Folate is an essential B-vitamin that is needed for DNA synthesis and cell division. Folate deficiency can lead to anemia, and deficiency early in pregnancy can lead to neural tube defects – birth defects of the brain, spine and spinal cord, including spina bifida.
A Cochrane systematic review on the benefits and safety of fortifying wheat or maize flour with folic acid and population health outcomes, led by scientists in the Division of Nutritional Sciences at Cornell, found that fortification with folic acid (the synthetic form of folate) may improve folate status and reduce the occurrence of neural tube defects. However, the review found limited evidence for an effect of fortifying wheat or maize flour with folic acid on hemoglobin levels or risk of anemia, and no studies reported on the occurrence of adverse side effects.
The researchers’ findings, published in the Cochrane Database of Systematic Reviews, will help to inform World Health Organization (WHO) guidelines and recommendations for the national policies and public health programs of its 194 member states.
Cochrane systematic reviews are recognized internationally as representing a gold standard for high-quality evidence for medicine and public health.
This is the first Cochrane systematic review to examine the efficacy of wheat and maize flour fortified with this essential vitamin that is widely known to help prevent neural tube defects.
“The links between maternal folate status early in pregnancy and risk of neural tube defects, a type of severe pregnancy outcome, has been known for over 50 years – and the benefits of periconceptional folic acid supplementation were established with two landmark randomized trials in the early ‘90s,” said Julia Finkelstein, assistant professor in Cornell’s Division of Nutritional Sciences.
“Based on this evidence, flour has been fortified with folic acid in over 60 countries and is one of the most important public health success stories worldwide to prevent neural tube defects,” she said. “However, a systematic review was needed to evaluate the efficacy and safety of folic acid fortification interventions of these two staple flours – and to inform the development of World Health Organization guidelines,” she said.
“This review complements the existing evidence from observational studies and programmatic experience from public health programs, and the findings lead to a better understanding of the benefits and safety of folic acid-fortified wheat and maize flour on population health outcomes,” said Elizabeth Centeno-Tablante, doctoral student in the Division of Nutritional Sciences.
Fortification is one of the main approaches to improve vitamin and mineral intake in populations – to reach at-risk populations without requiring behavior change. “Fortification of staple foods with folic acid is an important strategy to improve folate status in women of childbearing age – since neural tube defects develop in the first four weeks of pregnancy when most women do not yet know they are pregnant,” said Finkelstein.
“In a public health framework, if you can shift the population distribution of folate, you can improve folate nutrition in women during a vulnerable period and help reduce the risk of a very serious health outcome – without changing behavior, in an inexpensive way, to the most vulnerable populations,” Finkelstein said.
No previous systematic reviews evaluated the efficacy of folic acid fortified flour on other health outcomes in the general population. For example, what are its impacts on folate status, anemia or other pregnancy outcomes? What might the benefits or harms be for those with no chance of becoming pregnant – such as children, men or the elderly?
“This Cochrane review includes benefits and safety and any health outcome in any population – for a holistic view of the scientific evidence available to date on this topic,” Finkelstein said.
Evidence from this review has been incorporated into the World Health Organization guideline titled, “Fortification of Maize Flour and Corn Meal With Vitamins and Minerals” and will be incorporated into the upcoming WHO guideline for wheat flour fortification.
The Division of Nutritional Sciences at Cornell University has been a PAHO/World Health Organization Collaborating Centre since 2015, and this year was named an Affiliate Centre for Nutrition in the new Cochrane US Network.
The Cochrane protocol and review were developed as part of the annual WHO/Cochrane/Cornell University Summer Institute for Systematic Reviews in Nutrition for Global Policy Making, hosted by the Division of Nutritional Sciences.
Stephen D’Angelo is the Assistant Director for communications for the College of Human Ecology.
The Cochrane Crowd challenges are always fun. People from around the world log in to Cochrane Crowd and assess titles and abstracts, deciding whether they are describing a randomised trial or not. Here’s an example:
It’s slightly odd perhaps just how fun it is; how with every challenge the race towards the finish line is a guaranteed adrenalin rush. This latest challenge was no exception.
We got off to a very strong start. Even just after two hours, I knew we’d have to change the target of 48,000; by the halfway point we had already reached that. Picking a new target is always a slightly risky business. Whilst it is good to aim high, setting a target too high and then missing it by some way would be a little deflating. I’ll admit a part of me thought, we’re all tired, and it’s the end of the year: why don’t we just go for something totally achievable and sit back and relax. But no, that’s not what we do in Cochrane Crowd!
We like to push ourselves to the limits: in that case, let’s aim for 100,000 classifications in 48 hours! As soon as I twitted this new target, I regretted it. Time seemed to suddenly speed up and for a while we struggled to keep pace, but then just as I was considering how to reduce the target, the numbers starting climbing up and up. At 97,000 classifications I knew we’d make it (just) and I’ll admit I shed a little tear. We ended on 100,724 classifications. Never underestimate the Cochrane Crowd community.
In context: we did more in 48 hours, than we did in the first six months of the Embase project. We launched the former version of Cochrane Crowd (the Embase project) in February 2014. Back then it took us six months to reach 100,000 classifications. Nowadays, it takes around 2-3 months to notch up 100,000 classifications. Doing it in 48 hours is therefore pretty darn impressive.
It was a truly international effort: 165 people based in 47 countries took part and collectively identified just over 6750 reports of randomised trials from 100724 total classifications made. A special thanks needs to go to the challenge’s top three screeners who devoted a significant amount of time to the challenge. A very well done to: Abhijit Dutta, Nikolaos Sideris and Brian Li.
