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Featured Review: Promoting patient utilisation of cardiac rehabilitation

Thu, 01/31/2019 - 14:29

Cochrane reviewers from Canada, the UK and Brazil came together to assess how to get more patients using cardiac rehabilitation programmes, which aid recovery from cardiac events such as heart attack, coronary stent placement, and bypass surgery, and reduce the likelihood of further illness. 

Cardiac rehabilitation programmes offer the following to patients: exercise, education, risk factor management, and psychological counselling/support. Despite the benefits of cardiac rehabilitation, not everyone enrolls, and, of those who do, many people do not adhere to and complete the programme. This review evaluated trials of strategies to promote cardiac rehabilitation utilisation, namely enrolment, adherence, and completion.

The review team found 26 trials (5,299 participants) that were suitable for inclusion, with these trials evaluating a variety of techniques to improve utilisation, such as: 

  • Peer support
  • Starting cardiac rehabilitation early after hospital
  • Educating patients
  • Offering cardiac rehabilitation outside a hospital setting
  • Offering shorter programmes
  • Women-only programmes

Cochrane author Professor Sherry L Grace from York University and the University Health Network in Canada said, “International clinical practice guidelines routinely recommend that cardiac patients participate in rehabilitation programmes for comprehensive secondary prevention. However, only a small proportion of patients use these programmes. 

“The review findings show strategies to increase enrolment are effective, particularly those that target healthcare providers, training nurses, or allied healthcare providers to intervene face-to-face. Interventions to increase adherence to programmes are also effective, particularly where they are delivered remotely, such as through a smartphone. Interventions to increase programme completion are also effective, but it remains unclear which specific strategies work."



The review also focused on patient groups that are less well-represented in cardiac rehab. “There was insufficient evidence for quantitative assessment of whether women-tailored programmes were associated with increased use, but future trials should test the impact of motivational, women-only programs. For older participants, qualitative analysis suggested that peer support or post-discharge visits may improve enrolment, and group sessions promoting self-regulation skills may increase completion.”

Friday, February 1, 2019

New Cochrane review assesses the benefits and harms of exercise for preventing falls in older people living in the community

Wed, 01/30/2019 - 19:26

New evidence published in the Cochrane Library today provides strong evidence that falls in people over sixty-years old can be prevented by exercise programmes.

Falls are a leading cause of accidental or unintentional injury deaths worldwide. Older adults suffer the greatest number of fatal falls and over 37 million falls are severe enough to require medical attention each year.

A new Cochrane Review produced by a team comprising researchers from the University of Sydney in Australia and University of Oxford, UK, summarizes the results from 108 randomized controlled trials with 23,407 participants from across 25 countries. The average age of the participants in the studies was 76 years old and three quarters of them were women. Eighty-one of these trials compared exercise (all types) versus a control intervention (doing no exercise or minimal gentle exercise that is not thought to reduce falls) in people living independently at home, in retirement villages, or in sheltered accommodation.

The review looked at two different ways of measuring falls. Firstly, they found that exercise reduces the number of falls over time by around a quarter (23% reduction). This means that if there were 850 falls among 1000 older people doing no fall-preventive exercise during one year, there would be 195 fewer falls among  people who were undertaking fall-prevention exercise. They also found that exercise reduces the number of people experiencing one or more falls (number of fallers) by around a sixth (15% reduction). For example, if 480 out of 1000 people experienced one or more falls over one year, participating in exercise programmes would reduce the number of fallers by 72 people.

The review found that exercise programmes carried out in group classes or done at home prescribed by a health professional (such as a physiotherapist) or a trained exercise leader were effective. Exercises were mostly done while standing as this better enhances balance and the ability to do daily activities such as standing up from a low chair or climbing stairs. Some effective exercise programmes also used weights to make the exercises harder.

The results of the studies varied so the researchers assessed different types of exercise programmes to see how they compared. There is high certainty evidence that programmes that mainly involve balance and functional exercises reduce falls, while there was less certainty about programmes that include multiple exercise categories (most commonly balance and functional exercises plus resistance exercises). Tai Chi may also prevent falls but there is uncertain evidence on the effectiveness of resistance exercises (without balance and functional exercises) including dance or walking.

The certainty of the evidence for the overall effect of exercise on preventing falls was high. However, the findings that exercise reduces fractures and the need for medical attention are less certain, reflecting in part the relatively small number of studies and participants for those outcomes.

The reporting of the side effects of exercise in the trials was limited but when side effects were reported they were usually not serious, such as joint or muscle pain; however, one trial reported a pelvic stress fracture.

Author, Professor Cathie Sherrington from The University of Sydney, Institute for Musculoskeletal Health said: “This evidence helps build an even stronger picture that exercise can help prevent older people having falls. It also illustrates which types of exercise can be beneficial. It is well known that keeping active promotes good health but this review pinpoints which types of exercise are more likely to be effective for preventing falls.”

“More work is needed to establish the impact of exercise on fall-related fractures and falls requiring medical attention because such falls have major impacts for the individual and are particularly costly to health systems. Further research is also required to establish the effectiveness of fall prevention programmes in emerging economies where the burden of falls is increasing more rapidly than in developed countries due to rapidly ageing populations.”

This Cochrane Review was supported by the Cochrane Bone, Joint and Muscle Trauma Group, based at the University of Manchester UK, and Cochrane’s Acute and Emergency Care Network. This project was partly funded by the National Institute for Health Research (NIHR) via Cochrane Infrastructure funding to the Cochrane Group. Additional funding for the review was via the National Institute for Health Research (UK): NIHR Cochrane Reviews of NICE Priority scheme, project reference: NIHR127512. The views and opinions expressed therein are those of the authors and do not necessarily reflect those of the Systematic Reviews Programme, NIHR, NHS or the Department of Health. Australian National Health and Medical Research Council Fellowships provided salary funding for several of the authors.

