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Podcast: Selective serotonin reuptake inhibitors for stroke recovery

Wed, 02/26/2020 - 14:51

Stroke is a major cause of death and disability across the world, with many reviews from the Cochrane Stroke Group providing evidence on the effects of treatments and rehabilitation interventions. In November 2019, the Group published their update of their review of selective serotonin reuptake inhibitors and we asked lead author, Gillian Mead from the University of Edinburgh in Scotland, to tell us more.

Stroke is a common cause of disability in the community. Although there have been major advances in the care of stroke patients over the last few years, many survivors are still left with physical disability, such as weakness down one side of the body, called hemiparesis, difficulty speaking, low mood, anxiety, fatigue, and memory and thinking problems. Therefore, we need better treatments to address stroke disability.

One possibility is the group of drugs called selective serotonin reuptake inhibitors (or SSRI for short). These have been used for many years to treat mood disorders in the general population and also after stroke. In 2011, a French trial showed that one of the SSRI, fluoxetine, improved recovery of arm weakness if given early after stroke, in people without mood problems.  We then performed a Cochrane review of all trials of SSRI given after stroke and found that SSRIs did seem to reduce disability. However, we could not be confident that the results were reliable, because many of the studies were small and had multiple sources of bias. On the positive side, we identified three large trials that were being planned, one from the UK, one from Sweden and one from Australasia. 

Generally, Cochrane Reviews should be updated when important new evidence becomes available. We knew that the UK trial (called FOCUS) was scheduled to be published in December 2018, and so we decided to update the review.

Our updated review found a total 63 trials recruiting more than 9000 stroke survivors within one year of their stroke.

However, only three of these trials, with 3249 participants with just over 3100 from FOCUS, were at low risk of bias and likely to provide robust findings on the effects of SSRIs. The participants in these three trials did not have to be depressed to enter the trial, and they were all recruited soon after their stroke. Our meta-analysis of their results showed that SSRIs did not affect disability score or dependency. The drugs reduced the risk of future depression but increased the risk of problems with the digestive system.

When we combined data from all the studies, irrespective of their risks of bias, there appeared to be a beneficial effect on recovery, but this was almost certainly because the studies at high risk of bias tended to give the positive results.

The review will be updated again after the large Swedish and Australasian trials are published in 2020.

Monday, March 9, 2020

We are now accepting applications for Cochrane stipends for #CochraneToronto

Wed, 02/26/2020 - 12:18

A number of stipends and bursaries are available to help consumers and other attendees based in developing countries to attend Cochrane Colloquium Toronto 2020. This is our 27th annual flagship event and this year it will take place at The Westin Harbour Castle in Toronto, Canada, 4-7 October 2020.

Stipends and bursaries represent funding you can apply for, if you are eligible, that are intended to help cover registration and other expenses associated with attending the 2020 Colloquium.

Cochrane is providing stipends for:

  1. Cochrane Consumers
  2. individuals living in low-lower-middle, (LMIC) and upper-middle-income countries (UMIC)

The deadline for applying is Monday 18 May 2020 and winners will be notified in June

Find out whether you are eligible and how to apply

Wednesday, February 26, 2020

Cochrane International Mobility - Astrid Modiano Hedenmalm

Tue, 02/25/2020 - 19:45

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

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

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

Name: Astrid Modiano Hedenmalm
Location: Lund, Sweden
Cochrane International Mobility location: Utrecht, Netherlands with Cochrane Netherlands

How did you first learn about Cochrane?
I did not have any involvement with Cochrane before Cochrane International Mobility (CIM) programme. I was looking for a supervisor to do my master thesis with, and I saw a post on social media by an older medical student at Lund University who was promoting Cochrane as well as his supervisor there. After some e-mailing with the student, I got in touch with his supervisor at Cochrane Sweden, and half a year later I did CIM in the Netherlands.

What was your experience with Cochrane International Mobility?
I basically did a smaller version of my masters thesis, which was a Diagnostic Test Accuracy (DTA) review. Instead of going through each step entirely, I did just a little bit of each step of the review and got tutoring along the way. I also joined in on things that were happening at the center, like listening to other people present their research, and I attended a conference that took place when I was there. Through CIM I made contacts who continued to help me out with my thesis through e-mails and teleconferences when I was back in Sweden.

What are you doing now in relation to your Cochrane International Mobility experience?
I have finished my thesis, and now we are in the process of editing it in order to submit a manuscript to a journal for publishing.

Do you have any words of advice to anyone conserving a Cochrane International Mobility experience?
If you are a medical student like me, and you mostly work clinically, I think you will get a lot out of this experience. As doctors, we will need to be updated on research in our fields, and for me this experience with CIM and writing my thesis with Cochrane has really improved my skills when it comes to critically appraising research.

Tuesday, February 25, 2020

Podcast: Pharmacies might be able to support people with their depression medicines

Mon, 02/24/2020 - 15:57

The Cochrane Common Mental Disorders Group had published more than 180 reviews relevant to conditions such as anxiety and depression by the end of 2019. In December 2019, they added a review of whether pharmacist support can help people take their anti-depressants and we asked one of the authors, Jennifer Brown from the Centre for Reviews and Dissemination at the University of York in the UK, to tell us about the latest findings.

Many people who have depression are prescribed drugs, often called antidepressants, to help manage their condition, but it can take months for them to make a difference. It’s important, therefore, that people continue to take the drugs as prescribed, to give them the best chance of working. In most cases, their family doctor or GP supports them with this treatment to make sure they take the correct dose at the correct times and to watch out for side effects. However, in spite of this, some people struggle with their antidepressants and don’t take the drugs as prescribed, which can stop them from getting better or might even make their illness worse.

We’ve investigated whether an alternative approach improves this problem. We were interested in the effect of people receiving support with their antidepressants from a pharmacist or a pharmacy-based team, rather than their GP or another primary care provider. This approach is being used successfully for physical health conditions such as monitoring blood pressure and is sometimes called “pharmacy-based management”. It’s promising because, in countries such as the UK, pharmacies are more easily accessible than GP practices, pharmacists and their teams are likely to have more time than GPs, and they have the necessary knowledge about the different drugs people might be prescribed. There is also some evidence that people form a closer relationship with their pharmacist than with their GP.

