Friday, March 15, 2024

Wednesday, March 13, 2024

Wednesday, March 13, 2024

Tuesday, March 12, 2024

In this blog for colorectal surgeons and health professionals involved in stoma reversals, Dr Stina Öberg, Dr Siv Fonnes, and Professor Jacob Rosenberg from the Cochrane Colorectal Group discuss new practice-changing Cochrane evidence, showing that a simple change of suture technique likely results in a large reduction in surgical site infections in people undergoing stoma reversal.

Take-home points

• The stoma closure site can be considered a clean-contaminated wound, and many patients develop a surgical site infection after having a temporary ileostomy or colostomy reversed.
• Surgeons often use linear skin closure after stoma reversal. In theory, a clean-contaminated wound can benefit from drainage, which is achieved by using the purse-string skin closure technique.
• A new Cochrane Review has demonstrated that the purse-string skin closure technique likely results in a large reduction in surgical site infections after stoma reversal compared with linear skin closure.
• This simple and inexpensive change of practice may also improve patient satisfaction slightly. Even though the evidence is very uncertain, there seems to be no difference in incisional hernias.

Can surgeons improve their skin closure technique after stoma reversal? Yes - in a straightforward way! Researchers have found clinically important evidence in a new Cochrane review, showing that a simple change of suture technique likely results in a large reduction of surgical site infections in people undergoing stoma reversal. This blog presents the key results from this Cochrane review.

Skin closure after stoma reversal
Temporary stomas are created to protect distal bowel segments. At the time of stoma reversal, the last step is to close the skin. Due to the proximity to intestinal content, the stoma closure site should be considered a clean-contaminated wound. This could also explain why surgical site infections are common after stoma reversal, occurring in up to 40% of patients. When a wound is potentially contaminated, it will in theory benefit from free drainage.

Linear skin closure
Most surgeons use linear (transverse) skin closure despite the possible contamination of the wound at the stoma reversal site. Linear skin closure provides poor or no wound drainage and is theoretically a poor choice for a clean-contaminated wound. The stoma reversal wound is often close to a circular shape, and there is an alternative skin closure technique that at the same time provides drainage - the purse-string technique.

Purse-string skin closure
The purse-string skin closure technique can be used for circular or ellipse-formed wounds. The technique is performed by using intradermal sutures that are drawn together like an old-fashioned drawstring purse (see illustration at the top of the page), leaving a small opening in the centre. The theoretical advantage of using purse-string skin closure for a clean-contaminated wound is that it provides free drainage. This advantage could lower the risk of developing surgical site infections compared with linear skin closure. A lower surgical site infection risk could also result in a better cosmetic result, a higher patient satisfaction, and fewer incisional hernias.

What are the benefits of the purse-string skin closure?
In the Cochrane review comparing purse-string skin closure versus linear skin closure in people undergoing stoma reversal, surgical site infection was assessed in nine randomised controlled trials including almost 800 patients. The purse-string technique likely results in a large reduction in surgical site infections compared with linear skin closure. The anticipated risk within 30 days after linear closure was 243 surgical site infections per 1000 patients versus 52 (95% confidence interval 28 to 85) per 1000 patients after purse-string skin closure.

Purse-string closure may also have other advantages over linear closure. Patients who received the purse-string skin closure seemed to be slightly more satisfied six and twelve months after surgery: the anticipated effect in two randomised controlled trials was 885 satisfied or very satisfied patients per 1000 patients having linear skin closure versus 994 (95% confidence interval 894 to 1000) per 1000 patients having purse-string skin closure.

Finally, a reduced risk of surgical site infections could reduce the risk of incisional hernias. This outcome was reported by four randomised controlled trials with nearly 300 patients followed between three and twelve months, showing an anticipated risk of 55 incisional hernias per 1000 patients after linear skin closure versus 29 (95% confidence interval 4 to 177) per 1000 patients having purse-string skin closure. Even though the purse-string skin closure theoretically could lower the risk of incisional hernias, this was not shown, and there seems to be little to no difference in the risk of developing incisional hernias regardless of the skin closure technique used. However, the evidence is very uncertain, and further randomised controlled trials with longer follow-up might alter this result.

