Monday, January 22, 2024

Cochrane is an international, not-for-profit network of clinicians, patients and carers, researchers, and policy-makers creating high-quality healthcare evidence synthesises. Cochrane has a long and rich history of collaborating with healthcare consumers and this is the story of what breast cancer patients experienced when contributing to a Cochrane Review.  

In 1995, Nora Carbine and Liz Lostumbo, both former breast cancer patients, embarked on a transformative journey as attendees of the Leadership, Education, Advocacy, and Development (LEAD) program developed by the National Breast Cancer Coalition (US). Designed to equip patients with the necessary scientific and leadership essentials for becoming proactive advocates, this five-day initiative taught by notable scientists provided a platform for people with breast cancer to amplify their voices.  

One of the founders of LEAD and a course teacher was  Kay Dickerson MD, an epidemiologist and an active Cochrane member. Post-LEAD, Dr. Dickerson encouraged them to form a Journal Club, meeting monthly with her. Initially guided by Dr. Dickerson's article choices, the members eventually took the reins, presenting their findings on breast cancer research articles. Over a transformative two-year period, they developed their skills in scrutinizing research methods, assessing statistical validity, and distinguishing misinformation. Dr. Dickerson proposed to the group – would they be interested in leading on conducting a Cochrane systematic review on mastectomy to prevent breast cancer (prophylactic mastectomy)? 

A determined group of seven breast cancer advocates undertook the challenge to provide accessible information on prophylactic mastectomy for both patients and physicians, emphasizing the importance of informed decision-making. Guided by Dr. Dickerson and Davina Ghersi at Cochrane, they submitted their plan of study (Protocol) to Cochrane in 2000. They would gather at each other’s houses after work or on a Saturday morning and go through article after article, debating which ones to include and which to exclude. Despite one of the original members and driving force, Annette Drummond, becoming seriously ill with a recurrence of breast cancer, other members dropping out, and the abundance of evidence they had to wade through, the Cochrane review published in 2004, four years after this remarkable journey started.  

A unique feature of Cochrane reviews is that they are updated when new evidence is available. Classes in RevMan (Cochrane’s software for preparing and maintaining Cochrane and other systemic reviews) were taken and more people were added to the team, including an experienced reviewer. The first updated review was published in 2010. 

“Actress Angelina Jolie revealing her family history and her procedures coupled with the increasing availability of DNA testing, thrust the topic of mastectomy for breast cancer prevention into the limelight," says Liz Lostumbo. “We worried that women facing the decision of whether to undergo a prophylactic mastectomy might only encounter anecdotes in the popular media. We were particularly concerned about the lack of discussion concerning the quality of life for patients after mastectomy. The Cochrane review and its accompanying plain language summary became our means of addressing the critical gap in knowledge." 

For the third revision in 2018, they brought in more expertise and updated the wording, changing “prophylactic mastectomy” to “risk-reducing mastectomy”. The review is highly cited, has been made into a Cochrane Clinical Answer for clinicians, and has been included in three clinical guidelines. The plain language summary has been translated into 8 languages making it more accessible globally to patients making a decision and has been included in several Wikipedia articles.  

Nora and Liz note that they will hand other future updates to authors who can break the review into parts that ask more concise questions and produce more high-value conclusions – some of this work is already underway.  

“For us, the whole process of being the only group of patients to take on the responsibility of preparing a review and updating it was one of great satisfaction and pride,” says Nora Carbine. “We believe our work has helped thousands of women facing the decision of having a mastectomy to prevent breast cancer by providing evidence they need to be well informed to make their choice. We applaud Cochrane for giving us the opportunity and thank those who supported us in our endeavour.” 

Cochrane is extremely proud of Nora and Liz and all our patient and advocate volunteers. “While the work of Nora and Liz is extraordinary, it embodies the spirit of what Cochrane is trying to achieve.  We are proud to engage with patients to co-produce health evidence that is meaningful, easy to understand, and can be used for decision-making,” explains Richard Morley, Cochrane’s Consumer Engagement Officer. “The Cochrane Consumer Network has played a formal role since 1995 with over 2,000 members and Cochrane has a formal framework for involving patients, carers, and the public. While it’s likely most patients and caregivers aren’t as ambitious to author a Cochrane systematic review, we do hope this story is an inspiration for others to join our work.” From learning about health evidence and making informed health choices to volunteering to read over our plain language summaries on our volunteer hub Cochrane Engage, there are lots of ways you too can make a global impact on health! 

