We are very pleased to welcome you to the 2019 Cochrane Colloquium to be held in Santiago, Chile on 22 - 25 October 2019 - so mark your calendars! The Cochrane Colloquium is an annual event, bringing people together from around the world to discuss putting research into important global health questions and promoting evidence-informed health care.

Although we do not want to give away the treats in store, we hope to open the show with artists that are well recognised internationally, and that represent all aspects of diversity, from gender identity and how it impacts (and is impacted by) health systems, to ethnic minorities and their voice in health matters. In addition to this, we hope to spice up the offering with a delicious presentation of colours and sounds, exhibiting our country’s rich cultural diversity. 

We have been working enthusiastically to put together an excellent scientific program to cater to diverse tastes. Among the plenaries that have been planned, we hope to represent the diversity in language that we see in Cochrane and how taking diverse socioeconomic aspects into policy making has improved the lives and health of individuals from minority groups. We also hope to showcase how diverse stakeholders have worked together to achieve great gains, and how diversity in methodological approaches has served us all in Cochrane as a global community.

We hope to see you all in Chile, and are sure that in addition to the cultural and scientific fruits of the Colloquium, visitors will also enjoy the spectacular and unique catalogue of natural wonders that Chile has to offer.

Gabriel Rada
Chair

Click here for more information on the 26th Cochrane Colloquium Santiago, 2019

David Tovey, Editor in Chief of the Cochrane Library, responds to a recent article in The BMJ, 'Has Cochrane lost its way?' David Tovey states that; "Cochrane is at its most effective when it adheres to its 10 key principles, which promote a culture that is open, diverse, inclusive and outwards facing, a community that is vibrant and iconoclastic, and a mission to search for truth and realism in health care." He also ensures "by all objective measures, Cochrane is thriving."

• Read 'The BMJ and Melanie Newman are telling a partial story'

Examining evidence for routine scale and polish treatment – an updated review

The Cochrane Review 'Routine scale and polish for periodontal health in adults' was carried out by authors working with Cochrane Oral Health to assess the effects of routine scale and polish treatments for healthy adults and to establish whether different time intervals between treatments influence these effects. The review had aimed to compare the effectiveness of the treatment when given by a dentist compared to a dental therapist or hygienist, but there were no studies evaluating this comparison.

This review updates the version published in 2013 and includes two studies with a total of 1711 participants. Both studies involved adults without severe periodontitis who were regular attenders at dental appointments in the UK. The studies were conducted in general dental practices, which is the most appropriate setting to evaluate 'routine scale and polish' treatments.

Dr. Thomas Lamont, lead author explains,

“This evidence could help patients and dental professionals make informed decisions about routine scale and polish treatment - which can be also known as ‘prophylaxis’, ‘professional mechanical plaque removal’ and ‘periodontal instrumentation’ - as it questions the effectiveness of the traditional delivery of routine scale and polish treatment in primary dental care.

“The studies found that regular planned scale and polish treatments didn’t reduce the early signs of gum disease more than scale and polish delivered only when the dental professional judged it necessary or it was requested by the patient. The tartar levels were slightly more reduced with scheduled treatments, but it’s uncertain if this small difference would be considered important by patients or their dentists.

“Participants receiving six-monthly and 12-monthly scale and polish treatments reported feeling that their teeth were cleaner than those who were not scheduled to receive treatment, but the evidence is low quality, and the studies didn’t find any difference between the groups in terms of quality of life.

“It should be noticed that neither of the studies measured side effects, such as damage to tooth surfaces and tooth sensitivity, changes in attachment level, tooth loss or bad breath, and available evidence on the costs of the treatments is uncertain.”

Please describe yourself and your Cochrane Group?

I graduated in dentistry from Glasgow University in 2008 and went on to complete a PhD at the University of Dundee. I am currently a Clinical Research Fellow and Honorary Specialty Registrar in Restorative Dentistry at the University of Dundee. I am also a clinical editor at Cochrane Oral Health, which was founded in 1994. For over 20 years, Cochrane Oral Health has been producing high-quality, relevant systematic reviews that can improve oral health care and oral health. We currently have 163 active reviews on the Cochrane Library, as well as 35 protocols for reviews currently in progress.

What is the background to this review and the update?

Many adults in high-income countries will be used to having a ‘scale and polish’ when they go to the dentist. It is intended as a supplementary form of plaque removal in addition to oral hygiene undertaken regularly at home by patients, with the aim of reducing the risk of gum disease.

The first Cochrane Review of regular scale and polish treatment was conducted in 2004 and showed that there was very little evidence to go on. In the review’s conclusions, the authors recommended that a trial be conducted to find out whether routinely providing a scale and polish treatment to people who had relatively healthy mouths and tended to visit the dentist regularly actually had an impact on their long-term oral health, and specifically on periodontal disease. NIHR picked up on this, and Professor Jan Clarkson of the University of Dundee collaborated with Professor Craig Ramsay of the University of Aberdeen, together with colleagues from several other universities, to apply for HTA funding to run such a trial. I joined them as the Clinical Research Fellow on the trial, which was known as ‘IQuaD’ in 2011 and subsequently became involved in updating theCochrane Review. IQuaD was completed in 2017, and the findings were published in 2018 (https://www.journalslibrary.nihr.ac.uk/hta/hta22380/#/abstract)

(Improving the Quality of Dentistry (IQuaD): A cluster factorial randomised controlled trial comparing the effectiveness and cost-benefit of oral hygiene advice and/or periodontal instrumentation with routine care for the prevention and management of periodontal disease in dentate adults attending dental primary care. Health Technology Assessment Volume 22, Issue 38, July 2018)

Why is an update of the review important?

As Cochrane’s mission is to promote evidence-informed health decision-making by producing high-quality, accessible systematic reviews and other synthesised research evidence, there is a commitment to ensure Cochrane Reviews are kept up-to-date by identifying and incorporating new evidence. The IQuaD trial reached some strong conclusions that we felt should be combined with the existing evidence and shared widely.

What are the main implications of this research?

This review questions whether it is necessary for scale and polish to be delivered routinely, that is, on a standard schedule of every 6 or 12 months. Many people like the clean feeling that they get from a scale and polish treatment every six months, but it is not clear that there is any real clinical benefit in terms of reducing gum disease. The updated review shows that providing scale and polish treatment when the dentist deems it appropriate or when the patient requests it, does not result in poorer oral health outcomes after 2 to 3 years than providing scale and polish treatments on a predetermined 6- or 12-monthly schedule. 

