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Cochrane in the news: August 2016

Fri, 26/08/2016 - 12:42

A round-up of selected recent media coverage citing, discussing, and presenting health evidence - updated throughout the month.


'Testing government policies first means we spend public money better – so why are we so bad at doing it?' Campbell Collaboration CEO Howard White in the The Independent on the importance of using evidence to inform policy making.

Feeling Guilty About Not Flossing? Maybe There’s No Need’ in The New York Times focuses on Cochrane Oral Health Review. 

 

 

 

 

 

 

 

 

 

 

Friday, August 26, 2016

Alder Hey Children's Hospital seeks Research Assistant - Liverpool, UK

Thu, 25/08/2016 - 06:32

The Alder Hey Children's Hospital, Liverpool, is seeking a research assistant to assist with the compilation of a series of systematic reviews relating to the non-pulmonary respiratory complications of influenza in children and pregnancy. The successful candidate should have a degree in a relevant discipline with experience in assisting with the production of systematic reviews of medical conditions or therapeutic interventions. Evidence of expert search and data extraction skills are essential. The post is available for 3 months. The lead researcher has confirmed the possibility of the work being done remotely or from at home with regular catch-up meetings at Alder Hey Children’s Hospital (Institute in the Park) or Liverpool University main campus.

For more details and to access the application form, please see the advertisement.

Closing date for applications: 12 September 2016

Thursday, August 25, 2016 Category: Jobs

What are systematic reviews?

Wed, 24/08/2016 - 02:27

 

"What are systematic reviews?"

If you’re a Cochrane contributor and have ever attempted to explain Cochrane’s work to someone, chances are you’ve tried to answer this question. And if you’re reading this because you’re new to Cochrane and the work we do, you may be wondering about this too.

Thanks to a team of creative colleagues from Cochrane Consumers and Communication, we’re pleased to share a video resource which answers this question clearly and simply for people who may not be familiar with the concept of systematic reviews: what they are, how researchers prepare them, and why they’re an important part of making informed decisions about health - for everyone. You can find this video on Cochrane’s YouTube channel, and we hope you’ll share and spread the word about the importance of evidence!

Wednesday, August 24, 2016

Cochrane 2015 Annual Review now available

Tue, 23/08/2016 - 05:39

Cochrane's 2015 Annual Review is now available. The 2015 Review features updates from the Steering Group Co-Chairs, the CEO, and the Editor in Chief, as well as achievements from 2015 and plans for 2016. Get the latest updates on Strategy to 2020, our financial standing, and our geographical reach. Read more about how Cochrane Reviews are making a difference in healthcare policy and practice, and find out about projects underway to change how we involve, support, and train Cochrane contributors at every stage of the evidence cycle.

Access a PDF version of the Annual Review

Tuesday, August 23, 2016

Cochrane Nutrition Field established in South Africa

Mon, 22/08/2016 - 16:34

Cochrane Nutrition's vision is to make Cochrane the independent, globally recognized go-to place for nutrition systematic reviews

Cochrane is delighted to announce the establishment of the Cochrane Nutrition Field (Cochrane Nutrition), under the leadership of Cochrane South Africa (SA), the South African Medical Research Council, and the Centre for Evidence-based Health Care (CEBHC), Stellenbosch University, along with international partners.

Co-Directors Solange Durão of Cochrane SA and Celeste Naude of the CEBHC will lead Cochrane Nutrition, with guidance from an international advisory board comprising representatives from multiple stakeholder and partner groups. Cochrane Nutrition has been in active development since an exploratory meeting with interested stakeholders held in Cape Town in 2015, which established that broad-based support from both Cochrane and external stakeholders.

“The vision of Cochrane Nutrition is that Cochrane will be the independent, globally recognised go-to place for nutrition systematic reviews,” said Solange Durão. “Cochrane Nutrition will support and enable evidence-informed decision-making for nutrition policy and practice by advancing the production and use of high-quality, globally relevant nutrition-related Cochrane reviews.”

The objectives of Cochrane Nutrition will include:

  1. increasing the coverage, quality, and relevance of Cochrane nutrition reviews;
  2. increasing the impact of Cochrane nutrition reviews across all stakeholder groups; and
  3. contributing to strengthening methods for conducting Cochrane nutrition reviews.

Cochrane Fields are responsible for disseminating evidence related to the Field’s topic area; building relationships with relevant stakeholders within and outside of Cochrane; coordinating methods research for conducting reviews; and supporting authors of relevant reviews, among other activities. The topic area usually focuses on a cross-cutting dimension of health care not specific to a certain body system or healthcare condition.

“The decision to create Cochrane Nutrition was based on research conducted by Cochrane SA and the CEBHC assessing the scope and quality of Cochrane nutrition reviews which found that these reviews are produced by a large number of Cochrane Review Groups without consistent guidance on how to deal with methodological and reporting challenges specific to nutrition reviews,” said Jimmy Volmink, Dean of the Faculty of Medicine and Health Sciences, Stellenbosch University. “The research also indicated a gap in currently available Cochrane Reviews addressing upstream public health nutrition problems.”

“Cochrane Nutrition will aim to coordinate activities related to nutrition reviews within Cochrane; to ensure that priority nutrition reviews are conducted with rigorous methodological approaches; and, to promote the use of evidence from nutrition systematic reviews to inform healthcare decision-making,” said Celeste Naude.


