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First Impact Factor for The Cochrane Library

The first official Impact Factor (IF) for the Cochrane Database of Systematic Reviews (The Cochrane Library) has just been released. The 2007 impact factor (generated from citations in 2007 to reviews published in 2005 and 2006) is 4.654, which ranks CDSR 14th out of the 100 journals in the ISI category �Medicine, General and Internal�. This is a considerable achievement for The Cochrane Library, in its first year of ranking, for several reasons.

- Being in the ISI category �Medicine, General and Internal�, means that we are ranked alongside the world�s major general medical journals, such as the New England Journal of Medicine, the Lancet, JAMA and the BMJ.

- A journal�s impact factor is calculated by dividing the number of citations in the last year by the total number of articles published in the preceding two years. Our annual number of publications (the denominator) is very large. The Cochrane Collaboration produces a huge number of reviews each year. In 2005 and 2006 we published 1126 reviews (roughly twice the number of articles published by NEJM, JAMA and the Lancet in the same period). To compensate for this level of output, the number of subsequent citations to these articles needs to be very high indeed.

- Uniquely, The Cochrane Collaboration also substantively updates and republishes reviews to ensure that our reviews are fully up-to-date with the latest evidence. These substantively updated reviews are counted as new publications by ISI, increasing our denominator further.

The publication of our first impact factor is a highly significant event for the Cochrane Collaboration, which has fought for years for The Cochrane Library to be regarded and measured alongside the more traditional medical journals. The agreement by ISI in 2005 to list us was a major achievement and thanks to the lobbying of our publisher John Wiley and Sons.

In 2008 The Cochrane Collaboration is a highly respected organisation and our work is widely cited throughout the world, yet until now the lack of an impact factor has, to some extent, impaired our standing in the scientific community. It has also sometimes put authors in the difficult position of having to consider publication elsewhere in order to fulfil the requirements of their academic institutions. Although the use of the impact factor as a tool to measure the quality of journals is widely debated, not having one at all has been very restrictive for the Cochrane Collaboration. We are optimistic that this news will encourage increasing numbers of authors to publish and maintain Cochrane reviews. As an organisation we are also highly ambitious to see our impact factor rise still further in the next few years. So watch this space!

Cochrane Ear, Nose and Throat Disorders Group

Newsletter

http://www.cochrane-

ent.org

Issue 13 June 2008

Inside this issue

2 RevMan 5 released

3 New Cochrane review tools: Risk of Bias & Summary of Findings tables

4 Cochrane ENT Group news

5-7 Abstracts of new ENT reviews

8 Cochrane Colloquium Freiburg October 2008

9 Cochrane Collaboration news: Changes to the display of reviews in The Cochrane Library New Reviewers� Handbook released New Cochrane Style Guide Adverse effects in reviews

10 Editor-in-Chief for Cochrane Library Strategic review of Cochrane Changes to permission to publish form for protocols Upcoming submission dates Free Cochrane Library CDs

11 Specialist Library for ENT & Audiology The DUETs database

12 Calendar of events and workshops

13 Contact us

Steering Group Elections All active members of Cochrane Review Groups are eligible to vote for the CRG �At Large� position on the Cochrane Collaboration Steering Group. If eligible, you should already have been contacted by the Collaboration Secretariat with details of how to vote. Voting closes at midnight (BST) on 25 July 2008. The election results will be notified to all Cochrane entities on 28 July 2008.

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RevMan 5 released In March 2008 the Cochrane Collaboration released RevMan 5, the new version of its software for producing systematic reviews. RevMan 5 introduces a completely new interface, significantly improved functionality and includes a number of new features designed to enhance the experience of preparing a Cochrane review and the quality of the finished product. New functionality and interface These are a few highlights of the new functions in RevMan 5: • Designed to interact fluidly with the Cochrane Collaboration�s �Archie� server for document storage and

exchange. RevMan 5 is designed for draft sharing. Authors and editors will always be able to get the right version of the review.

• Editing reviews will be much more like working with one single document (similar to MS Word). With RevMan 5, the experience is more �what you see is what you get� than with RevMan 4.

• The new text editor allows more formatting in more sections, including subheadings, tables embedded in the text, and nested lists (lists within lists).

• Track changes functionality and a new note system facilitate the tasks of multiple authors working together on a review.

• The advanced undo system allows you to undo everything from small text edits to deletion of whole studies and comparisons.

• Real time spell checking and validation of reviews help to prevent errors. • Reorganise your review using simple move and renumber functions. Move multiple items around using

drag and drop or copy and paste. • Improved data analysis functions: see real time changes to forest plots as data are entered and edited. New review structure The review structure has been extensively updated for RevMan 5, changes which are supported by full guidance in the new Cochrane Handbook for Systematic Review of Interventions (see page 9). Some main points are: • Text: there is a new structure for the main text of a review, including a number of new standard

subheadings, and support for the inclusion of appendices. It is now possible to create links to individual graphs, all tables, feedback, other sections of the review, appendices and web sites to help readers navigate effectively around your review.

• New tables: �Summary of Findings� and �Risk of Bias� tables are two new standardised (currently optional) tables (see page 3 for full details).

• Embedded figures: a new way to give prominence to specific analyses in the published review. • Contact details: these will now be maintained in Archie and cannot be edited inside RevMan. One person

can be marked as contact person (not necessarily an author). The author list can be ordered, and the byline will be automatically generated.

RevMan 4 will be phased out over the next 9 months. Published authors will already have been contacted about converting their existing work to the new format.