Full Citation: Sherrington C, Fairhall NJ, Wallbank GK, Tiedemann A, Michaleff ZA, Howard K, Clemson L, Hopewell S, Lamb SE. Exercise for preventing falls in older people living in the community. Cochrane Database of Systematic Reviews 2019 , Issue 1 . Art. No.: CD012424. DOI: 10.1002/14651858.CD012424.pub2

Thursday, January 31, 2019

Cochrane expresses thanks to Professor Gerd Antes for leadership of Cochrane Germany

Wed, 01/30/2019 - 18:46

After leading Cochrane Germany for over 20 years, Professor Gerd Antes has stepped down as Director.

Gerd has focused his career on contributing to evidence-based medicine in Germany. While working on developing Cochrane Germany, he was also one of the founders of the German Network for Evidence Based Medicine. A recurrent theme during all these years was his work and advocacy for increasing public access to research results. He campaigned for ensuring clinical trial results are published in a timely manner and emphasized the challenges of non-publishing for the provision of non-biased high-quality synthesized evidence. He also was a strong advocate for making evidence available in other languages than English. And, in addition to language translation, Gerd’s work included the transfer of knowledge in commonly understood (lay) language. He worked with the media in making complex methodology understandable for patients, students and lay persons. One of the products of this work is the German version of the Testing Treatments website: Wo ist der Beweis? Cochrane Germany also became an active contributor to translations into German language (jointly with Cochrane Austria and Cochrane Switzerland), demonstrated by Cochrane Kompakt and the blog Wissen was Wirkt.

Cochrane’s Chief Executive Officer, Mark Wilson, said: ‘I would sincerely like to thank Gerd for his outstanding contributions to Cochrane’s work over the last two decades. Cochrane Germany was one of the first Cochrane Centres to be established in 1998 and under Gerd’s leadership its impact on informing the debates about evidence-based medicine in Germany and beyond has been formidable. Gerd’s commitment and persistence to the cause of ensuring all have access to the best available evidence is truly commendable. On behalf of all of your Cochrane colleagues and friends, we thank you, Gerd, and wish you every success and happiness for the future.”

 

 

Cochrane Germany will be led under the new Directorship of Prof Joerg Meerpohl, supported by Michael Graf managing Director of the Cochrane Germany Foundation. Joerg holds the Cochrane professorship for Evidence in Medicine at the University of Freiburg and directs the Institute for Evidence in Medicine, Medical Center – University of Freiburg.

 

Wednesday, January 30, 2019

Cochrane's 30 under 30: Petter Brattström

Tue, 01/29/2019 - 12:15

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

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

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

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

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

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

Name: Petter Brattström
Age: 26
Occupation: Last year Medical Student
Programe: Medical Programme at the Faculty of Medicine, Lund University Sweden

How did you first hear about Cochrane?  Why did you chose to work/volunteer for Cochrane?
I first heard about Cochrane during my preclinical studies. Cochrane reviews were often mentioned when discussing medical evidence at lectures about research methodology. I remember finding the systematic approach appealing, however I did not know about the possibilities of getting involved with the organisation.

How did you become involved with Cochrane? What is your background?
I am a last year medical student at Lund University in Sweden, graduating January 2019. I have a strong interest in health in general and evidence-based medicine particularly.

When planning my master’s thesis, I had the luck of coming into contact with Matteo Bruschettini, director of the newly founded Cochrane Sweden. He introduced me to and involved me in the work of Cochrane and later came to supervise my thesis, a systematic review about caffeine treatment in preterm infants.

What do you do in Cochrane?
I am a new Cochrane member! I began my Cochrane experience with a four-week training period as an intern in Krems an der Donau at Cochrane Austria where I was excellently introduced to the methodology of systematic reviews and meta-analysis. This was the start of a 20-week research project at Cochrane Sweden. As of yet I have co-authored two systematic reviews, one as part of my master’s thesis. I have also worked on how to recruit and engage students in Cochrane, as Cochrane Sweden is a new and expanding Associate Centre.

What specifically do you enjoy about working for Cochrane and what have you learnt?
What I find most inspiring, enjoyable and rewarding, apart from being part of a global network and meeting engaged people, is how enlightening and informative it is to work with Cochrane. I think that I have learnt a lot about evidence synthesis and also about medical research in general, which is useful both as a clinician and a researcher, e.g. how to design high-quality clinical trials or how to critically review scientific papers.

What are your future plans?
I look forward to learn more about systematic reviews and methodology. My future plans are to continue my medical training and work as clinician. Hopefully, I will be able to combine this with clinical research and evidence synthesis with Cochrane Sweden. My hope is that I, in the future, can help to improve the way evidence-based medicine is implemented in everyday healthcare.

In your personal experience, what one thing could Cochrane do better to improve its global profile?
My period as an intern at a Cochrane Centre abroad was a truly positive experience. It would be great if Cochrane could provide some kind of platform and funding for internship exchanges or electives as it would make internships like my own more available. Through this, students and novel researchers could gain experience and learn methodology as well as establish international connections improving the global profile of the collaboration.


What do you hope for Cochrane for the future?
I hope that Cochrane continues to be a developing and including organisation open to new as well as varying people and ideas. Cochrane Library should be the obvious source of information when looking for trustworthy medical evidence, regardless if you are a researcher, clinician, policy maker, patient, or just anyone with an interest in evidence-based research. Moreover, I think it is important to introduce evidence-based medicine to future clinicians early, making it a natural part of everyday clinical work and ultimately providing evidence-based healthcare to patients.

Additionally, with my current perspective as a medical student, I hope that more undergraduate students will become involved in the work of Cochrane in the future. Hopefully, the initiative to launch Cochrane Interactive Learning as part of the medical training at Lund University this year can inspire other universities to do the same.

How important is it that young people get involved in Cochrane?
It is fundamental!

Why is this, do you think?
I would like to paraphrase the cliché of young people being the future. Young people come with new ideas, new perspectives and new enthusiasm, and are an essential part of keeping Cochrane progressive and evolving. Through the many initiatives of Cochrane, such as Cochrane Crowd, it is very possible for young and inexperienced people to contribute to the organisation.

