Dr John Kelly, Elizabeth R. Spallin Professor of Psychiatry in the Field of Addiction Medicine, Harvard Medical School; Director, Massachusetts General hospital (MGH) Recovery Research Institute tells us about this updated Cochrane review.

What was the aim of this Cochrane review?
The aim of the review was to determine the clinical and public health benefits attributable to Alcoholics Anonymous and related 12-step Facilitation Treatments (TSF) designed to proactively link patients to AA, in helping people achieve remission from alcohol use disorder and improve their functioning and well-being.

Why is it important?
It is important because alcohol use disorder is a major cause of misery, premature death, and disease worldwide, killing ten times more people than all illicit drugs combined. AA is one of the most ubiquitous and popular sources of help for alcohol use disorder so it is important to determine the degree to which it may be helpful when evaluated against the most rigorous scientific standards available, as in the Cochrane Collaboration. 

There has been a great deal of confusion and misinformation about the state of the science on AA so we felt it was important to clarify the evidence using the highly structured and rigorous review criteria inherent in the Cochrane system.

Included in this review were more than twenty randomized controlled trials that compared AA/TSF interventions to other well-established active treatments like cognitive-behavioural interventions and motivational interviewing type treatments. Also, because AA is free and widely available, we wanted to examine the potential health care cost-benefits of implementing AA/TSF treatments relative to other more well-researched treatments to determine whether there may be savings to health care systems if they were to implement treatments that linked patients to AA.

This is an update of a review published in 2006. What has changed?
The prior review published in 2006 was based on only 8 studies and included just a few thousand participants. The quality of the evidence at that time was not strong. This updated review is based on 27 rigorous comparative investigations and included around 11,000 participants, as well as economic analyses. Thus, both the quantity and quality of the research has increased substantially in the intervening years prompting this new summary.

What are the conclusions the authors have been able to draw?
When compared to other well-established commonly delivered treatments for alcohol use disorder, AA/TSF generally performs as well as other interventions on most clinical outcomes, except for abstinence, where it does quite a bit better - particularly true for helping many more patients achieve sustained abstinence and remission. The review also found that AA/TSF reduced health care costs substantially while simultaneously improving patient’s abstinence relative to other treatments.

The quality of the evidence for the abstinence and economic outcomes was moderate to high indicating there is generally a high degree of confidence that can be placed in these new findings.

What can practitioners take from this review?
When treating patients with alcohol use disorder, AA/TSF interventions should be a frontline treatment option to be implemented in countries where AA is available. Implementing TSF interventions along the lines of those tested in this review is very likely to result in improved alcohol use disorder treatment outcomes and substantially lowered use of health care resources that saves money.

What can people seeking help for recovery from alcohol abuse learn from this Cochrane review?
Findings have important implications for people suffering from an alcohol use disorder in that there is a free, community-based, option in AA that can really help people to stop drinking and achieve lasting remission and recovery. One important finding from this review was that it does matter what type of TSF intervention people receive - better organized and well-articulated clinical linkage treatments resulted in the best outcomes. In other words, it is important for clinical programs and clinicians to utilize one of the proven manualized interventions to maximize the benefits attainable from AA participation. 

Research into freely available, community-based, recovery support resources, such as AA, was once considered nearly impossible, in recent years researchers have found creative methods of evaluating AA carefully and objectively. However what further research is needed?
The last 25 years has seen a rapid expansion in the growth of studies on AA and TSF clinical interventions designed to proactively link patients with AA. The culmination of this body of work has shown that AA can be studied and subjected to the same scientific standards as other interventions proving itself effective at helping people suffering from alcohol use disorder achieve sobriety and lasting remission all at a reduced health care cost.

These superior benefits makes sense when alcohol use disorder is viewed as a chronic illness, which for many is susceptible to relapse over months and years; one of the reasons why AA helps more people over the long-term is through its ability to keep people actively involved in its recovery-focused peer support social network over these long periods so that their brains and bodies can adjust to the absence of alcohol and the demands of recovery and help them adopt a new lifestyle that is more conducive and supportive to long-term stable remission and enhanced quality of life.

It is important to note, however, that some countries do not have AA as available as some other nations and some patients will not attend AA for various reasons despite being clinically facilitated to attend. Thus, while AA can be a valuable asset where it exists, it is important to remember that it is not suited to everyone and we need to have a variety of options available for people suffering from the range of alcohol problems and severities of alcohol use disorder. Such alternatives can take the form of medications like naltrexone and acamprosate, other ongoing professionally-delivered therapies like cognitive-behavioural counselling, and other recovery specific peer-support organizations like SMART Recovery, LifeRing, and Women for Sobriety. These other peer-based organizations await additional research to demonstrate their helpfulness but they look very promising as well.

For now, I think of AA as the closest thing in public health that we have to a free lunch - it is effective, cost-effective, and freely available. The findings are good news for sufferers and their families and, given the economic burden of alcohol use disorder in most middle and high-income countries, its availability is also good news for health care systems and national economies.

• Read the full Cochrane systematic review
• Learn more about Cochrane Drugs and Alcohol

Salary:  £26,715 to £27,511 plus London Allowance of £3,147 (pro rata) Fixed Term 9 months, Part Time 0.5 FTE
Closing Date: Friday 17 January 2020

St George's University of London is seeking a Research Assistant who is interested in conducting evidence based research examining the harms of violence and abuse on mental health. This is a stimulating 12 months research programme, funded by the UK Research and Innovation (UKRI), Violence, Abuse and Mental Health Network (VAMHN) investigating the relationship between the severity of mental health outcomes and specific characteristics of victimization including timing, duration, frequency, severity, and types of violence. These associations will be further analysed between women and men to assess the gendered nature of violence, and in relation to other social inequalities. They seek to unpack how these interacting factors are implicated in survivors’ mental health as an outcome of VA.

