In this interview with lead author Christopher Gibbons, we find out more about the recently published review, Routine provision of information on patient-reported outcome measures to healthcare providers and patients in clinical practice.
Tell us about this review
The aim of this Cochrane Review was to find out whether healthcare workers who receive information from questionnaires completed by their patients give better health care and whether their patients have better health. We collected and analysed all relevant studies.
What did you find out?
Patient questionnaire responses fed back to health workers and patients may result in moderate benefits for patient\provider communication and small benefits for patients' quality of life. Healthcare workers probably make and record more diagnoses and take more notes. The intervention probably makes little or no difference for patient's general perceptions of their health, social functioning, and pain. There appears to be no impact on physical and mental functioning, and fatigue. Our confidence in these results is limited by the quality and number of included studies for each outcome.
What was studied in the review?
When receiving health care, patients are not always asked about how they feel, either about their physical, mental or social health. This can be a problem as knowing how the patient is feeling might help to make decisions about diagnosis and the course of the treatment. One possible solution is to ask the patients to complete questionnaires about their health, and then give that information to the healthcare workers and to patients.
What are the main results of the review?
We found 116 studies (49,785 participants), all of which were from high income countries. We found that feeding back patient questionnaire responses to healthcare workers and patients probably slightly improves quality of life and increases communication between patients and their doctors, but probably does not make a lot of difference to social functioning. We are not sure of the impact on physical and mental functioning or fatigue of feeding back patient questionnaire responses as the certainty of this evidence was assessed as very low. The intervention probably increases diagnosis and note taking. We did not find studies reporting on adverse effects defined as distress following or related to Patient reported outcomes measures (PROM) completion.
What would you like to see happen next to provide more evidence in this area?
I would like to see more large, high quality, cluster randomized clinical trials that increase the evidence base for the intervention that use Computerized Adaptive Testing in the measurement of patient reported outcomes. In these interventions, the information which is fed-back combines standardized and individualized measurement, these randomize patients and clinicians to different modalities of feed-back interventions and recipients (including patient only, patient and professional, professional only).
Outcomes of interest include:
- adverse effects
- general health perceptions,
- specific symptoms, (cough, insomnia, nausea, anorexia, constipation, diarrhoea),
- clinicians ratings of severity,
- different types of visits, admissions and their length,
- patient physician relationship,
- unmet patient needs,
- quality of care and costs;
- and that focus on people with multimorbidity
Further research on the mechanisms by which the intervention operates is needed.
Salary: €46,442 - €56,369
Start Date: 4th Jan 2022
Application closing date: 25 November 2021
More information/apply: https://www.universityvacancies.com/national-university-ireland-galway/systematic-reviewer-post-doctoral-researcherresearch-fellow
Applications are invited from suitably qualified candidates for a four year (1.0 FTE) fixed term contract position as Post-Doctoral Researcher/Research Fellow with Evidence Synthesis Ireland (ESI).
Evidence Synthesis Ireland is an all-Ireland initiative funded by the Health Research Board (HRB) and the Health and Social Care, Research and Development (HSC R&D) Division of the Public Health Agency in Northern Ireland.
Position is full-time (1.0 FTE) and is available from 4th Jan 2022 to 30 November 2025. The successful candidate will be based in the Centre for Health Evaluation, Methodology Research and Evidence Synthesis (CHEMRES) in NUI Galway. CHEMRES is also host to Cochrane Ireland and the HRB-Trials Methodology Research Network.
The role is to plan, conduct and support ESI activity in relation to the co-ordination of prioritised national and international evidence syntheses relevant to policy and practice on the island of Ireland and integration of capacity building into this activity. This role will require substantial evidence synthesis methodology experience and expertise as well as demonstratable evidence of leadership ability.
The successful candidate will contribute to the research programme of ESI. The successful candidate is expected to build capacity in evidence synthesis by supporting ESI’s training programme. The successful candidate will also have access to a large program of education for their own professional development.
The successful candidate will be responsible for leading and supporting evidence syntheses across a range of study designs and for leading a program of primary synthesis methodology research. The successful applicant will be highly motivated, passionate about developing high quality research, self-motivated with strong attention to detail and quality.
The latest update of the Cochrane review ‘Vaccines for preventing rotavirus diarrhoea: vaccines in use’ has found that rotavirus vaccines pre-qualified by the World Health Organization (WHO) (Rotarix, RotaTeq, Rotasiil, and Rotavac), prevent episodes of rotavirus diarrhoea in children and no increased risk of serious adverse events was found.
Rotavirus infection is a common cause of diarrhoea in infants and in young children, and can cause mild illness, hospitalization, and death. Since 2009, the WHO has recommended that a rotavirus vaccine be included in all national infant and child immunization programmes. To date, 107 countries have followed this recommendation. In the years before infants and children started receiving rotavirus vaccine, rotavirus infection resulted in about 0.5 million deaths per year in children under five years of age, mainly in low- and middle-income countries.
This Cochrane Review, processed by the Cochrane Infectious Diseases Group (CIDG) editorial base at Liverpool School of Tropical Medicine, was first published in 2004 and has been updated five times. In 2012, in consultation with the WHO, the data underwent major restructuring by country mortality rates to reflect the observation that vaccine efficacy profiles are different in countries with different mortality rates.