About the Co-Directors
Celeste Naude is a senior researcher and registered dietitian at the Centre for Evidence-based Health Care at the Faculty of Medicine and Health Science, Stellenbosch University. Dr Naude holds a PhD (Nutritional Sciences), a Masters in Nutrition and a BSc in Dietetics, and is a registered dietitian in South Africa and the United Kingdom. She is a member of author teams for systematic reviews and evidence summaries addressing relevant research questions in nutrition and health, and collaborates with African and international research networks via the Effective Health Care Research Consortium.  Her interests include public-health nutrition, evidence synthesis and knowledge translation to promote uptake of best evidence in policy and practice. She serves on the South African Ministerial Committee on Mortality and Morbidity in Children, the working group for the National Obesity Strategy, the Technical Reference Group on Healthy Eating (Western Cape Government) and the Cochrane Fields Executive Committee. She is an Associate Editor of the Cochrane Effective Practice and Organisation of Care (EPOC) Group, and an invited member of the Chronic Disease Initiative for Africa. She has co-authored papers in peer-reviewed international scientific journals and textbook chapters, disseminated research findings at international and national congresses, and been an invited speaker at scientific meetings.

Solange Durão is a senior scientist at Cochrane SA. She completed her Masters in Public Health (specialising in epidemiology) at the University of Cape Town and her BSc Dietetics at the University of the Western Cape. Her research interests include public-health nutrition and ensuring nutrition-related policies and practices that are based on systematic reviews of the best-available evidence. She is currently working on Cochrane reviews addressing access to food, screening for type-2 diabetes, and micronutrient supplementation in HIV-infected adults, among other nutrition-related research projects. She collaborates actively with national and international researchers and research networks in methods research about nutrition systematic reviews and in developing and implementing relevant research for the African continent. She is an invited member of the Chronic Disease Initiative for Africa and of the WHO guidelines development group for nutrition actions 2016-2018.  She is also involved in capacity building activities and networks to increase and improve the conduct and use of systematic reviews, and promoting evidence-based practice, on the African continent.



http://nutrition.cochrane.org

Contact details:
Solange Durão: +27 21 938 0506, solange.durao@mrc.ac.za
Celeste Naude: +27 21 938 9886, cenaude@sun.ac.za

Media queries:
Michelle Galloway: 084 604 4955, michelle.galloway@mrc.ac.za
Mandi Barnard: 021 938-9505, 082 573 4477, mandi@sun.ac.za

Monday, August 22, 2016

Seoul Colloquium news

Mon, 22/08/2016 - 06:00

Cochrane Colloquia are our annual flagship events, bringing together Cochrane contributors from around the world to discuss, develop and promote Cochrane, and help shape its future.

The 2016 Cochrane Colloquium will be held in Seoul, South Korea from the 23-27 October. For full information regarding the Colloquium, please visit the website.

Key information:

Programme overview: colloquium.cochrane.org/programme-overview

Registration fees: colloquium.cochrane.org/registration-fees

Key dates: colloquium.cochrane.org/key-dates

Website: colloquium.cochrane.org

Hashtag: #CochraneSeoul

Latest news:Registration closes on 10 October

Don't miss out on a chance to learn more about Cochrane and evidence-based health care. Registration closes on 10 October. Click here for the registration rates.

30 rooms left at the Grand Hilton

Reserve your room now if you would like to stay at the Grand Hilton as there are only 30 rooms left. Click here for the Hilton rates and booking information.

Plenaries, speakers and symposia:Plenary 1: Overdiagnosis and overtreatment in health care

In this session, the role of evidence-based health care and systematic reviews in limiting overdiagnosis and oversue will be discussed, including realignment of disease definition; quantification and monitoring of overdiagnosis; sensitisation of health professionals and patients; provision of balanced information on risk and benefits intervention; and the implications for Cochrane.

Speakers:

  • Alexandra Barratt, Professor of Public Health, School of Public Health, University of Sydney

  • Rita F. Redberg, Editor, JAMA Internal Medicine. Professor of Medicine, Division of Cardiology, University of California, San Francisco

  • Jenny Doust, Professor of Public Health, Faculty of Health Sciences and Medicine, Bond University

Plenary 2: Challenges and different approaches to improve the quality, timeliness and usability of Cochrane Reviews

The speakers in the plenary session have been asked to describe their experiences in making challenging decisions regarding the quality and usability of Cochrane reviews. Different perspectives and lively debate will be sought with particular focus on potential initiatives that are being explored and are consistent with the CEU vision for high quality and timely Cochrane Reviews that meets the needs of end-users and informs clinical care and health policy.

Speakers:

  • James Thomas, Project Transform, Cochrane. Director of the EPPI-Centre’s Reviews Facility, Department of Health, England

  • Karla Soares-Weiser, Deputy Editor in Chief, Cochrane Library & Cochrane Innovations

  • Marguerite Koster, External Member, Cochrane Steering Group

  • Harriet MacLehose, Senior Editor, Cochrane Library

  • Claire Glenton, Director, Cochrane Norway

Plenary 3: Data transparency: where are we and what can we get?

Pressure to increase transparency of data in clinical research is growing as scientific academies, regulatory agencies, funders and international organisations join the call for more data transparency. In this session, recent issues in the open data movement, data access policies and its impact on health care are discussed. Some examples of the impact of lack of transparency in East Asia will highlighted.