The post-holder will be a key member of the team from the Population Health Research Institute at St George’s University of London working alongside the prime investigator and the Research Team. The post-holder will draft data extraction templated, conduct data extraction, contribute to data analysis, assist with integration of study findings and help writing blog for the study’s findings. A survivor panel will be involved in the review which the postholder will help coordinate.

 For more information and to apply: https://jobs.sgul.ac.uk/Vacancy.aspx?ref=541-19

Cochrane is made up of 11,000 members and over 67,000 supporters come from more than 130 countries, worldwide. Our volunteers and contributors are researchers, health professionals, patients, carers, people passionate about improving health outcomes for everyone, everywhere.

Getting involved in Cochrane’s work means becoming part of a global community. The Cochrane International Mobility programme connects successful applicants with a placement in a host Cochrane Group, learning more about the production, use, and knowledge translation of Cochrane reviews. The prgramme offers opportunities for learning and training not only for participants but also for host staff.

In this series, we profile those that have participated in the Cochrane International Mobility Program and learn more about their experiences.

Name: Franciszek Borys
Location: Poznan, Poland
Cochrane International Mobility location: Cochrane Sweden

How did you first learn about Cochrane?
I first heard about Cochrane systematic review in a lecture: 'Volume-targeted versus pressure-limited ventilation in neonates" during a neonatal scientific conference in Poznan. I was really impressed by this study. However I was not involved in Cochrane research before I joined the Cochrane International Mobility Programme (CIM).

What was your experience with Cochrane International Mobility?
At the beginning of my CIM exchange I had an opportunity to complete Cochrane Interactive Training which gave me basic knowledge about systematic reviews and taught me how to conduct it. It was also great experience in terms of learning about overall research methodology. This I find definitely valuable if you are involved in evidence-based medicine. Later I was working on a systematic review on harms in Cochrane reviews on screening, which was led by the Director of Cochrane Sustainable Health Care. Last but not least, CIM is also an amazing opportunity to meet open-minded, interesting and hardworking scientist from other countries.

What are you doing now in relation to your Cochrane International Mobility experience?
 When I came back to Poland I joined DTA review about Continuous Glucose Monitoring in preterm neonates, led by Cochrane Sweden and Cochrane Netherlands. I am also going to attend workshop about DTA methodology in Sweden. My future plan is to continue collaboration with Cochrane Sweden especially in the fields of neonatology and sustainable healthcare.

Do you have any words of advice to anyone conserving a Cochrane International Mobility experience?
Just do it ;)

There are more than 50 Cochrane Reviews of the effects of interventions to help people quit smoking; one of which investigates whether reducing smoking before quitting might be an alternative to stopping suddenly. It was updated in September 2019 and we asked lead author, Nicola Lindson, from the Cochrane Tobacco Addiction Group based in the University of Oxford in the UK to tell us about their latest findings.

The standard way that people are told to quit smoking is to smoke as normal until a quit day, and then stop using all cigarettes. However, this is daunting for many, and those who have tried it without success might like to try another way. Cutting down on cigarettes smoked before quitting may provide such an alternative, and so it’s important to know whether it is as effective as quitting abruptly.

Our review investigates this and we’ve found that there is moderate quality evidence that people who were asked to stop smoking all of their cigarettes at once were not more likely to quit than people who were asked to cut down their smoking before quitting. We had also wanted to explore whether cutting down to quit resulted in any adverse effects, such as cigarette cravings, difficulty sleeping, low mood or irritability; but very few studies provided this information, so it remains unclear.

We included 51 randomised studies in the review, involving more than 22,000 people who smoked tobacco. Most were adults, and they typically smoked at least 23 cigarettes a day at the start of the research. The studies compared people who were asked to cut down their smoking and then quit tobacco smoking altogether with either a group who did not receive any treatment to stop smoking, a group who were asked to stop smoking all at once, or a group who were asked to cut down their smoking in a different way. 

Reduction methods tested varied greatly across studies; with some simply asking participants to reduce the amount they smoked, while others provided detailed instructions or suggestions of how to go about it; some of which was face to face.

Looking deeper into the evidence, we found that people who cut down their smoking while using varenicline or a fast-acting form of nicotine replacement therapy (NRT), such as gum or lozenge, may be more likely to quit than those who cut down their smoking using a different medicine, or no medicine. We also found that giving people face-to-face support to cut down may help more to quit than if they are simply provided with self-help materials.

The take home message, therefore, is that asking people to cut down their smoking first may be a useful way to help people to stop smoking. Cutting down to quit whilst using fast-acting NRT or varenicline, and whilst receiving behavioural support may maximise people’s chances of success. Future well-conducted studies should focus on investigating whether cutting-down-to-quit may be more helpful for particular populations, and which ways of cutting-down-to-quit result in the highest quit rates.

• Read the Cochrane Review
• Listen to more Cochrane Podcasts
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• Visit the Cochrane Cochrane Tobacco Addiction Group

Cochrane is for anyone interested in using high-quality information to make health decisions. Whether you are a doctor or nurse, patient or carer, researcher or funder, Cochrane evidence provides a powerful tool to enhance your healthcare knowledge and decision making. Our mission is to promote evidence-informed health decision-making by producing high-quality, relevant, accessible systematic reviews and other synthesized research evidence.

October to December 2019, was a busy quarter for Cochrane! Here we provide some highlights of the last quarter of the year.

Cochrane produces high-quality, relevant, up-to-date systematic reviews, and other synthesized research evidence to inform health decision making.

In May 2019 Dr. Karla Soares-Weiser joined us as the new Editor in Chief of the Cochrane Library. She shared with us her journey through Cochrane since 1995.

Cochrane was delighted to announce the publication of the new edition of the Cochrane Handbook for Systematic Reviews of Interventions following  extensive revision. The new edition includes: a  new chapter addressing issues around intervention complexity; a major new chapter on network meta-analysis; substantial developments in the area of risk of bias assessment; and new chapters addressing how authors can plan the review’s questions, comparisons and outcomes.

