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.
It is with the deepest disappointment and regret that I have to inform you that as a result of the continued spread and impact of the COVID-19 (coronavirus) across the world, Cochrane’s 27th Colloquium in Toronto, Canada, between 4-7th October this year has been cancelled.
Cochrane’s Governing Board have concluded that it is the most appropriate decision to cancel the Toronto Colloquium in its entirety for 2020 and instead hold it in the Fall of 2022. We are looking at availability options in Toronto and hope to secure dates within the coming weeks.
Thus, we have decided to not hold an in-person, ‘virtual’ or ‘hybrid’ Colloquium this year. Given the extraordinary and ever changing circumstances we are all living through, the uncertainties around how the pandemic will develop and its ongoing impact, and the continuing pressures imposed on all of Cochrane’s Groups and its Central Executive Team in working on our COVID-19 response as well as critical ‘Business as Usual’ activities, the Board decided that trying to plan a colloquium in the coming months would put unnecessary pressure on the organization.
I understand that this news is extremely sad to hear. The Governing Board members have openly expressed their thanks to us as local organizing teams and recognize the extraordinary efforts of Cochrane Canada, the members of scientific and numerous other committees and many Cochrane contributors who have been supporting this year’s planned Colloquium as well as all the work already in place to secure such a distinguished scientific programme and roster of international speakers and guests.
We realize many members of the community have invested a great deal of effort in submitting abstracts for the colloquium. Cochrane will offer the opportunity to have accepted abstracts published in a supplement to the Cochrane Library and an online showing of the work. Of course, those of you who prefer to not take that opportunity and instead present the work at a later point in time, can let us know. Additional information regarding the abstract process will be sent directly to those involved. Cochrane is also exploring opportunities of using submitted workshop abstracts to support Cochrane’s continued learning and educational programs.
Despite the disappointment this news brings, I hope we can stay in “close” touch and you will all be able to cope with the circumstances the pandemic brings.
Thank you for your ongoing support and commitment to a Toronto Colloquium, and we will be in contact again soon with our future plans.
Holger Schünemann
On behalf of Cochrane Canada and Colloquium Toronto Local Organizing Committee
The agenda and open access papers for the Cochrane Governing Board teleconference on April 29th are now available to view online, for information only.
Cochrane's governing body is the Governing Board. The Board is responsible for overseeing the development and implementation of Cochrane’s strategic direction. If you would like to comment on an item you can contact the Board: support@cochrane.org
Are you interested in helping to shape Cochrane evidence related to COVID-19, and to help make it accessible to the public? We are forming a group of patients and carers who are able to take on tasks at short notice to help contribute to Cochrane’s rapid review work, and more.
Cochrane responds to the COVID-19
As part of our response to the coronavirus (COVID-19) pandemic, Cochrane will be working on reviews of evidence in the weeks and months ahead. Many of these reviews are carried out very quickly and aim to answer questions submitted by users of our evidence, including policymakers, to help them make decisions.
You can read more about how Cochrane is responding to the pandemic, including through rapid reviews, here.
Consumer (patient and carer) involvement in rapid reviews
We are keen to have consumer (patient and carer) involvement in these rapid reviews. As these reviews are done very quickly, everyone’s help needs to be organized in a focused and timely way. In order to best facilitate patient and carer involvement in these reviews, we would like to recruit consumers to be a part of a COVID-19 consumer rapid response group.
Who can be involved in the rapid response group?
We are particularly looking for people who have experience of helping with Cochrane reviews, and who are one or more of the following:
People at high risk of COVID-19 infection (e.g. such as immunosuppressed, people living in high risk areas, people working with sick persons)
People who are ill or have recovered from COVID-19
People who have experience caring for someone with COVID-19 as an informal caregiver
Family members and/or co-habitants of people who experienced COVID-19
People with lived experience of other conditions (e.g. mental health, cancer) that are influenced by COVID-19
People who do not have direct lived experience related to COVID-19 but are interested in contributing to reviews and guidelines
Experienced consumers who could support new consumers
How might I contribute?
Tasks that you might be asked to undertake as part of this group include:
Helping to choose important questions for future research
Helping to define the research question
Working as part of an author team throughout a review
Helping to think about the implications of a review for consumers
Commenting as a consumer peer reviewer
Helping with turning the research into accessible information for consumers
Helping to make sure this information reaches other consumers
What volunteers can expect
We will offer members of the group access to training, support and other resources where needed, so that they are ready to contribute to these rapid reviews.
Members of the group will need to respond to reviews at very short notice. Members will be offered access to learning, support, and other resources where needed, so that they are ready to contribute to these rapid reviews. We will continuously evaluate the initiative, implementing changes as needed in response to feedback from consumers and review teams.
How to get in touch
If you think you may be able to help, please let us know that you are interested by:
Following this link and completing the details in the online form)
AND
Registering as a member of the Cochrane Consumer Network and joining our mailing list (if you haven’t already done this) so that we can keep in touch with you
What happens next
We are now creating the resources you will need to support this work. The situation is rapidly changing so please be patient. We will respond to you as soon as we can.
And finally
Thank you for your interest. If you have urgent questions, please email consumers@cochrane.org.
The NIHR Complex Reviews Unit (CRSU) has offered to provide advice and analytical support for COVID-19 related evidence synthesis, in whatever way Cochrane authors consider appropriate, including support for Rapid Reviews and Living Systematic Reviews.
Expertise within the CRSU include:
Diagnostic test accuracy reviews
Network meta-analysis
Individual participant data/clinical study report meta-analysis
Economic evaluation
Realist synthesis
Narrative Synthesis
Use of routine data
Non-randomised studies
Prognostic reviews
Prevalence reviews
Causal pathway analysis
The service is free to use and open to everyone working on COVID-19 related work, regardless of where they are located.
Please contact the CRSU Project Manager Moira Sim (moira.sim@glasgow.ac.uk) or Director, Olivia Wu (olivia.wu@glasgow.ac.uk). They will respond to your email within 2 working days and can set up support arrangements within one week.