In our review, we compared pharmacy-based management with active control (for example, special information leaflets) or treatment as usual, which would be the “normal” care delivered by GPs or nurses.  The moderate quality evidence we found, from more than 2200 adults in 12 studies, shows that there is no reason to believe that there is a difference in the reduction of the symptoms of depression between pharmacy-based management and treatment as usual. We also found no evidence of a difference between the acceptability of these two approaches to participants, given the similar number who left the trials early in the pharmacy-based management and treatment as usual groups, but there is uncertainty about this because of the low quality evidence for this outcome.

In summary, our review does not necessarily rule out a more active role for pharmacists in the treatment of people with depression. If additional support from pharmacists can reduce the time needed from GPs, without a detrimental effect on outcomes, this has important implications for cost-effectiveness. This would be important to assess in future research as we did not investigate this in our review. There is also a need for further research to establish which parts of the pharmacy-based management approach make it successful and why some models work better than others.

Monday, March 2, 2020

Cochrane Eyes and Vision seeks new Co-ordinating Editor – flexible location

Fri, 02/21/2020 - 17:56

 The Cochrane Eyes and Vision Group is looking to appoint one or more new Co-ordinating Editors to provide leadership of the Group. The Eyes and Vision Group is part of the Cochrane Musculoskeletal, Oral, Skin and Sensory ( MOSS) Network. This is an important opportunity to lead and shape the future development of a strategically important area of Cochrane’s healthcare evidence coverage. The Eyes and Vision Group portfolio of reviews includes 212 published reviews and 45 protocols.

We invite applications from individuals based anywhere in the world, from existing Cochrane Groups and from outside Cochrane, and also those interested in a job share arrangement. Applicants should be aware of the following requirements:

1. The Co-ordinating Editor(s) must have:

  • Experience of authoring Cochrane or alternative high-quality systematic review
  • Clinical expertise and standing in the field of eyes and vision
  • Methodology expertise in the field of evidence synthesis, including risk of bias and GRADE assessments

2. The following attributes are highly desirable

  • Experience of editing Cochrane reviews or alternative high-quality systematic review
  • Advanced methodological skills and knowledge

3. The new Co-ordinating Editor(s) must work within the terms of the Collaboration Agreement that defines the responsibilities of Cochrane and the Cochrane Review Group. 

4. The new Co-ordinating Editor(s) must actively engage with the MOSS Network and adhere to the Network’s strategic plan.

For further information, please see the full role description, which sets out all of the responsibilities of the role.

Potential applicants should familiarise themselves with Cochrane’s commercial sponsorship and conflict of interest policy.

Individuals who are interested in exploring this opportunity are welcome to contact Karla Soares-Weiser, Editor-in-Chief ( or Peter Tugwell, Senior Editor, MOSS Network (

To apply, please send a cover letter detailing the responses to the numbered bullet points above, and a short Curriculum Vitae to Karla Soares-Weiser (

Friday, February 21, 2020 Category: Jobs

Cochrane Bosnia and Herzegovina symposium called 'Cochrane for everyone' held at Medical School in Mostar

Wed, 02/19/2020 - 19:04

Cochrane Bosnia and Herzegovina second scientific symposium took place on Friday January 17th in front of the full auditorium of the University of Mostar School of Medicine.

The theme of the  symposium was 'Cochrane for everyone' and it attracted huge interest from the media, medical students, and clinicians. Below is just a sample of some of the media coverage:

 Co-directors of Cochrane Croatia, Irena Zakarija-Grković and Tina Poklepović Peričić presented the work of Cochrane, talked about the importance of evidence in medicine, and the role of Cochrane in improving clinical practice.

 Assist. prof. Goran Poropat from Medical School in Rijeka presented the design of Cochrane systematic reviews, the Cochrane review process, including the challenges during the process and he has a longtime experience authoring Cochrane reviews, both intervention and diagnostic test accuracy and takes great part in the editorial base of the Cochrane Hepatobiliary Group.

 The symposium in Mostar was useful in terms of promoting the work of Cochrane and its influence to all stakeholders within the health system, but it also allowed an opportunity to talk about further developing Cochrane network and building future collaboration between Croatia and Bosnia and Herzegovina.

Wednesday, February 19, 2020

Oxford University seeks Senior Systematic Reviewer (Cochrane)

Wed, 02/19/2020 - 11:43

Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Kadoorie Critical Care Research Centre, John Radcliffe Hospital, Oxford

Specifications: Full-time, fixed-term (12 months)
Salary: Grade 8: £41,526 - £49,553 p.a.
Application Closing Date: Monday 16 March 2020 12:00 noon

We are seeking a Senior Systematic Reviewer to join Oxford Trauma group, within the Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS) based at the Kadoorie Research Centre, John Radcliffe Hospital, Oxford. This is an exciting opportunity to join a dynamic team of collaborators from a number of groups.

As a Senior Systematic Reviewer, you will have an overall responsibility for the conduct and delivery of a suite of top quality, high profile Cochrane systematic reviews, working with a team of reviewers, statisticians and content experts. You will lead the reviewing component of the programme, including managing a grade 7 Systematic Reviewer and you will undertake meta-analyses and network meta-analyses, with the support from the project statistician. You will be responsible for writing and dissemination of Cochrane Reviews and Overviews, including major contribution to linked material for peer-reviewed publications.

You will hold a first degree (first or upper class second) in a health related or scientific discipline. You will have an extensive previous experience of delivering high quality systematic reviews (e.g. Cochrane Reviews or reviews for NICE or similar technology hub). Outstanding communication skills and ability to communicate results effectively to colleagues in any discipline as well as external collaborators, excellent IT literacy (RevMan, email, Microsoft Office) are essential. A higher degree in a health related or scientific discipline or equivalent professional experience, knowledge of GRAPEPro and other software for undertaking more complex meta-analyses (CMA, STATA, R, WinBugs, or SAS) are desirable.

This is a full-time, fixed-term (12 months) post.

You will be required to upload a CV and supporting statement as part of your online application.

