Optimal methods for the use of ‘pain’ as an outcome in systematic reviews of postoperative pain management

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Optimal methods for the use of ‘pain’ as an outcome in systematic reviews of postoperative pain management

The Cochrane Pain, Palliative and Supportive Care (PaPaS) Review Group was awarded a Cochrane Network Innovation Fund to produce expert guidance on how to manage pain as an outcome in systematic reviews of postoperative care. Co-ordinating Editor Dr Neil O’Connell and Managing Editor Anna Erskine from the PaPaS Group are pleased to present the results of this project – a set of resources to help drive improvement in the standard of systematic reviews in this field, and also a useful guide for those seeking to use systematic reviews to guide clinical decisions.

Background and introduction
We probably all think about the potential for pain when we think about surgery. Pain is a common primary or secondary outcome in systematic reviews of perioperative anaesthesia and postoperative care. How methods are applied and outcomes are managed varies substantially across published reviews and this can present a number of challenges when trying to interpret their findings. Indeed, while it can appear to be simple, managing pain as an outcome presents us with a number of interesting challenges.

In Cochrane PaPaS, we are in the business of synthesizing evidence from clinical trials (and other well conducted studies) for the treatment and management of pain. In this process we have to make numerous decisions about the place of pain and analgesia in both the trials and the reviews.

Variability, inconsistency, and errors in pain reporting have been identified by Cochrane UK, by the Musculoskeletal, Oral, Skin and Sensory (MOSS) Network, and by other stakeholders. It is an area for which harmonisation and standards will help improve communication, impact, and therefore the reputation of the Library. We viewed this project as an opportunity to share good practice and expertise.

objective

To develop tools/ guidance to support review authors dealing with acute postoperative pain in systematic reviews (in particular Cochrane Reviews).

What we did
We established an expert group of editors and authors, and consulted with the MOSS Network and the Cochrane Anaesthesia Review Group. We reviewed the evidence to support best practice, elucidated examples, and provide some recommendations and considerations. Discussion is presented on areas of uncertainty where further research is needed, how to incorporate this practice into systematic reviews, and on transferable learnings to systematic review practice in general.

The resources
All resources are freely available on the Cochrane PaPaS website: https://papas.cochrane.org/resources/acute-pain-outcomes.

checklisr


From our meetings and discussions we identified the key themes of:

  • trial accuracy and reliability;
  • participants pain status and severity;
  • measurement issues and important outcomes for pain;
  • relevant associated outcomes of interest;
  • analysis issues.

From these we developed a checklist of critical items that authors of reviews in this field should consider when designing and conducting their review. The checklist also serves as a guide to optimal methods for people who are trying to make sense of a systematic review that has postoperative pain as an important outcome.

Presentations


The checklist is accompanied by sets of slides and reference lists for the following topic areas:

  1. some background to postoperative pain and its importance;
  2. measurement of pain emphasising the importance of patient reporting;
  3. outcomes in pain trials emphasising patient-reported outcomes of value to people with pain;
  4. fundamental considerations in acute pain studies;
  5. issues of interpretation of evidence around small studies, and small numbers of small studies in postoperative pain;
  6. an examination of dealing with publication bias used in acute pain studies;
  7. a worked example of possible sensitivity analyses that can be used in reviews of postoperative pain.

Benefit and impact
We hope the resources will reduce variability and inconsistency across Cochrane Reviews in the Library, and provide the community with the opportunity to improve their understanding of clinical trials investigating acute postoperative pain.

Beyond supporting Cochrane authors, we also hope these resources will be useful and used by Cochrane editors, authors of non-Cochrane Reviews, and anyone using Cochrane Reviews of interventions for acute postoperative pain to make informed decisions about healthcare in this area.

We welcome any feedback or comments on these resources at any time, so please do contact the team directly if you have any suggestions or would like to discuss any aspect of the resources.

Acknowledgements
Thank you to the Cochrane Network Innovation Fund for investing in this project.
Thank you to Mohammed A. Abusayed (University Hospitals of Derby and Burton, UK) for auditing reviews of interventions for pain in the Cochrane Library in 2016.

Thank you to all the project team members, advisers, and MOSS key contacts.

 

September 20, 2021

The Cochrane Official Blog is curated and maintained by the Knowledge Translation Department. To submit items for publication to the blog or to add comments to a blog, please email mumoquit@cochrane.org.

The Cochrane Blog presents commentary and personal opinion on topics of interest from a range of contributors to the work of Cochrane. Opinions posted on the Cochrane Blog are those of the individual contributors and do not necessarily reflect the views or policies of Cochrane.

What can we learn from results of the RoB 2 comparison study?

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The full report of a Cochrane-funded study designed to compare the existing and revised Cochrane risk of bias tools for RCTs was finalised in June 2021 and has now been made available to the Cochrane community. The study was initiated to collect evidence about the amount of time and effort review authors need to invest to use the revised risk of bias tool for RCTs (RoB 2) compared with the existing study-based tool (hereafter referred to as RoB 1), and how review quality is impacted. The work, led by Bernd Richter and Bianca Hemmingsen from the Cochrane Metabolic and Endocrine Disorders Group, represents an important step in assessing the benefits RoB 2 holds for improving the reliability and quality of Cochrane Reviews, and whether there is a compromise with time taken to complete the assessments.

