Author interview: Diagnostic test accuracy of telehealth assessment for dementia and mild cognitive impairment
Recently Cochrane Dementia and Cognitive Improvement published 'Diagnostic test accuracy of telehealth assessment for dementia and mild cognitive impairment.' We spoke with Dr Jenny McCleery, one of the authors of this Cochrane review, a Consultant Psychiatrist at Oxford Health NHS Foundation Trust, and the Joint Coordinating Editor, of Cochrane Dementia and Cognitive Improvement Group. Find out about the findings, how it came about, and how the pandemic prompted this review.
Can you tell us about this Cochrane Review? We'd love to know how it came about and what drew to you the topic.
We chose to write this review when we did because of the COVID-19 pandemic. All the authors work in NHS clinical services. Some of my regular work is in a community memory clinic, where we assess older people with suspected dementia. Of course, not every patient gets a diagnosis, but most commonly we diagnose dementia or mild cognitive impairment (MCI), which is a less severe condition in which the patient has some problems with thinking and/or remembering, but can still manage all their daily activities independently. In our service, a patient usually has some investigations before the appointment (blood tests and often a brain scan), and then spends 1-2 hours in clinic being interviewed and examined before a doctor makes a diagnosis.
Once the pandemic hit, there was an immediate suspension of all non-urgent face-to-face contacts and memory clinics were left scrabbling to find alternative ways to keep their services going. One way to do this was to offer telehealth assessments, that is assessments conducted using telephone or videoconferencing systems where the patient and the doctor making the diagnosis did not meet in person. Although it was clear that this would not be an ideal solution for many older people with suspected dementia, some patients were willing to try this approach.
This brought up lots of questions. One of these was whether patients could be confident that we would be able to make accurate diagnoses of dementia or mild cognitive impairment using telehealth methods. We knew there was some literature about this, mainly from higher income countries where there is an interest in providing services to remote and rural areas. We thought it would be important to look at the work that had been done in those areas to see what was known about accuracy of telehealth diagnoses.
Although we were motivated chiefly by the pandemic, there are other very good reasons to be interested in the use of telemedicine in dementia services. Worldwide, a large majority of people with dementia have not had a formal diagnosis. This affects not only their own and their families’ knowledge about the cause of their symptoms, but also their access to support services and treatments. It also means that governments and health and social care providers lack essential information to plan services for their populations. The World Health Organization (WHO) has set a target that by 2025 at least 50% of the estimated number of people with dementia in 50% of countries should have had a diagnosis. This target will be challenging in many countries, and innovative ways to increase access to assessment will be needed, particularly for older people living outside urban centres. Telehealth might be one part of a solution.
What is included in the review?
We looked for studies in which participants had two assessments for dementia within four weeks of each other - one assessment using telehealth methods and one standard face-to-face assessment. The face-to-face assessment was the ‘reference standard’, that is, it was assumed to give the correct result, and we then looked to see how well the telehealth assessment (the index test) agreed with it. These kinds of studies are known as cross-sectional diagnostic test accuracy studies.
We knew that in remote and rural services, the telehealth models used are not necessarily very ‘pure’. Even if the specialist making the diagnosis does not meet the patient in person, it is quite common for local healthcare professionals, e.g. nurses, to meet the patient to gather some information or do some of the examination in advance. Although these models might not be very useful in a pandemic situation, we included them because of the wider importance of telemedicine for dementia care in future.
We only found three studies with 136 participants to include in the review. Two studies (20 and 100 participants) took place in community settings in Australia and one study (16 participants) was conducted in veterans' care homes in the USA. All the telehealth assessments were done using videoconferencing systems. Only the smaller Australian study (20 participants) used a pure telehealth model in which all aspects of the assessment were done remotely. In the other two studies, quite a lot of information was gathered in person by nurses and used in both diagnostic assessments; this could make it more likely for the researchers to find close agreement between the in-person and telehealth diagnoses.
How can people with dementia, their carers and clinicians use the review to help them with their decision making?
The conclusions we could draw were limited by the very small amount of evidence and the application of our results to the pandemic situation was limited by the type of telehealth model used in the included studies.
In as far as they went, the results were reassuring for the accuracy of telehealth assessment. We found that telehealth assessment correctly identified 80% to 100% of the people who were diagnosed with dementia at face-to-face assessment and also correctly identified 80% to 100% of people who did not have dementia. Only one study (100 participants) attempted to diagnose MCI. In this study, 71% of participants who had MCI were correctly identified using telehealth assessment, as were 97% of those who had any cognitive diagnosis (either MCI or dementia), but only 22% of those who had no cognitive diagnosis at face-to-face assessment. However, the latter result was especially uncertain because there were so few patients in this category.
It is important to note that diagnoses of dementia and MCI made by two specialists seeing patients face-to-face will not show 100% agreement. Therefore, perfect agreement between telehealth and face-to-face assessments cannot be expected. The larger Australian study was interesting because it also included a group who had two face-to-face assessments; the authors found that agreement between telehealth and face-to-face assessments was no worse than agreement between two face-to-face assessments.
Therefore, although there was less evidence than we would like to have found, we did not find any reason to think that dementia diagnoses made by clinicians using videoconference assessments were likely to be inaccurate.
What would you like to see happen next to build on this study?
There are many more questions to be answered. We have not touched so far on the diagnosis of different subtypes of dementia, which is something else clinicians in memory clinics are usually trying to achieve. Although we intended to study accuracy of subtype diagnosis, we did not find any data on this at all. That would be something very important to study if telehealth were to remain in widespread use.
A few established telehealth dementia services, again mainly in remote and rural areas, have published data on the acceptability of the telehealth model to their populations. The factors affecting acceptability are likely to vary a lot from place to place, so local research on acceptability, equity and barriers to use is really important to inform service developments.
There is also clearly a need to compare different telehealth models on accuracy, acceptability, cost effectiveness and sustainability measures.
Although we were only looking at the accuracy of diagnosis in this review, patients and carers are of course also interested in the quality of ongoing support after a dementia diagnosis. Whether telehealth support services are effective is another whole area for interesting research.
Featured review: Non‐pharmacological interventions for preventing delirium in hospitalised non‐ICU patients
Cochrane Convenes is an online event hosted by Cochrane and co-organized with the World Health Organization and the COVID-19 Evidence Network to support Decision making (COVID-END) in October 2021.
Drawing on experiences of the COVID-19 pandemic, the inaugural Cochrane Convenes will bring together leaders across the world to explore and then recommend the changes needed in evidence synthesis to prepare for and respond to future global health emergencies. It will also engage a larger global community of evidence producers and users in conversation via social media and other parallel activities.
In order to help us plan the programme, we want to learn from your experiences over the past 18 months. Please can we ask you to respond to this short questionnaire by 9 August. It will take about 10 minutes. You will remain anonymous.
We will share responses and more information on how you can get involved in this opportunity in due course.