• Read a more detailed account of Nora and Liz’s story 
• Join Cochrane’s work as a patient, carer, or member of the public 

Tuesday, March 19, 2024 Category: The difference we make

A new Cochrane Library Editorial has been published about the history of a recently updated Cochrane review on healthcare decision aids and its implications for practice. There is also an accompanying podcast where you can hear the current lead author explain the need for the review and its latest findings in under four minutes.

Decision aids are one type of tool that can be used to support the process of shared decision making between patients and their health professionals, a key element of person-centred care and health system improvements. A major update to the landmark Cochrane review on decision aids has just been published with an analysis of 209 studies involving 107,698 participants. It provides clear evidence of the benefits of the use of decision aids over usual care across a huge array of health options, ranging from choices about cancer screening to decisions about major elective surgery.

An accompanying editorial describes the influence of this review on practice for over 20 years, with successive updates responding to the changing understanding of decision aids and shared decision-making over this time. The review has been referred to in more than 90 clinical practice guidelines and has been one of the most cited reviews published in the Cochrane Library for over a decade. 

With more convincing evidence of the benefits of using decision aids now available, the editorial discusses implications for practice and highlights some remaining challenges of implementing decision aids. This Cochrane review will continue to be updated and the authors hope to see the findings not only reflected in many guidelines but implemented across many health systems. 

• Read the Cochrane Library editorial 
  Ryan RE, Hill S. Decision aids: challenges for practice when we have confidence in effectiveness. Cochrane Database of Systematic Reviews 2024, Issue 1. Art. No.: ED000164. DOI: 10.1002/14651858.ED000164.

• Read the Cochrane review
   Stacey D, Lewis KB, Smith M, Carley M, Volk R, Douglas EE, Pacheco-Brousseau L, Finderup J, Gunderson J, Barry MJ, Bennett CL, Bravo P, Steffensen K, Gogovor A, Graham ID, Kelly SE, Légaré F, Sondergaard H, Thomson R, Trenaman L, Trevena L. Decision aids for people facing health treatment or screening decisions. Cochrane Database of Systematic Reviews 2024, Issue 1. Art. No.: CD001431. DOI: 10.1002/14651858.CD001431.pub6.
  
  
  
  
• Listen to the podcast
  Current lead author, Dawn Stacey from the University of Ottawa and Ottawa Hospital Research Institute in Canada, explains the need for the review and its latest findings in under 4 minutes.
  
  

• Evidently Cochrane blog - Decision aids: helping people make better healthcare choices
  When faced with healthcare choices, how do we work out what to do? Decision aids can help, as can good conversations with our clinicians as part of shared decision-making, discussions that take into account clinical expertise, evidence and personal factors such as our preferences and circumstances. This blog includes Joanna’s story of her experience of making an important treatment decision but without the benefit of supportive discussions with her surgeon, plus some Cochrane evidence and useful UK resources.

Monday, January 29, 2024 Category: The difference we make

In celebration of 2024 International Women's Day (IWD), Cochrane is delighted to share a recording of an event showcasing a diverse panel of speakers discussing the IWD 2024 theme of #InspireInclusion

Tiffany Duque, Cochrane US Senior Officer, Panelist, and 2022 winner of the Anne Anderson Award says, "The 2024 IWD event was organized and hosted by our talented Cochrane US Mentees. This marks the third cohort through the Cochrane Mentoring program and the third IWD event. Hailing from 21 different countries, participants range from students to early career professionals, all poised for a bright future within Cochrane. We were delighted that they could once again host this cherished event. Thank you to everyone who attended and we invite everyone to watch the recording."