This was a special challenge, designed to run alongside a very special Colloquium: Cochrane’s first virtual Colloquium: https://colloquium2019.cochrane.org
If you are new Cochrane Crowd but looking for a way to contribute to the work of Cochrane that is flexible and fun, then do take a look to see if Cochrane Crowd is for you: https://crowd.cochrane.org It’s a thriving and clearly very energetic community! And if you have any questions or queries please don’t hesitate to get in touch with me (Anna) or my brilliant team mate Emily at firstname.lastname@example.org
Finally, thank you to everyone who was able to join in with this latest challenge and indeed any of our previous challenges.
Together we are making a difference.
Anna and EmilyTuesday, December 10, 2019
In this interview with review author Anjna Rani we learn more about the recently published review, Interventions to reduce Staphylococcus aureus in the management of eczema.
Tell us about this Cochrane Review
This review looks at the evidence of treatments, such as antibiotics, antibacterial soaps/baths, to reduce a type of bacteria called Staphylococcus aureus (S. aureus) that is predominant on skin with eczema. The review assessed a wide variety of treatments to help treat/reduce infected eczema – 41 studies involving 1753 participants were included in total.
Why is it important for patients with eczema?
Eczema is a frustrating skin condition with a number of different treatments. It is important for patients with eczema to understand the variety of treatments available and which one(s) would be suitable for them and are more likely to work to reduce impact on everyday life.
What can this review tell us about how effective treatments are to reduce skin infections in the management of eczema?
Topical corticosteroid/antibiotic combinations are still prescribed widely due to effective marketing. Antiseptic wash products are also widely used, and antibiotics prescribed readily for “infected” eczema when what is needed is adequate control of skin inflammation. Unfortunately, however, despite the number of trials included, there was so much variance in the types of treatment that the quality of evidence is low
How does this review link to a James Lind Alliance priority topic? (This is a shared priority, important to patients and health professionals.)
This was one of the top 10 questions, actually grouped in the health professional priorities, - “How effective are interventions to reduce skin infections in the management of eczema?”
Does the review point to more research being needed?
The conclusion of the review, “In view of the low quality of evidence and lack of information on quality of life and antibiotic resistance, a larger, definitive trial on steroid/antibiotic combination treatment is required. With the increased concerns about antibiotic resistance, other strategies to treat S. aureus infection that do not involve antibiotics should be further investigated.”
The authors reviewed the evidence on the effect on death of using corticosteroids in children and adults with sepsis.
Sepsis is present when an infection is complicated by organ failure. People develop rapid breathing, hypotension (low blood pressure), and mental confusion. Sepsis can interfere with the effectiveness of the body’s corticosteroids, which serve as a key defence against infection. Corticosteroids have been given for decades to people with infection resulting from various causes.
The review included 61 trials (12,192 participants). Fifty-eight trials compared corticosteroids to no corticosteroids (placebo or
usual care in 48 and nine trials, respectively); three trials also compared continuous versus bolus administration of corticosteroids.
The authors analysed the following two comparisons:
- Corticosteroids versus placebo/usual care: Corticosteroids probably reduce the risk of death at 28 days by 9% (50 trials; 11,233 participants), with consistent treatment effects between children and adults. They also probably slightly reduce the risk of dying in hospital. There may be little or no effect of corticosteroids on risk of dying over the long term (longer than three months), but these results are less certain. Corticosteroids result in a large reduction in length of stay in the intensive care unit (ICU) and in hospital. Corticosteroids increase the risk of muscle weakness and hypernatraemia. They probably increase the risk of hyperglycaemia. They probably do not increase the risk of superinfection. There may be little or no effect of corticosteroids on risk of gastroduodenal bleeding, neuropsychiatric events, stroke, or cardiac events.
- Continuous infusion versus intermittent boluses of corticosteroids: We are uncertain about the effects of continuous infusion of corticosteroids compared with intermittent bolus administration. Three studies reported data for this comparison, and the certainty of evidence for all outcomes was very low.
The authors assessed the certainty of evidence as;
- Corticosteroids versus placebo/usual care.The authors judged the certainty of evidence for 28-day mortality as moderate due to some inconsistency related to differences among study populations, types of corticosteroids and how they were given, and use of additional interventions
- Continuous infusion versus intermittent boluses of corticosteroids.The authors judged the certainty of evidence for 28-day mortality as very low due to inconsistency and imprecision.
Monday, December 9, 2019
All content remains freely available on the Colloquium website and open to everyone!
Cochrane’s annual flagship event brings together the world’s most influential health researchers, scientists, academics, opinion leaders, clinicians, and patients to promote evidence-informed decision-making. The unprecedented situation of civil unrest across Santiago led to the cancellation of our face-to face 2019 Colloquium and Cochrane’s first virtual Colloquium. Whilst we recognize our virtual meeting can never replace what we would have achieved together in-person in Chile, we believe that this unique week of content as a fitting tribute to recognizing the extraordinary efforts of hundreds of contributors and the Cochrane community's spirit of resilience and collaboration.
We were so pleased to see all of the social media activity around Virtual #CochraneSantiago last week and it was very exciting to see the diverse content. The amount of work that went into the nearly 180 digital posters and close to 120 video oral presentations was impressive! We heard about equity in systematic reviews; learned about how to better disseminate evidence to diverse stakeholders; and looked at different elements of methodological diversity. We also had time to look back; we relived some memories of prior Colloquia, celebrated acheivements of our community, and had our Annual General Meeting. We ended the week by looking ahead; to ways people can get involved, the vision of our new Cochrane Library Editor, and to our next Colloquium; #CochraneToronto in 2020! In the midst of all of this content, we also screened more than 100,000 records for the Cochrane Crowd #ColloquiumChallenge2019!