Wednesday, February 19, 2020 Category: Jobs

Podcast: Regular treatment with formoterol and inhaled steroids for chronic asthma: serious adverse events

Fri, 02/14/2020 - 10:29

Most Cochrane Reviews seek to cover both the benefits and harms of interventions, but the complexity of the research on the adverse effects of some treatments means that a few reviews are dedicated to just the potential harms. One of these, on one of the drugs used for treating asthma was updated in September 2019, and lead author, Sadia Janjua from the Population Health Research Institute at the University of London in the UK, tells us about the latest findings in this podcast.

The standard treatment for people with asthma is a low-dose inhaled corticosteroid. But if this does not control their asthma on its own, many guidelines recommend adding a long-acting beta₂-agonist, or LABA. Our focus is one of drugs in this class of drugs, formoterol. §

LABA, such as formoterol, have the advantage of longer duration of action than short acting beta- agonists, which means that they can be taken twice daily and used alongside inhaled steroids for regular maintenance treatment for people with persistent asthma symptoms. There has been, however, some apprehension about using LABA as long-term maintenance treatment because they may mask symptoms of deteriorating asthma, which could delay treatment for severe exacerbations. In turn, this could increase the risk of asthma-related deaths. LABAs may also lead to tolerance to their bronchodilator effects when used long-term.

The concerns over safety led the American Food and Drug Administration to commission large trials to assess the safety of the combination of a LABA and a corticosteroid when given together in a single inhaler as regular treatment for adults with asthma. These trials have now been published and we updated our review of serious adverse effects in children and adults taking formoterol in combination with an inhaled corticosteroid, to incorporate the new results. This has given us more information to assess whether this combination is safe in the long term and although we have found no evidence that it’s not safe, some uncertainty remains.

Following the recent trials, the FDA removed the black triangle from its guidance on LABAs, showing that they consider the long-term use of LABA with an inhaled corticosteroid to be safe. And, looking at the research evidence, we’ve not found any long-term safety concerns (such as an increased risk of dying from asthma) when the results of the new studies are combined with the information from earlier trials which was already in the 2017 version of the review. However, it needs to be noted that this reassurance comes from trials in which treatment with formoterol and corticosteroid was usually well supervised. Moreover, there were very few deaths from asthma in any of the trials. Just three adults out of 13,000 on regular formoterol and inhaled corticosteroid died of asthma and none of 11,000 on the steroid alone die during the trials, and there were no deaths in children.

So, even with the evidence from the large new trials, the very small number of deaths does not allow us to say for sure that there is no additional risk when formoterol is given regularly in combination with an inhaled corticosteroid. Therefore, it might be best to assess the benefits of regular combination treatment for people with asthma on an individual level and, if symptom control is clearly improved, then this may outweigh the fact that we cannot completely rule out any increase in the risk of harm.

Monday, February 24, 2020

Podcast: Flexibility exercise training for adults with fibromyalgia

Thu, 02/13/2020 - 13:22

People with fibromyalgia have persistent, widespread body pain and there are more than 30 Cochrane Reviews of interventions that might help them. In September 2019, a new review was added to the Cochrane Library, studying the effects of flexibility exercise training. We asked its lead author, Soo Kim from the University of Saskatchewan in Canada, to tell us about the findings.

"As well as suffering from pain across their whole body, some people with fibromyalgia also have fatigue, anxiety, depression, and sleep difficulties. Exercise training is commonly recommended for them and flexibility exercise training is one of the techniques that is frequently prescribed. This is a type of exercise that focuses on improving or maintaining the amount of motion available in muscles and joint structures by holding or stretching the body in specific positions. We’ve investigated its impact when compared to regular treatment which doesn’t include any formal exercise program; land-based aerobic training, such as treadmill walking; resistance-training, such as using weight machines to provide resistance and other interventions, such as Pilates.

Our main comparison was flexibility exercise versus land-based aerobic training and we found very low-certainty evidence that there were no clinically important benefits for flexibility exercise with regard to quality of life, pain intensity, fatigue, stiffness, and physical function.

Our review includes 12 randomized trials, involving nearly 750 people, with an average age of 49. The trials were done in seven countries, and seven of the 12 included women only. The stretching exercise programs ranged from 40 to 60 minutes, 1 to 3 times a day, with patients taking part in the trials for between 4 and 20 weeks.

The reports differed in how much detail they provided on the exercise but one of the main limitations of the trials may be that the protocols for flexibility exercise training were not set according to American College of Sports Medicine, or ACSM, guidelines, and may not have reached the necessary threshold to achieve benefits for people with fibromyalgia. None of the included studies met all the recommended FITT‐VP (frequency, intensity, time, type, volume, and progression) principles for healthy individuals outlined in the 2013 guidelines.

In conclusion therefore, although our review has shown no significant long-term benefits of flexibility exercise training, there is so much variability in how trials have been conducted that we cannot be sure if there will, or won’t, be lasting benefits for people doing this form of exercise intervention. It’s also not possible to make specific recommendations about the optimal design of flexibility exercise training protocols without a larger body of high‐quality studies with clearly outlined flexibility training protocols that meet the recommended FITT principles and ACSM guidelines. Such studies would greatly advance our understanding of the potential benefits and harms of this type of exercise.”

Friday, February 14, 2020

Cochrane seeks - Cochrane Information Specialist Support Team Member

Thu, 02/13/2020 - 11:28

Specifications: Part time (1 day per week), we anticipate this being a secondment from a Cochrane Group, but we will also consider suitably qualified independent consultants.
Salary: £35,000 FTE per annum, will be prorated for 1 day per week
Location: Remote
Application Closing Date: 09 March 2020 (Midnight GMT)

CIS Support Team members will provide both introductory and ongoing support and training to the CIS community in the areas related to Cochrane editorial processes, information technology, and study identification methods. Support and training will be guided by the needs of practicing CISs and current Cochrane policies and technology developments.

