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Cochrane in Everyday Life - Compression stockings for preventing deep vein thrombosis in airline passengers

Thu, 03/14/2019 - 20:54

Cochrane does not make clinical recommendations, instead it provides unbiased and high-quality health evidence so that health decisions, policies, and clinical guidelines can be informed by the best available evidence. ‘Cochrane Evidence in Everyday Life’ series collects stories about individuals, families, and carers making health decisions based on Cochrane evidence. Each piece in the series collects stories around the personal impact that one Cochrane Review has made.

Review: Compression stockings for preventing deep vein thrombosis in airline passengers
Year published: 2016
Review Group: Cochrane Vascular
Conclusions: High‐quality evidence shows that airline passengers similar to those in the trials in this review can expect a substantial reduction in their risk of a symptomless deep vein thrombosis (DVT) if they wear compression stockings. Wearing stockings might reduce the incidence of this outcome from a few tens per thousand passengers, to two or three per thousand. There is moderate‐quality evidence that superficial vein thrombosis may be reduced if passengers wear compression stockings. Low‐quality evidence shows that passengers who wear stockings will also experience less oedema in their legs. However, this review is unable to identify whether these effects of wearing stockings translate into effects on outcomes such as death, pulmonary embolism and symptomatic DVT.
Plain language summary: available in  English, Deutsch, Hrvatski, Polski, Português, and Русский
Note worthy mentions: Wikipedia entry on compression socks

User story:

"My name is Ciara from Ireland. I’m the founder and Editor of Meta-Evidence, which helps promote the work of the Campbell Collaboration across the UK and Ireland. After reading the Cochrane Review on compression socks, I made sure to wear my flight socks on a recent trip to Campbell's summit, GEIS,  in Melbourne Australia. Normally my ankles swell up after a long flight and I was worried about the possibility of blood clots; I was so happy to see strong Cochrane-evidence on a practical solution to help safe guard against this! Given Cochrane Evidence, I will now wear my compression socks on every flight!” @MetaEvidence

Would you  like to add your story of using this review? Please contact to share your story.  

Tuesday, March 19, 2019 Category: The difference we make

Get Social with Cochrane!

Wed, 03/13/2019 - 21:17

Our Strategy to 2020 aims to put Cochrane evidence at the heart of health decision-making all over the world. This not only means making our producing high-quality and relevant systematic review but making sure that our evidence is accessible and advocating for evidence. We aim to make Cochrane the ‘home of evidence’ to inform health decision making, build greater recognition of our work, and become the leading advocate for evidence-informed health care.

You can access Cochrane evidence in news on your favourite social media platform! Follow us on:

Friday, March 29, 2019

Cochrane-REWARD prize - 2017 Award Winner: SYRCLE

Wed, 03/13/2019 - 19:32

When it received the joint second Cochrane-REWARD prize in 2017, SYRCLE (the SYstematic Review Center for Laboratory animal Experimentation) was focused on encouraging the use of systematic reviews of animal studies to reduce waste and improve quality. Since then, SYRCLE has evolved, and here Merel Ritskes-Hoitinga gives an overview of how things have developed.

SYRCLE started in the Netherlands with the aim of improving the reliability of laboratory animal research and its relevance for patients by using systematic reviews. Systematic reviews have not been commonly used for animal studies, yet we saw the potential of implementing them to identify knowledge gaps, reduce duplication and improve the design of future animal and clinical studies.

We have developed an education programme designed to support researchers to conduct high-quality systematic reviews of animal studies. ZonMw (the Netherlands Organisation for Health Research and Development) funding has helped us to offer workshops and coaching. We have also set up a global SYRCLE ambassador network who can help to spread the messages locally.

Many of our systematic reviews of animal studies show that publication quality is quite low. They also show that the translation of findings from animal to human studies is quite poor. We think it is important to create transparency about this, in order to promote quality and translation of primary studies, as well as help speed up more use of replacement alternatives, such as human-based model systems.

We have already seen that participants from our workshops are getting good publications and citations, and people are accepting the idea. Our work has since grown, and we are now focussing on preclinical studies in general, including, for example, in vitro studies.

Impact of the prize
Receiving the second Cochrane-REWARD prize in 2017 was very important – it was fantastic to have international recognition from Cochrane and the REWARD alliance, especially for an initiative in a relatively new field.

We used the prize money to identify new ambassadors – our network has doubled from 15 to 30, from 15 countries around the world. Our network is made up of enthusiastic individuals that see the need to set up education in this area, and with more support this work could go even further.

In the coming years, we hope to be able to spread the messages of SYRCLE more quickly and widely, for example, through a train the trainer programme. However, funding is a challenge, especially as this is such a new field.

Collaborating with others on research waste
Through winning the prize, I met Matt Westmore from the UK National Institute for Health Research (NIHR) and Paula Williamson of COMET (Core Outcome Measures in Effectiveness Trials), who were the other recipients that year, and Iain Chalmers and Paul Glasziou. Through these connections I have also become involved in the Ensuring Value in Research (EViR) Funders’ Forum.

EViR has produced 10 guiding principles to work towards increasing the value of health-related research, which are currently being implemented for clinical studies. We are now working together on a set of principles for preclinical studies. Implementing these will lead to higher quality research, improved reporting – and ultimately the better use of resources and protection of animals and humans.

 The Cochrane-REWARD prize – 2019 nominations open
The annual Cochrane-REWARD prize recognizes good local or pilot initiatives that have the most potential to reduce research waste if scaled up globally.

Nominations for this year’s prize are open until 5 June 2019.

Thursday, March 14, 2019

The Thomas C Chalmers Award - 2018 Award Winner, Adriani Nikolakopoulou

Tue, 03/12/2019 - 11:57

The Thomas C Chalmers Award is awarded to the principal author of the best oral and the best poster presentation addressing methodological issues related to systematic reviews.

