We spoke to Cochrane Oral Health Author Terry Simpson about the updated review Treatment of periodontitis for glycaemic control in people with diabetes mellitus. He explains the results of this review and what it means for the research community as well as medical, nursing, and dental professionals - with thanks also to Josh Twigg, Ambrina Qureshi, Sarah Wild, Ian Needleman and Laura MacDonald.

Terry, can you tell us about this updated Cochrane Review?
Our review of studies evaluating the impact of treatment of periodontitis (gum disease) on glycaemic control in people with diabetes was originally published in 2010 (based on a protocol published in 2004) and first updated in 2015. For the 2022 update, we divided the review in two due to the sheer volume of studies on this topic and to account for the clear divide that has emerged in the research, focusing on two different key questions. This update answers the question: how does treatment of periodontitis compare to usual care or no treatment for improving glycaemic control in people with diabetes; the second part of the update will compare different approaches to treatment of periodontitis against one another, to assess if there is a gold standard for treatment.

This first part of our update found that glycaemic (blood sugar) control in people with diabetes can be improved with treatment of periodontitis. The improvement in diabetic control from treating any periodontitis appears to be approximately equivalent to the threshold for determining effectiveness of an additional diabetes drug - but without the side effects.

What does it mean for the research community?
For the first time since this review began, we have shown that we do not need to conduct further randomised controlled trials that compare periodontal treatment against no treatment or usual care in people who have both diabetes and periodontitis. Within the population of people with diabetes, there is the potential for individuals to improve glycaemic control through treating their periodontitis and therefore we recommend that research should not withhold periodontal treatment from such people for the purpose of a research study that is highly unlikely to add new information to the evidence base. Trials comparing different approaches to periodontal treatment may still be useful, while qualitative studies and process evaluations will be helpful to establish how best to optimise the provision of effective periodontal treatment in primary care settings and to support patients to improve their periodontal health and oral hygiene practices.

Given the evidence is clear, what needs to change?
As treatment of periodontitis in people who also have diabetes can have a beneficial effect on metabolic control (glycaemic levels), it is important that there is better communication between dental and medical professionals managing patients with diabetes and periodontitis as this will facilitate appropriate treatment to minimise risk of complications of diabetes. Unfortunately, care pathways between diabetes and oral health do not exist for most patients. Therefore, healthcare policy and guidance are needed to establish such funded pathways.

For dental professionals, greater awareness is required regarding effective monitoring and treatment of diabetic patients with periodontitis. Professional development for all relevant healthcare staff (including diabetologists, other medical and nursing teams dealing with diabetic patients and the dental professionals) must be delivered to transfer knowledge, address barriers and support implementation. Partnering with organisations that provide information and support for people with diabetes and oral health would be helpful.

Governments may wish to review how socially funded health schemes are addressing the need for periodontal care, particularly among people with diabetes, where the potential for improvement in health and quality of life may be profound. The role of periodontal specialists in providing training and advice on referral for further management is critical in ensuring the dental workforce is equipped to manage this group of patients to the best standard.  

Groups formulating guidelines on diabetes or periodontitis should incorporate the findings of our review so that appropriate educational resources are available for professionals and patients. In the UK, we are aware that NICE have already undertaken this responsibility.

How can clinicians working in this field change what they do?
Medical and nursing professionals should ask all patients diagnosed with diabetes whether they have had a dental visit to get their gums checked and to emphasise the importance of gum health in diabetes management. They can signpost or refer their patients to dental professionals in the case of any unusual presentation or poor oral health identified during general screening on follow-up visits. Similarly, dental professionals (dentists and hygienists/therapists) can advise all patients with diabetes of their increased risk of gum disease and the benefits of good gum health for their overall health and wellbeing. Regular screening of gum health should continue to be provided to all patients, with detailed assessment for those identified at risk of periodontitis. Most patients will continue to be suitable for treatment under the care of a general dentist. However, for people with more severe gum disease and where gum disease is not responding to treatment, referral to a specialist (periodontist) should be considered where available.

Dental and medical professionals can familiarise themselves with the evidence about the links between periodontitis and diabetes. Both professions can assist in the process of educating patients about this relationship. Dentists can play a role in screening for diabetes, considering the possibility of undiagnosed diabetes in patients with risk factors (such as increasing age, higher BMI, non-white ethnicity, family history of diabetes) and the presence of periodontitis, particularly when the condition is severe. They should be able to inform patients of local options for testing for diabetes.

Where can clinicians find out more?