The ABC’s recent documentary series Old people’s home for 4 year olds surprised many by becoming a runaway ratings success. It attracted more viewers than Masterchef and took out an international Emmy Award to boot. It’s the first time the lives of lonely older Australians struggling with isolation, health and mental health issues have been the subject of so much public interest and attention. For Cochrane author Dr Paul Gardiner, this represents a welcome development.
‘One of the great public health successes of the twentieth century was increasing people’s lifespan,’ Paul says, ‘Now we really need a greater focus on the health and quality of life of older people throughout those additional years. To date, in many ways, they’ve been a largely forgotten population.’
Paul has long been interested in the well-being of older people, and believes understanding and addressing the impact of sedentary behaviour is one of the keys to delivering better health outcomes. As part of his broader research program, he recently co-authored a new Cochrane review on interventions for reducing sedentary behaviour in community‐dwelling older adults.
‘This is the first review of interventions specifically targeting older people living in the community,’ he explains. ‘This is especially important because while we often hear concerns about children’s screen time or office workers sitting for too long at their desks, older adults are actually the most sedentary segment of society—they spend over 80 percent of their waking day sitting. At the same time, increasing evidence is telling us that sedentary behaviour is detrimental to their physical and mental health. Among other things, it’s linked with depression, chronic diseases, frailty, social isolation and premature death.’
It’s worth noting that sedentary behaviour is often confused with inactivity but is actually distinctly different. The former involves sitting or reclining while awake—think watching TV for long periods—while inactivity is regarded as too little exercise/not meeting physical activity guidelines. So for example, you might meet physical activity guidelines by doing an hour of moderate intensity activity each day, but you could still be sitting for very long periods as well.
Key findings reflect lack of research, data and diversity
‘Having weighed up the latest evidence for this review, our main finding was disappointing but not unexpected,’ Paul says. ‘In a nutshell, our conclusion was that we simply don’t have enough research in this area, and need more and better studies to build our evidence base.’
‘Overall I think this reflects that research in this area has often focused on younger populations, and that older people have largely been a neglected part of the population until recently, and that’s compounded by the fact the data we have on sitting time has only been gathered from as recently as 2000 onwards. So when we think about some of those big population cohort studies that have data from across 50 or 60 years, none of them ask about sitting time or sedentary behaviours across lifetimes and we don’t know if there are critical periods when it matters more how sedentary we are or if the impacts on health are accumulated. We’ll have to wait another few decades to get the kind of cumulative data we really need.’
‘For this latest review, we identified only seven relevant studies with 397 adults aged over 60—predominantly white, female and all from high-income countries. We really need to see future studies recruiting much larger and more varied global samples in terms of age, gender, ethnicity, and socioeconomic background. And within high-income countries, we need to recruit people from different cultural groups.’
Intervention-wise, the majority of studies looked at ways to help change sedentary behaviour through a combination of behaviour change techniques and strategies that included information, education, counselling and goal setting. Some used wearable technology and apps that record behaviour, others included prompts, text messages and phone calls. None of the studies looked at changes to the natural, built, home or social environment, or making changes at policy level.
‘Given the various limitations in terms of the size and quality of the studies, we can’t draw any definitive conclusions about whether these interventions are effective in changing sedentary behaviour at this stage,’ Paul says. ‘The evidence suggests they may reduce sedentary time slightly, but it’s unclear whether they have an impact on physical and mental health.’
So what’s next?
‘The need for higher-quality randomised controlled trials assessing the impact of interventions is clear,’ Paul says. ‘We recommend that future studies use more device-based measures, with devices that recognise posture and can distinguish between sitting, standing or lying down. There needs to be greater consistency and accuracy around what’s measured, recorded and assessed. We also need accurate assessments of individual behaviours like TV viewing time as there is some evidence that not all behaviours have the same impacts on health.’
‘Throughout Covid lockdowns we’ve seen older people embracing FaceTime, Zoom and other apps to communicate with family and friends, and research suggests that older people will embrace technology if they're trained and understand how to use it. If we can encourage this and address access and equity considerations, hopefully technology will provide new avenues for effective interventions, research and data collection.’
‘With these developments on the horizon and more relevant studies currently underway, hopefully we'll be in a much better position to make more conclusive recommendations when it’s time to update this latest Cochrane review. In the meantime, here’s hoping the next series of Old people’s home for 4 year olds will provide top tips and information on the importance of reducing sitting time—for all the young and old alike.'
Approaches sedentary behaviour interventions take to decreasing or breaking-up prolonged sitting time include:
- Providing information: interventions could be used to educate people on the benefits of decreasing their overall sedentary time and breaking up prolonged sedentary periods, by using consultations/interviews, reviewing their own behaviour (self-monitoring by diary), or using a monitor to detect sedentary behaviour that provides feedback to identify times when prolonged sitting could be reduced.
- Prompting: real-time behaviour prompts using wearable sensor and mobile technology that detects prolonged sedentary periods and prompts the individual to rise and move. Less frequent reminders by email and phone messages may act as a less regular prompt system.
- Environmental restructuring: interventions may alter indoor or outdoor spaces to attempt to decrease individuals’ sedentary time. More specifically, home or care setting layout changes might be considered in order to encourage individuals to sit less. Standing tables and perching stools rather than comfortable seats are some other potential examples of this.
- Challenge to cultural and social norms: it’s culturally and socially acceptable in many places to expect older adults to sit. It’s considered important to offer seats to older adults, such as on public transport. Friends and family often start doing household jobs and tasks for older people rather than them being encouraged to be active and continue doing these activities. There is also a tendency for a risk-averse culture around older adults, with a perception that sitting is safe and that standing might lead to a fall. Some interventions might challenge these cultural norms by educating older adults, family members or carers, or changing the perception of the place of older adults and active ageing in society.
Images: Old People's Home for 4 Year Olds courtesy of the ABC (home page feature photo), Paul Gardiner (pictured above)
The launch of Cochrane Cameroon was officially celebrated on 30 June from its base at the Hôpital Central de Yaoundé.
At the launch Cochrane Cameroon highlighted its commitment to promoting evidence-based healthcare policy and practice; translation of research to policy and practice; advocating for evidence to promote access and equity to healthcare; effective collaboration, and, strengthening capacity for conducting and using systematic reviews.
"Cochrane Cameroon will play an important role in developing a critical mass of those who understand the role of evidence in improving healthcare," said Co-Director Pierre Ongolo-Zogo.
Cochrane activities in Cameroon have been underway for a number of years with collaborations working to produce high-quality, Africa-relevant reviews (particularly in HIV/AIDS, Tuberculosis and Malaria) and to support their use in policy and practice through stakeholder engagement and capacity building.
“There have been Cochrane activities in Cameroon for a long time especially in author training and development,” said Lawrence Mbuagbaw Co-Director of Cochrane Cameroon. "Reviews by Cameroonian authors especially on HIV/AIDS have informed national and international guidelines, and impacted on the lives of people living with HIV. This launch is a huge step forward in our commitment to developing the evidence ecosystem in Cameroon."
Cochrane Cameroon has also been part of Cochrane Africa since its inception. This was initially an informal network established in 2007, created to build on the strong track record and to enhance and expand activities. Cochrane Africa was officially launched at the Global Evidence Summit in Cape Town in 2017 with a vision to increase the use of best evidence to inform healthcare decision making in sub-Saharan Africa.