RoB 2 represents a change to the way bias is assessed and reported in Cochrane Reviews and was designed to guide authors through meaningful, results-based assessments. The revised tool requires a change in focus from studies to the data they contribute, and biases introduced into review analyses. However, following concerns about the usability of the revised tool and the time it might add to the review process, Cochrane set out plans to support the first author teams and review groups using it in a pilot. The aim was to observe any difficulties encountered throughout the review journey and build resources and functionality in our technology that would minimize the disruption of wider uptake. The comparison study ran alongside the pilot to compare RoB 2 with RoB 1 and collect empirical evidence within an index review.

Kayleigh Kew

The study was conducted using data from a Cochrane review on insulin analogues for type 1 diabetes mellitus, and the review sample for comparison was 26 RCTs that included parallel, crossover, non-inferiority, superiority, open-label and blinded designs. The review looked at eleven outcome measures including both dichotomous and continuous outcomes and objective and patient-reported endpoints. The team applied both tools to all outcomes according to a pre-specified protocol to compare key features, difficulties in use, and potential consequences for the results of the systematic review.

What were the main findings?
The study authors found mean assessment times using RoB 2 for all outcomes comparable to RoB 1 (approximately 30 minutes), despite experiencing a learning curve with RoB 2, and reported no major usability problems with either tool. Overall, the study found few difficulties with RoB 1 or RoB 2 in achieving agreement between raters and differences in consensus judgements between tools were not common. The biggest divergence between the tools was with subjective outcomes in open-label studies, where RoB 1 was more likely to penalize than RoB 2. RoB 1 also tended to lead to harsher risk of bias judgements as a result of the options available (high/low/unclear), whereas the ratings, algorithm, signalling questions and guidance built into the RoB 2 tool made it easier to work through complexity and context. The study also investigated the impact of clinical study reports (CSRs) for bias assessment with both tools and found them to be very valuable irrespective of the tool used, though the time taken to complete assessments was longer (45 to 90 minutes).

Differences were reported in the nature of discrepancies requiring consensus for RoB 1 and RoB 2. With RoB 1, disagreements were most common in the  ‘performance bias’ and ‘detection bias’ domains for participant-reported outcome measures. These biases are teased out in a more granular way with RoB 2, and the authors noted that systems to capture outcome-based variation with RoB 1 can overlook issues (e.g. by grouping objective or subjective), or require post-hoc clinical judgement that might itself introduce bias. For RoB 2, ‘deviations from intended interventions’ (domain 2) and ‘selection of the reported result’ (domain 5) led to most discrepancies, particularly when trial protocols were not available.

The study’s conclusions highlight the benefits of RoB 2 in encouraging reviewers to think in terms of endpoints and results to improve the quality and relevance of risk of bias assessment in Cochrane reviews. The authors also make several recommendations to improve usability of RoB 2, such as adding elaborations or tweaking wording for some signalling questions, and creating processes within the Excel® tool to automatically populate study-based data that is not expected to vary across outcomes.

What does it mean for Cochrane?
The results of any comparison between the two tools may be expected to vary with knowledge of the topic area, methodological expertise, familiarity with the existing tool, and the type and number of outcomes within the review. Therefore, no one study can provide definitive results about their relative usability and impact. The authors of this study are both experienced methodologists and familar with the clinical area. They also applied both tools in line with MECIR to capture differences in bias across outcomes, which may have reduced the extent of difference between the tools, both in terms of time taken to conduct assessments and translation to impact on the analysis results. Interpretation of the study’s findings must be made in light of these factors, and though the efficiency difference may have been starker had RoB 1 been applied at study level, it follows that so too would reliability and usefulness of the assessments.

The study is an important addition to the real-world evidence base and allows Cochrane to understand how the tools vary and continue tailoring implementation resources to address common issues and errors

The authors also highlight that differences in the way the tools are structured and how reviewers choose to embed bias judgements in their analyses limit the usefulness of some comparisons, especially when it comes to demonstrating impact on analysis results. Nonetheless, it is an important addition to the real-world evidence base and allows Cochrane to understand how the tools vary and continue tailoring implementation resources to address common issues and errors. Studies like the one reported here also provide rich stories to streamline how the tool is implemented through technology to create efficiencies and make it easier for the benefits of bias assessment to be realised.

It is in light of these considerations that the expectations for RoB 2 have remained as they were set in November 2020 , which incorporate an element of flexibility in continuing to use RoB 1, providing it is applied in a way that allows for differences in bias across outcomes to be captured. The expectations accommodate the ongoing learning curve with RoB 2 and circumstances where, on the joint judgement of authors and CRG staff, adopting the new tool might not be feasible (e.g. for a large update). This does not preclude that purely study-based bias assessments should be a thing of the past and that training, planning, careful consideration and debate within the author team should underpin any meaningful bias assessment.

The Methods Team and Bias Methods Group welcome feedback about the usability of RoB 2 and any suggestions about how the Excel tool and the wording of signalling questions can be improved, and will continue to develop resources to support the author teams and editors.