Speakers:

  • Kay Dickersin, Director, Cochrane United States. Director, Johns Hopkins Center for Clinical Trials & Evidence Synthesis

  • Byung Joo Park, Professor, Department of Preventive Medicine, Seoul National University College of Medicine

  • Lesley Stewart, Director, Centre for Reviews and Dissemination, University of York

  • Rintaro Mori, Director, Cochrane Japan. Head of Department National Center for Child Health and Department of Clinical Epidemiology

Annual Cochrane Lecture: Four challenges for EBM and Cochrane’s future

Since the term evidence based medicine (EBM) was coined over 20 years ago it has had a remarkable global influence. But EBM is not a static set of concepts, set in stone tablets in the 1990s; it is a young and evolving discipline. The fundamental concept of systematic reviews – providing a periodic summary of all controlled trials to aid clinical care – may have changed little since the birth of Cochrane. However, how to best provide and apply these in practice continues to develop.

In this year’s Cochrane Lecture, Paul Glasziou will propose four areas requiring renewed or ongoing attention:

  1. Improve dialogue between “evidologists” and clinicians
  2. Treatment is the patient’s decision: support and promote shared decision making
  3. Take non-drug interventions as seriously as pharmaceuticals
  4. Sustain investment in automating evidence synthesis 

Speaker:

  • Paul Glasziou, Professor, Evidence-Based Medicine at Bond University; Chair, International Society for Evidence-Based Health Care

#CochraneTech Symposium: The new ecosystem for evidence synthesis

Cochrane’s technological innovations are set to transform the way evidence for health is created and used. Join us at the #CochraneTech Symposium in Seoul to discover first-hand the emerging Cochrane ecosystem for evidence synthesis.

We’re preparing an exciting morning of talks and discussion centred around how Cochrane is using its technology to help both prepare systematic reviews more efficiently but also better deliver outputs to our end-users. The #CochraneTech Symposium is the premier event for those interested in the application and integration of existing and emerging technologies in the production of Cochrane systematic reviews and evidence synthesis in health care.

Since the inaugural #CochraneTech Symposium in Québec City in 2013 several ambitious technological strategies have been pursued by Cochrane, and we welcome you to join us in exploring this new ecosystem for evidence synthesis.

Methods Symposium: Living Systematic Reviews: Methods, Opportunities and Challenges

Living systematic reviews, as online summaries of healthcare research that are updated as new research becomes available, offer exciting possibilities in the new evidence ecosystem. Momentum is building around the living systematic review concept: a number of approaches are being piloted and Cochrane is at the forefront of these efforts. Living systematic reviews differ from traditional systematic reviews in several ways that have important implications for review methods and processes, affecting authors, editors and publishers. 

At this interactive symposium, we will explore what living systematic reviews actually are and their implications for Cochrane. Participants will hear from those who have been piloting living systematic review methods and will be invited to contribute their expertise as we explore the implications of LSRs for review methods and review production processes, plus the enablers within Cochrane to support their introduction.

Knowledge Translation (KT) Symposium

In 2016 Cochrane is embarking on the development of a Knowledge Translation (KT) Strategy, which will inform, facilitate and coordinate KT activities within Cochrane. We hope this strategy will scope knowledge translation activities for Cochrane, build on the Strategy to 2020 goals and provide a framework and co-ordination to support those who are undertaking knowledge translation activities in Cochrane. This framework will guide our knowledge translation work and ensure quality of outputs. We hope to establish mechanisms for better coordination of knowledge translation work within Cochrane so that organisational learning in this area flows through Cochrane.

In this symposium we will be presenting the current draft of Cochrane’s KT strategy. There will be brief presentations on the work around the strategy, an opportunity for discussion and input into further development of the strategy and the implementation plans accompanying it and what it will mean for knowledge translation in Cochrane.

Looking forward to seeing you in Seoul in October!

Monday, August 22, 2016

Featured Review: Interventions to reduce corruption in the health sector

Thu, 18/08/2016 - 17:34

Scarce evidence, but pointers to promising strategies to fight corruption in  health care

Corruption can occur in any area of the health sector, and happens when people abuse their own position to benefit themselves, their organization, or other people close to them. It can take many forms, including bribes, theft, or giving incorrect or inaccurate information deliberately. Healthcare officials, for instance, may steal healthcare funds; hospital administrators may change patient records to increase hospital fees; doctors may accept gifts or hospitality from pharmaceutical companies in exchange for using their products; and patients may try to bribe hospital staff to avoid treatment queues. Corruption can therefore take money away from health care, lead to poorer quality care, or make access to health care unfair, and often affects poor people the most.

A team of Cochrane authors based in Chile, India, Norway, and the USA worked with Cochrane Effective Practice and Organisation of Care to assess the effectiveness of strategies to reduce corruption in the health sector.

This Cochrane Review includes nine studies; five were from the USA, and the other four were from Germany, India, Kyrgyzstan, and South Korea. The review found that some strategies to fight corruption in the health sector may have an effect on corruption. Promising interventions include:

  • the use of independent anti-corruptions agencies to investigate and punish corruption;
  • guidelines that prohibit doctors from accepting any form of benefits from the pharmaceutical industry;
  • ensuring that information about medical fees is clear and accessible to the public, together with ensuring that healthcare workers are appropriately remunerated.

However, given magnitude of the problem and the limited evidence of the effects of strategies to reduce corruption, there is a need to monitor and evaluate the impacts of all interventions to reduce corruption, including their potential adverse effects.

“Anticorruption interventions can range from information campaigns to the establishment of anti-corruption agencies. It is clear that corruption is a big problem, but there is little evidence out there about how best to reduce corruption. Nonetheless, policy makers and other stakeholders still must make decisions about what to do” said Rakhal Gaitonde, the lead author of the Cochrane Review. “We found some promising strategies, but the certainty of this evidence is mostly low or very low. We are hopeful that this Cochrane Review will encourage policy makers and other stakeholders to properly evaluate the effects of whatever strategies they use to fight corruption.”