What are the benefits of linear skin closure?
The Cochrane review showed no advantage of using linear skin closure compared with purse-string skin closure in patients undergoing stoma reversal.

What are the risks of the purse-string skin closure?
The Cochrane review suggested that there was no evidence of an increased risk when patients received the purse-string technique compared with linear skin closure.

Pros and cons of purse-string versus linear skin closure
To summarise:

The benefits of using purse-string skin closure:

• likely results in a large reduction in surgical site infections
• may improve patient satisfaction slightly

The benefits of using linear skin closure:

• none found

There seems to be no evidence of a difference between purse-string and linear skin closure regarding:

• incisional hernia (but the evidence is very uncertain)
• operative time (but the evidence is very uncertain)
• length of hospital stay (but the certainty of evidence is unknown)
• anastomotic leak (but the certainty of evidence is unknown)
• intestinal obstruction (but the certainty of evidence is unknown)

Which skin closure technique is best to use after stoma reversal?
Purse-string skin closure both has the theory and the evidence to back up a lower risk of surgical site infections compared with linear skin closure, seemingly without any risks of complications. The result from this Cochrane review could make surgeons reconsider their skin closure method in patients undergoing stoma reversal. A change of practice from linear to purse-string skin closure is both straightforward and inexpensive.

Clinical reflections on the implications of the review
When asking Professor Jacob Rosenberg, the co-ordinating editor of the Cochrane Colorectal Group, about the clinical implications of this Cochrane Review, he stated that:

• This review clearly shows that a simple change in skin closure technique can have a large impact on patient outcome after stoma reversal.
• The purse-string skin closure technique for the stoma site is simple, effective, and seemingly without negative effects.
• These results have the potential to change clinical practice around the world.
• The recommendation to use the purse-string method for skin closure of stoma sites should be included in future clinical guidelines.

Read the full Cochrane Review and plain language summary in the Cochrane Library 

Listen to the lead author, Shahab Hajibandeh from Health Education and Improvement Wales, to tell us more about this review in three minutes

Hajibandeh S, Hajibandeh S, Maw A. Purse‐string skin closure versus linear skin closure in people undergoing stoma reversal. Cochrane Database of Systematic Reviews 2024, Issue 3. Art. No.: CD014763. DOI: 10.1002/14651858.CD014763.pub2. 

Image: The featured image at the top of the page was created by Malene Agnete Højland and Louise Rosengaard from the Cochrane Colorectal Group.

 

Tuesday, March 12, 2024

Tuesday, March 12, 2024

Monday, March 11, 2024

Cochrane marks the second anniversary of the commitment to Public Involvement in Health and Social Care Research, a pledge launched in March 2022. This commitment underscores Cochrane's ongoing efforts to enhance its practice of public involvement in health and social care research.

Cochrane is one of twenty-one organizations signed up to the pledge, including the UK’s National Institute for Health and Care Research (NIHR) and the Health Research Authority (HRA).

Richard Morley, Cochrane's Consumer Engagement Officer, reflects on this initiative: “Making a public commitment to involving the users of our evidence sets out our serious intent to build on our past achievements and deepen and broaden our work.”

A notable achievement is the establishment of the Co-Production Methods Group, launched in October 2023. Aligned with the ‘Putting People First’ commitment, this group will spearhead methods research, share resources for best practice, and supports learning and dissemination activities to help systematic review authors engage with and respond to the needs of consumers. 

To help people make sense of health evidence, Cochrane provides a free Evidence Essentials learning module. This free online resource offers an introduction to health evidence and how to use it to make informed health choices. The module has been co-produced by healthcare consumers, researchers and Cochrane's specialists, with contributions from a range of experts in their fields.

