Many of you have said you joined Cochrane Crowd not only to contribute but also to learn. That’s why we’ve been busy building Cochrane Crowd learning opportunities. We want to make it easy for you to learn while you contribute to Crowd tasks.

Here are six tips for boosting your knowledge with Cochrane Crowd.

By the way, if you don’t know about Cochrane Crowd, first watch this 2-minute video.

Tip 1: Trust us

We’ve carefully considered how to help you incrementally build skills in health evidence. When you first join up, you have access to beginner tasks that focus on identifying randomised controlled trials (RCTs). These tasks are relatively simple; you need to grasp just a few key concepts to be able to take part. As you gain experience, more challenging tasks become available to you. So, relax – we’ve got you!

Tip 2: Scale up your training

We want you to be confident when you’re screening in Cochrane Crowd. That’s why we provide interactive training modules: you get immediate feedback as you progress through the exercises. The basic training modules are mandatory, but you might not know that optional advanced training is available for many tasks through the Training Records button. So if you’d like to push yourself a little further, have a go.

Tip 3: Use the additional resources

Each Cochrane Crowd task has an FAQs and Quick Reference section. We highly recommend reading these resources before starting a new task and referring back to them as needed. You may even like to keep the Quick Reference table open the first few times you work on a task.

Tip 4: Monitor your accuracy

You can monitor your accuracy on each Crowd task through the History and Settings buttons, accessible on your dashboard. Celebrate your accurate classifications, and learn from your mistakes:

• Check records where your classification differed from the final classification, by filtering on the My History tab. Scroll the records, pausing to consider where you went wrong. The training records, FAQs and Quick Reference tables may help. And if you’re stumped, feel free to email us at crowd@cochrane.org.
• Take a look at the My Statistics tab, next door to My History. This tab gives a high-level view of your activity and accuracy. It’s great if you’re a fan of graphics!

Tip 5: Become a GOLD BADGE member

I don’t know about you, but I like to collect prizes! Keep moving forward on Cochrane Crowd and collect badges as you go. You’ll move from a green (for go) badge once you finish training through to bronze, silver and finally gold badges as you complete classifications. Exceptional members who are highly accurate will become tasks experts and receive purple badges. If you’re interested in the latter, keep a very keen eye on your accuracy!

Tip 6: Make it relevant to your interests

We engage when we’re motivated. We learn when we’re interested. If you’re passionate about a particular health topic, you can focus on that topic in Cochrane Crowd. For each task simply go to the History and Settings button/Settings tab, and enter the topic under Prioritise Records I Receive. Et voila! You’ll be reading up on your favourite topic while screening for Cochrane Crowd.

If you’re interested in other learning opportunities, take a look at Cochrane Crowd’s Learning Zone, a series of short modules focusing on how to interpret health claims and health research. We’re road-testing the modules at the moment, and we welcome all feedback! Just log in to Crowd and you’ll see the modules on the dashboard.

One final thing: If you’re a teacher of health evidence, you can introduce your students to Cochrane Crowd through our teachers’ toolkit Cochrane Classmate.

Sign up to Cochrane Crowd, follow us on Twitter and contact us at crowd@cochrane.org.

Support for Project Transform was provided by Cochrane and the National Health and Medical Research Council of Australia (APP1114605). The contents of the published material are solely the responsibility of the Administering Institution, a Participating Institution or individual authors and do not reflect the views of the NHMRC.

Cochrane UK runs occasional special series, sharing evidence and experience on a topic in multiple blogs and other material through social media channels. Sarah Chapman and Selena Ryan-Vig share tips on how to put together a successful series. This is an abridged version of the blog post on Evidently Cochrane.

In the traditional tale, Goldilocks had to try several beds and bowls of porridge, and even break a chair, before she found what was ‘just right’. This seems a fair analogy for the process of creating and sharing our special series. Beginning in 2015 with Men’s Health Week, we have run up to four series a year, and over the past year we have had series on The Problem With Sex, Dementia, Antibiotic Resistance and Life After Stroke. We have learned things each time that have fed into the next series, repeating approaches that seem to have worked and making adjustments where we feel things could have gone better. Whilst we can’t claim to have got it ‘just right’ yet, we hope that we have some tips to share.

Plentiful porridge

At Cochrane UK we are fortunate that two of us are able to work full time on creating and sharing content for social media based on Cochrane (and other) evidence and resources to help people understand and use evidence for decisions about health. We also benefit from hosting the Students 4 Best Evidence site, run by one of our colleagues; from the support of our Information Specialists; and the clinical input and blogging skills of our Cochrane Fellows and Trainees.

These resources all come into play when we put together a special series, but we think what we’ve learned could be helpful for others wanting to do something similar with fewer resources.

Once upon a time… Choosing a topic

Audience: choose topics relevant to your target audience(s). We choose common topics, of importance for the UK population and the provision of healthcare here.

Timeliness: ask, why focus on this topic now? It might tie in with a health awareness event, ongoing external campaign, the publication of a key report or with new Cochrane evidence. Tying in with a bigger campaign is a bit of a gamble. It can pay off, providing a ready-made audience with an interest in the chosen topic, and organizations keen to share relevant evidence, but we found that our #AntibioticResistance series got rather lost during a global campaign on this topic, and using a widely-used hashtag.

Core material: what’s in the Cochrane Library? We make sure there are plenty of up-to-date Cochrane Reviews to share, on different aspects of the overall topic. Whilst having robust evidence to highlight is desirable, our series #TheProblemWithSex took as its central point the lack of good evidence on an important and widespread set of health problems, and this worked very well.

Into the woods: content

Goldilocks principle

We have experimented to find just the right amount of content. We have settled on spreading a series over a month, sharing two (occasionally three) blogs a week, with blogshots in between, and ideally a tweetchat. There seems to be a midweek dip in blog views so we avoid publishing mid-week unless sharing three blogs.

We’ve started including a ‘round-up’ blog where we add links to all the blogs as and when they are published, alongside blogshots, vlogshots (video summaries), podcasts and other resources. A round-up is a handy resource in itself to re-share and pulling together content in this way has been well-received. For example, the Life After Stroke round-up was the most-viewed blog post of the series, receiving comments such as “fantastic and clear multimedia presentation of research evidence @CochraneUK in #LifeAfterStroke".

The path is long and rarely straight

We generally have the topic planned for our next three series and begin planning the next soon after we finish one.

We gather up relevant Cochrane Reviews and any other key material, choose which will feature in blogs and blogshots, and identify the key target audiences (such as patients or nurses) and potential guest bloggers – experts by experience, researchers and clinicians.  We ask for draft blogs to be submitted at least two weeks before the series launch, as working with bloggers to get to the final version may take quite a lot of time.

We have successfully co-hosted tweetchats with the We Communities, for whom this is a core activity. Their schedules tend to be set a long way in advance, so this needs planning well ahead of time. Writing a blog summarizing the chat and reflecting on it is well worth doing.

Top tips: work out how much time you think you need and double it. Have contingency plans in case an anticipated piece of content doesn’t materialize.

Mirror, mirror….