It is important to point out that the participants in the two trials included in the review had relatively healthy mouths; none of them had severe periodontitis. It is also important to point out the trials were conducted in the UK. In other high-income countries, the treatment may be known as  “prophylaxis”, “professional mechanical plaque removal” or “periodontal instrumentation”, and it is reasonable to assume that the findings would be the same.

• Read the Cochrane Review
• Read the blog post 'Is there a case for routine scale and polish?'
• Learn more about Cochrane Oral Health

When someone has an acute ischemic stroke, urgent and reliable treatments will reduce their risks of disability or dying from their brain tissue damage. The treatments used vary around the world, and a drug called cerebrolysin is widely used in post-Soviet countries, Eastern Europe, Central and Southeast Asia. In April 2017, the latest update of this review was published by researchers from Kazan Federal University in Russia and Chinara Razzakova, a PhD student from the university interviewed one of the authors, Liliya Eugenevna, for this podcast.

"This Cochrane Review is about a medicine called cerebrolysin, which is used for people who’ve had an acute ischemic stroke. It’s believed to have neuroprotective and neurotropic properties and is widely used here in Russia, countries of the former Soviet Union, China and elsewhere in Asia. We wanted to examine its potential benefits for people with acute ischemic stroke, and whether there are any harms associated with its use.

One of the reasons for the review was the fact that cerebrolysin is used so often for this type of stroke, but the main issue as we worked on the review was the drug’s use as a potential neuroprotector. In ischemic stroke, the concept of “neuroprotection” includes the suppression of changes that lead to an influx of calcium ions, activation of the reactive oxygen species or free radicals, and cell necrosis. These ideas have stimulated the development of many potentially “neuroprotective” substances, some of which were shown to be effective in animal studies. However, the evidence from clinical trials in patients continues to be problematic. This led us to try to find out whether cerebrolysin effectively protects the brain from damage and has benefits, or harms, for people who have had an acute ischemic stroke.

We looked for studies in which patients who were receiving a standard treatment regimen for ischemic stroke were randomized to receive either cerebrolysin or a placebo. We then used these studies to investigate the effects on death and adverse events. We found six randomized trials with a total of approximately 1500 participants. Three of the six trials were large multicentre studies, two were small and one did not provide quantitative information to include in the final meta-analyses.

When we combined the evidence, we found no benefit of cerebrolysin use. There was no obvious effect on deaths and the data from the three multicentre studies, which reported serious adverse events, showed that cerebrolysin more than doubled the number of people with non-fatal serious adverse events.

Although high-quality large-scale randomized trials are always necessary for getting reliable information about the potential value of drugs used in acute ischemic stroke, our review has shown that the potential benefit of cerebrolysin is not supported by reliable evidence and we would not recommend its routine use in acute ischemic stroke. We’ve also shown that the use of cerebrolysin is unsafe and, so, if it is going to be tested in future research, this needs to take the form of well-designed randomised trials and include assessments of the risks of serious adverse events.

In summary; myself and my co-authors of this review recommend that cerebrolysin is not the right choice for the treatment of acute ischemic stroke."

• Read the Cochrane Review
• Listen to more Cochrane Podcasts
• Get Cochrane Podcasts on iTunes
• Visit the Cochrane Stroke website

The use of pain-relieving drugs during labour is common throughout the world, and an updated Cochrane Review from June 2018 looks at the use of a class of drugs called opioids. Lead author, Lesley Smith from Oxford Brookes University in the UK tells us what they found.

"For many women in labour, an epidural containing a local anaesthetic has become an increasingly popular choice for pain relief. However, not all women choose this and some give birth in places were an epidural is not available. One of alternatives is the use of an opioid drug, such as pethidine, diamorphine or meptazinol given either intramuscularly or intravenously. These are used less frequently than epidurals but are still widely used in obstetric and midwife-led birth units to relieve pain during labour, and we did this review to satisfy the need for up-to-date information on their effectiveness.

Opioids are known to provide very effective pain relief for various causes of pain, such as that following surgery, but they can cause side effects like nausea and vomiting, and drowsiness. An additional consideration when used for pregnant women, is that they cross the placenta perhaps leading to unintended effects on the baby.

Therefore, despite their widespread use it is still unclear just how effective opioids are at relieving pain during labour, which one provides the best pain relief and what the adverse effects are on the mother and baby. We investigated different types and doses of intramuscular and intravenous opiod drugs to evaluate all this.

We found 61 randomised trials involving more than 8,000 healthy pregnant women. Unfortunately, despite this large body of evidence, few trials had compared the same drug with a control and, instead, we were faced with a total of 34 different drug comparisons. Many comparisons had just a single study providing data, which seriously limited our ability to make firm conclusions. Another problem was that the trials were generally of poor quality, due to relatively small sample sizes, subjective outcome assessment using measures of uncertain validity and reliability, and a lack of blinding of investigators and women.

Overall, we found that intramuscular or intravenous opioids provided some pain relief and women were moderately satisfied with the pain relief during labour, although up to two thirds of women reported moderate or severe pain or poor pain relief one to two hours after receiving an injection. Some women also experienced nausea, vomiting and drowsiness, but there was no clear evidence of adverse effects on the baby. It also wasn’t possible to establish whether one drug was superior to another, because of the lack of the necessary comparative evidence.

In summary, our updated review shows that the evidence supporting the choice of intramuscular or intravenous opioids for pain management during labour is poor. We still need research to establish which drug provides the greatest satisfaction to women, with acceptable levels of unintended effects on both them and the newborn."

• Read the Cochrane Review
• Listen to more Cochrane Podcasts
• Get Cochrane Podcasts on iTunes
• Visit the Cochrane Pregnancy and Childbirth website

The 26th Cochrane Colloquium, Santiago 2019 call for abstracts and workshops is now open. 

This year’s theme is ‘Embracing diversity’, recognizing Cochrane as a truly global independent community, addressing relevant health questions from international stakeholders using a range of diverse methods. 

We ask that abstract submissions consider the relevance to this theme. In particular, we welcome submissions that address or discuss diversity on reviews from different viewpoints/angles. 

The deadline for submissions is 12 April 2019.