The 2012, 2019, and 2021 review updates were preceded by systematic reviews commissioned by the WHO Immunization, Vaccines & Biologicals department and were used for WHO policy decisions on rotavirus vaccination schedules. These reviews were carried out by members of the author team and the subsequent Cochrane review updates built on the WHO reviews and vice versa.
The most recent review includes 60 studies: Rotarix (36 trials), RotaTeq (15 trials), Rotasiil (5 trials), and Rotavac (4 trials). The findings were presented at Session 6 - Rotavirus Vaccines at the October 2020 SAGE Meeting and was provided to SAGE Members as key background material to inform discussions (access presentation and background materials here). As a result of this SAGE discussions, an updated WHO Rotavirus Vaccine Position Paper was published on 16 July 2021). This position paper provides global advice on rotavirus vaccine policy. In turn, the updated WHO position paper and the supporting background materials support Regional and National Immunization Technical Advisory group discussions which lead to decisions for local rotavirus vaccine policies.
Lead author, Hanna Bergman, noted, “The two globally established vaccines already have a proven track record and we now have high confidence in the two newer vaccines, all showing similar efficacy in preventing severe rotavirus diarrhea in infants and young children in high-mortality settings. This review also reinforces that more work needs to be done to improve and explore the reasons behind the lower efficacy of rotavirus vaccines seen in high-mortality countries.”
Bergman H, Henschke N, Hungerford D, Pitan F, Ndwandwe D, Cunliffe N, Soares‐Weiser K. Vaccines for preventing rotavirus diarrhoea: vaccines in use. Cochrane Database of Systematic Reviews 2021, Issue 11. Art. No.: CD008521. DOI: 10.1002/14651858.CD008521.pub6.
The editorial base of the Cochrane Infectious Diseases Group is funded by UK aid from the UK government for the benefit of low- and middle-income countries (project number 300342-104). The views expressed do not necessarily reflect the UK government’s official policies.
This review provides insight into the effectiveness of measures implemented in the school setting to contain the COVID-19 pandemic.
While there are limitations to this review, the review demonstrates that a range of different measures can be effective at reducing COVID-19 transmission, especially when multiple interventions are implemented together. Importantly, the review demonstrates that schools can stay open (or reopen) safely when prevention measures are implemented effectively. The effectiveness of interventions is influenced by many things, including the levels of community transmission. Given the rapid and widespread advancements in prevention and containment measures, most notably, the COVID-19 vaccines and increases in testing capacity, as well as the rise of more transmissible variants of the virus, an update to this review may yield very different results.
What was studied in the review?
In order to reduce the spread of the virus that causes COVID-19, many governments and societies put mitigation measures in place in schools. However, we do not know whether these measures work with regards to reducing the spread of the virus, or how these measures affect other aspects of life, such as education, the economy or society as a whole.
Reopening schools or keeping schools open while having a broad range of measures in place can reduce transmission of the virus that causes COVID-19. Such measures can also reduce the number of people who will need to go to hospital due to developing COVID-19. However very little is known about other consequences of these measures, such as those linked to education, resources, and physical or mental health, as this knowledge is mostly based on studies modelling the real world. More studies set in the real world using real-world data are needed.
Lead author Shari Krishnaratne explains:
“This review provides insight into the effectiveness of measures implemented in schools to contain the COVID-19 pandemic. Whilst the review addresses a very important question there are limitations to the evidence it provides. We searched for studies for the review in December 2020, at a time when there was a lack of real-world evidence. As such, most of the studies included in this review use modelling. This review therefore shows an overall absence of real-world evidence about the effectiveness of these measures. However, there is enough evidence from the modelling studies and in other reviews such as one on travel measures for us to have some confidence that there is likely to be a positive effect on transmission, but how an intervention works in one location might not be the same as in another.
There are limitations to the evidence, but it does suggest that schools can stay open (or reopen) safely when prevention measures are implemented effectively. The effectiveness of interventions is influenced by many things, including the levels of community transmission. Given the rapid and widespread advancements in prevention and containment measures, most notably, the COVID-19 vaccines and increases in testing capacity, as well as the rise of more transmissible variants of the virus, an update to this review may yield very different results.”
What are measures implemented in the school setting?
Measures in the school setting can be grouped into the following four broad categories.
- Measures reducing the opportunity for contacts: by reducing the number of students in a class or a school, opening certain school types only (for example primary schools) or by creating a schedule by which students attend school on different days or in different weeks, the face-to-face contact between students can be reduced.
- Measures making contacts safer: by putting measures in place such as face masks, improving ventilation by opening windows or using air purifiers, cleaning, handwashing, or modifying activities like sports or music, contacts can be made safer.
- Surveillance and response measures: screening for symptoms or testing sick or potentially sick students, or teachers, or both, and putting them into isolation (for sick people) or quarantine (for potentially sick people).
- Multicomponent measures: measures from categories 1, 2 and 3 are combined.
What is the aim of the review?
The authors aimed to find out which measures implemented in the school setting allow schools to safely reopen, stay open, or both, during the COVID-19 pandemic.
What did we do?