Pictures chosen for blogs and blogshots need to reflect the content accurately (right clinical equipment or population, for example) and sensitively. Think about illustrating a concept in the blog (decision-making, for example) which can make for variety and interest and get around the problem of a finding an image of the right piece of medical kit or a tricky clinical topic. I’ve written here before about the difficulties of working with stock images. Photos need to meet the Cochrane brand guidelines. We sometimes get images free to use from unsplash.com or buy them through istock – these are then available for others in Cochrane to use.

Straw, sticks or bricks?

Those pigs were never going to build wolf-proof houses from the first two. Top tip: think carefully about your resources and plan accordingly.

Climbing Rapunzel’s hair: risks and opportunities 

Top tip: think ahead about what might go wrong, or be risky, and who or what could help make the series successful.

Some things might have the potential to be both, as with our choice of running the #AntibioticAwareness series during a global campaign. The risk of our series getting swamped had to be balanced against the potential for increased interest and visibility.

Bring back the treasures: impact

Many traditional tales involve three sons or daughters sent away to complete a task (or three). They will have all sorts of adventures on the way, but it’s vital that they bring back the required items to show they have succeeded in the task. So it is with our social media efforts, and we must try to show some results from our efforts.

Measuring the impact of our series can be challenging. We often receive positive feedback on social media, such as “Loving the #LifeAfterStroke series by @CochraneUK. Great to see perspectives of stroke survivors, researchers and health professionals on life after stroke”. We also track various analytics, such as view counts and click-throughs to content. These often sound impressive. For example, our Dementia Spotlight blogs were viewed over 10,000 times, as were our Life After Stroke blogs and our related tweets during that month had 5.8 million impressions. During #AntibioticResistance Week, Cochrane UK were 1 of the top 5 ‘influencers’ on Twitter.

Key questions when planning a special series:

• Which topic?
• Who will be interested?
• What can we share?
• What resources do we have?
• How long will it take? (Add extra time!)
• When’s a good time to run it and over what period?
• Who can contribute content (bring in people with different perspectives) or help promote it?
• What might go wrong?
• How will we measure impact?

Read the full version of this blog post on Evidently Cochrane that includes many great examples of the tips above.

Join in the conversation on Twitter with @CochraneUK @SarahChapman30

Sophie Staniszewska (University of Warwick Medical School), Simon Denegri (NIHR), Heather Bagley (The COMET Initiative & public contributor), Gary Hickey (NIHR INVOLVE), and Richard Morley (Cochrane) provide an update on #globalPPINetwork

Patient and public involvement is becoming embedded within health research internationally, dedicated to making research an activity done with or by patients, rather than one done about or for them. There are strong movements globally towards co-production in research, with the UK publishing recent guidance on how to bring the patients closer to key decisions in research (Hickey et al 2018). This week we held our second meeting of the International Patient and Public Involvement Network, #globalPPINetwork, building on our inaugural launch in November 2017, where the foundations for our global network were established. We want to join with organisations and individuals who want to promote and strengthen patient and public involvement in its many global forms. We believe by joining together we will be stronger, creating synergy, collaboration and influence by leveraging international change in the nature of research.

We have set ourselves an ambitious goal, to create a social movement globally, changing the paradigm, content and nature of research, so that embedded collaboration between patients, clinicians and researchers focuses on answering key questions in ways that create the most benefit for patients. As Heraclitus stated, “big results require big ambitions.”

We want to work together with a wide range of countries, with different cultural, democratic and political contexts. We recognise that patient and public involvement comes in many shapes and sizes, depending on these contexts. We want to work collectively and creatively to embrace its many forms, understand and celebrate them, and share and adopt them. Together we will strengthen our endeavour and deepen our understandings of each other’s practice.   

Our ambition for changes in the nature of research was matched by our ambition of holding an international meeting which combined a conventional conference setting with a virtual component, enabling colleagues and public contributors to present and join from all around the world and contribute to the dialogue with comments and questions. Those who joined us at the Royal Society and on-line were from Australia, Canada, Croatia, Denmark, Eire, France, Germany, Italy, Kenya, Lebanon, Netherlands, Nigeria, Norway, Spain, UK and USA.

Key speakers came from across the globe and included Simon Denegri (NIHR National Director for Patients, Carers and the Public) who provided an overview of the progress of the International Network. Professor Peter Littlejohn from Kings College London provided key insights into the international variation in forms of involvement in priority setting, based on the Brocher Foundation workshop he developed with colleagues (Slutsky et al 2016). Understanding the political and democratic context of a country was a key message in understanding how different forms of involvement might evolve. This provided an excellent context for Dr Gary Hickey from NIHR INVOLVE to present our Network’s current mission, vision and key themes for review. Everyone enthusiastically contributed thoughts to help shape and refine them further. We then welcomed Sarah Watson, Head of Finance and Core Services at Cochrane to help us think through the governance and legal entity of such a network, vital to our success as our intention is to develop a multi-funder strategy, helping us to grow internationally as a social movement.  

Our afternoon included a set of international presentations about PPI. Tamara Lotfi, Coordinator of the Global Evidence Synthesis Initiative (GESI) Secretariat at the American University of Beirut and Irena Zakarija-Grkovic, Co-director of Cochrane Croatia. Their presentations identified the need and the interest in working together to better understand how involvement might work in their country contexts. Anne Mackenzie completed the first afternoon session with a journey through the development of public involvement in Australia over the last decade, reflecting the long relationship with NIHR INVOLVE.

Now on the last leg of our amazing day, with the Royal Society technology working beautifully, enabling our international collaborators to contribute their thoughts, we looked forward to presentations by Philippa Yeeles from the National Institute for Health Research (NIHR) in England and Laura Forsyth from the Patient-centred Outcomes Research Institute(PCORI) in the USA, who both provided valuable insights into the practice of public involvement in their organisations,  the mechanisms for assessing the impact of involvement, and the opportunities for collaboration.  

At this point we said goodbye to our online participants and broke into small groups in the face to face meeting to consider the key areas we should focus on in the next period of time. We are sending a survey to our online participants to ensure their perspectives are included as we move forward. A clear need was to consider the legal entity of our Network so we can maximise our potential. Sharing resources and knowledge was key, as was joining forces to develop research that moves us forward in our understanding of what PPI works, for whom and why.  We thank everyone for their incredible engagement, including the technical team who so capably enabled us to engage with the world.  Please contact us if you want to be involved.  

Together we will be stronger. Join us.  #globalPPINetwork

• Read about the launch of #globalPPNetwork

References

• Hickey, G., Coldham, T., Denegri, S., Green, G., Staniszewska, S., Tembo, D., Torok, K., and Turner,K. (2018) Guidance on co-producing a research project. Southampton: INVOLVE.
• Slutsky J, Tumilty E, Max C, Lu L, Tantivess S, Curi R, Whitty J, Weale A, Pearson S, Tugenhardt A, Wang H, Staniszewska S, Weerasuriya K, Ahn J, Cubillos L (2016). Patterns of Public Participation: Opportunity Structures and Mobilization from a Cross-National Perspective. Journal of Health Organization and Management. Publication September 2016. Journal of Health Organization and Management. DOI: http://dx.doi.org/10.1108/JHOM-03-2016-0037
• Special edition  -  http://www.emeraldinsight.com/toc/jhom/30/5

To celebrate International Women’s Day (8 March),  Cochrane Indonesia’s Director Dr Detty Nurdiati reflects on her continued contributions to maternal and perinatal health and the work of Cochrane.