RevMan 5, which is free for those preparing a Cochrane review, can be downloaded from: http://www.cc-ims.net/RevMan/RevMan5/download The software includes a comprehensive User Guide and also an interactive tutorial, which is ideal for familiarising yourself with the more advanced features of the software. When ready to begin, you will need to contact the Cochrane ENT Group Co-ordinator, Ian Chamberlain (ichamberlain@cochrane-ent.org) who will assign you a user account for Archie; then you can get started!

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�Risk of bias graph�:

example from the

Cochrane Handbook1

New Cochrane review tools 1: Risk of bias tables RevMan 5 includes a new tool for assessing the risk of bias in individual included studies. This is a two-part tool, which addresses six specific domains: sequence generation, allocation concealment, blinding, incomplete outcome data, selective outcome reporting and �other issues�. Each of these domains includes one or more specific entries in the �Risk of Bias� table. Within each entry, the first part of the tool requires the review authors to describe what was reported to have happened in the study (often by direct quotation). The second part requires the authors to assign a judgement relating to the risk of bias for that entry, by answering a pre-specified question about the adequacy of the study using a drop-down list. For each entry, a judgement of �Yes� indicates a low risk of bias, �No� indicates a high risk of bias, and �Unclear� indicates an unclear or unknown risk of bias. Risk of Bias tables are currently optional features of Cochrane reviews, although the domain �allocation concealment� will need to be completed. Completed Risk of Bias tables can also be used to generate a �risk of bias summary� and/or �risk of bias graph�, which can be included as figures in the review.

New Cochrane review tools 2: Summary of findings tables From Issue 3, 2008 of The Cochrane Library Cochrane reviews may include a �Summary of Findings� table, which presents the main findings of the review in a transparent, simple table format. Specifically, they are intended to provide key information about the quality of evidence, the magnitude of effect of the interventions examined and the sum of available data on the main outcomes. In The Cochrane Library, the Summary of Findings table of a review will appear at the beginning, before the Background section.

Although Summary of Findings tables can be adapted to the individual review, a standard format for them has been developed which includes the following six elements:

• a list of all important outcomes, both desirable and undesirable; • a measure of the typical burden of these outcomes (e.g. illustrative risk, or illustrative mean); • absolute and relative magnitude of effect (if both are appropriate); • numbers of participants and studies addressing these outcomes; • a rating of the overall quality of evidence for each outcome (which may vary by outcome); • space for comments.

An additional piece of software, GRADEpro, is available to assist review authors in the preparation of Summary of Findings tables. GRADEpro retrieves data from RevMan and combines this with user-entered control group risks to produce the relative effects and absolute risks associated with interventions. It also leads the user through the process of a GRADE assessment, and produces a table that can be imported into RevMan 5 as a Summary of Findings table. Alternatively, review authors can create their own table in RevMan 5.

Currently, Summary of Findings tables are optional features of Cochrane reviews, but in the future most reviews will be expected to include one. Full guidance is available in the Cochrane Handbook1 and on the GRADEpro website: http://www.gradeworkinggroup.org/.

1 Higgins JPT, Green S (editors). Cochrane Handbook for Systematic Reviews of Interventions Version 5.0.0 [updated February 2008]. The Cochrane Collaboration, 2008. Available

from www.cochrane-handbook.org.

�Risk of bias summary�: example from the Cochrane Handbook1

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Collaboration with Otolaryngology � Head & Neck

Surgery journal The Cochrane ENT Disorders Group works inclose and fruitful co-operation with the editor ofOtolaryngology � Head & Neck Surgery (theofficial journal of the American Academy forOtolaryngology � Head & Neck Surgery) topromote Cochrane activities, The CochraneLibrary, and the ENT Disorders Group. Theabstract of a Cochrane ENT Group review ispublished quarterly in the journal with an invitedcommentary in a dedicated section, �CochraneCorner�.

Also in collaboration with the editor, we preparedand published in the same journal a commissionedsupplement on Cochrane and Evidence BasedMedicine. This was published in October 2007 andcomprised the following articles:

- Martin J. Burton. Evidence-based medicine and otolaryngology�HNS: Passing fashion or permanent solution (pp S47-S511)

- Mike Clarke. The Cochrane Collaboration and The Cochrane Library (pp S52-S541)

- Jenny Bellorini, Carolyn Dorée, Ian Chamberlain, Martin J. Burton. The Cochrane Ear, Nose and Throat Disorders Group (pp S55-S601)

- Steve Sharp, Richard J. Harvey, Martin J. Burton. The epistemology of otolaryngology � head and neck surgery: A scientific evaluation of the knowledge base (pp S61-S651)

- Richard J. Harvey. Systematic review as a primer rather than endpoint for clinical research: The training perspective (pp S66-S681)

- Iain Chalmers. Better information systems are needed to help patients and clinicians integrate clinical research within everyday clinical practice (pp S69-S711)

- Mark Haggard. The relationship between evidence and guidelines (pp S72-S771)

- J.A. Muir Gray. Knowledge-based commissioning (pp S78-S791)

1Otolaryngology - Head and Neck Surgery. Volume 137, Issue 4, Supplement (October 2007) Evidence-Based Medicine and Otolaryngology - Head and Neck Surgery, Edited by Richard Rosenfeld MD, MPH

New Trials Search Co-ordinator

Our super Trials Search Co-ordinator, Carolyn Dorée, has recently moved on to pastures new (to work for the UK National Blood Service). We would like to thank Carolyn for her wonderful contribution to the ENT Group over the last 5 years, and to wish her all the very best in her new job.