Cochrane Africa consists of regional centres including a Southern and Eastern Africa Hub, West Africa Hub and Francophone Africa Hub, and co-ordinating centre at Cochrane South Africa. Cochrane Cameroon focuses on Francophone African countries.
The launch of Cochrane Cameroon follows on the launch of Cochrane Kenya on 8 June. The increased presence of Cochrane in sub-Saharan Africa means the increased conduct of relevant reviews based on priority setting, identification of research gaps, and regional needs with the overall aim of improving health outcomes in Africa.
"Cochrane Cameroon will build on an important Cochrane goal of ensuring far more representation in Africa," said Charles Shey Wiysonge, Cochrane South Africa Director.
Preparing for and responding to global health emergencies: what have we learnt from COVID-19?
In this interview, Dr Karla Soares-Weiser introduces Cochrane Convenes, a virtual event that Cochrane is organizing from 5-8 October 2021. Cochrane Convenes will bring together key thought leaders from around the world to discuss the COVID-19 evidence response and develop recommendations to help prepare for and respond to future global health emergencies.
Tell us about Cochrane Convenes.
Cochrane is co-organizing this event with the World Health Organization (WHO) and the COVID-19 Evidence Network to support Decision making (COVID-End). Our objective is to bring together leaders from a diversity of disciplines and perspectives from across the world to explore and recommend the changes needed in evidence synthesis to prepare for and respond to future global health emergencies.
One of the outputs will be an Action Plan with recommendations to be presented to policy makers at the next World Health Assembly. Cochrane will also use the Action Plan to inform our own strategy and response to global health priorities and to advocate for change within the wider evidence synthesis community.
“If not now, when?” The last 18 months have shown us the importance of collaboration, but we have also seen an increase in the amount of published research and how this may have contributed to misinformation and the politicization of health decision making as part of the infodemic. Evidence synthesis is more important than ever, but we need to understand the challenges to identify opportunities to respond better in the future. We know that the next pandemic is not a hundred years away. There are also longer-term crises to address, which have major impacts on people’s health, including climate change and inequity. The COVID-19 pandemic has highlighted the importance of challenging global inequality.
The response to COVID-19 has emphasized the need for evidence to support decisions in health and social care. Cochrane has a wealth of expertise in preparing and maintaining evidence syntheses and our global community was central in our ability to respond to this crisis. Our unique perspective places us well to host these discussions. As a global community of evidence producers, we know we need to support WHO and its member states with the best possible evidence and guidance, to ultimately ensure that local decision-makers and frontline healthcare professionals have the information they need. Our collective challenge is to find the best way to do this.
What themes will Cochrane Convenes address?
It will be an opportunity to reflect on how the evidence community responded to the pandemic, and how evidence was shared and used in decision making. Perhaps most importantly, we will also discuss what worked and did not work - relating to both primary and secondary research - and what we should keep or change to make sure the world is better prepared to respond to future health emergencies.
Who is Cochrane Convenes for?
The inaugural event will be organized into a series of invitation-only thematic roundtables, where recommendations will be discussed and developed, with some plenary sessions and personal experiences and stories from senior health professionals working on the frontline during the pandemic. We aim to include researchers; policy makers; and funders of research, primarily – because we hope the learnings and reflections bought about by this event will influence their decisions and ways of working in the future. We will also involve civil society and the public as the ultimate beneficiaries of good research and policy making – they will also help shape the agenda of this event and, in time, help hold the professionals to account.
What do you hope to achieve?
We want to create an environment for collaboration and the sharing of ideas on how we can be better prepared and aligned for future health emergencies. This support and advocacy will help build on strategic priorities but also identify ways that we can practically prepare – for example, identifying evidence gaps to inform future research as well as maintaining a database of evidence syntheses that can be available when needed . Awareness, advocacy and availability of high-quality and timely evidence will support a better response worldwide to inform improved health outcomes for all people. From Cochrane’s perspective, we will embed what we learn in our future organizational strategy.
Featured review: How well does botulinum toxin (type A; often called ‘Botox’) treat wrinkles on the face?
Communicating to the public about vaccines and using digital strategies to promote vaccine uptake: information for planners and implementers
Based on evidence from systematic reviews, Cochrane Effective Practice and Organisation of Care (EPOC) has prepared three information leaflets for health systems planners and implementers involved in developing vaccine communication strategies. The leaflets are underpinned by systematic reviews from Cochrane and other sources and include this qualitative evidence synthesis: Healthcare worker's perceptions and experiences of communicating with people over 50 years of age about vaccination, which published today in the Cochrane Library.
The reviews underlying these leaflets include studies carried out prior to the COVID-19 pandemic. However, they include important information that has relevance for implementers rolling out vaccines for COVID-19. With countries at different stages of the COVID-19 vaccine rollout, the leaflets provide timely guidance for decision making.
The first leaflet provides prompts and questions for planners implementing strategies to improve vaccination communication between healthcare workers and older adults. The leaflet is based on the findings of a review of qualitative research published today by Cochrane EPOC, and produced within the VITAL (Vaccines, Infectious Diseases in the Ageing Population) consortium. “The review suggests a number of issues that implementers should consider, including the potential tension between the public health goal of increasing vaccine uptake and the goal of supporting informing vaccination choices by individuals,” says Claire Glenton, review author and EPOC editor at the Norwegian Institute of Public Health.
EPOC staff have also prepared two additional leaflets for the OECD’s COVID-19 Global Evaluation Coalition. One of these leaflets presents prompts and questions for planners implementing communication strategies for all target groups, including parents, older adults and healthcare workers and is based on four systematic reviews of qualitative research. The leaflet encourages planners to consider a range of factors, including people’s concerns and misconceptions about the disease and the vaccine; and the extent to which the information they are providing is transparent, timely and understandable, and accessible to hard-to-reach groups.
The third leaflet presents what we know about the effectiveness of digital strategies to promote vaccine uptake and summarises evidence from four systematic reviews on this topic. This leaflet illustrates that despite these strategies being used widely, the evidence is fragmented and shows mixed results.
Governments worldwide are currently undertaking or planning the rollout of COVID-19 vaccines, and some are starting to review their progress and refine their communication efforts to promote vaccine uptake.
Communication to the public is an important part of these and other vaccination strategies. Simon Lewin, review author and Joint Coordinating Editor of EPOC at the Norwegian Institute of Public Health and the South African Medical Research Council noted that, “Cochrane has been systematically assessing evidence about vaccine communication for a number of years. This remains a topic area that does not receive the attention it deserves from implementers or researchers. We hope that these leaflets will help implementers to better plan vaccination communication strategies in their setting”.
One of the contributing reviews was undertaken within the Vaccines, Infectious Diseases in the Ageing Population (VITAL) consortium. For more information, see https://vital-imi.eu/
Two of the briefs were commissioned and funded by the Evaluation Department of the Norwegian Agency for Development Cooperation (Norad).