Despite rising prosperity, over 40 women die in childbirth every day in Indonesia. It’s an intractable national health statistic that represents loss and suffering on a scale that Dr Detty Nurdiati has long been determined to change. Her many endeavours in research, teaching and patient care over three decades give clear expression to what is a deep personal and professional commitment to maternal and child health. 

‘I know my dream is very big,’ Detty says. ‘But for me, work in this area is what you might call very addictive. The more you learn, the more you work and the more you love it.’ This is evident in Detty’s many clinical and academic roles, and her extensive contributions to many organisations. As well as caring for mothers at her private obstetrics practice, she does the rounds at Yogyakarta’s Dr Sardjito Hospital, heads the Department of Obstetrics and Gynaecology at Universitas Gadjah Mada, and provides training to clinicians, midwives and other health workers.

In recent years, Detty pioneered Indonesia’s first health and social care program for victims of domestic violence, based at Yogyakarta’s Dr Sardjito Hospital. ‘This is work we began with tear drops in our eyes,’ Detty explains. ‘It’s hard and tough, but I love this work and am happy our program has now become a model for others. We have a hidden shelter for the women and children; and clinicians, social workers, psychologists and NGOs work together to provide real help to these victims of violence. We have become a model for other hospitals who are now setting up similar programs.’

Detty’s role in establishing this program is characteristically bold. As a young doctor, Detty made the big decision to study for her PhD in Europe. ‘It was definitely a culture shock for me, but also a bit of a surprise for people in Sweden too!’ she laughs. ‘I was a mother of five children who wore a hijab who came all the way from Indonesia to study abroad for five years – that was seen as very unusual in the early 1990s. But everyone was so kind and helpful to me. During those years I was excited to read of Iain Chalmers’ work in effective care in pregnancy and childbirth, and had the chance to visit Oxford where I met many people involved with the beginnings of Cochrane. So it’s no coincidence that my love for evidence-based medicine (EBM) grew bigger and bigger.’ 

Detty returned to Indonesia and was instrumental in integrating EBM into the curriculum at Faculty of Medicine UGM as part of an ambitious agenda to help both individuals and institutions contribute to better knowledge, health and practice. This has since spread to include midwives, physiotherapists, librarians and other health workers. ‘I see so many midwives who are eager to learn. They want to both use evidence and contribute to the evidence base. Often in Indonesia we don’t have access to the equipment or medicine we need, and this is the art of EBM here – gathering and adapting evidence so it is relevant and useful to our circumstances.’

Recognising the importance of generating local evidence, Detty and her team joined two major international collaborative projects that represent Cochrane’s beginnings in Indonesia - SEA-ORCHID and SEA-URCHIN. ‘These two projects, focusing on care during childbirth and preventing neonatal infection, gave us the chance to build our capacity not only as users of evidence, but as producers and providers of evidence. We built up a network of researchers and teachers of evidence-based health care across Indonesia, Philippines, Malaysia and Thailand.’  

More recently, Detty was part of the expert working group providing evidence synthesis advice to inform the Evidence Summit on Reducing Maternal and Neonatal Mortality in Indonesia, convened by the Ministry of Health and the Indonesian Academy of Sciences. ‘The Summit was really a challenge for us in terms of gathering and analysing our own national evidence according to systematic review methods. It’s clear that we need to teach people here how to produce and provide high quality evidence that we can use to inform policy and practice.’ 

‘The good news is Cochrane Indonesia will now have greater capacity for training and a more visible platform to advocate for increasing the capacity within Indonesia to conduct and use systematic reviews. We now have the opportunity to provide technical expertise and advice to the Ministry of Health and focus on knowledge translation in our region. The translation of Cochrane findings into Bahasa will be a key part of this. Given we have a population of 260 million people, the majority of whom don’t speak English, this is very important.’  

‘Ultimately we are looking forward to making greater progress producing evidence for daily practice and policy in our country, the way we have seen many other Cochrane colleagues doing around the world since the organisation first began.’ 

When asked about the source of the endless energy and enthusiasm needed to realise these big aims and ambitions, Detty answers without hesitation. ‘I have so much motivation from within myself and my family,’ she says. ‘You might say I have hidden memories of being a young mother myself, breastfeeding babies and caring for small children. I have memories of attending the deliveries of all my grandchildren and in my work each day now I am seeing healthy mothers and healthy babies. All this makes me happy. It makes me more and more powerful in my work.’

Image: Dr Detty Nurdiati
Words: Shauna Hurley

Every year Cochrane recognizes the outstanding work of Kenneth Warren, a scientist, extremely influential in drawing attention to the 'great neglected diseases' that plague people in developing countries. He prioritized the need for valid summaries of key research studies and to the way electronic media could be used to disseminate results of health research.

Kenneth was an enthusiastic supporter of the pilot work in pregnancy and childbirth that led to the creation of The Cochrane Collaboration, and, with Fred Mosteller, he co-organized the meeting at the New York Academy of Sciences at which the vision for Cochrane was first made public.

The Kenneth Warren Prize is awarded every year by Cochrane to a scientist who publishes a Cochrane Review about a health issue in developing countries. The winning entry judged to be both of high methodological quality and relevant to health problems in low income countries.

2017’s winner is Ahizechukwu Eke, for 'Hepatitis B Immunoglobulin for the prevention of mother to child transmission of hepatitis B virus'.

How did it feel winning the prize?

When I learnt I won the prize, I knew it was God who did it for me. I was stunned! It took a while to sink in but then I enjoyed my moment of fame. It was a complete surprise to have been selected for the prestigious Kenneth Warren Prize. It was the first time I had submitted any work for consideration for this award, and being selected was really exciting. I personally experienced what a friend of mine told me 2 years ago - 'winning an award is about the least humbling thing in the world, and yet when people receive an award or some other illustrious honor, they often say they feel “humbled.” Really, what winners feel is immense pride—and immense fear of being seen as prideful—and so they cover for it by saying they feel the exact opposite, humility’…Haha. I truly felt humbled and honored that our work won this award. Special thanks to all my co-authors, especially Dr George Eleje. Above all, I give God all the glory.

How did you first find out about Cochrane, and indeed the Kenneth Warren Prize?

I first found out about Cochrane and the Kenneth Warren Prize in 2009 when I attended the International Federation of Gynecology and Obstetrics (FIGO) conference in Cape-Town, South Africa. During that trip, I visited the South African Cochrane Centre (SACC) where I read about Kenneth Warren. I was really inspired by his work. Since 2009, I have had a variety of roles in Cochrane in preparing several reviews and serving as an Associate Editor (Cochrane Clinical Answers), as an author and a peer reviewer. I am a member of six different Cochrane Review Groups (Pregnancy & Childbirth, HIV-AIDS, Gynaecology & Fertility, Gynaecological & Neuro-Oncology, Pain & Palliative, and Hepato-Biliary Groups). As at February of 2018, I have authored and published quite a number of Cochrane Reviews and protocols. In five of the reviews, I am the lead author. Five years ago (2013), I was appointed as an Associate Editor of the Cochrane Clinical Answers (CCA), working with Cochrane Editors Sera Tort and Karen Patterson to publish 17 CCAs to date. This extensive exposure to Cochrane Review standards gave me a basis for parallel work on projects and initiatives intended to bring Cochrane Reviews into practice. I have also helped Cochrane’s efforts to promote awareness of and engagement in the review process across the developed and developing world.

