Dear colleagues,
Members of this list may be interested in several job postings which are currently available on Cochrane's Jobs page:
http://www.cochrane.org/news/jobs
Please also feel free to share this information with others in your networks.
Best
Nancy
Nancy Owens
Senior Communications Manager | Communications & External Affairs Department (CEAD)
Cochrane Central Executive
-----Original Message-----
From: Evidence based health (EBH) [mailto:[log in to unmask]] On Behalf Of EVIDENCE-BASED-HEALTH automatic digest system
Sent: 19 November 2015 11:06
To: [log in to unmask]
Subject: EVIDENCE-BASED-HEALTH Digest - 17 Nov 2015 to 18 Nov 2015 (#2015-105)
There are 7 messages totaling 2879 lines in this issue.
Topics of the day:
1. ONLINE course - Ethics for Bioscience
2. 1 RCT (SPRINT): can redifines BP targets? (6)
----------------------------------------------------------------------
Date: Wed, 18 Nov 2015 14:32:07 +0000
From: University of Oxford CPD Centre <[log in to unmask]>
Subject: ONLINE course - Ethics for Bioscience
Ethics for Bioscience
ONLINE Course
1 February – 8 April 2016
Register at www.conted.ox.ac.uk/efb
Designed to facilitate understanding, reflection on and engagement with key ethical issues This ten week online module is designed to facilitate understanding, reflection on and engagement with key ethical issues thrown up by conducting clinical research, practicing evidence-based health care, and engaging with science and technology. Online discussion forums enable real time communication between students and the tutor, and encourage critical thought and interpretation of practical scenarios. The course contains guided readings, online discussion, case studies and other activities. Students' writing skills will improve throughout the course because of ample constructive feedback on the brief essays they produce.
Full details and information on how to apply can be found on the course webpage - www.conted.ox.ac.uk/efb
------------------------------
Date: Wed, 18 Nov 2015 20:43:39 +0100
From: Juan Gérvas <[log in to unmask]>
Subject: 1 RCT (SPRINT): can redifines BP targets?
-many of you probably have follow the SPRINT publications, at least these
three:
A Randomized Trial of Intensive versus Standard Blood-Pressure Control http://www.nejm.org/doi/full/10.1056/NEJMoa1511939#t=articleTop
SPRINT redefines blood-pressure target goals and challenges us to improve blood-pressure management. Success will require a marathon effort.
http://www.nejm.org/doi/full/10.1056/NEJMe1513301
Generalizability of the SPRINT Results
http://www.jwatch.org/na39586/2015/11/09/generalizability-sprint-results
-but, what about a Cochrane Review:
Antihypertensive drugs, adults, systolic 140-159 mmHg and/or diastolic 90-99? No thanks, no impact morb/mortality.
http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD006742.pub2/abstract
-see also:
New blood pressure trial.
http://www.statschat.org.nz/2015/11/10/new-blood-pressure-trial/
The SPRINT Blood Pressure Study: Small Numbers, Questionable Significance.
http://www.curingmedicare.com/#!The-SPRINT-Blood-Pressure-Study-Small-Numbers-Questionable-Significance/c1q8z/5643e9520cf2708e00169405
-un saludo juan gérvas
------------------------------
Date: Wed, 18 Nov 2015 21:35:15 +0000
From: Rod Jackson <[log in to unmask]>
Subject: Re: 1 RCT (SPRINT): can redifines BP targets?
Dear Juan and colleagues. The key difference between SPRINT and most other BP-lowering trials in primary prevention (i.e those in the Cochrane Review) is that the investigators appropriately chose high risk patients. The observational study evidence on the relationship between BP and CVD and trials in diabetic and secondary prevention suggest that lowering SBP down to 120-130mmHg is appropriate. However if a person is at very low risk, the benefit will be very small. That's why the Cochrane review found nothing - the power was very low. SPRINT adds to the evidence demonstrating that it's time to take the main focus off BP thresholds and targets and focus on treating people at high risk.