Cochrane strives to produce evidence that is accessible and useful to everybody, everywhere in the world. We create Plain Language Summaries,  provide podcasts from Cochrane Review Authors, translate our work into 15 languages, and provide  Cochrane Clinical Answers. This quarter we highlighted that you can follow us on your favourite social media platforms - Twitter, Facebook, LinkedIn, YouTube, and Instagram. 

The unprecedented situation of civil unrest across Santiago, Chile led to the cancellation of the physical gathering of Cochrane's annual Colloquium. Whilst it has caused huge disappointment and inconvenience for hundreds of Colloquium delegates, we were impressed by the generosity and perseverance to make the most out of this sad situation by our members and supporters. In a fitting tribute to Cochrane community‘s spirit of resilience and collaboration, we held a  virtual #CochraneSantiago that was open to everyone. We shared 180 digital posters, close to 120 video oral presentations, and had many special presentations on equity in systematic reviews,  how to better disseminate evidence to diverse stakeholders, and on different elements of methodological diversity. All this content is remains freely available to everyone!

We also introduced Cochrane PICO search BETA, which  can help you find the most relevant Cochrane evidence to answer your research or clinical question. It allows you to search over 4,500 Cochrane intervention reviews published since 2015 by Population (or Patient or Problem), Intervention, Comparison, or  Outcome.

Only around 6% of the world’s population are native English speakers, while 75% of people don’t speak English at all. This means many people do not have access to high quality health information, because it is not readily available in a language that they understand. We were delighted to officially launch of  Biblioteca Cochrane - the Spanish portal of the Cochrane Library. We also highlighted Cochrane's multi-language activities in a series of short videos. We have published more than 29,000 translations of Cochrane plain language summaries and abstracts as of November 2019.

 Cochrane is the ‘home of evidence' to inform health decision making. We are building greater recognition of our work and becoming the leading advocate for evidence-informed health care.

Cochrane supported an AllTrials report updating the UK House of Commons Science and Technology Select Committee on rates of clinical trial reporting among universities and NHS trusts.

Through Cochrane Crowd, our Citizen Scientist platform, we introduced many people to Randomized Controlled Trials. The community screened also screened more than 100,000 records for the #ColloquiumChallenge2019!

Cochrane strives to a be a diverse, inclusive, and transparent international organization that effectively harnesses the enthusiasm and skills of our contributors, is guided by our principles, governed accountably, managed efficiently, and makes optimal use of its resources.

Getting involved in Cochrane’s work means becoming part of a global community. We were happy to help connect our members with Cochrane Groups across the world through the launch of the Cochrane International Mobility programme! We also expanded our organization by welcoming  Cochrane Dominican Republic and the Cochrane Sustainable Healthcare Field.

Karla Soares-Weiser, Cochrane Library’s Editor in Chief, outlined a new conflict of interest policy that is forthcoming in 2020 in a BMJ opinion piece. Cochrane is committed to independence, transparency, and integrity in healthcare research and minimizing the impact of conflicts of interest in the conduct of Cochrane Reviews. Although Cochrane’s current conflict of interest policy is stricter than most journals, we have revisited it recently with the aim of strengthening our approach to financial conflicts of interest and clarifying our position regarding non-financial interests.

• Learn more about Cochrane's mission and work
• Join Cochrane and be part of a global network of more than 79,000 supporters and members
• See Q1 2019 highlights
• See Q2 2019 highlights
• See Q3 2019 highlights

Su Min Lai and Laura Tan took home the  Borrow Foundation Early Career Poster Award in a poster competition at the annual conference of the British Association for the Study of Community Dentistry.

Su Min and Laura were the only undergraduate students to verbally present, and were the youngest presenters at the conference, making their achievement all the more remarkable. The students are from the University of Dundee and work with Cochrane Oral Health on the Wikipedia Collaboration of Dental Schools. The Collaboration's mission is to improve Wikipedia by making the articles more evidence-based. The poster set out the mission and ethos of the Collaboration, which to date has amended 287 Wikipedia articles in two languages.

Congratulations to Su Min and Laura, and to the hard-working student volunteers who give up their time to this project.

• View the winning poster
• Learn more about The Cochrane Wikipedia Partnership and how you can get involved

Specifications: Full Time
Salary: Competitive
Location: London
Application Closing Date: January 6th, 2020 (At 12 Midnight GMT)

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

The Junior Systems Administrator will support the smooth running of Cochrane’s infrastructure and systems used by Cochrane Central Executive (CET) members (approx. 100 people. They will support and troubleshoot local and remote computers managed by Informatics & Technology Services (ITS) department.

The successful candidate will be responsible for the following activities:

• Provide frontline technical support to Cochrane Central Executive, investigating and troubleshooting issues efficiently communicating technical information where required in an accessible way to non-technical people.
• Manage and maintain Cochrane IT infrastructure, systems and application software, network services and data on behalf of the Cochrane Informatics and Knowledge Management Department (IKMD).
• Ensure enough IT support and provision for the Cochrane Central Executive by responding to technical queries and ensuring IT equipment is maintained and replaced according to agreed internal IT equipment guidelines.
• Perform regular routine backup, maintenance and checks of the Cochrane ITS systems.
• Maintain operational, configuration, security, or other standard operation procedure documentation for all ITS standard operation procedures to be held.
• Provide second line technical support to non-Cochrane staff whose queries come through our central support service, through efficient and timely use of the help desk system whilst endeavouring to meet reasonable service standard resolution times wherever possible.

