We hope you enjoyed the Global Evidence Summit in Cape Town. Your feedback is important, please fill in our short survey on your experiences of the event here: surveymonkey.com/r/GESummit
The Global Evidence Summit was the first time that Cochrane, The Campbell Collaboration, Guidelines International Network, International Society for Evidence-based Health Care, and Joanna Briggs Institute have joined forces to create this premiere event in evidence-based policy.
The theme of the Summit was ‘Using evidence. Improving lives’ and aimed to advance the use of reliable research evidence in addressing some of the world’s most serious health and social challenges. Attendees from across the world were exposed to an illuminating line-up of content and world-class speakers and facilitators that intrigued and engaged wide audiences. We were also treated to an astonishing array of social events and entertainment including talented performers from the Drum Café, gumboot dancing, and the Marimba band. Here are just a few highlights from the week that was, The Global Evidence Summit 13 – 17th September 2017.Community Experience
- #thingswelearnt at #GESSummit17: a twitter summary.
- Blog post by Evidence Synthesis Team.
- Networking session between senior health researchers and students.
- Cochrane Croatia celebrates the GES
- The Nordic Cochrane Centre at GES Summit 2017
- Evidence in a Post-Truth World - Global Evidence Summit 2017: Blog post by a Ph.D. student who attended the GES.
- Cochrane Africa officially launches; a network with a vision to increase the use of best evidence to inform healthcare decision-making across the sub-Saharan African continent.
- Promoting evidence-based health care in Africa; interview with the Director of Cochrane South Africa.
Cochrane's community recognizes success : Find out more about new initiatives to get involved with our work and share with the community and beyond.
How Cochrane's partners recognize and define our success: Cochrane's partnerships play an essential role in developing and sharing our evidence with key people and organizations across the health community.
Patients and their stories: Three stories about how Cochrane evidence has affected people's lives and how these experiences have contributed to Cochrane's work.Tweet from GES
On Saturday 16 September several students from a school near Cape Town attended the morning plenary at the Global Evidence Summit. The students go to school at the Centre Of Science and Technology (COSAT). They were accompanied by their principal and two mentors from the Children’s Radio Foundation who are training them to create radio journalism on public health topics. Following the plenary the students interviewed each of the presenting experts on the topic of evidence in a post-truth world.Wednesday, September 27, 2017
Students and teachers play an important role in Cochrane. They are involved in educating the next generation of healthcare professionals about evidence-based medicine, directly contributing to a global effort of identifying health evidence, to translating Cochrane evidence in 14 different languages.
Hanna Martikainen conducts PhD research at Paris Diderot University on the French-language translation of Cochrane Systematic Review abstracts. Having previously worked as a translation coordinator and post-editor for Cochrane France, she now teaches a class in post-editing medical LSP at the Department of Cross-Cultural Studies and Applied Languages (EILA) at Paris Diderot University. During the past academic year (2016-2017), second year Master’s students in specialized translation have had a unique opportunity to contribute to the French translation project by post-editing machine-translated Cochrane abstracts and Plain Language Summaries. The project has been renewed for the coming academic year and the students have shared their experience here.
Marie, Angèle, Margarita, Pierre, and Pauline described the profiles and general background of students in their second year Master’s degree in specialized translation: "We are a group of 20 students from the ILTS (Industrie de la Langue et Traduction Spécialisée) Master’s degree at Paris Diderot University This course is open to students with prior translation experience in which is the case for most of us, but also to students who have technical experience and who speak at least two languages. None of our courses had trained us to domedical translation. Each one of us had the opportunity to post-edit five medical texts for Cochrane. It was a great experience because we discovered a new field and a new way to work with languages.”
Vera, Marie, Lionelle, Marion, and Justine explained their post-editing work: "Post-editing consists of editing automatic translation produced by a machine. You may already have used machine translation such as Google Translate. Post-editing will undoubtedly play an important part in the future of translation since it will help improve productivity and reduce costs. During the post-editing process, we often had to rephrase or rearrange long and complex sentences, and fix mistranslations, grammatical errors, and inconsistencies."
Nadjet, Mélanie, Pauline, and Lucie noted the specificities of medical English and their importance when translating: "We noticed that English terms do not necessarily belong to languages for specific purposes (LSP), they often seem very simplified. In French, it is quite the opposite since specialized terminology of Latin origin is almost the only one to be used in both LSP and general language.Also the use of passive sentences in English is very common, while we are instructed to avoid them in French as much as possible.”
Joanna, Maya, Camille, Bruno, and Mickaël discussed how their pre-conceived expectations compared to the reality of post-editing: "We thought it would be necessary to have medicine-related knowledge. In reality, the first paragraphs gave us a good grasp of the subject. We simply needed to do some extra research to make sure the terminology was accurate and we had correctly understood the process of thought. Ofcoursethe machine version is not entirely reliable but it was far more efficient than we expected."
Post-editing machine-translated Cochrane texts gave the students a hands-on introduction not only to this recent and booming domain of translation industries, but also to the specificities of medical translation. Moreover, the experience was a professionalizing one, given that the student post-editions were all published on Cochrane websites with acknowledgment given to post-editors.If you are a student, learn about the many ways you can get involved with Cochane:
- Students for Best Evidence: a network for students interested in evidence-based healthcare
- Translate Cochrane evidence: learn about translating Cochrane materials
- Cochrane Crowd: become a Cochrane citizen scientist.
- Join Cochrane: help us improve the health of people everywhere
Dementia Awareness Week, 20-27 May 2019, is a week on which organizations around the world concentrate their efforts on raising awareness about dementia.
Cochrane Dementia and Cognitive Improvement remit includes producing systematic reviews of both global cognitive impairment and focal cognitive impairments occurring in the context of brain disease. Many of these reviews are concerned with dementia and the Dementia Awareness Week provides an opportunity to put the spotlight on some of this Cochrane health evidence.
Many of us are caring for a family member with dementia, know someone with dementia, or may be looking ahead to our own futures, perhaps wondering what we could do to avoid or delay developing dementia ourselves. There are also many working in health and social care, and numerous third sector organisations, looking after and supporting people with dementia; and researchers working to change the future of dementia. There can’t be very many of us not touched by dementia in some way, which is why we have rounded-up some Cochrane evidence on dementia.
Take a look at these Evidently Cochrane blog posts featuring Cochrane Review evidence:
- Dementia in the spotlight: Evidence and Experience. An introduction to the blog series.
- Do memories matter? Is reminiscence over-rated as a therapy for people with dementia? Dementia care practitioner and researcher Bob Woods talks about reminiscence therapy and the evidence which he and his colleagues brought together in their recent Cochrane Review.
- I have dementia and I take part in research. Here’s why. Patient with young onset dementia writes about taking part in dementia research, being valued, and opportunities to change the future.
- Rivastigmine reviewed: doubts about dementia drug. Care home nurse reflects on Cochrane evidence on rivastigmine and the use of this drug in practice.
- Drug withdrawal in people with dementia: what we know. Geriatrician features two Cochrane reviews on statin withdrawal and on antihypertensive withdrawal in people with dementia.
- Arts therapies for dementia: “where words leave off, music begins”. Joint Co-Editor for Cochrane Dementia and Cognitive Improvement looks at the latest Cochrane evidence for creative arts therapies for people with dementia; music, dance, and visual arts.
- Carers of people with dementia: with them, through to the end of it. A look at the state of the evidence on interventions that might help carers of people with dementia and a look at their experiences.
- Cerebrolysin for vascular dementia: how much evidence is enough? A blog post designed for a scientific audience looking at a putative treatment for vascular dementia called Cerebrolysin.