Regards Rod Jackson
* * * * * * * *
sent from my phone
On 19/11/2015, at 08:44, Juan Gérvas <[log in to unmask]<mailto:[log in to unmask]>> wrote:
-many of you probably have follow the SPRINT publications, at least these three:
A Randomized Trial of Intensive versus Standard Blood-Pressure Control http://www.nejm.org/doi/full/10.1056/NEJMoa1511939#t=articleTop
SPRINT redefines blood-pressure target goals and challenges us to improve blood-pressure management. Success will require a marathon effort.
http://www.nejm.org/doi/full/10.1056/NEJMe1513301
Generalizability of the SPRINT Results
http://www.jwatch.org/na39586/2015/11/09/generalizability-sprint-results
-but, what about a Cochrane Review:
Antihypertensive drugs, adults, systolic 140-159 mmHg and/or diastolic 90-99? No thanks, no impact morb/mortality.
http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD006742.pub2/abstract
-see also:
New blood pressure trial.
http://www.statschat.org.nz/2015/11/10/new-blood-pressure-trial/
The SPRINT Blood Pressure Study: Small Numbers, Questionable Significance. http://www.curingmedicare.com/#!The-SPRINT-Blood-Pressure-Study-Small-Numbers-Questionable-Significance/c1q8z/5643e9520cf2708e00169405<http://www.curingmedicare.com/#%21The-SPRINT-Blood-Pressure-Study-Small-Numbers-Questionable-Significance/c1q8z/5643e9520cf2708e00169405>
-un saludo juan gérvas
------------------------------
Date: Wed, 18 Nov 2015 22:44:40 +0100
From: Juan Gérvas <[log in to unmask]>
Subject: Re: 1 RCT (SPRINT): can redifines BP targets?
-thanks, Rod
-you are right about the treating people at high risk -but i am not sure about SPRINT, see SPRINT. Los resultados de este estudio no merecen la extraordinaria atención de los medios. Problemas metodológicos.
SPRINT. The results of this trial did not merit the extraordinary treatment from the press. Methodological issues.
ht
*tp://www.healthnewsreview.org/2015/11/do-published-sprint-study-results-live-up-to-premature-nih-news-release-hype/*
<http://www.healthnewsreview.org/2015/11/do-published-sprint-study-results-live-up-to-premature-nih-news-release-hype/>
*-un saludo juan gérvas @JuanGrvas*
2015-11-18 22:35 GMT+01:00 Rod Jackson <[log in to unmask]>:
> Dear Juan and colleagues. The key difference between SPRINT and most
> other BP-lowering trials in primary prevention (i.e those in the
> Cochrane Review) is that the investigators appropriately chose high
> risk patients. The observational study evidence on the relationship
> between BP and CVD and trials in diabetic and secondary prevention
> suggest that lowering SBP down to 120-130mmHg is appropriate. However
> if a person is at very low risk, the benefit will be very small.
> That's why the Cochrane review found nothing - the power was very low.
> SPRINT adds to the evidence demonstrating that it's time to take the
> main focus off BP thresholds and targets and focus on treating people at high risk.
>
> Regards Rod Jackson
>
> * * * * * * * *
> sent from my phone
>
>
> On 19/11/2015, at 08:44, Juan Gérvas <[log in to unmask]
> <[log in to unmask]>> wrote:
>
> -many of you probably have follow the SPRINT publications, at least
> these
> three:
> A Randomized Trial of Intensive versus Standard Blood-Pressure Control
> http://www.nejm.org/doi/full/10.1056/NEJMoa1511939#t=articleTop
> SPRINT redefines blood-pressure target goals and challenges us to
> improve blood-pressure management. Success will require a marathon effort.