We are looking for a self-motivated and highly organised individual who is able to work effectively and collaboratively with a diverse range of contacts across the world.  The successful candidate will also have:

• Degree in computer science or equivalent experience
• Experience helping to diagnose and solve computers systems (PC/Mac), and network problems
• Excellent analytical and problem-solving abilities to identify and fix problems and security risks
• Excellent organizational, collaboration and interpersonal skills
• Ability to prioritize own tasks against project and team goals
• Ability to multitask and prioritize work requirements
• Able to work efficiently and effectively with a geographically-dispersed department and organization
• Willingness to travel as required

Cochrane is a global, independent network of health practitioners, researchers, patient advocates and others, responding to the challenge of making vast amounts of research evidence useful for informing decisions about health. We do this by synthesizing research findings to produce the best available evidence on what can work, what might harm and where more research is needed. Our work is recognised as the international gold standard for high quality, trusted information.

If you would like to apply for this position, please send a CV along with a supporting statement to recruitment@cochrane.org with “Junior Systems Administrator” in the subject line.  The supporting statement should indicate why you are applying for the post, and how far you meet the requirements for the post outlined in the job description using specific examples.  List your experience, achievements, knowledge, personal qualities, and skills which you feel are relevant to the post.

• For further information, please download the full job description from here
• Deadline for applications: January 6th 2020 (12 midnight GMT)
• Interviews to be held on:
• Phone interviews between 6th and 13th January 2020
• Face to face interviews on the 23rd or 24th January

Since its beginnings, Cochrane has involved healthcare consumers (the language is interesting but consumers are patients, care-givers, and family members and others) in producing new knowledge about healthcare treatments. The reasons for this are compelling. Consumers are the ultimate beneficiaries of all of Cochrane’s work. Our strapline is “Trusted evidence, informed decisions, better health”. Meaningfully involving patients is a key part of ensuring that we achieve our mission. This two minute video recorded for Cochrane Common Mental Disorders Review Group briefly sums up why we should all think about how we can involve consumers in our work.

Cochrane’s Statement of Principles for Consumer Involvement was adopted by the Cochrane Governing Board in 2017 and, amongst other things, says this: “Cochrane believes that the benefits of consumer involvement are best realised when consumers contribute throughout the process of production and dissemination of research.”

Cochrane’s author teams are at the forefront of producing the evidence that consumers increasingly rely on to make their healthcare decisions. There have been some inspiring examples of innovative work undertaken with consumers. You can hear Alex Pollock talk about how consumers were involved in shaping a Cochrane review here. And these resources – Involving People – have been designed to give author teams access to advice, a framework for thinking about involvement, and examples of how other people have done this complex but rewarding work.

Involvement can be a key part of Cochrane’s groups’ work too, from prioritisation to consumer peer review, and the new peer review policy more strongly emphasised the role of consumers. You can read a blog about what peer review feels like from a consumer perspective here.  Consumers are involved in the running of the organisation, from the Cochrane Consumer Network to the Cochrane Council. Learning from patients’ experiences and spreading information about Cochrane’s evidence is an important role for consumers too, see Cochrane UK’s Evidently Cochrane for example.

If you are thinking about involving consumers more in your work or are a consumer and want to get involved, here are 5 things you can do today!

1. Subscribe to the Cochrane Consumer monthly news digest
2. Join the the new International Network for Patient and Public Involvement in Health and Social Research
3. Join the Cochrane Consumer Network
4. Watch this video by Neal Haddaway talking about stakeholder involvement in evidence synthesis
5. Follow these Twitter accounts @cochraneconsumr and @GlobalPPINet

For more support with involvement contact Richard Morley, Consumer Engagement Officer rmorley@cochrane.org

In 2021, Cochrane in collaboration with Guidelines International Network, Campbell Collaboration and Joanna Briggs Institute, will host a Global Evidence Summit 2 (GES) in place of their annual organizational events. The four global organizing partners and the hosts, Czech National Centre for Evidence-Based Healthcare and Knowledge Translation (CEBHCKT), are now inviting Professional Conference Organizer’s (PCOs) to tender for the provision of event management services for its quadrennial event in 2021.

The GES brings together the world’s leading organizations in evidence-based practice to provide a multi-disciplinary and cross-cultural platform to discuss critical issues in health, education, social justice, climate change and clinical care and practice.

We plan to host a 6-day event comprising pre-conference workshops/symposia (1 day); the Global Evidence Summit (4 days) consisting of meetings, plenaries, workshops, poster and oral presentations and post-conference workshops/meetings (1 day).

The spirit of the GES is ‘Using Evidence. Improving Lives.’ It aims to:

• advance the use of reliable research evidence in addressing some of the world’s most serious health and social challenges;
• bring together multidisciplinary actors from the global evidence community;
• facilitate communication and collaboration between all those working on the synthesis, dissemination and implementation of evidence
• promote evidence-based decision-making worldwide;
• strengthen ties between all partners and supporters within the partnership framework; and
•  showcase the work of all partners and supporters with high-quality scientific presentations.

Click here for full detail

SUBMISSION OF TENDER DEADLINE

Please submit all information requested no later than Friday 31 January 2020 to: Contact@globalevidencesummit.org

TIME FRAME FOR TENDER PROCESS

Tuesday 17 December 2019 - Invitation to Tender forwarded to PCOs

Friday 31 January 2020 - Closing date for tender submission

Week commencing 10 February 2020 - Call with shortlisted Tenderers

Friday 28 February 2020 - Announcement of decision (subject to Contract negotiation)

AWARDING OF CONTRACT

It should be noted that the Appointment of the PCO and the awarding of this contract will not only be dependent on the fees quoted but will be dependent upon the proven ability of the PCO to have understood the requirements of the Summit and their ability, based on experience, to deliver the event.

ENQUIRIES

Requests for further information or clarification of requirements may be directed to: Contact@globalevidencesummit.org

Please note that we reserve the right to advise, at our discretion, all parties issued with a request for proposal, of further information/clarification of tender requirements resulting from any enquiry.

Cochrane US Network convened for their first in-person meeting on 10 – 11 December 2019 in Philadelphia, hosted by American College of Physicians, an affiliate center.  The meeting was well attended, with delegates representing 17 of the 21 member groups that comprise the US Network. This convening served as an opportunity for sharing information, networking, and discussing governance and strategic priorities for the US Network. 

