As many across the Cochrane community may be aware, Professor Chris Del Mar, Co-ordinating Editor of Cochrane Acute Respiratory Infections and long-time Cochrane contributor, was involved in a serious surfing accident earlier this year. During one of his regular early morning surfing sessions on Australia’s Gold Coast, Chris sustained a very high level spinal cord injury and as a result, spent over three months in intensive care. 
 
In recent months Chris has moved to the Brisbane hospital’s spinal injury rehabilitation unit. Arrangements are now being made for home modifications and purchase and installation of equipment that will enable Chris to return home and participate in daily life. Some of the priorities include a hospital bed, power wheelchair, a wheelchair-accessible vehicle, and specialized communication devices.

Despite everything he has been through in recent months, Chris is continuing to do some work. His PhD students and research colleagues visit him at his hospital bedside to discuss projects and papers and Chris plans to return to work next year aided by a wheelchair and voice- or eye-activated computers and other devices. ‘Chris is a very inspiring man and very brave,’ says his wife and fellow Cochrane contributor Professor Tammy Hoffmann. ‘It’s taking a ton of courage to get through this situation.’
 
Concerned friends, colleagues and organizations from around the world have been reaching out to support Chris since his accident, and many have asked how they can best help. Some colleagues have now set up a crowdfunding campaign to make Chris’s home wheelchair-accessible. It is also hoped the funds will enable the purchase of other assistive equipment that he needs, including the specialized computers and input devices needed for him to continue working. If you’d like to support Chris and his family, this recent update on his progress contains links to further information.

• https://www.gofundme.com/f/85svf-help-get-chris-home

Tuesday, August 13, 2019

Cochrane are signing a collaboration licence agreement with NICE, the National Institute for Health and Care Excellence, the UK government’s guideline organization. Cochrane has a long-established relationship with the NHS and the National Institute for Health research (NIHR), and Cochrane Reviews are already used to inform NICE guidelines. The agreement seeks to make this sharing of Cochrane evidence for use in NICE guidelines easier and more efficient.

Toby Lasserson, Cochrane’s Deputy Editor in Chief, and Gill Leng, Chief Executive Officer, NICE, sat down with us to explain more about the agreement and its impact.

Can you tell us about the collaboration agreement between Cochrane and NICE?
Gill: The agreement between Cochrane and NICE is a collaborative one which will allow both organisations to share the latest evidence more quickly and efficiently. The agreement will help NICE specifically in achieving faster and more flexible ways of working when it comes to developing our guideline recommendations by using high quality, relevant Cochrane systematic reviews. Cochranes systematic reviews have a well-established reputation for producing high quality reviews of evidence. NICE will be able to utilise those reviews to ensure we are making new recommendations or updating existing recommendations more quickly when new evidence comes to light.

Toby: Over the last few years Cochrane Review Groups have been approached by NICE guideline committees with a view to prioritising and producing reviews to support the guideline process. This has led to some high priority Cochrane Reviews being used in guidelines for lung disease and preventing falls. It can be hard to coordinate timely production of reviews with the guideline development process. Sharing results of reviews before publication in the Cochrane Library has helped to reduce some of the time pressure.

For Cochrane there’s been understandable concern about sharing unpublished reviews because they have not been subject to complete editorial and peer review processes. However, it’s important to remember that most guideline committees are used to drawing on systematic reviews that have not yet been peer reviewed or formally published. They also tend to focus on results and GRADE tables, whereas Cochrane will see these as constituent parts of the published review. We should acknowledge that the licence is only a mechanism that outlines the terms of sharing results from reviews in advance of publication. There is a lot to be gained from effective dialogue and engagement between guideline developers and review teams as early as possible.

What does this mean, in practice, for sharing evidence between the two organisations? Why is it important?
Gill: Sharing evidence is going to add a much more flexible and efficient way of working for NICE. The world of healthcare is changing at a rapid pace, and we all need to respond and move with it. Advancements in healthcare and innovative practices really are coming thick and fast, and by working together to share the evidence we have built up, NICE and Cochrane can maintain robust procedures to assess clinical and cost-effectiveness while keeping up with the pace of change around us. That is something we know is expected of us on a political level, but more important than that, the people working within and who use our health services expect us to do that.

Toby: It means that there is a formal process for people preparing reviews for publication in the Cochrane Library to share their findings with NICE guideline developers ahead of publication. We needed an agreement that did not change the terms of the licence for publication that Cochrane author teams sign when they publish with us. There were plenty of technical discussions between us, but thanks to Christie Redley and Beth Collins in the contracts team in Cochrane and Ian Moir at NICE we’ve got the balance of rights in place.

It’s important to recognise that the licence does not change some hard-edged difficulties that delivering reviews to inform guideline development can bring. People involved in the preparation of these reviews will not always be funded directly to do this,  and, as we saw last year there is always a balance between rigour and speed. There’s a widespread recognition that there is not always a good alignment between questions of interest to guideline developers with those of Cochrane Reviews. The commissioning brief might necessitate the collection of data for other outcomes than those prespecified, and that can be hard to work into the review that’s already been developed to a published protocol.

Establishing engagement between guideline development teams and review teams is an important part of identifying what’s feasible. In that regard the licence is less important than the principle of collaborative working.

What will the impact of this agreement be for putting Cochrane evidence into practice via NICE guidelines?
Toby: Actively supporting the process of delivering reviews for NICE guidelines in this way means that we can get the findings of our reviews in to the process of developing practice recommendations for the NHS. This ensures we are better placed to inform decisions through the guidance of a respected public body.

Sharing evidence with NICE is part of a broader approach to help Cochrane to identify priority reviews, and to identify them early. Some of the key decisions around initiating updates of Cochrane Reviews are about the question that they address. This will inevitably mean carefully re-evaluating the population, intervention, comparison and outcomes in our reviews. Whilst review questions change over time, delivering reviews that our stakeholders need from us will always be a fundamental good we can offer.

Who will benefit from this agreement?
Gill: By using the expertise we have at both NICE and Cochrane, we will ultimately be able to provide recommendations which react to and utilise the very latest scientific evidence. That’s going to have a tangible impact for clinicians working on the front line in the health service as they will be able to access NICE guidelines faster which will ultimately lead to better health outcomes for those who need it most.

Toby: This helps NICE, Cochrane Review Groups and authors. NICE will get the findings of a Cochrane Review to use in their deliberations, Cochrane groups will be able to demonstrate responsiveness in supporting production of high priority reviews, and for authors it guarantees impact. The ultimate beneficiaries will be people who need evidence to make decisions about their health or that of someone else.

What other work is being done to align research priorities between Cochrane and NICE? How has the pandemic affected this work?
Gill: The COVID-19 pandemic has made the last 15 months incredibly difficult for everyone working in the health service. However, one of the things we all need to take away from this period is the way organisations have built on existing collaborative and effective working relationships to deliver the best outcomes for patients despite the pandemic. NICE and Cochrane have been no different, and the work we have done together before and during the pandemic can now be built on by this agreement and help inform NICE’s recommendations across our guideline portfolio.

