Category: Collaboration

Conference of Cochrane Evidence: Useful, Usable & Used #CE3U

My journey with Cochrane started one summer afternoon in 2010, when I interviewed a Tallaghtdoctor (Tallaght is a rough suburb in Dublin, Ireland) about treatments for drinking problems of people who also use other drugs. I emphasized that brief psychosocial interventions were the treatment of choice for patients who don’t use other drugs and that there’s no reason why this should be different for drug users. He asked me whether I was Swedish, because of my accent, and replied by a single question which kept me awake at night and started my career as an addiction investigator: “Does it work?” I decided to celebrate the four years of trying to find an answer to his question at the Cochrane conference in Manchester, UK.
Wednesday 23rd April 2014
This year’s conference of UK and Irish Cochrane contributors’ swapped plenaries and workshops – Wednesday kicked off with two sessions of developmental workshops. The motto of the priority setting workshop was  “Don’t start a journey that you can’t finish”. Pragmatism is a very important part of priority setting. The value of setting priorities in healthcare is the expected gain from reducing the uncertainty. In another words, to reduce the probability that somebody somewhere is getting a wrong treatment.
Figure 1. Bees were the theme of Cochrane conference
The key question of the public health workshop was How to produce good reviews quickly? Growing number of people are interested in doing reviews under the public health group. Most public health studies are non-randomised. Evidence forms just one part of the complex process of public health policy – timeliness is the big factor. The idea of local context permeates all policies – is this relevant to your local area? All of us, as Cochrane reviewers, give shades of grey and they [policy makers] want black& white answers.
The first afternoon plenary started a faithful member of the Cochrane family, Nicky Cullum. She described how easy reviews were in the past. Her talk inspired 12 new tweets in the first 5 minutes of the plenary (#CE3Useful). The beginning of Cochrane nursing group was accompanied by skepticism “Are RCTs possible in nursing?  Is experimentation at odds with caring?” The explosion of nursing trials in the recent years posed new challenges “How on earth do we help non-academic clinicians to have both clinical and academic career?” Trisha Greenhalghconcluded the first with provocative lecture about boringness of Cochrane reviews. She used the example of young doctor Archie Cochrane in a German camp to demonstrate that the art of rhetoric consists of logos, ethos and pathos. Her other work on how innovations rise and how they spread further supported the rhetoric argument. While a logo is the only thing in scholarship rhetoric, factual knowledge can be rarely separated from ethical or social context. By trying to do so, the Cochrane researchers are stripping away the very thing they need to be exploring – how to change the world through science. The methodological fetishism developed in Cochrane collaboration (linked to control, rationalism and accountability) hinders production of more realist and interesting reviews.
Thursday morning plenaries helped the delegates to confer after the gala dinner last night. Rich Rosenfeld, a Professor and Chairman of Otolaryngology, explained how Cochrane reviewers can help policy makers by rapid reviews – Good is ok, perfect we don’t need [for guidelines]. A health economist, Karl Claxton, continued the discussion on when no more evidence is needed. Research takes long time and evidence that we already have can inform allocation of research funds for new projects. However, we should be cautious about judging the usefulness trials with hindsight, it’s wrong because we don’t know the context. Neal Maskery made the audience “lol” with very entertaining and interactive plenary which focused on what we know about how people make decisions. Our brain is so good at patterns recognition – it wants to do it all the time. This phenomenon is called Base rate neglect – a cognitive bias. Biases such as this one hinder innovation and affect our decisions in all areas from buying a car to prescribing medicines. Al Mulley, an expert on shared decision making, finished morning lectures with a story of how every patient brings their own context by using examples from his research on how bothersome is urinary dysfunction.

The special addition to the conference was presence of Students 4 Best Evidence, some of whom won prizes from UK Cochrane centre, including free travel and conference participation. Read more about their winning entries on prostatecancer, dentalhealth, smoking, and long-term illness.

From a personal perspective, starting a Cochrane review took me on a journey which led from a clinical question (from the Tallaght doctor), to policy development, medical education and further research in a very short time. I still don’t know whether counselling works for drink problems in people who also use other drugs, but I’ve learned how to find an answer using the Cochrane methodology.

