Cochrane News

Subscribe to Cochrane News feed
Updated: 9 hours 28 min ago

Podcast: Laparoscopy versus laparotomy for the management of presumed early stage endometrial cancer

Tue, 02/26/2019 - 13:46

Recent decades have seen greater and greater use of laparoscopy, or keyhole surgery, when people need an operation on their abdomen. There are now dozens of Cochrane Reviews of this, for a wide variety of conditions and, in October 2018, the one for laparoscopy versus laparotomy, or open surgery, for women with early stage endometrial cancer was updated. The review is led by Khadra Galaal from the Royal Cornwall Hospital in Truro in the UK and she tells us the latest findings in this podcast.

"Worldwide, cancer of the womb or 'endometrial cancer' is the fifth most common cancer among women under 65 years of age, with a higher incidence in high income countries than in low and middle income countries. The current standard treatment is a hysterectomy to remove the woman’s womb and removal of her fallopian tubes and ovaries. Other treatments include radiotherapy and chemotherapy. Traditionally, the surgery has been done as a laparotomy, through an open cut in the abdomen, and our review compares this technique against laparoscopic or keyhole surgery.

We looked at the effects of the two types of surgery on how long women remained alive after the diagnosis of their cancer and the length of time that they remained disease‐free. We were able to use results from six randomised trials that had analysed data for nearly 4000 participants with early stage endometrial cancer. We found no significant difference in the risk of death between the women who underwent laparoscopy and those who underwent laparotomy. In addition, results from five randomised trials confirmed no difference in the risk of cancer recurrence if women had laparoscopy or laparotomy. Notably, laparoscopy was associated with less blood loss and earlier discharge from hospital.

In summary, this update confirms the findings of our previous review from six years ago, that laparoscopy is an effective and viable alternative to laparotomy for the treatment of women with early stage endometrial cancer. With regards to long term survival, outcomes for laparoscopy are comparable to laparotomy."

Tuesday, February 26, 2019

Apply now: the Cochrane-REWARD prize for reducing waste in research

Fri, 02/22/2019 - 14:59

Nominations are open for the 2019 Cochrane-REWARD prize, which recognizes initiatives that have potential to reduce research waste.

An estimated $170 billion of research funding is wasted each year because its outcomes cannot be used [1]. The waste occurs during 5 stages of research production: question selection, study design, research conduct, publication, and reporting [2,3]. Much of this waste appears to be avoidable or remediable, but there are few proposed solutions.  

The Cochrane-REWARD prize was established in 2017 to stimulate and promote research in this area.  

Cochrane is now calling for nominations for the 2019 prize

All nominations will be assessed using the following criteria:
1.    The nominee has addressed at least one of the 5 stages of waste (questions, design, conduct, publication, reporting) in health research;
2.    The nominee has pilot or more definitive data showing the initiative can lower waste;
3.    The initiative can be scaled up;
4.    The estimated potential reduction in research waste that the initiative might achieve.

Nominations for the 2019 prize should be submitted by 5 June 2019. Two prizes will be awarded (a 1st prize of £1500 and a 2nd prize of £1000), but other shortlisted candidates will also be highlighted to help disseminate good ideas.

The winners of the 2019 prize will be announced at the 5th International Clinical Trials Methodology Conference, which will take place in Brighton, UK on 6-9 October 2019.

More information on the prize and how to submit a nomination
Read about the previous winners of the Cochrane-REWARD prize

Deadline for submissions: 5 June

References:

  1. Chalmers I, Glasziou P. Avoidable waste in the production and reporting of research evidence. Lancet. 2009 Jul 4;374(9683):86-9.
  2.  Macleod MR, Michie S, Roberts I, et al. Biomedical research: increasing value, reducing waste. Lancet. 2014 Jan 11;383(9912):101-4.
  3. Glasziou P, Altman DG, Bossuyt P, et al. Reducing waste from incomplete or unusable reports of biomedical research. Lancet. 2014 Jan 18;383(9913):267-76.
  4. Glasziou, P and Chalmers, I. Research waste is still a scandal—an essay by Paul Glasziou and Iain Chalmers. BMJ. 2018 Nov 12;363:k4645

 

Friday, February 22, 2019

Elections to the Cochrane Consumer Executive open

Thu, 02/21/2019 - 12:12

Are you interested in taking a leadership role in the Cochrane consumer community? Cochrane’s Consumer Engagement Officer; Richard Morley, and Consumer Executive member; Nancy Fitton explain what’s involved and how to apply.