If you participated in the Colloquium last week, please share your feedback with us by 20 December. This short survey will help us know what you thought of Cochrane’s first Virtual Colloquium and will help inform what we do virtually in the future!
Finally, we would like to remind you that all Virtual #CochraneSantiago content will stay active and the 2019 Colloquium website, so you can get back to watching those oral presentations you missed during Colloquium week.
Thank you for your participation and feedback!
Cochrane Library Editorial -Cochrane Sustainable Healthcare: evidence for action on too much medicine
Medical excess threatens the health of individuals and the sustainability of health systems. The best available evidence demonstrates that reducing medical excess is very challenging and that there is a pressing need for more and broader work on how to move forward. A new editorial in the Cochrane Library examines these issues and how the priorities and vision of the new Cochrane Sustainable Healthcare field will address them.
- Read the new Cochrane Library Editorial, 'Cochrane Sustainable Healthcare: evidence for action on too much medicine'
- View the news item about the launch of Cochrane Sustainable Healthcare field
Friday, December 6, 2019
Location: London Office based
Application Closing Date: 5 January 2020 Midnight GMT
This role is an exciting opportunity to use your experience in HR to make a difference in the field of health care research. You will be part of a small team providing a high quality, responsive, efficient and effective Human Resources function for Cochrane and its subsidiaries.
Your key areas of responsibility will be:
- Responsible for our recruitment and on-boarding processes from end to end
- Leads on workforce planning so that we can meet our future staffing needs
- Key responsibility for promoting equality, diversity and inclusion
- Offers a casework management service to all levels of Cochrane managers
- Develops, reviews and implements HR policies across the organisation
- Leads on ensuring an effective HR appraisal system is in operation
- Maintain effective and supportive relationships throughout the organisation
We are looking for a self-motivated and highly organised individual who can work effectively and collaboratively with a diverse range of contacts across the world. The successful candidate must also be able to offer:
- CIPD qualification equivalent to Level 7 or working towards this
- Previous experience of HR in the not-for-profit sector with a generalist remit
- Skilled at coaching and supporting managers to build their competence
- Self-confidence, personal credibility and the ability to support and challenge others appropriately
- Good understanding and application of the principles of equality, diversity and inclusion in the workplace
- Pragmatism and problem-solving skills and the ability to think creatively when faced with new problems
- Commitment to Cochrane’s mission and values
- Although not essential, we would also welcome candidates with a working knowledge of employment legislation in Denmark and/or Germany, plus experience of supporting remote workers internationally.
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 email@example.com with “Senior Human Resources Advisor” in the subject line. The supporting statement should indicate why you are applying for the post, and how far you meet the requirements for the post outlined in the job description using specific examples. List your experience, achievements, knowledge, personal qualities, and skills which you feel are relevant to the post.
- For further information, please download the full job description from here
- Interviews to be held early in January 2020
Specifications: Part-time (0.4 – 0.6 FTE, flexible working pattern)
Salary: £45,000 – 55,000 pro rata
Location: Remote (1-2 days a month in the London Office)
Application Closing Date: 5th January 2020 (Midnight GMT)
This role is an exciting opportunity for an experienced research contracts negotiator to share their knowledge and hone their skills in a new environment.
The Senior Contracts Specialist will maintain an effective contracts service for Cochrane, providing contracts support and advice to the Central Executive Team. They will be the first point of call for all legal queries; be accountable for ensuring the proper processing and recording of all contractual documents; and be responsible for the training and ongoing development of the Contracts Officer.
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:
- Higher education to degree level.
- Formal legal qualification either at undergraduate or postgraduate level.
- Substantial experience of contracts management within the Higher Education, health research, charity, and/or publishing sectors.
- Knowledge of intellectual property rights management and laws (particularly related to the UK).
- Excellent oral and written communication skills in English.
- The ability to use judgement, initiative and creativity to identify and solve complex problems.
- Excellent organisational and planning skills including proven ability to organise and prioritise workload, work efficiently and meet tight deadlines.
- Colloborative, flexible, diligent approach and ability to work well and effectively with colleagues worldwide.
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 firstname.lastname@example.org with “Senior Contracts Specialist” in the subject line. The supporting statement should indicate why you are applying for the post, and how far you meet the requirements for the post outlined in the job description using specific examples. List your experience, achievements, knowledge, personal qualities, and skills which you feel are relevant to the post.
- For further information, please download the full job description from here
- Deadline for applications: 5th January 2020 (12 midnight GMT)
- Interviews to be held on: (TBC)
Cochrane China Network working groups had an informal meeting included in the 13th China Health Technology Assessment Forum, hosted by Prof Yingyao Chen (from Fudan University) on 17th November.
Eight Cochrane China Network working groups reported their work on Cochrane and some achievements in health technology assessment Cochrane. Prof Jianping Liu (Beijing University of Chinese medicine) gave the opening session, and introduced Cochrane China network and the whole session.
- Prof Shiyao Chen, from Zhongshan hospital affiliated to Fudan University, talked about “The clinical decision on screening helicobacter pylori for gastric cancer, when combined with the Cochrane evidence, how to make decision”.
- Prof Yaolong Chen, from Lanzhou University and Cochrane China Network GRADE and guidelines Working Group, introduced the process of publishing the RIGHT, the Standards of reporting guidance for clinical guideline.
- Prof Yan Hu, from Fudan University and Cochrane China Network Nursing Working Group, presented the model and practice on clinical evidence and translation, specific in the field of nursing and quality study.