Meanwhile, we are delighted to announce the return of a familiar figure to the post. Gemma Sandberg (née Healy), who was the ENT Group�s Trials Search Co-ordinator (TSC) between 2003 and 2004 has returned to her former position, and is here to help with all your searching needs as of June 2008. Welcome back Gemma!

For those of you that have not previously had contact with the Group�s TSC, Gemma is responsible for the development and publication (in The Cochrane Library) of the ENT Group Trials Register � a database of (currently) in excess of 12,000 references to controlled trials in ENT and head and neck cancer. Gemma also helps review authors by designing and running all search strategies, arranging trial translations and providing advice on all areas of searching and information management.

Gemma can be contacted at: gsandberg@cochrane-ent.org.

Cochrane ENT Group News Gemma

Sandberg Trials Search Co-ordinator

Walter Jobson Horne Prize for Martin Burton Martin Burton, Co-ordinating Editor of the Cochrane Ear, Nose and Throat Disorders Group, has beenawarded the Walter Jobson Horne Prize by the British Medical Association. This is in recognition of hisdistinguished work in the science and practice of laryngology and otology, in particular his work in TheCochrane Collaboration, including the establishment of the Cochrane ENT Group in 1998. In accepting thishonour, Martin is keen to point out that the award also attests to the hard work of his staff and colleagues inthe ENT Group.

Stephen O�Leary appointed to the William Gibson Chair in

Otolaryngology

Congratulations to Professor Stephen O'Leary, aneditor of the Cochrane ENT Group since itsinception, who was appointed to the William GibsonChair in Otolaryngology at The University ofMelbourne, Australia in April 2008.

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New Reviews Abstracts from recent new Cochrane ENT Group systematic reviews Coblation versus other surgical techniques for tonsillectomy MJ Burton, C Doree Background Tonsillectomy is one of the most commonly performed surgical procedures. There are several operative methods currently in use, but the superiority of one over another has not been clearly demonstrated. Objectives To assess the effectiveness of coblation tonsillectomy compared with other surgical techniques in reducing morbidity. Search strategy We searched the Cochrane Ear, Nose and Throat Disorders Group Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library Issue 4, 2006), MEDLINE (1966 to 2006) and EMBASE (1974 to 2006). The date of the last search was December 2006. Selection criteria Randomised controlled trials of children and adults undergoing tonsillectomy by means of coblation compared with any other surgical technique for removal of the tonsils. Trials were assessed for methodological quality according to the method outlined in the Cochrane Handbook for Systematic Reviews of Interventions 4.2.6. Data collection and analysis Data were extracted using standardised data extraction forms. Authors were contacted where additional data were required. Main results Nineteen studies were identified with sufficient data for further assessment. Four of these were excluded because intra-capsular tonsillectomy (i.e. tonsillotomy) rather than sub-capsular tonsillectomy was performed, and a further five studies because tonsils rather than participants were randomised. One further study was excluded because, although describing itself as a randomised trial, its participants turned out not to have been randomised to their intervention groups. Nine trials met the inclusion criteria, comparing coblation to other tonsillectomy techniques. All but two studies were of low quality and therefore a meta-analytical approach was not appropriate. In most studies, when considering most outcomes, there was no significant difference between coblation and other tonsillectomy techniques.

Authors' conclusions In terms of postoperative pain and speed and safety of recovery, there is inadequate evidence to determine whether coblation tonsillectomy is better or worse than other methods of tonsillectomy. Evidence from a large prospective audit suggests that it has been associated with a higher level of morbidity, in terms of postoperative bleeding. Large, well-designed randomised controlled trials supplemented by data from large prospective audits are needed to produce information on effectiveness and morbidity respectively. Burton MJ, Doree C. Coblation versus other surgical techniques for tonsillectomy. Cochrane Database of Systematic Reviews 2007, Issue 3. Art. No.: CD004619. DOI: 10.1002/14651858.CD004619.pub2 Interventions for treating functional dysphonia in adults JH Ruotsalainen, J Sellman, L Lehto, M Jauhiainen, JH Verbeek Background Poor voice quality due to functional dysphonia can lead to a reduced quality of life. In occupations where voice use is substantial it can lead to a loss of employment. Objectives To evaluate the effectiveness of interventions to treat functional dysphonia in adults. Search strategy We searched MEDLINE (PubMed, 1950 to 2006), EMBASE (1974 to 2006), CENTRAL (The Cochrane Library, Issue 2 2006), CINAHL (1983 to 2006), PsychINFO (1967 to 2006), Science Citation Index (1986 to 2006) and the Occupational Health databases OSH-ROM (to 2006). The date of the last search was 5th April 2006. Selection criteria Randomised controlled trials (RCTs) of interventions evaluating the effectiveness of treatments targeted at adults with functional dysphonia. For work-directed interventions interrupted time series and prospective cohort studies were also eligible. Data collection and analysis Two authors independently extracted data and assessed trial quality. Meta-analysis was performed where appropriate.