About the role
The postholder would be responsible for the following key accountabilities:

  • Provide new CISs with an introduction and orientation to processes, procedures, and policies related to the production of systematic reviews and Specialised Register maintenance.
  • Provide ongoing training and support to all CISs in using the Cochrane Register of Studies (CRS).
  • Provide established CISs with support for processes, procedures and policies related to the production of systematic reviews relevant to their role.
  • Provide help and support to all CISs in using Cochrane editorial tools, e.g. RevMan and Archie.
  • Develop programmes and materials to support the training and educational needs of CISs, including the management of CRG Specialised Registers within the CRS.
  • Maintain and update the CIS portal and the CIS user guide.
  • Identify and advocate for professional development opportunities for CISs within Cochrane.
  • Work with the Learning and Support Officer (Group Staff) to ensure training projects/support aligns with
  • CET initiatives and objectives.
  • Collaborate with learning team colleagues on development of learning and teaching materials.
  • Consult with IRMG for input on topical methodological issues.
  • Organise and/or co‐facilitate workshops and seminars relevant to the CIS community at Colloquia or regional conferences.
  • Assist the Learning and Support Officer (Group Staff) to ensure that reports on the activities of the CIS Support Team are prepared for Cochrane as required.
  • Maintain activity logs to assist in the assessment of the CIS Support Team programme.

About you
We are looking for a self-motivated and highly organised individual who is able to work effectively and collaboratively with a diverse range of contacts across the world. The successful candidates will also have:

  • Current or very recent experience of working as a CIS in a CRG, field or Centre, preferably for at least two years.
  • Library or information science qualification.
  • An understanding of information retrieval methodologies, particularly as they apply to the production of systematic reviews.
  • Experience of managing a Cochrane Review Group’s Specialised Register using the CRS.
  • Knowledge and/or experience of the core Cochrane review production infrastructure e.g. RevMan, Archie, Task Exchange, Cochrane Crowd, etc.
  • Experience in biomedical database searching, e.g. The Cochrane Library, MEDLINE, Embase, trial registries, etc.
  • Good written, verbal and presentation skills in English.
  • Organisational and time management skills.
  • Ability to work independently and in a self‐directed manner, and as part of a virtual team.
  • Flexibility and willingness to undertake national and international travel on occasion.

About us
Cochrane is a global, independent network of health practitioners, researchers, patient advocates and others, responding to the challenge of making vast amounts of research evidence useful for informing decisions about health. We do this by synthesizing research findings to produce the best available evidence on what can work, what might harm and where more research is needed. Our work is recognised as the international gold standard for high quality, trusted information.

If you would like to apply for this position, please send a CV along with a supporting statement to with “CIS Support Team Member” in the subject line.  The supporting statement should indicate why you are applying for the post, and how far you meet the requirements for the post outlined in the job description using specific examples.  List your experience, achievements, knowledge, personal qualities, and skills which you feel are relevant to the post.

  • For further information, please download the full job description from here
  • Deadline for applications: 09 March 2020 (12 midnight GMT)
  • Interviews to be held: Week commencing 16 March 2020
Thursday, February 13, 2020 Category: Jobs

Cochrane launches new Interactive Learning module on Health Equity

Wed, 02/12/2020 - 15:27

Cochrane is pleased to announce the release of a new, eleventh module of the Cochrane Interactive Learning course on Health equity in systematic reviews

In it, users will learn about health equity, which is the absence of avoidable and unfair differences in health outcomes among groups, and how and when health equity can be incorporated in all steps of the systematic review process. The module also addresses how health equity should be considered in planning aspects of knowledge translation.

Improving health equity is an important goal and is recognized as a priority by the WHO and many other international organizations. Systematic reviews that incorporate health equity can help policymakers assess how interventions work for different population groups. Cochrane is committed to promoting the consideration of health equity in evidence synthesis, and the new Cochrane Handbook for Systematic Reviews of Interventions has a full chapter dedicated to this subject.

Karla Soares-Weiser, Editor in Chief of the Cochrane Library, says of the module, “We are delighted to present this new module on health equity in systematic reviews. Cochrane fully supports the methods to incorporate health equity into our systematic reviews. We hope that Cochrane authors and the broader community will use this valuable resource to learn more about how we can consider health equity in evidence synthesis.”

The eleventh module of the Cochrane Interactive Learning Course was developed by a partnership between members of the Campbell and Cochrane Equity Methods Group, the Learning Team in Cochrane’s People Services Department and world-leading e-learning designers.

With this module, Cochrane continues our commitment to providing high quality, engaging, and innovative distance learning. Some Cochrane contributors and residents of HINARI countries may access the new module (and the entire Cochrane Interactive Learning course) for free, and subscription options are available for individuals and institutions. To find out more and access the new module, please visit this page.

Wednesday, February 12, 2020

Appointment of lead to independent advisory group

Wed, 02/12/2020 - 14:55

In October 2019, Cochrane announced its commitment to a full update the Cochrane Review Exercise therapy for chronic fatigue syndrome. The statement noted plans for: “a comprehensive review of the protocol, which will be developed in consultation with an independent advisory group that we intend to convene. This group will involve partners from patient-advocacy groups from different parts of the world who will help us to embed a patient-focused, contemporary perspective on the review question, methods and findings.”

Cochrane is now pleased to announce that Hilda Bastian has been appointed to lead the independent advisory group. Hilda has been a health consumer advocate and researcher, and has held many roles with healthcare bodies. She is also author of the popular PLoS blog “Absolutely Maybe”, which looks at the uncertainties in medicine, and reported on the contents and conduct of the Cochrane Review Exercise therapy for chronic fatigue syndrome. Her knowledge and understanding of myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS), and the methodology of systematic reviews, saw broad support for her blog posts from consumers and researchers alike.

Cochrane’s Editor-in-Chief, Dr Karla Soares-Weiser, said: “Hilda’s appointment marks the first steps in Cochrane’s commitment to update the Cochrane Review on exercise therapy for chronic fatigue syndrome. We look forward to learning from the process of involving an independent advisory group of patients, clinicians and researchers in the development of Cochrane Reviews.”

As lead of the independent advisory group, Hilda will be involved in the recruitment of members to the group, as well as facilitating group discussions and input. Hilda remarked on her new role: “It is wonderful to see this level of responsiveness to serious community concerns about a Cochrane review, and I am honoured to be involved. I look forward to learning more from the ME/CFS community and the advisory group, as well as working with the Cochrane editorial team.”

There will be further announcements as the independent advisory group, protocol and review update progress.

The independent advisory group can be contacted directly on When the independent advisory group finishes its work, the contents of this email account will be archived at Cochrane.