> http://www.nejm.org/doi/full/10.1056/NEJMe1513301
> Generalizability of the SPRINT Results
> http://www.jwatch.org/na39586/2015/11/09/generalizability-sprint-resul
> ts
> -but, what about a Cochrane Review:
> Antihypertensive drugs, adults, systolic 140-159 mmHg and/or diastolic
> 90-99? No thanks, no impact morb/mortality.
> http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD006742.pub2/abst
> ract
> -see also:
> New blood pressure trial.
> http://www.statschat.org.nz/2015/11/10/new-blood-pressure-trial/
> The SPRINT Blood Pressure Study: Small Numbers, Questionable Significance.
> http://www.curingmedicare.com/#!The-SPRINT-Blood-Pressure-Study-Small-
> Numbers-Questionable-Significance/c1q8z/5643e9520cf2708e00169405
> -un saludo juan gérvas
>
>
------------------------------
Date: Wed, 18 Nov 2015 22:21:26 +0000
From: Neal Maskrey <[log in to unmask]>
Subject: Re: 1 RCT (SPRINT): can redifines BP targets?
I agree Rod (as you’d expect).
The NICE hypertension guideline found 8 RCTs of more vs less intensive BP control all of low to moderate quality on the GRADE criteria (and I think they were generous with the moderate). The NICE guideline development group concluded in 2011 that “the evidence specifically examining optimal treatment targets for hypertension is inadequate and consequently the optimal treatment target could not be clearly defined with certainty.” They still made a recommendation of course, which is incorporated into the QOF. Don’t start me off re pay for performance again http://blogs.bmj.com/bmj/2015/08/12/neal-maskrey-what-will-replace-qof/ <http://blogs.bmj.com/bmj/2015/08/12/neal-maskrey-what-will-replace-qof/>
At least people with the same characteristics as those recruited to SPRINT now have a new option of a 120mmHg systolic target (as Harlan Krumholz blogged). Its a small absolute benefit of bad things happening (I make the annual NNT 183 for the primary end point) and they’ll need to set that against an annual NNH of 163 for serious adverse events possibly or definitely attributed to the intervention and an annual NNH of 116 for a >30% reduction in eGFR if they don’t have CKD at baseline. People will make different choices.
IMHO the task is to interpret these results and support a shared decision, not extrapolate that approach to the majority of people with hypertension to which this approach does not apply (especially those people with T2 diabetes), and to deploy clinical expertise and dissuade people who do meet the SPRINT higher CV risk characteristics and want to go for 120mmHg but on the basis of their individual characteristics are unlikely to do well with a further 20mmHg drop in blood pressure.
Best wishes to all
Neal
Neal Maskrey
[log in to unmask] <mailto:[log in to unmask]> Visiting Professor of Evidence-informed decision making, Keele University Co-Lead ADVOCATE Field Studies, University of Amsterdam
Mobile: 07976276919
> On 18 Nov 2015, at 21:35, Rod Jackson <[log in to unmask]> wrote:
>
> Dear Juan and colleagues. The key difference between SPRINT and most other BP-lowering trials in primary prevention (i.e those in the Cochrane Review) is that the investigators appropriately chose high risk patients. The observational study evidence on the relationship between BP and CVD and trials in diabetic and secondary prevention suggest that lowering SBP down to 120-130mmHg is appropriate. However if a person is at very low risk, the benefit will be very small. That's why the Cochrane review found nothing - the power was very low. SPRINT adds to the evidence demonstrating that it's time to take the main focus off BP thresholds and targets and focus on treating people at high risk.
>
> Regards Rod Jackson
>
> * * * * * * * *
> sent from my phone
>
>
> On 19/11/2015, at 08:44, Juan Gérvas <[log in to unmask] <mailto:[log in to unmask]>> wrote:
>
>> -many of you probably have follow the SPRINT publications, at least these three:
>> A Randomized Trial of Intensive versus Standard Blood-Pressure
>> Control
>> http://www.nejm.org/doi/full/10.1056/NEJMoa1511939#t=articleTop
>> <http://www.nejm.org/doi/full/10.1056/NEJMoa1511939#t=articleTop>
>> SPRINT redefines blood-pressure target goals and challenges us to improve blood-pressure management. Success will require a marathon effort.