• Our Cochrane Review
• New NICE guidance
• NHS England commissioning standards for dental services for people with diabetes
• The Scottish Dental Clinical Effectiveness Programme leaflet for patients Diabetes and Your Oral Health: Prevention of Gum Disease
• The British Society of Periodontology leaflets about gum health:
  
  • Gum Health Awareness (for patients)
  • Gum Health Awareness: Health Care Professionals (for healthcare staff)
• Diabetes.co.uk online article Diabetes and Dental Health
• Mouth Healthy online article Diabetes and Your Smile

Thursday, June 16, 2022

JBI, Cochrane, Campbell, GIN, the Institute for Evidence-Based Healthcare, the Centre for Evidence-based Health Care, and NICE recently launched the World Evidence-Based Healthcare (EBHC) Day 2022 campaign, ‘Partnerships for Purpose’. 

World EBHC Day is held on 20 October each year. It is a global initiative that raises awareness of the need for better evidence to inform healthcare policy, practice and decision making in order to improve health outcomes globally. It is an opportunity to participate in debate about global trends and challenges, but also to celebrate the impact of individuals and organisations worldwide, recognising the work of dedicated researchers, policymakers and health professionals in improving health outcomes.

The 2022 campaign aims to examine partnerships and practical considerations around establishing different types of partnerships, accelerating innovation, ensuring equity and integrity, overcoming challenges and biases, lessons learned and achieving impact for improved health outcomes globally.

 

There is a growing concern, which was heightened during the pandemic, about making partnerships and collaboration equitable for — and beneficial to — all partners. Although willingness to collaborate has increased, vested interests, bureaucracy and inability to change remain limiting factors. Around the globe, organisations have set up networks, task forces and working groups to coordinate efforts and overcome some of these challenges.

Cochrane’s Editor in Chief, Dr Karla Soares-Weiser says, 

"Partnerships are at the heart of evidence-informed healthcare, and I am very proud of the work Cochrane does with our partners. As a global evidence community, we know that we need to work together to coordinate efforts and make the best use of limited resources. Working together is also an opportunity to listen to and learn from other perspectives, ultimately to benefit the health of all worldwide. I look forward to the discussions that this year’s World EBHC Day campaign on partnerships for purpose will generate."

World EHB Day Events

• Talking the walk: equity in global health partnerships 
  
  • 19 October 2022
  • Free webinar
  • In this 90-minute moderated discussion we will hear from key global experts who challenged the status quo of what ‘equity’ means in global health partnerships, including open and engaging conversations with participants.  Includes Tamara Kredo, Deputy Director and Chief Specialist Scientist at Cochrane South Africa. 
• Making health decisions: what’s best for you?
  
  • 20 Oct 2022
  • Free webinar
  • Hosted by Cochrane UK, this webinar will equip you with some questions and considerations that you can reflect on and discuss with a healthcare professional – to help you make the best health decision for you.
• Cochrane and Partnerships
  • 20 Oct 2022
  • Free webinar
  • Hosted by Cochrane US Network, this webinar will focus on why partnerships are important across the spectrum - from your own life to healthcare policy and practice. Come hear from three Cochrane Board members and three Cochrane US mentees.

Cochrane World EBHC Day Blogs

• Maximize your organisational partnerships by considering these 5 essential points 
  
• NICE and Cochrane: Working together 
• Cochrane First Aid: Using partnerships to reach practitioners and laypeople
• Building capacity through partnership: the cochrane affiliate program at tufts university school of medicine
• Want more free time for research? Try a partnership approach! 
• Facilitating the dissemination of evidence-based practice: cochrane rehabilitation blogshot translation

Cochrane World EBHC Day Vlogs

• Visit the World EBHC website
• #WorldEBHC on Twitter

 

Wednesday, October 19, 2022

Specifications: Part time 22.5 hours (Permanent/Consultancy role considered)
Salary: £45,000 per annum full time equivalent
Location: Flexible
Application Closing Date:  27 June 2022

The Evidence Production and Methods Directorate in Cochrane is made up of three departments that are responsible for the efficient and timely publication of high-quality systematic reviews in the Cochrane Library. One of the three departments is the Methods and Evidence Synthesis Development team.