NICE is currently prioritising its large guideline portfolio (over 300 guidelines with 20,000 recommendations) to ensure that it focuses on areas where it is best placed to use our skills to add value.This means that we will be prioritising specific areas from within guidelines for surveillance and updating activity.

Following prioritisation of the NICE Guideline portfolio, NICE has committed to working with Cochrane, the UK Cochrane Centre and individual Cochrane Review Groups to identify relevant reviews that may inform the surveillance, development or update of high priority guideline recommendations. Dedicated technical resource will be recruited by NICE to work with Cochrane to develop and implement processes for aligning where feasible, reviewing and guideline development activities to ensure efficient, sustainable processes going forward.

Our experience from developing and maintaining rapid reviews and guidelines in response to the COVID pandemic has revealed how resource intensive a living approach to evidence reviewing and guideline development can be. The pandemic also emphasised the importance of collaborative approaches to ensuring scalability and sustainability of living approaches and the NICE Cochrane collaborative agreement is an important step toward realising this vision.

How will the partnership between Cochrane and NICE advance each organisation’s strategic goals?
Gill: In March 2021, NICE published our new 5-year strategy. One of the main commitments within the new direction was to provide dynamic, living guideline recommendations that are useful, useable and rapidly updated. Those guidelines will incorporate the latest evidence and newly recommended technologies to maximise uptake and access for patients. Cochrane has a well-established reputation for providing high quality systematic reviews of the latest evidence, and already works closely with the NHS, so a formal partnership which gives NICE access to the expertise that Cochrane has really made sense. That’s not just so we can tick a box and say we’re delivering on our strategic goals though; it’s going to have a real benefits for a wide range of stakeholders.

Toby: Cochrane has always recognised the importance of the evidence it produces for guideline development, and our reviews are flagged in this way on the Cochrane Library. It also means that we know we are producing high priority reviews for stakeholders.  

Cochrane’s vision is a world of better health transformed by evidence. Knowing what questions are most important to end users of our evidence helps us to achieve that.

• Learn more about Cochrane's partnerships
• Visit the NICE website

Wednesday, September 1, 2021

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.

Cochrane is an incredible community of people who all play their part in improving health and healthcare globally. We believe that by putting trusted evidence at the heart of health decisions we can achieve a world of improved health for all. 

Many of our contributors are young people working with Cochrane as researchers, citizen scientists, medical students, and volunteer language translators and we want to recognize the work of this generation of contributors as part of this series called, Cochrane’s “30 under 30." 

In this series, we will interview 30 young people, 30 years old or younger who are contributing to Cochrane activities in a range of ways, all promoting evidence-informed health decision making across the world. 

We will be hearing from them in a series of interviewees published over the coming months.

The Cochrane 30 Under 30 series is now closed. However, we are keen to hear from early career professionals about their work with Cochrane for future series. If you would like to be added to our waitlist, please conact lparsonson@cochrane.org. Or if you want to know more about Cochrane's work contact membership@cochrane.org where our community support team will be happy to answer your questions.

Name: Soodabeh Behboodi
Age: 25
Occupation: Dentist and Clinical Lecturer
Program: Author & Peer Reviewer at Cochrane Oral Health Group

How did you first hear about Cochrane?
In 2012, Iranian Evidence-Based Center held a Cochrane workshop, then I decided that I want to be a clinician who applies trusted up to date evidence in her daily practice and I decided to join Cochrane family.

It didn’t take much reading to realise the importance of Cochrane’s work. So, when the opportunity presented itself, I was keen to work for an organization whose mission – of generating reliable health information which is free from commercial sponsorship – I respect. 

How did you become involved with Cochrane? What is your background?
I filled the 'Getting Involved' form and as I had a presentation titled "Low level laser therapy in orthodontics" for a study club which was awarded as best presentation, I chose Laser as my interested field. Now I am an active member in Oral Health Group of Cochrane and I am participating as Peer reviewer and Author in a Cochrane systematic review titled "Laser therapy for dentine hypersensitivity".

What do you do in Cochrane?
I am involved in updating a Cochrane systematic review titled "Laser therapy for dentine hypersensitivity".

What specifically do you enjoy about working for Cochrane and what have you learnt?
I have developed a passion for practicing evidence based and getting to know Cochrane and using its trainings enabled me to critically appraise the evidence which would lead to make better decision in treatment planning.

What are your future plans?
I am a Clinical Lecturer in Azad University of Tabriz as well as the supervisor of a research team. I want to give the same chance for my students who are at the start of their career, to get to know Cochrane and be able to critically appraise the evidence to apply for their first patients.

In your personal experience, what one thing could Cochrane do better to improve its global profile?
In my opinion, Cochrane is an interconnecting subsets, working as a whole system, in which each region's activity could affect system. In my region, there is a great potential of passionate participants which could contribute to Cochrane, if they have opportunity by getting introduced to Cochrane which could be beneficial for Cochrane and health system. In my region expanding Cochrane credentialed trainings would be of great help in this regard.

What do you hope for Cochrane for the future?
I hope for Cochrane to make links with clinics to assess the obstacles clinicians face in implementing the recommended evidence. This could help decision-making clinicians, guideline developers, which is along with Cochrane's slogan: Trusted evidence, Informed decisions, Better health.

How important is it that young people get involved in Cochrane? Why is this, do you think?
I face many of them in university and I think they have time, which could be managed to be used for Cochrane under supervision of a professional if they get to know the system, because clinicians come up with good questions and ideas during their daily practice but they don’t have enough time to pursue them. If Cochrane could make a system for youngsters to get involved under supervision this could be beneficial for individuals and Cochrane.

Providing better health which is Cochrane's aim is only possible if many participants contribute according to their abilities and conditions. This contribution will be of great help for the healthcare network of each region.

What would your message be to other young people who want to get involved with Cochrane’s work but not sure where to start….?
I want to say this for your readers who are just having a glance, I think they are convinced that evidence based practicing is the future of medical industry, I recommend they get more training with Cochrane's extensive online training programs. Also, I want to outline that donating their time to this system will have a great impact for the healthcare network in the society they're living.

 

Monday, August 12, 2019

Closing Date: Wednesday, 4th September 2019

Salary: £30395 to £39609 per annum pro-rata depending on skills and experience.

Contact type: Maternity leave cover - fixed-term, part-time. Maximum 27 hours – minimum 18.5 hours per week.

A short-term opportunity (to provide maternity leave cover) has arisen for a Systematic Review Methodologist to join the Cochrane Skin team at its editorial base within the Centre of Evidence Based Dermatology (CEBD), School of Medicine, University of Nottingham. CEBD has an international reputation for independent research into the prevention and treatment of skin disease with a focus on delivering independent clinical research that informs the NHS.

Cochrane Skin (CS) is part of the international Cochrane organisation, and is the editorial base for the preparation and dissemination of Cochrane systematic reviews on the treatment and prevention of skin diseases. It is one of 62 Cochrane review groups worldwide which contribute to Cochrane, and this busy editorial base currently has around 40 review teams preparing protocols or reviews for publication or updating published reviews; please see skin.cochrane.org for more information. In providing maternity leave cover for the Cochrane Systematic Review Methodologist, you will lead on giving support and guidance on all methodological aspects of CS systematic reviews. You will be responsible for working with review teams at all stages of the review-writing and editorial process (from title registration to review publication), and will ensure that relevant methodological procedures are adhered to.

