Specifications: Maximum of 0.2 FTE
Salary: Competitive
Location: Flexible
Contract: 2 years
Application Closing Date: 15 August 2018

Context
In 2017 Cochrane created eight new Networks of Cochrane Review Groups (CRGs) responsible for the efficient and timely production of high quality systematic reviews that address the research questions that are most important to decision makers. The creation of these thematic Networks provided an exciting opportunity for experts in the field to join Cochrane’s new editorial leadership and help the organization deliver its Strategy to 2020 objectives.

Cochrane is now seeking a high-performing Senior Editor to lead the Cochrane Children and Families Network.

Accountability and Responsibility
The Senior Editor is accountable to Cochrane’s Editor in Chief. Upon her/his appointment, the Senior Editor will join the Editorial Board for the Cochrane Library. The Editorial Board will be responsible for supporting the EiC and overseeing development and implementation of editorial strategy, in particular the review production process for Cochrane Reviews, and also monitoring the performance of the Cochrane Library. 

Within her/his Network, working with CRG teams and the Associate Editor, the Senior Editor’s main responsibilities are both strategic and operational:

• Ensure that the reviews produced and published by the CRGs within the Network are of high quality and meet Cochrane’s standards.
• Identify gaps in scope coverage based on (at a minimum) the global burden of diseases, and lead and support prioritization processes within the Network.
• Lead and support the identification of shared priorities within the Network.
• Support communication between the Network and Cochrane community.
• Support innovation in the production of Cochrane systematic reviews and their end use.

Each Senior Editor will be responsible for one Network.

Person specification
The Senior Editor will possess the seniority and experience that enables her/him to fulfil their roles, preferably with the expertise relevant to an organization such as Cochrane, operating as a not-for-profit charity in the research and publishing sectors.

The Senior Editor should also have experience and expertise in key areas of systematic review production, and in addition should be able to demonstrate:

• Sensitivity, openness and awareness of non-verbal communication;
• Critical thinking, creativity and strategic awareness;
• An ability to identify potential problems and deal with risk;
• Cross-cultural sensitivity and an awareness of issues of equity.

Essential attributes:

• Leadership and strategy skills and experience
• Skills and knowledge in basic and advanced systematic review methods
• Recent experience of conducting and leading high-quality systematic reviews (Cochrane Reviews desirable)
• Advanced communication, influencing, and negotiation skills
• Advanced problem solving and time management skills
• Strong commitment to Cochrane’s Strategy to 2020, and the importance of high quality, relevant systematic reviews that impact on health care and policy
• Ability to support and lead innovation
• Ability to commit to being available for one day per week for a three-year period

Desirable attributes:

• Relevant content expertise
• Past or present experience of being a Co-ordinating Editor of a high performing CRG
• Past or present experience of editing systematic reviews

Resources
The Senior Editor will receive funding from Cochrane to support their work – scaled at about one day per week of activity.

Senior Editors will be able to draw on support from the Associate Editor allocated to their Network, and from a Methods Support Team. Cochrane’s Central Executive Team (CET) will also seek internal and external opportunities for attracting resources for additional support to the Network.

Term of appointment
The Senior Editor will be appointed in September 2018. They will serve as members of Cochrane’s Editorial Board for a period of three years, renewable.

Co-ordinating Editors who wish to apply for a Senior Editor’s position within a Network that consists of their CRG, should be prepared to step down from that role for the duration of their appointment.

Recruitment process
This position is open to anyone who meets the requirements described above.

All applications will be reviewed by the Editor in Chief and the Deputy Editor in Chief, who will jointly make the appointment.

We are open to job share applications that describe how the functions will be divided, and how continuity will be achieved. We would also welcome applications from candidates wishing to undertake this role as a part-time secondment from their employer.

The appointment process will consider the need for all aspects of diversity, including those of gender, age, experience, language and geographical location. Cochrane’s Editor in Chief aims to appoint a balanced Editorial Board that includes Senior Editors who possess a wide range of content and methodological expertise.

To apply please send a letter, Curriculum Vitae, and letter of support to recruitment@cochrane.org by 15 August 2018.

For further information, please download the full job description.

Deadline for applications: (12 midnight GMT)

Interviews to be held on: (TBC)

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

Wednesday, August 1, 2018 Category: Jobs

Cochrane Pain, Palliative and Supportive Care  (PaPaS)  group addresses the gap in knowledge on chronic  pain in childhood and helps push solutions forward.

On July 12th at the Wellcome Trust in London, UK,  world-leading experts came together to look at evidence, policy and practice in the area of childhood pain.

Clinicians, researchers, funders and policy makers from charities, universities and hospitals discussed the lack of knowledge in this area and shared their collective ambition to increase the quality of evidence in this field.

Professor Christopher Eccleston, Coordinating Editor of the Cochrane Pain, Palliative and Supportive (PaPaS)  Review Group, who initiated the event explained, “Four years ago the Cochrane PaPaS Group promised a programme of systematic reviews on the evidence for interventions for adults with chronic pain (both neuropathic and cancer related) and children with chronic pain. The work was supported by the NIHR. We produced 49 systematic reviews in a three year period, 10 of which for children and adolescents with chronic pain. The principal finding from these ten reviews was a distinct lack of evidence,  with too few trials in this area. The lack of research in this important field is so striking that we wanted to gather a group of influencers together fast  to address this gap in knowledge and think creatively about what the solutions could be.”

Presentations were shared on pain in babies, pharmalogical treatments in chronic pain, pharmalogical treatments for disease related pain and psychological treatments for chronic pain followed by discussions which highlighted the lack of large, high quality trials in this area.

 Group discussions reflected;

• clinical concerns about how pain is identified and measured in children and how adult measures don’t work for children
• how cost effectiveness is used as evidence for decision-making in the absence of other knowledge
• the lack of interest in researching old drugs
• personalised medicine and how this effects creation of systematic reviews
• the suitability of longitudinal studies for this age group (but the challenge of including them in systematic reviews.) 
• how social media feeds a desire for immediate solutions and responses, but smart phones offer an opportunity to collect data differently 

The initiative led by the Cochrane PaPaS Group was funded by NIHR and backed by partners including the European Pain Federation, Wellcome Trust, and Arthritis Research UK. 