Attributed to Kayleigh Kew, not on behalf of EMD

Related links:

  • Full report of the study  for more detail about how it was conducted and what it found
  • News item stating expectations about RoB 2 in light of the comparison study
  • Blog post summarising important resources and practical guidance for Cochrane authors and editors using RoB 2
July 23, 2021

The Cochrane Official Blog is curated and maintained by the Knowledge Translation Department. To submit items for publication to the blog or to add comments to a blog, please email mumoquit@cochrane.org.

The Cochrane Blog presents commentary and personal opinion on topics of interest from a range of contributors to the work of Cochrane. Opinions posted on the Cochrane Blog are those of the individual contributors and do not necessarily reflect the views or policies of Cochrane.

Six Step Stakeholder Engagement Framework

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Who are my stakeholders? What can they offer me? What can I offer them? And how do I begin engaging them? These were some of the questions tackled by NIHR Network Support Fellows Roses Parker (Cochrane Musculoskeletal, Oral, Skin and Sensory Network; MOSS) and Eve Tomlinson (Cochrane Cancer Network) as they embarked on stakeholder engagement projects for their networks, leading to their collaboration on the production of a Six-Step Stakeholder Engagement Framework.  

Why does stakeholder engagement matter?
Engaging the end-users of Cochrane reviews is vital to improve research relevancy and quality, and increase the likelihood that Cochrane evidence will be used in clinical decision making. Stakeholder engagement can be beneficial in all research activities conducted by Cochrane Review Groups (CRGs), including one off events (such as the co-production of a systematic review), broader projects (such as the prioritisation of systematic review topics), and stakeholder engagement over a sustained period covering several different areas (such as to support the direction or focus of a CRG and to disseminate research).

What we did
We both recognised that there is a lot of experience with stakeholder engagement in Cochrane, but sometimes the information is not shared between groups. We wanted to explore this within our Cochrane Networks and see what we could do to help improve stakeholder engagement.

Roses writes:

In the MOSS Network, I conducted interviews with each review group aiming to:

  • Understand the current stakeholder engagement work within MOSS,
  • Share examples of stakeholder engagement work within MOSS, and
  • Gather information to inform the next steps in stakeholder engagement work within MOSS.

I then conducted interviews with consumer representatives from each review group aiming to:

  • Understand the experience of consumers when working with MOSS, and
  • Gain their perspectives on the stakeholder engagement framework in a draft form

Eve writes:

  • In the Cancer Network, CRGs wanted to know more about other CRGs’ relationships with stakeholders and requested support with improving stakeholder engagement.
  • I surveyed each CRG about their experiences with stakeholder engagement and shared the findings in a Network meeting in November 2019.
  • Discussion in the Network meeting, along with stakeholder information given by CRGs, informed a Cancer Network stakeholder mapping project in which I identified relevant stakeholders, gathering information for each CRG and the Network overall. Since then, I have been working with Cancer CRGs to use the stakeholder maps and engage new stakeholders as required.

Together, we used our experiences to collaborate and produce:

  1. A report summarising stakeholder engagement in the MOSS Network: This report details the experiences of each MOSS CRG. These examples offer both inspiring reading of large-scale stakeholder engagement, as well as examples of innovative stakeholder engagement when resource is scarce.
  2. A range of consumer case studies: The case studies provide insight into how consumers are recruited, types of activities they engage in, and some tips on what to do/or not to provide them with a positive experience. We're looking forward to sharing the final documentation soon!
  3. A Six-Step Stakeholder Engagement Framework:
  • The framework is based on insights from both the MOSS Network and the Cancer Network, and a wide array of individuals from Cochrane.
  • It is formatted around the four key stakeholders identified in the Cochrane Knowledge Translation Framework and its key audience is Research Groups (such as CRGs) embarking on stakeholder engagement.
  • It suggests that users consider six key steps (see Figure below) in stakeholder engagement.
  • It aims to cover common and key steps in the engagement process, provide a helpful structure, and raise important considerations for stakeholder engagement, whilst encouraging modifications to be made based on the individual Research Group’s circumstance. We are keen to acknowledge that there is not a neat ‘one size fits all approach’ to stakeholder engagement but many ways researchers could engage stakeholders in their work!
Six Step Diagram

 

Next steps
We hope that by sharing experiences of stakeholder engagement and providing a methodical and pragmatic framework to support the process, this work will be helpful to Groups within and even beyond Cochrane in planning and implementing successful stakeholder engagement.

We are keen to use this work to open up a discussion about stakeholder engagement across Cochrane. We have had some great feedback already! A Managing Editor in the MOSS Network writes:

Laura Prescott

 

Acknowledgements
We would like to acknowledge the input of CRG members in the MOSS Network who gave their time to be interviewed about their experiences with stakeholder engagement. We would also like to thank the members of the Cancer Network who have worked with Eve on stakeholder mapping and engagement. Thanks also to the following people for their help in bringing this work together: Peter Tugwell, Karen Head, Alex Pollock, Neal Haddaway, Jo Anthony, Katie Abbotts, Richard Morley, Anne Littlewood, Ruth Foxlee, Sarah Elliott, Tom Concannon, Elie Akl, Janet Gunderson, Megan Prictor, Chrissi Kelly, Stella O’Brien, Amanda Roberts, the Formalising Strategic Partnerships Working Group, and members of the Multi Stakeholder Engagement (MuSE) Consortium.