What would your message be to other young people who want to get involved with Cochrane’s work but not sure where to start….?
My message would be to take chances, be open to new experiences and do not be afraid to ask questions and to show interest! To be a bit more concrete, they should get in contact with their local Cochrane Centre, investigate the option of Cochrane Crowd, Cochrane Task Exchange or check out Students 4 Best Evidence, a community for students interested in evidence-based research with some really useful learning tools and sources of inspiration.

 

Tuesday, January 29, 2019

Cochrane Wounds seeks Editorial Assistant - Manchester, UK

Mon, 01/28/2019 - 19:58

Part-time: 21 hours per week
Location: Manchester, UK

Cochrane Wounds sits within the Division of Nursing Midwifery and Social Work.  We are looking for a confident and self-motivated editorial assistant with excellent organisational and communication skills to support the production and publication of high quality Cochrane systematic reviews in the field of wound care.

The ideal candidate will have a high level of attention to detail and be able to work with considerable autonomy to meet regular deadlines.  Your computing and numeracy skills will be strong and you will have the ability to learn new software quickly.  You will be highly organised, able to show initiative, be flexible in taking on new tasks or areas of work and be able to work as part of a team.

Applications for this vacancy are to be made online - the closing date is 11 February 2019.

Monday, January 28, 2019 Category: Jobs

Joint Cochrane Oral Health Co-ordinating Editor, Helen Worthington, awarded BDA's 2019 John Tomes Medal

Mon, 01/28/2019 - 15:19

Cochrane Oral Heath's Joint Co-ordinating Editor, Professor Helen Worthington, has been awarded a John Tomes Medal by the British Dental Association's 2019 Honours and Awards round, for her extensive contributions and influence in promoting evidence-based oral healthcare.

In her role as Director of Evidence for Practice at The University of Manchester's Division of Dentistry, Helen has ensured teaching across the School is underpinned by appropriate evidence and has cultivated a reputation for research excellence in dentistry at the University.

She has significantly impacted the development of methodologies for systematic reviews and randomised controlled trials in dentistry, and has authored over 400 peer-reviewed publications in the field.

Professionally, Helen has received substantial recognition rarely afforded to statisticians (an IADR Distinguished Scientist Award and Honorary Fellowship of the Royal College of Surgeons England), resulting from her expertise and impact on clinical practice, research practice and policy across the UK and globally.

Cochrane warmly congratulates her on this honour.

Monday, January 28, 2019

Cochrane seeks Editor-in-Chief, Cochrane Clinical Answers - Flexible Location

Mon, 01/28/2019 - 15:15

Specifications: 2 days/month
Location: Flexible
Application Closing Date: 25 February 2019

Cochrane Clinical Answers (CCAs) is a key database within the Cochrane Library which aims to deliver Cochrane content in a format that meets the needs of a clinical audience. This honorary role is an exciting opportunity to use your clinical experience to focus on the dissemination of the health care research most relevant to clinicians and allied health-care professionals.

Cochrane Clinical Answers are developed by two production teams working to a single set of policies, with an agreed overall CCA production target. The successful candidate will oversee the development and implementation of editorial policies for CCA, guide editorial strategy decisions and have responsibility for ensuring the quality of CCA content is consistent across both teams.

We are looking for an enthusiastic individual with a clinical background and a keen understanding of evidence synthesis and its potential impact on health delivery. The successful candidate will be highly organized, with excellent written and verbal communication skills. The following are essential attributes for the post:

  • Clinical experience
  • Understanding of the principles of evidence-based medicine
  • Experience of Cochrane or alternative high quality systematic reviews
  • Editorial experience in a scientific/medical/research publishing setting
  • Excellent computer skills and proficiency in Excel, Microsoft Word, Outlook and Access

The successful applicant will receive a stipend of £5,000 per annum plus reasonable expenses, a sponsored registration to attend the annual Cochrane Colloquium, and a license to the Cochrane Library if the candidate does not have access via any other route.

If you would like to apply for this position, please send a CV along with a supporting statement to recruitment@cochrane.org with “CCA Editor-in-Chief” 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 see the full job description

Deadline for applications:  25th February, 2019
Interviews to be held on: To be confirmed

Monday, January 28, 2019 Category: Jobs

Cochrane seeks Methods Liaison Officer - Flexible Location

Mon, 01/28/2019 - 14:44

Specifications: Part time 22.5 hours per week, 1-year Fixed Term Contract
Salary: Competitive
Location: Flexible with regular attendance at the London office expected
Application Closing Date: 8th February 2019

This role is an exciting opportunity to support methods implementation to make a difference in the field of health care research. 

The Methods Liaison Officer will liaise with, and provide support to, the Cochrane Methods Groups, Methods Executives, Methods Board and Scientific Committee, as well as provide support to the Methods Implementation Co-ordinator, and assist with the facilitation of methods activities to support Cochrane’s strategic objectives.

Key Tasks:

Manage and support the Methods Groups to facilitate their involvement in Cochrane, as well as assisting the Methods Implementation Co-Ordinator, to provide the following:

  • Liaison between the Methods Groups, Methods Executives, Method Board, Scientific Committee and the Central Executive
  • Dissemination of Cochrane methods activity by producing annual reports and other promotional material
  • Maintain and develop the Cochrane Methods and MECIR websites to ensure that information is up to date and easily accessibleLiaison with other Cochrane Departments to ensure clarity of communication across all Cochrane groups

Provide administrative support, as required, to the Methods Implementation Co-ordinator, specifically provide administrative support to:

  • The organization of methods specific meetings, prepare agendas and other documentation, ensuring minutes are taken, distributed, and actions followed up
  • The grant management of funds given to Methods related projects
  • The implementation, co-ordination and editorial management of the Cochrane Handbook for Systematic Reviews of Interventions
  • The annual specialist methods training event, by liaising with the course organisers and course participants
  • To other methods related reports, policy documents and other activities as required

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

Essential:

  • Undergraduate degree in a related academic field or relevant experience
  • Is diligent with attention to detail
  • Excellent computer skills, for example, MS Office applications, internet, email, with the ability to take on information management and other software as required
  • Knowledge of Cochrane, evidence based health care, and or/the global health sector
  • Time management skills and ability to work flexible hours as needed
  • Experience related to the planning and organising of meetings
  • Experience in co-ordinating activities in a diverse team
  • Excellent presentation, interpersonal and communication skills
  • Willingness to travel as required

Preferred:

  • Experience of healthcare charity sector

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 “Contracts 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 see the full job description.