The Methods Support Unit (MSU) sits in the Methods and Evidence Synthesis Development team. The MSU provides hands on statistical and methods support to people preparing Cochrane systematic reviews. As Statistical Editor, you will provide advanced methods support and advice as requested by the Methods Support Unit Manager, from members of the Cochrane community directly or via  the Community Support Team as needed. The post holder will also provide independent methods review of high-profile reviews, including those intended for press release. In addition to this you will support the implementation of established and more complex methods in Cochrane reviews and work on monitoring the quality of statistical methods and analysis in Cochrane reviews to inform priorities for training and guidance. The role will require a formal qualification in epidemiology or biomedical statistics, and a good understanding of methods used in meta-analysis.

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. An understanding of Cochrane’s work and health research more generally is an advantage, but not essential.

The majority of Cochrane Central Executive staff are located in London, UK, however flexible location or a part-time appointment are possible for the right candidate.

How to apply

• For further information on the role and how to apply, please click here. 
• The deadline to receive your application is by 27 June 2022. 
• The supporting statement should indicate why you are applying for the post, and how far you meet the requirements, using specific examples.
• Note that we will assess applications as they are received, and therefore may fill the post before the deadline.
• Interviews to be held on: w/c 11 July 2022
• Read our Recruitment Privacy Statement 

Tuesday, June 14, 2022 Category: Jobs

Specifications: Permanent
Salary: £52,000 per annum
Location: UK
Application Closing Date:  27 June 2022

The Evidence Production and Methods Directorate in Cochrane is made up of three departments that are responsible for the efficient and timely publication of high-quality systematic reviews in the Cochrane Library. One of the three departments is the Methods and Evidence Synthesis Development team.

The Methods Support Unit (MSU) sits in the Methods and Evidence Synthesis Development team. The MSU provides hands on statistical and methods support to people preparing Cochrane systematic reviews. As lead for the Methods Support Unit, you will be responsible for ensuring that people preparing reviews for publication in the Cochrane Library have access to current advice about the implementation of systematic review methods, including searching, statistical analysis, and bias assessment. The team comprises a Systematic Review Methodology Editor, a Statistical Editor and an Information Specialist. Additional budget will be made available to fund additional methods expertise as may be required.

The Methods Support Unit Manager will be responsible for ensuring that methodological and statistical queries from the Evidence Synthesis Development Editors, Editorial Service or Cochrane Support Team are addressed. The role will require a formal qualification related to systematic review methods.

How to apply

• For further information on the role and how to apply, please click here. 
• The deadline to receive your application is by 27 June 2022. 
• The supporting statement should indicate why you are applying for the post, and how far you meet the requirements, using specific examples.
• Note that we will assess applications as they are received, and therefore may fill the post before the deadline.
• Read our Recruitment Privacy Statement 

Tuesday, June 14, 2022 Category: Jobs

Monday, June 13, 2022

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

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

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

Name: Filip Wikström
Location: Lund, Cochrane Sweden
CIM location: Barcelona, Cochrane Iberoamerica

How did you first learn about Cochrane?
The Cochrane Learning Modules are integrated into the Medicine Programme in Lund University, so I was gradually exposed to the Cochrane Methodology over several semesters. I think reading and assessing past research is an invaluable skill to have, so I was very glad to get the opportunity to do my Master’s Thesis with Cochrane.

What was your experience with Cochrane International Mobility?
My experience with the international mobility program was fantastic. The researchers at Cochrane Iberoamerica were very welcoming and I look back very fondly to the weeks I spent there. I learned a lot about systematic reviews but I also got to know amazing researchers and the projects they were working on.

What are you doing now in relation to your Cochrane International Mobility experience?
Currently I am contributing to a Cochrane Review on Tumor Necrosis Factor alpha inhibitors, under the supervision of Michele Compagno and Matteo Bruschettini (both based at Lund University). In the future I aspire to collaborate on more Cochrane projects.

Do you have any words of advice to anyone considering a Cochrane International Mobility experience?
Based on my own experience, I would advise anyone who likes systematic reviews to consider the program. It is a great opportunity to meet passionate researchers and work in an international environment. I got new perspectives on Cochrane methodology but also experiences that I think are important on a personal level.

 

 

Monday, June 20, 2022

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

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

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

Name: Agata Stróżyk
Location: Warsaw, Poland
CIM location: Lund, Cochrane Sweden

How did you first learn about Cochrane?
I first got a chance to better know what systematic reviews are and what the role of Cochrane is when I was participating in the Evidence-Based Medicine faculty at my university. Systematic reviews are critical in summarizing clinical evidence and Cochrane is the most methodologically rigorous at doing it! In Poland, we call the Cochrane Handbook our Bible for systematic reviews.