We are seeking an individual with proven knowledge and experience of involvement in systematic review methods e.g. by being the lead author of quality systematic reviews. You should possess a good understanding of statistical and research methodology, including knowledge of the relevant statistical techniques used in meta-analysis along with an ability to critically appraise systematic review methodology with attention to detail. Excellent verbal and written communication skills, including the ability to communicate with clarity on complex and conceptual ideas to those with limited knowledge and understanding as well as to peers, are also essential. We particularly welcome applications from candidates with knowledge of Cochrane systematic review methodology. 

This is a part-time post (maximum 27 hours – minimum 18.5 hours per week – please state your preference on your application) and will be offered on a fixed-term contract until 31 July 2020.

• Learn more about this position and apply

 

Friday, August 9, 2019 Category: Jobs

Recent developments allow surgeons to do operations remotely by guiding mechanical arms, rather than needing to be next to the patient. This is called robot-assisted surgery and the Cochrane Review of its use in gynaecological surgery was updated in October 2018. Theresa Lawrie from the Cochrane Gynaecology, Neuro-oncology and Orphan Cancer Group based in Bath in the UK, tells us the latest.

Robot-assisted surgery is used in several countries for gynaecological surgery, particularly for removing the uterus, known as a hysterectomy, and also for other procedures including removal of uterine fibroids, restoring fertility, and repairing vaginal vault prolapse. This last procedure is known as sacrocolopexy. The approach has also been used for the treatment of women with endometrial and cervical cancers.

However, robot-assisted surgery is controversial because of the significant commercial interests involved and because the potential benefits and harms over standard surgical approaches have not been clearly established. Unfortunately, despite our updating of the previous version of this review, which was published in 2014, we’re still not able to fully resolve the uncertainties. Much of the evidence remains low quality, and we cannot be sure whether there is a difference between robot-assisted and conventional laparoscopic, or keyhole, surgery in overall complication rates and other outcomes for the patients.

We now include 12 randomised trials, involving just over a thousand women. Eight studies compared robot-assisted surgery with conventional surgical approaches for hysterectomy, three looked at sacrocolpopexy and the last examined surgical treatment for endometriosis. Among studies of women undergoing hysterectomy, two involved women with endometrial cancer while the others involved women with benign conditions.

For hysterectomies, when robot-assisted and conventional laparascopic surgery were compared, we could not be sure whether there was a difference in complication rates during or after the operation, for either benign disease or cancer. Two studies did show that robot-assisted operations took about 40 minutes longer than conventional approaches, but hospital stays were slightly shorter. However, the evidence for these findings was of very low certainty, partly because of the high risk of bias in the trials. One study compared robot-assisted surgery with open abdominal surgery for hysterectomy; but it was too small, with just 20 women, to be able to detect any possible differences between the two techniques.

For sacrocolpopexy, limited data from three studies suggest that, overall, there may be little or no difference in the rate of complications during the operation between robot-assisted and conventional surgery. However, low-certainty evidence from a single study suggests that post-operative complications might be higher with robot-assisted techniques. With regard to operating time, robot-assisted surgery for sacrocolpopexy might be associated with longer operations than conventional surgery, but the duration of hospital stay was similar for the two procedures.

Finally, the one study of robot-assisted versus conventional surgery for endometriosis, was, once again, too small to show potential differences between these surgical approaches.

In conclusion, low-certainty evidence for hysterectomy and sacrocolpopexy operations suggests that complication rates for robot-assisted surgery might be similar to those for conventional laparoscopic surgery. Things are more uncertain for gynaecological cancer, where we found no comparative evidence on cancer recurrence or survival after the surgery. As robot-assisted surgery depends on the skill and experience of the surgeon and is expensive, evaluating its effectiveness and safety continues to present a challenge; but this needs to be met if we are to have reliable evidence on its potential benefits and harms.

• Read the Cochrane Review
• Listen to more Cochrane Podcasts
• Get Cochrane Podcasts on iTunes
• Visit the Cochrane Gynaecological, Neuro‐oncology and Orphan Cancer Group Website

Friday, August 9, 2019

A series of papers highlighting innovative work carried out by the Cochrane Effective Practice and Organisation of Care Group and the World Health Organization on using reviews of qualitative research in guideline development processes has been published in Health Research Policy and Systems.

Cochrane is a non-governmental organization in official relations with WHO. The Cochrane Effective Practice and Organisation of Care (EPOC) Group, as well as other Cochrane contributors, has a long-standing relationship with WHO and works closely with them on guideline development. This fruitful collaboration had led to several innovations, such as the inclusion of qualitative evidence syntheses in WHO guideline processes and the development of GRADE-CERQual, an approach to assess the confidence of evidence from reviews of qualitative research.

EPOC produced Cochrane’s first qualitative evidence synthesis review, Barriers and facilitators to the implementation of lay health worker programmes to improve access to maternal and child health, in 2013. This review was used in a WHO guideline on health worker task shifting, providing the panel with important information about the acceptability and feasibility of lay health worker programmes and complementing another review that focused on the effectiveness of these programmes.

Since then, WHO and Cochrane EPOC have continued to collaborate. Several WHO guidelines now include evidence from Cochrane qualitative evidence syntheses, and Cochrane EPOC is working closely with WHO to improve methods for this approach.  

Now, a series of papers detailing this work has been published in Health Research Policy and Systems. The articles were commissioned by WHO in response to requests for direction on how to use qualitative evidence syntheses in guidelines and were authored by a team from WHO, Cochrane staff at the Norwegian Public Health Institute and the University of Central Lancashire.

Evidence-based guidelines, such as those produced by WHO, have traditionally focused on quantitative evidence from reviews of effectiveness. However, guideline panels also discuss issues such as the cost, acceptability and feasibility of an intervention and its potential implications for equity – though this has often been done in an unsystematic way. Reviews of qualitative research can help look at these more systematically.

The three new articles, each led by a different Cochrane EPOC editor, highlight different ways that using qualitative evidence synthesis can benefit guideline development.

“The papers discuss how qualitative evidence syntheses can be a powerful means of improving the relevance of guidelines, how they can help to integrate the views and experiences of all types of stakeholders – including groups who may not be otherwise represented in the decision-making process – and how they are also a useful source of information for implementation,” explains Claire Glenton, a Cochrane EPOC editor who led one of the papers. “They also highlight a number of issues for further development.”

The series showcases several Cochrane qualitative evidence syntheses and offers practical advice to others who want to include this type of evidence in guidelines, providing examples of what was done well, and the lessons learnt. The authors also highlight knowledge gaps for further research and practice.

Soo Downe, another EPOC editor who led one of the papers, emphasises the value of qualitative evidence synthesis for guidelines: “Health care is only useful if it meets the needs, values and beliefs of those it is designed for, and of those who have to use it. Qualitative insights are critical for ensuring that care is not only effective clinically, but useful practically.”

“This is a crucial safety issue as well as an issue of high quality, respectful, acceptable and affordable care. For the first time, this series provides guidance on how this essential but previously overlooked component of health care quality can be realised.”