Deadline for applications: Friday 8th February 2019 (12 midnight GMT)
Interviews to be held on: (TBC)

Monday, January 28, 2019 Category: Jobs

Featured Review: Oral H1 antihistamines as ‘add-on’ therapy to topical treatment for eczema

Mon, 01/28/2019 - 12:05

The findings of this Cochrane Review may challenge the prescribing of H1 antihistamines for patients with eczema.

This Cochrane Review assessed the effects of oral H1 antihistamines as 'add-on' therapy to topical treatment in adults and children with eczema. Are H1 antihistamines taken as tablets or liquid, effective and safe in people of any age with diagnosed eczema, if given in addition to creams and ointments, compared to treatment with an inactive substance (placebo) or nothing added to creams and ointments?

Eczema (also known as 'atopic eczema/dermatitis') is a skin disorder frequently affecting both children and adults. In developed countries, 10% to 20% of all people are affected by eczema during their lifetime. The main symptom is itch, which results in scratching and, together with skin inflammation, frequently produces reddening of the skin. The symptoms of eczema can lead to sleeplessness and fatigue, lowering quality of life. Antihistamines are frequently given for itch (specifically H1 antihistamines taken by mouth), and they may alleviate the symptoms of eczema when given in addition to conventional treatments directly applied to the skin (e.g. emollients, moisturisers, steroid creams), although they are not thought to cure it.

Many antihistamines are available without prescription, for instance, cetirizine or loratadine. Although H1 antihistamines are frequently prescribed for treating eczema, we do not know whether they are effective and safe. The review includes 25 randomised controlled trials with 3285 participants of all ages with diagnosed eczema.

Review author Uwe Matterne, from the Institute of Epidemiology and Preventive Medicine, University of Regensburg, Germany said, “The findings of this research may challenge the prescribing of H1 antihistamines as we found no convincing evidence that H1 antihistamines help patients with eczema.

“Based on the main comparisons, we did not find consistent evidence that H1 AH treatments are effective as 'add-on' therapy for eczema when compared to placebo; evidence for this comparison was of low and moderate quality.

“However, fexofenadine probably leads to a small improvement in patient-assessed pruritus, with probably no significant difference in the amount of treatment used to prevent eczema flares. Cetirizine was no better than placebo in terms of physician-assessed clinical signs nor patient-assessed symptoms, and we found no evidence that loratadine was more beneficial than placebo, although all interventions seem safe."

The quality of evidence was limited because of poor study design and imprecise results. Future researchers should clearly define the condition (course and severity) and clearly report their methods, especially participant selection and randomisation; baseline characteristics; and outcomes (based on the Harmonising Outcome Measures in Eczema initiative).

Tuesday, February 5, 2019

Cochrane Database of Systematic Reviews is the most referenced health-related journal on Wikipedia

Wed, 01/23/2019 - 22:54

Wikipedia, the multilingual encyclopedia, is the world’s largest and most visited online general reference website. It is also one of the most read sources of online medical information by the general public, and it is used by medical students, doctors, and policymakers. Wikipedia has, for years, been virtually in the top five most accessed websites globally.

An international group of researchers have explored in detail how much scientific knowledge, by way of journal articles, underpins Wikipedia’s medical content. They also looked at the speed of incorporation of this content. The study published 18 January 2019 in the Journal of Medical Internet Research found that the Cochrane Database of Systematic Reviews was the most referenced journal on Wikipedia, followed by The New England Journal of Medicine and The Lancet. It also found that there were over 135,000 biomedical journal articles cited and the speed that which they were added has been getting faster over time. Cochrane is proud to be on the leading front of contributing to the reliability, completeness, and accuracy of Wikipedia medical information.

Wednesday, January 23, 2019 Category: The difference we make

Find out what we have planned for the 2019 Colloquium

Wed, 01/16/2019 - 12:30

We are very pleased to welcome you to the 2019 Cochrane Colloquium to be held in Santiago, Chile on 22 - 25 October 2019 - so mark your calendars! The Cochrane Colloquium is an annual event, bringing people together from around the world to discuss putting research into important global health questions and promoting evidence-informed health care.

Although we do not want to give away the treats in store, we hope to open the show with artists that are well recognised internationally, and that represent all aspects of diversity, from gender identity and how it impacts (and is impacted by) health systems, to ethnic minorities and their voice in health matters. In addition to this, we hope to spice up the offering with a delicious presentation of colours and sounds, exhibiting our country’s rich cultural diversity. 

We have been working enthusiastically to put together an excellent scientific program to cater to diverse tastes. Among the plenaries that have been planned, we hope to represent the diversity in language that we see in Cochrane and how taking diverse socioeconomic aspects into policy making has improved the lives and health of individuals from minority groups. We also hope to showcase how diverse stakeholders have worked together to achieve great gains, and how diversity in methodological approaches has served us all in Cochrane as a global community.

We hope to see you all in Chile, and are sure that in addition to the cultural and scientific fruits of the Colloquium, visitors will also enjoy the spectacular and unique catalogue of natural wonders that Chile has to offer.

Gabriel Rada
Chair

Click here for more information on the 26th Cochrane Colloquium Santiago, 2019

Thursday, January 17, 2019

Cochrane's Editor in Chief's response to BMJ Article - 'Cochrane is thriving'

Tue, 01/15/2019 - 17:01

David Tovey, Editor in Chief of the Cochrane Library, responds to a recent article in The BMJ, 'Has Cochrane lost its way?' David Tovey states that; "Cochrane is at its most effective when it adheres to its 10 key principles, which promote a culture that is open, diverse, inclusive and outwards facing, a community that is vibrant and iconoclastic, and a mission to search for truth and realism in health care." He also ensures "by all objective measures, Cochrane is thriving."