All submissions will be notified of their outcome by the first week in June 2019. 

• View the call for abstracts
• View the call for workshops
• Find out more about this year’s Cochrane Colloquium in the exciting of Santiago, Chile.

v\:* {behavior:url(#default#VML);} o\:* {behavior:url(#default#VML);} w\:* {behavior:url(#default#VML);} .shape {behavior:url(#default#VML);} Methodological rigour and impartiality are key attributes of Cochrane reviews. In an era where the validity of research is under scrutiny, the impact of conflicts of interest (COI), real and perceived, cannot be underestimated. It is critical, therefore, that Cochrane has a policy in place to minimize this concern and retain the confidence of all its stakeholders.

To ensure Cochrane’s policy is fit for purpose, we are reviewing the Commercial Sponsorship Policy for Cochrane reviews and Cochrane review groups, which was last updated in October 2014.  We aim to make it easier to identify, prevent and manage COI from initial declarations to published statements in Cochrane reviews. The revised policy will cover both financial and non-financial aspects of COI. By improving clarity and removing ambiguity, we hope that the new policy will deal with issues around perception and transparency.

In revising the policy, we must consider the unique challenges that arise from Cochrane being both the publisher of the Cochrane Library and an international healthcare research organization which serves multiple stakeholder interests and is powered by a largely volunteer workforce. Like other international organizations, we must ensure that our COI policy is understood and applied in a wide variety of countries and cultural contexts. Information gathered in the survey will be combined with a review of COI policies from other organizations and interviews with key stakeholders and COI experts, to inform the policy update.

We invite feedback from people who create, use or fund the production of Cochrane Reviews, on how conflict of interest should be defined and managed. Please take 15 minutes to complete this important survey on COI by 17th February.

If you have any questions about the survey or the COI revision project generally, please contact the team at COISurvey@cochrane.org.

• Provide feedback via the survey  
• Read the Cochrane Library editorial: ‘Cochrane's plans to update its COI policy: truth and fiction’

In this Evidently Cochrane blog, Sarah Chapman looks at the latest evidence on vitamin and mineral supplements for preventing dementia or at least slowing cognitive decline. Can they really help?

"I have a clear memory of watching a tv drama with my mum, when I was about fifteen. As we watched a vivid portrayal of a middle-aged woman struggling to cope with her mother, declining with dementia, Mum voiced a fervent hope that she would never be like that. With her own mother enjoying good health in her nineties, the possibility must have seemed as remote to her as middle age did to me. But now I am there, and so is my mum, diagnosed with Alzheimer’s last summer.

Is there anything my bright, busy mother could have done to reduce her risk of dementia? This woman, who for much of her adult life had a fulfilling career and later voluntary work; was happily busy with friends and family; enjoyed theatre-going, singing in a choir and participating in various special interest groups; read voraciously and had a daily crossword habit. Is there?"

Despite the many important and positive inroads into our understanding of dementia in recent years, and an increasing shift in emphasis from dementia being something people suffer from to something they can live with, dementia frightens us. Katie Marais from Alzheimer’s Research UK says that “How can I prevent dementia?” is one of the most common questions put to them, and explains here what last year’s Lancet Commission on Dementia found about risk factors. While 65% of the risk for dementia comes from things we can’t change, like our age and our genes, the report lists nine ‘modifiable risk factors’ for dementia, things that we may be able to do something about, including smoking, lack of physical activity and social isolation.

Preventing dementia: what do we try?

There are many things that people do in the hope of staving off cognitive decline, from dietary modifications to daily sudoku solving. I think we may travel more in hope than expectation, but sometimes we can find evidence to see if our efforts might actually reduce our risk, and whether we could be doing ourselves any harm by trying.

Two Cochrane Reviews bring together the best available evidence on the safety and effectiveness of vitamin and mineral supplements for maintaining cognitive function and preventing dementia. In theory, these could help, as vitamins and minerals have many functions in our central nervous systems which may help keep the brain healthy and our minds working well. But is there robust evidence to inform our choices? Let’s see.

Vitamin and mineral supplements for cognitively healthy people

This new Cochrane Review concerns the effects of vitamin and mineral supplements on cognitive function in people with no cognitive problems when they started taking part in the research studies. Although the review authors looked for studies involving people aged 40 and over, there are few data on people taking supplements under the age of 60. Despite being able to include 28 studies involving more than 83,000 people, there are limitations of the evidence which mean that confident conclusions can’t be drawn. Here’s what they found.
B vitamin supplements

Taking B vitamin supplements probably has little or no effect on overall cognitive function at any time point up to five years and may have no effect at five to ten years. There are very few data on harms or on the incidence of cognitive impairment or dementia.

Antioxidant vitamins: ß‐carotene, vitamin C or vitamin E

The results are mixed, but the review authors say that long-term supplementation with antioxidant vitamins may be the most promising area for future research. There is low-certainty evidence of benefit in overall cognitive function with long-term supplementation with ß‐carotene (after a mean of 18 years of treatment) and with vitamin C (after 5 to 10 years), but an antioxidant vitamin combination or vitamin E, alone or with selenium, may have no effect.

Selenium

Selenium alone, taken for around five years, may have no effect on the incidence of dementia.

Zinc and copper supplementation

Moderate-certainty evidence suggests that this has little or no effect on overall cognitive function, or the incidence of cognitive impairment, after five to ten years.

Complex supplements

Combinations of B vitamins, antioxidant vitamins, and minerals may have little or no effect on cognitive function, after around 8.5 years of taking them. The authors’ bottom line is:

“We did not find evidence that any vitamin or mineral supplementation strategy for cognitively healthy adults in mid or late life has a meaningful effect on cognitive decline or dementia, although the evidence does not permit definitive conclusions.”

Omega 3-PUFA (fish oils)

An older Cochrane Review looks at the effect of omega-3 fatty acid supplementation (in gel capsules or margarine) compared with placebo (olive oil capsules or omega-free margarine) in cognitively healthy older people.  There is no direct evidence of the effect of omega-3 supplements on the number of people being diagnosed with dementia, while three high quality randomised trials show no benefit for cognitive function, measured by the Mini Mental State Examination (MMSE) score at 24 or 40 months. Some people taking omega-3 supplements experienced mild gastrointestinal problems.