"Cochrane is an amazing movement to change the way that evidence is produced and used. It is a global community of over 63,000 supporters and members who use and create new knowledge so that healthcare decisions can be made using reliable evidence.

A feature of its work since 1994 has been to support a global network of healthcare consumers (patients, care-givers, and family members) of over 1550 people who help produce Cochrane evidence by setting priorities for future research, defining outcomes in reviews, working alongside researchers, peer reviewing abstracts and reviews, and helping to disseminate evidence. They work with Cochrane’s network of Review Groups, Centres and Fields. And they are part of the governance of the organisation.

One of the ways in which consumers do this latter role is by being part of the Consumer Network Executive. This group of consumers has an important role to play in representing the voice of consumers, they help to take forward work that improves the way that Cochrane works with consumers, and make its evidence accessible to its non-scientist users.

Over recent years the Consumers Executive has helped produce the Consumer Structure and Function Review (2015) and Consumer Delivery Plan (2016), setting out the ways in which consumer involvement will be improved. It formed a group that developed the Statement of Principles for Consumer Involvement in Cochrane (2017). The Executive has supported many consumers at Colloquia, Cochrane’s annual meeting. It has commented on a range of policy documents like the recent Peer Review policy that now makes it mandatory to seek consumer peer review on protocols and reviews. Presently it is working with the network of Cochrane Centres to spread consumer involvement and engagement across our global organisation.
Nancy Fitton, member of the present Consumers Executive, shares her experience of being a member of the group.

It has been a privilege to serve on the Consumer Executive for the last five years.  Each member of the CE has their unique skill set, point of view, and experience with Cochrane.  We are all from different countries.  These differences provide a rich mix of input for the tasks that we undertake.

The work of Cochrane is very important to us.  Of course, the participation of consumers in that work is of utmost importance.  We work, through various channels, to improve the experience of consumers involved in Cochrane, and to help Cochrane groups embrace consumers as members of the team.  This has been a very rewarding endeavour for me.  Additionally, the other members of the CE are excellent co-workers in this task.  We have an outstanding champion in our Consumer Engagement Officer, Richard Morley.
If you have wished that you had more input into “how things are done,” and would like to build on your involvement with Cochrane by contributing to the consumer experience, you might consider running for a spot on the Consumer Executive."
 
Members of the Consumers Executive are elected by the whole membership of the consumer community, for a period of three years, with an option to stand for a further period. Elected members are asked to attend monthly online or telephone meetings, to undertake some work in between meetings, and to come to the Mid-year business gathering that takes place in April each year, and the Colloquium (where funding allows). This is not a paid post, but all expenses are met by Cochrane. The Consumers Executive also appoints two people to serve on the Cochrane Council. Members of the Executive are supported by Cochrane’s Consumer Engagement Officer.

This year there are two vacancies to be filled and one of those positions is kept for someone from a Low and Middle-income country.  We are particularly keen to encourage people to come forward who can provide leadership to the network, can represent the consumer voice to the wider Cochrane community, support the wider network in its ambition to involve consumers, and actively contribute to the debate about the best ways to involve consumers in the organisation. It’s important to know that the function of all Cochrane’s Executive groups is being reviewed.

If you are still interested, you can download the document that explains how to apply.

Nominations close Friday 29th March 2019

Thursday, February 21, 2019

World Oral Health Day

Wed, 02/20/2019 - 20:28

World Oral Health Day is celebrated globally every year on 20 March. It helps to spread messages about good oral hygiene practices and demonstrates the importance of optimal oral health in maintaining general health and well-being. It's an excellent time to put the spotlight on related Cochrane evidence.