Read this Feature in Russian

Read the full Cochrane Review

Visit the Cochrane Effective Practice and Organisation of Care website

Thursday, August 18, 2016

Stay connected! Sign up for the Cochrane newsletter.

Tue, 16/08/2016 - 19:28

Cochrane Connect brings you a monthly dose of news, events, and noteworthy Cochrane Reviews - right to your inbox.

Get the latest Cochrane news with our monthly newsletter, Cochrane Connect. It rounds up the month's most important Cochrane Reviews and biggest news stories, so you can stay up to date with the latest Cochrane information.  

Each newsletter contains:

  • Feature stories from the Cochrane community
  • Cochrane Review news that includes links to free access collections, editorials, featured reviews, and press releases.
  • Organizational news which covers what Cochrane is up to and how you can get involved.

Stay connected with Cochrane by signing up for Cochrane Connect today!

Tuesday, August 16, 2016

Featured Review: Interventions for preventing abuse in the elderly

Tue, 16/08/2016 - 13:06

Lack of good research on which programs or strategies are useful in preventing or reducing elder abuse

The maltreatment of older people, also known as elder abuse, is a global problem, affecting large numbers of people worldwide. It’s a single or repeated act and, although it may be caused by employed carers, the abuse is more commonly committed by a relative, such as the son or daughter of the abused person. The maltreatment can take many forms including financial abuse, social abuse, physical abuse, sexual abuse, and neglect.

It’s difficult to know just how big the problem is, as it often occurs behind closed doors and conditions such as dementia make it more difficult to monitor. But we know that millions of older people have suffered it and that it will increase significantly as populations age. In response, communities, agencies and governments are looking for ways to prevent abuse and protect the rights of older people. A broad range of programs are on offer: including those that target carers and family members through education, systems to improve financial independency, and work with perpetrators and victims.

A team of Cochrane authors based in Australia and Malaysia worked with Cochrane Public Health to identify specific programs or strategies that are useful to prevent or reduce abuse in people 60 years and over, either aimed at the elderly themselves or people with whom they interact, such as caregivers or nursing home staff. Both randomised trials and other comparative studies that lasted at least 12 weeks were included.

Included in this Cochrane Review are seven studies which had recruited about 1,900 elderly participants and 700 other people, such as caregivers and family members, across various settings. The quality of the evidence varied with most being low or very low quality, which means that we have to be cautious about what they found on the effects of the interventions.

Overall there is inadequate trustworthy evidence to assess the effects of elder abuse interventions on occurrence or recurrence of abuse, although there is some evidence to suggest it may change the combined measure of anxiety and depression of caregivers. The included studies suggests it is uncertain whether targeted educational interventions improve the knowledge of health and allied professionals and caregivers about elder abuse and if it actually leads to changes in the way they behave thereafter, leading  to the elderly being abused less. Similarly, supporting and educating elderly victims of abuse appear to lead to more reporting of abuse, however it is unclear if the higher reporting meant more abuse occurred or a greater willingness to report the abuse as it occurred.

“It was disappointing that for such a common and worrying problem, that an abundance of good research was lacking,” said Philip Baker from Queensland University of Technology in Australia and the lead author of the Cochrane Review. “This lack of research needs to change if we are to find effective ways to prevent abuse in the elderly. There is an urgent need for government funding bodies to prioritise research in this area, given the considerable uncertainties that remain in the limited research done to date and the fact that there is very little to guide the development of a best-practice model of care. This means that there is a risk that many of the programs currently delivered do not achieve their intended purpose, or may even make things worse.  Prevention strategies need to be properly evaluated and wasteful research avoided if we are to reduce this global problem.”

Read the full Cochrane Review

Listen to the podcast  (listen in Arabic and Simplified Chinese)

Visit the Cochrane Public Health website

Tuesday, August 16, 2016

Featured Review: Music interventions for improving psychological and physical outcomes in cancer patients

Mon, 15/08/2016 - 16:10

Are there benefits of offering music interventions as a complementary treatment to people with cancer?

Cancer may result in extensive emotional, physical, and social suffering. Current cancer care increasingly incorporates psychosocial interventions to improve quality of life. Music therapy and music medicine interventions have been used to alleviate symptoms and treatment side effects and address psychosocial needs in people with cancer. In music medicine interventions, the patient simply listens to pre-recorded music that is offered by a medical professional. Music therapy requires the implementation of a music intervention by a trained music therapist, the presence of a therapeutic process, and the use of personally tailored music experiences.

A team of Cochrane authors based in the United States worked with Cochrane Gynaecological, Neuro-oncology and Orphan Cancers  to update a previous Cochrane Review from 2011 which assessed and compared the effects of music therapy and music medicine interventions for physiological and physical outcomes in people with cancer. The team identified 22 new trials for inclusion in this update, bringing the total number included in this Cochrane Review to 52 trials with 3731. Most trials were at high risk of bias, and therefore these results need to be interpreted with caution.

This Cochrane Review indicates that music interventions may have beneficial effects on anxiety, pain, fatigue, depression, and quality of life in people with cancer. Furthermore, the results suggest that music may reduce heart rate, respiratory rate, and blood pressure, though this reduction is rather small and therefore may not be clinically significant. Overall, evidence of the trials included in this review suggest that music interventions may be offered as a complementary treatment to people with cancer.