Vitamin and mineral supplements for people with mild cognitive impairment

The authors of this Cochrane Review on the effects of vitamin and mineral supplementation on cognitive function in people with mild cognitive impairment (MCI) have found that the evidence is very limited. Only B vitamins have been assessed in more than one clinical trial. Taking B vitamins for six months to two years probably results in little or no difference in memory, thinking skills or quality of life, and the evidence doesn’t tell us whether or not there are any harms from taking them.

They conclude:

“At the moment, it is not possible to identify any supplements which can reduce the risk of people with MCI developing dementia or which can effectively treat their symptoms.”

Where does this leave us?

So many things that we try in the hope of maintaining our health are costly in terms of money, time, effort and the hopes we pin on them. Preventive strategies, like taking dietary supplements, are often pushed hard by those with a commercial interest in their uptake. Whether it is NHS budgets or individuals’ purses that take the financial hit, knowing whether there is evidence to guide these choices, and what that evidence tells us, is so important. These Cochrane Reviews show us what the state of the evidence is to date and when more evidence becomes available it can be assessed for inclusion in an update of the reviews. Meanwhile, we are anticipating three new Cochrane Reviews on another popular preventive strategy, computerised cognitive training or ‘brain training’, which we’ll be  blogging about here.

• Join in the conversation on Twitter with @SarahChapman30 @CochraneUK @CochraneDCIG
• Leave a comment on the original blog post
• Review all References
• Read more Evidently Cochrane blog posts

We recognize the work of Cochrane Nigeria who are supporting national guideline development groups in using Cochrane evidence to develop evidence-based guidelines and to be able to adapt existing guidelines to the Nigerian context. Cochrane Nigeria has been developing skills in how to appraise and adapt existing guidelines using the AGREE II tool, and how to use evidence, including Cochrane evidence, in the guideline development process.

• Visit the Cochrane Nigeria website
• Read more about this work
• Learn more about how Cochrane is improving the uptake of evidence

Cochrane is made up of 13,000 members and over 50,000 supporters come from more than 130 countries, worldwide. Our volunteers and contributors are researchers, health professionals, patients, carers, people passionate about improving health outcomes for everyone, everywhere.

Cochrane is an incredible community of people who all play their part in improving health and healthcare globally. We believe that by putting trusted evidence at the heart of health decisions we can achieve a world of improved health for all. 

Many of our contributors are young people working with Cochrane as researchers, citizen scientists, medical students, and volunteer language translators and we want to recognize the work of this generation of contributors as part of this series called, Cochrane’s “30 under 30." 

In this series, we will interview 30 young people, 30 years old or younger who are contributing to Cochrane activities in a range of ways, all promoting evidence-informed health decision making across the world. 

We will be hearing from them in a series of interviewees published over the coming months.

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

Name: Robin Vernooij
Age: 29
Occupation: Post-doctoral researcher at the Netherlands Comprehensive Cancer Organisation and post-doctoral fellow at the Dalhousie University in the Nutritional Recommendations and Accessible Evidence Summaries Composed of Systematic Reviews (NutriRECS) group
Program: Netherlands Comprehensive Cancer Organisation

How did you first hear about Cochrane?
I became aware of Cochrane in 2011 while working on my Master's degree in Epidemiology and Biostatistics at the VU University in Amsterdam. One of my courses focused on the methodology and statistics of systematic reviews and meta-analyses. The Cochrane Handbook was a “suggested reading” and not surprisingly turned out to be an invaluable learning resource.

How did you become involved with Cochrane? What is your background?
My medical career started in 2006 at the HAN University of Applied Sciences in Nijmegen, the Netherlands where I obtained his Bachelor's degree in nursing in 2010. Afterwards, as part of my Master's degree, I completed a one-year placement at the Iberoamerican Cochrane Centre in Barcelona. Subsequently I was fortunate to continue to work at the centre for two more years. It was with the same centre, affiliated with Autonomous University of Barcelona, that I completed my PhD thesis in the Methodology of Biomedical Research and Public Health (2013 to 2018).

What do you do in Cochrane?
Apart from being employed by the Iberoamerican Cochrane Center for almost three years, I have been involved in the Cochrane community by collaborating with several Cochrane groups. In this capacity, I have helped author teams in completing their systematic reviews, including authors and editors of the Anaesthesia, Critical, and Emergency Care group; Dementia and Cognitive Improvement group; Urology group; and the Vascular group. Additionally, I serve as a contact editor for the Cochrane Urology group and as a regular peer-reviewer for the Cochrane Screening and Diagnostic Tests Methods Group.

What specifically do you enjoy about working for Cochrane and what have you learnt?
Working for Cochrane on a systematic review includes commonly a multidisciplinary collaboration between methodologists, statisticians, clinicians, and policy-makers. This collaboration allows me to learn more about the practices of the other involved disciplines. Secondly, I welcome any opportunity to learn more about the quality standards and emerging methods in conducting systematic reviews or meta-analyses. Being involved in the Cochrane collaboration allows me to remain up-to-date with the “gold standard” of systematic reviews and meta-analyses. Finally, contributing to the most comprehensive up-to-date evidence summaries on a given topic is very motivating.

What are your future plans?
Apart from my enthusiasm about systematic reviews, I am also keen on the development and updating of guidelines. Obviously, they go hand in hand since guidelines should be informed by the best summaries of the latest evidence available. My future plans are to collaborate on making an evidence ecosystem in which guidelines (informed by high-quality systematic reviews) are used to implement quality indicators in clinical practice. These quality indicators, based on the recommendations of the guidelines, should be used by healthcare professionals to treat their patients accordingly. Ideally, adherence to these quality indicators should be measured by registry data, allowing real-time feedback of the healthcare professionals performance.

In your personal experience, what one thing could Cochrane do better to improve its global profile?
Cochrane has grown a lot in the last five years and has many demands and priorities, particularly with respect to emerging methods including network-meta-analyses and living systematic reviews. I think that Cochrane should emphasise the need for living systematic reviews based on new practice-changing trials. If, at least, 75 new trials are published every day, it becomes very difficult to keep all available Cochrane reviews up-to-date. Methods and software development for identifying new trials, prioritising evidence that may be practice-changing, and conducting updates would be an asset to the organisation.

What do you hope for Cochrane for the future?
“It is surely a great criticism of our profession that we have not organised a critical summary, by specialty or subspecialty, adapted periodically, of all relevant randomised controlled trials” (Cochrane 1979).