- Diagnosing dementia: is a questionnaire (IQCODE) good enough? A blog post for members of the public and the professionals who care for them that summarises the findings of a series of Cochrane reviews describing a structured questionnaire that is used to help identify possible dementia. The questionnaire is called the IQCODE (Informant Questionnaire for COgnitive Decline in the Elderly).
Cochrane is delighted to announce the official launch of its new, online introductory training course on how to conduct a systematic review of interventions.
As part of the launch of Cochrane’s new online learning programme, Cochrane Interactive Learning, Cochrane authors and other producers of systematic reviews from across the world will be able to access self-directed learning on framing a review, searching for studies, risk of bias assessment, meta-analysis, GRADE and the complete systematic review process, developed by world-leading experts in systematic review methods.
Cochrane Interactive Learning is a new offering from Cochrane, a global, independent network of researchers, professionals, patients, carers and people interested in health. The online learning modules will promote evidence-based decision making in healthcare globally by supporting and training authors of Cochrane Reviews and other systematic reviews of healthcare interventions.
New learners will have the chance to embark on modular, interactive training on how to produce systematic reviews, and experienced authors and can refresh their skills with the latest guidance and best practice.
Miranda Cumpston, Cochrane’s Head of Learning and Support, says this is a hugely exciting opportunity: “Our new online training course offers dynamic, flexible and engaging content with nine modules and over 100 bite-size learning units, building knowledge for new and existing authors one step at a time. They provide clear explanations with stimulating interactions, quizzes, animations, examples and reference resources, and enable learners to tailor their learning experience, in their own time, and from anywhere in the world, from a laptop, tablet or phone.”
Charlotte Pestridge, CEO of Cochrane Innovations, adds “Cochrane Interactive Learning will also serve educators in evidence-based health care, providers of professional development to researchers or health professionals, researchers within guideline development or HTA settings, commercial research organisations, and commissioners of systematic reviews who rely on rigorous methods to make evidence-informed decisions.”
The first four modules of Cochrane Interactive Learning are available now for free trial access for individuals and institutions.
Find out more:
Cochrane is a global independent network of researchers, professionals, patients, carers and people interested in health.
Cochrane produces reviews which study all of the best available evidence generated through research and make it easier to inform decisions about health. These are called systematic reviews.
Cochrane is a not-for profit organisation with collaborators from more than 120 countries working together to produce credible, accessible health information that is free from commercial sponsorship and other conflicts of interest. Our work is recognised as representing an international gold standard for high quality, trusted information.
Follow us on twitter @cochranecollab
If you are a journalist or member of the press and wish to receive news alerts before their online publication or if you wish to arrange an interview with an author, please contact the Cochrane press office: firstname.lastname@example.orgTuesday, September 19, 2017
Cochrane, a global independent network of researchers, professionals, patients, carers and people interested in health will be holding the 25th annual Cochrane Colloquium at the Edinburgh International Conference Centre in Scotland from 15th to 18th September 2018. It will be hosted by Cochrane UK.
The theme of the Colloquium will be:
‘Cochrane for all – better evidence for better health decisions’
This will be a Colloquium for everyone. It will welcome newcomers to Cochrane from all parts of the world and from all backgrounds. One of the key aims is to increase the involvement of patients, carers and family members (healthcare consumers) in our work. As such, the Colloquium 2018 will be a Patients Included event that is co-designed, co-produced and co-presented by healthcare consumers and where everyone’s input is valued equally.
The Colloquium 2018 will focus on the key goals of Cochrane’s Strategy to 2020, looking through the eyes of healthcare consumers and in partnership with them:
- Producing evidence
- Making evidence accessible
- Advocating for evidence
- Effective and sustainable organization
Martin Burton, Director of Cochrane UK, said: “We have been asked why our focus is on patients, when Cochrane has so many different stakeholders, and we know that all stakeholders ultimately share the same goal – better health for patients. We believe we can best achieve this by working together as equal partners.
We want to make this an inclusive, inspiring and accessible event. We also want to build on our existing work involving and engaging with consumers, to take this engagement to a new level after the event is over”.
For more on the rationale behind making the 2018 Colloquium a ‘Patients Included’ event, you can read a blog here co-authored by Cochrane Consumer Co-ordinator Richard Morley, and Cochrane UK's Director Martin Burton and Sarah Chapman. At the bottom of the blog there is a survey inviting suggestions for making the Colloquium a ‘Patients Included’ event.
More detail on dates, registration, and the scientific programme will be announced in the coming months.
Twitter: @CochraneUK #cochraneforall
Registration will open in late 2017.
Communications and Media Consultant, Cochrane UK
I am delighted to announce a new initiative that I believe will transform Cochrane as an evidence-producing and knowledge-diffusing organization. Today, we are proud to launch our new Cochrane Membership scheme, making it easier than ever before for anyone from anywhere in the world to become a part of our global community of supporters and collaborators passionate about improving healthcare decisions.
The Cochrane Membership scheme will enable us to grow our collaboration, attracting many new people with a wider range of experience and skills into our work, and allowing us to recognize their contributions and sustain our global activities for better health outcomes.
Cochrane’s past, present, and future success is built on the quality of the people it attracts and retains. We are so proud of the tens of thousands of volunteers who already work with us because we know that what we do and the impact for good that we have as an organization are rooted in their efforts. And from today, that world is becoming wider; a world where decisions about health and health care are informed by high-quality, relevant and up-to-date synthesized research evidence.
Today’s announcement is part of the first phase of our Membership scheme, which will evolve and expand in the coming months and years. I wanted to share with you what this means, how you can make contributions to Cochrane’s work, and be a part of our expanding global community.
Whether you just want to stay close to what we're about and what we're doing; build your health research skills and training; help us translate Cochrane evidence into your language; support us with a financial contribution; or eventually become an independent published author in one of the world's top health journals – the Cochrane Library – we have many ways that you can become part of our work.
Joining Cochrane as a supporter can be a commitment as immediate as screening records to find randomized trials with only five minutes of training as part of Cochrane Crowd; or as demanding and involved as being accepted as an author of a Cochrane Review. Many of our contributors work on Cochrane projects during working hours, others in their spare time, in workplaces or at home. It's up to you, depending on your interests and the time you have to contribute.
We’ve created a central membership database that stores details of Cochrane’s supporters and members and tracks their contributions to Cochrane, whether as an author, translator, Crowd participant, Task Exchange contributor, or a learner. The system will recommend activities to new supporters and members to help them expand your skills, experience, and expertise, making it easier to contribute to Cochrane’s work without increasing the workload of our Cochrane Groups.
Supporters are eligible to become Cochrane members after reaching a threshold of activities linked to their contributions. By becoming a member of Cochrane, you will:
- Develop new skills and interests
- Work with like-minded colleagues and collaborators
- Grow professional and social networks
- Receive world class training from world leading experts in the fields of medicine, health policy, research methodology, and consumer advocacy
- See your contributions recorded and recognized
- Receive discounts for Cochrane’s annual conference registration and Cochrane’s Interactive Learning online training course (Cochrane authors and editorial teams will continue to have free access to all learning resources)
- Influence how Cochrane is run through voting for Governing Board members and resolutions in the Annual General Meeting
To find out more about Cochrane’s work in improving global health decision making and how you can make a difference, visit our Membership pages.
Cochrane Membership signals a huge change for the organization and I’m delighted we are announcing its launch this week at the Global Evidence Summit in Cape Town. Our doors are now open to the world in a new expansive way; everyone is welcome to join us and make a contribution – large or small – to our global mission: an open collaboration of brilliant people from around the world all working together to inform and impact health decision making.
With my very best wishes,
Cochrane’s Chief Executive Officer.