What was your experience with your virtual Cochrane International Mobility?
To be a part of a Cochrane systematic review was definitely on my to-do list. I was looking for any opportunity to be involved in Cochrane for about two years. I was a supporter at Cochrane TaskExchange and Cochrane Crowd. Finally, I contacted Matteo at Cochrane Sweden, who involved me in a systematic review that was already ongoing. Thus, I didn’t have to go through all process, but from the beginning of my traineeship, I had to do specific tasks. Matteo and Giovanni Cagnotto (also based at Lund University) were my supervisors and are very friendly, kind, patient, and supportive at each step, but also very motivating and fast-working – that was a great experience!

What are you doing now in relation to your Cochrane International Mobility experience?
At the moment, we hope to complete our systematic review, “Tumor necrosis factor (TNF) inhibitors for the treatment of psoriatic arthritis”, in a couple of weeks. For sure, I will use what I’ve learned to do methodologically better systematic reviews in the future. Moreover, I will still look for other opportunities to be a part of the Cochrane community, and maybe one day to prepare a new Cochrane systematic review within my area of expertise.

Do you have any words of advice to anyone considering a Cochrane International Mobility experience?
If you are interested in systematic reviews, I think it is a highly desirable step to participate in any kind of traineeship supervised by Cochrane. For any medical practitioners and researchers who would like to better understand the critical appraisal of evidence and its translation into practice, I think it’s a great option too. My personal advice: do not give up, if you do not get any response for the first time! Be persistent in chasing your dreams

 

Monday, June 13, 2022

帮助哮喘患者按处方服药的数字化技术 综述问题的背景 哮喘是全世界最常见的慢性疾病之一。有可治疗症状的有效药物，例如含类固醇吸入剂。但是，为达最佳效果，需要按处方服用维持药物。许多人并未服药，是由于日程繁忙以及坚信药物只是短期需要。此即所谓“不依从”，这可引出更多症状和发作。不依从是一个主要的健康问题；达到依从对预防发作和降低死亡风险非常重要。医疗保健领域越来越多在使用数字化干预，例如手机、文本消息和可反馈服药信息的“智能”吸入器。然而，有关这些技术是否改善哮喘药物服用或改善症状的证据有限。 本综述旨在了解数字化技术是否真起作用而改善哮喘药物的服用，以及这种依从性改善是否带来对哮喘症状和其他益处的改善。 研究特征 我们发现了40项研究，纳入15000多名患有哮喘的成人和儿童。研究时间范围为大约2周至24个月，因此我们并不能说，这些方法是否长期（多年）有效。我们检索了多个信息源以找到相关研究。本综述最新截至2020年6月。我们查看数据旨在了解数字化技术是否会帮助哮喘患者按处方服药，以及使用该技术者是否比不用该技术者对哮喘控制更好、哮喘发作更少。 主要结果 与未接受该技术者相比，接受了数字化技术以支持哮喘药物服用的哮喘者能更好地按处方服药；与未接受数字化技术者（平均服用其药物处方量的45%）相比，接受数字化技术者按规定服药者增加了15%（可能处在8%至22%之间）。重要的是，接受数字化...

Rho激酶抑制剂用于治疗原发性开角型青光眼和高眼压 问题 Rho激酶抑制剂滴眼液治疗青光眼或眼压增高的益处和风险是什么？ 关键信息 与rho激酶抑制剂（rho kinase inhibitor, ROKi）治疗相比，抗青光眼滴眼液，如拉坦前列素（latanoprost）和噻吗洛尔（timolol），或许更能降低眼压，但与噻吗洛尔的差异为小。rho激酶抑制剂与不同类型的药物联合使用时，眼压可能会降低更多。与其他治疗相比，采用rho激酶抑制剂治疗者会经历更多的不良事件（副作用）。未来在此领域的研究应侧重于报告疾病的进展（青光眼如何随着时间推移而恶化）。 什么是青光眼？ 青光眼是一种威胁视力的眼疾，若不治疗则可会导致失明。青光眼有不同的类型，最常见的是原发性开角型青光眼（primary open-angle glaucoma, POAG）。高眼压是发生青光眼的已知危险因素。 青光眼的药物治疗 有不同类型的滴眼液可用于治疗青光眼。所有的青光眼药物治疗都是通过降低眼压而起作用。拉坦前列素（Latanoprost）和噻吗洛尔（timolol）是两种治疗青光眼的药物，其中有一种被称为rho激酶抑制剂（rho kinase inhibitor）的新型青光眼药物。 我们想了解什么？ 我们想检验rho激酶抑制剂滴眼液的有效性和安全性是否比其他药物更好或更差。 我们做了什么？ 我们检索了进行以下比较的...