Two years on blogger Today

Time to celebrate and take stock of my blogging activity

Join me and have a look at my top posts, page views and the audience.
All posts
62
Pageviews last month
229
Pageviews all time history
3,870


Top Stories

Entry
Pageviews
3 Dec 2012
162
4 Sep 2012
148
8 Aug 2012
144
20 Jul 2012, 2 comments
137
18 Jul 2012
64
15 Jul 2013
56
23 Jun 2012
56
17 Jul 2012
55
5 Aug 2013
37
16 Dec 2013
37

Audience



Country
Pageviews
United States
1228
Russia
591
Ireland
400
United Kingdom
151
Germany
138
France
133
Ukraine
87
Romania
42
Australia
40
Canada
39

Do talking treatments help problem drinkers who also use illicit drugs? We’re still guessing – by Sarah Chapman

19 Nov 2012

Do talking treatments help problem drinkers who also use illicit drugs? We’re still guessing

shutterstock_98318528

Alcohol Awareness Week starts today, with the theme ‘It’s time to talk about drinking’, so I thought we’d kick-start the week in this bit of the woodland by doing just that. Alcohol Concern’s Hair of the Dog campaign poster displays facts which may well achieve their aim of prompting conversation on this subject, including the surprising information that around 200,000 people will have turned up to work with a hangover today (and people who work are more likely to drink alcohol than unemployed people).
Talking treatments were the focus for a new Cochrane review, published last week, which looked at different psychosocial interventions to reduce alcohol consumption in people with problem alcohol and drug use. Four studies with 594 people were included, comparing cognitive-behavioural coping skills training with 12-step facilitation, a brief intervention with treatment as usual, motivational interviewing with hepatitis health promotion and brief motivational interviewing with assessment only.
Here’s what they found:
  • The only study finding a significant difference found that people in the control group receiving ‘treatment as usual’ drank less alcohol at three and nine months than those receiving a brief intervention.
  • The evidence is weak, coming from low quality studies
  • Studies differed too much for their results to be combined
I was rather surprised to read a positive result favouring the control group, until I discovered that the only additional intervention for the intervention group was a single one-hour talking session. Otherwise, everyone in the trial received ‘treatment as usual’ which included a barrage of things including drugs, medical and psychiatric follow-up AND, wait for it, psychosocial interventions…
The reviewers, not surprisingly, said that
 no conclusion can be made because of the paucity of the data and the low quality of the retrieved studies.
So targeting drug and alcohol use together may be a logical approach, given the high rate of these problems occuring together, but one that still lacks an evidence base. If you want to talk about drinking this week, check-out the drinkaware website for some facts about alcohol and you could use the MyDrinkaware feature to track or cut down your drinking. I’m off now to grab a glass of water, something I definitely don’t drink enough.

Links:

Klimas J, Field CA, Cullen W, O’Gorman CSM, Glynn LG, Keenan E, Saunders J, Bury G, Dunne C. Psychosocial interventions to reduce alcohol consumption in concurrent problem alcohol and illicit drug users. Cochrane Database of Systematic Reviews 2012, Issue 11. Art. No.: CD009269. DOI: 10.1002/14651858.CD009269.pub2. Cochrane summary 

Sarah Chapman

My name is Sarah Chapman. I have worked on systematic reviews and other types of research in many areas of health for the past 17 years, for the Cochrane Collaboration and for several UK higher education institutions including the University of Oxford and the Royal College of Nursing Institute. I also have a background in nursing and in the study of the History of Medicine.

Read the full article here

Irish Network of Medical Educators (#INMED2014): The 7th Annual Scientific Meeting

A network of volunteers for all interested in medical education on the island of Ireland met in Belfast yesterday. The network’s aim is to improve education. Network’s vision:

“The Network seeks to enhance medical education on the island of Ireland by bringing together individuals and organisations with an interest in and responsibilities in medical and healthcare education in a National Medical Education Network.”

The 2014 conference theme was creating supportive learning environments. See figure 1 below.

This year, the programme extended over two half-days and a full day between them.
The Wednesday half day offered five pre-conference workshops: Maximising clinical education opportunities, Researching clinical workplaces, Identifying trainees in difficulty, Overcoming obstacles to reflective practice, and Mixed methods research. As of Tuesday, February 18 (8am), there were 152 names on the delegate list. Of those, 7 were marked as judges, 4 as chairs, and 4 as chair/judge – a transparent practice rather unusual at conferences.

Thursday was the main day of the conference. It started with the usual welcomes and opening addresses in a packed room. In fact, delegates who came late stood in the back of the room, because there were no free seats left.

Two keynotes attracted most delegates, Prof Billet from Australia and Prof McAvoy from Britain. Prof Billet’s lecture was pre-recorded and projected on a large screen, because he was in Geneva at the time of conference. He explained meaning of important education terms, such as curriculum or apprenticeship. In simple words, he talked about learning by doing, but his theory-heavy talk with big words was difficult to follow in some places, as reported by delegates. The organizers helped the audience by pausing the video, interacting with the audience, and letting 20 seconds of silence for free-flow thinking

Doctors in difficulty and the re-mediators were discussed by Prof McAvoy (shown in Figure 2). Her talk reminded us that doctors are people too. Most are motivated, they’re not burned out. The reasons for their underperformance are subject of McAvoy’s research: professional, personal, physical health (e.g., high blood pressure), or mental health problems; the group identified 18% of cognitive problems among doctors, and in one case recommended psychiatric assessment which ended doctor’s career. Comprehensive assessment of underperforming doctors is critical – if you’re not getting the diagnosis right, the treatment won’t be effective. Following the assessment, absolute clarity of feedback is paramount for performance improvement.