>> http://www.nejm.org/doi/full/10.1056/NEJMe1513301
>> <http://www.nejm.org/doi/full/10.1056/NEJMe1513301>
>> Generalizability of the SPRINT Results
>> http://www.jwatch.org/na39586/2015/11/09/generalizability-sprint-resu
>> lts
>> <http://www.jwatch.org/na39586/2015/11/09/generalizability-sprint-res
>> ults>
>> -but, what about a Cochrane Review:
>> Antihypertensive drugs, adults, systolic 140-159 mmHg and/or diastolic 90-99? No thanks, no impact morb/mortality.
>> http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD006742.pub2/abs
>> tract
>> <http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD006742.pub2/ab
>> stract>
>> -see also:
>> New blood pressure trial.
>> http://www.statschat.org.nz/2015/11/10/new-blood-pressure-trial/
>> <http://www.statschat.org.nz/2015/11/10/new-blood-pressure-trial/>
>> The SPRINT Blood Pressure Study: Small Numbers, Questionable
>> Significance.
>> http://www.curingmedicare.com/#!The-SPRINT-Blood-Pressure-Study-Small
>> -Numbers-Questionable-Significance/c1q8z/5643e9520cf2708e00169405
>> <http://www.curingmedicare.com/#%21The-SPRINT-Blood-Pressure-Study-Sm
>> all-Numbers-Questionable-Significance/c1q8z/5643e9520cf2708e00169405>
>> -un saludo juan gérvas
>>
------------------------------
Date: Wed, 18 Nov 2015 22:33:47 +0000
From: "Bill Cayley, Jr" <[log in to unmask]>
Subject: Re: 1 RCT (SPRINT): can redifines BP targets?
Absolutely need to emphasize shared decision-making - even before getting to a discussion of NNT vs NNH, most of the time when recommend an additional BP medication, patients decline even before we get to risk vs benefit - they simply don't want another pill. It is RARE that a patient comes in asking "what more medications can I take". We need to describe the evidence and the risks vs benefits, but need to support clinical practices that support patient decision-making.
Bill Cayley, Jr, MD MDiv
[log in to unmask]@fammed.wisc.eduhttp://twitter.com/bcayleyWork: 715.286.2270
Pager: 715.838.7940
Home: 715.830.0932
Mobile: 715.828.4636
"I think some of the most celebrated moments in human achievement should be those times when everything is going against a person and they are down in the dumps but they simply choose to get up. That's real greatness." -- Ryan Hall
On Wednesday, November 18, 2015 4:21 PM, Neal Maskrey <[log in to unmask]> wrote:
I agree Rod (as you’d expect).