Can you tell us a little more about what made you decide to enter for the award and the process involved?

I decided to apply for the Kenneth Warren Prize for 4 important reasons: First, this review (Hepatitis B immunoglobulin during pregnancy for prevention of mother-to-child transmission of hepatitis B virus Cochrane Database Syst Rev. 2017; 2:CD008545) has very high methodological quality. The review has been judged to have made one the greatest contribution to the advancement of knowledge in the field of Infectious Disease and HBIG prophylaxis in pregnancy by experts in the field. Second, significant amount of work went into making this review a success. It took 7 years of rigorous review process from publication of the protocol (in 2010) to full review completion and publication (in 2017) despite constant work and revision of the review. Between 2010 and 2017, we worked on this review constantly. The review was checked in and out of RevMan 340 times over the 7 year period. In addition, we replied to 16 different peer reviewers who reviewed the protocol at different times between 2010-2017 before the review was approved for publication! Third, the review applied one of the most rigorous methodologies in Cochrane Reviews - Trial Sequential Analysis (TSA) on the outcomes to calculate and assess the eventual breach of the cumulative Z-curve of the relevant trial sequential monitoring boundaries for benefit, harm, or futility. A more detailed description of Trial Sequential Analysis can be found in the review. And most importantly, this review addressed a very significant health problem affecting pregnant women in developing countries – Hepatitis B.

The application process is simple - email your published review to admin@cochrane.org before the deadline (submission opens on 4 May 2018). Be sure you are the principal author of the review published on the Cochrane Database of Systematic Reviews in the Cochrane Library, in Issues 4-12 of the previous year and issues 1-3 of the current year.

What’s been the impact of winning the prize to you, and your work?

Since winning the Kenneth Warren Prize, I have found a leadership niche to further this organization’s drive towards inclusive scholarly interchange. I have actively increased the geographical diversity of Cochrane by collaborating, training and mentoring new authors from around the world. Along with my collaborator, Dr. George Eleje, I have set-up networks of authors in developing countries, creating new groups and committees to encourage rising scholars from African nations in particular. In my current role, I have been responsible for leading projects which demand teams to trust and respect my experience and my decision making. My leadership style involves management skills, but mostly relies upon the trust my teams have in me, to make informed, inspired decision-making, matched with personal character and a positive attitude. A large part of my style involves the use of effective planning; organizational systems; and appropriate communications methods, in part due to having the necessary tools built from experience in leadership roles.

Finally, how important is this prize, its heritage, and prestige in promoting Cochrane and evidence based health care?

The heritage and prestige of this prize is important. Kenneth Warren was an exceptionally persuasive scientist who drew attention by prioritizing dissemination of valid management summaries of 'neglected diseases' that were endemic in developing countries. Even more interesting to me as an Obstetrician/Gynecologist was that Kenneth Warren was an avid advocate of the preliminary work in pregnancy and childbirth that prompted the formation and establishment of Cochrane. Through the Kenneth Warren Prize, Cochrane recognizes individuals who exemplify his highest values of volunteerism, community engagement, leadership and dedication to the care of underserved populations. Over the years, winners of this award have progressed to be leaders in their various fields. They have identified strategies that increase the impact of Cochrane Reviews to evidence based medicine, including increased involvement of authors in the processes of selecting, preparing and updating reviews, and in the organizational structure of Cochrane. Through these contributions, the number of high quality, up-to-date and relevant Cochrane Reviews and the number of authors who have regular collaboration with the Cochrane entities will continue to increase. Above all, the impact this would have on science as a whole would be huge!

Cochrane’s Kenneth Warren Prize nominations open on the 4 May 2018 - learn more and see if you are eligible.

Rebecca Normansell is Joint Co-ordinating Editor of Cochrane Airways, one of five Review Groups in the Cochrane Circulation and Breathing Networks. She shares with us some of her personal views on the work of her Group this year, and outlines the opportunities and challenges facing Cochrane Airways in 2018.

Can you tell us a little about the main highlights from 2017? What have been the most impactful reviews or activities of work for Cochrane Airways this year? What have you been most proud of?

2017 has been an eventful year for Cochrane Airways. We were very sad to say goodbye at the end of 2016 to our fantastic Systematic Reviewer, Kayleigh Kew, but were delighted to hear in 2017 that we had been awarded another three-year NIHR (UK National Institute for Health Research) programme grant, which is already underway.

The Global Evidence Summit in Cape Town was a highlight with four members of the Airways editorial base attending. It was great to catch up with the co-ordinator of our Australian satellite, Julia Walters, as well as other Airways editors and authors. We were also pleased to be able to arrange an informal lunch meeting for members of our new Circulation and Breathing Network while we were there. It was great to put faces to names and share some of our thoughts about the challenges and opportunities associated with becoming a Network.

For me personally, it’s been a privilege working as Deputy Co-Ed alongside Chris Cates for the last few years. In 2017, I gradually stepped up into the role of Joint Co-Ed and now take more responsibility for the day-to-day Co-Ed tasks. Chris is still on hand to help with any queries, especially tricky stats issues; his wisdom continues to be hugely appreciated by the whole Airways team around the world.

One review published in 2017 that we are particularly proud of is “Non-invasive ventilation for the management of acute hypercapnic respiratory failure due to exacerbation of chronic obstructive pulmonary disease”. This update was led by one of our excellent editors, Christian Osadnik, a physiotherapist based in Australia. We hope this review will help COPD patients and practitioners around the world and were delighted to learn that the review was used in a successful Wiley journal club.

What has been the most challenging piece of work or review for you?

Coordinating our programme grant application was a challenge, but I had fantastic support and learnt a great deal along the way. I also continue to be challenged almost daily by review-related queries and problems; rarely a day passes when I don’t acquire some additional knowledge!

A major challenge that we face, along with many other Review Groups, is what to do when reviews fail to meet our methodological expectations, or take a very long time to complete. However, the new Rejection Policy has been a great help and has given us practical tools to use when making difficult decisions.

The full Structure & Function Implementation plan was announced to the Cochrane Review Groups in August. Can you remember your first impressions of seeing the plan?

We’ve been aware of planned changes to the structure and function of Cochrane for some time now. It makes good sense to us that Cochrane needs to evolve to keep pace with the changing landscape of systematic reviewing and research funding. We want to be part of an organization producing high-quality, relevant, and timely reviews; we believe that improved co-ordination and communication across Cochrane is essential to meet this goal.

On receiving the report in August, we were glad that a plan was finally in place and that the Networks had been decided so we can start to move on with some certainty. We felt a bit anxious about who might be overseeing our Network and whether they could bring about the kinds of changes we are hoping for on one day a week.

What thoughts have you had since understanding more about the formation of the Networks? What do you see as the main opportunities? What do you see as the biggest challenges in 2018?