- Find out more about Cochrane, what we do, and who we are.
- Follow us on twitter @cochranecollab
- Join Cochrane now
- For all media enquiries, please Jo Anthony or the Cochrane Press Office
Thursday, September 14, 2017
Four new Cochrane EPOC overviews of reviews show reliable evidence on the effects of different ways of organising, financing, and governing health systems in low-income countries and identify important evidence gaps.
Strengthening health systems in low-income countries is key to achieving universal health coverage and achieving the health-related Sustainable Development Goals. Achieving these goals requires informed decisions about health systems. Systematic reviews on the effects of different health system arrangements are essential for making informed decisions, and many such reviews are available. However, policymakers and other stakeholders may struggle to identify which reviews are reliable and what are the key results.
Broad overviews of the findings of systematic reviews can help policymakers, their support staff, and other stakeholders to identify strategies for addressing problems with how their health systems are organised, financed, and governed and with identifying effective strategies for implementing changes. It can also help to identify needs and priorities for new evaluations of health system arrangements and for systematic reviews.
A team of Cochrane researchers from Argentina, Chile, Norway, and South Africa prepared four overviews of the available evidence from up-to-date systematic reviews about the effects of health system arrangements in low-income countries. They included 124 systematic reviews in the four overviews. For each review, a user-friendly summary of key findings was produced (see http://supportsummaries.org/), enabling users to explore the overview findings in more depth. The summaries include over 480 key messages about the effects of health system arrangements in low-income countries.
An overview of delivery arrangements included 50 systematic reviews that included a total of 919 studies. These reviews found that many delivery arrangements probably have desirable effects, including task shifting or role expansion and strategies for coordinating care.
An overview of financial arrangements included 15 systematic reviews that included a total of 276 studies. The effects of most of the financial arrangements that were reviewed were uncertain. This includes the effects of providing financial incentives and disincentives for health care workers, and the effects of most types of financial incentives and disincentives for people using health services.
An overview of governance arrangements included 21 systematic reviews that included a total of 172 studies. These reviews found that restrictions on medicines reimbursement (pre-authorisation), community mobilisation, and disclosing to the public performance data on health facilities and providers probably have desirable effects. The effects of other governance arrangements that were reviewed were uncertain.
An overview of implementation strategies included 39 systematic reviews that included a total of 1332 studies. These reviews found that many different implementation strategies probably improve professional practice, including educational meetings, educational outreach, practice facilitation, local opinion leaders, audit and feedback, and tailored interventions. Many strategies targeted at healthcare recipients also probably have desirable effects on the use of health care. For example, mass media interventions lead to an increase in immediate uptake of HIV testing and reminders and recall strategies for caregivers probably increase routine childhood vaccination uptake.
Dr Simon Lewin, Joint Co-ordinating Editor of Cochrane’s Effective Practice and Organisation of Care (EPOC) Group and Cochrane author noted that: “These overviews are a key source of evidence for decision makers in low-income countries who are considering options for strengthening the health system in their setting. The overviews use a unique approach, based on user-friendly summaries of each contributing review, and we hope that this will make the evidence identified much more accessible to decision makers and those who support them.”
Dr Andy Oxman, another Cochrane author and a Senior Researcher at the Norwegian Institute of Public Health added: “On the one hand, these overviews show that there is a large body of evidence that can inform decisions about health systems in low-income countries. On the other hand, they show that there are many important gaps in what is known. In addition to using the evidence identified in these overviews to inform their decisions, health policymakers and those who support them should routinely consider rigorously evaluating the effects of decisions to change health system arrangements when there are important uncertainties about the benefits and harms.”
Dr Charles Shey Wiysonge, one of the Cochrane authors and the Director of Cochrane South Africa noted that “These overviews have come at an opportune moment, when African countries are considering the best approaches for achieving Universal Health Coverage. The overviews and the underlying user-friendly evidence summaries – the SUPPORT Summaries - are important resources for constructive engagement and exchange between Cochrane Africa and relevant national stakeholders for evidence-informed health decision making in Africa.”
For more information please contact; Simon Lewin: Simon.Lewin@fhi.no
World-leading dermatologists and their patients are celebrating huge improvements in the treatment of skin diseases like skin cancer, psoriasis, and acne as the Cochrane Skin Group marks its 20th anniversary this week. The effects of the 120 plus published Cochrane Skin Reviews have been far-reaching and have had real impacts on patient care. These include skin cancer, skin allergies, and acne, blistering diseases, hair disorders like alopecia, fungal infections and psoriasis as well as tropical parasitic diseases.
The group is coordinated by the University of Nottingham’s Centre of Evidence Based Dermatology and is part of the global Cochrane network that carries out systematic reviews of primary research covering all areas of health and health policy. Cochrane is internationally recognised as setting the highest standards in evidence-based health care resources.
The effects of the 120 plus published Cochrane Skin Reviews have been far-reaching and have had real impacts on patient care. These include skin cancer, skin allergies and acne, blistering diseases, hair disorders like alopecia, fungal infections and psoriasis as well as tropical parasitic diseases.
“By systematically reviewing and summarising all relevant clinical trials, Cochrane Skin tries to drive up the quality of primary research into skin disease prevention and treatments,” says Professor Hywel Williams, the visionary founder of Cochrane Skin. “A lot of dermatology clinical trials have addressed unimportant questions that mean little to patients, and which have been designed and reported badly. By sorting out the wheat from the chaff, Cochrane Skin draws a line in the sand in order to stimulate better primary research.”
Inspired by a call to action from one of the original Cochrane founders, Sir Iain Chalmers, in the British Medical Journal in 1992, Professor Williams set about building Cochrane Skin, which was officially registered with Cochrane (originally The Cochrane Collaboration) on 12th September 1997.
At present more than 1,300 people from 61 different countries contribute to the work of the Cochrane group, with an established Satellite group in France and others planned in South America and the USA.
From the outset, Cochrane Skin has closely involved patient groups in its work. Maxine Whitton MBE, a co-founder of The Vitiligo Society, was formerly Chairman and is now a Patron, has had the skin pigmentation condition ‘vitiligo’ since childhood. Maxine said:
“Professor Williams encouraged and supported me in producing the first review of interventions for vitiligo. This review retrieved just 19 randomised trials, mostly of poor quality, published since 1966, highlighting the need for more research and well-designed trials as the basis for informed decisions on treatments. We conducted two further Cochrane Skin reviews published in 2010 (57 trials) and 2015 (96 trials).
“The review has stimulated further vitiligo research and projects. For example, the Vitiligo Society has helped us in the recruitment of participants for a pilot study of psychological interventions for vitiligo and also a large multi-centre trial combining topical treatment and NB-UVB for vitiligo (Hi-Light) based at Nottingham, which is ongoing.”
Cochrane Skin will be celebrating its 20th anniversary as the first Global Evidence Summit (GES) takes place in Cape Town, South Africa (13th – 16th September 2017). This event sees Cochrane join with four other leading organisations – the Guidelines International Network, The Campbell Collaboration, the International Society for Evidence-based Health Care, and the Joanna Briggs Institute – to focus on the opportunities and challenges facing low- and middle-income countries. The theme of the GES, ‘Using Evidence. Improving Lives’, will highlight and promote evidence-informed approaches to health policy and development, offering the most cost-effective interventions.
Cochrane Skin is grant-funded by the National Insitute for Health Research (NIHR) Systematic Reviews Programme.