- Prof Yinghui Jin, from Center for evidence-based and translational medicine, Wuhan university, presented the important aspects we should take care of, especially the health economics, during the process of developing guideline and conduct the guideline.
- Prof Jianping Liu, from Beijing University of Chinese medicine and Cochrane China Network Traditional Chinese Medicine Working Group, introduced the application of Cochrane in traditional Chinese medicine, and the impact of Cochrane on evidence-based Chinese medicine.
- Phd Chunli Lu, from Centre for Evidence-based Chinese medicine, Beijing University of Chinese medicine and Cochrane China Network Translation and dissemination Working Group, introduced the translation and dissemination of Cochrane evidence into Simplified Chinese in China.
- Prof Dong Xu, from Global Health Institute, Sun Yat-sen University and Cochrane China Network Implementation science Working Group, introduced the unannounced standardized patients (USP) and the quality of primary health care in seven provinces of China using USP.
- Prof Jiajie Yu, from West China Hospital of Sichuan University; Chinese Cochrane Centre and Cochrane China Network rapid reviews and recommendations Working Group, introduced the method on rapid reviews and recommendations.
Finally, Prof Yingyao Chen organised a lunch time informal gathering and discussion. All participants from different working groups had a discussion about Cochrane China network group activities and meeting in 2020, and all members approved that we should have more face to face meetings and longer time to present and share their own researches to promote more close collaboration in the future.
There is no one place or office that is 'Cochrane'. Our global network of members and supporters work together to achieve our strategic goals and are usually affiliated to one or more Cochrane Groups based on their interests, expertise, and/or geographical location. This year’s virtual #CochraneSantiago Colloquium embodies this global and collaborative spirt! With five days of content organized around celebrating our diversity, we are gathering together as a Cochrane global community.
Members of Cochrane Malaysia took this as an opportunity to bring some of their members in Malaysia together. On Tuesday 4 December they gathered at two locations brought together by technology. Members met at the RCSI & UCD Malaysia Campus in Penang and at Perdana University in Kuala Lumpur and connected via video conference for a local opening and welcome to the Virtual #CochraneSantiago Colloquium in Malaysia. Then, each team screened the #CochraneSantiago content separately, engaging with the presentations and discussing with their colleagues. They were joined by their College President, David Whitford, who is a Cochrane Metabolic and Endocrine Disorders author.
It is wonderful to see Cochrane Malaysia coming together to share, explore, discuss and learn from the content provided by the Colloquium. All Virtual #CochraneSantiago Colloquium content is freely available to all, on the Colloquium website.
Karla Soares-Weiser, Cochrane Library’s Editor in Chief, outlined a new conflict of interest policy that is forthcoming in 2020 in a BMJ opinion piece. Cochrane is committed to independence, transparency, and integrity in healthcare research and minimizing the impact of conflicts of interest in the conduct of Cochrane Reviews. This commitment is reflected in our current Commercial Sponsorship Policy which not only requires interests to be declared, it also rules that some conflicts will prevent authors from conducting Cochrane Reviews. Although Cochrane’s current conflict of interest policy is stricter than most journals, we have revisited it recently with the aim of strengthening our approach to financial conflicts of interest and clarifying our position regarding non-financial interests.
Cochrane’s new, more rigorous approach includes the following key changes:
- The proportion of conflict free authors in a team will increase from a simple majority to a proportion of 66% or more.
- Last authors will be treated in the same way as first authors and, therefore, must be entirely free of conflicts.
- Authors of industry-funded clinical studies eligible for inclusion in a Cochrane Review will be prohibited from being the first or last author on that review.
- Reviews funded by not-for-profit organizations with a specific interest in the outcome will be assessed by Cochrane’s Conflict of Interest Arbiter Panel and the Editor in Chief, who will judge whether the review is conflicted.
- Cochrane authors will need to declare non-financial interests and think critically about how these might influence the results of the review.
An important motivation for strengthening our conflict of interest policy is an understanding of how this issue impacts a reader’s trust in the healthcare information they read. As an organization, Cochrane looks forward to the improvements this policy will bring in keeping Cochrane Reviews demonstrably independent and impartial in their reporting and conclusions.
- Read Karla's piece on BMJ Opinion
- Read the ‘Commercial influence in health: from transparency to independence’ Collection from the BMJ
Wednesday, December 4, 2019
Cochrane author, and joint Co-ordinating editor, Alex Pollock, of Glasgow Caledonian University has seen her ground-breaking work in co-producing a Cochrane review included in a new UK’s National Institute of Health Research (NIHR) INVOLVE publication.
Alex involved stroke survivors, carers, physiotherapists and educators in an update of a Cochrane systematic review relating to physiotherapy after stroke. Her innovative work was included in Co-production in Action Number Two, as an example of good practice in Co-production, published in November 2019 by INVOLVE. You can hear Alex talk about her work in a webinar recorded ahead of the Cochrane Virtual Colloquium here.
Alex Pollock said “Our team was delighted that NIHR INVOLVE chose to include our example of involving people in our Cochrane review as part of their co-production collection. I think that this highlights the fact that involving people in systematic reviews is now viewed as being as important as involving people in other areas of research, such as research prioritisation or primary research studies. Although we don’t yet know the “best” way to involve people in reviews, our work on the ACTIVE project shows that there are some great examples of different ways of successfully involving people in reviews, including examples - like ours - where people have had real and meaningful control over key decisions relating to a review”.