They searched for studies that looked at the impact of these types of measures in the school setting on the spread of the virus that causes COVID-19, the impact on the healthcare system (i.e. how many hospital beds are needed), as well as important social aspects (i.e. how often students attended school). The studies could focus on students, teachers and other school staff, as well as on families and the whole community. They could use real-life data (observational studies) or data from computer-generated simulations (modelling studies).
What are the main results of the review?
The authors found 38 relevant studies. Most of these were modelling studies (33 studies). Five studies used real-world data. Twenty studies were conducted in North or South America, 16 in Europe and two in China.
Below we summarise the main findings by category.
- Measures reducing the opportunity for contacts
The authors found 23 modelling studies assessing measures to reduce the opportunity for contacts. All studies showed reductions in the spread of the virus that causes COVID-19 and the use of the healthcare system. Some studies also showed a reduction in the number of days spent in school due to the intervention.
- Measures making contacts safer
The authors found 11 modelling studies and two real-world studies looking at measures, such as mask wearing in schools, cleaning, handwashing, and ventilation. Five of these studies combined multiple measures, which means we cannot see which specific measures worked and which did not. Most studies showed reductions in the spread of the virus that causes COVID-19; some studies, however, showed mixed or no effects.
- Surveillance and response measures
We found 13 modelling studies and one real-world study assessing surveillance and response measures. Twelve studies focused on mass testing and isolation measures, while two looked specifically at symptom-based screening and isolation. Most studies showed results in favour of the intervention, however some showed mixed or no effects
- Multicomponent measures
They found three studies that looked at multicomponent interventions, where it was not possible to determine the effect of each individual intervention. These included one modelling study and two real-world studies. These studies assessed physical distancing, modification of activities, cancellation of sports or music classes, testing, exemption of high-risk students, handwashing, and face masks. Most studies showed reduced transmission of the virus that causes COVID-19, however some showed mixed or no effects.
How confident are we in the findings of this review?
Confidence in these results is limited. Most studies used models, that is, they estimated the effects of the interventions rather than observing outcomes. As the models are built on assumptions about how the virus spreads and how people behave, we lack real-world evidence. Many studies were published as 'preprints' without undergoing rigorous checks of published studies, which further limits confidence. Also, the studies were very different from each other (for example, with regards to the levels of transmission in the community).
How up to date is this evidence?
The evidence is up-to-date to December 2020. It is expected this review will be updated in Spring 2022.
Cochrane Library Special Collections provide a round-up of up-to-date Cochrane evidence on a specific topic. This Special Collection contains Cochrane Reviews summarizing data on the benefits and harms of several interventions for preventing and treating influenza. The Cochrane Reviews look at vaccines, antiviral drugs, and physical interventions, such as the use of masks and hand washing.
This evidence for physical interventions may help inform policies and practices relevant to the ongoing COVID-19 pandemic. These comprehensive reviews provide valuable information for patients, doctors, and healthcare decision-makers about what steps to take or interventions to use to prevent influenza or aid its treatment.
Cochrane Sustainable Healthcare joins forces with the BMJ to explore new ways to make health systems healthier
New podcast series looks at initiatives to wind back the medical excess that is causing harm to people and the planet.
Cochrane Sustainable Healthcare has joined forces with the BMJ to launch a new podcast series called The Recovery - Voices of action towards sustainable healthcare co-hosted by The BMJ’s Editor in Chief Dr Fiona Godlee and journalist and Bond University health researcher Dr Ray Moynihan.
The series will feature compelling and inspirational conversations with healthcare researchers, doctors, and activists from around the world who are actively working to wind back medical excess and forge more sustainable healthcare systems to improve our health, wellbeing, and climate.
Over six episodes, listeners will hear about new and sometimes radical initiatives that are changing the way doctors practice medicine, to ensure better access to high quality, evidence-based, and safe healthcare.
- Australian doctors fearlessly challenging professional norms to wind back ineffective and dangerous care
- A high-profile cancer specialist in India helping to reduce wasteful care in low- and middle-income countries
- A US-based doctor leading a non-violent revolution of care, built on compassion and solidarity
- A UK general practitioner championing physical activity, creating garden spaces, and improving access to fresh food, to empower patients, improve equity, and enhance the community’s wellbeing and health
“All these voices are part of a growing global chorus campaigning for fundamental reform of how we practice medicine and showing that radical new alternatives are imminently feasible,” write Godlee, Moynihan and Dr Minna Johansson, Director of Cochrane Sustainable Healthcare in an opinion article to launch the series.
“All those unnecessary tests, treatments, and diagnoses bring direct harm to people through adverse effects of drugs and surgeries, psychosocial harms of labelling, and increasing the burden of treatments. And since resources for healthcare are finite, waste is also harming patients indirectly because the overuse of some medical interventions means there are less resources to tackle underuse and underdiagnosis in other areas.”
They acknowledge that the drivers of unsustainable healthcare are complex and diverse and say we must adapt to support more sustainable decision-making within healthcare.
“Most healthcare extends lives and reduces suffering, but too much medicine remains unnecessary and harmful,” they warn. “Reducing medical excess is not primarily about saving money, it is about avoiding harm to people and the planet.”