Eve and Roses


                             

Resources: 

 

July 9, 2021

The Cochrane Official Blog is curated and maintained by the Knowledge Translation Department. To submit items for publication to the blog or to add comments to a blog, please email mumoquit@cochrane.org.

The Cochrane Blog presents commentary and personal opinion on topics of interest from a range of contributors to the work of Cochrane. Opinions posted on the Cochrane Blog are those of the individual contributors and do not necessarily reflect the views or policies of Cochrane.

5 easy hacks for time-crunched Cochrane Comms

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Communication tips that are easy to implement and take minimal time.

As part of the KT mentorship programRoses Parker who is a NIHR Network Support Fellow, wanted to find out more about what the capacity, challenges, and priorities were for the Cochrane MOSS review groups that she was working with when it came to doing communications via social media. With this in mind, she ran a quick survey with the groups to see how she could help them best. Building from this information, she is joined by Muriah Umoquit, Communications and Analytics Officer with Cochrane’s Knowledge Translation Department, to share some tips that are easy to implement and take minimal time. 

When it came to doing social media communication work, groups had between 3 hours to just 15 minutes a week to spend on social media activities. This lack of capacity was self-identified as the primary factor limiting groups. Given this, we gathered our 5 best hacks to save you time but get the maximum output for any minutes you are able to invest!

Sign up for the Cochrane Comms Digest

1. Use suggested tweets from the Cochrane Comms Digest

What: The Comms Digest is sent weekly by email with a round-up of organizational, evidence, and translation news. Most items in the digest come with a 'suggested tweet' in English. e.g. Suggested tweet: What is the best way to place medicines directly into the eye to widen the pupil during #CataractSurgery? https://buff.ly/3uswqFN New @CochraneEyes systematic review looks at the evidence from 14 studies with 1652 people. #Cataract @CCGlobalAgeing
Why: Scan the digest for items that would be of interest to your audience and copy-and-paste relevant suggested tweets. 
Time commitment: 10 minutes every week.
Ongoing benefit: Once you have mastered the weekly scan and disseminating of suggested tweets, you can also use the digest to 'boost the signal' on your own news. The digest accepts submissions for news items and tweets to share with others! 
Links: Learn more about the comms digest and sign-up! 

Use a scheduler

2. Use a social media posting scheduler 

What: An external tool that lets you manage your social media accounts from one place, allowing you to schedule posts at a later time. 
Why: Sit down once a week and schedule all your social media posts at one time; these posts will automatically go out when you want without you having to log-in.
Time commitment: 1 hour initial investment and then 10 minutes a day or less if you pair this with the Comms Digest! 
Ongoing benefit: Once you get the hang of scheduling, you can look at changing the messaging slightly so you can post about one review multiple times for different audiences, time zones, or branching out into other social media platforms.
Links: We recommend Buffer (It's free for 3 social media channels and 10 posts at a time) and Cochrane UK has an helpful how-to video. 

Know your Dissemination Essentials

3. Know your Dissemination Essentials

What: A checklist of 18 considerations when disseminating health evidence. There is a 1-page checklist that is great to print-out and keep handy; the full document is also available with some helpful examples.
Why: If you're low on time, then you are likely not going to be creating elaborate dissemination products but this checklist is fantastic to use as a reference when creating messaging for social media posts. By using the checklist, you will get information to the people who need it, when they need it, in a way they can understand and use it. 
Time commitment: One time commitment of 10 minutes to review the 1 page checklist and one hour to browse and review the supporting materials.
Ongoing benefit: Once you get familiar with the 18 items on the checklist and how to apply them, it can become more of a routine to communication messages. 
Links: Print the 1-page checklist and review the Dissemination Essentials supporting materials - a recorded webinar and the full document with examples. 

Reach your target audience

4. Keep track of how to reach your target audience

What: Create and maintain an Excel table that you can refer to that has common hashtags you can use to reach your audience and relevant organizations/association/advocacy groups/partners to tag. 
Why: You are likely to have more than one audience and it's likely not everyone from those audiences are following you on social media. Use hashtags and other trusted organizations to help get information you are trying to disseminate in front of the people who need to see it. 
Time commitment: 1 hour for initial set-up and a few minutes a week to update.
Ongoing benefit: Think of this as a long-term project you can build upon. It will become a personalized resource when planning out future dissemination.
Links: Start by looking at the Altmertic Scores of some of your recent top reviews (linked to on the review!) to see who is sharing your reviews and what hashtags they are using. You can also look up specific healthcare hashtags on Symplur.

Add a picture to your posts

5. Add a picture to your posts 

What: Add a relevant photo or graphic to your social media posts - Cochrane has a Dropbox of folder of helpful images which are free for you to use. 
Why: It's generally known that images get more attention on social media over not having an image - our small-scale study using Cochrane social media accounts showed this too! An 'Image Checklist' will help give you the confidence to select images and the Central Executive Team can help provide images to you for free. 
Time commitment: One time commitment of an hour to review the check-list and supporting materials and then an few minutes extra for each post.  
Ongoing benefit:
You can tailor the pictures you use to your target audience demographics so that the pictures used are relatable and appropriate to your setting and culture. This may concern ethnicity, skin colour, gender roles, hierarchy, moral ideas and common behaviour, gestures, religious practices and places, food, meaning associated with colours or symbols, and design preferences. 
Links: View the Image Checklist with helpful examples and learn about getting access to a free Dropbox folder of images.