Tom Chalmers (1917-1995) was an outspoken advocate of randomised trials, whether at the bedside, at professional meetings, in class or in situations pertaining to his own life. His creativity spanned his entire career, influencing clinicians and methodologists alike. He is perhaps best known for the notion ‘randomise the first patient’, his belief that it is more ethical to randomise patients than to treat them in the absence of good evidence. In his later years, in arguably his most important work, Tom and his colleagues showed that, had information from RCTs been systematically and cumulatively synthesised, important treatments such as thrombolytic therapy for myocardial infarction would have been recognised as useful much earlier.

For more information on the prize eligibilty and criteria, visit the Colloquium Prize page. The call for abstracts is open and the deadline for submission is 12 April 2019. Abstracts for oral presentations and posters are invited in areas relevant to the work of Cochrane as well as evidence-based practice, policy, methodology, and advocacy.

In 2018, the winner of best short oral presentation winner was Adriani Nikolakopoulou  for 'The emerging evidence synthesis tools: actively living network meta-analysis'. We spoke to Adriani on what winning the Thomas C Chalmers Award 2018 has meant to her.

"I work as a post-doctoral researcher in the Evidence Synthesis Methods group at the Institute of Social and Preventive Medicine (ISPM) of the University of Bern.

Cochrane’s mission and the life of Thomas C Chalmers are a big inspiration to me and I consider an honour to be able to associate my work with them.

Developing methodology for systematic reviews is a key aspect of my work. Thus, an award for the best oral presentation addressing methodological issues related to systematic reviews seemed like a good fit. Moreover, as an early career researcher, I consider any means to help dissemination of your research to be very important. The process involved in applying for the award was as easy as indicating that you consider yourself eligible for the Thomas C Chalmers Award when submitting an abstract for the Colloquium.

In my presentation, I described the concept of an actively living network meta-analysis, which combines ideas of living systematic reviews, network meta-analysis and evidence-based sample size calculations. Winning the award for this piece of work constitutes a recognition of the potential usefulness and importance of such a framework.

Although it is not that long ago since I was awarded, so I was not able to experience benefits career-wise, I am certain that the award will strengthen significantly future applications for grants and academic positions. Moreover, winning the Award had a huge impact on my moral. The experience was very motivating, and I came out of it with more confidence and sense of responsibility.

To anyone considering applying for this award; apart from any benefits of winning the award, I find that participating is an important motivation to prepare a good presentation and to think whether and how your work meets the criteria for the evaluation of the applications: originality of thought, high quality science, relevance to the advancement of the science of systematic reviews, and clarity of presentation."

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

Thursday, March 14, 2019

Symposium on using qualitative evidence to inform decisions in the SDG era – 9-11 October 2019, Brasilia, Brazil

Fri, 03/08/2019 - 18:21

Are you interested in qualitative research and the UN Sustainable Development Goals (SDGs)? Are you working within health, education, social welfare, crime and justice, the environment, agriculture or other related sectors?

Researchers, policy makers, research commissioners and other stakeholders from across the world are invited to attend the first Symposium on using qualitative evidence to inform decisions in the SDG era, to be held on 9 -11 October 2019 in Brasilia.

Multisectoral action is needed to achieve the UN Sustainable Development Goals (SDGs). Such action requires a deep and contextualised understanding of the needs, views and experiences of a wide range of stakeholders. It also requires an in-depth understanding of how policies impact on different groups and sectors, and on equity and social inclusion. Qualitative research can play a critical role in providing this type of evidence, and in ensuring the representation of diverse voices.

The Symposium
The Symposium is hosted by the Oswaldo Cruz Foundation in collaboration with the Norwegian Institute of Public Health. It will advance conversations and collaborations on innovative ways of using qualitative evidence to broaden and humanise decision and policy-making processes to achieve the SDGs. The Symposium will also explore the tools and methods needed to support the translation of qualitative evidence into policy and practice, and will examine ways of strengthening capacity in this area, particularly in the global South. Further information and key dates are available on the Symposium website.

Who is invited?
As researchers and research commissioners, policy makers and other evidence users, and other stakeholders from across the world, we hope you will consider participating in this important gathering. The Symposium will provide opportunities to share with a multisectoral community your experiences and ideas on using qualitative evidence to support decision making. A wide range of organisations from across sectors are contributing to developing an exciting and innovative programme for the Symposium.

Help us identify Symposium themes!
You can get involved now by helping to identify themes that should be covered in the Symposium – please participate via the website. There, you can also indicate interest in participating in the 'Virtual Symposium' that will include a number of online activities such as plenary sessions webcasts and online group discussions.

Friday, March 8, 2019

Covidence seeks Community Manager(s) - Flexible location

Thu, 03/07/2019 - 22:08

Specifications: 0.5-1.0 FTE
Salary: AU$60,000 – AU$80,000 pro-rata DOE
Location: Flexible - this is a remote position; preferred locations are UK/EU or AU/NZ, but other options are possible for the right candidate
Application closing date: 25 March 2019

What does a Covidence Community Manager do?
You will work to understand user needs, support users in their experience using Covidence, manage major institutional accounts, and contribute to the design and development of Covidence. Working with researchers from around the world, you will collaborate to build a new way of making sense of research data, transforming the impact that research can have on health and wellbeing.

For more information and to apply, please see the full ad at:

Thursday, March 7, 2019 Category: Jobs

Salt Awareness Week

Wed, 03/06/2019 - 20:36

'World Salt Awareness Week' is a global event t o bring attention to salt intake and the risks to health it can bring, including high blood pressure and increased risk of stroke and heart disease. This year, the awareness week is being observed 4-10 March, 2019.

Cochrane Nutrition Field's aim is to support and enable evidence-informed decision-making for nutrition policy and practice by advancing the preparation and use of high-quality, globally relevant nutrition-related Cochrane reviews. Cochrane Nutrition covers a wide spectrum of nutrition-related issues and questions, ranging from clinical to public health nutrition.

To mark World Salt Awareness Week, we have collated a selection of Cochrane Reviews on salt intake:




Wednesday, March 6, 2019

Relaunch of Cochrane Ireland

Wed, 03/06/2019 - 19:29

We are delighted to announce the recent relaunch of Cochrane Ireland and its establishment as an Associate Centre. The official launch will take place at the upcoming joint Cochrane UK and Cochrane Ireland Symposium in Oxford in March 2019.