Gary Hickey, of NIHR INVOLVE said” It’s great to see co-production gaining traction in various aspects of research, including Cochrane systematic reviews. Alex’s example demonstrates how the public can work with researchers and healthcare professionals to analyse and interpret data and disseminate findings, ensuring that systematic reviews are more relevant and accessible.”
Alex’s work led to the ACTIVE project, supported by Cochrane Training and the Cochrane Consumer Network. This included a systematic scoping review aimed to document the evidence-base relating to stakeholder involvement in systematic reviews and to use this evidence to describe how stakeholders have been involved in systematic reviews. This was followed by the development of the ACTIVE framework that provides a structure to describe key components of stakeholder involvement within a systematic review. The ACTIVE framework may support the decision-making of systematic review authors in planning how to involve stakeholders in future reviews. The learning resource Involving People turned this work into guidance for systematic review authors who wish to involve stakeholders in producing their reviews.
Today, a new Cochrane entity, which will focus on tackling medical excess, launches at the annual Preventing Overdiagnosis Conference in Sydney. Cochrane Sustainable Healthcare will advocate and promote the use of evidence to ensure a more sustainable approach to healthcare.
The new Cochrane Field aims to become a hub that will foster, support and coordinate research in collaboration with patients, healthcare professionals, researchers, policymakers and carers, positioning Cochrane as a place to acquire the latest and most reliable evidence on responding to challenges of sustainability in healthcare systems.
Medical excess, which includes overuse of medical diagnostics and treatments, threaten the health of individuals and the sustainability of health systems in many countries. Unnecessary tests, treatments and diagnoses bring direct harms to people through adverse effects of interventions, psychosocial impacts of labelling people as diseased, and overwhelming treatment burden. Medical excess also consumes scarce resources leading to underdiagnosis and underuse in other areas, indirectly harming patients.
Tackling the crisis of medical excess, reducing harms and winding back waste will make global health systems more sustainable. These are the principles that will underpin the work of the new Cochrane Sustainable Health Field.
Cochrane Sustainable Healthcare is one of 13 Fields at Cochrane and joins a global independent network of volunteers, professionals, patients, carers and people interested in contributing to evidence-based health.
Like other Cochrane Fields, Cochrane Sustainable Healthcare will focus on dimensions of healthcare other than a condition or topic by aiming to strengthen the link between primary research, evidence synthesis, policymaking and practice in relation to issues of medical excess and sustainability of healthcare. Cochrane Sustainable Healthcare will be led by Minna Johansson, PhD, a general practitioner based at Herrestads Healthcare Centre, Uddevalla, Sweden and researcher at Cochrane Sweden.
Speaking at the Preventing Diagnosis Conference in Sydney, Australia, Director Minna Johansson says, “Many nations face huge challenges in terms of unsustainable health systems with sharp increases in costs, limited human resources and most importantly – harms from medical excess to individual patients. The situation is urgent and the need for novel approaches to tackle these issues is increasingly recognized. Preventing Overdiagnosis is a superb platform from which to launch the Cochrane Sustainable Healthcare. We are grateful to the organizers for this opportunity. Also, I am so pleased with the support we have received so far within the Cochrane community and from external organisations and people from across the world.”
During the keynote session at the Preventing Diagnosis Conference, Cochrane’s Editor in Chief, Karla Soares-Weiser commented, “Advocating for sustainable healthcare is at the heart of what Cochrane seeks to do, so that healthcare decisions are based on evidence. We are excited to welcome this new Cochrane Field into our global and diverse collaboration of supporters and members. This new Field will contribute to our Cochrane community in gaining insight and guidance and build on our understanding of how healthcare excess can be addressed in the production and dissemination of Cochrane Reviews.”
If you would like to know more about how you can get involved in Cochrane’s Sustainable Healthcare, contact the Director Minna Johansson and the Field Coordinator Dina Muscat Meng.
Welcome to Cochrane’s first ever Virtual Colloquium, #CochraneSantiago!
We are delighted to see everyone’s hard work for this Colloquium on display and we look forward to engaging with all of you in this new Colloquium format.Daily themes
We have so much share with you - vitural posters, recorded oral presentations, and special content!
To help organize the week, we are focusing on daily themes - you can get an overview here. At the top of the website in the blue navigation bar there are tabs for each day. Come to the website each day and engage with the content.Navigating the content
Special Content videos will premiere at 10:00 Toronto time/12:00 Chilean time/15:00 GMT on YouTube each day this week; check out the daily page to find these videos, links, and participate in the live chat on YouTube!
Links to specific and relevant oral presentation and poster categories are highlighted at the bottom of each page. You can also browse all oral presentations and all posters and filter by categories that interests you.Available to all
A reminder that you do not have to register or login to the Colloquium site to see Virtual #CochraneSantiago content—all is free, open to all, and available on the website!
Join the conversation by tagging #CochraneSantiago on your social media posts, and follow our content creators to continued the conversation on your preferred social media.
Welcome to Virtual #CochraneSantiago, we are so glad you’re here!Monday, December 2, 2019
Psoriasis is a common skin problem and there are several Cochrane Reviews of various ways to treat it. These were added to in July 2019 with the publication of a new review on the potential benefits of lifestyle changes. We asked Professor Ching-Chi Chi from the Chang Gung Memorial Hospital in Taoyuan Taiwan to tell us what they found.
Psoriasis is a chronic inflammatory skin disease. It causes thick, red, itching, and scaling plaques, and affects more than 100 million people worldwide.
Obesity, drinking, smoking, and lack of physical activity may make the condition worse, and we wanted to find out whether changes to these lifestyle factors might help. We were particularly interested in things such as diet and exercise; and although we also wanted to investigate interventions targeting smoking or alcohol consumption; we found no trials on alcohol abstinence or smoking cessation.