Tuesday, January 15, 2019

Cochrane's 30 under 30: Andrea Cervera Alepuz

Tue, 01/15/2019 - 16:25

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

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

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

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

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

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

Name: Andrea Cervera Alepuz
Age: 30
Occupation: Interim Translations Co-ordinator and Translations and Communications Manager for Cochrane Iberoamerica

 How did you first hear about Cochrane?  Why did you chose to work/volunteer for Cochrane?
I first heard about Cochrane while studying my Master’s. I needed to train as medical translator at some company/charity to complete my studies, and my father —who is a pharmacist— suggested I should try at Cochrane. He explained me what their mission was and —although it took a while to understand systematic reviews and meta-analyses (still learning that)— I thought it was a great place to gain experience.

How did you become involved with Cochrane? What is your background?
I started working for the Iberoamerican Cochrane Centre with an internship agreement as part of my Master’s training. After I completed my training period I was offered a job as translator and communications manager. I have a BA in Translation and Interpreting from the University of the Basque Country, and I then moved to Barcelona to get my Master’s degree on Biomedical Translation.

What do you do in Cochrane?
As interim translations co-ordinator, I work together with the Cochrane IT Services , and the Cochrane support team to guarantee that all 17 Cochrane translation teams can conduct knowledge translation activities in their language. I also participate in the development of the enhanced Cochrane Library as internationalization subject matter expert.

As Translator and Communications Manager at Cochrane Iberoamerica I translated knowledge translation products such as podcasts, press releases, blog shots, infographics, etc., and disseminated them through our website, newsletters, mailing lists and social media. I also edited Spanish Cochrane reviews before their publication, and helped creating the new portal of the Biblioteca Cochrane (Spanish Cochrane Library).

What specifically do you enjoy about working for Cochrane and what have you learnt?
What’s most rewarding is being able to work for a ‘greater good’. Medical translation jobs are often linked to pharmaceutical companies, so working for Cochrane, which totally respect and subscribe to its principles, is exceptional. I particularly enjoy the network design, which allows you to work with colleagues all around the world almost as if they were sitting in the office next to you.


What are your future plans?
My aim is to continue working as a Medical translator/ Spanish editor, learning from Cochrane’s experience and colleagues and helping deliver healthcare evidence to all kind of audiences.

In your personal experience, what one thing could Cochrane do better to improve its global profile?
Resources are limited in Cochrane translation teams. I think they do a great job despite these challenges. However, raising the resources and making efforts in improving the conditions for translation teams — especially those of widely spoken languages (Spanish, Chinese, Arabic, French)—, would probably make an impact on spreading Cochrane evidence throughout the world.

What do you hope for Cochrane for the future?
I’ll illustrate it with an example, which I hope is understood. When I started working at Cochrane, I always had to explain what it was to my friends and family. I thought it was is perfectly normal for lay people not to have a clue about Cochrane. However I was very surprised whenever someone working in the healthcare/pharmaceutical field had no idea of Cochrane’s work; and I’ve met quite a few of them. If I were to answer this question back then, I would’ve said that I hoped Cochrane evidence would reach all healthcare/pharmaceutical professionals. And I still do, but my ambition has grown; so what I hope now is that every person —patient or clinician, journalist or researcher, lay or professional— understands what Cochrane is and uses Cochrane evidence.

How important is it that young people get involved in Cochrane?
I think the only possible way any organization can survive is by welcoming new young members. Not only because of aging, but because any entity needs to be constantly re-thinking and confronting its principles and processes to make sure it evolves and adapts to new scenarios and challenges. Experience is certainly very precious, but we can learn very much from young people too.

Why is this, do you think?
Young people are normally much more up-to-date with the latest ways of interaction, partly because they grew up with them. This obviously doesn’t mean that the newer the better, but you definitely need to try it before rejecting it; also, different ways of working and interacting can co-exist and complement each other within the same organization.

What would your message be to other young people who want to get involved with Cochrane’s work but not sure where to start….?
I think that depends hugely on what your background is and in what area you would like to get involved. If we are talking about young people who want to get involve in Knowledge Translation, I’d suggest they getting in touch with their country’s Cochrane centre to see if they need a hand with their translations and communications activities. If they have translation skills in one of the languages Cochrane translates to, I’d suggest a good starting point would be to join Cochrane as a volunteer translator by taking Cochrane’s translation test. If their language isn’t there, they can always try browsing Cochrane’s TaskExchange where there are plenty of translation tasks being posted every day.

Monday, January 28, 2019

Featured Review: Routine scale and polish for periodontal health in adults

Tue, 01/15/2019 - 10:39

Examining evidence for routine scale and polish treatment – an updated review

The Cochrane Review 'Routine scale and polish for periodontal health in adults' was carried out by authors working with Cochrane Oral Health to assess the effects of routine scale and polish treatments for healthy adults and to establish whether different time intervals between treatments influence these effects. The review had aimed to compare the effectiveness of the treatment when given by a dentist compared to a dental therapist or hygienist, but there were no studies evaluating this comparison.

This review updates the version published in 2013 and includes two studies with a total of 1711 participants. Both studies involved adults without severe periodontitis who were regular attenders at dental appointments in the UK. The studies were conducted in general dental practices, which is the most appropriate setting to evaluate 'routine scale and polish' treatments.

Dr. Thomas Lamont, lead author explains,

“This evidence could help patients and dental professionals make informed decisions about routine scale and polish treatment - which can be also known as ‘prophylaxis’, ‘professional mechanical plaque removal’ and ‘periodontal instrumentation’ - as it questions the effectiveness of the traditional delivery of routine scale and polish treatment in primary dental care.

“The studies found that regular planned scale and polish treatments didn’t reduce the early signs of gum disease more than scale and polish delivered only when the dental professional judged it necessary or it was requested by the patient. The tartar levels were slightly more reduced with scheduled treatments, but it’s uncertain if this small difference would be considered important by patients or their dentists.