The Learning Live series builds on this, offering free webinars aimed at a range of audiences. Some webinars are aimed at Cochrane review authors, to help them make their research more widely accessible and understood. Others are aimed at helping people to engage with Cochrane research, such as webinars for teachers on using Cochrane Crowd in school projects. 

Looking ahead, Cochrane has a framework for consumer engagement and involvement that runs until 2027. This comprehensive approach revolves around five key elements. It emphasizes proactive engagement strategies, including communication, evidence dissemination, recruitment, and learning. Cochrane aims to elevate co-production by intensifying consumer involvement in the evidence production process, aligning reviews with user needs, and supporting consumer governance.

Prioritizing accessibility, the framework strives to enhance health literacy among healthcare consumers while making Cochrane's evidence more easily accessible. Strategic partnerships, particularly with patient groups, aim to enhance engagement, co-production, advocacy, and health literacy activities.

Finally, the framework incorporates an observatory to ensure evidence-based practices, monitor, and evaluate the impact of Cochrane's ongoing efforts in engagement and involvement.

• Learn more about Cochrane’s commitment to healthcare consumers
• Join Cochrane’s work as a patient, carer, or member of the public
• Email the Cochrane Consumers Network at consumers@cochrane.org 

 

Monday, March 11, 2024

Specifications: Permanent – Full Time
Salary:  £55,000 - £57,000 per Annum  
Location: Remote - Ideally based in the UK, Germany or Denmark. Candidates from the rest of the world will be considered; however, Cochrane’s Central Executive Team is only able to offer consultancy contracts outside these countries.
Closing date: 24 March 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 Executive Editor will be expected to prioritise and delegate editorial tasks as appropriate. The role holder will need to be an advocate for the Editorial Service internally and externally to Cochrane and remain alert to immediate demands of delivering high-quality review content for publication in a timely fashion.        

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, please click here
• The deadline to receive your application is 24th March 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

Friday, March 8, 2024 Category: Jobs

Thursday, March 7, 2024

Tuesday, March 5, 2024

Tuesday, March 5, 2024

Cochrane's strength is in its collaborative, global community. Cochrane Geographic Groups represent Cochrane in their host country, advocate for the use of Cochrane evidence in health policy and practice, and support Cochrane's members and supporters who live there.  Here we look more closely at the impact of Cochrane Thailand, exploring its initiatives and contributions to advancing healthcare not only within Thailand but also across the Southeast Asian region.

Since its inception in 2002, initially as the Thai Cochrane Network before evolving into Cochrane Thailand in 2003, the group has been steadfast in its commitment to disseminating the fundamental concepts of research synthesis and championing the importance of evidence-based healthcare. Located at Khon Kaen University in Northeast Thailand, Cochrane Thailand shares information about Cochrane, translates Cochrane plain language summaries into Thai, and provides workshops about preparing Cochrane reviews and how to use the Cochrane related software. 

"We are dedicated to promoting the use of Cochrane evidence in healthcare decision-making, with a focus not only on local but also global impact," states Professor Pisake Lumbiganon, Convenor of Cochrane Thailand. "Our designation as the WHO Collaborating Centre for Research Synthesis in Reproductive Health in 2014 and as the WHO HRP Alliance Hub for research capacity strengthening for WHO/SEARO in 2017 underscores our commitment to driving change on a global scale. The reviews we contribute to have a far-reaching impact, with many being incorporated into WHO guidelines. Cochrane Thailand takes pride in its role in shaping healthcare practices both within Thailand and beyond." 

One of the group's primary objectives is to facilitate training workshops on Cochrane review preparation and the utilization of related software tools like RevMan and GRADE. These workshops have been instrumental in empowering healthcare researchers across Asia, fostering a community of those equipped with the necessary skills to conduct rigorous research synthesis.