儿童肘部骨折的不同治疗方法有哪些益处和风险？ 关键信息 发生肘关节髁上骨折（即肘关节上方约5厘米处骨折）的儿童，用两支或多支钢丝从肘关节外侧插入，而非用一支钢丝从肘关节内侧插入又用一支从外侧插入（交叉钢丝），可能有更低的神经损伤风险。医生手动复位骨骼的方法可能不会增加或降低神经损伤的风险，但闭合法可能会降低感染的风险。 - 关于这些肘部骨折的其他治疗方法，因为我们没有找到足够多的研究，其益处和风险并不清楚。 - 需要有更多设计良好的研究来更好地估计其他治疗的益处和伤害。这些研究应关注肘部运动相关结局及生活质量和儿童如何不安。 什么是肘关节髁上骨折？ 这种类型的骨折位于上臂骨，肘关节上方约5厘米处。它是儿童期最常见的肘部骨折，会影响儿童的日常功能及其玩耍和运动能力。 如何治疗这些骨折骨？ 治疗根据骨骼是否移位而有不同。如果它已移位，医生可能会手动将其移回正常位置。医生采用“闭合复位”（不打开皮肤）或“开放复位”（打开皮肤后）来进行此操作。 手术过程中，金属丝用于在骨愈合时将骨骼在位。医生可能会使用不同类型和数量的钢丝，并从不同的角度插入。 如果骨骼没有移位，则可能不需手术。在此情况下，在骨愈合时将骨骼固定在位的治疗包括采用石膏模型、吊带或牵引（使用重物、绳索和滑轮）。 我们想知道什么？ 我们想知道： - 哪种类型的治疗对骨愈合最有效；以及 - 这些治疗是否与任何不良反应有关。 我们...

New Review published: Digital technologies to help people with asthma take their medication as prescribed

Asthma is one of the most common long-term conditions worldwide. There are effective medicines available to treat symptoms, such as inhalers containing steroids. However, for best effect, maintenance medication need to be taken as prescribed. Many people do not take their medication, due to busy schedules and the belief that medication is only needed short-term. This is known as 'non-adherence', which can lead to more symptoms and attacks. Non-adherence is a major health problem; achieving adherence is very important to prevent attacks and reduce the risk of death. In healthcare there is increasing use of digital interventions such as mobile phones, text messages, and 'smart' inhalers that can feed back information about medication-taking. However, there is limited evidence on whether these technologies work to improve asthma medication-taking or improve symptoms.

This review aimed to find out whether digital technologies really work to improve asthma medication-taking, and whether this improved adherence leads to improvements in asthma symptoms and other benefits.

Study characteristics

We found 40 studies including more than 15,000 adults and children with asthma. Studies ranged from about 2 weeks to 24 months' duration, so we cannot say whether these methods are effective in the long term (a long period of years). We searched multiple information sources to identify relevant studies. This review is current as of June 2020. Looking at the data, we aimed to find out whether digital technologies helped people with asthma to take their medication as prescribed, and whether people who used the technology had better asthma control, and fewer asthma attacks, than those who did not use the technology.

Key results

People with asthma who were given the digital technology to support asthma medication-taking were better at taking their medication as prescribed compared to people who did not get the technology; 15% more people (likely to be somewhere between 8% and 22%) took their medication as prescribed when they received the digital technology, compared to those who did not (who took their medication on average 45% of the amount prescribed).

Importantly, people who got the digital technology had much better asthma control and half the risk of asthma attacks (likely somewhere between 32% and 91%), which has direct benefits for reducing the risk of asthma-related deaths. We saw improvements in quality of life and lung function, but the effect on lung function was small and may be of limited clinical relevance.

No improvements were seen in unscheduled healthcare visits. There was not enough information to tell us about the effect of digital technologies on time off work or school or the cost-benefits, nor whether there are any harms. Technologies were generally acceptable to patients. Certain types of technologies such as 'smart' inhalers and text messages seemed to be better for improving medication-taking than other technology types, although the small number of studies means we cannot be certain that these technologies definitely work better than others.

Quality of the information

There is some uncertainty about our results because the studies were quite different from each other. These differences mean that we cannot be completely sure what the real benefit is, as the benefits may be due to other factors not directly related to the technology - for example, being involved in a study can improve medication-taking. Sometimes the studies did not give us enough information for us to include them with the other studies to work out their effectiveness. We had concerns about a quarter of the studies where people did not finish the study, and we were uncertain whether studies reported everything they measured.

