth and impact – precisely the aims of our Strategy to 2020. And every day brings exciting news of more outstanding work accomplished by our members and supporters, only the latest being the celebrations from the hard-working team who have just completed Cochrane’s updated Methods Handbook! I’m immensely proud of these achievements, delivered through the inspirational hard work and creativity of an extraordinary community of Cochrane collaborators around the world. I hope you are, too.

Last week, Cochrane’s Governing Board held a very successful meeting in London following the election of four new members in December; recommitting the organization to the Goals and Objectives in Strategy to 2020 and approving a 2019 Plan & Budget. We will be providing more details on the 2019 Plan in the next week but see below for some of its exciting highlights. There are also many other initiatives, including priorities for the coming months identified by the Board and the Cochrane Council, involving Cochrane Groups and contributors from across our diverse organisation, supported by the Central Executive Team, that will help Cochrane collaborators to do their work and help all of us work more effectively together.

Strategy to 2020 is only a piece of paper. What it represents, much more fundamentally and importantly, is a statement and an ambition by Cochrane and all of its members and supporters to be better at what we do; helping us to get closer to our collective mission of improving the health and lives of millions more people around the world. Looking back shows us how far we’ve come since 2013, energising us to continue to do more and better in the years ahead.

 

Cochrane in 2019: some highlightsGoal 1: Producing evidence

• Continuing development of Cochrane’s Systematic Review-producing Groups and Processes, through the development of the Review Group Networks and implementation of the CRG Transformation Programme.
• Implementation and ongoing development of Cochrane’s new Content Strategy, including:
  • Implementing the Risk of Bias 2 tool (ROB2);
  • Scaling up Cochrane’s ‘Living Systematic Reviews’;
  • Developing standards and scaling up our Network Meta-analysis (NMA);
  • Deciding whether to progress work on developing Rapid Reviews
  • Exploring the use of Clinical Study Reports as source data for drug intervention reviews.
• Assuring the quality and consistency of Cochrane’s editorial process, by:
  • Developing an editorial charter that describes agreed expectations across Review Group Networks and CRGs to assure the equity and consistently high quality of editorial processes; and
  • Developing and implementing an agreed quality assurance process for high-profile reviews.
• Revising and completing Cochrane’s Conflict of Interest policy (including financial and non-financial conflicts) and Scientific Misconduct policy.

Goal 2: Making our evidence accessible

• Making Cochrane Reviews more accessible to decision makers, by:
  • Developing a prioritised and costed list of potential changes to the structure and format of Cochrane Reviews with a proposed development and implementation plan to be undertaken over the course of three years.
• Reviewing Cochrane’s Open Access and Open Data approaches.

Goal 3: Advocating for evidence

• Continuing to deliver more features and enhancements in the Cochrane Library, with a focus on continuing to improve the discoverability, accessibility, usability and impact of our content.
  • Projects to be delivered in 2019 include PICO based search, RoB2, Living Systematic Reviews and the integration of Health Systems Evidence.
• Influencing health policy makers to use Cochrane evidence and new advocacy initiatives, by:
  • Strengthening Cochrane’s capacity to support policy-makers and health policy managers in their uptake and use of Cochrane evidence applicable to their language and context;
  • Advocating for evidence-informed health care and the uptake of synthesized research evidence in health policy making and service planning.

Goal 4: Building an effective and sustainable organization

• Building capacity in the Cochrane Community to produce more complex reviews and undertake knowledge translation activities to increase the impact of our evidence.
• Evaluating, planning and beginning implementation of an improved Editorial Management System for Cochrane Review production, carried out in consultation with key Cochrane community stakeholder groups.
• Strengthening Cochrane as a global organization, through a series of initiatives including:
  • Establishing new Cochrane Networks in the US and China to extend Cochrane’s global reach and facilitate the accessibility, use and uptake of Cochrane evidence in practice;
  • Promoting diverse participation within our organization;
  • Expanding equity in the content and accessibility of our work;
  • Supporting the next generation of Cochrane Contributors.

