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Spotlight on Cochrane’s Sustainable Healthcare Field: An interview with Minna Johansson

Fri, 11/05/2021 - 17:22

In this interview with Dr. Minna Johansson, Cochrane Sustainable Healthcare Field Director we learn more about the work of this field, the issues it wants to address and some of the ways they are engaging audiences to learn more.

Can you tell us about the Sustainable Healthcare Field?
Cochrane Sustainable Healthcare is a new Cochrane group focused on addressing medical excess. The background for our work is the notion that medical excess threatens the health of individuals and poses challenges for health system sustainability - and the need of an evidence base better suited to support sustainable decisions about healthcare. In essence, we are developing a global network for collaboration with partners within and beyond Cochrane on activities ranging from short‐term research projects to longer‐term reform initiatives.

What is the field’s main goal?
Our fundamental aim is to contribute to a more sustainable healthcare for patients, for health systems, for our societies, and for the planet. Our more concrete goals are to enhance the relevance of primary research and evidence synthesis to tackle medical excess, and to increase the use of that evidence to enable a more sustainable healthcare.

Who is involved?
I am leading the work, together with Dina Muscat Meng who is coordinator of Cochrane Sustainable Healthcare. But more importantly, during these first two years since the launch we have had enormous support, help and engagement from a broad international network of highly skilled people who have generously contributed with time and resources to help bring this work further. Some of these people and organizations are mentioned at our website. We would like to especially thank Cochrane Sweden and Cochrane Denmark. We will develop this network further by partnering with primary researchers, funders of research, organizations working with evidence synthesis, guideline developers, policy makers, health systems organizations, professional medical associations, citizen and patient organizations, and the general public. We welcome anyone who is interested in this initiative to contact us.

Where can we go to learn more?
An Editorial about us is available here, and at our website you can read more about our work.

We are just about to launch a pop-up podcast series; “The Recovery – Voices of action towards sustainable healthcare” - co-published with The BMJ. In these podcasts, our co-hosts Ray Moynihan from Bond University and Fiona Godlee, editor in chief of The BMJ, meet thought-leaders around the world who are cutting the edge of sustainable healthcare. From Mumbai to Minnesota, you will hear about new initiatives that are changing the way we practice medicine, to ensure better access to high quality, evidence-based, and safe healthcare. The series includes an interview with Rachelle Buchbinder and Ian Harris, recent author of book, Hippocrasy: How doctors are betraying their oath.

Further, in collaboration with people from Cochrane Argentina, Cochrane Chile, Cochrane Methods, Cochrane Sweden and Cochrane Denmark, we have recently launched a Special Collection of Cochrane Reviews featuring examples of resource-intense interventions, including those requiring extra healthcare visits, for which there is high or moderate certainty evidence that they confer clinically small or no effects, and for which there is some evidence of harm to patients. The reviews are particularly relevant to the COVID-19 pandemic, and should inform guideline, and policy developers, and decision makers planning health care, both during and after the pandemic. This Special Collection is intended as the first in a series, with subsequent Collections focusing on other healthcare interventions shown to being ineffective, harmful, or unproven.

What is planned in the future?
We have a wide range of exciting projects in pipeline – one of the most exciting in my opinion is a collaboration with GRADE where we are just about to form a GRADE Working Group focused on medical excess. We are also working on a project evaluating the quality and balance of messaging in disease awareness campaigns observed by the WHO, Cochrane and the US government – and we plan to develop reporting guidance for such campaigns, which can be used by campaign organizers to ensure high quality and balanced messaging when developing a campaign, as well as by organizations and authorities when deciding on whether to endorse a campaign or not. We also aim to develop our collaboration with international and regional stakeholders – such as for example Choosing Wisely.

In conclusion, the need for novel approaches to tackle medical excess is increasingly recognized. We believe that an intensified focus on projects and initiatives that cross the traditional boundaries between the different stakeholders in the evidence chain is required. The reasons for these challenges are diverse and complex, and so are the solutions – a strong collaboration integrating differing and sometimes contradictory perspectives is indicated. This will undoubtedly be challenging, but a more sustainable healthcare will benefit individual patients, as well as our communities.

Monday, November 8, 2021

Johns Hopkins Bloomberg School of Public Health seeks Tenure-Track Assistant or Associate Professor (Baltimore, US)

Fri, 11/05/2021 - 16:13

Location: Baltimore, MD, US
Deadline: 30 Nov, 2021

The Department of Epidemiology at the Johns Hopkins Bloomberg School of Public Health invites applications for a tenure-track Assistant or Associate Professor specializing in evidence synthesis.  The candidate will be based in the Center for Clinical Trials and Evidence Synthesis. 

They welcome applications from candidates who are in the early to mid phases their academic career.  Academic rank will be commensurate with experience. 

Applicants should hold a doctoral degree in epidemiology, medicine, or a related discipline with graduate training in epidemiology.  Successful candidates will have demonstrated original scholarship, possess excellent written and communication skills as evidenced by peer-reviewed publications and professional meeting presentations, and have the capacity for an independent research program.  Candidates will be expected to teach classes in epidemiology and mentor graduate students. 