We hope this podcast series will inspire listeners all over the world to imagine novel and radical approaches for a more sustainable healthcare, and to dare to move from imagination to action.
In this interview with Dr. Minna Johansson, Cochrane Sustainable Healthcare Field Director we learn more about the work of this field, the issues it wants to address and some of the ways they are engaging audiences to learn more.
Can you tell us about the Sustainable Healthcare Field?
Cochrane Sustainable Healthcare is a new Cochrane group focused on addressing medical excess. The background for our work is the notion that medical excess threatens the health of individuals and poses challenges for health system sustainability - and the need of an evidence base better suited to support sustainable decisions about healthcare. In essence, we are developing a global network for collaboration with partners within and beyond Cochrane on activities ranging from short‐term research projects to longer‐term reform initiatives.
What is the field’s main goal?
Our fundamental aim is to contribute to a more sustainable healthcare for patients, for health systems, for our societies, and for the planet. Our more concrete goals are to enhance the relevance of primary research and evidence synthesis to tackle medical excess, and to increase the use of that evidence to enable a more sustainable healthcare.
Who is involved?
I am leading the work, together with Dina Muscat Meng who is coordinator of Cochrane Sustainable Healthcare. But more importantly, during these first two years since the launch we have had enormous support, help and engagement from a broad international network of highly skilled people who have generously contributed with time and resources to help bring this work further. Some of these people and organizations are mentioned at our website. We would like to especially thank Cochrane Sweden and Cochrane Denmark. We will develop this network further by partnering with primary researchers, funders of research, organizations working with evidence synthesis, guideline developers, policy makers, health systems organizations, professional medical associations, citizen and patient organizations, and the general public. We welcome anyone who is interested in this initiative to contact us.
We are just about to launch a pop-up podcast series; “The Recovery – Voices of action towards sustainable healthcare” - co-published with The BMJ. In these podcasts, our co-hosts Ray Moynihan from Bond University and Fiona Godlee, editor in chief of The BMJ, meet thought-leaders around the world who are cutting the edge of sustainable healthcare. From Mumbai to Minnesota, you will hear about new initiatives that are changing the way we practice medicine, to ensure better access to high quality, evidence-based, and safe healthcare. The series includes an interview with Rachelle Buchbinder and Ian Harris, recent author of book, Hippocrasy: How doctors are betraying their oath.
Further, in collaboration with people from Cochrane Argentina, Cochrane Chile, Cochrane Methods, Cochrane Sweden and Cochrane Denmark, we have recently launched a Special Collection of Cochrane Reviews featuring examples of resource-intense interventions, including those requiring extra healthcare visits, for which there is high or moderate certainty evidence that they confer clinically small or no effects, and for which there is some evidence of harm to patients. The reviews are particularly relevant to the COVID-19 pandemic, and should inform guideline, and policy developers, and decision makers planning health care, both during and after the pandemic. This Special Collection is intended as the first in a series, with subsequent Collections focusing on other healthcare interventions shown to being ineffective, harmful, or unproven.
What is planned in the future?
We have a wide range of exciting projects in pipeline – one of the most exciting in my opinion is a collaboration with GRADE where we are just about to form a GRADE Working Group focused on medical excess. We are also working on a project evaluating the quality and balance of messaging in disease awareness campaigns observed by the WHO, Cochrane and the US government – and we plan to develop reporting guidance for such campaigns, which can be used by campaign organizers to ensure high quality and balanced messaging when developing a campaign, as well as by organizations and authorities when deciding on whether to endorse a campaign or not. We also aim to develop our collaboration with international and regional stakeholders – such as for example Choosing Wisely.
In conclusion, the need for novel approaches to tackle medical excess is increasingly recognized. We believe that an intensified focus on projects and initiatives that cross the traditional boundaries between the different stakeholders in the evidence chain is required. The reasons for these challenges are diverse and complex, and so are the solutions – a strong collaboration integrating differing and sometimes contradictory perspectives is indicated. This will undoubtedly be challenging, but a more sustainable healthcare will benefit individual patients, as well as our communities.
Johns Hopkins Bloomberg School of Public Health seeks Tenure-Track Assistant or Associate Professor (Baltimore, US)
Location: Baltimore, MD, US
Deadline: 30 Nov, 2021
The Department of Epidemiology at the Johns Hopkins Bloomberg School of Public Health invites applications for a tenure-track Assistant or Associate Professor specializing in evidence synthesis. The candidate will be based in the Center for Clinical Trials and Evidence Synthesis.
They welcome applications from candidates who are in the early to mid phases their academic career. Academic rank will be commensurate with experience.
Applicants should hold a doctoral degree in epidemiology, medicine, or a related discipline with graduate training in epidemiology. Successful candidates will have demonstrated original scholarship, possess excellent written and communication skills as evidenced by peer-reviewed publications and professional meeting presentations, and have the capacity for an independent research program. Candidates will be expected to teach classes in epidemiology and mentor graduate students.
The Department of Epidemiology is one of the oldest and largest departments of epidemiology in the world, with over 200 doctoral and master’s students and a diverse research program directed by over 125 faculty. The institution has a strong research infrastructure and commitment to conduct both observational and experimental research. Candidates should possess a solid epidemiologic foundation to contribute to the research and teaching missions of the Department.