 

We hope you put some of these 5 hacks into action! If you found this helpful, take a look at these other communication blogs:

June 7, 2021

The Cochrane Official Blog is curated and maintained by the Knowledge Translation Department. To submit items for publication to the blog or to add comments to a blog, please email mumoquit@cochrane.org.

The Cochrane Blog presents commentary and personal opinion on topics of interest from a range of contributors to the work of Cochrane. Opinions posted on the Cochrane Blog are those of the individual contributors and do not necessarily reflect the views or policies of Cochrane.

5 tips for a low-maintenance Cochrane group website

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Muriah Umoquit, Communications and Analytics Officer with Cochrane’s Knowledge Translation Department, and Paolo Rosati, Web Operations Manager with Cochrane’s Information and Technology Department, share their top tips for creating a low maintenance website

Most Cochrane groups are granted their own website - it’s a place to highlight your achievements, showcase your best work, and be a landing spot for anyone searching the web for information about your work. However, sometimes due to capacity issues, websites are left neglected and outdated. This can send the wrong message to visitors…sometimes even to funders!

This blog posts offers you our top five tips for creating your best digital footprint, while keeping the maintenance low.

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1. Content for the end user

Who do you want to use your website? People using the evidence (public, clinicians policy makers)? Your review authors? Your funders? A mix of audiences? Taking some time to answer these questions can help you make the decisions about the type of content you share. 

Keeping your audience in mind, take a look at what is already on your website. If it's not specific to your Group, you could just redirect them. For example, Cochrane Authors don't need to come to your site for latest in training that you would then need maintain - instead, redirect them to the Cochrane Training website

2. Cover the basics

We recommend that you have at the minimum three pages with static content.

  • About Us - this can be your landing/front page if you'd like. This should cover the scope of what your group covers and explain in plain language what your group does. If you need to display logo's of your Funders, this is a great spot them. 
  • Contact us - provide your email address! Other things to include could be any social media accounts that you maintain. 
  • Join Cochrane or Join Us - people looking to get involved with your group can now be funneled directly to the 'Join Cochrane' pages; less work for you handling inquiries and ensures people get assigned membership points for the work they do.

After you have covered the basics, then see if you have the capacity for regular news items. Only if you think you have time to maintain things, add in non-static pages, like news items that show up on https://[yourwebsite]/news. If you don't have time to post news items regularly, you don't need to. You are not required to use the format of having Feature Items and News on your front page (like here on the Community website); this feature is optional. Any information on your front landing page should be current and should speak to your target users - ensure that you are promoting the most important information for you group! 

3. Automate!

There are several things that you can have update on your page with no additional work for you once set-up. These include:

  • Twitter feed - If you have a Twitter account, consider it being added to your landing page or other relevant page. Whenever you tweet, it will automatically show up in this feed. 
  • News feed - If you have trouble adding news to your website, you can add a feed for any news posted on Cochrane.org or a particular Network to show up on website in a feed. 
  • Evidence feed - If you are a review group, consider having a page labeled 'Our Evidence' or 'Our Reviews' where reviews that are produced by your group will automatically show up - see an example here.

4. Get social

Maintaining social media accounts for your group is optional. If you do have a social media account, provide links to the accounts to make it easy to find them. The right-hand side of your landing page is a great place for this or you may wish to add them to the Contact Us page if you have several accounts. As mentioned above, you can also add a feed of your Twitter account on the right-hand side of your landing page. If you don't have any social media accounts you can list the Cochrane and Cochrane Library ones.

5. Maintain

Once your website is set-up with static and automated content, that doesn't mean you can just forget about it! On page 9 of the website admin manual we suggest quarterly and provide a list of things to check on. If things are pretty static, this won't take you long at all! 

 

Need help with your Cochrane website? Contact support@cochrane.org

 

Get help implementing these 5 tips!


Removing the news boxes from your front page, adding in feeds, adjusting your tabs, adding in a language toggle to support translations - these can be tricky things to do because they aren't things you do often! We do have a page on Cochrane Community for webmasters, as well as a detailed website admin manual. You are also welcome to contact support@cochrane.org and we can give you hand and direct you to the information needed! Setting your website up for your particular audience and for your capacity levels take a bit of work but having a polished virtual space on the internet for your group's information is worth the effort! 

 

Sources of further information:

 

May 13, 2021

The Cochrane Official Blog is curated and maintained by the Knowledge Translation Department. To submit items for publication to the blog or to add comments to a blog, please email mumoquit@cochrane.org.

The Cochrane Blog presents commentary and personal opinion on topics of interest from a range of contributors to the work of Cochrane. Opinions posted on the Cochrane Blog are those of the individual contributors and do not necessarily reflect the views or policies of Cochrane.