- Visit the Cochrane Skin website
- Read the University of Nottingha blog post
- More information is available from Professor Hywel Williams, Centre of Evidence Based Dermatology, Faculty of Medicine and Health Sciences on +44 (0)115 or email email@example.com or Emma Rayner in the Communications Office at The University of Nottingham, on +44 (0)115 951 5793, firstname.lastname@example.org
The specialist director will be responsible for developing the field of evaluation of interventions in the Division for Health Services, including systematic reviews, health technology assessments (HTAs) and health economic analyses. The specialist director will be responsible for many of the division's and the Norwegian Institute of Public Health's external activities in these fields, including collaboration with external stakeholders within and outside Norway. In autumn 2017, the division will adopt a new organisational structure, with more work in teams and projects. The specialist director, together with the rest of the division’s management group, will be responsible for implementing and further developing the new organisational structure and new working methods within the division.
The Division for Health Services is one of four divisions in the Norwegian Institute of Public Health. We work with health system assessments, evaluation of interventions, dissemination and use of knowledge, and global health. With regard to the evaluation of interventions, the division contributes with systematic reviews on the effect of interventions in the health, care and welfare sectors, as well as systematic reviews on causes of disease and prognosis for various conditions. The division also conducts health technology assessments (HTAs) of new interventions that are relevant for introduction into the health service, where safety, efficacy, costs and other aspects of the interventions are considered. Our target groups are decision makers in health administration, in the health and care services and in the welfare sectors - including healthcare professionals and patients. The division collaborates with a number of key actors in Norway and internationally, including Cochrane and the Campbell Collaboration.
- Participate in the division’s management group and contribute to the overall management of the division together with the executive director and the rest of the management group
- Contribute to optimal resource use across the divisions of the Norwegian Institute of Public Health and across the departments in the division
- Further develop the field of evaluation of interventions and seek to realise the division's development plan for 2018–2022 in this field
- Further develop the field of evaluation of interventions at the Norwegian Institute of Public Health and ensure collaboration and co-ordination of activities across the divisions at the institute
- Implement and further develop new organisational structure and new working methods in the division
- Promote a good working environment and professional development for the division's and institute's employees
- Contribute to open and professional communication at the institute and towards partners, users and the media
- Line manager responsibility (staff, finance, etc.) for one or more departments may be delegated from the executive director. Management of other interdisciplinary functions may also be considered
- Doctoral degree in a field relevant for the post, preferably within the health, natural or social sciences
- High research expertise
- Healthcare expertise
- Significant expertise in systematic reviews and/or health technology assessments
- Management experience
- Wide international network is an advantage
- Good oral and written skills in Norwegian (within 18 months) and English
- Commitment to contributing to better health and health services, both in Norway and globally
- Commitment to management, particularly management promoting team collaboration
- Ability to lead with confidence and clarity
- Ability to inspire and prioritise
- Flexible, solution-oriented and with a strong drive to get things done
- Good collaborative and communication skills
- A new Cochrane Overview has identified effective and safe clinician-focussed interventions to reduce antibiotic prescribing for acute respiratory infections (ARIs) in primary care.
- The authors found that point-of-care CRP testing, procalcitonin-guided management and shared decision making probably safely reduce antibiotic prescribing in the management of ARIs compared to usual care.
- There were no trials in the included reviews which compared interventions against one another, so we do not know which is most effective at reducing antibiotic prescribing for ARIs in primary care.
- Antibiotic resistance has become a major public health problem, with some infections no longer treatable using currently available drugs. The inappropriate use of antibiotics is associated with the increase of resistance.
- Most antibiotics are prescribed in primary care, and most commonly for ARIs. In most cases ARIs seen in primary care are spontaneously resolved without antibiotics.
- The management of ARIs in primary care is therefore a key target for influencing the antibiotic prescribing behaviour of clinicians.
What does the review say?:
- The authors identified eight systematic reviews assessing clinician-focussed interventions to influence antibiotic prescribing for ARIs in primary care, containing a total of 44 trials.
- Moderate-quality evidence suggests that the following interventions probably have an important effect on reducing antibiotic prescribing in primary care:
- C-reactive protein point-of-care testing in general practice probably reduces antibiotic prescribing with little or no effect on symptom duration, patient satisfaction, or reconsultation;
- shared decision making in the management of ARI in general practice probably reduces antibiotic prescribing without increasing likelihood of reconsultation, and may maintain patient satisfaction;
- procalcitonin-guided management of ARI in probably reduces antibiotic prescribing in general practice and emergency departments without affecting health-related quality of life and whilst avoiding treatment failure.
- There were no trials in the included reviews which compared these interventions against one another, so we do not know which is the most effective.
- For the other interventions, including multifaceted interventions, those centred on clinician education, patient information leaflets, and the use of rapid viral diagnostics, the evidence was of low or very low quality across outcomes, and we could not confidently draw any conclusions about the effects of these interventions compared to usual care. Further primary research is necessary to improve the evidence base in order to be able to make informed decisions about the value of these interventions.
- None of the trials in the included reviews reported on management costs for the treatment of an ARI or any associated complications, so it was difficult to weigh the benefits and costs of implementing these interventions in practice.
- Most of this research was undertaken in high-income countries, and it may not generalize to other settings.
Get access to this Cochrane Overview online: Clinician-targeted interventions to influence antibiotic prescribing behaviour for acute respiratory infections in primary care: an overview of systematic reviews
Get access to a PDF of this Cochrane Overview: Clinician-targeted interventions to influence antibiotic-prescribing behaviour for acute respiratory infections in primary care: an overview of systematic reviewsFriday, September 8, 2017
A very warm welcome to Cape Town! We look forward to welcoming more than 1400 people from at least 67 countries to the first ever Global Evidence Summit.
The Global Evidence Summit will be the first time that Cochrane, The Campbell Collaboration, Guidelines International Network, International Society for Evidence-based Health Care, and Joanna Briggs Institute have joined forces to create this premiere event in evidence-based policy.
The theme of the Summit is ‘Using evidence. Improving lives’ and aims to advance the use of reliable research evidence in addressing some of the world’s most serious health and social challenges. We’ve created an illuminating line-up of content and world-class speakers and facilitators that promises to excite, intrigue and engage wide audiences.
We hope the Summit will provide the fruitful ground for all delegates to meet, share and collaborate to progress our aims. For a full programme schedule visit globalevidencesummit.org/signup.
Enjoy the Summit, and do take some time to explore a little of our beautiful country during your stay with us.
Jimmy Volmink and Tamara Kredo
Chairs of the Organising Committees for the 2017 Global Evidence Summit
The Cochrane Tobacco Addiction Group, based at the University of Oxford in the UK, is one of the oldest groups working on Cochrane Reviews. It has produced dozens of these during the last two decades and in 2016, it embarked on a project to identify the top priorities for future research into tobacco control.
The Cochrane Tobacco Addiction Group's research prioritization exercise involved more than 300 people and identified a total of 183 unanswered questions in tobacco control through two online surveys and an Oxford-based workshop. It identified 24 priority questions, grouped into eight priority themes. This new set of research priorities to support tobacco control will help ensure future research provides the greatest benefit to public health and value for money.
"The range, appearance, and accessibility of tobacco products has changed significantly in recent years," said Dr Jamie Hartmann-Boyce, Senior Researcher and Managing Editor in the Cochrane Tobacco Addiction Group, which is based in Oxford University's Nuffield Department of Primary Care Health Sciences. "Technology has given rise to new ways of delivering nicotine that can help reduce the harms associated with traditional cigarettes.
"To ensure our research continues to address the contemporary issues in tobacco control, we aimed to develop a set of research priorities that represent the views of the widest group possible."
