Translating Cochrane Reviews to Ensure that Healthcare Decision-Making is Informed by High-Quality Research Evidence

Erik von Elm and colleagues discuss plans to increase access and global reach of Cochrane Reviews through translations into other languages. Please see later in the article for the Editors' Summar

Captivating thoughts: nocturnal pollution, imagination and the sleeping mind in the twelfth and thirteenth centuries

Medieval attempts to understand nocturnal emissions – involuntary bodily excretions during sleep which were identified as morally ambiguous – became extensive explorations of the unique and problematic features of sleep and the mental state it produced. During the twelfth and thirteenth centuries, nocturnal pollutions became the object of an intensive scrutiny of sleep as a site of moral concern. Causal explanations often centred on human psychology, in particular the unusual status of the sleeping mind, in an attempt to understand the intricate ways in which mind, body and soul were uniquely bound together in sleep. The mental states before, during and after sleep were understood to interact with one another in complex ways which centred on questions of culpability and its lack. A comparison of medical, natural-philosophical, theological and canon law materials discussing nocturnal pollution reveals a preoccupation with the sleeper’s mind as exceptional, uncontrollable and problematic

A semi-parametric approach to estimate risk functions associated with multi-dimensional exposure profiles: application to smoking and lung cancer

A common characteristic of environmental epidemiology is the multi-dimensional aspect of exposure patterns, frequently reduced to a cumulative exposure for simplicity of analysis. By adopting a flexible Bayesian clustering approach, we explore the risk function linking exposure history to disease. This approach is applied here to study the relationship between different smoking characteristics and lung cancer in the framework of a population based case control study

A scoping review of competencies for scientific editors of biomedical journals

Background Biomedical journals are the main route for disseminating the results of health-related research. Despite this, their editors operate largely without formal training or certification. To our knowledge, no body of literature systematically identifying core competencies for scientific editors of biomedical journals exists. Therefore, we aimed to conduct a scoping review to determine what is known on the competency requirements for scientific editors of biomedical journals. Methods We searched the MEDLINE®, Cochrane Library, Embase®, CINAHL, PsycINFO, and ERIC databases (from inception to November 2014) and conducted a grey literature search for research and non-research articles with competency-related statements (i.e. competencies, knowledge, skills, behaviors, and tasks) pertaining to the role of scientific editors of peer-reviewed health-related journals. We also conducted an environmental scan, searched the results of a previous environmental scan, and searched the websites of existing networks, major biomedical journal publishers, and organizations that offer resources for editors. Results A total of 225 full-text publications were included, 25 of which were research articles. We extracted a total of 1,566 statements possibly related to core competencies for scientific editors of biomedical journals from these publications. We then collated overlapping or duplicate statements which produced a list of 203 unique statements. Finally, we grouped these statements into seven emergent themes: (1) dealing with authors, (2) dealing with peer reviewers, (3) journal publishing, (4) journal promotion, (5) editing, (6) ethics and integrity, and (7) qualities and characteristics of editors. Discussion To our knowledge, this scoping review is the first attempt to systematically identify possible competencies of editors. Limitations are that (1) we may not have captured all aspects of a biomedical editor’s work in our searches, (2) removing redundant and overlapping items may have led to the elimination of some nuances between items, (3) restricting to certain databases, and only French and English publications, may have excluded relevant publications, and (4) some statements may not necessarily be competencies. Conclusion This scoping review is the first step of a program to develop a minimum set of core competencies for scientific editors of biomedical journals which will be followed by a training needs assessment, a Delphi exercise, and a consensus meeting

Bayesian Methods for Highly Correlated Exposures: an Application to Tap Water Disinfection By-Products and Spontaneous Abortion

Highly correlated exposures are common in epidemiology. However, standard maximum likelihood techniques frequently fail to provide reliable estimates in the presence of highly correlated exposures. As a result, hierarchical regression methods are increasingly being used. Hierarchical regression places a prior distribution on the exposure-specific regression coe±cients in order to stabilize estimates and incorporate prior knowledge. We examine three types of hierarchical models: semi-Bayes, fully-Bayes, and Dirichlet Process Priors. In the semi-Bayes approach, the prior mean and variance are treated as fixed constants chosen by the epidemiologist. An alternative is the fully-Bayes approach that places hyperprior distributions on the mean and variance of the prior distribution to allow the data to inform about their values. Both of these approaches rely on a parametric specification for the exposure-speciffic coe±cients. As a more flexible nonparametric option, one can use a Dirichlet process prior which also serves to cluster exposures into groups, effectively reducing dimensionality. We examine the properties of these three models and compare their mean squared error in simulated datasets. We use these hierarchical models to examine the relationship between disinfection by-products and spontaneous abortion. Spontaneous abortion is a common pregnancy outcome, although relatively little is known about its causes. Previous research has generally indicated an increased risk of spontaneous abortion among those who consume higher amounts of disinfection by-products. Right from the Start is a large multi-center cohort study of women who were followed through early pregnancy. Disinfection by-product concentrations were measured each week during the study, allowing for more precise exposure measurement than previous epidemiologic studies. We focus our attention on the concentrations of 13 constituent disinfection by-products (4 trihalomethanes and 9 haloacetic acids), some of which are so highly correlated that conventional maximum likelihood estimates are unreliable. To allow simultaneous estimation of effects, we implement 4 Bayesian hierarchical models: semi-Bayes, fully-Bayes, Dirichlet process prior (DPP1) and Dirichlet process prior with a selection component (DPP2). Models that allowed prior parameters to be updated from the data tended to give far more precise coe±cients and be more robust to prior specification. The DPP1 and DPP2 models were in close agreement in estimating no effect of any constituent disinfection by-products on spontaneous. The fully-Bayes model largely agreed with the DPP1 and DPP2 models but had less precision, while the semi-Bayes model provided the least precise estimates.Doctor of Philosoph