The Department of Epidemiology is one of the oldest and largest departments of epidemiology in the world, with over 200 doctoral and master’s students and a diverse research program directed by over 125 faculty.  The institution has a strong research infrastructure and commitment to conduct both observational and experimental research.  Candidates should possess a solid epidemiologic foundation to contribute to the research and teaching missions of the Department.

Friday, November 5, 2021 Category: Jobs

Featured review: What are the benefits and risks of visible light therapy for treating atopic eczema?

Thu, 11/04/2021 - 15:10

Cochrane Skin is pleased to announce the publication of a new review, Phototherapy for atopic eczema. This review was led by dermatologists from Amsterdam University Medical Centers, and supported by a key stakeholder: the American Academy of Dermatology (AAD). The AAD provided funding for this systematic review (32 studies, 1219 people with clinically diagnosed atopic eczema), which enabled publication of the protocol and full review within 13 months of title registration.

Key messages

  • Narrowband (NB) ultraviolet B (UVB), compared to placebo (a sham treatment), may improve eczema severity (including itch) and may not affect the number of people leaving a study because of unwanted effects.
  • We were unable to confidently draw conclusions for other phototherapy (light therapy) treatments.
  • Future research needs to assess longer term effectiveness and safety of NB-UVB and other forms of phototherapy for eczema.

This Cochrane Review will be used to inform the AAD’s update to their guidelines of care for the management of acne (expected in the third quarter of 2023).

What is eczema and how is it treated?
Eczema is a condition that results in dry, itchy patches of inflamed skin. Eczema typically starts in childhood, but can improve with age. Eczema is caused by a combination of genetics and environmental factors, which lead to skin barrier dysfunction. Eczema can negatively impact quality of life, and the societal cost is significant.

Eczema treatments are often creams or ointments that reduce itch and redness, applied directly to the skin. If these are unsuccessful, systemic medicines that affect the whole body, or phototherapy are options. Phototherapy (light therapy or visible light therapy) can be UVB, ultraviolet A (UVA), or photochemotherapy (PUVA), where phototherapy is given alongside substances that increase sensitivity to UV light.

What did we do?
We searched for studies that investigated phototherapy compared with no treatment, placebo, other forms of phototherapy, or another type of eczema treatment. Studies could include people of all ages, who had eczema diagnosed by a healthcare professional.

What did we find?
We found 32 studies, involving 1219 people with eczema (average age: 28 years), who were recruited from dermatology clinics. Most studies assessed people with skin type II to III (which is classed as white to medium skin colour), and moderate to severe eczema, with which they had lived for many years. Studies included similar numbers of males and females. The studies were conducted in Europe, Asia, and Egypt (setting was not reported by seven studies), and lasted, on average, for 13 weeks. Almost half of the studies reported their source of funding; two were linked to commercial sponsors.

Our included studies mostly assessed NB-UVB, followed by UVA1, then broadband ultraviolet B; fewer studies investigated other types of phototherapy. The studies compared these treatments to placebo, or no treatment, another type of phototherapy, different doses of the same sort of phototherapy, or other eczema treatments applied to the skin or taken by tablet.
None of the studies investigated excimer lamp (a source of UV radiation) or heliotherapy (the use of natural sunlight), other light therapies in which we were interested.

What are the main results of our review?
When compared to placebo, NB-UVB may:

  • improve signs of eczema assessed by a healthcare professional (1 study, 41 people);
  • increase the number of people reporting less severe itching (1 study, 41 people);
  • increase the number of people reporting moderate or greater improvement of eczema, measured by the Investigator Global Assessment scale (IGA), a 5-point scale that measures improvement in eczema symptoms (1 study, 40 people); and
  • have no effect on the rate of people withdrawing from treatment due to unwanted effects (3 studies, 89 people).

None of the studies assessing NB-UVB against placebo measured health-related quality of life.

We do not know if NB-UVB (compared with UVA1 or PUVA) or UVA1 (compared with PUVA) has an effect on the following:

  • signs of eczema assessed by a healthcare professional;
  • patient-reported eczema symptoms;
  • IGA;
  • health-related quality of life; and
  • withdrawals due to unwanted effects.

This is because either we are not confident in the evidence, or they were not reported.

We did not identify any studies that investigated UVA1 or PUVA compared with no treatment.

Some studies reported that phototherapy caused some unwanted effects, including skin reactions or irritation, UV burn, worsening of eczema, and skin infections. However, these did not occur in most people.

What are the limitations of the evidence?
Our confidence in the evidence is limited, mainly because only a few studies could be included in each comparison, and the studies generally involved only small numbers of people.

How up to date is this evidence?
The evidence is up to date to January 2021.

Thursday, November 4, 2021

Cochrane Nigeria: 15 years on

Mon, 11/01/2021 - 16:21

Cochrane Nigeria recently launched as a full Cochrane Centre. Here they reflect on their journey and contributions over the past 15 years. 