“Participants receiving six-monthly and 12-monthly scale and polish treatments reported feeling that their teeth were cleaner than those who were not scheduled to receive treatment, but the evidence is low quality, and the studies didn’t find any difference between the groups in terms of quality of life.

“It should be noticed that neither of the studies measured side effects, such as damage to tooth surfaces and tooth sensitivity, changes in attachment level, tooth loss or bad breath, and available evidence on the costs of the treatments is uncertain.”

Interview with – Dr Thomas Lamont, lead author of this Cochrane review

Please describe yourself and your Cochrane Group?

I graduated in dentistry from Glasgow University in 2008 and went on to complete a PhD at the University of Dundee. I am currently a Clinical Research Fellow and Honorary Specialty Registrar in Restorative Dentistry at the University of Dundee. I am also a clinical editor at Cochrane Oral Health, which was founded in 1994. For over 20 years, Cochrane Oral Health has been producing high-quality, relevant systematic reviews that can improve oral health care and oral health. We currently have 163 active reviews on the Cochrane Library, as well as 35 protocols for reviews currently in progress.

What is the background to this review and the update?

Many adults in high-income countries will be used to having a ‘scale and polish’ when they go to the dentist. It is intended as a supplementary form of plaque removal in addition to oral hygiene undertaken regularly at home by patients, with the aim of reducing the risk of gum disease.

The first Cochrane Review of regular scale and polish treatment was conducted in 2004 and showed that there was very little evidence to go on. In the review’s conclusions, the authors recommended that a trial be conducted to find out whether routinely providing a scale and polish treatment to people who had relatively healthy mouths and tended to visit the dentist regularly actually had an impact on their long-term oral health, and specifically on periodontal disease. NIHR picked up on this, and Professor Jan Clarkson of the University of Dundee collaborated with Professor Craig Ramsay of the University of Aberdeen, together with colleagues from several other universities, to apply for HTA funding to run such a trial. I joined them as the Clinical Research Fellow on the trial, which was known as ‘IQuaD’ in 2011 and subsequently became involved in updating theCochrane Review. IQuaD was completed in 2017, and the findings were published in 2018 (https://www.journalslibrary.nihr.ac.uk/hta/hta22380/#/abstract)

(Improving the Quality of Dentistry (IQuaD): A cluster factorial randomised controlled trial comparing the effectiveness and cost-benefit of oral hygiene advice and/or periodontal instrumentation with routine care for the prevention and management of periodontal disease in dentate adults attending dental primary care. Health Technology Assessment Volume 22, Issue 38, July 2018)

Why is an update of the review important?

As Cochrane’s mission is to promote evidence-informed health decision-making by producing high-quality, accessible systematic reviews and other synthesised research evidence, there is a commitment to ensure Cochrane Reviews are kept up-to-date by identifying and incorporating new evidence. The IQuaD trial reached some strong conclusions that we felt should be combined with the existing evidence and shared widely.

What are the main implications of this research?

This review questions whether it is necessary for scale and polish to be delivered routinely, that is, on a standard schedule of every 6 or 12 months. Many people like the clean feeling that they get from a scale and polish treatment every six months, but it is not clear that there is any real clinical benefit in terms of reducing gum disease. The updated review shows that providing scale and polish treatment when the dentist deems it appropriate or when the patient requests it, does not result in poorer oral health outcomes after 2 to 3 years than providing scale and polish treatments on a predetermined 6- or 12-monthly schedule. 

It is important to point out that the participants in the two trials included in the review had relatively healthy mouths; none of them had severe periodontitis. It is also important to point out the trials were conducted in the UK. In other high-income countries, the treatment may be known as  “prophylaxis”, “professional mechanical plaque removal” or “periodontal instrumentation”, and it is reasonable to assume that the findings would be the same.

Wednesday, January 16, 2019

World Cancer Day

Mon, 01/14/2019 - 17:41

World Cancer Day is an international day marked on February 4 to raise awareness of cancer and to encourage its prevention, detection, and treatment. 2019 marks the launch of the 3-year ‘I Am and I Will’ campaign; an empowering call-to-action urging for personal commitment and represents the power of individual action taken now to impact the future.

Cochrane Cancer supports and coordinates the work across multiple Cochrane Review Groups dealing with the topic of Cancer. These  Cochrane Review Groups provide reliable evidence required to make important decisions on issues concerning cancer and related topics. Cochrane Review Groups facilitate the identification of reports of clinical trials and carry out systematic reviews of available evidence. These are published on the Cochrane Library, and updated periodically as new evidence is identified. This ensures that Cochrane Reviews are relevant, useful, usable, and used.

To mark World Cancer Day, we have collated a selection of  highly view Cochrane Reviews on cancer:

    Monday, February 4, 2019

    Podcast: Cerebrolysin for acute ischaemic stroke

    Thu, 01/10/2019 - 15:39

    When someone has an acute ischemic stroke, urgent and reliable treatments will reduce their risks of disability or dying from their brain tissue damage. The treatments used vary around the world, and a drug called cerebrolysin is widely used in post-Soviet countries, Eastern Europe, Central and Southeast Asia. In April 2017, the latest update of this review was published by researchers from Kazan Federal University in Russia and Chinara Razzakova, a PhD student from the university interviewed one of the authors, Liliya Eugenevna, for this podcast.

    "This Cochrane Review is about a medicine called cerebrolysin, which is used for people who’ve had an acute ischemic stroke. It’s believed to have neuroprotective and neurotropic properties and is widely used here in Russia, countries of the former Soviet Union, China and elsewhere in Asia. We wanted to examine its potential benefits for people with acute ischemic stroke, and whether there are any harms associated with its use.

    One of the reasons for the review was the fact that cerebrolysin is used so often for this type of stroke, but the main issue as we worked on the review was the drug’s use as a potential neuroprotector. In ischemic stroke, the concept of “neuroprotection” includes the suppression of changes that lead to an influx of calcium ions, activation of the reactive oxygen species or free radicals, and cell necrosis. These ideas have stimulated the development of many potentially “neuroprotective” substances, some of which were shown to be effective in animal studies. However, the evidence from clinical trials in patients continues to be problematic. This led us to try to find out whether cerebrolysin effectively protects the brain from damage and has benefits, or harms, for people who have had an acute ischemic stroke.