Music therapists who work with cancer patients do not limit their interventions to offering music listening for relaxation purposes. Music therapists are specially trained clinically and academically to carefully select music interventions to offer emotional and spiritual support, support communication with loved ones, enhance sense of control, and improve physical well-being in patients with cancer. Comparative analyses suggest that music therapy interventions lead to more consistent results across studies than music medicine studies. This is likely due to the fact that music therapists are trained to meet the individual needs of patients through music interventions (e.g. meeting the patient's in-the-moment needs when offering live music) rather than offering a limited selection of pre-recorded music which may not be suitable for all patients. Participants in a cross-over trial who experienced both music therapy and music medicine interventions overwhelmingly preferred the music therapy sessions because of the personal attention and care, the creativity of the interactive music making, and the opportunity for emotional expression through singing and playing instruments.

“The review is currently one of Cochrane Gynaecological, Neuro-oncology and Orphan Cancers' highest accessed reviews and this update includes an additional 22 studies in this area,” said Joke Bradt, Associate Professor at the Department of Creative Arts Therapies, College of Nursing and Health Professions, Drexel University and the lead author of the Cochrane Review. “We hope that this review may inform people with cancer, their caretakers, and physicians of the importance of therapies that work alongside medical treatment to improve the health, wellbeing, and recovery from cancer treatments. Overall, evidence of the trials included in this review suggest that music interventions offer benefits as a complementary treatment to people with cancer.”

Read the full Cochrane Review

Listen to the podcast

Visit the Cochrane Gynaecological, Neuro-oncology and Orphan Cancers website

Monday, August 15, 2016

Featured Review: Sun protection to prevent basal cell carcinoma and cutaneous squamous cell carcinoma of the skin

Wed, 10/08/2016 - 22:44

One randomized trial has been done to date that compares different ways of using sunscreen and physical barrier methods to protect against common non-melanoma skin cancers. The quality of evidence to date is low, but the review team urge caution in changing behaviour on the basis of the review findings.

Keratinocyte cancer is a more common but less serious type of skin cancer than melanoma. It comprises basal cell carcinoma (BCC) and cutaneous squamous cell carcinoma (cSCC). The main risk factor for keratinocyte cancer is exposure to ultraviolet radiation, which is a component of sunlight. The incidence of this type of cancer has increased since the 1960s, and costs of treating it are high because as much as 95% of skin cancers are of this type. Applying sunscreen and physical barrier methods, such as sun-protective clothing, hats, sunglasses, and avoiding direct exposure to sun by  searching for shade when outdoors, are often advised to stop this type of cancer from developing.

A team of Cochrane authors based in Colombia and the United Kingdom worked with Cochrane Skin to investigate how different strategies such as topical sunscreen and physical barrier methods prevent the development of BCC and cSCC of the skin in adults and children, when compared with any type of control.

The team found one randomized controlled trial from Australia that evaluated two different strategies. In one group, people were instructed to apply sunscreen daily; in the other group, they were instructed to use it when they wanted. The study had 1621 participants who were monitored for 4.5 years for new cases of BCC or cSCC. The authors found low quality evidence that the strategies had similar effects  in the number of people who developed BCC (about 8% in each group) or cSCC (about 3% in each group) over the time period of the trial.  The authors found no studies that evaluated advising people to adopt other sun protection measures, such as the use of sun-protective clothing, sunglasses, or hats, or seeking the shade when outdoors.

Lead author Guillermo Sanchez, MD, MSc, PhD from Instituto de Evaluación Tecnológica en Salud- IETS, Fundación Universitaria de Ciencias de la Salud in Bogotá, Colombia answers a few questions about this review and what the evidence means:   
 

The review set out to assess sunscreen versus other methods of sun protection such as sun-protective clothing, hats, sunglasses, or shade for preventing keratinocyte skin cancer. But based on extremely limited evidence, with just one study of occasional versus daily sunscreen, the review didn't find evidence to support these preventive measures. What’s the take-home message for patients or consumers from this lack of evidence?

“Nobody should see our review as a reason to stop protecting themselves against spending too much time in the sunlight or to avoid using sunscreen when they are outdoors. There are good reasons to avoid excessive exposure to sunlight apart from non-melanoma skin cancers. One of the key features of this review is the question we set out to address; namely how much of an effect do different skin protection strategies have on non-melanoma skin cancer risk (i.e. basal and squamous cell cancer of the skin)? We need to draw attention to this because some of the media coverage of this review challenges advice that public health agencies currently provide about reducing the risks of skin cancer, namely using sunscreen and avoiding excessive exposure to sunlight. Our most important finding relates to the lack of evidence on different approaches to reducing non-melanoma skin cancer risk by how people are advised to use sunscreen. Because further high-quality research is very likely to have an important impact on our conclusions, it is necessary to carry out additional research about sunscreen effectiveness, as well as effectiveness of other sun protection strategies (such as wearing sun-protective clothing, glasses, or hats, or seeking the shade when outdoors) for preventing of these types of cancer.

Lack of high-quality experimental evidence should not be equated with evidence that such interventions are ineffective. It is important that patients and consumers do not stop protecting their skin until better quality evidence emerges. Patients and consumers in general need to consult health professionals to obtain specific advice about the need of specific preventive measures, according with their age, skin color, occupation, and presence of other risk factors for skin cancer, among other factors.”

This review focused on more common but generally less deadly types of skin cancer - based on your knowledge of other research on skin cancer prevention, do you think there is also insufficient evidence to suggest that sunscreen or other sun protection protects against melanoma?