Cochrane takes hold in Nigeria
The story of Cochrane Nigeria dates back to 1998 when Prof. Martin Meremikwu, by chance met Prof. Paul     Garner, the Coordinating Editor of the Cochrane Infectious Diseases Group, at the Centenary celebration of the Liverpool School of Tropical Medicine. Prof. Garner introduced Prof. Meremikwu to the Cochrane Collaboration and gave him a head start in the conduct of systematic reviews. In 1999, Prof. Meremikwu conducted his first systematic review on “Blood transfusion for treating malaria anaemia”. He went on to convince as many colleagues of his as he could to learn the art of preparing Cochrane systematic reviews; working from a small office at the Federal Neuropsychiatric Hospital Calabar, which was later moved to a more spacious office at the University of Calabar Teaching Hospital. He mentored them through personal and group mentorship programmes, regular in-house training, hands-on experience as co-authors/authors of systematic reviews and by sharing Cochrane Collaboration literature.

In the bid to build capacity to conduct systematic reviews in the country, an initial group of five young potential Cochrane review authors under the oversight of Prof. Meremikwu received support from the Effective Health Care Research Programme grant held by Prof. Paul Garner to attend 4-week Systematic Review fellowship at the Liverpool School of Tropical Medicine. During the fellowship they received direct mentoring and coaching and also participated in the Critical Appraisal Module of the Master’s in International Public Health Course. Among these forerunners were Prof. Angela Oyo-Ita (Community Physician), Prof. Afolabi Lesi (Paediatrician), Prof. Godwin Aja (Public Health), Prof Bosede Afolabi (Obstetrician), Prof Christy Okoromah (Paediatrician) and Dr. Oluseyi Oniyangi (Paediatrician). Today, they are all accomplished academic researchers and professionals who have continued to contribute to the work of Cochrane while promoting and building capacity for evidence-based healthcare in their home institutions and at various levels of influence. Prof. Afolabi Lesi currently Chairs the Advisory Board of Cochrane Nigeria.

In September 2005, more young Nigerian researchers and health professionals were supported by the Nuffield Foundation to attend a one-month Cochrane Protocol Development Course organized by the South African Cochrane Centre (SACC) under the auspices of the Reviews for Africa Programme (RAP). Some of these authors were later invited to the RAP Finishing School in 2006. The effort of Prof. Jimmy Volmink (then Director of the SACC), Mrs. Joy Oliver, Mrs. Elizabeth Pienaar and Prof. Taryn Young towards making the experience of participants at the RAP course an unforgettable one is worth mentioning.

Capacity and contributions grow
Following the increase in the number of Cochrane authors in the country and the capacity of the Nigerian authors to conduct high quality systematic reviews, the Nigerian Branch of the South African Cochrane Centre was formed in 2006 with Prof. Martin Meremikwu as the Branch Director and Prof. Angela Oyo-Ita as the Deputy Director. In 2017, Cochrane African Network was formed with Cochrane Nigeria leading the West African Hub of the network.  

Some of the notable contributions of Cochrane Nigeria to global health were conduct of systematic reviews and provision of technical input towards WHO Guideline on Female Genital Mutilation; systematic review on “Seasonal Malaria Chemoprophylaxis” and “Artemether for Severe Malaria” on which the current WHO guidelines on the management of these health conditions are based. The Centre collaborated with the Federal Ministry of Health to develop a guideline on the management of diabetes. In partnership with professional groups, it has provided support for the production of guidelines for the management of community acquired pneumonia in children, hypertension and post-partum haemorrhage.

 A cross section of Cochrane Nigeria Directors, Staff, and Associates

Full Cochrane Centre launched
Cochrane Nigeria attained full Centre status in December 2020 following the approval of its application by the Governing Board of Cochrane. Cochrane Nigeria had been an associate centre under Cochrane South Africa. Today, Cochrane Nigeria has nodes strategically located in the different parts of the country. The Centre is running with the clear mandate of promoting collaboration and evidence based health care policy and practice in the country through:

  1. Production of high quality and high priority systematic reviews
  2. Dissemination of Cochrane reviews to relevant stakeholders using channels such as social media, newsletters, podcasts and mass media
  3. Multilingual translation of relevant reviews
  4. Translation of evidence from reviews into policy and practice
  5. Refining the methods of Cochrane reviews

Cake to commemorate the Launch of Cochrane Nigeria 

Launch of Cochrane Nigeria as a full Cochrane Centre
Cochrane Nigeria recently hosted the 4th Cochrane Africa Indaba. Cochrane Africa is a network of Cochrane entities in sub-Saharan Africa established in 2017. A key highlight of the Conference was the Launch of Cochrane Nigeria as a full Cochrane Centre. The event brought together a number of notable personalities from various organizations including the World Health Organization Nigeria, European Union delegation to Nigeria and the ECOWAS, National Health Insurance Scheme, and Federal Ministry of Health – all key stakeholders in evidence based health care in Nigeria.