• #InspireInclusion in health: What is the first step? from Dr Luis Gabriel Cuervo Amore
•   Women in Science: Strategies to Call to Action from Dr Vivian Welch
•  Mentee & Mentor: different languages, different cultures, and how to foster inclusion together from Kehinde Ayomide Agubosim and Dr Karen Gibbs

Paola Andrenacci, Cochrane US Mentor Program Coordinator, and lead for this event, shares her excitement, "We are thrilled about the turn out to this webinar and so happy we can expand the reach with this recording. It was wonderful to bring together this dynamic group to discuss issues of inspiring inclusion in healthcare. Their diverse perspectives and experiences can help us identify barriers to equity and work towards solutions benefiting everyone. I encourage everyone to watch and share the recording! A special thank you to our  Moderators Maya Abdelwahab, Claudia De Santis, Julia Costa-Maria Carolina Isaza."

Related resources:

• VIDEO: 2023 International Women's Day Panel on embracing equality
• VIDEO: 2022 International Women's Day Panel on gender bias in health science and evidence synthesis
• VIDEO: 2021 International Women's Day Panel on diversity in health evidence synthesis
• Celebrating Anne Anderson and Cochrane diversity with new designs: an interview with artist Heather Tubwon
• Cochrane Indonesia’s Director reflects on her continued contributions to maternal and perinatal health and the work of Cochrane

 

Friday, March 8, 2024

Monday, January 15, 2024

Specifications: Permanent – Full Time (1.0 FTE)
Salary:  £36,000 per Annum  
Location: (Remote – Flexible) Ideally based in the UK, Germany or Denmark. Candidates anywhere from the world will be considered; however, Cochrane’s Central Executive Team is only able to offer consultancy contracts outside these countries for 1-Year.
Closing date: 28 January 2024
 
Cochrane is an international charity. For 30 years we have responded to the challenge of making vast amounts of research evidence useful for informing decisions about health. We do this by synthesising research findings and our work has been recognised as the international gold standard for high quality, trusted information.

Cochrane's strength is in its collaborative, global community. We have 110,000+ members and supporters around the world. Though we are spread out across the globe, our shared passion for health evidence unites us. Our Central Executive Team supports this work and is divided into four directorates: Evidence Production and Methods, Publishing and Technology, Development, and Finance and Corporate Services.

The Cochrane Support and Training Officer will work within the Cochrane Support Team, with special responsibility for providing training to internal Central Executive Team colleagues, Cochrane authors, and Cochrane Group staff. Training will focus on new Review Manager (RevMan) project and portfolio management features in 2024. The role also includes ongoing internal training responsibilities.   

Don’t have every single qualification? We know that some people are less likely to apply for a job unless they are a perfect match. At Cochrane, we’re not looking for “perfect matches.” We’re looking to welcome people to our diverse, inclusive, and passionate workplace. So, if you’re excited about this role but don’t have every single qualification, we encourage you to apply anyway. Whether it’s this role or another one, you may be just the right candidate.

Our organization is built on four core values: Collaboration: Underpins everything we do, locally and globally. Relevant: The right evidence at the right time in the right format. Integrity: Independent and transparent. Quality: Reviewing and improving what we do, maintaining rigour and trust.  

You can expect:  

• An opportunity to truly impact health globally.  
• A flexible work environment  
• A comprehensive onboarding experiences.
• An environment where people feel welcome, heard, and included, regardless of their differences.

Cochrane welcomes applications from a wide range of perspectives, experiences, locations, and backgrounds; diversity, equity and inclusion are key to our values.

How to apply

• For further information on the role and how to apply
• The deadline to receive your application is 28th January 2024.
• The supporting statement should indicate why you are applying for the post, and how far you meet the requirements, using specific examples. 
• Read our Recruitment Privacy Statement