“Our review was focused on keratinocyte cancer, sun protection for preventing basal cell and squamous cell skin cancer, so our knowledge is limited to this issue. However, we know that being exposed to ultraviolet radiation is a risk factor for all skin cancers, and this can be avoided or reduced. Several high-quality scientific publications have addressed the evidence about melanoma, and also have been focused on population at high-risk of skin tumors. ”

 If you had a patient ask you about sun protection to minimize their skin cancer risk, what would you tell them to do?

“Given the risk factors for developing skin cancer, avoiding them and increasing protective factors are likely to play a role in lowering our risk of skin cancer. Sun exposure is one of the risk factors that can be avoided or reduced, especially in children. However, as health professionals, we need more information to decide which strategy (sunscreen type, frequency, clothing, or seeking shade) or which combination of them is more effective in the prevention of non-melanoma skin cancer. Consumers should consult qualified health professionals to obtain advice about the need of specific preventive measures, according to their age, occupation, and presence of other risk factors for skin cancer. Those with a previous history of a skin cancer and those at higher risk of skin cancer (such as people with fair skin or on immunosuppressive drugs for organ transplant) should also seek specialist advice and continue with a range of sun-protective measures until better evidence emerges.”

Read the Plain Language Summary (Also available in Croatian, Polish, Russian, and Spanish)

Read the full Cochrane Review

Visit Cochrane Skin website
    
Selected media coverage:
"Sunscreen may not prevent skin cancer, says new study: What to do now" on Medical Daily

"Scientists rehash evidence on sunscreen and skin cancer" on Reuters UK, Yahoo! UK and Ireland, Business Insider, and Channel NewsAsia

"Not much evidence sunscreen prevents skin cancer: Review" on NewsMax.com

"There's almost no evidence daily sunscreen use can prevent skin cancer" on Huffington Post

Friday, August 12, 2016

Featured Review: Fluoride mouthrinses for preventing tooth decay in children and adolescents

Fri, 05/08/2016 - 13:11

Supervised regular use of fluoride mouthwash by children and adolescents is associated with a large reduction in tooth decay in permanent teeth

Tooth decay is a health problem worldwide, affecting the vast majority of adults and children. Repair and replacement of decayed teeth is costly in terms of time and money, and is a major drain on the resources of healthcare systems. Preventing tooth decay in children and adolescents is regarded as a priority for dental services and is considered more cost-effective than treatment. Use of fluoride, a mineral that prevents tooth decay, is widespread. As well as occurring naturally, fluoride is added to the water supply in some areas, and is used in most toothpastes and in other products that are available to varying degrees worldwide. As an extra preventive measure, fluoride can be applied directly to teeth as mouthrinses, lozenges, varnishes, and gels.

Fluoride mouthrinse has frequently been used under supervision in school-based programmes to prevent tooth decay. Supervised (depending on the age of the child) or unsupervised fluoride mouthrinse needs to be used regularly to have an effect. Recommended procedure involves rinsing the mouth one to two minutes per day with a less concentrated solution containing fluoride, or once a week or once every two weeks with a more concentrated solution. Because of the risk of swallowing too much fluoride, fluoride mouthrinses are not recommended for children younger than six years of age.

A team of Cochrane authors based in the United Kingdom worked with Cochrane Oral Health to investigate how effective and safe the use of fluoride mouthrinse are for preventing tooth decay in children and adolescents compared with placebo (a mouthrinse without the active ingredient fluoride) or no treatment. The team included 37 randomized controlled trials with 15,813 children from age six to 14. The evidence was rated to be of moderate quality.  

The review found that supervised regular use of fluoride mouthrinse by children and adolescents is associated with a large reduction in caries increment in permanent teeth. Most of the evidence evaluated use of fluoride mouthrinse supervised in a school setting, but the findings may be applicable to children in other settings with supervised or unsupervised rinsing, although the size of the preventive effect is less clear. Very little evidence is available to assess adverse effects.




Wednesday, August 3, 2016

Why publish a systematic review in Cochrane?

Thu, 04/08/2016 - 19:26

Study offers insight on factors influencing choice of publication in Cochrane and non-Cochrane sources.

New evidence published in BioMed Central’s Systematic Reviews provides some insights into authors’ experiences preparing and publishing systematic reviews, as well as factors that influence choice of publication arena, specifically Cochrane and non-Cochrane sources. Results suggest that authors of systematic reviews of child-relevant topics publish in Cochrane due to its positive reputation and impact factor. Reasons for publishing in non-Cochrane sources include lack of familiarity or challenges with the Cochrane processes and desire to publish in a source more directly relevant to the topic of interest. This study suggests that end users looking for evidence in the form of systematic reviews need to be aware that there is a vast number of systematic reviews published across the medical literature.

“The value of publishing systematic reviews in Cochrane was very evident. Cochrane authors valued the support, guidance and the technical resources offered. Even authors who did not conduct and publish their systematic reviews with Cochrane used Cochrane resources, such as The Cochrane Handbook,” says Dr. Lisa Hartling, lead author of the study.  "While this study may be limited by generalizability, we hope it provides some insight on the motivations of authors when they are deciding where to publish their systematic review.”
 
Related resources:
•    Publication of reviews synthesizing child health evidence (PORSCHE): a survey of authors to identify factors associated with publication in Cochrane and non-Cochrane sources
•    Cochrane Handbook for Systematic Reviews of Interventions

Thursday, August 4, 2016

Featured Review: Xylitol sugar supplement for preventing middle ear infection in children

Wed, 03/08/2016 - 00:12

Chewing gum, lozenges, or syrup with xylitol can reduce the occurrence of middle ear infection among healthy children from 30% to 22%.