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Main results We identified six randomised controlled trials including a total of 163 participants in intervention groups and 141 controls. One trial was high quality. Interventions were grouped into 1) Direct voice therapy 2) Indirect voice therapy 3) Combination of direct and indirect voice therapy and 4) Other treatments: pharmacological treatment and vocal hygiene instructions given by phoniatrist. No studies were found evaluating direct voice therapy on its own. One study did not show indirect voice therapy on its own to be effective when compared to no intervention. There is evidence from three studies for the effectiveness of a combination of direct and indirect voice therapy on self-reported vocal functioning (SMD -1.07; 95% CI -1.94 to -0.19), on observer-rated vocal functioning (WMD -13.00; 95% CI -17.92 to -8.08) and on instrumental assessment of vocal functioning (WMD -1.20; 95% CI -2.37 to -0.03) when compared to no intervention. The results of one study also show that the remedial effect remains significant for at least 14 weeks on self-reported vocal functioning (SMD -0.51; 95% CI -0.87 to -0.14) and on observer-rated vocal functioning (Buffalo Voice Profile) (WMD -0.80; 95% CI -1.14 to -0.46). There is also limited evidence from one study that the number of symptoms may remain lower for a year. The combined therapy with biofeedback was not shown to be more effective than combined therapy alone in one study nor was pharmacological treatment found to be more effective than vocal hygiene instructions given by phoniatrist in one study. Publication bias may have influenced the results. Authors' conclusions Evidence is available for the effectiveness of comprehensive voice therapy comprising both direct and indirect therapy elements. Effects are similar in patients and in teachers and student teachers screened for voice problems. Larger and methodologically better studies are needed with outcome measures that match treatment aims. Ruotsalainen JH, Sellman J, Lehto L, Jauhiainen M, Verbeek JH. Interventions for treating functional dysphonia in adults. Cochrane Database of Systematic Reviews 2007, Issue 3. Art. No.: CD006373. DOI: 10.1002/14651858.CD006373.pub2 Vestibular rehabilitation for unilateral peripheral vestibular dysfunction SL Hillier, V Hollohan Background Unilateral peripheral vestibular dysfunction (UPVD) can occur as a result of disease, trauma or post-operatively. The dysfunction is characterized by complaints of dizziness, visual or gaze disturbances and balance impairment. Current management includes medication, physical manoeuvres and

exercise regimes, the latter known collectively as vestibular rehabilitation (VR). Objectives To assess the effectiveness of vestibular rehabilitation in the adult, community dwelling population of people with symptomatic unilateral peripheral vestibular dysfunction. Search strategy The search included the Cochrane Ear, Nose and Throat Disorders Group Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL) in The Cochrane Library Issue 1 2007, MEDLINE (1950 to 2007) and EMBASE (1974 to 2007). The date of the last search was March 2007. Selection criteria Randomised trials of adults living in the community, diagnosed with symptomatic unilateral peripheral vestibular dysfunction. Comparisons sought were: - Vestibular rehabilitation versus control (placebo

etc.) - Vestibular rehabilitation versus other treatment

(non-vestibular rehabilitation e.g. pharmacological)

- Vestibular rehabilitation versus another form of vestibular rehabilitation

Outcome measures that were considered included: frequency and severity of dizziness or visual disturbance; changes in balance impairment, function or quality of life; measure/s of physiological status with known functional correlation. Data collection and analysis Both authors independently extracted data and assessed trials for quality. Main results Thirty-two trials were identified and eleven were excluded because of mixed/unclear vestibular pathology, leaving twenty-one trials in the review. Included studies addressed the effectiveness of vestibular rehabilitation against control/sham interventions, non-vestibular rehabilitation interventions or other forms of vestibular rehabilitation, by comparing the subjects in each group who had significant resolution of symptoms and/or improved function. Individual and pooled data showed a statistically significant effect in favour of the vestibular rehabilitation over control or no intervention. The exception to this was when movement based vestibular rehabilitation was compared to physical manoeuvres for benign paroxysmal positional vertigo, where the latter was shown to be superior in cure rate in the short term. There were no reported adverse effects. Authors' conclusions There is moderate to strong evidence that vestibular rehabilitation is a safe, effective management for

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unilateral peripheral vestibular dysfunction, based on a number of high quality randomised controlled trials. There is moderate evidence that vestibular rehabilitation provides a resolution of symptoms in the medium term. However there is evidence that for the specific diagnostic group of benign paroxysmal positional vertigo, physical (repositioning) manoeuvres are more effective in the short term than exercise based vestibular rehabilitation. There is insufficient evidence to discriminate between differing forms of vestibular rehabilitation. Hillier SL, Hollohan V. Vestibular rehabilitation for unilateral peripheral vestibular dysfunction. Cochrane Database of Systematic Reviews 2007, Issue 4. Art. No.: CD005397. DOI: 10.1002/14651858.CD005397.pub2 Antibiotics to reduce post-tonsillectomy morbidity M Dhiwakar, WA Clement, M Supriya, WS McKerrow Background Tonsillectomy continues to be one of the most common surgical procedures performed in children and adults. Despite improvements in surgical and anaesthetic techniques, postoperative morbidity, mainly in the form of pain, remains a significant clinical problem. Postoperative bacterial infection of the tonsillar fossa has been proposed as an important factor causing pain and associated morbidity, and some studies have found a reduction in morbid outcomes following the administration of perioperative antibiotics. Objectives To determine whether perioperative antibiotics reduce pain and other morbid outcomes following tonsillectomy. Search strategy Cochrane ENT Group Trials Register, Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library, Issue 1 2007), MEDLINE (1950 to 2007) and EMBASE (1974 to 2007) were searched. The date of the last search was March 2007. Selection criteria All randomised controlled trials examining the impact of perioperative administration of systemic antibiotics on post-tonsillectomy morbidity in children or adults. Data collection and analysis Two authors independently collected data. Primary outcomes were pain, consumption of analgesia and secondary haemorrhage (defined as significant if patient re-admitted, transfused blood products or returned to theatre, and total if any documented haemorrhage). Secondary outcomes were fever,