The NICE hypertension guideline found 8 RCTs of more vs less intensive BP control all of low to moderate quality on the GRADE criteria (and I think they were generous with the moderate). The NICE guideline development group concluded in 2011 that “the evidencespecifically examining optimal treatment targets for hypertension is inadequateand consequently the optimal treatment target could not be clearly defined withcertainty.” They still made a recommendation of course, which is incorporated into the QOF. Don’t start me off re pay for performance again http://blogs.bmj.com/bmj/2015/08/12/neal-maskrey-what-will-replace-qof/
At least people with the same characteristics as those recruited to SPRINT now have a new option of a 120mmHg systolic target (as Harlan Krumholz blogged). Its a small absolute benefit of bad things happening (I make the annual NNT 183 for the primary end point) and they’ll need to set that against an annual NNH of 163 for serious adverse eventspossibly or definitely attributed to the intervention and an annual NNH of 116 for a >30% reduction in eGFR if they don’t have CKD at baseline. People will make different choices. IMHO the task is to interpret these results and support a shared decision, not extrapolate that approach to the majority of people with hypertension to which this approach does not apply (especially those people with T2 diabetes), and to deploy clinical expertise and dissuade people who do meet the SPRINT higher CV risk characteristics and want to go for 120mmHg but on the basis of their individual characteristics are unlikely to do well with a further 20mmHg drop in blood pressure. Best wishes to all Neal Neal [log in to unmask] Professor of Evidence-informed decision making, Keele UniversityCo-Lead ADVOCATE Field Studies, University of AmsterdamMobile: 07976276919
On 18 Nov 2015, at 21:35, Rod Jackson <[log in to unmask]> wrote:
Dear Juan and colleagues. The key difference between SPRINT and most other BP-lowering trials in primary prevention (i.e those in the Cochrane Review) is that the investigators appropriately chose high risk patients. The observational study evidence on the relationship between BP and CVD and trials in diabetic and secondary prevention suggest that lowering SBP down to 120-130mmHg is appropriate. However if a person is at very low risk, the benefit will be very small. That's why the Cochrane review found nothing - the power was very low. SPRINT adds to the evidence demonstrating that it's time to take the main focus off BP thresholds and targets and focus on treating people at high risk.
Regards Rod Jackson
* * * * * * * *
sent from my phone
On 19/11/2015, at 08:44, Juan Gérvas <[log in to unmask]> wrote:
-many of you probably have follow the SPRINT publications, at least these three:
A Randomized Trial of Intensive versus Standard Blood-Pressure Control http://www.nejm.org/doi/full/10.1056/NEJMoa1511939#t=articleTop
SPRINT redefines blood-pressure target goals and challenges us to improve blood-pressure management. Success will require a marathon effort.
http://www.nejm.org/doi/full/10.1056/NEJMe1513301
Generalizability of the SPRINT Results
http://www.jwatch.org/na39586/2015/11/09/generalizability-sprint-results
-but, what about a Cochrane Review:
Antihypertensive drugs, adults, systolic 140-159 mmHg and/or diastolic 90-99? No thanks, no impact morb/mortality.
http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD006742.pub2/abstract
-see also:
New blood pressure trial.
http://www.statschat.org.nz/2015/11/10/new-blood-pressure-trial/
The SPRINT Blood Pressure Study: Small Numbers, Questionable Significance.http://www.curingmedicare.com/#!The-SPRINT-Blood-Pressure-Study-Small-Numbers-Questionable-Significance/c1q8z/5643e9520cf2708e00169405
-un saludo juan gérvas
------------------------------
Date: Wed, 18 Nov 2015 22:38:32 +0000
From: "McCormack, James" <[log in to unmask]>
Subject: Re: 1 RCT (SPRINT): can redifines BP targets?
Hi Neal - well said and very much agree - none of this research (including SPRINT) shows that the magnitude of the benefit of treating HTN substantially outweighs the potential harms, costs and inconvenience enough to justify black and white recommendations as to who to treat and to what threshold.
Unfortunately, as we showed recently with the latest American and European diabetes guidelines http://www.ncbi.nlm.nih.gov/pubmed/26294778, writers of these guidelines basically refuse to provide information in a way that would allow clinicians to discuss the risk, benefits and harms in a balanced and thoughtful way. The simple message is still high blood pressure and high glucose are bad and if one has them they should be treated - even if they are only "pre-numbers"
What an interesting world it would be if guideline writers had to have as their mandate the distribution of guidelines that distill the evidence into a way that allows clinicians to simply inform patients of the risks, benefits and harms. This seems like such a simple thing yet I believe I will retire (or die) well before this ever happens.
James
On Nov 18, 2015, at 2:21 PM, Neal Maskrey <[log in to unmask]<mailto:[log in to unmask]>> wrote:
I agree Rod (as you’d expect).