With the formal launch of Cochrane Nigeria on the 13th July 2021 at the National Hospital, Abuja, the Centre now has a good launching pad for engagement with relevant stakeholders for the achievement of its core mandates in the country and continent. What started as a humble beginning in 1998 has now metamorphosed into a global movement, impacting on the health of people globally. The days ahead look very promising as we hope to engage more meaningfully with relevant stakeholders and policy makers, increase capacity for the production of high priority systematic reviews that will inform national and global policies and practices, strive for a strong national presence and support evidence-based decision making processes in the Federal Ministry of Health and other health-related sectors of the country.

Prof. Martin Meremikwu (Director, Cochrane Nigeria). Prof. Afolabi Lesi (Chair, Advisory Board, Cochrane Nigeria) being interviewed by the Press.
Prof. Angela Oyo-Ita (Co-Director, Cochrane Nigeria) giving  opening remarks. Dr. Anthony Ayeke (EU Delegation to Nigeria & Ecowas) and Prof. Martin Meremikwu (Director Cochrane Nigeria). 

 

Monday, November 1, 2021

Cochrane Library Editorial: It’s time to increase the global relevance of Cochrane Reviews by applying an ‘equity lens’

Wed, 10/27/2021 - 20:55

Health inequities, defined as avoidable and unfair differences in health, have been worsening within and between countries. This has been brought to the forefront by the COVID-19 pandemic. 

A newly published Cochrane Library Editorial puts forth that it is time to increase the global relevance of Cochrane Reviews by applying an 'equity lens'. An equity lens is defined as a focus on health equity to ensure that the most hard-to-reach groups within a population benefit, while avoiding intervention-generated inequalities.

To support review authors in applying an equity lens, Cochrane has created a number of useful resources, including: 

The editorial also provides additional suggestions to authors to create a Cochrane Review that help equip decision makers to determine the applicability of evidence to their setting,  resulting in facilitating the implementation of programs and policies that may contribute to reductions in global health inequities.

 

 

Thursday, October 28, 2021

Cochrane India Network launches in online event

Mon, 10/25/2021 - 19:56

Cochrane is pleased to announce the launch of a new network of institutions from across India that will promote evidence-informed health care and policy in the country.

The Cochrane India Network launched in an online event today featuring keynotes from prominent national and international presenters, including the Director General of the Indian Council of Medical Research Dr Balram Bhargav; Dr Vinod Paul who is a member of NITI Aayog; WHO Chief Scientist Dr Soumya Swaminathan and Cochrane’s Editor in Chief Karla Soares-Weiser. Presentations from each of the affiliate institutions followed, and the event concluded with plenary sessions related to resources available for contributors of the Network. 

The Cochrane India Network is chaired by Dr. Meenu Singh and Dr. Anju Pradhan Sinha, and comprised of teams from nine affiliate institutions, including: 

  • All India Institute of Medical Sciences, New Delhi
  • Christian Medical College Vellore
  • India Council of Medical Research, New Delhi
  • Indian Institute of Public Health, Hyderabad
  • Institute of Dental Sciences, Bhubaneshwar
  • King George’s Medical University, Lucknow
  • Manipal Academy of Higher Education, Manipal
  • Postgraduate Institute of Medical Education and Research, Chandigarh
  • Tata Memorial Centre, Mumbai


The Network Affiliates each have their own strategic plan with Cochrane activities they wish to implement. Activities vary from training in the use of Cochrane systematic reviews, sharing information about new reviews published by Cochrane and advocating for their use in policy and practice, to the production of systematic reviews.

Judith Brodie, Cochrane’s Interim Chief Executive Officer, said of the Network’s launch: “I am excited by the expertise and diverse focus of the Affiliates in the Cochrane India Network, and so pleased to see them join together to advocate for evidence-informed health and care in India.”

Speaking about the launch, Dr. Meenu Singh, Co-Chair of the Network, said, “The launch of Cochrane India Network is a long-cherished dream of all the ‘Cochranites’ from India. Working with Cochrane for more than 20 years, it has provided an opportunity for development of in-house Cochrane products with global applications for evidence-based healthcare. The institutions involved in the Network will act as vehicles of Cochrane methodology for carrying out systematic reviews and help translate evidence into policy and practice.”

Dr. Anju Pradhan Sinha, Network Co-Chair, added, "The establishment of the Cochrane India Network is a significant milestone in India's journey on the path of evidence-informed decision making. The activities coordinated through the Network will lead to the effective implementation of evidence in clinical practice and policy making."

Tuesday, October 26, 2021

Featured review: Mindfulness‐based interventions for substance use disorders

Thu, 10/21/2021 - 09:54
Thursday, October 21, 2021

Cochrane Live: Discuss the next chapter of Cochrane live in Sweden

Wed, 10/20/2021 - 16:18

Cochrane Sweden is hosting a free face-to-face event on the 7th of December to discuss and reflect over the next chapter of Cochrane and the future of review production.