Tuesday, January 23, 2024 Category: Jobs

テストステロンは勃起に問題のある男性に効果があるか？ 背景 テストステロンは重要な男性ホルモンである。テストステロンは、勃起障害を経験するテストステロン値の低い男性によく使用される。しかし、この治療法がどの程度有効なのか、また、特に心臓の健康に好ましくない有害作用（副作用）があるかどうかは不明である。 要点 短期的には、テストステロン補充療法は勃起機能、性的生活の質(QOL)、心血管死亡率への影響は少なく、副作用もほとんどない。 勃起機能に対するこの治療法の長期的な効果はまだ不明であり、長期的な性的QOLと心血管死亡率に関するデータは不足している。 これらの結果は、将来の臨床ガイドラインや医療判断に役立つものである。 知りたかったこと 勃起障害を持つ男性に対するテストステロン補充療法の効果を知りたかった。 実施したこと テストステロン値が低い男性を対象とした研究を包括的に検索した。これらの研究では、テストステロンの効果をプラセボや勃起の改善を目的とした他の薬と比較している。 わかったこと テストステロンとプラセボを比較した43件の研究、11,419人の参加者を対象としたが、ホスホジエステラーゼ5阻害薬（勃起改善薬の一群）と比較した研究も含まれる。また、両群（テストステロンとプラセボ）にホスホジエステラーゼ5阻害薬を投与した研究も見つけた。 主な結果 短期的には、テストステロンをプ...

Thursday, January 11, 2024

Thursday, January 11, 2024

喘息の小児や青年を助ける心理療法 要点 1 . 利用可能なエビデンスは、心理的介入が喘息を持つ小児や青年にとって有益であることを示唆している。 2．研究間の差があるため、データを比較するのは非常に難しく、このレビューの結果は非常に不確かで解釈が難しい。 背景 喘息を持つ小児や青年は、喘息を持たない小児や青年よりも心理的苦痛の症状（不安、抑うつ、またはその両方など）を経験する可能性が高い。心理療法は、このような苦痛を軽減し、その結果、小児や青年が喘息を管理する方法を改善するのに役立つかもしれない。 何を調べようとしたのか？ 心理療法が、通常のケア、心理的要素を含まない治療、あるいは無治療と比較して、以下の結果(評価項目)の改善において優れているかどうかを明らかにしたかった。 1．不安の症状； 2．抑うつ症状；および 3．医療サービスの利用（入院や救急外来の受診など） 4.喘息発作 5.喘息の症状 6.薬物療法 7.QOL(生活の質） また、心理療法が喘息の小児や青年に好ましくない影響を及ぼすかどうかも知りたかった。 実施したこと 喘息を有する5～18歳の女児および男児を対象に、心理学的治療（行動療法、認知療法、カウンセリングなど）を標準的な喘息治療、心理的要素を含まない治療、または無治療と比較して評価した研究を検索した。 わかったこと 1,639人の小児および青年を登録した24件の...

Wednesday, January 10, 2024

Wednesday, January 10, 2024

マインドフルネスを取り入れた育児プログラムによる子どもと親のアウトカムの改善 要点 - マインドフルネスを強化した育児トレーニング・プログラムは、子どもの情緒的・行動的適応、育児スキル、親の抑うつや不安、育児ストレス、親のマインドフルネスなど、いくつかの子どもと親のアウトカムを改善する可能性がある。 - スキルに基づく育児トレーニング・プログラムにマインドフルネスの要素を取り入れると、育児ストレスが減少する可能性がある。 - 現在のエビデンスは限られており、今回の結果に確信を持つためには、さらなる研究が必要である。 子どもの情緒的・行動的問題 子どもの情緒的・行動的な困難はよくあることで、さまざまな外向的行動や内向的行動が長期にわたって続いてしまうのが特徴である。子どもの情緒的・行動的な困難は、小児期における機能障害の重要な原因であり、青年期以降における心理社会的、学業的、職業的機能の低下につながる。情緒的・行動的困難の有病率、安定性、長期的影響を考えると、行動パターンを修正しやすい幼少期に介入することが重要である。 なぜマインドフルネスを取り入れた育児トレーニングなのか？ 育児は、子どもの情緒的・行動的困難の発生や持続に重要な役割を果たしている。従来の行動やスキルに基づく育児トレーニング・プログラムは、子どもと親のさまざまなアウトカムに望ましい効果があることが示されているが、す...

