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Updated: 6 hours 27 min ago

Cochrane Library Editorial - Implementing systematic reviews of prognosis studies in Cochrane

Thu, 10/11/2018 - 16:12

Over the last 30 years Cochrane has strived to advance the importance of conducting systematic reviews of therapeutic strategies, diagnostic tests, and risk factors. Now, the Cochrane community embarks on systematic reviews of prognosis studies in the Cochrane Database of Systematic Reviews.

Prognosis research has escalated in the last two decades. Today, frequently echoed terms are ‘personalized medicine’, ‘precision medicine’, or ‘risk‐based medicine’, often used as synonyms.

Read a new Cochrane Library Editorial on the work Cochrane Prognosis Methods is doing produce systematic reviews that summarize the huge amount of data and evidence emerging from primary prognosis studies, to enable stakeholders to make appropriate healthcare decisions.

Thursday, October 11, 2018

Featured Review: Progestogen for preventing miscarriage

Thu, 10/11/2018 - 11:02

Can progestogen help prevent miscarriage?

 Early pregnancy loss, also known as miscarriage, generally occurs in the first trimester. For some women and their partners, miscarriages can happen several times, also known as recurrent miscarriages. While there are sometimes causes for miscarriages that are found, often no clear reasons can be discovered. The hormone called progesterone prepares the womb (uterus) to receive and support the newly fertilized egg during the early part of pregnancy. It has been suggested that some women who miscarry may not make enough progesterone in the early part of pregnancy. Supplementing these women with medications that act like progesterone (these are called progestogens) has been suggested as a possible way to prevent recurrent miscarriage.

This updated Cochrane Review identified a total of 13 trials that enrolled a total of 2556 women with a history of recurrent miscarriages. 

David Haas, Cochrane Pregnancy and Childbirth Group Editor said, 

“We found evidence from randomized controlled trials that giving progestogen medication can probably prevent miscarriage for many women with recurrent previous miscarriages. The trials included in this study found that giving progestogen medication to women with recurrent miscarriages early in their pregnancy may help lower the rates of miscarriage in that pregnancy from 26.3% to 19.4%. We believe that these findings are based on evidence of only moderate quality, so we cannot be certain about the results – but can confidently say giving progestogen medication can probably prevent miscarriage. 

“Having miscarriages can be both physically and emotionally difficult for women and their partners. Finding a therapy to help reduce recurrent miscarriages could help women and their partners avoid this and go on to successfully have a baby.”

Monday, October 15, 2018

Featured Review: Pelvic floor muscle training versus no treatment, or inactive control treatments, for urinary incontinence in women

Tue, 10/09/2018 - 18:09

Chantal Dumoulin and Licia P Cacciari from Cochrane Incontinence  wanted to find out if pelvic floor muscle training (PFMT) helps women with urinary incontinence problems. They did this by comparing the effects of this training with no treatment, or with any inactive treatment (for example, advice on management with pads). We asked Chantal and Lucia questions about this recent Cochrane Review.

1. Please can you describe yourself and your Cochrane Group?

Since 2012 I have held a Canada Research Chair in Urogyneacoogical health and Aging. Our research program's overarching goal is to Improve continence care in older Canadian women. With this goal in mind, I partnered with a New Zealand expert in pelvic floor rehabilitation reviews; Dr. J. Hay Smith and a post-doctoral fellow and physiotherapist from Brazil, Dr Licia Carciari, to update our knowledge of the effectiveness of pelvic floor rehabilitation for urinary incontinence, in women. Conducting this review update will help inform my research program but most importantly will transfer the evidence to patients, clinicians and researchers with the overall goal to improve continence care, in women.

2. What was the background to the Review? 

Stress incontinence is leaking of urine which cannot be easily controlled (if at all) when performing a physical activity. Physical activities could include coughing, sneezing, sporting activities or suddenly changing position. Urgency incontinence happens with a sudden, strong need to urinate. This can often lead to not making it to the toilet in time to urinate, resulting in leakage. Mixed incontinence is where someone has both stress and urgency incontinence.

A wide range of treatments have been used in the management of urinary incontinence, including conservative interventions (such as physical therapy, lifestyle intervention, behavioural training and anti-incontinence devices), pharmaceutical intervention and surgery. This review focus on one of the physical therapies, specifically pelvic floor muscle training (PFMT). 

Pelvic floor muscle training is a program of exercises to improve pelvic floor muscle strength, endurance, power, relaxation or a combination of these. It is a widely used treatment for women with stress, urgency and mixed incontinence.