We examined the research evidence that was available up to July 2018, and identified 10 relevant randomised trials, with a total of approximately 1,200 participants. The quality of evidence was moderate to low, with study limitations including participants knowing which treatment they were receiving and a large number of withdrawals from the trials.
However, we were able to draw some conclusions. We found that among obese patients with psoriasis, dietary intervention with a low-calorie diet may reduce the severity of psoriasis, and probably improves their quality of life and reduces their body mass index, or BMI. Also, among obese patients with psoriasis, combined low-calorie diet and exercise programme probably reduces the severity of psoriasis and BMI. Generally, participants complied with the assessed lifestyle changes successfully.
When compared to usual care, we found no evidence that education promoting healthy lifestyle alone without explicit dietary intervention or an exercise programme had an effect on the severity of psoriasis.
In summary, among obese patients with psoriasis, a low-calorie diet with or without an exercise programme may improve the severity of psoriasis and probably improves quality of life and BMI. However, whether dietary interventions prolong the time to relapse or whether it is effective in non-obese patients with psoriasis remains unclear.
Cochrane Dominican Republic joins Cochrane, a global independent network of researchers, professionals, patients, careers and people interested in health. Cochrane works with collaborators from more than 130 countries to produce credible, accessible health information that is free from commercial sponsorship and other conflicts of interest. Cochrane’s work is recognized as representing an international gold standard for high quality, trusted information.
Cochrane Dominican Republic is an Affiliate of Cochrane Central America and Spanish speaking Caribbean, and is part of the Iberoamerican Cochrane Network.
The Directors of Cochrane Dominican Republic, Andelys de la Rosa and José Mordan said, “This is a hugely exciting opportunity in the region of the Caribbean. Increasing dissemination and improving the use of the evidence in health care is critical for clinicians, patients, students everywhere in the world, including Dominican Republic. To start, we have arranged for the Cochrane Library to be available across the Dominican Republic from November 2019.”
Cochrane’s CEO Mark Wilson, warmly welcomed today’s news, “Cochrane Dominican Republic joins a global collaboration of Cochrane groups involved in creating and presenting Cochrane evidence across the world. It is exciting to see this affiliate join this network with the aim of deepening the scope reach and impact of Cochrane evidence in the Caribbean region.”
Xavier Bonfill, Director of Cochrane Iberoamerica, “This new Affiliate is already backed by support from the national academic community and commitments by the Ministry of Health, as well as the global Cochrane community. This strong start is a signal to health decisions makers in Dominican Republic to collaborate with Cochrane in the dissemination and use of health evidence.”
On November 29th, Cochrane Dominican Republic will host a launch event bringing together health leaders from across the education and health sector in the Dominican Republic. Friday, November 29, 2019
It’s only a few days away - Virtual #CochraneSantiago
Next week is our first Virtual Colloquium and we are delighted to showcase the fabulous work of hundreds of Cochrane contributors.
We look forward to welcoming you Monday 2 December - Friday 6 December and here’s more information on how you can take part and hopefully answer some of your questions:How do I access Virtual #CochraneSantiago content?
All content will be available on the Colloquium website! At the top of the home page, there is a menu-tab for each day of the Virtual Colloquium with that day’s theme. On each daily page, you can scroll through to find Special Content (Special and Plenary-style presentations), links to Related Content, highlighted categories of daily Oral Presentations and Posters, and information about how to join the conversation on social media across our SEVEN platforms. Take a look at the content now and check back daily next week.Do I need to register for the Virtual #CochraneSantiago Colloquium?
No, it’s just about selecting what you want to see and hear. All Virtual Colloquium content is free, open to all, and hosted on the Colloquium website. You will not need to login or need to have a Cochrane ‘account’ to access the content, either. The more global participation, the better!When will Special Content videos premiere?
Each day, all Special Content videos will premiere at 10:00 Toronto time/12:00 Chilean time/15:00 GMT on YouTube. During the premiering of the video, you can watch on the video’s YouTube page and participate in the live chat happening at the same time. You can go to the daily menu-tabs on the Colloquium website and see what we have planned and even set personal reminders in your YouTube account so that you are notified when they go live. If you are not able to see it at this exact time, no problem, you can watch it any time after it premieres on YouTube or when it’s embedded under the daily menu-tabs on the Colloquium website.How can I see Colloquium posters and oral presentations?
We have about 180 digital posters and over 100 oral presentations to share with you! Starting on Monday 2 December, all oral presentations will be available here and virtual posters will be available here. You can sort through these pages by abstract category, or scroll through them all! These are also linked on the Colloquium homepage in the Menu “Presentations”, and certain categories of posters and oral presentations will be highlighted for each themed day.Is there any truly ‘live’ Colloquium content?
Yes! If you are a Cochrane Member, Cochrane’s Annual General Meeting will be held live on Thursday, December 5, from 09:00-10:00 GMT. To register for this live meeting and find out about voting, visit here.Join the conversation!
As you take part in this unique week of Virtual #CochraneSantiago content, we want to hear from you! We have 40+ International Content Creators who will be actively discussing our content each day and our #CochraneSantiago hashtag will be abuzz on Twitter, Instagram, and other platforms. You can also join the YouTube chat for the launch of Special Content videos. Make your voice heard and help make this Virtual Colloquium as interactive as possible. Finally, a survey will be posted on the Colloquium website and social media on the final day, we will collect your feedback so please get involved and share! Our Virtual Colloquium format is a first for Cochrane, and we want to hear what you think!