The event will take place in Malmö, Sweden, a 20-minute train ride from Copenhagen Airport. Karla Soares, Editor in Chief of the Cochrane Library and Toby Lasserson, Deputy Editor in Chief are invited to present and facilitate the discussions. Having coffee and a Swedish "fika" will hopefully lead to great conversations!

Where: Malmö Live Clarion Hotel, Malmö, Sweden. 
When: 7th of December 2021, 10.00 - 16.30.  
More: For available participants interested in further follow-up discussions, the day after the event (8th of December) is open for discussions at Cochrane Sweden's office in Lund (10-minute train ride and a 15-minute walk or tram from Malmö Central station). 

Who: 
All Cochrane members and contributors are invited.
How: We hope that the starting time (10.00) opens up the possibility to travel directly to the event in the morning for participants within Europe. Our suggestion would be to travel to Copenhagen Airport and take the train from the airport to Malmö Central Station which takes 20 minutes. The location is a 5-minute walk from Malmö Central Station. It is also possible to travel to Malmö Airport and take a bus or taxi to Malmö Central Station. After 16.30 on the 7th we will plan to have a joint dinner in Malmö for available participants.
Content: The meeting will be facilitated by Karla Soares and Toby Lasserson combined with face-to-face discussions about the next chapter of Cochrane and the future of review production. The topics will center around the Community Engagement Workshop Series and futurecochrane.space.

Cost: The event is free for all Cochrane Members and contributors and includes lunch. Accommodation and travel expenses to the event are not included and have to be covered by the participant. 
Accommodation: For participants who plan to stay from 6th to 7th of December, and/or 7th - 8th of December the event venue (Malmö Live) might be a convenient accommodation solution, although it is not a cheap option. 
Travel restrictions: You can find the latest updates on current travel restrictions and Covid-19-measures FOR SWEDEN from https://www.krisinformation.se/en/ or by visiting the Swedish Police website or by checking this FAQ from the Swedish Government. If you travel to Copenhagen Airport (Denmark) and after that to Sweden, there are special rules for different countries regarding Covid-passports and sometimes the need to show a test before entering. More information is available from the Copenhagen Covid-19 Travel Guide or from https://www.oresunddirekt.se/. 

Registration: You need to have a Cochrane Account, and sign in using THIS LINK. The last day to register is November 8th 2021. Please note that we have a limited number of attendees due to the size of the venue. 

 

Wednesday, October 20, 2021

What factors influence parents’ and carers’ decisions on routine vaccinations for their children?

Wed, 10/20/2021 - 11:46

This recently published Cochrane Review, published by Cochrane Effective Practice and Organisation of Care, explores how parents and carers make decisions regarding vaccinating their children. Cochrane EPOC have also produced a short implementation guide related to this review. 

Key messages

  • Many factors influence parents’ vaccination views and practices, including those related to individual perceptions, social relationships, and the wider social and political context in which parents live.
  • When parents make decisions about vaccination for their children, they are often communicating not just what they think about vaccines, but also who they are, what they value, and with whom they identify.

Why is it important to understand what affects parents’ and carers’ decisions around vaccinating their children?
Childhood vaccination is one of the most effective ways to prevent serious illnesses and deaths in children. To be successful, vaccination programmes depend on high levels of vaccination uptake.

However, worldwide, many children do not receive all recommended vaccinations. There are several potential reasons for this. Vaccines might be unavailable, or parents may experience difficulties in accessing vaccination services; for instance, because of poor-quality health services, distance from a health facility, or lack of money. Some parents may not accept available vaccines and vaccination services.

Increasing our understanding of what influences parents’ views and practices around childhood vaccination, and why some parents may not accept vaccines for their children will allow healthcare services to tailor their programmes and information to particular groups of people. This should help to promote acceptance and uptake of childhood vaccination and improve child health worldwide.

What did we want to find out?
We wanted to know what factors influence parents’ views and practices around routine childhood vaccination and how these factors influence  parents. We were interested in factors that may ‘enhance’ or ‘reduce’ acceptance of vaccination.

What did we do?
We searched for studies that assessed parents’ views, experiences, and practices of childhood vaccination. Studies could take place anywhere in the world where childhood vaccination is provided. People in the study had to be parents or carers who were responsible for deciding whether a child should be vaccinated.



What did we find?
We found 145 relevant studies and analysed the results from 27 of them. Studies took place in Africa, the Americas, South-East Asia, Europe, and the Western Pacific, and included urban and rural locations, as well as high-, middle-, and low-income settings.

Main results
Many complex factors influence what parents think about vaccination and what actions they take. We divided these into 4 themes.

  1. Parents’ vaccination ideas and practices may be influenced by their broader ideas and practices about health and illness generally, and specifically about their children and the role of vaccination in their health care.
  2. Many parents’ vaccination ideas and practices were influenced by the people they mix with socially. At the same time, shared vaccination ideas and practices helped some parents establish social relationships, which in turned strengthened their views and practices around vaccination.
  3. Parent’s vaccination ideas and practices may be influenced by wider political issues and concerns, and particularly their trust (or distrust) in those associated with vaccination programmes.
  4. Parent’s vaccination ideas and practices may be influenced by their access to and experiences of vaccination services and their frontline healthcare workers.