Thursday, February 13, 2020

Cochrane seeks - Associate Editor

Tue, 02/11/2020 - 10:43

Specifications: Full Time, permanent
Salary: c.£40,000 FTE per annum
Location: Flexible
Application Closing Date: 02 March 2020 (12 Midnight GMT)

Cochrane is seeking to appoint two full-time Associate Editors to increase the support for producing high quality reviews across its eight thematic Cochrane Review Group (CRG) Networks. The eight Networks of CRGs support the efficient and timely production of high-quality systematic reviews that address the research questions that are most important to decision makers.

The Networks are made up of between 5 and 9 CRGs, covering the areas of:

  • Abdomen and Endocrine;
  • Acute and Emergency Care;
  • Cancer;
  • Children and Families;
  • Circulation and Breathing;
  • Mental Health and Neuroscience;
  • Musculoskeletal, Ocular, Skin and Sensory; and
  • Public Health and Health Systems.

The Networks are led by eight Network Senior Editors, and currently supported by a team of four Associate Editors and eight Network Support Fellows (see for more information).

About the role

The two posts will provide support for the five main objectives identified in each Network strategic plan:

  • Supporting review production and capacity
  • Evaluating Network scope and prioritisation of topics
  • Fostering collaboration within the Network and with the wider Cochrane community
  • Supporting knowledge translation to increase the impact of Cochrane reviews
  • Ensuring accountability and sustainability of the Network

About you

We are looking for a self-motivated and highly organised individual who is able to work effectively and collaboratively with a diverse range of contacts across the world. The successful candidates will also have:

  • An understanding of the importance of systematic reviews to clinical decision making
  • Familiarity with Cochrane guidance and standards in the design, conduct, and reporting of systematic reviews, including MECIR and GRADE methods.
  • Knowledge and skills relevant to the systematic review process
  • Strong organization and prioritization skills
  • Past or present experience of providing technical editing for systematic reviews

The assignment of the new Associate Editors to Networks will be judged on their profile and skillset.

About us

Cochrane is a global, independent network of health practitioners, researchers, patient advocates and others, responding to the challenge of making vast amounts of research evidence useful for informing decisions about health. We do this by synthesizing research findings to produce the best available evidence on what can work, what might harm and where more research is needed. Our work is recognised as the international gold standard for high quality, trusted information.

If you would like to apply for this position, please send a CV along with a supporting statement to with “Associate Editor” in the subject line.  The supporting statement should indicate why you are applying for the post, and how far you meet the requirements for the post outlined in the job description using specific examples.  List your experience, achievements, knowledge, personal qualities, and skills which you feel are relevant to the post.

  • For further information, please download the full job description from here
  • Deadline for applications: (12 midnight GMT)
Tuesday, February 11, 2020 Category: Jobs

Special Collection: Coronavirus (2019-nCoV): evidence relevant to critical care

Tue, 02/11/2020 - 10:25

The 2019 Coronavirus outbreak was declared a global Public Health Emergency by the World Health Organization (WHO) on 30th January 2020.
The WHO is now working closely with global experts, governments and partners to rapidly expand scientific knowledge on this new virus, to track the spread and virulence of the virus, and to provide advice to countries and individuals on measures to protect health and prevent the spread of this outbreak.
Today Cochrane has released a Special Collection: Coronavirus (2019-nCoV): evidence relevant to critical care

This Cochrane Library Special Collection pulls together the Cochrane Reviews that are most relevant to the management of people hospitalized with severe acute respiratory infections. It features Cochrane Reviews from three Cochrane Groups who are part of the Acute and Emergency Care Network to inform health-decision making relevant to current WHO recommendations for the 2019 Coronavirus outbreak.
The collection will be reviewed as the situation changes to ensure ongoing relevance, and an additional collection of reviews addressing prevention and infection control measures will be developed separately.  

Picture credit: Stocktrek Images/Getty Images

Tuesday, February 11, 2020

Cochrane seeks - Office Manager

Thu, 02/06/2020 - 16:25

Specifications: Full Time, Permanent
Salary: £30,000 per annum
Location: London
Application Closing Date: Midnight 13th February 2020

This role is an exciting opportunity to use your experience in office management to make a difference in the field of health care research. 

Operating in a small, friendly office environment, we are looking for an Office Manager who can work independently in supporting the wider Cochrane team. You will undertake the administrative activities that facilitate the smooth running of the Cochrane office in London. You'll ensure the office environment and equipment is maintained to the appropriate quality and quantity, relevant records are up to date and retained appropriately and all administrative processes work effectively.

The successful candidate will also have:

  • Previous office/facilities management experience
  • Previous senior administration experience
  • Excellent organisational and prioritization skills; with a flexible approach as needs change
  • Ability to prioritise and manage own workload amid conflicting demands and busy work periods
  • Excellent interpersonal skills

Cochrane is a global, independent network of health practitioners, researchers, patient advocates and others, responding to the challenge of making vast amounts of research evidence useful for informing decisions about health. We do this by synthesizing research findings to produce the best available evidence on what can work, what might harm and where more research is needed. Our work is recognised as the international gold standard for high quality, trusted information.

If you would like to apply for this position, please send a CV along with a supporting statement to with “Office Manager” in the subject line.  The supporting statement should indicate why you are applying for the post, and how far you meet the requirements for the post outlined in the job description using specific examples.  List your experience, achievements, knowledge, personal qualities, and skills which you feel are relevant to the post.

  • For further information, please download the full job description from here
  • Deadline for applications: 13 February 2020 (12 midnight GMT)
  • Interviews to be held on week commencing 24 February

Thursday, February 6, 2020 Category: Jobs

Omega-3 fatty acids for the primary and secondary prevention of cardiovascular disease

Wed, 02/05/2020 - 17:38

In this interview with Dr. Lee Hooper we find out more about this new Cochrane review - Omega-3 fatty acids for the primary and secondary prevention of cardiovascular disease

Tell us about this Cochrane Review
There is a great deal of public belief in the cardiovascular benefits of omega-3 fats.  Intakes of long-chain omega-3 fats in the US are higher from dietary supplements than foods.  But public health advice differs across countries. The National Institute for Health and Clinical Excellence in the UK encourages people to eat oily fish intake (the major source of long-chain omega-3 fats) but discourages supplementation.  The American Heart Association in the US also recommends eating oily fish and suggests that supplements may also be needed.  We were interested in the evidence – are omega-3 fats protective, and how protective?  We assessed effects of long-chain omega-3 fats give as oily fish and as supplements, and we also assessed effects of alpha-linolenic acid (ALA, the shorter chain omega-3 found in plant oils) given as foods or supplements.