As a relatively new Co-Ed, the possibility of a being part of a Network with ready access to advice and support from a Senior Editor and Associate Editor is very appealing. Although as a group we feel well-supported by the CEU, we recognize that providing input across 50+ CRGs is a challenge for the central team. We look forward to working closely with our Senior and Associate Editors as the Network becomes fully established.

But of course we have some worries: what if we’re pushed into new ways of working that are not familiar to us? How will we manage to work meaningfully with Network colleagues in different disease areas and different time zones? However, we also recognize the necessity for change and the potential benefits and for us and for Cochrane as a whole; this has always trumped our concerns. One way in which we hope to deal with any challenges that arise is by being actively involved and engaged from the outset.

As a Cochrane Co-ordinating Editor, what do you see as your key priority in 2018 for Cochrane Airways, and as the Networks form together?

Our top priority as a CRG is to produce reliable and relevant systematic reviews that help people, and to continue to enjoy our work. Ensuring that the Networks facilitate this aim is essential. We want to see the Networks implemented with conviction and a positive attitude and will do what we can to support this.

Cochrane Airways has a history of staff advocating for change and sitting on committees. With the advent of the Networks, we hope that the CRG voice has more weight by virtue of several Groups working together, and that innovations made in our Group – for example using the workflows as a package to manage all work in the life of a review rather than ‘just’ the editorial process – can be rolled out, and that we will be able to use innovations made in other Groups too. Or it could be that within the Network we can attract more funding and employ someone to write systematic reviews across the Groups – we know from our own experience that this is the best way to get high-quality and timely reviews.

What would be your message to other Co-Eds, or indeed other CRG staff, perhaps who share the same concerns/excitement?

Personally, I am grateful to all the people whose enormous, often voluntary, efforts to date have made Cochrane the organization I am proud to work for. Even as a more recent arrival to Cochrane, I can entirely understand why the changes proposed may appear to threaten some of the ideals on which the Collaboration was founded. However, I don’t think we have a choice; we’re living in an age of huge technological, scientific, and economic change. We need to maintain all our ‘best bits’ as an organization (inclusivity, independence, rigour, and trustworthiness) while becoming more responsive, cohesive, and sustainable.

Three Cochrane Reviews focussing on the prevention of influenza in healthy adults, healthy children, and in the elderly are long-running reviews under the same senior author team. The protocol for the oldest review was first published 20 years ago.

Over the years the reviews have progressively accumulated evidence leading to ever greater stability in their conclusions. ‘Stable’ is a publication flag that usually indicates that the results are unlikely to change with the inclusion of new studies, such is the certainty of the results. The influenza vaccine reviews present us with a partly different situation. Readers will notice important outcomes where we have little or no data. They may also see that for some measures of influenza and ‘influenza-like illness’ (ILI), we have low-certainty evidence. We have reached a point where the evidence is not showing anything different to what it has done for a number of years. We know with varying degrees of certainty about vaccination effects on influenza and ILI, but the gap in our understanding of how vaccines affect the consequences of influenza persist. For each review, the impact of single studies is documented in the summary table 1 "Studies included in the various versions of this review and their impact on our conclusions". This month the three reviews appear in their latest updated and stabilised format.^1,2,3 Whilst we do not believe that periodic updating will complete the picture, our decision to stabilise is conditional. The three reviews will not be updated again unless certain criteria are met.

First, a new trial that meets inclusion criteria becomes available. Few trials of interest have been conducted recently, as a comparison with an inactive control is considered by some to be unethical. In the elderly, the latest completed trial dates from nearly two decades ago. Our searches have failed to find relevant ongoing trials.

A second condition is the introduction of a new generation of vaccines, based on new technology. This is possible given that several new technologies are being developed, such as vaccines containing fragments of the haemagglutinin antigen “stalk” on the viral surface (so called stalk-specific vaccines).⁴

The third condition is more complex: the development and testing of a new causal paradigm for ILI and influenza. Currently, massive worldwide machinery is needed to produce new vaccines every year to address viral antigenic changes, and to address the poor persistence of the antibody response in individuals. However, the vaccination selection and production programmes are based on aetiological assumptions which are neither explanatory nor predictive, as shown in our reviews. Overall the largest dataset to have accumulated to date is from trials conducted in the population least likely to benefit from vaccines but most likely to produce immunity: healthy adults. In healthy adult trials a high serological response is matched by a very small clinical effect (71 healthy adults need to be vaccinated to prevent one of them experiencing influenza). This weak effect cannot be explained simply by the mismatch of vaccine antigens with wild virus ones. A larger effect is observed in children over the age of two (five children need to be vaccinated to prevent one case of influenza, although there is huge uncertainty around these estimates). There is little evidence on prevention of complications, transmission, or time off work. Other reviews have drawn similar conclusions.⁵

During stabilisation we updated the randomised evidence, but for the first time have decided against updating the large observational evidence base. The observational dataset still appears in the reviews, but only as a historical record of earlier versions. Observational studies were included in the reviews over a decade ago in the hope they could provide long-term and rare harms data and improve the external validity of the trial evidence. They turned out to be of such low quality that their conclusions were inconclusive or unreliable. The most important example is the case-negative study to assess influenza vaccine effectiveness post hoc (i.e. after an influenza season) by harvesting data from a surveillance programme. This study design, which is similar to a case-control study, selects influenza cases (cases of ILI which have tested positive for influenza) and controls (cases of ILI which have tested negative) and calculates the relevant odds ratio (OR) of exposure to that season’s vaccine. An estimate of vaccine effectiveness is derived from this OR using a standard formula (vaccine effectiveness = 1 - OR%). However, despite their institutional popularity,^6,7 case-negative designs have limited public health significance because the design does not test field effectiveness, but, rather, laboratory efficacy of the vaccine (the capacity of the vaccine to generate a negative polymerase chain reaction (PCR) result). Both cases and controls are symptomatic, so any prevention is solely focused on PCR negativity. In addition, no useful public health absolute measures of effect can be derived (such as absolute risk reduction (ARR) and its reciprocal number needed to vaccinate to prevent one case (NNV)) because the background rates of infection and viral circulation are not part of the calculation of the estimates of effect. There are also problems with the mathematical assumptions made in this design (for details see the reviews). Case-negative studies are an illustration of the narrow and retrospective focus on influenza viruses at the expense of overall ILI - the illness cluster of interest to patients and their clinicians. Retrospective calculation of relative estimates of laboratory efficacy can be of interest for future decisions on composition of vaccines, but their relevance to everyday decisions seems questionable.

The underlying assumption that influenza vaccination does not affect the risk of non-influenza is contradicted by a recent report from the follow up of a trial by Cowling et al.⁸ In 115 participants, those who received trivalent influenza vaccines had higher risk of acute respiratory infection associated with confirmed non-influenza respiratory virus infection (RR, 4.40; 95% CI, 1.31–14.8) compared to placebo recipients. The agents were mainly rhinoviruses and coxsackie/echoviruses; ILI episodes occurred shortly after a peak of influenza activity.

Current yearly registration of candidate influenza vaccines is based on their ability to trigger a good antibody response. But antibody responses are poor predictors of field protection. This is another example of the use of surrogate outcomes in biomedicine, where effects on clinically important outcomes remain unmeasured or unproven from randomised trials: complications and death by influenza.