Co-organiser Systematic reviewer and editorial assistant Dr Emma Fisher from the PaPaS Group, explained, “All the attendees are working in some way to mitigate the lack of data in this field, for some it is a daily challenge - treating young patients, knowing they can’t help them as much as they would like. This is a springboard and just the beginning. As an academic collective we have to focus on taking our recommendations forward.” 

Following the event, Cochrane PaPaS are considering next steps, this might be a prioritization series for a journal, or a commentary style piece. They are also hoping to see more funding coming into this area and to continue to advocate for more and better research into chronic pain in children.

• Visit the  Cochrane Pain, Palliative and Supportive Care Review  (PaPaS) website

Thursday, August 2, 2018

After 20 years of stellar contributions to Cochrane, Elaine Beller is shifting her keen focus from biostatistics to bushwalking, and embracing semi-retirement. Last week we caught up with Elaine on the road from outback Birdsville – a leisurely 27 hour drive from her home on Queensland’s Sunshine Coast. Though never one to seek the limelight, she was (after a little encouragement) happy to share some parting thoughts about her time as a prolific and multi-talented Cochrane contributor.  

Elaine Beller is widely recognised as having an amazing ability to analyse and explain the most complex of matters and methods - be it through her writing, research, teaching, statistical consulting or training materials. An Associate Professor of Biostatistics at Bond University, she’s worked as a biostatistician for some of Australia’s largest randomised clinical trials (RCTs). Through her research work, she has looked at improving the conduct, analysis and use of RCTs across cardiology, nephrology, oncology and orthopaedics. Add to that over 100 peer-reviewed papers and a host of workshops and training resources on clinical trials methods, systematic reviews and epidemiology, and you have a fraction of her distinguished career outside of the world of Cochrane.

Inside Cochrane, her contributions are similarly substantial. Elaine has been an author and statistician for 11 Cochrane Groups, and is a long-time member of both the Trainers Network and Statistical Methods Group among others. For the past three years she has been the Deputy Co-ordinating Editor of Cochrane Kidney and Transplant (CKT) and also worked closely with Acute Respiratory Infections (ARI) at Bond. With such an expert guiding hand in so many groups, projects and reviews, Elaine’s departure represents a significant loss of knowledge, skills and trademark good humour for her many colleagues and friends across the organisation. 

‘I’ve really enjoyed the variety of working for so many different groups and getting to know different disease areas in detail,’ Elaine says. ‘It’s been a difficult decision to step back from my Cochrane commitments but it’s time to spend more concentrated blocks of time on other things. Workwise I’ll still be at Bond developing a new Masters in Evidence Based Practice, supervising my PhD students and getting around to publishing a few unfinished papers. But I’ll also be able to travel a bit more and get to a few more of the folk festivals I’d love to see in different parts of Australia.’  

Looking back rather than forward, Elaine was what you might now call an early-adopter when it comes to all things Cochrane. ‘I first heard about systematic reviews when Dave Sackett visited Australia in the late ‘80s,’ she says. ‘He was such an amazing guy and I was fascinated by his ideas. We started looking at systematic reviews in our journal club at the Clinical Trials Centre at Sydney Uni and got to know about Cochrane reviews through that. Before long people started consulting me about the analysis of systematic reviews and it all evolved from there.’ 

In 2009 Elaine headed to Oxford for a sabbatical at the UK Cochrane Centre and the Centre for Statistics in Medicine, where she had the opportunity to pursue methodological research with Doug Altman. ‘I remember being so nervous the first time I was going to meet ‘The Great Doug Altman’, as I’d heard so much about him,’ Elaine laughs. ‘But of course Doug was just so humble and laid back. He was instrumental in getting me into the quality and methodological side of reviews more so than just statistical consulting, so he really changed the course of my career. I was quite devastated when he passed away recently.’

Elaine’s work with Doug sparked an ongoing interest in looking at and improving the way systematic reviews are written up. She returned to Australia from Oxford to join long-time colleague Paul Glasziou at the Centre for Research in Evidence Based Research at Bond University, and a conversation between the two about several confusing abstracts prompted them to publish a call to arms in JAMA in 2011. In it, they argued abstracts should include the main results in both numbers and words, and that the interpretation of results shouldn’t require statistical knowledge. 

‘That was our first methodological paper on abstracts and a lot of interesting work then arose out of that – including the PRISMA for Abstracts checklist that now gives authors a framework and guidance to present systematic reviews in a way that meets the needs of different readers. There’s still a long way to go, but we have seen some progress in the overall quality of abstracts – particularly Cochrane abstracts. I do think we should just have one abstract rather than a technical and a plain English abstract. The problem is that authors often assume readers have the necessary technical knowledge to understand what are often badly written technical abstracts, but as the research consistently shows even experienced clinicians often don’t understand them. I’m working on another paper in this area so hope to have a little more time to get that published before too long.’

Elaine’s many contributions to this and other important areas have been much valued within Cochrane and beyond, bringing as she does an unusual depth of knowledge across statistics, methods and the written word – areas that few people understand when taken together. Her skills and accessible approach will be greatly missed. Before wrapping up our interview and getting back to the first of many intrepid adventures of semi-retirement, Elaine offered some sage advice for future contributors. 

‘Getting involved in a systematic review as an author is a great thing, but at first just get involved as an author - not as a lead author,’ she concludes. ‘I see a lot of students take on a systematic review as a lead author and really struggle. So I think it’s better to come in as an author with an experienced lead before you take on your own. Overall, I just have to say that Cochrane is an incredible organisation that’s worth belonging to and getting involved with, because what you will learn and take out of it is just amazing.’