It is an update, what has changed (studies, inclusion of new trial, quality of these trials)
We ran this update because three very large trials of several years’ duration assessing effects of long-chain omega-3 supplements on cardiovascular outcomes were published in late 2018 and early 2019.  These boosted the numbers of people randomised into relevant trials for at least 12 months by over 30%, so had the potential to alter outcomes.  This update includes 86 RCTs (162,796 participants) that randomised participants to either long-chain omega-3 or ALA for at least one year and assessed mortality or some form of cardiovascular disease. Including more participants, some of whom experienced cardiovascular events, has given us more power to see any effects of omega-3 fats on cardiovascular health.
Of the 86 included trials 28 were at low summary risk of bias (high quality trials), most trials gave supplements, and 19 trials gave supplements of at least 3g/d long-chain omega-3.
The 2018 review provided good evidence that taking long-chain omega 3 does not benefit heart health, risk of stroke or death. Is this still the case?
As in the previous version of this review, meta-analysis suggested little or no effect of increasing long-chain omega-3 on all-cause mortality, cardiovascular mortality, cardiovascular events, stroke or arrhythmia.
However, the update suggested that increasing long-chain omega-3 may slightly reduce coronary heart disease mortality and coronary heart disease events. These effects were very small.  334 people would need to take more long-chain omega-3 for several years for one person to avoid dying of coronary heart disease, and 167 people would need to take more to avoid one person experiencing a coronary heart disease event.
We wondered whether the effects of long-chain omega-3 fats would be greater in longer trials, or in studies giving higher doses.  However, effects did not differ by trial duration or dose in pre-planned subgrouping or meta-regression.
Increasing long-chain omega-3 had little or no effect on serious adverse events, fatness, lipids or blood pressure, except increasing LCn3 reduced triglycerides by ~15% in a dose-dependent way.

How does this effect size, a Number Needed to Benefit (NNTB) of 167 or 334, compare with other medications used in cardiovascular disease prevention?
Simvastatin (a statin, or lipid-lowering medication) in secondary prevention: In the 4S trial, which enrolled people who had recently experienced myocardial infarction, 8% of the participants taking simvastatin died, and 12% of those taking the placebo died, a difference of 4%, so the NNTB was 25. Twenty-five people needed to take simvastatin for around five years to prevent one person dying. Most of us decide to take statins post-myocardial infarction.
Statins in primary prevention: The ten-year NNTBs for statins in primary prevention when used according to appropriate guidance are around 30.  Thirty people need to take a statin for around 10 years so that one person does not experience atherosclerotic cardiovascular disease.
Ezetimibe (a cholesterol absorption inhibitor) in secondary prevention: If 50 people with acute coronary syndrome take ezetimibe in addition to statin for seven years one person will avoid a cardiovascular event.
These are the numbers that we associate with effective drugs – NNTBs of 25 to 50.  Many more people need to take a long-chain omega-3 supplement to prevent a single coronary heart disease event or death.  Long-chain omega-3 fats are much less effective than these drugs (with NNTBs of 167 or 334), and almost all the people who take the supplements will not gain from them.
Have the conclusions changed around oily fish? Is it protective of our hearts?
Sadly, we didn’t find any additional trials that increased the amount of oily fish that participants ate.  That means that we still don’t fully understand the effects of eating more oily fish on cardiovascular health.  Fish and seafood are nutrient-dense and rich in a variety of other nutrients (such as vitamin D, calcium, iodine, selenium, protein) so are useful foods even without cardiovascular benefits.
What are the effects of the vegetarian /vegan version of omega-3, ALA?
Increasing ALA intake probably makes little or no difference to all-cause mortality, cardiovascular mortality, coronary heart disease mortality and coronary heart disease events. However, increased ALA may slightly reduce risk of cardiovascular disease events and arrhythmia.  Again, these effects are small: 500 people would need to increase their ALA intake for several years to prevent one person experiencing a CVD event, and 91 people would need to increase ALA to prevent one person experiencing arrhythmia.
Are there plans to update this review again soon?
The review will need to be updated once further large and high-quality trials of eating oily fish and/or increasing ALA intake are available.  We hope that is soon. There are no further very large trials of long-chain omega-3 supplements underway that will trigger update automatically, though some large trials may make further outcome data available.

Monday, March 2, 2020

Cochrane seeks - Plain Language Summary Science Writer

Tue, 02/04/2020 - 16:26

Specifications: Full or Part Time considered
Salary: £38,000 FTE per annum
Location: Flexible
Application Closing Date: 27th February 2020

This role is an exciting opportunity to use your writing experience to make a difference in the field of health care research. 

This new role within Cochrane will be responsible for producing Plain Language Summaries (PLS), a vitally important part of our systematic reviews, which provides an easy-to-understand summary of the key information provided in our reviews; improving the accessibility, readability and understanding of Cochrane evidence.

We are looking for a self-motivated and highly organised individual with excellent written communication skills.  Alongside the ability to manage projects and work collaboratively with a diverse range of contracts, the successful candidate will also have:

  • Experience working within a professional science or health-writing/editing environment, or in journalism and/or in a similar role.
  • Familiarity with Cochrane guidance and standards on the design, conduct, and reporting of systematic reviews, including MECIR and GRADE methods.
  • Ability to explain complex material to a non-expert audience, including summarizing data accurately and producing reports on systematic review outcomes.

Cochrane is a global, independent network of health practitioners, researchers, patient advocates and others, responding to the challenge of making vast amounts of research evidence useful for informing decisions about health. We do this by synthesizing research findings to produce the best available evidence on what can work, what might harm and where more research is needed. Our work is recognised as the international gold standard for high quality, trusted information.