Cochrane Ireland will be hosted within the newly-established Evidence Synthesis Ireland (ESI), based at the National University of Ireland Galway. ESI is supported by funding from the Health Research Board of Ireland and the Health and Social Care Research and Development Division, Northern Ireland and aims to build evidence synthesis knowledge, awareness and capacity among the public, health care institutions and policymakers, clinicians and researchers on the Island of Ireland. A key goal of ESI is to re-establish the activities of Cochrane Ireland; these include the development of an extensive programme of Cochrane training events and Cochrane fellowship and studentship schemes.

Cochrane Ireland will be led by Professor Declan Devane as Director of Cochrane Ireland and Evidence Synthesis Ireland, and the Cochrane Ireland team; Dr Elaine Toomey (Associate Director of Cochrane Ireland), Dr Patricia Healy (Programme Manager of Evidence Synthesis Ireland) and Sheena Connolly (Administrator of Evidence Synthesis Ireland). Speaking about the relaunch of Cochrane Ireland, Professor Devane said: “We are delighted to be part of Cochrane’s work across the Island of Ireland and are excited by the potential it has to make a difference to health care decisions across the Island. Health care decisions should be based on the full range of information that is available on a topic; it can't rely on one or more individual pieces of information, or studies. Together with our friends in Cochrane UK and our wider team of collaborators, we look forward to helping build capacity to conduct syntheses of evidence for which Cochrane is a global leader”.

Cochrane CEO Mark Wilson commented: “I’m thrilled with the re-launch of Cochrane Ireland and the appointment of Professor Declan Devane as its new Director. Declan is a highly experienced systematic reviewer and trainer, and we look forward to working together. Given the passion and generosity Declan brings to everything he does, I am sure that he and the new team will expand the reach and impact of Cochrane evidence in health decision making in Ireland in the coming years.”

Cochrane Ireland will join its international Cochrane colleagues to represent and promote Cochrane on the island of Ireland, facilitate engagement with regional stakeholders to improve knowledge translation and dissemination of Cochrane reviews, and build capacity for review production and use.

Professor Martin Burton, Director of Cochrane UK, commented: “All of us at Cochrane UK have enjoyed working with our friends and colleagues on the island of Ireland.  We are delighted that Cochrane Ireland is re-launching itself under the auspices of Professor Declan Devane and his team in Galway. We wish them every success and look forward to meeting them at the joint Cochrane UK and Cochrane Ireland Symposium in Oxford in March”.

A full list of the Cochrane Ireland training events is available here, and more information on the Cochrane Ireland fellowship and studentship schemes is available here. For more information or to get in touch, contact us on, follow us on Twitter at @CochraneIreland or visit our website at  

Friday, March 8, 2019

Podcast: Sedation of children undergoing dental treatment

Wed, 03/06/2019 - 12:11

Fear associated with going to the dentist is common and, among children especially it can make it difficult to deliver the treatment they need. Therefore, among their many reviews of the effects of dental treatments, the Cochrane Oral Health Group maintains a review of the effects of sedation on children undergoing such treatment. The review’s third update was published in December 2018 and lead author, Paul Ashley, from the UCL Eastman Dental Institute in London England tells us where things now stand in this podcast.

"Children who are scared of the dentist will often express this as uncooperative or difficult behaviour during their visit. If this prevents effective treatment, it can result in a child's tooth decay going untreated. Behaviour management techniques might help but aren’t always enough. For children who can’t manage, dentists may consider using sedation and we examined the effectiveness of drugs to sedate a child whilst keeping them conscious in order to carry out dental treatment; but found that there are many more holes than fillings in the evidence.

We did identify a total of 50 randomised trials involving more than 3,700 children, from countries across the world; but most of these studies were at high risk of bias. It was also difficult to combine their data because of reasons such as the variety of outcomes reported, the mixture of dosage and delivery methods used for the drugs, and the large number of different drugs and drug combinations that were tested. In fact, we recorded 34 different combinations in the review and of all the interventions assessed, we could only do one meta-analysis, which combined the results of the six small trials comparing oral midazolam to placebo. This did show that oral midazolam is probably effective, but it means we can say little about the effects of treatments, but lots about the need for future research.

We made several recommendations for new studies in order to deal with some of the issues we encountered. In general, there are the problems seen in many other Cochrane Reviews around poor quality reporting, randomization, studies being too small, and so on. But there were some issues specific to our review and these included the need for greater consistency in the outcome measures used; better consideration of the age ranges assessed, since sedative techniques appropriate for a 3-year old may be different to those for a 12-year old; and more studies of the same drug and drug combinations to allow better assessment of overall effectiveness.

In summary, although our review shows moderate‐certainty evidence that oral midazolam is an effective sedative agent for children undergoing dental treatment, there is a need for further well‐designed and well‐reported clinical trials to evaluate other potential sedation agents. This research should also consider evaluating experimental regimens against oral midazolam or inhaled nitrous oxide."

Wednesday, March 6, 2019

Cochrane Infectious Disease Group works with WHO on latest guidelines for malaria vector control

Tue, 03/05/2019 - 19:01

The World Health Organization published Guidelines for malaria vector control, drawing on seven Cochrane reviews specially prepared for them by the Cochrane Infectious Diseases Group (CIDG). 

With its editorial base at Liverpool School of Tropical Medicine (LSTM), CIDG was asked to review all of the evidence that was used in bringing together what WHO have described as a “one-stop shop” for countries and partners working to implement effective malaria vector control measures. Consolidating more than 20 sets of WHO recommendations and good practice statements into one user friendly document, the guidelines support each country to select and implement the most effective interventions for its own unique malaria landscape.