Although we have, over the last 40 years, came a long way, in my modest experience, there is still much room for improvement in the original aim. And now we are facing additional challenges, such as: how are we going to keep our systematic reviews and guidelines up-to-date? How do we prioritise practice-changing new evidence? And how do we use new technologies to facilitate systematic review development? I hope we can collectively work together to answer these questions.

How important is it that young people get involved in Cochrane?
As with most successful medical and public health organisations that are non-for-profit, research volunteers are crucial and it is important that a substantial proportion have healthcare and research training. It is important that trainees recognise the role of systematic reviews for evidence-informed health care decision-making. Crucial to learning about systematic reviews is the opportunity to have hands-on-experience.

Why is this, do you think?
For most of the young people, building both an academic and clinical network is crucial for the success of their career. Those pursuing a PhD project in the field of medicine or public health should consider –in my opinion – conducting or supporting a Cochrane review. This allows collecting all available evidence, understanding risk of bias issues, summarising the certainty of evidence to generate conclusions, and, identifying gaps in the current knowledge. The identified gaps could be used as inspiration on follow-up studies in a PhD project and beyond.

What would your message be to other young people who want to get involved with Cochrane’s work but not sure where to start….?
I would suggest reaching out to authors and editors that may be in need of a helping hand. For instance, Cochrane often posts on its website, reviews in need of update help, particularly priority reviews. Additionally, they can start browsing Cochrane’s TaskExchange for opportunities such as translation, data-extraction, or risk of bias assessment, as well as Cochrane Crowd, which allows gaining experience in literature screening. To get started, there are often simple tasks (e.g. literature screening, data-extraction) available on these websites that can be of great help to those leading the systematic review process, tasks that perhaps lead to co-authorship!

Cochrane is made up of 13,000 members and over 50,000 supporters come from more than 130 countries, worldwide. Our volunteers and contributors are researchers, health professionals, patients, carers, people passionate about improving health outcomes for everyone, everywhere.

Cochrane is an incredible community of people who all play their part in improving health and healthcare globally. We believe that by putting trusted evidence at the heart of health decisions we can achieve a world of improved health for all.

Many of our contributors are young people working with Cochrane as researchers, citizen scientists, medical students, and volunteer language translators and we want to recognize the work of this generation of contributors as part of this series called, Cochrane’s “30 under 30."

In this series, we will interview 30 young people, 30 years old or younger who are contributing to Cochrane activities in a range of ways, all promoting evidence-informed health decision making across the world.

We will be hearing from them in a series of interviewees published over the coming months.

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

Name: Emma Persad
Age: 26
Occupation: Part-time student researcher at the Department of Evidence-based Medicine and Clinical Epidemiology at Danube University Krems and Cochrane Austria
Program: Bachelor of Science Honours in Molecular Biology (Canada), Medicine (Austria)

How did you first hear about Cochrane?
Cochrane Austria is fortunately located on campus at the Department of Evidence-based Medicine and Clinical Epidemiology at Danube University Krems. Due to the convenience of having the Centre so close and the importance of teaching evidence-based medicine to medical students, Cochrane’s methods, work, and strict standards have been taught extensively since the first year of the program.

How did you become involved with Cochrane? What is your background?
My background is more in molecular biology and laboratory research, but after starting my medicine program I got introduced to Cochrane’s work and was lucky enough to get a job working alongside Cochrane Austria. I have always been passionate about public health and international affairs, so working for an international organization like Cochrane really fits my profile.

What do you do in Cochrane?
I’ve been involved in a variety of Cochrane reviews, with research and outreach for the Rapid Reviews Methods Group, and am currently leading an update of a Cochrane Review alongside my thesis.

What specifically do you enjoy about working for Cochrane and what have you learnt?
I really enjoy working for such a tight-knit community that is so determined to reach out with the best available evidence to both professionals and the general public. A great example of this is the plain language summaries of reviews to make the major points understood by lay people. As a future doctor, I have personally learned the importance of evidence-based medicine in my future career, and I can now appreciate that most people, especially doctors, don’t have time to read and synthesize all of the studies that are published. Thus, it is reassuring to have a set place to find the most trustworthy, all-inclusive, and up-to-date evidence.

What are your future plans?
I hope to work in the medical field while combing my passion for evidence-based medicine and public health into my career. I would like to stay involved in Cochrane’s work as much as possible and continue to be involved in reviews, when presented with the opportunity. I would eventually like to work with the WHO, and I’m sure my background with Cochrane will be a great asset for me there.

In your personal experience, what one thing could Cochrane do better to improve its global profile?
I think Cochrane could do a better job with student outreach and involvement. My university is lucky to have Cochrane so close and so involved in the curriculum, but I think many students in science and research-related disciplines unfortunately graduate without knowing what Cochrane even is. If Cochrane can be more present in universities, then people worldwide will know Cochrane’s work and take that knowledge into their careers with them. This could be made possible by country Centres offering internships to interested students or by holding lectures on Cochrane and how to get involved in relevant faculties at universities, for example.

What do you hope for Cochrane for the future?
I hope that the country Centres will continue to grow and expand so that Cochrane’s high-quality research can be done around the world and influence the public health and medical practices in each country. 

How important is it that young people get involved in Cochrane?
Very important!

Why is this, do you think?
I believe that youth involvement is needed to continue Cochrane’s work in the future and that people planning to work in this field should be exposed to Cochrane as early as possible. This way, proper recognition and respect for evidence-based medicine can be taught, passed-on, and used throughout their whole careers.

What would your message be to other young people who want to get involved with Cochrane’s work but not sure where to start….?
First of all, check out Cochrane’s website to find out the ways that you can get involved. Translating Cochrane reviews or becoming a Cochrane citizen scientist are good ways to start. You can also contact your country Cochrane Centre to see if you can do an internship or get involved in their work. 

Which drug is best for reducing excessive blood loss after birth?

The aim of this Cochrane Review was to find out which drug is most effective in preventing excessive blood loss at childbirth and has the least side effects. The authors collected and analysed all the relevant studies to answer this question.

The review’s lead author Dr Ioannis Gallos from the University of Birmingham explains, “Bleeding after birth is the most common reason why mothers die in childbirth worldwide. Although most women will have moderate bleeding at birth, others may bleed excessively, and this can pose a serious risk to their health and life. To reduce excessive bleeding blood loss at childbirth, the routine administration of a drug to contract the uterus (uterotonic) has become standard practice across the world. The aim of this research was to identify which drug is most effective in preventing excessive bleeding after childbirth and has the least side-effects.