We developed two concepts for understanding possible pathways to reduced acceptance of childhood vaccination.

  1. Neoliberal logic’, suggests that many parents, particularly from high-income countries, understood health and healthcare decisions to be matters of individual risk, choice, and responsibility. Some parents experienced this understanding as in conflict with vaccination programmes, which emphasise generalised risk and population health. This perceived conflict led some parents to be less accepting of vaccination for their children.
  2. Social exclusion’, suggests that some parents, particularly from low- and middle-income countries, were less accepting of childhood vaccination due to their experiences of social exclusion. Social exclusion may damage trustful relationships between government and the public, generate feelings of isolation and resentment, and give rise to demotivation in the face of public services that are poor quality and difficult to access. These factors in turn led some parents who were socially excluded to distrust vaccination, to refuse vaccination as a form of resistance or a way to bring about change, or to avoid vaccination due to the time, costs, and distress it creates.

What are the limitations of the evidence?
Our confidence in the evidence is mainly moderate to high. Some studies did not report their findings or methods very well, and some focused on one vaccine, type of participant or country, so were not relevant for other vaccines, participants or countries.  All of the included studies were published in English, so we we may have missed findings not published in English. The studies were often quite long with a lot of data, so we had to make practical decisions about how best to manage our analysis, which may have affected interpretations of the evidence.

How up to date is this evidence?
The evidence is up to date to July 2020.

Wednesday, October 27, 2021

What is an infodemic and how can we prevent it?: a Lifeology and Cochrane collaboration

Tue, 10/19/2021 - 16:43

In this free Lifeology course, learn what an infodemic is and what you can do to slow and prevent the spread of misinformation. 

Lifeology’s tagline is ‘The place where science and art converge’. They offer a platform that brings together scientists, artists, and storytellers to help people better understand and engage with science and health information and research. One of the main ways they meet their objectives is through beautifully illustrated, science-backed, bite-sized ‘flashcard’ courses about science and health-related topics aimed at the general public and students.

Image from the Lifeology 'What is an infodemic and how can we prevent it?' course

For World Evidence-Based Healthcare (EBHC) Day, with the 2021 campaign theme of  'the role of evidence in an infodemic', they collaborated with Cochrane to create a free course. The 41 slides walk the user through the  story of Ronald who has been misguided by misinformation and teaches what an infodemic is and how to slow the spread of misinformation.

Image from the Lifeology 'What is an infodemic and how can we prevent it?' course

Paige Jarreau, co-founder of Lifeology, said "At Lifeology, we believe that science communication in any format, including our flashcard courses, is far better when it is the product of collaboration between scientists and professional creatives like storytellers and artists. We were pleased to be able to work closely with people from Cochrane to create this course on infodemics. We've produced a beautifully illustrated free course that is practical in its tips to combat misinformation and accessible through its plain language, empathetic storytelling and relatable imagery  - it's also available in both Spanish and English!"

Image from the Lifeology 'What is an infodemic and how can we prevent it?' course

Jordan Collver, the illustrator of the Lifeology course, said "This was an exciting project to work on. We had some fun with metaphors and with well known memes in this course while keeping the story empathic and relatable in a global context.'

  • View the Lifeology course 'what is an infodemic and how we can prevent it?' in English or Spanish

 

Learn more about Lifeology: 

Tuesday, October 19, 2021

Visualizing an infodemic and approaches to countering misinformation: Lifeology SciComms Challenge

Mon, 10/18/2021 - 19:28

On 20 October it is World Evidence-Based Healthcare (EBHC) Day with the 2021 campaign focusing on the 'the role of evidence in an infodemic'. For the month of October, Cochrane is co-hosting a Science Communication challenge with Lifeology to get people to create a visual to explain what an infodemic is or an approach to countering misinformation. 

The COVID-19 infodemic is a WHO-declared pandemic that is running parallel with the COVID-19 pandemic. This infodemic, according to Tiffany Duque at Cochrane US Network, is “too much information, including false or misleading information, in digital and physical environments during a disease outbreak” that causes confusion and risk-taking behaviors, and can lead to mistrust in health authorities. An infodemic can be compared to a barrage of information spreading like wildfire across the globe through social media platforms, or waves of (both good and bad) information that overwhelm and confuse people. 

This month, Lifeology is challenging people create a visual metaphor to explain what an infodemic is or how people can help to counter misinformation and fight the infodemic.  Give people something to relate to or empower them by creating a visual metaphor for an action they can take to protect themselves or others from misinformation!

Featured submissions: 

Carrie Ekeroth @Sketchimal

 

Monday, October 18, 2021

The world must learn from pandemic lessons to avoid future catastrophes. Millions of lives could be saved through increased use of evidence.

Wed, 10/13/2021 - 15:59

Hundreds of health leaders and experts meet today to recommend the international community urgently mount stronger evidence-based responses to global health emergencies.

