Scientific expert reaction to new Cochrane Review on HPV vaccine for cervical cancer prevention in girls and women
New evidence published today in the Cochrane Library shows that human papilloma virus (HPV) vaccines protect against cervical lesions in young women, particularly in those who are vaccinated between the ages of 15 and 26. It also summarizes findings on harms that have been assessed in randomized controlled trials. Below is a collection of expert reactions to this new Cochrane Review.
Prof Keith Neal, Emeritus Professor of Epidemiology, University of Nottingham, said:
“This study looks at a collection of studies looking at the benefit of HPV vaccines in reducing pre cervical cancer lesions. HPV also causes many other serious cancers (especially head and neck). In time, as more people have been vaccinated, we will see a reduction in all HPV cancers. The HPV vaccine is one of a number of vaccines using virus like particles (VLPS) which have been shown to be very safe over the last 35 years.
“The Cochrane library of reviews has a very rigorous assessment process of all their reviews.
“The review only looked at cervical precancer (in women and girls), and does not make any comments about whether boys should be given the vaccine too. But it is an interesting question – the current argument from UK authorities is that herd immunity will protect boys as well. But this is not completely true because 10% of girls do not get vaccinated, nor does it cover sexual activity when abroad or with arrivals to the UK after the vaccination age. Gay men will never be covered by herd immunity from females, hence the separate programme for gay men to receive the vaccine at GUM clinics. Boys can only be fully protected if all their sexual partners have been vaccinated fully.”
Dr Mary Ramsay, Head of Immunisations, PHE, said:
“This study adds to the wealth of growing evidence from around the world which shows that the HPV vaccine is the most effective way for young girls to protect themselves against cervical cancer.
“Most women aged 15 to 25 years in the UK have now received the HPV vaccine. Public Health England has already shown that the HPV vaccine has contributed to a significant decrease in rates of infection with the two main cancer-causing HPV types(16 and 18) in vaccinated and unvaccinated women. This is consistent with very high vaccine effectiveness and substantial herd protection. In time, it is expected that the vaccine will save hundreds of lives every year.”
Prof Peter Openshaw, President of the British Society for Immunology, said:
“Today’s publication of the Cochrane Library review into the effectiveness and safety of the human papilloma virus (HPV) vaccine paints a reassuring picture, highlighting the huge public health benefits that this vaccine offers to young women.
“This very comprehensive review found that the HPV vaccine protects against pre-cancerous changes in the cervix, particularly when given to women aged 15–26. It also finds that, so far, the vaccine causes no serious side-effects. This is very important to emphasise: the negative press that the vaccine has received in some countries is completely unfounded on evidence. The fact that we now have a vaccine that can safely reduce the likelihood of women developing cervical lesions (which often lead to cervical cancer) should be greeted with the highest level of enthusiasm.
“Although the HPV vaccine was originally introduced to prevent cervical cancer in women, it’s now recognised that human papilloma virus can cause a number of other diseases in both sexes (which aren’t included in this review) such as genital warts and some other cancers, including those of the anus and some types of mouth and throat cancer. These cancers are rarer than cancer of the cervix, but are really important to prevent too. While this review only concentrates on the effectiveness of the HPV vaccine in relation to cervical lesions, we need to remember that it may confer additional health benefits outside the scope of this review.
“Vaccines are among the most effective methods we have to prevent disease. The introduction of the HPV vaccine in the UK in 2008 represented a major step forward in public health, protecting future generations from developing cervical cancer.
“The British Society for Immunology celebrates the huge health benefits that this vaccine delivers. It is now crucial that we redouble efforts to ensure that HPV vaccination rates in girls remain high and that we continue to actively communicate the benefits of this vaccine to parents and children.”
Prof Margaret Stanley FMedSci, Emeritus Professor of Epithelial Biology and Research Visitor in the Department of Pathology, University of Cambridge, said:
“This intensive and rigorous Cochrane analysis of the published clinical trials undertaken with the commercially available HPV vaccines provides reassuring and solid evidence of the safety of these vaccines in young women, with no differences between vaccinated and unvaccinated girls and women in terms of reported serious side effects. It reinforces the evidence that preventing infection by vaccination in young women, with the most important cancer causing HPVs 16 and 18, reduces cervical precancers dramatically. These cervical precancers are the obligate precursors to the life threatening cancer; prevent the precancer and you prevent the cancer. In every clinical trial reviewed in this study the vaccines prevented the development of almost all HPV16/18 caused precancers. These clinical trial results are now being replicated in real life in countries with national HPV vaccination programmes such as the UK – dramatic reductions in the high grade precancers have been shown in Scotland in 20-25 year old women vaccinated at school when they were 12-15.”
Dr David Elliman, Consultant in Community Child Health, and RCPCH paediatrician (Royal College of Paediatrics and Child Health), said:
“An expert group under the umbrella of the respected Cochrane Collaboration has reviewed all the trials of HPV vaccines. They looked at how well the vaccines worked and how safe they were. After carefully examining all the data, and only including all that which was likely to be accurate and unbiased, they reviewed 26 trials covering 73,428 girls or women. Data on boys and men were not included.
“They concluded that both the vaccines that have been in common use (the bivalent vaccine Cervarix and the quadrivalent vaccine Gardasil) were highly effective at preventing infection with the HPV viruses in the vaccines and to a lesser extent reduced infection with some other HPV strains. They also found that the vaccines were highly effective at reducing the incidence of precancerous changes in the cervix, associated with the vaccine strains, that can lead on to cancer. (Because it takes a long time after infection with the virus before cancer develops, there are no published data on this yet.) Changes due to other strains were also reduced, but less so. The main effects were seen in younger females, especially those who were known not to be already infected with HPV.
“The group also looked at the incidence of side effects, following the vaccines. They found that, as expected, a number of people had local reactions but there were no serious side effects following the vaccine.”
Prof Helen Bedford, Professor of Children’s Health, UCL Great Ormond Street Institute of Child Health, said:
“HPV vaccine was introduced 10 years ago for 13-14 year old girls to prevent infection with human papillomavirus (HPV) which can lead to cancer of the cervix, a condition that claims the lives of over 800 women in the UK each year.
“This important review of high quality studies shows that HPV vaccines are effective in preventing changes in the cervix that can lead to cancer, particularly when given to young women. It also provides reassuring evidence of the safety of HPV vaccines.
“This study provides solid evidence of the effectiveness of HPV vaccines. This, together with early evidence of reduction in cervical cancer in Finland1, confirms the ground breaking value of this cancer preventing vaccine.”
1 Luostarinen T et al. ‘Vaccination protects against invasive HPV-associated cancers’. Int J Cancer, 2018; 142 (2186-2187)
- Prof Keith Neal: "No conflicts."
- Prof Peter Openshaw: “Prof Peter Openshaw’s research is funded by the Wellcome Trust, the MRC, BBSRC and the European Union. He has received honoraria or consultancy fees from GSK, Janssen, and Mucosis BV.”
- Prof Margaret Stanley: “Professor Margaret Stanley has acted as consultant and advisor to Glaxo Smith Kline Biologicals and Merck.”
- Dr David Elliman: “No interests.”
- Prof Helen Bedford: “I have no conflicts of interest.”
- No others received.
Full citation: Arbyn M, Xu L, Simoens C, Martin-Hirsch PPL. Prophylactic vaccination against human papillomaviruses to prevent cervical cancer and its precursors. Cochrane Database of Systematic Reviews 2018, Issue 5. Art. No.: CD009069. DOI: 10.1002/14651858.CD009069.pub3.Wednesday, May 9, 2018
Does HPV vaccination prevent the development of cervical cancer? Are there harms associated with being vaccinated?
New evidence published today in the Cochrane Library shows that human papilloma virus (HPV) vaccines protect against cervical lesions in young women, particularly in those who are vaccinated between the ages of 15 and 26. It also summarizes findings on harms that have been assessed in randomized controlled trials.
Most people who have sexual contact at some point in their life will be exposed to the human papilloma virus (HPV). In the majority of women, HPV infection will be cleared by the immune system. When the immune system does not clear the virus, persistent HPV infection can cause abnormal cervical cells. These lesions are known as cervical ‘precancer’ because over time they can progress to cervical cancer if left untreated.
There are many different types of HPV. Some are associated with the development of cervical lesions that can become cancerous and are considered as high-risk HPV types. Two of these high-risk types (HPV16 and HPV18) account for about 70% all cases of cervical cancer worldwide. Vaccines have been developed that help the immune system to recognize certain HPV types. Because cervical cancer can take several years to develop, regulatory bodies and international health agencies such as the World Health Organization (WHO) regard cervical lesions as the preferred outcome measure for HPV vaccine trials.
A team of Cochrane researchers has summarized results of 26 studies in 73,428 women conducted across all continents over the last eight years. Most women in the studies were under the age of 26 years old, although three trials recruited women between 25 and 45 years. The studies were well-designed, randomizing the women to either HPV vaccine or a placebo. The review evaluates evidence for two vaccines: the bivalent vaccine targeting HPV16 and 18, and the quadrivalent vaccine targeting HPV16/18 and two low-risk HPV types causing genital warts. The newer vaccine that targets nine HPV types was not included in the review since it has not been compared against a placebo in a randomized controlled trial.
The review looked at two groups of people: women who are free of high-risk HPV at the time of vaccination and all women regardless of HPV status at vaccination. The effects of the vaccine were measured as precancer associated with HPV16/18 and precancer irrespective of HPV type. The review looked at data from ten trials assessing cervical lesion data at between three and a half to eight years after vaccination.
None of the studies have followed up participants for long enough to detect an effect on cervical cancer. The researchers looked at precancer cervical lesions instead. They found that in young women who did not carry HPV, vaccination reduced the risk of developing precancer. About 164 per 10,000 women who got placebo and 2 per 10,000 women who got the vaccine went on to develop cervical precancer.
The researchers also looked at data from all enrolled women regardless whether they were free of high-risk HPV at vaccination or not. Among women aged 15 to 26 years, vaccines reduced the risk of cervical precancer associated with HPV16/18 from 341 to 157 per 10,000. HPV vaccination reduced also the risk for any precancer lesions from 559 to 391 per 10,000.
In older women vaccinated between 25 to 45 years the HPV vaccine does not work as well. This might be because older women are more likely to have been exposed already.
The evidence also shows that the vaccine does not appear to increase the risk of serious side effects which was about 7% in both HPV vaccinated or control groups. The researchers did not find increased risk of miscarriage in women who became pregnant after vaccination. However, they emphasize that more data are required to provide greater certainty about very rare side effects and the effect vaccines have on rates of stillbirth, and babies born with abnormalities in those who became pregnant around the time of vaccination.
Cochrane lead author, Dr. Marc Arbyn, from the Unit of Cancer Epidemiology, Belgian Cancer Centre, Sciensano, said: “The findings of this review should be viewed within the context of multiple global surveillance studies, which have been conducted by the Global Advisory Committee on Vaccine Safety from the WHO since the vaccinations were licensed. The committee concluded that the risk-benefit profile of prophylactic HPV vaccines remains favourable and expressed its concerns about unjustified claims of harm that lack biological and epidemiological evidence, and which may affect the confidence of the public. At the same time, the Committee encouraged health authorities to continue surveillance and examination for potential adverse events."
Dr. Jo Morrison, Consultant in Gynaecological Oncology at the Musgrove Park Hospital, Somerset, UK, said: “Vaccination aims to prime the immune system to produce antibodies that can block subsequent natural HPV infection. These data show that immunizing against HPV infection protects against cervical precancer, and it is very likely that this will reduce cervical cancer rates in the future. However, it cannot prevent all cervical cancer and it is still important to have regular screening, even if you have been vaccinated.”
She added: “Cervical cancer can take many years to develop following HPV infection and development of precancer lesions, therefore long-term follow-up studies are needed to find out the effects of HPV vaccination on cervical cancer rates.
Full citation: Arbyn M, Xu L, Simoens C, Martin-Hirsch PPL. Prophylactic vaccination against human papillomaviruses to prevent cervical cancer and its precursors. Cochrane Database of Systematic Reviews 2018, Issue 5. Art. No.: CD009069. DOI: 10.1002/14651858.CD009069.pub3.
Breakdown of results by sub-groups of women:
Women who are hrHPV DNA negative (only efficacy data for women aged 16-26y)
HPV vaccines reduce hgCIN associated with HPV16/18 from 164/10,000 to 2/10,000 (high certainty). They reduce also any precancer irrespective of HPV types from 287/10,000 to 106/100,000 (high certainty). HPV vaccination protects also against AIS associated with HPV16/18 (from 9 to 0 per 10,000) and any AIS (from 10 to 0/10,000) - moderate certainty for both AIS outcomes.
Women who are HPV16/18 DNA negative
The effect of HPV vaccines on risk of precancer differ by age group. In younger women, HPV vaccines reduce precancer associated with HPV16/18 from 113 to 6/10,000 (high certainty). HPV vaccines lower any precancer from 231 to 95/10,000 (high certainty). In females older than 25, the vaccines probably reduce precancer associated with HPV16/18 from 45 to 14/10,000 (moderate certainty).
Women unselected by HPV DNA status
In women vaccinated at 15 to 26 years of age, HPV vaccination reduces precancer associated with HPV16/18 from 341 to 157/10,000 (high certainty) and any precancer from 559 to 391/10,000 (high certainty).
In older women vaccinated between 25 to 45 years, the effects of HPV vaccine on precancer are smaller, and this may be due to previous exposure to HPV. The risk of precancer associated with HPV16/18 is probably lowered from 145/10,000 in unvaccinated women to 107/10,000 following HPV vaccination (moderate certainty). The risk of any precancer is probably similar between unvaccinated and vaccinated (341/10,000 compared with 356/10,000, moderate certainty).
For further information, please contact,
Dr. Marc Arbyn
Unit of Cancer Epidemiology, Belgian Cancer Centre
Juliette Wytsmanstreet 14
Dr. Jo Morrison:
Consultant in Gynaecological Oncology
Department of Gynaecological Oncology
Musgrove Park Hospital
Taunton and Somerset NHS Foundation Trust, UK
If you are a journalist or member of the press and wish to receive news alerts before their online publication or if you wish to arrange an interview with an author, please contact the Cochrane press office: firstname.lastname@example.orgWednesday, May 9, 2018
Cochrane Crowd, Cochrane’s citizen science platform, is a global community made up of volunteers who are helping to identify the research needed to support informed decision-making about healthcare treatments.
Cochrane Crowd has reached almost 2 million individual classifications of reports of randomized controlled trials (RCTs) eligible for Cochrane’s Central Register of Controlled Trials (CENTRAL), helping review authors around the world find the evidence they need for their reviews of effectiveness of health treatments.
Every contribution counts – and we’d like your help reaching two million!
How can you help?
First of all, sign up to Cochrane Crowd.
Then complete the short (10-15minutes) training module for the randomised controlled trial task (RCT ID).
And then head straight into live screening, where you’ll contribute to the tally and get us closer to 2 million!
Join the Crowd 2 million: Show us your screen campaign
Once you’ve signed up and done the training, please join us for Crowd 2 million: Show us your screen. It’s our way of connecting our community while we work to 2 million together.
Here’s how to get involved:
2. Post the image to Twitter with this message “Countdown to @crowd_cochrane 2 million! My screen shows [insert number, e.g. 1,935,781]. How about yours? Take a look: www.crowd.cochrane.org #Crowd2million #ShowUsYourScreen”
Here’s an example tweet:
Might as well log in to Twitter right now! ;)
3. Then, get screening, of course!
4. We encourage you to tweet as per numbers 1 & 2 above as often as you like in the lead up to 2 million, updating your screenshot each time.
Prizes will be given to the 10 people who get screenshots AT or as close as possible to 2 million!
To be eligible for a prize you’ll need to post two or more times within the #Crowd2million campaign. That is, at least once in the lead up, and once as close to the milestone as you can get!
When will we cross 2 million?
There really is no way to know when the 2 million mark will be crossed. It will be the thick of night for some of you. Loyal screeners have been known to set 2am alarms in an effort to be there for milestones (I’m thinking back to the countdown to 1 million). Now we don’t necessarily want to create a broken night’s sleep but we would love you to be there, if you would like to be!
See you at 2 million!
From Anna, Emily and the rest of the Cochrane Crowd team
The College of Optometrists, UK has funded two Cochrane Review updates in support of the Cochrane Eyes and Vision (CEV) group based at the London School of Hygiene and Tropical Medicine (LSHTM). The global review updates were used to answer questions on the topics of Vision screening for correctable visual acuity deficits in school-age children and adolescents and Reading aids for adults with low vision.
The review updates produced the following key findings:
- There are no studies comparing vision screening with no vision screening highlighting a gap in evidence.
- Vision screening with the provision of free spectacles results in more children wearing spectacles after screening compared with giving the children a prescription on its own. Children in the free-spectacle group had better educational attainment, although this evidence was not as strong.
- Ready-made and custom-made spectacles appear to give similar visual results and similar spectacle wearing compliance levels.
- There is insufficient evidence supporting the use of a specific type of electronic or optical device for the most common profiles of low-vision aid users. However, there is some evidence that stand-mounted electronic devices may improve reading speeds compared with optical devices.
- There is less evidence to support the use of head-mounted or portable electronic devices; however, the technology of electronic devices may have improved since the studies included in this review took place.
- There is no good evidence to support the use of filters or prism spectacles.
Priya Morjaria MCOptom, author of the vision screening review, said: “Over the past decade, it has become more apparent that as clinicians, we need evidence-based practice and practice-based evidence to make sure that we are not only doing what is best for our patients but also doing it in the best way possible. Findings from reviews help us understand this and ensure we continue to improve and do what is best based on evidence.
“This specific review highlights that screening children with a vision impairment and providing them with spectacles can increase their compliance with spectacles. This can in turn lead to better educational outcomes.”
Jennifer Evans, Editor at CEV, said: “Cochrane Eyes and Vision would like to thank the College of Optometrists for supporting two important Cochrane Review updates. Uncorrected refractive error is an important cause of visual impairment in children. Approximately one per cent of children worldwide (13 million) are estimated to be visually impaired due to the eye disorder. The current update of the vision screening review enabled us to include emerging evidence that shows that vision screening with provision of free spectacles results in more children wearing spectacles and may lead to better educational attainment.
The second review demonstrates that it is important for people with low vision to find the right reading aid. Our review on reading aids for low vision provides a systematic assessment of the research in this area. The updated review provides evidence that electronic aids may help people with low vision with improved reading speeds and reading duration, compared with using optical aids. The review highlights lack of evidence for use of filters or prism spectacles for people with age-related macular degeneration.”
The 7th national congress of Croatian Society of Physical and Rehabilitation Medicine (PRM), Croatian Medical Association (CSPRM) was been held in Šibenik, Croatia, 19-22 April 2018. Two round tables - about Quality management in PRM and Cochrane Rehabilitation initiative were held.
During the meeting a Memorandum of Understanding between Cochrane Rehabilitation and the CSPRM was been signed. This will ensure a collaboration between the two Organizations in projects of mutual interest, supporting the development of PRM worldwide and aiming to optimize the treatment of patients with disability.
Congratulations on this new partnership!
Today Cochrane announces important decisions on its future publishing and open access arrangements, part of its commitment of making Cochrane evidence freely and openly accessible to everyone all over the world.
Cochrane has agreed improved terms and a two-year extension of its existing publishing agreement with John Wiley & Sons, Limited, which means Wiley will continue to publish the Cochrane Library until 31st December 2020. In June 2018 the enhanced Cochrane Library will be launched on a new publishing platform (built by the specialist third party HighWire), allowing many new features to be developed and launched over the next two years that will offer increasing value for Cochrane Library subscribers.
Cochrane will also open and run a competitive tender process in 2019 to establish who will publish the Cochrane Library from 1st January 2021. Future publishers will be required to show how they plan to partner with Cochrane to develop the Library so that it becomes the ‘Home of Evidence’ at the heart of health decision making around the world; whilst also maintaining and expanding Cochrane Library revenues. Royalties from sales of the Cochrane Library are the major source of funds for the charity – over £6 million in 2017 – despite 3.66 billion people around the world having one-click access to the Library either through highly-subsidised national licences (for 1.5 billion) or free provision for populations in low- and middle-income countries eligible under the WHO’s HINARI initiative (2.1 billion).
This is part of Cochrane’s extensive commitment in its Strategy to 2020 that aims to put Cochrane evidence at the heart of health decision-making all over the world.
Since February 2013, when the current contract with Wiley was signed, Cochrane is proud to have:
- Provided free access to new and updated Cochrane Reviews for all readers worldwide 12 months after publication, under our ‘green’ Open Access scheme. Over half of all Cochrane Reviews are now available this way.
- Deposited all Cochrane Reviews in PubMed Central for open access publication 12 months after publication (started September 2016).
- Made all Cochrane Review protocols freely available on publication (since February 2016).
- Provided Cochrane author teams with the option to pay an Article Publication Charge in order to make their new and updated reviews freely available worldwide on publication, and to take up other benefits of a Creative Commons licence, via a ‘gold’ Open Access option.
Cochrane’s Governing Board has decided to continue these policies under the post-2020 publishing arrangements, but to postpone implementation of the target set out in Strategy to 2020 to make all Cochrane Reviews open access ‘immediately upon publication’. This remains Cochrane’s long-term ambition, but it will be implemented only when the Governing Board are confident that it will not undermine Cochrane’s future sustainability and, therefore, its ability to meet other strategic goals.
Cochrane’s Governing Board Co-Chair, Martin Burton said: “Extending our already very successful partnership with Wiley until the end of Strategy to 2020 will give us the time to develop exciting new products and features in the Cochrane Library, focus on the transformative organizational changes we need to deliver in the next two years, provide us with a stable and more predictable financial base, whilst also allowing us adequate time to choose our future publishing partners.” Cochrane’s Chief Executive Officer, Mark Wilson added: “We’re enormously proud of the Open Access offering that we’ve established over the last five years, which will make an ever-larger proportion of Cochrane Reviews universally accessible in the future. We plan to review our Open Access policy regularly after 2020 with our publishing partners to ensure we balance Cochrane’s financial viability with our long-term goal of providing immediate free access to Cochrane Reviews for the whole world.”
For more information on access options to the Cochrane Library, please visit cochranelibrary.com.Monday, April 30, 2018
Looking for an innovative tool to teach evidence production? Cochrane Classmate might well be the answer!
Classmate is a trainers’ toolkit that allows you to create exciting, interactive tasks that help your students learn about evidence production. It is easy to use, and its first release is now available free of charge to anyone interested.
Register for our webinar to learn about Classmate and the benefits of using this new online learning environment. The webinar is on Thursday 17th May, 12.30-1.30pm BST.
Who is Classmate for? Anyone who teaches on topics related to evidence production, such as evidence-based medicine, systematic review production, understanding PICO, study designs, citation screening or research reporting standards. Classmate can be used in a variety of contexts such as university courses, workshops or other events.
What will be covered in the webinar? You’ll be taken on a tour of Classmate, including how to create a learning activity, invite students to the activity and monitor their progress. You’ll see the modules currently available on Classmate and hear about others launching soon.
- Can’t make the webinar? We will tweet the recording once it’s available, so follow us at @cochrane_crowd.
- Visit the Cochrane Crowd website
Tuesday, April 24, 2018
Support for Project Transform was provided by Cochrane and the National Health and Medical Research Counc12/12/1996il of Australia (APP1114605). The contents of the published material are solely the responsibility of the Administering Institution, a Participating Institution or individual authors and do not reflect the views of the NHMRC.
Specifications: Part Time 30 hours per week
Application Closing Date: Friday 4th May 2018
This role is an exciting opportunity to use your experience as a Finance Officer to make a difference in the field of health care research.
The Finance Officer will maintain the sales and purchase ledgers for Cochrane, Collaboration Trading and Cochrane Innovations, including processing expenses for CET members, facilitating payments and reconciling bank statements.
- Demonstrable experience in all aspects of purchase ledger
- Experience of using Xero
- Intermediate Microsoft Excel skills
- Excellent communication skills with the ability to build relationships across the business
- Have the proven ability to work both independently and as part of a team
- Ability to work to tight deadlines
- Can demonstrate problem solving skills and a practical approach to dealing with day-to-day issues
- Proven experience of building productive working relationships, both internally and externally
- Ability to communicate clearly with non-finance employees about financial matters
- Commitment to Cochrane’s mission and values
Cochrane is a global, independent network of health practitioners, researchers, patient advocates and others, responding to the challenge of making vast amounts of research evidence useful for informing decisions about health. We do this by synthesizing research findings to produce the best available evidence on what can work, what might harm and where more research is needed. Our work is recognised as the international gold standard for high quality, trusted information.
If you would like to apply for this position, please send a CV along with a supporting statement to email@example.com with “Finance Officer” in the subject line. The supporting statement should indicate why you are applying for the post, and how far you meet the requirements for the post outlined in the job description using specific examples. List your experience, achievements, knowledge, personal qualities, and skills which you feel are relevant to the post.
For further information, please download the full job description.
Deadline for applications: Friday 4th May 2018(12 midnight GMT)
Interviews to be held on: Monday 14th May 2018
Thiazides best first choice for hypertension
High blood pressure or hypertension can increase the risk of heart attacks and stroke. One of the most important decisions in treating people with elevated blood pressure is what drug class to use first. This decision has important consequences in terms of health outcomes and cost.
The Cochrane Hypertension Group, which is part of Cochrane Circulation and Breathing, updated their original 2009 Cochrane Review looking at what drug class was the best first-line choice in treating adult patients with raised blood pressure. No new trials were found in the update; keeping the total at 24 studies, that randomly assigned 58,040 adult people (mean age 62 years) with high blood pressure, to four different drug classes or placebo. Duration of these studies ranged from three to five years. Drug classes studied included thiazide diuretics, beta-blockers, ACE inhibitors, and calcium channel blockers.
The Cochrane Review concluded that most of the evidence demonstrated that first-line low-dose thiazides reduced mortality, stroke, and heart attack. No other drug class improved health outcomes better than low-dose thiazides. Beta-blockers and high-dose thiazides were inferior. High-quality evidence supported that low-dose thiazides should be used first for most patients with elevated blood pressure. Fortunately, thiazides are also very inexpensive.
“The decision as to which drug to use first-line for the management of hypertension is an important one for clinicians" says James Wright the first author of this updated Cochrane Review. “Knowing that the evidence for first-line thiazides is better than other classes of drugs is great news for clinicians as thiazides are also the least expensive and have other advantages. Both clinicians and patients can be reassured that Cochrane evidence, recognized as the gold standard of health evidence, supports this.”
The March for Science is a celebration of passion for science and the many ways science serves our global communities.
Cochrane officially supports and is in partnership with the March for Science. The March is organized in Washington, DC, with satellite marches in cities around the world, to champion the science that upholds the common good.
For the second year, the Cochrane contibuters and supporters around the globe marched for science! Will you march with us in 2019?Friday, April 20, 2018
On Monday 16th April Cochrane published the first Cochrane-wide peer review policy. In addition to standardising current practice across all of Cochrane’s 53 Review Groups, the introduction of the new policy aims to improve transparency in communication and decision making, consistent with core Cochrane principles, and taking the opportunity to implement current best practice.
The key highlights of the new policy include:
- From January 2019 Cochrane will adopt a named peer review policy, whereby authors and peer reviewers know each other’s identities during the peer review process.
- A decision workflow for deciding when to peer review updated protocols and updated Cochrane Reviews.
- A minimum number and type of peer reviewer.
- A minimum standard for acknowledgement of peer reviewer contributions.
As the policy will require some Cochrane Review Groups to change the current practice significantly, the policy will be implemented between now and January 2019, with the aim that each Cochrane Review Group will be compliant with the new policy by January 2019.
If you have any comments of questions about the peer review policy, please contact Bryony Urquhart, Editorial and Methods Department.
Editor in Chief
The annual Medical Library Association (MLA) Meeting is a premier event that draws thousands of medical librarians and other health information professionals from around the globe. The meeting is a 4 and 1/2 day interdisciplinary educational experience, with a 3-day commercial exhibition. In 2018, the meeting will take place in Atlanta, USA from 18-23 May.
Our publisher, Wiley, and members of the Cochrane team will be attending. We invite you stop at the Wiley booth (#311), 19-21 May for demonstrations and information about the Cochrane Library. Some live demonstrations include:
- Cochrane Interactive Learning: learn about introduction modules on how to conduct a systems review of interventions
- How to search the Cochrane Library
- Tops tips for using the Cochrane Library
- Meet the experts: have all your questions answered
The well-attended Cochrane Library sunrise session be run again this year on Sunday 20 May at 7am. Carol Lefebvre, Independent Information Consultant and Co-Convenor, Cochrane Information Retrieval Methods Group will outline how the Cochrane Library continues to be an essential tool for evidence-based medicine, provide you with search tips, and answer your questions.
On Monday 21 May, 10: 35am, members of Cochrane’s Editorial Unit will present on ‘Search Filter to Identify Reports of Randomized Controlled Trials in CINAHL.’
The 2018 MLA meeting will be a great opportunity to meet with Cochrane experts and learn more about the Cochrane Library. We’re looking forward to meeting you at booth 311!Tuesday, April 17, 2018
We are delighted to confirm that Wiley will offer free one-click access to the Cochrane Library including more than 10,000 full text Cochrane Systematic Reviews and Protocols in over 100 countries with approximately 2.1 billion people. One-click free access is provided by country IP recognition for all the included countries, so no individual login is needed. Users from the eligible countries can simply go to www.cochranelibrary.com to gain full text access to Cochrane Reviews.
Effective 7 February 2018, Azerbaijan, Belarus and Venezuela (Bolivarian Republic of) are now on the list of eligible countries. The country list is reviewed by Wiley and Cochrane annually, and is informed by the HINARI Access to Research in Health Programme list http://www.who.int/hinari/en/.
To find out if you are eligible to benefit from one-click free access, please visit the Cochrane Library access information page.Monday, March 25, 2019
We are delighted to confirm that Wiley will offer free one-click access to the Cochrane Library including more than 10,000 full text Cochrane Systematic Reviews and Protocols in over 100 countries with approximately 2.1 billion people. One-click free access is provided by country IP recognition for all the included countries, so no individual login is needed. Users from the eligible countries can simply go to www.cochranelibrary.com to gain full text access to Cochrane Reviews.
Effective 1 May 2018, Argentina will graduate out of the free access program. The country list is reviewed by Wiley and Cochrane annually, and is informed by the HINARI Access to Research in Health Programme list http://www.who.int/hinari/en/.
To find out if you are eligible to benefit from one-click free access, please visit the Cochrane Library access information page.Thursday, April 12, 2018
Announcing a great opportunity for some keen tweeters to come to the Cochrane Colloquium 2018 (with free registration, accommodation and a travel bursary) as part of the #BeyondTheRoom team.
We’re really excited about this. Not ‘excited’ as in “we know we need to appear enthusiastic about this and this is an easy word to reach for” kind of excited, but actually excited!
In Edinburgh this September (Sunday 16th – Tuesday 18th) Cochrane UK is hosting Cochrane’s annual global conference, the Cochrane Colloquium. It will bring together around 1200 people who are interested in producing, sharing and using high quality evidence to inform health decisions.
Through talks, workshops and other activities and presentations, we will be exploring the broad themes of producing evidence, making evidence accessible and advocating for the use of evidence in making choices about health. There will be opportunities to meet new people, share ideas, take part in a variety of activities and maybe start new work together.
This year the theme is #CochraneForAll and, for the first time, it will be a Patients Included event. We are delighted to be involving patients and other healthcare consumers in the planning and delivery of the conference to a greater extent than ever before. We believe there are potential benefits for everyone in doing this, not only through enriching the conversations and ways of working together at the event, but also for improving the quality and relevance of Cochrane evidence and how it is shared and used.
The event is not all work and no play. You can also look forward to a lively social programme.Going #BeyondTheRoom
Also new this year is that we’re putting together a team to take the event #BeyondTheRoom. This digital conference service was started in 2016 by André Tomlin from the Mental Elf who saw an opportunity to increase the reach and impact of health events by live tweeting and podcasting from them, to involve people virtually and facilitate a much more democratic conversation (www.beyondtheroom.net). The #BeyondTheRoom team will include André and his colleague Douglas Badenoch, myself and Selena from Cochrane UK, and some new recruits – perhaps it could be you!
“Our #BeyondTheRoom service helps health events reach the right audience. All too often, conversations at conferences are dominated by just a few voices. We open up the discussion to everyone who wants to be involved, but also work hard before the event to create a buzz and start to explore some of the key conference themes.”Do you want to be part of the #BeyondTheRoom team at the Cochrane Colloquium?
We’re looking to add three people to the team. You are welcome to apply if you are a student (of any discipline, with an interest in health evidence), a patient/other healthcare consumer, or a health professional/allied health professional.
This is a brilliant opportunity to be part of an advanced social media activity, increase your visibility, and participate in our conference as a valued team member.If you’re selected:
You will get free registration for the 3 days of the conference, including lunches and attendance at the Welcome Reception and Gala dinner, four nights accommodation and up to £200 for travel costs (reasonable costs, standard class travel).
You will be part of the #BeyondTheRoom team:
- ahead of the event. A lot of work goes into #BeyondTheRoom ahead of the event, including preparing material to share on Twitter at the event. Each member of the team will need to do some of this preparation, which can be done remotely.
- at the event. All team members will be involved in Tweeting from the key talks and some other sessions. There may be opportunities to be involved in other activities such as podcasting and blogging, according to your skills and preferences.
- after the event. Write or contribute to a blog about the event and your #BeyondTheRoom experience.
We are looking for experienced tweeters who can hit the ground running. We’ll be aiming to put together a team with a variety of experience and style! Familiarity with Cochrane and systematic reviews is not essential. Enthusiastic and interested people who are confident using Twitter are what we need!How to apply
Complete and submit this form, telling us about yourself, why you’d like to do it and what you can bring to it. You are also welcome to get in touch via email if you’d like to find out more: firstname.lastname@example.org
Closing date: 4th May
Notification of the outcome by 14th May.
This is a brilliant opportunity. Please spread the word!
Cochrane and the Cochrane Iberoamerican Network are delighted to announce the launch of a new Centre in Mexico.
The Mexican Cochrane Centre consists of five Associated Centres located at Culiacán (Sinaloa's Pediatric Hospital), Guadalajara (University of Guadalajara), Mexico City (Mexico's Children Hospital Federico Gómez and Clínica Médica Sur Foundation) and Cuernavaca (National Institute of Public Health).
The Mexican Cochrane Centre will promote evidence-based decision making in health care in Mexico by supporting and training new Mexican 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.
The Mexican Cochrane Centre is part of Cochrane, a global independent network of researchers, professionals, patients, carers and people interested in health. Cochrane works with collaborators from more than 130 countries to produce credible, accessible health information that is free from commercial sponsorship and other conflicts of interest. Cochrane’s work is recognized as representing an international gold standard for high quality, trusted information.
The Mexican Cochrane Centre will be led by the coordinators of the five Associated Centres, which will offer methodological support, mentoring, and supervision in the country.
The Director of Cochrane Mexico, Giordano Pérez-Gaxiola, says this is a hugely exciting opportunity: “The launch of the Mexican Cochrane Centre is very important, both to Mexico and globally. Producing and increasing the dissemination of the best available information on health care is critical for clinicians and patients everywhere in the world, including Mexico”
Cochrane’s CEO Mark Wilson, warmly welcomed today’s news, “I am delighted we are announcing the Mexican Cochrane Centre which, by working closely together, will deepen and expand the scope, reach, and impact of Cochrane activities on health and healthcare decision making across Mexico. This is also an important announcement for global health research. The Mexican Cochrane Centre will promote recognition of studies conducted and published in Mexico and this will not only simply increase the access of evidence, but also promote sharing of clinical experiences across the country, and the world.”
For further information, please contact,
Senior Media and Communications Manager, 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 organisation with collaborators from more than 120 countries working together to produce credible, accessible health information that is free from commercial sponsorship and other conflicts of interest. Our work is recognised as representing an international gold standard for high quality, trusted information.
Find out more at cochrane.org
Follow us on twitter @cochranecollab
If you are a journalist or member of the press and wish to receive news alerts before their online publication or if you wish to arrange an interview with an author, please contact the Cochrane press office: email@example.comWednesday, April 11, 2018
A number of stipends and bursaries are available to help consumers and other attendees based in developing countries to attend Cochrane Colloquium Edinburgh 2018.
The stipends (funding you can apply for, if eligible) are to help cover registration, travel, accommodation, and other expenses associated with attending the 2018 Colloquium.
Cochrane are providing stipends for: 1) Cochrane Consumers; 2) Cochrane contributors living in low-, lower-middle-, (LMIC) and upper-middle-income countries (UMIC); 3) students living in LMIC and UMIC countries.
The deadline for applying is Friday 27 April 2018.
Follow the link to find out whether you are eligible and how to apply: colloquium.cochrane.org/stipends-and-bursariesFurther information:
New evidence on the best drugs to prevent postpartum haemorrhage point away from Oxytocin – the standard drug currently used to treat this condition.
- Bleeding after birth is the most common reason why mothers die in childbirth worldwide.
- Includes data from 88,000 women across 140 trials.
- The review found that ergometrine plus oxytocin, misoprostol plus oxytocin, and carbetocin were more effective drugs for reducing excessive bleeding at childbirth than oxytocin which is the current standard drug used to treat this condition.
Bleeding after birth is the most common reason why mothers die in childbirth worldwide. Although most healthy women can cope well with some bleeding at childbirth, others do not, and this can pose a serious risk to their health and even life. To reduce excessive bleeding 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 from Cochrane Pregnancy and Childbirth was to identify which drug is most effective in preventing excessive bleeding after childbirth with the least side-effects.
Different drugs given routinely at childbirth have been used for preventing excessive bleeding. They include oxytocin, misoprostol, ergometrine, carbetocin, and combinations of these drugs, each with different effectiveness and side-effects. Side-effects may 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.
This network meta-analysis includes 140 randomised trials with data from 88,947 women.
The authors’ of the review concluded:
Ergometrine plus oxytocin, misoprostol plus oxytocin, and carbetocin were more effective drugs for reducing excessive bleeding at childbirth than oxytocin which is the current standard drug used to treat this condition.
Carbetocin has the least side-effects (less vomiting, high blood pressure and fever) among the top three drug options, but to date studies of carbetocin were small and of poor quality.
There are some ongoing studies that are not yet complete, including two key studies. One is a large study (involving around 30,000 women across 10 different countries) comparing the effectiveness of carbetocin versus oxytocin for preventing PPH among women having a vaginal birth. The other is a UK-based trial (involving more than 6000 women) comparing carbetocin, oxytocin and ergometrine plus oxytocin combination. Both trials are expected to report in 2018 and these results will be incorporated when this review is updated.
University of Birmingham Clinician Scientist Dr Ioannis Gallos, of the Cochrane Pregnancy and Childbirth Group and Review Author, said: "Whilst postpartum haemorrhage is a rare complication, it is the most common reason why mothers die in childbirth worldwide and happens because a woman's womb has not contracted strongly enough after birth or the placenta has been left in the womb and results in excessive bleeding.
"Currently, to reduce excessive bleeding at childbirth, the standard practice across the world is to administer to women during the third stage of labour a drug called oxytocin - a uterotonic which contracts the uterus and stimulates contractions to help push out the placenta.
"However, there are a number of other uterotonics and combinations of these drugs that can be given that may be more effective and result in fewer side effects.
"By analysing data from 140 different clinical trials involving over 88,000 women, we have been able to use evidence to compare all of these drugs and calculate a ranking among them, providing robust effectiveness and side-effect profiles for each drug.
"Our research is important as it has highlighted which drugs may be more effective than oxytocin and we hope that this could impact existing recommendations worldwide."
This Cochrane review is expected to be updated later this year to incorporate the results of some key ongoing studies which will report their findings in coming months, including a large study involving around 30,000 women across 10 different countries comparing the effectiveness of carbetocin versus oxytocin for preventing bleeding in women having a vaginal birth, and a UK-based trial involving more than 6,000 women comparing carbetocin, oxytocin and ergometrine plus oxytocin combination.
The Lung Cancer Group is looking for an author of systematic reviews in English language
You will participate in the writing of the LCG systematic reviews from the registration of the titles until the publication of the reviews.
Missions and activities
Mission 1: Participation in the systematic reviews of the group
- Writing review protocols
- Bibliographic search
- Selection of studies to be included in reviews
- Data extraction
- Assessment of risk of bias in included studies
- Writing reviews
- Regular updates of existing reviews
- Participation in the peer review of reviews submitted to the group by external authors
Mission 2: Seeking finance
- Identification of possible sources of funding
- Writing funding applications
Mission 3: Literature monitoring in lung cancer
- Identification of reviews and other sources of information
- Reading and integration of the latest news in lung cancer
- Diffusion of the relevant information to the LCG
- English : read, written and spoken, excellent level required
- Writing skills
- Ability to work autonomously
- Rigorous approach and organisational skills
- A medical background would be an advantage
- Knowledge on cancer research, ideally on lung cancer
- Basic understanding of medical statistics
Please send your application to firstname.lastname@example.org before 15 June 2018Wednesday, April 4, 2018 Category: Jobs
“In the end, this will improve health around the world,” said Maria Emilia Aragon de Leon, a consultant with the Division of Policy and Governance for Health and Well-being, who attended bothfull-day workshops on systematic reviews and qualitative evidence synthesis. She clarified: “Even though we are not necessarily producing evidence in our program, we are using it. These workshops can help any WHO staff member make better use of the evidence to make informed choices about the policies, plans, strategies and interventions we recommend.”
“At university” she continued, “you normally get an introduction to systematic reviews and methods. These workshops went into much more detail about which tools are available, which steps you need to follow, and they introduced me to the methods for systematic reviews for qualitative studies, which I was not familiar with at all. In general, both workshops helped me better understand how to assess evidence and make sure I use high-quality information only.”
The two workshops on 14 and 16 February 2018 consisted of a combination of presentations, hands-on exercises, interactive sessions, plenary sessions and group discussions. They were organized by the Division of Information, Evidence, Research and Innovation and its Knowledge Management, Evidence and Research for Policy-Making (KER) unit in line with the mandate of the Evidence-informed Policy Network (EVIPNet) Europe in collaboration with Cochrane and with the support of the WHO/Europe Staff Development Team. Both workshops were wellattended by staff and consultants from divisions and units across the European Regional Office.
The benefits of training in Cochrane methodology
Cochrane’s systematic reviews and qualitative evidence syntheses, as well as the methods used to develop them, are widely considered to be the benchmark for high-quality information about the effectiveness of health care and public health nterventions.
Training in Cochrane’s methodology and the conceptual and practical applications for conducting systematic reviews and qualitative evidence synthesis is, therefore, an essential resource for WHO staff: To increase their knowledge and skills on how these reviews are developed and to ensure that their work is based on high-quality, relevant and up-to-date synthesized research evidence.
A focus on the systematic use of quantitative and qualitative evidence
The workshops emphasized the impact of using both quantitative and qualitative reviews on effectiveness as well as implementation and acceptability, and were facilitated experienced Cochrane trainers:
The workshop on systematic reviews on 14 February was co-facilitated by Liliya Ziganshina (Director of Cochrane Russia) together with Livia Puljak (Inaugural Director of Cochrane Croatia and its current Knowledge Translation Coordinator), who both have extensive experience in training a wide range of users in support of fostering research utilization.
The workshop on qualitative evidence synthesis on 16 February was co-facilitated by Ruth Garside (one of the conveners of the Cochrane Qualitative & Implementation Methods Group) who has extensive experience in both qualitative evidence synthesis and implementation research, and Heather Ames (Cochrane Norway), a pioneer in using CERQual, a transparent method for assessing the confidence of evidence from reviews of qualitative research.
A step towards a stronger partnership – and the use of stronger evidence
The workshops cemented the relationship between Cochrane and WHO. Since 2011, WHO has engaged in meaningful collaborations with Cochrane, which envisions a world of improved health where decisions about health and health care are informed by high-quality, relevant and up-to-date synthesized research evidence.
Co-facilitator Liliya Ziganshina from Cochrane Russia said, “With this workshop, WHO Europe has once again proved its strong commitment to trusted evidence and informed decisions, which are at the very heart of its mandate in health-policy guidance to countries for better health. EVIPNet Europe will continue to develop in the framework of the WHO partnership with Cochrane.”