US Network work groups reported on their activities and proposed priorities. Initial areas of work have involved:

1. Developing an evidence package and dissemination strategy for a selection of systematic reviews on the management of opioid use during pregnancy and among neonates exposed in utero. The US Network has engaged the American College of Obstetricians and Gynecologists to inform this project.
2. Defining consumer engagement and involvement as a priority for the US Network, with priority for identifying and promoting best practices for consumer engagement and involvement in systematic review production, knowledge translation and dissemination. Additionally, the US Network has a priority interest in gaining understanding of how consumers prefer to receive health information, what health information is most valuable to consumer decision-making, and consumer preferences for involvement in the research process.
3. Examining opportunities for accelerating data curation and standardizing data to support interoperability and better use of data.

Meeting participants discussed governance of the US Network. Consensus was established among meeting participants on US Network membership, decision-making, an executive committee structure. Meeting participants also provided their input on priority areas of work for the US Network during the next twelve months. The list of priorities included raising awareness of Cochrane and the US Network (e.g., social media presence), focusing on strategic dissemination of Cochrane evidence, advocating for evidence and evidence informed health decision-making, and planning for a US-based conference to engage stakeholders and provide opportunities for training.

Following the internal convening of members, a meeting with stakeholders was held to gain their insight and input to US Network priorities. This session was also well attended, with delegates from the American College of Obstetricians and Gynecologists, Agency for Healthcare Research and Quality, Centers for Disease Control and Prevention, Environmental Protection Agency, National Library of Medicine, Patient-Centered Outcomes Research Institute and Robert Wood Johnson Foundation.

The US Network will continue to convene via monthly virtual meetings and will plan a next in-person meeting later in 2020.

• Learn more about the Cochrane US Network

In this interview we asked authors Dr Laurence Le Cleach and Emilie Sbidian to tell us more about this Cochrane Living Systematic Review: Systemic pharmacological treatments for chronic plaque psoriasis, network meta analysis

Tell us about this Cochrane Review...
Psoriasis is a frequent inflammatory skin disease affecting between 2 and 8% of the general population. Plaque psoriasis characterized by raised and well-demarcated areas of inflamed skin covered with silvery white, scaly skin is the most common form. Psoriasis affects deeply quality of life. There is currently no cure for psoriasis, but various treatments can help to control the symptoms; thus, long-term treatment is usually needed. About 20% to 30% of people with psoriasis have a moderate to severe form requiring a second-line therapy including phototherapy and conventional systemic agents. Biological agents are more recent systemic therapies.

The objectives of our review were to compare the efficacy and safety of conventional systemic agents for patients with moderate to severe psoriasis and to provide a ranking of these treatments according to their efficacy and safety by the mean of a network meta-analysis.

Our review included 140 studies (31 new studies for the update) and 51,749 participants. 

Is it the first iteration of this Living Systematic Review (LSR) or an update?
This review was published for the first time in December 2017. This version evolves this review into a LSR. This current version is both an update and first occurrence of the LSR.

How often will it be updated? And what will be included in the updates?
Search for study, selection, data extraction followed by inclusion of characteristics and risk of bias analysis for each newly identified trial will be performed each month. Every 3 months, each newly identified trial will be incorporated in the Network Meta Analysis.

Why is pharmacological treatments for psoriasis a good topic for a LSR?
This is a very good topic for LSR as numerous new trials assessing systemic treatments for moderate to severe plaque psoriasis are regularly published. It is demonstrated by the high number of new trials added between the first version published in December 2017 and this one published only two years later and the 42 identified ongoing studies identified in the present study.

Who will benefit from this LSR?
It is a major resource for guidelines teams who are encouraged to move to living guidelines methods in order to constantly adapt the recommendations to reflect the new evidence highlighted in the LSR.

Is this the first time you have worked on a LSR? How does the experience differ?
Yes, it is the first time. Moving to an LSR means we’ve had to define new ways of organization for both the author and the editorial team. This organization is an ongoing process for us. We have anticipated the new processes involved, but obviously we will face new ones in the coming months.

• Read the full Cochrane Review
• Learn more about the Cochrane Skin Group
• Learn more about LSRs

Specifications: Permanent, 80-100% Full Time Equivalent, flexible working patterns
Salary: £52,000 pro rata
Location: Flexible (options include working from Cochrane’s offices in London, UK or in Freiburg, Germany; or remotely from anywhere else)
Application Closing Date: 5 January 2020 Midnight GMT

This is an exciting opportunity to improve Cochrane’s planning and performance management capabilities as the organization completes its transformational Strategy to 2020 and enters a new strategic planning phase. The Planning & Performance Manager will hold responsibility for designing and implementing improved strategic and operational planning processes, supporting the Senior Management Team and departmental staff to build robust, measurable workplans through which delivery can be managed and achieved.

In this newly created position, you’ll also be required to design processes for, and then collect and provide analysis of, key organizational performance information. These processes should enable progress against strategic and operational objectives to be measured, evaluated, effectively communicated to internal and external stakeholders, and used as the evidence-base to inform further plans. In other words, you’ll be responsible for developing what Cochrane currently regards as a ‘missing link’ in its strategic infrastructure for operationalizing strategic plans.

We are looking for someone dynamic and self-motivated who is comfortable working independently, but also collaboratively with a diverse range of contacts across the world. The successful candidate will have:

• Experience in a similar cross-functional role, or in project portfolio or programme management
• Experience of developing and managing the implementation of planning, performance and evaluation processes, and of developing performance indicators and results frameworks
• Outstanding communication skills in English, both written and in person, with the ability to synthesize and explain complex information to a range of audiences
• Ability to rapidly establish credibility, and maintain positive relationships, with people and teams from a range of functional, professional, linguistic and cultural backgrounds, including those who are not familiar with planning processes and performance indicators

In return, Cochrane offers an exciting, international work environment, the opportunity to travel, and a competitive benefits package.