Featured review: What are the benefits and risks of visible light therapy for treating atopic eczema?
Cochrane Skin is pleased to announce the publication of a new review, Phototherapy for atopic eczema. This review was led by dermatologists from Amsterdam University Medical Centers, and supported by a key stakeholder: the American Academy of Dermatology (AAD). The AAD provided funding for this systematic review (32 studies, 1219 people with clinically diagnosed atopic eczema), which enabled publication of the protocol and full review within 13 months of title registration.
- Narrowband (NB) ultraviolet B (UVB), compared to placebo (a sham treatment), may improve eczema severity (including itch) and may not affect the number of people leaving a study because of unwanted effects.
- We were unable to confidently draw conclusions for other phototherapy (light therapy) treatments.
- Future research needs to assess longer term effectiveness and safety of NB-UVB and other forms of phototherapy for eczema.
This Cochrane Review will be used to inform the AAD’s update to their guidelines of care for the management of acne (expected in the third quarter of 2023).
What is eczema and how is it treated?
Eczema is a condition that results in dry, itchy patches of inflamed skin. Eczema typically starts in childhood, but can improve with age. Eczema is caused by a combination of genetics and environmental factors, which lead to skin barrier dysfunction. Eczema can negatively impact quality of life, and the societal cost is significant.
Eczema treatments are often creams or ointments that reduce itch and redness, applied directly to the skin. If these are unsuccessful, systemic medicines that affect the whole body, or phototherapy are options. Phototherapy (light therapy or visible light therapy) can be UVB, ultraviolet A (UVA), or photochemotherapy (PUVA), where phototherapy is given alongside substances that increase sensitivity to UV light.
What did we do?
We searched for studies that investigated phototherapy compared with no treatment, placebo, other forms of phototherapy, or another type of eczema treatment. Studies could include people of all ages, who had eczema diagnosed by a healthcare professional.
What did we find?
We found 32 studies, involving 1219 people with eczema (average age: 28 years), who were recruited from dermatology clinics. Most studies assessed people with skin type II to III (which is classed as white to medium skin colour), and moderate to severe eczema, with which they had lived for many years. Studies included similar numbers of males and females. The studies were conducted in Europe, Asia, and Egypt (setting was not reported by seven studies), and lasted, on average, for 13 weeks. Almost half of the studies reported their source of funding; two were linked to commercial sponsors.
Our included studies mostly assessed NB-UVB, followed by UVA1, then broadband ultraviolet B; fewer studies investigated other types of phototherapy. The studies compared these treatments to placebo, or no treatment, another type of phototherapy, different doses of the same sort of phototherapy, or other eczema treatments applied to the skin or taken by tablet.
None of the studies investigated excimer lamp (a source of UV radiation) or heliotherapy (the use of natural sunlight), other light therapies in which we were interested.
What are the main results of our review?
When compared to placebo, NB-UVB may:
- improve signs of eczema assessed by a healthcare professional (1 study, 41 people);
- increase the number of people reporting less severe itching (1 study, 41 people);
- increase the number of people reporting moderate or greater improvement of eczema, measured by the Investigator Global Assessment scale (IGA), a 5-point scale that measures improvement in eczema symptoms (1 study, 40 people); and
- have no effect on the rate of people withdrawing from treatment due to unwanted effects (3 studies, 89 people).
None of the studies assessing NB-UVB against placebo measured health-related quality of life.
We do not know if NB-UVB (compared with UVA1 or PUVA) or UVA1 (compared with PUVA) has an effect on the following:
- signs of eczema assessed by a healthcare professional;
- patient-reported eczema symptoms;
- health-related quality of life; and
- withdrawals due to unwanted effects.
This is because either we are not confident in the evidence, or they were not reported.
We did not identify any studies that investigated UVA1 or PUVA compared with no treatment.
Some studies reported that phototherapy caused some unwanted effects, including skin reactions or irritation, UV burn, worsening of eczema, and skin infections. However, these did not occur in most people.
What are the limitations of the evidence?
Our confidence in the evidence is limited, mainly because only a few studies could be included in each comparison, and the studies generally involved only small numbers of people.
How up to date is this evidence?
The evidence is up to date to January 2021.
Cochrane Nigeria recently launched as a full Cochrane Centre. Here they reflect on their journey and contributions over the past 15 years.
Cochrane takes hold in Nigeria
The story of Cochrane Nigeria dates back to 1998 when Prof. Martin Meremikwu, by chance met Prof. Paul Garner, the Coordinating Editor of the Cochrane Infectious Diseases Group, at the Centenary celebration of the Liverpool School of Tropical Medicine. Prof. Garner introduced Prof. Meremikwu to the Cochrane Collaboration and gave him a head start in the conduct of systematic reviews. In 1999, Prof. Meremikwu conducted his first systematic review on “Blood transfusion for treating malaria anaemia”. He went on to convince as many colleagues of his as he could to learn the art of preparing Cochrane systematic reviews; working from a small office at the Federal Neuropsychiatric Hospital Calabar, which was later moved to a more spacious office at the University of Calabar Teaching Hospital. He mentored them through personal and group mentorship programmes, regular in-house training, hands-on experience as co-authors/authors of systematic reviews and by sharing Cochrane Collaboration literature.