The 2020 Journal Citation Report (JCR) has just been released by Clarivate Analytics, and we are delighted to announce that Cochrane Database of Systematic Reviews (CDSR) Journal Impact Factor is now 9.266. This is an increase on the 2019Journal Impact Factor, which was 7.890.
The CDSR Journal Impact Factor is calculated by taking the total number of citations in a given year to all Cochrane Reviews published in the past 2 years and dividing that number by the total number of Reviews published in the past 2 years. It is a useful metric for measuring the strength of a journal by how often its publications are cited in scholarly articles.
Some highlights of the CDSR 2020 Journal Impact Factor include:
- The CDSR is ranked 11th of the 169 journals in the Medicine, General & Internal category
- The CDSR received 81,212 cites in the 2020 Journal Impact Factor period, compared with 67,763 in 2019
- The 5-Year Journal Impact Factor is 9.871 compared with 7.974 in 2019
Cochrane Library’s Editor in Chief, Karla Soares-Weiser, commented: “I am delighted to see a rise in Impact Factor for the Cochrane Database of Systematic Reviews. We are pleased to see a rise in total citations and the five year impact factor is consistently strong. All of these data demonstrate the usage and impact of Cochrane reviews, and reflect enormous credit on our many thousands of contributors and groups.”
The main Journal Impact Factor report and the Cochrane Review Group reports will be delivered in August 2021.
Wednesday, June 30, 2021
Science in the Break is a communication platform to make research more accessible to everyone and give more visibility to young researchers, which will potentially enhance their network and future collaborations. They focuses on health sciences and rehabilitation, touching on methods like musculoskeletal imaging, movement analysis, brain imaging, and brain stimulation techniques. Led by Tea Lulic-Kuryllo, Cristina Simon-Martinez, and Francesco Cenni, guests chat about their work, explain methods, and share academic and funding experiences.
In their most recent episode they provide overview about Cochrane Rehabilitation (Carlotte Kiekens), practical information on how to learn/contribute (Chiara Arienti), and a young researcher's perspective on their experience (Vanessa Young).
- 1:18 - What is Cochrane?
- 2:15 - What is Cochrane Rehabilitation? What other groups are there?
- 4:55 - How can clinicians use Cochrane evidence?
- 7:53 - What is a good level of knowledge to write a systematic review?
- 10:15 - How can early career professionals get involved in Cochrane Rehabilitation?
- 10:58 - Cochrane International Mobility Programme and Cochrane Rehabilitation opportunities
- 13:38 - Students 4 Best Evidence blog
- 17:17 - Citizen Scientist platform, Cochrane Crowd
- 17:33 - Cochrane TaskExchange
- 19:06 - Cochrane community is a very welcoming environment for entry-level researchers
- 22:43 - 3 top points
Learn more about Science in the Break:
- @SciInTheBreak on Twitter
- @scienceinthebreak on Instagram
- Science in the Break on Youtube
- Science in the Break on Spotify
Learn more about Cochrane Rehabilitation:
Wednesday, July 7, 2021
First author of this new Cochrane Review, 'Low‐dose oral misoprostol for induction of labour', Robert Kerr explains, “Our review found that Misoprostol given orally outperforms the ‘gold-standard’ drug which is much more expensive, and used in preference in many countries. This review has the potential to impact millions of women and babies who have inductions of labour through its comparison of oral misoprostol with other commonly used induction techniques."
Labour inductions are common around the world. Induction rates vary worldwide, but for example in the UK, 1 in 3 women will have labour induced. Induction of labour may be a life-saving intervention and identifying effective and safe methods will help achieve greater positive birth experiences for mothers and their babies.
In this recently published Cochrane review, authors explored the evidence from randomised controlled trials to see if low-dose misoprostol given by mouth is effective in starting labour in women in their third trimester with a live baby. They compared misoprostol with other commonly used methods of inducing labour.
What is the issue?
Artificially starting labour, or induction, is common in pregnancy. Reasons include the mother having high blood pressure in pregnancy or the baby being past the due date. Misoprostol is a type of prostaglandin that can be taken in low doses by mouth to induce labour. Prostaglandins are hormone-like compounds that are made by the body for various functions (including the natural onset of labour). Unlike other prostaglandins such as vaginal dinoprostone, misoprostol does not need to be stored in the refrigerator. Taking a tablet is convenient to mothers and the low-dose tablet sizes are now available (25 µg).
Why is this important?
A good induction method achieves a safe birth for mother and baby. It is effective, results in a relatively low number of caesarean sections, has few side effects, and is highly acceptable to mothers. Some methods of inducing labour may cause more caesarean sections by being ineffective at bringing on labour, other methods may lead to more caesareans as they cause too many contractions (hyperstimulation) that result in the baby becoming distressed (foetal heart rate changes).
What evidence did we find?
We searched for evidence on 14 February 2021 and identified 61 trials involving 20,026 women for inclusion in this review. Not all trials were high quality.
Starting with oral misoprostol immediately may have a similar effect on rates of caesarean section (4 trials, 594 women; low-certainty evidence) to giving no treatment for 12 to 24 hours then starting oxytocin, while the effects of misoprostol on uterine hyperstimulation with foetal heart rate changes are unclear (3 trials, 495 women; very low-quality evidence). All women in theses trials had ruptured membranes.
Oral misoprostol was compared to vaginal dinoprostone in 13 trials (9676 women). Misoprostol use probably decreased the risk of caesarean section (moderate-certainty evidence). When studies were divided by their initial dose of misoprostol, there was evidence that use of 10 µg to 25 µg may be effective in reducing the risk of a caesarean section (9 trials, 8652 women), while the higher 50 µg dose might not reduce the risk (4 trials, 1024 women). There may be very small or no differences between misoprostol and dinoprostone in rates of vaginal births within 24 hours (10 trials, 8983 women; low-certainty evidence) but may be fewer cases of hyperstimulation with foetal heart rate changes with oral misoprostol (11 trials, 9084 women; low-certainty evidence).
Oral misoprostol was compared with vaginal misoprostol in 33 trials (6110 women). Oral use may have resulted in fewer vaginal births within 24 hours (16 trials, 3451 women; low-certainty evidence). Oral use may have caused less hyperstimulation with foetal heart rate changes (25 trials, 4857 women; low-certainty evidence), especially with a dose of 10 µg to 25 µg. There was no clear difference in the number of caesarean sections overall (32 trials, 5914 women; low-certainty evidence) but oral use likely resulted in fewer caesareans being performed because of concerns of the baby being in distress (24 trials, 4775 women).
When oral misoprostol was compared to oxytocin for induction, misoprostol use probably resulted in fewer caesarean sections (6 trials, 737 women). We found no clear difference in vaginal birth within 24 hours (3 trials, 466 women; moderate-certainty evidence) or hyperstimulation with foetal heart rate changes (3 trials, 331 women; very low-certainty evidence).