Cochrane is a global, independent network of health practitioners, researchers, patient advocates and others, responding to the challenge of making vast amounts of research evidence useful for informing decisions about health. We do this by synthesizing research findings to produce the best available evidence on what can work, what might harm and where more research is needed. Our work is recognised as the international gold standard for high quality, trusted information.

If you would like to apply for this position, please send a CV (Resume) along with a supporting statement to recruitment@cochrane.org, with “Planning & Performance Manager” in the subject line.  The supporting statement should indicate why you are applying for the post, and how far you meet the requirements for the post outlined in the job description using specific examples.  List your experience, achievements, knowledge, personal qualities, and skills which you feel are relevant to the post.

• For further information, please download the full job description from here
• Interviews to be held early in January 2020

Specifications: Permanent, 80-100% Full Time Equivalent, flexible working patterns
Salary: £40,000 pro rata
Location: Flexible (options include working from Cochrane’s offices in London, UK or in Freiburg, Germany; or remotely from anywhere else)
Application Closing Date: 5 January 2020 Midnight GMT

This is an exciting opportunity to improve Cochrane’s project prioritization, planning and management capabilities as the organization completes its Strategy to 2020 and enters a new strategic planning phase.

In this newly created position, you’ll be required to establish and co-ordinate a project and portfolio management framework for Cochrane; developing tools and resources, and provide training, to improve the project management skills of staff; and monitoring and reporting on Cochrane’s portfolio of projects to inform evidence-based strategic decision-making.

We are looking for someone dynamic and self-motivated who is comfortable working independently, but also collaboratively with a diverse range of contacts across the world. The successful candidate will have:

• An industry standard qualification in project, portfolio or programme management
• Experience in providing training or coaching to others, especially in project or programme management
• Excellent communication skills in English, both written and in person, with the ability to synthesize and explain complex information to a range of audiences
• Ability to rapidly establish credibility, and maintain positive relationships, with people and teams from a range of functional, professional, linguistic and cultural backgrounds, including those who are not familiar with project management

In return, Cochrane offers an exciting, international work environment, the opportunity to travel, and a competitive benefits package.

Cochrane is a global, independent network of health practitioners, researchers, patient advocates and others, responding to the challenge of making vast amounts of research evidence useful for informing decisions about health. We do this by synthesizing research findings to produce the best available evidence on what can work, what might harm and where more research is needed. Our work is recognised as the international gold standard for high quality, trusted information.

If you would like to apply for this position, please send a CV (Resume) along with a supporting statement to recruitment@cochrane.org, with “Project Portfolio Officer” in the subject line.  The supporting statement should indicate why you are applying for the post, and how far you meet the requirements for the post outlined in the job description using specific examples.  List your experience, achievements, knowledge, personal qualities, and skills which you feel are relevant to the post.

• For further information, please download the full job description from here
• Interviews to be held early in January 2020

Originally published in the Cornell Chronicle

Folate is an essential B-vitamin that is needed for DNA synthesis and cell division. Folate deficiency can lead to anemia, and deficiency early in pregnancy can lead to neural tube defects – birth defects of the brain, spine and spinal cord, including spina bifida.

A Cochrane systematic review on the benefits and safety of fortifying wheat or maize flour with folic acid and population health outcomes, led by scientists in the Division of Nutritional Sciences at Cornell, found that fortification with folic acid (the synthetic form of folate) may improve folate status and reduce the occurrence of neural tube defects. However, the review found limited evidence for an effect of fortifying wheat or maize flour with folic acid on hemoglobin levels or risk of anemia, and no studies reported on the occurrence of adverse side effects.

The researchers’ findings, published in the Cochrane Database of Systematic Reviews, will help to inform World Health Organization (WHO) guidelines and recommendations for the national policies and public health programs of its 194 member states.

Cochrane systematic reviews are recognized internationally as representing a gold standard for high-quality evidence for medicine and public health.

This is the first Cochrane systematic review to examine the efficacy of wheat and maize flour fortified with this essential vitamin that is widely known to help prevent neural tube defects.

“The links between maternal folate status early in pregnancy and risk of neural tube defects, a type of severe pregnancy outcome, has been known for over 50 years – and the benefits of periconceptional folic acid supplementation were established with two landmark randomized trials in the early ‘90s,” said Julia Finkelstein, assistant professor in Cornell’s Division of Nutritional Sciences.

“Based on this evidence, flour has been fortified with folic acid in over 60 countries and is one of the most important public health success stories worldwide to prevent neural tube defects,” she said. “However, a systematic review was needed to evaluate the efficacy and safety of folic acid fortification interventions of these two staple flours – and to inform the development of World Health Organization guidelines,” she said.

“This review complements the existing evidence from observational studies and programmatic experience from public health programs, and the findings lead to a better understanding of the benefits and safety of folic acid-fortified wheat and maize flour on population health outcomes,” said Elizabeth Centeno-Tablante, doctoral student in the Division of Nutritional Sciences.

Fortification is one of the main approaches to improve vitamin and mineral intake in populations – to reach at-risk populations without requiring behavior change. “Fortification of staple foods with folic acid is an important strategy to improve folate status in women of childbearing age – since neural tube defects develop in the first four weeks of pregnancy when most women do not yet know they are pregnant,” said Finkelstein.

“In a public health framework, if you can shift the population distribution of folate, you can improve folate nutrition in women during a vulnerable period and help reduce the risk of a very serious health outcome – without changing behavior, in an inexpensive way, to the most vulnerable populations,” Finkelstein said.

No previous systematic reviews evaluated the efficacy of folic acid fortified flour on other health outcomes in the general population. For example, what are its impacts on folate status, anemia or other pregnancy outcomes? What might the benefits or harms be for those with no chance of becoming pregnant – such as children, men or the elderly?

“This Cochrane review includes benefits and safety and any health outcome in any population – for a holistic view of the scientific evidence available to date on this topic,” Finkelstein said.