If you would like to apply for this position, please send a CV along with a supporting statement to with Plain Language Summary Writer in the subject line.  The supporting statement should indicate why you are applying for the post, and how far you meet the requirements for the post outlined in the job description using specific examples.  List your experience, achievements, knowledge, personal qualities, and skills which you feel are relevant to the post.

  • For further information, please download the full job description from here.
  • Deadline for applications: 27th February 2020 (12 midnight GMT)
  • Interviews to be held from 12th March onwards
Tuesday, February 4, 2020 Category: Jobs

Winner of Thomas C Chalmers Award 2019 for Best Poster Presentation - Rui Wang

Tue, 02/04/2020 - 13:42

The Thomas C Chalmers MD Award Committee 2019 wishes to extend its congratulations to this year’s winner for best Poster presentation, Rui Wang.

2019 Poster presentation winner - Rui Wang 

Froeks Kamminga, Methods Liaison Officer in the Editorial and Methods Department, caught up with best Poster presentation winner Rui Wang to find out a little more about him and ask what winning the award meant to him.

Rui is a research fellow from the Department of Obstetrics and Gynaecology, School of Clinical Sciences at Monash University in Melbourne, Australia. He works as a methodologist in the Evidence-based Women’ Health Care Research Group. He started his career as a gynaecologist and subsequently undertook training in epidemiology and shifted his career into clinical research and research methodology. He was awarded a PhD on evidence synthesis in November 2019. His methodology interests are randomised controlled trials and evidence synthesis methods, while his main clinical research interest is women’s health.

Why did you enter the competition?
You may agree with me that research on methodology seems to be less acknowledged and more difficult to engage the audience than clinical research. I think this competition is an excellent opportunity for all early career researchers to share their research on methodology and engage with a wider community. By entering the competition, I’m also committed to do my best to prepare my presentation.

What does the award mean to you personally?
I regard Thomas Chalmers as an inspiring pioneer in evidence-based medicine and consider it a great honour to receive the award named after him, also on behalf of my co-authors. I am motivated to continue my research to improve research quality in evidence-based medicine. It was not just his work that got me the award, and I thank my co-authors, especially Lene Seidler from the University of Sydney, for their help for preparing the presentation.

What impact has the award had on your work?
This was the first time I attended the Cochrane Colloquium, but I felt very welcomed by the community. I am grateful for all the congratulatory messages from old and new friends on social media, by email or in person, and I have also received some great suggestions and feedback on my presentation from the Cochrane community, despite it being a virtual colloquium. I really appreciate the opportunity to network and establish future collaborations. I would like to thank the Cochrane team, especially the Cochrane Chile team, for their efforts to organise such an amazing virtual event.

What advice have you got for researchers considering entering for the award in 2020:
There was a famous quote “A conference poster should be readable in 3 minutes, from 3 metres away, after 3 beers.” I think the idea is that delivering a clear and concise message is important for poster presentations, as in most cases a reader would have to spend maybe less than 1 minute on a poster. Therefore, it would be worth highlighting the key message by visualising the data so that the audience can be easily engaged during the presentation. We should also embrace diversity in poster designs and therefore you may get inspired by the #betterposter design. All the best!

You can find Rui's Poster here:

 "Reporting of Cochrane systematic review protocols with network meta-analyses – a scoping review"

For further information on other prizes which are awarded at the Colloquium, please visit

Tuesday, February 4, 2020

Living Systematic Review: Interventions for increasing fruit and vegetable consumption in children aged five years and under

Tue, 02/04/2020 - 10:51

In this interview we ask Rebecca Hodder from the National Health and Medical Research Centre Early Career Research Fellow, the University of Newcastle, Australia and Nicole Martin, Managing Editor, Cochrane Heart, University College London, London, UK to tell us more about this Living Systematic Review, which looks at increasing fruit and vegetable consumption in children under five years old.

Why was this review selected to be a Living Systematic Review (LSR) originally, was it in response to a target audience need?

Rebecca: The original review was initiated by the author team, who are embedded within the Hunter New England Local Health District, to inform the delivery of healthy eating health promotion services to children. The original review identified 5 studies and little evidence of effectiveness to inform what interventions could be implemented within the Local Health District to increase the fruit and vegetable consumption of young children.

For the first update of this review, the number of studies had substantially increased from 5 to 50 studies and it was during this update that we were approached to participate in a pilot study to maintain our review as an LSR.

Our review was considered appropriate for an LSR, given it met three key criteria:

First, the review question was considered a priority for decision making. There is a growing burden of disease internationally as a result of inadequate fruit and vegetable consumption, we know that childhood is a critical period during which lifelong healthy eating behaviours are established, and evidence from this review has the potential to inform international childhood obesity prevention interventions (as well as those within our Local Health District).   

Second, the quality of the evidence for each of the comparisons from the original review was assessed as very low. This indicated there was a lack of certainty in the evidence and the results and the conclusions of the review were likely to change with the addition of new studies, if any were identified.

Third, on the basis of the identification of 45 new studies and a further 5 ongoing studies since the publication of the original review, there was new research evidence available that may change the conclusions and recommendations.

The current review update was published in November 2019. It includes 78 studies with a further 16 ongoing studies yet to be synthesised, and the quality of evidence for comparisons range from very low to moderate quality evidence. As a result it remains appropriate for an LSR and we will continued to maintain it as an LSR.

Nicole: This review meets the three criteria that make it appropriate for a review to be living (according to the Cochrane LSR Methods Guidance):

  • The topic is a priority for decision making
  • There is uncertainty in the existing evidence base
  • Emerging evidence that may impact on the conclusions 

This review has applied living systematic review methods since September 2017. Since then monthly searches are being run and screened and three subsequent updates were published – in January 2018, May 2018 and November 2019.

The increase in included and ongoing studies over time shows that this is a very active research area. The large disease burden based on insufficient consumption of fruit and vegetables means there is a need to incorporate new evidence when it emerges to adequately inform policy makers and the public.

Is the review in partnership with any other organisations?

Rebecca: Whilst the review is not explicitly conducted in partnership with other organisations, the author team hold positions or affiliations with the University of Newcastle, Hunter New England Local Health District and Hunter Medical Research Institute (Australia.)  Author roles within Hunter New England Local Health District include delivering health promotion services, including those focused on healthy eating, to children via various settings including childcare services, hospitals and community health. Our LSR provides current evidence regarding which interventions are most likely to be effective for improving child heathy eating which can then be implemented within the Local Health District.