Intrarectal quinine for treating Plasmodium falciparum malaria: a systematic review

BACKGROUND: In children with malaria caused by Plasmodium falciparum, quinine administered rectally may be easier to use and less painful than intramuscular or intravenous administration. The objective of this review was to compare the effectiveness of intrarectal with intravenous or intramuscular quinine for treating falciparum malaria. METHODS: All randomized and quasi-randomized controlled trials comparing intrarectal with intramuscular or intravenous quinine for treating people with falciparum malaria located through the following sources were included: Cochrane Infectious Diseases Group Specialized Register, CENTRAL, MEDLINE, EMBASE, LILACS and CINAHL. Trial quality was assessed and data, including adverse event data, were extracted. Dichotomous data were analysed using odds ratios and continuous data using weighted mean difference. RESULTS: Eight randomized controlled trials (1,247 children) fulfilled the inclusion criteria. The same principal investigator led seven of the trials. Five compared intrarectal with intravenous quinine, and six compared intrarectal with intramuscular treatment. No statistically significant difference was detected for death, parasite clearance by 48 hours and seven days, parasite and fever clearance time, coma recovery time, duration of hospitalization and time before drinking began. One trial (898 children) reported that intrarectal was less painful than intramuscular administration. CONCLUSION: No difference in the effect on parasites and clinical illness was detected for the use of intrarectal quinine compared with other routes, but most trials were small. Pain during application may be less with intrarectal quinine. Further larger trials, in patients with severe malaria and in adults, are required before the intrarectal route could be recommended

The role of collaboration in the cognitive development of young children: a systematic review.

BACKGROUND: Collaboration is a key facilitator of cognitive development in early childhood; this review evaluates which factors mediate the impact of collaborative interactions on cognitive development in children aged 4-7 years. METHODS: A systematic search strategy identified relevant studies (n = 21), which assessed the role of ability on the relationship between collaboration and cognitive development. Other factors that interact with ability were also assessed: gender, sociability/friendship, discussion, age, feedback and structure. RESULTS: Immediate benefits of collaboration on cognitive development are highlighted for same-age peers. Collaborative interactions are beneficial for tasks measuring visual perception, problem-solving and rule-based thinking, but not for word-reading and spatial perspective-taking. Collaboration is particularly beneficial for lower-ability children when there is an ability asymmetry. High-ability children either regressed or did not benefit when paired with lower-ability participants. CONCLUSIONS: Overall, the studies included within this review indicate that brief one-off interactions can have a significant, positive effect on short-term cognitive development in children of infant school age. The longer-term advantages of collaboration are still unclear. Implications for practice and future research are discussed

A Foucauldian Analysis of‘Troubled Families’

The ‘Troubled Families Agenda’ (TFA), a national initiative launched by the UKGovernment in 2011, aimed to identify and work with families defined by theGovernment as ‘troubled’, in order to decrease their ‘anti-social behaviour’, helpchildren back into school and support parents into employment. This research,undertaken from a social constructionist critical realist epistemological position,attempted to gain an understanding of the Government’s construction of ‘troubledfamilies’, and to consider what ways of thinking about, and working with, familiesthese constructions might have enabled and silenced. The dataset consisted of: theseven policy and guidance documents available on the Government’s TFA website;five speeches concerning the TFA made by leading politicians; and fourparliamentary debate and Commons’ Select Committee report extracts. The datasetinclusion criteria required government policy documents and texts of speeches anddebates to have been published between 6th March 2010 and 31st March 2013, andto refer to ‘troubled families’ more than twice. The analysis of this dataset wasconducted using a discourse analytic approach, drawing on the work of MichelFoucault. Seven analytic steps were followed, which included repeated readings andcoding of the texts. Four dominant governmental constructions of ‘troubled families’were identified, that of: ‘violent’; ‘workless’; ‘helpless’ families that are ultimately a‘costly waste of human productivity’.The Government seems to have presented the TFA as an innovative, benevolentsocial care agenda. However, at its root, the TFA appears to be driven by neo-liberaleconomic forces, intent on reducing the cost of families that may have a range ofdifficulties. The Government seems to have taken a reductive approach towardstheir construction of ‘troubled families’, allowing families to be produced ashomogenous and less complex discursive objects. This has allowed theGovernment to set simple material outcomes for services to achieve with familiesthat may have a range of complex difficulties. These outcomes neatly connect to thefinancial models underpinning the TFA, enabling the introduction of financialproducts, such as social impact bonds, which might allow private investors to exertinfluence upon the TFA services. The Government appears to be using families whomay have a range of difficulties as vehicles to grow the social investment market. Itis argued that this is likely to negatively impact the design of services, which mighthinder social and health care professionals’ ability to work in a manner that will meetthe complex needs of families.This research calls for the financial models that underpin services to be designed inthe best interest of the service users, rather than that of investors and Government.This research also echoes calls for the perspectives and experiences of familieswith complex needs to be more effectively incorporated into the development offamily initiatives, such as the TFA. Finally, this study encourages frontline workersand clinical psychologists to be more aware of the political forces and neo-liberalassumptions that are shaping the services in which they work, if effective forms ofresistance are to be made possible

Issues in the incorporation of economic perspectives and evidence into Cochrane reviews

Methods for systematic reviews of the effects of health interventions have focused mainly on addressing the question of 'What works?' or 'Is this intervention effective in achieving one or more specific outcomes?' Addressing the question 'Is it worth it given the resources available?' has received less attention. This latter question can be addressed by applying an economic lens to the systematic review process.This paper reflects on the value and desire for the consideration by end users for coverage of an economic perspective in a Cochrane review and outlines two potential approaches and future directions