The simple answer is that we do not understand what the target is. What is the threat of influenza, and what can we ever expect of the vaccines?

The WHO Global Influenza Programme(GIP) with its backbone Global Influenza Surveillance and Response System(GISRS) is a complex network of 143 national reference centres and specialist laboratories in 113 states carrying out surveillance of circulating influenza viruses. GISRS was devised and developed to guide annual influenza vaccine production, and the emphasis is mainly on influenza viruses, their variants, and emerging strains.

However there is no reliable system to monitor and quantify the epidemiology and impact of ILI, the syndrome that presents clinically. Few states produce reliable data on the number of physician contacts or hospitalised cases due to ILI, and none tie these data to the proportion of ILI caused by influenza. We do not know for certain what the impact of ILI is, nor the impact of the proportion of ILI caused by influenza. Prospective studies apportioning positivity to the scores of viruses probably causing ILI are rare, as interest is focused on influenza. The standard quoted figure of 36,000 yearly deaths in the US is based on the “respiratory and circulatory deaths” category including all types of pneumonia, including secondary to meconium ingestion or bacterial causes. More recently, the US Centers for Disease Control and Prevention (CDC) have proposed estimates of impact ranging between 3,000 and 49,000 yearly deaths. When actual death certificates are tallied, influenza deaths on average are little more than 1,000 yearly. So, the actual threat is unknown (but likely to be small) and so is the estimation of the impact of vaccination.

The uncertainty over the aetiology of ILI, its capricious nature and the weak correlation between immunity and protection, point to possible causal or concurrent factors in the genesis of both ILI and influenza. In other words, virus positivity may only be one of the factors necessary for a case of influenza or ILI to manifest itself.

We await to see whether anyone has the interest or the courage to develop effective ways to control upper respiratory viral syndromes. Meanwhile our reviews will remain as a testimonial to the scientific failure of industry and governments to address the most important clinical outcomes for patients.

Tom Jefferson
Senior Associate Tutor
University of Oxford and Centre for Evidence Based Medicine
Oxford OX2 6GG
 

Alessandro Rivetti
Dipartimento di Prevenzione - S.Pre.S.A.L, ASL CN2 Alba Bra, Alba, Italy
 

Vittorio Demicheli
Cochrane ARI Group

Tom Jefferson is Senior Associate Tutor at the University of Oxford and Centre for Evidence Based Medicine. He and his co-authors are long-time Cochrane authors and contributors. In this post they have shared their personal interpretation of the findings and relevance of three recently updated Cochrane Reviews on the effectiveness of influenza vaccines on various populations. Please also note the standard disclaimer for all Cochrane Blog posts at the bottom of this page.
 

Acknowledgments

Chris Del Mar, Peter Doshi, Mark Jones
 

References

1. Demicheli V, Jefferson T, Ferroni E, Rivetti A, Di Pietrantonj C. Vaccines for preventing influenza in healthy adults. Cochrane Database of Systematic Reviews 2018, Issue 2. Art. No.: CD001269. DOI: 10.1002/14651858.CD001269.pub6.

2. Jefferson T, Rivetti A, Di Pietrantonj C, Demicheli V. Vaccines for preventing influenza in healthy children. Cochrane Database of Systematic Reviews 2018, Issue 2. Art. No.: CD004879. DOI: 10.1002/14651858.CD004879.pub5.

3. Demicheli V, Jefferson T, Di Pietrantonj C, Ferroni E, Thorning S, Thomas RE, Rivetti A. Vaccines for preventing influenza in the elderly. Cochrane Database of Systematic Reviews 2018, Issue 2. Art. No.: CD004876. DOI: 10.1002/14651858.CD004876.pub4.

4. Treanor J. Influenza vaccination. New England Journal of Medicine 2016;375(13):1261-8. [DOI: 10.1056/NEJMcp1512870]

5. Osterholm MT, Kelley NS, Sommer A, Belongia EA. Efficacy and effectiveness of influenza vaccines: a systematic review and meta-analysis. Lancet Infectious Diseases 2012;12(1):36-44.

6. Foppa IM, Haber M, Ferdinands JM, Shay DK. The case test-negative design for studies of the effectiveness of influenza vaccine. Vaccine 2013;31(30):3104-9.

7. Valenciano M, Ciancio BC, I-MOVE study team. I-MOVE: a European network to measure the effectiveness of influenza vaccine. Eurosurveillance 2012;17(39):pii=20281.

8. Cowling B, Fang V, Nishiura H, Chan K-H, Ng S, Ip DKM, et al. Increased risk of noninfluenza respiratory virus infections associated with receipt of inactivated influenza vaccine. Clinical Infectious Diseases 2012;54(12):1778–83.
 

Disclosure

TJ was a recipient of a UK National Institute for Health Research grant for a Cochrane Review of neuraminidase inhibitors for influenza. In addition, TJ receives royalties from his books published by Il Pensiero Scientifico Editore, Rome and Blackwells. TJ is occasionally interviewed by market research companies about phase I or II pharmaceutical products. In 2011-13, TJ acted as an expert witness in litigation related to the antiviral oseltamivir, in two litigation cases on potential vaccine-related damage and in a labour case on influenza vaccines in healthcare workers in Canada. He has acted as a consultant for Roche (1997-99), GSK (2001-2), Sanofi-Synthelabo (2003), and IMS Health (2013). In 2014 he was retained as a scientific adviser to a legal team acting on oseltamivir. TJ has a potential financial conflict of interest in the drug oseltamivir. In 2014-16, TJ was a member of three advisory boards for Boerhinger Ingelheim. He is holder of a Cochrane Methods Innovations Fund grant to develop guidance on the use of regulatory data in Cochrane Reviews. TJ was a member of an independent data monitoring committee for a Sanofi Pasteur clinical trial on an influenza vaccine. Between 1994 and 2013, TJ was the coordinator of the Cochrane Vaccines Field. TJ is a co-signatory of the Nordic Cochrane Centre Complaint to the European Medicines Agency (EMA) over maladministration at the EMA in relation to the investigation of alleged harms of HPV vaccines and consequent complaints to the European Ombudsman. TJ is co-holder of a John and Laura Arnold Foundation grant for development of a RIAT support centre (2017-2020) and Jean Monnet Network Grant, 2017-2020 for The Jean Monnet Health Law and Policy Network.

Demicheli and Rivetti: none.

While we’re almost at the end of January already, it is still well worth reflecting on Cochrane’s achievements in 2017 and what lies ahead for the organization. 2018 promises to be another exciting year of transformation and change as we increase still further our capacity to produce and disseminate high-quality evidence to impact health decision making around the world.

We can be enormously proud of our achievements in 2017. Use of Cochrane’s evidence from our organizational website, Cochrane.org, continued its phenomenal growth, with visits rising by another 49% to 15 million (from 10 million in 2016 and 5.7 million in 2015), peaking in Quarter 4 at 4.24 million indicating that further growth will be seen in 2018. Total demand for evidence from the Cochrane Library was up by 11.8%, with pdf downloads of Cochrane Reviews up by 23% from 2016. Review production again fell slightly (to 406 Reviews, 321 Updates and 426 Protocols) but analysis showed continued improvements in the quality and timeliness of priority titles and our new Rapid Review pilot was very successful. Of the ten 2017 strategic targets we set for ourselves over 12 months ago, nine were achieved – with only the launching of the new Enhanced Cochrane Library platform delayed until the end of March. We are seeing demonstrable success, therefore, in achieving our fundamental goals and in delivering our ambitious Strategy to 2020. I hope you can see and appreciate these changes; and there were many highlights in 2017 reflecting the transformation of Cochrane that is taking place.