What does the review tell us?

Rebecca: Despite the large number of studies that have been conducted, now 78 in total, there is still limited evidence regarding effective ways to increase the fruit and vegetable consumption of young children. Of the types of approaches that have been investigated, multicomponent interventions (e.g. those that combine parent nutrition education with preschool nutrition policy changes), seem to have the most promise. The review found that multicomponent programs probably increase fruit and vegetable intake by children (by 0.36 cups per day) based on the moderate quality of the evidence from 14 studies. The review also found child feeding interventions may increase, and it was uncertain whether parent nutrition education interventions alone increased, child fruit and vegetable consumption.

How is working on/updating an LSR different to a ‘normal’ Cochrane review update, does this present any challenges/opportunities?

Rebecca: The main differences between maintaining an LSR and conducting a ‘normal’ Cochrane review update is the frequency of searching for and synthesising data from new studies.

For an LSR, database searches, screening of identified records, and data extraction from eligible studies are conducted on a monthly basis. Data from newly identified studies are then incorporated into the existing review; results and conclusions are updated; and the review update re-published. For our LSR we aim to re-publish the review every 3-4 months.

The main challenge of LSRs for an author team, is the ongoing availability of authors to undertake the required monthly and other tasks within a short time frame, and often concurrently. Early on we identified a team of authors that had expertise in child nutrition, the conduct of systematic reviews and ongoing capacity to contribute to our LSR. For the most part we have maintained this team of authors since the inception of our LSR. Additionally, we have used a number of tech-enablers to reduce the workload for authors during the screening stage, including a machine learning classifier of randomised controlled trials and Cochrane Crowd, which combined have more than halved the number of studies to be screened.

The RCT classifier (available in the CRE-Web) identifies which records from a database search are most likely to be RCTs (10-100% likely to be an RCT) and which are not (0-9% likely to be an RCT). For our LSR, those records likely to be RCTs were then screened by the author team against all review eligibility criteria, whereas those unlikely to be RCTs were sent to Cochrane Crowd to be screened. Any records identified as RCTs by Cochrane Crowd members were sent back to the author team to be screened.

Other key enablers for the conduct of LSRs includes the support and strong partnership with your Cochrane editorial team and access to LSR expertise. For our LSR, the Cochrane Heart Group have conducted the monthly database searches and facilitated an expedited timeline for editorial review and publication which has made our LSR possible. We have also had ongoing guidance and advice from many experienced members of the LSR Support team formed as part of Project Transform regarding the conduct of LSRs.

Our LSR provides an opportunity to generate the most up to date evidence for practitioners and policy-makers and inform international efforts to improve the dietary intake of young children. We are also currently investigating some other opportunities, including ways our LSR can be linked with child nutrition guidelines, and also partnering with health policy-makers to ensure the research evidence generated by our LSR is translated into policy and can achieve population wide benefits. There are also a number of other tech-enablers available or in development to assist with LSRs both within and beyond Cochrane, including Screen4Me.

Nicole: From an editorial prospective, the main challenge an LSR presents relates to time.

Our team’s Information Specialist works on compiling the latest search results on a monthly basis. While some of this is covered by search alerts, other databases have to be searched afresh each time. Deduplication of records against each month’s yield as well as all previously retrieved records also takes time. The numbers of search results to manage each month are relatively small, but the frequency of this task can be a challenge.

The time for the editorial review of LSR updates is much reduced compared to our usual processes. This requires careful planning and for everyone involved to be committed to very quick turn-around times - the editorial team, peer reviewers, editors, copy editors, sign-off editor and review authors.

For the latest update published on 7 November 2019 the first draft of the review update was submitted to us on 3 October 2019. Within just over a month, comments from everyone mentioned above were obtained and the authors addressed those in two separate rounds of revisions.

This highlights another prerequisite for an LSR – a high quality of the initial submission.

Some specific aspects are slightly different to the usual review process. We aim to involve peer reviewers repeatedly for LSR update cycles as familiarity with the review contents is thought to support a quicker response time. This was done for the publications in January and May 2018 and we aim to apply this again, with a new set of peer reviewers, to this current round of publications in November 2019 and the subsequent two during the first half of 2020.

A similar principle applies to copy editing in that the same copy editor looks at only those elements of the review that have changed compared to the previously published version.

How often will the LSR be updated?

Rebecca: During 2020 we will continue to maintain our review as an LSR. This involve ongoing monthly searches and identification of new studies, and re-publication of the review every 3-4 months. The ‘What’s new’ section of the review is updated every month to indicate how many new studies have been identified to date that will be synthesised in the next review update.

Tuesday, February 11, 2020

Toronto Colloquium - Early registration open

Mon, 02/03/2020 - 17:52
Register before the 2 July 2020 to receive the reduced early bird rate

The 2020 Cochrane Colloquium will be held at The Westin Harbour Castle in Toronto, Canada on the October 4-7, 2020. 

This year’s theme is ‘Rapid-learning Health Systems’, exploring approaches to improving people’s experiences and health outcomes while keeping costs manageable and health care stakeholders engaged. Rapid-learning health systems apply to all levels of health care (from clinical encounter to program, organization and system) and across all parts (from home care to primary and specialty care and public health). The Colloquium will also address the role of technology in achieving Rapid-learning health systems. More information on the theme can be found here.

To ensure that all levels of health care decision-makers feel welcome and included, we were recently excited to announce that this year’s Colloquium, will now become a Patients Included Accredited Event. The choice to make the 2020 Colloquium a Patients Included event also furthers some of the key goals identified in Cochrane’s Strategy to 2020. As Cochrane prepares a new organizational strategy beyond 2020, Cochrane Canada and the 2020 Colloquium will play a key role in launching the next phase of Cochrane’s future growth and sustainability plans. This includes continuing to bring together stakeholders under the common goal of creating better health outcomes for patients.

See how the Toronto Colloquium will meet the 5 charter criteria here.

Further information:

Twitter:  @CochraneCanada and #CochraneToronto

Monday, February 3, 2020