In addition to training initiatives, Cochrane Thailand actively collaborates with various national and international organizations to generate evidence and inform healthcare policies and guidelines. Notably, the group has been invited to support WHO guideline development groups on critical health issues, contributing to the formulation of recommendations that impact healthcare practices globally. Another notable project was working with Cochrane Australia on the five-year 'South East Asia - Optimising Reproductive and Child Health in Developing Countries' project that helped to improve the clinical practice of treating pregnancy and childbirth-related disorders and enhance the health outcomes of mothers and infants in South East Asia. 

 

Cochrane Thailand has also been instrumental in translating Cochrane evidence into Thai, ensuring accessibility for Thai-speaking healthcare professionals, patients and families, and policymakers. With over 1,000 translated Cochrane reviews, the group has significantly enhanced the dissemination and utilization of evidence-based information in the region. "We believe that language should not be a barrier to accessing high-quality healthcare information. Our translation efforts aim to bridge this gap and empower healthcare stakeholders with valuable evidence. We are very proud and thankful to all our volunteer Thai translators who are helping make an impact," emphasizes Nampet Jampathong who helps coordinate the Thai translation.

Looking ahead, Cochrane Thailand is excited about being a Centre of Research Excellence for the project called Accelerating Research and Progress in maternal And Newborn health (ARPAN). This project will help to address the major gaps across the Asia-Pacific region to improve outcomes for women and newborns. 

Cochrane Thailand welcomes collaboration and support from individuals and organizations passionate about making a difference in healthcare. they are looking for funding opportunities to continue to expand their impact throughout South Asia.  Whether through training workshops, research collaborations, or translation efforts, Cochrane Thailand remains dedicated to its vision of enhancing healthcare practices and policies through rigorous research synthesis and evidence dissemination.

• Visit the Cochrane Thailand website
• Follow Cochrane Thailand on X
• View Cochrane Evidence in Thai
• Find a Cochrane Geographic Group in your country

Wednesday, March 13, 2024

Wednesday, February 28, 2024

The second Global Evidence Summit (GES) is taking place in the picturesque city of Prague, Czech Republic, from 10 to 13 September 2024 - registration is still open!  Hosted by global leaders in evidence synthesis and evidence-based practice, including Cochrane, JBI, Guidelines International Network (GIN), and The Campbell Collaboration, the summit represents a unique opportunity for knowledge exchange and collaboration. It is an opportunity for professionals across various sectors, such as health, education, social justice, the environment, and climate change, to engage in discussions about producing, summarizing, and disseminating evidence to inform policy and practice.

GES is committed to inclusivity and global partnership, with a particular focus on low- and middle-income countries (LMICs). We spoke with Sabrina Khamissa, Cochrane's Events Support Officer closely involved in GES, to uncover insights, behind-the-scenes information, and updates about the event.



Hi Sabrina! Excitement is building for the upcoming GES event in September. Could you give us an overview of GES's approach to inclusivity and global participation?
Sabrina: The GES stands out as a unique gathering, uniting individuals across various disciplines and roles, from policymakers to patients and government officials to advocates. This diversity is also reflected in our attendees and our program. Ensuring a diverse and representative audience is important to us. Our commitment to including LMICs has been integral to every stage of planning. From the formation of committees working behind the scenes, to the selection of conference themes and speakers, and even to offering discounts to LMIC attendees. We've strived to make the participation of people from LMICs a central focus of the event.

That's wonderful to hear! Could you share a bit about what's happening behind the scenes to involve LMICs that people might not know about?
Sabrina: Absolutely! Behind the scenes, there has been an effort to make the GES accessible and inclusive for participants from LMICs. One aspect that may not be immediately apparent is the meticulous process of selecting the event location. The choice of the Czech Republic was intentional. Its accessibility via train or plane, price points of accommodation and other expenses, and reasonable visa requirements make it an ideal venue that ensures ease and affordability for global attendees. We also have many committees working behind the scenes. We've taken deliberate steps to ensure that these committees encompass a range of perspectives, including representation from LMICs. From reviewing abstract submissions to curating the roster of keynote speakers, diversity is at the forefront of our considerations. This ensures that the program reflects the global diversity of voices and experiences, enriching the summit's discourse and impact.