The different drugs oxytocin, misoprostol, ergometrine, carbetocin, and combinations of these drugs, each have different effectiveness and side-effects. Some of the side effects identified include: vomiting, high blood pressure and fever. We analysed all the available evidence to compare all of these drugs and calculated a ranking among them providing robust effectiveness and side-effect profiles for each drug.

We found all drugs were generally effective for preventing excessive bleeding when compared with no uterotonic drug treatment. Ergometrine plus oxytocin combination, carbetocin, and misoprostol plus oxytocin combination may have some additional benefits compared with the current standard oxytocin. The two combination drugs, however, are associated with significant side effects that women might find disturbing compared with oxytocin. Carbetocin may have some additional benefits compared with oxytocin and appears to be without an increase in side effects.”

This updated review includes 196 studies involving 135,559 women. Studies were conducted across 53 countries. In most studies women were giving birth normally and in a hospital.

• The results of this review will be integrated into a WHO guideline for prevention of PPH
• Read the full Cochrane Review
• Read an Interview with Dr Ioannis Gallos lead author
• Learn more about the Cochrane Pregnancy and Childbirth Group

The aim of this Cochrane Review was to find out which drug is most effective in preventing excessive blood loss at childbirth and has the least side effects. The authors collected and analysed all the relevant studies to answer this question.

The lead author of this review is Dr Ioannis Gallos. He is a Clinician Scientist in University of Birmingham and Honorary Consultant in Obstetrics & Gynaecology for Birmingham Women’s Hospital. Ioannis obtained his Degree in Medicine and Surgery (DMS) cum laude from the University of Rome, Italy. He subsequently trained in Obstetrics & Gynaecology in the UK and sub-specialised in Reproductive Medicine & Surgery before joining University of Birmingham.

Ioannis’ research is focussed on reproduction, early pregnancy and maternal health. Ioannis has carried out evidence synthesis including the first network meta-analysis in O&G within Cochrane with cost-effectiveness analysis for identifying the most effective and cost-effective uterotonic agents for preventing postpartum haemorrhage in collaboration with the World Health Organisation. He is the National Clinical Co-ordinator for the “Letrozole or Clomifene, with or without metformin, for ovulation induction in women with polycystic ovary syndrome: a 2x2 factorial design randomised trial (The LOCI trial)” funded by the NIHR HTA programme and is expected to roll out in 50 hospitals across the UK. Ioannis is a consultant for the Tommy's National Centre for Miscarriage Research based at Birmingham Women’s Hospital. He is also the principal investigator for Tommy’s Net, a platform that will help us to collect and store information from many different centres. By sharing information, hospitals will be able to work together to carry out more effective research.  

We asked the review’s lead author, Dr Ioannis Gallos  a few questions about this important Cochrane Review.

What is the history behind this updated review (what came before?)
This review was originally published in April 2018. It has been updated so soon to incorporate results from a large WHO trial and other recent large trials. We have added 56 new trials (46,612 women), and the update now includes a total of 196 trials (135,559 women). 

Why was it important to conduct this review?
The individual uterotonics described in the review have been compared in existing Cochrane Reviews and all comparisons are based on trials that directly compared one uterotonic against another uterotonic agent in head-to-head trials. In the absence of a single randomised controlled trial comparing all available uterotonic agents, uncertainty remains over their relative effectiveness and ranking. When multiple interventions are available, a network meta-analysis is better placed for synthesising and interpreting the wider picture of the evidence and to understand the relative effects of all available interventions. Network meta-analysis has advantages over conventional pairwise meta-analysis, as the technique uses both direct and indirect evidence in a single coherent analysis to improve certainty about all possible treatment comparisons. Indirect evidence is obtained when the relative effectiveness of two competing interventions is inferred through a common comparator, even though this pair may not have been compared directly. WHO wished to update their recommendations on prevention of postpartum haemorrhage for the first time using a Cochrane network meta-analysis.

Can you give a brief summary of results?
All agents were generally effective for preventing excessive bleeding when compared with no uterotonic drug treatment. Ergometrine plus oxytocin combination, carbetocin, and misoprostol plus oxytocin combination may have some additional benefits compared with the current standard oxytocin. The two combination drugs, however, are associated with significant side effects that women might find disturbing compared with oxytocin. Carbetocin may have some additional benefits compared with oxytocin and appears to be without an increase in side effects.

 How did you co-ordinate with WHO to have this review integrated into the guideline?
Together with Cochrane Pregnancy and Childbirth and WHO we ran, in parallel, the updated evidence synthesis for the effectiveness and safety of the uterotonic agents. Results of the synthesis were integrated to the guideline and presented to the WHO guideline development group as forthcoming evidence to help them reach a decision about which uterotonic to recommend.

What does the review mean in terms of influencing policy and/or practice?
The results of this work are already integrated in the recent WHO recommendations and we hope they are helpful to other policy-makers and practising clinicians. You can view this here.

• The results of this review will be integrated into a WHO guideline for prevention of PPH
• Read the full Cochrane Review
• Read the feature news item about this Cochrane Review
• Learn more about the Cochrane Pregnancy and Childbirth Group

The recently published Cochrane Review from the Bone, Joint and Muscle Trauma Group assessed the best-quality evidence for different treatments of wrist fractures in children.

 Wrist fractures are the most common bone injury in children. Most are buckle (or torus) fractures, where the bone surface bulges out. These minor fractures heal well. They are often treated with a wrist splint or a below-elbow plaster cast.

More serious fractures are where the bone breaks, generally resulting in displacement of the bone parts. Usually the bone is manipulated back into place ('reduction'), followed by cast immobilisation, often with an above-elbow cast including the elbow. When considered, surgery generally involves placing wires through the skin and into the bone (percutaneous wiring).

The review includes 30 studies with 2930 children. Most of the 14 comparisons made by the studies were tested in one study only. The review focussed on five key comparisons. The three comparisons involving children with buckle fractures compared a removable splint with a below-elbow cast (6 studies); a soft or elasticated bandage with a below-elbow cast (4 studies); and cast removal at home by parents versus at the hospital fracture clinic by clinicians (2 studies). The other two comparisons, which involved children with displaced fractures, compared below-elbow versus above-elbow casts (4 studies) and percutaneous wiring and above-elbow cast immobilisation versus above-elbow cast immobilisation alone (5 studies).