Thursday, January 31, 2019

Cochrane reviewers from Canada, the UK and Brazil came together to assess how to get more patients using cardiac rehabilitation programmes, which aid recovery from cardiac events such as heart attack, coronary stent placement, and bypass surgery, and reduce the likelihood of further illness. 

Cardiac rehabilitation programmes offer the following to patients: exercise, education, risk factor management, and psychological counselling/support. Despite the benefits of cardiac rehabilitation, not everyone enrolls, and, of those who do, many people do not adhere to and complete the programme. This review evaluated trials of strategies to promote cardiac rehabilitation utilisation, namely enrolment, adherence, and completion.

The review team found 26 trials (5,299 participants) that were suitable for inclusion, with these trials evaluating a variety of techniques to improve utilisation, such as: 

• Peer support
• Starting cardiac rehabilitation early after hospital
• Educating patients
• Offering cardiac rehabilitation outside a hospital setting
• Offering shorter programmes
• Women-only programmes

Cochrane author Professor Sherry L Grace from York University and the University Health Network in Canada said, “International clinical practice guidelines routinely recommend that cardiac patients participate in rehabilitation programmes for comprehensive secondary prevention. However, only a small proportion of patients use these programmes. 

“The review findings show strategies to increase enrolment are effective, particularly those that target healthcare providers, training nurses, or allied healthcare providers to intervene face-to-face. Interventions to increase adherence to programmes are also effective, particularly where they are delivered remotely, such as through a smartphone. Interventions to increase programme completion are also effective, but it remains unclear which specific strategies work."

The review also focused on patient groups that are less well-represented in cardiac rehab. “There was insufficient evidence for quantitative assessment of whether women-tailored programmes were associated with increased use, but future trials should test the impact of motivational, women-only programs. For older participants, qualitative analysis suggested that peer support or post-discharge visits may improve enrolment, and group sessions promoting self-regulation skills may increase completion.”

• Read the full Cochrane Review review
• Find out more about the Cochrane Heart Group

Friday, February 1, 2019

New evidence published in the Cochrane Library today provides strong evidence that falls in people over sixty-years old can be prevented by exercise programmes.

Falls are a leading cause of accidental or unintentional injury deaths worldwide. Older adults suffer the greatest number of fatal falls and over 37 million falls are severe enough to require medical attention each year.

A new Cochrane Review produced by a team comprising researchers from the University of Sydney in Australia and University of Oxford, UK, summarizes the results from 108 randomized controlled trials with 23,407 participants from across 25 countries. The average age of the participants in the studies was 76 years old and three quarters of them were women. Eighty-one of these trials compared exercise (all types) versus a control intervention (doing no exercise or minimal gentle exercise that is not thought to reduce falls) in people living independently at home, in retirement villages, or in sheltered accommodation.

The review looked at two different ways of measuring falls. Firstly, they found that exercise reduces the number of falls over time by around a quarter (23% reduction). This means that if there were 850 falls among 1000 older people doing no fall-preventive exercise during one year, there would be 195 fewer falls among  people who were undertaking fall-prevention exercise. They also found that exercise reduces the number of people experiencing one or more falls (number of fallers) by around a sixth (15% reduction). For example, if 480 out of 1000 people experienced one or more falls over one year, participating in exercise programmes would reduce the number of fallers by 72 people.

The review found that exercise programmes carried out in group classes or done at home prescribed by a health professional (such as a physiotherapist) or a trained exercise leader were effective. Exercises were mostly done while standing as this better enhances balance and the ability to do daily activities such as standing up from a low chair or climbing stairs. Some effective exercise programmes also used weights to make the exercises harder.

The results of the studies varied so the researchers assessed different types of exercise programmes to see how they compared. There is high certainty evidence that programmes that mainly involve balance and functional exercises reduce falls, while there was less certainty about programmes that include multiple exercise categories (most commonly balance and functional exercises plus resistance exercises). Tai Chi may also prevent falls but there is uncertain evidence on the effectiveness of resistance exercises (without balance and functional exercises) including dance or walking.

The certainty of the evidence for the overall effect of exercise on preventing falls was high. However, the findings that exercise reduces fractures and the need for medical attention are less certain, reflecting in part the relatively small number of studies and participants for those outcomes.