LSTM’s Professor Paul Garner is Coordinating Editor of CIDG. He said: “These guidelines are based on a complete and thorough review of all of the existing evidence regarding various insecticide-treated nets, insecticide residual spraying, space spraying, larviciding, larvivorous fish and repellents. Systematic reviews are at the heart of the guidelines and the work was carried out by a number of Cochrane authors, including a group of early career researchers who brought to the table enthusiasm and commitment to understanding the evidence and identifying best practice throughout, and completed this momentous task in time for the panel”.

The intensive process of reviewing the evidence base for the guidelines enabled WHO to identify where gaps exist, which they describe as critical to refining the research agenda for the ongoing development of the guidelines. WHO also believes that the new guidelines will support malaria control by increasing the level of transparency around the evidence that underpins WHO’s vector control recommendations.

Dr Jan Kolaczinski, Coordinator of the Entomology and Vector Control unit of the WHO Global Malaria Programme, said: “Through greater transparency, we hope that innovators and research partners will understand why new tools and interventions need to be fully evaluated. We really want all malaria stakeholders to recognise the benefits of conducting solid research which, in turn, generates an evidence base from which WHO can develop recommendations.”

Tuesday, March 5, 2019

Launch of Cochrane Colombia to support the use of high quality, trusted health information

Mon, 03/04/2019 - 15:29

Cochrane, a global independent network of researchers, professionals, patients, carers and people interested in health, is proud to announce its newest Centre, ‘Cochrane Colombia’.

Cochrane Colombia will promote evidence-based decision making in healthcare in Colombia by supporting and training authors of Cochrane Reviews, as well as working with clinicians, professional associations, policy-makers, patients, and the media to encourage the dissemination and use of Cochrane evidence.

Cochrane works with collaborators from more than 130 countries to produce credible, accessible health information that is free from commercial sponsorship and other conflicts of interest.  Cochrane’s work is recognized as representing an international gold standard for high quality, trusted information. Institutions from Colombia have been involved in the Cochrane Iberoamerica Network for many years. Establishing Cochrane Colombia as a full Centre is a next step in its development. The Centre brings together three institutions – the Pontifical Xavierian University, through the Department of Clinical Epidemiology and Biostatistics; the National University of Colombia through the Institute of Clinical Research; and, the University of Antioquia thorough the Faculty of Medicine– that will jointly manage the activities of Cochrane Colombia. In addition, five institutions will join as Cochrane Affiliates.

In its first phase, Cochrane Colombia will be coordinated and led by Professor Maria Ximena Rojas-Reyes from the Pontifical Xaverian University: “The launch of Cochrane Colombia is a recognition to the voluntary work done for years by different Colombian professors, students and health care professionals that believe in evidence based health care. Producing and increasing the dissemination of the best available information on healthcare is critical for clinicians and patients everywhere in the world. The centers that today give life to Cochrane Colombia have been working hard for more than 20 years in promoting the use of evidence in health care and policy decisions in our country. With the establishment of Cochrane Colombia as a formal Centre, we can expand our work, to support the synthesis of evidence according with Colombia´s needs for health decision making, while continuing the training people in the use of evidence and particularly the Cochrane evidence” 

Hernando G Gaitán, Coordinating Editor of the Cochrane Sexually Transmitted Infections Group: "The Cochrane Colombia Centre will strengthen the leadership that Colombian researchers have in knowledge translation products such as Clinical Practice Guidelines and Health Technology assessment reports.  Also with the new Center different opportunities for training and participation in Systematic Reviews will come up and we are sure the Groups, and authors, located in Colombia will improve their performance."

Xavier Bonfill, director of the Iberoamerican Cochrane Center and Network, expresses his congratulations: “The launch of Cochrane Colombia is a culmination of many years of Colombian participation in the Cochrane Collaboration and, specifically, in the Iberoamerican Network. Progressively, a variety of people working in different institutions have been involved as authors, trainers or have contributed in other important tasks such as trials identification, as it is reflected in the corresponding data. Now there are the necessary conditions for assuming the challenges of being a national Centre, which should bring more opportunities for working together and making more significant contributions to Cochrane and to their country”.

Cochrane’s Chief Executive Officer, Mark Wilson, warmly welcomed today’s news: “I am delighted we are announcing the launch of Cochrane Colombia, which I’m confident will deepen and expand the reach and impact of Cochrane activities on health and healthcare decision-making across Colombia and therefore improve health outcomes for its 50 million citizens.”

Cochrane Colombia will remain closely connected to the Cochrane Iberoamerican Network, through which methodological support, mentoring, and supervision will be provided.

Monday, March 4, 2019

The Thomas C Chalmers Award - 2018 Award Winner, Leonie Van Grootel

Fri, 03/01/2019 - 11:57

The Thomas C Chalmers Award is awarded to the principal author of the best oral and the best poster presentation addressing methodological issues related to systematic reviews.

Tom Chalmers (1917-1995) was an outspoken advocate of randomised trials, whether at the bedside, at professional meetings, in class or in situations pertaining to his own life. His creativity spanned his entire career, influencing clinicians and methodologists alike. He is perhaps best known for the notion ‘randomise the first patient’, his belief that it is more ethical to randomise patients than to treat them in the absence of good evidence. In his later years, in arguably his most important work, Tom and his colleagues showed that, had information from RCTs been systematically and cumulatively synthesised, important treatments such as thrombolytic therapy for myocardial infarction would have been recognised as useful much earlier.

For more information on the prize eligibilty and criteria, visit the Colloquium Prize page. The call for abstracts is open and the deadline for submission is 12 April 2019. Abstracts for oral presentations and posters are invited in areas relevant to the work of Cochrane as well as evidence-based practice, policy, methodology, and advocacy.

In 2018, the winner of best short oral presentation winner was Leonie Van Grootel for 'Using Bayesian information for matchinig qualitative and quantative sources in a mixed studies review'. We spoke to Leonie on what winning the Thomas C Chalmers Award 2018 has meant to her.

"I am an assistant professor at the department of Methodology & Statistics, Faculty of Social Sciences, Tilburg University., the Netherlands. In addition, I also have relations with the EPPI-Centre at University College London, for we are working on several short-time appointments as a visiting fellow.