In the bid to build capacity to conduct systematic reviews in the country, an initial group of five young potential Cochrane review authors under the oversight of Prof. Meremikwu received support from the Effective Health Care Research Programme grant held by Prof. Paul Garner to attend 4-week Systematic Review fellowship at the Liverpool School of Tropical Medicine. During the fellowship they received direct mentoring and coaching and also participated in the Critical Appraisal Module of the Master’s in International Public Health Course. Among these forerunners were Prof. Angela Oyo-Ita (Community Physician), Prof. Afolabi Lesi (Paediatrician), Prof. Godwin Aja (Public Health), Prof Bosede Afolabi (Obstetrician), Prof Christy Okoromah (Paediatrician) and Dr. Oluseyi Oniyangi (Paediatrician). Today, they are all accomplished academic researchers and professionals who have continued to contribute to the work of Cochrane while promoting and building capacity for evidence-based healthcare in their home institutions and at various levels of influence. Prof. Afolabi Lesi currently Chairs the Advisory Board of Cochrane Nigeria.
In September 2005, more young Nigerian researchers and health professionals were supported by the Nuffield Foundation to attend a one-month Cochrane Protocol Development Course organized by the South African Cochrane Centre (SACC) under the auspices of the Reviews for Africa Programme (RAP). Some of these authors were later invited to the RAP Finishing School in 2006. The effort of Prof. Jimmy Volmink (then Director of the SACC), Mrs. Joy Oliver, Mrs. Elizabeth Pienaar and Prof. Taryn Young towards making the experience of participants at the RAP course an unforgettable one is worth mentioning.
Capacity and contributions grow
Following the increase in the number of Cochrane authors in the country and the capacity of the Nigerian authors to conduct high quality systematic reviews, the Nigerian Branch of the South African Cochrane Centre was formed in 2006 with Prof. Martin Meremikwu as the Branch Director and Prof. Angela Oyo-Ita as the Deputy Director. In 2017, Cochrane African Network was formed with Cochrane Nigeria leading the West African Hub of the network.
Some of the notable contributions of Cochrane Nigeria to global health were conduct of systematic reviews and provision of technical input towards WHO Guideline on Female Genital Mutilation; systematic review on “Seasonal Malaria Chemoprophylaxis” and “Artemether for Severe Malaria” on which the current WHO guidelines on the management of these health conditions are based. The Centre collaborated with the Federal Ministry of Health to develop a guideline on the management of diabetes. In partnership with professional groups, it has provided support for the production of guidelines for the management of community acquired pneumonia in children, hypertension and post-partum haemorrhage.
A cross section of Cochrane Nigeria Directors, Staff, and Associates
Full Cochrane Centre launched
Cochrane Nigeria attained full Centre status in December 2020 following the approval of its application by the Governing Board of Cochrane. Cochrane Nigeria had been an associate centre under Cochrane South Africa. Today, Cochrane Nigeria has nodes strategically located in the different parts of the country. The Centre is running with the clear mandate of promoting collaboration and evidence based health care policy and practice in the country through:
- Production of high quality and high priority systematic reviews
- Dissemination of Cochrane reviews to relevant stakeholders using channels such as social media, newsletters, podcasts and mass media
- Multilingual translation of relevant reviews
- Translation of evidence from reviews into policy and practice
- Refining the methods of Cochrane reviews
Cake to commemorate the Launch of Cochrane Nigeria
Launch of Cochrane Nigeria as a full Cochrane Centre
Cochrane Nigeria recently hosted the 4th Cochrane Africa Indaba. Cochrane Africa is a network of Cochrane entities in sub-Saharan Africa established in 2017. A key highlight of the Conference was the Launch of Cochrane Nigeria as a full Cochrane Centre. The event brought together a number of notable personalities from various organizations including the World Health Organization Nigeria, European Union delegation to Nigeria and the ECOWAS, National Health Insurance Scheme, and Federal Ministry of Health – all key stakeholders in evidence based health care in Nigeria.
With the formal launch of Cochrane Nigeria on the 13th July 2021 at the National Hospital, Abuja, the Centre now has a good launching pad for engagement with relevant stakeholders for the achievement of its core mandates in the country and continent. What started as a humble beginning in 1998 has now metamorphosed into a global movement, impacting on the health of people globally. The days ahead look very promising as we hope to engage more meaningfully with relevant stakeholders and policy makers, increase capacity for the production of high priority systematic reviews that will inform national and global policies and practices, strive for a strong national presence and support evidence-based decision making processes in the Federal Ministry of Health and other health-related sectors of the country.
Prof. Martin Meremikwu (Director, Cochrane Nigeria). Prof. Afolabi Lesi (Chair, Advisory Board, Cochrane Nigeria) being interviewed by the Press.
Prof. Angela Oyo-Ita (Co-Director, Cochrane Nigeria) giving opening remarks. Dr. Anthony Ayeke (EU Delegation to Nigeria & Ecowas) and Prof. Martin Meremikwu (Director Cochrane Nigeria).