The reporting of the side effects of exercise in the trials was limited but when side effects were reported they were usually not serious, such as joint or muscle pain; however, one trial reported a pelvic stress fracture.

Author, Professor Cathie Sherrington from The University of Sydney, Institute for Musculoskeletal Health said: “This evidence helps build an even stronger picture that exercise can help prevent older people having falls. It also illustrates which types of exercise can be beneficial. It is well known that keeping active promotes good health but this review pinpoints which types of exercise are more likely to be effective for preventing falls.”

“More work is needed to establish the impact of exercise on fall-related fractures and falls requiring medical attention because such falls have major impacts for the individual and are particularly costly to health systems. Further research is also required to establish the effectiveness of fall prevention programmes in emerging economies where the burden of falls is increasing more rapidly than in developed countries due to rapidly ageing populations.”

This Cochrane Review was supported by the Cochrane Bone, Joint and Muscle Trauma Group, based at the University of Manchester UK, and Cochrane’s Acute and Emergency Care Network. This project was partly funded by the National Institute for Health Research (NIHR) via Cochrane Infrastructure funding to the Cochrane Group. Additional funding for the review was via the National Institute for Health Research (UK): NIHR Cochrane Reviews of NICE Priority scheme, project reference: NIHR127512. The views and opinions expressed therein are those of the authors and do not necessarily reflect those of the Systematic Reviews Programme, NIHR, NHS or the Department of Health. Australian National Health and Medical Research Council Fellowships provided salary funding for several of the authors.

• Read the full Cochrane Review
  
• Read two previous Cochrane reviews published on this subject:  Gillespie 2012 and Hopewell 2018.

Full Citation: Sherrington C, Fairhall NJ, Wallbank GK, Tiedemann A, Michaleff ZA, Howard K, Clemson L, Hopewell S, Lamb SE. Exercise for preventing falls in older people living in the community. Cochrane Database of Systematic Reviews 2019 , Issue 1 . Art. No.: CD012424. DOI: 10.1002/14651858.CD012424.pub2

Thursday, January 31, 2019

After leading Cochrane Germany for over 20 years, Professor Gerd Antes has stepped down as Director.

Gerd has focused his career on contributing to evidence-based medicine in Germany. While working on developing Cochrane Germany, he was also one of the founders of the German Network for Evidence Based Medicine. A recurrent theme during all these years was his work and advocacy for increasing public access to research results. He campaigned for ensuring clinical trial results are published in a timely manner and emphasized the challenges of non-publishing for the provision of non-biased high-quality synthesized evidence. He also was a strong advocate for making evidence available in other languages than English. And, in addition to language translation, Gerd’s work included the transfer of knowledge in commonly understood (lay) language. He worked with the media in making complex methodology understandable for patients, students and lay persons. One of the products of this work is the German version of the Testing Treatments website: Wo ist der Beweis? Cochrane Germany also became an active contributor to translations into German language (jointly with Cochrane Austria and Cochrane Switzerland), demonstrated by Cochrane Kompakt and the blog Wissen was Wirkt.

Cochrane’s Chief Executive Officer, Mark Wilson, said: ‘I would sincerely like to thank Gerd for his outstanding contributions to Cochrane’s work over the last two decades. Cochrane Germany was one of the first Cochrane Centres to be established in 1998 and under Gerd’s leadership its impact on informing the debates about evidence-based medicine in Germany and beyond has been formidable. Gerd’s commitment and persistence to the cause of ensuring all have access to the best available evidence is truly commendable. On behalf of all of your Cochrane colleagues and friends, we thank you, Gerd, and wish you every success and happiness for the future.”

 

 

Cochrane Germany will be led under the new Directorship of Prof Joerg Meerpohl, supported by Michael Graf managing Director of the Cochrane Germany Foundation. Joerg holds the Cochrane professorship for Evidence in Medicine at the University of Freiburg and directs the Institute for Evidence in Medicine, Medical Center – University of Freiburg.

• Visit the Cochrane Germany website

 

Wednesday, January 30, 2019