Cochrane South Africa hosted the first ever Global Evidence Summit in September, which was a huge success attended by more than 1,300 people from 75 countries, marking the first time that Cochrane joined forces with multiple partner organizations to create a premiere event in evidence-based policy. Cochrane’s new membership scheme was launched, which will help us attract new supporters and members with a wider range of experience and skills into our work, allow us to recognize their contributions, and sustain and expand our global activities. New Centres and Affiliates were established extending Cochrane’s geographic reach and influence to new countries and regions. At the Global Evidence Summit, we held our first Annual General Meeting (AGM) under Cochrane’s new Articles of Association, with every member entitled to one vote, and led by our new-look Governing Board. At the AGM members of the community provided their own perspectives on what will define a successful Strategy to 2020. I encourage you to watch the wonderful video series from that event if you were not there in person, including the flagship presentation on success in 2017.

In the same month the first phase of Cochrane Interactive Learning was launched, providing over 10 hours of self-directed learning on the complete systematic review process for both new and experienced review authors. The Governing Board approved the implementation plan for Cochrane’s new Knowledge Translation framework, with the aim of making Cochrane’s evidence more relevant and accessible to, and used by, users. And of course, the Cochrane Review Group Transformation Programme, perhaps Strategy to 2020’s most important change initiative, began its implementation phase, with eight new CRG Networks being launched later this month. The establishment and development of the CRG Networks will remain an important focus for the organization in 2018 and will feature prominently at the strategic session of Cochrane’s Governance Meetings in Lisbon in April. For those Cochrane members planning to attend, please make sure you sign-up to these meetings by 4 March 2018.

A full 2017 Annual Report and Dashboard of progress against our Strategy to 2020 targets last year will be released within the coming weeks. Against this background of organizational success, I wanted to remind you that you have the opportunity to celebrate individual achievement by nominating a colleague for the Chris Silagy Prize, which recognizes those who make an extraordinary contribution to Cochrane.

Looking ahead to 2018, I am delighted to let you know that the Governing Board has approved five Strategy to 2020 Targets this year. Together the Central Executive Team and Cochrane community will:

1. Form eight new Cochrane Review Group Networks, and begin implementation of Network plans and improved ways of working together.
2. Complete the new standardized technology workflow for Cochrane Review production.
3. Agree Cochrane’s future priority review types, methods and data sources through the development of a ‘content strategy’, and begin associated implementation activities.
4. Deliver more features and enhancements of the Cochrane Library after its re-launch.
5. Build capacity and engagement in Knowledge Translation activities across the organization.

You can read more about how the Targets will be delivered and access the supporting Plan & Budget for 2018 on the Cochrane Community website. We are three years away from the end of Strategy to 2020 and looking forward at what else we still need to do to achieve all of the defined measures of success that we have set for ourselves. We are introducing on 5th February a new look Central Executive Team structure that we think will better help Cochrane’s members and supporters meet those objectives in the coming years, and the exciting changes establish two new Departments focusing on Knowledge Translation, and Membership, Learning & Support. More details on the changes will be available soon.

Let me end by thanking, once again, all Cochrane collaborators for their contributions to our work over the last twelve months, and in the coming year. We are hugely grateful for your enthusiasm and willingness to change and adapt to new ways of working to make Cochrane’s evidence meet the needs of millions more patients, carers, clinicians, policymakers, researchers and others in 2018 and beyond.

With my very best wishes,

Mark

Mark G. Wilson
Chief Executive Officer

For the past three years, Cochrane was a partner in the EU-funded project called Health in my Language (HimL), aiming to use advances in machine translation to make health content available in different languages. Here, Hayley Hassan, Translation Support Officer, presents the results of an evaluation task led by Cochrane as part of the project, which investigated whether post-editing a machine translation was faster than translating “from scratch”, and a follow-up interview with some of the translators involved.

What was the aim of Health in my Language?

HimL aimed to address the need for reliable health information in multiple languages by developing health-domain adapted machine translation systems.  This means, these machine translation systems were specifically trained to translate health information, which made them potentially superior to generic machine translation services like Google Translate.

HimL focused on building systems to translate from English into Czech, German, Polish and Romanian. The results of HimL aim to inform the potential use of machine translation for other languages and domains.

What role did Cochrane play in the project?

As part of HimL, Cochrane Plain Language Summaries and health information from NHS24 Scotland served as use cases to evaluate the quality and usefulness of the HimL machine translations. Accuracy is very important in the context of health information, as mistakes in translations could lead to patient harm. Cochrane therefore participated in a range of activities to carefully evaluate Plain Language Summaries that were translated using the HimL translation systems. We wanted to know whether they would be acceptable and useful to the public, or whether they could support the translation process.

Evaluating the quality of machine translations

In one of the evaluation tasks, we investigated whether it is quicker to post-edit a HimL machine translation or to translate “from scratch”, which usually constitutes our standard human translation process in Cochrane. 

We chose ten Plain Language Summaries at random and had them translated twice by two different translators – once translating from scratch and once post-editing the HimL machine translations.  We measured the time it took translators to complete either task.

What were the results?

Post-editing was clearly quicker than standard human translation for Czech, German, and Romanian. For Czech, post-editing reduced the required translation time by about 30% on average compared to standard human translation, for German by about 40%, and for Romanian by about 60%. For Polish, however, post-editing and standard human translation took about the same time.

Upon completion of the task, we invited the Polish and German translators to take part in a debrief: Joanna Zajac and Malgorzata Kolcz (Polish translators), and Andrea Puhl, (German translator), to learn about their experience in more detail.

Did you prefer to translate from scratch, or post-edit, and why?

Andrea Puhl: “I really preferred the post-editing. For German, the quality was already so high, translation was quite easy to do, and the focus could be on fine-tuning, instead of finding words. In some instances, the translation was so good we didn’t have to do anything.”

Joanna Zajac: “The Polish language is quite tricky. Automatic translations in Polish often do not account for the context, which some words strongly depend on. You have to be careful, read each word, since one wrong word could change the whole meaning. Long sentences in Polish do not work at all and cannot be translated using automatic translation. Good machine translations were probably only about 30%.”

Malgorzata Kolcz: “I found that for some simple sentences, it was easy, and the translation was almost perfect, but for more complex sentences, about 90% of the time, the translation was incorrect. It is because of the structure of the Polish language.”

We have been hearing a lot lately about the rise of machine translation. What do you think is the future of machine translations in your language?

MK: “I think in the future, machine translation will act as an aid to the translator.”

JZ: “Sentences have to be broken down. If we break them down into smaller pieces, maybe that could help improve the quality of machine translation.”

MK: “However, this would have to be done by the author, to avoid changing the meaning of the text. In the Cochrane context, we cannot change the original version of the text we want to translate.”