Led by Cochrane, co-sponsored by the World Health Organization (WHO), and co-organized with partners of COVID-END (COVID-19 Evidence Network to support Decision-making), Cochrane Convenes brings together leaders in health care and evidence synthesis to discuss the global healthcare challenges created by COVID-19.

COVID-19 created a once-in-a-generation focus on health evidence for governments, businesses and non-governmental organizations as well as many types of professionals and the public. The pandemic fast-tracked collaboration among decision-makers and researchers but also laid bare shortfalls in the systems of producing and sharing evidence.

Introducing Cochrane Convenes today, WHO Director-General Dr Tedros Adhanom Ghebreyesus said,

“During the COVID-19 pandemic, WHO’s Science Division has worked closely with the Health Emergencies Programme to produce and quality-assure more than one thousand six hundred guidance documents. This would not have been possible without our partnership with Cochrane, the partners of the COVID-END network, and our WHO Evidence Collaborative for COVID-19.”

Watch the full welcome message from Dr Adhanom Ghebreyesus on the Cochrane Convenes website

The recommendations and learning from Cochrane Convenes will form an action plan to advocate for change across the global health evidence community including those who produce evidence, share health messages and those who use evidence to make decisions in policy and practice. Participants include scientists, researchers, funders, public health decision makers and practitioners, patient and consumer advocates as well as health and science editors.

The recommendations include:

  •  The pandemic evidence response has been weighted towards high-income countries. Funders should invest more in research carried out by low and middle-income countries, support training and communication needs, and address the inequity in what is funded
  •  Building expertise in conveying uncertainty about what is known and not known during a health emergency
  • Stronger connections are needed across sectors; this involves building and incentivising institutions, partnerships and networks to be better prepared for future emergencies

Leading WHO’s involvement in Cochrane Convenes, Dr. John Grove, WHO Director of Quality Assurance, Norms and Standards explained,

“As a community of evidence producers and users we had a huge amount to take stock of. We needed to harvest what we’ve learned and Cochrane Convenes has given us the opportunity to start this. It has come out loud and clear that we need to remain connected as a community around our aim to shore up good practice in evidence production and use - for the good of all our health across the world.

Promisingly, the participants have shown the collective will exists to get us fit for purpose and now we need to move towards putting these recommendations into action.”

Cochrane’s Editor in Chief, Dr Karla Soares-Weiser said:

“Cochrane’s unique perspective placed us well to host these strategic discussions and we’ve been pleased to see a global community of evidence producers and users come together. We know we need to support the World Health Organization and its member states with the best possible evidence and guidance to ensure that local decision-makers and frontline healthcare professionals have the most trusted, high-quality evidence and information they need – but the question has been how to improve and do this better.”

She added, “What we have learned today is that the focus lies not only in maintaining the rigour of the science but also investing in our global networks and partnerships. We need to build a system we can all trust, that caters for all users of evidence wherever they are in the world.”

A summary of recommendations will inform an action plan due out later this year and will be used to advocate for change ensuring better preparedness for future global health emergencies.

Thursday, October 14, 2021

Cochrane launches new focus on diversity and inclusion

Mon, 10/11/2021 - 10:20

Cochrane wants to welcome people, no matter who they are or where they live. The more varied perspectives we have, the better we can provide evidence to help inform health and healthcare decisions.
 
We have contributors, supporters and members from all over the world, but we know very little about our community and what is important to you. This is an opportunity to learn from our community and hear your ideas about how Cochrane can become a more diverse and inclusive organisation.
 
We’ve launched a survey and are also running small online meetings. You can take part by:

  1. completing the short survey here now.  It only takes a few minutes. You don’t need to give your name
  2. AND letting us know if you are interested in attending a small group meeting to talk about your experiences of diversity and inclusion in Cochrane. If you are interested sign up here to stay informed.

We want to hear from you whether you are involved a lot in Cochrane or not much at all.  Your feedback will help to create a Diversity and Inclusion Strategy in 2022.
 
Chris Champion, Head of People Services, says

“Cochrane is a worldwide organisation that aspires to be diverse and inclusive. We want everyone to be able to participate in Cochrane, regardless of who they are and where they come from. This matters to Cochrane, because if we are more inclusive, we will be able to provide better and more relevant evidence to our users who are at the heart of our vision.”

If you want to know more about this work then please contact Chris Champion, cchampion@cochrane.org.

Friday, October 15, 2021

Author Q&A: Ketamine as a treatment for depression

Thu, 10/07/2021 - 14:01

In this interview with Doctoral Researcher Rebecca Dean and Professor Andrea Cipriani we learn more about two reviews investigating the use of ketamine as a treatment for depression recently published through Cochrane’s Common Mental Disorders Group.

Tell us about this Cochrane Review
This review is an update of a Cochrane review published in 2015, investigating the use of ketamine and other glutamate receptor modulators as a treatment for unipolar depression (also known as major depressive disorder).

Since 2015, a lot of research has been published in this area and the FDA has recently licensed esketamine (Spravato) for use in treatment resistant depression, so we realised it was time to update the review with the most recent evidence.