Practising GPs and authors on this Cochrane review Anna De Simoni and Chris Griffiths discuss using apps and digital tools with patients with asthma, they explain,

"The evidence in this review gives us more confidence to discuss their use. From this review we know electronic adherence monitors and text messages can help patients make more informed choices."

Key message

The studies we found suggest that digital technologies may help people with asthma take their medication better, improve their asthma control, and potentially halve their risk of asthma attacks, compared with people who did not get the technology. Certain types of digital technologies, such as text-message interventions, may work better than others. However, we have some uncertainties about the quality of the information reported in some studies, and the small number of studies for the different technology types, which means we cannot be 100% certain of their benefits.

Author Amy Chan explains,

 “Digital technologies that aim to improve medication taking can increase people taking their medication in way it has been prescribed by 15%, and improve asthma control and quality of life. Technologies that use text messages or electronic adherence monitors appear to be particularly effective for improving people taking their medication as prescribed.”

• Read the full review
• Visit the Cochrane Airways website

Monday, June 13, 2022

Tuesday, June 7, 2022

Monday, June 6, 2022

类固醇联合抗生素较单独使用抗生素治疗眼内手术或注射引起的急性眼内炎 本综述的目的是什么？ 本Cochrane综述的目的是研究类固醇辅助抗生素较单独使用抗生素对眼内手术或注射引起的急性眼内炎（一种可能导致失明的眼球内感染）的疗效。我们检索了所有能回答该问题的研究，并找到了四项。 关键信息 无法确定与单独使用抗生素治疗眼内手术或注射引起的眼内炎相比，使用类固醇辅助抗生素是否更有益或更有害。 本综述研究了什么？ 虽然眼内炎的发病率很低，但可能会导致患者失明，因此有眼内手术史或注射史的患者应知晓其风险，同时医生也应掌握最佳治疗方案。眼内炎最常见的病因是眼内手术或注射时引发、或是术后几天内引发的细菌感染。当医生怀疑可能是眼内炎时，会抽取患者眼内液体（严重时需引流取样），并给患者眼内注射广谱抗生素。虽然使用抗生素治疗眼内炎的疗法已广为接受，但就是否额外使用类固醇这一问题上还存在较大争议。类固醇也许能缓解眼内炎患者的炎症状况。我们研究了在抗生素的基础上联合使用类固醇是否会对眼内炎患者的结局产生影响。 本综述的主要结果是什么？ 我们纳入了来自南非、印度和荷兰的四项研究。绝大部分研究中的受试者为白内障手术引发的眼内炎患者。四项研究都比较了眼内注射地塞米松（一种类固醇）及两种抗生素与单独注射抗生素的疗效。低质量证据表明，地塞米松组的受试者在接受治疗后3个月内的视力结局优于抗生素组，但12个月内的效果...

对于肠癌和大息肉的群体筛查，哪种粪便血液检测更准确？ 研究背景 大肠癌或结直肠癌（colorectal cancer, CRC）是最常见的癌症类型之一。在症状出现之前的早期检测，可以使治疗肠癌变得更加容易并增加生存机会。参加肠癌筛查计划可以早期发现和切除大的或晚期的息肉（晚期腺瘤），这些息肉被认为是肠癌的前兆。简单的粪便测试用于检测粪便中是否存在血液，这可能是肠癌或息肉的早期症状。人群筛查中使用的两种粪便血液测试是：愈创木脂粪便隐血试验（guaiac-based faecal occult blood tests, gFOBTs）和免疫化学法粪便试验（faecal immunochemical tests, FITs）。大型的、以往的研究表明，使用gFOBTs进行筛查可以降低死亡率。在1项对文献的系统综述中，我们比较了这两种测试的准确性，以评估哪种测试在人群中筛查肠癌以及晚期肿瘤（包括肠癌和晚期息肉）的效果最好。 研究特征 我们对线上数据库进行了详细检索，以查找评估或比较这两种测试（其中之一）在CRC筛查中的研究。本综述仅纳入在40岁以上无症状的平均风险个体的中开展的研究。用于比较测试结果的参考标准是使用通过肛门的软管上的摄像头对大肠进行全面内窥镜检查（结肠镜检查）。我们评价了两种类型的研究：所有受试者都接受了粪便检查和结肠镜检查的研究，以及仅对粪便检查结果不佳的受试者进行结肠镜...