AP: “The role of the translator is not what it used to be but it is not obsolete. Fine-tuning is very important. As the Polish team notes, often one word can change things, if it’s not quite the right meaning, so you still need the translator. It could speed up translation, but you can’t fully replace a translator.”

Do you think the public trust the quality of machine translations?

AP: “As long as it is high quality, the public should not be suspicious.”

MK: “The future is automatic translation, there is so much information that needs to be translated nowadays. It will definitely be the future - it’s unavoidable. People will not see the difference between a human translation and a machine translation.”

JZ: “It will become even more and more useful. People are not suspicious, if they speak two languages they can test it themselves. From feedback we have had about our machine translations, people are not suspicious about them, especially if they are post-edited.”

Do you think machine translation could provide a sustainable approach for organisations such as Cochrane who rely primarily on volunteers to do translations?

MK: “There is so much Cochrane content to translate – it is a solution. But you would still need someone to check it. You cannot publish it without somebody checking the translated text. This is a very good option for Cochrane, it would probably be a quicker and easier way to translate all the information.”

AP: “I agree. It is definitely a very helpful option for somewhere like Cochrane, where there is a high volume of new information, and making this information available in other languages in a timely manner. Wrong information could have serious consequences so it is highly important to have editors to approve it before it is published.”

JZ: “This cooperation between human and machine is necessary. Sometimes it is worth splitting the text into shorter sentences to make it easier for the machine to translate.”

How could Cochrane change its Plain Language Summaries to result in better machine translation?

JZ: “As I have said, the shorter sentences make things so much easier. Sometimes they are three or four lines long, which is impossible for machine translation.”

MK: “Shorter sentences would be better all round, since it is meant to be in plain language, that can be written using normal words, understood by someone who is not a healthcare professional. At the same time, it would make it easier for a machine to translate.”

AP: “Cochrane could include patients or other stakeholders at a final edit stage to get their opinion.”

Any final comments?

AP: “I found it to be a pleasant experience and I was struck by the quality.  I didn’t expect it to be like that.”

With thanks to Joanna Zajac, Andrea Puhl and Malgorzata Kolcz for their participation and our HimL partners:

• The University of Edinburgh (project coordinator)
• Charles University, Prague
• Ludwig Maximilian University of Munich

For more information about the project please visit www.himl.eu. The full set of project results will be available on the website soon.

Cochrane Iberoamérica has been working on a blogshots translation project with a Spanish evidence-based nutrition network. The partnership came about after a chance encounter at a Cochrane virtual meeting for translators! Here, Eduard Baladia, a dietician and member of RED-NuBE, and Andrea Cervera, translation manager at Cochrane Iberoamérica, talk more about how their collaboration has developed and some exciting future plans.

“One’s youth is not measured by age, but by the curiosity one stores up.” (Salvador Pániker Alemany).

How did it happen? With Cochrane, anything is possible…

On March 11th, 2016 a dietician snuck into a Cochrane translator’s meeting. The reason behind this could be attributed to the curious nature of the dietician profession in Spain. It just happened. And once again Cochrane’s amazing ability to actively listen and make the most of collaborative projects made it possible. Instead of kicking the intruder out of the meeting, Andrea Cervera (Translator and Communications Manager at Cochrane Iberoamérica) said: “Email me with your proposal.” On March 14th, Eduard Baladia, dietician of the Academia Española de Nutrición y Dietética (Spanish Academy of Nutrition and Dietetics) demonstrated the interest of all dieticians in helping to translate and disseminate nutrition blogshots of Cochrane UK into Spanish.

For those who still do not know what a blogshot is, Sarah Chapman from Cochrane UK explains it wonderfully here. On March 18th we received an affirmative answer approved by Xavier Bonfill, director of Cochrane Iberoamérica. This is how our good relationship began.

How did we do it?

The collaboration was established through Red de Nutrición Basada en la Evidencia (RED-NuBE [Evidence-based Nutrition Network]), a co-operative network established by the Academia Española de Nutrición y Dietética with a focus on Iberoamérica which intends to unite all efforts in secondary research (evidence-based guidelines and meta-analysis development) in the field of human nutrition and dietetics. The network has quite a few followers on social media, especially its Twitter and Facebook accounts, so the calls for blogshot translation were very much welcomed, and people did work on it. Each translation would then be posted on the blogshot webpage of Cochrane Iberoamerica – nutrition section, shared on social media and posted on the blog of RED-NuBE —where each blogshot is linked to its author (very important for engagement). On October 24th, 2016, we decided to go one step further to be more proactive by developing nutrition blogshots for Cochane Iberoamérica ourselves. On November 21st, after considering some of the drafts developed by Red-NuBE, the initiative received the green light. However, the intricacies of the collaboration were not fully established until March, and it was on April 20th, 2017 that the project was truly launched with this blog post explaining how to collaborate.

The key was that the steps to develop a Cochrane blogshot had to be as simple and self-managed as possible:

1. Find a Nutrition Cochrane review. To make it simpler, we provided free access to our library Zotero – Cochrane corner. We have been searching all publications on the Cochrane Library since 2014 to collate the nutrition-related reviews.
2. Check that it had not been translated as a blogshot and published on the Cochrane Iberoamerica website.
3. Self-assign the blogshot development in Red-NuBE through this link.
4. Download the blogshot template and follow the instructions.
5. Send the blogshot to cochrane@rednube.net
6. The permanent team of RED-NuBE, proofreads and sends the blogshots to Andrea Cervera, who approves or modifies them… and then dissemination can start.

And what have we achieved with all this?

We have accomplished an increase of shared nutrition blogshots in Spanish. Currently, out of the 23 blogshots posted by Cochrane Iberoamérica – nutrition section, 10 have been created (they include the Red-NuBE logo) and members of Red-NuBE have translated 8. Members of Red-NuBE are responsible for 18 of the 23 nutrition blogshots (78%).

We have achieved a greater impact of blogshots. Since August 2017, tweets with blogshots developed and shared by Red-NuBE resulted in around 30% more impact than standard translated blogshots.

We achieve new ideas, projects and opportunities.

And now, our goals

Future goals of the collaboration between Cochrane and Red-NuBE

1. (2018) – Strengthen the development of nutrition blogshots by creating around 50-70 new blogshots from the Cochrane reviews published every year (average).  

2.  (2018-2019) – We want blogshots to be the beginning of a deeper evidence‑generating work. On October 23rd, 2017, we suggested to Cochrane Iberoamérica that Red-NuBE could apply the GRADE method to nutrition systematic reviews to obtain evidence-based recommendation of interest to dietician of the Academia Española de Nutrición y Dietética and the Practice‑based Evidence in Nutrition (PEN; international) —a project in which we are partners too.

We can only end with acknowledgements:

Thanks to the Cochrane Iberoamérica team for all the support and opportunities they have provided us! Thanks to Cochrane and Cochrane UK for making it possible by echoing and keeping rowing! Thanks to the Academia Española de Nutrición y Dietética for creating and funding the Red-NuBE project, to Rodrigo Martínez-Rodríguez for his unconditional friendship and support and to the excellent Red-NuBE team. And, above all, thanks to the members of Red-NuBE who selflessly dedicate their free time (see the blog) to work within the network; nothing would exist without them! 

Eduard Baladia and Andrea Cervera