Exploring how people experience Evidently Cochrane blogs and how we can make them more useful

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Sarah Chapman and Selena Ryan-Vig, Knowledge Brokers at Cochrane UK, share interesting lessons from a qualitative evaluation project which looked at what could be learnt from blog comments and what could make the blogs more helpful.

Evidently Cochrane is Cochrane UK’s blog site, which aims to make Cochrane evidence really accessible, and to encourage discussion about it, through blogs which usually feature new or updated Cochrane Reviews on health topics.

What do readers get from Evidently Cochrane blogs and how could they be made more useful? To address these questions, we worked with independent qualitative researcher Fran Toye to carry out a qualitative study, using the comments from five blogs as our data (463 comments, almost 59,000 words). The bloggers also contributed to the analysis.

The blogs focus on menopause, frozen shoulder, stillbirth and subsequent pregnancy, care after major stroke, and tubal flushing to increase the chance of conceiving. Four included the blogger’s relevant personal experience and one included data from in-depth interviews with patients and family members. 

Despite the variety of topics, it is clear that people commenting on the different blogs have much in common. Our findings indicate three key uses of the blogs: to provide a space where people negotiate ambiguity and uncertainty; as a testament of their suffering; and to fill a need for solidarity through shared suffering. People in the comments share the agony and ambiguity of making and living with difficult decisions. They write about their experiences, using the blog as a space where they could safely voice their suffering, and it seems that this gave them some relief. They describe heartbreak, despair and desperation in the face of physical and emotional suffering. They also often expressed that ‘we are in the same boat, sharing our suffering’, describing the value of finding community. 

Experiencing Evidently Cochrane blogs: uncertainty, suffering and solidarity

As a result of what we’ve learned, we’ve made some changes, hoping to make the blogs more useful. We have revised our guide to blogging for Evidently Cochrane, asking bloggers to signpost readers to sources of information and support, and to make suggestions that could help readers think about their treatment options and discuss them with their healthcare providers. 

We have also reflected on our policy for moderating online comments. We remain committed to protecting bloggers and readers from offensive comments. At the same time, this work has shown the value of allowing readers to respond freely to each others’ shared experiences. At times, this may mean that readers will recommend treatments that are not supported by evidence. We have now revised the disclaimer in the blogs to clarify that we do not fact check comments or endorse treatments mentioned by readers.

 

April 28, 2021

The Cochrane Official Blog is curated and maintained by the Knowledge Translation Department. To submit items for publication to the blog or to add comments to a blog, please email mumoquit@cochrane.org.

The Cochrane Blog presents commentary and personal opinion on topics of interest from a range of contributors to the work of Cochrane. Opinions posted on the Cochrane Blog are those of the individual contributors and do not necessarily reflect the views or policies of Cochrane.

Publishing Review Summaries in Journals – what you need to know!

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In this Cochrane community blog Karen Head, Justin Mann and Cat Fowler (Wiley) talk about publishing summaries of Cochrane Reviews in journals to help Cochrane evidence reach health professionals.  Many Cochrane Groups work with medical journals to either re-publish the short versions of a Cochrane Review, or to publish an original commentary based on the results of a Cochrane Review. These articles (sometimes called ‘Cochrane Corners’ or ‘Practical Evidence About Real Life Situations’ [PEARLS]) may include

In this Cochrane community blog Karen Head (Project Manager, Knowledge Translation Department, Cochrane), Justin Mann (Assistant Editor, Editorial and Methods Department, Cochrane) and Cat Fowler (Associate Editor, Wiley) talk about publishing summaries of Cochrane Reviews in journals to help Cochrane evidence reach health professionals.

Many Cochrane Groups work with medical journals to either re-publish the short versions of a Cochrane Review, or to publish an original commentary based on the results of a Cochrane Review. These articles (sometimes called ‘Cochrane Corners’ or ‘Practical Evidence About Real Life Situations’ [PEARLS]) may include clinical scenarios or commentaries on how the evidence can be applied. Examples of different types of article can be found at the end of the ‘Reviews in Journals’ page of the Cochrane KT learning webpages.

At the end of March 2021, some of these groups met to share their experiences of writing, translating, publishing, and evaluating these types of journal articles.  The discussions at the meetings have been summarised and notes are now available.

 

Infographic of terms

 

When to contact Wiley?

This was the biggest area of discussion! The Cochrane Editorial and Publishing Policy Resource provides the most up to date information about when co-publication agreements are needed and provides a list of journals where such agreements have already been made. However, our advice is: if in doubt, please ask! Any requests can be made through Justin (jmann@cochrane.org) and Tony Aburrow (taburrow@wiley.com).         

Wiley support the desire to share Cochrane evidence widely and have developed processes and templates to support Cochrane Groups in discussions with journals.

Sharing what has been done across Cochrane

Those at the meeting expressed an interest in better sharing of original articles based on individual Cochrane Reviews. It was thought that this could reduce duplication across Cochrane for summaries written on the same Review and allow Review Groups better information about how their Reviews had been disseminated. We are starting to think about how this could be completed and if you would be interested in knowing more or helping think of solutions, please contact Karen (khead@cochrane.org).