Acute otitis media (AOM) is the most common bacterial infection among young children in the United States. AOM creates a thick of sticky fluid behind the eardrum in the middle ear with a rapid onset of ear pain, discharge from ear, or fever. Although serious complications are rare, this common childhood ailment imposes a huge impact on the healthcare system. 62% of children have experienced at least one episode of AOM by the age of one and 83% by the age of three. Antibiotic treatment is costly and raises concerns about the development of antibiotic-resistant strains of bacteria, and surgery is invasive and costly.  Given these factors, effective measures for preventing AOM are sought.

An alternative preventive strategy is the use of xylitol or birch sugar, which is naturally found in plums, strawberries, raspberries, and rowan berries. Xylitol has been used for decades as a natural non-sugar sweetener, principally in chewing gums, candy, toothpaste, and medicines. Driven by increasingly health- and weight-conscious consumers, xylitol demand is expected to grow in sugar-free and low-calorie food products, especially in chewing gum. Xylitol has also been noted as being potentially clinically useful in preventing pneumococcal diseases, including AOM. Xylitol can be administered through gum or lozenges to older children, or in syrup for younger children.

A team of Cochrane authors based in Canada worked with Cochrane Acute Respiratory Infections to investigate the effectiveness and safety of using xylitol for treating AOM in children up to 12 years of age, and to update the evidence in the Cochrane Review on this subject which was last published in 2011. The authors identified five clinical trials that involved 3,405 children in daycare. The quality of evidence was moderate for healthy children and children with respiratory infections, but low for otitis-prone children.

Xylitol, administered in chewing gum, lozenges, or syrup, can reduce the occurrence of AOM among healthy children with no acute upper respiratory infection from 30% to 22%. There is no difference in side effects (namely, abdominal discomfort and rash). Based on these results, we would expect that out of 1,000 children up to 12 years of age, 299 would experience an AOM compared with between 194 and 263 children who would experience an AOM if they are provided with xylitol chewing gum. The preventive effect among healthy children with respiratory infection or among otitis-prone children is inconclusive.

“Middle ear infections in children are very common and they are a cause of worry for many parents. A cheap and safe way to prevent these episodes is very welcome,” says Amir Azarpazhooh, from the University of Toronto, Canada and the lead author of the Review. “This study shows that there is evidence for the use of xylitol in preventing middle ear infections. We hope that future studies will widen their sample, determine the ideal dosage of xylitol and, the ideal mode of delivery.”

Read the full Cochrane Review

Visit the Cochrane Acute Respiratory Infections website


Related Resources:

Wednesday, August 10, 2016

Cochrane evidence on Tumblr

Mon, 01/08/2016 - 18:16

Browse through our Tumblr account and get a visual dose of Cochrane evidence!

Tumblr is a microblogging social networking website – a place where people post images and animated graphics. On our Cochrane Tumblr account, you can view visual summaries of Cochrane evidence.

If you have a Tumblr account, you can follow us to add Cochrane evidence to your feed. If you don’t have a Tumblr account, just stop by and browse by health area or language – we have posts in seven different languages!

Cochrane Tumblr: https://cochraneblogshots.tumblr.com/ 

Tuesday, August 2, 2016

Cochrane South Africa seeks Director - Cape Town

Fri, 29/07/2016 - 06:00

Permanent position, Cape Town 

Closing Date: 29 July 2016

http://www.mrc.ac.za/hr/job4.htm

The South African Medical Research Council (MRC) strives to improve the nation’s health and quality of life through promoting and conducting relevant and responsive health research. Cochrane South Africa (CSA) is an intramural unit at the MRC.  Its mission is to prepare and maintain Cochrane reviews of the effects of health care interventions, and to promote access to, and the use of best evidence in healthcare decision-making within South Africa and the region.

The Director position calls for a senior researcher with international standing, proven leadership skills and the ability to enhance and maintain a centre of excellence that facilitates the generation and dissemination of Cochrane systematic reviews, methodological research and primary research to enhance evidence-informed healthcare and policy.  Applicants should possess the following knowledge, skills and experience:

  • Considerable experience and understanding in the conduct of Cochrane reviews or equivalent systematic reviews and meta-analysis.
  • Experience in health-related research at a senior level, with international standing
  • Extensive experience in the management of projects, staff and budgets, including the development of a multi-year programme of work.
  • Sound knowledge of the health system and disease burden of South Africa and the African region
  • Excellent communication skills, both written and oral, and a passionate champion of ‘evidence-based medicine/practice’.
  • Extensive experience or knowledge of the working of The Cochrane Collaboration, within South Africa and/or internationally.
  • Experience in training others in these methods.
  • Ability to work collaboratively, and to provide leadership.
  • Ability to work with people from a range of backgrounds, including healthcare and methodological specialists.

The post requires that the jobholder have a medical degree with specialist qualifications or a doctorate degree preferably in the health sciences, with a sound knowledge of epidemiology and/ biostatistics, 10 years of experience in the field of health research.  Experience in knowledge translation would be advantageous. The post holder should have a valid driver’s licence and be willing to travel nationally, and internationally.

The MRC offers a total cost-to-company remuneration package will be negotiated in accordance with qualifications and experience. Interested candidates should send their CV, a covering letter outlining experience relevant to the key responsibilities of the post and contact details of three referees to: Mrs Lee-Anne Louw, Human Capital Management Division, MRC, P.O. Box 19070, Tygerberg 7505 or via fax 086 742-8365 or e-mail to recruitment@mrc.ac.za More information here: http://www.mrc.ac.za/hr/job4.htm

Please quote the reference number (R951) in the subject line of your email, CV and all other communications. Certified copies of your ID and highest formal qualifications must be submitted with this application. The MRC retains the right not to make an appointment and subscribes to the principles of Employment Equity.