    We looked for studies in which patients who were receiving a standard treatment regimen for ischemic stroke were randomized to receive either cerebrolysin or a placebo. We then used these studies to investigate the effects on death and adverse events. We found six randomized trials with a total of approximately 1500 participants. Three of the six trials were large multicentre studies, two were small and one did not provide quantitative information to include in the final meta-analyses.

    When we combined the evidence, we found no benefit of cerebrolysin use. There was no obvious effect on deaths and the data from the three multicentre studies, which reported serious adverse events, showed that cerebrolysin more than doubled the number of people with non-fatal serious adverse events.

    Although high-quality large-scale randomized trials are always necessary for getting reliable information about the potential value of drugs used in acute ischemic stroke, our review has shown that the potential benefit of cerebrolysin is not supported by reliable evidence and we would not recommend its routine use in acute ischemic stroke. We’ve also shown that the use of cerebrolysin is unsafe and, so, if it is going to be tested in future research, this needs to take the form of well-designed randomised trials and include assessments of the risks of serious adverse events.

    In summary; myself and my co-authors of this review recommend that cerebrolysin is not the right choice for the treatment of acute ischemic stroke."

    Thursday, January 17, 2019

    Podcast: Intramuscular and intravenous opioid pain relieving drugs in labour

    Thu, 01/10/2019 - 15:26

    The use of pain-relieving drugs during labour is common throughout the world, and an updated Cochrane Review from June 2018 looks at the use of a class of drugs called opioids. Lead author, Lesley Smith from Oxford Brookes University in the UK tells us what they found.

    "For many women in labour, an epidural containing a local anaesthetic has become an increasingly popular choice for pain relief. However, not all women choose this and some give birth in places were an epidural is not available. One of alternatives is the use of an opioid drug, such as pethidine, diamorphine or meptazinol given either intramuscularly or intravenously. These are used less frequently than epidurals but are still widely used in obstetric and midwife-led birth units to relieve pain during labour, and we did this review to satisfy the need for up-to-date information on their effectiveness.

    Opioids are known to provide very effective pain relief for various causes of pain, such as that following surgery, but they can cause side effects like nausea and vomiting, and drowsiness. An additional consideration when used for pregnant women, is that they cross the placenta perhaps leading to unintended effects on the baby.

    Therefore, despite their widespread use it is still unclear just how effective opioids are at relieving pain during labour, which one provides the best pain relief and what the adverse effects are on the mother and baby. We investigated different types and doses of intramuscular and intravenous opiod drugs to evaluate all this.

    We found 61 randomised trials involving more than 8,000 healthy pregnant women. Unfortunately, despite this large body of evidence, few trials had compared the same drug with a control and, instead, we were faced with a total of 34 different drug comparisons. Many comparisons had just a single study providing data, which seriously limited our ability to make firm conclusions. Another problem was that the trials were generally of poor quality, due to relatively small sample sizes, subjective outcome assessment using measures of uncertain validity and reliability, and a lack of blinding of investigators and women.

    Overall, we found that intramuscular or intravenous opioids provided some pain relief and women were moderately satisfied with the pain relief during labour, although up to two thirds of women reported moderate or severe pain or poor pain relief one to two hours after receiving an injection. Some women also experienced nausea, vomiting and drowsiness, but there was no clear evidence of adverse effects on the baby. It also wasn’t possible to establish whether one drug was superior to another, because of the lack of the necessary comparative evidence.

    In summary, our updated review shows that the evidence supporting the choice of intramuscular or intravenous opioids for pain management during labour is poor. We still need research to establish which drug provides the greatest satisfaction to women, with acceptable levels of unintended effects on both them and the newborn."

     

    Thursday, January 10, 2019

    Cochrane’s Colloquium, Santiago 2019 - call for abstracts and workshops now open

    Tue, 01/08/2019 - 17:31

    The 26th Cochrane Colloquium, Santiago 2019 call for abstracts and workshops is now open. 

    This year’s theme is ‘Embracing diversity’, recognizing Cochrane as a truly global independent community, addressing relevant health questions from international stakeholders using a range of diverse methods. 

    We ask that abstract submissions consider the relevance to this theme. In particular, we welcome submissions that address or discuss diversity on reviews from different viewpoints/angles. 

    The deadline for submissions is 12 April 2019.

    All submissions will be notified of their outcome by the first week in June 2019. 

     

    Tuesday, January 8, 2019

    Cochrane Survey: Provide feedback on Cochrane’s Policy on Conflicts of Interest

    Mon, 01/07/2019 - 16:04

    v\:* {behavior:url(#default#VML);} o\:* {behavior:url(#default#VML);} w\:* {behavior:url(#default#VML);} .shape {behavior:url(#default#VML);} Methodological rigour and impartiality are key attributes of Cochrane reviews. In an era where the validity of research is under scrutiny, the impact of conflicts of interest (COI), real and perceived, cannot be underestimated. It is critical, therefore, that Cochrane has a policy in place to minimize this concern and retain the confidence of all its stakeholders.

    To ensure Cochrane’s policy is fit for purpose, we are reviewing the Commercial Sponsorship Policy for Cochrane reviews and Cochrane review groups, which was last updated in October 2014.  We aim to make it easier to identify, prevent and manage COI from initial declarations to published statements in Cochrane reviews. The revised policy will cover both financial and non-financial aspects of COI. By improving clarity and removing ambiguity, we hope that the new policy will deal with issues around perception and transparency.

    In revising the policy, we must consider the unique challenges that arise from Cochrane being both the publisher of the Cochrane Library and an international healthcare research organization which serves multiple stakeholder interests and is powered by a largely volunteer workforce. Like other international organizations, we must ensure that our COI policy is understood and applied in a wide variety of countries and cultural contexts. Information gathered in the survey will be combined with a review of COI policies from other organizations and interviews with key stakeholders and COI experts, to inform the policy update.