Image: Elaine arrives at Machu Picchu after a fantastic four day trek on the Inca Trail in Peru.  
Words: Shauna Hurley, originally posted on Cochrane Australia

Wednesday, August 1, 2018

Cochrane is pleased to announce that the Cochrane Library, which provides high-quality, independently produced evidence to inform healthcare decision-making, has been redesigned and enhanced to improve user experience and functionality.

Cochrane is a global independent network of researchers, professionals, patients, carers, and people interested in health. Cochrane contributors and groups produce high-quality systematic reviews, which collate and summarize the best available evidence on the effects of interventions, to inform decisions about health. Cochrane Reviews are recognized internationally as representing a gold standard for high-quality, trusted information, and are published in the Cochrane Database of Systematic Reviews, one of the databases within the Cochrane Library.

The new online platform, designed in collaboration with Cochrane’s publisher Wiley and built by the technology platform provider HighWire, includes several features that will improve the user experience for people whose preferred language is not English, including improved visibility of non-English content, a new Spanish language homepage, and the ability to search in different languages. The new Cochrane Library also delivers a series of improved design features and functionality and allows users to search across varying content types, including Cochrane Reviews and Protocols, CENTRAL trials reports, Cochrane Clinical Answers, Editorials, Special Collections, and other systematic reviews from Epistemonikos, a collaborative, multilingual database of health evidence.

Cochrane’s Editor in Chief, David Tovey warmly welcomed today’s launch: “I am delighted to see the launch of our newly designed Cochrane Library today. This complex project has been all about improving user experience; we have ambitious plans for future development of the Cochrane Library and these can only be delivered by this move to a new and more flexible platform. With this launch, users will immediately notice a richer experience, but we see this is as merely the start of our journey.”

Wiley’s Editorial Director, Deborah Pentesco-Murphy added: “We are delighted that Wiley are able to offer Cochrane’s gold standard Evidence, including the Cochrane Clinical Answers Database, on a new multi-lingual platform, including a Spanish interface, to serve our global audience of users better and with an improved ability to quickly locate relevant information to make informed health decisions. ”

HighWire CEO, Dan Filby, said, “The Cochrane Library is globally recognized for publishing world leading research. We are proud to deliver a user experience for Cochrane that reflects the high quality of content; improving discoverability to help users in their research.”

• Visit the Cochrane Library
• Learn more about the Cochrane Library and how to use the new site
• Read this Press Release in Spanish

For further information or to arrange an interview, please contact,
Jo Anthony
T +44 207 183 7503
E pressoffice@cochrane.org

About Cochrane Reviews
Cochrane Reviews are systematic reviews of primary research in human health care and health policy, and are internationally recognized as the highest standard in evidence-based health care. Cochrane Systematic Reviews investigate the effects of interventions for disease prevention, treatment, and rehabilitation. They also assess the accuracy of a diagnostic test for a given condition in a specific patient group and setting.  Cochrane Library is published by Wiley.

About Wiley
Wiley, a global research and learning company, helps people and organizations develop the skills and knowledge they need to succeed. Our online scientific, technical, medical, and scholarly journals, combined with our digital learning, assessment and certification solutions help universities, learned societies, businesses, governments and individuals increase the academic and professional impact of their work. For more than 210 years, we have delivered consistent performance to our stakeholders. The company's website can be accessed at www.wiley.com

About HighWire
HighWire is the technology partner of choice for world-leading commercial and academic publishers. With offices globally, HighWire provides digital publishing solutions and platform expertise across all aspects of the publishing life cycle, including content management and hosting, e-commerce, analytics, access and identity management, manuscript submission and tracking. HighWire also delivers strategic consulting services for system and application development, and improving the customer experience.

Wednesday, August 8, 2018

"It is crucial that people have an understanding of what interventions work in what populations so as to make correct clinical and policy practice related decisions.”

An international team, supported by  Cochrane Bone, Joint & Muscle Trauma, assessed whether fall-prevention strategies that target two or more risk factors for falls are effective in preventing falls in older people living in the community.

As people age they are more likely to fall. Although most fall-related injuries are minor, they can cause significant pain and discomfort, affect a person's confidence and lead to a loss of independence. Some falls can cause serious long-term health problems. A combination of factors increases the risk of falls with ageing, such as weak muscles, stiff joints, hearing problems, changes in sight, side effects of medications, tiredness or confusion. Poor lighting, slippery or uneven surfaces, and issues with poor footwear can also increase the risk of falling.

Different interventions have been developed to help prevent falls in older people. They may involve a single type of intervention, such as exercise to increase muscle strength, or combinations of interventions, such as exercise and adjustment of a person's medication. A combination of two or more components can be delivered as either a multifactorial intervention based on an assessment of a person's risk factors for falling or as a multiple component intervention where the same combination of interventions is provided to all participants.

The lead author of the review, Dr Sally Hopewell, explains, "This review is an important update for anyone with an interest in falls in older people. It provides useful information on the benefits and risks associated with both multifactorial and multiple component interventions. The growing use of these more complex types of intervention for preventing falls reflect the theory that multiple risk factors are at play, and that these risk factor profiles vary between people.  It is crucial that people have an understanding of what interventions work in what populations so as to make correct clinical and policy practice related decisions.”

The team identified 43 trials that compared multifactorial interventions with an inactive control group.  They concluded that multifactorial interventions led to some reduction in the rate at which people fall but not the number of people who experienced one or more falls (fallers); however, the quality of the evidence was low.  They identified 17 trials that looked at multiple component interventions and concluded they probably reduce the rate at which people fall and the number of fallers compared with the inactive control group.

The review includes 62 randomised trials involving 19,935 older participants living in the community.

• Read a full copy of the Cochrane Review
• Visit the Cochrane Bone, Joint & Muscle Trauma website

Wednesday, August 1, 2018

Cochrane is pleased to announce plans to establish a new, open and collaborative Network within the US.

An internal review of Cochrane’s structures carried out in 2016 highlighted that a single Center approach for a country the size of the US has many limitations, and that a Network of multiple groups based across the country is a better model to deliver a wider range and expanded scale of Cochrane activities, share collaboration across and between institutions, and create greater impact of that work in diverse regions and different contexts.