Lead author Helen Handoll concluded, “There is not enough evidence to determine the best ways of treating different types of wrist fractures in children. However, the review findings are consistent with the treatment trend away from cast immobilisation for buckle fractures.”

• Read the full review
• Learn more about the Cochrane Bone, Joint and Muscle Trauma Group

Up to 70 million people worldwide have epilepsy and there are many Cochrane Reviews of ways to treat it. These include reviews that work with the original researchers to gather data on everyone who was in their studies, to perform individual participant data meta-analyses. In June 2018, Sarah Nevitt and colleagues from the University of Liverpool in the UK updated one of these reviews, comparing two commonly used drugs, lamotrigine and carbamazepine.

"Carbamazepine and lamotrigine are both recommended as first-line treatments for people with newly diagnosed focal onset epileptic seizures and as second-line treatments for those with newly diagnosed generalised onset seizures, if first-line treatment with sodium valproate is considered unsuitable. Therefore, in order to help choose between them, we have brought together the evidence from randomised trials, increasing the precision of results relating to efficacy and tolerability of the two drugs. 

Our primary outcome for the analyses was the time between a patient starting the drug and being withdrawn from it, which reflects both how effective the drugs are for seizure control and the tolerability of the drugs in terms of side effects. We also examined secondary efficacy outcomes, including time to first seizure and remission of seizures, as well as the types and frequency of side effects. 

We found fourteen relevant trials for this updated review, involving nearly 3800 people, and were able to obtain individual participant data for more than 2500 people from nine of the trials, representing nearly 70 percent of all the data. 

Our main results from the meta-analyses of these data suggest that people are more likely to withdraw earlier from carbamazepine than from lamotrigine treatment, with the most common reason for withdrawal being side effects, followed by seizure recurrence. The results also suggest that recurrence of seizures after starting treatment with lamotrigine may happen earlier than with carbamazepine and that people will achieve a period of six months without a seizure quicker on carbamazepine than lamotrigine. Adverse events occurred with a similar frequency for both drugs. The most common ones were dizziness, fatigue, gastrointestinal disturbances, headache and skin problems.

In summary, the evidence from the randomised trials shows that both carbamazepine and lamotrigine are effective treatments for people with focal onset seizures. Carbamazepine may be superior in terms of seizure control, while lamotrigine therapy is less likely to be withdrawn than carbamazepine therapy. This means that a choice between these first-line treatments should be made with careful consideration, taking personal circumstances of individuals into account, and using the information in our updated review as a guide to what might happen to patients on either drug."

• Read the Cochrane Review
• Listen to more Cochrane Podcasts
• Get Cochrane Podcasts on iTunes
• Visit the Cochrane Epilepsy website

Buruli ulcer is a neglected tropical disease caused by Mycobacterium ulcerans. It predominantly affects children below age 15 in sub‐Saharan Africa and people of any age in Australia. The infection manifests as a skin nodule, oedematous lesion, plaque, or ulcer. Transmission of Buruli ulcer is not entirely understood, with aquatic insects and mosquitoes being linked to disease transmission in some settings. It is clear, however, that disease is caused by the puncturing injury and introduction of the environmental pathogen into the skin and subcutaneous tissues. Whether the bacteria are thriving within a vector before they are transmitted (biological transmission) or merely transported and injected (mechanical transmission) is yet to be elucidated. Another hypothesis is that M ulcerans on the host skin is introduced following an insect bite or minor trauma.

A new Cochrane Infectious Diseases Review by included and discussed five randomized controlled trials and 13 prospective observational studies on drug treatment of Buruli ulcer - the first of its kind to formally assess the available evidence for drug treatment. This Cochrane Library Editorial discusses the latest findings, what we know, and what questions are still left unanswered.

• Read the Editorial - Treatment for Buruli ulcer: the long and winding road to antimicrobials‐first
• Read the Cochrane Review - Drugs for treating Buruli ulcer (Mycobacterium ulcerans disease)
• Visit the Cochrane Infectious Diseases website

Cochrane Crowd, Cochrane’s citizen science platform, is a global community of volunteers who are helping to classify the research needed to support informed decision-making about health care.

The job of the Cochrane Crowd community is to review descriptions of research studies to identify and classify randomized controlled trials (RCTs), a type of study that is considered the gold standard for clinical trials. Reports of RCTs are then fed into Cochrane’s Central Register of Controlled Trials, helping Cochrane authors and other systematic reviewers around the world quickly find the evidence they need to determine whether a treatment works, or whether a diagnostic test is accurate.

A challenge held in partnership with the Cochrane Associated Centre at Sinaloa’s Pediatric Hospital (Mexico) and the Autonomous University of Sinaloa (Mexico) recently broke all previously held challenge records. 

Giordano Perez-Gaxiola, director of Cochrane Mexico and key challenge organiser said; "I had run a couple of small challenges through Cochrane Classmate with my students in the past year. I thought it was a simple way to motivate them to learn what Cochrane is, what a clinical trial is, and how an easy-to-use platform like Cochrane Crowd could help them learn. A couple of months ago I had a meeting with the dean of the medical faculty of the Autonomous University of Sinaloa (Universidad Autónoma de Sinaloa, UAS), Dr. Gerardo Alapizco, to discuss how the university and our Cochrane Associated Centre at Sinaloa’s Pediatric Hospital (Hospital Pediátrico de Sinaloa, HPS) could collaborate. I proposed setting up a university-wide challenge in order to engage a large number of students. This would introduce them to Cochrane and hopefully pique their interest, potentially leading to further engagement with Cochrane. This proposal was then discussed and approved by the medical faculty’s governing committee. We agreed that all students at UAS would be invited to take part."

Over three days from Dec 5-8, 738 people signed up, 455 participated and 319,643 individual assessments were made equating to 89,692 records being screened. 90 people screened at least 1000 records during the challenge and as a result were invited to become Cochrane members. And finally, almost 10,000 RCTs were identified for Cochrane’s CENTRAL register of controlled trials, where they can be accessed by systematic reviewers around the world.

Perez-Gaxiola added; "In my opinion, a Cochrane Crowd challenge is a simple way to engage students, to help them learn about Cochrane and about clinical trials. It is very easy to set up (takes about 10 minutes) and easy for the students to participate. It can be a useful teaching tool, too. And if you make it a competition, it can be fun."

• Learn about the benefits of joining Copchrane Crowd as a student
  
• Read the full interview with Giordano Perez-Gaxiola
• Learn more about Cochrane Crowd
• Learn more about Cochrane ClassMate
• Visit the Cochrane Mexico website

 Knowledge Translation in Cochrane is delighted to share this request for proposal for the project to agree a set of ‘principles for dissemination’ and to develop practical tools in order to improve the quality of Cochrane’s dissemination products.

This new and exciting opportunity is a commissioned piece of work open to the Cochrane community and will involve working with the Knowledge Translation (KT) ‘Improving and Upscaling KT products’ Working Group and our KT Advisory Group.

The deadline is Friday 18th January 2019, 17:00 GMT. For further information or any questions please contact Karen Head (khead@cochrane.org).

• Review the request for proposal
• Find out more information about KT in Cochrane
  

On Friday, 7th December, Cochrane enthusiasts gathered at the University of Split School of Medicine to celebrate the 10th anniversary of Cochrane Croatia.

Cochrane Croatia was founded as a Branch of the Italian Cochrane Centre on 8th December, 2008, ten years following initial discussions between Prof. Ana Marušić, Sir Iain Chalmers and Prof. Alessandro Liberati. Prof. Peter Tugwell, and his team, were instrumental in building capacity within Cochrane Croatia, along with the Mamić family who warmly welcomed several members of Cochrane Croatia into their family home, in Ottawa. Together, with the support of the Italian Cochrane Centre, later lead by Roberto D’Amico, Cochrane Croatia grew to become an independent Cochrane Centre in 2017. 

Today, Cochrane Croatia has 20 members, 19 partner organisations, 1 Affiliate - with another two in the pipeline. The Anniversary celebration was opened by the Vice-Dean for Research at the University of Split School of Medicine, Prof. Mirna Saraga-Babić, and by Cochrane Croatia’s Co-Director, Dr. Tina Poklepović Peričić. This was followed by an address given by the Chancellor of the University of Split, Prof. Dragan Ljutić and by Prof. Stipan Janković, Dean of the medical school in Split at the time Cochrane Croatia was founded. Prof. Ozren Polašek, Director of Croatian Centre for Global Health, underlined the importance of systematic reviews and Cochrane’s crucial role in their production and dissemination. Prof. Žarko Alfirević, from Cochrane Pregnancy and Childbirth, shared how Cochrane reviews influenced his clinical practice.  

The videos ‘Three patients and their stories contributing to Cochrane’s success’ and ‘Recognising success in Cochrane in 2017’ were screened. This was followed by Prof. Matko Marušić’s reminder of the early days of Cochrane Croatia, after which Cochrane Croatia’s Co-Director, Irena Zakarija-Grković, provided an overview of the first ten years, summarized in a published report ‘Cochrane Croatia: 2008-2018’. Finally, Dr Ljubo Znaor, Research Office Coordinator at the University Hospital Split, spoke of future projects with Cochrane Croatia.

All present celebrated Cochrane Croatia’s achievements with an appropriately decorated birthday cake and plenty of good cheer!

Irena Zakarija-Grković, Co-Director Cochrane Croatia

• Visit the Cochrane Croatia website
• Read Cochrane Evidence in Croatian

Cochrane, a global independent network of researchers, professionals, patients, carers and people interested in health, is proud to announce its newest Associate Centre,  Cochrane Czech Republic, at the Faculty of Medicine, Masaryk University, Brno.

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

Cochrane works with collaborators from more than 130 countries to produce credible, accessible health information that is free from commercial sponsorship and other conflicts of interest.  Cochrane’s work is recognized as representing an international gold standard for high quality, trusted information.

Cochrane Czech Republic will be coordinated and led by its new Associate Director, Professor Dr. Miloslav Klugar: “The launch of Cochrane Czech Republic is very important. Producing and increasing the dissemination of the best available information on healthcare is critical for clinicians and patients everywhere in the world, including the Czech Republic. Cochrane Czech Republic is one of three important pillars of the Czech National Centre for Evidence-Based Healthcare and Knowledge Translation as an umbrella centre."

Cochrane’s Chief Executive Officer, Mark Wilson, warmly welcomed today’s news: “I am delighted we are announcing the launch of Cochrane Czech Republic, which I’m confident will deepen and expand the reach and impact of Cochrane activities on health and healthcare decision-making across the Czech Republic and therefore improve health outcomes for its 10.5 million citizens. This is why the establishment of Cochrane Czech Republic is so important. We hope that it will also promote health research in the Czech Republic
and Central European region and its application into policy and clinical practice across the country and the world.”

Jitka Klugarová, Associate Professor and Deputy Director for evidence syntheses and implementation, added: “This is an innovation for our region and we intend to collaborate in the dissemination of Cochrane Reviews and to continue supporting Cochrane to reach its 2020 strategic objectives.”

Andrea Pokorná, Associate Professor and Deputy Director for education activities also commented: “This is an excellent opportunity for scientific growth and gives us the chance to train students and a future generation of health workers that will develop high-quality research. Our chance to support health professionals in improving their decision-making based on the best available Cochrane evidence will support patient care.” 

Cochrane Czech Republic is an Associate Centre of Cochrane Germany. This means it will be supported by Cochrane Germany who will offer methodological support, mentoring, and supervision.

For more information on the work of the Cochrane Czech Republic, please visit the website: https://czechrepublic.cochrane.org

Facebook: @CochraneCzechRepublic

Twitter: @czcochrane

About Cochrane
Cochrane is a global independent network of researchers, professionals, patients, carers and people interested in health.

Cochrane produces reviews which study all of the best available evidence generated through research and make it easier to inform decisions about health. These are called systematic reviews.

Cochrane is a not-for profit organization with collaborators from more than 130 countries working together to produce credible, accessible health information that is free from commercial sponsorship and other conflicts of interest. Our work is recognized as representing an international gold standard for high quality, trusted information.

If you are a journalist or member of the press and wish to receive news alerts before their online publication or if you wish to arrange an interview with an author, please contact the Cochrane press office: pressoffice@cochrane.org