急性呼吸窘迫住院婴儿与儿童的体位治疗 综述问题 我们探究了急性呼吸窘迫综合征（acute respiratory distress syndrome, ARDS）婴幼儿在人工通气时取腹卧位（俯卧位）与背躺位（仰卧位）或侧卧位的结局是否有差异。 研究背景 ARDS是全球造成婴幼儿住院与死亡最常見的原因之一。严重呼吸窘迫患儿住院时，治疗可能包括额外给氧、有或无辅助通气。这些用于提高氧合的方式可能会损害肺部。有呼吸困难的婴儿和儿童处于特定的体位可能会更舒适、能更轻松地呼吸且有更好的结局。然而，不同的体位也可能增加不良结局风险，如气管内管（连接人与呼吸机的管子）阻塞及意外脱管（管路移出）。为了解情况是否如此，我们进行了文献检索从而找到随机对照临床试验（randomised controlled trials, RCTs）与类随机对照临床试验（quasi-RCTs），以比较两种或多种体位用于管理急性呼吸窘迫综合征住院婴儿和儿童。 检索日期 目前证据检索至2021年7月26日。 研究特征 我们纳入了6项试验，共有198名年龄为4周至16岁的受试者。其中大多数为机械通气。干预时间范围起于儿童入院安顿于病床15分钟后，及至7天最长干预时间。仅有少量儿童（n=15）未用呼吸机来支持其呼吸。 研究经费来源 纳入试验皆得到公立机构的支持。 主要结果 与仰卧位相比，腹卧位似乎可改善氧气利用（氧合指数是指...

预防帕金森病患者跌倒的干预 综述问题 在本综述中，我们评估了旨在减少帕金森病（Parkinson’s disease, PD）患者跌倒干预效果的证据。干预包括运动、药物、防跌倒教育以及运动加教育联合。我们排除了旨在减少晕厥（如头晕和昏厥）所致跌倒的干预。本综述证据截至2020年7月16日。 背景 PD患者中，频繁跌倒是最严重的疾病里程碑状况之一。有效防跌倒策略相关信息将有助于防跌倒干预的实施。 研究特征 我们纳入了32项随机对照临床试验，有3370名受试者。其中25项有2700名受试者的研究为运动试验。3项有242名受试者的研究为药物试验。1项有53名受试者的研究为教育试验。3项有375名受试者的研究为运动加教育试验。总体而言，运动和运动加教育研究纳入了轻中度PD患者。 主要结果 12项研究比较了运动与认为不会减少跌倒的对照干预。运动可能会使跌倒次数减少约26%。运动可能会使经历1次或多次跌倒的人数略微减少约10%。 运动可能会使健康相关生活质量即刻有略微改善。然而，我们无法确定，运动是否会减少跌倒相关骨折的人数，它是否对发生不良事件的人数有影响，或者它是否是有成本效益的跌倒预防干预。 3项研究比较了胆碱酯酶抑制剂，即卡巴拉汀（rivastigmine）或多奈哌齐（donepezil)，与安慰剂药物（一种非活性治疗），发现此药可使跌倒率降低约50%。然而，并不确定此药对经历1次或...

用于管理COVID-19疫情的学校措施的意外结果 这个问题为何重要？ 世界各国已采取很多公共卫生和社会措施来预防和控制SARS-CoV-2的扩散，而SARS-CoV-2是一种造成COVID-19的有高度传染性的呼吸道病毒。已经采取了一系列措施，以最大限度降低SARS-CoV-2在学校和更广泛社区的传播。学校有可能成为高病毒传播场所，因其涉及近距离人员间的广泛互动。先前有综述针对并检验了此类学校措施在SARS-CoV-2传播方面的有效性的研究。同样重要的是要检视其健康和社会相关意外结果，从而使政策制定者和父母能做出知情决策。公共卫生措施的意外结果可能有益或有害（或两者皆有）。公共卫生措施可能导致益处与伤害混杂存在。在本综述中，我们计划查验旨在预防和控制SARS-CoV-2在学校扩散的措施的意外结果。因此可将本综述视作是对先前有关此类措施有效性的综述的补充。 我们做了什么? 首先，我们在9个数据库中检索了评估学校（小学或中学，或两者皆有）为防止病毒传播而采取的任何措施的研究。我们考虑了各种类型的研究和宽泛的结局。 其次，我们根据其所查验的措施类型而对找到的研究进行分组。继之，我们就描述这些研究使用了哪些方法、在哪里施行了这些方法以及评价了哪些意外结果。 我们发现了什么？ 我们发现了18项符合我们纳入标准的研究。5项研究使用了“真实生活”数据（观察性研究）；5项研究使用了基于系列假设的...