Monday, November 1, 2021
Featured review: Reduced breast density following endocrine therapy as an indicator of breast cancer risk
Featured review: Are there ways to improve stop‐smoking treatment in primary care to help more people to quit smoking?
Featured review: Do invitations, lay health worker interventions and educational interventions increase the uptake of cervical screening?
Cochrane Library Editorial: It’s time to increase the global relevance of Cochrane Reviews by applying an ‘equity lens’
Health inequities, defined as avoidable and unfair differences in health, have been worsening within and between countries. This has been brought to the forefront by the COVID-19 pandemic.
A newly published Cochrane Library Editorial puts forth that it is time to increase the global relevance of Cochrane Reviews by applying an 'equity lens'. An equity lens is defined as a focus on health equity to ensure that the most hard-to-reach groups within a population benefit, while avoiding intervention-generated inequalities.
To support review authors in applying an equity lens, Cochrane has created a number of useful resources, including:
- Campbell and Cochrane Equity Methods Group's resources
- Cochrane Handbook chapter about health equity
- Cochrane interactive learning health equality module
The editorial also provides additional suggestions to authors to create a Cochrane Review that help equip decision makers to determine the applicability of evidence to their setting, resulting in facilitating the implementation of programs and policies that may contribute to reductions in global health inequities.
- Read the Editorial 'It's time to increase the global relevance of Cochrane Reviews by applying an ‘equity lens'
Thursday, October 28, 2021
Cochrane is pleased to announce the launch of a new network of institutions from across India that will promote evidence-informed health care and policy in the country.
The Cochrane India Network launched in an online event today featuring keynotes from prominent national and international presenters, including the Director General of the Indian Council of Medical Research Dr Balram Bhargav; Dr Vinod Paul who is a member of NITI Aayog; WHO Chief Scientist Dr Soumya Swaminathan and Cochrane’s Editor in Chief Karla Soares-Weiser. Presentations from each of the affiliate institutions followed, and the event concluded with plenary sessions related to resources available for contributors of the Network.
The Cochrane India Network is chaired by Dr. Meenu Singh and Dr. Anju Pradhan Sinha, and comprised of teams from nine affiliate institutions, including:
- All India Institute of Medical Sciences, New Delhi
- Christian Medical College Vellore
- India Council of Medical Research, New Delhi
- Indian Institute of Public Health, Hyderabad
- Institute of Dental Sciences, Bhubaneshwar
- King George’s Medical University, Lucknow
- Manipal Academy of Higher Education, Manipal
- Postgraduate Institute of Medical Education and Research, Chandigarh
- Tata Memorial Centre, Mumbai
The Network Affiliates each have their own strategic plan with Cochrane activities they wish to implement. Activities vary from training in the use of Cochrane systematic reviews, sharing information about new reviews published by Cochrane and advocating for their use in policy and practice, to the production of systematic reviews.
Judith Brodie, Cochrane’s Interim Chief Executive Officer, said of the Network’s launch: “I am excited by the expertise and diverse focus of the Affiliates in the Cochrane India Network, and so pleased to see them join together to advocate for evidence-informed health and care in India.”
Speaking about the launch, Dr. Meenu Singh, Co-Chair of the Network, said, “The launch of Cochrane India Network is a long-cherished dream of all the ‘Cochranites’ from India. Working with Cochrane for more than 20 years, it has provided an opportunity for development of in-house Cochrane products with global applications for evidence-based healthcare. The institutions involved in the Network will act as vehicles of Cochrane methodology for carrying out systematic reviews and help translate evidence into policy and practice.”
Dr. Anju Pradhan Sinha, Network Co-Chair, added, "The establishment of the Cochrane India Network is a significant milestone in India's journey on the path of evidence-informed decision making. The activities coordinated through the Network will lead to the effective implementation of evidence in clinical practice and policy making."
Cochrane Sweden is hosting a free face-to-face event on the 7th of December to discuss and reflect over the next chapter of Cochrane and the future of review production.
The event will take place in Malmö, Sweden, a 20-minute train ride from Copenhagen Airport. Karla Soares, Editor in Chief of the Cochrane Library and Toby Lasserson, Deputy Editor in Chief are invited to present and facilitate the discussions. Having coffee and a Swedish "fika" will hopefully lead to great conversations!
Where: Malmö Live Clarion Hotel, Malmö, Sweden.
When: 7th of December 2021, 10.00 - 16.30.
More: For available participants interested in further follow-up discussions, the day after the event (8th of December) is open for discussions at Cochrane Sweden's office in Lund (10-minute train ride and a 15-minute walk or tram from Malmö Central station).
Who: All Cochrane members and contributors are invited.
How: We hope that the starting time (10.00) opens up the possibility to travel directly to the event in the morning for participants within Europe. Our suggestion would be to travel to Copenhagen Airport and take the train from the airport to Malmö Central Station which takes 20 minutes. The location is a 5-minute walk from Malmö Central Station. It is also possible to travel to Malmö Airport and take a bus or taxi to Malmö Central Station. After 16.30 on the 7th we will plan to have a joint dinner in Malmö for available participants.