We wanted to find out if PFMT helps women with urinary incontinence problems. We did this by comparing the effects of this training with no treatment, or with any inactive treatment (for example, advice on management with pads). We also summarized findings on costs and cost-effectiveness.

3. What has changed in this update? 

In this update we included ten new trials, which did not change the essential findings of the prior review. However, the wider range of populations, countries and secondary outcomes within these new trials emphasized the strength of recommendation of PFMT for women with urinary incontinence. There is now one report of reduction of urinary leakage episodes for women with urgency urinary incontinence treated with PFMT and one report of better quality of life for women with mixed urinary incontinence treated with PFMT.

Of note, in almost all new included trials, the PFMT protocols were described in more details, with progressive training based on exercise physiology. Grade A patient reported symptoms and quality of life outcomes were used more often, in line with recent international guidelines recommendations. Finally, we are starting to gather data supporting PFMT cost-effectiveness and the results look promising.

4.  Why was it important to conduct this Review?

Earlier Cochrane Reviews of PFMT are outdated as new trials have been published. There is sufficient uncertainty about the effects of PFMT to suggest that continuing to update earlier Cochrane reviews is warranted.

5. What are the main implications of this research?

This review is important for clinicians and consumers.  Based on the data available, we can be confident that PFMT can cure or improve symptoms of stress urinary and all other types of UI. It’s also important to note that negative side effects of performing PFMT were rare and, in the two trials that did report them, the side effects were minor.

This review is also important for researches, since it highlights the need for more pragmatic, well-conducted and explicitly reported trials comparing PFMT with control to investigate the longer-term clinical effectiveness and cost-effectiveness of PFMT for women with symptoms of stress, urgency and mixed urinary incontinence.

6.  What would you like to see happen as a result of publishing this review?  

The findings of the review suggest that PFMT could be included in first-line conservative management programs for women with urinary incontinence. Clinicians and health care providers should be aware of these evidences.  

Wednesday, October 10, 2018

Featured Review: Individual, family, and school-level interventions targeting multiple risk behaviours in young people

Thu, 10/04/2018 - 15:55

Findings suggest that school-based interventions may have a role to play in preventing risk behaviours

Health risk behaviours, such as smoking and drug use, can group together during the teenage years, and engagement in these multiple risk behaviours can lead to health problems such as injury and substance abuse during childhood and adolescence, as well as non-communicable diseases later in life. 

The Cochrane Public Health review team carried out thorough searches of multiple scientific databases and identified 70 studies that looked at ways of preventing or decreasing engagement in two or more risk behaviours, among young people aged eight to 25 years. The studies were divided into groups of individual-level, family-level, and school-level studies and most were conducted in the USA or in high-income countries.

Risk behaviours include:

  • tobacco use 
  • alcohol use 
  • illicit drug use 
  • gambling
  • self-harm 
  • sexual risk behaviour
  • antisocial behaviour 
  • vehicle-risk behaviour 
  • physical inactivity
  • poor nutrition

Lead author Georgie MacArthur from the Cochrane Public Health Group summarises, “The findings suggest that school-based interventions offered to children may have a role to play in preventing tobacco use, alcohol use, illicit drug use, and antisocial behaviour. We did not find strong evidence of benefit of interventions for families or individuals, although fewer such interventions were identified. 

Nevertheless, concerns around reporting of studies and study quality highlight the need for additional robust, high-quality studies to further strengthen the evidence base in this field.”

Friday, October 5, 2018

Featured Review: Non-clinical interventions for reducing unnecessary caesarean section

Thu, 10/04/2018 - 14:35

With numbers of caesarean sections increasing world wide this review looks at non-clinical interventions for reducing caesarean sections.

Caesarean section is an operation used to prevent and reduce complications of childbirth. While it can be a life‐saving procedure for both the mother and baby, caesarean section is not without harm and should only be carried out when necessary. The number of caesarean sections performed has been increasing worldwide. The aim of this updated Cochrane Review was to find out whether non-clinical interventions, which aim to reduce unnecessary caesarean sections, such as providing education to healthcare workers and mothers, are safe and effective. 

The review team from Cochrane Effective Practice and Organisation of Care  studied a wide range of non-clinical interventions drawn from 29 studies, mostly in high-income countries. 

Based on high‐quality evidence, they found the following interventions reduce caesarean section rates without adverse effects on maternal or neonatal outcomes. These interventions are mainly aimed at healthcare professionals (nurses, midwives, physicians) and involve using: clinical guidelines combined with mandatory second opinion for caesarean section indication; clinical guidelines combined with audit and feedback about caesarean section practices; and opinion leaders (obstetrician/gynaecologist) to provide education to healthcare professionals.

Thursday, October 4, 2018

The Recommended Dose podcast: long-time Cochrane luminary Jeremy Grimshaw

Thu, 10/04/2018 - 09:42

President, Campbell Collaboration & long-time Cochrane luminary

Named by Reuters as one of the most influential scientific minds of our time, this week’s guest wears many hats and pursues all kinds of surprising interests. Jeremy Grimshaw has earned a global reputation for translating evidence into genuine changes that improve human health. He’s a Professor of Medicine at the University of Ottawa, President of the global Campbell Collaboration and a long-time Cochrane luminary. And as Ray discovers, he can make complex behavioural science, obscure music festivals and Formula 1 racing the most comfortable of companions in the course of just one lively conversation. Here, Jeremy closes out series 2 of the Recommended Dose with his original insights into health and social sciences research, and throws in some top musical tips for good measure.

Listen to Recommended Dose podcasts on SoundCloud, iTunes, Stitcher  or wherever you listen to your favourite podcasts. 

Find more details and our show notes the podcast page or follow on twitter  or facebook.

The Recommended Dose is produced by Cochrane Australia and co-published with The BMJ.

Thursday, October 4, 2018

World Mental Health Day

Wed, 10/03/2018 - 17:41

World Mental Health Day (WMHDAY) is being held on October 10th 2018. The World Federation for Mental Health is focusing the 2018 WMHDAY campaign on ‘Young People and Mental Health in a Changing World’. They want to bring attention to the issues our youth and young adults are facing and begin the conversation around what they need in order to grow up healthy, happy, and resilient.

Cochrane Common Mental Disorders Group works with authors from around the world to produce and disseminate systematic reviews of healthcare interventions for treating and preventing a range of mental health problems. Some of the conditions they cover include depression, anxiety, eating disorders, somatoform disorders and suicide.

One recent Cochrane Review of interest is ‘E‐Health interventions for anxiety and depression in children and adolescents with long‐term physical conditions’. Long‐term physical conditions affect 10% to 12% of children and adolescents worldwide; these individuals are at greater risk of developing psychological problems, particularly anxiety and depression. This Cochrane Review found that at present, the field of e‐health interventions for the treatment of anxiety or depression in children and adolescents with long‐term physical conditions is limited to five low quality trials. The very low‐quality of the evidence means the effects of e‐health interventions are uncertain at this time, especially in children aged under 10 years. Although it is too early to recommend e‐health interventions for this clinical population, given their growing number, and the global improvement in access to technology, there appears to be room for the development and evaluation of acceptable and effective technologically‐based treatments to suit children and adolescents with long‐term physical conditions.

Friday, October 5, 2018

Cochrane Russia for the first time in history publishes in PLOS ONE the results of the quality assessment of Russian clinical practice guidelines using the AGREE tool

Tue, 10/02/2018 - 16:08

Recently PLOS ONE published a paper from Cochrane Russia, a Research and Education Centre for Evidence-Based Medicine, housed at the Kazan Federal University, which presents the first experience of scientific assessment of the quality of Russian clinical practice guidelines on the international criteria of the AGREE instrument.

The authors from Kazan, Kaliningrad (Russian Federation) and Phoenix (Arizona, USA) for the first time applied the AGREE II instrument to clinical practice guidelines for surgical treatment of diseases of the hepatopancreatobiliary system and showed their generally poor quality, highlighting as the best CPG that for chronic pancreatitis.

The AGREE Tool (Appraisal of Guidelines for Research & Evaluation) has become the international gold standard for the evaluation and development of clinical practice guidelines (CPGs). However, it has never been used in Russia to develop the health system and improve health policy, while the appreciation of the value of CPGs is high in the academic and leadership health community, and the need for quality CPGs is screaming today.

The AGREE tool is a method of consolidating expert appraisals, it allows assessment of the methodological rigour and transparency of the process of guideline development, ideally should be used in the process of developing CPGs.

Clinical practice guidelines represent the essential tool of health policy based on evidence. Their quality and reliability determine the quality of care and allow to achieve better results of treatment or outcomes in patients.

In the Russian Federation, the majority of clinical practice guidelines have been developed over the past two decades, and many are still under development. Their legal status, both in the provision of medical care, and in its expert evaluation, has not yet been fully determined. The issues of improving the development and use of CPGs in Russia are now widely discussed at all levels of the health system and at the highest government level.

This work was undertaken to improve clinical practice in Russia and to promote health policy development, namely, the development of clinical practice guidelines, dissemination and use that of CPGs that meet the best international standards.

Diseases of the hepatopancreatobiliary system are the most common diseases of the digestive system, requiring surgical treatment. The severity of their complications with high mortality rates and the currently used high-cost technologies for their diagnosis and treatment pose serious challenges for health systems.
The authors asked four experts in this field to evaluate, using the questionnaire AGREE II, independently of each other the following Russian produced CPGs, found as a result of systematic search: 1 CPG – for acute cholecystitis, 2 CPGs – for acute cholecystitis, 1 CPG – for acute pancreatitis, 1 CPG – for chronic pancreatitis, and 1 CPG on cholelithiasis. All CPGs were developed by the associations and scientific societies of specialists from Russia and CIS countries.

All six clinical recommendations received the highest scores for the domain Clarity of Presentation (46-80%) and the lowest domain scores were for Editorial Independence (6-25%), on the whole, experts rated the quality of recommendations low.

The authors believe that these results probably reflect the situation with the quality of clinical practice guidelines in general, and suggest ways to overcome this problem, in particular, the use of the AGREE II tool in developing new and updating existing clinical practice guidelines.

The authors, noting the limitations of their research and analysing the possible reasons for the low quality of the CPGs and the differences in expert assessments, justify the need to repeat the same study in two to three years.

The publication of these results in the journal PLOS ONE, a reliable, peer-reviewed open access journal, gives us confidence that this is the best way to make these results widely known internationally and in the rapidly developing Russian academic health community.

The lead author of this paper, the Cochrane Russia Director, Liliya Eugenevna Ziganshina says that this work represents the first humble steps of Cochrane Russia in launching a project for the systematic assessment of Russian clinical practice guidelines and clinical trial reports. This is essential to enable improvement of medical research and presentation of publications or reports on this research and clinical trials as a basis for the implementation of Cochrane strategy of Knowledge Translation in Russia. Introduction and implementation of unified systematic requirements and standards that ensure quality, reliability and independence of clinical practice guidelines based on principles and tools of evidence-based medicine are urgently needed.

Tuesday, October 2, 2018

Cochrane seeks Business Analyst - London, UK

Mon, 10/01/2018 - 19:20

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Specifications: Full Time
Salary: £35,000 to £40,000 DOE
Location: London with flexibility to work from home up to 2 days per week
Application Closing Date: 26th October 2018

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

The Cochrane Library Business Analyst (BA) you will gather, analyse, validate and document business requirements using workshops, interviews, document analysis, site visits, use cases, business analysis, task, workflow analysis and observations, ensuring they are sufficiently detailed, reviewed, signed off, and kept up-to-date and are fully traceable. They will create and manage functional specifications and help identify and validate appropriate solutions, to support business objectives.

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:

  • Experience evaluating information gathered from multiple sources, reconcile conflicts, and translate high-level requirements from the customer into detailed tasks for the technical team.
  • In-depth knowledge of feature definition, technical analysis, and software development processes.
  • Highly proficient technical skills/knowledge enabling you to work effectively with engineers and understand the technical aspects of the platform(s).
  • Ability to translate technical requirements into a form which is understandable by non-technical customers
  • Excellent written English
  • Excellent verbal and written communication skills and the ability to interact professionally with executives, managers, and subject matter experts.
  • Ability to assess project requirements and understand processes for gathering, validating and documenting.
  • Ability to understand and create workflows of requirements (user journey, functional specification).
  • Strong ability to translate business requirements to technical requirements that developers can use to implement.
  • Able to work efficiently and effectively with a geographically-dispersed department and organization.

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 “Business Analyst” 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 see the full job description.

Deadline for applications: 26th October 2018 (12 midnight GMT)

Interviews to be held on: (TBC)


Monday, October 1, 2018 Category: Jobs

Cochrane Summer School 2018

Mon, 10/01/2018 - 17:01

Improving Cochrane evidence uptake in clinical practice is a joint goal of Cochrane Neurological Sciences and Cochrane Italy. They have been making progress with their annual Summer Schools. Over a week they gather young doctors to talk about clinical decision making, evidence-based medicine, and the methodology behind Cochrane Reviews.

Thursday, October 11, 2018

Featured Review: Patient-mediated interventions to improve professional practice

Mon, 10/01/2018 - 15:28


Our annual meeting, the Cochrane Colloquium, had patient involvement as central theme for 2018. We took the chance to meet two of the Cochrane Eddective Practice and Organizsation of Care authors of the newly published review, ‘Patient‐mediated interventions to improve professional practice’, to get their reflections on patient involvement in clinical practice as it linked so well with the theme of the Cochrane Colloquium.

Healthcare professionals are important contributors to healthcare quality and patient safety, but their performance does not always follow recommended clinical practice. There are many approaches to influencing practice among healthcare professionals. In this review, authors assessed the effectiveness of patient‐mediated interventions on healthcare professionals' performance. Examples of patient‐mediated interventions include 1) patient‐reported health information, 2) patient information, 3) patient education, 4) patient feedback about clinical practice, 5) patient decision aids, 6) patients, or patient representatives, being members of a committee or board, and 7) patient‐led training or education of healthcare professionals

25 studies with a total of 12,268 patients were included in this Cochrane Review. The review  found:

  • Patients can improve the performance of healthcare professionals through a broad range of approaches. Strategies where patients give healthcare professionals information about themselves and patient education are promising
  • It seems fair to imply that patient-mediated interventions, where communication with and involvement of patients is a given, indeed improve the quality of healthcare.

“We do Cochrane reviews to improve healthcare, this review shows patients can influence the quality of the healthcare they receive by influencing healthcare professionals. Not only can it improve their own healthcare but the care others receive too, ” say Martita S Fonhus, lead author of the Cochrane Review.

Therese K Dalsbo, co-author, added: “In this way patients can think of themselves as responsible for their own care and that of others later on. The colloquium put patients at the heart of the event, a sentiment we agree with, this democratic approach affects the healthcare we all receive."

Fonhus concluded: “An informed patient leads to better health, there are two pathways. One which improves the patients own health and one which improves the practice of the clinician. Patients can help clinicians to remember all they need to do – especially given that clinical encounters are often so brief.”

Wednesday, October 3, 2018

Not at the 2018 AGM?

Wed, 09/26/2018 - 13:34

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The recording of this year’s Cochrane Annual General Meeting, held on Monday 17 September at the Cochrane Colloquium in Edinburgh, is now available.


All proposed Resolutions were passed by the Members at the meeting. The results of the votes are available at Draft minutes from the meeting will be sent to Members in due course.

Wednesday, September 26, 2018

Edinburgh Colloquium 2018: Round-Up

Wed, 09/26/2018 - 12:59

The Cochrane Colloquium is an annual event, bringing people together from around the world to discuss research into important global health questions and promote evidence-informed health care.  This year the theme is ‘Cochrane for all - better evidence for better health decisions’.  It was a Patients Included event, co-designed, co-produced and co-presented by healthcare consumers, where everyone’s input is valued equally. It focused on key goals of Cochrane’s Strategy to 2020: producing evidence, making evidence accessible, and advocating for evidence.

Colloquium by the numbers
  • 1275+ attendees from over 57 countries
  • 82 workshops
  • 243 posters
  • 222 oral presentations
 Colloquium Podcasts

For the first time at a Cochrane Colloquium, we took the conversation #BeyondTheRoom. Beyond the Room is a digital conference service, started in 2016 by André Tomlin from the Mental Elf. Its aim is to increase the reach and impact of health events by live tweeting and podcasting from them, to involve people virtually and facilitate a much more democratic conversation. Our Beyond the Room team have recorded podcasts with some of the speakers and presenters at the Colloquium - Have a listen!

For this year’s Patients Included Cochrane Colloquium, Richard Morley interviewed Simon Denegri, National Director for Patients, Carers and the Public, UK National Institute of Health Research.

Edinburgh Colloquium Pictures

Browse through pictures taken at the Colloquium!

AbstractsVideos from the colloquium Wednesday, September 26, 2018

Statement from Cochrane’s Governing Board – 26th September 2018

Tue, 09/25/2018 - 17:21

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The Cochrane Collaboration’s Governing Board of Trustees voted unanimously on 25th September to terminate Professor Peter Gøtzsche’s membership of the organization, and his present position as a Member of the Governing Board and Director of the Nordic Cochrane Centre.

Cochrane is a collaboration: an organization founded on shared values and an ability to work effectively, considerately and collaboratively. The Governing Board’s decision was based on an ongoing, consistent pattern of disruptive and inappropriate behaviours by Professor Gøtzsche, taking place over a number of years, which undermined this culture and were detrimental to the charity’s work, reputation and members.

Professor Gøtzsche has also repeatedly represented his personal views as those of Cochrane, including in correspondence with members of the academic community; in the media; and when acting as an expert witness for a criminal trial. Cochrane’s strength and independence rests on our ability to engage in frank, open and transparent debate about health evidence and Professor Gøtzsche, like every other Cochrane member, has the right to express his views. However, as a leader of Cochrane – a Director of a Cochrane Centre and a trustee of the charity – he had a special duty of care to the organization about the way his views were expressed; particularly those made in a personal capacity. Despite numerous attempts to engage with him on this topic and warnings about his behaviour, he consistently failed to exercise this care. This has resulted in multiple complaints to the charity and damaged its credibility within the research community.

The decision has not been taken lightly and the process has included full Governing Board consideration of an independent legal review of the relevant facts. Professor Gøtzsche has been given a number of opportunities to make representations and to put forward his perspective on events, both as part of the independent review and subsequently.

The final decision follows an initial Governing Board meeting on 13th September 2018. At this meeting:

  • Eleven members of the Board voted that Professor Gøtzsche had breached the Trustees’ Code of Conduct as a result of these behaviours;
  • a majority voted that Professor Gøtzsche should accordingly resign as a trustee; and
  • a majority concluded that Professor Gøtzsche has acted counter to the best interests of the charity as a whole and therefore voted to serve notice to terminate Professor Gøtzsche’s membership of the charity, in accordance with Cochrane’s Articles of Association.

Professor Gøtzsche was then given the opportunity to provide further representations to the Governing Board, in accordance with the established procedure, which were considered fully by the Board on 25th September before a final decision was made. 

In making its decision, the Governing Board has also taken into consideration events since the independent review began: in particular, a series of public statements by Professor Gøtzsche which have breached his obligations of confidentiality as a trustee and continued the pattern of behaviours which led to the Board’s initial decision.

We are committed to the highest standards of governance and to ensuring that Cochrane is a welcoming, open, dynamic organization, that lives up to its values, and has a working culture which attracts the best researchers, clinicians and others interested in healthcare evidence. We continue to lead and support the organization to deliver our Strategy to 2020, which aims to put Cochrane evidence at the heart of health decision-making all over the world.

Cochrane’s Governing Board

Wednesday 26th September 2018

For media enquiries, please contact

Wednesday, September 26, 2018

An interview on consumer involvement in research with Simon Denegri, NIHR

Tue, 09/18/2018 - 08:57

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Tuesday, September 18, 2018

Statement from Cochrane's Governing Board

Mon, 09/17/2018 - 14:48

Dear Cochrane members,

These are extraordinary times and we find ourselves in an extraordinary situation. Your Board is always happy to answer questions about our decisions, and today is no different. We want to explain how we got here today. This wasn’t our original plan because we wanted to behave fairly and with integrity, in a process that respected the privacy of an individual, whilst taking place over a number of days. Days, which unfortunately span this special Colloquium.

This is about the behaviour of one individual. There has been a lengthy investigation into repeated bad behaviour over many years. It is exceptionally unusual for a Board to have to do such an investigation.

Last Thursday, the Board took a decision which divided the Board. Subsequently, four Board members chose to resign and have actively disseminated an incomplete and misleading account of events. At the same time, others contributed to a public and media campaign of misinformation.

We recognize that the last 24 hours have been exceptionally difficult and as a result, we as a Board have decided to share with you information about the decision that was made, the process by which it was made, and where we are now, in order to act in the best interests of Cochrane.

We now want to put before you as much evidence as we can, so you know what is going on. We cannot tell you everything. All of you will understand why individuals have a right to privacy and confidentiality. We ask that you all respect this, because we may not be able to tell you everything, for legal reasons and reasons of privacy.

By way of background, we are a global organization which operates under British law because we were founded as a UK charity. Our mission is to benefit the public. We are governed by our Articles of Association.

As the Board, we are in fact the employers of the Cochrane staff. All our staff, and our members, have the right to do their work without harassment and personal attacks. We are living in a world where behaviours that cause pain and misery to people, are being ‘called out’. This Board wants to be clear that while we are Trustees of this organization, we will have a “zero tolerance” policy for repeated, seriously bad behaviour. There is a critical need for ALL organizations to look after their staff and members; once repeated, seriously bad behaviour had been recognized, doing nothing was NOT an option.

So, here are the facts as we are able to report them. We may be able to tell you more later, we may not. Time will tell.

This Board decision is not about freedom of speech.
It is not about scientific debate.
It is not about tolerance of dissent.
It is not about someone being unable to criticize a Cochrane Review.

It is about a long-term pattern of behaviour that we say is totally, and utterly, at variance with the principles and governance of the Cochrane Collaboration. This is about integrity, accountability and leadership.

In March this year, we received three complaints about an individual. These were not the first complaints that had ever been received. In fact, the earliest recorded goes back to 2003. Many have been dealt with over the years. Many disputes have arisen. Formal letters have been exchanged. Promises have been made. And broken. Some disputes have been resolved, some have not.

It was clear to the Co-Chairs that the Board had to reach a decision about these most recent complaints. The individual then made serious allegations against one of the Senior Management Team and shared those with the Board. We seemed to be in an impossible situation. How could the Board now reach a decision about the complaints in a fair way? How could we fulfil our responsibilities as employers of the Senior Management Team? Or alternatively, act to admonish that member of the Senior Management Team if they had done wrong?

With guidance from a Trustee with extensive experience of complaints, we proposed asking a totally independent person to undertake a review. The report was to be confidential to the Board.

After failing to get agreement from the individual to an independent review, we then sought legal advice on behalf of Cochrane. We asked the lawyers, what should a Charity such as Cochrane do in this situation? We were advised that various legal consequences flowed from the events – the complaints and the accusations - and that Cochrane should take them seriously.

We asked the lawyers to take particular note of Cochrane’s commitment to transparency. They noted that, but also stressed the importance of confidentiality.

They advised that an independent review was both a sensible and proportionate response.

At the Governing Board Teleconference on 13th June 2018, all Board members read the letter from our lawyers. The lawyers stated that given the serious legal concerns about this matter they strongly recommended an independent review by a very senior lawyer. The Board approved a motion to accept the lawyer’s advice and establish the independent review.

Our lawyers identified a senior independent lawyer (QC) and he was instructed on 2nd July 2018. As part of the process, he invited written submissions from both individuals concerned. He invited both to be interviewed. The lawyer was asked to work to a deadline of the Board Meeting on Thursday last week, 13th September. And, we did in fact receive his preliminary report in time for that meeting. The report completely exonerated the member of the Senior Management Team but did not exonerate the other individual.

Whilst the review was underway, and as a completely separate matter, a paper was published in the journal BMJ-EBM co-authored by the individual concerned on July 27th 2018. The publication of this paper has proved controversial. As a result, the Board received a number of letters of complaint. Each was sent to the individual to allow a written response. In order to avoid any misunderstanding, the Board want you to be clear that this was a matter that arrived very late in this whole process.

So, at the Board Meeting on Thursday September 13th, the trustees reviewed the lawyer’s report of his independent review, and all the material related to the recently published paper. After they had reviewed and discussed this at length, the Trustees exercised their judgement, and looking across a broad range of behaviours, the Board came to a decision to invoke Article 5.2.1. relating to termination of membership. This was not unanimous.

As a result, Article 5.3 was triggered, and the member has been invited to make a written response within seven days.

At this point in time, this person remains a member of the Cochrane Collaboration. We are waiting for the process to be completed. We will report back to you about the outcome as soon as we are able to.

Let us repeat, this is an extremely rare and unusual thing to do. We hope never to have to do this again.

Cochrane Governing Board
17th September 2018

Monday, September 17, 2018

Beyond the Room Edinburgh Colloquium 2018 Podcasts

Mon, 09/17/2018 - 14:27

For the first time at a Cochrane Colloquium, we will be taking the conversation #BeyondTheRoom. Beyond the Room is a digital conference service, started in 2016 by André Tomlin from the Mental Elf. Its aim is to increase the reach and impact of health events by live tweeting and podcasting from them, to involve people virtually and facilitate a much more democratic conversation. 

Our Beyond the Room team includes  @SarahChapman30 @TheJackLeahy @Mental_Elf @MightyCasey @DBadenoch @sally_crowe Selena @CochraneUK and  @Laconic_doc They have recorded podcasts with some of the speakers and presenters at the Colloquium - Have a listen!

Monday, September 17, 2018

An Interview with Doug Altman

Sun, 09/16/2018 - 15:23

Roberto D’Amico from Cochrane Italy shares an interview with Doug Altman. Everyone within the Cochrane community was sad to learn of the death of Professor Doug Altman this year. Doug Altman was a Cochrane leader and pioneer since the Collaboration’s beginning in 1993. He is best known for his work on improving the reliability and reporting of medical research and for highly cited papers on statistical methodology. Doug’s long-serving contributions to Cochrane have been universally acknowledged across the world. He was a long standing co-convenor of Cochrane’s Statistical Methods, and more recently co-convened both the Cochrane Bias and Cochrane Prognosis Methods; he authored over 450 papers in statistical methodology, with 11 being cited more than 1,000 times.

In 1998, I came to the Centre for Statistics in Medicine, which was directed by Doug Altman. For two years I had the privilege of working closely with Doug and his team. That time in Oxford had an important impact on my methodological training and on my way of thinking about clinical research.

In 2013 I was asked to organize a session on state-of-the-art methodology for Cochrane systematic reviews and meta-analyses, at the annual meeting of SISMEC, which is the Italian Society of Medical Statistics and Clinical Epidemiology.

I immediately thought Doug was the person to invite. Unfortunately, he had prior engagements for the dates of the meeting and therefore could not come. I had the idea of interviewing him instead, and when I proposed it to him, he accepted gracefully. We spent half a day together in his office recording the interview. Doug was relaxed and enjoyed answering the questions. I have great memories of that day.

Listening to Doug is always a pleasure. His points of view and his suggestions are exceptionally educational and inspiring. I would like to share his insights with all of you to remember the great person he was and to keep being inspired by him. Doug Altman will always remain an example to follow.

Roberto D’Amico
Professor of Biostatistics
Università di Modena and Reggio Emilia
Azienda Ospedaliero-Universitaria di Modena
Cochrane Italy


The interview is in six parts, with Doug responding to these questions:

  1. What are the main changes in methodology of meta-analysis of interventions observed in the last 20 years?
  2. How has the methodology of systematic reviews influenced clinical research?
  3. Where is the methodology of systematic reviews and meta-analyses heading and where should it be heading?
  4. Which skills should young statisticians acquire and what knowledge should they have?
  5. What are the challenges in communicating research findings?
  6. Has the methodological quality of medical research improved in the last 30 years?

Monday, September 17, 2018

Cochrane Library Editorial - Information specialists: ensuring quality as the basis of evidence synthesis

Sun, 09/16/2018 - 14:52

The foundations of both Cochrane and the wider evidence synthesis community rest on the involvement of methodologists in the production of high‐quality systematic reviews. Epidemiologists, statisticians, and information specialists have had an enormous impact on the evolution of Cochrane and the advancement of systematic review methodology. Compared with other methodologists, information specialists tend to fly somewhat under the radar despite the fact that they act in a wide variety of roles. Information specialists organize, disseminate, and interpret information; they also preserve knowledge and ensure that it is discoverable in the future.

Read a new Cochrane Library Editorial on how information specialist expertise should be leveraged further to ensure quality and improve the efficiency of evidence synthesis.

Sunday, September 16, 2018

Message from the Governing Board

Sat, 09/15/2018 - 17:03

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This week at its meeting in Edinburgh, Cochrane’s Governing Board considered, as planned, the findings of an independent review and additional complaints related to the conduct of a Member. The Board’s conclusion was communicated to the individual concerned and is part of an ongoing process. The Co-Chairs of the Board will provide further details once this process is complete.

Following this, four Board members (Gerald Gartlehner, David Hammerstein Mintz, Joerg Meerpohl and Nancy Santesso) decided to resign as Cochrane trustees with immediate effect. This situation required further changes in the composition of the Board in order to comply with Cochrane’s Articles of Association, and as a result Rae Lamb and Catherine Marshall, two appointed trustees, volunteered to step down.

An election for new Board members will take place soon. In the meantime, the Board will continue to govern The Cochrane Collaboration as usual, guided by our principles, Charter and Articles. The Board completed its planned business today and expresses its strong support for the commitment and professionalism of Cochrane’s Central Executive Team.

As the 25th Cochrane Colloquium gets underway in Edinburgh, the Governing Board looks forward to welcoming nearly 1,300 participants from 57 countries to celebrate our theme of ‘Cochrane for all: better evidence for better health decisions’.

Marguerite Koster and Martin Burton
Governing Board Co-Chairs

Saturday, September 15, 2018