Evidence from this review has been incorporated into the World Health Organization guideline titled, “Fortification of Maize Flour and Corn Meal With Vitamins and Minerals” and will be incorporated into the upcoming WHO guideline for wheat flour fortification.

The Division of Nutritional Sciences at Cornell University has been a PAHO/World Health Organization Collaborating Centre since 2015, and this year was named an Affiliate Centre for Nutrition in the new Cochrane US Network.

The Cochrane protocol and review were developed as part of the annual WHO/Cochrane/Cornell University Summer Institute for Systematic Reviews in Nutrition for Global Policy Making, hosted by the Division of Nutritional Sciences.

Stephen D’Angelo is the Assistant Director for communications for the College of Human Ecology.

• Read the full Cochrane Review: 'Fortification of wheat and maize flour with folic acid for population health outcomes'
• Visit the Cochrane Public Health website

The Cochrane Crowd challenges are always fun. People from around the world log in to Cochrane Crowd and assess titles and abstracts, deciding whether they are describing a randomised trial or not. Here’s an example:

It’s slightly odd perhaps just how fun it is; how with every challenge the race towards the finish line is a guaranteed adrenalin rush. This latest challenge was no exception.

We got off to a very strong start. Even just after two hours, I knew we’d have to change the target of 48,000; by the halfway point we had already reached that. Picking a new target is always a slightly risky business. Whilst it is good to aim high, setting a target too high and then missing it by some way would be a little deflating. I’ll admit a part of me thought, we’re all tired, and it’s the end of the year: why don’t we just go for something totally achievable and sit back and relax. But no, that’s not what we do in Cochrane Crowd!

We like to push ourselves to the limits: in that case, let’s aim for 100,000 classifications in 48 hours! As soon as I twitted this new target, I regretted it. Time seemed to suddenly speed up and for a while we struggled to keep pace, but then just as I was considering how to reduce the target, the numbers starting climbing up and up. At 97,000 classifications I knew we’d make it (just) and I’ll admit I shed a little tear. We ended on 100,724 classifications. Never underestimate the Cochrane Crowd community.

In context: we did more in 48 hours, than we did in the first six months of the Embase project. We launched the former version of Cochrane Crowd (the Embase project) in February 2014. Back then it took us six months to reach 100,000 classifications. Nowadays, it takes around 2-3 months to notch up 100,000 classifications. Doing it in 48 hours is therefore pretty darn impressive.

It was a truly international effort: 165 people based in 47 countries took part and collectively identified just over 6750 reports of randomised trials from 100724 total classifications made. A special thanks needs to go to the challenge’s top three screeners who devoted a significant amount of time to the challenge. A very well done to: Abhijit Dutta, Nikolaos Sideris and Brian Li.

This was a special challenge, designed to run alongside a very special Colloquium: Cochrane’s first virtual Colloquium: https://colloquium2019.cochrane.org

If you are new Cochrane Crowd but looking for a way to contribute to the work of Cochrane that is flexible and fun, then do take a look to see if Cochrane Crowd is for you: https://crowd.cochrane.org It’s a thriving and clearly very energetic community! And if you have any questions or queries please don’t hesitate to get in touch with me (Anna) or my brilliant team mate Emily at crowd@cochrane.org

Finally, thank you to everyone who was able to join in with this latest challenge and indeed any of our previous challenges.

Together we are making a difference.

Anna and Emily

In this interview with review author Anjna Rani we learn more about the recently published review, Interventions to reduce Staphylococcus aureus in the management of eczema.

Tell us about this Cochrane Review  
This review looks at the evidence of treatments, such as antibiotics, antibacterial soaps/baths, to reduce a type of bacteria called Staphylococcus aureus (S. aureus) that is predominant on skin with eczema.  The review assessed a wide variety of treatments to help treat/reduce infected eczema – 41 studies involving 1753 participants were included in total.

Why is it important for patients with eczema?
Eczema is a frustrating skin condition with a number of different treatments. It is important for patients with eczema to understand the variety of treatments available and which one(s) would be suitable for them and are more likely to work to reduce impact on everyday life.

What can this review tell us about how effective treatments are to reduce skin infections in the management of eczema?  
Topical corticosteroid/antibiotic combinations are still prescribed widely due to effective marketing. Antiseptic wash products are also widely used, and antibiotics prescribed readily for “infected” eczema when what is needed is adequate control of skin inflammation.  Unfortunately, however, despite the number of trials included, there was so much variance in the types of treatment that the quality of evidence is low

How does this review link to a James Lind Alliance priority topic? (This is a shared priority, important to patients and health professionals.)
This was one of the top 10 questions, actually grouped in the health professional priorities, - “How effective are interventions to reduce skin infections in the management of eczema?”

Does the review point to more research being needed?
The conclusion of the review, “In view of the low quality of evidence and lack of information on quality of life and antibiotic resistance, a larger, definitive trial on steroid/antibiotic combination treatment is required. With the increased concerns about antibiotic resistance, other strategies to treat S. aureus infection that do not involve antibiotics should be further investigated.” 

• Read the review
• Learn more about Cochrane Skin

The authors reviewed the evidence on the effect on death of using corticosteroids in children and adults with sepsis.

Sepsis is present when an infection is complicated by organ failure. People develop rapid breathing, hypotension (low blood pressure), and mental confusion. Sepsis can interfere with the effectiveness of the body’s corticosteroids, which serve as a key defence against infection. Corticosteroids have been given for decades to people with infection resulting from various causes.

The review included 61 trials (12,192 participants). Fifty-eight trials compared corticosteroids to no corticosteroids (placebo or

usual care in 48 and nine trials, respectively); three trials also compared continuous versus bolus administration of corticosteroids.