Content: The meeting will be facilitated by Karla Soares and Toby Lasserson combined with face-to-face discussions about the next chapter of Cochrane and the future of review production. The topics will center around the Community Engagement Workshop Series and futurecochrane.space.
Cost: The event is free for all Cochrane Members and contributors and includes lunch. Accommodation and travel expenses to the event are not included and have to be covered by the participant.
Accommodation: For participants who plan to stay from 6th to 7th of December, and/or 7th - 8th of December the event venue (Malmö Live) might be a convenient accommodation solution, although it is not a cheap option.
Travel restrictions: You can find the latest updates on current travel restrictions and Covid-19-measures FOR SWEDEN from https://www.krisinformation.se/en/ or by visiting the Swedish Police website or by checking this FAQ from the Swedish Government. If you travel to Copenhagen Airport (Denmark) and after that to Sweden, there are special rules for different countries regarding Covid-passports and sometimes the need to show a test before entering. More information is available from the Copenhagen Covid-19 Travel Guide or from https://www.oresunddirekt.se/.
Registration: You need to have a Cochrane Account, and sign in using THIS LINK. The last day to register is November 8th 2021. Please note that we have a limited number of attendees due to the size of the venue.
Wednesday, October 20, 2021
This recently published Cochrane Review, published by Cochrane Effective Practice and Organisation of Care, explores how parents and carers make decisions regarding vaccinating their children. Cochrane EPOC have also produced a short implementation guide related to this review.
- Many factors influence parents’ vaccination views and practices, including those related to individual perceptions, social relationships, and the wider social and political context in which parents live.
- When parents make decisions about vaccination for their children, they are often communicating not just what they think about vaccines, but also who they are, what they value, and with whom they identify.
Why is it important to understand what affects parents’ and carers’ decisions around vaccinating their children?
Childhood vaccination is one of the most effective ways to prevent serious illnesses and deaths in children. To be successful, vaccination programmes depend on high levels of vaccination uptake.
However, worldwide, many children do not receive all recommended vaccinations. There are several potential reasons for this. Vaccines might be unavailable, or parents may experience difficulties in accessing vaccination services; for instance, because of poor-quality health services, distance from a health facility, or lack of money. Some parents may not accept available vaccines and vaccination services.
Increasing our understanding of what influences parents’ views and practices around childhood vaccination, and why some parents may not accept vaccines for their children will allow healthcare services to tailor their programmes and information to particular groups of people. This should help to promote acceptance and uptake of childhood vaccination and improve child health worldwide.
What did we want to find out?
We wanted to know what factors influence parents’ views and practices around routine childhood vaccination and how these factors influence parents. We were interested in factors that may ‘enhance’ or ‘reduce’ acceptance of vaccination.
What did we do?
We searched for studies that assessed parents’ views, experiences, and practices of childhood vaccination. Studies could take place anywhere in the world where childhood vaccination is provided. People in the study had to be parents or carers who were responsible for deciding whether a child should be vaccinated.
What did we find?
We found 145 relevant studies and analysed the results from 27 of them. Studies took place in Africa, the Americas, South-East Asia, Europe, and the Western Pacific, and included urban and rural locations, as well as high-, middle-, and low-income settings.
Many complex factors influence what parents think about vaccination and what actions they take. We divided these into 4 themes.
- Parents’ vaccination ideas and practices may be influenced by their broader ideas and practices about health and illness generally, and specifically about their children and the role of vaccination in their health care.
- Many parents’ vaccination ideas and practices were influenced by the people they mix with socially. At the same time, shared vaccination ideas and practices helped some parents establish social relationships, which in turned strengthened their views and practices around vaccination.
- Parent’s vaccination ideas and practices may be influenced by wider political issues and concerns, and particularly their trust (or distrust) in those associated with vaccination programmes.
- Parent’s vaccination ideas and practices may be influenced by their access to and experiences of vaccination services and their frontline healthcare workers.
We developed two concepts for understanding possible pathways to reduced acceptance of childhood vaccination.
- ‘Neoliberal logic’, suggests that many parents, particularly from high-income countries, understood health and healthcare decisions to be matters of individual risk, choice, and responsibility. Some parents experienced this understanding as in conflict with vaccination programmes, which emphasise generalised risk and population health. This perceived conflict led some parents to be less accepting of vaccination for their children.
- ‘Social exclusion’, suggests that some parents, particularly from low- and middle-income countries, were less accepting of childhood vaccination due to their experiences of social exclusion. Social exclusion may damage trustful relationships between government and the public, generate feelings of isolation and resentment, and give rise to demotivation in the face of public services that are poor quality and difficult to access. These factors in turn led some parents who were socially excluded to distrust vaccination, to refuse vaccination as a form of resistance or a way to bring about change, or to avoid vaccination due to the time, costs, and distress it creates.
What are the limitations of the evidence?
Our confidence in the evidence is mainly moderate to high. Some studies did not report their findings or methods very well, and some focused on one vaccine, type of participant or country, so were not relevant for other vaccines, participants or countries. All of the included studies were published in English, so we we may have missed findings not published in English. The studies were often quite long with a lot of data, so we had to make practical decisions about how best to manage our analysis, which may have affected interpretations of the evidence.
How up to date is this evidence?
The evidence is up to date to July 2020.