This collaboration between EPOC and WHO has been a useful opportunity to explore how Cochrane reviews and qualitative evidence syntheses can be made as relevant as possible for this key target audience. WHO plans to continue to incorporate qualitative evidence syntheses into their guidelines and will keep working with Cochrane about how best to do this.

Later this year, several of the authors involved in this project are also organizing the QESymposium in Brazil. Simon Lewin, another Cochrane EPOC editor who led a paper in this series, is part of the Scientific Programme Advisory Committee and notes: “The symposium will explore the use of qualitative research in decision making processes tied to the Sustainable Development Goals, and we expect many of the issues raised in these papers to be discussed there.”

• Learn more about the work of Cochrane’s EPOC Group

Access the papers

• Using qualitative evidence synthesis to inform guideline scope and develop qualitative findings statements (led by Soo Downe)
• Using qualitative evidence synthesis findings to inform evidence-to-decision frameworks and recommendations (led by Simon Lewin)
• Using qualitative evidence syntheses to develop implementation considerations and inform implementation processes (led by Claire Glenton)

 

Thursday, August 8, 2019

Cochrane Overviews bring together the findings from multiple reviews and one of the largest, first published in September 2013, was updated and republished in May 2018. Cindy Farquhar, from the Department of Obstetrics and Gynaecology at the University of Auckland in New Zealand describes this enormous volume of evidence for assisted reproduction.

"Infertility is defined as failure to conceive after one year of trying. Up to one in six couples will experience this at some point in their lives and many will seek fertility treatment in the form of assisted reproduction. When they do so, they will hope that they are getting the best available care, and this Overview of a wide breadth of research should help to achieve this.

Fertility treatments are complex and costly, and the stakes are high. A cycle of assisted reproduction includes several steps which start with down regulation, ovulation induction, triggering of ovulation, oocyte retrieval, fertilization, embryo transfer and luteal phase support. 

With this in mind, it is important that each step in assisted reproduction, or ART, is supported by good evidence from well-designed studies. With this aim, the Cochrane Gynaecology and Fertility Group has considered the evidence from all Cochrane systematic reviews of ART published on the Cochrane Library.

We included 68 Cochrane Reviews of various stages in the ART cycle. All the reviews were assessed for quality, all were found to be high quality and this overview provides the most up to date evidence from randomised trials for ART cycles.

Reviews of in vitro fertilisation (IVF) and intracytoplasmic sperm injection (ICSI) were included in the overview, but reviews of intrauterine insemination and ovulation induction were not included.

Thirty-eight of the reviews identified interventions that were effective or promising, 19 reviews identified interventions that were ineffective or possibly ineffective, and 15 reviews were unable to draw conclusions due to lack of evidence.

Use of the evidence from this overview to guide clinical practice should help to improve live birth rates and reduce rates of multiple pregnancy, cycle cancellation and ovarian hyperstimulation syndrome.

As with the previous version of this overview, we hope that medical societies and guideline groups will find it useful it in their efforts to guide their clinical practice."

• Read the Cochrane Review
• Listen to more Cochrane Podcasts
• Get Cochrane Podcasts on iTunes
• Visit the Cochrane Gynaecology and Fertility Group Website

Wednesday, August 7, 2019

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.

Cochrane is an incredible community of people who all play their part in improving health and healthcare globally. We believe that by putting trusted evidence at the heart of health decisions we can achieve a world of improved health for all. 

Many of our contributors are young people working with Cochrane as researchers, citizen scientists, medical students, and volunteer language translators and we want to recognize the work of this generation of contributors as part of this series called, Cochrane’s “30 under 30." 

In this series, we will interview 30 young people, 30 years old or younger who are contributing to Cochrane activities in a range of ways, all promoting evidence-informed health decision making across the world. 

We will be hearing from them in a series of interviewees published over the coming months.

The Cochrane 30 Under 30 series is now closed. However, we are keen to hear from early career professionals about their work with Cochrane for future series. If you would like to be added to our waitlist, please conact lparsonson@cochrane.org. Or if you want to know more about Cochrane's work contact membership@cochrane.org where our community support team will be happy to answer your questions.

Name: Eve Tomlinson and Audrey Tan
Age: 26 and 24
Occupation: NIHR Network Support Fellows for the Cancer Network and Circulation and Breathing Network

How did you first hear about Cochrane?
Eve: I first found out about Cochrane during my BSc in Psychology. I came across a Cochrane review whilst searching for literature for one of my research projects and found it to be such a useful resource giving a thorough overview of the studies in the topic area I was exploring. I was struck by how robust the methods for the review were and found it a great base to work from to then delve into the individual studies further.

Audrey: I first heard about Cochrane during my MSc in Evidence-Based Social Intervention and Policy Evaluation. Cochrane was introduced to us as the gold-standard for evidence synthesis and the pre-eminent organisation for synthesis methodology.

How did you become involved with Cochrane? What is your background?
Eve: Prior to becoming involved with Cochrane I worked as a Clinical Trial Coordinator at the Royal United Hospital, Bath, in the Oncology and Haematology Department. I think it is the combination of my experience in Cancer clinical trials and in health research from my degrees that means I’m well placed in the role of Network Support Fellow for the Cancer Network.

Audrey: While my undergraduate background is in qualitative research methods, after my MSc I started working for the Royal College of Obstetricians and Gynaecologists as a Systematic Reviewer writing systematic reviews for NICE clinical guidelines. I jumped at the opportunity to work for Cochrane as a Network Support Fellow; having the chance to work for this pre-eminent organization in the field of evidence-based medicine at an early stage in my career seemed too good to pass up.

What do you do in Cochrane?
Eve: I am the Network Support Fellow for the Cancer Network. I am working alongside the Network Senior Editor and Associate Editor to aid the delivery of our Network Strategic Plan. One of my main focuses is to support the six Cancer Cochrane Review Groups with review prioritisation activities, in order to ensure that Groups are producing reviews relevant to end users such as patients, carers, health care professionals and decision makers. I am also working to improve collaboration and shared learning in the Cancer Network, recently setting up the Cancer Network Newsletter to facilitate this.

Audrey: Similar to Eve, I’ve been helping my Groups develop prioritisation plans. I’ve also undertaken a stakeholder mapping exercise to identify groups and organisations that can facilitate research dissemination, conducted a member profile survey of people within the Network to identify opportunities for collaboration, and joined the author team on several reviews. Another main component that’s unique to my role is increasing Groups’ capacities to perform network meta-analyses.

What specifically do you enjoy about working for Cochrane and what have you learnt?
Cochrane is a global organisation and between our Networks (Cancer and Circulation and Breathing) there are Review Groups based in the UK, France, The Netherlands, Germany, Australia, Canada, and America. We enjoy being able to work with people from all over the world that care about making a difference to health care. We’ve learnt early on that although the Review Groups are different geographically, with differing personnel structure, funders and resources, they are all exerting enormous effort to achieve the same overarching goal: to produce high-quality, accessible reviews of evidence to allow people to make accurate and informed decisions about their health and health care generally.

 What are your future plans?
Eve: I look forward to working more with the Review Groups in the Cancer Network on review prioritization, dissemination and the identification and development of stakeholder partnerships. I plan to learn more about the process of conducting a Cochrane review by joining a priority review author team.  