Cochrane Oral Health publishes systematic reviews of the best quality research available to help patients, carers, clinicians, researchers, and funders make better informed decisions about oral healthcare choices. Cochrane Oral Health's work is carried out by over 1600 members, with over 900 authors from more than 40 different countries.

What do you think are the most important questions to answer in taking care of the mouth, teeth, and gums? Cochrane Oral wants your view on which systematic reviews they should undertake or update. Please take a few minutes to fill out this survey!

Featured EvidenceEvidently Cochrane Blogs View more Cochrane Oral Health Evidence

 

Friday, March 15, 2019

World Tuberculosis Day

Wed, 02/20/2019 - 18:04

Cochrane Library release Special Collection on diagnosing tuberculosis

 World Tuberculosis Day is marked annual on 24 March as it commemorates the date in 1882 when Dr. Robert Koch announced his discovery of Mycobacterium tuberculosis, the bacillus that causes tuberculosis (TB).

Tuberculosis (TB) causes more deaths globally than any other infectious disease and is a top 10 cause of death worldwide. When it is detected early and effectively treated, TB is largely curable, but in 2017, around 1.6 million people died of tuberculosis, including 300,000 people living with HIV.[1] Early diagnosis of TB, including universal drug susceptibility testing and systematic screening of contacts and high-risk groups, is a pillar of the World Health Organization (WHO) "End TB" strategy.

The Cochrane Library has released a Special Collection, curated by Cochrane contributors, includes Cochrane Reviews from the Cochrane Infectious Diseases Group and other systematic reviews from other international teams. It highlights how Cochrane evidence contributes within a wider landscape of TB evidence and guidelines. The Collection also describes key WHO guidelines on TB diagnostics, and their underpinning systematic reviews, some which are published within the WHO Guideline itself. 

This Special Collection covers:

  • Early detection of TB
  • Diagnosis of active TB disease and TB drug resistance
  • Diagnosis of TB in people living with HIV
  • Diagnosis of TB in children
  • Diagnosis of latent TB infection

View the Special Collection: Diagnosing Tuberculosis

 

Sunday, March 24, 2019

Cochrane's 30 under 30: Ibrahem Hanafi

Wed, 02/20/2019 - 17:18

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

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

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

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

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

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

Name: Ibrahem Hanafi (on Twitter at @Ibrahem_Hanafi )
Age: 24
Occupation: Resident Physician
Program: Neurology Residency, Internal Medicine Department, Faculty of Medicine, Damascus University, Damascus, Syria

How did you first hear about Cochrane?
I first heard about Cochrane before being admitted to the faculty of medicine in a conference about medical information resources.  Since then, Cochrane left a lasting impression on me for being a collaboration aiming at improving healthcare services all over the world. It was not until my second year at med school, when I attended a workshop about evidence-based medicine and conducting systematic reviews, that I started applying for participations in Cochrane review groups. That was not just my entry to the Cochrane community, but also to the world of evidence-based medicine as a whole.

How did you become involved with Cochrane? What is your background?
The first time I applied to get involved with Cochrane was in my third year at the faculty of medicine. My application consisted of the few skills I learned through the 8-hour workshop and the huge motivation I had to join their elite researchers. In Damascus University and even in Syria, there is no geographic group for Cochrane, and it was hard for us to start an overseas project for the first time with people we have never met. Nevertheless, several friends and I succeeded to participate and publish with Cochrane. Initially, I had some difficulties catching up with the required tasks, however, I was promptly provided with all the assistance I needed by the review group I got involved in.