Registration prices and visa requirements can often pose significant barriers for attendees from LMICs. How is GES addressing these challenges?
Sabrina: To promote inclusivity, we have implemented significantly reduced registration rates for attendees joining us from low-income, lower-middle-income, and upper-middle-income economies, as classified by the World Bank. This initiative aims to mitigate financial barriers that often deter participation from LMICs, ensuring that cost is not a prohibitive factor for delegates seeking to attend GES. 

We understand the logistical challenges faced by attendees from LMICs, including visa requirements. To alleviate this burden, we are happy to provide letters of invitation to support visa applications. We encourage all attendees to check visa requirements and if you need a letter, please get in touch as early as possible. Our goal is to facilitate smooth and hassle-free participation for all delegates!



There are also stipends. What exactly are those and what does it cover?
Sabrina: Cochrane is committed to promoting diversity and inclusion within its network and recognizes the importance of making its events accessible to individuals from all backgrounds. The organization understands that individuals from low and middle-income countries may face financial barriers that prevent them from attending GES and wants to help alleviate those barriers by offering stipends and bursaries. This is a long tradition at Cochrane and we have been offering this for many years.

Stipends were made available to those residing in low-, lower-middle-, and upper-middle-income countries who are actively contributing to GES's mission. We are grateful to TDR and EDC TP for sponsoring people from LMICs who may not have otherwise been able to attend.  Recipients of these scholarships are expected to provide a report detailing their experiences at the Global Evidence Summit. This report may be utilized as a blog post or news item, contributing to the dissemination of insights and knowledge gained from the event. We also offered stipends for patients and consumers too! 

And what about the GES program? 
Sabrina: The official GES themes have relevance to LMIC, including sustainable development and global evidence to local impact. Each plenary session will feature an LMIC or UMIC representative speaker, ensuring that diverse perspectives are incorporated into the discussions. Plenaries serve as a valuable platform where all attendees come together for presentations followed by panel discussions—an enriching shared experience for all involved.

The program also encompasses many posters and smaller oral presentations, all revolving around our GES themes. These sessions provide attendees with the opportunity to delve into their specific areas of interest, fostering a dynamic learning environment tailored to individual preferences. As I said before, it's a very unique event and we are confident that there will be interesting content for all attendees!

Looking ahead, what are the long-term implications of efforts in involving LMICs in global initiatives like the Global Evidence Summit?
Sabrina: That's an interesting question and it's been one that we have been conscious of. GES organizers and the partners involved truly feel that the efforts extend far beyond the confines of a GES single event. By fostering collaboration and knowledge exchange among diverse people, we lay the foundation for sustainable partnerships that transcend geographical boundaries. Ultimately, we aim to empower attendees to take ownership of evidence-based practices, driving positive health outcomes and equity on a global scale. 

Registration is still open for GES (with onsite registration available!) and we're looking forward to welcoming you all to Prague! See you there! 

• Visit the GES website
• Learn more about registration

Tuesday, August 20, 2024

Specifications: 6-Months Fixed –Term Contract
Salary:  Hourly Rate – £12-£15 per Hour depending on experience
(Please note: This is a short-term project-based contract that is open to anyone who would like to gain experience in this field without necessarily having professional experience.)
Location: UK (Remote – Flexible)  
Closing date:  11 March 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.

As Cochrane’s Data Scientist, you will work with our technology, product and publishing teams to leverage data in supporting the work of Cochrane in advocating for evidence-informed health decision-making worldwide.  