Audrey: My long-term goal is to transition my career into working in health policy so gaining the experience now “on the ground” in evidence-based research is an ideal starting place.

In your personal experience, what one thing could Cochrane do better to improve its global profile?
Cochrane should improve the ways it disseminates research in order to make sure it is being accessed and understood by those who need it most. Cochrane reviews are a robust and comprehensive source of knowledge, but a lot of people just don’t know about them. The increase in the creation of working links with sites such as Wikipedia will hopefully help with this, as will the use of alternative methods of dissemination such as using BlogShots and social media. Cochrane should work with medical students and registrar doctors to engage them with Cochrane work and translate findings into best practice, to get involved with reviews and recommend Cochrane reviews to patient groups.

What do you hope for Cochrane for the future?
We hope that Cochrane will focus efforts to expand further into lower and middle-income countries, opening up more Centres and Review Groups in these countries to ensure that Cochrane evidence is applicable worldwide.

How important is it that young people get involved in Cochrane? Why is this, do you think?
It is important for Cochrane to have a diverse workforce, including younger voices that bring enthusiasm, new ideas and challenge current practice.

Involving young people in Cochrane’s work has numerous benefits, including improving research and development by introducing young people’s perspectives, facilitating research dissemination and achieving a wider impact, and enabling young people to improve their own research skills.

What would your message be to other young people who want to get involved with Cochrane’s work but not sure where to start….?
There is so much you can be part of in Cochrane at the click of a mouse e.g. through accessing Cochrane TaskExchange and Cochrane Crowd. As there are so many different topics covered by Cochrane and departments within the organisation, it would be a good idea to check out the Cochrane Website to learn more and determine which part you want to get involved with, then contact your local Cochrane Centre for further information. 
 

Monday, August 5, 2019

Throughout August, the Cochrane UK team are running a new special series; ‘Maternity Matters’.

Maternity Matters is series of blogs and other resources, including graphics and podcasts, sharing some of the latest evidence on women's and babies' health, from pregnancy through to the early days after birth. 

The series focuses on NHS priorities on maternity and highlights new Cochrane Reviews or research. The blogs look at risk reduction in pregnancy with new Cochrane Reviews on smoking cessation and vitamin D; on women’s experiences and particular needs in pregnancy after recurrent miscarriage and after stillbirth; on continuity of care; and on managing the third stage of labour. 

Professor Catherine Swann (@cjswannPHE), Deputy Director of Maternity and Community at Public Health England, welcomes the series:

See below for a round-up of materials and join in the discussions on Twitter, by following @CochraneUK and using the hashtag #MaternityMatters 

Blogs 

•  Maternity Matters: a special series from Cochrane UK This blog introduces Maternity Matters, a special series of blogs and other resources on women's and babies’ health, during and after pregnancy and childbirth.

 

Learn more about Cochrane UK, the Cochrane Pregnancy and Childbirth Group, the Cochrane Neonatal Group, the Cochrane Children and Families Network and the Cochrane Child Health Field.

Friday, August 2, 2019

The Cochrane Pregnancy and Childbirth Group has produced more than 600 reviews and one of its first from 1995 looked at the effects of providing support during pregnancy for women at increased risk of having a low birthweight baby. The review underwent another update in April 2019 and we asked a new member of the research team, Christine East from Monash University and La Trobe University in Melbourne, Australia to tell us about the importance of the review and its latest findings.

.

Some newborn babies are smaller than expected and this can be for a number of reasons. Sometimes they are simply born early. Others may be born at full term but may not have grown well enough in the womb. Whatever the reason, low birthweight babies face more challenges than babies born at a normal weight.

One of the ideas for how to prevent babies being born small is to provide social support to women during their pregnancy. This might be in the form of emotional support, helping women get to appointments, or helping them understand when to let their midwife or doctor know about any concerns they are having.

Our review examines the evidence on these and other such strategies. We looked at the randomised trials that had tested the effects of programmes offering additional social support to women who were at risk of having a low birthweight baby. Some trials involved support from healthcare professionals, while, in others, lay persons provided the support. The main outcomes were babies born preterm, that is, three or more weeks earlier than the usual 40 weeks, or weighing less than 2500 grams at birth.

We included 25 reports, which had data for more than 11,000 mothers and their babies, across 21 different studies. We found that when compared with routine care, programmes that offered additional social support for these at-risk women may slightly reduce the number of babies born weighing under 2500 grams. There was also evidence that social support might decrease the number of babies born preterm, although the potential effect was not large. We also found that additional social support might reduce the number of births by caesarean section and the number of hospital admissions during pregnancy. And the results were consistent whether the support came from healthcare professionals or specially trained lay persons.

In summary, pregnant women need the support of caring family members, friends and health professionals. Programmes that offer additional social support during pregnancy are unlikely to have a large impact on babies being born small or before term. However, these support services may help in reducing the likelihood of caesarean birth and the need for the woman to have to stay in hospital at some point during her pregnancy.

• Read the Cochrane Review
• Listen to more Cochrane Podcasts
• Get Cochrane Podcasts on iTunes
• Visit the Cochrane Pregnancy and Childbirth Group Website

Thursday, August 1, 2019

A recent article in Nature, 'Out of date before it's published', looked at how we are keeping pace with fast-moving research fields. It featured the work of Cochrane to increase the speed and efficiency of Cochrane systematic review production.

Julian Elliott co-leader of Project Transform, discussed the need for the latest health evidence to be available and the idea of living systematic reviews. You can learn more about Project Transform and the work in this short video:

Chris Mavergames, Cochrane’s Head of Informatics & Knowledge Management, touched upon our 'evidence pipeline', Cochrane Crowd, and what's next for technology to make the process faster. You can learn more about our Citizen Scientist platform, Cochrane Crowd, in this short video:

• Read Nature's 'Out of date before it's published' article
• Offer your expertise on Cochrane TaskExchange
• Become a Citizen Scientist with Cochrane Crowd

Thursday, August 1, 2019

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.

Cochrane is an incredible community of people who all play their part in improving health and healthcare globally. We believe that by putting trusted evidence at the heart of health decisions we can achieve a world of improved health for all. 

Many of our contributors are young people working with Cochrane as researchers, citizen scientists, medical students, and volunteer language translators and we want to recognize the work of this generation of contributors as part of this series called, Cochrane’s “30 under 30." 

In this series, we will interview 30 young people, 30 years old or younger who are contributing to Cochrane activities in a range of ways, all promoting evidence-informed health decision making across the world. 

We will be hearing from them in a series of interviewees published over the coming months.

The Cochrane 30 Under 30 series is now closed. However, we are keen to hear from early career professionals about their work with Cochrane for future series. If you would like to be added to our waitlist, please conact lparsonson@cochrane.org. Or if you want to know more about Cochrane's work contact membership@cochrane.org where our community support team will be happy to answer your questions.