I was planning to go to the Cochrane Edinburgh Colloquium and talk about my research on mixed studies reviewing methodology. When checking the program, I never imagined that would have any chance at winning such a prestigious award. However, when reading the description of what the award stood for, I was triggered by the aspect of methodological innovation. Since I consider methodological innovation in reviews a central aspect in my work, I decided to give it a try.

First of all, a great honour to receive at the start of my academic career. The fact that a leading organization as Cochrane welcomes my ideas is very flattering. In addition to that, I very much appreciate the recognition of Cochrane for the potential of incorporation of qualitative research for systematic reviews - which is the main issue discussed in my presentation and paper. Qualitative research will, I believe, becoming increasingly important for systematic reviews in medical and health sciences, and the potential of mixed studies reviews has not yet been reached. Thanks to the recognition of Cochrane for this topic, I am confident that further pursuing research in this field is worthwhile and can possibly aid evidence-based medicine and clinical practice. I am currently even applying for research funding for research on this very topic; and the Cochrane prize on my CV will definitely increase my chances of getting it.

My message to other colleagues or Cochrane collaborators who are considering applying for this award is to keep believing in doing the research that you feel is important for evidence practice. Even if the topic might not be popular or at the top of the agenda of the big institutions or funding agencies; do not let your research agenda be determined by what is expected from you or what happen to be ‘hot topics’ but stand for what you really think is important. Your audience will notice your genuine dedication to your work and will appreciate it."

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

Wednesday, March 6, 2019

Featured Review: Mediterranean-style diet for the prevention of cardiovascular disease

Wed, 02/27/2019 - 14:53
In this Q&A we asked the lead author Professor Saverio Stranges from Western University Canada to explain more about the mediterranean diet and its role in preventing cardiovascular disease following the publication of a Cochrane Review on this topic. What makes a diet ‘Mediterranean’?Scientific interest in the traditional Mediterranean dietary pattern originated in the 1960s because of the observation that populations in countries of the Mediterranean region, such as Greece and Italy, had lower mortality from cardiovascular disease compared with northern European populations or the US, probably as a result of different eating habits. Key components of a Mediterranean dietary pattern are a high monounsaturated/saturated fat ratio (use of olive oil as main cooking ingredient and/or consumption of other traditional foods high in monounsaturated fats such as tree nuts) and a high intake of plant based foods, including fruits, vegetables, and legumes. How might consuming these kinds of foods help to reduce the risk of heart disease and stroke?There is ample observational and experimental evidence supporting potential mechanisms to explain the beneficial effect of the Mediterranean diet on cardiovascular health. For example, there is evidence of favourable effects of the Mediterranean diet on insulin resistance and endothelium-dependent vasoreactivity, as well as of the antioxidant and anti-inflammatory effects of the Mediterranean diet and its individual components such as fruits and vegetables, olive oil, nuts, whole grains, fish and red wine. Overall, the protective effects of the Mediterranean Diet on health outcomes are likely derived from synergistic interactions among different components as a whole dietary pattern rather than from relative effects of specific food groups. The Cochrane Review looks at primary and secondary prevention. What’s the difference between the two types of population you studied in the review?Primary prevention refers to adults without established cardiovascular disease (CVD), such as previous myocardial infarction, stroke, revascularisation procedure, angina, cerebrovascular disease (stroke) and peripheral arterial disease. Secondary prevention refers to individuals with established CVD. We wanted to examine the potential effect of a Mediterranean dietary pattern in both populations, to assess the impact of this intervention at different stages of the natural history of CVD.  What are the main findings based on the outcomes of most importance in the Cochrane Review?Despite the large number of trials included in the review there is still uncertainty regarding the effects of a Mediterranean-style diet on CVD clinical endpoints for both primary and secondary prevention. Overall, the available trial evidence is promising (though not conclusive) and generally supportive of favourable effects of the Mediterranean-style diet on individual cardio-metabolic risk factors (i.e., total cholesterol, systolic and diastolic blood pressure and type 2 diabetes) in primary prevention studies, and potentially cardiovascular morbidity (stroke) and mortality. One of the trials that was included in the review has been subject to some criticism following its retraction and subsequent republication. It’s a particularly influential trial (PREDIMED) and it’s been blogged about by Hilda Bastian recently.

What happened with this trial and do you think we can still trust its findings?The original trial (Estruch 2013) was retracted and re-analysed when methodological issues concerning randomisation came to light for 2 sites, and the inclusion of non-randomised second household members. The new publication (Estruch 2018) controlled for these in the analyses and conducted a series of sensitivity analyses excluding these sites. The re-analysed paper also reports clinical endpoints separately where there was low quality evidence of little or no effect of the PREDIMED intervention compared to a low fat diet on total mortality, CVD mortality, or MI, but moderate quality evidence of a reduction in the number of strokes was seen with the intervention.

Overall, we should treat findings from this trial with extreme caution, given the number of methodological issues flagged, as also clearly outlined by Hilda Bastian’s piece.  There are other studies in the review that you had concerns over. Does this reflect problems in running studies or could misconduct be the problem here?Both issues are possible indeed. Concerns have been publicly raised about potential scientific misconduct and data fabrication, as well as about the integrity and reliability of the published data for a few secondary preventions trials (Singh 1992; Singh 2002).  The review includes a large number of studies yet provides only low or very low certainty evidence. Can you explain why this is? Overall, there were limited data on clinical endpoints, our primary outcome. Two studies were excluded from all main analyses in sensitivity analyses due to published concerns regarding the reliability of the data (Singh 1992; Singh 2002). Only one trial reported clinical endpoints for primary prevention and this study experienced methodological issues regarding randomisation with the report subsequently being retracted and re-analysed (PREDIMED). The findings in secondary prevention are based on one older trial reporting very large effect estimates (The Lyon Diet Heart Study) using a modified Zelan design. In addition, both the PREDIMED trial and The Lyon Diet Heart Study supplied supplemental foods as well as dietary advice to follow a Mediterranean-style diet so the policy implications of the findings of these trials are unclear (Appel 2013). The majority of studies included in this review were at unclear risk of bias for many of the risk of bias domains so results should be interpreted cautiously. High risk of bias was noted for differential attrition rates between the intervention and control groups in two trials (Djuric 2009; Vincent-Baudry 2005), and high risk of other bias in two trials where there are published concerns regarding the reliability of the data (Singh 1992; Singh 2002). These two studies have been excluded from the main analyses. What sort of studies do we need now to address the uncertainties that the review has identified?Several ongoing trials have been identified, particularly reporting clinical endpoints in secondary prevention, which will add to the evidence base. Further adequately powered primary prevention trials are needed to confirm findings on clinical endpoints to date. With the accrual of further evidence, the heterogeneity observed between trials in terms of both the nature and duration of the intervention, comparators, and the range of participants recruited can be explored further and its impact on outcomes examined. The ongoing studies may help reduce the uncertainty. Wednesday, March 13, 2019