2022 marks the 5 year anniversary of  Cochrane Sweden. The center was established on the 17th of May 2017, in the city of Lund. For this milestone, Cochrane Sweden shares some of their many highlights. 

Over the past five years, Cochrane Sweden has been busy promoting evidence-based decision-making in healthcare in Sweden. Some accomplishments have been providing learning tools on how to conduct, edit and read systematic reviews. Cochrane Sweden launched Cochrane Interactive Learning as part of the curriculum for medical students at Lund University to support training in evidence-based health care. Cochrane Sweden is also the first Cochrane group to get unlimited access to Cochrane Interactive Learning. This has led to Sweden having the highest number of users per inhabitant in the world. Moreover, the strategic and fruitful collaboration with Lund University has provided unlimited access to Covidence and, in the coming days, to RevMan Web.

Each year Cochrane Sweden also provides many workshops, courses, and lectures about Cochrane, systematic reviews, evidence-based medicine, and more specialized topics, such as reviews of non-randomized studies, diagnostic test accuracy reviews and complex meta-analyses. We have trained hundreds of PhD students in the Cochrane methodology, and some of them have become Cochrane authors. Eleven master medical students have prepared their master theses at our centre. In 2017, Cochrane Sweden launched the Cochrane International Mobility program. Since then, more than 20 people have participated in this international exchange program to learn more about evidence-based medicine through collaborations between Cochrane Sweden and other Cochrane centers. You can read some examples of the researchers experience with the program here. We are much grateful to all members of our Advisory Board, which includes Swedish health professionals and Cochrane staff from six different groups, for their generous and qualified guidance.

For the past five years, Cochrane Sweden has been busy producing new research. So far, researchers affiliated to our center have completed 22 new or updated Cochrane Reviews, published 25 new Cochrane protocols and 38 other journal articles and reports. This has led to us often being mentioned in international and Swedish media. Currently, we also have 19 protocols and reviews in preparation. Several of these reviews have been commissioned by national and international stakeholders, including the World Health Organization.

 Cochrane Sweden has also collaborated with other centers through the Scandinavian GRADE Network. In 2022, we led the establishment of the network together with Cochrane Denmark, Cochrane Norway, SBU, the Danish Health Authority and the Norwegian Institute of Public Health.  

Our team has also grown up! In 2020, Martin joined as project coordinator, and indeed is coordinating lots of projects, from training to research and dissemination; Katarina is brilliantly delivering administrative support to our activities and contributing to develop new projects; in 2022, also Lea became part of the staff: she contributes to daily operations and ongoing research, such as the Swedish trial transparency report.

We have also produced a lot of content on social media. You can follow us on Twitter, LinkedIn, and Instagram, or register to our monthly newsletter. 

Visit the Cochrane Sweden website here, or drop-in at our office!

Vi ses!

Lea, Martin, Katarina, and Matteo

Tuesday, May 31, 2022

Candidates with experience in accounting and financial management are encouraged to apply

Cochrane is a diverse, global organization committed to informing healthcare decisions with the best available evidence from research. Organizationally, we are an international network of autonomously funded groups and a registered charity in the United Kingdom. Members of the Governing Board come from around the world and provide strategic leadership for the whole organization, as well as acting as Trustees of the UK charity.
 
Governing Board members work as a team, with complementary skills and backgrounds. They are a mix of elected members - who must be Cochrane Members - and appointed members, who bring an external perspective to the Board. Appointed members can be anyone with the relevant skills and experience and will not normally be Cochrane Members.

The Treasurer is a member of the Governing Board who supports their fellow Trustees to fulfil their obligation to provide financial oversight for the organization. Our current Treasurer, Karen Kelly, will step down from her position at the end of August 2023. To ensure a smooth handover and to increase the number of Board members with financial expertise, we are looking to appoint a new Board member who can act as Deputy Treasurer until August 2023, taking over as Treasurer from September 2023.

This is an exciting opportunity to join the board of an internationally renowned healthcare organization as we embark on a program of substantial change in how we are organized as a global collaboration, and seek to complete our transition to become a fully Open Access source of health evidence.

Appointed members serve an initial three-year term and may be reappointed. Board membership is a voluntary, unpaid role, although expenses will be paid.
 
The deadline for applications is 15 July 2022. To find out how to stand for appointment, please visit elections.cochrane.org.

 

Tuesday, May 31, 2022