- Read about the findings of the Tobacco Addition Priorities Report
- Read the full report: Setting research priorities in tobacco control: A stakeholder engagement project
- Read the press release from the Nuffield Department of Primary Care Health Sciences, University of Oxford
- Listen to the podcast about how priorities were set and what it covers with Dr Jamie Hartmann-Boyce, Senior Researcher and Managing Editor in the Cochrane Tobacco Addiction Group
- Learn more about the Priority Setting project
- Learn more about the Priority Setting Workshop
- Visit the Cochrane Tobacco Addition Group website
Cochrane announces a three-year agreement to establish a Cochrane Russian Associate Centre at the Kazan Federal University
Cochrane Russia was established at the Kazan Federal University in 2014 and was soon assigned as the national coordinating center for Cochrane. Partnering together they have launched two master programs (in evidence-based medicine and pharmacology), held several international conferences, a national round-table of evidence based medicine, courses for new systematic reviewers, and published many systematic reviews. An agreement has been recently signed that will have Kazan Federal Univerity hosting Cochrane Russia for the next three years.
Cochrane CEO, Mark Wilson said: “I’m delighted to sign this three-year agreement with Rector Gafurov to establish a Cochrane Russia Associate Centre at the Kazan Federal University. Followed up with the appropriate resourcing it provides a great opportunity for the KFU and Cochrane to develop evidence-informed medicine in the Russian Federation and establish KFU’s leadership in this area. There is so much potential for Cochrane evidence to make a huge contribution to improving Russia’s health outcomes; and we are looking forward to working further with Lilia Ziganshina, the Cochrane Russia team, and her colleagues at KFU to accomplish this.”
We are pleased to announce the publication of our organizational Dashboard for the second quarter of 2017. This Dashboard, which we publish quarterly, presents our achievements in a series of key metrics, such as publishing output, Cochrane Library usage, and progress on meeting Strategy to 2020 targets. Work on Strategy targets is covered in more detail in the Target Report below.
This initiative is part of Cochrane’s commitment to organizational transparency. For everyone interested in Cochrane and our work, these critical indicators provide an opportunity to monitor our production and dissemination of evidence, and our organizational health.
Highlights from the second quarter include:
- Global usage of Cochrane.org continues its quarter-by-quarter growth; now exceeding 3.5m sessions in the quarter.
- 62% of Cochrane.org usage is viewing non-English content. Usage is soaring in South America. Mexico has become the top user of Cochrane.org, replacing USA for the first time and exceeding half a million sessions in a quarter for the first time.
- Sales and royalties year to date are excellent. Royalties year to date are up 24.5% compared with the same period last year.
For more information:
Covidence is one of Cochrane’s recommended tools to support you in some of the most labour-intensive stages of your systematic review, saving up to 35% of researcher time. Covidence allows your team to upload search results, screen abstracts and full text, complete data collection, conduct risk of bias assessment, resolve disagreements and export data into RevMan or Excel. Covidence is free to use for all Cochrane reviews, and is designed to be intuitive and user-friendly.Want to know more about Covidence?
Give it a try and let us know what you think!Visit Covidence
The Covidence platform continues to evolve, with recent product updates advancing the tool towards the vision of a world where answers to questions about health and other fields of human wellbeing are accurate, up to date and accessible. The Covidence team is committed to engaging with the Cochrane community and continuing to make improvements that are user-focused. Significant improvements have been made recently to data extraction and to importing.Covidence at Global Evidence Summit
The Covidence team will be at stand 13A at the Global Evidence Summit in Cape Town. Please say hello and let us know how your research is going! In addition, two workshops will be held: Introduction to Covidence, and Covidence Forum. Introduction to Covidence is a complete walk-through of the tool designed for novice users. Covidence Forum is intended for individuals already familiar with Covidence, and will share more in-depth tips and have additional time for discussion and feedback.Recent updates
Additional customisation during data extraction
Covidence has a streamlined data extraction form with many of the standard elements pre-programmed, minimising time research teams have to spend on constructing their forms. You can see a walkthrough of creating a data extraction form in Covidence here.
You’ll see that there have been several recent additions to make the form even more flexible. You can now create custom effect measures, in which the data type collected in the table can be an integer, a decimal, a percentage, or even free text for qualitative outcomes. Furthermore, these data types are now validated, so the system will flag for users when a data point differs from the indicated type. Custom text fields can also be added to several sections of the form, so if there’s information you’d like to capture that isn’t covered in the standard form, you can create a place for it.Improved Imports
You can now view your import history directly from your review dashboard. In addition, in response to feedback that the de-duplication process was unclear, it is now displayed more explicitly in this improved review history on the dashboard. Finally, the structure of the importer has been significantly improved leading to faster and more stable imports!What’s coming next
Upcoming work will focus on building relationships directly with each Cochrane Review Group to lay foundations for further integration between Archie / Cochrane and Covidence. Our intention is that in the future, reviews will be automatically created under the Cochrane Review Group in Covidenceas soon as they are registered, making it seamless for teams to begin work as soon as they’d like. Each review will be associated with a specific group account in Covidence, which will also enable editorial team members to easily see an overview of how everyone is going. Your Covidence homepage will look similar to the accompanying image, with reviews collated by review group for easy organisation.Have some ideas on how to continue improving Covidence?
Thank you for voicing your feedback and user needs, these are an invaluable input into our product roadmap and prioritisationprocess. The Covidenceteam would love to hear more from you! Please contact CovidenceSupport at email@example.com if you’d like to share some ideas, have a chat, or just say hello!Thursday, August 24, 2017
Cochrane is delighted to announce the official launch of Cochrane Africa; a network with a vision to increase the use of best evidence to inform healthcare decision making across the sub-Saharan African continent.
The Africa Network consists of regional centres including its co-ordinating centre at Cochrane South Africa, South African Medical Research Council, and the establishment of hubs at University of Calabar, Teaching Hospital, Nigeria, Stellenbosch University, South Africa and Yaoundé University, Cameroon.
Cochrane Africa is part of the global, independent Cochrane network of researchers, professionals, patients, carers, and people interested in health. The Network will promote evidence-based decision making in health care across the sub-Saharan African region by supporting and training new 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.
Since the late 1990s, African collaborators have worked to improve the production of high-quality, Africa-relevant reviews and to support their use in policy and practice through stakeholder engagement and capacity building. In 2007, the informal Cochrane Network was created to build on this track record and to enhance and expand these activities.
Reviews from Africa have informed several national and international guidelines, particularly in the areas of malaria, tuberculosis, and HIV/AIDS.
Cochrane Africa Founding Director Jimmy Volmink warmly welcomed today’s news: “Cochrane SA has been investing in building capacity and relationships on the African continent over many years, and it is now wonderful to see the vision of a formally registered Cochrane African Network coming to fruition.”
Cochrane Africa will be co-ordinated by Cochrane SA, which will offer methodological support, mentoring, and supervision to the regions.
The Director of Cochrane South Africa, Charles Wiysonge, says this is a hugely exciting opportunity: “The launch of the first-ever Cochrane Africa Network is very important, both to sub-Saharan Africa and globally. Producing and increasing the dissemination of the best-available information on health care is critical for clinicians and patients everywhere in the world, including Africa. We wish to build partnerships to promote evidence-informed health care in collaboration with African leadership, and create further opportunities to grow the network.”
Solange Durão from the Cochrane Africa Coordinating Unit is proud to be a part of this Network: “Health care will benefit from the increased presence of Cochrane’s work in sub-Saharan Africa. Conducting relevant reviews based on priority setting, identification of research gaps, and regional stakeholder needs is going to stimulate and focus our actions relating to the care of patients based on strong scientific evidence. Many African countries will benefit from this collaboration as we welcome new contributors to build capacity by providing learning and mentoring opportunities for conducting and using relevant Cochrane systematic reviews.”