There is a sophisticated and well-developed health evidence landscape in the US, and while Cochrane evidence is well known and widely respected, we believe we can do more and better. The Cochrane US Network primary functions will be around ensuring that Cochrane’s evidence is increasingly used in policy and practice inside the US; supporting the Cochrane community of volunteers (authors, methodologists, editors) in the US; and promoting and representing Cochrane in the country.

In the coming months, we will consult widely with a range of stakeholders to develop the strategy and focus of this new Cochrane Network:

This will include:

• An open meeting to be held during the Cochrane Colloquium in Edinburgh, on Tuesday 18th September, from 07.30-08.45;
• A two-day strategic planning meeting (by invitation) to be held on 29th-30th October in Fort Worth, Texas.

Following these consultative meetings, a call for ‘Expressions of Interest’ will be issued that allows institutions in the US to express their interest to become a member of the Cochrane US Network.

The responsibility for leading the establishment of the new Cochrane US Network is being taken by Cochrane’s Chief Executive Office, but the process is advised and fully supported by the existing Cochrane US West Associate Centre based at the Oregon Health & Science University (OHSU, Portland, Oregon), and the consultation meeting in October is to be hosted by the Texas Christian University.

It is expected that a formal launch of Cochrane’s US Network will take place in early 2019.

For more information of Cochrane’s US Network, and sharing suggestions and information that promote Cochrane’s work across the US, please contact Sylvia de Haan, Senior Advisor (Centres, Partnerships and Fundraising), Cochrane.

Additional resources:

• Structures and Functions of Cochrane Geographically oriented structures
• Find out more about Cochrane and how our health evidence can help you 

Thursday, August 2, 2018

Leading institutions, including Cochrane, sign on to international platform which aims to accelerate medical research

The nonprofit organization Vivli launched a novel data-sharing and analytics platform to help researchers move faster toward new treatments and cures. This innovative platform makes it easy for researchers worldwide to discover, share and analyze data from clinical trials, regardless of who sponsored the research or where the research took place.

The Vivli platform launches at a crucial time in the evolution of science. Increasingly, researchers are being required to make their data openly available. New guidelines issued this month by the International Committee of Medical Journal Editors demand that researchers share the data underlying their published results. Government and non-profit research funders are stipulating data-sharing as a condition of their grants. The culture within industry is also shifting to reward more open sharing of data. The Vivli platform boosts these emergent data-sharing efforts by bringing data from all clinical trials together in one place.

“To this day, much of the world’s clinical trial data is not shared, and even when it is shared, it is not integrated across the entire clinical research ecosystem,” said Vivli’s Executive Director Rebecca Li, PhD. “Vivli acts as bridge, enabling researchers of every stripe across the world to build upon each other’s work and speed up science.”

Vivli provides researchers with a secure, easy-to-use online platform to store and share clinical trial data across all diseases, nations and research entities. Vivli also allows researchers to freely combine and analyze data from multiple trials using state of the art tools. This means researchers can validate research findings—from confirming a treatment’s safety to identifying side effects—and avoid duplicative studies, thus reducing costs and shielding research participants from unnecessary risks. The data can also be combined to ask new research questions, such as how a disease evolves over time, and gain information to inform the design of future studies.

Vivli evolved from a project at the Harvard policy center, The Multi-Regional Clinical Trials Center of Brigham and Women’s Hospital to enhance access to clinical trials data. For five years, a group of volunteers embarked on a mission to define, design and launch a global solution for sharing clinical trial data. “Sharing clinical trial data is critical in order to move science forward. We owe nothing less to the people who put themselves at risk by participating in these studies that benefit us all,” said Li.

The Vivli platform was built with grants from the Doris Duke Charitable Foundation, the Laura and John Arnold Foundation and the Leona M. and Harry B. Helmsley Charitable Trust. The platform is powered by Microsoft.

About Vivli

Vivli is a non-profit organization working to advance human health through the insights and discoveries gained by sharing and analyzing data. It is home to an independent global data-sharing and analytics platform which serves all elements of the international research community. The platform includes a data repository, in-depth search engine and cloud-based analytics, and harmonizes governance, policy and processes to make sharing data easier. Vivli acts as a neutral broker between data contributor and data user and the wider data sharing community. For more information, visit www.vivli.org and follow us on Twitter @VivliCenter.

Wednesday, August 1, 2018

Cochrane Wounds is looking for a new Information Specialist to join the team in Manchester, UK.

Apply online. Closing date 14 August 2018.

They are looking for a dynamic and enthusiastic individual with excellent communication skills to support the production of systematic reviews in the field of wound care.

You will be a graduate with a strong health information background. A qualification in librarianship, information science or equivalent experience is essential.

Experience of designing and conducting online literature searches of databases such as MEDLINE, good computer literacy and a sound knowledge of medical terminology and systematic reviews are also essential.

You will have excellent interpersonal, time management and organisational skills and be able to work with considerable autonomy to regular deadlines.

As an equal opportunities employer we welcome applicants from all sections of the community regardless of gender, ethnicity, disability, sexual orientation and transgender status. All appointments are made on merit.

Monday, July 30, 2018 Category: Jobs

Episode 11 - Dr Norman Swan

A familiar voice to millions, Dr Norman Swan is one of the English-speaking world's best known health reporters. This week he’s on the other side of the microphone. Norman joins host Ray Moynihan to talk frankly about medicine and the media. He shares some of the joys and challenges of his work inside and outside of the Australian national broadcaster - including his stint as resident medic on commercial TV show The Biggest Loser and his work founding a private media company that advertises inside health clinics across Australia. A multi-award winning journalist and now popular podcaster with a global audience, the common thread running through Norman Swan's distinguished career is a life-long interest in bringing new ideas, information and evidence to audiences of all kinds.

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

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

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

Friday, July 27, 2018

Music-based therapeutic intervention probably reduces depressive symptoms and improves overall behavioural problems.