Evaluating Cochrane Corners

The attendees share some interesting experiences where journals identified that Cochrane Summaries had been widely accessed and enjoyed by their readers. However, there is still a desire by some to understand more about whether the summaries are having the impact the Groups hoped for and were effective use of their limited dissemination resources. The Knowledge Translation team is pulling together a small group of people from Cochrane Groups who want support to evaluate their activities. If you are interested in joining this small evaluation group for your review summaries then please contact Karen (khead@cochrane.org).

 

Take home messages

    April 21, 2021

    The Cochrane Official Blog is curated and maintained by the Knowledge Translation Department. To submit items for publication to the blog or to add comments to a blog, please email mumoquit@cochrane.org.

    The Cochrane Blog presents commentary and personal opinion on topics of interest from a range of contributors to the work of Cochrane. Opinions posted on the Cochrane Blog are those of the individual contributors and do not necessarily reflect the views or policies of Cochrane.

    Using awareness days to promote Cochrane evidence

    Blog
    Elena Kostova, Managing Editor of Cochrane Gynaecology and Fertility

    Awareness days have existed as means to spread a message and to raise awareness on a subject matter way before the advent of social media. Nowadays, conversations are largely happening online and joining awareness days and campaigns on social media by means of hashtags is a widespread phenomenon. We spoke to Elena Kostova, Managing Editor of Cochrane Gynaecology and Fertility, about her experience using social media as a dissemination tool.

    "In my previous job as an editor, I worked closely with marketing communications managers while designing our journals’ content strategy and we often used trending hashtags to promote our published papers. I was interested to know how patients experienced using social media. I found studies reporting that patients could be empowered by using social media for health-related purposes and felt that they took a more active part in the treatment decision-making process.  That’s why when I started working on the social media strategy for our group Cochrane Gynaecology and Fertility, I thought that by sharing Cochrane evidence via Twitter using specific hashtags, we could potentially reach a wider and diverse audience.

    I was aware that many campaigns existed, and we would have to focus on those relevant to our group. In addition, I was interested in awareness days/months with an already established online international presence. I checked whether they had dedicated hashtags and if people were using these hashtags. It was important that the campaigns had a legitimate message to raise awareness, rather than selling a product for example.

    I found two awareness campaigns that seemed relevant for our group – #EndometriosisAwarenessMonth in March and #PCOSAwarenessMonth in September. Cochrane Gynaecology and Fertility has published more than 50 reviews on polycystic ovary syndrome (PCOS) and endometriosis. In our tweets we summarised results from these reviews. We aimed at including a picture every time we posted, as visual posts reach a bigger audience. We also created web pages on our Group’s website to track page visits directly. Twitter Analytics is an easy-to-use tool to assess how popular your tweets are. We used Twitter Analytics to measure the number of tweet impressions (how many times a tweet is seen) and engagement (retweets, likes, click links).  Furthermore, using Google Analytics we could not only measure the number of visits to our website, but also where visitors came from.  

    Elena

    Our experience shows that joining hashtag awareness campaigns on social media is an effective way to disseminate Cochrane evidence to a bigger audience. Using freely available tools like Twitter analytics and Google analytics is a good way to measure how many people you are reaching and how they interact with your posts.  We have also presented what we did in more detail in this Cochrane Colloquium poster, and this video shows in more detail how we evaluated this work."

    New – Guidance on the use of awareness days to promote Cochrane evidence
    While awareness days present a communications opportunity, they also can carry some risk.  This guidance has been prepared to help you think through the opportunity associating with an awareness day could bring to your group.

    Cochrane, for example, has used Mental Health Day and Stoptober as moments to place a spotlight on relevant Cochrane evidence.

    However, other awareness moments have been the focus of criticsm. For, example Breast Cancer Awareness Month (Pink October/Octobre Rose) has been criticised by an independent civil and scientific inquiry in France, which found promotional information linked to this awareness day was misleading and exaggerated.

    A one page guide, with helpful questions has been created, to support groups making decisions about using awareness days, weeks, months to support their work. This guide summarizes a full report about this topic. 

    February 5, 2021

    The Cochrane Official Blog is curated and maintained by the Knowledge Translation Department. To submit items for publication to the blog or to add comments to a blog, please email mumoquit@cochrane.org.

    The Cochrane Blog presents commentary and personal opinion on topics of interest from a range of contributors to the work of Cochrane. Opinions posted on the Cochrane Blog are those of the individual contributors and do not necessarily reflect the views or policies of Cochrane.

    Cochrane First Aid shares key achievements in 2020

    Blog
    Drawing of hands holding a magnifying glass to a sheet of paper with graphs on it

    Cochrane FirstAid is pleased to share their annual report with the wider Cochrane Community. In this Cochrane Community Blog, Vere Borra, Field Coordinator for Cochrane First Aid, shares some of the Field's achievements from 2020. 

    Tell us about a little about your key achievements last year? What are you most proud of? 

    In 2020, the COVID-19 pandemic has emphasized the importance of providing reliable scientific evidence to everyone, including laypeople, in a timely manner. We feel proud to have contributed to this, by spreading Cochrane evidence as much as possible in a format that is ready to use.