Podcast: Laparoscopy versus laparotomy for the management of presumed early stage endometrial cancer

Tue, 02/26/2019 - 13:46

Recent decades have seen greater and greater use of laparoscopy, or keyhole surgery, when people need an operation on their abdomen. There are now dozens of Cochrane Reviews of this, for a wide variety of conditions and, in October 2018, the one for laparoscopy versus laparotomy, or open surgery, for women with early stage endometrial cancer was updated. The review is led by Khadra Galaal from the Royal Cornwall Hospital in Truro in the UK and she tells us the latest findings in this podcast.

"Worldwide, cancer of the womb or 'endometrial cancer' is the fifth most common cancer among women under 65 years of age, with a higher incidence in high income countries than in low and middle income countries. The current standard treatment is a hysterectomy to remove the woman’s womb and removal of her fallopian tubes and ovaries. Other treatments include radiotherapy and chemotherapy. Traditionally, the surgery has been done as a laparotomy, through an open cut in the abdomen, and our review compares this technique against laparoscopic or keyhole surgery.

We looked at the effects of the two types of surgery on how long women remained alive after the diagnosis of their cancer and the length of time that they remained disease‐free. We were able to use results from six randomised trials that had analysed data for nearly 4000 participants with early stage endometrial cancer. We found no significant difference in the risk of death between the women who underwent laparoscopy and those who underwent laparotomy. In addition, results from five randomised trials confirmed no difference in the risk of cancer recurrence if women had laparoscopy or laparotomy. Notably, laparoscopy was associated with less blood loss and earlier discharge from hospital.

In summary, this update confirms the findings of our previous review from six years ago, that laparoscopy is an effective and viable alternative to laparotomy for the treatment of women with early stage endometrial cancer. With regards to long term survival, outcomes for laparoscopy are comparable to laparotomy."

Tuesday, February 26, 2019

Apply now: the Cochrane-REWARD prize for reducing waste in research

Fri, 02/22/2019 - 14:59

Nominations are open for the 2019 Cochrane-REWARD prize, which recognizes initiatives that have potential to reduce research waste.

An estimated $170 billion of research funding is wasted each year because its outcomes cannot be used [1]. The waste occurs during 5 stages of research production: question selection, study design, research conduct, publication, and reporting [2,3]. Much of this waste appears to be avoidable or remediable, but there are few proposed solutions.  

The Cochrane-REWARD prize was established in 2017 to stimulate and promote research in this area.  

Cochrane is now calling for nominations for the 2019 prize

All nominations will be assessed using the following criteria:
1.    The nominee has addressed at least one of the 5 stages of waste (questions, design, conduct, publication, reporting) in health research;
2.    The nominee has pilot or more definitive data showing the initiative can lower waste;
3.    The initiative can be scaled up;
4.    The estimated potential reduction in research waste that the initiative might achieve.

Nominations for the 2019 prize should be submitted by 5 June 2019. Two prizes will be awarded (a 1st prize of £1500 and a 2nd prize of £1000), but other shortlisted candidates will also be highlighted to help disseminate good ideas.

The winners of the 2019 prize will be announced at the 5th International Clinical Trials Methodology Conference, which will take place in Brighton, UK on 6-9 October 2019.

More information on the prize and how to submit a nomination
Read about the previous winners of the Cochrane-REWARD prize

Deadline for submissions: 5 June


  1. Chalmers I, Glasziou P. Avoidable waste in the production and reporting of research evidence. Lancet. 2009 Jul 4;374(9683):86-9.
  2.  Macleod MR, Michie S, Roberts I, et al. Biomedical research: increasing value, reducing waste. Lancet. 2014 Jan 11;383(9912):101-4.
  3. Glasziou P, Altman DG, Bossuyt P, et al. Reducing waste from incomplete or unusable reports of biomedical research. Lancet. 2014 Jan 18;383(9913):267-76.
  4. Glasziou, P and Chalmers, I. Research waste is still a scandal—an essay by Paul Glasziou and Iain Chalmers. BMJ. 2018 Nov 12;363:k4645


Friday, February 22, 2019

Elections to the Cochrane Consumer Executive open

Thu, 02/21/2019 - 12:12

Are you interested in taking a leadership role in the Cochrane consumer community? Cochrane’s Consumer Engagement Officer; Richard Morley, and Consumer Executive member; Nancy Fitton explain what’s involved and how to apply.

"Cochrane is an amazing movement to change the way that evidence is produced and used. It is a global community of over 63,000 supporters and members who use and create new knowledge so that healthcare decisions can be made using reliable evidence.

A feature of its work since 1994 has been to support a global network of healthcare consumers (patients, care-givers, and family members) of over 1550 people who help produce Cochrane evidence by setting priorities for future research, defining outcomes in reviews, working alongside researchers, peer reviewing abstracts and reviews, and helping to disseminate evidence. They work with Cochrane’s network of Review Groups, Centres and Fields. And they are part of the governance of the organisation.

One of the ways in which consumers do this latter role is by being part of the Consumer Network Executive. This group of consumers has an important role to play in representing the voice of consumers, they help to take forward work that improves the way that Cochrane works with consumers, and make its evidence accessible to its non-scientist users.