time taken to resume normal diet and activities and adverse events. Where possible, summary measures were generated using random-effects models. Main results Nine trials met the eligibility criteria. Most did not find a significant reduction in pain with antibiotics. Similarly, antibiotics were not shown to be effective in reducing the need for analgesics. Antibiotics were not associated with a reduction in significant secondary haemorrhage rates (Relative Risk (RR) 0.49, 95% CI 0.08 to 3.11, P = 0.45) or total secondary haemorrhage rates (RR 0.92, 95% CI 0.45 to 1.87, P = 0.81). With regard to secondary outcomes, antibiotics reduced the proportion of subjects with fever (RR 0.63, 95% CI 0.46 to 0.85, P = 0.002). Authors' conclusions The present review suggests that there is little or no evidence that antibiotics reduce the main morbid outcomes following tonsillectomy (i.e. pain, the need for analgesia or secondary haemorrhage rates). They do however appear to reduce fever. Some important methodological shortcomings exist in the included trials which are likely to have produced bias favouring antibiotics. We therefore advocate caution when prescribing antibiotics routinely to all patients undergoing tonsillectomy. Whether a subgroup of patients who might benefit from selective administration of antibiotics exists is unknown and needs to be explored in future trials.

Dhiwakar M, Clement WA, Supriya M, McKerrow WS. Antibiotics to reduce post-tonsillectomy morbidity. Cochrane Database of Systematic Reviews 2008, Issue 2. Art. No.: CD005607. DOI: 10.1002/14651858.CD005607.pub2

ENT Group reviews in progress

For full details of our reviews and protocols, both published and in progress, can be found on the CRG website here:

http://www.cochrane-ent.org/en/localrevs.html

If you select �By Subtopic� you can browse through our work by clinical area. Recent new title registrations include:

• Allergen injection immunotherapy for perennial allergic rhinitis

• Anticonvulsants for tinnitus • Chinese herbal medicine for treating allergic

rhinitis • Enteral feeding methods for nutritional

management in patients with head and neck cancers being treated with radical radiotherapy

• The role of surgery for tympanic membrane retraction pockets

Cochrane Collaboration News

16th Cochrane Colloquium �Evidence in the era of globalization� Freiburg, Germany 3rd to 7th October 2008

From the programme �Globalisation is the predominant buzzword of our time, and its effects, both positive and negative, are not fully understood. Health care is part of this globalisation process, with its global exchange of knowledge in research and practice. The development of evidence-based health care is a driving force towards a standardised, international appraisal system of healthcare interventions. Over the last 15 years, The Cochrane Collaboration has laid critical groundwork for this development by producing more than 3000 systematic reviews and contributing to numerous methodological developments� The Cochrane Colloquium 2008 offers an outstanding opportunity to interact with central players active in evidence-based health care, global knowledge management and systematic reviews. Catch up on current international developments and perspectives and attend workshops to delve further into individual topics�.

Freiburg The city of Freiburg is located in the lower Rhine valley between the mountain range of the Vosges and the Black Forest, close to the borders of both France and Switzerland. It is a compact city, with most facilities within easy walking reach. The old town is described as �a heady mix of quaint old lanes, tiny shops, pubs and boutiques�. It is famous for its beautiful gothic, renaissance and baroque buildings: the Freiburger Münster (cathedral) is said to have �one of the most beautiful spires on earth". Situated in wine making country, the city is surrounded by vineyards and undulating hills. To the east is the beautiful Black Forest, with ample opportunities for walking or biking, and to the south are the

thermal springs at Bad Krozingen and Badenweiler. The city of Basel (Switzerland) is just a half-hour train ride away, while to the west is the Alsace region of France, with its cosy, rustic villages and gastronomic specialities.

Registration fees Early registration: 660 Euro (deadline: 30 June) Full registration: 800 Euro

Day tickets will also be available at The Konzerthaus from 3rd to 7th October on a limited basis.

Key dates 30 June 2008 Early registration deadline 15 July 2008 Start: sign up for meetings and workshops3 September 2008 Cancellation deadline

4 September 2008 Hotel registration deadline

Full details and online registration at: http://www.colloquium.info/

Multimedia portal � www.cochrane.org Audio summaries of selected Cochrane reviews are now available as podcasts on The Cochrane Collaboration website. Users may also choose to subscribe to all future Cochrane review audio summaries. The Cochrane multimedia portal at http://www.cochrane.org/multimedia/index.htm also includes video introductions to the Cochrane Collaboration. Watch Cochrane contributors and staff discuss the Collaboration's work and impact in a series of 2006 interviews. The portal also features podcasts, slidecasts and videos from the plenary sessions of the Cochrane Colloquia and other meetings.

The Black Forest

Important changes to the display of reviews in The Cochrane Library

From Issue 3, 2008 there are some important changes to the way that reviews and protocols are displayed in The Cochrane Library. The former �Update� flag has gone and is replaced by three new flags (New search, Conclusions Changed and Major Change) which are intended to provide a more precise definition of the type of update that has taken place, and to improve searching.

Contact details and affiliations for all authors are now displayed at the top of the review, under the byline.

The What�s New section has moved from the Cover Sheet to the end of the review with other information about the article and can be accessed via Quick Links. What�s New now also includes the historical information currently published on the Cover Sheet.

Some reviews will now also feature a Summary of Findings table (see page 3) presenting the main findings of a review in clear and simple table format. This table will be found near the start of the review and also under the heading Quick Links. In the future most reviews will be expected to have a summary of findings table. The new Risk of Bias table can be viewed as an extension of the �Characteristics of included studies table�.