Cochrane’s CEO Mark Wilson says: “I believe this is an important announcement for improved health outcomes in Africa. The continent’s health and healthcare challenges are huge, and with limited resources and fragile health systems in many countries it is more important than anywhere else in the world that the decisions of Africa’s doctors, nurses and policy-makers are made on the basis of the best evidence. Cochrane Africa will deepen and expand the scope, reach, and impact of Cochrane evidence on health and healthcare decision making; as well as developing Africa’s own production of high-quality evidence amongst its clinicians, researchers and academics. I’m delighted we are launching Cochrane Africa, our newest geographic network, at the Global Evidence Summit in Cape Town as an indication of Cochrane’s growing commitment to overcoming the global inequalities in healthcare provision and life chances that continue to exist.”
West Africa Hub
Martin Meremikwu and Emmanuel Effa
Calabar Institute of Tropical Diseases Research & Prevention
University of Calabar Teaching Hospital
Francophone Africa Hub
Pierre Ongolo-Zogo and Lawrence Mbuagbaw
Centre for the Development of Best Practices in Health
Yaoundé Central Hospital
Cochrane Africa Coordinating Unit
Tamara Kredo, Solange Durão, Charles Wiysonge and Taryn Young
Cochrane South Africa
South African Medical Research Council
W: www.mrc.ac.za/cochrane or southafrica.cochrane.org
Tuesday, August 22, 2017
A new Cochrane Review has examined large welfare-to-work studies conducted in North America.
Led by Dr Marcia Gibson from the MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, the review looks at a series of welfare-to-work studies, comparing what happened to lone parents who were in welfare-to-work interventions with lone parents who were not.
The review indicates that welfare-to-work interventions probably have little to no effect on the health of lone parents. The study also found that effects on lone parent employment rates were small, as those who were not in the interventions often found work on their own.
The studies included in the Cochrane Review were large welfare-to-work studies, conducted in North America, where welfare reform was implemented in the 1990s.
Key findings included:
- Although in some countries lawmakers and policy advisors have argued that such policies will have positive health benefits, the Cochrane Review findings indicate that there is probably very little to no effect on health.
- Poverty and depression remained high among all participants in the studies analyzed, whether they took part in a welfare to work intervention or not.
- Lone parents appear to find work by themselves when jobs are available.
- Economic conditions may have a stronger influence on lone parent employment than interventions in the welfare system that mandate employment.
- Employment increased both for parents who were in welfare-to-work programmes and those who were not, but income did not increase.
Lead author of the review Dr Gibson said: “The evidence from our Cochrane Review indicates that welfare to work probably does not change lone parents’ health, and may have negative effects in some cases. In conjunction with evidence from other studies, our findings also suggest that economic conditions are likely to have a stronger influence on lone parent employment.”
Work on the Cochrane Review “Welfare-to-work interventions and their effects on the mental and physical health of lone parents and their children” was funded by the UK Medical Research Council and the Scottish Government Chief Scientist Office.
For more information contact Elizabeth McMeekin or Ali Howard in the University of Glasgow Communications and Public Affairs Office on 0141 330 4831 or 0141 330 6557; or email Elizabeth.firstname.lastname@example.org or email@example.com
Follow us on Twitter @UofGNews
Cochrane is a global independent network of researchers, professionals, patients, carers, and people interested in health.
Cochrane produces reviews which study all of the best available evidence generated through research and make it easier to inform decisions about health. These are called systematic reviews.
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Charles Shey Wiysonge, Director of Cochane South Africa, gave an interview to the World Health Organization Bulletin. Here is a re-post , with premission, from their recent publication.
Charles Shey Wiysonge is devoted to encouraging better use of scientific evidence for health policies and programmes in African countries. He is the director of the South African Cochrane Centre, a unit of the South African Medical Research Council, and a professor of epidemiology and biostatistics at the department of Global Health in the Faculty of Medicine and Health Sciences at Stellenbosch University in South Africa. He was Chief Research Officer at the Joint United Nations Programme on HIV/AIDS 2006–2007 and a Medical Research Council Africa Fellow at the University of Cape Town (UCT) 2004–2006. In Cameroon, he worked for the National Ministry of Public Health 1998–2004. From 1995 to 1998, he was a physician at the University Teaching Hospital in Yaoundé, Cameroon. He is a member of several editorial boards and joined the World Health Organization’s (WHO) Strategic Advisory Group of Experts on immunization in 2016. He graduated in medicine from the University of Yaoundé I in 1995, earned his Master’s degree in epidemiology from Cambridge University in the United Kingdom of Great Britain and Northern Ireland and a Doctor of Philosophy in vaccinology from UCT.Q: How did you become interested in medicine and public health?
A: Growing up in Cameroon I wanted to study mathematics and was drawn to complex equations and aeronautics, but people said I should study medicine, so I did. At medical school most students wanted to become clinical specialists, public health was not popular at all. After graduating, several things drew me to public health. I worked as a hospital physician and saw several outbreaks of measles. People used to say “don’t count your children until measles have come and gone.” Children were dying of measles every day. This experience eventually led me to work on immunization. Also, while working in internal medicine, there were several treatment options for hypertension and heart disease. I was not always sure which was the best. That’s when I discovered evidence-based medicine. At that time – around the year 2000 – the Cochrane Collaboration started a new fellowship to train leaders in evidence based medicine from low- and middle income countries. I applied, became the first holder of the award and trained at the Cochrane Centre in Oxford.Q: What is evidence-based medicine?
A: Research and other evidence are constantly changing and health-care professionals need to keep up with the latest developments so they can offer the interventions that are known to work and not those that are harmful or ineffective. There are many examples of unspeakable and unnecessary suffering resulting from the failure to take an evidence-based approach to clinical care. For example, in 1999 Cochrane researchers did a systematic review to find out whether drugs that inhibited massive calcium influx into cells reduce the risk of death or dependency after stroke. At the time, stroke patients were widely treated with calcium channel blockers. They found no evidence of a beneficial effect. Evidence-based medicine has been defined as the “conscientious, explicit and judicious use of current best evidence in making decisions about the care of individual patients”, although today, health-care professionals prefer the term “evidence-based health care” for a more holistic approach.Q: You did not learn about evidence based health care at medical school, is it included in medical curricula today?
A: Some medical and dental schools in South Africa offer separate courses on evidence-based health care, others have embedded the approach in all courses, and some do both. Our Cochrane collaborators at the universities of Calabar in Nigeria and Yaoundé I in Cameroon also offer programmes in the evidence-based approach for physicians. Evidence-based health care is included in the curricula for health-care professionals in these and some other African countries, but more needs to be done at the undergraduate and the postgraduate levels across the continent.Q: The Cochrane Collaboration prepares and disseminates information on what works and what doesn’t in health care globally. How is the South African Cochrane Centre doing this in Africa?
A: Our centre was set up in 1997 as a unit of the South African Medical Research Council. It is the only Cochrane centre in Africa and has a branch in Nigeria. There is increasing recognition in sub-Saharan African countries, that policy-making should be based on the best available scientific evidence. To this end, we have been training researchers in these countries to do systematic reviews and recently expanded these activities via the recently established Cochrane African Network. The Cochrane Collaboration charges a fee to access its global library of systematic reviews and other evidence. Low-income countries can access this evidence via a special online platform, thanks to the Evidence Aid initiative. In South Africa, free access to the Cochrane Library is now provided by the South African Medical Research Council and we hope other middle-income countries in Africa will follow this model.Q: Are the Cochrane reviews useful in Africa too, or do countries in Africa need evidence that is tailored to their specific situation?