Over recent years the Consumers Executive has helped produce the Consumer Structure and Function Review (2015) and Consumer Delivery Plan (2016), setting out the ways in which consumer involvement will be improved. It formed a group that developed the Statement of Principles for Consumer Involvement in Cochrane (2017). The Executive has supported many consumers at Colloquia, Cochrane’s annual meeting. It has commented on a range of policy documents like the recent Peer Review policy that now makes it mandatory to seek consumer peer review on protocols and reviews. Presently it is working with the network of Cochrane Centres to spread consumer involvement and engagement across our global organisation.
Nancy Fitton, member of the present Consumers Executive, shares her experience of being a member of the group.

It has been a privilege to serve on the Consumer Executive for the last five years.  Each member of the CE has their unique skill set, point of view, and experience with Cochrane.  We are all from different countries.  These differences provide a rich mix of input for the tasks that we undertake.

The work of Cochrane is very important to us.  Of course, the participation of consumers in that work is of utmost importance.  We work, through various channels, to improve the experience of consumers involved in Cochrane, and to help Cochrane groups embrace consumers as members of the team.  This has been a very rewarding endeavour for me.  Additionally, the other members of the CE are excellent co-workers in this task.  We have an outstanding champion in our Consumer Engagement Officer, Richard Morley.
If you have wished that you had more input into “how things are done,” and would like to build on your involvement with Cochrane by contributing to the consumer experience, you might consider running for a spot on the Consumer Executive."
Members of the Consumers Executive are elected by the whole membership of the consumer community, for a period of three years, with an option to stand for a further period. Elected members are asked to attend monthly online or telephone meetings, to undertake some work in between meetings, and to come to the Mid-year business gathering that takes place in April each year, and the Colloquium (where funding allows). This is not a paid post, but all expenses are met by Cochrane. The Consumers Executive also appoints two people to serve on the Cochrane Council. Members of the Executive are supported by Cochrane’s Consumer Engagement Officer.

This year there are two vacancies to be filled and one of those positions is kept for someone from a Low and Middle-income country.  We are particularly keen to encourage people to come forward who can provide leadership to the network, can represent the consumer voice to the wider Cochrane community, support the wider network in its ambition to involve consumers, and actively contribute to the debate about the best ways to involve consumers in the organisation. It’s important to know that the function of all Cochrane’s Executive groups is being reviewed.

If you are still interested, you can download the document that explains how to apply.

Nominations close Friday 29th March 2019

Thursday, February 21, 2019

World Oral Health Day

Wed, 02/20/2019 - 20:28

World Oral Health Day is celebrated globally every year on 20 March. It helps to spread messages about good oral hygiene practices and demonstrates the importance of optimal oral health in maintaining general health and well-being. It's an excellent time to put the spotlight on related Cochrane evidence.

Cochrane Oral Health publishes systematic reviews of the best quality research available to help patients, carers, clinicians, researchers, and funders make better informed decisions about oral healthcare choices. Cochrane Oral Health's work is carried out by over 1600 members, with over 900 authors from more than 40 different countries.

What do you think are the most important questions to answer in taking care of the mouth, teeth, and gums? Cochrane Oral wants your view on which systematic reviews they should undertake or update. Please take a few minutes to fill out this survey!

Featured EvidenceEvidently Cochrane Blogs View more Cochrane Oral Health Evidence


Friday, March 15, 2019

World Tuberculosis Day

Wed, 02/20/2019 - 18:04

Cochrane Library release Special Collection on diagnosing tuberculosis

 World Tuberculosis Day is marked annual on 24 March as it commemorates the date in 1882 when Dr. Robert Koch announced his discovery of Mycobacterium tuberculosis, the bacillus that causes tuberculosis (TB).

Tuberculosis (TB) causes more deaths globally than any other infectious disease and is a top 10 cause of death worldwide. When it is detected early and effectively treated, TB is largely curable, but in 2017, around 1.6 million people died of tuberculosis, including 300,000 people living with HIV.[1] Early diagnosis of TB, including universal drug susceptibility testing and systematic screening of contacts and high-risk groups, is a pillar of the World Health Organization (WHO) "End TB" strategy.

The Cochrane Library has released a Special Collection, curated by Cochrane contributors, includes Cochrane Reviews from the Cochrane Infectious Diseases Group and other systematic reviews from other international teams. It highlights how Cochrane evidence contributes within a wider landscape of TB evidence and guidelines. The Collection also describes key WHO guidelines on TB diagnostics, and their underpinning systematic reviews, some which are published within the WHO Guideline itself. 

This Special Collection covers:

  • Early detection of TB
  • Diagnosis of active TB disease and TB drug resistance
  • Diagnosis of TB in people living with HIV
  • Diagnosis of TB in children
  • Diagnosis of latent TB infection

View the Special Collection: Diagnosing Tuberculosis


Sunday, March 24, 2019

Cochrane's 30 under 30: Ibrahem Hanafi

Wed, 02/20/2019 - 17:18

Cochrane is made up of 13,000 members and over 50,000 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 a new 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.

We're keen to hear from you. Would you like to take part in this series? Do you know someone you'd like to see interviewed? Contact  Or if you want to know more about Cochrane’s work contact where our community support team will be happy to answer your questions.

Name: Ibrahem Hanafi (on Twitter at @Ibrahem_Hanafi )
Age: 24
Occupation: Resident Physician
Program: Neurology Residency, Internal Medicine Department, Faculty of Medicine, Damascus University, Damascus, Syria

How did you first hear about Cochrane?
I first heard about Cochrane before being admitted to the faculty of medicine in a conference about medical information resources.  Since then, Cochrane left a lasting impression on me for being a collaboration aiming at improving healthcare services all over the world. It was not until my second year at med school, when I attended a workshop about evidence-based medicine and conducting systematic reviews, that I started applying for participations in Cochrane review groups. That was not just my entry to the Cochrane community, but also to the world of evidence-based medicine as a whole.