Name: Selena Ryan-Vig (on Twitter: @CochraneUK)
Age: 26
Occupation: Communications & Engagement Officer, Cochrane UK

How did you first hear about Cochrane?
I have to admit that it was only in my final year at university that I became familiar with Cochrane. I was studying a module about ‘the psychology of pain’ and my lecturer was an author on Cochrane Reviews assessing interventions for the treatment and prevention of pain. He asked the class whether we’d heard of Cochrane Reviews and, if not, why not. I made sure to brush up at that point.

It didn’t take much reading to realise the importance of Cochrane’s work. So, when the opportunity presented itself, I was keen to work for an organization whose mission – of generating reliable health information which is free from commercial sponsorship – I respect. 

How did you become involved with Cochrane? What is your background?
I studied psychology at the University of Bath, with a placement year spent working in a national mental health charity for women. After graduating, I wasn’t entirely sure what kind of job I was looking for, but I was interested in research and I knew I’d like to work within the charity or public sector. When I saw an opening at Cochrane UK on the NHS jobs website, it felt like a good fit. I began working at Cochrane UK as an information and administration assistant and moved into my current role about a year and a half later.

What do you do in Cochrane?
My role primarily involves sharing information about Cochrane and Cochrane Reviews with different audiences, such as researchers, healthcare professionals and the public. For example, I make video summaries and ‘blogshots’ (a kind of infographic) to share the key messages from Cochrane Reviews in ways which can be easily and quickly accessed and understood. I also produce our newsletters, curate Cochrane UK's website and social media accounts and monitor the analytics on these.    

Additionally, with a colleague, I run interactive sessions in schools with students aged 15-18. We give an overview of evidence-based health care and why it’s important, and encourage students to think critically, particularly around health claims they may see in the media (such as ‘bacon causes cancer’). I also give occasional talks in universities or at conferences to raise awareness of Cochrane’s work.

What specifically do you enjoy about working for Cochrane and what have you learnt?
The global nature of Cochrane is amazing and something which I only really appreciated when I was fortunate to attend my first Cochrane Colloquium in Seoul in 2016. Everyone has to make decisions about health, and when we do it’s important that those decisions are informed by the best available research evidence. It’s inspiring to be part of an organization made up of so many people from around the world who are driven by that ethos. I enjoy the variety of my role at Cochrane UK. I’ve been given many different opportunities and feel lucky to be part of a team so generous with their support and time.

 

What are your future plans?
To be decided! I’m interested in science communication; particularly how nuanced and complex research findings can be conveyed accurately but accessibly to different audiences. Equally, it’s been really rewarding working with young people to hone their critical thinking skills about some of the (mis)information about health we’re bombarded with every day. Both are potential avenues I’d be keen to gain more training in and explore further.

In your personal experience, what one thing could Cochrane do better to improve its global profile?
I’m bound to be biased given my role in communications, but I would love to see even more resources in Cochrane being allocated towards the dissemination of Cochrane Reviews. So much work goes into conducting a Cochrane Review, but if the target audiences of that review don’t know it exists – or are unsure how to access it – a lot of that effort is undermined.  We’re fortunate at Cochrane UK to have two full time members whose primary focus is on disseminating Cochrane evidence, but not every centre or group has this luxury.

What do you hope for Cochrane for the future?
Making decisions about health that are informed by the best available evidence seems like such a no-brainer, that it’s scary to think that – globally - this is often far from the current reality. With so much misleading and sensationalised health information in circulation, I hope that Cochrane – and other organizations like it – can be ‘louder’. It would be great to see Cochrane doing more outreach work to help better equip individuals to distinguish between reliable, and less reliable, sources of evidence.

How important is it that young people get involved in Cochrane? Why is this, do you think?
It’s really important that young people get involved with, and become more aware of, the importance of evidence-based decision-making and Cochrane’s role in that. This is particularly true of early career researchers or health professionals but more broadly than that too. That’s because everyone needs to make decisions about health at some stage in their lives and being aware of reliable, trust-worthy sources of information is a key part of that.

What would your message be to other young people who want to get involved with Cochrane’s work but not sure where to start….?
Students could look up Students 4 Best Evidence; a blogging website for, and by, students interested in evidence-based practice for introductions to some of the fundamentals of evidence-based practice. TaskExchange is also good if you’d like to get stuck in contributing to some of the tasks involved in producing a systematic review; from data extraction to translation. There’s lots more information about getting involved here too.
 

Tuesday, July 30, 2019

Salary: £28,660 per annumContract type: Full-time, fixed-term for up to 12 monthsClosing date: 14 August 2019

 Founded in 1898 and the oldest of its kind in the world, the Liverpool School of Tropical Medicine (LSTM) is an internationally recognised centre of excellence for teaching and research in tropical diseases. 

LSTM’S Centre for Evidence Synthesis in Global Health leads developments in evidence synthesis for tropical medicine and global health. In the 1990s, we helped establish Cochrane. We now run the Cochrane Infectious Diseases Group (CIDG), with over 150 Cochrane reviews and 600 authors throughout the world; we work closely with the World Health Organization and we co-ordinate a global evidence ecosystem, with active partner programmes in South Africa, India and Sri Lanka. As part of this, we are recruiting staff as part of a six year “Research, Evidence and Development Initiative” (READ-It) programme. The successful applicant will be part of this process and be part of review teams in the existing and new review portfolio.  Our priorities are developing rapidly, and we are seeking to engage the successful applicant in a high-priority area commensurate with their areas of interest.  For example, some topics we have include:

• rapid diagnostic tests in malaria

• triple therapy in filariasis

• Public health aspects of tampon use

• Short course management of latent TB

• Qualitative synthesis

There are also a variety of methodological projects related to Cochrane (review updating, conflicts of interest, statistical reporting); and methods for moving from evidence to policy, including how WHO use aspects of human rights in guideline development. We aim for a mixed portfolio to provide a broad exposure to evidence informed science.

The ideal candidate will have a Masters in epidemiology, public health, or clinical tropical medicine, and have good quantitative skills. You will have experience in evidence synthesis in topics related to biomedical or social science research in low- and middle-income countries and have confidence in critically appraising medical literature at postgraduate level.

You need to have completed a systematic review or an applied research project.  You need clear evidence of critical insight into priority policy questions in international health relevant to infectious diseases.

Demonstrating initiative, commitment, organisational skills, and the ability to meet deadlines is essential; as is a flexible approach to work with the ability to work independently or as part of a diverse team.

If you have authored a Cochrane review, have experience of using GRADE, or have a track record in published research, it will be an added advantage to your application.

• Learn more about this position and apply

 

Tuesday, July 30, 2019 Category: Jobs

Cochrane has created eight new Networks of Cochrane Review Groups responsible for the efficient and timely production of high-quality systematic reviews that address the research questions that are most important to decision makers.

In this short film we focus on the Cochrane Abdomen and Endocrine Network. This film introduces the team, what has happened so far, and the ambition for what is to come.

• Learn more about the Cochrane Addomen and Endocrine Network
• Watch other Cochrane Review Group Network videos

Monday, July 29, 2019

The rising incidence of cancer and successes in its treatment mean that an ever increasing number of people are living with cancer. This is leading to the involvement of more and more informal caregivers in their care. In a new Cochrane Review from June 2019, Charlene Treanor from the Centre for Public Health in Queen’s University Belfast in Northern Ireland and colleagues looked at the evidence on the effects of psychosocial interventions for these people. We asked her to tell us about their findings in this podcast.