Thursday, July 21, 2016 Category: Jobs

The Society for Research Synthesis Methodology presents awards to Cochrane contributors

Wed, 27/07/2016 - 21:08

Tianjing Li and Julian Higgins recognized for their important contributions.

The Society for Research Synthesis Methodology supports and promotes the development and use of innovative and robust methods of research synthesis. At their 2016 Annual Meeting, held in Florence, Italy from 11-13 July, the Society recognized the important contributions of two Cochrane contributors.

The inaugural Early Career Award was given to Tianjing Li. This award recognizes young investigators of outstanding potential, promise, and accomplishment in the field of research synthesis methodology. Li is Associate Director of Cochrane United States, Co-Convenor of the Cochrane Comparing Multiple Interventions Methods Group and the Priority Setting Methods Group, and Senior Methodologist of the Cochrane Eyes and Vision. She is also Assistant Professor, Department of Epidemiology, at the Johns Hopkins Bloomberg School of Public Health. "I am greatly honoured to receive the inaugural early career award from a distinguished society formed by researchers who I have long admired and respected," say Li. "I look forward to new collaborations and innovations that will fulfill the promise of the award." Kay Dickersin, Cochrane US Director stated, "All of us at Cochrane United States and well beyond are enormously proud of Tianjing receiving this well-deserved honor.  Her unselfish contributions to systematic review methodology, teaching, and service to the research community are greatly valued by all, as is the contagious spirit of fun that she brings to all she does."

Jessica Gurevitch, outgoing SRSM President, presenting award to Tianjing Li.

The Ingram Olkin Award was presented to Julian Higgins. This award recognizes an individual who has made distinguished lifetime achievement in research synthesis methodology, and represents the highest honour bestowed by the Society. Higgins' primary affiliation is the University of Bristol; he is also involved in many Cochrane Groups, including acting as the Co-Editor of the Cochrane Handbook for Systematic Reviews of Interventions and Co-Convenor of the Cochrane Comparing Multiple Interventions Methods Group. "It is an immense honour to receive this award, although sad to be receiving it shortly after Prof Olkin passed away earlier this year,” says Higgins. “My research contributions have all been highly collaborative, and the award really deserves to be shared among the many generous and brilliant people I have been fortunate to work with over the last 24 years."

Kay Dickersin, incoming SRSM President, presenting award to Julian Higgins.

Congratulations to Tianjing Li and Julian Higgins and to the Cochrane Groups they represent for this great honour!

Wednesday, July 27, 2016

Suite of Cochrane Reviews on chronic rhinosinusitis

Tue, 26/07/2016 - 19:03

Authors working with the Cochrane ENT Group recently published six reviews which look at the evidence around different treatment options for chronic rhinosinusitis.

Chronic rhinosinusitis is a common condition that is defined as inflammation of the nose and paranasal sinuses (a group of air-filled spaces behind the nose, eyes, and cheeks). Patients with chronic rhinosinusitis experience at least two or more of the following symptoms for at least 12 weeks: blocked nose, discharge from their nose or runny nose, pain or pressure in their face and/or a reduced sense of smell (hyposmia). Some people will also have nasal polyps, which are grape-like swellings of the normal nasal lining inside the nasal passage and sinuses.

Listen to a podcast that talks about the findings of all six reviews.


Saline irrigation

Saline irrigation for chronic rhinosinusitis

Oral steroids alone

Short-term oral corticosteroids compared with no treatment or other treatments for chronic rhinosinusitis

Oral steroids added

Short-course oral steroids as an adjunct therapy for chronic rhinosinusitis

Antibiotics

Systemic and topical antibiotics for chronic rhinosinusitis

Different types of intranasal steroids

Different types of intranasal steroids for chronic rhinosinusitis

Intranasal steroids

Intranasal steroids versus placebo or no intervention for chronic rhinosinusitis


Visit the Cochrane ENT website

Tuesday, July 26, 2016

Cochrane in the news: July 2016

Thu, 21/07/2016 - 06:00

A round-up of selected recent media coverage citing, discussing, and presenting health evidence - updated throughout the month




"When and how to update systematic reviews: consensus and checklist": BMJ paper from a team of Cochrane-affiliated contributors outlines issues relevant to making decisions about updating reviews, and provides a  framework to support the decision-making process.

 

 "This clever graph shows which health supplements work - and which don't": SBS News Australia discusses the popularity of 'natural' supplements and profiles Information is Beautiful's "Snake Oil Supplements?" infographic.

A new Cochrane review on Yoga for Asthma was mentioned in the latest print edition of MindFood magazine this month. The review found yoga may have a beneficial effect on symptoms and quality of life in people with asthma, but effects on lung function and medication use are uncertain.

 

 

 

Cochrane evidence on ‘endometrial scratch’ technique to increase fertility rates was presented at the European Society of Human Reproduction and Embryology conference and picked up by many media outlets, including this story from UK’s The Telegraph.

 

 

 

Director of Cochrane Norway, Claire Glenton, explains to the nursing journal Sykepleien what Cochrane evidence is and how nurses can benefit from it (article in Norwegian).

 

 

 

 

 

Cochrane evidence on stretching to prevent or reduce muscle soreness after exercise has been used to debunk running myths in a recent article from The Guardian. Stretching before and after a run may not be as vital as some believe.

 

Thursday, July 21, 2016