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 11th March, 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, February 27, 2024 Category: Jobs

Specifications: 1-Year Fixed Term Contract
Salary:  £35,000 per Annum  
Location: UK (Remote – Flexible)  
Closing date: 15 March 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 Future of Evidence Synthesis (FES) is a critical programme of work for Cochrane over the next 3 years. Successful delivery is essential for Cochrane’s future and sustainability. A core component of the new production model is the creation of Cochrane Evidence Synthesis Units  and Thematic Groups. This role will work closely with the Head of Change Management, to support the Thematic Groups and Evidence Synthesis Units across the implementation cycle – from application process management, through to onboarding and monitoring and evaluation.
       
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 15 March 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, February 27, 2024 Category: Jobs

Friday, February 23, 2024

A new Cochrane Library Editorial has been released following the publication of two Cochrane systematic reviews on Hospital at Home (HAH) programmes, urging a shift in the trajectory of HaH research. 

Hospital at Home provides hospital-level care at home, for people who would otherwise be inpatients in hospital. One type of Hospital at Home is to avoid admission to hospital. This is called Admission Avoidance Hospital at Home. These services replace an admission to hospital, for people whose condition would normally need treatment in a hospital bed, for example for a flare-up of a lung condition. Instead, a doctor can refer a patient they assess as being suitable to receive treatment for an illness in their own home (or the place where they usually live, including in residential care), for a limited time. Another type is called Early Discharge Hospital at Home. These services shorten the length of time people need to stay in hospital after being admitted as an inpatient, for example following surgery or treatment for an illness or condition. The care patients would usually receive from healthcare professionals in a hospital bed is instead provided in their home, and is not expected to compromise the quality of care.

This first Cochrane review examined if providing health care in an admission avoidance hospital at home setting improves patient health outcomes and reduces health service costs.

• Read the Cochrane review

Edgar K, Iliffe S, Doll HA, Clarke MJ, Gonçalves-Bradley DC, Wong E, Shepperd S. Admission avoidance hospital at home. Cochrane Database of Systematic Reviews 2024, Issue 3. Art. No.: CD007491. DOI: 10.1002/14651858.CD007491.pub3.

The second Cochrane review is a qualitative evidence synthesis on what is important when introducing, running, and receiving care from Hospital at Home services. The authors wanted to explore a range of experiences of, and views on, Admission Avoidance and Early Discharge services. Topics covered things that managers want to know when planning to set up a Hospital at Home service, healthcare professionals’ views on working in a Hospital at Home service, what matters to patients who receive this type of care, or how family and caregivers experience Hospital at Home services for those they care for.

• Read the Cochrane review

Wallis JA, Shepperd S, Makela P, Han JX, Tripp EM, Gearon E, Disher G, Buchbinder R, O'Connor D. Factors influencing the implementation of early discharge hospital at home and admission avoidance hospital at home: a qualitative evidence synthesis. Cochrane Database of Systematic Reviews 2024, Issue 3. Art. No.: CD014765. DOI: 10.1002/14651858.CD014765.pub2. 

These two updated Cochrane reviews demonstrate HaH's clinical and cost-effectiveness but also show the lack of effective scale-up strategies. An accompanying Cochrane Library editorial strongly suggests that the future direction of HaH research must move beyond repeating clinical and cost-effectiveness studies comparing HaH to usual care and instead focus on identifying and testing strategies to increase adoption and sustainability across different healthcare systems. 

The authors summarized the Cochrane Library Editorial by saying:

This editorial recognises the conclusive evidence that Hospital at Home (HaH) programmes are comparable to traditional hospital care, and encourages the  shift in the discourse from “does HaH work?” to “how to we scale up HaH successfully?”. 

Key challenges that needs to be addressed are: patient and  caregiver engagement, policy development, and sustainability to integrate HaH as a core component of acute care strtagies.

• Read the Cochrane Library editorial

Lai YF, Ko SQ. Time to shift the research agenda for Hospital at Home from effectiveness to implementation. Cochrane Database of Systematic Reviews 2024, Issue 3. Art. No.: ED000165. DOI: 10.1002/14651858.ED000165.

Tuesday, March 5, 2024

Thursday, February 22, 2024