"Informal caregivers, meaning those people who are not paid or trained healthcare professionals, play an important role in supporting individuals affected by cancer. They include family members, friends and neighbours and the type of support they provide is wide ranging. Among other things, it includes going to hospital appointments, taking on additional household roles such as shopping and cooking, and providing emotional support.

Informal caregivers can spend up to 30 hours a week providing care, often in addition to their job and any other family caring roles they have. This additional role, coupled with having to come to terms with the cancer diagnosis of their loved one, can impact on all aspects of their health including increased fatigue, disturbed sleep and impaired quality of life.

Formal support for informal caregivers is often limited or absent, but it’s important to know whether there are things that might be done to help them. We’ve looked at this for psychosocial interventions designed to inform, educate and increase the coping capacity of informal caregivers through an interaction with a healthcare professional. We wanted to see if this might improve outcomes for informal caregivers and, perhaps, for the individuals living with cancer.

We identified 19 trials covering a range of psychosocial interventions including psychoeducation and psychotherapy delivered face-to-face or by telephone to groups of caregivers, pairs of caregivers and patients (usually spouses), or individual caregivers. Almost 2000 caregivers and just over 1700 patients took part in the studies. All were from high income countries and, given the differences in resources which mean that informal caregivers in lower resource settings might take on caring tasks more akin to those of a healthcare professional, their experiences and need for support are unlikely to be represented by this review.

Disappointingly, we found that psychosocial interventions did not help with the health or wellbeing of informal caregivers or patients. And although there did seem to be a small benefit for caregiver global quality of life immediately after the intervention, this did not last. Indeed, some interventions even had a negative effect, including discomfort related to the intervention’s content, distress for caregivers who had previously low distress, and negative changes in relationship satisfaction.

There may be several reasons for the lack of benefits. For instance, it wasn’t clear if caregivers were included in the design of the interventions, so those being tested might not have addressed their needs appropriately. Moreover, caregivers with a history of, or current psychological illness were excluded from the research, and these might be those in most need of the help.

We identified 13 ongoing studies and it will be interesting to see how these add to the current evidence, although the interventions being tested appear similar to those already included in the review. However, it may be that the interventions are effective for other important caregiver outcomes such as relationship quality and these outcomes should be captured in future updates of our review. Looking further into the future, research needs to be done for caregivers in low and middle income countries and for caregivers most in need. The researchers doing these trials should also involve caregivers in intervention design and development.”

• Read the Cochrane Review
• Listen to more Cochrane Podcasts
• Get Cochrane Podcasts on iTunes
• Visit the Cochrane Cochrane Consumers and Communication Group Website

Friday, July 26, 2019

Here at Cochrane we are delighted to hear that Professor Julian Higgins has received the 2019 Extraordinary Service Award at the Society of Research Synthesis Methodology 2019 Annual Meeting.

The Extraordinary Service Award (also called the Shadish Award) is named for Professor William Shadish and recognizes an individual who has made extraordinary service contribution to the Society of Research Synthesis Methodology. Julian was a founding trustee and is a past President of the Society for Research Synthesis Methodology (2005-2006).

The impact of Julian’s work in the field is massive. He is involved in a wide range of systematic review methods research, including assessing and adjusting for bias in primary studies, meta-epidemiological studies, meta-analysis methods including Bayesian approaches, network meta-analysis and analysing individual participant data.

In Cochrane, Julian also has a long-standing history, contributing to the development of methods that are integral to the Reviews Cochrane produces. A Co-Convenor of the Cochrane Bias Methods Group,  he has made major contributions to bias assessment in Cochrane Reviews, developing Risk of Bias (RoB) 1 and RoB 2 tool. He is currently a member of the MERCIR coordinating group, Senior Methods Advisor at Cochrane and sits on its Editorial Board, Scientific Committee, and Methods Executive. He has also co-edited the Cochrane Handbook for Systematic Reviews of Interventions since 2003 (Version 6 of the Handbook launches in October 2019).

Congratulations to Julian on this well deserved award!

Thursday, July 25, 2019

Location: Notting Hill, UK
Employment Type: Full-time
Duration: 3 year fixed-term appointment
Remuneration: $27,872 AUD per annum full-time rate (tax-free stipend for 3 years)
Closing Date: 13 Aug 2019

An exciting opportunity exists for an exceptional candidate who is interested in undertaking a PhD project in the field of implementation science, within the Implementing work-related Mental health guidelines in general PRacticE (IMPRovE) NHMRC Partnership Trial.

Located within the Department of General Practice at Monash University, IMPRovE will implement the recently published Clinical practice guidelines for the diagnosis and management of work-related mental health conditions through a pragmatic cluster randomised controlled trial. Our key objectives are to increase the delivery of evidence-based general practice care for patients, assess the cost-effectiveness of our intervention and plan for national scale up. Components of the intervention will include academic detailing, peer-to-peer support and learning through a digital Community of Practice and the provision of resources.

The PhD project attached to this scholarship will focus on using implementation science theory and methods to contribute to a process evaluation of the IMPRovE trial. Supported by a large interdisciplinary team of investigators, and policy and practice partners, the PhD candidate will characterise the aspects of the intervention and our partnership approach that are likely to lead to successful change in GP practice, and to characterise aspects that may hinder success. This will involve initially undertaking a systematic review to identify the elements of a successful digital Community of Practice. Then, the focus will move towards evaluating the successful and unsuccessful components of the intervention as part of the process evaluation of the trial.

• See here for more information and to apply

Thursday, July 25, 2019 Category: Jobs

At its teleconference on 10 July, the Governing Board voted unanimously to appoint Catherine Marshall as its new Co-Chair from 1 September 2019. Catherine will work alongside fellow Co-Chair Martin Burton, and replace Marguerite Koster, who is stepping down from the role after one year due to increased commitments in her job at Kaiser Permanente, in Southern California, but will remain on the Board as a member.

Catherine was one of the first two appointed members of the Cochrane Governing Board in 2016. She is also a member of the Board’s Governance Committee, and Finance Audit and Investment Committee, and was elected as Treasurer in September 2018.

Outside Cochrane, Catherine is an Independent Guideline Adviser and Health Sector consultant based in New Zealand. She is currently Co-Chair of the Partnership Advisory Group with the Guidelines International Network (G-I-N) and was previously Vice Chair of its board of trustees. She was also the inaugural Chief Executive of the New Zealand Guidelines Group, where one of her key responsibilities was the development and implementation of evidence-based guidelines and advice – which often relied on evidence from the Cochrane Library. Catherine is also a prominent health consumer advocate, working on the development of health consumer legislation in New Zealand and as a former member of the NZ Stronger Consumer Voices Alliance. In 2018, she helped organize and participate in the consumer programs for the Cochrane Colloquium in Edinburgh.

“Catherine is a recognized leader in the global evidence-based medicine community” says outgoing Co-Chair Marguerite Koster. “Her experience leading non-governmental and charitable organizations will be a significant asset to Cochrane as she assumes the position of Co-Chair of the Governing Board.”
 