Figure 2. Professor McAvoy

An hour and a half before the lunch, the delegates viewed 77 research and education posters. Judges assessed the posters allowing 3 minutes for presenters’ speech plus a couple of question.

Lunchtime provided opportunities for meeting the experts. After lunch, the delegates scattered into 5 workshops: i. student narratives (n= 6), ii. clinical ethics (n= 15), iii. emotional intelligence (n= 12), iv. organizational culture (n= 13), and v. emotions (n= 16). The numbers of delegates who attended workshops but did not put their names on the list are not included. Students led the mental health session from 4-5PM. The day finished with traditional AGM, drinks and dinner.

Friday half day concluded the conference with four sessions including research presentations, keynote speech by Prof Dornan from Netherlands, and hot topics in medical education. Read more about the conference here: www.inmed.ie

Is it easier to recruit participants in space? Ten years of Cochrane and Mike Clarke in Ireland

Tenth annual Cochrane in Ireland conference“From evidence to clinical guidelines” took place on 24 January 2014 at School of Nursing& Human Sciences, Dublin City University.

The 7-hours programme kicked off with a welcome by Professor John Costello, Executive Dean of the Faculty of Science and Health, Dublin City University, followed by the National Clinical Effectiveness Agenda of Dr Kathleen MacLellan, Director National Clinical Effectiveness Committee, Department of Health, Dublin.

Figure 1 Yellow arrow card
Mike Clarke’s (Professor & Director of MRC Methodology Hub, Queen’s University Belfast) random thoughts about randomised trials covered some of the more unusual things people have studied. There are approximately 25000 new randomised trials every year, leading to around 700 000 trials registered in CENTRAL Cochrane database. From this overwhelming amount of evidence, Dr Clarke cherry-picked the most unusual, controversial and interesting trials. His presentation started by distributing yellow-arrow cards to delegates in anticipation of active engagement (See figure 1).

Figure 2 Votes and Mike Clarke
Dr Clarke’s random thoughts started with sweets as tip boosters and continued through gamgee hats to lipsticks, restaurants and vegetables, organ music, citruses, chocolate and space trials – a truly spectacular collection. We all voted on Clarke’s provoking questions about these trials (shown in figure 2): did sweets increase, decrease or unchanged the size of the tip? Does smiley face make more difference in tips size than a hand-written thank you? How beneficial is doodling while working or phone-calling? Mike encouraged us to relate each of these entertaining questions to bigger dilemmas about trials, for example, who is in charge of interpreting whether an intervention works? Or, do we believe something because it was published? Ending on a positive note, Clarke presented trials that were conducted on astronauts in the international space station. The drop-out rate was 0 because they had nowhere to go?

Help, I’m stuck.

After a brief tea and coffee break, the participants dispersed into three parallel sessions (N=25:12:7). Dr Clarke’s session was most popular. Traditionally, Mike uses the power and knowledge of a group of people at his workshops that might have some problems with their Cochrane reviews, but collectively have the knowledge to solve them. The list of participants’ questions that he wrote on the white board at the session start was left with only 2-3 questions unanswered. The group disciplines were mutually helpful – psychology, general practice, nursing or information science, experienced reviewers and Cochrane’s novices.
Two other sessions happened in parallel with Clarke’s workshop. Drs O’Rourke & O’Toole covered practicalities of generating clinical guidelines for cancer treatment in Ireland. Dr Matthews, HRB Cochrane Fellow and Senior Lecturer, School of Nursing & Human Sciences, Dublin City University, helped delegates with issues around starting Cochrane reviews.

Lunch was in the campus canteen – each delegate got a €10 voucher. The atmosphere in the canteen was conducive to contact making; we sat by long tables surrounded by students.

The afternoon programme included 2 lectures by Susan Smith and Anne Matthews, and a conclusion by Dr Teresa Maguire – Head of the population science and health services research at the Health Research Board in Ireland. Dr Matthews corroborated on her experience of doing a review on morning sicknessand being a Cochrane fellow – it’s for life, not just for the 2-year fellowship. Dr Smith is a Professor of general practice at Royal College of Surgeons in Ireland who has done 9 Cochrane reviews. Her rich experiences from these reviews were especially useful for those interested in multimorbidity.