A: Not all Cochrane reviews are applicable to Africa. Since 2007, the South African Cochrane Centre has collaborated with the Centre for Informed Health Choices in Norway and others to improve the use of reliable research evidence in policy and management decisions in Africa. We found, overall, that most primary studies on health system issues are from high-income countries and that only some of these reviews are applicable in low-income settings, including parts of sub-Saharan Africa. For this reason, reviews that synthesize such studies have limited relevance to Africa, especially those written by researchers with no experience in Africa.Q: So more research is needed that is specific to sub-Saharan Africa?
A: Our analyses suggest that external partners, rather than national priorities, have driven health research in most African countries over the last two decades. However, we don’t need to re-invent the wheel, as much of the global research evidence is applicable to Africa. A major priority for new research in African countries should therefore be implementation research. This type of research helps us understand which health-care interventions work in specific contexts and which do not, and to test different ways to make health-care more effective. African countries often fail to make optimal use of evidence in decision-making, resulting in unnecessary loss of life, reduced quality of life and lost productivity. An example, is acquired immune deficiency syndrome (AIDS) denialism in South Africa from 1998 to 2003, characterized by the refusal to use antiretrovirals for human immunodeficiency virus (HIV) prevention and treatment. This resulted in a reversal of gains in child survival and life expectancy and the loss of a generation of economically active adults in their prime.Q: How are you working to make policymakers in Africa more aware of the need to base their health-care decisions on the best available scientific evidence?
A: The use of health research in decision-making in African countries is generally weak. That’s why we advocate for the dissemination and use of evidence, and building partnerships to promote evidence-informed health care in collaboration with decision makers. African countries sometimes develop new guidelines, but often adopt or adapt existing WHO guidelines to suit national contexts. Our analyses of the development or contextualization of guidelines used in African countries reveals deficiencies in the rigour of development and adherence to international reporting standards. We advise countries on how to develop guidelines for their specific national contexts. We try to work with the health ministries through expert groups to encourage governments to base their policies on the best available evidence and we are involved in initiatives, such as the Effective Health Care Research Consortium, an international group with partners in Cameroon, Kenya, Nigeria and South Africa. However, we are limited by financial constraints, as our work does not attract much funding.Q: What are the barriers stopping African countries from basing their public health policies and practice on the best scientific evidence?
A: There are several barriers. The health research field in Africa is characterized by numerous players, diverse interests, dispersed efforts and uncertain outcomes in relation to its impact on the major health challenges of the continent. For a better understanding and uptake of scientific evidence in health policymaking, we need a stronger research community – research is not well funded or supported in many African countries – and this community needs to forge closer links with policy-makers, programme managers and implementers. Sometimes the evidence is difficult for policy-makers to understand. That’s why we provide easy-to-read summaries for them. Sometimes, policy-makers ignore the evidence because it’s not what they want to hear. For example, the South African Department of Health once asked the South African Cochrane Centre to prepare a review of the evidence on how best to prevent mother-to-child transmission of HIV infection. But when we gave them the review, they ignored it.Q: Have you noticed any improvement in the uptake of evidence in health policy-making?
A: We have seen a positive change in attitudes towards the use of evidence in health-care planning. For example, the Paediatric Association of Kenya has been using explicit, transparent guideline development procedures when developing recommendations for the prevention and treatment of childhood conditions for the last decade. Another example is the increasing number of African countries with functioning national immunization technical advisory groups, which provide evidence-based advice to national health authorities on how to implement WHO vaccine policies and recommendations.Q: How will the conference you are hosting in Cape Town from 13 to 16 September contribute to improving the uptake of scientific evidence in policy-making in Africa?
A: The Cochrane Collaboration holds a colloquium every year. This year will be the first time that Cochrane will be joined by the four other biggest players in evidence-based policy: the Campbell Collaboration, the Johanna Briggs Institute, the Guidelines International Network and the International Society for Evidence based Health Care, to organise the first ever Global Evidence Summit. We are expecting thousands of participants, including those from every health-care discipline and from virtually every country on the continent of Africa. There is strong evidence that such interactive, educational meetings, can help health-care workers improve their performance. Participants will have the chance to learn more about guideline development, using evidence for emerging global health and social crises and how the evidence community can overcome denial of clear scientific findings. We are really excited about this opportunity to highlight the evidencebased approach to policy and practice in health for countries in Africa.
Cytology versus HPV testing for cervical cancer screening in the general population: a DTA Review from the Cochrane Gynaecological, Neuro-oncology and Orphan Cancers Group, (CGNOC)
Cochrane Reviews are systematic reviews of research in health care and policy. They are internationally recognized as a high-quality source of evidence for decision-making. They collate and summarize all the best available research evidence on the effects of healthcare interventions or the accuracy of diagnostic tests into a systematic review.
Diagnostic Test Accuracy Reviews (DTA) provide essential information regarding the accuracy of the available diagnostic tools for key decision makers, including patients, clinicians, guideline developers and researchers.
The purpose of a Cochrane DTA review is very like the purpose of a conventional Cochrane systematic review. Using explicit, transparent, and systematic methods to pool together all the available evidence relevant to a DTA research question, we can obtain more precise estimates of the accuracy of diagnostic tests than single DTA studies alone can provide. Estimates of sensitivity and specificity may also be more generalizable than estimates from single studies.
Cochrane GNOC has recently published its DTA review: Cytology versus HPV testing for cervical cancer screening in the general population.
Among its many international collaborators, Cochrane GNOC Group works with key contributors who are interested in disseminating evidence about the accuracy tests for diagnosing cancer. We spoke with three contributors, Jo Morrison, Co-ordinating Editor of Cochrane GNOC, Kate Sanger, Head of Communications & Public Affairs, Jo's Cervical Cancer Trust and Nuala Livingstone, Editor of the Cochrane Editorial Unit, to discuss the importance of this Review:
How important was this Cochrane Review to produce?
Jo Morrison: The review compares the accuracy of two different methods of testing cervical smears in picking up pre-cancerous changes (known as high grade cervical intra-epithelial neoplasia – HG CIN). Both tests start with a smear test, taken by directly visualising the cervix and using a ‘broom’ or spatula to sweep cells off the cervix. The difference is in what is done with the test once it is in the pot. One test puts cells onto a slide so they can be examined under a microscope and is called cytology, often called a Pap test. The other test takes a sample of cells and checks for the presence of viruses that can lead to pre-cancerous changes in the cervix (HG CIN). These viruses are called high risk Human Papilloma Virus or HR HPV. The test for the virus looks for genetic material (either DNA or RNA depending on the test) using a process called the polymerase chain reaction (PCR) and does not rely on someone looking at cells down a microscope.
Kate Sanger: This review is timely, as in the UK it has been announced that testing for HPV as the primary cervical screening test is to be rolled out over the coming years. We are in a position where the implications of this change on the workforce, systems and indeed patients are at the top of the agenda. The aim of the screening programme is to reduce incidence and mortality from cervical cancer through identifying women who are more at risk of the disease and providing treatment where appropriate. The confirmation through this review that screening for HPV is more sensitive and therefore more effective at identifying cases of CIN 2 or greater is extremely welcome and positive.
What did they find?
Jo Morrison: This DTA review found 40 studies comparing the two tests in over 140,000 women who had a smear test. Testing a smear test for HR HPV is less likely to miss HG CIN, as it is a more sensitive test than cytology. However, if the test is positive there is a lower chance that there really is HG CIN, as it is a less specific test. For every 1000 women who had a smear test, 20 actually had HG CIN. Cytology (Pap test) would have correctly identified 12 of these women (but missed 8 women with HG CIN); HPV testing would have correctly identified 16 women (and missed 4). The test is therefore more sensitive and has fewer false negative tests than cytology. However, this increased sensitivity comes at a cost. The HPV test would have suggested that 101 women had HG CIN when in fact they did not, whereas only 29 women would have had an over-call (false positive) with cytology (Pap) testing. This would result in an increase in women needing to be referred to a clinic for colposcopy, were the HPV test used as a stand-alone test, causing increased anxiety for these women. This is because the test is less specific and has more false positive test results than cytology.