シートベルト着用を奨励するための介入 要点 - 教育（行動と健康リスク評価（HRA））と工学に基づいた介入が、青年期初期および青年期後期と成人におけるシートベルト着用を促進する可能性を示唆するエビデンスがいくつか見つかった。しかし、現在のエビデンスには確信が持てない。 - シートベルト着用に対する教育と工学に基づく介入の有効性をより深く理解するためには、さらなる研究が必要である。 - また、インセンティブ（単独または他の介入との組み合わせ）の有益性、他の種類の介入、異なる組み合わせの介入、さまざまな状況を調査するには、質の高い研究が必要である。 なぜシートベルト着用が重要なのか？ 毎年多くの人が交通事故により死亡しており、その大半は子どもや若者である。交通事故による死亡は死因の上位となっており、若い男性が交通事故関連死の約75％を占めている。また、多くの人が永久的な重傷を負っている。シートベルトは、衝撃によって乗員が車外に放り出されるのを防ぎ、身体の傷つきにくい部分に衝撃を分散させてダメージ（被害）を軽減するように設計されている。シートベルトの着用を義務付ける法律を成立させるだけでは、シートベルトの着用を促すには不十分である。 何を調べようとしたのか？ シートベルト着用を奨励するために、法執行ではなく、教育、インセンティブ、工学に基づく介入の有効性を調査し、どのタイプの介入が最も...

新たな腰痛患者に対する椎体骨折のスクリーニングのための医師によるレッドフラッグの使用 注意事項:  このトピックをカバーし、このレビューに取って代わった最新のレビューは以下のレビューである https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD014461.pub2/full。 このレビューでは、家庭医、腰痛クリニック、救急外来に新たな腰痛を訴える患者が来院した際に、脊椎損傷の有無を確認するための一般的な方法についての理解を述べている。 医師は通常、脊椎骨折の可能性をチェックするために、いくつかの質問をし、背中を診察する。 骨折をチェックする理由は、一般的な腰痛と骨折では治療法が異なるからである。 骨折は通常、X線検査で診断され、安静、背部装具、鎮痛剤で治療される。 一般的な背部痛は、運動療法、カイロプラクティックによる手技療法、鎮痛剤で治療される。X線検査、コンピュータ断層撮影（CT）検査、磁気共鳴画像検査は診断には役に立たない。 骨折が腰痛の原因であることはまれで、家庭医を新たに訪れる腰痛の1％から4.5％程度である。 数千人の患者を対象とした8件の研究では、脊椎骨折の有無を調べるために用いられてきた29種類の異なる質問と身体検査テストについて述べられている。 29種類の質問のほとんどは正確ではなかっ...

Monday, January 8, 2024

Monday, January 8, 2024

Monday, January 8, 2024

Monday, January 8, 2024

妊娠中の女性のためのビタミンB 12 補給 要点 - 妊娠中にビタミンB 12 サプリメントを摂取していた女性は、ビタミンB 12 サプリメントを摂取していなかった女性と比較して、ビタミンB 12 欠乏症が少なく、ビタミンB 12 濃度が高いなど、妊娠中または産後のビタミンB 12 状態が改善される可能性があるが、エビデンスは不明である。 - 妊娠中のビタミンB 12 サプリメントの摂取が、妊婦やその子どものその他の健康アウトカムに及ぼす影響は不明である。 公衆衛生上の意義 ビタミンB 12 は、体内の血液細胞や神経細胞を健康に保つのに重要な栄養素である。ビタミンB 12 欠乏症は、特に低・中所得国において重要な公衆衛生上の問題であり、妊婦や小児の間で重い負担となっている。妊娠中のビタミンB 12 濃度が低いと、流産、子宮内での赤ちゃんの発育不良、赤ちゃんの脳や脊髄の障害（神経管欠損症と呼ばれる）、乳児のビタミンB 12 の低下など、妊娠に関連するいくつかの不利なアウトカムのリスクが高くなる。 妊娠中のビタミンB 12 補充は、女性と赤ちゃんの健康と栄養状態の改善に役立つ可能性がある。ビタミンB 12 は、世界保健機関（WHO、国際公衆衛生を担当する国連の専門機関）が妊娠中の女性に推奨するサプリメントには含まれていない。 調べたかったこと 妊娠中にビタミンB 12 サプリメントを...