New Cochrane Style Guide The 4th edition of the Cochrane Style Guide was released in May 2008. The Guide is designed to help review authors and editorial

groups to use a consistent house style when copy editing Cochrane Reviews. Using the Style Guide when drafting your review is beneficial as it can considerably lessen the amount of time your review needs to spend in the editorial process. A shorter, Cochrane Style Basics, for authors will also be released soon. Both can be downloaded from http://www.cochrane.org/style/home.htm.

Are you studying adverse effects in your review?

The Cochrane Adverse Effects Group was officially registered in June 2007. The Group has now established a discussion list and invites anyone to join who is interested in any aspect of incorporating adverse effects into systematic reviews, whether this is searching, inclusion criteria, quality assessment and/or meta-analysis. To join the discussion list please go to http://lists.cochrane.org/mailman/listinfo/aemg.

For more details on the Cochrane Adverse Effects Group see http://aemg.cochrane.org/.

A full review, complete with results and discussion and possibly meta-analysis, combining results cross studies.

A protocol, which is the outline of a review in preparation, including the background, rationale and methods.

A new protocol or review that has been published in the latest (quarterly) issue.

A full-text systematic review of methodological studies.

A new search for studies has been conducted for an existing review, as published in the most recent (quarterly) issue.

There has been an important change to the conclusions of the review as published in the most recent issue.

The protocol has been amended to reflect a change in scope, as published in the most recent issue.

The review or protocol has been withdrawn, which may be because it was considered to be out of date. Reasons for withdrawal are specified in the document.

A full review that also contains commentary/criticism. Readers can submit comments which are incorporated into the review together with answers and feedback from the review author.

New flags used in The Cochrane Library

Major revision of the Cochrane Handbook

A major revision of the Cochrane Handbook for Systematic Reviews of Interventions (Version 5.0.0) has been released. A browseable, online version of the Handbook can be accessed directly at: www.cochrane-handbook.org.

The Handbook is also included in full in RevMan 5 (under the Help menu), and is also scheduled to be published inbook form by Wiley-Blackwell in time for the FreiburgColloquium (October 2008).

The Handbook now consists of 22 chapters in three parts.The core material (Parts 1 and 2) has been extensivelyrevised and updated, and includes:

- new definitions around updates; - the new 'Risk of bias' tool; - 'Summary of findings' tables; - a new chapter on reporting biases; - extensive resources to aid searching for studies.

Part 3 consists of chapters on special topics:

- Including non-randomised studies; - Adverse effects; - Incorporating economics evidence; - Special topics in statistics; - Patient-reported outcomes; - Reviews of individual patient data; - Prospective meta-analysis; - Qualitative research and Cochrane reviews; - Reviews in health promotion and public health; and - Overviews of reviews.

Free copies of The Cochrane Library available on CD-ROM! Those users with limited or intermittent access tothe Internet, or without an institution or nationalprovision, may find the alternative of a locally-installed copy of The Cochrane Library a usefulsolution. Here at the editorial base we have a smallsupply of CD-ROM versions which we are happy todistribute on request. These are replaced followingthe publication of each new issue of the Library, sothat user who chooses to access the Library in thisway can be assured of up-to-date content. For more information or to request your copy,please email Ian Chamberlain atichamberlain@cochrane-ent.org.

Upcoming publication dates and submission deadlines

for The Cochrane Library

Review Group

submission deadlines*

Publication dates

Issue 3, 2008

07:00 GMT/UTC, 15 May 2008 16 July 2008

Issue 4, 2008

07:00 GMT/UTC, 14 August 2008

8 October 2008

Issue 1, 2009

07:00 GMT/UTC, 13 November 2008

21 January 2009

* For Review Group Co-ordinators to submit their Group�s articles for The Cochrane Library. Individual authors should contact Ian Chamberlain (ichamberlain@cochrane-ent.org) for editorial deadlines.

Permission to publish form: now needed for protocols as well as reviews Whereas we have previously only asked authorsof full reviews to complete the Cochrane �Licencefor Publication� form, following a change in policyacross the Collaboration, we will now also beasking authors (and all co-authors) of protocols tosign a form before their work is submitted forpublication. The change in policy is due to theneed to address the following issues whensubmitting a protocol for publication:

a) that authors have read the final version; b) thatauthors are content with the corrections and/oramendments; c) authors are content for theirname to appear on the by-line; d) authors use theform to declare any conflict of interest; and e)copyright is transferred to the Collaboration.

Editor-in-Chief for the Cochrane Collaboration

A highly significant development for theCochrane Collaboration is the approval by theSteering Group in April 2008 of a proposal toestablish an office of Editor-in-Chief for The Cochrane Library. This is the most significantchange to the editorial structure of theCollaboration since its foundation in 1993 and willtransform the overall management of key issuessuch as productivity, prioritisation and quality. The Editor-in-Chief will be supported by anappropriately staffed office and a newly-formedCo-ordinating Editors� Board, which will workclosely with other Cochrane entities, with theremit of ensuring quality is maintained andimproved within and across Cochrane reviews.For further information, see the latest SteeringGroup bulletin:http://www.cochrane.org/newslett/CCSGBulletinVelloreJanuary2008.pdf.