And we understand you recently published Ketamine and other glutamate receptor modulators for depression in adults with bipolar disorder. How do these reviews complement each other?
Both reviews look at the use of ketamine and other glutamate receptor modulators in the treatment of depression, but they are reviewed separately as these drugs may work differently according to diagnosis.

What can we learn about the role of ketamine in treating depressive disorders because of these studies?
Ketamine and esketamine may be effective in the short-term at reducing symptoms of depression for people with unipolar depression. Both of these drugs can cause side effects, which may be a consideration for treatment.

For depression in bipolar disorder, we did not find data on esketamine, but ketamine was efficacious in reducing depressive symptoms, again only in the short-term. There was no difference in side effects between ketamine and placebo for people with bipolar disorder, but this was based on very limited evidence.

There was no evidence that any other glutamate receptor modulators that we included in these reviews (such as memantine, lanicemine, and N-acetylcysteine) were more effective in treating depression over placebo in either unipolar depression or bipolar disorder.



Is there a strong message for people with depressive disorders, clinicians or policy makers?
Ketamine (and possibly esketamine) can be used to treat depression, however there wasn’t enough certainty in the evidence to be able to take away a strong message, as there were many limitations in the data available.

Further research needs to focus on the long-term effects of ketamine and other glutamate receptor modulators, so we can have enough evidence to assess whether these drugs are good at treating depression over longer periods of time and what the side effects are.

We also need more trials to compare ketamine and other glutamate receptor modulators with active drugs (not just placebo), so we can compare them and know whether they are better than current treatments for depressive symptoms.

With more evidence in a future update of this review, we hope we will be able to make stronger conclusions that can reliably inform policy and practice.

Are there any more Cochrane reviews planned on this topic OR do you plan to update these reviews in the future?
We will update these reviews as more evidence becomes available to help us better understand the role of ketamine and other glutamate receptor modulators in depressive disorders in future. There is a need for effective treatments for mood disorders, supported by robust evidence and implemented in the NHS.

Monday, October 11, 2021

Cochrane UK seeks Public Health Consultant, Oxford UK

Tue, 10/05/2021 - 14:37

Cochrane UK is seeking a dynamic, self-motivated, public health consultant with an interest in evidence-based practice to work with us one day per week. You should be on the GMC/GDC Specialist Register or the UK Public Health (Specialist) Register and be an accredited educational supervisor for public health trainees. The role can be offered as a secondment from your current employer or on a consultancy contract. 

 

You will join the small friendly team at Cochrane UK, supporting the global work of Cochrane and maximizing the use and impact of Cochrane Reviews for the UK and Ireland. You will provide expert public health advice and leadership on a range of public health issues relevant to Cochrane UK and lead on the development of links between Cochrane UK and National Public Health NHS bodies. You will play an active role in teaching and training, developing current initiatives, and supervising public health trainees and trainees in medical specialities on placement at Cochrane UK.

Download the job description and person specification (word doc).

If you would like more information, please contact Therese Docherty, Business & Programme Manager therese.docherty@cochrane.nhs.uk. Our Director, Martin Burton, is happy to discuss the role with interested candidates.

 

To apply for this post, please send a covering letter and CV to therese.docherty@cochrane.nhs.uk

Closing date 1st November 2021.

Interviews will be held virtually on the afternoon of 11th November.

Tuesday, October 5, 2021 Category: Jobs

NICE seeks Technical Analyst - Manchester, UK

Fri, 10/01/2021 - 20:42

Job Type: Fixed term (12 months),  Full time
Specialty/Function: Technical Analyst
Employer: National Institute for Health and Care Excellence
Department: Centre for Guidelines
Location: Manchester, UK
Salary: £40,057 - £45,839 per annum
Closing Date: 17/10/2021

The National Institute for Health and Care Excellence (NICE) is the independent organisation responsible for providing national guidance and advice on promoting high quality health, public health and social care.

We are looking for a Technical Analyst to support the organisation through a period of dynamic transformation.

Reporting to the Research associate – Strategic Engagement, the Technical Analyst will be a key member of the team responsible for establishing and building on existing collaborative partnerships with external organisations to facilitate the delivery of efficient and sustainable systems and processes to enable the delivery of dynamic, living guideline recommendations.

The post holder should be able to demonstrate the following:

  • Advanced theoretical and practical knowledge of a range of work procedures and practices related to process and methodology for evidence synthesis in guidelines or health services research
  • Understanding of the principles of evidence-based health care, critical appraisal and the interpretation and synthesis of health care research evidence
  • Ability to think and plan strategically and to exercise sound judgement in the face of conflicting pressures
  • An understanding of the social, political, economic and technological context in which the NHS and the Institute operates
  • Ability to establish effective working relationships with a range of professionals both within and outside the Institute
  • Effective and persuasive communicator demonstrating oral, written and presentation skills with a high degree of personal credibility and sensitivity

Learn more and apply before 17 October

Friday, October 1, 2021

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