Oral misoprostol was compared to a balloon catheter inserted in the cervix to mechanically induce labour. The number of vaginal births within 24 hours may have increased with misoprostol (4 trials, 1044 women; low-certainty evidence). Misoprostol probably reduced the risk of caesarean section (6 trials, 2993 women; moderate-certainty evidence) with no difference in risk of hyperstimulation with foetal heart rate changes (4 trials, 1044 women; low-certainty evidence).
Different doses and timings of giving oral misoprostol were explored in three small trials. The certainty of the findings from these trials was either low or very low so we cannot draw any meaningful conclusions from this data.
What does this mean?
Using low-dose (50 µg or less) oral misoprostol to induce labour likely leads to fewer caesarean sections and so more vaginal births than vaginal dinoprostone, oxytocin, and a transcervical Foley catheter. Rates of hyperstimulation with foetal heart rate changes were comparable with these methods. Misoprostol taken by mouth causes less hyperstimulation with foetal heart changes compared to when taken vaginally.
More trials are needed to establish the most effective misoprostol regimen for labour induction, but for now the findings of this review support oral rather than vaginal use, and suggest that commencing oral misoprostol at a dose of 25 µg or less may be safe and effective.
Low-dose oral misoprostol is probably associated with fewer caesarean sections (and therefore more vaginal births) than vaginal dinoprostone, and lower rates of hyperstimulation with foetal heart rate changes. However, time to birth may be increased, as seen by a reduced number of vaginal births within 24 hours.
Compared to transcervical Foley catheter, low-dose oral misoprostol is associated with fewer caesarean sections, but equivalent rates of hyperstimulation.
Low-dose misoprostol given orally rather than vaginally is probably associated with similar rates of vaginal birth, although rates may be lower within the first 24 hours. However, there is likely less hyperstimulation with foetal heart changes, and fewer caesarean sections performed due to foetal distress.
The best available evidence suggests that low-dose oral misoprostol probably has many benefits over other methods for labour induction. This review supports the use of low-dose oral misoprostol for induction of labour, and demonstrates the lower risks of hyperstimulation than when misoprostol is given vaginally. More trials are needed to establish the optimum oral misoprostol regimen, but these findings suggest that a starting dose of 25 µg may offer a good balance of efficacy and safety.
We are delighted to announce the creation of "Estudantes para Melhores Evidências", a Portuguese-language blog for all students that aims to be a source for sharing and disseminating evidence-based information, as well as a centerpiece platform to encourage networking among Portuguese-speaking healthcare workers interested in evidence-based healthcare. The initiative, inspired by the English and Spanish-language counterparts (S4BE and ExME), was conceived by Cochrane Brasil Rio de Janeiro (an Affiliate of the Cochrane Brazil Network) and is supported by Cochrane and Cochrane Brazil.
Beyond bringing together recent reviews, EME will provide tools for evidence-based training (like one of their series of posts on "Key Concepts"), interact with the community via social media, and encourage interaction among members.
"We truly believe that the success of evidence-based practice in the future goes through the engagement and training of generations of healthcare students to the philosophy of using the best evidence available to support clinical decision making, as well as understanding and helping to overcome evidence production and dissemination challenges we face currently," states Prof. Luis Eduardo Fontes, director of Cochrane Brasil Rio de Janeiro Affiliate.
"We are a community for students, by students. Our goal is to gather resources on evidence-based healthcare in an interactive space. We believe we will be able to inspire students from multiple backgrounds to learn and disseminate evidence-based healthcare, which is in much needed, especially today," says the Organizing Committee, initially composed by students from the Centro Universitário Arthur Sá Earp(UNIFASE) - host of Cochrane Brasil Rio de Janeiro- and Universidade Federal de São Paulo (UNIFESP), the two academic institutions leading this initiative.
From undergraduate to graduate students, EME is open for new contributors interested in learning more or producing new blog posts on evidence-based healthcare. If you would like to become an EME contributor, feel free to contact them at firstname.lastname@example.org.
" É com grande entusiasmo e alegria que hoje lançamos o ESTUDANTES PARA MELHORES EVIDÊNCIAS (EME), iniciativa organizada pelo Centro Afiliado Cochrane Brasil Rio de Janeiro, Cochrane Brasil e pela Cochrane. Trata-se de um blog em lingua portuguesa feito por estudantes para estudantes que têm interesse em Saúde Baseada em Evidências. Um ambiente virtual para compartilhar e disseminar informações , assim como uma plataforma central para encorajar o networking entre os profissionais de saúde que falam ou compreendem português interessados em Saúde Baseada em Evidências.
" Nós realmente acreditamos que o sucesso da prática clínica baseada em evidências no futuro passa pelo engajamento e treinamento de gerações de estudantes da área da saúde na filosofia de usar as melhores evidências disponíveis para apoiar a tomada de decisões clínicas, assim como entender e ajudar a superar os desafios de produção e disseminação de evidências que enfrentamos atualmente" afirma o Prof. Luis Eduardo Fontes, diretor do Centro Afiliado Cochrane Brasil Rio de Janeiro.
"Somos uma comunidade para estudantes, por estudantes. Nosso objetivo é reunir recursos em Saúde Baseada em Evidências em um espaço interativo e acreditamos que seremos capazes de inspirar estudantes de países de lingua portuguesa de todo mundo a aprender e disseminar a prática clínica baseada em evidências" acredita o Comitê Organizador, inicialmente composto por estudantes do Centro Universitário Arthur Sá Earp (UNIFASE) - instituição sede do Centro Afiliado Cochrane Brasil Rio de Janeiro - e da Universidade Federal de São Paulo (UNIFESP), as duas instituições acadêmicas que lideram esta iniciativa.
Da escola aos estudantes de pós-graduação, o EME está aberta a novos colaboradores interessados em aprender mais ou produzir novos posts no blog (se você gostaria de se tornar um colaborador da EME, entre em contato com email@example.com)
Cochrane Sweden recently held a webinar on registration and reporting of clinical trials in collaboration with their host institution, Lund University.
Clinical trial transparency is a key advocacy topic for Cochrane, and the webinar was a continuation of Cochrane Sweden’s efforts to promote this issue. At the end of 2020, they launched a joint report with TranspariMED which highlighted shortcomings in clinical trial reporting in Sweden – finding that over 70% of verifiably due clinical trial results are missing.
Emma Thompson, Cochrane’s Advocacy and Partnership Officer, moderated alongside Heiko Herwald, Vice-Dean at the Lund University Faculty of Medicine.
Mixing both regional and national perspectives, the webinar aimed to be relevant both within and outside of the context of Sweden. Presentations covered topics including current trial transparency regulations and best practices for improving reporting at universities. Examples were also shared from Karolinska Institutet and Clinical Studies Sweden, who have both taken steps to improve the reporting of their trials. Participants then had the opportunity to ask panellists their questions in an extended Q&A session.
26:48 Getting all clinical trial results reported - lessons learnt from successful universities (Slides and QUEST manual for clinical trial reporting)
Till Bruckner, author of a clinical trial reporting manual for universities. He is a Research Fellow at the BIH QUEST Center and the founder of the TranspariMED campaign
47:10 Centralizing the Clinical Trial Registration and Results Reporting Process in Academic Institutions (Slides)
Tony Durkee, Lead Coordinator for Clinical Trials at the Compliance and Data Office (CDO) at Karolinska Institutet
1:16:03 Panel Discussion and Q&A
- If you are interested in learning more about this work and how you can support it, please contact Emma Thompson.