What does this mean for clinical practice?
Jo Morrison: For the UK, this will mean that we can change the cervical screening programme. Currently all smears are screened for cytology first and those with features of low grade dyskaryosis are ‘triaged’ using HPV testing – those with HR HPV detected are referred to colposcopy. And those with no HR HPV are returned to routine re-call. However, mathematically, it makes more sense to use the most sensitive test (HPV test) up-front and then use cytology on those found to have HR HPV. By introducing a second level test after HPV testing, fewer false positives will be generated and fewer women will require colposcopy than with HPV testing alone. However, this change will have major implications for the screening programme since: 1) more women may be referred to colposcopy; 2) overall many fewer smears will require cytological evaluation. This has repercussions for the current laboratory services, since many fewer cytopathology screeners will be required and the service could be streamlined to only a few laboratories providing this service across the UK (since there are minimum numbers of smears screened per screener to maintain expertise).
World-wide this has major benefits since HPV testing is much more easily deliverable in the developing world that cytological screening, which is where the heaviest burden of disease from cervical cancer lies.
Kate Sanger: For patients, there is a clear need for increased information provision regarding why the changes to the screening programme are beneficial and the different pathways women invited for screening may take depending on the outcome of their initial HPV test. For women testing negative for HPV it is essential that they fully understand the need to continue to attend screening when next invited; greater symptom awareness for all women must also be increased. It is especially important that women who test positive for high risk HPV, but do not have cell changes that require treatment, fully understand what it means, for example with women starting new relationships or who may have multiple sexual partners. This is essential to reduce uncertainty, distress and to ensure being ‘HPV positive’ does not get a negative stigma attached to it. Information and support need to be available to women at every stage with clinicians able to signpost women to external sources.
How robust is this evidence?
Nuala Livingstone: Overall, I would consider this evidence to be robust. The review authors have provided detailed, and carefully considered information in this review to assist the user in assessing the ‘robustness’ of the evidence.
Firstly, they assessed the methodological quality of the included studies using the QUADAS tool, as recommended by the Cochrane Diagnostic Test Accuracy Working Group. This assessment revealed that most the included studies in this this review were ‘low risk of bias’. Review authors also assessed the quality of the body of evidence for each outcome in the Cochrane review using the GRADE considerations. This assessment considers the methodological quality of the included studies (as assessed by QUADAS) along with the precision, consistency, completeness and applicability of the evidence available. Based on these factors, review authors judged the overall quality of the evidence in this review to range from moderate to high. Evidence was downgraded from ‘high’ to ‘moderate’ quality because the sensitivity values among included studies were slightly inconsistent, with values ranging from 52%-94% for Cytology, and 61% to 100% for HPV testing.
Kate Sanger: It would be interesting to see a breakdown of the research by age group, as women under 25 and over 65 were part of the study and in the UK these women are not invited for screening. Data on women over 65 could contribute to evidence as to whether there should be a consideration of increasing the screening age in the UK. With women under 25 further research into the impact of the HPV vaccination on incidence will be particularly important, especially following the potential introduction of Gardasil 9.
How clinically relevant is it, and how can the evidence be used?
Jo Morrison: This review is highly clinically relevant and affects all women in a screened population – ideally it should be relevant to all women world-wide, since universal cervical screening would be a major contributor to global health and the burden of disease is largely in less developed countries.
What would your message be to clinicians and policy-makers in this area or cervical screening?
Jo Morrison: HPV-testing has increased sensitivity, but less specific than cytology. Used as the up-front test in a two-stage screening test, it has the potential to reduce the number of false-negative tests, thereby reducing the number of ‘interval’ cancers, which are missed by cytologyical screening. There are also potentials for cost savings, although this review did not perform an economic evaluation.
What would your message be to patients?
Nuala Livingstone: The high sensitivity of this test should provide reassurance that a negative result on this test is highly likely to be accurate. This finding is supported by moderate to high quality evidence, which suggests we can be fairly certain in the result. However, a positive result will not necessarily prove to be true.
Jo Morrison: HPV testing is much less likely to miss changes than conventional cytology, although this may come at the price of more women needing referral to colposcopy for someone to look at their cervix and possibly perform biopsies. It is hugely reassuring to have a negative HPV test, since this shows that the risk of having CIN is very low. There is the possibility that the interval between smear tests could be extended, reducing the frequency that women need smears, which nobody enjoys! However, this would need to be tested in a different sort of study than a DTA study.
What further research would you like to see, and what would this tell us?
Jo Morrison: The results of studies comparing screening programmes using conventional cytological screening up-front versus HPV screening up-front are in progress and initial results demonstrate that this is likely to reduce the number of cancers missed by the screening test due to false negative smear results.
Kate Sanger: This review provides evidence which will hopefully increase activity to ensure the roll out of HPV primary in the UK is not delayed. It also provides a range of considerations that policy makers and clinicians need to address to ensure the physical and emotional health of the women in their population is protected. We must however not lose sight that across the UK attendance of screening is in worrying decline and addressing this, regardless of the screening test, must remain a priority.
Nuala Livingstone: The results of this review have provided detailed an important information regarding the statistical evidence available for this research question. However, I would like to see further research that provides information regarding the clinical importance of the evidence, and the long-term implications for women.
Jo Morrison, Nuala Livingstone, Kate Sanger.
Jo, Nuala and Kate’s words stated and expressed in this blog are entirely personal, and do not represent any official views or opinions of Cochrane.
CGNOC are committed to providing reliable evidence required to make important decisions on issues concerning Gynaecological cancers, Neuro-oncology and related topics.
CGNOC's main task is to facilitate the identification of reports of controlled clinical trials and to carry out systematic reviews which are then published on the Cochrane Library. The reviews are updated as new evidence is identified. This ensures that Cochrane reviews are relevant, useful, usable and used.
Evidence relating to the care of people with cancer comes from a number of sources and so a multi-faceted approach is taken, including searching electronic databases of clinical trial reports, handsearching printed journals, and scanning of the 'grey' literature i.e. conference proceedings and abstracts. Every effort is made to find unpublished trials to avoid bias.
f you would like more information about proposing a review title or getting involved with the Cochrane Gynaecological, Neuro-oncology and Orphan Cancer Group, please contact us:
For more information, please contact:
Jo’s Cervical Cancer Trust is the only UK charity dedicated to women affected by cervical cancer and cervical abnormalities. Our vision is a future where cervical cancer is a thing of the past. We want to see cervical cancer prevented and the impact for everyone affected by cervical abnormalities and cervical cancer reduced. We do this through providing the highest quality information and support, and campaigning for excellence in cervical cancer treatment and prevention. www.jostrust.org.uk
August 2017: The Cochrane Official Blog is curated and maintained by the Communications & External Affairs Department. To submit items for publication to the blog or to add comments to a blog, please email firstname.lastname@example.org.Monday, August 14, 2017
Cochrane Norway and the Norwegian Satellite of the Cochrane Effective Practice and Organisation of Care (EPOC) review group, which has the responsibility for developing systematic reviews of interventions to improve health systems are seeking a full-time statistician. Closing date for applications is 1 September.
For complete information on the job and how to apply, read more at the Norwegian Insitute of Public Health websbite.Wednesday, August 9, 2017 Category: Jobs