Martin Burton adds, “I am delighted that Catherine has been elected to the Co-Chair position. She is passionate about Cochrane and brings a unique set of skills to the role. At the same time, I am sorry to say “goodbye” to Marguerite. She has been a truly outstanding Co-chair and a wonderful colleague to work with. I am very pleased that she is prepared to continue to serve on the Governing Board.”

And of her appointment, Catherine says, “In the last three years as a Governing Board member of Cochrane, I have been deeply impressed by the strength of Cochrane and the talent of the people who contribute to the collaboration. I am strongly committed to expanding our reach around the globe and finding ways Cochrane advice can assist health consumers.”
 
Members of the Governing Board can be contacted at governingboardsecretary@cochrane.org

Thursday, July 25, 2019

The Cochrane Review 'Financial conflicts of interest in systematic reviews: associations with results, conclusions, and methodological quality' has recently published. We talked to author Camilla Hansen to learn what the latest evidence says and why it is important.

Can you please tell us about this Cochrane Review?
"Systematic reviews summarise existing evidence on a specific research question. These summaries sometimes provide a basis for developing clinical guidelines and can have a major impact on how patients are treated. It is therefore essential that findings from systematic reviews are trustworthy. If not, we may end up wasting resources on interventions that don’t actually work, or even harming patients by using interventions that are dangerous, rather than helpful.

There is a lot of debate about the impact of financial conflicts of interest on research findings and their interpretation. This exact issue has been investigated in many methodology studies of financial conflicts of interest in primary research studies, mainly clinical trials; and these studies have shown that financial conflicts of interest do impact on the conclusions drawn from the randomised trials.

In contrast, fewer methodological studies have investigated the impact of financial conflicts of interest in systematic reviews, and we are not aware of any previous attempt to bring these studies together into a methodological systematic review. We decided to fill this gap.

We included ten studies that investigated a total of 1010 systematic reviews. We primarily investigated the potential impact on results (divided into estimated treatment effects and statistically favourable results) and conclusions. We found no clear difference in results between systematic reviews with and without financial conflicts of interest, but our findings are based on very limited data with a high degree of uncertainty. However, the evidence is stronger in relation to the conclusions of systematic reviews and we found that those with financial conflicts of interest more often had favourable conclusions than systematic reviews without financial conflicts of interest. This is based on seven methodology studies that looked at a total of 411 systematic reviews.

We also investigated the potential impact on the quality of the systematic reviews and found a tendency that systematic reviews with financial conflicts of interest had lower methodological quality than those without financial conflicts of interest.

What are financial conflicts of interest in this context and why are they important?
Financial conflicts of interest can occur when either a company or individuals may benefit financially from how the evidence in a systematic review is interpreted and used, and our focus was on those that relate to connections with drug and device companies. The issue can arise when a systematic review is directly funded by such a company or done by authors employed by such companies. It can also happen when a systematic review is conducted by authors who have financial relationships with drug or device companies, for example when authors have received fees or research grants, or are on advisory boards of drug and device companies. The Cochrane review did not investigate systematic reviews done by authors with a personal financial and professional interest related to certain interventions. For example, surgeons doing specific fee-based procedures in private practice. Similarly, the Cochrane review did not investigate academic conflicts of interest where researchers’ grant applications and academic careers may be influenced by positive studies published in high impact journals.

How did this review come about?
I am doing a PhD on conflicts of interest in clinical research. I realised, together with my supervisors, that no methodological systematic review had been published on this important topic. We therefore decided to do a Cochrane Methodology Review.

What sort of funding can present a conflict of interest? And why?
In medical research, funding can present conflicts of interest in a variety of ways. Sometimes, systematic reviews are primarily funded by non-profit sources (e.g. when reviews are conducted by academic researchers employed at public universities and financed through their salaries), but occasionally industry provides additional indirect funding by contributing with assistance from medical writer or company statisticians. In some cases, systematic reviews are funded by non-profit sources, but conducted by authors with financial ties to the manufacturer of the drug or device they are reviewing. At other times, systematic reviews are solely financed through industry funding (e.g. when drug or device companies provide funding and salary for academic researchers at public institutions to conduct a specific review).  

Common for all types of funding is that it can create ties between the researchers and industry. In some cases, the funding company may influence the design, analysis, or reporting of the study. Since the company has an interest in reaching a specific conclusion, this can impact on decisions made in the way that a study is carried out. In other cases, the conflicts of interest may result in the academic researchers being unduly influenced by the interests of the funder, when interpreting the evidence.

For this review, we focused on funding from drug and device companies only. However, previous studies have also demonstrated that funding from other industries, e.g. tobacco and nutrition companies, impact on research findings and interpretation. Recently, it has been debated whether funding from non-profit organisations or governmental institutions may also create conflicts of interest since they may have an interest in a particular direction of the findings of a study. However, currently little research has been done on the topic.

How does your review build on the work of the previously published review update in 2017 that concluded “sponsorship of drug and device studies by manufacturing company leads to more favourable efficacy results and conclusions than sponsorship by other sources?”
The review from 2017 was led by my colleague Andreas Lundh and focused on funding in primary research studies, mainly clinical trials. Although we deployed similar methods in our review, our focus was on financial conflicts of interest in systematic reviews, rather than the trials in those reviews.

We are also working on a third Cochrane Methodology Review focusing on conflicts of interest in a group of non-research publications, namely clinical guidelines, transcripts from drug and device advisory committee meetings, opinion pieces such as editorials, and narrative reviews.

Therefore, there will soon be three Cochrane Methodology Reviews investigating how conflicts of interest impact on three core types of publications that all influence patient care.

I was interested to read that in contrast to the 2017 review on primary studies, you did not find an association between financial interests and statistically favourable results in systematic reviews. Were you surprised?
You are right that we did not find such an association, but we only found two studies investigating the results sections of systematic reviews, which means that there is not enough data at the moment to determine whether or not there is an association.

You mentioned that you are working on another review: “Conflicts of interest in clinical guidelines, opinion pieces, and narrative reviews”. When is it due? Any preliminary findings you can share?
We are finalising that review right now, and it looks as though the findings from the 2017 review on clinical trials, the new one on systematic reviews, and that third Cochrane Review are quite similar.

What can people who read and use systematic review evidence learn from your review?
Our findings suggest that systematic reviews with financial conflicts of interest should be interpreted carefully. People who read and use systematic review evidence should primarily look for systematic reviews without financial conflicts of interest, for example a Cochrane Review. If that is not available, we suggest that users read the review conclusions with scepticism, are aware of the declarations of interest for the review authors and funding sources, and pay particular attention to their critical appraisal of the review’s methods."

• Read the full review here
• Learn more about Cochrane Methodology Review Group

 

Wednesday, August 7, 2019

The British Medical Journal 'Talk Medicine' podcast recently featured the work of Medizin-Transparent in the Podcast "Fighting bad science in Austria". Gerald Gartlehner, Director of Cochrane Austria, explains how Medizin-Transparent works.

Medizin-Transparent.at tests the truth of medical statements made in the media in order to support readers, patients, doctors, and decision-makers to critically analyze the information they encounter. This online service is a project of Cochrane Austria and the Department for Evidence-based Medicine and Evaluation.

 

Tuesday, July 23, 2019