    We invite feedback from people who create, use or fund the production of Cochrane Reviews, on how conflict of interest should be defined and managed. Please take 15 minutes to complete this important survey on COI by 17th February.

    If you have any questions about the survey or the COI revision project generally, please contact the team at COISurvey@cochrane.org.

    Monday, January 7, 2019

    Preventing dementia: do vitamin and mineral supplements have a role?

    Mon, 01/07/2019 - 15:09

    In this Evidently Cochrane blog, Sarah Chapman looks at the latest evidence on vitamin and mineral supplements for preventing dementia or at least slowing cognitive decline. Can they really help?

    "I have a clear memory of watching a tv drama with my mum, when I was about fifteen. As we watched a vivid portrayal of a middle-aged woman struggling to cope with her mother, declining with dementia, Mum voiced a fervent hope that she would never be like that. With her own mother enjoying good health in her nineties, the possibility must have seemed as remote to her as middle age did to me. But now I am there, and so is my mum, diagnosed with Alzheimer’s last summer.

    Is there anything my bright, busy mother could have done to reduce her risk of dementia? This woman, who for much of her adult life had a fulfilling career and later voluntary work; was happily busy with friends and family; enjoyed theatre-going, singing in a choir and participating in various special interest groups; read voraciously and had a daily crossword habit. Is there?"

    Despite the many important and positive inroads into our understanding of dementia in recent years, and an increasing shift in emphasis from dementia being something people suffer from to something they can live with, dementia frightens us. Katie Marais from Alzheimer’s Research UK says that “How can I prevent dementia?” is one of the most common questions put to them, and explains here what last year’s Lancet Commission on Dementia found about risk factors. While 65% of the risk for dementia comes from things we can’t change, like our age and our genes, the report lists nine ‘modifiable risk factors’ for dementia, things that we may be able to do something about, including smoking, lack of physical activity and social isolation.

    Preventing dementia: what do we try?

    There are many things that people do in the hope of staving off cognitive decline, from dietary modifications to daily sudoku solving. I think we may travel more in hope than expectation, but sometimes we can find evidence to see if our efforts might actually reduce our risk, and whether we could be doing ourselves any harm by trying.

    Two Cochrane Reviews bring together the best available evidence on the safety and effectiveness of vitamin and mineral supplements for maintaining cognitive function and preventing dementia. In theory, these could help, as vitamins and minerals have many functions in our central nervous systems which may help keep the brain healthy and our minds working well. But is there robust evidence to inform our choices? Let’s see.


    Vitamin and mineral supplements for cognitively healthy people

    This new Cochrane Review concerns the effects of vitamin and mineral supplements on cognitive function in people with no cognitive problems when they started taking part in the research studies. Although the review authors looked for studies involving people aged 40 and over, there are few data on people taking supplements under the age of 60. Despite being able to include 28 studies involving more than 83,000 people, there are limitations of the evidence which mean that confident conclusions can’t be drawn. Here’s what they found.
    B vitamin supplements

    Taking B vitamin supplements probably has little or no effect on overall cognitive function at any time point up to five years and may have no effect at five to ten years. There are very few data on harms or on the incidence of cognitive impairment or dementia.

    Antioxidant vitamins: ß‐carotene, vitamin C or vitamin E

    The results are mixed, but the review authors say that long-term supplementation with antioxidant vitamins may be the most promising area for future research. There is low-certainty evidence of benefit in overall cognitive function with long-term supplementation with ß‐carotene (after a mean of 18 years of treatment) and with vitamin C (after 5 to 10 years), but an antioxidant vitamin combination or vitamin E, alone or with selenium, may have no effect.

    Selenium

    Selenium alone, taken for around five years, may have no effect on the incidence of dementia.

    Zinc and copper supplementation

    Moderate-certainty evidence suggests that this has little or no effect on overall cognitive function, or the incidence of cognitive impairment, after five to ten years.

    Complex supplements

    Combinations of B vitamins, antioxidant vitamins, and minerals may have little or no effect on cognitive function, after around 8.5 years of taking them. The authors’ bottom line is:

    “We did not find evidence that any vitamin or mineral supplementation strategy for cognitively healthy adults in mid or late life has a meaningful effect on cognitive decline or dementia, although the evidence does not permit definitive conclusions.”

    Omega 3-PUFA (fish oils)

    An older Cochrane Review looks at the effect of omega-3 fatty acid supplementation (in gel capsules or margarine) compared with placebo (olive oil capsules or omega-free margarine) in cognitively healthy older people.  There is no direct evidence of the effect of omega-3 supplements on the number of people being diagnosed with dementia, while three high quality randomised trials show no benefit for cognitive function, measured by the Mini Mental State Examination (MMSE) score at 24 or 40 months. Some people taking omega-3 supplements experienced mild gastrointestinal problems.

    Vitamin and mineral supplements for people with mild cognitive impairment

    The authors of this Cochrane Review on the effects of vitamin and mineral supplementation on cognitive function in people with mild cognitive impairment (MCI) have found that the evidence is very limited. Only B vitamins have been assessed in more than one clinical trial. Taking B vitamins for six months to two years probably results in little or no difference in memory, thinking skills or quality of life, and the evidence doesn’t tell us whether or not there are any harms from taking them.

    They conclude:

    “At the moment, it is not possible to identify any supplements which can reduce the risk of people with MCI developing dementia or which can effectively treat their symptoms.”

    Where does this leave us?

    So many things that we try in the hope of maintaining our health are costly in terms of money, time, effort and the hopes we pin on them. Preventive strategies, like taking dietary supplements, are often pushed hard by those with a commercial interest in their uptake. Whether it is NHS budgets or individuals’ purses that take the financial hit, knowing whether there is evidence to guide these choices, and what that evidence tells us, is so important. These Cochrane Reviews show us what the state of the evidence is to date and when more evidence becomes available it can be assessed for inclusion in an update of the reviews. Meanwhile, we are anticipating three new Cochrane Reviews on another popular preventive strategy, computerised cognitive training or ‘brain training’, which we’ll be  blogging about here.

    Wednesday, January 9, 2019

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