The authors analysed the following two comparisons:

•  Corticosteroids versus placebo/usual care: Corticosteroids probably reduce the risk of death at 28 days by 9% (50 trials; 11,233 participants), with consistent treatment effects between children and adults. They also probably slightly reduce the risk of dying in hospital. There may be little or no effect of corticosteroids on risk of dying over the long term (longer than three months), but these results are less certain. Corticosteroids result in a large reduction in length of stay in the intensive care unit (ICU) and in hospital. Corticosteroids increase the risk of muscle weakness and hypernatraemia. They probably increase the risk of hyperglycaemia. They probably do not increase the risk of superinfection. There may be little or no effect of corticosteroids on risk of gastroduodenal bleeding, neuropsychiatric events, stroke, or cardiac events.
• Continuous infusion versus intermittent boluses of corticosteroids: We are uncertain about the effects of continuous infusion of corticosteroids compared with intermittent bolus administration. Three studies reported data for this comparison, and the certainty of evidence for all outcomes was very low.

The authors assessed the certainty of evidence as;

1. Corticosteroids versus placebo/usual care.The authors judged the certainty of evidence for 28-day mortality as moderate due to some inconsistency related to differences among study populations, types of corticosteroids and how they were given, and use of additional interventions
2. Continuous infusion versus intermittent boluses of corticosteroids.The authors judged the certainty of evidence for 28-day mortality as very low due to inconsistency and imprecision.

• Read the review
• Learn more about Cochrane Anaesthesia

All content remains freely available on the Colloquium website and open to everyone!

Cochrane’s annual flagship event brings together the world’s most influential health researchers, scientists, academics, opinion leaders, clinicians, and patients to promote evidence-informed decision-making. The unprecedented situation of civil unrest across Santiago led to the cancellation of our face-to face 2019 Colloquium and Cochrane’s first virtual Colloquium.  Whilst we recognize our virtual meeting can never replace what we would have achieved together in-person in Chile, we believe that this unique week of content as a fitting tribute to recognizing the extraordinary efforts of hundreds of contributors and the Cochrane community's spirit of resilience and collaboration.

We were so pleased to see all of the social media activity around Virtual #CochraneSantiago last week and it was very exciting to see the diverse content. The amount of work that went into the nearly 180 digital posters and close to 120 video oral presentations was impressive! We heard about equity in systematic reviews; learned about how to better disseminate evidence to diverse stakeholders; and looked at different elements of methodological diversity. We also had time to look back; we relived some memories of prior Colloquia, celebrated acheivements of our community,  and had our Annual General Meeting. We ended the week by looking ahead; to ways people can get involved, the vision of our new Cochrane Library Editor, and to our next Colloquium; #CochraneToronto in 2020! In the midst of all of this content, we also screened more than 100,000 records for the Cochrane Crowd #ColloquiumChallenge2019!

If you participated in the Colloquium last week, please share your feedback with us by 20 December. This short survey will help us know what you thought of Cochrane’s first Virtual Colloquium and will help inform what we do virtually in the future!

Finally, we would like to remind you that all Virtual #CochraneSantiago content will stay active and the 2019 Colloquium website, so you can get back to watching those oral presentations you missed during Colloquium week.

Thank you for your participation and feedback!

• Take part in the 5 minute participation survey
• Visit all the virtual #CochraneSantiago content

Medical excess threatens the health of individuals and the sustainability of health systems. The best available evidence demonstrates that reducing medical excess is very challenging and that there is a pressing need for more and broader work on how to move forward. A new editorial in the Cochrane Library examines these  issues and how the priorities and vision of  the new Cochrane Sustainable Healthcare field will address them.

• Read the new Cochrane Library Editorial, 'Cochrane Sustainable Healthcare: evidence for action on too much medicine'
• View the news item about the launch of Cochrane Sustainable Healthcare field

Specifications: Permanent
Salary: c£40,000
Location: London Office based
Application Closing Date: 5 January 2020 Midnight GMT

This role is an exciting opportunity to use your experience in HR to make a difference in the field of health care research.  You will be part of a small team providing a high quality, responsive, efficient and effective Human Resources function for Cochrane and its subsidiaries.

Your key areas of responsibility will be:

• Responsible for our recruitment and on-boarding processes from end to end
• Leads on workforce planning so that we can meet our future staffing needs
• Key responsibility for promoting equality, diversity and inclusion
• Offers a casework management service to all levels of Cochrane managers
• Develops, reviews and implements HR policies across the organisation
• Leads on ensuring an effective HR appraisal system is in operation
• Maintain effective and supportive relationships throughout the organisation

We are looking for a self-motivated and highly organised individual who can work effectively and collaboratively with a diverse range of contacts across the world.  The successful candidate must also be able to offer:

• CIPD qualification equivalent to Level 7 or working towards this
• Previous experience of HR in the not-for-profit sector with a generalist remit
• Skilled at coaching and supporting managers to build their competence
• Self-confidence, personal credibility and the ability to support and challenge others appropriately
• Good understanding and application of the principles of equality, diversity and inclusion in the workplace
• Pragmatism and problem-solving skills and the ability to think creatively when faced with new problems
• Commitment to Cochrane’s mission and values
• Although not essential, we would also welcome candidates with a working knowledge of employment legislation in Denmark and/or Germany, plus experience of supporting remote workers internationally.

Cochrane is a global, independent network of health practitioners, researchers, patient advocates and others, responding to the challenge of making vast amounts of research evidence useful for informing decisions about health. We do this by synthesizing research findings to produce the best available evidence on what can work, what might harm and where more research is needed. Our work is recognised as the international gold standard for high quality, trusted information.

If you would like to apply for this position, please send a CV along with a supporting statement to recruitment@cochrane.org with “Senior Human Resources Advisor” in the subject line.  The supporting statement should indicate why you are applying for the post, and how far you meet the requirements for the post outlined in the job description using specific examples.  List your experience, achievements, knowledge, personal qualities, and skills which you feel are relevant to the post.

• For further information, please download the full job description from here
• Interviews to be held early in January 2020