This review team from the Netherlands set out to see if they could find evidence that therapy based on music improves the emotional well-being and quality of life of people with dementia. They were also interested in evidence about effects on emotional, behavioural, social or cognitive (e.g. thinking and remembering) problems in people with dementia.

The team found 22 trials to include in the review and were able to combine results for at least some outcomes from 890 people. All of the people in the trials stayed in nursing homes or hospitals. Some trials compared music-based treatments with usual care, and some compared them with other activities, such as cooking or painting. The quality of the trials and how well they were reported varied, and this affected the confidence in the results.

Lead author Jenny van der Steen, explains, "First, we looked at outcomes immediately after a course of therapy ended. From our results, we could be moderately confident that music-based therapy improves symptoms of depression and overall behavioural problems, but not specifically agitated or aggressive behaviour. Music-based therapy may also have little or no effect on cognition, but we were less confident about this result. We were also not that confident about whether the therapy improves anxiety and emotional well-being including quality of life and we had very little confidence in possible beneficial effects on social interaction.

Jenny continues, “Some studies also looked to see whether there were any lasting effects four weeks or more after treatment ended. However, there was little data and we were uncertain or very uncertain about the results. Further trials are likely to have a significant impact on what we know about the effects of music-based treatments for people with dementia, so continuing research is important. We need high-quality research with blinded outcome assessment to not overestimate effects.”

In summary:
Providing people with dementia who are in institutional care with at least five sessions of a music-based therapeutic intervention probably reduces depressive symptoms and improves overall behavioural problems at the end of treatment. It may also improve emotional well-being and quality of life and reduce anxiety, but may have little or no effect on agitation or aggression or on cognition. We are uncertain about effects on social behaviour and about long-term effects. Future studies should examine the duration of effects in relation to the overall duration of treatment and the number of sessions.

•  Read the full Cochrane Review
• Visit the Cochrane Dementia and Cognitive Improvement website
• Read the Evidently Cochrane blogpost 'Bringing harmony to the hospital: music therapies revisited'

Thursday, July 26, 2018

Which treatment can help resolve wax build up?

Build up of ear wax is common. It can be uncomfortable for the patient and can cause hearing problems. Ear drops have been studied as a potential tool to soften the wax, preventing the need for further treatment such as syringing. This new review, produced by a team from the UK and US as part of Cochrane Ear, Nose and Throat,  looks at which treatment (oil- and water-based drops or sprays) can help resolve wax build up.

The review includes 10 studies, with 624 participants (835 ears). Interventions included:

• oil-based treatments (triethanolamine polypeptide, almond oil, benzocaine, chlorobutanol);
• water-based treatments (docusate sodium, carbamide peroxide, phenazone, choline salicylate, urea peroxide, potassium carbonate);
• other active comparators (e.g. saline or water alone) and no treatment.

Key results: Only one study compared using drops with an active ingredient to not using drops at all. The drops may help increase the proportion of ears cleared of wax from 1 in 20 (if you do nothing) to about 1 in 5 (if you use drops).

The authors did not find any evidence that water-based or oil-based drops were any different to saline or water. However, we also did not find any evidence that water or saline were better than doing nothing.

Adverse (side) effects were not common. Fewer than 30 patients reported any adverse events when using the drops and these were mild (such as slight irritation or pain, or unpleasant smell). No serious side effects were reported by any participant.

Quality of the evidence: For wax clearance, we rated the quality of the evidence as low. For adverse effects we rated the quality of the evidence as low.

Professor Martin Burton, joint Co-ordinating Editor of Cochrane ENT said, “Many people use ear drops when they want to soften or remove wax from their ears.  There’s not much high quality, scientific evidence out there to help people decide which to use.  But what there is, suggests that using any sort of drops is better than nothing.  When it comes to the choice of drops, there are various chemical-containing preparations sold over-the-counter for this purpose.  This study shows that they aren’t necessarily any better than plain or salty water.”

• Read the full review
• Visit the Cochrane ENT website

Wednesday, July 25, 2018

The Department of Anesthesiology, Pharmacology & Therapeutics at the University of British Columbia in Canada seeks applications for a full-time Research Associate in the Therapeutics Section.

The successful candidate will lead and conduct a complex systematic review, synthesizing research evidence on the effects of regulatory safety advisories on prescribing, medicine use, and health outcomes. The candidate will also conduct related analyses and contribute tok nowledge translation for multiple projects at the Therapeutics Initiative within the Therapeutics Section of the Department. 

The candidate will hold a graduate degree (Ph.D. preferred) in a health sciences discipline and have a minimum of 5 years of experience conducting systematic reviews.  

• Read more about this job and apply before 15 August.

Wednesday, July 18, 2018 Category: Jobs

New evidence published today shows there is little or no effect of omega 3 supplements on our risk of experiencing heart disease, stroke or death. Below is a round-up for some of the media coverage.

• Fishy findings: Cochrane review finds omega-3 supplements don't help hearts on Scimex
• Omega 3 supplements do not reduce risk of heart disease, stroke, or death, finds review on the bmj
• Omega-3 pills and fish oil ‘useless’ for preventing disease on The Times
•  IT'S OIL A MYTH Omega-3 and fish extracts don’t help your heart health, researchers claim on The Sun
• Fish oil for a healthy heart 'nonsense' on BBC News
• ‘Better spending money on vegetables’ – mega study busts omega-3 heart myth on Irish Examiner
• Taking Omega 3 supplements WON'T cut the risk of early death and may even do some harm on Daily Mail
• Omega-3 no protection against heart attack or strokes, say scientists on The Guardian
• Omega 3 supplements have little or no heart or vascular health benefit on Bioengineer.org
  
• Taking Omega 3 dietary supplements won't reduce the danger of early dying and will even do some hurt on Trending Hits
• Comprehensive study concludes omega-3 fish oil supplements don't reduce risk of heart disease on New Atlas
• How fish oil supplements can CUT levels of good fat on 24H Online News
• Video: Taking Omega 3 supplements WON'T cut the risk of early death and may even do some harm from News Media

• Read the press release
• Read the scientific  expert reaction

Wednesday, July 18, 2018

New evidence published today in the Cochrane Library shows that there is little or no effect of omega 3 supplements on our risk of experiencing heart disease, stroke or death. Below is a Science Media Centre roundup of third-party expert reaction to this review.