Strategic review of The Cochrane Collaboration

In 2008, The Cochrane Collaboration is undergoing a strategic review of its structures, processes and governance. A special website has been launched to give more information about this initiative. The Strategic Review will result in recommendations for the future, with the aim of �taking the Cochrane Collaboration wisely forward over the next 10 years�. It will involve a great deal of consultation both within and outside of the Collaboration, which will be structured around seven different dialogues (streams of inquiry) and will identify themes and potential actions for strong decision-making and future success. They are:

- 1st dialogue: Purpose - 2nd dialogue: External and Internal Coherence - 3rd dialogue: External environment - 4th dialogue: Financial viability - 5th dialogue: Accountability and decision making - 6th dialogue: Structures and Processes - 7th dialogue: Communication, advocacy and

engagement with external stakeholders

To learn more, see the website: www.cochrane.org/ccsg/review (this will direct you to a site separate to The Cochrane Collaboration). The website will tell you more about the review, who is involved, who they will be consulting with, what questions will be asked, and what other opportunities there will be to give your input. The Strategic Review Team are Jeremy Grimshaw, Mary Ellen Schaafsma and Lisa McGovern.

The Specialist Library for ENT and Audiology http://www.library.nhs.uk/ent/

Have you ever wondered how many of the countless clinical decisions made every day are actually informed by reliable evidence? The reality is - alarmingly few of them! Clinicians are in desperate need of accurate research evidence but lack the time and often the skills to go online

and retrieve it. This is why the Specialist Library has become indispensable as a timesaving gateway to the best available evidence, offering several key benefits to its users:

• reaches multidisciplinary professional audience across both primary and secondary and tertiary care; • resources are easily accessible 24/7 without charge; • contains concise summaries of evidence and links to full text

where available; • up-to-date with new evidence added as it emerges; • emphasis on quality assured content; • a one stop shop through a single point of access; • a forum for sharing and exchanging knowledge.

Recent Developments • Searching Service for specific queries • Sign up for regular email updates • New online journals service for NHS staff • Hearing and Rhinitis National Knowledge Weeks present the

latest evidence and expert commentaries • Your chance to influence the research agenda � DUETs: a new project to identify and address therapeutic

uncertainties (see below).

The Library can equip you with the knowledge you need whilst enabling you to devote more of your time to patient care and research. We invite you to make use of this unique online service and share its content with your colleagues. Further information is available from: Steve Sharp, Information Specialist, E-mail: ssharp@speclib-ent.org; Tel: (+44) 07966 740913.

DUETS � facilitating the prioritisation of systematic reviews in ENT

Well performed systematic reviews provide the most reliable answers to healthcare questions. More organisations and groups, such as the Cochrane ENT Disorders Group, have become increasingly aware of the need to prioritise which systematic reviews are performed � not only to optimise the use of often scarce resources, but to ensure that it is the questions and uncertainties that potentially make the biggest difference to patient care, which are addressed first. A dichotomy is also often perceived between the interests of the health research community and the information needs of health professionals working at the coalface: although the numbers of systematic reviews published are growing rapidly � the �newsworthiness� and �relevance� of the reviews themselves is not always certain.

A new online resource, the Database of Uncertainties about the Effects of Treatments (DUETs), has been established in the UK to map out where unanswered questions exist relating to therapy. It has been developed by The James Lind Alliance � a non profit-making initiative whose main aim is to help identify the most important gaps in knowledge about the effects of treatment.

DUETs is an exciting new project because it offers a mechanism by which patients, carers, health professionals and other researchers can communicate with research communities and make clear what uncertainties, not thus far addressed by systematic reviews, matter to them. Current ENT-related questionssubmitted by clinicians on the DUETs database include:

- In which circumstances is post operative radiotherapy to lymph node areas beneficial for head and neck cancer in terms of improving local control and overall survival? - In preschool children with otitis media with effusion, does the insertion of ventilation tubes (grommets) as opposed to watchful waiting have an effect on language development? - What evidence is there for leukotriene receptor antagonists in the treatment of nasal polyps?

DUETs is freely available online to everyone and users can browse the database by health condition or use the advanced search function. Currently, DUETs is restricted to uncertainties submitted by UK contributors as it will be used primarily to inform the prioritisation of systematic reviews and other appropriate research conducted in the UK. The Cochrane ENT Disorders Group will regularly monitor the addition of new uncertainties falling within its scope. A feedback facility is available on the DUETs website for users to submitcomments and criticisms.

Quick Links DUETs: http://www.duets.nhs.uk/Default.asp James Lind Alliance: http://www.lindalliance.org/

CALENDAR OF COCHRANE

WORKSHOPS AND OTHER EVENTS IN 2008/9

Location Centre Workshop Date Academic Medical Center, Amsterdam, The Netherlands

DTA review Support Units

Cochrane Diagnostic Test Accuracy Reviews http://srdta.cochrane.org/en/newPage2.html Contact: Mariska Leeflang, CESU@amc.uva.nl

19 to 20 June 2008

Baltimore-Washington metropolitan area North American

North American Conference on Systematic Reviews Contact: Janie Gordon, jlgordon@jhsph.edu

10 to 11 July 2008

Mount Washington Conference Center Baltimore, MD, USA

North American Workshop on Completing a Cochrane Systematic Review

16 to 18 July 2008

Sydney, Australia Australasian New Cochrane Handbook Methods & RevMan 5 for Existing Review Authors Workshop 16 July 2008

Sydney, Australia Australasian Developing a Protocol for a Systematic Review 17 to 18 July 2008

Sydney, Australia Australasian Introduction to Analysis 18 July 2008

Khon Kaen, Thailand Thai Cochrane Network Developing a protocol for a Cochrane Review 23 to 24 July