    One of the achievements we are most proud of is our blogshot that summarized the findings of the Cochrane COVID-19 rapid review on the effectiveness of handwashing with ash in reducing infection spread, which is highly relevant in areas where soap and water are not widely available. Together with our team of volunteers, we translated the English blogshot to 7 other languages to make sure that the evidence is available in people's preferred languages. This case was published as an impact story for the inaugural World EBHC Day 2020 and as a Cochrane vs COVID-19 case study, which was also spotlighted during a Join the Conversation webinar hosted by Cochrane's Editor in Chief Karla Soares-Weiser.

    Other key achievements in 2020 include:

    • Expanding our team of voluntary contributors, who help us create and translate blogshots, and help disseminate our work. We finished off 2020 with a team of 17 contributors from 11 countries. 
    • Creating 9 English blogshots, which were translated to up to 7 different languages.
    • Actively contributing to the inclusion of Cochrane systematic reviews in the 2020 International First Aid, Resuscitation and Education Guidelines.
    • Hosting a live webinar during a virtual first aid conference on how to consult, interpret and use first aid research evidence. 
    • Further compiling our register of first aid-related Cochrane systematic reviews, currently consisting of 170 Cochrane Reviews.
    • Performing systematic reviews for the International Liaison Committee on Resuscitation (ILCOR) used to inform the guidelines of the European Resuscitation Council, as well as 2 reviews to inform a World Health Organization guideline on drowning prevention. 
    • Involving our stakeholders in a priority setting exercise. With this information, we will be able to make a ranking of the topics and communicate this to the relevant Cochrane Groups.

    Our full 2020 annual report can be viewed on our website.  

     

    Cochrane First Aid logo and partner logos

    How did the pandemic affect your work and what changed for you?

    Due to the pandemic, the CFA team started working from home full-time. 

    Furthermore, during the COVID-19 pandemic:

    • We prioritized topics relevant during the pandemic 
      • for blogshot creation and translation, e.g. handwashing with ash, performing chest compression-only cardiopulmonary resuscitation, interventions to manage bad breath (halitosis)
      • for communication on social media
    • We actively shared relevant first aid messages from other sources/our stakeholders, such as the European Resuscitation Council's COVID-19 first aid guidelines.
    • We posted relevant COVID-19 news messages on our website.

    What did you learn? 

    We have learnt that it is important to:

    • Prioritize topics for knowledge translation, dissemination and development, based on what people need 
    • Collaborate with others and avoid duplication of work 

    What’s the big priority for 2021?

    In 2021, we will: 

    • Continue to create and translate blogshots
    • Increase the involvement of laypeople as a target audience of Cochrane First Aid
    • Disseminate priority topics for new Cochrane reviews to Networks and Groups
    • Further expand our register of relevant first aid-related systematic reviews

    To learn more...

    February 2, 2021

    The Cochrane Official Blog is curated and maintained by the Knowledge Translation Department. To submit items for publication to the blog or to add comments to a blog, please email mumoquit@cochrane.org.

    The Cochrane Blog presents commentary and personal opinion on topics of interest from a range of contributors to the work of Cochrane. Opinions posted on the Cochrane Blog are those of the individual contributors and do not necessarily reflect the views or policies of Cochrane.

    Mentoring Community Blog - Cochrane KT Mentoring gets up and running again!

    Blog
    Person with headset having a virtual meeting

    In this Cochrane Community blog Karen Head from Cochrane’s Knowledge Translation department discusses the start of the second cohort of the Cochrane KT mentoring scheme.  

    Whether it be prioritising review topics, involving end-users in producing Cochrane reviews, disseminating evidence or supporting decision makers to be able to find and use Cochrane evidence, –  two brains are often better than one!

    Mentoring for knowledge translation is a way of matching people who have knowledge translation projects or activities in Cochrane with people who have experience of delivering KT projects. An initial pilot study complete in 2020 identified that it was a helpful way of building knowledge translation knowledge and confidence.

    In November 2020, 17 new pairs of mentors and mentees from across the world started out on their Cochrane knowledge translation mentoring journey.

    A global cohort
    The 34 mentee and mentor participants come from 18 different countries across 6 continents. We are still working on Antarctica!  We are delighted that this time we have included three pairs who will be completing the mentoring in languages other than English.
     

    KT Mentoring Cohort 2

    The mentees
    Participating mentees across from Cochrane group types with Review Groups and Review Group Networks, Geographic groups and Cochrane authors all represented.

    The mentors
    We were delighted with the response to the applications for KT mentors. The mentors include people already working with Cochrane, but also seven who have knowledge translation experience outside Cochrane, providing an opportunity to learn from knowledge translation experts from other organisations.  We were also delighted to welcome back four of the mentors from the pilot scheme.

    What next?
    Mentoring will run for the next four to six months. In June we will complete a short evaluation of the scheme in order to plan our next steps.

    If you are interested in this or any of our other Knowledge Translation work, please get in touch! Khead@cochrane.org

    January 12, 2021

    The Cochrane Official Blog is curated and maintained by the Knowledge Translation Department. To submit items for publication to the blog or to add comments to a blog, please email mumoquit@cochrane.org.

    The Cochrane Blog presents commentary and personal opinion on topics of interest from a range of contributors to the work of Cochrane. Opinions posted on the Cochrane Blog are those of the individual contributors and do not necessarily reflect the views or policies of Cochrane.

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