Prof Tim Chico, Professor of Cardiovascular Medicine and Honorary Consultant Cardiologist, University of Sheffield, said:

“Although diet plays an important role in preventing heart disease, this is complex and unlikely to relate much to any single element of the diet.  In addition, it is hard to know whether the effects of diet are due directly to what someone actually eats, or other influences such as income.

“Previous experience has shown that although some types of diet are linked to lower risk of heart disease, when we try to identify the beneficial element of the diet and give it as a supplement it generally has little or no benefit.  This was the case for vitamins; we know a diet rich in vitamins is associated with lower risk of heart disease, but studies giving people vitamin pills showed that these gave no benefit and indeed may have caused harm.

“This analysis of many studies shows clearly that omega-3 supplements do not reduce heart disease.  This is in keeping with medical practice; although there was a period where people who had suffered a heart attack were prescribed these on the NHS, this stopped some years ago.  Such supplements come with a significant cost, so my advice to anyone buying them in the hope that they reduce the risk of heart disease, I’d advise them to spend their money on vegetables instead.”

Dr Ian Johnson, Nutrition researcher and Emeritus Fellow, Quadram Institute Bioscience, said:

“This is a high-quality, comprehensive analysis of all the best available evidence from human intervention studies on the supposedly protective effects of omega 3 fatty acids from fish and some plant foods against cardiovascular disease.  The results show little or no evidence for important beneficial effects.  Given the strong evidence from previous epidemiological studies this conclusion is somewhat surprising, but it needs to be taken seriously.  Either the protective effects of oily fish consumption that are observed in populations are due to mechanisms that cannot be reproduced by relatively short-term interventions with purified omega 3 supplements, or perhaps they are caused by other unidentified environmental factors somehow linked to oily fish consumption.”

Prof Tom Sanders, Professor emeritus of Nutrition and Dietetics, King's College London, said:

“The major limitation of this review of randomised controlled trials is that it has been unable to allow for the increased intakes of omega-3 fatty acids over the past 20 years.  This has occurred because the food industry recognised the need to redress the balance between omega-6 and omega-3 fatty acids in oils used in food processing as well as ceasing to partially hydrogenate vegetable oils such as rapeseed and soybean oil, which destroyed alpha linolenic acid.  The increased use of unhydrogenated canola (rapeseed oil) and soybean oil in processed food has resulted in higher intakes of linolenic acid than in the past.

“Most of the trials in this review were in patients with pre-existing cardiovascular disease (CVD), which is a further limitation when extrapolating to the prevention of heart attacks in the general population.  This is important as a substantial proportion of first heart attacks are fatal (it is worth noting that this proportion has fallen greatly in the past twenty years).  Previous observational cohort studies, not looked at here, suggest that omega-3 fatty acids may reduce the risk of sudden cardiac death.  This outcome can only be studied in a primary prevention trial (that is among individuals who have not had a cardiovascular event).

“The data from previous observational cohort studies, which this review doesn’t take into account, suggest a threshold intake where intakes below 1g/d of alpha linolenic acid are associated with increased risk of fatal heart disease.  It follows, therefore, that intakes above this level are unlikely to have any further benefit.  Because a small amount of an essential nutrient is needed, it does not follow that more is always better.

“Fish consumption is more consistently associated with reduced risk of cardiovascular disease, again in previous observational studies.  Oily fish (sardines, mackerel, salmon) are the main source of long-chain omega-3 fatty acids (eicosapentaenoic, docosapentaenoic and docosahexaenoic acid).  These fatty acids are made by marine algae and accumulate in the tissues of fish, particularly oil fish.  These long-chain omega-3 fatty acids have different physiological effects from alpha-linolenic acid (lowering blood pressure, decreasing serum triglycerides and reducing the inflammatory response) but these are only seen clearly at high intakes usually in excess of 3g/d, which is generally much higher than the amounts used in the trials (which is typically 1g/d).  The recent trials show no benefit of omega-3 supplements in patients with cardiovascular disease who are treated with drugs such as statins, aspirin, and blood pressure lowering medication.  However, there may still be a role for omega-3 fatty acids in patients with heart failure, which is still under investigation.  Current dietary guidelines to prevent cardiovascular disease encourage fish consumption (two portions of fish a week of which one should be oily) – that would supply in the range of 0.2-0.4 g/d long-chain omega-3 fatty acids – rather than taking supplements.  This study provides no evidence to suggest that this dietary advice should change.”

• Read the press release
• See the media coverage
  

Declared interests

Prof Tim Chico: “No conflicts.”

Dr Ian Johnson: “Ian Johnson has previously held honorary academic appointments in the medical school at the University of East Anglia.”

Prof Tom Sanders: “Scientific governor of British Nutrition Foundation, Honorary Director of Nutrition HEART UK.”

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Wednesday, July 18, 2018

New evidence published today shows there is little or no effect of omega 3 supplements on our risk of experiencing heart disease, stroke or death.

Omega 3 is a type of fat. Small amounts of omega 3 fats are essential for good health, and they can be found in the food that we eat. The main types of omega 3 fatty acids are; alpha­linolenic acid (ALA), eicosapentaenoic acid (EPA), and docosahexaenoic acid (DHA).  ALA is normally found in fats from plant foods, such as nuts and seeds (walnuts and rapeseed are rich sources). EPA and DHA, collectively called long chain omega 3 fats, are naturally found in fatty fish, such as salmon and fish oils including cod liver oil.

Increased consumption of omega 3 fats is widely promoted globally because of a common belief that that it will protect against heart disease. There is more than one possible mechanism for how they might help prevent heart disease, including reducing blood pressure or reducing cholesterol. Omega 3 fats are readily available as over-the-counter supplements and they are widely bought and used.