Professor Hywel Williams has been awarded an Order of the British Empire (OBE). He has received the award for services to the national Covid-19 research response and his lifelong research into skin diseases.
Professor Williams was a founding member of the Cochrane Skin group in 1997 and was the Co-ordinating Editor for 21 years. He is a Professor of Dermato-Epidemiology and Co-Director of the Centre of Evidence-Based Dermatology in the School of Medicine at the University of Nottingham, where Cochrane Skin is based.
In his role as Director of the NIHR Health Technology Assessment Programme Director and more recently as NIHR Scientific and Coordinating Centre Programmes Contracts Advisor, Professor Williams worked tirelessly to galvanise a joined-up research response to the pandemic. He was, and still is, a key advisor to a number of funding and oversight groups set up to help manage the Covid-19 research response, and to ensure that effective treatments reach NHS patients in record time.
Within dermatology, Professor Williams contributed to national guidance on shielding for patients taking immunosuppressive medications at the request of the Chief Medical Officer. He co-ordinated efforts to ensure consistent advice to people with eczema on how to handwash during the pandemic; producing a training video which has been used worldwide.
Karla Soares-Weiser, Editor in Chief of the Cochrane Library said, “The impact of Hywel’s work in the field is massive. He is one of the most cited dermatologists in the world. His impact at Cochrane has been just as important. He established the Cochrane Skin group and worked tirelessly to champion patient and public involvement in research and the evidence-based approach for treatment for people with skin problems.”
Dr Bob Boyle and Professor Robert Dellavalle, Joint Co-Ordinating Editors, said, “Cochrane Skin extends their warmest congratulations to Hywel on this well-deserved recognition. Words cannot describe the importance of the contributions Dr. Williams has made to the field of dermatology.”
- Visit the Cochrane Skin website
- Learn more about the history of Cochrane Skin
- Listen to a podcast with Professor Williams discusses his involvement in Cochrane and his belief in the importance of patient involvement in research.
- Check out the COVID-19 Resources for Dermatology
Dr. Murrary Enkin, whos work contributed to the creation of Cochrane, passed away on 6 June 2021.
An obstetrics pioneer and prominent influencer in the early days of the formation of Cochrane, Dr. Murray Enkin was instrumental in developing evidence-based perinatal clinical trials and systematic reviews, challenging many common interventions not supported by research evidence. He, along with his latewife, Eleanor, also strongly advocated for family-centred maternity care such as the presence of fathers during childbirth and non-labour room deliveries.
Dr. Enkin, who passed away on 6 June 2021, graduated from medical school at the University of Toronto, Canada, in 1947 and received specialist training on obstetrics and gynecology at Long Island College Hospital in Brooklyn, United States, a few years later. The mainstay of his medical practice was in Hamilton, Canada, becoming departmental chief of Obstetrics and Gynaecology at St. Joseph’s Hospital and among inaugural faculty for the opening of the McMaster University Medical School. As Professor Emeritus, he retired in 1988.
Dr. Enkin was recognized with the Order of Canada in 2013 for his contributions to maternal care and development of midwifery as a recognized profession in Canada. From 1999-2017, McMaster hosted the annual Murray and Eleanor Enkin Lectureship, to focus on the key role that humanitarian values should take in clinical research and science in general.
Iain Chalmers, the first Director of Cochrane UK, said, “My friend and colleague Murray Enkin has died a few days after his 97th birthday. He had every reason to be pleased with the contributions he made during his long life, and I am indebted to him for many of these. My friendship and collaboration with Murray began in the late 1970s when we had met at a meeting entitled ‘Maternity Care in Ferment’ organised by the Maternity Center Association (MCA) in New York. Prompted by discussions at the MCA meeting, Murray and his wife Eleanor decided to spend a sabbatical year with me and my colleagues at the National Perinatal Epidemiology Unit in Oxford. The most tangible result of our work together there was a book we co-edited entitled ‘Effectiveness and Satisfaction in Antenatal Care’ (Enkin and Chalmers 1982). The less tangible result of our work was the mutual learning that resulted from our different backgrounds in care during pregnancy and childbirth: Murray provided the wisdom that had come from decades of challenging some aspects of obstetric orthodoxy; I had come to challenge orthodoxy by raising questions about the effects of components of maternity care, reviewing existing evidence from research, and doing additional research to address important uncertainties. Our recruitment of Marc Keirse (who brought expertise in reproductive physiology) as a third editor led to the creation of an international team of over 100 people who worked together throughout the 1980s to create the 2- volume book ‘Effective Care in Pregnancy and Childbirth” (Chalmers et al. 1989). Murray was also primarily responsible for creating a paperback summary of the larger book for women using the maternity services entitled ‘A Guide to Effective Care in Pregnancy and Childbirth’ (Enkin et al. 1989). To correct the systematic reviews in the books and keep them up to date, the reviews were also published electronically as the updatable ‘Oxford Database of Perinatal Trials’ (Chalmers ed. 1988).”
James Neilson, Editor with Cochrane Pregnancy and Childbirth shares, “The Pregnancy & Childbirth Group was the first review group to establish with the start of the Cochrane Collaboration in 1992. Murray was its Co-ordinating Editor. He and Eleanor spent large periods of time in Oxford, and Murray developed the template of what it was to be a Cochrane Co-ordinating Editor and what a Cochrane review group would look like. More than anyone, he was the practical bridge between ‘The Oxford Database of Perinatal Trials’ and The Cochrane Database of Systematic Reviews. He stepped down as Co-ordinating Editor in 1995 when the editorial base moved to Liverpool but continued to contribute as Editor and review author. Murray Enkin was not only a systematic reviewer of high methodological standing, but he was also a beautiful writer. He was very much the lead author of ‘Guide to Effective Care in Pregnancy and Childbirth’, which ran to three editions. It started life as a paperback guide to the mammoth ‘Effective Care in Pregnancy & Childbirth,’ but took on a life of its own, combining evidence from Cochrane systematic reviews with a beautifully composed linking narrative. It was wildly popular, the third edition selling > 35,000 copies. Popular with consumers, obstetricians and midwives, its success was testament to Murray Enkin’s rare ability to communicate clearly and succinctly”.
Karla Soares-Weiser, Editor in Chief of the Cochrane Library said, "Murray Enkin will be deeply missed. We are proud of the contribution he made to the work that inspired the Cochrane Collaboration. Together, the ‘Effective Care in Pregnancy and Childbirth’, its paperback summary of contents ‘A Guide to Effective Care in Pregnancy and Childbirth’, and ‘Oxford Database of Perinatal Trials’ provided the model that led to the development of the Cochrane Collaboration in the early 1990s.”
Research evaluation of the Cochrane COVID-19 Study Register finds high comprehensiveness for interventional studies and added value to review authors for containing additional references for eligible studies.