See you in just a few days….Wednesday, November 27, 2019
Featured Review: Reducing uncertainties in choosing first-line treatment in newly diagnosed multiple myeloma
Multiple myeloma is a type of blood cancer. It accounts for approximately 2% of all cancers and is still considered incurable. For people with newly diagnosed multiple myeloma (NDMM), who are unsuitable for a procedure where damaged blood cells are replaced with healthy ones (stem-cell transplant), treatment is usually a multiple drug combination of bortezomib, lenalidomide, or thalidomide, plus melphalan and prednisolone (MP) or dexamethasone (D). Multiple drug combinations are approved for initial anti-myeloma therapy, however, access to these medicines is restricted in many countries worldwide.
The Cochrane Review used network meta-analysis (NMA) to compare the benefits and harms of selected anti-myeloma drugs (bortezomib (V), lenalidomide (R), thalidomide (T)) for transplant-unsuitable NDMM.
The review identified 25 studies involving 11,403 transplant-unsuitable adults with NDMM, and comparing 21 different treatment regimens. It looked at survival, harms and quality of life.
The review concluded that VRDc showed the highest overall survival benefits, compared to MP. RD and TMP also improved OS compared to MP. However, these combinations of drugs also led to more adverse events compared to MP, and led to more people stopping treatment. More trials are needed that look carefully at both harms and quality of life.
The results of this review informed a successful application to the World Health Organization (WHO) Essential Medicines List (EML), which previously had no anti-myeloma medicines included.
The editorial process for this review was managed by the Cochrane Fast-Track Service.
Read the reviewTuesday, November 26, 2019
All content will be freely available on the Colloquium website and open to the entire Cochrane Community of members and supporters!
Cochrane’s annual flagship event brings together the world’s most influential health researchers, scientists, academics, opinion leaders, clinicians, and patients to promote evidence-informed decision-making. We are getting excited to share and interact with Virtual #CochraneSantiago content starting on Monday 2 December - Friday 6 December!
Virtual #CochraneSantiago will highlight the overall theme of ‘Embracing Diversity’, with each day having daily themes. During the week, content will be curated here on our Colloquium website. We have created a dedicated page for each day’s content that will include posters, plenary content, bespoke curated materials from long and short oral presentations as well as pre-produced videos posted ‘as live’ on YouTube each day.
We have lots of content to share with you and we invite you to visit the Cochrane Colloquium website daily, join in on conversations on social media using the #CochraneSantiago hashtag, and take part in this unique opportunity to fully embrace the diversity of voices that make up Cochrane’s global community.
Monday 2 December: Equity Matters: Cochrane’s Next Frontier
A welcome from the Local Organizing Committee will begin our Virtual Colloquium and two speakers will highlight the importance of equity in Cochrane evidence. Peter Tugwell will discuss Cochrane’s content strategy on equity, and Beibei Yuan will talk about equity analysis in research. Additionally, two presenters will discuss aspects from the new Cochrane Handbook chapter on equity.
Tuesday 3 December: Stakeholder Diversity
Participants can view a recorded webinar regarding the launch of Cochrane's Dissemination Checklist, and Guidance, enabling them to share Cochrane evidence more effectively for use with diverse stakeholders. We’ll also look at how Cochrane is working with patients and their caregivers.
Wednesday 4 December: Methodological Diversity
Multiple speakers will address the importance, and challenge, of incorporating Methodological diversity into Cochrane. Lisa Bero will discuss the importance of making Cochrane evidence relevant for public health practitioners and policy makers; Adrienne Stevens will discuss rapid reviews and the future of this type of review in Cochrane; and Jane Noyes will discuss what the Cochrane Methods Executive are doing to address the importance of methodological diversity. Participants can also watch a recorded webinar introducing the new Cochrane Handbook for Systematic Reviews, as well as presentations by Miranda Cumpston and James Thomas about aspects of the Handbook. There will also be an introductory presentation on RevMan Web, and Cochrane members are encouraged to try out the new Cochrane PICO search BETA on the Cochrane Library! Finally, starting at 11:00 am GMT on Wednesday, Cochrane Crowd is holding a Virtual #CochraneSantiago Challenge to screen 48,000 records in just 48 hours; learn more and get ready to participate!
Thursday 5 December: Looking back
Marking #ThrowbackThursday, this day is a celebration of the last 25 years of Colloquia and focusing on Cochrane’s diverse community of 11,000 members and 70,000 supporters from 130 countries around the world! The Annual General Meeting will be held live from 09:00 to 10:00 am GMT, and members are reminded to register to attend the online meeting. A slideshow of memories from past Cochrane Colloquia will premiere, and a full line-up of 2019's Award and Prize Winners will be recognized and celebrated.
Friday 6 December: Looking ahead
Today, we will turn our focus to 2020 and the next Cochrane Colloquium in Toronto; a video presenting plans for #CochraneToronto will premier, and ways to contribute to and get involved in Cochrane will be highlighted. We will introduce of new Editor in Chief of the Cochrane Library, Dr. Karla Soares-Weiser, and we'll have the results of the Cochrane Crowd challenge will end at 11:00 am GMT.
All content will be available for free on the Colloquium website and open to the entire Cochrane Community of members and supporters!
How are you planning on participating? What are you looking forward to the most? Start the conversation today – tell us by using #CochraneSantiago and follow our social media accounts as we get ready for Cochrane’s first-ever Virtual #CochraneSantiago!Thursday, November 21, 2019
New Cochrane Review assesses different HPV vaccines and vaccine schedules in adolescent girls and boys
New evidence published in the Cochrane Library today provides further information on the benefits and harms of different human papillomavirus (HPV) vaccines and vaccine schedules in young women and men.