A new Cochrane systematic review, published today in the Cochrane Library, combines the results of seventy-nine randomised trials involving 112,059 people. These studies assessed effects of consuming additional omega 3 fat, compared to usual or lower omega 3, on diseases of the heart and circulation. Twenty-five studies were assessed as highly trustworthy because they were well designed and conducted.

The studies recruited men and women, some healthy and others with existing illnesses from North America, Europe, Australia and Asia. Participants were randomly assigned to increase their omega 3 fats or to maintain their usual intake of fat for at least a year. Most studies investigated the impact of giving a long-chain omega 3 supplement in a capsule form and compared it to a dummy pill.  Only a few assessed whole fish intake. Most ALA trials added omega 3 fats to foods such as margarine and gave these enriched foods, or naturally ALA-rich foods such as walnuts, to people in the intervention groups, and usual (non-enriched) foods to other participants.

The Cochrane researchers found that increasing long-chain omega 3 provides little if any benefit on most outcomes that they looked at. They found high certainty evidence that long-chain omega 3 fats had little or no meaningful effect on the risk of death from any cause. The risk of death from any cause was 8.8% in people who had increased their intake of omega 3 fats, compared with 9% in people in the control groups.

They also found that taking more long-chain omega 3 fats (including EPA and DHA), primarily through supplements probably makes little or no difference to risk of cardiovascular events, coronary heart deaths, coronary heart disease events, stroke or heart irregularities. Long-chain omega 3 fats probably did reduce some blood fats, triglycerides and HDL cholesterol. Reducing triglycerides is likely to be protective of heart diseases, but reducing HDL has the opposite effect. The researchers collected information on harms from the studies, but information on bleeding and blood clots was very limited. 

The systematic review suggests that eating more ALA through food or supplements probably has little or no effect on cardiovascular deaths or deaths from any cause. However, eating more ALA probably reduces the risk of heart irregularities from 3.3 to 2.6%. The review team found that reductions in cardiovascular events with ALA were so small that about 1000 people would need to increase consumption of ALA for one of them to benefit. Similar results were found for cardiovascular death. They did not find enough data from the studies to be able to measure the risk of bleeding or blood clots from using ALA.

Increasing long-chain omega 3 or ALA probably does not affect body weight or fatness.

Cochrane lead author, Dr. Lee Hooper from the University of East Anglia, UK said: “We can be confident in the findings of this review which go against the popular belief that long-chain omega 3 supplements protect the heart. This large systematic review included information from many thousands of people over long periods.  Despite all this information, we don’t see protective effects.

“The review provides good evidence that taking long-chain omega 3 (fish oil, EPA or DHA) supplements does not benefit heart health or reduce our risk of stroke or death from any cause.  The most trustworthy studies consistently showed little or no effect of long-chain omega 3 fats on cardiovascular health. On the other hand, while oily fish is a healthy food, it is unclear from the small number of trials whether eating more oily fish is protective of our hearts. 

“This systematic review did find moderate evidence that ALA, found in plant oils (such as rapeseed or canola oil) and nuts (particularly walnuts) may be slightly protective of some diseases of the heart and circulation. However, the effect is very small, 143 people would need to increase their ALA intake to prevent one person developing arrhythmia. One thousand people would need to increase their ALA intake to prevent one person dying of coronary heart disease or experiencing a cardiovascular event.  ALA is an essential fatty acid, an important part of a balanced diet, and increasing intakes may be slightly beneficial for prevention or treatment of cardiovascular disease."

• Read the scientific expert reaction
• See the media coverage

Full citation: Abdelhamid AS, Brown TJ, Brainard JS, Biswas P, Thorpe GC, Moore HJ, Deane KHO, AlAbdulghafoor FK, Summerbell CD, Worthington HV, Song F, Hooper L. Omega 3 fatty acids for the primary and secondary prevention of cardiovascular disease. Cochrane Database of Systematic Reviews 2018, Issue 7. Art. No.: CD003177. DOI: 10.1002/14651858.CD003177.pub3.

For further information and media enquiries, please contact,

Katie Abbotts
Media Officer, Cochrane
M +44(0) 7810 504380
E kabbotts@cochrane.org or pressoffice@cochrane.org

Dr. Lee Hooper
Norwich Medical School
University of East Anglia
Norwich Research Park
Norwich
Norfolk, UK
E l.hooper@uea.ac.uk

About Cochrane
Cochrane is a global independent network of researchers, professionals, patients, carers and people interested in health.
Cochrane produces reviews which study all of the best available evidence generated through research and make it easier to inform decisions about health. These are called systematic reviews.
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If you are a journalist or member of the press and wish to receive news alerts before their online publication or if you wish to arrange an interview with an author, please contact the Cochrane press office: pressoffice@cochrane.org

About UEA
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Wednesday, July 18, 2018

Find out more about what we have planned for the 2018 Colloquium  in Edinburgh

Cochrane UK is delighted to be hosting the 25th Cochrane Colloquium, at the Edinburgh International Conference Centre in Scotland, from 16th to 18th September 2018.

We have given the Colloquium the title ‘Cochrane for all – better evidence for better health decisions’.  This is to emphasize that Cochrane welcomes everyone and recognizes that everything Cochrane does is about and for patients and other health consumers.  The Colloquium in 2018 is an event that is co-designed, co-produced and co-presented with healthcare consumers; an event where everyone’s input is valued equally.

We have been asked about this particular focus. We believe passionately that we all share the same goal: better health for patients, healthcare consumers and the world at large.

The Colloquium will be in Edinburgh, the capital city of Scotland, ‘Auld Reekie’ to the Scots.  With its medieval and classic architecture built on the side of an extinct volcano, and its Castle visible from most corners of the city, Edinburgh is best discovered on foot. Wander the narrow passageways and medieval streets winding down from the Castle to join the New Town, and stroll through the gardens that now flourish where once a moat surrounded the Old Town. If walking isn’t for you, there are bus tours of the sights and the city is well served by public buses and trams. With its blend of old and new, three national art galleries and more bars and restaurants per capita than any other city in the UK, Edinburgh is vibrant and diverse, with much to see and do. If you have a Scottish name, you might even be able to find your clan tartan.