The Cochrane COVID-19 Study Register (CCSR) is a freely available collection of study references on COVID-19. The CCSR links different references for the same studies, making all references easier for systematic reviewers to find. The aim of the CCSR is to support rapid and living evidence synthesis, including the CEOsys evidence ecosystem for COVID-19 research. CEOsys is a consortium of 21 German university medical centers providing researchers and guideline developers with a comprehensive, up-to-date source of curated evidence from clinical and public health studies.
As part of CEOsys project, an evaluation study was conducted in November 2020 to measure the CCSR's performance and to identify areas for improvement. The study found high comprehensiveness (sensitivity) for trial registry records (100%) and journal articles (86.5%), interventional studies (94%) and clinical management topics (87%). The evaluation also found high accuracy of the CCSR's study descriptions (e.g., interventional or observational) (93-98%) and rapid publishing times for trial registry records (0.5 day) and journal article records (2 days). Areas for improvement were identified as coverage and publishing times for preprints.
An exciting evaluation finding was that the CCSR contained 112 additional (uncited) references for 286 eligible studies from a sample of COVID-19 systematic reviews from journals with a high impact factor. Of these extra 112 references contained in the CCSR, 70 (62.5%) could have been retrieved at the time the systematic reviews in the sample conducted their searches. This means that systematic reviewers searching the CCSR will find higher coverage of all available references and data for their eligible studies.
The CEOsys evaluation study showed that the CCSR is performing well as a COVID-19 evidence source and provided insights to improve its coverage and publishing times. Further, the evaluation showed the value of study registers to provide a complete evidence-base for the production of systematic reviews. The CEOsys consortium concluded that the CCSR is a time-saving resource for retrieving COVID-19 evidence to support evidence synthesis.
For more information, please see Maria-Inti Metzendorf's and Robin Featherstone's publication in Research Synthesis Methods:
In 2020, Cochrane’s editorial response to COVID-19 pandemic brought together collaborations across our global organization to publish reviews addressing stakeholder needs as they emerged. Large, highly organized review teams worked together to produce evidence addressing priorities in treatment, prevention, and diagnostics. In 2021, Cochrane continues to produce new and updated reviews in response to the pandemic.
In this interview with Deputy Editor in Chief Toby Lasserson and Executive Editor of Cochrane's Central Editorial Service Helen Wakeford, we ask them about Cochrane’s editorial approach to COVID-19 in 2021. The interview supports their paper, which sets out how Cochrane will respond to COVID-19 going forward and the priorities which inform this response.
What have you set out to explain in this paper?
Helen: "The scope of reviews that Cochrane could potentially publish on COVID-19 is enormous. In addition, most review questions have a rapidly evolving evidence base that demands frequent updating of the review in order for it to remain useful to readers. So we needed to prioritise key topics on which to focus our resources. This paper sets out those priorities, and the rationale for why we have identified them as such. In 2021 and beyond, we will consider future submissions against these priorities. We will also be able to identify evidence synthesis gaps within our priority areas and actively commission reviews.
We are aware that the COVID-19 pandemic is a rapidly evolving situation and we want to retain flexibility to respond to emerging priorities. In the report, we have explained that will stay tuned into organisations such as COVID-END who ‘horizon scan’ for emerging areas of need. We will also track the production of other high quality evidence syntheses to make sure that we are avoiding research waste."
What was 2020 like in terms of pace and coverage?
Helen: "2020 – at least, from March onwards - was extremely fast-paced! Authors from Cochrane Centres, CRGs and those who were new to Cochrane, worked around the clock to address urgent evidence synthesis questions. We considered producing preprints of these reviews, but instead developed an ultra-rapid editorial process of between 7-21 days in order to retain both speed and editorial rigour, and stay true to Cochrane’s reputation for ‘trusted evidence’. This meant close collaboration between the Central Editorial Service team and many colleagues across Cochrane, involving long days and late nights at work.
Cochrane’s coverage of COVID-19 reviews in 2020 was broad and responded to the needs of guideline developers. Our reviews examined the effectiveness of public health measures such as quarantine, PPE, ash for hand washing, universal screening, travel control measures and digital contact tracing in controlling COVID-19. We also published a qualitative review of barriers and facilitators of healthcare workers’ adherence to infection and prevention control, and scoping reviews looking at school measures to control COVID-19 and ICU care bundles for improving patient outcomes.
Reviews of diagnostic test accuracy were another major feature of our COVID-19 response, examining the diagnostic accuracy of antibody tests, signs and symptoms, thoracic imaging, routine laboratory tests and rapid, point of care tests.
As high-quality data from trials of COVID-19-specific therapeutics were slower to emerge, so were reviews of these interventions. We published reviews of convalescent plasma and hyperimmune immunoglobulin, and anticoagulants. The mental health of particularly impacted populations was also addressed by our reviews Interventions to support the resilience and mental health of frontline health and social care professionals during a disease outbreak, epidemic or pandemic and following de-escalation and Video calls for reducing social isolation and loneliness in older people.
Several of these reviews were updated multiple times during the course of the year (e.g. quarantine, convalescent plasma, thoracic imaging).
The above reviews were managed centrally, but others were published via Cochrane Review Groups, including a suite of reviews on mouth washes and sprays for preventing COVID infection, oxygen targets during ventilation and an update of a review of physical interventions to reduce the spread of respiratory viruses.
We were very much, and quite rightly in my view, in ‘response mode’ in 2020, attempting to address the urgent needs of our stakeholders. But now we can take stock, look at our emerging priorities and plan for the future."
What key priorities are set out in the paper?
Toby: "We identified important public health intervention and diagnostic accuracy reviews last year, so keeping those up to date is important. We are also looking to expand coverage in three areas relating to vaccination and immunity, generic medicines, and mental health consequences of the pandemic.
We would also do well to look back as well as forward. In the years after the influenza pandemic of 1918, there was an increase in neurological conditions thought to be related to the influenza virus. In a similar vein we can expect long term health consequences of COVID 19 to emerge years from now. Priorities will continue to shift but the need for evidence is fixed. To ensure that the evidence we can provide is relevant, we need to be flexible and move with what we know is happening.
Varied as these topic areas are, they each serve to highlight how misinformation and inequity have exacerbated and lengthened the course of the global pandemic. Addressing them will require no shortage of effort or evidence. To be relevant to the challenges ahead, our response to COVID 19 is not just about what we cover, but how we cover it. Where possible we want to see our reviews adopt an equity perspective to ensure that we can inform health and policy decisions."
How will these priority areas shape what Cochrane publishes?
Toby: "They will keep us on track to ensure our output is focused and relevant to what we know are the most important considerations for health systems globally. Since the start of 2020 I think we’ve got a better sense of what we need to stay on top of, but we’ve also seen how quickly gaps in coverage can emerge as new interventions and diagnostic tests are promoted and used. The need for effective treatments and tests has stressed efforts to evaluate these things properly, so balancing speed and rigour has become ever more important for us.