HPV is the most common viral infection of the reproductive tract in both women and men globally (WHO 2017). Most people who have sexual contact will be exposed to HPV at some point in their life. In most people, their own immune system will clear the HPV infection.
HPV infection can sometimes persist if the immune system does not clear the virus. Persistent infection with some ‘high-risk’ strains of HPV can lead to the development of cancer. High-risk HPV strains cause almost all cancers of the cervix and anus, and some cancers of the vagina, vulva, anus, penis, and head and neck. Other ‘low risk’, HPV strains cause genital warts but do not cause cancer. Development of cancer due to HPV happens gradually, over many years, through a number of pre-cancer stages, called intra-epithelial neoplasia. In the cervix (neck of the womb) these changes are called cervical intraepithelial neoplasia (CIN). High-grade CIN changes have a 1 in 3 chance of developing into cervical cancer, but many CIN lesions regress and do not develop into cancer. HPV-related cancers accounted for an estimated 4.5% of cancers worldwide in 2012 (de Martel 2017).
Vaccination aims to prevent future HPV infection and the cancers caused by high-risk HPV infection. HPV vaccines are mainly targeted towards adolescent girls because cancer of the cervix is the most common HPV-associated cancer. For the prevention of cervical cancer, the World Health Organization recommends vaccinating girls aged 9-14 years with HPV vaccine using a two-dose schedule (0, 6 months) as the most effective strategy. A three-dose schedule is recommended for older girls ≥15 years of age or for people with human immunodeficiency virus (HIV) infection or other causes of immunodeficiency (WHO 2017).
Three HPV vaccines are currently in use: a bivalent vaccine that is targeted at the two most common high-risk HPV types; a quadrivalent vaccine targeted at four HPV types, and a nonavalent vaccine targeted at nine HPV types. In women, the bivalent and quadrivalent vaccines have been shown to protect against pre-cancer of the cervix caused by the HPV types contained in the vaccine if given before natural infection with HPV (Arbyn 2018).
This Cochrane Review summarizes the results from 20 randomized controlled trials involving 31,940 people conducted across all continents. In most studies, the outcome reported was the production of HPV antibodies by the vaccine recipient’s immune system. HPV antibody responses predict protection against the HPV-related diseases and cancers the vaccines are intended to prevent. Antibody response is often used as a surrogate in HPV vaccine studies because it takes many years for pre-cancer to develop after HPV infection, so it is difficult for studies to follow participants over such long periods of time. Moreover, because trial participants were tested for HPV infection and offered treatment, if HPV-related precancer was found, progression to cervical cancer in this group would be expected to be very low, even without vaccination.
Four studies compared a two-dose vaccine schedule with a three-dose schedule in 2,317 adolescent girls and three studies compared different time intervals between the first two vaccine doses in 2,349 girls and boys. Antibody responses were similar after two-dose and three-dose HPV vaccine schedules in girls. Antibody responses in girls and boys were stronger when the interval between the first two doses of HPV vaccine was longer.
There was evidence from one study of 16 to 26-year old men that the quadrivalent HPV vaccine reduces the incidence of external genital lesions and genital warts compared with a group who did not receive the HPV vaccine.
There was also evidence from a study of 16 to 26-year old women that compared the nonavalent and quadrivalent vaccines that they provide a similar level of protection against cervical, vaginal, and vulval pre-cancerous lesions.
There was evidence from seven studies about HPV vaccines in people living with HIV. HPV antibody responses in children living with HIV were higher after vaccination with either bivalent or quadrivalent vaccine than with a non-HPV control vaccine. These antibody responses against HPV could be maintained up to two years. The evidence about clinical outcomes and harms for HPV vaccines in people with HIV was very limited.
Evidence suggested that up to 90% of males and females who received an HPV vaccine experienced local minor adverse events such as redness, swelling and pain at the injection site. Due to the low rates of serious adverse events in quadrivalent and nonavalent vaccine groups, and the broad definition of these events used in the trials, we cannot really determine the relative safety of different vaccine schedules.
The lead editor of this review and Consultant in Gynaecological Oncology, Musgrove Park Hospital, Somerset, UK, Dr. Jo Morrison said: “We need long-term population-level studies to provide data on the effects of dosing intervals, schedules and vaccines on HPV-related cancers, as well as giving us a more complete picture of rare harms. However, with fewer doses having a similar antibody response, and more extensive evidence from vaccine studies in boys, policy makers are now in a better position to determine how local vaccination programmes can be designed. It would be interesting to see how different schedules and vaccines influence immunisation coverage, but this review, and the studies within it, were not designed to be able to answer that question.”
Full citation: Bergman H, Buckley BS, Villanueva G, Petkovic J, Garritty C, Lutje V, Riveros-Balta AX, Low N, Henschke N. Comparison of different human papillomavirus (HPV) vaccine types and dose schedules for prevention of HPV-related disease in females and males.
World Health Organization. Human papillomavirus vaccines: WHO position paper, May 2017. Weekly Epidemiological Record 2017;92:241–68.
de Martel 2017
de Martel C, Plummer M, Vignat J, Franceschi S. Worldwide burden of cancer attributable to HPV by site, country and HPV type. International Journal of Cancer 2017;141(4):664–70.
Arbyn M, Xu L, Simoens C, Martin-Hirsch PP. Prophylactic vaccination against human papillomaviruses to prevent cervical cancer and its precursors. Cochrane Database of Systematic Reviews 2018, Issue 5. DOI: 10.1002/14651858.CD009069.pub3