We look forward to welcoming you to Edinburgh!

Martin Burton (Director) and Therese Docherty (Business and Programme Manager)
Cochrane UK

• Cochrane Colloquium website
• Registration
• Plenaries and speakers
• Social events and tours

Friday, July 13, 2018

Find out more about what we have planned for the 2018 Colloquium  in Edinburgh

Cochrane UK is delighted to be hosting the 25th Cochrane Colloquium, at the Edinburgh International Conference Centre in Scotland, from 16th to 18th September 2018.

We have given the Colloquium the title ‘Cochrane for all – better evidence for better health decisions’.  This is to emphasize that Cochrane welcomes everyone and recognizes that everything Cochrane does is about and for patients and other health consumers.  The Colloquium in 2018 is an event that is co-designed, co-produced and co-presented with healthcare consumers; an event where everyone’s input is valued equally.

We have been asked about this particular focus. We believe passionately that we all share the same goal: better health for patients, healthcare consumers and the world at large.

The Colloquium will be in Edinburgh, the capital city of Scotland, ‘Auld Reekie’ to the Scots.  With its medieval and classic architecture built on the side of an extinct volcano, and its Castle visible from most corners of the city, Edinburgh is best discovered on foot. Wander the narrow passageways and medieval streets winding down from the Castle to join the New Town, and stroll through the gardens that now flourish where once a moat surrounded the Old Town. If walking isn’t for you, there are bus tours of the sights and the city is well served by public buses and trams. With its blend of old and new, three national art galleries and more bars and restaurants per capita than any other city in the UK, Edinburgh is vibrant and diverse, with much to see and do. If you have a Scottish name, you might even be able to find your clan tartan.

We look forward to welcoming you to Edinburgh!

Martin Burton (Director) and Therese Docherty (Business and Programme Manager)
Cochrane UK

• Cochrane Colloquium website
• Registration
• Plenaries and speakers
• Social events and tours

Friday, July 13, 2018

Delivery of primary healthcare services by nurses instead of doctors probably leads to similar or better patient health and higher patient satisfaction

Current and anticipated problems such as ageing, increased prevalence of chronic conditions and multi-morbidity, increased emphasis on healthy lifestyle and prevention, and efforts to move care from hospitals to communities encourage countries worldwide to develop new models of primary care delivery. Interest in using nurses to expand the capacity of the primary care workforce to address these problems is increasing. The substitution of trained nurses (such as nurse practitioners, practice nurses, and registered nurses) for doctors is one strategy used to improve access, efficiency, and quality of care. Nurse tasks may include diagnostics, treatment, referral to other services, health promotion, management of chronic diseases, or management of acute problems needing same-day consultations. Gains in service efficiency may be achieved if doctors no longer provide the services they have delegated to nurses, enabling doctors to focus on complexity in their caseload and on utilising their role-specific  training and experience.

A team of Cochrane authors based in Netherlands, Thailand, and the United Kingdom worked with Cochrane Effective Practice and Organisation of Care to update the 2005 Cochrane Review that investigated the impact of nurses working as substitutes for primary care doctors on: patient outcomes; processes of care; and utilisation, including volume and cost. Nine randomized trials were added to this update, bringing the total examined to 18. One study was conducted in a middle-income country, and all other studies in high-income countries. The nursing level was often unclear or varied between and even within studies.

Delivery of primary healthcare services by nurses instead of doctors probably leads to similar or better patient health and higher patient satisfaction. Nurses probably also have longer consultations with patients. Using nurses instead of doctors makes little or no difference in the numbers of prescriptions and tests ordered. However, the impacts on the amount of information offered to patients, on the extent to which guidelines are followed and on healthcare costs are uncertain.

“This updated Cochrane Review indicates that nurses can effectively expand the capacity of the primary care workforce, ” says Miranda Laurant, the lead author of the Cochrane Review. “It doesn’t suggest that we can or should eliminate doctors from the primary care level; instead it shows that, in the cases assigned to them, trained nurses can probably provide equal or better quality of care compared to primary care doctors. This is very positive news as doing so may allow doctors to spend more time focusing on more complex cases or cases that utilize their more advanced training. Whether nurse-doctor substitution leads to substantial savings or whether nurse-doctor substitution is cost-effective remains unclear; we hope that future research will examine this.”

• Read the full Open Access Cochrane Review
• Visit the Cochrane Effective Practice and Organisation of Care

Monday, July 16, 2018

This week influential Editor-in-Chief of JAMA Internal Medicine Dr Rita Redberg joins host Ray Moynihan on Cochrane Australia's podcast The Recommended Dose to share a wide ranging conversation on all things health. A Professor at the University of California San Francisco and high profile contributor to The Washington Post and New York Times, Rita is also a practising cardiologist who loves to see patients. She says that ‘being a doctor is really a privilege’.

Together, Ray and Rita canvas many topics including shared decision making between doctors and patients, the tricky territory of medical device approvals, the controversy surrounding both statins and CT scans, and the implications of not including enough women in clinical trials. 

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

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

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

Thursday, July 12, 2018

This week influential Editor-in-Chief of JAMA Internal Medicine Dr Rita Redberg joins host Ray Moynihan on Cochrane Australia's podcast The Recommended Dose to share a wide ranging conversation on all things health. A Professor at the University of California San Francisco and high profile contributor to The Washington Post and New York Times, Rita is also a practising cardiologist who loves to see patients. She says that ‘being a doctor is really a privilege’.

Together, Ray and Rita canvas many topics including shared decision making between doctors and patients, the tricky territory of medical device approvals, the controversy surrounding both statins and CT scans, and the implications of not including enough women in clinical trials. 

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

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

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

Thursday, July 12, 2018