What do you do in Cochrane?
I am an author in Schizophrenia and Lung Cancer review groups and a referee in Common Mental Disorders and Pain, Palliative and Supportive Care groups. I am also a member of Cochrane Trainers’ Network, which contributed greatly to my Cochrane experience. I have participated as a trainer in a Cochrane training workshop in Damascus, and organized a full workshop for conducting Cochrane systematic reviews for the first time in Aleppo. Furthermore, I had the honour to receive a stipend from Cochrane to attend GRADE CERQual Training in Modena, Italy in 2017, where I was the youngest trainee amongst a group of esteemed reviewers from all over the world.

What specifically do you enjoy about working for Cochrane and what have you learnt?
What I truly like about Cochrane is that it is not just a network for collaborative work, but also a pooled innovative learning spot. In Cochrane, I always feel active learning and applying new tools and techniques, as well as pumping and absorbing experience from peers. Fortunately, Cochrane also provides equal opportunities for individuals whether young or experienced to get involved in that collaborative community.


What are your future plans?
My plans start from completing my specialization in Neurology and getting trained to become a professional medical researcher with experience, ensuring high standards in exploring and investigating the edges of neuroscience. Then, I plan to start and lead my own research lab that will aim to further investigate the behavioural and cognitive neuroscience aspects of the people suffering from psychological stress in war-torn countries.

In your personal experience, what one thing could Cochrane do better to improve its global profile?
I think Cochrane is paying much attention to involving young people, however, it does not always reach them all, especially in countries with limited research productivity. I suggest creating groups for Cochrane supporting individuals in each country/city/med-school to encourage medical students and residents to get involved in Cochrane’s various projects. These groups would facilitate contact with Cochrane, build review teams, and share previous experiences in the countries that do not have any Cochrane geographical centres.

What do you hope for Cochrane for the future?
I hope that Cochrane keeps its fresh projects up, as well as further facilitating the involvement of young individuals, in addition to getting them mentored and supported by experienced researchers. I also hope that Cochrane becomes more popular in third-world countries where medical research collaborations are being absent the most.

How important is it that young people get involved in Cochrane?
Since experience can sometimes have the side effect of narrowing the horizons of creativity, young unexperienced people have the ability to make new innovative projects out of very little supplies. Although Cochrane has much power in the fields of medical research, I think young medical personnel are its main and constant mean to spin the wheel of boosting the quality of healthcare systems worldwide in the near future.

Why is this, do you think?
People who get involved in high quality medical knowledge synthesis while young, will always stick to evidence during their practice and will also give medicine a great push towards evidence-based practice in a not so far future.

What would your message be to other young people who want to get involved with Cochrane’s work but not sure where to start….?
Never hesitate! Many experienced Cochrane reviewers now were as young and unexperienced as you when they decided to take the initiative themselves! You will be supported with facilitating resources and courses throughout your probable interesting journey with Cochrane. All you need is an open-mind, flexible skills, and some of your time.

Tuesday, March 12, 2019

Cochrane seeks HR Assistant - London, UK

Wed, 02/20/2019 - 12:26

Specifications: Part time 18.75 hours per week (0.5 FTE), days and times to be agreed
Salary: £28,000 pro rata
Location: London - with flexibility to work from home 1 day a week
Application Closing Date: 3rd March 2019

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

As part of the Human Resources Team, the HR Assistant assists with the administration of the day-to-day operations of the HR functions and duties.

Key tasks:

  • Work with the HR Team in providing HR support to deliver a responsive, pro-active HR function.
  • To support the smooth running of the recruitment process by providing guidance to managers, responding to applicants and scheduling interviews.
  • To respond to general and specific queries from staff in relation to their employment terms and conditions, local entitlements and HR policies.
  • To generate letters and appropriate paperwork covering the full range of employee lifecycle events, including job offers, contracts, training courses, holidays and other absences.
  • To support the HR Team in the delivery of HR related projects.
  • To use and maintain the HR database and contribute to its development and best use
  • To attend HR team meetings, contributing to the smooth running and development of the HR function in providing a quality service to the organisation as a whole.
  • To maintain confidentiality at all times
  • In line with other HR staff, to manage queries via shared HR mailboxes, ensuring queries are dealt with or referred on as appropriate.
  • Supporting meetings as required including co-ordinating agendas, taking minutes, circulating paperwork and organising refreshments
  • To undertake other tasks in support of team objectives and at the appropriate level as allocated by the HR Manager
  • Undertake other duties that may be considered appropriate to the role, including supporting the admin function across the organisation.
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 Knowledge, Skills and Abilities:
  • Good IT skills across MS Office and databases, sufficient to input and retrieve data
  • Good interpersonal skills with the ability to build good working relationships with a range of contacts
  • Self-confidence, personal credibility and the ability to challenge others appropriately
  • Very good communication skills sufficient to respond to varied queries verbally and in writing in a clearly understood way
  • Good written English, sufficient to draft guidance and correspondence
  • Proven ability to work both independently and productively as part of a team
  • Ability to accomplish projects with little supervision
  • Very good organisational and time management skills with the ability to prioritise work efficiently to meet deadlines
  • Good understanding of and ability to apply the principles of confidentiality
  • High 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

Desired:

  • Experience of healthcare charity sector
  • CIPD qualification
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 “HR Assistant” 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: 3rd March 2019 (12 midnight GMT)
 
Interviews to be held on: w/c 11th March 2019 (TBC)
Wednesday, February 20, 2019

Global Evidence Summit 2021 - Call for Hosts

Tue, 02/19/2019 - 16:15
We are now inviting expressions of interest to host the Global Evidence Summit in 2021

Following the success of the inaugural Global Evidence Summit (GES) in Cape Town in 2017, four global leaders in evidence-based policy and practice will again join forces to deliver the second Global Evidence Summit in 2021.

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

Expressions of interest to host the Global Evidence Summit 2021 are open

Important Information

  • To apply, download the application form
  • Please also refer to the Terms of Reference document that sets out the roles, responsibilities and structure for all relevant Parties (Organizing Partners, Host Organization, Programme Partners, Sponsors, Supporters and Committees) in the planning and development of the Global Evidence Summit.
  • You are required to submit a proposed budget alongside the form - link to template in application form.
  • All proposals must include a letter of support from your host institution and/or funders
  • Your proposal will be put forward to the organizing partners who aim to announce the host by July 2019.
  • Deadline for submissions is 31 May 2019. 

Please submit application forms and support documentation to contact@globalevidencesummit.org by 31 May 2019.

Global Evidence Summit 2021 Organizing Partners:

Friday, February 22, 2019

Podcast: Improving the implementation of health-promoting policies and practices in workplaces

Mon, 02/18/2019 - 16:28

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.

Thursday, February 21, 2019

Podcast: C-reactive protein for diagnosing infection in newborn infants

Mon, 02/18/2019 - 13:54

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."

Monday, February 18, 2019

Special thank you and recognition of 22 years of service to Cochrane: Founder of Cochrane Finland, Marjukka Mäkelä

Fri, 02/15/2019 - 10:56

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's 30 under 30: Carlo Frassetto

Thu, 02/14/2019 - 16:10

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's 30 under 30: Shalini Suresh

Thu, 02/14/2019 - 15:20

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

Featured Review: Iodine deficiency disorders; fortification of food and condiments

Thu, 02/14/2019 - 10:40

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

Cochrane seeks Editor in Chief of the Cochrane Library

Wed, 02/13/2019 - 11:52

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

Cochrane’s Governing Board is seeking to appoint a new member – February 2019

Wed, 02/13/2019 - 11:42

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

Featured Review: Are general health checks beneficial?

Tue, 02/12/2019 - 14:19

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."

Wednesday, February 20, 2019

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

Mon, 02/11/2019 - 14:30

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.

Monday, February 11, 2019

Cochrane seeks Office Administrator - London, UK

Mon, 02/11/2019 - 12:31

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

Podcast: Cannabis products for adults with chronic neuropathic pain

Wed, 02/06/2019 - 16:12

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.

Wednesday, February 6, 2019

Pages