The collaborative work between all parts of Cochrane in response to COVID 19 needs to continue for us to continue to meet the information needs of our users. Working closely with CRGs as we have done in responding to COVID 19 so far shows how effective we are as a team in Cochrane. For the collaboration to truly pay off, we also need to reduce unnecessary duplication of effort, and so we recommended surveillance of what other review producers are doing."
If you look back in five-years-time, what will you most proud and pleased to have achieved in response to the pandemic?
Toby: "I think seeing the reviews coming through to publication having worked with Helen to put together an editorial team and process so quickly. Something profound was happening as so many people from across the community found a connection with us and with each other through this process. To know that all of this was happening against a backdrop of great turmoil and isolation from colleagues, friends and family was humbling."
Helen: "I feel proud of the number of reviews published and the speed at which this was achieved, despite such stressful circumstances. The Central Editorial Team have managed the editorial process for 29 COVID-19 reviews and updates to date, and this shows no sign of slowing down. Seeing the number of times these reviews have been shared and cited makes me feel that we may have made a real contribution to evidence-based decision making during the pandemic.
What makes me most pleased is that when we could have felt at our most isolated, we came together as a global team and supported one another. I feel much closer to my colleagues after the past year and consider them friends."
Over a 12-week period from March to August 2020, we drew together reflections about what external stakeholders thought about Cochrane’s initial response to COVID-19 - you can read the External Stakeholder Evaluation of Cochrane's COVID-19 response here. If you would like more information on the findings, please contact Jo Anthony firstname.lastname@example.org or Karen Head Khead@cochrane.org from Cochrane's Knowledge Translation Department.
Cochrane launches Cochrane Kenya to promote evidence-informed decision making in healthcare in the country
Cochrane is pleased to announce that on June 8, Cochrane Kenya launched at the 11th KASH (Kenya Medical Research Institute Annual Scientific and Health) Conference.
Cochrane Kenya is a geographical affiliate of the global Cochrane collaboration. It is also part of Cochrane Africa, a regional, independent Cochrane network of researchers, professionals, patients, carers, and people interested in health in Africa. Cochrane Kenya will promote evidence-informed decision making in health care in Kenya by supporting and training new authors of Cochrane Reviews, as well as working with clinicians, professional associations, policy makers, patients, and the media to encourage the dissemination and use of synthesized or summarized evidence.
Judith Brodie, Cochrane’s Interim Chief Executive Officer, said of the launch: “I am delighted we are announcing the launch of Cochrane Kenya, which I’m confident will deepen and expand the reach and impact of Cochrane activities, extending access to the best evidence for health and healthcare decision-making in East Africa, and therefore improving lives for citizens in Kenya and this region.”
The launch was well-received at the Conference, with Charles Wiysonge, Director of Cochrane South Africa, saying, "Cochrane Kenya will make an impact in Kenya, in Africa and globally. It could not have been born at a better time."
"COVID-19 highlights the hunger for rapid evidence to inform decision making. Cochrane Kenya will actively advocate for evidence-informed healthcare in Kenya & the East African region," said Eleanor Ochodo, from the Kenya Medical Research Institute and Centre for Evidence Based Health Care at the launch.
Cochrane Kenya is part of Cochrane, a global independent network of researchers, professionals, patients, carers and people interested in health. Cochrane produces reviews which study all of the best available evidence generated through research and make it easier to inform decisions about health. Cochrane is a not-for profit organization working to produce credible, accessible health information that is free from commercial sponsorship and other conflicts of interest. Cochrane’s work is recognized as representing an international gold standard for high quality, trusted information.
Can you tell us a bit about yourself and background?
My name is Jennifer Ma (I go by Jen). I am a researcher by training and did my PhD in the Stem Cell Bioengineering lab at the University of Toronto. I originally planned to stay in research and contribute to innovations in healthcare, but gradually discovered the crucial role of science communication to bring the existing body of knowledge to the public. Examples were all around me: friends were choosing alternative medicine over evidence-based treatments; unproven and dangerous “stem cell therapies” were masquerading as Regenerative Medicine and thriving; the anti-vax movement was gaining more followers by the day. I wanted to use my education, combined with my passion in visual arts, to fight misinformation and promote engagement with science. I also hope to reach an audience that might have been missed by traditional science media and connect with them at a human level. After finishing grad school, I am now focusing mostly on my science communication project Gentle Facts and loving every minute of it!
And how did Gentle Facts get started? Can you explain the focus?
I was finishing up my PhD thesis during the pandemic. It was a very stressful time so, to stay sane, I shielded myself from all other stressors from the outside world, including the constant bombardment of information about COVID-19 and the polarization of opinions online. However, being uninformed prevented me from doing my part as a citizen and a researcher/science advocate to fight the pandemic and other social issues, leaving me with feelings of guilt and powerlessness.
I saw that many others had similar sentiments: struggling to find a balance between staying in these important conversations and protecting our mental health. Gentle Facts is my attempt to be the solution, where we curate concise, actionable, evidence-based information and present them in an accessible way without drama. We hope that our mindful approach will lessen the mental toll and empower people to take informed actions more confidently.
What’s your goal for Gentle Facts?
Our main goal is to create social change through compassionate science communication. The current infodemic and increasingly hostile environment online means people are often talking over each other and nobody is actually listening. We believe an empathy-driven approach is necessary to facilitate constructive conversations and inspire positive actions. Gentle Facts creates a space where our audience’s emotions, especially those who feel drained and overwhelmed, are validated and cared for. We address their concerns through concise, evidence-based, and actionable information and empower them to create change together as a community.
You use art to communicate health evidence and science. What do you think about this intersection?
Appealing visuals really help catch people’s attention. But art can be so much more than just a “pretty face” for science content. Art is an amazing medium for expressing and evoking emotions. There is plenty of evidence that scientific facts and emotions both play an important part in our decision making process. Art and Science, therefore, work well together to connect, inform, and motivate towards common goals—what we aim to achieve at Gentle Facts. By relating evidence and emotions through art and compassion-driven communication, we hope to reach and connect with audiences who do support science but are usually disengaged.
What do you see as a challenge for evidence-based information on social media?
Social media is an interesting place where both good and bad are exponentially amplified. It can bring some people together while dividing others, provide high quality resources and spread misinformation on the same platform. Therefore, one critical piece of the puzzle is to boost the positive signals. Create evidence-based content that is engaging and sharable. Promote scientific and media literacy through education. Help people connect with each other by facilitating conversations and building communities. I believe with the right training, everyone can practice compassionate science communication, and we need all hands on deck to beat the infodemic.
Recently you illustrated the Cochrane review on walking for hypertension. Why did you pick this review and what did you want to get across?
I picked this review because it aligns very well with Gentle Facts’ principles: compassionate, factual, and actionable. It acknowledges and addresses the issue that exercising can be difficult for some people physically or mentally. The evidence collected is high in quality and includes participants with diverse backgrounds. It provides an easy-to-implement solution that most people can do. It is a great example of how evidence can empower people to take better care of themselves and contribute to public health.
If you would like to learn more about Jen and Gentle Facts:
If you would like to learn more about knowledge translation and disseminating evidence at Cochrane: