These are the first translations of Cochrane’s methods guidance since the launch of version 6 of the Cochrane Handbook for Systematic Reviews of Interventions (see this Cochrane Editorial for more details about the Handbook’s launch). This is an important milestone in supporting the engagement of people with different native languages in Cochrane Reviews.
Ensuring that Cochrane Reviews represent the highest possible quality is critical if they are to inform decision making in clinical practice and health policy. MECIR are Standards that guide the conduct and reporting of Cochrane Intervention Reviews; they are essential the ‘how-to’ guide for Cochrane Reviews and are drawn from the Cochrane Handbook for Systematic Reviews of Interventions. All Standards are tagged as ‘mandatory’ or ‘highly desirable’. Mandatory Standards should always be met unless an appropriate justification for not doing so can be provided. Highly desirable Standards should generally be implemented but justification for not implementing them is unnecessary.
The development of MECIR has been a collaborative effort over the years, involving review authors, editors and methodologists from all corners of our community. We are thrilled that this collaboration now includes Cochrane Translation Teams.
Dr Karla Soares-Weiser, Cochrane’s Editor-in-Chief, said: “Cochrane has published more than 33,900 translations of Cochrane Review plain language summaries and/or abstracts as of December 2020. Even though Cochrane Reviews are produced in English, having methods guidance for our Reviews available in non-English languages can help increase the diversity and inclusivity of author teams, especially for Reviews that need expertise from particular settings or countries where English is not a native language. The translation of Cochrane methods guidance is also important for review and methods training in non-English speaking countries as it reduces the linguistic barrier for researchers getting involved.”
Dr Xavier Bonfill Cosp, Director of Cochrane Iberoamerica, said: “The Spanish version of MECIR is a useful tool for Spanish-speaking authors and will contribute to ensuring that high-quality reviews are conducted in the global multilingual collaboration that is Cochrane. At Cochrane Iberoamerica we are happy to have been part of this translation effort and we look forward to increasing its accessibility in the future through more interactive on-line platforms.”
Dr Norio Watanabe, Director of Cochrane Japan, said: “I am very happy and honored to publish the Japanese version of the MECIR, because I believe this can contribute not only to Cochrane review authors but also to anyone who thinks of interpreting results from systematic reviews in Japan. We are now planning to translate the latest version of Cochrane Handbook for Systematic Reviews of Interventions as a next step.”
Post written by Judith Deppe (Multi-language Programme Manager, Cochrane) and Ella Flemyng (Methods Implementation Manager, Cochrane)
Welcome to the fourth annual Cochrane Methods report compiled by the Methods Team in the Central Executive Team (CET) to provide an overview of the key methodological developments in Cochrane over the past year. The report highlights the importance of our Methods community, particularly Cochrane Methods Groups and their members, in continuing to improve the relevance, quality and timeliness of Cochrane reviews. Major developments this year have included…
Rapid Reviews and Living Systematic Reviews come to the forefront in Cochrane’s COVID-19 response
As the World Health Organisation declared coronavirus (COVID-19) a global pandemic in March 2020, pressures mounted to ensure interventions to treat and prevent COVID-19 were based on evidence. As part of Cochrane’s response, working with the Rapid Reviews Methods Group, we developed processes for the production of Cochrane Rapid Reviews on COVID-19 so decisions that needed to be made quickly, could be made on evidence. As of 23 November 2020, Cochrane has published nine COVID-19 Rapid Reviews, with another seven in development. Living Cochrane Reviews have also taken centre stage as primary research has evolved dramatically since early 2020, and health decisions need to be made to the most up-to-date evidence. As of 23 November 2020, Cochrane has published six COVID-19 Living Reviews, with another six in development. You’ll be able to read more about rapid reviews and living reviews as part of Cochrane’s COVID-19 response in the 'Collaborating in response to COVID-19: editorial and methods initiatives across Cochrane’ CDSR supplement, due to publish in December 2020.
Methods Support Unit establishes its position supporting Cochrane Review Groups
The Methods Support Unit (MSU) launched in October 2019 and includes one part-time Statistical Editor, one part-time Epidemiological Editor, a fulltime Systematic Review Methodological Editor and a short-term, part-time Statistical Editor. Since then we have responded to 443 requests for support or peer review of protocols, full reviews and updates. This support ranges from specific advice and comment to individual review authors and Cochrane Review Groups (CRGs) through to development of materials that can be shared widely through the Cochrane community. Our support has predominantly been for complex methods including: network meta-analysis (NMA); non-randomised studies (NRS); Risk of Bias 2 (RoB 2); Synthesis Without Meta-analysis (SWiM) and for COVID rapid-review protocols and full reviews. We’ve developed three protocol templates for standard intervention reviews, reviews including NMA and reviews including NRS. We’ve delivered editorial training on RoB 2 to Networks and CRGs, created checklists for including RoB 2 in protocols and reviews and provided discussion space through monthly Web Clinics. In addition, we’ve organised two webinar series: one for network meta-analysis, which included five webinars, and one for RoB 2, which included 9 webinars.
The MSU also hosts a monthly Web Clinic, which is currently dedicated to RoB 2 and open to all Cochrane authors and CRG staff memebrs.
From pilot to phased implementation of Risk of Bias 2
A lot of work has been done in 2020 to understand the experience of Cochrane authors and editors using the use the new Risk of Bias 2 (RoB 2) tool, and to put the necessary training, guidance and technology in place to support a wider uptake in Cochrane Reviews. As of 23 November 2020, RoB 2 is being used, or planning to be used, in more than 80 Cochrane Reviews across 35 Cochrane Review Groups (CRGs). The Cochrane Editorial Board has posted a position statement on RoB 2 in Cochrane and the expectations for Cochrane Review Groups going forward, which takes on board the experiences of authors and editors during the pilot so far. The recommendations highlight that the use of RoB 2 is the preferred tool to assess RCTs in Cochrane Intervention Reviews, but it is not mandatory, with more details in the full post. Additional community items detail what you need to know about RoB 2 in Cochrane and what we’ve learnt during the pilot, as well as the release of an introductory leaflet with short videos, the RoB 2 Starter Pack and detailed FAQs (all available via Cochrane Methods: methods.cochrane.org/risk-bias-2).
Following feedback from the Cochrane Review Groups (CRGs) and Cochrane Methods Groups, the Methods Team are developing the Cochrane Methods website to create a go-to place for CRG staff, Cochrane authors and members of the Cochrane Methods Network to get the most up-to-date information on these methods projects. Watch this space for updates soon!
Achievements and contributions from the Methods Groups
The Cochrane Central Executive Team greatly appreciate the expertise and contributions of the Cochrane Methods Groups. In fact, this year we want to showcase the Groups and bring their contributions to the fore. A full overview of the outputs in methods research and development, best practice and guidance, methods implementation, as well as publications and other achievements from each of our 17 Methods Groups can be found via the links in the box below. To give you a quick overview of their main achievements we have created summary reports. We are also pleased to share the annual highlight from each Methods Group. You can access all this by exploring the links in the box below.
To further highlight the work of the Methods Groups, Cochrane has launched a series of ‘A Day With..’ events to highlight the people behind Cochrane’s 17 Methods Groups and how their work contributes to Cochrane’s mission. The series kicked off with the Information Retrieval Methods Group on 22 October, followed by the GRADEing Methods Group on 18 November, and more to be announced in 2021.
The Cochrane Handbook for Diagnostic Test Accuracy Reviews continues to develop under the leadership of Jon Deeks and Patrick Bossuyt, Senior Scientific Editors, with Mariska Leeflang (Associate Scientific Editor), Yemisi Takwoingi (Associate Scientific Editor), Laura Mellor (Editorial Assistant) and Ella Flemyng (Managing Editor). The first chapters are out to peer review and an update on the status of the project will be shared in early 2021.
Methods community
Co-Chaired by Julian Higgins and Jo McKenzie, we hosted a virtual Methods Symposium in February 2020 on developing robust review protocols with increasingly diverse evidence. Joined by researchers from across the Methods Groups, talks included issues with pre-specification, the notion of PICO for synthesis, the problem of multiplicity, NMA, qualitative evidence, adverse effects and test accuracy. Full details and recording are available here.
Yemisi Takwoingi stepped down from the Cochrane Council and the associated position on the Cochrane Methods Executive Ian Shemilt and Luke Vale, Co-Convenors, Economics Methods Group Sally Crowe, Co-Convenor, Priority Setting Methods Group Maroeska Rovers, Co-Convenor, IPD Meta-Analysis Rob Scholten, Associate Scientific Editor for the Cochrane Handbook for DTA Reviews
And we welcome:
Sarah Nevitt to the Cochrane Council as methods representative, with the associated position on the Methods Executive. A news post on the appointment is here Mona Nasser and Jamie-Hartmann-Boyce to the Cochrane Scientific Committee. A news post on their appointment is here Denny John is appointed Convenor Chair of the Economics Methods Group Pauline Sobiesuo, Co-Convenor Economics, Methods Group Kevin Pottie and Elizabeth Kristjansson, Co-Convenors, Equity Methods Group Sumanth Kumbargere Nagraj, Co-Convenor, Priority Setting Methods Group Declan Devane, Co-Convenor, Rapid Reviews Methods Group Kayleigh Kew, Senior Editor for Methods (Editorial and Methods Department) Simon Turner, Statistical Editor in the Methods Support Unit (Editorial and Methods Department)
A day with… GRADEing Methods Group is taking place on Wednesday 18 November 2020. The free event will cover Cochrane GRADEing Methods Group, GRADE approach to assessing certainty of evidence, 'Summary of findings' tables and related topics. You can sign up to join us for a session on latest methodological developments, pose a challenging methods question for one of our experts, explore some of the free learning that is available, or take part in Twitter chats on the day.
The efficient retrieval of evidence from randomized controlled trials (RCTs) is core to Cochrane's work. Cochrane developed its own search filters to identify reports of RCTs in 1994 (updated most recently in 2008). These search filters, published in the Cochrane Handbook for Systematic Reviews of Interventions, are widely used across Cochrane and by other systematic reviewers, and also to identify trial records for CENTRAL, Cochrane’s database of RCTs.
As Cochrane’s RCT filters have not been validated for many years and newer filters are now available, Cochrane commissioned York Health Economics Consortium (YHEC) information specialists, to test available RCT filters for MEDLINE. YHEC’s study found that, even though there are slightly more sensitive filters available, the Cochrane sensitive filter offers better relative precision (0.14) with very high sensitivity (0.96) – meaning it still performs very well for finding RCTs in systematic reviews and can continue to be used to capture RCTs for CENTRAL.
For more information, please see Julie Glanville’s publication in the Journal of the Medical Library Association:
Glanville J, Kotas E, Featherstone R, Dooley G. Which are the most sensitive search filters to identify randomized controlled trials in MEDLINE? Journal of the Medical Library Association: JMLA. 2020 Oct 1;108(4):556. http://jmla.mlanet.org/ojs/jmla/article/view/912
In this blog, Cochrane UK’s Knowledge Brokers, Sarah Chapman and Selena Ryan-Vig, introduce new guidance for anyone who needs to choose images for a dissemination product based on any Cochrane Review, which may also be helpful for others interested in image selection, and reflect on what they’ve learned along the way. In this blog, we highlight a few examples from the guidance. You can see more in the full guide.
Wrinkly hands, snapped cigarette, smiling white middle-aged man, overweight torso… We could go on. This is the tip of the iceberg of problems with images we see used in the media and that we may have used ourselves. Perhaps you wouldn’t use any of these, though the snapped cigarette, for example, which we’ve learned can trigger smoking behaviour in ex-smokers or those trying to quit, is a common image in smoking cessation campaigns and materials. Then how about images of a crying child being vaccinated, or a predominantly red image to accompany evidence on self-harm? Would you pause when choosing these? What aren’t you choosing? How much diversity are you showing across your dissemination products? What do families look like in the images you choose? Do people with visible differences only appear when the evidence is specifically about them?
Using images that include somebody with a visible difference where this is not directly relevant to the subject matter could help challenge assumptions about disability. For example, this image could be used when sharing evidence about encouraging any young people to take part in physical activity.
These are the kind of things we’ve been grappling with as we’ve worked on producing a new checklist and guidance, “Choosing images for sharing evidence: a guide”, which is now available to all (not only Cochrane members) on the Cochrane Training website. We have found putting this together, with invaluable help from a diverse, global advisory group and other colleagues, a fascinating and instructive business. We set out to share best practice, as we understood it, and in the process have learned new things about image selection and refined our own practice. We hope to give you an appetite for exploring and using this guide, and to highlight just a few of the things we learned along the way.
It’s just a picture - isn’t it?
We don’t think so! The images we share with our evidence have a huge part to play in encouraging our target audiences to engage with our products, in getting our evidence to people who may find it useful for their health decisions. An early lesson for us at Cochrane UK was our fortunate choice of image to accompany evidence on weight reduction, a warm, positive image of parents with an overweight teenager, the three sitting together and smiling. One reader told us it was such a contrast to negative images which so often accompany stories about obesity and was key to them feeling able to share the article with their overweight teen. As we discussed in an earlier blog “The power of the picture: opportunity and responsibility when illustrating health topics” thoughtful image choice can inform or misinform, attract or repel, and they can help challenge assumptions and change the conversation about health conditions. Images really matter, and they are a vital part of telling the story we want to tell when we share evidence.
Migraine Action Art Collection: Image 174, Unnamed artist,
‘Unnamed Image’. (2000). Available at: http://www.migraineart.org.uk/artwork/1168/
Images, including artwork created by those with lived experience of a particular health condition, are a vital part of telling a story. This image is by someone who has migraines, illustrating their pain experience.
Recognising a need for some guidance on choosing images
Back in January, in those pre-pandemic days when we could be in a room with colleagues from around the world, we participated in the first two-day training event focussed on the new Cochrane Dissemination Checklist. As the group discussed image choices for sharing evidence about a sensitive issue, conversation ranged across the importance of the images we share alongside evidence, the complex considerations involved and that many worry about ‘getting it wrong’.
So we have developed ‘Choosing images for sharing evidence: a guide’ for the Cochrane community, designed to complement the Dissemination Checklist. Like that guidance, it has a one page checklist with 15 items as well as full explanations of each, with lots of examples. We hope that this is going to be really useful.
A bit about how we produced this guidance
We searched for relevant literature and found some helpful material. We also drew on conversations, experiences, learning and feedback that have shaped our dissemination work over the years. The input of a geographically and culturally diverse Advisory Group of 17 Cochrane contributors with a variety of roles and expertise in sharing systematic reviews with a range of audiences was so important. Their comments on our first draft of the guidance transformed it, bringing to our attention things we hadn’t considered, and their input on the second draft further refined it. Colleagues from Cochrane UK and others involved in knowledge translation tried out the guidance and gave us feedback, which resulted in some final revisions.
Some key things we’ve learned and how it has changed our practice
Several of the things we highlight below illustrate the importance of consulting people with relevant subject knowledge and/or target audience members, which has been a really standout lesson for us as we’ve been working on this guidance.
Ensuring accuracy and showing best practice
We’ve long been consulting those with relevant knowledge at a basic level - checking that we’re showing the right bit of medical equipment, used correctly, for example. But while it may be obvious to check that a piece of medical equipment is the right one, there can be more subtle aspects of the image that need checking. Is every bit of what’s being shown appropriate? Recent discussion on Twitter about how an image of a woman breastfeeding, not used by us but one we could imagine choosing, deviated from best practice was a reminder that it’s wise to check with someone with relevant expertise. The same conversation also raised the issue of details that might show bad practice, such as an image of a baby lying on its back (correct position) but surrounded by soft bedding such as pillows and bumpers, which present a hazard.
Showing best practice is important. Although the image on the left shows how children may commonly use inhalers, the image on the right is preferable as it demonstrates recommended practice (i.e. proper use of an inhaler, using a spacer).
Cultural differences
Cultural differences can also easily trip us up. We selected an image from an archive of art created by individuals to express their experiences of migraine. Art can be a great way to encourage people to connect with the accompanying information. Every one of the images in this archive is an authentic representation of health experience and no doubt relatable for many. But a member of our advisory group for the project told us that in her cultural context, in Cameroon, the image we chose would have connotations of witchcraft (in particular the prominent long fingernails, conveying pain), so we chose a different one.
Members of our Advisory Group pointed out that in some cultures non-therapeutic touching may be considered inappropriate and we are now sensitive to this. We have discovered that it can be quite challenging to find stock images of people in health-related situations where there is no touching!
Consider the context (time, place)
Cultural relevance is one aspect of considering the context in which dissemination products will be shared. This could include, for example, the type of food shown, or the healthcare setting. But it’s also important to think about the possible implications of current events for image selection. An image of people round a campfire may become inappropriate if shared in a time and place where wildfires are happening. The COVID-19 pandemic has certainly brought changes in the images we are using at the moment too. This might be showing someone wearing a mask where we are currently required to or choosing an image of someone exercising at home rather than in a gym - making sure it still accurately represents the evidence it accompanies - another aspect of image selection of which we now have a heightened awareness.
When sharing evidence about exercise, the image on the left may have been inappropriate to share when gyms were closed in many countries during the COVID-19 pandemic. The image on the right is a suitable alternative.
Avoiding images that could trigger unwanted feelings or behaviour
One section of the guidance is focused on this. While there are few hard and fast rules when it comes to image selection, we came across some strong recommendations in the area of mental health from those working in this area. We have included the only ‘do not’ instruction here: do not use images which could indicate a means (methods or location) of suicide or self-harm in any circumstance. Other triggers may seem less obvious (such as the association of the colour red with self-harm), which again is a reminder that it can be very helpful to consult those with expertise.
Some help for ongoing challenges
We’ve written before in the blog “Pineapples and stethoscopes: the problem with stock images” about the challenges we face in finding realistic and relatable images in Stock libraries. Many images are also inaccurately labelled and this can be a problem for people making dissemination products without specific clinical knowledge. There is also a huge bias towards white Western people and settings. We have included in the new guidance document a sizable list of image sources, including free ones (Appendix 1: Useful sources of images.).
There is also technical help in appendices on image resolution and size (Appendix 2: Useful sources of images) and making images accessible through the addition of ‘alt-text’ (Appendix 4: Adding alt-text to images).
Finally, we have given some worked examples of choosing images which illustrate a range of challenges and considerations where the choice is not straightforward (Appendix 3: Choosing images - worked examples from Cochrane UK).
Take-home points
Choosing images for sharing evidence: a guide is a new, user-friendly guide for people in Cochrane that may also be helpful for others selecting images to accompany health information.
Images play a huge part in getting evidence to people who may find it useful for their health decisions and encouraging engagement with it.
Image choice is complex! Consulting someone with relevant health experience can be enormously helpful.
We hope you find Choosing images for sharing evidence: a guide useful and stimulating. If you have comments about it, ideas for improvements, or a story to share about ways it might influence your practice, we’d love to hear them - either in the comments section below or by email: general@cochrane.nhs.uk
In May 2020, as a result of the continuing spread and impact of COVID-19, Cochrane’s Governing Board and Cochrane Canada agreed to cancel the Toronto Colloquium. Despite the cancellation, the review process for the submitted abstracts continued, and this Supplement includes accepted abstracts of research that would have been presented as oral or poster presentations.