The NICE hypertension guideline found 8 RCTs of more vs less intensive BP control all of low to moderate quality on the GRADE criteria (and I think they were generous with the moderate). The NICE guideline development group concluded in 2011 that “the evidence specifically examining optimal treatment targets for hypertension is inadequate and consequently the optimal treatment target could not be clearly defined with certainty.” They still made a recommendation of course, which is incorporated into the QOF. Don’t start me off re pay for performance again http://blogs.bmj.com/bmj/2015/08/12/neal-maskrey-what-will-replace-qof/
At least people with the same characteristics as those recruited to SPRINT now have a new option of a 120mmHg systolic target (as Harlan Krumholz blogged). Its a small absolute benefit of bad things happening (I make the annual NNT 183 for the primary end point) and they’ll need to set that against an annual NNH of 163 for serious adverse events possibly or definitely attributed to the intervention and an annual NNH of 116 for a >30% reduction in eGFR if they don’t have CKD at baseline. People will make different choices.
IMHO the task is to interpret these results and support a shared decision, not extrapolate that approach to the majority of people with hypertension to which this approach does not apply (especially those people with T2 diabetes), and to deploy clinical expertise and dissuade people who do meet the SPRINT higher CV risk characteristics and want to go for 120mmHg but on the basis of their individual characteristics are unlikely to do well with a further 20mmHg drop in blood pressure.
Best wishes to all
Neal
Neal Maskrey
[log in to unmask]<mailto:[log in to unmask]>
Visiting Professor of Evidence-informed decision making, Keele University Co-Lead ADVOCATE Field Studies, University of Amsterdam
Mobile: 07976276919
On 18 Nov 2015, at 21:35, Rod Jackson <[log in to unmask]<mailto:[log in to unmask]>> wrote:
Dear Juan and colleagues. The key difference between SPRINT and most other BP-lowering trials in primary prevention (i.e those in the Cochrane Review) is that the investigators appropriately chose high risk patients. The observational study evidence on the relationship between BP and CVD and trials in diabetic and secondary prevention suggest that lowering SBP down to 120-130mmHg is appropriate. However if a person is at very low risk, the benefit will be very small. That's why the Cochrane review found nothing - the power was very low. SPRINT adds to the evidence demonstrating that it's time to take the main focus off BP thresholds and targets and focus on treating people at high risk.
Regards Rod Jackson
* * * * * * * *
sent from my phone
On 19/11/2015, at 08:44, Juan Gérvas <[log in to unmask]<mailto:[log in to unmask]>> wrote:
-many of you probably have follow the SPRINT publications, at least these three:
A Randomized Trial of Intensive versus Standard Blood-Pressure Control http://www.nejm.org/doi/full/10.1056/NEJMoa1511939#t=articleTop
SPRINT redefines blood-pressure target goals and challenges us to improve blood-pressure management. Success will require a marathon effort.
http://www.nejm.org/doi/full/10.1056/NEJMe1513301
Generalizability of the SPRINT Results
http://www.jwatch.org/na39586/2015/11/09/generalizability-sprint-results
-but, what about a Cochrane Review:
Antihypertensive drugs, adults, systolic 140-159 mmHg and/or diastolic 90-99? No thanks, no impact morb/mortality.
http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD006742.pub2/abstract
-see also:
New blood pressure trial.
http://www.statschat.org.nz/2015/11/10/new-blood-pressure-trial/
The SPRINT Blood Pressure Study: Small Numbers, Questionable Significance. http://www.curingmedicare.com/#!The-SPRINT-Blood-Pressure-Study-Small-Numbers-Questionable-Significance/c1q8z/5643e9520cf2708e00169405<http://www.curingmedicare.com/#%21The-SPRINT-Blood-Pressure-Study-Small-Numbers-Questionable-Significance/c1q8z/5643e9520cf2708e00169405>
-un saludo juan gérvas
------------------------------
End of EVIDENCE-BASED-HEALTH Digest - 17 Nov 2015 to 18 Nov 2015 (#2015-105)
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