2008 Oxford, UK UK Developing a Protocol for a Review 29 July 2008 Oxford, UK UK Introduction to Analysis 30 July 2008

online North American Handsearching: Identifying and Classifying Controlled Trial Reports (online) 1 to 2 Aug 2008

Oxford, UK UK Developing a Protocol for a Review 2 Sep 2008 Oxford, UK UK Introduction to Analysis 3 Sep 2008

Khon Kaen, Thailand Thai Cochrane Network

Introduction to Systematic Reviews for Diagnostic Test Accuracy (SRDTA) Workshop 2 to 3 Sep 2008

Adelaide, Australia Australasian Developing a Protocol for a Systematic Review 4 Sep 2008 Adelaide, Australia Australasian Introduction to Analysis 5 Sep 2008 Copenhagen, Denmark Nordic RevMan 5 workshop 11 Sep 2008 York, UK UK Developing a Protocol for a Review 24 Sep 2008 Copenhagen, Denmark Nordic Protocol workshop 29 Sep 2008 Freiburg, Germany German 16th Cochrane Colloquium (see page 8) 3 to 7 Oct 2008

Khon Kaen, Thailand Thai Cochrane Network

New Cochrane Handbook Methods & RevMan 5 for Existing Review Authors Workshop 20 Oct 2008

Khon Kaen, Thailand Thai Cochrane Network Cochrane Review Completion 21 to 22 Oct

2008

Calabar, Nigeria South African

Reviews for Africa Programme (RAP) Contact: Martin Meremikwu, cochranenigeria@yahoo.co.uk (Application deadline: 4pm 30 June 2008)

1 to 31 Oct

Khon Kaen, Thailand Thai Cochrane Network

The EQUATOR Network: Key guidelines for reporting health research studies 11 Nov 2008

Khon Kaen, Thailand Thai Cochrane Network Introduction to Cochrane Risk of Bias Tool 12 Nov 2008

Melbourne, Australia Australasian Cochrane Review Completion & Update Program

17 to 21 Nov 2008

Sydney, Australia Australasian Developing a Protocol for a Systematic Review 4 Dec 2008 Sydney, Australia Australasian Introduction to Analysis 5 Dec 2008 For further information on the above courses / workshops and details of all Cochrane Collaboration workshops go to http://www.cochrane.org/news/workshops.htm or visit the websites of the relevant centre.

The Cochrane ENT Disorders Group Editorial Team

Co-ordinating Editor Mr Martin Burton Review Group Ian Chamberlain Co-ordinator Assistant Review Group Jenny Bellorini and Development Co-ordinator Information Manager / Gemma Trials Search Sandberg Co-ordinator Editors Dr Lito Acuin (Philippines) Professor Martin Birchall (UK)

Mr William McKerrow (UK) Professor Randall Morton (New Zealand)

Professor Stephen O�Leary (Australia)

Dr Maroeska Rovers (Netherlands)

Dr Ian Williamson (UK) Comments & Mr Martin Burton (acting) Criticisms Editor Statistician Rafael Perera, UK

The Cochrane Centres

There are currently 12 Cochrane Centres around the world, located in: Australia (Monash), http://www.cochrane.org.au/ Brazil (São Paulo), http://www.centrocochranedobrasil.org/ Canada (Hamilton), http://www.centrocochranedobrasil.org/ China (Chengdu), http://www.ebm.org.cn/ Germany (Freiburg), http://www.cochrane.de/de/index.htm Iberoamerican (Barcelona), http://www.cochrane.es/ Italy (Milan), http://www.cochrane.it/ The Netherlands (Amsterdam), http://www.cochrane.nl/index.html Nordic (Copenhagen), http://www.cochrane.dk/ South Africa (Cape Town), http://www.mrc.ac.za/cochrane/cochrane.htm the UK (Oxford), http://www.cochrane.co.uk/ and the USA (Providence) http://www.cochrane.us/ All the centres provide support for Cochrane reviewers and other volunteers in their areas. Details can be found on the Cochrane website (http://www.cochrane.org) or obtained from the Cochrane ENT Group.

Access/subscription to The Cochrane Library

Details of The Cochrane Library can be found on

the Cochrane Collaboration website http://www.cochrane.org

For subscription information please see:

http://www.thecochranelibrary.com

Residents in a number of countries or regions can access The Cochrane Library online for free through a �provision� or a special scheme. These exist for the following geographic areas:

Australia, Canada (New Brunswick, Northwest Territories, Nunavut, Yukon, Nova Scotia, Saskatchewan), Finland, India, Ireland, Latin America and the Caribbean, Low-Income Countries (with free one-click access to all residents of countries in the World Bank�s list of low-income economies), New Zealand, Norway, Poland, South African Cochrane Centre Sponsorship, Sweden, United Kingdom (England, Northern Ireland, Scotland, Wales), United States (Wyoming).

How to contact us

Cochrane Ear, Nose and Throat Disorders Group

Department of Otolaryngology Level LG1, West Wing

John Radcliffe Hospital Headley Way

Oxford OX3 9DU

UNITED KINGDOM Phone: +44 (0)1865 231051

Fax: +44 (0)1865 231091 Email: ichamberlain@cochrane-ent.org

Web: http://www.cochrane-ent.org

Please contact us if you would like any more information or if you would like to become

involved in our activities.

We would welcome your contributions to this newsletter - please send us any items that you would like us to publish, or let us know about any issues you would like to see covered. Any comments which will help us improve this newsletter will be gratefully received. The next newsletter will appear in the winter. Contributions, comments and suggestions should be forwarded to Ian Chamberlain at the address above.