Topics of abstracts include:
Priority setting
Stakeholder involvement
Knowledge translation
Global health and equity
Evidence advocacy
Innovative solutions for evidence production
Living meta-analysis
Machine learning and artificial intelligence
Health policy
Health technology assessment
Guideline development
Research waste
Conflict of interest and research integrity
Education and training
Searching and information retrieval
Investigating different types of bias
Statistical methods
Synthesis of other designs data
Overviews of other types of evidence synthesis
Rapid reviews
Qualitative evidence synthesis
Network meta-analysis
Diagnostic test accuracy review methods
Systematic reviews of interviews
Other topics
We would like to gratefully thank our Scientific Committee, Reviewers, and all those who submitted an abstract.
Cochrane's Editor in Chief invites members of Cochrane groups to submit a Short Report on their editorial or methods initiatives related to the COVID-19 response, including ongoing work and future preparedness. Accepted reports will be published as part of a special COVID-19 Supplement in the Cochrane Database of Systematic Reviews. We aim to publish the Supplement on the Cochrane Library in October 2020.
The Cochrane community has responded to the COVID-19 pandemic in many ways. We want to take this opportunity to recognize and report on some of this work through a publication on the Cochrane Library.
We will consider Short Reports from Cochrane groups working on editorial and methods initiatives during the pandemic, reporting on what was done as well as lessons learned on how we can improve preparedness for future pandemic situations. This could include, but is not limited to: the production of prioritized systematic reviews; new methods for addressing questions; informing policy, guidelines or practice; improved patient outcomes; developing best practice; mapping or scoping projects; and capacity building. All submissions will be assessed and edited by a team at the Editorial and Methods Department.
You can submit you manuscript via our online submission system. Please use the COVID-19 Short Report article type when submitting and confirm you are submitting the short report to the Special Supplement to the Cochrane Database of Systematic Reviews on COVID-19.
The deadline for submissions is 23 September 2020.
If you have any questions, please contact Ella Flemyng (Methods Implement Coordinator - eflemyng@cochrane.org) or John Hilton (Senior Editor Publishing Operations - jhilton@cochrane.org).
Cochrane has published one of its first prognostic model reviews, via the EMD Editorial Service. Prognostic model reviews combine multiple factors to produce a model to estimate the risk of future outcomes in individuals with a particular disease or health condition. A useful model provides accurate predictions to support decision making by individuals and caregivers.
The review Prognostic models for newly-diagnosed chronic lymphocytic leukaemia in adults: a systematic review and meta-analysis looks at how well tools predict what happens with adults with newly‐diagnosed chronic lymphocytic leukaemia (CLL) over time. The review authors found that there is no reliable way to predict what might happen over time to people who have (untreated) CLL. One reason is because the prediction tools have not been tested enough times with enough different people to know how well they really work. Also, researchers continue to develop more effective CLL treatment options that have better results, and the prediction tools have not kept up with advances in treatment.
REMINDER - The deadline for your nomination is Friday 31 July 2020.
Dear Cochrane Members,
Cochrane is seeking to fill two places on the Governing Board that will become vacant shortly and you are invited to stand for election. One place has specifically been designated for an individual from a Lower- and-Middle-Income Country or Territory.
These roles are open to any Cochrane Member who wants to shape Cochrane’s strategic direction, help to ensure its work remains effective and innovative, and support the organization to deliver its mission. You should bring high levels of personal integrity to the role and demonstrate understanding of and commitment to the Cochrane community, but you do not need to have served in a leadership position before.
What is the Governing Board?
Cochrane's governing body is the Board, with a majority of its members elected by you - Cochrane Members - and some appointed directly by the Board. The Board is responsible for overseeing the development and implementation of the organization’s strategies and policies. Cochrane is a registered charity in the United Kingdom and the Board serves as the organization’s Board of Trustees. Trustees carry ultimate responsibility for the organization.
How can I stand for election?
Cochrane is a collaboration whose strength is in its diversity and international reach. The Governing Board wants to make sure this is reflected in its own membership and so for this election, one of the two places available is restricted to a Cochrane Member who is a citizen or resident of a Lower- and-Middle-Income Country or Territory (LMIC). The other place is available to anyone who is a Cochrane Member, including citizens or residents of LMICs.
To find our more, please visit elections.cochrane.org. The deadline for your nomination is Friday 31 July 2020.