How did you become involved with Cochrane? What is your background?
The first time I applied to get involved with Cochrane was in my third year at the faculty of medicine. My application consisted of the few skills I learned through the 8-hour workshop and the huge motivation I had to join their elite researchers. In Damascus University and even in Syria, there is no geographic group for Cochrane, and it was hard for us to start an overseas project for the first time with people we have never met. Nevertheless, several friends and I succeeded to participate and publish with Cochrane. Initially, I had some difficulties catching up with the required tasks, however, I was promptly provided with all the assistance I needed by the review group I got involved in.

What do you do in Cochrane?
I am an author in Schizophrenia and Lung Cancer review groups and a referee in Common Mental Disorders and Pain, Palliative and Supportive Care groups. I am also a member of Cochrane Trainers’ Network, which contributed greatly to my Cochrane experience. I have participated as a trainer in a Cochrane training workshop in Damascus, and organized a full workshop for conducting Cochrane systematic reviews for the first time in Aleppo. Furthermore, I had the honour to receive a stipend from Cochrane to attend GRADE CERQual Training in Modena, Italy in 2017, where I was the youngest trainee amongst a group of esteemed reviewers from all over the world.

What specifically do you enjoy about working for Cochrane and what have you learnt?
What I truly like about Cochrane is that it is not just a network for collaborative work, but also a pooled innovative learning spot. In Cochrane, I always feel active learning and applying new tools and techniques, as well as pumping and absorbing experience from peers. Fortunately, Cochrane also provides equal opportunities for individuals whether young or experienced to get involved in that collaborative community.

What are your future plans?
My plans start from completing my specialization in Neurology and getting trained to become a professional medical researcher with experience, ensuring high standards in exploring and investigating the edges of neuroscience. Then, I plan to start and lead my own research lab that will aim to further investigate the behavioural and cognitive neuroscience aspects of the people suffering from psychological stress in war-torn countries.

In your personal experience, what one thing could Cochrane do better to improve its global profile?
I think Cochrane is paying much attention to involving young people, however, it does not always reach them all, especially in countries with limited research productivity. I suggest creating groups for Cochrane supporting individuals in each country/city/med-school to encourage medical students and residents to get involved in Cochrane’s various projects. These groups would facilitate contact with Cochrane, build review teams, and share previous experiences in the countries that do not have any Cochrane geographical centres.

What do you hope for Cochrane for the future?
I hope that Cochrane keeps its fresh projects up, as well as further facilitating the involvement of young individuals, in addition to getting them mentored and supported by experienced researchers. I also hope that Cochrane becomes more popular in third-world countries where medical research collaborations are being absent the most.

How important is it that young people get involved in Cochrane?
Since experience can sometimes have the side effect of narrowing the horizons of creativity, young unexperienced people have the ability to make new innovative projects out of very little supplies. Although Cochrane has much power in the fields of medical research, I think young medical personnel are its main and constant mean to spin the wheel of boosting the quality of healthcare systems worldwide in the near future.

Why is this, do you think?
People who get involved in high quality medical knowledge synthesis while young, will always stick to evidence during their practice and will also give medicine a great push towards evidence-based practice in a not so far future.

What would your message be to other young people who want to get involved with Cochrane’s work but not sure where to start….?
Never hesitate! Many experienced Cochrane reviewers now were as young and unexperienced as you when they decided to take the initiative themselves! You will be supported with facilitating resources and courses throughout your probable interesting journey with Cochrane. All you need is an open-mind, flexible skills, and some of your time.

Tuesday, March 12, 2019

Cochrane seeks HR Assistant - London, UK

Wed, 02/20/2019 - 12:26

Specifications: Part time 18.75 hours per week (0.5 FTE), days and times to be agreed
Salary: £28,000 pro rata
Location: London - with flexibility to work from home 1 day a week
Application Closing Date: 3rd March 2019

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

As part of the Human Resources Team, the HR Assistant assists with the administration of the day-to-day operations of the HR functions and duties.

Key tasks:

  • Work with the HR Team in providing HR support to deliver a responsive, pro-active HR function.
  • To support the smooth running of the recruitment process by providing guidance to managers, responding to applicants and scheduling interviews.
  • To respond to general and specific queries from staff in relation to their employment terms and conditions, local entitlements and HR policies.
  • To generate letters and appropriate paperwork covering the full range of employee lifecycle events, including job offers, contracts, training courses, holidays and other absences.
  • To support the HR Team in the delivery of HR related projects.
  • To use and maintain the HR database and contribute to its development and best use
  • To attend HR team meetings, contributing to the smooth running and development of the HR function in providing a quality service to the organisation as a whole.
  • To maintain confidentiality at all times
  • In line with other HR staff, to manage queries via shared HR mailboxes, ensuring queries are dealt with or referred on as appropriate.
  • Supporting meetings as required including co-ordinating agendas, taking minutes, circulating paperwork and organising refreshments
  • To undertake other tasks in support of team objectives and at the appropriate level as allocated by the HR Manager
  • Undertake other duties that may be considered appropriate to the role, including supporting the admin function across the organisation.
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 candidate will also have:

Essential Knowledge, Skills and Abilities:
  • Good IT skills across MS Office and databases, sufficient to input and retrieve data
  • Good interpersonal skills with the ability to build good working relationships with a range of contacts
  • Self-confidence, personal credibility and the ability to challenge others appropriately
  • Very good communication skills sufficient to respond to varied queries verbally and in writing in a clearly understood way
  • Good written English, sufficient to draft guidance and correspondence
  • Proven ability to work both independently and productively as part of a team
  • Ability to accomplish projects with little supervision
  • Very good organisational and time management skills with the ability to prioritise work efficiently to meet deadlines
  • Good understanding of and ability to apply the principles of confidentiality
  • High attention to detail
  • Pragmatism and problem-solving skills and the ability to think creatively when faced with new problems
  • Commitment to Cochrane’s mission and values


  • Experience of healthcare charity sector
  • CIPD qualification
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 “HR Assistant” 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: 3rd March 2019 (12 midnight GMT)
Interviews to be held on: w/c 11th March 2019 (TBC)
Wednesday, February 20, 2019